Prevalence Of Dyspnea Research Articles

Hyponatremia and risk factors for death in human visceral leishmaniasis: new insights from a cross-sectional study in Brazil

BackgroundVisceral leishmaniasis (VL) is an important and potentially fatal neglected tropical disease. The aim of this study was to investigate hyponatremia and risk factors for death among VL patients.MethodsThis is a cross-sectional study with VL patients admitted to a tertiary hospital in Northeast Brazil, from 2002 to 2009. Patients were divided into two groups: non-survivors and survivors. Hyponatremia was defined as serum sodium < 135 mEq/L. A logistic regression model was done to investigate risk factors for death.ResultsA total of 285 VL patients were included, with mean age 37 ± 15 years, and 74% were males. Thirty-four patients died (11.9%). Non-survivors had a significantly higher prevalence of dyspnea (38.2 vs. 16.7%, p = 0.003), pulmonary crackles (11.8 vs. 4.0%, p = 0.049), dehydration (23.5 vs. 10.8%, p = 0.033), oliguria (8.8 vs. 0.8%, p = 0.001) and jaundice (47.1 vs. 14.3%, p < 0.001). They also presented higher prevalence of hyponatremia (41.9 vs. 24.1%, p = 0.035), thrombocytopenia (91.2 vs. 65.3%, p = 0.002) and severe hypoalbuminemia (78.3 vs. 35.3%, p < 0.001). In multivariate analysis, moderate/severe hyponatremia (OR = 2.278, 95% CI = 1.046–4.962), thrombocytopenia (OR = 5.482, 95% CI = 1.629–18.443), jaundice (OR = 5.133, 95% CI = 1.793–14.696) and severe hypoalbuminemia (OR = 6.479, 95% CI = 2.124–19.766) were predictors of death.ConclusionHigher prevalence of dehydration, oliguria, pulmonary symptoms and liver involvement was found in non-survivors VL patients. Hypoalbuminemia and hyponatremia were frequent and significantly associated with mortality.

Prognostic Importance of Dyspnea for Cardiovascular Outcomes and Mortality in Persons without Prevalent Cardiopulmonary Disease: The Atherosclerosis Risk in Communities Study.

BackgroundThe relationship between dyspnea and incident heart failure (HF) and myocardial infarction (MI) among patients without previously diagnosed cardiopulmonary disease is unclear. We studied the prognostic relevance of self-reported dyspnea for cardiovascular outcomes and all-cause mortality in persons without previously diagnosed cardiopulmonary disease.Methods and ResultsWe studied 10 881 community-dwelling participants (mean age 57±6, 56% women, 25% black) who were free of prevalent cardiopulmonary disease from Atherosclerosis Risk in Communities Study. Dyspnea status at study entry using the modified Medical Research Council (mMRC) scale. The primary outcomes were time to HF, MI or all-cause death. Dyspnea prevalence was 22%, and was mild (mMRC grade 1 or 2) in 21% and moderate-to-severe (mMRC 3 or 4) in 1%. The main correlates of dyspnea were older age, female sex, higher BMI and active smoking. Over a follow-up of 19±5 years, greater self-reported dyspnea severity was associated with worse prognosis. Mild dyspnea was associated with significantly heightened risk of HF (adjusted Hazard Ratio, HR,1.30; 95% CI: 1.16–1.46), MI (adjusted HR 1.34; 95%CI: 1.20–1.50), and death (adjusted HR 1.16; 95%CI: 1.06–1.26), with moderate/severe dyspnea associated with an even greater risk (adjusted HR 2.14, 95%CI: 1.59–2.89; 1.93, 95%CI: 1.41–2.56; 1.96, 95%CI: 1.55–2.48, respectively).ConclusionIn community-dwelling persons free of previously diagnosed cardiopulmonary disease, self-reported dyspnea is common and, even when of mild intensity, it is independently associated with a greater risk of incident HF, MI, and death. Our data emphasize the prognostic importance of even mild self-reported dyspnea for cardiovascular outcomes.

