Respiratory Disease Patients Research Articles

Development and validation of a simple tool composed of items on dyspnea, respiration rates, and C-reactive protein for pneumonia prediction among acute febrile respiratory illness patients in primary care settings

BackgroundAcute febrile respiratory illness (AFRI) patients are susceptible to pneumonia and suffer from significant morbidity and mortality throughout the world. In primary care settings, the situation is worse. Limited by computerized tomography resources and physician experiences, AFRI patients in primary care settings may not be diagnosed appropriately, which would affect following treatment. In this study, we aimed to develop and validate a simple prediction model to help physicians quickly identify AFRI patients of pneumonia risk in primary care settings.MethodsA total of 1977 AFRI patients were enrolled at two fever clinics in Shanghai, China, and among them, 727 patients who underwent CT scans were included in the analysis. Acute alveolar or interstitial infiltrates found on CT images were diagnosed with pneumonia. Characteristics and blood parameters were compared between pneumonia and non-pneumonia patients. Then a multivariable model for pneumonia prediction was developed through logistic regression analysis. Its value for pneumonia prediction was prospectively assessed in an external multi-center population, which included 1299 AFRI patients in primary settings from 5 different provinces throughout China.ResultsIn the model development population, pneumonia patients (n = 227) had a longer duration of fever; higher frequencies of purulent sputum, dyspnea, and thoracic pain; and higher levels of respiration rates and C-reactive protein (CRP) than non-pneumonia patients (n = 500). Logistic regression analysis worked out a model composed of items on dyspnea, respiration rates > 20/min, and CRP > 20 mg/l (DRC) for pneumonia prediction with an area under curve (AUC) of 0.8506. In the external validation population, the predictive accuracy of the DRC model was the highest when choosing at least one positive item (1 score) as a cut-off point with a sensitivity of 87.0% and specificity of 80.5%. DRC scores increased with pneumonia severity and lung lobe involvement and showed good performance for both bacterial and viral pneumonia. For viral pneumonia, dyspnea plus respiration rates > 20/min had good predictive capacity regardless of CRP concentration.ConclusionsDRC model is a simple tool that predicts pneumonia among AFRI patients, which would help physicians utilize medical resources rationally in primary care settings.

CLINICAL IMPACT OF ESCALATIONS TRIGGERED BY REMOTE PATIENT MONITORING IN COPD

CLINICAL IMPACT OF ESCALATIONS TRIGGERED BY REMOTE PATIENT MONITORING IN COPD

Biofilm Producing Pseudomonas Aeruginosa in Patients with Lower Respiratory Tract Infections

Background and Aim: Pseudomonas aeruginosa is a vital pathogen causing major life-threatening infections among respiratory disease patients that leads to higher morbidity and mortality. Lower respiratory tract infections (LRTIs) are amongst these infections commonly found in hospitalized patients. Antibiotic tolerant biofilms formation and bacterium high intrinsic resistance to antibiotics make these infections difficult to treat. The present study aimed to assess the biofilm producing pseudomonas aeruginosa in lower respiratory tract infections patients. Methodology: This cross-sectional study was carried out on 246 Lower respiratory tract infections patients admitted to ICUs of Sharif Medical and Dental College Lahore and Mohi-ud-Din Teaching Hospital, Mirpur Azad Kashmir for the duration from June 2021 to December 2021. The signs and symptoms of LRTIs were investigated in each patient. Prior to study conduction, ethical approval was obtained from the institutes research and ethical committee. Each individual provided written informed consent. Identification of isolated organisms and antimicrobial sensitivity was done. Microtiter method was used for all the isolated, to imperil the isolates of P. aeruginosa for biofilm detection. SPSS version 25 was used for the data analysis. Results: Of the total 246 specimens consisted of sputum 198 (80.5%), pleural fluid 19 (7.7%), suction tube 16 (6.5%), and tracheostomy tip specimens 13 (5.3%). The incidence of positive culture was 78 (31.7%). Out of 78 positive cultures, sputum 56 (71.8%) was the major factor followed by pleural fluid 3 (3.8%), suction tube 12 (15.4%) and tracheostomy tip 7 (9.0%). Of the 78 positive specimens, the prevalence of single bacterium and poly-microbial infection was 58 (74.4%) and 20 (25.6%) respectively. The poly-microbial infection consisted of sputum 10 (50%), pleural fluid 1 (5.0%), suction tube 6 (30.0%), and tracheostomy tube 3 (15%). Out of 78 positive culture specimens, isolated gram-negative bacteria were 102, out of which K. pneumonia and P. aeruginosa were present in 46 (45.1%) and 24 (23.5%) respectively. Regarding the resistance pattern of gram-negative respiratory pathogens, Cefepime (86.9%) and ceftriaxone (91.9%) were given higher resistance by K. pneumoniae. Likewise, higher numbers of Acinetobacter spp provided resistance to cefepime (86.7%) and ceftriaxone (87%). Out of 24 P. aeruginosa isolates, biofilm producers were found in 16 isolates, in which the incidence of strong, moderate, and weak biofilm producers was 3 (18.7%), 5 (31.3%), and 8 (50%) respectively. Sputum in 11 (68.8%) was the prevalent biofilm producer isolates followed by suction tube 4 (25%) and tracheostomy tube 1 (6.3%). The incidence of inpatients and outpatients were 15 (93.8%) and 1 (6.2%) respectively. Conclusion: Our study concluded that gram-negative bacteria was the predominant and had increased resistance to antibiotics in Lower respiratory tract infections (LRTIs) patients. In LRTIs, the most common organism was K. pneumonia. Also, P. aeruginosa isolated in LRTIs patients were susceptible to producing biofilm. Biofilm producers had higher resistance than biofilm non-producers. Keywords: Biofilm producing P. aeruginosa, K. pneumonia, Lower respiratory tract infections

