RESUMO
Patients with asthma should be vaccinated against COVID-19. This includes patients with severe asthma. Treatment with a biological for asthma is no contra-indication for vaccination against COVID-19.
Assuntos
Asma , COVID-19 , Pneumologia , Asma/tratamento farmacológico , Áustria , Vacinas contra COVID-19 , Humanos , SARS-CoV-2 , VacinaçãoAssuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Dessensibilização Imunológica , Humanos , SARS-CoV-2RESUMO
OBJECTIVE: The real-world effectiveness and tolerability of an extrafine fixed dose beclomethasone/formoterol (BDP/FF) treatment of patients with partially or non-controlled asthma was evaluated in five non-interventional studies (NISs) from Austria. METHODS: Asthma patients enrolled in these five NISs were treated with beclomethasone/formoterol (Foster® or Foster® Nexthaler®) as maintenance and reliever over 12 weeks. Asthma control, lung function and symptom scores were assessed at baseline, after 4-8 weeks and at the end of the investigations in week 12. In addition, tolerability and handling of the devices were evaluated by questionnaires. RESULTS: The combined analysis included 891 patients (53% female, aged 49.3 years) demonstrating significant improvements in asthma control, lung function parameters (PEF, FEV1 and FVC) and symptom scores (reduction of breathlessness, wheezing, chest tightness and cough). These changes were already detectable after 4-8 weeks. The treatment was effective irrespective of smoking status, exercise, or previous medication. Tolerability of the therapy with extrafine BDP/FF was rated as "very good" or "good" in 98% of the patients. 95% of the patients intended to continue the treatment, and nearly all (99%) rated the handling of the device as "very good" or "good". No serious adverse reactions were reported. CONCLUSIONS: This combined analysis of five non-interventional studies confirms the effectiveness and tolerability of the extrafine fixed-dose BDP/FF combination (Foster® and Foster® Nexthaler®) in a heterogenous patient population suffering from partially or non-controlled asthma. Therapy was associated with a high patient satisfaction and the absence of serious adverse reactions.
Assuntos
Antiasmáticos , Asma , Humanos , Feminino , Masculino , Beclometasona/efeitos adversos , Fumarato de Formoterol , Áustria/epidemiologia , Antiasmáticos/efeitos adversos , Resultado do Tratamento , Administração por Inalação , Combinação de Medicamentos , Asma/tratamento farmacológico , Asma/induzido quimicamenteRESUMO
UNLABELLED: AIMS OF THE INVESTIGATION: The 6-minute-walk-test (6-MWT) is an effective tool for measuring physical fitness in elderly patients. The increased walking distance is taken as a parameter for improved physical conditions. Frequently an unaltered walking distance is found after participation in a rehabilitation measure, but heart rate is significantly lower in the second challenge, indicating an improved physical fitness. This positive effect is not recognized when only the walking distance is considered. METHODS: We therefore carried out a retrospective analysis of the 6-MWT tests performed by 303 male patients (69.2 ± 8.7 years) before and after 3-4 weeks of clinical rehabilitation. Instrumented by a mobile pulse oximeter for recording oxygen saturation and heart rate, patients were instructed at the outset and at the end of their rehabilitation stay to walk as fast as they could during 6 min. Measurements were performed every 30 s and printed. A new parameter, efficiency (E = S/6/f (C)) was introduced: the ratio of the walking distance, S, divided by 6 min and divided by the mean heart frequency, f (C) (beats/minute). RESULTS: The patients group walked 351 ± 79 m at 106.2 ± 12.7 beats/min in the initial 6-MWT and 362 ± 76.0 m at a heart rate of 104.0 ± 12.2 beats/min in the final test. Along with the increase in walking distance, efficiency E increased from 0.56 ± 0.13 m/beat to 0.59 ± 0.12 m/beat. Efficiency significantly correlates with the walking distance (p < 0.01). 54 patients (18%) had an increased efficiency in the final test at the end of rehabilitation although they walked a shorter distance compared to the initial test value: they walked with a lower heart frequency. CONCLUSIONS: The patient's performance of the second walk test with an unchanged distance at a lower heart frequency reveals an improved physical fitness. This is solely described by an increase of the parameter of efficiency, E. Calculation of this parameter delivers a quantification of the effect of exercise training irrespective of the patient's cooperation. Efficiency, hence, is a meaningful complement to the sole consideration of the distance walked in the assessment of physical fitness as a benefit of rehabilitation.
