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Singh M, De Rubis G, Kokkinis S, Paudel KR, Yeung S, Hansbro PM, Oliver BGG, Dua K. Curcumin-loaded liposomes modulating the synergistic role of EpCAM and estrogen receptor alpha in lung cancer management. Pathol Res Pract 2024; 257:155317. [PMID: 38657558 DOI: 10.1016/j.prp.2024.155317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
Lung cancer (LC) remains a leading cause of cancer-related mortality worldwide, necessitating the exploration of innovative therapeutic strategies. This study delves into the in vitro potential of liposomal therapeutics utilizing Curcumin-loaded PlexoZome® (CUR-PLXZ) in targeting EpCAM/TROP1 and Estrogen Receptor Alpha (ERα) signalling pathways for LC management. The prevalence of LC, particularly non-small cell lung cancer (NSCLC), underscores the urgent need for effective treatments. Biomarkers like EpCAM/TROP1 and ERα/NR3A1 play crucial roles in guiding targeted therapies and influencing prognosis. EpCAM plays a key role in cell-cell adhesion and signalling along with ERα which is a nuclear receptor that binds estrogen and regulates gene expression in response to hormonal signals. In LC, both often get overexpressed and are associated with tumour progression, metastasis, and poor prognosis. Curcumin, a phytochemical with diverse therapeutic properties, holds promise in targeting these pathways. However, its limited solubility and bioavailability necessitate advanced formulations like CUR-PLXZ. Our study investigates the biological significance of these biomarkers in the A549 cell line and explores the therapeutic potential of CUR-PLXZ, which modulates the expression of these two markers. An in vitro analysis of the A549 human lung adenocarcinoma cell line identified that CUR-PLXZ at a dose of 5 μM effectively inhibited the expression of EpCAM and ERα. This finding paves the way for targeted intervention strategies in LC management.
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Affiliation(s)
- Manisha Singh
- Department of Biotechnology, Jaypee Institute of Information Technology (JIIT) Noida, Uttar Pradesh, India; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Gabriele De Rubis
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Sofia Kokkinis
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia; Pharmako Biotechnologies, Sydney, NSW 2086, Australia
| | - Keshav Raj Paudel
- Centre of Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, School of Life Sciences, Sydney, NSW 2007, Australia
| | - Stewart Yeung
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Philip Michael Hansbro
- Centre of Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, School of Life Sciences, Sydney, NSW 2007, Australia
| | - Brian Gregory George Oliver
- Woolcock Institute of Medical Research, Macquarie University, New South Wales, Australia; School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia.
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Zhong P, Zhao Y, Cao Y, Chen C, Xie J, Chang C. Urban-Rural Disparity in Mortality Patterns of Respiratory Diseases Among Older Adults - China, 1987-2021. China CDC Wkly 2023; 5:1125-1130. [PMID: 38124883 PMCID: PMC10728557 DOI: 10.46234/ccdcw2023.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
What is already known about this topic? Respiratory diseases (RDs) are the primary cause of death in older adults in China. However, there is limited evidence regarding the disparity in mortality rates of RDs between urban and rural areas among the elderly population. What is added by this report? The age-standardized mortality rate (ASMR) due to RDs in the elderly population in both urban and rural areas of China has shown a consistent decrease. This trend is observed in both males and females. However, there was no significant change in the average annual percentage of ASMR for pneumonia among the urban elderly population and rural elderly men throughout the study period. What are the implications for public health practice? Efforts should be made in China to reduce mortality from chronic lower respiratory disease and pneumonia among the elderly, particularly in urban populations.
