Pre-existing Pulmonary Disease Research Articles

Comparison of emergency consultations of patients with neurologic complaints before and during COVID-19 pandemic in a single tertiary hospital in Makati City, Philippines

Background & Objective: COVID-19 forced us to develop adaptive ways to the new normal of healthcare delivery. Neurology has one of the most diverse types of patients who require urgent, prolonged and multidisciplinary care. This study aimed to understand the impact of the unprecedented community lockdown among patients with chronic and new onset neurologic conditions on emergency room (ER) utilization in a single tertiary hospital in Makati City, Philippine. Methods: We retrospectively examined all consecutive neurology referrals made at the ER from March to August 2020 and compared them with a control group consisting of all ER neurology referrals during the same months in 2019. Results: There was a 45% decline in the volume of referral to neurology service at the ER during the first 6 months of the lockdown period. There were fewer females who sought emergency neurologic care (p=0.019). The average age of patients increased from 55.5 years (σ=19.9) in 2019 to 59.5 years (σ=18.4) in 2020 (p<0.001). The top three chief neurologic complaints in 2019 were dizziness (17.7%), motor weakness (14.1%), and headache (13.2%). In 2020, the top three neurologic complaints where motor weakness (19.0%), decreased level of consciousness or loss of consciousness (13.2%), and dizziness (11.2%), (p<0.001). The average time from symptom onset to ER admission in 2019 was 5.1 days (σ=23.9) which increased to 8.4 days in 2020(σ=28.1), (p<0.001). The proportion of patients with no co-morbidities at the ER decreased from 27.6% in 2019 to 17.0% in 2020 (p<0.001). Patients with pre-existing cardiovascular diseases, endocrine diseases, pulmonary diseases, renal diseases, cancers, and others have significantly increased (p<0.05). However, the increase in the proportion of patients with pre-existing neurological disorders (p=0.143) was not statistically significant (p>0.05). The only pre-existing neurologic conditions with significantly increased in proportion was stroke (p=0.010). Among new onset neurologic diagnoses, headache and facial pain (p<0.001) and peripheral and other neuropathies (p=0.005) significantly decreased in proportions while proportions of cases with new stroke or vascular pathology (p<0.001) and encephalopathy (p=0.003) have significantly increased. ER dispositions showed a significant (p<0.001) decrease in proportions of patients who were admitted, discharged, and transferred to hospital of choice; while patients who were discharged against medical advice and who died at the ER have significantly increased. Conclusion: The initial six months of community lockdown during COVID-19 pandemic caused a significant change in the characteristics of patients referred to neurology for emergency care. These changes provide us a new perspective on how to better deliver optimal neurologic care to these diverse patients especially during times of pandemic.

County health ranking: untangling social determinants of health and other factors associated with short-term bariatric surgery outcomes

BackgroundThe complex interplay of the social determinants of health, race/ethnicity, and traditional surgical risk factors on outcomes following metabolic surgery is poorly understood. ObjectiveTo evaluate the relationship between the social determinants of health as measured by county health ranking (CHR) and short-term metabolic surgery outcomes. SettingFive accredited bariatric program sites at a national academic health system. MethodsData were collected from 5 sites of a single health system from 2010 to 2021. Current procedural terminology codes identified primary and revisional cases. Patient characteristics, procedural data, and 30-day occurrences were collected. CHRs for health factors were determined by ZIP Code and stratified into best, middle, and worst terciles. The primary outcome was 30-day complications, readmissions, or reinterventions/reoperations. Logistic regression assessed the correlation between CHR tercile and morbidity. ResultsWe analyzed 4,315 primary and 370 revisional metabolic surgery cases. Overall, 64.0%, 27.4%, and 8.6% of patients lived in the best, middle, and worst CHR terciles, respectively. Patients in the middle and worst CHR terciles were more commonly older; non-Hispanic Black or Hispanic; suffered from preexisting chronic obstructive pulmonary disease or hypertension, were dialysis dependence, were on therapeutic anticoagulation, or had inferior vena cava filters. Middle and worst CHR tercile patients were more likely to undergo index sleeve gastrectomy or robotic-assisted surgery and have surgery performed by a self-designated general surgeon. Thirty-day outcomes were similar across CHR terciles. Racial disparity in multiple short-term outcomes persisted despite adjustment for CHR tercile. ConclusionHigher-risk patients are more likely to be from counties with lower CHRs, but CHR was not independently associated with 30-day outcomes after metabolic surgery.

Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD

Wildfires are a global natural phenomenon. In North America, wildfires have not only become more frequent, but also more severe and longer in duration, a trend ascribed to climate change combined with large fuel stores left from modern fire suppression. The intensification of wildfire activity has significant implications for planetary health and public health, as exposure to fine particulate matter (PM2.5) in wildfire smoke is linked to adverse health effects. This review focuses on respiratory morbidity from wildfire smoke exposure. Inhalation of wildfire PM2.5 causes lung injury via oxidative stress, local and systemic inflammation, airway epithelium compromise, and increased vulnerability to infection. Wildfire PM2.5 exposure results in exacerbations of pre-existing asthma and chronic obstructive pulmonary disease, with an escalation in healthcare utilization, including emergency department visits and hospitalizations. Wildfire smoke exposure may be associated with asthma onset, long-term impairment of lung function, and increased all-cause mortality. Children, older adults, occupationally-exposed groups, and possibly women are the most at risk from wildfire smoke. Future research is needed to clarify best practices for risk mitigation and wildfire management.

Modeling Molecular Pathogenesis of Idiopathic Pulmonary Fibrosis-Associated Lung Cancer in Mice.

This characterization of tumors associated with lung diseases provides new therapeutic targets that may aid in the development of treatment paradigms for lung cancer patients with preexisting pulmonary diseases.

Inhaled toxicants and pulmonary lipid metabolism: biological consequences and therapeutic interventions.

Inhaled toxicants drive the onset of and exacerbate preexisting chronic pulmonary diseases, however, the biological mechanisms by which this occurs are largely unknown. Exposure to inhaled toxicants, both environmental and occupational, drives pulmonary inflammation and injury. Upon activation of the inflammatory response, polyunsaturated fatty acids (PUFAs) are metabolized into predominately proinflammatory lipid mediators termed eicosanoids which recruit immune cells to the site of injury, perpetuating inflammation to clear the exposed toxicants. Following inflammation, lipid mediator class-switching occurs, a process that leads to increased metabolism of hydroxylated derivates of PUFAs. These mediators, which include mono-hydroxylated PUFA derivatives and specialized proresolving lipid mediators, initiate an active process of inflammation resolution by inhibiting the inflammatory response and activating resolution pathways to return the tissue to homeostasis. Exposure to inhaled toxicants leads to alterations in the synthesis of these proinflammatory and proresolving lipid mediator pathways, resulting in greater pulmonary inflammation and injury, and increasing the risk for the onset of chronic lung diseases. Recent studies have begun utilizing supplementation of PUFAs and their metabolites as potential therapeutics for toxicant-induced pulmonary inflammation and injury. Here we will review the current understanding of the lipid mediators in pulmonary inflammation and resolution as well as the impact of dietary fatty acid supplementation on lipid mediator-driven inflammation following air pollution exposure.

An overview of atmospheric aerosol and their effects on human health.

Epidemiologic investigations have previously been published in more than 200 papers, and several studies have examined the impacts of particle air pollution on health. The main conclusions now being made about the epidemiological evidence of particle pollution-induced health impacts are discussed in this article. Although there is no universal agreement, most reviewers conclude that particulate air pollution, particularly excellent combustion-cause contamination prevalent in many municipal and manufacturing environments, is a significant risk for cardiopulmonary sickness and mortality. Most epidemiological research has concentrated on the impacts of acute exposure, although the total public health implications of chronic acquaintance's outcome may be more extraordinarily significant. According to some reviewers, prolonged, repeated exposure raises the risk of cardiorespiratory death and chronic respiratory illness. A more general (but still universal) agreement is that short-term particle pollution exposure has been shown to aggravate pre-existing pulmonary and cardiovascular diseases and increase the number of community members who become sick, require medical treatment, or die. Several in-depth studies conducted in the global and Indian regions are addressed.

The Relationship between Post-COVID Syndrome and the Burden of Comorbidities Assessed Using the Charlson Comorbidity Index.

