Prevalence of comorbidity in patients with chronic obstructive pulmonary disease

Comorbidity is common in patients with chronic obstructive pulmonary disease (COPD); however, the relationship between comorbidity and quality of life is inconsistent. The objective was to establish the prevalence of comorbidity and the relationship with the quality of life of patients with COPD in Santa Marta, Colombia. A cross-sectional study was designed in which in which participated outpatients diagnosed with COPD. Quality of life was evaluated with the CAT (COPD Assessment Test) instrument; scores higher than ten were considered poor quality of life. The sample was of 292 patients, in ages between 49 and 95 years; 61.6% male. A group of 232 participants (79.5%) presented some comorbidity associated with COPD. Quality of life was reduced in 192 patients (65.8%). Comorbidity did not significantly add to the quality of life (OR = 1.33, 95% CI 0.72-2.45), adjusted for age and sex. It is concluded that comorbidity is very frequent; however, it does not affect the quality of life in patients with COPD in Santa Marta. More research is needed with more participants.La comorbilidad es frecuente en pacientes con enfermedad pulmonar obstructiva crónica (EPOC); sin embargo, es inconsistente la relación entre la comorbilidad y la calidad de vida. El objetivo fue establecer la prevalencia de comorbilidad y la relación con la calidad de vida de los pacientes con EPOC en Santa Marta, Colombia. Se diseñó un estudio transversal en el que participaron pacientes ambulatorios con diagnóstico de EPOC. La calidad de vida se evaluó con el instrumento CAT (COPD Assessment Test), las puntuaciones mayores de diez se consideraron pobre calidad de vida. La muestra fue de 292 pacientes, en edades entre 49 y 95 años; 61,6% de sexo masculino. Un grupo de 232 participantes (79,5%) presentó alguna comorbilidad asociada a la EPOC. La calidad de vida fue pobre en 192 pacientes (65,8%). La comorbilidad no asoció significativamente a la calidad de vida (OR=1,33; IC95% 0,72-2,45), ajustado por edad y sexo. Se concluye que la comorbilidad es muy frecuente; no obstante, afecta poco la calidad de vida en pacientes con EPOC de Santa Marta. Se necesitan más investigaciones con mayor número de participantes

Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

BACKGROUND: The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. METHODS: A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002) were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. RESULTS: The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. CONCLUSION: Extrapolating the observed cost-savings of$59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to$3.7 million

Prevalence of comorbidity in patients with chronic obstructive pulmonary disease

La comorbilidad es frecuente en pacientes con enfermedad pulmonar obstructiva crónica (EPOC); sin embargo, es inconsistente la relación entre la comorbilidad y la calidad de vida. El objetivo fue establecer la prevalencia de comorbilidad y la relación con la calidad de vida de los pacientes con EPOC en Santa Marta, Colombia. Se diseñó un estudio transversal en el que participaron pacientes ambulatorios con diagnóstico de EPOC. La calidad de vida se evaluó con el instrumento CAT (COPD Assessment Test), las puntuaciones mayores de diez se consideraron pobre calidad de vida. La muestra fue de 292 pacientes, en edades entre 49 y 95 años; 61,6% de sexo masculino. Un grupo de 232 participantes (79,5%) presentó alguna comorbilidad asociada a la EPOC. La calidad de vida fue pobre en 192 pacientes (65,8%). La comorbilidad no asoció significativamente a la calidad de vida (OR=1,33; IC95% 0,72-2,45), ajustado por edad y sexo. Se concluye que la comorbilidad es muy frecuente; no obstante, afecta poco la calidad de vida en pacientes con EPOC de Santa Marta. Se necesitan más investigaciones con mayor número de participantes

Transcriptional profile of genes involved in the production of terpenes and glyceollins in response to biotic stresses in soybean

Terpenes produced by plants comprise a diverse range of secondary metabolites, including volatile organic compounds (VOCs). Terpene VOC production may be altered after damage or by biological stimuli such as bacterial, fungal and insects, and subsequent triggering of plant defense responses. These VOCs originate in plants from two independent pathways: the mevalonate and the methylerythritol phosphate pathways, which utilize dimethylallyl and isopentenyl diphosphates to form the terpenoidal precursors. Phakopsora pachyrhizi fungi causes Asian soybean rust, limiting soybean production and resulting in losses of up to 80% if no control strategies are applied. By using a transcriptome datasets, we investigated the regulation of genes of the mevalonate pathway under different biotic stresses. We studied the impact of P. pachyrhizi infection in vivo expression profile of genes involved in terpenoid and glyceollin biosynthesis in genotypes harboring different resistance genes (Rpp), and across the infection cycle. In addition, we used UPLC and UPGC analysis to evaluate glyceollin and VOC production, respectively, to identify metabolites associated with soybean responses to pathogen infection. The regulation of soybean genes involved in terpene production was influenced by genotypes, depending on the Rpp gene, while glyceollin was induced in all genotypes. Furthermore, a sesquiterpene was identified as a potential marker associated with rust symptoms on soybean

Trauma-Informed Pediatric Primary Care: Facilitators and Challenges to the Implementation Process

This article describes the process of integrating trauma-informed behavioral health practices into a pediatric primary care clinic serving low-income and minority families while facing barriers of financial, staffing, and time limitations common to many community healthcare clinics. By using an iterative approach to evaluate each step of the implementation process, the goal was to establish a feasible system in which primary care providers take the lead in addressing traumatic stress. This article describes (1) the process of implementing trauma-informed care into a pediatric primary care clinic, (2) the facilitators and challenges of implementation, and (3) the impact of this implementation process at patient, provider, and community levels. Given the importance of trauma-informed care, especially for families who lack access to quality care, the authors conceptualize this paper as a guide for others attempting to integrate best behavioral health practices into pediatric clinics while working with limited resources

Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project.

Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs

Epidemiology of pneumonia in the pre-pneumococcal conjugate vaccine era in children 2-59 months of age, in Ulaanbaatar, Mongolia, 2015-2016.

BACKGROUND: Respiratory diseases, including pneumonia, are the second largest cause of under-five mortality in Mongolia and the most common cause of childhood hospitalization. However information regarding the contribution of Streptococcus pneumoniae to pneumonia causation in Mongolia is limited. We aimed to describe the epidemiology of hospitalized children aged 2-59 months with pneumonia, enrolled into a surveillance program in the period prior to pneumococcal conjugate vaccine (PCV) introduction, in Mongolia. METHODS: An expanded pneumonia surveillance program enrolled children, who met the surveillance case definition, at participating hospitals, between April 2015 and May 2016. Cumulative incidence rates were calculated by district for all pneumonia endpoints using district specific denominators from the Mongolian Health Department census for 2016. Socio-economic and disease-associated factors were compared between districts using chi-squared tests. RESULTS: A total of 4318 eligible children with pneumonia were enrolled over the 14 month period. Overall the incidence for all-cause pneumonia in children aged 12-59 months was 31.8 per 1000 population; children aged 2-11 months had an almost four-fold higher incidence than children aged 12-59 months. Differences were found between districts with regards to housing type, fuel used for cooking, hospital admission practices and the proportions of severe and primary endpoint pneumonia. DISCUSSION: This study shows a high burden of pneumonia in children aged 2-59 months in Mongolia prior to PCV introduction. Rates differed somewhat by district and age group and were influenced by a number of socio-economic factors. It will be important to consider these differences and risk factors when assessing the impact of PCV introduction

Unveiling the polyphasic evolution of the Neoarchean IOCG Salobo deposit, Carajás Mineral Province, Brazil : Insights from magnetite trace elements and sulfur isotopes

The Salobo iron oxide copper-gold (IOCG) deposit host an important Cu-mineralization of the Carajás Mineral Province. The ore is characterized by an association of (bornite-chalcocite-digenite) hosted by magnetite and biotite-garnet schists. These rocks record distinct stages of superimposed hydrothermal alteration and dynamic metamorphism. Three different occurrences of magnetite constitute the magnetite bodies: a pristine to inclusionpoor Mgt I; inclusion-rich magnetite-bearing breccia Mgt II, and the granoblastic-foliated Mgt III. In general, the magnetite types present a similar trace element composition with some variations in Si, Al, Mg and K indicating that the magnetite types share the same magmatic-hydrothermal origin with post-formation processes (dissolution/reprecipitation) recorded in Mgt III. In addition, sulfur isotope signatures for chalcopyrite (1.3–3.35‰), pyrrhotite (0.88–1.98‰), and pyrite (1.7–5.04‰) associated with magnetite I and II, are consistent with a magmatic-hydrothermal sulfur source at Salobo without/or minimal external sulfur contributions. Our data indicate that ore-forming Auids for Salobo ore could have undergone sulfur disproportionation processes during sulBde formation due to magnetite precipitation, which results in the classic IOCG mineral association of chalcopyrite + magnetite described for the Brst time in this contribution. Therefore, the main mineralization event in the Salobo deposit could be coeval with similar IOCG deposits in the Carajás Mineral Province related to the Neoarchean magmatism at ca. C.7 Ga. SubseDuent deformation and low-grade dynamic metamorphism related to reactivation of the Cinzento Shear Eone (ca. C.5 Ga) and A-type granite emplacement probably Paleoproterozoic in age resulted in remobilization-recrystallization of magnetite and Cu-sulBdes

Unravelling the immune signature of Plasmodium falciparum transmission-reducing immunity

Infection with Plasmodium can elicit antibodies that inhibit parasite survival in the mosquito, when they are ingested in an infectious blood meal. Here, we determine the transmission-reducing activity (TRA) of naturally acquired antibodies from 648 malaria-exposed individuals using lab-based mosquito-feeding assays. Transmission inhibition is significantly associated with antibody responses to Pfs48/45, Pfs230, and to 43 novel gametocyte proteins assessed by protein microarray. In field-based mosquito-feeding assays the likelihood and rate of mosquito infection are significantly lower for individuals reactive to Pfs48/45, Pfs230 or to combinations of the novel TRA-associated proteins. We also show that naturally acquired purified antibodies against key transmission-blocking epitopes of Pfs48/45 and Pfs230 are mechanistically involved in TRA, whereas sera depleted of these antibodies retain high-level, complement-independent TRA. Our analysis demonstrates that host antibody responses to gametocyte proteins are associated with reduced malaria transmission efficiency from humans to mosquitoes

Kinetic k-essence ghost dark energy model

A ghost dark energy model has been recently put forward to explain the current accelerated expansion of the Universe. In this model, the energy density of ghost dark energy, which comes from the Veneziano ghost of QCD, is proportional to the Hubble parameter, $\rho_D=\alpha H$. Here $\alpha$ is a constant of order $\Lambda^3_{QCD}$ where $\Lambda_{QCD}\sim 100 MeV$ is the QCD mass scale. We consider a connection between ghost dark energy with/without interaction between the components of the dark sector and the kinetic k-essence field. It is shown that the cosmological evolution of the ghost dark energy dominated Universe can be completely described a kinetic k-essence scalar field. We reconstruct the kinetic k-essence function $F(X)$ in a flat Friedmann-Robertson-Walker Universe according to the evolution of ghost dark energy density.Comment: 11 pages, 15 figures, some clarifications added in the introduction, added references. Accepted for publication in Phys. Lett.