Effects of a Long-Term Use of Carbocysteine on Frequency and Duration of Exacerbations in Patients with Bronchiectasis.

BACKGROUND: The failure of mucus clearance in bronchiectasis can be improved by chest physiotherapy or/and mucoactive agents. AIM: To assess the effects of long-term use of carbocysteine on frequency and duration of exacerbations in patients with bronchiectasis. METHODS: We performed an observational, non-randomized, open study (a real-life study) including 64 patients with bronchiectasis divided into two groups, examined group (EG) and control group (CG). All participants were treated with appropriate treatment for the stable disease, but in the study, subjects of EG two capsules 375 mg carbocysteine three times a day was added over three months. Daily diary cards realised collection of data regarding the occurrence and duration of exacerbation in all study subjects. RESULTS: Over the study period 43 exacerbations were documented, 17 in the EG and 26 in the CG, 10 (23.4%) of which required hospital treatment (four in the EG [23.5%] and six in the CG [23.1%]). A mean number of exacerbations over the study period was significantly lower in the EG (0.5 ± 0.1) as compared to their mean number in the CG (0.8 ± 0.2) (P = 0.0000). Mean duration of exacerbations expressed in days needed for complete resolution of symptoms or return of the symptoms to their baseline severity in the EG was significantly shorter than the mean duration of exacerbations in the CG (10.1 ± 2.6 vs 12.8 ± 2.1; P = 0.0000). The frequency of adverse effects, i.e. mild gastrointestinal manifestations and headache which did not require discontinuation of the treatment, in the EG during the study period was 15.6%. CONCLUSION: Our findings indicated positive effects of carbocysteine regarding the frequency and duration of exacerbations, as well as its good tolerability in the patients with bronchiectasis.

Moxifloxacin in the Outpatient Treatment of Moderate Exacerbations of Chronic Obstructive Pulmonary Disease.

BACKGROUND: Bacterial infections are involved in more than a half of the exacerbations of chronic obstructive pulmonary disease (COPD). AIM: To evaluate the efficacy and safety of moxifloxacin in the outpatient treatment of moderate exacerbations of bacterial origin in the COPD patients. METHODS: We performed a prospective, observational study including 64 COPD patients with moderate exacerbation of bacterial origin empirically treated with moxifloxacin. In 31 of them, moxifloxacin was used as an initial antibiotic (Group 1), whereas in 33 of them moxifloxacin was used after treatment failure with another antibiotic (Group 2). All patients have treated 7 days with moxifloxacin 400 mg once daily per os, and they were followed up for 20 days, with an intermediate visit at 3, 5 and 7 days at which the duration of symptoms and the side effects of the drug were evaluated. RESULTS: We registered high clinical success rate, i.e. the complete resolution of the symptoms or their return to the baseline severity, similar in both groups (84.3% in all study subjects, 83.9% in the Group 1 and 84.8% in the Group 2). The mean time to complete resolution of the cardinal symptoms or their return to the baseline severity was 5.2 ± 1.1 days. Also, the mean time to complete resolution of the certain cardinal symptoms (increased dyspnea, increased sputum volume and increased sputum purulence) or their return to the baseline severity is given 4.9, 4.7 and 4.2 days, respectively. The incidence of adverse effects during the treatment with moxifloxacin in all study subjects was 10.9%, 9.6% in Group 1 and 12.1% in Group 2. There was no serious adverse effect that required discontinuation of the treatment. Relapse during a 20 days follow-up period was registered in 7.4% of the all study subjects with complete resolution of the cardinal symptoms or their return to the baseline severity, i.e. in two patients from both Group 1 and Group 2 (7.6% and 7.1%, respectively). 4. CONCLUSION: Our findings suggest high efficacy and good tolerability of moxifloxacin in the treatment of moderate COPD exacerbations of bacterial origin.

Exacerbations in COPD Patients with Bronchiectasis.

