A profile of the elderly admitted to the emergency unit of Groote Schuur Hospital : with particular reference to their health care needs

This study is the first of its kind undertaken at Groote Schuur Hospital. It is an attempt to provide a holistic profile of their elderly patients with a view to encouraging further, more specific research, and to provide information for use in the planning of efficient health care for the aged. The study was based on three premises: (i) there is an interrelationship between the ageing process and disease; (ii) a non-disease-specific approach which focusses on the functional status of elderly patients can be used as a predictor of health services consumption; and (iii) any study which promotes understanding of the dynamics of health care of the elderly must also take into account the ageing process and its effect on a particular population within a specific social context. The research spanned 52 weeks (1 March 1989 - 27 February 1990). A sample of nine patients per week was selected from the total population of patients aged 65 and over admitted to the Emergency Unit of Groote Schuur Hospital. Two adult female researchers, using structured questionnaires, constructed in English and comprising subtests, utilising indexes and scales, interviewed respondents and/or household members in their own homes. Data was also obtained from the hospital files. Although essentially descriptive by nature, use was made of groups in regard to variables such as "first admission" (admission to the Emergency Unit), and "readmission" (a previous overnight admission in the preceding year). Statistical analysis, where indicated, was by means of non-parametric tests

COVID-Related Chronic Allograft Dysfunction in Lung Transplant Recipients: Long-Term Follow-up Results from Infections Occurring in the Pre-vaccination Era

Introduction: We report on characteristics and lung function outcomes among lung transplant recipients (LTRs) after COVID-19 with infections occurring in the first year of the coronavirus pandemic prior to introduction of the vaccines. Methods: This was a retrospective study of 18 LTRs who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. The mean age was 49.9 (22–68) years; 12 patients (67%) were male. Two patients died due to severe COVID-19. Results: During the study period, there were 18 lung transplant recipients with a community-acquired SARS-CoV-2 infection. In this cohort, seven had mild, nine had moderate, and two had severe COVID-19. All patients with mild and moderate COVID-19 survived, but the two patients with severe COVID-19 died in the intensive care unit while intubated and on mechanical ventilation. Most patients with moderate COVID-19 showed a permanent lung function decrease that did not improve after 12 months. Conclusion: A majority of LTRs in the current cohort did not experience an alteration in the trajectory of FEV1 evolution after developing SARS-CoV-2 infection. However, in the patients with moderate COVID-19, most patients had a decline in the FEV1 that was present after 1 month after recovery and did not improve or even deteriorated further after 12 months. In LTRs, COVID-19 can have long-lasting effects on pulmonary function. Treatment strategies that influence this trajectory are needed

COVID-19-Associated Lung Fibrosis: Two Pathways and Two Phenotypes, Lung Transplantation, and Antifibrotics

COVID-19 can be associated with lung fibrosis. Although lung fibrosis after COVID-19 is a relatively rare finding, the mere fact that globally a very large number of patients have had COVID-19 leads to a significant burden of disease. However, patients with COVID-19-associated lung fibrosis have different clinical and radiological features. The aim of this review is to define the different phenotypes of COVID-19-associated lung fibrosis, based on the medical literature. We found that two phenotypes have emerged. One phenotype is COVID-19-related acute respiratory distress syndrome (CARDS); the other phenotype is post-COVID-19 pulmonary fibrosis (PCPF). Both phenotypes have different risk factors, clinical, and radiological features, and differ in their pathophysiological mechanisms and prognoses. A long-term follow-up of patients with pulmonary complications after COVID-19 is warranted, even in patients with only discrete fibrosis. Further studies are needed to determine the optimal treatment because currently the literature is scarce, and evidence is only based on small case series or case reports

Effect of spatial distribution of daily rainfall on interior catchment response of a distributed hydrological model

International audienceWe investigate the effect of spatial variability of daily rainfall on soil moisture, groundwater level and discharge using a physically-based, fully-distributed hydrological model. This model is currently in use with the district water board and is considered to represent reality. We focus on the effect of rainfall spatial variability on day-to-day variability of the interior catchment response, as well as on its effect on the general hydrological behaviour of the catchment. The study is performed in a flat rural catchment (135 km2) in the Netherlands, where the climate is semi-humid (average precipitation 800 mm/year, evapotranspiration 550 mm/year) and rainfall is predominantly stratiform (i.e. large scale). Both range-corrected radar data (resolution 2.5×2.5 km2) as well as data from a dense network of 30 raingauges are used, observed for the period March?October 2004. Eight different rainfall scenarios, either spatially distributed or spatially uniform, are used as input for the hydrological model. The main conclusions from this study are: (i) using a single raingauge as rainfall input carries a great risk for the prediction of discharge, groundwater level and soil moisture, especially if the raingauge is situated outside the catchment; (ii) taking into account the spatial variability of rainfall instead of using areal average rainfall as input for the model is needed to get insight into the day-to-day spatial variability of discharge, groundwater level and soil moisture content; (iii) to get insight into the general behaviour of the hydrological system it is sufficient to use correct predictions of areal average rainfall over the catchment

Practical approach to early postoperative management of lung transplant recipients

