Impact of obesity and body fat distribution on pulmonary function of Egyptian children

Childhood obesity is an emerging global public health challenge. That is because the prevalence of obesity among children and adolescents has increased greatly in all parts of the world.[1] Overweight and obese children are at increased risk of a wide range of health conditions including respiratory diseases. A number of studies have reported an inverse relation between respiratory function and various indices of obesity or fat distribution.[2] The aim of this work: was to study the impact of obesity on pulmonary function and to assess the correlation between lung function impairment, degree of obesity and fat distribution in Egyptian children with simple obesity. Patients and method: This study was conducted on thirty children. They were divided into two groups. Group I included 20 children with simple obesity. Group II included 10 healthy normal children as a control group. All children were subjected to full history taking, thorough clinical examination, anthropometric assessment, plane x-ray left hand for bone age assessment, plane x-ray chest and pulmonary function testing including: FVC, FEV1, FEV1 / FVC or FEV1%, PEF maximum, PEF25%, 50% and 75%,: FEF25-75%, MVV. Obese children had statistically significant higher rate of chest symptoms suggestive of bronchial asthma than the control group. They had also statistically significant reductions in FVC, FEV1, PEF, and MVV. They showed also lower values of FEV1/FVC ratio FEF 25%, 50%, 75% and FEF 25-75% when compared with control group but the difference did not reach significant level. BMI had significant negative correlation with FVC, FEV1, PEF max, flow rates [FEF25%, FEF50%, and FEF25-75%] and MVV. Triceps skin fold thickness had significant negative correlation with, FEV1, FEF25%, FEF50%, PEF max, and MVV. MAC was inversely correlated with FEV1, FEF25%, FEF50%, FEF75%, PEF max, and MVV. There was no statistically significant correlation between waist circumference or WHR and all the parameters of pulmonary functions. Obese children have more respiratory symptoms than their normal weight peers. They have significant restrictive pulmonary defect, evident small airways obstruction and a defect in respiratory musculature, week effort and coordination, with increased airway resistance. BMI was inversely correlated with most of pulmonary function abnormalities. So, BMI is recommended to be used as a predictor of pulmonary function in assessment of obese children in epidemiological studies

Influence of obstructive sleep apnea syndrome on left ventricular performance: a tissue doppler imaging study

The syndrome of obstructive sleep apnea [OSAS] is characterized by recurrent upper airway obstructions during sleep, and this might lead to cardiovascular consequences such as heart failure, arrhythmias, myocardial infarction, systemic and pulmonary arterial hypertension. Is to assess, by tissue Doppler imaging [TDI] technique, left ventricular [LV] global systolic and diastolic functions, dimensions, wall thickness and mass index in normotensive patients with obstructive sleep apnea syndrome [OSAS]. Fifty one individuals were recruited in this study. They were divided into 2 groups: group 1 included 36 normotensive patients who were referred to sleep laboratory because of symptoms of nocturnal snoring and/or excessive daytime sleepiness and suspected OSAS. Group 2: included 15 healthy individuals of matched age, sex and body mass index. All patients had Epworth Sleepness Scale [ESS] > 10 and were subjected to sleep study by polysomnography. OSAS was considered mild to moderate if apnea- Hypopnea index [AHI] was 5- 20 and severe if AHl was >/= 20. All individuals underwent tissue Doppler imaging study for assessing left ventricular Tei index, mitral annulus systolic, early diastolic and late diastolic velocities [Sa, Ea and Aa, respectively] as well as isovolumetric relaxation and contraction times and ejection times. LV end diastolic and systolic dimensions [EDD and ESD] as well as interventricular septum and posterior wall thicknes [IVST and PWT] were measured by M-mode echocardiography. LV mass index was calculated according to previous formula. AHI was 5-20 in ten patients, and >20 in 26 patients. Patients group had higher Tei index suggesting impaired global systolic and/or diastolic functions [Tei index: 0.48 +/- 0.12 versus 0.37 +/- 0.03, p<0.05 in patients versus control groups, respectively]. They, also, had higher Aa and longer IVRT [Aa: 9.8 +/- 1.8 versus 8.1 +/- 1.5 cm/sec, p<0.05 and IVRT: 99 +/- 113 versus 73 +/- 8.2 msec, p<0.01], but lower Ea and Ea/Aa ratio, consistent with impaired diastolic function [Ea: 9.5 +/- 2.9 versus 12.9 +/- 2.6 cm/sec, p<0.01, Ea/Aa ratio: 0.85 +/- 0.2 versus 1.2 +/- 0.7, p<0.05. Again, IVST and PWT were more increased in patients group compared to controls. On the other hand, Sa and ejection fraction did not significantly differ from those of control group suggesting an intact LV systolic function [Sa: 8.9 +/- 1,8 versus 9.3 +/- 1.5 cm/sec, p>0.05 and EF: 61.2 +/- 5 versus 63.9 +/- 6.3%, p>0.05. Again, neither LV-EDD nor ESD differed significantly from control group. There was a significant positive correlation between AHI and Tei index [r= 0.73, p<0.01] and also between AHI and IVST, PWTandLVMI. This study suggests that LV diastolic function is impaired in normotensive patients with OSAS while systolic function is intact. Although these patients had normal blood pressure, they had LVH and increased LV mass index. There was a significant and positive correlation between AHI and Tei index and between AHI and IVST. The impact of these findings on clinical outcome may need further evaluation

Some differences between dyspnea of cardiac origin and dyspnea of pulmonary origin in the elderly

Acute dyspnea is a common problem among elderly patients. Few studies have examined acute dyspnea in the elderly. The most common causes of dyspnea in the elderly are either of cardiac origin include heart failure, or of pulmonary origin as chronic obstructive pulmonary disease and asthma. Other causes include parenchymal lung disease, pulmonary vascular diseases, upper airway obstruction and pneumonia. In clinical practice, it is often difficult to distinguish between cardiac and pulmonary causes of dyspnea. To detect some differences between cases of cardiac dyspnea and those suffering from pulmonary dyspnea in elderly patients admitted to the departement of Geriatrics in Ain Shams University hospital. All patients admitted to the department of Geriatrics in Ain Shams University hospital with acute dyspnea as a main complaint for a period of 6 months [56 patients] were evaluated by both clinical assessment and some investigations as arterial blood gases, chest X ray, ECG, echocardiography. Accordingly determination of the cause of dyspnea was made. Comparison between the three groups i.e. cardiac, pulmonary and mixed were made regarding number, mean age, mean PO2, delirium and ICU admission. The total number of patients presented to the geriatric department during the period of the study were 361 patients, so those 56 patients represented 15% from the total admission. 37.5% of cases were suffering from dyspnea of pulmonary origin. The rest were suffering from cardiac dyspnea [26.8%], mixed type [26.8%] and [8.9%] only were suffering from dyspnea due to other causes. The highest mean age was among the mixed group. There was no statistically significant difference between the three groups regarding sex, delirium and ICU admission. The lowest mean PaO[2] was among those with mixed cardiac and pulmonary dyspnea and the highest was among the cardiac group. In the elderly it is difficult to set out points of differentiation between dyspnea of cardiac origin and that of pulmonary origin. The number of mixed cases is relatively high. It was found also that there are other confounding factors which are important in predicting mortality and morbidity should be considered when we are assessing cases of acute dyspnea in the elderly