A hierarchical cluster analysis of the psycological impact of the COVID-19 pandemic on Italian severe asthma patients.

INTRODUCTION: In the context of COVID-19 pandemic, a consistent medical concern raised among severe asthma patients, though the studies excluded an increased risk of severe disease as well as an increased susceptibility.The aim of the study was to apply the Psychological General Well-Being Index (PGWBI) questionnaire to severe asthmatics during the COVID-19 pandemic and to evaluate the data with a hierarchical cluster analysis. METHODS: 114 severe asthmatics were asked to respond anonymously to the PGWBI questionnaire. The patients underwent a lung functional test, fractional exhaled nitric oxide (FeNO) measurement, Asthma Control Test (ACT), and Asthma Control Questionnaire (ACQ6). A hierarchical cluster analysis was performed using an agglomerative approach and complete linkage to evaluate the results. RESULTS: The study population predominantly included female (60%), middle-aged patients, with normal lung function parameters, mild signs of airway, and satisfactory asthma control. The PGWBI score (82.46 ± 16.53) of the study population showed a good state of psychological well-being and was similar to that of a representative sample of healthy adult Italian subjects. Thus, Hierarchical cluster analysis identified 3 groups of patients: Cluster 1 (32%), Cluster 2 (64%), and Cluster 3 (4%). Whilst the Cluster 2 patients' PGWBI score fell within the normal range, the Cluster 1 patients had a significantly lower total score (68.57 ± 7.2; p < 0.05), suggesting moderate distress. The Cluster 3 patients presented a total score markedly low. CONCLUSION: Although the majority of the severe asthma patients studied demonstrated good mental well-being during the COVID-19 pandemic, some did indeed show moderate to severe psychological distress.

Olfactory and rhinological evaluations in SARS-CoV-2 patients complaining of olfactory loss.

Since December 2019, a novel coronavirus SARS-CoV-2 (Covid-19) outbreak emerged in China and spread rapidly in several countries. As of April 5, 2020, 1.218.474 cases were confirmed with 65.884 deaths worldwide (1). The clinical manifestations of Covid-19 range from asymptomatic carrier status to severe pneumonia. In a study of 7,736 Covid-19 patients in China, of all the clinical symptoms, hyposmia was not reported in any patient(2). Anyway, it is now clear that olfactory dysfunction may also be present in these patients(3) as the only or prevalent manifestation(4).

The role of peak nasal and oral inspiratory flow in the evaluation of patients with sleep-related breathing disorders.

BACKGROUND: Sleep-related breathing disorders (SRBD) are common reported disorders in the adult population. The nose plays an important role in the development of SRBD; thus, the measurement of nasal respiratory function remains an important step in the management of these patients. Peak nasal inspiratory flow (PNIF) is a useful tool to assess nasal airflow and it has recently been studied together with peak oral inspiratory flow (POIF). OBJECTIVE: The aim of the present study was to evaluate the role of PNIF and POIF in an adult population of patients affected by SRBD. METHODOLOGY: Seventy consecutive adult patients with SRBD were included in the present study. All patients were evaluated with home-based sleep studies (type III), PNIF, POIF, SNOT-22 questionnaire, Epworth Sleepiness Scale test and VAS for nasal obstruction. RESULTS: Although PNIF and POIF showed to correlate with each other, no correlations were observed between Apnea Hypopnea index (AHI) and PNIF, POIF or NPI (PNIF/POIF). A further analysis showed a marginal correlation between SNOT- 22 and AHI and between SNOT-22 and POIF. Furthermore, in a multivariate analysis, also POIF marginally correlated with some of the sleep- related SNOT-22 items. CONCLUSIONS: In the present study neither PNIF nor POIF were found to be associated with OSAS severity. However, POIF values correlated better than PNIF with sleep related symptoms suggesting that POIF could be a more useful parameter for upper airway assessment in patients with SRBD. In addition, a correlation between OSAS severity, in terms of AHI, and SNOT-22 total score has been reported.

Nasal function before and after rapid maxillary expansion in children: A randomized, prospective, controlled study.

