Prevention of acute exacerbation of chronic obstructive pulmonary disease after bronchoscopic lung volume reduction with endobronchial valves

IntroductionBronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) has emerged as an important treatment method for patients with severe chronic obstructive pulmonary disease (COPD). Acute exacerbations of COPD (AECOPD) are a frequent complication following BLVR with EBV. However, there is no consensus on the prevention of AECOPD.ObjectivesOur study aims to compare the outcomes of different prophylactic measures on the occurrence of AECOPD after BLVR with EBV.MethodsWe conducted a multicenter, retrospective study of patients who underwent BLVR with EBV at six different institutions. Emphasis was directed towards the specific practices aimed at preventing AECOPD: antibiotics, steroids, antibiotics plus steroids, or no prophylaxis. Subgroups were compared, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated.ResultsA total of 170 patients were reviewed. The rate of AECOPD was 21.2% for the full cohort. Patients who received prophylaxis had a significantly lower rate of AECOPD compared with those who did not (16.7% vs. 46.2%; p = 0.001). The rate was lowest in patients who received antibiotics alone (9.2%). There was no significant difference in the rate of AECOPD between patients who received steroids alone or antibiotics plus steroids, compared with the other subgroups. The OR for AECOPD was 4.3 (95% CI: 1.8–10.4; p = 0.001) for patients not receiving prophylaxis and 3.9 (95% CI: 1.5–10.1; p = 0.004) for prophylaxis other than antibiotics alone.ConclusionsAdministration of antibiotics after BLVR with EBV was associated with a lower rate of AECOPD. This was not observed with the use of steroids or in combination with antibiotics.     

Relevance of male hormonal status with antiulcer effect of cimetidine in pylorus ligated rats

Ulcer formation after pylorus ligation was assessed in control, testosterone treated and castrated male rats after cimetidine treatment. The stomach was studied for incidence of ulcers and its contents analysed for pH, volume, total acidity, free acidity, pepsin and mucin activity. Testosterone and cimetidine when used alone protected from ulceration while when used in combination the degree of protection was decreased. Castration per se ead no effect on ulcer index but potentiated cimetidine induced gastric ulcer protection.     

Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures

A tip-apex distance (TAD) of greater than 25 mm has been shown to be an accurate predictor of lag screw cut-out when sliding hip screws (SHS) are used to treat peritrochanteric (PT) hip fractures. The purpose of this study was to determine which factors, including TAD, correlated with successful clinical outcomes of PT hip fractures surgically treated with intramedullary (IM) devices. A total of 192 patients were included in this retrospective study. The TAD values of this cohort were radiographically analysed at a mean follow-up of 13 months. This was correlated with limited functional status and the rate of revision for implant failure or inability to achieve fracture union. Only 82 patients had adequate follow-up to fracture union or definitive failure. There were 46 intertrochanteric (IT) hip fractures and 36 subtrochanteric (ST) fractures. Overall, seven patients (8.5%) went on to experience lag screw cut-out. The average TAD of the patients who did not cut-out was 18 mm, compared to 38 mm for those who did (p = 0.012). All patients who cut-out had IT fractures (p = 0.017). The percentage of cut-outs correlated directly to both the severity of IT fractures and the TAD. Using a cutoff of 25 mm there was a statistically significant difference in the incidence of lag screw cut-out (p < 0.001). As in sliding hip screws, surgeons should strive for a TAD less than 25 mm when using IM devices in the treatment of PT hip fractures to help avoid lag screw cut-out.     

HSP65-PRA identification of non-tuberculosis mycobacteria from 4892 samples suspicious for mycobacterial infections

Various molecular methods have been used for the rapid identification of mycobacterial species. In this survey, evaluation of antibiotic resistance and PCR-restriction fragment length polymorphism analysis (PRA) of the hsp65 gene was carried out for identification of non-tuberculosis mycobacteria (NTM) isolates from different clinical specimens. Forty-eight different mycobacterial isolates were selected and followed by the conventional and PRA of hsp65 for species identification. The antibiotic susceptibility test was carried out according to standard methods. A 439 bp PCR product of hsp65 in all selected isolates was amplified and digested with the BstEII and HaeIII restriction enzymes. The restriction fragment length polymorphism (RFLP) patterns were analyzed for species identification. Using PRA for 48 mycobacterial selected isolates, including 15 M. tuberculosis, one M. bovis and all 32 isolates of NTM, revealed 11 different species among the NTM isolates. The most frequent NTM isolates were M. kansasii, M. gordonae III, M. marinum, M. chelonae, M. scrofluaceum and M. gastri. In most cases, the PRA results were perfectly in accordance with the classical biochemical method. Combination of resistance to rifampin and isoniazid was present among M. kansasi, M. gordoniae III, M. scrofluaceum, M. chelonae, M. marinum, M. gastri, M. gordoniae II and M. trivale isolates. A high incidence of co-resistance to six, five, four and three anti-TB drugs was observed in 18.5%, 9.1%, 6.6% and 11.7% of all NTM isolates, respectively. Our results showed that PRA, in comparison with classical methods, is rapid and accurate enough for the identification of mycobacterial species from LJ medium. Additionally, we found that in Iran we have a highly diverse population of NTM isolates among patients suspected of having TB.