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Opinions of healthcare providers on the design of a smartphone application for asthma treatment in the Kingdom of Saudi Arabia. 医疗保健提供者对沙特阿拉伯王国哮喘治疗智能手机应用程序设计的意见。
IF 2.3 Pub Date : 2020-02-27 eCollection Date: 2020-01-28 DOI: 10.4081/mrm.2020.508
Hajed M Al-Otaibi, Khalid A Ansari, Osama Hamad, Turki M Alanzi

Introduction: In several countries of the world, smartphone applications have been designed to contribute to the treatment of asthma. However, none of these applications has been developed in Saudi Arabia. Therefore, the objective of this article is to design a smartphone application for the treatment of asthma based on the opinions of healthcare providers from the Kingdom of Saudi Arabia.

Methods: In order to know the opinion of the healthcare providers from Saudi Arabia about the design of an asthma App, we used a purposive sampling method and conducted a cross sectional survey employing a questionnaire which was distributed through the QuestionPro.com website to all healthcare providers working in this country. The questionnaire was sent to 376 healthcare providers and the response rate was 25%.

Results: The data indicated that the majority of the respondents opined that the following features were important or very important in the design of a smartphone application for asthma treatment in Saudi Arabia: information about patient diagnosis (98%), primary physician access information(83%), patient satisfaction with the therapeutic process (91%), push notifications about reminder for drugs (95%), push notification for treatment of inhaler and other drugs (92%), push notifications about reminders of clinic visits and therapy sections (81%), push notifications to ask for help sending SMS to primary physician about patients' attacks (89%), pathophysiology of asthma (82%), asthma triggers (98%), drug guidelines (94%), drug side effects (93%), number of asthma attacks (98%), medication statistics (88%), visual inputs such as peak flow (91%), data to link patients to healthcare providers and to healthcare centers (82%), and Global Initiative for Asthma (GINA) references (72%).

Conclusions: According to the opinion of the majority of healthcare providers (92%), the proposed smartphone application designed based on medical guidelines will contribute to improve the treatment of patients with asthma in the Kingdom of Saudi Arabia, and will help to reduce the number of asthma cases that need hospitalization, and the number of asthma cases in the emergency departments of the hospitals of the Kingdom.

导语:在世界上的一些国家,智能手机应用程序的设计有助于哮喘的治疗。然而,这些应用都没有在沙特阿拉伯开发出来。因此,本文的目的是根据沙特阿拉伯王国医疗保健提供者的意见,设计一款用于治疗哮喘的智能手机应用程序。方法:为了了解沙特阿拉伯医疗服务提供者对哮喘应用程序设计的意见,我们采用有目的抽样方法,采用横断面调查,通过QuestionPro.com网站向在沙特阿拉伯工作的所有医疗服务提供者发放问卷。对376名医疗服务提供者进行问卷调查,回复率为25%。结果:数据表明,大多数受访者认为在沙特阿拉伯设计用于哮喘治疗的智能手机应用程序时,以下特征是重要或非常重要的:患者诊断信息(98%)、主治医生访问信息(83%)、患者对治疗过程的满意度(91%)、药物提醒推送通知(95%)、吸入器和其他药物治疗推送通知(92%)、门诊和治疗部分提醒推送通知(81%)、向主治医生发送关于患者发作(89%)、哮喘病理生理(82%)、哮喘触发因素(98%)、药物指南(94%),药物副作用(93%),哮喘发作次数(98%),药物统计(88%),视觉输入,如高峰流量(91%),将患者与医疗保健提供者和医疗保健中心联系起来的数据(82%),以及全球哮喘倡议(GINA)参考资料(72%)。结论:根据大多数医疗保健提供者(92%)的意见,根据医疗指南设计的拟议智能手机应用程序将有助于改善沙特阿拉伯王国哮喘患者的治疗,并将有助于减少需要住院治疗的哮喘病例数量,以及沙特阿拉伯王国医院急诊科的哮喘病例数量。
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引用次数: 0
Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). 分次呼出一氧化氮(FENO)在哮喘管理中的作用:意大利呼吸学会(SIP/IRS)和意大利过敏、哮喘和临床免疫学学会(SIAAIC)的立场文件。
IF 2.3 Pub Date : 2020-02-19 eCollection Date: 2020-01-28 DOI: 10.4081/mrm.2020.36
Enrico Heffler, Giovanna Elisiana Carpagnano, Elisabetta Favero, Giuseppe Guida, Mauro Maniscalco, Andrea Motta, Giovanni Paoletti, Giovanni Rolla, Eugenio Baraldi, Vincenza Pezzella, Giorgio Piacentini, Stefano Nardini

Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment, asthma can be a very severe condition (even leading to death), however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.

