Pulmonary ventilatory parameters changes after pharmacologic lung volume reduction in hyperinflated stable COPD

Background: chronic obstructive pulmonary disease [COPD] increases tissue compliance, reduces elastic recoil on expiration and limits expiratory air flow which increases residual volume [RV] and thoracic gas volume [TGV] resulting in lung hyperinflation and air trapping

Objective: to evaluate pulmonary function changes after long acting inhaled bronchodilators and breathing exercise for 2 months in stable COPD patients

Study design and intervention: randomized controlled study included 60 hyperinflated stable COPD patients [total lung capacity >120% predicted].Patients were classified into 4 groups [15 patient in each group]: Breathing exercise group, Salmeterol inhalation group, Tiotropium bromide inhalation group and Control group

Main outcome measures: dyspnea and pulmonary function tests[PFT] parameters

Results: in Breathing exercise group, the mean forced expiratory volume in 1 second [FEV l], forced vital capacity [FVC] and inspiratory capacity[1C] increased significantly [pi 0.005 for each], the mean functional residual capacity [FRC], RV and total lung capacity [TLC] decreased significantly [PO 0.005 for each]. In Salmeterol inhalation group the mean FEVl and the FEVl/FVC % predicted increased significantly [p=0.014, p=0.040 respectively], the mean FRC, RV, TLC, and RV/TLC % predicted decreased significantly [p 0.005 for each]. In Tiotropium bromide inhalation group the mean FEVl value and mean IC increased significantly [p=0.001, p=0.022 respectively], the mean value for RV/TLC actual and the mean value for RV/TLC % of predicted significantly increased [p 0.005 for each]

Conclusions: in COPD addition of inhaled long acting bronchodilator or breathing exercise reduce hyperinflation and gas trapping in patients with significant hyperinflation, often to a remarkable degree

Impact of pulmonary tuberculosis on menstrual pattern and fertility

The association of pulmonary tuberculosis and female reproductive health problems is not well addressed in literature. This prospective case control study was done at Assiut University and Woman's Health Hospitals to estimate the effect of pulmonary tuberculosis [TB] on menstrual pattern and fertility of females in the childbearing period. A total of Four hundred twenty nine females with pulmonary TB in the child bearing period [study group] and one hundred age matched healthy volunteers [control group] were included in this study, A detailed history taking, clinical examination, routine investigations of pulmonary TB, and transvaginal ultrasonography [TVS] were done for all cases. Hysterosalpingography +/- combined laparoscopy and hysteroscopy whenever indicated. Menstrual abnormalities were reported in 66% of cases [286 patients]. Secondary amenorrhea [112 cases, 26.5%, p, 0.001] and hypomenorrhea [86 cases, 20%, p, 0.001] were significantly higher in study cases compared to control subjects. After completed antituberculous treatment 76% had retained normal cycles. TVS revealed functional ovarian cysts in 85 cases [19.8%]. Among 68 cases who sought fertility within one year after completion of the treatment, peritubal and fine intrauterine adhesions were diagnosed by laparoscopy and hysteroscopy in 2 and 1 infertile case respectively whereas persistence of the simple cysts was observed in 2 cases. TB had marked reversible effect on menstrual function but minimal association with genital tuberculosis and infertility. Presentment counseling of pulmonary tuberculosis patients should include a hint on these reversible changes. Persistence of menstrual dysfunction or the presence of infertility after completion of treatment should attract attention about the possibility of genital tract involvement

Influence of isotretinoin treatment on monoamines in different brain areas of male rats

Despite widespread use of isotretinoin for its anti-acne effects and its current evaluation in clinical trials as a cancer treatment, little is known about its effect on brain function and neuronal pathways in adult animals, particularly after oral administration which mimics the human route. Here, adult male rats were gavaged daily with olive oil and 1.5mg/kg/day isotretinoin for 4 weeks during which body weight was measured and changes in food intake and locomotor activity were observed. After decapitation, the concentrations of dopamine [DA], norepinephrine [NE], serotonin [5-HT] and 5-hydroxyindoleacetic acid [5-HIAA] were measured in different brain areas of rats after 2 and 4 weeks of repeated injection. The results show that, following isotretinoin administration body weight, food intake and locomotor activity were generally decreased. Treatment with isotretinoin produced marked increases in the concentrations of DA and 5-HIAA after 2 and 4 weeks and of NE after 4 weeks in the various brain regions examined. However, level of 5-HT was significantly decreased in most of the brain areas studied after 2 and 4 weeks following isotretinoin treatment. The results also show that all of these effects induced by isotretinoin treatment were tended to resolve within one week of drug cessation. It is possible to conclude that such alteration in monoamine systems could contribute to the isotretinoin induced increase in depression related behavior