Assuntos
Teste de Esforço/métodos , Aptidão Física , Pneumoconiose/reabilitação , Doença Pulmonar Obstrutiva Crônica/reabilitação , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Resistência Física , Centros de Reabilitação , Treinamento Resistido , Indenização aos TrabalhadoresRESUMO
Daily inspiratory muscle strength and endurance training (IMT) was performed in a 44-year-old patient with idiopathic bilateral diaphragmatic paralysis (BDP) in addition to nocturnal non-invasive ventilation (NIV). After 4 months of training inspiratory muscle function improved satisfactorily whereas phrenic nerve latency remained pathological. Due to the improvement of inspiratory muscle capacity nocturnal NIV could be stopped without inducing nocturnal respiratory insufficiency.
Assuntos
Exercícios Respiratórios , Inalação/fisiologia , Músculos Respiratórios/fisiologia , Paralisia Respiratória/terapia , Adulto , Humanos , Masculino , Nervo Frênico/fisiologia , Respiração com Pressão Positiva , Troca Gasosa Pulmonar , Músculos Respiratórios/inervação , Paralisia Respiratória/fisiopatologiaRESUMO
Activated charcoal provides effective treatment for most toxic ingestions. Accidental aspiration of activated charcoal is rare. Previously, there have been a few single cases reported on charcoal-related pulmonary complications. We describe an unusual case of pulmonary lesions 35 years after accidental aspiration of activated charcoal. The 38-year-old female patient presented with recurrent pneumothorax. A routinely performed chest roentgenogram revealed pulmonary lesions, highly suggestive to lymphangioleiomyomatosis (LAM). Histopathological investigation of the lung tissue demonstrated some features of LAM but showed prominent pneumoconiotic lesions with cystic tissue destruction. The pneumoconiotic reaction was characterized by prominent black deposits accompanied by foreign-body granuloma formation and minimal fibrosis. Scanning electron microscopic investigation of these deposits showed particles measuring up to 300 microm in greatest diameter. Energy-dispersive X-ray spectra of these particles revealed carbon-rich material, presumably charcoal. The aspiration event was confirmed by the clinical history. To our knowledge, this is the first report not only on a long-term follow-up after aspiration of activated charcoal but also on charcoal-related pulmonary lesions in combination with LAM.
Assuntos
Carvão Vegetal/efeitos adversos , Neoplasias Pulmonares/patologia , Linfangioleiomiomatose/patologia , Pneumoconiose/etiologia , Adulto , Carvão Vegetal/análise , Feminino , Seguimentos , Granuloma de Corpo Estranho/etiologia , Granuloma de Corpo Estranho/patologia , Humanos , Neoplasias Pulmonares/ultraestrutura , Microscopia Eletrônica de Varredura , Pneumoconiose/patologiaRESUMO
Adjustable maintenance dosing with either budesonide/formoterol or budesonide was compared in asthma patients. This double-blind trial randomized 133 patients (mean forced expiratory volume in 1s 66% predicted) to receive 2 inhalations twice daily of budesonide/formoterol 160/4.5 microg (640/18 microg/day) or budesonide 320 microg (1280 microg/day) for 4 weeks. The study drug was adjusted in both groups according to symptoms to 2-4 inhalations daily during Weeks 5-8 and 1-4 inhalations daily during Weeks 9-20. Asthma was well controlled in both groups, with minimal levels of treatment failure (5 budesonide/formoterol vs. 2 budesonide patients; P=NS) and minimal use of reliever therapy. Clinically important improvements in health-related quality of life (HRQL) occurred in the physical functioning and emotional role functioning domains (both P<0.05) for the budesonide/formoterol group compared with budesonide. Physician and patient treatment satisfaction favored budesonide/formoterol (both P<0.05). Budesonide/formoterol patients used fewer daily inhalations of study drug (P=0.024). The median average daily inhaled corticosteroid dose during the study was 448 microg with budesonide/formoterol and 1152 microg with budesonide. Adjustable maintenance dosing with budesonide/formoterol and budesonide resulted in high levels of asthma control. Adjustable budesonide/formoterol treatment achieved greater HRQL benefits and patient satisfaction, with lower overall drug use.
