Bone mineral density changes in male patients with chronic obstructive pulmonary disease: clinical and biochemical variables in correlation with glucocorticoids use

Recent studies have shown that osteoporosis and vertebral fractures are quite common in postmenopausal women with chronic obstructive pulmonary disease [COPD]. Few data are available in correlation between bone mass density [BMD] and men with COPD. This study was designed to investigate the prevalence of osteoporosis in men with COPD, with special regards to the role of glucocorticoids [GCs] use in these patients. We aimed to determine factors that influence bone metabolism and the clinical variables of this group of patients. We also tried to answer the arising question: should COPD patients be routinely evaluated for BMD? The study included 56 male patients with documented COPD for at least two years, their age ranged 24-66 years. Subjects were divided into 3 groups: group 1. Consisted of 18 patients, who were oral GCs users, group 2. consisted of 18 patients who were inhaled GCs users and group 3 consisted of 20 patients, never GCs users [this group was considered as the control group]. All subjects underwent measurement of BMD pulmonary function tests [PFTs] and a number of biochemical markers of bone metabolism. The associations between BMD Pulm. Function tests GCs use biochemical markers and clinical variables were analyzed. Of all 56 patients with COPD, the prevalence of osteopenia and osteoporosis as defined by WHO criteria was 26.8% and 21.4% at the lumber spine, 30.4% and 23.2% at total hip. 35.7% and 28.5% at femoral neck and 32.1% and 28.8% for total body respectively. Patients included group 1 had the lowest BMD at any site [p<0.0001]. group 2 patients had over all bone mass loss, that was indistinguishable from those who were receiving oral GCs. Group 3 patients had less bone mass reduction than the other two groups. Of the clinical and biochemical markers measured N-telopeptide was significantly correlated with bone mass [P<0.01], but there was no correlation with other markers. The lowest mean of FEVI [Forced Expiratory Volume in one second] was observed in group 1 patients. BMI [Body Mass Index] was weakly correlated with bone mass in the 3 studied groups. Bone mass loss is a common problem in male patients with COPD, while the use of oral GCs increases the frequency of osteoporosis, inhaled GCs therapy offered to protection from bone loss. COPD patients who had never treated with GCs had also a substantial risk for osteoporosis. We advocate early screening and preventive intervention

Helicobacter pylori infection with iron deficiency anemia and subnormal growth at adolescence

It is thought that helicobacter pylori infection may influence growth rate in children. The aim of this study was to determine whether helicobacter pylori infection can contribute to growth deficit, especially in adolescent children who need large amount of iron for growth. A structured questionnaire was sent to the parents of 265 healthy children aged 10 to 15 years [mean 12.9] to obtain demographic information in the parents and the environment of the 265 questionnaires sent out, 187 [70.6%, 85 girls and 102 boys] were returned. After collecting blood samples from participants, hemoglobin, serum iron, total iron binding capacity, serum ferritin, the children were tested for H. pyloti infection by CI 3-urea breath test then,for positive one, upper gastrointestinal endoscope was done to see the antrum and biopsy specimens were obtained from the antrum from which rapid urease test was done. The effects of risk factors such as H.pylori infection, iron deficiency anemia, sex, socio economic status, type of house and crowding index on growth were analyzed during multiple regression analysis of 32 H.pylori positive children, 9 [28.1%] were below 25 centile values for height, compared with 32 of 156 [20.5] H.pylori negative children. The prevalence rate of H.plylori infection was 15.8%[27 of 171]] in children without iron deficiency anemia and 31.3% [5 of 16] in those affected. The relative risk of short stature was 2.2 [95% confidence interval [CI], 1.0 to 4.8] for iron deficiency anemia, and 1.4 [95% CI, 0.8 to 2.4] for H. pylori infection. The mean height was significantly lower in the group having both H.pylori infection and iron deficiency anemia. Therefore, H.pylori infection accompanied by iron deficiency anemia, rather than H.pylori infection per se, might delay pubertal growth

Changes in the lower oesophageal sphincter after oesophageal transection for the treatment of oesophageal varices

Obviously oesophageal transection interfere with the delicate anti-reflux mechanism and it is not surprising that some patients also complain of heartburn after operation. Fourty patients [35male [87.5%] and 5 female [12.5%], mean age 35 years] with portal hypertension and oesophageal varices were treated by splenectomy, gastro-esophageal devascularisation and oesophageal transection. Pre - and post-transection manometry was done for evaluation of changes in the lower oesophageal sphincter [LOS] pressure, length and function. The results revealed, a significant reduction in the lower oesophageal sphincter pressure [LOSP] following transection [mean 14.2 mmHg] than preoperatively [mean 21.8 mm Hg] The total lower oesophageal sphincter length [LOSL] was shortened postoperatively [mean, 2.5 cm] compared to the preoperative length [mean, 3.7cm]. The percentage of lower oesophageal sphincter relaxation [LOSR] although insignficant, it was lower postoperatively [mean, 8 0.3%] than preoperative measures [mean, 93.2%]. The stage is therefore set for reflux of gastric contents and these patients should be placed on anti-reflux medication routinely. Whether the additional technical difficulty of doing an anti-reflux procedure with the oesophageal transection in patients with portal hypertension is warranted requires