Special Issue:
Challenges and Opportunities in Respiratory Medicine
Zijing Zhang, PhD
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Taeyoung Park, BS
Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Jamuna K. Krishnan, MD
Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Kapil Gangwar, MS
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Jianlin Zhou, PhD
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Thomas B. Conroy, MS
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Edwin C. Kan, PhD
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Veerawat Phongtaknuel, MD, MS
Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Abstract
Background: The symptom of dyspnea is commonly encountered in patients with underlying serious illness and can lead to distress and poor quality of life. In patients with chronic obstructive lung disease (COPD), the prevalence is reported in up to 95% of patients. With the growth in sensor technologies, continuous monitoring of respiratory metrics provides an opportunity to better understand the relationship between patient-reported dyspnea and objective respiratory measures.
Aims: To assess the feasibility of implementing a radio-frequency (RF) sensor in patients with COPD and describe the relationship between dyspnea and respiratory metrics in patients with COPD when compared to healthy controls.
Methods: A prospective cohort study was conducted to collect data on dyspnea scores and respiratory metrics in patients with COPD and healthy controls while conducting a walking test using a wearable RF sensor.
Results: Of the 12 COPD patients and 15 healthy controls recruited, all participants completed the modified incremental shuttle walking test while wearing the RF sensor; there was no attrition. For every one-point increase in the dyspnea score, there was a mean 1.94 increase in the respiratory rate per minute in the COPD group as compared to a 1.09 increase in respiratory rate in the healthy control group.
Conclusion: Preliminary data demonstrate the potential of using the RF sensors to track respiratory metrics in COPD patients and healthy adults. As this technology develops, it shows considerable promise and could provide significant implications regarding the use of non-invasive continuous monitoring for patients with lung disease.
Richard Thorley
Department of Respiratory Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Joshua Graeme-Wilson
Department of Respiratory Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Katrina Curtis
Department of Respiratory Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Abstract
Prone positioning has been demonstrated to significantly reduce mortality in invasively ventilated patients with moderate to severe acute respiratory distress syndrome through several physiological mechanisms, including optimization of ventilation and perfusion and a reduction in ventilator-associated lung injury. The marked increase of hospitalisation rates of patients with acute hypoxaemic respiratory failure during the COVID-19 pandemic, and associated strain on healthcare resources, led to interest in the use of prone positioning in conscious self-ventilating, or “awake”, patients, as an adjunct to the provision of oxygen therapy and respiratory support. The adoption of this technique was with the intent of reducing the likelihood of progressive respiratory failure and thus the need for invasive mechanical ventilation. In this review we summarize the background, physiological mechanisms and current evidence for the use of awake prone positioning in both COVID-19 related hypoxaemic respiratory failure and that attributed to other aetiologies. Whilst several studies note an improvement in respiratory parameters including oxygenation, the effect on clinically important outcomes such as rates of intubation and mortality remain unclear. The evidence base beyond COVID-19 related respiratory failure remains constrained and there is a paucity of evidence to help identify those most likely to benefit from this therapy. There remains no agreed consensus on how to implement awake prone positioning and significant variation exists in practice. Several clinical questions should be the focus for future research studies of this treatment modality including how to identify early responders and non-responders to therapy.
Zirhirhi Kaoutar
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2, University, Casablanca, Morocco.
Tougar Sanaa
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2. University, Casablanca, Morocco
Afif Amine
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2, University, Casablanca, Morocco.
Elkhaouri Imane
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2, University, Casablanca, Morocco.
Charra Boubaker
Head of Department of Medical Intensive Care, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco.
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 virus has a strong tropism for the cardiovascular system, with direct or indirect interactions mediated by inflammation. The virus can cause cardiovascular lesions that can compromise the prognosis. We report the case of a 43-year-old patient with no particular medical history, admitted with acute respiratory distress syndrome due to coronavirus disease 2019 pneumonia complicated by myocardial injury, whose condition gradually improved with apyrexia, normalization of troponins, inflammatory markers, and restoration of left ventricular function. This case report demonstrates the need to identify cardiac involvement through widespread use of echocardiography and close monitoring of cardiac and inflammatory biomarkers during coronavirus disease 2019 infection, given the prognostic implications of such involvement.
