Pulmonary Department Research Articles

Clinical and social characterization of patients hospitalized for COPD exacerbation using Machine Learning tools

Objective: This study aims to employ machine learning (ML) tools to cluster patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) based on their diverse social and clinical characteristics. This clustering is intended to facilitate the subsequent analysis of differences in clinical outcomes.Methods: We analysed a cohort of patients with severe COPD from two Pulmonary Departments in north-western Spain using the k-prototypes algorithm, incorporating demographic, clinical, and social data. The resulting clusters were correlated with metrics such as readmissions, mortality, and place of death. Additionally, we developed an Intelligent Clinical Decision Support System (ICDSS) using a supervised ML model (Random Forest) to assign new patients to these clusters based on a reduced set of variables.Results: The cohort consisted of 524 patients, with an average age of 70.30 ± 9.35 years, 77.67% male, and an average FEV1 of 44.43 ± 15.4. Four distinct clusters (A-D) were identified with varying clinical-demographic and social profiles. Cluster D showed the highest levels of dependency, social isolation, and increased rates of readmissions and mortality. Cluster B was characterized by prevalent cardiovascular comorbidities. Cluster C included a younger demographic, with a higher proportion of women and significant psychosocial challenges. The ICDSS, using five key variables, achieved areas under the ROC curve of at least 0.91.Conclusions: ML tools effectively facilitate the social and clinical clustering of patients with severe COPD, closely related to resource utilization and prognostic profiles. The ICDSS enhances the ability to characterize new patients in clinical settings.

Effectiveness of pulmonary rehabilitation in post-COVID-19 patients: A pre- and post-interventional study.

The need of pulmonary rehabilitation (PR) for COVID-19 patients with long-term effects was desperately felt. The study's objective was to measure the effect of PR on functional capacity and health-related quality of life (HRQOL) in patients with post COVID conditions. Pulmonary medicine department of a teaching hospital conducted this pre-experimental study. The patient underwent a pre and post-assessment, including a six-minute walk test (6MWT) measuring distance, oxygen desaturation, pulse rate, and HRQOL. The intervention had six components; education to patients and caregivers, breathlessness relieving exercises, postural correction, aerobic training, strength training, and stretching exercises. These activities were carried out twice a week for eight weeks, supervised, unsupervised in homes, and a combination. The study enrolled 155 post-COVID patients (Males, 102 and female, 53), out of which 28 (18.1%) had mild, 55 (35.5%) had moderate and 72 (46.5%) had severe COVID. Paired t-test showed improvement in resting pulse rate (P = 0.001) and resting oxygen saturation (P < 0.0001). Distance walking for six minutes increased after rehabilitation (P < 0.0001). After eight weeks of pulmonary rehabilitation, there was an improvement (P < 0.001) in all domains of quality of life, that is, mobility, self-care, pain and discomfort, usual activity, sleep, anxiety and depression. Pulmonary rehabilitation is beneficial for post-COVID patients in improving their quality of life and six-minute walk test parameters, resulting in improved functional capacity and overall quality of life.

Anthropometric and Nutritional status of Chronic Obstructive Pulmonary Disease presenting in Acute Exacerbation in Tertiary care Hospital in Eastern Nepal

Background: There is scarcity of data regarding the nutritional status of COPD patients presenting in exacerbation in our setup, thus this observational study was conducted. Methods: We performed an observational study of patients with acute exacerbation of COPD, who were admitted in the Department of Pulmonary, Critical care and Sleep Medicine in tertiary hospital in eastern Nepal from April 2023 to June 2023. Results: During the study period, a total of 154 patients of COPD with exacerbations were admitted in our department. The baseline anthropometric parameters, lab parameters as well as the malnutrition scores were determined. The mean BMI was 21.82 ± 3.92 kg/m2 and only 29% had BMI &lt; 18.5 kg/m2.The mean hemoglobin, mean cell volume, serum protein, serum albumin, serum calcium, phosphorus and vitamin D level were 12.43 ± 2.32 g/dL, 84.4 ± 9.41 fL, 6.42 ± 1.74 g/ dL, 3.32 ± 0.34 g/dL, 8.98 ± 0.63 mg/dL, 3.02 ± 0.42 mg/dL, 18.48 ± 8.22 pg/mL and 40%, 12%, 28%, 41%, 31%, 42% and 49% of these values were below the lower normal limit respectively. The nutritional status tool used NRS-2002, MUST and MNAS-F screened malnutrition in about 68%, 51% and 54% respectively. There shows a discrepancy between the evaluation of the malnutrition assessed by BMI with that of nutritional assessment score. Conclusion: COPD who present in exacerbations are malnourished, but use of sole BMI to rule out malnutrition in such group of patients can cause false negative result.

