Incidence Of Dyspnea Research Articles

Study on the therapeutic effects and prognosis evaluation of non-invasive ventilation in patients with chronic obstructive pulmonary disease with lung cancer.

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory complication among the elderly, and its severity can escalate to respiratory failure as the disease progresses. To evaluate the application value of non-invasive ventilation in the clinical treatment of patients with COPD and lung cancer. This study assesses its therapeutic effects and its impact on patients' quality of life (QoL) as measured by the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. A retrospective analysis was conducted on clinical data from 102 patients with COPD and lung cancer. Patients were divided into two groups: the control group (n= 48), who received conventional treatment, and the observation group (n= 54), who received non-invasive positive pressure ventilation (NIPPV) in addition to conventional treatment. Relevant indicators of curative effect, including blood gas indices, incidence of dyspnoea, improvements in mental health and appetite, and FACT-L QoL scores, were analysed at 2 weeks, 1 month, and 6 months post-treatment. At 2 weeks post-treatment, the observation group who had used NIPPV showed significant improvements in blood gas indices, dyspnoea, mental state and self-care ability compared with the control group (p< 0.05). At 1 month, these benefits persisted and included improved maintenance of body weight (p< 0.05). By 6 months, the observation group had a lower incidence of pulmonary encephalopathy (p< 0.05), and QoL, as measured by the FACT-L scale, improved significantly in the observation group but declined in the control group (p< 0.05). NIPPV demonstrates significant efficacy in treating COPD patients with lung cancer, particularly in enhancing curative effects and improving patients' QoL.

Avoidable emergency department visits among palliative care cancer patients: novel insights from Saudi Arabia and the Middle East

BackgroundSeveral studies emerging from developed countries have highlighted a significant number of potentially avoidable emergency department (ED) visits by cancer patients during the end-of-life period. However, there is a paucity of information from developing nations regarding palliative care practices and the utilization of the ED by palliative care patients. Herein, we aim to characterize ED admissions among patients receiving palliative care at our tertiary center in Saudi Arabia.MethodsThis is a retrospective, cross-sectional study evaluating ED visits amongst adult patients with advanced cancer who were receiving treatment under the palliative care department. This study took place over a period of 12 months from July 2021 through to July 2022. Three palliative care specialist physicians independently and blindly reviewed each patient’s ED visits and determined whether the visit was avoidable or unavoidable.ResultsA total of 243 patients were included in the final analysis, of which 189 (78.1%) patients had unavoidable visits and 53 (21.9%) patient visits were classified as avoidable. A significantly higher proportion of breast cancer patients presented with unavoidable admissions (14.3% vs. 3.8%, P = 0.037) compared to other cancer types. The incidence of dyspnea (23.8% vs. 5.7%, P < 0.001) and fevers/chills (23.3% vs. 5.7%, P = 0.005) was significantly higher in patients with unavoidable visits. Patients with avoidable visits had a significantly greater proportion of visits for dehydration (13.2% vs. 2.1%, P = 0.002). Notably, although hospital stay was significantly longer in the unavoidable group (P = 0.045), mortality for palliative care patients—regardless of whether their ED visit was avoidable or unavoidable—was not statistically different (P=-0.069).ConclusionTo our knowledge, this is the largest and most comprehensive study from Saudi Arabia and the Middle East providing insights into the utilization of palliative care services in the region and the propensity of advanced cancer patients towards visiting the ED. Future studies ought to explore interventions to reduce the frequency of avoidable ED visits.

Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER)

BackgroundThe incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored.Patients and methodsA total of 1242 patients diagnosed...

The impact of the COVID-19 pandemic on head and neck cancer diagnosis: a single-center study

Abstract Introduction The COVID-19 pandemic has changed healthcare systems’ functioning and priorities worldwide, negatively impacting cancer screening. Adverse effects of delayed diagnosis of head and neck cancer (HNC) may be associated with poorer overall survival. The aim of the study was to assess the impact of the COVID-19 pandemic on HNC diagnosis. Materials and Methods A retrospective analysis of database records of patients diagnosed with HNC in a single tertiary center from March 1, 2020, until April 30, 2021 (COVID group) was performed and compared to the period from January 1, 2019, to February 30, 2020 (pre-COVID group). Patients’ general characteristics, disease extent in TNM classification, symptom duration, incidence of dyspnea at admission, emergency tracheotomy at admission, and indications for percutaneous endoscopic gastrostomy (PEG) were compared. Results One hundred and seventy-two patients with newly diagnosed HNC were enrolled. The most common tumor location was the larynx, followed by the hypopharynx. There were no significant differences between the groups in terms of the patients’ general or clinical characteristics, disease extent in TNM classification, and symptoms duration. However, the likelihood of PEG being performed in the COVID group was over three times higher (OR=3.15, 95% CI: 1.08 to 9.18, p=0.049). Conclusions During the pandemic, more patients had dysphagia or malnutrition requiring PEG. However, the pandemic did not affect the progression of patients’ HNC significantly.