Introduction: The post-COVID-19 syndrome is a clinical entity characterized by the manifestation of signs and symptoms that develop after the acute phase of COVID-19, which persist for a duration of more than 12 weeks and are not explained by any alternative diagnosis. It has been observed that individuals with pre-existing chronic diseases, including cardiovascular and pulmonary diseases, are at a greater risk of developing post-COVID-19 syndrome. The Charlson Comorbidity Index (CCI) is a useful tool employed to evaluate the burden of comorbidities and predict the prognosis of patients with post-COVID-19 syndrome. The present study aims to assess whether the burden of comorbidities, evaluated using the CCI, correlates with post-COVID-19 syndrome. Materials and Methods: Between 21 April 2020 and 15 May 2023, we enrolled all consecutive outpatients with previous COVID-19 admissions to a post-acute day-hospital service three months after a negative SARS-CoV-2 molecular test. We assessed age, sex, BMI, acute COVID-19 and post-COVID-19 signs, and symptoms and calculated CCI according to its current definition. Post-COVID-19 syndrome was defined as the persistence of at least one sign or symptom lasting more than 12 weeks after COVID-19 resolution and not explained by an alternative diagnosis. The relationship between post-COVID-19 and CCI was explored first with the chi-squared test, then with different binary logistic regression models. We considered significant values of p lower than 0.05. Results: We obtained a cohort of 3636 patients and observed a significant association between the number of post-COVID-19 symptoms and CCI. Patients developing post-COVID-19 were more commonly affected by a greater burden of comorbidities. Patients with at least one CCI point had an increased risk of post-COVID-19 syndrome (OR:2.961; 95%CI: 2.269-3.863; p < 0.0001), which increased further for CCI ≥ 4 (OR:6.062; 95%CI: 3.163-11.618; p < 0.0001). Conclusions: Patients affected by post-COVID-19 show a greater clinical complexity and a larger burden of comorbidities, synthesized by a higher CCI; moreover, a higher CCI seems to correlate with an increasing post-COVID-19 risk, being the presence of ≥1 or ≥4 CCI points associated with a 3-fold and 6-fold increased risk of post-COVID-19 syndrome, respectively.

Three to Six-Months Follow-Up Chest CT Findings after COVID-19 Pneumonitis, Incidence of Complications and Correlation to Different Risk Factors

Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, has become a global pandemic. As of November 19, 2020, World Health Organization stated that this disease has been found in more than 200 countries. Pathology studies have shown that COVID-19 causes injuries in multiple organs and tissues, with extensive pulmonary involvement similar to that found in other coronavirus infections (ie, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus infection). Aim of the Work to evaluate pulmonary changes on 3-6 months follow-up chest CT scans and to explore the risk factors for fibrotic-like changes in the lung in patients who recovered from COVID-19 pneumonia. Patients and Methods This was a retrospective and prospective study that included 50 patients who had Symptoms of variable degree of fever, cough, and dyspnea with RT-PCR confirmed COVID- 19 infection at Ain Shams University Hospitals referred to the Radiodiagnosis Department for HRCT chest examination. All patients were evaluated for: (I): Incidence of complications (residual fibrotic like changes in their follow up CT chest scans). (Il): Correlation to different risk factors such as (smoking, diabetes mellitus, hypertension, pre-existing pulmonary disease, pre-existing renal disease and steroid therapy). Results 56% of cases showed residual fibrotic like changes in their follow up chest CT scans while 44% of cases showed total resolution of the disease process. Smoking and old age were significant risk factors while steroid therapy decreased risk of fibrotic like change. Conclusion Twenty eight cases (56%) showed residual fibrotic like changes in their 3-6 months follow-up chest CT scan (CO-RADS III to V). Patients with older age and smokers have higher incidence of residual fibrotic like changes in their follow up chest CT scans, while patients on steroid therapy have less liability to develop fibrotic changes.

Pre-diagnostic prescribing patterns in dyspnoea patients with as-yet-undiagnosed lung cancer: A longitudinal study of linked primary care and cancer registry data

