Predictors of depressive symptoms among hospitalized COVID-19 patients with respiratory problems.

COVID-19 patients and survivors quite often experience depressive symptoms, which can increase risk for lower immune system response and poorer recovery. Vulnerability to depressive symptoms may be elevated in those patients who have the most severe COVID-19 course of illness, that is, patients who require supplementary oxygen therapy or even intubation. The current study involved a unique sample of patients who were hospitalized due to COVID-19 and who required respiratory support (N = 34, 10 women) in which we investigated depressive symptoms as well as psychopathological personality traits (PID5) as predictors. The majority of patients (76.5%) presented some degree of depressive symptoms. Although we expected severe levels of depressive symptoms to be most prevalent, more patients showed rather moderate levels. At the same time, Negative Affectivity was most predictive of depressive symptoms. We suggest that medical care for patients with greater emotional sensitivity and vulnerability to stress be supplemented with psychological support in order to address depressive symptoms and foster recovery.

Complex home assessment of long-term non-invasive ventilation efficacy using transcutaneous monitoring of PCO2 and polygraphy - A feasibility study.

PURPOSE: Home non-invasive ventilation (HNIV) during sleep is a standard treatment for chronic hypercapnic respiratory failure (CHRF). The aim of this study was to evaluate the feasibility of the complex overnight assessment of HNIV in adults performed at home and the efficacy of HNIV after one year of treatment. METHODS: Stable patients with CHRF on HNIV for more than 12 months had unattended polygraphy (PG) with transcutaneous monitoring of PCO2 (tcPCO2) at home during one night. The recording quality was regarded as excellent when 100% and good if 80-99% of the analysis time was registered. The following efficacy criteria were approved: (1) SpO2<90% for <10% of analysis time, (2) increase in PtcCO2 ≤7.5 â€‹mmHg between baseline and average value at night, (3) apnea-hypopnea index (AHI) ≤5/h. RESULTS: Eighteen patients with CHRF (median age 66 [60-74] years, 10 female) were included. The quality of the PG tracings was good to excellent in 16 (89%) patients and the quality of the tcPCO2 data was good to excellent in 14 (78%) patients. There was no difference in the quality of tcPCO2 between patients who lived alone and those who lived with family (100 [50-100]% vs. 100 [90-100]% of analysis time, respectively). Only 4 (22%) patients fulfilled all three efficacy criteria. CONCLUSIONS: Home-based monitoring using PG and tcPCO2 is a feasible and adequate tool to assess the efficacy of HNIV. In most of the patients on HNIV for more than 12 months, the treatment was not effective based on the predefined efficacy criteria.

Impact of age on the diagnostic yield of four different biomarkers of tuberculous pleural effusion.

The diagnostic value of pleural fluid biomarkers in tuberculous pleurisy (TP) is firmly established. However, it is less clear whether patients' age affects the diagnostic accuracy of TP biomarkers. The aim of the study was to assess the impact of age, on the predictive value of ADA, IFN-γ, IP-10 and Fas ligand in patients with pleural effusion. The study included 222 patients, median age 64.5 (54-77) years, 58.6% men, with pleural effusion: TPE (60 patients; 27.0%), malignant PE (90 patients; 40.5%), parapneumonic effusion/pleural empyema (35 patients; 15.8%), pleural transudate (30 patients, 13.5%) and other causes of PE (7 patients; 3.2%). The odds ratio for the diagnosis of TPE significantly decreased with increasing age (OR = 0.62/10 years) and significantly increased with increasing level of all evaluated pleural fluid biomarkers. Age affected the diagnostic accuracy of ADA with a trend towards reduction in OR for TPE in older patients (P = 0.077, 95% CI 0.59-1.03). Younger age and high pleural fluid ADA level are associated with very high probability of TP. This probability significantly decreases not only with decreasing pleural fluid ADA, but also with increasing age. Patient's age does not affect the diagnostic yield of pleural fluid IFN-γ, IP-10 and sFas.

Pleural Effusion in Meigs' Syndrome-Transudate or Exudate?: Systematic Review of the Literature.

