Flu shot can save heart failure patients’ lives- study suggests

By Dr Deepu

Getting an annual flu shot can save heart failure patients’ lives, according to new research in the American Heart Association’s journal Circulation.
Flu season usually begins in the fall and runs through the spring, with cases often peaking during the winter months. Annual flu vaccination is regarded as a safe, low-cost way to reduce flu-related deaths and complications and is routinely recommended for patients with histories of heart disease and stroke. However, little is known about the possible impact a simple flu shot may have on the survival of heart failure patients.

Influenza can be very serious or even fatal for patients with heart failure because heart failure patients are often older than 65, have compromised circulation and other health complications, and infection may exacerbate heart failure symptoms. Moreover, heart failure is expected to increase over the next decade as the population ages, highlighting a greater need to provide better care for these patients.
In this study, researchers analyzed data on 134,048 patients with newly diagnosed heart failure over a 12-year period. Flu vaccination rates ranged from 16% in 2003 to 52% in 2015 with a peak of 54% in 2009. Among the researchers’ findings:
Flu vaccination was associated with an 18% reduced risk of premature death, even after accounting for other factors such as medications, other health conditions, income and education
Annual flu vaccination following a heart failure diagnosis was associated with a 19% reduction in both all-cause and cardiovascular death when compared with no vaccination.
Flu vaccination frequency mattered; getting a flu shot less than once per year but more than not at all was associated with a 13% reduced risk of all-cause death and an 8% reduced risk of cardiovascular death.
Timing mattered; there was a greater reduction in cardiovascular and all-cause death when vaccination occurred earlier in the flu season during September and October vs in November and December.
Read free access original study in AHA journal website

Blood Decorin Levels May Serve as Prognostic Marker for IPF Patients After Acute Exacerbation, Study Suggests

By Dr Deepu
A new research has suggested Reduced levels of decorin proteins in the blood may be linked to a lower risk of death among patients with idiopathic pulmonary fibrosis (IPF) who have experienced acute exacerbations. “Serum decorin is a potential prognostic biomarker in patients with acute exacerbation of idiopathic pulmonary fibrosis,” published in the Journal of Thoracic Diseases has shed light on the topic. Acute worsening of respiratory function, also known as acute exacerbations, can have a significant negative impact on the clinical outcome of patients with IPF. These acute events have been reported to occur in about 8.6% of IPF cases one year after diagnosis, increasing to 23.9% three years after diagnosis. After the onset of acute exacerbations, the death rate of IPF patients is about 50%. This high mortality rate highlights the importance of recognizing risk factors that could contribute to the development of these acute events to ensure adequate prevention. Researchers have now evaluated the role of the decorin protein in the development and progression of acute exacerbations in patients with IPF and idiopathic interstitial pneumonia (IIP), which is also a fibrotic lung disease. Decorin is known to regulate inflammation and wound healing. In IPF, decorin can be found at fibrotic lesions and was shown to prevent lung fibrosis in mice. This protein was also shown to inhibit collagen production by fibroblasts, which is a key mechanism in fibrosis progression. The team evaluated the levels of decorin in blood samples collected from 21 IPF patients, 35 patients with IIP (other than IPF) who were hospitalized due to acute exacerbations, and 36 healthy volunteers. They also evaluated the protein levels in 97 patients who had stable IIP (no disease exacerbations). Researchers found that IIP patients who had acute exacerbations had reduced levels of decorin by about 23.8% (7,183.8 vs. 9,430.2 ng/mL), compared with stable IIP patients, and 35.7% (7,183.8 vs. 11,171.9 ng/mL), compared with healthy controls. The team also compared the levels of decorin in 34 IIP patients between when they were clinically stable and during an acute exacerbation period. The analysis showed that blood decorin levels were significantly lower during an acute exacerbation than in the clinically stable phase in IPF patients, with a mean reduction of about 21.4% (6,894.5 vs. 8,778.5 ng/mL). However, this difference was not found in the non-IPF patient subgroup. Further analysis failed to find any correlation between blood decorin levels and any clinical parameter after hospital admission due to acute exacerbation, including blood laboratory results, SIRS score, and APACHE II score — two commonly used prognostic measures. Overall, the survival rate 60 days after hospital admission was 53.6% in IIP patients. Comparison of mean decorin levels between survivors and non-survivors did not reveal a significant difference. However, when the team divided IPF patients into high and low blood decorin groups — using median decorin level as a reference — the survival rate was significantly higher in patients with low decorin levels than in those with high levels. Still, the team could not find any significant differences in clinical parameters except PF ratio, which is the arterial partial pressure of carbon dioxide/fraction of inspiratory oxygen ratio, a measure of respiratory function. Overall, the team found that “decorin levels were lower in IIP patients than in HVs [healthy volunteers], and decreased during AE [acute exacerbation];” that “decorin levels during AE were not correlated with any clinical characteristics except for PF ratio in IPF patients; and [that] “IPF patients with lower serum decorin levels had better prognosis than those with higher levels after the onset of AE.” Based on these results, the team believes that “[blood] decorin level is a potential prognostic biomarker after the onset of acute exacerbations in patients with IPF.” Still, additional studies are necessary to clarify the role of decorin in the underlying mechanisms of both IPF and IIP

Exercise Training May Improve Daily Life For Obese Individuals With Asthma, Study Suggests

By Dr Deepu

Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated.

