"Selected Bibliography of Recent Research in Chronic Obstructive Pulmonary Disease." American Journal of Respiratory and Critical Care Medicine, 206(11), pp. 1408–1417
Our aim is to avoid thrombo-embolic and bleeding events in mechanical mitral valve prostheses and find a solution for the difficult adjustment of the INR with the given Vitamin K Antagonists/Oral anticoagulants (VKA) by adding small dose of Aspirin (75 or 81 mg/day)to the oral anticoagulants. We revised the data of 183 patients who had been submitted for mechanical mitral valve replacement between January 2007 and January 2011 and followed for 2–3 years post operative. All of them had been replaced with St.Jude prostheses. 104 of them received Aspirin with the VKA, referred to as group A; group B patients (79 patients) received only VKA. We followed both groups clinically, by coagulation profile and by echocardiography for 2–3 years to assess the INR and the state of the valve in response to the added Aspirin to the VKA. In the cases receiving Aspirin added to the oral anticoagulants we found less incidence of malfunctioning valves, less thrombo-embolism and less bleeding events. There were lower doses of oral anticoagulants taken, lower figures of INR in group A than in group B. Aspirin added to oral anticoagulants post MVR had the advantages of being safe, convenient and reliable with no need to frequently adjust the oral anticoagulants doses or fear of thrombo-embolic events.
Arteriotomy closure device (ACD) use has increased following percutaneous transfemoral coronary procedures (PTCP). However, their safety in patients with chronic kidney disease (CKD) is not known. Therefore, we evaluated the complication rates of ACD among patients with CKD.Six-hundred ten consecutive patients who underwent PTCP and ACD were retrospectively studied. Patients were grouped according to their creatinine clearance (CrCl in ml/min/1.73 m2) calculated by the Cockcroft-Gault formula using the National Kidney Foundation classification system; Stage I (CrCl > or = 90); Stage II (60-89); Stage III (30-59); Stage IV (15-29); and Stage V (< or = 15). The primary endpoint was the combined incidence of pseudoaneurysm, retroperitoneal hematoma, femoral artery thrombosis, surgical vascular repair, and groin infection.Among 610 patients 283 (46%) underwent PCI. The primary endpoint was seen in 66 (10.8%) patients. Univariate predictors of primary outcome were lower CrCl (p < 0.001), and presence of peripheral vascular disease (p = 0.03). There was an inverse relationship between CrCl and complication rate. CKD was the strongest independent multivariate predictor for the primary endpoint (OR 1.032; 95% CI 1.019-1.046; p < 0.0001), driven by higher infection (p < 0.0001), thrombosis (p = 0.003) and hematoma (p = 0.007).Renal function appears to be significantly associated with vascular access-site complications. Worsening renal function is associated with higher vascular access site complications, largely driven by an increased infection rate.
Few studies have investigated the association of long-term ambient ozone exposures with respiratory morbidity among individuals with a heavy smoking history.To investigate the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography (CT) scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD.This multicenter cross-sectional study, conducted from November 1, 2010, to July 31, 2018, obtained data from the Air Pollution Study, an ancillary study of SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Data analyzed were from participants enrolled at 7 (New York City, New York; Baltimore, Maryland; Los Angeles, California; Ann Arbor, Michigan; San Francisco, California; Salt Lake City, Utah; and Winston-Salem, North Carolina) of the 12 SPIROMICS clinical sites. Included participants had historical ozone exposure data (n = 1874), were either current or former smokers (≥20 pack-years), were with or without COPD, and were aged 40 to 80 years at baseline. Healthy persons with a smoking history of 1 or more pack-years were excluded from the present analysis.The 10-year mean historical ambient ozone concentration at participants' residences estimated by cohort-specific spatiotemporal modeling.Spirometry-confirmed COPD, chronic bronchitis diagnosis, CT scan measures (emphysema, air trapping, and airway wall thickness), 6-minute walk test, modified Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), postbronchodilator forced expiratory volume in the first second of expiration (FEV1) % predicted, and self-report of exacerbations in the 12 months before SPIROMICS enrollment, adjusted for demographics, smoking, and job exposure.A total of 1874 SPIROMICS participants were analyzed (mean [SD] age, 64.5 [8.8] years; 1479 [78.9%] white; and 1013 [54.1%] male). In adjusted analysis, a 5-ppb (parts per billion) increase in ozone concentration was associated with a greater percentage of emphysema (β = 0.94; 95% CI, 0.25-1.64; P = .007) and percentage of air trapping (β = 1.60; 95% CI, 0.16-3.04; P = .03); worse scores for the mMRC Dyspnea Scale (β = 0.10; 95% CI, 0.03-0.17; P = .008), CAT (β = 0.65; 95% CI, 0.05-1.26; P = .04), and SGRQ (β = 1.47; 95% CI, 0.01-2.93; P = .048); lower FEV1% predicted value (β = -2.50; 95% CI, -4.42 to -0.59; P = .01); and higher odds of any exacerbation (odds ratio [OR], 1.37; 95% CI, 1.12-1.66; P = .002) and severe exacerbation (OR, 1.37; 95% CI, 1.07-1.76; P = .01). No association was found between historical ozone exposure and chronic bronchitis, COPD, airway wall thickness, or 6-minute walk test result.This study found that long-term historical ozone exposure was associated with reduced lung function, greater emphysema and air trapping on CT scan, worse patient-reported outcomes, and increased respiratory exacerbations for individuals with a history of heavy smoking. The association between ozone exposure and adverse respiratory outcomes suggests the need for continued reevaluation of ambient pollution standards that are designed to protect the most vulnerable members of the US population.
