Hoover's sign is a predictor of airflow obstruction severity and is not related to hyperinflation in chronic obstructive pulmonary disease

Background

Several phenotypes are described in COPD.

Objectives

To assess if COPD patients with Hoover's sign (HS) belong to a particular phenotype.

Methods

All consecutive COPD patients with varying degree of airflow obstruction that came for lung function testing in one university hospital were prospectively assessed, using clinical and magnetometer detection of HS, body mass index (BMI), St. George's Respiratory Questionnaire for health-related quality of life, six-minute-walk test (6MWT) with inspiratory capacity (IC) measurements and expiratory flow limitation (EFL) detection. Previous exacerbations were also reported.

Results

82 patients were studied. Magnetometers confirmed HS in 56 of them, of which 79% (44/56) were detected by clinical assessment. HS (+) patients were older (64 ± 10 vs 59 ± 10 years, p = 0.03), had a higher BMI (26 ± 5 vs 23 ± 4, p = 0.04), a lower FEV1 (53% ± 18% vs 63% ± 18% pred, p = 0.02) and a higher IC decrease at the end of 6MWT, (− 19 ± 2 vs − 7 ± 4% pred, p = 0.003). A larger proportion of HS (+) patients also reported severe exacerbations during the past 2 years (39% vs 12% p = 0.01). There was no statistical evidence that HS was related to hyperinflation and/or EFL.

Conclusion

The very simple clinical HS allows identifying a particular population of COPD patients of older age and higher BMI with a more severe airflow obstruction, increased dynamic hyperinflation during exercise and higher exacerbation frequency. These characteristics were not linked to hyperinflation or EFL.     

Prognostic utility of NT-proBNP in acute exacerbations of chronic pulmonary diseases

Background

The prognostic value of NT-proBNP levels in patients admitted to hospital due to acute exacerbations of chronic pulmonary diseases (CPDs) is unknown.

Setting

Internal Medicine units at two general hospitals.

Methods

NT-proBNP levels were obtained within 72 h after admission in 192 consecutive patients with acute exacerbations of CPDs and no history of heart failure or diuretic treatment. Clinical characteristics and main outcomes were assessed over a 12-month follow-up. NT-proBNP cut-points for outcomes were obtained by ROC (receiver operating characteristics) curve analysis.

Results

Chronic obstructive lung disease (69.3%) and chronic asthma (22.4%) were the most prevalent CPDs, and non-pneumonic acute respiratory infection (72.4%) and pneumonia (22.9%) were the most frequent causes of exacerbation. Atrial flutter or fibrillation rate was 11%. During the one-year follow-up period, 22 patients died, 42 were re-admitted, 46 received new long-term oxygen therapy, and 39 received new diuretic treatment.NT-proBNP values correlated with hospitalisation days. NT-proBNP values over 587.9 pg/ml were associated with significantly raised one-year mortality (OR = 3.90; 95% IC 1.46-10.47; p = 0.006) and over 782.2 pg/ml with cardio-pulmonary deaths (OR = 6.38; 95% IC 1.91-21.3; p = 0.002). That association persisted after adjustment for age, gender, creatinine levels and cardiac rhythm. NT-proBNP values over 628.7 pg/ml were associated with significantly higher probability of new diuretic treatment (OR = 4.38; IC 95% 2.07-9.25; p < 0.001). The negative predictive values for these cut-points ranged from 89% to 97%.

Conclusion

NT-proBNP levels below 587.9 pg/ml in patients with acute exacerbations of CPD were associated with favourable one-year outcomes.     

Effects of arm-cranking exercise in cutaneous microcirculation in older, sedentary people

Objectives

Microvascular integrity is compromised by several diseases and conditions as well as age. Exercise can reverse these effects but it is unclear whether these are systemic or localised, or which mechanisms are responsible for observed improvements Therefore, the primary objective of this study was to assess whether arm-cranking exercise had a systemic or localised cutaneous, microcirculatory effect in an older, healthy population and compare these findings with our previous work on patients with chronic venous disease. A secondary objective was to see if improvements were greater in the lower- or in the upper-limb.

