An observational study of correlation of cardiac manifestations with severity of COPD.

Introduction: Various systemic manifestations and complications have been observed throughout the course of Chronic Obstructive Pulmonary Disease. Out of those manifestations one of the important manifestations is cardiac involvement. The major and well-known cardiac complications of COPD are pulmonary vascular disease and its impact on right ventricular function, higher incidence of myocardial infarction and arrhythmias. These complications correlate inversely with survival. Aim: To study cardiac manifestations in COPD patients and its correlation with severity of the disease. Methodology: This observational study was conducted in the department of medicine at a tertiary care hospital in Solapur, Maharashtra. Data of 80 patients diagnosed and their cardiac status assessed on the basis of clinical findings, radiological changes and spirometry, electrocardiography and echocardiography. All patients were analyzed for cardiac involvement based on symptomatology, ECG and 2D-ECHO results. Results: Out of 80 COPD patients 6 patients were GOLD class 1 (mild), 28 in class 2 (moderate), 36 in class 3 (severe) and 10 patients belonged to GOLD class 4 (very severe). Cardiovascular complications were found in 40 patients out of 80. Of these, pulmonary hypertension was found in 45%, IHD in 30%, cor-pulmonale in 20% and arrhythmias were found in 10% of which supraventricular arrhythmias were seen in 75% and ventricular arrhythmia in25%. Conclusion:Our study concluded that patients with mild to moderate COPD may also have cardiac complications. Due to common symptomatology, they are difficult to diagnose. Hence, it is necessary at the time of initial diagnosis to carry out ECG and 2DECHO for early detection and for better management of these patients

A retrospective longitudinal study on the effect of ultra short course of steroid therapy on clinical and hematologic parameters of secondary hemophagocytic lymphohistiocytosis in children

Background: The aim was to study the effect of ultra-short course of injectable steroid followed by oral steroid therapy for cumulative 14 days on clinical and hematologic parameters of secondary hemophagocytic lymphohistiocytosis in children.Method: A retrospective longitudinal study was conducted by collecting data from case records. Cases diagnosed with secondary hemophagocytic lymphohistiocytosis had been included. The cases with malignancy were excluded. Remaining cases had been given injectable methyprednisolone (30 mg/kg/day) for three days followed by oral prednisolone (1 mg/kg/day) for 11 days. The time' to cessation of fever and organomegaly were noted. The changes in mean hematologic parameters, ferritin and triglycerides were noted at the time of suspicion of HLH or MAS, after therapy and on follow up.Results: About 96% of children were afebrile within five days of therapy. There was regression of hepatospleenomegaly in all 100% surviving children by day seven of therapy. Improvement in hemoglobin (mean value 8.1 mg/dl to 8.7 mg/dl) and platelet count (mean value 0.89 lakh to 1.47 lakh) was seen by day seven of therapy. Fall in serum ferritn (mean value 1419 ng/ml to 298 ng/ml) and serum triglycerides (mean value 307 mg/dl to 176 mg/dl) was seen at one-month follow-up. 96% survival was observed. None of the survivors had any recurrence at 6 months follow up.Conclusion: Ultra short course of injectable methyprednisolone for 3 days followed by oral prednisolone for 11 days was successful in 95% survival in our study. This cost-effective regimen, with use of less toxic drugs leading to a shorter hospital stay maybe helpful in resource limited settings.

Prescription patterns of antihypertensive drugs in a tertiary care hospital in India.

Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India. Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with comorbidities were excluded from study. The data were analyzed to fi nd out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency. Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensinconverting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed. Conclusions: This study represents the current prescribing patterns for antihypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing.

Co-circulation of dengue virus serotypes with chikungunya virus in Madhya Pradesh, central India.