The relationship between obstructive sleep apnea syndrome severity and vitamin D levels in sera

Aims: Obstructive Sleep Apnea Syndrome (OSAS) is a disorder characterized by complete or partial upper airway obstruction episodes and frequently decreased arterial oxygen saturation. Etiological factors and risk factors of OSAS are still investigated and studies in this topic continue. Until recently, researches were focused on the major effects of vitamin D on the bone metabolism and calcium homeostasis. Today; it has been found that vitamin D plays roles in many cells and tissues of human body additional to its functions in the musculoskeletal system. In our study, we aimed to examine vitamin D levels in patients who are diagnosed as OSAS and to investigate the relationship between OSAS and vitamin D deficiency. Methods: 83 volunteers, who were suspected to have OSAS, were included in the study. They all underwent polysomnography (PSG) in the Sleep Disorders Center in Pulmonary Department, between January 2015 – May 2015. Twenty cases with apnea hypopnea index (AHİ) &lt; 5/hour were evaluated as simple snoring/control group. Cases with AHİ &gt; 5/hour were diagnosed as OSAS; 22 patients were diagnosed as mild, 20 patients were diagnosed as moderate and 21 patients were diagnosed as severe OSAS. Blood samples of these patients were studied for the measurement of vitamin D [25(OH)D3], parathormone (PTH) , calcium (Ca), phosphor (P) levels and the samples were quickly delivered to biochemistry laboratory Results: A statistically significant difference in vitamin D levels were observed (p&lt;0.05) between the control and OSAS groups. However, no statistically significant difference was found in PTH, Ca, P levels among these groups (p&gt;0.05). Vitamin D levels in the control group were significantly higher than the mild and the severe OSAS patients. No statistically significant difference was observed in PTH, Ca, P levels between these patients. Conclusion: Our study indicates that there is a significant relationship between vitamin D deficiency and OSAS. This finding suggests that vitamin D deficiency may play a role in the OSAS physiopathology. There are few studies exists about the association between vitamin D deficiency and OSAS. In this regard, we think our study will contribute to the literature. Moreover; prospective, randomized, controlled studies with large series were needed.

Role of GeneXpert in the diagnosis of extrapulmonary tuberculosis.

The World Health Organization endorsed the cartridge-based nucleic acid amplification test Xpert MTB/RIF (GXP) for the diagnosis of tuberculosis (TB). Studies about GXP efficiency in extrapulmonary TB (EPTB) are scarce. Hence, we decided to study the role of GXP in EPTB. This prospective observational study, conducted in the pulmonary medicine department of a tertiary care hospital after ethics committee permission, recruited 200 EPTB patients. The diagnosis of TB was achieved with the help of clinico-radiological correlation with microbiological test positivity. Acid-fast bacilli (AFB) culture was treated as the comparative gold standard. Patients who had no or incomplete data were excluded from the study. Data was analyzed to calculate the sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of TB and the detection of rifampicin resistance. The majority of cases were women (126 patients: 63%). The mean age was 23.71 years. On GXP, 130 (65%) had detected mycobacterium tuberculosis (MTB), and 70 (35%) did not. Adding AFB culture data, 168 (81.5%) showed microbiological evidence of TB, and 32 (18.5%) were negative. On the drug susceptibility test, 131 cases were rifampicin-sensitive, 32 were rifampicin-resistant TB, and in 5 cases, data was unavailable. The most common extrapulmonary site of involvement was the lymph node, with 94 patients (47%). The most common lymph node involved was the cervical lymph node, with 70 patients (74.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of GXP in EPTB collectively were 76.68%, 86.48%, 96%, and 45.7%, respectively. GXP is useful for the rapid detection of EPTB and the identification of rifampicin resistance, especially in a high-prevalence country like India.

Yes! We can end TB

In celebration of World Tuberculosis Day 2024, an e-poster titled "Yes! We Can End TB" was created by Sushant Kumar Yadav, a first-year medical student at B.P. Koirala Institute of Health Sciences, Nepal. This poster earned second place in a competition organized by the PSRN Student Chapter in association with the Department of Pulmonary, Critical Care, and Sleep Medicine at B.P. Koirala Institute of Health Sciences and Dharan Submetropolitan City, Nepal. The poster highlights the global efforts and strategies to eradicate tuberculosis, emphasizing public awareness, early diagnosis, and effective treatment.

Chronic Generalized Periodontitis in a Patient with Infiltrative Pulmonary Tuberculosis

Currently, the World Health Organization, in its annual Global Tuberculosis Report, notes an increase in the incidence of tuberculosis in the world associated with the failure of health systems. In 2022, 7.5 million people worldwide were diagnosed with tuberculosis, the highest rate since 1995. In the Russian Federation, the stabilization of reduced morbidity and mortality rates from tuberculosis infection is currently being determined. Patients with tuberculosis often have comorbid and concomitant diseases, which are one of the main causes that impressively affect the diagnosis and treatment of inflammatory periodontal diseases. There is a pathogenetic relationship and aggravation of the course of diseases. The aim of the study is to analyze the course of chronic generalized periodontitis in a patient with pulmonary tuberculosis and to select personalized therapy. A clinical case of combined pathology (dental and infectious diseases) is presented, which was observed on the basis of the pulmonary therapeutic department of the N.S. Pokhvisneva KUZ in the VOKPTD. The conducted studies allowed us to conclude about the positive effect of a personalized approach in treatment.

