Multidisciplinary Respiratory Medicine最新文献

{"title":"Emergency Department Visits for allergy related-disorders among children: experience of a single Italian hospital during the first wave of the COVID-19 pandemic.","authors":"Marina Attanasi,&nbsp;Annamaria Porreca,&nbsp;Giuseppe Francesco Sferrazza Papa,&nbsp;Gulia Di Donato,&nbsp;Chiara Cauzzo,&nbsp;Roberta Patacchiola,&nbsp;Paola Di Filippo,&nbsp;Sabrina Di Pillo,&nbsp;Francesco Chiarelli","doi":"10.4081/mrm.2021.786","DOIUrl":"https://doi.org/10.4081/mrm.2021.786","url":null,"abstract":"<p><p><i>Introduction:</i> The aim of this study was to compare the number of the Pediatric Emergency Department (PED) visits for young allergic patients with respiratory or cutaneous symptoms during the first wave of the coronavirus disease 19 (COVID-19) pandemic in 2020 with the same period in 2019, evaluating the percentage of positive cases to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We carried out a retrospective analysis using data from young patients who visited the PED with cutaneous or respiratory symptoms in the period from 20^th February to 12^th May of the years 2020 and 2019. Data on allergy and COVID-19 nasal swab were also collected. We observed eleven (28.2%) PED visits for allergic patients with respiratory or cutaneous symptoms for the period from 20^th February to 12^th May of the year 2020 and ninety-three (31.8%) PED visits for the same time frame of the year 2019 (p=0.645). Only a two-month-old child out of 39 patients with non-allergic respiratory or cutaneous symptoms resulted positive for SARS-CoV-2. Specifically, we found for all the PED visits: 21 (7.2%) in 2019 <i>vs</i> 2 (5.1%) in 2020 for patients with urticaria/angioedema or atopic dermatitis (p=0.634); 3 (1.0%) in 2019 <i>vs</i> 3 (7.7%) in 2020 for patients with anaphylaxis (p=0.003); 19 (6.5%) in 2019 <i>vs</i> 2 (5.1%) in 2020 for those with asthma (p=0.740); 11(3.8%) in 2019 <i>vs</i> 1(2.6%) in 2020 for those with lower respiratory diseases, excluding asthma (p=0.706); 39(13.4%) in 2019 <i>vs</i> 3 (7.7%) in 2020 for those with upper respiratory diseases (URDs) (p=0.318). We also showed a substantial decrease (~80%) in all PED visits compared with the same time frame in 2019 (absolute number 263 <i>vs</i> 1,211, respectively). Among all the PED visits a significant reduction was mostly found for URDs [155 (12.8%) in 2019 <i>vs</i> 17 (6.5%) in 2020; p=0.045)]. The total number of PED visits for allergic patients with respiratory or cutaneous symptoms dropped precipitously in 2020. It is very tricky to estimate whether it was a protective action of allergy or the fear of contagion or the lockdown or a reduction in air pollution that kept children with allergy from visiting the PED. Further studies are needed to better understand the impact of underlying allergies on COVID-19 susceptibility and disease severity.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"786"},"PeriodicalIF":2.3,"publicationDate":"2021-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/86/mrm-16-1-786.PMC8524361.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39597880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real world effectiveness of benralizumab on respiratory function and asthma control.","authors":"Francesco Menzella,&nbsp;Matteo Fontana,&nbsp;Carla Galeone,&nbsp;Giulia Ghidoni,&nbsp;Silvia Capobelli,&nbsp;Patrizia Ruggiero,&nbsp;Chiara Scelfo,&nbsp;Anna Simonazzi,&nbsp;Chiara Catellani,&nbsp;Francesco Livrieri,&nbsp;Nicola Cosimo Facciolongo","doi":"10.4081/mrm.2021.785","DOIUrl":"https://doi.org/10.4081/mrm.2021.785","url":null,"abstract":"<p><strong>Background: </strong>Biological drugs have been recognized as a breakthrough in the treatment of severe refractory asthma. This retrospective real-life observational study aims to evaluate the effect of add-on benralizumab on lung function, exacerbation rate, oral corticosteroids (OCS) reduction and asthma control questionnaire (ACQ) score after 52-weeks.