Obesity and risk for respiratory diseases: a Mendelian randomization study

Background

No existing comprehensive Mendelian randomization studies have focused on how obesity affects respiratory diseases.

Methods

BMI and waist circumference, mainly from the UK Biobank, and 35 respiratory diseases from the FinnGen Biobank were subjected to Mendelian randomization analyses. In this study, the inverse variance weighting method was used as the predominant analysis method and was complemented by MR-Egger and weighted median methods. Horizontal pleiotropy and potential outliers were detected by employing the MR-PRESSO method.

Results

This study indicated that obesity rises the possibility of acute upper respiratory infections (BMI: OR=1.131, p<0.0001; WC: OR=1.097, p=0.00406), acute sinusitis (BMI: OR=1.161, p=0.000262; WC: OR=1.209, p=0.000263), acute pharyngitis (WC: OR=1.238, p=0.0258), acute laryngitis and tracheitis (BMI: OR=1.202, p=0.0288; WC: OR=1.381, p=0.00192), all influenza (BMI: OR=1.243, p=0.000235; WC: OR=1.206, p=0.0119), viral pneumonia (WC: OR=1.446, p=0.000870), all pneumoniae (BMI: OR=1.174, p <0.0001; WC: OR=1.272, p <0.0001), bacterial pneumoniae (BMI: OR=1.183, p=0.000290; WC: OR=1.274, p<0.0001), acute bronchitis (BMI: OR=1.252, p <0.0001; WC: OR=1.237, p=0.000268), acute unspecified lower respiratory infection (BMI: OR=1.303, p=0.000403), chronic tonsils and adenoids diseases (BMI: OR=1.236, p <0.0001; WC: OR=1.178, p=0.000157), chronic laryngotracheitis and laryngitis (WC: OR=1.300, p=0.00785), COPD (BMI: OR=1.429, p <0.0001; WC: OR=1.591, p <0.0001), asthma (BMI: OR=1.358, p <0.0001; WC: OR=1.515, p <0.0001), necrotic and suppurative conditions of lower respiratory tract (WC: OR=1.405, p=0.0427), pleural effusion (BMI: OR=1.277, p=0.00225; WC: OR=1.561, p<0.0001), pleural plaque (BMI: OR=1.245, p=0.0312), other diseases of the respiratory system (BMI: OR=1.448, p <0.0001; WC: OR=1.590, p <0.0001), and non-small cell lung cancer (BMI: OR=1.262, p=0.00576; WC: OR=1.398, p=0.00181). This study also indicated that obesity decreases the possibility of bronchiectasis (BMI: OR=0.705; p=0.00200).

Conclusion

This study revealed that obesity increases the risk of the majority of respiratory diseases (including 20 of all 35 respiratory diseases) and that obesity decreases the risk of bronchiectasis.

COVID-19 Omicron variant-induced laryngitis

OBJECTIVES

The COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat, characterize the infection with this variant. Therefore, in laryngeal stenosis, disease severity assessment through blood oxygen saturation has not been useful.

METHODS

We report the case of "omicron laryngitis" in a 59-year-old male who visited the ear, nose, and throat (ENT) clinic with complaints of a sore throat and difficulty in swallowing saliva that persisted for a day.

RESULTS

Laryngoscopy revealed severe swelling of the transglottic region and exudates on the larynx. He was then diagnosed with COVID-19 and subjected to emergency tracheostomy for airway management. Until the emergence of the omicron variant, COVID-19 showed mainly lower airway and mild upper airway inflammatory features. However, upper airway stenosis should be suspected in cases presenting with "muffled speech," "dysphagia," "severe pain on swallowing," and "inspiratory dyspnea or stridor."

CONCLUSION

Therefore, laryngeal and pharyngeal evaluation using a flexible laryngoscope under appropriate infection control measures is necessary, considering the possibility of progression to fatal laryngeal stenosis, as noted in this case.

