Clinical efficacy of caspofungin combined with voriconazole in the treatment of older adult patients with pulmonary fungal infection / 中国基层医药

Objective:To investigate the clinical efficacy of caspofungin combined with voriconazole in the treatment of older adult patients with pulmonary fungal infection and its effects on pulmonary function and inflammatory factors.Methods:A total of 100 patients with pulmonary fungal infection admitted to Hangzhou Ninth People's Hospital from January 2016 to December 2020 were included in this study. They were randomly assigned to undergo treatment with either voriconazole (control group, n = 50) or caspofungin combined with voriconazole (observation group, n = 50) for 14 consecutive days. Clinical efficacy and changes in pulmonary function and inflammatory factors after treatment relative to before treatment were determined in each group. Results:Total response rate in the observation group was significantly higher than that in the control group [90.00% (45/50) vs. 74.00% (37/50), χ2 = 4.33, P < 0.05). After treatment, forced vital capacity, forced expiratory volume in 1 second, and maximum expiratory flow rate in the observation group were (2.31 ± 0.77) L, (79.30 ± 6.72)%, (86.14 ± 7.27)%, respectively, which were significantly higher than (1.78 ± 0.74) L, (73.22 ± 6.56)%, (78.16 ± 7.09)% in the control group ( t = 3.50, 4.57, 5.55, all P < 0.05). Tumor necrosis factor α, interleukin-6, and procalcitonin levels in the observation group were (8.32 ± 1.41) ng/L, (35.19 ± 3.40) μg/L, (1.94 ± 0.78) ng/L, respectively, which were significantly lower than (10.15 ± 1.58) ng/L, (46.09 ± 3.64) μg/L, (2.43 ± 0.84) ng/L in the control group ( t = 6.11, 15.43, 3.02, all P < 0.05). The incidence of adverse reactions in the observation group was 4.0% (2/50), which was significantly lower than 18.0% (9/50) in the control group ( χ2 = 5.00, P < 0.05). Conclusion:Caspofungin combined with voriconazole for the treatment of pulmonary fungal infection in older adult patients can effectively improve pulmonary function, inhibit the inflammatory response, and have no obvious adverse reactions with accurate clinical efficacy.

Comparison of the effect of recumbent body positions on dynamic lung function parameters in healthy adults

Background: Pulmonary function parameters can be altered with the change in body position. Therefore, physiological basis behind such consequent influence is essential to be understood. Pulmonary function tests are generally conducted in the erect sitting posture as it is more feasible and comfortable. However, bedridden patients are unable to do so and only few studies are found on recumbent postures. Thus, to comfort such patients in breathing, need arises to meet this requisite investigation to conclude the best recumbent body posture. Aim and Objectives: To compare and assess forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, forced expiratory flow of during 25�% expiration (FEF25�%, and peak expiratory flow rate (PEF) in the Supine, Crook-lying and Fowler抯 position. Materials and Methods: The present research was carried out on 128 healthy adults to measure FVC, FEV1, FEV1/FVC ratio, FEF25�% and PEF using a computer-based spirometer in the Supine, Crook-lying and Fowler抯 position. One-way Analysis of Variance with Tukey HSD post-hoc test was utilized between each body postures by evaluation of their mean values. Results: This study consisted of 128 subjects (males 57, females 71) with mean age of 21.62 � 1.75 years, mean weight 59.71 � 9.97 kg, mean height 164.68 � 9.30 cm and Body mass index 21.91 � 2.38 kg/m2. Fowler抯 posture showed significantly (P < 0.05) higher value in all spirometric parameters as compared to other two postures. Outcome of the study showed all spirometric parameters value- greater in the Fowler抯 posture than that of Supine or Crook-lying posture. Conclusion: The implication of this research is that it will meet the need of selection of the most suitable substitute posture for better pulmonary functioning in bedridden people.

