Prevalence of severe asthma according to the drug regulatory agency perspective: An Italian experience

Severe asthma prevalenc

Computed tomography for evaluation of abdominal wall hernias-what is the value of the Valsalva maneuver?

PURPOSE To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver. METHODS This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar's test. RESULTS The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias. CONCLUSIONS Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias

Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias

PURPOSE Inguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. METHODS This single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1-3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff's α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader. RESULTS The final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia. CONCLUSION Valsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias

Essential amino acid supplementation in patients with severe COPD: a step towards home rehabilitation

Background. Pulmonary Rehabilitation ("Rehabilitation") can improve both lung function and quality of life in patients suffering from chronic obstructive pulmonary disease (COPD) even if only a very small proportion of patients have access to Rehabilitation. Supplementation of Essential Amino Acids (EAAs) might allow COPD patients to achieve some typical Rehabilitation outcomes such as a better physical performance and an improved health status. Methods. 88 COPD out-patients (GOLD class 3-4) with a body mass index (BMI) &lt;23 Kg/m2 were randomised to receive EAAs (n=44) or placebo (n=44) for twelve weeks. Primary outcome measures were changes in both physical activities in daily life (measured by Sense Wear Armband in terms of mean steps walked in one week) and in quality of life (measured by the St George's Respiratory Questionnaire, SGRQ). Results. After 12 weeks, the physical performance was significantly increased vs baseline only in patients who received EAAs (1140.33 ± 524.69 and 638.68 ± 662.1 steps/day, respectively; p=0.02), being also the comparison vs the placebo group highly significant (p=0.003). Similarly, the SGRQ score improved significantly only in EAA patients (69.35 ± 9.51 vs baseline 72.04 ± 8.62; p&lt;0.01), and changes were significantly different from those measured in the placebo group (p&lt;0.001). Furthermore, when compared to those who received placebo, EAAs patients significantly increased their fat-free mass (p=0.04), muscle strength (p&lt;0.01), saturation of oxygen (p=0.05), serum albumin (p&lt;0.001), and also ameliorated their original cognitive dysfunction (p=0.02). Conclusions. Oral supplementation with EAAs contribute to improve the daily-life performance in domiciliary severe COPD patients who can not enter any Rehabilitation programme, together with their quality of life; nutritional and cognitive status, and muscle strength

Severe asthma management in the era of biologics: insights of the Italian Registry on Severe Asthma (IRSA)

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Drop-out rate among patients treated with omalizumab for severe asthma: Literature review and real-life experience

BACKGROUND: In patients with asthma, particularly severe asthma, poor adherence to inhaled drugs negatively affects the achievement of disease control. A better adherence rate is expected in the case of injected drugs, such as omalizumab, as they are administered only in a hospital setting. However, adherence to omalizumab has never been systematically investigated. The aim of this study was to review the omalizumab drop-out rate in randomized controlled trials (RCTs) and real-life studies. A comparative analysis was performed between published data and the Italian North East Omalizumab Network (NEONet) database. RESULTS: In RCTs the drop-out rate ranged from 7.1 to 19.4 %. Although the reasons for withdrawal were only occasionally reported, patient decision and adverse events were the most frequently reported causes. In real-life studies the drop-out rate ranged from 0 to 45.5 %. In most cases lack of efficacy was responsible for treatment discontinuation. According to NEONet data, 32 % of treated patients dropped out, with an increasing number of drop outs observed over time. Patient decision and lack of efficacy accounted for most treatment withdrawals. CONCLUSIONS: Treatment adherence is particularly crucial in patients with severe asthma considering the clinical impact of the disease and the cost of non-adherence. The risk of treatment discontinuation has to be carefully considered both in the experimental and real-life settings. Increased knowledge regarding the main reasons for patient withdrawal is important to improve adherence in clinical practice

The structural heterogeneity of an urbanised mangrove forest area in southeastern Brazil: Influence of environmental factors and anthropogenic stressors

