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

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

Identification of right ventricular infarction in acute inferior wall myocardial infarction by tissue doppler imaging

It's important to identify patient with dominant right ventricular infarction with inferior wall MI in which right ventricular dysfunction is primarily responsible for development of hypotension and cardiogenic shock Jacob, et al., 2000.Aim to assess tissue Doppler imaging is a useful method for the detection of the right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction. Thirty patients, nine females and twenty-one males, admitted to [CCU] at Al-Hussein University Hospital between December 2009 and July 2010, classified into 2 groups, group A 15 without RVI and group B 15 with RVI plus Control group C Ten healthy individuals ;following scheme. History, risk factors, Clinical examination, 12 leads ECG ,Cardiac enzyme and Echocardiography was performed within 48 hours after the MI. As the following. Left ventricular ,Right ventricular study,Pulsed Tissue Doppler parameters show statistically significant difference between groups in JVP, Blood pressure ,cardiac enzymes, Right ventricular ejection fraction ,tricuspid annular motion ,Tricuspid regurgitation, Myocardial systolic velocity, Myocardial early diastolic velocity, Myocardial late diastolic velocity ,Isometric contraction time Jsometric relaxation time, Ejection time, myocardial performance index. The right ventricular MPI increases in patients with RVMI when accompanied by acute inferior wall MI .So RVMI could be diagnosed and predicted correctlyby the use of these Tissue Doppler imaging which are easily obtained

Critical evaluation of the role of ESWL in the management of lower ureteric stones

1 79 patients with distal ureteral calculi were treated with ESWL using the Lithostar Lithotriptor. Average stone mass was 2.13 mm and overall stone-free rate was 89.9%. Our re-treatment rate was high [47.2%] and complications were mostly minor. We noticed a relation between stone mass and stone-free rate as well as a statistically significant relation with degree of hydronephrosis. We concluded that ESWL is an appropriate line of treatment of distal ureteral stones and that ureteroscopy should also be considered. in large volume stones

Metabolic parameters in response to exercise: a study on patients with uncontrolled and controlled diabetes

The aim of this study was to assess the impact of uncontrolled diabetes on metabolic functions in response to exercise and determine whether or not appropriate control of diabetes could restore an adequate exercise tolerance. The study was conducted on 40 patients with uncontrolled diabetes mellitus. The study showed a significant impairment of the majority of the metabolic capacities in response to exercise in patients with uncontrolled diabetics. After one year of a proper control of the diabetic state, a significant improvement of the metabolic parameters was detected including maximum oxygen uptake. It was concluded that the appropriate control of diabetes improved significantly most of the metabolic functions in response to exercise