| 1. |
- Devito, Fiorella, et al.
(författare)
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Evaluation of endothelial function and cardiovascular risk in non-obese patients with slight degree of obstructive sleep apnea syndrome
- 2017
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Ingår i: Monaldi Archives for Chest Disease. - : Fondazione Salvatore Maugeri. - 1122-0643 .- 2532-5264. ; 87:3, s. 112-118
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Tidskriftsartikel (refereegranskat)abstract
- Recently, it has been clearly described an independent relationship between obstructive sleep apnea syndrome (OSAS) and cardiovascular risk, with underlying mechanisms also including endothelial dysfunction. We enrolled 32 consecutive non-obese patients (mean age of 39.5 +/- 11.5 years), of which 16 with mild OSAS and 16 snoring without OSAS. Mild OSAS is defined by an AHI index between 5 and 15. We have investigated if whether there was a relationship between mild OSAS, endothelial function and carotid intima-media thickness (C-IMT). The population was divided into two groups: Group 1 (16 simple snorer patients with an average age of 39.4 +/- 12.1 years) and Group 2 (16 subjects with mild OSAS with an average age of 39.6 +/- 11.2 years). Each group underwent cardiovascular investigation including measurement of flow-mediated dilation (FMD) of the brachial artery and C-IMT. Both groups comprised non-obese subjects. Patients with mild OSAS had serum total cholesterol values statistically significantly higher than simple snores patients (178.6 +/- 24.9 vs 159.2 +/- 25.3; p=0.038). OSAS patients had also a trend towards higher values of maximum C-IMT compared to simple snorer patients (0.70 +/- 0.15 vs 0.65 +/- 0.16), although below the level of significance. Between the two groups, no difference was found for FMD values. The present results on mild OSAS strengthen the importance of a diagnosis of OSAS as soon as possible, in order to encourage all primary prevention interventions to correct risk factors responsible for disease progression and the occurrence of cardiovascular diseases, not excluding the use of therapies of non-invasive ventilation even in the early stages of the disease.
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| 2. |
- Diktanas, S, et al.
(författare)
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Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study
- 2021
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Ingår i: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. - : PAGEPress Publications. - 1122-0643. ; 91:1
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Tidskriftsartikel (refereegranskat)abstract
- The global proportion of successful treatment outcomes of Multidrug-Resistant/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) remains unacceptably low. Time to culture conversion is important in making treatment-related decisions and is used as an interim predictor of pulmonary MDR/RR-TB treatment success. No previous studies have been conducted to assess determinants of time to culture conversion for MDR/RR-TB patients in Lithuania. Secondary analysis of data of culture-positive MDR/RR-TB patients, treated in Republican Klaipeda Hospital between 1st July 2016 and 1st July 2019 was performed. Culture conversion was defined as two consecutive negative cultures on solid media submitted at least 30 days apart. Factors associated with culture conversion were estimated by crude and multivariable Cox regression accounting for competing risks. In total, 115 consecutive patients starting treatment were included in the study. Of them, the majority was male (86/115; 74.8%) with a mean age of 48 (standard deviation (SD) ±12) years and Human Immunodeficiency Virus (HIV) negative (105/115; 91.3%). Nearly two-thirds (72/115; 62.6%) had XDR (extensive drug resistance) or MDR/RR-TB with additional resistance to second-line injectables or fluoroquinolones. Of 115 culture-positive patients at baseline, 103 (89.6%) patients achieved culture conversion during 12 months of treatment. The median time to culture conversion was 1.1 months (interquartile range: 0.9-1.8). Patients aged ≥60 years compared with <40 years [adjusted hazard ration (aHR): 0.40, 95% confidence interval (CI): 0.18-0.86], smokers (aHR: 0.39, 95% CI: 0.2-0.73), patients with positive sputum smear microscopy at baseline (aHR: 0.40, 95% CI: 0.25-0.63), cavities on initial chest X-ray (aHR: 0.56, 95% CI: 0.35-0.88) and resistance to at least one fluoroquinolone drug (aHR: 0.52, 95% CI: 0.32-0.84) were slower to culture convert. In conclusion, we recommend providing additional counseling, treatment adherence interventions and scale up the use of new and repurposed TB drugs to patient groups at risk of worse interim treatment outcome: patients aged 60 and above, with resistance to fluoroquinolones, smear–positive, smokers, or with signs of extensive disease evident on initial chest radiography.
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| 3. |
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| 4. |
- Russkikh, A, et al.
