Blog About Health and Care News - Part 2

Canadian HealthCare Mall: Airway Inflammation During Severe Exacerbations of COPD

COPDCOPD is characterized by periodic exacerbations and remissions. As lung function worsens, exacerbations become more frequent and severe. In patients with stage III to IV COPD (the Global Initiative for Chronic Obstructive Lung Disease classification), exacerbations become an important feature of the disease with a considerable negative impact on the quality of life.” In addition, severe exacerbations often require hospital admission and are associated with high morbidity and mortality rates.

Inflammatory and oxidant stimuli induce the cellular expression of inducible nitric oxide synthase (iNOS) and heme oxygenase (HO)-1. HO-1 confers protection against oxidative stress conditions, through antioxidant, antiapoptotic, and antiinflammatory actions. On the contrary, iNOS generates nitric oxide (NO), which shifts the cellular redox potential to a more oxidized state. NO under aerobic conditions reacts with oxygen and superoxide anion radicals to yield nitrite and peroxynitrite. Peroxyni-trite or peroxidase-dependent nitrite oxidation leads to tyrosine nitration. Nitrotyrosine is an indicator of the involvement of NO in irreversible oxidative reactions and has been associated with altered protein function.” Although a number of studies have related COPD exacerbations to increased airway inflammation and oxidative stress, there are relatively limited data regarding severe COPD exacerbations requiring hospital admissions. This is mainly due to technical difficulties in studying lung tissue samples obtained from COPD patients during exacerbation. On the contrary, sputum induction is a relatively noninvasive and safe technique, which can be performed on COPD patients even at the time of an exacerbation.

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Canadian Health and Care Mall: Fat Embolism Syndrome

Fat embolism syndromeLiquid silicone (polydimethylsiloxane) is an inert material that has minimal tissue reaction, a high degree of thermal stability, a low surface tension, a lack of immuno-genicity, and little or no change in physical property during aging. For these reasons, the injection of liquid silicone is frequently used for medical purposes, illegal breast augmentation, and other cosmetic procedures.

After a patient was hospitalized at our institution because of life-threatening pulmonary hemorrhage following illegal silicone injection, we collated all of the cases published in English of patients who had been hospitalized after illegal subcutaneous silicone injection with the aim of describing the common aspects of the silicone syndrome. We found a striking correlation between the clinical features following silicone injection and the features of fat embolism syndrome (FES).

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Canadian Neighbor Pharmacy : Results and Disscusion of Some Short-term Effects of Changing to Lower Yield Cigarettes

cessation of cigaretteMid-tar to Low-tar Study

There were no significant changes in 90mTc DTPA clearance (tVzLB) in either group of subjects over the four-week period of the study (Table 2). The difference in mean values for tVfcLB between group 1 and group 2 in any of the four weeks was not statistically significant. In the group of subjects smoking middle tar cigarettes throughout the whole study period, COHb% showed no significant change between week 2 and 4. In the group who switched to low-tar cigarettes, the fall in COHb was not statistically significant (Table 2). There was a significant difference (p <0.025) between COHb% in group 1 and 2 at week 2 but not week 4.

Individual subject data for weeks 2 and 4 are shown in Figure 1. There was no significant correlation between COHb% and tMsLB.

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Canadian Neighbor Pharmacy: Results of Oxygen Supplemented Exercise of Ventilatory and Nonventilatory Muscles in Pulmonary Rehabilitation

pulmonary rehabilitation programAll patients who entered the Malden Hospital pulmonary rehabilitation program in its first four years were evaluated. There were 41 men and 22 women. The age ranged from 43 to 76 years, with a median age of 64. The range and distribution of FEVj values were as follows: 40 percent had FEVj between 0.5 and 1 L/min; 20 percent, 1 to 1.5 L/min; 15 percent, 1.5 to 2 L/min; 9 percent, <0.5 L/min; 6 percent, 2.5 to 3 L/min; 5 percent, >3 L/min; and 5 percent, 2 to 2.5 L/min. The average FEVj was 1.34 L.

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Pleuropulmonary Complications

ischemiaWhen a foreign object is inserted into the body, it can cause injury from the site of entry to the site of distal placement. Since the introduction of nasogastric tubes, refinements have been made, and the spectrum of injuries has changed. Earlier large-bore stiff tubes (16 to 20 French) were inserted easily, but there were problems related to the patients comfort and to ischemia and necrosis of superficial tissues due to compression of the tube against mucosal surfaces. Ulceration and bleeding from the nose, posterior larynx, esophagus, and stomach were reported. Tracheoesophageal fistulas also were a known complication. These larger tubes also were capable of perforating the esophagus and entering the tracheobronchial tree. In order to eliminate these problems, narrow-bore nasogastric tubes were developed. They range from 12 French (4 to 5 mm in external diameter) to 1 to 2 mm in external diameter and are soft pliable polyvinylchloride-based tubes with weighted ends and stylets for use on insertion. These stylets give stiffness and strength to the tubing and allow easier advancement of the device; however, with insertion of the stylet, the tubing becomes stiff and could perforate a number of structures if excessive pressure is applied with the distal tip deflected against an organ. The procedure for passage of a nasogastric tube has been described. Passage of a narrow-bore nasogastric tube is similar. In general, it involves having the sitting patient swallow repeatedly when the tube enters the oropharynx. There are a number of commonly accepted guidelines which suggest proper tube placement: (1) insufflation of air with sounds heard over the left upper quadrant (stomach); (2) aspiration of fluid, suggesting placement in the stomach; (3) passage of the tube the full distance (60 cm) with easy removal of the stylet, suggesting that the tubing is straight, not kinked, and unlikely to be in the bronchial tree; and (4) absence of coughing, suggesting esophageal passage of the tube.

