Background Tracheal, Bronchus, and Lung (TBL) cancer continues to represent the majority of cancer-related incidence and mortality in United States (U.S.). While air pollutants are considered ...essential risk factors, both global and national average concentrations of major harmful air pollutants have significantly decreased over the decades. Green space may have a beneficial effect on human health. Methods We obtained data on national and state-level burden of TBL cancer, the annual average concentration of main air pollutants, and levels of green spaces in 2007, 2013, and 2019. According to generalized estimating equation (GEE), we examine the associations among incidence and mortality of TBL cancer, air pollutants, and greenspaces, represented by the Normalized Difference Vegetation Index (NDVI) in different age groups with models adjusted with meteorological, and socio-demographic. We observed additional effects of the interaction between the NDVI, Ozone, PM2.5, and other factors, which helped us to interpret and understand our results. Also, we collated states that witnessed net increments in forest coverage and conducted the same analysis separately. Results In our analysis, the majority of associations between NDVI and air pollutants with TBL cancer remained significantly positive, particularly noticeable among individuals aged 20 to 54. However, our findings did not explore air pollution as a potential mediator between greenspace exposure and TBL cancer. While the associations of PM2.5 with TBL cancer remained positive, the other four pollutants showed positive but statistically insignificant associations. Our interaction analysis yielded that there were positive associations between NDVI and ozone, PM2.5, and tobacco use. Max NDVI acts as a protective factor along with high HDI. Additionally, PM2.5 and HDI also showed a negative association. In 18 states with more forest, NDVI acts as a protective factor along with higher health care coverage, better health status, and participation in physical activities. Conclusion In the state-level of U.S., the effects of total greenspace with TBL cancer are mixed and could be modified by various socio-economic factors. PM2.5 has a direct correlation with TBL cancer and the effects can be influenced by underlying socioeconomic conditions.
This is the second and updated version of the Textbook of Allergy for the Clinician. It is a unique book in the field of allergy. The uniqueness lies in the international character of the book with ...contributors representing both the East and West. This book represents the diversity of issues affecting patients in the specialty of allergy, asthma & immunology. There is some discussion of the basic mechanisms involved and extensive elaboration for the clinicians. This book will appeal to medical students, residents and fellows undergoing training as well as consultants in academic and clinical practice settings. The color plates, especially in the section on Aerobiology, will help in the interaction between the patient and consultant in identifying the plant or flora which is the causative factor. The differences and similarities between the Eastern and Western approaches in the practice of the specialty are being addressed for the first time in a book.
Ischemic heart disease (IHD) and chronic airway disease (COPD and Asthma) are major epidemics accounting for significant mortality and morbidity. The combination presents many diagnostic challenges. ...Clinical symptoms and signs frequently overlap. There is a need for airway evaluation in these patients to plan appropriate management.
Consecutive stable IHD patients attending the cardiology OPD in a tertiary care centre were interviewed for collecting basic demographic information, brief medical, occupational, personal history and risk factors for coronary artery disease and airway disease, modified medical research centre (MMRC) grade for dyspnea, quality of life-St. George respiratory questionnaire (SGRQ), spirometry and six-min walk tests. Patients with chronic airway obstruction were treated as per guidelines and were followed up at 3rd month with spirometry, six-minute walk test and SGRQ.
One hundred fourteen consecutive patients with stable cardiac disease were included (Males-88, Females-26). Mean age was 58.89±12.24years, 53.50% were smokers, 31.56% were alcoholics, 40.35% diabetics, 47.36% hypertensive. Twenty five patients had airway obstruction on spirometry (COPD-13 and Asthma-12) and none were on treatment. Thirty-one patients had cough and 48 patients had dyspnea. Patients with abnormal spirometry had higher symptoms, lower exercise tolerance and quality of life. Treatment with appropriate respiratory medications resulted in increase in lung function, quality of life and exercise tolerance at 3rd month.
Chronic respiratory disease in patients with stable IHD is frequent but often missed due to overlap of symptoms. Spirometry is a simple tool to recognize the underlying pulmonary condition and patients respond favorably with appropriate treatment
The prevalence and mortality of CRDs and the action taken by various stakeholders such as World Health Organization-Global Alliance against Chronic Respiratory Diseases (GARD), European Union and ...European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) have been discussed in the sixth chapter. Section IV with three chapters deals with health information technology (HIT) and precision medicine: the role of telemedicine and mobile health technology, how these have evolved over time, how these can be used to offer better management to patients, telemedicine facilitated interventions, mobile health apps as well as the limitations for the use of these health devices, which is equally important to understand. The next chapter deals with the real-time clinical decision support at point-of-care, how to organize the clinical decision-making algorithms and the key components of the clinical decision support systems.
Chronic obstructive pulmonary disease (COPD) has the highest increased risk due to household air pollution arising from biomass fuel burning. However, knowledge on COPD patho-mechanisms is mainly ...limited to tobacco smoke exposure. In this study, a repeated direct wood smoke (WS) exposure was performed using normal- (bro-ALI) and chronic bronchitis-like bronchial (bro-ALI-CB), and alveolar (alv-ALI) lung mucosa models at air-liquid interface (ALI) to assess broad toxicological end points.
The bro-ALI and bro-ALI-CB models were developed using human primary bronchial epithelial cells and the alv-ALI model was developed using a representative type-II pneumocyte cell line. The lung models were exposed to WS (10 min/exposure; 5-exposures over 3-days; n = 6-7 independent experiments). Sham exposed samples served as control. WS composition was analyzed following passive sampling. Cytotoxicity, total cellular reactive oxygen species (ROS) and stress responsive NFkB were assessed by flow cytometry. WS exposure induced changes in gene expression were evaluated by RNA-seq (p ≤ 0.01) followed by pathway enrichment analysis. Secreted levels of proinflammatory cytokines were assessed in the basal media. Non-parametric statistical analysis was performed.
147 unique compounds were annotated in WS of which 42 compounds have inhalation toxicity (9 very high). WS exposure resulted in significantly increased ROS in bro-ALI (11.2%) and bro-ALI-CB (25.7%) along with correspondingly increased NFkB levels (bro-ALI: 35.6%; bro-ALI-CB: 18.1%). A total of 1262 (817-up and 445-down), 329 (141-up and 188-down), and 102 (33-up and 69-down) genes were differentially regulated in the WS-exposed bro-ALI, bro-ALI-CB, and alv-ALI models respectively. The enriched pathways included the terms acute phase response, mitochondrial dysfunction, inflammation, oxidative stress, NFkB, ROS, xenobiotic metabolism of AHR, and chronic respiratory disorder. The enrichment of the 'cilium' related genes was predominant in the WS-exposed bro-ALI (180-up and 7-down). The pathways primary ciliary dyskinesia, ciliopathy, and ciliary movement were enriched in both WS-exposed bro-ALI and bro-ALI-CB. Interleukin-6 and tumor necrosis factor-α were reduced (p < 0.05) in WS-exposed bro-ALI and bro-ALI-CB.
Findings of this study indicate differential response to WS-exposure in different lung regions and in chronic bronchitis, a condition commonly associated with COPD. Further, the data suggests ciliopathy as a candidate pathway in relation to WS-exposure.
Atlas of fiberoptic bronchoscopy Mahesh, P
Indian Journal of Medical Research,
11/2016, Letnik:
144, Številka:
5
Journal Article, Book Review
Recenzirano
Odprti dostop
The next chapter describes the cleaning, disinfection and sterilization of the bronchoscopes and other accessories, knowledge of which is vital for the bronchoscopist to prevent contamination of ...their instrument and nosocomial transmission of infections especially during bronchoscopic procedures in patients who are positive for HIV or hepatitis. The last two sections discuss the two most important specimen collection procedures for diagnostic FOB, the bronchoalveolar lavage (BAL) and the transbronchial lung biopsy (TBLB) in detail. The last two chapters deal with an extensive collection of case reports of both benign and malignant pulmonary diseases from the author's own collection of more than 2000 bronchoscopies.
