scholarly journals Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara C. Auld ◽  
Hardy Kornfeld ◽  
Pholo Maenetje ◽  
Mandla Mlotshwa ◽  
William Chase ◽  
...  
Keyword(s):  
Lung Function ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Pulmonary Impairment ◽  
Mixed Pattern

Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

scholarly journals Prognostic Marker for Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Analysis of Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) and Forced Expiratory Volume in One Second (FEV1)

2021 ◽  
Author(s):  
Juwhan Choi ◽  
Jae Kyeom Sim ◽  
Jee Youn Oh ◽  
Young Seok Lee ◽  
Gyu Young Hur ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Length Of Hospital Stay ◽  
Forced Expiratory Volume ◽  
Curve Analysis ◽  
Chronic Obstructive ◽  
Diffusing Capacity ◽  
Roc Curve Analysis ◽  
Obstructive Pulmonary Disease

Abstract Background: It is important to assess the prognosis and classify patients in chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) treatment. Recently, it was suggested that diffusing capacity of the lung for carbon monoxide (DLCO) should be added to multidimensional tools for assessing COPD. This study aimed to compare the DLCO and forced expiratory volume in one second (FEV1) to identify better prognostic factors for admitted patients with AECOPD.Methods: We retrospectively analyzed 342 patients with AECOPD receiving inpatient treatment. We classified 342 severe AECOPD events using DLCO and FEV1. We defined the prognostic factors of severe AECOPD as the length of hospital stay, mortality in hospital, experience of mechanical ventilation, and experience of intensive care unit (ICU) care. We analyzed the prognostic factors by multivariate analysis using logistic regression. In addition, we conducted a correlation analysis and receiver operating characteristic (ROC) curve analysis.Results: In univariate and multivariate analyses, DLCO was shown to predict mortality rate (odds ratio = 4.408; 95% confidence interval, 1.070–18.167; P = 0.040), experience of ventilator (odds ratio = 2.855; 95% confidence interval, 1.216–6.704; P = 0.016) and ICU (odds ratios = 2.685; 95% confidence interval, 1.290–5.590; P = 0.008). However, there was no statistically significant difference in mortality rate when using FEV1 classification (P = 0.075). In the correlation analysis, both DLCO and FEV1 showed a negative correlation with length of hospital stay. The correlation rate was more pronounced in the DLCO (DLCO; B = -0.103, P < 0.001) (FEV1; B = -0.075, P = 0.007). In addition, DLCO showed better predictive ability than FEV1 in ROC curve analysis. The area under the curve (AUC) of DLCO was greater than 0.68 for all prognostic factors, and in contrast, the AUC of FEV1 was less than 0.68.Conclusion: DLCO was likely to be as good as or better prognostic marker than FEV1 in severe AECOPD.

scholarly journals Prognostic and Functional Impact of Perioperative LAＭA/LABA Inhaled Therapy In Patients With Lung Cancer and Chronic Obstructive Pulmonary Disease 

2021 ◽  
Author(s):  
Yoko Azuma ◽  
Atsushi Sano ◽  
Takashi Sakai ◽  
Satoshi Koezuka ◽  
Hajime Otsuka ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Postoperative Complications ◽  
Lung Function ◽  
Pulmonary Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Abstract Background: Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. The utility of several perioperative bronchodilators in patients with COPD requiring surgery for lung cancer has been reported, but the most suitable agent and its specific effect on postoperative long-term prognosis remain unclear. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.Methods: Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical records. Patients were divided into 3 groups according to perioperative management: LAMA/LABA (n=64), LAMA (n=23) and rehabilitation only (no bronchodilator) (n=43). Results: Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p<0.001 for both forced expiratory volume in 1 second (FEV1) and percentage of predicted forced expiratory volume in 1 second (FEV1 %pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, 223.1 mL vs 130.0 mL, ΔFEV1 %pred, 10.8% vs 6.8%; both p<0.05). There was a trend toward a lower incidence of postoperative complications in the LAMA/LABA group compared with the LAMA and rehabilitation-only groups. In patients with moderate to severe air flow limitation (n=61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with patients in the other groups. Perioperative LAMA/LABA therapy was also associated with lower recurrence rates. Conclusions: Patients who receive perioperative LAMA/LABA for moderate to severe COPD have improved prognosis and better pulmonary function with surgery for lung cancer. We believe this treatment combination is optimal for patients with lung cancer and COPD.

scholarly journals Labor Dystocia and Risk of Histological Chorioamnionitis and Funisitis: A Study from a Single Tertiary Referral Center

2020 ◽  
Author(s):  
Hyo Kyozuka ◽  
Tuyoshi Murata ◽  
Toma Fukuda ◽  
Shun Yasuda ◽  
Aya Kanno ◽  
...  
Keyword(s):  
Risk Factor ◽  
Preterm Birth ◽  
Confidence Interval ◽  
Umbilical Cord ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Neonatal Outcomes ◽  
Spontaneous Preterm Birth ◽  
Labor Dystocia

Abstract Background: Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal membranes and umbilical cord, respectively. Although labor dystocia includes a potential risk of intrauterine inflammation, the risk of labor dystocia in histological chorioamnionitis and funisitis has not been evaluated yet. This study aimed to examine the association between labor dystocia and risk of histological chorioamnionitis and funisitis.Methods: In this retrospective cohort study, the patients who underwent histopathological examinations of the placenta and umbilical cord at Fukushima Medical University Hospital, Japan, between 2015 and 2020, were included. From the dataset, the pathological findings of the patients with labor dystocia and spontaneous preterm birth were reviewed. Based on the location of leukocytes, the inflammation in the placenta (histological chorioamnionitis) and umbilical cord (funisitis) was graded as 0–3. Multiple logistic regression analysis was performed to evaluate the risk of histological chorioamnionitis, histological chorioamnionitis stage ≥2, funisitis, and funisitis stage ≥2.Result: Of 317 women who met the study criteria, 83 and 144 women had labor dystocia and spontaneous preterm birth, respectively, and 90 women were included as controls. Labor dystocia was a risk factor for histological chorioamnionitis (adjusted odds ratio, 6.3; 95% confidential interval, 1.9-20.5), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 6.0; 95% confidence interval, 1.7-21.8), funisitis (adjusted odds ratio, 9.4; 95% confidence interval, 1.8-48.2), and funisitis stage ≥2 (adjusted odds ratio, 23.5; 95% confidence interval, 2.3-23.8). Spontaneous preterm birth was also a risk factor for histological chorioamnionitis (adjusted odds ratio, 3.7; 95% confidence interval, 1.7-7.8), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.9), and funisitis (adjusted odds ratio, 4.5; 95% confidence interval, 1.2-16.8). However, the adjusted odds ratio was smaller in spontaneous preterm births than in labor dystocia. Conclusion: Labor dystocia is a risk factor for severe histological chorioamnionitis and funisitis. Further studies are required to evaluate the effects of histological chorioamnionitis and funisitis on long-term neonatal outcomes.

scholarly journals Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

2020 ◽  
Vol 14 ◽  
pp. 175346662096303
Author(s):  
Hayoung Choi ◽  
Hyun Lee ◽  
Jiin Ryu ◽  
Sung Jun Chung ◽  
Dong Won Park ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Respiratory Diseases ◽  
Chronic Obstructive ◽  
Study Cohort ◽  
Limited Information ◽  
Term Survival ◽  
Obstructive Pulmonary Disease ◽  
All Cause Mortality ◽  
The Impact

Background: Long-term corticosteroid (CS) use is associated with increased mortality in patients with asthma, and comorbid bronchiectasis is also associated with frequent asthma exacerbation and increased healthcare use. However, there is limited information on whether bronchiectasis further increases mortality in patients with CS-dependent asthma. This study examined the impact of bronchiectasis on mortality in patients with CS-dependent asthma. Methods: A retrospective cohort of patients with CS-dependent asthma ⩾18 years old was established using records from the Korean National Health Insurance Service database from 2005 to 2015. Patients with CS-dependent asthma with and without bronchiectasis were matched by age, sex, type of insurance, and Charlson comorbidity index. We evaluated the hazard ratio (HR) for all-cause mortality in patients with bronchiectasis compared with those without bronchiectasis. Results: The study cohort included 754 patients with CS-dependent asthma with bronchiectasis and 3016 patients with CS-dependent asthma without bronchiectasis. Patients with CS-dependent asthma with bronchiectasis had a higher all-cause mortality than those without bronchiectasis (8429/100,000 versus 6962/100,000 person-years, p < 0.001). The adjusted HR for mortality in patients with CS-dependent asthma with bronchiectasis relative to those without bronchiectasis was 1.33 (95% confidence interval, 1.18–1.50), and the association was primarily significant for respiratory diseases (subdistribution HR = 1.65, 95% confidence interval, 1.42–1.92). Conclusions: Bronchiectasis further increases all-cause mortality in patients with CS-dependent asthma, a trend that was especially associated with respiratory diseases including chronic obstructive pulmonary disease. Strategies to improve treatment outcomes in patients with CS-dependent asthma with bronchiectasis are urgently needed to improve long-term survival. The reviews of this paper are available via the supplemental material section.

