Role of Coenzyme Q10 in Prophylaxis of Myocardial Infarction.

INTRODUCTION: Coenzyme Q10 (CoQ10) has a potential role in reducing the risk of myocardial infarction by slowing the progression of atherosclerosis and improving ischemia. In this study, we will assess the role of coenzyme Q10 in prophylaxis for reducing myocardial infarction and mortality related to myocardial infarction. METHODS: This open-label two open placebo-controlled randomized clinical trial was conducted in a tertiary care hospital in Sukkur, Pakistan from April 2016 to September 2019. Eight hundred nighty-two (892) patients with clinically diagnosed and documented evidence of hypertension were enrolled in the study from the outpatient department. Participants were randomized into two groups by 1:1 ratio using an online randomizer software, Research Randomizer (https://www.randomizer.org/). Group A received 100 mg coenzyme Q10 daily (coenzyme Q10 group) in addition to standard therapy and group B received standard therapy only (placebo group). RESULTS: Participants who received coenzyme Q10 had fewer incidence of non-fatal myocardial infarction over 12 months (5.4% vs 8.4%) with relative risk reduction of 2.92 (confidence interval 95%, 0.55-2.76). The number needed to treat to prevent one non-fatal myocardial infarction was 34. Participants who received coenzyme Q10 had fewer incidence of fatal myocardial infarction over 12 months (1.5% vs 3.1%) with relative risk reduction of 1.65 (confidence interval 95%, 0.39-3.69). Number needed to treat to prevent one fatal myocardial infarction was 60. CONCLUSION: According to this study, coenzyme Q10 reduced the incidence of fatal and non-fatal myocardial infarctions. Clinicians should consider adding coenzyme Q10 to the treatment regimen of high-risk patients of myocardial infarction. We suggest coenzyme Q10 may be an effective prophylactic agent in patients at risk of myocardial infarction and it may help in reducing burden on the health care system.

Do COVID-19 Antibodies Provide Long-Term Protection?

INTRODUCTION: Post severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, an immune response is generated among healthy, immunocompetent individuals with immunoglobulins (IgG and IgM) antibodies. IgM rises earlier than IgG, indicating a recent infection. However, a detailed analysis is required to assess long-term immune reactions induced by antibodies. METHOD AND MATERIALS: The study was conducted at a tertiary care hospital in Pakistan from June 2020 to October 2020 where serum samples were collected from patients. The samples were obtained by phlebotomy for antibody testing. All the reactive patients were followed up after 60 days of initial testing. RESULTS: A total of 728 patients participated in the study, of which 79​ (10.8%) were seropositive at baseline. Seventy-two (91.1%) participants came back for follow-up after 60 days (two months) and were included in the final analysis. Among the 72 participants, 35 (48.6%) exhibited symptoms of coronavirus disease 2019 (COVID-19) infection and 37 (51.4%) were asymptomatic. After 60 days, 37 (including 20 symptomatic and 17 asymptomatic) participants were still seropositive for SARS-CoV-2 enzyme-linked immunosorbent assay (ELISA) test. Mean change in percentage from seropositive to seronegative was more in asymptomatic compared to symptomatic patients (54.0% vs. 42.8%). CONCLUSION: In this study, humoral immunity against SARS-CoV-2 is not long-lasting among individuals with mild signs and symptoms. Care should be taken while implicating that antibodies can provide long term protection against SARS-CoV-2. Further large-scale studies are needed.

Risk Factors Associated With Frequent Acute Exacerbations of Asthma.

INTRODUCTION: Asthma can lead to fatigue, frequent hospital visits, psychological problems, and learning problems in children. One of the complications of asthma is its life-threatening acute exacerbation. It is important to identify precipitating factors responsible for frequent acute exacerbations of asthma. METHODS: This case-control study was conducted in the pulmonology ward of Liaquat University of Medical and Health Sciences, Jamshoro, from May 2019 to February 2020. Sampling was done by convenient probability technique. The case group was identified as patients with two or more episodes of acute exacerbation of asthma and the control group was identified as asthmatic patients without acute exacerbation in the last year. RESULTS: Factors leading to acute exacerbation of asthma include number of asthma attacks in the past seven days (4.9 ± 3.4 vs. 2.2 ± 2.0; p < 0.0001) and number of nights with troublesome cough in the past 28 days (12.2 ± 8.1 vs. 4.3 ± 3.1; p < 0.0001). Participants with recent upper respiratory tract infection (38.4% vs. 10%; odds ratio [OR] 5.62), smoking history (30.7% vs. 12%; OR 3.25), gastroesophageal reflux disease (26.9% vs. 8.0%; OR 4.2) and non-adherence to medication (26.9% vs. 8.0%; OR 4.2) were more likely to experience from exacerbation of asthma. CONCLUSION: It is important to identify risk factors that may cause acute exacerbation of asthma in the patients. Patients should be educated of the risk factors and complications of the exacerbation episode of asthma.

