COMPLEX ESTIMATE OF THE TEST OF A 6-MINUTE WALK IN PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE

Одним из важных проявлений большинства хронических легочных заболеваний является одышка, которая, в свою очередь, становится основной причиной ограничения переносимости физических нагрузок. Снижение физической толерантности у больных, страдающих хроническими легочными заболеваниями, обусловлено неспособностью организма обеспечивать необходимое поступление кислорода во время нагрузки, а в клиническом отношении - с невозможностью для пациента выполнять ту физическую работу, которую мог выполнять ранее. Среди методов оценки переносимости физических нагрузок используют кардиопульмонарное тестирование на велоэргометре, тредмиле, которое требует обязательного присутствия врача, что не всегда возможно в амбулаторных условиях. В ряде работ показана достаточная эффективность для диагностики состояния больного и оценки переносимости нагрузки использование для этой цели теста 6-минутный ходьбы. Это тест с ходьбой в произвольном темпе в течение 6 мин. Результатом теста является расстояние, которое больной может быстро пройти по ровной твердой поверхности за 6 мин. Расстояние, пройденное в тесте 6-минутной ходьбы, имеет прогностическое значение при многих заболеваниях, включая ХОБЛ. В данной статье оценивается комплексная оценка модифицированного теста 6-минутной ходьбы у больных ХОБЛ с использованием динамической пульcоксиметрии, которая расширяет диагностические возможности нагрузочного тестирования. Показано, что параллельно нарастанию выраженности одышки у больных снижается сатурация кислорода с постепенным восстановлением в покое. В контрольной группе, несмотря на сопоставимую с больными ХОБЛ одышку, оцениваемую по шкале Борга, насыщение крови кислородом не менялось. Комплексная оценка теста 6-минутной ходьбы поможет объективизировать эффективность проводимых лечебных и профилактических мероприятий у больных с ХОБЛ One of the important manifestations of most chronic pulmonary diseases is a shortness of breath, which, in turn, becomes the main reason for the restability of physical exertion. A decrease in physical tolerance in patients suffering from chronic pulmonary diseases is due to the inability of the body to provide the necessary flow of oxygen during the load, and in the clinical terms - with the impossibility of the patient to carry out that physical work that could be performed earlier. Among the methods for estimating the tolerability of physical loads, cardiopulmonary testing on the bikergometr, tredmil, which requires the mandatory presence of a doctor, which is not always possible in the outpatient conditions. A number of work shows sufficient efficiency for the diagnostic of the patient's condition and the use of load portability to use for this purpose a 6-minute walk. This is a walking speed in an arbitrary pace for 6 minutes. The result of the test is the distance that the patient can quickly go through a smooth solid surface for 6 minutes. The distance traveled in a 6-minute walk test is prognostic in many diseases, including COPD. This article is estimated to be an integrated assessment of a 6-minute walk test using a dynamic pulse oximetry, which expands the diagnostic capabilities of load testing. It has been shown that in parallel increasing the severity of shortness of breath in patients decreases the saturation of oxygen with gradual restoration alone. In the control group, despite comparable with sickness patient with COPD, the oxygen saturation estimated on the Borg scale did not change. A comprehensive test assessment of a 6-minute walk will help to facility the effectiveness of therapeutic and preventive measures to patients with COPD

Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran

Introduction COVID-19 clinical course, effective therapeutic regimen, and poor prognosis risk factors in pediatric cases are still under investigation and no approved vaccinehas been introduced for them. Methods This cross-sectional study evaluated different aspect of COVID-19 infection in hospitalized COVID-19 positive children (≺18 years oldwith laboratory confirmed COVID-19 infection, using the national COVID-19 registry for all admitted COVID-19 positive cases from February 19 until November 13,2020, in Iran. Results We evaluated 6610 hospitalized children. Fifty-four percent (3268) were male and one third of them were infants younger than 1 year. Mortality rate in total hospitalized children was 5.3% and in children with underlying co-morbidities (14.4%) was significantly higher (OR: 3.6 [2.7-4.7]). Chronic kidney disease (OR: 3.42 [1.75-6.67]), Cardiovascular diseases (OR: 3.2 [2.09-5.11]), chronic pulmonary diseases (OR: 3.21 [1.59-6.47]), and diabetes mellitus (OR: 2.5 [1.38-4.55]), resulted in higher mortality rates in hospitalized COVID-19 children. Fever (41%), cough (36%), and dyspnea (27%) were the most frequent symptoms in hospitalized children and dyspnea was associated with near three times higher mortality rate among children with COVID-19 infection (OR: 2.65 [2.13-3.29]). Conclusion Iran has relatively high COVID-19 mortality in hospitalized children. Pediatricians should consider children presenting with dyspnea, infants≺ 1 year and children with underlying co-morbidities, as high-risk groups for hospitalization, ICU admission, and death.

Mechanisms of Hypercapnia-Induced Endoplasmic Reticulum Dysfunction

Protein transcription, translation, and folding occur continuously in every living cell and are essential for physiological functions. About one-third of all proteins of the cellular proteome interacts with the endoplasmic reticulum (ER). The ER is a large, dynamic cellular organelle that orchestrates synthesis, folding, and structural maturation of proteins, regulation of lipid metabolism and additionally functions as a calcium store. Recent evidence suggests that both acute and chronic hypercapnia (elevated levels of CO2) impair ER function by different mechanisms, leading to adaptive and maladaptive regulation of protein folding and maturation. In order to cope with ER stress, cells activate unfolded protein response (UPR) pathways. Initially, during the adaptive phase of ER stress, the UPR mainly functions to restore ER protein-folding homeostasis by decreasing protein synthesis and translation and by activation of ER-associated degradation (ERAD) and autophagy. However, if the initial UPR attempts for alleviating ER stress fail, a maladaptive response is triggered. In this review, we discuss the distinct mechanisms by which elevated CO2 levels affect these molecular pathways in the setting of acute and chronic pulmonary diseases associated with hypercapnia.

The Pharmacokinetic Profile and Bioavailability of Enteral N-Acetylcysteine in Intensive Care Unit

Background and Objectives: N-acetylcysteine (NAC) is a mucolytic agent used to prevent ventilator-associated pneumonia in intensive care units. This study aimed to evaluate the oral bioavailability of NAC in critically ill patients with pneumonia, isolated acute brain injury and abdominal sepsis. Materials and Methods: This quantitative and descriptive study compared NAC’s pharmacokinetics after intravenous and enteral administration. 600 mg of NAC was administered in both ways, and the blood levels for NAC were measured. Results: 18 patients with pneumonia, 19 patients with brain injury and 17 patients with abdominal sepsis were included in the population pharmacokinetic modelling. A three-compartmental model without lag-time provided the best fit to the data. Oral bioavailability was estimated as 11.6% (95% confidence interval 6.3–16.9%), similar to bioavailability in healthy volunteers and patients with chronic pulmonary diseases. Conclusions: The bioavailability of enteral NAC of ICU patients with different diseases is similar to the published data on healthy volunteers.

Evaluation of Work-Related Symptoms by Job Exposure Matrix in Chronic Pulmonary Diseases - A Cross-sectional Study