Pulmonary functions in car air conditioner users and non-air conditioner users in tertiary care centre, South Tamilnadu, India

Background: Air conditioners are used extensively these days of the modern lifestyle. Inhalation of cold dry air while using Air conditioners causes bronchoconstriction due to which alteration may occur in pulmonary function. This study was aimed to compare the Pulmonary Function tests of Car AC users and non AC users. Methods: The Study included 52 employees not exposed to car air conditioner as a control (group I) and 52 employees exposed to car air conditioner  with minimum exposure of 1 hour per day for 6 months as a subject (group II). Pulmonary function tests were performed using computerised spirometer. Statistical analysis was done by unpaired t test.Results: Age, Height and weight are not statistically significant between study group and control group. Forced vital capacity, forced expiratory volume in 1 second, Ratio of Forced vital capacity and Forced expiratory volume in 1 second, Inspiratory reserve volume, Expiratory reserve volume, Maximum voluntary ventilation are decreased in car air conditioner users compared to non-users, but was not significant. Forced expiratory flow (FEF), Peak expiratory flow rate (PEFR) values shows statistically significant decreased in car air conditioner users.Conclusions: The present study shows hyper-responsive airways on exposure to cold air which leads to bronchoconstriction. The significant decrease in PEFR, FEF suggest that upper airways as well as smaller airways are affected on exposure to car AC. So, Exposure to car Air Conditioner leads to risk of developing respiratory dysfunction.

Clinical effect of Guben-Huoxue decoction on chronic obstructive pulmonary disease / 国际中医中药杂志

Objective To explore the clinical effect of Guben-Huoxue decoction on chronic obstructive pulmonary disease (COPD) and its influence on patients'respiratory rehabilitation and quality of life. Methods A total 108 patients with COPD admitted to our hospital from May 2013 to January 2018 were selected as the research subjects. The patients were divided into control group and observation group by random number table grouping method, 54 in each group. All patients were given basic treatment such as oxygen inhalation, anti-infection, bronchiectasis, and correction of acidosis. The control group was treated with budesonide formoterol powder inhalation, while the observation group was treated with Guben-Huoxue decoction on the basis of the control group. The maximum ventilation volume per minute (MVV), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiratory volume in the second (FEV1%) were measured by pulmonary function meter. Adverse reactions were recorded. Results The difference of FVC, MVV, FEV1%, symptoms, activity ability, disease influence and comprehensive scores in the observation group were significantly greater than those in the control group (t values were 6.480, 13.679, 5.853, 3.743, 5.786, 5.309, 5.058, respectively, all Ps<0.05). The total effective rate (94.4%) in the observation group were significantly higher than those in the control group (79.6%); the total incidence of adverse reactions (9.3%) was significantly lower than that of the control group (25.9%), and the difference was statistically significant (P<0.05). Conclusions The Guben-Huoxue decoction can improve the clinical symptoms and pulmonary function of COPD patients, promote respiratory rehabilitation and improve the quality of life.

Clinical effect of Guben-Huoxue decoction on chronic obstructive pulmonary disease / 国际中医中药杂志

Objective@#To explore the clinical effect of Guben-Huoxue decoction on chronic obstructive pulmonary disease (COPD) and its influence on patients'respiratory rehabilitation and quality of life.@*Methods@#A total 108 patients with COPD admitted to our hospital from May 2013 to January 2018 were selected as the research subjects. The patients were divided into control group and observation group by random number table grouping method, 54 in each group. All patients were given basic treatment such as oxygen inhalation, anti-infection, bronchiectasis, and correction of acidosis. The control group was treated with budesonide formoterol powder inhalation, while the observation group was treated with Guben-Huoxue decoction on the basis of the control group. The maximum ventilation volume per minute (MVV), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiratory volume in the second (FEV1%) were measured by pulmonary function meter. Adverse reactions were recorded.@*Results@#The difference of FVC, MVV, FEV1%, symptoms, activity ability, disease influence and comprehensive scores in the observation group were significantly greater than those in the control group (t values were 6.480, 13.679, 5.853, 3.743, 5.786, 5.309, 5.058, respectively, all Ps<0.05). The total effective rate (94.4%) in the observation group were significantly higher than those in the control group (79.6%); the total incidence of adverse reactions (9.3%) was significantly lower than that of the control group (25.9%), and the difference was statistically significant (P<0.05).@*Conclusions@#The Guben-Huoxue decoction can improve the clinical symptoms and pulmonary function of COPD patients, promote respiratory rehabilitation and improve the quality of life.

