Return to work after trauma: A survival analysis / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To evaluate the return to work (RTW) rate, time and predictors among trauma patients using survival analysis.</p><p><b>METHODS</b>This cohort study was conducted with a three-month follow-up on 300 trauma patients hospitalized in Shahid Beheshti Hospital, Kashan, Iran in 2014. The data were collected through conducting interviews and referring to patients' medical records during their hospital stay and follow-up information at one & three months after discharge from hospital. Final analysis was conducted on the data retrieved from 273 patients. Data were analyzed by chi-square test, Mann-Whitney U test and survival analysis method.</p><p><b>RESULTS</b>The rate of RTW at the end of the first and the third follow-up months was respectively 21.6% and 61.2%. Survival analysis showed that the RTW time (Time between admission to first return to work) was significantly longer among patients with illiteracy, drug abuse, hospitalization history in the intensive care unit, low socioeconomic status, non-insurance coverage, longer hospital stay, multiple and severe injuries as well as severe disability.</p><p><b>CONCLUSION</b>Our findings indicated that trauma has profound effects on the rate and time of RTW. Besides disability, many personal and clinical factors can affect the outcome of RTW.</p>

Influence of body mass indexes on response to treatment in acute asthma

Increases in body mass index [BMI] are reported to influence asthma response to treatment. The aim of this study was to investigate the relationship between BMI and response to treatment in a group of patients that were referred for asthma control. Effectiveness measurements in this analysis included percentage of changes in forced volume in 1 second [FEV1], forced volume capacity [FVC], FEV1/FVC, and forced expiratory flow between 25% and 75% of FVC [FEF25-75%]. A total of 293 subjects with asthma of both genders and above 18 years of age were divided into the following BMI categories: 107 [36.5%] non-obese [BMI <25], 186 [63.5%] overweight and obese [BMI >/= 25]. Percentage of change was defined as change in variable between baseline and end-of-treatment. Analyses of non-obese vs. overweight/obese asthmatics demonstrated non-significant differences in baseline FEV1 [1.62 +/- 0.56 Lit vs. 1.63 +/- 0.56 Lit L, P=0.89]; FVC [2.58 +/- 0.73 Lit vs. 2.47 +/- 0.82 Lit, P=0.25]; and FEF25-75% [1.04 +/- 0.55 ml/sec vs. 1.05 +/- 0.50 ml/sec, P=0.47] respectively. Compared with non-obese subjects, in overweight/obese subjects with asthma were less responded to treatment. Percentage changes of FEV1, FVC, FEF25-75%, and FEV1/FVC in non-obese versus obese/overweight patients were: 79.57 +/- 55.14% vs. 62.13 +/- 41.72%, P=0.005; 47.71 +/- 33.76% vs. 39.93 +/- 28.30%, P=0.036; 151.98 +/- 127.82% vs. 123 +/- 91.12%, P=0.041; 20.54 +/- 15.63% vs. 15.63 +/- 11.32%, P=0.005; respectively. Percentage changes of spirometric values to treatment in over weight/obese asthmatic patient were lesser in compared with non-obese subjects

Evaluation of high-sensitivity C-reactive protein in acute asthma

High sensitivity C-reactive protein [hs-CRP] is an inflammatory marker known to be related to inflammation, infection, and cardiovascular diseases. The aim of this study was to evaluate hs-CRP level in serum of asthmatics and its relationship with pulmonary function tests, serum IgE levels, and peripheral blood white blood cell [WBC] counts. The under study subjects were 108 patients with acute asthma and 93 healthy volunteers. The levels of hs-CRP of 108 patients with acute bronchial asthma and 93 non-asthmatic control subjects were measured. Spirometry, serum immunoglobulin-E [IgE] measurement, and WBC counts were done for patient and control groups. The mean serum hs-CRP levels were significantly higher in patients with acute asthma compared with controls [5.47 +/- 7.33 mg/l versus 1.46 +/- 1.89 mg/l, p<0.001]. Among asthmatic patients, mean hs-CRP levels were not correlated with indices of pulmonary function tests [forced expiratory volume in one second, forced vital capacity and forced mid-expiratory flow], serum IgE level, eosinophil count or WBC count. Serum C-reactive protein levels measured by high-sensitivity assays increase in acute asthma and may be useful as a diagnostic tool for detecting and monitoring inflammation in these patients. In our study on patients with acute asthma, no significant correlation was revealed between hs-CRP and pulmonary function tests, total serum IgE, or peripheral blood white blood cell counts

Effect of age on response to treatment in adult patients with severe persistent Asthma

