Blood eosinophilia as predictor for patient outcomes in chronic obstructive pulmonary disease (COPD) exacerbations

INTRODUCTION: The eosinophilic phenotype of chronic obstructive pulmonary disease (COPD) has been demonstrated to respond better to corticosteroids and associated with better outcomes. This review aims to clarify the correlation of blood eosinophilia and outcomes patients with COPD exacerbations. METHODS: This is a review of cohorts and case-control studies that looked into eosinophilia and outcomes in exacerbations using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. The primary study outcome was length of hospitalization; other outcomes include readmission and mortality rate within one year, in-patient mortality, and need for mechanical ventilation. RESULTS: Six studies were included in the review. Patients with blood eosinophilia had significantly shorter hospital stay compared to non-eosinophilic patients (mean difference 0.68 days [95% CI 1.09,0.27]). Eosinophilic patients had significantly less frequent readmissions (OR 0.69 [95% CI 0.55,0.87]) but there was no statistically significant difference in the one-year mortality rate (OR 0.88 [95% CI 0.73, .06]). Analysis showed a trend toward lower in-patient mortality among eosinophilic patients (OR 0.53 [95% CI 0.27,1.05]). Furthermore, COPD patients with eosinophilia had significantly less need for mechanical ventilation during an exacerbation (OR 0.56 [95% CI 0.35,0.89]). CONCLUSION: COPD patients with blood eosinophilia had significantly shorter hospital stay, less frequent readmissions, and are less likely to require mechanical ventilation compared to the non-eosinophilic phenotype. 

Non-invasive ventilation versus conventional oxygen therapy in immunocompromised patients: A meta-analysis

INTRODUCTION: Respiratory failure is common in immunocompromised patients. Intubation and mechanical ventilation (MV) is the mainstay of treatment but is associated with increased risk of pneumonia and other complications. Non-invasive ventilation (NIV) is an alternative to MV in a select group of patients and aims to avoid the complications of MV. In these patients, we performed a meta-analysis on the effect of NIV versus conventional oxygen therapy in reducing intubation rates and other important clinical outcomes. METHODS: We performed an extensive online and unpublished data search for relevant studies that met the inclusion criteria. Randomized controlled trials that used NIV versus conventional oxygen therapy in immunocompromised patients with respiratory failure were included in the metaanalysis. Eligbility and risk of bias assessments were performed independently by three authors. The primary outcome of interest was intubation and mechanical ventilation rate. The secondary outcomes were intensive care unit (ICU) and all-cause mortality, ICU length of stay and duration of mechanical ventilation. RESULTS: Out of the twenty initially screened studies, four studies with a total of 553 patients met the criteria for inclusion and were included in the analysis. Patients given NIV were 38% less likely to be intubated vs. those given oxygen, RR 0.62 (95%CI 0.42,0.93); however, this analysis result is significantly heterogenous. After sensitivity analysis, results showed 48% less likelihood of intubation and mechanical ventilation in the group treated with NIV, RR 0.52 [95% confidence interval (CI) 0.35,0.77]. Patients on NIV had 1.18 days less stay in the ICU vs. oxygen group (95%CI -1.84,-0.52 days ). Three studies included ICU mortality in their outcomes and showed a 54% decrease in ICU mortality among patients given NIV, RR 0.46 (95% CI 0.17, 1.29), however this result is non-significant and heterogenous I2=58%. There was no statistically significant decrease in all-cause mortality between the two groups, RR 0.77 (95% CI 0.53,1.11). After a sensitivity analysis performed specifically for this outcome, results showed a 32% reduction in all cause mortality in patients given NIV vs. oxygen therapy, however was not statistically significant RR 0.68 (95% CI 0.53-1.11) and was heterogenous I2=50%. There is no difference in the duration of mechanical ventilation between groups. CONCLUSION: In immunocompromised patients with respiratory failure, NIV reduced intubation rates, and length of ICU stay, compared to standard oxygen therapy. This intervention also showed trend toward ICU and all-cause mortality reduction.

Histomorphologic effects of Bacillus clausii spores in enteropathogenic E. coli O127:H21-infected mice: A pilot study

OBJECTIVE: The study aimed to determine the basic histomorphologic effects of Bacillus clausii (B. clausii) spores in enteropathogenic Escherichia coli (E. coli) O127:H21-infected mice by evaluating the spleen, mesenteric lymph nodes, and intestinal mucosa. METHODS: The study involved 46 apparently healthy Balb/c mice (Mus musculus) which were acclimatized for 19 days prior to any intervention. Sixteen mice were used to determine the sublethal dose of E. coli, which was performed by administering serially-diluted solutions and subsequent generation of a standard curve. From the remaining 30 mice, ten served as normal controls while the remaining 20 were randomized to receive either B. clausii or placebo of sterile water for a week. All mice were then challenged with E. coli for another week and euthanized, and the spleen, mesenteric lymph nodes, and small intestine harvested and examined microscopically. All study personnel were blinded of the treatment assignments. RESULTS: Histologic evaluation of the small intestine in E. coli only-fed mice exhibited prominent attachment effacement lesions, with severely denuded mucosa, lymphocytic infiltration, and debris in the intestinal lumen. However, mice given B. clausii prior to E. coli infection displayed only minimal mucosal damage with less sloughing of villus tips, plus increased mucus-secreting goblet cells. In the spleen, E. coli only-fed mice showed moderate to severe lymphoid hyperplasia with blurred boundaries between red and white pulp. In contrast, mice which received B. clausii prior to E. coli infection had only mild degrees of lymphoid hyperplasia. Similar findings were seen in the mesenteric lymph nodes where E. coli only-fed mice showed moderate to severe lymphoid hyperplasia while those given B. clausii prior to E. coli infection merely had mild lymphoid hyperplasia. CONCLUSION: B. clausii exerts a potential protective and immunomodulatory action in E. coli O127:H21-infected mice based on histomorphologic effects. However, additional studies are needed to fully characterize these mechanisms.mice based on histomorphologic effects. 

Efficacy of tiotropium as add-on therapy for adults with uncontrolled asthma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to evaluate efficacy of tiotropium as add-on therapy on top of standard regimens for uncontrolled asthma, specifically in terms of FEV1, morning and evening PEF, reduction in exacerbations, rescue medication use, and quality of life improvement.<br /><strong>METHODS:</strong> A search was done for eligible trials after which validity screen and data extraction was performed. Results were presented as mean differences, standard errors, and 95% confidence intervals, and graphically as forest plots. Estimates were pooled using the random effects model with I2 and Chi2 tests used to assess heterogeneity. Adverse events were reported as dichotomous variables.<br /><strong>RESULTS:</strong> Four studies were included totaling 1617 participants. The tiotropium group had statistically significant improvement in FEV1 (95% Cl, 0.14 [0.09, 0.19], p<0.00001), morning (95% Cl, 20.03 [11.71, 28.35], p<0.00001) with trend towards benefit in reduction of rescue medications (95% Cl, 0.12 [-0.17,0.4],p=0.42) and quality of life improvements (95% Cl, 0.1 [-0.05,0.25], p=0.20). Homogeneity (I2= 0%, Chi2= 0.47-3.22) was found across studies.<br /><strong>CONCLUSION:</strong> Tiotropium is associated with significant improvement in pulmonary function among patients with uncontrolled asthma, with possible benefit in reduction of rescue medications and quality of life improvement.</p>