A case of acanthosis nigricans in a HIV-infected patient

Background: To date, very little information is available concerning the relationship between acanthosis nigricans (AN) and infection with human immunodeficiency virus type 1 (HIV-1). Case presentation: Herein, we report the case of a middle-aged man admitted for fever and progressively worsening dyspnea in the context of an opportunistic pneumonia and firstly diagnosed with acquired immunodeficiency syndrome (AIDS). At the time of diagnosis, physical examination revealed the presence of a palpable, hyperpigmented skin lesion on the left areola with surface desquamation and velvety texture consistent with AN. Of note, the most common primary etiologies related to AN were excluded and the complete regression of the skin lesion was observed once antiretroviral therapy was started. Conclusion: This is the second report of AN found in patients with AIDS and apparently responsive to prolonged antiretroviral treatment. Possible explanations of this association are still not completely understood, probably related to virus-induced changes in lipid metabolism. Our experience suggests that HIV testing should always be considered in the setting of apparently idiopathic AN

Bosentan for digital ulcers prevention does not worsen cardiopulmonary exercise test parameters in SSc patients with interstitial lung disease

Bosentan for digital ulcers prevention does not worsen cardiopulmonary exercise test parameters in SSc patients with interstitial lung diseas

Relationship between pulmonary exacerbations and daily physical activity in adults with cystic fibrosis

The aim of this study was to examine the relationship between pulmonary exacerbations and physical activity (PA) in adults with cystic fibrosis (CF)

Pancreatic cystosis in cystic fibrosis. Sometimes a bike ride can help you decide

Pancreatic cystosis (PC) is an uncommon manifestation of pancreas involvement in cystic fibrosis (CF), characterized by the presence of multiple macrocysts partially or completely replacing pancreas. Only few reports are available from literature and management (surgery vs follow up) is commonly based on the presence of symptoms or complications due to local mass effect, although evidence-based recommendations are still not available. We here report the case of a young adult CF patient with PC, in which cardiopulmonary exercise testing (CPET) provided important information to be integrated to the radiological finding of inferior vena cava compression by the multicystic pancreas complex. Through the analysis of oxygen kinetic cardiodynamic phase pattern, CPET may be helpful to safely exclude significant mass effects on blood venous return and to improve the decision-making process on whether to consider surgery or not in patients with PC

The clinical value of cardiopulmonary exercise testing in the modern era

Cardiopulmonary exercise testing (CPET) has long been used as diagnostic tool for cardiac diseases. During recent years CPET has been proven to be additionally useful for 1) distinguishing between normal and abnormal responses to exercise; 2) determining peak oxygen uptake and level of disability; 3) identifying factors contributing to dyspnoea and exercise limitation; 4) differentiating between ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular, metabolic and peripheral muscle causes of exercise intolerance; 5) identifying anomalies of ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular and metabolic systems, as well as peripheral muscle and psychological disorders; 6) screening for coexistent ischaemic heart disease, peripheral vascular disease and arterial hypoxaemia; 7) assisting in planning individualised exercise training; 8) generating prognostic information; and 9) objectively evaluating the impact of therapeutic interventions. As such, CPET is an essential part of patients’ clinical assessment. This article belongs to the special series on the “Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders”, addressed to clinicians, physiologists and researchers, and aims at encouraging them to get acquainted with CPET in order to help and orient the clinical decision concerning individual patients

Metabolic and cardiovascular response to exercise in patients with type 1 diabetes

Physical activity is an effective therapeutic tool for cardiovascular risk prevention. However, exercise aerobic capacity of patients with type 1 diabetes (T1DM) has not been thoroughly investigated. Aim of the present study is to evaluate exercise aerobic capacity in patients with T1DM compared to a normal control population

Roflumilast is safe and effective in improving symptoms and lung function in severe COPD

The case of a 66-year-old man with severe chronic obstructive pulmonary disease (COPD) is presented. Diagnosis was based on baseline pulmonary function tests (PFTs) and clinical examination. Therapy with tiotropium 18 μg (once daily) and salmeterol/fluticasone 50/500 μg (twice daily) failed to achieve optimal disease control. Roflumilast (Daxas) 500 μg once daily was therefore added and a progressive improvement in the patient's condition was observed during the 1-year followup. In this patient with severe COPD, roflumilast represented a safe and effective therapeutic strategy for managing clinical symptoms and for significantly improving lung function parameters

Combinatorial nanoconstructs for biomedical imaging and drug delivery

Over the last 15 years, a plethora of materials and different formulations have been proposed for the realization of nanomedicines. Yet, drug loading efficiency, sequestration by phagocytic cells and tumor accumulation are sub-optimal. This implies that radically new design approaches are needed to push forward the clinical integration of nanomedicines, overcoming well-accepted clichés. Combinatorial nanoconstructs are particle-based nano-scale systems designed for the ‘smart’ delivery of therapeutic and imaging agents.[1-4] The Laboratory of Nanotechnology for Precision Medicine (nPMed) at IIT synthesizes combinatorial nanoconstructs, made out of polymers, with different sizes, ranging from a few tens of nanometers to a few microns; shapes, including spherical, cubical and discoidal; surface properties, with positive, negative, neutral coatings; and mechanical stiffness, varying from that of cells to rigid, inorganic materials, such as iron oxide. These are the 4S parameters – size, shape, surface, stiffness – which can be precisely tuned in the synthesis process enabling disease- and patient-specific designs of multifunctional nanoconstructs. The role of manipulating these 4S parameters over different temporal and length scales will be elucidated in the context of future nanomedicines using in silico, in vitro and in vivo assays. Please click Additional Files below to see the full abstract

Uncommon presentation of allergic bronchopulmonary aspergillosis during the COVID‑19 lockdown: a case report

Background: During the ongoing pandemic of coronavirus disease 2019 (COVID-19), lockdown periods have changed the way that people and communities live, work and interact. Case presentation: This case report describes an uncommon but important presentation of allergic bronchopulmonary aspergillosis (ABPA) in a previously healthy male, who decided to live in the basement of his house when Italy entered a nationwide lockdown during the COVID-19 pandemic. As high resolution computed tomography (HRCT) of the chest on admission showed diffuse miliary nodules, a miliary tuberculosis was initially suspected. However, further investigations provided a diagnosis of unusual presentation of ABPA. Conclusions: This case highlights the importance of maintaining awareness of Aspergillus-associated respiratory disorders during the COVID-19 pandemic, especially because lifestyle changes associated with home isolation carry an increased risk of exposure to mold spores present in some indoor environments

Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin

BACKGROUND: Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. METHODS AND RESULTS: Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P<0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P=0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO(2)/FiO(2) ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality. CONCLUSIONS: This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia