Hasil untuk "Diseases of the respiratory system"

Xing Ni, Lin Lu, Jirui Bi et al.

A 62-year-old male patient with cervical spinal cord injury, developed multidrug-resistant Acinetobacter baumannii pneumonia, Klebsiella pneumoniae infection, Clostridium difficile colitis and intestinal candidiasis. Despite targeted antibacterial drug treatment and some radiological improvements, he still experienced persistent fever and watery diarrhea. A careful re-examination revealed the mechanic's hand. High-resolution computed tomography (HRCT) showed interstitial lung disease (ILD) and anti-asparaginyl-tRNA synthetase (anti-KS) antibodies were identified upon laboratory evaluation. Corticosteroid treatment led to rapid fever recurrence when tapered. Mycophenolate mofetil was added to stabilize the condition, gradually reducing steroids and eliminating the recurrence of fever after discontinuing antibiotics. This case highlights the diagnostic challenges of differentiating infection from autoimmune inflammation in critically ill patients and emphasizes the need to consider anti-KS antibody-positive antisynthetase syndrome (ASS) when persistent fever and gastrointestinal symptoms coexist with ILD.

Huseyin Kaya, Hasim Boyaci, Serap Argun Baris et al.

Marcin Piotr Walkowiak, Dariusz Walkowiak

Abstract Background This study aims to accurately estimate influenza‐associated deaths in Poland and their certified cause of death, due to significant discrepancies between official numbers and expected impact. Methods Excess influenza‐associated mortality in Poland from 2000 to 2019 was calculated using Seasonal‐Trend Decomposition Procedure based on LOESS (STL), which can detect non‐linear trends and non‐sinusoidal cycles. Excess mortality was then used as an explanatory variable in a model predicting monthly fluctuations of officially recorded causes of death from 2010 to 2019. Results A total of 142,000 conservative estimates of influenza‐associated deaths were identified, representing 1.86% of overall mortality. Only 0.61% of influenza‐associated deaths were officially recorded as influenza. Nearly half of certified influenza deaths were attributed to the seasonal baseline mortality, potentially doubling estimated impact based solely on influenza peaks. Influenza‐associated deaths were frequently recorded as respiratory diseases (24.36%), with majority attributed to underlying conditions such as cardiovascular diseases (45.31%), cancer (9.06%), or diabetes (2.66%). Influenza‐associated deaths were more commonly certified as nervous system diseases (1.84%) or mental disorders (1.04%), rather than influenza itself. There was a noticeable impact of influenza on secondary infections, such as meningococcal and gastrointestinal infections. Conclusion These findings highlight the importance of improved estimation for informing public health policy decisions.

Jessie R. Chung, Sara S. Kim, Edward A. Belongia et al.

Abstract Background Individuals in contact with persons with COVID‐19 are at high risk of developing COVID‐19; protection offered by COVID‐19 vaccines in the context of known exposure is poorly understood. Methods Symptomatic outpatients aged ≥12 years reporting acute onset of COVID‐19‐like illness and tested for SARS‐CoV‐2 between February 1 and September 30, 2021 were enrolled. Participants were stratified by self‐report of having known contact with a COVID‐19 case in the 14 days prior to illness onset. Vaccine effectiveness was evaluated using the test‐negative study design and multivariable logistic regression. Results Among 2229 participants, 283/451 (63%) of those reporting contact and 331/1778 (19%) without known contact tested SARS‐CoV‐2‐positive. Adjusted vaccine effectiveness was 71% (95% confidence interval [CI], 49%–83%) among fully vaccinated participants reporting a known contact versus 80% (95% CI, 72%–86%) among those with no known contact ( p ‐value for interaction = 0.2). Conclusions This study contributes to growing evidence of the benefits of vaccinations in preventing COVID‐19 and support vaccination recommendations and the importance of efforts to increase vaccination coverage.

Lisa Maria Sele Sætre, Sanne Rasmussen, Kirubakaran Balasubramaniam et al.

