Exacerbations Of Chronic Bronchitis Research Articles

Bilateral vestibulopathy and sensorineural hearing loss in necrobiotic xanthogranuloma, multiple myeloma and amiloidosis

This article describes a rare case of necrotic xanthogranuloma in a 46-year-old patient who presented with the development of periorbital xanthelasms, progressive bilateral sensorineural hearing loss and bilateral vestibulopathy, followed by multiple myeloma and amyloidosis. For several years, the patient underwent standard rehabilitation for chronic sensorineural hearing loss and was fitted with a hearing aid. During hospitalisation for exacerbation of chronic bronchitis, monoclonal gammopathy was identified, and later, after careful examination and repeated biopsies, necrotic xanthogranuloma, multiple myeloma and AL-amyloidosis were confirmed. Targeted immunochemotherapy resulted in improvement of hearing and significant recovery of the vestibuloocular reflex bilaterally.

Analyzing the Impact of Diesel Exhaust Particles on Lung Fibrosis Using Dual PCR Array and Proteomics: YWHAZ Signaling.

Air pollutants are associated with exacerbations of asthma, chronic bronchitis, and airway inflammation. Diesel exhaust particles (DEPs) can induce and worsen lung diseases. However, there are insufficient data to guide polymerase chain reaction (PCR) array proteomics studies regarding the impacts of DEPs on respiratory diseases. This study was performed to identify genes and proteins expressed in normal human bronchial epithelial (NHBE) cells. MicroRNAs (miRNAs) and proteins expressed in NHBE cells exposed to DEPs at 1 μg/cm2 for 8 h and 24 h were identified using PCR array analysis and 2D PAGE/LC-MS/MS, respectively. YWHAZ gene expression was estimated using PCR, immunoblotting, and immunohistochemical analyses. Genes discovered through an overlap analysis were validated in DEP-exposed mice. Proteomics approaches showed that exposing NHBE cells to DEPs led to changes in 32 protein spots. A transcriptomics PCR array analysis showed that 6 of 84 miRNAs were downregulated in the DEP exposure groups compared to controls. The mRNA and protein expression levels of YWHAZ, β-catenin, vimentin, and TGF-β were increased in DEP-treated NHBE cells and DEP-exposed mice. Lung fibrosis was increased in mice exposed to DEPs. Our combined PCR array-omics analysis demonstrated that DEPs can induce airway inflammation and lead to lung fibrosis through changes in the expression levels of YWHAZ, β-catenin, vimentin, and TGF-β. These findings suggest that dual approaches can help to identify biomarkers and therapeutic targets involved in pollutant-related respiratory diseases.

Можливості використання декаметоксину у пацієнтів з хронічними захворюваннями нижніх дихальних шляхів при гострих респіраторних вірусних інфекціях

The annual increase in the number of patients with chronic respiratory diseases and a significant increase in the level of antibiotic resistance in Ukraine and in the world has set modern scientists an extremely important task - the search for new effective ways of combating infectious agents of viral and bacterial exacerbations of pathologies of the tracheobronchial tree. The aim: to assess the efficacy and safety of decamethoxine in patients with exacerbations of chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB). Materials and methods: clinical symptoms were evaluated in 19 patients with COPD (group I) and 38 patients with COPD (group II) with signs of acute respiratory viral infection (ARVI) at three visits: the initial visit (at the time of the initial visit to the family doctor ), the second visit (on days 3-5 after the initial application) and the third visit (on days 7-10 after the initial application). Subgroups were divided depending on the prescribed anti-infective therapy: subgroups Ib and IIb received symptomatic therapy, and subgroups Ia and IIa additionally received decamethoxine. The results. One of the most frequent symptoms at the initial visit was cough for the patients of both groups. Decamethoxine contributed to a decrease in the frequency of cough on the 7-10th day of treatment by two times in subgroup Ia (p < 0.05) and by almost 5 times in subgroup IIa (p < 0.001). The dynamics of dyspnea in patients with COPD who did not receive additional therapy with decame thoxine was not variable during the entire study period. Patients with CB extremely rare had such a symptom as shortness of breath. In both subgroups of patients treated with decamethoxine, a certain tendency to an increase in cases of purulent sputum was observed only at visit 2, however, at the third visit, the number of such patients decreased and clearly coincided with the appointment of antibacterial drugs. Manifestations of the intoxication syndrome decreased over time in all subgroups, and at the third visit were less pronounced compared to the first two visits in most patients and practically did not depend on the additional intake of decamethoxine. There was no significant difference in the reduction of symptoms of nasopharyngoconjunctival syndrome. The conducted analysis of the frequency of hospitalization showed that only 1 patient from subgroups Ia and IIa continued treatment in hospital conditions at visit 3, and in patients with standard basic therapy by the time of visit 3, hospitalization was required for 2 patients of subgroup Ib and two from IIb. Conclusions. The inclusion of decamethoxin solution in the complex treatment of ARVI in patients with chronic diseases of the lower respiratory tract allows to reduce the duration of cough, shortness of breath, producing of purulent sputum, manifestations of nasopharyngeal syndrome by 1.5-3 times. Additional inhalation use of 0.02 % decamethoxine solution reduces the need to prescribe antibacterial drugs and the risk of hospitalization by 2.2 times among patients with COPD. Patients with CB who received inhalation nebulizer therapy with a sterile solution of decamethoxine used antibiotics 2.2 times less often, and none of them were hospitalized.

