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Kemper TA, Woo H, Belz D, Fawzy A, Lorizio W, Eakin MN, Putcha N, McCormack MC, Brigham EP, Hanson C, Koch AL, Hansel NN. Higher Plasma Omega-3 Levels are Associated With Improved Exacerbation Risk and Respiratory-Specific Quality of Life in COPD. Chronic Obstr Pulm Dis 2024. [PMID: 38687147 DOI: 10.15326/jcopdf.2023.0468] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Background Omega-3 polyunsaturated fatty acids (PUFAs) have been associated with systemic anti-inflammatory responses. Dietary intake of omega-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has also been associated with lower COPD morbidity using self-report food frequency questionnaires. Objective To investigate the relationship between measured PUFA intake using plasma EPA+DHA levels and COPD morbidity. Methods Former smokers with moderate-severe COPD living in low-income communities were enrolled in a 6-month prospective cohort study. Participants completed standardized questionnaires, spirometry, and plasma samples at 3-month intervals. Total plasma PUFAs were analyzed using gas chromatography/ mass spectrometry for DHA and EPA concentrations. Linear or logistic mixed model regression was used to evaluate EPA+DHA's and COPD morbidity's association, accounting for demographics, lung function, pack years, comorbidities, and neighborhood poverty. Results 133 plasma EPA+DHA samples from 57 participants were available. Participants exhibited average plasma EPA and DHA levels of 14.7±7.3 µg/mL and 40.2±17.2 µg/mL, respectively, across the three clinic visits. Each standard deviation increase in EPA+DHA levels was associated with 2.7 points lower SGRQ score (95% CI -5.2, -0.2) and lower odds of moderate exacerbation (OR 0.4; 95% CI 0.2, 0.9) but lacked significant association with CAT score (95% CI -2.4, 0.8), mMRC (95% CI -02, 0.2), or severe exacerbations (95% CI 0.3, 1.4). Conclusion Plasma EPA+DHA levels are associated with better respiratory-specific quality of life and lower odds of moderate exacerbations in patients with moderate-to-severe COPD. Further research is warranted to investigate the efficacy of an omega-3 dietary intervention in the management of COPD morbidities.
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Affiliation(s)
| | - Han Woo
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Daniel Belz
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Ashraf Fawzy
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Wendy Lorizio
- Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Nirupama Putcha
- Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Emily P Brigham
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Corrine Hanson
- University of Nebraska Medical Center, Omaha, Nebraska, United States
| | | | - Nadia N Hansel
- Johns Hopkins University, Baltimore, Maryland, United States
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Hansel NN, Woo H, Koehler K, Gassett A, Paulin LM, Alexis NE, Putcha N, Lorizio W, Fawzy A, Belz D, Sack C, Barr RG, Martinez FJ, Han MK, Woodruff P, Pirozzi C, Paine R, Barjaktarevic I, Cooper CB, Ortega V, Zusman M, Kaufman JD. Indoor Pollution and Lung Function Decline in Current and Former Smokers: SPIROMICS AIR. Am J Respir Crit Care Med 2023; 208:1042-1051. [PMID: 37523421 PMCID: PMC10867935 DOI: 10.1164/rccm.202302-0207oc] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Rationale: Indoor pollutants have been associated with chronic obstructive pulmonary disease morbidity, but it is unclear whether they contribute to disease progression. Objectives: We aimed to determine whether indoor particulate matter (PM) and nitrogen dioxide (NO2) are associated with lung function decline among current and former smokers. Methods: Of the 2,382 subjects with a history of smoking in SPIROMICS AIR, 1,208 participants had complete information to estimate indoor PM and NO2, using individual-based prediction models, in relation to measured spirometry at two or more clinic visits. We used a three-way interaction model between time, pollutant, and smoking status and assessed the indoor pollutant-associated difference in FEV1 decline separately using a generalized linear mixed model. Measurements and Main Results: Participants had an average rate of FEV1 decline of 60.3 ml/yr for those currently smoking compared with 35.2 ml/yr for those who quit. The association of indoor PM with FEV1 decline differed by smoking status. Among former smokers, every 10 μg/m3 increase in estimated indoor PM was associated with an additional 10 ml/yr decline in FEV1 (P = 0.044). Among current smokers, FEV1 decline did not differ by indoor PM. The results of indoor NO2 suggest trends similar to those for PM ⩽2.5 μm in aerodynamic diameter. Conclusions: Former smokers with chronic obstructive pulmonary disease who live in homes with high estimated PM have accelerated lung function loss, and those in homes with low PM have lung function loss similar to normal aging. In-home PM exposure may contribute to variability in lung function decline in people who quit smoking and may be a modifiable exposure.