Methods

Endothelial-dependent- and independent-vasodilation were assessed on the forearm and the perimalleolar region in 14 older (59 ± 4.5 years), sedentary, healthy participants using LDF and incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP), before and after a session of arm-cranking exercise. Cutaneous blood flux data were expressed as cutaneous vascular conductance (CVC).

Results

Endothelial-dependent vasodilation increased both in the upper- (p = 0.04, d = 0.59) and lower-limb (p = 0.03, d = 0.52), after exercise. Endothelial-independent vasodilation did not change either in the lower- and upper-limb (p > 0.05 on both occasions). “Between-limbs” comparison showed that pre-exercise differences between the forearm and the lower-leg (p = 0.04, d = 0.47) disappeared after ACh-induced vasodilation, following arm-cranking exercise (p > 0.05). Conversely, SNP-induced did not change.

Conclusion

Our results suggest that in a healthy, sedentary population (and in contrast to post-surgical varicose vein patients), acute arm-cranking exercise leads to an improvement of microvascular endothelial function in the extremities.     

Low testosterone level in middle-aged male patients with coronary artery disease

Background

Endogenous testosterone has been shown to provide a protective role in the development of cardiovascular diseases in men. This study investigated the changes of testosterone level and its relationship to the severity of coronary artery stenosis in middle-aged men with coronary artery disease (CAD).

Methods

Serum testosterone concentration was measured in 87 middle-aged men patients with CAD including stable angina pectoris (SAP), unstable angina pectoris (USAP) and acute myocardial infarction (AMI). All patients underwent coronary angiography and the severity of coronary stenosis was estimated by the Gensini coronary score. The patients with the severity of coronary artery stenosis of less than 50% served as control group.

Results

The levels of testosterone in SAP group (488.2 ± 96.8 ng/dl), USAP group (411.6 ± 128.6 ng/dl) and AMI group (365.3 ± 116.6 ng/dl) were significantly lower than that in control group (562.8 ± 110.2 ng/dl) (all p < 0.05). When compared with another group among SAP, USAP and AMI groups, the level of testosterone in the AMI group was the lowest, the USAP group was the median while the SAP group was the highest (all p < 0.05). There was a significant correlation between angiographic Gensini score and testosterone level (n = 87, r = − 0.513, p < 0.05). Multiple regression analysis found that testosterone and BMI were independent predictors for CAD (testosterone: odds ratio 0.311, 95% confidence interval 0.174-0.512; BMI: odds ratio 1.905, 95% confidence interval 1.116-2.973).

Conclusion

The present study showed that middle-aged male patients with CAD present a lower level of serum testosterone and the testosterone level was negatively correlated with the severity of coronary artery stenosis.     

Renin-angiotensin system inhibitors reduce the progression of mesangioproliferative glomerulonephritis: 10 year follow-up

Background

Proteinuria is a common presentation of mesangioproliferative glomerulonephritis (MsPGN). No studies are available on the long-term effect of treatment by renin-angiotensin system (RAS) inhibitors on renal outcome in MsPGN patients. This study prospectively evaluates the effects of RAS inhibitors on renal outcome in patients with low risk MsPGN followed up for 10 years using historical patients with similar features at the time of presentation as untreated controls.

Methods

Endpoints: decrease of basal proteinuria > 20% and loss > 20% of basal glomerular filtrate rate (GFR) at the end of first year of observation. The patients were re-evaluated bimonthly during the first year and every 6 months thereafter.

Results

Twenty-five patients fulfilled the selection criteria. After one year follow-up 19 patients reached the endpoint of proteinuria and no patient reached the endpoint of GFR. No significant change in blood pressure levels (BP) and GFR was registered, by contrast daily proteinuria decreased significantly (p < 0.001), falling by 29% at sixth month and 47% at the end of the follow-up. The historical control group consisted of 15 untreated patients seen between 1987 and 1992. The two-way analysis of variance for repeated measures showed greater values of GFR (p < 0.001) and lower levels of daily proteinuria (p < 0.001) in treated patients as compared to untreated controls.