Análise de pico de fluxo de tosse voluntária de pacientes em um hospital de urgências / Analysis of voluntary cough flow peak of patients in an emergency hospital

INTRODUÇÃO: A tosse, voluntária ou reflexa, é um dos principais mecanismos de depuração para proteção das vias aéreas. O pico de fluxo de tosse (PFT) é um método de avaliação específica, mas que vem demonstrando utilidade para avaliar riscos de complicação pulmonares bem como sua gravidade. Variável muito semelhante ao pico de fluxo expiratório cuja principal diferença consiste no fechamento da glote durante a manobra de tosse. Então avaliar a tosse é importante para identificar pacientes com alterações no pico de fluxo de tosse, e consequente risco de complicações pulmonares. OBJETIVO: Analisar o PFT voluntário e parâmetros clínicos e epidemiológicos em uma população internada nas enfermarias de um hospital de urgências. MÉTODOS: Estudo transversal com pacientes internados nas enfermarias de um Hospital Público de Goiânia. Foram coletados dados epidemiológicos e clínicos. O PFT foi mensurado pelo peak flow meter e a avaliação de dor através da Escala de Dor Visual Numérica associada à Escala de Dor de Faces. RESULTADOS: A amostra foi composta em sua maioria por homens 288 (81,36). A média de idade da população estudada foi de 45,91 anos (±20,14). Sessenta e um por cento dos pacientes (219) apresentaram tosse eficaz, e 43 (12,15%) tosse ineficaz, revelou associação com idade, sexo e diagnóstico. CONCLUSÃO: Os pacientes que mais apresentaram alterações na força de tosse foram os idosos, sexo feminino e vítimas acometidas por desordens neurológicas e toracoabdominais. [AU]

INTRODUCTION. Cough, whether voluntary or reflex, is one of the major clearance mechanisms for airway protection. Peak cough flow is a recent and specific evaluation method, but it has been useful for evaluating pulmonary complications as well as their severity. Variable very similar to the peak of expiratory flow whose main difference consists in the closure of the glottis during the maneuver of cough. Therefore, assessing cough is important to identify patients with changes in peak cough flow, and the consequent risk of pulmonary complications. OBJECTIVE: To analyze the peak flow of voluntary cough and its association with clinical and epidemiological parameters in a population hospitalized in the wards of an emergency hospital. METHODS: A cross-sectional study with 354 patients admitted to the wards of a Public Hospital of Goiânia. Epidemiological and clinical data were collected. Optic cough flow was measured by the peak flow meter and the pain assessment using the Numerical Visual Pain Scale associated with the Face Pain Scale. RESULTS: The sample consisted mostly of 288 (81,36) men. The mean age of the study population was 45,91 years (± 20,14). 61, 86% (219) of the patients had effective cough, and 43 (12,15%) had an ineffective cough. CONCLUSION: Patients who presented the greatest changes in coughing strength were the elderly, females and victims of neurological and thoracoabdominal disorders. [AU]

Prediction Equations for Spirometry for Children from Northern India.

