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Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease.

Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease.

COPD. 2013 Feb;10(1):62-71

Authors: Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML

Abstract
Abstract Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease. Electrocardiography (ECG) carries information about cardiac disease and prognosis, but studies comparing ECG characteristics between patients with and without COPD are lacking. We related ECG characteristics of patients with COPD, to ECG characteristics of patients without COPD, and determined whether ECG abnormalities are related to COPD severity. A cross-sectional study was conducted within a cohort of 243 COPD patients, aged 65 years or older. All patients underwent extensive examinations, including resting 12-lead ECG and pulmonary function tests. The reference group (n = 293) was a sample from the general population, also aged 65 or older, without COPD. Abnormal ECGs were more prevalent in COPD patients (50%) than in patients without COPD (36%, p = 0.054). Conduction abnormalities were the most common ECG abnormality in COPD patients (28%) being significantly more prevalent than in patients without COPD (11%, p < 0.001). The mean heart rate was higher in COPD patients (72 bpm (SD 14)) compared to controls (65 bpm (SD 13), p < 0.001), and QTc prolongation was less frequent in COPD patients (9% versus 14%, p = 0.01). The prevalence of ECG abnormalities increased with severity of pulmonary obstruction. ECG abnormalities, especially conduction abnormalities are common in COPD patients, and the prevalence of ECG abnormalities increases with severity of COPD. This underlines the importance of an integrated-care approach for COPD patients, paying attention to early detection of unrecognized coexisting cardiac disorders.

PMID: 23413894 [PubMed - in process]

Critical assessment of the value of sputum neutrophils.

Critical assessment of the value of sputum neutrophils.

COPD. 2013 Feb;10(1):107-14

Authors: Gupta V, Singh D

Abstract
Abstract Neutrophils are central to the pathogenesis of COPD, releasing a range of pro-inflammatory and tissue destructive mediators. Sputum neutrophil numbers are elevated in COPD patients compared to healthy controls. We critically appraise the potential of sputum neutrophils as a biomarker in COPD. We show that there is insufficient evidence to support the use of this biomarker to define a phenotype of patients with more severe disease characteristics or a different prognosis. However, sputum neutrophil measurements can be used to measure the effects of anti-inflammatory drugs for the treatment of COPD.

PMID: 23413897 [PubMed - in process]

Evolution and Complications of Chest Trauma.


OBJECTIVE: To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications.
METHODS: Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation.
RESULTS: A total of 376patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218cases; 57.9%) and motor vehicle accidents (57cases; 15.1%). The most frequent type of trauma was rib contusion (248cases; 65.9%) and rib fractures (61cases; 16.2%). Complications were observed in 43patients (11.4%), mainly hemothorax (13cases), pneumothorax (9cases), pneumonia (6cases) and acute renal failure (4cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60.
CONCLUSIONS: Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.

Effectiveness of pulmonary rehabilitation in exercise capacity and quality of life in chronic obstructive pulmonary disease patients with and without global fat-free mass depletion.

OBJECTIVE: To investigate the effectiveness of pulmonary rehabilitation (PR) in exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) with and without global fat-free mass (FFM) depletion.
DESIGN: Retrospective case-control.
SETTING: Outpatient clinic, university center.
PARTICIPANTS: All COPD patients referred to the PR program were stratified according their FFM status measured by bioelectrical impedance. They were considered depleted if FFM index was ≤ 15 kg/m(2) in women and ≤ 16 kg/m(2) in men. From this initial sample, all depleted patients (n=31) composed the FFM depleted group. It was composed predominantly by females (68%) with a mean age of 64.4±7.3yrs and forced expiratory volume in 1 second (FEV(1)) of 33.6±13.2% predicted. Paired for sex and age, 32 non-depleted patients were selected from the initial sample to compose the non-depleted group.
INTERVENTION: PR including whole-body and weight training during twelve weeks, three times/week.
MAIN OUTCOME MEASURES: St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6-MWD) and FFM evaluation applied before and after PR.
RESULTS: Improvement in 6-MWD was similar in these two groups after PR. Both groups improved SGRQ, although the observed power was small and did not allow adequate comparison between depleted and non-depleted patients. There was no difference between groups in weight change whereas FFM tended to be greater in depleted patients. This increase had no correlation with 6-MWD or SGRQ.
CONCLUSION: Benefits of PR to exercise capacity were similar comparing FFM depleted and non-depleted COPD patients. Although FFM change tended to be greater in depleted patients, this increase had no definite relation with clinical outcomes.

Quantitative thoracic CT techniques in adults: can they be applied in the pediatric population?


With the rapid evolution of the multidetector row CT technique, quantitative CT has started to be used in clinical studies for revealing a heterogeneous entity of airflow limitation in chronic obstructive pulmonary disease that is caused by a combination of lung parenchymal destruction and remodeling of the small airways in adults. There is growing evidence of a good correlation between quantitative CT findings and pathological findings, pulmonary function test results and other clinical parameters.
This article provides an overview of current quantitative thoracic CT techniques used in adults, and how to translate these CT techniques to the pediatric population.

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