Wearing surgical face mask has no significant impact on auscultation assessment.

Objective: During the COVID-19 pandemic, universal mask-wearing became one of the main public health interventions. Because of this, most physical examinations, including lung auscultation, were done while patients were wearing surgical face masks. The aim of this study was to investigate whether mask wearing has an impact on pulmonologist assessment during auscultation of the lungs. Methods: This was a repeated measures crossover design study. Three pulmonologists were instructed to auscultate patients with previously verified prolonged expiration, wheezing, or crackles while patients were wearing or not wearing masks (physician and patients were separated by an opaque barrier). As a measure of pulmonologists' agreement in the assessment of lung sounds, we used Fleiss kappa (K). Results: There was no significant difference in agreement on physician assessment of lung sounds in all three categories (normal lung sound, duration of expiration, and adventitious lung sound) whether the patient was wearing a mask or not, but there were significant differences among pulmonologists when it came to agreement of lung sound assessment. Conclusion: Clinicians and health professionals are safer from respiratory infections when they are wearing masks, and patients should be encouraged to wear masks because our research proved no significant difference in agreement on pulmonologists' assessment of auscultated lung sounds whether or not patients wore masks.

Stress Hyperglycaemia Indicates Embolus Size and Localization in Patients with Acute Pulmonary Embolism.

OBJECTIVE: Acute pulmonary embolism is a life-threatening form of venous thromboembolism often causing stress hyperglycaemia. The aim of this study was to determine the prognostic value of stress hyperglycaemia in acute pulmonary embolism, providing new insights into the presumed embolus size and localization, clinical parameters (Pulmonary Embolism Severity Index, PESI), and in-hospital mortality. Design and Methods. Among a total of 95,454 patients referred to the Emergency Department of the Sestre Milosrdnice University Hospital Centre between 2014 and 2016, all patients with acute pulmonary embolism were included into this observational cohort study. The study group consisted of 190 patients aged 25-96. Relevant patient history, clinical data, and laboratory findings were collected during the entire hospitalization period. Data were analyzed for the entire group of patients, as well as separately for patients without diabetes, using the Fisher exact test and logistic regression. RESULTS: Analysis of embolus localization as an indirect parameter of embolus size showed that patients with stress hyperglycaemia more often had emboli located in proximal parts of the pulmonary circulation (i.e., main artery or lobar branches) (p < 0.05). Furthermore, stress hyperglycaemia correlated with PESI score and diabetes (p < 0.05) in the entire patient group. Stress hyperglycaemia showed independent association with in-hospital mortality in patients (p < 0.05). CONCLUSION: Stress hyperglycaemia in patients with acute pulmonary embolism is associated with embolus localization in larger arteries of the pulmonary circulation and higher PESI score and therefore could serve as an independent in-hospital mortality predictor.

Correlation Between Concentration of Air Pollutants and Occurrence of Cardiac Arrhythmias in a Region with Humid Continental Climate

In this study, we investigated the correlation of air temperature, pressure and concentration of air pollutants with the rate of admissions for cardiac arrhythmias at two clinical centers in the area with a humid continental climate. This retrospective study included 3749 patients with arrhythmias admitted to emergency department (ED). They were classified into four groups: supraventricular tachycardia (SVT), ventricular tachycardia (VT), atrial fibrillation/undulation (Afib/Aund), and palpitations (with no ECG changes, or with sinus tachycardia and extrasystoles). The number of patients, values of meteorological parameters (average daily values of air temperature, pressure and relative humidity) and concentrations of air pollutants (particles of dimensions ~10 micrometers or less (PM(10)), ozone (O(3)) and nitrogen dioxide (NO(2))) were collected during a two-year period ( July 2008-June 2010). There were 1650 (44.0%), 1525 (40.7%), 451 (12.0%) and 123 (3.3%) patients with palpitations, Afib/Aund, SVT and VT, respectively. Spearman's correlation yielded positive correlation between the occurrence of arrhythmias and air humidity on the day (r=0.07), and 1 (r=0.08), 2 (r=0.09) and 3 days before (r=0.09), and NO(2) particles on the day (r=0.08) of ED admission; palpitations and air humidity on the day (r=0.11), and 1 (r=0.09), 2 (r=0.07) and 3 days before (r=0.10), and PM(10) (r=0.11) and NO(2) (r=0.08) particles on the day of ED admission; and Afi b/Aund and air humidity 2 days before (r=0.08) ED admission (p<0.05 all). In conclusion, there was a very weak positive correlation of the occurrence of cardiac arrhythmias with air humidity and concentration of air pollutants in the region with a humid continental climate.

Correlation Between Occurrence and Deterioration of Respiratory Diseases and Air Pollution Within the Legally Permissible Limits.

The aim of the study was to investigate the unknown effect of air pollutants on the occurrence or deterioration of respiratory diseases in the area with a humid continental climate. This retrospective study included 5868 patients with respiratory symptomatology (upper respiratory tract infection (URTI), pneumonia, acute bronchitis, chronic obstructive pulmonary disease (COPD), and asthma) admitted to emergency department (ED). The number of patients, values of meteorological parameters (mean daily values of air temperature pressure and relative humidity) and concentrations of air pollution particles (≤10 µm (PM10), ozone (O3) and nitrogen dioxide (NO2)) were collected during a two-year ( July 2008 - June 2010) period. There were 1839 (31.3%), 1712 (29.2%), 1313 (22.4%), 614 (10.5%) and 390 (6.6%) patients with pneumonia, COPD, URTI, acute bronchitis and asthma, respectively. The mean daily concentrations of NO2 (25.9 (1.7-89.7) µg/m3), O3 (47.1 (4.7-135.4) µg/m3) and PM10 particles (25.7 (4.6-146.6) µg/m3) were below the legally defined thresholds. Among other results, the occurrence of respiratory diseases showed positive Spearman's correlation with the values of air humidity (days 0-3, r=0.15 to 0.19), PM10(days 0-3, r=0.10 to 0.13) and NO2 concentrations (day 0, r=0.11), and negative correlation with the values of air temperature (days 0-3, r=-0.36 to -0.34), pressure (day 0, r=-0.10) and O3 concentrations (days 0-3, r=-0.21 to -0.22) (p<0.05 all). In conclusion, the occurrence of respiratory diseases showed correlation with weather conditions and air pollutants despite the legally permitted values in the region with a humid continental climate.

Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus.

Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. During an observation time of 33.4 months, death of any cause occurred in 40.9 % of the non-ketotic hyperglycemia group and 30.2 % of the DK group (hazard ratio in the diabetic ketosis group, 0.63; 95 % confidence interval 0.48-0.82; P = 0.0005). Patients with diabetic ketosis had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Patients with hyperglycemic crisis and diabetic ketosis have decreased all-cause mortality when compared to those with non-ketotic hyperglycemia. diabetic ketosis might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted.