Effects of Pulmonary Rehabilitation on Exercise Tolerance in Patients with COPD.

Background: Pulmonary rehabilitation (PR) is known to be therapeutically useful for COPD patients. Objective: To evaluate the effects of combination of breathing exercises (pursed lip breathing and diaphragmatic breathing) and lower extremity endurance training (LEET) as part of PR program on six minute walk distance (6MWD), on oxygen saturation (SpO2%), on the level of dyspnea and fatigue in patients with moderate stable COPD. Methods: This prospective study was conducted in the Department of Physiology, BSMMU, Dhaka from July 2010 to June 2011 on 116 male stable moderate COPD patients aged 50 to 65 years. They were enrolled from the out patient department (OPD) of the Department of Medicine of BSMMU and NIDCH Dhaka. 56 patients without PR constituted control group and experimental group included 60 patients intervened with PR. The experimental patients were advised to perform the PR program for 30 minutes duration per session at home twice daily, for consecutive 60 days along with the standard drug treatment of COPD. The control patients were advised to continue their standard drug treatment alone for consecutive 60 days. For the assessment of exercise tolerance, 6MWD, SpO2%, the level of dyspnea and fatigue of all subjects were recorded on day 0 and day 60 for both the groups. SpO2% was recorded by portable Pulse Oximeter and the level of dyspnea as well as fatigue were recorded by Modified Borg Scale. Statistical analysis was done by independent sample ‘t’ test and paired sample ‘t’ test. Results: Significant improvement were observed in 6MWD, SpO2%, the level of dyspnea and fatigue in patients who performed PR program. In addition, significant improvement in these parameters were observed after completing PR program compared to the beginning of the intervention. Conclusion: The study concludes that regular exercise of all components of PR program significantly improve exercise tolerance in COPD patients.

Autonomic Dysfunction in Major Depressive Disorder.

Background: Cardiovascular (CV) morbidity is a major problem in patients suffering from depression as greater CV mortality is found in cardiac patients with depression. Objective: To assess cardiac autonomic nerve activity by power spectral analysis of heart rate variability in patients with Major Depressive disorder. Methods: This case control study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka during 2011. Sixty patients of both sexes with Major Depressive disorder (MDD) aged 20-50 years were enrolled. The patients were selected from the Department of Psychiatry in Bangabandhu Sheik Mujib Medical University (BSMMU). Thirty drug naive MDD patients and thirty medicated MDD patients were compared with 30 healthy control and also between them. The HRV parameters were recorded by 4 active channels, RMS Polyrite-D. For statistical analysis independent sample t-test test was used. Results: LF norm and LF/HF were significantly higher and Total power, HF power, HF norm were significantly lower in both drug naive and medicated MDD patients in comparison with those of healthy control. Conclusion: Autonomic nerve dysfunction involved both the drug naive and medicated MDD patients which was associated with higher sympathetic activity and reduced vagal modulation of the heart and sympathovagal imbalance. Antidepressent drug treatment did not have any effect on autonomic dysfunction.

Effects of Pulmonary Rehabilitation on Lung Functions In Patients with COPD.

Background: The importance of pulmonary rehabilitation (PR) as a therapeutic measure for COPD patients is well known. Objective: To evaluate the effects of PR program by pursed lip breathing (PLB) and diaphragmatic breathing (DB) on FVC, FEV1, FEV1/FVC ratio in male patients with moderate stable COPD. Methods: This prospective study was conducted in the Department of Physiology, BSMMU, Dhaka from July 2010 to June 2011 on 116 male stable moderate COPD patients aged 50 to 65 years. They were enrolled from the out patient department of the Department of Medicine of BSMMU and NIDCH Dhaka. They were grouped as control (56 patients without PR) and experimental (60 patients with PR). The experimental patients were advised to perform PR program for 30 minutes duration per session at home twice daily, for consecutive 60 days along with the standard drug treatment of COPD. On the contrary, the control patients were advised to continue their standard drug treatment alone for consecutive 60 days. For the assessment of spirometric lung function status, FVC, FEV1, FEV1/FVC ratio of all subjects were recorded on day 0 and day 60 for both the group by a portable digital MicroDL Spirometer and the statistical analysis was done by independent sample ‘t’ test and paired Student’s ‘t’ test. Results: FVC and FEV1 value were significantly increased in comparison to the control patients after 60 days of follow up. On the other hand, post exercise value of FEV1/FVC ratio was decreased but it was not statistically significant. Conclusion: The study reveals improvement of lung functions with this sort of combination of PR program in stable COPD patients.

