scholarly journals Pathogenetic aspects of cachexia

2020 ◽  
Vol 17 (1) ◽  
pp. 33-40
Author(s):  
Irina S. Klochkova ◽  
Ludmila I. Astafyeva ◽  
Boris A. Kadashev ◽  
Yuliya G. Sidneva ◽  
Pavel L. Kalinin
Keyword(s):  
Underlying Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Regulation Of Metabolism ◽  
High Prevalence ◽  
Oncological Diseases ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Irreversible Nature ◽  
Cachexia Syndrome

The relevance of cachexia syndrome is determined by its high prevalence in clinical practice. It accompanies the course of not only oncological diseases, but also the majority of chronic somatic pathologies, such as chronic heart failure, renal failure, diabetes mellitus, chronic obstructive pulmonary disease, acquired immunodeficiency syndrome, rheumatoid arthritis, Alzheimers disease and others. It is known that even a slight weight loss in patients can determine an unfavorable prognosis of the underlying disease and reduce the effectiveness of therapy, and sometimes it becomes the direct cause of death of the patient. Cachexia is a complex metabolic syndrome, which is based on a violation of the central regulation of metabolism. The dangerous combination of decreased appetite (anorexia) and increased metabolism is the result of an imbalance in energy exchange. Treatment of cachexia syndrome is ineffective and limited in means. Given the progressive and irreversible nature of this syndrome, early diagnosis and prevention of its development are the primary task of the doctor. The article describes the main pathogenetic aspects of the development of cachexia syndrome. They can be common in different diseases. The article discusses the difficulties of diagnosing cachexia syndrome, the possibilities and prospects of treatment.

Comparison of plasmapheresis efficacy and complex antioxidant therapy in patients with comorbid course of chronic pancreatitis and chronic obstructive pulmonary disease

2014 ◽  
Vol 18 (4 (72)) ◽  
Author(s):  
O. S. Khukhlina ◽  
O. O. Ursul ◽  
V. S. Smandych
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Pancreatitis ◽  
Pulmonary Disease ◽  
Underlying Disease ◽  
Pancreatic Tissue ◽  
Inhalation Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Complex Therapy ◽  
Reduced Intensity

60 patients with chronic obstructive pulmonary disease (COPD) and chronic pancreatitis (CP) were examined in the dynamics of treatment. The complex therapy of patients with COPD and CP including inhalation therapy with Thiotropium bromide, Serrathiopeptidase and Emoxypin promoted reduced intensity of oxidative stress, restoration of antioxidant protective components activity and natural detoxication system, intensified the activity of enzymatic, Hagemmandependant fibrinolysis and collagenosis, improving the processes of microcirculation, elimination of ischemia and swelling of the pancreatic tissue, quick removal of clinical exacerbation signs of the underlying disease and comorbid diseases. According to the correction degree of enzyme deviation syndrome in the blood, intensity of nitrositic stress and endogenic intoxication in patients with COPD and CP, the effect of 30-day intake of Serrathiopeptidase and 15-day intake of Emoxypin is equal to the efficacy of five plasmapheresis sessions.

scholarly journals High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000848 ◽  
Author(s):  
Andreas Jönsson ◽  
Artur Fedorowski ◽  
Gunnar Engström ◽  
Per Wollmer ◽  
Viktor Hamrefors
Keyword(s):  
Myocardial Ischaemia ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Clinical Factors ◽  
Obstructive Pulmonary Disease ◽  
Presenting Symptoms ◽  
High Prevalence ◽  
History Of ◽  
Artery Disease ◽  
Global Initiative

ObjectiveChronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.MethodsAmong 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.ResultsA total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.ConclusionsAmong middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.

Human Immunodeficiency Virus-Associated Thrombocytopenia

DICP ◽  
1989 ◽  
Vol 23 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Dennis M. Hoffman ◽  
Rocco F. Caruso ◽  
Timothy Mirando
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Globulin ◽  
Disease Process ◽  
Underlying Disease ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Acquired Immunodeficiency ◽  
A New Technique ◽  
Immunodeficiency Syndrome

Thrombocytopenia has emerged as a major hematological manifestation associated with AIDS (acquired immunodeficiency syndrome) and human immunodeficiency virus (HIV)-positive patients. A study of homosexual patients with thrombocytopenia indicates 93 percent had serological evidence of HIV exposure whereas only 33 percent of homosexuals without thrombocytopenia exhibited this finding. Thrombocytopenia in patients with hemophilia has been identified as an increased risk factor for AIDS development and has been observed in about one-third of children with AIDS. The management of thrombocytopenia in HIV-infected patients poses a therapeutic dilemma for clinicians since many of the traditional modalities for treating immune thrombocytopenia may adversely affect the underlying disease process or further compromise the immune system. Splenectomy, corticosteroids, danazol, intravenous immune globulin, vincristine, and RHo(D) immune globulin have all been used with variable results. A new technique that physically removes antibodies and immune complexes associated with thrombocytopenia is under investigation. Due to either toxicity or the high incidence of transient response, asymptomatic patients may not be candidates for treatment.

