COPD Comorbidities Research Articles

Polymyxin-B induced bartter-like syndrome: an unusual adverse effect

Introduction and Importance: Bartter syndrome is a rare autosomal recessive disorder affecting renal tubular function, leading to electrolyte and volume homeostasis disturbances. It can also manifest as Bartter-like syndrome, a rare side effect of certain medications. Polymyxin-B, used to treat multidrug-resistant infections, is infrequently associated with BLS, making early recognition crucial to prevent severe electrolyte imbalances. Case Presentation: A 73-year-old female with coronary artery disease, COPD, hyperlipidemia, and other comorbidities presented with fever, respiratory distress, and hypoxia on mechanical ventilation. Initial labs showed leukocytosis, anemia, and normal potassium. Despite broad-spectrum antibiotics, sputum cultures revealed pandrug-resistant Acinetobacter baumannii, sensitive only to Polymyxin-B. After six days of Polymyxin-B, the patient developed fever, hypotension, hypokalemia, hypomagnesemia, and polyuria. Urine studies indicated increased potassium excretion. A diagnosis of Bartter like syndrome was made. Polymyxin-B was discontinued, and the patient’s electrolytes normalized, resolving the polyuria. She was discharged with daily potassium and magnesium supplements. Clinical Discussion: Bartter-like syndrome can result from Polymyxin-B-induced tubular dysfunction, characterized by hypokalemia and hypomagnesemia. Close electrolyte monitoring is essential for patients receiving this antibiotic, particularly in those with complex medical conditions. Early recognition allowed for timely discontinuation of Polymyxin-B, which rapidly reversed the electrolyte disturbances. Conclusion: This case underscores the importance of recognizing Polymyxin-B-induced Bartter-like syndrome. Clinicians should be vigilant for electrolyte disturbances in patients undergoing treatment with Polymyxin-B, ensuring timely interventions to mitigate adverse outcomes.

COPD comorbidity and checkpoint inhibitor pneumonitis in a case-control study of patients with lung cancer.

e14700 Background: Checkpoint inhibitor pneumonitis (CIP) is the most common high-grade immune-related adverse event among patients with lung cancer. Risk factors for CIP include interstitial lung disease, fibrosis on pre-treatment CT imaging, and likely COPD. This study aims to compare COPD variables and CIP outcomes between cases of high and low-grade CIP, and controls without CIP. We hypothesized that the presence and severity of COPD would affect the evaluation, management, and outcomes of CIP. Methods: From a database of patients with lung cancer who received at least one dose of an immune checkpoint inhibitor between 2/1/11 and 4/7/22 at a comprehensive cancer center, we identified all CIP cases and randomly selected a larger number of controls without CIP. The study team reviewed routine clinical documentation and collected data on pre-treatment respiratory function (e.g., comorbidities, spirometry) and CIP outcomes (e.g., diagnostic testing, interventions, severity). Low-grade (grades 1-2) versus high-grade (grades 3-5) CIP were defined by the Common Terminology Criteria for Adverse Events. We tested categorical variables using Chi-squared or Fisher’s exact test depending on assumptions. We compared continuous variables using the Wilcoxon rank sum or the Kruskall-Wallis test. The database was maintained on a secure, cloud-based REDCap database, validated with data quality rules, and with IRB approval. Results: This study compared 84 cases of CIP (including high-grade CIP in 48/84 cases, 57%) with 252 controls. COPD was a commonly documented comorbidity in both groups (60% cases, 53% controls, p 0.28), although not all patients had spirometry (44% cases, 40% controls). Among the cases, CIP diagnosis occurred at a median of 3 months; at that time, 29% of cases were using a scheduled daily inhaled corticosteroid, and 18% continued to smoke tobacco. Between high-grade and low-grade CIP, there was similar COPD prevalence (64% vs. 56%, p 0.51), severity by forced expiratory volume in one second (FEV1) as a predicted percentage (64 ± 21% vs. 62 ± 16%, p 0.81), and diffusing capacity of the lungs for carbon monoxide as a predicted percentage (62 ± 19% vs. 61 ± 18%, p 0.82). In terms of CIP outcomes, COPD was not associated with the incidence of hospitalization (26/46, 57%, p 0.76), length of hospitalization (8.4 vs. 7.8 days, p=0.33), intensive care unit utilization (10/21, 48%, p 0.52), or death (5/9, 56%, p 0.94). Cardiac evaluation appeared slightly different among patients with COPD (e.g., more often ordered echo; less often ordered BNP or diuresis), although CIP management was overall similar. Conclusions: The presence or severity of pre-treatment COPD was not associated with differences in the management or outcomes of CIP when it occurred. The cardiac evaluation of CIP may have been different because COPD can decrease the specificity of BNP and be less responsive to diuretics.