Predictive Value of Adenoviral Load for Bronchial Mucus Plugs Formation in Children with Adenovirus Pneumonia

Background The study aimed to explore risk factors for bronchial mucus plugs (BMP) formation in children with adenovirus (AdV) pneumonia. Methods A retrospective study was conducted on children with AdV pneumonia who underwent bronchoscopy from January 2019 to December 2019. Children were divided into the BMP group and the control group, depending on whether BMP was formed or not. The clinical information and treatment proposals of the two groups of children were counted and analyzed via multiple logistic regression analysis, ROC curve analysis, and correlation analysis. Results Among 453 patients with AdV pneumonia, 185 (40.84%) were in the BMP group. Among all the cases, there were 188 patients with a single AdV infection, including 64 (34.04%) in the BMP group and 124 (65.96%) in the control group. The incidence of dyspnea, poor spirits, mixed infections, and other symptoms in the BMP group was higher than in the control group. Children in the BMP group had a longer heat range. C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (DD), and AdV load levels were higher in the MBP group. AdV load, Mycoplasma coinfection, DD, heat range, and LDH were independent risk factors for BMP, among which AdV load was the most significant (AUC = 0.819). AdV load was positively correlated with other risk factors, respectively. AdV load and heat range were independent risk factors for BMP patients with a single AdV infection. Conclusion AdV load might have important clinical value in predicting BMP development in AdV pneumonia.

COVID-19 in Iran: clinical presentations and outcomes in three different surges of COVID-19 infection

BackgroundA few studies compared the characteristics and outcomes of COVID-19 patients during the first and second surges of the disease. We aimed to describe the clinical features and outcomes of COVID-19 patients across the first, second, and third surges of the disease in Tehran, Iran.MethodWe conducted a retrospective cohort study of patients with COVID-19 admitted to Sina hospital in Tehran, Iran, during three surges of COVID-19 from February 16 to October 28, 2020.ResultSurge 1 patients were younger with more prevalence of hypertension. They also presented with significantly higher oxygen saturation, systolic blood pressure, and respiratory rate on admission. Patients had higher levels of neutrophil to lymphocyte ratio, Urea, CRP, and ESR, in surge 2. The incidence of dyspnea, chest pain, and neurological manifestations followed a significant increasing trend from surge 1 to surge 3. There was no difference in severity and in-hospital mortality between the surges. However, the length of hospital stays and acute cardiac injury (ACI) was less in surge 1 and acute respiratory distress syndrome (ARDS) in surge 2 than in other surges.ConclusionPatients did not significantly differ in disease severity, ICU admission, and mortality between surges; however, length of hospital stay and ACI increased during surges, and the number of patients developing ARDS was significantly less in surge 2 compared to other peaks.

312. Clinical Attributes and Risk Factors for In- Hospital Mortality among Covid-19 Patients in a Community Hospital Setting: A Propensity Matched Analysis

Abstract Background New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution. Methods We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed. Results The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P &amp;lt; 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (&amp;lt; .0001), SGOT or AST (IU/L) ≥ 54 (p &amp;lt; 0.001), SGPT or ALT (IU/L) ≥ 41 (p &amp;lt; 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P &amp;lt; 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) &amp;gt; 465 (OR = 2.18, P = 0.001), systolic blood pressure &amp;lt; 90 mm Hg (OR = 4.28, p = .02), respiratory rate &amp;gt; 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients. Conclusion Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation. Disclosures All Authors: No reported disclosures

26. Risk of Post–COVID-19 Dyspnea and Interstitial Lung Disease (ILD) in a Real-World Cohort of Patients Hospitalized with COVID-19 in the United States

