Allergic rhinitis and asthma: inflammation in a one-airway condition

BACKGROUND: Allergic rhinitis and asthma are conditions of airway inflammation that often coexist. DISCUSSION: In susceptible individuals, exposure of the nose and lungs to allergen elicits early phase and late phase responses. Contact with antigen by mast cells results in their degranulation, the release of selected mediators, and the subsequent recruitment of other inflammatory cell phenotypes. Additional proinflammatory mediators are released, including histamine, prostaglandins, cysteinyl leukotrienes, proteases, and a variety of cytokines, chemokines, and growth factors. Nasal biopsies in allergic rhinitis demonstrate accumulations of mast cells, eosinophils, and basophils in the epithelium and accumulations of eosinophils in the deeper subepithelium (that is, lamina propria). Examination of bronchial tissue, even in mild asthma, shows lymphocytic inflammation enriched by eosinophils. In severe asthma, the predominant pattern of inflammation changes, with increases in the numbers of neutrophils and, in many, an extension of the changes to involve smaller airways (that is, bronchioli). Structural alterations (that is, remodeling) of bronchi in mild asthma include epithelial fragility and thickening of its reticular basement membrane. With increasing severity of asthma there may be increases in airway smooth muscle mass, vascularity, interstitial collagen, and mucus-secreting glands. Remodeling in the nose is less extensive than that of the lower airways, but the epithelial reticular basement membrane may be slightly but significantly thickened. CONCLUSION: Inflammation is a key feature of both allergic rhinitis and asthma. There are therefore potential benefits for application of anti-inflammatory strategies that target both these anatomic sites

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Economic evaluation of platelet-rich-plasma versus hyaluronic acid for the treatment of knee osteoarthritis. Scenarios to 1 and 5 years

Purpose: The increasing incidence of total joint arthroplasty reflects the rises of osteoarthritis (OA) prevalence. OA is a degenerative pathology affecting joints with a significant impact on quality of life causing pain, leading to social life limitations and loss of work productivity. According to the World Health Organization, OA is one of the most important causes of people's disability. The burden of the disease is correlated with a huge economic impact on the health care systems. Intra-articular infiltration therapies are used between the pharmacological and the surgical phases, in order to delay surgery. This work aims to carry out an economic evaluation on the use of the Platelet-Rich-Plasma (PRP) therapy in the treatment of knee OA. The comparator is the hyaluronic acid, i.e. the standard therapy for drug-resistant OA that does not benefit or has short term benefits (<1 month) with intra-articular corticosteroids.Methods: A cost-effectiveness analysis has been performed using a decision-analytic model considering two scenarios: short period and medium period. The effectiveness outcomes are reported in term of quality-adjusted life-years (QALYs), while costs are expressed in euro ((sic)). The adopted perspective is the Italian National Health System (INHS). The results are shown through the incremental cost-effectiveness ratio (ICER) examining the PRP versus the comparator. Moreover, deterministic and probabilistic sensitivity analyses have been performed to test the robustness of the results.Results: The PRP therapy, for patients with moderate to severe knee OA in the Italian context, is cost-effective versus HA with ICERs of (sic)1,524/QALY in the 1 year and (sic)162/QALY in the 5 year scenarios.Conclusions: In the short term, it seems that the PRP therapy is cost-effective in the treatment of knee OA versus the HA therapy. However, more research is needed to assess its cost-effectiveness in the long term and to figure out if this treatment may be an efficient resource allocation for the INHS