ABSTRACT
Loss of body weight and depletion of muscle mass are common nutritional problems in Chronic Obstructive Pulmonary Disease [COPD] patients. They are associated with increase disability, reduction of respiratory and skeletal muscle mass and strength, and these exert destructive effects on pulmonary function and quality of life in COPD patients. The aim of the current study was to assess the anthropometric indices and Fat-Free Mass Index and their relationship with pulmonary function in COPD patients in Hazrat Rasool Akram hospital in Tehran. This cross sectional study comprised 63 stable COPD patients, with a mean age [SD] of 67.6 [9.4] years in disease stages 2 to 4. In this study, assessment of anthropometric indices included BMI [Body Mass Index], TSF [Triceps Skinfold Thickness], MAMC [Mid Arm Muscle Circumference] and FFMI [Fat-Free Mass Index] analyzed by bioelectric impedance categorized by percentiles according to the severity of disease. Also spirometry for measuring FEV1, FVC, FEV1/ FVC, VC was performed on all participating COPD patients. Fisher's Exact Test was used for assessing relation between anthropometric indices and FFMI with stages of disease. Assessment of relationship between anthropometric indices, FFMI and respiratory factors was performed using Pearson's Correlation Coefficient test. SPSS V.12 was used for data analysis. Reduction of weight, depletion of fat mass and fat-free mass was observed in different disease stages. Reduction of body mass index, and depletion of muscle mass showed a significant increase as the disease progressed, MAMC [P=0/02] and BMI [P=0/04]. After assessing relationship between anthropometric indices and FFMI with respiratory factors, results showed significant relationship between BMI [P=0.02, r = 0.2] and MAMC [P=0.03, r = 0.2] with FEV1. Reduction of weight, depletion of muscle and fat mass were observed in many patients along with an increase in the severity of the disease. In regard to these results, measurement of anthropometric indices in addition to BMI in routine evaluation of COPD patients, provide more information about nutritional abnormalities and alterations in body composition usually occurs in COPD patients
ABSTRACT
Adrenal insufficiency following initial treatment of active tuberculosis [TB] is a rare phenomenon. It is also one of the most important causes of mortality within the first few days of TB treatment. The present study evaluated this adverse effect of anti-tuberculous treatment. A prospective study was performed on TB patients hospitalized in Masih Daneshvari Hospital between 2004 and 2005. All patients had received standard anti-TB drug regimen. We evaluated pseudo-adrenal insufficiency in these patients. The study group included 429 patients out of which 6[1.4%] developed adrenal insufficiency following anti-TB treatment. In all 6 patients, basal serum cortisol levels were measured which were below the normal range after treatment. No patient had clinical findings of adrenal insufficiency before initiation of anti-TB therapy. After treatment with dexamethasone, the general condition of patients improved. [The average response to treatment was 3.1 +/- 1.7 days]. No mortality was reported during the treatment course or follow-up period. In TB patients, the adrenal reserve/ serum cortisol reserve level is low. Standard anti-TB drug regimen including rifampicin causes rapid catabolism of cortisol in tissues specially in the liver and lungs; therefore, serum cortisol level will be more decreased and consequently the patient develops adrenal insufficiency. As a whole, despite of the low incidence rate of this adverse effect, early diagnosis and treatment is essential to save the patient's life