Association of pruritus and chronic cough: an all of us database study.

PURPOSE: Based on a potential shared pathophysiology tied to mast cell activity and neurogenic inflammation that may link pruritus and chronic cough (CC), this study, leveraging the All of Us database, examines the association between the two conditions. MATERIALS AND METHODS: A nested case-control comparison was used to examine the association, identifying cases with SNOMED codes 418363000 (pruritus) and 68154008 (CC). Matching was performed on a 1:4 ratio by age, sex, and ethnicity using the MatchIt package in R, followed by maximum likelihood method to estimate odds ratios (ORs) and 95% confidence intervals from 2x2 contingency tables. RESULTS: CC patients (n = 2,388) were more than twice as likely to be diagnosed with pruritus (OR: 2.65) and pruritus patients (n = 22,496) were more than twice as likely to be diagnosed with CC (OR: 2.57), than respective matched controls. CONCLUSIONS: These results highlight the potential bidirectional relationship between CC and pruritus, suggesting possible shared immune and neural pathways. Treatments like difelikefalin and nalbuphine that modulate these pathways, alongside P2X3 targeting agents, are emerging as potential therapeutic approaches for itch and chronic cough given the possible interconnected pathophysiology. This study's insights into the associations between pruritus and CC may pave the way for targeted therapeutic strategies that address their shared mechanisms.

Quantifying how much host, pathogen, and other factors affect human protective adaptive immune responses.

Recognizing the "essential" factors that contribute to a clinical outcome is critical for designing appropriate therapies and prioritizing limited medical resources. Demonstrating a high correlation between a factor and an outcome does not necessarily imply an essential role of the factor to the outcome. Human protective adaptive immune responses to pathogens vary among (and perhaps within) pathogenic strains, human individual hosts, and in response to other factors. Which of these has an "essential" role? We offer three statistical approaches that predict the presence of newly contributing factor(s) and then quantify the influence of host, pathogen, and the new factors on immune responses. We illustrate these approaches using previous data from the protective adaptive immune response (cellular and humoral) by human hosts to various strains of the same pathogenic bacterial species. Taylor's law predicts the existence of other factors potentially contributing to the human protective adaptive immune response in addition to inter-individual host and intra-bacterial species inter-strain variability. A mixed linear model measures the relative contribution of the known variables, individual human hosts and bacterial strains, and estimates the summed contributions of the newly predicted but unknown factors to the combined adaptive immune response. A principal component analysis predicts the presence of sub-variables (currently not defined) within bacterial strains and individuals that may contribute to the combined immune response. These observations have statistical, biological, clinical, and therapeutic implications.

Estudio observacional de validación clínica del diagnóstico de enfermería de disfunción sexual en pacientes con insuficiencia cardíaca crónica / Observational study of clinical validation of the nursing diagnosis of sexual dysfunction in patients with chronic cardiac insufficiency

Objetivos: Verificar el estado funcional, el estado civil, la religión, la edad y el sexo de pacientes con insuficiencia cardíaca crónica estable con diagnóstico de enfermería de disfunión sexual y verificar las características definidoras de mayor predominio, menor predominio e irrelevantes de este diagnóstico. Métodos: Estudio descriptivo, observacional y cuantitativo. Se utilizó el modelo práctico de validación clínica del diagnóstico en 30 pacientes con insuficiencia cardíaca crónica estable en acompañamiento ambulatorial que presentaron diagnóstico de enfermería de disfunción sexual en el Hospital Universitario Antonio Pedro en el periodo septiembre-noviembre de 2011. Resultados: De las 20 características definidoras validadas, se observó que 8 fueron clasificadas como de mayor predominio, 9, de menor predominio y 3, irrelevantes. Las características definidoras de mayor predominio tenían relación con el esfuerzo físico y la presentación de disfunción sexual con la enfermedad y el tratamiento; las clasificadas como de menor predominio tenían relación con presencia, ausencia o alteraciones en la excitación, en la satisfacción y en el interés por otras personas. El cansacio, el dolor y el miedo relacionado al esfuerzo físico también fueron referidos por los pacientes de este grupo; las clasificadas como irrelevantes tenían relación al amor propio y a la relación con el cónyuge. Conclusión: Este estudio comprobó que las características definidoras presentadas en NANDA-I son válidas para diagnosticar pacientes con insuficiencia cardíaca crónica estable en acompañamiento ambulatorial, dado que éstas se presentan en un ambiente clínico real.

Objectives: To verify the functional state, the civil state, religion, age and sex of patients with chronic stable cardiac insufficiency with nursing diagnosis of sexual dysfunction and to verify the definitive characteristics, the most common ones, the less common and the ones that are irrelevant to this diagnostic. Methods: Descriptive study, observational and quantitative. The practical model of clinical validation of the diagnosis in 30 patients with stable chronic cardiac insufficiency in ambulatory accompaniment that presented a nursery diagnostic of sexual dysfunction in the Hospital Universitario Antonio Pedro on september-november of 2011 period. Results: From the 20 definitive characteristics validated, 8 were classified as more dominant, 9 as less dominant and 3 as irrelevant. The most dominant definitive characteristics were related to physical effort and the presentation of sexual disfunction with the disease and the treatment; the less dominant were related to presence, absence or alteration of arousal, satisfaction and interest in the other person. Tiredness, pain and fear related to the physical effort were also referred by the patients of this group; the irrelevant characteristics were related to self-esteem and the relation with the partner. Conclusion: This study proved that the definitive characteristics presented in the NANDA-I are valid to diagnose patients with stable chronic insufficiency in ambulatory accompaniment, since these are presented in a real clinical environment.

Objetivos: Verificar o estado funcional, estado civil, religião, idade e sexo de pacientes com insuficiência cardíaca crônicaestável, com diagnóstico de enfermagem disfunção sexual e verificar as características definidoras de maior prevalência, menor prevalência e irrelevantes deste diagnóstico. Método: Trata-se de um estudo descritivo, observacional com abordagem quantitativa. Foi utilizado o modelo prático de validação clínica de diagnóstico em 30 pacientes com insuficiência cardíaca crônicaem acompanhamento ambulatorial que apresentaram o diagnóstico de enfermagem disfunção sexual. Resultados: Das 20 características definidoras validadas, observou-se que 8 foram classificadas como de maior prevalência, 9 foram consideradas de menor prevalência e 3 foram consideradas irrelevantes. As características definidoras de maior prevalênciarelacionavam-se ao esforço físico e ao aparecimento da disfunção sexual com a doença e tratamento; as classificadas como de menor prevalênciarelacionavam-se a presença, ausência e/ou alteraçãona excitação, na satisfação e no interesse por outras pessoas; o cansaço, a dor e o medo relacionado ao esforço físico tambémforam referidos pelos pacientes deste grupo; e as classificadas como irrelevantes relacionavam-se a auto-estima e o relacionamento com o parceiro. Conclusão: Este estudo comprovou que as características definidoras apresentadas na NANDA Internacional são válidas para diagnosticar pacientes com insuficiência cardíaca crônicaem acompanhamento ambulatorial, visto que estas se apresentam em ambiente clínico real.