Panagiota Xaplanteri
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Vasileios Zoitopoulos
Department of Microbiology, General Hospital of Eastern Achaia, Aigio, Greece
Vasiliki Diamanti
Department of Microbiology, General Hospital of Eastern Achaia, Aigio, Greece
Athanasia Moutafidi
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Panagiota Masoura
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Charalampos Potsios
Department of Internal Medicine, University General Hospital of Patras, Greece
Konstantina Filioti
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Angeliki Rapanou
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Christina-Panagiota Koutsouri
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Zoi Grammenidou
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Aimilios Tzoudas
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Chara Sakarelou
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Tatiana Beqo Rokaj
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Katerina Ntzinia
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Elsa Kampos Martinez
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Georgios Papachristopoulos
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Constantinos A Letsas
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Abstract
Background: Since December 2019 mankind is agonized over the deadly coronavirus disease 2019 (COVID-19) which is due to the novel coronavirus (2019-nCoV) or Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-cov-2).
Methods: In this retrospective study, laboratory findings and demographic features from all confirmed COVID-19 patients who attended the Emergency Department of both branches of our hospital during the first semester of 2021 were collected and analyzed. The working hypothesis was that initial laboratory data at the time the patients sought medical assistant for the first time, regardless of comorbidities and day of onset of symptoms, can help predict patients’ outcomes. Demographic data and laboratory tests were compared between hospitalized and non-hospitalized patients.
Results: Data from 270 patients were collected and analyzed retrospectively. 31 blood measurement parameters performed in both hospital branches were compared between hospitalized and non-hospitalized patients. Of those, WBC count (p=0.016), neutrophil percentage (p<0.001), lymphocyte percentage (p<0.001), platelet count (p=0.041), glucose (p<0.001), urea (p<0.001), creatinine (p<0.001), SGOT (p=0.024), CK (p<0.053), LDH (p<0.001), GGT (p<0.001), sodium (p<0.001), calcium (p<0.001), high sensitivity Troponin I (p<0.001), and ferritin levels (p<0.001), proved statistically significant. Regarding demographic data, age was significantly linked to patients’ survival.
Conclusion: Our data suggest that common initial laboratory findings of COVID-19 patients who seek first-time medical assistance regardless of comorbidities and time from onset of symptoms can give clues to the patient outcome. Age is also important for patients’ survival. Especially in a Primary Health Care Setting, common blood parameters like WBC count, neutrophil and lymphocyte percentage, platelet count, glucose, urea, creatinine, SGOT, CK, LDH, GGT, sodium, calcium, high sensitivity Troponin I, and ferritin levels, could be really helpful to predict disease severity.
Rahul G. Sangani, MD
Division of Pulmonary, Critical Care and Sleep Medicine, Dept. of Medicine, West Virginia University, Morgantown, WV
Vishal Deepak
Division of Pulmonary, Critical Care and Sleep Medicine, Dept. of Medicine, West Virginia University, Morgantown, WV
Bhanusowmya Buragamadagu
Division of Pulmonary, Critical Care and Sleep Medicine, Dept. of Medicine, West Virginia University, Morgantown, WV
Andrew J. Ghio
US EPA, Chapel Hill, NC
Abstract
Exposure to cigarette smoking is extensive in rural Appalachia where one in four adults’ smokes. The clinical implications of this habit are evident among patients with some of the highest national rates for chronic obstructive pulmonary disease (COPD), lung cancer, and pulmonary fibrosis. Individuals undergoing surgical lung resection for suspicious lung nodules or masses at a major rural academic center in the area demonstrated an excessive burden of histologic emphysema (73.5%). This destructive process of the alveoli was linked to a significant burden of comorbid conditions, various radiologic patterns of interstitial lung diseases and interstitial lung abnormalities, histologic fibrosis, inflammatory processes (respiratory bronchitis, desquamative interstitial pneumonia, peribronchiolar metaplasia), anthracosis, and lung cancer. Physiologically, this combination of injuries imposed substantial limitations. Findings presented may enhance the understanding of concurrent changes occurring in the smoker. The complex inter-relationships and disparities between clinical COPD, radiologic and histologic emphysema are defined. While emphysema remains an irreversible pathology, associated inflammatory and fibrotic conditions are possibly amenable to earlier smoking cessation strategies and available disease-modifying therapies.