Cefpodoxime proxetil – new opportunities in antibacterial therapy of respiratory infections

The purpose of the expert council was to determine the place of cefpodoxime in the ABT algorithms for upper and lower respiratory tract infections and to form a consensus position on its use in clinical practice. Based on the available data, the possibility of including cefpodoxime in national guidelines for the treatment of rhinosinusitis, acute tonsillopharyngitis, community-acquired pneumonia (CAP), as well as infectious exacerbations of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) is being considered.

Promena mentalnog statusa izazvana maksifloksacinom

Introduction: Moxifloxacin is an antibiotic used orally or parenterally in the emergency department (ED) for the treatment of various infections, especially acute exacerbation of chronic bronchitis and community-acquired pneumonia. The side effects of the drug are mainly on the gastrointestinal system, while the central nervous system side effects are rare. Case report: Herein, we present an elderly patient who had altered mental status associated with the use of moxifloxacin. Upon discontinuation of the drug, the patient quickly returned to baseline neurologic status. In the evaluation of altered mental status in elderly patients in the ED, much of the effort should be spent primarily on ruling out more complex diagnoses. However, this approach requires more invasive and advanced testing. Conclusion: Considering drug side effects among these more complicated diagnoses may increase noninvasive and radiation-free options for the patient and physician.

Immuno-hormonal and dopplerometric characteristics of placental insufficiency in pregnant women with exacerbation of chronic bronchitis associated with reactivation of cytomegalovirus infection

Aim. To give immune-hormonal and dopplerometric characteristics of placental insufficiency in pregnant women with exacerbation of chronic bronchitis associated with reactivation of cytomegalovirus infection (CMVI).Ma­terials and methods. The concentration of IL-ie, IL-2 and progesterone was studied in the blood serum, and the pulsation index (PI) in the right uterine artery (RUA) was determined in 80 patients at 21-24 weeks of gestation, uncomplicated and complicated by exacerbation of chronic simple bronchitis due to reactivation of CMVI. In a retrospective analysis, 3 groups were formed. The first group - 30 women with CMV-seronegative physiological pregnancy; the second - 25 patients with chronic bronchitis in the acute stage, initiated by the acute phase of CMVI, leading to chronic compensated placental in­sufficiency (CCPI); the third - 25 women with exacerbation of chronic bronchitis CMVI etiology, causing the development of chronic subcompensated placental insufficiency (CSPI) in the third trimester of gestation.Results. In the first group, the concentration of IL-ie was 22.8±0.02 pg/mL, IL-2 - 30.6±2.34 pg/mL, progesterone - 130.8±8.19 nmol/L, and the value of PI in RUA - 0.83±0.04 rel. units. In patients of the second group, compared with the first, the level of IL-ie in­creased by 3.82 times (p<0.00i), IL-2 - by 2.55 times (p<0.00i) and PI in the RUA - by i.40 times (p<0.00i) against the background of a decrease in the progesterone concentration by i.47 times (p<0.00i). The third group compared with the first was characterized by an increase in the concentration of IL-ie by 6.87 times (p<0.001), IL-2 - by 3.19 times (p<0.001) and PI in RUA by i.66 times (p<0.00i) with lower levels of progesterone (i.93 times, p<0.00i). In the third group, in contrast to the second one, an increase in IL-ie was observed by 1.79 times (p<0.001), IL-2 - by 1.24 times (p<0.05) and PI in RUA - by i.i7 times (p<0.05), as well as a decrease in progesterone levels by i.3i times (p<0.0i). There was an in­crease in the relationship of PI in RUA with the concentration of IL-ie (r=0.69; p<0.001), IL-2 (r=0.75; p<0.001) and progesterone (r=-0.55; p<0.01).Conclusion. A more pronounced systemic inflammatory reaction, leading to inhibition of progesterone synthesis and increased resistance to blood flow at RUA develops in exacerbation of chronic bronchitis in the second trimester of gestation against the background of reactivation of CMVI, which initiates the development of CCPI, in comparison with the exacerbation of bronchopulmonary pathology of a similar etiology, which determines the formation of subsequent CCPI.

