Prognostic value of plasma brain natriuretic peptide in patients with stable chronic obstructive pulmonary disease

Early detection of pulmonary hypertension or cor pulmonale could be beneficial in managing patients with chronic obstructive pulmonary disease [COPD] because the prognosis of these conditions is poor. Plasma brain natriuretic peptide [BNP] levels are elevated in patients with PH secondary to chronic lung diseases. The aim of the present study was to investigate the use of plasma BNP levels as a prognostic marker in patients with stable COPD. Plasma BNP was measured in controls and patients with stable COPD stage II, III and IV [according to the Global Initiative for Chronic Obstructive Lung Disease classification]. Echocardiography, arterial blood gas analysis, and spirometry were also performed for COPD patients. The study included 57 male patients with stable COPD; 19 had stage II COPD, 21 had stage III COPD, and 17 had stage IV COPD. Twenty age-matched healthy male smokers were enrolled as a control group. The plasma BNP levels were significantly higher in COPD patients compared to controls. The plasma BNP levels in COPD patients increased with disease severity. Plasma BNP levels significantly correlated with FEV1%, PaCO2, PaO2 and pulmonary artery systolic pressure. Plasma BNP levels increased significantly with disease severity, progression of chronic respiratory failure, and secondary pulmonary hypertension in patients with stable COPD. These results suggest that plasma BNP can be a useful prognostic marker to monitor COPD progression and identify cases of secondary pulmonary hypertension in patients with stable COPD

Hepatitis C virus Infection and Diabetic microvascular complications

The microvascular complications are the important cause of mortality and morbidity of either type 1 or 2 DM. Great efforts have been made to recognize the possible susceptibility or etiologic factors of these complications; whether genetic or environmental. Hepatitis C virus infection is another prevalent problem in our community. The present work aimed to study the possible impact, if any of HCV infection on microvascular complications. A total 70 diabetic patients 17 type 1 and 53 type 2, were included [20 males and 50 females] with age ranging from 13 to 72 years and 30 healthy volunteers with matched age and sex were taken as a control group. Complete history taking and full clinical examination were done. Laboratory work up was done for patients and control including urinalysis, blood sugar, serum creatinine, urinary albumin excretion, lipogram, liver function tests, HbAlc and HCV antibodies. Fundus examination was done for patients and control. Diabetics were found to have a prevalence rate of HCV infection of 32%. Prevalence of microvascular complication, nephropathy, retinopathy and neuropathy were found to be relatively higher in diabetics with HCV infection. Advanced grades of microvascular complication were more prevalent in HCV-positive diabetics. It was concluded that HCV infection is possibly a potential aggravating factor for microvascualr complications

Pituitary adrenal axis status in children with protein calorie malnutrition [PCM]

Thirty six children suffering from various forms of protein calorie ma1nutrition [PCM] [15 with marasmus, 9 with kwashiorkor and 12 with marasmic kwashiorkor] Their ages ranged in between 4 to 20 months, beside 10 healthy children of matched age and sex were similarly taken as a control group. The following investigations [serum Na and K. plasma ACTH, serum cortisol and aldosterone] were performed. There were: [1] Increased serum cortisol levels with loss of diurnal variation in all groups of PCM [2] Increased plasma ACTH levels in all groups of PCM. [3] Incomplete dexamethasone suppression [4] variable changes in the levels of serum aldosterone among various forms of PCM. In marasmic group mean serum aldosterone level was within normal, but the mean levels were significantly higher in both kwashiorkor and marasmic kwashiorkor groups. After nutritional rehabilitation the levels of these hormones returned to normal indicating that these changes are protective mechanisms as well as easy reversibility of the axis