scholarly journals Severity assessment of non-cystic fibrosis bronchiectasis by the FACED score

2020 ◽  
Vol 0 ◽  
pp. 1-10
Author(s):  
Ahmed Ben Saad ◽  
Asma Migaou ◽  
Nesrine Fahem ◽  
Saousen Cheikh Mhamed ◽  
Naceur Rouatbi ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Respiratory Function ◽  
Care Utilization ◽  
High Morbidity ◽  
Major Health Problem ◽  
Major Health ◽  
Single Center Study ◽  
Acute Exacerbations ◽  
Co2 Level ◽  
The Impact

Objectives: Bronchiectasis (BE) is a major health problem associated with a high morbidity and mortality. This study aimed to determine the relation of the FACED score (a multidimensional score contributing to stratify patients into risk categories) with the severity of non-cystic fibrosis bronchiectasis (NCFB) among our population. Materials and Methods: This is a retrospective single center study of 105 consecutive patients with NCFB hospitalized for acute exacerbations (AE) at the Department of Respiratory Medicine of Fattouma Bourguiba Teaching Hospital in Monastir (Tunisia) between January 2005 and December 2017. Patients were divided into two groups (G): G1: FACED Score ≤ 2 and G2: FACED score ≥3. We compared different severity parameters of BE between the two groups. Results: The study included 105 patients with NCFB. Patients of G2 had more comorbidities (P = 0.028), an altered respiratory function with a lower forced vital capacity (G1:2.73, G2:1.33 L; P < 0.001), a decreased PaO2 (88 vs. 68 mmHg; P < 0.001), a high CO2 level (P < 0.001), and a higher number of AE/year (0.96, 2.12 AE/year;P < 0.001). Hospitalizations for AE of G2 were characterized by a lower PaO2, a higher PaCO2 (P < 0.001), a longer course of antibiotic (P < 0.001) with an extended hospitalization (P = 0.007). An ultimate evolution toward chronic respiratory failure was more common in G2 (P < 0.001). Conclusion: A high FACED score is associated with more symptoms, an altered respiratory function, a higher number and more severe AE, more health-care utilization with worse outcomes. Further studies are necessary to evaluate the impact of such scales in clinical practice.

scholarly journals Impact of COVID-19 on social determinants of health for adults with cystic fibrosis

2021 ◽  
Vol 15 ◽  
pp. 175346662110374
Author(s):  
Dana Albon ◽  
Heather Bruschwein ◽  
Morgan Soper ◽  
Rhonda List ◽  
Deirdre Jennings ◽  
...  
Keyword(s):  
Health Care ◽  
Cystic Fibrosis ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Issues ◽  
Determinants Of Health ◽  
Care Utilization ◽  
Health Questionnaire ◽  
Improvement Project ◽  
The Impact

Introduction: Outcomes in cystic fibrosis are influenced by multiple factors, including social determinants of health. Low socioeconomic status has been shown to be associated with lung function decline, increased exacerbation rates, increased health care utilization, and decreased survival in cystic fibrosis. The COVID-19 pandemic disrupted the US economy, placing people with cystic fibrosis at risk for negative impacts due to changes in social determinants of health. Methods: To characterize the impact of COVID-19-related changes in social determinants of health in the adult cystic fibrosis population, a social determinants of health questionnaire was designed and distributed to patients as part of a quality improvement project. Results: Of 132 patients contacted, 76 (57.6%) responses were received. Of these responses, 22 (28.9%) answered yes to at least one question that indicated an undesired change in social determinants of health. Patients with stable employment prior to COVID-19 were more likely to endorse undesired change in all domains of the questionnaire, and the undesired changes were most likely to be related to employment, insurance security, and access to medications. Patients receiving disability were more likely to report hardship related to utilities and food security compared with patients previously employed or unemployed. Of patients endorsing risk of socioeconomic hardship, 21 (95.5%) were contacted by a social worker and provided resources. Conclusion: Utilizing a social determinants of health questionnaire to screen for social instability in the context of COVID-19 is feasible and beneficial for patients with cystic fibrosis. Identifying social issues early during the pandemic and implementing processes to provide resources may help patients with cystic fibrosis mitigate social hardship and maintain access to health care and medications.

scholarly journals PERAN LINGKUNGAN DAN INDIVIDU TERHADAP MASALAH DIARE DI PULAU JAWA DAN BALI