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Affiliation(s)
- Panliang Zhong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yihao Zhao
- Department of Chronic Diseases, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yi Cao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Chen Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Junqing Xie
- Center for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Chun Chang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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Groiss S, Somvilla I, Daxböck C, Stückler M, Pritz E, Brislinger D. Bei Mu Gua Lou San facilitates mucus expectoration by increasing surface area and hydration levels of airway mucus in an air-liquid-interface cell culture model of the respiratory epithelium. BMC Complement Med Ther 2023; 23:414. [PMID: 37978392 PMCID: PMC10655387 DOI: 10.1186/s12906-023-04251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Bei Mu Gua Lou San (BMGLS) is an ancient formulation known for its moisturizing and expectorant properties, but the underlying mechanisms remain unknown. We investigated concentration-dependent effects of BMGLS on its rehydrating and mucus-modulating properties using an air-liquid-interface (ALI) cell culture model of the Calu-3 human bronchial epithelial cell line and primary normal human bronchial epithelial cells (NHBE), and specifically focused on quantity and composition of the two major mucosal proteins MUC5AC and MUC5B. METHODS ALI cultures were treated with BMGLS at different concentrations over three weeks and evaluated by means of histology, immunostaining and electron microscopy. MUC5AC and MUC5B mRNA levels were assessed and quantified on protein level using an automated image-based approach. Additionally, expression levels of the major mucus-stimulating enzyme 15-lipoxygenase (ALOX15) were evaluated. RESULTS BMGLS induced concentration-dependent morphological changes in NHBE but not Calu-3 ALI cultures that resulted in increased surface area via the formation of herein termed intra-epithelial structures (IES). While cellular rates of proliferation, apoptosis or degeneration remained unaffected, BMGLS caused swelling of mucosal granules, increased the area of secreted mucus, decreased muco-glycoprotein density, and dispensed MUC5AC. Additionally, BMGLS reduced expression levels of MUC5AC, MUC5B and the mucus-stimulating enzyme 15-lipoxygenase (ALOX15). CONCLUSIONS Our studies suggest that BMGLS rehydrates airway mucus while stimulating mucus secretion by increasing surface areas and regulating goblet cell differentiation through modulating major mucus-stimulating pathways.
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Affiliation(s)
- Silvia Groiss
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre, Medical University of Graz, Neue Stiftingtalstraße 6/II, Graz, 8010, Austria
| | - Ina Somvilla
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre, Medical University of Graz, Neue Stiftingtalstraße 6/II, Graz, 8010, Austria
| | - Christine Daxböck
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre, Medical University of Graz, Neue Stiftingtalstraße 6/II, Graz, 8010, Austria
| | - Manuela Stückler
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre, Medical University of Graz, Neue Stiftingtalstraße 6/II, Graz, 8010, Austria
| | - Elisabeth Pritz
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre, Medical University of Graz, Neue Stiftingtalstraße 6/II, Graz, 8010, Austria
| | - Dagmar Brislinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre, Medical University of Graz, Neue Stiftingtalstraße 6/II, Graz, 8010, Austria.
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Garcia-Vilanova A, Olmo-Fontánez AM, Moliva JI, Allué-Guardia A, Singh H, Merritt RE, Maselli DJ, Peters JI, Restrepo BI, Wang Y, Schlesinger LS, Turner J, Weintraub ST, Torrelles JB. The aging human lung mucosa: A proteomics study. J Gerontol A Biol Sci Med Sci 2022; 77:1969-1974. [PMID: 35460553 PMCID: PMC9536443 DOI: 10.1093/gerona/glac091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
The older adult population, estimated to double by 2050, is at increased risk of respiratory infections and other pulmonary diseases. Biochemical changes in the lung alveolar lining fluid (ALF) and in alveolar compartment cells can alter local immune responses as we age, generating opportunities for invading pathogens to establish successful infections. Indeed, the lung alveolar space of older adults is a pro-inflammatory, pro-oxidative, dysregulated environment that remains understudied. We performed an exploratory, quantitative proteomic profiling of the soluble proteins present in ALF, developing insight into molecular fingerprints, pathways, and regulatory networks that characterize the alveolar space in old age, comparing it to that of younger individuals. We identified 457 proteins that were significantly differentially expressed in older adult ALF, including increased production of matrix metalloproteinases, markers of cellular senescence, antimicrobials, and proteins of neutrophilic granule origin, among others, suggesting that neutrophils in the lungs of older adults could be potential contributors to the dysregulated alveolar environment with increasing age. Finally, we describe a hypothetical regulatory network mediated by the Serum Response Factor that could explain the neutrophilic profile observed in the older adult population.