Clinical diagnosis and treatment of seven patients diagnosed pneumonia caused by Chlamydia abortus: a case series report.

Chlamydia abortus pneumonia is very rare in normal people. At present, there is a lack of clinical data on the clinical characteristics and diagnosis and treatment experience of patients with this type of infection. Our team had recently treated 7 cases of these patients. This study aims to comprehensively summarize and analyze the clinical characteristics and treatment methods of Chlamydia abortus pneumonia, and to provide clinical evidence for the diagnosis and treatment of Chlamydia abortus pneumonia. Clinical data were retrospectively collected from patients diagnosed with Chlamydia abortus pneumonia through metagenomic next-generation sequencing (mNGS) at the Department of Pulmonary and Critical Care Medicine, Meizhou People's Hospital. Seven patients with Chlamydia abortus pneumonia reported a history of poultry exposure, experiencing fever alongside respiratory or digestive symptoms. Marked elevation of blood inflammation markers, accompanied by hypoproteinemia and liver damage, was observed. Chest CT scans revealed pneumonia and pleural effusion. Chlamydia abortus was detected in blood or bronchoalveolar lavage fluid (BALF) through mNGS, often co-occurring with Chlamydia psittaci or other bacteria infections. Notably, Doxycycline demonstrated efficacy in treating Chlamydia abortus. Chlamydia abortus infection is a zoonotic disease, particularly among individuals with a history of poultry exposure, and mNGS emerges as a reliable diagnostic tool for its detection. Chlamydia abortus infection manifests with systemic and lung inflammation, effectively addressed through Doxycycline therapy.

Transforming health care: Investigating Influenzer, a novel telemedicine-supported early discharge program for patients with lower respiratory tract infection: A non-randomized feasibility study.

The COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design. A non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed. Nineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent. The feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial. ClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.

Clinical characteristics of hospitalized children with respiratory syncytial virus infection and risk prediction of severe illness during the post-COVID-19 era in Kunming

Objective: To compare the epidemiological and clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection in Kunming among the pre-and post-COVID-19 era, and to establish a prediction model for severe RSV infection in children during the post-COVID-19 period. Methods: This was a retrospective study. Clinical and laboratory data were collected from 959 children hospitalized with RSV infection in the Department of Pulmonary and Critical Care Medicine at Kunming Children's Hospital during January to December 2019 and January to December 2023. Patients admitted in 2019 were defined as the pre-COVID-19 group, while those admitted in 2023 were classified as the post-COVID-19 group. Epidemiological and clinical characteristics were compared between the two groups. Subsequently, comparison of the clinical severity among the two groups was performed based on propensity score matching (PSM). Furthermore, the subjects in the post-COVID-19 group were divided into severe and non-severe groups based on clinical severity. Chi-square test and Mann-Whitney U test were used for pairwise comparison between groups, and multivariate Logistic regression was applied for the identification of independent risk factors and construction of the prediction model. The receiver operating characteristic (ROC) curve and calibration curve were employed to evaluate the predictive performance of this model. Results: Among the 959 children hospitalized with RSV infection, there were 555 males and 404 females, with an onset age of 15.4 (7.3, 28.5) months. Of which, there were 331 cases in the pre-COVID-19 group and 628 cases in the post-COVID-19 group. The peak period of RSV hospitalization in the post-COVID-19 group were from May to October 2023, and the monthly number of inpatients for each of these months were as follows: 72 cases (11.5%), 98 cases (15.6%), 128 cases (20.4%), 101 cases (16.1%), 65 cases (10.4%), and 61 cases (9.7%), respectively. After PSM for general data, 267 cases were matched in each group. The proportion of wheezing in the post-COVID-19 group was lower than that in the pre-COVID-19 group (109 cases (40.8%) vs. 161 cases (60.3%), χ2=20.26, P<0.001), while the incidences of fever, tachypnea, seizures, severe case, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein and interleukin-6 levels were all higher than those in the pre-COVID-19 group (146 cases (54.7%) vs. 119 cases (44.6%), 117 cases (43.8%) vs. 89 cases (33.3%), 37 cases (13.9%) vs. 14 cases (5.2%), 69 cases (25.8%) vs. 45 cases (16.9%), 3.6 (1.9, 6.4) vs. 2.3 (1.8, 4.6), 9.9 (7.1, 15.2) vs. 7.8 (4.5, 13.9) mg/L, 20.5 (15.7, 30.4) vs. 17.2 (11.0, 26.9) ng/L, χ2=5.46, 6.36, 11.47, 6.42, Z=4.13, 3.06, 2.96, all P<0.05). There were 252 cases and 107 cases with co-infection in the post-and pre-COVID-19 groups, respectively. The proportion of triple and quadruple infection in the post-COVID-19 group was higher than that in the pre-COVID-19 group (59 cases (23.4%) vs. 13 cases (12.1%), 30 cases (11.9%) vs. 5 cases (4.7%), χ2=5.94, 4.46, both P<0.05). Among the 252 cases with co-infection in post-COVID-19 group, the most prevalent pathogens involving in co-infections, in order, were Mycoplasma pneumoniae 56 cases (22.2%), Influenza A virus 53 cases (21.0%), Rhinovirus 48 cases (19.0%), Parainfluenza virus 35 cases (13.9%), and Adenovirus 28 cases (11.1%).The result of multivariate Logistic regression showed that age (OR=0.70, 95%CI 0.62-0.78, P<0.001), underlying diseases (OR=10.03, 95%CI 4.10-24.55, P<0.001), premature birth (OR=6.78, 95%CI 3.53-13.04, P<0.001), NLR (OR=1.85, 95%CI 1.09-3.15, P=0.023), and co-infection (OR=1.28, 95%CI 1.18-1.38, P<0.001) were independently associated with the development of severe RSV infection in the post-COVID-19 group. The ROC curve of the prediction model integrating the above five factors indicated an area under the curve of 0.85 (95%CI 0.80-0.89, P<0.001), with an optimal cutoff of 0.21, a sensitivity of 0.83 and a specificity of 0.80. The calibration curve showed that the predicted probability in this model did not differ significantly from the actual probability (P=0.319). Conclusions: In the post-COVID-19 era in Kunming, the peak in pediatric hospitalizations for RSV infection was from May to October, with declined incidence of wheezing and increased incidence of fever, tachypnea, seizures, severe cases, and rates of triple and quadruple co-infections. Age, underlying diseases, premature birth, NLR, and co-infection were identified as independent risk factors for severe RSV infection in the post-COVID-19 period. In this study, a risk prediction model for severe pediatric RSV infection was established, which had a good predictive performance.