BackgroundWhile COVID-19 carries substantial morbidity and mortality, the extent of long-term complications remains unclear. Reports suggest that acute lung damage associated with severe COVID-19 can result in chronic respiratory dysfunction. This study: (1) estimated the incidence of dyspnea and ILD after COVID-19 hospitalization, and (2) assessed risk factors for developing dyspnea and ILD in a real-world cohort of patients hospitalized with COVID-19 using US electronic health records (EHR).MethodsPatients in the Optum de-identified COVID-19 EHR database who were hospitalized for COVID-19 (lab confirmed or diagnosis code) between February 20 and July 2020 and had at least 6 months of follow-up were eligible for analysis. Dyspnea and ILD were identified using diagnosis codes. The effects of baseline characteristics and hospitalization factors on the risk of incident dyspnea or ILD 3 to 6 months’ post discharge were evaluated. ResultsAmong eligible patients (n=26,339), 1705 (6.5%) had dyspnea and 220 (0.8%) had ILD 3 to 6 months after discharge. Among patients without prior dyspnea or ILD (n=22,613), 110 (0.5%) had incident ILD (Table 1) and 1036 (4.6%) had incident dyspnea (Table 2) 3 to 6 months after discharge. In multivariate analyses, median (IQR) length of stay (LOS; 5.0 [3.0, 9.0] days in patients who did not develop ILD vs 14.5 [6.0, 26.0] days in patients who developed ILD; RR: 1.12, 95% CI: 1.08, 1.15; P=4.34 x 10-10) and age (RR: 1.02, 95% CI: 1.01, 1.03; P=4.63 x 10-3) were significantly associated with ILD. Median (IQR) LOS (5.0 [3.0, 9.0] days in patients who did not develop dyspnea vs 7 [4.0, 14.0] days in patients who developed dyspnea; RR: 1.04, 95% CI: 1.02, 1.06; P=8.52 x 10-4), number of high-risk comorbidities (RR: 1.18, 95% CI: 1.12, 1.24; P=3.85 x 10-9), and obesity (RR: 1.52, 95% CI: 1.25, 1.86; P=2.59 x 10-4) were significantly associated with dyspnea.Table 1. Selected Baseline Risk Factors for Incident ILD Table 2. Selected Baseline Risk Factors for Incident Dyspnea ConclusionIn a real-world cohort, 4.6% and 0.5% of patients developed dyspnea and ILD, respectively, after COVID-19 hospitalization. Multivariate analyses suggested that LOS, age, obesity, and comorbidity burden may be risk factors for post-COVID-19 respiratory complications. Limitations included sensitivity of diagnosis codes, availability of labs, and care-seeking bias.Disclosures Kelly Zalocusky, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Devika Chawla, PhD MSPH, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Margaret Neighbors, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Shemra Rizzo, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Larry Tsai, MD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee)

Clinical profile and in-hospital course of patients with primary and secondary takotsubo syndrome: single center experience

Abstract Background Takotsubo syndrome (TTS) is an acute cardiac disease increasingly recognized in a variety of clinical scenarios. Heart Failure Association of the ESC classified TTS in primary (occurring in the setting of psychological or emotional trigger or without clear identifiable stressors) and secondary (triggered by physical stressors or other critical illnesses). However, the clinical profile and outcome of these different subtypes is still controversial. Aim of the study To compare baseline features, clinical presentation and in-hospital outcomes in patients with primary or secondary TTS in a single referral center. Methods Overall study population included 210 patients (mean age 66.1±12.2 years, 14 male); 165 and 45 with primary and secondary TTS, respectively; consecutively enrolled from 2012 to 2019 in our center. Clinical, instrumental and laboratory data and in-hospital events were also recorded in both groups. Results Compared to patients with primary TTS, patients with secondary form were older (70.6±14.6 vs 64.9±11.2 years; p=0.006) and more frequently man (13.3% vs 4.8%; p=0.043). Several comorbidities such as diabetes (23.8% vs 8.9%; p=0.008); pulmonary (45.2% vs 12.9%; p&amp;lt;0.001); neurologic (23.8% vs 9.7%; p=0.015); nephro-urologic (31% vs 13.5%; p=0.008); psychiatric (42.9% vs 26.5%; p=0.039) and orthopedic (28.6% vs 13.5%; p=0.020) diseases were prevalent in secondary TTS patients. Atypical presentation with higher incidence of dyspnea was significantly prevalent (42.2% vs 19.4%; p=0.002) in secondary group. The number of patients with ST-T elevation on admission was similar (80% vs 77%; p=0.5) in both groups. Prolonged QT interval in a majority of secondary TTS patients (46.3% vs 28.4%; p=0.029) was detected. Peak levels of troponin, creatine-kinase and myoglobin did not differ between the two groups. Echocardiography revealed larger left ventricular end-diastolic and end-systolic volumes (62.7±25.3 vs 50.6±14.3 ml/mq; p=0.024 and 35.1±14.5 vs 28.7±9 ml/mq; p=0.048) at presentation in secondary TTS, however no differences in baseline left ventricular ejection fraction were detected. Furthermore, the prevalence of apical ballooning was similar between the two groups. Of note, secondary TTS patients experienced more frequently acute heart failure (40.5% vs 23.1%; p=0.024), hyperkinetic arrhythmia (9.1% vs 1.9%; p=0.022), cardiogenic shock (15.9% vs 3.2%; p=0.002), and mechanical ventilation use (9.3% vs 1.3%; p=0.006) during the acute phase. In-hospital stay (10.8±6.9 vs 7.4±6.2 days, p=0.004) was longer in this cohort. Conclusion Our results demonstrate that to classify TTS patients in primary or secondary form is clinically relevant. Secondary form generally is associated to higher rate of comorbidities and to atypical presentation. Owing to the worse in-hospital outcome of the secondary TTS patients a tailored and more intensive treatment should be adopted in this cohort. Funding Acknowledgement Type of funding source: None

