COPD is a major cause of death worldwide. Early identification of the complications, particularly pulmonary hypertension and right ventricular dysfunction can prevent or delay long-term complications. AIM OF THE STUDYTo study ECG and Echocardiographic profile among COPD patients and study their importance in the management of COPD. MATERIALS AND METHODSWe have studied 103 (N=103) patients diagnosed as COPD in our tertiary care centre. We categorized them into mild (FEV1/FVC<0.7 and FEV1 is >80% predicted), Moderate (FEV1/FVC<0.7 and FEV1 is between 50-80% predicted). Severe (FEV1/FVC<0.7 and FEV1 between 30-50% of predicted) and Very Severe (FEV1/FVC<0.7 and FEV1 is <30% predicted). Mild group included 6 patients, moderate group 90 patients. Severe group consisted of 5 patients and very severe group consisted of 2 patients. We studied the ECG and Echocardiographic profile of the moderate, severe and very severe group patients totalling 97. RESULTS AND CONCLUSIONSP pulmonale was present in 19.58%. R/S ratio <1 in V6 was seen in 15.55% of the patients. R/S ratio >1 was seen in 4.44%. Atrial ectopics were seen in 18.55% and ventricular ectopics were seen in 3.09%. Right axis deviation was seen in 5.55% and no ECG changes in 39.17%. Echocardiogram showed consistent abnormal findings in 94%. Pulmonary arterial hypertension was seen in 94.84%, RV hypertrophy was seen in 26.82%. Cardiac arrhythmias and cardiac failure were seen in 8.24% each. ECG and Echocardiography can identify early pulmonary hypertension and right ventricular dysfunction. Proper institution of therapy can prevent long-term complications of severe pulmonary hypertension and right heart failure and can prolong the life and improve quality of life among COPD patients.
We have studied a total of 103 COPD patients based on spirometry. We excluded patients with a history of Tuberculosis. Majority of them were in the moderate obstruction group of FEV1 between 50% and 80% predicted. All of them had FEV1/FVC of 0.7 or less. Mean age of the patients was 57.6±8. Male:Female ratio was 73:30. All except two male patients were smokers. Eighteen out of thirty female patients were passive smokers. Majority in our study were agricultural workers. Majority of the symptomatic COPD patients had a smoking index of more than 100. Predominant symptom in our study was shortness of breath. Only a third of the patients showed clinical signs of wheeze and crepitations. Predominant number of patients presented with signs of emphysema. Chest X-ray showed Emphysema in 86%, Chronic Bronchitis in 31%, Cardiomegaly in 14.5% and Enlarged Pulmonary Artery in 13.5%.
Treatment of Type II Respiratory Failure in a COPD patient is a difficult task for the ICU and Pulmonary physician. Multi factorial and multi-disciplinary approach is required. Our experience of two cases treated recently in Katuri medical College Hospital have common features. One is a male of 54 years age and the other is a female of similar age. Both of them were obese and were nonsmokers. Both were poor and could not afford any ICU treatment on their own. Both were rescued by State sponsored Arogyasree programme. Both of them had the advantage of support from their families. Aided by Arogyasree programme, dedicated staff of ICU, Pulmonology, ENT departments, timely interventions with electrolyte balance, balanced antibiotic therapy, Noninvasive and invasive ventilator strategies, Nutritional support, Blood transfusions, Timely Tracheostomy and excellent nursing care and drug administration in ICU both patients recovered back to normalcy. Initially both required home oxygen therapy and both were subsequently seen maintaining normal oxygenation status even without oxygen causing happiness to family members and the treating physicians. CASE 1: 54 year old male patient was brought to ICU of Katuri Medical college hospital on 9 th of September 2014. Family members gave history of Ischaemic heart disease three years ago and the angio at that time revealed a 40% block of circumflex artery. Patient was drowsy but arousable. He was a bus driver by occupation with long history of exposure to dust but was a non-smoker. Patient had generalized edema laboured breathing. Initial examination revealed PR 122/mt, BP 110/70. Respiratory rate 12 breaths/mt and SpO2 82%. Cardioivascular status was normal with normal ejection fraction suggesting diagnosis of COPD, pulmonary Hypertension and corpulmonale.The first ABG revealed a pH 7.23, pO2 74mmof Hg, pCO2 99 mm of Hg and HCO3 of 41 mmol/l. A diagnosis of Type II respiratory failure with partially compensated respiratory acidosis was made. He was put on noninvasive ventilation (Bilevel Positive airway pressure). By next morning Patient's General condition worsened with increased acidosis decreased pH to 7.17 with bicarbonate of 43.4 mmol/l. Patient was registered under Arogyasree (State sponsored health programme where selective diseases were given free treatment with the Government aid) and Invasive ventilation was started. Subsequent ABGs showed improvement with pCO2 coming back
BACKGROUND Context-We have chosen 216 patients presenting with a chief complaint of haemoptysis attending our tertiary care unit both mild, moderate and severe in our prospective study from 2013 to 2016. Aim-To study patients of haemoptysis including their age, sex distribution, background disease, severity of haemoptysis, smoking status, active disease existing and method of treatment. Settings and Design-We have taken up patients with the complaint of haemoptysis analysed history and did thorough Physical examination. MATERIALS AND METHODS A total of 216 patients presented with haemoptysis above 20 years of age were included in our study. Investigated these patients with chest x-ray and sputum for AFB. CT scan chest, bronchoscopy were done in selective patients. Smoking history was taken from all the patients, both male and female after taking consent from the Ethical Committee. Majority of the patients were subjected to conservative management. Glue therapy and Bronchial artery embolisation were required for 6 patients. RESULTS Among 216 patients admitted in the prospective study, maximum number of patients were seen in 30-49 years' group. Males outnumbered females in our study. Pulmonary tuberculosis both acute and old inactive tuberculous residual lesions are responsible for haemoptysis in nearly 60% of patients; 9.2% cases had bronchiectasis. Nearly 10% of patients came for streaky haemoptysis secondary to acute pharyngitis. Iatrogenic haemoptysis secondary to pulmonary procedures occurred in 3.24%. Post bronchoscopy procedures are an important cause of significant haemoptysis in 6.10%. Post procedural haemoptysis was always self-limiting and never life-threatening in our study. Among TB patients, active tuberculosis is responsible for haemoptysis in 25.92% among new cases of TB, followed by old inactive TB (19.9%), Defaulters (9.72%), Relapse after successful treatment (3.24%) and MDR TB (0.92%). Haemoptysis in our study group was mild in a majority (< 100 mL/day), moderate (100-300 mL/day) in only 9 patients and severe (> 300 mL/day) in only 4 patients. Most of the patients were managed only conservatively. Only six patients required intervention in the form of cyanoacrylate glue bronchoscopically and only three patients were subjected to bronchial artery embolism. CONCLUSION Haemoptysis is an alarming symptom both to the patient and the physician. Tuberculosis old and active is an important cause of haemoptysis in India. URTI, acute pharyngitis, bronchiectasis, chronic bronchitis and lung tumours and cancer are important causes of haemoptysis. Haemoptysis is mild in a large number of patients. Glue therapy and bronchial artery embolisation were required for 6 patients. Majority of the patients were managed conservatively; 10% required ICU admission.
BACKGROUNDWe have studied seven cases of Pleural effusion of pancreatic aetiology from 2015 to 2017. Aim of the Study-Alcoholism is increasing in our society and so are the pancreatic problems. Pleural effusions of pancreatic aetiology are also increasing in clinical practice. We intended to study the clinical presentation, alcoholic history and investigated the patients.
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