Impaired systemic vascular reactivity & raised high-sensitivity C reactive protein levels in chronic obstructive pulmonary disease

BACKGROUND & OBJECTIVES

Chronic obstructive pulmonary disease (COPD) is characterized by slowly progressive airflow limitaion, chronic lung inflammation and associated systemic manifestations. The objective of this preliminary study was to investigate the levels of high sensitivity C reactive protein (hs CRP) and tumour necrosis factor-α (TNF-α) as markers of systemic inflammation and assessment of systemic vascular reactivity that may play an important role in development of cardiovascular disease in COPD patients.

METHODS

Systemic vascular reactivity was assessed non-invasively by measuring peripheral pulse waveform changes during reactive hyperemia (RH) in 16 COPD patients and 14 controls by photoplethysmography technique (PPG). Parameters measured were pulse wave amplitude (PWA), slope and pulse transit time (PTT). Tumour necrosis factor-α (TNF-α) and hs CRP were measured as markers of inflammation.

RESULTS

PWA during the 1 st , 2 nd and 3 rd minutes post release of occlusion were significantly higher than the baseline means in controls, whereas in the patient group there was no significant change in the PWA during any of the observed time periods following release of occlusion, in comparison to the baseline means. Similar results were observed in slope values for patients and controls. Maximum percentage change in PWA during RH with reference to baseline was significantly lower in patients as compared to controls (26.78±20.19 vs 57.20±19.80%, p<0.001). Maximum percentage change in slope during RH with reference to baseline was significantly lower in patients as compared to controls (19.77±10.73 vs 39.25±13.49%, P<0.001). A vascular tone response as represented by PTT was also impaired in the 3 rd minute of RH as compared to baseline mean values in COPD patients only.

INTERPRETATION & CONCLUSIONS

Our findings showed raised hs CRP levels and impaired systemic vascular reactivity in COPD patients. Whether these may increase the risk of cardiovascular disease in COPD patients need to be confirmed in future studies with large sample size and appropriate study design.

Postural variation of pulmonary diffusing capacity as a marker of lung microangiopathy in Indian patients with type 2 diabetes mellitus

INTRODUCTION

Diabetes mellitus (DM) is characterized by the presence of chronic hyperglycemia and formation of advanced glycation end products (AGEs). Interaction between AGE and its receptor leads to endothelial damage and microangiopathy. This study was undertaken to investigate the possibility of using a postural variation of diffusing capacity as an early marker of lung microangiopathy and its correlation with the level of adhesion molecules, HbA1c, duration of diabetes, and insulin resistance in type 2 DM (T2DM) patients with and without microangiopathy.

MATERIALS AND METHODS

Forty patients having T2DM without any microangiopathy (n = 20) as well as with microangiopathy (n = 20), and 22 age and sex matched healthy controls were enrolled in this cross-sectional study. Measurement of lung volumes and capacities were done. DLco was measured in sitting and supine position. Levels of vascular cell adhesion molecule-1 (VCAM-1), E-selectin, fasting glucose, and insulin were estimated in plasma of the patients and compared with controls.

RESULTS

Restrictive type of ventilatory change was observed in DM patients. Diffusing capacity (% predicted) in the supine position (P < 0.0001), postural change in DLco (P < 0.0001), and coefficient of diffusion were significantly less in DM patients as compared to controls. Plasma levels of VCAM-1 were significantly higher in DM patients without microangiopathy and negatively correlated (r = -0.4054, P = 0.0094) with Δ DLco in all diabetic subjects. All patients had significantly higher insulin resistance.

CONCLUSION

Lack of postural increase in diffusing capacity in type 2 diabetic patients along with increased VCAM-1 levels could reflect the presence of an early microangiopathy of the small pulmonary vessels.

Oscillating Positive Expiratory Pressure on Respiratory Resistance in Chronic Obstructive Pulmonary Disease With a Small Amount of Secretion: A Randomized Clinical Trial

This study aims to evaluate the acute effects of an oscillating positive expiratory pressure device (flutter) on airways resistance in patients with chronic obstructive pulmonary disease (COPD).Randomized crossover study: 15 COPD outpatients from Asthma Lab-Royal Brompton Hospital underwent spirometry, impulse oscillometry (IOS) for respiratory resistance (R) and reactance (X), and fraction exhaled nitric oxide (FeNO) measures.Thirty minutes of flutter exercises: a "flutter-sham" procedure was used as a control, and airway responses after a short-acting bronchodilator were also assessed.Respiratory system resistance (R): in COPD patients an increase in X5insp (-0.21 to -0.33 kPa/L/s) and Fres (24.95 to 26.16 Hz) occurred immediately after flutter exercises without bronchodilator. Following 20 min of rest, a decrease in the R5, ΔR5, R20, X5, and Ax was observed, with R5, R20, and X5 values lower than baseline, with a moderate effect size; there were no changes in FeNO levels or spirometry.The use of flutter can decrease the respiratory system resistance and reactance and expiratory flow limitation in stable COPD patients with small amounts of secretions.

