Title: Analysis of the course of chronic obstructive pulmonary disease in a fifteen- year follow-up.

Abstract:

Chronic obstructive pulmonary disease (COPD) is an important medical and social problem due to its growing prevalence and negative impact on the quality of life and prognosis. A growing body of evidence strengthens the understanding of the significance of various factors in the clinically heterogeneous course of COPD.
Methods: COPD progression was monitored over 15 years at three-time points (at study inclusion, after 3 years, and after 15 years). A total of 170 men with COPD were included in the study. Smoking history, the severity of respiratory symptoms, body mass index (BMI), and spirometry data were taken into account. To assess the significance of the factors, we performed a Kaplan-Meier analysis of long-term survival. Multivariate Cox regression model analysis was used to assess the influence of various factors and their combinations on long-term survival.
Results: Of the 170 patients included in the study, 119 died by the third time point, which was 70%. The mean life expectancy of those who died was 70.48 ± 0.63 years. The results of the study showed that comorbid atherosclerotic cardiovascular disease was a major cause of death in patients with COPD. Survival analysis using Kaplan-Meier curves showed that BMI;21 was associated with a poor prognosis. The analysis also showed that the frequency of exacerbations correlated with the severity of the course and prognosis. An increase in the frequency of exacerbations by more than 3 per year was an independent predictor of a negative prognosis. Another factor was physical frailty. Individuals who move only within the confines of the home have been found to have a worse prognosis. A high Charlson comorbidity index was a factor of adverse prognosis. Cox regression model results showed that atherosclerotic cardiovascular disease, high frequency of COPD exacerbations, and high FEV1 decline rate were significant predictors of poor prognosis in patients with COPD at 15-year follow-up.
Conclusion: Thus, comorbid atherosclerotic cardiovascular disease, low BMI, high exacerbation rate, rapid FEV1 decline, physical frailty, and high Charlson index are significant factors of poor prognosis of COPD and should be considered in patient follow-up.

Biography:

Stanislav Kotlyarov was educated as a medical doctor in 2007 and received his Ph.D. in 2011. His thesis was on "Structure of respiratory symptoms and spirometry screening in the assessment of chronic obstructive pulmonary disease at the primary treatment level". He works at Ryazan State Medical University as head of the department. He is board-certified as a general practitioner and family medicine physician. Was involved in clinical trials of medicines and medical devices. He has over 50 publications, including several articles in leading international peer-reviewed journals. Areas of research interests: molecular immunology, and molecular pharmacology of respiratory and cardiac diseases.

Title: Mechanisms of lung endothelial barrier protection in acute lung injury: role of extracellular purines

Abstract:

The endothelial cells (EC) lining the vessels are in close contact with each other forming a tight barrier. Any breach in the EC barrier is a cardinal feature of acute lung injury (ALI) and its more severe form, Acute Respiratory Distress Syndrome (ARDS), and results in pulmonary edema, and impaired gas exchange and may cause respiratory failure. Despite the obvious importance of the EC barrier, a paucity of information exists concerning the mechanisms involved in the preservation of barrier integrity. We have demonstrated that extracellular purines, ATP (stable analog, ATPγS) and adenosine can preserve EC barrier integrity in vitro and reduce ALI in mice. However, while in both cases EC barrier-protective mechanisms involved cytoskeletal reorganization culminating in an increase in cortical F-actin, the upstream signaling events for extracellular purines differ significantly and include activation of P1 A2 receptors coupled to Gs for adenosine and P2Y receptors coupled to Gi for ATP. Further, we demonstrated that adenosine-induced EC barrier enhancement involves activations of cAMP-dependent protein kinase A (PKA) and myosin light chain (MLC) phosphatase (MLCP), followed by decrease in MLC phosphorylation, thus reducing EC contractility. In parallel, adenosine strengthens EC barrier through activation of small GTPase, Rac1. Unlike adenosine, ATP-mediated EC barrier-enhancement involves unconventional Gi-mediated cAMP-independent PKA, MLCP and Rac1 activations, which may be coordinated through the actions of adapter protein GAB1, Shp2 (a non-receptor Tyr phosphatase), and AKAP2 (PKA anchoring protein 2)-mediated signaling. AKAP2 was found in immune complexes with PKA and Gi and directly interacts with MLCP suggesting that the AKAP2/MLCP axis is a novel regulator of P2Y/Gi-mediated EC barrier enhancement. Further, our data demonstrate the involvement of a regulatory molecule ELMO1 (Engulfment and cell motility protein 1) in P2Y/Gi-mediated EC barrier strengthening, which together with the adapter protein Dock180 formed a bipartite GEF (Guanine nucleotide exchange factor) for Rac1, suggesting the involvement of ELMO1/Dock180 axis in Gi-mediated Rac1 activation. Collectively, our data suggested that while adenosine-induced EC barrier enhancement involves activation of Gs/cAMP-mediated signaling, ATPγS-induced P2Y-mediated EC barrier strengthening requires Gi-mediated, coordinated activation of GAB1/Shp2 and Dock180/ELMO1 leading to activation of PKA and Rac1 pathways, respectively.

Biography:

Verin completed his Ph.D. at the age of 29 years from Moscow State University, Moscow, USSR, and postdoctoral studies at the University of Indiana. During his scientific carrier, he was a faculty member at Johns Hopkins and the University of Chicago. Currently, he is a Professor at the Vascular Biology Center and Pulmonary Division, School of Medicine, Medical College of Georgia, at Augusta University, Augusta, GA.   He has published more than 170 papers in reputed journals primarily in the field of pulmonary vascular endothelial barrier regulation.  He served as an Editorial board member of the American Journal of Physiology (Lung) from 2006-2011 and Editor-in-chief of the academic journal, Vessel Plus, in 2016-2022. He is currently serving as an academic editor of the British Journal of Medicine and Medical Research and Cardiology and Angiology, and an editorial board member in several other journals in the field of pulmonary/cardiovascular research such as Biomolecules, Cardiovascular Pharmacology, Journal of Multidisciplinary Pathology, Tissue Barriers, World Journal of Respirology.

Title: New Effective, Better and Faster Strategies by Prolonged Weaning by GOLD D Patients on Respiratory Intensive Care Unit

Biography:

M Lavae-Mokhtari is a consultant in the Respiratory Intensive Care Unit at General Hospital Ibbenburen in Germany since 2013. He has seven publications, 17 national and international poster publications, one book publication, and three scientific international and one national oral presentation. He has 152 citations and a 17.48 RG Score by research gate. He is a member of the German Respiratory Society, Section Intensive-Care and Ventilation Medicine, European Respiratory Society, Section Intensive-Care and Ventilation Medicine, and Section Thorax oncology and German Interdisciplinary Society of Outpatient Ventilation.

Title: Socio-Demographic Determinants of Adult Pulmonary Tuberculosis Patients: A Hospital Based Study at Dhanmondi, Dhaka, Bangladesh

Abstract:

Background: Tuberculosis (TB) is a multi-system infectious disease with a major cause of morbidity and mortality all over the world but particularly in developing countries like Bangladesh. A normal healthy individual does not face the symptoms causing by tuberculosis due to their immune system that’s why infection among healthy individuals always remain silent. As it is highly infectious air borne disease that’s why treatment completion for TB is the cornerstone of its control and prevention. So to understand these factors efficiently this study was carried out about socio-demographic determinants of adult TB patients attending the tertiary care teaching hospital, Dhanmondi, Dhaka. Methodology: This was hospital based cross sectional observational study done at Bangladesh Medical College Hospital, Dhanmondi, Dhaka with the study period from January 2020 to December 2021.Total 410 patients of age group 18 years and above with persistent cough with sputum production for more than 2 weeks were enrolled for this study purpose. Results: Total prevalence of sputum positive adult pulmonary TB among the studied group was 69.02%. Majority 54% were male patients in the age group of 41-50 years (31.45%). Pulmonary TB was predominantly diagnosed among employed group 41.34%, those who have completed their high school level (34.28%) in mainly the rural (66.08%) locality. Joint family (61%) with 8-10 family members (43.46%) have been found mostly affected in our study. The cardinal features were cough with sputum production (80.21%) followed by fatigue (71.73%), fever (42.05%), sweating (46.99%), loss of appetite (32.86%) and weight loss (27.56%). Pulmonary TB was found mostly among smokers (57.23%) with normal BMI (44.88%).

