Mild Exacerbations Research Articles

Continuous infusion of magnesium sulfate to treat acute severe asthma in a Brazilian pediatric emergency department

Purpose: Magnesium sulfate (MgSO4) emerged as an adjunctive therapy to help manage acute severe asthma refractory to the first-line therapy, such as oxygen, ipratropium, corticosteroids, and bronchodilators. Despite the known benefits of MgSO4, limited information is available regarding potential adverse effects (AEs). We aimed to investigate potential AEs and clinical response of intravenous MgSO4 by assessing vital signs and the modified Wood-Downes score (mWDS), a relevant clinical scoring system. Methods: This investigation constitutes a prospective, single-arm study, conducted from June 2022 through May 2023, in a pediatric emergency department of the quaternary public hospital in Brazil. This study included all children aged 3-14 years who visited the pediatric emergency department during the period and underwent a 6-hour continuous infusion of MgSO4 at 50 mg/kg/hour, against acute severe asthma, a case refractory to the first-line therapies. We evaluated the safety and efficacy of the infusion by using vital signs and the mWDS. Clinical response was defined as a reduction of at least 1 point in the scoring system.Results: We analyzed a total of 42 children including 24 boys (57.1%), whose mean age was 5.7 ± 2.4 years. The 6-hour continuous infusion of MgSO4 reduced mWDS from 3 (interquartile range, 3-4) to 2 (2-3) (P < 0.001) and resulted in the clinical response in 30 children (71.4%) without an AE. After the infusion, 13 of the 15 children (86.7%) classified as having moderate asthma exacerbation (mWDS, 4-6) were improved to having mild asthma exacerbation (mWDS, 1-3) (P < 0.001). The mean serum magnesium concentration after the infusion was 4.7 mg/dL. Pneumonia and viral infection did not predict the clinical response.Conclusion: This study indicates the safety and efficacy of the 6-hour continuous infusion of MgSO4 as a therapeutic option for acute severe asthma, which is refractory to the first-line therapy.

Analysis of guideline recommendations for treatment of asthma exacerbations in children: a Pediatric Emergency Research Networks (PERN) study

RationaleThere is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines.ObjectivesTo describe and compare the content and...

Clonal Hematopoiesis of Indeterminate Potential Is Associated with Current Smoking Status and History of Exacerbation in Patients with Chronic Obstructive Pulmonary Disease.

There is limited data regarding the clinical outcomes of clonal hematopoiesis of indeterminate potential (CHIP) in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the clinical significance of CHIP as a COPD biomarker. This retrospective study was conducted on patients with COPD who were enrolled prospectively in the Seoul National University Hospital Airway Registry from January 2013 to December 2019 and underwent pulmonary function and blood tests. We evaluated the CHIP score according to smoking status and severity of airflow obstruction. We analyzed next-generation sequencing data to detect CHIP in 125 patients with COPD. Current smokers had a higher prevalence of CHIP in combination of DNMT3A, TET2, and PPM1D (DTP), DNA methyltransferase 3 alpha (DNMT3A), and protein phosphatase, Mg2+/Mn2+ dependent 1D (PPM1D) genes than in never- or ex-smokers. CHIP of DTP and DNMT3A genes was significantly associated with current smokers (adjusted odds ratio [aOR], 2.80; 95% confidence interval [CI], 1.01 to 7.79) (aOR, 4.03; 95% CI, 1.09 to 14.0). Patients with moderate-to-severe airflow obstruction had a higher prevalence of CHIP in most of the explored genes than those with mild obstruction, although the difference was not statistically significant. CHIP in ASXL transcriptional regulator 1 (ASXL1) genes was significantly associated with history of mild, severe, and total acute exacerbation. Given that CHIP in specific genes was significantly associated with current smoking status and acute exacerbation, CHIP can be considered as a candidate biomarker for COPD patients.

Understanding the effects of Haemophilus influenzae colonization on bronchiectasis: a retrospective cohort study

