Bronchodilator reversibility testing in morbidly obese non-smokers: fluticasone/salmeterol efficacy versus salbutamol bronchodilator.

A positive response in reversibility testing is widely used to diagnose patients with airway limitations. However, despite its simple procedure, it doesn't accurately reflect the exact airway irreversibility. This study aimed to investigate the efficacy of a bronchodilation reversibility test using salbutamol and fluticasone/salmeterol combination in obese non-smoker subjects.The study included patients without a history of obstructive lung disease or bronchodilators. A sub-classification of patients based on body mass index (BMI) was carried out into normal (< 24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (BMI ≥ 30). Spirometry measurements were performed before and after salbutamol or fluticasone/salmeterol administration.The study included 415 (49.9% male) patients with a mean age of 40.92 ± 10.86 years. Obese subjects showed a high prevalence of restrictive patterns (23.4%), with non-significantly lower spirometric values compared to normal and overweight subjects (p > 0.05). The magnitude of bronchodilation, as identified by spirometry, following fluticasone/salmeterol was higher in all participants, with a significant increase in obese subjects with a p-value of 0.013, 0.002, and 0.035 for FEV1, FEV1% predicted, and FEV1/FVC, respectively.Fluticasone/salmeterol combination increases FEV1, FEV1% of predicted, and FEV1/FVC ratio than the conventional test using salbutamol inhaler, and it can be a potential candidate for assessment of airway obstruction using reversibility test, especially among the obese population.

PID and LQG controllers for diabetes system with internal delay: a comparison study.

Closed-loop treatment for insulin dependent type 1 diabetes patients is a recent medical practice in insulin delivery (bionic pancreas) which aims to achieve tight control of glucose level in plasma and ensure minimizing risk of hypoglicemia. Among those most popular closed-loop controller strategies, proportional integral derivative (PID) and linear quadratic Gaussian (LQG) controllers are designed and compared for insulin delivery in diabetic patients. The controllers are designed based on individual and nominal model which is to study the ability of each controller in order to maintain blood glucose concentration for similar patient's dynamic. The comparison is conducted numerically not only for for patients suffering type 1 diabetes mellitus (T1DM), but also type 2 diabetes mellitus (T2DM), and double diabetes mellitus (DDM) in the present of internal delay systems, which causes instability. The responses show that the proposed PID controller is better at maintaining the blood glucose level in the normal range for a longer delay of delay in hepatic glucose production. The patient with longer performing physical exercise has lower oscillation peaks in blood glucose concentration.

Management of Neglected Patellar Tendon Rupture via the Ilizarov Apparatus and Patellar Transport Following Multistage Reconstruction using Contralateral Patella Tendon Bone Autograft: A Case Study.

Muscle elongation by Ilizarov apparatus is one of the most remarkable surgeries performed to date. Chronic patella tendon injury is an uncommon condition, and due to its rarity, it is difficult to operate and restore the quality of life and function of the patient. Here we demonstrated a 40-year-old Saudi person who underwent a three-stage operative procedure on him: in the first stage we entailed debridement and removal of the implant; in the second stage, we performed this innovative Ilizarov muscle elongation of the quadriceps, and in the third stage, we reconstructed the right patellar tendon using a contralateral patella tendon bone autograft fixed by 3.5 screws proximal to the patella and distal to the tibial tuberosity and augmented by cerclage wires. After 3 months of intensive physical therapy, the patient regained his knee's range of motion and muscle strength and was able to return to his security job. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00608-5.