Endocrinal disturbances and systemic inflammation in chronic obstructive pulmonary disease [COPD]

COPD is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders such as those involving the pituitary, thyroid, gonads, adrenals and pancreas. The aim of this work is to detect the endocrinal and inflammatory changes in COPD patients during stability of the disease and the effect of acute exacerbation on these changes. Twenty acute exacerbated COPD [AECOPD] male patients with acute respiratory failure [ARF] were included in this study as a patient group and a control group which included 10 healthy age-matched males with normal pulmonary functions and without any of the exclusion criteria. For patients enrolled in this study, measurement of serum levels of sex hormones [total testosterone, luteinizing hormone [LH] and follicle-stimulating hormone [FSH]], insulin like growth factor-1 [IGF-1] and C-reactive protein [CRP] were done on admission and 1 month after hospital discharge. For healthy group, the previous measurements were done once only. There were statistically significant decrease in serum testosterone and IGF-1 levels in patients after stabilization than those in the control group with more decrease of their levels during exacerbation and the difference between their levels in patients during exacerbation and after stabilization was statistically highly significant. As regards serum LH and FSH, there were statistically highly significant increase in their levels in COPD patients during exacerbation than those in the control group but there were non-significant differences in these hormones levels between the patients after stabilization and the control group. As regards serum CRP, there was highly significant increase in its serum level in patients in both exacerbation and after stabilization than that in the control group. The level of CRP in patients during exacerbation was higher than that after stabilization and the difference was statistically highly significant. As regards disease severity, there were statistically highly significant decrease in testosterone level in severe to very severe COPD patient group than that in mild to moderate one. There was also statistically significant decrease in serum IGF-1 level in severe to very severe COPD patient group than that in mild to moderate one. There was statistically highly significant increase in serum CRP level in severe to very severe COPD patient group than that in mild to moderate one. On the other hand, there was statistically non-significant increase in serum LH and FSH levels in severe to very severe CPOD patient group than those in mild to moderate one. There were statistically highly significant positive correlations between serum testosterone levels and both FEV[1%] predicted and PaCo[2]. There were also statistically highly significant positive correlations between serum IGF-1 levels and both FEV[1%] predicted and PaCo[2]and also between serum CRP levels and PaCo[2] in patients during exacerbation. Also during exacerbation, there was statistically highly significant negative correlation between serum CRP levels and FEV[1%] predicted. COPD leads to alterations in serum levels of sex hormones [testosterone, LH and FSH], IGF-1 and CRP. There was decrease in testosterone hormone levels of male stable COPD patients and this decrease was more evident, with compensatory increase in LH and FSH hormones levels, during exacerbation period when hypoxemia is more significant. CRP level is increased even in stable COPD and this rise is magnified with increased disease severity. IGF-1 decreased in stable COPD patients with more decrease in its level during acute exacerbation

ESAT-6-ELISpot and interferon gamma in the diagnosis of pleural tuberculosis

Appropriate diagnostic methods for tuberculous pleural effusion are vital. The IFN-gamma tests using specific Mycobacterium Tuberculos is antigens in samples from the site of infection may be promising in diagnosis of tuberculosis. Objective we examined the ability of ELISpot test using circulating peripheral blood mononuclear cells [PBMC] and compartmentalized pleural fluid mononuclear cells [PFMC] for diagnosis of active TB infection in patients with tuberculous pleural effusion. Methods PBMC and PFMC-based ELISpot test for IFN-gamma test using specific M. tuberculosis antigen: Early Secretory Antigen Target-6 protein [ESAT-6] was used for diagnosis of active TB infection. Thirty-five patients with clinically suspected tuberculous pleural effusion were enrolled over a 12-month period. Results 11 patients out of 35 were positive by culture and PCR [31.4%]. Incubation of PBMC with ESAT-6 for 8 h showed sensitivity and specificity of 82% and 92%, respectively, for the PBMC-ELISpot as compared to PFMC-ELISpot that was 54% and 96% respectively. With 24 h incubation of ESAT-6 there was around 2.5 fold increase in the median number of spot forming cells [SFCs] in PFMC from 30 to 74, whereas there was minimal increase of median number of SFCs in PBMC from 55 to 60. Conclusion ESAT-6 - ELISpot using PBMC and PFMC is useful as a tool for diagnosis of TB effusion. PFMC needs longer period of incubation for processing of ESAT-6 than PBMC. Moreover, IFN-gamma in pleural effusion [PE] is another useful way for diagnosis of TB pleurisy which is sensitive, simple and cheap

impact of repeated thoracentesis on the outcome of chemical pleurodesis in malignant pleural effusion