BackgroundBacterial colonization is an essential aspect of bronchiectasis. Although Haemophilus influenzae is a frequent colonizer in some regions, its clinical impacts are poorly understood. This study aimed to elucidate the impact of H. influenzae colonization in patients with bronchiectasis.MethodsThis retrospective study screened adult patients diagnosed with bronchiectasis at a tertiary referral center between April 1, 2003, and May 16, 2021, in South Korea. Propensity score matching was used to match patients with and without H. influenzae colonization. We assessed the severity of bronchiectasis as per the bronchiectasis severity index, the incidence of exacerbation, differences in lung function, and all-cause mortality.ResultsOut of the 4,500 patients with bronchiectasis, 79 (1.8%) were colonized by H. influenzae. After 1:2 propensity score matching, 78 and 154 patients were selected from the H. influenzae colonizer and non-colonizer groups, respectively. Although there were no significant differences between the groups regarding baseline demographics, patients colonized with H. influenzae had a higher bronchiectasis severity index (median 6 [interquartile range 4–8] vs. 4 [2–7], p = 0.002), associated with extensive radiographic involvement (52.2% vs. 37.2%, p = 0.045) and mild exacerbation without hospitalization (adjusted incidence rate ratio 0.15; 95% confidence interval 0.12–0.24). Lung function and mortality rates did not reveal significant differences, regardless of H. influenzae colonization.ConclusionH. influenzae colonization in bronchiectasis was associated with more severe disease and greater incidence of mild exacerbation, but not lung function and mortality. Attention should be paid to patients with bronchiectasis with H. influenzae colonization.

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies.

While systemic corticosteroids quicken patient recovery during acute exacerbations of COPD, they also have many adverse effects. The optimal duration of corticosteroid administration remains uncertain. We performed a systematic review and meta-analysis to compare patient outcomes between short- (≤7 days) and long- (>7 days) corticosteroid regimens in adults with acute exacerbations of COPD. MEDLINE, EMBASE, CENTRAL, and hand searches were used to identify eligible studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. Data were summarized as ORs (odds ratios) or MDs (mean differences) whenever possible and qualitatively described otherwise. A total of 11532 participants from eight RCTs and three retrospective cohort studies were included, with 1296 from seven RCTs and two cohort studies eligible for meta-analyses. Heterogeneity was present in the methodology and settings of the studies. The OR (using short duration as the treatment arm) for mortality was 0.76 (95% CI = 0.40-1.44, n = 1055). The MD for hospital length-of-stay was -0.91 days (95% CI = -1.81--0.02 days, n = 421). The OR for re-exacerbations was 1.31 (95% CI = 0.90-1.90, n = 552). The OR for hyperglycemia was 0.90 (95% CI = 0.60-1.33, n = 423). The OR for infection incidence was 0.96 (95% CI = 0.59-1.156, n = 389). The MD for one-second forced expiratory volume change was -18.40 mL (95% CI = -111.80-75.01 mL, n = 161). The RCTs generally had low or unclear risks of bias, while the cohort studies had serious or moderate risks of bias. Our meta-analyses were affected by imprecision due to insufficient data. Some heterogeneity was present in the results, suggesting population, setting, and treatment details are potential prognostic factors. Our evidence suggests that short-duration treatments are not worse than long-duration treatments in moderate/severe exacerbations and may lead to considerably better outcomes in milder exacerbations. This supports the current GOLD guidelines. Trial registration: Our protocol is registered in PROSPERO: CRD42023374410.

Clinical effect of aquatop rescue cream in patients with mild or moderate exacerbation of atopic dermatitis

Introducción: La dermatitis atópica, produce prurito y lesiones eccematosas, afectando la calidad de vida. Actualmente está disponible el dermocosmético Aquatop crema rescate, indicado para cuadros leves a moderados. El objetivo fue describir el curso clínico de una cohorte de pacientes con exacerbación de la dermatitis atópica, que recibieron tratamiento con Aquatop crema rescate durante quince días. Métodos: Estudio descriptivo retrospectivo, con base en registros clínicos de pacientes con exacerbación leve a moderada de su dermatitis atópica. Se describió su evolución empleando la variable SCORAD que mide el nivel de severidad de la dermatitis atópica. Se registró el promedio de prurito y su nivel máximo en las últimas 24 horas. Se hicieron tres evaluaciones: basal, al día siete y al día quince. Resultados: Se incluyeron 60 pacientes, con una mediana de edad de 12.5 años (RIQ:7-19,5), 50% eran hombres (30/60). La mediana de SCORAD al ingreso fue de 29,4 puntos, se redujo a 14 puntos al día siete y llegó a 12,2 puntos al día quince. Al inicio del seguimiento, el 65% de los casos fueron clasificados como exacerbación moderada, y este porcentaje se redujo al día siete hasta un 13,3%, que para el día quince disminuyó a 10%. En total se presentaron nueve eventos adversos leves. Conclusiones: Aquatop crema rescate, es una alternativa terapéutica que tiene un efecto clínico favorable en los pacientes con exacerbaciones de la dermatitis atópica leves y moderadas, por su rápido efecto sobre la reducción de los síntomas y su adecuado perfil de seguridad.

