INTRODUÇÃO: O papel da ressecção pulmonar em controlar as complicações e períodos de exacerbação de sintomas em pacientes com bronquiectasia é bem descrito na literatura. No entanto, não existem estudos com um instrumento objetivo e validado para avaliação de qualidade de vida no pós-operatório desses pacientes. OBJETIVO: Avaliar a qualidade de vida de pacientes com diagnóstico clínico e radiológico de bronquiectasia não fibrocística, ainda sintomáticas após o tratamento clínico adequado, antes e após a ressecção das áreas bronquiectásicas mais afetadas. MÉTODOS: Estudo longitudinal prospectivo, realizado entre 2010 e 2013. Foram incluídos todos os pacientes encaminhados ao ambulatório de Cirurgia Torácica com diagnóstico de bronquiectasia que apresentavam ausência de resposta ao tratamento clínico adequado após 1 ano de seguimento e/ou presença de complicações da doença. Foram avaliadas qualidade de vida por meio de dois questionários - SF36v2 e WHOQOL, função de pulmonar completa e capacidade de exercício dos indivíduos antes a após a ressecção da área pulmonar mais comprometida pela bronquiectasia. RESULTADOS: Sessenta e um pacientes foram incluídos consecutivamente no estudo. Oito pacientes foram excluídos por diversas razões. Após isso, 53 pacientes (50,9% do sexo masculino, com idade 41,3 anos, ± 12,9) foram submetidos a cirurgia, mas apenas 44 completaram os nove meses de follow-up. A tuberculose foi a causa de bronquiectasias em 60,4% dos pacientes e 26,4% apresentavam doença bilateral, mas apenas a área mais afetada foi ressecada. Os resultados cirúrgicos foram pneumonectomia (direita 3 - 5,7% / esquerda 6 - 11,3%), lobectomia superior (direito 13 - 24,5% / esquerda 10 - 18,9%), lobectomia média (5 - 9,4%) e lobectomia inferior (direito 6 - 11,3% / esquerda 10 -18,9%). Dois pacientes apresentaram complicações graves e morreram e, além disso, treze pacientes (24,5%) tiveram complicações clínicas e cirúrgicas. Após a ressecção do pulmão, os pacientes apresentaram valores ligeiramente inferiores a espirometria, mas por causa de volumes pulmonares inferiores, uma vez que o FEV1/FVC permaneceu constante. A DLCO não foi alterada após a intervenção, o que sugere que predominantemente não-funcionantes áreas pulmonares foram ressecadas. No teste cardiopulmonar, o desempenho do exercício em geral não mudou, mas cerca de 52% dos pacientes melhoraram seu consumo máximo de oxigênio e carga de trabalho após a intervenção. Os domínios do questionário de qualidade de vida SF36 melhoraram no pós-operatório - capacidade física 81,1 (± 26,2) p = 0,000; limitação física 79,2 (± 38,7) p = 0,000; saúde geral 70,9 (± 23,7) p = 0,000; vitalidade 72,1 (± 20,5) p = 0,002; aspectos sociais 85,8 (± 22,5) p = 0,000; dor 78,6 (± 27,3) p = 0,034; aspectos funcionais 81,8 (± 36,3) p = 0,000 e saúde mental 74,3 (± 19,7) p 0,019; apenas o domínio dor apresentou uma melhora negativa, provavelmente devido à dor incisional apresentada após a cirurgia. Os mesmos resultados foram observados no WHOQOL. A regressão logística (backward stepwise) mostrou que o sexo masculino foi um preditor independente de complicações pós-operatórias - OR 5,185, IC 1,085-24,791, p = 0,039. O modelo de regressão linear múltipla não identificou um preditor que poderia explicar o aumento da qualidade dos resultados vida após a cirurgia; no entanto, VEF1 apareceu de forma consistente como um preditor limítrofe (entre 0,05 e 0,1, em todas as análises). CONCLUSÃO: O estudo mostrou uma melhora significativa na qualidade de vida após a ressecção pulmonar de indivíduos com diagnóstico de bronquiectasia sintomática sem comprometer a sua capacidade de se exercitar. Nessa amostra, apenas baixo escores de qualidade de vida no pré-operatório foram melhores preditores de qualidade de vida no dia 9 de pós-operatório e também descobrimos que as fórmulas comumente usadas para prever o desempenho pós-operatório subestimaram os valores reais observadas nos períodos de 3 e 9 meses após a ressecção pulmonar / BACKGROUND: The role of pulmonary resection in controlling complications and periods of exacerbation of symptoms in patients with bronchiectasis is well described in the literature. However, there are no studies with an objective and validated instrument for assessing quality of life in the postoperative period in these patients. OBJECTIVE: To evaluate the quality of life measured after resection of bronquiectásicas areas in patients with clinical and radiological diagnosis of