Human rhinoviruses.

Clin Microbiol Rev. 2013 Jan;26(1):135-62

Authors: Jacobs SE, Lamson DM, St George K, Walsh TJ

Abstract
SUMMARY Human rhinoviruses (HRVs), first discovered in the 1950s, are responsible for more than one-half of cold-like illnesses and cost billions of dollars annually in medical visits and missed days of work. Advances in molecular methods have enhanced our understanding of the genomic structure of HRV and have led to the characterization of three genetically distinct HRV groups, designated groups A, B, and C, within the genus Enterovirus and the family Picornaviridae. HRVs are traditionally associated with upper respiratory tract infection, otitis media, and sinusitis. In recent years, the increasing implementation of PCR assays for respiratory virus detection in clinical laboratories has facilitated the recognition of HRV as a lower respiratory tract pathogen, particularly in patients with asthma, infants, elderly patients, and immunocompromised hosts. Cultured isolates of HRV remain important for studies of viral characteristics and disease pathogenesis. Indeed, whether the clinical manifestations of HRV are related directly to viral pathogenicity or secondary to the host immune response is the subject of ongoing research. There are currently no approved antiviral therapies for HRVs, and treatment remains primarily supportive. This review provides a comprehensive, up-to-date assessment of the basic virology, pathogenesis, clinical epidemiology, and laboratory features of and treatment and prevention strategies for HRVs.

PMID: 23297263 [PubMed - in process]

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Impact of Chronic Obstructive Pulmonary Disease on Postoperative Outcomes: Results from a National Database.

Chest. 2013 Jan 3;

Authors: Gupta H, Ramanan B, Gupta PK, Fang X, Polich A, Modrykamien A, Schuller D, Morrow LE

Abstract
ABSTRACT BACKGROUND: Although chronic obstructive pulmonary disease (COPD) affects large sections of the population, its effects on postoperative outcomes have not been rigorously studied. Our objectives were to describe the prevalence of COPD in patients undergoing surgery and to analyze the associations between COPD and postoperative morbidity, mortality, and length of stay. METHODS: Patients with COPD who underwent surgery were identified from the NSQIP database (2007 -08). Using this multicenter, prospective dataset (n=468,795), univariate and multivariate analyses were performed. RESULTS: COPD was present in 22,576 (4.82%) patients. These patients were more likely to be older, males, Caucasians, smokers, on corticosteroids, and with lower BMI (p<0.0001 for each). Median length of stay was 4 days for COPD patients vs. 1 day in those without COPD (p<0.0001). Thirty-day morbidity rates were 25.8% and 10.2%, for patients with and without COPD, respectively (p<0.0001). Thirty-day death rate was 6.7% for COPD patients vs. 1.4% in those without COPD (p<0.0001). After controlling for more than 50 comorbidities using logistic regression modeling, COPD was independently associated with higher postoperative morbidity (OR 1.35; 95%CI- 1.30-1.40; p<0.0001) and mortality (OR 1.29; 95%CI- 1.19-1.39; p<0.0001). Multivariate analyses using each individual postoperative complication as the outcome of interest showed that COPD was associated with increased risk for postoperative pneumonia, respiratory failure, myocardial infarction, cardiac arrest, sepsis, return to operating room, and renal insufficiency/failure (p<0.05 for each). CONCLUSION: COPD is common among patients undergoing surgery and is associated with increased morbidity, mortality, and length of stay.

PMID: 23287892 [PubMed - as supplied by publisher]

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Combination antihypertensive therapy among patients with COPD.

Chest. 2013 Jan 3;

Authors: Herrin MA, Feemster LC, Crothers KA, Uman JE, Bryson CL, Au DH

Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and hypertension both increase the risk of congestive heart failure (CHF). Current clinical trials do not inform selection of combination antihypertensive therapy among patients with COPD. We performed a comparative effectiveness study to investigate whether choice of dual agent antihypertensive therapy is associated with risk of hospitalization for CHF among patients with these two conditions. METHODS: We identified a cohort of 7,104 patients with a diagnosis of COPD and hypertension receiving care within VA between 1/2001-12/2006 with follow-up through 4/2009. We included only patients prescribed two antihypertensive medications. We used Cox proportional hazard models for statistical analysis. RESULTS: Compared with beta-blockers plus an ACE-I/ARB, patients prescribed a thiazide diuretic plus a beta-blocker (adjusted hazard ratio [HR] = 0.49; 95% CI: 0.32 - 0.75), a thiazide plus an ACEI/ARB (adjusted HR = 0.50; 95% CI: 0.35 - 0.71), and a thiazide plus a CCB (adjusted HR = 0.55; 95% CI: 0.35 - 0.88) had a significantly lower risk of hospitalization for CHF. After stratification by previous history of CHF, we found this association was isolated only to those patients without a pre-existing history of CHF. Adjustment for patient characteristics and comorbidities had a small effect on risk of hospitalization. Antihypertensive medication combination choice had no significant association with risk of COPD exacerbation. CONCLUSIONS: Among patients with comorbid hypertension and COPD requiring two antihypertensive agents, combination therapy including a thiazide diuretic was associated with a significantly lower risk of hospitalization for CHF among patients without prior diagnosis of CHF.

PMID: 23287970 [PubMed - as supplied by publisher]

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Retrospective Analysis of the Relationship between Decline in FEV(1) and Abdominal Circumference in Male Smokers: the Takahata Study.

Int J Med Sci. 2013;10(1):1-7

Authors: Sato M, Shibata Y, Abe S, Inoue S, Igarashi A, Yamauchi K, Aida Y, Kishi H, Nunomiya K, Nakano H, Sato K, Watanabe T, Konta T, Ueno Y, Kato T, Kayama T, Kubota I

Abstract
Background:Metabolic syndrome (Mets) is reportedly associated with chronic obstructive pulmonary disease (COPD). However, the relationship between abdominal circumference (AC) and decline in FEV(1) has not been elucidated. We aimed to investigate this relationship among male current smokers.Methods:Spirometry was performed on subjects (n = 3,257) ≥ 40 years of age, who participated in a community-based annual health check in Takahata, Japan, from 2004 through 2006 (visit 1). Spirometry was re-evaluated, and AC was assessed in 147 of the male current smokers in 2009 (visit 2). The diagnosis of Mets was based on the criteria used in the Hisayama Study.Results:No significant relationships were observed between AC and spirometric parameters such as % predicted forced vital capacity (FVC), % predicted forced expiratory volume in 1 s (FEV(1)) and FEV(1)/FVC. However, decline in FEV(1) was significantly correlated with AC. Multivariate logistic regression analysis showed that AC was a significant discriminating factor for decline in FEV(1), independently of age, Brinkman index and change in body mass index from visit 1 to visit 2. At visit 2, there was a greater prevalence of decline in FEV(1) among subjects with Mets (n=17) than among those without Mets. Although there were no differences in % predicted FVC, % predicted FEV(1) or FEV(1)/FVC between subjects with or without Mets, the rate of decline in FEV(1) was significantly greater in subjects with Mets than in those without.Conclusions:This retrospective analysis suggested that measuring AC may be useful for discriminating male smokers who show a decline in FEV(1).

PMID: 23288999 [PubMed - in process]