High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, especially ...in low- and middle-income countries (LMICs), due to lack of ventilators and manpower resources despite the paucity of data regarding their efficacy. This prospective study aimed to analyse the efficacy of HFNC versus NIV in the management of COVID-19 ARDS. A total of 88 RT-PCR-confirmed COVID-19 patients with moderate ARDS were recruited. Linear regression and generalized estimating equations (GEEs) were used for trends in vital parameters over time. A total of 37 patients were on HFNC, and 51 were on NIV. Patients in the HFNC group stayed slightly but not significantly longer in the ICU as compared to their NIV counterparts (HFNC vs. NIV: 8.00 (4.0-12.0) days vs. 7.00 (2.0-12.0) days;
= 0.055). Intubation rates, complications, and mortality were similar in both groups. The switch to HFNC from NIV was 5.8%, while 37.8% required a switch to NIV from HFNC. The resolution of respiratory alkalosis was better with NIV. We conclude that in patients with COVID-19 pneumonia with moderate ARDS, the duration of treatment in the ICU, intubation rate, and mortality did not differ significantly with the use of HFNC or NIV for respiratory support.
The use of the Ratio of Oxygen Saturation (ROX) index to predict the success of high-flow nasal oxygenation (HFNO) is well established. The ROX can also predict the need for intubation, mortality, ...and is easier to calculate compared with APACHE II. In this prospective study, the primary aim is to compare the ROX (easily administered in resource limited setting) to APACHE II for clinically relevant outcomes such as mortality and the need for intubation. Our secondary aim was to identify thresholds for the ROX index in predicting outcomes such as the length of ICU stay and failure of non-invasive respiratory support therapies and to assess the effectiveness of using the ROX (day 1 at admission, day 2, and day 3) versus Acute physiology and chronic health evaluation (APACHE) II scores (at admission) in patients with Coronavirus Disease 2019 (COVID-19) pneumonia and Acute Respiratory Distress Syndrome (ARDS) to predict early, late, and non-responders. After screening 208 intensive care unit patients, a total of 118 COVID-19 patients were enrolled, who were categorized into early (n = 38), late (n = 34), and non-responders (n = 46). Multinomial logistic regression, receiver operating characteristic (ROC), Multivariate Cox regression, and Kaplan-Meier analysis were conducted. Multinomial logistic regressions between late and early responders and between non- and early responders were associated with reduced risk of treatment failures. ROC analysis for early vs. late responders showed that APACHE II on admission had the largest area under the curve (0.847), followed by the ROX index on admission (0.843). For responders vs. non-responders, we found that the ROX index on admission had a slightly better AUC than APACHE II on admission (0.759 vs. 0.751). A higher ROX index on admission HR (95% CI): 0.29 (0.13-0.52) and on day 2 HR (95% CI): 0.55 (0.34-0.89) were associated with a reduced risk of treatment failure. The ROX index can be used as an independent predictor of early response and mortality outcomes to HFNO and NIV in COVID-19 pneumonia, especially in low-resource settings, and is non-inferior to APACHE II.
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a global health problem, mainly in developing countries. It affects pulmonary blood vessels, right ventricle, and also left ventricle ...leading to pulmonary hypertension, Cor pulmonale and right and left ventricular dysfunction. Aim: To assess the cardiac, right and left ventricular changes in subjects with increasing COPD severity staged according to Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines and to compare Arterial Blood Gases (ABG), St George Respiratory Questionnaire (SGRQ) percentages and BODE (Body-mass index, airflow Obstruction, Dyspnea, and Exercise) scores to cardiac changes in COPD. Materials and Methods: The present study was a cross- sectional study conducted at tertiary care hospital in Southern Karnataka, India. The sample size was 60. A structured questionnaire was administered which included demographic, clinical variables followed by a detailed clinical examination, spirometry, Electrocardiograph (ECG), ABG, chest radiograph, echocardiography and a 6-Minute Walk Test (6MWT). Data collected was analysed using Statistical Package for the Social Sciences (SPSS) and Epi INFO software for mean, Standard Deviation (SD) and multivariate analysis. Results: All the patients diagnosed with COPD (using GOLD criteria) were included in study and assessed for right and left ventricular changes. Out of 60 patients, 58 were males and 02 were females, with mean age being 64.71±28.28 years. Among the study population, 45 (75%) patients had one or the other cardiac condition. Cardiac changes included left ventricular diastolic dysfunction (58.3%), right ventricular dilatation (33.3%), right ventricular hypertrophy, right atrial dilation, tricuspid regurgitation and pulmonary hypertension and left heart changes included left ventricular hypertrophy. Conclusion: The study highlights the need for early and active cardiac screening of all COPD patients. This will help in early treatment and good prognosis, and will further contribute in reducing the morbidity and mortality.
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