bronchiectasis non-fibrocystic and persistent symptoms after appropriate clinical treatment. METHODS: This is a prospective longitudinal study conducted between 2010 and 2013. We included all patients referred to our outpatient clinic during the study period with symptomatic bronchiectasis and failed medical treatment. We assessed quality of life through two questionnaires - SF36v2 and WHOQOL, complete lung function and exercise capacity of individuals before and after resection of lung area most affected by bronchiectasis. RESULTS: Sixty-one patients were sequentially enrolled in the study. Eight patients were excluded for several reasons. After that, 53 patients (50.9% male; age 41.3 years, ± 12.9) underwent surgical resection, but only 44 complete the nine months of follow-up. Tuberculosis is the cause of bronchiectasis in 60.4% of the patients and 26.4% has bilateral disease, but only the most affected area was resected. The surgical outcomes are pneumonectomy (right 3 - 5.7% and left 6 - 11.3%), Upper lobectomy (right 13 - 24.5% and left 10 - 18.9%), right middle lobectomy (5 - 9.4%) and lower lobectomy (right 6 - 11.3% and left 10 - 18.9%). Two patients had serious complications and died and in addition, thirteen patients (24.5%) had clinical and surgical complications. After lung resection, patients had mildly lower values at spirometry, but because of lower lung volumes, since the FEV1/FVC remained constant. The DLCO was not changed after intervention, suggesting that predominantly non-functioning lung areas were resected. At cardiopulmonary test, exercise performance generally has not changed but around 52% patients improved their VO2 and workload after intervention. The domains of the quality of life questionnaire SF36v2 improved after ninth month postoperatively - physical functioning 81.1 (±26.2) p=0.000; role physical 79.2 ( ± 38.7) p=0.000; general health 70.9 ( ± 23.7) p=0.000; vitality 72.1 ( ± 20.5) p=0.002; social functioning 85.8 (± 22.5) p=0.000; bodily pain 78.6 ( ± 27.3) p=0.034; role emotional 81.8 (±36.3) p=0.000; mental health 74.3 ( ± 19.7) p 0,019, only the bodily pain had a negative improvement probably due to incisional pain presented after surgery. The same results were seen in the WHOQOL. The stepwise backward logistic regression showed that male gender was an independent predictor of postoperative complications - OR 5.185, IC 1.085 - 24.791, p = 0.039. The multiple linear regression model do not identified a predictor that could explain the increase in quality of life results after surgery; nevertheless, FEV1 appeared consistently as a borderline predictor (between 0.05 and 0.1 in all analysis). CONCLUSION: Our study showed a significant improvement in quality of life after pulmonary resection in patients diagnosed with symptomatic bronchiectasis without compromising their ability to exercise. In this sample, only low quality of life scores in the preoperative period were better predictors of quality of life in the 9th postoperative and we also found that the commonly used formulas for predicting postoperative performance underestimated the actual values observed in periods of 3 and 9 months after pulmonary resection

INTRODUÇÃO: Em contraste aos bons resultados do transplante pulmonar no tratamento de pacientes com doença supurativa pulmonar avançada, a colonização por Burkholderia cepacia complex (BCC), sobretudo o genomovar III, vem sendo relacionada a pior prognóstico e, por conseguinte, uma contraindicação ao procedimento em alguns centros transplantadores. O objetivo deste estudo foi avaliar o impacto em sobrevida após o transplante pulmonar de pacientes com doença pulmonar supurativa colonizados por BCC, além de determinar a incidência da colonização e suas variantes genômicas no Instituto do Coração/HC-FMUSP. MÉTODOS: Foram analisados prospectivamente dados clínicos e amostras de culturas do trato respiratório dos pacientes que realizaram transplante pulmonar por doença supurativa entre janeiro de 2008 e dezembro de 2013. A tipagem molecular para estudar os diferentes genótipos da BCC foi realizada a partir de janeiro de 2012 por método de sequenciamento genético e análise do gene RecA. RESULTADOS: Foram realizados 132 transplantes pulmonares, 62 pacientes com doença pulmonar supurativa, sendo 28 em pacientes com Bronquiectasias e 34 com Fibrose Cística. Observou-se a colonização por BCC em 16 pacientes; em 7 amostras identificados os seguintes subtipos: três cepas B. metallica e quatro