OBJECTIVES: Children can well detect and respond to odours in order to have information about food and environment. Rapid Maxillary Expansion seems to improve dental and skeletal crossbite and increase nasal patency correcting oral respiration in children. A previous pilot study suggested that Rapid Maxillary Expansion may lead to improved N-Butanol olfactory thresholds, and peak nasal inspiratory flow values (PNIF). The aim of the present study was to prospectively evaluate olfactory threshold, nasal flows and nasal resistances in children aged from 6 to 11 years before and after Rapid Maxillary Expansion, comparing treated children with a control group of similar age, growth stage (prepubertal) and transversal skeletal deficiency. METHODS: N-butanol olfactory thresholds, anterior active rhinomanometry (AAR) and PNIF were measured in 11 children (6-11 years) before (T0), immediately and 6 months after Rapid Maxillary Expansion application (T1 and T2 respectively), and in a control group of 11 children (6-11 years) whose members remained under observation for the period of the study. RESULTS: Considering the study group, PNIF values improved at T1 respect to the T0 values (p = 0.003), while T2 values were significantly higher than T0 ones (p = 0.0002). N-Butanol Olfactory Threshold significantly improved at each control (p = 0.01, p = 0,01 and p = 0.0003, for T1 vs T0, T2 vs T1, T2 vs T0 respectively). No differences on AAR values were found during the six months follow-up in this group. Considering the control group, no significant differences were found for any of the considered variables during the time of the study. Comparing the two groups, there was a significant increase of PNIF values in the study group compared to the control group (p = 0.003) at T1, which was even more evident six months after Rapid Maxillary Expansion (p = 0.0005). This improvement was not shown by AAR values. N-Butanol Olfactory Threshold showed a significant improvement at T2 respect to T1 (p = 0.002) and T0 (p = 0.0005). CONCLUSION: Rapid Maxillary Expansion seems to significantly improve the respiratory capacity of treated patients, at least in terms of PNIF, and their olfactory function, measured by N-Butanol Olfactory Threshold Test. Further studies should be performed to evaluate if also changes in nasal resistances, measured by AAR, could occur, maybe considering a larger group of subjects and possibly using 4-phase rhinomanometry in order to evaluate the effective resistances during the entire breath.

Influence of number of drugs on olfaction in the elderly.

BACKGROUND: The etiology of age-related olfactory loss is still unclear, but it has been claimed that polypharmacotherapy may contribute to olfactory dysfunction, particularly in the elderly, who are more likely to need multiple drugs. The present pilot study investigated the relationship between smell and the number and type of drugs taken in a group of elderly. METHODOLOGY: 50 elderly volunteers (over 64 years old) who were healthy from the sinonasal standpoint (SNOT-22 under 1) and had no cognitive impairments [Mini Mental State Examination (MMSE over 18) were administered the Screening 12 test and tested on their n-butanol olfactory threshold. Their olfactory performance was then connected with the number and type of drugs participants used. RESULTS: The mean age of the included volunteers was 74 plus/minus 7 years. No association emerged between odor identification and number of drugs taken. The number of drugs taken correlated directly with a worse olfactory threshold and with a worse MMSE score, meaning a worse cognitive status. Odor identification significantly worsened with age. Comparing those volunteers taking only one drug known to not influence olfaction with another sub-group of volunteers taking five or more drugs, it was evident that subjects taking only one drug scored significantly better in olfactory threshold test and MMSE, and marginally better in olfactory identification test. For what concerns the difference between male and female volunteers, no difference in olfactory test result was shown, both for threshold and identification. Univariate analysis showed a direct correlation between the consumption of calcium channel blockers, beta-blockers, acetylsalicylic acid and olfactory threshold, meaning a worse sense of smell. Acetylsalicylic acid also correlated inversely with odor identification, meaning again a worse sense of smell, and so did potassium-sparing diuretics. Multivariate analysis showed that MMSE scores correlated with a better sense of smell, that is a lower olfactory threshold, and that beta-blockers and acetylsalicylic acid negatively affected olfactory threshold, meaning a worse sense of smell. Acetylsalicylic acid also correlated inversely with odor identification, meaning again a worse sense of smell. CONCLUSIONS: The number of drugs taken demonstrated to be significantly correlated with a worse olfactory threshold and worse MMSE. Larger studies on elderly volunteers are needed to confirm these preliminary findings.

