The relationship between glycated hemoglobin A1c levels and exacerbation status in the patients with chronic obstructive pulmonary disease.

OBJECTIVE: This study was performed in Razi Hospital, Rasht, Iran, between March 2016 and August 2018 on a population of chronic obstructive pulmonary disease (COPD) patients (56 as COPD exacerbation group and 56 as COPD stable group). Study variables include age, sex, occupation, body mass index (BMI), cigarette consumption, duration of COPD, annual hospitalization, dyspnea, glycated hemoglobin (HbA1c), FEV1, and FEV1/FVC indices. RESULT: The mean age of the participants was 63.92 ± 10.75 years. There was a significant difference in the hospitalization between the patients with both exacerbation and normal state of COPD (P ≤ 0.001). HbA1c in the patients with exacerbation of COPD was significantly higher than stable status (P = 0.001). Logistic regression showed that HbA1c levels and hospitalization were predictors of exacerbation of COPD. HbA1c levels were statistically significant in terms of hospitalization in patients with COPD exacerbation. There was a significant difference between the HbA1c levels and MMRC in patients with COPD. The percentage of HbA1c was associated with exacerbation of COPD and HbA1c is a good predictor of disease severity in patients with COPD. It also shows that patients with COPD exacerbation and severe COPD are at the higher risk of hyperglycemia.

The effects of functional endoscopic sinus surgery on chronic obstructive pulmonary disease (COPD) and asthma: A comparative study.

PURPOSE: Chronic Rhinosinusitis (CRS) can be accompanied by asthma and, rarely by chronic obstructive pulmonary disease (COPD). Functional endoscopic sinus surgery (FESS) is the most common surgical approach for CRS which also improves asthma symptoms, but little is known about its effects on COPD. This study investigates the effects of FESS on COPD and asthma symptoms in CRS patients referred to a university hospital in northern Iran. MATERIALS AND METHODS: In a prospective study, patients with COPD or asthma and CRS who were candidates for FESS underwent endoscopic examination, spirometry, and evaluation of symptoms of CRS, COPD, and asthma before, and 2 and 6 months after FESS. Statistical analyzes were performed using SPSS software version 21 and the level of significance was considered as P < 0.05. RESULTS: Eighty-two CRS patients (45 with asthma/ mean age: 49.24 ± 12.75 years and 37 patients with COPD/ mean age: 61.43 ± 6.93 years) enrolled. In asthmatic patients, the mean FEV1 and FVC, and ACT (Asthma Control Test) score increased significantly after FESS (P < 0.001). In COPD cases, spirometry indices decreased, but CAT (COPD Assessment Test) score improved significantly (from 15.70 to 32.11) after FESS (P < 0.001). The mean SNOT score in both groups was significantly reduced. CONCLUSIONS: In CRS patients with COPD, FESS improves the condition of SNOT-22 and CAT, although does not increase spirometry parameters. In asthmatic patients, FESS improves pulmonary function and asthma symptoms. So both patient groups (i.e. CRS with COPD and with asthma) will benefit from FESS.

Persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19: a hospital-based longitudinal study.

BACKGROUND: The persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmission. There is still uncertainty on whether the recommended quarantine duration is sufficient to reduce the risk of transmission. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19. METHODS: In this hospital-based longitudinal study, 100 confirmed cases of COVID-19 were recruited between March 2020 and August 2020 in Guilan Province, north of Iran. Nasopharyngeal, blood, urine, and stool samples were obtained from each participant at the time of hospital admission, upon discharge, 1 week after discharge, and every 2 weeks until all samples were negative for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) assay. A survival analysis was also performed to identify the duration of viral persistence. RESULTS: The median duration of viral RNA persistence in the nasopharyngeal samples was 8 days from the first positive RT-PCR result upon admission (95% CI 6.91-9.09); the maximum duration of viral shedding was 25 days from admission. Positive blood, urine, and stool RT-PCR results were detected in 24%, 7%, and 6% of the patients, respectively. The median duration of viral persistence in the blood, urine, and stool samples was 7 days (95% CI 6.07-7.93), 6 days (95% CI 4.16-8.41), and 13 days (95% CI 6.96-19.4), respectively. Also, the maximum duration of viral persistence in the blood, urine, and stool samples was 17, 11, and 42 days from admission, respectively. CONCLUSION: According to the present results, immediately after the hospitalized patients were discharged, no evidence of viral genetic materials was found. Therefore, appropriate treatments were selected for the patients at this hospital. However, we recommend further investigations on a larger sample size in multi-center and prospective randomized controlled trials (RCTs) to evaluate the effects of different drugs on the shedding of the virus through body secretions.

