Chronic Obstructive Disease Research Articles

Respiratory comorbidities. Looking ahead to new glaucoma risk factors

AbstractPurpose: Open‐Angle glaucoma (OAG) continues being the first cause of irreversible blindness worldwide. Recent advances in biotechnology did not cover all needs for avoiding glaucoma neurodegeneration (GND) and its high socioeconomic burden. Revisiting OAG risk factors, (including respiratory comorbidities), is mandatory to optimize OAG managing.Methods: A total of 412 participants were recruited in a prospective nationwide study (Spain and Portugal) according to strict inclusion/exclusion criteria, and classified into: OAG patients (n = 214) and ocular hypertension (OHT) subjects (n = 198). Sociodemographic, personal characteristics/lifestyle, and comorbid respiratory disorders were recorded. Among the latter asthma, chronic obstructive pulmonar disease (COPD) and sleep apnea/hypopnea syndrome (SAHS). Statistical processing was done by RStatistics v4.1.2 and RStudio v2021.09.1.Results: Mean age and gender distribution were: 62 years and 49% men (OAG group) and 61 years and 61% men (HTO group). Univariant analysis reflected that smoking and COPD (p < 0.001) were significantly different between groups. Logistic regression of all variables showed that asthma (p = 0.003) and COPD (p = 0.035) were the most statistically significant characteristics between groups. When eliminating the outlier variables, the logistic regression displayed that asthma (p = 0.002) and COPD (p = 0.05) were the most discriminative parameters between groups. The SAHS did not show statistical significance.Conclusions: Data from this population strongly indicated that in addition to traditional OAG risk factors, asthma, COPD, and smoking habit can be considered detrimental to the OAG course.

Neurogenic bladder dysfunction in spina bifida: a case report and a brief review of the literature

Spina bifida is a developmental defect of the spinal cord and/or spinal cord that results from abnormal closure of the embryonic neural tube. Many factors have been described to determine the risks of developing this pathology, but the incidence of the defect is still high. 61% of patients with spina bifida have neurogenic bladder dysfunction based on intravesical hypertension, which contributes to reverse urethral flow and vesico-uretero-renal reflux, associated with chronic inflammatory and obstructive diseases of the urinary tract. Between 25-50% of patients with spina bifida develop chronic kidney disease, significantly reducing their quality of life. In some types of Spina bifida, urological symptoms may be prominent and indicate the presence of this malformation. Therefore, early diagnosis of Spina bifida and timely prophylactic and therapeutic measures are particular importance. This article describes a clinical case of Spina bifida posterior L1-L2 with a closed L1-L2 meningocele in which urological symptoms were the dominant manifestation. The development of secondary complications of neurogenic bladder in the presented patient cannot be excluded, which requires closer monitoring.

Might Dog Walking Reduce the Impact of COPD on Patients' Life?

Low levels of physical activity (PA) lead to a worsening of physical condition and contributes to multimorbidity in Chronic Obstructive Respiratory Disease (COPD). Unsupervised PA related to dog ownership may contribute to reducing sedentary behavior. We aimed to investigate the relationship between dog walking, patient-reported outcomes (PROs) and exacerbations in COPD. A pre-defined sample of 200 COPD patients (dog owners and non-dog owners) with symptomatic COPD was sourced from a database representative of the Italian population. A computer-assisted personal interview was used to assess health status impairment (CAT), fatigue (FACIT), health-related quality of life (HRQoL) (EQ-5D), and PA frequency. In the whole sample, PA was associated with better CAT, EQ-5D, VAS, FACIT scores and reduced number of exacerbation (p < 0.001). Under the same CAT scores, dog-walking duration was associated with a better HRQoL (EQ5D, p = 0.015) and less fatigue (FACIT, p = 0.017). In an adjusted regression model, walking dogs >30 min was associated with lower fatigue (FACIT) than having no dogs and walking dogs <15 min (p = 0.026 and p = 0.009, respectively). Motivation related to dog walking could modify patients' tendency to focus on symptoms during PA and, therefore, to perceive the fatigue. Dog walking may be effective for increasing and maintaining regular PA, reducing the subjective impact of COPD.

