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Aim of this paper is to describe the management of an outbreak of COVID-19 in a slaughtering and meat processing plant in Bari Province (Southern Italy). At the end of the outbreak investigation, 18.4% of the employees were positive to the molecular test for SARS-CoV-2. Higher prevalence has been reported in the bovine slaughtering house and swine meat processing plant.In addition to lack of physical distancing and correct use of personal protective equipment, the spread of the virus has been eased by low level of literacy, indoor microclimate, intensive working time, and aerosol-generating procedures in specific areas of the processing plant where more positive cases have been detected. The analysis of this cluster may suggest specific actions to prevent similar outbreaks in the future.

Inflammatory rhinitis is a very common disorder. It includes allergic rhinitis (AR) and non-allergic rhinitis (NAR). Nasal inflammation is shared by both disorders. So, anti-inflammatory treatment is indicated for both. Beclomethasone dipropionate (BDP) is a corticosteroid that is long time available both as intranasal spray and aerosol solution. BDP is a corticosteroid with proved efficacy in the treatment of rhinitis, both as spray and aerosol. Safety issue has been satisfactory explored, thus BDP is usually safe and well tolerated. Hyaluronic acid (HA) with high molecular weight has anti-inflammatory activity associated with wetting-lubricating effect. BDP may be usefully employed in acute forms, HA may be also used in chronic ones.

Objectives: to define a national geographic domain, with high spatial (1 km²) and temporal (daily) resolution, and to build a list of georeferenced environmental and temporal indicators useful for environmental epidemiology applications at national level., Design: geographic study., Setting and Participants: study domain: Italian territory divided into 307,635 1-km² grid cells; study period: 2006-2012, divided into 2,557 daily time windows., Main Outcome Measures: for each grid cell and day, an extensive number of indicators has been computed. These indicators include spatial (administrative layers, resident population, presence of water bodies, climatic zones, land use variables, impervious surfaces, orography, viability, point and areal emissions of air pollutants) and spatio-temporal predictors (particulate matter data from monitoring stations, meteorological parameters, desert dust advection episodes, aerosol optical depth, normalized difference vegetation index, planetary boundary layer) potentially useful to characterize population environmental exposures and to estimate their health effects, at national level., Results and Conclusions: this study represents the first example of relational big data in environmental epidemiology at national level, where multiple sources of data (satellite, environmental, meteorology, land use, population) have been linked on a common spatial and temporal domain, aimed at promoting environmental epidemiology applications at national and local level.

Allergic rhinitis is the most frequent allergic disorder, as its prevalence is more than 20% in the general population. Non-allergic rhinitis has similar symptoms, but pathogenic mechanisms are non-IgE-mediated. Anyway, both diseases share a common inflammatory pathway, thus anti-inflammatory drugs represent the optimal therapeutical option. Beclomethasone dipropionate (BDP) is a corticosteroid that is long time available both as intranasal spray and aerosol solution. The present review aims at analysing the most relevant and recent studies concerning the BDP use in allergic and non-allergic rhinitis. The research was performed using Medline and Scopus database, key words were: allergic and non-allergic rhinitis, beclomethasone (last access 31st July 2014). BDP is a corticosteroid with proved efficacy in the treatment of rhinitis, both as spray and aerosol. Safety issue has been satisfactory explored, thus BDP is usually safe and well tolerated.

A number of factors, for example water temperature, can encourage the growth of microorganisms such as Legionella spp in spa facilities. Individuals who attend this type of facility are often subjects at risk for infection who are undergoing inhalation therapy and hot tub treatments. A very accurate management of these facilities is therefore required to avoid infection by Legionella spp. The purpose of this study was to verify the current Italian national and Apulia regional legislation regarding the control of contamination by Legionella spp. in spa facilities.

