Uric Acid : A Mirror to the Lungs in COPD.

Chronic obstructive pulmonary disease (COPD) is presently the third major cause of death in the world with 80% of deaths due to COPD occurring in countries with low- and middle income. Impaired lung function is associated with high serum uric acid levels due to tissue hypoxia-induced degradation of adenosine, pulmonary arterial hypertension and inflammation-induced damage of lung tissue. This study aims to find out if serum uric acid can be used as an early marker of disease severity in COPD patients by correlating it to spirometry values. Material: The objectives of this study were to estimate serum uric acid levels in patients with COPD and to correlate serum uric acid levels with spirometry values in patients with COPD. This is a cross-sectional study conducted on 80 patients of COPD satisfying inclusion and exclusion criteria admitted in hospitals attached to Bangalore Medical College & Research Institute. All necessary investigations were done, including serum uric acid levels. The patients underwent spirometry and the severity of airflow limitation was classified according to GOLD 2021 guidelines and correlated with the serum uric acid levels. Observation: The age of the patients ranged from 42 to 88 years of which 72 were males and 8 were females with 85% of the total patients being smokers. In this study, out of 80 patients, 7.5%, 16.3%, 38.8% and 37.5% belonged to MMRC grade 0, 1, 2 and 3 respectively. Majority of patients i.e. 37(46.3%) belonged to GOLD stage 2 with 9(11.3%) and 34(42.5%) categorized as GOLD stage 1 and 3 respectively. Mean uric acid level in patients was 3.74, 5.44 and 6.70 mg/dL in patients with post-bronchodilator FEV1 of ≥ 80%, FEV1 50% to < 80% and FEV1 30% to < 50% predicted values respectively while it was 4.43, 6.27 and 6.61 mg/ dL in patients with post-bronchodilator FVC of 100-120%, 80-99% and 60-79% predicted value respectively. Uric acid levels correlated significantly with FEV1 and FVC values (p = 0.00). Significant correlation was also seen between GOLD staging and uric acid (p = 0.00) with uric acid levels of 3.74, 5.43 and 6.70 mg/dL corresponding to GOLD stage 1, 2 and 3 respectively Conclusion: Rising uric acid levels correspond with increasing severity of airflow limitation in patients with COPD. Serum uric acid is a useful, easily available, cost effective marker for predicting disease severity and thereby the prognosis in patients with COPD.

Study of hba1c and serum ferritin levels in covid 19 associated Mucor mycosis.

India witnessed a huge surge in Covid 19 cases in the second wave. There was also an increased presentation of Mucor mycosis cases associated with Covid 19 illness. Severe COVID-19 is a hyper-ferritinemic syndrome, but whether high ferritin is a marker of a severe systemic disease versus a modulator of pathophysiology is not known. Irrespective of its role, high ferritin levels lead to excess intracellular iron that generates reactive oxygen species resulting in tissue damage. There are many theories existing presently to associate the development of Mucor mycosis in Covid 19 patients. The present study is to evaluate the correlation between HbA1c and serum ferritin levels in COVID 19 associated Mucor mycosis and the associated outcomes. MATERIAL: It is prospective observational study. RT-PCR confirmed cases of COVID 19 pneumonia with clinical, microbiological or radiologically confirmed cases of mucor mycosis were selected after obtaining informed consent. Relevant clinical data collected, Serum Hba1c and Ferritin was sent. Data analysis was done using SPSS software. OBSERVATION: Among the 97 patients, 63 (64.9 %) were male and 34 (35.1%) were females, 10 (10.3 %) patients had no comorbidities, 82 (84.5 %) patients had diabetes mellitus, 32 (33.0 %) patients had hypertension and 30 (30.9 %) patients had both diabetes and hypertension. Mean Hba1c among the patients was 10.98 %. Mean serum ferritin level was 929.11 ng/dl. Mean Serum ferritin was significantly lower among survivors (843.8 ng/dl) when compared to non survivors (1150.2 ng/dl) (p= 0.034). CONCLUSION: Serum ferritin is significantly elevated in COVID-19- associated mucor mycosis (CAMCR) cases. The mean Hba1c of 10.98 % suggests a background of poorly controlled diabetes mellitus along with COVID 19 infection is a risk factor for mucor mycosis. Serum ferritin was significantly lower among survivors when compared to non survivors. Increased serum ferritin can be associated with poor prognosis and mortality in COVID-19 associated mucor mycosis.