Holy basil (Ocimum sanctum Linn.) leaf extract enhances specific cognitive parameters in healthy adult volunteers: A placebo controlled study

INTRODUCTION

Ocimum sanctum (OS), known as Holy basil, has been documented to possess neuroprotective, cognition-enhancing and stress relieving effects in animal models. However there is paucity of clinical studies to document these effects.

MATERIALS AND METHODS

Effect of OS on parameters related to cognition and stress in humans was evaluated with administration of 300 milligram capsules of ethanolic leaf extracts of Ocimum sanctum (EtOS) or placebo per day, over 30 days.

RESULTS

Intra-group comparison of Sternberg and Stroop test showed improvement in both the placebo and EtOS groups, however, the improvement stabilized after day 15 in the placebo group. Intergroup comparison revealed a significant improvement of the following cognitive parameters in the EtOS as compared to the placebo: reaction time (RT) and error rate (ER) of Sternberg test, RT of neutral task of Stroop, RT and ER of interference task of Stroop. The intra-group comparison of P300 latency, salivary cortisol, and State-Trait Anxiety Inventory showed improvement over time in the EtOS group alone, though the inter-group difference was significant in the P300 latency alone. There were no changes in heart rate (HR), AHR, or galvanic skin response (GSR) or AGSR.

CONCLUSION

Ocimum sanctum leaf extract seems to have potential cognition-enhancing properties in humans.

Serum cytokine profiling and enrichment analysis reveal the involvement of immunological and inflammatory pathways in stable patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major global health problem. It results from chronic inflammation and causes irreversible airway damage. Levels of different serum cytokines could be surrogate biomarkers for inflammation and lung function in COPD. We aimed to determine the serum levels of different biomarkers in COPD patients, the association between cytokine levels and various prognostic parameters, and the key pathways/networks involved in stable COPD. In this study, serum levels of 48 cytokines were examined by multiplex assays in 30 subjects (control, n=9; COPD, n=21). Relationships between serum biomarkers and forced expiratory volume in 1 second, peak oxygen uptake, body mass index, dyspnea score, and smoking were assessed. Enrichment pathways and network analyses were implemented, using a list of cytokines showing differential expression between healthy controls and patients with COPD by Cytoscape and GeneGo Metacore™ software (Thomson-Reuters Corporation, New York, NY, USA). Concentrations of cutaneous T-cell attracting chemokine, eotaxin, hepatocyte growth factor, interleukin 6 (IL-6), IL-16, and stem cell factor are significantly higher in COPD patients compared with in control patients. Notably, this study identifies stem cell factor as a biomarker for COPD. Multiple regression analysis predicts that cutaneous T-cell-attracting chemokine, eotaxin, IL-6, and stem cell factor are inversely associated with forced expiratory volume in 1 second and peak oxygen uptake change, whereas smoking is related to eotaxin and hepatocyte growth factor changes. Enrichment pathways and network analyses reveal the potential involvement of specific inflammatory and immune process pathways in COPD. Identified network interaction and regulation of different cytokines would pave the way for deeper insight into mechanisms of the disease process.

Cardiopulmonary exercise performance after total cavopulmonary connection with or without prior superior cavopulmonary connection

OBJECTIVE

To compare cardiopulmonary exercise capacity of patients undergoing primary total cavopulmonary connection (TCPC) with those undergoing TCPC after a prior bidirectional Glenn (BDG).

METHODS

Out of 42 patients in this study, 24 had undergone primary TCPC while 18 had undergone staged TCPC. The peak oxygen consumption (O(2) peak), O(2) pulse, chronotropic index, and other exercise parameters were studied.

RESULTS

There were no significant differences in O(2) peak (940 ± 538 vs. 1010 ± 417 mL/min, p=0.42) and O(2) pulse (5.76 ± 3.52 vs. 6.85 ± 2.95) of patients undergoing staged TCPC versus primary TCPC, respectively; however, chronotropic index (0.43 ± 0.23 vs. 0.30 ± 017, p=0.047) was significantly different. Exercise tolerance was the same in fenestrated versus nonfenestrated TCPC groups and age at TCPC less than or more than 7 years. However, O(2) peak and O(2) pulse of patients with extracardiac TCPC was better than patients with lateral tunnel TCPC (p values 0.05, 0.04 and respectively). Some parameters of exercise tolerance of patients with antegrade pulmonary blood flow (APBF) interrupted at the time of BDG were better than those with APBF open.

