Acute Pulmonary Disease Research Articles

Frequency of Blood Eosinophilia in Patients of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

Objective: To determine the frequency of eosinophilia in patients presenting with acute exacerbation chronic obstructive pulmonary disease (AECOPD). Patients and Methods: A total number 217 patients presenting with AECOPD were included from August-2021 to March-2022. Data regarding patients age, gender, diabetes, hypertension, smoking and duration of COPD was collected for each patient. After inclusion, venous blood samples were taken and were analyzed for presence of eosinophilia. Results: Mean age of patients was 59.32±8.92 years. Mean duration of COPD was 6.56±2.49 years. There were 127 (74.7%) male and 43 (25.3%) female patients. Out of 170, 121 (71.2%) patients were smokers, 66 (38.8%) diabetic and 79 (46.5%) hypertensive patients. Eosinophilia was diagnosed in 37 (21.8%) patients. Conclusion: Based on the data of our study including 170 patients hospitalized for AECOPD, we found that 21.8% patients had blood eosinophilia (defined as ≥300 cells/μL). So Peripheral blood eosinophilia can be used a significant biomarker in patients with acute exacerbation of COPD. Keywords: Acute exacerbation, Eosinophilia, chronic obstructive pulmonary disease.

Nebulizer versus metered dose inhaler with space chamber (MDI spacer) for acute asthma and chronic obstructive pulmonary disease (COPD) exacerbation: attitudes of patients and healthcare providers in the COVID-19 era

Objective Short-acting bronchodilators for asthma and chronic obstructive pulmonary disease (COPD) exacerbations are commonly delivered by nebulizers although administration using metered dose inhaler with space chamber (MDI spacer) has been shown to be equally efficacious. There are few studies examining patients’ and healthcare providers’ attitudes on the 2 administration methods in adults. This study explores patients’ and healthcare providers’ attitudes on the use of nebulizer versus MDI spacer for acute asthma and COPD exacerbations in adults. Methods Patients admitted for asthma or COPD exacerbations, doctors and nurses in a university-affiliated hospital were surveyed from 1 April 2021 to 30 Sept 2021 regarding their views on the effectiveness, ease of use, preparation and administration, side effects, and infection risk of the 2 administration methods. Results Ninety-nine patients, 103 doctors and 650 nurses completed the survey. 60.6% of patients perceived nebulizer to be more effective. Patients who found nebulizer more comfortable were more likely to prefer nebulizer (OR 43.97, p = 0.01), while those who associated it with a greater infection risk were less likely to prefer nebulizer (OR 0.15, p = 0.03). 49.5% of doctors and 49.1% of nurses perceived nebulizer to be more effective, compared to 10.7% and 34.5%, respectively, for MDI spacer. Effectiveness and patient comfort influenced doctors’ and nurses’ preference for nebulizer while ease of preparation and administration influenced nurses’ preference only. Conclusions Patients and healthcare providers perceived nebulizer to be more effective. Factors unique to each group influenced their preference for nebulizer.

Inflammatory profile of ACS reached by COPD in Algeria

Abstract Funding Acknowledgements Type of funding sources: None. As a common factor of both acute coronary syndrome (ACS) and chronic obstructive pulmonary disease (COPD), circulating biomarkers of inflammation may provide a link between these two diseases. The objective of this study was to explore the inflammatory profile of patients with COPD and ACS. 94 men with COPD according to GOLD criteria in stable clinical condition; are included prospectively in the study. Patients was divided into two groups with ACS and without ACS. The levels of circulating CRP, TNF-α and IL6 were determined for both groups. The results showed that circulating biomarkers of inflammation are higher in the group of COPD patients with associated ACS. The rate of CRP g / l: 8.79 ± 17.12VS 8.83 ± 13.09 in the absence of ACS, TNFα pg / ml: 14.99 ± 28.88VS13.01 ± 16.40 and IL6 pg/ml: 32.66 ± 79.12 VS 23.79 ± 37.99. Circulating cytokines are significantly associated with ACS, particularly the level of IL-6, which correlates with the presence of ACS in COPD. These results confirm the association between ACS and chronic inflammation of COPD. And that inflammation and more particularly circulating IL-6 seem strongly implicated in the pathophysiology of atherosclerotic remodeling in the COPD patient with ACS.