Abstract Healthcare-seeking with lung cancer symptoms is a prerequisite for improving timely diagnosis of lung cancer. In this study we aimed to explore barriers towards contacting the general practitioner (GP) with lung cancer symptoms, and to analyse the impact of social inequality. The study is based on a nationwide survey with 69,060 individuals aged ≥40 years, randomly selected from the Danish population. The survey included information on lung cancer symptoms, GP contacts, barriers to healthcare-seeking and smoking status. Information about socioeconomics was obtained by linkage to Danish Registers. Descriptive statistics and multivariate logistic regression model were used to analyse the data. “Being too busy” and “Being worried about wasting the doctor’s time” were the most frequent barriers to healthcare-seeking with lung cancer symptoms. Individuals out of workforce and individuals who smoked more often reported “Being worried about what the doctor might find” and “Being too embarrassed” about the symptoms. The social inequality in barriers to healthcare-seeking with lung cancer symptoms is noticeable, which emphasises the necessity of focus on vulnerable groups at risk of postponing relevant healthcare-seeking.

M. Fujii, M. Kobayakawa, Kiyoshi Saito et al.

Simple Summary Neurofibromatosis type 2 (NF2) is a rare genetic hereditary disease characterized by multiple central nervous system tumors, most frequently bilateral vestibular schwannomas (VSs). No chemotherapeutic agents are available for clinical use, and surgery and radiotherapy are the only therapeutic options available now. Still, neither treatment option alleviates hearing loss in patients with NF2 and VS; they may even exacerbate it. However, bevacizumab has been reported to be effective in suppressing the tumor’s growth and has shown unprecedented efficacy in improving hearing. We describe a new ongoing and novel clinical trial, BeatNF2, a randomized, double-blinded, placebo-controlled, multicenter trial to assess bevacizumab’s efficacy and safety in patients with NF2. The study’s primary endpoint is improved hearing function 24 weeks after the beginning of the treatment protocol. Abstract Neurofibromatosis type 2 (NF2) causes bilateral vestibular schwannomas (VSs), leading to deafness. VS is treated by surgery or radiation, but neither treatments prevent hearing loss. Bevacizumab was found to be effective in suppressing the tumor’s growth and may help to improve hearing. We are conducting a randomized, double-blind, multicenter clinical trial to verify the efficacy and safety of bevacizumab in NF2-related VS. The primary objective is to evaluate the efficacy of bevacizumab in improving hearing in the affected ear. One of the secondary objectives is to evaluate bevacizumab’s efficacy in rechallenge treatment in relapsed cases. Sixty patients will randomly receive either bevacizumab or a placebo and will be clinically observed for 48 weeks in the initial intervention phase. In the first half (24 weeks), they will receive either 5 mg/kg of bevacizumab or a placebo drug. In the second half, all patients will receive 5 mg/kg of bevacizumab. If hearing function deteriorated in a patient who had shown improvement during the first phase, a rechallenge dose with bevacizumab would be offered.

Camilla Pedersen, C. Rechnitzer, E. Andersen et al.