The risk of dyspnea in patients treated with third-generation P2Y12 inhibitors compared with clopidogrel: a meta-analysis of randomized controlled trials

BackgroundTicagrelor and prasugrel are two third-generation oral P2Y12 inhibitors which are more commonly used in clinical practice. However, dyspnea has been consecutively reported in patients using third-generation oral P2Y12 inhibitors. This study aims to compare the risk of dyspnea in patients treated with third-generation P2Y12 inhibitors compared with clopidogrel.MethodsWe systematically searched the PubMed, Cochrane Central Register of Controlled Trials databases, ClinicalTrials.gov and Web of Science for randomized control trials (RCTs) comparing ticagrelor or prasugrel with clopidogrel until July 2019. The primary outcome was the incidence of dyspnea. The risk ratios (RR) and 95% confidence intervals (CI) were estimated using meta-analysis.ResultsWe included 25 RCTs involving 63,484 patients in this meta-analysis, including 21 studies on ticagrelor and 4 studies on prasugrel. Compared to the clopidogrel group, third-generation oral P2Y12 inhibitors were associated with an increased risk of dyspnea compared with clopidogrel (RR 2.15, 95% CI 1.59–2.92), which was consistent in the analysis of ticagrelor (RR 2.65, 95% CI 1.87–3.76). However, the adverse effect was not found among patients receiving prasugrel therapy (RR 1.03, 95% CI 0.86–1.22). The increased dyspnea risk of ticagrelor was consistent in subgroups with different follow-up durations (≤ 1 month RR 1.87, 95% CI 1.56–2.24; 1–6 months RR 4.19, 95% CI 1.99–8.86; > 6 months 2.45, 95% CI 1.13–5.34).ConclusionsTicagrelor has a higher risk of dyspnea than clopidogrel, which was not observed in patients using prasugrel.

Diaphragmatic dysfunction associates with dyspnoea, fatigue, and hiccup in haemodialysis patients: a cross-sectional study

Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Nevertheless, little is known regarding diaphragm dysfunction in HD patients. We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion during quiet and deep breathing. HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity (0.386 ± 0.144 cm vs. 0.439 ± 0.134 cm, p < 0.01) and thickening fraction (TF) (0.838 ± 0.618 vs. 1.127 ± 0.757; p < 0.01) compared to controls. The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing (3.686 ± 1.567 cm/s vs. 4.410 ± 1.720 cm/s, p < 0.01; 5.290 ± 2.048 cm vs. 7.232 ± 2.365 cm; p < 0.05). Changes in diaphragm displacement from quiet breathing to deep breathing (△m) were lower in HD patients than in controls (2.608 ± 1.630 vs. 4.628 ± 2.110 cm; p < 0.01). After multivariate adjustment, diaphragmatic excursion during deep breathing was associated with haemoglobin level (regression coefficient = 0.022; p < 0.01). We also found that the incidence of dyspnoea and hiccup and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients.

Safety, Tolerability, and Effects of Sodium Bicarbonate Inhalation in Cystic Fibrosis.

Among the many consequences of loss of CFTR protein function, a significant reduction of the secretion of bicarbonate (HCO3-) in cystic fibrosis (CF) is a major pathogenic feature. Loss of HCO3- leads to abnormally low pH and impaired mucus clearance in airways and other exocrine organs, which suggests that NaHCO3 inhalation may be a low-cost, easily accessible therapy for CF. To evaluate the safety, tolerability, and effects of inhaled aerosols of NaHCO3 solutions (4.2% and 8.4%). An experimental, prospective, open-label, pilot, clinical study was conducted with 12 CF volunteer participants over 18years of age with bronchiectasis and pulmonary functions classified as mildly to severely depressed. Sputum rheology, pH, and microbiology were examined as well as spirometry, exercise performance, quality-of-life assessments, dyspnea, blood count, and venous blood gas levels. Sputum pH increased immediately after inhalation of NaHCO3 at each clinical visit and was inversely correlated with rheology when all parameters were evaluated: [G' (elasticity of the mucus) = - 0.241; G″ (viscosity of the mucus) = - 0.287; G* (viscoelasticity of the mucus) = - 0.275]. G* and G' were slightly correlated with peak flow, forced expiratory volume in 1 s (FEV1), and quality of life; G″ was correlated with quality of life; sputum pH was correlated with oxygen consumption (VO2) and vitality score in quality of life. No changes were observed in blood count, venous blood gas, respiratory rate, heart rate, peripheral oxygen saturation of hemoglobin (SpO2), body temperature, or incidence of dyspnea. No adverse events associated with the study were observed. Nebulized NaHCO3 inhalation appears to be a safe and well tolerated potential therapeutic agent in the management of CF. Nebulized NaHCO3 inhalation temporarily elevates airway liquid pH and reduces sputum viscosity and viscoelasticity.

P6411Dyspnea in ticagrelor treated patients in the all-comer randomized GLOBAL LEADERS study and its association with clinical outcomes

Abstract Background Dyspnea represents a drug adverse effect reported with a higher frequency for ticagrelor, as compared with other P2Y12 antagonists. The impact of dyspnea on clinical outcomes has not been yet evaluated in the context of aspirin-free therapies after percutaneous coronary intervention (PCI). Purpose The study aimed to evaluate the incidence of dyspnea and its associations with demographic characteristics and clinical outcomes in patients undergoing PCI treated with ticagrelor either as monotherapy or as a part of a dual antiplatelet therapy (DAPT) in the GLOBAL LEADERS cohort. Methods This is a sub-analysis of the randomized all-comer GLOBAL LEADERS study (n=15991), comparing the experimental strategy of ticagrelor monotherapy following one-month DAPT after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. The incidence of dyspnea reported as adverse event (AE) and its relation to demographic characteristics and 2-year clinical outcomes was evaluated (intention-to-treat analysis). Multivariable Cox proportional hazards models were performed, including randomized treatment and incidence of first dyspnea event as a time-dependent covariate. The primary endpoint was a composite of 2-year all-cause mortality or centrally adjudicated, new Q-wave myocardial infarction (MI). Patient-oriented clinical endpoints (POCE) comprised all-cause death, any stroke, MI or revascularization, whereas net adverse clinical events (NACE) included POCE and Bleeding Academic Research Consortium (BARC)-defined bleeding type 3 or 5. Results Overall, dyspnea was reported as an AE in 2101 patients (13.2%) up to two years of follow-up, with a higher frequency in the experimental arm (16.4%) as compared with the reference group (11.1%) (hazard ratio [HR]1.70, 95% confidence interval [CI] 1.56–1.86, p=0.001). Predictors of dyspnea AE up to 2 years by multivariate analyses were: chronic obstructive pulmonary disease (HR1.71, 95% CI 1.56–1.87, p=0.001), female gender (HR1.31, 95% CI 1.18–1.44, p=0.001), hypertension (HR1.31, 95% CI 1.19–1.44, p=0.001, prior coronary artery bypass grafting (HR1.30, 95% CI 1.10–1.54, p=0.003), left ventricle ejection fraction below 40% (HR1.22, 95% CI 1.04–1.42, p=0.012), presentation with acute coronary syndrome (HR1.19, 95% CI 1.09–1.29, p=0.001) and body mass index (≥27kg/m2) (HR1.17, 95% CI 1.08–1.28, p=0.001). In patients who reported dyspnea AE, the two-year rates of the efficacy and safety endpoints in the experimental and reference arm were: for the primary endpoint 3.4% vs. 4.3% (p adjusted=0.807), for POCE 15.8% vs. 17.6% (p adjusted=0.218), for NACE 17.2% vs. 19.6% (p adjusted=0.082), for BARC 3 or 5 type bleeding 17.2% vs. 19.6% (p adjusted=0.082), respectively. Conclusions The occurrence of dyspnea AE up to two years after PCI appeared not to affect the safety of the experimental treatment strategy of 23-month ticagrelor monotherapy following one-month DAPT after PCI. Acknowledgement/Funding Study founded by European Cardiovascular Research Institute, which received unrestricted grants from Biosensors Int., AstraZeneca, Medicines Company.

