Echocardiography and N-terminal-pro-brain natriuretic peptide in assessment of left ventricular diastolic dysfunction in stable COPD in relation to disease severity

Introduction: Left ventricular diastolic dysfunction (LVDD) is found to be frequent in COPD patients. Relationship between airflow obstruction and cardiovascular risk can be explained by inflammation which is considered one of systemic manifestations of COPD. Objective: To assess the LVDD in COPD patients in relation to disease severity using echocardiography, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitive C-reactive protein (hs-CRP). Patients and methods: This prospective study was carried out on 60 stable COPD patients who were recruited from outpatient chest clinics, Tanta University Hospitals. Diagnosis of COPD was made according to criteria of the Global Initiative for Chronic Obstructive Lung Disease. Patients were subjected to medical history and physical examination, chest X ray, pulmonary functions, ECG and echocardiography. Blood samples were withdrawn for assessment of NT-proBNP and hs-CRP. Results: Diastolic function of the heart was evaluated by echocardiography using: isovolumetric relaxation time (IVRT), deceleration time of early transmitral flow, ratio of the peak velocity of the early E wave/A wave which suggested that LVDD was recorded more in severe/very severe compared to mild/moderate COPD. Significant positive correlations were found between Nt-pro BNP and hs-CRP, IVRT, deceleration time of early transmitral flow and E/A wave ratio. Sensitivity, specificity and accuracy were 83.1, 90 and 0.94% for Nt-pro BNP. Conclusions: Evaluation of NT-proBNP was important for detection of LVDD in COPD patients, which was correlated with disease severity. Echocardiographic assessment of COPD patients, especially in combination with NT-proBNP can be considered as good diagnostic tools of LVDD in COPD

Medical thoracoscopic versus ultrasound guided transthoracic pleural needle biopsy in diagnosis of pleural lesions

Background: Medical thoracoscopy increases the diagnostic yield in patients with undiagnosed pleural effusion. Ultrasound guided pleural biopsies are safe procedures with high diagnostic yields. Objective: To compare safety and efficacy of medical thoracoscopic versus ultrasound guided transthoracic needle biopsy in the diagnosis of pleural lesions. Patients and methods: 40 patients with undiagnosed pleural lesions were divided into 2 groups. After clinical, radiological examination and laboratory investigations; pleural biopsies were taken by ultrasound guided needle biopsy and medical thoracoscopy in group I and II respectively. Results: Complications in group I were in the form of pain in 2 patients (10%), hemoptysis in 1 (5%), while complications in group II were pain in 4 (20%), failure of the lung to expand in 5 (25%), pneumothorax in 5 (25%) and wound infection in 3 patients (15%). Final histopathological diagnosis in group I was parapneumonic effusion in 3 patients (15%), inflammatory lung lesion in 1 (5%), pleural fibroma in 2 (10%), malignant mesothelioma in 4 (20%), sarcoma in 1 (5%), adenocarcinoma in 1 (5%), squamous cell carcinoma in 4 (20%), and metastatic adenocarcinoma in 1 (5%). Final histopathological diagnosis in group II was pleural TB in 4 patients (20%), inflammatory lung lesions in 2 (10%), malignant mesothelioma in 6 (30%), adenocarcinoma in 5 (25%), and metastatic adenocarcinoma in 2 (10%). The diagnosed cases were 17 (85%) and 19 (95%) in groups I and II respectively. Conclusions: Medical thoracoscopy is an important diagnostic method for the diagnosis of undiagnosed pleural effusion while it is concluded that US guided pleural biopsy is more useful in cases of pleural lesions without effusion

Uncovering the Cardioprotective Potential of Diacerein in Doxorubicin Cardiotoxicity: Mitigating Ferritinophagy-Mediated Ferroptosis via Upregulating NRF2/SLC7A11/GPX4 Axis

Doxorubicin (DOX)-induced cardiotoxicity (DIC) is a life-threatening clinical issue with limited preventive approaches, posing a substantial challenge to cancer survivors. The anthraquinone diacerein (DCN) exhibits significant anti-inflammatory, anti-proliferative, and antioxidant actions. Its beneficial effects on DIC have yet to be clarified. Therefore, this study investigated DCN’s cardioprotective potency and its conceivable molecular targets against DIC. Twenty-eight Wister rats were assigned to CON, DOX, DCN-L/DOX, and DCN-H/DOX groups. Serum cardiac damage indices, iron assay, oxidative stress, inflammation, endoplasmic reticulum (ER) stress, apoptosis, ferritinophagy, and ferroptosis-related biomarkers were estimated. Nuclear factor E2-related factor 2 (NRF2) DNA-binding activity and phospho-p53 immunoreactivity were assessed. DCN administration effectively ameliorated DOX-induced cardiac cytomorphological abnormalities. Additionally, DCN profoundly combated the DOX-induced labile iron pool expansion alongside its consequent lethal lipid peroxide overproduction, whereas it counteracted ferritinophagy and enhanced iron storage. Indeed, DCN valuably reinforced the cardiomyocytes’ resistance to ferroptosis, mainly by restoring the NRF2/solute carrier family 7 member 11 (SLC7A11)/glutathione peroxidase 4 (GPX4) signaling axis. Furthermore, DCN abrogated the cardiac oxidative damage, inflammatory response, ER stress, and cardiomyocyte apoptosis elicited by DOX. In conclusion, for the first time, our findings validated DCN’s cardioprotective potency against DIC based on its antioxidant, anti-inflammatory, anti-ferroptotic, and anti-apoptotic imprint, chiefly mediated by the NRF2/SLC7A11/GPX4 axis. Accordingly, DCN could represent a promising therapeutic avenue for patients under DOX-dependent chemotherapy