Conclusions

This 10-year follow-up study indicates that the early treatment with RAS inhibitors at low doses favourably influences the long-term renal outcome in proteinuric patients with MsPGN. Limitations were the small sample size and lack of randomization.     

Impaired carbon monoxide diffusing capacity as a marker of limited systemic sclerosis

Background

As impairment of diffusing capacity for carbon monoxide (DLCO) likely reflects underlying pulmonary vasculopathy in limited systemic sclerosis (lSSc), we examined whether DLCO could help to distinguish secondary from idiopathic Raynaud's phenomenon (iRP).

Methods

We compared pulmonary function test (PFT) results in 145 lSSc patients and 24 age- and sex-matched iRP patients. RP duration at time of PFT was similar in the two groups.

Results

DLCO values were low (< 80% of predicted) in 106 (73%) of the 145 lSSc patients, and in 69 (71%) of the 97 patients with early lSSc. Interstitial lung disease (ILD) was found in 10% of lSSc patients. DLCO was significantly lower in lSSc than in iRP (72 ± 15% versus 89 ± 9%, p < 0.0001). When evaluated, alveolar capillary membrane conductance (Dm) was markedly lower in lSSc patients without ILD than in iRP patients (45 ± 12% versus 71 ± 2.5%, p = 0.003), although capillary blood volume was not different. DLCO was low in 3 iRP patients (12.5%). The sensitivity and specificity of low DLCO values for early lSSc diagnosis in patients with Raynaud's phenomenon were 71% and 87.5%, respectively. Sensitivity was similar to that of anti-centromere-antibodies (75%) and nailfold capillary abnormalities (81%). A DLCO cutoff of < 70% had a sensitivity and specificity of 41% and 100%, respectively.In multivariable analysis, age and low DLCO were the only independent predictors of death; the hazard ratio for DLCO ≤ 50% was 7.9 (95% CI 2.3-26, p = 0.0007).

Conclusion

Isolated DLCO impairment is significantly more frequent in patients with lSSc than in patients with idiopathic iRP. DLCO measurement could be a useful diagnostic tool for lSSc.     

Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis

Background

Prediction of the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected choledocholithiasis (CDL) remains a challenging task.

Aims

We aimed to evaluate the predictive value of biochemical and ultrasound parameters and to create a corresponding model for prediction of the need for therapeutic ERCP.

Methods

203 consecutive patients referred to our center due to a firm clinical and/or biochemical suspicion for CDL. All patients underwent ERCP. Biochemical and ultrasound variables were analyzed.

Results

The sample was divided into testing group (103; 50.7%) and validation group (100; 49.3%) which did not differ in their baseline characteristics. Elevated gamma glutamil transaminase (GGT), common bile duct (CBD) diameter and presence of hyperechoic structures in CBD were found to be significant predictors for presence of CBD stones on ERCP (p < 0.05) in the testing group. We used these variables to construct a predictive model for the presence of CBD stones on ERCP. The model was tested on a second, validation group of patients using ROC analysis with the area under the ROC curve of 0.81 (%95 CI = 0.75-0.86; p < 0.001). We identified a threshold (0.86) above which, patients had a high probability (93.1%) for the need for interventional ERCP.

Conclusion

Our predictive model may help predict the need for therapeutic ERCP in patients with a suspicion for choledocholithiasis.     

Role of occult hepatitis B virus in chronic hepatitis C patients with flare of liver enzymes

Background

Occult HBV infection is defined by detection of HBV DNA in the serum or liver tissue of patients who test negative for HBsAg. The prevalence of occult HBV is higher in hepatitis C virus (HCV) positive patients than HCV negative patients and may have an impact on their clinical outcome. In this study, we evaluated the role of occult hepatitis B virus infection in chronic hepatitis C patients with ALT flare.