Reflections on COPD comorbidities.

Reflections on COPD comorbidities.

Statins did not reduce the frequency of exacerbations in individuals with COPD and cardiovascular comorbidities in the COSYCONET cohort

BackgroundThe evidence regarding effects of statins on exacerbation risk in COPD remains controversial. Previous studies often excluded patients with cardiovascular comorbidities despite their high prevalence in COPD and role for exacerbations. Based on the cardioprotective properties of statins, we hypothesised that statins may reduce the risk of exacerbations especially in patients with cardiovascular comorbidities.MethodsOne thousand eight hundred eighty seven patients of the German COPD cohort COSYCONET (COPD and Systemic Consequences Comorbidities Network) of GOLD grades 1–4 (37.8% female, mean age 64.78 ± 8.3) were examined at baseline and over a period of 4.5 years for the occurrence of at least one exacerbation or severe exacerbation per year in cross-sectional and longitudinal analyses adjusted for age, gender, BMI, GOLD grade and pack-years. Due to their collinearity, various cardiovascular diseases were tested in separate analyses, whereby the potential effect of statins in the presence of a specific comorbidity was tested as interaction between statins and comorbidity. We also identified patients who never took statins, always took statins, or initiated statin intake during the follow-up.ResultsOne thousand three hundred six patients never took statins, 31.6% were statin user, and 12.9% initiated statins during the follow-up. Most cardiovascular diseases were significantly (p < 0.05)may associated with an increased risk of COPD exacerbations, but in none of them the intake of statins was a significant attenuating factor, neither overall nor in modulating the increased risk linked to the specific comorbidities. The results of the cross-sectional and longitudinal analyses were consistent with each other, also those regarding at least 1 exacerbation or at least 1 severe exacerbation per year.ConclusionThese findings complement the existing literature and may suggest that even in patients with COPD, cardiovascular comorbidities and a statin therapy that targets these comorbidities, the effects of statins on exacerbation risk are either negligible or more subtle than a reduction in exacerbation frequency.Trial registrationTrial registration ClinicalTrials.gov, Identifier: NCT01245933.Other Study ID (BMBF grant): 01GI0881, registered 18 November 2010, study start 2010–11, primary completion 2013–12, study completion 2023–09.https://clinicaltrials.gov/study/NCT01245933?cond=COPD&term=COSYCONET&rank=3

Experiences of Burden and Coping Strategies and their Associations with Mental Health and Well-Being in COPD - a Mixed Methods Study

Understanding trigger and maintaining factors regarding psychiatric comorbidities in COPD is of great importance. In the presented mixed-methods study, qualitative interview data on burden experience and coping were related to psychiatric comorbidity (using PHQ-D) and quality of live (Positive Affect Negative Affect Schedulde, PANAS and Satisfaction with Life Scale, SWLS) and extended by the Freiburg Questionnaire on Coping with Illness (FKV-LIS). The two interview questions prompting narrative were 1.) "What is currently bothering you most?"; 2.) "How do you cope with your chronic disease in everyday life?" A total of 62 patients who were hospitalized due to COPD participated. The severity of physical impairment was assessed using GOLD stage and the Charlson Comorbidity Index (CCI). The interviews conducted were content analyzed and then quantified. The collected data were then compared between two groups with regard to mental distress. 13 themes of burden and 11 coping strategies were identified by content analysis. A total of 42 patients showed signs of mental distress, while 20 patients did not show signs of distress. There were no significant differences between the two groups in terms of sociodemographic characteristics and the severity of their physical symptoms. In the first interview question, the stressed group more frequently addressed issues related to death (35.7% versus 15.0%) and social stress (21.4% versus 0.0%). With respect to the second interview question, the nonstressed group was significantly more likely to mention strategies for consciously emphasizing positive emotions (70.0% versus 31.0%). In addition, higher scores on the FKV scales for depressive coping and trivialization and wishful thinking were evident in the stressed group. Quality of life and mental distress should be considered in clinical care for COPD. Interventions to influence illness perception and related coping styles are important, especially with regard to the development of a realistic and optimistic perspective on life and disease burden, as well as the inclusion of group and family therapeutic interventions.