Due to current controversies regarding the effect of age on response to treatment in asthmatic patient, the present study was performed on patients referred with acute asthma attack for further evaluation of this matter. In this study 138 patients with severe persistent asthma were enrolled and divided into two categories of young [age /= 50 yrs; 56 cases, mean age 57.4 +/- 6.4 years]. Response to treatment was determined by pulmonary function tests. The mean percentage change of FEV1 from baseline in male and female patients of young and old age was 75.05 +/- 46.61 and 71.39 +/- 41.30%, [P=0.721] and 100.79 +/- 51.34% and 69 +/- 37.39% [P=0.015], respectively. The mean percentage of possible improvement of FEV1 among male and female patients of young and old age was 62.81 +/- 25.67% and 54.46 +/- 23.82% [P=0.148], and 78 +/- 24.04% and 63.58 +/- 41.24% [P=0.087]; respectively. Response to treatment was significant in both young and old age groups suffering from acute asthmatic attack except for young female patients in which, percentage change of FEV1 increased compared to older patients. Among other patients this value and percentage of possible improvement of FEV1 between the 2 groups did not change significantly and age did not play a significant role in assessing the response to treatment in acute asthmatic attack

Pulmonary tuberous sclerosis

Pulmonary involvement in tuberous sclerosis is very rare and seems to be associated with a more benign course. We present a 21-year-old woman with bilateral angiomyolipoma. She developed spontaneous pneumothorax which was successfully managed by tube thoracostomy. No recurrence of pneumothorax has been observed up to the present [4 years follow-up]

Relationship of pleural and serum cholesterol and lipoprotein levels in exudative and transudative effusions

This study aimed to assess whether total cholesterol [CHOL], low-density lipoprotein cholesterol [LDL], and high-density lipoprotein [HDL] are sensitive markers for discriminating between transudative and exudative pleural effusions [PE]. In this study CHOL, LDL, HDL, TG, protein and LDH were analyzed in PE and serums of 119 patients with pleural effusion out of which 49 had transudative and 70 had exudative pleural effusion. Sensitivity, specificity, and area under the curve [AUC] of CHOL, LDL and HDL were measured by receiver operating characteristic curve [ROC]. Pleural fluid CHOL, LDL and HDL levels were significantly lower in the transudate group compared to the exudate [29.6 +/- 16.3 mg/dl versus 65.24 +/- 25.9 mg/dl, p < 0.001; 17 +/- 14.8 mg/dl versus 43.94 +/- 21.6 mg/dl, p < 0.001; and 9.2 +/- 4.8 mg/dl versus14.9 +/- 6.3 mg/dl, p<0.001, respectively]. Sixty-seven percent of cases with pleural transudates were secondary to heart failure, while 41% and 39% of those with pleural exudates were of parapneumonic effusion and neoplastic origin, respectively. Pleural fluid CHOL, LDL and HDL levels were significantly higher in malignant pleural effusion [71.5 +/- 18.6, 48.1 +/- 17.4 and 16.1 +/- 6.6mg/dl, respectively], and in parapneumonic effusion [70.7 +/- 28.5, 49.4 +/- 22.4 and 14.7 +/- 6.4 mg/dl, respectively] than in heart failure [30.6 +/- 11.9, 17.5 +/- 10.4 and 9.6 +/- 5.4 mg/dl, respectively]. The optimum cut-off value for pleural fluid CHOL level of >/= 38 mg/dL had a sensitivity of 87% and 80% specificity, for LDL pleural fluid level a cut-off value of >/= 22.5 mg/dl had a sensitivity of 87% and 78% specificity, and for HDL pleural fluid a cut-off value of >/= 10.5 mg/dl had a sensitivity of 70% and 69% specificity. AUC values were 0.906, 0.883, and 0.783, for CHOL, LDL, and HDL of pleural fluid, respectively. We conclude that pleural fluid CHOL, LDL and HDL are significantly increased in exudative effusions compared to the transudative ones. Measurement of CHOL, LDL and HDL concentrations in pleural effusions is useful in distinguishing exudates from transudates

Comparison of arterial and venous blood gases analysis in patients with exacerbation of chronic obstructive pulmonary disease

To investigate whether venous blood gases [VBG] test can be replace by an arterial blood gases [ABG] in exacerbation of chronic obstructive pulmonary disease [COPD]. From October 2005 to March 2006, at the Emergency Room of Kashan Beheshti Hospital, the data of 107 patients with exacerbation of COPD were assessed. Arterial blood gases and VBG samples were obtained simultaneously, and indexes of pH, carbon dioxide partial pressure [PCO2], bicarbonate [HCO3], oxygen partial pressure [PO2] and Oxygen [O2] saturation level were analyzed. The mean +/- SD of indexes in ABG and VBG samples were as follows: pH=7.37 +/- 0.47 versus 7.34 +/- 0.047; PCO2=53.88 +/- 7.63 mm Hg versus 59.55 +/- 8.96 mm Hg, HCO3=30.66 +/- 4.49 mEq/L versus 31.94 +/- 4.39 mEq/L; PO2=55.37 +/- 11.19 mm Hg versus 43.08 +/- 10.54 mm Hg. The average difference between indexes in ABG and VBG samples were as follows: pH=0.0241 +/- 0.004, p<0.001, r=0.864; PCO2=5.673 +/- 1.126 mm Hg, p<0.001, r=0.761; HCO3=1.279 +/- 0.604 mEq/L, p<0.001, r=0.749; and PO2=12.294 +/- 2.115 mm Hg, p<0.001, r=0.702. Venous blood gases, especially pH and PCO2 levels have relatively good correlation with ABG values. In view of the fact that, this correlation is not close, VBG cannot be substitute for ABG in exacerbation of COPD

