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Background Early life conditions are associated with lung function and the development of respiratory and non-respiratory illnesses. The relationship with birthweight (BW) is however conflicting. We examined associations of BW with lung function and respiratory diseases within the GEIRD (Gene-Environment Interaction in Respiratory Diseases) study. Methods GEIRD is an Italian multi-centre, multi-case control study of people aged 20-84 from the general population conducted from 2008 to 2014. The study included cases of COPD, asthma, allergic rhinitis and controls. Multinomial logistic regression was performed with case/control status (control/COPD/asthma/allergic rhinitis) as response variable, and BW as main determinant adjusting for sex, age and smoking status. Results Of 2,287 reporting BW, 6.4 % (n = 147) had low BW ( Conclusions BW was not associated with lung function in adulthood, when controlling for sex and height. Low BW was a risk factor for respiratory diseases in childhood, not in adulthood. Key messages • Low birthweight was associated with respiratory diseases in childhood but not in adulthood. • Although spirometrically-assessed lung volumes were lower in adults with low birthweight, this is likely explained by associations of low birthweight with sex and height.

Lung transplantation can improve the survival of patients with severe chronic pulmonary disorders. However, the short- and long-term risk of infections can increase morbidity and mortality rates. A non-systematic review was performed to provide the most updated information on pathogen, host, and environment-related factors associated with the occurrence of bacterial, fungal, and viral infections as well as the most appropriate therapeutic options. Bacterial infections account for about 50% of all infectious diseases in lung transplanted patients, while viruses represent the second cause of infection accounting for one third of all infections. Almost 10% of patients develop invasive fungal infections during the first year after lung transplant. Pre-transplantation comorbidities, disruption of physical barriers during the surgery, and exposure to nosocomial pathogens during the hospital stay are directly associated with the occurrence of life-threatening infections. Empiric antimicrobial treatment after the assessment of individual risk factors, local epidemiology of drug-resistant pathogens and possible drug-drug interactions can improve the clinical outcomes.

BACKGROUND: The early detection of factors predicting hospital length of stay (LOS) in patients affected by severe acute respiratory syndrome in Coronavirus 2 (SARS-CoV-2) disease (COVID-19) might facilitate therapeutic decisions and patient flow management. METHODS: We collected routine clinical and laboratory parameters and derived inflammatory indexes on admission in 65 consecutive COVID-19 patients transferred to the Unit of Respiratory and Infectious Disease of the University Hospital of Sassari (North-Sardinia, Italy) who were alive on discharge. RESULTS: Patients with prolonged length of stay (LOS) (PLOS >= 26 days, N.=22) had significantly higher chest CT severity scores, neutrophils, neutrophil lymphocyte ratio (NLR), aggregate index of systemic inflammation, Systemic Inflammation Response Index, Systemic Inflammation Index (SII), aspartate aminotransferase, lactate dehydrogenase (LDH), and rates of obesity and respiratory support, than non-PLOS patients (N.=43). In univariate analysis, LOS was significantly and negatively correlated with lymphocytes and monocytes, and positively correlated with Body Mass Index (BMI), intensity of care, chest CT severity score, NLR, platelet lymphocyte ratio, SII and LDH. In multivariate regression analysis, only the SII was significantly associated with LOS (beta=0.506, P=0.002) after adjusting for BMI, intensity of care, chest CT severity score and LDH. CONCLUSIONS: SII values on admission were independently associated with LOS in COVID-19 patients. Prospective studies in larger cohorts are required to confirm our findings and to determine the role of the SII in clinical decision making.

Background Studies on the prevalence of eczema and atopic dermatitis (AD), and on the factors associated with these diseases, have been mostly performed in children, whereas studies on adult populations are lacking. Objectives To determine the prevalence of eczema and AD in the Italian adult population, and to investigate risk factors associated with the disease. Methods A postal screening questionnaire was administered to 18 357 randomly selected subjects aged 20–44 years in the Gene–Environment Interaction in Respiratory Diseases study, which involved seven centres distributed across northern, central and southern Italy. The questionnaire included items on the occurrence of doctor-diagnosed eczema, asthma and hay fever, socio-demographic characteristics and environmental exposures. Results In all, 10 464 (57.0%) subjects responded to the questionnaire. The prevalence of current eczema was 8.1% (95% CI: 7.6–8.7%), while the prevalence of eczema with asthma and/or hay fever (EAH), which was adopted as proxy of AD, was 3.4% (95% CI: 3.1–3.8%). About 60% of the subjects with current eczema reported the onset of the disease in adulthood. In multi-variable models, the prevalence of eczema was significantly associated with female sex, older age, living close to industrial plants, high levels of heavy traffic near home and living in central-southern Italy. Conclusions Eczema and EAH are highly prevalent in Italian young adults, especially in women. Our results suggest that adult onset is not unusual, and that environmental factors may influence the occurrence of eczema and EAH.