Objective: To develop prediction equations for spirometry for children from northern India using current international guidelines for standardization. Design: Re-analysis of cross-sectional data from a single school. Participants: 670 normal children (age 6-17 y; 365 boys) of northern Indian parentage. Methods: After screening for normal health, we carried out spirometry with recommended quality assurance according to current guidelines. We developed linear and nonlinear prediction equations using multiple regression analysis. We selected the final models on the basis of the highest coefficient of multiple determination (R2) and statistical validity. Main outcome measures: Spirometry parameters: FVC, FEV1, PEFR, FEF50, FEF75 and FEF25-75. Results: The equations for the main parameters were as follows: Boys, Ln FVC = -1.687+0.016*height +0.022*age; Ln FEV1 = -1.748+0.015*height+0.031*age. Girls, Ln FVC = -9.989 +(2.018*Ln(height)) + (0.324*Ln(age)); Ln FEV1 = -10.055 +(1.990*Ln(height))+(0.358*Ln(age)). Nonlinear regression yielded substantially greater R2 values compared to linear models except for FEF50 for girls. Height and age were found to be the significant explanatory variables for all parameters on multiple regression with weight making no significant contribution. Conclusions: We developed prediction equations for spirometry for children from northern India. Nonlinear equations were superior to linear equations.

Depression and quality of life in patients with severe chronic obstructive pulmonary disease – A cross sectional study.

Background: We assessed the prevalence of depression and quality of life and their associations in patients with severe and very severe COPD. Materials and methods: Sixty individuals who gave consent and who met the gold criteria for severe and very severe COPD were recruited for the study. The results of spirometry (FEV1%) which gives the severity of COPD were noted. The recruited individuals were screened for depression through a clinical interview and ICD-10 criterion was used to diagnose depression. The severity of depression of each individual participating in the study was estimated using Hamilton Depression Rating and the quality of life of each individual was estimated using the WHO Quality of Life Questionnaire –BREF Version. Results: Mean age of the patients was 53±4.5 years. The duration of COPD was 8.68±4.3 years. 93.3% of the individuals recruited for the study had severe COPD. 68.3% had been mild to severe depression while 31.7% were normal. The mean HAM-D and quality of life total score of these patients were 17±9.09 and 52±15.1 respectively. HAM-D scores in patients suffering from very severe COPD were much higher when compared to that of patients suffering with severe COPD. Patients with severe depression have poor quality of life on all aspects in comparison with moderate and mildly depressed. Numbers of exacerbations and hospitalizations have a significant correlation with severity of depression and a significant negative correlation with all domains of quality of life. Lakshmi Rajesh Channareddy, Eshwar Reddy Ravula, G. P. Vignan Kumar. Depression and quality of life in patients with severe chronic obstructive pulmonary disease - A cross sectional study. IAIM, 2016; 3(4): 78-83. Page 79 Conclusion: The prevalence of depression in patients with severe to very severe COPD is as high as 68.3%. There was a positive correlation between the number of hospitalizations and exacerbations to the severity of depression. Quality of life in COPD patients with depression was found to be poor in all the four domains namely physical, psychological, social and environmental when compared to those having only COPD as an illness. The severity of COPD was positively correlated with severity of depression and showed a negative correlation with the quality of life.

Estrategias terapéuticas para aumentar la eficacia de la tos en pacientes con enfermedades neuromusculares / Therapeutic strategies to increase the effectiveness of cough

Cough is a natural reflex that protects respiratory airways against infections or mucus retention. Cough maintains an adequate cleaning of the airways and is a mainstay of respiratory therapy. It can be triggered voluntarily by the patient or by a specific cough device. Peak cough flow (PCF) is used to assess the effectiveness of the cough. When this value is below 160 L/min, cough is considered inefficient and becomes a risk factor for respiratory problems. Patients with weak cough, especially those with neuromuscular disease, have in common a low tidal volume and a decreased maximum insufflation capacity. Both factors directly affect the inspiratory phase previous to cough, which is considered vital to obtain the optimum flow for a productive cough. Different therapeutic measures may help to increase cough efficiency among patients with cough weakness. These interventions may be performed using manual techniques or by mechanical devices. The aim of this review is to analyze the different techniques available for cough assistance, set a hierarchy of use and establish a scientific basis for their application in clinical practice.

