ABC of chronic obstructive pulmonary disease - Definition, epidemiology, and risk factors

Department of Environmental and Occupational Medicine, University of Aberdeen, Aberdeen.
BMJ (online) (Impact Factor: 16.38). 06/2006; 332(7550):1142-4. DOI: 10.1136/bmj.332.7550.1142
Source: PubMed
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is associated with significant mortality. It is currently the fourth leading cause of death in Canada and the world. To describe the mortality of elderly patients in Ontario after hospital admission for COPD. A retrospective cohort study was conducted using the Discharge Abstract Database from the Canadian Institute for Health Information. Patients aged 65 years and older who were admitted to hospital between 2001 and 2004 with primary discharge diagnoses labelled with International Classification of Diseases, Ninth Revision codes 491, 492 and 496 were included in the study. Mortality rates were 8.81, 12.10, 14.53 and 27.72 per 100 COPD hospital admissions at 30, 60, 90 and 365 days after hospital discharge, respectively. Mortality also increased with age, and men had higher rates than women. No significant differences in mortality rates were found between different socioeconomic groups (P>0.05). Patients with shared care of a family physician or general practitioner and a specialist had significantly lower mortality rates than the overall rate (P<0.05), and their rates were approximately one-half the rate of patients with only one physician. Hospitalization with COPD is associated with significant mortality. Patients who were cared for by both a family physician or general practitioner and a specialist had significantly lower mortality rates than those cared for by only one physician, suggesting that continuous and coordinated care results in better survival.
    Canadian respiratory journal: journal of the Canadian Thoracic Society 14(8):485-9. · 1.66 Impact Factor
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    ABSTRACT: Anterior cruciate ligament rupture (ACL) is a major source of morbidity in the dog, leading to severe osteoarthritis of the knee joint and marked lameness. Following rupture, the ACL will not heal and in the dog, ACL rupture is thought to be the end stage of degenerative ligament disease (non-contact ACL injury). The extracellular matrix (ECM) of CLs has been extensively studied but little is known of the role of elastic fibres in the physiology of the ECM, the mechanics of CL function and in CL degeneration. Elastic fibres include polymers of fibrillins (microfibrils), bundles of microfibrils (oxytalan fibres) and elastin fibres (bundles of microfibrils with an elastin core). The hypothesis of this thesis is that elastin has a mechanical and a biological role in the canine cruciate ligament complex. It is further hypothesised that the distribution and function of elastic fibres will vary between three breeds of dog with differing risk of ACL rupture are: the greyhound with a low risk, the beagle with a low-to-moderate risk and the Labrador retriever with a high risk. The distribution of elastic fibres, fibrillins and cells was investigated throughout the CL complex using a combination of histochemical staining and immunofluorescence. CL microanatomy was studied using Nomarski differential interference microscopy. Elastin was measured biochemically and compared to histologic assessment of tissue architecture, elastic fibre staining and other biochemical parameters. The biological effect of elastin degradation products (EDPs) was assessed in an in vitro ACL cell culture model. A low risk dog breed to ACL rupture (greyhound) was used in all investigations and comparisons were made with other breeds with regard to cellular and elastic fibre anatomy. Differences in cell morphology between breeds with differing risk of ACL rupture may reflect fundamental differences in CL physiology possibly through altered cell-to-cell communication. Cellular and matrix changes, considered degenerative, were seen throughout the CL complex and may reflect adaptation rather than degeneration in certain dog breeds such as the greyhound. Elastin content ranged from 5.9 to 19.4% of ligament dry weight. This was a far greater proportion of canine CLs than previously. Elastin fibres may have a mechanical role in bundle reorganization following ligament deformation. The distribution of fibrillins 1 and 2 was different from the pattern previously reported in tendon and may represent a fundamental difference between ligament and tendon. In the greyhound CL there was a significant proportional increase in oxytalan fibre staining with advancing CL degeneration. This response was seen also in the Labrador retriever and the beagle but the increase in oxytalan fibre staining was less marked with advancing degeneration. Therefore production of oxytalan fibres may reflect a healing response in damaged CL tissue in breeds at a low risk of ligament rupture. Fragments of elastin containing the VGVAPG motif affect canine ACL cells in vitro resulting in increased transcription of fibrillin 2 mRNA. Additionally, there was synergism with TGF-β1 resulting in upregulation of the elastin laminin receptor 1, through which EDPs are transduced. EDPs may thus have a role in response to injury in the CL.
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    ABSTRACT: Mujer de 37 años, multípara. Intensa fumadora, bronquítica crónica e historia de disnea sibilante de años de evolución. Cursando embarazo de 30 semanas de edad gestacional, mal controlado y mal tolerado por aumento progresivo de su disnea que llega a ser de mínimos esfuerzos en el último trimestre. Consulta por expectoración purulenta, fiebre e insuficiencia respiratoria. Es valorada con radiografía de tórax, gasometría y espirometría. Tratada en base a antibióticos, oxígeno y broncodilatadores. Se realiza inducción del parto a las 38 semanas. Requiere cesárea de urgencia por agravación de la insuficiencia respiratoria, obteniéndose recién nacido de 2688 g con Apgar 6 19. La evolución de ambos fue favorable. Se discute la incidencia de esta rara asociación y su posible aumento en el futuro. Se revisan los aspectos espirométricos de mal pronóstico que podrían contraindicar la gestación y que permanecen controversiales.
    Revista Chilena de Obstetricia y Ginecologia 12/2007; 73(5). DOI:10.4067/S0717-75262008000500011


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