Role of peripheral eosinophilia in acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Eosinophil counts are a promising guide to systemic steroid administration for chronic obstructive pulmonary disease(COPD).AIM To study the role of peripheral eosinophilia in hospitalized patients with acute exacerbation of COPD(AECOPD).METHODS From January 2014 to May 2017,patients with AECOPD hospitalized in Taipei Tzu Chi Hospital were retrospectively stratified into two groups according to their peripheral eosinophil count:The EOS group(eosinophil count≥2%)and the non-EOS group(eosinophil count<2%).Demographics,comorbidities,laboratory data,steroid use,length of hospital stay,and COPD-related readmissions were compared between the groups.RESULTS A total of 625 patients were recruited,with 176 patients(28.2%)in the EOS group.The EOS group showed a lower prevalence of infection,lower cumulative doses of prednisolone equivalents,shorter length of hospital stay,and higher number of COPD-related readmissions than the non-EOS group.There were significantly linear correlations between eosinophil percentage and number of readmissions and between eosinophil percentage and length of hospital stay P<0.001,and a lower percent-predicted value of forced expiratory volume in one second(FEV1)were associated with shorter time to first COPD-related readmission[adjusted hazard ratio(adj.HR)=1.488,P<0.001;adj.HR=0.985,P<0.001,respectively].CONCLUSION The study findings suggest that the EOS group had the features of a shorter length of hospital stay,and lower doses of systemic steroids,but more frequent readmissions.The EOS group and lower percent-predicted FEV1 values were risk factors for shorter time to first COPD-related readmission.

Snapping wrist due to bony prominence and tenosynovitis of the first extensor compartment:A case report

BACKGROUND A snapping wrist is a rare symptom that results from the sudden impingement of one anatomic structure against another,subsequently causing a sudden movement only during wrist movement.CASE SUMMARY A 30-year-old woman with a history of right wrist contusion reported right wrist snapping after overuse.The snapping became symptomatic after moving heavy objects.The pain persisted even when she received 1 mo of conservative treatment.Physical examination showed painful wrist snapping during wrist radioulnar motion and thumb abduction-adduction.Radiography demonstrated bone overgrowth over the radial styloid process.Sonography disclosed a tendon jumping over a bony prominence in the first compartment during wrist motion.Magnetic resonance imaging revealed no anomalous tendon nor tumorlike lesion.Under the wide-awake local anesthesia no tourniquet(WALANT)technique,the lesion was identified in the first extensor compartment.The patient received stepwise extensor retinaculum release,synovectomy,and bone spur removal.By 6th week,the patient was completely free of pain and unable to snap her wrist.She started working 7 wk after the surgery.One year after the surgery,the wrist snap was not recurrent.CONCLUSION Careful physical examination and dynamic sonography may confirm the diagnosis of a snapping wrist.With the WALANT technique,the lesion could be identified under direct vision,and we could take stepwise interventions according to intraoperative presentations.