Assuntos
Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Budesonida/administração & dosagem , Etanolaminas/administração & dosagem , Administração por Inalação , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Esquema de Medicação , Combinação de Medicamentos , Feminino , Volume Expiratório Forçado , Fumarato de Formoterol , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de VidaRESUMO
The antibiotic A23187 carries Ca2+ across Müller-Rudin membranes made from 1,2-dierucoyl-sn-glycero-3-phosphocholine and n-decane. The conductance of the membranes is not increased by the Ca2+-transport. The flux depends linearly on Ca2+ concentration and ionophore concentration (above pH 6). It increases with increasing pH, approximately by a factor of 4-5 between pH 6 and pH 8. Maximal Ca2+-fluxes of about 10(-10) mol-cm-2-s-1 were found. A counter transport of H+ could not be detected. The complex formation between A23187 and Ca2+ in egg phosphotidylcholine vesicles was studied spectroscopically. The results are consistent with the formation of a 2:1 complex. Optical absorption measurements on single phophatidylcholine membranes were used to calculate the concentration of membrane-bound ionophore A23187.
Assuntos
Antibacterianos/farmacologia , Calcimicina/farmacologia , Cálcio/metabolismo , Membranas Artificiais , Condutividade Elétrica , Concentração de Íons de Hidrogênio , Fosfatidilcolinas , EspectrofotometriaRESUMO
In order to test the question if a pool of lipophilic ions may exist in black lipid membranes which cannot be detected by electrical relaxation measurements we have performed simultaneously measurements of the optical absorption of a lipophilic ion. The absorbance of membrane-bound dipicrylamine at 410 nm was measured with a sensitive spectrophotometer which can detect absorbance changes larger than or equal to 4-10(-5). A minimal concentration of about 6-10(11) dipicrylamine ions per cm2 of the membrane could be detected with this instrument. The dipicrylamine concentration in the membrane obtained with the optical method Ntopt is compared with the concentrations Ntel obtained from simultaneous electrical relaxation meausurements. Ntopt and Ntel agreed at low dipicrylamine concentrations (10(-8)--10(-7) M in the aqueous phase) and showed saturation at higher concentrations (up to 5-10(-6) M). In the saturation range Ntopt was maximally four times higher than Ntel. The significance of this difference is discussed together with general aspects of the saturation phenomenon.
Assuntos
Compostos de Anilina , Difenilamina , Membranas Artificiais , Compostos de Anilina/análogos & derivados , Transporte Biológico Ativo , Difenilamina/análogos & derivados , Condutividade Elétrica , Picratos , EspectrofotometriaRESUMO
Technetium-99m DTPA clearance (99mTc-DTPA) clearance measured by a gamma camera or a scintillation probe not only reflects epithelial transport, but is also influenced by an unknown amount of mucociliary clearance depending on particle size and aerosol deposition. This is confirmed by factor analysis of dynamic inhalation studies. Assessment of epithelial absorption by urinary excretion of inhaled 99mTc-DTPA is largely independent of aerosol lung deposition. Twenty-four-hour excretion reflects the amount of aerosol cleared by absorption, while two-hour excretion is a quantitative measure of the aerosol absorption rate from the epithelium into blood. Urinary 99mTc-DTPA excretion of two aerosols with different particle size correlated significantly (p less than 0.001) with analysis of lung clearance curves. A very similar regression in the form of a cumulative exponential function was found with both aerosols. Two-hour urine values of nonsmokers differed significantly from those of smokers or patients with active interstitial or infectious lung disease. This alternative procedure is suited as a bedside test and holds promise for patient monitoring and follow-up.