scholarly journals LO002: Improving safety of patients in respiratory distress: identifying preventable adverse events related to care provided in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S30-S31
Author(s):  
S. Pretty ◽  
S. Scaffidi Argentina ◽  
C. Vaillancourt ◽  
J.J. Perry ◽  
I.G. Stiell ◽  
...  
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Diagnostic Error ◽  
Underlying Disease ◽  
Chronic Obstructive ◽  
Health Records ◽  
Obstructive Pulmonary Disease ◽  
Management Procedure ◽  
Non Invasive Ventilation ◽  
Acute Exacerbations

Introduction: Patients with acute exacerbations of heart failure (HF) or chronic obstructive pulmonary disease (COPD) may be at high risk for preventable adverse events (AEs). Preventable AEs are ED care-associated complications due to medical error. Our objective was to identify and characterize preventable AEs among ED patients over 50 presenting with dyspnea from an acute exacerbation of HF or COPD; who were subsequently admitted or discharged. Methods: We conducted a multicentre health records review from six academic centers in Ontario and Alberta. We analysed health records for all prospectively enrolled patients who experienced flagged outcomes: relapse to ED within 14 days requiring admission; admission to a monitored unit (AMU), cardiac care unit(CCU), or intensive care unit(ICU); intubation(ETI); non-invasive ventilation(NIV); diagnosis of acute myocardial infarction(AMI); or death within 30 days. Using a validated approach, an ED physician analyzed case summaries for flagged outcomes that were associated with ED care, designated as AEs. Preventable AEs had contributing errors in diagnosis, management, procedure, medications or unsafe disposition decisions. We analyzed these data using thematic coding and descriptive statistics. Results: Of 2,515 patients enrolled (1,100 HF and 1,415 COPD), 210 patients experienced flagged outcomes, 47.1% of which were female, 64.3% had HF and the remaining COPD. The majority (86.2%) of flagged outcomes were related to underlying disease, but 13.8% of cases met criteria for AE and all were deemed preventable. Of the identified AEs, 72.4% returned to the ED and required admission to hospital; 17.2% were admitted to ICU, CCU, or AMU; 6.9% of patients died; 3.4% were intubated; 3.4% had a diagnosis of AMI and 0% required NIV. We found 75.8% of preventable AEs resulted from a management error (eg. not prescribing steroids on discharge for moderate COPD exacerbation); 31.0% from an unsafe disposition decision and 10.3% of AEs resulted from diagnostic error. Conclusion: Patients with acute exacerbations of HF and COPD are at high risk of preventable AEs directly related to care provided in the ED. Management and disposition decisions were a concerning source of error and should compel and focus future quality improvement efforts.

Incidence and causes of new-onset dyspnea in 3,719 patients treated with clopidogrel and aspirin combination after coronary stenting

2008 ◽  
Vol 100 (08) ◽  
pp. 314-318 ◽  
Author(s):  
Ilya Pokov ◽  
Wiktor Kuliczkowski ◽  
Javad Vahabi ◽  
Dan Atar ◽  
Victor Serebruany
Keyword(s):  
Antiplatelet Agent ◽  
Coronary Intervention ◽  
Underlying Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Telephone Interviews ◽  
Coronary Stent Implantation ◽  
Percutaneous Coronary ◽  
Registry Analysis

SummaryThe experimental oral antiplatelet agent AZD6140 causes dyspnea in randomized trials. Whether clopidogrel may also cause dyspnea remains controversial. We sought to define the incidence and causes of dyspnea in a large post-percutaneous coronary intervention (PCI) cohort based on open-labeled consecutive registry analysis of in-hospital charts and discharge diagnoses. Data were collected at six-month follow-up by means of telephone interviews or returned questionnaires during outpatient visits. Patients undergoing coronary stent implantation were loaded with 600 mg clopidogrel followed by 75 mg/daily in combination with 75–325 mg of aspirin daily for at least six months. Data from 3,719 patients were analyzed. Dyspnea was diagnosed in 157 (4.2%) patients caused by chronic obstructive pulmonary disease (n=43 or 27% of the dyspnea group), heart failure (n=30 or 19%), cancer (n=22 or 14%), pneumonia (n=17 or 11%); asthma (n=8 or 5%), pulmonary hypertension (n=8 or 5%);pericarditis (n=5 or 3%);cardiac arrhythmias (n=4 or 2.5%); pleural effusion (n=1), pulmonary embolism (n=1), anxiety (n=1), or unknown (n=17,or 11%).The incidence of dyspnea at six months in a post-stent cohort treated with aspirin and clopidogrel is low (4.2%). The majority of patients with dyspnea (140/157) exhibit a distinct underlying disease or condition, in contrast to only 17 patients (0.45% of total cohort) in whom the pathogenesis of dyspnea remained unidentified. These data closely match the frequency of dyspnea that was observed in the CAPRIE trial, suggesting that therapy with clopidogrel, and/or aspirin holds very small (if any) risk for dyspnea.