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Affiliation(s)
- Andreu Garcia-Vilanova
- Population Health and Host Pathogen Interactions Programs, Texas Biomedical Research Institute, San Antonio, TX
| | - Angélica M Olmo-Fontánez
- Population Health and Host Pathogen Interactions Programs, Texas Biomedical Research Institute, San Antonio, TX.,Integrated Biomedical Sciences Program, The University of Texas Health Science Center at San Antonio, TX
| | - Juan I Moliva
- Vaccine Research Center; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Anna Allué-Guardia
- Population Health and Host Pathogen Interactions Programs, Texas Biomedical Research Institute, San Antonio, TX
| | - Harjinder Singh
- Division of Pulmonary and Critical Care Medicine, School of Medicine, UT-Health SA, San Antonio, TX
| | - Robert E Merritt
- Department of Surgery, College of Medicine, The Ohio State University, Columbus OH
| | - Diego J Maselli
- Division of Pulmonary and Critical Care Medicine, School of Medicine, UT-Health SA, San Antonio, TX
| | - Jay I Peters
- Division of Pulmonary and Critical Care Medicine, School of Medicine, UT-Health SA, San Antonio, TX
| | | | - Yufeng Wang
- Department of Molecular Microbiology and Immunology, South Texas Center for Emerging Infectious Diseases, UTSA, San Antonio, TX
| | - Larry S Schlesinger
- Population Health and Host Pathogen Interactions Programs, Texas Biomedical Research Institute, San Antonio, TX
| | - Joanne Turner
- Population Health and Host Pathogen Interactions Programs, Texas Biomedical Research Institute, San Antonio, TX
| | - Susan T Weintraub
- Department of Biochemistry and Structural Biology, UT-Health SA, San Antonio, TX
| | - Jordi B Torrelles
- Population Health and Host Pathogen Interactions Programs, Texas Biomedical Research Institute, San Antonio, TX
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Ku Y, Kwon SB, Yoon JH, Mun SK, Chang M. Machine Learning Models for Predicting the Occurrence of Respiratory Diseases Using Climatic and Air-Pollution Factors. Clin Exp Otorhinolaryngol 2022; 15:168-176. [PMID: 34990536 PMCID: PMC9149237 DOI: 10.21053/ceo.2021.01536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/19/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Because climatic and air-pollution factors are known to influence the occurrence of respiratory diseases, we used these factors to develop machine learning models for predicting the occurrence of respiratory diseases. Methods We obtained the daily number of respiratory disease patients in Seoul. We used climatic and air-pollution factors to predict the daily number of patients treated for respiratory diseases per 10,000 inhabitants. We applied the relief-based feature selection algorithm to evaluate the importance of feature selection. We used the gradient boosting and Gaussian process regression (GPR) methods, respectively, to develop two different prediction models. We also employed the holdout cross-validation method, in which 75% of the data was used to train the model, and the remaining 25% was used to test the trained model. We determined the estimated number of respiratory disease patients by applying the developed prediction models to the test set. To evaluate the performance of each model, we calculated the coefficient of determination (R2) and the root mean square error (RMSE) between the original and estimated numbers of respiratory disease patients. We used the Shapley Additive exPlanations (SHAP) approach to interpret the estimated output of each machine learning model. Results Features with negative weights in the relief-based algorithm were excluded. When applying gradient boosting to unseen test data, R2 and RMSE were 0.68 and 13.8, respectively. For GPR, the R2 and RMSE were 0.67 and 13.9, respectively. SHAP analysis showed that reductions in average temperature, daylight duration, average humidity, sulfur dioxide (SO2), total solar insolation amount, and temperature difference increased the number of respiratory disease patients, whereas increases in atmospheric pressure, carbon monoxide (CO), and particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) increased the number of respiratory disease patients. Conclusion We successfully developed models for predicting the occurrence of respiratory diseases using climatic and air-pollution factors. These models could evolve into public warning systems.
