BackgroundLittle is known about iron deficiency (ID) and anemia in Chronic Obstructive Pulmonary Disease (COPD). The purposes of this study were: (i) To study the prevalence and treatment of anemia and ID in patients hospitalized with an exacerbation of COPD. (ii) to study the hematological responses and degree of dyspnea before and after correction of anemia with subcutaneous Erythropoiesis Stimulating Agents (ESAs) and intravenous (IV) iron therapy, in ambulatory anemic patients with both COPD and chronic kidney disease.Methods(i) We examined the hospital records of all patients with an acute exacerbation of COPD (AECOPD) to assess the investigation, prevalence, and treatment of anemia and ID. (ii) We treated 12 anemic COPD outpatients with the combination of ESAs and IV-iron, given once weekly for 5 weeks. One week later we measured the hematological response and the severity of dyspnea by Visual Analogue Scale (VAS).Results(i) Anemia and iron deficiency in hospitalized COPD patients: Of 107 consecutive patients hospitalized with an AECOPD, 47 (43.9%) were found to be anemic on admission. Two (3.3%) of the 60 non-anemic patients and 18 (38.3%) of the 47 anemic patients had serum iron, percent transferrin saturation (%Tsat) and serum ferritin measured. All 18 (100%) anemic patients had ID, yet none had oral or IV iron subscribed before or during hospitalization, or at discharge. (ii) Intervention outpatient study: ID was found in 11 (91.7%) of the 12 anemic ambulatory patients. Hemoglobin (Hb), Hematocrit (Hct) and the VAS scale scores increased significantly with the ESAs and IV-iron treatment. There was a highly significant correlation between the ∆Hb and ∆VAS; rs = 0.71 p = 0.009 and between the ∆Hct and ∆VAS; rs = 0.8 p = 0.0014.ConclusionsID is common in COPD patients but is rarely looked for or treated. Yet correction of the ID in COPD patients with ESAs and IV iron can improve the anemia, the ID, and may improve the dyspnea.
The prevalence of ear lobe crease (ELC) was determined in 421 patients with myocardial infarction (MI) and in 421 controls. A higher prevalence (p less than 0.05) of ELC was found in MI patients (77 percent) in comparison to controls (40 percent), regardless of age. In addition, a higher prevalence was found in patients in whom MI was combined with diabetic retinopathy or hypertension, and in Ashkenazi Jews compared to non-Ashkenazi Jews. Ear lobe biopsies in 12 subjects revealed tears of the elastic fibers in all subjects with ELC, and prearteriole wall thickening in subjects with MI and/or ELC, but not in the 2 subjects with neither MI nor ELC. The early appearance of ELC may imply the existence of coronary heart disease with or without coronary risk factors.
Background: Vibration response imaging (VRI) is a new technology that provides a radiation-free dynamic lung image from the vibrations produced by airflow. The vibration energy from the respiratory cycle can be quantified for any lung region. This is obtained by integrating the energy profiles from 42 acoustic sensors placed on the patient’s back. Objective: The aim of this study was to evaluate whether a physician trained in interpreting acoustic images can accurately distinguish between normal and abnormal breath sound distribution in patients with pneumothoraces compared to healthy controls. Methods: In total, 14 patients with spontaneous or iatrogenic pneumothoraces and 15 healthy volunteers were enrolled in the study. VRI recordings and physical examination were obtained in all cases. Chest radiographs (CXRs) were reviewed in patients with pneumothoraces. Dynamic images recorded during one complete respiratory cycle were analyzed for each subject. Results: The VRI images of patients with pneumothoraces demonstrated a reduction in the vibration response on the affected side which correlated with the CXR. Sensitivity was 100%, specificity was 87% and positive predictive value and negative predictive value were 86 and 100%, respectively. Conclusions: This study demonstrates that VRI can be safely used to assess patients with pneumothoraces. Moreover, the analysis of breath sound distribution images obtained noninvasively can distinguish between patients with a normal chest examination from those with pneumothoraces.
We compared exhaled breath condensate (EBC) and induced sputum (IS) for assessing inflammation in pulmonary diseases in patients with obstructive lung disease (n = 20), persistent cough >6 months (n = 20), interstitial lung disease (n = 25) and controls (n = 10). EBC was collected by suspending a Teflon perfluoroalkoxy tube installed in an ice-filled container and connected to a polypropylene test tube. IS was recovered after 20' inhalation of 3% saline with an ultrasonic nebulizer, and 300 cells were differentially counted in cytospin Giemsa-stained slides. H(2)0(2) was measured by a method based on oxidation of phenolsulfonphthalein (phenol red) mediated by horseradish peroxidases and H(2)0(2). Pulmonary function tests were performed by conventional methods. H(2)0(2) levels in EBC and % eosinophils in IS were significantly different between groups. A positive and significant correlation was found between % eosinophils in IS and the levels of H(2)0(2) in EBC for each group and for all patients combined.
Summary A 37 year old man with Behçet's disease who was maintained on prolonged corticosteroid therapy, developed diabetic ketoacidosis and pneumonia. Secondary infection with mucor intervened with abscess formation cured by pneumonectomy. The association of Behçet's disease and mucormycosis has not been previously reported, although diabetes mellitus was almost certainly the predisposing cause. Surgical treatment offers the best chance of survival in similar cases.
Background: Activation of the renin-angiotensin system (RAS) has been suggested to have an important role in the pathogenesis of atrial fibrillation (AF). Aldosterone synthase is a key enzyme in aldosterone production, the final product of the RAS. We analyzed the possible association between CYP11B2 T-344C polymorphism in aldosterone synthase, which is associated with increased aldosterone activity, and the prevalence of AF in patients with chronic systolic heart failure (HF). Methods: We studied 178 consecutive patients who had symptomatic systolic HF (LVEF<40%) for at least 3 months prior to recruitment. Subjects were genotyped for the CYP11B2 polymorphism, using the polymerase chain reaction-restriction fragment length polymorphism approach. Results: AF was present in 57 (32%) patients. We found the -344 CC genotype to be a strong independent marker for AF: almost half (45%) patients with this genotype had AF compared to a quarter (27%) with -344 TT and TC genotypes ( Figure, p=0.02). A multivariate stepwise logistic regression model which included age, sex, New York Heart Association (NYHA) class, CYP11B2 -344CC genotype and echocardiographic measurements of LVEF, left atrium size, left ventricular end diastolic diameter and mitral regurgitation severity showed that after age and LA size, the CYP11B2 CC genotype was the most powerful independent predictor of AF (adjusted OR 2.59, 95% CI 1.68 -3.98, p=0.02). AF according to CYP11B2 T-344C genotypeConclusion: in chronic systolic HF patients, the CYP11B2 T-344 C polymorphism predisposes to clinical AF. The possibility of identifying patients at increased risk for AF supports the use of genome based treatment strategies in HF patients. In selected patient subsets, more aggressive pharmacotherapy aimed at modulating the RAS may be preferable to reduce rhythm disturbances in HF. 530Dinstinct pro-inflammatory cytokines regulate matrix metalloproteinase-2 and 9 levels in congestive heart failure
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