ABSTRACT
Introduction: The relationship between OSA and glycemichealth is a topic of increasing clinical and research interest.Community-based studies have suggested that the presenceand severity of OSA are independent predictors of insulinresistance and T2DM prevalence the aim of the present studywas to examine the potential correlation of OSA and HbA1Cvalues in patients with Metabolic SyndromeMaterial and Methods: A cross-sectional study was conductedamong a total of 63 patients with a history of metabolicsyndrome and were divided into two groups diabetic and nondiabetic. The risk of OSA was assessed by three structuredand validated questionnaires namely STOP-BANG, ESS,Modified Berlin. Fasting blood sugars and HbA1C was done.All patients were evaluated with Polysomnography level III.Results were analyzed using statistical methods (Descriptiveanalysis and correlation). Using SSPS version 22 used.Results: Out of the total of 63 subjects, there was a malepreponderance (Male - 61%) with a mean age of 50.9 ± 12.98years. Increased AHI was seen in 91% of the subjects (morethan 5) with the mean AHI of 29.63 ± 22.14. The mean FBS &HbA1C was 151.62 ± 49.5mg/dl & 7.22 ± 1.71 respectively.In both diabetic & non-diabetic groups, the correlation of FBS& HbA1C values with AHI was statistically not significant.Conclusion: AHI severity did not correlate with FBS andHbA1c values in patients with metabolic syndrome. However,in the non-diabetic subgroup with severe AHI the fastingblood sugar levels were above a higher limit of normal.
ABSTRACT
Introduction: Thoracic dimensions play a vital role in thepathogenesis and management of dyspnea among Chronicobstructive pulmonary disease [COPD] patients. COPD maycause changes in the shape of thoracic cage by increasing lungvolume and hyperinflation. Hence it is essential to know thevariations in thoracic dimensions among normal and COPDpatients. Study aimed to compare the thoracic dimensionsAntero posterior [AP] diameter, Transverse diameter andHeight of diaphragm [HDI] between COPD patients andhealthy controls.Material and Methods: The present study was a crosssectional study. The study included 80 subjects diagnosedwith COPD as per GOLD guidelines and 80 healthy controls.Both the groups underwent chest radiographic evaluation withPA and Lateral views.Results: The average AP diameter was significantly greaterin subjects with COPD [10.64cms ± 2.16cms] compared tohealthy controls [9.29cms ± 1.47cms]. The difference wasstatistically significant [p <0.001]. The Mean transversediameter was 22.5cms ± 2.1cms in COPD subjects and amongthe healthy controls [21.83cms ± 2.02cms]. The difference wasstatistically significant (P value 0.041). Also, among COPDmean HDI was 23.35cms ± 2.6cms and among the healthycontrols was 20.57cms ± 0.91cms which was statisticallysignificant [p<0.001].Conclusion: The present study demonstrated that AP,Transverse diameters of thoracic cage, and HDI evaluatedusing Chest X-ray, were increased in COPD subjects comparedto healthy controls.
ABSTRACT
Background: Pulmonary Artery Hypertension (PAH) is defined as mean pulmonary artery pressure greater than 25 mmHg at rest as assessed by Right heart catheterization. 1 PAH secondary to lung disease is categorized under Group 3 PAH according to WHO classification, the major causes being COPD, ILD, OSA etc. Only few studies have analyzed the clinico-radiological profile, severity, morbidity and mortality associated with group 3 PAH. Hence this study was undertaken to study the clinic-radiological and functional profile of patients with group 3 pulmonary hypertension and to correlate grade of PAH with six-minute walk distance (6MWD) and Dyspnoea grading by modified Medical Research Council (mMRC). Primary objective was to correlate grade of PAH with 6MWD and dyspnoea grading (mMRC) in group 3 pulmonary artery hypertension. Secondary objective was to study the clinic- radiological and functional profile of patients with group 3 pulmonary hypertension in a tertiary care centre.Methods: Seventy two patients diagnosed to have PAH by 2D ECHO with underlying lung disease were retrospectively analyzed in Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai. Their demographic data, clinical history, examination, Dyspnoea according to MMRC grading, Chest X ray, CT chest, ECG, 2D ECHO (using VIVID 5), PFT (Easy on PC 2700-1-01. EOPC SN 219295, ATS guidelines), six minute walk test (ATS guidelines) and other Special investigations like CT Pulmonary Angiogram, Polysomnography were included wherever necessary.Results: Out of the 72 patients with group 3 PAH 44.4% belong to the age group of 46-65 years with a mean age of 57.59�.6 years along with a slight male preponderance. The commonest cause being COPD (27.7%) followed by ILD (15.30%) and Bronchiectasis (5.50%) and the combined etiology contributing to 48.8%. There was a statistically significant positive correlation between grade of PAH and mMRC score (p< 0.05) and significant negative correlation between grade of PAH with 6MWD and FEV1 (p <0.05).Conclusions: This study shows that Simple bed side tools like 6MWD and mMRC score can be used for the evaluation of presence and severity of Group 3 PAH.
