Exacerbation Of Disease Research Articles

Evaluating the Usability of a Telehealth System for People with COPD: A Cross Sectional Study.

Pulmonary Disease (COPD) exacerbations. However, the effect of telehealth for COPD remains uncertain, which may be due to a lack of attention to usability during the development of telehealth solutions. The aim was to evaluate the usability of a telehealth system for COPD using the Danish Telehealth Usability Questionnaire. A total of 96 people with COPD, who were already using a telehealth system consisting of weekly measurements of physiological parameters and symptom-related questionnaires, were included. The D-TUQ was used to assess the usability of the telehealth system. The overall experience with the usability of the telehealth system was mainly positive, but there was room for improvement.

Role of Non-invasive Ventilation (NIV) in Managing Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review.

Chronic obstructive pulmonary disease (COPD) is a significant global health issue that is characterized by airflow constriction and breathing difficulties. Non-invasive ventilation (NIV) is a recommended treatment for acute exacerbations of COPD (AECOPD), offering benefits over invasive mechanical ventilation (IMV). We aimed to evaluate the effectiveness, safety, and impact of NIV in managing AECOPD. The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Medline, Cochrane Library, Embase, and Google Scholar for relevant studies published between 2015 and 2024. Inclusion criteria focused on studies involving AECOPD patients treated with NIV, including randomized controlled, cohort, and observational studies. We included 10 studies that fit our inclusion criteria for a thorough review. From the studies selected, NIV demonstrated significant reductions in mortality rates, intubation rates, and hospital stays compared to IMV. Albeit the need to train healthcare providers is essential, high adherence to NIV guidelines was observed. Different NIV modes showed comparable efficacy, and structured weaning protocols reduced relapse rates. NIV is a highly effective and safe treatment for patients with AECOPD than IMV. High-flow nasal therapy(HFNT) is a viable alternative for patients intolerant to NIV. Further research should standardize treatment protocols and optimize NIV use in clinical practice.

ASB3 expression aggravates inflammatory bowel disease by targeting TRAF6 protein stability and affecting the intestinal microbiota.

Ubiquitination is a key process that controls protein stability. We determined the ubiquitination of TRAF6 by ASB3 in intestinal epithelial cells during colonic inflammation. Inflammatory bowel disease patients exhibit upregulated ASB3 expression at focal sites, supporting the involvement of degradation of TRAF6, which promotes TLR-Myd88/TRIF-independent NF-κB aberrant activation and intestinal microbiota imbalance. Sustained inflammatory signaling in intestinal epithelial cells and dysregulated protective probiotic immune responses mediated by ASB3 collectively contribute to the exacerbation of inflammatory bowel disease. These findings provide insights into the pathogenesis of inflammatory bowel disease and suggest a novel mechanism by which ASB3 increases the risk of colitis. Our results suggest that future inhibition of ASB3 in intestinal epithelial cells may be a novel clinical strategy.

Airway epithelial cell response to RSV is mostly impaired in goblet and multiciliated cells in asthma

BackgroundIn patients with asthma, respiratory syncytial virus (RSV) infections can cause disease exacerbation by infecting the epithelial layer of the airways, inducing subsequent immune response. The type I interferon antiviral...

Health disparities among incarcerated populations: a crucial laboratory and pathology review.

The United States notoriously has one of the highest rates of incarceration in the world, yet scant attention to the health care needs of those incarcerated exists within laboratory medicine and pathology training and education. This article explores health disparities among incarcerated and released individuals regarding diagnostic laboratory testing and pathology services. A literature search was conducted for articles published between 2002 and 2023 using keywords including "healthcare," "incarcerated," "laboratory services," "pathology services," and "health insurance for prisoners." Central themes were extracted and discussed to reveal the realities of health care during and after release from incarceration. Excluded from the analysis were articles about the immediate or extended family of incarcerated persons. Incarcerated individuals have an increased risk for the development and exacerbation of communicable and noncommunicable diseases and mental health disorders, which results in exceedingly high morbidity and mortality rates. Policy changes are needed to mitigate disparities and improve health outcomes for incarcerated and released persons. Central to these disparities is decreased access to laboratory and pathology services, impeded by inadequate health care funding for these carceral institutions. Providing additional funding to the carceral system's health care budget is necessary to improve access to pathology and laboratory services.

