Six-minute walk test for assessment of work capability in patients with chronic obstructive pulmonary disease: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is a systemic disorder causing morbidity, disability, and mortality throughout the world. Although, spirometry parameters have been used for decades to diagnose COPD as well as to grade the severity of this disease, others factors such as the BMI, degree of inflation, and exercise capacity have become important outcome measures for extra-pulmonary manifestations. The 6-min walk test (6MWT) is considered as a simple test to assess the functional capacity of COPD patients. The aim of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Aims and Objectives: The objective of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Materials and Methods: A cross-sectional comparative study was conducted on thirty COPD patients and thirty control subjects. All the subjects were investigated through history taking, clinical examination, spirometry, and 6MWT in the Department of Physiology, R.G. Kar Medical College and Hospital, Kolkata. Statistical analysis was done by SPSS version-21. Results: The values of the spirometry parameters were significantly reduced in cases than in the controls (P < 0.05). The values of 6-min walk distance as well as 6-min work (6MWORK) were also significantly reduced in cases than in the controls (P = 0.0023 and P = 0.0028, respectively). A strong positive correlation was found between forced vital capacity and 6MWORK (r = 0.556), BMI, and 6MWORK (r = 0.84) in patients of COPD. Conclusion: Our study substantiates that 6MWT can be implemented in our set up to assess the work capability and thus to predict morbidity in patients of COPD.

Genetic, Epigenetic, and Molecular Biology of Obesity: From Pathology to Therapeutics the Way Forward

Obesity is a globally expanding silent epidemic having multiple risk factors and consequences associated with it. Genetic factors have been found to be playing undeniable roles in obesity. Intermingled relationship between epigenetics, metagenomics, and the environment influences obesity traits. High precision diagnostic tools have outlined many single nucleotide polymorphisms (SNPs), as well as many novel genes, that have been identified that create an obesogenic environment. Rare single-gene diseases can lead to early childhood obesity and less satiety. With almost 30% of the global population being under the grip of obesity, the coming days are alarming. This review summarizes the existing knowledge on the genetic causes of obesity including the epidemiology as well as the issues of concern and new additions to the list. Furthermore, we discuss the ways to enhance the healthcare outcome for patients of obesity through interdepartmental collaborations apart from pharmacological therapy that is still limited to a few drugs. The teamwork of geneticists, genetic counselors, physicians, bariatric surgeons, nurses, endocrinologists, and pharmacists may provide promising results in intervention.

Procurement, storage and utilization trends of eye banks in India

Purpose: To study the trends in collection, storage and utilization of donor corneas in eye banks in India. Methods: The data was collected from 12 eye banks in India that collected more than 1000 corneas per year. The retrospective analysis of the parameters like characteristics of the donor and the host, storage media used, number of eyes collected, number of eyes utilized, causes of non-utilization of the tissue and the procedures performed was done. Results: A total of 20,564 eyes were collected by the 12 eye banks during the year 2013–2014. Voluntary eye donation (VED), and hospital cornea retrieval program (HCRP) contributed to 59.6% and 40.4% of tissue procurement respectively. Whole globe enucleation (52.3%) was more commonly performed as compared to in-situ excision of the donor corneas. The most commonly used storage media at all eye banks was McCarey-Kaufman (MK) media (83.3%). The utilization rate of the donor eyes was 50.5%. The most frequent indication for corneal transplantation was infection (active infection - 33.13%, healed infection - 10.78%) followed by Pseudophakic bullous keratopathy (PBK) (13.57%). Full thickness keratoplasty (optical penetrating keratoplasty - 47.23%, therapeutic penetrating keratoplasty - 31.74%) was performed most often followed by endothelial keratoplasty (12.41%) in the developing country. Conclusion: VED still contributes to majority of the donor tissue retrieval in India. The majority of the eye banks still utilize whole globe enucleation technique and store tissues in MK media. Trends from previous years showed a change towards HCRP, in-situ excision technique and preservation in the long-term storage media.

Evaluation of Efficacy and Tolerability of Perindopril 8 mg in Bangladeshi Hypertensive Patients: Results from an Open-label, Observational, Multi-center Study (CONTROL).