Effect of Losartan and Amlodipine on Heart Rate Variability In Essential Hypertensive Patients.

Background: Essential hypertension is characterized by sympathovagal imbalance that is responsible for arrhythmias and sudden cardiac death. Antihypertensive drugs restores sympatho vagal balance. Losartan and amlodipine are common antihypertensive drugs. Objective: To compare the effect of losartan and amlodipine on heart rate variability (HRV) in hypertensive patients . Methods: This prospective analytical study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from July 2012 to June 2013. For this study, 120 newly diagnosed hypertensive patients without any treatment (group B, age 30-55 years) were selected from the Out Patients Department of cardiology, BSMMU, Dhaka on their first day of visit. 60 apparently healthy normotensive subjects were also studied as control (group A). HRV of the patients were measured both before and after they were treated with two different antihypertensive drugs (losartan and amlodipine) separately. According to the selection of drug these patients were divided into two groups. Group B1 included 60 patients received losartan 50 mg daily and group B2 included 60 patients treated by amlodipine 5 mg daily. They were observed once before the treatment (B1a&B2a) and after3 months medication(B1b & B2b ) and also after 6 months medication (B1c & B2c ). For assessing HRV, Mean heart rate (HR),Mean R-R interval, Max/Min R-R interval, SDNN, RMSSD were recorded by a polyrite. Data were compared among before treatment, after 3 months treatment and after 6 months treatment. For statistical analysis ANOVA, independent sample‘t’ test and paired sample ‘t’ were performed. Results: Mean resting pulse rate, mean heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) were significantly higher(P<0.001) and mean R-R interval, SDNN, RMSSD were significantly lower(P<0.001) in patients before treatment compared to those of healthy normotensive subjects and to the values after treatment. In both drug groups, SDNN, RMSSD,mean R-R interval were found significantly higher after 6 months of treatment compared to their values after 3 months treatment and also close to the values in normotensive subjects. In losartan group RMSSD were found significantly higher (p<0.01) and mean R-R interval,SDNN were found though higher but not significant than the corresponding values in amlodipine treated patients after 6 months treatment. Conclusion: Vagal modulation is decreased in untreated hypertensive patients which is increased by treatment with both losartan and amlodipine but the effect is more pronounced in losartan. The decreased autonomic function was improved better with longer treatment duration.

FVC, FEV1, FEV1/FVC ratio and FEF25-75% in End-stage renal disease (ESRD) patients undergoing maintenance haemodialysis.

Background: End-stage renal disease causes multiple pulmonary complications and lung functions are decreased in ESRD patients undergoing maintenance haemodialysis. Objectives: To observe FVC, FEV1, FEV1/FVC ratio and FEF25-75% in ESRD patients undergoing maintenance haemodialysis to evaluate their lung functions status. Methods: This cross sectional study was carried out in the Department of Physiology, BSMMU, Dhaka, from July 2011 to June 2012. For this, 30 ESRD patients aged 25-55 years undergoing maintenance haemodialysis with less than 1 year duration were studied and 30 age, sex matched healthy subjects were taken as control. Patients were selected from the Nephrology department of BSMMU, Dhaka. FVC, FEV1, FEV1/FVC ratio and FEF25-75% were measured by a Digital Spirometer. For statistical analysis Independent Sample‘t’ test and One way ANOVA test were performed as applicable. Results: The mean percentage of predicted values of FVC, FEV1 and FEF25-75% were significantly lower in patients except FEV1/FVC ratio which was almost similar to control. 63.33% patients had restrictive and 36.67% patients had both restrictive and obstructive (small airway obstruction) feature. Conclusion: This study concluded that some pulmonary functions were markedly reduced in ESRD patients undergoing maintenance haemodialysis. In addition most of the patients were suffering from restrictive and some of them were affected with both obstructive and restrictive type of pulmonary disorders.

Micronutrient Deficiency in Severe Preeclampsia.