Unraveling the causality between chronic obstructive pulmonary disease and its common comorbidities using bidirectional Mendelian randomization

BackgroundChronic obstructive pulmonary disease (COPD) frequently coexists with various diseases, yet the causal relationship between COPD and these comorbidities remains ambiguous. As a result, the aim of our study is to elucidate the potential causality between COPD and its common comorbidities.MethodsWe employed the Mendelian randomization (MR) method to analyze single nucleotide polymorphism (SNP) data of common comorbidities with COPD from FinnGen and Integrative Epidemiology Unit (IEU) databases. Causality was primarily assessed using the inverse variance weighting (IVW) method. Multivariable Mendelian randomization (MVMR) analysis was also conducted to eliminate the interference of smoking-related phenotypes. Sensitivity analysis was conducted to ensure the reliability of our findings.ResultsPreliminary univariable MR revealed an increased risk of lung squamous cell carcinoma (LUSC) (IVW: OR = 1.757, 95% CI = 1.162–2.657, P = 0.008), chronic kidney disease (CKD) (IVW: OR = 1.193, 95% CI = 1.072–1.326, P < 0.001), chronic periodontitis (IVW: OR = 1.213, 95% CI = 1.038–1.417, P = 0.012), and heart failure (HF) (IVW: OR = 1.127, 95% CI = 1.043–1.218, P = 0.002). Additionally, the reverse MR analysis indicated that genetic susceptibility to HF (IVW: OR = 1.272, 95% CI = 1.084–1.493, P = 0.003), obesity (IVW: OR = 1.128, 95% CI = 1.056–1.205, P < 0.001), depression (IVW: OR = 1.491, 95% CI = 1.257–1.770, P < 0.001), and sleep apnea syndrome (IVW: OR = 1.209, 95% CI = 1.087–1.345, P < 0.001) could raise the risk of COPD. The MVMR analysis showed no causal effect of COPD on susceptibility to chronic periodontitis after adjusting for smoking.ConclusionsOur study identified that COPD may elevate the risk of LUSC, HF, and CKD. Additionally, our analysis revealed that HF, sleep apnea symptoms, depression, and obesity might also increase the susceptibility to COPD. These findings revealed a potential causal relationship between COPD and several prevalent comorbidities, which may provide new insights for disease early prediction and prevention.

Study the Correlation between covid-19 infection and chronic disorder

The significant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that started in China highly risky for human live. The symptoms that describe Coronavirus Disease 2019 include asymptomatic, moderate, or severe pneumonia. (COVID-19). People with COVID-19 who also have diabetes, COPD, CVD, hypertension, cancer, HIV, and other comorbidities could be in danger of dying. SARS-CoV-2 employs the ACE-2 receptors on the host cell's surface to enter the cell. Increased ACE-2 receptor expression and proportion converses release are associated with several comorbidities, which facilitate viral entry into host cells. The comorbidities, which are closely connected to severe morbidity and mortality, cause the COVID-19 patient to enter a life-long cycle of infectious disease. Comorbid patients require special attention and precautions, as well as extra measures. The study's goal is: The current study were focused to examine the association between chronic illnesses and poorer COVID-19 infection outcomes (death and ICU hospitalization) as well as how chronic illnesses alter an individual's assessment of their own risk for these outcomes. Patients and procedures: Information about each of the 15000 COVID-19 patients was entered into a questionnaire. This model covered chronic illnesses such as respiratory, cardiovascular, cancer, renal, and stomach ailments. A few documents have been found that discuss the connection between COVID-19 and comorbidities; however, this study shows the wider range of comorbidities that COVID-19 patients deal with. Conclusions: Males are more likely to have Covid-19 (60%) than females (40%). With age comes a rise in the Covid-19. The COVID-19 recorded the highest percentage of infections in individuals with cardiovascular illnesses (53.3% and 15.7%).