Difficult glottis: Diagnostic dilemma in viewof the clinical presentation

<br><b>Introduction:</b> The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. However, we observe rare cases when numerous pathologies overlap, resulting in an unclear and complicated clinical presentation of the glottis.</br> <br><b>Aim:</b> The aim of this paper is to present cases of overlapping etiopathological factors which poses a challenge when making a diagnosis and referring a patient for adequate treatment.</br> <br><b>Material and method:</b> The study presents different photographs of the glottis, including some unique and unusual images in which overlapping pathologies were captured. The photographs are accompanied by case descriptions, comments, and pathological analyses.</br> <br><b>Results:</b> Four selected photographs showed a bunch of exophytic growth lesions with foci of whitish plaques, covered by yellowish crusts, with thinned, reddened vocal folds presenting foci of leukoplakia. The study discussed possible causes of vocal folds edema, diffuse erythema, presence of crusts or exudate, whitish debris/plaques or development of leukoplakia, non-neoplastic ulceration, as well as injected and reddened mucous membrane. Chronic infectious laryngitis, idiopathic ulcerative laryngitis, and drug-induced laryngitis were also mentioned. The study also raised the issues concerning diabetics and patients treated with inhaled corticosteroids, including candidiasis and primary aspergillosis of the larynx.</br> <br><b>Conclusions:</b> To conclude, everyday clinical practice involves encountering cases of unclear onset and course, with complicated presentation of the glottis. Therefore, comprehensive history-taking and thorough investigation of systemic causes are of immense importance. Recommended management includes conducting the most meticulous differential diagnosis, implementing treatment for the most likely cause, and, whenever possible, refraining from biopsy in order to avoid permanent damage to vocal cords.</br>.

[Association of temperament type and mother's emotional state with acute respiratory infection in children]

OBJECTIVE

To explore the correlation of temperament type and mother's emotional state with acute respiratory tract infections in children so as to provide evidence for comprehensive treatment of the infections.

METHODS

A total of 200 children aged between 3 and 6 were enrolled in this study from two kindergartens of Guangzhou and Hengyang. The mothers were invited to complete a questionnaire of the children's general information followed by assessment using children's temperament scale and the Depression-Anxiety-Stress Scale.

RESULTS

The total incidence of acute respiratory infection was significantly higher in children with a hard- to-raise temperament than the easy- to-raise children (P < 0.05); the incidences of acute rhinitis, acute pharyngitis, acute laryngitis and acute bronchitis were all significantly higher in the hard-to-raise children (P < 0.05). A significant positive correlation was identified between the total number of episodes of acute respiratory tract infection in children and their mothers' stress and anxiety levels (P < 0.01). Acute rhinitis and acute tracheitis in the children were both positively correlated with the mothers' stress scores (P < 0.05), while acute pharyngitis and acute laryngitis were positively correlated with the mothers' anxiety scores (P < 0.05), while acute bronchitis was positively correlated with the mothers' stress and anxiety scores (P < 0.05). Multiple linear regression analysis with the factors influencing the types of acute respiratory tract infections in children as the independent variables suggested that the easy-to-raise type of temperament was a protective factor against acute rhinitis in children (P < 0.05), while mothers' anxiety was a risk factor of acute laryngitis in children (P < 0.05); the mothers' stress was a risk factor for acute bronchitis in children (P < 0.05).

CONCLUSION

Acute respiratory tract infection in children is closely related to the temperament type of the children and the emotional state of the mothers, which are important therapeutic targets in comprehensive interventions of acute respiratory tract infection in children.

Specifics and diagnostic procedure in reflux-related dysphonia

Voice is a work tool for many professional groups. Currently, cases of dysphonia of multiple origin consist a growing issue. Voice disorders may result from disturbed voice production process, congenital defects, post-traumatic conditions, chronic diseases or hormonal disorders. Chronic diseases causing voice disorders include laryngopharyngeal reflux disease and esophageal reflux disease.The chronic character of reflux causes the formation of numerous morphological changes of the larynx, including: hyperemia of the mucosa limited to arytenoid and intraarytenoid area, edema of the vocal folds, edema of the larynx mucosa. These changes contribute to voice disorders. Among the pathological changes of voice organ etiologically associated with reflux, the following disease units may be distinguished: reflux laryngitis, subglottic edema, contact ulceration, larynx granuloma, larynx and pharynx cancer. Many of disorders in the upper respiratory tract are etiologically related to reflux, e.g. dysphonia, grunting, coughing and dyspnoea.

