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  • 1.
    Labor, Marina
    et al.
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Cancer- och lungsjukvårdsenheten.
    Kirui, Brian K.
    Univ Gothenburg, Sweden.
    Nyberg, Fredrik
    Univ Gothenburg, Sweden.
    Vanfleteren, Lowie E. G. W.
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Regular Inhaled Corticosteroids Use May Protect Against Severe COVID-19 Outcome in COPD2023Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 18, s. 1701-1712Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Population-based studies provide conflicting evidence about how inhaled corticosteroids (ICS) impact COVID-19 outcomes among COPD patients. We investigated whether regular ICS exposure affects risk, severity, or survival in SARS-CoV-2 infection, using a nationwide linked Swedish population register database.Patients and Methods: During January-December 2020, we studied two defined Swedish adult populations - Whole population [?40 years] (N = 5243479), and COPD subpopulation [?40 years] (N = 133372), in three study cohorts, respectively: 1. Overall cohort (index date 1 Jan 2020), 2. COVID-19 diagnosed sub-cohort (index date = diagnosis date), and 3. COVID-19 hospitalized sub-cohort (index date = admission date). Regular exposure was defined as ?3 ICS prescriptions in the year before index. Hazard ratios (HRs) for outcomes (COVID-19 onset, hospitalization, ICU admission, or death) related to ICS exposure were estimated using Cox regression. Confounding was controlled by propensity score methods applying Average Treatment effect in the Treated (ATT) weighting.Results: Regular ICS use was associated with only very slightly increased onset of COVID-19, hospitalization, ICU admission, and death in the overall whole population cohort and in the overall COPD subpopulation cohort, except for ICU admission (marginally non-significant HRs, up to 1.13); and no clear increase in the diagnosed sub-cohorts. However, in the COVID-19 hospitalized COPD sub-cohort, ICS therapy showed reduced risks against progression to ICU admission and death, significant for death (HR 0.82 95% CI [0.67-0.99]).Conclusion: For COPD patients, ICS therapy offers some protection against progression to ICU admission and death among COVID-19 hospitalized patients. Our findings alleviate concerns about increased risks of COVID-19 by ICS treatment and provide evidence supporting the continuation of ICS therapy for COPD patients.

  • 2.
    Vrbica, Zarko
    et al.
    Univ Dubrovnik, Croatia; Dubrovnik Gen Hosp, Croatia.
    Steiner, Justinija
    Osijek Baranja Country Med Ctr, Croatia.
    Labor, Marina
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Cancer- och lungsjukvårdsenheten.
    Gudelj, Ivan
    Univ Split, Croatia.
    Plavec, Davor
    Prima Nova, Croatia; Josip Juraj Strossmayer Univ Osijek, Croatia.
    Breathlessness and "exacerbation" questions predictive for incident COPD (MARKO study): data after two years of follow-up2023Ingår i: PeerJ, E-ISSN 2167-8359, Vol. 11, artikel-id e16650Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To determine the predictability of the MARKO questionnaire and/or its domains, individually or in combination with other markers and characteristics (age, gender, smoking history, lung function, 6-min walk test (6 MWT), exhaled breath temperature (EBT), and hsCRP for the incident chronic obstructive pulmonary disease (COPD) in subjects at risk over 2 years follow-up period).Participants and Methods: Patients, smokers/ex-smokers with >20 pack-years, aged 40-65 years of both sexes were recruited and followed for 2 years. After recruitment and signing the informed consent at the GP, a detailed diagnostic workout was done by the pulmonologist; they completed three self-assessment questionnaires-MARKO, SGRQ and CAT, detailed history and physical, laboratory (CBC, hsCRP), lung function tests with bronchodilator and EBT. At the 2 year follow-up visit they performed: the same three self-assessment questionnaires, history and physical, lung function tests and EBT.Results: A sample of 320 subjects (41.9% male), mean (SD) age 51.9 (7.4) years with 36.4 (17.4) pack-years of smoking was reassessed after 2.1 years. Exploratory factor analysis of MARKO questionnaire isolated three distinct domains (breathlessness and fatigue, "exacerbations", cough and expectorations). We have determined a rate for incident COPD that was 4.911/100 person-years (95% CI [3.436-6.816]). We found out that questions about breathlessness and "exacerbations", and male sex were predictive of incident COPD after two years follow-up (AUC 0.79, 95% CI [0.74-0.84], p < 0.001). When only active smokers were analyzed a change in EBT after a cigarette (Delta EBT) was added to a previous model (AUC 0.83, 95% CI [0.78-0.88], p < 0.001).Conclusion: Our preliminary data shows that the MARKO questionnaire combined with EBT (change after a cigarette smoke) could potentially serve as early markers of future COPD in smokers.

  • 3.
    Zebic Mihic, Petra
    et al.
    Univ Hosp Ctr Osijek, Croatia; JJ Strossmayer Univ Osijek, Croatia.
    Arambasic, Jerko
    Univ Hosp Ctr Osijek, Croatia; JJ Strossmayer Univ Osijek, Croatia.
    Mlinarevic, Drazen
    Univ Hosp Ctr Osijek, Croatia.
    Saric, Sandra
    Univ Hosp Ctr Osijek, Croatia; JJ Strossmayer Univ Osijek, Croatia.
    Labor, Marina
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Cancer- och lungsjukvårdsenheten.
    Bosnjak, Ivica
    Univ Hosp Ctr Osijek, Croatia.
    Mihaljevic, Ivica
    JJ Strossmayer Univ Osijek, Croatia; Univ Hosp Ctr Osijek, Croatia.
    Bilic Curcic, Ines
    JJ Strossmayer Univ Osijek, Croatia; Univ Hosp Ctr Osijek, Croatia.
    Juric, Iva
    Univ Hosp Ctr Osijek, Croatia; JJ Strossmayer Univ Osijek, Croatia.
    Coronary Tortuosity Index vs. Angle Measurement Method for the Quantification of the Tortuosity of Coronary Arteries in Non-Obstructive Coronary Disease2024Ingår i: Diagnostics, ISSN 2075-4418, Vol. 14, nr 1, artikel-id 35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Coronary tortuosity has been recognized as a potential pathophysiological mechanism in the development of non-obstructive coronary artery disease (CAD). The aim of this study was to examine the role of two coronary tortuosity measurement methods in the detection of clinically significant coronary tortuosity. The study included 160 patients with angina symptoms and myocardial ischemia detected by cardiac stress tests in chronic settings and those diagnosed with acute coronary syndrome. After coronary angiography, tortuosity of coronary arteries was assessed by two methods, including measurement of tortuosity angles and calculating of tortuosity index. Significantly more tortuous coronary arteries were detected in the group with non-obstructive CAD (p < 0.01 for all three arteries), with significantly higher tortuosity index (TI) for all three coronary arteries in this group of patients, compared to patients with obstructive CAD. The highest TI for LCX was found in patients with lateral ischemia (p < 0.001) and for LAD in patients with anterior ischemia (p < 0.001). When measured by the angle method, the only association was found between LCX tortuosity and lateral ischemia (OR 4.9, p = 0.046). In conclusion, coronary tortuosity represents a pathophysiological mechanism for myocardial ischemia in non-obstructive CAD. The coronary tortuosity index could be a reliable and widely applicable tool for the quantification of coronary tortuosity.

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