Background: Electrostatic filters are widely used in applications requiring high filtration efficiency and low pressure drop. However various studies showed that the penetration through electrostatic filters increases during exposure to an aerosol flow., Objectives: This study investigates the effects of prolonged exposure to an oily aerosol on the penetration through filtering facepieces available on the market., Methods: Some samples of FFP1, FFP2 and FFP3 filtering facepieces were exposed for 8 hours consecutively to a paraffin oil polydisperse aerosol. At the end of the exposure about 830 mg of paraffin oil were deposited in the facepiece., Results: All the examined facepieces showed penetration values that increased with paraffin oil load while pressure drop values were substantially the same before and after exposure. The measured maximum penetration values did not exceed the maximum penetration values allowed by the European technical standards, except in one case. According to the literature, 830 mg of oil load in a facepiece is not feasible in workplaces over an eight- hour shift. However, the trend of the penetration versus exposure mass suggests that if the load increases, the penetration may exceed the maximum allowed values. For comparison a mechanical filter was also studied. This showed an initial pressure drop higher than FFP2 filtering facepieces characterized by comparable penetration values. During exposure the pressure drop virtually doubled while penetration did not change., Conclusions: The increase in penetration with no increase in pressure drop in the analyzed facepieces indicates that it is necessary to comply with the information supplied by the manufacturer that restricts their use to a single shift.

A bicarbonate-sulphate-calcic water of a therapeutic spa was monitored for the presence of Legionella, Pseudomonas and Mycobacteria. The water was analysed by taking samples from the well, the feed tank and from the final aerosol generating devices of two different water lines, the former at 21-23 degrees, the second at 36-38 degrees. The bacteria in question were always absent from the well. Legionellae were found in the water of aerosol equipment: Legionella micdadei was isolated from 75% of samples, L. bozemanii from 75% and 50% (respectively 36-38 degrees and 21-22 degrees water lines) and other species of environmental Legionellae from 25% of samples. The water of aerosol equipment presented high total bacterial counts (10(3)-10(4) cfu/ml) and exspecially high concentrations of Pseudomonadaceae (10(2)-10(3) cfu/100 ml). These bacteria, unlike the Legionellae, were also isolated from the feed tank at mean concentrations of about 10(2) cfu/100 ml. Mycobacteria were found in 75 and 50% of samples collected from final devices, respectively from the heated and not heated water lines. The isolates were M. gordonae (85% of isolates) and M. fortuitum (15%), but at concentrations very low. Both treatments with sodium hypochlorite (20 ppm of residual chlorine) and peracetic acid (20 ppm) resulted in the reduction of total bacterial counts and elimination of Pseudomonas from the water in the tank, but not in elimination of Pseudomonas and Legionellae from the nebulizers. The disinfectants were evidently not able to efficiently reach all the points where Pseudomonas and Legionella had settled and grown. In order to obtain total abatement it was necessary to carry out a radical restructuring of the plant, involving the replacement of the old nebulizer benches with new aerosol equipment that could be subjected to a new system of programmed thermal shock.

The authors remind the main epidemiological and clinical findings of Chronic Obstructive Pulmonary Disease (COPD); the prevalence and incidence of COPD is increasing and COPD is now the IV cause of death in the world. Moreover, it is cause of increasing pharmaceutic and hospital charges. COPD has multifactorial etiology, linked to genetic and exogenous factors, as tobacco smoke, air pollution, microbial infections and cold. The GOLD guide lines of the medical therapy of the COPD are showed. The spa therapy of COPD is based on the inhalation use of mineral water, mainly sulphurous and salsojodic. Sulphurous mineral waters have vasodilating activity on vessels of bronchial mucose, improving its trophic state, and increase the production of secretory IgA and muco-ciliary clearance; they have fluidificant activity on bronchial secretion. Clinical trials showed improvement of cough, sputum and functional indexes as FEV1 and CV. Salsojodic mineral waters increase the fluidity of the bronchial mucus, muco-ciliary clearance and the trophism of the bronchial mucose. The authors remind the properties of sulphate and bicarbonate mineral waters in the spa therapy of COPD. Finally authors refer about some effects of spa therapy and climatic-environmental situations on COPD morbidity.