2020 ◽  
Vol 19 (2) ◽  
pp. 84-93
Author(s):  
Ika Dharmayanti ◽  
Dwi Hapsari Tjandrarini
Keyword(s):  
Drinking Water ◽  
High Morbidity ◽  
Open Defecation ◽  
Major Health Problem ◽  
Major Health ◽  
Data Source ◽  
Integration Data ◽  
And Behavior ◽  
Diarrhea Disease ◽  
The Relationship

ABSTRACT  Diarrhea is a major health problem in Indonesia with high morbidity and mortality rates. Unhealthy environment and unhygienic behavior are closely related to diarrhea disease. This study aims to identify the association between environmental conditions and behavior with the occurrence of diarrhea in Jawa and Bali. Data source used was the integration data of March’s Susenas and Riskesdas 2018. A logistic regression analysis was chosen to elicit the relationship between sanitation and drinking water facilities, open defecation practice, and other factors with the prevalence of diarrhea. The results showed that open defecation (OR = 1.2; 95% CI: 1.12 to 1.29; P<0.001, and improper of household sanitation and drinking water (OR = 1.11; 95% CI: 1.04 to 1.2; P = 0.003) had significant association with diarrhea. Other factors are age 0-5 years (OR = 1.56; 95% CI: 1.46 to 1.66; P <0,001) and low education (OR = 1.33; 95% CI: 1.21 to 1.47; P <0,001). This study shows the hygienic behavior is the essential factors to reduce the incidence of diarrhea. Therefore, it is recommended to to prioritize aspects of behavior and environmental health, namely changing people’s behavior to defecate in a latrine, and provide proper sanitation and sufficient drinking water. Keywords: Diarrhea; sanitation; drinking water; open defecation   ABSTRAK Penyakit diare merupakan masalah kesehatan utama di Indonesia dengan angka kesakitan dan kematian yang masih tinggi. Lingkungan yang tidak sehat dan perilaku tidak higienis sangat erat kaitannya dengan penyakit diare. Penelitian ini bertujuan untuk menganalisis hubungan antara kondisi lingkungan dan perilaku dengan penyakit diare di pulau Jawa dan Bali. Sumber data yang digunakan adalah data integrasi Susenas Maret dan Riskesdas 2018. Analisis dilakukan dengan menggunakan regresi logistik untuk melihat hubungan antara ketersediaan sanitasi dan air minum, perilaku buang air besar serta faktor lainnya terhadap kejadian diare. Hasil menunjukkan bahwa faktor perilaku buang air besar sembarangan (OR = 1,2; 95% CI: 1,12 - 1,29; P <0,001) serta akses sanitasi dan air minum rumah tangga tidak layak/tidak tersedia (OR = 1,11; 95% CI: 1,04 - 1,2; P = 0,003) memiliki hubungan dengan kejadian diare. Faktor lainnya yaitu: usia 0-5 tahun (OR = 1,56; 95% CI: 1,46 - 1,66; P <0,001) dan pendidikan rendah (OR = 1,33; 95% CI: 1,21 - 1,47; P <0,001).  Penelitian ini menunjukkan bahwa perilaku higienis sangat penting untuk menurunkan kejadian diare. Oleh karena itu direkomendasikan untuk mengutamakan aspek perilaku dan kesehatan lingkungan, yaitu merubah perilaku masyarakat untuk BAB di jamban, serta menyediakan sanitasi dan air minum yang layak. Kata kunci: Diare, sanitasi, sarana air minum, buang air besar sembarangan

scholarly journals PERAN INTERFERON GAMMA PADA INFEKSI Mycobacterium tuberculosis

2017 ◽  
Vol 17 (2) ◽  
pp. 126-132
Author(s):  
Nur Wahyuniati
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Interferon Gamma ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Th1 Cell ◽  
Major Health Problem ◽  
Major Health ◽  
High Morbidity Rate ◽  
Keywords Tuberculosis ◽  
Cellular Immune

