Hospitalizations Due to Cirrhosis: Clinical Aspects in a Large Cohort of Italian Patients and Cost Analysis Report

2017 ◽  
Vol 35 (5) ◽  
pp. 433-438 ◽  
Author(s):  
Marco Di Pascoli ◽  
Elena Ceranto ◽  
Paolo De Nardi ◽  
Daniele Donato ◽  
Angelo Gatta ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Economic Impact ◽  
Large Population ◽  
Clinical Aspects ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Obstructive Pulmonary Disease ◽  
Epidemiological Analysis ◽  
Duration Of Hospitalization ◽  
Upper Gastrointestinal

Background and Aim: Liver cirrhosis is characterized by high morbidity and mortality rates. This study was addressed to evaluate the epidemiological and economic impact of cirrhosis on hospitalizations in a large population in Italy. Methods: Epidemiological analysis was performed using hospital discharge sheets of 57,720 hospitalizations due to liver disease from 2006 to 2008, selected from the Veneto regional archive. In a sample of 100 randomly selected hospitalizations, a detailed cost analysis was performed and a comparison was made with sets of patients admitted for heart failure (HF) and chronic obstructive pulmonary disease (COPD). Results: Among patients with cirrhosis, ascites emerged as the most frequent cause of admission, followed by hepatic encephalopathy, hepatocellular carcinoma, and upper gastrointestinal bleeding. Encephalopathy and ascites were the complications with the highest rates of readmission. The detailed cost analysis of hospitalizations revealed that economic expenses in the set of patients admitted for cirrhosis were about 30% higher than those for patients admitted for HF or COPD, mainly due to the longer duration of hospitalization. Conclusions: Cirrhosis has a relevant epidemiological and economic impact on hospitalizations and preventive strategies for its clinical management are warranted.

scholarly journals COVID-19, COPD, and AECOPD: Immunological, Epidemiological, and Clinical Aspects

2021 ◽  
Vol 7 ◽  
Author(s):  
Francesca Polverino ◽  
Farrah Kheradmand
Keyword(s):  
Cigarette Smoke ◽  
Clinical Features ◽  
Respiratory Infections ◽  
Severe Disease ◽  
Epidemiological Data ◽  
Clinical Aspects ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Obstructive Pulmonary Disease ◽  
Ultimate Cause

The newly identified severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) causes several heterogeneous clinical conditions collectively known as Coronavirus disease-19 (COVID-19). Older patients with significant cardiovascular conditions and chronic obstructive pulmonary disease (COPD) are predisposed to a more severe disease complicated with acute respiratory distress syndrome (ARDS), which is associated with high morbidity and mortality. COPD is associated with increased susceptibility to respiratory infections, and viruses are among the top causes of acute exacerbations of COPD (AECOPD). Thus, COVID-19 could represent the ultimate cause of AECOPD. This review will examine the pathobiological processes underlying SARS-CoV-2 infection, including the effects of cigarette smoke and COPD on the immune system and vascular endothelium, and the known effects of cigarette smoke on the onset and progression of COVID-19. We will also review the epidemiological data on COVID-19 prevalence and outcome in patients with COPD and analyze the pathobiological and clinical features of SARS-CoV-2 infection in the context of other known viral causes of AECOPD. Overall, SARS-CoV-2 shares common pathobiological and clinical features with other viral agents responsible for increased morbidity, thus representing a novel cause of AECOPD with the potential for a more long-term adverse impact. Longitudinal studies aimed at COPD patients surviving COVID-19 are needed to identify therapeutic targets for SARS-CoV2 and prevent the disease's burden in this vulnerable population.

scholarly journals Frequency and Pattern of Bronchiectasis in Patients with Chronic Obstructive Pulmonary Disease Presenting in a Tertiary Care Hospital

2021 ◽  
Vol 35 (3) ◽  
pp. 54-57
Author(s):  
Asifa Karamat
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Tertiary Care ◽  
Lower Lobe ◽  
The United States ◽  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a high burden respiratory issue all over the world. It has high morbidity and mortality in the United States. Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) and is under diagnosed as diagnostic tools like HRCT though easily available but an expensive test in developing countries like Pakistan. We aim to establish the frequency and patterns of bronchiectasis in patients of COPD. Aims and Objectives: To establish the frequency and pattern of bronchiectasis in COPD in our population so that we can improve patient care and quality of life of these patients. Place and duration of study: We did a cross sectional survey in Department of Pulmonology, Gulab Devi Hospital, Lahore. Study was completed from 1st September 2017 to 28th February 2018. Material & Methods: After taking an informed consent 150 already diagnosed COPD patients were included. Bronchiectasis was seen on high resolution CT scan (HRCT). Data was collected on a structured proforma and analyzed on SPSS version 20. Results: Bronchiectasis was observed in 76 (50.6%) patients of COPD while 74 patients had no bronchiectasis. Out of 76, cylindrical bronchiectasis was seen in 82%. Lower lobe and bilateral involvement was more common. Means of age, gender, exacerbations of COPD, and history of pulmonary tuberculosis were not related to bronchiectasis while pack years of smoking, duration of illness and Modified Medical Research Council (MMRC) Dyspnea Scale were significantly related to bronchiectasis. Conclusion: This is observed that bronchiectasisis quite common (50.6%) in patients of COPD in our population.

scholarly journals Effectiveness of a Community Health Worker(CHW) training in monitoring and care of patients with Chronic Obstructive Pulmonary Disease(COPD) in rural Gujarat, India.