Background:. Micronutrient such as calcium, magnesium and zinc deficiency are associated with preeclampsia. Objective: To observe serum calcium, magnesium and zinc levels in severe preeclamptic women. Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka from July 2009 to June 2010. 60 cases of preeclampsia, aged 18-39 years and >20th weeks of pregnancy were included in the study group. They were further sub divided into group B1 (30 mild preeclampsia) and group B2 (30 severe preeclampsia). Age and gestational period matched 30 normotensive pregnant women (Group A) were also studied as control. All the preeclamptic women were selected from the Obstetric and Gynaecology in and out patient Department of BSMMU and Dhaka Medical College Hospital. Serum calcium and magnesium was measured by colorimetric and serum zinc was measured by spectrophotometric method. For statistical analysis one way ANOVA, independent sample t test and ÷2 test were used. Results: The mean serum calcium, magnesium and zinc levels were significantly (p<0.001) lower in both group of preeclampsia than normotensive pregnant women. Again serum calcium and zinc levels were significantly lower (P<0.05) in severe preeclampsia compared to mild preeclampsia whereas serum magnesium levels were found almost similar in both group of preeclampsia (P>0.05). Again in this study, 40% mild, 73.3 % severe preeclamptic women and 20% normotensive pregnant women had hypocalcaemia. 36.7% mild, 30.0% severe preeclamptic women and 3.3% normotensive pregnant women had hypomagnesaemia and 6.7% mild, 20 % severe preeclamptic women and no normotensive pregnant women had hypozincemia. Conclusion: This study may conclude that micronutrient deficiency may be one of the risk factor of preeclampsia and increases the risk of its severity. Therefore early detection and supplementation to treat this deficiency may reduce the incidence of preeclampsia.

Relationships of Nerve Conduction Parameters with the Thyroid Hormones in Hypothyroid Patients.

Background: Impairment of nerve conduction may occur in hypothyroidism which usually develops insidiously over a long period of time due to irregular taking of drugs or lack of thyroid hormone replacement. Objectives: To evaluate the thyroid hormone status and the clinical and electrophysiological changes in hypothyroid patients in order to observe their relationships with nerve conduction changes. Methods: Thirty healthy euthyroid subjects with the age range from 20 to 50 years of both sexes were as control and 15 hypothyroids with TSH with <60 MIU /L and the duration of 6 months to 5 years were as experimental. Serum TT3, TT4 were measured by RIA and IRMA method. The distal latency (D L) and Nerve Conduction Velocities (NCV) for sensory and motor function were measured by a standard electrophysiological technique in median and ulnar nerve for upper limb and for lower limb, in sural nerve for sensory function and common peroneal nerve for motor function. Data were analyzed statistically by unpaired ’t’ test, Z test, Pearson’s correlation coefficient test. Results: Both TT3, TT4 levels were significantly (P<0.001) lower in hypothyroids. Again, 60% hypothyroids and 10% euthyroids (P<.001) had abnormal NCV. The relationships of TSH with both the median and ulnar sensory and motor distal latencies, common peroneal motor and sural sensory distal latencies and ulnar sensory conduction velocity were positive. But these relationships were negative with the median and common peroneal motor nerve conduction velocities, sural sensory conduction velocities. Only the relationships between median sensory distal latency and TSH was statistically significant (P <0.05). Again, a positive correlation of TT3 and TT4 with the median, and sural sensory and common peroneal motor conduction velocities, but negative correlation with median motor and sural sensory latencies were found. In addition, positive correlation between TT3 and ulnar sensory and between TT4 and Ulnar motor conduction velocities were observed. Again the relationships median and ulnar sensory latencies were negative with TT4 only. The value of coefficient between TT4 and sural distal latency and conduction velocities were statistically significant (P<0.05). Conclusion: Results of this study showed that the impairment of nerve conduction occurs in hypothyroidism.

Serum Zinc, Copper and Calcium Levels In Female Rheumatoid Arthritic Patients.

