Allergy in urban elderly population living in Campania region (Southern Italy). A multicenter study.

Given the increasing life expectancy observed in Western countries, there is a marked interest to know more about how aging could influence respiratory health. The aim of our study was to assess the prevalence, clinical characteristics and age of onset of allergic sensitization and clinical symptoms in a sample of atopic elders living in Campania region area (Southern Italy). Fourteen Allergy units or Centres examined a total of 462 patients. In this context 215 (46.53%) had positive skin prick tests (SPTs) to at least one allergen and were diagnosed with respiratory allergy. Parietaria represents the most common sensitizing agent in elders living in Campania region, followed by dust mites, grass pollen and Olea europaea. A relatively high percentage of atopic subjects suffered from respiratory symptoms at a fairly advanced age, namely 8.3% at 60-64 years, 10.2% at 65-70 and 5.7% at > 70 years. In conclusion, the prevalence and clinical significance of airway allergic sensitization in the elderly living in Campania region is more significant than expected in latter stages of life. Physicians should not neglect the role of atopy as a risk factor for the onset of allergic respiratory symptoms even in elderly patients.

Cypress pollen: an unexpected major sensitizing agent in different regions of Italy.

OBJECTIVES: In this multicenter survey, we assessed the impact of sensitization to cypress in atopic patients in Italy and determined whether cypress pollen concentration changed over time. METHODS: Allergists were required to collect the results of 100-200 consecutive skin prick tests (SPTs) performed during 2012. Seasonal symptoms were also recorded, as were airborne cypress pollen concentrations (data from the Italian Aerobiology Association) in 1998-2000 and 2010-2012. RESULTS: We examined 2258 atopic outpatients (56% females; age, 2-84 years) sensitized to at least 1 of the aeroallergens tested (Dermatophagoides species, grass, pellitory, olive, cypress, birch, Alternaria tenuis, and dog and cat dander). We found that 62.9%, 16.1%, and 32.7% of patients living in central, northern, and southern Italy, respectively, were sensitized to cypress (P < .0001). The cypress pollen concentration peak was delayed from February to March in 1998-2000 and 2010-2012 in all 3 regions, with a shift in pollination towards spring. Patients who were monosensitized to cypress reported mainly rhinitis (90.7%-97.6%) and conjunctivitis (38.1%-100%). In polysensitized patients, the prevalence of rhinitis, conjunctivitis, and asthma increased progressively (P < .0001) from southern to northern Italy. The same trend was observed for the prevalence of reported winter symptoms typical of cypress allergy (28%-65%). CONCLUSIONS: Today, cypress pollen is the most frequent sensitizing aeroallergen (assessed by SPT) in several areas of central Italy. Variations in the timing of the cypress pollination period may have favored this increased sensitization. Rhinitis and conjunctivitis are the predominant symptoms. The clinical impact of this allergy was poor in southern Italy and increased in central areas before reaching its peak in northern regions.

Sensitization to cockroach allergens in the urban atopic populations living in Campania district (southern Italy). A multicenter study.

BACKGROUND: Although cockroach (CR) is an important cause of allergic sensitization worldwide, only a few data are available in Italy and in a previous study we have observed, in Naples area, a low prevalence of CR sensitization. OBJECTIVES: We sought to perform a prospective study for assessing the prevalence of allergic sensitization to CR in a sample of atopic population living in Campania district area (Southern Italy). METHODS: Ten Allergy Units or Centres of Campania district participated in this cross-sectional study. Each centre was required to collect the results of at least 100 allergy consultations in consecutive outpatients referred for actual or suspected respiratory allergy. We registered demographic data, type and duration of respiratory symptoms, pets ownership, possible exposure to CR allergens, results of the skin prick tests (SPTs). RESULTS: A total of 1477 patients were examined, 985 (66.68%) had a SPTs positivity to at least one allergen. In this context, ninety were sensitized to CR, thus the overall sensitization prevalence in subjects with respiratory allergy was 6.09% ranging between 0-11% and only five patients were mono-sensitized. Thirteen patients reported rhinitis (R) + bronchial asthma (A), twenty-one R + A + conjunctivitis (C), thirty-seven R + C, five only A and eleven individuals only R. Sixty-seven patients exhibited persistent and twenty-three intermittent symptoms. Dust mite constituted the first cause of associated sensitization to CR. CONCLUSIONS: The prevalence of allergic sensitization to CR is not negligible in population living in Campania district and shows a higher trend in comparison to that found recently and some years ago in Naples area. Finally, we suggest atopic individuals and especially those highly sensitized to mite allergens or those living in low-income areas to be tested by SPTs / evaluation of serum specific IgE to CR allergens to exclude the occurrence of CR allergic sensitization.

