Predicting cognitive decline in patients with hypoxaemic COPD

AbstractThe objective was to identify predictors of cognitive decline in patients with hypoxaemic COPD on continuous oxygen therapy.Eighty-four consecutive ambulatory hypoxaemic COPD patients in stable clinical conditions were prospectively studied over the course of 2 yr. Baseline multidimensional assessment included respiratory function tests, blood gas analysis, Mini Mental Status (MMS) test, Geriatric Depression Scale (GDS), Activities of Daily Living (ADLs) and Charlson's index of comorbidity. Reassessments were made 1 yr and 2 yr thereafter. Sequential changes in MMS, GDS and ADLs were assessed by Friedman's ANOVA by rank test.Forty patients completed the study (group A), while 44 died or were lost to follow-up (group B). Group B was characterized by more severe respiratory function impairment and worse performances on ADLs and GDS. In group A, MMS deteriorated from baseline to the 1 yr and 2 yr reassessments (27 ± 2·9 vs. 25·8 ± 4·1 and 25·4 ± 4, P<0·005), whereas GDS and ADLs did not change significantly; the 23 patients experiencing a decline of MMS had baseline lower percentage predicted FVC (52·3 ± 17·1 vs. 66·9 ± 13·4, P<0·03) and FEV1 (27·2 ± 8·6 vs. 44 ± 26·8, P<0·02) values and better affective status (GDS score: 11·9 ± 7·7 vs. 16·5 ± 5·6, P<0·04). Two-year changes in MMS and in GDS scores were inversely correlated (Spearman's ρ = −0·32, P = 0·04).Cognitive decline is faster in the presence of severe bronchial obstruction and parallels the worsening of the affective status in COPD patients on oxygen therapy. The onset of depression rather than baseline depressive symptoms seems to be a risk factor for cognitive decline

Do GOLD stages of COPD severity really correspond to differences in health status?

The purpose of this study was to assess whether different stages of chronic obstructive pulmonary disease (COPD) severity defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria correlate with meaningful differences in health status. A total of 381 COPD patients, aged 73+/-6 yrs, were classified in the five GOLD stages. Disease-specific (St George Respiratory Questionnaire (SGRQ)) and generic indexes of health status were measured in all patients. Multivariate analysis of covariance or Kruskal Wallis tests were used to compare health status indexes across the spectrum of GOLD stages of COPD severity. GOLD stages of COPD severity significantly differed in SGRQ components and Barthel's index, but not in the indexes assessing cognitive and affective status and quality of sleep. The largest variation in health status was observed at the transition from stage IIa to stage IIb, while there were no other significant differences between consecutive stages. Both female sex and comorbidity were associated with a greater impact of COPD on the health status. In conclusion, the upper limit of stage IIb (forced expiratory volume in one second of 49%) marks a threshold for dramatic worsening of health status. Progression of chronic obstructive pulmonary disease severity from stage 0 to stage IIa does not correspond to any meaningful difference in health status

Repeatability of the ISAAC video questionnaire and its accuracy against a clinical diagnosis of asthma

AbstractThe objective of the study was to evaluate the performance of the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire in terms of repeatability and accuracy against a clinical diagnosis of asthma achieved according to the National Heart, Lung and Blood Institute (NHLBI) algorithm.Two hundred and forty-one subjects, aged 13–14 years from two secondary schools in Rome, Italy, were enrolled. Video and written ISAAC questionnaires were completed twice, 3 months apart, by 194 and 190 adolescents, respectively. Two months later, 106 subjects were visited by two physicians blinded to the results of questionnaires.Sixteen subjects were classified as having clinical asthma (CA) at the clinical visit, and eight of them as having clinical active asthma (CAA) on the basis of at least one positive outcome of the NHLBI algorithm. The repeatability of video questionnaire was similar to that of the written questionnaire for items on exercise wheeze and nocturnal cough and, to a lesser degree, for items concerning any wheeze in the past. The video questionnaire showed a worse performance than the written questionnaire for items on asthma attack: K-value (95% CL)=0·59 (0·37–0·80) for video scene no. 5 and K-value (95% CL)=0·86 (0·74–0·98) for written question no. 6. The overall accuracy of the video questionnaire, estimated as a positive answer to any video scene, was lower in terms of sensitivity than that of any written question when CA was used as a gold standard (0·50 vs. 0·81, P=0·025) and increased with respect to CAA (0·75vs. 0·87, P=0·317). The specificity of any video scene was better than that of any written question, independently from the gold standard used.In conclusion, the video questionnaire showed a fairly good accuracy, although slightly lower than that of the written questionnaire and provided sufficiently reliable results. However, samples of subjects from different geographic areas and cultures should be studied in order to conclusively define the performance of the ISAAC video questionnaire

Indoor exposure to environmental tobacco smoke and dampness: respiratory symptoms in Sardinian children- DRIAS study

