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Summary Clay interaction with fluids is a well-known phenomenon that depends on formation mineralogy. This paper focuses on the impact of kaolinite clay dispersion on well injectivity impairment. It is based on field evidence from more than 50 injectors, and it is supported by a huge set of laboratory tests. All analyzed wells showed an initial injectivity lower than the theoretical potential, estimated on the basis of reservoir quality and drawdown mobilities (DDMs). This impairment occurs before connecting wells to the injection network; therefore, injected water quality and network conditions do not take part in the damage. Consequently, the impairment mechanism seems to be correlated to the interaction between the formation and drilling fluids. A set of laboratory experiments was planned on cuttings collected in two recently drilled wells. Different intervals were selected in the reservoir sandstones, representative of the facies where injected water is most likely to flow. Samples were first mineralogically characterized by different laboratory techniques: Fourier-transform infrared (FT-IR) spectroscopy, X-ray diffraction, and cation exchange capacity. Then, swelling and recovery tests were performed using different fluids: mud (field formulation), mud filtrate, and water (varying pH and salinity). Results were correlated with petrophysical analysis, mercury injection tests on cores, and major injectivity impairments observed on the analyzed wells. Analyzed samples showed the presence of kaolinite that may affect the formation permeability by filling porosity and pore throats (diagenetic effect). Moreover, in case of interaction with fluids, kaolinite can lead to an additional permeability reduction by disaggregation and dispersion phenomena. Laboratory tests showed a clear trend: The higher the kaolinite content is in the selected intervals, the higher the observed disaggregation will be, especially when the samples interact with mud filtrate and water. It was observed that mud formulation is effective, allowing to preserve disaggregation, but only below a threshold of kaolinite content. Field experience proved that the only effective remedial actions to restore the well injectivity potential are fracturing jobs, allowing bypass of the near-wellbore damaged zone.

Temperature sensitive foods require monitoring of their time–temperature history in order to assure their safety and high quality. The same holds for other perishable products such as medical and pharmaceutical. The best means to have information on the time–temperature history of a product is by having measurement of these variables along the whole product shelf-life. As an answer to this need several time–temperature indicators have been developed and commercialized for monitoring the quality of food products. In this work a full history time–temperature indicator (TTI) has been designed and developed based on capillary penetration of safe and low surface tension liquids in micro porous polyethylene porous media. For the development of the indicator the appropriate porous media and penetration liquids were selected and capillary penetration of the selected liquids took place at two different temperatures. Based on the results of the capillary penetration experiments the TTI was developed and a prototype was evaluated in a food product in order to assess its capability to be used in food packaging. The results showed that the TTI is simple in use and could provide a quantitative and easy-to-read response. Moreover, the response of the TTI could be calibrated by changing several design parameters, in order to match the quality deterioration kinetics of the specific food product to be monitored.

Background: Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon’s experience. Aims: The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring. Methods: A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic–chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation. Conclusions: In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.

Color specification is an important challenge in many application domains including Cultural Heritage. The collection of metadata concerning Cultural Heritage involves the valorization, fruition and becomes part of the conservation process. It becomes essential to find methods that simplify and optimize the acquisition of such data as color information. In this regard, in this work we present the preliminary results of a project that involves the acquisition by 3D scanner of samples of different colors placed in a controlled environment and with different illumination conditions. To make more accurate the color rendering, the color coordinates of each sample were measured by a spectrophotometer. All the obtained measurements become part of a dataset with which to train a machine learning model that learns how to perform the transformation from the RGB to the CIELab color space in different lighting condition.

La rinitis alérgica (RA) es la enfermedad alérgica más frecuente. La prevalencia en niños y adolescentes de Argentina oscila entre 22.3 y 34.9 %. Ante esto, integrantes de los comités científicos de pediatría y rinitis de la Asociación Argentina de Alergia e Inmunología Clínica (AAAeIC) revisaron evidencia científica para actualizar las normativas terapéuticas de esta patología en la población pediátrica. La clasificación y categorización de la RA se encuentra actualmente en plena revisión en todo el orbe. Es necesario realizar un diagnóstico diferencial con otras rinitis no alérgicas en los niños, y confirmar la RA con base en la historia clínica, el examen físico, la determinación de biomarcadores o pruebas cutáneas. El tratamiento no farmacológico incluye la educación y pautas de control ambiental para alérgenos como ácaros, hongos anemófilos, epitelio de animales y pólenes. Se propone un tratamiento farmacológico escalonado de acuerdo con el control de la enfermedad. Los antihistamínicos de segunda generación no sedativos son la primera línea de tratamiento. La asociación con descongestivos orales no se recomienda en menores de cuatro años. Los corticoides nasales inhalados son de primera elección en formas moderadas y graves. El presente documento alerta a los pediatras sobre la importancia del diagnóstico precoz, el uso racional del tratamiento farmacológico escalonado y la inmunoterapia específica en niños.