Usefulness of Glucose to Lymphocyte Ratio to Predict in-Hospital Mortality in Patients with AECOPD Admitted to the Intensive Care Unit

The purpose of this study was to investigate the relationship between glucose to lymphocyte ratio (GLR) and the outcome of acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients admitted to the intensive care unit (ICU). This study included 3573 patients from the eICU Collaborative Research Database (eICU-CRD) and 926 AECOPD patients admitted to ICU from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The optimal cutoff value for GLR was 5.6. Kaplan-Meier analysis demonstrated that patients in lower GLR (< 5.6) group showed a better overall survival than patients in higher GLR (≥ 5.6) group in all sets. Multivariate Cox regression analysis demonstrated that age, Sequential Organ Failure Assessment (SOFA) score, SpO2, albumin and GLR are independent predictors of poor overall survival in the training cohort and were incorporated into the nomogram for in-hospital mortality as independent factors. The nomogram exhibited excellent discrimination with C-indexes in training cohort, internal validation and external validation cohort were (0.801, 95%CI: 0.769-0.863), (0.805, 95%CI: 0.759-0.851) and (0.811, 95%CI: 0.772-0.850), respectively. The calibration plot indicated an adequate fit of the nomogram for predicting the risk of in-hospital mortality in all sets. Moreover, the ROC analyses demonstrated that the discrimination abilities of GLR were better than other blood-based inflammatory biomarkers. As an easily available biomarker, GLR can independently predict the in-hospital mortality in AECOPD patients admitted to ICU. The nomogram combining GLR with other significant indicators exhibited excellence predictive performance for in-hospital mortality.

Percutaneous Endoscopic Gastrostomy Tube Timing in Head and Neck Cancer Surgery.

To examine outcomes and complications in patients receiving a percutaneous endoscopic gastrostomy (PEG) tube on the same day of head and neck cancer (HNC) surgery versus later in hospitalization. The 2003-2014 Nationwide Inpatient Sample was queried for patients undergoing ablative HNC procedures who had a PEG tube placed. Cases were stratified by PEG tube timing into an early (on the same day as ablative procedure) and late (later in hospitalization) group. Demographics and outcomes were compared using univariate analysis and multivariate regression modeling. A total of 4,068 cases were included, of which 2,206 (54.23%) underwent early PEG and 1,862 (45.77%) received a late PEG tube. Late PEG tube patients were more likely to have a diagnosis of malnutrition (18.0% vs. 15.3%, p=0.018) or renal failure (4.7% vs. 3.0%, p=0.006). On multivariate regression analysis, patients receiving late PEG tubes were more likely to experience aspiration pneumonia, acute pulmonary disease, infectious pneumonia, sepsis, hematoma, wound disruption, surgical site infection, and fistula formation (all p < 0.05). The mean length of stay and hospital charges in the late PEG group were significantly greater (17.1 vs. 12.6 days, p < 0.001) and ($159,993 vs. $125,705, p < 0.001), respectively. Patients undergoing HNC surgery who received a PEG tube on the day of ablative surgery had lower complication rates, shorter length of stay, and decreased hospital costs compared to those who had a PEG tube placed later during hospitalization. Further research is needed to determine the causal relationships behind these findings. 3 Laryngoscope, 133:109-115, 2023.

Risk Factors for Length of Hospital Stay in Acute Exacerbation Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study.