(författare)
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Factors associated with culture conversion among adults treated for pulmonary extensively drug-resistant tuberculosis during 2018-2019 in the Russian Federation: an observational cohort study
- 2021
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Ingår i: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. - : PAGEPress Publications. - 1122-0643. ; 91:1
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Tidskriftsartikel (refereegranskat)abstract
- Treatment outcomes for Multidrug/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) remain poor across the globe and in the Russian Federation. Treatment of XDR-TB is challenging for programmes and patients often resulting in low success rates and onward transmission of drug-resistant strains. Analysis of factors affecting culture conversion rate among XDR-TB patients may serve as a basis for optimization of treatment regimens. We conducted a retrospective cohort study using health records from 54 patients with pulmonary XDR-TB treated at a tertiary level facility in the Russian Federation. The study population included adult patients with culture-positive pulmonary XDR-TB who started treatment between 1 January 2018-30 June 2019. Culture conversion was defined as two consecutive negative cultures, collected at least 30 days apart. The date of sputum culture conversion was taken from the first of two consecutive negative sputum cultures fulfilling these criteria. We measured time to culture conversion using cumulative incidence functions accounting for competing risks and applied binary cause-specific Cox regressions to assess associated factors. Sputum culture conversion was recorded for 43 (79.6%) patients. Median time to culture conversion adjusted for competing risk of loss to follow up was 4 months [95% confidence interval (CI): 2–5]. The number of patients who had culture converted by treatment months 2, 4, and 6 were 12 (22%), 29 (54%) and 38 (70%) respectively. In unadjusted analysis, positive baseline sputum smear microscopy [hazard ratio (HR): 0.34, 95% CI: 0.18-0.66; p=0.001), hepatitis C (HR: 0.35, 95% CI: 0.14-0.89; p=0.023], and human immunodeficiency virus (HR: 0.30 95%, CI: 0.09-0.97; p=0.045), and receipt of fewer than 4 effective drugs in the treatment regimen (HR: 0.13, 95% CI: 0.03-0.60; p=0.009) were associated with delayed culture conversion. When compared to their combined use, patients receiving regimens with bedaquiline only (HR: 0.12, 95% CI: 0.03-0.49; p=0.003) or linezolid only (HR: 0.21, 95% CI: 0.06-0.69; p=0.010) were less likely to achieve timely culture conversion. Factors delaying sputum culture conversion should be considered in the management of patients with XDR-TB and considered by clinicians for regimen design and treatment strategies. Our study outlines the importance of simultaneous inclusion of bedaquiline and linezolid in treatment regimens for patients with XDR-TB to reduce time to sputum conversion and increase treatment success.
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| 5. |
- Bjermer, Leif, et al.
(författare)
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The use of leukotriene receptor antagonists (LTRAs) as complementary therapy in asthma
- 2002
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Ingår i: Monaldi Archives for Chest Disease. - 1122-0643. ; 57:1, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- The cysteinyl-leukotrienes (cysLTs: LTC4, LTD4 and LTE4) have an important pathophysiological role in asthma. They are not only extremely potent bronchoconstrictors, but are also involved in the central mechanisms of the asthmatic inflammation and the subsequent remodelling of the airways. Allergen-induced bronchoconstriction as well as spontaneous exacerbations of asthma are associated with increased secretion of LTE4 in urine. This increase does not seem to be affected by high doses of inhaled or systemic corticosteroids. On the contrary, both in vivo and in vitro experiments indicate that corticosteroids to a certain degree may even upregulate the cysLTs synthesis. Moreover, inhaled medication may not get as far as the small airways, which are affected by inflammatory changes in asthma. Hence, the combination of an oral leukotriene receptor antagonist (LTRA) with an inhaled corticosteroid (ICS) seems a rational therapeutic approach to achieve a more complete control of the inflammatory mechanisms in asthma. The additive effects by combining an LTRA with an ICS have been investigated in adults as well as in children from 6-14 years of age. The addition of LTRA improves lung function, and reduces day and night time symptoms in all age groups. More importantly, the combination has also been found to decrease the exacerbation rates in all age groups. More recently, a few studies have compared the effect of additive therapy with LTRA and ICS versus long-acting beta 2-agonists (LABAs) and ICS in asthmatics. Depending on the patient and outcome parameters preselection, some studies found that addition of LABA to ICS resulted in a better lung function and a better overall disease control. Yet one--unsponsored-study, comparing the protective effects of LABA versus LTRA on inflammatory outcome parameters in asthma, found a significant protection against airway hyperresponsiveness to adenosine monophosphate (AMP), together with significant decreases in exhaled nitric oxide (NO) and sputum eosinophils following one week treatment with LTRA, whereas the initial protection by LABA on the AMP responsiveness was lost after one week, and no anti-inflammatory effects could be observed. Similar beneficial effects from LTRA therapy are expected in patients with nocturnal asthma, in whom a decreased responsiveness to corticosteroids has been demonstrated. The choice of either combination therapy has clinical implications. It seems that especially patients with a suboptimal lung function and a significant beta 2-agonist reversibility will benefit from the addition of a LABA, whereas asthmatics with mainly exercise-induced asthma, nocturnal symptoms, or a frequent worsening due to low tolerance to provocative stimuli, may mostly benefit by adding an LTRA to ICS. However, it remains to be determined which combination has the most profound effect on the inflammatory process and the structural changes in asthma.
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| 6. |
- Bossone, Eduardo, et al.
(författare)
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The T.O.S.CA. Project: research, education and care.
- 2011
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Ingår i: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo. - 1122-0643. ; 76:4, s. 198-203
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Tidskriftsartikel (refereegranskat)abstract
- Despite recent and exponential improvements in diagnostic-therapeutic pathways, an existing "GAP" has been revealed between the "real world care" and the "optimal care" of patients with chronic heart failure (CHF). We present the T.O.S.CA. Project (Trattamento Ormonale dello Scompenso CArdiaco), an Italian multicenter initiative involving different health care professionals and services aiming to explore the CHF "metabolic pathophysiological model" and to improve the quality of care of HF patients through research and continuing medical education.
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| 7. |
- Frostell, CG
(författare)
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Nitric oxide and acute respiratory failure
- 1996
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Ingår i: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. - 1122-0643. ; 51:6, s. 538-42
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Westerdahl, Elisabeth, 1964-, et al.
(författare)
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Chest physiotherapy and breathing exercises for cardiac surgery patients in Sweden--a national survey of practice.
- 2011
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Ingår i: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. - : PAGEPress Publications. - 1122-0643. ; 75:2, s. 112-9
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Tidskriftsartikel (refereegranskat)abstract
- Various chest physiotherapy techniques are recommended after cardiac surgery around the world. There is limited published data on what breathing exercises actually are recommended to patients after surgery in Europe. The aim of this national survey was to establish the current practice of chest physiotherapy and breathing exercises for adult patients following cardiac surgery in Sweden.
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| 9. |
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