Helicopter route chart, New York.

Aeronautical chart showing designated helicopter routes and control areas.

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia.

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children’s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia. Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014. Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%). Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician. Keywords:

Portugal at the cross road of international chronic respiratory programmes

July 1-4, 2015 two meetings will be held with the Directorate General of Health in Lisbon, Portugal to discuss chronic respiratory programmes of the WHO Global Alliance against Chronic Respiratory Diseases (GARD)1,2 and European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)3 (AIRWAYS ICPs: Integrated Care Pathways for airway diseases).4 The goals of these meetings will be to make an update of these two international actions and to strengthen the WHO noncommunicable disease (NCD) action plan (2013---2020).

Estudo retrospetivo sobre traqueostomia permanente como tratamento cirúrgico em cães com síndrome braquicefálica obstrutiva

Dissertação de Mestrado Integrado em Medicina Veterinária

Desvendando a resposta dos eosinófilos, dos neutrófilos e dos monócitos nas parasitoses intestinais, na asma e na associação de ambas em crianças

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Pós-graduação em Medicina Tropical, 2015.

Investigation of the enhanced antimicrobial activity of combination dry powder inhaler formulations of lactoferrin

The airways of most people with cystic fibrosis are colonized with biofilms of the Gram-negative, opportunistic pathogen Pseudomonas aeruginosa. Delivery of antibiotics directly to the lung in the form of dry powder aerosols offers the potential to achieve high local concentrations directly to the biofilms. Unfortunately, current aerosolised antibiotic regimes are unable to efficiently eradicate these biofilms from the airways. We investigated the ability of the innate antimicrobial, lactoferrin, to enhance the activity of two aminoglycoside antibiotics (tobramycin and gentamicin) against biofilms of P. aeruginosa strain PAO1. Biofilms were prepared in 96 well polystyrene plates. Combinations of the antibiotics and various lactoferrin preparations were spray dried. The bacterial cell viability of the various spray dried combinations was determined. Iron-free lactoferrin (apo lactoferrin) induced a 3-log reduction in the killing of planktonic cell by the aminoglycoside antibiotics (p < 0.01) and also reduced both the formation and persistence of P. aeruginosa biofilms (p < 0.01). Combinations of lactoferrin and an aminoglycoside displays potential as an effective new therapeutic strategy in the treatment of P. aeruginosa biofilms infections such as those typical of the CF lungs.

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5)

Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing.

Caracterización paraclínica de trabajadores con patologías respiratorias de un centro de referencia neumológico, Bucaramanga, 2014-2016

Introducción: La enfermedad respiratoria ocupacional es causada por la exposición a diferentes agentes en el trabajo. Las pruebas objetivas realizadas en sospecha de enfermedad respiratoria de origen laboral, son importantes herramientas que permiten realizar un adecuado diagnóstico, una detección precoz de la enfermedad respiratoria ocupacional, disminuye el progreso rápido de la patología, la morbilidad de los trabajadores y el impacto negativo sobre su futuro laboral. Objetivo: Caracterizar las pruebas paraclínicas de las patologías respiratorias de trabajadores, en un centro de referencia neumológico de Bucaramanga año 2014-2016. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo con datos secundarios de 96 trabajadores que laboran en diferentes actividades económicas. Se incluyeron variables sociodemográficas, laborales, ayudas imagenológicas y pruebas de función pulmonar, realizando 3 grupos de acuerdo a su patología que fueron: Asma, síndrome de disfunción reactiva de la vía aérea y neumoconiosis. En el análisis estadístico se emplearon medidas de tendencia central y dispersión. Resultados: De los 96 trabajadores 84.4% son hombres, las actividades económicas más frecuentes fueron la industria del petróleo y gas en un 27.1% y trabajadores en materiales de construcción en un 19.8%. En la caracterización paraclínica por grupo de patología, para asma predominó la obstrucción en la espirometría (46.9%) y los volúmenes pulmonares con atrapamiento aéreo (95.5%), en RADS (síndrome de disfunción de vías aéreas reactivas) los volúmenes pulmonares con atrapamiento aéreo (77%) y en las neumoconiosis para Rx de tórax (90.3%) y Tac de tórax (100%) reportaron alteraciones parenquimatosas, espirometría con obstrucción (54.8%) y volúmenes pulmonares con atrapamiento aéreo (62.5 %).Discusión y Conclusiones: Las ocupaciones de mayor riesgo para desarrollo de neumopatías de origen ocupacional fuero, , son la minería y construcción y para asma la agricultura y manufacturas. Para asma se evidenció que no hay significancia diagnóstica para estudios imagenológicos pero sí para las pruebas de función pulmonar. Para neumoconiosis el estudio imagenológico es el de mayor importancia ya que en las radiografías se presentan cambios incluso mucho antes de la afectación de la función pulmonar. Para RADS se concluyó que la realización de un test de provocación con metacolina sería el Gold estándar para el diagnóstico. Las pruebas de función respiratoria son de vital importancia para determinar la enfermedad ocupacional en trabajadores expuestos para vigilancia y detección precoz, es conveniente la realización de protocolos para la evaluación y diagnóstico de la enfermedad respiratoria de origen ocupacional. Palabras claves: Neumoconiosis, asma ocupacional, función pulmonar, radiografía de tórax, ocupación, Colombia.