意大利的哮喘患病率呈上升趋势,估计占总人口的6%以上。哮喘的诊断可能是具有挑战性和难以捉摸的,特别是在儿童和过去二十年带来的证据表明,哮喘不是一种单一的疾病,而是由多种表型组成。症状可能被患者低估,或未向临床医生报告,而体征可能很少。通常的客观测量,如肺活量测定,是必要的,但有时并不重要。尽管进行了适当的治疗,哮喘仍可能是一种非常严重的疾病(甚至会导致死亡),但最近出现了一些新药,可以非常有效地控制哮喘。由于哮喘目前被认为是由炎症引起的,因此对炎症的直接测量是至关重要的。为此,自本世纪初以来,分数呼出一氧化氮(FENO)的测量已被用作一种非侵入性,易于评估的工具,可用于诊断和管理哮喘。SIP-IRS/SIAAIC立场文件是一篇叙述性综述,总结了FENO在哮喘诊断、管理和表型化方面有用的证据。
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引用次数: 42
The role of phenotype on ventilation and exercise capacity in patients affected by COPD: a retrospective study. 表型对COPD患者通气和运动能力的影响:一项回顾性研究
IF 2.3 Pub Date : 2020-02-03 eCollection Date: 2020-01-28 DOI: 10.4081/mrm.2020.476
Rocco F Rinaldo, Michele Mondoni, Sofia Comandini, Pietro Lombardo, Beatrice Vigo, Silvia Terraneo, Pierachille Santus, Stefano Carugo, Stefano Centanni, Fabiano Di Marco

Background: The idea of phenotype in chronic obstructive pulmonary disease (COPD) has evolved in the last decades, and the importance of peculiar treatment strategies has now been acknowledged. Although dyspnea and exercise limitation are hallmarks of COPD, this aspect has never been fully explored in literature in terms of disease phenotype. The aim of the present study was to explore the relevance of clinical COPD phenotypes on exercise ventilation and maximal capacity.

Methods: In this observational cohort retrospective study we analyzed the data of 50 COPD patients who underwent cardiopulmonary exercise test, categorized as emphysematous (n=29), and non-emphysematous (n=21) according to a previously validated model.

Results: We found a significant difference in terms of VE/VCO2 slope (median values 32.4 vs 28.0, p=0.015) and VE/VCO2 ratio at nadir (median values 37 vs. 33, p=0.004), which resulted higher in emphysematous patients, who also presented lower PETCO2 values (median values 32.6 vs 35.6, p=0.008). In a subgroup of 31 tests which met the maximality criteria, emphysematous patients presented a significantly lower work rate at peak (median value 51 vs 72% predicted, p=0.016), and showed a lower peak oxygen consumption, although at the limit of significance (median values of 63 vs 85 % predicted, p=0.051).

Conclusions: This study extends our knowledge about the characterization of the COPD phenotypical expression of disease, showing that patients affected by emphysema are more prone to ventilatory inefficiency during exercise, and that this is likely to be an important cause of their overall reduced exercise capacity.

背景:在过去的几十年里,慢性阻塞性肺疾病(COPD)的表型概念已经发展,现在已经认识到特殊治疗策略的重要性。虽然呼吸困难和运动受限是COPD的标志,但在疾病表型方面,尚无文献对这方面进行充分探讨。本研究的目的是探讨临床COPD表型与运动通气和最大容量的相关性。方法:在这项观察性队列回顾性研究中,我们分析了50例接受心肺运动试验的COPD患者的数据,根据先前验证的模型,这些患者分为肺气肿(n=29)和非肺气肿(n=21)。结果:我们发现在VE/VCO2斜率(中位数32.4 vs 28.0, p=0.015)和最低点VE/VCO2比值(中位数37 vs 33, p=0.004)方面存在显著差异,导致肺气肿患者较高,PETCO2值也较低(中位数32.6 vs 35.6, p=0.008)。在符合最大值标准的31个测试亚组中,肺气气性患者在峰值时表现出明显较低的工作率(中位数为51%,预测为72%,p=0.016),并且显示出较低的峰值耗氧量,尽管在显著性极限(中位数为63%,预测为85%,p=0.051)。结论:本研究扩展了我们对COPD疾病表型表达特征的认识,表明肺气肿患者在运动时更容易出现通气效率低下,这可能是其整体运动能力下降的重要原因。
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引用次数: 8
Predictors of chronic kidney disease in obstructive sleep apnea patients. 阻塞性睡眠呼吸暂停患者慢性肾脏疾病的预测因素。
IF 2.3 Pub Date : 2020-01-28 DOI: 10.4081/mrm.2020.470
Phunphai Somkearti, Paiboon Chattakul, Sittichai Khamsai, Panita Limpawattana, Jarin Chindaprasirt, Verajit Chotmongkol, Kittisak Sawanyawisuth

Introduction: Obstructive sleep apnea (OSA) is a common condition in patients with chronic kidney disease (CKD). It may worsen renal function in CKD patients and is associated with uncontrolled blood pressure. Although OSA is found in up to 80% of CKD patients, there are limited data available on its clinical features in patients with and without CKD.