Two new species of Phareicranaus Roewer, 1913 (Opiliones: Laniatores: Cranaidae), with notes on gregarious behavior and maternal care in Phareicranaus manauara.

In this paper we describe two new species of Phareicranaus Roewer, 1913: Phareicranaus rohei sp. nov. from the state of Amazonas, Brazil and Phareicranaus tizana sp. nov., from the state of Zulia, Venezuela. The number of known species of this genus increases to 47. We discuss and suggest the possible relationships of these species with their relatives and assign them into the clades proposed by Pinto-da-Rocha & Bonaldo (2011). Additionally, we conducted field observations at the type locality of Phareicranaus manauara (Pinto-da-Rocha, 1994), provide the first descriptions of maternal care and gregarious behavior, and discuss the occurrence of this behavior in the genus.

Contributions to the taxonomy of some Amazonian Stygnidae (Opiliones: Laniatores: Gonyleptoidea).

Some taxonomic changes are made in Amazonian Stygnidae, based on reinterpretation of generic boundaries: (1) the hitherto monotypic genus Jime Pinto-da-Rocha Tourinho, 2012 is newly recorded from Venezuela: Jime praecursor spec. nov. (Tobogán de la Selva, Amazonas state) is described and a new generic diagnosis is provided. The genital chaetotaxy is interpreted for the two known species of Jime, and (2) three species which have been originally described as Stygnoplus Simon, 1879 are herein newly transferred to Yapacana Pinto-da-Rocha, 1997 (hitherto monotypic): Y. ianomami (Pinto-da-Rocha Tourinho, 2012) comb. nov., Y. neblina (Pinto-da-Rocha Tourinho, 2012) comb. nov., and Y. tapirapeco (Pinto-da-Rocha Tourinho, 2012) comb. nov. A key for identification of males of the genus Yapacana is offered.

Development process of the Practical Approach to Lung Health in Kyrgyzstan.

The Practical Approach to Lung Health (PAL) strategy was adopted by the Ministry of Health of Kyrgyzstan to improve the quality of case management of priority respiratory illnesses, including tuberculosis (TB). The process of development and implementation of the strategy is described in the present study. The World Health Organization stepwise framework was adapted and used to initiate the PAL strategy within the Kyrgyzstan primary health care (PHC) system. The process followed 10 steps which included the government decision to support PAL development, and the establishment of a national working group in charge of adapting guidelines, developing training materials and testing the feasibility and impact of the guidelines. On the basis of the test results, the guidelines and training materials were revised and a national PAL implementation plan was developed. The ongoing health sector reform which focuses, in priority, on strengthening PHC services and the assistance from the government of Finland, generated favourable political, technical and financial circumstances for the development and implementation of the PAL strategy.

Feasibility test results of the Practical Approach to Lung Health in Bishkek, Kyrgyzstan.

SETTING: Ambulatory health centres in Bishkek, Kyrgyzstan. OBJECTIVE: To assess the results of training family doctors in Practical Approach to Lung Health (PAL) techniques. DESIGN: Comparison of the results of two surveys, before (baseline) and after (impact) training on PAL guidelines. Both surveys were carried out according to the same protocol. RESULTS: A total of 86 family physicians working in three ambulatory health centres participated in both surveys. Respectively 893 and 992 respiratory patients were registered in the baseline and impact surveys. Baseline survey patients had longer duration of symptoms, were older and had more concomitant health conditions than impact survey patients. Findings suggest that PAL training has resulted in a decrease by one third in referrals to hospital or specialists or for diagnostic tests. Data do not show any improvement in tuberculosis case detection. However, in the impact survey, the number of drugs prescribed per patient decreased by 13.6% and the average cost of prescription of any drug per patient was reduced by 32.2%. CONCLUSION: The study suggests that training in standardised PAL guidelines is likely to reduce referral as well as drug prescription costs for respiratory patients. These findings need to be confirmed by further studies.

The value of in vivo real time ultrasonography in assessing loin muscularity and carcass composition of rabbits.

