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1.
Int J Infect Dis ; 110: 237-246, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303842

RESUMO

INTRODUCTION: RSV is increasingly recognized in adults. An improved understanding of clinical manifestations and complications may facilitate diagnosis and management. METHODS: This was a retrospective study of hospitalized patients aged ≥ 18 years with RSV or influenza infection at Siriraj hospital, Thailand between January 2014 and December 2017. RESULTS: RSV and/or influenza were detected by RT-PCR in 570 (20.1%) of 2836 patients. After excluding patients coinfected with influenza A and B (n = 5), and with influenza and RSV (n = 3), 141 (5.0%) RSV and 421 (14.8%) influenza patients were analyzed. Over the study period, RSV circulated during the rainy season and peaked in September or October. Patients with RSV were older than patients with influenza and presented significantly less myalgia and fever, but more wheezing. Pneumonia was the most common complication, occurring in 110 (78.0%) of RSV cases and in 295 (70.1%) of influenza cases (p = 0.069). Cardiovascular complications were found in 30 (21.3%) RSV and 96 (22.8%) influenza (p = 0.707), and were reasons for admission in 15 (10.6%) RSV and 50 (11.9%) influenza. The in-hospital mortality rates for RSV (17; 12.1%) and influenza (60; 14.3%) were similar (p = 0.512). CONCLUSIONS: In Thailand, RSV is a less common cause of adult hospitalization than influenza, but pulmonary and cardiovascular complications, and mortality are similar. Clinical manifestations cannot reliably distinguish between RSV and influenza infection; laboratory-confirmed diagnosis is needed.


Assuntos
Influenza Humana , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Infecções Respiratórias , Adulto , Hospitalização , Humanos , Influenza Humana/complicações , Influenza Humana/epidemiologia , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/epidemiologia , Estudos Retrospectivos , Tailândia/epidemiologia
2.
Ann Am Thorac Soc ; 17(10): 1222-1230, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32614240

RESUMO

Rationale: Diaphragm function is a key determinant of dyspnea in chronic obstructive pulmonary disease (COPD); however, it is rarely assessed in clinical practice. Lung hyperinflation can also impair diaphragm function. Ultrasound can assess the activity, function, and force reserve of the diaphragm.Objectives: To compare diaphragm activity, function, and force reserve among patients with COPD and healthy control subjects.Methods: Patients with stable COPD (n = 80) and healthy control subjects (n = 20) were enrolled (97% of them were men). Ultrasound was used to measure the thickening fraction of the diaphragm during tidal breathing and maximum volitional effort. Outcome measures were as follows: 1) the difference in diaphragm force reserve, activity, and function between patients with COPD and control subjects; 2) the correlation between lung volumes and diaphragm force reserve, activity, and function; and 3) the relationship between diaphragm force reserve and the rate of moderate to severe exacerbation of COPD.Results: The tidal thickening fraction of the diaphragm during resting breathing (TFdi-tidal) was higher in patients with COPD than in control subjects (P = 0.002); it was approximately twice as high in patients with severe COPD than in control subjects. Patients with COPD had poorer diaphragm function than control subjects as assessed by the maximal thickening fraction of the diaphragm during Muller maneuver (P < 0.01). Diaphragm force reserve ratio assessed by 1-(tidal thickening fraction of the diagphragm during resting breathing/maximal thickening fraction of the diaphragm) was lower in patients with COPD than in control subjects, and it fell with increasing Global Initiative for Chronic Obstructive Lung Disease stages (P < 0.001); it correlated with inspiratory capacity (r = 0.46) and the body mass index, airflow obstruction, dyspnea, exercise capacity (BODE) index, a multidimensional scoring system (r = -0.49). Patients who developed exacerbation during the following 2 years had less force reserve than patients without exacerbation (P = 0.024).Conclusions: Male patients with COPD have increased diaphragm workload, impaired diaphragm function, and reduced force reserve compared with healthy subjects. Ultrasound assessment of the diaphragm in COPD provides important functional information.Clinical trial registered with the Thai Clinical Trials Registry (TCTR20160411001). Registered 31 April 5, 2016.


