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1.
Medicine (Baltimore) ; 98(46): e17996, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725666

RESUMO

To investigate the difference of clinical characteristics between chronic obstructive pulmonary disease (COPD) patients with the frequent exacerbators with chronic bronchitis (FE-CB) phenotype and those with the asthma-COPD overlap syndrome (ACO) phenotype.We searched CNKI, Wan Fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and ACO phenotypes and which qualified the inclusion criteria were included. Cross-sectional/prevalence study quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis.Ten studies (combined n = 4568) qualified the inclusion criteria. The FE-CB phenotype of COPD was associated with significantly lower forced vital capacity percent predicted (mean difference [MD] -9.05, 95% confidence interval [CI] [-12.00, -6.10], P < .001, I = 66%), forced expiratory volume in 1 second (FEV1) (MD -407.18, 95% CI [-438.63, -375.72], P < .001, I = 33%), forced expiratory volume in 1 second percent predicted (MD -9.71, 95% CI [-12.79, -6.63], P < .001, I = 87%), FEV1/forced vital capacity (MD -5.4, 95% CI [-6.49, -4.30], P < .001, I = 0%), and body mass index (BMI) (MD -0.81, 95% CI [-1.18, -0.45], P < .001, I = 44%) as compared to the ACO phenotype. However, FE-CB phenotype was associated with higher quantity of cigarettes smoked (pack-years) (MD 6.45, 95% CI [1.82, 11.09], P < .001, I = 73%), COPD assessment test score (CAT) (MD 4.04, 95% CI [3.46, 4.61], P < .001, I = 0%), mMRC score (MD 0.54, 95% CI [0.46, 0.62], P < .001, I = 34%), exacerbations in previous year (1.34, 95% CI [0.98, 1.71], P < .001, I = 68%), and BMI, obstruction, dyspnea, exacerbations (BODEx) (MD 1.59, 95% CI [1.00, 2.18], P < .001, I = 86%) as compared to the ACO phenotype.Compared with the ACO phenotype, COPD patients with the FE-CB phenotype had poorer pulmonary function, lower BMI, and higher CAT score, quantity of cigarettes smoked (pack-years), exacerbations in previous year, mMRC score, and BODEx.This study is an analysis of published literature, which belongs to the second study. Therefore, this study does not require the approval of the ethics committee. The findings will be disseminated through a peer-reviewed journal publication or conference presentation.


Assuntos
Pneumopatias Obstrutivas/epidemiologia , Pneumopatias Obstrutivas/fisiopatologia , Asma/epidemiologia , Asma/fisiopatologia , Índice de Massa Corporal , Bronquite Crônica/epidemiologia , Bronquite Crônica/fisiopatologia , Fumar Cigarros/epidemiologia , Progressão da Doença , Dispneia/epidemiologia , Humanos , Estudos Observacionais como Assunto , Fenótipo , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Testes de Função Respiratória
2.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(10): 755-759, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31594109

RESUMO

Objective: To analyze the clinical characteristics of pulmonary embolism patients from different altitudes in plateau areas. Methods: A retrospective cross-sectional study was used to analyze the patients with acute pulmonary embolism diagnosed definitely by pulmonary angiography or pulmonary artery CT angiography admitted to Tibet Autonomous Region People's Hospital from August 2014 to December 2018. The subjects were divided into 3 groups according to the altitude of long-term residence before onset, i.e. low-altitude group (group 1, 2 700 m ≤ altitude ≤3 700 m, n=44), medium-altitude group (group 2, 3 700 m

Assuntos
Altitude , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Dor no Peito/epidemiologia , China/epidemiologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Dispneia/epidemiologia , Humanos , Hipóxia , Incidência , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos
3.
Pneumologie ; 73(11): 651-669, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31499562

