Title: Analysis of the course of chronic obstructive pulmonary disease in a fifteen- year follow-up.
Chronic obstructive pulmonary disease (COPD) is an important medical and social problem due to its growing prevalence and negative impact on the quality of life and prognosis. A growing body of evidence strengthens the understanding of the significance of various factors in the clinically heterogeneous course of COPD.
Methods: COPD progression was monitored over 15 years at three-time points (at study inclusion, after 3 years, and after 15 years). A total of 170 men with COPD were included in the study. Smoking history, the severity of respiratory symptoms, body mass index (BMI), and spirometry data were taken into account. To assess the significance of the factors, we performed a Kaplan-Meier analysis of long-term survival. Multivariate Cox regression model analysis was used to assess the influence of various factors and their combinations on long-term survival.
Results: Of the 170 patients included in the study, 119 died by the third time point, which was 70%. The mean life expectancy of those who died was 70.48 ± 0.63 years. The results of the study showed that comorbid atherosclerotic cardiovascular disease was a major cause of death in patients with COPD. Survival analysis using Kaplan-Meier curves showed that BMI;21 was associated with a poor prognosis. The analysis also showed that the frequency of exacerbations correlated with the severity of the course and prognosis. An increase in the frequency of exacerbations by more than 3 per year was an independent predictor of a negative prognosis. Another factor was physical frailty. Individuals who move only within the confines of the home have been found to have a worse prognosis. A high Charlson comorbidity index was a factor of adverse prognosis. Cox regression model results showed that atherosclerotic cardiovascular disease, high frequency of COPD exacerbations, and high FEV1 decline rate were significant predictors of poor prognosis in patients with COPD at 15-year follow-up.
Conclusion: Thus, comorbid atherosclerotic cardiovascular disease, low BMI, high exacerbation rate, rapid FEV1 decline, physical frailty, and high Charlson index are significant factors of poor prognosis of COPD and should be considered in patient follow-up.
Stanislav Kotlyarov was educated as a medical doctor in 2007 and received his Ph.D. in 2011. His thesis was on "Structure of respiratory symptoms and spirometry screening in the assessment of chronic obstructive pulmonary disease at the primary treatment level". He works at Ryazan State Medical University as head of the department. He is board-certified as a general practitioner and family medicine physician. Was involved in clinical trials of medicines and medical devices. He has over 50 publications, including several articles in leading international peer-reviewed journals. Areas of research interests: molecular immunology, and molecular pharmacology of respiratory and cardiac diseases.
Title: Socio-Demographic Determinants of Adult Pulmonary Tuberculosis Patients: A Hospital Based Study at Dhanmondi, Dhaka, Bangladesh
Background: Tuberculosis (TB) is a multi-system infectious disease with a major cause of morbidity and mortality all over the world but particularly in developing countries like Bangladesh. A normal healthy individual does not face the symptoms causing by tuberculosis due to their immune system that’s why infection among healthy individuals always remain silent. As it is highly infectious air borne disease that’s why treatment completion for TB is the cornerstone of its control and prevention. So to understand these factors efficiently this study was carried out about socio-demographic determinants of adult TB patients attending the tertiary care teaching hospital, Dhanmondi, Dhaka. Methodology: This was hospital based cross sectional observational study done at Bangladesh Medical College Hospital, Dhanmondi, Dhaka with the study period from January 2020 to December 2021.Total 410 patients of age group 18 years and above with persistent cough with sputum production for more than 2 weeks were enrolled for this study purpose. Results: Total prevalence of sputum positive adult pulmonary TB among the studied group was 69.02%. Majority 54% were male patients in the age group of 41-50 years (31.45%). Pulmonary TB was predominantly diagnosed among employed group 41.34%, those who have completed their high school level (34.28%) in mainly the rural (66.08%) locality. Joint family (61%) with 8-10 family members (43.46%) have been found mostly affected in our study. The cardinal features were cough with sputum production (80.21%) followed by fatigue (71.73%), fever (42.05%), sweating (46.99%), loss of appetite (32.86%) and weight loss (27.56%). Pulmonary TB was found mostly among smokers (57.23%) with normal BMI (44.88%).
Conclusion: To decrease the rate of infection with Tuberculosis, a ultifactorial approach can play the pivotal role by improving the living conditions, education level, economic status and adequate sanitation. Awareness can bring a new dimension in this regard.
Keywords: Socio-demographic determinants, tuberculosis.
Title: The prevalence of Heart Failure in patients with Chronic Obstructive Pulmonary Disease: A systematic review and meta-analysis
Background: To assess the prevalence of heart failure in patients with COPD.
Methods: CENTRAL, Embase, and MEDLINE were searched for studies from 2017 up to June 2022 using the medical subject headings “COPD” and “Heart failure”. The risk of bias was assessed using the Newcastle-Ottawa scale for observational studies. The studies were narratively and statistically analyzed. Studies were reviewed in accordance with PRISMA guidelines.
