Therapeutic innovation and sustainability in immune-mediated pathologies

2021 ◽  
Author(s):  
Miguel Ángel Calleja Hernández
Keyword(s):  
Patient Adherence ◽  
Serum Levels ◽  
Pharmacy Service ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Clinical Activity ◽  
Pharmacy Services ◽  
Biological Drugs ◽  
Obstructive Pulmonary Disease ◽  
Immune Mediated

For a few years now, we have been experiencing a disruptive therapeutic innovation in immune-mediated pathologies with the incorporation of biological and targeted therapies that have significantly improved efficacy, safety and convenience for patients. The objective of the Pharmacy Services is to achieve the best health results with the rational use of the drug, that is, it is effective, safe and efficient. Pharmacy Services behave as a strategic element in hospitals and have four main axes: technology, logistics, scientific advice and direct clinical activity. In clinical activity, from the Pharmacy Services we promote greater patient adherence to their treatments, information about them to patients, review of drug interactions and effective monitoring to achieve the best health results. We use the CMO model (Capacity / Motivation / Opportunity), and we have implemented telepharmacy programs to facilitate collaborative dispensing with the community pharmacy. Thus, we gain comfort for patients and improvement of the comprehensive approach to patient needs. The levels of adherence are lower in chronic diseases as time passes from the start of treatment and with the disease controlled; pathologies such as chronic obstructive pulmonary disease, diabetes, or depression have mean adherence values of less than 50%. In the case of immune-mediated diseases the values are 70-90%, but we still need to improve them to achieve maximum effectiveness. From the Pharmacy Service we promote the maximum individualization of therapy, and we believe that no two patients are the same, not even the same patient is the same after the diagnosis and when he has been treatment for several years. For this reason, we have incorporated the determination of levels of biological drugs in the blood to be able to adjust the dosage to the individual needs of the patient. This allows us to optimize the dose when the pathology is controlled, maintaining the target serum levels, or to intensify the dose when control of the disease is not achieved, due to low levels of the drug or high levels of the antibodies that the patient may have generated. Currently, in the Pharmacy Service of University Hospital Virgen Macarena we monitor the levels of Infliximab, Adalimumab, Vedolizumab and Ustekinumab, with optimal results for the patients. It is vital to implement these strategies in a multidisciplinary way with the services involved, in this case mainly Digestive, Rheumatology and Dermatology. We have a pharmacist who is an expert in these pathologies who streamlines and catalyzes all activities in this area.

scholarly journals Implementation of a Targeted Screening Program to Detect Airflow Obstruction Suggestive of Chronic Obstructive Pulmonary Disease within a Presurgical Screening Clinic

2015 ◽  
Vol 22 (4) ◽  
pp. 209-214 ◽  
Author(s):  
Chantal Robitaille ◽  
Esther Dajczman ◽  
Andrew M Hirsch ◽  
David Small ◽  
Pierre Ernst ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Screening Program ◽  
Tertiary Care ◽  
Airflow Obstruction ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Targeted Screening ◽  
History Of

BACKGROUND: Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.OBJECTIVE: The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.METHODS: The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.RESULTS: After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.CONCLUSIONS: Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.

Oxidized low-density lipoproteins and its connection with dyslipidemia, inflammatory markers, and oxidative stress in patients with occupational chronic obstructive pulmonary disease

2021 ◽  
Vol 31 (4) ◽  
pp. 456-462
Author(s):  
I. A. Umnyagina ◽  
L. A. Strakhova ◽  
T. V. Blinova ◽  
V. V. Troshin ◽  
V. D. Fedotov
Keyword(s):  
Oxidative Stress ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Comparison Group ◽  
Serum Levels ◽  
Low Density Lipoproteins ◽  
Chronic Obstructive ◽  
Low Density ◽  
Obstructive Pulmonary Disease ◽  
Occupational Copd

The role of low-density oxidized lipoproteins (OxLDL) in the pathogenesis of occupational chronic obstructive pulmonary disease (COPD) is not understood well enough.The study aims to determine the serum levels of oxidized low-density lipoproteins and their relationship with lipid profile, the level of oxidative stress and level C-reactive protein in patients with occupational chronic obstructive pulmonary disease.Methods. 116 patients diagnosed with occupational COPD and 25 patients with no respiratory diseases (comparison group) were examined. Serum levels of OxLDL was determined by solid phase enzyme-linked immunosorbent assay (ELISA) using the commercial reagent kit MDA-oxLDL from Biomedica Gruppe, Austria.Results. Circulating OxLDL was detected in serum in a significant proportion of patients with stable occupational COPD. In most of the patients, the concentration of OxLDL was within the values observed in the comparison group or exceeded them by no more than two times. In the minority of patients with occupational COPD (16.5%), the concentration of OxLDL was high and 4 – 10 times higher than its average value in the comparison group. It can be assumed that the revealed differences in the concentration of OxLDL are due to the different degree and intensity of oxidation of low-density lipoproteins. The relationships between OxLDL and lipid metabolism, oxidative stress (OS), the antioxidant capacity of serum (AOS), and serum levels of C-reactive protein were described.Conclusion. Serum OxLDL levels in patients with occupational COPD, the relationship between OxLDL and lipid metabolism, oxidative stress, and inflammation will provide an expanded view of the pathogenetic aspects of occupational COPD.

