Distribution and outcomes of a phenotype-based approach to guide COPD management: Results from the CHAIN cohort

Rationale: The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). However, little is known on the distribution and outcomes of the four suggested phenotypes. Objective: We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes. Methods: We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes. Results: Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%); ACOS, 125 (15.0%); FEE, 38 (4.6%); and FECB, 99 (11.9%); additionally 19 (2.3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV1 and BODE index (all p<0.05). The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0.05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year. Conclusions: There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use

Botulismo em ruminantes causado pela ingestão de cama-de-frango Botulism in ruminants being fed with poultry litter

Botulismo é uma intoxicação causada pela ingestão das toxinas produzidas pelo Clostridium botulinum, que acomete mamíferos e aves. Neste trabalho é descrito um surto de botulismo em ruminantes, ocorrido em duas propriedades localizadas no município de Patos, no Estado da Paraíba, Brasil. Em uma das propriedades, de um total de 88 bovinos, 85 (96,6%) vieram a óbito. Na segunda, morreram 145 ovinos (96,7%), 233 caprinos (57,8%) e 30 bovinos (96,8%). Os animais acometidos apresentavam paralisia progressiva, dificuldade de locomoção, sialorréia e dispnéia. A morte ocorreu entre 24 e 48 horas após o início dos sinais, por parada cardio-respiratória. Nenhuma alteração significativa foi observada no exame post-mortem. O diagnóstico de botulismo foi confirmado pela demonstração das toxinas C e D no conteúdo intestinal e na cama-de-frango utilizada na alimentação dos animais, pela técnica de soroneutralização em camundongos.<br>Botulism is a poisoning caused by the ingestion of toxins produced by Clostridium botulinum, that infects mammals and birds. This article reports an outbreak of botulism in two different flocks of ruminants at Paraíba, Brazil. In one, 85 out of 88 (96.6%) cattles died. In the other, 145 (96.7%) sheeps, 233 (57.8%) goats and 30 (96.8%) cattles died. Clinical signs were progressive paralysis, difficulties in moving, sialorrhoe and dyspnoe. Death occurred 24 to 48 hours after the beginning of clinic signs and at post-mortem examination no noteable changes were observed. Type C and D toxins were demonstrated in the intestinal contents and poultry litter by neutralization test in mice