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Miravitlles M, Sliwinski P, Rhee CK, Costello RW, Carter V, Tan JHY, Lapperre TS, Alcazar B, Gouder C, Esquinas C, García-Rivero JL, Kemppinen A, Tee A, Roman-Rodríguez M, Soler-Cataluña JJ, Price DB. Changes in Control Status of COPD Over Time and Their Consequences: A Prospective International Study. Arch Bronconeumol 2020; 57:122-129. [PMID: 32709534 DOI: 10.1016/j.arbres.2020.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/26/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Control status may be a useful tool to assess response to treatment at each clinical visit in COPD. Control status has demonstrated to have long-term predictive value for exacerbations, but there is no information about the short-term predictive value of the lack of control and changes in control status over time. METHOD Prospective, international, multicenter study aimed at describing the short-term (6 months) prognostic value of control status in patients with COPD. Patients with COPD were classified as controlled/uncontrolled at baseline and at 3,6-month follow-up visits using previously validated criteria of control. Moderate and severe exacerbation rates were compared between controlled and uncontrolled visits and between patients persistently controlled, uncontrolled and those changing control status over follow-up. RESULTS A total of 267 patients were analyzed: 80 (29.8%) were persistently controlled, 43 (16%) persistently uncontrolled and 144 (53.7%) changed control status during follow-up. Persistently controlled patients were more frequently men, with lower (not increased) body mass index and higher FEV1(%). During the 6 months following an uncontrolled patient visit the odds ratio (OR) for presenting a moderate exacerbation was 3.41 (95% confidence interval (CI) 2.47-4.69) and OR=4.25 (95%CI 2.48-7.27) for hospitalization compared with a controlled patient visit. CONCLUSIONS Evaluation of control status at each clinical visit provides relevant prognostic information about the risk of exacerbation in the next 6 months. Lack of control is a warning signal that should prompt investigation and action in order to achieve control status.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain.
| | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Richard W Costello
- Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland
| | | | - Jessica H Y Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Therese Sophie Lapperre
- Duke-National University of Singapore Medical School, Singapore; Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Bernardino Alcazar
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Respiratory Department, Hospital de Alta Resolución de Loja, Spain
| | - Caroline Gouder
- Department of Respiratory Medicine, Mater Dei Hospital, Malta
| | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d'Hebron; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Public Health, Mental, Maternal and Child Health Nursing Department, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | | | | | - Augustine Tee
- Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | - Juan José Soler-Cataluña
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - David B Price
- Centre of Academic Primary Care, University of Aberdeen, UK; Observational and Pragmatic Research Institute, Singapore
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Miravitlles M, Sliwinski P, Rhee CK, Costello RW, Carter V, Tan JHY, Lapperre TS, Alcazar B, Gouder C, Esquinas C, García-Rivero JL, Kemppinen A, Tee A, Roman-Rodríguez M, Soler-Cataluña JJ, Price DB. Predictive value of control of COPD for risk of exacerbations: An international, prospective study. Respirology 2020; 25:1136-1143. [PMID: 32249487 DOI: 10.1111/resp.13811] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 12/02/2019] [Revised: 02/16/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The concept of clinical control in COPD has been developed to help in treatment decisions, but it requires validation in prospective studies. METHODS This international, multicentre, prospective study aimed to validate the concept of control in COPD. Patients with COPD were classified as controlled/uncontrolled by clinical criteria or CAT scores at baseline and followed up for 18 months. The main outcome was the difference in rate of a composite endpoint of moderate and severe exacerbations or death over the 18-month follow-up period. RESULTS A total of 307 patients were analysed (mean age = 68.6 years and mean FEV1 % = 52.5%). Up to 65% and 37.9% of patients were classified as controlled by clinical criteria or CAT, respectively. Controlled patients had significantly less exacerbations during follow-up (by clinical criteria: 1.1 vs 2.6, P < 0.001; by CAT: 1.1 vs 1.9, P = 0.014). Time to first exacerbation was significantly prolonged for patients controlled by clinical criteria only (median: 93 days, IQR: 63; 242 vs 274 days, IQR: 221; 497 days; P < 0.001). Control status by clinical criteria was a better predictor of exacerbations compared to CAT criteria (AUC: 0.67 vs 0.57). CONCLUSION Control status, defined by easy-to-obtain clinical criteria, is predictive of future exacerbation risk and time to the next exacerbation. The concept of control can be used in clinical practice at each clinical visit as a complement to the current recommendations of initial treatment proposed by guidelines.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Spain
| | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Richard W Costello
- Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland
| | | | - Jessica H Y Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Therese S Lapperre
- Duke-National University of Singapore Medical School, Singapore.,Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Bernardino Alcazar
- CIBER de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital de Alta Resolución de Loja, Granada, Spain
| | - Caroline Gouder
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | - Cristina Esquinas
- Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Public Health, Mental, Maternal and Child Health Nursing Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | | | | | - Augustine Tee
- Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | - Juan José Soler-Cataluña
- CIBER de Enfermedades Respiratorias (CIBERES), Spain.,Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | - David B Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.,Observational and Pragmatic Research Institute, Singapore
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Tan JHY, Chew WM, Lapperre TS, Tan GL, Loo CM, Koh MS. Role of bronchoprovocation tests in identifying exercise-induced bronchoconstriction in a non-athletic population: a pilot study. J Thorac Dis 2017; 9:537-542. [PMID: 28449460 DOI: 10.21037/jtd.2017.02.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Studies on diagnostic tests for exercise-induced bronchoconstriction (EIB) have centered around the asthmatic and elite athletic population. Traditionally, the exercise challenge test (ET) was recommended to assess EIB. We aimed to compare the performance of surrogate testing, mainly the hypertonic saline (HS) test, and methacholine challenge test (MCT) versus ET in identifying EIB among non-athletic subjects. METHODS We prospectively recruited subjects who did not have confirmed active asthma, but who reported exercise-induced dyspnoea. The participants underwent HS and ET on separate days within two weeks. MCT performed within one year were obtained retrospectively from medical records. The sensitivity, specificity, and accuracy of each diagnostic test were calculated using ET as the gold standard. RESULTS We recruited 27 participants (mean age 20.6±2.5 years; 92.6% male). Five (18.5%) had a history of self-reported asthma prior to recruitment. Eleven participants (40.7%) had a positive ET test. The sensitivity, specificity and accuracy of HS in diagnosing EIB was 90.9%, 62.5% and 74.1%; while that of MCT was 88.9%, 83.3% and 85.7% respectively. Six subjects were positive to HS but had negative ET test. CONCLUSIONS Both HS and MCT were found to be suitable alternatives to ET in screening for EIB in the non-athletic population in this pilot study. Further large scale studies are required to confirm this finding. These tests have the potential to replace ET for the diagnosis of EIB in centres without ET equipment or facilities.
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Affiliation(s)
- Jessica H Y Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Wui Mei Chew
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Therese S Lapperre
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Gan Liang Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Chian Min Loo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Mariko S Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore.,Allergy Centre, Singapore General Hospital, Singapore
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Tan JHY, Hsu AAL. Challenges in diagnosis and management of giant solitary fibrous tumour of pleura: a case report. BMC Pulm Med 2016; 16:114. [PMID: 27501789 PMCID: PMC4976512 DOI: 10.1186/s12890-016-0279-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/24/2016] [Accepted: 08/03/2016] [Indexed: 12/25/2022] Open
Abstract
Background Majority of patients with solitary fibrous tumours of the pleura (SFTP) are asymptomatic. Acute presentation with symptoms resulting from mass effect due to rapid expansion of tumour size has not been reported before. Case presentation This report chronicles the case of a giant SFTP in a 76-year-old lady who presented with acute onset of haemoptysis, left-sided pleuritic chest pain and hoarseness of voice. Her chest radiograph showed a large left upper hemithorax mass with an ipsilateral effusion. Computed tomography (CT) scan of the thorax confirmed the presence of a pleural-based mass lesion in the left apex measuring 9.7 cm with close apposition to the aortic arch. The mass demonstrated neovascularization and there was also presence of a moderate-sized heterogeneous-appearing left pleural effusion. Thoracocentesis yielded deeply haemoserous pleural fluid with a pleural aspirate hematocrit closely approaching that of peripheral blood hematocrit and alongside a 2 unit decrease in haemoglobin, was indicative of a haemothorax. Repeat CT 10 days from initial presentation showed reduction in size of the left apical mass as well as resolution of the left effusion. This was consistent with the occurrence of an intra-tumoural bleed resulting in rapid increase in the size of the SFTP, causing rupture of superficial blood vessels on the tumour surface (haemothorax) and consequential compression of the lung parenchyma (haemoptysis) and left recurrent laryngeal nerve (hoarseness of voice). The patient eventually underwent an uneventful surgical resection. Conclusion A benign SFTP can present acutely with compressive symptoms as a result of spontaneous intra-tumoural bleed causing sudden increase in its size. It is important to allow temporal regression of these acute changes before deciding on surgical resectability.
