RESUMEN
BACKGROUND: Dupilumab is an anti-IL-4Rα antibody used in the treatment of patients with moderate-to-severe atopic dermatitis (msAD). This study explored the potential benefit of dupilumab in perennial allergic rhinoconjunctivitis (PAR) and perennial allergic asthma (PAA) caused by indoor allergens in adults with msAD. METHODS: This multicentric, prospective, observational, real-life study included adult patients with msAD who had been treated with dupilumab in 16 Italian care centres. Efficacy outcomes regarding AD, PAR and PAA were collected at baseline and 16 weeks. Safety was also assessed. RESULTS: We enrolled 123 patients with msAD. Between baseline and 16 weeks of treatment, the following measurements decreased statistically significantly: Eczema Area and Severity Index, SCOring AD, Patient-Oriented Eczema Measure, pruritus score, sleep score, Dermatology Life Quality Index and IgE. Dupilumab treatment in patients with comorbid PAR (n = 41) was associated with significant improvements in PAR disease control (measured using a Rhinitis Control Scoring System) and in PAR Quality of life (QoL) (measured using the Rhinoconjunctivitis QoL Questionnaire scores). In 32 patients with comorbid PAA, dupilumab significantly improved PAA control (measured using the Asthma Control Test and five-item Asthma Control Questionnaire scores) and disease-related QoL (measured using the Asthma QoL Questionnaire scores). Thirty-five patients (28.5%) developed conjunctivitis during the study period. CONCLUSION: These results support the benefits of dupilumab for adult patients with PAR and/or PAA associated with msAD.
Asunto(s)
Dermatitis Atópica , Calidad de Vida , Adulto , Anticuerpos Monoclonales Humanizados , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/epidemiología , Método Doble Ciego , Humanos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: This mono-center randomized, controlled, double-blind study evaluates the safety and efficacy of MD2011001 cream versus placebo, in mild-to-moderate atopic dermatitis (AD). MD2011001 is a nonsteroidal topical cream containing vitamin E, epigallocatechin gallate and grape seed procyanidins. METHODS: Patients with AD (corresponding to an IGA score of 2 or 3), involving the face, the perioral/periocular area and/or the neck, were enrolled. Patients were randomized 1:1 ratio to receive MD2011001 or placebo before the start of the study (D0), then evaluated after 7 days, and after 28 days. The study was approved by the Local Independent Ethics Committee and conducted according to the Declaration of Helsinki and local regulations. The statistical tests used were the Wilcoxon test and the Mann-Whitney U-test. RESULTS: Forty-four patients (29F and 15M) were enrolled. The IGA values showed a statistically significant reduction during the treatment period obtaining a favorable safety profile and local tolerance for both the products. The reduction in the surface area affected by AD was significantly faster with MD2011001. DISCUSSION: This study focuses on very sensitive areas known to be particularly susceptible to local complications. CONCLUSIONS: These results suggest the usefulness of an emollient treatment for mild/moderate AD.
Asunto(s)
Antiinflamatorios/uso terapéutico , Catequina/análogos & derivados , Dermatitis Atópica/tratamiento farmacológico , Extracto de Semillas de Uva/administración & dosificación , Proantocianidinas/administración & dosificación , Vitamina E/administración & dosificación , Administración Tópica , Adolescente , Adulto , Antiinflamatorios/química , Catequina/administración & dosificación , Niño , Preescolar , Método Doble Ciego , Emolientes/uso terapéutico , Cara , Femenino , Humanos , Masculino , Cuello , Resultado del Tratamiento , Adulto JovenRESUMEN
The study describes the mortality of 417 workers employed in a asbestos-cement plant, located in Bari, Puglia, Southern Italy. Follow up started on February 1st 1972. The vital status and cause of death were ascertained at 1995. The mortality experience of the Apulian population was used as comparison. Using 90% confidence limits (CLs), a significant increase in mortality was observed in our cohort from: all causes of death (SMR 118, CL 100-139), pneumoconiosis (SMR 14810, CL 10298-20683), all types of cancer (SMR 139, CL 105-181), lung (SMR 191, CL 126-277), pleural (SMR 1560 CL 431-4081) and peritoneum (SMR 1705, CL 303-5367) malignant neoplasms. In our cohort, the discrepancy between observed and expected mortality for lung and pleural cancer occurred 30 years after the first exposure, after 40 years for all neoplasms and peritoneum cancer. Under the Cox regression model, lung cancer SMR showed a curvilinear trend along time since first exposure, the peak being detected at 35 years. Finally, SMRs from our cohort were compared to a previously described cohort including workers from the same plant compensated for asbestosis by INAIL.