Objective: This study aimed to identifying the differences in the clinical characteristics of OSA between CKD and non-CKD OSA patients and determine the clinical predictors for CKD in OSA patients.

Methods: This was a retrospective study conducted at Khon Kaen University's Srinagarind Hospital in Thailand between July and December 2018. The inclusion criteria were diagnosis with OSA via polysomnography and having undergone laboratory tests for CKD. Obstructive sleep apnea is diagnosed according to the apnea-hypopnea index (AHI) as experiencing ≥5 events/hour, while CKD diagnosed based on the KDOQI guidelines. Eligible patients were divided into two groups: OSA with CKD and OSA without CKD. Predictors of CKD in OSA patients were analyzed using multivariate logistic regression analysis.

Results: During the study period, there were 178 OSA patients who met the study criteria, 88 (49.44%) of whom were in the OSA with CKD group. Both age and body mass index were comparable between OSA patients with CKD and those without (age: 59 and 57 years, respectively; body mass index: 30 and 29 kg/m2, respectively. There were three significant factors that differed between those with and without CKD group including systolic blood pressure (147 vs 135 mmHg), proportion of patients with diabetes (55% vs 34%), and proportion of patients with Mallampati scores of 3-4 (73% vs 39%). There were three independent predictors for OSA in patients with CKD: female sex, high systolic blood pressure, and Mallampati score of 3 or 4, with adjusted odds ratios (95% confidence interval) of 4.624 (1.554, 13.750), 1.060 (1.020, 1.101), and 2.816 (1.356, 5.849), respectively. The Hosmer-Lemeshow chi-square statistic of the predictive model was 6.06 (p 0.640). Systolic blood pressure of more than 130 and 150 mmHg resulted in sensitivity of 84.21% and specificity of 81.40%, respectively.

Conclusions: Female sex, high systolic blood pressure, and Mallampati score of 3-4 were suggestive of OSA with CKD. Obstructive sleep apnea patients with one or more of these predictors may have a high risk of CKD.

