The effect of osteoporosis on the respiratory function indices of patients with chronic obstructive pulmonary disease

Objective: Osteoporosis is highly prevalent among patients with chronic obstructive pulmonary disease (COPD) and most commonly presents as a vertebral compression fracture (VCF). Our objective was to quantify the effect of osteoporosis and VCFs on the mortality and pulmonary function tests (PFTs), such as forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), of patients with COPD.Methods: Research conducted for the purposes of this thesis consisted of 2 parts. The first part consisted of a meta-analysis. A PubMed/Medline search was conducted using the search terms “chronic obstructive pulmonary disease”, “osteoporosis” and “vertebral compression fracture”. Meta-analyses were conducted to evaluate the differences in mortality and PFTs between patients with COPD with and without osteoporosis or VCFs, according to PRISMA guidelines. The second part consisted of a pilot study of COPD patients, to evaluate the presence of osteoporosis in a Greek cohort of patients with COPD.Results: Of the 896 abstracts identified, 27 studies describing 7662 patients with COPD of which 1883(24.6%) had osteoporosis or VCFs, were included. Random effects model analysis demonstrated that patients with COPD and osteoporosis or VCFs had an increased OR for mortality of 2.40 (95% CI: 1.24;4.64, I2= 89%, P < 0.01), decreased FEV1/FVC with a mean difference of −4.80% (95% CI: −6.69; −2.90,I2= 83%, P < 0.01) and decreased FEV1, with a mean difference of −4.91% (95% CI: −6.51; −3.31, I2= 95%,P < 0.01) and −0.41 L (95% CI: −0.59; −0.24, I2= 97%, P < 0.01), compared to control subjects. Apart from FEV1(liters) in subgroup 1 (P = 0.06), all subgroup analyses found significant differences between groups, as did sensitivity analysis of low risk of bias studies. Regarding the pilot study, 12 patients were included, (7 male, 5 female) with a mean age of 65 years. Of these, 3 had osteopenia and 2 had osteoporosis.Conclusion: Osteoporosis and VCFs are associated with a significant reduction in survival and pulmonary function among patients with COPD. Additional studies are required in this field to corroborate these findings in the Greek population.Στόχος: Η οστεοπόρωση είναι ιδιαίτερα διαδεδομένη σε ασθενείς με χρόνια αποφρακτική πνευμονοπάθεια (ΧΑΠ) και συνήθως εκδηλώνεται με συμπιεστικά κατάγματα σπονδυλικής στήλης. Ο στόχος της παρούσας μελέτης ήταν να ποσοτικοποιηθεί η επίδραση της οστεοπόρωσης και των συμπιεστικών καταγμάτων σπονδυλικής στήλης στη θνησιμότητας και στις δοκιμασίες αναπνευστικής λειτουργίας των ασθενών αυτών, όπως ο βίαια εκπνεόμενος όγκος σε 1 δευτερόλεπτο (forced expiratory volume in one second, FEV1) και η βίαια εκπνεόμενη ζωτική χωρητικότητα (forced vital capacity, FVC).Μέθοδοι: Η μελέτη αυτή περιλάμβανε 2 σκέλη. Το πρώτο μέρος αφορούσε μια εκτενή μετα-ανάλυση μελετών που αφορούσαν ασθενείς με ΧΑΠ και οστεοπόρωση. Για τους σκοπούς της μετα-ανάλυσης διεξήχθη μια αναζήτηση PubMed/Medline με χρήση των όρων αναζήτησης “chronic obstructive pulmonary disease”, “osteoporosis” και “vertebral compression fracture”. Διεξήχθησαν μετα-αναλύσεις για την αξιολόγηση των διαφορών στη θνησιμότητα και των δεικτών αναπνευστικής λειτουργείας μεταξύ ασθενών με ΧΑΠ με και χωρίς οστεοπόρωση ή συμπιεστικά κατάγματα σπονδυλικής στήλης, σύμφωνα με τις οδηγίες της PRISMA. Το δεύτερο σκέλος αφορούσε μια πιλοτική μελέτη ασθενών με ΧΑΠ για την αξιολόγηση της παρουσίας οστεοπόρωσης σε μια ελληνική ομάδα ασθενών με ΧΑΠ.Αποτελέσματα: Από τα 896 άρθρα που εντοπίστηκαν, συμπεριλήφθηκαν 27 μελέτες που περιέγραφαν 7662 ασθενείς με ΧΑΠ, εκ των οποίων οι 1883 (24.6%) είχαν οστεοπόρωση ή συμπιεστικά κατάγματα σπονδυλικής στήλης. Η ανάλυση του μοντέλου τυχαίων επιδράσεων έδειξε ότι οι ασθενείς με ΧΑΠ και οστεοπόρωση ή συμπιεστικά κατάγματα σπονδυλικής στήλης είχαν αυξημένο λόγο πιθανοτήτων (odds ratio, OR) για θνησιμότητα 2.40 (95% CI: 1.24;4.64, I2= 89%, P <0.01), μειωμένο FEV1/FVC με μέση διαφορά − 4.80% (95% CI: -6.69; -2.90,I2= 83%, P <0.01) και μειωμένο FEV1, με μέση διαφορά −4.91% (95% CI: -6.51; −3.31, I2= 95%, P < 0.01) και −0.41 L (95% CI: −0.59; −0.24, I2= 97%, P <0.01), σε σύγκριση με τα άτομα ελέγχου. Εκτός από το FEV1 (λίτρα) στην υποομάδα 1 (P = 0.06), όλες οι αναλύσεις υποομάδας βρήκαν σημαντικές διαφορές μεταξύ των ομάδων, όπως και η ανάλυση ευαισθησίας των μελετών χαμηλού κινδύνου μεροληψίας. Όσον αφορά την πιλοτική μελέτη, συμπεριλήφθηκαν 12 ασθενείς, (7 άνδρες, 5 γυναίκες) με μέση ηλικία τα 65 έτη. Από αυτούς, 3 είχαν οστεοπενία και 2 οστεοπόρωση.Συμπέρασμα: Η οστεοπόρωση και τα συμπιεστικά κατάγματα σπονδυλικής στήλης σχετίζονται με σημαντική μείωση της επιβίωσης και της πνευμονικής λειτουργίας σε ασθενείς με ΧΑΠ. Απαιτούνται επιπλέον μελέτες στον τομέα αυτό για να επιβεβαιωθούν αυτά τα ευρήματα στον ελληνικό πληθυσμό

