Non invasive predictors for decision making in acute exacerbation of chronic obstructive pulmonary disease [AECOPD]

Accurate prediction for prognosis is important for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease [AECOPD] requiring mechanical ventilation [MV] and for proper assessment of decision making regarding plane of management and ongoing hospital morbidity and mortality. The present study was designed to determine the predictability of non invasive parameters including APACHE II score, arterial blood gases [ABGs] and bedside Echocardiography in management of critically ill patients with COPD exacerbation either invasively or conservatively. The study was conducted on 60 adult patients [50 male and 10 female] with AECOPD, with mean age 60.1 +/- 6.2 were admitted to intensive care unite [ICU]. All patients were subjected to arterial blood gases [ABGs], APACHE II score and bedside Echocardiography study. Patients were divided into two groups according to ventilatory requirement invasive or non invasive into group I [34 patients] with need of MV and group II [26 patients] with success of conservative treatment. We found that APACHE II score, had a high predictive value for MV necessity, it was 19.17 +/- 3.4 in the group I Vs 11.46 +/- 4.4 in the group II also Doppler evidence of pulmonary hypertension had high predictive value for MV necessity. The mean value of PASP was 48.95 +/- 12.44mmHg in group I, Vs 30.71 +/- 6.5mmHg in group II with significant p value. The mean value of PAPm was 42.08 +/- 6.89mmHg in group I Vs 31.50 +/- 7.71 mmHg in group II with significant p value. Increases in the APACHE II score, the mean pulmonary artery pressure [PAPm] and pulmonary artery systolic pressure [PASP] were significantly more in patients who died in comparison to survivors in the group I. APACHE II score, bedside Echocardiography and routine arterial blood gases could be used as a marker to identify patients at the time of admission who are likely to have a poor prognosis, so that such patients can be managed aggressively, either medical conservative treatment or mechanical ventilation [NIPPV or Invasive MV]

Evaluation of polypeptide YY and ghrelin in complicated type 2 diabetic patients

The gut peptides polypeptide YY [PYY], [a potent satiety agent] and ghrelin [a potent hunger signal] are suggested to play a role in obesity. Obesity is commonly associated or complicated with hypertension [HT] and type 2 diabetes [T2D]. Thus, the current study aimed to: [i] estimate the fasting plasma levels of PYY and ghrelin in lean versus overweight subjects as well as overweight HT and T2D subjects, [ii] assess if PYY and ghrelin are affected by the glycemic state; and [iii] intercorrelate the levels of PYY and ghrehn considering insulin sensitivity, blood pressure values and lipid profile in HT and/or T2D subjects. Twelve lean healthy male subjects [group I] and fifty eight overweight, age and sex matched subjects [group II] were included in the present study. Group II [overweight group] was further sub classified into: [i] group IIa: normoglycemic normotensive subjects [n=14]; [ii] group IIb: T2D normotensive patients [n=18]; [iii] group IIc: normoglycemic HT patients [n=14]. Fasting plasma lipid profile, glucose [FG], insulin [Fl]. PYY, ghrelin and blood glycated hemoglobin A1C [HbA1C] were estimated. Insulin sensitivity was evaluated according to the homeostatic model assessment [HOMA] index. In the present study significantly lower mean plasma levels of both ghrelin and PYY were observed in all overweight groups versus the lean control group. The hypertensive and T2D groups, also, showed lower PYY and ghrelin levels compared to the over-weight normotensive normoglycemic group. Furthermore, in hypertension T2D group both present, both PYY and ghrelin levels showed further decrease. Ghrelin correlated positively with high density lipoprotein cholesterol, HDL-c [r=0.43, p<0.01]. Both ghrelin and PYY correlated negatively with BMI, FG, Fl, HbA1c, HOMA index, low density lipoprotein cholesterol [LDL-c] and mean arterial blood pressure [r=0.52, r=0.62, r=-0.73, r=-0.71, r=-0.76, r=-0.42, and r=-0.5. p<0.01 respectively for ghrelin: and r=-0.51, r=-0.61, r=-0.62, r=-0.39, and r=-0.48, p<0.05 respectively for PYY]. In controls, PYY and ghrelin were negatively correlated [r=-0.76, p<0.001]. However, in all groups of patients studied, they were positively correlated [r=0.64, p<0.001], Multiple regression analysis revealed that low ghrelin and PYY concentration were independently correlated to BMI [p=0.002, and p=0.009 respectively]. Low ghrelin was, also, independently correlated to FI [i.e., hyperinsulinemia] [p=0.04]. In the diabetic groups both PYY and ghrelun levels were lower in patients with poor glycemtc control versus controlled diabetics, as assessed byHbA1C. Thus, from the current study it could be concluded that low PYY and ghrelin levels may play a role in the pathogenesis of obesity, hypertension and T2D. Combination of a ghrelin antagonist [a hunger signal antagonist] and PYY [a satiety signal] is potentially and attractive therapeutic strategy for treatment of obesity and its complications