Sixty nine growing rabbits were scanned over the lumbar region using a real time ultrasonography (RTU) machine to estimate loin muscularity and carcass composition. Longissimus thoracis et lumborum muscle (LM) depth, width and area were taken. Animals were weighed (LW), slaughtered and carcass composition was determined. Equivalent measurements to those taken by RTU in vivo were taken on the carcass and muscularity indices were calculated on carcass and in vivo. Simple correlations between the two types of measurements were determined and carcass composition was estimated by simple and multiple regressions. The LW varied from 1200 to 3410g. The simple correlations between carcass and in vivo RTU LM measurements were high (P<0.001) and the LM area was the trait with the highest correlation (r=0.92). Simple correlations between muscularity indices measured by RTU and in carcass were significant (P<0.001). In vivo RTU measurements explained a large amount of the variation of the carcass meat weight (MW) and bone weight (r(2) range from 0.49 to 0.77; P<0.001). Using multiple regression equations to estimate carcass composition, the best fit was obtained with the LW and one or more in vivo RTU measurement. The LW explained 90.6% of the variation of MW in the carcass. In vivo RTU is able to estimate loin muscularity and carcass composition of rabbits with accuracy. The usefulness of in vivo RTU and LW to predict carcass composition of rabbits using multiple regressions was also shown.

Results of the feasibility test of the Practical Approach to Lung Health in the Syrian Arab Republic.

We assessed implementation of the Practical Approach to Lung Health (PAL) in primary care facilities in the Syrian Arab Republic and its short-term impact on respiratory care in patients aged 5+ years. After training on PAL for 76 general practitioners in 75 health centres, referrals and sputum smear examinations for patients increased. The mean number of drugs prescribed per patient decreased by 14.8% and that of antibiotics by 33.3%, while prescriptions for inhaled medications increased. The mean cost of drug prescriptions fell by 26.2%.

Results of PAL feasibility test in primary health care facilities in four regions of Bolivia.

SETTING: Primary health care (PHC) centres in four Bolivian regions. OBJECTIVES: To test the feasibility and impact of training general practitioners (GPs) in standard case management of respiratory conditions in patients aged > or =5 years. DESIGN: Comparison of the results of two surveys: the baseline survey before training and the impact survey after training on standard guidelines on case management of respiratory conditions. RESULTS: A total of 78 GPs working in 65 health centres participated in both surveys. The baseline survey registered 1033 respiratory patients and the impact survey 1154. The patients were comparable in sex distribution, previous visits, duration of symptoms and clinical diagnoses. The differences were significant in age distribution, concomitant diseases and risk factors. As a result of training, referrals to a higher level decreased by 34.6% and the proportion of tuberculosis (TB) suspects identified increased by 30%. The number of drugs prescribed per patient decreased by 16.2%. The average cost of prescription of any drug per patient dropped by 32.3%. CONCLUSION: Training in the standard practical approach to lung health guidelines improved the quality and reduced the cost of treatment of respiratory diseases at PHC units. Training should be an integral part of a comprehensive managerial approach for the implementation of case management guidelines.

First Amazonian species of Maracaynatum, with comments on the genus (Opiliones: Laniatores: Samoidae).

Among Opiliones, the family Samoidae Sørensen, 1886 is a group of small Laniatores with a wide tropical distribution. Neotropical samoids are distributed mainly in the Caribbean subregion, with species recorded from insular localities and the Venezuelan coastal range. Previously, for continental South America only three genera and just a few specimens of unidentified Samoidae have been recorded from Brazil. In this paper we describe Maracaynatum isadorae sp. nov., the first record of the genus for Brazil and the first samoid described for the Amazon biome. We also provide an emended diagnosis for the genus and a map with its distribution.

Taxonomic notes on the genus Auranus (Opiliones, Laniatores, Stygnidae), with description of two new species.

Among the Amazonian families of harvestmen the members of Stygnidae are better known due to the recent revision of the family and efforts of specialists describing new taxa in the last few years. Species of Amazonian genus Auranus Mello-Leitão, 1941, have been collected in several inventories that were carried out in different locations of the Amazon basin. In this paper we provide a new diagnosis for Auranus, and the description of two new species: Auranus leonidas sp. nov. and Auranus xerxes sp. nov. from the Brazilian states of Roraima and Amazonas, respectively. We also offer complementary genital descriptions of Auranus hehu Pinto-da-Rocha & Tourinho 2012, Auranus parvus Mello-Leitão, 1941, and Auranus tepui Pinto-da-Rocha & Tourinho 2012. Five species are recognized in Auranus, including the two new species described in this paper. The lamina parva modified into a calyx is proposed as putative synapomorphy for the genus Auranus. Therefore, A. hoeferscovitorum, which does not possess this character, is removed from Auranus. Instead we propose for it the new combination Verrucastygnus hoeferscovitorum comb. nov. We also provide a key to the males of Auranus, and a map with the distribution for all species examined in this work.