Repeated thoracentesis may cause pleural inflammation and induce local release of proinfammatory cytokine as tumor necrosis factor-alpha [TNF-alpha] which may subsequently enhance the release of plasminogen activator inhibitor-1 [PAI-1] and lead to fibrin formation in malignant effusion. The presence of fibrin strands after repeated thoracentesis may be of considerable value in predicting the success of subsequent pleurodesis in patients with malignant pleural effusions [MPEs]. So, the aim of this work is to study the impact of repeated thoracentesis on the outcome of chemical pleurodesis in MPE. This is a retrospective study included 116 patients with MPE, they were diagnosed finally by pleural fluid [PF] cytology and/or either computed tomography [CT]-guided biopsy or tissue biopsy [Abram's or thoracoscopic biopsy]. These patients were admitted and subjected to the following: a] Pleural tapping and the aspirated fluid was sent for chemical, cytological and bacteriological examinations for determination of the inclusion criteria, [b] Tube thoracostomy insertion, [c] Pleurodesis, and assessment of the response to pleurodesis was done once after 30 days and another after 60 days. Regarding pleurodesis success or failure in this work, there was statistically highly significant decrease in the duration of chest tube before pleurodesis in patients with successful pleurodesis than that in patients with failed one. But, statistically non-significant decrease was observed in the duration of chest tube after pleurodesis in patients with successful pleurodesis than that in patients with failed one. There was statistically significant negative correlation between the number of pleural fluid [PF] aspiration and the duration of chest tube after pleurodesis and statistically nonsignificant negative correlation between the number of PF aspiration and the duration of chest tube before pleurodesis. Also, to predict the success of the pleurodesis, after 30 days of pleurodesis with cut-point of PF aspiration number >7 times, sensitivity and specificity were 75.3% and 65.7% respectively and after 60 days of pleurodesis, also, at cut-point of PF aspiration number >7 times, sensitivity of 80.3% was higher than that after 30 days of pleurodesis and specificity of 64.4% which was near that after 30 days of pleurodesis. Repeated thoracentesis may be of considerable value in predicting the success of subsequent chemical pleurodesis in MPE. Repeated thoracentesis of MPE >7 times has good sensitivity, but low specificity in predicting success of subsequent chemical pleurodesis. Measurement of PF glucose levels and PF cytology provide information about the outcome of chemical pleurodesis in MPE

Can brain natriuretic peptide predict the outcome in patients with acute pulmonary embolism?

Risk of death is high in patients with pulmonary embolism [PE] because of right ventricular [RV] failure. Plasma levels of brain natriuretic peptide [BNP] are increased in cases of isolated chronic right ventricular dysfunction [RVD] and chronic pulmonary hypertension. However, little is known about BNP secretion during acute RVD caused by acute PE. The aim of this study is to determine BNP levels in patients with acute PE with and without RVD and to assess its role in prediction of severity and outcome of these patients. This study was conducted on 47 patients with confirmed acute PE who were admitted to the intensive care unit [ICU] of Chest Department, Zagazig University Hospitals. Patients enrolled in this study were subjected to: [a] Transthoracic echocardiography, [b] Measurement of BNP plasma levels, [c] Measurement of D-dimer serum levels and d] Computed tomography pulmonary angiography [CTPA]. There was statistically highly significant increase in plasma level of BNP [pg/mL] in patients with RVD than those without it. There were highly significant positive correlations between plasma level of BNP [pg/mL] and both RV diameter [mm] and RVSP [mmHg]. A plasma BNP level >72.5 pg/mL can predict occurrence of RVD, while a plasma level of BNP >150 pg/mL can predict death in patients with acute PE. An elevated plasma level of BNP is a prognostic factor for short-term mortality and overall short-term complicated clinical outcome, and it is a powerful indicator of RVD in patients with acute PE in the absence of left ventricular dysfunction [LVD]

Interferon gamma as a diagnostic marker for pleural tuberculosis

Background appropriate diagnostic methods for tuberculosis pleural effusion [TBPE] are vital. The IFN-gamma tests using specific M. Tuberculosis antigens in samples from the site of infection may be promising in diagnosis of tuberculosis

Objective we examined the ability of ELISpot test using circulating peripheral blood mononuclear cells [PBMC] and compartmentalized pleural fluid mononuclear cells [PFMC] for diagnosis of active TB infection in patients with TBPE

Methods PBMC and PFMC-based ELISpot test for IFN-gamma test using specific M. Tuberculosis antigen: Early Secretory Antigen Target-6 protein [ESA T-6] was used for diagnosis of active TB infection. Thirty-five patients with clinically suspected TBPE were enrolled over a 12-month period

Results eleven patients out of 35 were positive by culture and PCR [31.4%]. Incubation of PBMC with ESAT-6 for 8 hrs showed sensitivity and specficity of 82 % and 92 % respectively .for the PBMC-ELlSpot as compared to PFMC- ELlSpot that was 54% and 96 % respectively. With 24 hrs incubation of ESAT- 6 there was around 2.5 fold increase in the median number of spot forming cells [SFCs] in PFMC from 30 to 74, whereas there was minimal increase of median number of SFCs in PBMC from 55 to 60

Conclusion ESAT-6 - ELlSpot using PBMC and PFMC is useful as a tool for diagnosis of TB effusion. PFMC needs longer period of incubation for processing of ESAT-6 than PBMC. Moreover, IFN-gamma in pleural effusion [PE] is another useful way for diagnosis of TB pleurisy which is sensitive, simple and cheap

Evaluation of diagnostic value of quantiferon -TB gold test in active pulmonary tuberculosis

Tuberculosis [TB] remains the single infectious disease, causing the highest mortality in humans, leading to 3 million deaths annually. The aim of this study was to evaluate Quantiferon-TB Gold test as a method for rapid diagnosis of active pulmonary tuberculosis in comparison to tuberculin skin test [TST], sputum smear for acid fast bacilli [AFB], and sputum PCR. The study included 40 subjects who were suspected to have pulmonary TB, there were 26 cases diagnosed as active pulmonary TB by culture method, the other 14 cases was diagnosed as another pulmonary diseases and considered as control group

Results: Sputum smears for AFB had sensitivity of 46.2%, specificity of 100 %.TST had sensitivity of 76.9%, specificity of 64.3%. PCR had sensitivity of 92.3%, specificity of 100 %. Quantiferon-TB Gold had sensitivity of 84.6%, its specificity was 100 %. The combined sensitivity of Quantiferon-TB Gold test with sputum smear for AFB was 88.5% which was higher than the sensitivity of each test alone and was comparable with PCR sensitivity alone or when combined with Quantiferon -TB Gold test

Conclusion: Quantiferon-TB Gold test had good sensitivity, very high specificity and can be used as an additional rapid immunological test and may replace TST in diagnosis of active TB. The combination of Quantiferon-TB Gold test with sputum smear for AFB may be used for exclusion of active pulmonary TB