Cardiopulmonary exercise testing versus pulmonary function test in the assessment of respiratory impairment in chronic obstructive pulmonary disease patients.

INTRODUCTION: Cardiopulmonary exercise testing (CPET) is a non-invasive method for the determination of disability and comprehensive evaluation of exercise responses involving the cardiovascular, pulmonary and musculoskeletal systems. MATERIAL AND METHODS: To assess exercise performance measured by CPET in different chronic obstructive pulmonary disease (COPD) stages and to compare between pulmonary function test (PFT) and CPET in assessing the degree of respiratory impairment. Sixty patients diagnosed with COPD were enrolled in the study. Modified Medical Research Council scale (mMRC) and COPD assessment test (CAT) to evaluate dyspnea symptom. PFT and CPET were performed. RESULTS: There was a significant decrease in peak VO2 and anaerobic threshold in patients with stages III, IV (P < 0.001), while COPD stage I, II had significantly higher minute ventilation, tidal volume and oxygen pulse (P < 0.001). 76.67% of patients were similarly classified by CPET and PFT, while 23.33% were found to be less impaired according to CPET when compared to PFT. A significant correlation between both VE/VO2 (r = 0.31, 95% CI 0.19-0.92, P < 0.001) and VE/VCO2 (r = 0.69, 95% CI 0.86-1.08, P < 0.001) with FEV1. Whereas, an inverse correlation were found between both VE/VCO 2 (r = -0.34, 95% CI -0.77 -1.11, P < 0.001) and VE/VO2 (r = -0.55, 95% CI -0.88 to -0.15, P < 0.001), with the degree of air trapping as estimated by RV/TLC ratio. No significant correlation between neither CAT nor MRC and exercise testing parameters. CONCLUSION: CPET is an extremely valuable method for the determination of functional capacity and exercise intolerance in COPD rather than PFT. CPET is considered a gold-standard tool for better evaluation of respiratory impairment in COPD.

Intelligent volume assured pressure support (iVAPS) vs. spontaneous/timed mode as a weaning strategy for intubated COPD patients with acute exacerbation.

INTRODUCTION: Noninvasive positive-pressure ventilation (NPPV) is applied to facilitate weaning process and decrease complications associated with prolonged intubation. Interest has emerged in using Intelligent Volume Assured Pressure Support (iVAPS) to facilitate earlier removal of an endotracheal tube. MATERIAL AND METHODS: This study was conducted to compare the effectiveness of iVAPS versus standard Spontaneous/timed (S/T) mode in facilitating weaning process of mechanically ventilated chronic obstructive pulmonary disease (COPD) in acute exacerbation. In a prospective randomized study, 80 invasively ventilated COPD patients in acute exacerbations were extubated then immediate applicationof NPPV using either S/T mode (Group I) or iVAPS mode (Group II) was done. Clinical parameters (heart rate, respiratory rate, and arterial blood gas parameters at selected time intervals of treatment were recorded for both groups and analyzed. RESULTS: No significant differences were found between both groups regarding age, sex, mMRC dyspnea scale, CAT score and APACHE II score. Heart rate and mean arterial blood pressure in the two groups decreased with time, but no significant differences were found between the two groups. Likewise, there was no significant difference in RR between S/T and iVAPS groups. Regarding arterial blood gas analysis, there were no detectable differences in PaCO2 level, PaO2 level or oxygen saturation. The successful outcome was achieved in (82.5%) in the S/T group vs (80%) in the iVAPS group. The two modes achieved comparable levels of comfort as assessed by VAS and the total Mask Fitness Score. There was no statistically significant difference in reintubation, the duration of NPPV, duration of ICU stay or in mortality rate. CONCLUSION: iVAPS mode is as effective as fixed-pressure S/T mode in facilitating weaning of hypercapnic COPD patients.

Terminalia Arjuna (Roxb.) Modulates Circulatory Antioxidants on 7,12-dimethylbenz(a)anthracene- induced Hamster Buccal Pouch Carcinogenesis.

OBJECTIVES: Oral cancer is the fifth most frequent cancer worldwide and India has recorded the highest incidence (40-50%) of oral malignancy. This study is designed to investigate the effect of aqueous extract of Terminalia arjuna bark (TaBet) on circulatory lipid peroxidation and antioxidant status during 7,12-dimethylbenz[a]anthracene (DMBA)-induced hamster buccal pouch carcinogenesis. METHODS: Male Syrian golden hamsters painted with 0.5% 7,12-dimethylbenz[a]anthracene on the buccal pouches and developed oral squamous cell carcinoma were included in this study. RESULTS: The enhanced Thiobarbituric acid reactive substances in circulation of tumor-bearing animals was accompanied by a significant decrease in the levels of vitamin C, vitamin E, reduced glutathione, superoxide dismutase, catalase and glutathione peroxidase. Administration of TaBet (500 mg/kg body weight) significantly suppressed DMBA-induced hamster buccal pouch carcinomas, decreased lipid peroxidation and enhanced the levels of antioxidants. CONCLUSION: The chemopreventive potential of TaBet is probably due to its antilipidperoxidative effect or the presence of some potent bioactive chemopreventive principles in the bark of Terminalia arjuna. The results of the present study indicate that T. arjuna may emerge as a putative chemopreventive agent against oral carcinogenesis.

Effects of chronic ethanol and vitamin C administration on production of tumor necrosis factor-alpha and interleukin-6 in rats.

Chronic alcoholism complicated by alcoholic liver disease (ALD) is characterized by activation of inflammatory responses. Alcohol intake increases gut permeability allowing substances such as lipopolysaccharides (LPS) which are strong inducers of proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) to enter the circulation. Vitamin C is an antioxidant with many cellular activities seemed to protect cells against alcohol-induced peroxidation. In present study, serum levels of TNF-alpha and IL-6 were measured by ELISA method in four groups of albino rats, each group consists of 10 rats. Group (I) was untreated group (control), group (II) was treated with ethanol, group (III) was treated with ascorbic acid and group (IV) was treated with ethanol + ascorbic acid. Results revealed that both TNF-alpha and IL-6 serum levels were very highly significantly increased in group (II) and (IV) than control group (1) (P < 0.001). Group (III) showed significantly (P < 0.001) decreased TNF-alpha serum level than group (II) and (IV) while it showed significantly (P < 0.001) increased IL-6 serum level than control group (I) and also significantly decreased IL-6 serum level than group (IV). Serum IL-6 level was significantly (P < 0.01) decreased in group (III) than (II). These results indicate that serum levels of the proinflammatory cytokines TNF-alpha and IL-6 may serve as predictive biomarkers for progression of ALD. In addition, using TNF-alpha neutralizing agent (or its antagonist)/or IL-6 as an anti-apoptotic factor could be useful as a treatment strategy of ALD.