Triple Therapy with Mometasone/Indacaterol/Glycopyrronium or Doubling the ICS/LABA Dose in GINA Step 4: IRIDIUM Analyses.

GINA guidelines recommend increasing the dose of inhaled corticosteroids (ICS) as a step-up option for patients with inadequately controlled asthma at GINA step 4 [inadequately controlled asthma on medium-dose ICS/long-acting beta-2 agonist (LABA)]. The aim of this study was to compare the efficacy and safety of long-acting muscarinic antagonists (LAMA) add-on to medium-dose ICS/LABA in patients at GINA 2022 step 4. This post hoc analysis of the IRIDIUM study evaluated the change from baseline in trough forced expiratory volume (FEV1 ) in patients receiving medium-dose MF/IND/GLY versus high-dose MF/IND and high-dose FLU/SAL at Week 26. Other outcomes included improvement in lung functions [peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory flow between 25% and 75% of the FVC (FEF)25-75%)], asthma control [Asthma Control Questionnaire (ACQ-7)], responder analysis (≥0.5 unit improvement in ACQ-7), and reduction inasthma exacerbations at Weeks 26 and 52. A total of 1930 patients were included in this analysis. Medium-dose MF/IND/GLY improved trough FEV1 versus high-dose MF/IND (Δ 41mL; 95% CI -7-90) and high-dose FLU/SAL (Δ 88mL; 95% CI 39-137) at Week 26 which were sustained until Week 52. Exacerbation rates were 16% lower with medium-dose MF/IND/GLY versus high-dose MF/IND for all (mild, moderate, and severe) exacerbations and 21-30% lower versus high-dose FLU/SAL for all (mild, moderate, and severe), moderate or severe, and severe exacerbations over 52weeks. Further improvements in other lung functions were observed with medium-dose MF/IND/GLY. No new safety signals were identified. Medium-dose MF/IND/GLY improved lung function and reduced asthma exacerbations compared to high-dose ICS/LABA and may be an undervalued option in patients at GINA 2022 step 4. ClinicalTrials.gov Identifier: NCT02571777.

Impact of COVID-19 Pandemic on the Exacerbation Rates in COPD Patients in Southern India - A Potential Role for Community Mitigations Measures.

The impact of the coronavirus 2 (SARS-CoV-2) pandemic and the effect of preventive health strategies on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are largely unknown. The public health model imposed during the pandemic and the lessons learnt have implications on recommending future preventive strategies for COPD care in general and exacerbations in particular. This study endeavors to assess the role of preventive strategies of COVID-19 on exacerbation rates of COPD during the lockdown period compared to similar periods the previous year and assess the compliance to preventive strategies for COVID-19 among COPD patients. This is a hospital-based descriptive cross-sectional study at a tertiary care center. AECOPD in patients during a period spanning five months in the pre-lockdown days was compared with exacerbation rates for a similar period during the national lockdown. Sixty-eight patients were recruited (mean age: 67.38) among whom 47 were males and 21 were females. There were only 7 (10.3%) reported admissions during the lockdown period of 5 months compared to 50 (73.5%) during the corresponding period pre-lockdown. Mild exacerbations reported during the lockdown period were also significantly less with only 17 (25%) against 58 (85.3%) during the pre-lockdown period. Adherence to measures such as donning of masks, hand hygiene, and social distancing was observed among COPD patients with good compliance to the health practices promulgated in the pandemic. A significant reduction in exacerbation rates among AECOPD patients during the period of lockdown was observed compared to a similar period the year prior. Noticeable were the findings that both community-based milder exacerbations and severe exacerbations necessitating hospitalizations showed a reduction during the period of lockdown. Adaptability, compliance and acceptance to usage of masks, hand hygiene measures, and norms such as physical distancing were observed in the majority of COPD patients.

Comparative analysis of the course of COVID-19 and post-COVID syndrome in patients with inflammatory bowel disease and COVID-19 caused by the Omicron strain and earlier strains