Assuntos
Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Depuração Mucociliar/fisiologia , Compostos de Organotecnécio , Ácido Pentético , Administração por Inalação , Aerossóis , Humanos , Pneumopatias/urina , Tamanho da Partícula , Cintilografia , Fumar/fisiopatologia , Pentetato de Tecnécio Tc 99mRESUMO
Adult respiratory distress syndrome (ARDS), a multifactorial disease with poor prognosis, is characterized by an accumulation of inflammatory cells within the airspaces of the lungs. There is evidence that alveolar macrophages (AM) are involved in the pathogenesis of this pulmonary disease. It has been demonstrated that AM synthesize heat shock proteins (HSPs) after exposure to certain stress factors. Increasing evidence suggests that HSPs could confer protection against oxidative injury, noxious molecules, and bacterial toxins. In stressed cells HSP 72 appears to be essential for survival during and after exposure to cellular injury. The aim of this study was to evaluate the magnitude of HSP 72 expression by human AM of patients with ARDS and correlate that with respiratory burst activity. Bronchoalveolar lavage was performed in six ARDS patients, 10 patients with high risk for developing ARDS, and two patients who underwent bronchoscopy for other reasons. Spontaneous ex vivo expression of HSP 72 in AM could be demonstrated by immunocytochemistry. Total RNA as well as poly(A)-rich mRNA were extracted from recovered AM and analyzed by Northern blot and slot blot using a human HSP 72-specific probe. Signals of slot blot were analyzed by densitometry and expressed as relative levels of HSP 72 mRNA of stressed (42 degrees C) HT 1080 control cells. Significantly (p < .001) higher levels of HSP 72 mRNA were measured in patients with ARDS (96.2 +/- 9.5 relative levels) in comparison to those not developing this syndrome (46.0 +/- 4.2). With regard to respiratory burst activity of AM in patients with ARDS, there was a negative correlation between HSP 72 expression and reactive oxygen species production. The AM of patients with ARDS with high relative levels of HSP 72 expression showed low respiratory burst activity. A predictive value for disease severity of high level of HSP 72 mRNA in AM in patients at risk for ARDS has to be evaluated by future studies. This demonstration of HSP 72 expression ex vivo suggests a protective role of HSP response against endo/exogenously generated stress factors in AM.
Assuntos
Proteínas de Choque Térmico/genética , Macrófagos Alveolares/metabolismo , RNA Mensageiro/biossíntese , Síndrome do Desconforto Respiratório/metabolismo , Adulto , Idoso , Northern Blotting , Líquido da Lavagem Broncoalveolar/citologia , Estudos de Casos e Controles , Citocinas/metabolismo , Feminino , Radicais Livres , Proteínas de Choque Térmico HSP72 , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Espécies Reativas de Oxigênio/metabolismo , Explosão Respiratória , Fatores de RiscoRESUMO
In continuation of earlier work, the steady-state fluorescence polarization in a globally oriented system of planar lipid membranes was analyzed experimentally and theoretically for the fluorophores 8-anilino-1-naphthalenesulfonate, 1,6-diphenyl-1,3, 5-hexatriene, dansyllysine-valinomycin and n-(9-anthroyloxy) fatty acids. The theoretical analyses of experiments were mainly done in terms of the mean orientation of transition moments with respect to the membrane normal, an angle describing the region of hindered rotational diffusion and the coefficients of rotational diffusion perpendicular to the membrane and around the membrane normal. The nonvanishing angle between the moments of absorption and emission was taken into account. In the case of n-(9-anthroyloxy) fatty acids it was found that the orientational disorder increases significantly with the depth of the fluorophore within the membrane. In order to compare with recent results from time-dependent fluorescent polarization in globally isotropic membrane suspensions and with 2H-NMR experiments, the second moment ('order parameter') of the steady-state orientational distribution of absorption dipoles was calculated. For all fluorophores the theoretical analysis indicates a preferred orientation of absorption moments within the membrane plane.
RESUMO
After reviewing types of sclerosis of the vertebral bodies and spondylodiscitides occurring near the vertebral discs, the causes of which are relatively well known, two observations of cases of chronic progressive sclerosing spondylodiscitis are described in detail together with their case history. The primary manifestation (in the lumbar vertebral column) is seen, apart from a discitis, in a relatively early and eventually homogeneous sclerosing of the spongiosa. The course of the disease is extremely protracted; after 1-5 years, other parts of the vertebral column are affected in a similar manner. Inflammatory parameters are definitely involved, and the nosological neighbourhood to angylosing spondylitis is discussed. In the absence of any other hints, it appears justified to assume non-specific chronic progressive sclerosing spondylodiscitis which begins monostotically and can proceed according to a polystotic pattern.