Background/PurposeA patient’s length of hospital stay (LHS) is associated with the severity and outcome of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Therefore, identification of patients with prolonged LHS at an early stage can potentially reduce the risk of adverse events and treatment costs in patients with AECOPD. Therefore, this study aimed to explore the independent predictors of prolonged LHS in AECOPD patients.Patients and MethodsThis multicenter cross-sectional study was conducted at two tertiary hospitals between January 2019 and August 2020. Demographic data, underlying diseases, symptoms, and laboratory findings were collected. Univariate analysis was used to identify variables with significant differences. A collinearity diagnostic was applied to the selected variables before the establishment of the regression model. Ordinal logistic regression was performed to explore the independent risk factors for prolonged LHS in patients with AECOPD.ResultsIn total, 598 patients with AECOPD were screened. Finally, the LHS of 111, 218, and 100 patients was <7, 7–10, and ≥11 days, respectively. Significant differences in the 12 variables were found in the univariate analysis. Because collinearities among white blood cells (WBC), neutrophils (NS), and NS% were observed, WBC and NS% were excluded. Subsequently, an ordinal logistic regression model identified that rates of hypertension and chronic cor pulmonale (CCP), neutrophil–lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) were independent predictors of prolonged LHS in AECOPD patients.ConclusionCollectively, our results showed that inflammatory status, hypertension, and CCP were independently associated with LHS in patients with AECOPD. These data indicate that early and appropriate administration of antibiotics and anti-inflammatory drugs is essential for reducing LHS. Hypertension and CCP were independent predictors of worse outcomes in patients with AECOPD. Therefore, advanced management and care should be provided to AECOPD patients with hypertension and/or CCP on admission.

Mesenchymal stem cell-based treatments for COVID-19: status and future perspectives for clinical applications.

As a result of cross-species transmission in December 2019, the coronavirus disease 2019 (COVID-19) became a serious endangerment to human health and the causal agent of a global pandemic. Although the number of infected people has decreased due to effective management, novel methods to treat critical COVID-19 patients are still urgently required. This review describes the origins, pathogenesis, and clinical features of COVID-19 and the potential uses of mesenchymal stem cells (MSCs) in therapeutic treatments for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. MSCs have previously been shown to have positive effects in the treatment of lung diseases, such as acute lung injury, idiopathic pulmonary fibrosis, acute respiratory distress syndrome, lung cancer, asthma, and chronic obstructive pulmonary disease. MSC mechanisms of action involve differentiation potentials, immune regulation, secretion of anti-inflammatory factors, migration and homing, anti-apoptotic properties, antiviral effects, and extracellular vesicles. Currently, 74 clinical trials are investigating the use of MSCs (predominately from the umbilical cord, bone marrow, and adipose tissue) to treat COVID-19. Although most of these trials are still in their early stages, the preliminary data are promising. However, long-term safety evaluations are still lacking, and large-scale and controlled trials are required for more conclusive judgments regarding MSC-based therapies. The main challenges and prospective directions for the use of MSCs in clinical applications are discussed herein. In summary, while the clinical use of MSCs to treat COVID-19 is still in the preliminary stages of investigation, promising results indicate that they could potentially be utilized in future treatments.

Clinical impact of pulmonary hypertension on the outcomes of acute myocardial infarction patients with or without chronic obstructive pulmonary disease.

Acute myocardial infarction (AMI) and chronic obstructive pulmonary disease (COPD) are leading global causes of morbidity and mortality. In patients with both of these conditions, the presence of pulmonary hypertension (PH) can further worsen their prognosis. We examined the outcomes of AMI patients with COPD (AMI+COPD) and without COPD (AMI−COPD), depending on the presence or absence of PH.A total of 318 AMI patients with COPD (AMI+COPD cohort) (n = 109) or without COPD (AMI-COPD cohort) (n = 209) were included in this study and were subdivided into 2 groups according to right ventricular systolic pressure (RVSP) level (PH group [RVSP ≥35 mm Hg] and no PH group [RVSP <35 mm Hg]).We investigated characteristics and clinical outcomes in both the AMI-COPD and AMI+COPD cohorts. When investigating in-hospital clinical outcomes, the PH group had a higher proportion of new-onset heart failure (HF) in both cohorts. In the AMI+COPD cohort, however, the PH group had a higher incidence of cardiogenic shock than the no PH group, which was consistent with the result of the post-inverse probability of treatment weighting (IPTW) analysis. When investigating 1-year clinical outcomes, the PH group had higher incidences of a major adverse cardiac event and all-cause mortality in both cohorts. This finding was mainly driven by cardiac death in the AMI-COPD cohort, whereas it was mainly driven by non-cardiac death in the AMI+COPD cohort. After IPTW adjustment, these differences were statistically attenuated such that all variables were similar between both groups.PH may be associated with the development of new-onset HF (in all patients) and cardiogenic shock (in the AMI+COPD cohort). In addition, PH may be also associated with all-cause mortality, although it was statistically attenuated after IPTW adjustment.