Stressors, emotions, and social support systems among respiratory nurses during the Omicron outbreak in China: a qualitative study

BackgroundRespiratory nurses faced tremendous challenges when the Omicron variant spread rapidly in China from late 2022 to early 2023. An in-depth understanding of respiratory nurses’ experiences during challenging times can help to develop better management and support strategies. The present study was conducted to explore and describe the work experiences of nurses working in the Department of Pulmonary and Critical Care Medicine (PCCM) during the Omicron outbreak in China.MethodsThis study utilized a descriptive phenomenological method. Between January 9 and 22, 2023, semistructured and individual in-depth interviews were conducted with 11 respiratory nurses at a tertiary hospital in Wuhan, Hubei Province. A purposive sampling method was used to select the participants, and the sample size was determined based on data saturation. The data analysis was carried out using Colaizzi’s method.ResultsThree themes with ten subthemes emerged: (a) multiple stressors (intense workload due to high variability in COVID patients; worry about not having enough ability and energy to care for critically ill patients; fighting for anxious clients, colleagues, and selves); (b) mixed emotions (feelings of loss and responsibility; feelings of frustration and achievement; feelings of nervousness and security); and (c) a perceived social support system (team cohesion; family support; head nurse leadership; and the impact of social media).ConclusionNursing managers should be attentive to frontline nurses’ needs and occupational stress during novel coronavirus disease 2019 (COVID-19) outbreaks. Management should strengthen psychological and social support systems, optimize nursing leadership styles, and proactively consider the application of artificial intelligence (AI) technologies and products in clinical care to improve the ability of nurses to effectively respond to future public health crises.

Integrating tabular data through image conversion for enhanced diagnosis: A novel intelligent decision support system for stratifying obstructive sleep apnoea patients using convolutional neural networks.

High-dimensional databases make it difficult to apply traditional learning algorithms to biomedical applications. Recent developments in computer technology have introduced deep learning (DL) as a potential solution to these difficulties. This study presents a novel intelligent decision support system based on a novel interpretation of data formalisation from tabular data in DL techniques. Once defined, it is used to diagnose the severity of obstructive sleep apnoea, distinguishing between moderate to severe and mild/no cases. The study uses a complete database extract from electronic health records of 2472 patients, including anthropometric data, habits, medications, comorbidities, and patient-reported symptoms. The novelty of this methodology lies in the initial processing of the patients' data, which is formalised into images. These images are then used as input to train a convolutional neural network (CNN), which acts as the inference engine of the system. The initial tests of the system were performed on a set of 247 samples from the Pulmonary Department of the Álvaro Cunqueiro Hospital in Vigo (Galicia, Spain), with an AUC value of ≈ 0.8. This study demonstrates the benefits of an intelligent decision support system based on a novel data formalisation approach that allows the use of advanced DL techniques starting from tabular data. In this way, the ability of CNNs to recognise complex patterns using visual elements such as gradients and contrasts can be exploited. This approach effectively addresses the challenges of analysing large amounts of tabular data and reduces common problems such as bias and variance, resulting in improved diagnostic accuracy.

