Effect of obesity on lung volumes among adults

Background: Obesity has long been recognized to have significant effect on respiratory functions. Many studies have reported exponential decrease in pulmonary function test (PFT) with increasing body mass index (BMI), which is a crude indicator of obesity. Also, the relationship between BMI and PFTs varies with age, race, geographical region and the different obesity standards used. To the best of our knowledge, not many studies have been done to examine the relationship between obesity and lung volumes among adults in our region, Jammu. This cross-sectional study was carried out with the objective of evaluating the effect of obesity on lung function test in obese but otherwise healthy adults of Jammu region.Methods: This cross-sectional study was conducted in Jammu region on subjects selected randomly from different colleges in the age group of 18-40 years. The study involved 300 subjects; divided into three groups of 100 each, based on BMI into normal, overweight and obese groups. Four respiratory parameters viz. FVC (Forced Vital Capacity), FEV1 (Forced Expiratory Volume in 1 second), FEV3 (Forced Expiratory Volume in 3 seconds), and MVV (Maximum Voluntary Ventilation) were used to assess their lung functions.Results: All the respiratory parameters exhibited statistically significant decrease in obese groups as compared to normal and overweight groups.Conclusions: The present study suggests that obesity alters the respiratory physiology by producing a restrictive ventilatory pattern.

Quality improvement initiative: improving proportion of preterm infants on mothers only milk at the time of discharge

Background: Availability of mothers only milk (MOM) for preterm infants is a boon for their growth and development. Authors found that in our Special Newborn Care Unit (SNCU), the availability of MOM was very less with excessive use of formula feed. So, authors planned a quality improvement (QI) study to improve availability of MOM for preterms in level 3 SNCU catering to both in-born and out-born neonates.Methods: Authors aimed to improve availability of MOM to preterm infants admitted in SNCU from the current 10% to 80% at day 7 of admission over a period of 8 weeks. Authors included preterm and mother dyads with <34 weeks of gestation or having birth weight <1800 gm. and likely to stay in SNCU for at least a week. For this initiative a QI team was formed. Baseline data was collected for a period of 3 weeks and analysis was performed of various constrains in providing MOM to preterms was later an interventional package was implemented which included counselling to mothers, Kangaroo mother care (KMC), demonstration of milk expression techniques. Intervention phase was implemented for the period of 8 weeks followed by sustenance phase for 2 months.Results: Proportion of preterm infants on MOM increased from 10% to 81% during intervention phase at day 7 of admission and remained 66% during sustenance phase.Conclusion: QI initiative has the potential to bring a tremendous change in making mothers milk available to both inborn and out-born preterms. With existing resources simple interventions can increase availability of MOM to preterm infants.

Age and Sex Related Changes in Thyroid Functions in Normal Healthy Subjects of Jammu Region.

The study was conducted on 150 normal healthy subjects of different age groups of both sexes (belonging to Jammu region only) to find out the pattern of physiological variations in the levels of the thyroid hormones viz. T3 (triiodothyronine), T4 (thyroxine) and TSH (thyroid stimulating hormone). The blood levels of T3, T4 and TSH of these subjects were found out by using radioimmunossay technique. The serum T3 and T4 levels decreased progressively with age with the highest levels being observed in children and lowest in the elderly. The serum T3 levels of males and females did not show any difference in any age group, whereas the mean serum T4 level in the adult females was more than that of adult male though the difference is statistically insignificant. There was, however, no difference between the serum T4 levels of males and females of children, adolescents and elderly groups. The mean serum TSH level was found to increase progressively with age and did not show any significant difference in males and females in any age group.

Autonomic Functions in Postmenopausal Women

The study was undertaken on 24 human female postmenopausal subjects above the age of 50 years, to test the hypothesis that estrogen exerts regulatory influence on the autonomic nervous system in postmenopausal women. The parameters recorded and the test used were- pulse, blood pressure, orthostasis, cold pressor test, mental arithmetic and QTc interval for assessment of sympathetic activity and valsalva ratio, heart rate response, expiratory-inspiratory ratio (E.I. Ratio), standinglying ratio (S.L. Ratio) and 30:15 ratio for assessment of parasympathetic activity. Our findings show that the changes in sex hormone levels, after menopause may affect the autonomic system response, with increase in reactivity of both sympathetic and parasympathetic systems.

Right-sided diaphragmatic hernia masquerading as staphylococcal pneumonia.

A 9-month-old infant who was diagnosed to have right-sided diaphragmatic hernia with no other associated anomalies, is being reported here. He had presented with cough for one month and respiratory difficulty for one-week duration and history of bilious vomiting two days prior to admission. His chest X-ray showed multiple lucent shadows in the right lower zone in A-P and lateral views, with not very well defined diaphragm on the same side. A diagnosis of staphylococcal pneumonia was considered but with clinical and radiological picture, a right-sided diaphragmatic hernia was strongly suspected which was confirmed by doing fluoroscopy and CT-scan of the chest. He underwent a successful correction of the defect. So radiological finding of pleural effusion with displacement of mediastinum to the left and the presence of bowel gas high in the right upper quadrant should alert the possibility of a right-sided Bochdalek hernia.

Pseudo tumoral laryngeal tuberculosis.

An 11-year-old female child presented with high grade intermittent fever and cough for a duration of 6-7 months and hoarseness of voice for 6 months. Skiagram of the chest showed evidence of miliary mottling. Direct laryngoscopic examination revealed inflammatory swelling over left vocal cord. The biopsy of the swelling showed chronic granulomatous lesion. Patient improved remarkably with anti-tubercular therapy.

Quantification of coronary risk score.

OBJECTIVE: To quantify the coronary risk score in children and/or grandchildren of patients with coronary artery disease (CAD). METHODS: One hundred and fifty children with positive family history of CAD (cases) and age and sex matched children with no such history (controls) were enrolled in the study. Fasting blood sugar, serum cholesterol and triglycerides were estimated on all children and a risk score was calculated using Nora's scheme. RESULT: The cases and controls were similar with respect to mean age, six distribution, mean weight and mean height. None of the child was hypertensive. Mean serum levels of triglycerides were 164.7 m/dl and 105.7 mg% respectively in cases and controls (p < 0.005). Prevalence of hypertriglyceridemia was three times more in cases (p < 0.001). Cases had a significantly higher risk scores (p < 0.00001) and this was mainly attributable to higher biochemical risk (P < 0.0006). CONCLUSION: Children and grand children with a positive family history of CAD had significantly higher risk scores for future CAD. The increased risk was mainly due to biochemical derangements.

AIDS IN JAMMU An Epidemiological Profile.

HIV seropositivity. in blood samples collected from AIDS suspect cases (ASC) and the anonymous unlinked high risk groups, was assessed by using two or three screening tests based on different principles for confirmation of the results. The HIV seropositivity was found to be high (9.4%) in the AIDS suspect cases and 0.9% in the unlinked anonymous high risk group of patients attending STD clinic, District Hospital, Gandhi Nagar, Jammu.