Top PDF Pulmonary function test in type 1 diabetics

Abstract: Objective: Present study was undertaken to find out the effect of diabetes on the respiratory system. Background: Diabetes is a disease with multiple organ involvement. Glycosylation of tissue proteins occur when blood glucose level remain elevated for a prolonged duration. Due to this, there occur irreversible changes in the chemical structure of tissue proteins. Basement membrane and connective tissues in skin, muscles, respiratory system, vascular bed, kidney, peripheral nervous system, etc. are the targets for glycosylation. Pulmonary function testing (P.F.T.) is a valuable tool for evaluating the respiratory system, representing an important adjunct to the patient history, various lung imaging studies, and invasive testing such as bronchoscopy and open-lung biopsy. Material and Method: 64 type 1 diabetic subjects and 60 controls were selected for the study. Anthropometric parameters, blood investigations and P.F.T. were performed on all subjects. Result and Discussion: Fasting and Post Meal blood glucose levels as well as HbA 1 c% were

There are several treatment options including a multidisciplinary clinical approach designed to promote weight loss, pharmacological therapies, and bariatric and metabolic surgical techniques [8, 9]. The ileal transposition involves the segment removal of the distal ileum and its insertion into the proximal small intestine, a procedure that promoting early satiety and exerting benefits on glucose metabolism and weight loss. These effects probably can be attributed to incretins stimulation such as glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), increasing insulin sensitivity in the short-and medium-term, allowing clinical type 2 DM patient control without the need for insulin or oral hypoglycemic agents [10 - 13].

Although our data also suggest that en- dogenous insulin secretion estimated by ba- sal C-peptide had no association with micro- albuminuria or retinopathy, two points con- cerning our patients should be discussed. First, our sample comprised mostly young patients with a relatively short duration of diabetes (58% with <10 years) and conse- quently we had only 7 and 13 patients with microalbuminuria and retinopathy, respec- tively. The second point was the small num- ber of patients (N = 7) with high basal C- peptide levels. For an 80% statistical power a sample comprising 92 patients would be necessary to avoid a type 2 statistical error which may have occurred with our sample. Even though these facts could have influ- enced our results, a prospective study with different types of diabetes has not demon- strated an effect of higher levels of basal C- peptide on 6-year progression of retinopathy in younger onset insulin-dependent patients (4). The level of glycemic control was the most important predictor of the incidence of retinopathy (4). Another 2-year prospective study with type 1 diabetics also did not find an influence of stimulated C-peptide on the evolution of retinopathy and/or microalbu- minuria (13). Since we found a negative correlation between basal C-peptide and HBA 1 , it is possible that low basal C-peptide

The maximal strength test was done according to the following steps: (1) the participants were familiarized with the equipment during 2 weeks (three sessions/ week), using the minimal resistance of the equipment; (2) for the test, the individuals first participated in a warm-up activity, consisting of stretching and performing 20 repetitions with minimal load in the equipment of the test; at the end of the warm-up, the volunteers had 3 minutes of recovery period; (3) next, the 1RM test began, in which the individuals performed two repetitions of the proposed exercise; if they were able to perform it, they had a 5-minute recovery period, and then a new attempt was made with a heavier load; (4) the steps were followed until the moment in which the individuals were able to do only one repetition, thus obtaining the maximal load for each exercise proposed. It is important to emphasize that each person had, at most, five attempts to attain a load regarding the 1RM. When more than five attempts were necessary, the test was performed on another day. The evaluations were done before and after the end of the program, and the last evaluation was performed 72 hours after the last exercise session.

predictors of obstructive defect development within 5 years after completion of pulmonary TB treatment. The time interval (DT) between the date of each pulmonary function test and the timing of the worst pulmonary function (obtained by LOESS smoothing models) was included in the analysis. Other parameters with the potential to influence pulmonary function after completion of pulmon- ary TB treatment were also included in the analysis; these parameters were demographic data, smoking history, underlying co-morbidities, radiographic findings, labora- tory results, and pulmonary tuberculosis treatment courses. A two-sided p value ,0.05 was considered to be significant. All analyses were performed using SAS software (version 9.1.3, SAS Institute Inc., Cary, NC, U.S.A.).