Diagnostic Performance and Comparative Analysis of Conventional Drug Susceptibility Testing, Line Probe Assay, and GeneXpert in Extrapulmonary Tuberculosis Cases: A Cross-sectional Observational Study

Introduction: Tuberculosis (TB), a known threat to mankind for ages, causes a significant burden on healthcare worldwide. The alarming rise of Extrapulmonary Tuberculosis (EPTB) has led healthcare professionals to opt for molecular diagnostics. Despite the availability of rapid diagnostics, conventional culture Drug Susceptibility Testing (DST) is still considered the gold standard in diagnosing TB. Aim: To assess the diagnostic accuracy of culture DST which is considered the gold standard. Materials and Methods: This cross-sectional observational study included 150 suspected EPTB patients and was conducted over a period of one year (September 2018 to August 2019) at Lokmanya Tilak Municipal Medical College and Sion Hospital (LTMMC), a tertiary care hospital in central Mumbai, Maharashtra, India. The hospital is located adjacent to Dharavi, the largest slum area with a high population density, which contributes to the majority of patients attending clinics. Patients attending the pulmonary medicine Outpatient Department (OPD) with extrapulmonary manifestations and suspected cases of EPTB were enrolled in the study. Samples, excluding sputum, were sent to the Department of Microbiology, LTMMC, Sion Hospital for GeneXpert analysis. The samples were further evaluated by microscopy, GeneXpert, and culture DST to detect the presence of Mycobacterium tuberculosis (M. tuberculosis) and drug susceptibility, respectively. Patients positive for Pulmonary Tuberculosis (PTB) were excluded from the study. Categorical variables were described using percentages. A Chi-square test was applied, and a p-value of &lt;0.05 was considered significant. All statistical analyses were performed using SPSS statistical software (IBM SPSS version 26.0, Armonk, N.Y.). Results: Out of the 150 extrapulmonary samples, 23 (15.33%) samples were culture positive for M. tuberculosis and were subjected to DST using the 1% proportion method and GeneXpert assay. The MDR isolates were tested using the firstline Line Probe Assay (LPA). Eleven (47.8%) showed resistance to first-line antitubercular drugs. Among the 12 new cases, only 2 (16.7%) showed resistance compared to 9 (81.8%) in previously treated cases. A discordance of 8.7% was observed between DST with GeneXpert and LPA. Additionally, a discordance of 8.7% was observed between DST and LPA for rifampicin resistance and 4.3% for isoniazid resistance. Conclusion: The paucibacillary nature of extrapulmonary samples contributes to the challenging diagnosis of EPTB cases, leading to increased drug resistance. Highlighting the importance of the conventional solid culture DST method, this study strongly recommends the use of conventional DST accompanied by LPA for extrapulmonary cases.

Healthcare Resource Utilisation of Severe Uncontrolled T2low and Non-T2low Asthma in Finland During 2018-2021.

Patients with asthma and low levels of type 2 inflammatory biomarkers (T2 low) have limited effective treatment options. Such biomarkers include eg blood eosinophils (b-eos) and fractional exhaled nitric oxide (FeNO). The healthcare resource utilisation (HCRU) of severe uncontrolled T2 low asthma remains unexplored. Thus, this study aimed to estimate the HCRU of T2 low and non-T2 low severe uncontrolled asthma patients using real-world data in Finland. Adult patients with an asthma diagnosis during baseline (2012-2017) at the pulmonary department of Turku University Hospital were included and followed during 2018-2021, or until death. Total HCRU costs and respiratory-related HCRU costs were evaluated. The main drivers for the HCRU and costs were assessed with gamma and negative binomial regression models. Of the severe uncontrolled asthma patients with T2 status available, 40% (N=66) were identified with T2 low and 60% (N=103) with non-T2 low asthma. The average cumulative cost per patient was similar in patients with T2 low compared with non-T2 low, with all-cause costs cumulating in four years of follow-up to 37,524€ (95% CI: 27,160, 47,888) in T2 low compared to 34,712€ (25,484, 43,940) in non-T2 low. The corresponding average cumulative respiratory-related costs were 5178€ (3150, 7205) in T2 low compared to 5209€ (4104, 6313) in non-T2 low. Regression modelling identified no differences between the T2-status groups when assessing all-cause healthcare costs per patient-year (PPY). On the other hand, the regression modelling predicted more inpatient days PPY for severe uncontrolled patients with T2 low status compared to the patients with non-T2 low status. Patients with uncontrolled severe T2 low asthma use equal healthcare resources as corresponding non-T2 low patients. This study brought new insights into the HCRU of severe uncontrolled asthma patients per T2 status, which has not previously been investigated.

