Effect of treatment of depression and anxiety on physiological state of severe COPD patients

AbstractBackgroundAnxiety and depression are mental health problems that result in reduced health-related quality of life (HRQL), and increased mortality. Patients with COPD have a higher risk of anxiety and depression compared to healthy individuals. Recent studies reported a significant relationship between the presence of anxiety and depression and the functional status of COPD patients.ObjectivesTo study the effect of treatment of anxiety and depression on the physiological status in COPD patients.Materials and methodsThe study included 50 severe COPD patients with depression and/or anxiety as evaluated and scored by Montgomery and Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating (HAM-A) Scale. They were classified into 2 groups: group I included 25 patients who received antidepressant/anxiolytic therapy in addition to COPD treatment and group II included 25 patients who received COPD treatment only. Modified Borg scale dyspnea score, spirometry (vital capacity, forced vital capacity, forced expiratory volume in first second and forced expiratory flow through 25–75% of expiration), arterial blood, MADRS and HAM-A scale were assessed in all patients at the start of the study and after 3months.ResultsPatients with severe COPD who were treated for depression and/or anxiety showed a significant improvement in MADRS, HAM-A and dyspnea scales, spirometeric parameters and oxygenation. MADRS and HAM-A scale showed a significant negative correlation to FEV1.ConclusionTreatment of depression and anxiety in COPD patients is recommended as it is associated with a significant improvement in pulmonary physiological status and HRQL. Further studies on larger scales are recommended

6S rRNA of a Bacillus isolate 16S rRNA characterization of a Bacillus isolate and its tolerance profile after subsequent subculturing

ABSTRAC

Impact of drought, heat, and their combination on chlorophyll fluorescence and yield of wild barley (Hordeum spontaneum)

The impact of (long-term) drought acclimation and (short-term) heat stress and their combination on fast chlorophyll fluorescence induction curves (OJIP) and grain yield was tested using pot-grown plants of wild barley (Hordeum spontaneum) originating from Northern Egypt. Concerning agronomic traits, the main effect of drought was decreased biomass accumulation and grain yield, while heat specifically affected floral development. The treatments caused specific inhibitions of photosystem II (PSII) functionality. While heat stressed plants showed a reduction of maximum quantum efficiency of PSII (φP0), an indication of effects on oxygen evolving complex (OEC) functionality, and the connectivity of PSII units, these features were entirely missing in drought acclimated plants. Drought caused a reduction of the Performance Index (PIabs) and of the relative amplitude of the IP-phase of the OJIP induction curve (ΔVIP). Individuals suffering from a combination of drought and heat showed a better ability to recover photosynthetic electron transport after the relief of stress in comparison to heat stressed plants. However, this improved capacity to recover was not accompanied by an increased grain yield. Thus, we conclude that chlorophyll fluorescence measurements provide valuable physiological data; however, their use in agronomic studies for the prediction of agronomic traits should be done with some precaution

Thyrotoxic burden in the ICU and the value of bedside thyroid ultrasound in the diagnosis of thyrotoxicosis and thyrotoxic cardiac emergencies in critically-ill patients

Background: Thyrotoxicois is not uncommonly suspected in many ICU patients. There are many clinical and laboratory fallacies that may hinder the rapid diagnosis of thyrotoxicosis in ICU patients especially those presenting with cardiac emergencies. Aim: First, to estimate the thyrotoxic burden in the ICU. Second, to assess the usefulness of thyroid ultrasound in early evaluation of suspected thyroid disease in critically ill patients especially those with life threatening cardiac emergencies. Patients and methods: 854 patients admitted in 2 general intensive care units from Jan to November 2011 were evaluated. All patients suspected to have thyrotoxicosis were assessed by thyroid ultrasound and by measurement of serum levels of Ft3,Ft4,TSH, echocardiography and continuous ECG monitoring. Radioisotope scanning was done in selected cases. Results: Out of 854 admitted patients, 113 (13.2%) were suspected to have thyrotoxicosis. Thyrotoxicosis was proved in 28 patients (24.7% of suspected cases and 3.3% of all admitted cases): 15% of all suspected cases had Graves’ disease and 9.7% had toxic nodules. Most diagnosed patients (No: 16, 59.3%) had masked thyrotoxicosis. Seventy-six patients (67.3% of suspected patients) were admitted as critically ill cardiac patients and presented mainly by cardiac arrhythmias, heart failure, acute chest pain and malignant hypertension and 21 of these patients (27.6%) were proved to be thyrotoxic. Conclusion: Thyrotoxicosis and thyrotoxic cardiac emergencies are not uncommon in the ICU and should be thoroughly investigated as most cases are clinically masked. Thyroid ultrasound is a feasible, rapid and accurate bedside diagnostic tool for suspected thyrotoxic emergencies in ICU

Critically ill systemic lupus erythematosus patients referred to the intensive care unit of Fayoum University Hospital: Frequency, complications and outcome

Aim of the work: To determine the frequency of critical complications of systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU), study the risk factors and outcome. Patients and methods: Fifty SLE patients consequently admitted to the ICU were prospectively studied. The SLE Disease Activity Index (SLEDAI) was assessed. Results: The mean age of the patients was 29.3 ± 8.7 years; they were 42 females (84%) and disease duration of 4.9 ± 3.4 years. The overall mortality was 24% (12 patients) and tended to be higher in males (37.5% vs 21.5%). The commonest causes of death were infection (p < 0.001) and pulmonary complications (p = 0.04) in all non-survivors. Metabolic acidosis was significantly increased in deceased patients (75%) compared to survivors (23.7%) (p = 0.003). Cardiac and CNS complications were significantly increased in non-survivors (p = 0.04 and p = 0.03 respectively). Acute renal failure was significantly more frequent in mortality case 9/12 compared to survivors (28.9%) (p = 0.007) as well as abnormal arterial blood gases (100% vs 57.9%; p = 0.005). The SLEDAI was significantly increased in non-survivors (41.8 ± 8.2) compared to survivors (21.4 ± 5.1) (p = 0.001). There was a significant correlation between mortality and SLEDAI (r = 0.58, p = 0.001) and inversely with the pH (r = −0.38, p = 0.01). On multiple regression, only increasing SLEDAI was a significant predictor of mortality (β0.26, OR 1.29, 95%CI 1.12–1.49; p < 0.0001). Mortality prediction by SLEDAI showed at a cut-off of 28.5; sensitivity 84% and specificity 90% (p = 0.001). Conclusion: SLE patients admitted to the ICU are at an increased risk of mortality especially those with high disease activity. The main causes of mortality were infection, respiratory, cardiac and neurological complications. Keywords: Systemic lupus erythematosus, Intensive care unit, Mortality rate, Critical complication