</p><p><strong>Methods: </strong>In this observational study, a cohort of 18 patients with severe eosinophilic asthma (SEA) according to the ERS / ATS and GINA 2020 classifications, with reference to the Pulmonology Unit of the Azienda USL - IRCCS, Reggio Emilia, Italy, were enrolled from 1 September 2019 to 31 August 2020. For each patient, the following data were collected: demographic data (age, sex, age of onset of asthma, history of smoking and atopy); comorbidity; clinical data (lung function, exacerbations, emergency room visits and hospitalizations); asthma control questionnaire (ACQ); biomarkers (blood eosinophil count and total serum IgE); asthma control drugs as high-dose inhaled corticosteroids / long-acting beta-adrenoceptor agonists (ICS / LABA), long-acting muscarinic antagonists (LAMA), leukotriene receptor antagonists (LTRA), theophylline, OCS. The benralizumab 30 mg treatment schedule was based on the currently recommended dosing regimen.</p><p><strong>Results: </strong>After end-of-treatment (EOT), a complete weaning of all patients from OCS was confirmed. After 26 weeks, the number of exacerbations decreased from 2.90 to 0.05 (p<0.0001), hospitalizations and ACQ score decreased from 3.37 to 0.97 (p<0.0001). At EOT, the number of exacerbations was unchanged, while no hospitalizations had occurred. Overall, lung function markedly improved over the study period. After 52 weeks, the increase in FEV₁ from baseline was 26,8% (p=0.0002). The subset of patients with nasal polyposis (NP) had an increase of nearly 50% (1008 ml) and patients with blood eosinophils count (BEC) greater than 500 cells / μl showed an increase of 68% (1081 ml) in FEV₁ at EOT.</p><p><strong>Conclusions: </strong>The notable improvement in respiratory function is a significant result in this study and it is much higher than what has emerged to date. This result, together with the OCS sparing effect and the excellent clinical control of asthma, makes benralizumab a reliable and safe therapeutic option for SEA.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"785"},"PeriodicalIF":2.3,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/0c/mrm-16-1-785.PMC8506201.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39588484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and clinical features of most frequent phenotypes in the Italian COPD population: the CLIMA Study.","authors":"Roberto W Dal Negro,&nbsp;Mauro Carone,&nbsp;Giuseppina Cuttitta,&nbsp;Luca Gallelli,&nbsp;Massimo Pistolesi,&nbsp;Salvatore Privitera,&nbsp;Piero Ceriana,&nbsp;Pietro Pirina,&nbsp;Bruno Balbi,&nbsp;Carlo Vancheri,&nbsp;Franca M Gallo,&nbsp;Alfredo Chetta,&nbsp;Paola Turco","doi":"10.4081/mrm.2021.790","DOIUrl":"https://doi.org/10.4081/mrm.2021.790","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a complex, progressive respiratory condition characterized by heterogeneous clinical presentations (phenotypes). The aim of this study was to assess the prevalence of the main COPD phenotypes and match of each phenotype to the most fitting clinical and lung function profile.</p><p><strong>Methods: </strong>the CLIMA (Clinical Phenotypes in Actual Clinical Practice) study was an observational, cross-sectional investigation involving twenty-four sites evenly distributed throughout Italy. Patients were tentatively grouped based on their history and claimed prevailing symptoms at recruitment: chronic cough (CB, suggesting chronic bronchitis); dyspnoea (possible emphysema components, E); recurrent wheezing (presuming asthma components, A). Variables collected were: anagraphics; smoking habit; history of asthma; claim of >1 exacerbations in the previous year; blood eosinophil count; total blood IgE and alpha¹ anti-trypsin (α¹-AT) levels; complete lung function, and the chest X-ray report. mMRC, CAT, BCS, EQ5d-5L were also used. The association between variables and phenotypes were checked by Chi-square test and multinomial logistic regression.</p><p><strong>Results: </strong>The CB phenotype was prevalent (48.3%), followed by the E and the A phenotypes (38.8% and 12.8%, respectively). When dyspnoea was the prevailing symptom, the probability of belonging to the COPD-E phenotype was 3.40 times higher. Recurrent wheezing was mostly related to the COPD-A phenotype. Lung function proved more preserved in the COPD-CB phenotype. Smoke; n. exacerbations/year; VR, and BODE index were positively correlated with the COPD-E phenotype, while SpO₂, FEV₁/FVC, FEV₁/VC, and FEV₁ reversibility were negatively correlated. Lower DLco values were highly probative for the COPD-E phenotype (p<0.001). Conversely, smoke, wheezing, plasma eosinophils, FEV₁ reversibility, and DLco were positively correlated with the COPD-A phenotype. The probability of belonging to the COPD-A phenotype raised by 2.71 times for any increase of one unit in % plasma eosinophils (p<0.001). Also multiparametrical scores contributed to discriminate the three phenotypes.