Condições de saúde e risco de internação hospitalar em idosas praticantes de hidroginástica

The aging brings a new reality to the health system, since they are more prone to chronic diseases, which demand a high cost. This study aimed to analyze the prevalence of dyspnea and fatigue and its correlation with anthropometric measurements, and hospitalization risks in elderly women engaged in water aerobics. This cross-sectional, quantitative study with 94 elderly women engaged in water aerobics. Held data collection through risk assessment questionnaires hospitalization and pulmonary function and dyspnea, and anthropometric measurements. The results showed average value of BMI, WC and WHR above the ideal (28.6 / 93.6 / 0.87 respectively). The self-rated health was positive for 74.3% of the women and about 90% had no hospitalizations in the last twelve months. Still, there are significant negative correlation between the water aerobics practice time and fatigue. Therefore, we can see the positive effects of practicing gymnastics since even with altered anthropometric results, the vast majority of older reported good health, low number of visits for treatment and hospitalization. As dyspnea and fatigue, percentage around 5% reported having dyspnea and severe/very severe fatigue, which require appropriate care.

Treating Dyspnea: Is Oxygen Therapy the Best Option for All Patients?

The high prevalence of dyspnea at the end of life carries with it significant health and economic burden. Given the complex mechanism of dyspnea, management should be tailored to the individual patient experience and the underlying disease process. No clear role for supplemental oxygen has been established in the treatment of dyspnea in patients without no hypoxemia, and providers should consider the negative effects of oxygen supplementation. Symptom control with medications, exercise, behavioral therapy, treatment of associated anxiety, and the use of fans may be more effective and less costly than oxygen therapy. Further research is needed in the assessment and treatment of this symptom to more effectively treat patients.

Prevalence and burden of dyspnoea among COPD patients in Japan.

Dyspnoea is the most common symptom of chronic obstructive pulmonary disease (COPD) significantly affecting activity, impairing patients' well-being and contributing to the economic burden of COPD. The objective of this study was to estimate the prevalence of dyspnoea and its impact on COPD management costs in Japan. A cross-sectional survey was conducted among 82 internal medicine physicians and 85 respiratory specialists representing 420 patients with COPD in Japan. Information was collected on demographic and clinical characteristics, dyspnoea (mMRC scale), and healthcare resource use. Dyspnoea prevalence was estimated among all patients and those on specific COPD treatments. The economic burden was derived from two cohorts based on their level of dyspnoea that were matched by propensity scores balancing their demographic and disease burden characteristics. Moderate-severe dyspnoea (mMRC score ≥ 2) was reported by 37.5% of COPD patients and ranging from 21.5% among patients treated with a mono bronchodilator to 59.8% among patients treated with triple therapy. Descriptive analysis showed that dyspnoeic patients have higher annual costs attributable to consultations (€2999 vs. €1906), medications (€1139 vs. €716), exacerbations (€674 vs. €36), other resources (€1789 vs. €140) and in total (€6348 vs. €2797) (p < 0.0001 for all comparisons) compared to patients with mild or no dyspnoea (mMRC score < 2). The total costs remained significantly higher in a propensity-matched cohort adjusted for severity and cardiovascular comorbidity [€6776.1 vs. €4461.3, p = 0.0236]. Moderate-severe dyspnoea is common among consulting COPD patients in Japan and is a significant cost driver for the healthcare system.

Dying With Dyspnea in the Hospital.