Diaphragmatic Dysfunction Contributes to Dyspnoea, Fatigue, and Snoring in Haemodialysis Patients

Background: Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Little is known regarding diaphragmatic dysfunction under CKD conditions. Methods: We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion. We further examined the prevalence of diaphragmatic dysfunction and its influence factor and relationship with debilitating symptoms (dyspnoea, hiccups, and fatigue) in HD patients. Results: HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity and thickening fraction compared to controls. The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing. Changes in diaphragm displacement from quiet breathing to deep breathing (△m) were lower in HD patients than in controls. After multivariate adjustment, hemoglobin level may have effects on diaphragmatic functions such as diaphragm excursion at total lung capacity (DMTLC) and △m. Diaphragm thickness during deep breathing was positively correlated with weight and was greater in males than in females. We also found that the incidence of dyspnoea and snoring and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). In addition, diaphragmatic dysfunction was confirmed in a CKD mouse model. Conclusions: Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients. Trial Registration Information: Chinese Clinical Trials Registry, 2018ZDKYSB167. Retrospectively registered on May 18, 2018. Funding Statement: This work was supported by grants from the National Natural Science Foundation of China (81700618), the Natural Science Foundation of Jiangsu Province (BK20181487), the China Young Nephrologist Research Project, and a Southeast University High Level Thesis Project to Bin Wang. It was supported by additional grants from the National Natural Science Foundation of China (81720108007, 81470922, 31671194, 81720108007, and 81670696), the National Key Research Programme (2018YFC130046, 2018YFC1314000) and the Clinic Research Center of Jiangsu Province (BL2014080) to Bi-cheng Liu. Declaration of Interests: None of the authors has any conflict of interest to declare. Ethics Approval Statement: The study protocol was approved by the Ethics Committee of Zhongda Hospital affiliated to Southeast University. The details of the study were explained to each patient; if he or she agreed to participate, a written informed consent was signed.

Efficacy of regional analgesia techniques in abdominal surgery patients with obesity

The use of regional anesthetic techniques in abdominal surgery is an essential component of the multimodal approach to perioperative analgesia, yet data on their use in obese patients remains limited. The aim of this study is to determine the effectiveness of the epidural analgesia (EA) and the transversus abdominis plane block (TAP-block) in laparoscopic obese patients, as well as to evaluate the possibility of using the rectus sheath block (RSB) as a “rescue” anesthetic technique after laparotomy in obese patients. Materials and methods. The data on the 102 obese patients operated on esophageal hiatal diaphramgmatic hernia, colon tumor, postoperative ventral hernia, morbid obesity and choledocholithiasis were analyzed. In laparoscopic surgery 20 patients received EA (EA group), 21 patients – TAP-block (TAP group), 21 patients – opioids and non-steroidal anti-inflammatory drugs (NSAIDs) without any regional anesthesia techniques (group TIVA 1 ). In laparotomic surgery 16 patients received RSB (RSB group) and 24 patients – only opioids and NSAIDs (TIVA 2 group). After the surgery the following was estimated: the time of extubation, the total dose of opioids, the level of pain according to the 10-point numeric range score (NRS), the incidence of dyspnea using the monitor Utas 300 (Ukraine), the incidence of postoperative nausea and vomiting (PONV), the time of active patient mobilization, and the level of satisfaction with analgetic regimen. For the RSB group, the complexity of the RSB and the mean time to achieve adequate analgesia (pain intensity ≤3 points per NRS) were determined additionally. The statistical analysis was performed using the Statistica for Windows version 6.0 software. Results . In the EA group, the intraoperative dose of fentanyl was twice lower, and patients were extubated two times faster than in the TAP, TIVA 1 , RSB, TIVA 2 groups (P < 0.05). At the same time, none of the patients in the EA group required the restoration of neuromuscular conduction with neostigmine (P < 0.05). After the surgery, the pain level was 2–3 times higher in the TIVA 1 , RSB, and TIVA 2 groups than in the EA and TAP groups (P < 0.05). “Rescue” analgesia in the RSB group was performed from the first attempt in all the patients in 5–10 minutes and provided an adequate effect in 3 (2–4) min. The complexity level of RSB was defined as “easy” in 12 (75 %) patients, as “average” in 4 (25 %) patients (P < 0.05). The incidence of dyspnea and opioid doses after surgery in the EA, TAP and RSB groups of patients were 2 times lower, and the incidence of PONV was 3 to 4 times lower than in the TIVA 1 and TIVA 2 patients’ groups (P < 0.05). In the EA and TAP groups, patients became mobile after 8–13 hours after surgery, in the group TIVA 1 – after 16–22 hours, in the group RSB – after 18–36 hours, in the group TIVA 2 – after 48–96 hours (P < 0.05). 100 % of the respondents from the EA, TAP and RSB groups were satisfied with the analgesic regimen at the “excellent – good” level. In the TIVA 1 and TIVA 2 groups, 20–25 % of respondents identified analgesic comfort as “good”, 60–65 % of respondents – as “satisfactorily”, about 15 % of respondents – as “unsatisfactorily” (P < 0.05). Conclusions . In laparoscopic surgery the use of EA or TAP-block in obese patients significantly reduces the level of postoperative pain, the need for opioids, the incidence of dyspnea and PONV, which leads to the possibility of patients’ mobilization within 8–13 hours after surgery. After laparotomic surgery in obese patients RSB effectively “rescues” from pain and prevents excessive use of opioids, which reduces the number of adverse reactions and increases satisfaction with the quality of analgesia.

