Use of voltammetric analysis for fast and objective discrimination of the etiology, evolution, and bacterial infection of lower limb ulcers.

The timely recognition of leg ulcers (LU) etiology and infection is pivotal to optimize management and accelerate healing. The objective of this proof-of-concept study was to test the diagnostic performance of voltammetric analysis (VA) on ulcer exudate to identify LU etiology, infection, and predict clinical course. We enrolled 25 patients aged ≥60 years, affected by 42 venous/arterial LU. Clinical examination (Leg Ulcer Measurement Tool score, LUMT), swab culture, and VA were performed at baseline and 30 days. The ability of VA to predict outcomes was tested using partial least square-discrimination analysis. Mean age was 75 years (SD 11.1), 9/25 were male. The accuracy, sensitivity, and specificity vs. etiology were 97.4, 100%, and 94.1%, respectively; the corresponding figures were 95.2%, 100%, 88.9%, for infection and 94%, 84.6%, 100% for predicted objective LUMT worsening. VA is a promising diagnostic/prognostic tool for management of LU that may allow a more timely targeted therapy.

Comorbidity modulates non invasive ventilation-induced changes in breath print of obstructive sleep apnea syndrome patients.

INTRODUCTION: In obstructive sleep apnea syndrome (OSAS), exhaled volatile organic compounds (VOCs) change after long-term continuous positive airway pressure (CPAP). The objective of the study was to verify whether changes in VOCs pattern are detectable after the first night of CPAP and to identify correlates, if any, of these changes. METHODS: Fifty OSAS patients underwent a multidimensional assessment and breath print (BP) analysis through 28 sensors e-nose at baseline and after the first night of CPAP. Boxplots of individual BP evolution after CPAP and groups were compared by ANOVA and Fisher's exact t. Partial least square discriminant analysis (PLS-DA), with leave-one-out as cross-validation was used to calculate to which extent basal BP could predicts changes in apnea-hypopnea index (AHI). RESULTS: CPAP was effective in all the patients (delta AHI 35.8 events/h; residual AHI 6.0 events/h). BP dramatically changed after a single-night CPAP and changes conformed to two well-distinguished patterns: pattern C (n = 29), characterized by consonant boxplots, and pattern D (n = 21), with variably discordant boxplots. The average number of comorbid diseases (1.55 [standard deviation, SD 1.0] in group C, 3.14 [SD 1.8] in group D, p < 0.001) and the prevalence of selected comorbidity (diabetes mellitus, metabolic syndrome, and chronic heart failure), were the only features distinguishing groups. CONCLUSION: We found that BP change after a single night of CPAP largely depends upon comorbidity. Comorbidity likely contributes to phenotypic variability in OSAS population. BP might qualify as a surrogate index of the response to and, later, compliance with CPAP.