Reduced forced vital capacity is independently associated with ethnicity, metabolic factors and respiratory symptoms in a Caribbean population: a cross-sectional study.

BACKGROUND: Relationships between low forced vital capacity (FVC), and morbidity have previously been studied but there are no data available for the Caribbean population. This study assessed the association of low FVC with risk factors, health variables and socioeconomic status in a community-based study of the Trinidad and Tobago population. METHODS: A cross-sectional survey was conducted using the Burden of Obstructive Lung Disease (BOLD) study protocol. Participants aged 40 years and above were selected using a two-stage stratified cluster sampling. Generalized linear models were used to examine associations between FVC and risk factors. RESULTS: Among the 1104 participants studied a lower post-bronchodilator FVC was independently associated with a large waist circumference (- 172 ml; 95% CI, - 66 to - 278), Indo-Caribbean ethnicity (- 180 ml; 95% CI, - 90 to - 269) and being underweight (- 185 ml; 95% CI, - 40 to - 330). A higher FVC was associated with smoking cannabis (+ 155 ml; 95% CI, + 27 to + 282). Separate analyses to examine associations with health variables indicated that participants with diabetes (p = 0∙041), history of breathlessness (p = 0∙007), and wheeze in the past 12 months (p = 0∙040) also exhibited lower post-bronchodilator FVC. CONCLUSION: These findings suggest that low FVC in this Caribbean population is associated with ethnicity, low body mass index (BMI), large waist circumference, chronic respiratory symptoms, and diabetes.

Low back pain in a diabetic on chronic haemodialysis: pyogenic spondylodiscitis.

Spondylodiscitis of the lumbar spine is described in a 67-year-old-man receiving chronic haemodialysis via a central venous catheter for diabetic nephropathy. He also had a forearm arteriovenous fistula created 1 month earlier. Clinical, MRI and surgical findings are described. The patient died despite spinal surgery and 1 month of antibiotic therapy from suspected pulmonary embolism. Early recognition by MRI or other imaging technique, prompt antibiotic therapy and often surgery are necessary for a successful outcome in this increasingly recognised complication in patients on chronic haemodialysis. Diabetes mellitus may be an added risk factor.