cepas B. cenocepacia. A incidência de BCC nos pacientes com Fibrose Cística foi de 38,2%, enquanto nos pacientes com Bronquiectasias foi 10,7%. Dentre os 16 pacientes colonizados por BCC, ocorreram 2 óbitos, nenhum deles relacionados à infecção pelo agente. Um óbito foi atribuído a sepse por Acinetobacter baumannii resistente a múltiplas drogas e o outro, a disfunção orgânica múltipla. O estudo desenvolvido demostrou que a colonização por BCC não gerou impacto em mortalidade nos pacientes após o transplante pulmonar, mesmo quando colonizados pelo subtipo B. cenocepacia / INTRODUCTION: Notwithstanding the good results of lung transplantation for treatment of patients with advanced lung suppurative disease, colonization by Burkholderia cepacia complex (BCC), especially genomovar III has been related to a worse prognosis in these patients and therefore contraindication to the procedure certain centers. The aim of this study was to evaluate the impact on survival after lung transplantation in patients with suppurative lung disease colonized with BCC to determine the incidence of colonization and its genomic variants at the Heart Institute / HC -FMUSP. METHODS: We prospectively analyzed clinical data and respiratory tract samples of suppurative lung disease patients that performed lung transplantation from January-2008 through November-2013. From January-2012 through December-2013, we also subtyed the different B. cepacia genotypes by DNA sequencing primers of the gene RecA. RESULTS: 132 lung transplantation were performed, 62 patients with suppurative lung disease, 28 patients with Bronchiectasis and 34 with Cystic Fibrosis. BCC was observed in 16 patients; in 7 samples we identified the following subtypes: three strains B. metallica and four strains B. cenocepacia. The incidence of BCC in patients with Cystic Fibrosis was 38.2% while in patients with Bronchiectasis was only 10.7%. Among the 16 patients colonized with BCC, there were two deaths, none of them related to infection by the agent. One death due to sepsis Acinetobacter baumannii resistant to multiple drugs and the other, multiple organ dysfunction. The study demonstrated that colonization by BCC developed no impact on the mortality rate of patients after lung transplantation, even when colonized by the subtype B. cenocepacia

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-21T18:14:35Z No. of bitstreams: 1 Anderson Alves de Camargo .pdf: 1030153 bytes, checksum: 6ca31fab8598bd8ac6319e473c1dac59 (MD5) / Made available in DSpace on 2018-06-21T18:14:35Z (GMT). No. of bitstreams: 1 Anderson Alves de Camargo .pdf: 1030153 bytes, checksum: 6ca31fab8598bd8ac6319e473c1dac59 (MD5) Previous issue date: 2015-12-16 / Introduction: There is a shortage of studies evaluating the effects of respiratory physiotherapy isolated and linked to pulmonary rehabilitation in adults with bronchiectasis (BCT), and inflammatory level comparison of these patients with a control group. Aim: Study 1: To correlate the inflammatory and oxidative stress state with lung function and physical capacity, and with basal physical capacity after a pulmonary rehabilitation program associated with the respiratory physiotherapy; and Study 2: To compare the effects of a pulmonary rehabilitation program associated to respiratory physiotherapy with respiratory physiotherapy singly in physical capacity, peripheral muscle function and quality of life in patients with bronchiectasis. Methods: In the first study, 74 patients and 29 controls performed cardiopulmonary exercise test on cycle ergometer (CPET) and incremental shuttle walking test (ISWT), in addition to the assessment of the total number of steps/day (NSD) and the Pro and anti-inflammatory mediators and Pro and anti-oxidants in plasma. In the second study, 82 patients were randomized into two groups: respiratory physiotherapy (RP) and RP associated to pulmonary rehabilitation (RP+PR). Patients performed the ISWT and SWT endurance (ESWT), the maximum and submaximal CPET (sub), test of strength for the biceps brachii (BB), medium deltoids (MD) and quadriceps femoris (QF) and responded to the St. George's Respiratory Questionnaire (SGRQ) for assessment of health-related quality of life (HRQOL). NSD was obtained by pedometer and dyspnoea was measured by the Medical Research Council (MRC). Results: Study 1 – The level of cytokines IL1-β and IL-6 was significantly higher compared to the control group, but for Pro markers and antioxidants no differences