</p><p><strong>Conclusion: </strong>The recognition of the main phenotypes of COPD can be effectively pursued by means of a few clinical and instrumental parameters, easy to obtain also in current daily practice. The phenotypical approach is crucial in the management of COPD as it allows to individualize the therapeutic strategy and to obtain more effective clinical outcomes.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"790"},"PeriodicalIF":2.3,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/22/mrm-16-1-790.PMC8506204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39588485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In memory of Dr. Claudio F. Donner","authors":"C. Sanguinetti","doi":"10.4081/mrm.2021.804","DOIUrl":"https://doi.org/10.4081/mrm.2021.804","url":null,"abstract":"Claudio F. Donner suddenly passed away on August 19 of this year. He was one of the most outstanding and skilled scientists in the field of respiratory medicine.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"1 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43721933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors correlated with hypertension secondary from obstructive sleep apnea.","authors":"Sittichai Khamsai,&nbsp;Pawornwan Mahawarakorn,&nbsp;Panita Limpawattana,&nbsp;Jarin Chindaprasirt,&nbsp;Wattana Sukeepaisarnjaroen,&nbsp;Songkwan Silaruks,&nbsp;Vichai Senthong,&nbsp;Bundit Sawunyavisuth,&nbsp;Kittisak Sawanyawisuth","doi":"10.4081/mrm.2021.777","DOIUrl":"https://doi.org/10.4081/mrm.2021.777","url":null,"abstract":"<p><strong>Background: </strong>In 2003, the JNC 7 reported obstructive sleep apnea (OSA) as a cause of secondary hypertension. The prevalence of OSA in hypertension ranges from 30-80%. There are limited data on the prevalence and risk factors of OSA in hypertensive patients. This study thus aimed to evaluate prevalence and clinical predictors of obstructive sleep apnea (OSA) in these patients.</p><p><strong>Methods: </strong>This was a cross-sectional study and conducted at the hypertension clinic at Khon Kaen University's Srinagarind Hospital, Thailand. We enrolled patients with hypertension treated at the clinic. OSA was defined as apnea-hypopnea index of 5 events/hour or over according to cardiopulmonary monitoring. Patients whose hypertension was due to any other causes were excluded. The prevalence of OSA was calculated and risk factors for OSA were analyzed using multivariate logistic regression.</p><p><strong>Results: </strong>There were 726 hypertensive patients treated at the clinic. Out of those, 253 (34.8%) were randomly studied and categorized as either non-OSA (147 patients, 58.1%) or OSA (106 patients, 41.9%). There were four independent factors associated with OSA-induced hypertension: age, sex, history of snoring, and history of headache. Headache had an adjusted odds ratio (95% confidence interval) of 3.564 (95% confidence interval of 1.510, 8.411).</p><p><strong>Conclusion: </strong>Age, male sex, history of snoring, and headache were independent predictors of hypertension caused by OSA.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"777"},"PeriodicalIF":2.3,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5e/6b/mrm-16-1-777.PMC8447556.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39519221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new mode of mechanical ventilation: positive + negative synchronized ventilation.","authors":"Umberto Vincenzi","doi":"10.4081/mrm.2021.788","DOIUrl":"https://doi.org/10.4081/mrm.2021.788","url":null,"abstract":"<p><p>Supporting patients suffering from severe respiratory diseases with mechanical ventilation, obstacles are often encountered due to pulmonary and/or thoracic alterations, reductions in the ventilable lung parenchyma, increases in airway resistance, alterations in thoraco-pulmonary compliance, advanced age of the subjects. All this involves difficulties in finding the right ventilation parameters and an adequate driving pressure to guarantee sufficient ventilation. Therefrom, new mechanical ventilation techniques