In-Won Park

The effect of diabetic control status on the clinical features of pulmonary tuberculosis

The aim of this study was to determine whether control status of diabetes mellitus influences clinical and radiographic manifestations and treatment responses in patients with tuberculosis (TB). The medical records of 492 patients who started anti-TB medication between January 2005 and December 2009 were retrospectively reviewed. Diabetes was diagnosed in 124 patients (25.2%). Of these, 74 (59.7%) were uncontrolled (HbA1C ≥7.0), 25 (20.2%) were controlled (HbA1C <7.0), and HbA1C levels were not assessed in the remaining 25 (20.2%). There were no differences in clinical symptoms between diabetics and non-diabetics, regardless of diabetes control status. There were also no differences in radiographic findings or AFB results between controlled diabetics and non-diabetics. However, uncontrolled diabetics had more cavitary lesions (p = 0.008) and higher positive smear rates (p < 0.001) compared with non-diabetics. After adjustment for age, cavities and positive smears before initiation of treatment, uncontrolled diabetes was a significant risk factor for a positive sputum culture at 2 months (odds ratio, 4.316; 95% CI, 1.306–14.267; p = 0.017). Uncontrolled diabetics seem to have more cavities, higher positive smear rates and lack of culture conversion after two months of therapy. Therefore, TB patients with uncontrolled diabetes should be carefully managed and treated.

Pulmonary Impairment in Tuberculosis Survivors: The Korean National Health and Nutrition Examination Survey 2008-2012

Objectives Pulmonary tuberculosis (TB) can affect lung function, but studies regarding long-term follow-up in patients with no sequelae on chest X-ray (CXR) have not been performed. We evaluated lung functional impairment and persistent respiratory symptoms in those with prior pulmonary TB and those with prior pulmonary TB with no residual sequelae on CXR, and determined risk factors for airflow obstruction. Methods We used data from adults aged ≥ 40 years from the annual Korean National Health and Nutrition Examination Surveys conducted between 2008 and 2012. P values for comparisons were adjusted for age, sex, and smoking status. Results In total of 14,967 adults, 822 subjects (5.5%) had diagnosed and treated pulmonary TB (mean 29.0 years ago). The FVC% (84.9 vs. 92.6), FEV1% (83.4 vs. 92.4), and FEV1/FVC% (73.4 vs. 77.9) were significantly decreased in subjects with prior pulmonary TB compared to those without (p < 0.001, each). In 12,885 subjects with no sequalae on CXR, those with prior pulmonary TB (296, 2.3%) had significantly lower FEV1% (90.9 vs. 93.4, p = 0.001) and FEV1/FVC% (76.6 vs. 78.4, p < 0.001) than those without. Subjects with prior pulmonary TB as well as subjects with no sequalae on CXR were more likely to experience cough and physical activity limitations due to pulmonary symptoms than those without prior pulmonary TB (p < 0.001, each). In total subjects, prior pulmonary TB (OR, 2.314; 95% CI, 1.922–2.785), along with age, male, asthma, and smoking mount was risk factor for airflow obstruction. In subjects with prior pulmonary tuberculosis, inactive TB lesion on chest x-ray (OR, 2.300; 95% CI, 1.606–3.294) were risk factors of airflow obstruction. Conclusion In addition to subjects with inactive TB lesion on CXR, subjects with no sequelae on CXR can show impaired pulmonary function and respiratory symptoms. Prior TB is a risk factor for airflow obstruction and that the risk is more important when they have inactive lesions on chest X-ray. Hence, the patients with treated TB should need to have regular follow-up of lung function and stop smoking for early detection and prevention of the chronic airway disease.

Delayed diagnosis of allergic bronchopulmonary aspergillosis due to absence of asthmatic symptoms

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease with small prevalence. Exposure to aspergillus mold causes immunologic hypersensitivity and may cause ranges of symptoms from minimal to detrimental outcomes. Diagnosing and treating the disease before the development of bronchiectasis may save the patient from poor outcomes. This report presents a case of recurrent ABPA without any symptom of asthma, which impeded the correct diagnosis even after numerous hospitalizations.

Genetic markers of severe cutaneous adverse reactions

Adverse drug reactions can cause considerable discomfort. They can be life-threatening in severe cases, requiring or prolonging hospitalization, impeding proper treatment, and increasing treatment costs considerably. Although the incidence of severe cutaneous adverse reactions (SCARs) is low, they can be serious, have permanent sequelae, or lead to death. A recent pharmacogenomic study confirmed that genetic factors can predispose an individual to SCARs. Genetic markers enable not only elucidation of the pathogenesis of SCARs, but also screening of susceptible subjects. The human leukocyte antigen (HLA) genotypes associated with SCARs include HLA-B*57:01 for abacavir (Caucasians), HLA-B*58:01 for allopurinol (Asians), HLA-B*15:02 (Han Chinese) and HLA-A*31:01 (Europeans and Koreans) for carbamazepine, HLA-B*59:01 for methazolamide (Koreans and Japanese), and HLA-B*13:01 for dapsone (Asians). Therefore, prescreening genetic testing could prevent severe drug hypersensitivity reactions. Large-scale epidemiologic studies are required to demonstrate the usefulness and cost-effectiveness of screening tests because their efficacy is affected by the genetic differences among ethnicities.

15P Change of mTOR, p6, NBR1 and LC3A/B-I/II in A549 cells treated with graphene oxides.

Background: Measuring levels of ligands in peripheral blood representing systemic circulation and in blood isolated from tumour vascular bed accompanied by evaluation of binding receptor expression in tumour tissue gives insight into cancerogenesis. We have incorporated this research strategy into surgical practice to investigate the role of CXC chemokines as potential biomarkers of lung cancer. Methods: The study recruited 40 patients (mean age 62±10.4) with primary NSCLC ranging from stage IA to IIB undergoing anatomical pulmonary resection between June 2010 and October 2014. Blood samples from peripheral vein and from pulmonary vein draining tumour vascular bed were collected at the time of surgery. Levels of CXC chemokine ligands (CXCL) potentially involved in cancerogenesis – CXCL1, CXCL4, CXCL5, CXCL6, CXCL7, CXCL8, CXCL9, CXCL10, CXCL11 and CXCL12 were measured using ELISA. CXCL gradients were calculated. Corresponding CXC chemokine receptor (CXCR) expression – CXCR1, CXCR2, CXCR3 and CXCR4 was evaluated in resected tumour by immunohistochemistry and analysed semiquantitatively (expression intensity scale 0–3). Prognostic value of CXCL levels and CXCR expression was assessed evaluating relapse time. Paired two-tailed t-test was used to compare CXCL levels and Pearson test was used to assess statistical relationship between CXCL levels and CXCR expression. Results: Statistically significant difference between circulating CXC levels was found for CXCL4 (p < 0.001), CXCL5 (p < 0.05), CXCL7 (p < 0.001). Moderate statistically significant correlation was found between CXCL10, CXCL11 gradient and stromal expression of CXCR3. CXCL1, CXCL4 and CXCL10 gradients correlated with relapse (r = 0.38, r = 0.39, r = 0.35, p < 0.05). CXCR2 expression in tumour tissue correlated with relapse (r = 0.44, p < 0.05) and mortality (r = 0.45, p < 0.05). Conclusions: Our approach has facilitated identifying chemokine ligands and receptors potentially involved in NSCLC tumour metabolism and improved understanding of a complex and variable background of proteomic profile in lung cancer leading to biomarker discovery. Legal entity responsible for the study: Pauls Stradins Clinical University Hospital Funding: Pauls Stradins Clinical University Hospital Disclosure: All authors have declared no conflicts of interest.