Non-adherence to COPD medications and its association with adverse events: A longitudinal population based cohort study of older adults

ObjectiveTo determine the association between non-adherence to long term chronic obstructive pulmonary disease (COPD) medications and COPD related emergency department (ED) visits and hospitalizations in patients with incident COPD, utilizing time varying measures of adherence as well as accounting for time-varying confounding impacted by prior adherence. Study design and settingWe conducted a population-based retrospective cohort study between 2007–2017 among individuals aged 66 years and older with incident COPD using multiple linked administrative health databases from the province of Ontario, Canada. Adherence to COPD medications was measured using time varying proportion of days covered based on insurance claims for medications dispensed at community pharmacies. The parametric g-formula was used to assess the association between time-varying adherence (in the last 90-days) to COPD medications and risk of COPD related hospitalizations and ED visits while accounting for time varying confounding by COPD severity. ResultsOverall, 60,251 individuals with incident COPD were included; mean age was 76 (SD 7) and 59% were male. Mean adherence over the entire follow-up was 23% (SD 0.3). There were 7248 (12%) COPD related ED visits (2.8 events per 100 person years [PY]) and 9188 (15%) COPD related hospitalizations (3.5 events per 100 PY). Compared to those with 0% 90-day adherence, those with adherence between 1–33% had a 19% decreased risk of COPD related ED visits (adjusted risk ratio[aRR]:0.81, 95% confidence interval [CI]:0.78–0.83), those with adherence between 34%−67% had a 18% decreased risk (aRR: 0.82, 95% CI: 0.77–0.85) while those with 68%−100% 90-day adherence had a 63% increased risk of COPD related ED visits (aRR: 1.63, 95% CI: 1.47–1.78). Nearly identical results were obtained for COPD specific hospitalizations. ConclusionAfter accounting for time varying confounding by COPD severity, the highest time varying 90-days adherence was associated with an increased risk of both COPD related ED visits and hospitalizations compared to the lowest adherence categories. Differences in COPD severity between adherence categories, perception of need for medication management in the higher adherence categories, and potential residual confounding makes it difficult to disentangle the independent effects of adherence from the severity of the condition itself.

Effectiveness of using a long-term individualized treatment regimen of tuberculosis with multiple drug resistance in elderly people with concomitant diseases

BACKGROUND. The actuality of the correct approach to the treatment of elderly patients with multidrug-resistance tuberculosis (MDR-TB) and concomitant diseases is unquestionable. We did not find in the available literature a study of the use of a completely oral long-term individualized treatment regimen (ITR) in this category of patients, which confirms the scientific novelty of the research.&#x0D; OBJECTIVE. To analyze the using of fully oral long-term ITR of MDR-TB in a 73-year-old patient with concomitant diseases on the example our own observation.&#x0D; MATERIALS AND METHODS. A clinical case of our own observation of a patient who was treated in the pulmonary TB department No. 2 of the Zaporizhzhia Regional Phthisiopulmonological Clinical Treatment and Diagnostic Center.&#x0D; RESULTS AND DISCUSSION. A 73-year-old man previously suffered from TB. He fell ill for the first time in 1987 and the first relapse of the specific process occurred in 2010. In both cases the patient received treatment of sensitive to antimycobacterial drugs TB, which ended with a positive outcome. During the relapse case described in the presented work, MDR-TB was diagnosed in the patient. Concomitant diseases of the cardiovascular system and the organ of vision were diagnosed in the patient. Before the ITR course completion the patient suffered a repeated myocardial infarction against the background of alcohol abuse. The patient received a completely oral long-term (18 month) course of MDR-TB ITR: 4 months of Lfx-Bdq-Cfz-Cs-Mpn-Amx/Clv, 2 months of Lfx-Bdq-Cfz-Cs, 12 months of Lfx-Cfz-Cs. Treatment was prescribed considering the data of the drug sensitivity test and the presence of contraindications to the appointment of Lzd. Complete cessation of bacterial excretion was registered after 4 months of antimycobacterial treatment. Tolerability of antimycobacterial therapy was satisfactory, adverse drugs’ reactions were not determined.&#x0D; CONCLUSIONS. The presented clinical case of our own observation demonstrates the high safety and effectiveness of a completely oral long-term (18 months) course of MDR-TB ITR in an elderly person with concomitant diseases, which is new data, since we did not find similar works in the available literature. The obtained data are an addition to the indications for use the all-oral long-term (18 months) course of ITR, including 4 months of Lfx-Bdq-Cfz-Cs-Mpn-Amx/Clv, 2 months of Lfx-Bdq-Cfz-Cs, 12 months of Lfx-Cfz-Cs in elderly patients with the simultaneous course of MDR-TB and concomitant cardiovascular and visual diseases.

