Pulmonary function changes in diabetic lung

Diabetes mellitus is a chronic and debilitating disease. Its complications give rise to micro and macrovascular diseases which affect eyes, kidneys, heart, blood vessels, nerves and also lungs. There may be a relationship between diabetes and reduced lung function, so this study was designed to evaluate the impairment of lung function on spirometry among diabetic patients. To study the effect of diabetes mellitus on the evolution of respiratory function parameters. Hundred subjects were enrolled in the study, 30 patients with type I, another 30 patients with type II and 40 subjects were controls. Mean age was 42.78 +/- 3.14 years, 45 were males and 55 were females. Mean HbAlC was 8.9 +/- 1.1%. 22 patients with diabetes duration from 5 to 10 years, 38 patients with a duration of more than 10 years. Spirometric tests were done for all groups by computerized Spirometry with six parameters Forced vital capacity [FVC], Forced expiratory volume in first second [FEV1], Peak expiratory flow rate [PEFR], Forced expiratory volume in first second to forced vital capacity [FEV1/FVC], Peak expiratory flow rate [FEFR 25-75] and Diffusing capacity for carbon monoxide [DLCO]. There was a predominant reduction in all the Spirometric parameters of diabetic patients toward the restrictive pattern as there was significant deterioration in DLCO in comparison with healthy controls. FVC [p < 0.01], and FEV1/FVC% [p < 0.001] were significantly lower in typel diabetic patients in comparison to those of type II. Impairment of lung functions was obvious with a longer duration of diabetes. Conclusion: Diabetes is associated with a significant impaired pulmonary function in a restrictive pattern as compared to non diabetics. The pulmonary function impairment was found to be more marked with diabetic duration especially after 10 years. Subjects with type I diabetes had lower FVC and FEV1/FVC% than predicted; it could be related to poor glycemic control

role of procalcitonin as a guide for the diagnosis, prognosis, and decision of antibiotic therapy for lower respiratory tract infections

Objectives: To assess the value of PCT as a rapid and sensitive marker for diagnosis, prognosis, and therapy of lower respiratory tract bacterial infections necessitating antimicrobial treatment and comparing this marker with other markers of infections including C-reactive protein [CRP] and total white-blood cell counts [WBCs]

Patients and methods: Sixty Patients were enrolled in the study, they were subjected to complete history taking, physical examination, laboratory investigations including complete blood count, blood gases, blood chemistry, bacteriological culture for sputum and blood, serology for atypicals, and PCR for respiratory viruses, serum C-reactive protein [CRP] and PCT levels were measured. The patients were divided into two groups, group 1 included 26 patients who were culture negative for bacterial infection and group 2 included 34 patients who were culture positive. Group 2 patients were given antibiotic therapy according to the culture sensitivity

Result: The results revealed that, there was no significant difference between group 1 and group 2 patients as regards age, sex, clinical manifestations, final diagnosis, white blood cell counts, blood gases, number of admitted patients, intensive care unit admission and length of hospital stay. A significant increase of PCT and CRP levels was detected in group 2 compared to group 1 at initial diagnosis. At cutoff value >0.5 ng/ml, PCT gave a sensitivity of 94.1%, specificity of 88.4%, positive predictive value [PPV] of 91.4%, negative predictive value [NPV] of 92% and diagnostic efficiency of 91.6% for diagnosis of respiratory tract bacterial infections. However, at a cutoff value >8 mg/L, CRP gave a sensitivity of 85.2%, specificity of 76.9%, PPV of 82.8%, NPV of 80% and diagnostic efficiency of 81.7%. After antibiotic therapy PCT and CRP levels dropped in group 2 patients as compared to their pre-treatment levels

Conclusion: Serum PCT level could be used as a novel marker of lower respiratory tract bacterial infections for diagnosis, prognosis and follow up of therapy. This reduces side-effects of an unnecessary antibiotic use, lowers costs, and in the long-term, leads to diminishing drug resistance