梗阻性睡眠呼吸暂停(OSA)是慢性肾脏疾病(CKD)患者的常见病。它可能使CKD患者的肾功能恶化,并与血压失控有关。尽管高达80%的CKD患者存在OSA,但关于其在CKD患者和非CKD患者中的临床特征的数据有限。目的:本研究旨在探讨CKD与非CKD OSA患者在OSA临床特征上的差异,确定OSA患者CKD的临床预测因素。方法:这是一项回顾性研究,于2018年7月至12月在泰国孔敬大学斯利那加林医院进行。纳入标准是通过多导睡眠图诊断为OSA,并接受过CKD的实验室检查。阻塞性睡眠呼吸暂停是根据呼吸暂停-低通气指数(AHI)诊断为≥5次/小时,而CKD是根据KDOQI指南诊断的。符合条件的患者分为两组:OSA合并CKD和OSA无CKD。采用多因素logistic回归分析OSA患者CKD的预测因素。结果:研究期间符合研究标准的OSA患者178例,其中OSA合并CKD组88例(49.44%)。OSA合并CKD患者与未合并CKD患者的年龄和体重指数具有可比性(年龄分别为59岁和57岁;体重指数:30和29 kg/m2。有CKD组和无CKD组之间存在三个显著差异因素,包括收缩压(147对135 mmHg)、糖尿病患者比例(55%对34%)和Mallampati评分为3-4的患者比例(73%对39%)。CKD患者的OSA有3个独立预测因素:女性、高收缩压和Mallampati评分为3或4,校正优势比(95%可信区间)分别为4.624(1.554,13.750)、1.060(1.020,1.101)和2.816(1.356,5.849)。预测模型的Hosmer-Lemeshow卡方统计量为6.06 (p 0.640)。收缩压> 130 mmHg和> 150 mmHg敏感性为84.21%,特异性为81.40%。结论:女性、收缩压高、Mallampati评分3-4提示OSA合并CKD。具有上述一种或多种预测因素的阻塞性睡眠呼吸暂停患者可能具有较高的CKD风险。
{"title":"Predictors of chronic kidney disease in obstructive sleep apnea patients.","authors":"Phunphai Somkearti,&nbsp;Paiboon Chattakul,&nbsp;Sittichai Khamsai,&nbsp;Panita Limpawattana,&nbsp;Jarin Chindaprasirt,&nbsp;Verajit Chotmongkol,&nbsp;Kittisak Sawanyawisuth","doi":"10.4081/mrm.2020.470","DOIUrl":"https://doi.org/10.4081/mrm.2020.470","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) is a common condition in patients with chronic kidney disease (CKD). It may worsen renal function in CKD patients and is associated with uncontrolled blood pressure. Although OSA is found in up to 80% of CKD patients, there are limited data available on its clinical features in patients with and without CKD.</p><p><strong>Objective: </strong>This study aimed to identifying the differences in the clinical characteristics of OSA between CKD and non-CKD OSA patients and determine the clinical predictors for CKD in OSA patients.</p><p><strong>Methods: </strong>This was a retrospective study conducted at Khon Kaen University's Srinagarind Hospital in Thailand between July and December 2018. The inclusion criteria were diagnosis with OSA <i>via</i> polysomnography and having undergone laboratory tests for CKD. Obstructive sleep apnea is diagnosed according to the apnea-hypopnea index (AHI) as experiencing ≥5 events/hour, while CKD diagnosed based on the KDOQI guidelines. Eligible patients were divided into two groups: OSA with CKD and OSA without CKD. Predictors of CKD in OSA patients were analyzed using multivariate logistic regression analysis.</p><p><strong>Results: </strong>During the study period, there were 178 OSA patients who met the study criteria, 88 (49.44%) of whom were in the OSA with CKD group. Both age and body mass index were comparable between OSA patients with CKD and those without (age: 59 and 57 years, respectively; body mass index: 30 and 29 kg/m<sup>2</sup>, respectively. There were three significant factors that differed between those with and without CKD group including systolic blood pressure (147 <i>vs</i> 135 mmHg), proportion of patients with diabetes (55% <i>vs</i> 34%), and proportion of patients with Mallampati scores of 3-4 (73% <i>vs</i> 39%). There were three independent predictors for OSA in patients with CKD: female sex, high systolic blood pressure, and Mallampati score of 3 or 4, with adjusted odds ratios (95% confidence interval) of 4.624 (1.554, 13.750), 1.060 (1.020, 1.101), and 2.816 (1.356, 5.849), respectively. The Hosmer-Lemeshow chi-square statistic of the predictive model was 6.06 (p 0.640). Systolic blood pressure of more than 130 and 150 mmHg resulted in sensitivity of 84.21% and specificity of 81.40%, respectively.</p><p><strong>Conclusions: </strong>Female sex, high systolic blood pressure, and Mallampati score of 3-4 were suggestive of OSA with CKD. Obstructive sleep apnea patients with one or more of these predictors may have a high risk of CKD.</p>","PeriodicalId":49031,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"470"},"PeriodicalIF":2.3,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/03/mrm-15-1-470.PMC7037503.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37722530","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}
引用次数: 4
Efficacy and adherence of auto-CPAP therapy in patients with obstructive sleep apnea: a prospective study. 阻塞性睡眠呼吸暂停患者自动cpap治疗的疗效和依从性:一项前瞻性研究。
IF 2.3 Pub Date : 2020-01-28 DOI: 10.4081/mrm.2020.468
Hang Dinh-Thi-Dieu, Anh Vo-Thi-Kim, Huong Tran-Van, Sy Duong-Quy

Introduction: The use of auto-continuous positive airway pressure (auto-CPAP) therapy has been recommended for subjects with moderate-to-severe obstructive sleep apnea (OSA) without significant comorbidities. This study is aimed at evaluating the efficacy and adherence of auto-CPAP therapy in subjects with OSA.

Methods: It was a perspective and descriptive study. All study subjects who had apnea-hypopnea index (AHI) > 30/h, measured by polysomnography, were included. They were treated with auto-CPAP and followed-up for 6 months for evaluating the effect of CPAP-therapy on clinical and biological features and treatment adherence.

Results: One hundred and thirty-nine subjects with severe OSA were accepted for auto-CPAP therapy at inclusion. BMI was 28.4±3.8 kg/m2; neck and abdomen circumferences were 38.2±6.4 and 85.7±11.6. Epworth and Pichot scores were 18.4±6.3 and 28.3±4.5, respectively; AHI was 39±7/h and arousal index was 39±13/h. At 6th month, 96.4% of study subjects continued to use auto-CPAP-therapy within 6.5±2.4 h/night. There was a significant correlation between the modification (Δ) of Epworth scores and (Δ) AHI after 3 and 6 months of auto-CPAP-therapy (R=0.568 and p=0.003; R=0.745 and p=0.002; respectively). At 6th month follow up, the main side effects of auto-CPAP were difficult sleeping, dry mouth or nose, skin marks or rashes, discomfort when breathing, and nasal congestion (36.1%, 32.0%, 20.8%, 16.0%, and 11.9%, respectively).

