Effect of somatotypes on lung volumes, capacities and respiratory impedance: A pilot study.

BACKGROUND: The current morphological condition of an individual is described by a somatotype, which is a three-number scale. The endomorph, mesomorph and ectomorph components are presented in the same sequence, and each number corresponds to one of the three basic components of body composition. METHODS: We recruited 50 healthy male subjects with a mean age of 24.10 ± 4.55 yrs. Somatotype was determined by the Heath and Carter method. Impulse oscillometry was performed followed by spirometry according to the European Respiratory Society (ERS) or American Thoracic Society (ATS) guidelines. Resistance at 5 Hz (R5) %pred, R20%pred, R5-R20, X5%pred, X20, area of reactance (Ax) and resonant frequency (Fres) were obtained by doing impulse oscillometry. Slow vital capacity (SVC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio and maximum mid-expiratory flow (MMEF) were assessed by doing spirometry. RESULTS: Endomorphs (0.05 (0.00-0.09) vs 0.01 (0.00-0.04); P < 0.0001) and mesomorphs (0.04 (0.000.09) vs 0.01 (0.00-0.04); P = 0.002) had significantly higher R5-R20 than ectomorphs. Similarly, endomorphs (0.32 (0.07-0.82) vs 0.15 (0.08-0.35); P = 0.001) and mesomorphs (0.28 (0.17-0.64) vs 0.15 (0.08-0.35); P = 0.015) also showed significantly higher Ax than ectomorphs, Fres of endomorphs (15.37 (8.43-21.85) vs 10.08 (8.94-14.30); P < 0.0001) and mesomorphs (14.32 (10.24-20.86) vs 10.08 (8.94-14.30); P < 0.0001) were significantly high than ectomorphs. Moreover, spirometric measures reveal significant variation in which mesomorphs had significantly higher values of % predicted of FVC than ectomorphs (92.49 ± 7.211 vs 83.86 ± 7.861; P = 0.042) and the ratio of FEV1 to FVC was significantly higher in ectomorphs than in endomorphs (89.00 ± 5.80 vs 85.04 ± 5.73; P = 0.03). CONCLUSION: Peripheral airway dysfunction was observed in endomorphs and mesomorphs as compared to ectomorphs. Mesomorphs had a relatively higher FVC that may be due to their greater muscular strength.

Impact of comorbidities and inflammatory markers on mortality of COVID-19 patients.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes coronavirus disease 2019 (COVID-19) is a serious global health concern. The severity of the disease can be determined by serologic indicators such as C-reactive protein, lactate dehydrogenase, D-dimer, ferritin, and interleukin-6. (IL-6). Patients with preexisting conditions such as respiratory, cardiovascular, and pulmonary disease could be at risk of adverse outcomes. It is crucial to provide adequate medical care to manage these patients and increase their chances of survival. AIM: The study examined the impact of comorbidity and inflammatory markers on the severity and mortality of hospitalised COVID-19 patients. MATERIALS AND METHODS: This retrospective study included 101 COVID-19 patients who had comorbidities and were hospitalised from April 2021 to April 2022. RESULTS: Patients with a severe COVID-19 infection could be anticipated to have higher levels of inflammatory markers in their blood. Patients with chronic kidney and coronary artery disease have a worse prognosis than those with other comorbidities (P value <0.001). However, tuberculosis had no statistically significant effect on mortality and showed a minimal chance of death (P value = 0.303). In addition, tocilizumab performed poorly and was ineffective against the COVID-19 treatment. However, ivermectin exhibited a statistically significant probability of survival in COVID-19 patients. CONCLUSION: The inflammatory markers D-dimer, ferritin, and IL-6 were identified as valuable indicators of disease severity. Further, chronic kidney disease and coronary artery disease were identified as risk factors for mortality, while tuberculosis showed potential protective effects. The study showed that higher neutrophil levels were linked to mortality in tocilizumab-treated patients, while ivermectin showed promise in increasing survival rates.