IntroductionPatients with as-yet undiagnosed lung cancer (LC) can present to primary care with non-specific symptoms such as dyspnoea, often in the context of pre-existing chronic obstructive pulmonary disease (COPD). Related medication prescriptions pre-diagnosis might represent opportunities for earlier diagnosis, but UK evidence is limited. Consequently, we explored prescribing patterns of relevant medications in patients who presented with dyspnoea in primary care and were subsequently diagnosed with LC. MethodLinked primary care (Clinical Practice Research Datalink) and National Cancer Registry data were used to identify 5434 patients with incident LC within a year of a dyspnoea presentation in primary care between 2006 and 2016. Primary care prescriptions relevant to dyspnoea management were examined: antibiotics, inhaled medications, oral steroids, and opioid analgesics. Poisson regression models estimated monthly prescribing rates during the year pre-diagnosis. Variation by COPD status (52 % pre-existing, 36 % COPD-free, 12 % new-onset) was examined. Inflection points were identified indicating when prescribing rates changed from the background rate. Results63 % of patients received 1 or more relevant prescriptions 1–12 months pre-diagnosis. Pre-existing COPD patients were most prescribed inhaled medications. COPD-free and new-onset COPD patients were most prescribed antibiotics. Most patients received 2 or more relevant prescriptions. Monthly prescribing rates of all medications increased towards time of diagnosis in all patient groups and were highest in pre-existing COPD patients. Increases in prescribing activity were observed earliest in pre-existing COPD patients 5 months pre-diagnosis for inhaled medications, antibiotics, and steroids, ConclusionResults indicate that a diagnostic window of appreciable length exists for potential earlier LC diagnosis in some patients. Lung cancer diagnosis may be delayed if early symptoms are misattributed to COPD or other benign conditions.

Definition and Clinical Evaluation for Trimethoprim-Sulfamethoxazole Severe Acute Respiratory Failure.

Trimethoprim-sulfamethoxazole (TMP-SMX)-associated severe acute respiratory distress syndrome (ARDS) has gone underrecognized. We propose the first disease definition and clinical evaluation for a novel adverse drug reaction (ADR) based on a series of recently identified rare cases of life-threatening ADRs. A retrospective study was conducted. All medical records were evaluated. Available pathology samples were sent to Massachusetts General for clinical consultation. Blood samples from surviving patients were obtained and human leukocyte antigen (HLA) analysis was performed by the Children's Mercy Hospital Genomic Center and Vanderbilt University Medical Center. U.S. ICUs, 1996-2021. Nineteen young patients (10-37) were identified. Patients were previously healthy, with no preexisting pulmonary disease, no other cause for respiratory failure, and no chronic history of smoking/vaping. None. Through our retrospective analysis, we analyzed clinical characteristics associated with TMP-SMX. Pathology samples were reviewed, and HLA analysis was performed on available samples by the study team or as standard of care at treatment hospitals in some cases. In 19 critically ill patients, we identified a pattern of severe respiratory failure requiring ICU admission, mechanical ventilation, and frequent extracorporeal membrane oxygenation use. We describe the first three-part clinical diagnosis and evaluation strategy: 1) Clinical definition: Unexplained severe respiratory failure in a patient receiving greater than or equal to 6 days of TMP-SMX at treatment dose (not prophylaxis). TMP-SMX ARDS is a diagnosis of exclusion. 2) Genetic association: One hundred percent of currently available TMP-SMX respiratory failure patient genomic data, ( n = 11) have been carriers of both HLA-B*07:02 and HLA-C*07:02 alleles. HLA allele evaluation could be considered in patients with suspected TMP-SMX respiratory failure. 3) Lung pathology: A unique pulmonary pathologic pattern of lung injury termed diffuse alveolar injury with delayed epithelialization has been observed in these cases. In suspected cases, surgical lung biopsy early in the clinical course could be considered. TMP-SMX is a commonly prescribed antibiotic. However, we find it imperative to share this relatively rare but life-threatening condition with clinicians as the mortality rate approaches 40%.

Dual lumen cannulation and mobilization of patients with venovenous extracorporeal membrane oxygenation.