scholarly journals Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
François Dépret ◽  
Clément Hoffmann ◽  
Laura Daoud ◽  
Camille Thieffry ◽  
Laure Monplaisir ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Smoke Inhalation ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

Tobacco Price Increase and Successful Smoking Cessation for Two or More Years in Japan

2020 ◽  
Author(s):  
Keisuke Matsubayashi ◽  
Takahiro Tabuchi ◽  
Hiroyasu Iso
Keyword(s):  
Smoking Cessation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Longitudinal Survey ◽  
Price Increase ◽  
National Longitudinal Survey ◽  
Middle Aged ◽  
Price Increases

Abstract Introduction Assessing long-term smoking cessation after tobacco price increases is more valuable than short-term cessation as smokers often relapse after temporary cessation. We investigated whether tobacco price increases were associated with long-term smoking cessation and whether the association differed according to demographic, socioeconomic, and behavioral factors, using a national longitudinal survey of middle-aged individual-level data from 10 waves, every November from 2005 to 2014. Methods Temporary and long-term at least 1 year (1y+) or 2 years (2y+) quitters were defined by smoking in any one wave and quitting in the subsequent two or three waves in a discrete-time design. November 2006 (after July 11% increase) and November 2010 (after October 37% increase) were used as proxy variables for price increases. Generalized estimating equation models adjusted for demographic, socioeconomic, and behavioral covariates, and analyses stratified by these covariates were performed to estimate the association between price increases and smoking cessation. Results Of 43 630 smokers aged 50–65, 7.7%, 5.6%, and 5.2% of smokers quit temporarily, for at least 1 year and at least 2 years, respectively. 2y+ quitters significantly increased in November 2005–November 2008 (adjusted odds ratio = 1.23, 95% confidence interval: 1.06–1.43) and November 2009–November 2012 (adjusted odds ratio = 1.85, 95% confidence interval = 1.57–2.16). In stratified analyses, higher prices were associated with 2y+ quitters in all subgroups with some exceptions, including participants who smoked 21–30 cigarettes per day and those aged 60–65. Conclusions Increasing tobacco prices may be effective in promoting long-term smoking cessation in various subgroups among middle-aged Japanese adults. Implications Few longitudinal studies have examined the effect of a tobacco price increase on long-term smoking cessation. In a national longitudinal survey of middle-aged Japanese from 10 waves, the 37% tobacco price increase was found to be a trigger for successful smoking cessation for two or more years. Price increases were significantly associated with 2y+ smoking cessation in most demographic, behavioral, and socioeconomic subgroups. Results indicate that higher tobacco prices may be effective for long-term smoking cessation in almost all subgroups. Raising tobacco taxes and prices may be one of the most effective strategies for promoting long-term smoking cessation.

scholarly journals Long-term doxycycline and lung function in chronic obstructive pulmonary disease: A pilot observation

Lung India ◽  
2014 ◽  
Vol 31 (3) ◽  
pp. 306 ◽  
Author(s):  
Partha Bhattacharjee ◽  
Rantu Paul ◽  
Ratna Dey ◽  
Malabika Ghosh ◽  
Parthasarathi Bhattacharyya ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Function ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

scholarly journals Labor dystocia and risk of histological chorioamnionitis and funisitis: a study from a single tertiary referral center

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hyo Kyozuka ◽  
Tuyoshi Murata ◽  
Toma Fukuda ◽  
Erina Suzuki ◽  
Riho Yazawa ◽  
...  
Keyword(s):  
Risk Factor ◽  
Preterm Birth ◽  
Confidence Interval ◽  
Umbilical Cord ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Neonatal Outcomes ◽  
Spontaneous Preterm Birth ◽  
Labor Dystocia