Relationship between Antithrombin III Activity and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

We aimed to explore the role of antithrombin III (AT-III) activity in diagnosing patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and chronic bronchitis, and its relationship with all-cause mortality of AECOPD patients. We performed univariate and multivariate Cox regression analyses of the factors determining all-cause mortality. We recruited 279 patients with AECOPD and 91 with chronic bronchitis. On admission, patients with AECOPD had lower AT-III activity (80.7 vs. 86.35%, p = 0.002) and higher neutrophil percentages (70.12 vs. 66.40%, p = 0.02) than those with chronic bronchitis. The patients who died were older (78 vs. 73 years, p < 0.001); had higher CRP (39.05 vs. 5.65 mg/L, p < 0.001), D-dimer (1.72 vs. 0.46 mg/L, p < 0.001), FIB (3.56 vs. 3.05 g/L, p = 0.01) levels; and exhibited lower AT-III activity (71.29 vs. 82.94%, p < 0.001) than the survivors. The AT-III area under the receiver operating characteristic curve for predicting COPD all-cause mortality was 0.75 (p < 0.001), optimal cutoff point 79.75%, sensitivity 86.8%, and specificity 57.1%. Multivariate Cox regression analyses showed that increased levels of CRP (HR = 1.005, p = 0.02), D-dimer (HR = 1.17, p = 0.01), WBC count (HR = 1.11, p = 0.002), and reduced AT-III activity (HR = 0.97, p = 0.02) were independent prognostic factors for all-cause mortality. Patients with AT-III ≤ 79.75% were 4.52 times (p = 0.001) more likely to die than those with AT-III > 79.75%. AT-III activity was lower in patients with AECOPD than in those with chronic bronchitis and is potentially useful as an independent predictor of all-cause mortality in patients with AECOPD: reduced AT-III activity and increased CRP and D-dimer levels indicate a higher risk of all-cause mortality.

Simple Determination of Gemifloxacin Levels in Human Plasma using High-Performance Liquid Chromatography-Tandem Mass Spectrometry

Gemifloxacin, a broad-spectrum antibacterial agent of the fluoroquinolone class, is used to treat bacterial infections, including acute bacterial exacerbation of chronic bronchitis and community-acquired pneumonia. This study aimed to develop a simple and robust analysis of gemifloxacin in human plasma by high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). The sample was prepared using simple protein precipitation procedures with acetonitrile and separated using the Gemini C18 column with a mobile phase (0.1% formic acid: 0.1% formic acid in acetonitrile = 78: 22 (V/V)). Moxifloxacin was used as an internal standard. The mass spectrometer was operated in the positive ion mode using multiple reaction monitoring. Each precursor ion of gemifloxacin and moxifloxacin was monitored at m/z 390.1/402.1, and their product ions were monitored at m/z 372.3/384.4. The calibration curve showed linearity in 0.005–5 μg/mL with an appropriate correlation coefficient (≥0.99). The variation coefficient of intra- and interprecision values of gemifloxacin was &lt;15%. The intra- and interaccuracy values ranged from 85% to 115%, except for the lower limit of quantification (accuracy range: 80%–120%). The proposed method was performed with a simple preparation step, and moxifloxacin, which is easily accessible, was used as the internal standard. These results suggest that the present assay is a practical analytical method and, therefore, can be readily applied for analysis, including in pharmacokinetic studies and therapeutic drug monitoring of gemifloxacin.