Assuntos
Diafragma , Doença Pulmonar Obstrutiva Crônica , Estudos de Casos e Controles , Diafragma/diagnóstico por imagem , Dispneia/etiologia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Ultrassonografia
3.
Hum Vaccin Immunother ; 16(6): 1371-1379, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-31770051

RESUMO

We compared the antibody responses and persistence of the reduced-dose, 9 µg hemagglutinin (HA)/strain intradermal (ID) injection via the Mantoux technique and the 15 µg HA/strain intramuscular (IM) injection of the repeated annual identical trivalent, inactivated, split-virion vaccine 2011-2012 in chronic obstructive pulmonary disease (COPD) patients. Eighty patients were randomized to ID (n = 41) and IM (n = 39) groups. Four weeks post-vaccination, the antibody responses of the two groups were similar; those for influenza A(H1N1)pdm09 and influenza A(H3N2)-but not influenza B-met the criteria of the Committee for Proprietary Medicinal Products (CPMP). The antibody responses for influenza A(H1N1)pdm09 rapidly declined in both groups, especially with the ID injection, whereas those for influenza A(H3N2) maintained above the CPMP criteria throughout 12 months post-vaccination. The geometric mean titres for influenza A(H1N1)pdm09 persisted above the protective threshold (≥ 40) until 6 months post-vaccination in both the ID and IM groups. The seroprotection rates of the ID and IM groups were above 60% until 3 months and 6 months post-vaccination, respectively. In conclusion, the 9 µg HA/strain ID injection of vaccine 2011-2012 elicited antibody responses similar to the standard dose of 15 µg of the HA/strain IM injection at 4 weeks post-vaccination. However, the antibody responses for influenza A(H1N1)pdm09 rapidly declined, especially in the case of the ID injection, whereas they were comparable for influenza A(H3N2). Additional strategies for increasing vaccine durability should be considered, especially for new pandemic strains affecting elderly COPD patients.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza , Influenza Humana , Doença Pulmonar Obstrutiva Crônica , Idoso , Anticorpos Antivirais , Testes de Inibição da Hemaglutinação , Humanos , Vírus da Influenza A Subtipo H3N2 , Influenza Humana/prevenção & controle , Injeções Intradérmicas , Injeções Intramusculares
4.
Heart Lung Circ ; 29(8): 1180-1186, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31735684

RESUMO

BACKGROUND: Although the use of incentive spirometry with a deep breathing exercise (DBE) is widely used in clinical practice in patients who have undergone coronary artery bypass graft (CABG) surgery, the effect of this combination therapy has not been conclusively elucidated. The aim of this study was to investigate the effect of postoperative combined incentive spirometry and DBE versus DBE alone on inspiratory muscle strength following CABG. METHOD: This randomised clinical trial was conducted in patients scheduled to undergo CABG surgery at Siriraj Hospital, Bangkok Thailand. The study group received incentive spirometry and DBE, and the control group received DBE only. Maximal inspiratory pressure (MIP) before surgery and at day 4 after surgery was assessed by a respiratory pressure meter. Secondary outcomes, including postoperative pulmonary complication and duration of postoperative hospitalisation, were obtained from the medical records. RESULTS: Ninety (90) patients were included, with 47 and 43 patients assigned to the study and control groups, respectively. In both groups, there was a significant reduction in MIP from preoperative baseline to postoperative day 4; however, the MIP in the incentive spirometry group had a significantly smaller reduction in MIP compared with the control group (33.0±23.2% vs 47.2±20.1%, respectively; p=0.006, 95% confidence interval, 3.9-23.3). There was no difference between groups regarding secondary outcomes. CONCLUSIONS: Patients in the study group had significantly better recovery of inspiratory muscle strength on day 4 post-CABG than patients in the control group. There was no significant difference between groups for either postoperative pulmonary complications or length of hospital stay.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Força Muscular/fisiologia , Complicações Pós-Operatórias/prevenção & controle , Músculos Respiratórios/fisiopatologia , Espirometria/métodos , Idoso , Doença da Artéria Coronariana/fisiopatologia , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos
5.
J Clin Virol ; 117: 103-108, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31280089

RESUMO

BACKGROUND: Respiratory syncytial virus (RSV) is an important virus found in adult hospitalized patients. OBJECTIVES: To study the clinical outcomes of hospitalized patients aged ≥ 15 years and diagnosed with RSV infection. STUDY DESIGN: Both retrospective and prospective cohort studies were conducted at a university hospital between May 2014 and December 2015. RESULTS: RSV was detected in 86 of 1562(5.5%) adult hospitalized patients suspected of respiratory viral infection. Sixty-nine patients were included in the study. RSV was detected by RT-PCR (82.6%), IFA (10.1%), and both RT-PCR and IFA (7.3%). Most patients (87.0%) were aged ≥ 50 years. Cardiovascular diseases, pulmonary diseases, immunocompromised hosts, and diabetes were the major comorbidities. The common manifestations were cough (92.8%), dyspnea (91.3%), sputum production (87.0%), tachypnea (75.4%), wheezing (73.9%), and fever (71.0%). Fifty- five patients (79.7%) were diagnosed with pneumonia. Hypoxemia (SpO2 ≤ 92%) was found in 53.6% patients. Twenty-five of 69(36.2%) patients developed respiratory failure and required ventilatory support. Cardiovascular complications were found in 24.6% of patients. Congestive heart failure, acute myocardial infarction (MI), new atrial fibrillation, and supraventricular tachycardia were found in 9(13.0%), 7(10.1%), 4(5.8%), and 3(4.3%) of 69 patients, respectively. Overall mortality was 15.9%. Pneumonia (81.8%) and acute MI (18.2%) were the major causes of death. CONCLUSIONS: Most adult hospitalized patients with RSV infection were of advanced age and had comorbidities. Cardiopulmonary complications were the major causes of death. Management and prevention of RSV infection in these vulnerable groups are necessary.