Phenotypic Profiling of Immune Cells and Their Mediators in Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder and has been proposed to have an imbalance between pro-inflammatory and anti-inflammatory factors. METHODS: This study was conducted on 41 participants {18 COPD patients (smokers, COPD S (n = 9); reformed smokers, COPD RS (n = 9)) and 23 controls (non-smokers, CNS (n = 14); smokers, CS (n = 9))}. Flow cytometry was used to identify circulatory immune cells and correlated with serum cytokines. RESULTS: On comparison, significantly lower frequency of CD3+ T cells were observed in COPD S as compared to CNS (p < 0.01) and CS (p < 0.01); CD4+ T cells were lower in COPD S (p < 0.05), COPD RS (p < 0.05) and CNS (p < 0.01) as compared to CS. CD8+ T cells were elevated in COPD S as compared to CS (p < 0.05). Lower frequency of cDCs were observed in COPD S as compared to CS (p < 0.05) and COPD RS as compared to CNS (p < 0.01) and CS (p < 0.01). Lower frequency of pDCs were observed in COPD RS as compared to COPD S (p < 0.05), CNS (p < 0.05) and CS (p < 0.01). Lower frequency of Tregs was observed in COPD S as compared to CNS (p < 0.05) and CS (p < 0.05). CONCLUSIONS: Characteristic changes observed indicate a significant impact of immune cells in the progression of the disease.

Effect of Obesity on Airway Mechanics.

Background: Obesity is known to induce lung function impairment. Previous studies of decline in lung function associated with obesity are well established. Materials and Methods: In this cross-sectional study, to evaluate the effects of different obesity indices on lung mechanics, healthy subjects (males-23 and females-22) were recruited. Anthropometric parameters like body mass index (BMI), waist circumference (WC), hip circumference (HC) and neck circumference (NC) were measured and waist-hip ratio (WHR) was derived. Spirometry, impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) measurements were performed to assess lung function. Subgroups were divided and analysed. Results: In males, increased WHR is associated with increased total airway resistance (R5). BMI correlates positively with R5, R5% predicted, resistance at 20 Hz (R20) and R20% predicted; likewise, WHR shows a positive correlation with R5. In females, increased WHR has significantly higher R5, R5% predicted, R20, R20% predicted, area of reactance (Ax), resonant frequency (Fres) and decreased reactance at 5 Hz (X5), reactance at 20 Hz (X20), X20% predicted. The female group with higher WC shows significantly increased R5, R5% predicted, R20, R20% predicted, Ax, Fres and lower fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC), X5, X20, X20% predicted. The group with higher NC has a lower FEV1/FVC ratio. WHR positively correlated with R5% predicted and Fres while WC correlated positively with R5, R5% predicted, Ax and Fres; same way, NC with X5% predicted. Conclusion: Obesity/overweight causes significant changes in lung volumes, capacity and airway mechanics, Higher WC and WHR are associated with significant changes in lung mechanics, which are more prominent in females than in males. NC is not associated with changes in lung mechanics.

Comparative study of the effect of N95 facemask and Powered Air-purifying Respirator (2 fans, N95 filter) on cardiovascular parameters of healthy individuals during exercise.

N95 masks filter 95% of the small particles and respiratory droplets (>0.3 µm diameter). Therefore, they are widely used both by general public and health workers during pandemic. When physical activity or exercise is performed wearing N95 mask, it induces hypercapnic environment. The heat burden is also increased leading to discomfort and reduced compliance. This study was done to compare physiological effects and subjective perceptions while wearing N95 mask and powered air-purifying respirator (PAPR) (2 fans, N95 filter) during incremental exercise. ECG, respiratory movement, SpO2, temperature inside the mask were recorded and perception of discomfort was also assessed. Heart rate variability (HRV) values during baseline were within normal limits in both the mask conditions signifying that cardiac autonomic tone is comparable. During incremental exercise, fall in SpO2 was significantly lesser in PAPR as compared to N95 mask at 60-70% and 70-80% of maximum achievable heart rate. The temperatures inside both the mask conditions were significantly higher than ambient temperature. The scores of humid, hot, breath resistance and fatigue were significantly lower in PAPR than N95 mask. In conditions where prolonged use of mask is required with strenuous physical exertion or exercise, PAPR could be preferred over N95 mask.

Respiratory Dysfunction in Parkinson's Disease: Relation with Dysautonomia.