Aim: Our research evaluates the efficacy of the inalation therapy by mineral sulphureous water in patients suffering from cronic bronchopneumopathy., Materials and Methods: From August to October 2002, two groups of patients, randomly selected, suffering from cronic bronchopneumonopathy, were studied at spa center "Pompeo" in Ferentino (FR). Every patient was treated daily during a cycle of twelve days. The first group was treated by pneumonic mechanical ventilation associated to sulphureous water aerosolinalation, the second by mechanical pulmonary ventilation associated to sulphureous water aerosol-inalation medicated with flunisolide. Every patient carried out spirometry, before and after treatment, and the measurement of FEV1 was considered a good parameter to evaluate the respiratory function., Results: All patients reported an improvement in symptoms as dyspnea and cough. Results obtained show a significant functional improvement of respiratory function in both groups, evaluated by FEV1. Equal efficacy treating the patients by medicated and not medicated treatments stress the therapeutic role of mineral sulphureous waters in chronic bronchopneumopathies. Our research points out the usefullness of pneumonic ventilation associated with sulphureous water aerosol-inalation in patients suffering from chronic bronchopneumopathies.

Authors report data about microbiological characterization of solid wastes and aerosol in the municipal solid waste landfill site in Poiatica (RE). In solid waste samples high values of total coliform and fecal coliform were observed (10(5)-10(6) CFU/g): total bacterial counts at 22 degrees, at 36 degrees and at 44 degrees ranged from 10(7) to 10(9) CFU/g. Aerosol samples collected during waste movement in the landfill site showed values of total and fecal bacterial ranging from 10(3)-10(4) CFU/m3. Staphylococci and fungi reported the same values while streptococci, total and fecal coliform and spore evidenced lower values. Municipal solid wastes and aerosol have to be considered as an infective substrate: it is necessary to adopt protective barriers in occupationally exposed subjects.

Unlabelled: Estrogen supplementation, given mainly by oral or transdermal route has been shown to decrease climacteric symptoms, bone turnover, prevent postmenopausal bone loss, and significantly reduce fracture risk in both early and late postmenopausal women. Estrogens exert their principal biological effects through the actions on 2 different intracellular estrogen receptor (ER) proteins, ERa and ERb. These receptors, are completely distinct in their action. However, regardless the type of receptor involved, the response induced through the action of ER induction can be dependent also on the total dose exposure rather than estradiol concentrations at subsaturating levels. The nasal route is an effective and well-established route of drug delivery. Nasal administration produces a pulsed profile of plasma estradiol, with plasma levels rising rapidly and returning to pre-administration levels within 12 h (fall to 10% of their peak level within approximately 2 h). As a consequence, daily intranasal administration results in a pulse-like estrogen profile, rather than the relatively sustained serum levels attained with both oral and transdermal administration. In addition, exposure obtained with a single dose is compared with the exposure obtained with the same total dose given as 2 divided doses administered 12 h apart. It's known that different route of administration exert different biological and clinical, Results: In the years, several clinical studies have demonstrated the efficacy and safety of intranasal estradiol in the treatment of climacteric symptoms, compared with other routes of estrogen administration. Interestingly, intranasal therapy also showed a lower tendency to stimulate endometrial proliferation than the oral route, with a high incidence of atrophic endometrium maintained during the long-term study. The reduced level of stimulation of the reproductive organs produced by Aerodiol compared with oral estradiol therapy of equivalent efficacy on climacteric symptoms may be related to the pulsed kinetic profile of estradiol exposure that occurs with the intranasal route. Improvement of climacteric symptoms observed with nasal estradiol administration is comparable to that seen with transdermal or oral estrogens. A similar reduction in Kupperman Index or in the number of hot flushes was reported over a 6-month period with results similar to those of several studies performed with transdermal patches delivering estradiol or with conjugated equine estrogen. Different routes of administration may exert different results in terms of compliance, biological and clinical effects even if long term clinical trials are needed for demonstrating it. The pulsed kinetics of Aerodiol may exert less side effects in terms of coagulation cascade activation and a favourable lipid profile with less mammary tissue stimulation. These aspects became of paramount importance since the recent publication of 2 trials, Women Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS), regardless their important population selection bias and uncertain results, left important consequences in terms of HRT indication and use for both women and clinicians. In conclusion, Aerodiol introduces the new concept of pulsed estrogen therapy. Pulsed estrogen therapy is safe, well accepted and highly efficient in alleviating postmenopausal symptoms and prevent postmenopausal bone loss. Aerodiol therapy demonstrated also a lower stimulation of reproductive tissues (endometrium, breast) compared with the equivalent oral therapy, with important repercussion for future HRT strategies.