Antecedentes: El Angioedema Hereditario es una enfermedad genética rara; se manifiesta principalmente con edema cutáneo y/o mucoso. Pequeños traumas pueden desencadenar eventos potencialmente fatales. En Angioedema Hereditario tipo I y tipo II, se puede hacer profilaxis a corto plazo con concentrado plasmático de C1 Inhibidor. En Angioedema Hereditario con C1 Inhibidor normal, la profilaxis aún no está estandarizada pero este podría ser beneficioso. Reporte de caso: Mujer de 69 años, con diagnóstico genético de angioedema hereditario con C1 inhibidor normal, consultó a la Sección de Alergia por requerir exodoncias dentarias múltiples. El procedimiento se realizó bajo anestesia general, utilizándose como profilaxis 1000U de concentrado de C1 inhibidor derivado del plasma una hora antes. Cursó el postoperatorio en terapia intensiva con buena evolución. Conclusiones: Resaltamos la posibilidad de utilizar con éxito el concentrado de C1 inhibidor derivado del plasma como profilaxis, en pacientes con Angioedema Hereditario con C1 inhibidor normal.

BackgroundAntiTNF-α biosimilars are broadly available for the treatment of inflammatory arthritis. There are a lot of data concerning the maintenance of clinical efficacy after switching from originators to biosimilars. However, there is lack of data on the switch between biosimilars. The current evidence on the safety, efficacy, and immunogenicity of switching multiple times from a biosimilar to another biosimilar comes from a limited number of randomized-controlled trials and real world evidence studies.ObjectivesThe aim of our work was to evaluate the disease activity trend after multiple switching from ADA originator-Humira (oADA) to its biosimilars (bsADA; ABP 501 and SB5 subsequently) in a cohort of inflammatory arthritis patients.MethodsIn this real-life study, we selected patients with clinical diagnosis of rheumatoid Arthritis (RA), psoriatic Arthritis (PsA) and ankylosing spondylitis (AS). Patients had been previously treated with oADA and switched to the bsADA (first ABP 501 and then SB5). At each outpatient visit, we recorded demographic features (age, sex, and time since diagnosis) and the following disease activity measures: DAS28, DAPSA, BASDAI and the HAQ. Rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA), C-reactive protein (CRP) and HLAB27 were also measured over the observational period (visits 0, 12, 24 and 36 months). The disease activity was evaluated during the year before the introduction of the bsADA, and then evaluated in the following 36 months during the first and the second bsADA treatment. We also examined whether some baseline characteristics, such as the duration of ADA treatment, concomitant therapy, comorbid disease and baseline disease activity, could influence the bsADA discontinuation.ResultsWe evaluated the 3-year drug survival and efficacy of the multiple switch of bsADA in RA, PsA and AS patients, previously treated with oADA in 127 patients (Table 1). All the patients enrolled underwent a first switch lasting one year and then a second switch with a follow up of one year too. The 1-year retention rate for ABP501 was 84.4%, 78% and 76% in AS, RA and PsA patients, respectively. The 1-year retention rate for SB5 was 82.1%, 78,7% and 77,5% in AS, RA and PsA patients, respectively. Disease activity, as measured by DAS28, DAPSA and BASDAI remained stable over the 3 years (Figure 1). Comorbid disease (HR: 3.04, p < 0.001) and HAQ at baseline (HR: 2.12, p = 0.001) significantly increased the risk of ADA discontinuation, while previous ADA duration was positively associated with bsADA retention rate (HR: 0.83, p = 0.0024). 27.4% patients left the study due to the interruption of the bsADA, 76.5% discontinued due to inefficacy and 23.5% due to adverse events.Table 1.Baseline characteristics of RA, PsA and AS patientsCharacteristicsTotal cohort N=127RA N=41PsA N=52AS N=34Female gender (%)75 (60)35 (85)31 (59)9 (26)Age (years)61.7±12.7860.5±12.6461.55±11.656.3±10.71Disease duration (years)15.86±9.4917.23±10.6413.75±6.5714.92±9.50Comorbidities, (%)17,8 (14)5,7 (14)9,8 (19)2 (6)ACPA+, n (%)-25 (63.3)--RF+, n (%)24 (62.5)HLAB27+, n (%)--8 (15)17 (50)CRP (mg/L)1.65±2.272.31±1.900.42±0.271.36±1.91DAS 28-2.65±0.75DAPSA-8.25±3.69BASDAI-3.23±1.58HAQ0.73±0.570.72±0.550.73±0.520.76±0.69Prednisone, n (%)46 (36)23 (55)20 (44)3 (13)Combo Therapy65 (51)29 (68)25 (48)11 (32)oADA duration (months)49.74±40.7556.43±41.2725.00±13.6740.08±37.78ABP501 duration (months)12.42±2.4112.77±2.3412.82±1.4912.49±2.95SB501 duration (months)11.92±1.4112.47±1.7412.72±1.4912.41±1.95ABP501 (Adalimumab biosimilar, Amgevita), SB501 (Adalimumab biosimilar, Imraldi)ConclusionNo difference was found between oADA and bsADA in terms of efficacy. This real-life study confirms the similar efficacy profile of multiple switch bsADA with long-term retention and a good safety profile in inflammatory arthritis patients.References[1]Feagan BG et al. Adv Ther. 2020 Nov;37(11):4491-4518. doi: 10.1007/s12325-020-01472-1. Epub 2020 Sep 10.Disclosure of InterestsNone declared

