Magana-Arachchi D.N.,Sri Lanka Institute of Fundamental Studies |
Medagedara D.,Respiratory Unit |
Thevanesam V.,University of Peradeniya
Asian Pacific Journal of Tropical Disease | Year: 2011
Objective: To determine tuberculosis epidemiology in Kandy, Sri Lanka. Methods: IS. 6110 RFLP and spoligotyping analyses were performed on 100 Mycobacterium tuberculosis (M. tuberculosis) clinical isolates from Kandy district, Sri Lanka. RFLP hybridization patterns (n=73) were analysed by the software GeneDirectory. Spoligotypes (n=110) were compared with the international database SPOTCLUST. Results: The majority of the circulating M. tuberculosis strains in Kandy belong to a single family, but the degree of IS. 6110 DNA polymorphism was high. 71 (80%) of the strains displayed distinct RFLP patterns and 63 (71%) were clustered into one main family. Within the family three isolates were grouped into one cluster while the rest isolates were grouped into one. The copy number varied from 1 to 17 while single copy strains were predominant (12) and 15 lacked the IS. 6110 element. Spoligotyping revealed a total of 24 families including the 9 major families. Strains were distributed among all the three principle genetic groups PGG1, PGG2, and PGG3. Except for two strains, the rest were not defined in the latest spoligotype database SpolDB4/SITVIT. Conclusions: The first study of RFLP and spoligotyping of M. tuberculosis strains in Sri Lanka demonstrates the applicability of the genetic marker IS. 6110 to differentiate strains and the heterogeneity and predominance of several worldwide-distributed spoligotypes. © 2011 Asian Pacific Tropical Medicine Press.
Paneroni M.,Respiratory Rehabilitation Unit |
Colombo F.,Respiratory Unit |
Papalia A.,Respiratory Unit |
Colitta A.,Telbios |
And 5 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2015
In patients with COPD non-naïve to rehabilitation we tested the feasibility, adherence and satisfaction of a home-based reinforcement telerehabilitation program (TRP). Outcomes were compared with a standard outpatient rehabilitation program (ORP). Then 18 TRP patients underwent 28 sessions of strength exercises (60 min) and cycle training (40 min) using a satellite platform provided telemonitoring, tele-prescription, video-assistance and phone-calls, patients were equipped with an oximeter, steps-counter, bicycle, remote control and interactive TV software. 18 matched ORP, retrospectively identified from our hospital ORP database, were used as controls. At baseline and end of program, the 6-min walking test (6MWT), Medical Research Council (MRC) scale and Saint George's Respiratory Questionnaire (SGRQ) were administered. In TRP only, we assessed platform use, incremental exercise, steps walked/day and patient satisfaction. TRP patients completed all sessions without side effects, used the remote control 1,394 ± 2,329 times being in the 84% of the cases satisfied with the service. In 22% of the cases patients found the technology unfriendly. Each health-professional performed 46 ± 65 actions, 14.6 ± 2.12 phone calls and 1 ± 1.67 videoconference sessions per patient. TRP patients increased physical activity (3,412 vs. 1,863 steps/day, p = 0.0002). Both programs produced significant (all, p < 0.01) gains in 6MWT meters, TRP +34.22 ± 50.79; ORP +33.61 ± 39.25, dyspnea TRP - 0.72 ± 0.89; ORP - 0.94 ± 0.53 and SGRQ TRP - 6.9 ± 9.96, ORP - 9.9 ± 12.92 without between-group differences. In conclusion, TRP is feasible and well accepted by patients, although sometimes technology was perceived as difficult. It seems to improve walking capacity, dyspnea, quality of life and daily physical activity. Future RCTs will demonstrate cost-effectiveness. © 2015 Informa Healthcare USA, Inc.
Corrado A.,Respiratory Intensive Care Unit |
Rossi A.,Respiratory Unit
Respiratory Medicine | Year: 2012
Background: According to the GOLD international guidelines, the treatment of chronic obstructive pulmonary disease (COPD) should be proportional to the severity of airflow obstruction graded according to FEV 1% predicted. Regular treatment with long-acting bronchodilators should be prescribed for symptomatic patients with FEV 1 < 80%. Inhaled corticosteroids should be added in patients with FEV 1 < 50% predicted and frequent exacerbations. Aim: To investigate whether pulmonologists follow the GOLD guidelines when prescribing treatment for COPD. Methods: A multicenter, cross-sectional, observational study was carried out in 49 Pulmonary Units evenly distributed throughout the country. For each patient the demographic, clinical data and the current therapies were registered in an electronic database. Results: 4094 patients (mean age: 70.9 ± 9.4; males 72.4%, female 27.6%) were enrolled. Disease severity was classified as: mild (745), moderate (1722), severe (923), very severe (704). Irrespective of disease severity, inhaled corticosteroids alone or in combination with long-acting bronchodilators were used in 15.2% and 66.8% of patients, respectively. The appropriateness of the pharmacological treatment of the COPD patients was defined in accordance with the GOLD recommendations. The treatment was appropriate in 37.9% of patients and inappropriate in 62.1%, p < 0.0001. The inappropriateness was due to under-prescription in 7.2% and to over-prescription in 54.9% of patients. The presence and the number of exacerbations represented an important trigger for over-prescription at stages I and II. Conclusions: This study shows that there is a poor relationship between the recommendations of the GOLD international guidelines and current clinical practice, and that exacerbations may play a role in over-prescription. © 2012 Elsevier Ltd. All rights reserved.