This study is focused on some biological factors, liable to increase health risks within specific indoor settings. The authors describe the pathologies associated with the exposure to specific indoor biological agents. For lack of threshold levels and appropriate regulations on the matter, research has hardly provided any reliable results. This study is therefore to be considered a starting point for further investigation.

During pregnancy the asthma has an incidence of 1-4%. In addition to this pathology we find, during pregnancy, an increased incidence of complications both maternal and fetal. These complications, often serious, happen nearly exclusively in patients with severe asthma and/or badly controlled. Therefore, to reduce the risk of beginning of these complications it's necessary to assess correctly the gravity of asthma before becoming pregnant, to make a careful and periodic control of the respiratory function of the patient, to effect a suitable preventive and/or symptomatic pharmacological therapy and to establish specific sanitary-action measures able to prevent the disease becomes acute.

Epidemiological studies conducted in different countries have reported associations between increases in PM concentration and increases in morbidity and mortality, particularly among those people with respiratory or cardiovascular diseases. However, there are still important unanswered questions concerning potential biologic mechanisms of PM effects, the identification of the factors responsible of the adverse health effects (size and or chemical composition), the groups of people that may be particularly sensitive to the effects of PM. The most recent hypotheses indicate that ultrafine particles (UF) (< 0.1 microm) and transition metals (like Fe) may play an important role in the induction of toxic effects. Results obtained during last years in some sites located in the city center of Rome, showed mean annual levels of PM10 and PM2.5, that were often higher than 40 microg/m3, with peak values during winter months. UF particles concentrations showed similar seasonal trends, and daily trend correlated with increasing traffic fluxes, with peak levels of 10(5) p/cm3.

Background: Bacterial contamination in dental offices plays a primary role in the evaluation of infective risks for patients and dental personnel. The aim of the research was to study bacterial contamination in eight Italian dental offices by investigating the water of dental units, the air and certain surfaces (push-button panel and instrument cabinet) in order to evaluate potential risks in dental practices., Methods: The water underwent a microbiological test as specified by Italian law (DPR 236/88). The water was sampled from the hoses and air/water syringes of twenty dental units. The microbiological analysis of the air was performed using sedimentation plates to evaluate microbial fall-out. The microbiological analysis of the surfaces was performed using membrane filters to evaluate microbial accumulation., Results: The research showed bacteriological contamination of the dental unit water in all the dental offices. During the working activity total bacteriological counts in the air fall-out were fairly high and the surfaces examined showed some widespread bacterial contamination in dental practices. The results of this study show the importance of routine monitoring of microbial contamination of dental offices and, in case of contamination, the need to apply disinfection treatments for the waterlines and preventive measures for the aerosol reduction., Conclusions: Our research was used to work out a program for the prevention of environmental contamination in dental offices.

A survey was carried out on the animal virus occurrence in wastewater and aerosols, in 2 treatment plants. Forty-five samples of sewage (10 litres) and 118 aerosol (2.3 m3) were examined. Forty out of forty-five (88.9%) of sewage and four out of one hundred and eighteen of aerosol (3.4%) samples were positive for viruses. Thirty-three reovirus and nine enterovirus strains were recovered from the sewage, two reovirus and two enterovirus strains from aerosol. Among enterovirus strains 6 resulted coxsackievirus B5, 3 coxsackievirus B4, 1 poliovirus, 1 strains remained unidentified.

