Sleep - related breathing disorders in patients with chronic obstructive pulmonary disease

The association of obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD) is not rare as COPD and OSA are both frequent diseases. The aim of this study was to determine the effect of OSA on quality of life (QOL) in patients with overlap syndrome (OVS). Thirty subjects with OVS and 15 control subjects participated. The St George's Respiratory Questionnaire (SGRQ) was used to determine QOL. The control group included subjects with COPD and no evidence of OSA by overnight polysomnography. All subjects were habitual snorers with normal Epworth Sleepiness Scale scores. Significant differences were found between the groups for the total score and each of the three components of the SGRQ suggesting worse QOL in OVS patients (symptoms 54.9 ± 18.9 vs. 38.2 ± 19.3, p = 0.008; activity 59.2 ± 16.2 vs. 44.4 ± 11.3, p = 0.003; impacts 35.2 ± 23 vs. 20.8 ± 8.7, p = 0.025 and total 45.7 ± 17.7 vs. 30.9 ± 8.7, p = 0.004 in OVS patients and control group, respectively). Obstructive sleep apnoea has a major impact on QOL in patients with OVS and can exist in COPD patients with habitual snoring even in the absence of daytime sleepiness. Further studies are needed to determine the impact of OSA treatment on QOL and morbidity in this population.Ο συνδυασμός του συνδρόμου αποφρακτικής άπνοιας στον ύπνο (ΣΑΥ) και της χρόνιας αποφρακτικής πνευμονοπάθειας (ΧΑΠ) δεν είναι σπάνιος, αφού τόσο η ΧΑΠ όσο και το ΣΑΥ είναι συχνές νόσοι. Ο στόχος αυτής της μελέτης ήταν να καθοριστεί η επίδραση του ΣΑΥ στη σχετική με την υγεία ποιότητα ζωής (ΣΥ-ΠΖ), σε ασθενείς με σύνδρομο επικαλύψεως (ΣΕ). Συμμετείχαν τριάντα ασθενείς με ΣΕ και 15 ως ομάδα ελέγχου. Το ερωτηματολόγιο του St George's respiratory (SRGQ) χρησιμοποιήθηκε για τον καθορισμό της ΣΥ-ΠΖ. Η ομάδα ελέγχου περιελάμβανε ασθενείς με ΧΑΠ που αποδεδειγμένα δεν έπασχαν από ΣΑΥ, αφού υποβλήθηκαν σε πολυπαραμετρική μελέτη ύπνου (ΠΠ-ΜΥ). Όλα τα μελετούμενα άτομα ροχάλιζαν συχνά και είχαν φυσιολογικές τιμές στην κλίμακα μέτρησης υπνηλίας του Epworth (ESS). Αποδείχθηκαν σημαντικές διαφορές μεταξύ των δύο ομάδων στο συνολικό σκορ και για κάθε μία από τις ενότητες του SRGQ, αναδεικνύοντας χειρότερη ΣΥ-ΠΖ στους ασθενείς με ΣΕ (συμπτώματα: 54,9 ± 18,9 έναντι 38,2 ± 19,3 με p = 0,008, δραστηριότητα: 59,2 ± 16,2 έναντι 44,4 ± 11,3 με p = 0,003, επιδράσεις: 35,2 ± 23 έναντι 20,8 ± 8,7 με p = 0,025 και συνολικά: 45,7 ± 17,7 έναντι 30,9 ± 8,7 με p = 0,004 σε ασθενείς με ΣΕ και την ομάδα ελέγχου αντίστοιχα). Η αποφρακτική άπνοια στον ύπνο έχει σημαντική επίδραση στην ΣΥ-ΠΖ σε ασθενείς με ΣΕ και μπορεί να συνυπάρχει σε ασθενείς με ΧΑΠ που ροχαλίζουν συχνά, ακόμα και με την απουσία ημερήσιας υπνηλίας. Επιπλέον έρευνες χρειάζονται για να καθορίσουν την επίδραση της θεραπείας του ΣΑΥ, στην ΣΥ-ΠΖ και στη νοσηρότητα σε αυτό τον πληθυσμό

Bilateral pulmonary nodules in an adult patient with bronchiolitis obliterans-organising pneumonia

A 58-year-old male ex-smoker was admitted to hospital because of nodular infiltrates on chest x rays. He was complaining of fatigue, dyspnoea with exertion, low grade fever and weight loss. Physical examination was unremarkable. Bronchoscopy was inconclusive but revealed endobronchial lesions of chronic active inflammation. The diagnosis of cryptogenic organising pneumonitis bronchiolitis obliterans-organising pneumonia (COP-BOOP) was established by open lung biopsy. Proliferative bronchiolitis with regions of organising pneumonia is the characteristic feature of COP. The radiological picture of bilateral pulmonary nodules is an infrequent manifestation of COP. Lung biopsy, open or with video assistance thoracic surgery, is recommended to confirm the diagnosis

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)