BACKGROUND: Patients with inflammatory bowel disease have specific features of the course of COVID-19 and post-COVID syndrome. The available literature is limited in data comparing the course of COVID-19 of different strains in patients with inflammatory bowel disease as well as assessing the course of post-COVID syndrome.
 AIM: To conduct a comparative analysis of the course of COVID-19 and post-covid syndrome in patients with inflammatory bowel disease and COVID-19 caused by the Omicron strain and earlier strains.
 MATERIALS AND METHODS: The study included 159 patients diagnosed with ulcerative colitis and Crohns disease and COVID-19, who were observed in two temporary infectious diseases hospitals in Kazan (Republican Clinical Hospital and City Clinical Hospital No. 7) and on outpatient basis since April 2020 to May 2022. For a comparative analysis of the course of COVID-19 and post-COVID syndrome in patients who had come through COVID-19, 2 periods were defined: the 1st period from March 2020 to December 2021, the 2nd period from January 2022.
 RESULTS: None of the patients with Omicron developed lung damage (0 (0%) vs 36 (44.4%), p 0.05). It has been also found that among patients with Omicron there were more patients with comorbidity (62 (79.5%) versus 50 (61.7%), (p 0.05).
 Dynamic observation of the patients has revealed that post-covid syndrome was significantly less common in the patients with Omicron for 3 months after COVID-19 (25.6% vs. 47.1%).
 When analyzing the complaints associated with asthenia, it was found that they were significantly more common in the patients with Omicron 3 months after COVID-19 (58 (74.3%) in comparison with 17 (50%), p 0.05). The complaints associated with cognitive impairment (0 (0%) vs. 3 (8.8%), p 0.05) and depression (Hospital Anxiety and Depression Scale (31 (39.7%) vs. 22 (64.7%), p 0.05), Hamilton scale (22 (28.2%) vs. 22 (64.7%), p 0.05)) were significantly less common in the patients with Omicron for 3 months after COVID-19.
 After analyzing the activity in the patients with inflammatory bowel disease before COVID-19 and 3, 6, 9 months after COVID-19, we have found that the maximum number of patients with the exacerbation of inflammatory bowel disease was noted after 3 months in the patients with Omicron and after 6 months in the patients with earlier strains.
 CONCLUSIONS: Thus, the results of the study have shown that in the patients with inflammatory bowel disease, both in ulcerative colitis and Crohns disease, the course of COVID-19 caused by the Omicron strain proceeded in a milder form compared with the patients who had earlier strains. In the patients with Omicron, complaints characteristic of post-COVID syndrome were less common. After a previous infection with COVID-19, the frequency of inflammatory bowel disease relapses increased: in the patients with Omicron due to mild exacerbation 3 months after COVID-19; in the patients with earlier strains due to moderate and severe relapse.

Phenotypic Features of Pediatric Bronchiectasis Exacerbations Associated With Symptom Resolution After 14 Days of Oral Antibiotic Treatment

Respiratory exacerbations in children and adolescents with bronchiectasis are treated with antibiotics. However, antibiotics can have variable interindividual effects when treating exacerbations. Can phenotypic features associated with symptom resolution after a 14-day course of oral antibiotics for a nonsevere exacerbation of bronchiectasis be identified? Combining data from two multicenter randomized controlled trials, we identified 217 children with bronchiectasis assigned to at least 14days of oral antibiotics to treat nonsevere (nonhospitalized) exacerbations. Univariable and then multivariable logistic regression were used to identify factors associated with symptom resolution within 14days of commencing antibiotics. Identified associations were re-evaluated by mediation analysis. Of the 217 study participants (52%male patients), 41%were Indigenous (Australian First Nations, New Zealand Māori, or Pacific Islander). The median age was 6.6 years (interquartile range, 4.0-10.1 years). By day 14, symptoms had resolved in 130 children (responders), but persisted in the remaining 87 children (nonresponders). Multivariable analysis found those who were Indigenous (adjusted OR [AOR], 3.59; 95%CI, 1.35-9.54) or showed new abnormal auscultatory findings (AOR, 3.85; 95%CI, 1.56-9.52) were more likely to be responders, whereas those with multiple bronchiectatic lobes at diagnosis (AOR, 0.66; 95%CI, 0.46-0.95) or higher cough scores when starting exacerbation treatment (AOR, 0.55; 95%CI, 0.34-0.90) were more likely to be nonresponders. Detecting a respiratory virus at the beginning of an exacerbation was not associated with antibiotic failure at 14days. Children with Indigenous ethnicity, milder bronchiectasis, mild exacerbations (low reported cough scores), or new abnormal auscultatory signs are more likely to respond to appropriate oral antibiotics than those without these features. These patient and exacerbation phenotypes may assist clinical management and development of biomarkers to identify those whose symptoms are more likely to resolve after 14days of oral antibiotics. Australian New Zealand Clinical Trials Registry; Nos.: ACTRN12612000011886 and ACTRN12612000010897; URL: https://www.anzctr.org.au.