Simple Summary The treatment of osteosarcoma and Ewing sarcoma, the two major types of malignant bone tumors in children, has progressed considerably during the last decades, with more patients becoming long-term survivors. This improvement has resulted in an increasing number of patients with long-term adverse health consequences from the life-saving treatment. The aim of this study was to provide a detailed, comprehensive overview of somatic diseases that require hospitalization in long-term survivors of osteosarcoma and Ewing sarcoma. This study contributes new insights into the risk of somatic late effects in survivors of osteosarcoma and Ewing sarcoma which are urgently requested by pediatric oncologists, researchers, and by survivors and their families. The study provides an essential basis for the development of preventive intervention strategies and for optimal patient counseling and follow-up care, which all contribute to improving the health and quality of life in survivors. Abstract Survivors of malignant bone tumors in childhood are at risk of long-term adverse health effects. We comprehensively reviewed cases of somatic diseases that required a hospital contact in survivors of osteosarcoma and Ewing sarcoma. In a population-based cohort study, 620 five-year survivors of osteosarcoma (n = 440) or Ewing sarcoma (n = 180), diagnosed before the age of 20 years in Denmark, Finland, Iceland, and Sweden during 1943–2008, were followed in the national hospital registers. Overall rates of hospital contacts for any somatic disease and for 12 main diagnostic groups and 120 specific disease categories were compared with those in a matched comparison cohort (n = 3049) randomly selected from the national population registers. The rate of hospital contact for any somatic disease was 80% higher in survivors of malignant bone tumors than in comparisons and remained elevated up to 30 years after diagnosis. The rate of hospital contacts was higher after Ewing sarcoma (rate ratio (RR) 2.24; 95% confidence interval (CI) 1.76–2.85) than after osteosarcoma (RR 1.67; 95% CI 1.41–1.98). Elevated rates were observed for 11 main diagnostic groups, including infections, second malignant neoplasms, and diseases of the skin, bones, and circulatory, digestive, endocrine, and urinary systems. Survivors of malignant bone tumors in childhood are at increased risk of somatic diseases many years after diagnosis. This comprehensive study contributes new insight into the risk of late effects in survivors of osteosarcoma and Ewing sarcoma, which is an essential basis for optimal patient counseling and follow-up care.

F. Caobelli, C. H. Kamani, R. Nkoulou et al.

The worldwide increase in coronary artery disease and its associated metabolic diseases is a major cause of human morbidity and mortality [1] and, as such, advancing cardiovascular disease remains a significant burden on the healthcare systems in western countries. The focus has been on the impact of advances in medical therapy and interventional cardiology on lowered mortality rates,but these came with more widespread availability of noninvasive methods allowing early diagnosis and effective risk stratification [2]. The concept of myocardial viability emerged from the postoperative clinical observations in the first decades of aorto-coronary bypass grafting. Then it was generally thought that left ventricular dysfunction in ischaemic heart disease was irreversible, since no persistent myocardial ischaemic state would have been possible in abnormal resting myocardium [3]. However, in the early 1980s Rahimtoola [3], in line with previous observations [4, 5], extensively described the improvement of left ventricular contractility after surgical revascularisation in patients with left ventricular dysfunction and ischaemic heart disease. Following these observations, many efforts have been made to understand the pathophysiological processes underlying this recovery phenomenon, as well as the diagnostic tools to achieve an accurate evaluation of the recovery potential in the clinical setting. Nowadays, the term myocardial viability in territories presenting altered contractility, beyond the concept of myocardial ischaemia, encompasses two phenomena: myocardial stunning and myocardial hibernation [6]. Myocardial stunning is characterised by persistent myocardial contractile dysfunction resulting from transient episodes of hypoperfusion. Its duration depends on the severity and the duration of the ischaemic episode [7]. This state can potentially of fully recover after restoration of blood supply, as long as no irreversible damage (necrosis) has occurred. In the case of prolongued or chronic ischaemia, ischaemic myocardial cells undergo adaptive changes, leading to a shift from fatty acid metabolism to glucose utilisation, as well as to downregulation of the contractile function in order to reduce the demand for oxygen and metabolic substrates [8, 9]. These changes are believed to induce the state of “hibernating myocardium”, a clinical condition characterised by contractile dysfunction with abnormal resting myocardial blood flow, and with a potential for full recovery after blood flow restoration [10, 11]. Repetitive episodes of myocardial stunning may also cause structural changes within the cardiomyocytes [9, 11], which tend to become irreversible over time. The correct identification of viable myocardium has a strong rationale, in that the myocardium may potentially regain its function after revascularisation in the setting of myocardial hibernation or stunning. It is therefore clear that diagnostic tools able to provide an early and precise diagnosis as well as prognostic information are highly warranted. Owing to the tendency to progress toward irreversible structural changes within the myocytes, viability imaging plays a pivotal role both in identifying patients at increased risk of coronary artery disease progression and in driving the choice of appropriate therapeutic measures. In fact, restoration of contractile function can be achieved by referring the patient earlier to invasive coronary revascularisation in the case of viable myocardium [12, 13]. Among the available techniques able to identify a viable myocardium, positron emission tomography / computed tomography (PET/CT) with fluorine 18-fluorodeoxyglucose (18FFDG), in combination with myocardial perfusion imaging, constitutes a cornerstone of myocardial viability assessment in nuclear cardiology [14]. The identification of myocardial viability relies on the metabolic shift towards gluCorrespondence: Federico Caobelli, MD, FEBNM, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031 Basel, federico.caobelli[at]usb.ch