There is evidence that coexisting bronchiectasis (BE) in patients with chronic obstructive pulmonary disease (COPD) aggravates the course of the disease. In this study, we aimed to evaluate the frequency and severity of bacterial exacerbations in COPD patients with BE. The frequency and duration of bacterial exacerbations treated in a 12-month period, as well as the duration of the exacerbation-free interval, were evaluated in 54 patients with COPD (Group D) who were diagnosed and assessed according to official recommendations. In 27 patients, BE was diagnosed by high-resolution computed tomography (HRCT), whereas an equal number of COPD patients who were confirmed negative for BE by HRCT, served as controls. We found a significantly higher mean number of exacerbations in a 12-month period in COPD patients with BE (2.9 ± 0.5), as compared to their mean number in controls (2.5 ± 0.3) (p = 0.0008). The mean duration of exacerbation, i.e. the mean number of days elapsed before complete resolution of the symptoms or their return to the baseline severity, was significantly longer in COPD patients with BE as compared to their mean duration in controls (6.9 ± 1.8 vs. 5.7 ± 1.4; p = 0.0085). In addition, the mean exacerbation-free interval expressed in days, in patients with COPD with BE, was significantly shorter than in COPD patients in whom BE were excluded (56.4 ± 17.1 vs. 67.2 ± 14.3; p = 0.0149). Overall, our findings indicate that coexisting BE in COPD patients may lead to more frequent exacerbations with a longer duration.

Effects of Pleuran (Β-Glucan from Pleurotus Ostreatus) Supplementation on Incidence and Duration of COPD Exacerbations.

BACKGROUND: 1,3/1,6-ß-glucans are recognised as immunomodulators in human and veterinary medicine for over 50 years. AIM: To assess the effects of pleuran (1,3/1,6-ß-glucan from Pleurotus ostreatus) on incidence and duration of bacterial exacerbations in patients with COPD. METHODS: We performed an observational, non-randomized, open-label study including 32 COPD patients (Group D) in whom besides the recommended chronic treatment for the stable disease were administered supplement combination containing pleuran 100 mg, vitamin C 60 mg and zinc 5 mg once daily over a three month-period (Group 1). Also, an equal number of Group D COPD patients who besides the recommended treatment for stable disease received the supplement combination containing vitamin C 60 mg and zinc 5 mg once daily, matched to the study subjects of the Group 1 by sex and age served as control (Group 2). RESULTS: Over the study period 57 exacerbations (24 in the Group 1 and 33 in the Group 2) were documented. A mean number of exacerbations over the study period was significantly lower in the Group1 (0.7 ± 0.4) as compared to their mean number in the Group 2 (1.0 ± 0.6) (P = 0.0218). Furthermore, a mean duration of exacerbations expressed in days needed for cure or clinical improvement (i.e. complete resolution of symptoms or return of the symptoms to their baseline severity) in the Group 1 (6.7 ± 0.8 days) was significantly shorter than the mean duration of exacerbations in the Group 2 (7.4 ± 1.3 days) (P = 0.0118). There was not reported any adverse effect during the study period by study subjects from both examined groups. CONCLUSION: Our findings indicated that pleuran might impact the incidence and duration of bacterial exacerbations in patients with COPD. There is a need for further studies for more precise determination of the influence of pleuran on the course of COPD.

Effect of two laparoscopic techniques for treatment of ovarian endometrioma on ovarian reserve.