Methods

Sixty HBsAg negative patients with chronic hepatitis C virus infection were included. Patients were divided into 2 groups according to their ALT level: 30 patients with normal or slightly high ALT and 30 patients with ALT flare (≥ 5 times normal values). Patients in both groups were examined for the detection of anti-HBs, anti-HBc IgM, and anti-HBc IgG. HBV DNA was detected using semi-nested PCR technique.

Results

In patients with normal or slightly high ALT, HBV DNA was detected in 4 (13.3%) patients, while in those with ALT flare, HBV DNA was detected in 19 (63.3%) patients (p < 0.001). No association was found between the presence of HBV DNA and various serology markers of HBV infection.

Conclusion

Presence of occult hepatitis B, with its added deleterious effect, must always be considered in chronic hepatitis C patients especially those with flare in liver enzymes; HBsAg should not be used alone for the diagnosis of HBV infection.     

Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment

Background

Several database studies report a lack of care in elderly patients with colorectal cancer.

Purpose

To describe the management of elderly patients admitted for colorectal cancer; to identify factors associated with standard management according to recommendations and to study factors influencing the survival.

Patients and methods

All consecutive patients over 75 years managed for a colorectal adenocarcinoma in our hospital from 1995 to 2000 and followed until 2006 were retrospectively included. The appropriateness of the management of their disease according to the recommendations available at that time was assessed. Several risk factors in receiving the standard cancer treatment were tested using univariate and then multivariate logistic regression. Risk factors of survival were studied using univariate and then multivariate survival analysis.

Results

One hundred and ten patients were included. Median age was 82 years (range: 75-96). A surgical treatment was performed in 96 patients. The median overall survival was 32 (1-108) months. A standard cancer treatment according to recommendations was performed in 53 (48%) patients: adjuvant chemotherapy in 6/23 patients with stage III tumour, palliative chemotherapy in 3/18 patients with stage IV tumour and adjuvant radiotherapy in 4/14 patients who had a rectal tumour resection. Multivariate analysis retains tumour stage I or II (OR = 7.6, 95% C.I. = [2.9-19.9], p < 0.0001) as the only factor associated with standard treatment and presence of metastasis (HR = 3.9, 95% C.I. [1.4-10.8], p = 0.005), and Charlson's score >3 (HR = 28.9, 95% C.I. [2.5-335.6], p = 0.001) as independent risk factors of poor survival.

Conclusions

Fifty two percent of elderly patients have had a sub-standard cancer treatment. The majority had a surgical treatment, but only a few received chemotherapy or radiotherapy. Metastasis, older age and Charlson's comorbidity score are the main prognosis factors of poor survival.     

Mucosal healing for predicting clinical outcome in patients with ulcerative colitis using thiopurines in monotherapy

Background

Mucosal healing (MH) has emerged as a desirable treatment goal for patients with ulcerative colitis (UC). Currently little is known about the efficacy of using thiopurine immunosuppressants in monotherapy to achieve and maintain long-term MH in UC. This study analyzes the efficacy and the clinical impact of MH in patients with UC responded to thiopurine immunosuppressants in the long term.

Methods

An open, observational, cohort study in 20 patients with UC had been in clinical remission in monotherapy with thiopurine immunosuppressants for at least 1 year. MH was assessed by endoscopy. The patients according to the Mayo Endoscopic Score (0 vs 1 and 2), were followed until the end of the study or patient relapse. (according to Truelove and Witts criteria).

Results

Mean treatment time was 5.4 years. Twelve (60%) patients presented a Mayo Endoscopic Score of 0. A total of 18 patients were followed up for a median of 27.1 months. After endoscopy, 4 patients (22.2%) presented relapse, with a mean time of 27.5 months for a score ≥ 1 (95% CI; 18.2-36.8) versus 54.3 months for a score = 0 (95% CI 47.2-61.3) (p = 0.032).

Conclusions

This study shows the efficacy of thiopurine immunosuppressants in achieving mucosal healing in patients who respond to thiopurine immunosuppressants in the long term. We also observe the presence of endoscopy activity is not a rare event in this group of patients and is a predictor of early relapse.     