RESUMO

When caring for patients with respiratory diseases, always think of the heart! This is especially important for COPD patients, but also for a variety of other disorders of the respiratory system. At the workshop "Luftschlösser", held once more at Wiesbaden, Germany in February 2019 the many and important interactions of the lungs and the heart as well as the therapeutic implications were discussed. Based on pathophysiology, the psycho-social consequences of dyspnea, the leading symptom in patients with lung and heart disease became apparent. A particularly demanding diagnostic and therapeutic situation occurs in patients suffering simultaneously of lung and heart disease. It has been shown how frequently the diagnosis myocardial infarction is missed in COPD patients - and vice versa. Surprisingly, this is also the case in asthmatics with coronary heart disease or heart failure, a fact not readily known in clinical practice. In patients with emphysema and no apparent heart disease, hyperinflation leads to significantly restricted heart function. Reducing hyperinflation by inhaling broncholytics thus improves heart function. Biomarkers are increasingly being used for diagnostic purposes. Their role is being investigated in the large German COPD cohort COSYCONET. Lung patients suffering from more severe heart diseases pose a challenge for therapy in intensive care, especially when ventilated, and weaning from the ventilator is prolonged. Lung vessel diseases are "classic" examples of the intimate interaction of the lungs and the heart. In pulmonary arterial hypertension as well as in chronic thrombo-embolic pulmonary hypertension the lag time between the first symptoms and the definite diagnosis is often unacceptably long. For both diseases of the lung vessels therapeutic options have improved significantly over the last years. Pulmonologists should take care of this increasingly important patient group. Sleep-related breathing disorders and heart function are closely intertwined. Both conditions need special attention after the results of the SERVE-HF trial have been published. But there is no doubt that obstructive sleep apnea represents an independent and important risk factor for cardiovascular disease and needs to be treated according to existing guidelines.This workshop demonstrated impressively the multiple interactions of the respiratory system with cardiac function, resulting diagnostic and therapeutic problems, and means to overcome these problems. Guidelines for respiratory diseases should appropriately address cardiac comorbidity.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Comorbidade , Dispneia/epidemiologia , Alemanha/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia
4.
Eur J Oncol Nurs ; 42: 14-20, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446259

RESUMO

PURPOSE: Symptoms experienced by breast cancer patients often cluster together in groups known as "symptom clusters". The aim was to determine the symptom clusters in women with non-metastatic breast cancer treated by radiation therapy (RT). METHODS: Edmonton Symptom Assessment Scale (ESAS) scores were taken from breast cancer patients receiving RT before, at completion of RT, and after RT. Exploratory factor analysis (EFA), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items at all three time points. RESULTS: This study included 1224 patients. The PCA and EFA identified the same two symptom clusters before the start of RT: 1) pain, tiredness, nausea, drowsiness, appetite, and dyspnea; 2) depression, anxiety, and wellbeing. The HCA further split the symptoms into three clusters. Wellbeing, depression, and anxiety consistently clustered together. Among the ESAS scores collected at the end of and after RT, each statistical method identified different symptom clusters. For the symptom clusters experienced at the end of RT, the following symptoms were always in the same cluster: wellbeing, depression, and anxiety; nausea and appetite; drowsiness and dyspnea. Following RT, depression and anxiety consistently clustered together, with nausea and appetite in a second cluster. CONCLUSION: Among the symptom clusters derived before, at the end of RT, and after RT, the following symptoms consistently presented together: depression and anxiety, nausea and appetite, pain and tiredness, and drowsiness, dyspnea, and tiredness. Understanding symptom clusters in this population can improve management of symptoms.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Neoplasias da Mama/psicologia , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Análise por Conglomerados , Depressão/diagnóstico , Depressão/epidemiologia , Dispneia/diagnóstico , Dispneia/epidemiologia , Análise Fatorial , Fadiga/diagnóstico , Fadiga/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/epidemiologia , Análise de Componente Principal , Avaliação de Sintomas/métodos
5.
Int J Occup Med Environ Health ; 32(4): 553-567, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31303647

RESUMO

OBJECTIVES: This study explores the association between self-reported exposure to traffic-related air pollution and respiratory health symptoms, as well as lung functions and skin prick tests in adolescents living in the vicinity of main roads. MATERIAL AND METHODS: The data in the study were acquired using a cross-sectional study conducted between 2004-2005 in Chorzów (Silesia, Poland) among adolescents (N = 936) aged 13-15 years, attending junior high schools. Adverse respiratory health symptoms and exposure to traffic-related air pollution were determined on the basis of a questionnaire. Moreover, all children underwent spirometry and skin prick tests. Multivariable logistic regression with multiple imputation for missing data was used to assess the prevalence of adverse respiratory symptoms in relation to self-reported exposure to traffic-related air pollution, adjusted for socioeconomic and environmental factors. RESULTS: Among respiratory tract diseases, asthma and allergic rhinitis associations were statistically significant (OR = 2.16, 95% CI: 1.12-4.15 and OR = 1.69, 95% CI: 1.08-2.64, respectively). Likewise, among respiratory disorders, statistically significant associations were found in the case of wheezes and dyspnea attack (OR = 1.58, 95% CI: 1.10-2.26 and OR = 2.39, 95% CI: 1.56-3.66, respectively), with respect to the vicinity of the main road. Living in the area with high traffic intensity was statistically significantly associated with a higher prevalence of asthma and wheezes (OR = 2.31, 95% CI: 1.22-4.39 and 1.48, 95% CI: 1.09-2.01, respectively). The results obtained did not confirm the relationship between the adopted way of exposure to traffic-related air pollution and lung function indices or skin prick tests. CONCLUSIONS: Results of the study suggest that children living in the area with intense traffic are more likely to develop respiratory disorders. Moreover, the vicinity of a main road as well as traffic intensity could be suitable in assessing the relationship between road transport and potential health problems among exposed inhabitants. Int J Occup Med Environ Health. 2019;32(4):553-67.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Respiratórias/epidemiologia , Poluição Relacionada com o Tráfego/efeitos adversos , Adolescente , Poluição do Ar/efeitos adversos , Asma/epidemiologia , Asma/etiologia , Estudos Transversais , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Humanos , Masculino , Polônia/epidemiologia , Testes de Função Respiratória , Sons Respiratórios , Doenças Respiratórias/etiologia , Rinite Alérgica/epidemiologia , Rinite Alérgica/etiologia , Testes Cutâneos , Inquéritos e Questionários , Emissões de Veículos
7.
Respir Med Res ; 75: 13-25, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31235453

