Six-minute walk work in patients with chronic obstructive pulmonary disease

Background:Six Minute Walk Test (6MWT) has demonstrated good reliability and validity as an assessment for exercise tolerance for moderate to severe COPD. 6MWD is a known to be a preferred outcome for this test; however, it does not account for differences in body weight that are known to influence exercise capacity.Aim of current study was to correlate of distance product (6MWWORK) with various variables in study group of patients with Chronic Obstructive Pulmonary Disease (COPD).Methods:Sixty patients of diagnosed COPD underwent pulmonary function test and 6MWT. Correlation coefficients were calculated for the 6-Min Walk Distance (6MWD) and 6MWORK with variables of pulmonary function and 6MWT.Results:The mean of 6MWD was 312.0 ± 21.2 meters and mean 6MWWORK was 31246 ± 2414 kg.m in the study population. 6MWD significantly correlated with age (r = 0.25), height (r = 0.42), body mass index (r = -0.32) and body weight (r = 0.48). 6MWORK yielded higher correlation coefficients than did 6MWD when correlated with FEV (r = 0.66 vs. 0.35), FEV1/FVC ratio (-0.46 vs. -0.24). The ROC curve demonstrated that 6MWORK had a significantly larger calculated area under the curve (P <0.05) than 6MWD with FEV1.Conclusion: 6MWWORK is an improved outcome of 6MWT to monitor functional capacity in patients of chronic obstructive pulmonary disease.

SUBCLINICAL SYSTOLIC DYSFUNCTION AMONG NEWLY DIAGNOSED HYPERTENSIVES WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION USING TWO DIMENSIONAL STRAIN IMAGING METHOD: HOSPITAL BASED OBSERVATIONAL STUDY

Background: Heart failure is the major cause of morbidity and mortality in hypertension. Early detection of sub- clinical systolic heart failure thus is an important step in prevention of clinical heart failure. There are limited studies evaluating the presence and determinants of subclinical heart failure along axial, circumferential and radial axis among hypertensives with normal Left Ventricular Ejection Fraction (LVEF) using strain imaging methods. Present study aimed to detect the subclinical global and regional systolic dysfunction in longitudinal, circumferential and radial axis and its determinants in hypertensive patients with normal LVEF. Material and Method: 2-dimensional echocardiographic (2DE) images of the Left Ventricle (LV) were acquired in apical 4-chamber and parasternal short-axis view at mid ventricular levels to assess global and regional strain in lon- gitudinal, radial and circumferential axis in 72 hypertensive patients with normal LVEF and 57 healthy controls us- ing speckle tracking method. LV Mass and LVEF were measured using 2D guided M Mode scan and diastolic func- tion was assessed in early diastole with tissue Doppler imaging. Results: The regional strain in longitudinal axis was significantly reduced at Apex and Apico lateral segment of LV in hypertensive population compared to normotensive group (-17.99± 5.21 Vs-19.77±4.17; p<0.01 and -14.78 ±5.69 Vs -17.40± 5.23; p<0.01) respectively. However the mean Global Longitudinal and circumferential systolic Strain was not significantly reduced in the hypertensive group when compared to the normotensive group. Conclusions: The regional LV systolic function in longitudinal axis at apex and apico lateral wall was significantly reduced while the global systolic function in longitudinal and circumferential axis was preserved in hypertensive patients compared to normotensive healthy individuals

EFFECT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON BODY COMPOSITION PARAMETERS AND EXERCISE CAPACITY BY COMPARISON WITH AGE MATCHED HEALTHY CONTROLS

Background & Objectives: Nutritional abnormalities are frequent systemic manifestation associated with COPD. The purpose of the present study was to compare the body composition parameters & exercise capacity between stable COPD patients and healthy controls, and to find the strength of association between exercise capacity, FMI and FFMI. Methods: 100 subjects were recruited, and divided into two groups. Group I included stable COPD patients, and Group II consisted of age matched healthy controls respectively. The spirometric parameters recorded were FEV1 (Litres), FVC (Litres), FEV1/FVC ratio (% predicted), FEF 25%75% (Litres/sec). Anthrometric measurements included Body Weight, Height and BMI measurements. Body composition was assessed by four-frequency bioelec- trical impedance analysis (BODY STAT, QUAD SCAN, USA). The following parameters were calculated: FFM, FFMI, FM and FMI. The exercise capacity was assessed by the six-minute walking distance test (6MWD). All the recordings were compared between groups and correlation was also computed between 6MWD, FMI & FFMI with- in groups. Results were analyzed using SPSS, version 16 & Pearson correlation coefficient. Results: We found that COPD patients showed lower FFM, FFMI & exercise capacity as compared to healthy con- trols. And, great strength of association was found between FFMI and exercise capacity. Conclusions: Thus, our study indicates that with COPD there is preferential loss of lean body mass evident from lower FFMI leading to decreased walking distance in these patients. Hence, it is prudent to include nutritional and exercise capacity assessment in patients of COPD, to better manage these patients and improve their quality of life.

