Sex differences in mortality in patients with COPD

Little is known about survival and clinical prognostic factors in females with chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine the survival difference between males and females with COPD and to compare the value of the different prognostic factors for the disease. In total, 265 females and 272 males with COPD matched at baseline by BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) and American Thoracic Society/European Respiratory Society/Global Initiative of Chronic Obstructive Lung Disease criteria were prospectively followed. Demographics, lung function, St George’s Respiratory Questionnaire, BODE index, the components of the BODE index and comorbidity were determined. Survival was documented and sex differences were determined using Kaplan–Meier analysis. The strength of the association of the studied variables with mortality was determined using multivariate and receiver operating curves analysis. All-cause (40 versus 18%) and respiratory mortality (24 versus 10%) were higher in males than females. Multivariate analysis identified the BODE index in females and the BODE index and Charlson comorbidity score in males as the best predictors of mortality. The area under the curve of the BODE index was a better predictor of mortality than the forced expiratory volume in one second for both sexes. At similar chronic obstructive pulmonary disease severity by BODE index and forced expiratory volume in one second, females have significantly better survival than males. For both sexes the BODE index is a better predictor of survival than the forced expiratory volume in one second

TNFA-863 polymorphism is associated with a reduced risk of chronic obstructive pulmonary disease: a replication study

We replicated the previously reported association between the TNFA -863 SNP and COPD. TNFA -863A allele may confer a protective effect to the susceptibility to the disease in the Spanish populatio

Gender associated differences in determinants of quality of life in patients with COPD: a case series study

BACKGROUND: The influence of gender on the expression of COPD has received limited attention. Quality of Life (QoL) has become an important outcome in COPD patients. The aim of our study was to explore factors contributing to gender differences in Quality of Life of COPD patients. METHODS: In 146 men and women with COPD from a pulmonary clinic we measured: Saint George's Respiratory Questionnaire (SGRQ), age, smoking history, PaO(2), PaCO(2), FEV(1), FVC, IC/TLC, FRC, body mass index (BMI), 6 minute walk distance (6MWD), dyspnea (modified MRC), degree of comorbidity (Charlson index) and exacerbations in the previous year. We explored differences between genders using Mann-Whitney U-rank test. To investigate the main determinants of QoL, a multiple lineal regression analysis was performed using backward Wald's criteria, with those variables that significantly correlated with SGRQ total scores. RESULTS: Compared with men, women had worse scores in all domains of the SGRQ (total 38 vs 26, p = 0.01, symptoms 48 vs 39, p = 0.03, activity 53 vs 37, p = 0.02, impact 28 vs 15, p = 0.01). SGRQ total scores correlated in men with: FEV(1)% (-0.378, p < 0.001), IC/TLC (-0.368, p = 0.002), PaO(2 )(-0.379, p = 0.001), PaCO(2 )(0.256, p = 0.05), 6MWD (-0.327, p = 0.005), exacerbations (0.366, p = 0.001), Charlson index (0.380, p = 0.001) and MMRC (0.654, p < 0.001). In women, the scores correlated only with FEV(1)% (-0.293, p = 0.013) PaO(2 )(-0.315, p = 0.007), exacerbations (0.290, p = 0.013) and MMRC (0.628, p < 0.001). Regression analysis (B, 95% CI) showed that exercise capacity (0.05, 0.02 to 0.09), dyspnea (17.6, 13.4 to 21.8), IC/TLC (-51.1, -98.9 to -3.2) and comorbidity (1.7, 0.84 to 2.53) for men and dyspnea (9.7, 7.3 to 12.4) and oxygenation (-0.3, -0.6 to -0.01) for women manifested the highest independent associations with SGRQ scores. CONCLUSION: In moderate to severe COPD patients attending a pulmonary clinic, there are gender differences in health status scores. In turn, the clinical and physiological variables independently associated with those scores differed in men and women. Attention should be paid to the determinants of QoL scores in women with COPD

TNFA-863 polymorphism is associated with a reduced risk of Chronic Obstructive Pulmonary Disease: A replication study