A. Desai, G. Caltagirone, S.Y. Sarı et al.

Background: Our aim was to investigate the impact of therapeutics with antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mortality of older adults affected by coronavirus disease 2019 (COVID-19), taking into consideration the time interval from symptoms onset to drugs administration. Methods: Data from 143 COVID-19 patients over 65 years of age admitted to the Humanitas Clinical and Research Center Emergency Department (Milan, Italy) and treated with Lopinavir/ritonavir (LPV/r) or Darunavir/cobicistat (DVR/c) associated to Hydroxychloroquine (HCQ) were retrospectively analyzed. Statistical analysis was performed by using a logistic regression model and survival analysis to assess the role of different predictors of in-hospital mortality, including an early (80 years old). Results: Multivariate analysis showed that an older age (OR: 2.54) and dyspnea as presenting symptom (OR: 2.01) were associated with higher mortality rate, whereas cough as presenting symptom (OR: 0.53) and a timely drug administration (OR: 0.44) were associated with lower mortality. Survival analysis demonstrated that the timing of drug administration had an impact on mortality in 65–80 years-old patients (p = 0.02), whereas no difference was seen in those >80 years-old. This impact was more evident in patients with dyspnea as primary symptom of COVID-19, in whom mortality decreased from 57.1% to 38.3% due to timely drug administration (OR: 0.5; p = 0.04). Conclusions: There was a significant association between the use of a combined antiviral regimen and HCQ and lower mortality, when timely-administered, in COVID-19 patients aged 65–80 years. Our findings support timely treatment onset as a key component in the treatment of COVID-19.

Shirin Saberianpour, Jamal Jalili Shahri, Mohammad Hossein Hassani et al.

Traumatic carotid artery jugular vein fistula is a rare entity that is not usually detected during the acute injury phase. We presented 1 cases of traumatic carotid–jugular fistula. A 52 years old man that was referred to us because of an expanding neck hematoma. There was a 1×1 cm ulcer with a clot in zone II right neck and a thrill was palpated. We clamped the proximal and distal site of injury (Arteriovenous fistula), then divided the fistula and primarily repaired the artery (transversely) and the vein with 7-0 prolene suture. We placed two hemovac drains and then repaired the subcutaneous and skin and covered the site with gauze and then the patient was transferred to ICU. He was extubated the next day and physical exam was completely normal without any neurologic deficit. Carotid–jugular fistula should always be treated early to avoid the complications associated with the injury.

Magnus Ekström, Andreas Palm, Thea Wilhelmine Bech et al.