RESUMO

INTRODUCTION: The aim of this systematic review was to summarize the effects of yoga, qi gong or tai chi in COPD patients. METHODS: Studies evaluating effects of the selected complementary therapies on lung function, dyspnea, quality of life or functional exercise capacity in COPD patients were identified and reviewed from three databases. RESULTS: Eighteen studies were included. Six studies evaluated the effects of yoga and the others focused on tai chi or qi gong separately or combined. The duration of the programs ranged from 6 weeks to 6 months and the frequency from 2 to 7 times a week. Each session reached 30 to 90 minutes. Benefits were observed on lung function and functional exercise capacity but benefit was clearly stated neither on quality of life nor on dyspnea. CONCLUSION: This systematic review highlights the potential of these therapies as complementary therapeutic approach in COPD patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Qigong , Tai Ji , Ioga , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapias Complementares , Dispneia/epidemiologia , Dispneia/etiologia , Dispneia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Qualidade de Vida , Resultado do Tratamento
8.
N Z Med J ; 132(1495): 30-41, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31095542

RESUMO

AIMS: Perform an audit which identifies the breadth and commonality of presenting complaints and diagnoses presenting to Middlemore Hospital over a one-week period in August 2016. METHODS: Two thousand and eleven patients attended Middlemore Hospital over one week in winter 2016, with 53 patients excluded. Information from the remaining 1,958 patient discharge summaries were obtained and made confidential for coding purposes. RESULTS: Of 1,958 patients, there were 78 different presenting complaints, with 444 individual final diagnoses. The five most common complaints were cough (n=158, 8.1%), chest pain (n=133, 6.8%), shortness of breath (n=92, 4.7%), finger pain (n=69, 3.5%) and collapse (n=59, 3.0%). Viral illness (n=84, 4.3%), pneumonia (n=83, 4.3%) and laceration/incised wound (n=75, 3.8%) were the three most common diagnoses. With hindsight, only 2 of the 25 most common diagnoses could be classified as severe conditions-often associated with high morbidity or mortality. CONCLUSIONS: Numerous patients are diagnosed with mild conditions after work-up in the emergency department, however a broad diagnostic approach is required by junior clinicians given the possibility of more worrying diagnoses. An analysis of specific markers used by junior clinicians to aid differential diagnosis shows that not all signs and symptoms are required to make common diagnoses. For example, the absence of a documented fever, raised CRP or both, does not rule out significant infection in the case of pneumonia, urinary tract infection and cellulitis. This audit contributes to understanding the case-mix within the emergency department at Middlemore Hospital and allows for tailoring of service delivery and education of junior clinicians.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dor no Peito/epidemiologia , Criança , Pré-Escolar , Tosse/epidemiologia , Dispneia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Sumários de Alta do Paciente Hospitalar , Estudos Retrospectivos , Adulto Jovem
9.
BMC Pulm Med ; 19(1): 95, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096982

RESUMO

BACKGROUND: Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Because of the major disability related to chronic breathlessness, symptomatic treatments including opioids have been recommended by several authors. The prevalence of chronic breathlessness in COPD and its management in routine clinical practice have been poorly investigated. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort. METHODS: A prospective study was conducted among 120 consecutive COPD patients recruited, in stable condition, at Nancy University Hospital, France. In parallel, 88 pulmonologists of the same geographical region were asked to respond to an on-line questionnaire on breathlessness management. RESULTS: Sixty four (53%) patients had severe breathlessness (modified Medical Research Council scale≥3), despite optimal inhaled medications for 94% of them; 40% had undergone pulmonary rehabilitation within the past 2 years. The severity of breathlessness increased with increasing airflow limitation. Breathlessness was associated with increased symptoms of anxiety, depression and with osteoporosis. No relation was found with other symptoms, exacerbation rate, or cardiovascular comorbidities. Among the patients with chronic breathlessness and Hospitalized Anxiety and/or Depression score > 10, only 25% were treated with antidepressant or anxiolytic. Among the pulmonologists 46 (52%) answered to the questionnaire and expressed a high willingness to prescribe opioids forchronic breathlessness, which contrasted with the finding that none of these patients received such treatments against breathlessness. CONCLUSION: Treatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness.