BackgroundApremilast, an inhibitor of the phosphodiesterase 4, is indicated for Psoriatic Arthritis (PsA) treatment. The 3 years retention rate, an outcome indirectly related to efficacy, observed in clinical trials [1] is 55,5%. A single subsequent real world setting study [2] suggested a lower efficacy as it reported that the six months retention rate was about 57%.ObjectivesThe main aim of this retrospective observational study is the assessment of apremilast 3 years retention rate in a real world PsA patients’ cohort. Moreover, the secondary objective is reporting the reasons of apremilast suspension and the most relevant factor related to treatment persistence.MethodsIn thirteen Italian rheumatological referral centers, all PsA consecutive patients who received apremilast were enrolled. Anamnestic data, treatment history and PsA disease activity (DAPSA) at baseline and after 6 and 12 months were recorded. The Kaplan-Meier curve and the Cox analysis computed the apremilast retention rate and treatment persistence-related risk factors. A p-value < 0.05 was considered statistically significant.ResultsThe three-hundred-twenty-four enrolled patients (median age 60 [InterQuartile Range IQR 52-67] yrs; female prevalence 57,0%) median observation period was 17 [IQR 7-36] months (6848 patients-months). The apremilast retention rate at 6, 12 and 36 months was, respectively, 95%, 86% and 66% (Figure 1). The main discontinuation reasons were: primary inefficacy (40% of interruptions), secondary inefficacy (18%) and gastro-intestinal intolerance (17%%). The oligo-articular onset was the only factor associated to apremilast persistence (Hazard ratio 0.57 IQR 0.34-0.96). Sex, age, and sever comorbidities (cancer, chronic infections etc) were not related to treatment discontinuation. The basal DAPSA (24.1, IQR 18.5-32.0) decreased after 6 and 12 months (respectively 14.5, IQR 10.1-22.6 and 10.5, IQR 8,0-15.2). Remission or minimal disease activity (DAPSA < 15) was achieved after 12 months in 38.0% of patients.ConclusionAlmost two third of PsA patients receiving apremilast were still in treatment after 3 years. The study’s data, confirmed its efficacy and safety profile. Apremilast appear a good treatment choice in patients with oligo articular PsA or burdened by severe comorbidities.References[1]Mease et al. ACR Open Rheumatology (2020)[2]Favalli et al Clin Exp Rheum (2020)Disclosure of InterestsAlarico Ariani Speakers bureau: Zentiva, Consultant of: Boeringher, Amgen, Bristol-Meyers-Squibb, Novartis, Sanofi, Novo Nordisk, Lilly, Janssen, Bruno Farmaceutici, Simone Parisi: None declared, Patrizia Del Medico: None declared, antonella farina: None declared, elisa visalli: None declared, Aldo Molica Colella: None declared, Federica Lumetti Consultant of: Amgen, rosalba caccavale: None declared, Palma Scolieri: None declared, Romina Andracco: None declared, Francesco Girelli: None declared, Elena Bravi: None declared, Matteo Colina: None declared, Veronica Franchina: None declared, Ilaria Platé: None declared, eleonora Di Donato Consultant of: Novartis, Giorgio Amato: None declared, Carlo Salvarani: None declared, Francesco De Lucia: None declared, Daniele Santilli Consultant of: Novartis, eugenio arrigoni: None declared, Flavio Mozzani Consultant of: Novartis, Abbvie, Rosario Foti: None declared, Gilda Sandri: None declared, Vincenzo Bruzzese: None declared, Marino Paroli: None declared, Enrico Fusaro: None declared, Andrea Becciolini: None declared