Perspectives in Therapy of Chronic Rhinosinusitis.

The recent classification of chronic rhinosinusitis (CRS) focusses on investigating underlying immunopathophysiological mechanisms. Primary CRS is subdivided based on endotype dominance into type 2 (that relates mostly to the Th2 immune response with high levels of IL-5, IL-13, and IgE), or non-type 2 (that corresponds to the mix of type 1 and type 3). The treatment selection of CRS is dependent on endotype dominance. Currently, the majority of patients receive standardized care—traditional pharmacological methods including local or systemic corticosteroids, nasal irrigations or antibiotics (for a selected group of patients). If well-conducted drug therapy fails, endoscopic sinus surgery is conducted. Aspirin treatment after aspirin desensitization (ATAD) with oral aspirin is an option for the treatment in nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) patients. However, in this review the focus is on the role of biological treatment—monoclonal antibodies directed through the specific type 2 immune response targets. In addition, potential targets to immunotherapy in CRS are presented. Hopefully, effective diagnostic and therapeutic solutions, tailored to the individual patient, will be widely available very soon.

Cognitive Function and the Ability to Operate Long-Term Oxygen Therapy Equipment: An Exploratory Study.

Chronic respiratory disease patients with severe hypoxia receive long-term oxygen therapy (LTOT). The proper operation of LTOT equipment is essential for continuing treatment. This exploratory study investigated the relationship between cognitive impairment as a comorbidity in patients receiving LTOT and their ability to operate the LTOT equipment. The study measured responses to questions based on the ability of participants to operate the equipment and applied the Montreal Cognitive Assessment (MoCA). The ability of groups with MoCA scores ≤ 25 and >25 to operate LTOT equipment was compared to confirm the correlation between MoCA and ability to operate the equipment. An aggregate of 60 participants receiving LTOT were recruited, of whom 45 (75%) were MoCA score ≤ 25. The group of MoCA score ≤ 25 demonstrated a lower ability to operate LTOT equipment than group of MoCA score > 25 (p = 0.012). Additionally, a correlation was found between the ability to operate LTOT equipment and MoCA (rs = 0.743, p < 0.001). The results indicated that the group of MoCA score ≤ 25 indicated a lower ability to operate LTOT equipment than that of MoCA score > 25. Cognitive impairment in patients receiving LTOT can affect their ability to operate LTOT equipment.