Haemophilus influenzae Protein D antibody suppression in a multi-component vaccine formulation.

Nontypeable Haemophilus influenzae (NTHi) has emerged as a dominant mucosal pathogen causing acute otitis media (AOM) in children, acute sinusitis in children and adults, and acute exacerbations of chronic bronchitis in adults. Consequently, there is an urgent need to develop a vaccine to protect against NTHi infection. A multi-component vaccine will be desirable to avoid emergence of strains expressing modified proteins allowing vaccine escape. Protein D (PD), outer membrane protein (OMP) 26, and Protein 6 (P6) are leading protein vaccine candidates against NTHi. In pre-clinical research using mouse models, we found that recombinantly expressed PD, OMP26, and P6 induce robust antibody responses after vaccination as individual vaccines, but when PD and OMP26 were combined into a single vaccine formulation, PD antibody levels were significantly lower. We postulated that PD and OMP26 physiochemically interacted to mask PD antigenic epitopes resulting in the observed effect on antibody response. However, column chromatography and mass spectrometry analysis did not support our hypothesis. We postulated that the effect might be in vivo through the mechanism of protein vaccine immunologic antigenic competition. We found when PD and OMP26 were injected into the same leg or separate legs of mice, so that antigens were immunologically processed at the same or different regional lymph nodes, respectively, antibody levels to PD were significantly lower with same leg vaccination. Different leg vaccination produced PD antibody levels quantitatively similar to vaccination with PD alone. We conclude that mixing PD and OMP26 into a single vaccine formulation requires further formulation studies.

Changes in immunological parameters and umbilical blood flow in pregnant women during exacerbation of chronic bronchitis associated with cytomegalovirus infection

Aim. To evaluate changes in immunological parameters and umbilical blood flow in pregnant women with exacerbation of chronic bronchitis associated with cytomegalovirus infection (CMVI).Materials and methods. The concentration of secretory immunoglobulin A (sIgA), immunoglobulin E (IgE), circulating immune complexes (CIC), interleukin- 6 (IL-6), interleukin-4 (IL-4) and systolic-diastolic ratio (SDR) in the umbilical artery was studied in 80 women with exacerbation of chronic bronchitis in the second trimester of pregnancy, uncomplicated and complicated by the acute phase of CMVI. The first group was represented by 30 women with cytomegalovirus seronegative physiological pregnancy; the second – 25 patients with exacerbation of chronic bronchitis caused by reactivation of CMVI, complicated by the development of chronic compensated placental insufficiency (CCPI); the third – 25 women with chronic simple bronchitis in the acute stage in the setting of the acute phase of CMVI, initiating the formation of chronic subcompensated placental insufficiency (CSPI) at 30-34 weeks of gestation.Results. In the first group, the concentration of sIgA in blood serum was 4.3±0.26 mg/L, IgE – 3.64±0.23 IU/mL, CIC – 0.091±0.005 AU, IL-6 – 2.41±0.21 pg/mL, IL-4 – 30.1±2.19 pg/mL, cortisol – 527.2±20.95 nmol/L, and SDR in the artery umbilical cord – 3.41±0.06 relative units. In women of the second group, in comparison with the first one, there was an increase in the concentration of sIgA by 1.40 times (p&lt;0.01), IgE – by 1.95 times (p&lt;0.001), CIC – by 1.83 times (p&lt;0.001) , IL-6 – 2.61 times (p&lt;0.001), IL-4 – 1.29 times (p&lt;0.05), cortisol – 1.35 times (p&lt;0.001) in the absence of statistically significant differences the magnitude of vascular resistance in the umbilical artery. In the third group, in comparison with the first one, there was a decrease in sIgA values by 1.26 times (p&lt;0.05) in the setting of an increase in the concentration of IgE by 2.56 times (p&lt;0.001), CIC – by 2.09 times (p&lt;0.001 ), IL-6 – by 3.65 times (p&lt;0.001), IL-4 – by 1.64 times (p&lt;0.001), cortisol – by 1.52 times (p&lt;0.001) and SDR in the umbilical artery – 1.27 times (p&lt;0.001). In women of the third group, in contrast to the second one, a decrease in the concentration of sIgA by 1.77 times (p&lt;0.001), as well as an increase in IgE by 1.31 times (p&lt;0.01), CIC ‒ by 1.14 times (p&lt;0.001), IL-6 ‒ 1.39 times (p&lt;0.001), IL-4 ‒ 1.27 times (p&lt;0.05), cortisol ‒ 1.13 times (p&lt;0.05) and SDR in the umbilical artery ‒ 1.21 times (p&lt;0.001). A direct correlation was established between IL-6 and cord blood flow (r=0.53; p&lt;0.01), as well as an inverse relationship between sIgA and cortisol (r=-0.44; p&lt;0.05).Conclusion. In the second trimester of gestation, exacerbation of chronic simple bronchitis caused by reactivation of CMVI, which initiates the development of CSPI, in contrast to chronic bronchitis in the acute stage, associated with the acute phase of chronic CMVI, which induces the formation of CCPI, is accompanied by an imbalance of nonspecific local and systemic immune responses, as well as stress-reaction, which leads to the growth of SDR in the umbilical artery.