Assuntos
Doenças Cardiovasculares/epidemiologia , Insuficiência Respiratória/epidemiologia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etiologia , Comorbidade , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Mortalidade , Estudos Prospectivos , Insuficiência Respiratória/etiologia , Infecções por Vírus Respiratório Sincicial/complicações , Vírus Sincicial Respiratório Humano/genética , Estudos Retrospectivos , Tailândia/epidemiologia , Adulto Jovem
6.
Per Med ; 15(5): 371-379, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30259785

RESUMO

AIM: The risk of vitamin D binding protein (DBP) variations in chronic obstructive pulmonary disease (COPD) compared with non-COPD Thai males were investigated. MATERIALS & METHODS: The rs7041 and rs4588 polymorphisms of the DBP gene and protein level were measured in 136 COPD and 68 non-COPD Thai males. RESULTS: In the COPD group, GC1-1 gave increased forced expiratory volume at 1 s % predicted compared with GC1-2 but with no significant difference. Significantly lower average DBP serum levels were observed in COPD than non-COPD subjects. Positive correlation between serum DBP and forced expiratory volume at 1 s % predicted was observed in non-COPD subjects. DISCUSSION & CONCLUSION: DBP variations might be associated with risk factors in COPD caused by both inflammatory and vitamin D circulation processes.


Assuntos
Doença Pulmonar Obstrutiva Crônica/genética , Proteína de Ligação a Vitamina D/genética , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Volume Expiratório Forçado/genética , Volume Expiratório Forçado/fisiologia , Predisposição Genética para Doença/genética , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Doença Pulmonar Obstrutiva Crônica/metabolismo , Testes de Função Respiratória , Fatores de Risco , Índice de Gravidade de Doença , Tailândia , Transcriptoma/genética , Vitamina D/metabolismo , Proteína de Ligação a Vitamina D/sangue , Proteína de Ligação a Vitamina D/metabolismo
7.
Medicine (Baltimore) ; 95(28): e4090, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27428193

RESUMO

Asia-Pacific Burden of Respiratory Diseases (APBORD) was a cross-sectional, observational study examining the burden of respiratory disease in adults across 6 Asia-Pacific countries.This article reports symptoms, healthcare resource utilization (HCRU), work impairment and cost burden associated with allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis in Thailand.Consecutive participants aged ≥18 years with a primary diagnosis of AR, asthma, COPD, or rhinosinusitis were enrolled at 4 hospitals in Thailand during October 2012 and October 2013. Participants completed a survey detailing respiratory symptoms, HCRU, work productivity, and activity impairment. Locally sourced unit costs were used in the calculation of total costs.The study enrolled 1000 patients. The most frequent primary diagnosis was AR (44.2%), followed by rhinosinusitis (24.1%), asthma (23.7%), and COPD (8.0%). Overall, 316 (31.6%) of patients were diagnosed with some combination of the 4 diseases. Blocked nose or congestion (17%) and cough or coughing up phlegm (16%) were the main reasons for the current medical visit. The mean annual cost for patients with a respiratory disease was US$1495 (SD 3133) per patient. Costs associated with work productivity loss were the principal contributor for AR and rhinosinusitis patients while medication costs were the highest contributor for asthma and COPD patients.The study findings highlight the burden associated with 4 prevalent respiratory diseases in Thailand. Thorough investigation of concomitant conditions and improved disease management may help to reduce the burden of these respiratory diseases.


Assuntos
Asma/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Rinite Alérgica/epidemiologia , Rinite/epidemiologia , Sinusite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tailândia/epidemiologia
8.
J Med Assoc Thai ; 99(3): 276-81, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27276738

