Overweight and obesity as risk factors for impaired lung function in patients with asthma: A real-life experience.

Several studies have outlined a possible relationship between an increased body mass index (BMI) and asthma. The aim of the study was to investigate in patients with asthma, enrolled in a real-life setting, a possible relationship between BMI and asthma parameters, including lung function markers (i.e., forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], FEV1/FVC ratio, and forced expiratory flow at 25-75%), fractional concentration of exhaled nitric oxide (FeNO), asthma control level, Asthma Control Test (ACT), comorbid allergy, and allergic rhinitis (AR). The study included 286 patients with asthma. All subjects were evaluated performing clinical examination, spirometry, FeNO measurement, and ACT questionnaire. Ninety-six (33.6%) patients were overweight and 45 (14.1%) patients were obese. Lung function was significantly impaired in overweight and obese asthmatic patients in comparison with normal-weight ones. Increased BMI did not affect FeNO values and asthma control level. Overweight patients had double the risk (odds ratio [OR], 1.89) and obese patients had triple the risk (OR, 3.17) of having pathological FEV1 in comparison with normal-weight patients. Both in overweight (OR, 2.415) and obese patients (OR, 2.126), the risk to have pathological FEV1/FVC was about two times higher than in normal-weight patients. In overweight and obese asthmatic patients the probability of allergy was, respectively, 3.5 times (OR, 0.285) and 4.5 times (OR, 0.224) lower compared with normal-weight asthmatic patients. The risk of suffering from AR was three times lower in overweight (OR, 0.331) patients and six times lower in obese (OR, 0.163) patients. The present study suggests that BMI assessment should be routinely considered in asthmatic patients to reveal bronchial obstruction, also, in controlled asthma.

Influence of spurious hemolysis on blood gas analysis.

BACKGROUND: Although the prevalence of hemolyzed samples referred for blood gas analysis is as high as 4%, no studies have assessed the bias introduced by spurious erythrocyte breakdown, nor it is known which parameters are mostly influenced and to what extent. This study was hence planned to assess the influence of spurious hemolysis on venous blood gas analysis. METHODS: Venous blood was collected from nine healthy volunteers in sodium heparin tubes and divided in two aliquots of 3 mL. The former aliquot was mechanically hemolyzed by aspiration with 0.5 mL insulin syringe equipped with 30 gauge needle. One milliliter of all aliquots was tested for hemoglobin, pH, oxygen partial pressure (pO2), partial pressure of carbon dioxide (pCO2), bicarbonate (HCO³â»), oxygen tension at 50% hemoglobin saturation (p50), oxygen saturation (sO2), actual base excess (ABE), carboxyhemoglobin (COHb), methemoglobin (metHb), ionized calcium (Ca²âº) and potassium, on ABL800 flex. The remaining 2 mL of blood were centrifuged, plasma separated and tested for hemolysis index. RESULTS: The concentration of cell-free hemoglobin increased from <0.5 g/L to 8.9±1.5 g/L in hemolyzed aliquots. In hemolyzed blood, significant decreases were found for pH (-0.2%), pO2 (-4.9%), sO2 (-4.9%), COHb (-11%) and Ca²âº (-7.0%), whereas significant increases were observed for pCO2 (+4.1%), HCO³â» (+1.4%) and potassium (+152%). Clinically meaningful bias was found for pO2, pCO2, Ca²âº and potassium. CONCLUSIONS: Spurious hemolysis is likely to introduce meaningful biases in blood gas analysis, hence manufacturers of blood gas analyzers should develop instrumentation capable of identifying interfering substances in whole blood. The presence of spurious hemolysis should also be suspected whenever test results do not reflect the clinics.

Preanalytical quality improvement: from dream to reality.

Abstract Laboratory diagnostics (i.e., the total testing process) develops conventionally through a virtual loop, originally referred to as "the brain to brain cycle" by George Lundberg. Throughout this complex cycle, there is an inherent possibility that a mistake might occur. According to reliable data, preanalytical errors still account for nearly 60%-70% of all problems occurring in laboratory diagnostics, most of them attributable to mishandling procedures during collection, handling, preparing or storing the specimens. Although most of these would be "intercepted" before inappropriate reactions are taken, in nearly one fifth of the cases they can produce inappropriate investigations and unjustifiable increase in costs, while generating inappropriate clinical decisions and causing some unfortunate circumstances. Several steps have already been undertaken to increase awareness and establish a governance of this frequently overlooked aspect of the total testing process. Standardization and monitoring preanalytical variables is of foremost importance and is associated with the most efficient and well-organized laboratories, resulting in reduced operational costs and increased revenues. As such, this article is aimed at providing readers with significant updates on the total quality management of the preanalytical phase to endeavour further improvement for patient safety throughout this phase of the total testing process.

Autologous mesenchymal stem cells foster revascularization of ischemic limbs in systemic sclerosis: a case report.

BACKGROUND: Mesenchymal stem cells can differentiate into endothelial cells and participate in angiogenesis in adults. In experimental models of acute myocardial infarction, mesenchymal stem cells led to the recovery of cardiac function through the formation of a new vascular network. OBJECTIVE: To describe treatment with intravenous infusions of expanded autologous mesenchymal stem cells in 1 patient with critical limb ischemia due to systemic sclerosis. DESIGN: Case report. SETTING: The rheumatology unit at the University of Florence, Florence, Italy. PATIENT: A woman, aged 34 years, with systemic sclerosis who developed acute gangrene of the upper and lower limbs. INTERVENTION: 3 intravenous pulses of expanded autologous mesenchymal stem cells. MEASUREMENTS: Angiography, skin histopathology, and immunohistochemistry. RESULTS: Areas of necrotic skin were reduced after the first mesenchymal stem-cell infusion. After the third infusion, angiography showed revascularization of the patient's extremities. Skin section analysis revealed cell clusters with tubelike structures, and angiogenic factors were strongly expressed. LIMITATION: Causality cannot be established by a single case. CONCLUSION: In patients with systemic sclerosis who have severe peripheral ischemia, intravenous infusion of expanded autologous mesenchymal stem cells may foster the recovery of the vascular network, restore blood flow, and reduce skin necrosis. PRIMARY FUNDING SOURCE: Fondazione Cassa di Risparmio di Pistoia e Pescia (partial funding).