Microbiome modifications by steroids during viral exacerbation of asthma and in healthy mice.

In the present studies the assessment of how viral exacerbation of asthmatic responses with and without pulmonary steroid treatment altered the microbiome in conjunction with immune responses presents striking data. The overall findings identify that while steroid treatment of allergic animals diminished the severity of the respiratory syncytial virus (RSV)-induced exacerbation of airway function and mucus hypersecretion, there were local increases in IL-17A expression. Analysis of lung and gut microbiome suggested that there are differences in the RSV exacerbation that are further altered by fluticasone (FLUT) treatment. Using metagenomic inference software, PICRUSt2, we were able to predict that the metabolite profile that the changed gut microbiome produced was significantly different with multiple metabolic pathways and associated with specific treatments with or without FLUT. Importantly, measuring plasma metabolites, our data indicate that there are significant changes associated with chronic allergen exposure, RSV exacerbation, and with FLUT treatment. The changes to the metabolites have contributions from both host and microbial pathways. To understand if airway steroids on their own altered lung and gut microbiome along with host responses to RSV infection, naïve animals were treated with FLUT prior to RSV infection. The naïve animals with FLUT prior to RSV infection demonstrated enhanced disease corresponding to altered microbiome and the PICRUSt2 metagenomic inference analysis. Altogether, these findings set the foundation for identifying important correlations of severe viral exacerbated allergic disease with microbiome changes a potential for early life pulmonary steroid influence on subsequent viral induced disease.

Non-linear association of triglyceride-glucose index with cardiovascular and all-cause mortality in T2DM patients with diabetic kidney disease: NHANES 2001–2018 retrospective cohort study

BackgroundThe triglyceride glucose (TyG) index is a cutting-edge and highly effective marker of insulin resistance, a crucial factor in the development and exacerbation of diabetic kidney disease (DKD). To date, there has been limited research on how the triglyceride-glucose (TyG) index affects the outlook for patients suffering from DKD.MethodsIn this multicenter retrospective cohort study, the analysis recruited 2,203 DKD patients from the National Health and Nutrition Examination Survey (NHANES) dataset, which covers the US from 2001 to 2018. The research applied a Cox proportional hazards model with multiple variables to investigate the association of the TyG index with mortality outcomes. Restricted cubic splines (RCS) and methods for analyzing threshold effects were employed to identify possible non-linear relationships.ResultsOver nearly 19 years of follow-up, this study captured data on 753 all-cause and 231 cardiovascular disease-specific fatalities. Sophisticated statistical methods, including RCS and smoothing curve adjustments via penalized splines, helped identify distinctive patterns: The baseline TyG index was observed to have a U-shaped pattern related to overall mortality and an L-shape with cardiovascular diseases(CVD) mortality among individuals with DKD. Notably, TyG index below 9.15 for overall mortality and 9.27 for CVD mortality were linked to reduced death rates (HR = 0.65, 95% CI = 0.52–0.82 for all-cause; HR = 0.58, 95% CI = 0.43–0.83 for CVD). On the other hand, TyG index exceeding these benchmarks (greater than 9.15 for all-cause and 9.27 for CVD) correlated with increased all-cause mortality risks (HR = 1.21, 95% CI = 1.02–1.43) and showed a non-significant change in CVD mortality risks (HR = 1.07, 95% CI = 0.83–1.38).ConclusionsThis study emphasizes the non-linear linkage involving the TyG index and death rates due to CVD and other factors in patients with DKD, demonstrating its effectiveness in estimating potential adverse events within this demographic.

Unraveling the Complexities of Coagulation Dysfunction in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Investigating the Interplay between Infection, Hypercapnia and Hemostatic Abnormalities

Unraveling the Complexities of Coagulation Dysfunction in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Investigating the Interplay between Infection, Hypercapnia and Hemostatic Abnormalities

The Interplay between Airway Cilia and Coronavirus Infection, Implications for Prevention and Control of Airway Viral Infections.