RESUMO

BACKGROUND: Previous analysis of survey data from a study in older urban Thai persons reported prevalence of chronic obstructive pulmonary disease (COPD) of 7.11% according to formerly recommended criteria that used fixed ratio (70%) of pre-bronchodilator FEV1/FVC as the cut-off value. In 2012, the Global Lung Initiative (GLI)-2012 equations for spirometric reference were established and the diagnostic criteria for COPD were changed. OBJECTIVE: To reanalyze the data collected during the 2002 respiratory health survey to determine prevalence of COPD in older urban Thai persons according to the new GLI-2012 equations. MATERIAL AND METHOD: Demographic and clinical data of 3,094 subjects aged ≥ 60 years from 124 urban communities were re-analyzed. Prevalence of COPD determined by post-bronchodilator FEV1/FVC and GLI-2012 equations using lower limit of normal by the Lambda-Mu-Sigma method (LMS-LLN) was compared to COPD prevalence findings based on criteria used in previous analysis. RESULTS: Prevalence of COPD in the study population using post-bronchodilator FEV1/FVC and LMS-LLN was 6.50% (95% CI: 5.63-7.3 7), compared with 7.82% (95% CI: 6.87-8.77) when fixed ratio (70%) of FEV1/FVC was used as cut-off. Diagnostic agreement of COPD between LMS-LLN and fixed ratio was high (kappa 0.88, p < 0.0001). However 45/242 (18.6%) subjects diagnosed as COPD by fixed ratio criteria were considered as "over-diagnosed" when LMS-LLN was used as the standard cut-off The same comparison applied to subjects aged 80 years revealed an increased rate of over-diagnosis to 7/22 (31.8%) subjects. Higher agreement was observed (kappa 0.95, p < 0.0001) when comparing between cut-offs for diagnosis of "at least GOLD stage II" COPD. CONCLUSION: Prevalence of COPD in older urban Thai persons was lower when LMS-LLN was substituted for fixed ratio (70%) of FEV1/FVC. Agreement in COPD diagnosis between both criteria was high, but a substantial proportion of subjects may be over-diagnosed


Assuntos
Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia
9.
Hum Vaccin Immunother ; 12(7): 1728-37, 2016 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-27153158

RESUMO

The antibody responses of a reduced-dose intradermal seasonal influenza vaccination have never been studied in COPD patients soon after a pandemic. A total of 149 COPD patients (60 y of age or older) were randomized to receive trivalent influenza vaccine (Sanofi-Pasteur, France) either 9 µg of hemagglutinin (HA) per strain split into 2-site intradermal (ID) injections via the Mantoux technique or one intramuscular (IM) injection of 15 µg of HA per strain. The geometric mean titers, seroconversion factors, seroconversion rates and seroprotection rates for influenza A(H3N2) and B administered through the ID injection (n = 75) were similar to those obtained with the IM injection (n = 74) 4 weeks post-vaccination. The antibody responses for influenza A(H1N1)pdm09 administered through the ID injection were lower than those obtained with the IM injection, but all of these responses met the 3 criteria proposed by the Committee for Proprietary Medicinal Products (CPMP) for annual re-licensure. The seroprotection rates 4 weeks post-vaccination for influenza A(H1N1)pdm09 were 64.0% (95%CI 52.7-74.0%) in the ID group vs. 78.4% (95% CI 67.6-86.3%) in the IM group (p = 0.053). Influenza-related acute respiratory illness (ARI), diagnosed as a 4-fold rise in HI titers with a convalescent titer > 1:40, and/or the RT-PCR between the ID group (5.3%) and the IM group (8.1%) were not significantly different. The reduced-dose intradermal influenza vaccine may expand vaccine coverage in cases of vaccine shortage.


Assuntos
Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Feminino , França , Humanos , Injeções Intradérmicas , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
J Med Assoc Thai ; 98(3): 314-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25920303

RESUMO

Asbestosis is an occupational lung disease defined as pulmonary fibrosis caused by asbestos. Asbestosis was previously reported in Thailand based on radiologic findings, which demonstrated interstitial lung with calcified pleural plaques, and the patient worked in a fiber cement factory. However there was some doubt about the diagnosis because clinical and radiological findings are nonspecific; there was no data support of asbestos exposure in the patient and no histologic confirmed diagnosis. Histologic diagnosis is most useful when an equivocal of ahistory of asbestos exposure in patients with interstitial lung diseases take place. The authors report a patient presenting with progressive dyspnea for 2 years. She worked in an electric, wire, mesh fan cover factory to check quality of protective wire mesh for 10 years until the factory was closed 6 years ago. This type of factory had never officially reported asbestos use. Her clinical manifestations and radiologic findings are compatible with interstitial lung disease. She subsequently underwent thoracotomy with wedge lung resection. Pathology revealed interstitial fibrosis with honeycombing. Asbestos bodies were found more than 10 per cm2 in the fibrosis. She was diagnosed asbestosis. The patient is suffering from dyspnea, severe hypoxemia and cor pulmonale. The patient is put on waiting lists for heart lung transplantation. The authors thus confirmed that asbestosis exists in Thailand. A policy to protect workers and people who may have risk of asbestos exposure is necessary, since diseases related to asbestos are incurable, but preventable.