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Affiliation(s)
- Yunseo Ku
- Department of Biomedical Engineering, Chungnam National University College of Medicine, Daejeon, Korea
| | - Soon Bin Kwon
- Department of Neurology, Columbia University, New York, NY, USA
| | - Jeong-Hwa Yoon
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Seog-Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Munyoung Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Ebell MH, Rahmatullah I, Cai X, Bentivegna M, Hulme C, Thompson M, Lutz B. A Systematic Review of Clinical Prediction Rules for the Diagnosis of Influenza. J Am Board Fam Med 2021; 34:1123-40. [PMID: 34772768 DOI: 10.3122/jabfm.2021.06.210110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/08/2021] [Accepted: 08/19/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Clinical prediction rules (CPRs) can assist clinicians by focusing their clinical evaluation on the most important signs and symptoms, and if used properly can reduce the need for diagnostic testing. This study aims to perform an updated systematic review of clinical prediction rules and classification and regression tree (CART) models for the diagnosis of influenza. METHODS We searched PubMed, CINAHL, and EMBASE databases. We identified prospective studies of patients presenting with suspected influenza or respiratory infection and that reported a CPR in the form of a risk score or CART-based algorithm. Studies had to report at a minimum the percentage of patients in each risk group with influenza. Studies were evaluated for inclusion and data were extracted by reviewers working in parallel. Accuracy was summarized descriptively; where not reported by the authors the area under the receiver operating characteristic curve (AUROCC), predictive values, and likelihood ratios were calculated. RESULTS We identified 10 studies that presented 14 CPRs. The most commonly included predictor variables were cough, fever, chills and/or sweats, myalgias, and acute onset, all which can be ascertained by phone or telehealth visit. Most CPRs had an AUROCC between 0.7 and 0.8, indicating good discrimination. However, only 1 rule has undergone prospective external validation, with limited success. Data reporting by the original studies was in some cases inadequate to determine measures of accuracy. CONCLUSIONS Well-designed validation studies, studies of interrater reliability between telehealth an in-person assessment, and studies using novel data mining and artificial intelligence strategies are needed to improve diagnosis of this common and important infection.
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Tipparaju VV, Mora SJ, Yu J, Tsow F, Xian X. Wearable Transcutaneous CO 2 Monitor Based on Miniaturized Nondispersive Infrared Sensor. IEEE Sens J 2021; 21:17327-17334. [PMID: 34744520 PMCID: PMC8570579 DOI: 10.1109/jsen.2021.3081696] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Transcutaneous oxygen and carbon dioxide provide the status of pulmonary gas exchange and are of importance in diagnosis and management of respiratory diseases. Though significant progress has been made in oximetry, not much has been explored in developing wearable technologies for continuous monitoring of transcutaneous carbon dioxide. This research reports the development of a truly wearable sensor for continuous monitoring of transcutaneous carbon dioxide using miniaturized nondispersive infrared sensor augmented by hydrophobic membrane to address the humidity interference. The wearable transcutaneous CO2 monitor shows well-behaved response curve to humid CO2 with linear response to CO2 concentration. The profile of transcutaneous CO2 monitored by the wearable device correlates well with the end-tidal CO2 trend in human test. The feasibility of the wearable device for passive and unobstructed tracking of transcutaneous CO2 in free-living conditions has also been demonstrated in field test. The wearable transcutaneous CO2 monitoring technology developed in this research can be widely used in remote assessment of pulmonary gas exchange efficiency for patients with respiratory diseases, such as COVID-19, sleep apnea, and chronic obstructive pulmonary disease (COPD).
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Kyung SY, Jeong SH. Particulate-Matter Related Respiratory Diseases. Tuberc Respir Dis (Seoul) 2020; 83:116-121. [PMID: 32185911 PMCID: PMC7105434 DOI: 10.4046/trd.2019.0025] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/10/2019] [Accepted: 01/21/2020] [Indexed: 12/05/2022] Open
Abstract
Particulate matter (PM) is suspended dust that has a diameter of <10 µm and can be inhaled by humans and deposited in the lungs, particularly the alveoli. Recent studies have shown that PM has an adverse effect on respiratory diseases. The aim of this article is to review respiratory diseases associated with PM. According to existing studies, PM is associated with chronic obstructive pulmonary disease, bronchial asthma, and several other respiratory diseases and increases the mortality rates of these diseases. Moreover, increased exposure in the high concentration of atmospheric PM is associated with the development of lung cancer. The most simple and common way to protect an individual from airborne PM is to wear a face mask that filters out PM. In areas of high concentration PM, it is recommended to wear a face mask to minimize the exposure to PM. However, the use of N95 or KF94 masks can interfere with respiration in patients with chronic respiratory diseases who exhibit low pulmonary function, leading to an increased risk of respiratory failure. Conclusionally, reduction of the total amount of PM is considered to be important factor and strengthening the national warning notification system to vulnerable patients and proper early management of exacerbated patients will be needed in the future.
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Affiliation(s)
- Sun Young Kyung
- Department of Allergy, Pulmonary and Critical Care Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon Particulate Matter Associated Disease Institute, Gachon University, Incheon, Korea
| | - Sung Hwan Jeong
- Department of Allergy, Pulmonary and Critical Care Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon Particulate Matter Associated Disease Institute, Gachon University, Incheon, Korea.