Prognostication of co-morbidity clusters on hospitalisation and mortality in advanced COPD

RationaleAs the prevalence of multimorbidity increases, understanding the impact of isolated comorbidities in people COPD becomes increasingly challenging. A simplified model of common comorbidity patterns may improve outcome prediction and allow targeted therapy. ObjectivesTo assess whether comorbidity phenotypes derived from routinely collected clinical data in people with COPD show differences in risk of hospitalisation and mortality. MethodsTwelve clinical measures related to common comorbidities were collected during annual reviews for people with advanced COPD and k-means cluster analysis performed. Cox proportional hazards with adjustment for covariates was used to determine hospitalisation and mortality risk between clusters. Measurements and main resultsIn 203 participants (age 66 ± 9 years, 60 % male, FEV1%predicted 31 ± 10 %) no comorbidity in isolation was predictive of worse admission or mortality risk. Four clusters were described: cluster A (cardiometabolic and anaemia), cluster B (malnourished and low mood), cluster C (obese, metabolic and mood disturbance) and cluster D (less comorbid). FEV1%predicted did not significantly differ between clusters. Mortality risk was higher in cluster A (HR 3.73 [95%CI 1.09–12.82] p = 0.036) and B (HR 3.91 [95%CI 1.17–13.14] p = 0.027) compared to cluster D. Time to admission was highest in cluster A (HR 2.01 [95%CI 1.11–3.63] p = 0.020). Cluster C was not associated with increased risk of mortality or hospitalisation. ConclusionsDespite presence of advanced COPD, we report striking differences in prognosis for both mortality and hospital admissions for different co-morbidity phenotypes. Objectively assessing the multi-system nature of COPD could lead to improved prognostication and targeted therapy for patients.

Анализ распространенности полиморфизма rs4646994 гена ангиотензин превращающего фермента у больных с хронической обструктивной болезнью легких

The purpose — to analyze the prevalence of polymorphism of the ACE Alu I/D angiotensin-converting enzyme gene (rs4646994) in patients with chronic obstructive pulmonary disease. Material and methods. The study included 285 patients with COPD hospitalized at the regional pulmonological center of the Samara Regional Clinical Hospital named after V.D. Seredavin. Practically healthy individuals without hereditary predisposition and clinical manifestations of cardiorespiratory pathology were selected for control. The PCR method with allele-specific primers was used on SNP-express systems of NPO Litech. Results. In the group of patients with a verified diagnosis of COPD, the pathological homozygous deletion D/D genotype significantly prevailed (χ2 = 16.51, df = 2, p = 0.0001). The genetic cardiovascular risk in COPD patients associated with the deletion variant of the D/D ACE gene in our study was OR 8.87, 95% CI 2.61–30.13. Conclusion. A personalized diagnostic approach allows identifying predictors of cardiovascular risk in COPD. The dominant role of cardiovascular mechanisms of comorbidity in COPD may be associated with the participation of some candidate genes of the renin-angiotensin-aldosterone system, in particular, insertion-deletion polymorphism rs4646994 of the angiotensin-converting enzyme gene.

СУЧАСНИЙ ПОГЛЯД НА ХОЗЛ: НА ЩО ЗВЕРНУТИ УВАГУ?

Last decade has been marked by the worsening of COPD epidemiology, particularly due to increase of its prevalence and mortality. According to recent data COPD is a cause of more than 3 million or 6 % of all deaths annually. Among the causes of high mortality rate the experts mention the exacerbations of the disease. An exacerbation of COPD is defined as an event, characterized by dyspnea and/or cough and sputum, that worsen over last 14 days. Exacerbations are frequently associated with the increased local and systemic inflammation caused of respiratory tract infection, air pollution or other insults to the lungs. Prevention of exacerbations as a major factor of COPD progression is one of the prerogatives of respiratory medicine. Patients with COPD and cardio-vascular comorbidity is the most vulnerable cohort due to high risk of mortality. Timely initiation of triple inhalation therapy with LAMA/LABA/ICS combination for patients with high risk of unfavorable outcomes is one of effective tools to reduce mortality. Clinical trials proved its statistically significant efficacy. Current understanding of the problem requires individualized approach to management of COPD, based on close contact with the patients, monitoring of availability and accessibility of medications, control of inhalation technique and treatment compliance, psychological and information support of the patients. Key words: chronic obstructive pulmonary disease, GOLD-2024, changes and additions.

Serum Metabolomics Analysis Revealed Metabolic Pathways Related to AECOPD Complicated with Anxiety and Depression.