Hereditary angioedema (HAE) is a rare disease. During the last years, many studies and advances have been developed with the aim of better understanding the pathophysiology, as well as optimizing patient management. Several international working groups have attempted to clarify and standardize the care of HAE communicated as guidelines and consensus recommendations. We considered necessary to provide recommendations for the diagnosis and treatment of patients with HAE in Argentina.A group of specialists of allergy and immunology from Argentina by using the online surveys methodology as well as face to face meetings developed the intended consensus.Recommendations were established based on published evidence and the expert opinion. The consensus focused on diagnosis, acute management of attacks, short and long-term prophylaxis, special situations (pediatrics and pregnancy) and disease management considering the health care system in Argentina.The recommendations established in this consensus guidelines will optimize the management of patients with HAE in Argentina.Objetivos: El angioedema hereditario es una enfermedad poco frecuente. Durante los últimos años se han desarrollado muchas investigaciones y registrado avances con el objetivo de entender mejor la fisiopatología y optimizar la atención a los pacientes. Diversos grupos de trabajo internacionales han intentado clarificar y normalizar el cuidado de pacientes con angioedema hereditario, lo que se ha reflejado en guías y consensos. Consideramos necesario desarrollar un documento de consenso con recomendaciones para el diagnóstico y tratamiento del angioedema hereditario en Argentina. Metodología: Un grupo de expertos de Argentina, conformado por especialistas en Alergia e Inmunología mediante metodología de ronda de encuestas a distancia y reuniones presenciales llevó adelante la elaboración del consenso pretendido. Resultados: Se establecieron recomendaciones basadas en la evidencia publicada y en el criterio de los expertos participantes. Las recomendaciones se enfocaron en el diagnóstico, tratamiento y profilaxis de las crisis a corto y largo plazo, control de situaciones especiales y consideraciones del sistema de salud en Argentina. Conclusión: Las recomendaciones establecidas en este consenso permitirán optimizar la atención médica de los pacientes con angioedema hereditario en Argentina.

Làtex; Gestió; A nivell mundial Latex; Management; Wordwide Látex; Gestión; A nivel mundial Despite the efforts made to mitigate the consequences of this disease, natural rubber latex allergy (NRLA) continues to be a global health problem and is still considered one of the main worries in the working environment in many countries throughout the world. Due to thousands of products containing latex, it is not surprising that the current statistics suggest that prevalence remains high among healthcare workers and susceptible patients. In developed countries, reduction in the prevalence of IgE-mediated allergy to latex proteins from gloves may lead to lax attention by health care personnel. On the other hand, this situation is different in developing countries where there is a lack of epidemiological data associated with a deficit in education and awareness of this issue. The aim of this review is to provide an update of the current knowledge and practical recommendations regarding NRLA by allergologists from different parts of the world with experience in this field. The authors have not received any funding to prepare the manuscript.

Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care.

Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up.Dados los avances sobre mucopolisacaridosis I con posterioridad al consenso publicado en la Argentina por un grupo de expertos en 2008, se revisan recomendaciones respecto a estudios genéticos, seguimiento cardiológico, cuidado de la vía aérea, alertas sobre aspectos auditivos, de la patología espinal y neurológica. Se hace revisión de la terapéutica actual y se enfatiza en la necesidad de un diagnóstico y tratamiento precoces, así como de un seguimiento interdisciplinario.