While many patients hope to die at home, many die in hospitals. Patients die with unrecognized and untreated symptoms including dyspnea. We sought to determine prevalence of dyspnea at end of life in patients dying in acute hospital care and examine treatment patterns. A retrospective chart review of deaths at tertiary care hospital over a 3-month period evaluated dyspnea in last 24 hours of life, opioid orders and administration as well as presence of palliative care consultation. Of 106 decedents, 88 experienced dyspnea or tachypnea in last 24 hours of life. Health care providers noted only 50% as dyspneic, even those undergoing terminal comfort extubation. Almost all patients with dyspnea documented by staff had orders and received opioids; however, few orders described treatment specifically for dyspnea. Patients with palliative care consultations more often received opioids ( P = .0007), and opioid orders more often specified treatment of dyspnea ( P = .013). These findings support that previous work noting many patients experience dyspnea at end of life. Despite national guidelines, health care providers may still be underrecognizing and likely not optimally treating dyspnea at the end of life in the hospital. Collaboration with palliative medicine providers may improve assessments and treatments for quality end-of-life care for hospitalized patients.

Clinical features of the systolic anterior motion of the mitral valve among patients without hypertrophic cardiomyopathy

BackgroundThe prevalence and clinical features of the systolic anterior motion of the mitral valve (SAM) without hypertrophic cardiomyopathy (HCM) have not been studied well. MethodsRecords of 9180 sequential patients who underwent echocardiography at Tokyo Women's Medical University Hospital were reviewed. SAM patients were divided into those with HCM (HCM; n=60, 68%) and those without HCM (non-HCM; n=28, 32%). To assess SAM morphology, non-HCM patients were divided into the valvular and chordal groups. ResultsThe prevalence of non-HCM SAM was 0.3%. Non-HCM patients showed older age (65.7±15.0 years vs. 56.9±16.8 years, p=0.02), higher prevalence of sigmoid septum (75% vs. 50%, p=0.03), and lower left ventricular outflow tract pressure gradient (LVOT-PG) (27±31mmHg vs. 43±41mmHg, p=0.03) than HCM patients. However, 8 of 28 non-HCM patients showed a LVOT-PG >30mmHg. Valvular SAM showed higher dyspnea prevalence (29% vs. 0%, p=0.04), higher LVOT-PG (39±36mmHg vs. 6±2mmHg, p<0.001), longer anterior mitral leaflet (28±2mm vs. 26±3mm, p=0.04) and more pronounced mitral regurgitation than chordal SAM. ConclusionNon-HCM SAM prevalence was 0.3% in the Japanese population. Non-HCM SAM correlated with older age, sigmoid septum, and a lower LVOT-PG compared with HCM SAM. Among non-HCM SAM, valvular SAM showed a significant symptom, higher LVOT-PG, and more pronounced mitral regurgitation than chordal SAM.

Prevalence and Predictive Value of Dyspnea Ratings in Hospitalized Patients: Pilot Studies.

BackgroundDyspnea (breathing discomfort) can be as powerfully aversive as pain, yet is not routinely assessed and documented in the clinical environment. Routine identification and documentation of dyspnea is the first step to improved symptom management and it may also identify patients at risk of negative clinical outcomes.ObjectiveTo estimate the prevalence of dyspnea and of dyspnea-associated risk among hospitalized patients.DesignTwo pilot prospective cohort studies.SettingSingle academic medical center.PatientsConsecutive patients admitted to four inpatient units: cardiology, hematology/oncology, medicine, and bariatric surgery.MeasurementsIn Study 1, nurses documented current and recent patient-reported dyspnea at the time of the Initial Patient Assessment in 581 inpatients. In Study 2, nurses documented current dyspnea at least once every nursing shift in 367 patients. We describe the prevalence of burdensome dyspnea, and compare it to pain. We also compared dyspnea ratings with a composite of adverse outcomes: 1) receipt of care from the hospital’s rapid response system, 2) transfer to the intensive care unit, or 3) death in hospital. We defined burdensome dyspnea as a rating of 4 or more on a 10-point scale.ResultsPrevalence of burdensome current dyspnea upon admission (Study 1) was 13% (77 of 581, 95% CI 11%-16%). Prevalence of burdensome dyspnea at some time during the hospitalization (Study 2) was 16% (57 of 367, 95% CI 12%-20%). Dyspnea was associated with higher odds of a negative outcome.ConclusionsIn two pilot studies, we identified a significant symptom burden of dyspnea in hospitalized patients. Patients reporting dyspnea may benefit from a more careful focus on symptom management and may represent a population at greater risk for negative outcomes.