Conclusion: Auto-CPAP is effective in treatment of Vietnamese patients with severe OSA in short term follow up.

自动持续气道正压通气(auto-CPAP)治疗已被推荐用于无明显合并症的中度至重度阻塞性睡眠呼吸暂停(OSA)患者。本研究旨在评估OSA患者auto-CPAP治疗的疗效和依从性。方法:采用透视法和描述性研究。所有通过多导睡眠描记术测量的呼吸暂停低通气指数(AHI) > 30/h的研究对象均被纳入。采用auto-CPAP治疗,随访6个月,评估cpap治疗对临床和生物学特征及治疗依从性的影响。结果:139例重度OSA患者在纳入时接受了自动cpap治疗。BMI为28.4±3.8 kg/m2;颈围为38.2±6.4,腹围为85.7±11.6。Epworth和Pichot评分分别为18.4±6.3和28.3±4.5;AHI为39±7/h,兴奋指数为39±13/h。在第6个月,96.4%的研究对象在6.5±2.4小时/晚的时间内继续使用auto- cpap治疗。auto- cpap治疗3个月和6个月后Epworth评分(Δ)与AHI (Δ)的变化有显著相关性(R=0.568和p=0.003;R=0.745, p=0.002;分别)。随访6个月时,自动cpap的主要不良反应为睡眠困难、口鼻干燥、皮肤印痕或皮疹、呼吸不适和鼻塞(分别为36.1%、32.0%、20.8%、16.0%和11.9%)。结论:在短期随访中,Auto-CPAP治疗越南重度OSA患者是有效的。
{"title":"Efficacy and adherence of auto-CPAP therapy in patients with obstructive sleep apnea: a prospective study.","authors":"Hang Dinh-Thi-Dieu,&nbsp;Anh Vo-Thi-Kim,&nbsp;Huong Tran-Van,&nbsp;Sy Duong-Quy","doi":"10.4081/mrm.2020.468","DOIUrl":"https://doi.org/10.4081/mrm.2020.468","url":null,"abstract":"<p><strong>Introduction: </strong>The use of auto-continuous positive airway pressure (auto-CPAP) therapy has been recommended for subjects with moderate-to-severe obstructive sleep apnea (OSA) without significant comorbidities. This study is aimed at evaluating the efficacy and adherence of auto-CPAP therapy in subjects with OSA.</p><p><strong>Methods: </strong>It was a perspective and descriptive study. All study subjects who had apnea-hypopnea index (AHI) > 30/h, measured by polysomnography, were included. They were treated with auto-CPAP and followed-up for 6 months for evaluating the effect of CPAP-therapy on clinical and biological features and treatment adherence.</p><p><strong>Results: </strong>One hundred and thirty-nine subjects with severe OSA were accepted for auto-CPAP therapy at inclusion. BMI was 28.4±3.8 kg/m<sup>2</sup>; neck and abdomen circumferences were 38.2±6.4 and 85.7±11.6. Epworth and Pichot scores were 18.4±6.3 and 28.3±4.5, respectively; AHI was 39±7/h and arousal index was 39±13/h. At 6<sup>th</sup> month, 96.4% of study subjects continued to use auto-CPAP-therapy within 6.5±2.4 h/night. There was a significant correlation between the modification (Δ) of Epworth scores and (Δ) AHI after 3 and 6 months of auto-CPAP-therapy (R=0.568 and <i>p</i>=0.003; R=0.745 and <i>p</i>=0.002; respectively). At 6<sup>th</sup> month follow up, the main side effects of auto-CPAP were difficult sleeping, dry mouth or nose, skin marks or rashes, discomfort when breathing, and nasal congestion (36.1%, 32.0%, 20.8%, 16.0%, and 11.9%, respectively).</p><p><strong>Conclusion: </strong>Auto-CPAP is effective in treatment of Vietnamese patients with severe OSA in short term follow up.</p>","PeriodicalId":49031,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"468"},"PeriodicalIF":2.3,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/20/3a/mrm-15-1-468.PMC7037646.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37722529","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}
引用次数: 8
Focus on the cetirizine use in clinical practice: a reappraisal 30 years later. 关注西替利嗪在临床实践中的应用:30年后的重新评估。
IF 2.3 Pub Date : 2019-12-06 eCollection Date: 2019-01-01 DOI: 10.1186/s40248-019-0203-6
Angelo G Corsico, Salvatore Leonardi, Amelia Licari, Gianluigi Marseglia, Michele Miraglia Del Giudice, Diego G Peroni, Carmelo Salpietro, Giorgio Ciprandi

Antihistamines are currently one of the most commonly administered categories of drugs. They are used to treat symptoms that are secondary to histamine release, which is typical of certain allergic conditions, including rhinitis, conjunctivitis, asthma, urticaria, and anaphylaxis. Cetirizine belongs to the second-generation family, so, it is very selective for peripheral H1 receptors, is potent and quickly relieves symptoms, exerts additional anti-allergic/anti-inflammatory effects, and is usually well-tolerated. It has been marketed 30 years ago. In these years, a remarkable body of evidence has been built. The current review provides a practical update on the use of cetirizine in clinical practice.