The accuracy of gross medical thoracoscopy findings in the diagnosis of pleural tuberculosis: A hospital-based study from Qatar

Background: Pleural tuberculosis (TB) diagnosis is a challenging clinical entity. Medical thoracoscopy (MT) is quickly replacing other diagnostic methods as the preferred diagnostic method for exudative pleural effusions. This study aimed to describe the gross MT findings in pleural TB and to evaluate the accuracy of these findings in the diagnosis of pleural TB in terms of sensitivity and specificity. Methods: This is a retrospective descriptive study involving all patients who underwent MT in the pulmonary department of Hamad General Hospital, from January 2014 to December 2019 to determine the etiology of undiagnosed pleural effusions. Results: We studied 400 cases, 353 (88.3%) were male and 47 (11.7%) were female. Their mean age was 37.49±12.46 years. Gross MT findings included free fluid 400 (100%), nodules 307 (76.8%), adhesions 226 (56.5%), pleural thickening 382 (95.5%), and pleural hyperemia 366 (91.5%). Confirmed cases of pleural TB based on histomicrobiologic studies were 320 (80.0%). The specificities of pleural nodules, adhesions, thickening, and hyperemia were 52.50%, 11.25%, 50.00%, and 25.00%, respectively. While the sensitivities for pleural nodules, adhesions, thickening, and hyperemia were 58.75%, 97.19%, 83.44%, and 95.62%, respectively. Conclusion: Gross MT findings without pleural nodules, hyperemia, and thickening can be used to rule out pleural TB, thereby allowing the treating physician to postpone antitubercular therapy until the final diagnosis is confirmed. However, the presence of these gross findings has no significant association with pleural TB. On the other hand, pleural adhesions showed low sensitivity and specificity for pleural TB.

Rehabilitation for Post-COVID Syndrome covered by the German Pension Insurance in 2021

The present work is intended to give an overview of rehabilitation of patients with post COVID-19 condition covered by the German Pension Insurance in 2021. Cross-sectional analysis of medical rehabilitation completed in 2021, in which COVID-19 sequelae were coded in first or second place in the uniform discharge report according to the International Statistical Classification of Diseases and Related Health Problems was carried out. The codes U08(.9), U09(.9) and U10(.9) as well as the corresponding codes from 2020 were taken into the evaluation as COVID-19-related diseases. Children's rehabilitation and oncological rehabilitation for pensioners and their relatives were excluded. Statistically, relative and absolute frequencies are given for nominal and ordinal variables, and median and quartiles for continuous, skewed distributed variables. 9,666 rehabilitations with one of the codes mentioned in first or second place remained. 54.8% of the patients were women and 43.2% men. The median age was 54 and 55 years (women/men). In all, 64.4% of the rehabilitations were carried out in the pulmonary medicine department. Owing to somatic indications, almost 50% of these patients in rehabilitation remained in the clinic beyond the regular approval period. The most common other diagnoses were diseases of the respiratory system. In 80.7% of those affected, the treating physicians considered the post-COVID-19 condition-associated symptoms as improved through rehabilitation. Furthermore, employment was subject to social security contributions for 88.0% of these patients, and 30.5% were employed in the fields of health, social affairs, teaching, and education. Of those affected, 63.8% were on sick leave when they were admitted, 63.0% when they were discharged. With regard to performance in the last job or on the general job market, over 90.0% received a prognosis for 6 hours and more. The importance of post-COVID-19 condition in the context of medical rehabilitation increased significantly over the course of 2021. The disease causes long periods of disability. With regard to performance, the available analyses give a positive picture; only 6.5% of those individuals undergoing rehabilitation were assessed as having a reduced capacity to earn of less than 3 hours on the general labor market.

Esophageal dysmotility detection in patients with gastroesophageal reflux-related cough and its influence on the efficacy of anti-reflux therapy

