Vitamin D and chronic obstructive pulmonary disease

Background: Evidence is increasing that suggests an expanded role of vitamin D in health outcomes apart from its classic actions on the bone and calcium homeostasis. Vitamin D deficiency has been associated with some chronic respiratory illnesses; one of them is chronic obstructive pulmonary disease (COPD). Objective: This study was designed to detect vitamin D level among stable COPD patients. The effect of vitamin D supplements (200,000 IU monthly for 6 months) with regular therapy of COPD on COPD outcomes was also evaluated. Patients and methods: Pulmonary function test (PFT), COPD assessment test (CAT), 6 min walk test (6MWT), serum 25-hydroxyvitamin D (25-OHD) and ionized calcium were performed on 61 COPD patients (50 males and 11 females, mean age 61.1 years). PFT and clinical assessment were carried out at the start and completion of 6 month treatment among those with vitamin D deficiency. Twenty healthy age-matched and sex matched volunteers were also studied as a control group. Results: The distribution of vitamin D status including vitamin D deficiency, vitamin D insufficiency and vitamin D sufficiency was 16.4%, 34.4% and 49.2% respectively among COPD patients. There was no significant improvement of 6MWT, CAT score and PFT among those treated with vitamin D supplements in addition to standard therapy of COPD. Conclusion: Low serum level of vitamin D was less common among COPD patients than other studies and correlates with severity of COPD. 6 month supplementation of standard treatment with 200,000 IU monthly of vitamin D did not provide additional clinical benefit among COPD patients

Diagnostic performance of trans-thoracic sonography in patients of pneumonia and pulmonary embolism

Background: Trans-thoracic ultrasonography (TUS) has attracted great interest in the last few years in the diagnosis of some chest diseases that have a high mortality rate. Objective: This study was conducted to determine the diagnostic accuracy of TUS in patients with pneumonia and pulmonary embolism. In addition, the sonomorphological changes in both diseases were studied. Patients and methods: The study population comprised of 17 cases of pneumonia (10 males and 7 females) with a mean age of 52.02 years and 14 cases of pulmonary embolism (9 males and 5 females) with a mean age of 43.4 years. Diagnosis was based on the standard guidelines. Chest X-rays, arterial blood gases, CT chest and TUS were performed. Lung profile and other sonographic abnormalities were assessed by TUS. Results: The sensitivities, specificities and diagnostic accuracies of TUS based on lung profile vs. CT findings were 88.2%, 87.5% and 93.5% for pneumonia, 71.4%, 80.9% and 87.1% for pulmonary embolism, respectively. Chest X-ray was diagnostic for pneumonia in 11/17 cases (sensitivity 64.7%) whereas TUS was positive in 14/17 (sensitivity 82.4%) with a significant higher area under the curve for TUS vs. chest X-ray (0.84 vs. 0.70, P = 0.02). 82% and 64.3% of patients with pneumonia and pulmonary embolism, respectively had abnormal parenchymal lesions with most of these lesions showing no significant difference in the two disease entities. Conclusions: Lung profiles that can be detected using TUS can perform well to some extent as a rapid diagnostic technique among patients with pneumonia and pulmonary embolism. TUS seems to be superior to chest X-ray in the diagnosis of pneumonia. However, TUS failed to discriminate between pneumonia and pulmonary embolism on studying their parenchymal lesions

Role of cancer antigen 125 in active pulmonary tuberculosis

Background: Conventional TB diagnosis continues to rely on smear microscopy, culture and chest radiography. Other non-conventional approaches include detection of immunological response and the search for biochemical markers. Cancer antigen 125 (Ca-125) was evaluated mainly in patients with extra pulmonary TB. Objective: This study was designed to detect the role of Ca-125 in differentiating pulmonary tuberculosis from other pulmonary infections. Also to determine the value of Ca-125 was an indicator of response to anti-tuberculous drugs. Design: Eighty patients were included in the study, 27 with active pulmonary TB and 33 with other pulmonary infections. Twenty healthy volunteers were used as a control group. Measurement of serum Ca-125 was performed once in all groups, it was re-assayed after 4 months of anti-tuberculous drugs among patients with active pulmonary TB. Results: There was a significant increase of Ca-125 among patients with active pulmonary TB than the other groups, which decrease significantly after anti-tuberculous drugs. The sensitivity and specificity of Ca-125 were found to be 81.4% and 95%, respectively, at a 34.6 U/ml cut-off point. Conclusion: Ca-125 can be a useful marker in differentiating pulmonary TB from other pulmonary infections and in assessment the response to anti-tuberculoussis drugs