The present paper shows the results of an experimental study aimed at arranging a microbiological characterization of bioaerosol and leachate resulting from a sanitary landfill for solid urban waste situated near Rome. Bioaerosol sampling was performed by using the active sampling method referred to as surface air system, that is extensively used during indoor environmental monitoring. The microorganisms (bacteria and fungi) believed to be of relevance on bioaerosol and leachate with a view to hygienic risks, were investigated in order to estimate the potential risks to which the population and the workers can be exposed and consequently to allow corrective measures by monitoring campaigns of the examined matrices and by models of low environmental impact landfill.

Unlabelled: Aerosolized tobramycin represents an efficient alternative to the systemic administration, especially in patients with cystic fibrosis and bronchiectasis affected with Pseudomonas aeruginosa infections. Aim of this study was, using a Time Of Flight Aerosol Beam Spectrometer (API Aerosizer Mach2), to compare the granulometric characteristics of tobramycin aerosolized in 1 sec by three nebulizers and, using mathematic models, to value the particles and drug deposition in the lower airways, particularly at: P level, which includes bronchiolar and alveolar tract; TB level, which includes tracheobronchial tract; ET level, which includes the extrathoracic tract; the amount of particles (Dp) and drug (Dd) dispersed., Results: Nebula Nuovo: Mass Median Aerodynamic Diameter (MMAD): 3,722 microns; Geometric Standard Deviation (GSD): 2,382; Particles deposited-P: 42.86%; TB: 4.99%; ET: 8.7%; Dp: 43.45%; Tobramycin deposited-P: 36.84%; TB: 11.52; ET: 26.36%; Dd: 25.28. Pari IS2: MMAD: 3,179 microns; GSD: 1,367; Particles deposited--P: 41.99%; TB: 8.67%; ET: 17.26%; Dp: 32.07%; Tobramycin deposited-P: 33.19%; TB: 14.37%; ET: 34.12%; Dd: 18.3%. Artsana with Sidestream ampulla-MMAD: 3,083 microns; GSD: 2,313; Particles deposited-P: 43.96%; TB: 7.11%; ET: 6.23%; Dp: 42.68%; Tobramycin deposited-P: 43.63%; TB: 8.1%; ET: 15.3%; Dd: 32.97%., Conclusions: Differences in nebulizers performance influence therapeutic effects and tobramicyn deposition in the lower airways.

The IARC has recently included crystalline silica among substances considered carcinogenic for man. This new evaluation immediately posed the need to measure the exposure levels of the general population. The paper reports the results of measurements of the concentrations of quartz (i.e., the most common form of crystalline silica) in a location in the urban area of Rome. First we studied the respirable fractions of the airborne particles (PM10) sampled in the Spring of 1996 with a cascade impactor, which were characterized using a scanning electron microscope equipped with an X-ray microprobe. Ten components were identified including total silica (crystalline and amorphous), which was present in a percentage of 3.7% on average. On the basis of these data a methodological study was undertaken of the concentration of quartz in the historic series of PM10 sampled daily at the same site by means of an AMP instrument (Airborne Particles Monitor). The filters of mixed cellulose esters on which the PM10 was collected were incinerated at low temperature in oxygen plasma to eliminate the organic component. The residue was deposited on silver filters which were read with a conventional X-ray diffractometer in order to determine the quantity of quartz. We analyzed 28 filters from four representative weeks of the four seasons of 1994, the year in which systematic sampling was initiated. The results showed a mean weekly concentration of airborne quartz of between 0.6 and 1.5 micrograms/Nmc, which gives a percentage over PM10 of 1.7 and 3.4 respectively. These data substantially agree with previous results obtained with electron microscopy and show that the levels of quartz in the urban atmosphere under study were about one hundred times lower than the TLV currently recommended by the ACGIH for working environments (100 micrograms/Nmc) and which are also in force in Italy.