Anxiety and depression are two of the most common comorbidities of COPD, which can directly lead to the number of acute exacerbations and hospitalizations of COPD patients and reduce their quality of life. At present, there are many studies on anxiety and depression in stable COPD, but few studies on anxiety and depression in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. We aim to explore the changes of serum metabolomics in AECOPD complicated with anxiety and depression and to provide some clues for further understanding its pathogenesis. This is an observational high-throughput experimental study based on retrospective data extraction. Twenty-one AECOPD with anxiety and depressive patients and 17healthy controls (HCs) were retrospectively enrolled in the Second Affiliated Hospital of Anhui Medical University. Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) for anxiety and depression were used to assess the patients with AECOPD. Untargeted metabolomics analysis was carried out to investigate different molecules in the serum of all participants. General information of all participants, baseline data and clinical measurement data of AECOPD patients were collected. Statistical analysis and bioinformatics analysis were performed to reveal different metabolites and perturbed metabolic pathways. A total of 724 metabolites in positive ionization mode and 555 metabolites in negative ionization mode were different in AECOPD patients with anxiety and depression. The 1,279 serum metabolites could be divided into 77 categories. Based on multivariate and univariate analysis, 74 metabolites were detected in positive ionization mode, and 60 metabolites were detected in negative ionization as differential metabolites. The 134 metabolites were enriched in 18 pathways, including biosynthesis of unsaturated fatty acids, aldosterone synthesis and secretion, protein digestion and absorption, ovarian steroidogenesis, long-term depression, retrograde endocannabinoid signaling, and so on. This work highlights the key metabolites and metabolic pathways disturbed in AECOPD patients with anxiety and depression. These findings support the use of metabolomics to understand the pathogenic mechanisms involved in AECOPD patients with anxiety and depression.

Bronchodilator reversibility in the GAN severe asthma cohort.

Positive bronchodilator reversibility (BDR) is a diagnostic criterion for asthma. However, patients with asthma may exhibit negative BDR test.To describe frequency of positive and negative BDR in patients with severe asthma and associations with phenotypic characteristics. Positive BDR was defined as FEV1 increase > 200 ml AND > 12% upon testing with a short-acting beta-agonist (SABA). Out of 2013 patients included in the German Asthma Net (GAN) severe asthma registry, 793 had data on BDR. Hereof, 250 (31.5%) had a positive and 543 (68.5%) had a negative BDR test. Comorbidities significantly associated with negative BDR were gastro-esophageal reflux (GERD) (28.0% vs 40.0%, p<0.01) and EGPA (0.4% vs 3.0%; p<0.05), while smoking history (active: 2.8% vs 2.2%; ex: 40.0% vs 41.7%) and COPD comorbidity (5.2% vs 7.2%) were similar in both groups. Patients with positive BDR had worse asthma control (median ACQ-5 3.4 vs 3.0, p<0.05), reported dyspnea at rest (26.8% vs 16.4%, p<0.001) and chest tightness (36.4% vs 26.2%, p<0.001) more frequently, had more severe airway obstruction at baseline (FEV1% pred: 56 vs 64, p<0.001) and higher FeNO levels (41 vs 33 ppb, p<0.05), while diffusion capacity did not differ (DLCO-SB % pred. 70% vs 71%). Multivariate linear regression analysis identified association of lower baseline FEV1% (p<0.001) and chest tightness (p<0.05) with positive, and GERD (p<0.05) with negative BDR. In this real-life setting the majority of patients with severe asthma exhibited negative BDR. Interestingly, this was not associated with smoking history or COPD, but with lower FeNO and presence of GERD.

A Bibliometric Analysis of Comorbidity of COPD and Lung Cancer: Research Status and Future Directions.

Although studies on the association between COPD and lung cancer are of great significance, no bibliometric analysis has been conducted in the field of their comorbidity. This bibliometric analysis explores the current situation and frontier trends in the field of COPD and lung cancer comorbidity, and to lay a new direction for subsequent research. Articles in the field of COPD and cancer comorbidity were retrieved from Web of Science Core Collections (WoSCC) from 2004 to 2023, and analyzed by VOSviewer, CiteSpace, Biblimatrix and WPS Office. In total, 3330 publications were included. The USA was the leading country with the most publications and great influence. The University of Groningen was the most productive institution. Edwin Kepner Silverman was the most influential scholar in this field. PLOS One was found to be the most prolific journal. Mechanisms and risk factors were of vital importance in this research field. Environmental pollution and pulmonary fibrosis may be future research prospects. This bibliometric analysis provided new guidance for the development of the field of COPD and lung cancer comorbidity by visualizing current research hotspots, and predicting possible hot research directions in the future.