Evaluation of the Advantages of Myocardial Blood Flow Index in the Diagnosis of Chronic Obstructive Coronary Artery Disease Versus Coronary Computed Tomography Angiography: A Feasibility Study

Background: There is a hidden relationship between the degree of coronary artery stenosis and downstream myocardial remodeling. The mutual influence in myocardial ischemia and myocardial remodeling provides an index for quantifying the myocardial blood flow based on the principles of physics. Objectives: This study aimed to evaluate the advantages of myocardial blood flow index (MBFI) in the diagnosis of chronic obstructive coronary artery disease (CAD). Patients and Methods: The data of 68 patients (39 males; mean age: 57.0 ± 10.20 years) with suspected CAD were analyzed retrospectively, including the imaging findings of coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within one week. The MBFI was also calculated for the patients. After determining the optimal cut-off value based on ICA (stenosis ≥ 70%) as the gold standard test, the diagnostic performance of MBFI and CCTA was compared. The diagnostic accuracy was examined by the receiver operating characteristic (ROC) curve. For statistical analysis, chi-square test was performed to analyze influence data, and a P-value less than 0.05 was considered statistically significant. Results: In 68 cases evaluated in this study, the average scan dose of CCTA was 3.02 ± 1.15 millisievert (mSv). There were 28 cases with stenosis ≥ 70%. The optimal cutoff value of MBFI and CCTA was 0.111 and 70%, respectively. Also, the area under the curve (AUC) for MBFI and CCTA was 0.857 and 0.621 (Z = 2.091, P = 0.0365), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 92.31%, 92.86%, 88.89%, and 95.12% for MBFI and 61.54%, 78.57%, 64.00%, and 76.74% for CCTA, respectively. The diagnostic accuracy was also estimated at 92.65% for MBFI and 72.06% for CCTA (χ2 = 9.844, P = 0.0017). Conclusion: In this study, MBFI performed better than CCTA in identifying lesions with stenosis ≥ 70%. A lower MBFI indicated the need for an upcoming active intervention, while a higher MBFI suggested avoiding unnecessary invasive testing.

Systematic Review and Meta Analysis on Symptoms and Comorbidities Associated with COVID-19 Disease

Corona disease outbreak occurred in 2019 from Wuhan, China and the virus was identified to be a member of the Coronaviridae family. The disease was named as COVID-19 by WHO. It started as an epidemic and later turned into pandemic affecting world wide. The present study was aimed to conduct a systematic review on most prevalent symptoms associated with COVID-19 and to perform a Meta analysis on Comorbidities associated with COVID-19 and assess its severity in underlying conditions. A literature search was conducted using search engines like Pubmed, Web of Science, Elsevier COVID-19 and LitCovid databases between January 2020 and August 2020. Forest plot analysis was done using Random effects model to estimate odds ratio and 95% confidence interval estimate. 83 papers with a sample size of 19,454 were analysed statistically after adopting inclusion and exclusion criteria. Our results showed the most prevalent symptoms to be Cough, fever, dyspnoea and myalgia in interval plot analysis. When assessed for comorbidities, Hypertension (27.02%), Diabetes (16.61%), Cardiovascular disease (12.75%) and Chronic pulmonary obstructive diseases(19.9%) are found to be the most risk factors in comparison with others. However, a finer experimental research needs to be confirmed with the findings.

Cardiovascular Disease and its Risk Factors: Frequency in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the respiratory conditions which is indicated by persistent airflow obstruction. It is linked with various different comorbidities. Ischemic heart disease (IHD) is reported to be the most recurring in patients with COPD. Its impact in context of patient's exercise capacity, health status and manifestation of symptoms is poorly understood. The objective of my study is to ascertain the frequency of ischemic heart disease in patients with chronic obstructive pulmonary disease and to evaluate current magnitude of the problem in our local population. It a cross sectional study conducted in Department of Pulmonology, Nishtar Hospital Multan. Patients with COPD (as defined in Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria 2021) with duration of more than 3 months were taken in the study. Of these 212 study cases, 127 (59.9 %) were male patients while 85 (40.1 %) were female patients. Mean age of our study cases was 56.75 ± 6.78 years. Diabetes was present in 57 (26.9 %), Dyslipidemia in 43 (20.3%), hypertension in 98 (46.2%) our patients and 29 (13.7 %) were obese. Smoking was noted in 100 (47.2 %). Ischemic Heart disease was present in 57 (26.9%) of our study cases. High frequency of ischemic heart disease was noted in patients with chronic pulmonary obstructive disease in our study. Ischemic Heart Disease was significantly linked with male gender, increasing age, diabetes, hypertension, obesity, and family history for IHD and dyslipidemia.