Background Several studies highlighted a great variability, both between and within countries, in the prevalence of asthma and chronic airways diseases. Aim To evaluate if geo-climatic variations can explain the heterogeneity in the prevalence of asthma and respiratory diseases in Italy. Methods Between 2006 and 2010, a postal screening questionnaire on respiratory health was administered to 18,357 randomly selected subjects, aged 20–44, living in 7 centers in northern, central, and southern Italy. A random-effects meta-analysis was fitted to evaluate the between-centers heterogeneity in the prevalence of asthma, asthma-like symptoms, allergic rhinitis, and chronic bronchitis (CB). A principal component analysis (PCA) was performed to synthetize the geo-climatic information (annual mean temperature, range of temperature, annual rainfalls, global solar radiations, altitude, distance from the sea) of all the 110 Italian province capital towns. The associations between these geo-climatic components obtained with PCA and the prevalence of respiratory diseases were analyzed through meta-regression models. Results 10,464 (57%) subjects responded to the questionnaire. There was a significant between-centers heterogeneity in the prevalence of asthma (I 2 = 59.5%, p = 0.022) and CB (I 2 = 60.5%, p = 0.019), but not in that of asthma-like symptoms or allergic rhinitis. Two independent geo-climatic components explaining together about 80% of the overall geo-climatic variability were identified: the first principally summarized the climatic variables; the second the topographic ones. Variations in the prevalence of asthma across centers were significantly associated with differences in the climatic component (p = 0.017), but not with differences in the topographic one. Conclusions Our findings suggest that climate play a role in determining the between-center heterogeneity in the prevalence of asthma in Italy, with higher prevalence in dry-hot Mediterranean climates, and lower in rainy-cold northern climates.

A 58-year-old man was admitted because of respiratory failure, episodic fever with chilling, cough, malaise, fatigue, myalgia and weight loss lasting for at least one month. Chest x-rays and CT scan of the chest showed bilateral pulmonary consolidations in upper lobes, the left lower lobe, and mediastinal lymphadenopathy. Bronchoscopy with cytology was unremarkable. A needle CT-guided lung biopsy documented an inflammatory pseudotumor, lymphoplasmacytic type. Serology showed high titer antibodies to phase II Coxiella burnetii infection. Therapy with doxycycline and hydroxychloroquine for three months led to a complete resolution of symptoms and radiological findings, and a marked decrease in titers to Q fever.

Background: Assessment of the mutational status in EGFR, KRAS, BRAF has become crucial in recent years for the molecular classification of patients with non small cell lung cancer (NSCLC). In this population-based study, we evaluated the incidence rates and distribution of such somatic mutations among NSCLC patients in genetically isolated population from Sardinia. Material and methods: From July 2010, a total of 1,047 formalin-fixed paraffin-embedded tumor tissues from patients with NSCLC and ascertained Sardinian origin was prospectively collected at clinics across the entire island. Genomic DNA was isolated from tissue sections and screened for somatic mutations in EGFR, KRAS, and BRAF genes by automated DNA sequencing. Results: Overall, 112 (10.7%) analyzed patients carried an EGFR mutation. Somatic mutations in EGFR gene were quite equally distributed between exon 19 (57/112; 51%) and exon 21 (52/112; 46%), with few mutations (3/112; 3%) in exon 18 of EGFR. No significant difference in distribution of EGFR mutations according to the age at diagnosis was observed [EGFR mutant: median age, 67 (range, 37-85); EGFR wild-type: median age, 65 (range, 35-89)]. Females presented a significantly higher frequency of EGFR mutations in comparison to males (23.6% vs. 5.7%, respectively] (p = 0.003). According to the smoking history, a significant preponderance of EGFR mutations were observed in never smokers (43.2%) as compared to former smokers (5.8%) and smokers (3.6%) (p < 0.001). Among 634 patients whose somatic DNA was available for further analyses [71 (11.2%) cases carried EGFR mutations], we detected 138 cases (21.8%) with KRAS mutations and 3 (0.5%) with BRAF mutation (V600E). KRAS and BRAF mutations were significantly more prevalent in males than females (22.4% vs. 10.3%, respectively; p = 0.012) as well as in smokers (31.8%) than in former smokers (17.6%) or never smokers (4.5%) (p = 0.023). In this series, no concomitant mutations in EGFR, KRAS, and BRAF genes were detected. Therefore, two thirds (422/ 634; 66.6%) of such patients lacked somatic mutations in all three analyzed genes. Conclusions: Although the prevalence of mutations in the three main candidate gens among NSCLC patients from Sardinia was consistent with that reported in literature for Western populations, their distribution varied into the different clinical subgroups

