Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.

Osteoporosis is observed in a quarter of unselected patients with HHC, independently of the genetic background, and is associated with ALP, hypogonadism, body weight, and severity of iron overload.

Normal human dermis has been analyzed using stereological methods to estimate the quantitative modifications of collagen and elastic fibers in relation to age, sex, and body region. Forty-five skin biopsies from the trunk or the limbs of 26 males and 19 females of different age were fixed in glutaraldehyde and osmium tetroxide and embedded in epoxy resin. The relative volumes of collagen and elastic fibers were calculated by the point counting method on 1 micron semithin sections. Photographic sampling was performed on four consecutive dermis layers: the papillary layer and three consecutive layers of reticular dermis. The data were subjected to analysis of variance which showed that all the factors studied exert a significant influence on the relative amounts of collagen and elastic fibers. The fractional volume of collagen fibers is constant throughout all dermis layers analyzed and is always higher in females than in males, except for the second and third decades of life. Collagen fiber density increases with age in both sexes up to 30-40 years, when it starts decreasing. Both the relative volumes and the diameters of elastic fibers increase from papillary to deep reticular dermis. In reticular dermis of both sexes there is an increment of elastic fiber density in the first decade of life, followed by a drop particularly marked in males. After 20 years, the relative volume of elastic fibers displays a decreasing trend in females, whereas it increases in males, attaining the highest values beyond the 40s.

There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts’ opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.

Objective-To establish the frequency of connective tissue diseases (CTD) in a cohort of Italian patients with primary biliary cirrhosis (PBC) and to evaluate the availability of a marker for the early identification of the more common associated CTD. Methods-One hundred and seventy consecutive patients with histologically diagnosed PBC were screened for the presence of a CTD and/or Raynaud's phenomenon (RP). Patients were classified as having a CTD only if they fulfilled standardised criteria. Results-Forty seven patients had a CTD. The most common CTD was systemic sclerosis (SSc), found in 21 patients. RP was present in 54 patients, most of whom (n=39) had an associated CTD. The most prevalent autoantibodies included antinuclear antibodies (ANA) with anticentromere (ACA) and speckled patterns (34 and 33 patients, respectively) and extractable nuclear antigens (ENA, 27 patients). However, while the frequencies of ACA and ENA were significantly higher in patients with an associated CTD (p<0.0001 and p<0.005, respectively), no relationship was found for speckled ANA. ACA was the best predictor of a CTD in patients with PBC (odds ratio (OR) 24.5, 95% CI 5.5 to 108.8), followed by the presence of ENA (OR 23.9, 95% CI 5.6 to 101.0) and RP (OR 20.2, 95% CI 5.7 to 71.2). Conclusions-Using strict standardised classification criteria we have found that SSc is the most common CTD associated with PBC and that ACA and ENA are strong markers for an associated CTD in patients with PBC.