Laryngeal disorders in patients with gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common medical condition affecting approximately 35-40% of the adult population in the western world. Chronic laryngeal signs and symptoms associated with GERD are often referred to as reflux laryngitis or laryngopharyngeal reflux (LPR). It is estimated that up to 15% of all visits to the otolaryngology offices are because of manifestations of LPR. Injury may occur as a result of one or chronic reflux of gastroduodenal contents directly injuring the laryngeal mucosa. Since less amount of acid is required to make the injury to the larynx as compared to injury to esophagus; it is believed that intermittent exposure to small amount of gastric content can result in laryngitis. The most common presenting symptoms of LPR include hoarseness, sore throat, throat clearing, and chronic cough. The diagnosis of LPR is usually made on the basis of presenting symptoms and associated laryngeal signs including laryngeal edema and erythema. Current recommendation for management of this group of patients is empiric therapy with twice daily proton-pump inhibitors for 2 to 4 months. In majority of those who are unresponsive to such therapy other causes of laryngeal irritation is considered. Surgical fundoplication is most effective in those who are responsive to acid suppressive therapy.

[Clinical observation on acupuncture kinetotherapy for acute simple laryngitis of wind-heat type]

OBJECTIVE

To observe clinical therapeutic effect of acupuncture kinetotherapy for acute simple laryngitis of wind-heat type and to probe the mechanism.

METHODS

Eighty cases were randomly divided into a test group and a control group, 40 cases in each group. The test group were treated with acupuncture kinetotherapy (Acupuncture was given at Kaiyin point No. 1 combined with deep respiratory movement of the glottis), once daily. The control group were treated with ultrasonic aerosol inhalation of 0.9% sodium chloride injection, gentamicin sulfate injection 80 000 U and Dexamethasone injection 5mg, twice a day. The treatment was given for 5 days for the 2 groups.

RESULTS

The cured and markedly effective rate was 90.0% in the test group and 82.5% in the control group with no significant difference between the two groups (P>0.05); in the test group there was a very significant difference before and after treatment in the cumulative score of symptoms and the acoustic parameters (P<0.01).

CONCLUSION

Acupuncture kinetotherapy has obvious therapeutic effect on acute simple laryngitis of wind heat type, with no toxic and adverse effects.

Supra-oesophageal manifestations of gastro-oesophageal reflux disease

The extra-oesophageal signs that are most commonly related to gastro-oesophageal reflux include chest pain, asthma, chronic cough, posterior laryngitis and dental erosions. It is characteristic to find in such patients a poor presence of symptoms and endoscopic and pH-metric findings that are common in typical reflux. The therapeutic response to antisecretory drugs has become the most cost-effective tool for the diagnosis and treatment of this condition. Both the evidence available and expert agreement in consensus conferences support the use of proton pump inhibitors with doubled standard doses for at least 12 weeks in most cases. While an acceptable response is achieved with this significant acid inhibition, there are still questions to be answered in these and other aspects, such as the true prevalence, path physiology and diagnosis of this condition. It is therefore necessary and increasingly useful to create multidisciplinary teams with the aim to improve and promote understanding and the care of patients suffering from these supra-oesophageal symptoms caused by gastro-oesophageal reflux.

Supraglottitis. A simultaneous presentation in a parent and child

Supraglottitis, or epiglottitis, was once thought to be a disease solely of children. As this case report illustrates, however, the disease is appearing more frequently among adults.

Is admission to hospital with stridor and acute viral croup influenced by time?

Study of the records of 100 children admitted sequentially to hospital with viral croup suggested that they were more likely to be admitted at night than during the day when compared with other common conditions. The actual day of the week was unimportant, suggesting that medical availability was not a factor.

[Viral respiratory diseases in childhood]

Viral infections of the respiratory apparatus occur more frequently and their aetiology is often different, but there is no substantial difference between cases in children and in adults. Some clinical pictures, such as colds, laryngitis and bronchiolitis do, however, have an aetiology, symptomatology and course that deserves consideration. Features and diagnostic and therapeutic problems of these forms are analysed in brief.

Nurse perceptions of patient characteristics

To determine whether nurse perceptions of patients are influenced by a patient's socioeconomic class, 78 nurse subjects observed slides and read about a patient and then rated him on a seven-point scale. Nurses were randomly given one of eight written descriptions in which the patient was identified as middle or lower class., with a more or a less serious and a more or a less socially acceptable illness. Results were subjected to 2 X 2 X 2 analysis of variance. Nurses were found to stereotype lower-class patients as dependent, passive, unintelligent, noncomprehending, ummotivated, lazy, forgetful, inaccurate, careless, uninformed, unsuccessful, and unreliable. Patients with less-acceptable illnesses were rated more negatively than those with more-acceptable illnesses and were perceived as sensitive, rigid, bored, and resistant to learning about their illness. Since nurses admitted they would feel embarrassed and would conceal having these less-acceptable illnesses themselves, these negative perceptions of patients may be projections of the nurses' feelings.