Pleuropulmonary manifestations in juvenile onset systemic lupus erythematosus: Assessment by pulmonary function tests and multidetector computed tomography

AbstractIntroductionPulmonary involvement is a common finding in adults with systemic lupus erythematosus (SLE) also it is one of the most important systems that can be affected in Juvenile onset SLE (JOSLE). Early detection and evaluation of the extent and severity of pulmonary involvement are quite critical for disease prognosis and patients management.Aim of the workTo determine the frequency and type of pleuropulmonary involvement in JOSLE using pulmonary function tests (PFTs) and multidetector CT (MDCT).Patients and methodsTwenty five patients with JOSLE were evaluated for the detection of pleuropulmonary affection in them. The evaluation included clinical, functional & radiological examination using MDCT as a recent & accurate modality for chest imaging. Based on clinical evaluation, patients were divided into two groups; group A (No=16) and group B (No=9), consisting of those asymptomatic and symptomatic as regard pleuropulmonary symptoms, respectively.ResultsThis study revealed that PFT abnormalities were detected in 60% of all studied JOSLE patients while MDCT abnormalities were detected in 52% of them. 37.5% of the asymptomatic patients had abnormal PFTs & 31.25% of them had abnormal findings on MDCT. There was statistically significant difference between patients groups regarding SLEDAI, percentages of abnormal PFTs, abnormalities in plain X-ray and MDCT. With the exception of forced expiratory flow at 25–75% of forced vital capacity (FEF25–75%), the study revealed statistically significant lower values of mean±SD of all measured PFTs in group B compared to group A. The most frequent MDCT findings in all studied patients were pleural effusion and pleural thickening in 16% of all findings, also ground glass opacities found in 16% of all abnormalities suggesting early interstitial lung disease.ConclusionClinical assessment and PFTs revealed a significant percentage of pleuropulmonary involvement in JOSLE patients. MDCT can be helpful in diagnosing the pulmonary involvement in asymptomatic JOSLE patients with normal chest X-ray and uncertain PFT

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially