Diabetes and Deteriorating Lung Function Based on Spirometry: A Narrative Review

Background: Many pulmonary dysfunctions are noted in both type 1 and 2 diabetes. This dysfunction can be mechanical in terms of muscle tone or strength, functional in terms of diffusion capacity or gaseous exchange and chemical with regards to mediators. Many hypothesis or mechanisms were proposed and changed along the course of time to support the issue. The studies have shown an increased evidence of lung dysfunction changes in diabetes, both at a time or during the course of time. So the lung complications should also be considered among micro vascular complications to actively search for a better prognosis. Aim: To study the association of diabetes and lung function based on spirometry. Materials and methods: We identified all studies in English Language that evaluated the association of diabetes mellitus and lung function using keywords like “diabetes, lung volume, lung function, diabetes micro angiopathy, spirometry” across various published research articles using Google Scholar Data Base. Conclusion: From our narrative review, a conclusion was made that both varieties of diabetes, type 2 and type1 have reduced lung functions as reviewed by spirometry not only due to adverse events like pneumonia but also due to the extensive period of consequence of diabetes which may be because of micro angiopathy or diminished elastic recoil capability of lungs.

An under studied co-relation of diabetes and lung function

The World Health Organization estimates that more than 180 million people worldwide have diabetes, and by 2030 it is expected that this number will have doubled. There is an alarming increase in the incidence and prevalence of diabetes mellitus (DM) in Asian Indians. Epidemiology of Diabetes in India. The prevalence of diabetes is rapidly rising all over the globe at an alarming rate . Over the past 30 years, the status of diabetes has changed from being considered as a mild disorder of the elderly to one of the major causes of morbidity and mortality affecting the youth and middle aged people. Pulmonary function test (PFT) is a complete evaluation of the respiratory system including patient history, physical examinations, and tests of pulmonary function. with insulin-dependent diabetes compared with age-matched control subjects, all lifelong non-smokers. Lung CO transfer capacity is significantly affected by the integrity of lung capillary endothelium and, therefore, the findings of Sandler et al. focused attention on pulmonary vascular changes. The concept of the lung as a target organ for diabetic microangiopathy received continuing attention. Reports of lung function tests in patients with diabetes over the next 15 years have focused largely on pulmonary microangiopathy with relatively few studies of pulmonary mechanical function which leads to a restrictive lung pattern. Diabetes and Lung Function Test : Some studies showed that all the pulmonary parameters, that is, FVC, FEV1, FEF25, FEF50, FEF75, FEF25–75, FEF0.2–1.2, and PEFR were significantly reduced except FEV1/FVC in patients of type 2 DM as compared with the healthy controls. It can be concluded from our narrative review that the Type II or Type I diabetes is definitely having decreased lung functions assessed by spirometry not only because of diabetic complications like pneumonia or other but also due to long term effect of diabetes may be because of micro-angiopathy or decreased elastic recoil capacity of lungs.

Diagnostic appraisal of simultaneous application of two nested PCRs targeting MPB64 gene and IS6110 region for rapid detection of M. tuberculosis genome in culture proven clinical specimens.

Background: Early diagnosis of tuberculosis is critical for its effective management and prevention. Several gene amplifi cation methods are used in the detection of tubercle bacilli from clinical specimens. MPB64 gene and IS6110 region have been identifi ed as potential gene targets for the specifi c detection of Mycobacterium tuberculosis from direct clinical specimens. Objective: The present study was conducted to evaluate the diagnostic utility of simultaneous application of two nested polymerase chain reaction (nPCRs) targeting MPB64 and IS6110 region for the detection of M. tuberculosis genome. Materials and Methods: A total of 100 and 354 clinical specimens from the control group and clinically suspected tuberculosis patients, respectively, were included in the study. nPCRs targeting MPB64 and IS6110 region were performed. Results and Conclusion: All of the 100 clinical specimens from the control group were negative for both nPCRs. Out of the 354 clinical specimens, 339 were positive for both culture and nPCRs, 10 and 5 were positive for culture, and nPCR targeting IS6110 and MPB64 regions, respectively. To conclude, nPCRs targeting MPB64 and IS6110 region are reliable and specifi c targets when applied simultaneously on clinical specimens to attain 100% sensitivity for the detection of M. tuberculosis genome.

Nanoemulsified ethanolic extract of Pyllanthus amarus Schum & Thonn ameliorates CCl4 induced hepatotoxicity in Wistar rats.