Total Hip Arthroplasty in Patients Who Have Respiratory Disease Who use Supplemental Home Oxygen

BackgroundThe purpose of this study is to investigate the association between supplemental home oxygen prior to surgery and both medical and surgical complications after primary elective total hip arthroplasty (THA) in patients who have respiratory disease (RD). MethodsThe Mariner database was used to identify patients who have RD who received primary elective THA from 2010 to 2020. The THA patient cohorts consisted of 20,872 patients who had RD prescribed home oxygen and 69,520 patients who had RD without home oxygen. For patients who had a diagnosis of RD and were prescribed supplemental home oxygen (O2) and those who were not, the rates of postoperative medical and surgical complications, hospital readmissions, and emergency room visits were determined. Reimbursements and lengths of stay were also determined. Logistic regression analyses were utilized to compare both cohorts to matched cohorts without RD, as well as to each other directly. ResultsIn comparison to the matched control group, the RD with home oxygen group had a significantly higher rate of pneumonia (odds ratio [OR] 4.27, P < .0001), pulmonary embolism (OR 1.81, P < .0001), periprosthetic joint infection (OR 1.21, P < .0001), and periprosthetic fracture (OR 1.81, P = .001). The RD with home oxygen cohort also had a significantly higher incidence of pneumonia (OR 2.16, P < .0001), periprosthetic joint infection (OR 1.38, P < .0001), and periprosthetic fracture (OR 1.24, P = .009) compared to RD patients who did not have home oxygen. ConclusionSupplemental home oxygen use prior to surgery is associated with a significantly higher risk of postoperative medical and surgical complications after elective THA.

Renin-angiotensin system antagonists and mortality due to pneumonia, influenza, and chronic lower respiratory disease in patients with hypertension.

BACKGROUNDIt is controversial whether angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) have a potentially beneficial role in the respiratory system. This study investigated the association between ACEI/ARB medications and respiratory-related mortality in hypertensive patients in a real-world nationally representative cohort.METHODSThis was a retrospective analysis based on a prospective cohort study. A total of 10,530 patients with hypertension aged ≥ 20 years were included. The data was extracted from the US National Health and Nutrition Examination Survey during 1988–1994 and 1999–2006. The study was approved by the Institutional Review Boards. Moreover, inform concent was taken form all the participants.RESULTSOverall, 27.7% (n = 2920) patients took ACEI/ARB agents. During a median follow-up of 12.4 years, 278 individuals died of respiratory disease, including chronic lower respiratory disease (n = 155) and influenza or pneumonia (n = 123). Compared with the patients without ACEI/ARB use, those taking ACEI/ARB were not associated with respiratory-specific mortality in a multivariable-adjusted Cox model. After 1: 1 matching, taking ACEI/ARB was also not related to respiratory mortality (Hazard ratio (HR) = 1.07, 95% CI: 0.79–1.43), influenza- or pneumonia-related (HR = 1.00, 95% CI: 0.65–1.54) and chronic pulmonary mortality (HR = 1.13, 95% CI: 0.75–1.69). After separating ACEI and ARB from anti-hypertensive medications, those associations remained unchanged. CONCLUSIONSWe discovered no significant link between ACEI or ARB medication and pulmonary-related mortality in hypertensive patients. In hypertensive patients, standard ACEI/ARB administration may have little effect on the respiratory system.

Subcutaneous allergen immunotherapy in the treatment of allergic respiratory disease.

Subcutaneous immunotherapy is recognized as a cornerstone in the management of allergic respiratory disease in patients who are properly characterized with allergy and with allergic rhinoconjunctivis and/or well-controlled asthma, and who are willing to adhere to the rigorous treatment program. A key tenet is that it affords the opportunity to effect long-term clinical remission through its disease-modifying properties. Furthermore, it has the potential to prevent the progression of allergic rhinitis to asthma, prevent new allergen sensitivities, and improve a patient's quality of life.