Background: Rheumatoid Arthritis is a chronic multi-system autoimmune inflammatory disease, characterized by inflammatory synovitis involving symmetrical peripheral joints. Serum copper, zinc and calcium levels are altered in Rheumatoid Arthritis. Objective: To observe serum zinc, copper and calcium levels in patients with Rheumatoid Arthritis (RA). Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2010. For this, 60 female patients with Rheumatoid arthritis aged 30-50 years were included in the study group. The patients were selected from outpatient Department of Rheumatology wing of medicine in Bangabandhu Sheik Mujib Medical University (BSMMU). For comparison age and BMI matched 30 apparently healthy female were also studied. Serum calcium level was measured by Colorimetric method. Serum zinc and copper was measured by Spectrophotometric method. For statistical analysis, independent sample t test was performed by using SPSS for windows version-12. Results: In this study, serum zinc and calcium levels were significantly lower (p<0.001) and serum copper level was significantly higher (p<0.001) in the RA patients than those of control. Conclusion: This study may conclude that hypozincemia and hypocalcemia and hypercupremia occur in RA. Therefore early detection of these micronutrient abnormalities may be helpful for the physicians to prevent various complications in RA patients.

Relationship Of FEF25-75, Pefr And SVC With Estrogen And Progesterone Level In Postmenopausal Women.

Background: Deterioration of lung function is common in women after menopause, which may be related to very low estrogen and progesterone level. Objective: To observe FEF25-75, PEFR and SVC (slow vital capacity) values in apparently healthy postmenopausal women to find out their relationships with serum estrogen and progesterone. Methods: This study was carried out in the Department of Physiology in BSMMU, Dhaka in the year 2007. 30 healthy postmenopausal women aged 45 to 60 years and 30 healthy premenopausal women aged 20 to 30 years during their different phases of menstrual cycle were studied. Postmenopausal women were residents of Dhaka city and premenopausal subjects were medical students. FEF25-75, PEFR and SVC of all subjects were measured by a digital micro spirometer. Their estrogen and progesterone levels were estimated by Micro particle Enzyme Immunoassay (MEIA) method. Data were analyzed by Pearson’s correlation coefficient test, one way ANOVA and unpaired‘t’ test Results: The mean percentage of predicted values of FEF25-75 and PEFR were lower in postmenopausal women compared to those of follicular and luteal phases of premenopausal women but it was not significant. Measured values of SVC was Significantly (p<.001) lower in postmenopausal women compared to those of follicular and luteal phases of premenopausal women. Again Mean serum estrogen and progesterone levels were significantly (p<.001) lower in post menopausal women compared to those of follicular and luteal phases of premenopausal women. In post menopausal women, FEF25-75 was positively, PEFR and SVC were negatively correlated with progesterone level. PEFR and SVC showed positive correlattion and FEF25-75 showed negative correlation with serum estrogen level. All these correlations were statistically non significant. In premenopausal women FEF25-75 and PEFR showed positive correlation and SVC showed negative correlation with serum progesterone level. The relationships were statistically significant in luteal phase but nonsignificant in follicular phase. FEF25-75 ,PEFR and SVC were positively correlated with serum estrogen level in luteal phase but FEF25-75 and PEFR negatively correlated and SVC positively correlated with estrogen level in follicular phase. Conclusion: The outcome of this study shows FEF25-75 , PEFR and SVC may be reduced in postmenopausal women which in turn may be associated with their low progesterone and estrogen levels.

Calcium And Zinc Deficiency In Preeclamptic Women.

Background: Pre-eclampsia is the most common medical complication of pregnancy associated with increased maternal and infant mortality and morbidity. Reduced serum calcium and zinc levels are found associated with elevated blood pressure in preeclampsia. Objective: To observe serum calcium and zinc levels in preeclamptic women. Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka between July 2009 to June 2010. In this study, 60 pregnant women of preeclampsia, aged 18-39 years with gestational period more than 20th weeks were included as the study (group B). For comparison age and gestational period matched 30 normotensive pregnant women control (group A) were also studied. All the subjects were selected from Obstetric and Gynae In and Out patient Department of BSMMU and Dhaka Medical College Hospital. Serum calcium was measured by Colorimetric method and serum zinc was measured by Spectrophotometric method. Data were analysed by independent sample t test and Pearson’s correlation coefficient test. Results: Mean serum calcium and zinc levels were significantly (p<0.001) lower in study group than those of control group. Again, serum calcium and zinc showed significant negative correlation with SBP and DBP in preeclamptic women. Conclusion: This study concludes that serum calcium and zinc deficiency may be one of the risk factor of preeclampsia. Therefore, early detection and supplementation to treat this deficiency may reduce the incidence of preeclampsia.