SARS-COV-2 Pandemic for Patients with Chronic Obstructive Peripheral Arterial Disease: Impact of Interruption to Access According to Gender in a Single Center Experience

This retrospective study aims to evaluate the impact of interrupted services for peripheral arterial disease (PAD) patients and especially women in a single north-eastern Italian center over a period of 3months prior to the pandemic, during the first (2020) and the second (2021) wave of contagion in northern Italy. Patients with PAD at Rutherford stages 3 to 6 that required revascularization between March 2019 and March 2021 were classified into 3 groups, according to the period of treatment: the prepandemic period, the pandemic-20 period, and the pandemic-21 period. Twenty-eight patients were treated in the prepandemic period, 21 in the pandemic-20 period, and 39 in the pandemic-21 period. It was observed that in the both pandemic periods patients presented with more severe stages of limb ischemia, Rutherford 5 and 6 stages. During pandemic-20, patients underwent mostly open surgery, followed by hybrid procedures. No differences were observed between the 3 groups in major amputations, length of hospital stay, type of discharge, limb salvage and mortality. During long-term follow-up, limb salvage appeared to be significantly better in the pandemic-21 group. The gender analysis revealed a significantly reduced female proportion of overall treated patients in 2020 and 2021 compared to the prepandemic period. In the pandemic-20 this difference appears even more evident since treatments on females represented 19% of the total while in the same period of the previous year the male/female percentage was comparable (54% vs. 46%). The women admitted presented higher stages of disease and tended to have a longer hospital stay than men. At 12-month follow-up, limb salvage was similar between the 2 genders but was slightly worse in women. An efficient reorganization of the vascular surgery services during the pandemic period guaranteed the quality and standard of treatment offered in the preceding periods. Among patients suffering from PAD the impact of the pandemic was greater for the female gender. It is therefore important that in addition to a reorganization of hospital services to provide adequate care for patients with ACOP in the pandemic period, greater information and awareness of women.

Assessment of extrafine beclomethasone/formoterol for the treatment of chronic obstructive pulmonary disease: A non-interventional study in a Bulgarian population

BackgroundThe beneficial effects of application of a fixed dose beclomethasone dipropionate (BDP) and formoterol fumarate (F) for the treatment of severe chronic obstructive disease (COPD) has been amply proven in well controlled clinical trials. Whether this also holds for real-world conditions and in such a heterogeneous patient population as is encountered in Bulgaria remained to be investigated. MethodsIn an observational, non-interventional study, 441 Bulgarian patients with severe COPD who were enrolled at 36 sites across the country received extrafine BDP/FF-combination therapy using the NEXThaler® DPI or the Foster® pMDI over a period of 16 weeks. At visits at the beginning, after 4 weeks and at the end of the study, alterations in lung function parameters FEV1 and FVC, disease symptoms, changes in CAT score, and patient distribution in GOLD 2017 categories A through D were assessed. ResultsA large share of the Bulgarian patients with severe COPD suffered from serious comorbidities, received additional medication, and about 2/3 were former or current smokers. Extrafine BDP/FF caused an increase in mean FEV1, FVC, a decrease of health impact as assessed by the CAT score, and a considerable shift of the share of category C and D patients towards A and B. In addition, the percentage of patients that were free of symptoms impacting everyday life such as fatigue and shortness of breath at rest increased throughout the study. A comparison of both application devices indicated that the NEXThaler® was superior in terms of lung functional aspects, as these parameters displayed a constant improvement over the observation period, whereas they plateaued at week 4 when using the pMDI. ConclusionsThe therapeutic benefits of extrafine BDP/FF known from clinical trials could also be observed in a real-world setting, even in such a heterogenous patient population as the Bulgarian. The NEXThaler® appeared to be highly efficient in this setting, opening a new choice for the lung specialist and the patient to select the one device considered most suitable and practical.