were found. There was significant negative correlation of VO2 with IL1-β (r: -0.42), IL-6 (r: -0.31), thiobarbituric acid (T-BARS, r: 0.30), Carbonyl (r: -0.39) and nitrite (r: 0.32). The ISWT correlated with Catalase (r: 0.25) and total antioxidant capacity (TRAP, r: 0.23). Study 2 – Comparing the pre-and post-intervention intra-group effects, there was significant increase in ISWT, ESWT, CPET load, and muscle strength of DM and BB for the RP+PR group, while the endurance time in CPETsub increased both in RP+PR and RP groups; there was improvement for the RP group in all domains of SGRQ, while the RP+PR group only improved in symptoms. When comparing the effects of treatment in both groups (RP vs RP+PR), there was no statistically significant difference for any of the outcomes studied. Conclusion: Study 1 – Patients with BCT presented high systemic inflammation even in the stable phase of the disease, with equivalent Pro markers and antioxidants compared to the control group. Oxidative and inflammatory markers correlate with the aerobic and functional capacity. Study 2 – Although there was increasing exercise tolerance only at the RP+PR group, both groups showed improvement in HRQOL. Even though there wasn’t difference between interventions, it is preferable to associate RP to PR, because the latter promoted significant benefits in peripheral muscle strength and physical ability. / Introdução: Há escassez de estudos avaliando os efeitos da fisioterapia respiratória (FR) isolada e associada à reabilitação pulmonar (RP) em adultos com bronquiectasia (BCQ) e a comparação do nível inflamatório destes doentes com a de um grupo controle. Objetivos: Estudo 1: Correlacionar o estado inflamatório e estresse oxidativo com a função pulmonar e capacidade física e com a capacidade física após o programa de RP associado à FR e Estudo 2 – Comparar os efeitos de um programa de RP associado à FR com a FR isoladamente na capacidade física, função muscular periférica e qualidade de vida em pacientes com bronquiectasia. Método: No primeiro estudo, 74 pacientes e 29 controles realizaram o teste de exercício cardiopulmonar máximo em cicloergômetro (TECP) e o shuttle walking teste incremental (SWTI), além da avaliação do número total de passos/dia (NTP) e dos mediadores pró e anti-inflamatórios e pró e anti-oxidantes no plasma. No segundo estudo, 82 pacientes foram randomizados em dois grupos (Grupo 1 – FR e Grupo 2 – FR associada à RP). Os pacientes realizaram o SWTI e o SWT endurance (SWTE), o TECP máximo e submáximo (sub), teste de força para o bíceps braquial (BB), deltóide médio (DM) e quadríceps femoral (QF) e responderam ao Saint George’s Respiratory Questionnaire (SGRQ) para avaliação da qualidade de vida relacionada à saúde (QVRS). O NTP foi obtido por pedômetro e a dispneia foi mensurada pela escala Medical Research Council (MRC). Resultados: Estudo 1 - O nível de citocinas IL-1β e IL-6 foi significantemente maior em comparação ao grupo controle, mas para os marcadores pró e anti-oxidantes não foram encontradas diferenças. Houve correlação negativa significante do VO2 com IL-1β (r = -0,42), IL-6 (r = -0,31), ácido tiobarbitúrico (T-BARS, r = 0,30), Carbonila (r = -0,39) e Nitrito (r = 0,32). O SWTI correlacionou-se com a Catalase (r = 0,25) e a capacidade anti-oxidante total (TRAP, r = 0,23). Estudo 2 – Ao compararmos os efeitos pré e pós-intervenção intragrupo: houve aumento significante no SWTI, SWTE, carga no TECP, força muscular do BB e DM para o grupo FR+RP, enquanto o tempo de endurance no TECPsub aumentou tanto neste grupo quanto no grupo FR; no grupo FR houve melhora em todos os domínios do SGRQ, enquanto para o grupo FR+RP apenas no domínio sintomas. Ao comparar os efeitos do tratamento em ambos os grupos (FR vs FR+RP) não houve diferença estatisticamente significante para quaisquer dos desfechos estudados. Conclusão: Estudo 1 - Os pacientes com BCQ apresentaram elevada inflamação sistêmica, mesmo na fase estável da doença, com equivalentes marcadores pró e anti-oxidantes em relação ao grupo controle. Marcadores inflamatórios e oxidativos se correlacionam com a capacidade aeróbia e funcional. Estudo 2 – Embora ocorreu aumento da tolerância ao exercício apenas no grupo FR+RP, ambos os grupos demonstraram melhora da QVRS. Embora não tenha ocorrido diferença entre ambas as intervenções, é preferível associar à FR a RP, pois esta última promoveu benefícios significativos na capacidade física e força muscular periférica.