Mobilization is important in longer courses in intensive care unit (ICU), typical for patients requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). For patients supported with ECMO, especially out-of-bed mobilizations improve outcome. We hypothesized that utilization of a dual lumen cannula (DLC) for V-V ECMO would facilitate out-of-bed mobilization compared to single lumen cannulas (SLC). Retrospective single center registry study including all V-V ECMO patients cannulated between 10/2010 and 05/2021 for respiratory failure. The registry included 355 V-V ECMO patients (median age 55.6 years, 31.8% female, 27.3% with preexisting pulmonary disease), 289/355 (81.4%) primary cannulated with DLC, and 66/355 (18.6%) using SLC. Both groups had similar pre-ECMO characteristics. The runtime of the first ECMO cannula was significantly longer in DLC compared to SLC (169 vs. 115 h, p = 0.015). The frequency of prone positioning during V-V ECMO was similar in both groups (38.4 vs. 34.8%, p = 0.673). There was no difference in in-bed mobilization (41.2 vs. 36.4%, for DLC and SLC, respectively, p = 0.491). Patients with DLC were more often mobilized out-of-bed (25.6 vs. 12.1%, OR 2.495 [95% CI 1.150 to 5.268], for DLC and SLC, respectively, p = 0.023). Hospital survival was similar in both groups (46.4 vs. 39.4%, for DLC and SLC, respectively, p = 0.339). Patients cannulated with a dual lumen cannula for V-V ECMO support were significantly more often mobilized out-of-bed. Since mobilization is important in prolonged ICU courses typical for ECMO patients, this might be an important benefit. Other benefits of DLC were the longer runtime of the initial cannula set and fewer suction events.

Changes in endotracheal tube cuff pressure with the changes in peak airway pressures during total laparoscopic hysterectomy and pelvic surgeries. A prospective and observational study

Background: The abdominal insufflation and changes in endotracheal tube (ETT) cuff pressure due to creation of pneumoperitoneum and changes in patient positioning during laparoscopic abdominal surgeries have not been explored thoroughly. Aims and Objectives: The aim of our study was to see the changes in ETT cuff pressures during creation, maintenance, release of pneumoperitoneum, and during surgical positioning. Materials and Methods: A total of 60 patients were finally taken for study. Written informed consent was taken for participation in the study as well as consent for surgery. Inclusion criteria were patients of age above 30 years, American society of anesthesiology physical status 1 and 2, patients undergoing total laparoscopic hysterectomy requiring trendelenburg positioning. Exclusion criteria were patients with pre-existing pulmonary or cardiac disease, patients with pre-existing vocal cord palsy, goitre or any other airway or thoracic pathology, pregnant or lactating females, BMI more than 25 or &lt;18.5. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analyzed and compared. Results: Baseline cuff pressure after manual inflation was 28.85±11.4 cm H2O. Significant correlation was observed between change in cuff pressure and increase in peak airway pressure at the end of the surgery (P&lt;0.05). Serial measurements of ETT cuff pressure, peak airway pressure, and ETCO2 were significantly increased compared to baseline (P&lt;0.05). Conclusion: Pneumoperitoneum in Trendelenburg position increases ETT cuff pressure probably due to increase in airway pressure. Therefore, it seems advisable to include routine monitoring of ETT cuff pressure. Objective adjusted measurement of cuff pressure and airway pressures is recommended for such surgeries.

Imaging Findings in Aspergillosis: From Head to Toe.

Aspergillosis is a mycotic infection induced by airborne fungi that are ubiquitous. Inhalation of Aspergillus conidia results in transmission through the respiratory tract. The clinical presentation is dependent on organism and host specifics, with immunodeficiency, allergies, and preexisting pulmonary disease constituting the most important risk factors. In recent decades, the incidence of fungal infections has increased dramatically, due in part to the increased number of transplants and the pervasive use of chemotherapy and immunosuppressive drugs. The spectrum of clinical manifestations can range from an asymptomatic or mild infection to a swiftly progressive, life-threatening illness. Additionally, invasive infections can migrate to extrapulmonary sites, causing infections in distant organs. Recognition and familiarity with the various radiological findings in the appropriate clinical context are essential for patient management and the prompt initiation of life-saving treatment. We discuss the radiological characteristics of chronic and invasive pulmonary aspergillosis, as well as some of the typically unexpected extrapulmonary manifestations of disseminated disease.