effect of positions on spirometric values in obese asthmatic patients

Obesity as a common health risk is increasing all over the world. The aim of this study was evaluation of standing and sitting positions on spirometric values in obese asthmatic patients, in comparison with normal obese subjects. The study included 49 obese asthmatic patients with mean age of 42.63 years and body mass index of 36.06 kg/m2, and 51 control obese normal subjects with mean age of 39.86 years and body mass index of 36.69 kg/m2. Subjects with body mass index of [BMI]>/=30 kg/m2 were enrolled in the study. Spirometric values were measured according to American Thoracic Society [ATS] recommendation. In both groups forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1] were measured in sitting and standing positions, and the results were compared. The mean +/- SD of FVC in sitting and standing positions in obese asthmatic patients were: 3.04 +/- 0.93 lit and 3.03 +/- 0.96lit, p=0.37; and in control group: 3.68 +/- 1.12 lit and 3.72 +/- 1.11 lit, p=0.39, respectively. The mean +/- SD of FEV1 in the sitting position and standing positions in obese asthmatic patients were: 2.38 +/- 0.75 lit and 2.40 +/- 0.81 lit, p=0.20; and in control subjects: 3.17 +/- 0.92 lit and 3.21 +/- 0.93 lit, p=0.07. This study showed that spirometric values in obese asthmatic patients with BMI>/=30 are not affected by the standing and sitting positions

comparative efficacy of oral prednisone with intramuscular triamcinolone in acute exacerbation of asthma

Corticosteroids are recommended for emergency management of an asthmatic attack. This study was designed to compare the effectiveness of oral and intramuscular steroid on spirometric results in acute asthma. We performed a randomized trial involving 88 adults, aged 15-70 years, with acute exacerbation of asthma requiring treatment with steroids. All had been treated with standard bronchodilator regimens and then received oral prednisone, 40 mg/day for 7 days, or 40 mg/day intramuscular triamcinolone long acting [LA] for 3 days. Spirometric variable and percentage of change to baseline forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1] after treatment were calculated. Baseline characteristic were comparable in the oral prednisone group [n=44] and in the intramuscular triamcinolone LA groups [n=44]. After 7 days of treatment, the mean [SD] FEV1 and FVC in both groups improved statistically over baseline values [P<0.001]. The median percentage change improvement of FEV1 between two treatment groups was statistically significant: 68 +/- 45.3% vs. 53.4 +/- 46.5%, P=0.04] respectively, but for FVC although improvement with prednisone was better than intramuscular triamcinolone LA groups, it was not statistically significant [52.6 +/- 40.1% vs. 45.8 +/- 39.9%, P=0.43] respectively. We conclude that in adults with acute asthma, oral prednisone is more effective than intramuscular triamcinolone LA in improvement of FEV1, but although efficacy of oral prednisone in improvement of FVC is more than intramuscular triamcinolone LA group, this effect is not significant

Spirometric standards for healthy Iranians dwelling in the centre of Iran

In order to determining spirometric reference values in healthy, nonsmoker adult subjects, this study was performed on populations dwelling in the centre of Iran, Kashan city. The area was selected as the representative of a less polluted area in Iran, as we intended to exclude possible effects of air pollution on spirometric values. The study was performed on 550 subjects [295 Males, 255 Females] aged 17 to 82 years, randomly selected from the general population, and assessed anthropometrically for age and height by using stepwise regression analysis. The prediction equations were calculated on the basis of age and height for forced vital capacity [FVC], forced expiratory volume in one second [FEV1], and forced expiratory flow during the middle half of the FVC [FEF25-75%].Comparisons with predictions of other Caucasians studies are reported. A Comparative study of FVC and FEV1 values of our subjects, standardized for age and height was much closer to FVC and FEV1 of other studies. The prediction equations [based on age and standing height] for FVC [liters] in males: -5.546 + 0.065 height - 0.027 age; and females -3.214+ 0.046 height - 0.023 age; FEV1 [liters] in males: -2.853 + 0.046 height - 0.029 age; and females: - 2.430 + 0.039 height- 0.024 age; for FEF25-75% in males: + 1.987 + 0.027height - 0.044 age; and females: - 0.769 + 0.037 height - 0.033 age. A comparison between equation from the present study and other available reference data shows that our prediction values were similar to those previously reported. The present regression equations for predicted values of lung function measurements may be regarded as the definitive norms for adult population dwelling in the centre of Iran and will be useful for diagnostic and research purposes