Abstrak.Penyakit tuberkulosis masih tetap merupakan masalah kesehatan yang utama di dunia. Penyakit ini menyebabkan angka kesakitan yang tinggi pada jutaan penduduk dunia setiap tahunnya. Mycobacterium tuberculosis (M.Tb) memiliki kemampuan aktifitas replikasi dan metabolisme yang tinggi dan memiliki kemampuan untuk bertahan hidup di dalam fagosit profesional. Respon imun seluler sangat berperan penting untuk proses eliminasi M. Tb. Sel TH1 yang teraktivasi akan mengeluarkan interferon gamma yang akan mengaktivasi makrofag. Interferon gamma memiliki peran yang sangat penting dalam imunitas protektif terhadap infeksi M.Tb.(JKS 2017; 2: 131-137)Kata kunci: Tuberkulosis, Mycobacterium tuberculosis, respon T­H1,Interferon gammaAbstract. Tuberculosis remains a major health problem in the world. This disease causes a high morbidity rate in millions of the world's population each year. Mycobacterium tuberculosis (M.Tb) has high replication and metabolism activity and has the ability to survive in professional phagocytes. Cellular immune responses play an important role in the elimination process of M. Tb. The activated TH1 cell will secrete interferon gamma that leads to activation of macrophages. Interferon gamma has a very important role in protective immunity against infection M.Tb.(JKS 2017; 2: 131-137)Keywords: Tuberculosis, Mycobacterium tuberculosis, TH­1 response, Interferon gamma

scholarly journals Two Gut Microbiota-Derived Toxins Are Closely Associated with Cardiovascular Diseases: A Review

Toxins ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 297
Author(s):  
Tomoya Yamashita ◽  
Naofumi Yoshida ◽  
Takuo Emoto ◽  
Yoshihiro Saito ◽  
Ken-ichi Hirata
Keyword(s):  
Cardiovascular Diseases ◽  
Gut Microbiota ◽  
Experimental Studies ◽  
The Body ◽  
Bioactive Metabolites ◽  
High Morbidity ◽  
Major Health Problem ◽  
Major Health ◽  
Research Findings ◽  
Near Future

Cardiovascular diseases (CVDs) have become a major health problem because of the associated high morbidity and mortality rates observed in affected patients. Gut microbiota has recently been implicated as a novel endocrine organ that plays critical roles in the regulation of cardiometabolic and renal functions of the host via the production of bioactive metabolites. This review investigated the evidence from several clinical and experimental studies that indicated an association between the gut microbiota-derived toxins and CVDs. We mainly focused on the pro-inflammatory gut microbiota-derived toxins, namely lipopolysaccharides, derived from Gram-negative bacteria, and trimethylamine N-oxide and described the present status of research in association with these toxins, including our previous research findings. Several clinical studies aimed at exploring the effectiveness of reducing the levels of these toxins to inhibit cardiovascular events are currently under investigation or in the planning stages. We believe that some of the methods discussed in this review to eliminate or reduce the levels of such toxins in the body could be clinically applied to prevent CVDs in the near future.

scholarly journals Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 124
Author(s):  
Marta Torres-Arrese ◽  
Gonzalo García de Casasola-Sánchez ◽  
Manuel Méndez-Bailón ◽  
Esther Montero-Hernández ◽  
Marta Cobo-Marcos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Point Of Care ◽  
Femoral Vein ◽  
Common Disease ◽  
Point Of Care Ultrasound ◽  
High Morbidity ◽  
Major Health Problem ◽  
Study Results ◽  
The Impact

Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE × US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation–SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE × US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE × US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE × US score, should be further studied before expanding its use in AHF patients.

scholarly journals Preventive aspects of genetic morbidity: experiences of the Canadian model

1999 ◽  
Vol 5 (6) ◽  
pp. 1121-1128
Author(s):  
M. M. Khalifa
Keyword(s):  
Health Problem ◽  
Susceptibility Testing ◽  
Early Recognition ◽  
Genetic Disorders ◽  
Industrialized Countries ◽  
Major Health Problem ◽  
Major Health ◽  
Genetic Contributions ◽  
Success Of Treatment ◽  
The Impact