The role of treatment regimen and duration in treating patients with Mycobacterium avium complex lung disease: A real-world experience and case–control study

PurposeThe treatment advantage of guideline-based therapy (GBT) in Mycobacterium avium complex lung disease (MAC-LD) is well-known. However, GBT is not always feasible. The aim of the study was to analyze the relationship of treatment regimens and duration with outcomes. Materials and methodsThis study screened patients with MAC-LD from Jan 2011 to Dec 2020 and enrolled those who received treatment. The treatment regimens were categorized to triple therapy (three active drugs) and non-triple therapy. The favorable outcomes included microbiological cure or clinical cure if no microbiologic persistence. ResultsA total of 106 patients with MAC-LD were enrolled. Among them, 88 subjects (83 %) received triple therapy, 58 (54.7 %) had MAC treatment >12 months, and 66 (62.3 %) had favorable outcomes. Patients receiving triple therapy (90.9 % vs. 67.5 %, p = 0.008) and treatment >12 months (62.1 % vs. 42.5 %, p = 0.07) had higher proportion of favorable outcomes than unfavorable outcomes. Multivariable logistic regression analysis showed that age >65, comorbidities of COPD and prior tuberculosis, low hemoglobin, and high MAC burden were independent risk factors of unfavorable outcome. In contrast, triple therapy (OR: 0.018, 95 % CI: 0.04–0.78, p = 0.022) and treatment duration >12 months (OR: 0.20, 95 % CI: 0.055–0.69, p = 0.012) were protective factors against unfavorable outcome. ConclusionsTriple therapy including GBT, and treatment more than 12 months achieved more favorable outcome. Maintenance of triple therapy, but not reducing the number of active drugs, might be an acceptable alternative of GBT.

Increased Age, Operative Time, American Society of Anesthesiologists Classification, Functional Dependency, and Comorbidity Burden Are Risk Factors for Adverse Events After Meniscectomy and Meniscus Repair: 10-Year Analysis of 64,223 Patients

To use the National Surgical Quality Improvement Program (NSQIP) database to identify risk factors for 30-day adverse events and hospital readmission following isolated and unilateral meniscectomy or meniscus repair. A retrospective review of the NSQIP database from the years 2012 to 2021 identified all patients undergoing isolated, unilateral meniscectomy or meniscus repair. Multivariable analyses were performed for each procedure to identify patient characteristics associated with any adverse event (AAE) or unplanned hospital readmission within 30 days of surgery. From 2012 to 2021, 59,450 (93%) patients underwent meniscectomy, and 4,773 (7%) patients underwent meniscus repair. Overall adverse event rate was 0.95% after meniscectomy and 1.40% after repair. Risk factors for AAE after meniscectomy included increased age (odds ratio [OR]= 1.010; P= .009), increased operative time (OR= 1.003; P= 0.011), American Society of Anesthesiologists (ASA) class IV (OR= 2.048; P= .045), functional dependency (OR= 3.527; P= .001), and current smoking (OR= 1.308; P= .018). Risk factors for AAE after meniscus repair included age (OR= 1.024; P= .016), operative time (OR= 1.004; P= .038), and bleeding disorders (OR= 7.000; P= .014). ASA class III increased risk of hospital readmission after both procedures (OR=1.906; P= .008; OR= 4.101; P= .038), and medical comorbidities of heart failure (OR= 3.924; P=.016), hypertension (OR= 1.412; P= .011), and chronic obstructive pulmonary disease (OR = 2.350; P < .001) increased readmission risk after meniscectomy only. Per analysis of the American College of Surgeons (ACS)-NSQIP database, surgical treatment of meniscal tears in the knee has been performed frequently over the past 10 years, with meniscectomies comprising over 90% of cases. Increased age and operative time were associated with a modest risk of adverse events after both meniscectomy and meniscus repair. Increased comorbidity burden, evidenced by ASA class, dependent functional status, current smoking, and systemic medical conditions, such as heart failure, hypertension, chronic obstructive pulmonary disease, and bleeding disorders, greatly increased rates of unfavorable outcomes within 30 days of meniscus surgery. Level III, retrospective prognostic comparative investigation.

