Evaluation of dynamic hyperinflation parameters and exercise capacity at maximal exercise in patients with COPD

Hyperinflation is an important limiting factor for exercise performance in patients with chronic obstructive pulmonary disease (COPD). Hyperinflation can be determined by measuring residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC) at rest, and by measuring inspiratory capacity (IC) and end-expiratory lung volume (EELV) at maximal exercise. This study aimed to evaluate changes in hyperinflation parameters on maximal exercise in subjects with COPD. Patients with clinically stable COPD (n= 43) and healthy controls (n= 14) were included. Subjects performed pulmonary function tests and an incremental exercise test on cycle ergometry. Statistically significant differences (p< 0.05) were found regarding exercise test parameters including exercise duration, maximum oxygen uptake, breathing reserve, maximum minute ventilation, and breathing pattern between groups. There was significant increase in EELV (p< 0.05) and decrease in IC (p< 0.05) at maximum exercise when hyperinflation parameters were compared at baseline and maximum exercise. Our results showed that hyperinflation was evident at maximal exercise, although there were no hyperinflation findings at rest in subjects with COPD. We believe that in patients with COPD, it is better to evaluate hyperinflation at maximal exercise than at rest.     

Intravenous iron therapy as a possible risk factor for atherosclerosis in end-stage renal disease

Atherosclerosis is a disease of the arterial wall, with increasing wall thickness representing an early event in the progression of the disease. It has been suggested that iron overload, as assessed by increased serum ferritin concentration, may be a risk factor for atherosclerosis. The aim of this study was to investigate the relationship between the influence of intravenous (IV) iron therapy and ferritin levels and carotid intima media thickness (C-IMT) in dialysis patients. Sixty patients (51 +/- 14) years were divided into two groups according to their IMT obtained by ultrasound; group I (high risk) and group II (low risk). The parameters assessed were serum creatinine, urea, calcium, phosphorus, hemoglobin, albumin, uric acid, iron, ferritin, and lipid levels. Thirty-eight patients (88%) in group I and 5 patients (12%) in group II received IV iron therapy while 5 patients (29%) in group I and 12 patients (71%) in group II (P < 0.001) did not receive IV iron therapy. Ferritin levels were higher in group I than in group II (581 +/- 303 and 306 +/- 224) (P < 0.001). C-IMT measurements correlated with serum ferritin and with the intravenous iron dose received during the 24 months preceding the study (r = 0.315, P = 0.015; r = 0.471, P = 0.001). The findings indicate that IV iron therapy and elevated serum ferritin levels may cause an increase in the incidence of atherosclerosis.     

Anti-tumor necrosis factor-alpha therapy-induced vasculitis: case series

As experience with anti-tumor necrosis factor (TNF-alpha) therapy increases, there has been the expected emergence of reports on uncommon side effects. Large clinical trials identified the development of autoantibodies and postmarketing surveillance has identified problems including tuberculosis. There have been several case reports of drug-induced systemic lupus erythematosus. We describe eight patients with rheumatoid arthritis treated with anti-TNF therapies who developed presumed vasculitis, with different pathophysiologic causes. We discuss the literature and potential causal mechanisms, including disease activity, the role of autoantibodies, and shifts in T cell responses.     

Brain natriuretic peptide levels and cardiac functional capacity in patients with dyspnea and isolated diastolic dysfunction

Diastolic heart failure affects approximately 40%-50% of patients presenting with signs and symptoms of heart failure. The aim of this study was to investigate the relationship between brain natriuretic peptide (BNP) levels and functional capacity in patients admitted with dyspnea and diagnosed with isolated diastolic dysfunction. Fifty-four patients (mean age, 57.4 +/- 8.5 years) with class-2 dyspnea with isolated diastolic dysfunction were enrolled. Serum levels of BNP were measured, and peak oxygen consumption (peak VO(2)), anaerobic threshold (AT), and metabolic equivalent (MET) values were determined with a cardiopulmonary exercise test (CPET). There was a negative correlation between BNP levels and exercise duration (P < 0.05, r = -0.304), AT (P < 0.05, r = -0.380), and number of MET (P < 0.05, r = -0.322) determined by CPET. When patients were divided into 2 groups according to BNP levels; BNP < or = 50 pg/mL (n = 40) versus BNP > 50 pg/mL (n = 14) and analyzed, those with BNP levels > 50 pg/mL had lower peak VO(2) (P = 0.05) and anaerobic threshold (P = 0.01) compared with patients with BNP < or = 50 pg/mL. The results suggest that BNP levels provide an indication about the functional capacity determined by CPET in patients admitted with dyspnea and isolated diastolic dysfunction.     