Monosensitization and polysensitization in allergic rhinitis

Background

Polysensitization is common in patients with allergic rhinitis (AR) and may affect clinical feature. However, there are patients who remain monosensitized.

Objective

This cross-sectional study aimed at evaluating a large cohort of AR patients to define the percentage and the features of mono- and poly-sensitized subjects.

Methods

This observational cross-sectional study included a large group of AR patients: 2415 subjects (1958 males, mean age 24.6 ± 5 years) were consecutively evaluated. Symptom severity, type and number of sensitizations, and AR duration were considered.

Results

621 patients (25.7%) were monosensitized: 377 to Parietaria, 194 to house dust mites, 19 to birch, 17 to grasses, 12 to molds, 2 to olive, and 1 to cypress. There was no difference between mono- and polysensitized patients concerning the duration of rhinitis (6 ± 2.14 years vs 6 ± 3.7).Severity of symptoms was higher in polysensitized patients than in monosensitized (p < 0.05); in addition, there was a difference among monosensitized patients: Parietaria-allergy induces the most severe symptoms.

Conclusion

This study conducted in a large AR population might suggest that monosensitized and polysensitized AR patients could constitute two different categories. In addition, the specific type of allergy may condition the clinical feature.     

The predictive value of mean platelet volume in differential diagnosis of non-functional pancreatic neuroendocrine tumors from pancreatic adenocarcinomas

Objective

The aim of the present study is to evaluate in a retrospective manner the diagnostic value of mean platelet volume (MPV) in pancreatic adenocarcinomas and pancreatic neuroendocrine tumors (PNETs).

Patients and methods

A total of 92 patients, who were admitted for pancreatic adenocarcinoma (n = 76) and PNET (n = 16) between March 2007 and December 2009, were analyzed retrospectively for demographics and clinical information.

Results

Thirty-nine patients (51.3%) had a resectable, whereas 37 patients (48.7%) had an unresectable pancreatic adenocarcinoma. Nine patients (56.3%) had a non-functional PNET, 6 patients (37.5%) had an insulinoma, and the remaining one patient had a gastrinoma. The mean age was 59.3 ± 10.5 for pancreatic adenocarcinomas and 45.1 ± 10.6 for PNETs. The mean age at diagnosis was significantly higher in patients with pancreatic adenocarcinomas than the patients with PNET (p < 0.001). Preoperative mean hemoglobin levels were significantly lower in patients with pancreatic adenocarcinoma than those with PNET (12.4 ± 1.8 g/dl vs 13.7 ± 2.2 g/dl), (p < 0.013). The preoperative median MPV levels were significantly lower in patients with PNET 7.8 fL (7.2-9.4) than in patients with pancreatic adenocarcinomas 8.6 fL (6.6-13.5), (p < 0.014). In subgroup analysis, a significant difference in MPV levels was mainly caused by the difference between pancreatic adenocarcinomas and non-functional PNETs (p = 0.017). The cut-off value of MPV level for detection of PNETs was calculated as ≤ 7.8 fL using ROC analysis [Sensitivity: 66.7%, specificity: 75.9%, AUC: 0.734 (0.587-0.880) p = 0.022]. In logistic regression analysis, independent predictive factors for determining PNETs in the differential diagnosis of pancreatic adenocarcinomas were calculated as age (OR = 0.068, 95% CI: 0.012-0.398), Ca 19-9 (OR = 0.039, 95% CI: 0.006-0.263), MPV (OR = 0.595, 95% CI: 0.243-1.458), and hemoglobin (OR = 1.317, 95% CI: 0.831-2.086).

Conclusion

Age, Ca 19-9, MPV, and hemoglobin levels have diagnostic value for distinguishing PNETs from pancreatic adenocarcinomas.     

Pyogenic liver abscess: clinical presentation and predictors of unfavorable outcome

Objectives

To describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome.

Material and methods

We performed a retrospective review of the clinical histories of patients with liver abscess (1996-2009), including those that met the diagnostic criteria for PLA. Outcome was classified as favorable or unfavorable (severe sepsis, distant infectious complications, local complications, intensive care unit admission, admission for > 30 days, death, readmission).