<p/> <p>Background</p> <p>TNF-α mediated inflammation is thought to play a key role in the respiratory and systemic features of Chronic Obstructive Pulmonary Disease. The aim of the present study was to replicate and extend recent findings in Taiwanese and Caucasian populations of associations between COPD susceptibility and variants of the <it>TNFA </it>gene in a Spanish cohort.</p> <p>Methods</p> <p>The 3 reported SNPs were complemented with nine tag single nucleotide polymorphisms (SNP) of the <it>TNFA </it>and <it>LTA </it>genes and genotyped in 724 individuals (202 COPD patients, 90 smokers without COPD and 432 healthy controls). Pulmonary function parameters and serum inflammatory markers were also measured in COPD patients.</p> <p>Results</p> <p>The <it>TNFA </it>rs1800630 (-863C/A) SNP was associated with a lower COPD susceptibility (ORadj = 0.50, 95% CI = 0.33-0.77, p = 0.001). The -863A allele was also associated with less severe forms of the disease (GOLD stages I and II) (ORadj = 0.303, 95%CI = 0.14-0.65, p = 0.014) and with lower scores of the BODE index (< 2) (ORadj = 0.40, 95%CI = 0.17-0.94, p = 0.037). Moreover, the -863A carrier genotype was associated with a better FEV₁percent predicted (p = 0.004) and a lower BODE index (p = 0.003) over a 2 yrs follow-up period. None of the <it>TNFA </it>or <it>LTA </it>gene variants correlated with the serum inflammatory markers in COPD patients (p > 0.05).</p> <p>Conclusions</p> <p>We replicated the previously reported association between the <it>TNFA </it>-863 SNP and COPD. <it>TNFA </it>-863A allele may confer a protective effect to the susceptibility to the disease in the Spanish population.</p

Seguridad de la resonancia mágnetica en pacientes con neuroestimuladores medulares: Nuestra experiencia

Aims: Over the past decade, nuclear magnetic resonance imaging (MRI) has been introduced as a safe, non-invasive routine clinical diagnostic tool. However, its use has been contraindicated in patients with implanted electronic devices, such as motor cortex and spinal cord neurostimulators. Despite the rapid growth in neurostimulation technology and its clinical application, there have been few studies addressing the safety of performing MRI procedures in patients with implanted neurostimulators. Our hypothesis is that MRI is a safe diagnostic technique in patients with implanted neurostimulators. The aim of our study is to offer some objective proof towards this point. Methods: Eight patients with implanted neurostimulators (ITRELL III Model 7425, Medtronic) undergoing 9 MRI procedures (1,5 T General Electric Sigma Excite) in 2005 are presented, following the Liem van Dongen´s protocol, with a focus in the appearance of adverse effects, during and immediately after the imaging study. Results: During the MRI studies there were no overall adverse effects detected in any case, in those in which the scanning was performed on a location away from the site of the implanted neurostimulators, nor in those in which it was performed in the same anatomic region. Once the MRI study concluded, no patient reported any sensation of discomfort attributable to heating or the electromagnetic interaction of the MRI with the neurostimulators. Neither there was any failure in the neurostimulators rescheduling, except in one case in which it was impossible its reprogrammation once the study was completed. Conclusions: In general, all these investigations indicate that in most cases MRI can be performed safely in patients with implanted stimulators, following the Liem van Dongen´s protocol, but it seems that under some circumstances this recommendation is not completely reliable. In the case of our patient in which the neurostimulator was impossible to reschedule after the MRI, this may have been caused by a battery failure, or there could have been a breakup in the generators electronic circuit. As the generator could not be examined, a hypothesis about the train of events leading to its failure was not established. In any case more studies are desirable to reliably explain the safety conditions required for the performance of MRI in patients with implanted neurostimulators.Introducción: En la ultima década la resonancia magnética (RM) ha sido introducida como una herramienta rutinaria de diagnóstico clínico por imagen, siendo considerada como una prueba no invasiva y segura. Sin embargo se ha contraindicado su utilización en pacientes que poseen dispositivos electrónicos implantados, entre ellos neurostimuladores medulares y corticales. A diferencia del avance de la tecnología en neuroesti-mulación y su aplicación clínica, hay pocos estudios que avalen la seguridad de la RM en pacientes con neuroestimuladores implantados. Nuestra hipótesis es que la RM es un método diagnóstico seguro en los pacientes con neuroestimuladores implantados. Nuestro trabajo tiene como finalidad aportar más pruebas objetivas acerca de esta cuestión. Material y Métodos: Serie de 8 pacientes con neuroestimuladores implantados (ITRELL III modelo 7425, Medtronic) sometidos a 9 estudios de RM (1,5 T General Electric Sigma Excite) durante el 2005, siguiendo el protocolo de Liem van Dongen en los que se vigiló la aparición de efectos adversos relacionados, durante e inmediatamente después del estudio de imagen. Resultados: Durante los estudios de RM no se produjeron incidencias, ni efectos adversos, en ninguno de los casos, tanto en los que el estudio se realizó en zonas alejadas del implante del neuroestimulador, como en los que se realizó en la misma zona anatómica. Una vez concluido el estudio de RM no se objetivó ninguna referencia de los pacientes a sensaciones relacionadas con el calentamiento o interacción electromagnética de la RM con su neuroestimulador. Tampoco se produjo ningún fallo en la reprogramación de los neuroestimuladores, excepto en un caso en el que fue imposible reprogramar el neuroestimulador una vez concluido el estudio de RM. Conclusiones: Todo parece indicar que en la mayoría de los casos la RM puede ser aplicada de forma segura en pacientes con sistemas de neruroestimulación implantados, siguiendo el protocolo de Liem-van Dongen, pero al parecer existen determinadas circunstancias en las que no queda totalmente claro la fiabilidad de esta recomendación. En el caso de la paciente en la que no fue posible reprogramar su neuroestimulador después de la RM en nuestro estudio, pudiera haber ocurrido un fallo de batería, o bien un daño en el circuito electrónico del generador. El no haber podido examinar el generador con problemas, no nos permite establecer una sospecha fundada sobre el conjunto de hechos que pueden haber concurrido en la producción del fallo. En cualquier caso se impone la realización de más estudios para esclarecer de forma más fiable las condiciones seguras de realización de la RM en pacientes con neuroestimuladores implantados