EPOC ocupacional : una revisión de la literatura (2004 - 2016)

EPOC OCUPACIONAL: UNA REVISION DE LA LITERATURA (2004 - 2016) Camilo Alfredo Vanegas Clavijo, Md. Resumen La enfermedad pulmonar obstructiva crónica (EPOC) es una de las condiciones patológicas más frecuentes en la población general la cual produce una alta morbimortalidad en las personas que la padecen. A pesar de que el tabaquismo es la principal causa, los factores ocupacionales vienen incrementando su importancia para el desarrollo de esta enfermedad. Se cree que cerca del 20% de los casos de EPOC son atribuibles a la exposición ocupacional desencadenando un bajo rendimiento laboral por el deterioro de la calidad de vida. Objetivo Realizar una revisión de la literatura de los años 2004 al 2016 de los factores de riesgo ocupacional en el desarrollo de la EPOC y de las actividades que más incidencia tienen en la aparición de esta patología. Métodos Se utilizaron las bases de datos PubMed, Science Direct y Ovid para identificar artículos científicos relacionados con la exposición ocupacional, sus componentes y el desarrollo de la EPOC, y que estén publicados desde el año 2004 al 2016. Se tuvieron en cuenta solo artículos en idiomas inglés y español y se excluyeron artículos relacionados con población general y publicaciones editoriales, suplementos o publicaciones no científicas. Revisando títulos y resúmenes inicialmente con aplicación de filtros se obtuvieron en total 83 artículos. Resultados Según se describe en la mayoría de estudios y revisiones recientes, ya sea en muestras de población general o en lugares de trabajo, se indica que alrededor del 15 al 20% de todos los casos de EPOC están relacionados con el trabajo. Se documenta en varios de estos estudios una fuerte asociación entre la exposición ocupacional y un mayor riesgo de EPOC en trabajadores de la minería de carbón y oro, en las actividades relacionadas con la construcción y los trabajadores de las industrias textiles. Desestimular el tabaquismo, las medidas preventivas y la detección temprana de la enfermedad reducen la instauración y progresión de la enfermedad, mejorando la calidad de vida de los trabajadores y con ello aumentando el desempeño laboral. Conclusión En áreas como la minería, la construcción, la industria metalmecánica y la fabricación de textiles, la exposición ocupacional a polvos, gases, vapores y humos en los diversos ambientes laborales tienen una alta relación con la producción de la EPOC. Se recomienda incentivar al personal involucrado en el cuidado de la salud de los trabajadores en el desarrollo de programas de vigilancia en donde las medidas preventivas y de identificación temprana de esta enfermedad sean una prioridad. Palabras Clave EPOC, COPD, Chronic Obstructive Pulmonary Disease, occupational exposure, work – related, airways obstruction, lung disease, workplace.

Aviation English: una lingua per volare Analisi linguistica della comunicazione in aviazione civile

La tesi si propone l'obiettivo di esaminare le caratteristiche della lingua dell'aviazione, il cosiddetto Aviation English (AE), rivolgendo un'attenzione particolare alle dinamiche delle interazioni verbali che avvengono tra piloti e controllori del traffico aereo. A partire da un breve excursus sui diversi tipi di linguaggi, da quelli specialistici alle lingue controllate, si cercherà di fornire una chiara definizione dell'AE, delineando gli aspetti che lo rendono una vera e propria lingua e non una semplice varietà di inglese. La tesi passerà in rassegna tutte le convenzioni e le regole che compongono questa lingua e che rendono la comunicazione in volo efficace a livello internazionale. Si vedrà anche come la comunicazione in aviazione sia suscettibile a molti fattori linguistici (e non), il che comporta per gli operatori del settore, l'obbligo di conoscerla a fondo, più della loro stessa lingua madre. In conclusione, si eseguirà un'analisi conversazionale di una comunicazione terra-bordo-terra realmente avvenuta in un'emergenza. Più precisamente, si tratta dell'estratto del volo US Airways 1549, diventato famoso come "il miracolo dell'Hudson". Questo permetterà di mettere in risalto le regole dell'AE, applicate in un caso concreto, quanto singolare, e notare come queste siano efficaci nel gestire, a livello comunicativo e operativo, gli imprevisti.

