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Horita N.,Yokohama City University | Miyazawa N.,Saiseikai Yokohamashi Nanbu Hospital | Yoshiyama T.,Fukujuji Hospital | Tsukahara T.,Yokohama City University | And 5 more authors.
Respirology | Year: 2013

Background and objective We evaluated the association between activities of daily living and drug-induced liver injury by anti-tuberculosis drugs. Methods This retrospective cohort study included adult inpatients with newly diagnosed smear-positive lung tuberculosis treated with standard regimen in two hospitals. (n = 346; 63.6 ± 20.3 years old; 106 (30.6%) females). Activities of daily living was divided into 'independent' (Barthel Index (BI) 80-100, 60.4%) and 'decreased' (BI 0-75, 39.6%) categories. Liver injury was defined as the withdrawal or change of treatment regimen on the basis of the following criteria: serum transaminase concentrations were more than three times the upper limit of normal range with jaundice and/or hepatitis symptoms, or more than five times the upper limit of the normal range. Results Compared with 'independent' patients, patients with 'decreased' activities of daily living had odds ratios for liver injury of 4.2 (P < 0.001) in univariate analysis and 5.7 (P = 0.002) in logistic regression analysis after adjusting for other risk factors. Conclusions Decreased activity of daily living is a strong risk factor for liver injury among adult inpatients with newly diagnosed smear-positive lung tuberculosis treated using a standard regimen. This retrospective cohort study included adult inpatients having newly diagnosed smear-positive lung tuberculosis treated with a standard regimen (N = 346). Patients with decreased activities of daily living had an odds ratio of 5.7 for drug-induced liver injury after adjusting for 11 other risk factors. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology. Source


In Japan, tuberculosis (TB) patients aged over 80 years are usually treated with a regimen not including pyrazinamide (PZA) because of the risk of drug-induced hepatitis. The purpose of this study was to investigate the occurrence of drug-induced hepatitis in TB patients over 80 years of age, who are treated with a regimen including PZA, and compare the findings with those of younger patients. [Methods] Thirty-six patients with pulmonary tuberculosis, who were admitted to Yokohama City University Hospital between June 2011 and March 2012 were included. They were treated with isoniazid, rifampicin, ethambutol, and PZA and had their liver function assessed once a week for 2 months. Hepatitis occurred in 4 of 28 (14.3%) patients aged under 80 years and in 1 of 8 (12.5%) patients aged over 80 years. There was no difference in the frequency of drug-induced hepatitis between patients aged under and over 80 years. We conclude that elderly patients aged over 80 years should be treated with a short course regimen that includes PZA. Source


Horita N.,Saiseikai Yokohamashi Nanbu Hospital | Miyazawa N.,Saiseikai Yokohamashi Nanbu Hospital | Tomaru K.,Saiseikai Yokohamashi Nanbu Hospital | Inoue M.,Saiseikai Yokohamashi Nanbu Hospital | And 2 more authors.
Respirology | Year: 2015

Background and objective Genetic susceptibility for development of chronic obstructive pulmonary disease (COPD) is under intensive investigation. Among the three alleles of vitamin D binding protein, or group-specific (GC) components, some have suggested that having GC-1F and GC-2 alleles was associated with a risk of COPD. Although previous studies have shown considerable variance, no meta-analysis has been conducted. Methods Through four databases, two independent investigators searched for case-control studies providing sufficient data to calculate odds ratios by the vitamin D binding protein allele variant and genotype variant for a case of COPD. Studies whose control did not satisfy the Hardy-Weinberg equilibrium (Chi-square P ≥ 0.05) were excluded. We used a fixed-model to estimate the pooled odds ratio at both allele and genotype level. Results Of 141 candidate studies, six were included. We analysed 1712 subjects, consisting of 466 Asians, 1246 Caucasians, 531 COPD cases and 1181 non-COPD controls. The prevalence of each allele among the 1181 controls was as follows: GC-1F 14.0%, GC-1S 53.8% and GC-2 31.9%. When compared to GC-1S, the GC-1F allele and GC-2 allele were associated with COPD risk with pooled odds ratios of 1.44 (95% CI 1.14-1.83, P = 0.002) and 0.83 (95% CI 0.69-0.996, P = 0.045), respectively. When compared to the 1S-1S genotype, the 1F-1F genotype was a risk factor of COPD with pooled odds ratio of 2.64 (95% CI 1.29-5.39, P = 0.008). Conclusion The GC-1F allele of the vitaminD binding protein was a risk for COPD in recessive mode. © 2014 Asian Pacific Society of Respirology. Source