Background: Dengue and chikungunya present with very similar signs and symptoms in the initial stage of illness and so it is difficult to distinguish them clinically. Both are transmitted by Aedes aegypti and Aedes albopictus mosquitoes. This study was conducted with the aim to explore the co-circulation of dengue and chikungunya viruses in central India. Materials and methods: Samples from suspected dengue cases were subjected to dengue immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and dengue-negative samples were tested with chikungunya-specific IgM ELISA. The samples collected in acute phase of illness were tested by nested reverse transcription polymerase chain reaction (nRT-PCR). Chikungunya virus (CHIKV) sequences were analysed to determine their genotype. Results: Of 138 samples screened for dengue, 21 (15.2%) were positive, and of 119 samples screened for chikungunya, 13 (10.9%) were positive. Dengue viruses 1 and 4 were found co-circulating with chikungunya virus in Jabalpur, central India. The chikungunya virus detected belonged to the East Central South African genotype. Conclusion: Accurate and timely diagnosis would help in patient management and use of resources. It is advocated to simultaneously test samples for these two diseases in endemic areas. This will also aid in understanding the epidemiology of chikungunya.

Can the special care neonatal unit admission cut-off be lowered down to 1500g babies.

Objective. The study was conducted to find out whether there is any significant difference in outcome if low birth weight babies weighing between 1500g and 1800g are managed by keeping them with their mothers, i.e., without special care neonatal unit (SCNU) admission. Methods. It was a retrospective study for which data was collected from past medical record section of 6 months duration from 01.07.06 to 31.12.06, Medical College, Kolkata. The subject of the study was babies born with weight between 1500g and 2000g, divided into 2 groups. Group A representing babies born between weight 1500g and 1800g, groups B representing babies born between 1801g and 2000g. The groups were compared with regard to four variable namely average material age, sex of the babies, singleton or twin pregnancy, mode of delivery and gestational maturity. Test of one proportion was used for statistical analysis of outcome. Results. Total number of live born babies in group A were 198 and in group B 223. Two group were comparable with respect to average maternal age (23.7 yr), sex distribution, singleton or twin pregnancy and number of cesarian section or vaginal delivery and proportion of small for gestational age (SGA) babies. In both the group 13 babies required SCNU admission after being given to their mothers in the postnatal ward. No significant difference in outcome was observed between the groups. Conclusion. We conclude that the recommended guidelines for giving institutional care to babies below 1800g may be lowered down to 1500g. However, more babies should be evaluated prospectively, over a longer duration of time, before changing the standard guidelines.

Early diagnosis of cervical cancers. Our experience at the Rural Cancer Registry, Barshi, India.

In the cervical cancer cases registered at the Cancer Hospital at Barshi, India during 1988-90, 99 of the 105 cases were clinically staged (Total number of cases registered: 136). The annual number of cases were too few for a comparison of stage distribution between the registry years. However, comparison of the proportions of early cases (FIGO Ib, IIa & IIb) in each year, with the corresponding proportion in a large series at the Tata Memorial Hospital (TMH) in Bombay in 1988, showed that the proportions of early cases in 1988 & 1989 (0.31 and 0.35 respectively) were similar to that (0.30) in TMH but in 1990, it (0.50) was significantly higher (P < 0.01). The shift to early stages observed three years after the inception of the Registry is most likely due to the registry activity which involved inter-personal contact with the community and motivation of the symptomatics to undergo a medical investigation. These activities were designed to overcome the adverse conditions for cancer registration prevailing in the rural population. It is suggested that to achieve early diagnosis similar activities be incorporated in the initial phase of a cervical cancer control programme in the country, where cervical cancer is not only the predominant cancer in women but also the cases generally present themselves in advanced stages.

Experience in screening for cervical cancer in rural areas of Barsi Tehsil (Maharashtra).

The organization of cancer detection camps is gaining popularity in our country and it is therefore necessary to evaluate the effectiveness of this approach in the early diagnosis and treatment of cancer. This to our knowledge has not been done. This report analyses an experience in screening for cervical cancer in rural areas of Barsi Tehsil (Maharashtra). The Barsi Tehsil consists of 134 villages with a population of 34,080 women above the age of 30 years (1982-1987). Of these 2,846 were screened through a series of cancer detection camps between 1982 and 1987. The results of the cytological screening in these women have been presented. An evaluation of the camp approach was carried out by the Population based Cancer Registry set up under the National Cancer Registry Programme (Indian Council of Medical Research) in Barsi, Paranda and Bhum tehsils. It was shown that acceptance of cytological screening was poor, thereby indicating that the mere holding of camps was not in itself sufficient to motivate the people, to subject themselves to the Pap smear. Certain suggestions which would appreciably increase the acceptance of cytological screening have been put forward.