The hepatitis D virus in Italy. A vanishing infection, not yet a vanished disease.

INTRODUCTION: Hepatitis D Virus (HDV) infection is vanishing in Italy. It is therefore believed that hepatitis D is no longer a medical problem in the domestic population of the country but remains of concern only in migrants from HDV-endemic areas. OBJECTIVES: To report the clinical features and the medical impact of the residual domestic HDV infections in Italy. METHODS: From 2010 to 2019, one hundred ninety-three first-time patients with chronic HDV liver disease attended gastroenterology units in Torino and San Giovanni Rotondo (Apulia); 121 were native Italians and 72 were immigrants born abroad. For this study, we considered the 121 native Italians in order to determine their clinical features and the impact of HDV disease in liver transplant programs. RESULTS: At the last observation the median age of the 121 native Italians was 58 years. At the end of the follow-up, the median liver stiffness was 12.0 kPa (95% CI 11.2-17.4), 86 patients (71.1%) had a diagnosis of cirrhosis; 80 patients (66.1%) remained HDV viremic. The ratio of HDV to total HBsAg transplants varied from 38.5% (139/361) in 2000-2009 to 50.2% (130/259) in 2010-2019, indicating a disproportionate role of hepatitis D in liver transplants compared to the minor prevalence of HDV infections in the current scenario of HBsAg-positive liver disorders in Italy. CONCLUSION: Though HDV is vanishing in Italy, a legacy of ageing native-Italian patients with advanced HDV liver disease still represents an important medical issue and maintains an impact on liver transplantation.

Influence of mechanical trauma of blood and hemolysis on PFA-100 testing.

Although the appropriate quality of samples is essential for platelet function testing, information is lacking on interference from mechanical trauma of blood and hemolysis on PFA-100 analyzer. Citrated blood collected from nine healthy volunteers was divided into three aliquots. The first aliquot ('A') was processed without further manipulation, whereas the second and third were subjected to mechanical trauma by two ('aliquot B') or four passages ('aliquot C') through a very fine needle (30 gauge) to produce hemolysis and cell trauma mimicking poor sample collection. Samples were tested on PFA-100 and Advia 2120, and plasma then separated and tested for lactate dehydrogenase (LDH) and hemolysis index. Negligible hemolysis was present in aliquot A (hemolysis index 0.2 ± 0.1, cell-free hemoglobin 0-0.5 g/l), whereas an increasing amount was present in aliquots B (hemolysis index of 13.1 ± 1.8, cell-free hemoglobin 6.0-6.5 g/l) and C (hemolysis index 24.0 ± 1.1, cell-free hemoglobin 11.5-12.0 g/l). Increases in LDH, and concomitant reductions in platelet and red blood cell counts were observed in aliquots B and C. In hemolyzed aliquots B, four out of nine samples yielded 'flow obstruction' with both PFA-100 agonist cartridges, whereas the closure times were dramatically prolonged in the remaining five samples. In hemolyzed aliquots C, flow obstruction was recorded in six of nine samples for collagen and ADP and all samples for collagen and epinephrine, whereas closure times of collagen and ADP in the remaining three samples were dramatically prolonged. Mechanical trauma of blood causing hemolysis makes PFA-100 testing unreliable. When flow obstructions are observed, the potential presence of hemolysis should be investigated.

Neonatal screening for cystic fibrosis does not affect time to first infection with Pseudomonas aeruginosa.

OBJECTIVE: Newborn screening for cystic fibrosis was introduced in the Piedmont region of Italy in the year 2000. Our aim with this study was to estimate the effect of newborn screening on the risk of Pseudomonas aeruginosa infection at the regional cystic fibrosis pediatric reference center. METHODS: The time to first infection with P aeruginosa within the historical cohort of cystic fibrosis children diagnosed between January 1, 1997, and June 30, 2004, was investigated, comparing survival functions and the adjusted hazard ratio of children diagnosed before and after newborn screening introduction. The role of pancreatic insufficiency was also concurrently investigated. RESULTS: Overall, 71 children diagnosed with cystic fibrosis were identified, 27 cases were clinically diagnosed before newborn screening introduction, and 5 of them presented with meconium ileus, whereas 44 were identified by newborn screening. Among them 35 needed pancreatic enzyme supplementation, whereas 34 children were infected with P aeruginosa. Both the nonparametric and semiparametric survival estimates failed to show any significant increase in the risk of P aeruginosa infection among screened children compared with historical controls. However, the median time from cystic fibrosis diagnosis to P aeruginosa infection among screened children was significantly shorter (183 vs 448 days). Children with impaired pancreatic function were at high risk of P aeruginosa infection. CONCLUSIONS: The results of the study suggest that health authorities should regard newborn screening for cystic fibrosis as an opportunity to improve care and outcomes among affected children and shift the focus from whether it is appropriate to screen to how to optimize biomedical and psychosocial outcomes of screening.