Ana Hecimovic

Early onset of nontuberculous mycobacterial pulmonary disease contributes to the lethal outcome in lung transplant recipients: report of two cases and review of the literature.

Lung transplant (LuTx) recipients represent a population at risk of nontuberculous mycobacterial pulmonary disease (NTM‐PD). Yet the risk factors, the timing of NTM‐PD after transplantation, and the association with allograft dysfunction all remain poorly defined. We report 2 cases of early‐onset NTM‐PD and review the literature, focusing on NTM‐PD in LuTx recipients not colonized with NTM prior to transplantation. In addition, we summarize the main characteristics and differences between early‐ and late‐onset disease.

5-year survival of patients with nontuberculous mycobacteria pulmonary disease (NTM-PD)–data from Croatian national registry

Background: impact of NTM-PD is difficult to assess. Aims and objectives:to calculate survival rates of patients with NTM isolate and/or NTM-PD. Methods: Retrospective analysis of all Croatian residents with pulmonary NTM isolated from 2006 to 2016. Based on previously shown correlation (Jankovic M et al, IJTLD 2016,20(7):934-40), we assessed the 5-year survival regarding fulfilment of American Thoracic Society (ATS) microbiologic criteria and the level of species’ clinical relevance. For those with clinically diagnosed NTM-PD, survival rate was calculated regarding the received therapy (adequate therapy;short duration adequate therapy;inadequate/no therapy;tuberculosis therapy). Results: Of 2007 patients with pulmonary NTM isolate, 436 met the microbiologic criteria. A 5-year survival rate for those meeting the criteria was 60%, compared to 70% in those who did not (p M.xenopi (intermediately relevant species) but didn’t reach statistical significance (p=0,055), while there was no difference for M.avium complex (highly relevant species). NTM-PD was diagnosed in 160/545 patients with available medical records. With respect to the treatment, we found no differences regarding the NTM caused mortality, but the all cause mortality was 17% in adequately treated, compared to 36% in those receiving no treatment (HR 3.04;p=0.018). Conclusion: patients meeting the microbiologic criteria had significantly lower survival rate compared to those who do not, but the difference was lost in case of species of high clinical relevance. Adequate treatment of NTM-PD significantly reduces the all-cause mortality indicating a high morbidity of the disease.

Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation

Aim To determine in-hospital and post-discharge mortality, readmission rates, and predictors of invasive mechanical ventilation (IMV) in patients treated at intensive care unit (ICU) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective observational cohort study included all patients treated at a respiratory ICU for AECOPD during one year. A total of 62 patients (41 men) with mean age 68.4 ± 10.4 years were analyzed for outcomes including in-hospital and post-discharge mortality, readmission rates, and IMV. Patients’ demographic, hematologic, biochemical data and arterial blood gas (ABG) values were recorded on admission to hospital. Mean duration of follow-up time was 2.4 years. Results Of 62 patients, 7 (11.3%) died during incident hospitalization and 21 (33.9%) died during the follow-up. The overall 2.4-year mortality was 45.2%. Twenty nine (46.8%) patients were readmitted due to AECOPD. The average number of readmissions was 1.2. Multivariate analysis showed that blood pH, bicarbonate levels, low albumin, low serum chloride, and low hemoglobin were significant predictors of IMV during incident hospitalization (P < 0.001 for the overall model fit). Conclusion High in-hospital and post-discharge mortality and high readmission rates in our patients treated due to AECOPD at ICU indicate that these patients represent a high risk group in need of close monitoring. Our results suggested that anemia, hypoalbuminemia, and elevated troponin levels were risk factors for the need of IMV in severe AECOPD. Identification of such high-risk patients could provide the opportunity for administration of an appropriate and timely treatment.

Disease effect on psychological burden in patients attending pulmonary rehabilitation

Introduction: Difficulties resulting from chronic pulmonary diseases carry a great psychological burden that is expected to be greater with greater difficulties. Pulmonary rehabilitation (PR) has proven its positive effects in this field. Aim: To show if higher levels of physiological difficulties in asthma and chronic obstructive pulmonary disease (COPD), mean a bigger psychological burden. To compare asthma and COPD patients in the size of that burden pre and post PR. Methods: Study included 102 asthma and COPD patients who completed PR in 20 visits. Physiological difficulties were measured with spirometry (FVC,FEV1,FEV1/FVC) and 6-minute walking distance (6MWD). Depression(D), anxiety(A) and stress(S) were measured with DASS21. Quality of life (QoL) was obtained by single item estimation. We compared pre- and post PR data for all patients and in regards to physiological and psychological variables. Results: All patients, regardless of disease and physiological/psychological difficulties had improved after PR in all outcomes (p (FVC,FEV1,FEV1/FVC,6MWD,QoL,D,A,S) As expected,COPD patients had significantly larger physiological difficulties pre PR (p (QoL) =.591; p (D) =.939;p (A) =.211;p (S) =.299). We expected but did not find lower psychological distress in asthma due to lower physiological burden. Conclusion: Higher levels of physiological difficulties pre PR do not mean higher psychological burden pre or post PR, thus indicating other mechanisms affecting the psychological burden of the disease. Asthma and COPD patients did not deffer in the size of the PR9s positive effect on physiological/psychological burden.