Indoorexposuresathome,environmentaltobaccosmoke(ETS)andmould/dampnessadverselyaffect respiratoryhealthofchildren.DisturbiRespiratorinell’InfanziaeAmbienteinSardegna(DRIAS) (RespiratorySymptomsinchildrenandtheEnvironmentinSardegna,Italy)aimsatrelatingthe prevalenceofrespiratoryandallergicsymptomstoindoorexposuresinSardinianchildren. DRIAS,across-sectionalinvestigationofrespiratorysymptoms/diseases,usedamodifiedversionof ISAACquestionnaire,included4122childrenattending29primaryschoolsintheschoolyear 2004–2005. If bothparentssmoketheprevalenceforcurrentwheezeandcurrentasthmaisalmostdoubledin comparisonwithneversmokers,forpersistentcoughandphlegmaroleissuggestedwhenonlymother smokes.Amongmotherssmokinginpregnancy,theprevalenceofcurrentwheezeandcurrentasthmais increased. ExposuretoETSandfamilyatopyhaveajointeffectresultinginanalmosttriplingof prevalenceforcurrentwheezeandmorethanfourtimesforcurrentasthma.Exposureto‘‘dampness’’ (mouldordampness)bothduringthefirstyearoflifeandcurrentlyisassociatedwithincreased prevalenceofcurrentwheeze,persistentcoughorphlegmandcurrentrhino-conjunctivitis;ifexposure is onlyduringthefirstyearoflifeadoublingormoreofprevalenceisobservedforcurrentwheeze, current asthma,andpersistentcoughorphlegm. DRIASresultsaddevidencetothecausalroleofchildhoodexposuretoETSinthedevelopmentof respiratorysymptoms(cough,phlegm,andwheezing)andasthma.ThejointeffectofETSandfamily atopyiscorroborated.Theresultsstrengthentheevidenceforacausalassociationbetween‘‘dampness’’ and respiratoryhealth,pointingtoitspossibleindependentroleincausingasthma,along-lasting exposureentailsadoubledprevalenceforbothasthmaticandbronchitissymptoms

Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER Registry.

Background: Clinical characteristics and management of acute deep vein thrombosis and pulmonary embolism (PE) have been reported to be different in patients with and without cancer. The aim of this paper was to provide information on clinical characteristics and management of acute venous thromboembolism in patients with cancer by means of a large prospective registry. Design and Methods: MASTER is a multicenter registry of consecutively recruited patients with symptomatic, objectively confirmed, acute venous thromboembolism. Information about clinical characteristics and management was collected by an electronic data network at the time of the index event. Results: A total of 2119 patients were enrolled, of whom 424 (20%) had cancer. The incidence of bilateral lower limb deep vein thrombosis was significantly higher in patients with cancer than in patients without cancer (8.5% versus 4.6%; p&lt;0.01), as were the rates of iliocaval thombosis (22.6% versus 14%; p&lt;0.001), and upper limb deep vein thrombosis (9.9% versus 4.8%; p&lt;0.001). Major bleeding (3.3% versus 1.1%; p=0.001), in-hospital treatment (73.3% versus 66.6%; p=0.02) and inferior vena cava filter implantation (7.3% versus 4.1%; p=0.005) were significantly more frequent in patients with cancer, in whom oral anticoagulants were less often used (64.2% versus 82%; p&lt;0.0001). Conclusions: The clinical presentation of acute venous thromboembolism is different and often more extensive in cancer patients than in patients free from malignancy. Moreover, the management of the acute phase of venous thromboembolism is more problematic in cancer patients, especially because of a higher rate of major bleeding and the need for implantation of inferior vena cava filters

Antimicrobial activity of Inga fendleriana extracts and isolated flavonoids.

The EtOAc and n-BuOH extracts of Inga fendleriana inhibited Gram-positive, but not Gram-negative bacteria; a narrow spectrum of activity against Staphylococcus epidermidis was detected. The MIC values of the extracts ranged from 125 to 850 μg/mL. Quercetin 3-methylether, myricetin 3-O-rhamnoside and tricetin showed antibacterial activity against the same bacterial strains with MICs in the range from 31 to 250 μg/mL. In time-kill kinetic studies, the flavonoids showed bactericidal effects at the concentrations corresponding to four times the MICs

Antioxidant and antimicrobial phenolic compounds from extracts of cultivated and wild-grown Tunisian Ruta chalepensis

The antioxidant and antibacterial activities of phenolic compounds from cultivated and wild Tunisian Ruta chalepensis L. leaves, stems, and flowers were assessed. The leaves and the flowers exhibited high but similar total polyphenol, flavonoid, and tannin content. Moreover, two organs showed strong, although not significantly different, total antioxidant activity, 2,2-diphenyl-1-picrylhydrazyl scavenging ability, and reducing power. Investigation of the phenolic composition showed that vanillic acid and coumarin were the major compounds in the two organs, with higher percentages in the cultivated organs than in the spontaneous organs. Furthermore, R. chalepensis extracts showed marked antibacterial properties against human pathogen strains, and the activity was organ- and origin-dependent. Spontaneous stems had the strongest activity against Pseudomonas aeruginosa. From these results, it was concluded that domestication of Ruta did not significantly affect its chemical composition and consequently the possibility of using R. chalpensis organs as a potential source of natural antioxidants and as an antimicrobial agent in the food industry