Pulmonary arterial hemodynamic in patients with or without pulmonary disease admitted after cardiac arrest - a sub study of the BOX trial

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation Background Patients with pulmonary disease may have altered pulmonary hemodynamic compared to patients without pulmonary disease. We hypothesize that these patients with pre-existing pulmonary disease have significantly elevated pulmonary arterial pressure during the first 48 hours of ICU-stay. Methods The BOX-trial was an investigator-initiated, randomized, controlled study of targeted MAP (63 vs 77 mmHg) and PaO2 (9-10 vs 13-14 kPa) interventions in 789 comatose OHCA (of presumed cardiac origin) patients. Pre-existing, significant pulmonary disease was recorded at baseline. Patients underwent serial hemodynamic assessments with pulmonary artery catheter at time of insertion (0 h), 6 h, 12 h, 24 h, 36 h and 48 h. Among parameters recorded was cardiac output (CO). Pulmonary arterial pressures and central venous pressure were measured continuously. Patient characteristics included age, time to return of spontaneous circulation (ROSC) and initial rhythm. Results Hemodynamic parameters from 730 patients were analysed, of which 89 (12%) had pulmonary disease. Of these, 57 (8%) had COPD, 26 (4%) had asthma and 6 (1%) had non-obstructive pulmonary disease. Patients with pulmonary disease were older (66±12 vs 62±14 years) and had similar time to ROSC (20±14 vs 23±16 minutes). Initial shockable rhythm was present in 73/89 (82%) with pulmonary disease and in 580/641 (90%) without, p=0.015. At 12 hours, mean pulmonary artery pressure (27±5 vs 24±6 p&amp;lt;0.0001, see Figure 1), systolic pulmonary pressure (36±7 vs 33±8 p=0.0004), and diastolic pulmonary pressure (21±5 vs 18±5 p&amp;lt;0.0001) were all significantly higher for patients with pulmonary disease than patients without. This association remain statistically significant, when adjusting for primary rhythm, time to ROSC and age. Also, heart rate (72±21 vs 66±17 bpm, p&amp;lt;0.0056) was significantly higher in patients with pulmonary disease. Cardiac index (cardiac output adjusted for body surface), central mixed venous saturation and CVP was similar between groups. Conclusions Pre-existing pulmonary disease in resuscitated OHCA-patients is associated with significantly elevated pulmonary pressures.

HAEMODIALYSIS: A KING OR A CLOWN FOR COVID POSITIVE PATIENTS WITH PRE-EXISTING PULMONARY DISEASES!

Background: COVID-19 infection in patients with pre-existing respiratory diseases, manifesting as ARDS, while simultaneously affecting multiple organs severely worsened the outcome, raising the need to explore various treatment modalities. To study the impact of haemodialysis on outcomes of COVID-19 pati Objective: ents with pre-existing pulmonary diseases. Methods: Data of patients with known pulmonary comorbities admitted to COVID wards, undergoing haemodialysis for AKI at tertiary care centre, was collected from July 2020 to January 2022. The demographics, baseline parameters and outcomes were recorded. Total 61 Results: patients were included in this retrospective observational study. The percentage of different pre-existing pulmonary pathologies (COPD, Asthma, ILD, and Pulmonary Tuberculosis) were equally distributed among survivors(n=47) and non-survivors(n=14). The non-survivors were older(p=0.003), and had a higher percentage of males (p=0.02), higher percentage of smokers (p=0.02) and alcohol consumers(p=0.011), a lower mean systolic blood pressure, higher pulse rate, higher respiratory rate and lower SpO2. The non-survivors had a lower mean hemoglobin, platelet count, and a higher mean TLC, NLR, and D-dimer levels. On admission, the non-survivors had a higher mean blood urea level and serum creatinine level (p&lt;0.001). The number of hemodialysis done was signicantly higher(p=0.041) in the survivors as compared to non-survivors. Conclusion: Our study strongly suggests that haemodialysis can be used as a life saving treatment modality for AKI in COVID positive patients with pre-existing pulmonary disease. Also protocols need to be redened for early initiation and increased frequency of haemodialysis in patients with acute on chronic multisystem insult.

Incidence and Healthcare Burden of Pertussis among Older Adults with and without Pre-Existing Chronic Obstructive Pulmonary Disease or Asthma in South Korea

