Evaluation of the Impact of Corticosteroid Dose on the Incidence of Hyperglycemia in Hospitalized Patients with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

PURPOSE: Guidelines recommend systemic corticosteroids for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) albeit in lower doses than studies that cemented corticosteroids' place in therapy. Corticosteroids potentiate hyperglycemia, however it is undetermined how corticosteroid dose impacts hyperglycemia incidence. OBJECTIVES: To establish whether a greater incidence of steroid-induced hyperglycemia (SIHGLY) exists for high- versus low-dose corticosteroids. METHODS: Patients with primary discharge diagnosis 491.21/491.22 in a community hospital were retrospectively reviewed and divided into tertiles based on corticosteroid dosage. Baseline characteristics and primary endpoint were statistically assessed between tertiles using logistic regression analysis. A Cox proportional hazards (CPH) model adjusted for potential covariates. Post hoc analysis for primary outcome and CPH model was run removing non-insulin dependent diabetics because of disproportionate event count. A secondary endpoint used a Kaplan-Meier curve to evaluate time to event between tertiles. RESULTS: Tertile divisions were 125 and 187.5 mg methylprednisolone equivalents. The primary outcome for incidence of SIHGLY was insignificant; post hoc analysis removing non-insulin-dependent diabetics narrowly missed significance between tertiles 1 and 3 (P = .056). CPH analysis found significant differences in SIHGLY between tertiles 1 and 2 (hazard ratio [HR], 1.68; 95% CI, 1.02-2.76) and tertile 1 and 3 (HR, 1.79; 95% CI, 1.13-2.84), further post hoc analysis resulted in a loss of significance for the CPH analysis. Of 21 non-insulin-dependent diabetics, 20 met event status. The Kaplan-Meier analysis results were insignificant. CONCLUSIONS: Study results suggest that a link between larger corticosteroid doses and hyperglycemia incidence may exist, but it requires further study. RESULTS in non-insulin-dependent diabetics provide evidence for increased glucose monitoring upon initiation of corticosteroid therapy.

Severity of obstructive sleep apnea between black and white patients.

Obstructive sleep apnea (OSA) is a relatively common problem with potentially serious health consequences. The purpose of this study was to identify whether race has any effect on the severity of OSA. Our hypothesis was that OSA, when present, is more severe in black patients than white patients. This cross-sectional study was performed at Truman Medical Centers, a teaching hospital affiliated with University of Missouri-Kansas City School of Medicine (Kansas City, MO). Multiple linear regression analysis was conducted to establish if race was predictive of apnea-hypopnea index (AHI) score when controlling for age, sex, and body mass index. The analysis included 280 patients with complete data for each of the variables in the model. Race (the primary predictor of interest) did not significantly predict AHI score (P = 0.172), and neither did age (P = 0.783). Men had higher AHI scores than women (P < 0.001), and higher body mass index was associated with higher AHI score (P < 0.001). There were more black women in the sample population than white women (P = 0.043). Black patients were also more likely to have hypertension (P = 0.037). This study suggests that race is not a predictor of OSA severity after controlling for age, sex, and body mass index. There is a need for more studies to examine the prevalence of OSA in different races.

Membrane level of omega-3 docosahexaenoic acid is associated with severity of obstructive sleep apnea.

BACKGROUND: Patients with obstructive sleep apnea (OSA) are at increased risk of cardiovascular disease (CVD). The omega-3 fatty acid docosahexaenoic acid (DHA) is a major component of neural tissues, and supplementation with fish oils improves autonomic tone and reduces risk for CVD. A link between low DHA status and less mature sleep patterns was observed in newborns. METHODS: We investigated the relations between red blood cell (RBC) levels of DHA and OSA severity in 350 sequential patients undergoing sleep studies. Severity categories were defined as none/mild, moderate, and severe, based on apnea hypopnea index (AHI) scores of 0 to 14, 15 to 34, and > 34, respectively. RESULTS: After controlling for age, sex, race, smoking, BMI, alcohol intake, fish intake, and omega-3 supplementation, RBC DHA was inversely related with OSA severity. For each 1-SD increase in DHA levels, a patient was about 50% less likely to be classified with severe OSA. The odds ratios (95% CI) were 0.47 (0.28 to 0.80) and 0.55 (0.31 to 0.99) for being in the severe group versus the none/mild or moderate groups, respectively. CONCLUSION: These findings suggest that disordered membrane fatty acid patterns may play a causal role in OSA and that the assessment of RBC DHA levels might help in the diagnosis of OSA. The effects of DHA supplementation on OSA should be explored.

Complex karyotype in a low grade phyllodes tumor of the breast.

Cytogenetic analysis of a phyllodes tumor of low grade malignancy disclosed the karyotype 52-55,XX, -1,+5,+7,+9,+10,+11,-15,+18,-19,+20,der(21)t(1;21)(p13;q22),+mar1x 2-4,+mar2[cp18]/46,XX. This study shows that a complex chromosome karyotype can be found in low-grade phyllodes tumors and is not necessarily a sign of extreme malignancy of these neoplasms.