Simonetta Masieri

Bio: Simonetta Masieri is an academic researcher from Sapienza University of Rome. The author has contributed to research in topics: Asthma & Allergen immunotherapy. The author has an hindex of 14, co-authored 63 publications receiving 499 citations. Previous affiliations of Simonetta Masieri include Policlinico Umberto I.

Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask.

Abstract: To assess noise exposure during noninvasive ventilation (NIV) with different types of interface (helmet, nasal, and facial masks). Ten “naive” healthy volunteers underwent NIV at pressure support levels of 10 and 15 cmH2O with: (a) helmet, (b) helmet equipped with HME filters at the junctions between the helmet and the inspiratory and expiratory branches of the respiratory circuit, (c) nasal mask, and (d) facial mask. Noise intensity was assessed with a sound level meter by placing a microphone near the right ear. Noise intensity and degree of discomfort were also assessed subjectively with a visual analogue scale. Inside the helmet noise exceeded 100 dB. Noise intensity was poorly affected by pressure support level and unaffected by the presence of HME filters. During NIV with nasal or facial masks the noise did not exceed 70 dB (i.e., noise was not louder than the usual noise background in ICU). Subjective evaluation of noise intensity mirrored objective measurements; however, the presence of HME filters was associated with the feeling of less noise inside the helmet. The discomfort associated with the helmet did not significantly differ from that associated with the masks. NIV helmet is associated with significantly greater noise than nasal and facial masks, but is as comfortable as masks, at least in the short term. Medium- and long-term exposure to loud noise may potentially impair ear function and increase the patient’s discomfort.

Intensive care after elective surgery: a survey on 30-day postoperative mortality and morbidity.

Abstract: Background Postoperative admission to the surgical intensive care unit (S-ICU) is routinely planned in order to prevent and treat early complications. Currently, limited studies have been conducted on this topic, and as such, early morbidity and mortality in patients undergoing postoperative intensive care were investigated. Methods This prospective analysis was performed in the S-ICU of a University hospital and included 1045 consecutive patients. All patients underwent elective surgery and were admitted to the S-ICU on the basis of preoperative clinical assessment. On the second, seventh, and thirtieth postoperative days, the location of the patients was recorded (ICU, surgical ward, or home) as were any complications that occurred. Predicted mortality and morbidity were assessed using the POSSUM score. Results The observed postoperative mortality rate was 2.4% (95% CI: 1.5-3.3%), which was much lower than the rate predicted by both POSSUM (6.2%) and P-POSSUM (5.3%) analyses, and 36% of patients experienced complications, a percentage slightly higher than that predicted by POSSUM (30.2%). The first 48 hours following surgery were characterized by the highest mortality rate (2.85 deaths per thousand vs 0.7 per thousand by the third postoperative day) as well as the highest morbidity rate (7.7% vs 4.3% between the third and seventh postoperative days, and 0.9% between the eighth and thirtieth postoperative days). The presumed causes of early death were primarily secondary to cardiovascular complications (five out of six). Conclusions The first 48 hours after surgery is a critical period in high-risk patients, and a stay in the S-ICU should be seriously considered. Planned admission to the S-ICU may effectively decrease postoperative mortality, as suggested by the highly significant difference between expected and observed deaths following S-ICU admission.

Exposure to noise during continuous positive airway pressure : influence of interfaces and delivery systems

Abstract: Background: We measured noise intensity and perceived noisiness during continuous positive airway pressure (CPAP) performed with two interfaces (face-mask, helmet) and four delivery systems. Methods: Eight healthy volunteers received CPAP in random order with: two systems provided with a flow generator using the Venturi effect and a mechanical expiratory valve (A: Venturi, Starmed; B: Whisperflow-2, Caradyne Ltd); one ‘free-flow’ system provided with high flow O2 and air flowmeters, an inspiratory gas reservoir, and a water valve (C: CF800, Dragerwerk, AG); and a standard mechanical ventilator (Servoventilator 300, Siemens-Elema). Systems A, B, and C were tested with a face-mask and a helmet at a CPAP value of 10 cm H2O; the mechanical ventilator was only tested with the face mask. Noise intensity was measured with a sound-level meter. After each test, participants scored noisiness on a visual analog scale (VAS). Results: The noise levels measured ranged from 57±11 dBA (mechanical ventilator plus mask) to 93±1 and 94±2 dBA (systems A and B plus helmet) and were significantly affected by CPAP systems (A and B noisier than C and D) and interfaces (helmet CPAP noisier than mask CPAP). Subjective evaluation showed that systems A and B plus helmet were perceived as noisier than system C plus mask or helmet. Conclusions: Maximum noise levels observed in this study may potentially cause patient discomfort. Less noisy CPAP systems (not using Venturi effect) and interfaces (facial mask better than helmet) should be preferred, particularly for long or nocturnal treatments.

Vanilloid (Capsaicin) Receptors and Mechanisms

Abstract: Natural products afford a window of opportunity to study important biology. If the natural product is used or abused by human beings, finding its biological target(s) is all the more significant. Hot pepper is eaten on a daily basis by an estimated one-quarter of the world’s population and

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Abstract: Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis.

Abstract: BACKGROUND: Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS: Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS: The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION: This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

Mepolizumab for Severe Eosinophilic Asthma (DREAM): A Multicentre, Double-Blind, Placebo-Controlled Trial

Abstract: ID Pavord, S Korn, P Howarth. Lancet. 2012;380(9842):651–659 To elucidate the efficacy, safety, and patient characteristics of responsiveness to mepolizumab (a humanized monoclonal antibody against interleukin 5). Previous small, proof-of-concept studies in subjects with severe, eosinophilic asthma revealed that mepolizumab decreased exacerbation rates. From 81 multinational centers, 621 pa-tients were enrolled. Major inclusion criteria included: age 12 to 74 years, asthma diagnosis with objective measures, ≥2 asthma exacerbations requiring oral corticosteroids in the last year, refractory asthma as defined by the American …

BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

Abstract: ### Principles of mechanical ventilation #### Modes of mechanical ventilation Recommendation 1. Pressure-targeted ventilators are the devices of choice for acute NIV (Grade B). Good practice points #### Choice of interface for NIV Recommendation 2. A full face mask (FFM) should usually be the first type of interface used (Grade D). Good practice points #### Indications for and contra-indications to NIV in AHRF Recommendation 3. The presence of adverse features increase the risk of NIV failure and should prompt consideration of placement in high dependency unit (HDU)/intensive care unit (ICU) (Grade C). Good practice points #### Monitoring during NIV Good practice points #### Supplemental oxygen therapy with NIV Recommendations 4. Oxygen enrichment should be adjusted to achieve SaO2 88–92% in all causes of acute hypercapnic respiratory failure (AHRF) treated by NIV (Grade A). 5. Oxygen should be entrained as close to the patient as possible (Grade C). Good practice points