Impact of vitamin D on spirometry findings and quality of life in patients with chronic obstructive pulmonary disease: a randomized, double-blinded, placebo-controlled clinical trial.

COPD is an irreversible chronic illness with airflow limitation. The aim of the current study was to assess the role of vitamin D3 on quality of life and pulmonary function in patients with COPD. A randomized, double-blinded clinical trial was conducted in 63 patients with COPD. Patients were placed into intervention and placebo groups. Each individual in the intervention group took 50,000 IU vitamin D3once a week for 8 weeks and then once a month for 4 months. There was no significant difference among FEV1, FEV1/FVC, and number of exacerbations in patients with COPD (P>0.05). In the intervention group, a significant difference was observed in quality of life at 2 months (P<0.001) and 6 months (P<0.001). In addition, qualitative analysis showed that the status of exacerbation had not got worse six months after initiation in the intervention group. The current study shows that consumption of 50,000 IU vitamin D3, as a convenient supplementation in a daily diet, is able to increase quality of life in patients with COPD.

Lung cancer in idiopathic pulmonary fibrosis: A systematic review and meta-analysis.

BACKGROUND: There are many epidemiological pieces of evidence that show IPF patients have the highest risk of lung cancer. We conducted a systematic review of all published data to define the characteristics of lung cancer that develops in IPF by performing a meta-analysis. METHOD: This study was performed based on the PRISMA guideline. Documents gathered by searching through the Web of Sciences, Scopus, PubMed/Medline, OVID, and COCHRANE databases which published before 03/25/2018 that related to lung cancer in IPFs' patients. Articles were searched using standard keywords as well as Mesh and Mesh Entry and all probabilistic combinations of words using Boolean operators. Data searching, extracting and quality appraising were done by two researchers, independently. At last, Random-effects size based on Cochrane test and I2 were used. The review protocol has been registered in PROSPERO with ID: CRD42018094037. RESULTS: Based on the meta-analysis conducted in 35 (0.18%) included studies, the total sample size of patients with IPF was estimated 131947 among whom 6384 had LC. The total rate of LC prevalence in IPF patients was estimated to be 13.54% (95% CI: 10.43-17.4) that was significantly 9 times higher in men vs. Women and smoker vs. non-smoker. Highest to lowest prevalence of cellular (histological) subtypes of lung cancer in IPF were SQCC (37.82%), ADC (30.79%), SmCC (20.48%), LCC (5.21%), and ADQC (4.81%), respectively. The highest and lowest stage of lung cancer in IPF patients was estimated at III and II, respectively. The highest involvement location of lung cancer in IPF patients was in the Peripheral. Also, the prevalence of the tumor region involved from the highest to the lowest was estimated to be in the RLL, LLL, RUL and LUL regions. CONCLUSIONS: Lung cancer in IPF, most commonly SQCC, presents in elderly heavy smokers with a male, locating in peripheral regions and the lower part of lung predominance.

Association of depression with type 2 diabetes and relevant factors.

BACKGROUND: Based on the high prevalence of diabetes and depression in Rasht, we conducted a study to evaluate the prevalence of depression in type 2 diabetic patients, and its association with glycemic control, chronic complications, and some clinical and paraclinical parameters in this northern state of Iran. MATERIALS AND METHODS: Beck depression inventory was used for evaluating depression on 90 type 2 diabetics and 90 healthy controls selected. Information on demographic and clinical and paraclinical characteristics was collected by interviews and from medical records. RESULTS: This cross-sectional study was performed on 90 type 2 diabetic patients (63 female and 27 male with a mean age of 54.17 ± 10.57 years) and 90 healthy matched controls. Overall, depression was significantly more prevalent in case group [37.8% vs. 16%, odds ratio (OR) = 3.29, P = 0.001]. The prevalence of depression in diabetic women was significantly higher than nondiabetic ones (39.7% vs. 15%, P = 0.002). We could not find any significant correlation between depression and positive family history of depression, duration of diabetes, HBA1c level, and body mass index. The prevalence of depression was prominently more in diabetic patients with retinopathy than in those without this complication (55.6% vs. 24%, P = 0.015). Logistic regression analysis indicated that diabetes itself was the only significant determinant of having depression (OR = 3.29, P = 0.005, 95% confidence interval: 0.118-0.667). CONCLUSION: There was a prominent prevalence of depression in type 2 diabetics overall. Depression was not correlated with duration of diabetes and glycemic control. There was a significant association between depression and retinopathy in diabetic patients. Diabetes itself was the only significant determinant of having depression after matching with other variables.