Exercise-induced desaturation in patients with chronic obstructive pulmonary disease on six-minute walk test

Background and Objectives: Exercise-induced desaturation (EID) is associated with increased mortality in chronic obstructive pulmonary disease (COPD). However, the relationship of EID with anthropometric and clinical parameters of resting pulmonary function test and six-minute walk test (6MWT) in COPD remains unclear. The study was designed to assess the correlate of EID and to identify various possible predictors of EID in stable normoxemic patients of COPD. Materials and Methods: Sixty patients with stable COPD diagnosed and staged as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines underwent 6MWT. A drop in standard pulse oximetry (SpO 2 ) of ≥4% or nadir up to ≤88% was defined as EID. Based on EID during 6MWT, two groups were formed: desaturators (DS) and nondesaturators (NDS). DS and NDS were compared for baseline and clinical characters by the Student′s t-test while Pearson and Spearman rho correlation coefficient assessed strength of the association of anthropometric and clinical variables with EID. The predictors of EID were identified by logistic regression and receiver operator curve analysis. Result: Out of 60 patients with stable COPD, 33 patients desaturated on exercise (n = 33/60). DS had significantly lower values of FEV 1 (P < 0.001), FVC (P < 0.01) FEV 1 /FVC (P < 0.01) compared to NDS. EID had significant negative correlation with FEV 1 (r = 0.31, P < 0.01), resting oxygen saturation (r = 0.549, P < 0.001) and 6MWD (r = 0.511, P < 0.001). Resting SpO 2 ≤93% was found to a predictor of EID with a sensitivity and specificity of 83% and 78%, respectively. Interpretation and Conclusion: The 6MWT is a safe and sensitive test to recognize EID in normoxic stable COPD patients. Resting oxygen saturation is a good predictor of EID

Effect of pranayama as adjuvant to medical treatment on severity, frequency, and duration of headache in migraine patients: An open-label randomized controlled trial

Background: Migraine is the second leading cause of disability worldwide with high rates of dissatisfaction for allopathic treatment among patients. Pranayama is an easy, convenient, and cost-effective method that can supplement existing standard medical treatment of migraine. Objective: To study the effect of pranayama as an adjuvant to standard medical treatment of migraine on clinical outcome variables of migraine. Materials and Methods: This was a randomized controlled trial conducted on 80 consecutive migraine patients who were diagnosed as per International Classification of Headache Disorders-3 (ICHD-3) criteria and were randomly allocated into two groups, that is, standard medical treatment (SMT) group and standard medical treatment plus pranayama (SMT + P) group. The effect of pranayama on clinical outcome variables of migraine was evaluated by using standardized questionnaires. The data was statistically analyzed using SPSS Statistics 20 software. A P value of ≤0.05 was considered statistically significant. Results: Intragroup analysis showed all clinical outcome variables of migraine reduced significantly in the SMT + P group whereas all clinical outcome variables of migraine except the duration of headache episodes reduced significantly in the SMT group. Although statistically non-significant, intergroup analysis demonstrates that reduction in headache severity, duration of headache episodes, and headache impact test-6 (HIT-6) score was more in the SMT + P group whereas reduction in headache frequency and migraine disability assessment (MIDAS) score was more in the SMT group. Conclusion: Pranayama supplements the standard medical treatment of migraine by reducing the duration of headache episodes in addition to the reduction in headache severity, headache frequency, HIT-6 scores, and MIDAS scores

STUDY THE FREQUENCY OF ANAEMIA IN PATIENTS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ITS IMPACT ON HEALTH RELATED QUALITY OF LIFE

  Background & Objectives:  Anemia is a common co-existing entity in numerous chronic diseases like COPD, but has little published evidence stating its association with this disease. The effect of COPD on the health related quality of life and mortality in COPD patients, also remains least explored. The recent studies have suggested that anemia in patients with COPD has a frequent prevalence ranging from 7.5% to 34%. This data indicate towards the necessity of knowing the real prevalence and clinical impact of Anaemia of Chronic Disease in COPD and how does it affect their Health Related Quality of Life. Methods: This study was conducted on all consecutive stable COPD patients and related data was recorded. The St George Respiratory Questionnare (SGRQ) and the BODE index (Body Mass Index, FEV1, Dyspnoea, Exercise Capacity) was used to analyze the Health Related Quality of Life and the morbidity level of included patients. Results: 32 COPD patients had anaemia. The analysis showed significantly higher symptom score in the anaemic COPD patients (p=0.04). Also anaemics had significantly lesser BMI (p=0.03), significantly poor dyspnoea score (p=0.05) and significantly lesser six minute walk distance (p=0.05). Conclusions: The prevalence of anaemia in stable COPD patients is 32%, which is significantly associated with low BMI, dyspnoea and reduced exercise capacity. These factors can affect the quality of life of COPD patients thus, leading to increased morbidity. Hence, treating anaemia should hold a special place in treatment regime for COPD