Asunto(s)
Amianto/efectos adversos , Materiales de Construcción/efectos adversos , Industria Procesadora y de Extracción , Neoplasias/mortalidad , Enfermedades Profesionales/mortalidad , Neumoconiosis/mortalidad , Adulto , Asbestosis/mortalidad , Causas de Muerte , Estudios de Cohortes , Enfermedades del Sistema Digestivo/mortalidad , Industria Procesadora y de Extracción/estadística & datos numéricos , Estudios de Seguimiento , Humanos , Italia , Enfermedades Pulmonares/mortalidad , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/mortalidad , Neoplasias Pleurales/mortalidad , Modelos de Riesgos Proporcionales , Factores de TiempoRESUMEN
OBJECTIVE: Data in the literature suggest the possibility of using ultrasonography to diagnose sliding gastric hiatal hernia. The aim of this study was to confirm the diagnostic accuracy of transabdominal ultrasonography for the diagnosis of sliding gastric hiatal hernia, using endoscopy as the reference test. The latter procedure was used since it also recognizes the presence of esophagitis and/or varices, two pathological conditions that could per se influence ultrasonographic evaluation, based on measurement of the esophageal diameter. MATERIAL AND METHODS: A total of 180 consecutive patients, admitted to our hospital for endoscopy, were examined. Of these, 12 patients were not included in the final study. After fasting, the remaining 168 patients were first evaluated by ultrasonography and later by endoscopy. Esophageal diameter was measured by ultrasonography at the level of the diaphragmatic hiatus. RESULTS: Using a diameter > or = 18 mm as the sensitivity threshold, 29 patients potentially affected by hiatal hernia were identified by ultrasonography. Upper endoscopy examination confirmed the presence of hiatal hernia in 24 of these patients and documented 4 additional hernias in the group of patients with a transdiaphragmatic esophageal diameter <18 mm (positive and negative predictive values were 82.7% and 97%, respectively). Analysis of the distribution of esophageal varices and esophagitis in all 168 excluded the possibility that these pathological conditions could influence the esophageal diameter. CONCLUSIONS: Ultrasonography represents a simple and well-tolerated diagnostic approach in sliding gastric hiatal hernia. The good diagnostic accuracy suggests its potential use in clinical and epidemiological settings.
Asunto(s)
Hernia Hiatal/diagnóstico por imagen , Hernia Hiatal/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Esófago/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
We retrospectively evaluated data from 213 consecutive patients; 152 were affected by obstructive sleep apnea (OSA), 29 had OSA associated with chronic obstructive pulmonary disease (COPD), also known as overlap syndrome, and 32 had COPD. Patients with obesity-hypoventilation syndrome were not included. The aims of the study were to evaluate the anthropometric, pulmonary, and polysomnographic characteristics of patients affected by overlap syndrome compared to "simple" OSA and to COPD subjects and to analyze the determinants of hypercapnia in overlap syndrome. In the comparison between overlap and OSA patients, the overlap group had a significantly higher PaCO2 (44.59 vs. 39.22 mm Hg; p < 0.01), in the presence of a similar AHI (40.46 vs. 41.59/h). Comparing overlap to COPD patients, overlap showed a significantly higher PaCO2 value (44.59 vs. 39.63 mm Hg; p < 0.005) and had significantly less severe obstructive impairment (FEV 162.93 vs. 47.31%; FEV1/FVC ratio 66.71 vs. 59.25%; p < 0.005). Anthropometric, pulmonary function, and polysomnographic data did not differ between normo- and hypercapnic overlap patients. The best model (stepwise multiple regression analysis) for predicting PaCO2 in overlap patients showed r2 value 0.65: PaO2 contributed to 38%, FEV1 to 15%, and weight to 12%. In conclusion, the occurrence of hypercapnia in overlap patients is only partially explained by the combination of overweight and reduced respiratory function, supporting the hypothesis of a multifactorial genesis.