Objective: To investigate the characteristics of esophageal dysmotility in patients with an initial diagnosis of acid/non-acid gastroesophageal reflux-related cough (GERC), and its correlation with the therapeutic response to anti-reflux treatments to search for the useful indicators to screen patients with chronic cough suitable for anti-reflux therapy. Methods: A total of 173 patients with suspicious GERC who attended the Chronic Cough Specialist Clinic of Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University between June 2020 and December 2022 were retrospectively selected for the study. The age of the patients was (45.1±14.6) years old, including 87 males and 86 females. Their demographic characteristics, clinical manifestations, and the results of high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring (MII-pH) were collected. Information on the etiological identification process and final diagnosis was also recorded. The recruited cases were grouped according to therapeutic outcomes and divided into cases with a favourable response to conventional anti-reflux treatment, cases with a favourable response to intensified anti-reflux treatment, and cases with no response to anti-reflux treatment. Factors influencing the efficacy of anti-reflux treatment were investigated. Differences between groups were compared using the χ2 test, Student-Newman-Keuls test, and Kruskal-Wallis H(K) test, where applicable. Logistic regression analysis using forward stepwise regression based on maximum likelihood estimation was used to screen for influence factors. Results: The 175 patients with suspicious GERC included 45 (26.0%) patients who responded to conventional anti-reflux treatment, 54 (31.2%) who responded to intensified anti-reflux treatment and 74 (42.8%) who did not respond to anti-reflux therapies. Esophageal dysmotility was present in 52.0% of patients (90/173), but was less common in patients who responded to conventional anti-reflux treatment (χ2=8.09, P=0.018). Although the majority of reflux episodes were non-acid (136/173, 78.6%), the proportion of acid reflux (χ2=19.49, P<0.001) and acid exposure time (H=11.04, P=0.004) were significantly higher in patients who responded to conventional anti-reflux treatment. The patients with acid and non-acid GERC had comparable proportion of esophageal dysmotility (64.9% vs. 48.5%, χ2=3.11, P=0.078), with a shorter break [2.4 (0.7, 5.6) cm vs. 6.1 (1.4, 10.0) cm, Z=-2.39, P=0.017], longer upper esophageal sphincter [(4.1±0.9) cm vs. (3.7±1.3) cm, t=-2.09, P=0.038], higher percentage of normal esophageal contractions [60.0% (17.8%, 90.0%) vs. 30.0% (0, 80.0%), Z=-2.14, P=0.032], and lower percentage of large break [10.0% (0, 40.0%) vs. 50.0% (0, 100.0%), Z=-2.92, P=0.004] in the patients with non-acid GERC. The mean resting pressure of the lower esophageal sphincter was significantly lower (H=7.49, P=0.024), while the percentage of ineffective esophageal contractions was markedly higher (H=8.60, P=0.014) in the patients who responded to intensified anti-reflux treatment and in the patients who did not respond to the anti-reflux therapies. Multifactorial logistic regression analysis identified the percentage of ineffective contraction as an independent factor predicting the efficacy of conventional anti-reflux treatment, with a cut-off value of≤45% and a moderate predictive value (AUC=0.67, P=0.004). Conclusions: Esophageal dysmotility is common in GERC patients with different characteristics in acid and non-acid GERC. The percentage of ineffective esophageal contraction may be a useful indicator for selecting an anti-reflux strategy and predicting treatment outcomes.

Клініко-інструментальні, цитологічні та інфламатометричні маркери ремоделінгу дихальних шляхів у хворих на бронхіальну астму дітей

Purpose - to investigate the clinical-instrumental, cytological and inflammatory characteristics of the disease in children with bronchial asthma, taking into account the content of the remodeling marker matrix metalloproteinase-9 (MMP-9) in the sputum to optimize the timely detection of structural remodeling of the bronchi. Materials and methods. A cohort of 99 children with BA was examined by the method of random sampling in the conditions of the Pulmonary Allergology Department of the RMCE CRCCH. All children underwent a complex clinical and paraclinical examination with the determination of the cytological composition of sputum, the determination of bronchial hyperreactivity and their hypersensitivity in a sample with serial dilution of histamine, the study of the concentration of metabolites of nitrogen monoxide in peripheral blood and condensate of pulmonary expiratory air. Two clinical groups were formed. The Group I included 55 patients in whom the content of MMP-9 in the sputum supernatant did not reach the level of 5.4 ng/ml, and the II group was formed by 44 patients with MMP-9 content ≥5.4 ng/ml. The main clinical characteristics of the observation groups were comparable. Results. It was established that the risk of a clinically more severe exacerbation of the disease is twice as high in children with an increased content of MMP-9 in the sputum (relative risk - 1.4, odds ratio - 2.0) with the preservation of this trend during 5 days of inpatient treatment. The work also shows that in patients with an increased content of MMP-9 in sputum, the concentration of FeNO more than 22.0 μmol/l occurs twice as often as in the first clinical group (pφ&lt;0.05). This finding reflects the association of the processes of allergic inflammation of the respiratory tract and their remodeling. The results of the PC20H bronchoprovocation test indicate statistically significantly lower levels of the provocation dose and provocation concentration of histamine, which corresponds to significant bronchial hypersensitivity, the chances of which increase against the background of the accumulation of MMP-9 in sputum: 27.7 times for PC20H (FEV1) &lt;3.7mg/ml and 48.8 times for PD20H (FEV1) &lt;0.8mg. Conclusions. An increase in the content of MMP-9 in the supernatant fluid of sputum was associated with a more severe course of exacerbations of bronchial asthma in children, an increase in the content of metabolites of nitrogen monoxide in the blood and lung expiratory air, more pronounced signs of bronchial hypersensitivity. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.