Value of integrated pulmonary index to predict exacerbation of chronic obstructive pulmonary Disease's severity

PurposeIn this study, we aimed to examine the correlation between current prognostic scores and the integrated pulmonary index (IPI) in patients admitted to the emergency department (ED) with exacerbation of chronic obstructive pulmonary disease (COPD), and the diagnostic value of using the IPI in combination with other scores in determining patients who can be discharged safely. MethodsThis study was conducted as a multicenter and prospective observational study between August 2021 and June 2022. Patients diagnosed with COPD exacerbation (eCOPD) at the ED were included in the study and they were grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age older than 65 years), BAP-65 (Blood urea nitrogen, Altered mental status, Pulse rate, and age older than 65 years), and DECAF (Dyspnea, Eosinopenia, Consolidation, Academia, and atrial Fibrillation) scores and IPI values of the patients were recorded. The correlation between the IPI and the other scores and its diagnostic value in detecting mild eCOPD were examined. The diagnostic value of CURB-IPI, a new score created by the combination of CURB-65 and IPI, in mild eCOPD was examined. ResultsThe study was carried out with 110 patients (49 female and 61 male), mean age of 67 (min/max: 40/97). The IPI and CURB-65 had better predictive value in detecting mild exacerbations than DECAF and BAP-65 scores [Area under curves (AUC) were 0.893, 0.795, 0.735, 0.541 respectively]. The CURB-IPI score, on the other hand, had the best predictive value for detecting mild exacerbations (AUC 0.909). ConclusionWe found that the IPI has good predictive value in the detection of mild COPD exacerbations, and its predictive value increases when used in combination with CURB-65. We think that the CURB-IPI score can be a guide when deciding whether patients with exacerbation of COPD can be discharged.

Cost-effectiveness of Arg16Gly in ADRB2 pharmacogenomic-guided treatment for pediatric asthma

ABSTRACT Objectives To assess the cost-effectiveness of Arg16Gly ADRB2 pharmacogenomic testing compared with no Arg16Gly ADRB2 testing to guide the use of long-acting β2 receptor agonist (LABA) in asthma patients aged 1 to 5 years in China. Methods This economic evaluation developed a Markov model with four health states (no exacerbation, mild exacerbation, moderate-to-severe exacerbation, and death). Transition probabilities were estimated from the rate of exacerbations, the case-fatality rate of patients hospitalized for exacerbations, and natural mortality. Costs included drug costs and exacerbation management costs. Cost inputs and utilities for each health state were gained from public databases and the literatures. Costs and quality-adjusted life years (QALYs) were estimated for ten years. Deterministic and probabilistic sensitivity analyses were performed. Results In the base case analysis, in contrast to the group without the genotype test, the incremental total cost was -¥334.7, and the incremental QALY was 0.001 in the Arg16Gly ADRB2 genotyping group. Therefore, the Arg16Gly ADRB2 test group was the dominant strategy for children with asthma in China. The sensitivity analyses showed that the model was relatively stable. Conclusion Arg16Gly ADRB2 testing before using LABA is a cost-effective approach compared with no gene testing for pediatric asthma.

P186 Airway clearance in the STOP PEDS pilot study of oral antibiotic treatment strategies for paediatric cystic fibrosis pulmonary exacerbations

Increased frequency of airway clearance therapy (ACT) is a key component of pulmonary exacerbation (PEx) treatment. STOP PEDS (Streamlined Treatment of Pulmonary exacerbations in Pediatrics) was a multicenter, prospective, open-label feasibility study in which oral antibiotic treatment for a mild outpatient pulmonary exacerbation was assigned randomly to either “immediate oral antibiotics” or “tailored therapy” (oral antibiotics started only for pre-specified criteria). Here we report the self-reported frequency of ACT among participants in both arms.

MiR-185-5p measurement assists in reflecting Th1/Th2 cell imbalance, inflammatory cytokine production, and exacerbation risk for childhood asthma.

MicroRNA (miR)-185-5p participates in the pathology of asthma by regulating immune imbalance, inflammation, periostin synthesis, and smooth muscle contraction. This study intended to explore the dysregulation of miR-185p and its correlation with T-helper (Th)1, Th2 cells, and inflammatory cytokines in childhood asthma. In 150 childhood asthma patients and 30 healthy controls (HCs), miR-185-5p from peripheral blood mononuclear cells was detected using reverse transcription-quantitative polymerase chain reaction, Th cells from peripheral blood samples were detected using flow cytometry, inflammatory cytokines from serum samples were detected using enzyme-linked immunosorbent assay. MiR-185-5p was increased in childhood asthma patients versus HCs [median (interquartile range (IQR)): 2.315 (1.770-3.855) versus 1.005 (0.655-1.520)] (P < 0.001). Meanwhile, miR-185-5p was negatively associated with Th1 cells (P = 0.035) but positively correlated with Th2 cells (P = 0.006) and IL-4 (P = 0.003) in childhood asthma patients; however, miR-185-5p was not linked to Th1 cells, Th2 cells, IFN-γ, or IL-4 in HCs (all P > 0.05). In addition, miR-185-5p was positively related to TNF-α (P < 0.001), IL-1β (P = 0.015), and IL-6 (P = 0.008) in childhood asthma patients, miR-185-5p was only linked to TNF-α (P = 0.040) but not IL-1β or IL-6 (both P > 0.05) in HCs. Moreover, miR-185-5p was increased in exacerbated childhood asthma patients versus remissive patients [median (IQR): 3.170 (2.070-4.905) versus 1.900 (1.525-2.615)] (P < 0.001). Besides, miR-185-5p was highest in patients with severe exacerbation followed by patients with moderate exacerbation, and lowest in patients with mild exacerbation (P = 0.010). MiR-185-5p is associated with imbalanced Th1/Th2 cells, increased inflammatory cytokines along with elevated exacerbation risk, and severity in childhood asthma patients.