Coronaviruses (CoVs) are a class of respiratory viruses with the potential to cause severe respiratory diseases by infecting cells of the upper respiratory tract, bronchial epithelium, and lung. The airway cilia are distributed on the surface of respiratory epithelial cells, forming the first point of contact between the host and the inhaled coronaviruses. The function of the airway cilia is to oscillate and sense, thereby defending against and removing pathogens to maintain the cleanliness and patency of the respiratory tract. Following infection of the respiratory tract, coronaviruses exploit the cilia to invade and replicate in epithelial cells while also damaging the cilia to facilitate the spread and exacerbation of respiratory diseases. It is therefore imperative to investigate the interactions between coronaviruses and respiratory cilia, as well as to elucidate the functional mechanism of respiratory cilia following coronavirus invasion, in order to develop effective strategies for the prevention and treatment of respiratory viral infections. This review commences with an overview of the fundamental characteristics of airway cilia, and then, based on the interplay between airway cilia and coronavirus infection, we propose that ciliary protection and restoration may represent potential therapeutic approaches in emerging and re-emerging coronavirus pandemics.

Genetically Determined Circulating Saturated and Unsaturated Fatty Acids and the Occurrence and Exacerbation of Chronic Obstructive Pulmonary Disease-A Two-Sample Mendelian Randomization Study.

Research on dietary fatty acids (FAs) and lung health has reported skeptical findings. This study aims to examine the causal relationship between circulating FAs and Chronic Obstructive Pulmonary Disease (COPD) onset and exacerbation, using a two-sample Mendelian Randomization (MR) analysis. Strong and independent genetic variants of FAs were obtained from the UK Biobank of European ancestry. The exposure traits included saturated FA (SFA), poly- and mono-unsaturated FA (PUFA and MUFA), omega-3 and omega-6 PUFA, docosahexaenoic acid (DHA), and linoleic acid (LA), all expressed as total FA (TFA) percentages. Summary statistics for COPD outcomes were obtained from the FinnGen consortium including COPD, COPD hospitalization, COPD/asthma-related infections, COPD-related respiratory insufficiency, and COPD/asthma/interstitial lung disease (ILD)-related pneumonia. The inverse-variance weighted (IVW) was the primary MR approach. MR-Egger regression and MR-PRESSO were utilized to evaluate heterogeneity and pleiotropy. MR-PRESSO tests suggested no obvious horizontal pleiotropy. MR results by the IVW approach indicated that the genetically high SFA/TFA levels were associated with an increased risk of COPD/asthma/ILD-related pneumonia (OR: 1.275, 95%CI: 1.103-1.474, p for FDR = 0.002). No significant relationship was observed between other types of FAs and COPD outcomes. Our MR analysis suggests that there is weak evidence that the genetically predicted high SFA/TFA was associated with an increased risk of pneumonia.

Ultrasound of the bowel with a focus on IBD: the new best practice.

Inflammatory Bowel Disease (IBD) is a lifelong chronic disease affecting any part of the gastrointestinal tract with a predilection for the terminal ileum. IBD patients require repeat imaging throughout the course of their disease, necessitating a safe, noninvasive, available, and repeatable method. Imaging is required at diagnosis, routine surveillance, and acute exacerbation of disease. Ultrasound imaging meets these demands with a high degree of accuracy and wide patient acceptance. Ultrasound provides high-resolution imaging and is excellent for detailed evaluation of the bowel wall and surrounding soft tissues. Regular greyscale bowel evaluation and color Doppler imaging now have accepted standards for evaluating disease activity based on wall thickness, perienteric inflammatory fat, and blood flow, which is invaluable in staging and grading disease. High-resolution dynamic real-time imaging on ultrasound has the ability to show functional as well as morphologic detail, including dysfunctional peristalsis associated with bowel stricture and incomplete mechanical bowel obstruction. Fibrostenotic and penetrating complications of IBD may be associated with an acute or chronic presentation that is easily assessed using ultrasound. Newer software technologies for ultrasound, including Contrast-Enhanced ultrasound and Shear wave elastography, have transformed ultrasound from a basic preliminary imaging technique into a highly sophisticated modality that is now competitive with CT and MR enterography for managing IBD patients. Our long experience with ultrasound of the bowel suggests that the new best practice would include ultrasound as the first test for evaluation of the bowel at any stage of the disease.