Results

There were 54 patients with PLA (65% men), with a mean age of 61 years. Predisposing factors consisted of biliopancreatic disease in 33%, recent admission in 20%, alcoholism in 15%, diabetes mellitus in 15%, a history of gastrointestinal neoplasm in 11% and abdominal surgery in 11%. The cause was cryptogenic in 65%, biliary in 31%, and portal in 4%. Symptoms consisted of fever in 100%, abdominal pain in 65%, vomiting in 37%, enlarged liver in 33%, systemic inflammatory response syndrome in 26%, and jaundice in 9%. Blood and pus cultures were positive in 40% and 65%, respectively. The most frequently isolated microorganisms were E. coli and Streptococcus spp. Percutaneous drainage was performed in 72% (surgical drainage was also performed in 6%), and antibiotic treatment alone was administered in 28%. Outcome was unfavorable in 52% and was associated with greater age (p = 0.016), a history of biliopancreatic disease (p = 0.007), systemic inflammatory response syndrome at diagnosis (p = 0.005), coagulation alterations (p = 0.043), aspartate aminotransferase elevation (p = 0.033), and biliary etiology (p < 0.001).

Conclusions

PLA developed in patients with comorbidity, although most were cryptogenic. The majority of PLA were resolved with antibiotic therapy and percutaneous drainage, without surgery. Mortality was 9%, but half the patients had unfavorable outcome, associated with biliary etiology and some laboratory alterations.     

Importance of maternal and cord blood viremia in pregnant women with chronic hepatitis B virus infection

Background/aim

The spontaneous preterm birth (SPB) rates in a group of HBeAg-negative chronic HBV infected pregnant women without several known risk factors for preterm delivery as well as the mother to infant HBV transmission rates was evaluated. Moreover the role of maternal data during perinatal period as well as the role of HBsAg and/or HBV-DNA presence in cord blood in respect to preterm labour and vertical transmission of the infection was examined.

Methods

138 consecutive chronic HBV infected pregnant women were haematologically, serologically and virologically evaluated during the perinatal period. 102 women were finally evaluated and fifteen of them (14.7%) exhibited SPB. Overall, 44 infants who had completed the proposed vaccination schedule were evaluated at month 12 of their life.

Results

A significant association between SPB and HBV-DNA presence in cord blood was observed (p = 0.007). HBV-DNA positivity in cord blood was significantly associated with maternal HBV-DNA levels (p = 0.002). The relative risk of HBV-DNA presence in cord blood was 6.43 times higher among women with serum HBV-DNA ≥ 10.000 copies/ml and lymphocyte count < 1500 compared to those with all the other combinations of both parameters (p = 0.001). All infants evaluated at month 12 were HBsAg-negative and exhibited undetectable HBV-DNA levels.

Conclusion

The presence of HBV-DNA in cord blood is significantly associated with SPB in chronic HBV infected pregnant women. Maternal or cord blood viremia does not pose an additional risk factor for vertical transmission of HBV infection, in passive-active immunoprotected infants from HBeAg-negative chronic HBV infected mothers.     

Is serum cystatin-C a reliable marker for metabolic syndrome?

Purpose

Chronic kidney disease and metabolic syndrome are recognized as major cardiovascular risk factors. It has been shown that cystatin C has a stronger association with mortality risk than creatinine-based estimations of glomerular filtration rate. We measured cystatin values in dyslipidemic patients and looked for correlations between renal function, cystatin, and metabolic syndrome.

Methods

There were 925 dyslipidemic patients prospectively included in this cross-sectional study and evaluated over 10 months. Each visit included clinical and biological assessment.