Detection of respiratory viruses and expression of inflammatory cytokines in patients with acute exacerbation chronic obstructive pulmonary disease in Mongolia China.

Chronic obstructive pulmonary disease (COPD) was estimated to be the third cause of global mortality by 2020. Acute exacerbation COPD (AECOPD) is a sudden worsening of COPD symptoms and could be due to virus/bacterial infections and air pollution. Increased expression of inflammatory markers in patients with AECOPD is associated with viral infection. This study aimed to detect different viruses and analyze the expression of various inflammatory markers associated with AECOPD patients. Three hundred and forty-seven patients diagnosed with COPD according to GOLD criteria were included in this study. Swab samples and blood were collected for the detection of viruses by RT-PCR and expression of inflammatory markers, respectively. Of the swab samples, 113 (32.6%) of samples were positive for virus detection. Of these, HRV (39.8%) was the predominant virus detected followed by FluB (27.4%) and FluA (22.1%). The presence of HRV was significantly higher (p=0.044) among the other detected viruses. When compared to healthy controls the expression levels of TNF-α, IL-6 and IL-8 were significantly higher (p<0.05) in virus-positive patients. The IL-6 and IL-8 were the next predominantly expressed in markers among the samples. The higher expression rate of IL-8 was significantly (p<0.05) associated with patients having COPD GOLD III severity level and smoking history. Although HRV was the predominant virus detected the combined prevalence of Influenza A and B surpassing the rate of HRV. The high-level expression of well known inflammatory markers of AECOPD, TNF-α, IL-6 and IL-8 indicates a chronic severe illness. These markers play an important role and could be used as a marker for determining the severity of AECOPD.

Management of acute severe asthma and chronic obstructive pulmonary disease.

Management of acute severe asthma and chronic obstructive pulmonary disease.

Atrial electromechanical delay, neutrophil-to-lymphocyte ratio, and echocardiographic changes in patients with acute and stable chronic obstructive pulmonary disease.

