ABSTRACT
Background: Hypothyroidism is a common disease with a prevalence rate of 11% in India. It affects all organ systems in the body. Patients with hypothyroidism frequently have symptoms of fatigue and exercise intolerance. These symptoms could arise from a reduced pulmonary reserve, cardiac reserve or decreased muscle strength or increased muscle fatigue. This study aims to study the pulmonary function test in patients with hypothyroidism.Methods: This is a cross sectional study conducted on 100 patients divided into 2 groups (a) newly detected hypothyroids (b) normal control group. Cases were matched with controls in having similar environment exposure and age group. All patients had routine symptom and clinical assessment. Laboratory investigations such as complete blood picture, pulmonary function test, chest x ray and thyroid function test were done. Data was entered and analysed.Results: In this study conducted on 100 patients, case group had symptoms of easy fatiguability (36%), breathlessness (20%), menstrual abnormality (20%), weight gain (7%) and generalised body aches (5%). Mean FEV1 levels between cases and controls were 1.34 and 1.72 (p value 0.00), mean FVC were 1.88 and 2.09 (p value 0.114), FEV1/FVC ratio of 70.56, 81.98 respectively (p value 0.00). The distribution of PFT pattern was 32% obstructive, 28% mixed pattern and 22% restrictive pattern.Conclusions: This study shows that hypothyroidism causes significant decrease in FEV1 and FEV1/FVC ratio, thereby suggesting obstructive patterns of lung involvement .Therefore PFT can be used routinely as a screening test for all hypothyroid patients to detect early respiratory dysfunction and thereby optimise treatment especially in obese patients and patients with pre-existing lung disease as hypothyroidism adds to their respiratory dysfunction.
ABSTRACT
Background: Antiretroviral therapy is one of the reasons for falling trend of HIV epidemic at present. The clinical efficacy, toxicity and reasons for failure of first line ART is understudied. This study aimed to determine the frequency rates and reasons for discontinuation of first line ART in a cohort of HIV positive adult patients.Methods: Cross sectional study was conducted on 11,968 patients of HIV registered at Victoria Hospital ART centre from 2011 to 2017. Using a structured proforma, relevant information was collected from patients taking first line ART. Descriptive statistics was used for analysing the results obtained.Results: Total 11,968 HIV patients were registered at ART centre during our study period of which only 4,008 patients were taking ART among them, 167 patients were referred for initiation of 2nd line ART. After evaluation 28 were continued on First line,1 opted out, 20 were transferred out,1 discontinued treatment, 17 died, 14 were lost to follow up, 5 were excluded from the study and only 81 patients were started on second line ART. Failure rate of first line ART in our study was 2.02%. Immunological failure followed by clinical failure were the most common reasons for changeover in this study. Tuberculosis was the most common comorbid disease in this study.Conclusions: First line ART is very effective and well tolerated and has a low failure rate. Low CD4 count, anaemia, raised ALP, low albumin were among the factors associated with treatment failure. WHO staging did not correlate with the treatment failure, recommended routine viral load monitoring for assessing treatment failure.