Role of Extracellular Vesicles in Crohn's Patients on Adalimumab Who Received COVID-19 Vaccination.

Crohn's disease (CD) is a type of inflammatory bowel disease (IBD) affecting the gastrointestinal tract that can also cause extra-intestinal complications. Following exposure to the mRNA vaccine BNT162b2 (Pfizer-BioNTech) encoding the SARS-CoV-2 Spike (S) protein, some patients experienced a lack of response to the biological drug Adalimumab and a recrudescence of the disease. In CD patients in progression, resistant to considered biological therapy, an abnormal increase in intestinal permeability was observed, more often with a modulated expression of different proteins such as Aquaporin 8 (AQP8) and in tight junctions (e.g., ZO-1, Claudin1, Claudin2, Occludin), especially during disease flares. The aim of this study is to investigate how the SARS-CoV-2 vaccine could interfere with IBD therapy and contribute to disease exacerbation. We investigated the role of the SARS-CoV-2 Spike protein, transported by extracellular vesicles (EVs), and the impact of various EVs components, namely, exosomes (EXOs) and microvesicles (MVs), in modulating the expression of molecules involved in the exacerbation of CD, which remains unknown.

Serum Uric Acid as a Biomarker in Patients Admitted with Acute Exacerbation of Chronic Obstructive Pulmonary Disease to a Tertiary Hospital, Kerala

ABSTRACT Background: Chronic obstructive pulmonary disease (COPD) is a highly prevalent and debilitating condition worldwide, imposing significant economic and social burdens on societies. Serum uric acid contributes to inflammation and is often used a biomarker. Aims and Objectives: This study aims to assess the potential role of serum uric acid as a cost-effective biomarker in hospitalized patients experiencing acute exacerbation of COPD. Additionally, it aims to investigate the relationship between the severity of airflow obstruction and serum uric acid levels in patients with COPD. Materials and Methods: The study design is a prospective cohort study involving 144 COPD patients admitted for acute exacerbation, excluding those with concurrent chronic comorbidities or receiving medications known to substantially elevate uric acid levels. Results: Our findings demonstrate elevated serum uric acid levels in patients with advanced-stage COPD and severe airflow obstruction. Furthermore, patients with higher levels of serum uric acid exhibit poorer prognosis compared to those with lower levels in COPD. Conclusion: Serum uric acid can serve as a valuable biomarker to prognosticate COPD patients and assess disease severity in patient admitted with exacerbations.

The influence of glucocorticoids on the bone tissue in patients with chronic obstructive pulmonary disease

Background. According to the GOLD guidelines, glucocorticoids (GCs) are recommended for exacerbations of chronic obstructive pulmonary disease (COPD). Bone mineral density (BMD) can be reduced in case of the use of therapeutic doses of GCs. The aim of the study was to determine the influence of GCs on BMD and the frequency of osteoporosis in patients with COPD depending on the prescribed therapy. Materials and methods. We examined 202 patients with COPD (group E) in the acute phase. Group I consisted of 129 patients taking basic dual treatment, group II — 73 patients taking triple therapy with inhaled GCs. During exacerbations, systemic GCs were prescribed at the cumulative dose of 352.94 ± 30.51 mg/year. The bone state was examined using an ultrasound densitometer SONOST-2000. A Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA), Stiffness index (SI), and T- and Z-scores were determined. Results. Decreases in SI, BUA, T- and Z- scores were established in 43.51 % of the patients from the I group and 83.56 % from the II group (p < 0.05). In the II group, SI was lower by 9.54 %, BUA — by 14.35 %, SOS — by 14.57 %, T- score — by 6.9 %, Z- score — by 25.86 %; in subjects with GOLD 3: BUA — by 40.27 %, SI — by 3.25 %, T- score — by 17.9 %; in patients with GOLD 4: SI — by 19.9 %, BUA — by 77.8 %, T- score — by 5.6 % compared to the I group. Conclusions. Glucocorticoid-induced osteoporosis was diagnosed in 10.71 % of patients from the I group and 20.55 % of the II group. Its frequency depended on the stage of COPD: GOLD 3 — in 22.22 % of patients, GOLD 4 — in 50.0 % of the subjects.