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Affiliation(s)
- Jessica H Y Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
| | - Anne A L Hsu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
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Tan JHY. Surgical Anatomy Around the Orbit: the system of zones. Eye (Lond) 2007. [DOI: 10.1038/sj.eye.6702280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Uric acid, an antioxidant, is reduced in multiple sclerosis (MS). Patients with gout have a reduced incidence of MS. Optic neuritis (ON), often the first manifestation of MS, is not known to be associated with reduced uric acid. Patients with recent onset of ON were investigated to determine whether uric acid levels were reduced at presentation. Twenty-one patients with ON were included, 17 females and 4 males. The mean (SD) serum uric acid in the ON female group was 184.4 ( +/-55.1) micromol/L (range, 116-309 micromol/L), whilst in the control group it was 235.2 (+/- 50.2) micromol/L (range, 172-381 micromol/L). The difference was statistically significant (chi2 = 8.93, P = 0.003). In the small male cohort, mean (SD) serum uric acid was 305 (+/- 52.1) micromol/L, whilst in the control group it was 328 (+/- 80.4) micromol/L. These differences were not statistically significant. Reduced antioxidant reserve is possibly an early pathogenic mechanism in inflammatory demyelination, and raises the possibility that low uric acid levels could be an indicator of disease activity. Since optic neuropathies of other causes were not investigated, future research needs to determine whether low uric acid represents a unique feature of optic neuritis or is seen in other optic neuropathies.
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Affiliation(s)
- C M Knapp
- Department of Ophthalmology, Faculty of Medicine and Biological Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, The Leicester Royal Infirmary, Leicester LE2 7LX, UK.
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Abstract
BACKGROUND Amblyopia treatment is not standardised and differences between centres and countries have not been systematically investigated. This survey compares the different patterns of orthoptic treatment of amblyopia in the United Kingdom (UK) and three German speaking countries (GSC). METHODS Questionnaires were sent to orthoptists in the UK and the GSC asking for their preferred choices of treatment of amblyopia between the ages of 6 months to 10 years. RESULTS The following significant differences in management of amblyopia were found: (1) the number of hours of occlusion per week was higher in the GSC, p<0.0001, (2) orthoptists in the GSC treat amblyopia up to an older age. Orthoptists in the GSC and in the UK predicted similar treatment outcomes. CONCLUSION Orthoptists in the GSC usually treat patients more intensively and for longer, while the prediction of visual outcome does not differ significantly between countries. These results highlight the lack of standardisation in the treatment of the various types of amblyopia.
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Affiliation(s)
- J H Y Tan
- Department of Ophthalmology, University Hospitals of Leicester, Leicester, UK.
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Tan JHY, Karwatowski WSS. Phacoemulsification cataract surgery and unplanned anterior vitrectomy--is it bad news? Eye (Lond) 2002; 16:117-20. [PMID: 11988808 DOI: 10.1038/sj.eye.6700015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2001] [Accepted: 09/21/2001] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to determine the final visual outcome of patients who undergo complicated phacoemulsification cataract surgery in which the posterior capsule is compromised and vitrectomy was required. METHODS Data were collected for patients operated on over an 18-month period from the 1st of January till the 24th of June 1999 at the Department of Ophthalmology, Leicester Royal Infirmary. All grades of surgeons were included and patients were identified from the theatre logbook. A standard proforma was completed and the data evaluated. RESULTS A total of 2538 phacoemulsification cataract operations were performed over this duration. Of these, 2446 (96.4%) had uncomplicated phacoemulsification cataract surgery while 92 (3.6%) required anterior vitrectomy. In order to allow for a more accurate interpretation of the visual outcome, patients were divided into two groups, depending on whether or not there was pre-existing eye disease at initial listing.Sixty-five patients did not have pre-existing eye disease. From this, notes were available for 57 patients, whereby the best-corrected visual acuity (BCVA) was obtained postoperatively. Vision of 6/12 or better was used to define acceptable postoperative vision. This group consisted of 49 patients (86%): five had visual acuities of 6/12, 26 = 6/9, one = 6/7.5 and 17 = 6/6. There were eight (14%) patients with poor visual outcome, largely represented by patients with cystoid macular oedema (8.8%). The most frequent stage of vitreous loss was during primary phacoemulsification in 46 (50%). Irrigation and aspiration, which resulted in 21 (23%) instances, followed this. The rate of posterior capsule rupture and anterior vitrectomy during phacoemulsification cataract surgery is 2% when performed by consultants, 4% by specialist registrars and staff grades and 10% by senior house officers. CONCLUSION This study looks at the final visual outcome of patients who underwent unplanned anterior vitrectomy during routine phacoemulsification cataract surgery, in a university teaching hospital in the United Kingdom. It includes all levels of surgeons with varying experience. The rate of vitreous loss in this study for phacoemulsification cataract surgery is 3.6%. Patients who undergo complicated phacoemulsification cataract surgery do comparatively well.
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Affiliation(s)
- J H Y Tan
- Department of Ophthalmology, Leicester Royal Infirmary, Leicester, LE1 5WW UK.
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Tan JHY, Newman DK, Klunker C, Burton RL. Letter. Eye (Lond) 2000. [DOI: 10.1038/eye.2000.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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