Meticulous attention to detail during the early postoperative period after lung transplantation is crucial for the overall success of the procedure. It starts in the intensive care unit with the initiation of immunosuppression, implementation of anti-infective strategies and stabilisation of respiratory function. The subsequent days and weeks on the regular ward focus on titration of immunosuppressive drugs, vigilant fluid management, early mobilisation and initiation of physiotherapy. In parallel, the lung transplant recipients are actively taught about self-monitoring and self-management strategies to allow for a smooth transition to outpatient follow-up care. This article intends to communicate the practical aspects and principles of the patient management used at the authors' centre on a daily basis by a multi-disciplinary transplant team, having at its core both a transplant pulmonologist and a thoracic surgeon. It focuses on the first month after lung transplantation, but does not cover surgical techniques, rare complications or long-term management issues of lung transplant recipients. The target audience of this practical guide are advanced trainees of pulmonology, thoracic surgery, intensive care, anaesthesiology and other clinicians involved in the early postoperative care of lung transplant recipients either in the intensive care unit or on the peripheral ward

The BeppoSAX WFC X-ray source catalogue

We present the catalogue of X-ray sources detected by the two Wide Field Cameras (WFCs) in complete observations on board BeppoSAX during its 6 years of operational lifetime, between April 1996 and April 2002. The BeppoSAX WFCs were coded mask instruments sensitive in the 2-28 keV energy band with a 40x40 square degree fields of view, pointing in opposite directions and perpendicularly to the BeppoSAX Narrow Field Instruments (NFI). The WFCs were usually operated simultaneously to NFI observations, each lasting up to several days. WFCs observed thus the entire sky several times with a typical sensitivity of 2 to 10 mCrab. A systematic analysis of all WFC observations in the BeppoSAX archive has been carried out using the latest post-mission release of the WFC analysis software and calibrations. The catalogue includes 253 distinct sources, obtained from a total sample of 8253 WFC detections. We describe the basic statistical properties of the sample and present a six-year history of two celestial calibration X-ray sources.Comment: 15 pages, 11 figures, Catalogue, Accepted for publication on A&

COVID-19-related end stage lung disease: two distinct phenotypes

In COVID-19 related end stage lung disease, there are two distinct phenotypes. The first phenotype is the COVID-19 related acute respiratory distress syndrome (CARDS) showing a classical histopathological pattern of fibrotic diffuse alveolar damage (DAD). The second phenotype is the post-COVID pulmonary fibrosis (PCPF), in which the diagnosis is based on the combined clinical, radiological and (if available) pathological information. Both phenotypes have different clinical features, risk factors, biomarkers and pathophysiology. The exact prognosis in these two phenotypes as well as optimal treatment needs further studies. Key messages Two different phenotypes exist for COVID-19 related pulmonary fibrosis. The CARDS phenotype has a worse prognosis compared to the PCPF phenotype, which requires longer-term follow-up and evolves without ARDS picture. The best treatment options for the two different phenotypes, such as anti-fibrotic drugs or lung transplantation, still needs to be defined in future studies

On the absence of appreciable half-life changes in alpha emitters cooled in metals to 1 Kelvin and below

The recent suggestion that dramatic changes may occur in the lifetime of alpha and beta decay when the activity, in a pure metal host, is cooled to a few Kelvin, is examined in the light of published low temperature nuclear orientation (LTNO) experiments, with emphasis here on alpha decay. In LTNO observations are made of the anisotropy of radioactive emissions with respect to an axis of orientation. Correction of data for decay of metallic samples held at temperatures at and below 1 Kelvin for periods of days and longer has been a routine element of LTNO experiments for many years. No evidence for any change of half life on cooling, with an upper level of less than 1%, has been found, in striking contrast to the predicted changes, for alpha decay, of several orders of magnitude. The proposal that such dramatic changes might alleviate problems of disposal of long-lived radioactive waste is shown to be unrealistic.Comment: 27 pages, 12 figures, accepted for publication in Nucl.Phys.A. Revised version, including quantitative analysis of the sensitivity of nuclear orientation experiments, discussed in this work, to changes of alpha-decay lifetimes in metals at low temperatures. Conclusions remain unchange

Diagnostic value of post-bronchodilator pulmonary function testing to distinguish between stable, moderate to severe COPD and asthma

Daphne C Richter1, James R Joubert1, Haylene Nell1, Mace M Schuurmans2, Elvis M Irusen21Tiervlei Trial Centre, Karl Bremer Hospital, Bellville, RSA; 2Respiratory Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of Stellenbosch, RSAObjective: The GOLD guidelines suggest that the presence of a post-bronchodilator forced expiratory volume in one second (FEV1) 80% of the predicted value in combination with a FEV1/forced vital capacity (FVC) < 70% confirms the diagnosis of COPD. Limited data exist regarding the accuracy of these criteria to distinguish between COPD and asthma. The aim of this study therefore was to investigate the diagnostic value of post-bronchodilator lung function parameters in obstructive lung disease.Methods: The pulmonary function tests of 43 (22 = COPD, 21 = asthma) patients with similar baseline characteristics were evaluated (baseline FEV1 were 55.7% + 7.6%, and 59.3% + 8.4% predicted for COPD and asthma, respectively). Bronchodilator responsiveness (BDR) was calculated according to three recognized pulmonary function test criteria.Results: The first criteria, post-bronchodilator FEV1 < 80% of the predicted value in combination with a post-bronchodilator FEV1/FVC ratio of <70%, had an accuracy of 70% to diagnose COPD. This combination was very sensitive (100%) in diagnosing COPD, but it was not specific (38%). The second BDR criteria, defined as an increase of <12% and 200 mL of initial FEV1 and criterion number 3, an increase of <9% of predicted FEV1, were less sensitive (55% and 59%, respectively), but more specific (81% and 76% respectively) to diagnose COPD. Our findings suggest that the current recommended spirometric indices are not optimal in differentiating between COPD and asthma.Keywords: obstructive lung disease, diagnosis, post-bronchodilator pulmonary function tes