抗组胺药是目前最常用的药物之一。它们用于治疗继发于组胺释放的症状,这是某些过敏性疾病的典型症状,包括鼻炎、结膜炎、哮喘、荨麻疹和过敏反应。西替利嗪属于第二代家族,因此,它对外周H1受体具有很强的选择性,有效且快速缓解症状,具有额外的抗过敏/抗炎作用,并且通常耐受性良好。它已经上市30年了。这些年来,已经建立了大量的证据。目前的综述提供了在临床实践中使用西替利嗪的实际更新。
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引用次数: 9
Image analysis in posttreatment non-small cell lung cancer surveillance: specialists' interpretations reviewed by the thoracic multidisciplinary tumor board. 治疗后非小细胞肺癌监测的图像分析:胸部多学科肿瘤委员会审查的专家解释。
IF 2.3 Pub Date : 2019-12-04 eCollection Date: 2019-01-01 DOI: 10.1186/s40248-019-0198-z
Franco Gambazzi, Lukas D Frey, Matthias Bruehlmeier, Wolf-Dieter Janthur, Juerg Heuberger, Andres Spirig, Richard Williams, Roland Zweifel, Bettina Boerner, Gabrielo M Tini, Sarosh Irani

Background: Data show that the initial specialist's image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist's and MTB's image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance.

Methods: In the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6 months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist's image interpretation and the final MTB's image interpretation.

Results: In 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements).Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB's view, the specialist's interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB's interpretation was more accurate.

Conclusions: In an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB.

Trial registration: ISRCTN16281786, Date 23. February 2017.

背景:数据显示,在治疗前的癌症环境中,最初的专家图像解释和最终的多学科肿瘤委员会(MTB)评估可能存在很大差异。这项事后分析的目的是调查在接受系统治疗后肺癌图像监测的患者中专科医生和MTB图像解释的一致性。方法:在最初的前瞻性研究中,接受治疗意图治疗的肺癌患者被随机分配接受对比增强计算机断层扫描(CE-CT)或18f -氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描(PET-CT)。每6个月进行一次影像学检查,持续2年,所有影像学检查最终由我们的MTB评估。这个事后分析评估了最初的专家图像解释和最终的MTB图像解释之间的差异。结果:89例患者共进行266次影像学检查(129次PET-CT, 137次CE-CT)。87.2%(88.4, 86.1%)的研究结果完全一致。在12.8%(11.6,13.9%)的结果不一致中,7.5%(6.9,8.0%)的结果与患者管理的改变有关(主要分歧)。在17例研究患者中发现了20个主要分歧。回顾性分析,17例患者中有8例(47%)与MTB的观点相反,专科医生的解释更合适,而17例患者中有9例(53%)MTB的解释更准确。结论:在经验丰富的结核分枝杆菌中,在治疗后肺癌图像监测的背景下,成像专家和其他结核分枝杆菌之间关于图像解释的一致性很高。似乎在有分歧的情况下,更准确的解释率在成像专家和MTB之间得到了很好的平衡。试验注册:ISRCTN16281786,日期23。2017年2月。
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引用次数: 4
Clinical course and management of idiopathic pulmonary fibrosis. 特发性肺纤维化的临床病程及治疗。
IF 2.3 Pub Date : 2019-12-02 eCollection Date: 2019-01-01 DOI: 10.1186/s40248-019-0197-0
Caitlin Quinn, Amy Wisse, Stephenie T Manns

Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal interstitial lung disease (ILD) with an unpredictable clinical course. Although IPF is rare, healthcare professionals should consider IPF as a potential cause of unexplained chronic dyspnea and/or cough in middle-aged/elderly patients and refer patients to a pulmonologist for evaluation. Making a diagnosis of IPF requires specialist expertise. Multidisciplinary discussion, involving at minimum a pulmonologist and a radiologist with expertise in the differential diagnosis of ILDs, is required to ensure the most accurate diagnosis. Prompt diagnosis of IPF is important to enable patients to receive appropriate care from an early stage. Optimal management of IPF involves the use of antifibrotic drugs, as well as the provision of supportive care to alleviate symptoms and preserve patients' quality of life. Antifibrotic drugs have been shown to slow lung function decline seen in patients with IPF. Patients' symptoms and functional capacity can be improved through participation in pulmonary rehabilitation programs and the use of supplemental oxygen. Patient education is essential to help patients understand and manage their disease. The identification and management of comorbidities, such as obstructive sleep apnea, pulmonary hypertension, and emphysema, is also an important element of the overall care of patients with IPF. Patients with IPF should be evaluated for lung transplantation at an early stage to maximize their chances of meeting eligibility criteria. In this review, we describe the clinical course and impact of IPF and best practice in its management, highlighting the importance of taking a patient-centered approach.