4C mortality score and CT severity score among COVID-19 patients: a single center prospective study

Abstract Background Predictions about the hospital course of the coronavirus disease 2019 (COVID-19) patients are of paramount value. This research was designed to validate 4C mortality and CT severity scores (CT-SS) as prognostication tools of mortality and detect their relations among patients with COVID-19 who are hospitalized. The identification of other potential mortality risk factors was also evaluated. Methods Two hundred and ninety-six confirmed COVID-19 adult cases were prospectively included. They were allocated into 3 groups according to severity; 78 in moderate group, 97 in severe group, and 121 patients in critical group. Patient demographics, clinical characteristics, co-morbidities, lines of treatment, 4C mortality score and CT severity score were assessed upon admission. Results The study revealed that 90% and 84.3% sensitivities were observed for 4C mortality and CT-SS respectively as predictors of mortality. Significant correlation between both scores (r = 0.6. p = 0.0001) was detected. Multivariate analysis identified 6.9-fold increased risk of mortality for the patients with 4C mortality score > 9.5 (p = 0.001). CT-SS > 12, age ≥ 60, male gender, hypertension and diabetes mellitus were also found as significant independent factors associated with increased mortality. Conclusions Both of 4C mortality score and CT-SS have a high sensitivity as a risk-stratification scores with a considerable correlation. In addition, they represent the most independent risk factors associated with mortality in comparison to other clinical or laboratory indices

Corneal sensitivity, ocular surface health and tear film stability after punctal plug therapy of aqueous deficient dry eye

AIM: To evaluate the effect of punctal occlusion using thermosensitive (smart plug) versus silicone plug for management of aqueous deficient dry eye on corneal sensitivity, ocular surface health and tear film stability. METHODS: A comparative prospective interventional case study included 45 patients with bilateral severe form of aqueous deficient dry eye. In each patient, the smart plug was inserted in the lower punctum of the right eye which was considered as study group 1 and silicone plug was inserted in the lower punctum of the left eye of the same patient which was considered as study group 2. All patients were subjected to careful history taking and questionnaire for subjective assessment of severity of symptoms. Corneal sensitivity, corneal fluorescein, rose bengal staining, Schirmer’s I test, tear film break up time and conjunctival impression cytology were performed pre and 1, 3 and 6mo post plug insertion. RESULTS: A statistically significant improvement in subjective and objective manifestations occurred following treatment with both types of plugs (P<0.01). The thermosensitive plug caused significant overall improvement, decrease in frequency of application of tear substitutes and improvement of conjunctival impression cytology parameters in the inserted side (P<0.01). Canaliculitis was reported in two eyes (4.4%) following punctal occlusion using thermosensitive plug (study group 1). Spontaneous plug loss occurred in 21 eyes (46.6%) in the silicone plug group (study group 2). CONCLUSION: Improvement of subjective and objective manifestations of aqueous deficient dry eye occurs following punctal plug occlusion. Thermosensitive plug has good patient's compliance with fewer complications and lower rates of loss compared to the silicone plug

Ultrasound assessment of upper airway dilator muscle contraction during transcutaneous electrical stimulation in patients with obstructive sleep apnoea