Beta-blockers in acute coronary syndrome: does rhythm matter?

Abstract Introduction Beta-blockers (BB) are recommended in patients with previous acute myocardial infarction (AMI), aiming to reduce morbidity and mortality. Their benefit is greater in patients with associated left ventricular dysfunction. However, in patients with atrial fibrillation (AF) its prognostic benefit is controversial. Purpose To assess and compare the in-hospital and 1-year prognostic impact of BB prescription after acute coronary syndrome (ACS), in patients with previous or de novo AF, and in patients with sinus rhythm (SR). Methods This was a national multicentre retrospective study of patients hospitalized for ACS between October 2010 and December 2021. A total of 35279 patients was included, and divided in two groups according to the prescription or not of BB. Patients with previous history of ischemic heart disease (myocardial angina, AMI or coronary revascularization) or heart failure, as well as presenting in Killip class IV or submitted to coronary artery bypass graft during admission were excluded. The impact of BB prescription on in-hospital and 1 year mortality rates, in patients with AF versus SR, was compared. Results A total of 14906 patients was selected, 82.5% with and 17.5% without BB prescription. Most patients were in SR (90.2%), with 9.8% presenting previous or new-onset AF. Patients without BB prescription were older (67±14 vs. 63±13 years) and had more comorbidities, namely valvular disease (2.3% vs. 1.2%, p<0.001) and chronic pulmonary obstructive disease (7.1% vs. 3.1%). The mean left ventricular ejection fraction was 53±13% in patients without BB prescription and 52±11 in the group with BB prescription (p<0.001). In-hospital and after discharge BB prescription was less frequent in AF patients (80.2% vs. 82.5% and 74.7% vs. 78.8%, respectively). The in-hospital mortality rate was 2.2%, 1.3% in the BB group and 6.6% in patients without BB prescription (p<0.001). At 1 year, mortality rate increased to 5.1%. BB prescription was associated with lower in-hospital mortality rate regardless of the rhythm, with an 81% risk reduction in SR (OR = 0.19, 95% CI 0.14–0.24) and 79% in AF patients (OR = 0.21, 95% CI 0.13–0.35). In a multivariate regression analysis, after adjusting for all the possible confounders, in-hospital BB prescription was associated with 70% of mortality risk (OR = 0.30, 95% CI 0.23–0.35). Overall, after discharge BB prescription was associated with reduced 1-year mortality risk (HR = 0.57, 95% CI 0.44–0.73), although it didn't reach statistical significance in AF patients (p=0.413). Nevertheless, in a bivariate Cox regression, rhythm showed no impact on BB protective effect (p-interaction = 0.335). As expected, AF had a negative prognostic impact (HR = 3.85, 95% CI 2.66–5.02). Conclusion BB prescription was associated with reduced in-hospital and 1 year mortality rates. The prognostic benefit of BB therapy was equivalent in ACS patients in sinus rhythm and with previous or new-onset AF. Funding Acknowledgement Type of funding sources: None.

Targeted AntiBiotics for Chronic pulmonary diseases (TARGET ABC): can targeted antibiotic therapy improve the prognosis of Pseudomonas aeruginosa-infected patients with chronic pulmonary obstructive disease, non-cystic fibrosis bronchiectasis, and asthma? A multicenter, randomized, controlled, open-label trial