Background: The CONTROL (COversyl in Newly diagnosed stage-II & unconTROlled hypertensive patients triaL) was performed with an objective to evaluate the blood pressure (BP) lowering efficacy and tolerability of Perindopril 8mg in newly diagnosed stage II patients and uncontrolled hypertensive patients among Bangladeshi population. Methods: This was an open-label, observational, multi-center study conducted in consultation centers for out-patients located in different cities of Bangladesh. Adults, aged above 18 years with newly diagnosed stage-II hypertension or uncontrolled hypertension, were recruited. Patients were treated with Perindopril 4mg daily for first 1 week, afterwards uptitrated to Perindopril 8 mg daily and continued treatment for 12 weeks. Patients were followed-up at week-1, week-4, week-8 and week-12. Results: In total, 245 patients were enrolled. Among them, 88 were newly diagnosed stage-II (Group- I) and 157 were uncontrolled (Group-II) hypertensive patients. Male and female distribution was 57% and 43% respectively. Mean age of patients was 54.5 ±11.7 years. After 12 weeks treatment, there was a significant reduction in BP from baseline (p<0.001) in overall population as well as in Group I and in Group II. In overall population, the mean BP reduction was -31/-15 mmHg (from 163.7/96.8 mmHg to 132.4/81.7 mmHg. In Group I, the reduction was -33/-16 mmHg (from 166.5/98.2 mmHg to 133.4/82.0 mmHg) and in Group II, -30/-14 mmHg (from 159.3/ 95.6 mmHg to 129.1/81.6 mmHg). 10 patients (4.1%) had to discontinue the treatment due to adverse effects. Dry cough (2%) and hypotension (1.2%) were the main cause of discontinuation. Perindopril 8mg was well tolerated as indicated by the high proportion of physicians (81%) reporting ‘good’ to ‘excellent’ tolerability at week 12. Conclusion: This study suggests that Perindopril 8mg is effective and safe in the treatment of hypertension in Bangladeshi patients.

Renal pathological changes in poisonous snake bite.

There are more than 3000 species of snakes in the world but only about 350 are venomous. With approximately 10000 deaths occurring annually in India, a large proportion of snake bites occur when people work barefoot in the fields or while walking at night or early morning through fields or along roads. Although, nearly all snakes with medical relevance can induce nephropathy, leading to Acute Renal Failure (ARF), it is unusual except with bites by Russell‟s Viper, E. Carinatus and members of the genera Crotalus and Bothrops. In India, ARF is mostly associated with Russell‟s Viper and E. Carinatus bites. The incidence of ARF following Russell‟s Viper or E. Carinatus bites is 13-32% in India. A histopathological study was conducted on renal autopsy specimens from those subjects who were admitted to IPGME&R and SNP Hospital, Kolkata as a result of development of acute renal failure following poisonous snake bite. Acute tubular necrosis (100%) and Acute cortical necrosis (25%) were the most significant renal histopathological changes. Glomerular lesions were also present in 30% of cases.

A partial sequence of lipoxygenase gene from genomic DNA of aromatic rice (Oryza sativa L.).

Aromatic (Bas-370, PB-1) and non-aromatic (Pusa-677, Pusa-834) rice were selected for the characterization and for distribution of lipoxygenase (Lox) genes. Polymorphism was observed when genomic DNA of rice varieties was hybridized with a heterologous lipoxygenase probe. A distinct polymorphic fragment (approximately 1.2 kb) was found in Bas-370. Sub-genomic library of Bas-370 was constructed and screened with LoxA probe. The smallest putative clone (pBas-14) of approximately 1.2 kb was sequenced. Complete nucleotide and deduced amino acid sequence showed the clone was 1134 bp long and comprised of 378 amino acid residues. PCR amplification of genomic DNA from four rice varieties with a soybean Lox primer also showed a polymorphic fragment of size approximately 600 bp (amplicon) in aromatic varieties that was sequenced directly. Nucleotide sequence alignment between pBas-14 and amplicon concluded that the amplicon was a part of the insert pBas-14.

Structural perturbation of proteins in low denaturant concentrations.