Background Breathlessness is prevalent in severe disease and consists of different dimensions that can be measured using the Multidimensional Dyspnea Profile (MDP) and Dyspnea-12 (D-12). We aimed to evaluate the feasibility of MDP and D-12 over telephone interviews in oxygen-dependent patients, compared with other patient-reported outcomes (modified Medical Research Council (mMRC) and Chronic Obstructive Pulmonary Disease Assessment Test (CAT)) and with completion by hand.Methods Cross-sectional, telephone study of 50 patients with home oxygen therapy. Feasibility was assessed as completion time (self-reported by patients and measured), difficulty (self-reported) and help required to complete the instruments (staff). Completion time was compared with mMRC and CAT, and feasibility was compared with completion by hand in cardiopulmonary outpatients (n=182). Feasibility by age and gender was analysed using logistic regression.Results Of 136 patients approached, 50 (37%) participated (mean age: 72±10 years, 66% women). Completion times (in minutes) were relatively short for MDP (self-reported 6 (IQR 5–10), measured 8 (IQR 6–10)) and D-12 (self-reported 5 (IQR 3–8), measured 3 (IQR 3–4)), and slightly longer than mMRC (median 1 (IQR 1–1)) and CAT (median 3 (IQR 2–5)). Even though the majority of patients required no help, more assistance was required by older patients. Compared with patients reporting by hand, completion over the telephone required somewhat longer time and more assistance.Conclusion Many patients with severe oxygen-dependent disease were unable or unwilling to assess symptoms over the telephone. However, among those able to participate, MDP and D-12 are feasible to measure multiple dimensions of breathlessness over the telephone.

Rodrigo Torres Castro, Homero Puppo Gallardo, Daniel Zenteno Araos

Carlos Ubilla Pérez, María Angélica Palomino Montenegro, José Antonio Castro-Rodríguez

Hulya Sahin, Ilknur Naz, Seher Susam et al.

BACKGROUND: Bronchiectasis is common in patients with advanced chronic obstructive pulmonary disease (COPD) and adversely affects the patients' clinical condition. This study aimed to investigate the effects of bronchiectasis on exercise capacity, dyspnea perception, disease-specific quality of life, and psychological status in patients with COPD and determine the extent of these adverse effects by the severity of bronchiectasis. METHODS: A total of 387 COPD patients (245 patients with only COPD [Group 1] and 142 COPD patients with accompanying bronchiectasis [Group 2]) were included in the study. The patients in Group 2 were divided into three subgroups as mild, moderate, and severe using the Bronchiectasis Severity Index. Six-minute walk distance, dyspnea perception, St. George's Respiratory Questionnaire (SGRQ), and hospital anxiety and depression scores were compared between the groups. RESULTS: In Group 2, dyspnea perception, SGRQ total scores, depression score were higher, and walking distance was lower (P = 0.001, P = 0.007, P = 0.001, and P = 0.011, respectively). Group 2 had significantly worse arterial blood gas values. Dyspnea perception increased with the increasing severity in Group 2 (P < 0.001). Walking distance was lower in patients with severe bronchiectasis (P < 0.001). SGRQ total score, anxiety, and depression scores were significantly higher in the severe subgroup (P < 0.001, P = 0.003, and P = 0.002, respectively). CONCLUSIONS: In patients with Stage 3 and 4 COPD, the presence of bronchiectasis adversely affects the clinical status of the patients, decreases their exercise capacity, deteriorates their quality of life, and disrupts their psychological status. Investigating the presence of bronchiectasis in COPD patients is crucial for early diagnosis and proper treatment.

Yaru Wang, Yaru Wang, Junbao Du et al.

Neurally mediated syncope (NMS) is the most common underlying disease of pediatric syncope, which generally includes vasovagal syncope (VVS), postural tachycardia syndrome (POTS), and situational syncope. Allergic diseases involving the respiratory system, digestive system, skin, and other systems are prevalent in children. In recent years, increasing attention has been paid to children with the comorbidity of NMS and allergic diseases. This article reviews the featured clinical manifestations and pathogenesis of the comorbidity according to the progress of related studies. Clinical studies have shown that the comorbidity rate of pediatric VVS and/or POTS with allergic diseases amounts to ~30–40%, referring to the whole population of children with VVS and/or POTS. Additionally, children with the comorbidity present some relatively special clinical characteristics. A series of mechanisms or regulatory factors relating to allergies, such as the imbalance of vasoactive elements, dysfunction of the autonomic nervous system (ANS), and autoimmunity may play a role in the development of the comorbidity. Moreover, 90% of children with cough syncope, a type of situational syncope, have a history of asthma, indicating a potential relationship between asthma and NMS. Further studies exploring the clinical characteristics and pathogenesis of the comorbidity are still needed to aid in the diagnosis and treatment of children with NMS.