Wendel Dierckx
Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium
Wilfried De Backer
Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium; Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; FLUIDDA NV, Kontich, Belgium
Yinka De Meyer
Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium; Clinical Operations, FLUIDDA NV, Kontich, Belgium
Eline Lauwers
Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Clinical Operations, FLUIDDA NV, Kontich, Belgium
Erik Franck
Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Kris Ides
Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium; Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; CoSys Research Lab, Faculty of Applied Engineering, University of Antwerp, Antwerp, Belgium and Flanders Make Strategic Research Center, Lommel, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
Abstract
Purpose: Respiratory pump failure in COPD patients can lead to CO2 retention during exercise, but little is known about the factors determining CO2-levels during exercise in COPD patients.
The aim of this study is to investigate the pattern of TcPCO2 in COPD patients during exercise and factors driving this CO2 response.
Patients and methods: 24 COPD patients (age 66(8) y, FEV1 43(18) %pred, TcPCO2 at rest 37(4) mmHg, oxygen users 6/24) performed lung function and cardiopulmonary exercise test (CPET). During CPET TcPCO2 was measured continuously and in O2 users the CPET was performed with supplemental oxygen.
Results: At baseline, 16 patients were normocapnic (TcPCO2 35-45 mmHg) and 8 hypocapnic (TcPCO2<35 mmHg). At the end of the CPET, 9 patients were normocapnic, 2 showed hypocapnia and 10 were hypercapnic. CO2-retention (∆TcPCO2 >4mmHg) was observed in 18 patients.
∆TcPCO2 correlated significantly with VeMax (r=-.64; p=.004), FEV1 %predicted (r = -.53; p = .008), RV %predicted (r = .54; p = .007), RV/TLC (r = .56; p = .005), sRAW (r =.61; p = .005), sGAW (r = -.60; p = .002), and maximal TcPCO2 (r=.63; p<.001), but did not correlate with baseline TcPCO2 (r = -.08; p = .728). Furthermore, baseline TcPCO2 correlated with the maximal TcPCO2 (r = 0.67; p < .001).
Conclusion: The CO2-response of COPD-patients during CPET is heterogeneous with 10/24 developing hypercapnia. This study revealed that the lung mechanics are the most important factor correlating with CO2 retention during exercise while ∆TcPCO2 was not associated with baseline TcPCO2.
Kyle M. Hocking, PhD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
Jessica Huston, MD
Department of Medicine, Division of Cardiovascular Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Jeffery Schmeckpeper, MD, PhD
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Monica Polcz, MD
Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
Marisa Case, RN
Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
Meghan Breed, MD
Department of Emergency Medicine, TriStar Skyline Medical Center, Nashville, TN, USA
Lexie Vaughn, MD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
Dawson Wervey, BS
Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
Colleen Brophy, MD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
JoAnn Lindenfeld, MD
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Bret D Alvis, MD
Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
Abstract
Introduction: A cornerstone of heart failure assessment is the right heart catheterization and the pulmonary capillary wedge pressure measurement it can provide. Clinical and hemodynamic parameters such as weight and jugular venous distention are less invasive measures often used to diagnose, manage, and treat these patients. To date, there is little data looking at the association of these key parameters to measured pulmonary capillary wedge pressure (PCWP). This is a large, retrospective, secondary analysis of a right heart catheterization database comparing clinical and hemodynamic parameters against measured PCWP in heart failure patients.
Methods: A total of 538 subjects were included in this secondary analysis. Spearman’s Rho analysis of each clinical and hemodynamic variable was used to compare their association to the documented PCWP. Variables analyzed included weight, body mass index (BMI), jugular venous distention (JVD), creatinine, edema grade, right atrial pressure (RAP), pulmonary artery systolic pressure (PASP), systemic vascular resistance, pulmonary vascular resistance, cardiac output (thermal and Fick), systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, oxygen saturation (SpO2), and pulmonary artery diastolic pressure (PADP).
Results: Ten out of 17 selected parameters had a statistically significant association with measured PCWP values. PADP had the strongest association (0.73, p<0.0001), followed by RAP and PASP (0.69, p<0.0001 and 0.67, p<0.0001, respectively). Other significant parameters included weight (0.2, p<0.001), BMI (0.2, p<0.001), SpO2 (-0.17, p<0.0091), JVD (0.24, p<0.005) and edema grade (0.2, p<0.0001).
