1,721,068 research outputs found
Rhabdomyolysis after the administration of Itraconazolo to an asthmatic patient with bronchopulmonary aspergillosis
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Malattie cutanee nei frequentatori delle piscine: identificazione dei principali fattori di rischio
No full textINTRODUZIONE: Il problema delle patologie dermatologiche nei frequentatori abituali degli impianti natatori non viene approfondito in Letteratura.
OBIETTIVI: Valutare la diffusione delle patologie cutanee nei frequentatori delle piscine ed in particolare i possibili determinanti delle verruche.
METODI: In quattro piscine del Comune di Verona sono stati arruolati 1136 soggetti (età media 31,0±11,1 anni; 41,0% maschi) a cui è stato somministrato un questionario per valutare la durata della frequentazione della piscina, il rispetto
delle norme igieniche e la presenza in anamnesi di patologie cutanee. Successivamente, gli stessi soggetti sono stati sottoposti a visita dermatologica. Una stima del numero medio di frequentatori annui delle quattro piscine prese in considerazione è stata ottenuta mediante i registri delle presenze del 2006.
RISULTATI: La frequenza media annua nelle quattro piscine era: piscina “A” 80.500 presenze/anno; piscina “B” 71.500 presenze/anno; piscina “C” 115.000 presenze/anno; piscina “D” 120.000 presenze/anno. Il 64,3% dei soggetti ha dichiarato in anamnesi una malattia cutanea, mentre alla visita dermatologica,
123 soggetti (10,8%) hanno presentato una malattia cutanea trasmissibile. Nel modello di regressione logistica la presenza di verruca in anamnesi è risultata significativamente associata agli anni di frequentazione (OR=1,043; 95%CI:1,023-1,065; p<0,001) ed alla piscina frequentata (OR piscina D vs piscina B = 1,903; 95%CI: 1,114-3,250; p=0,019).
CONCLUSIONI: Lo studio evidenzia come più del 10% dei frequentatori abituali delle piscine continui ad accedere agli impianti nonostante presenti una patologia cutanea trasmissiva. Con particolare riferimento alle verruche, sembra che la probabilità di insorgenza sia proporzionale agli anni di frequentazione degli impianti e al numero di frequentatori. Ulteriori studi dovranno essere condotti per confermare tale ipotesi
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Reflux associated cough is usually not associated with reflux: role of reduced cough threshold
No full textIn a recent article Sifrim and coworkers addressed the issue of the importance of weakly acidic reflux (as measured by 24 hour ambulatory pressure and pH-impedance monitoring) in patients with chronic cough. The presence of asthma, postnasal drip, or the use of ACE inhibitors was ruled out, so that an association with gastro-oesophageal reflux was probable. They found that only 15% of cough bursts were preceded by reflux episodes, which in 4% of cases were weakly acidic and therefore not detectable by conventional automated analysis of oesophageal pH tracings. Though the temporal relationship between acid or weakly acidic reflux and cough was highly significant, it could not be demonstrated in most episodes. In this respect their findings are in agreement with a previous study by Laukka and coworkers, who also used manometry for a more accurate timing of cough. Taken together, the results of the two studies suggest that the pathogenetic mechanisms usually proposed as a link between reflux and cough (micro/macroaspiration of refluxate into airways and vagally mediated cough reflex) may be involved, at best, in a minority of cough episodes.
A different explanation has therefore to be formulated, not requiring a strict temporal relationship between reflux and cough. We suggest that such explanation is represented by a low cough threshold induced by repeated reflux. We have previously demonstrated that patients with reflux oesophagitis present a tussive response to minute amounts of inhaled capsaicin. In our series, the temporal relationship between irritant inhalation and cough bursts was so reproducible and immediate that a casual association with a single reflux is unlikely. Rather, our finding strongly suggests the presence of a reduction in cough threshold, related to cumulated effect of repeated oesophageal acid exposures. These lead to nociceptor sensitisation, which has been reported to be reversible by PPI treatment. Actually, in our series of oesophagitis patients, only five days of omeprazole treatment produced a striking improvement in tussive reactivity, so that a dose of capsaicin 15-fold higher was required to elicit cough . Once this acid-driven mechanism is activated, a variety of otherwise subliminal stimuli (smoke, pollution, etc) can cause cough. For this reason, the temporal association of reflux with cough does not appear a reliable criterium to diagnose reflux-associated cough, even using state of the art methodology. Future studies will clarify whether variations in cough threshold after PPI therapy has a role for identifying among patients with cough the ones in whom the symptom is due to reflux
Association between daytime sleepiness and impaired expiratory lung function due to smoking in patients with mild-to-severe OSA: an observational study