Background. The increasing prevalence and incidence of type 2 Diabetes has turned it into a worldwide epidemic. Although Physical Activity (PA) may play an essential role in the prevention and management of this disease, sedentary lifestyles continue to increase among diabetics. Besides, there is evidence to believe that diabetics and non- diabetics show different patterns of PA behavior, perceptions and information seeking. Objectives. This study aims to analyze diabetics and non-diabetics differences regarding (1) PA patterns (level, barriers, goals/expectations and preferred activities); (2) PA-related information sources and (3) evidenced perception on the need and importance of PA. Methods. Using data from 485 Portuguese subjects aged between 41 and 90 years old, differences between diabetics (n=85) and non-diabetics (n=400) were analyzed with Pearson’s chi-square and independent t-test. Results. The study concludes that 32% of diabetics that are physically inactive. Their attitude toward PA is not much different from non-diabetics. Nevertheless, the importance given to the time available and the schedules of activities as well as exercising with friends were more relevant for diabetics. Diabetics considered that the exercise is not safe for their health condition and present lower expectation towards exercise. Regarding information seeking behavior about PA, diabetics use as leading information source doctors and less online information. Conclusion. Diabetics and non- diabetics give different importance to PA. Results establish a foundation for the development of effective tailored communication strategies to promote PA among the diabetics.

infection [8]. In human studies, elevated levels of IL-10 have been detected in the lungs and serum of those with active PTB [26,27,28] and neutralization of IL-10 has been shown to promote T cell proliferation and IFNc production [29,30,31]. Based on these studies, we postulated that IL-10 could play an important role in modulation of cytokine responses in TB infection. However, we did not detect any significant increase in the antigen – driven levels of IL-10 in PTB or TBL individuals compared to LTB. While the reason behind the differences in IL-10 levels in our study from previous studies remain to be explored, it is likely to reflect differences in both host and pathogen factors, including host and pathogen genotypes and presence of co-existent infections. Nevertheless, neutralization of IL-10 prior to stimula- tion with Mtb antigen had a profound effect in overcoming the impaired cytokine production in PTB. To our knowledge, this study is the first to demonstrate a role for IL-10 in the suppression of Type 2 and Type 17 cytokine responses in tuberculosis. In Figure 3. PTB is associated with decreased antigen-stimulated production of IL-4. Whole blood from PTB, TBL and LTB individuals was stimulated with (A) PPD (10 mg/ml) or (B) ESAT-6 (10 mg/ml) or (C) CFP-10 (10 mg/ml) or (D) anti-CD3 (5 mg/ml) for 72 h, and levels of Type 2 cytokines IL-4, IL-5 and IL-13 were measured by ELISA. Results are shown as net cytokine production over media control. The bars represent geometric means and 95% confidence intervals. P values were calculated using the Kruskal-Wallis test with Dunn’s multiple comparisons comparisons (* p,0.05, ** p,0.01, *** p,0.001).

