Echocardiographic findings in patients with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition involving the airways and characterized by airflow limitation. Pulmonary hypertension (PH) is a well-known predictor of increased morbidity and mortality in COPD. The present study was done to assess the cardiac changes in patients diagnosed with COPD in this department using two-dimensional echocardiography.Methods: This observational study was conducted on fifty patients admitted with signs and symptoms suggestive of COPD in the Department of Pulmonary Medicine, Dr. DY Patil Medical College, Navi Mumbai from January 2018 to December 2018. Pulmonary function tests (PFT) were done in all and patients were graded according to the severity of COPD with guidelines given by Global initiative for Obstructive Lung Disease (GOLD). Comprehensive two-dimensional echocardiography was performed.Results: The most common age group was 60 to 69 years. There were 68% males and 32% females. Mean body mass index of the patients included in the study was 27.8±8.13 kg/m2. COPD according to the GOLD classification was mild, moderate, severe and very severe in 12%, 36%, 30% and 22% of the patients. PH was diagnosed in 56% of the patients, Cor pulmonale in 54%, right ventricular dilatation in 48%, right atrial dilatation in 38%, inter-ventricular septal wall motion abnormality in 18% and right ventricular failure in 14% of the patients.Conclusions: Echocardiography examination is a reliable method in COPD patient to assess PH and helps in early detection of cardiac complications in COPD cases giving time for early interventions.

Adverse Drug Reactions in Multidrug and Extensively Drug Resistant Tuberculosis Patients with Diabetes Mellitus

Background: Prevalence of DM among TB patients range between 5% and 50%, while the prevalence of TB among DM patients has been reported approximately two to ten times higher than that of the general population. The purpose of this study is to describe the side effects of anti-tubercular drugs in patients with MDR/XDR tuberculosis with and without DM. Methods: This cross-sectional study was conducted to describe the side effects of anti-tubercular therapy in patients of TB with and without diabetes mellitus. Equal number of diabetic and non-diabetic (n=100 each) MDR and XDR TB patients who received at least 3 months of anti-TB treatment under directly observed treatment short course (DOTS) at our centre were included. Adverse drug reactions were determined based on the clinical presentation and were ascertained after examination by a senior physician. Results: Presenting complaint of cough was almost universal in both the patient groups. Most common side effect reported by the diabetic tuberculosis patients was gastritis (55%), followed by vomiting (45%). Less common side effects in this patient group was peripheral neuropathy, depression, dizziness, joint pain and hearing loss. Gastritis was also the most commonly reported side effect in non-diabetic tuberculosis patients (85%), followed by the complaint of vomiting in 65%. Other common side effects reported in this patient group were peripheral neuropathy, depression, hypothyroidism and dizziness. Conclusion: Bidirectional screening of DM in TB patients and TB in DM patients needs to be encouraged. Further studies are needed to study the long term effect of DM on TB management and their final clinical outcomes.

Interstitial Lung Disease in a Patient with Primary Sjogren’s Syndrome

Sjogren’s syndrome (SS) is a chronic inflammatory disease characterized by lymphocytic infiltrates in the exocrine glands, mainly the salivary and lacrimal glands. Interstitial lung disease (ILD) can be seen in 3 to 11 % of the patients with primary SS, often leading to life-threatening complications like ventilator failure and pulmonary hypertension. A sixty year old female presented with dry cough, low grade intermittent fever, and dryness of mouth and eyes. On examination, the patient was afebrile and all vitals were within normal limits. Oxygen saturation was at 96%. Breath sounds were heard equally bilaterally and infrascapular fine crepitations were heard on both sides. Pulmonary function testing had a mild restriction pattern and diffusing capacity of the lungs for carbon monoxide was reduced. Rheumatoid factor was raised and Schirmer’s test showed wetting of less than 5 mm in 5 minutes. High resolution computed tomography revealed diffuse ground glass opacities and areas of consolidation in lung lobes bilaterally. Anti-nuclear antibody profile was positive for SS-A, SS-B and Ro 52 antigens. Findings of HRCT diagnosed the presence of interstitial lung disease. Symptomatic treatment was given for dry mouth and eyes and psoriasis. Steroid and immunosuppressive therapy was considered for interstitial lung disease. Conclusion: ILD in patients with primary SS may have numerous histopathologic patterns. Though evidence based treatment regimes have not been wellestablished, early diagnosis and treatment is associated with improved lung functions and increased survival.