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Vitamin d deficiency in patients with tuberculosis.

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Vitamin d deficiency in patients with tuberculosis.

J Coll Physicians Surg Pak. 2013 Nov;23(10):780-3

Authors: Iftikhar R, Kamran SM, Qadir A, Haider E, Hassan Bin Usman

Abstract
Objective: To determine the frequency and association of Vitamin D deficiency in patients with tuberculosis. Study Design: Case control study. Place and Duration of Study: Medical Department, Combined Military Hospital, Kharian, from July 2010 to June 2012. Methodology: One hundred and five outdoor patients of tuberculosis were selected with 255 gender matched controls. Tuberculosis was diagnosed by presence of acid fast bacilli in sputum smears, positive culture for Mycobacterium tuberculosis or demonstration of chronic caseating granulomatous inflammation in tissue specimens. Controls were drawn randomly from general population. Serum 25 hydroxyvitamin D [25 (OH) D3] levels < 25 ng/ml was considered Vitamin D deficiency. The results were analyzed on SPSS version 17. Results: Mean Vitamin D levels were 23.23 ± 6.81 ng/ml in cases, 29.27 ± 8.89 ng/ml in controls (p < 0.0001). Vitamin D deficiency was found in 57% of cases and 33% controls (p < 0.0001). Mean Vitamin D levels were significantly lower in females with tuberculosis (20.84 ng/ml) as compared to males (25.03 ng/ml, p = 0.002). Mean BMI in patients of tuberculosis with Vitamin D deficiency were 19.51 ± 1.77 kg/m2 and in patients with normal Vitamin D were 21.65 ± 1.79 kg/m2 (p < 0.0001). Mean Vitamin D levels in patients with multi-drug resistant tuberculosis was lower to a mean of 15.41 ± 4.67 ng/ml (p < 0.0001). Conclusion: There is significant deficiency of Vitamin D in patients with tuberculosis as compared to controls. This deficiency is more pronounced in females, individuals with low BMI, extra pulmonary and MDR tuberculosis.

PMID: 24169384 [PubMed - in process]

Respiratory diseases: meeting the challenges of screening, prevention, and treatment.

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Respiratory diseases: meeting the challenges of screening, prevention, and treatment.

N C Med J. 2013 Sep-Oct;74(5):385-92

Authors: Chang LH, Rivera MP

Abstract
Respiratory conditions, both acute and chronic, continue to have a significant impact on worldwide health because of their high prevalence, the high disease burden they place on individual health, and their enormous cost to the health care system. There are also unmeasured indirect economic costs due to loss of productivity. Despite advances in our understanding of the complex pathophysiology of respiratory diseases, as well as the availability of relatively straightforward primary prevention measures, the prevalence of chronic respiratory diseases continues to rise. In addition, periodic outbreaks of acute infectious respiratory conditions result in significant cost and even mortality, and the incidence of these conditions fluctuates widely from year to year. Although we have seen recent developments in medical therapies for respiratory diseases, and there are established and well-publicized disease management guidelines, morbidity and mortality remain high. One intervention that has lagged behind has been smoking prevention and cessation, which is the mainstay of prevention for chronic obstructive pulmonary disease and lung cancer. The persistence of these conditions underscores vulnerabilities within our national and regional health care systems. Several of the articles in this issue of the NCMJ describe innovative programs to address these challenges.

PMID: 24165763 [PubMed - in process]

Contractile Fatigue of the Quadriceps Muscle Predicts Improvement in Exercise Performance After Pulmonary Rehabilitation.

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Contractile Fatigue of the Quadriceps Muscle Predicts Improvement in Exercise Performance After Pulmonary Rehabilitation.

J Cardiopulm Rehabil Prev. 2013 Oct 25;

Authors: Mador MJ, Mogri M, Patel A

Abstract
RATIONALE:: We hypothesized that among patients with chronic obstructive pulmonary disease, those who develop quadriceps contractile fatigue (QCF) after exhaustive submaximal cycle exercise would have a greater response to exercise training than those who do not develop QCF (NQCF).
METHODS:: Patients (N = 132) had measurement of QCF at baseline. Six-minute walk distance (6MWD), maximal incremental cycle exercise testing, and quality of life measured by the Chronic Respiratory Questionnaire were obtained before and after pulmonary rehabilitation (PR).
RESULTS:: Eighty of the 132 patients (60.6%) developed QCF following constant workload exhaustive cycle exercise. Patients who developed QCF had a significantly greater improvement in 6MWD following PR (45.3 ± 45.2 m) than those who did not (27.5 ± 45.7 m; P = .032). When baseline differences between patients who developed QCF and NQCF were accounted for, the difference in 6MWD remained significant. Patients who developed QCF were not more likely to identify leg fatigue as the factor limiting exercise (56.2% of QCF group stated that leg fatigue was the limiting factor compared with 47.9% in the NQCF group; P = .46). When baseline differences were accounted for, the symptom causing exercise termination was not a predictor of the response to PR.
CONCLUSION:: Patients who were capable of developing QCF had a significantly greater improvement in 6MWD after PR compared to NQCF. Symptoms causing exercise termination could not be used to predict the development of contractile fatigue or the response to PR.

PMID: 24165798 [PubMed - as supplied by publisher]

Respiratory Dialysis for Avoidance of Intubation in Acute Exacerbation of COPD.

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Noninvasive ventilatory support has become the standard of care for patients with chronic obstructive pulmonary disease (COPD) experiencing exacerbations leading to acute hypercapnic respiratory failure. Despite advances in the use of noninvasive ventilation and the associated improvement in survival, as many as 26% of these patients fail noninvasive support and have a higher subsequent risk of mortality than patients treated initially with invasive mechanical ventilation.

We report the use of a novel device to avoid invasive mechanical ventilation in two patients who were experiencing acute hypercapnic respiratory failure because of an exacerbation of COPD and were deteriorating, despite support with noninvasive ventilation. This device provided partial extracorporeal carbon dioxide removal at dialysis-like settings through a single 15.5 Fr venovenous cannula inserted percutaneously through the right femoral vein. The primary results were rapid reduction in arterial carbon dioxide and correction of pH. Neither patient required intubation, despite imminent failure of noninvasive ventilation before initiation of extracorporeal support. Both patients were weaned from noninvasive and extracorporeal support within 3 days.

We concluded that low-flow extracorporeal carbon dioxide removal, or respiratory dialysis, is a viable option for avoiding intubation and invasive mechanical ventilation in patients with COPD experiencing an exacerbation who are failing noninvasive ventilatory support.

Nocturnal non-invasive ventilation for cardio-respiratory disorders in adults.

Following the classic 'iron lung' non-invasive negative pressure ventilator, non-invasive positive pressure ventilation (NIPPV), particularly used 'nocturnally' has developed a broad role in both the acute hospital setting and domiciliary long-term use for many cardio-respiratory disorders associated with acute and chronic ventilatory failure.

This role is based in part upon the perceived relative ease of application and discontinuation of NIPPV, ability to avoid intubation or tracheostomy and their associated morbidities and availability of increasingly portable pressure and volume cycled NIPPV devices. Nevertheless, the many methodologies necessary for optimal NIPPV use are often underappreciated by health care workers and patients alike.

This review focuses on the rationale, practice, and future directions for 'nocturnal' use of non-invasive positive pressure ventilation (nNIV) in cardio-respiratory disorders in adults which are commonly associated with sleep-related apnea, hypoventilation and hypoxemia: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), cystic fibrosis (CF) and neuromuscular disorders.

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