근로자의 화학적 노출과 주관적 호흡곤란 증상간의 연관성: 3차 근로환경조사 자료 분석

Objectives: The purpose of this study was to investigate whether chemical exposure among workers has relevance to dyspnea using data from the <TEX>$3^{rd}$</TEX> Korea Working Conditions Survey. Methods: The research subjects were 29,711 wage workers. Chemical exposures consist of four factors, (1) breathing in vapors, fumes, dust and dirt, (2) breathing in organic solvent vapors, (3) handling or touching chemicals, and (4) secondhand smoke. Multiple logistic regression analysis was performed to examine the association between chemical exposure and dyspnea in the last 12months using proc surveylogistic in SAS 9.3 statistical software excluding people who had received a diagnosis of hypertension or obesity that can affect the respiratory distress symptoms(n=27,842). Results: Chemical exposure among workers was associated with dyspnea after adjustment for demographics and job characteristics. Prevalence of dyspnea was 4.9 per 1,000 among men and 5.8 per 1,000. Compared to a total score of 0 points of chemical exposure among workers, a total score of 1, 2-3, and 4 points tended to have increased risk of dyspnea in a dose-response manner for both men (OR=1.43, 1.93, and 4.26; P-for trend=0.002) and women(OR=1.10, 2.81, and 7.70; P-for trend=0.002). Stratified analysis by duration of current job showed that the association between chemical exposure and dyspnea tended to get stronger until 15 years and then disappeared afterwards, which reflects healthy worker survivor effect. Conclusions: We observed significant association between chemical exposure and dyspnea using the data of the <TEX>$3^{rd}$</TEX> Korea Working Conditions Survey. Our results warrants providing knowledge related to chemical exposure, performing prevention activities, and creating various health policies to protect workers.

Identifying tools for capturing the overall experience of dyspnea in a lung cancer population: The patient’s perspective.

73 Background: Efficient methods of tracking dyspnea can improve quality of care. We asked lung cancer patients to assess five validated patient-reported outcome (PRO) tools and determine whether these tools captured different domains of their dyspnea experience. Methods: This cross-sectional study of adult lung cancer outpatients of all stages utilized touch screen tablets to administer five dyspnea tools (Borg severity (B), Reduced Cancer Dyspnea (R), Breathlessness intensity (I), breathlessness distress (D), and MRC breathlessness (M) scales) that focused on the severity, experience, intensity, extent, and functional impairment of dyspnea, respectively. Patients were then asked whether each tool captured their dyspnea experience. Results: Of 226 lung cancer patients, 120 reported some level of dyspnea, and their responses were analyzed. Median age (range) was 67 (30-97) years; 53% were males; 37% were stage I-II; 56%, were stage III-IV. All the tools except B were completed by over 90% of patients (R 95%, I 93%, D 91%, M 91%). 71% of patients thought that M captured functional impairment well, while 58-62% of patients thought that R, S, A captured experience, intensity and distress well. B had the lowest completion rate (83%) and the lowest patient perception that is captured severity of dyspnea well (49%). Qualitative analysis suggests that most dyspnea is activity-related in this population, which would be consistent with patients favoring M (functional assessment) over B (dyspnea at present in clinic). I+D+M takes under 5 minutes to complete, whilst R takes 5+ minutes alone to complete. Conclusions: In a sample of cancer patients with high prevalence of dyspnea, patients felt four of five tools were useful in capturing various domains of their dyspnea experience. The majority of patients felt that the questions were relevant to their circumstances. I, D, M are appropriate screening tools, whilst R may be useful under specific circumstances. Our next step is the application and evaluation of self management tools in the dyspnea setting using these four tools.

