Background and ObjectivesTobacco smoking has been established as a major risk factor for chronic obstructive pulmonary disease (COPD) in women of developing countries, but emerging evidence suggests that biomass fuel is an important risk factor as well. The primary objective of the study was to find the true prevalence of COPD in Indian women exposed to biomass fuel using spirometry. We also aimed to find the determinants of underdiagnosis of COPD in these participants.MethodsWomen with a history of exposure to biomass fuel for >10 years were screened for COPD using spirometry following all standard protocols as per GOLD/ATS/ERS definitions.ResultsOf the 2868 women screened, a total of 529 (18.4%) women were confirmed to have COPD in which 123 (4.2%) were "Women with known COPD" and 406 (14.2%) "Women with new COPD". The mean age at the time of Diagnosis was 61±5.2 and 47±3.6 respectively. The duration of exposure to biomass fuel had a great impact on the risk of COPD with OR 1.2, 95% CI (1.1-1.9) for patients with 10-15 years exposure and OR 2.9, 95% CI (2.5-3.1) for exposure >25 years, p<0.001.ConclusionThe prevalence of COPD among women exposed to biomass fuel is very high. A strong correlation was found between the risk of COPD and the duration of exposure along with the age at which the exposure to biomass fuel begins. Underdiagnosis of COPD was frequent in women due to the lack of the availability of spirometry, lack knowledge of hazards of biomass fuel, a low level of education and the ignorance of the health care provider being the important determinants of underdiagnosis.

BackgroundChronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including diabetes, hypertension and cardiovascular diseases. As very limited data is available in India, the aim of the present study was to determine the relationship between COPD and the common, chronic comorbid conditions of diabetes mellitus (DM), hypertension (HTN), and cardiovascular diseases (CVD) and also to determine how these affect the clinical course of COPD.MethodsAll the COPD cohorts diagnosed as per Global Initiative for Chronic Obstructive Lung Disease-2013 (GOLD-2013) criteria were screened for DM, HTN, and CVD as per stipulated national and WHO guidelines.ResultsThe prevalence of DM, HTN, and CVD in the 2432 COPD subjects was 25.94%, 37.25%, and 13.93%, respectively. In multivariate analyses, very severe COPD was associated with a higher risk of DM (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2), HTN (OR 1.6, 95% CI 1.4–1.9), and CVD (OR 2.5, 95% CI 1.9–3.0).ConclusionA significant relationship was found between COPD and the presence of comorbid DM, HTN, and CVD. It was also found that subjects with advanced COPD were more likely to have at least two of these conditions and hugely affect the outcome of the disease. These findings suggest that the presence of COPD could provide a rationale to look for other comorbid disease and, conversely, that the presence of DM, HTN, or CVD might be the basis for the assessment of patients for airflow limitation and COPD as the tobacco smoking and advancing age were common risk factors.

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BACKGROUND Diabetes mellitus and hypertension remain one of the most common causes of chronic kidney disease. Diabetes hypertension, kidney disease syndrome is a new term introduced in medical terminology. The present study was conducted to examine clinical & laboratory profile of diabetes hypertension kidney disease syndrome – “DHKD syndrome” over a period of one year. METHODS A hospital-based observational cross-sectional study was done in the Department of General Medicine and Nephrology, outpatient department (OPD), among 120 patients with diabetes & hypertension in combination with kidney disease, with duration of diabetes > 2 years and duration of hypertension > 2 years after obtaining ethical clearance. The patients were then scored based on modified diet in renal disease (MDRD) formula and chronic kidney disease epidemiology collaboration equation (CKD EPI) formula to calculate the estimated glomerular function rate & placed into various stages of CKD. RESULTS A total of 120 subjects were included in the final analysis. The mean age was 63.64 ± 10.80. In study population of no albuminuria group, 50 % had glomerular filtration rate (GFR) of 30 - 44 (grade 3 CKD) and 50 % had GFR of < / = 15 (grade 5), among microalbuminuria group, 4.45 % had GFR of 60 - 89 (grade 2) and 1 had GFR of 45 - 59 (grade 3a), 13.64 % had GFR 30 - 44 (grade 3b), 40.91 % had GFR 15 - 29 (grade 4), 36.36 % had GFR < = 15 (grade 5), among macroalbuminuria group, 4.6 % had GFR 45 - 59 (grade 3a), 9.2 % had GFR 30 - 44 (grade 3b), 13.79 % had GFR 15 - 29 (grade 4) and 72.41 % had GFR < = 15 (grade 5). Majority had macro albuminuria. The proportion of the difference between systolic blood pressure (SBP) and macroalbuminuria was statistically significant. (P-value < 0.05) as well as proportion of the difference between insulin usage with macroalbuminuria was statistically significant. (P-value < 0.05). CONCLUSIONS Our study delivers sufficient evidence endorsing high relationship between diabetes, hypertension, and kidney disease. KEYWORDS Diabetic Nephropathy, Macroalbuminuria, Hypertension, DHKD Syndrome

Introduction and Aim:Co-existence of thyroid disorder and Diabetes Mellitus is no more a coincidence. The cause and impact of thyroid disorder on glucose levels or vice versa is a well -established fact.Hence in this study we wanted to know the glycemic status by estimating fructosamine and glycated hemoglobin of the newly diagnosed thyroid patients without diabetes mellitus. The aim of the study was to estimatefructosamine and glycated hemoglobin levels in newly diagnosed subclinical hypothyroid, clinical hypothyroid and hyper thyroid patients without diabetes mellitus. Material and Methods:Twenty cases of subclinical hypothyroid,30 cases of hypothyroid,30 cases of hyperthyroid  and 30 healthy participantswere included in the study. Fasting plasma glucose and thyroid profile was estimated in suspected cases of thyroid disorder and participants with fasting plasma glucose (FPG) more than 110 mg/dL were excluded from the study.The participants who were eligible for an inclusion criterion were estimated for fructosamine by nitro bluetetrazolium, (NBT) method andion-exchange high performance liquid chromatography was for glycated hemoglobin. Results:In Subclinical hypothyroid group there was a statistically significant increase in the mean fasting plasma glucose, fructosamine and glycated hemoglobin levels when compared with the controls.There was a significant increase in the mean fasting plasma glucose,fructosamine and glycated hemoglobin(HbA1c) levels in clinical hypothyroid group when compared with the controls.Pairwise comparison of FPG (p=0.001), fructosamine (p=0.001) and HbA1c (p=0.001) levels with controls showed a statistically significant difference.In clinical hyperthyroid group the mean FPG and HbA1c levels were high and low fructosamine levels when compared with the controls by one way ANOVA.Pairwise comparison of FPG (p=0.001), fructosamine levels (p=0.001) and HbA1c (p=0.001) levels (p=0.001) with controls showed a statistically significant difference. Conclusion: Unidentified hyperglycemia could have an impact on thyroid disorder leading to its complication.Hence a systematic approach to fructosamine testing(monitor the plasma glucose concentration over 2–3 weeks) as a routine test in thyroid disorder patients, needs to be considered.Also the management of hyperglycemia in thyroid patients without diabetes mellitus may prove  to be beneficial.