Daily allergic multimorbidity in rhinitis using mobile technology: A novel concept of the MASK study.

BACKGROUND: Multimorbidity in allergic airway diseases is well known, but no data exist about the daily dynamics of symptoms and their impact on work. To better understand this, we aimed to assess the presence and control of daily allergic multimorbidity (asthma, conjunctivitis, rhinitis) and its impact on work productivity using a mobile technology, the Allergy Diary. METHODS: We undertook a 1-year prospective observational study in which 4 210 users and 32 585 days were monitored in 19 countries. Five visual analogue scales (VAS) assessed the daily burden of the disease (i.e., global evaluation, nose, eyes, asthma and work). Visual analogue scale levels <20/100 were categorized as "Low" burden and VAS levels ≥50/100 as "High" burden. RESULTS: Visual analogue scales global measured levels assessing the global control of the allergic disease were significantly associated with allergic multimorbidity. Eight hypothesis-driven patterns were defined based on "Low" and "High" VAS levels. There were <0.2% days of Rhinitis Low and Asthma High or Conjunctivitis High patterns. There were 5.9% days with a Rhinitis High-Asthma Low pattern. There were 1.7% days with a Rhinitis High-Asthma High-Conjunctivitis Low pattern. A novel Rhinitis High-Asthma High-Conjunctivitis High pattern was identified in 2.9% days and had the greatest impact on uncontrolled VAS global measured and impaired work productivity. Work productivity was significantly correlated with VAS global measured levels. CONCLUSIONS: In a novel approach examining daily symptoms with mobile technology, we found considerable intra-individual variability of allergic multimorbidity including a previously unrecognized extreme pattern of uncontrolled multimorbidity.

Pulmonary rehabilitation at home guided by telemonitoring and access to healthcare facilities for respiratory complications in patients with neuromuscular disease.

BACKGROUND: Pulmonary complications are the main cause of morbidity and mortality in neuromuscular patients. Aim of this study was to evaluate the feasibility of a home follow-up program combining telemonitoring and chest physiotherapy (CPT) in preventing acute respiratory episodes. DESIGN: Prospective observational study in a period of 24 months, and comparison with preintervention data of the same patients. SETTING: Outpatients and community. POPULATION: Neuromuscular patients. Enrolment criteria were: reduced efficacy of cough, high family support, long home-to-hospital distance. METHODS: Caregivers and patients had to register daily respiratory signs and symptoms. Each patient was equipped with a pulse oximeter with a modem for transmitting data to a remote control center, in charge of alerting the pulmonologist in case of sign and symptom deterioration. CPT interventions at home were planned after indication by the pulmonologist. The number of emergency room admissions or hospitalization following respiratory exacerbations were registered. RESULTS: Thirteen patients were enrolled. In the first year of monitoring, 18 alerts were transmitted to the pulmonologist, average 1.38±1.38 alert/patient. In the second year, the number of alerts were 5, average 0.38±0.65 alert/patient (P<0.01). In 24 months, 241 respiratory therapists' interventions were conducted on 11 patients. In the first 12 months there were four episodes of hospitalisation, none in the following 12 months. In the year prior to the project, there were seven cases of hospitalisation and one case of emergency room admission. CONCLUSION: The combination of telemonitoring and CPT at home is feasible in the long-term for patients with neuromuscular disease. CLINICAL REHABILITATION IMPACT: An apparent reduction of hospitalisation and emergency room admissions for respiratory complications can justify a randomized control trial to confirm efficacy and effectiveness.

[Pulmonary hyalinizing granuloma. Clinicopathologic study of 2 cases, with some original ultrastructural observations and review of the literature]. / Granuloma jalinizzante del polmone. Studio clinico-patologico di 2 casi, con alcune originali osservazioni ultrastrutturali e revisione della letteratura.

AIM: To report the clinical, histological, immunohistochemical and ultrastructural features of 2 new cases of pulmonary hyalinizing granuloma. RESULTS: Both patients were males: one, 72-year-old with retroperitoneal fibrosis, was asymptomatic, while the other, 67-year-old, presented with non productive cough. In both cases, a chest x-ray showed a solitary pulmonary nodule. Microscopically, the nodules were well circumscribed and composed of lamellae of hyalinized collagen. At the periphery, a more cellular rim consisting of lymphocytes, plasma cells and myofibroblasts was present. Immunohistochemical and ultrastructural examinations revealed myofibroblastic elements actively synthesizing collagen fibrils.

Acute and chronic hyperbaric oxygen exposure in humans: effects on blood polyamines, adrenocorticotropin and beta-endorphin.

Plasma beta-endorphin, adrenocorticotropin (ACTH) and blood polyamine (spermidine and spermine) concentrations were evaluated in healthy adult male athletes undergoing hyperbaric oxygen exposure for 10 days (2.8 atm, 100% O2, 60 min daily). In the "acute phase", corresponding to the first day of treatment, and in the "acute in the chronic phase", corresponding to the values obtained on the 5th and 10th days after 60 min of hyperbaric O2, both ACTH and beta-endorphin levels increased significantly, whereas no variations were observed for polyamine concentrations. In the "chronic phase", corresponding to the basal values of the 5th and 10th days of treatment, we found a different pattern. In fact, the concentration of polyamines showed a remarkable enhancement, while ACTH and beta-endorphin levels remained unchanged. No significant variations were observed during hyperbarism with air. These results demonstrate different modifications of polyamines and beta-endorphin and ACTH in subjects submitted to hyperbaric oxygen exposure.

Primary malignant non-Hodgkin's lymphoma of the lung arising in mucosa-associated lymphoid tissue (MALT).

We describe a 10 yr follow-up of a patient with a primary malignant non-Hodgkin's lymphoma of the lung, arising in mucosa-associated lymphoid tissue (MALT). Although the patient was not treated with chemotherapy or radiotherapy, no peripheral spread occurred, confirming that MALT-associated lymphomas apparently remain localized until late in the course of the disease.

[Measurement of compliance and resistance to respiratory airflow in the course of mechanical ventilation]. / Misura della compliance e delle resistenze al flusso delle vie aeree in corso di ventilazione meccanica.

The importance in resuscitation treatment of the measurement of air ways flow resistance and compliance is stressed. In this regard, attention is paid to the possibility of utilizing the automatic respiratory (recording the mouth pressure curve) as an authentic measuring apparatus for these factors. Research into mechanical models and real patients also points to the possibility (seemingly not reported up to now) of measuring expiratory resistance independently and of highlighting air-trapping phenomena.