[ASSIMILATING PROMS DURING AND POST-HOSPITALIZATION OF COPD PATIENTS DUE TO DISEASE EXACERBATION MAY IMPROVE THEIR CLINICAL FOLLOW-UP - A CLINICAL, PROSPECTIVE, OBSERVATIONAL STUDY].

BACKGROUND: Chronic obstructive pulmonary disease (COPD) exacerbations necessitating hospitalization are known to have a negative impact on post-discharge clinical outcomes. In the present study, we evaluated the potential benefits in applying Patient-Reported-Outcome-Measures (PROMS) in order to better these patients' post-hospitalization prognostication. METHODS: This was a prospective, observational study. RESULTS: Ninety-nine COPD patients were recruited (aged 9.7±73 years, 61.6% males). All patients filled two separate PROMS (EXACT & PROMIS GLOBAL 10) while 69 of them also filled a second battery of PROMS within 3 months post discharge. The median follow-up time was 14.3 months. The patients' characteristics found to have a statistically significant association with increased risk for 90-days re-hospitalization were: permanent use of oxygen at home [55.2% vs. 32.8%, p=0.045]; significant change in the dyspnea score of the EXACT [54(40-71) vs. 38(11-60), OR=1.115; 95CI 1.006-1.236, p=0.038] and significant change in the cough and sputum, score section of the EXACT [0 (-19-25) vs. -14 (-31-0), OR=1.095; 95CI 1.011-1.187, p=0.027]. Patients' characteristics found to have a statistically significant association with increased risk for 90-days mortality were: age [83±8.43 vs. 72.46±9.53, p=0.047], diagnosis of pneumonia during index hospitalization [60% vs. 14.9%, P=0.034] and low ALT blood activity [10IU (5.5-13.8) vs. 17IU (13-22.8), p=0.016]. Significant change in the EXACT score was associated with increased risk of long-term mortality [-3 (-8.8-9.5) vs. -9 (-21.5-0), OR=1.047; CI95% 1.005-1.091, p=0.03]. CONCLUSIONS: Assimilating PROMS, during and post-hospitalization due to COPD exacerbation could improve our prediction for negative clinical outcomes, both short- and long-term. This may offer better therapeutic interventions in the future. We recommend usage of the EXACT as part of the post-discharge follow-up of COPD patients.

[THE DEVELOPMENT OF TREATMENTS IN RHEUMATOID ARTHRITIS].

INTRODUCTION: Rheumatology is an ancient field in medicine which deals with inflammatory diseases affecting the joints, muscles and skeleton. Rheumatic diseases challenge patients and care providers coping with chronic pain, fatigue, depression, low self-esteem and agony. The hallmark of rheumatic diseases is rheumatoid arthritis. In this review, we will present the variety of treatments that are available today. Some of them, created a revolution in the patient's prognosis and quality of life.

[PULMONARY EMBOLISM IN A PATIENT WITH KLINEFELTER SYNDROME].

INTRODUCTION: Klinefelter syndrome (47, XXY) is the most common chromosomal aberration in males. It occurs in 0.15% of newborn males. The syndrome is related to increased mortality from a variety of medical problems including cardiovascular diseases, malignancies, nervous system disturbances, epilepsy and diabetes. In a review of the literature it was found that patients with the Klinefelter syndrome are more likely to develop thrombosis and pulmonary embolism. Even though the pathophysiological mechanism is still not entirely understood, we should consider the appropriate medical attention to the prevention and treatment of thromboembolic events in Klinefelter patients.

Comparison of magnesium status using X-ray dispersion analysis following magnesium oxide and magnesium citrate treatment of healthy subjects.

The magnesium content in food consumed in the Western world is steadily decreasing. Hypomagnesemia is associated with increased incidence of diabetes mellitus, metabolic syndrome, all-cause and coronary artery disease mortality. We investigated the impact of supplemental oral magnesium citrate versus magnesium oxide on intracellular magnesium levels ([Mg2+]i) and platelet function in healthy subjects with no apparent heart disease. In a randomized, prospective, double-blind, crossover study, 41 (20 women) healthy volunteers [mean age 53±8 (range 31-75) years] received either magnesium oxide monohydrate tablets (520 mg/day of elemental magnesium) or magnesium citrate tablets (295.8 mg/day of elemental magnesium) for one month (phase 1), followed by a four-week wash-out period, and then crossover treatment for one month (phase 2). [Mg2+]i was assessed from sublingual cells through x-ray dispersion (normal values 37.9±4.0 mEq/L), serum magnesium levels, platelet aggregation, and quality-of-life questionnaires were assessed before and after each phase. Oral magnesium oxide, rather than magnesium citrate, significantly increased [Mg2+]i (34.4±3 versus 36.3±2 mEq/L, p<0.001 and 34.7±2 versus 35.4±2 mEq/L, p=0.097; respectively), reduced total cholesterol (201±37 versus 186±27 mg/dL, p=0.016 and 187±28 versus 187±25 mg/dL, p=0.978; respectively) and low-density lipoprotein (LDL) cholesterol (128±22 versus 120±25 mg/dL, p=0.042 and 120±23 versus 121±22 mg/dL, p=0.622; respectively). Noteworthy is that both treatments significantly reduced epinephrine-induced platelet aggregation (78.9±16% versus 71.7±23%, p=0.013 and 81.3±15% versus 73.3±23%, p=0.036; respectively). Thus, oral magnesium oxide treatment significantly improved [Mg2+]i, total and LDL cholesterol compared with magnesium citrate, while both treatments similarly inhibited platelet aggregation in healthy subjects with no apparent heart disease.

[Chronic stimulation of the immune system in sarcoidosis and monoclonal gammopathy of undetermined significance].

Sarcoidosis is a systemic granulomatous disease which predominantly involves the lungs. Monoclonal gammopathy of undetermined significance (MGUS) characterized by clonal proliferation of plasma cells, can develop into multiple myeloma at a later stage. Although the cause of sarcoidosis remains unknown, the most likely etiology relates to chronic stimulation of the immune system that may result in polyclonal B cell proliferation. In some patients this polyclonal proliferation may develop into a monoclonal B-cell proliferation and induce the appearance of monoclonal gammopathy. In this article, a possible linkage between sarcoidosis and MGUS is raised, based on the case study of a 67-year-old woman and a review of the literature.