Fever and Ulcerative Skin Lesions in a Patient Referred for Altered Mental Status: Clinical and Microbiological Diagnosis of Ulceroglandular Tularemia

Background: Tularemia is a devastating disease that affects multiple organ systems and can have several different presentations. In its most frequent form—that of ulceroglandular tularemia—a detailed history and physical examination can enable a physician to make the diagnosis clinically, leading to the prompt initiation of the appropriate antibiotic treatment. Detailed Case Description: A 63-year-old man was brought by ambulance to the emergency department for an evaluation of an altered mental status noted by his psychiatrist at a telehealth appointment. A physical examination revealed a fever and two ulcerative lesions with a central eschar on his left leg (of which the patient was unaware) with ipsilateral tender inguinal lymphadenopathy. When asked, the patient recalled visiting Martha’s Vineyard and having removed ticks from his legs. Gentamicin was administered on the clinical suspicion of ulceroglandular tularemia. Blood and skin lesion cultures grew Gram-negative rods, which were confirmed to be Francisella tularensis on hospital day eight, and the patient fully recovered. Conclusion: This case highlights the importance of clinician perception of altered mental status as a key alarm sign, the necessity of a thorough physical exam independent of the chief compliant in the emergency department, and the essential role of pattern recognition by front-line providers for the appropriate management of uncommon but serious infections such as tularemia

The relationship of neutrophil-to-lymphocyte ratio with health-related quality of life, depression, and disease activity in SLE: a cross-sectional study

The neutrophil-to-lymphocyte ratio (NLR) emerged as a potential biomarker in SLE, but its association with several outcomes remains unclear. We aimed to evaluate the relationship between NLR and SLE disease activity, damage, depression, and health-related quality of life. A cross-sectional study was conducted, including 134 patients with SLE who visited the Division of Rheumatology between November 2019 and June 2021. Demographics and clinical data including NLR, Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus disease activity index (SELENA-SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), physician global assessment (PhGA), patient global assessment (PGA), patient health questionnaire (PHQ)-9, patient self-rated health, and lupus quality of life (LupusQoL) scores, were collected. Patients were stratified into two groups and compared using the NLR cut-off of 2.73, the 90th percentile value of healthy individuals. The analysis included t-test for continuous variables, χ2-test for categorical variables, and logistic regression adjusting for age, sex, BMI, and glucocorticoid use. Among the 134 SLE patients, 47 (35%) had an NLR ≥ 2.73. The NLR ≥ 2.73 group had significantly higher rates of severe depression (PHQ ≥ 15), poor/fair self-rated health, and the presence of damage (SDI ≥ 1). These patients also scored significantly lower in LupusQoL domains (physical health, planning, and body image), and higher in SELENA-SLEDAI, PhGA, and PGA. Logistic regression confirmed that high NLR is associated with severe depression (PHQ ≥ 15) (OR:7.23, 2.03-25.74), poor/fair self-rated health (OR:2.77,1.29-5.96), high SELENA-SLEDAI score(≥ 4) (OR:2.22,1.03-4.78), high PhGA (≥ 2) (OR:3.76, 1.56-9.05), and presence of damage (SDI ≥ 1) (OR:2.67, 1.11-6.43). High NLR in SLE may indicate depression, worse quality of life, active disease, and the presence of damage

The impact of osteoporosis and vertebral compression fractures on mortality and association with pulmonary function in COPD: A meta-analysis

Objective: Osteoporosis is highly prevalent among patients with chronic obstructive pulmonary disease (COPD) and most commonly presents as a vertebral compression fracture (VCF). Our objective was to quantify the effect of osteoporosis and VCFs on the mortality and pulmonary function tests (PFTs), such as forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), of patients with COPD. Methods: A PubMed/Medline search was conducted using the search terms “chronic obstructive pulmonary disease”, “osteoporosis” and “vertebral compression fracture”. Meta-analyses were conducted to evaluate the differences in mortality and PFTs between patients with COPD with and without osteoporosis or VCFs, according to PRISMA guidelines. PROSPERO registration: CRD42019120335. Results: Of the 896 abstracts identified, 27 studies describing 7662 patients with COPD of which 1883 (24.6%) had osteoporosis or VCFs, were included. Random effects model analysis demonstrated that patients with COPD and osteoporosis or VCFs had an increased OR for mortality of 2.40 (95% CI: 1.24; 4.64, I2 = 89%, P < 0.01), decreased FEV1/FVC with a mean difference of −4.80% (95% CI: −6.69; −2.90, I2 = 83%, P < 0.01) and decreased FEV1, with a mean difference of −4.91% (95% CI: −6.51; −3.31, I2 = 95%, P < 0.01) and −0.41 L (95% CI: −0.59; −0.24, I2 = 97%, P < 0.01), compared to control subjects. Apart from FEV1 (liters) in subgroup 1 (P = 0.06), all subgroup analyses found significant differences between groups, as did sensitivity analysis of low risk of bias studies. Conclusion: Osteoporosis and VCFs are associated with a significant reduction in survival and pulmonary function among patients with COPD