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Exhaled Biomarkers: Future Directions

Exhaled breath temperature and bronchial blood flow may reflect rubor and calor in the airways, and therefore may be markers of tissue inflammation and remodeling in asthma and COPD. The fact that lower breath temperature, after the inhalation of corticosteroids, is correlated with reduced levels of bronchial blood flow may suggest that these non-invasive measurements may be useful to evaluate airway inflammation and may provide a tool to assess steroid sensitivity.
Other Novel Technologies for Exhaled Biomarkers Assessment
Proteomics and Metabonomics
These noninvasive technologies offer rapid, mechanistic information of response of living systems to any exposure (smoke, bacterial/viral, treatment) regarding protein expression or metabolic regulation. They may facilitate incorporation of clinical data at earlier stages of drug development and particularly aid biomarker discovery and characterization.
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Exhaled Biomarkers: Exhaled Breath Condensate

Exhaled Biomarkers: Exhaled Breath CondensateNOS Substrates: L-arginine supplementation has been studied in a variety of clinical situations in which the increase of NO production is desired. For example, orally administered and inhaled L-arginine has been used in normal subjects and patients with primary ciliary dyskinesia to improve the bactericidal activity of the lungs, ciliary beating, and mucociliary dysfunction in COPD.
Effect of ICS: Lack of effect of conventional ICS on Calv brings an important advantage of MEFT FeNO measurements in COPD for monitoring the inflammatory process that is clearly different from asthma. It can be speculated, however, that antiinflammatory effect of some novel formulation, for example, combination of beclomethasone dipropionate with formoterol delivered by small-particle-size aerosols, may be assessed by the MEFT in COPD.
Effect of Smoking: Smoking may trigger this inflammatory cascade in COPD but does not have a direct effect on the source of Calv, which therefore may provide valuable additional information for assessing the inflammatory process. This may make this technique particularly valuable for assessing the antiinflammatory effects of new therapies in COPD in the future.
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Exhaled Biomarkers: NO Modulators

Resolution ofAirway and Lung Inflammation: The average exacerbation recovery time of COPD patients is 10.7 days (from 1 to 2 weeks) and currently is monitored by symptoms, purulence of sputum, and lung function. A significant proportion of patients treated for COPD exacerbation demonstrate incomplete recovery, and frequent exacerbations contribute to decline in lung function and poor health status. Lower airway bacterial colonization in stable patients with COPD instigates airway inflammation, which leads to a protracted self-perpetuating vicious circle of progressive lung damage and disease progression. We speculate that normalization of Calv may indicate the degree of recovery from lower airway bacterial colonization, and may serve as the predictors of poor outcome if the Calv levels do not respond to antibacterial treatment.
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Exhaled Biomarkers: COPD

Exhaled Biomarkers: COPDCombination inhalers (ICS plus long-acting (3-agonists) are the first-line treatment in asthma, although not in the United States. It is important, however, to monitor the underlying airway inflammation, independently of patients’ lung function and symptoms, which are affected by long-acting (3-agonists. Symptom-driven dosing with combination inhalers may be useful in the future, as long as the dose of the steroid can be determined by the degree of symptoms at a particular time. We suggest that serial FeNO measurements using a portable NO analyzer may be used to adjust doses of combination therapy based on control of inflammation in asthma.
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Exhaled Biomarkers: Asthma

Monitoring of Airway Inflammation: Symptoms of atopic asthma often begin in early childhood and mostly improve or even seem to disappear at puberty, but will relapse later in life. This persistent but latent airway inflammation, known as airway remodeling, leads to the thickening of the airway wall and may account for bronchial hyperresponsiveness, which could have a substantial impact on the progression of asthma. Elevated exhaled NO, blood eosinophil cell counts, and bronchial response to adenosine-5′-monophosphate correlated significantly with the quantity of tissue eosinophils in the bronchoscopy samples from adolescents in clinical remission of atopic asthma. This signifies that airway inflammation and remodeling are both ongoing processes even in subjects in clinical remission, and may be detected and monitored by routine exhaled NO measurements in clinic. It can be speculated that subjects with subclinical airway inflammation and elevated exhaled NO levels could benefit from an “early” antiinflammatory treatment, preventing subsequent airway remodeling and progression of asthma.
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