Aplicação clínica do pico de fluxo da tosse: uma revisão de literatura / Clinical application of peak cough flow: a literature review

Introdução: A tosse é responsável pela manutenção da via aérea livre de secreção e corpos estranhos. O pico de fluxo da tosse (PFT) é o fluxo expirado máximo medido durante uma manobra de tosse por meio de um peak flow meter. A eficácia da tosse depende da magnitude do pico de fluxo. Técnicas de insuflação assistida e de assistência manual à tosse podem aumentar a sua eficácia. Um PFT mínimo de 160 L/minfoi relatado por alguns autores como necessário para manutenção da clearance brônquica e desmame da ventilação mecânica. Objetivo: Realizar uma revisão de literatura sobre a utilização do pico de fluxo da tosse na avaliação da eficácia da tosse em diferentes situações clínicas. Método: Foi utilizado o descritor peak cough flow, durante a pesquisa realizada nas bases de dados Medline, SciELO e LILACS. Resultado:Foi encontrado um total de 36 artigos, sendo 31 selecionados para leitura. Foram selecionados os artigo sem português, espanhol ou inglês. Conclusão: O PFT vem sendo cada vez mais utilizado na avaliação dos doentes neuromusculares e também em outras situações clínicas.

Coughing is responsible for the clearance of secretion and foreign bodies from the respiratory airway. The peak cough flow (PCF) is the maximum expiratory flow measured by a peak flow meter during a coughing maneuver. Coughing effectiveness is dependant on the peak flow's magnitude. Assisted insufflation technique and manually assisted coughing can increase ability to cough. PCF of 160L/min was reported by some authors as the minimum required to clear airway and mechanical ventilation weaning. Objective: The purpose of this review was to research on the use of PCF to evaluate coughing strength in different clinical conditions. Method: The subject headings used was peak cough flow in a search from Medline, SciELO and LILACS databases. Results: It was found a total of 36 papers and 31 bibliographic references in Portuguese, Spanish and English languages were selected. Conclusion: The PCF is more and more measured in neuromuscular disease valuation and in other clinic condition.

Variáveis perioperatórias de função ventilatória e capacidade física em indivíduos submetidos a transplante cardíaco / Perioperative variables of ventilatory function and physical capacity in heart transplant patients

INTRODUÇÃO: O transplante cardíaco é atualmente a única alternativa cirúrgica amplamente aceita para tratar pacientes com insuficiência cardíaca (IC) grave que a terapia medicamentosa otimizada não consiga manter qualidade de vida adequada. OBJETIVO: Descrever e comparar os valores entre pré e pós-operatório, das capacidades física e pulmonar de pacientes que realizaram transplante cardíaco. MÉTODOS: Estudo de coorte retrospectivo composto por indivíduos submetidos ao transplante cardíaco, entre janeiro de 2001 a março de 2005, no IC-FUC/RS. RESULTADOS: Foram incluídos na análise 21 indivíduos. Observou-se redução dos valores de volumes e capacidades pulmonares (VEF1 e CVF) no 1º dia de pós-operatório em relação ao pré-operatório (P<0,001) e recuperação destes valores no 14º dia de pós-operatório (P<0,001). Os valores de força muscular inspiratória demonstraram tendências semelhantes, reduzindo no 1º dia de pós-operatório em relação ao pré-operatório (P< 0,001) e recuperando no 14º pós-operatório (P< 0,001). A capacidade funcional útil, mensurada por meio do teste de caminhada de 6 minutos (T6') mostrou melhora no 14º pós-operatório em relação ao pré-operatório (P< 0,001). CONCLUSÃO: Alterações na função ventilatória de indivíduos submetidos a transplante cardíaco são previsíveis, porém estes recuperam a força de músculos ventilatórios e capacidades pulmonares dentro de duas semanas, além de melhorar a capacidade funcional útil em relação ao préoperatório, sendo o transplante, quando indicado, associado à reabilitação funcional boa estratégia terapêutica.