Results

Most patients exhibited cardiovascular risk factors other than dyslipidemia: hypertension in 34%, diabetes in 11%, and smoking in 18%. Mean triglycerides were 149 ± 136 mg/dL, mean high-density lipoprotein cholesterol 54 ± 14 mg/dL, and low-density lipoprotein 167 ± 48 mg/dL. Metabolic syndrome was present in 238 (26%) patients. Plasma creatinine did not differ between control group and metabolic syndrome patients (80 ± 26 vs 82 ± 20 μmol/L, respectively, P = .2), but creatinine clearance evaluated by abbreviated Modification of Diet in Renal Disease Study formula was lower in the metabolic syndrome group than in the non-metabolic-syndrome group (83.3 ± 18.8 mL/min/1.73m² vs 86.8 ± 16.9 mL/min/1.73m², respectively, P <.007). Cystatin value was significantly higher in metabolic syndrome patients than in others (0.86 ± 0.23 vs 0.79 ± 0.20 mg/L, respectively, P <.0001), independently of serum creatinine level and creatinine clearance. Furthermore, there was a progressive increase in cystatin, as a function of the number of metabolic syndrome components.

Conclusions

Our study shows that cystatin is associated with metabolic syndrome in dyslipidemic patients. Cystatin may be an interesting marker of metabolic syndrome and of increased cardiovascular and renal risk.     

Relation of functional characteristics and serum alpha-1-antitrypsin (AAT) concentration in patients with PiMM phenotype and chronic obstructive pulmonary disease (COPD)

Introduction

The relation of AAT phenotype and COPD still raises lots of controversy. In this study we aimed to investigate relation lung function characteristics, AAT serum level and COPD in smoking and non smoking population.

Patients and methods

This was a prospective non-randomized study in which we evaluated 45 patients with severe (stage IV) COPD. In all patients we determined AAT phenotype, serum AAT levels and lung function tests. We correlated findings in relation to the smoking status.

Results

All patients were MM type homozygotes. Serum AAT concentrations were within the reference values, amounting to 1.66 g/l in smokers and 1.80 g/l in nonsmokers. There was no significant correlation between serum AAT concentrations and lung function parameters. We have observed the higher mean values of ITGV, RV, TLC and RV/TLC in smokers and a statistically significant difference only in ITGV.

Conclusion

All of the investigated patients with severe COPD were MM type homozygotes with normal plasma level of AAT. There was no significant correlation between the phenotype and severity of COPD. We did not find significant relation of plasma AAT level and lung function impairment.     

Association of serum uric acid with body mass index among long-lived Chinese

Objectives

To examine the individual association between BMI and level of serum uric acid (SUA) among the very elderly Chinese population.

Methods

A survey was conducted on 870 long-lived subjects (aged ≥ 90 years). Subjects were divided into four groups according to quartile of BMI (< 16.6, 16.6–18.9, 18.9–21.1, ≥ 21.1 kg/m²) and to classification criteria of underweight, normal weight, overweight and obesity in BMI (< 18.5, 18.5–23.0, 23.0–27.5, ≥ 27.5 kg/m², respectively). Subjects were also divided into hyperuricemia and normal SUA groups.

Results

The sample included 661 unrelated Chinese. The mean age was 93.52 ± 3.29 years (range 90–108 years). The mean level of BMI was 19.16 ± 3.47 kg/m² and mean SUA was 318.72 ± 87.01. Compared to individuals without hyperuricemia, high level of SUA was associated with a higher level of BMI in both genders (p < 0.001). According to the both BMI classification criteria, the group with higher BMI had higher level of SUA (p < 0.001). Pearson correlation showed that SUA was significantly correlated with BMI (with coefficients r = 0.235, 0.140, in men and women, respectively). Unadjusted and adjusted multiple logistic regressions showed that odds ratios for hyperuricemia were associated with BMI according to quartile of BMI.

Conclusions

We found that among long-lived Chinese subjects, higher levels of SUA may be associated with higher BMI.     

Malaria severity status in patients with soil-transmitted helminth infections

Objective

To investigate the possible impact of soil-transmitted helminth (STH) infection on malaria severity, level of parasitaemia and clearance/reduction of Plasmodium parasites following treatment with anti-malarial drugs.