were sought that could help overcome the aforementioned obstacles. A new mode of mechanical ventilation is being presented, <i>i.e</i>., a Positive + Negative Synchronized Ventilation (PNSV), characterized by the association and integration of two pulmonary ventilators; one acting inside the chest with positive pressures and one externally with negative pressure. The peculiarity of this combination is the complete synchronization, which takes place with specific electronic modifications. The PNSV can be applied both in a completely non-invasive and invasive way and, therefore, be used both in acute care wards and in ICU. The most relevant effect found, due to the compensation of opposing pressures acting on the chest, is that, during the entire inspiratory act created by the ventilators, the pressure at the alveolar level is equal to zero even if adding together the two ventilators' pressures; thus, the transpulmonary pressure is doubled. The application of this pressure for 1 hour on elderly patients suffering from severe acute respiratory failure, resulted in a significant improvement in blood gas analytical and clinical parameters without any side effects. An increased pulmonary recruitment, including posterior lung areas, and a reduction in spontaneous ventilatory rate have also been demonstrated with PNSV. This also paves the way to the search for the best ventilatory treatment in critically ill or ARDS patients. The compensation of intrathoracic pressures should also lead, although not yet proven, to an improvement in venous return, systolic and cardiac output. In the analysis of the study in which this method was applied, the total transpulmonary pressure delivered was the sum of the individual pressures applied by the two ventilators. However, this does not exclude the possibility of reducing the pressures of the two machines to modulate a lower but balanced total transpulmonary pressure within the chest.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"788"},"PeriodicalIF":2.3,"publicationDate":"2021-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/32/mrm-16-1-788.PMC8441538.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39468275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the knowledge gap in Malaysian pharmacists: a virtual Allergic Rhinitis Boot Camp initiative.","authors":"Baharudin Abdullah,&nbsp;Ramiza Ramza Ramli,&nbsp;Norasnieda Md Shukri,&nbsp;Sakinah Mohamad","doi":"10.4081/mrm.2021.775","DOIUrl":"https://doi.org/10.4081/mrm.2021.775","url":null,"abstract":"<p><strong>Background: </strong>In primary care, general practitioners (GPs) and pharmacists are at the frontline to identify, classify and manage patients suffering from allergic rhinitis (AR). The Allergic Rhinitis and its impact on Asthma (ARIA) guidelines aid clinicians in disease management by providing evidence-based recommendations. A recently published ASEAN primary care survey demonstrated that the awareness of ARIA guidelines was high among GPs but notably lower in pharmacists. Hence, this study seeks to evaluate the effectiveness of a Boot Camp education initiative in bridging the unmet needs in pharmacist awareness and education.</p><p><strong>Methods: </strong>The boot camp was organised as a virtual event. The participants answered the same questionnaire before (pre-assessment) and immediately after (post-assessment) the boot camp session. Statistical analysis was performed on the data paired between the pre- and post- assessments using SPSS v. 25.0 software.</p><p><strong>Results: </strong>The boot camp survey results showed that second-generation oral antihistamines and allergen avoidance are the most preferred options for AR treatment in pharmacy practice, irrespective of the disease severity. In both pre- and post-assessments, efficacy was ranked as the most important factor considered for choosing an antihistamine and which affects patient adherence. With the boot camp initiative, there was a statistically significant increase in awareness about the patient profiling tool (from 31.6% to 88.2%) and ARIA guidelines (from 40.4% to 91.2%) among the pharmacists (p<0.05). The proportion of pharmacists who were able to identify, classify and refer AR patients was significantly increased in post-assessment (p<0.05). Post the boot camp, among the proportion of pharmacists (91.2%) who were already aware of ARIA, a high percentage of them further agreed that ARIA guidelines were useful in identifying and treating patients with AR, as well as classifying AR, respectively (97.6%, 95.2%, and 93.5%).