Horita N.,Saiseikai Yokohamashi Nanbu Hospital | Horita N.,Yokohama City University | Miyazawa N.,Saiseikai Yokohamashi Nanbu Hospital | Tomaru K.,Saiseikai Yokohamashi Nanbu Hospital | And 2 more authors.
Respirology | Year: 2015

Some trials have been conducted to compare long-acting muscarinic antagonist (LAMA)-+-long-acting beta agonist (LABA) versus LABA-+-inhaled corticosteroids (ICS) for chronic obstructive pulmonary disease (COPD), but no meta-analysis were reported. Two investigators independently searched for eligible articles using the PubMed, Web of Science and Cochrane databases. Articles in authors' reference files were also regarded as candidates. The eligibility criteria for the current meta-analysis were original trials written in English comparing the impact of LAMA-+-LABA and LABA-+-ICS for COPD patients. A pooled value for the continuous value was calculated using the genetic inverse variance method for mean difference. Incidence of events was evaluated using the odds ratio (OR). Minimal clinically important difference were 50-mL for forced expiratory volume in 1 s (FEV1), four points for St George Respiratory Questionnaire (SGRQ) and one point for transition dyspnoea index (TDI). We included seven randomized controlled trials and one cross-over trial with follow-up period of 6-26 weeks. Compared with LABA-+-ICS, LAMA-+-LABA led to significantly greater improvements of trough FEV1 by 71 (95% CI: 48-95) mL, TDI by 0.38 points (95% CI: 0.17-0.58), less exacerbations with an OR of 0.77 (95% CI: 0.62-0.96) and less pneumonia with an OR of 0.28 (95% CI: 0.12-0.68). Frequencies of any adverse event, serious adverse event, adverse event leading to discontinuation, all-cause death and change of total score of SGRQ were not different in both arms. LAMA-+-LABA might be a better option for treating COPD than LABA-+-ICS. © 2015 Asian Pacific Society of Respirology. Source


Horita N.,Yokohama City University | Miyazawa N.,Saiseikai Yokohamashi Nanbu Hospital | Morita S.,Yokohama City University | Kojima R.,Saiseikai Yokohamashi Nanbu Hospital | And 3 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2014

Minimum clinically important change of 5 points in the University of California, San Diego Shortness of Breath Questionnaire (SOBQ) is established, but cutoff values between a small, a moderate, and a large change are still unknown. We used the data set of National Emphysema Treatment Trial consisting of severe and very severe chronic obstructive pulmonary disease patients, whose mean age was 64 years. Changes from baseline to post-surgical 6-month follow-up were evaluated. The St. George's Respiratory Questionnaire was used as anchor: ΔSGRQ < 4, meaningless change; 4 ≤ ΔSGRQ < 8, small change; 8 ≤ ΔSGRQ < 13, moderate change; 13 ≤ ΔSGRQ, large change. We decided the final cutoff values for the SOBQ as medians of the three anchor methods. We also decided the range of cutoff values as the range of three values. In a cohort of surgically treated patients (N = 484), we propose value of 5 (range 5-6), 11 (range 9-15), and 16 (range 14-20) for the cutoff values between a meaningless and a small change (minimum clinically important difference), a small and a moderate change, and a moderate and a large change, respectively. In a cohort of medically treated patients, numbers of patients categorized according to ΔSOBQ scores were similar to those of the patients categorizes according to the ΔSGRQ (N = 480) or ΔForced expiratory volume in 1 second (N = 425). We propose group-level cutoff values and range between a small, a moderate, and a large changes. © 2014 Informa Healthcare USA, Inc. Source

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