Results: Of 3346 studies identified, 2220 were screened for title and abstract, and 348 were selected for full-text review. 11 studies were eligible for inclusion involving 91,919 participants, of which 10 were included in our meta-analyses. 3 conditions were investigated (i.e., HF, LVDD, and RVDD), of which 2 conditions were included in the meta-analyses and all were descriptively synthesized). From our meta-analyses, we found overall pooled prevalence estimated of was 16 %, 95 % CI (12 % to 19 %), for heart failure; and 61 %, 95 % CI (53 % to 70 %), for LVDD. The pooled data for HF were significantly heterogenous (I2= 97.55 %, p<0.001), whereas the pooled data for LVDD were moderately heterogeneous (I2= 50 %, p= 0.16). Discussion: Meta-analyses for LVDD and HF had a moderate to large statistical heterogeneity. Only three studies out of 11 aimed to investigate the primary outcome of HF or LVDD. HF is a clinically important condition that is prevalent within a significant proportion of patients with COPD and negatively impacts important clinical outcomes. There is a need for more research investigating HF prevalence in COPD. In addition, we hope this review raises the awareness of clinicians and policymakers to consider implementing diagnostic tools to assess HF among the COPD population.
Other: This systematic review is registered with PROSPERO, CRD42022328570
Sufana is a Lecturer in the Respiratory Care Department at Imam Abdulrahman bin Faisal University, Saudi Arabia. Master of Respiratory Medicine from the University of Birmingham, UK. Bachelor of Respiratory Care from AlMaarefa University, Saudi Arabia.
Title: Efficacy of Noninvasive positive pressure ventilation in ARDS caused by Covid19
Noninvasive positive pressure ventilation was being practiced in the management of covid19 ARDS but there were no specific studies for its effectiveness.
This study was conducted to analyze the effectiveness of NIPPV in covid19 ARDS patients.
One hundred and seventeen patients from the Corona Intensive Care Unit of Nishtar Hospital Multan with severe covid19 ARDS having PaO2/FiO2 ratio <100mHg, GCS > 13, and Respiratory breathing index <105 were selected. These patients were hospitalized in 2021 during covid pandemic for their management. Noninvasive positive pressure ventilation with a high flow system was applied to all patients along with a heat and moist exchanger (HME) at the interface and viral/bacterial filters at the expiratory limb of the ventilatory circuit. 62% patients were improved with improvement in PaO2/FiO2 ratio over time period of 7 days. 38% of patients deteriorated and they were switched to mechanical ventilation.
After ruling out general contraindications of NIPPV, its use was a remarkably effective and safe modality for covid19 ARDS patients. Additionally, patients are at ease with the use of NIPPV contrary to IMV. Further, larger-scale studies should be carried out to determine the effectiveness of NIPPV.
Title: A SIMULATION STUDY ON QUAD/DUO PATIENT SPLIT MECHANICAL VENTILATOR
Respiratory diseases and injury-induced respiratory failure are among the major public health problems in both developed and developing countries. Asthma, chronic obstructive pulmonary diseases, and other chronic respiratory conditions are widespread. Patients with underlying lung diseases may develop respiratory failure due to a variety of challenges and they can be supported by mechanical ventilation. A mechanical ventilator is a machine that helps a patient breathe (ventilate) when they cannot breathe on their own due to a critical illness. The COVID-19 outbreak has become a global issue as this new pandemic socially and economically affected the entire world. This virus has caused a substantial global health problem with very significant economic and social impacts. According to the World Health Organization (WHO), as of 23 January 2022, over 346 million confirmed cases of COVID-19 were reported worldwide, and many of those critically ill have required days of supportive invasive mechanical ventilation (IMV) as part of their treatment. Most developing nations, especially those in sub-Saharan Africa have been facing ventilator shortages for a long time. The high cost of ventilators has also contributed to limited access to life-saving machines in countries like Zambia. The need for ventilators in many hospitals in most developing nations has surpassed the supply. The novel coronavirus disease (COVID-19) has exposed critical shortages of ventilators in both developing and developed countries. One possibility to address this problem is the utilization of a single ventilator on two to four patients. The need to carry out mathematical modeling and simulation of the machine-patient configurations to ascertain the feasibility as well as understand the limitations of this approach is nontrivial. This paper presents a simulation study on the implementation of a single ventilator on two or more patients with different lung compliances. Results show that in theory, it is technically possible to ventilate two or more patients provided a control strategy is implemented to regulate the inhalation tube resistances. It has also been demonstrated that ventilating two or more patients with unequal lung compliances from a single ventilator without a controlling resistance will lead to clinically significant reductions in tidal volume in the patient with the lowest respiratory compliance. The study demonstrates that it may be possible to achieve the same tidal volumes in two and four patients with mismatched lung compliances, and the results show that the tidal volume of one patient can be manipulated independently of the others.
George Pule is a 3rd-year Biomedical Engineering Technology Student at Evelyn Hone College of Applied Arts and Commerce; and he is a student Member of the Engineering Institution of Zambia and IEEE, Engineering in medicine and biology society (EMBS). He is the inventor and Lead innovator of the Vent Splitting Device (VSD) under development at Evelyn Hone College with sponsorship from the National Science and Technology Council. The invention received a grant from the National Science and Technology Innovation Youth Fund. He presented an abstract on ventilator-sharing methods at the 2022 IEEE EMBS Middle East Africa international conference in Uganda.