CD14 C-159T polymorphism and its association with chronic lung diseases: A pilot study on isocyanate exposed population of Central India.

CONTEXT: CD14 functions as a multifunctional receptor for bacterial cell wall components including endotoxin and lipopolysaccharide and is likely to influence the cytokine profile and subsequent immunoglobulin E production in response to antigen/allergen contact in allergic phenotypes. AIMS: The present study was to investigate genetic polymorphism in CD14 gene - 159C/T, which may be one of the risk factor for increased prevalence of Chronic Lung Diseases in the Central India. SETTINGS AND DESIGN: Survivors of Methyl isocyanates toxicity in Bhopal still suffering from various respiratory ailments were examined. MATERIALS AND METHODS: Polymerase chain reaction-restriction fragment length polymorphism was performed to determine the polymorphism of C-159T. RESULTS: The genotype and allelic frequencies were in Hardy-Weinberg’s equilibrium. Prevalence of CC, CT, and TT were 5.5%, 22.2% and 9.25% respectively in asthmatics; 16.6%, 20.3% and 5.5% respectively in chronic obstructive pulmonary disease (COPD) patients and 5.5%, 14.8% and 1.85 respectively among interstitial lung disorder (ILD) patients; whereas the control cohort with no methyl isocyanate exposure displayed (CC, CT, and TT) cytosine, thymine as 2%, 1.6% and 2% respectively. Increased risk of Asthma among those carrying TT genotype and T allele (odds ratio [OR] =2.61 and 2.02 respectively). CONCLUSION: COPD risk significantly found among those with CC genotype and C allele (OR = 2.81 and 1.50 respectively), whereas ILD risk found significantly among CT genotype and C allele (OR = 1.75 and 1.40 respectively). Therefore, single nucleotide polymorphism (SNP) C-159T polymorphism in CD14 gene might be a risk factor for development of CLD in this population.

Body mass index among patient with chronic obstructive pulmonary diseases.

Body mass index (BMI) is one of the important parameter to assess functional status of patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of present study was to assess the prevalence of underweight among clinically stable COPD patients and relationship of BMI with increasing severity of COPD. COPD was defined as a subject who had post-bronchodilator FEV1/FVC < lower limit of normal, age more than 40 years and either current or ex smoker. Spirometry data of 7412 subjects were retrospectively analyzed and 1269 COPD patients and 1202 bronchial asthma patients were identified. The severity of airflow obstruction was classified as per GOLD guideline. The BMI of each patient was calculated from weight and height. The BMI of COPD patients were compared with bronchial asthma. The average BMI of COPD patients and bronchial asthma patients were 20.2±4.3 kg/m2 and 23.2±5.4 kg/m2 respectively. Overall, 38 % COPD patients were underweight (BMI<18.5 kg/m2) and irrespective of severity of the disease, proportion of underweight COPD patient was significantly more as compared to bronchial asthma patients (P<0.001). The mean BMI also reduces significantly with progression of COPD severity.

Multi-antigen and antibody assays (Seva TB Elisa) for the diagnosis of tuberculous pleural effusion.

Objective: Prospective evaluation of inhouse developed SEVA TB ELISA using cocktail of Mycobacterial antigens ES-31 and EST-6(containing ES-38 and ES-41) and their specific antibodies in the diagnosis of Tuberculous pleural effusion was done in a tertiary care hospital. Methods: Detection of circulating free and immune-complexed (IC) antigens and antibody by sandwich and indirect peroxidase ELISA respectively was done in pleural fluid and sera specimens. Total 33 patients with pleural effusion, including 24 patients diagnosed as tuberculous pleural effusion based on clinico-radiological, microbiological and biochemical profile (protein, LDH and ADA) of pleural effusion and nine patients with non-tuberculous pleural effusion, were studied. Results: Pleural fluid showing either antigen or immune-complexed antigen or antibody positive was considered as ELISA positive for tuberculous pleural effusion. Multi antigen and antibody assay (SEVATB ELISA) showed 100% specificity and 83% sensitivity in pleural fluid while 78% specificity and 92% sensitivity in serum of tuberculous pleuritis patients. Conclusion: This study showed usefulness of SEVATB ELISA, using cocktail of ES-31 and EST-6 antigens and their antibodies for antibody and antigen detection respectively in analysis of either sera or pleural fluid samples of suspected tuberculous pleuritis patients as an adjunct test to clinical diagnosis.

Retrospective analysis of lung function abnormalities of Bhopal gas tragedy affected population.