Genome analysis: A new approach for visualization of sequence organization in genomes.

In this article we describe and demonstrate the versatility of a computer program, GENOME MAPPING, that uses interactive graphics and runs on an IRIS workstation. The program helps to visualize as well as analyse global and local patterns of genomic DNA sequences. It was developed keeping in mind the requirements of the human genome sequencing programme, which requires rapid analysis of the data. Using GENOME MAPPING one can discern signature patterns of different kinds of sequences and analyse such patterns for repetitive as well as rare sequence strings. Further, one can visualize the extent of global homology between different genomic sequences. An application of our method to the published yeast mitochondrial genome data shows similar sequence organizations in the entire sequence and in smaller subsequences.

Tobacco usage in school children in Bombay, India. A study of knowledge, attitude and practise.

A study of knowledge, attitude and practice with regard to tobacco usage was conducted in 1278 boys and 353 girls studying in the final year in various schools in Bombay. The proportion of boys given to one or the other form of tobacco usage (including experimenters/triers) was significantly higher in private English median schools (22.5%) compared to private Indian language schools (6.9%) or municipal Indian language schools (13.8%). There was also a significant difference between the two types of Indian schools. Girls from only Indian language schools were entered into the study and the proportion of tobacco users in them was very low (1.1%). Most (86%) boys who used tobacco were smokers. Hence the detailed analysis is restricted to smokers. Several probable factors influencing smoking behavior were studied. It was found that significantly higher proportion of boys smoked if their father or best friend smoked. Generally boys were more sensitive to best friend's or elder brother's disapproval than to parental. They were well informed about harmfulness of smoking but knowledge about specific health hazards was limited. Most of them had a positive attitude towards nonsmoking and smoking control programmes. Tobacco use has been proven to be a major health hazard. Although its use in adults in India is common, prevalence in adolescents in urban schools is not yet high. Before the situation changes we need to mount anti-tobacco educational programmes and work towards a non-tobacco generation to contain the harmful consequences of tobacco usage.

Chemical analysis of smoke of Indian cigarettes, bidis and other indigenous forms of smoking--levels of steam-volatile phenol, hydrogen cyanide and benzo(a)pyrene.

Levels of steam-volatile phenol, hydrogen cyanide and benzo(a)pyrene in various types of tobacco smoking products marketed in the country have been determined for the first time. Steam-volatile phenol levels in six popular brands of Indian cigarettes varied from 118 to 226 micrograms, and in six popular brands of bidis, from 129 to 273 micrograms. Cheroot and cigarillos yielded 400 micrograms and 333 micrograms steam-volatile phenol respectively. The hydrogen cyanide levels in the mainstream smoke of five popular brands of Indian cigarettes varied from 366 to 638 micrograms and in the mainstream smoke of four popular brands of bidis from 688 to 904 micrograms. Cheroot and cigarillos yielded 588 micrograms and 1119 micrograms hydrogen cyanide respectively. The values of benzo(a)pyrene content in Indian cigarettes varied from 85 to 114 ng and in bidis from 108 to 144 ng. Herbal bidi and cheroot had 1315 ng and 2519 ng benzo(a)pyrene respectively. Cigarettes were smoked as per international standard smoking conditions and the levels of noxious agent were found to be higher than in currently marketed western cigarettes. However, these levels in all the indigenous products including bidis cannot be directly compared with those of cigarettes as they were smoked under modified conditions.

Total particulate matter and nicotine in Indian bidis and cigarettes: a comparative study of standard machine estimates and exposure levels in smokers in Bombay.

Standard emission levels of total particulate matter (TPM) and nicotine in bidi and cigarette smoke were compared with exposure levels based on smoking behaviour of smokers in Bombay. Bombay cigarette smokers are getting much higher amount of carcinogenic dry TPM (28 to 79%) and nicotine (31 to 104%), compared to standard machine estimates. In the case of regular bidi (60 mm) harmful ingredients like dry TPM decreased from 11 to 15 percent and nicotine increased from 11 to 22 percent, whereas long bidi (80 mm) delivered higher amount of dry TPM (14 to 22%) and nicotine (33 to 37%) in smokers in Bombay compared to standard machine estimates.