Assuntos
Analgésicos Opioides/uso terapêutico , Dispneia/tratamento farmacológico , Dispneia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Doença Crônica , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Prevalência , Estudos Prospectivos , Pneumologistas , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários , Centros de Atenção Terciária
10.
Yonsei Med J ; 60(6): 547-553, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124338

RESUMO

PURPOSE: Clinical use of cardiopulmonary exercise tests (CPETs) is increasing in elderly patients with cardiovascular (CV) diseases. However, data on Korean populations are limited. In this study, we aimed to examine the characteristics and safety of CPET in an elderly Korean population with CV disease. MATERIALS AND METHODS: We retrospectively analyzed records of 1485 patients (older than 65 years in age, with various underlying CV diseases) who underwent CPET. All CPET was performed using the modified Bruce ramp protocol. RESULTS: The mean age of patients was 71.6±4.7 years with 63.9% being men, 567 patients aged 60-65 years, 818 patients aged 70-79 years, and 100 patients aged 80-89 years. The mean respiratory exchange ratio was 1.09±0.14. During CPET, three adverse cardiovascular events occurred (total 0.20%), all ventricular tachycardia. All subjects showed an average exercise capacity of 21.3±5.5 mL/kg/min at peak VO2 and 6.1±1.6 metabolic equivalents of task, and men showed better exercise capacity than women on most CEPT parameters. A significant difference was seen in peak oxygen uptake according to age group (65-69 years, 22.9±5.8; 70-79 years, 20.7±5.1; 80-89 years, 17.0±4.5 mL/kg/min, p<0.001). The most common causes for CPET termination were dyspnea (64.8%) and leg pain (24.3%), with higher incidence of leg pain in octogenarians compared to other age groups (65-69 years, 22.4%; 70-79 years, 24.6%; 80-89 years, 32.0%, p<0.001). CONCLUSION: CPET was relatively a safe and useful modality to assess exercise capacity, even in an elderly Korean population with underlying CV diseases.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Teste de Esforço/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos
11.
Rev Bras Ter Intensiva ; 31(1): 57-62, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30970092

RESUMO

OBJECTIVE: To assess the Perme mobility scale score as a predictor of functional status and complications in the postoperative period in patients undergoing liver transplantation. METHODS: The sample consisted of 30 patients who underwent liver transplantation. The patients were evaluated at two time points to determine their perception of pain, degree of dyspnea, peripheral muscle strength, and functional status according to the Perme scale. The collected data were analyzed by descriptive and inferential statistics. To compare the means between the evaluations, Student's t test for paired samples was applied. In case of asymmetry, the Wilcoxon test was used. In the evaluation of the association between the quantitative variables, the Pearson or Spearman correlation tests were applied. RESULTS: A total of 30 individuals who underwent liver transplantation were included. The patients were predominantly male, and the mean age was 58.4 ± 9.9 years. The most prevalent underlying pathology was cirrhosis C virus (23.3%). Significant associations of the time on mechanical ventilation with the Perme scale score at discharge from the intensive care unit (r = -0.374; p = 0.042) and the number of physical therapy treatments (r = -0.578; p = 0.001) were recorded. When comparing the results of the initial evaluation and the evaluation at hospital discharge, there was a significant improvement in functional status (p < 0.001). CONCLUSION: Functional mobility, peripheral muscle strength, pain perception, and dyspnea are significantly improved at hospital discharge compared with those at inpatient unit admission.


Assuntos
Transplante de Fígado/métodos , Modalidades de Fisioterapia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica/fisiologia , Idoso , Dispneia/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Força Muscular/fisiologia , Percepção da Dor/fisiologia , Alta do Paciente , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo
12.
Can J Cardiol ; 35(4): 438-445, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30935634