Effects of omalizumab in severe asthmatics across ages: A real life Italian experience.

BACKGROUND: This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting. METHODS: 105 consecutive severe asthmatics (GINA step 4-5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18-39, 40-64 and ≥ 65 years. RESULTS: Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1 increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049). After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40-64 (OR = 0.284 [CI95% = 0.098-0.826], p = 0.021) and 18-39 (OR = 0.133 [CI95% = 0.026-0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (ß = -1.070; p = 0.046) passing from each age class was observed. CONCLUSION: Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.

The Worldwide Spread of the Tiger Mosquito as Revealed by Mitogenome Haplogroup Diversity.

In the last 40 years, the Asian tiger mosquito Aedes albopictus, indigenous to East Asia, has colonized every continent except Antarctica. Its spread is a major public health concern, given that this species is a competent vector for numerous arboviruses, including those causing dengue, chikungunya, West Nile, and the recently emerged Zika fever. To acquire more information on the ancestral source(s) of adventive populations and the overall diffusion process from its native range, we analyzed the mitogenome variation of 27 individuals from representative populations of Asia, the Americas, and Europe. Phylogenetic analyses revealed five haplogroups in Asia, but population surveys appear to indicate that only three of these (A1a1, A1a2, and A1b) were involved in the recent worldwide spread. We also found out that a derived lineage (A1a1a1) within A1a1, which is now common in Italy, most likely arose in North America from an ancestral Japanese source. These different genetic sources now coexist in many of the recently colonized areas, thus probably creating novel genomic combinations which might be one of the causes of the apparently growing ability of A. albopictus to expand its geographical range.

Case management of childhood pneumonia in developing countries: recent relevant research and current initiatives.

Acute respiratory infections (ARI), mostly pneumonia, are one of the leading causes of death in young children in developing countries, accounting for 28% of childhood mortality. This paper provides a summary of the research and technical development efforts made in the last 15 years which contributed to improving the effectiveness of the case management strategy to reduce mortality from pneumonia in children in developing countries. Community intervention studies provided strong evidence that the strategy was feasible and effective in producing a substantial impact on pneumonia mortality. Clinical studies provided the rationale for improving the sensitivity and specificity of key signs of pneumonia, and for enhancing the therapeutic efficacy of standard home treatment. Research also provided data to deal with the problem of the clinical overlap of pneumonia and malaria in children. Technological initiatives succeeded in making appropriate diagnostic and therapeutic devices available. An important body of socio-cultural knowledge about family practices regarding pneumonia and ARI in children was built up and provided orientation on effective communication between health workers and families about home care of children with ARI. Health systems research focused on methods for surveillance of bacterial drug resistance and methodologies for evaluating the control programmes. Despite advances in the development of vaccines against respiratory bacteria and in the prevention of risk factors for pneumonia in children, case management will continue to be a central strategy for preventing mortality. Current international research initiatives are looking into measures that can improve the referral of severe pneumonia and effective management of severe pneumonia at first level hospitals.

Epidemiology of tuberculosis.

Author refers some data about prevalence and incidence of infection and morbidity in tubercular disease. These data are very discordant according to different social conditions of countries in which they are been derived. Particularly, he analyses the importance of an extended tuberculin survey, as the essential method to study both epidemiological parameters. In this paper, Author emphasizes how the test needs to be used systematically and in subjects of the same age. At last, mortality is more an indicator of the efficiency of the case finding and treatment programme than an epidemiological index. Indeed there is a parallel increase in the proportions of deaths of patients older than 45 years of age also in under-developing countries.

Indoor air pollution in a Kenyan village.