scholarly journals The pulmonary cachexia syndrome: aspects of energy balance

1999 ◽  
Vol 58 (2) ◽  
pp. 321-328 ◽  
Author(s):  
Jo Congleton
Keyword(s):  
Energy Balance ◽  
Current Knowledge ◽  
Resting Energy Expenditure ◽  
Prognostic Indicator ◽  
Negative Energy ◽  
Nutritional Supplementation ◽  
Fat Free Mass ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cachexia Syndrome

The present paper reviews current knowledge of the pulmonary cachexia syndrome with reference to chronic obstructive pulmonary disease (COPD). Aspects of incidence, aetiology and management are discussed. Malnutrition occurs in approximately one-quarter to one-third of patients with moderate to severe COPD. Both fat mass and fat-free mass become depleted. Loss of fat-free mass is the more important and appears to be due to a depression of protein synthesis. Weight loss is an independent prognostic indicator of mortality, and is associated with increased morbidity and decreased health-related quality of life. The aetiology of malnutrition in COPD is not well understood. Reduced food intake does not seem to be the primary cause. Resting energy expenditure (REE) is elevated in a proportion of patients and probably contributes to negative energy balance. Measurement of actual REE is helpful when considering the adequacy of nutritional supplementation. The underlying reason for a hypermetabolic state is not known. Although weight-losing COPD patients are not catabolic, nutritional supplementation alone does not appear to reverse the loss of fat-free mass. Strategies involving nutritional supplementation in combination with a second intervention are being explored, and there are some encouraging results using anabolic hormones.

Asthmatic bronchitis for 2 years: A case report

2003 ◽  
Vol 44 (4) ◽  
pp. 392-394
Author(s):  
I. Starakis ◽  
M. Mylona ◽  
K. Spyropoulos ◽  
P.A. Dimopoulos
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Underlying Disease ◽  
Chronic Obstructive ◽  
Lower Respiratory Tract Infections ◽  
Aged Patients ◽  
Obstructive Pulmonary Disease ◽  
Asthmatic Bronchitis ◽  
Tract Infections

Longstanding asthmatic bronchitis, without evidence of underlying disease, occurring in middle-aged patients, is usually attributed to chronic obstructive pulmonary disease and is treated appropriately. We report a case of 2-year asthmatic bronchitis with recurrent attacks of wheezing, in a 60-year-old patient. He had three repeated hospitalizations, in different institutions, where he was treated for exacerbations of chronic bronchitis complicated by lower respiratory tract infections. During his final hospitalization, a tracheal hamartoma was found and removed, releasing him from his symptoms.

scholarly journals Novel Association Between Asthma and Osteoarthritis: A Nationwide Health and Nutrition Examination Survey

2020 ◽  
Author(s):  
Hyeon-Kyoung Koo ◽  
Pamela Song ◽  
Joo-Hyun Lee
Keyword(s):  
Smoking Status ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Comorbid Condition ◽  
Nutrition Examination Survey ◽  
Obstructive Pulmonary Disease ◽  
Knee Oa ◽  
Health And Nutrition ◽  
High Prevalence ◽  
Asthma Patients

Abstract Backgrounds: Asthma and osteoarthritis (OA) are medical conditions that disable physical activity and deteriorate patients’ quality of life. Despite the high prevalence, there are limited studies focusing on the comorbid condition and association between asthma and OA. The aim of study was to assess the prevalence and identify the clinical considerations for this special population.Methods: Adult patients aged over 40 years who completed questionnaire assessments and spirometry were enrolled from Korean National Health and Nutrition Examination Survey. Asthma and OA were defined on the history of doctor-diagnosed disease. Radiographic severities of OA were measured using the Kellgren/Lawrence grading system. Chronic obstructive pulmonary disease (COPD) as a comparative respiratory disease was diagnosed on the basis of spirometric results.Results: A total of 9344 subjects were enrolled, and the prevalence of asthma and COPD were 4.6%±0.3% and 12.0%±0.5%, respectively. The prevalence of OA in the asthma group was 31.9%±2.8%, which was significantly higher than those in the COPD (17.8%±1.5%) or control (16.2%±0.6%) groups. OA was more prevalent in asthma patients after adjusting for age, sex, body mass index, and smoking status (OR, 1.65; 95% CI, 1.27-2.13). After further adjustment of this model for prescription of OA medication, OA was still independently associated with asthma (OR, 1.56; 95% CI, 1.10-2.20). In contrast, the relationship of OA medication with asthma was not significant (P=0.64). This relationship was evident in subjects with asthma without airflow limitation measured by spirometry (OR, 1.97; 95% CI, 1.32-2.93). Moreover, radiographic severity of knee OA correlated with asthma (OR, 1.10; 95% CI, 1.0-1.21). Conclusions: OA shows a high prevalence in patients with asthma, with the prevalence being higher than that in COPD patients or controls. The comorbid characteristics of these two conditions need to be considered in clinical practice.

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