Background & objectives: A large numbers of subjects were exposed to the aerosol of methyl isocyanate (MIC) during Bhopal gas disaster and lung was one of the most commonly affected organs. The aim of the present study was to analyze retrospectively the lung function abnormalities among the surviving MIC exposed population (gas victims) and to compare it with the non-MIC exposed (non gas exposed) population. Methods: The spirometry data of both gas victims and non gas exposed population who attended the Bhopal Memorial Hospital & Research Centre for evaluation of their respiratory complaints from August 2001 to December 2009, were retrospectively evaluated and compared. Results: A total 4782 gas victims and 1190 non gas exposed individuals performed spirometry during the study period. Among the gas victims, obstructive pattern was the commonest (50.8%) spirometric abnormality followed by restrictive pattern (13.3%). The increased relative risk of developing restrictive abnormality among gas victims was observed in 20-29 yr age group only (adjusted relative risk: 2.94, P<0.001). Male gas victims were more affected by severe airflow obstruction than females and the overall increased relative risk (1.33 to 1.45, P<0.001) of developing obstructive pattern among gas victims was observed. Interpretation & conclusions: The present study showed that the relative risk for pulmonary function abnormalities in gas victims was significantly more among those who were young at the time of disaster. Increased smoking habit among gas victims might have played an additive effect on predominance of obstructive pattern in spirometry.

Assessment of severity of methaemoglobinemia following fibreoptic bronchoscopy with lidocaine.

Background. Lidocaine is commonly used for topical anaesthesia during fibreoptic bronchoscopy (FOB) and it can cause methaemoglobinemia. The present study was undertaken to evaluate the severity of post-bronchoscopy methaemoglobinemia while using lidocaine as a topical anaesthetic agent. Methods. We prospectively studied consecutive adult patients who underwent diagnostic FOB in our institution. Blood methaemoglobin levels were estimated by co-oximetry before bronchoscopy and one hour after first instillation of lidocaine. Occurrence of symptoms suggestive of mild methaemoglobinemia (i.e., fatigue, palpitation, dizziness, nausea and headache) were recorded in a severity scale before collection of post-bronchoscopy blood samples. Results. A total of 48 adult patients were enrolled in this study. The mean amount of lidocaine used for bronchoscopy during this study was 7.4±1.4mg/kg body weight. The mean pre- and post-bronchoscopy methaemoglobin levels were 0.44mg/mL and 0.80mg/mL, respectively. After bronchoscopy, severe and very severe symptoms were reported by 2.1% to 10.4% patients. However, severities of the symptoms were unrelated to post-bronchoscopy methaemoglobin level or the amount of lidocaine used during the FOB. Conclusions. Blood methaemoglobin levels following FOB remained within the physiological limits when British Thoracic Society recommended dose of lidocaine was used. However, few patients had symptoms similar to mild methaemoglobinemia after FOB.

Prevalence of depression in stable chronic obstructive pulmonary disease.

Background. Psychological impairment is a significant co-morbid condition of chronic obstructive pulmonary disease (COPD). No studies from India have been conducted to assess the prevalence of depression in COPD. Methods. We investigated the prevalence of depression in 100 consecutive stable COPD patients during their routine outpatient department visits. Patients diagnosed to have depression or chronic systemic diseases were excluded. Severity of the COPD was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Hindi translations of patient health questionnaire-9 (PHQ-9) were administered and severity of depression was assessed at each stage of the COPD. Results. All subjects were males with a mean age of 61.7±9.6 years. Six patients in stage I, 32 patients in stage II, 40 patients in stage III and 22 patients in stage IV of the COPD were enrolled. The cumulative prevalence of depression in the study population was 72 percent. Conclusions. Symptoms of depression were observed at all stages of COPD and its severity increased with an increase in severity of the COPD. High prevalence of depressive symptoms in Indian patients with COPD may be due to various confounding factors. Screening for symptoms of depression in patients with COPD by simple and quick validated questionnaires during their out-patient visits will be helpful in early diagnosis and appropriate treatment or referral.

Clinical significance of hilar thoracic index and width of right descending branch of pulmonary artery in chronic obstructive pulmonary disease.

BACKGROUND: Clinical recognition of pulmonary artery hypertension (PAH) is a major challenge in the management of COPD. Increased hilar-thoracic (HT) index and width of the descending branch of the right pulmonary artery (DRPA) measured on a plain PA chest radiograph have been shown to have a good correlation with pulmonary arterial pressures (PAP) measured by right-heart catheterization. Color Doppler echocardiography has evolved as a noninvasive method to estimate PAP. In the absence of information of the relationship between these radiological signs and PAP measured using this technique, we carried out the present study from an out patient unit of a tertiary care hospital. METHODS: Spirometry, arterial blood gas analysis and color Doppler echocardiography to estimate systolic and mean PAP were carried out in fifty patients with COPD. HT index and width of the DRPA were measured on a plain PA chest radiograph. RESULTS: The mean values and the proportions of patients with increased HT index (> 35%) and increased width of the DRPA (20 mm or more) increased with increasing severity of the disease. Both the indices had significant correlations with FEV1% predicted, arterial PO2, arterial PCO2 and the systolic pulmonary artery pressure, and, in the case of the HT index, also with the mean pulmonary arterial pressure. The two radiological indices were highly correlated with each other. Increased HT index and increased width of the DRPA had a 100% specificity and predictive value positive (PVP) in identifying patients with pulmonary hypertension. However, sensitivity and predictive value negative (PVN) were low. CONCLUSION: It was concluded that the HT index and width of the DRPA are useful and clinically valid measurements in patients with COPD.