Prevalence and Burden of Dyspnoea Among Patients with Chronic Obstructive Pulmonary Disease in Five European Countries

Dyspnoea is a common symptom of chronic obstructive pulmonary disease (COPD) that has a significant direct impact on patients’ respiratory health status and contributes substantially to the economic burden of the disease. The objective of this study was to report on the prevalence of dyspnoea and its cost impact among patients with COPD in five European countries (France, Germany, Italy, Spain and the UK). A population-based cross-sectional survey (Respiratory Disease-Specific Programme, Adelphi Real World) was conducted among 2531 patients with COPD and their treating physicians. Information was collected on demographic and clinical characteristics, dyspnoea [modified Medical Research Council (mMRC) scale], health status [COPD Assessment Test (CAT), EuroQol (EQ-5D-3L)], sleep [Jenkins Sleep Evaluation Questionnaire (JSEQ)], and healthcare resource use including moderate-to-severe COPD exacerbations, physician visits, COPD medications, and other COPD-related resources. The humanistic and economic burden was derived from two cohorts based on their level of dyspnoea (mMRC 2/year) compared to patients with mMRC <2 (n = 1332). Descriptive analysis indicated that the patient cohort with worse dyspnoea had poorer health status (CAT: 25.1 vs. 16.2; P < 0.0001), poorer sleep (JSEQ: 7.1 vs. 3.8; P < 0.0001), and poorer quality of life (EQ-5D-3L: 0.66 vs. 0.88; P < 0.0001). These findings were replicated in each of the five EU countries. In the propensity score-matched population balanced for non-dyspnoeic severity parameters, patients with worse dyspnoea had significantly higher annual costs for COPD management (€4372 vs. €2031, P < 0.0001). Moderate-to-severe dyspnoea is highly prevalent in patients with COPD across the five European countries studied. It is associated with a significant disease burden and more than doubles the economic burden on health care systems. GlaxoSmithKline (Study number HO-15-15223).

Acute myocardial infarction in the elderly. A case-control study with a younger population and review of literature

ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. 462 patients (205 M and 257 F) aged > or =75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were evaluated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs. 15% and 25% vs. 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4.9% vs. 1.8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6.5% in the control group. The patients >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.

Measurement of Dyspnea in Ambulatory African Americans With Heart Failure and a Preserved or Reduced Ejection Fraction.

Dyspnea is a burdensome and disabling heart failure (HF) symptom. Few studies examining dyspnea in HF have included African Americans (AAs), despite their developing HF at a younger age and having the highest mortality rates. The purpose of this cross-sectional study was to examine dyspnea in AA patients with HF and a preserved ejection fraction (HFpEF) compared with those with a reduced ejection fraction (HFrEF), before and after the 6-minute walk test (6MWT). A convenience sample of ambulatory AA patients (HFrEF, n = 26; HFpEF, n = 19) 50 years or older was recruited from an urban HF clinic. The Borg Scale and a visual analog scale (VAS) were used to measure dyspnea intensity before and after the 6MWT. Activity limitations related to dyspnea were described using the modified Medical Research Council Dyspnea Scale. Group comparisons were analyzed using repeated-measures analysis of variance and χ 2tests. Convergent validity was determined between the Borg and VAS using Bland-Altman plots. No significant differences were found in age, gender, and comorbidities between HF groups. Most HFpEF patients reported dyspnea at baseline (Borg, 63%; VAS, 73%) and after the 6MWT (Borg, 78%; VAS, 79%). In the HFrEF group, the prevalence of baseline dyspnea was greater when measured with the VAS (Borg, 34%; VAS, 80%) but was similar between instruments after the 6MWT (Borg, 64%; VAS, 77%). Both groups reported a similar change in dyspnea intensity during and after the 6MWT. The Bland-Altman plots indicated moderate agreement at each time point. Most patients described walking hurriedly or uphill as dyspnea-provoking on the Modified Respiratory Council Dyspnea Scale. The prevalence of dyspnea at baseline and after the 6MWT was high for both groups, but intensity varied with the dyspnea instrument used.

