ObjectivesChronic obstructive pulmonary disease (COPD) is one of the main late complications of sulfur mustard poisoning. The aim of this study was to evaluate serum levels of interleukin (IL)-6 in war veterans with pulmonary complications of sulfur mustard poisoning and their correlation with severity of airways disease.MethodsFifty consecutive patients with sulfur mustard poisoning and stable COPD, and of mean age 46.3 ± 9.18 years were enrolled in this study. Thirty healthy men were selected as controls and matched to cases by age and body mass index. Spirometry, arterial blood gas, six- minute walk test, BODE (body mass index, obstruction, dyspnea, and exercise capacity), and St George’s Respiratory Questionnaire about quality of life were evaluated. Serum IL-6 was measured in both patient and control groups.ResultsFifty-four percent of patients had moderate COPD. Mean serum IL-6 levels were 15.01 ± standard deviation (SD) 0.61 pg/dL and 4.59 ± 3.40 pg/dL in the case and control groups, respectively (P = 0.03). There was a significant correlation between IL-6 levels and Global Initiative for Chronic Obstructive Lung Disease stage (r = 0.25, P = 0.04) and between IL-6 and BODE index (r = 0.38, P = 0.01). There was also a significant negative correlation between serum IL-6 and forced expiratory volume in one second (FEV1, r = −0.36, P = 0.016).ConclusionOur findings suggest that serum IL-6 is increased in patients with sulfur mustard poisoning and COPD, and may have a direct association with airflow limitation.

BACKGROUND: Lower limb amputations (LLAs) are a major debilitating complication of diabetes. The toe and flow model (TFM) describes the framework for multidisciplinary centers aiming to reduce this complication. In this study, we investigate the efficacy of the TFM to reduce diabetes-related major LLAs in comparison with the standard of care (SOC) in the Canadian health care system. METHODS: We retrospectively reviewed the anonymized diabetes-related LLA reports in two similar metropolitan health zones in Alberta, Canada from 2007 to 2017. Although both zones have the same provincial health care system and similar demographics, Calgary, our first zone operates on the basis of the TFM while the Edmonton zone operates in accordance with the provincial SOC. LLAs were divided into minor and major amputation cohorts. We used the chi-square test, linear regression, and Pearson correlation for analysis. The lower proportion of major LLAs was denoted as a positive sign for the efficacy of the TFM. RESULTS: Although the number of LLAs remained relatively comparable (Calgary zone: 2238 and Edmonton zone: 2410), the Calgary zone had both significantly lower major (45%) and higher minor (42%) amputation incidence rates compared to the Edmonton zone. The increasing trend in minor LLAs and decreasing trend in major LLAs in the Calgary zone were negatively and significantly correlated (r = -0.730, p = 0.011). No significant correlation was found in the Edmonton zone. CONCLUSIONS: A significant reduction in the incidence rate, decreasing trend of diabetes-related major LLAs and the significant negative correlation of minor and major LLAs rates in the Calgary zone (TFM) compared to its sister zone Edmonton (SOC), provides supporting evidence for the impact of the TFM. This investigation provides support for a modernization of the diabetes-related limb preservation practice in Canada through the implementation of TFMs across the country to combat major LLAs.

Background Malignant pleural effusion continues to be a common problem in patients with metastatic disease. This study was conducted to compare the efficacy and safety of bleomycin pleurodesis with povidone-iodine pleurodesis through a chest drain as palliative treatment for recurrent malignant pleural effusion. Methods Sixty cancer patients (36 males and 24 females) with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Thirty patients received povidone-iodine pleurodesis and 30 received bleomycin pleurodesis. Age, sex, side of the primary pathology, treatment outcome (recurrence and relapse time), and complications were analyzed. Results The mean age was 59.63 ± 7.68 years in the povidone-iodine group and 57.97 ± 9.27 years in the bleomycin group ( p = 0.452). The complications were identical in both groups: 2 (6.7%) patients had chest pain, 2 (6.7%) had fever, and one (3.3%) had hypotension. There was a good response to therapy in 20 (66.7%) patients in the bleomycin group and 25 (83.3%) in the povidone-iodine group ( p = 0.136). Conclusion The results of this study indicate that povidone-iodine should be considered as a selective chemical agent to perform pleurodesis in patients with recurrent malignant pleural effusion because it has the same effect but costs less than bleomycin.

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