<p>Hronične inflamatorne bolesti disajnih organa su&nbsp;jedan od vodećih uzroka morbiditeta i mortaliteta&nbsp;&scaron;irom sveta. I pored stalnog napretka u naučnim&nbsp;istraživanjima, u otkrivanju molekularnih i ćelijskihmehanizama koji doprinose progresiji bolesti, uvođenju novih prognostičkih biomarkera, novim&nbsp;metodama detektovanja infektivnih uzročnika,&nbsp;primeni novih moćnih bronhodilatatornih,&nbsp;antiniflamatornih i antiinfektivnih lekova, hronične&nbsp;plućne bolesti i danas u dvadeset prvom veku beleže&nbsp;stalan porast broja obolelih i umrlih. Prema savremenom tumačenju HOBP je&nbsp; heterogena bolest koja je udružena sa brojnim komorbiditetima i&nbsp;sistemskim manifestacijama. Zajednički faktori rizika&nbsp;su osnova za javljanje udruženih hroničnih bolesti. Komorbiditeti i akutne egzacerbacije doprinose&nbsp;ukupnoj težini bolesti . S obzirom da se HOBP&nbsp;manifestuje i izvan pluća kod svakog pacijenta je&nbsp;potrebno proceniti postojanje sistemskih&nbsp;manifestacija&nbsp; i tragati za komorbiditetima. U reviziji&nbsp;&bdquo;Globalne strategije za dijagnozu, lečenje i prevenciju hronične opstruktivne bolesti pluća H GOLD&ldquo;&nbsp; iz 2011. godine navedene sledeće pridružene bolesti za&nbsp;kojima je potrebno aktivno tragati: kardiovaskularne&nbsp;bolesti, disfunkcija skeletnih mi&scaron;ića, metabolički&nbsp;sindrom, osteoporoza, depresija i karcinom pluća.&nbsp;Bronhiektazije sepredstavljaju hronično oboljenje&nbsp;pluća koje se karakteri&scaron;e abnormalnim pro&scaron;irenjem&nbsp;lumena bronha koje je uzrokovano slabljenjem ili&nbsp;destrukcijom mi&scaron;ićnih i elastičnih komponenti&nbsp;bronhijalnog zida, smanjenim klirensom mukusa i&nbsp;čestim infekcijama respiratornog trakta. Bronhiektazije se nekim svojim&nbsp; kliničkim&nbsp;karakteristikama preklapaju&nbsp; sa hroničnom opstruktivnom bolesti pluća. Metabolički sindrom&nbsp;predstavlja skup metaboličkih poremećaja koji&nbsp;povećavaju rizik za razvoj kardiovaskularnih bolesti i tipa 2 &scaron;ećerne bolesti. Za na&scaron;e istraživanje smo&nbsp;koristili definiciju NCEPHATPIII prema kojoj se metabolički sindrom zasniva na prisustvu tri od pet&nbsp;komponenti: Abdominalna gojaznost (obim struka&nbsp;preko 102 cm za&nbsp; mu&scaron;karce i preko 88 cm za žene),&nbsp;povi&scaron;ene vrednosti triglicerida na&scaron;te preko 1,7 mmol/l ili od ranije lečen poremećaj, snižen nivo HDL&nbsp;holesterola manje od 1,03 mmol/l za mu&scaron;karce i&nbsp;manje od 1,29 mmol/l za žene ili već lečen&nbsp;poremećaj, povi&scaron;en sistolni krvni pritisak preko 130 mmHg i/ili dijastolni preko 85 mmHg ili već lečena&nbsp;hipertenzija, povi&scaron;en nivo glukoze na&scaron;te preko 5,6 mmol/l ili već postojeći tip 2 &scaron;ećerne bolesti.&nbsp;Istraživenje je sprovedeno u Institutu za plućne&nbsp;bolesti Vojvodine u Sremskoj Kamenici. Cilj je bio&nbsp;da se utvrdi učestalost metaboličkog sindroma i&nbsp;komponenti među bolesnicima sa HOBP i&nbsp;bronhiektazijama. Sledeći cilj je bio da analizira&nbsp;i uporedi&nbsp; zastupljenosti metaboličkog sindroma i pojedinih komponenti među ispitivanim grupama u&nbsp;odnosu na pol, starost bolesnika i dužinu lečenja&nbsp;HOBP. Bilo je uključeno ukupno 193 ispitanika. Od&nbsp;ovog broja 163 su činili bolesnici od HOBP i&nbsp;bronhiektazija&nbsp; koji su bili podeljeni u tri grupe:&nbsp;pacijenti oboleli od hronične opstruktivne bolesti&nbsp;pluća (n=55, grupa 1), pacijenti oboleli od bronhiektazija (n=50, grupa 2) i pacijenti sa&nbsp;udruženom hroničnom opstruktivnom bolesti pluća i&nbsp;bronhiektazijama (n=58, grupa 3). Kontrolna grupa,&nbsp;koja je označena kao grupa 4, formirana je od 30&nbsp;ispitanika bez bronhiektazija i hronične opstruktivne bolesti pluća, tako da je ukupan broj ispitanika u&nbsp;istraživanju bio 193. Učestalost metaboličkog&nbsp;sindroma prema kriterijumuma NCEP/ATP III kod&nbsp;bolesnika hroničnim bolestima respiratornog sistema&nbsp;(hroničnom opstruktivnom bolesti pluća,&nbsp;bronhiektazijama i udružena ova dva oboljenja) je&nbsp;iznosila je kod 37,3 % . Metabolički sindrom je bio&nbsp;učestaliji kod ispitanika sa hroničnim opstruktivnom<br />bolesti pluća i/ili bronhiektazijama u odnosu na&nbsp;ispitanike iz kontrolne grupe bez&nbsp; hroničnih bolesti&nbsp;respiratornog trakta. Kod bolesnika sa hroničnom&nbsp;opstruktivnom bolesti pluća dokazano je prisustvo&nbsp;metaboličkog sindroma kod 38,2%&nbsp; ispitanika, kod&nbsp;bolesnika sa bronhiektazijama kod 54% ispitanika i&nbsp;IV kod pacijenata sa udruženom hroničnom&nbsp;opstruktivnom bolesti pluća i bronhiektazijama kod&nbsp;36,2% ispitanika. Prosečan broj komponenti&nbsp;metaboličkog sindroma kod bolesnika sa hroničnom&nbsp;opstruktivnom bolesti pluća je iznosio 2,18, kod&nbsp;bolesnika sa bronhiektazijama je bio 2,56, a kod&nbsp;bolesnika sa udružena ova dva oboljenja 2,1.