CONCLUSION

There were no differences in the exercise parameters of patients undergoing a staged versus a primary TCPC, fenestrated versus nonfenestrated TCPC, and age at surgery less than or more than 7 years. Exercise parameters were better in the extracardiac conduit group versus lateral tunnel TCPC groups. Patients who had a TCPC after prior interruption of APBF had better exercise parameters.

Immediate and long-term effects of meditation on acute stress reactivity, cognitive functions, and intelligence

CONTEXT

With the current globalization of the world's economy and demands for enhanced performance, stress is present universally. Life's stressful events and daily stresses cause both deleterious and cumulative effects on the human body. The practice of meditation might offer a way to relieve that stress.

OBJECTIVE

The research team intended to study the effects of meditation on stress-induced changes in physiological parameters, cognitive functions, intelligence, and emotional quotients.

METHODS

The research team conducted the study in two phases, with a month between them. Each participant served as his own control, and the first phase served as the control for the second phase. In phase 1, the research team studied the effects of a stressor (10 minutes playing a computer game) on participants' stress levels. In phase 2, the research team examined the effects of meditation on stress levels.

SETTING

The research team conducted the study in a lab setting at the All India Institute of Medical Sciences (AIIMS), New Delhi, India.

PARTICIPANTS

The participants were 34 healthy, male volunteers who were students.

INTERVENTION

To study the effects of long-term meditation on stress levels, intelligence, emotional quotients, and cognitive functions participants meditated daily for 1 month, between phases 1 and 2. To study the immediate effects of meditation on stress levels, participants meditated for 15 minutes after playing a computer game to induce stress.

OUTCOME MEASURES

The research team measured galvanic skin response (GSR), heart rate (HR), and salivary cortisol and administered tests for the intelligence and emotional quotients (IQ and EQ), acute and perceived stress (AS and PS), and cognitive functions (ie, the Sternberg memory test [short-term memory] and the Stroop test [cognitive flexibility]). Using a pre-post study design, the team performed this testing (1) prior to the start of the study (baseline); (2) in phase 1, after induced stress; (3) in part 1 of phase 2, after 1 month of daily meditation, and (4) in part 2 of phase 2, after induced stress, both before and after 15 minutes of meditation.

RESULTS

Induced stress from the computer game resulted in a significant increase in physiological markers of stress such as GSR and HR. In the short term, meditation was associated with a physiological relaxation response (significant decrease in GSR) and an improvement in scores on the Stroop test of reaction times. In the long-term, meditation brought significant improvements in IQ and scores for cognitive functions, whereas participants' stress levels (GSR and AS) decreased. EQ, salivary cortisol, and HR showed no significant changes.

CONCLUSIONS

The practice of meditation reduced psychological stress responses and improved cognitive functions, and the effects were pronounced with practice of meditation for a longer duration (1 month).

Evaluation of hypoglycemic and antioxidant effect ofOcimum sanctum

Ocimum sanctum leaves have been traditionally used in treatment of diabetes mellitus. Dietary supplementation of fresh tulsi leaves in a dose of 2 gm/kg BW for 30 days led to significant lowering of blood glucose levels in test group. Intake ofOcimum sanctum also led to significant increase in levels of superoxide dismutase, reduced glutathione and total thiols, but marked reduction in peroxiodised lipid levels as compared to untreated control group. The leaves were found to possess both superoxide and hydroxyl free radical scavenging action. The present observations establish the efficacy ofOcimum sanctum leaves in lowering blood glucose levels and antioxidant property appears to be predominantly responsible for hypoglycemic effect.