RESUMO

BACKGROUND: This study describes the different types of congenital vascular rings according to their anatomy, symptoms, and age at clinical onset and reports the surgical outcomes. METHODS: A retrospective observational database study was conducted, reviewing the medical charts of 69 adult survivors with a history of a vascular ring, identified from the Dutch Congenital Cor vitia database. RESULTS: Median age at presentation was 8.5 years (0-53.0 years). Thirty patients (43.5%) had a "left aortic arch with aberrant right subclavian artery," 21 patients (30.4%) a "double aortic arch," and 16 patients (23.2%) a "right aortic arch with aberrant left subclavian artery." The main symptomatology at presentation comprised respiratory symptoms (82.9%). Almost three-quarters of patients were also diagnosed with asthma/bronchial hyperreactivity. Patients with a double aortic arch had more symptoms than patients with a left aortic arch with aberrant right subclavian artery and right aortic arch with aberrant left subclavian artery (P < 0.001), requiring surgery most often (P < 0.001). In patients with childhood onset of symptoms, preoperative spirometry (ie, peak expiratory flows) was more often abnormal as compared with adult patients (P = 0.007). Surgery was performed in 42.0% of all patients at a median age of 17 years (0-63.0 years). Twenty-four (92.3%) of the operated patients showed improvement or complete relief of symptoms shortly after surgery. Of 26 asymptomatic nonoperated patients, 3 patients (11.5%) eventually developed symptoms. CONCLUSIONS: The low incidence of vascular rings, their anatomic heterogeneity, and a wide range of common symptoms often lead to misdiagnosis. Clinical awareness is warranted as a large subset of patients could benefit from surgery, even at an adult age.


Assuntos
Aorta Torácica/anormalidades , Artéria Subclávia/anormalidades , Sobreviventes , Anel Vascular/epidemiologia , Adolescente , Adulto , Idoso , Asma/epidemiologia , Hiper-Reatividade Brônquica/epidemiologia , Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Dor no Peito/epidemiologia , Criança , Pré-Escolar , Cianose/epidemiologia , Transtornos de Deglutição/epidemiologia , Dispneia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Sons Respiratórios , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Espirometria , Anel Vascular/cirurgia , Adulto Jovem
13.
Adv Clin Exp Med ; 28(3): 319-324, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30943332

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with various comorbidities, which influence the course of COPD and worsen prognosis. OBJECTIVES: The aim of this study was to analyze the comorbidities in a cohort of COPD patients in Poland during 12 months of observation. MATERIAL AND METHODS: A total of 444 COPD patients (median age: 66.1 years) in all stages of airflow limitation severity were enrolled. Medical histories and a questionnaire concerning comorbidities were analyzed at baseline and after 12 months (data of 267 patients available). Anthropometric data, pulmonary function, and body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE index) were assessed. RESULTS: No comorbidities were reported in 9 patients (2.0%), 101 patients (22.7%) had 1-2 comorbidities, 243 (54.7%) had 3-5, and 91 (20.6%) had more than 5 comorbidities. Cardiovascular diseases (CVDs) were the most frequent ones, followed by peptic ulcer, obstructive sleep apnea (OSA), diabetes, gastroesophageal reflux disease (GERD), and osteoporosis; 11 patients had a history of lung cancer. Cachexia was observed in 11 cases, overweight in 136 cases and obesity in 139 cases. The incidence of CVDs increased with time. The number of comorbidities correlated with the body mass index (BMI) and the number of hospitalizations for extra-pulmonary causes, but not with airflow limitation. The BODE index score increased with the number of comorbidities. CONCLUSIONS: In a cohort of Polish COPD patients, the most frequent comorbidities were CVDs. The number of comorbidities affected the BODE index, but not airflow limitation. The BODE index is better than forced expiratory volume in 1 s (FEV1) in the rating of COPD patients' condition. The BMI correlated with the number of comorbidities as well as the number of hospitalizations for extra-pulmonary causes.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Idoso , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus/epidemiologia , Dispneia/epidemiologia , Volume Expiratório Forçado , Refluxo Gastroesofágico/epidemiologia , Humanos , Úlcera Péptica/epidemiologia , Polônia/epidemiologia , Índice de Gravidade de Doença
14.
Breast Cancer Res Treat ; 175(3): 721-731, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30879223

RESUMO

PURPOSE: Studies examining symptom differences between surgeries for breast cancer patients rarely incorporate the effects of adjuvant treatment choice. We sought to understand differences in patient-reported symptoms between lumpectomy plus radiation and mastectomy in the year following surgery. METHODS: This cohort study used linked administrative datasets. The exposure was defined as lumpectomy plus radiation or mastectomy. The outcomes of moderate-to-severe (score ≥ 4) patient-reported symptoms were obtained using the Edmonton symptom assessment system (ESAS). Line plots were created to determine symptom trajectories in the 12 months following surgery, and the relationships between surgery and each of the nine symptoms were assessed using multivariable analyses. Clinical significance was determined as a difference of 10%. RESULTS: Of 13,865 Stage I-II breast cancer patients diagnosed 2007-2015, 11,497 underwent lumpectomy plus radiation and 2368 underwent mastectomy. Symptom trajectories were similar for all nine symptoms until approximately 5 months postoperatively when they diverged and mastectomy symptoms started becoming more severe. On multivariable analyses, patients undergoing mastectomy were at an increased risk of reporting moderate-to-severe depression (RR 1.19, 95% CI 1.09-1.30), lack of appetite (RR 1.11, 95% CI 1.03-1.20), and shortness of breath (RR 1.16, 95% CI 1.04-1.15) compared to those undergoing lumpectomy plus radiation. CONCLUSIONS: Even with the addition of adjuvant radiation, patients who are treated with lumpectomy fare better in three of nine patient-reported symptoms. Further examination of these differences will assist in better shared decision-making regarding surgical treatments.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Depressão/epidemiologia , Dispneia/epidemiologia , Mastectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Estudos de Coortes , Terapia Combinada , Depressão/etiologia , Dispneia/etiologia , Feminino , Humanos , Mastectomia/métodos , Mastectomia/psicologia , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Medidas de Resultados Relatados pelo Paciente , Autorrelato , Resultado do Tratamento , Adulto Jovem
15.
BMC Pulm Med ; 19(1): 63, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876423