<br />Komponente metaboličkog sindroma nisu učestalije i&nbsp;nisu statistički vi&scaron;e kod bolesnika sa udruženom&nbsp;hroničnom opstruktivnom bolesti pluća i&nbsp;bronhiektazijama u odnosu na obolele sa HOBP i&nbsp;bronhiektazijama kao samostalnim oboljenjima.<br />Razlika u pojedinačnim vrednostima komoponenti&nbsp;metaboličkog sindroma i učestalosti pojedinih&nbsp;komponenti među posmatranim grupama bolesnika sa<br />hroničnim plućnim bolestima nije statistički značajna.&nbsp;Učestalost metaboličkog sindroma kod bolesnika sa&nbsp;hroničnim bolestima respiratornog sistema nije u vezi sa polom i ne zavisi od starosti ispitanika. Nije&nbsp;dokazano da je metabolički sindrom učestaliji kod&nbsp;mu&scaron;karaca i i nije dokazano da je učestaliji kod&nbsp;ispitanika koji imaju vi&scaron;e od &scaron;esdeset i pet godina&nbsp;u odnosu na mlađe bolesnike među ispitivanim.&nbsp;Učestalost metaboličkog sindroma kod ispitanika sa&nbsp;hroničnom opstruktivnom bolesti pluća ne zavisi od&nbsp;dužine lečenja hronične opstruktivne bolesti pluća.&nbsp;Dokazano je da učestalost&nbsp; metaboličkog sindoma&nbsp;nije veća kod bolesnika kojima je dijagnoza bolesti postavljena pre vi&scaron;e od pet godina i koji se od HOBP&nbsp;leče duže od pet godina. Na osnovu rezultata koje&nbsp;smo dobili u na&scaron;em istraživanju zaključili smo da&nbsp;hronične plućne bolesti, bronhiektazije i hronična&nbsp;opstruktivna bolest pluća, predstavljaju stanja sa povi&scaron;enim kardiometaboličkim rizikom.</p><p>&nbsp;</p> / <p>Chronic inflammatory diseases of the respiratory&nbsp;organs are one of the leading morbidity and&nbsp;mortality causes all over the world. Despite the&nbsp;steady advance in scientific research, discovery&nbsp;of&nbsp; the disease-progression-contributing molecular<br />and cellular mechanisms, introduction of novel&nbsp;prognostic biomarkers, new detection methods of&nbsp;infectious agents, application of&nbsp; new, potent&nbsp;bronchodilation, anti-inflammatory and anti-infectious drugs,&nbsp; a constant&nbsp; increase in&nbsp; the&nbsp;number of the affected and deceased from chronic&nbsp;pulmonary diseases has still been permanently<br />evidenced in the 21st century. In a modern&nbsp;concept, the chronic obstructive pulmonary<br />disease (COPD) is understood as a heterogenous&nbsp;disorder associated with numerous comorbidities&nbsp;and systemic manifestations. Common risk factors&nbsp;represent the basis for concomitant chronic&nbsp;diseases to develop. Comorbidities and acute&nbsp;exacerbations contribute to the overall disease&nbsp;severity. As a COPD may develop extrapulmonary manifestations as well, each&nbsp;patient should be evaluated for systemic&nbsp;manifestations and comorbidities. The 2011&nbsp;update of the &bdquo;Global Strategy for Chronic&nbsp;Obstructive Lung Disease Diagnosis,&nbsp;Management, and Prevention &ndash;GOLD&rdquo; lists the&nbsp;following comorbidities to be actively searched&nbsp;for: cardiovascular diseases, skeletal muscle<br />dysfunction, metabolic syndrome, osteoporosis,&nbsp;depression, and lung cancer. Bronchiectases&nbsp;represent a chronic lung disorder marked by&nbsp;VII excessively dilated bronchial lumen&nbsp; induced by&nbsp;weakened or destructed muscular and elastic&nbsp;components of the bronchial wall, reduced mucus&nbsp;clearance, and recurrent respiratory infections.