Although Meigs' syndrome is regarded as a well-defined entity, contradictory data on pleural fluid characteristics have been presented, with some papers classifying it as a transudate, whereas others stating that it is an exudate.The aims of the study were: (1) to evaluate pleural fluid characteristics in patients with Meigs' syndrome and (2) to analyze the prevalence of transudative and exudative pleural effusion in relation to the applied definition of the syndrome.We performed a search through medical databases (MEDLINE, EMBASE, SCOPUS, and GOOGLE SCHOLAR) to identify papers on Meigs' syndrome published between 1940 and 2013. Two authors independently reviewed each paper searching for prespecified data: (1) signs and symptoms, (2) tumor characteristics, (3) clinical and laboratory data on ascites, (4) clinical, radiological, and laboratory data on pleural fluid, (5) clinical course after tumor removal. All case reports were reclassified according to a new unequivocal classification of Meigs' syndrome-related entities.A total of 653 papers were initially identified, and 454 articles reporting 541 patients were included in the final analysis. After reclassification according to our case definitions, there were 196, 113, and 108 patients defined as classic Meigs' syndrome, nonclassic Meigs' syndrome, and pseudo-Meigs' syndrome, respectively. Significantly more patients presented with right-sided than left-sided and bilateral pleural effusions (P < 0.001). Median volume of withdrawn pleural fluid was 2950 (1500-6000) mL. The classification of pleural effusion with the use of Light's criteria was possible in only 7 patients. In 6 of these patients pleural effusion met the criteria for an exudate. When the protein concentration > 3.0 g/dL was applied as a criterion of pleural exudate, 88.8% (80/90) of effusions were classified as exudates. Increasing the cut-off level to 3.5 g/dL resulted in only a modest decrease in the percentage of exudative effusions (81%, 73/90).Surprisingly few reports on Meigs' syndrome present data reliably defining the character of pleural effusion. The available data indicate, however, that the majority of pleural effusions in patients with this entity are exudates. This finding may be a prerequisite for the verification of some earlier presented concepts.

Heterozygous α1­antitrypsin deficiency in liver transplant candidates.

INTRODUCTION: It is estimated that in about 1% of all liver transplant candidates liver cirrhosis is caused by hereditary homozygous α1­antitrypsin (AAT) deficiency. OBJECTIVES: The aim of the study was to evaluate the role of heterozygous AAT deficiency in the development of liver cirrhosis leading to liver transplantation. PATIENTS AND METHODS: In the years 2009-2011, we conducted a prospective study of 304 consecutive patients (men, 57%) scheduled for orthotopic liver transplantation. AAT phenotyping and the clinical assessment of hepatic and cardiopulmonary functions were performed in all subjects.  RESULTS: The most common causes of liver cirrhosis were viral hepatitis (21%) and alcohol abuse (12%). Normal protease inhibitor (Pi) MM phenotype was observed in 284 patients. The PiMZ phenotype was detected in 11 subjects (4%), which indicates its higher prevalence in patients with liver cirrhosis compared with the general population (2%). PiMS phenotype was found in 6 patients (2%), and this value was similar to that observed in the Polish population. In 3 patients, less common phenotypes were observed: MP, IM, and MX. CONCLUSIONS: The PiMZ phenotype may be an independent risk factor for the development of liver cirrhosis along with the most common causes, namely, viral hepatitis and alcohol abuse.

[Role of biomarkers in making the diagnosis of tuberculous pleurisy]. / Rola biomarkerów w diagnostyce gruzliczego wysiekowegozapalenia oplucnej.

Although tuberculosis is one of the most common causes of pleural effusion, diagnosis of tuberculous pleuritis still remains a challenge. This is due to paucity of M. tuberculosis organisms in pleural effusion which results in a relatively low sensitivity of the routinely used diagnostic methods. Thus, different biomarkers in pleural effusion have been extensively studied in order to improve the diagnostic accuracy. Pleural fluid deaminase adenosine activity (ADA) and interferon gamma (IFN-γ) concentration have been shown to be the most reliable and cost-effective markers of tuberculous pleurisy. Hence, these markers have been included in different diagnostic algorithms for patients suspected of tuberculous pleurisy. A high variability of the diagnostic performance and/or more advanced technical demands significantly limit the use of other relatively new diagnostic methods, such as nucleic acid amplification tests (NAATs) and IFN-γ releasing assays (IGRAs). The article presents a current data on the potential use of different biomarkers in the diagnosis of tuberculous pleurisy.