Background: Despite the high prevalence of occupational airway disorders, they are usually underestimated by physicians. This study designed to study the prevalence of work-related symptoms (WRS) and their association with occupational exposure in outpatient pulmonary clinics. Methods: Adults with more than one year of lower respiratory symptoms were included. Retired patients, housewives and those unable to perform spirometry were excluded. Demographic, anthropometric and medical data were documented. The Persian version of National institute for health and safety respiratory questionnaire was used to classify job titles. WRS were defined as 2 (or more) positive questions with improvement of symptoms on days off work. Job exposure matrix (JEM) was used for classifying the type of occupational exposure into one of three categories: high molecular weight (HKW), low molecular weight (LMW) and mixed. Results: A total of 250 patients (69% male) with mean (±SD) age of 40 (±11.6) years, 178 cases of asthma and 59 chronic obstructive pulmonary disease (COPD) cases entered. Occupational exposure was seen in 51.2% of patients (26, 51 and 51 cases with HMW, LMW and mixed, respectively). WRS were lower in those who exercised regularly (24.6% vs. 39.4%) and higher in those with eczema (62.5% vs. 33.6%). Eczema had an odds ratio (OR) of 4.13 (95% CI 1.3 to 12.9, P = 0.01). Exposure to LMW almost tripled the risk of WRS (OR: 2.9, 95% CI: 1.4 to 5.9, P = 0.003) in our patients. Conclusion: Pulmonologists are firmly advised to take their patients’ occupational and vocational exposures into consideration for treatment plans, especially in those with positive history of eczema and exposure to LMW.

The Role of CO-RADS Scoring System in the Diagnosis of COVID-19 Infection and its Correlation with Clinical Signs

Background: Computed tomography (CT) evaluation systematics has become necessary to eliminate the difference of opinion among radiologists in evaluating COVID-19 CT findings. Introduction: The objectives of this study were to evaluate the efficiency of CO-RADS scoring system in our patients with COVID-19 as well as to examine its correlation with clinical and laboratory findings. Method: The CO-RADS category of all patients included in the study was determined by a radiologist who did not know the rtRT-PCR test result of the patients, according to the Covid-19 reporting and data system of Mathias Prokop et al. Results: A total of 1338 patients were included. CT findings were positive in 66.3%, with a mean CO-RADS score of 3,4 ± 1,7. 444 (33.1%) of the patients were in the CO-RADS 1-2, 894 (66.9%) were in the CO-RADS 3-5 group. There were positive correlations between CO-RADS score and age, CMI, hypertension, diabetes mellitus, chronic pulmonary diseases presence of symptoms, symptom duration, presence of cough, shortness of breath, malaise, CRP, and LDH, while CO-RADS score was negatively correlated with lymphocyte count. The results of the ROC analysis suggested that those with age ≥40 years, symptom duration >2 days, CMI score >1 and/or comorbid conditions were more likely to have a CO-RADS score of 3-5. Conclusion: The CO-RADS classification system is a CT findings assessment system that can be used to diagnose COVID-19 in patients with symptoms of cough, shortness of breath, myalgia and fatigue for more than two days.

Mycobacterium-Induced Th1, Helminths-Induced Th2 Cells and the Potential Vaccine Candidates for Allergic Asthma: Imitation of Natural Infection

Bronchial asthma is one of the most chronic pulmonary diseases and major public health problems. In general, asthma prevails in developed countries than developing countries, and its prevalence is increasing in the latter. For instance, the hygiene hypothesis demonstrated that this phenomenon resulted from higher household hygienic standards that decreased the chances of infections, which would subsequently increase the occurrence of allergy. In this review, we attempted to integrate our knowledge with the hygiene hypothesis into beneficial preventive approaches for allergic asthma. Therefore, we highlighted the studies that investigated the correlation between allergic asthma and the two different types of infections that induce the two major antagonizing arms of T cells. This elucidation reflects the association between various types of natural infections and the immune system, which is predicted to support the main objective of the current research on investigating of the benefits of natural infections, regardless their immune pathways for the prevention of allergic asthma. We demonstrated that natural infection with Mycobacterium tuberculosis (Mtb) prevents the development of allergic asthma, thus Bacille Calmette-Guérin (BCG) vaccine is suggested at early age to mediate the same prevention particularly with increasing its efficiency through genetic engineering-based modifications. Likewise, natural helminth infections might inhabit the allergic asthma development. Therefore, helminth-derived proteins at early age are good candidates for designing vaccines for allergic asthma and it requires further investigation. Finally, we recommend imitation of natural infections as a general strategy for preventing allergic asthma that increased dramatically over the past decades.