35 research outputs found
Switching to nebulised short acting bronchodilators does not increase the risk of arrhythmia in patients hospitalized with a COPD exacerbation
No full textIf short acting β2-agonists and muscarinic antagonists (SABA/SAMA) may have proarrhythmic effects during acute COPD exacerbations (AECOPD) is still unknown. The primary objective of the study was to investigate the incidence of new onset arrhythmias in hospitalized patients shifted to SABA/SAMA during an AECOPD compared with continuing chronic inhaled therapy. Secondary objectives were to assess the clinical characteristics of patients shifted to SABA/SAMA and risk factors for arrhythmia. This was a retrospective, observational, study enrolling consecutive patients hospitalized with an AECOPD. Incidence of arrhythmias was obtained reviewing digital records. Patients with chronic arrhythmias or home-treated with SABA/SAMA were excluded. 235 patients (63.8% males) were included, and 10/182 patients shifted to SABA/SAMA experienced arrhythmias, while no events were observed in patients on chronic inhaled therapy (p = 0.122). Shifted patients had a more severe AECOPD and history of paroxysmal atrial fibrillation was an independent risk factor for arrhythmia (OR 14.010, IC95%: 2.983–65.800; p = 0.001). In conclusion, shifting patients to SABA/SAMA appears not to increase the risk for arrhythmia during severe AECOPD. However, the pharmacological approach in patients with a history of paroxysmal arrhythmia should be carefully evaluated and monitored
FRI0241 INFLUENCE OF PATIENT REPORTED ‘’ARTHRITIS ACTIVITY’’ IN DETERMINING SHAQ, HAQ-DI AND COCHIN SCORES IN SYSTEMIC SCLEROSIS
No full textRelationship of the six minute walking test and quality of life in patients with systemic sclerosis
No full textBackground The six minute walking test (6MWT) is a standardised measure of submaximal exercise capacity. It is a surrogate measure of heart and lung involvement. There are no studies on relationship between 6MWT and quality of life evaluated by Short form 36.
Objectives To evaluate the relationships between of the 6 min walking distance (6MWD) and each items of SF36
Methods Fifty consecutive SSc patients were investigated. They underwent 6MWT and complete the SF-36 (assessed the 8 domains of the questionnaire as well as the physical component score-PCS and mental component score-MCS).
Results 6MWD ranged from 253 to 582 (median 420); we listed the correlations from 6MWT and only the statistically significant features of SSc and the items of SF36
Age: median 48 (range 20–72); Rho −0.51; p<0.00001
EScSG Activity Index: median 0.5 (range 0–5); Rho −0.33; p0.009
HAQ-DI: median 0.375 (range 0–2.275); Rho −0.26; p 0.048
mRSS: median 2 (range 0–17); Rho-0.35; p0.007
Pulmonary hypertension (echocardiography): median 30 (range 13–80); Rho −0.26; p 0.048
SF36: PCS: median 43 (range 20–65); Rho 0.41; p 0.0016
PF: median 75 (Range 0–100); Rho 0.40; p 0.002
GH: median 50 (range 10–92); Rho 0.43; p 0.0007
Conclusions Our study first demonstrates that 6MWT is correlated to some aspects of quality of life as measured by SF36 in the SSc patients. This results must been considered when assessing 6MWT in SSc.
References [1] Schoindre Yet al, J Rheumatol2009.