Time Domain Measures Of Heart Rate Variability In Heavy Workers.

Background: Physical inactivity and low resting heart rate variability (HRV) are associated with increased incidence of coronary heart disease. Heavy physical activity is associated with higher heart rate variability and reduces the risk of coronary heart disease Objective: To assess some time domain measures of HRV in order to compare Cardiac Autonomic Function between sedentary and heavy workers. Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University between 1st July 2008 to 30th June 2009 on 30 apparently healthy heavy workers aged 28-50 years from low socioeconomic condition (study group). For comparison 30 age, sex, BMI and socioeconomic status matched apparently healthy sedentary subjects (group A) were also studied. The study subjects were selected among rickshaw-pullers living in the slum areas nearby BSMMU, Dhaka and the controls were from fourth class employee of BSMMU, Dhaka. Heart Rate Variability were assessed by a Polygraph. Several time domain measures of HRV such as mean R-R interval, mean HR, SDNN, RMSSD were analyzed. For statistical analysis, Independent-Samples t-test, and Pearson’s correlation coefficient tests were done as applicable. Results: Resting mean heart rate (P<0.01), SDNN (P<0.01) and RMSSD (P<0.001) were significantly lower but mean R-R interval (P<0.001) was significantly higher in heavy workers than those of sedentary control. The mean R-R interval (P<0.05) showed significant positive correlation in heavy workers but significant negative correlation in sedentary workers with BMI. Conclusion: Cardiac autonomic nerve function status may be higher with parasympathetic dominance by increased physical activity.

PEFR and FEF 25-75 in Rheumatoid Arthritic Female and their Relationships with Duration of the Disease.

Background: Rheumatoid Arthritis (RA) is a chronic, progressive multisystemic inflammatory disorder of unknown etiology affecting approximately 1% of the population. Pulmonary involvement is a frequent extraarticular manifestation in rheumatoid arthritis. Objective: To observe PEFR, FEF 25-75 in female patients of RA in order to find out their relationships with duration of the disease. Methods: This cross-sectional study was carried out in the Department of Physiology, BSMMU, Dhaka, between January and December 2009 on 90 RA female patients of 30-50 years age (Group B). For comparison, 30 age and BMI matched apparently healthy subjects (Group A) were also studied. According to the duration of disease, RA patients were subdivided into B1 (newly diagnosed), B2 (3-5 years) and B3 (6- 10 years). They were selected from the Out Patient Department of Physical Medicine of Bangabandhu Sheikh Mujib Medical University, Dhaka. PEFR, FEF25-75 of all the subjects were measured by a digital MicroDL spirometer. Results were expressed as percentage of predicted value. For statistical analysis One-Way ANOVA, Unpaired Student’s ‘t’ test and Pearson’s correlation coefficient test were performed. Results: The mean percentage of predicted values of these lung function parameters in the healthy female subjects and newly diagnosed (B1) RA patients were within normal ranges. The mean percentage of predicted values of both the spirometric variables were significantly lower in B3 compared to those in B2 (PEFR p<0.001, FEF25-75 p<0.001), B1 (PEFR p<0.05, FEF25-75 p<0.02) and A(PEFR p<0.05, FEF25- 75 p<0.01). Again the same parameters were significantly lower in B2 in comparison to those of B1 (PEFR p<0.001, FEF25-75 p<0.05) and A (PEFR p<0.001, FEF25-75 p<0.05). In addition both the ventilatory variables had significant (p<0.001) negative correlation with durations of disease. Conclusion: This study reveals that pulmonary functions may be lower in patients with RA and their lung function is inversely related to the duration of disease.

FVC, FEV1 and FEV1 / FVC % in Hypothyroid Female and their Relationships with Thyroid Hormones.