A Short Review on Cefueoxime Axetil Tablet

Cefuroxime axetil is a broad-spectrum antibiotic with a simple pharmacokinetic profile. The medicine treats otitis media, pharyngitis, sinusitis, CAP, and acute exacerbations of chronic bronchitis effectively and well. Cefuroxime axetil was beneficial in intravenous/oral sequential therapy for CAP, but dosage recommendations are not accessible in some countries. Cefuroxime axetil may be used to treat community-acquired infections, including those caused by -lactamase-producing respiratory bacteria. In an era of rapidly growing bacterial resistance, empirical treatment with cefuroxime axetil may assure the proper use of newer antibacterial medicines, reducing bacterial resistance to these drugs.&#x0D;

Chronic bronchitis in the practice of a family doctor

Chronic bronchitis is the most common chronic nonspecific lung disease (CNSLD). The prevalence of chronic bronchitis in the Russian Federation ranges from 10 to 20%, and the increase in the incidence of chronic nonspecific lung diseases is 6–7% for the urban and 2–3% for the rural population per year. The recent increase in the incidence of bronchitis in most countries of the world is associated with air pollution with dust particles and gases, the popularity of smoking, and allergies of the population. The article tells about the modern principles of diagnosis and treatment of chronic bronchitis. Particular attention is paid not only to the optimal choice of antibiotic therapy for infectious exacerbation of chronic bronchitis (CB), but also to the role of topical antibacterial drugs (ABD) in this case. The basic points outlined in the article can be useful for general practitioners and pulmonologists who are faced with this disease.

Clinical Pharmacology of Ampicillin

Ampicillin is active against gram-negative and gram-positive organisms. Ampicillin is a β-lactam antibiotic and β-lactam ring is destroyed by β-lactamases thus ampicillin is co-formulated with sulbactam an inhibitor of β-lactamases. Ampicillin has been found efficacy and safe in treatment of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis and ampicillin/sulbactam has been found efficacy and safe in treatment of multidrug-resistant Acinetobacter baumannii. Ampicillin treats sinusitis, otitis media, acute exacerbations of chronic bronchitis, epiglottitis, and bacterial meningitis and ampicillin/sulbactam treats upper respiratory-tract and skin infections, and many life-threatening infections. Ampicillin and sulbactam penetrates into body-tissues. Ampicillin and sulbactam elimination half-life is 1.41 and 1.73 hours, respectively, in healthy subjects, but the half-life of ampicillin and sulbactam is increased in patients with acute kidney injury undergoing dialysis. The prophylaxis with ampicillin/sulbactam prevents infections in patients undergoing surgery and the treatment with ampicillin or ampicillin/sulbactam has been studied. Ampicillin penetrates into cerebrospinal fluid in significant amounts and ampicillin treats the bacterial meningitis caused by Haemophilus influenzae type b and Haemophilus meningitis but ampicillin may become resistant to Streptococcus aureus, Klebsiella, Pseudomonas, Salmonella enterica serotype Typhimurium, and Shigella dysenteriae. Ampicillin freely crosses the human placenta and migrates into breast-milk is significant amounts. The aim of this study is to review ampicillin and ampicillin/sulbactam efficacy and safety, ampicillin and sulbactam penetration into body-tissues, ampicillin and sulbactam pharmacokinetics, ampicillin/sulbactam prophylaxis and treatment, treatment of bacterial meningitis with ampicillin, ampicillin transfer across the human placenta, ampicillin migration into the breast-milk, and ampicillin resistance.

Interrelation of immunological and hemodynamic parameters of the fetoplacental system in exacerbation of chronic bronchitis of cytomegalovirus etiology

Aim. To establish the relationship of immunological and hemodynamic parameters of the fetoplacental system during exacerbation of chronic bronchitis of cytomegalovirus etiology. Materials and methods. A study was carried out of the concentration of TNFα, IgA, IgM in the blood serum and the systolic-diastolic ratio (SDR) in the right uterine artery (RUA) in 80 women in the second trimester of pregnancy, uncomplicated and complicated by exacerbation of cytomegalovirus infection (CMVI). Three groups were retrospectively distinguished. The first group included 30 patients with CMV seronegative physiological pregnancy, the second group included 25 women with exacerbation of chronic bronchitis caused by CMVI reactivation, initiating the development of chronic compensated placental insufficiency (CCPI), in the third group – 25 pregnant women with chronic bronchitis in the acute stage, induced by CMVI, leading to the formation of chronic subcompensated placental insufficiency (CSPI) in the third trimester of gestation. Results. In the first group, the concentration of TNFα in the blood serum was Me 16.4 (13.1–33.8) pg/mL, IgA – Me 2.5 (2.23–2.62) mg/mL, IgM – Me 0.99 (0.87–1.56) mg/mL, and SDR in RUA – Me 1.95 (1.87–2.30). In the second group, compared with the first one, there was an increase in the concentration of TNFα by 4.95 times (p=0.000001), IgM − by 2.51 times (p = 0.000001) and SDR in RUA by 1.25 times (p = 0.000001) with a 1.49-fold decrease in the IgA level (p = 0.000001). In the third group, compared with the first one, there was an increase in TNFα by 6.12 times (p = 0.000001), IgM − by 2.98 times (p = 0.000001) and the value of SDR in RUA by 1.70 times (p = 0.000001) against the background of a 2.31-fold decrease in IgA concentration (p = 0.000001). In patients of the third group, in comparison with the second group, higher levels of TNFα (by 1.23 times, p = 0.000001), IgM (by 1.18 times, p = 0.000001) and SDR in the RUA (by 1.35 times, p = 0.000001), as well as lower values of the IgA concentration (1.54 times, p = 0.000001). Conclusion. In women with exacerbation of chronic bronchitis caused by CMVI reactivation, leading to the formation of CSPI, in contrast to patients with a similar bronchopulmonary pathology of cytomegalovirus origin and the development of CCPI, a more pronounced activation of the systemic inflammatory response and an imbalance in the humoral component of immune system lead to an increase in vascular resistance in the RUA pool.

­­­­­Cefotaxime: A reappraisal for use in lower respiratory tract infections

Lower respiratory tract infections (LRTIs) are documented to cause significant morbidity and mortality in patients worldwide. During the ongoing pandemic, LRTIs like pneumonia are posing a major health concern for patients and the healthcare system. In COVID-19-related pneumonia bacterial co-infection is not uncommon and remains a leading cause of mortality in affected cases. Cefotaxime, a third-generation parenteral cephalosporin, has a broader spectrum of antimicrobial activity with a high-level of stability against β-lactamases. Despite many years of clinical usage for cefotaxime in LRTIs, resistance to this drug does not seem to be a major concern, and it is still one of the cornerstones in the choice effective antimicrobial therapy. This paper attempts to delineate available evidence for cefotaxime usage in various clinical situations like community acquired pneumonia (CAP), nosocomial pneumonia, acute exacerbations of chronic bronchitis (AECB) and acute bronchitis. This may be of help for a clinician to develop a thorough viewpoint on the rational use of this time-tested antimicrobial agent and to take an apt clinical decision towards the optimum patient care.

Sinobronchial Syndrome Patients with Suspected Non-Tuberculous Mycobacterium Infection Exacerbated by Exophiala dermatitidis Infection

BackgroundExophiala dermatitidis is an environmental black fungus that rarely causes respiratory infections, yet its pathophysiological features and treatment regimens have not been established.Case SeriesTwo cases of exacerbations of chronic bronchitis and sinusitis due to E. dermatitidis infection in Japan are presented. Both patients were women, and non-tuberculous Mycobacterium (NTM) infection was suspected based on chest radiological findings, but E. dermatitidis was detected from bronchial lavage fluid and nasal mucus, respectively. Both cases were successfully treated by antifungal agents such as liposomal amphotericin B, voriconazole, and itraconazole, but clarithromycin, rifampicin, ethambutol, and sitafloxacin for NTM were not effective.ConclusionE. dermatitidis can become a respiratory pathogen, especially in patients with chronic sinobronchial syndrome.