A Practical Approach to Tailor the Term Long COVID for Diagnostics, Therapy and Epidemiological Research for Improved Long COVID Patient Care.

The term long COVID (LC) effectively describes the broad long-term disease burden of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections, encompassing individual suffering and significant socioeconomic impacts. However, its general use hampers precise epidemiological research, diagnostics and therapeutic strategies. Misinterpretations occur, for example, when population surveys are compared to studies using health record data, because both refer to these data as LC. This also emphasizes the need for different terminology. The National Institute for Health and Care Excellence (NICE) rapid guideline differentiates ongoing symptomatic COVID-19 from post-COVID conditions, yet real-world observations challenge these two subgroup definitions. We propose refining the term LC into three subgroups: ongoing symptomatic COVID-19, SARS-CoV-2 induced or exacerbated diseases and post-acute COVID condition. This stratification aids targeted diagnostics, treatment and epidemiological research. Subgroup-specific documentation using the International Classification of Diseases, Tenth Revision (ICD-10) codes ensures accurate tracking and understanding of long-term effects. The subgroup of post-acute COVID condition again includes various symptoms, syndromes and diseases like post-exertional malaise (PEM), dysautonomia or cognitive dysfunctions. In this regard, differentiation, especially considering PEM, is crucial for effective diagnostics and treatment.

Biosafety assessment of novel organoselenium zidovudine derivatives in the Caenorhabditis elegans model

Antiretrovirals have improved considerably since the introduction of 3′-azido-3′-deoxythymidine (zidovudine or AZT), a molecule with also anticancer effects. Subsequently, a variety of other nucleosides have been synthesized. However, these medications are often associated with serious adverse events and the onset or exacerbation of degenerative processes, diseases, and syndromes, affecting mainly the mitochondria. In this study, we used Caenorhabditis elegans to investigate the toxicity potential of AZT and three new organoselenium derivatives with modifications in the 5′ position of the sugar ring in place of the 5′-OH group, with the insertion of a neutral, an electron-withdrawing and an electron-donating group attached to the aryl selenol moiety: 5′-seleno-(4-chloro-phenyl)-3-(amino)-thymidine (ASAT-4-Cl), 5′-seleno-(phenyl)-3-(amino)-thymidine (ASAT-Ph), and 5′-seleno-(4-methoxyphenyl)-3-(amino)- thymidine (ASAT-4-OMe). Analyzes included worm survival, behavior parameters, high-resolution respirometry, citrate synthase activity, and ATP levels. Although all compounds negatively affected C. elegans, ASAT-4-Cl and ASAT-Ph showed lower toxicity compared to AZT, especially in mitochondrial viability and ATP production. Therefore, more studies must be carried out on the use of these new compounds as pharmacological interventions.

Assessing the efficacy of hemoperfusion for dermatomyositis-associated acute exacerbation of interstitial pneumonia: a multicenter retrospective study.

Hemoperfusion (HP) is used to treat various diseases, including sepsis and acute respiratory distress syndrome. However, few studies have explored the efficiency of HP in dermatomyositis-associated acute exacerbation of interstitial lung disease. We conducted a retrospective study. Two hundred and sixteen patients with dermatomyositis-associated acute exacerbation of interstitial lung disease were included. Patients were divided into the HP group (treatment group) and the control group. Changes in oxygenation, hemodynamic parameters, lung ultrasound scores, and inflammatory cytokine levels were evaluated before and after HP in the treatment group. The length of intensive care unit (ICU) stays, duration of ventilator therapy, mortality rate, and incidence of complications were compared between the treatment and control groups. Hemodynamic and oxygenation variables in the treatment group significantly improved after treatment. However, the levels of the inflammatory factors significantly decreased after treatment. The length of ICU stay and the duration of ventilator therapy were significantly shorter in the treatment group than in the control group. The mortality rate of the treatment group was significantly lower than that of the control group. This study demonstrated that HP could improve treatment efficacy in patients with dermatomyositis-associated acute exacerbation of interstitial lung disease.