The authors point out the remarkable importance that pneumonia has today among infectious diseases, and survey the main risk factors and etiological agents both of the forms acquired in the community and in the hospital, also considering the data from the international literature. The authors stress the high incidence of gram-positive microorganisms, among which Streptococcus pneumoniae is the most widespread in the forms acquired in the community, and the absolute prevalence of the gram-negatives in the nosocomial forms and, among the gram-positives, the pre-eminence of Staphylococcus aureus; these are "difficult" bacterial species, whose prevalence has been determined mainly by induced selective pressure through the inadequate use of antibiotics. The authors also point out the principal factors that favor the onset of pneumonia; they are connected to the host and to the environment; their combination with the infectious agent causes the infective event.

The objective of our study was to evaluate the presence of respiratory symptoms and chronic obstructive pulmonary disease (COPD) in a human immunodeficiency virus (HIV)-infected outpatient population and to further investigate the role of highly active antiretroviral therapy (HAART) and other possibly associated risk factors.We consecutively enrolled in a cross-sectional study HIV-infected patients and HIV-negative age, sex and smoking status matched controls. All participants completed a questionnaire for pulmonary symptoms and underwent a complete spirometry.We enrolled 111 HIV-infected patients and 65 HIV-negative age- and sex-matched controls. HIV-infected patients had a significantly higher prevalence of any respiratory symptom (p = 0.002), cough (p = 0.006) and dyspnoea (p = 0.02). HIV-infected patients also had a significantly higher prevalence of COPD in respect of HIV-negative controls (p = 0.008). Furthermore, HIV-infected individuals had significantly (p = 0.002) lower forced expiratory volume at one second (FEV1) and FEV1/forced vital capacity (FVC) ratio (Tiffeneau index) (p = 0.028), whereas the total lung capacity (TLC) was significantly higher (p = 0.018). In the multivariate analysis, significant predictors of respiratory symptoms were current smoking [adjusted odds ratio (AOR) 11.18; 95 % confidence interval (CI) 3.89-32.12] and previous bacterial pneumonia (AOR 4.41; 95 % CI 1.13-17.13), whereas the only significant predictor of COPD was current smoking (AOR 5.94; 95 % CI 1.77-19.96). HAART receipt was not associated with respiratory symptoms nor with COPD.We evidenced a high prevalence of respiratory symptoms and COPD among HIV-infected patients. HIV infection, current cigarette smoking and previous bacterial pneumonia seem to play a significant role in the development of respiratory symptoms and COPD. Thus, our results suggest that the most at-risk HIV-infected patients should be screened for COPD to early identify those who may need specific treatment.

The clinical severity of human infection with the novel influenza virus A/H1N1v has not been completely defined, especially in HIV/hepatitis C virus (HCV) infected patients. Although most patients develop mild to moderate symptoms, severe disease may occur in a limited proportion of cases. We report the case of a 44-year-old man infected with HIV and HCV with a high CD4 cell count who developed acute respiratory distress syndrome associated with influenza virus A/H1N1v infection. The patient recovered completely after oseltamivir therapy and mechanical ventilation.