Functional state of the autonomic nervous system in patients with chronic pancreatitis combined with chronic bronchitis

60 patients with chronic pancreatitis (acute exacerbation) combined with chronic bronchitis (mild exacerbation) were examined. 33 almost healthy patients (the control group) were also examined.&#x0D; The functional state of the autonomic nervous system was assessed using an analysis of heart rate variability.&#x0D; The study was carried out in two stages. The electrocardiogram was recorded in standard lead II at rest and in active orthostasis for 100 cardiocycles. The obtained data were processed using the Korveg computer program. Based on the data obtained, the following indices were calculated: the regulatory system stress index (SI), which reflects the total activity of the central regulatory mechanisms, allows us to assess the degree of shift of the autonomic balance towards sympathetic regulation, characterizes the stress of compensatory mechanisms, and the level of functioning of the central circuit of heart rate regulation; vegetative balance index (VBI), which reflects the ratio of the activity of the sympathetic and parasympathetic divisions of the autonomic nervous system; an indicator of the adequacy of regulation processes (IARP), which reflects the adequacy of the activity of the sympathetic division of the autonomic nervous system; vegetative rhythm index (VRI), which reflects the vegetative balance in terms of assessing the activity of the autonomic regulation circuit; orthoprobe ratio (OR), which is the ratio of the 30th R–R interval to the 15th R–R interval after standing up, this coefficient reflects the state of the parasympathetic division of the autonomic nervous system.&#x0D; SI was statistically significantly higher in the group of chronic pancreatitis combined with bronchitis at rest than in controls, indicating a shift in the autonomic balance towards the sympathetic system.&#x0D; VBI in patients with chronic pancreatitis combined with bronchitis was significantly higher in the lying position, but significantly lower in the standing position than in the control group.&#x0D; IARP was statistically significantly lower in the group of patients in the standing position, which indicates some excessive centralization of heart rate control in comorbidities.&#x0D; VRI did not differ statistically significantly in the control group and in the group of chronic pancreatitis combined with bronchitis, which indicates the normalization of parasympathetics in the group of patients during exercise.&#x0D; OR was significantly lower in chronic pancreatitis combined with bronchitis, which indicates an increase in the effect of the parasympathetic nervous system.&#x0D; Thus, there is an imbalance in the sympathetic and parasympathetic divisions of the autonomic nervous system in patients with chronic pancreatitis combined with chronic bronchitis, which depends on the position of the patient (lying or standing).&#x0D;

Dynamics of clinical manifestations, functional state and structural changes of the pancreas, quality of life of patients with chronic pancreatitis in combination with chronic obstructive pulmonary disease under the influence of eradication of the syndrome of excessive bacterial growth in the small intestine

