PULMONARY REHABILITATION RESPONSE IN ELDERLY AND YOUNGER PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

WOS: 000328934700012Introduction: Pulmonary rehabilitation has been shown to improve exercise capacity, health status, anxiety and depression in patients with chronic obstructive pulmonary disease (COPD), but the response in younger and elderly patients has not been fully established. The aim of this study was to investigate the effectiveness of pulmonary rehabilitation in elderly people. Materials and Method: Younger (>= 65 years) and older (>65 years) patients with stable COPD underwent an 8 week outpatient pulmonary rehabilitation procedure twice weekly, along with home exercise training. Dyspnea, incremental shuttle walk distance, health status with St. George's Respiratory Questionnaire, anxiety and depression score were assessed before and after pulmonary rehabilitation. A comparison was made between younger and elderly patients. Results: The study group included 109 patients with COPD. There were 52 patients (mean age 58.96+/-4.63 yrs) in the younger group and 57 patients (mean age 73.58+/-5.75 yrs) in the elderly one. The increase in walking distance in younger patients was 76.86+/-93.18m (p<0.0001) and 34.64+/-60.35m (p<0.0001) in the elderly group after the data was compared to the baseline. In the younger group, the decrease in BORG score was -0.46+/-1.50 (p=0.04) whereas it was -0.12+/-0.96 (p=0.35) among the elderly patients. Although St. George's Respiratory Questionnaire and hospital anxiety-depression score improved significantly after pulmonary rehabilitation in younger patients, the improvement was only on the 'total' score in the elderly. Comparing the mean changes after pulmonary rehabilitation, both age groups showed similar improvements in dyspnea, St. George's Respiratory Questionnaire and hospital anxiety-depression score (p=NS). Only walking distance increased more in the younger ages after pulmonary rehabilitation (p=0.006). Conclusion: Elderly patients with COPD can benefit from pulmonary rehabilitation just as younger patients can and need not be excluded because of age

Pulmonary Rehabilitation Response in Elderly and Younger Patients With COPD

CHEST Annual Meeting -- OCT 22-26, 2016 -- Los Angeles, CAWOS: 000400118602240CHES

Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study

Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56-3.14); prior exposure to N-acetylcysteine, 0.11 (0.03-0.34) and prior surgical intervention, 1.26 (0.76-2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution

Anti-stress and anti-anxiety effects of centrally acting angiotensin II AT\u3csub\u3e1\u3c/sub\u3e receptor antagonists

The brain and the peripheral (hormonal) angiotensin II systems are stimulated during stress. Activation of brain angiotensin II AT1 receptors is required for the stress-induced hormone secretion, including CRH, ACTH, corticoids and vasopressin, and for stimulation of the central sympathetic activity. Long-term peripheral administration of the angiotensin II AT 1 antagonist candesartan blocks not only peripheral but also brain AT1 receptors, prevents the hormonal and sympathoadrenal response to isolation stress and prevents the formation of stress-induced gastric ulcers. The mechanisms responsible for the prevention of stress-induced ulcers by the AT1 receptor antagonist include protection from the stress-induced ischemia and inflammation (neutrophil infiltration and increase in ICAM-1 and TNF-α) in the gastric mucosa and a partial blockade of the stress-induced sympathoadrenal stimulation, while the protective effect of the glucocorticoid release during stress is maintained. AT1 receptor antagonism prevents the stress-induced decrease in cortical CRH1 and benzodiazepine binding and is anxiolytic. Blockade of brain angiotensin II AT1 receptors offers a novel therapeutic opportunity for the treatment of anxiety and other stress-related disorders. © 2005 Elsevier B.V. All rights reserved