Inflammation and comorbidities of chronic obstructive pulmonary disease: The cytokines put on a mask!

ObjectiveChronic obstructive pulmonary disease (COPD) is a well-known complex multicomponent disease characterized by systemic inflammation that frequently coexists with other conditions. We investigated the relationship between some inflammatory markers and complications in COPD patients to explore the possible roles of inflammation in these comorbidities. MethodsThis study used cross-sectional and case-control methods. We included 336 hospitalized COPD patients, 64 healthy controls, and 42 major depression patients and evaluated all participants using the Hamilton Rating Scale. C-reactive protein (CRP), red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were collected and measured in the study population. Statistical methods were used to analyze the association of inflammatory markers with COPD comorbidities. ResultsCor pulmonale and psychological comorbidities (depression and anxiety) were more common in this study on COPD patients. We found that MLR (OR = 2.054, 95 % CI 1.129–3.735, p = 0.018) and RDW (OR = 1.367, 95 % CI 1.178–1.586, p = 0.000) were related to COPD patients complicated with cor pulmonale, while IL-6 (OR = 1.026, 95 % CI 1.001–1.053, p = 0.045) and RDW (OR = 1.280, 95 % CI 1.055–1.552, p = 0.012) were related to depression symptoms. ConclusionMLR, RDW and IL-6 were closely related to cor pulmonale and depression in COPD patients. IL-1 β and IL-6 are closely related to depression in humans.

Systematic review and meta-analysis of prevalence of undiagnosed major cardiac comorbidities in COPD.

It is often stated that heart disease is underdiagnosed in COPD. Evidence for this statement comes from primary studies, but these have not been synthesised to provide a robust estimate of the burden of undiagnosed heart disease. A systematic review of studies using active diagnostic techniques to establish the prevalence of undiagnosed major cardiac comorbidities in patients with COPD was carried out. MEDLINE, Embase, Scopus and Web of Science were searched for terms relating to heart failure (specifically, left ventricular systolic dysfunction (LVSD), coronary artery disease (CAD) and atrial fibrillation), relevant diagnostic techniques and COPD. Studies published since 1980, reporting diagnosis rates using recognised diagnostic criteria in representative COPD populations not known to have heart disease were included. Studies were classified by condition diagnosed, diagnostic threshold used and whether participants had stable or exacerbated COPD. Random-effects meta-analysis of prevalence was conducted where appropriate. In general, prevalence estimates for undiagnosed cardiac comorbidities in COPD had broad confidence intervals, with significant study heterogeneity. Most notably, a prevalence of undiagnosed LVSD of 15.8% (11.1-21.1%) was obtained when defined as left ventricular ejection fraction <50%. Undiagnosed CAD was found in 2.3-18.0% of COPD patients and atrial fibrillation in 1.4% (0.3-3.5%). Further studies using recent diagnostic advances, and investigating therapeutic interventions for patients with COPD and heart disease are needed.

THE EFFECT OF COMORBIDITIES ON MORTALITY IN COVID-19 PATIENTS IN dr RADEN SOEDARSONO HOSPITAL PASURUAN

Background: COVID-19 patients with comorbidities have the highest mortality risk in Indonesia during the pandemic. Purpose: This study purposed to determine the prevalence of comorbidities on mortality of COVID-19 patients at RSUD dr. Raden Soedarsono, Pasuruan. Methods: This study used a case-control design with 560 samples collected from January until December 2021. The samples consisted of 140 COVID-19 patients who were treated at RSUD dr. Raden Soedarsono, Pasuruan, in 2021 and declared dead as a case group, as well as 420 COVID-19 patients treated at RSUD dr. Raden Soedarsono, Pasuruan, in 2021 but did not die as a control group. The data were then analyzed using a logistic regression test with SPSS 22.0. Results: The results show that almost all COVID-19 patients did not have comorbidities of diabetes mellitus (85.50%), autoimmune (98.60%), kidney disease (98.20%), gastrointestinal diseases (92.10%), thrombosis and coagulation disorders (93.60%), myocardial injury (99.30%), heart failure (94.30%), hypertension (95.20%), and tuberculosis (5.70%). Also, almost all COVID-19 patients did not have comorbidities of geriatrics (71.60%), COPD (64.10%), and mortality status (25.00%). The results of the logistic regression test show that comorbidities of diabetes mellitus (P-value 0.01; OR 1.99) and geriatrics (P-value 0.00; OR 2.82) affect mortality in COVID-19 patients. Whereas comorbidities of autoimmune (P-value 0.84), kidney disease (P-value 0.37), gastrointestinal diseases (P-value 0.73), thrombosis and coagulation disorders (P-value 0.24), myocardial injury (P-value 0.84), heart failure (P-value 0.43), hypertension (P-value 0.93), COPD (P-value 0.86), and tuberculosis (P-value 0.15) do not affect mortality inCOVID-19 patients. Conclusion: Diabetes Mellitus and geriatrics are the most significant comorbidities in causing the death of COVID-19 patients at RSUD dr. Raden Soedarsono, Pasuruan.

Differences in smoking behaviors and readiness to change for patients with COPD and differing categories of depressive symptoms: a descriptive cross-sectional design

BackgroundChronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world with nearly 90% of cases caused by tobacco smoking. Nearly 40% of people with COPD are diagnosed with depression which impacts quality of life and smoking cessation. The purpose of this study was to describe factors influencing smoking behaviors and readiness to change in people with comorbid COPD and depression.MethodsA descriptive cross-sectional design was used. A convenience sample of 222 participants self-reported and/or had a documented diagnosis of COPD. Participants completed study measures which included the PHQ-9 for depressive symptoms, assessment of smoking behaviors using The Cigarette Dependence Scale, report of readiness to change using The Smoking Stage of Change Questionnaire, The Smoking Decisional Balance Questionnaire, and The Processes of Change Questionnaire. Electronic and paper questionnaires were used. Data was stored in RedCap and analyzed using SPSS version 26. Based on variable type, descriptive and comparative analyses were conducted using ANOVA, t-test, chi-square, Pearson correlation, linear regression, and multiple linear regression to determine the relationships between smoking behaviors, COPD, and depressive symptoms.ResultsOnly 18 participants were classified as having no depressive symptoms. Participants who smoked had high nicotine dependence and wanted to quit smoking. Overall, participants saw more cons to smoking and were engaged in the processes of change. The majority of participants were in the maintenance or contemplation stage. Cigarette dependence could decrease by 9% if depressive symptoms are treated.ConclusionsThere is a need to assess COPD patients for depression and to assess COPD patients’ smoking behaviors and readiness to change. Adequate treatment of depression could promote an individual to move through the stages of change from chronic contemplation to action, thus improving smoking cessation efforts for individuals with COPD. Understanding patients’ smoking behaviors and readiness to change can aid in developing personalized interventions to achieve smoking cessation and improve long-term outcomes.

The Functional and Psychosocial Consequences of COPD.

COPD is a chronic respiratory disease that commonly coexists with other chronic conditions. These comorbidities have been shown to influence overall disease burden and mortality in COPD, and these comorbidities have an important impact on functional status and other psychosocial factors. Mental health disorders, especially anxiety and depression are common comorbidities in COPD. However, the mechanisms and interactions of anxiety and depression in COPD are poorly understood and these conditions are often underdiagnosed. The interplay between anxiety and depression and COPD is likely multifactorial and complex. An obvious mechanism is the expected psychological consequences of having a chronic illness. However, there is increasing interest in other potential biological processes, such as systemic inflammation, smoking, hypoxia, and oxidative stress. Recognition and diagnosis of comorbid anxiety and depression in patients with COPD is often challenging because there is no consensus on the appropriate screening tools or rating scales to use in this patient population. Despite the challenges in accurate assessment of anxiety and depression, there is growing evidence to support that these comorbid mental health conditions in COPD result in worse outcomes, including poor health-related quality of life, increased exacerbations with associated health-care utilization and cost, increased functional disability, and increased mortality. There are limited data of variable quality on effective treatment and management strategies, both pharmacologic and non-pharmacologic, for anxiety and depression in COPD. However, cumulative evidence demonstrates that complex psychological and lifestyle interventions, which include a pulmonary rehabilitation component, may offer the greatest benefit. The high prevalence and negative impact of depression and anxiety highlights the need for comprehensive, innovative, and standardized chronic disease management programs for individuals with COPD.