RESUMO

BACKGROUND: Frailty is a state of increased vulnerability that has a significant risk of unfavorable outcomes such as increased dependency and/or death, but little is known about frailty in people with chronic obstructive pulmonary disease (COPD). METHOD: We aimed to determine the prevalence of frailty in COPD patients and to identify the associated risk factors. Two hundred fifty-seven COPD patients enrolled from primary care in Greece between 2015 and 2016. Physicians used structured interviews to collect cross-sectional data including demographics, medical history, symptoms and COPD Assessment Tool (CAT) or modified Medical Research Council Dyspnea scale (mMRC) score. Patients were classified into severity groups according to GOLD 2017 guidelines. Participants completed the The Frail Non-Disabled (FiND) questionnaire, exploring the frailty and disability domains. In the present analyses, frail patients with and without mobility disability were pooled and were compared to non-frail patients. Factors associated with frailty were analyzed using univariate and multivariate logistic regression. RESULTS: Mean (SD) age was 65 (12.3) with 79% males. The majority of patients suffered with frailty (82%) of which 76.8% had mobility disability. 84.2% were married/with partner and 55.4% retired. 55.6% were current smokers. Uncontrolled disease (≥10 CAT score) was reported in 91.1% and 37.2% of patients had ≥2 exacerbations in the past year. Dyspnea (38%) and cough (53.4%) were the main symptoms. Main comorbidities were hypertension (72.9%), hyperlipidaemia (24.6%) and diabetes (11%). Risk of frailty was significantly increased with age (OR; 95%CI: 1.05; 1.02-1.08), hypertension (2.25; 1.14-4.45), uncontrolled disease (≥10 CAT score 4.65; 1.86-11.63, ≥2 mMRC score 5.75 (2.79-11.85) or ≥ 2 exacerbations 1.73; 1.07-2.78), smoking cessation (ex compared to current smokers: 2.37; 1.10-5.28) and GOLD status (B&D compared to A&C groups: CAT-based 4.65; 1.86-11.63; mMRC-based: 5.75; 2.79-11.85). In multivariate regression smoking cessation and GOLD status remained significant. Gender, body mass index, occupational or marital status, symptoms and other comorbidities were not significant. CONCLUSIONS: Frailty with mobility disability is common in COPD patients and severity of disease increases the risk. It is possible that frail patients are more likely to quit smoking perhaps because of their disability and uncontolled disease. Routine assessment of frailty in addition to COPD control may allow early interventions for preventing or delaying progression of frailty and improvement in COPD disease.


Assuntos
Fragilidade/epidemiologia , Fragilidade/fisiopatologia , Atenção Primária à Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar/epidemiologia , Idoso , Comorbidade , Tosse/epidemiologia , Estudos Transversais , Progressão da Doença , Dispneia/epidemiologia , Feminino , Grécia/epidemiologia , Humanos , Modelos Logísticos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Índice de Gravidade de Doença , Fumar/terapia , Abandono do Hábito de Fumar , Inquéritos e Questionários
16.
Artigo em Inglês | MEDLINE | ID: mdl-30841531