Abstract Background Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal membranes and umbilical cord, respectively. Although labor dystocia includes a potential risk of intrauterine inflammation, the risk of histological chorioamnionitis and funisitis of labor dystocia has not been evaluated yet. This study aimed to examine the association between labor dystocia and risk of histological chorioamnionitis and funisitis. Methods In this retrospective cohort study, the cases who underwent histopathological examinations of the placenta and umbilical cord at Fukushima Medical University Hospital, Japan, between 2015 and 2020, were included. From the dataset, the pathological findings of the patients with labor dystocia and spontaneous preterm birth were reviewed. Based on the location of leukocytes, the inflammation in the placenta (histological chorioamnionitis) and umbilical cord (funisitis) was staged as 0–3. Multiple logistic regression analysis was performed to evaluate the risk of histological chorioamnionitis, histological chorioamnionitis stage ≥2, funisitis, and funisitis stage ≥2. Result Of 317 women who met the study criteria, 83 and 144 women had labor dystocia and spontaneous preterm birth, respectively, and 90 women were included as controls. Labor dystocia was a risk factor for histological chorioamnionitis (adjusted odds ratio, 6.3; 95% confidential interval, 1.9–20.5), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 6.0; 95% confidence interval, 1.7–21.8), funisitis (adjusted odds ratio, 15.4; 95% confidence interval, 2.3–101.3), and funisitis stage ≥2 (adjusted odds ratio, 18.5; 95% confidence interval, 2.5–134.0). Spontaneous preterm birth was also a risk factor for histological chorioamnionitis (adjusted odds ratio, 3.7; 95% confidence interval, 1.7–7.8), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 3.0; 95% confidence interval, 1.2–7.9), and funisitis (adjusted odds ratio, 6.6; 95% confidence interval, 1.4–30.6). However, the adjusted odds ratio was smaller in spontaneous preterm births than in labor dystocia. Conclusion Labor dystocia is a risk factor for severe histological chorioamnionitis and funisitis. Further studies are required to evaluate the effects of histological chorioamnionitis and funisitis on long-term neonatal outcomes.

scholarly journals Integrated palliative care networks from the perspectives of patients: A cross-sectional explorative study in five European countries

2018 ◽  
Vol 32 (6) ◽  
pp. 1103-1113 ◽  
Author(s):  
Marlieke den Herder-van der Eerden ◽  
Anne Ebenau ◽  
Sheila Payne ◽  
Nancy Preston ◽  
Lukas Radbruch ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Confidence Interval ◽  
Pulmonary Disease ◽  
Odds Ratio ◽  
Healthcare Professionals ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Lower Odds

Background: Although examining perspectives of patients on integrated palliative care organisation is essential, available literature is largely based on administrative data or healthcare professionals’ perspectives. Aim: (1) Providing insight into the composition and quality of care networks of patients receiving palliative care and (2) describing perceived integration between healthcare professionals within these networks and its association with overall satisfaction. Design: Cross-sectional explorative design. Setting/participants: We recruited 157 patients (62% cancer, 25% chronic obstructive pulmonary disease, 13% chronic heart failure, mean age 68 years, 55% female) from 23 integrated palliative care initiatives in Belgium, Germany, the United Kingdom, Hungary and the Netherlands. Results: About 33% reported contact with a palliative care specialist and 48% with a palliative care nurse. Relationships with palliative care specialists were rated significantly higher than other physicians ( p < 0.001). Compared to patients with cancer, patients with chronic obstructive pulmonary disease (odds ratio = 0.16, confidence interval (0.04; 0.57)) and chronic heart failure (odds ratio = 0.11, confidence interval (0.01; 0.93)) had significantly lower odds of reporting contact with palliative care specialists and patients with chronic obstructive pulmonary disease (odds ratio = 0.23, confidence interval (0.08; 0.71)) had significantly lower odds of reporting contact with palliative care nurses. Perceptions of main responsible healthcare professionals or caregivers in patient’s care networks varied across countries. Perceived integration was significantly associated with overall satisfaction. Conclusion: Palliative care professionals are not always present or recognised as such in patients’ care networks. Expert palliative care involvement needs to be explicated especially for non-cancer patients. One healthcare professional should support patients in understanding and navigating their palliative care network. Patients seem satisfied with care provision as long as continuity of care is provided.

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