An insight into continence management in patients with dementia

This article discuses the prevalence of urinary and faecal incontinence in people with dementia. The content explores the physiological changes affecting the older bladder and bowel together with the psychological and behavioural problems associated with dementia that impact on continence.     

A randomised trial of a Haemophilus influenzae type b conjugate vaccine in a developing country for the prevention of pneumonia--ethical considerations.

In 1993 a placebo-controlled field trial of a Haemophilus influenzae type b (Hib) conjugate vaccine was started in The Gambia. At that time Hib conjugate vaccines had been shown to be efficacious in Europe and North America for the prevention of Hib meningitis. However doubts remained about their value in developing countries, where the epidemiology of Hib disease is quite different and the most important manifestation of Hib disease is pneumonia. The ethical issues facing the investigators before and during the trial are outlined in this paper, along with the views of the different groups involved in the trial. The trial demonstrated the efficacy of the vaccine in this setting and revealed the proportion of childhood pneumonia that is likely due to Hib, which was much higher than had previously been estimated. Since the completion of the trial Hib vaccines are now recommended for use in developing countries by the World Health Organization, largely based on the results of this trial. After a delay of 17 months following the completion of the trial, national Hib vaccination was started in The Gambia in 1997 using vaccine provided by a donation from industry.     

The clinicopathological significance of Bax and Bcl-2 protein expression with tumor infiltrating lymphocytes in ovarian carcinoma

The aim of the study was to establish the prognostic and predictive value of Bax and Bcl-2 proteins in conjunction with the host immune response in primary epithelial ovarian carcinoma.83 patients were evaluated. Immunohistochemical staining was performed using anti-Bcl-2 (Dako; clone 124) and anti-Bax (Springbio; E17994) monoclonal antibodies. Additionally, the number of lymphocytes within tumor stroma lymphocyte nests were counted. Bcl-2 protein expression was lower in advanced stage than early stage (p= 0.005). High (H) Bax expression was associated with longer overall survival (OS) than lower (L) Bax expression (p=0.03). The OS of the (L) Bax/(L) Bcl-2 group was shorter than (H) Bax/(L) Bcl-2 group in advanced stage (p=0.05). The platinum-sensitive group had a statistically significant tendency for high Bax expression (p=0.04). Furthermore, the intensity of the lymphocyte infiltration was associated with tumor differentiation (p= 0.003). Our data suggests that (H) Bax protein expression prolongs survival, predicts platinum sensitivity and can be used after confirmation of this hypothesis in further prospective studies. The combined evaluation of Bax and Bcl-2 protein expression may provide additional significant prognostic information. The quantity of lymphocyte infiltration could be important for prognostic outcome.     

Assessment of the Molecular Marker of Plasmodium falciparum Chloroquine Resistance (Pfcrt) in Senegal after Several Years of Chloroquine Withdrawal