Assuntos
Disco Intervertebral , Espondilite/diagnóstico por imagem , Adulto , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Esclerose , Fatores de Tempo , Tomografia por Raios XRESUMO
This study summarizes weight development, plasma glucose concentrations and reproductive parameters in lactating (n = 46) and non-lactating Lipizzaner mares (n = 11) throughout the breeding season. It was the aim of the study to analyse if an energy deficit with possible effects on reproductive functions occurs at any time during the first 4 months of gestation. Mean gestation length was 334.3 +/- 7.3 days. Gestation of foals born in May/June was shorter (P < 0.01) than for foals born in March/April. Out of the 46 lactating mares, 44 ovulated between Days 8 and 18 postpartum and two mares ovulated on days 30 and 145, respectively. Pregnant mares were significantly (P < 0.001) heavier (600.1 +/- 5.3 kg) than non-pregnant mares (521.8 +/- 10.0 kg) at the beginning of the study. Birth resulted in weight reduction of 64.8 +/- 2.4 kg. During the first 2 weeks postpartum mares lost on average 3.0 +/- 1.8 kg and in the following 2 weeks gained 3.6 +/- 1.4 kg of weight. Thereafter, weight increased slightly but continuously (P < 0.01). At no time after foaling, weight differed significantly between groups. Weight of the foals three days after birth varied between 29 and 67 kg (53.7 +/- 1.1 kg). Average daily weight gain of foals was relatively constant throughout the study period (1.15 +/- 0.17 kg). Although lactation at no time was associated with a major weight loss, it had clear effects on energy metabolism as shown by constantly lower plasma glucose concentrations in lactating mares. Glucose concentrations decreased after foaling and were significantly lower in lactating mares from Weeks 3 to 16 after foaling than at corresponding times in non-lactating mares (P < 0.01). However, glucose concentrations were still within the physiological range. Mares seem to be able to compensate energy losses during lactation mainly by increasing feed intake and not by mobilisation of body fat.
Assuntos
Animais Recém-Nascidos/crescimento & desenvolvimento , Glicemia/análise , Peso Corporal , Ciclo Estral , Cavalos/fisiologia , Lactação/fisiologia , Envelhecimento , Animais , Cruzamento , Feminino , Idade Gestacional , Cavalos/sangue , Cavalos/crescimento & desenvolvimento , Masculino , Ovulação , Período Pós-Parto , Gravidez , Estações do AnoRESUMO
Idiopathic bronchiolitis obliterans organizing pneumonia (idiopathic BOOP) and idiopathic CD4+ T lymphocytopenia are syndromes of unknown origins which have been characterized in recent years. An important feature of both syndromes is the good prognosis. The clinical and histological features of idiopathic BOOP are unspecific but characteristic, whereas the clinical features of idiopathic CD4+ T lymphocytopenia are not homogeneous. We present a report on the first patient in whom both syndromes were found simultaneously. Initially the chest x-ray showed bilateral patchy opacities and the peripheral blood showed a severe CD4+ T cell depletion. The diagnosis of BOOP was verified by open lung biopsy, which demonstrated the histological features of BOOP. No evidence was found of congenital or acquired reasons associated with CD4+ T cell depletion or with the histological features of BOOP, which implies the diagnosis of idiopathic CD4+ T lymphocytopenia and idiopathic BOOP. Within a follow-up period of 14 months the pulmonary opacities disappeared completely and the CD4+ T cells increased, but did not reach normal values.
