Prevalence of chronic obstructive pulmonary disease among non-smokers in rural areas of Lucknow district, Uttar Pradesh, India

Background: Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease of the airways and lung parenchyma and the risk factors include both genetic and environmental factors. Tobacco smoking has remained the most important risk factor associated with it. The occurrence of COPD in non-smokers is not widely appreciated, even though its relative burden is higher in developing countries than developed countries. There is limited information on the risk factors associated with spirometrically confirmed COPD in non-smokers in the general population and more data from population-based studies are needed. Hence, the objective of this study was to determine the prevalence of COPD and associated risk factors among non-smokers in rural areas of Lucknow district, Uttar Pradesh, India. Methods: This cross-sectional study with multi-stage random sampling was conducted among 552 non-smoking participants aged 18 years and above in rural areas of Lucknow. It was conducted using pre-designed questionnaire for data collection. COPD assessments were done using a combination of clinical history and portable spirometry. Data collected was analysed using SPSS 23.0 version. Results: FEV1/FVC <0.7 was used to define COPD which yielded a prevalence of 8.5 percent among non-smoking participants. Gender, occupation, type of family, presence of ex-smoker, presence of dampness and livestock in the house were the risk factors that showed statistically significant association with COPD. Conclusions: The higher prevalence noted in this study highlights the need for enhanced community-based screening programme for secondary prevention of COPD among adults.

Comparison between incremental shuttle run test and Harvard’s step test on peak exercise performance in healthy males: a cross-sectional study

Background: Cardiovascular fitness is directly related to the physical health of the person. Aerobic capacity (VO2max) is one of the major criteria to decide the cardiovascular fitness of an individual. To help quantify the fitness level by calculating their VO2max, there are various indirect maximal tests available but out of these, which one would predict VO2max better, is a major concern. Hence the purpose of this study was to compare the effects of two indirect maximal tests i.e. Incremental Shuttle Run Test (ISRT) and Harvard’s Step Test (HST) on peak exercise performance in young healthy males.Methods: A cross-sectional study with purposive sampling was performed on healthy untrained 100 males of age group 18-25 years. Day 1 subjects performed ISRT on 20 m track and after a 48 hours rest period, on day 3 same subject performed Harvard’s step test. Pre and post-test parameters (Pulse rate, respiratory rate, systolic and diastolic blood pressure and RPE) were measured and predicted VO2max was calculated.Results: Post-test parameters i.e. PR, RR, SBP significantly increased (p=0.00*) by Harvard’s step test. The diastolic blood pressure did not change significantly (p=0.3) for both the tests. Rating of perceived exertion by both the test was of the range 17-19 (very hard to maximal). Calculated predicted VO2max was significantly more by ISRT than HST in males (p=0.00*).Conclusions: Incremental shuttle run test is more efficient in predicting VO2max than Harvard’s step test in healthy adult’s males.

Smoking habits, its forms and impact on pulmonary health in planes of Uttar Pradesh.

A total of 611 rural and 164 urban subjects were studied. Smoking was found more prevalent in urban areas as compared to rural areas. In relation to sex it was more prevalent among urban males and rural females. Bidi was the commonest mode of smoking among rurals, and cigarette in urban population. Pulmonary function test (PFT) analysis proved that smoking causes definite pulmonary functional impairments among smokers. Though its aetiology in producing restrictive impairment remains doubtful and may be additive only but its role in precipitating obstructive impairment is definite in urban smokers. On the contrary rural non-smokers suffer more from the obstructive impairment. Environmental pollution, exposure to toxic fumes and industrial gases in urban areas and organic and inorganic dust exposure in rural areas may be responsible for precipitation of pulmonary function impairments among non-smokers.

Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.

OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

Precut papillotomy using a needle knife: experience in 100 patients with malignant obstructive jaundice.

BACKGROUND: Precut papillotomy enhances the success of selective bile duct cannulation. Doubts have been raised about the relative safety of the procedure. This study was undertaken to assess the success rate and complications of precut papillotomy using a needle knife. METHODS: 100 consecutive patients undergoing precut papillotomy for biliary endoprosthesis placement were studied. A needle knife was used in these patients after bile duct cannulation was not successful using other techniques. The success rate, complications and mortality were determined. RESULTS: Selective bile duct cannulation was achieved in 65 patients. There were six complications: bleeding (3), pancreatitis (2), and perforation (1). One patient died following duodenal perforation. The success rate for endoprosthesis placement was increased by 14.2% following precut papillotomy. CONCLUSIONS: Precut papillotomy enhances the success of selective bile duct cannulation, with complication rates similar to standard papillotomy.

Synchronous adenocarcinoma and lymphoma of the colon.