特发性肺纤维化(IPF)是一种进行性、致死性间质性肺疾病(ILD),临床病程不可预测。虽然IPF很少见,但医疗保健专业人员应将IPF视为中/老年患者不明原因的慢性呼吸困难和/或咳嗽的潜在原因,并将患者转介给肺科医生进行评估。诊断IPF需要专业知识。为了确保最准确的诊断,需要多学科讨论,至少包括一名肺病专家和一名具有ILDs鉴别诊断专业知识的放射科医生。IPF的及时诊断对于使患者在早期阶段接受适当的治疗非常重要。IPF的最佳管理包括使用抗纤维化药物,以及提供支持性护理以减轻症状并保持患者的生活质量。抗纤维化药物已被证明可以减缓IPF患者的肺功能下降。患者的症状和功能可以通过参与肺部康复计划和使用补充氧气来改善。患者教育对于帮助患者了解和管理自己的疾病至关重要。识别和管理合并症,如阻塞性睡眠呼吸暂停、肺动脉高压和肺气肿,也是IPF患者整体护理的重要组成部分。IPF患者应在早期阶段进行肺移植评估,以最大限度地提高其符合资格标准的机会。在这篇综述中,我们描述了IPF的临床过程和影响以及其管理的最佳实践,强调了采取以患者为中心的方法的重要性。
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引用次数: 13
A pilot study with early adolescents: dealing with diet, tobacco and air pollution using practical experiences and biological markers. 一项针对早期青少年的试点研究:利用实际经验和生物标记处理饮食、烟草和空气污染。
IF 2.3 Pub Date : 2017-12-01 eCollection Date: 2017-01-01 DOI: 10.1186/s40248-017-0111-6
Chiara Marabelli, Elena Munarini, Micaela Lina, Roberto Mazza, Roberto Boffi, Cinzia De Marco, Ario Ruprecht, Giorgia Angellotti, Chiara Veronese, Paolo Pozzi, Eleonora Bruno, Giuliana Gargano, Adalberto Cavalleri, Giulia Garrone, Franco Berrino

Background: Tobacco use and the Western diet are two of the most important and investigated topics in relation to adolescents' health. In addition, air pollution is a crucial subject for future generations. School is a key social environment that should promote healthy behaviors in children and adolescents. In this field many different programs have been conducted, with mixed results and effectiveness. Research data suggest that comprehensive and multicomponent approaches may have a greater effect on tobacco use and diet, especially when integrated into a community-wide approach.

Methods: The present work describes a multi-area pilot study called "La Scuola della Salute" (the School of Health) with a focus on the methodological aspects of the intervention. In our study we assessed different web-based and practical experiences related to adolescents' smoking and dietary behaviors and awareness of smoke-related air pollution. Furthermore, to make adolescents more conscious of smoking and dietary behaviors, we conducted experiential workshops that addressed smoking and environmental pollution, food education, and lifestyle. Teachers and school administrators were involved in the project.

Results: At baseline we investigated dietary habits, tobacco use, and individual and social characteristics by means of lifestyle questionnaires. In addition, we collected anthropometric parameters and performance indicators such as exhaled carbon monoxide and urinary fructose to assess smoking and nutrition habits. At the end of the intervention lifestyle questionnaire and biological markers were collected again: knowledge about these topics was significantly improved, and the urinary fructose was able to estimate the levels of obesity in the classes.

Conclusions: The integrated approach, combined with the use of biological markers, could be an innovative approach to the promotion of healthy lifestyles among adolescents, but further research is needed.