Methods

458 voluntary malaria patients who visited the Alaba Kulito Health Center, southern Ethiopia, for medical treatment in November and December 2007 were included in this study. Giemsa-stained thick and thin blood films were used for the determination of parasitaemia and identification of Plasmodium species, respectively. Stool sample was collected from these patients and diagnosed for intestinal helminths using Kato-Katz technique. Haemoglobin concentration was measured using a portable spectrophotometer (HemoCue HB 201). Malaria parasite clearance was checked on day 3 post-treatment.

Findings

The prevalence of co-infection of malaria with the major soil-transmitted helminths (STHs), i.e., with hookworm species, Ascaris lumbricoides and Trichuris trichiura was 9.6%, 6.3% and 2.1%, respectively. About 8.1% of the study subjects had severe malaria. Intensity of hookworm infection showed positive association with malaria parasite densities (F = 3.510, P = 0.033). STHs infection in general was negatively correlated with the symptoms of severe malaria (OR = 0.317, 95% CI = 0.315-0.86, P = 0.01), but a small proportion (4.5%) of malaria patients who were concurrently harboring one or more intestinal helminths had severe malaria. Only few malaria patients (2.3%) co-infected with STHs were found positive for Plasmodium parasites on day 3 post-treatment.

Conclusion

The present findings indicate that soil-transmitted helminths have very little contribution to malaria severity in co-infected individuals. The findings also indicate that STHs do not have significant impact on clearance rate of Plasmodium falciparum and Plasmodium vivax when treated with anti-malarial drugs.     

Adequacy of Vitamin D Replacement in Severe Deficiency Is Dependent on Body Mass Index

Background

Obesity is associated with hypovitaminosis D. Whether body mass index (BMI) determines the replacement dose of vitamin D to achieve sufficiency is unclear.

Objective

To determine the relationship between BMI and serum 25-OH vitamin D concentrations and whether the increase in serum 25-OH vitamin D concentrations with vitamin D replacement is dependent on BMI.

Methods

Retrospective review of anthropometric data and serum 25-OH vitamin D concentrations in 95 patients attending an outpatient clinic in a tertiary hospital. In a second component of the study, 17 hospital inpatients with severe vitamin D deficiency (serum 25-OH D concentrations < 6 ng/mL [15 nmol/L]) were supplemented with 10,000 units vitamin D₃/day orally for 1 week. Biochemistry and anthropometric measurements were compared before and after vitamin D replacement.

Results

Serum 25-OH vitamin D concentrations correlated negatively with BMI in the 95 outpatients (r² = 0.11, P <.01). In the longitudinal study, BMI correlated positively with serum intact parathyroid hormone (r² = 0.84, P <.01) and negatively with 1.25-(OH)₂ vitamin D (r² = 0.19, P = .06) at baseline. Serum 25-OH D concentrations achieved following 1 week of vitamin D₃ replacement correlated negatively with BMI (r² = 0.63, P <.01).

Conclusion

Efficacy of vitamin D supplementation is dependent on BMI. Overweight and obese patients with hypovitaminosis D might require higher doses of vitamin D to achieve vitamin D repletion compared with individuals with normal body weight.     

Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients

Purpose

To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk patients with diabetes.

Methods

In this physician-blinded, 18-month randomized controlled trial, 225 subjects with diabetes at high risk for ulceration were assigned to standard therapy (Standard Therapy Group) or dermal thermometry (Dermal Thermometry Group) groups. Both groups received therapeutic footwear, diabetic foot education, regular foot care, and performed a structured foot inspection daily. Dermal Thermometry Group subjects used an infrared skin thermometer to measure temperatures on 6 foot sites twice daily. Temperature differences >4°F between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.

Results

A total of 8.4% (n = 19) subjects ulcerated over the study period. Subjects were one third as likely to ulcerate in the Dermal Thermometry Group compared with the Standard Therapy Group (12.2% vs 4.7%, odds ratio 3.0, 95% confidence interval, 1.0 to 8.5, P = .038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (P = .04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Patients that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week before ulceration than did a random 7 consecutive-day sample of 50 other subjects that did not ulcerate (3.50 ± 1.0 vs 0.74 ± 0.05, P = .001).

Conclusions

High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.