Takahito Suzuki, Noriyuki Enomoto, Yasuoki Horiike et al.

Abstract A 44‐year‐old woman with no symptoms was referred to our hospital for thorough examination of consolidation opacity on her left lung, which was growing for four years. She was diagnosed with systemic lupus erythematosus (SLE) at the age of 35 years and had been treated with prednisolone 10 mg/day. Physical examination and bronchoscopy revealed no abnormality including microbiological tests. She underwent surgical resection of the lung lesion. Lung biopsy specimens showed aggregation of lymphocytes with germinal centres and collagen deposition. Vasculitis and pulmonary alveolar proteinosis (PAP)‐like reaction were also found. We diagnosed this lung opacity as an SLE‐related lung lesion with vasculitis and PAP‐like reaction. Lung involvement of SLE is scarce and long‐term lung vasculitis and PAP‐like reaction are extremely rare in patients with SLE. Clinicians should be aware of such SLE‐related lung consolidation opacity that comprises lung vasculitis and PAP‐like reaction.

Matilde Tomaselli, S. Craig Gerlach, Susan J. Kutz et al.

Understanding human-wildlife relationships and interactions is crucial to implementing policies and practices related to wildlife and public health that are locally relevant and adapted to local communities and needs. With the goal of informing a community-based participatory muskox health surveillance system in the community of Iqaluktutiaq (Cambridge Bay) on Victoria Island, Nunavut, Canada, we explored the importance of muskoxen for community residents, their relevance for local food security, and the relationships and interactions between Iqaluktutiamiut and muskoxen. We investigated these themes through individual interviews of 30 community members identified as muskox experts by local organizations. Results were finalized and refined with 26 interviewees in feedback sessions. For Iqaluktutiaq residents, muskoxen have nutritional, economic, sociocultural, and environmental importance. The decline of muskoxen documented locally has a multidimensional impact on the community, with negative effects on all the domains explored, from food security to the integrity of the cultural system. Descriptions of subsistence and commercial harvesting and butchering practices are an asset for the successful implementation of participatory muskox health surveillance activities (e.g., hunter-based sampling), as well as for interpretation of derived data (e.g., local knowledge on muskox diseases). Knowledge of specific harvesting practices that might increase exposure to zoonotic agents is also relevant for designing targeted strategies to mitigate public health risks. This research underlines how careful examination of the human-wildlife context through local perspectives can benefit wildlife health surveillance, public health, and wildlife co-management outcomes.

Jennifer Brown, Joanna Cohen, Katherine Smith

Background Tobacco companies use descriptors on cigarette packs to convey less harm. The WHO FCTC Article 11 calls for the elimination of misleading packaging. This study compares the use of misleading descriptors on packs before (2013) and after (2015/2016) regulations on misleading descriptors were implemented in three lower middle income Asian countries. Methods A census of cigarette packs on the market were purchased in 2013 and 2015/2016 in Indonesia, the Philippines, and Vietnam using a systematic protocol. Packs displaying the country's health warning labels in rotation at time of purchase were double coded for select misleading descriptors in 2013 and for banned descriptors in 2015/2016. Results In 2013, 33%, 28%, and 11% of packs, in Indonesia (n=215), the Philippines (n=98), and Vietnam (n=83), respectively, displayed "light(s)", "mild", or "low". In 2015/2016, 76 packs (36%) from Indonesia (n=209) displayed one or more of the following banned descriptors: "light", "mild", "low tar", "slim", "special", "full flavor", and "premium", 36 with those in the brand name. No packs from the Philippines (n=83) displayed explicitly banned descriptors. Three packs from Vietnam (n=88) displayed "mild" but no other banned descriptors. In the Philippines and Vietnam, alternative descriptors such as "smooth" and colors (e.g. "wind blue") have replaced "light(s)". Conclusions While compliance with new regulations in the Philippines and Vietnam is high, as they do in other countries, tobacco companies are using alternative descriptors to convey cigarette strength. By retaining a similar overall design, many brands previously labeled "light(s)" may still be recognizable to consumers. In Indonesia, tobacco companies are taking advantage of a loophole in regulations that allows for misleading descriptors to remain in previously used brands or trademarks. These findings reinforce that tobacco companies continue to use the same tactics to circumvent regulations on misleading descriptors and the need for plain packaging that includes restrictions on brand names.