Assuntos
Asbestos/efeitos adversos , Asbestose/diagnóstico , Dispneia/etiologia , Pneumopatias/induzido quimicamente , Asbestose/patologia , Feminino , Humanos , Pneumopatias/patologia , Pessoa de Meia-Idade , Doenças Pleurais/induzido quimicamente , Doenças Pleurais/patologia , Tailândia
11.
J Med Assoc Thai ; 97 Suppl 7: S50-4, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25141527

RESUMO

OBJECTIVE: To compare lipid and carbohydrate use during and after a high-intensity endurance exercise bout between lean and obese subjects. MATERIAL AND METHOD: Lean and obese healthy male subjects with energetic physical activity and stable body weight were recruited to participate in the present study. The respiratory exchange ratio (RER), lipid and carbohydrate oxidation, and lipid and carbohydrate energy expenditure during resting condition, high-intensity exercise and 180 min after exercise were determined by indirect calorimetry RESULTS: Ten lean and ten obese healthy male subjects, aged 26+/-4 years, completed a 300-kcal high-intensity exercise session. Resting energy expenditure and lipid energy expenditure in the obese group were significantly higher than those of the lean group. The RER, lipid oxidation, and carbohydrate oxidation were not significantly different between groups throughout the exercise period. The total energy expenditure and total lipid and carbohydrate energy expenditure were also not significantly different between lean and obese groups. During the 180-minute post exercise period, both lean and obese subjects showed a declination in RER and carbohydrate oxidation and an increase in lipid oxidation. CONCLUSION: Substrate use during and after high-intensity exercise between healthy lean and obese subjects was not significantly different. Both groups used carbohydrates and lipids as the main substrate sources during and after high-intensity exercise, respectively.


Assuntos
Peso Corporal/fisiologia , Metabolismo Energético/fisiologia , Exercício Físico/fisiologia , Obesidade/fisiopatologia , Adulto , Calorimetria Indireta , Humanos , Masculino , Adulto Jovem
12.
J Med Assoc Thai ; 97(12): 1290-5, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25764636

RESUMO

OBJECTIVE: To determine the association between emphysema extent from high-resolution computed tomography (HRCT) and the physiological derangement in patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHOD: A cross-sectional study was undertaken to quantify the emphysema severity in 23 COPD patients by automated HRCT scoring techniques. Correlation with phenotypic characters in term of exercise capacity [Modified Medical Research Council (mMRC) dyspnea scale, and 6-minute walk distance (6MWD)], pulmonary function testing [spirometry (forced expiratory volume in 1 second, FEV1 and forced vital capacity, FVC), and diffusing capacity (DLCO)], were then assessed. RESULTS: Nineteen patients were male and four were female, the mean age was 73 ± 8 years, with the mean FEV1 % predicted of 67.8 ± 25.4. Percentage of inspiratory emphysematous lung volume (%ELVi) had significant negative correlation with %FEV/FVC (r = -0.50, p = 0.016) and DLCO (r = 0.58, p = 0.011). Percentage of expiratory emphysematous lung volumes (%ELVe) also had the same correlation with %FEV/FVC (r = -0.58, p = 0.004) and DLCO (r = 0.48, p = 0.042). In addition, %ELVe also had significant negative correlation with 6MWD (r = 0.50, p = 0.016), but had significant positive correlation with mMRC scale (r = 0.53, p = 0.01). CONCLUSION: Severity of emphysema assessed by HRCT was well correlated with pulmonary function test results and exercise capacity. It can be used as one aspect ofphenotypic characters in patients with COPD,for designing personalize management plan.


Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Função Respiratória , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
13.
J Med Assoc Thai ; 95(8): 1021-7, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23061305

RESUMO

OBJECTIVE: To study the prevalence of osteoporosis and osteopenia in Thai COPD patients and the factors associated with osteoporosis. MATERIAL AND METHOD: A cross sectional study was used to evaluate 102 male stable COPD patients. Bone mineral density at lumbar spine (L2-4) and femoral neck were measured by dual energy x-ray absorptiometer scan. Demographic data including age, body mass index (BMI), inhaled corticosteroids use, tobacco smoke, force expiratory volume at 1 second (FEV1), and high sensitivity C-reactive protein (hs-CRP) were analyzed. RESULTS: The overall prevalence of osteoporosis and osteopenia according to the lowest T-score at either L2-4 or femoral neck were 31.4% and 32.4%, respectively. This prevalence of osteoporosis in COPD patients was higher than that in age-matched Thai males from historical data (31.4% vs. 12.6%, respectively). BMI and hs-CRP were significantly associated with osteoporosis. There was no association between osteoporosis and severity of COPD, age, smoking, and corticosteroid use. The predictive value of BMI < 20.5 kg/m2 and hs-CRP > 2.3 mg/L demonstrated risk of osteoporosis in COPD patients (adjusted Odds ratio 7.2 and 4.1, respectively). CONCLUSION: The prevalence of osteoporosis and osteopenia in Thai COPD patients was higher than that in normal age-matched Thai males. Osteoporosis was associated with low BMl and high level of hs-CRP when compared to COPD patients with normal bone mineral density.