Evaluation of the risk of diabetic peripheral neuropathy: Design and validation of the NeuDiaCan nursing screening procedure

Objetivo Diseñar y validar un procedimiento enfermero de cribado de la neuropatía periférica diabética en atención primaria. Método El estudio se llevó a cabo en tres fases. 1) Construcción de un banco de ítems para conformar el procedimiento con una puntuación de salida que describiera la situación clínica del paciente. 2) Prueba y reducción del procedimiento tentativo inicial sobre una muestra de 50 pacientes usuarios de consultas enfermeras comunitarias, eliminando los componentes con baja fiabilidad inter-intra enfermeras. 3) Validación de la versión del procedimiento obtenida en el paso anterior sobre una muestra de 106 pacientes. Cálculo de validez y fiabilidad eliminando componentes con baja validez de criterio respecto a los resultados de la electromiografía diagnóstica utilizada como patrón de referencia. Se estimaron puntos de corte para el empleo del procedimiento como herramienta de cribado, valores predictivos, rendimiento, consistencia interna y fiabilidad inter-intra enfermera. Resultados El procedimiento tentativo inicial constó de 12 componentes que fueron reducidos a 10. En el proceso de validación de esta segunda versión el procedimiento se simplificó nuevamente, quedando conformado por 6 componentes, con un punto de corte de 2,5 en su escala de salida, punto en el que alcanza valores adecuados de sensibilidad y predictivos negativos para emplearlo como instrumento de cribado. Para este punto de corte la fiabilidad inter-intra enfermeras, la validez de criterio y la validez predictiva alcanzaron valores aceptables. Conclusiones NeuDiaCan como procedimiento de cribado enfermero de la neuropatía periférica diabética en atención primaria resulta válido, fiable y de fácil empleo.Objective To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. Methods The study was carried out in three phases. 1) Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2) Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3) Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. Results The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. Conclusions NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use.Sin financiaciónNo data JCR 20200.226 SJR (2020) Q3, 11/17 Fundamentals and SkillsNo data IDR 2020UE

TNFA-863 polymorphism is associated with a reduced risk of chronic obstructive pulmonary disease: a replication study

We replicated the previously reported association between the TNFA -863 SNP and COPD. TNFA -863A allele may confer a protective effect to the susceptibility to the disease in the Spanish populatio