The other sister J.K. was born two years after the fatal outcome in K.K. Previously, the parents declined referral to genetic counseling. She was diagnosed with GD at two years of age on the basis of bone marrow infiltration with Gaucher cells and low leukocyte ß-glucosidase activity. Genetic test- ing (mutation analysis in Biochemical laboratory of Univer- sity of Amsterdam) revealed that J.K. was homozygous for L444P mutation. Initial manifestations of disease included massive hepatomegaly and splenomegaly, hematologic ab- normalities (thrombocytopenia, anemia), growth retardation and oculomotor apraxia as only neurological sign. That pa- tient was assigned with moderate SSI of 16 at the onset of disease. There were no clinical nor radiological signs of in- trinsic pulmonary disease within GD at the time. Enzyme re- placement therapy was started with imiglucerase at the age of four years with dose of 120 IU/kg/month. After two years of ERT dose was increased to 240 IU/kg/month due to dis- crete neurological progression. Other aspects of disease, however, showed a significant improvement: decreased vis- ceromegaly and compensatory growth spurt. At six years of age routine pulmonary function testing revealed moderately reduced forced expiratory volume in the first second, but without any clinical signs of lung disease. Chest radiography revealed fine reticulonodular pattern of involvement in lung interstitium. Six months later high resolution computerized tomography (HRCT) of the lungs showed marked bilateral interstitial markings with ground-glass appearance (Figure 1). Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy of lung parenchyma were performed. Numerous Gaucher cells were identified in BAL fluid (Figure 2). Histopathology of transbronchial biopsy re-

This prospective study analyzed the involvement of the autonomic nervous system in pulmonary and cardiac function by evaluating cardio- vascular reflex and its correlation with pulmonary function abnormali- ties of type 2 diabetic patients. Diabetic patients (N = 17) and healthy subjects (N = 17) were evaluated by 1) pulmonary function tests includ- ing spirometry, He-dilution method, N 2 washout test, and specific airway conductance (SGaw) determined by plethysmography before and after aerosol administration of atropine sulfate, and 2) autonomic cardiovas- cular activity by the passive tilting test and the magnitude of respiratory sinus arrhythmia (RSA). Basal heart rate was higher in the diabetic group (87.8 ± 11.2 bpm; mean ± SD) than in the control group (72.9 ± 7.8 bpm, P<0.05). The increase of heart rate at 5 s of tilting was 11.8 ± 6.5 bpm in diabetic patients and 17.6 ± 6.2 bpm in the control group (P<0.05). Systemic arterial pressure and RSA analysis did not reveal significant differences between groups. Diabetes intragroup analysis revealed two behaviors: 10 patients with close to normal findings and 7 with signifi- cant abnormalities in terms of RSA, with the latter subgroup presenting one or more abnormalities in other tests and clear evidence of cardiovas- cular autonomic dysfunction. End-expiratory flows were significantly lower in diabetic patients than in the control group (P<0.05). Pulmonary function tests before and after atropine administration demonstrated comparable responses by both groups. Type 2 diabetic patients have cardiac autonomic dysfunction that is not associated with bronchomotor tone alterations, probably reflecting a less severe impairment than that of type 1 diabetes mellitus. Yet, a reduction of end-expiratory flow was detected.

FEV 1 /FVC ratio. Results: Our sample comprised 74 children. The spirometry success rate was 82%. Although the performance improved with age, the difference between younger and older children was not significant (p > 0.05). An average of 6.6 attempts/test were needed in order to achieve acceptable, reproducible curves. All 61 successful tests produced satisfactory FEV 0.5 and FEV 1 values. By calculating Z scores, we found that 21.6% of the children presented with an obstructive pattern. Conclusions: In our sample, the spirometry success rate was high, showing that spirometry is a valid method for assessing pulmonary function in preschool children. The high success rate in our sample might be attributable to the use of an incentive and to the fact that the tests were performed by professionals specializing in pediatrics.

ABSTRACT: The purpose of this study was to determine the prevalence of respiratory symptoms among cotton-ginning workers. Byssinosis is a respiratory disease caused by inhalation of cotton dust for prolonged period of time. This is most frequently occurs in the cotton mill workers. The Aim of the study is 1. Determining the proportion of workers experiencing difficulty in breathing, chest tightness, chest pain, coughing, wheezing and phlegm. 2. To evaluate the pulmonary function test variation in textile workers with non-textile workers. The present study was conducted on three groups (I, II, III) of male subjects of age ranging 30 to 40 yrs, 41 to 50 yrs & 51 to 60 yrs. And each of the group is divided again into textile workers & non-textile workers. A structured questionnaire enquiring about the respiratory health was administered to the employees. And our result shows the Byssinotic symptoms were too high in cotton mill workers than control group. The pulmonary function test shows a significant reduction in lung capacity, and the mean values of FVC, FEV1, FEV1%, FEF 50%, were on negative side among cotton mill workers compared to control group and which is statistically significant.