Background: Hypothyroidism is a common hormonal disorder affecting various organs including lungs. It may be associated with respiratory symptoms and can decrease lung function. Objective: To observe FVC, FEV1 and FEV1 / FVC % in hypothyroid female patients. Methods: This crosssectional study was carried out in the Department of Physiology, BSMMU, Dhaka, from 1st July 2008 to 30th June 2009 on 60 hypothyroid female patients of 30-50 years age (Group B). For comparison, 30 age and BMI matched apparently healthy subjects (Group A) were also studied. Based on receiving treatment, hypothyroid patients were divided into B1 (untreated patients on their 1st day of diagnosis) and B2 (patients treated for at least 12-18 months). They were selected from the Out Patient Department of Endocrinology wing of department of Medicine, BSMMU, Dhaka. Serum TSH and FT4 levels were measured by Microparticle Enzyme Immunoassay (MEIA) principle in AxSYM system. The FVC, FEV1, FEV1/FVC%, of all the subjects were measured by a digital MicroDL spirometer. Data were analyzed by One way ANOVA test, Independent sample t- test and Pearson’s correlation coefficient test. Results: The mean percentage of predicted values of all the lung function variables in healthy female subjects and treated hypothyroids were within normal ranges. However, all of them were lower in untreated hypothyroids in comparison to those of control and treated hypothyroids.FVC and FEV1 showed statistically significant (p<0.001) difference and FEV1/FVC% showed non significant difference . In addition, all the ventilatory variables had negative correlation with serum TSH level and positive correlation with serum FT4 level and these relationships were statistically significant in control (p<0.001) and treated hypothyroids (p<0.01). Conclusion: This study reveals that lung function may be lower in untreated hypothyrod patients and correlated with thyroid hormones. Treatment of hypothyroids may reverse this changes..

Power Spectral Analysis of Heart Rate Variability in Hypertensive Male.

Background: Essential hypertension is associated with altered cardiovascular autonomic nerve function. Heart Rate Variability (HRV) analysis is an important tool for quantitative measurement of autonomic nerve activity. Objective: To assess the cardiac autonomic nerve function status in essential hypertension by analyzing power spectral measures of heart rate variability. Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University between July 2008 and June 2009. Sixty male hypertensive patients with age range 40-60 years (group B) were enrolled from the Out Patient Department of Cardiology,BSMMU, Dhaka. Thirty age and sex matched apparently healthy normotensive subjects (group A) were studied as control, Hypertensive patients were further divided into group B1 consisting of 30 untreated patients on their 1st day of diagnosis and group B2 consisting of 30 patients under antihypertensive therapy. Power Spectral measures of Heart Rate Variability (HRV) such as total power, low frequency (LF) and high frequency power(HF) LH/HF ratio were assessed by a digital Polygraph. For statistical analysis , Independent sample t-test, One-way ANOVA test and Pearson’s correlation coefficient test were done as applicable. Results: Mean TP,LF,HF and HF norm was significantly (p<0.001) lower and LF/HF ratio and LF norm were significantly (p<0.001) higher in both untreated and treated hypertensive patients compared to those of normotensive subjects. Again, significant differences of LF norm and HF norm and LF/HF ratio were found between the two hypertensive groups. The LF/HF ratio and LF norm were positively and HF norm was negatively correlated with SBP and DBP in both the hypertensive groups. However, all these findings were more marked in untreated hypertensive patients than those of treated group. Conclusion: Sympathovagal balance in hypertensive patients is towards higher sympathetic and lower vagal modulation and effective treatment of the patients can return the balance towards normal.

Power Spectral Analysis of Heart Rate Variability In Hypothyroidism.