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Affiliation(s)
- Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine and
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine and
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Gassett
- Department of Environmental and Occupational Health Sciences and
| | - Laura M. Paulin
- Section of Pulmonary and Critical Care, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Hanover, New Hampshire
| | - Neil E. Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, Division of Allergy and Immunology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Wendy Lorizio
- Division of Pulmonary and Critical Care Medicine and
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine and
| | - Daniel Belz
- Division of Pulmonary and Critical Care Medicine and
| | - Coralynn Sack
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - R. Graham Barr
- Division of Pulmonary and Critical Care, Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Fernando J. Martinez
- Department of Internal Medicine, Weill Cornell Medical College, New York, New York
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Cheryl Pirozzi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Robert Paine
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Christopher B. Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Victor Ortega
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Marina Zusman
- Department of Environmental and Occupational Health Sciences and
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences and
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Lorizio W, Woo H, McCormack MC, Liu C, Putcha N, Wood M, Green T, Kaviany P, Belz D, Fawzy A, Carson S, Eakin MN, Koehler K, Hansel NN. Patterns and Predictors of Air Cleaner Adherence Among Adults with COPD. Chronic Obstr Pulm Dis 2022; 9:366-376. [PMID: 35731929 PMCID: PMC9448002 DOI: 10.15326/jcopdf.2022.0309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Rational Poor indoor air quality has been associated with worse chronic obstructive pulmonary disease (COPD) morbidity. In-home portable air cleaners reduce indoor pollutants and could improve respiratory health. Factors associated with air cleaner adherence among adults with COPD remains unknown. Methods In a 6-month trial of former smokers with COPD, participants (n=116) received active or sham portable air cleaners. Air cleaner adherence was measured by electronic monitors. Potential baseline predictors of adherence included individual factors (demographics, socioeconomic status, smoking history, psychological well-being), COPD disease severity, and housing characteristics. Time and season were also considered. Stepwise logistic regression and longitudinal fixed effect analysis were performed to assess independent predictors of adherence. Results A total of 109 participants had an objective measure of adherence, and 76.1% used at least 1 air cleaner 80% of the time (defined a priori as adherent). Higher annual household income ≥$35,000 (odds ratio [OR]=4.4, 95% confidence interval [CI], 1.1-18.0) and use of heat pump/electricity (versus gas) for heating (OR=6.1, 95%CI, 1.7-22.4) were associated with higher odds of adherence. Further, poor quality of life (St George's Respiratory Questionnaire, per 10-point increase) and prior year exacerbations were associated with lower odds of adherence (OR=0.65, 95%CI, 0.4-1.0) and (OR=0.26, 95%CI, 0.1-0.9), respectively. Adherence was highest during the first month and lower during winter compared to other seasons. Conclusion These findings suggest that cold weather season, use of gas for home heating, and lower annual income negatively impact adherence. Poor quality of life and worse disease control may also decrease adherence. Addressing factors associated with air cleaner adherence should be considered when designing future environmental studies.
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Affiliation(s)
- Wendy Lorizio
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Meredith C. McCormack
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Chen Liu
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Megan Wood
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Timothy Green
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Parisa Kaviany
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, School of Medicine and Health Sciences, George Washington University, Washington, DC, United States
| | - Daniel Belz
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sara Carson
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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4
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Woo H, Brigham EP, Allbright K, Ejike C, Galiatsatos P, Jones MR, Oates GR, Krishnan JA, Cooper CB, Kanner RE, Bowler RP, Hoffman EA, Comellas AP, Criner G, Barr RG, Martinez FJ, Han M, Ortega VE, Parekh TM, Christenson S, Belz D, Raju S, Gassett A, Paulin LM, Putcha N, Kaufman JD, Hansel NN. Racial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 204:536-545. [PMID: 33971109 PMCID: PMC8491265 DOI: 10.1164/rccm.202009-3721oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Racial residential segregation has been associated with worse health outcomes, but the link with chronic obstructive pulmonary disease (COPD) morbidity has not been established.Objectives: To investigate whether racial residential segregation is associated with COPD morbidity among urban Black adults with or at risk of COPD.Methods: Racial residential segregation was assessed using isolation index, based on 2010 decennial census and baseline address, for Black former and current smokers in the multicenter SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study), a study of adults with or at risk for COPD. We tested the association between isolation index and respiratory symptoms, physiologic outcomes, imaging parameters, and exacerbation risk among urban Black residents, adjusting for established COPD risk factors, including smoking. Additional mediation analyses were conducted for factors that could lie on the pathway between segregation and COPD outcomes, including individual and neighborhood socioeconomic status, comorbidity burden, depression/anxiety, and ambient pollution.Measurements and Main Results: Among 515 Black participants, those residing in segregated neighborhoods (i.e., isolation index ⩾0.6) had worse COPD Assessment Test score (β = 2.4; 95% confidence interval [CI], 0.7 to 4.0), dyspnea (modified Medical Research Council scale; β = 0.29; 95% CI, 0.10 to 0.47), quality of life (St. George's Respiratory Questionnaire; β = 6.1; 95% CI, 2.3 to 9.9), and cough and sputum (β = 0.8; 95% CI, 0.1 to 1.5); lower FEV1% predicted (β = -7.3; 95% CI, -10.9 to -3.6); higher rate of any and severe exacerbations; and higher percentage emphysema (β = 2.3; 95% CI, 0.7 to 3.9) and air trapping (β = 3.8; 95% CI, 0.6 to 7.1). Adverse associations attenuated with adjustment for potential mediators but remained robust for several outcomes, including dyspnea, FEV1% predicted, percentage emphysema, and air trapping.Conclusions: Racial residential segregation was adversely associated with COPD morbidity among urban Black participants and supports the hypothesis that racial segregation plays a role in explaining health inequities affecting Black communities.