Predictors of stroke outcome in Egyptian patients following acute stroke

Stroke is a major public health problem. Certain clinical factors can predict the prognosis of functional outcome of acute stroke. Identify factors which predict the outcome of stroke Egyptian patients. Hospital-based prospective study included 220 patients with stroke. Data collection was carried out using a pretested questionnaire. The questionnaire was used to record the demographic data, clinical data, the pre hospital delay. Neurological examination with special emphasis on the muscle power was done. The patients were followed up till their time of discharge to record the length of hospital stay, and the functional outcome at time of discharge which was assessed by modified Rankin Scale [mRS]. The mean age of the studied patients was 59.8 +/- 13.2, males constituted 64.1%. Hypertension was the main co morbidity detected in 65%. The degree of weakness of the patient recorded complete paralysis in 6.8%. The median prehospital delay was 6 hours, while median the length of hospital stay was 6 days. 53.2% were independent according to mRS [good outcome] and 46.3% were dependent [bad outcome]. Forward logistic regression analysis demonstrated that motor weakness, older age, female sex and prehospital delay were the only significant predictors with prediction change in the odds equal [12.9, 7.8, 2.6,4.6 respectively]. Our data confirmed that old age, female sex, pre hospital delay, lower manual muscle strength testing score were the independent predictor of poor outcome in Egyptian stroke patients

regulatory T cells in peripheral blood of Egyptian pade with hpatitis C infection and hatocellular carcinoma

Recent studies have suggested that CD4[+] CD25[+] regulatory T cells [Tregs] are increased and linked to compromised immune responses in patients with hepatocellular carcinoma [HCC]. The forkhead/winged helix transcription factor [FOXP3] is a useful marker for the presence of Tregs as it is required for their development and function. Failure of host antitumor immunity may be caused by exaggerated suppression of tumor-associated antigen-reactive lymphocytes mediated by Treg cells; however, definitive evidence that Treg cells have an immunopathological role in human cancer is lacking. This study attempted to characterize CD4[+] CD25[+] FOXP3 Treg cells in peripheral blood of HCV and HCV related HCC patients and to understand how the Treg cells affect immune responses and contribute to disease progression. A total of 80 patients, 30 with HCV-related HCC, 25 with chronic hepatitis C virus [CHC] infection 25 HCV-related liver cirrhosis [LC] patients and 20 normal controls were enrolled randomly. Flow cytometric assay for quantification of CD4[+] CD25[+] T cells and real time PCR assay for analysis of FOXP3 were used. Our study showed that the frequency of Treg cells was significantly increased in HCC patients compared with controls, CHC and cirrhotic patients [p<0.001]. However, the frequency of Treg cells was not significantly different in CHC and cirrhotic patients, which suggests that they play a central role in tumor immunity. In addition, the level of Treg cells in peripheral blood of HCC patients was significantly higher with the extent of tumor burden [large tumor size, increased number. unclear margin and vascular involvement]. Our results suggest that CD4[+] CD25[+] FOXP3 Treg cells may impair the effector function of T cells in HCC patients, promote disease progression and represent both a potential prognostic marker and a therapeutic target for HCV-related HCC individuals. A better understanding of the mechanisms of the Treg increase in HCC may allow for future immunotherapeutic and diagnostic opportunities in this population

Compliance of diabetic patients. Pros and cons

Diabetes is a major public health problem allover the world. Compliance refers to a patient both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other health care workers. This study was conducted to demonstrate the pattern of compliance among diabetic patients, its determinants and reasons beyond noncompliance. This cross section descriptive study was conducted at the outpatient Clinic of Diabetes, Kasr Al-Aini. Their compliance pattern were assessed using special scoring. Improper compliance to diet was more prevalent [104[34.7%]]. The significant determinants of improper compliance to diet were younger age, type 1 diabetes, long duration of illness, absence of complication, positive family history, receiving 3 or more drugs per day and improper compliance to drugs. Financial constraints and depression were beyond improper diet and drugs compliance. Compliance to appointment and drugs were better than compliance to diet. Cost and psychological depression were among the main reasons of improper compliance

Do survivin and HER-2/neu play a role in rheumatoid arthritis?

