AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2637-8892/168
1 Senior Lecturer, CM Deptt At Kims Karachi Pakistan
2 Assistant Prof of Pharmacology at LMDC, Lahore Pakistan
3 HOD Pharmacology at IMDC, Islamabad, Pakistan
*Corresponding Author: Shah Murad, HOD, Pharmacology at IMDC, Islamabad, Pakistan
Citation: Masood S., Firdous A., Murad S. (2022) The Brain Fog by COVID 19: An Illustration. Psychology and Mental Health Care, 6(4): DOI: 10.31579/2637-8892/168
Copyright: © 2022, Shah Murad, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 11 April 2022 | Accepted: 21 April 2022 | Published: 18 June 2022
Keywords: chronic obstructive pulmonary disease (COPD); anemia; hemoglobin.
Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease due to smoking. It is avertable as well as treatable. COPD is a one of the main cause of morbidity and mortality affecting developed and developing countries. We aim to estimate burden of anemia at a tertiary care public sector hospital.
Methods: This is a descriptive cross sectional study, done at JPMC Karachi in 2014. All COPD patients admitted in medicine and pulmonology departments were enrolled in this study. After informed consent, data of complete blood count was accessed from medical record and anemia was labeled as per operational definition. Data analyzed by SPSS version 16.0. Frequency and percentage proportion of qualitative variables, mean and standard deviation of numerical values were calculated with P value <0.05 was taken as significant.
Results: Of 137 cases, 118(86.13%) were males and 19(13.87%) were females while male to female ratio was 6.2: 1. The average age and weight of the patients was 58.31±12.17 years and 59.36±10.56kg, similarly average duration of disease and hemoglobin of the patients was 5.69±4.42 years and 12.34±1.58 mg/dl respectively. 37.96% (52/137) patients were anemic in our study. Rate of anemia in COPD patients was not significant among age groups (p=0.076) and with duration of disease (p=0.22).
Conclusion: Anemia seems to be a common feature in COPD (37.96%), mechanisms involved in the genesis of anemia in COPD are poorly studied. Low hemoglobin level can have adverse effects on certain respiratory parameters in COPD, increasing morbidity and mortality.
Chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD) is progressive inflammatory airway disease that is associated with poor quality of life. COPD is one of the leading illness causing mortality worldwide. It includes previously two disease processes that are emphysema and chronic bronchitis. It manifests as a chronic breathing problem and poor airflow with air trapping in lungs. According to recommendation of the Global Initiative for chronic obstructive lungDisease (GOLD), that the chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD) will be diagnosed on the basis of clinical features (signs and symptoms) i-e productive cough (cough with sputum) for at least 3 months/year for at least two years are characteristic of chronic bronchitis and shortness of breathing or dyspnea and cough are characteristic of emphysema. These diseases processes are measured by Spirometry. On the basis of Spirometry COPD patients were staged on the basis of severity of symptoms into four stages[ stage I (FEV1≥80%), stage II(50%≤FEV1<80>
Anemia is caused by chronicity of disease or chronicity of illness, systemic inflammatory or oxidative process.[12] although it is “traditionally” associated with secondary polycythemia but practically many patients are found to be anemic. This anemia is known as anemia of chronic disease (ACD). The systemic effects or systemic inflammation had direct effects of the disease with having a relationship with cause-and-effect output. Screening and treatment of these co-morbid conditions i-e Ischemic heart disease (IHD), Osteoporosis, Skeletal muscle dysfunction (wasting), Depression, nutritional disorders (malnutrition) and blood disorders (anemia) had a role in management of COPD. Chronic systemic inflammation had a vital role in the development of extra-pulmonary manifestations of COPD. Anemia worsens dyspnea or shortness of breathing and limit exercise tolerance.[13] The Hemoglobin (Hb%) levels correlated with reduced functional capacity, increased shortness of breathing, reduced exercise tolerance or capacity, reduced or impaired quality of life (QOL), increased stay in hospital, early morbidity and mortality with severe inflammation in COPD patients.[14]
There are many cofounders in chronic obstructive pulmonary disease patients like old age, nutritional disorders (malnutrition) and cardiovascular disease (IHD, CCF), and leads to development of anemia. Nutritional disorders or Malnutrition had association development of anemia due to with iron, folate or vitamin B12 deficiency.[11] The objective of this study is to assess the burden of anemia in chronic obstructive pulmonary disease patients at a tertiary care hospital Karachi.
Operational definition
Anemia is defined as a decrease in the total number of erythrocytes or decreased concentration of hemoglobin in the blood, in our study hemoglobin levels <13 xss=removed>15, 16]
This study was a descriptive cross-sectional, which included 137 COPD patients. These COPD patients were admitted in departments of medicine and pulmonology. This study was conducted for six months in 2014 in Jinnah Postgraduate Medical center Karachi. Sample size was calculated by formula:
Sample Size*: n=Nz2p (1-P)/d2 (N-1)+z2 p(1-P).