Assuntos
Doenças Ósseas Metabólicas/complicações , Osteoporose/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Índice de Massa Corporal , Proteína C-Reativa/análise , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Tailândia
14.
Vaccine ; 28(24): 4045-51, 2010 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-20412877

RESUMO

We evaluated the immunogenicity of a reduced-dose intradermal trivalent, inactivated, split-virion seasonal influenza vaccine compared to that of a conventional intramuscular vaccination in chronic obstructive pulmonary disease (COPD) patients. One hundred and fifty-six COPD patients randomly received either 0.2 ml (6 microg hemagglutinin (HA) per strain) split into two-site intradermal (ID) injections or a single 0.5 ml (15 microg HA per strain) intramuscular (IM) injection. Geometric mean titers, seroconversion factors, seroconversion rates and seroprotection rates at 4 weeks post-vaccination in the ID group were less than those in the IM group. Only the seroconversion factor to influenza B in the ID group was statistically less than in the IM group (18.8 in the ID group, n=81 versus 37.3 in the IM group, n=75, p=0.045). Nevertheless, each strain of the ID vaccination met all the Committee for Proprietary Medicinal Products (CPMP) criteria. Seroprotection rates were above 60% throughout the year in influenza A (H3N2), for at least 6 months in influenza A (H1N1) and at least 4 weeks in influenza B in both ID and IM groups. The reduced-dose intradermal vaccination may be considered for use in COPD patients in a vaccine shortage situation.


Assuntos
Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Formação de Anticorpos , Feminino , Testes de Inibição da Hemaglutinação , Glicoproteínas de Hemaglutininação de Vírus da Influenza/imunologia , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A Subtipo H3N2/imunologia , Vacinas contra Influenza/administração & dosagem , Injeções Intradérmicas , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/virologia
15.
J Physiol ; 575(Pt 2): 481-90, 2006 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-16793905

RESUMO

We addressed the hypothesis that single vagal afferent C-fibres can be stimulated via either the adenosine A1 or A2A receptor subtypes. The effect of adenosine on the nerve terminals of vagal sensory nerve subtypes was evaluated in an ex vivo perfused guinea pig lung preparation using extracellular recording techniques. Adenosine (10 microm) consistently evoked action potential discharge in lung C-fibre terminals arising from the nodose ganglia, but failed to evoke action potential discharge in most jugular ganglion C-fibres. Adenosine also failed to activate stretch-sensitive nodose A-fibres in the lungs. The selective A1 antagonist DPCPX (0.1 microm) or the selective A2A antagonist SCH 58261 (0.1 microm) partially inhibited the nodose C-fibre activation by adenosine, and the combination of both antagonists almost completely inhibited the response. The adenosine-induced action potential discharge in nodose C-fibres was mimicked by either the selective A1 agonist CCPA (1 microm) or the selective A2A agonist CGS 21680 (1 microm). Single cell PCR techniques revealed that adenosine A1 and A2A receptor mRNA was expressed in individual nodose neurons retrogradely labelled from the lungs. The gramicidin-perforated patch clamp technique on neurons retrogradely labelled from the lungs was employed to study the functional consequence of adenosine receptor agonists directly on neuronal membrane properties. Both the selective A1 agonist CCPA (1 microm) and the selective A2A agonist CGS 21680 (1 microm) depolarized the airway-specific, capsaicin-sensitive, nodose neurons to action potential threshold. The data support the hypothesis that adenosine selectively depolarizes vagal nodose C-fibre terminals in the lungs to action potential threshold, by stimulation of both adenosine A1 and A2A receptor subtypes located in the neuronal membrane.


Assuntos
Pulmão/inervação , Fibras Nervosas Amielínicas/fisiologia , Gânglio Nodoso/fisiologia , Receptor A1 de Adenosina/fisiologia , Receptores A2 de Adenosina/fisiologia , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Adenosina/análogos & derivados , Adenosina/farmacologia , Antagonistas do Receptor A1 de Adenosina , Antagonistas do Receptor A2 de Adenosina , Animais , Capsaicina/farmacologia , Regulação da Expressão Gênica/genética , Regulação da Expressão Gênica/fisiologia , Cobaias , Pulmão/fisiologia , Masculino , Fibras Nervosas Amielínicas/efeitos dos fármacos , Fibras Nervosas Amielínicas/metabolismo , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Neurônios/fisiologia , Gânglio Nodoso/efeitos dos fármacos , Gânglio Nodoso/metabolismo , Técnicas de Patch-Clamp , Fenetilaminas/farmacologia , Pirimidinas/farmacologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Receptor A1 de Adenosina/metabolismo , Receptores A2 de Adenosina/metabolismo , Triazóis/farmacologia , Xantinas/farmacologia
16.
J Allergy Clin Immunol ; 116(2): 325-31, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16083787