ABSTRACT
Background: Pregnancy is a physiological state causing significant physical and functional changes in Cardiovascular and Respiratory system. It is important to recognize the adaptive changes during pregnancy in order to identify and manage Respiratory impairment. The Respiratory system undergoes structural and functional alterations affecting the thoracic cage, abdominal cavity and diaphragm. There is a decrease in Functional Residual Capacity (FRC), Expiratory Reserve Volume (ERV), Chest wall Compliance & increases in Tidal Volume (TV), Minute Ventilation (MV) during pregnancy. However, Airway function is postulated to largely remain unchanged during pregnancy with Peak Expiratory Flow Rate (PEFR), FVC and Forced Expiratory Rates like FEV1 showing little change. Hence, PEFR which is a simple, portable, cheap and reproducible parameter can be utilized to assess airway function during pregnancy. Due to conflicting reports of PEFR with advancing gestation in different ethnic groups and limited studies in the South Indian population, the present study was undertaken to evaluate the PEFR variation in different trimesters of normal pregnancy. Aim: To Evaluate the Peak Expiratory Flow Rate in Pregnancy in different trimesters. Aruna Shanmuganathan, Krishnaveni R, Meenakshi Narasimhan, Viswambhar V, Ragulan R, Nisha Ganga, Gangaiamaran M, SSJ Shiek Fareeth Ahmed. Evaluation of Peak Expiratory Flow Rate in Pregnancy in a South Indian Tertiary Care Centre. IAIM, 2017; 4(7): 61-66. Page 62 Materials and methods: Total of 165 pregnant women in the age group of 20-35 year with no respiratory illness or co morbidities (55 in each trimester) were included in our study. Control group consisted of 55 age and height matched non pregnant women. Informed consent was obtained and PEFR was performed using Mini Wright s Peak Flow Meter and best of three recordings noted. Data analyzed using SPSS package version 21.0. Association between PEFR with Age and BMI performed using Pearson correlation. The Bonferroni’s Multiple Comparison Test executed to determine the significant variance of PEFR between control and study groups. Results: PEFR was significantly lower in all trimesters of pregnancy compared to controls. However, there was no significant difference in PEFR across trimesters. Age and BMI did not correlate with PEFR. Conclusions: PEFR was significantly lower in all trimesters compared to controls. Hence, prospective Indian studies with larger samples are needed to arrive at Normograms for PEFR in each trimester of normal pregnancy which would enable us to use PEFR as a simple tool to assess airway obstruction in pregnancy.
ABSTRACT
Introduction: Mean platelet volume (MPV) and Platelet Distribution Width (PDW) is a relatively simple, inexpensive tool that indicates the platelets size, the rate of platelet production, platelet activation and the severity of inflammation since inflammation plays an important role in COPD, any alteration in platelet activity can cause alteration in MPV. Red blood cell distribution width (RDW) reflects morphology of erythrocytes whereas RDW can also vary due to systemic inflammation and ineffective erythropoiesis. Hence we aimed to study Platelet indices in patients with exacerbation of COPD. Aim and objectives: Our aim is to evaluate the role of platelet Indices in COPD patients. Since only limited data were available on the relationship between COPD and platelet indices, we aimed to evaluate and find out the correlation between Mean Platelet Volume (MPV), Red Cell Distribution Width (RDW), Platelet Distribution Width (PDW) and Plateletcrit (PCT) in exacerbation of COPD patients at a tertiary care hospital in south India. Materials and methods: A total of 135 subjects, 79 men and 56 women, who were admitted in our hospital with exacerbation of COPD during a period of one year were enrolled in this prospective Ragulan R, Viswambhar V, Krishnaveni R, Meenakshi Narasimhan, Aruna Shanmuganathan, Nisha Ganga, Gangaiamaran M. Evaluation of platelet indices among patients with exacerbation of COPD in a tertiary care center in South India. IAIM, 2017; 4(7): 161-166. Page 162 observational study. The levels of MPW, RDW, PDW and PCT were assessed during the course of hospital stay in patients with COPD exacerbation Results: In our study we found out that there exists a statistical significance among male and female COPD exacerbation patients with respect to Mean Platelet Volume (P=<0.0001) and Red Cell Distribution Width (P=<0.0001). There also exists statistical significance between our COPD patients with other study stable controls (p=<0.005). Using ROC curve, considering optimal level of MPV <8.8Fl, male population showed sensitivity of 95% and specificity of 85% with Average age in men with diagnosed COPD is 49 and average age of female COPD patient is 55. Conclusion: Our study suggests that Mean Platelet Volume and Red Cell Distribution Width values may be useful for identifying patients who are at high risk for exacerbation of COPD. RDW per se is an important risk factor for Ischemic heart disease (IHD) and elevated RDW may suggest increase in risk of IHD in patients with COPD