INTRODUCTION: Heart transplantation is currently the only widely accepted surgical alternative to treat patients with severe heart failure (HF) drug therapy cannot maintain optimal quality of life appropriate. OBJECTIVE: To describe and to compare the values between pre-and postoperative physical capacity and pulmonary patients who underwent heart transplantation. METHODS: A retrospective cohort composed of patients undergoing heart transplantation between January 2001 to March 2005 in IC-FUC/RS. RESULTS: Were included in the 21 individuals. We observed decreased levels of volume and lung capacity (FEV1 and FVC) in the first days after surgery compared to preoperatively (P <0.001) and recovery of these values in the 14th postoperative day (P <0.001). The values of muscle strength showed similar trends in reducing post-operative period compared to preoperative (P <0.001) and recovered on the 14th postoperative day (P <0.001). A useful functional capacity, measured by testing 6-minute walk test (T6') showed improvement in the 14th postoperative day in relation to pre-operatively (P <0.001). CONCLUSION: Changes in ventilatory function of subjects undergoing cardiac transplantation are predictable, but these recover respiratory muscle strength and lung capacity within two weeks, and improve functional capacity useful in relation to pre-operative, the transplantation, when indicated, associated with good functional rehabilitation is very god treatment strategy.

Utility of a forced expiratory flow of 25 to 75 percent as a predictor in children with asthma / 소아과

PURPOSE: Asthma is defined as chronic inflammation of the lower small airways, and bronchial hyperreactivity (BHR) is a pathophysiologic feature of asthma. It has been proposed that although there is no direct variable capable of assessing the small airways, a forced expiratory flow of between 25 and 75 percent (FEF25-75) might be considered a more sensitive early marker of small airway obstruction than the forced expiratory volume in 1 second (FEV1). Thus, we proposed that the presence and degree of positive responses to bronchial methacholine testing were related to the difference (DFF) and ratio (RFF) between FEV1 and FEF25-75 in asthmatic children. METHODS: The subjects were 583 symptomatic children, including 324 children with BHR and 259 controls. Pulmonary function tests, methacholine challenge tests, and skin prick tests were performed, and the total eosinophil count, total serum IgE, and serum eosinophil cationic protein level were measured in all subjects. From a concentration-response curve, the methacholine concentration required to produce a decrease of 20% from post-saline FEV1 was calculated (PC20). RESULTS: The median DFF and RFF values decreased in controls compared to subjects with bronchial hyperresponsiveness, and this trend was found in groups ranked by its severity. PC20 had a negative correlation with DFF and RFF. Cutoff values of 0.5 for DFF and 1.042 for RFF were identified, and sensitivity and specificity were calculated. CONCLUSION: This study revealed that DFF and RFF might be predictive of bronchial hyperresponsiveness in the context of normal FEV1 in children.

Usefulness of FEF25-75% in Methacholine Bronchial Provocation Test in Children with Asthma / 소아알레르기및호흡기학회지

PURPOSE: Although asthma is generally understood as a disease of the the small airways, FEF25-75%, an index representing peripheral small airways, is a appropriately used in the diagnosis of asthma. The objectives of this study are to assess the usefulness of FEF25-75% in children with asthma for clinical application. METHODS: Five hundred sixty two 5- to 15-year-old children with symptoms suggestive of asthma were enrolled. Methacholine bronchial provocation tests were performed and the children were divided into two groups according to their test results. RESULTS: Forced expiratory flow between 25-75 percent of vital capacity (FEF25-75%) was significantly lower in asthma group (P< 0.001). A 25 percent fall of FEF25-75% of percentage predicted value was correlated with PC20FEV1 (provacation concentration of methacholine required to reduce FEV1 by 20 percent) (r=0.601, P< 0.001). The sensitivity of PC25FEF25-75% (provocation concentration of methacholine required to reduce FEF25-75% by 25 percent) was 94.11 percent when PC20FEV1 was a point of reference. Youden's index was 0.64. CONCLUSION: FEF25-75% is an useful and sensitive index that predicts the presence or absence and the degree of bronchial hyperresponsiveness and PC25FEF25-75% should be brought into clinical application in asthmatic children.