Conclusion: To decrease the rate of infection with Tuberculosis, a ultifactorial approach can play the pivotal role by improving the living conditions, education level, economic status and adequate sanitation. Awareness can bring a new dimension in this regard.
Keywords: Socio-demographic determinants, tuberculosis.

Biography:

Sadia Saber, currently working as an Assistant Professor in the Department of Medicine, at Bangladesh Medical College, Dhanmondi, Dhaka, Bangladesh for the last 4 years. She completed her MBBS at the university of Dhaka in the year July 2010 with honors marks in Anatomy, Physiology, Biochemistry, and Pathology. She also secured 4th position in the merit list during her 2nd Professional MBBS Examination. Then she completed her 5 years of Post-graduation Clinical Training at Bangladesh Medical College Hospital From January 2012 – December 2016. She acquired her Fellowship (FCPS) in Internal Medicine from the Bangladesh College of Physicians and Surgeons (BCPS) in the session of January 2017. She obtained her MRCP (UK) & MRCP (Ireland) in the year of November 2017 & October 2019 respectively. She has passed MRCP SCE in Respiratory Medicine (UK) in the year of October 2021. She has also completed her Postgraduate Diploma in Respiratory Medicine, at the University of South Wales, Cardiff (UK) in the session of 2021-2022. She acquired European Diploma in Respiratory Medicine (Switzerland) in 2022. Currently, she is doing her Master’s Degree in Sleep Medicine at the European University of Madrid, Madrid, Spain. She is working as an active member of the Royal College of Physicians and Surgeons of Glasgow (UK), the Royal College of Physicians of Edinburgh (UK), the American College of Physicians (USA) & the American College of Chest Physicians (USA). She has got more than 35 publications in both national and international levels, among those she is the 1 st author for more than 25 publications.

Title: The prevalence of Heart Failure in patients with Chronic Obstructive Pulmonary Disease: A systematic review and meta-analysis

Abstract:

Background: To assess the prevalence of heart failure in patients with COPD.

Methods: CENTRAL, Embase, and MEDLINE were searched for studies from 2017 up to June 2022 using the medical subject headings “COPD” and “Heart failure”. The risk of bias was assessed using the Newcastle-Ottawa scale for observational studies. The studies were narratively and statistically analyzed. Studies were reviewed in accordance with PRISMA guidelines.

Results: Of 3346 studies identified, 2220 were screened for title and abstract, and 348 were selected for full-text review. 11 studies were eligible for inclusion involving 91,919 participants, of which 10 were included in our meta-analyses. 3 conditions were investigated (i.e., HF, LVDD, and RVDD), of which 2 conditions were included in the meta-analyses and all were descriptively synthesized). From our meta-analyses, we found overall pooled prevalence estimated of was 16 %, 95 % CI (12 % to 19 %), for heart failure; and 61 %, 95 % CI (53 % to 70 %), for LVDD. The pooled data for HF were significantly heterogenous (I2= 97.55 %, p<0.001), whereas the pooled data for LVDD were moderately heterogeneous (I2= 50 %, p= 0.16). Discussion: Meta-analyses for LVDD and HF had a moderate to large statistical heterogeneity. Only three studies out of 11 aimed to investigate the primary outcome of HF or LVDD. HF is a clinically important condition that is prevalent within a significant proportion of patients with COPD and negatively impacts important clinical outcomes. There is a need for more research investigating HF prevalence in COPD. In addition, we hope this review raises the awareness of clinicians and policymakers to consider implementing diagnostic tools to assess HF among the COPD population. 