Cx‐CP‐ABE: Context‐aware attribute‐based access control schema and blockchain technology to ensure scalable and efficient health data privacy

AbstractNowadays, advancements in health technology have characterized modern illness diagnosis methods in the global healthcare system. The World Health Organization (WHO) has received a large number of respiratory disease patients in recent years, resulting in billions of personal health records (PHRs) being created and transmitted via cloud with the aim of taking precautions and restricting the disease. The transmission of PHR through Internet has generated significant security and privacy concerns for the global health care system. Furthermore, the potential change in the patient's health situation at any time needs immediate and secure healthcare access. For robust authentication and optimal confidentiality, it is necessary to reinforce the access control policies. As a result, various security schemes have been developed but lack efficiency while deploying cloud‐based e‐health applications, where the cloud providers are honest but curious and may obtain sensitive data without the consent of users. In this article, we present a new security scheme for e‐health mobile applications based on hybrid cipher text‐policy attribute access control, blockchain, and context‐awareness (Cx‐CP‐ABE). The approach is based on reinforcing security policies pertaining to the continuous evolution of the patient's state and context changes and the improvement of the patient's data confidentiality. The proposed security scheme has been evaluated under various patient contexts, and its performance has been measured in terms of sensitivity, number of health attributes, and execution time.

Use of Supplemental Home Oxygen is Associated With Early Postoperative Complications Following Total Knee Arthroplasty

BackgroundThe objective of this study is to evaluate preoperative supplemental home oxygen use as a potential risk factor for both medical and surgical complications following primary elective total knee arthroplasty (TKA) in patients who have respiratory disease (RD). MethodsPatients with a diagnosis of RD who underwent elective TKA from 2010 to 2020 were identified using a national database. The rates of postoperative medical and surgical complications, hospital readmissions, and emergency room visits were calculated for RD patients who used supplemental home oxygen and those who did not. Additionally, reimbursements and lengths of stay were determined. Both cohorts were then compared to matched cohorts who did not have RD using logistic regression analyses. ResultsA total of 41,418 patients who underwent TKA with RD on home oxygen and 138,635 patients who had RD without home oxygen use were compared with matched cohorts. The RD cohort with home oxygen use had a significantly higher incidence of periprosthetic joint infection (5.78% versus 2.69%, odds ratio [OR] 1.42, P < .0001), pneumonia (3.95% versus 0.69%, OR 4.44, P < .0001), venous thromboembolism (3.17% versus 2.10%, OR 1.12, P = .007), and periprosthetic fracture (0.82% versus 0.34%, OR 1.72, P < .0001) compared to the matched control cohort. Additionally, the RD with home oxygen cohort had a significantly higher incidence of periprosthetic joint infection (5.78% versus 3.77%, OR 1.15, P < .0001), pneumonia (3.95% versus 1.63%, OR 1.99, P < .0001), and several other medical complications compared to RD patients without home oxygen use. ConclusionPreoperative supplemental home oxygen use is associated with significantly increased risk of postoperative surgical and medical complications following elective TKA. This finding can help guide risk assessment and the informed consent process prior to surgery.

Shortened Telomere Length in Sputum Cells of Bronchiectasis Patients is Associated with Dysfunctional Inflammatory Pathways.

Telomere attrition is an established ageing biomarker and shorter peripheral blood leukocyte telomere length has been associated with increased risks of respiratory diseases. However, whether telomere length in disease-relevant sputum immune cells of chronic respiratory disease patients is shortened and which pathways are dysfunctional are not clear. Here we measured telomere length from sputum samples of bronchiectasis and asthmatic subjects and determined that telomere length in sputum of bronchiectasis subjects was significantly shorter (Beta = - 1.167, PAdj = 2.75 × 10-4). We further performed global gene expression analysis and identified genes involved in processes such as NLRP3 inflammasome activation and regulation of adaptive immune cells when bronchiectasis sputum telomere length was shortened. Our study provides insights on dysfunctions related to shortened telomere length in sputum immune cells of bronchiectasis patients.

P125 Genotype-phenotype correlation of triazole-resistant pulmonary aspergillosis in chronic respiratory disease patients

P125 Genotype-phenotype correlation of triazole-resistant pulmonary aspergillosis in chronic respiratory disease patients

Effectiveness of influenza vaccination on in-hospital death and recurrent hospitalization in older adults with cardiovascular diseases