Atrial electromechanical delay (AEMD) is the time interval between the beginning of P wave on surface electrocardiography and starting of the late diastolic wave on tissue Doppler imaging. We investigated the prolongation of AEMD, echocardiographic changes, and correlation of these findings with neutrophil-to-lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD). The study consisted of 105 (49 females and 56 males; mean age: 65.1 ± 9) patients with COPD exacerbation and 104 (21 females and 83 males; mean age: 64.8 ± 9.6) stable COPD outpatients. Demographics, body mass index, pulmonary function tests, and transthoracic echocardiography of the patients were evaluated. Echocardiography was performed in the first 6 h for stable COPD outpatients and in the first 24 h for COPD exacerbation patients. Diameters of right ventricle (RV), left ventricle (LV) and left atrium, aortic root diameters, left ventricular ejection fraction (LVEF), Emax, Amax, Emax/Amax, tricuspid annular plane systolic excursion (TAPSE), Ea, Aa, Ea/Aa, Emax/Ea, and tricuspid regurgitation velocity (TRV) were evaluated. AEMD measurements were obtained from lateral/tricuspid, lateral/mitral, and septal annulus from apical four-chamber views with tissue Doppler imaging and corrected for heart rate. Complete blood count including NLR was also assessed. The mean age of patients in exacerbation period (65.1 ± 9) was higher than the stable group (64.8 ± 9.6). RV basal and mid diameters (P < 0.001), Amax (P < 0.001), Ea tricuspid (P = 0.040), Aa tricuspid (P < 0.001), TRV, and systolic pulmonary artery pressure (P < 0.001) were higher; TAPSE and tricuspid Emax/Amax (P < 0.001) were significantly lower in patients with COPD exacerbation. LV end-diastolic diameter (P = 0.002) and LVEF (P = 0.005), Emax/Amax mitral (P < 0.001), Ea/Aa mitral (P < 0.001), and Ea/Aa septal (P < 0.001) were significantly lower; Amax mitral (P = 0.002), Aa mitral (P < 0.001), Aa septal (P < 0.001), and systolic motion mitral (P = 0.011) were significantly higher in patients with exacerbation. AEMD lateral/tricuspid (P < 0.001), lateral/mitral (P < 0.001), and septal (P < 0.001) were significantly higher in patients with COPD exacerbation. Neutrophil and lymphocyte count (P < 0.001) and NLR (P = 0.003) were significantly higher in the acute group. A weak correlation of NLR with LV end-diastolic diameter (P = 0.003; r = 0.357), Emax/Ea mitral (P = 0.019; r = 0.285), Emax tricuspid (P = 0.045; r = -0.244), and systolic motion septal (P = 0.003; r = 0.352) was detected in patients with stable COPD. In COPD exacerbation patients, prolongation of AEMD intervals was determined. Acute period of COPD may trigger atrial dysrhythmias including atrial fibrillation and flutter, multifocal atrial tachycardia, premature beats, and both systolic and diastolic dysfunctions frequently.

Investigation of an Unusual Crow Mortality Event in Jessore, Bangladesh, December 2018

After a report of an unusually high number of crow deaths in Jessore, Bangladesh, a multidisciplinary team investigated the event in December 2018 to identify the etiologic agent, and the source and extent of the outbreak. We interviewed students, teachers, live bird sellers, poultry farm owners and cleaners for fever and cough symptoms. We reviewed the hospital records for acute respiratory distress syndrome and chronic obstructive pulmonary disease. We observed live bird market practices, crow roosts and their feeding behavior, and collected cloacal and oropharyngeal swabs from moribund and dead crows, and pooled environmental samples from live bird markets (LBMs) and farms. All samples were tested for influenza A/H5, H7 and H9 by RT-PCR. The H5 prevalence was 77.4% in samples obtained from crow roosts. Among environmental samples from the LBMs, 11.1% were positive for H5 and 5.5% had co-infections with H5 and H9. Our results indicate that the H5 influenza virus is circulating in LBMs and was transmitted to crows through their feeding on the waste. We recommend that continuous surveillance in wild birds and LBMs is required to understand the virus’s evolution, transmission pathways and potential source of infection. Improved waste management practices in LBMs and public awareness are needed to reduce the risk and stop spillover of avian influenza virus to humans in Bangladesh.

Effect of a Multiorgan Focused Clinical Ultrasonography on Length of Stay in Patients Admitted With a Cardiopulmonary Diagnosis