Abstract The objective of this study is to evaluate the characteristics of the forest in an urbanised mangrove using vegetation structure and abiotic conditions to distinguish habitat heterogeneity/quality. A total of 16 points in Vitória Bay were selected in the fringe and basin forests. The variables evaluated were height and diameter of the individual trees, basal area, density, dominance, interstitial water, litter mass, grain size, organic matter and anthropogenic influences. The results indicated that the mangrove area, due to suffering intensely from various anthropogenic effects, forests with varying degrees of maturity. Areas more distant from direct human effects had a higher degree of development and environmental quality relative to points closer to urban pressures. Intermediate development levels were also observed, which indicated pulses of environmental change. Human interventions caused alterations in the development of the forest which increased the mortality rate and reduced the diameter and height of the trees. The environmental variables of salinity, organic matter, litter mass, grain size and anthropogenic stressors contributed to the structural patterns. Our data suggest that an analysis of the vegetation structure and the abiotic factors are useful indicators to evaluate habitat quality, thus providing a basis for future management

The mental health effects of eco-anxiety - a systematic review of quantitative research

Review question / Objective: The aim of the review is to synthesise findings from quantitative studies that investigate ecological grief, eco-anxiety, and climate-anxiety in relation to self-reported mental health. Population of interest: The general adult population aged 18 years. Exposure (risk factor): The exposure is defined as the presence of any ecological grief, eco-anxiety, and/or climate-anxiety that is quantified either before, concurrently, or after a mental health symptom (e.g. depression, and/or anxiety - see Outcomes). As ecological grief, eco-anxiety, and climate-anxiety are relatively new concepts that lack a standard definition, we will include validated and emerging unvalidated self-report measures of these constructs, as well as closely related constructs" solastalgia, eco- and climate grief, eco- and climate-guilt, eco- and climate-distress, eco- and climate-despair, eco- and climate-worry. Ineligible exposures are detrimental environmental events (e.g. flood, bushfire, drought) or climatic conditions (e.g. ambient temperatures) or distress related to psychosocial impacts of environmental events (e.g. loss of income or housing due to landslide). Comparator: The general adult population aged 18+ without ecological grief, eco-anxiety, and/or climate-anxiety or related constructs as defined above in Exposure. Outcome: The primary outcomes are mental health symptoms quantified by validated self-report measures of depression, anxiety, stress

Essential amino acid supplementation in patients with severe COPD: a step towards home rehabilitation

Background. Pulmonary Rehabilitation (“Rehabilitation”) can improve both lung function and quality of life in patients suffering from chronic obstructive pulmonary disease (COPD) even if only a very small proportion of patients have access to Rehabilitation. Supplementation of Essential Amino Acids (EAAs) might allow COPD patients to achieve some typical Rehabilitation outcomes such as a better physical performance and an improved health status. Methods. 88 COPD out-patients (GOLD class 3-4) with a body mass index (BMI) <23 Kg/m2 were randomised to receive EAAs (n=44) or placebo (n=44) for twelve weeks. Primary outcome measures were changes in both physical activities in daily life (measured by Sense Wear Armband in terms of mean steps walked in one week) and in quality of life (measured by the St George’s Respiratory Questionnaire, SGRQ). Results. After 12 weeks, the physical performance was significantly increased vs baseline only in patients who received EAAs (1140.33 ± 524.69 and 638.68 ± 662.1 steps/day, respectively; p=0.02), being also the comparison vs the placebo group highly significant (p=0.003). Similarly, the SGRQ score improved significantly only in EAA patients (69.35 ± 9.51 vs baseline 72.04 ± 8.62; p<0.01), and changes were significantly different from those measured in the placebo group (p<0.001). Furthermore, when compared to those who received placebo, EAAs patients significantly increased their fat-free mass (p=0.04), muscle strength (p<0.01), saturation of oxygen (p=0.05), serum albumin (p<0.001), and also ameliorated their original cognitive dysfunction (p=0.02). Conclusions. Oral supplementation with EAAs contribute to improve the daily-life performance in domiciliary severe COPD patients who can not enter any Rehabilitation programme, together with their quality of life; nutritional and cognitive status, and muscle strength