Assessing the impact of temperature on acute exacerbation of chronic obstructive pulmonary disease hospitalizations in residents of Panzhihua City: a multi-districts study using a distributed lag non-linear model

BackgroundTemperature fluctuations can impact the occurrence and progression of respiratory system diseases. However, the current understanding of the impact of temperature on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains limited. Therefore, our study aims to investigate the relationship between daily mean temperature (DMT) and the risk of AECOPD hospitalizations within Panzhihua City.MethodsWe systematically collected data on AECOPD hospitalizations at Panzhihua Central Hospital from 2015 to 2020 and meteorological factors across Panzhihua City’s districts. A two-stage analysis method was used to establish a distributed lag non-linear model to elucidate the influence of DMT on the frequency of admissions for AECOPD. Subgroup analyses were conducted by gender and age to identify populations potentially susceptible to the impact of DMT.ResultsA total of 5299 AECOPD hospitalizations cases were included. The DMT and the risk of AECOPD hospitalization showed a non-linear exposure–response pattern, with low temperatures exacerbating the risk of hospitalizations. The lag effects of low temperature and relatively low temperature peaked at 2th day, with the lag effects disappearing at 16–17 days. Females and elders aged ≥ 65 years were more sensitive to effects of low and relatively low temperature at lag 0–4 days, while male AECOPD patients exhibited longer lasting lag effects.ConclusionsLow temperatures are associated with an increased risk of AECOPD hospitalizations. Females or elders aged ≥ 65 years with chronic obstructive pulmonary disease should pay more attention to taking protective measures in cold environments. These findings are crucial for the formulation of public health policies, as they will help significantly alleviate the burden of AECOPD and improve respiratory health in the face of climate challenges.

AM/PM dosing of LAMA for COPD: a randomized controlled trial protocol using digital recruitment and registries.

Long-acting muscarinic antagonists (LAMAs) reduce the risk of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), usually taken once daily in the morning. However, the circadian activity of autonomic regulation suggests that the highest need for anticholinergic therapy may be in the late night/early morning. This is supported by evidence that AECOPD most often begins in the morning. Furthermore, the trough spirometry effect of LAMA is lower than the peak effect, which further argues that evening dosing may be more optimal than morning dosing. This trial aims to determine whether evening administration of LAMA reduces hospitalization-requiring AECOPD or death from all causes within 1 year as compared to morning administration of the same LAMA. Randomized controlled open-label trial. Persons aged 30 years or older with a once-daily LAMA prescription and a confirmed COPD diagnosis were recruited. Participants were randomized in a 1:1 ratio to either morning or evening LAMA administration. Complete follow-up for the primary outcome, hospitalization-requiring AECOPD, or death from all causes within 1 year was captured from the Danish National Health Register, as were patient-reported outcome assessments at 6 and 12 months. A total of 10,013 participants were randomized, and the recruitment process started on 9 March 2023. Secondary outcomes include (i) moderate COPD exacerbations; (ii) all-cause hospitalization; (iii) ICU admission; (iv) need for non-invasive ventilation; and (v) all-cause mortality, among others. All outcomes will be evaluated 12 months after recruitment.Clinical trial registration:ClinicalTrials.gov, NCT05563675.

Stress granule formation helps to mitigate neurodegeneration.

Cellular stress pathways that inhibit translation initiation lead to transient formation of cytoplasmic RNA/protein complexes known as stress granules. Many of the proteins found within stress granules and the dynamics of stress granule formation and dissolution are implicated in neurodegenerative disease. Whether stress granule formation is protective or harmful in neurodegenerative conditions is not known. To address this, we took advantage of the alphavirus protein nsP3, which selectively binds dimers of the central stress granule nucleator protein G3BP and markedly reduces stress granule formation without directly impacting the protein translational inhibitory pathways that trigger stress granule formation. In Drosophila and rodent neurons, reducing stress granule formation with nsP3 had modest impacts on lifespan even in the setting of serial stress pathway induction. In contrast, reducing stress granule formation in models of ataxia, amyotrophic lateral sclerosis and frontotemporal dementia largely exacerbated disease phenotypes. These data support a model whereby stress granules mitigate, rather than promote, neurodegenerative cascades.