Portal J.A.R.,Respiratory Unit |
Carazo-Fernandez L.,Complejo Asistencial Universitario Of Leon
Current Respiratory Medicine Reviews | Year: 2012
Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory condition of the airways, pulmonary vessels, and lung parenchyma, distinguished by airflow limitation that is not reversible. Cigarette smoking is responsible for the vast majority of COPD, but it does not explain the increasing prevalence worldwide. Occupational and environmental factors have harmful effects on the airway. Particulate pollutants, ozone (O3), and NO2 can all produce deleterious effects on the airways and are increasingly believed to play important roles. As with other conditions, COPD develops due to multiple causes, and genetic factors and the way they relate to environmental factors play an important role. Among these factors, exposure to high levels of ambient air pollution may lead to increased incidence rates of this type of illnesses, and it is also linked to exacerbations of chronic processes. A considerable amount of epidemiological research has been conducted to investigate acute and chronic effects on health resulting from exposure to ambient air pollution, most of it focusing on the health effects of short-term fluctuations in ambient pollution levels. In contrast, evidence is not sufficient to prove a causal relationship between ambient air pollution and COPD. Improving ambient air quality appears to be an effective intervention that could benefit the health of the general population. Determining the role played by retained PM in COPD lung inflammation could lead to novel therapeutic interventions in the future. © 2012 Bentham Science Publishers.
Rodriguez Portal J.A.,Respiratory Unit
Advances in Clinical Chemistry | Year: 2012
Malignant pleural mesothelioma (MPM) is an extremely aggressive tumor which develops in the epithelial lining of the lungs. Exposure to asbestos is the most influential risk factor for developing this disease. Despite recent advances in the treatment of other types of cancer, patients with mesothelioma currently face a poor prognosis. Therefore, it is highly important to develop an early diagnostic method with the greatest challenge on screening techniques to detect the disease at a subclinical stage. Early detection is critical for the development of more effective therapies in these patients. Unfortunately, radiologic studies have not proven effective. Biomarkers might be a useful adjunct tool among populations previously exposed to asbestos. This review will provide an update of recent progress in serum biomarkers (osteopontin (OPN), soluble mesothelin (SM), and megakaryocyte potentiating factor (MPF)) to diagnose, detect, and monitor MPM. Of these, SM has demonstrated the greatest diagnostic potential although MPF may serve as an equal alternative. Despite recent studies, it is apparent that long-term large-cohort research is required to conclusively demonstrate the usefulness of these markers in this disease. Copyright 2012, Elsevier Inc.
Gamble C.,University of Liverpool |
Wolf A.,Bristol Royal Childrens Hospital |
Sinha I.,Respiratory Unit |
Spowart C.,University of Liverpool |
Williamson P.,University of Liverpool
PLoS ONE | Year: 2013
Background: Adequate sedation is crucial to the management of children requiring assisted ventilation on Paediatric Intensive Care Units (PICU). The evidence-base of randomised controlled trials (RCTs) in this area is small and a trial was planned to compare midazolam and clonidine, two sedatives widely used within PICUs neither of which being licensed for that use. The application to obtain a Clinical Trials Authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA) required a dossier summarising the safety profiles of each drug and the pharmacovigilance plan for the trial needed to be determined by this information. A systematic review was undertaken to identify reports relating to the safety of each drug. Methodology/Principal Findings: The Summary of Product Characteristics (SmPC) were obtained for each sedative. The MHRA were requested to provide reports relating to the use of each drug as a sedative in children under the age of 16. Medline was searched to identify RCTs, controlled clinical trials, observational studies, case reports and series. 288 abstracts were identified for midazolam and 16 for clonidine with full texts obtained for 80 and 6 articles respectively. Thirty-three studies provided data for midazolam and two for clonidine. The majority of data has come from observational studies and case reports. The MHRA provided details of 10 and 3 reports of suspected adverse drug reactions. Conclusions/Significance: No adverse reactions were identified in addition to those specified within the SmPC for the licensed use of the drugs. Based on this information and the wide spread use of both sedatives in routine practice the pharmacovigilance plan was restricted to adverse reactions. The Clinical Trials Authorisation was granted based on the data presented in the SmPC and the pharmacovigilance plan within the clinical trial protocol restricting collection and reporting to adverse reactions. © 2013 Gamble et al.
