RESUMEN
BACKGROUND: Chronic respiratory failure complicating sleep-disordered breathing in obese patients has important adverse clinical implications in terms of morbidity, mortality and healthcare utilisation. Screening strategies are essential to identify obese patients with chronic respiratory failure. METHOD: Prospective data were collected from patients with obesity-related sleep-disordered breathing admitted for respiratory assessment at a UK national sleep and ventilation centre. Hypercapnia was defined as an arterial partial pressure of carbon dioxide of >6kPa. RESULTS: 245 obese patients (56±13â years) with a body mass index of 48±12â kg/m(2), forced vital capacity (FVC) of 2.1±1.1â L, daytime oximetry (SpO2) of 91±6% and abnormal overnight oximetry were included in the analysis. Receiver operator curve analysis for the whole group showed that an FVC ≤3â L had a sensitivity of 90% and a specificity of 41% in predicting hypercapnia, and an SpO2 ≤95% had a sensitivity of 83% and a specificity of 63% in predicting hypercapnia. Gender differences were observed and receiver operator curve analysis demonstrated 'cut-offs' for (1) SpO2 of ≤95% for men and ≤93% for women and (2) FVC of ≤3.5â L for men and ≤2.3â L for women, in predicting hypercapnia. CONCLUSIONS: The measurement of FVC and clinic SpO2 in obese patients with abnormal overnight limited respiratory studies predicted hypercapnia. This may have clinical utility in stratifying patients attending sleep clinics.
RESUMEN
The association between physical activity and risk of hospitalisation for chronic obstructive pulmonary disease (COPD) is not yet clear. We conducted a systematic review of the literature to fill this gap in knowledge. Eight electronic databases were searched using a selection of controlled vocabulary and keywords. The search resulted in more than 1000 initial hits, of which four met the inclusion criteria. For each identified study, relevant data were extracted and appraised. The results indicate that less physically active patients with COPD were more likely to be admitted to hospital. Consistent with a lower level of physical activity, the patients tended to have shorter walking times as well as spend fewer hours outdoors. In multivariate regression analysis, self-reported physical activity predicted hospitalisation in patients from the general population and re-hospitalisation in patients admitted for an acute exacerbation. The evidence for an association between physical activity and risk of hospitalisation for COPD is limited to a few prospective cohort studies. More research is needed to quantify the degree of physical activity associated with reduced risk of hospitalisation.
Asunto(s)
Hospitalización , Enfermedad Pulmonar Obstructiva Crónica/terapia , Conducta Sedentaria , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Readmisión del Paciente , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , CaminataRESUMEN
We investigated the effect of aqueous extract of Vitex rotundifolia (L.) (Verbenaceae) fruits (VRFE) on the immediate-type allergic reactions in vivo and in vitro. VRFE (10(-4)-1.0 g/kg) dose-dependently inhibited systemic allergic reaction induced by compound 48/80. When VRFE was employed in a systemic allergic reaction test, the plasma histamine levels were reduced in a dose-dependent manner. VRFE (5x10(-1) and 1.0 g/kg) inhibited passive cutaneous anaphylaxis activated by anti-dinitrophenyl (DNP) IgE. VRFE (10(-3)-1.0 mg/ml) also dose-dependently inhibited the histamine release from the rat peritoneal mast cells (RPMC) by compound 48/80 or anti-DNP IgE. Moreover, VRFE (10(-3) mg/ml) had a significant inhibitory effect on anti-DNP IgE-induced tumor necrosis factor-alpha production from RPMC. These results suggest that VRFE may be beneficial in the regulation of immediate-type allergic reaction.