A retrospective cohort study was conducted to examine trends in the incidence and burden of pertussis among adults ≥50 years in South Korea, with/without pre-existing chronic obstructive pulmonary disease (COPD) or asthma. The nationwide Health Insurance Review and Assessment Service (HIRA) database was used to identify patients ≥50 years diagnosed with pertussis (2009–2018). Mean annual incidence of pertussis per 100 000 persons and overall mean incidence rate ratios (IRR) were calculated for patients with pre-existing COPD or asthma versus those with neither. Incremental healthcare costs (all-cause and pertussis-related) and healthcare utilisation (number of outpatient visits, emergency room visits, and number and length of hospitalisations) up to 12 months after, compared to 3 months before pertussis diagnosis, were also measured for each group (matched on sex, age, and Charlson Comorbidity Index). Of 1011 pertussis cases, 175 had asthma, 96 had COPD (not mutually exclusive), and 796 had neither. Overall mean pertussis incidence was 2.5, 3.4, and 0.5 for adults with pre-existing COPD, asthma, and those with neither. IRR (95% confidence interval) of pertussis for adults with pre-existing COPD and asthma was 4.9 (4.0–‍6.1) and 6.7 (5.7–7.9). Both COPD-pertussis and asthma-pertussis groups had higher mean incremental all-cause costs and length of hospitalisations than the general-pertussis group 3 months following pertussis diagnosis. In conclusion, individuals ≥50 years in South Korea with pre-existing COPD or asthma were at an increased risk of being diagnosed with pertussis and had higher healthcare resource utilisation than those without these conditions.

Venous or arterial thrombosis in COVID-19 cases in the North Carolina COVID-19 Community Research Partnership (NC-CCRP)

BackgroundAlthough the incidence of venous and arterial thrombosis after a COVID-19 diagnosis and hospitalization has been well described using data available from electronic health records (EHR), little is known about their incidence after mild infections. ObjectivesTo characterize the cumulative incidence and risk factors for thrombosis after a COVID-19 diagnosis among those identified through the EHR and those with a self-reported case. MethodsWe calculated the cumulative incidence of thromboembolism diagnoses after EHR-identified and self-reported cases in the North Carolina COVID-19 Community Partnership, a prospective, multisite, longitudinal surveillance cohort using a Kaplan-Meier approach. We performed Cox regression to estimate the hazard of a thromboembolism diagnosis after COVID-19 by comorbidities, vaccination status, and dominant SARS-CoV-2 variant. ResultsOf a cohort of comprising more than 39,500 participants from 6 North Carolina sites, there were 6271 self-reported or EHR-diagnosed cases of COVID-19 reported between July 1, 2020, and April 30, 2022, of which 46 participants were diagnosed with a new-onset thromboembolism in the 365 days after their reported case. Self-reported cases had a lower estimated cumulative incidence of 0.15% (95% CI, 0.03-0.28) by day 90 and 0.64% (95% CI, 0.30-0.97) by day 365 compared with EHR-based diagnoses that had cumulative incidences of 0.73% (95% CI, 0.36-1.09) and 1.78 (95% CI, 1.14-2.46) by days 90 and 365 (log-rank test P value <.001). Those hospitalized and with pre-existing pulmonary and cardiovascular diseases were associated with the highest risk of a thromboembolism. ConclusionWe observed a higher cumulative incidence of thromboembolism after EHR-identified COVID-19 than self-reported cases.

Epidemiology, clinical features, and outcomes of strongyloidiasis in Taiwan from 1988 to 2020: A case series and literature review.

We described a case of Strongyloides hyperinfection syndrome, reported a case series, and reviewed published cases of strongyloidiasis in Taiwan. Confirmed cases of strongyloidiasis at the National Taiwan University Hospital (NTUH) and NTUH Hsin-Chu Branch from 1988 to 2020 were identified in the medical record database. Literature search was carried out through Pubmed, Google Scholar, and Index to Taiwan Periodical Literature System to identify published cases of strongyloidiasis in Taiwan from 1979 to 2020. Data pertaining to the demographics, underlying medical conditions, clinical manifestations, laboratory findings, and outcomes were extracted. A total of 117 cases of strongyloidiasis were identified, including 20 previously unpublished cases from the two hospitals and 97 published cases in the literature. Overall, 85 (73%) were male and the mean age was 64 years (range, 6-95 years). Classical symptoms such as diarrhea, cough, and skin rash were only observed in 43%, 37%, and 18% of the patients, respectively, whereas eosinophilia at presentation was only found in 48%. Strongyloides hyperinfection syndrome and disseminated strongyloidiasis were identified in 41 (35%) and 4 (3%) patients, respectively. Four (3%) patients had concurrent meningitis. In univariable analysis, being older and having pre-existing chronic obstructive pulmonary disease or asthma were associated with hyperinfection or dissemination (p=0.024 and 0.003, respectively). The mortality rate was 43% among those with hyperinfection or disseminated infection. Strongyloidiasis can cause serious complications and mortality. Efforts to diagnose strongyloidiasis early are urgently needed to improve the outcome of patients with strongyloidiasis in Taiwan.