[2] Flahertyet al, Am J Respir Crit Care Med2006
[3] Casanova C. et al, Eur respire J2007
Disclosure of Interest None declare
Prevalence of the metabolic syndrome in patients with systemic sclerosis
No full textBackground The metabolic syndrome is an independent risk factor for ischaemic heart disease. Patients with systemic lupus eriythematosus have un increased prevalence of the metabolic syndrome.1 There are no controlled studies of the metabolic syndrome in patients with SSc. Objectives To compare the prevalence of the metabolic syndrome in patients with SSc and controls and to evaluate its relationship to activity and severity of disease. Methods Methods: 50 consecutive patients with SSc (45 female, median age 48; range 20–72) and 50 controls (patients whit fibromyalgia) (45 female, median age 46; range 25–72) were studied. The prevalence of the metabolic syndrome was compared in patients and controls using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII): central obesity: waist. 102 cm in men and. 88 cm in women;2 hypertriglyceridaemia:>150 mg/dl;3 low HDL, 40 mg/dl in men and, 50 mg/dl in women;4 high blood pressure:>130/85 mm Hg or use of drugs for high blood pressure; and5 high fasting glucose >110 mg/dl, and associations with activity and severity of the disease were examined. Results The metabolic syndrome was present in 24% of patients and in 30% of controls subjects (p>0.05). Among patients with SSc, the metabolic syndrome was significantly associated with higher value of ESR (ESR >30) (5/7 vs 4/34;p=0.027). Neither disease activity nor severity scores were associated with the metabolic syndrome Conclusions Patients with SSc have a lower prevalence of the NCEP-ATPIII-defined metabolic syndrome than controls. This result may help to justify the coronary prevalence in SSc patients similar to that of the general population.2–3 References [1] Bengtsson AA, et al. PLoS One2016Jul;21;11(7). [2] Hattema ME, et al. Rheumatology2008;45:578–83. [3] Akram MR, et al. Rheumatology2006;45:1395–8. Disclosure of Interest None declare
THU0341 DIGITAL ARTERY VOLUME INDEX (DAVIX©) PREDICTS THE ONSET OF FUTURE DIGITAL ULCERS IN PATIENTS WITH SYSTEMIC SCLEROSIS
No full textOxidative stress and viral Infections: rationale, experiences, and perspectives on N-acetylcysteine
No full textThis article explores current evidence on the role of oxidative stress in viral infections, and on the use of antioxidant drugs as adjunctive treatment. MEDLINE/PubMed was searched for appropriate keywords, and preclinical and clinical studies with reviews were retrieved and examined by authors. Old and current evidence shows that GSH content reduction is the main mechanism of redox imbalance in viral-infected cells. Clinical studies found that GSH levels are depleted in patients with viral infections such as HIV and SARS-CoV. Viral infections activate inflammation through different pathways, and several of these mechanisms are related to oxidative stress. NAC is a precursor of GSH, and many of its intracellular effects are mediated by GSH replenishment, but it also activates some anti-inflammatory mechanisms. NAC has an excellent safety profile and better oral and topical bioavailability than GSH. These characteristics make NAC a suitable option as a repurposed drug. Adjunctive antioxidant treatment may improve the outcomes of antiviral therapies. Current evidence supports the rationale for this practice and some clinical experience showed encouraging results
Improvement in health-related quality of life questionnaires with biologic treatment in severe asthma and comorbid chronic rhinosinusitis with or without nasal polyposis: a real-life experience
No full textBackground: Patients with severe asthma frequently have comorbid chronic rhinosinusitis (CRS) with or without nasal polyps, that can increase the symptom burden and complicate treatment. Real-life clinical data on the impact of biologic treatments on CRS-specific quality-of-life questionnaires are still lacking. Materials and methods: In this retrospective real-life study, we collected data from patients with severe asthma with comorbid CRS with/without nasal polyposis at baseline, and after 3, 6 and 12 months of treatment with omalizumab, mepolizumab, benralizumab or dupilumab. In particular, we evaluated improvements in HRQoL as measured by SinoNasal Outcome Test‐22 (SNOT‐22, 0–110), Visual Analog Scale symptom scores (VAS, 0–10), and Asthma Control Test (ACT, 5–25) and the proportion of patients meeting the minimal clinically important difference (MCID). Results: Disease-specific HRQoL, as measured by SNOT 22 and VAS score improved in all patients at 3, 6, and 12 months of treatment compared with baseline (SNOT-22: 14, IQR: 0–52 vs 10, IQR:0–30 vs 0, IQR:0–15 vs 0, IQR:0–12, p < 0.001, VAS score: 1, IQR: 0–5 vs 0, IQR:0–3 vs 0, IQR:0-2 vs 0, IQR 0–1, p < 0.001). After 3 months of treatment >80% of patients reached the MCID for ACT, while only patients on dupilumab showed to reach a MCID in 100% of cases. The effect size depended upon the symptom burden at baseline. Conclusions: The study confirms the efficacy of omalizumab, mepolizumab, benralizumab, and dupilumab in a real-life setting, with a rapid improvement in CRS-specific HRQoL and general health status. These data highlight the importance of targeting type 2 inflammation in asthmatic patients with co-existing upper and lower airways disease. The Authors disclose that preliminary data and analysis of the present study have been presented in abstract form during the “X International Workshop on Lung Health–Respiratory Disease and Immune Response”, held in Nice on 19–21 January 2023