Liao KM, Chen YC, Cheng KC et al.

Kuang-Ming Liao,1 Yi-Chen Chen,2 Kuo-Chen Cheng,3 Jhi-Joung Wang,2 Chung-Han Ho2,4 1Department of Internal Medicine, Chi&nbsp;Mei Medical Center, Chiali, Taiwan;&nbsp;2Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 4Department of Hospital and Health Care Administration, Chia Nan University&nbsp;of Pharmacy and Science, Tainan, Taiwan Objective: The objective of this study was to investigate the trends in COPD patients admitted to the intensive care unit (ICU) in Taiwan from 2003 to 2013. Patients and methods: A retrospective study was conducted to analyze the available data in the National Health Insurance Research Database compiled by the Taiwan Department of Health. We selected patients admitted to the ICU nationwide from 2003 to 2013. Patients older than 40&nbsp;years with a diagnosis of COPD were enrolled. The ICU admission date was used as the index date. Baseline comorbidities existing before the index date were identified. The comorbidities of interest included diabetes, hypertension, diabetes mellitus, coronary artery disease, stroke, dyslipidemia, cancer, and end-stage renal disease. Results: The number of COPD patients in the ICU increased from 12,384 in 2003 to 13,308 in 2013 (P&lt;0.0001). The mean age of patients and SD was 76.66&plusmn;9.48 and 78.32&plusmn;10.59 in 2003 and 2013, respectively. The percentage of COPD patients aged &ge;70&nbsp;years in the ICU decreased markedly. COPD patients per 10,000 ICU patients decreased for both males and females. The length of ICU stays, and in-hospital mortality increased from 21.58 to 23.14&nbsp;days and 14.97% to 30.98% from 2003 to 2013, respectively. Conclusion: The number of COPD patients admitted to the ICU in Taiwan increased over the 11-year study period. Increased mean patient age, length of ICU stays, hospital mortality, and comorbidities were observed. The use of a nationwide population-based database allowed for a sufficient sample size, generalizability, and statistical power to analyze COPD patients admitted to the ICU in Taiwan. Keywords: COPD, intensive care unit, trend

Marius Eremia, Cornel Radu-Loghin, Lucia Maria Lotrean

Background World Health Organization calls for comprehensive measures for tobacco control which includes legislative, socio-economical and educational measures. This presentation has two objectives. First it gives an overview of the tobacco control in Romania. Second it gives examples which illustrate the role plaid by non-governmental organizations in establishing activities and cooperation for long term strategies in this field. Methods The results are based on data from literature as well as personal experience of the authors. The presentation underlines the strengths and weakness of tobacco control in Romania, giving a special attention to the role plaid by non-governmental organizations. Results The strengths of the tobacco control in Romania includes the legislation which limits the exposure to tobacco control advertisement and exposure to passive smoking in public places, the presence of pictogram on tobacco packages, increasing prices for tobacco products, development of some educational programs, including a smoking cessation program using the information technology. The weaknesses include the limited funding for educational activities for tobacco prevention and support for quitting smoking, poor reinforcement of legislation which prohibits the access of adolescents to tobacco products. The non-governmental organizations plaid an important role in developing national and international cooperation which stimulated the development of educational activities for tobacco prevention and cessation, training and capacity building as well as advocacy for adopting and implementation of legislation for tobacco control. Conclusions Non-governmental organizations play an important role in enhancing tobacco control in Romania through a wide cooperation with national and international partners, which several times stimulated the implication and commitment of several organizations in this field.