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Affiliation(s)
- Han Woo
- Division of Pulmonary and Critical Care Medicine and
| | | | | | - Chinedu Ejike
- Division of Pulmonary and Critical Care Medicine and
| | | | - Miranda R. Jones
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, Illinois
| | - Christopher B. Cooper
- Department of Medicine and
- Department of Physiology, School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Richard E. Kanner
- Division of Pulmonary and Critical Care, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Russell P. Bowler
- Division of Pulmonary and Critical Care, National Jewish Health, Denver, Colorado
| | - Eric A. Hoffman
- Department of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Alejandro P. Comellas
- Department of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Gerard Criner
- Division of Pulmonary and Critical Care, Temple University Hospital, Philadelphia, Pennsylvania
| | - R. Graham Barr
- Division of Pulmonary and Critical Care Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Fernando J. Martinez
- Department of Internal Medicine, Weill Cornell Medical College, New York, New York
| | - MeiLan Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan
| | - Victor E. Ortega
- Center for Genomics and Personalized Medicine Research, Wake Forest University, Winston-Salem, North Carolina
| | - Trisha M. Parekh
- Division of Pulmonary and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephanie Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Daniel Belz
- Division of Pulmonary and Critical Care Medicine and
| | - Sarath Raju
- Division of Pulmonary and Critical Care Medicine and
| | - Amanda Gassett
- Department of Environmental and Occupational Health Sciences
- Department of Medicine, and
- Department of Epidemiology, University of Washington, Seattle, Washington; and
| | - Laura M. Paulin
- Section of Pulmonary and Critical Care, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Hanover, New Hampshire
| | | | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences
- Department of Medicine, and
- Department of Epidemiology, University of Washington, Seattle, Washington; and
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5
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Belz D, Moinzadeh P, Riemekasten G, Henes J, Müller‐Ladner U, Blank N, Koetter I, Siegert E, Pfeiffer C, Schmalzing M, Zeidler G, Schmeiser T, Worm M, Guenther C, Susok L, Kreuter A, Sunderkoetter C, Juche A, Aberer E, Gaebelein‐Wissing N, Ramming A, Kuhr K, Hunzelmann N. Large Variability of Frequency and Type of Physical Therapy in Patients in the German Network for Systemic Sclerosis. Arthritis Care Res (Hoboken) 2020; 72:1041-1048. [DOI: 10.1002/acr.23998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 05/28/2019] [Indexed: 11/07/2022]
Affiliation(s)
- D. Belz
- University Hospital Cologne Cologne Germany
| | | | | | - J. Henes
- University Hospital Tübingen Tübingen Germany
| | - U. Müller‐Ladner
- Justus Liebig University Giessen Campus Kerckhoff Bad Nauheim Germany
| | - N. Blank
- University Hospital Heidelberg Heidelberg Germany
| | | | - E. Siegert
- Charité, Universitätsmedizin Berlin Berlin Germany
| | | | | | - G. Zeidler
- Johanniter‐Krankenhaus im Fläming Treuenbrietzen Treuenbrietzen Germany
| | | | - M. Worm
- Charité, Universitätsmedizin Berlin Berlin Germany
| | - C. Guenther
- University Hospital Carl Gustav Carus Dresden Germany
| | - L. Susok
- St. Josef Hospital Bochum Bochum Germany
| | - A. Kreuter
- Helios St. Elisabeth Klinik Oberhausen Oberhausen Germany
| | | | - A. Juche
- Immanuel Krankenhaus Berlin‐Buch Berlin Germany
| | - E. Aberer
- Medical University of Graz Graz Austria
| | | | - A. Ramming
- University Hospital Erlangen Erlangen Germany
| | - K. Kuhr
- University of Cologne Cologne Germany
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Moinzadeh P, Frommolt P, Franitza M, Toliat MR, Becker K, Nürnberg P, Nihtyanova SI, Ahrazoglu M, Belz D, Hunzelmann N, Abraham D, Ong VH, Mouthon L, Hesselstrand R, Denton CP, Krieg T. Whole blood gene expression profiling distinguishes systemic sclerosis-overlap syndromes from other subsets. J Eur Acad Dermatol Venereol 2020; 34:e236-e238. [PMID: 31945216 DOI: 10.1111/jdv.16198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Moinzadeh
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - P Frommolt
- CECAD University of Cologne, Cologne, Germany
| | - M Franitza
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - M R Toliat
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - K Becker
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - P Nürnberg
- CECAD University of Cologne, Cologne, Germany
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - S I Nihtyanova
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - M Ahrazoglu