INTRODUCTION: Operative laparoscopy is the most common used technique for treatment of patients with ovarian endometriomas, because of many positive effects in comparison with laparotomy. There are many laparoscopic techniques, but most used are cystectomy and puncture with endocoagulation (ablation) of the cyst's capsule. The aim of this study was to evaluate the effect of two laparoscopic techniques for treatment of ovarian endometriomas on ovarian reserve. We used two ultrasonographic markers for ovarian reserve: ovarian volume and antral follicle count (AFC). MATERIALS AND METHODS: Sixty patients in reproductive age (18-42 years) were treated for a chronic pelvic pain or infertility in a tertiary hospital (University Clinic for Gynecology and Obstetrics in Skopje, R. Macedonia). The study was prospective and two laparoscopic techniques were used. All patients were with confirmed ultrasound diagnosis for ovarian endometriomas with diameter between 3 and 8 cm. Complete cystectomy was done in 30 patients (group A) and puncture with endocoagulation was done in other 30 patients (group B). Ovarian reserve was analyzed before surgery and was controlled one and three months after laparoscopic surgery. RESULTS: In group A (operated with cystectomy) ovarian volume was 53.46±29.97 cm³ before surgery, which fell to 13.06±7.34 cm³ after one month, and 13.28±7.17 cm³ after three months. Statistical analysis showed a significant reduction in ovarian volume one and three months after surgery (p≤0.01). In group B (operated with puncture and endocoagulation) the ovarian volume was 58.34±37.99 cm³ before surgery, which fell to 18.96±7.90 cm³ one month and 17.38±6.86 cm³ three months after surgery. In both groups there was a significant reduction in ovarian volume one and three months postoperatively (p≤0.01). In the first group AFC was 3.03±1.27 before surgery, 4.8±1.30 one month after surgery and 6.23±1.57 after three months. Statistical analysis showed a significant increase in AFC after laparoscopic cystectomy (p≤0.01). In the second group AFC was 3.07±1.05 before surgery, 5.33±1.60 after one month and 7.0±1.62 after three months. The comparison of AFC showed high statistically significant difference (p≤0.001), e.g. increase of AFC after one and three months in comparison with AFC before surgery. CONCLUSIONS: Ovarian reserve decreases after laparoscopic surgery using both laparoscopic techniques. But, this decrease was more frequent using cystectomy in comparison with ablation of the endometriotic cyst.

Course of COPD Assessment Test (CAT) Scores During Bacterial Exacerbations of Chronic Obstructive Pulmonary Disease Treated in Outpatient Setting.

INTRODUCTION: COPD Assessment Test (CAT) is an 8-items questionnaire for assessment of health status in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To evaluate the course of CAT scores during bacterial exacerbations of COPD treated in outpatient setting. METHODS: We performed an observational, prospective study including 81 outpatients (57 males and 24 females, aged 43 to 74 years) with bacterial exacerbation of COPD. All participants completed CAT at initial visit (i.e. at the time of diagnosis of exacerbation and beginning of its treatment), 10 and 30 days after initial visit. Mean scores of each item, as well as the overall mean score, at these time points were compared. RESULTS: The mean scores for each CAT question at initial visit varied from 2.6 to 3.5, whereas the mean scores for each CAT question 10 days after initial visit varied from 1.7 to 2.6. We registered significant reduction of the mean overall CAT score 10 days after initial visit as compared to its value at initial visit of 6.9 ± 2.7 points (16.8 vs 23.7; P < 0.001). The mean scores for each CAT question 30 days after initial visit varied from 1.3 to 2.4. We registered reduction of mean overall CAT score 30 days after initial visit as compared to its score 10 days after initial visit of 2.9 ± 1.2 points (13.9 vs 16.8; P < 0.005). The mean overall CAT score 30 days after initial visit was reduced for 9.8 ± 4.5 points as compared to its value at initial visit (13.9 vs 23.7; P < 0.001). CONCLUSION: We found significant improvement in the patient's health status during recovery from exacerbation as compared to their health status at the time of exacerbation confirming the CAT as an effective tool to measure health status in patients with COPD.

Relationship between ADHD and depression among university students in macedonia.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder usually diagnosed in children, with appearance of the first symptoms before the age of seven years. The disorder is characterized by inattention and/or impulsivity and hyperactivity that can seriously affect many aspects of behavior and performance at school. ADHD can be associated with comorbidities, such as oppositional defiant disorder, conduct disorder, anxiety or depression. MATERIAL AND METHODS: The study was done on a sample of 500 university students. For the measurement of ADHD symptoms, the ADHD Adult Self-report Scale was used and for depression measurement DASS. RESULTS: The results of this screening study showed that ADHD is highly significant associated with gender (p = 0.0004). Men more often than women have this kind of disorder. Female students have attention subtype deficit, while man student have often hyperactivity/impulsivity disorder and combined subtype due to psychological, temperament and character gender differences among boys and girls. Female examinees are significantly (p=0.028) more often depressed compared to male examinees. CONCLUSION: The examined correlations are positive ones or direct, meaning that by increasing the values of the scores from both subscales from the Evaluation ADHD Scale one also increases the scores from the Depression Scale, and vice versa. For a value of p=0.001 and p=0.004 these correlations are statistically highly significant, in other words highly important.

