Pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD). Usually ABSTRACT Background: Pulmonary hypertension (PH) secondary to chronic obstructive pulmonary disease (COPD) has a prevalence from 20 to 91% depending on the definition of PH (mPAP >20 versus >25 mmHg). Pulmonary vasoconstriction, pulmonary vascular remodeling, endothelial dysfunction, inflammation and destruction of the pulmonary vascular bed being the common mechanisms behind. Transthoracic echocardiograms (TTE) though the most important non-invasive tool to measure degree of PH, may give false negative results in severe COPD cases due to poor echo window. This could be overcome by doing transesophageal echocardiograms (TEE) in those cases, which is, though invasive but gives good results. The aim of the study was to evaluate the role of transesophageal echocardiography in COPD patients. Methods: Total 100 patients of COPD were evaluated for PH via TTE and TEE was performed in all those 33 patients whose TTE were non-confirmatory due to poor echo window. Results: There were 0% patient with poor echo window in COPD grade 1, 18.18% in grade 2, 42.2% and 39.39% in grade 3 and grade 4 respectively. P-value obtained was statistically significant P <0.001. Out of 33 COPD patients with poor echo window, In grade 3 and grade 4, 64.2% and 76.9% patients had TEE findings respectively while in grade1 and grade 2 0% and 33.33% patient had TEE finding. Conclusions: TTE though is an excellent tool for diagnosing pulmonary artery hypertension in COPD patients, has its limitation especially in severe COPD cases due to poor echo window which may give false negative results. So TEE should be recommended in all those severe COPD cases that have poor echo window.

Patient with COPD carry increased risk of morbidity and mortality due to pulmonary artery hypertension, corpulmonale, cardiac arrhythmias, congestive heart failure and pulmonary embolism. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes secondary to severe COPD. AIM: To evaluate right ventricular dysfunction and pulmonary artery hypertension secondary to COPD severity as per GOLD guidelines by Electrocardiogram and Echocardiography. MATERIAL AND METHODS: A total 80 of patients of COPD were selected and graded as per GOLD guidelines by spirometry and evaluated by ECG and Echocardiography. RESULT: ECG and Echocardiographic evaluation reveal a direct correlation between cardiac changes and COPD severity. Presence of P pulmonale was seen in 16/34 (47%) in moderate COPD patients, 20/26 (76.9%) in severe COPD patients and 11/12 (91.6%) in very severe COPD patients. The frequencies of Pulmonary artery Hypertension in mild,moderate,severe,and very severe COPD were 1/8 (12.5%), 14/34(41.1%), 18/36 (50%) and 8/12 (66%) respectively. Moderate to severe pulmonary artery hypertension was more commonly seen in COPD Grade 3 and Grade 4 patient as comparison to COPD grade 2 patients. Corpulmonale was observed in 5/12(41.7%) in very severe COPD, 4/26(15.3) in severe COPD and 1/34(2.9%) in moderate COPD patient. CONCLUSION: Prevalence of Pulmonary Artery Hypertension and Corpulmonale has a linear relationship with severity of COPD patients. Severe PAH and corpulmonale is a major complication commonly found in severe and very severe COPD patients. Echocardiography helps in early detection of cardiac changes secondary to severe and very severe COPD cases providing time for early interventions.