&nbsp;Bronchiectases and COPD have some clinical&nbsp;features in common. The metabolic syndrome is a&nbsp;group of metabolic disorders which increase the&nbsp;risk of&nbsp; cardiovascular diseases and type 2&nbsp;diabetes. In our investigation, we utilized the&nbsp;NCEP HATPIII definition of the metabolic&nbsp;syndrome based on the presence of three of five&nbsp;components: abdominal obesity (&gt; 102 cm and &gt;<br />88 cm waist&nbsp; measure for males and females&nbsp;respectively), elevated (&gt;1.7 mmol/l) triglyceride&nbsp;levels on an empty stomach, or a former history of&nbsp;the disorder treatment, reduced&nbsp; HDL cholesterol&nbsp;(&lt; 1.03 mmol/l and &lt;1.29 mmol/l for males and&nbsp;females respectively), or a former history of the&nbsp;disorder treatment, elevated systolic blood<br />pressure of &gt;130 mmHg and/or diastolic blood&nbsp;pressure of &gt; 85 mmHg, or a former history of&nbsp;treated hypertension, elevated glucose levels&nbsp; (&gt;5.6 mmol/l), or already existing type 2 diabetes&nbsp;mellitus. The investigation has been carried out in<br />the Institute for Pulmonary Diseases of&nbsp;Vojvodina, Sremska Kamenica, aimed at 1)<br />establishing the frequency of the metabolic&nbsp;syndrome and its components among the patients&nbsp;with COPD and bronchiectases; 2) analyze and&nbsp;compare the frequency of metabolic syndrome&nbsp;and its components in the examined groups related&nbsp;to the patients&rsquo; sex, age, and COPD treatment&nbsp;length. The study included 193 subjects, 163 of&nbsp;whom suffered from COPD and bronchiectases,&nbsp;classified into three groups: COPD patients (n=55,&nbsp;Group 1), patients with bronchiectases (n=50,&nbsp;Group 2), and patients with concurrent COPD and&nbsp;bronchiectases (n=58, Group 3). The control&nbsp;group, designated as Group 4, included 30&nbsp;subjects&nbsp; free of bronchiectases and COPD, so the&nbsp;total of 193 subjects were included in the&nbsp;investigation. The NCEP/ATP III criteria<br />established metabolic syndrome frequency among&nbsp;the patients with chronic respiratory diseases&nbsp;(COPD, bronchiectases, and concomitant COPD&nbsp;and bronchiectases) amounted to 37.3 % . The&nbsp;metabolic syndrome was more frequent in the&nbsp;patients with COPD and/or bronchiectases than in&nbsp;the control group patients free of any chronic&nbsp;respiratory disease. The metabolic syndrome was&nbsp;VIII confirmed in 38.2% of COPD patients, 54% of the&nbsp;patients with bronchiectases, and in 36.2% of the<br />patients with&nbsp; concomitant COPD and&nbsp;bronchiectases. The mean number of the<br />metabolic syndrome components was&nbsp; 2.18 in&nbsp;COPD patients,&nbsp;&nbsp; 2.56 in patients with<br />bronchiectases, and 2.1 in patients with&nbsp;concomitant COPD and bronchiectases. The<br />metabolic syndrome components were neither&nbsp;more frequent, nor statistically higher in the&nbsp;patients with concomitant COPD and&nbsp;bronchiectases as compared to the patients with a&nbsp;single presence of any of the two diseases. The&nbsp;difference in the single values of the metabolic&nbsp;syndrome components and the frequency of&nbsp;certain components in the examined groups of the&nbsp;patients with chronic pulmonary diseases was not&nbsp;statistically significant. Among the patients with&nbsp;chronic respiratory diseases, no correlation was&nbsp;observed between the metabolic syndrome&nbsp;frequency and the patients&rsquo; sex or age. The&nbsp;metabolic syndrome was not confirmed to be&nbsp;more frequent in males, or in&nbsp;&nbsp; &gt;65 yr old patients,&nbsp;as compared to younger patients. Among COPD<br />patients, no correlation was registered between the&nbsp;metabolic syndrome frequency and&nbsp;&nbsp; COPD&nbsp;treatment duration. It was confirmed that the&nbsp;metabolic syndrome frequency was not higher in&nbsp;the patients with &lt;5Hyear long COPD treatment<br />than in those treated for COPD longer. On the&nbsp;basis of the results obtained in our investigation,&nbsp;we conclude that chronic respiratory diseases,&nbsp;COPD and &nbsp;bronchiectases, are the conditions with&nbsp;a higher cardiometobolic risk.</p>

Twenty publications are submitted. All deal with the issues of control of two ends of the spectrum of immune-mediated respiratory disorders in children, namely atopic (asthma and allergic rhinitis) and HIV-related lung disease. This submission summarises the research by the author into this spectrum of lung diseases of children in South Africa, highlighting the diversity of conditions that are not only clinically important, but also common. Understanding of all conditions is required to improve the health of children in this region. Management of chronic conditions requires two major end points - adequate and timely diagnosis and - management to control the condition. The author has a passion for improving the quality of life of children and firmly believes that the research findings will, and