There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs. This is a prospective, parallel-group, superiority, randomized clinical trial with a 1:1 allocation ratio. The study was conducted at The Royal Melbourne Hospital, a tertiary public hospital located in Melbourne, Victoria, Australia. Adults aged 18 years or older admitted to the internal medicine ward with a cardiopulmonary diagnosis were enrolled between September 2018 and December 2019 and were followed up until hospital discharge. Data analysis was performed from August 2020 to January 2021. The intervention involved an internal medicine physician-performed heart, lung, and 2-point vein compression FCU in addition to standard clinical evaluation. The primary outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. A difference of 24 hours was defined as clinically important. Secondary outcomes included hospital readmissions at 30 days and hospital care costs. A total of 250 participants were enrolled and 2 were excluded, leaving 248 participants (mean [SD] age, 80.1 [11.0] years; 121 women [48.7%]) in the final analysis. There were 124 patients in the intervention group and 124 patients in the control group. The most common initial diagnoses were acute decompensated heart failure (113 patients [45.5%]), pneumonia (45 patients [18.1%]), and exacerbated chronic pulmonary disease (32 patients [12.9%]). The length of hospital stay was 113.4 hours (95% CI, 91.7-135.1 hours) in the FCU group and 125.3 hours (95% CI, 101.7-148.8 hours) in the control group (P = .53). The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan FCU of the heart, lungs, and lower extremities veins during their initial clinical assessment, did not have a shorter hospital length of stay by more than 24 hours, compared with patients who received standard care. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12618001442291.

Ninety Day Post Discharge Outcome in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Using the PEARL Score.

Chronic obstructive pulmonary disease exacerbation is a leading cause of frequent hospitalizations imposing substantial global health burden. The 90 day post discharge period has been associated with higher readmission rates and substantial risk of death. The aim of this study was to assess post discharge 90 day outcome in patients admitted with acute Chronic obstructive pulmonary disease exacerbation using the PEARL score. A longitudinal study was conducted at Tribhuvan University Teaching hospital from February 2019 to November 2019. Patients admitted in respiratory ward with acute Chronic obstructive pulmonary disease exacerbation were stratified into low, intermediate and high risk groups using PEARL score and post discharge 90 day outcome was assessed. Data entry and analysis was done in SPSS version 20.0. Descriptive and inferential statistics were performed. A total of 102 patients were included for final analysis. Mean age of patients was 70.54 ± 10.85 years. There were 53.9% male. Intermediate and high risk PEARL groups had the highest proportion of readmission within 90 days of discharge which was found to be 23 (52.3%) and 9 (50%) respectively. High risk PEARL group had the highest proportion of death within 90 days (11.1%). The difference in these outcomes among three PEARL groups was found to be statistically significant (p-value < 0.05). PEARL score is a simple tool that can be applied at bedside in assessing 90 dayrisk of readmission or death in acute Chronic obstructive pulmonary disease exacerbation. This can be beneficial in post-discharge planning and early referral especially in resource limited health care setting where advanced facilities are not available.