Galectin-3 in Patients with Acute Heart Failure: Preliminary Report on First Polish Experience.

Galectin-3 (Gal-3) as a biomarker of fibrosis and inflammation has been implicated in the development and progression of heart failure (HF) and may predict increased morbidity and mortality in society. In this preliminary report we investigated the utility of a novel serum marker for the diagnosis of acute HF (AHF). The study involved 14 AHF patients aged 67.0 ± 14.6 yrs. with left ventricular ejection fraction (LVEF) 29.29 ± 10.73%, hospitalized at the Intensive Coronary Care Unit, where the research took place. In addition, a control group consisting of 19 volunteers who were age, gender and ethnically matched to the HF group was recruited. In the study group, the concentrations of Gal-3, NT-proBNP, hsCRP and basic clinical parameters, such as prevalence of dyspnea and LVEF were determined. The concentration of Gal-3 in serum was examined by an automated quantitative test (VIDAS® Galectin-3, bioMerieux SA, France) using the ELFA technique. The survival rate was assessed after a 12-month follow-up. The median (IQR) Gal-3 concentrations in patients with AHF were higher (nearly 2.1-times) than in the control group - 17.8 (10.3-27.8) ng/mL vs. 8.4 (6.5-11.0) ng/mL; p = 0.0007. In our study group, the median (IQR) of concentrations of NT-proBNP 4723 (1415-29725) pg/mL and hsCRP 10.0 (4.9-13.9) mg/L were observed. In those patients, the statistically significant correlation (Spearman's rank-correlation coefficient) between the concentrations of Gal-3 and NT-proBNP (Rs = 0.565; p = 0.035) as well as the value of LVEF and the concentration of hsCRP (Rs = -0.663; p = 0.020) were stated. The serum Gal-3 concentrations were significantly higher among the 4 HF patients (28.6%) who had died than among the HF patients who were alive after this time (n = 10) (55.6 ± 37.6 ng/mL vs. 15.0 ± 7.04 ng/mL; p = 0.005). Higher expression of Gal-3 is an indicator of myocardial fibrosis and remodeling in decompensated HF. Therefore, galectin-3 seems to be an interesting and valuable marker of AHF.

Frequency of Genotype With ΔF508 Mutation in CFTR Gene Among Iranian Cystic Fibrosis Patients With Pancreatic Insufficiency.

Background:Cystic fibrosis (CF) is the most prevalent lethal autosomal recessive disease with a broad spectrum of phenotypes. Mutation of ΔF508 in the CFTR gene is the most important and lethal mutation in CF, which contains 70% of all predisposing mutations for CF worldwide.Objectives:Determining frequency of genotypes with ΔF508 mutation in CFTR gene, and evaluation of correlation between genotype and phenotype of Iranian patients with CF.Patients and Methods:Thirty six patients were included in this cross sectional study. ΔF508 mutations in both alleles of the CFTR gene were checked.Results:Among 36 pediatric patients, ΔF508 mutation was detected in 9 (25%) patients; 2 patients were heterozygous, and 7 patients homozygous for this mutation. From overall 72 tracked alleles, 11 (15.2%) were found to have ΔF508 mutations. Differences in prevalence of dyspnea and bronchiectasis were significant in homozygote group, compared with non-mutated group for ΔF508.Conclusions:It seems that more ΔF508 mutated alleles lead to more severe symptoms of CF.

Studies of the symptom dyspnoea: a systematic review.

