During bronchoscopy hypoxemia is commonly found and oxygen supply can be delivered by interfaces fed with high gas flows. Recently, the high-flow nasal cannula (HFNC) has been introduced for oxygen therapy in adults, but they have not been used so far during bronchoscopy in adults. Forty-five patients were randomly assigned to 3 groups receiving oxygen: 40 L/min through a Venturi mask (V40, N = 15), nasal cannula (N40, N = 15), and 60 L/min through a nasal cannula (N60, N = 15) during bronchoscopy. Gas exchange and circulatory variables were sampled before (FiO2 = 0.21), at the end of bronchoscopy (FiO2 = 0.5), and thereafter (V40, FiO2 = 0.35). In 8 healthy volunteers oxygen was randomly delivered according to V40, N40, and N60 settings, and airway pressure was measured. At the end of bronchoscopy, N60 presented higher PaO2, PaO2/FiO2, and SpO2 than V40 and N40 that did not differ between them. In the volunteers (N60) median airway pressure amounted to 3.6 cmH2O. Under a flow rate of 40 L/min both the Venturi mask and HFNC behaved similarly, but nasal cannula associated with a 60 L/min flow produced the better results, thus indicating its use in mild respiratory dysfunctions.

ObjectivesThe aim of the study was to investigate the incidence of AIDS-defining cancers (ADCs) and virus-related and non-virus-related non-AIDS-defining cancers (NADCs) in HIV-infected patients compared with the general population, and to assess the risk factors associated with these malignancies. MethodsWe performed a retrospective cohort study for the period from 1999 to 2009 of HIV-infected patients residing in the Local Health Authority of Brescia (northern Italy). Observed cancers in patients with HIV infection were compared with expected cancers in the population living in the same area using standardized incidence ratios (SIRs). Risk factors were assessed using Poisson regression analysis. ResultsA total of 5090 HIV-infected patients were included in the study, with 32 390 person-years of follow-up. We recorded 416 tumours in 390 HIV-infected patients. Two hundred of these (48.1%) were ADCs, 138 (33.2%) were non-virus-related NADCs and 78 (18.7%) were virus-related NADCs. An increased risk (SIR = 4.2) of cancers overall was found in HIV-infected patients. A large excess of ADCs (SIR = 31.0) and virus-related NADCs (SIR = 12.3) was observed in HIV-infected patients, while the excess risk for non-virus-related NADCs was small (SIR = 1.6). The highest SIRs were observed for Kaposi sarcoma among ADCs and for Hodgkin lymphoma among virus-related NADCs. Conversely, among non-virus-related NADCs, SIRs for a broad range of malignancies were close to unity. In multivariate analysis, increasing age and CD4 cell count < 50 cells/mL were the only factors independently associated with all cancers. ConclusionsAmong HIV-infected people there was an excess of ADCs and also of NADCs, particularly those related to viral infections. Ageing and severe immunodeficiency were the strongest predictors.

Imaging plays a pivotal role in systemic sclerosis for both diagnosis management of pulmonary complications, and high-resolution computed tomography (HRCT) is the most sensitive technique for the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Indeed, several studies have demonstrated that HRCT helps radiologists and clinicians to make a correct diagnosis on the basis of recognised typical patterns for SSc-ILD. Most SSc patients affected by ILD have a non-specific interstitial pneumonia pattern (NISP) on HRCT scan, whilst a minority of cases fulfil the criteria for usual interstitial pneumonia (UIP). Moreover, several recent studies have demonstrated that lung ultrasound (LUS) is an emergent tool in SSc diagnosis and follow-up, although its role is still to be confirmed. Therefore, this article aims at evaluating the role of LUS in SSc screening, aimed at limiting the use of CT to selected cases.

The prevalence and population cost of people living with HIV are likely to increase as a result of prolonged survival, aging of HIV-infected patients and increased risk of other chronic diseases. In the near future, HIV infection will rank as one of the most costly chronic diseases. Prevention strategies need to be more widely adopted to control the growing burden of the HIV epidemic and other chronic diseases affecting HIV-infected patients.

No abstract

No abstract

Background: The relationship between Length Of Stay (LOS) and Metres Above Sea Level (MASL) of Climate Therapy Stays (CTSs) and their therapeutic effectiveness and efficiency has been under-researched in the last four decades. As a consequence, the potentials of short-term and low-altitude CTSs remain unknown. Objectives: The purpose of this study is twofold. Firstly, it aims to ascertain whether LOS and MASL are related to the percentage change of Forced Expiratory Volume in 1 second (FEV1) and the percentage change of FEV1 Compound Daily Improvement Rate (FEV1 CDIR % Change). Secondly, it aims to provide an evidence-based positioning of CTSs by considering the same specific variables. Methods/Analysis: The study focuses on young people (age ˂18) who have asthma problems. The Resource-Based Theory, postulating the valuability of natural resources generating above-average benefits, has been adopted as a conceptual lens. Primary studies carried out in eastern and western European countries and separately reviewed have been considered jointly. Spearman’s rank correlation coefficient was used to determine the relationship between LOS and MASL of CTSs with FEV1Change (%) and FEV1Change CDIR (%) as indicators of health improvements. The descriptive statistics were implemented in calculating standardized and aggregated values. Findings: Negative and significant relationships have been highlighted between FEV1 Change (%) and MASL and between FEV1 Change CDIR % and LOS. In other words, subjects can achieve significant health improvements even by experiencing very short climate therapy stays at very low altitude mountain centres. Considering the FEV1Change (%) and the FEV1 Change CDIR (%) of climate stays by duration and elevation, the evidence-based knowledge platform has been established as a possible framework for developing an evidence-based marketing strategy for new health tourism products. Novelty/Improvement:Notwithstanding the need for further research, the metrics facilitating interdisciplinary, human health and economic studies have been devised. Further research on the effects of low altitude climate therapy stays could help define the healing potentials of macro and microclimatic conditions as potentially valuable ‘health devices’ for those suffering from respiratory diseases living in the COVID-19 era. Quantifying these effects through further studies, an evidence-based approach to formulating marketing strategies may be devised, useful both for supporting public health provision and policies, and for facilitating practitioners in health tourism interested in offering nature-based activities for their clients. Doi: 10.28991/ESJ-2022-06-02-04 Full Text: PDF

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe and underdiagnosed disease characterized by progressive hypertension secondary to organized thrombi in pulmonary vessels. The arteriolar lesions of CTEPH are similar to those seen in idiopathic pulmonary arterial hypertension (PAH). Surgical disobliteration of the vessels by pulmonary endarterectomy is the therapy of choice but this is not suitable for all cases. To date, there is no licensed specific drug for CTEPH. Endothelin-1, a vasoconstrictor and promoter of cell proliferation, is involved in the pathogenesis of both CTEPH and PAH. Bosentan, the first oral dual endothelin receptor antagonist, has been shown to be effective in PAH. Preliminary uncontrolled and/or unblinded studies reported efficacy of bosentan in CTEPH, and the only randomized, controlled trials showed a positive hemodynamic effect but failed its other co-primary end point, namely the improvement of 6-min walking distance. Nevertheless, bosentan has been shown to be safe and the data from most literature encourage its use for inoperable CTEPH. However, further randomized controlled trials are needed to definitively establish bosentan as a standard drug for CTEPH.