Background: Hypothyroidism is one of the common clinical problems with high incidence in women particularly in older age. It has profound effect on metabolic processes in almost all tissue of the body and heart is particularly sensitive to thyroid hormone action. Power spectral analysis (PSA)is useful to determine the cardiac autonomic regulation by assessing sympathovagal balance. Objectives: To assess the cardiac autonomic nervous activity by power spectral analysis of heart rate variability in patients with hypothyroidism.Method: This cross sectional study was carried out in the Department of Physiology, Banghabandhu Sheikh Mujib Medical University from 1st July 2008 to 30th June 2009 on 60 female patients of 30-50 years with hypothyroidism (group B). For comparison, 30 age sex matched apparently healthy euthyroid subjects (group A) were also studied. Based on treatment, hypothyroid patients were divided into B1 (patients on their 1st day of diagnosis, before starting of treatment) and B2 (patients with medication for 12-18 months). The patients were selected from the Out Patients Department of Endocrinology, BSMMU. Serum TSH and FT4 levels of all subjects were measured by AxSYM system. To perform power spectral analysis of HRV Total Power(TP), Low Frequency(LF),High Frequency(HF),LF norms (nu),HF norms (nu) and LF/HF ratio were assessed by a Polyrite. For statistical analysis of data, Independent Sample t test, One Way ANOVA and Pearson’s correlation coefficient test were done as applicable.Results: The mean serum TSH(38.16 vs2.18;2.04) was significantly higher and FT4(5.12vs 15.13; 15.08) was significantly lower(p<0.001) in group B1 than those of group A and B2.The mean values of all the spectral parameters of HRV in euthyroid subjects were within normal range. In untreated hypothyroid patients the mean values of TP ( 77.11vs2702.87;2683.73), HF power(56.68 vs 342.02; 437.34) HF nu( 24.79 vs 36.35;34.55) were found significantly (p<0.001) lower LF/HF(1.7±0.3,3.16±.84 and 1.93±.58) and LF nu(75.32 vs 63.71, and 65.90) were significantly (p<0.001) higher and in comparison to both euthyroids and treated patients. Conclusion: Alteration in cardiac autonomic nervous activity characterized by reduced vagal modulation and higher sympathetic activity may occur in the hypothyroid patients..

Sympathetic Nerve Function Status in Postmenopausal Women.

Background: Postmenopausal women usually suffer from increased incidence of cardiovascular diseases than premenopausal women. Alterations in autonomic nerve functions often develop in this group of women that commonly affect cardiac vagal control and usually associated with sympathetic hyperactivity. Objectives: To observe the sympathetic nerve function status in postmenopausal women and their relationships with serum estrogen level. Methods: This cross sectional study was carried out in the Department of Physiology, BSMMU, Dhaka from 1st January to 31st December 2007. A total number of 60 apparently healthy subjects of whom 30 were postmenopausal women with age ranged from 45-60 years(group B) and 30 were premenopausal women with age ranged from 20-30 years (group A) were enrolled. Premenopausal women were studied during follicular phase of menstrual cycle.Two simple autonomic nerve function tests, rise of diastolic blood pressure (DBP) during hand grip and fall of systolic blood pressure (SBP) on standing were done to assess sympathetic activity and serum estrogen level was measured in both the groups. Data were analysed by unpaired t test and Pearson correlation coefficient test. Results: Mean resting SBP and DBP were significantly higher (p<0.001) in postmenopausal women than premenopausal women. The mean value of estrogen was significantly (p<0.001) lower in group B (postmenopause) than those in group A (premenopause). Fall in systolic blood pressure after standing was significantly (p<0.001) higher and rise in diastolic blood pressure after sustained handgrip was significantly (p<0.001) lower in postmenopausal women than those in premenopausal women during their follicular phase of menstrual cycle. Again, rise in diastolic blood pressure after sustained handgrip and fall in systolic blood pressure after standing showed (p>0.05) negative correlation with estrogen level in the postmenopausal women which was statistically not significant. In addition, regression analysis further revealed significant association of sympathetic activity with estrogen level and age in postmenopausal women. Conclusion: From this study it can be concluded that sympathetic activity is higher in postmenopausal women, which may be related to their low estrogen level and age as well.

Sympathetic Nerve Function Status in Obesity.

Background: Obesity is an important and independent risk factor for cardiovascular morbidity and mortality. High incidence of cardiac autonomic nerve dysfunction has been noted in obese subjects who are at increased risk for sudden death Objective: To study the relationship between sympathetic nerve function and obesity. Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University between July 2006 to June 2007 and 40 apparently healthy obese subjects aged18-40 years of both sexes with BMI > 25 kg/m2 in study group. Age and sex matched 40 apparently healthy nonobese subjects with BMI range of 18.5-22.9 kg/m2 were also included for comparison (Control). Two noninvasive cardiovascular reflex tests like blood pressure response to sustained handgrip and blood pressure response to standing were done to assess sympathetic nerve function status. Unpaired Student’s ‘t’ test and Pearson correlation coefficient test were used for statistical analysis. Results: Mean values of resting heart rate, resting systolic and diastolic blood pressure were significantly(p<0.05) higher and both the sympathetic nerve function parameters(BP response to hand grip and BP response to standing) were significantly (p>0.05) lower in obese compared to those of non obese control subjects. Again, BP response to hand grip were negatively and BP response to standing were positively correlated with BMI in all subjects. These correlations are statistically significant(p<0.05). Conclusion: The results of this study revealed that sympathetic nerve function may be reduced in obesity.