Background: Parkinson's disease (PD) is a neurodegenerative disease perceived as a motor disorder. It is most commonly associated with autonomic dysfunction, affecting multiple systems. This altered autonomic control might be reflected by a parallel change in the airway caliber of these patients. Aim: To correlate the pulmonary impairment in patients with Parkinson's disease with the underlying dysautonomia. Materials and Methods: A total of 30 patients with Parkinson's disease participated in the study. Heart rate (HR) variability was recorded for 5 min to assess the autonomic dysfunction, followed by impulse oscillometry (IOS) and spirometry. IOS being an effort independent technique uses sound waves at different frequencies (5-25 Hz) to measure the airway impedance. Results: There was a significant decrease in SDSD (6.60 (10.18-6.01) vs. 12.22 (13.95-11.30); P = 0.04), RMSSD (6.59 (10.17-5.50) vs. 12.20 (13.93-11.28); P = 0.04), and total power (315.8 (506.3-120.7) vs. 771.3 (799.0-643.6); P = 0.04) in stage II as compared to stage I. Resistance at 20 Hz (R20) was found to be positively correlated with SDSD (r = 0.40, P = 0.04), RMSSD (r = 0.40, P = 0.04), and HF (r = 0.41, P = 0.03). Conclusion: Amongst the PD population, any changes in the parasympathetic component (responsible for bronchoconstriction) due to the underlying dysautonomia might be reflected as increased airway resistance in the pulmonary system.

Pulmonary Functions and Inflammatory Biomarkers in Post-Pulmonary Tuberculosis Sequelae.

BACKGROUND: Post-tuberculosis (TB) sequelae is a commonly encountered clinical entity, especially in high TB burden countries. This may represent chronic anatomic sequelae of previously treated TB, with frequent symptomatic presentation. This pilot study was aimed to investigate the pulmonary functions and systemic inflammatory markers in patients with post-TB sequelae (PTBS) and to compare them with post-TB without sequelae (PTBWS) participants and healthy controls. METHODS: A total of 30 participants were enrolled, PTBS (n=10), PTBWS (n=10), and healthy controls (n=10). Pulmonary function tests included spirometry and measurement of airway impedance by impulse oscillometry. Serum levels of matrix metalloproteinase (MMP)-1, transforming growth factor-ß, and interferon-γ were estimated. RESULTS: Slow vital capacity (SVC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and peak expiratory flow were significantly lower in PTBS as compared to controls. SVC and FEV1 were significantly less in PTBS as compared to PTBWS. Total airway impedance (Z5), total airway resistance (R5), central airway resistance (R20), area of reactance (Ax), and resonant frequency (Fres) were significantly higher and respiratory reactance at 5 and 20 Hz (X5, X20) were significantly lower in PTBS as compared to PTBWS. Spirometry parameters correlated with impulse oscillometry parameters in PTBS. Serum MMP-1 level was significantly higher in PTBS as compared to other groups. CONCLUSION: Significant pulmonary function impairment was observed in PTBS, and raised serum MMP-1 levels compared with PTBWS and healthy controls. Follow-up pulmonary function testing is recommended after treatment of TB for early diagnosis and treatment of PTBS.

Effect of Smoking and Its Cessation on the Transcript Profile of Peripheral Monocytes in COPD Patients.

RATIONALE: Smoking is the primary cause of chronic obstructive pulmonary disease (COPD); however, only 10-20% of smokers develop the disease suggesting possible genomic association in the causation of the disease. In the present study, we aimed to explore the whole genome transcriptomics of blood monocytes from COPD smokers (COPD-S), COPD Ex-smokers (COPD-ExS), Control smokers (CS), and Control Never-smokers (CNS) to understand the differential effects of smoking, COPD and that of smoking cessation. METHODS: Exploratory analyses in form of principal component analysis (PCA) and hierarchical component analysis (uHCA) were performed to evaluate the similarity in gene expression patterns, while differential expression analyses of different supervised groups of smokers and never smokers were performed to study the differential effect of smoking, COPD and smoking cessation. Differentially expressed genes among groups were subjected to post-hoc enrichment analysis. Candidate genes were subjected to external validation by quantitative RT-PCR experiments. RESULTS: CNS made a cluster completely segregated from the other three subgroups (CS, COPDS and COPD-ExS). About 550, 8 and 5 genes showed differential expression, respectively, between CNS and CS, between CS and COPD-S, and between COPD-S and COPD-ExS. Apoptosis, immune response, cell adhesion, and inflammation were the top process networks identified in enrichment analysis. Two candidate genes (CASP9 and TNFRSF1A) found to be integral to several pathways in enrichment analysis were validated in an external validation experiment. CONCLUSION: Control never smokers had formed a cluster distinctively separated from all smokers (COPDS, COPD-ExS, and CS), while amongst all smokers, control smokers had aggregated in a separate cluster. Smoking cessation appeared beneficial if started at an early stage as many genes altered due to smoking started reverting towards the baseline, whereas only a few COPD-related genes showed reversal after smoking cessation.