Synchronous lymphoma and adenocarcinoma of the colon are extremely rare. A 32-year-old woman was referred to us for colon cancer. Investigations revealed two primary tumors, one in the cecum and the other in the sigmoid colon. Subtotal colectomy with ileorectal anastomosis was performed. Histology revealed the cecal tumor to be non-Hodgkin's lymphoma, diffuse small cell type with plasmacytoid features. The sigmoid colon tumor was moderately differentiated adenocarcinoma. The patient received 6 cycles of chemotherapy postoperatively for lymphoma but died of recurrent disease after 17 months.

Dilatation of radiation-induced esophageal strictures under sublingual buprenorphine analgesia: a pilot study.

BACKGROUND: Pain during dilatation of radiation strictures is a troublesome complaint. There is little information on sedation and analgesia during this procedure. We performed a pilot study to compare the analgesic efficacy of sublingual buprenorphine and intravenous pentazocine during dilatation of radiation-induced esophageal strictures. METHODS: Thirty-one patients with esophageal cancer who had radiation-induced strictures were randomized to receive either buprenorphine 0.2 mg sublingually two hours before dilatation (n = 17) or pentazocine 30 mg intravenously five minutes before dilatation (n = 14). Dilatation was considered successful if it could be performed to 12 mm diameter or more. Pain experienced during dilatation was graded as mild, moderate or severe. RESULTS: Sixteen patients in the buprenorphine group and 12 in the pentazocine group were dilated to > 12 mm size (p = ns). Twelve and nine patients respectively in the two groups experienced mild or no pain; ten and six patients had minor side-effects (p = ns). CONCLUSION: Buprenorphine is useful for sedoanalgesia during dilatation of radiation-induced strictures of the esophagus.

Topical pharyngeal anesthesia without intravenous sedation during upper gastrointestinal endoscopy.

BACKGROUND: There have been conflicting reports about the usefulness of topical pharyngeal anesthesia as a pre-endoscopic medication. AIMS: To assess the effect of topical pharyngeal anesthesia without intravenous sedatives on easing upper gastrointestinal endoscopy. METHODS: 153 consecutive consenting patients were randomized to receive either placebo (normal saline) spray (78 patients) or 80 mg of 4% lidocaine spray (75 patients). Difficulty of intubation was judged both by the patient and the physician on a linear analogue scale. RESULTS: There was no significant difference in the scores in the two groups (p > 0.05). The patient and physician assessments correlated well. CONCLUSIONS: Topical lignocaine spray does not facilitate upper gastrointestinal endoscopy in the absence of intravenous sedation.

Massive lower gastrointestinal bleeding from cecal lymphoid polyp in renal transplant recipient.

A 25-year-old renal transplant recipient receiving anticoagulant therapy for renal vein thrombosis, presented with massive lower gastrointestinal bleeding. Superior mesenteric angiogram revealed active bleeding in the cecum. Colonoscopy revealed a sessile ulcerated polyp in the cecum with satellite polyps. The polyps were fulgurated with Nd:YAG laser. Colonoscopy later revealed a remnant of the polyp, which was excised. The histopathology revealed a lymphoid polyp.

Solid and cystic papillary neoplasm of pancreas--a report of seven cases.

OBJECTIVE: To study the clinico-pathological features of patients with solid and cystic papillary neoplasm of the pancreas. METHODS: The clinico-pathological features of solid and cystic papillary neoplasm of the pancreas were studied in seven fully documented and confirmed cases presented during the last seven years. RESULTS: All the patients were women with a median age of 18 years (range 12-40). Four presented with epigastric pain and three had a painless abdominal lump. The median duration of symptoms prior to presentation was 3 months (range 1-6). The tumor size ranged from 6-16 cm (mean 10 cm). Preoperative diagnosis was established by fine needle aspiration cytology in three patients. All the seven underwent resection. Pericapsular adhesions were found in two patients. All the patients were free of disease on follow-up ranging from 3-60 months (median 16 mo). CONCLUSION: Occurrence in young females, solid and cystic areas on imaging, resectability in spite of large size, and good prognosis are the important features of this tumor.

Ultrastructural changes in mild gastroesophageal reflux disease: results of a pilot study.

Few studies have examined the ultrastructural changes in mild reflux esophagitis. Endoscopic esophageal biopsies were obtained from 10 patients with reflux symptoms and mild endoscopic esophagitis (grade 0:3 patients, grade I: 7 patients) and 9 patients with erosive esophagitis (grade II-IV), at least 5 cm above the Z line. The biopsies were evaluated by light and transmission electron microscopy. Ultrastructural changes were present in one patient with grade 0, 7 with grade I and 9 with grade II-IV esophagitis. Four of the 10 patients with grade 0-I esophagitis and 6 of 9 with grade II-IV esophagitis had light microscopic abnormalities. The ultrastructural abnormalities in patients with mild esophagitis were seen in the cell membrane, cytoplasmic organelles, desmosomes, and nuclei of all the three layers of esophageal mucosa and the basal lamina. Ultrastructural studies by transmission electron microscopy on endoscopic pinch biopsies may be a sensitive research tool to study the pathogenesis of mild reflux esophagitis.

Unusual bone metastasis as the initial symptom of gastric cancer--a report of four cases.