The role of genetic and environmental factors, as well as their interaction, in the natural history of asthma, allergic rhinitis and chronic obstructive pulmonary disease (COPD) is largely unknown. This is mainly due to the lack of large-scale analytical epidemiological/genetic studies aimed at investigating these 3 respiratory conditions simultaneously. The GEIRD project is a collaborative initiative designed to collect information on biomarkers of inflammation and oxidative stress, individual and ecological exposures, diet, early-life factors, smoking habits, genetic traits and medication use in large and accurately defined series of asthma, allergic rhinitis and COPD phenotypes. It is a population-based multicase-control design, where cases and controls are identified through a 2-stage screening process (postal questionnaire and clinical examination) in pre-existing cohorts or new samples of subjects. It is aimed at elucidating the role that modifiable and genetic factors play in the occurrence, persistence, severity and control of inflammatory airway diseases, by way of the establishment of a historical multicentre standardized databank of phenotypes, contributed by and openly available to international epidemiologists. Researchers conducting population-based surveys with standardized methods may contribute to the public-domain case-control database, and use the resulting increased power to answer their own scientific questions.

N-acetyl-l-cysteine (NAC) is a therapeutic drug widely used as mucolytic agent in the treatment of respiratory diseases. Recently it has been proposed that NAC administration may modify the plasma levels of low molecular weight thiols (LMW) like cysteine, homocysteine and glutathione, though it has been still debated if their plasma concentration increases or decreases during the therapy. Therefore research calls for methods able to analyze simultaneously NAC and the other plasma LMW thiols in order to evaluate if NAC is able to modify plasma thiols concentration and in particular to reduce homocysteine levels in hyperhomocysteinemia. In this paper we present a new capillary electrophoresis method that allows a baseline separation of plasma NAC from the physiological thiols. The proposed method has been utilized to measure the drug and the physiological LMW thiols in NAC administered chronic obstructive broncho-pneumopathy (COPB) disease patients.

Bronchial carcinoma is the most common cause of death among all malignant tumours. Despite a progressive increase, many Italian regions--ours included--do not have a Regional Cancer Registry.To assess lung cancer incidence and mortality rates in Sardinia during the period 1980-1996.Data were gathered by consulting hospital registers and the case notes of individual patients released from hospital with a diagnosis of bronchial carcinoma at all Sardinian medical centres between 1980 and 1996.A total of 7734 patients with lung cancer were registered in Sardinia between 1980 and 1996. Data showed a steady increase in lung cancer incidence rates over the years (from 22.3/100000 in 1980 to 34.5 in 1996). The same increase was evident in mortality rates (from 25.7/100000 in 1980 to 42.9 in 1996). The increase in mortality rates was higher in women (+146%) than in men (+59.5%).Results show a slow but steady increase in lung cancer incidence and mortality rates in Sardinia. The high number of smokers among lung cancer patients seems to indicate that anti-smoking campaigns need to be more effective in Sardinia.

Environmental factors are likely to be involved in explaining the wide geographical variation in asthma and atopic diseases that has been documented in many recent epidemiological studies.To evaluate to what extent climate and outdoor NO2 pollution can explain the geographical variation in the prevalence of asthma and allergic rhinitis, and to estimate the relative risk for exposure to different levels of these two factors.The impact of climate and long-term exposure to nitrogen dioxide (NO2) pollution on asthma and allergic rhinitis was assessed in a cross-sectional study, carried out during 1998 to 2000 on young adults aged 20 to 44 years (n = 18 873), living in 13 areas from two different Italian climatic regions (subcontinental and Mediterranean).Mediterranean areas had a significantly higher prevalence of asthma-like symptoms (P0.001), higher annual mean temperature (16.2 degrees C vs. 12.9 degrees C), lower temperature range (16.0 C degrees vs. 22.1 degrees C) and lower NO2 levels (31.46 microg/m3 vs. 57.99 microg/m3) than subcontinental ones. Mediterranean climate was associated with an increased risk of wheeze (OR = 1.23; 95% CI 1.13 to 1.35), tightness in the chest (OR = 1.21; 95% CI 1.11 to 1.33), shortness of breath (OR = 1.21; 95% CI 1.08 to 1.36) and asthma attacks (OR = 1.19; 95% CI 1.07 to 1.31). After adjusting for climate, an increase of 18.3 microg/m3 in NO2 levels moderately increased the risk of asthma attacks (OR = 1.13; 95% CI 0.98 to 1.32), tightness in the chest (OR = 1.11; 95% CI 0.98 to 1.26) and wheeze (OR = 1.11; 95% CI 0.96 to 1.28). When the levels of outdoor NO2 exposure rose, the prevalence of allergic rhinitis increased significantly in the Mediterranean region (OR = 1.38; 95% CI 1.12 to 1.69), but not in the subcontinental one (OR = 1.03; 95% CI 0.83 to 1.28).Our results show that the prevalence of asthma increases when annual mean temperature increases and temperature range decreases. Furthermore, climate interacts with NO2 outdoor exposure, increasing the risk for allergic rhinitis in people exposed to high stable temperatures. A long-term role for the effect of traffic pollution on asthma is also suggested.

