The role of impulse oscillometry in detecting airway dysfunction in athletes

Background: Impulse oscillometry (IOS) has previously been proposed to provide greater sensitivity than spirometry when employed with indirect bronchoprovocation testing for the diagnosis of airway dysfunction in athletes. However, this recommendation is based on a highly selected population of symptomatic patients. Objective: To compare IOS, spirometry and respiratory symptoms following indirect bronchoprovocation in a screened cohort of athletes. Methods: One hundred and one recreational athletes were recruited. Respiratory symptoms were assessed via the Dyspnoea-12 questionnaire. Spirometry and IOS were performed pre and post a eucapnic voluntary hyperpnoea (EVH) challenge. Results: Ninety-four athletes completed the study. Sixteen athletes (17%) were positive for airway dysfunction based on spirometry (i.e. ≥10% fall in FEV₁) and 17 athletes (18%) based on IOS (i.e. ≥50% increase in R₅). Only nine athletes (10%) met both diagnostic thresholds. A poor relationship was observed between respiratory symptoms (i.e. Dyspnoea-12 score) and all spirometry and IOS variables. A direct relationship was observed between percentage change in R₅ (r?=?0.65), Z₅ (r?=?0.68), R_F (r?=?0.65), A_X (r?=?0.69) and the maximum fall in FEV₁ (ΔFEV₁max; p?<?0.001). A weak relationship was observed between R₂₀ (r?=?0.27), X₅ (r?=?0.37) and ΔFEV₁max (p?<?0.01). Conclusion: Impulse oscillometry and spirometry do not concur precisely following indirect bronchoprovocation. However, IOS detects additional cases of airway dysfunction in athletes and therefore may provide diagnostic value in this population. Further work is required to establish diagnostic thresholds and fully determine the place of IOS in screening athletes for airway dysfunction.     

Elevated Complement Factor H Levels in Asthmatic Sputa

Background

The alternative pathway of the complement system is known to play a role in the generation of asthmatic airway inflammation, but its regulatory complement protein, factor H has not been investigated in this disease.

Purpose

Our aim was to determine the local bronchial complement factor H (CFH) levels in asthma, and to investigate its relationship with complement activation, systemic CFH concentrations and clinical characteristics of patients.

Methods

Induced sputum and plasma were collected from 21 healthy and 26 asthmatic subjects, and complement factor H and SC5b-9 concentrations were assessed by ELISA. Total protein concentrations were determined by biuret-reaction based microassay system from induced sputa.

Results

CFH was detectable in 81 % of healthy and 100 % of asthmatic subjects, while SC5b-9 exceeded the detection limit in 62 % of healthy subjects and 85 % of asthmatic patients. Sputum CFH concentrations and CFH/protein ratios were increased in samples from asthmatic patients, and correlated with loss of lung function, asthma control, severity and medication intensity, but not with plasma CFH concentrations. Sputum CFH/protein ratios were in positive correlation also with sputum eosinophilic cell counts in asthma. SC5b-9 concentrations were not higher in the asthmatic sputa, although they correlated with sputum CFH concentrations.

Conclusions

CFH level is elevated on asthmatic airway surface, and may be associated with uncontrolled inflammation in asthma.     

Traumatic brain injury in older adults

Traumatic brain injury (TBI) is a serious health risk for older adults, and the consequences of TBI range from full recovery to death. For many who survive, there is a legacy of cognitive, physical, and emotional disability. Falls are the major cause of head injury in older adults. There are many risk factors including pre-existing brain disease, other diseases, and, sometimes, iatrogenic factors. Efforts directed at prevention are of great importance. Outcome studies indicate that outcome is generally worse for older people than for younger people with similar injuries, but older individuals also deserve aggressive rehabilitation directed at the best possible recovery. This review will discuss the symptoms and syndromes that commonly result from TBI with comments about treatment.     

Exercise increases exhaled breath condensate cysteinyl leukotriene concentration in asthmatic patients

Background. Although the importance of cysteinyl leukotrienes (Cys-LTs) in exercise-induced bronchoconstriction (EIB) is supported by various sources of evidence, how the concentration of these mediators change during the development of EIB has not been investigated. Objectives. Our goal was to determine the effect of exercise on the concentration of airway Cys-LT in asthmatic patients by measuring Cys-LT in exhaled breath condensate (EBC). Methods. Seventeen atopic asthmatic patients with a previous history of EIB and six healthy volunteers were studied. Before and two times within 10 minutes after exercise challenge, FEV₁ was measured and EBC was collected for Cys-LT measurement. Exhaled nitric oxide level, a marker of airway inflammation, was also determined at baseline. Results. Baseline Cys-LT level was higher in the asthmatic group versus healthy subjects (168 pg/mL /112–223/ vs. 77 pg/mL /36–119/, p = .03). EBC Cys-LT concentration increased in all asthmatic patients post-exercise (n = 17, p = .03), with the increase significantly greater in patients developing exercise-induced bronchospasm (n = 7, p = .03), whereas no change was observed in healthy controls (p = .59). The exercise-induced fall in FEV₁ in asthmatics was related to the increase in EBC Cys-LT concentration (r = ?0.40, p = .03). Conclusions. Our study shows that Cys-LT concentration of EBC is elevated minutes after physical exercise in asthmatic patients and strongly supports the concept that the release of this mediator is involved in the development of EIB.     

Needs and unmet needs for rehabilitation services: a scoping review

Background: There is a global demand for rehabilitation services but to date little attention has been paid to rehabilitation as part of the health agenda, especially in low- and middle-income countries. The objective of the scoping review was to get an overview of the needs and unmet needs for rehabilitation services described in the literature.

Materials and methods: Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017.

Results: Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services.

Conclusions: There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level.

• Implications for rehabilitation

• There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases.

• This scoping review shows that the need for rehabilitation considerably outstrips the provision of services.

• There are substantial unmet needs for rehabilitation and numerous barriers to accessing services.

• Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries.

     

The 'bear trap': the colliding epidemics of tuberculosis and HIV in Russia

In April, 2003 the World Bank approved a long-awaited $150 million loan to the Russian Federation to support tuberculosis (TB) and AIDS control. Although the Russian Federation accounts for a relatively small fraction of the global TB case-load the proportion of cases which are drug-resistant and particularly multidrug-resistant is very high in some regions. HIV incidence, principally associated with intravenous drug abuse, has also increased dramatically and this will impact upon TB control efforts. Federation-wide data are limited but a focus on one region shows something of the confluence of the epidemics of HIV and TB. Approaching 200 cases of HIV-associated TB have occurred in the past two years, and the age structure of the HIV-infected population and that with high rates of TB shows sizeable overlap. The region has high rates of multidrug-resistant TB which are likely to impact considerably on efforts to meet this emerging and complex public health challenge. Insights gained through the examination of this one region can tell us something of the magnitude of the challenge now faced by both the international community and Russia.