Background: Our objective in this multicenter retrospective study is to discuss the optimum timing for CABG after STEMI.The second question is whether the Off-Pump technique differs regarding the timing or affects the outcome compared to the On-Pump technique. Methods: Between September 2009 and June 2016 in Saudi German hospitals group in Saudi Arabia and central Hospital BadBerka in Germany, 379 STEMI patients, who were not candidates for or failed PCI; were operated for CABG.200 (52.77%)were operated Off-Pump and 179(47.23%)On -Pump; with an age range of 36-63years.195 males in the off-pump patients (97.5%) and 175 males (97.76%) in the on-pump patients.we arranged them into 2main groups; group A as off-Pump and group B as on-pump.Both groups were further subdivided into groups A1 (off-pump early surgery; 100 patients), group A2 (offpump late surgery; 100 patients) group B1 (on-pump early surgery; 88 patients) and group B2 (late surgery; 91 patients).We excluded patients with Complicated PCI, Mechanical complications, Cardiogenic shock, Life threatening arrhythmias and Late presentation of ischemia or infarction after PCI.Results: 25 mortalities occurred in early operated cases.There were no intra-operative mortality in the groups operated late after the infarction, and only one late postoperative mortality in group B2. 9 mortalities in group A1 (4.5% of the off-pump CABG-9% of group A1) and 16 mortalities of group B (8.9% of group B, 15 cases in group B1; 17% and 1 case in group B2; 1.09%).There was significant statistical difference between group A and group B, A1 and A2, B1 and B2; regarding the intra-and postoperative mortality with p-value of 0.004, 0.0022, 0.001 intraoperatively and 0.0047, 0.001, 0.003 postoperatively.The postoperative duration for mechanical ventilation was longer in group B than in group A, and longer in group A1 compared to group A2.The use of intra-aortic balloon pump was more in group B than A and more in A1 compared to A2 also more in cases of group B1 than B2.The use of inotropic support was more in group B than A while it was less in A2 than A1 and more in B1 than B2.The total ICU and hospital stay were longer in cases of B than A and more in A1 than A2, also longer in B1 than B2.The intra and post operative arrhythmias and complications were more in A1 than A2 and in B1 than B2. Conclusion:The more we wait after STEMI for surgical intervention for cases not candidate or failed for primary PCI, the better the outcome of surgery With no sharp time limit for postponing the surgery.
The impact of iron deficiency on COPD morbidity independent of anemia status is unknown. Understanding the association between iron deficiency, anemia status, and risk of hospitalization in COPD may inform an approach to these comorbidities. Adults ≥40 years from the Johns Hopkins COPD Precision Medicine Center of Excellence data repository with an outpatient iron profile and 1 year of subsequent follow-up time were included in the study. Baseline characteristics were compared across iron status, defined by transferrin saturation (TSAT), using t-tests and Chi-squared tests. The association between continuous TSAT and all-cause hospitalization over the 1-year follow-up period was assessed by logistic regression. Models were adjusted by covariates with an interaction term for anemia and stratified by sex. There were 6532 individuals included with an average age of 65±12 years, 59% were female, and 56% White. Fifty-two percent of the cohort were iron deficient (TSAT≤20%), among whom 27% were non-anemic. Iron-deficient individuals had lower lung function and a higher prevalence of heart failure and diabetes. Iron deficiency was more prevalent among females (57%) compared to males (44%). In adjusted models, a decrease in TSAT by 10% was associated with 14.3% higher odds of all-cause hospitalization for females (95%CI:1.0-1.3), but not among males (OR:1.08, 95%CI:0.9-1.3). There was effect modification by anemia such that the association between TSAT and all-cause hospitalization was greater in non-anemic women (p-value interaction=0.08). Iron deficiency may be associated with adverse outcomes in the absence of anemia, with non-anemic women being a COPD sub-population particularly sensitive to iron deficiency.
Background: Low socioeconomic status (SES) has been associated with worse clinical outcomes in chronic obstructive pulmonary disease (COPD).Food insecurity is more common among individuals with low SES and has been associated with poor outcomes in other chronic illnesses, but its impact on COPD has not been studied.Methods: Former smokers with spirometry-confirmed COPD were recruited from low-income areas of Baltimore, Maryland and followed for 9 months as part of a cohort study of diet and indoor air pollution.Food insecurity and respiratory outcomes, including COPD exacerbations and patient-reported outcomes, were assessed at regular intervals.The association between food insecurity and COPD outcomes was analyzed using generalized linear mixed models.Additional analyses examined the association of COPD morbidity with sub-domains of food insecurity and the association of food insecurity with measures of psychological wellbeing.Results: Ninety-nine participants had available data on food insecurity and COPD outcomes.26.3% of participants were food insecure at one or more times during the study.After adjusting for individual SES, neighborhood poverty, and low healthy food access, food insecurity was associated with higher incidence rate of moderate and severe exacerbations, worse dyspnea, COPD health status, and respiratory-specific quality of life.Sub-domains of food insecurity were independently associated with worse patient-reported outcomes.Food insecurity was additionally associated with higher perceived stress.Discussion: Among former smokers with COPD, food insecurity was associated with higher incidence of exacerbations, worse patient-reported outcomes, and higher perceived stress.Subdomains of food insecurity were independently associated with worse patient-reported outcomes.