ObjectivesThere is limited evidence on the effectiveness of influenza vaccination on hospitalization outcomes by cardiovascular disease (CVD) subtypes or comorbidities. MethodsThis study involved 713,488 records of hospitalization of adults ≥60 years with CVD from the Beijing Urban Employee Basic Medical Insurance database. Logistic regression with generalized estimating equations was conducted to estimate the effectiveness of influenza vaccination on in-hospital death and recurrent hospitalization, adjusting for unmeasured confounders. ResultsThe coverage of influenza vaccination was only 13.3% among older adults hospitalized for CVD. Influenza vaccination was associated with 15% (odds ratios 0.85 [0.74, 0.99]) lower risk of in-hospital death among patients with CVD, with stronger associations in patients with stroke. Influenza vaccination was associated with 6% (0.94 [0.88, 0.99]) and 28% (0.72 [0.56, 0.93]) lower risks of recurrent hospitalization for ischemic heart disease (IHD) and respiratory disease in patients with IHD, but there were no clear associations in patients with stroke. For in-hospital death, the protective association of influenza vaccination was stronger in patients with fewer comorbidities and was similar to that of joint vaccinations of influenza and pneumococcal vaccinations. ConclusionThe protective association of influenza vaccination on CVD hospitalization outcomes serves as the evidence base to increase the uptake of influenza vaccination among older adults in China.

CT severity score in COVID-19 patients, assessment of performance in triage and outcome prediction: a comparative study of different methods

BackgroundLung involvement in COVID-19 can be quantified by chest CT scan with some triage and prognostication value. Optimizing initial triage of patients could help decrease adverse health impacts of the disease through better clinical management. At least 6 CT severity score (CTSS) systems have been proposed. We aimed to evaluate triage and prognostication performance of seven different CTSSs, including one proposed by ourselves, in hospitalized COVID-19 patients diagnosed by positive polymerase chain reaction (PCR).ResultsAfter exclusion of 14 heart failure and significant preexisting pulmonary disease patients, 96 COVID-19, PCR-positive patients were included into our retrospective study, admitted from February 20, 2020, to July 22. Their mean age was 63.6 ± 17.4 years (range 21–88, median 67). Fifty-seven (59.4%) were men, and 39 (40.6%) were women. All CTSSs showed good interrater reliability as calculated intraclass correlation coefficients (ICCs) between two radiologists were 0.764–0.837. Those CTSSs with more numerous segmentations showed the best ICCs. As judged by area under curve (AUC) for each receiver operator characteristic (ROC) curve, only three CTSSs showed acceptable AUCs (AUC = 0.7) for triage of severe/critical patients. All CTSSs showed acceptable AUCs for prognostication (AUCs = 0.76–0.79). Calculated AUCs for different CTSSs were not significantly different for triage and for prediction of severe/critical disease, but some difference was shown for prediction of critical disease.ConclusionsMen are probably affected more frequently than women by COVID-19. Quantification of lung disease in COVID-19 is a readily available and easy tool to be used in triage and prognostication, but we do not advocate its use in heart failure or chronic respiratory disease patients. The scoring systems with more numerous segmentations are recommended if any future imaging for comparison is contemplated. CTSS performance in triage was much lower than earlier reports, and only three CTSSs showed acceptable AUCs in this regard. CTSS performed better for prognostic purposes than for triage as all 7 CTSSs showed acceptable AUCs in both types of prognostic ROC curves. There is not much difference among performance of different CTSSs.

Can Homecare Chronic Respiratory Disease Patients with Home Oxygen Treatment (HOT) in Southern Okinawa, Japan Be Evacuated Ahead of the Next Anticipated Tsunami?

An earthquake with a magnitude of 8 or 9 is predicted to occur near the Ryukyu Islands in Japan, for which the Okinawa Prefecture is preparing countermeasures. Evacuating people to a safe shelter within the tsunami arrival time is a crucial countermeasure. This study aims to understand the vulnerabilities of patients with chronic respiratory diseases in southern parts of Okinawa during a tsunami evacuation, thereby calculating evacuation distance of vulnerable patients and creating individual evacuation plans. Data for chronic respiratory patients obtained in July 2021 from the hospitals in Okinawa Prefecture include age, gender, diagnosis, residence, nearest tsunami shelter, oxygen flow at rest and walking, and maximum walking distance for 6 min based on a 6-min walk test. A quantum geographic information system was used for mapping the data. The survival potential of patients with chronic respiratory disease was evaluated by using a tsunami inundation depth of one meter and the distance within which an evacuation can be performed until the first tsunami wave reaches the nearest evacuation shelter. Results revealed a low survival potential for respiratory disease patients under the current tsunami evacuation plan. The study suggests creating an individual evacuation plan for vulnerable patients involving families and medical staff and then conducting a drill for improving the plan.