Assuntos
Pneumonia em Organização Criptogênica/diagnóstico , T-Linfocitopenia Idiopática CD4-Positiva/diagnóstico , Adulto , Biópsia , Linfócitos T CD4-Positivos/imunologia , Cortisona/administração & dosagem , Pneumonia em Organização Criptogênica/imunologia , Pneumonia em Organização Criptogênica/patologia , Feminino , Seguimentos , Humanos , Pulmão/patologia , Prognóstico , T-Linfocitopenia Idiopática CD4-Positiva/imunologia , T-Linfocitopenia Idiopática CD4-Positiva/patologia , Tomografia Computadorizada por Raios XRESUMO
We report on two patients with idiopathic CD4+ T cell depletion. A 26 year-old woman presented to us with acute respiratory failure requiring mechanical ventilation. Despite combined antibiotic therapy parenterally the opacities increased in the chest X-ray. An open lung biopsy was performed and led to the histological diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). Respiratory function was improved impressively by high dose parenteral cortisone administration. This patient showed a general lymphocytopenia with severe CD4+ T cell depletion (60(37%)/mm3 blood). The CT4+ T cell concentration increased during a follow up period of 14 months, but did not reach normal values. The second patient was a 33 year-old homosexual. He was admitted with a mucocutaneous fungal infection which was successfully treated by antifungal drugs. This patient demonstrated a transient CD4+ T cell depletion (350(32%)/mm3 blood). In both patients HIV type 1 and 2 infections were excluded by antibody- and p 24-antigen testing, polymerase chain reaction and virus culture. CONCLUSION. Idiopathic CD4+ T lymphocytopenia differs from HIV infection in immunological profile, in the tendency to reversal of the CD4+ T cell depletion over time and in its better prognosis. It is unclear if this is a new syndrome and whether a transmissible agent, or possibly a genetically-determined reaction to noxious agents is responsible.
Assuntos
Infecções Oportunistas/diagnóstico , T-Linfocitopenia Idiopática CD4-Positiva/diagnóstico , Adulto , Contagem de Linfócito CD4 , Diagnóstico Diferencial , Feminino , Soronegatividade para HIV , Homossexualidade Masculina , Humanos , Imunoglobulinas/sangue , Masculino , Infecções Oportunistas/imunologia , T-Linfocitopenia Idiopática CD4-Positiva/imunologiaRESUMO
In 176 patients with acute myocardial infarction (AMI) serum magnesium concentration (MGK) and serum potassium concentration (KK) were analysed during the first 48 hours after AMI. The patients rhythm was continuously recorded. In a subgroup of 70 patients a signal averaging-ECG was performed. 4.5% of the patients had a low, 55.7% a normal and 39.8% a high MGK. 14.8% of the patients had a low, 80.1% a normal and 5.1% a high KK. Ventricular arrhythmias > or = Lown IV b were found in 25% of the patients with low MGK, in 38.8% with normal and in 52.9% with high MGK. 50% of the patients with low, 62.2% with normal and 61.3% with high MGK had late potentials. There was no relation between hypomagnesemia and ventricular arrhythmias as between hypomagnesemia and late potentials. Thus, hypomagnesemia in AMI patients is rare and does not correlate with ventricular arrhythmia or delayed ventricular potentials.
Assuntos
Arritmias Cardíacas/fisiopatologia , Magnésio/sangue , Infarto do Miocárdio/fisiopatologia , Potássio/sangue , Idoso , Eletrocardiografia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Fibrilação Ventricular/fisiopatologiaRESUMO
Idiopathic pulmonary fibrosis (IPF) is characterized by a chronic inflammatory process in the lower respiratory tract of unknown etiology and poor prognosis. There is evidence that cytotoxic mediators released by neutrophils and eosinophils, such as myeloperoxidase (MPO) and eosinophil cationic protein (ECP) play a central role in the pathogenesis of this disease. The aim of this study was to assess disease activity in patients with IPF by measuring MPO and ECP concentrations in bronchoalveolar lavage (BAL). 14 patients with IPF had significantly higher concentrations of BAL-MPO and ECP (median = 117.2 micrograms/l, range: 4-217 micrograms/l and median = 16 micrograms/l, range: 4-34 micrograms/l, respectively) than patients with sarcoidosis (n = 9) (median = 6.5 micrograms/l, range: 4-12 micrograms/l and median = 7.1 micrograms/l, range: 2-13 micrograms/l, respectively) or pneumonia (n = 13) (median = 10.8 micrograms/l, range: 5-14 micrograms/l and median = 7.6 micrograms/l, range: 3-10 micrograms/l, respectively) (p < 0.01). Follow-up of MPO and ECP concentrations in BAL was performed in 8 patients with IPF before and after 4 weeks high-dose and 12 months low-dose corticosteroid therapy. Changes in MPO and ECP levels paralleled the clinical course and successful treatment resulted in a significant decrease of both MPO and ECP concentrations (p < 0.05), while clinical deterioration or treatment failure was associated with an increase of BAL-MPO and ECP levels. Increased MPO and ECP concentrations in BAL seem to reflect ongoing disease activity and may be useful prognostic markers in the management of patients with IPF.