Background: Electrical current can be used to stimulate upper airway dilator muscles to treat obstructive sleep apnoea (OSA). Ultrasound devices are widely available and may be used to detect contraction of the upper airway dilator muscles assessing the functionality of electrical stimulation (ES) used for this treatment. Methods: In a physiological sub-study of a randomised controlled trial, patients with OSA underwent ultrasound examination to assess contraction of the upper airway dilator muscles in response to transcutaneous ES. Ultrasound scans were scored according to the picture quality (poor = ‘0’, acceptable = ‘1’ and good = ‘2’). Tongue base thickness was assessed in mid-sagittal and coronal planes with (D2, A2) and without ES (D1, A1), while awake and seated. The primary outcome was to determine the increase in tongue thickness during ES in both views (D2 – D1 = ΔD), as well as any increase in the cross-sectional area (CSA) in the coronal view (A2 – A1 = ΔA). Data were presented as mean and standard deviation (SD). Results: Fourteen patients [eight male, age 57.5 (9.8) years, body mass index (BMI) 29.5 (2.8) kg/m2] with OSA [Apnea-Hypopnea Index (AHI) 19.5 (10.6) × hour-1] were studied. Quality of the ultrasound scans was acceptable or good with 1.5 (0.5) points. In the mid-sagittal plane, ΔD was +0.17 (0.07) cm in midline and +0.21 (0.09) cm in the widest diameter, a percentual change of 12.2% (4%) and 12.8% (5.2%) (P<0.001, respectively). In the coronal plane, ΔD was +0.17 (0.04) cm, an increase of 12.3% (4.6%) (P<0.001, respectively), ΔA in the CSA increased by +18.9% (3.0%) with stimulation (P<0.001). There was a negative correlation between age and ΔA (r= –0.6, P=0.03), but no significant associations were found with gender, BMI, neck circumference, Epworth Sleepiness Scale (ESS), AHI, skin and subcutaneous tissue in the submental area. Conclusions: Ultrasound can visualise upper airway dilator muscle contraction during transcutaneous ES in awake patients with OSA. Contraction is best detected in the CSA of the tongue base in the coronal plane. Keywords: Tongue; genioglossus; geniohyoid; ultrasonographic; sonography; upper airwa

Apnoea-hypopnoea-index comparing the 2007 and 2012 American Academy of Sleep Medicine criteria in chronic obstructive pulmonary disease/obstructive sleep apnoea overlap syndrome

Background: In 2007 and 2012, the American Academy of Sleep Medicine (AASM) updated their scoring criteria for nocturnal respiratory events. We hypothesised that this could have led to changes in the apnoea-hypopnoea index (AHI) of patients with chronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome. Methods: In a retrospective study, polysomnographic (PSG) recordings of 34 patients with COPD/OSA overlap syndrome were independently analysed using the AASM criteria from 2007 (AASM2007) and 2012 (AASM2012). The primary outcome was the difference in AHI, the secondary outcomes were frequency of hypopnoeas, diagnosis of overlap syndrome and differences between the AASM 2007 recommended (AASM2007Rec) and altered (AASM2007Alt) classifications. Data are presented as mean (standard deviation) if normally distributed, and as median (interquartile range) if non-normally distributed. Results: The PSGs of 34 elderly [aged 67 (7.0) years] and predominantly male (m:f, 31:3) patients with COPD [FEV1%pred 48.4% (19.6%)] were analysed. The AHI using AASM2007Rec criteria was 5.9 (2.0, 15.1) events/hour vs. 20.4 (11.5, 28.0) events/hour using the 2012 criteria (P<0.001); with the AASM2007Alt criteria, the AHI was 15.0 (9.3, 26.3) events/hour (P<0.001). Using the 2012 classification, the number of scored hypopnoeas increased by +48% compared to the AASM2007Rec criteria (P<0.001), 92% of these events were associated with arousal. Although statistically non-significant, using the AASM2007Alt classification, 12% of our cohort would not have been diagnosed with COPD/OSA overlap syndrome (P=0.114), this was also the case for 47% of the cohort when the AASM2007Rec classification was used (P<0.01). Conclusions: The use of the AASM2012 scoring rules results in a significantly higher AHI compared to the AASM2007 criteria in patients with COPD/OSA overlap syndrome, mostly due to an increased number of arousal-associated hypopnoeas. These observations are important for the definition of the COPD/OSA overlap syndrome. Keywords: Polysomnography; arousal; classification; desaturation; hypopnoea

Integrated multiomics analysis to infer COVID-19 biological insights

Abstract Three years after the pandemic, we still have an imprecise comprehension of the pathogen landscape and we are left with an urgent need for early detection methods and effective therapy for severe COVID-19 patients. The implications of infection go beyond pulmonary damage since the virus hijacks the host's cellular machinery and consumes its resources. Here, we profiled the plasma proteome and metabolome of a cohort of 57 control and severe COVID-19 cases using high-resolution mass spectrometry. We analyzed their proteome and metabolome profiles with multiple depths and methodologies as conventional single omics analysis and other multi-omics integrative methods to obtain the most comprehensive method that portrays an in-depth molecular landscape of the disease. Our findings revealed that integrating the knowledge-based and statistical-based techniques (knowledge-statistical network) outperformed other methods not only on the pathway detection level but even on the number of features detected within pathways. The versatile usage of this approach could provide us with a better understanding of the molecular mechanisms behind any biological system and provide multi-dimensional therapeutic solutions by simultaneously targeting more than one pathogenic factor