Numbers of participants were calculated i-e 137 subjects. After taking approval of synopsis from college of physicians and surgeons of Pakistan (CPSP), subjects were enrolled from admitted patients. Diagnosed cases of COPD, of both male and female sex and Age >35 years and <70>0.05) P-value.
137 COPD patients were enrolled and included in this study, out of this 118(86.13%) were males (M) and 19(13.87%) females (F) while M to F ratio was 6.2:1. The mean age and weight of the COPD patients was 58.31±12.17 years (median age 60 years) and 59.36±10.56 kg, similarly mean duration of disease and hemoglobin of the patients was 5.69±4.42 years and 12.34±1.58 mg/dl respectively as shown in table-1.1. In COPD patients included in our study frequency of anemia, smoking, hypertension and diabetes mellitus was 37.96% (52/137), 100% (137), 6.6% (9/137) and 2.2%(3/137) respectively as shown in Table- no 1.2.
In this study anemia in COPD patients has no significant association with age (p>0.076), gender (p>0.36), and duration of the disease (p>0.22) respectively as shown in Table 1.3
Anemia is one of the extra-pulmonary manifestations in patients having signs and symptoms of chronic obstructive pulmonary disease (COPD). In this study frequency of anemia has been observed in patients was 37.96%, median hemoglobin (Hb%) level was 12.5 gm/ dl and gender based comparison showed frequency of anemia was 36.4% (43/118) in males and 47.4% (9/19) in females which is not statistically significant (p>0.36). Similar results are reported in a study which includes 53 patients with median hemoglobin level (12.8 gm/dl) and gender based comparison showed frequency of anemia was (49.4% [41/83] in males and 52.2% [12/23] in females with P-value (P=1.00).[17] this study supports our results. In 2015, study was published in British Medical Journal (BMJ), in which anemia prevalence is in range b/w 33%–44% in COPD patients.18Perveen et al. done a hospital-based cross-sectional study in which she founded 18% anemia in chronic obstructive airway disease (COPD) patients.[19] Shorr et al. had done data analysis of chronic obstructive airway disease (COPD) patients retrospectively in which 33% patients were reported anemic [20]. Anemia is directly associated with worsening of clinical features that leads to mortality or death in chronic obstructive airway disease (COPD) patients. It is considered as predictor, which is affecting the prognosis (long term), so that it is causing mortality in exacerbations of admitted patients. During Exacerbation of symptoms in COPD patients, leads to increase in concentration of oxidative stress, plasma fibrinogen and serum interleukin (IL-6) levels, so comorbiditiesincreases in patients.The secretion of C-reactive protein (CRP) is increased by the liver due to interleukin 6(IL-6). C-reactive protein (CRP) is an acute phase reactant and is sensitive marker of inflammation [11] The anemia had multiple complex mechanisms in COPD patients like systemic inflammation and anemia of chronic disease (ACD).Multiple inflammatory cytokines like interleukins (IL-1&IL-6), and tumor necrosis factor (TNF-alpha) are responsible for inhibition or harmful effect in erythropoietic pathway (erythropoiesis) in COPD patients.The patients having lower levels of hemoglobin (Hb%) concentration or anemia will be associated with poor prognosis in COPD sufferers.21ACD occurs due to alternation in iron metabolism. There is increased level of hepcidin, and increased inflammatory cytokines or interleukins (IL-1&IL-6), and tumor necrosis factor (TNF-alpha) in chronic obstructive airway disease (COPD) patients. These are regulating iron homeostasis in human body. Functional iron deficiency is related to decreased oxygen concentration in the blood leads to decreased tolerance of exercise and limitation in response to pulmonary rehabilitation [22,23] Yuruk et al. had observed in his study that decreased hemoglobin (Hb%) concentrations or anemia was showing association with oxygen saturation within capillaries or microcirculation and after treatment of anemia resulted in improvement of transport capacity of oxygen and oxygen saturation in tissue cells [24]
Anemia is associated with shortness of breathing and it worsens the health related quality of life.25 Anemia or decreased hemoglobin concentration is major risk factor for repeated admissions (25%) and worsening of dyspnea than non-anemic COPD patients. Dyspnea and easy fatigability are main symptoms of COPD patients and it exerts negative effects on health related quality of life (QOL) of these patients. Hemoglobin correction (whether anemia or polycythemia) in COPD patients may improve QOL and decrease co-morbidity and mortality of these patients [26]
Anemia is quite common in our study (37.96%), as opposed to medical literature which mentions polycythemia in these patients. Mechanisms involved in the genesis of anemia in COPD are poorly studied; moreover low hemoglobin level can have adverse effects on oxygen saturation and functional class of patients in COPD, leading to increased morbidity and mortality.
Further studies are needed to look up if treatment of anemia in COPD patients results into better outcomes.
None to declare.
From College of Physicians & Surgeons, Pakistan (CPSP), Acceptance number: REU NO: 8813
Nil
Informed conset taken from the patients or their guardian, if language barrier via translator.
Single centre study.
Future studies with more number of patients and effect of anemia correction on COPD should be studied.
I dedicate this study to my patients who allowed me to publish their data.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