Bioelectrical impedance analysisfor the assessment of body composition in patients with systemic sclerosis
No full textObjectives The aim of the present study was to evaluate the body composition by bioelectrical impedance analysis (BIA) and to assess the nutritional status by BMI and possible correlations with epidemiological and clinical characteristics in patients with SSc Methods Malnutrition was defined as BMI <18.5 kg/m 2 or unintentional weight loss >10% in combination with a fat-free mass index (FFMI) <15 kg/m 2 for women or <17 kg/m 2 for men or BMI <20.0 kg/m 2 (age <70 years) or <22 kg/m 2 (age >70 years). Body composition was assessed in 40 patients (female) (age mean ±sd: 45.2±12.2) and 20 healthy controls (age mean ±sd 41.5±5.3) with BIA (Akern, Italy) and BMI. The manufacturer’s equation and the Geneva equation were used to estimate fat mass (FFM). In addition, correlations with disease activity, gastrointestinal severity, disease subset, autoantibody profile, skin score were evaluated. Results Malnutrition was found in 10% of patients vs 8% of healty controls; and low FFMI in 30% of patients vs 10 5 of HC. Bioimpedentiometry showed a Fat Free Mass (FFM) (metabolically active component of fat free mass) reduced in patients compared to controls (46.8±7.6 vs 53.6±6.3 respectively; p=0.01). Furthermore, with the same instrument a lower basal metabolic rate was found in patients compared to controls: 1462±145 vs 1720±169 calories (p=0.001). The correlations between FFM and basal metabolism with the clinical features of the patients were not statistically significant Conclusions This study confrim the study of Spanjer MJ et al1 and shows a relatively low prevalence of malnutrition in comparison with other studies, but a high prevalence of low FFMI, underlining the necessity of measuring body composition in SSc patients with a standardised and validated method. Furthermore, Caporali et al,2 have shown an alteration of the nutritional status of patients of SSc probably related to a gastro-intestinal commitment. In our patients despite the presence of an apparent good nutritional status the use of bioimpedanceometry revealed a different body composition, a lower share of muscle mass, in patients compared to controls, related, in part, to musculoskeletal involvement by systemic sclerosis (increase in muscle catabolism and/or poor nutrient supply due to malabsorption phenomena). The early detection of such alterations could be useful to insert subjects at risk in physical rehabilitation programs. References [1] Spanjer MJet al, Rheumatology2017 [2] Caporaliet al; Clin Nutr2012 Disclosure of Interest None declare
Lung Imaging and Artificial Intelligence in ARDS
No full textArtificial intelligence (AI) can make intelligent decisions in a manner akin to that of the human mind. AI has the potential to improve clinical workflow, diagnosis, and prognosis, especially in radiology. Acute respiratory distress syndrome (ARDS) is a very diverse illness that is characterized by interstitial opacities, mostly in the dependent areas, decreased lung aeration with alveolar collapse, and inflammatory lung edema resulting in elevated lung weight. As a result, lung imaging is a crucial tool for evaluating the mechanical and morphological traits of ARDS patients. Compared to traditional chest radiography, sensitivity and specificity of lung computed tomography (CT) and ultrasound are higher. The state of the art in the application of AI is summarized in this narrative review which focuses on CT and ultrasound techniques in patients with ARDS. A total of eighteen items were retrieved. The primary goals of using AI for lung imaging were to evaluate the risk of developing ARDS, the measurement of alveolar recruitment, potential alternative diagnoses, and outcome. While the physician must still be present to guarantee a high standard of examination, AI could help the clinical team provide the best care possible
Ultrasonographic Assessment of Diaphragmatic Function and Its Clinical Application in the Management of Patients with Acute Respiratory Failure
No full textAcute respiratory failure (ARF) is a common life-threatening medical condition, with multiple underlying etiologies. In these cases, many factors related to systemic inflammation, prolonged use of steroids, and lung mechanical abnormalities (such as hyperinflation or increased elastic recoil due to pulmonary oedema or fibrosis) may act as synergic mechanisms leading to diaphragm dysfunction. The assessment of diaphragm function with ultrasound has been increasingly investigated in the emergency department and during hospital stay as a valuable tool for providing additional anatomical and functional information in many acute respiratory diseases. The diaphragmatic ultrasound is a noninvasive and repeatable bedside tool, has no contraindications, and allows the physician to rapidly assess the presence of diaphragmatic dysfunction; this evaluation may help in estimating the need for mechanical ventilation (and the risk of weaning failure), as well as the risk of longer hospital stay and higher mortality rate. This study presents an overview of the recent evidence regarding the evaluation of diaphragmatic function with bedside ultrasound and its clinical applications, including a discussion of real-life clinical cases