BackgroundPseudomonas aeruginosa infection is seen in chronic pulmonary disease and is associated with exacerbations and poor long-term prognosis. However, evidence-based guidelines for the management and treatment of P. aeruginosa infection in chronic, non-cystic fibrosis (CF) pulmonary disease are lacking. The aim of this study is to investigate whether targeted antibiotic treatment against P. aeruginosa can reduce exacerbations and mortality in patients with chronic obstructive pulmonary disease (COPD), non-CF bronchiectasis, and asthma.MethodsThis study is an ongoing multicenter, randomized, controlled, open-label trial. A total of 150 patients with COPD, non-CF bronchiectasis or asthma, and P. aeruginosa-positive lower respiratory tract samples will be randomly assigned with a 1:1 ratio to either no antibiotic treatment or anti-pseudomonal antibiotic treatment with intravenous beta-lactam and oral ciprofloxacin for 14 days. The primary outcome, analyzed with two co-primary endpoints, is (i) time to prednisolone and/or antibiotic requiring exacerbation or death, in the primary or secondary health sector, within days 20–365 from study allocation and (ii) days alive and without exacerbation within days 20–365 from the study allocation.DiscussionThis trial will determine whether targeted antibiotics can benefit future patients with chronic, non-CF pulmonary disease and P. aeruginosa infection in terms of reduced morbidity and mortality, thus optimizing therapeutic approaches in this large group of chronic patients.Trial registrationClinicalTrials.gov NCT03262142. Registered on August 25, 2017.

Possibilities of respiratory rehabilitation in correction of small airway dysfunction

Introduction. It is now recognized that small airway dysfunction is a component of the development of chronic obstructive diseases. The damage of the small airways is characteristic of certain phenotypes of bronchial asthma and chronic obstructive pulmonary disease, which determines the characteristics of the clinical manifestations of the disease and requires a personalized approach to treatment.Aim. Summarizing the data of domestic and foreign researchers on the possibility of using non-drug methods of rehabilitation of chronic obstructive diseases in terms of their impact on the small airways.Materials and methods. The review uses data from articles published in PubMed, Google Scholar, eLIBRARY.Results. The article presents modern methods for assessing small airways. The choice of criteria and the complexity of diagnosing small airway dysfunction at the stage of rehabilitation treatment are discussed. The effectiveness of the use of natural and preformed physical factors in the rehabilitation treatment of chronic obstructive pulmonary diseases has been shown. The authors analyze the influence of physiotherapeutic factors on the dynamics of spirometry parameters, indirectly indicating the state of small airways. The preferred choice of inhalation preparations with extrasmall sizes of medicinal particles penetrating into the distal respiratory tract is shown. The influence of natural and preformed physical factors on the small airway dysfunction in chronic obstructive pulmonary diseases is highlighted.Conclusion. Literature data suggest a positive effect of pulmonary rehabilitation methods on the small airway dysfunction. Further studies are required to study the mechanisms of action of physiotherapeutic factors on the peripheral parts of the respiratory tract and the development of targeted medical technologies.

Analgesia-based Sedation for Oral Surgery in Patients With Chronic Respiratory Obstructive Disease.

Chronic obstructive pulmonary disease (COPD) is a risk factor for postoperative cardiovascular and respiratory complications. Thus, intravenous sedation can be a better option than general anesthesia for surgery in patients with severe COPD. Herein, we present 2 cases of analgesia-based sedation in patients with severe COPD who underwent oral surgery. The current study aimed to discuss these cases to provide knowledge about the appropriate sedation management in patients with this disease. In the current cases, the patients received sufficient analgesia and minimum sedation (analgesia-based sedation). Moreover, dexmedetomidine was used for maintaining sedation and fentanyl for analgesic effects. Furthermore, we focused on providing the maximum analgesic effect of local anesthesia. The patients' vital signs were stable. They did not have any psychological or physical complaints, such as anxiety and pain, during the procedure. Then, they were discharged from the hospital without any complications. Thus, analgesia-based sedation can be an alternative option for oral surgery in patients with COPD.

COVID-19 Pneumonia in Fully Vaccinated Adults during the Dominance of the Omicron Sublineages BA.1.1 and BA.2 in Mexico.