</p><p><strong>Conclusions: </strong>Based on improvements in knowledge and understanding of disease management post assessment, the Allergic Rhinitis Boot Camp initiative is effective and relevant to pharmacy practice. Outreach programs like this reiterate the emphasis on patient compliance and importance of utilizing ARIA guidelines in pharmacy practice that facilitates better management of AR in primary care.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"775"},"PeriodicalIF":2.3,"publicationDate":"2021-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/e4/mrm-16-1-775.PMC8441537.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39490429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of asthma severity as risk factor to future exacerbations in patients admitted for asthma exacerbation.","authors":"Narongwit Nakwan","doi":"10.4081/mrm.2021.780","DOIUrl":"https://doi.org/10.4081/mrm.2021.780","url":null,"abstract":"<p><strong>Background: </strong>To investigate the impact of disease severity on exacerbation patterns and identify its potential as a risk factor for future exacerbations in patients admitted for asthma exacerbations.</p><p><strong>Methods: </strong>We analyzed frequency and time to next exacerbation over a period of three years in 532 patients admitted for exacerbation. Disease severity was selected as a potential risk factor for the events. Kaplan-Meier analysis was used to identify the probability of future exacerbations. A Cox-proportional hazards model was used to assess independent relative risks.</p><p><strong>Results: </strong>Out of 532 patients analyzed, the frequency of exacerbations rose as the severity of the asthma increased. The exacerbation rates in the following year were 1.66 per person for patients with mild asthma and 3.98 for patients with severe asthma. The median time to the next exacerbation in patients with mild asthma was 61.4 weeks (95% CI, 40.1-82.6) compared to 15.0 weeks (95% CI, 11.3-18.6) in patients with severe asthma (p<0.001). Multivariate analysis showed that asthma severity (severe vs mild asthma, HR=1.42, 95% CI, 1.07-1.89), a history of 1-2 exacerbations (HR=1.95, 95% CI, 1.45-2.63) or > 2 exacerbations (HR=2.32, 95% CI, 1.56-3.44) in the previous 12 months, and a high number of comorbidities (≥5 <i>vs</i> none, HR=2.5, 95% CI, 1.41-4.45) were independent predictors of the probability of future exacerbations.</p><p><strong>Conclusion: </strong>Asthma severity is a strong independent risk factor for future exacerbations, and exacerbation rates also become more frequent as the severity of the asthma increases. These findings help in better understanding of the natural course of exacerbations across the spectrum of asthma disease severity.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"780"},"PeriodicalIF":2.3,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/ed/mrm-16-1-780.PMC8419716.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39446570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries.","authors":"Ablo Prudence Wachinou,&nbsp;Serge Ade,&nbsp;Maimouna Ndour Mbaye,&nbsp;Boubacar Bah,&nbsp;Naby Baldé,&nbsp;Jules Gninkoun,&nbsp;Wilfried Bekou,&nbsp;Marie Sarr,&nbsp;Oumou Bah Sow,&nbsp;Dissou Affolabi,&nbsp;Corinne Merle","doi":"10.4081/mrm.2021.783","DOIUrl":"https://doi.org/10.4081/mrm.2021.783","url":null,"abstract":"<p><strong>Background: </strong>To determine the prevalence of tuberculosis (TB) and associated factors in persons with diabetes mellitus (DM) in Benin, Guinea and Senegal.</p><p><strong>Patients and method: </strong>A cross-sectional study was conducted in the largest DM center in each country. Participants systematically underwent clinical screening and chest radiography. Participants who were symptomatic or with abnormal radiography underwent bacteriological investigations (sputum smear, Xpert MTB/RIF and culture) on sputum. Participants with no TB at enrolment were re-examined for TB six months later. Logistic regression was performed to identify factors associated with TB.