The presence of very low concentrations of the widely used chemical denaturants, guanidinium chloride and urea, induce changes in the tertiary structure of proteins. We have presented results on such changes in four structurally unrelated proteins to show that such structural perturbations are common irrespective of their origin. Data representative of such structural changes are shown for the monomeric globular proteins such as horseradish peroxidase (HRP) from a plant, human serum albumin (HSA) and prothrombin from ovine blood serum, and for the membrane-associated, worm-like elongated protein, spectrin, from ovine erythrocytes. Structural alterations in these proteins were reflected in quenching studies of tryptophan fluorescence using the widely used quencher acrylamide. Stern-Volmer quenching constants measured in presence of the denaturants, even at concentrations below 100 mM, were higher than those measured in absence of the denaturants. Both steady-state and time-resolved fluorescence emission properties of tryptophan and of the extrinsic probe PRODAN were used for monitoring conformational changes in the proteins in presence of different low concentrations of the denaturants. These results are consistent with earlier studies from our laboratory indicating structural perturbations in proteins at the tertiary level, keeping their native-like secondary structure and their biological activity more or less intact.

Unilateral pellucid marginal degeneration.

Pellucid marginal degeneration (PMD) is a rare and usually a bilateral condition. We report a case of typical PMD with a unilateral presentation.

Immunodiagnosis of human hydatid disease.

A study was undertaken to evaluate the efficacy of Enzyme Linked Immunosorbent Assay using locally prepared antigens for immunodiagnosis of human hydatid disease. A total of 90 cases clinically suspected to be suffering from hydatid disease and 100 controls matched for age and sex were included in the study. Two types of ELISA were performed on detected specific antihydatid antibodies belonging to IgG/IgM/IgA classes and other type detected IgE class of antibodies. Antigen prepared from the human hydatid fluid was found to be unsuitable for diagnosis as it contained host proteins i.e. IgG. Sheep hydatid fluid obtained from the fertile hydatid cyst was used to prepare and standardize the antigen. ELISA test to detect anti hydatid antibodies belonging to either IgG, IgM and or IgA was found to be highly specific (98 per cent) in surgically confirmed hydatid disease and was negative in all the controls. The results of the study indicate that ELISA along with casoni test may provide the best results in diagnosis of hydatid disease.

Study of myopathies by histological and histochemical methods with special reference to staining for desmin expression.

An attempt was made to study the histological and histochemical changes as well as immunohistochemical changes in desmin expression occurring in four types of clinical myopathies e.g. Chronic ischaemic myopathy due to Buerger's disease (Group I), Carcinomatous myopathy (Group II), Metabolic myopathy (Group III) and Muscular dystrophy (Group IV). The number of cases studied were 16 cases, 15 cases, 4 cases and 5 cases respectively. The study revealed: (i) a combination of normal, degenerated, necrotic and regenerating fibres in different proportions in all the four groups having maximum number of degenerated fibres in Group I and Group IV, relatively more number of regenerating fibres in groups III and absence of necrotic fibres in Group I. (ii) Altered tinctorial property in most of the fibres indicating degenerated and regenerating fibres in all the groups with Masson's trichrome staining against inconstant staining with PTAH appear to be a good indicator for myopathy. (iii) The Desmin expression was week and irregular in most of the cases with most of the fibres probably due to reduction of desmin content probably indicating degenerated fibres, appear to be a good indicator for myopathy. (iv) Chronic ischaemic myopathy showed close resemblance with muscular dystrophy though no typical or distinct distinguishing feature could be identified in these four groups.

Epidemiology of group-A streptococcal infection amongst children of different ethnic groups in Darjeeling.

The carrier rate of Group A Streptococcus (GAS) was studied amongst 932 children from 1+ upto 12 years of age in three major racial groups in the foothills of the Darjeeling district of West Bengal. It was altogether 13 per cent and was found to be evenly distributed in the three ethnic groups as Gurkhas: 11 per cent, Rajbanshis: 15 per cent and Cosmopolitans: 13 per cent, but the incidence of Rheumatic fever and/or Rheumatic heart diseases were unnoticed among the Gurkha children who also had significant low ASO titres.

Transferable drug resistance in Salmonella typhi strains isolated from an outbreak at Calcutta in the recent past.

Transferable drug resistance, phage type, biotype and minimum inhibitory concentration to different drugs were studied in 50 Salmonella typhi strains isolated during recent outbreak of enteric fever at Calcutta. The antibiotic sensitivity test showed that 44% strains were sensitive to multiple drugs including chloramphenicol. The minimum inhibitory concentrations of the drugs tested were well above the normal level. The transferable drug resistance test suggested that all the resistant strains were carrying transferable multidrug resistant gene containing ampicillin, chloramphenicol, streptomycin, tetracycline resistance factor. From phage typing it was observed that 30% strains belonging to phage type 51, and among them 80% strains were carrying transferable drug resistant factor containing ampicillin, chloramphenicol, streptomycin and tetracycline.