Relationship of Thyroid Hormones with Heart Rate Variability.

Background: Altered thyroid functions are associated with variation in autonomic regulation of cardiovascular activity. Cardiac Autonomic Nervous Activity (CANA) can be assessed quantitatively by analysis of Heart Rate Variability (HRV). Objective: To observe the relationship between CANA with altered TSH and FT4. Methods: This cross sectional study was carried out in the Department of Physiology, BSMMU, Dhaka between1st July 2007 and 30th June 2008 on 60 patients with excess thyroid hormone (group B, aged 30-50 years). Based on treatment, 30 untreated newly diagnosed patients were designated as group B1 and 30 patients under treatment with antithyroid drugs for at least 2 months were included into group B2 in order to observe the effect of treatment. All these patients were selected from the Out Patient Department of Endocrinology wing of Department of Medicine, BSMMU, Dhaka. Sociodemographically matched 20 apparently healthy euthyroid persons were selected for comparison (group A). To confirm thyroid status, serum TSH and serum FT4 levels were measured by AxSym system and some of the spectral HRV parameters i.e.mean R-R interval, mean heart rate, variance, LF n.u, HF n.u and LF/HF ratio were assessed by recordings of ECG for 5 minute (short term) with a polyrite. For statistical analysis Pearson’s correlation coefficient (r) test was used. Results: With serum TSH level, the LF n.u. power and LF/HF ratio showed significant (p<0.05) positive correlations but HF n.u. power showed significant (p<0.05) negative correlation in group B1. But these three parameters showed non significant correlations with TSH in the other two groups (A, B2). Similarly with serum TSH level, variance and mean R-R interval showed negative and mean HR showed positive correlation in group B1. In group A, all these parameters were positively correlated whereas in groupB2, RR interval and variance were positively and mean HR was negatively correlated. All these correlations were statistically non significant. With serum FT4 levels, mean R-R and HF n.u. were negatively and mean heart rate, LFnu, LF/HF were positively correlated in all three groups but variance showed positive in group A and negative correlation in B1 and B2. All these correlations were statistically non significant. Conclusion: From this study it can be concluded that changes in autonomic nervous regulation are related to altered serum level of TSH and FT4 in hyperthyroids.

PEFR and FEF25-75 in type 2 diabetes mellitus and their relationships with its duration.

Background: Diabetes mellitus is a major public health problem with increasing incidence worldwide and long term complications of various organs including lungs. The magnitude of the complications of this disease is related to its duration. Objective: To observe PEFR and FEF25-75 in type 2 diabetic male and their relationship with duration of the disease. Methods: This cross sectional study was carried out in the Department of Physiology, BSMMU, Dhaka, from 1st July 2007 to 30th June 2008 on 60 type 2 diabetic, non smoker, male of 40-60 years old. For comparison, 30 age, BMI and socioeconomic status matched apparently healthy non diabetic subjects were also studied. Based on the duration of disease, diabetic patients were divided into B1 (5-10 years) and B2 (10-20 years). PEFR and FEF25-75 of all the subjects were measured by an electronic spirometer. Data were analyzed by One way ANOVA, Unpaired Student’s ‘t’ and Pearson’s correlation coefficient tests. Results: The mean percentage of predicted values of PEFR and FEF25-75 in non diabetic male were within normal ranges. But, both the parameters were significantly (p<0.001) lower in both the groups of type 2 diabetic male compared to those of non diabetic male. Again, the PEFR and FEF25-75 were lower in the patients of longer duration compared to those of shorter duration but the differences were not significant. However, PEFR was negatively correlated and FEF25-75 was positively correlated with shorter duration of diabetes and the relationships were nonsignificant. On the other hand, both the parameters were negatively correlated with longer duration of diabetes while only PEFR showed significant (p<0.01) relationship. Conclusion: The PEFR and FEF25-75 may be lower in type 2 diabetic male, which are inversely related to the duration of the disease.