As a result of widespread antimalarial drug resistance, all African countries with endemic malaria have, in recent years, changed their malaria treatment policy. In Senegal, the health authorities changed from chloroquine (CQ) to a combination of sulfadoxine–pyrimethamine (SP) plus amodiaquine (AQ) in 2003. Since 2006, the artemisinin combination therapies (ACTs) artemether–lumefantrine (AL) and artesunate plus amodiaquine (AS/AQ) were adopted for uncomplicated malaria treatment. After several years of CQ withdrawal, the current study wished to determine the level of CQ resistance at the molecular level in selected sites in Senegal, because the scientific community is interested in using CQ again. Finger prick blood samples were collected from Plasmodium falciparum-positive children below the age of 10 years (N = 474) during cross-sectional surveys conducted in two study sites in Senegal with different malaria transmission levels. One site is in central Senegal, and the other site is in the southern part of the country. All samples were analyzed for single nucleotide polymorphisms (SNPs) in the P. falciparum CQ resistance transporter gene (Pfcrt; codons 72–76) using polymerase chain reaction (PCR) sequence-specific oligonucleotide probe (SSOP) enzyme-linked immunosorbent assay (ELISA) and real-time PCR methods. In total, the 72- to 76-codon region of Pfcrt was amplified in 449 blood samples (94.7%; 285 and 164 samples from the central and southern sites of Senegal, respectively). In both study areas, the prevalence of the Pfcrt wild-type single CVMNK haplotype was very high; in central Senegal, the prevalence was 70.5% in 2009 and 74.8% in 2010, and in southern Senegal, the prevalence was 65.4% in 2010 and 71.0% in 2011. Comparing data with older studies in Senegal, a sharp decline in the mutant type Pfcrt prevalence is evident: from 65%, 64%, and 59.5% in samples collected from various sites in 2000, 2001, and 2004 to approximately 30% in our study. A similar decrease in mutant type prevalence is noted in other neighboring countries. With the continued development of increased CQ susceptibility in many African countries, it may be possible to reintroduce CQ in the near future in a drug combination; it could possibly be given to non-vulnerable groups, but it demands close monitoring of possible reemergence of CQ resistance development.     

Fatigue and correlation with disease-specific variables, spinal mobility measures, and health-related quality of life in ankylosing spondylitis

Objectives

This study aimed to evaluate fatigue in Turkish patients with ankylosing spondylitis (AS) and its relationship with disease-specific variables, spinal mobility measures, and health-related quality of life (HR-QoL).

Methods

One hundred and ten patients diagnosed as AS according to the Modified New York Criteria and 40 healthy individuals were included in this study. The Multidimensional Assessment of Fatigue (MAF) was used in patient and control groups to assess fatigue. The first item of Bath AS Disease Activity Index (BASDAI) was also used to assess fatigue in the patient group. Evaluation included BASDAI, functional status [BAS Functional Index (BASFI)], and visual analog scale (VAS) of axial and joint pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. The generic instrument Short Form 36 (SF 36) was used to assess HR-QoL in the patient group.

Results

Patients with AS had higher total MAF scores and in all MAF subgroup scales than controls. All patient MAF scores were significantly correlated with morning stiffness, number of swollen joints, history of peripheral arthritis, BASDAI, BASFI, BASDAI-fatigue, VAS axial, VAS peripheral, and SF 36 subgroups (p < 0.05). No correlation was observed between all MAF scores and age, body mass index (BMI), disease duration, meteorological measures, and medications in patients.

Conclusions

Patients with AS defined significantly more fatigue when compared with healthy persons. MAF was related to clinical and functional status and HR-QoL of patients with AS. We assume that MAF can be used as a sensitive fatigue measure in patients with AS.     

Left Ventricular Hypertrophy and Blood Pressure Control in Automated and Continuous Ambulatory Peritoneal Dialysis Patients

Hypertension, non‐dipper blood pressure (BP) pattern and decrease in daily urine output have been associated with left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. However, there is lack of data regarding the impact of different PD regimens on these factors. We aimed to investigate the impact of circadian rhythm of BP on LVH in end‐stage renal disease patients using automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD) modalities. Twenty APD (7 men, 13 women) and 28 CAPD (16 men, 12 women) patients were included into the study. 24‐h ambulatory blood pressure monitoring (ABPM) and transthoracic echocardiography besides routine blood examinations were performed. Two groups were compared with each other for ABPM measurements, BP loads, dipping patterns, left ventricular mass index (LVMI) and daily urine output. Mean systolic and diastolic BP measurements, BP loads, LVMI, residual renal function (RRF) and percentage of non‐dippers were found to be similar for the two groups. There were positive correlations of LVMI with BP measurements and BP loads. LVMI was found to be significantly higher in diastolic non‐dippers compared to dippers (140.4 ± 35.3 vs 114.5 ± 29.7, respectively, P = 0.02). RRF and BP were found to be independent predictors of LVMI. Non‐dipping BP pattern was a frequent finding among all PD patients without an inter‐group difference. Additionally, higher BP measurements, decrease in daily urine output and non‐dipper diastolic BP pattern were associated with LVMI. In order to avoid LVH, besides correction of anemia and volume control, circadian BP variability and diastolic dipping should also be taken into consideration in PD patients.