A study of immune profile in human hydatid diseases.

A clinico haematological and immunological study was undertaken in 90 patients clinically suspected to be suffering from hydatid disease over a period of 1 year. The parameters studied included age of presentation, site of cyst localisation, haematological profile, total immunoglobins of different classes (IgG, IgM, IgA & IgE) and complement component C3, rosette forming lymphocytes, blast cell formation in response to phytohaemagglutinin (PHA-P) and concanavalin A (Con-A) and casoni test using standard methods. Twenty two out of 90 (22.44%) clinically suspected patients were surgically confirmed as hydatid disease cases. Hydatid disease occured in all age groups. Youngest case was 8 years and oldest 70 years. In 17/22 cases the cyst localised in the liver followed by lungs (3) neck (1) and kidney (1). Majority of patients (63.65%) belonged to blood group B. The mean total leucocyte and eosinophill counts were raised significantly (p < 0.001 and p < 0.05, respectively) in confirmed patients. The mean ESR value was raised in hydatid patients though, not significantly (P > 0.08). All the four classes of immunoglobulins viz. IgG, IgA, IgM, IgE and complement C3 were significantly raised in patients of hydatid disease compared to controls (P < 0.001, P < 0.002, p < 0.01 and p < 0.01, P < 0.02 respectively). The percentage of lymphocytes in peripheral blood in hydatid patients was reduced though, not significantly (P > 0.2). The absolute lymphocyte count was raised and mean percentage of T cells was reduced in patients with hydatid disease (P < 0.001 and P < 0.001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Serological study of human toxoplasmosis in Calcutta.

A total of 248 randomly selected subjects from urban, semiurban and rural areas of Calcutta was studied serologically for the prevalence of antibody to Toxoplasma gondii using latex agglutination technique. Fifty-nine (23.79%) out of these 248 subjects were found to possess anti-toxoplasma antibody. Seropositivity was found to be higher in females (25%) as compared to males (22.32%). Agewise highest positivity (30.5%) for toxoplasma antibody was observed in the third decade and lowest in the first decade of life, though all the age groups were involved by this protozoal infection. Sexwise distribution of anti-toxoplasma antibody showed highest positivity rate in the third decade in males and in the fourth decade in females. Twenty-five per cent of the subjects had history of contact with cat and/or soil and most of the subjects belonged to the middle and low income groups.

Leukaemoid reaction in diarrhoeal diseases.

There was an outbreak of diarrhoea/dysentery in Naxalbari, North Bengal in August-September of 1992. Ninety-seven cases were investigated. Bacterial pathogens were isolated from stools of 17 cases and the organisms were Salmonella typhimurium (76%), Salmonella enteritidis (12%) and Shigella dysenteriae type 1(12%). A leukaemoid reaction was observed in 4 cases (24%) amongst all 17 patients and they were all children.

Bacteriology of wound infection: evaluation by surface swab and quantitative full thickness wound biopsy culture.

A total of 171 cases of wounds of various aetiology were examined and screened bacteriologically for evidence of infection by surface swab culture and quantitative full thickness wound biopsy culture techniques. Staphylococcus pyogenes was the most frequently isolated (39.9%) single organism. Other organisms being Escherichia coli (26.1%), Pseudomonas aeruginosa (15.4%), klebsiella species (5.8%), Streptococcus pyogenes (4.9%), proteus species (4.8%) and coliform organism (3.1%). Collectively the Gram-negative organisms were the majority among the isolated organisms. As indicator of wound infection, surface swab culture was found to be reliable in 72% cases when correlated with wound biopsy culture. The latter technique was found to be more consistently valuable (in 95% cases) both for regular assessment of the wounds as well as to judge the response to treatment.

Aetiological studies on hospital inpatients with secretory diarrhoea in Calcutta.

Twenty-five cases of all age groups with secretory diarrhoea admitted to the Infectious Diseases Hospital, Calcutta were studied. Bacterial enteropathogens were detected by bacteriological examination of the faeces, in each and every case. The main pathogens detected were Escherichia coli and Vibrio cholerae. V cholerae was more commonly associated with severe illness except in the very young, while Esch coli was equally associated with moderate and severe illness. Multiple isolates were more commonly associated with severe illness and single isolates were more common in illness of moderate severity.