Ovarian reserve after laparoscopic treatment of unilateral ovarian endometrioma.

AIM: To evaluate the effect of laparoscopic treatment of unilateral ovarian endometrioma on ovarian reserve using ultrasonographic markers, ovarian volume and antral follicle count (AFC), and two biochemical markers, serum levels of Follicle-stimulating hormone (FSH) and Estradiol (E2). MATERIAL AND METHODS: This prospective study included 40 patients in their reproductive age, between 18 and 40 years old. They were treated laparoscopically for unilateral ovarian endometrioma. Markers of ovarian reserve were investigated before and three months after surgery. Transvaginal ultrasound examination was used for measurement of ovarian volume and AFC. Biochemical markers (FSH and E2 levels) were determined by chemiluminescent tests. RESULTS: Ovarian volume was significantly reduced after surgery. There was significant increase of AFC and non-significant increase of E2 levels in treated patients after three months. CONCLUSIONS: Laparoscopic cystectomy of unilateral ovarian endometrioma decreased ovarian reserve immediately after surgery with decrease of ovarian volume. But ovarian reserve was increased after three months with increase of AFC and estradiol levels.

Exercise-related respiratory symptoms and exercise-induced bronchoconstriction in industrial bakers.

In order to assess prevalence and characteristics of exercise-related respiratory symptoms (ERRS) and exercise-induced bronchoconstriction (EIB) in industrial bakery, the authors performed a cross-sectional study including 57 bakers and an equal number of office workers studied as a control. Evaluation of examined subjects included completion of a questionnaire, skin prick tests to common inhalant and occupational allergens, spirometry, and exercise and histamine challenge. The authors found a similar prevalence of ERRS and EIB in both bakers and controls. EIB was significantly associated with atopy, asthma, family history of asthma, and positive histamine challenge in either group, whereas in bakers it was closely related to sensitization to occupational allergens (p = .032). Bronchial reaction to exercise was significantly higher in bakers with EIB (25.7% vs 19.2%; p = .021). These findings suggest that occupational exposure in industrial bakery may accentuate bronchoconstrictive response to exercise.

Smoking among Macedonian workers five years after the anti-smoking campaign.

To assess the efficacy of nationwide anti-smoking campaign, we compared the findings of a study on worker smoking performed in 2005 with our latest cross-sectional study completed in 2010. It included 753 randomly selected workers, of whom 126 office, 108 construction, 93 agricultural, 97 petroleum refinery, 114 textile, 117 food processing workers, and 98 cleaners. Information was collected with a self-administered questionnaire. The prevalence of current smokers among all workers was 35.4 %, ranging from 30.2 % in office workers to 43.5 % in construction workers. It did not significantly differ from the prevalence recorded in 2005 (35.4 % vs. 36.8 %, respectively; P=0.441). Mean pack-years smoked among all smokers was 12.4 ± 2.3, ranging from 10.9 in administrative workers to 13.7 in agricultural workers. We did not find any significant difference in the prevalence of current smokers between male and female workers and between workers aged less or more than 40 years, as well as between workers of higher and lower education. The prevalence of ex-smokers was 10.5 %, ranging from 8.4 % in construction workers to 12.1 % in administrative workers, whereas the prevalence of passive smokers was 29.1 %, ranging from 26.2 % in food processing workers to 32.9 % in agricultural workers. Our findings indicate that the prevalence of current and passive smokers has remained high regardless of the anti-smoking campaign and call for stricter implementation of anti-smoking regulations.

Exercise-induced bronchoconstriction and exercise-induced respiratory symptoms in nurses.