Background and Objectives: A nationwide retrospective cohort study was conducted to evaluate the factors associated with the risk of laboratory-confirmed coronavirus disease 2019 (COVID-19)-related pneumonia in fully vaccinated adults during the dominance of the Omicron sublineages in Mexico. Materials and Methods: Fully COVID-19-vaccinated adults with laboratory-positive illness and symptom onset from April to mid-June 2022 were eligible. We computed the eta-squared (η2) to evaluate the effect size of the study sample. The characteristics predicting pneumonia were evaluated through risk ratios (RRs), and the 95% confidence intervals (CIs) were computed through generalized linear models. Results: The data from 35,561 participants were evaluated, and the overall risk of pneumonia was 0.5%. In multiple analyses, patients aged ≥ 60 years old were at increased risk of developing pneumonia (vs. 20–39 years old: RR = 1.031, 95% CI = 1.027–1.034). Chronic pulmonary obstructive disease, type 2 diabetes mellitus, arterial hypertension, chronic kidney disease (any stage), and immunosuppression (any cause) were also associated with a higher pneumonia risk. The η2 of all the variables included in the multiple models was <0.06. Conclusions: Our study suggests that, even when fully COVID-19-vaccinated, older adults and those with chronic conditions were at increased risk of pneumonia during the dominance of the Omicron sublineages BA.1.1 and BA.2.

Early risk stratification of mortality in the geriatric patients who are at high risk for bleeding and fall from a ground level: an analysis of the national data.

The purpose of the study is to identify the risk factors of mortality early in patients who have history of using of anticoagulants or coagulopathy and sustained a ground level fall (GLF). The American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) dataset of the calendar year 2013 through 2016 was accessed for the study. All elderly patients ≥ 65 years old, who were taking an anticoagulant and suffered from a GLF, were included in the study. Other patient characteristics included: sex, race, initial systolic blood pressure (SBP), hypotension (SBP less than 110 mmHg), Injury Severity Score (ISS), Glasgow Coma Scale (GCS) Score, comorbidities such as hypertension (HTN), congestive heart failure (CHF), chronic renal failure (CRF), chronic pulmonary obstructive disease (COPD) and cirrhosis. Multivariable analysis was performed to develop the risk model. A total of 10,368 patients qualified for the study. Of this total, 788 (7.6%) patients died. The median [IQR] age of the patients was 80 [75-85] years. More than 90% of the patients were white. Fifty-four percent of the patients were female. Approximately 8% of the patients presented with hypotension at the time of hospital arrival. Multivariable analysis showed advanced age, male gender, high ISS, low GCS, presence of hypotension, CHF, CRF, COPD and cirrhosis were highly significant for odds of mortality. Approximately 8% of the patients, who took an anticoagulant or had a history of coagulopathy and sustained a GLF, died. Certain demographics, higher injury severity and a few comorbidities were highly associated with in-hospital mortality.

Blacks’ Diminished Salience of Age as a Determinant of Chronic Obstructive Respiratory Disease

Background: Age is a major determinant of chronic respiratory disease (CRD). This is important because CRD have a main role in shaping morbidity and mortality of individuals and populations. However, less research is done on whether age-related changes in development of CRD differ across diverse racial groups. Objectives: Using a conceptual model that considers race as a proxy of racism rather than genetics and attributing racial differences to sociological rather than biological differences, this study was conducted to explore racial differences in the effects of age on CRD. Based on Marginalization-related Diminished Returns (MDRs) framework, we expect diminished relevance of risk and resources for marginalized people due to racism, segregation, and social stratification. Methods: Using data from baseline population assessment of tobacco and health (PATH) Adults data, we included 23761 adults. The independent variable was age treated as a categorical variable. The primary outcome was presence of any CRD including asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). Sex and education were the covariates. Race, as a proxy of racism, was the moderator. To analyze the data, we used logistic regression mode with and without interaction term between age and race. Results: Higher age was associated with higher odds of CRD, while sex, and socioeconomic status (SES) was controlled. In line with the MDRs framework, the positive association between age and CRD was weaker for Black than White adults. Conclusion: Under racism, age loses some of its effect as a major determinant of CRD across racialized groups

QUALITY OF LIFE AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE ATTENDING IN MEDICAL OPD OF CHITWAN MEDICAL COLLEGE, CHITWAN