Crimi C.,University of Catania |
Noto A.,Messina University |
Princi P.,National Research Council Italy |
Esquinas A.,Hospital Morales Meseguer |
Nava S.,Respiratory Unit
European Respiratory Journal | Year: 2010
Although noninvasive ventilation (NIV) is becoming very popular, little is known about its pattern of clinical and technical utilisation in different environments. We conducted a web-based survey in Europe to identify the perceived pattern of NIV utilisation and the reason for choosing a specific ventilator and interface type in four common clinical scenarios: acute hypercapnic respiratory failure (AHRF), cardiogenic pulmonary oedema (CPE), de novo hypoxic respiratory failure and weaning/post-extubation failure (W/PE). A response was obtained from 272 (51.3%) out of 530 selected European physicians involved in NIV practice. The NIV utilisation rate was higher for pulmonologists than intensivists/anesthesiologists (p<0.05). The most common indication for all the physicians was AHRF (48%). Physicians were more likely to use NIV dedicated ventilator in AHRF and CPE and an intensive care unit (ICU) ventilator with NIV module in de novo hypoxic respiratory failure and W/PE, mainly because of the possibility of using the double circuit and inspiratory oxygen fraction control. Overall, the oro-nasal mask was the most frequently used interface, irrespective of clinical scenarios. The use of NIV in Europe is generally relatively high, especially among pulmonologists and in AHRF. Dedicated NIV ventilators and ICU ventilators with NIV modules are preferably in AHRF and in de novo hypoxic respiratory failure, respectively, together with oro-nasal masks. Copyright©ERS 2010.
Vitacca M.,Respiratory Unit |
Paneroni M.,Respiratory Unit |
Comini L.,Health Directorate |
Bianchi L.,Respiratory Unit
Minerva Psichiatrica | Year: 2013
Aim. The aim of this paper was to evaluate the long-lasting effects of physical activity on exercise capacity in patients with mental disorders within a Community Residential Service. Methods. Eleven patients underwent tri-weekly sessions of a structured program of physical training for a period of 6-months (T6) followed by a 6-month period of program discontinuation (T12). During physical training patients performed different types of exercises mainly identified as free walking and gym sessions. At the end of the structured physical training, a period of discontinuation was proposed. During this time patients were free to choose whether to continue physical activity alone or stop altogether. Six-minute walking test (6MWT), body weight, waist circumference, steps counts, and quality of life were evaluated in all patients at baseline (T0), T6 and T12. At T6 adherence, training effect during different physical activities (free walking and gym sessions), and patients and counsellors satisfaction were also measured. Results. Six-minute walking distance increased significantly at T6 vs. TO (+ 69 (SD57) meters; P<0.002), this increase was maintained at T12. Heart rate (P<0.02) and oxygen saturation (P<0.03) significantly improved only at T6. Patients attended 82.5% of walking sessions and 63% of gym sessions, walking offered the best training effect. Satisfaction with the program by both patients and counsellors was high. Conclusion. In patients with mental disorders, a structured 6-month supervised physical activities program improves exercise tolerance mainly through walking with high adherence. This gain is maintained for a long time. Physical training is well accepted by both patients and counsellors.
PubMed | Respiratory Unit and Thoracic Surgery and Lung Transplantation Unit
Type: Journal Article | Journal: Transplantation proceedings | Year: 2016
The lung allocation score (LAS) was introduced in the United States in May 2005 with the main goal of reducing the waiting list mortality of patients with end-stage lung diseases, but also to enhance the lung transplant benefit and improve the management of urgent candidates. Several papers have reported that LAS resulted in a reduction of the waiting list mortality but no significant survival benefit was noted.We evaluate the usefulness of LAS as a predictor for lung transplantation outcome in 123 patients listed for lung transplantation in an Italian center. Primary endpoints were waiting list mortality and posttransplant mortality at 1 year; secondary endpoints included perioperative circulatory support, cardiopulmonary bypass, primary graft dysfunction, and long-term survival after transplantation.We observed the absence of correlation between LAS and waiting list mortality. The LAS did not affect the long-term survival in our population.High LAS was predictive of primary graft dysfunction of grade 3 in the first 72 hours after transplantation.
PubMed | Bambino Gesu Childrens Research Hospital, Respiratory Unit and Dentistry Unit
Type: Journal Article | Journal: Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale | Year: 2016
This clinical report describes a child suffering from obstructive sleep apnoea (OSA) and class II skeletal malocclusion with maxillary contraction and anterior open bite. He presented moderate obstructive sleep apnoea with large impact on quality of life of patient and parents. He was treated using an innovative orthodontic device (Sleep Apnea Twin Expander) to simultaneously carry out palatal expansion and mandibular advancement. After orthodontic therapy, the OSA-18 questionnaire demonstrated an improvement of the main respiratory symptoms, while cardiorespiratory sleep study revealed a reduction in obstructive sleep apnoea events. Post-treatment, clinical assessment and cephalometric analysis showed a reduction of sagittal maxillary discrepancy and an extension of upper airway space. In conclusion, this case report suggests that orthodontic treatment might be a valuable alternative treatment in children with obstructive sleep apnoea related to craniofacial anomalies.