RESUMO

BACKGROUND: Tachykinins such as substance P are localized in unmyelinated slow-conducting C fibers that can be activated by noxious stimuli and tissue inflammation. Substance P is seldom expressed in fast-conducting large-diameter (A-fiber) vagal sensory neurons. We have previously found that allergic inflammation causes a phenotypic change in tachykinergic innervation of the trachea such that the production of substance P is induced in large-diameter sensory neurons projecting mechanosensitive A fibers to the trachea. OBJECTIVE: To evaluate whether allergic inflammation also induces substance P synthesis in large-diameter sensory stretch-receptor neurons innervating guinea pig lungs, and to investigate potential mechanisms by which this may occur. METHODS: Sensitized guinea pigs were exposed to allergen (ovalbumin) aerosol. One day later, immunohistochemical analysis was performed on vagal sensory neurons that had been retrogradely labeled from the lungs. RESULTS: Ovalbumin inhalation caused a significant increase in substance P expression in large-diameter neurofilament-positive nodose ganglion neurons that innervate the lungs (P < .05). This effect was decreased by ipsilateral vagotomy. Exposing isolated nodose ganglia to the sensitizing antigen, ovalbumin, also significantly increased substance P expression compared with control. CONCLUSION: Allergic inflammation induces substance P synthesis in large-diameter (A-fiber) nodose ganglion neurons innervating guinea pig lungs. This could contribute to the hyperreflexia seen in allergic airway disease. The full expression of this phenotypic switch in vagus nodose ganglion neurons requires intact vagus nerve, but if allergen reached the systemic circulation in sufficient quantities, it could also affect substance P synthesis by local activation of vagal ganglionic mast cells.


Assuntos
Alérgenos/imunologia , Hipersensibilidade/metabolismo , Pulmão/inervação , Gânglio Nodoso/metabolismo , Substância P/biossíntese , Animais , Masculino , Camundongos , Ovalbumina/imunologia , Vagotomia
17.
Pulm Pharmacol Ther ; 18(4): 269-76, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15777609

RESUMO

5-Hydroxytryptamine (5-HT, serotonin) evokes pulmonary reflexes partially by activating vagal bronchopulmonary C-fibers. In the guinea pig, vagal bronchopulmonary C-fibers arise from cell bodies situated in the nodose and the jugular ganglia. The nodose and the jugular C-fibers differ both pharmacologically and neurochemically, and may subserve different functions. In this study, we compared the effect of 5-HT on the nodose and jugular C-fibers with receptive fields within the guinea pig lungs. The nerve terminals of the vagal bronchopulmonary C-fibers were studied in an ex vivo isolated perfused lung nerve preparation using the extracellular recordings. All nodose C-fibers responded to transient administration of 5-HT (10 microM) and to the selective 5-HT3 receptor agonist, 2-methyl-5-HT (10 microM), with the action potential discharge. The selective 5-HT3 receptor antagonist ondansetron (10 microM) inhibited (by approximately 90%) the activation of the nodose C-fibers evoked by 5-HT (10 microM). In contrast to the nodose C-fibers, the jugular C-fibers were unresponsive or poorly responsive to 5-HT (n=9) and unresponsive to 2-methyl-5-HT (n=11). A direct action of 5-HT on the C-fiber neurons was supported using the whole cell patch clamp recordings from the isolated vagal sensory neurons retrogradely labeled from the lungs. Consistently with the studies on the nerve terminals, 5-HT (10 microM) induced inward current in nodose lung-specific capsaicin-sensitive neurons. Conversely, 5-HT was inefficient to stimulate the lung-specific jugular neurons. We conclude that in the guinea pig lungs, 5-HT selectively stimulates vagal nodose, but not jugular C-fibers via the 5-HT3 receptors in the neuronal membrane.