There are very few studies about the prevalence of allergic rhinitis in Argentina.To determine the prevalence of allergic rhinitis in a population of inhabitants between the ages of 5 and 44 in Argentina.A cross-sectional national study in which a self-reported questionnaire was used. The included participants are between the ages of 5 and 44 and they reside in urban areas. The information was collected by phone.3200 participants were surveyed: 51.8% were women, 37.6% were between the ages of 5 and 19, and 62.4%, were between the ages of 20 and 44. The global prevalence of symptoms of allergic rhinitis was of 20.5%; the most frequent symptoms were sneezing (58.5%) and nasal congestion (51.4%). Overall, 44.3% of the participants had a family history of allergies. Allergic rhinitis was more frequent in women; the prevalence was of 22.3% in the group of participants between the ages of 5 and 19, and of 19.4% in the group of participants between the ages of 20 and 40 (p=0.0545); 63.8% of participants with symptoms did not have a medical diagnosis.The results of this first cross-sectional national survey have confirmed the high prevalence of self-reported symptoms of allergic rhinitis in adults and children in Argentina, particularly in women.Antecedentes: Existen pocos estudios sobre la prevalencia de rinitis alérgica en Argentina. Objetivo: Determinar la prevalencia de rinitis alérgica en una población entre cinco y 44 años de edad en Argentina. Métodos: Estudio transversal nacional en el que se utilizó un cuestionario autoinformado. Se incluyeron participantes entre cinco y 44 años de edad residentes en áreas urbanas. La información se recolectó telefónicamente. Resultados: Se encuestaron 3200 participantes: 51.8 % del sexo femenino, 37.6 % tenía entre cinco y 19 años y 62.4 % entre 20 y 44 años. La prevalencia global de síntomas de rinitis alérgica fue de 20.5 %; los síntomas más frecuentes fueron los estornudos (58.5 %) y la congestión nasal (51.4 %). En general, 44.3 % de los participantes tenía antecedentes familiares de alergia. La rinitis alérgica fue más frecuente en las mujeres; la prevalencia fue de 22.3 % en el grupo de cinco a 19 años y de 19.4 % en el de 20 a 44 años (p = 0.0545); 63.8 % de los participantes con síntomas no tenía diagnóstico médico. Conclusiones: Los resultados de esta primera encuesta transversal nacional confirman la alta prevalencia de síntomas autoinformados de rinitis alérgica en adultos y niños en Argentina, especialmente en las mujeres.

Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.

Background Worldwide 13 million babies born prematurely every year have increased susceptibility to infection and require adequate immunization. Hexavalent vaccines against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae type b are standard of care in pediatric vaccination and are particularly important for preterm infants. Hexyon® is registered in Europe since April 2013. Methods Considering birth data from official national databases and only countries with periods of exclusive use of Hexyon from 2013-19, we estimated the total number of preterm infants ( Results Since registration, Hexyon has been used in 23 European countries and exclusively used in the following: Austria, Feb-2017 to present; Belgium, Jul-2014 (Flanders)/Sep-2015 (Overall) to present; Bulgaria, Nov-2014 to Dec-2016; Croatia, Jan-2016 to present; Denmark, Feb-2016 to Apr-2017; Italy, Apr-2016 to present, exclusivity based on Regions; Macedonia, Oct-2015 to present; Norway, Feb-2017 to present; Romania, Apr-2015 to Dec-2017. The estimated total number of preterm infants during these periods of exclusive use is 183 000. Assuming 90% vaccination coverage, ∼164 700 preterm infants received at least 1 dose of this vaccine. From the analysis of the post-marketing safety data available to date, no new risk has been identified in preterm infants. Conclusions Hexyon has become a standard for hexavalent immunization in infants, regardless of the gestational age at birth. More than 90 million doses have been administered worldwide, including the estimated 164 000 preterm infants in the 9 European countries considered here. The EU Marketing Authorization granted in 2013 with no contraindication for use in preterm infants, was renewed in 2018 and the black triangle was removed confirming that the safety of Hexyon is well established. The marketing authorization holder continues to support evidence generation for use in preterm infants. Key messages Hexyon/Hexacima/Hexaxim has become a standard for hexavalent immunization in infants including for preterm infants (

This document summarizes the aims of GA2 LEN/HAEi Angioedema Centers of Reference and Excellence (ACAREs) and elaborates the requirements that ACAREs must fulfill to become certified. It also provides (see Appendix S1) background information on GA2LEN and HAEi, including HAEi member organizations and regional patient advocates, on why we need an Angioedema Center of Reference and Excellence (ACARE) program and network, and on the accreditation and certification process, governance and funding, and on the interaction with other GA2LEN networks of centers of reference and excellence. The protocols, aims, requirements, and provisions related to becoming a certified CARE are based on (a) the experience of the GA2LEN UCARE network and (b) input from angioedema patients, general practitioners, and angioedema specialists.