In April 1986, a study was carried out within rural households in Maragua area, Muranga District, Republic of Kenya, to assess the degree of indoor air pollution and to find its relationship, if any, to acute respiratory infections (ARI) among children aged below 5 years within the study. This study was carried out within an ongoing aetiological and epidemiological community study on ARI as a collaborative effort between the Department of Paediatrics, University of Nairobi; the Department of Chemistry, Kenyatta University; the Department of Environmental Sciences, Agricultural University, Wagenigen, The Netherlands; the World Health Organization; and the Ministry of Health, Republic of Kenya. Repeated 24 hour measurements of respirable suspended particles (RSP) and nitrogen dioxide (NO2), were carried out in 36 randomly selected houses where most of the cooking was done on open fires using firewood and crop residues as fuel. Data on house characteristics and activity in the study were gathered by questionnaire. The mean of 24 hour average RSP concentration (1400mg/m3), average during the 7 hours of daily burning (3000-4000mg/m3), and evening peak levels (up to 3600mg/m3) indicate that deleterious health effects due to exposure to excessive levels of toxic pollutants in smoke from biomass combustion are likely to occur especially among pre-school children and women. Concentrations of selected polycyclic hydrocarbons in the particulate material were found to be high. It was not possible to demonstrate a relationship between the indoor air pollution and episodes of ARI partly because of small sample size and also the more or less homogeneous nature of pollution among all the households.

Evolution of the concepts of functional anatomy of the knee joint.

It is the purpose of this study to present a review of studies on the kinematics of the knee joint and load distribution in the two compartments, medial and lateral, in order to reveal the evolution of concepts of functional anatomy. Flexion-extension features have been clearly defined by numerous authors who have used different methods of research. Transverse rotation, instead, still needs to be clarified. In particular, whether or not a screw-home movement exists has been questioned by many authors who have studied the kinematics of the knee, both without loading and during walking. Dynamic studies have shown how the radiographic method (static) to deduce load distribution in the knee joint is inadequate; this is because during walking, loading tends to be transmitted on the medial compartment, also the case in valgus knees.

Fourteen new generic and ten new specific synonymies in Pholcidae (Araneae), and transfer of Mystes Bristowe to Filistatidae.

Between 1998 and 2011, the Venezuelan arachnologist Manuel Ángel González-Sponga (GS) published a series of taxonomic papers devoted to the Pholcidae of Venezuela. Of his 22 new genera, 20 were monotypic when described, suggesting a high percentage of synonyms. We studied his descriptions and as far as accessible his type specimens and propose the following new generic synonymies: Autana GS, 2011 = Mesabolivar GS, 1998; Ayomania GS, 2005 and Venezuela Koçak & Kemal, 2008 (new replacement names for Falconia GS, 2003) = Mecolaesthus Simon, 1893; Carbonaria GS, 2009 = Mecolaesthus Simon, 1893; Caruaya GS, 2011 = Mesabolivar GS, 1998; Coroia GS, 2005 = Artema Walckenaer, 1837; Maimire GS, 2009 = Mecolaesthus Simon, 1893; Moraia GS, 2011 = Mecolaesthus Simon, 1893; Nasuta GS, 2009 = Mecolaesthus Simon, 1893; Portena GS, 2011 = Metagonia Simon, 1893; Rioparaguanus GS, 2005 = Mesabolivar GS, 1998; Tonoro GS, 2009 = Litoporus Simon, 1893; Sanluisi GS, 2003 = Mecolaesthus Simon, 1893. Three of the type species are also specific synonyms: Autana autanensis GS, 2011 = Mesabolivar aurantiacus (Mello-Leitão, 1930); Coroia magna GS, 2005 = Artema atlanta Walckenaer, 1837; Tonoro multispinae GS, 2009 = Litoporus uncatus (Simon, 1893). Six species that González-Sponga described under Blechroscelis (a genus previously synonymized with Priscula Simon, 1893) are all synonyms of Mesabolivar eberhardi Huber, 2000 (B. acuoso GS, 2011; B. araguanus GS, 2011; B. blechroscelis GS, 2011; B. copeyensis GS, 2011; B. cordillerano GS, 2011; B. andinensis GS, 2011). In addition, and unrelated to González-Sponga's work, we synonymize the Central Asian monotypic genus Ceratopholcus Spassky, 1934 with Crossopriza Simon, 1893; we synonymize the Chinese species Pholcus acerosus Peng & Zhang, 2011 with Pholcus fragillimus Strand, 1907 and remove the Malaysian monotypic genus Mystes Bristowe, 1938, previously thought to be the only East Asian representative of the subfamily Ninetinae, to the family Filistatidae.