Rheumatoid arthritis [RA] is an inflammatory joint disease characterized by hyperplasia of synovial tissue and pannus formation growing invasively into the cartilage, followed by cartilage and bone destruction. In RA, the proliferation of synovial fibroblasts and their invasive growth are due to impairment in the regulation of the cell cycle. Survivin belongs to the apoptosis-inhibiting proteins [IAP] family and regulates the inflammatory and destructive process inside the joints of patients with RA. RA Synovial Fibroblasts [SFs] over express the ErbB2/HER2 member of the epidermal growth factor [EOF] receptor family relative to normal fibroblasts. The aim was to study the role of survivin and HER-2/neu in the pathogenesis of RA and the association between their level and the presence of erosion in RA patients and evaluation of the possible influence of the ongoing treatment on their serum level. In this study, serum survivin and serum HER-2/neu levels were measured in 35 erosive and non-erosive RA patients and compared with age and sex matched healthy population. There was a statistically significant difference in serum HER-2/neu between RA patients and controls and also between RA patients treated with methotrexate and those treated with methotrexate and others. There was a statistically significant difference in the serum level of survivin between erosive and non-erosive RA patients

Epidemiological study for Kuwait measles outbreak - 2007

Measles is a highly contagious, serious disease. Despite the availability of a live attenuated vaccine, measles, among all vaccine-preventable diseases, remains the preeminent killer of children worldwide. Outbreaks among highly vaccinated populations have been reported elsewhere. In Kuwait despite reported MCV1 [one dose measles containing vaccine] coverage rates of >95% for more than 10 years and a routine 2-dose vaccination schedule since 1996, measles outbreaks occurred in Kuwait from second week of Jan-June 2007. This study was conducted to study epidemiological characteristics and possible sources of the outbreak. An outbreak investigation study was conducted with analysis of data provided from case based reports of confirmed measles cases recorded during the period of the outbreak were done. Analysis of data using SPSS program, with calculation of rates using midyear population census of 2007. A total of 209 cases with IR [Incidence Rate] of 6.3/10[5] population was recorded. Kuwaiti cases formed 45.0% of cases, while non-Kuwaiti were 55%. Outbreak cases reported mainly from Jabra health region [65.6%] and other health regions accounted for [34.4%]. Below one year infants formed 36.4% of cases, those between 1-4 years accounted for 27.3% of the outbreak and those aging 20 years or more formed 19.1%. Unvaccinated and those with unknown vaccination accounted for 83.3% and hospitalized cases were 72.7% of the total reported cases, but no deaths recorded. Vaccinated cases of measles formed 16.7% of the outbreak, and 6.2% caught infection from outside the countries. Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks in infants, adults, and any groups with low vaccine coverage. maintaining high vaccination coverage is important for both MCV1 and MCV2 [second dose measles containing vaccine] to prevent further outbreaks with catch up vaccination campaigns every 3-4 years to decrease accumulation of susceptible population

Incidence, risk factors, and causative agents of hospital acquired pneumonia [nosocomial pneumonia] in adult hospitalized patients in medical wards of a general hospital in Kuwait

To determine the incidence, risk factors and possible causative agents of hospital acquired pneumonia [HAP] in adult hospitalized patients in medical wards of a general hospital in Kuwait Four medical wards comprising a total of 140 beds in a 500 bedded general hospital in Kuwait Retrospective study involving records of all adult medical patients admitted to Al-Jahra Hospital between January and June 2005 who developed HAP. They were analyzed and reported by age, sex, risk factors, and causative agents. Patients admitted to the medical wards, who developed HAP [as defined by the American Thoracic Society [ATS] and the Infectious Diseases Society, IDSA] Out of a total of 1971 patients admitted over a six month period [from January to June 2005], 132 patients [6.6%] developed HAP. The commonest risk factors detected were the use of H2 blocker [75.8%], smoking [40.2%], diabetes mellitus [39.4%], and chronic obstructive pulmonary disease [COPD] [38.6%]. The commonest organisms detected on culture were Pseudomonas aerurginosa [46.2%], Klebsiella pneumoni [24.2%] and Candida albicans [21.2%]. Overall incidence of HAP in this study was 6.6% and is concordant with the reported international rates. H2 receptor blockers, cigarette smoking, diabetes mellitus and COPD were the common underlying risk factors. Candida infection likely represents a contamination effect

Serum resistin as a biomarker for hepatic state in HCV infected patients and its relation to insulin resistance