Overview of systematic reviews of Shufeng Jiedu Capsules

At present, there have been many clinical trials and systematic reviews/Meta-analysis proving the good clinical efficacy of Shufeng Jiedu Capsules in the treatment of respiratory diseases, while comprehensive discussion is still required. This article overviews and analyzes the systematic reviews/Meta-analysis of Shufeng Jiedu Capsules to provide evidence support for clinical practice. The systematic reviews/Meta-analysis of Shufeng Jiedu Capsules were searched from CBM, Wanfang, CNKI, VIP, PubMed, EMbase and Cochrane Library. The AMSTAR 2 scale and GRADE system were respectively employed for the evaluation of methodological quality and the grading of evidence quality. Finally, 8 systematic reviews/Meta-analysis published during 2018-2021 were included for analysis. The diseases involved include acute exacerbation of chronic obstructive pulmonary disease, community-acquired pneumonia, acute tonsillitis, acute exacerbation of chronic bronchitis and acute upper respiratory tract infection. The number of included RCTs studies ranged from 8 to 25. The results showed that Shufeng Jiedu Capsules combined with western medicine routine had better therapeutic effect than the latter alone in the treatment of the above five diseases. The reported adverse reactions caused by Shufeng Jiedu Capsules were mainly gastrointestinal discomforts such as mild nausea, diarrhoea and vomiting, with low incidence and mild symptoms, which can be relieved by drug withdrawal. The methodological quality of the included studies was extremely low, and the outcome indicators were mainly of low and very low grades. The efficacy and safety of Shufeng Jiedu Capsules in the clinical treatment of diseases still need to be verified based on more high-quality studies. The relevant clinical research and systematic review/Meta-analysis should pay more attention to methodological quality and reporting standards and strengthen the scientificity of research.

Out-patient Visit to the Pulmonologist: Peculiarities of Medical Pare Provision amid the COVID-19 Pandemic

Abstract. The coronavirus pandemic has significantly affected the health care system and continues to make adjustments to the work of physicians in various specialties.&#x0D; The aim of the study was to analyze the work of a pulmonologist of the polyclinic amid the pandemic COVID-19.&#x0D; Material and methods of the study. An assessment of appeals to the pulmonologist consultation in the medical center “Frankomed” in Ivano-Frankivsk from July 2020 to February 2021 has been performed.&#x0D; Research results.There were 143 patients, who made 185 visits and applied for an appointment with a pulmonologist within 8 months. Among those studied there were 72 women and 71 men. The age of patients was from 18 to 87 years, the average age of women was 49.31 ± 2.14 years, the average age of men was 48.86 ± 2.73 years.&#x0D; The reasons for seeking medical help from a pulmonologist were the following ones: acute bronchitis – 5 (2.73%), exacerbation of chronic bronchitis – 54 (29.51%), COPD – 12 (6.56%), bronchial asthma – 8 (4.37) %), pneumonia – 42 (22.95%), coronavirus disease – 30 (16.39%), idiopathic pulmonary fibrosis – 2 (1.09%), tuberculosis – 6 (3.28%), neoplasms – 3 (1.63%), metastatic lung damage– 1 (0.55%), pneumofibrosis – 18 (9.84%) cases.&#x0D; The vast majority of appeals is accounted for the chronic non-specific pulmonary pathology, namely chronic bronchitis, COPD, etc. All pulmonary beds of the region during the COVID-19 pandemic were repurposed to Covid ones, specialized diagnostic and therapeutic care could not be provided to such patients.&#x0D; In the second place there are coronavirus disease, pneumonia and post-pneumonic pneumofibrosis. The reasons for such patients’ appeals were their desire to receive a consultation of a narrow specialist, excessive workload of family doctors, and others.&#x0D; Isolated cases of tuberculosis and neoplasms of unknown etiology were reported. The latter patients were immediately advised to consult TB and thoracic specialists.&#x0D; Conclusions. During the coronavirus infection pandemic, temporary restrictions led to later visits to a pulmonologist in case of exacerbations, which could provoke the development of life-threatening conditions and required hospitalization.&#x0D; Patients who applied to the medical center, had the opportunity to get the professional opinion and treatment.&#x0D; Important work was done by a pulmonologist to identify important medical-social problems.&#x0D; Key-words: outpatient, pulmonologist, COVID-19

Efficacy and Safety of GHX02 in the Treatment of Acute Bronchitis and Acute Exacerbation of Chronic Bronchitis: A Phase Ⅱ, Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.