Background: Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide which can severely impair the individual’s quality of life. The study aimed to assess the quality of life of patients having chronic obstructive pulmonary disease. Methods: A cross-sectional hospital-based study was conducted in medical OPD of Chitwan Medical College. Purposive sampling technique was used to select 203 patients with chronic pulmonary obstructive disease for at least 3 months. Data were collected from July 16, 2021 to January 14, 2022 using a WHO Quality of Life Scale-Brief through face-to-face interview. Transformation of the scores was done to standardize the raw scores by using the formula applied for linear transformation is as follows: [(Actual raw score - Lowest possible raw score)/Possible raw score range]*100. Results: The mean score and standard deviation of total QOL was 40.64 ± 18.41, where 52.23 ± 13.68 for physical, 47.84 ± 9.70 for psychological, 66.63 ± 9.25 for social and 54.62 ± 13.44 for environment domain showing higher impairment in psychological. Sex (0.031), type of family (0.042), educational status (&lt;0.001), smoking habit (0.005) and duration of COPD (&lt;0.001) were found statistically significant with total QOL of COPD patient. Conclusions: This study showed an impaired quality of life in COPD patients. Longer disease duration and smoking habit of patient impacted negatively on their QOL. Hence, attention should be paid by health professional for enhancing QOL by addressing those factors while treating them in health care setting.

Options in the treatment of superficial and deep venous disease in patients with Klippel-Trenaunay syndrome

ObjectiveKlippel-Trenaunay syndrome (KTS) is a congenital mixed mesenchymal malformation syndrome that includes varicose veins, capillary and venous malformations, lymphatic abnormalities, and hypertrophy of various connective tissue elements. The purpose of the present study was to describe the clinical characteristics and outcomes in a subset of patients with KTS in whom venous interventions, including iliofemoral venous stenting, were performed after failure of conservative therapy. MethodsA single-center retrospective data review of 34 patients with KTS who had undergone interventions for venous disease between January 2000 and December 2020 was performed. ResultsTheir mean age was 38.4 ± 17.5 years (range, 12-80 years). No gender predilection was found. Of the 34 patients, 61% had had all three features of the classic triad for KTS. Varicose veins were present in all 34 patients (100%), and 30% had had a history of bleeding varicosities. Most patients (79%) had CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) class ≥C4. Of the 34 patients, 30% had a history of deep vein thrombosis and/or pulmonary embolism. Factor VIII elevation was the most common thrombophilia condition (12%). The venous filling index was elevated at baseline (5.9 ± 5.1 mL/s) and did not normalize despite intervention (3.5 ± 2.3 mL/s; P = .04). The superficial venous interventions (n = 35) included endovenous laser therapy; stripping of the great saphenous vein, small saphenous vein, anterior thigh vein, or marginal vein; ultrasound-guided sclerotherapy; and stab avulsion of varicose veins. One coil embolization of a perforator vein was performed. Deep interventions (n = 19) included endovenous stenting (n = 15), popliteal vein release (n = 3), and valvuloplasty (n = 1). The venous clinical severity score had improved from 9.4 ± 4.5 to 6.2 ± 5.6 (P = .04). The visual analog scale for pain score had improved from 5.5 ± 2.7 to 2.5 ± 3.3 (P = .008). Healing of ulceration was noted in 75% of the patients. Significant improvements in the total pain (P = .04) and total psychological (P = .03) domains were noted in the 20-item chronic venous disease quality of life questionnaire. ConclusionsSuperficial and deep venous interventions are safe and effective in patients with KTS when conservative therapy has failed. Iliofemoral venous stenting is a newer option that should be considered in the treatment of chronic deep venous obstructive disease in patients with KTS in the appropriate clinical context. An aggressive perioperative deep vein thrombosis prophylaxis protocol should be in place to reduce thromboembolic complications in these patients.

