RESUMEN
This study was aimed at searching new instruments for primary differentiation of dyspnea associated with lung or heart pathology. The study consisted of 3 stages and included analysis of "glossary dyspnea" of 482 patients aged 18-90yr. Stages i and II involved 359 patients with the known diagnosis: chronic obstructive pulmonary disease (COPD) (n=114, 31.8%), bronchial asthma (BA) (n=134, 3 7.3%), chronic heart failure (CHF) unrelated to lung pathology (n=111, 30.9%). The patients were 205 (57.1%) men and 154 (42.9%) women. Stage III involved 123 patients complaining ofdyspneapresumably ofpulmnonary or cardiac origin. 75 (61.0%) of these patients were men, 48 (39.0%) women aged 18-89 yr. Subsequent comprehensive diagnostics revealed BA in 47 (38.2%), COPD in 46 (37.4%), CHF in 30 (24.4%) patents. Stage I was designed to evaluate the dyspnea language based on the frequency of the phases of glossary dyspnea (Simon et al., 1999) and Fisher's Z criterion. It permitted to create the modified glossary dyspnea (MGD) consisting of 11i phrases and 7 clusters that revealed statistically significant differences between patients with BA, COPD, and CHE At stage II, we developed the model for estimating the probability of a priori diagnosis (PPD) as a possible cause of dyspnea based on the data of MGD and modified Bayesian classificator. At stage III, the PPD model was verified using blindly selected patients. Prior to verification, the patients filled MGD. The final diagnosis was specified in accordance with the national recommendations. on diagnostics of BA, COPD and CHE Comparison of the frequency of coincidence between preliminary (a priori) and definitive (a posteriori) diagnoses made it possible to evaluate sensitivity and specificity of the PPD model for BA, COPD, and CHF unrelated to lung pathology.
Asunto(s)
Asma/complicaciones , Disnea/clasificación , Insuficiencia Cardíaca/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Disnea/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
The study of thrombin production included 68 patients with severe pneumonia (SP) undergoing monitoring plasma thrombin potential in the thrombin generation test. Thrombin production was found to decrease in the patients who died compared with those alive on days 3-5 and 7-10 after onset of the disease. Endogenous thrombin potential decreased progressively during the first 7-10 days among the patients with the fatal outcome of SP. This trend in thrombin generation can be used to predict the unfavourable outcome of SP.
Asunto(s)
Neumonía Bacteriana , Sepsis , Trombina , Pruebas de Coagulación Sanguínea/métodos , Pruebas de Coagulación Sanguínea/normas , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Evaluación de Resultado en la Atención de Salud , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/metabolismo , Neumonía Bacteriana/mortalidad , Neumonía Bacteriana/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Federación de Rusia/epidemiología , Sepsis/etiología , Sepsis/fisiopatología , Índice de Severidad de la Enfermedad , Trombina/análisis , Trombina/metabolismo , Factores de TiempoRESUMEN
Pneumonia is a most common human disease and a leading cause of death from infectious pathology. The mortality rate amounts to 5.20% despite the improvement of the existing methods of treatment. Over 37,000 patients die from pneumonia each year in Russia. Severe pneumonia is an especially serious challenge. The aim of this work was to study the incidence of severe clinical variants of pneumonia (SP), elucidation of its main phenotypes and predictors of adverse outcome. It included retrospective analysis of 101 cases of SP diagnosed based on generally accepted criteria. The clinical symptoms of SP, its incidence, relationship between SP and sepsis are considered along with predictors of adverse outcome. The main phenotypes of SP are distinguished according the leading resuscitation syndrome (SP with sepsis without multiple organ failure (6.9%) including SP with clinical manifestations of acute respiratory failure/acute respiratory distress syndrome (4.0%), SP with severe sepsis (93.1%) including SP with septic shock (26.7%). Bacteremia was documented in 10.1% of the patients. Estimation of the cases with favourable outcome of SP using APACHE II, MODS-2 and SOFGA integral scales gave values of 12.4, 4.7 and 5.4 respectively. They were increased by a factor of 1.7, (APACHE II) and 1.9 (MODS-2 and SOFA) in the patients who died from pneumonia. These values can be regarded as predictors of adverse outcome of SP.
Asunto(s)
Indicadores de Salud , Neumonía , Índice de Severidad de la Enfermedad , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/complicaciones , Neumonía/mortalidad , Neumonía/fisiopatología , Adulto JovenRESUMEN
Sleep obstructive apnea syndrome (SOAS) is a life-threatening respiratory disorder. Its combination with COPD further deteriorates respiratory distress and accelerates the development of pulmonary hypertension (crossover syndrome). Systemic inflammation with concomitant oxidative stress in patients with SOAS and COPD suggests their influence on the development of circulatory disorders. Night-time cyclic hypoxia in patients with SOAS triggers systemic inflammation, oxidative stress, and atherogenesis which accounts for the frequent complications more severe in combination of SOAS and COPD than in either of these diseases. Intermittent hypoxia in patients with SOAS is associated with hypoventilation resulting from COPD, deteriorates clinical conditions of the patients, and requires the choice of specific methods of respiratory support.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Apnea Obstructiva del Sueño/complicaciones , Comorbilidad , Humanos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/fisiopatologíaRESUMEN
AIM: To study quality of monitoring, features of a course and therapy of severe bronchial asthma (BA) in Russia. MATERIALS AND METHODS: The trial recruited 378 patients with severe bronchial asthma (SBA) in 7 cities of Russia. Each center participating in the study filled in individual case sheets recording demographic, clinical, monitoring, pharmacotherapeutic data. A special focus was on factors influencing the disease course. The chi-square and Mann-Witney criteria were used. RESULTS: It was found that current recommendations of BA patients' management are not used in full. Most of the patients do not receive adequate therapy. Phenotypes of uncontrolled course of severe BA are prevalent. The key role of adequate management of severe BA patients in control of the disease is shown. CONCLUSION: Wider use of updated recommendations on therapy and monitoring of BA with special focus on patients with uncontrolled course of the disease is urgent. Fulfilment of all the components of management of a patient with bronchial asthma recommended by GINA including the patient education and control over the disease triggers contribute much to effective treatment and control over BA.