Efficacy of omalizumab in an atopic young adult with asthma and eosinophilic chronic rhinosinusitis with nasal polyps

OBJECTIVE

Chronic rhinosinusitis (CRS) presents a multifactorial etiology due to interactions between the immune host system and external agents. It can be classified into two phenotypes based on the presence or absence of polypoid neoformation (respectively CRSwNP and CRSsNP). According to EPOS2020, CRS is now classified into two endotypes, eosinophilic (ECRS) and non-eosinophilic (non-ECRS), based on eosinophil tissue count (more than 10 eosinophils per High Power Field, HPF).

CASE PRESENTATION

We present the case of a 31-year-old man affected by recalcitrant ECRSwNP and asthma.

RESULTS

He was treated with a combination of omalizumab and endoscopic sinus surgery. This combination led to a reduction in blood eosinophils, modified Lund-Kennedy endoscopic score, Lund-Mackay score, and Sino-Nasal Outcome Test (SNOT-22), almost 6 months after surgery.

CONCLUSIONS

In this clinical case, omalizumab regulated nasal symptoms for more than a year and with good control of the recalcitrant pattern when combined with ESS.

Temperature dependent nanoscale atomic correlations in Ir1-xPtxTe2 (x = 0.0, 0.03 and 0.04) system

X-ray absorption near-edge structure (XANES) spectroscopy has been used to investigate the unoccupied electronic states and local geometry of Ir1-xPtxTe2(x = 0.0, 0.03 and 0.04) as a function of temperature. The Ir L3-edge absorption white line, as well as high energy XANES features due to the photoelectron multiple scatterings with near neighbours, reveal clear changes in the unoccupied 5d-electronic states and the local geometry with Pt substitution. We find an anomalous spectral weight transfer across the known first-order structural phase transition from the trigonal to monoclinic phase in IrTe2, which characterizes the reduced atomic structure symmetry below the transition temperature. No such changes with temperature are seen in the Pt substituted superconducting samples. In addition, a gradual increase of the spectral weight transfer is observed in IrTe2 with a further decrease in temperature below the transition, indicating that the low temperature phase is likely to have a symmetry lower than the monoclinic one. The results suggest that the interplay between inter-layer and intra-layer atomic correlations should have a significant role in the properties of an Ir1-xPtxTe2 system.

Local structure of LiCoO2 nanoparticles studied by Co K-edge x-ray absorption spectroscopy

We have studied the local structure of LiCoO(2) nanoparticles by Co K-edge x-ray absorption spectroscopy as a function of particle size. Extended x-ray absorption fine structure data reveal substantial changes in the near neighbor distances and the associated mean square relative displacements with decreasing particle size. X-ray absorption near edge structure spectra show clear local geometrical changes with decreasing particle size, similar to those that appear in the charging (delithiation) process. The results suggest that the LiCoO(2) nanoparticles are characterized by a large atomic disorder confined to the Co-O octahedra, similar to the distortions generated during the delithiation, and this disorder should be the primary limiting factor for a reversible diffusion of Li ions when nanoparticles of LiCoO(2) are used as cathode material in rechargeable Li ion batteries.

Pulmonary diffusing capacity for carbon monoxide: a marker of depressed hypercapnic drive in type 1 diabetes mellitus?

AIMS

Decreased chemosensitivity to hypercapnia, a common finding in Type 1 diabetes mellitus, seems related to autonomic neuropathy. We proposed to verify whether simple neuroautonomic cardiovascular tests or indexes of severity of diabetes and respiratory impairment can identify patients with such a dysfunction, but no clinical evidence of autonomic neuropathy.

METHODS

Forty patients with Type 1 diabetes, 20 with autonomic neuropathy according to the results of a standardized test battery, were studied and compared with 40 normal subjects matched by age and sex. Spirometry and pulmonary diffusing capacity for carbon monoxide were performed. The chemosensitivity to hypercapnia was tested by the rebreathing method.

RESULTS

There was no significant difference between patients with and without autonomic neuropathy in chemosensitivity to hypercapnia, as expressed by the ventilation response to increasing end-tidal pressure of carbon dioxide; however, it was lower in the whole group of patients with diabetes than in control subjects (1.71 ± 0.80 vs. 2.45 ± 1.11 l⁻¹ min⁻¹ mmHg, respectively, P=0.002). No significant correlation was found between ventilation response to increasing end-tidal pressure of carbon dioxide and the results of autonomic tests. In patients with diabetes mellitus, the ventilatory response to hypercapnia significantly correlated with pulmonary diffusing capacity for carbon monoxide (Spearman's rho=0.387, P=0.013) and this was the only variable significantly associated with ventilation response to increasing end-tidal pressure of carbon dioxide in a multiple regression model.

CONCLUSIONS

Chemosensitivity to hypercapnia was depressed in patients with diabetes mellitus, irrespective of autonomic neuropathy, in comparison with control subjects. The correlation with pulmonary diffusing capacity for carbon monoxide suggests that microcirculatory damage might contribute to depress the central chemosensitivity.

Pulmonary involvement in systemic sclerosis due to therapy and as a complication

Lung involvement frequently occurs in systemic sclerosis (SS), similar to other connective tissue diseases. Sometimes lung disease may be a side effect of antirheumathic drugs. We report a case of a patient affected by SS, with isolated pulmonary hypertension, who developed bronchiolitis secondary to penicillamine. The latter was treated by withdraw of the drug without increasing the steroids. After one month, the patient's clinical conditions appeared improved.