Phyllanthus amarus (PA) is commonly used in traditional medicine for hepatoprotectivity. The major limitation is that, treatment requires a large quantity of herbal extract for a longer duration. Aim of the present study was to encapsulate ethanolic plant extract for sustained release of constituents in intestine and facilitate maximum absorption. The efficacy was compared for the hepatoprotective activity of nanoencapsulated ethanolic extract of P. amarus (NPA) and PA in carbon tetrachloride (CCl4) induced hepatotoxic male rats. Based on total phenol content (TPC), the loading efficiency of nanocapsules was 89% (pH 7.0) and optimum concentration was 2:18 (mg/mL) for plant extract: olive oil. Scanning electron microscopy (SEM) showed a spherical morphology, photon correlation spectroscopy (PCS) identified mean particle diameter as 213 nm and Fourier transform infrared spectroscopy (FT-IR) revealed that the phytoconstituents were stable. An oral dose of NPA (20 mg/kg body wt.) showed a better hepatoprotective activity than PA (100 mg/kg body wt.) and also repeated dose oral toxicity proved to be safe. These biochemical assessments were supported by rat biopsy examinations. In conclusion, the nanoemulsification method may be applied for poor water-soluble ethanolic herbal extracts to reduce the dosage and time.

Efficacy of the 6-month thrice-weekly regimen in the treatment of new sputum smear-positive pulmonary tuberculosis under clinical trial conditions.

Background. Under the Revised National Tuberculosis Control Programme of India, patients with new smear-positive pulmonary tuberculosis are treated with a thrice-weekly regimen of antitubercular drugs (2H3R3Z3E3/4H3R3 [H isoniazid, R rifampicin, Z pyrazinamide and E ethambutol]) for 6 months. We conducted a retrospective analysis of the efficacy and tolerability of this regimen under clinical trial conditions in HIV-negative patients with newly diagnosed smear-positive pulmonary tuberculosis. Methods. We retrospectively analysed the data on patients assigned to the control regimen (2H3R3Z3E3/4H3R3) in two clinical trials during 2001–06 at the National Institute for Research in Tuberculosis, Chennai, India. Results. Of the 268 patients treated with this regimen, data for efficacy analysis were available for 249. At the end of treatment, of 249 patients, 238 (96%) had a favourable status. Treatment failure occurred in the remaining 11: 7 in whom the organisms were initially drug-susceptible and 4 with initial drug resistance. Of the 238 patients who had a favourable status at the end of treatment, 14 (6%) had recurrence of tuberculosis during the following 24 months. In the intention-to-treat analysis, 245 (94%) of 262 patients had a favourable status at the end of treatment. Of the 28 patients with initial drug resistance, 24 (86%) had a favourable outcome. Only 4 of these 24 patients were found to have recurrence of tuberculosis in 2 years of follow-up. Among the 221 patients initially infected with drug-susceptible organisms, drug resistance did not develop in any of the 7 patients in whom the treatment failed or the 10 who had recurrence of tuberculosis. Further, 5 of the 7 patients in whom the treatment failed continued to excrete drug-susceptible bacilli at 6 months. Adverse drug reactions were observed in 38 (14%) of the 262 patients. Only 3 (1.1%) needed a modification in the treatment. Conclusion. This thrice-weekly 6-month regimen of antitubercular drugs, when administered under full supervision, is associated with a high rate of favourable treatment outcomes in HIV-negative patients with newly diagnosed sputum smearpositive pulmonary tuberculosis. There are few adverse drug reactions in these patients.

Detection of Mycobacterium tuberculosis directly from sputum specimens & phenotypic drug resistance pattern of M. tuberculosis isolates from suspected tuberculosis patients in Chennai.

Background & objectives: mRNA is more rapidly destroyed in cells than rRNA or genomic DNA, an assay targeting bacterial mRNA would provide a better guide to mycobacterial viability than amplification tests directed at DNA or rRNA targets. This study was carried out to standardize reverse transcriptase PCR (RT-PCR) targeting 85B gene for the rapid detection of viable Mycobacterium tuberculosis from sputum specimens of suspected TB patients at Chennai, South India and to detect MDR-TB circulating in this population. Methods: Sputum samples from clinically suspected tuberculosis patients (n=301) and 78 controls were included in the study. The sputum samples were collected in sterile diethyl pyrocarbonate (DEPC) treated containers and transported in ice to the laboratory within 2 h to prevent degradation of RNA. RT-PCR targeting 85B gene, mycobacterial culture and phenotypic drug susceptibility testing for the first line drugs streptomycin (S), isoniazid (H), rifampicin (R), ethambutol (E) and pyrazinamide (Z) were performed by BACTEC microMGIT culture system for all the sputum specimens. Results: All the 78 controls were negative for culture and RT-PCR. Among the 301 sputum specimens from patients, 231 (76.8%) were RT-PCR positive and 70 (23.2%) were negative. There were 166 M. tuberculosis isolates, of which 11 (2.9%) were MDR-TB, 33 (8.7%) were polyresistant, 31 (8.2%) were monoresistant and 91 (30.2%) were sensitive to all five first line anti-tuberculous drugs by phenotypic drug susceptibility testing. Monoresistance was higher with Z [20 (20.8%)], followed by S [6 (3%)]. Interpretation & conclusions: RT-PCR targeting 85B gene of M. tuberculosis was a specific, rapid, reliable technique to detect the M. tuberculosis directly from sputum specimens. Our results showed that 2.9 per cent of M. tuberculosis isolates in the study population of Chennai were MDR.