Validity of heart rate based nomogram fors estimation of maximum oxygen uptake in Indian population

Maximal oxygen uptake (VO2max) during a graded maximal exercise test is the objective method to assess cardiorespiratory fitness. Maximal oxygen uptake testing is limited to only a few laboratories as it requires trained personnel and strenuous effort by the subject. At the population level, submaximal tests have been developed to derive VO2max indirectly based on heart rate based nomograms or it can be calculated using anthropometric measures. These heart rate based predicted standards have been developed for western population and are used routinely to predict VO2max in Indian population. In the present study VO2max was directly measured by maximal exercise test using a bicycle ergometer and was compared with VO2max derived by recovery heart rate in Queen's College step test (QCST) (PVO2max I) and with VO2max derived from Wasserman equation based on anthropometric parameters and age (PVO2max II) in a well defined age group of healthy male adults from New Delhi. The values of directly measured VO2max showed no significant correlation either with the estimated VO2max with QCST or with VO2max predicted by Wasserman equation. Bland and Altman method of approach for limit of agreement between VO2max and PVO2max I or PVO2max II revealed that the limits of agreement between directly measured VO2max and PVO2max I or PVO2max II was large indicating inapplicability of prediction equations of western population in the population under study. Thus it is evident that there is an urgent need to develop nomogram for Indian population, may be even for different ethnic sub-population in the country.

Giant condyloma acuminatum of Buschke and Lowenstein: successful surgical treatment

The Buschke-Löwenstein tumour is an extremely rare, slow-growing, locally destructive, cauliflower-like mass, also known as giant condyloma acuminatum. We report a case of a 42-year-old man who presented to the department of surgery with a two-year history of a perineal tumour. The mass was painless initially but had become painful more recently. After histopathological confirmation, the tumour was removed surgically, as it was resistant to medical treatment. There has been considerable debate regarding the exact nature, aetiology and treatment of these lesions.

Issues regarding the delivery of early intervention psychiatric services to the South Asian population in England

INTRODUCTION

Little research has been done to ascertain how patients and families of South Asian origin access and use early intervention mental health services today. The aim of this retrospective study is to gain a better understanding of how well South Asian patients engage with standard psycho-social interventions.

SUBJECTS AND METHODS

In June 2003 an audit was conducted amongst 75 patients from different ethnic groups in Luton. Measures of engagement with mental health services included; number of missed outpatient appointments over one year and compliance with medication regimes.

RESULTS

The results of this audit showed that South Asian patients are more likely to miss appointments and refuse to take medication in comparison to their Caucasian or Afro- Caribbean counter-parts. Further analysis revealed that the Bangladeshi subgroup had missed more appointments and had a greater proportion of medication refusal in comparison to the other Asian subgroups.

CONCLUSIONS

These results support the pioneering work by Dr Robin Pinto in the 1970s he observed that Asian patients perceive and utilise mental health services in a different way compared to the Caucasian population. The observations from our study depict the difficulties in engaging ethnic minority patients into existing services. Hence we argue that future interventions should be adapted and tailored to overcome cultural and language barriers with patients and their families.

An overview of National AIDS Control Program (NACP) with special reference to targeted intervention: issues & challenges

Human Immune Deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) has posed different set of challenges towards the country's growth and has also changed the strategic approach of Public Health for containing the further growth of the disease. HIV/AIDS is considered as more of a social problem than a medical problem alone. National AIDS Control Program (NACP) though its three phases have tried to design & implement evidence based strategies including Targeted Interventions (TI) based on the lessons learnt in the past. It has been a long journey for more than a decade which has brought innovations & effectiveness into the program and is showing some preliminary results in positive direction in limiting the HIV infection among HRGs. In the present communication few of the salient features of the entire approach and possible impacts in the future have been discussed.

Vulval lymphoedema following pulmonary tuberculosis

Acquired lymphoedema of the vulva is induced by impaired lymph flow. We present the case of a 35-year-old woman having lymphoedema of the vulva following pulmonary tuberculosis, which she had developed four years back for which she had taken a full course of antitubercular treatment for nine months from the Chest and Tuberculosis department. The biopsy taken from the perianal swellings showed hyperkeratosis and acanthosis with multiple dilated lymph specs.

Does topical GTN on the sphincter of Oddi facilitate ERCP? A double-blind randomized control trial

BACKGROUND

Endoscopic retrograde cholangio pancreatography (ERCP) is a technically challenging procedure. Glyceryl trinitrate (GTN) has been shown to reduce tone in the sphincter of Oddi (SO), cannulation of which is a rate-limiting factor. A double-blind randomized control trial was performed to assess whether topical GTN on the SO would facilitate cholangiography and/or bile duct cannulation.

METHODS

104 patients requiring ERCP for biliary symptoms were randomized into two groups, 52 controls pretreated with 5 ml 0.9% normal saline (NS) and 52 pretreated with 5 ml GTN (concentration 1 mg/ml).

RESULTS

There was no significant between the control group and the GTN group in primary cannulation rate (p = 0.76), time taken to cholangiography (p = 0.58), or time to cannulation (p = 0.43).

CONCLUSION

Topically administered GTN to the SO does not aid in obtaining a cholangiogram or cannulation during an ERCP.