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.
Introduction: Idiopathic interstitial pulmonary fibrosis is an important debilitating disease among the interstitial lung diseases, frequently diagnosed with the help of HRCT among the symptomatics. Materials and Methods: We have studied a total of 48 cases of IPF over a span of two and half years. Among a total of 104 ILDs attending our tertiary care centre IPF constituted 48 cases accounting for 46%. IPF cases are diagnosed on the basis of clinical history and hRCT findings. Results: There is a female preponderance of 1.4:1. Mean age of IPF patients in our study is 57.9 years. Mean age in females is 60.71 and 53.9 in males.Among our 48 cases of radiologically diagnosed IPF forty patients had definite UIP Pattern and 8 patients have possible UIP pattern as defined by the radiologist. The frequency of difinite IPF cases increased with severity of symptoms as measured by MMRC scale and the association is statistically significant. More than 90% of patients expressed tiresomeness and breathlessness. Cough was seen in 60% and pain chest was found in 45% of IPF patients. There is a statistically significant correlation of disease severity measured by MMRC scale with decrease in DLCO. BAL fluid lavage showed predominant neutrophils in >90% of IPF patients. Severity of IPF measured by MMRC correlated with decrease in 6 minute walk distance(p<0.05). There is a statistically significant correlation with MMRC grade and percentage desaturatiion in 6 minute walk test.(p<.05). All the patients of IPF in our study had pulmonary arterial hypertension. The severity of PAH has no statististically significant correlation with severity of IPF as measured by MMRC grade of breathlessness. By spirometry 62.5% of IPF patients had restrictive lung disease and 29% had combined obstructive and restrictive lung disease. There is no statistically significant correlation between the severity of IPF as measured by MMRC scale with severity of restriction measured by FVC percentage. Summary and Conclusion:Idiopathic interstitial pulmonary fibrosis is a debilitating disease. Constitutes significant proportion of ILDs. Females outnumbered males. Tiresomeness and breathlessness are predominat symptoms. Disease occurred at a much earlier age in males. Active and passive smoking possibly contributes to the severity of IPF. MMRC grade correlates significantly with DLCO, 6 minute walk distance and definite UIP. There is no statistically significant correlation of MMRC grade with severity of PAH and FVC values.
Background: A total of 10682 patients were admitted in our tertiary care COVID hospital from April 2020 to January 2021. 419 patients died with a mortality rate of 3.92%. We have analysed 241 deaths that have taken place till 10 th September 2020. Methodology: We studied the history, symptomatology, HRCT chest, comorbidities, duration of hospital stay and special drugs administered along with the type of oxygen therapy. Results: 88% of patients have more than 30% lung burden by HRCT. All the patients have a CO-RADS score of 4 or more. 81% of the patients have CT severity index of 15/25 or more. The CO-RADS classification is a standardized reporting system for patients with suspected COVID-19 infection developed for a moderate to high prevalence setting. 71% of patients expired within first five days of admission. 23% of patients died in 5 to 10 days of admission. 80% of patients presenting with < 80% SPO 2 died in first five days. 77% of patients have single or multiple comorbidities. 23% of patients did not have any comorbidities. 34% of patients gave history of alcohol intake 41.9% have history of smoking. 38% of patients gave past history of lung disease. Shortness of breath, generalized weakness and cough were the common symptoms. Loss of smell was seen in 22% and loss of taste was seen in 25%. 81% of patients had more than 5 days of symptoms before admission. 19% had less than 5 days of symptoms. 73% of patients presented with Modified Medical research Council Scale Grade 3 or 4 breathlessness. Patients required oxygen in multiple forms. Only 5% of patients were put on mechanical ventilator. Remdesivir was given in 96% of patients. Anti IL6 Tocilizumab was given in 25%. Plasma therapy was given in 5%. Conclusions: Patients dying of COVID-19 disease had significant CT scan changes suggestive of corona disease. Past history of lung disease was seen in only a third. Shortness of breath was the commonest symptom and majority of the patients presented with SPO 2 of <90% and moderate to severe breathlessness.
BACKGROUNDInfective endocarditis (IE) is an infection of the endocardial surface of the heart structures, and is caused by the microbial bacterial organisms and fungal infection that occurs as a result of colonisation of the endothelium by microorganisms. The following study intended to evaluate the echocardiographic features of infective endocarditis on immunocompromised patients.
BACKGROUNDAmong the multiple causes of haemoptysis, active tuberculosis (TB), chronic inflammatory lung diseases due to bronchiectasis, aspergilloma within a chronic sarcoid or tuberculous cavity are the most common cause of haemoptysis in developing countries. Several diseases increase the risk of tuberculosis causing increased morbidity and mortality among these patients.The following study was intended to evaluate the role of comorbid risk factors in bronchial artery embolisation (BAE) for managing haemoptysis.
BACKGROUND Pterygium is a very common cause of visual disturbance and is treatable surgically. It is treatable by conjunctival autograft. The autograft can be sutured or can be fixed with glue or autoserum. In this study, we have compared the procedure of suturing of conjunctival autograft and sutureless autoserum procedure after the excision of pterygium. MATERIALS AND METHODS We have studied 100 patients of primary pterygium attending the outpatient department of tertiary care centre for treatment of primary pterygium, during the period from November 2015 to October 2017 with the approval of ethical committee of Katuri Medical College, Guntur. We have allocated these patients in to two groups. Group I patients numbering 50 underwent pterygium excision with limbal conjunctival autograft and the auto graft was secured with autologous serum. Group 2 patients numbering 50 had conjunctival autograft secured by sutures. Patients were examined on the first postoperative day and at the end of 1st week, 6th week and 12th week post operatively. RESULTS Eighty percent of the patients in both groups were in the age group of 31 to 60. 78% of patients of pterygium are females. Nearly half of the patients had Grade T2 Pterygium. Most of the patients in both the groups had wide based pterygia. The mean duration of surgery in Group 2 (28.34 minutes) was found to be longer than that of Group 1 (18.68 minutes), Pain and foreign body sensation were lesser throughout the follow-up period and disappeared more rapidly in Group 1 compared to Group 2, and the difference was found to be statistically significant (p<0.001). There was no difference in graft oedema between the two groups (p>0.05). There was no evidence of recurrence in both the groups, during the period of follow-up. CONCLUSION Both conjunctival autografting with autologous serum and with sutures are safe with low recurrence but autografting group has lesser symptoms and duration of surgery is shorter with autologous serum group. Graft displacement and graft retraction were equal in both the groups
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