2019 ◽  
Author(s):  
Ashish Gupta ◽  
Ajay Phatak ◽  
Meha Patel ◽  
Neha Das ◽  
Nirav Vaghela ◽  
...  
Keyword(s):  
Community Health ◽  
Health Workers ◽  
Clinical Aspects ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Assessment Scores ◽  
Distress Score ◽  
Case Vignettes ◽  
Effective Role ◽  
Health Experts

Abstract Background- COPD is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician based approach. Community Health Workers(CHWs) can play an effective role in making COPD care accessible and effective. Findings of an assessment of a training program for CHWs on COPD are reported here.Methods- 90 CHWs were exposed to a series of 5 training sessions designed and administered jointly by a team of public health experts and physiotherapists in the year 2017-18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes and 5 skill assessments through Objectively Structured Clinical Examination(OSCE). Mean percentage scores were calculated for each domain of assessment to make it comparable.Results 70 CHWs with a mean age of 42.2 years completed all the trainings and underwent the assessment. Mean percentage score(SD) for knowledge was 62%(16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration(92.1%) and the least in dyspnoea relieving positions(59.2%). The CHWs had difficulties in identifying signs of respiratory distress(score – 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile.Conclusion The results were encouraging and the program may be pilot tested in a Government setting.

Exosomal MicroRNA: Diagnostic Marker and Therapeutic Tool for Lung Diseases

2021 ◽  
Vol 27 ◽  
Author(s):  
Yu Hua ◽  
Yan Ding ◽  
Yapeng Hou ◽  
Yanhong Liu ◽  
Kejun Mao ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Diagnostic Marker ◽  
Treatment Strategies ◽  
Diagnostic Methods ◽  
Chronic Obstructive ◽  
Target Cells ◽  
High Morbidity ◽  
Therapeutic Tool ◽  
Obstructive Pulmonary Disease ◽  
Exosomal Microrna

: Lung diseases are common clinical illnesses with high morbidity and mortality, which seriously threaten human health. In recent years, increasing evidence suggests that exosomes play a pivotal role in intercellular communication by delivering their cargo to pulmonary target cells，such as microRNAs. Physiologically, exosomes have been shown to be a critical mediator in maintaining homeostasis function in the complex thin-walled lung tissue and airway structure. Apart from being a diagnostic and prognostic biomarker, exosomes also participate in the progression of some lung diseases, such as chronic obstructive pulmonary disease, asthma, pulmonary fibrosis, acute lung injury, lung cancer, interstitial lung disease, and tuberculosis. Here, we summarize the recent findings on the involvement of exosomes and exosomal microRNAs in the pathogenesis, diagnosis, and therapy of lung diseases, aiming to provide more information to discover novel diagnostic methods and treatment strategies for these disorders.

scholarly journals Cartography of Emergency Department Visits for Asthma – Targeting High-Morbidity Populations

2004 ◽  
Vol 11 (6) ◽  
pp. 427-433 ◽  
Author(s):  
Pierre Lajoie ◽  
Andrée Laberge ◽  
Germain Lebel ◽  
Louis-Philippe Boulet ◽  
Marie Demers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Administrative Database ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Age Group ◽  
Obstructive Pulmonary Disease ◽  
Asthmatic Patients ◽  
South Central ◽  
Ed Visits

BACKGROUND:Asthma education should be offered with priority to populations with the highest asthma-related morbidity. In the present study, the aim was to identify populations with high-morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions.METHODS:All emergency department (ED) visits for asthma were analyzed over a one-year period, considering individual and medical variables. Age- and sex-adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high-morbidity areas. Maps of all CLSC areas were generated for the above parameters.RESULTS:There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty-one CLSCs and 32 CLSCs were high-morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high-morbidity areas were located in the south-central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care.CONCLUSION:The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high-morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.

scholarly journals The Potential Role and Regulatory Mechanisms of MUC5AC in Chronic Obstructive Pulmonary Disease

Molecules ◽  
2020 ◽  
Vol 25 (19) ◽  
pp. 4437 ◽  
Author(s):  
Jingyuan Li ◽  
Zuguang Ye
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Signaling Pathways ◽  
Pulmonary Disease ◽  
Beat Frequency ◽  
Ciliary Beat Frequency ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Obstructive Pulmonary Disease ◽  
Mucus Hypersecretion ◽  
Airway Mucus

Chronic obstructive pulmonary disease (COPD) is associated with high morbidity and mortality globally. Studies show that airway mucus hypersecretion strongly compromises lung function, leading to frequent hospitalization and mortality, highlighting an urgent need for effective COPD treatments. MUC5AC is known to contribute to severe muco-obstructive lung diseases, worsening COPD pathogenesis. Various pathways are implicated in the aberrant MUC5AC production and secretion MUC5AC. These include signaling pathways associated with mucus-secreting cell differentiation [nuclear factor-κB (NF-κB)and IL-13-STAT6- SAM pointed domain containing E26 transformation-specific transcription factor (SPDEF), as well as epithelial sodium channel (ENaC) and cystic fibrosis transmembrane conductance regulator (CFTR)], and signaling pathways related to mucus transport and excretion-ciliary beat frequency (CBF). Various inhibitors of mucus hypersecretion are in clinical use but have had limited benefits against COPD. Thus, novel therapies targeting airway mucus hypersecretion should be developed for effective management of muco-obstructive lung disease. Here, we systematically review the mechanisms and pathogenesis of airway mucus hypersecretion, with emphasis on multi-target and multi-link intervention strategies for the elucidation of novel inhibitors of airway mucus hypersecretion.

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