Intra-Abdominal Hypertension is a Risk Factor for Increased VAP Incidence: A Prospective Cohort Study in the ICU of a Tertiary Hospital

2018 ◽  
Vol 35 (7) ◽  
pp. 700-707 ◽  
Author(s):  
Eleni Papakrivou ◽  
Demosthenes Makris ◽  
Efstratios Manoulakas ◽  
Marios Karvouniaris ◽  
Epaminondas Zakynthinos
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Cox Regression ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cox Regression Analysis ◽  
Abdominal Hypertension

Background: Ventilator-associated pneumonia (VAP) might be increased in cases with intra-abdominal hypertension (IAH). However, despite animal experimentation and physiological studies on humans in favor of this hypothesis, there is no definitive clinical data that IAH is associated with VAP. We therefore aimed to study whether IAH is a risk factor for increased incidence of VAP in critical care patients. This 1-center prospective observational cohort study was conducted in the intensive care unit of the University Hospital of Larissa, Greece, during 2013 to 2015. Consecutive patients were recruited if they presented risk factors for IAH at admission and were evaluated systematically for IAH and VAP for a 28-day period. Results: Forty-five (36.6%) of 123 patients presented IAH and 45 (36.6%) presented VAP; 24 patients presented VAP following IAH. Cox regression analysis showed that VAP was independently associated with IAH (1.06 [1.01-1.11]; P = .053), while there was an indication for an independent association between VAP and abdominal surgery (1.62 [0.87-3.03]; P = .11] and chronic obstructive pulmonary disease (1.79 [0.96-3.37]; P = .06). Conclusions: Intra-abdominal hypertension is an independent risk factor for increased VAP incidence in critically ill patients who present risk factors for IAH at admission to the ICU.

scholarly journals Risk Factors of Pneumonia Associated with Mechanical Ventilation

2020 ◽  
Vol 17 (2) ◽  
pp. 656 ◽  
Author(s):  
Maria Kózka ◽  
Aurelia Sega ◽  
Katarzyna Wojnar-Gruszka ◽  
Agnieszka Tarnawska ◽  
Agnieszka Gniadek
Keyword(s):  
Risk Factors ◽  
Chronic Obstructive Pulmonary Disease ◽  
Hemorrhagic Shock ◽  
Pulmonary Disease ◽  
High Risk Group ◽  
University Hospital ◽  
Medical Documentation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The University

Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5–15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP.

scholarly journals Changes in Th1/Th2-producing cytokines during acute exacerbation chronic obstructive pulmonary disease

2018 ◽  
Vol 46 (9) ◽  
pp. 3890-3902 ◽  
Author(s):  
Bing Wei ◽  
Chun Sheng Li
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive Lung Disease ◽  
Serum Levels ◽  
T Cell Subsets ◽  
Th2 Cells ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Ifn Γ

Objective This study aimed to explore cytokine serum levels and the ratio of type 1 T helper (Th1)/Th2 cells in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total 245 patients diagnosed with AECOPD and 193 patients who progressed to stable COPD after the initiation of treatment in hospital were selected, while a further 50 healthy individuals served as controls. All patients with COPD were diagnosed using Global Initiative for Chronic Obstructive Lung Disease criteria. Serum concentrations of interleukin (IL)-2, interferon (IFN)-γ, IL-4, IL-10, IL-17, and immunoglobulin (Ig)E were measured using enzyme-linked immunosorbent assays. Results AECOPD patients had higher levels of IL-2, IFN-γ, IL-4, IL-10, IL-17, and IgE than those with stable COPD or controls. Intriguingly, the ratios of Th1/Th2 and IL-17/IgE were lower in AECOPD patients compared with the other two groups. These data suggest that AECOPD patients produce more IgE and have more differentiated Th2 cells than other groups. Conclusion Our findings suggest that an imbalance of circulating CD4+ T cell subsets correlates with AECOPD, and that a shift of Th1/Th2 and IL-17/IgE ratios may be caused by increased Th2 cell production.

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