Genetic disorders are emerging as a major health problem in industrialized countries, especially with greater control of environmental diseases. Of total admissions to major paediatric hospitals, 50% are due to genetic disorders, and at least 10% of all adult admissions to hospitals involve major genetic contributions. Several programmes aimed at preventing or ameliorating these genetic disorders are being implemented. Identifying people at risk of genetic disease has helped decrease the burden of such diseases on families and society. Early recognition also leads to greater success of treatment and improves outcome and prognosis. In Arab populations, genetic disorders are still not perceived as a major health problem, even though they are widely prevalent. Applying similar programmes of early detection, maternal screening, neonatal screening, carrier testing and susceptibility testing will significantly help reduce the impact of these disorders in our populations

scholarly journals Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort

2021 ◽  
Author(s):  
Marta Torres-Arrese ◽  
Gonzalo García de Casasola-Sánchez ◽  
Manuel Méndez-Bailón ◽  
Esther Montero-Hernández ◽  
Marta Cobo-Marcos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Point Of Care ◽  
Vena Cava ◽  
Common Disease ◽  
Point Of Care Ultrasound ◽  
High Morbidity ◽  
Major Health Problem ◽  
Study Results ◽  
The Impact

Background and Objectives: Acute Heart Failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying the pulmonary hypertension (PH) in patients admitted due to AHF, predict the evolution of the disease during hospitalization and identify areas of improvement in the care of patients with AHF. Materials and Methods: Patients were evaluated with a standard exam of lung ultrasound, echocardiography, inferior vena cava (IVC) and femoral, renal, hepatic, portal venous Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation &ndash; SD 13,4). Seven patients (23.3%) had a renal function worsening. Regarding ultrasound findings, venous excess ultrasonography score (VExUS) score was calculated at admission and at discharge, surprisingly remaining unchanged or even worsened in most of them (21 patients, 70.0%). The area under the curve for the Lung Score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (p &amp;lt;0.001), hepatic vein Doppler (p &amp;lt;0.001), portal vein Doppler (p = 0.030), intra-renal vein Doppler (p = 0.025) and VExUS score (p = 0.023), remaining similar the femoral vein Doppler (p = 0.177) and IVC (p = 0.132). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VExUS score, should be further studied in different populations before expanding its use in AHF patients.

scholarly journals Impact of Achromobacter xylosoxidans isolation on the respiratory function of adult patients with cystic fibrosis

2019 ◽  
Vol 5 (4) ◽  
pp. 00051-2019 ◽  
Author(s):  
Macha Tetart ◽  
Frederic Wallet ◽  
Maeva Kyheng ◽  
Sylvie Leroy ◽  
Thierry Perez ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Respiratory Function ◽  
Forced Expiratory Volume ◽  
Adult Patients ◽  
Achromobacter Xylosoxidans ◽  
First Year ◽  
Long Term Effects ◽  
Lung Isolation ◽  
The Impact

BackgroundThe prevalence of Achromobacter xylosoxidans lung isolation in cystic fibrosis (CF) patients has increased, but the impact on lung function is controversial. The aim of this study was to evaluate the long-term effects of A. xylosoxidans isolation on respiratory function of adult patients with CF in the first 3 years after identification of A. xylosoxidans isolation.MethodsThis was a case–control retrospective study performed at a single CF centre in Lille, France. Data for 36 patients with CF who had at least one sputum culture positive for A. xylosoxidans (Ax+) were evaluated and compared with control CF patients uninfected by A. xylosoxidans (Ax−). Respiratory function and exacerbation frequency were evaluated between 1 year prior to and 3 years after A. xylosoxidans isolation.ResultsCompared with the Ax− group, the Ax+ group had a lower forced expiratory volume in 1 s (FEV1) at baseline (median (interquartile range): 55.2% (50.6–59.8%) versus 73.8% (67.2–80.4%); p=0.005), a greater decline in FEV1 (±se) in the first year after A. xylosoxidans identification (−153.6±16.1 mL·year−1versus −63.8±18.5 mL·year−1; p=0.0003), and more exacerbations in the first 3 years after A. xylosoxidans identification (9 (7–12) versus 7 (5–10); p=0.03). Ax+ patients co-colonised with Pseudomonas aeruginosa (n=27, 75%) had a greater FEV1 decline (p=0.003) and more exacerbations in the year after A. xylosoxidans identification (p=0.037) compared with patients colonised with A. xylosoxidans alone. Patients with chronic A. xylosoxidans isolation (n=23, 64%) had more exacerbations than intermittently colonised patients in the 3 years after A. xylosoxidans identification (p=0.012).ConclusionA. xylosoxidans isolation is associated with a decline in respiratory function in patients with CF. Chronic A. xylosoxidans isolation and P. aeruginosa co-isolation may be markers of more severe respiratory disease in Ax+ patients.