In order to assess prevalence and characteristics of exercise-induced respiratory symptoms (EIRSs) and exercise-induced bronchoconstriction (EIB) in health care workers, we performed a cross-sectional study including 48 female nurses from primary care settings and an equal number of female office workers studied as a control group. The evaluation of examined groups included completion of a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise and histamine challenge. We found a similar prevalence of EIRSs and EIB in both groups. EIB was closely related to asthma, atopy, family history of asthma, and positive histamine challenge in either group, while the association between EIB and daily smoking in nurses was of borderline statistical significance. Bronchial reaction to exercise was significantly higher in nurses than in controls with EIB. With the exception of exercise induced wheezing, EIRSs were weakly associated with EIB in both groups with a large proportion of false positive results.

Respiratory and nasal symptoms, immunological changes and lung function among petroleum refinery workers.

OBJECTIVE: To assess adverse respiratory effects and immunological changes among petroleum refinery workers. METHODS: We performed a cross-sectional study including 80 subjects employed in the coking unit of a petroleum refinery (54 males and 26 females, aged 28-56 years, duration of exposure 7-28 years) and an equal number of office workers, matched by sex, age and smoking habits. Asthma and allergic rhinitis diagnosed by a physician, as well as respiratory and nasal symptoms in the last 12 months, were recorded by questionnaire. Evaluation of the subjects under study also included skin prick tests for common inhalable allergens and lung function tests. RESULTS: We found a similar prevalence of asthma and allergic rhinitis in both examined groups. Prevalence of overall respiratory symptoms was higher among petroleum refinery workers (33.7% vs. 22.5%) with a statistically significant difference for cough (30.0% vs. 13. 7%, p = 0.018) and wheezing (21.1% vs. 8.6%, p = 0.029). Prevalence of overall nasal symptoms was higher among petrol refinery workers (36.2% vs. 23.7%) with a statistically significant difference for runny nose (28.7% vs. 12.5%, p = 0.014). We found a similar prevalence of allergic sensitization to common inhalable allergens in both examined groups. The results of lung function tests showed significantly lower value of MEF50 (61.9% vs. 67.4%, p = 0.019) and MEF75 (56.1% vs. 62.9%, p = 0.000) among petroleum refinery workers. Respiratory impairment was observed in both smoking and non-smoking petroleum refinery workers. CONCLUSION: Our data suggest that workplace exposure among petroleum refinery workers may lead to respiratory and nasal symptoms and lung function impairment.

Effects of passive smoking at work on respiratory symptoms, lung function, and bronchial responsiveness in never-smoking office cleaning women.

This cross-sectional study compares respiratory symptoms, lung function, and bronchial responsiveness between 27 office cleaning women exposed to environmental tobacco smoke at work and 57 unexposed controls. The age range of both groups was 24 to 56 years, and none of the women had ever smoked. Information on respiratory symptoms, cleaning work history, and passive smoking in the workplace were obtained with a questionnaire. The subjects also took a skin prick test to common inhalant allergens, a lung function test, and a histamine challenge. Despite smoking restriction in indoor environments, we found a high prevalence of passive smokers in the workplace (32.1 %). In these subjects we found a significantly higher prevalence of wheezing with breathlessness (25.9 % vs. 8.8 %; P=0.036), wheezing without cold (25.9 % vs. 7.0 %; P=0.016), and breathlessness after effort (29.6 % vs. 8.8 %; P=0.014) than in control subjects. Objective measurements showed a significantly lower MEF25 (53.6 % vs. 63.7 %; P=0.001) and a significantly higher prevalence of borderline bronchial hyperresponsiveness (22.2 % vs. 7.0 %; P=0.044) in the passive smokers in the workplace. This study provides evidence of adverse respiratory effects in office cleaning women associated with passive smoking in the workplace. Our findings support a stricter implementation of the current national law to protect respiratory health of all workers.

Exposure to environmental tobacco smoke in the workplace in Macedonia: where are we now?

