Javid Ahmad Malik

Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate.

BACKGROUND Anticholinergic premedication is commonly used during flexible bronchoscopy, although the benefits are unproven and potential risks exist. METHODS We studied 1,000 patients undergoing diagnostic flexible bronchoscopy to investigate the efficacy and safety of atropine and glycopyrrolate. Patients received atropine (0.01 mg/kg; n = 339), glycopyrrolate (0.005 mg/kg; n = 336), or placebo (2 mL of normal saline solution; n = 325) IM before bronchoscopy in a randomized, double-blind fashion. Bronchoscopist- and patient-reported secretions, cough and patient discomfort, oxygen desaturation, procedure time, and procedure-related adverse events were compared among the groups. RESULTS After adjusting for covariates, glycopyrrolate (p = 0.02), but not atropine (p = 0.064), was associated with reduced bronchoscopist-reported airway secretions. Neither drug was independently associated with patient-reported airway secretions or with bronchoscopist- or patient-reported cough or discomfort. Neither drug was independently associated with oxygen desaturation. Atropine was associated with a longer procedure time (p = 0.042). Rise in heart rate and BP was significantly greater with anticholinergics, particularly atropine, compared with placebo. CONCLUSIONS Anticholinergic premedication may reduce airway secretions during flexible bronchoscopy but is not associated with any significant reduction in cough, patient discomfort, oxygen desaturation, or procedure time and is associated with greater hemodynamic fluctuations. Routine anticholinergic premedication may be unnecessary or even harmful during flexible bronchoscopy.

Lipid peroxidation during acute coronary syndromes and its intensification at the time of myocardial ischemia reperfusion

We conclude that there is an excess of lipid peroxidation in patients with coronary artery disease, and the peroxidative processes are further intensified at the time of AMI and UAP. During the course of AMI, a peroxidative burst is observed in the first few hours after thrombolytic therapy.

Obstructive sleep apnea in Type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control

Background: Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are two interacting epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that the majority of patients with T2DM also have OSA and untreated OSA in these patients results in poor glycemic control leading to acceleration of diabetes-related complications. Objectives: To assess the prevalence and severity of OSA in T2DM patients and to assess the impact of OSA treatment on presenting symptoms and hemoglobin A1c (HbA1c). Methods: We performed polysomnography (PSG) studies and measured HbA1c in 62 consecutive patients with T2DM that were referred from various subspecialty clinics from July 2011 to August 2013. Results: In our 62 diabetic patients, 59 (95.2%) had abnormal PSG. Based on Apnea–Hypopnea Index (AHI) score, 3 (5.1%) patients had mild, 28 (47.5%) had moderate, and 28 (47.5%) had severe OSA. The mean AHI of diabetic patients was significantly more than nondiabetic patients, i.e., 25.7 versus 19.7 (P = 0.001). Variables that significantly correlated with the presence of OSA include age, gender, body mass index (BMI), hypertension, diabetes, and cardiovascular disease (P < 0.05); however, on logistic regression only BMI, hypertension, and nocturia correlated with OSA. Overall, 59% of diabetic patients showed improvement in their glycemic control as measured by HbA1c with continuous positive airway pressure (CPAP) treatment. Significant, moderate, and mild categories of treatment response were respectively observed in 7%, 20%, and 32% of patients. Conclusion: Treatment of OSA with CPAP reduces HbA1c in a significant number of diabetics.

Depression as a manifestation of obstructive sleep apnea

Background: Obstructive sleep apnea (OSA) often results in a wide range of comorbid conditions, predominantly of the cardiovascular/respiratory, endocrine/metabolic, and neuropsychiatric symptoms. In view of the ambiguity of literature regarding the association between OSA and depression, we conducted this study to show any association between the two disorders. Objective: The aim of the study was to see the association between OSA and depression and to study the prevalence of OSA in patients suffering from depression. Methods: We performed polysomnography (PSG) studies of patients that were referred from various subspecialty clinics from July 2011 to August 2013. Psychiatric diagnosis was done using mini international neuropsychiatric interview plus scale. This was followed by application of Hamilton Depression Rating Scale (HAM-D). Standard methods of statistical analysis were used for data analysis. Results: Out of 182 patients who underwent PSG, 47 were suffering from depression with a mean age significantly more (P < 0.001) than that of other population (58.60 years vs. 53.60 years). In our 47 depressed patients, 44 (93.6%) had abnormal PSG. Based on apnea-hypopnea index score, 3 (6.8%) patients had mild, 18 (40.9%) had moderate, and 23 (52.3%) had severe OSA. The mean HAM-D score was significantly more in depression patients, (17. 35 ± 5.45) as compared to non depressive patents (8.64 ± 6.24) (P = 0.0001). Conclusion: This study demonstrates significant overlap between the sleep apnea and depression. Health specialists need more information about screening for patients with OSA to ensure proper diagnosis and treatment of those with the condition. Most of the clinicians do not suspect this important comorbidity of depression in the beginning resulting in delayed diagnosis.

Community acquired methicillin resistant Staphylococcus aureus multiloculated empyema unmasking diabetes mellitus in a middle-aged female: A rare case report

After the introduction of methicillin, Staphylococcus has evolved into a major cause of infection. We report a case of previously healthy middle-aged women with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) multiloculated empyema, which unmasked diabetes in her. There was no parenchyma involvement on chest X-ray as well as computed tomography scan, but only pleural cavity was involved, secondary to the bacteremia caused by skin lesion. CA-MRSA multiloculated empyema is rare, and it should be included in the differential diagnosis of the multiloculated empyema, as it can be lifesaving.