Bedside cardiopulmonary characteristics distinguishing portopulmonary hypertension from primary pulmonary hypertension

The presence of pulmonary hypertension in combination with portal hypertension, otherwise termed porto-pulmonary hypertension [PPHTN], is a well-recognized complication of chronic liver disease. Primary pulmonary hypertension [IryPH] is another type of pulmonary hypertension with obscure aetiology that has similarities to PPHTN. The cardiopulmonary clinical characterestics of both types may be hard to distinguish from each other although they aren't synonymus. To differentiate the bedside cardiopulmonary profile of PPHTN from that of IryPH. A total of 20 patients with PPHTN [Group A] were recruited during the period from August 2005 to September 2007 and compared to a group of 20 patients with IryPH [GroupB]. Clinical assessment, trans-thoracic echocardiography, ECG, chest radiography, room air arterial blood gas measurements and respiratory function tests were done for all patients in addition to the diagnostic liver assessment investigations. Dyspnea on exertion, and cyanosis were main complaints of both groups. Patients with PPHTN [Group A] exhibited less elevated pulmonary pressures than patients with IryPH [mean pulmonary pressure, 51 +/- 2.1 mm Hg versus 62 +/- 2.3 mmHg, [P <0.05]. Chest radiography, Echocardiographic, and ECG findings secondary to pulmonary hypertension were different than group B [p, 0.08]. Echocardiographic signs of diastolic dysfunction were unexpectedly more in group A. Arterial blood gas measurements indicate that PPHTN exhibits a significant accentuation of the chronic respiratory alkalosis [p, 0.04] and has an increased alveolar-arterial gradient [P, 0.000] when compared to patients with IryPH. However, restrictive pulmonary dysfunction and reduced diffusion were more found in IryPH [Group B] [p, 0.05]. PPHTN and IryPH patients possess characteristics common to both groups, but, more importantly, they also have distinctive cardiopulmonary characteristics that allow differentiation. Despite tendency to have less degree of PH, PPHTN patients have more accentuated respiratory alkalosis and more increased alveolar aterial gradient than patients with primary PH also IryPH patients have more restrictive pulmonary functions. Cardiac Diastolic dysfunction is also more prominent in patients with PPHTN than in IryPH patients

Modification of lymphocyte DNA damage by antioxidant supplementation in LPS-treated rats

Oxidative stress and DNA damage have been implicated in the pathogenesis of many diseases such as chronic inflammation and sepsis. Oxidative DNA damage is an inevitable consequence of cellular metabolism, with a propensity for increased levels following toxic insult. Antioxidants could be a part of a protective strategy to minimize oxidative damage in such cases. The major goal of this study was to examine the ability of two antioxidants namely, alpha lipoic acid [ALA] and Antox [drug preparation] to protect brain from oxidative stress and modify lymphocyte DNA damage induced by lipopolysaccharid [LPS, endotoxin] Randomized seventy-five healthy adult male rats weighing 150-170 g were instructed to our experimental design. Lymphocyte DNA damage was measured using a single-cell gel electrophoresis [comet] assay. LPS injection resulted in a significant alteration on brain oxidative status observed as elevation in the level of malondialdehyde [MDA, index of lipid peroxidation], nitric oxide [NO] and reduction of reduced glutathione [GSH]. Also, the activities of antioxidant defense system, superoxide dismutase [SOD] and cataiase [CAT] were decreased significantly in rats' brain. Moreover, increase in the percentage damage of lymphocyte DNA concentration accompanied with higher tail length was observed following LPS administration. Antioxidants supplementation ameliorated brain oxidative stress by reducing levels of MDA and NO, restoring normal GSH content and normalizing the activities of antioxidant enzymes SOD and CAT. As well as the treated doses lowering the percentage of lymphocyte DNA damage and decreased tail length. In conclusion, antioxidants supplementation by ALA and Antox decreased brain oxidative stress markers and attenuated DNA damage