The aim of the present study was to evaluate the rheumatic profile in acromegalic patients to better characterize joint pain. The immunological pattern (rheumatoid factor; antinuclear antibodies—ANA, extractable nuclear antigens—ENA-Ab; anti-citrullinated protein antibodies; erythrocyte sedimentation rate) was evaluated in 20 acromegaly subjects (AS) and 20 control subjects (CS). Bilateral joint ultrasound of hands/wrists and nail capillaroscopy were also performed. Articular pain was more frequent in AS than in CS (p = 0.027). No difference was detected in immunological parameters. ANA and ENA-Ab were positive in only 10% of AS and in 5% of CS, while no difference was found in anti-citrullinated protein antibodies. No difference was detected between rheumatoid factor positivity, but threefold higher IgG were detected in AS compared to CS. The erythrocyte sedimentation rate was significantly higher in AS than CS (p = 0.040), while in AS, there was a trend in increased Power Doppler (PWD) articular uptake. The capillaroscopic evaluation showed a significant difference in almost each parameter (presence and number of tortuous capillaries, capillary enlargements, and hemorrhages), showing a moderate-to-severe microangiopathy in AS. The results of our study suggest that joint damage in acromegaly has not an autoimmune etiology. Increased erythrocyte sedimentation rate levels and PWD alteration in acromegalic population reflect a possible inflammatory nature, while the capillaroscopic findings suggest a moderate-to-severe microangiopathy that could help to identify patients with a greater macroangiopathic risk.

International audience; An assessment of 1 286 validated data from 231 on-site sanitation facilities was carried during 6 years in France. Facilities are classified in 3 families, 13 categories and 33 systems according to sanitation processes and industrial technologies developed by manufacturer. Classes of treated wastewater quality were created based on the analysis of the French regulation used for wastewater treatment. The frequency of curative maintenance is analyzed using fuzzy logic. Then, these two criteria are jointly analyzed and allow assessing 18 systems out of 33. Authors, members of the national public group "assessment of on-site sanitation systems", provide objective information on the quality of treated wastewater and curative maintenance of twenty systems under real operating conditions. Systems that obtain an "acceptable" quality class for both treated wastewater quality and frequency of curative maintenance are all from the Biofilm Systems on Fine Media (BSFM) family: i) traditional sand filter (S1) and 2 approved systems: ii) constructed wetland system (CW) and iii) one system of the coconut shavings category (CS2). Hence, only 12% of approved systems studied in this project are "acceptable" for both treated wastewater quality and frequency of curative maintenance. This study gives scientific and technical information for political stakeholders at different territory scales: Municipality, Public entities in charge of the on-site sanitation service (Spanc), French departments, Water agencies, Ministry in charge of on-site wastewater treatment and European Commission.; Le suivi in situ des installations d'assainissement non collectif (ANC) a duré 6 ans et a permis de collecter 1286 données validées sur 231 installations. Les installations sont classées en 3 familles, 13 filières et 33 dispositifs selon des critères liés aux processus d'épuration et aux techniques industrielles développées par les fabricants. Des classes de qualité des eaux usées traitées ont été élaborées, à partir de l'analyse de la réglementation française technique appliquée au traitement des eaux usées. La fréquence d'entretien curatif des installations est analysée par un outil utilisant la logique floue. Ces deux critères sont ensuite analysés conjointement et permettent de qualifier 18 des 33 dispositifs évalués. Les auteurs, constitués en groupe national public « suivi in situ des installations d'assainissement non collectif », fournissent ainsi des informations objectives d'une vingtaine de dispositifs d'ANC dans leurs conditions réelles de fonctionnement. Les dispositifs qui obtiennent une classe de qualité « acceptable » à la fois pour la qualité des eaux usées traitées et la fréquence d'entretien curatif sont trois dispositifs de la famille CFSF : i) le filtre à sable traditionnel de la filière « sable » (S1) ; deux dispositifs agréés : ii) le dispositif étudié de la filière « végétaux » (FPR) et iii) l'un des deux dispositifs étudiés de la filière « copeaux de coco » (CC2). Ainsi, seulement 12 % des dispositifs agréés étudiés répondent au qualificatif « acceptable » à la fois vis-à-vis de la qualité des eaux usées traitées et de la fréquence d'entretien curatif. Cette étude donne un éclairage scientifique et technique destiné à alimenter la réflexion des responsables des politiques publiques aux diverses échelles du territoire : Commune, Collectivité en charge du service public d'assainissement non collectif (SPANC), Conseil Départemental, Agences de bassin, Ministères en charge de l'assainissement non collectif et Commission Européenne.