Conclusion: This retrospective analysis clarifies the associations of commonly used clinical and hemodynamic parameters to the clinically used gold standard for volume assessment in heart failure patients, PCWP.
Paige M. Shaffer
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Abigail Helm
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Michael Andre
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Herschelle Reaves
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Kathryn E. Bruzios
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Jennifer Harter
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
David Smelson
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Abstract
Background: People with co-occurring substance use and mental health disorders (COD) who experience chronic homelessness often have difficulty engaging in treatment and support services. During the Coronavirus Disease 2019 (COVID-19) pandemic this problem was compounded by community agencies reducing or eliminating in-person care to minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examined the rapid adaptations that were made during COVID-19 to a community-based multicomponent intervention, Maintaining Independence and Sobriety Thorough Systems Integration, Outreach and Networking (MISSION), and how these changes impacted engagement in treatment and fidelity to the intervention prior to and during the COVID-19 pandemic.
Methods: Guided by the Model for Adaptation Design and Impact (MADI) framework, this mixed-methods study (1) qualitatively examines the nature of the rapid adaptations made to the MISSION model with n=4 MISSION clinical program staff and (2) quantitatively examines patterns of engagement and fidelity to the MISSION model prior to and during the pandemic among n=109 people with COD who are experiencing chronic homelessness in an urban region of Massachusetts.
Results: In consultation with the MISSION developers, clinical staff made rapid innovative adaptations to MISSION. These changes, identified through the qualitative interviews, included developing safe in-person session procedures (e.g., shortening sessions, adapting group sessions to individual sessions) and strategies to engage incarcerated individuals to provide continuity of care (e.g., mailing letters and coordinating with jail staff). Despite the adaptations, adherence to the MISSION model remained consistent during COVID-19 and compared to pre-COVID-19. However, there was more adherence to the structured components of care compared to the unstructured components of care during the pandemic. Interestingly, linkages to other needed treatments and community supports increased by 522% despite the pandemic closures.
Conclusions: This mixed-methods study demonstrated that a community-based multicomponent intervention for people experiencing chronic homelessness with COD can be adapted rapidly during a pandemic to help maintain COD treatment and with good fidelity, and that the MADI framework can help document those changes. Thus, these findings provide treatment settings with helpful guidance for community-based COD interventions and public health emergency preparedness.
Larry L Mweetwa
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Derrick D Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Tumelo Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Kabo Osmas Tshiamo
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Sody Mweetwa Munsaka
University of Zambia, School of Health Sciences, P. O. Box 32379 Lusaka, Africa.
Thatoyaone J Kenaope
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Getrude Mothibe
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Ogorogile Mokate
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Emmanuel T Oluwabusola
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or Coronavirus was initially detected in Wuhan China in December 2019 and has subsequently resulted in the COVID-19 pandemic. The disease presents asymptomatically in some of individuals yet also causes symptoms ranging from those associated with influenza and pneumonia, acute respiratory distress syndrome (ARDS) and even death. The world is currently relying on physical (social) distancing, hygiene and repurposed medicines; however, it was predicted that an effective vaccine will be necessary to ensure comprehensive protection against COVID-19. There was a global effort to develop an effective vaccine against SARS-CoV-2 with approximately 300 vaccines in clinical trials, and over 200 more in different stages of development and anticipated that their success will change research clinical trials processes. Although every one of these vaccines comes with its own particular set of characteristics and difficulties, they were all developed as a direct result of research and development efforts that were carried out on a scale that had never been seen before. It is the first time in the history of vaccination that a worldwide immunization campaign has begun during a time of severe pandemic activity that is defined by high virus transmission. This achievement marks an important milestone in the history of vaccination. More than anything else, the most important aspect of the new game change in drug design is that the traditional drug discovery rules have been rewritten. This is especially significant for the development of vaccines, as it is possible for all clinical trials to be accelerated, which would bring a vaccine or drug molecule to market within a year rather than the traditional fifteen years for each phase of drug clinical trials. This review provides insight in respect to first generation COVID-19 vaccines, which were in clinical use as of December 2020 and focused on the Pfizer/ BioNTech/Fosun, Moderna mRNA-1273, Johnson and Johnson and AstraZeneca/Oxford AZD1222 vaccines.