Real-world incidence of patient-reported dyspnoea with ticagrelor.

Dyspnoea, a common and multifactorial symptom in patients with acute coronary syndrome, has been associated with lower quality of life and hospital readmission. Prescriber preference for antiplatelet therapy, the standard of care in this patient group, is shifting to ticagrelor due to mortality benefits demonstrated in trials compared with clopidogrel. In these trials, dyspnoea was more commonly reported in patients prescribed ticagrelor but the aetiology is still debated. An observational cohort study was conducted to quantify the rates and severity of dyspnoea reported in patients with acute coronary syndrome and newly prescribed ticagrelor compared with those prescribed clopidogrel. Dyspnoea was more commonly reported in patients prescribed ticagrelor at each follow up post-discharge (p = 0.016). Rates were higher than previously reported in clinical trials. In some patients, dyspnoea necessitated drug therapy change and was associated with readmission to hospital (p = 0.046). As ticagrelor is widely prescribed as a first-line antiplatelet agent for a range of patients with acute coronary syndrome, the incidence of dyspnoea in a generalized patient cohort may result in higher rates of drug discontinuation. This in turn could lead to higher rates of rehospitalisation and potential treatment failure than that reported from the controlled setting of a clinical trial.

Comparison of Clinical Effectiveness of Ticagrelor and Clopidogrel in Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Patients Approaching A Tertiary Care Hospital in South India

Introduction: Dual antiplatelet therapy is recommended for prevention of secondary cardiovascular events in acute coronary syndrome patients who undergo percutaneous transluminal coronary angioplasty (PTCA). This therapy includes aspirin with either of a P 2 Y 12 platelet receptor inhibitor like clopidogrel or ticagrelor. Methodology: A retrospective cohort study with 1 year follow up which compared clopidogrel and ticagrelor for determining clinical effectiveness in post PTCA patients through the incidence of primary and secondary end points. Primary end points included cardiovascular death, Myocardial Infarction (MI), unstable angina, secondary revascularization and Congestive Heart Failure (CHF). Secondary end points were bleeding and dyspnea. Results: Age, gender, cardiovascular risk factors, concomitant medications administered and angioplasty specifications like the number of stents, type of stents and approach route were in comparable between clopidogrel and ticagrelor groups. The primary end points, a composite of cardiovascular death, unstable angina and secondary revascularization occurred more in the clopidogrel group (9%) than in ticagrelor group (5%) in 12 months follow up period. The secondary end points, a composite of bleeding and dyspnea were observed more in the ticagrelor group (11%) compared to clopidogrel group (5%). Conclusion: The use of ticagrelor prevents the incidence of secondary cardiovascular events in post PTCA patients to a greater degree than clopidogrel in comparable risk groups. Our observation revealed that ticagrelor was found to be better drug than clopidogrel as a prophylactic antiplatelet drug though there was increased incidence of dyspnea and bleeding in ticagrelor group. Key words: Antiplatelets, Ticagrelor, Clopidogrel.

