Background and objectiveChronic Obstructive Pulmonary Disease (COPD) causes substantial morbidity and mortality across the globe. Diagnosis of COPD requires post-bronchodilator FEV1/FVC <0.70 as per GOLD Guidelines. FVC maneuver requires a minimum of 6 seconds of forceful expiration with no flow for 1 second for an accepted effort, which lacks any fixed cut-off point. This leads to discomfort, especially in advanced COPD and old aged population. We conducted this study to find the utility of FEV1/FEV6 as a surrogate for FEV1/FVC, the correlation between the two ratios, and the fixed cut-off value of FEV1/FEV6 for COPD diagnosis.MethodsThis was a prospective, cross-sectional study approved by the institutional ethics committee conducted from January 2017 to November 2018. Consented patients above 18 years suspected of COPD underwent Spirometry as per ATS guidelines. FEV1, FEV6, FEV1/FEV6 and FEV1/FVC ratios were recorded from the best acceptable maneuver.ResultsOut of 560 screened patients, 122 diagnosed as COPD. The correlation coefficient between the post-bronchodilator FEV1/FVC ratio and FEV1/FEV6 ratio was 0.972 (p < 0.01). The relationship between the post-bronchodilator FEV1/FVC ratio and FEV1/FEV6 ratio (linear regression analysis) was found out as: FEV1/FVC = ?1.845 + 1.009(FEV1/FEV6). Using this formula, the post-bronchodilator FEV1/FEV6 value of 71.845 was obtained corresponding to the post-bronchodilator FEV1/FVC value of 70.00.ConclusionWe found a positive correlation coefficient (r = 0.972, p < 0.001) between the FEV1/FEV6 and FEV1/FVC ratios and the cut off value of 71.845 (p < 0.01) for the post-bronchodilator FEV1/FEV6 ratio for the diagnosis of COPD. Thus FEV1/FEV6 should be used as a surrogate for FEV1/FVC for the diagnosis of COPD. 相似文献
Objective: To investigate the potential beneficial effects of guideline-based pharmacological therapy on pulmonary function and quality of life (QOL) in Japanese chronic obstructive pulmonary disease (COPD) patients without prior treatment.
Research design and methods: Multicenter survey, open-label study of 49 Japanese COPD patients aged ≥ 40 years; outpatients with >10 pack years of smoking history; ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 70%; predicted FEV1 < 80%; treated with bronchodilators and/or inhaled corticosteroids as maintenance therapy until week 48.
Main outcome measures: The primary endpoint was change in pulmonary function (trough FEV1, trough FVC); secondary endpoints were QOL and physical activity at 48 weeks after initiation of therapy.
Results: Airway reversibility was confirmed in untreated patients. Significant changes over time were not observed for FEV1 and FVC, indicating lung function at initiation of treatment was maintained during the observation period. COPD assessment test scores showed statistical and clinical improvements. Cough, sputum, breathlessness, and shortness of breath were significantly improved.
Conclusions: Lung function and QOL of untreated Japanese COPD patients improved and improvements were maintained by performing a therapeutic intervention that conformed to published guidelines. 相似文献
Supraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy.
Methods
This prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the “sign of lace‐tying” that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay.
Results
Our series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the “sign of lace‐tying.” Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT.
Conclusions
Overall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the “sign of lace‐tying” or body position change before SVT, implying a diagnosis of SVT. 相似文献
Bedside ultrasound is often used as a part of the evaluation of patients who are critically ill. The McConnell sign is an important echocardiographic finding in some critically ill patients with pulmonary embolism and an acute right ventricular infarct. We present 3 critically ill patients with confirmed acute chest syndrome who showed the McConnell sign on echocardiography. In patients with sickle cell disease presenting with chest pain and shortness of breath, the presence of the McConnell sign does not narrow the differential diagnosis between pulmonary embolism, an acute right ventricular infarct, and acute chest syndrome. 相似文献
Pulmonary hypertension (PH) is one of the most common complications of COPD (chronic obstructive pulmonary disease), but its severe form is uncommon. Various factors play an important role in the occurrence and severity of pulmonary hypertension in patients.
Methods
This cross-sectional study was performed on patients with COPD referred to an emergency department over a one-year period. The tests—including complete blood count (CBC) and arterial blood gas (ABG), pulmonary functional test (PFT) and echocardiography—were performed for all patients to measure mPAP (mean pulmonary artery pressure), ejection fraction (EF) and body mass index (BMI). The prevalence of severe pulmonary hypertension and its associated factors were investigated in these patients.
Results
A total of 1078 patients was included in the study, of whom 628 (58.3%) were male and 450 (41.7%) were female. The mean age of the patients undergoing the study was 70.1 ± 12.2. A total of 136 (13.7%) of them had mPAP (mm Hg) ≥ 40 mm Hg as severe pulmonary hypertension. Following multivariable analysis by using the backward conditional method, it was shown that seven variables had a significant correlation with severe PH.
Conclusions
The results showed that there is an independent correlation between hypoxia, hypopnea and compensatory metabolic alkalosis, polycythemia, left ventricular dysfunction, emaciation, and cachectic with severe pulmonary hypertension. The prevalence of severe PH in these patients was 13.7%. 相似文献
Variant Creutzfeldt-Jakob disease (vCJD) is a rare, fatal prion disease resulting from transmission to humans of the infectious agent of bovine spongiform encephalopathy. We describe the clinical presentation of a recent case of vCJD in the United States and provide an update on diagnostic testing. The location of this patient’s exposure is less clear than those in the 3 previously reported US cases, but strong evidence indicates that exposure to contaminated beef occurred outside the United States more than a decade before illness onset. This case exemplifies the persistent risk for vCJD acquired in unsuspected geographic locations and highlights the need for continued global surveillance and awareness to prevent further dissemination of vCJD. 相似文献