Inhalation of sulphur dioxide (250 ppm), (SO2) or sodium metabisulfite (80 mM) (MBS) aerosol or perfusion with MBS (3 mM) induced a reduction in compliance and conductance in the isolated, perfused and ventilated guinea pig lung. Pretreatment of the lung with sodium sulfite (3 mM), a dissolution product of SO2 and MBS, reduced the bronchoconstriction induced by SO2 and MBS. Bronchoconstriction induced by SO2 and MBS in associated to increased levels of Calcitonin gene-Related Peptide (CGRP) in the perfusate effinent, indicating activation of sensory nerves. The release of CGRP induced by SO2 and MBS was not affected by sodium sulfite. Sulfite treatment did not modify lung reactivity towards acethylcholine, bradykinin, serotonin, histamine and substance P (fragment 5-11). An inhibitory effect by sulfite was observed on bronchoconstriction induced by neurokinin A (fragment 4-10). Since bronchoconstriction induced by SO2 and MBS appears to be mediated by neurokinin A release and action, sulfite may act by affecting its signal transduction pathway. In conclusion, the results indicate that during exposure to some environmental and occupational pollutants, e.g. SO2 and MBS, critical modifications of sulfhydryl groups on smooth muscle receptors may occur. We hypothesise this as a possible step in the development of tolerance and hyperreactivity.

The individuation of a 5:1 ratio for the posology of beta 2-agonist drugs administered respectively by nebulizer or as a spray plus a spacer, allows the use of these drugs by the latter way also during an acute attack of bronchospasm. Other qualifying aspects of beta 2-agonist are the possibility of increasing the dose up to a continuous administration in case of a severe attack of bronchoconstriction and the demonstrated clinical efficacy of these drugs during the first year of life. The question of the correct dose to administer according to the age of the patient appears to be rather complex: in fact if on the one hand during the first months of life the low tidal volume (VT) can reduce the quantity of drug inhaled, on the other the low pulmonary volumes (FRC) of the first years of life determine a lesser dilution of the inhaled drug and therefore a greater pulmonary concentrations. Among corticosteroids for inhalation, the ones with the fewer side effects should be chosen: these may appear although in a subclinical fashion at relatively low doses of about 400 micrograms/day of beclomethasone. The most frequent indication for an antibiotic treatment by inhalation is represented by chronic pulmonary infection caused by bacteria sensible only to parenteral antibiotics (for ex. Pseudomonas infection in cystic fibrosis). The extremely high cost of these treatments requires the use of devices with a very high efficiency, in other words capable of nebulizing very large percentages of drug into small particles (< 6 microns).(ABSTRACT TRUNCATED AT 250 WORDS)

The inhalation of aerosolized drugs for therapeutic purpose has been used for many years in respiratory diseases as asthma, chronic bronchitis, cystic fibrosis. Therapeutic aerosols have the advantages to deliver active substances directly to the site of disease, without systemic side effects, to produce a more rapid clinical response, to avoid barriers to the absorption of drugs such as the gastrointestinal tract. We review the mechanisms and the site of lung deposition and the range of devices that can provide an effective aerosol such as metered dose-inhaler and spacers. Besides drugs as cromolyn, beta-2-agonists and topical steroids, recently new inhalation therapies were proposed using antiviral drugs (interferon), pentamidine for Pneumocystis carinii in immunocompromised host, inhalation of attenuated virus (measles) for active immunization. However there is a need for further work in this area.

A microbiological analysis of the environment after dental work is presented in this paper. Detection of oral streptococci in the air is used as an index of the presence of salivary aerosol in consequence of the use of dental tools at high spin. This salivary aerosol may be considered a very important cause for the transmission of infectious diseases in the dental surgery. The real efficacy of a tool for the production of a dry aerosol of phenols or clorexidine with the purpose of environmental disinfection, is evaluated. Among possible parameters has been considered both the spray ability of the tool and the bactericidal activity of the aerosol at variable length from the source. Data here presented demonstrate the real utility of such an instrument for the disinfection of the dental surgery to be applied daily at the end of the work, not only in reducing environment microbial counts but also in totally eliminating salivary microorganisms.

In recent years the therapy of childhood asthma has progressively improved; in fact we passed from the exclusive use of oral or parenteral therapy to the prevalent use of aerosol-therapy. The aerosol therapeutic use can be carry out by traditional inhalation devices or by spacer devices (or simply spacers). The spacers have a low price and they allow a better effectiveness of the therapy for the good diffusibility of the drugs. Besides the children usually show a good compliance with this method. We studied the different effectiveness of a beta 2-stimulant drug given by traditional aerosol or by spacer devices. Our data seem to encourage the use of spacers in childhood asthma for the real better effectiveness and for the reduced rate and severity of systemic effects of inhaled drugs.

The aim of this study was to assess the prevalence, clinical patterns and treatment of asthma in a well-defined area near the North East Italian border (Province of Trieste, 212 kmq, 30,000 inhabitants aged 0-15 years), served by only one children's hospital. The study was carried out from January to December 1991, in the Emergency Department (ED). 118 patients aged from 3 months to 16 years (mean age 5 years) presented bronchial asthma (0.7% of total ED consultation, 6.2% of acute respiratory tract disease). 29 (24.6%) were first diagnosis, 89 (75.4%) were formerly diagnosed. 57% of patients came to the ED in autumn and winter, 36% in spring and 7% in summer; 19.5% of patients came to the ED during the night. Main presentation symptoms were cough (66%), dyspnea (46%), fever (24%). Treatment consisted of aerosolized salbutamol (50%), associated with oral corticosteroids (31%), iv corticosteroids (3%), aerosolized beclomethasone (10%); 6% of patients received only oral salbutamol. 21 patients were hospitalized, all but one in the ED. In all cases hospitalization lasted less than 2 days and therapy was similar to that of non hospitalized patients, except for administration of aminophylline and iv corticosteroid in 5% of patients. ED consultation and hospitalization for bronchial asthma are low in our area, probably due to good working of the Allergologic Centre and to good connection of this structure with paediatricians.

We report a case of a HIV+ patient treated with prophylactic aerosolized pentamidine. The patient showed evidence of tensive right pneumothorax and slight pleural effusion. The pleural fluid was aspired from the drainage and processed in our laboratory. The cytologic examination of aspired fluid revealed abundant Pneumocystis carinii organisms. The cytologic presentation is peculiar in pleural fluid because of the presence of a large amount of trophozoites and a small number of cysts. Direct examination and Giemsa stain are suitable methods to detect trophozoites. The diagnosis can be confirmed by Gomori and Toloidine Blu stains that demonstrate the presence of isolated and scarce cysts. Pneumocystis carinii can also be recognized in Papanicolaou-stained smears as eosinophilic aggregates.

A study was performed on a group of farm workers exposed to mancozeb to validate dose indicators. Two indirect methods have been employed to monitor the air-dispersed mancozeb in the working environment (average concentration 57.2 micrograms/Nm3): carbon disulfide and manganese dosage. The latter proved to be more applicable. To assess skin contamination, the concentration of mancozeb was measured on pads placed on work overalls and in the liquid employed to wash workers' hands. Average concentrations of 0.86 microgram/cm2 and 641 micrograms respectively were obtained. A good correlation between mancozeb concentration on pads and in the air was found. Urinary ethylenethiourea (ETU) and manganese measured before and after a three day exposure were selected as indicators for internal dose. In all cases except three (2.9-2.3 and 4.4 mg/g creat.) ETU was below the sensitivity limit of the method employed. Urinary manganese increased from a mean of 0.32 microgram/g creat. to a mean of 0.53 microgram/g creat. after the exposure. The correlation with environmental data was r = 0.667.