scholarly journals Practitioner Due Diligence: Real-World Lumacaftor/Ivacaftor Use

2020 ◽  
Vol 25 (5) ◽  
pp. 431-436
Author(s):  
Emily M. Stephan ◽  
Christopher J. Nemastil ◽  
Ann Salvator ◽  
Susan Gemma ◽  
Clarissa J. Dilaveris ◽  
...  
Keyword(s):  
Health Care ◽  
Body Mass Index ◽  
Cystic Fibrosis ◽  
Health Care Utilization ◽  
Body Mass ◽  
Real World ◽  
Forced Expiratory Volume ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
The Impact

OBJECTIVE Previous trials evaluated the efficacy of lumacaftor/ivacaftor in Phe508del homozygotes. These trials are limited by manufacturer sponsorship and were conducted under strict protocol. Additionally, this therapy is costly and does not allow for reduction in daily cystic fibrosis therapies. This study assessed the efficacy of lumacaftor/ivacaftor therapy and its effect on health care utilization in a real-world setting. METHODS Retrospective chart review comparing the first 12 months of therapy to the 24 months prior was conducted to evaluate the impact of lumacaftor/ivacaftor on pulmonary function following a streamlined process for therapy introduction. The impact on body mass index and healthcare utilization were also evaluated. The following measurements were assessed: percent predicted forced expiratory volume in 1 second, body mass index and z-scores, number of admissions, length of stay, number of emergency department visits. RESULTS Mean ppFEV1 was improved for the first 12 months on lumacaftor/ivacaftor treatment when compared with the 24 months prior: 78.8 (95% CI: 72.6, 84.9) vs 76.2 (95% CI: 70.1, 82.3) (p = 0.03). Body mass index significantly improved (patients ≥20 years), but improvement in BMI z-score (patients &lt;20 years) was not significant. Number of admissions and LOS were significantly decreased, but ED visits were not. CONCLUSIONS Lumacaftor/ivacaftor is effective for improving ppFEV1 and BMI and for reducing health care utilization. However, this small reduction does not overcome the financial cost of treatment. Long-term outcomes and use must be studied to determine the overall effect of this therapy on cystic fibrosis interventions and their costs.

scholarly journals IMPACT OF COVID-19 PANDEMIC ON GASTROINTESTINAL ENDOSCOPY PROCEDURES

2021 ◽  
Vol 9 (12) ◽  
pp. 423-428
Author(s):  
Sandesh Gawade ◽  
Divyangi Sarvankar ◽  
Shivani Chikhale
Keyword(s):  
Patient Care ◽  
Health Problem ◽  
Gastrointestinal Endoscopy ◽  
Medical Procedures ◽  
Major Health Problem ◽  
Major Health ◽  
Gi Endoscopy ◽  
Delay In Diagnosis ◽  
Validated Questionnaire ◽  
The Impact

Background- COVID-19, an emerging coronavirus disease is a major health problem. It has markedly affected the routine medical procedures including Gastrointestinal(GI) endoscopies. Inspite of guidelines suggested by various GI societies,for safe GI endoscopy procedures in period of COVID pandemic, most of the endoscopists as well as the patients were hesitant for the endoscopy procedures.We sought to measure the impact of the same on GI endoscopy activity in Pune. Method- A pre-validated questionnaire containing 28 questions was sent across to the GI endoscopy surgeons. Responses were collected to assess the perception of GI endoscopists regarding the practice of endoscopy and the risk of self-contamination during COVID-19 Pandemic. This data was analysed using appropriate statistical applications. Result-51 GI endoscopists from Pune participated in our study out of which 80.3% (41/51) were involved in the management of COVID-19 patients outside the endoscopy department. During the study period, 86.28% (44/51) of endoscopists had to cancel procedures on grounds of COVID19 pandemic.Symptoms compatible with COVID-19 infection were reported by 29.41% (15/51) of the endoscopists out of which 13 (86%) responders had a positive RTPCR test for COVID-19 Conclusion- COVID-19 pandemic has seriously affected GI endoscopy practice. COVID 19 infection rate was also remarkable in endoscopists and endoscopy staff. As the screening of patients with GI problems was hampered, there was definitive delay in diagnosis and treatment. Nevertheless, endoscopy centers should adapt and make changes in their practice to face future pandemic, emphasizing safety of staff without delaying patient care.

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