Investigating the mechanisms of Moraxella catarrhalis resistance to oxidative stress

Moraxella catarrhalis (Mcat) represents a human pathogen implicated in debilitating diseases, such as Chronic Obstructive Pulmonary Disease (COPD). One of the hallmarks of COPD is the excessive neutrophil oxidative stress mediated by reactive oxygen species (ROS). Mcat shows a higher innate level of resistance to exogenous oxidative stress compared to the co-infecting human airways pathogens such as non-typeable Haemophilus influenzae (NTHi) but the underlying mechanisms are currently not well defined. In this thesis, we demonstrated that, differently from NTHi, Mcat was able to directly interfere with ROS production and ROS-related responses such as neutrophil extracellular traps (NET) and autophagy in differentiated neutrophilic-like dHL-60 cells and primary cells. The underlying mechanisms were shown to be phagocytosis/opsonins-independent but contact-dependent, due to the engagement of the immunosuppressive receptors. Indeed, we identified that through OmpCD porin, Mcat was able to engage Siglec inhibitory receptors suppressing ROS generation by the host cells. Furthermore, Mcat provided a safer niche for the co-infecting NTHi bacterium which was otherwise susceptible to the host antimicrobial arsenal. Subsequently, to deeply characterize the Mcat global transcriptional response to oxidative stress, an RNA-Seq experiment was performed on exponentially growing bacteria exposed to sublethal amounts of H2O2 or CuSO4, stimuli that the pathogens experienced once they are phagocytosed. We unraveled a previously unidentified common transcriptional program following H2O2 and CuSO4 exposure, demonstrating a similar defense mechanism to the stress conditions encountered in neutrophils. We ascertained new crucial factors for this pathogen response and established a novel in vivo Mcat infection model, using the invertebrate Galleria mellonella. Actually, we observed that deletion mutants of genes implicated in oxidative stress resistance exhibited reduced virulence. In conclusion, this work represents an important step in the understanding of Mcat innate resistance mechanisms to oxidative stress and further elucidate the virulence mechanisms during infection.

Pathophysiology of bile acid aspiration in lung transplant recipients

Duodeno-gastroesophageal reflux aspiration is associated with chronic lung allograft dysfunction (CLAD) and aspiration of bile acids (BA), functional molecules in the gastro-intestinal tract with emulsifying properties. While links between reflux aspiration to lung disease have been identified, the relevance of bile acid as molecular ligands and outcome predictors is poorly defined. We sought to determine and quantify the various BA species in airways of the lung transplant recipients to better understand the various effects of aspirated BA that contribute to post-transplantation outcomes and to investigate their molecular effects on airway function and contractility.

Toxicological effects related to a novel heated tobacco product

The tobacco epidemic is a public health burden. Nicotine-Delivery-Systems(NDS) are devices designed to help people replace conventional cigarette(CC) and among these devices we find electronic cigarettes(e-cig), which are classified as Electronic-NDS(ENDS). E-cigs use different technologies to vaporize a liquid or to heat the tobacco avoiding the combustion phenomenon(IQOS). The US Food and Drug Administration(FDA) has labelled IQOS as modified risk tobacco products(MRTPs), indirectly encouraging the perception of safety in the consumers, but IQOS smoke, although to a lesser extent than conventional, still presents a great deal of harmful or potentially harmful compounds. My PhD thesis aims to study the toxic effects related to IQOS exposure. I sought to answer the question of whether the toxic compounds released by IQOS, albeit in reduced concentrations, could lead to genotoxicity and damage to the airways and liver in vivo. At the University of Nottingham, I have investigated in vitro the effects generated by the IQOS, e-cigs and CC exposure on PBMCs and human lung epithelial cell line. Finally, at University of Milano–Bicocca, I have developed a in vivo Positron Emission computed Tomography(PET) imaging procedure meant to be applied to the monitoring of ENDS toxicity, particularly in the brain. These results indicate that IQOS is not a low-risk product in vivo, for primary target organs but also for secondary organs, although we have observed a small impact in vitro. Labelling as MRTP may mislead consumers who interpret “a lower level of toxic compounds” as an indication of “harmlessness” when there is a health risk for users. In the last part, I set up a methodology for studying temporal fluctuations of regional brain metabolism and connectivity derived from mice of different ages allowing researchers to obtain normative values in investigations of the efficacy or toxicity of substances at the functional level of the CNS.