Bradykinin (Bk), a vasoactive nonapeptide which has been proposed as mediator in the pathogenesis of bronchial asthma, is a potent secretagogue in canine airways and in human nasal mucosa in vivo. A study was carried out in order to evaluate the effect of inhaled Bk on tracheobronchial clearance (TBC), measured by a radioaerosol technique in 10 healthy volunteers. Subjects inhaled Bk (8 mg/mL) or vehicle placebo on two occasions, at least 2 weeks apart, in a double blind and randomized fashion 30 min after radioaerosol inhalation. TBC, expressed as the area under the tracheobronchial radioaerosol retention curve calculated for the first 6 hours (AUC 0-6h), was enhanced in 9 of 10 subjects following inhaled Bk when compared to placebo. The mean values for AUC 0-6h were significantly reduced from 132%.h to 92%.h (p < 0.001) with placebo and Bk respectively. We conclude that Bk has a marked effect on tracheobronchial clearance in normal human airways.

In this study the Authors have verified the efficacy of Thymopentin administered via aerosol in the prevention of recurrent catarrhal episodes in the patients affected by COPD during the winter season, compared to the previous winter. In October, 1 phial of Thymopentin was administered via aerosol to 15 patients affected by COPD, daily, for 10 consecutive days; all patients were evaluated at monthly clinical control for 4 months and all patients were invited to keep a diary of daily variations. After 4 months from treatment a net improvement was observed in the clinical parameters studied: sputum (volume and purulence), cough and dyspnoea, but the most interesting datum was the total absence of recurrent episodes of infection, associated to the reduction in quantity of antibiotics, mucolytics and number of days of illness and with noticeable improvement in the quality of life of the patients.

With the aim of evaluating the technical and administrative problems which are relevant to the home aerosol therapy through ultrasonic nebulizers in the management of cystic fibrosis (CF), a comparative study was performed on three types of devices. The study was carried out by means of a questionnaire on the basis of an intensive motivation of the users who were enrolled. The questionnaire was given to 36 families involved in the CF management: they were subdivided into 3 groups of twelve, to each one of whom one of the 3 types of devices had been prescribed. Thirty three families, 11 for each group, answered. With regard to the supply of the devices, an enormous delay was observed: on average from 48 to 111 days according to the groups. The major problems of endurance and maintenance were concerning the american nebulizer Devilbiss Ultranebb mod. 99, the highest costs regarded the German nebulizer Klava 5000. The users' comprehensive evaluation of the devices were fairly in accordance to the results concerning their endurance over time. However, the study showed also some defects of compliance in the patients and their families as regard to the disinfection of the instruments as prescribed by the care Center.

Twenty-seven patients with acute sinusitis have been treated with lincomycin by aerosol 600 mg once a day for 6 days. The evaluations have been made in accordance with resolution of the clinical symptoms and radiological pictures. The trial has shown a marked reduction of the symptoms after only 3 days of treatment and almost total disappearance at the final control. Lincomycin proved to be effective and well tolerated in all patients.

The test has been performed on 20 patients, aged between 14 and 68 suffering from a catarrhal pathology of otorhinolaryngologic nature for which a mucolitic aerosol therapy was recommended. 4-carbomethoxythiazolidine has been administered with a posology of one bottle twice a day (by aerosol-nebulization) for periods of time ranging from 4 up to 15 days. Together with the 4-carbomethoxythiazolidine treatment, some patients have been administered concomitant drugs. At the end of the tests the development of the most significative symptomatologic parameters has been analysed according to the Wilcoxon test: quantity, kind and characteristics of nasal secretions, nasal obstruction, phlogosis of the nasal and pharyngeal mucosa, hoarseness, difficulty in catarrhal expectoration, hypoacusia, retraction of the tympanic membrane. The final clinic evaluation of the efficacy of 4-carbomethoxythiazolidine, expressed according to the examination of the achieved clinic result, has been "positive" in 17 cases (85%) and "negative" in 3 cases (15%). As for its tolerance, in no case has 4-carbomethoxythiazolidine caused detectable side-effects.