Comparison between unilateral PNIF and rhinomanometry in the evaluation of nasal cycle.

BACKGROUND: Human unilateral nasal airflow shows spontaneous changes over a period of hours due to the alternating congestion and decongestion of the venous sinuses within the nasal turbinates and nasal septum. The aim of the present study was to compare PNIF and unilateral PNIF with nasal resistances measured by means of AAR in the evaluation of the nasal cycle. METHODS: PNIF, unilateral PNIF and AAR measurements were randomly performed in 20 non-smokers, non-asthmatic volunteers, with a SNOT 22 score lower than 1. Nasal measurements were done four times in a single day at 08.30, 11.00, 13.30 and 16.00. The correlation between PNIF, unilateral PNIF and nasal resistances was studied. The pattern of nasal airflow for each subject was also analyzed. RESULTS: A significant negative correlation between PNIF-lPNIF-rPNIF and respectively AAR-lAAR-rAAR was found. Only 1 subject did not show nasal cycle, while all the rest were equally distributed between a reciprocal pattern of the nasal cycle, or an in-phase changes of the nasal cycle, both at PNIF and AAR. CONCLUSIONS: Nasal cycle can be easily assessed by means of PNIF. In fact, AAR and PNIF showed a reasonable correlation in the measurement of nasal cycle, although PNIF offered a lower variability. Reciprocal and in-phase patterns of the nasal cycle were equally distributed in our population.

Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses.

AIMS: Peak Nasal Inspiratory Flow (PNIF) is an easy method to assess nasal patency. Normative unilateral PNIF data in adults have been proposed. The study purpose was to compare PNIF and unilateral PNIF values to total and unilateral nasal resistances measured by anterior active rhinomanometry (AAR) in subjects with and without nasal obstruction to see whether unilateral PNIFis sensitive to detect nasal obstruction. METHODS AND RESULTS: Measurements of PNIF, unilateral PNIF and AAR were performed in 125 volunteers. Seventy of them were healthy subjects not complaining of nasal symptoms and entered into the study as the'normal' group. The other group consisted of fifty-five symptomatic subjects.Data were analysed to show the correlation between PNIF, unilateral PNIF and nasal resistances. The ability of PNIF and AAR in predicting pathologies were compared by receiver operating characteristic (ROC) analysis indicating that PNIF and AAR have a similar and significant power to discriminate pathologic from healthy subjects. CONCLUSION: The measurement of unilateral PNIF could be a helpful method to support the diagnosis of nasal blockage also in those cases with single nostril obstruction, but, in cases of doubt, AAR should also be performed to improve diagnostic accuracy.

[Sociodemographic factors in smoking habit]. / Determinanti sociodemografici nell'abitudine al fumo.

This article reports data on epidemiological survey carried out in a population of Sardinia. The aim of the research was to evaluate lifestyles and sociodemographic factors related and their changes in time by health promotion interventions. The authors analyzed smoking habit by gender, age and educational level with Multivariate analysis by Logistic Regression. The results show in males aged 20-64 years the prevalence of current smokers decreases in value with the increasing of educational level, while in males >64 years educational level has not an influence. In females 20-39 years the prevalence of smokers decreases with the increasing of educational level, while >40 years this prevalence increased with high educational level. Younger male smokers are decreasing in higher social categories, while younger female smokers are now increasing in lower social class. These results emphasize on necessities of reassessment in health promotion priorities.

Impact of TT virus infection in acute and chronic, viral- and non viral-related liver diseases.