THE INFLUENCES OF KNOWLEDGE LEVEL BEHAVIOUR AND ATTITUDE IN SELECTING TYPE OF POWDER ON THE INCIDENCE OF ACNE VULGARIS IN BANYUMAS REGENCY

Background: Acne vulgaris is a chronic obstructive and inflammatory skin disease. It occurs in almost all adolescents with a prevalence of 90%. Pathogenesis of Acne vulgaris is estimated to be related to several triggering factors such as food by 23.2%, stress by 26.4%, hormones by 32.7% and use of cosmetics by 47.3%. Powder is the most widely used cosmetic in the long term and one of the causes of Acne vulgaris which causes occlusion of pores on the skin surface. In the content of powder that causes acne vulgaris because there are comedogenic ingredients such as lanolin. Methods: This study was an observational study with data collection techniques using cluster sampling and sampling technique by accidental sampling. Results: The level of knowledge of women in the Banyumas Regency was dominated by the high category as many as 64 respondents (64.0%). The incidence of acne vulgaris out of 100 respondents, 67 (67.0%) of respondents had mild acne vulgaris, 22 respondents (22.0%) had moderate acne vulgaris and 1 respondent (1.0%) had severe acne vulgaris and the rest had no acne vulgaris. Chi-square analysis showed that there was a relationship between knowledge with behavior and attitude in choosing the type of powder to the incidence of acne vulgaris as evidenced by the p value of each variable, namely 0.044 and 0.028 (p &lt;0.05). Conclusion: the level of knowledge with behavior and attitude in choosing the powder type had a significant relationship to the incidence of acne vulgaris in women in Banyumas Regency.

The Comorbidities And Clinical Profile Of Chronic Obstructive Lung Disease Patients Attending Tertiary Care Hospital

Background: Chronic pulmonary obstructive disease (COPD) has been responsible for the decreased quality of life as well as increased morbidity and mortality. The objective of the present study was to observe the comorbidities and clinical profile of patients with chronic pulmonary obstructive disease at a tertiary care center.&#x0D; Methods: The data were collected from 80 COPD patients presenting to OPD of the pulmonary medicine department from August 2021 to January 2022. The data were extracted from a medical case sheet and for statistical analysis, MS Excel was used.&#x0D; Results: As the age increased the prevalence of COPD increased and the highest was found to be in the age group above 60 years of age. Males were more affected by COPD as compared with females. The smokers were more compared to the nonsmokers. The prevalence of smoking among COPD was noted to be 60% compared to 40% as non-smokers. The most common clinical feature was breathlessness 100% followed by cough 95%. 15% of the cases of copdhad Hypertension as the comorbidity.&#x0D; Conclusion: Breathlessness was the most common symptom at presentation and hypertension were the most common co-morbidities found.&#x0D;

Average molecular weight levels in patients with myocardial infarction against COPD depending on presence of complications in acute period

Purpose. To study the levels of average molecules in patients with myocardial infarction against the background of chronic obstructive disease depending on the presence of complications in the acute period of the infarction.Materials and methods. We studied 225 patients with STEMI. In 195 of them the MI developed against the background of COPD, and in 130 of them it was mono-inflammatory. Among mono-nososologic patients there were 85 patients with acute MI without any complications and 45 patients with complications. Among patients with COPD, 62 patients had uncomplicated MI, and 133 had complicated MI. The comparison group consisted of 110 somatically healthy individuals. Average molecules were determined according to M. Ya. Malakhova (1995) method by direct spectrometry. Statistical data processing was performed using SPSS 26.0 software package.Results of the study. The levels of LMWP and OP in various biological fluids in patients with complicated MI were statistically significantly higher both among patients with MI as a mononosomal disease and in the presence of COPD. Patients with complications registered higher levels of catabolic pool, endogenous intoxication index and lower values of intoxication coefficient. Among MI patients without complications stage I of endogenous intoxication prevailed, and among the patients with complicated MI and with uncomplicated MI against COPD – stage II, and among the patients with complicated MI against COPD – stage III.Conclusion. Complicated myocardial infarction is characterized by more pronounced endogenous intoxication. In comorbid patients with complicated MI, endogenous intoxication is more pronounced than in complicated MI without COPD. The demonstrability of the LMWP and OP levels allows us to recommend their use in prognostic algorithms for the development of coronary pathology in comorbid patients.