Sandra Maria Barbalho
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation – (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, SP, Brazil
Katia P Sloan
Texas Institute for Kidney and Endocrine Disorders, Lufkin, Texas, USA. 10 Medical Center Blvd, STE A – Lufkin TX 75904 – USA
Lance A Sloan
Texas Institute for Kidney and Endocrine Disorders, Lufkin, Texas, USA. 10 Medical Center Blvd, STE A – Lufkin TX 75904 – USA; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas, USA. 301 University Blvd, Galveston TX 77555 – USA
Ricardo A Goulart
Postgraduate Program in Structural and Functional Interactions in Rehabilitation – (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, SP, Brazil
Karina R. Quesada
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil
Lucas Fornari Laurindo
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil
Tereza Lais Menegucci Zutin
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil
Marcelo Dib Bechara
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation – (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, SP, Brazil
Abstract
Despite the possible effects of Vitamin D (VD) in decreasing the risk of infections and mortality in some viral diseases, the role of therapeutic VD supplementation in individuals infected with COVID is still obscure. This article reviews the possible effects of VD on COVID-19 severity. MEDLINE–PubMed, EMBASE, and Cochran were searched following PRISMA guidelines. Some studies have reported that VD does not seem to augment the immunogenicity of seasonal vaccines, nor does it significantly reduce the incidence or duration of upper respiratory tract infection, although others have. The reason for not getting a positive or significant difference may be due to inadequate VD treatment levels, and VD may not be that important in immunized individuals with adaptive immunity. VD deficiency is most prevalent in the elderly, obese, men, ethnic minorities with darker skin, people with diabetes, hypertension, and in nursing homes or institutionalized. These are individuals that are at increased risk of severe consequences of COVID-19 such as acute respiratory distress syndrome with the need for mechanical ventilation and death. Perhaps supplementation of VD to adequate VD levels will improve the inflammatory reaction and modulate a faster patient recovery with decreased morbidity and mortality.
Gautam S
Department of Respiratory Medicine, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, India.
Guruprasad Antin
Department of Respiratory Medicine, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, India.
Kirankumar Pujar
Department of Respiratory Medicine, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, India.
Abstract
Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a common, costly and preventable disease and is at present the fourth leading cause of death globally. To study the outcome of patients with acute exacerbation of COPD and to analyse the risk factors predicting adverse outcomes in patients with acute exacerbation of COPD.
Patients and Methods: A Prospective study was conducted over a period of one year, from December 2021 to December 2022, Minimum of 50 patients, both male and female with AECOPD getting admitted to a Tertiary care centre were included in this study.
Results: Of the 50 patients studied, 42 were males; all of them were smokers (84%). The mean age was 64.34 ± 10.47 years. The mean duration of the disease was 10.04±6 years. All patients presented with cough, recent worsening of Dyspnea and increased sputum purulence/volume. 70% patients had one or more associated co-morbid illness, majority had hypertension (40%). Of 32 patients with Respiratory failure on admission 17(53.12%) patients had Type II and 15(46.28%) had Type I failure. 44 patients received medical management and 6 patients required invasive mechanical ventilation (IMV). Overall mortality was 5 (10%). 20 variables were compared between survivors and non-survivors. Univariate sensitivity analysis revealed that presence of altered sensorium (P=0.001), Hypotension (P=0.02), cyanosis (P=0.00463), pedal edema (P=0.02), presence of infection (P=0.024) Severe Acidosis (P=0.012), Hypercapnia (P=0.016), cor pulmonale (P=0.04), at the time of admission and need for invasive mechanical ventilation (P<0.001) as predictors of mortality.
Conclusions: 64% of AECOPD presented with respiratory failure, majority were type II. Overall mortality was 10%. Altered Sensorium, pedal edema, presence of infection, cyanosis, hypotension, severe acidosis, hypercapnia and presence of cor pulmonale at the time of admission predict adverse outcome. Those who need invasive mechanical ventilation had high mortality. Survivors had less hospital stay.