This was a cross-sectional descriptive study. We analyzed the results of the spirometric tests conducted between June of 2009 and February of 2010 in the Pulmonary Function Laboratory of the Hospital Infantil Jeser Amarante Faria (HIJAF, Jeser Amarante Faria Children’s Hospital), located in the city of Joinville, Brazil. All children 6 years of age or younger who agreed to perform spirometric maneuvers were included. An appointment with a pulmonologist or an allergist was made for the patients through an appointment scheduling system of the Municipality of Joinville. During appointment scheduling, parents or legal guardians were instructed to stop giving their children their medications, especially bronchodilators, antihistamines, anticholinergics, and leukotriene receptor antagonists, one day prior to the test, not to let them drink tea or coffee, and to postpone the test if their children had exacerbations.

Spirometry (Spiromed- microplus M503, MAN5105, spirometer) was performed in all subjects. The best of at least three technically acceptable values for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were selected. Forced vital capacity and FEV1 were used as measures of ventilatory function. The pulmonary function test results were expressed as percentages of predicted normal values. 9 For the purpose of this study, the threshold of

Methods: We analyzed the pulmonary function test results of 211 adult patients submitted to spirometry and lung volume measurements. We used the clinical diagnosis at the time spirometry was ordered, together with various functional data, in order to distinguish between patients presenting with a “true” restrictive pattern (reduced TLC) and those presenting with a nonspecific pattern (normal TLC). Results: In the study sample, TLC was reduced in 144 cases and was within the normal range in 67. The most common causes of a nonspecific pattern were obstructive disorders, congestive heart failure, obesity, bronchiolitis, interstitial diseases, and neuromuscular disorders. In patients given a working diagnosis of pulmonary fibrosis, pleural disease, or chest wall disease, the positive predictive value (PPV) for restriction was ≥ 90%. In males, an FVC ≤ 60% of predicted had a PPV for restriction of 98.8%. In females, the restrictive pattern was found in 84.4% of those with an FVC ≤ 50% of predicted. A difference of ≥ 0% between the FEV 1 % and the FVC% had a PPV for restriction of 89.5%. After

Objective: Studies characterizing asthma phenotypes have predominantly included adults or have involved children and adolescents in developed countries. Therefore, their applicability in other populations, such as those of developing countries, remains indeterminate. Our objective was to determine how low-income children and adolescents with asthma in Brazil are distributed across a cluster analysis. Methods: We included 306 children and adolescents (6-18 years of age) with a clinical diagnosis of asthma and under medical treatment for at least one year of follow-up. At enrollment, all the patients were clinically stable. For the cluster analysis, we selected 20 variables commonly measured in clinical practice and considered important in deining asthma phenotypes. Variables with high multicollinearity were excluded. A cluster analysis was applied using a two- step agglomerative test and log-likelihood distance measure. Results: Three clusters were deined for our population. Cluster 1 (n = 94) included subjects with normal pulmonary function, mild eosinophil inlammation, few exacerbations, later age at asthma onset, and mild atopy. Cluster 2 (n = 87) included those with normal pulmonary function, a moderate number of exacerbations, early age at asthma onset, more severe eosinophil inlammation, and moderate atopy. Cluster 3 (n = 108) included those with poor pulmonary function, frequent exacerbations, severe eosinophil inlammation, and severe atopy. Conclusions: Asthma was characterized by the presence of atopy, number of exacerbations, and lung function in low-income children and adolescents in Brazil. The many similarities with previous cluster analyses of phenotypes indicate that this approach shows good generalizability.

