Study of pulmonary function tests in Type 2 Diabetes Mellitus and their correlation with glycemic control and systemic inflammation

Introduction: Reduced lung function in diabetes has been described for long but its clinical importance is not yet clear. Also, limited literature is available regarding its association with sugar control, and its correlation with inflammatory markers. Thus, we aimed to study the pulmonary function test abnormalities and systemic inflammation in type 2 diabetes mellitus. Material and methods: 100 patients with type 2 diabetes were divided into two groups depending on control of diabetes (group A–HbA1C ≤ 7% and group B-HbA1C > 7%). All the subjects selected underwent detailed evaluation including testing for HbA1C, HsCRP (high-sensitivity C-reactive protein), serum ferritin and serum fibrinogen, along with pulmonary function testing. Results: Percentage predicted FVC (forced vital capacity), FEV1 (forced expiratory volume in 1 second) and SVC (slow vital capacity) were significantly reduced, while mean values of inflammatory markers [fibrinogen (p < 0.001) and hsCRP (p < 0.002)] were significantly higher in uncontrolled diabetes group. There was a significant negative correlation between FEV1 (r = –0.739, p < 0.001), FVC (r = –0.370, p < 0.001), SVC (r = –0.635, p < 0.001) with HbA1C. HbA1C had a positive correlation with hsCRP (r = –0.308, p < 0.002) and fibrinogen (r = 0.388, p < 0.001). Conclusion: Pulmonary functions were decreased and inflammatory markers like hsCRP, fibrinogen, and ferritin significantly increased in uncontrolled diabetics. Also, a potential association was seen between higher values of inflammatory markers like hsCRP and fibrinogen and decrease in lung function. This information, requiring confirmation with larger multicentre studies, remains important because of potential epidemiological, clinical and therapeutic implications

Parametry czynności układu oddechowego u chorych na cukrzycę typu 2 i ich korelacja z kontrolą glikemii i zapaleniem systemowym

WSTĘP: Obniżone parametry czynności płuc u chorych na cukrzycę to zjawisko opisywane od wielu lat, ale kliniczne znaczenie tego faktu nie zostało dotychczas wyjaśnione. Piśmiennictwo dotyczące związku tego zjawiska z kontrolą glikemii i markerami zapalenia jest bardzo ubogie. Celem badania była ocena występowania zaburzeń czynności płuc i zapalenia systemowego u chorych na cukrzycę typu 2. MATERIAŁ I METODY: Chorych na cukrzycę typu 2 (n = 100) podzielono na dwie grupy w zależności od poziomu kontroli cukrzycy (grupa A — HbA1C ≤ 7% i grupa B — HbA1C &gt; 7%). U wszystkich chorych przeprowadzono badanie hemoglobiny glikowanej (HbA1C), stężenia białka C-reaktywnego (hsCRP), ferrytyny i fibrynogenu w surowicy oraz wykonano badanie spirometryczne. WYNIKI: W grupie chorych z niekontrolowaną cukrzycą wartości natężonej pojemności życiowej (FVC), natężonej objętości wydechowej w 1 sekundzie wydechu (FEV1) i wolnej pojemności życiowej (SVC) wyrażonych w procentach wartości należnej były znamiennie niższe, a średnie stężenia parametrów zapalenia systemowego (fibrynogenu, p &lt; 0,001 oraz hsCRP, p &lt; 0,002) znamiennie wyższe. Wykazano negatywną korelację pomiędzy wartością FEV1 (r = –0,739, p &lt; 0,001), FVC (r = –0,370, p &lt; 0,001), SVC (r = –0,635, p &lt; 0,001) a stężeniem HbA1C. Z kolei stężenie HbA1C korelowało dodatnio ze stężeniem hsCRP (r = –0,308, p &lt; 0,002) i fibrynogenu (r = 0,388, p &lt; 0,001). WNIOSKI: Parametry czynności płuc były obniżone a stężenia markerów zapalenia, takich jak hsCRP, fibrynogenu i ferrytyny znamiennie wyższe u chorych z niekontrolowaną cukrzycą. Ponadto stwierdzono związek pomiędzy wysokimi stężeniami markerów zapalenia i obniżonymi parametrami czynności płuc. Uzyskane wyniki, choć wymagają potwierdzenia w większych badaniach wieloośrodkowych, mają ważne implikacje epidemiologiczne, kliniczne i terapeutyczne.WSTĘP: Obniżone parametry czynności płuc u chorych na cukrzycę to zjawisko opisywane od wielu lat, ale kliniczne znaczenie tego faktu nie zostało dotychczas wyjaśnione. Piśmiennictwo dotyczące związku tego zjawiska z kontrolą glikemii i markerami zapalenia jest bardzo ubogie. Celem badania była ocena występowania zaburzeń czynności płuc i zapalenia systemowego u chorych na cukrzycę typu 2. MATERIAŁ I METODY: Chorych na cukrzycę typu 2 (n = 100) podzielono na dwie grupy w zależności od poziomu kontroli cukrzycy (grupa A — HbA1C ≤ 7% i grupa B — HbA1C > 7%). U wszystkich chorych przeprowadzono badanie hemoglobiny glikowanej (HbA1C), stężenia białka C-reaktywnego (hsCRP), ferrytyny i fibrynogenu w surowicy oraz wykonano badanie spirometryczne. WYNIKI: W grupie chorych z niekontrolowaną cukrzycą wartości natężonej pojemności życiowej (FVC), natężonej objętości wydechowej w 1 sekundzie wydechu (FEV1) i wolnej pojemności życiowej (SVC) wyrażonych w procentach wartości należnej były znamiennie niższe, a średnie stężenia parametrów zapalenia systemowego (fibrynogenu, p < 0,001 oraz hsCRP, p < 0,002) znamiennie wyższe. Wykazano negatywną korelację pomiędzy wartością FEV1 (r = –0,739, p < 0,001), FVC (r = –0,370, p < 0,001), SVC (r = –0,635, p < 0,001) a stężeniem HbA1C. Z kolei stężenie HbA1C korelowało dodatnio ze stężeniem hsCRP (r = –0,308, p < 0,002) i fibrynogenu (r = 0,388, p < 0,001). WNIOSKI: Parametry czynności płuc były obniżone a stężenia markerów zapalenia, takich jak hsCRP, fibrynogenu i ferrytyny znamiennie wyższe u chorych z niekontrolowaną cukrzycą. Ponadto stwierdzono związek pomiędzy wysokimi stężeniami markerów zapalenia i obniżonymi parametrami czynności płuc. Uzyskane wyniki, choć wymagają potwierdzenia w większych badaniach wieloośrodkowych, mają ważne implikacje epidemiologiczne, kliniczne i terapeutyczne