The Practice of Referring Patients with Rheumatic Diseases and Respiratory Involvement to Respirology Clinics

Background: There is a significant association between rheumatic diseases and pulmonary complications, mandating careful assessment for patients. Aim: We aimed to assess the current practice of rheumatologists in referring patients with rheumatic diseases and respiratory involvement to respirology clinics in Saudi Arabia. Materials and Methods: This study is a cross-sectional online survey conducted among rheumatologists and distributed from September 15th, 2021, to December 30, 2021. The first part of the questionnaire aimed to determine the participants' demographic data. The second part assessed the current practice of referring patients with respiratory symptoms to respirology clinics. The third part assessed the participants' awareness of evaluating respiratory diseases in patients with rheumatic conditions. Results: The survey was distributed to 250 rheumatologists using social media and E-mail. We received 61 responses. The majority, 56 (91.8%), did not have a preset respiratory questionnaire and 55 (90.2%) reported ordering pulmonary function tests and high-resolution computerized tomography of the chest before referring patients to a pulmonologist. Forty respondents (65.6%) screen their high-risk patients for respiratory involvement at baseline, and annually, 53 (86.9%) collaborate with a pulmonologist to manage patients who have lung involvement on a long-term basis. The majority of the respondents, 60 (98.4%), did not have an established combined rheumatology-respirology clinic; however, 43 (70.5%) believed that it was feasible to establish such a clinic in their workplace. There is consistency in agreement among the respondents regarding the importance of screening high-risk patients for pulmonary complications. Conclusion: Among the respondents, there was an appreciation of the importance of pulmonary complication screening and collaboration with a pulmonologist to comanage their patients. The concept of the combined rheumatology-respirology clinic is not widely adopted, considering its potential effect on prompt patient evaluation.

Study to compare efficacy of sit-stand test and victory stand test against 6 minute walk test in patients of respiratory and cardiac diseases

To compare efficacy of sit-stand test and victory stand test against 6 minute walk test in patients of respiratory and cardiac diseases. Materials and Methods: The present comparative study was carried out by the department of Pulmonary Medicine, MMIMSR (deemed to be university), Mullana, Ambala, Haryana, India. Total 44 patients who fulfilled the eligibility criteria were included from the OPD of the hospital. The patient’s BMI, Spirometery, Breath holding time was done at the OPD before the real 6MWT and the victory stand &amp; sit stand test. All the patients were then subjected to 6MWT first and the vitals (pulse rate and spo2) were recorded Pre and post-test using a pulse oximeter. The patients were instructed to walk for 6 minutes and the patient would return back to the OPD for the reading of the vitals. After giving adequate rest to the patient when the vitals returned to baseline, the patients were subjected to Sit and stand test in which the patient was instructed to sit and stand on patient stool inside the OPD in front of the clinician.

The Risk of Genetic Polymorphisms in the Immune Genes on the Developed of Respiratory Allergic Diseases

Allergic diseases are intricate and improvement includes both natural and hereditary components. besides classic Tcell-originated T helper form-2 cytokine comparable to IL4; IL5; IL13. Tissues created cytokine akin to thymic-stromal-lymphopoietin. IL25 as well as IL33 at the moment is famous the main contribution of allergies irritation. IL33 generated via quite a lot of tissue living cells and generally enhances allergic infection using its results in hematopoietic-cells varieties. Ecological and endogenously triggered which induce IL33 cell released could also correlated to contamination, irritation and tissues harm. Current review brief an extensive variety for certified IL33 efficiency in human-cellular-mediatory in irritation like good as genetically marker when IL33 contributed with sickness. At last, IL33 attached with IL1/RL1 was engaged with asthma. previous information shows in some investigation that contribution by IL33-IL1RL1 gene with asthma was biologically conceivable, IL33 on asthma patients can influence expressing levels for IL33 serum. Moreover, rs16924159/G-A variation is related in IL33 level of respiratory hypersensitive diseases patients.