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - D Belz
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - N Hunzelmann
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - D Abraham
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - V H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - L Mouthon
- National Reference Centre for Scleroderma and Systemic Vasculitis (LM, LG), Université Paris Descartes, Cochin Hospital, Paris, France
| | - R Hesselstrand
- Department of Rheumatology, Lund University, Lund, Sweden
| | - C P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - T Krieg
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
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Belz D, Moinzadeh P, Hunzelmann N. Therapie der Hautbeteiligung bei der Sklerodermie – aktuelle Empfehlungen. AKTUEL RHEUMATOL 2015. [DOI: 10.1055/s-0034-1395535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D. Belz
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Köln
| | - P. Moinzadeh
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Köln
| | - N. Hunzelmann
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Köln
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Belz D, Tantcheva-Poor I, Rasokat H, Fabri M, Schlaak M. Mycobacterium marinum infection initially diagnosed as metastatic Crohn's disease. J Eur Acad Dermatol Venereol 2014; 30:514-5. [PMID: 25510444 DOI: 10.1111/jdv.12911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D Belz
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - I Tantcheva-Poor
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - H Rasokat
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - M Fabri
- Department of Dermatology, University of Cologne, Cologne, Germany.,Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - M Schlaak
- Department of Dermatology, University of Cologne, Cologne, Germany
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Abstract
Digital ulcers (DU's) are one of the main symptoms of systemic scleroderma and occur in approximately 60% of all scleroderma patients. Due to possible complications such as infections, gangrene or amputation, they require regular medical attention and a good wound treatment by doctors and nursing staff. A definition of DU's has not yet been established. In 2009 the European League Against Rheumatism (EULAR) published guidelines for the treatment of DU's. An improvement of the healing of active ulcers has been described with Iloprost. Bosentan significantly reduced the frequency of occurrence of new DU's. In some small studies PDE-5 inhibitors appear helpful. Further studies with other therapeutic approaches will follow in the next few years.
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Affiliation(s)
- D Belz
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland,
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Abstract
OBJECTIVE To examine the delivery and effect of naloxone for opioid overdose in a tiered-response emergency medical services (EMS) system and to ascertain how much time could be saved if the first arriving emergency medical technicians (EMTs) could have administered intranasal naloxone. METHODS This was case series of all EMS-treated overdose patients who received naloxone by paramedics in a two-tiered EMS system during 2004. The system dispatches basic life support-trained fire fighter-EMTs and/or advanced life support-trained paramedics depending on the severity of cases. Main outcomes were geographic distribution of naloxone-treated overdose, severity of cases, response to naloxone, and time interval between arrival of EMTs and arrival of paramedics at the scene. RESULTS There were 164 patients who received naloxone for suspected overdose. There were 75 patients (46%) initially unresponsive to painful stimulus. Respiratory rate was <10 breaths/min in 79 (48%). Death occurred in 36 (22%) at the scene or during transport. A full or partial response to naloxone occurred in 119 (73%). Recognized adverse reactions were limited to agitation/combativeness in 25 (15%) and emesis in six (4%). Average EMT arrival time was 5.9 minutes. Average paramedic arrival time was 11.6 minutes in most cases and 16.1 minutes in 46 cases (28%) in which paramedics were requested by EMTs at the scene. CONCLUSIONS There is potential for significantly earlier delivery of naloxone to patients in opioid overdose if EMTs could deliver intranasal naloxone. A pilot study training and authorizing EMTs to administer intranasal naloxone in suspected opioid overdose is warranted.
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Affiliation(s)
- Daniel Belz
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Belz D. [Dentistry by computer: reality or future vision?]. Quintessenz Zahntech 1987; 13:604-10. [PMID: 3484044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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