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Ilievska-Poposka B, Zakoska M, Talevski S. Practical Approach to Lung Health - Experience from the Republic of Macedonia. Open Access Maced J Med Sci 2018; 6:618-623. [PMID: 29731926 PMCID: PMC5927489 DOI: 10.3889/oamjms.2018.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/09/2018] [Accepted: 03/10/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND: Among the adults and children aged 5 yrs who attend PHC settings, 20-30% seeks to care for respiratory symptoms. Over 80-90% of the respiratory patients suffer from acute respiratory infections (ARI), followed by chronic obstructive pulmonary diseases (COPD), asthma, and less frequently with pneumonia and tuberculosis (TB). To improve the quality of care in patients who seek assistance for respiratory symptoms in PHC settings and the efficiency of respiratory service delivery within healthcare systems, WHO has designated several initiatives among which one is PAL (Practical Approach to Lung Health). PAL is an integrated and symptom-based approach focused on all priority respiratory illnesses encountered in PHC, including TB. Its patient-centred syndromic approach aims to improve the quality of diagnosis and treatment of respiratory illnesses in a PHC setting. AIM: To evaluate the short-term impact of PAL approach in improving the management of patients with the most frequent respiratory diseases by the GPs from PHC settings in the Republic of Macedonia. MATERIAL AND METHODS: A total of 588 GPs were educated for the most frequent respiratory diseases during the PAL training from 2013-2016. To evaluate the efficiency of GPs education from PHC settings, GPs fill in a form out of 69 questions for the patients enrolled before (baseline survey) and after PAL training (impact survey), and the results of the two surveys were compared. This analysis aimed to assess if the theoretical and practical skills obtained during the PAL training have been used in the routine practice of the GPs who attended the training and to what degree. RESULTS: Our results showed that in the impact study more patients with ARI (P < 0.000001) and more patients with COPD exacerbations were treated in the PHC settings (P < 0.000008). More patients suspected of asthma were referred to upper health level for diagnosis (P < 0.037). The comparison of the findings between the baseline and impact surveys suggest that training on PAL had an impact in decreasing drug prescription through a reduction in a prescription for antibiotics for ARI, COPD and asthma. Our study indicates that training on PAL is likely to increase the prescription of inhaled corticosteroids and tends to decrease the prescription of other formulation of these drugs (P < 0.0000001). The impact surveys showed that the patients with COPD and pneumonia in the PHC settings were better managed due to the more frequent use of CAT questionnaires and CURB test. And regarding TB cases, our study indicates that the GPs were more aware of this disease and were more willing to take part in the patient treatment follow-up (P < 0.000001). CONCLUSION: The results from this study showed that implementation of PAL approach for GPs from the PHC setting in our country have positive results (effect) in the management of patients with respiratory symptoms: it is likely to reduce prescribing for antibiotics, to increase the use of inhalation medication which is highly recommended in the management of asthma and COPD, and to decrease the referral of patients with chronic diseases to the upper health level. However, more experience is needed for long-term influence on the effects over the cost-effectiveness of respiratory care services and on strengthening the health care system.
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Affiliation(s)
| | - Maja Zakoska
- Institute for Lung Diseases and Tuberculosis, Skopje, Republic of Macedonia
| | - Stefan Talevski
- Institute for Lung Diseases and Tuberculosis, Skopje, Republic of Macedonia
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Karim T, Muhit M, Khandaker G. Interventions to prevent respiratory diseases - Nutrition and the developing world. Paediatr Respir Rev 2017; 22:31-37. [PMID: 27793738 DOI: 10.1016/j.prrv.2016.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 01/22/2023]
Abstract
Malnutrition is a major cause of morbidity and mortality in developing countries and nutrition plays a critical role in both acute and chronic respiratory conditions. Inadequacies in the nutritional requirements of a developing lung in utero and in early life can compromise the respiratory system integrity and result in poor lung function, reduced protection against infections, greater likelihood of acute illnesses in childhood and chronic illness in adulthood. Nutritional interventions harness great potential in reducing respiratory illness related morbidity and mortality in the developing world. In this review we have summarized the findings from published systematic reviews/meta-analysis, experimental and observational studies that looked into different nutritional interventions for preventing respiratory diseases in developing countries.
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Affiliation(s)
- Tasneem Karim
- CSF Global, Dhaka, Bangladesh; Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh; Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Gulam Khandaker
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia.
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