Introduction: Idiopathic membranous nephropathy (IMN) is one of the most common causes of nephrotic syndrome in adults worldwide. Treatment using cyclical cyclophosphamide and steroids ('modified Ponticelli' regimen) has been the standard of care for decades, however potential therapy-related adverse effects are a significant concern. At our center, we have used lower-than-standard dose intravenous pulse steroid based modification of the conventional 'modified Ponticelli' regimen to minimize steroid-related adverse effects (Figure 1). The aim of this study was to assess the efficacy and safety of this regimen in IMN. Methods: This was a case-record based retrospective analysis conducted at our center over a period of nine years (January 2008-December 2017). All treatment-naive patients with primary MN fulfilling the following criteria: (1) biopsy proven MN and (2) initiated with a lower-than-standard dose pulse steroid-based modification of the conventional 'modified Ponticelli' regimen (Figure 1) were included. Clinical and laboratory parameters of all patients were recorded. Remission rates (both complete and partial) and adverse effects of therapy at the end of 6 months of therapy were studied. Follow-up data up was also collected. The study definitions used are as follows: Complete remission: Proteinuria < 0.3g/day or UPCR <0.3 mg/mg, with normalization of serum albumin ($3.5g/dL) Partial remission: Reduction of 24 hour urine protein (or UPCR) to < 50% of baseline to < 3.5g/day (or UPCR <3.5mg/mg), but > 0.3g/day (or UPCR > 0.3mg/mg) Relapse: Proteinuria >3.5g/day or >3500mg/g urine creatinine after remission has been attained. Analysis was carried out using SPSS version 18. Results: A total of 41 patients were included. Baseline characteristics are shown in Table 1. All patients received either angiotensin converting enzyme inhibitors/ angiotensin receptor blockers (ACEi/ARBS) as supportive therapy. Immunosuppression was stopped prior to completion of six months for four patients due to infection, while six patients were lost to follow-up. Of the 31 patients who completed six months of therapy, 71% (n=22) responded to therapy [complete remission in 25.8% (n=8), partial remission in 45.2% (n=14)] and 29% (n=9) failed to respond (Table 2). Most common complications seen during therapy were infections in 25.7% (n=9/35, of which immunosuppression was discontinued for four patients), steroid induced diabetes mellitus in 40% (n=14/35), and leucopenia in 8.5% (n=3/35).[R [1] The relapse rate during follow-up (mean follow-up period: 35.6 months) was 29% (n=9). Anti-PLA2R titers and percentage of glomerulosclerosis at presentation were significantly associated with response at 6 months (p<0.05). Conclusions: Use of lower-than-standard dose pulse steroid and cyclophosphamide is effective in achieving remission in idiopathic membranous nephropathy. Further large randomized control trials with longer follow-up are needed to confirm the same.

Background and objectives: Tobacco use is associated with cardiovascular, respiratory and peripheral vascular diseases. The short term effects of tobacco smoking on vital hemodynamic parameters and lipid profile of young smoker with increased quantity of smoking is still debatable. The objective of this study was to evaluate the effect of smoking on vital hemodynamic parameters and lipid profile of young smokers. Materials and methods: The current study was an observational cross sectional study conducted in a tertiary care hospital over a period of 18 months and included smokers and non-smokers. Data on vital hemodynamic parameters like blood pressure, heart rate, oxygen saturation (SPO2) and lipid profile were collected. Chi-square and analysis of variance (ANOVA) tests were used to analyze the data. Results: A total of 80 smokers and 80 non-smokers were enrolled in the study. Blood pressure, heart rate and mean SpO2 were significantly (p<0.001) lower in non-smokers compared to smokers. Breath holding time (BHT) and single breath count (SBC) were higher in non-smokers. Mean values of total cholesterol (T-chol), low density lipoprotein (LDL) and triglyceride (TG) were significantly (p<0.001) higher in smokers than non-smokers, while high density lipoprotein (HDL) was significantly low in smokers. SBP, T -chol and TG significantly (p<0.05) increased as the quantity of smoking increased. Conclusion: Smoking is associated with derangement of vital hemodynamic parameters and lipid profile across the age. Anti-smoking campaign should be organized to discourage both personal smoking and smoking in public places. IMC J Med Sci. 2023. 17(1): 007. DOI : https://doi.org/10.55010/imcjms.17.007 *Correspondence: Bhupendra Kumar Jain, Department of Pulmonary Medicine, School of Chhindwara Institute Of Medical Sciences, Jabalpur Medical University, Chhindwara, Madhya Pradesh, India. Email: drbhupendrakjain@gmail.com

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