Risk Factors of Pertussis Among Older Adults in South Korea: A Nationwide Health Data-Based Case-Control Study.

To better understand the conditions associated with pertussis diagnosis among older adults in South Korea, a matched case-control study was conducted of individuals≥50years diagnosed with pertussis between 2009 and 2018. Pertussis cases were identified using the nationwide Health Insurance Review and Assessment service (HIRA) database. Each case was then matched to up to 10 controls identified using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) by age, sex, and geographic region at index date. In the 12months and 30days prior to index date, the presence of clinical characteristics previously reported to be related to pertussis and pertussis-like conditions were assessed, respectively. A conditional multivariate logistic regression model was then used to calculate odds ratios (ORs) of pertussis diagnosis, adjusted for each of the characteristics. Pertussis cases (n=1004) generally demonstrated a higher prevalence of comorbidities compared to controls (n=9710). Pre-existing asthma and chronic obstructive pulmonary disease (COPD) within 12months of index date were associated with a two-fold increased risk of pertussis with adjusted ORs (95% confidence interval) of 2.08 (1.68-2.58) and 2.32 (1.59-3.39), respectively. Gastroesophageal reflux disease [GERD; 2.67 (2.23-3.19)], cancer [1.68 (1.23-2.31)], cardiovascular disease [1.62 (1.31-2.00)], renal disease [1.56 (1.12-2.16)], autoimmune disease [1.50 (1.25-1.79)], and hyperlipidemia [1.43 (1.16-1.77)] were also associated with pertussis diagnosis. Finally, acute respiratory events within 30days prior to index date, such as pneumonia, acute bronchitis, and upper respiratory tract infection (URTI), were highly associated with increased odds of pertussis diagnosis [adjusted ORs of 8.28 (5.10-13.44), 4.86 (3.84-6.14), and 2.90 (2.30-3.67), respectively]. This study's findings complement and expand upon previous studies on the adult pertussis population, generating real-world data to describe underlying clinical characteristics of those diagnosed with pertussis in South Korea.

Blood monocyte levels predict the risk of acute exacerbations of chronic obstructive pulmonary disease: a retrospective case–control study

Monocytes were critical cells in the innate immune system. Monocyte recruitment to the lungs is a crucial process of pathophysiology in chronic obstructive pulmonary disease (COPD). Current evidence on the association between the occurrence of acute exacerbations of COPD (AECOPD) and monocytes was unclear. This study aimed to examine whether blood monocytes are associated with the occurrence of AECOPD and to determine the specific blood monocyte level to predict AECOPD. A retrospective case–control study was conducted at Changhua Christian Hospital. A total of 444 eligible patients with COPD were included between January 2017 and December 2019. Restricted cubic splines were used to analyze the nonlinear relationships between continuous white blood cell values and the occurrence of AECOPD. The association between monocytes and the occurrence of AECOPD was assessed using the logistic, lasso, and ridge regression models. Restricted cubic splines revealed nonlinear associations among the monocyte level, the continuous value of the eosinophil-to-lymphocyte ratio, and the occurrence of AECOPD. The lowest risk of occurrence of AECOPD ranged from 7.4 to 10%; < 7.4% with an absolute count < 0.62 or > 10% indicated significant risk. No significant association was noted between the eosinophil-to-lymphocyte ratio categories in the tertiles (< 0.049, 0.049 to < 0.122, and ≥ 0.122) and the risk of AECOPD. A significantly higher risk was noted in the association of the occurrence of AECOPD with the CAT score; mMRC score; wheezing cough; preexisting chronic pulmonary disease; hypertension and malignancy; use of dual- and triple, and oral long-acting bronchodilators for COPD treatment; and WBC count. We reported a nonlinear relationship between monocytes and the occurrence of AECOPD. Patients with monocyte percentage of > 10% or < 7.4% with an absolute count < 0.62 had higher risk of occurrence of AECOPD. Overall, our study demonstrated the specific value of monocytes in identifying high risks of the occurrence of AECOPD; this value is an easy-to-obtain, inexpensive biomarker in patients with AECOPD and should be further investigated in future prospective clinical studies.