Acute bronchitis and acute exacerbations of chronic bronchitis (AECB) have cough and sputum as the main symptoms with a high prevalence and substantial economic burden. Although the demand for bronchitis treatment increases due to causes, such as air pollution, the appropriateness of antibiotic prescriptions and the effects of current symptomatic treatments for bronchitis are unclear. GHX02, which is a combined formulation containing four herbs, and has been clinically used for bronchitis in South Korea. We conducted a phase II, randomized, double-blind, and placebo-controlled, multicenter trial to evaluate its efficacy and safety. Patients with acute bronchitis or AECB were recruited and randomized to receive high-dose GHX02 (1920 mg/day), standard-dose GHX02 (960 mg/day), or placebo for 7 days. The primary outcome measure was the change in Bronchitis Severity Score (BSS) from baseline to Day 7. The secondary outcomes were the frequency of coughing fits, Questionnaire of Clinical Symptoms of Cough and Sputum (QCSCS), Leicester Cough Questionnaire (LCQ), Integrative Medicine Outcome Scale (IMOS), and Integrative Medicine Patient Satisfaction Scale (IMPSS). A total of 117 patients were randomized to parallel groups (38 in the high-dose GHX02, 41 in the standard-dose GHX02 group, and 38 in the placebo group). The mean differences in BSS from baseline to Day 7 in the treatment groups (4.2 ± 2.0 and 4.5 ± 1.8 in the high-dose GHX02 and standard-dose GHX02 groups, respectively) were higher than the placebo group (3.8 ± 2.1), p = 0.028. The mean differences in the frequency of coughing fits from baseline to Day 7 and IMPSS were better in the GHX02 treatment group than in the placebo group (standard-dose GHX02 group vs placebo group, p = 0.036). The QCSCS, LCQ, IMOS, and GHX02 of the treatment groups also showed more improvement than the placebo group, but there were no statistically significant differences between the groups. There were no severe adverse effects during the trial. This study supports that GHX02 is effective and safe for patients with bronchitis and provides the basis for progression to a phase III study. Clinical Trial Registration: [https://cris.nih.go.kr] WHO International Clinical Trials Registry Platform, Clinical Research Information Service [KCT0003665].

Emergency Department Utilization Patterns Among Physical Elder Abuse Victims in Comparison to Other Older Adults

Background: Physical elder abuse is common and has serious health consequences. Little is known, however, about the patterns of health care utilization among these victims, including whether opportunities may exist for earlier identification and intervention. Our goal was to describe Emergency Department (ED) utilization known physical elder abuse victims compared with non-victims. Methods: We used Medicare insurance claims to examine ED utilization patterns among a well-characterized cohort of 139 known physical elder abuse victims in the year before abuse was identified and compared this to control subjects matched on age, sex, race, and residential zip code. Results: Physical elder abuse victims were significantly more likely than control subjects to visit the ED (47.5% vs. 35.9%, p=0.01) during the year before identification and to have at least one visit for an injury-related complaint (14.4% vs. 8.3%, p=0.03). Victims were also more likely to have multiple visits (18.7% vs. 14.6%, p=0.24), visit multiple EDs (7.9% vs. 6.7%, p=0.63), or be high frequency utilizers (≥4 visits, 3.6% vs. 2.7%, p=0.58), but differences did not reach statistical significance. The most common diagnoses in ED visits among victims were: open wound of knee/ankle, exacerbation of chronic bronchitis, pneumonia, and chest pain. Conclusion: This work provides preliminary evidence that physical elder abuse victims use the ED more frequently and potentially have different patterns of utilization than other older adults. We plan to further characterize these different patterns to potentially to use them to develop tools for earlier identification.