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.

Characterization of phytotoxin producing Alternaria species isolatedfrom sesame leavesand their toxicity.

Sesame (Sesamum indicum L.), is an important oilseed crop in the tropics and subtropics, referred as “Queen of Oilseeds” owing to its high cooking quality and medicinal value. Sesame production, particularly in India, has been declining since last decade and ‘Leaf blight’ caused by Alternaria spp. is reported to cause yield loss up to 30-40%. Here, we investigated the fungal toxin produced by Alternaria and its pathogenicity. A total of 164 Alternaria strainswere isolated on potato dextrose agar media from the infected sesame leaves showing circular concentric rings with dark brown spots symptoms. All the isolates were screened for cultural and morphological characters. Colour of the fungus was grey to dark brown, formed smooth, raised, fluffy, and regular to irregular margins. Among 164 isolates, 43 isolates were moderately growing and 121 were fast in growth. The DNA of the isolate was amplified with ITS primers and sequence of BLAST results confirmed seven different species of Alternaria of NCBI database. Further, toxigenic potentiality of the isolates was tested with dilutions of culture filtrate (1:1 to 1:5) on sesame leaves. Among 164 isolates, 23 showed toxigenicity, varied from highly toxigenic to least toxigenic. Pathogenicity of the isolates showed that they were highly virulent to less virulent when tested by the detached leaf method. Based on the toxigenicity, the toxin was partially purified and brown coloured paste was recovered. Chemistry of the toxin was confirmed based on the IR, UV, NMR and mass spectra analyses, and it resembled the structure of alternariol mono methyl ether and altenuene which are mycotoxins in nature. Further, bioassay of toxin was carried out at different concentrations (50 to 2000 ppm) on seeds and seedlings of sesame. Maximum inhibition of seed germination of 81.1% was observed at 2000 ppm and the least was 6.67% at 50 ppm. With the increase in the concentration of toxin, the manifestation of the symptom was conspicuous and quick such as marginal, veinal necrosis, drooping and yellowing with lesion formation. From the present study, it is found that the species of Alternaria are responsible for the cause of blight disease symptoms and the toxicity of toxin produced by the pathogen was very high. The Alternaria toxin could inhibit the growth of the plant as well as seed germination rate.

Collecting Duct Carcinoma of the Kidney.

Collecting duct carcinoma (CDC) is a rare, highly aggressive malignant neoplasm that arises from the collecting duct epithelium of the kidney. It generally pursues a more aggressive course than conventional renal cell carcinoma. The average age is approximately 53 years. These are large tumors commonly located in medulla or central part of kidney with extension into perinephric fat and invasion into renal pelvis. Microscopically, they show combined tubulo-papillary, microcystic and solid growth pattern; cells are highly atypical with a basophilic or eosinophilic cytoplasm and polymorphic nuclei, often of the hobnail type. Stromal desmoplasia and dysplastic changes in the neighbouring medullary renal tubules are often associated. Their biologic behaviour is mostly aggressive with a high rate of local, lymphatic and haematogenous spread at the times of diagnosis and a poor long-term prognosis.