[Effects of nurse home visits on compliance to long-term oxygen therapy. 14 months follow-up]. / Wplyw czestych wizyt pielegniarskich na przestrzeganie przez pacjentów zalecen domowego leczenia tlenem. Obserwacja 14-miesieczna.

INTRODUCTION: Long-term oxygen therapy (LTOT) is the only treatment improving survival of patients with respiratory failure due to chronic obstructive pulmonary disease (COPD). Benefits of treatment depend mainly on daily duration of oxygen use. The aim of the study was to assess daily use of oxygen and to evaluate influencing factors. MATERIAL AND METHODS: Consecutive patients qualified to LTOT were included. Eligibility for LTOT was based on the ATS//ERS guidelines. All patients were instructed to use oxygen from oxygen concentrator for 15 hours per day or more. Duration of oxygen therapy was verified every 4 weeks by visiting respiratory nurse using counter clock of oxygen concentrator. The nurses were also encouraging patients to breathe oxygen for at least 15 h/d. RESULTS: Study group consisted of 30 patients (77% with COPD) aged 67+/-9 yrs, mean FEV, 46+/-18% pred., RV%TLC 64+/-16%, PaO2 50+/-6 mm Hg. Mean duration of oxygen therapy for the group was 12.5+/-4.6 h/d. Eleven (37%) subjects followed prescription during whole follow-up period (mean oxygen use 17.4+/-2.6 h/d). Mean oxygen use in the non-compliant group was 9.6+/-2.7 h/d. In COPD group compliant patients had significantly lower TLC (100+/-19% pred. v. 152+/-36% pred., p=0.001) and lower PaCO2 (38+/-6 mm Hg v. 47+/-8 mm Hg, p<0.05) when compared to the non-compliant group. During the first month of treatment 48% of patients were compliant. From the second month onward percentage of compliant patients fell to 30% and remained stable to the end of the study. Fourteen patients (47% complained of electricity consumption and 7 patients (23%) complained of the noise of working concentrator. Daily oxygen use in the latest group was significantly lower when compared to those who did not complain of the noise (9+/-3.7 h/d v. 13.5+/-4.4 h/d; p=0.02). CONCLUSIONS: The best compliance to home oxygen therapy is observed at the beginning of treatment. Frequent home nurse visits do not improve compliance. We hypothesize that the use of other oxygen sources eg. liquid oxygen, that are silent and do not increase the cost of electricity, could improve compliance.

[Lymphocyte and lymphocyte subsets in pleural fluid--comparison of malignant and non-malignant disorders]. / Limfocyty i ich subpopulacje w plynie z jamy oplucnej--porównanie plynów nowotworowych i nienowotworowych.

The role of lymphocytes in host defence in neoplastic disorders is known. Accumulation of lymphocytes in pleural cavity frequently occurs in different diseases. The aim of the study was to evaluate: 1) the frequency of lymphocyte predominance in different malignant and non-malignant pleural effusions; 2) lymphocyte phenotype and the ratio between helper (CD4+) and cytotoxic/suppressor (CD8+) lymphocytes in malignant and non-malignant effusions. Patients with mesothelioma, lung cancer, lymphoma and metastatic neoplasms were analysed. Analysis was performed on fluids with or without malignant cells. Non-malignant fluids were obtained from patients with: congestive heart failure, liver cirrhosis, pneumonia and tuberculosis. Lymphocytes were the predominant cell type in neoplastic effusions. For further analysis effusions with more than 10% of lymphocytes were included: 12 malignant and 9 non-malignant. For lymphocyte subpopulations analysis, the monoclonal antibodies anti-CD4 and anti-CD8 and APAAP method was used. We observed lower percentage of CD4+ lymphocytes (47%) and higher percentage of CD8+ (39%) lymphocytes in malignant when compared to non-malignant fluids (58% vs 31% respectively). The CD4+/CD8+ ratio was significantly lower in pleural fluid in cases with neoplastic disease when compared to benign cause of pleural involvement (1.03 vs 1.85). Our observations suggest the potential role of lymphocytes, especially CD8+ cells in local response in malignancy in pleural disease.