BACKGROUND/AIMS: The prevalence and pathogenicity of TT virus, recently identified in patients with non A-non G post-transfusional hepatitis, are questioned. METHODS: We investigated the impact of this new viral infection in a large series of patients with non A-non G, cryptogenic, non-viral and viral-related, acute and chronic liver diseases (n=577) and blood donors (n=300). TTV DNA was detected in serum by hemi-nested polymerase chain reaction. Phylogenetic analysis was performed in 13 isolates. RESULTS: TTV DNA was detected in 6/25 and 15/127 patients with cryptogenic non A-non G acute and chronic liver disease, respectively. TTV DNA positive subjects with post-transfusional acute hepatitis scored negative before transfusion. TTV prevalence was increased in patients with cryptogenic non A-non G acute and chronic liver disease compared to blood donors (6/300; p<0.001) and non-viral-related chronic liver diseases (6/137; p<0.05). TTV/HBV coinfection was frequently identified (35/147), but this was not the case for HCV-infected subjects (4/77). Transaminase activity or liver histological score was not significantly increased among TTV positive, HBV infected or non A-non G patients. The HBV infection and Mediterranean origin were the risk factors associated with TTV infection. The majority of analysed sequences clustered in genotype 1 (8=1b; 3=1a). Two isolates showed homology to genotype 2. CONCLUSIONS: These results support the view that TTV is a widely spread infectious agent with a weak pathogenicity. It raises the possibility, however, that TTV might be implicated in a few cases of acute and chronic non A-non G hepatitis. TTV-DNA-analysed sequences are related to genotypes 1 and 2 described in Europe.

Prevalence and genetic variants of hepatitis GB-C/HG and TT viruses in Gabon, equatorial Africa.

The distribution of Hepatitis GB-C/HG (GB-C/HG) and TT viruses (TTV) infections was investigated in selected populations from Gabon using Polymerase Chain Reaction (PCR) and Enzyme Linked Immunosorbent Assay (ELISA) for anti-Envelop 2 (anti-E2) GBV-C/HGV antibodies. Among pregnant women, 29 of 229 (12.6%) were Hepatitis GB virus-C and Hepatitis G virus (GBV-C/HGV) RNA positive (+) and 32 of 81 (39.5%) anti-E2 + versus 8 of 39 (20.5%) TTV DNA +. Among sickle cell anemia patients, 9.7% (3/31) were GBV-C/HGV RNA + versus 22.5% (7/31) TTV DNA +. For tuberculosis patients, the figures were 11.5% (4/35) and 0%. A study of hepatocellular carcinoma cases (n = 27) versus controls (n = 66) did not show significant differences for GBV-C/HGV RNA (10.7% versus 12.1%) and TTV DNA (44.4% versus 30.3%). According to phylogenetic analysis, the 15 GBV-C/HGV strains investigated clustered in group 1, the most common in sub-Saharan Africa whereas TTV sequences (n = 4) mostly clustered in genotypes G1 and one close to genotype G3. In the Gabonese populations investigated, GBV-C/HGV and TTV infections were highly endemic. These data are consistent with the low pathogenicity of these agents.

Immunity to tetanus in the 3-20 year age group in Italy.

In Italy, systematic mandatory tetanus immunization of children started in 1968. In 1989, immunity against tetanus was assessed in a random sample of 758 healthy subjects aged 3-20 y, from four Italian cities. There were 257 subjects 3-5 y old all residing in Southern Italy and 501 subjects 11-20 y old from both the South and North. The overall prevalence of non-immune subjects was 19.1%, without difference by sex. The rates of subjects lacking protective antibody titres was 25.3% in children 3-5 y old (all coming from South and the islands), 11.5% in those 11 y old, and 18.9% in the 18-20 y age-group, respectively. Subjects 11-20 y old residing in the South and the islands were more likely to be non-immune that those residing in the North (20.2% vs 6.0%; P < 0.01). Socio-demographic indicators such as lowest paternal education and largest family size were both unassociated with lack of protective antibodies. These findings indicate that an high rate of children in South of Italy do not have protective antibody levels, probably as consequence of lack of compliance with the vaccination programme. More efforts should be addressed to decrease geographical inequalities in the delivery of health care.

Calendar methods of fertility regulation: a rule of thumb.

"[Many] illiterate women, particularly in the third world, find [it] difficult to apply usual calendar methods for the regulation of fertility. Some of them are even unable to make simple subtractions. In this paper we are therefore trying to evaluate the applicability and the efficiency of an extremely simple rule which entails only [the ability to count] a number of days, and always the same way." (SUMMARY IN ITA)

[Low intensity electromagnetic fields produce a wave of calcium in the fibroblasts]. / Les champs electromagnétiques de faible intensité produisent une vague calcique dans les fibroblastes.

Human fibroblasts display a Ca2+ wave after irradiation with an electromagnetic field (EMF) of low intensity (100 to 900 microT) as seen by LASER confocal microscopy and excitation of Fluo 3. The number of excited cells is proportional to the intensity of EMF between 100 and 900 microT. Cellular activation by a dialysable serum factor is required to induce the Ca2+ wave. It also depends on extracellular Ca2+ and active tyrosine kinases and phospholipase C gamma.

[The quality of hospital discharge data in the Venice general hospital: methods and evaluation in the development of the Diagnosis Related Groups System]. / La qualità dei dati delle schede di dimissione ospedaliera nell'ospedale civile di Venezia: aspetti metodologici e valutativi ai fini dell'utilizzo dei DRG.

In this paper the A.A. illustrate the methodology and development of an evaluation programme of hospital discharge medical records data base quality to implement the DRG system. The work was organized into three phases: the first to analyze the quality base level, the second to sensitize the medical doctors to SDO coding through a Medical Managers Department tutorial action; the third to measure the results of a random sample. The A.A. realized a raise in the compilation level between the two analises, particularly as regards the trascription of surgical procedures and/or diagnostic and therapeutic procedures passed from 39.9% at 64.1%, and a greater correctness in the primary diagnosis coding passed from 69.9% at 83.3% and in the surgical procedures and/or diagnostic and therapeutic procedures (coding) passed from 88.7% at 93.7%.

Low prevalence of anti-HCV antibody among Italian children.

The seroprevalence of anti-HCV antibody was studied among 2,749 children and teenagers (1,438 males and 1,311 females) living in Italy. Anti-HCV antibody testing was positive by both EIA and RIBA in ten (0.36%) subjects. The positivity rate increased with age, ranging from 0 among children less than 6 years of age to 0.8% among those aged 17-19 years chi 2 linear regression = 0.038). Anti-HCV prevalence ranged from 0.2% in northeastern regions and in Apulia to 0.6% in Sicily and Sardinia (p > 0.005), and no difference was seen between males (0.35%, C.I. 95%: 0.04-0.66) and females (0.38%, C.I. 95%: 0.04-0.66) (Fisher's exact test = 0.565). From these data it appears that in Italy HCV infection is an uncommon event during childhood.

Immunogenicity of new virosome influenza vaccine in elderly people.

The safety and immunogenicity of a new virosome influenza vaccine was compared to commercial whole-virus vaccine and subunit vaccine in elderly people. The virosome vaccine was made by extracting the haemagglutinin from influenza virus and incorporating it into the membrane of liposomes composed of phosphatidylcholine (PC) and phosphatidylethanolamine (PE). 126 residents of a nursing home, aged 63-102, were randomised to receive one of the vaccines. All three were well tolerated and caused a significant rise in the geometric mean anti-haemagglutinin inhibiting (HAI) antibody titre to the 3 vaccine components (H1N1 Singapore, H3N2 Beijing, and B/Yamagata). The virosome formulation caused the highest geometric mean titres in addition to significantly (p = 0.039-0.0016) higher rates of more than four-fold or more titre rises to all 3 vaccine components. The percentage of those immunised who achieved protective levels of antibody (HAI > or = 40) was significantly (p = 0.035-0.0017) higher for the H1N1 and B/Yamagata strains following immunisation with virosome formulation. Participants with non-protective baseline titres to the H1N1 or B/Yamagata strains were more likely (p = 0.0049-0.006) to achieve protective levels of antibodies after immunisation with the virosome vaccine. Immunisation with the virosome formulation did not result in a significant rise in anti-PC or anti-PE antibodies.