Factors Associated With Referring Close Contacts to an App With Individually-Tailored Vaccine Information

Background: Infants too young to be fully vaccinated are vulnerable to potentially deadly influenza and pertussis infections. The cocooning strategy limits this risk by vaccinating those likely to interact with the infant and mother during this vulnerable time, such as close friends and family members. Distribution of accurate and accessible vaccine information through existing social networks could be an important tool in increasing vaccine confidence and coverage. Methods: We surveyed 1095 pregnant women from diverse prenatal care practices in Georgia and Colorado. These women were surveyed through a mobile app to assess vaccine intentions, attitudes, beliefs, norms, and levels of trust, and then presented brief individually-tailored educational videos about maternal and infant vaccines and the cocooning strategy. They were then given the opportunity to refer up to six contacts to enroll in the app and receive similar vaccine education. Results: Twenty-eight percent of these women referred at least one contact, with an average of 2.67 contacts per referring woman. Most referrals (93%) were partners, parents, siblings, relatives, or close friends. Attitudinal constructs significantly associated with increased likelihood of referring contacts included: intention to receive maternal influenza vaccine, perceived safety of maternal Tdap vaccine, perceived efficacy of maternal influenza vaccine, perceived susceptibility to and severity of influenza during pregnancy, and trust in vaccine information from the Centers for Disease Control and Prevention (CDC) and academic institutions. Uncertainty about infant vaccine intentions was associated with decreased likelihood of referring contacts. Conclusions: Pregnant women who valued vaccination and trusted vaccine information from academic institutions were more likely to refer an educational app about vaccines than those who did not. Further research is needed to determine the potential impact of this strategy on vaccine coverage when implemented on a large scale. Trial Registration: The survey informing this article was part of a randomized controlled trial funded by the National Institutes of Health [clinicaltrials.gov registration number NCT02898688]

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Distal Renal Tubular Acidosis Presenting as Recurrent Paralytic Crises A Case Report

Renal tubular acidosis (RTA) is a syndrome resulting from tubular dysfunction leading to deranged acid-base balance. One of the subtypes, distal RTA manifests as renal parenchymal stone disease with nephrocalcinosis, evidence of vitamin D deficiency and growth faltering in children with ultimate short stature in adulthood. The physician should be familiar with the condition, in order to expedite correct management and ameliorate the complications. We hereby report a case of distal renal tubular acidosis (dRTA), who presented with recurrent hypokalemic paralysis and osteopenia but, unusually, without any nephrocalcinosis. [Med-Science 2015; 4(4.000): 2933-7

Hypersensitivity Reaction and Acute Respiratory Distress Syndrome in Pyrethroid Poisoning and Role of Steroid Therapy