Assuntos
Pulmão/efeitos dos fármacos , Fibras Nervosas Amielínicas/efeitos dos fármacos , Serotonina/farmacologia , Nervo Vago/fisiologia , Animais , Relação Dose-Resposta a Droga , Cobaias , Pulmão/inervação , Pulmão/fisiologia , Masculino , Potenciais da Membrana/efeitos dos fármacos , Fibras Nervosas Amielínicas/fisiologia , Gânglio Nodoso/citologia , Gânglio Nodoso/fisiologia , Ondansetron/farmacologia , Técnicas de Patch-Clamp/métodos , Serotonina/análogos & derivados , Serotoninérgicos/farmacologia , Antagonistas da Serotonina/farmacologia , Nervo Vago/citologia
18.
Pulm Pharmacol Ther ; 17(6): 355-60, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15564076

RESUMO

There are several receptors capable of inducing activating generator potentials in cough-associated afferent terminals in the airways. The chemical receptors leading to generator potentials can be subclassified into ionotropic and metabotropic types. An ionotropic receptor has an agonist-binding domain, and also serves directly as an ion channel that is opened upon binding of the agonist. Examples of ionotropic receptors found in airway sensory nerve terminals include receptors for serotonin (5-HT3 receptors), ATP (P2X receptors), acetylcholine (nicotinic receptors), receptors for capsaicin and related vanilloids (TRPV1 receptors), and acid receptors (acid sensing ion channels). Afferent nerve terminals can also be depolarized via activation of metabotropic or G-protein coupled receptors (GPCRs). Among the GPCRs that can lead to activation of airway afferent fibers include bradykinin B2 and adenosine A1 receptors. The signaling events leading to GPCR-mediated membrane depolarization are more complex than that seen with ionotropic receptors. The GPCR-mediated effects are thought to occur through classical second messenger systems such as activation of phospholipase C. This may lead to membrane depolarization through interaction with specific ionotropic receptors (such as TRPV1) and/or various types of calcium activated channels.


Assuntos
Canais de Cálcio/fisiologia , Tosse/fisiopatologia , Neurônios Aferentes/fisiologia , Receptores de Superfície Celular/fisiologia , Sistema Respiratório/inervação , Potenciais de Ação , Eletrofisiologia , Humanos
19.
J Med Assoc Thai ; 86(11): 1033-41, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14696785

RESUMO

This study aimed to explore the cost-effectiveness of using a questionnaire as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly residing around Siriraj Hospital. The gold standard used for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. The questionnaire consisted of 10 questions on smoking status, respiratory symptoms and previous history of pulmonary tuberculosis. There were 3,094 elderly who participated, completed the questionnaire, and underwent spirometry as well as chest radiography in the community. The results showed that elderly individuals who are smokers (> 0.5 pack-year) or have ever experienced sudden cough with chest oppression or dyspnea when the weather changes or who have expectorated more than two tablespoons of sputum would be suspected of having COPD with a sensitiviy of 81.4 per cent (95% CI 79.4-83.4), specificity of 62.2 per cent (95% CI 60.4-64.0) false negative rate 1.2 per cent (95% CI 0.7-1.7) and false positive rate 38 per cent (95% CI 35.3-40.7) and subsequently required spirometry and chest X-ray for definitive diagnosis. The test needed to screen 17 elderly individuals to detect one COPD case at a cost of 1,538 baht. This questionnaire is also a self-assessment tool for COPD screening among the elderly in order to encourage them to seek for early medical attention and it is recommended that this should be publicized via the mass media.


Assuntos
Programas de Rastreamento/economia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Intervalos de Confiança , Análise Custo-Benefício , Estudos Transversais , Feminino , Avaliação Geriátrica , Educação em Saúde , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Probabilidade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/economia , Radiografia Torácica/economia , Sensibilidade e Especificidade , Espirometria/economia , Espirometria/métodos , Inquéritos e Questionários , Tailândia/epidemiologia , População Urbana
20.
J Med Assoc Thai ; 86(11): 1042-50, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14696786

RESUMO

Regular screening with chest radiography (CXR) in an annual physical check up of the elderly is most frequently practiced. This study aimed to identify the CXR indices and the cost-effectiveness of CXR as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities of Bangkok around Siriraj Hospital. The gold standard for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated, completed spirometry and a CXR. The selected nine indices from PA and lateral CXR for diagnosing COPD were based on the presence of hyperinflation. The positive criteria of each index were reported. The cut-off point of best average accuracy ie, Z score of the CXR was 0.07 with a sensitivity of 75.9 per cent (95% CI 70.2-81.6%), specificity of 72.4 per cent (95% CI 70.8-74.0%) and the best average accuracy of 74.1 per cent (95% CI 72.5-75.7%) whereas the cost-effective cut-off point of a Z score of CXR as a screening test for COPD was 0.04 at the lowest grand total cost. The cost to detect one case of COPD was 2,008 baht and needed to screen 17 elderly. It is suggested that CXR is probably not a suitable screening test for COPD in the elderly due to the complicated derivation of the CXR indices. However, its efficacy may be of some value in in-office diagnosis of COPD.


Assuntos
Programas de Rastreamento/economia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/economia , Radiografia Torácica/economia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Casos e Controles , Análise Custo-Benefício , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/métodos , Probabilidade , Curva ROC , Espirometria/economia , Tailândia , População Urbana
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