背景:烟草使用和西方饮食是与青少年健康有关的两个最重要和最受调查的主题。此外,空气污染对子孙后代来说是一个至关重要的问题。学校是一个重要的社会环境,应该促进儿童和青少年的健康行为。在这一领域开展了许多不同的方案,结果和效果好坏参半。研究数据表明,综合和多成分方法可能对烟草使用和饮食产生更大的影响,特别是在纳入社区范围的方法时。方法:目前的工作描述了一项名为“La Scuola della Salute”(卫生学院)的多领域试点研究,重点是干预的方法学方面。在我们的研究中,我们评估了与青少年吸烟和饮食行为以及吸烟相关的空气污染意识相关的不同网络和实践经验。此外,为了使青少年更加意识到吸烟和饮食行为,我们举办了关于吸烟与环境污染、食品教育和生活方式的体验讲习班。教师和学校管理人员都参与了这个项目。结果:在基线时,我们通过生活方式问卷调查了饮食习惯、烟草使用以及个人和社会特征。此外,我们收集了人体测量参数和性能指标,如呼出的一氧化碳和尿果糖来评估吸烟和营养习惯。在干预结束时,再次收集生活方式问卷和生物标记物:关于这些主题的知识显着提高,尿果糖能够估计班级的肥胖水平。结论:综合方法结合生物标志物的使用可能是促进青少年健康生活方式的一种创新方法,但需要进一步研究。
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引用次数: 2
Nasal Muco-ciliary transport time alteration: efficacy of 18 B Glycyrrhetinic acid. 鼻腔黏膜-纤毛运输时间的改变:18 B 甘草次酸的疗效。
IF 2.3 Pub Date : 2017-11-29 eCollection Date: 2017-01-01 DOI: 10.1186/s40248-017-0110-7
Desiderio Passali, Chiara Cappello, Giulio Cesare Passali, Cemal Cingi, Codrut Sarafoleanu, Luisa Maria Bellussi

Background: Mucociliary clearance is the main self-clearing system of the nasal cavity and paranasal sinuses.This is a very important means of non specific defence against continuous organic and inorganic contamination conveyed by air. It works by trapping particles and microorganisms in the mucus and then by transporting the mucous film to the pharynx where it is eliminated with a cough or swallowed. Its congenital or acquired abnormalities are involved in the occurrence of widespread infectious and often severe nose and paranasal sinuses diseases; generally concerning the rhinopharyngealtubal district.Restoring mucociliary clearance of the nasal epithelium when altered thus represents a key therapeutic tool against rhinosinus chronic diseases.This study evaluates the clinical efficacy of the inhalation of a natural compound (Narivent® nasal spray) in chronic vasomotor rhinitis.

Methods: The study involved 79 patients suffering from chronic vasomotor rhinitis presenting an increased mucociliary clearance time. Patients were randomized into 2 groups: a first group of 49 subjects and a second group of 30 subjects.The first group was treated with a nasal spray (Narivent® nasal spray) (2 sprays per nostril twice a day) for 30 days.The second group was treated with a nasal spray containing isotonic solution in the same way and for the same period of the first group.Nasal Mucociliary transport time was measured in the patients of both groups before treatment, after 15 days of treatment, and at the end of the 30 days treatment.

Results: The study shows how one of the treatments carried out determines a major objective reduction of the mucociliary clearance time in the patients under examination, using the method which involves the use of an insoluble coloured tracer (vegetable carbon), bringing the values back within normal range. At the end of the study we objectivated an increase in the rate of mucociliary transport in 97.9% percentage of patients we enrolled.

Conclusions: This study shows the effectiveness of treatment with natural extracts with nasal mucosa restoring function in the treatment of chronic vasomotor rhinitis, a nasal inflammatory disease characterized by morphological and functional alteration of the normal nasal mucosa.

背景:粘液纤毛清除是鼻腔和副鼻窦的主要自我清除系统。这是一种非常重要的非特异性防御手段,可抵御空气中持续不断的有机和无机污染。它的工作原理是将颗粒和微生物截留在粘液中,然后将粘液膜输送到咽部,通过咳嗽或吞咽排出体外。它的先天或后天异常参与了广泛的感染性疾病的发生,通常是严重的鼻和鼻窦疾病;一般涉及鼻咽管区。本研究评估了吸入天然化合物(Narivent® 鼻喷雾剂)对慢性血管运动性鼻炎的临床疗效:研究涉及79名慢性血管运动性鼻炎患者,这些患者的粘液纤毛清除时间延长。第一组使用鼻腔喷雾剂(Narivent® 鼻腔喷雾剂)治疗(每个鼻孔喷 2 次,每天 2 次),为期 30 天;第二组使用含有等渗溶液的鼻腔喷雾剂治疗,方法和时间与第一组相同:研究结果表明,使用不溶性有色示踪剂(植物碳)的方法,其中一种治疗方法在客观上大大缩短了受检病人的黏膜纤毛清除时间,使数值恢复到正常范围内。研究结束时,我们发现97.9%的受试患者的粘液纤毛清除率有所提高:这项研究表明,在治疗慢性血管运动性鼻炎(一种以正常鼻黏膜形态和功能改变为特征的鼻腔炎症性疾病)时,使用具有恢复鼻黏膜功能的天然提取物治疗效果显著。
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引用次数: 0
期刊
Multidisciplinary Respiratory Medicine
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