To assess the prevalence and the level of exposure to environmental tobacco smoke (ETS) in the workplace after the enactment of the law restricting indoor smoking in Macedonia, we performed a cross-sectional, self-administered questionnaire study including 372 never-smoking workers recruited from six workplaces. We found a high prevalence of workers exposed to ETS in the workplace (27.4 %) with no significant difference between particular occupation groups. We found no significant difference in the prevalence of passive smokers in the workplace between this study and our study conducted before the law was enacted (31.5 % vs. 27.4 %, P=0.324). The prevalence of workers exposed to ETS for less than three hours a day was significantly lower than of passive smokers with longer exposure (28.4 % vs. 71.6 %, P=0.038). The prevalence of workers exposed to ETS from less than 10 cigarettes smoked by coworkers per day was lower than the prevalence of workers with higher exposure, but statistical significance was not reached (37.9 % vs. 62.1 %, P=0.087). Our findings indicate a high prevalence and a high level of exposure to ETS in the workplace, which calls for stricter adherence to smoking-free legislation or even the total ban of smoking in the workplace.

Work-related asthma in automobile spray painters: two case reports.

This report describes two patients who had developed asthma after working as automobile painters with isocyanate-based aerosol paint for two years or over. In both patients asthma was confirmed using the standard diagnostic procedure. One of the subjects was atopic. One was ex-smoker and the other had never smoked. Neither had a family history of asthma. The symptoms occurred after workplace exposure lasting two years in one patient and three in the other. As both reported work-relatedness of the symptoms, they underwent serial peak expiratory flow rate (PEFR) measurement and bronchoprovocation testing. Significant work-related changes in PEFR diurnal variations and in non-specific bronchial hyperresponsiveness (NSBH) were observed in one patient, suggesting allergic occupational asthma (OA), while the other patient was diagnosed work-exacerbated asthma (WEA). Our data confirm that spray painting is an occupation with increased risk of respiratory impairment and asthma.

Occupational asthma in subjects occupationally exposed to herbal and fruit tea dust.

We performed a cross-sectional study to detect occupational asthma (OA) in 63 subjects occupationally exposed to herbal and fruit tea dust and in 63 corresponding controls. The evaluation included a questionnaire, skin prick tests to workplace and common inhalant allergens, spirometry, and histamine challenge test. The evaluation of the work-relatedness of asthma in the exposed workers was based on serial peak expiratory flow rate (PEFR) measurements and bronchoprovocation tests. We found a higher prevalence of respiratory symptoms in the exposed workers, whereas spirometric parameters were significantly lower. The prevalence of sensitisation to allergens and of bronchial hyperresponsivenss (BHR) did not differ significantly between the groups. The prevalence of asthma was also similar in both groups (8.0 % vs. 6.4 %; P=0.540). Work-relatedness of symptoms was reported by all asthmatic tea workers and by no control with asthma. Significant work-related changes in PEFR diurnal variations and in non-specific BHR, suggesting allergic OA, were found in one tea worker with asthma (1.6 %). No specific workplace agent causing OA in the affected subject was identified. None of the tea workers with asthma met the criteria for medical case definition of the reactive airway dysfunction syndrome (RADS). Our data confirm workplace exposure to herbal and fruit tea dust as a risk factor for OA.

Exercise-induced bronchoconstriction in textile and agricultural workers and in bakers.

To assess the prevalence and the characteristics of exercise-induced bronchoconstriction (EIB) in subjects occupationally exposed to organic dusts we performed a cross-sectional study including 152 exposed subjects (67 textile workers, 42 agricultural workers, and 43 bakers) and 72 unexposed controls. Evaluation of exposed and unexposed subjects included a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise challenge tests (ECT). The EIB prevalence found in textile workers was 8.9 %, in agricultural workers 7.1 %, in bakers 6.9 %, and in office workers 5.5 %. The highest bronchial reaction to exercise was found in ECT-positive agricultural workers (26.1+/-6.9), followed by textile workers (25.2+/-7.4), bakers (23.0+/-5.8), and office workers (21.8+/-4.4). EIB was significantly associated with atopy and positive family history of asthma in all exposed groups. EIB was significantly associated with smoking duration in textile workers (P=0.039) and agricultural workers (P=0.027). Bronchial reaction to exercise was significantly greater in smoking than in non-smoking textile (P=0.045) and agricultural workers (P=0.032). Our data suggest that the combination of daily smoking and workplace exposure to certain types of organic dusts could contribute to EIB development and severity.