BackgroundTo deal with patients suffering from dyspnoea, it is crucial for general practitioners to know the prevalences of different diseases causing dyspnoea in the respective area and season, the likelihood of avoidable life-threatening conditions and of worsening or recovery from disease.AimAim of our project was to conduct a systematic review of symptom-evaluating studies on the prevalence, aetiology, and prognosis of dyspnoea as presented to GPs in a primary care setting.MethodsWe did a systematic review of symptom-evaluating studies on dyspnoea in primary care. For this we included all studies investigating the complaint “dyspnoea” as a primary or secondary consulting reason in general practice. Apart from qualitative studies, all kind of study designs independent from type of data assessment, outcome measurement or study quality were included. Symptom-evaluating studies from other settings than primary care and studies which exclusively included children (age <18 years) were excluded from the review. Studies selecting patients prior to recruitment, e.g. because of an increased probability for a particular diagnosis, were also excluded.ResultsThis systematic review identified 6 symptom evaluating studies on dyspnoea in the primary care setting. The prevalence of dyspnoea as reason for consultation ranges from 0.87 to 2.59 % in general practice. Among all dyspnoea patients 2.7 % (CI 2.2–3.3) suffer from pneumonia. Further specification of underlying aetiologies seems difficult due to the studies’ heterogeneity showing a great variety of probabilities.ConclusionThere is a great lack of empirical evidence on the prevalence, aetiology and prognosis of dyspnoea in general practice. This might yield uncertainty in diagnosis and evaluation of dyspnoea in primary care.

Prevalence and nature of dyspnea in patients with hereditary hemorrhagic telangiectasia (HHT)

Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder associated with pulmonary AVMs (PAVMs), present in about 30-50% of patients. Dyspnea is frequently reported by about one-half of patients with PAVMs and has been related to the degree of right to left shunting. However, many HHT patients with PAVMs remain asymptomatic and those without PAVMs have been observed to have dyspnea, the cause of which has not been characterized. The study objectives were to determine the prevalence of dyspnea and its etiology in the HHT population. Retrospective review of over 1000 patients at an HHT Center of Excellence from 1997 to 2010. Patients were categorized as definite HHT if they met ≥3 clinical diagnostic criteria or had a positive genetic diagnosis. Patients were unlikely to have HHT (non-HHT) if they had 1 or fewer diagnostic criteria. Data on dyspnea prevalence (MMRC≥1), PAVMs, underlying cardio-pulmonary disease, symptomatic liver venous malformations, anemia and obesity was reviewed. 506 patients were categorized as having HHT, of which 202 (40%) had confirmed PAVMs. Dyspnea prevalence was 35% (178/506) vs. 18% (50/284, p<0.0001) in the HHT and non-HHT patients, respectively. With multivariable logistic regression, the odds of dyspnea (MMRC ≥1) was 3.45 (95% CI 2.08-5.71) with the presence of PAVMs in HHT patients. Other independent predictors of dyspnea were older age, underlying cardio-pulmonary disease, anemia, and obesity. Prevalence of dyspnea is significant, evident in about one-third of HHT patients, often associated with PAVMs. It is important to consider other etiologies for dyspnea when assessing patients with HHT.

Relationship between radiological (X-ray/HRCT), spirometric and clinical findings in dental technicians' pneumoconiosis.

Pneumoconiosis in dental technicians' has rarely been evaluated. To evaluate clinical, functional and radiological impacts of exposure to dust on respiratory functions via chest X-ray (CXR), high-resolution computed tomography (HRCT) and spirometry in dental technicians. Demographic data, respiratory symptoms, spirometry results, CXR and HRCT scans of 32 dental technicians were evaluated. The opacities on the radiological images were categorized based on their intensity. We investigated the relation of radiological scores with clinical, radiological and functional findings. The mean age of the study population was 31 ± 9 years and mean employment duration was 14 ± 9 years. Twenty-two (69%) technicians had a history of smoking. The most common symptom was phlegm, while dyspnea prevalence was higher in those with an elevated International Labour Office (ILO) profusion score (P < 0.01). Parenchymal opacities were determined in 10 (31%) technicians by CXR and in 22 (69%) technicians by HRCT (P < 0.01). There was a positive correlation between ILO profusion score and HRCT score (r = 0.765, P < 0.01). ILO profusion score and HRCT score showed positive correlation with employment duration (r = 0.599, P = 0.01; r = 0.514, P = 0.01, respectively), while exhibiting negative correlation with FVC (r = -0.509, P < 0.05; r = -0.627, P = 0.01 respectively), FVC% (r = -0.449, P < 0.05; r = -0.457, P < 0.05, respectively) and forced expiratory volume in 1 s (r = -0.473, P < 0.05; r = -0.598, P = 0.01, respectively). We believe that a combined approach including spirometry, CXR and HRCT modalities should be employed in demonstrating respiratory disorders associated with exposure to inorganic dusts in dental technicians.