718 Cardiac injury following immunization with mRNA SARS-CoV-2 vaccines

AimsCardiac involvement as myocarditis and/or pericarditis is now recognized as a rare but possible adverse event following SARS-CoV-2 mRNA vaccines. In this brief report we describe a series of four subjects: three of them with myocarditis and one with pericarditis probably due to hypersensitivity and developed in temporal association with COVID-19 mRNA vaccination.Methods and resultsDuring last summer, we observed a series of four young Caucasian male [median (range) age, 25 (18–32) years] presenting to the Emergency Department with severe acute chest pain within few days after second dose COVID-19 mRNA vaccine administration [median (range), 3 (2–5) days]. All of these were previously healthy and fitness males. All patients had abnormal electrocardiogram (EKG) and three of them had elevated high sensitive cardiac I troponin (hs-cTnI) levels. These latter three were diagnosed as having myocarditis and undergone cardiac magnetic resonance imaging (CMR). None had acute or prior COVID-19 or pulmonary disease on chest X-ray. Moreover, ischaemic injury, other infections, adverse drug reactions or any autoimmune diseases were excluded by appropriate tests. All patients underwent ecocardiography which showed preserved ejection fraction and no wall motion abnormalities and it excluded coronary origin abnormalities in each patient. The hospital course was uneventful for all four patients and they were discharged within few days of hospitalization [median (range), 6 (3–8) days] after a conservative treatment. The four patients met CDC criteria for probable myocarditis and pericarditis. To date, it is recognized a possible clinical correlation between cardiac injury and SARS-CoV-2 mRNA vaccination. The following elements support this hypothesis: (i) short time lapse between vaccine administration and symptoms onset; (ii) onset after the second dose suggesting an immune-mediated pathogenesis needing a previous sensibilization; (iii) exclusion of other possible damage causes (ischaemia, infections, other immune-mediated diseases, toxicity). In particular, we did not perform coronary angiography given the low pre-test probability of coronary heart disease. Although compending a small sample, our report includes a patient series with clinical features similar to those frequently encountered into other papers: i.e. a prevalence in young males without risk factors; symptoms onset within few days second dose administration; an eventful clinical course. This benign course, seen in the majority of cases in literature, raises the question of the need for specific therapy or an empirical one for symptoms control only. Our report suggest that possible cardiac involvement can range from isolated pericarditis to myocarditis with significant hs-cTnI raise and signs of acute inflammation at CMR or even a myocardial injury with a mild hs-cTnI raise in absence of pathological signs at CMR. This latter case suggests also a possible cardiac injury with subclinical course.ConclusionsTo date, we are observing a temporal association linking mRNA SARS-CoV-2 vaccines administration and cardiac involvement. According to the majority of papers, our experience suggests an acute benign course of such cardiac involvement; a longer follow-up will also reveal a long-term benign course or conversely the presence of any sequelae. Clinicians should adequately inform patients when receiving vaccine to ensure prompt symptoms recognition and consequently put in place the best management of myocarditis/pericarditis. Finally, it is important to keep in mind that the benefits of vaccines far outweigh the risks.

A Failed CCHD Screen.

A Failed CCHD Screen.

Pricing air pollution: evidence from short-term exposure to air pollution on hospitalization of acute bronchitis and chronic obstructive pulmonary disease in southwestern China.

Existing evidence suggests that ambient air pollution has serious adverse effects on respiratory diseases, yet there is little direct evidence from China regarding corresponding economic losses. Here we quantified air pollution-related acute health effects and related economic losses of the most common two respiratory diseases in southwestern China, acute bronchitis and chronic obstructive pulmonary disease (COPD). We applied a distributed lag non-linear model to analyse the relationship between ambient air pollutants and hospital admissions of acute bronchitis and COPD, then applied the cost of illness method to explore the attributing economic burden. During the study period, 528 334 and 99 419 hospital admissions of acute bronchitis and COPD, respectively, were recorded. As a result, during the study period the total hospitalization economic losses attributable to air pollution were 486.40 and 254.74 million yuan for acute bronchitis and COPD, respectively, accounting for 0.015% of local gross domestic product. Our research provides intuitive evidence on the health and economic impacts of short-term exposure to air pollution, which is a key basis for the formulation of environmental policies.

Non-Contact Spirometry Using a Mobile Thermal Camera and AI Regression.

Non-contact physiological measurements have been under investigation for many years, and among these measurements is non-contact spirometry, which could provide acute and chronic pulmonary disease monitoring and diagnosis. This work presents a feasibility study for non-contact spirometry measurements using a mobile thermal imaging system. Thermal images were acquired from 19 subjects for measuring the respiration rate and the volume of inhaled and exhaled air. A mobile application was built to measure the respiration rate and export the respiration signal to a personal computer. The mobile application acquired thermal video images at a rate of nine frames/second and the OpenCV library was used for localization of the area of interest (nose and mouth). Artificial intelligence regressors were used to predict the inhalation and exhalation air volume. Several regressors were tested and four of them showed excellent performance: random forest, adaptive boosting, gradient boosting, and decision trees. The latter showed the best regression results, with an R-square value of 0.9998 and a mean square error of 0.0023. The results of this study showed that non-contact spirometry based on a thermal imaging system is feasible and provides all the basic measurements that the conventional spirometers support.

Evaluating the glucagon-like peptide-1 receptor in managing asthma.