Other: This systematic review is registered with PROSPERO, CRD42022328570

Biography:

Sufana is a Lecturer in the Respiratory Care Department at Imam Abdulrahman bin Faisal University, Saudi Arabia. Master of Respiratory Medicine from the University of Birmingham, UK. Bachelor of Respiratory Care from AlMaarefa University, Saudi Arabia.

Title: Efficacy of Noninvasive positive pressure ventilation in ARDS caused by Covid19

Abstract:

Noninvasive positive pressure ventilation was being practiced in the management of covid19 ARDS but there were no specific studies for its effectiveness.
Objective:
This study was conducted to analyze the effectiveness of NIPPV in covid19 ARDS patients.
Method:
One hundred and seventeen patients from the Corona Intensive Care Unit of Nishtar Hospital Multan with severe covid19 ARDS having PaO2/FiO2 ratio <100mHg, GCS > 13, and Respiratory breathing index <105 were selected. These patients were hospitalized in 2021 during covid pandemic for their management. Noninvasive positive pressure ventilation with a high flow system was applied to all patients along with a heat and moist exchanger (HME) at the interface and viral/bacterial filters at the expiratory limb of the ventilatory circuit. 62% patients were improved with improvement in PaO2/FiO2 ratio over time period of 7 days. 38% of patients deteriorated and they were switched to mechanical ventilation.
Conclusion:
After ruling out general contraindications of NIPPV, its use was a remarkably effective and safe modality for covid19 ARDS patients. Additionally, patients are at ease with the use of NIPPV contrary to IMV. Further, larger-scale studies should be carried out to determine the effectiveness of NIPPV.

Title: Smartphone enabled home based self-management informatics platform for COPD in India

Abstract:

Background: COPD is one of the prominent causes of mortality, morbidity, and disability among chronic respiratory diseases. Digital health interventions exist to provide various healthcare services to individuals diagnosed with COPD. Training and support to COPD patients on self-management of their COPD status improves health-related QoL and can reduce unplanned hospital visits and admissions.
Method: A prospective non-randomized study will be conducted to implement the self-management informatics platform among 164 COPD patients (82 each in the intervention and control group) in the selected hospital in India. Mixed methods will be conducted among identified COPD patients to assess the impact of the COPD self-management informatics tools.
Intervention: Identified COPD patients (GOLD-2 and 3) will be provided a smartphone application that includes educational videos in the local language on breathing techniques, airway clearance techniques, exercise training, fatigue management, counseling on physical activities, nutrition, smoking cessation, and spirometry. Control group: COPD patients assigned to the control group will be treated with a standard treatment regime for their COPD.
Data Analysis: Data will be analyzed using statistical software like SPSS 21 version. The continuous variable will be summarized using mean and standard deviation and frequencies will be reported for categorical data. Independent or student t-tests will be used to analyze the mean difference between intervention and control groups. The chi-square test will be used for comparison between groups. Logistic regression will be done where the outcome variable is dichotomous.
Conclusion: Smartphone-enabled informatics platforms may assist COPD patients in the management of exacerbations, reduced healthcare facility admissions, hospitalization days, and health-related quality of life.

Title: A SIMULATION STUDY ON QUAD/DUO PATIENT SPLIT MECHANICAL VENTILATOR

Abstract:

Respiratory diseases and injury-induced respiratory failure are among the major public health problems in both developed and developing countries. Asthma, chronic obstructive pulmonary diseases, and other chronic respiratory conditions are widespread. Patients with underlying lung diseases may develop respiratory failure due to a variety of challenges and they can be supported by mechanical ventilation. A mechanical ventilator is a machine that helps a patient breathe (ventilate) when they cannot breathe on their own due to a critical illness. The COVID-19 outbreak has become a global issue as this new pandemic socially and economically affected the entire world. This virus has caused a substantial global health problem with very significant economic and social impacts. According to the World Health Organization (WHO), as of 23 January 2022, over 346 million confirmed cases of COVID-19 were reported worldwide, and many of those critically ill have required days of supportive invasive mechanical ventilation (IMV) as part of their treatment. Most developing nations, especially those in sub-Saharan Africa have been facing ventilator shortages for a long time. The high cost of ventilators has also contributed to limited access to life-saving machines in countries like Zambia. The need for ventilators in many hospitals in most developing nations has surpassed the supply. The novel coronavirus disease (COVID-19) has exposed critical shortages of ventilators in both developing and developed countries. One possibility to address this problem is the utilization of a single ventilator on two to four patients. The need to carry out mathematical modeling and simulation of the machine-patient configurations to ascertain the feasibility as well as understand the limitations of this approach is nontrivial. This paper presents a simulation study on the implementation of a single ventilator on two or more patients with different lung compliances. Results show that in theory, it is technically possible to ventilate two or more patients provided a control strategy is implemented to regulate the inhalation tube resistances. It has also been demonstrated that ventilating two or more patients with unequal lung compliances from a single ventilator without a controlling resistance will lead to clinically significant reductions in tidal volume in the patient with the lowest respiratory compliance. The study demonstrates that it may be possible to achieve the same tidal volumes in two and four patients with mismatched lung compliances, and the results show that the tidal volume of one patient can be manipulated independently of the others.

Biography:

George Pule is a 3rd-year Biomedical Engineering Technology Student at Evelyn Hone College of Applied Arts and Commerce; and he is a student Member of the Engineering Institution of Zambia and IEEE, Engineering in medicine and biology society (EMBS). He is the inventor and Lead innovator of the Vent Splitting Device (VSD) under development at Evelyn Hone College with sponsorship from the National Science and Technology Council. The invention received a grant from the National Science and Technology Innovation Youth Fund. He presented an abstract on ventilator-sharing methods at the 2022 IEEE EMBS Middle East Africa international conference in Uganda.

Title: Co-pathogens causing respiratory infections in patients with SARS-CoV-2 in Bulgaria

Abstract:

Statement of the Problem: Coinfections with SARS Co-2 and bacterial, fungal, or viral pathogens can worsen the clinical condition and pose challenges to the disease's diagnosis, treatment, and prognosis. This study aims to determine the prevalence and clinical significance of co-infection with SARS-Co-2 and another respiratory pathogen in Bulgaria. Methodology & Theoretical Orientation: Nasopharyngeal swabs from patients with confirmed SARS-CoV-2 infection were prospectively collected from both inpatients and outpatients, with female patients being 55% and male patients being 45%, respectively, and patient ages varied from 45 days to 98 years. RT-PCR was used to detect SARS-Co-2, 8 common respiratory viruses - respiratory syncytial virus(RSV), human metapneumovirus(HMPV), parainfluenza viruses(PIV)1/2/3, rhinoviruses(RV), adenoviruses(AdV), bocaviruses(BoV) and 4 seasonal coronaviruses: OC43, NL63, 229E, and HKU-1. Capillary electrophoresis was used for the detection of three bacterial co-pathogens: Mycoplasma pneumonia(MP), Chlamydophila pneumonia(ChP), and Haemophilus influenza(HI).
Results: From August 2021 to early May 2022, clinical samples from 337 SARS-CoV-2 positive patients were tested for the presence of respiratory co-pathogens, with 42 co-infections detected. Those involving bacterial pathogens were n=23(54.8%) and those involving viral pathogens were n=14(33.3%). The order of evidence of co-pathogens was: HI(n=20; 47.6%), RSV(n=4, 9.5%), ChP(n=3,7.1%), AdV(n=3;7.1%), HI+RSV(n=3;7.1%), BoV(n=2,4;8%), HMPV(n=1;2.4%),PIV-3(n=1;2.4%), RV(n=1;2.4%), HKU-1(n=1;2.4%), NL63(n=1;2.4%), HI+AdV(n=1;2.4%) and HI+PIV2 (n=1;2.4%). Children aged 6-16 years and patients over 65 years had the highest rate of co-infections (37.5%/18.2%). Of the co-infected patients, 32(76%) were hospitalized and three(7.1%) had a fatal outcome. The deaths were in patients co-infected with a bacterial pathogen and SARS-CoV-2.
Conclusion & Significance: In patients positive for SARS-Co-2, the frequency of co-infections with a bacterial pathogen prevailed over that with a viral one. Due to the large proportion of antibiotic-treated patients(83%) with complications due to COVID-19 and the risk of the emergence of resistant strains, timely diagnostics aimed at identifying co-pathogens is of particular importance, which would help in the correct and timely treatment of patients.
Acknowledgments: This abstract is supported by: contracts KΠ-06-H 43/5/30.11.2020/ Molecular-genetic and clinical characteristics of human coronavirus. Study of the role of SARS-CoV-2 in co-infections with other respiratory viruses, NO KΠ-0 6-DK1/7/29.03.2021/ Viral load, cytokines and serum antibody levels depending on the clinical severity of COVID-19 infection and by the European Regional Development Fund through Operational Program Science and Education for Smart Growth 2014–2020, Grant BG05M2OP001-1.002-0001-C04 Fundamental Translational and Clinical Investigations on Infections and Immunity.
Recent Publications: Trifonova I, Christova I, Madzharova I, Angelova S, Voleva S, Yordanova R, Tcherveniakova T, Krumova S, Korsun N. Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection. Front Public Health. 2022 Sep 2;10:959319. doi: 10.3389/fpubh.2022.959319. PMID: 36117597; PMCID: PMC947944 IF2021 6.46
Alexiev I, Giovanetti M, Cella E, Ivanov I, Stoikov I, Donchev D, Grigorova L, Gancheva A, Dimitrova R, Korsun N, Trifonova I, Philipova I, Dobrinov V, Grigorova I, Kantardjiev T, Christova I, Ciccozzi M. Initial introduction and spread of the SARS-CoV-2 AY.4.2.1 Delta variant in Bulgaria, a genomic insight. J Med Virol. 2022 Jul 28:10.1002/jmv.28033. doi: 10.1002/jmv.28033. Epub ahead of print. PMID: 35902787; PMCID: PMC9353378. IF2021 20.6
Alexiev I, Ivanov I, Philipova I, Korsun N, Stoikov I, Dimitrova R, Grigorova L, Gancheva A, Trifonova I, Dobrinov V, Grigorova I, Savov A, Asenova B, Ciccozzi M, Kantardjiev T. Postvaccination SARS-CoV-2 Alpha (B.1.1.7) lineage infection among healthcare workers on the background of IgG antibodies. J Med Virol. 2022 Mar;94(3):836-839. doi: 10.1002/jmv.27394. Epub 2021 Oct 20. PMID: 34647629; PMCID: PMC8661687. IF2021 20.6
Korsun NS, Angelova SG, Trifonova IT, Voleva SE, Grigorova IG, Tzotcheva IS, Mileva SD, Perenovska PI. The Prevalence and Genetic Characterization of Human Metapneumovirus in Bulgaria, 2016-2019. Intervirology. 2021;64(4):194-202. doi: 10.1159/000516821. IF2020 1.763
Korsun N, Trifonova I, Voleva S, Grigorova I, Angelova S. Genetic characterization of the influenza viruses circulating in Bulgaria during the 2019-2020 winter season. Virus Genes. 2021 Oct;57(5):401-412. doi: 10.1007/s11262-021-01853-w. IF2020 2.332

Biography:

Iveta Madzharova is a biologist at the National Center for Infectious and Parasitic Diseases, National Laboratory "Influenza and SARS", Sofia, Bulgaria since the beginning of 2022. She has а bachelor’s degree in Biotechnology - Sofia University "St. Kliment Ohridski", Biological Faculty and started a master's degree in 2021 in the field of Microbiology and microbiological control - Sofia University "St. Kliment Ohridski", Biological Faculty. She is developing a master's thesis on the research topic. She participated in two projects related to the research topic. She published one article with impact factor in a reputable journal on the topic "Clinical significance and role of co-infections with respiratory pathogens among individuals with confirmed coronavirus-2 infection with severe acute respiratory syndrome". She participated in an international congress.