RESUMO

Thousands of lower Manhattan residents sustained damage to their homes following the collapse of the Twin Towers on 11 September 2001. Respiratory outcomes have been reported in this population. We sought to describe patterns of home damage and cleaning practices in lower Manhattan and their impacts on respiratory outcomes among World Trade Center Health Registry (WTCHR) respondents. Data were derived from WTCHR Wave 1 (W1) (9/2003⁻11/2004) and Wave 2 (W2) (11/2006⁻12/2007) surveys. Outcomes of interest were respiratory symptoms (shortness of breath (SoB), wheezing, persistent chronic cough, upper respiratory symptoms (URS)) first occurring or worsening after 9/11 W1 and still present at W2 and respiratory diseases (asthma and chronic obstructive pulmonary disease (COPD)) first diagnosed after 9/11 W1 and present at W2. We performed descriptive statistics, multivariate logistic regression and geospatial analyses, controlling for demographics and other exposure variables. A total of 6447 residents were included. Mean age on 9/11 was 45.1 years (±15.1 years), 42% were male, 45% had ever smoked cigarettes, and 44% reported some or intense dust cloud exposure on 9/11. The presence of debris was associated with chronic cough (adjusted OR (aOR) = 1.56, CI: 1.12⁻2.17), and upper respiratory symptoms (aOR = 1.56, CI: 1.24⁻1.95). A heavy coating of dust was associated with increased shortness of breath (aOR = 1.65, CI: 1.24⁻2.18), wheezing (aOR = 1.43, CI: 1.03⁻1.97), and chronic cough (aOR = 1.59, CI: 1.09⁻2.28). Dusting or sweeping without water was the cleaning behavior associated with the largest number of respiratory outcomes, such as shortness of breath, wheezing, and URS. Lower Manhattan residents who suffered home damage following the 9/11 attacks were more likely to report respiratory symptoms and diseases compared to those who did not report home damage.


Assuntos
Doenças Respiratórias/epidemiologia , Ataques Terroristas de 11 de Setembro , Adulto , Doença Crônica , Poeira , Dispneia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Sistema de Registros , Sons Respiratórios , Inquéritos e Questionários
17.
Recenti Prog Med ; 110(2): 93-97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30843535

RESUMO

Background: Natural history and outcomes of patients with pulmonary embolism (PE) without typical symptoms (atypical PE) remain unclear. The aim of the study is to compare the clinical characteristics and the prognosis between typical PE and atypical PE. Methods: We retrospectively analyzed data from consecutive patients admitted to the Emergency Department (ED) because of a diagnosis of PE and classified them in two groups: typical PE and atypical PE. We defined PE to be typical in presence of almost one of the following symptoms or signs: dyspnea, chest pain, hemoptysis or signs of deep vein thrombosis. Results: Of the 191 patients with PE, 154 (81%) had typical PE and 37 (19%) had atypical PE. Patients with atypical and typical PE seemed to had similar prognostic factor such as high risk sPESI (73% vs 65%, p=0.3), right ventricular dysfunction (30% vs 26%, p=0.6) and central PE at chest CT scan (38% vs 36%, p=0.8). The rate of 30 day mortality was 7% in the typical group and 8% in the atypical group (p=0.8). The length of stay in hospital was the same in the two groups (6 days; p=0.2). Conclusions: We found that atypical and typical PE seem to be related diseases with a similar short term prognosis. Therefore, we could speculate that a missed diagnosis of PE in ED could expose the patients to a worsen prognosis. Further perspective studies are required for better investigate this diagnostic challenge.


Assuntos
Dor no Peito/epidemiologia , Dispneia/epidemiologia , Hemoptise/epidemiologia , Embolia Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/etiologia , Dispneia/etiologia , Serviço Hospitalar de Emergência , Feminino , Hemoptise/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/epidemiologia , Adulto Jovem
18.
Respir Res ; 20(1): 33, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764884

RESUMO

BACKGROUND: Early life exposure to tobacco smoke has been extensively studied but the role of second-hand smoke (SHS) for new-onset respiratory symptoms and lung function decline in adulthood has not been widely investigated in longitudinal studies. Our aim is to investigate the associations of exposure to SHS in adults with respiratory symptoms, respiratory conditions and lung function over 20 years. METHODS: We used information from 3011 adults from 26 centres in 12 countries who participated in the European Community Respiratory Health Surveys I-III and were never or former smokers at all three surveys. Associations of SHS exposure with respiratory health (asthma symptom score, asthma, chronic bronchitis, COPD) were analysed using generalised linear mixed-effects models adjusted for confounding factors (including sex, age, smoking status, socioeconomic status and allergic sensitisation). Linear mixed-effects models with additional adjustment for height were used to assess the relationships between SHS exposure and lung function levels and decline. RESULTS: Reported exposure to SHS decreased in all 26 study centres over time. The prevalence of SHS exposure was 38.7% at baseline (1990-1994) and 7.1% after the 20-year follow-up (2008-2011). On average 2.4% of the study participants were not exposed at the first, but were exposed at the third examination. An increase in SHS exposure over time was associated with doctor-diagnosed asthma (odds ratio (OR): 2.7; 95% confidence interval (95%-CI): 1.2-5.9), chronic bronchitis (OR: 4.8; 95%-CI: 1.6-15.0), asthma symptom score (count ratio (CR): 1.9; 95%-CI: 1.2-2.9) and dyspnoea (OR: 2.7; 95%-CI: 1.1-6.7) compared to never exposed to SHS. Associations between increase in SHS exposure and incidence of COPD (OR: 2.0; 95%-CI: 0.6-6.0) or lung function (ß: - 49 ml; 95%-CI: -132, 35 for FEV1 and ß: - 62 ml; 95%-CI: -165, 40 for FVC) were not apparent. CONCLUSION: Exposure to second-hand smoke may lead to respiratory symptoms, but this is not accompanied by lung function changes.