The aim of this study was to discuss the role of glucagon-like peptide-1 (GLP-1) receptor signalling in reducing lung inflammation and potential use for GLP-1 receptor agonists (GLP-1RAs) in management of asthma. Although GLP-1RA are currently used for the treatment of type 2 diabetes (T2D) and weight loss in obesity, there is much interest in expanding the indications for use in other diseases, including inflammatory pulmonary disease. In animal models of both acute and chronic pulmonary disease, use of GLP-1RA reduces airway inflammation, obstruction and fibrosis. In particular, GLP-1 receptor (GLP-1R) signalling seems to inhibit allergen-induced type 2 inflammation, making it an attractive agent for asthma. Results are especially promising in disease processes with disturbed metabolic regulation, such as T2D or metabolic syndrome. Retrospective clinical studies demonstrate promising evidence for the use of GLP-1RAs in comorbid diabetes and asthma, although prospective human studies are limited. Here, we discuss the biology of GLP-1 and GLP-1R signalling, review the preclinical and mechanistic evidence for how GLP-1R signalling may reduce pulmonary inflammation, and summarize recent and upcoming clinical studies. Ultimately, targeting GLP-1R signalling may represent a novel approach for asthma therapy that is glucocorticoid sparing and possibly disease modifying.

Evaluating the Benefits of Viral Respiratory Panel Test in the Reduction of Emergency Department Throughput Time for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

IntroductionThere has been a widespread antibiotic prescription in the Emergency Department (ED) among patients presenting with acute exacerbation chronic obstructive pulmonary disease (AECOPD) irrespective of the causative agent of the disease. The viral respiratory panel (VRP) test is designed to detect viral pathogens in the respiratory tract, which may contribute to the exacerbation of chronic obstructive pulmonary disease (COPD), as the upper and lower respiratory tract infections are caused by a broad range of microbes and not only bacteria. The aim of this study is to weigh the benefits of obtaining a VRP in patients presenting with isolated symptoms pertaining to well-defined criteria of an AECOPD with preexisting COPD or reactive airway disease to find out how such test impacts patient throughput time in the ED and also investigate how obtaining a VRP affects the use of antibiotics in this patient population. It is important that ED physicians accurately diagnose the main cause of AECOPD to help optimize the use of health care resources, including antibiotics, antivirals, inpatient, and ED beds. VRP testing must be taken into consideration as it helps eliminate the need of administering antibiotics to every patient who presents to the ED with AECOPD.Design and methodThis is a case-control observational study using retrospective chart review to obtain patients’ data from our hospital data warehouse. Data on patients with the primary diagnosis of AECOPD in the past two years were retrieved. A comparison between those who had VRP on arrival in the ED and those who did not have a VRP obtained was performed. We also compared ED throughput time for patients with AECOPD who received antibiotics to those who did not receive antibiotics. Only patients between the ages of 18 and 64 were included in the study. Patients with other preexisting health conditions such as cardiac diseases, neurological problems, and abdominal complaints were excluded. Patients who required hospitalization and pregnant patients were excluded from the study.ResultsWe collected the data of 340 patients who met the study criteria. Of the 340 patients enrolled, 65 (19%) received the VRP test and 275 (81%) did not receive VRP test. Among the 65 patients who received the VRP test, 45 (70%) had a virus etiology detected and reported in the ED (p=0.001). Also, 138 (50.2%) did not receive VRP test and were not given antibiotics, and 137 (49.8%) did not receive VRP test but were treated with antibiotics; 11 patients received antibiotics despite haven tested positive to a virus. The result showed that those who received antibiotics with no VRP test on arrival in the ED had a shorter throughput time compared to patients who did not receive antibiotics but received VRP test.ConclusionThe study is a quality improvement study to help determine the efficacy and appropriateness of ordering a VRP prior to ED disposition and the impact of overall ED throughput time for each patient presenting with AECOPD. The study showed that antibiotics did play a significant role in the duration of the throughput time in patients with AECOPD. However, rapid VRP testing was indeed associated with a trend toward decreased antibiotic use in the ED.