Impulse Oscillometry as a measure of airway dysfunction in Sarcoidosis.

BACKGROUND: Sarcoidosis is a systemic inflammatory granulomatous disease which commonly affects intrathoracic lymph nodes, lung parenchyma and airways. OBJECTIVES: To measure respiratory impedance using Impulse Oscillometry (IOS) in patients with pulmonary sarcoidosis and compare the parameters with healthy controls. METHODS: Patients diagnosed with sarcoidosis (n=28); and age and gender matched healthy controls (n=17) were recruited. Lung volumes and capacities were measured by spirometry and respiratory system impedance was assessed using Impulse Oscillometry System (IOS). Measurements were performed before and 15 minutes after inhalation of a short acting bronchodilator. The IOS and spirometric parameters were compared between two groups and correlated. ROC curve analysis was also performed to identify the IOS parameters which can discriminate between sarcoidosis and healthy controls. RESULTS: Resistance at 5 and 20 Hz (R5 and R20), small airway resistance (R5-R20), resonant frequency (FRes) and area of reactance (AX) were significantly higher in Sarcoidosis subjects compared with controls. Reactance at 5 and 20 Hz (X5 and X20) were significantly lower in sarcoidosis. FEV1 (% predicted) and FVC (% predicted) were significantly lower in patients with sarcoidosis while FEV1/FVC ratio and peak expiratory flow rate (PEF) values were comparable. Post bronchodilator inhalation, there was improvement in airway resistance and reactance, but no significant changes observed in spirometric parameters. R5, X5 and R5-R20 are promising parameters to discriminate sarcoidosis from healthy controls. CONCLUSION: Increased airway resistance is a better indicator of airway involvement than airflow limitation by spirometry in pulmonary sarcoidosis.

Exhaled Breath Temperature and Systemic Biomarkers for Assessment of Airway Inflammation in Asthmatics.

OBJECTIVES: Asthma is characterised by chronic airway inflammation and remodelling. Inflammation may alter the thermal balance of the affected tissues secondary to changes in the blood flow. Measurement of exhaled breath temperature (EBT) is a simple, safe and non-invasive technique to detect airway inflammation. The objective of this study was to measure EBT in asthma patients and compare it with healthy controls and also to correlate it with serum biomarkers of inflammation and remodelling. METHODS: 24 male asthma patients and 23 age and gender matched healthy controls were recruited in the study. EBT and core body temperature were recorded followed by spirometry to measure forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR). Serum levels of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were quantified by ELISA. RESULTS: Asthmatics had significantly lower FEV1% predicted compared to healthy subjects. EBT in asthma patients was significantly higher as compared to healthy controls while rate of rise of EBT was not significantly different. Serum biomarker of inflammation i.e. IL-6 and of tissue remodelling i.e. VEGF, MMP-9 and TIMP-1 were significantly raised in asthma patients while the ratio of MMP-9/TIMP-1 was comparable between two groups. But no correlation was observed between EBT and serum biomarkers. CONCLUSION: EBT may be used as an adjunct tool for non-invasive assessment of airway inflammation and remodelling in asthma patients.

Orchestration of Neutrophil Extracellular Traps (Nets), a Unique Innate Immune Function during Chronic Obstructive Pulmonary Disease (COPD) Development.