Rapid Detection of Viable M. tuberculosis Directly from Sputum by Reverse Transcriptase PCR Targeting 85B Gene.

This study was carried out to standardize reverse transcriptase PCR (RTPCR) targeting 85B gene for the rapid detection of viable Mycobacterium tuberculosis (M tuberculosis) from sputum specimens. 100 sputum samples from clinically suspected tuberculosis patients were included in the study. The sputum samples were collected in sterile diethyl pyrocarbonate (DEPC) treated containers and transported in ice to the laboratory within 2 hours to prevent degradation of RNA. The following microbiological analysis was performed on the sputum specimens: Ziehl Neelsen staining, Mycobacterial culture by BACTEC TB 460 reader and RT-PCR targeting 85B gene. Out of the 100 sputum samples, 40 sputum samples were Ziehl Neelsen stain positive, 58 sputum samples were culture and RT-PCR positive and 42 were culture and RT-PCR were negative. Among direct smear positive specimens, 3 specimens did not grow in culture and was RT-PCR negative indicating the non-viability of the acid-fast bacilli seen in the direct smear. The results of RT-PCR and culture against control group and clinically diagnosed tuberculosis patients were statistically significant by Chi square test (P<0.001). RT-PCR targeting 85B gene of M tuberculosis standardized in our laboratory for is a rapid, reliable and sensitive technique to detect the viable M tuberculosis directly from sputum specimens.

Spatial and temporal variations in phytoplankton in coral reef and seagrass ecosystems of the Palk Bay, southeast coast of India.

Spatial and temporal behavior of distribution of phytoplankton of the coral reef and seagrass environment of the Palk Bay was studied during April 2002 to March 2003. A total of 133 species of phytoplankton was recorded during the study period, of which, 98 species belong to Bacillariophyceae, 15 species belong to Dinophyceae, 12 species belong to Cyanophyceae and 8 species belong to Chlorophyceae. Diatoms (57.14 to 94.10%) contributed more towards the percentage composition of different groups of phytoplankton at the two stations, followed by dinoflagellates (3.12 to 28.57%), blue-greens (2.43 to 12.5%) and greens (3.7 to 7.69%). Higher phytoplankton population density was recorded during the summer season at both stations (St.1. 62,000 cells l-1 and St.2. 55,000 cells l-1). Coral reef environment was two-fold more productive (2.10-130.21 mg C m-3 hr-1) than the seagrass environment (3.30 - 85.56 mg C m-3 hr -1). Chlorophyll ‘a’ concentration showed higher values at station 1, corresponding to the higher phytoplankton population density recorded at this station along with primary productivity.

Water quality and phytoplankton characteristics in the Palk Bay, southeast coast of India.

The present study was carried out to determine the water quality in terms of physicochemical characteristics and plankton distribution in the coastal waters of Kattumavadi, Palk Bay for a period of one year from April 2002 to March 2003. Air and surface water temperatures varied from 28 degrees C to 32.50 degrees C and from 27.5 to 32.0 degrees C while light extinction coefficient (LEC) varied between 0.95 and 1.85. Salinity ranged from 26.0 to 34.5 per thousand and the pH ranged between 7.95 and 8.35. Variation in dissolved oxygen content was from 4.15 to 7.18 ml(-1), and the particulate organic carbon (POC) content varied between 0.49 and 2.28 mgCl(-1). Concentrations of nutrients viz. nitrate (2.15 to 8.28 microM), nitrite (0.12 to 0.62 microM), inorganic phosphate (1.28 to 2.15 microM) and reactive silicate (5.15 to 12.52 microM) also varied independently. Chlorophyll a content ranged from 0.28 to 1.48 mg m(-3) and the primary productivity, from 4.19 to 16.08 mgCm(-3) hr(-1). The present study recorded a total of 43 species of planktonic diatoms and two species of blue-green algae. Population density of phytoplankton varied from 18,000 to 34,000 cells l(-1). Percentage composition, of the diatoms showed minimum values during the monsoon season and the maximum values during the premonsoon season.

Cytologic diagnosis of Enterobius vermicularis eggs in an enterocutaneous fistula.

A middle-aged female underwent a laparotomy for suspected ovarian cancer and developed a discharging sinus in the right iliac fossa. Smears of the discharge showed helminthic eggs which were characterised as those of Enterobius Vermicularis. The possibility of an enterocutaneous fistula was suggested which was subsequently confirmed during a relook laparotomy.