The lack of efficiency in the diagnosis and treatment of chronic pancreatitis (CP) is associated with a number of objective and subjective reasons, one of which is insufficient knowledge about the pathogenesis of the disease, especially when it is combined with other internal diseases, in particular, with chronic obstructive pulmonary disease (COPD). The frequent combination of COPD and CP is associated not only with the frequency of these diseases, but also with the common links of pathogenesis, and a significant place in the pathogenesis of both diseases is occupied by the syndrome of excessive bacterial growth in the small intestine (SIBO). Aim: to increase the effectiveness of the treatment of CP in combination with COPD based on the inclusion of rifaximin and probiotic Subalin in the complex therapy of concomitant diseases. Materials and methods. We examined 128 patients with CP in the stage of exacerbation in combination with COPD in the stage of mild exacerbation, which were divided into two groups: the main group and the comparison group. The basic treatment of CP was carried out according to the clinical recommendations of the Russian Gastroenterological Association. Patients of the main group, in addition to basic therapy, received rifaximin (Alfa Normix) for 10 days, and then Subalin-forte for 2 weeks. Patients in the comparison group received only basic therapy. Results. Due to the treatment with the inclusion of rifaximin and Subalin, there is a significant suppression of the phenomenon of “evasion” of the pancreatic-specific enzyme into the blood, an improvement in the exocrine function of the pancreas according to the results of the fecal elastase test and the response of the pancreas to food intake according to the dynamics of uroamylase flow rates and endogenous pancreozymin induction coefficients. Under the influence of the main treatment option, there is an increase in the frequency of normalization of the echogenicity of the pancreas and less often than with traditional therapy, an increase in the pancreas or part of it, blurring and unevenness of the contours persist. In addition, the indicators of ultrasonic histography of the pancreas are significantly improved, and a more pronounced positive dynamics of the clinical manifestations of COPD is observed. Thus, the eradication of SIBO provides a significant increase in the effectiveness of the treatment of patients with a combination of CP and COPD.

Short-term exposure to ozone and asthma exacerbation in adults: A longitudinal study in China.

The relationships between short-term ozone exposure and the acute exacerbations of asthma in adults have not been fully studied. Existing studies commonly ignored the effects of ozone on mild or early asthma exacerbations. To investigate the associations between short-term ozone exposure and asthma exacerbations in Chinese adults. We administered health management for adult asthma patients through the Respiratory Home Platform and required them to monitor their lung function every morning and evening by themselves. Finally, a total of 4,467 patients in 18 Chinese cities were included in the current analyses, with 79,217 pairs of lung function records. The maximum daily 8-h average ozone concentrations were collected from fixed-site air quality monitoring stations. We calculated diurnal peak expiratory flow (PEF) variation using morning and evening measurements of PEF and then defined different severity of asthma exacerbations with diurnal PEF variations >10, 15, and 20%, respectively. A binomial distributed generalized additive mixture model combined with distribution non-linear models was applied to examine the association of ozone with asthma exacerbations. We further conducted stratified analyses by sex, age, season of lung function tests, and region. We found that short-term ozone exposure was independently associated with an elevated risk of asthma exacerbations defined by lung function and the effects could last for about 2 days. At lag 0-2 days, each 10 μg/m3 increment in ozone concentration was associated with odds ratios of 1.010 [95% confidence interval (CI): 1.003, 1.017], 1.014 (95% CI: 1.005, 1.023), and 1.017 (95% CI: 1.006, 1.028) for asthma exacerbations that were defined by diurnal PEF variation over 10, 15, and 20%, respectively. The associations remained significant after adjusting for other pollutants, and became unstable when using 24-h average ozone concentration. We also found that the associations were relatively stronger in males, those aged 45 years and older, and in the warm season. Our results suggest that short-term ozone exposure can increase the risk of asthma exacerbations, even in the early stage of exacerbation. Male and older asthma patients may be more vulnerable to ozone air pollution, especially in the warm season.

THE ROLE OF ENDOTOXICOSIS AND INFLAMMATION IN DEEPENING THE PANCREATIC FUNCTIONAL INSUFFICIENCY IN CHRONIC PANCREATITIS IN COMBINATION WITH TYPE 2 DIABETES.

Aim: To analyze the state of parameters of inflammation, endotoxicosis, and their influence on the functional capacity of the pancreas in the comorbid course of chronic pancreatitis and type 2 diabetes mellitus (DM2). Materials and methods: 115 patients with CP in the phase of mild therapeutic exacerbation in combination with DM2 in the stage of subcompensation were examined. To assess the impact of comorbid DM2 on the clinical condition of patients with CP, a comparison group of 25 patients with CP in the exacerbation phase was included in the study. The assessment of the presence and depth of pancreatic exocrine insufficiency (PEI) was carried out according to the "gold standard" - determination of the content of fecal α-elastase-1, which was determined by the method of enzyme immunoassay using standard kits. As the main criterion for diagnosis and monitoring of DM, the measurement of HbA1c was used, which was determined by the method of ion exchange chromatography. C-reactive protein (CRP) was determined by the immunoturbidometry method by photometric measurement of the antigen-antibody reaction to human CRP antibodies; reference values of CRP in blood serum are up to 3 mg/l. Endogenous intoxication (EI) was assessed based on the levels of medium-mass molecules (MMM) - MMM1 and MMM2 at wavelengths 254 and 280 nm. The level of circulating immune complexes (CIC) was determined by the method of selective precipitation in 3.75% ethylene glycol followed by photometry. Results: Moderate and moderate inverse correlations were established between CRP and fecal α-elastase in CP and CP-DM2 comorbidity (r=-0.423 and r=-0.565, p<0.05). This proved a reliable influence of the depth of inflammation according to the content of CRP on the increase in PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to CP. A deeper level of secretory insufficiency of the pancreas was established in CP with concomitant DM2, which deepened when the CRP level increased, compared to that in isolated CP: an increase in the strength of reliable direct moderate HbA1c-CRP correlations in patients with CP in combination with DM2 was proved in relation to such cases isolated CP (respectively r=0.313 and r=0.410, p<0.05). Conclusions: We proved a reliable influence of the index of endogenous intoxication on the level of PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to isolated CP: moderate and medium-strength inverse correlations were established IEI-fecal α-elastase in patients with CP and CP-DM2 comorbidity (r=-0.471 and r=-0.517, p<0.05). An increase in the strength of reliable direct, moderate, and moderate correlations between the levels of HbA1c and the index of endogenous intoxication in patients with isolated CP and CP-DM2 comorbidity (r=0.337 and r=0.552, p<0.05), which proved a deeper level of secretory pancreas insufficiency with concomitant DM2, which worsened with increasing endotoxicosis according to the value of the index of endogenous intoxication.