Morbidity, mortality and economic burden caused by chronic obstructive pulmonary disease (COPD) is a significant global concern. Surprisingly, COPD is already the third leading cause of death worldwide, something that WHO had not predicted to occur until 2030. It is characterized by persistent respiratory symptoms and airway limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles of gases. Neutrophil is one of the key infiltrated innate immune cells in the lung during the pathogenesis of COPD. Neutrophils during pathogenic attack or injury decide to undergo for a suicidal death by releasing decondensed chromatin entangled with antimicrobial peptides to trap and ensnare pathogens. Casting neutrophil extracellular traps (NETs) has been widely demonstrated to be an effective mechanism against invading microorganisms thus controlling overwhelming infections. However, aberrant and massive NETs formation has been reported in several pulmonary diseases, including chronic obstructive pulmonary disease. Moreover, NETs can directly induce epithelial and endothelial cell death resulting in impairing pulmonary function and accelerating the progression of the disease. Therefore, understanding the regulatory mechanism of NET formation is the need of the hour in order to use NETs for beneficial purpose and controlling their involvement in disease exacerbation. For example, DNA neutralization of NET proteins using protease inhibitors and disintegration with recombinant human DNase would be helpful in controlling excess NETs. Targeting CXC chemokine receptor 2 (CXCR2) would also reduce neutrophilic inflammation, mucus production and neutrophil-proteinase mediated tissue destruction in lung. In this review, we discuss the interplay of NETs in the development and pathophysiology of COPD and how these NETs associated therapies could be leveraged to disrupt NETopathic inflammation as observed in COPD, for better management of the disease.

Effect of Disease Severity on Respiratory Impedance in Parkinson's Disease.

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder. PD has been traditionally perceived as a motor disorder. However, it is frequently associated with pulmonary dysfunction which has been assessed by Spirometry, an effort-dependent technique. PURPOSE: To evaluate in patients with PD the effect of disease severity on respiratory impedance using Impulse Oscillometry (IOS) and to correlate with Spirometry. METHODS: The study was conducted on 30 patients diagnosed with PD. Pulmonary function was assessed by IOS and spirometer. IOS is an effort-independent technique that uses sound waves of different frequencies to measure airway resistance. Spirometer measures the lung volume and generates flow-volume and volume-time relationship. RESULTS: The mean age of patients was 60.1±9.45. Resistance at 5 Hz (R5) was found to be negatively correlated with forced expiratory volume in the first second of the FVC manoeuver (FEV1) (r = -0.628, P = .002), FEV1/FVC (forced vital capacity) (r = -0.487, P = .025), and PEF (r = -0.599, P = .004), and resistance at 20 Hz (R20) with FEV1 (r = -0.474,P = .029) and PEF (r = -0.522, P = .015). There was significant increase in R5 (0.32(0.36-0.28) vs 0.47(0.60-0.36); P = .04) and R20 (0.25(0.28-0.20) vs 0.30(0.40-0.25); P = .04) in stage II as compared to stage I of Hoehn-Yahr scale. CONCLUSION: IOS might be a promising tool for diagnosis of respiratory dysfunction in addition to Spirometry, especially in cases where patients are not able to perform forced manoeuvers.

Effects of Exercise Intervention Program on Bone Mineral Accretion in Children and Adolescents with Cystic Fibrosis: A Randomized Controlled Trial.

OBJECTIVE: To evaluate effect of one year exercise intervention program on bone mineral accrual in children and adolescent with cystic fibrosis (CF). METHODS: Fifty-two CF children (mean age 149.79 mo) were randomized into experimental (15 boys and 10 girls) and control groups (15 boys and 12 girls). Experimental group performed prescribed exercises three times/week, while control group continued with routine physical activities for one year. Following were assessed at baseline and at one year: Bone mineral density (BMD) of whole body and lumbar spine, pulmonary function, exercise capacity, quality of life and habitual activity. RESULTS: Change in whole body and lumbar spine BMD over 12 mo in experimental group was lower by 0.006 g/cm2 (95% CI -0.02 to 0.02) and higher by 0.001 g/cm2 (95% CI -0.04 to 0.03) than controls, respectively. However, difference between groups was non-significant for both parameters. Experimental group had a significant improvement in their exercise capacity (p = 0.006), quality of life, and serum vitamin D (p = 0.007) levels. Differences between groups for changes in pulmonary function and habitual activity were non-significant. CONCLUSIONS: Exercise regime was not associated with significant improvement in BMD of CF patients, but it had a positive impact on both physical and psychological health of these patients.