Prevalence and underlying causes of dyspnoea in older people: a systematic review

chronic dyspnoea is common in older people and is often of cardiac or pulmonary aetiology. Information on the exact prevalence and distribution of underlying causes is scarce. Our aim was to review the literature on prevalence and underlying causes of dyspnoea in the older population. two MEDLINE searches were conducted: the first on studies on the prevalence of dyspnoea in older persons aged ≥65 years using the Medical Research Council (MRC) dyspnoea scale and the second on the underlying causes of dyspnoea in this population. Quality assessment was performed for all included studies. Random effects models based on the logit transformed prevalences were used to calculate pooled prevalence with 95% confidence intervals (95% CI). a total of 21 articles from 20 different populations reported the prevalence in the general older population with a median sample size of 600 (Interquartile range 262-1289). The pooled prevalence was 36% (95% CI: 27-47%) for an MRC of ≥2, 16% (95% CI: 12-21%) for an MRC of ≥3 and 4% (95% CI: 2-9%) for an MRC of ≥4. Prevalence rates were higher in women than in men. Only one article investigated the underlying causes of dyspnoea in older persons; in 70% of these patients, the dyspnoea was considered to be of cardiac or pulmonary origin. dyspnoea is very common in older people, but estimates vary considerably between studies. Only one study describes the underlying causes.

The QT prolongation and clinical features in patients with takotsubo cardiomyopathy: Experiences of two tertiary cardiovascular centers

There are few data regarding clinical characteristics, laboratory parameters, electrocardiographic and echocardiographic findings in takotsubo cardiomyopathy patients presenting with QT prolongation. Aim of this study was to investigate the differences in these parameters between takotsubo cardiomyopathy patients presenting with and those without QT prolongation. We performed an observational retrospective study. One hundred five patients were enrolled from the takotsubo cardiomyopathy registry database and divided according to the presence of QT prolongation. Fifty patients presented with QT prolongation (QT group) and 55 did not (NQT group). Statistical analysis was performed using Student's t-test or Mann-Whitney U test and chi-square test. QT group had higher prevalence of dyspnea (66 versus 40%, p=0.008) and cardiogenic shock (46 versus 24%, p=0.016) than NQT group. QT group had higher prevalence of ST elevation (82 versus 64%, p=0.036), T wave inversion (96 versus 58%, p=0.001), ventricular tachycardia/ventricular fibrillation (8 versus 0%, p=0.032) and classic ballooning pattern (92 versus 66%, p=0.003), but lower left ventricular ejection fraction (mean, 39.2 versus 43.5%, p=0.005). In addition, QT group had significant higher hs-C-reactive protein (median, 6.6 versus 1.7 mg/L, p=0.023), creatine kinase-MB (median, 18.6 versus 7.6 ng/mL, p=0.032) and NT-pro-brain natriuretic peptide levels (median, 3637 versus 2145 pg/mL, p=0.044). QT group required more frequent use of inotropics (46 versus 24%, p=0.016) and diuretics (58 versus 38%, p=0.042) than NQT group. The clinical features of takotsubo cardiomyopathy are different according to the presence of QT prolongation. The QT group was lesser likely to have preserved cardiovascular reserve and more likely to require hemodynamic support than the NQT group despite the entire prognosis of takotsubo cardiomyopathy is excellent regardless of QT prolongation.