have, led to transformation in management of both these common disorders. This document follows the progression of the authors research work and highlights how interesting and important is the scope of two disorders which could be thought to have a central origin, namely in the T-cell. T-cells form the basis of cellular immunity and an excess of T-helper 2 cell activity promotes atopy, whilst the human immunodeficiency (HI) virus infects T-helper cells and promotes cellular immune deficiency and its attendant clinical disorders. The author’s research work is not based on the immunological basis of these conditions but does deal with the clinical implications and especially aspects relating to control of these two extremes of a clinical spectrum of disorders. To take the clarity of two diseases at the end of a spectrum to its natural conclusion these extremes are defined in aetiology or pathophysiological differences (excess versus suppression of the immune system), occurring in the affluent and poor alike versus just the poor, control being required to improve quality of life versus to save lives and finally that management requires anti-inflammatory therapy versus antibiotic and anti-infective therapy. For the eight publications based on atopic respiratory disease in children the themes are firstly that children with asthma and chronic rhinitis are diagnosed late, that most individuals with these conditions are not well controlled and finally that the reasons for lack of control are becoming obvious. For the first time, the significant lack of asthma and allergic rhinitis control in South Africa is documented. These studies suggest that, like surveys from the rest of the world, asthma control is seriously under-estimated and neglected in all asthmatics in South Africa, in both the privileged and the under-privileged. The research also defines reasons for poor asthma and allergic rhinitis control in this region. As in many studies published from around the world it is now evident that poor asthma and allergic rhinitis control cannot be blamed on any one source. A multitude of reasons underlie this phenomenon and each of the subsequent papers in this section illustrates attempts at defining these principles. The three most important reasons for poor control are probably that most asthmatics are managed in the wrong hands (by doctors who don’t understand adequate control and who aren’t empowered to use the correct therapy), that control may actually be a pipe dream and practically difficult to do or even impossible to achieve and lastly that the allergic basis of asthma is over emphasised and may not in fact determine all asthma. The subsequent papers summarise research work in the field of HV infection in children and exposes the opposite end of a spectrum of Paediatric respiratory disease and highlight research into the conditions common in HIV-infected children. Eleven papers are presented. For the diseases associated with the HI virus the major complications of inadequate diagnosis and prevention in children are acute pneumonia (especially severe pneumonia) and bronchiectasis. Bronchiolitis is not common in HIV infected children, despite epidemics of this condition in non-infected children. Passive smoking does not aggrevate or worsen disease progression in children. The complications of HIV related diseases in children require the same principles of adequate diagnosis and control as would apply to the chronic atopic conditions. Once the author delved into the disorders at the other end of the clinical spectrum, namely those associated with immune deficiency secondary to HIVinfection he faced the question of a possible relationship between the conditions. One submission explores that relationship. This research has a unique perspective, conferred by the fact that these two conditions do not occur to the same extent anywhere else in the world. Atopic respiratory conditions and HIV-related lung diseases occur side by side in abundance in this region. This perspective has created a clarity for research to address the two most important aims in clinical medicine, namely to diagnose correctly and then to manage the condition so that control is achieved. These must be universal principles of the successful practice of medicine. / Thesis (DSc)--University of Pretoria, 2013. / gm2013 / Paediatrics and Child Health / unrestricted