Four cases of gastric cancer presenting with bone pain due to metastasis as the initial symptom are reported. Investigations revealed solitary osteolytic metastasis in the mandible in one, and left scapula in one patient. Third patient had multiple osteosclerotic metastasis with elevation of acid phosphatase and another had multiple discrete osteolytic metastasis simulating multiple myeloma. All the primary gastric cancers were poorly differentiated adenocarcinoma and three were of Borrman type III on gross appearance. One patient had sparing of the liver inspite of extensive metastasis. Chemotherapy was in effective in two patients and the prognosis was uniformly poor.

Multiple lymphomatous polyposis of the gastrointestinal tract.

We report two rare cases of multiple lymphomatous polyposis of the gastrointestinal tract. Both patients had multiple polypoidal defects involving large segments of gastrointestinal tract. The histopathology in both cases was diffuse poorly differentiated lymphoma. One case had multiple relapses despite treatment and died after 58 months. The second patient died following induction chemotherapy.

Role of endoscopic ambulatory laser therapy in palliation of malignant colorectal diseases.

BACKGROUND: Endoscopic laser therapy is widely used in the palliation of advanced malignant colorectal diseases. The role of this therapy in improving the quality of life of these patients needs adequate assessment. METHODS: Nine patients with advanced colorectal cancers and three patients with secondary colorectal involvement by pelvic cancers underwent endoscopic Nd:YAG laser therapy for palliation using non-contact laser guides for tumor bleeding alone (n = 12) or associated with obstruction (n = 7). The therapy was performed on an outpatient basis in 9 of the 12 patients. One patient was lost to follow up. RESULTS: Symptom control was achieved in all the 11 bleeding tumors and in 5 of the 7 obstructive tumors. There were no major complications. Three patients had no improvement in the quality of life in spite of control of symptoms. CONCLUSION: Ambulatory endoscopic laser therapy is a minimally invasive, safe and effective method of palliation for selected patients with non-resectable malignant colorectal tumors.

Indigenous silicone rubber endoprosthesis for malignant esophago-pulmonary fistula.

Endoscopic placement of an esophageal endoprosthesis is the most rational therapy for relieving the distress of malignant esophago-pulmonary fistula. The commercial prostheses are very expensive for widespread use in India. We have indigenously prepared silicone rubber endoprostheses. The wall of the prosthesis was hardened in a graded manner until the desired resistance to compression with flexibility is achieved. This prosthesis was placed successfully in five patients with malignant esophago-pulmonary fistula. Dysphagia and aspiration were relieved in all the patients. One patient had delayed esophageal perforation and died of massive bleeding 3 weeks after the placement of prosthesis. The indigenous endoprosthesis is cost-effective and safe.

A prospective study of radiation induced damage of pancreatic ducts.

To study radiation-induced pancreatic duct damage, endoscopic retrograde pancreatograms of 11 patients with primary gastric lymphoma who had completed chemotherapy and moderate dose external radiation therapy were compared with those of 22 normal subjects. No significant alteration was seen in the length and caliber of the main pancreatic duct and number of side branches. Clubbing of one or two side branches was observed in four patients who had received radiation (p = ns). We conclude that significant structural changes do not develop in the pancreas following moderate dose upper abdominal radiation.

Palliative segment III biliary bypass (left cholangio-jejunostomy) in malignant block at porta hepatis.

Segment III cholangio-enteric anastomosis was performed in 17 patients with obstructive jaundice due to unresectable malignancies at the porta hepatis. The operative mortality was 6% (1/17) and morbidity 30% (5/17). More than 50% fall in bilirubin level with symptomatic improvement in pruritus was seen in 13 patients. Three patients had 25%-50% fall in bilirubin level. This procedure is safe and effective in palliation of unresectable hilar obstruction.

Out-patient esophageal dilation: an experience in 130 patients using Savary-Gilliard dilators.

Experience of outpatient esophageal dilation using Savary-Gilliard dilators in 130 patients during a 17 month period is reported. The strictures were radiation induced (48), tumoral stenoses (40), anastomotic (16) and due to other causes (26). Both fluoroscopy and endoscopy were used in 58%, endoscopy alone in 23% and fluoroscopy alone in 19% of patients for placement of the guide wire. One hundred and twenty six stricture dilations (97%) were technically successful. Eighty one (62%) patients could be dilated to 14 mm or more. One hundred and nineteen (94%) patients were dilated in one or two sessions. Among the 109 patients who followed up, dilation was successful in providing adequate dysphagia relief in 97 patients and facilitated the performance of other therapies in 9 patients. Major complications included severe continuous chest pain (1 case), hematemesis (2), fever (4) and transient stridor (2). The patient with persistent pain and 9 patients undergoing other therapies required hospitalization. There were no perforations or death. We conclude that esophageal dilation with Savary-Gilliard dilators is safe and effective even in tumors and post-radiation strictures. It can be performed on an outpatient basis in a majority of patients.