Attention deficit hyperactivity disorder (ADHD) and allergic rhinitis (AR) constitute high-prevalence entities in the pediatric population, and both affect the quality of life of children and their families. Over the last decade, it has been stated that a high number of patients with ADHD show comorbidities with allergic diseases. The aim of this review is to assess the current information about the relationship between both entities. According to some authors, a causal association between them has been proposed since they have genetic, environmental, and inflammatory physiopathological mechanisms in common. However, there is still some controversy on this issue. Sleeping disorders are present in both and should be assessed in patients who suffer these conditions. Therefore, proper treatment of AR and other atopic diseases may be beneficial for the clinical progress of ADHD. Reduction of AR unpleasant symptoms and improvements of sleep quality decrease the child’s irritability, and they may further improve their behavior pattern. Even though this association has not been clearly proven, the allergic conditions and sleep features have to be taken into account in order to improve the patients’ quality of life.

The outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, causing coronavirus disease 2019 (COVID-19), has had a deleterious effect on the delivery of care for all acu...

The management of chronic urticaria (CU) has been controversial. Recently updated international guidelines propose evidence-based diagnosis and treatment. Nevertheless, dermatologists have heterogeneous approaches to managing CU. To estimate the percentage of dermatologists who have an optimal approach to CU according to the international guidelines, and to explore the variables associated with optimal management a cross-sectional study using a 17-question survey was delivered by email to dermatologists from Argentina. Optimal first, second, and third line treatment were considered when dermatologists chose a nonsedative antihistamine; increased the dosage of nonsedative antihistamines, and added omalizumab, respectively. Logistic regression was used to identify variables associated with optimal management. A total of 165 questionnaires were available for analysis. An optimal first, second, and third-line treatment approach was identified in 50%, 35%, and 15% of the dermatologists, respectively. The dermatologists' age being above 55 years old (OR: 0.12, 95% CI: 0.01-0.99, p .005) and having more than 5 years of expertise (OR: 0.4, 95% CI: 0.19-0.81, p .001) were significantly associated with a suboptimal approach in second-line treatment. We could not find variables associated with an optimal first or third-line treatment. The real-life management of CU in Argentina is partly suboptimal according to the international guidelines.

Amoxicillin is a beta-lactam antibiotic commonly indicated in pediatrics and the most frequent cause of drug allergies.To determine the proportion of confirmed amoxicillin allergy in children with diagnostic suspicion seen at the Division of Pediatric Allergy.This descriptive, retrospective study was done between January 2009 and January 2017 in children younger than 18 years with diagnostic suspicion of amoxicillin allergy. The diagnosis was based on questions and specific tests.A total of 234 patients were included; amoxicillin allergy was diagnosed in 10.7 % (95 % confidence interval: 7-15). These patients had a higher prevalence of immediate symptoms (40 % vs. 22 %,Amoxicillin allergy in children referred to specialists was confirmed in 10.7 %.La amoxicilina es un antibiótico betalactámico comúnmente indicado en pediatría y es la causa más frecuente de alergia a medicamentos. Objetivos: Determinar la proporción de alergia confirmada a amoxicilina en niños con sospecha diagnóstica, atendidos en una sección de alergia pediátrica. Población y métodos: Estudio descriptivo retrospectivo entre enero de 2009 y enero de 2017, en menores de 18 años con sospecha diagnóstica de alergia a amoxicilina. Se realizó el diagnóstico según interrogatorio y pruebas específicas. Resultados: Fueron incluidos 234 pacientes; se diagnosticó alergia a la amoxicilina en el 10,7 % (intervalo de confianza del 95 %: 7-15). Estos pacientes tenían mayor prevalencia de síntomas inmediatos (el 40 % vs. el 22 %, p = 0,048) y de exposición previa a betalactámicos (el 84 % vs. el 56 %, p = 0,007). Conclusión: La confirmación de alergia a la amoxicilina en niños derivados a especialistas fue del 10,7 %.

To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69-77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P 0.001) were included. Acute gastro-intestinal (GI) toxicity G 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU 1 (P = 0.004) and for GI 1 (P 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.