Background: Pyrethroids are generally of low toxicity to humans, but in suicidal poisonings which are usually associated with ingestion of high doses, they lead to severe systemic effects. Case Report: A 30-year old woman presented to emergency department with a history of intentional ingestion of about 15 mL of prallethrin around 3 days earlier. She complained of shortness of breath along with chest pain for the last 2 days. She reported no vomiting or stomach pain prior to presentation to hospital. On chest auscultation, breath sounds were mildly decreased in bilateral infrascapular areas with generalized crepitation. Arterial blood gas analysis revealed respiratory alkalosis. Chest X ray and computed tomography of thorax revealed widespread confluent areas of consolidation with interlobular septal thickening involving bilateral parahilar regions suggestive of acute respiratory distress syndrome (ARDS). The patient did not respond to broad spectrum antibiotic coverage, diuretics and oxygen inhalation. Intravenous methylprednisolone (2 mg/kg/day divided 6 hourly) was started and slowly tapered off during the next days. The patient discharged after 3 weeks in good health. Discussion: As pyrethroids can affect sodium channels, the osmotic gradient of alveolar epithelium probably disrupts and therefore, alveolar infiltrations gradually spread over lungs. In addition, there is a possibility of hypersensitivity reactions to pyrethroids, which can cause progressive inflammation and involve respiratory tract in severe cases. Conclusion: Pyrethroid poisoning can lead to ARDS. Steroid therapy may help such patients tide over the pulmonary crisis

Study of Pulmonary Function Tests in Type 2 Diabetes Mellitus and Their Correlation with Glycemic Control and Systemic Inflammation

Introduction: Reduced lung function in diabetes has been described for long but its clinical importance is not yet clear. Also, limited literature is available regarding its association with sugar control, and its correlation with inflammatory markers. Thus, we aimed to study the pulmonary function test abnormalities and systemic inflammation in type 2 diabetes mellitus. Material and methods: 100 patients with type 2 diabetes were divided into two groups depending on control of diabetes (group A–HbA1C ≤ 7% and group B-HbA1C &gt; 7%). All the subjects selected underwent detailed evaluation including testing for HbA1C, HsCRP (high-sensitivity C-reactive protein), serum ferritin and serum fibrinogen, along with pulmonary function testing. Results: Percentage predicted FVC (forced vital capacity), FEV1 (forced expiratory volume in 1 second) and SVC (slow vital capacity) were significantly reduced, while mean values of inflammatory markers [fibrinogen (p &lt; 0.001) and hsCRP (p &lt; 0.002)] were significantly higher in uncontrolled diabetes group. There was a significant negative correlation between FEV1 (r = –0.739, p &lt; 0.001), FVC (r = –0.370, p &lt; 0.001), SVC (r = –0.635, p &lt; 0.001) with HbA1C. HbA1C had a positive correlation with hsCRP (r = –0.308, p &lt; 0.002) and fibrinogen (r = 0.388, p &lt; 0.001). Conclusion: Pulmonary functions were decreased and inflammatory markers like hsCRP, fibrinogen, and ferritin significantly increased in uncontrolled diabetics. Also, a potential association was seen between higher values of inflammatory markers like hsCRP and fibrinogen and decrease in lung function. This information, requiring confirmation with larger multicentre studies, remains important because of potential epidemiological, clinical and therapeutic implications

Study of the Prevalence of Microalbuminuria in Patients of Essential Hypertension and its Correlation with Left Ventricular Hypertrophy and Carotid Artery Intima-media Thickness

Background: Limited evidence is available among Indian patients regarding significance of microalbuminuria (MA) in context of hypertension and future cardiovascular morbidity. Therefore, the current study was undertaken to determine the prevalence of MA in hypertensive patients and to examine its correlation with severity of hypertension, left ventricular hypertrophy (LVH), and common carotid intima-media thickness (CCIMT). Material and Methods: Fifty treatment-naïve hypertensive patients (16–80 years of age) were prospectively enrolled. All patients underwent basic metabolic profile, urine evaluation, echocardiography, and measurement of CCIMT, and the data were evaluated. Results: MA (defined as urinary albumin excretion in the range of 30–300 mg/24 h) was present in 44% of patients with newly detected essential hypertension. A significant number of patients with MA had abnormally high mean left ventricular mass index as compared to those without MA. In addition, a positive correlation was also observed between MA and LVH. Furthermore, mean CCIMT was found to be higher in patients with MA (P < 0.001), with 69.2% of the patients with MA having elevated mean CCIMT. The CCIMT had a positive correlation with both MA and LVH. Conclusions: This study demonstrates the presence of MA in a significant number of newly detected and untreated patients of essential hypertension. Further, MA had a statistically significant relationship with LVH and CCIMT. Thus, screening of all recently diagnosed patients of essential hypertension for MA may be a reasonable strategy to predict the presence of future cardiovascular risk