A Phase 1b Study Investigating Carfilzomib Administered Once Weekly in Combination with Lenalidomide and Dexamethasone in Patients with Multiple Myeloma

A Phase 1b Study Investigating Carfilzomib Administered Once Weekly in Combination with Lenalidomide and Dexamethasone in Patients with Multiple Myeloma

Acute fibrinous and organizing pneumonia in a patient aged 80 years: a case report and review of the literature

Objective To explore the characteristics of clinical features, diagnosis, treatment and prognosis in acute fibrinous and organizing pneumonia (AFOP) patients. Methods We described an 80-year-old woman who was diagnosed with AFOP and got better after treatment with glucocorticoids. Clinical data of 51 patients which have been published in literatures in China and abroad were retrospectively analyzed. The differences in characteristics of clinical features were compared between the elderly and non-elderly patients. Results The case reported herein, who was a 80-year-old female with latent autoimmune diabetes in adults (LADA), presented with fever, dry cough and progressive dyspnea. Chest CT scan showed bilateral multiple patchy consolidation. CT-guided needle aspiration was performed and the pathological examination finding was consistent with AFOP. The patient was treated with oral methylprednisolone and experienced a significant improvement in symptoms and imaging manifestations. But she presented with deterioration with relapsing clinical symptoms when she discontinued corticosteroid treatment by herself, and the clinical symptoms were improved by retreatment. Clinical data of 51 reported cases with AFOP including 27 males and 24 females aged 38 d to 80 years were enrolled and analyzed in the study. Patients aged 60 years and over accounted for 47.1% (24 cases). No risk or predisposing factor was found in most of cases. Autoimmune diseases were the most common combined diseases in AFOP patients. The top three symptoms were dyspnea (80.4%, 41 cases), cough (64.7%, 33 cases) and fever (52.9%, 27 cases). The incidence of dyspnea was lower in elderly patients than in non-elderly patients〔66.7% (16/24) vs. 92.6% (25/27), P<0.05〕, and ground glass opacity in the chest image was also less in elderly patients than in non-elderly patients (P<0.05). 15 patients (29.4%) got definitive diagnosis by minimally invasive procedures including percutaneous lung puncture biopsy or transbronchial lung biopsy. Corticosteroids were the main drug treatment, and 39 cases (76.5%) received antibacterial drugs. The mortality rate of AFOP was 37.3% (15 cases). The average time from symptom onset to final diagnosis was shorter in dead cases than in recovered patients (19 days vs. 40 days, P<0.05). The rate of using mechanical ventilation was higher in dead cases than in recovered patients〔57.9% (11/19) vs. 9.4% (3/32), P<0.05〕. Conclusions There are no specific clinical and imaging features in AFOP, which is easily misdiagnosed as infectious diseases.AFOP is more common in elderly patients. Dyspnea and other symptoms can easily be ignored, and minimally invasive biopsy and pathological examination findings is helpful for diagnosis. The mortality rate of AFOP is high, and insufficient course of therapy is associated with the increased risk of AFOP relapse. Rapid progression of disease and the invasive mechanical ventilation predispose poor outcomes. Key words: Lung diseases, interstitial; Biopsy, needle

Dyspnoea in Patients with Pulmonary Hypertension (PH) - a Survey in Spezialized German PH Centres

Dyspnoea is the predominant symptom in patients with pulmonary hypertension (PH) at diagnosis. However, since dyspnoea is nonspecific and often occurs in a number of common diseases, the presence of PH can easily be underdiagnosed.In addition, this symptom underlies a high variability in the subjective perception, therefore further diagnostic procedures are often delayed by the patients.A survey of the incidence and severity of dyspnoea in 372 patients with PAH was conducted by questionnaire in German centres. Age, sex distribution and the range of comorbidities corresponded to the findings of national and international registries.Approximately 99 % of patients reported the presence of dyspnoea on exertion, even at low loads.Remarkably, in 13 % of patients dyspnoea occurs as a paroxysmal symptom, which may lead to the differential diagnosis of bronchial asthma. In addition, the patients who were being followed in specialized PH centres reported an increase in dyspnoea during the last year.The results of the survey on the incidence of dyspnoea in patients with PAH are consistent with the findings of international studies.