Pattern of Respiratory Diseases and Comorbidities in Patients Attending Casualty Department

Background: The common causes of respiratory emergencies include pneumonias, acute severe asthma, acute exacerbation of Chronic Obstructive Pulmonary diseases (COPD), TB, lung cancers, pneumothorax, pleural effusion, pulmonary embolism and Acute Respiratory Distress Syndrome (ARDS) from other causes. Aims and Objectives: To study patterns and co-morbidities of respiratory disease in patients attending casualty department. Materials and Methods: This Cross Sectional Study was conducted on 193 patients of Respiratory disease attending emergency department in Medical College and tertiary health care institute. Study was conducted for a period of 2 years (August 2018 to December 2020). Patients were enrolled after matching inclusion and exclusion criteria. Institutional ethics committee permission was taken prior study. Observations and Results: The most common age group amongst study population was 51 to 60 years (39.4%) followed by 61 to 70 years (37.8%) and more than 70 years (19.2%). There was male predominance (76.7%) amongst study population as Most of the study population had normal BMI (55.4%) followed by Underweight (27.5%) and Overweight (13.5%). Most of the study population were Farmer (37.3%) followed by Housewife (23.5%), Labourer (11.8%) and Shopkeeper (9.8%). The most common clinical features amongst study population was Breathlessness (100%) followed by Cough with expectoration (58%) and dry cough (22%). Most of the study population had mMRC Dyspnoea Grade 3 (48.2%) followed by grade 2 (30.1%), grade 4 (11.9%), grade 1 (9.8%). COPD (38%) was the most common respiratory disease amongst study population followed by Pleural effusion (19%), Asthma (15%), Pulmonary TB (11%), Pneumonia (6%), Pneumothorax (4%), ARDS (3%), ILD (2%), Pulmonary embolism (1%) and Swine flu (1%). Diabetes (46%) was the most common comorbidity amongst study population followed by Hypertension (36%), Ischemic Heart Disease (15%), Chronic Liver Disease (11%), Chronic kidney Disease (8%), Pneumonia (6%), Pneumothorax (4%) and Malignancy (2%). Conclusion: In the present study, Diabetes (46%) was the most common comorbidity amongst study population followed by Hypertension (36%), Ischemic Heart Disease (15%), Chronic Liver Disease (11%), Chronic kidney Disease (8%), Pneumonia (6%), Pneumothorax (4%) and Malignancy (2%). This findings was comparable with the study conducted by Sonisha Gupta et al. (2016)41, among these patients 10 (35.7%) were diabetic, 16 (57.1%) hypertensive, 6 (21.4%) had cardiac problem and 17 (60.7%) joint pain.

Relationship Between C-Reactive Protein and Respiratory Diseases in Patients with Type 2 Diabetic Retinopathy.

BackgroundThe aim of this study was to explore the relationship between C-reactive protein (CRP) and respiratory diseases in patients with diabetic retinopathy.Material/MethodsWe identified 855 patients with diabetic retinopathy who met the inclusion criteria from the “Diabetes Complications Data Set” in the National Population Health Data Center. We divided patients into 3 groups according to CRP tertiles: Q1 (<0.3 mg/dL), Q2 (0.3–0.35 mg/dL), and Q3 (>0.35 mg/dL). A multivariate logistic regression model was used to evaluate the relationship between CRP and respiratory diseases. The area under the receiver operating characteristic (ROC) curve was used to investigate the independent predictive effect of CRP on respiratory diseases.ResultsOf the 855 patients with diabetic retinopathy, 137 (16%) had respiratory diseases. Prevalence of respiratory diseases gradually increased with an increase in CRP level (P for trend=0.001). With CRP as a continuous variable in the logistic regression model adjusted for confounding factors (model 3), the odds ratio (OR) per 1 standard deviation increment of CRP was 1.25 (95% CI 1.07–1.45, P=0.004). When the lowest CRP tertile group was used as the reference group, the OR of the highest CRP tertile group was 1.99 (95% CI 1.22–1.3.26, P=0.006). Adding CRP to the risk factor model increased the area under the ROC curve (0.68 vs 0.65, P=0.017). Subgroup analysis showed that the relationship between CRP and respiratory diseases had no potential heterogeneity among subgroups.ConclusionsCRP can be used as an effective biomarker in predicting risk of respiratory diseases in patients with diabetic retinopathy.