Contribution of systemic vascular reactivity to variability in pulse volume amplitude response during reactive hyperemia.

PURPOSE: The aim of the present study was to investigate why the magnitude of reactive hyperemia (RH) observed by pulse volume amplitude (PVA) after arm occlusion differs greatly among study subjects. METHODS: Healthy subjects (n = 12) in the age range of 22-30 years participated in this study. Vascular reactivity was assessed by measuring the changes in finger PVA simultaneously in the test (occluded arm) and control arm (contralateral non-occluded arm) using two separate Photoplethysmographic sensors. Short-term HRV was computed from simultaneously acquired lead II ECG signal to monitor the changes in cardiac sympathetic nervous activity. RESULTS: The observed coefficient of variation for inter-subject variability in PVA response in test arm during second minute of RH was 115.3%. In the control arm, significantly reduced PVA was observed during the period of occlusion as well as RH. This observation was corroborated by simultaneously acquired short-term HRV which showed a significant rise in total power (p value < 0.005) and low-frequency (LF) power (p value < 0.05) during release of occlusion when compared to the baseline. A significant positive correlation (Spearman r = 0.33; p = 0.02) was observed between % change in PVA in the control arm and in the test arm for first 3 min of RH. CONCLUSIONS: Sympathetic activation possibly plays an important role in mediating the inter-subject variability of vascular responses during reactive hyperemia which warrants simultaneous recording of both the test and the control arm responses during RH to accurately assess endothelial function.

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.

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.

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.

FFT transformed quantitative EEG analysis of short term memory load.

BACKGROUND: The EEG is considered as building block of functional signaling in the brain. The role of EEG oscillations in human information processing has been intensively investigated. PURPOSE: To study the quantitative EEG correlates of short term memory load as assessed through Sternberg memory test. METHODS: The study was conducted on 34 healthy male student volunteers. The intervention consisted of Sternberg memory test, which runs on a version of the Sternberg memory scanning paradigm software on a computer. Electroencephalography (EEG) was recorded from 19 scalp locations according to 10-20 international system of electrode placement. EEG signals were analyzed offline. To overcome the problems of fixed band system, individual alpha frequency (IAF) based frequency band selection method was adopted. The outcome measures were FFT transformed absolute powers in the six bands at 19 electrode positions. RESULTS: Sternberg memory test served as model of short term memory load. Correlation analysis of EEG during memory task was reflected as decreased absolute power in Upper alpha band in nearly all the electrode positions; increased power in Theta band at Fronto-Temporal region and Lower 1 alpha band at Fronto-Central region. Lower 2 alpha, Beta and Gamma band power remained unchanged. CONCLUSION: Short term memory load has distinct electroencephalographic correlates resembling the mentally stressed state. This is evident from decreased power in Upper alpha band (corresponding to Alpha band of traditional EEG system) which is representative band of relaxed mental state. Fronto-temporal Theta power changes may reflect the encoding and execution of memory task.

Slower rise of exhaled breath temperature in cystic fibrosis.

OBJECTIVE: To measure exhaled breath temperature in patients with cystic fibrosis. METHODS: 17 patients (6-18 years) with cystic fibrosis and 15 age- and gender-matched healthy controls were recruited in this cross sectional study. Exhaled breath temperature was measured in subjects recruited in both the groups with a device X-halo and analyzed as plateau temperature achieved and rate of temperature rise. RESULTS: Patients with cystic fibrosis showed no significant difference in plateau temperature [34.4(32.3-34.6) versus 33.9 (33.0-34.4)oC; P=0.35] while mean (SEM.) rate of temperature rise was significantly less in patients [0.09 (0.01) versus 0.14 (0.02) ƼC/s ; P=0.04] as compared to controls. CONCLUSIONS: There was a slower rise of exhaled breath temperature in patients with cystic fibrosis whereas plateau temperature was not significantly different from controls.