A complete surveillance system for tuberculosis should be able to guarantee constant updating of incidence and provide useful data on a variety of problems related to tuberculosis such as drug resistance, co-infection with the human immunodeficiency virus (HIV), the geographic origin of patients, and mycobacterial species.To assess the completeness of the surveillance system currently operating in Sardinia, cases seen by all medical centres between 1987 and 1995 were compared with those notified to Sardinian Public Health Services for the same period.Each year, on average 39% of cases seen in Sardinia are notified; 646 (40%) of the 1591 patients notified during the study period were never seen by regional medical centres. An analysis of the results shows that from 1992 the decline recorded in incidence rates in previous years ceased: 1992 (26/100,000), 1993 (25/100,000), 1994 (28/100,000), and 1995 (24/100,000).The current surveillance system in Sardinia is inadequate for performing an accurate epidemiological survey of the disease. Epidemiological analysis based solely on notification can provide neither reliable incidence rates nor useful information concerning many aspects of tuberculosis.

A number of different clinical specimens, such as sputum, cerebrospinal fluid and blood, have been reported to be good substrates for the detection of Mycobacterium tuberculosis by PCR assay. We wanted to search for the presence of mycobacteria in other body fluids, such as urine. Urine samples and other samples obtained from AIDS patients and non HIV-infected patients were analysed by PCR. The results were compared with those obtained using conventional methods (Bactec 460 TB and AFB (acid fast bacilli strain)). We analysed 412 urine samples and 210 different other samples (sputum and cerebrospinal fluid) obtained from AIDS patients by PCR; almost identical levels of PCR-positive (14-17%) results were observed in all samples analysed. The results were then compared with those obtained with the Bactec 460 TB and AFB. PCR, Bactec 460 TB and acid fast stain were also used to analyse 190 urine samples and 230 other samples from non-HIV infected patients in the consumption ward of Sassari Hospital. The number of urine samples positive by PCR (6.3%) and Bactec 460 TB (2.1%) was half that obtained from samples taken from the AIDS patients. As expected, an increase in the number of positive sputum samples was observed with all methods. The results indicate that PCR analysis of urine samples represents a valid alternative for fast and sensitive detection of M. tuberculosis. This method can be routinely used in the clinical laboratory, especially in HIV-infected patients.

The present study has the aim of studying the morphological aspects of ciliary abnormalities in patients affected by immotile-dyskinetik cilia syndrome. Five patients affected by primary ciliary dyskinesia have been studied, examining by TEM the cells obtained by bronchial brushing during fiberoptic bronchoscopy. Many types of anomalies have been observed, and a morphologic classification was proposed. The frequency of abnormal cilia appears to be correlated to the severity of respiratory pathology. The morphological anomalies are not specific for this pathology.

To evaluate the prevalence of respiratory symptoms and COPD in a stable HIV-infected outpatient population and to further investigate the role of HAART and other possibly associated risk factors. Supplement: Abstracts of the Tenth International Congress on Drug Therapy in HIV Infection http://www.biomedcentral.com/content/pdf/1758-2652-13-S4-info.pdf Conference: Tenth International Congress on Drug Therapy in HIV Infection 7-11 November 2010 Glasgow, UK (Published: 8 November 2010) doi:10.1186/1758-2652-13-S4-P232 Cite this article as: Madeddu et al.: Prevalence and risk factors for chronic obstructive lung disease in HIV-infected patients in the HAART era. Journal of the International AIDS Society 2010 13(Suppl 4):P232. Full text: PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113019/