</p><p><strong>Results: </strong>There were 5,870 DM patients: 1,881 (32.0%) in Benin, 1,912 (32.6%) in Guinea and 2,077 (35.4%) in Senegal. Out of these, 114 had bacteriologically-confirmed TB, giving a pooled prevalence of 1.9% (95%CI=1.6-2.3). TB prevalence was 0.5% (95%CI=0.3-1.0), 2.4% (95%CI=1.8-3.2) and 2.8% (95%CI=2.2-3.6), respectively, in Benin, Guinea and Senegal. Factors associated with an increased odds of TB diagnosis were a usual residence in Guinea (aOR=2.62;95%CI=1.19-5.77; p=0.016) or in Senegal (aOR=3.73;95%CI=1.85-7.51; p<0.001), the age group of 35-49 years (aOR=2.30;95%CI=1.11-4.79; p=0.025), underweight (aOR=7.34;95%CI=4.65-11.57; p<0.001) and close contact with a TB case (aOR=2.27;95%CI=1.37-3.76; p=0.002). Obesity was associated with lower odds of TB (aOR=0.20; 95%CI=0.06-0.65; p=0.008).</p><p><strong>Conclusion: </strong>TB is prevalent among DM patients in Benin, Guinea and Senegal and higher than among the general population. The findings support the need for intensified case finding in DM patients in order to ensure systematic early detection of TB during the routine consultation process.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"783"},"PeriodicalIF":2.3,"publicationDate":"2021-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/ca/mrm-16-1-783.PMC8404526.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39446571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pharmacoeconomics of the state-of-the-art drug treatments for asthma: a systematic review.","authors":"Francesco Menzella,&nbsp;Carla Galeone,&nbsp;Giulia Ghidoni,&nbsp;Patrizia Ruggiero,&nbsp;Maria D'Amato,&nbsp;Matteo Fontana,&nbsp;Nicola Facciolongo","doi":"10.4081/mrm.2021.787","DOIUrl":"https://doi.org/10.4081/mrm.2021.787","url":null,"abstract":"<p><p>Asthma is a chronic disease characterized by significant morbidities and mortality, with a large impact on socio-economic resources and a considerable burden on health-care systems. In the standard care of asthma, inhaled corticosteroids (ICS) associated with long-acting β-adrenoceptor agonists (LABA) are a reliable and often cost-effective choice, especially if based on the single inhaler therapy (SIT) strategy; however, in a subset of patients it is not possible to reach an adequate asthma control. In these cases, it is possible to resort to other pharmacologic options, including corticosteroids (OCS) or biologics. Unfortunately, OCS are associated with important side effects, whilst monoclonal antibodies (mAbs) allow excellent results, even if far more expensive. Up to now, the economic impact of asthma has not been compared with equivalent indicators in several studies. In fact, a significant heterogeneity of the cost analysis is evident in literature, for which the assessment of the real cost-effectiveness of asthma therapies is remarkably complex. To maximize the cost-effectiveness of asthma strategies, especially of biologics, attention must be paid on phenotyping and identification of predictors of response. Several studies were included, involving comparative analysis of drug treatments for asthma, comparative analysis of the costs and consequences of therapies, measurement and evaluation of direct drug costs, and the reduction of health service use. The initial research identified 389 articles, classified by titles and abstracts. A total of 311 articles were excluded as irrelevant and 78 articles were selected. Pharmacoeconomic studies on asthma therapies often report conflicting data also due to heterogeneous indicators and different populations examined. A careful evaluation of the existing literature is extremely important, because the scenario is remarkably complex, with an attempt to homogenize and interpret available data. Based on these studies, the improvement of prescriptive appropriateness and the reduction of the use of healthcare resources thanks to controller medications and to innovative therapies such as biologics partially reduce the economic burden of these treatments. A multidisciplinary stakeholder approach can also be extremely helpful in deciding between the available options and thus optimizing healthcare resources.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"787"},"PeriodicalIF":2.3,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/42/mrm-16-1-787.PMC8404525.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39446572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}