Chronic respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung diseases, are associated with considerable morbidity and mortality in both developed and developing nations worldwide [1]. The diagnosis of chronic respiratory diseases typically consists of a comprehensive assessment of patients’ symptoms, pulmonary function tests (PFTs), radiological imaging, health and functional status and quality of life evaluations [2–4]. Once the diagnosis of chronic respiratory disease is established, adequate patient educa- tion is very important in achieving improvements in important health outcomes [5, 6]. The ideal physician-patient communication in patients with the common respiratory diseases will most likely be multi-faceted consisting of (but not restricted to) communicating diagnosis, test results, disease education and management plan/s. It is now well recognised that effective phy- sician-patient communication can positively influence a patient's adherence to treatment [7].

Methods: We analyzed the pulmonary function test results of 211 adult patients submitted to spirometry and lung volume measurements. We used the clinical diagnosis at the time spirometry was ordered, together with various functional data, in order to distinguish between patients presenting with a “true” restrictive pattern (reduced TLC) and those presenting with a nonspecific pattern (normal TLC). Results: In the study sample, TLC was reduced in 144 cases and was within the normal range in 67. The most common causes of a nonspecific pattern were obstructive disorders, congestive heart failure, obesity, bronchiolitis, interstitial diseases, and neuromuscular disorders. In patients given a working diagnosis of pulmonary fibrosis, pleural disease, or chest wall disease, the positive predictive value (PPV) for restriction was ≥ 90%. In males, an FVC ≤ 60% of predicted had a PPV for restriction of 98.8%. In females, the restrictive pattern was found in 84.4% of those with an FVC ≤ 50% of predicted. A difference of ≥ 0% between the FEV 1 % and the FVC% had a PPV for restriction of 89.5%. After

ABSTRACT | Background: The step test has been used to assess exercise capacity in patients with chronic respiratory disease; however, its use has not been described with regard to patients with bronchiectasis (BCT). Objective: This study assessed the reliability of the Chester step test (CST) and the modiied incremental step test (MIST) and also correlated these tests with pulmonary function, heart rate (HR), and distance walked during the 6-min walk test (6-MWT). Method: On separate days, 17 patients randomly underwent two CSTs, two MISTs, and two 6-MWTs. Number of steps (NOSs), HR, and perceived exertion were recorded immediately before and after these tests. Results: NOSs were similar across CSTs (124±65 and 125±67) and MISTs (158±83 and 156±76). Differences were not found across the CSTs and MISTs with regard to HR (138±25 bpm and 136±27 bpm), SpO 2 (91±5% and 91±3%), perceived exertion (dyspnea=4 [3-5] and 4 [2-4.5]) and fatigue (4 [2-6] and 4 [3-5]). The CST was signiicantly briefer than the MIST (6.0±2.2 min and 8.6±3.0 min) and had fewer associated NOS (125±67 and 158±83). NOSs were correlated with FEV1, the 6-MWD, and HR for both tests. Conclusions: The CST and MIST are reliable in patients with BCT. Patients tolerated the MIST more than the CST. Better lung function and 6-MWT scores predicted the greater NOSs and greater peak HR.

1. Santos AB, Chapman MD, Aalberse RC, Vailes LD, Ferriani VP, Oliver C, Rizzo MC, Naspitz CK, Arruda LK. Cockroach Allergens and Asthma in Brazil: Identification of Tropomyosin as a Major Allergen with Potential Cross- reactivity with Mite and Shrimp Allergens. J Allergy Clin Immunol 1999, 104:329-37

24. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status. Am J Respir Crit Care Med. 2003;167(4):544-9. 25. Sciurba F, Criner GJ, Lee SM, Mohsenifar Z, Shade D, Slivka W, Wise RA; National Emphysema Treatment Trial Research Group. Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length. Am J Respir Crit Care Med. 2003;167(11):1522-7.