Patients with chronic liver disease display disturbances of glucose metabolism which is more prevalent among patients with chronic HCV compared with those with other liver diseases and the general population, irrespective of whether cirrhosis is resent. Insulin resistance, a "prediabetic" abnormality of blood sugar, is a specific feature of chronic hepatitis C virus [HCV] infection. To evaluate the clinical utility of the adipokine hormone resistin a potential mediator in inflammatory processes as a biomarker of disease progression in HCV infected patients and to assess if it is involved in the pathogenesis of insulin resistance. The study included 60 HCV infected patients and 20 healthy subjects as control. All cases were recruited from Kasr El Ani Hospital. They were classified into 3 groups; group [I]: Included 20 cases of HCV infected patients with no liver cirrhosis; group [II]: Included 40 cases of HCV infected patients with liver cirrhosis, it was subdivided into three subgroups according to Child-Pugh classification which were [IIa]10 cases, [IIb] 15 cases and [IIc] 15 cases and group [III]: Control group included 20 healthy subjects who were matched with the studied patients as regard age, sex and body mass index. Abdominal ultrasonography, upper endoscopy [for patient groups only], liver function, complete blood picture, erythrocytes sedimentation rate [ESR], C-reactive protein [CRP], blood sugar, fasting insulin, fasting C-peptide with calculation of insulin sensitivity [IS] by the quantitative insulin sensitivity check index [QUICKI] and serum resistin levels were done for all participants. Serum resistin level showed statistically highly significant elevation in HCV infected patients compared with the matched control group [p<0.001] and also its level showed statistically significant differences in subgroups of group [II] being higher in patients presented with complication of liver cell failure [p<0.01]. Its serum level was inversely correlated with the hepatic synthetic function including albumin [r=-0.476, p<0.001] and prothrombin concentration [r=-0.346, p<0.001]. Also, a positive correlations between resistin and biomarkers of inflammation including CRP [r=0.305, p<0.004] and TLC [r=0.268, p<0.01] and insulin resistance parameters [C-peptide r=0.285, p<0.01] were detected, while resistin was inversely correlated with insulin sensitivity [QUICKI] [r=-0.289, p<0.05]. This study demonstrates that serum resistin level is elevated in patients with HCV related chronic liver disease and might be used as a biomarker for the clinical progression of the disease. The correlation of resistin to the insulin resistance [IR] present in such patients, may suggest its possible role in the pathogenesis of insulin resistance

Prevalent PCR ribotypes and antibiotic sensitivity of clinical isolates of clostridium difficile

C.difficile is an important cause of nosocomial diarrhoea and pseudomembranous colitis [PMC], has a mortality rate that ranges from 15 to 30%. Therefore, in this study we investigated the incidence rate, toxigenicity and susceptibility pattern of C.difficile isolates to anti-anaerobic agents. We have also investigated the genotypes of clinical isolates by PCR ribotyping. The study was conducted on 80 patients [40 diarrhoeic and 40 non diarrhoeic] who had history of antibiotic exposure in the previous four weeks as well as on 20 healthy control subjects. The overall incidence rate of C.difficile was 35%. None of the healthy controls had positive culture. Analysis of the cytotoxin producing C.difficile strains showed that 40% of symptomatic and 20% of asymptomatic patients were infected by the cytotoxigenic strains [p<0.05]. A total of 35 C.difficile isolates were investigated for their susceptibility to 15 antibiotics using the E test. Amoxycillin/clavulanic acid, ampicillin, meropenem, metronidazole, penicillin, piperacillin, piperacillin/tazobactam, teicoplanin and vancomycin had excellent activity against all isolates of C.difficile. Multiple resistance to two or more antibiotics was observed in toxigenic, more than the non-toxigenic strains [ratio, 2.75:1] and in symptomatic than the asymptomatic patients [ratio, 2.5: 1]. Interestingly, the 35 C.difficile culture positive patients harboured 10 different, highly diverse PCR ribotypes. Ribotypes 097 [23%] and 078 [17%] were the most prevalent toxigenic ribotypes responsible for over one-third of the cases of C.difficile associated diarrhoea [CDAD] seen. In conclusion, we believe that the extent of C.difficile involvement in diarrhoeal diseases would be better judged by direct comparison with the isolation rates of other enteric pathogens in antibioticassociated diarrhoea. In addition, our finding suggest that metronidazole should remain the drug of choice for the therapy of CDAD. It is also concluded that the prevalent PCR ribotypes of C.difficile strains isolated in our study are different from those found in Europe