Assuntos
Proteínas Sanguíneas/metabolismo , Líquido da Lavagem Broncoalveolar/citologia , Eosinófilos/imunologia , Neutrófilos/imunologia , Peroxidase/metabolismo , Fibrose Pulmonar/etiologia , Ribonucleases , Corticosteroides/administração & dosagem , Proteínas Granulares de Eosinófilos , Eosinófilos/efeitos dos fármacos , Feminino , Humanos , Contagem de Leucócitos , Assistência de Longa Duração , Medidas de Volume Pulmonar , Masculino , Neutrófilos/efeitos dos fármacos , Prognóstico , Fibrose Pulmonar/tratamento farmacológico , Fibrose Pulmonar/imunologiaRESUMO
Vitronectin is a multifunctional glycoprotein which is involved in several of the processes of inflammation and repair. In previous studies we demonstrated that increased concentrations of vitronectin can be detected in bronchoalveolar lavage fluids (BAL) of patients with interstitial lung disease (e.g. sarcoidosis). The outcome of sarcoidosis is generally favorable, however, some patients progress to pulmonary fibrosis. There is a need for markers indicating early fibrotic changes in the lung in patients with sarcoidosis. The present study was designed to evaluate the potential of BAL-vitronectin measurements for the assessment of disease activity in subjects with sarcoidosis. BAL-vitronectin concentrations were determined in 19 patients with biopsy proven sarcoidosis and sequential analysis of BAL-vitronectin levels were performed in 11 patients before and after therapy. Patients with active sarcoidosis had higher BAL-vitronectin concentrations (1.56 +/- 0.89 microgram/ml) than patients with inactive disease (0.68 +/- 0.33 microgram/ml; p < 0.01). Patients with active sarcoidosis received high-dose glucocorticoid treatment for four weeks followed by low-dose glucocorticoid therapy for eleven months. After high-dose medication BAL-vitronectin concentrations fell significantly (1.08 +/- 0.9 microgram/ml; p < 0.01). A further decrease in vitronectin levels resulted when therapy was continued for a year (0.75 +/- 0.48 micrograms/ml). Clinical deterioration correlated with an increase in BAL-vitronectin concentrations. Thus, measurement of BAL-vitronectin levels might be a useful marker for assessing disease activity and response to therapy in patients with sarcoidosis, but does not provide prognostic information.
Assuntos
Líquido da Lavagem Broncoalveolar/química , Proteínas da Matriz Extracelular/análise , Glicoproteínas/análise , Pneumopatias/diagnóstico , Sarcoidose/diagnóstico , Adulto , Idoso , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Pneumopatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Sarcoidose/tratamento farmacológico , VitronectinaRESUMO
The present study investigates the influence of COPD on attention functions, learning, and logical thinking. Therefore, 60 COPD patients and 60 healthy controls were recruited into a cross-sectional study and underwent extensive neuropsychological testing. The Attention Network Test was used for assessment of tonic and phasic alertness, orienting, and executive attention. Logical thinking and learning were determined with the Standard Progressive Matrices and the Verbal and Nonverbal Learning Test, respectively. Significant group differences were found in phasic alertness (p=0.001) and orienting (p=0.01) but not in executive attention. In addition overall reaction time was significantly slower in the COPD group (p=0.001). Further group differences were found in verbal (p<0.001) and visual learning (p<0.001) and logical thinking (p<0.001). Regression analysis revealed significant correlations for age (p=0.024) and blood carbon dioxide levels (p=0.043) in reaction time, a correlation for age and orienting (p=0.019) and finally for age (p=0.011) as well as for blood carbon dioxide values (p=0.048) and performance in logical thinking. Results are indicating a global impairment in cognitive functions of COPD patients which is negatively influenced by accelerated aging and increasing with disease severity.