The objective of the study was assess the effects of exercise on DLPA, asthma symptoms and psychosocial comorbidities in obese adults with asthma. The study included  Fifty-five grade II obese adults with asthma, the study subjects were randomly assigned to either a weight-loss program+exercise program (WL+E group, n=28) or a weight loss program +sham (WL+S group, n=27). The WL+E group incorporated aerobic and resistance muscle training into the weight-loss program (nutrition and psychological therapies), while the WL+S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality and anxiety and  depression  symptoms were quantified before and after treatment.

The results obtained after 3 months were positive, the WL+E group presented a significant increase in daily step counts (3,068 ± 2,325 vs. 729 ± 1,118 steps/day) and the number of asthma-symptom-free days (14.5 ± 9.6 vs. 8.6 ± 11.4 d/mo) compared with the WL+S group. The proportion of participants with improvements in depression symptoms (76.4 vs. 16.6 %) and a lower risk of developing obstructive sleepapnea (56.5 vs. 16.3%) was greater in the WL+E group than in the WL+S group (P<0.05). Significant improvements in sleep efficiency (6.6 ± 5.1 vs. 1.3 ± 4.7%) and latency (-3.7 ± 5.9 vs. 0.2 ± 5.6 min) were also observed in the WL+E group.

The authors concluded that exercise training plus a weight loss program improves DLPA, sleep efficiency and depressionand asthma symptoms in obese adults with asthma.

The three-month program targeted both weight loss and exercise through aerobic and resistance training, the study authors wrote in the journal Medicine and Science in Sports and Exercise.

When contacted over the email Dr Celso R F Carvalho gave the following insights into the study "In my opinion, the more important results of our study are the fact that exercise reduced the comorbidities of the obese asthmatic patients. I am not aware of any other non-pharmacological intervention that has presented such strong impact (bariatric surgery or diet support).

This is important because, in our clinical practice, most patients complain about having problems sleeping, lack of energy (sedentarism) and lower self-esteem (maybe due to the depression symptoms).

It is also important to reinforce that the effect in our study is compared with patients having an important support (nutritional and psychological). Then, the exercise had, on average, a 3-fold effect size compared with the "control group".

At last, I consider that the association we evaluated (Figures 4A-D) also suggest (or explain) how improvement in daily steps and depression symptoms are explained."

Read the findings of the study here.

Electrocautery snaring of endobronchial tumor

By Dr Deepu
Video of bronchoscopic guided electrocautery snaring of endobronchial tumor
Video courteously: Dr Ashok Kuwal

Flu may increase heart attack risk, study suggests

By Dr Deepu

"Cardiovascular events triggered by influenza are potentially preventable by vaccination," the researchers wrote.

       The study used confirmed cases of flu, analyzing 364 heart attacks from mid-2008 through mid-2015 among Ontario residents age 35 or older who were registered with the province’s publicly funded health insurance program.
The investigators found that the heart attack rate was 20.0 admissions per week during the seven days after diagnosis of the flu, versus 3.3 per week during the 52 weeks before and 51 weeks after that seven-day window.
The  above results were based on study involving 148,307 cases of  patients who were tested for influenza. Among all of those tests, 19,729 turned up positive for the flu. And among those cases, there were 332 patients who had at least one heart attack in the year before or after their flu specimen was tested. (The study authors tallied 364 hospitalizations for acute myocardial infarction overall, meaning that some unlucky folks had two or more heart attacks during the two-year observation period.)

Twenty of those heart attacks occurred within one week of a positive flu test. That, of course, was a rate of 20 heart attacks per week.
The other 344 heart attacks happened some other time in the two-year observation period. That worked out to 3.3 heart attacks per week.
That means the risk of a heart attack was six times greater in the first week after flu testing than at other times when the flu was much less likely to be a factor.

The researchers redid their analysis by splitting up that danger week into two parts. They found that heart attack risk was 6.3 times greater during the first three days after a flu test and 5.8 times greater in days four through seven.

About one-quarter of the patients in the study were 65 years old, and the rest were older. When the researchers examined those two groups separately, the link between flu infection and heart attack risk held up only for the older group.

There was no sign of an increased heart attack risk in the rest of the first month after getting a flu test.

The data in the study came from Ontario, Canada, where residents have public health insurance and universal access to medical care. Information on influenza test results came from the Flu and Other Respiratory Viruses Research Cohort, and heart attack hospitalizations were tracked by the Discharge Abstract Database of the Canadian Institute for Health Information.

The researchers, led by Dr. Jeffrey C. Kwong of the University of Toronto, acknowledged that they couldn't do their analysis based on the date when patients were actually infected with the influenza virus, or when they first began having symptoms, because that information was not available. However, in cases where patients get a flu test, they have typically been sick for only one or two days first.

Also, not all flu cases are severe enough to prompt patients to go and get tested. That means the results of this study may not apply to people with milder illnesses, they added.

The researchers did notice that when flu test results came back positive for certain other kinds of respiratory infections instead of for influenza, there was still an increased (though smaller) short-term risk for heart attacks. That suggests that it's not the flu itself that's the problem — it's the biological impact of a respiratory infection.

For instance, an infection can create conditions that make blood clots more likely to form and cause blood vessels to constrict. Infections also cause inflammation and can reduce blood pressure. All of these are risk factors for a heart attack, Kwong and his colleagues wrote.

The study results suggest that people who want to avoid a heart attack should be sure to get a flu shot — and that doctors and public health officials should encourage them to do so.