Assuntos
Nível de Saúde , Sistema Respiratório/fisiopatologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Asma/epidemiologia , Asma/etiologia , Bronquite Crônica/epidemiologia , Bronquite Crônica/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Europa (Continente)/epidemiologia , União Europeia , Seguimentos , Inquéritos Epidemiológicos , Humanos , Incidência , Prevalência , Testes de Função Respiratória , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco/estatística & dados numéricos
19.
In Vivo ; 33(2): 543-549, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804139

RESUMO

AIM: The aim of this study was to identify factors affecting the final diagnosis of cough. MATERIALS AND METHODS: This study recruited 463 consecutive patients who visited five Japanese general hospitals due to cough from October 2006 to September 2007. Of these, 418 patients (90%) who completed a questionnaire designed to acquire data regarding clinical manifestations of cough were included. RESULTS: Most patients with bronchial asthma had cough with seasonal variation and wheezing. Patients with gastro esophageal reflux disease suffered from heartburn and cough without daily or seasonal variation. Cough associated with sinobronchial syndrome was only observed in females and was linked to increased sputum. Patients with whooping cough were bothered by cough interrupting sleep and talking. Patients with cardiogenic cough had exertional dyspnea. CONCLUSION: The specific items on our questionnaire relating to patient characteristics, complications, and triggers of cough, represent useful tools for diagnosing the primary disease producing cough.


Assuntos
Asma/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Adulto , Asma/epidemiologia , Doença Crônica/epidemiologia , Tosse/epidemiologia , Estudos Transversais , Dispneia/epidemiologia , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Escarro/microbiologia , Inquéritos e Questionários
20.
J Pediatr Surg ; 54(2): 288-292, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30522799

RESUMO

INTRODUCTION: Bariatric surgery is an increasingly common treatment of morbid obesity in the United States and has demonstrated effective weight loss and improvement of comorbidities. We used the National Surgical Quality Improvement Program (NSQIP) data to characterize bariatric surgery utilization and complication rates in the adolescent population. METHODS: Demographics, surgical procedures, comorbidities, and 30-day outcomes of 2625 adolescents ages 18-21 who underwent bariatric surgery were analyzed from NSQIP data-bank from 2005 to 2015. RESULTS: 79.5% of patients were females. Majority of patients identified as Caucasian or Black/African American (BAA) at 66.7% (73% of US population) and 15.5% (12.6% of US population), respectively. 15.9% identified as Hispanic. Comorbidities included diabetes in 9.3% (7.8% NIDDM), hypertension (9.5%), and dyspnea on moderate exertion (13.2%). Sleeve Gastrectomy, Laparoscopic Roux-En-Y (RY) and Adjustable Gastric Banding (AGB) were the three most common procedures performed during the study period. There has been a sharp trend towards SG in recent years (11.4% in 2010, to 66.6% in 2015), while RY utilization declined (47.4% in 2010 to 28.6% in 2015). Surgical complications were 2.4%, with the most common being superficial surgical site infection (0.7%), UTI (0.7%), and organ-space infection (0.4%). Reoperation and readmission rates within 30-days post-operation were 1.5% and 4.1%, respectively. Those with complications had longer length-of-stays (2.7 vs. 1.8 days, P < 0.001), greater reoperation rates (OR = 9.6, P < 0.001) and readmission rates (OR = 11.8, P < 0.001). CONCLUSION: Morbid obesity is associated with significant comorbidity. SG is increasingly the most utilized form of bariatric surgery. While complications are low, they are associated with greater hospital length-of-stay, readmission, and reoperation rates. LEVEL OF EVIDENCE: Treatment Study, Level III.


Assuntos
Diabetes Mellitus/epidemiologia , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/estatística & dados numéricos , Gastroplastia/estatística & dados numéricos , Hipertensão/epidemiologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Adolescente , Comorbidade , Bases de Dados Factuais , Dispneia/epidemiologia , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/tendências , Derivação Gástrica/efeitos adversos , Derivação Gástrica/tendências , Gastroplastia/efeitos adversos , Gastroplastia/tendências , Humanos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Reoperação/estatística & dados numéricos , Estados Unidos/epidemiologia , Perda de Peso , Adulto Jovem
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