No full textPurposeThere are no studies about daytime sleepiness (DS) in patients with obstructive sleep apnea (OSA) and impaired expiratory lung function (IELF) due to the smoking habit. We aimed to evaluate the association between DS and IELF in patients with OSA and look for possible DS-related factors. MethodsIn a prospective study, 220 untreated patients with mild-to-severe OSA were divided into non-smokers (Group 1, N = 113), smokers without IELF (Group 2, N = 69) and smokers with IELF (Group 3, N = 38). Data about anthropometric characteristics, main comorbidities, spirometry, polygraphy, and DS (by Epworth Sleepiness Scale-ESS) were collected. ResultsCompared to other groups, patients in Group 3 had lower mean values and the lowest SpO2 (pulse oximetry oxygen saturation), with a greater ST90 (sleep time with SpO2 below 90%). In Group 3, DS was lower (ESS median 3) in comparison to Groups 1 (median 6; p = 0.043) and 2 (median 6; p = 0.005)(Kruskal-Wallis test p = 0.021). In Group 3, particularly in patients with moderate-to-severe IELF, there was a significant association between ESS values and nocturnal lowest heart rate (LHR) (r(2) = 0.436; p = 0.001). Finally, two multivariate linear regression-adjusted models, the second considering domiciliary treatment with bronchodilators, confirm the association between the nocturnal LHR and ESS (beta = -0.278; p < 0.001 and beta = -0.260; p = 0.001). ConclusionPatients with OSA and IELF are less sleepy than OSA patients without it, even if they are smokers. A probable effect of autonomic alteration may explain the lower perception of sleepiness in OSA patients with IELF
Body weight and mortality in COPD: focus on the obesity paradox
Full text linkThe positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the "obesity paradox". In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present. Interestingly, the "paradox" is more evident for subjects with severe bronchial obstruction (i.e., a lower FEV1), while in mild-moderate conditions, the weight-related mortality shows a behavior similar to that observed in the general population. Several factors may confound the relation between COPD, obesity and mortality. The lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. Due to the modified chest wall mechanical properties-related to increased fat mass-obese COPD patients may present, respect to their lean counterpart, a lower lung hyperinflation which is associated with higher mortality. The traditional classification of COPD attributes to obese "blue bloaters" a low-grade emphysema in opposition to lean "pink puffers"; the fact that emphysema extent is related to mortality may bias the relationship between weight and survival. It is also to underline that the majority of the studies, consider BMI rather than body composition (a better predictor of mortality) when studying the intriguing relation between weight, COPD, and mortality. Reverse bias has also to be taken into account, hypothesizing that an unintentional weight loss may be the deleterious factor related to mortality, rather than considering obesity a protective one. Further prospective studies are needed to shed light on the complexity of this emerging issue
Incidenza di asma e suoi possibili determinanti nei frequentatori delle piscine
No full textINTRODUZIONE: L’esercizio fisico in piscina è generalmente considerato un'attività salutare e non è controindicato negli asmatici. Si ritiene, infatti, che l’inalazione di aria umida dia meno rischi di broncocostrizione.
Tuttavia, in Letteratura, la frequentazione della piscina
viene associata a maggior rischio di patologie respiratorie nei nuotatori agonisti.
OBIETTIVO: Valutare la relazione fra frequentazione di piscine e
rischio di asma.
MATERIALI E METODI: In quattro piscine della città di Verona è stato somministrato a 1136 soggetti (età compresa tra 18 e 55 anni; 59.0% femmine) una versione modificata del questionario ECRHS. Il questionario indagava la presenza di patologie respiratorie, l'età d’insorgenza dell'asma e il tempo di frequentazione della piscina. Come indicatore di frequenza è stato adottato il prodotto tra gli anni di frequenza totali in piscina e il numero medio di ore per anno (ore-vita).
I partecipanti sono stati divisi in due sottogruppi sulla base della
mediana della somma delle ore-vita (gruppo A 320 ore-vita). I nuovi casi di asma (asma incidente), insorti dopo almeno 12 mesi di frequenza in piscina, sono stati considerati outcome principale.
RISULTATI: La rinite allergica (22.3%), l’anamnesi positiva per asma (8.7%), e la presenza di asma corrente (3.5%) hanno distribuzione simile in entrambi i gruppi. L’incidenza di asma (25 soggetti) è risultata maggiore nel gruppo B (2 nuovi casi nel gruppo A vs. 23 nel gruppo B; un-adjustedRR=11.2; 95%CI 2.6 ; 47.2). La frequenza in piscina viene confermata come determinante di asma incidente anche in analisi multivariata considerando come confondenti età, sesso, storia familiare di malattie allergiche e abitudine al fumo.
CONCLUSIONI: I nostri risultati sembrano suggerire come l’incidenza di asma sia associata al tempo trascorso in piscina
Sleep Disordered Breathing is Associated with Appropriate Implantable Cardioverter Defibrillator Therapy in Congestive Heart Failure Patients.
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