Ендотоксикоз і запалення як предиктори поглиблення функціональної недостатності підшлункової залози при хронічному панкреатиті у поєднанні із цукровим діабетом 2 типу

According to scientists, a significant role in the progression of chronic pancreatitis (CP) and diabetes mellitus (DM), as well as in the occurrence of complications of these diseases, is played by inflammation and endogenous intoxication by the products of protein breakdown as a result of the inflammatory process, fibrosis, and degradation of connective tissue in the patient’s body, in particular, and in the pancreas. The aim is to analyze the state of parameters of inflammation, endotoxicosis, and their influence on the functional capacity of the pancreas in the comorbid course of chronic pancreatitis and type 2 diabetes mellitus (DM2). Materials and methods. 112 patients with CP in the phase of mild therapeutic exacerbation in combination with DM2 in the stage of subcompensation were examined. The results. Moderate and moderate inverse correlations were established between CRP and fecal α-elastase in patients with CP and comorbidity of CP and DM2 (respectively r=-0.423 and r=-0.565, p&lt;0,05). An increase in the strength of reliable direct moderate correlations between the levels of HbA1c and CRP in patients with CP in combination with DM2 compared to those with isolated CP (respectively r=0.313 and r=0.410, p&lt;0,05) was proved. Conclusions: We proved a reliable influence of the index of endogenous intoxication on the level of pancreatic functional insufficiency according to the content of fecal α-elastase, which was more significant in the combined course of CP and DM2 compared to that in isolated CP. An increase in the strength of reliable direct, moderate, and moderate correlations between HbA1c levels and the index of endogenous intoxication in patients with isolated CP and CP in combination with DM2 has been proven.

Pulse oximetry and peak expiratory flow rate correlations in acute asthma exacerbation in children.

The relationship between oxygen saturation (SpO2) and peak expiratory flow rate (PEFR) in patients with acute asthma is variable. This study aims to assess the predictive value and correlation of this relationship in identifying children with mild symptoms of asthma exacerbation and defining their role in guiding early intervention decision-making. This was a retrospective review of the register of children with asthma seen at the respiratory clinic of a tertiary center in Nigeria from April 2014 to February 2020. Information on their biodata, medical history, clinical status, baseline SPO2, and %predicted PEFR was retrieved and analyzed. The mean values for participants with no symptoms and those with mild symptoms of asthma exacerbation were respectively: SpO2 was 97 ± 1.6% and 96 ± 2.6% (MD: 1.2; 95% CI; 0.7-1.7, P < 0.001); %predicted PEFR: 77.8 ± 17.8 and 64.1 ± 23 (MD; 13.68; 95% CI; 7.3 to 20.0, P < 0.001). Among those with uncontrolled asthma who were having mild symptom exacerbation of their asthma, the correlation between SpO2 and %predicted PEFR was significantly moderate (r = 0.44, P = 0.04). Children with SpO2 between the range of 92%-95% were significantly more likely to have mild symptoms of asthma exacerbation (OR: 2.52,95% CI: 1.22, 5.2, P = 0.01) compared to those with SpO2 >95%. Children with SpO2 of <95% are more likely to have an acute asthma exacerbation. While SpO2 and PEFR have more role in identifying children without acute asthma exacerbation and a limited role in identifying children with mild symptoms of asthma due to their exacerbation due to their moderate to poor correlation.