Assessment of endothelial dysfunction in idiopathic pulmonary fibrosis

Background: Idiopathic pulmonary fibrosis [IPF] is defined as a specific form of chronic fibrosing interstitial pneumonia limited to the lung, with the histopathology of UIP on surgical lung biopsy. Recent epidemiological evidence indicates that patients with IPF have an increased risk of cardiovascular disease. The vascular endothelium acts to maintain vascular homeostasis through multiple mechanisms, and alteration in its function precedes the development, progression and clinical expression of atherosclerosis

Aim of the work: To assess the prevalence of endothelial dysfunction in patients with idiopathic pulmonary fibrosis and its correlation with pulmonary hypertension

Subjects and methods: The study included two groups. The patient group included 30 IPF patients subdivided into 2 subgroups: Subgroup I [15 IPF cases] with pulmonary hypertension; Subgroup II [15 IPF cases] without pulmonary hypertension. The control group included 10 normal healthy individuals. Patients were subjected to written informed consent, detailed history taking, thorough clinical examination, collagen profile, arterial blood gases [PaO[2], SaO[2]], Pulmonary function tests [spirometry], 6 min walk test, HRCT chest scan, echocardiography, and brachial artery duplex to assess endothelial dysfunction

Results: Subgroup [I] and Subgroup [II] showed a statistically highly significant difference in brachial artery flow mediated dilatation [BADFMD] and endothelium - reactive dilatation [ERD] which indicate endothelial dysfunction compared to the control group

Conclusion: This work concluded that BADFMD and ERD more affected in IPF patients regardless of presence or absence of PH than normal population. So, endothelial dysfunction is a possible link between IPF and cardiovascular disease

Effect of support during child birth on maternal and meonatal outcome

Assess the effects on mothers and babies, of continuous, one-to-one intrapartum support compared with usual care. Assiut University Hospital, A referral hospital conducting 8000 deliveries a year. Randomized controlled trial [quasi randomization]. Women enrolled during 18 months period [January 2002 to July 2003]. A total of 500 women admitted early in labour, without risk factors necessitating continuous foetal heart rate monitoring, and consenting to participate in the trial. Women were randomly assigned to receive routine care [n=250] or continuous labour support by a specially trained nurse [n=250] during labour. Maternal outcome were need for analgesia, duration of labour, spontaneous vaginal delivery, intrapartum and immediate postpartum complications. Neonatal outcome included Apgar score <7 at five minutes, admission to special care nursery. Data were collected for all 500 women and their neonates. The need for analgesia was higher in the routine care group than the intervention group [80.4 and 66.4% respectively]. The mean duration of labour was significantly shorter in the intervention group in comparison to the control group [9.0+2.9 hrs versus 10.8+2.9 respectively]. The mode of delivery was not significant different in the two groups. There were no cases of caesarean section because, low risk cases were only recruited. Apgar score <7 at five minutes and admission to neonatal care unit were less in the intervention group than the routine care group, though the difference was not statistically significantly. Ninty percent of the intervention group expressed willingness to deliver in the hospital in the future versus 44% of the routine care group. Continuous one-to-one support started early in labour could be beneficial to the mother and the neonate, and could increase utilization of maternity services in low middle income countries