N-acetylcysteine in the Management of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Introduction Chronic obstructive pulmonary disease (COPD) is a preventable disease of the airways characterized by limited airflow. Acute exacerbations of COPD (AECOPD) may be precipitated by noxious stimuli. N-acetylcysteine (NAC) has mucolytic, antioxidant, and anti-inflammatory activity. We conducted this study to evaluate the effect of adding high-dose NAC to the protocol treatment of AECOPD. Methods In this single-center, prospective, interventional study, patients admitted with AECOPD, airflow obstruction on spirometry, and who were current smokers with 10 or more packs per year were included after attaining informed consent. NAC granules 600 mg twice daily orally (high dose) were included in the regimen of 25 randomly selected patients and the other 25 were managed without NAC. An improvement in clinical and biochemical markers was observed on day three and day seven. For statistical analysis, SPSS for Windows version 21.0 (IBM Corp., Armonk, NY) was utilized. Results The study was completed by 21 patients in the NAC group and 19 in the non-NAC group. In the NAC group, there was a significant improvement in the mean partial pressure of oxygen (PaO2) both on day three (p=0.03) and day seven (p=0.01). The mean partial pressure of carbon dioxide (PaCO2) was at the borderline in the two groups on day three; however, on day seven, the NAC group showed significantly improved PaCO2 as compared to the non-NAC group (p=0.007). There were significant improvements in oxygen saturation of the NAC group on day seven (p=0.02). There were significant improvements in clinical signs, including wheezing and dyspnea and the need for nasal oxygen support (p≤0.05). Conclusion The addition of 600 mg twice daily NAC (high dose) to the protocol treatment of patients with acute exacerbation of COPD may have beneficial outcomes. In the future, the role of high-dose NAC in AECOPD must be studied through multicenter, double-blinded, placebo-controlled trials with larger sample sizes in order to either establish or invalidate this association.

Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure Secondary to Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Introduction Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of poor quality of life and mortality in developing countries. Noninvasive positive pressure ventilation (NIPPV) remains the first-line intervention in hospitalized patients with acute respiratory failure (ARF) due to AECOPD. However, NIPPV may fail in some patients. This study was conducted to assess the frequency of NIPPV failure and clinical parameters and outcomes in AECOPD patients with failed NIPPV and their conversion to invasive positive pressure ventilation (IPPV). Methods This prospective observational study was conducted in the pulmonology unit of a tertiary care hospital in Pakistan. AECOPD patients with ARF who were candidates of NIPPV were included after securing informed consent. Their demographic characteristics, clinical parameters, and in-hospital outcomes were recorded on a semi-structured proforma. For statistical analysis, SPSS software version 22.0 for Windows (IBM, Armonk, NY) was used. Results With 24 hours of NIPPV, 73 (70.2%) patients improved and the remaining 31 (29.8%) were shifted to IPPV. Patients in the IPPV group had higher systolic blood pressure (BP) [133.8 mmHg (±21.2) vs. 121.1 mmHg (±8.3); probability value (p): <0.000] and lower diastolic BP [68.7 mmHg (±13.4) vs. 76.2 mmHg (±10.8); p: 0.003]. Their pH was more acidic [7.20 (±0.13) vs. 7.42 (±0.01); p: <0.000], heart rates were high [131.1 (±10.5) vs. 100.2 (±7.5); p: <0.000], and the percentage of oxygen saturation was low [90.7 (±3.0) vs. 93.4 (±4.5); p: 0.004]. Patients who were managed on NIPPV throughout their hospital stay required respiratory support for fewer days [3.2 (±1.3) vs. 4.1 (±1.8); p: 0.005], and their hospital stay was shorter [3.5 (±1.2) vs. 5.3 (±2.5) days; p: <0.000]. Mortality rate in the NIPPV group was significantly lower (1.4% vs. 12.9%; p: 0.01). Conclusions Deranged blood pressure, increased heart rate, acidemia, and a low percentage of oxygen saturation are crucial clinical and biochemical parameters that can predict the success of NIPPV with 24 hours of therapy in patients with AECOPD and secondary ARF. Patients who do not improve with 24 hours of NIPPV therapy usually have poor in-hospital outcomes including mortality.

Vitamin D and Serum Immunoglobulin E Levels in Allergic Rhinitis: A Case-control Study from Pakistan.

Introduction Allergic rhinitis (AR) is the most common non-infectious rhinitis and is associated with sneezing, cough, and flu-like symptoms. The exact pathophysiology of AR remains uncertain. The deficiency of vitamin D3 has been documented as a probable cause of allergic conditions due to its role in immunomodulation. The aim of this study was to evaluate the role of vitamin D3 deficiency in allergic rhinitis. Methods This case-control study was conducted with 50 patients of AR and 50 healthy individuals. Serum immunoglobulin (Ig) E and vitamin D3 levels were measured in all study participants. Data were analyzed using SPSS v. 21.0 (IBM Corp., Armonk, NY). Results Mean serum IgE levels in the AR group were 553.5 ± 53.9 IU/L as compared to 219.4 ± 32.1 IU/L in the control group (p <0.0001). AR patients had mean serum vitamin D levels of 14.8 ± 7.4 ng/mL as compared to 19.1 ± 6.6 ng/mL in the control group (p=0.002). Only 10% of participants in the AR group had adequate serum vitamin D levels as compared to 26% in the controls (p=0.08). Conclusion Vitamin D deficiency was present in both study groups. The AR group had significantly lower mean levels of serum vitamin D than the control group. However, upon stratification, the differences were insignificant.