Sushma Sood

Evaluation of brain stem auditory evoked potentials in stable patients with chronic obstructive pulmonary disease

Though there are few studies addressing brainstem auditory evoked potentials (BAEP) in patients with chronic obstructive pulmonary disease (COPD), subclinical BAEP abnormalities in stable COPD patients have not been studied. The present study aimed to evaluate the BAEP abnormalities in this study group. MATERIALS AND METHODS: In the present study, 80 male subjects were included: COPD group comprised 40 smokers with stable COPD with no clinical neuropathy; 40 age-matched healthy volunteers served as the control group. Latencies of BAEP waves I, II, III, IV, and V, together with interpeak latencies (IPLs) of I-III, I-V, and III-V, and amplitudes of waves I-Ia and V-Va were studied in both the groups to compare the BAEP abnormalities in COPD group; the latter were correlated with patient characteristics and Mini–Mental Status Examination Questionnaire (MMSEQ) scores to seek any significant correlation. RESULTS: Twenty-six (65%) of the 40 COPD patients had BAEP abnormalities. We observed significantly prolonged latencies of waves I, III, V over left ear and waves III, IV, V over right ear; increased IPLs of I-V, III-V over left ear and of I-III, I-V, III-V over right side. Amplitudes of waves I-Ia and V-Va were decreased bilaterally. Over left ear, the latencies of wave I and III were significantly correlated with FEV1; and amplitude of wave I-Ia, with smoking pack years. A weak positive correlation between amplitude of wave I-Ia and duration of illness; and a weak negative correlation between amplitude of wave V-Va and MMSEQ scores were seen over right side. CONCLUSIONS: We observed significant subclinical BAEP abnormalities on electrophysiological evaluation in studied stable COPD male patients having mild-to-moderate airflow obstruction.

Evaluation of spectrum of peripheral neuropathy in predialysis patients with chronic kidney disease.

Abstract Introduction: Neurological complications secondary to the uremic state, contribute largely to the morbidity and mortality in patients with renal failure. The prevalence of peripheral neuropathy remains high in advanced renal dysfunction. Materials and methods: The present cross-sectional study was conducted on 100 adult patients of chronic kidney disease between 18 and 75 years of age with serum creatinine greater than 2 mg/dL. Apart from routine examination and baseline investigations, detailed history was elicited pertaining to patients’ neurological symptoms, and scored according to the Neurological Symptom Score. Motor nerve conduction velocity was measured from right median, ulnar, peroneal, and tibial nerves. Results: It was observed that neurological symptoms increased steadily with raise in serum creatinine. The mean nerve conduction velocities (NCVs) of right median nerve, ulnar nerve, peroneal nerve, and tibial nerve were 51.34 ± 6.07, 53.04 ± 5.91, 44.72 ± 6.14, and 44.20 ± 5.17, respectively. The NCVs of all the tested nerves decreased significantly with increase in serum creatinine levels (p < 0.01): 70% of the patients had uremic polyneuropathy; 6% had asymptomatic neuropathy, 51% had symptomatic non-disabling neuropathy, while disabling neuropathy was seen in 13% of the patients. Conclusion: Our data suggests that NCV testing when complimented with meticulous neurological assessment can provide invaluable input. These tests apart from helping us detect neuropathy in advanced renal dysfunction; can also detect the disease in largely asymptomatic patients which avoids the necessity to order for detailed neurophysiological investigation

Assessment of visual evoked potentials in stable COPD patients with no visual impairment

OBJECTIVE: To assess whether patients having stable chronic obstructive pulmonary disease (COPD) with no clinical evidence of visual impairment or peripheral neuropathy have visual evoked potentials (VEP) abnormalities on electrophysiologic evaluation. METHODS: In the present study, 80 male subjects with no clinical neuropathy or visual impairment were included; 40 COPD patients and 40 age-matched healthy volunteers. The characteristics of subjects including age, quantum of smoking, duration of illness (in COPD patients only), and spirometric indices {forced expiratory volume in first second (FEV1), FEV1/forced vital capacity (FVC) %, and peak expiratory flow rate (PEFR)} were assessed. The mental status was assessed using a questionnaire Mini-Mental State Examination (MMSE) Questionnaire. Electrophysiologic studies for the evaluation of VEP were carried out on computerized equipment. Latency and amplitude of P100 wave were analyzed from the VEP wave patterns obtained through a standardized protocol in both the groups to detect abnormalities in the COPD group. For the COPD group, correlations of P100 parameters with patient characteristics, spirometric indices, and MMSE scores were assessed. Significant abnormality was defined as a variation beyond healthy volunteer mean ± 3 standard deviation. RESULTS: We observed significantly prolonged latency and decreased amplitude of P100 in both eyes of the patients in COPD group compared with healthy volunteers. Twenty-two of the 40 COPD patients (55%) had significant abnormalities in P100 latency, and three COPD patients (7.5%) had abnormalities in P100 amplitude. The latency of P100 on the right side had statistically significant inverse correlation with FEV1/FVC% and MMSE score. CONCLUSIONS: Twenty-three of the 40 stable COPD patients (compared with healthy volunteers) were observed to have significant VEP abnormality detected on electrophysiologic evaluation: 21/40 having prolonged P100 latency and only 2/40 with decreased P100 amplitude. The statistically significant correlations were observed only between P100 latency (right eye) and FEV1/FVC as well as MMSE scores. The rest of the correlations were not statistically significant.

A comparison of cognitive functions in non-hypoxemic chronic obstructive pulmonary disease (COPD) patients and age-matched healthy volunteers using mini-mental state examination questionnaire and event-related potential, P300 analysis

Objective: To assess sub-clinical cognitive dysfunctions in stable chronic obstructive pulmonary disease (COPD) patients having no hypoxemia vs. age-matched healthy volunteers using (i) an electrophysiological test: Auditory event related potential, P300 test and (ii) a questionnaire tool: Mini-mental state examination (MMSE) questionnaire. Materials and Methods: Eighty male subjects were included: 40 stable COPD patients (smoking history >20 pack years) and 40 healthy volunteers (HVs). Age, duration of illness, smoking pack years, and spirometric indices were assessed. MMSE scores were evaluated in these groups. Latency of P300 wave and amplitude of P300 wave were studied in both groups to detect P300 abnormalities in COPD group. Correlations of P300 abnormalities with patient characteristic parameters and MMSE scores were assessed. In addition, individual COPD patients having significant cognitive dysfunctions beyond cut-off value of 99th percentile of HVs were analyzed. Results: We observed significantly prolonged P300 latency (P < 0.001) and decreased P300 amplitude (P < 0.001) in COPD group. MMSE scores were significantly reduced in COPD group (P < 0.001). 10/40 COPD patients had prolongation of P300 latency, and 27/40 COPD patients had reduced MMSE scores beyond 99th percentile of HV. However, we did not observe any statistically significant correlation between P300 abnormalities and patients’ characteristics or MMSE scores (P > 0.05 for all). Conclusions: Our study explores cognitive dysfunctions in stable COPD patients with no hypoxemia. This study highlights the relative importance of using MMSE and P300. Cognitive dysfunctions were detected both by MMSE and P300; however, MMSE abnormalities were more frequent compared to P300 abnormalities (27/40 vs. 10/40) in COPD patients.

Assessment for efficacy of additional breathing exercises over improvement in health impairment due to asthma assessed using St. George's respiratory questionnaire

Background: Breathing exercises have been described to be useful in asthma management by few researchers in the past. Objective: To assess the efficacy of breathing exercises (Pranayamas) added to regular optimal medications in asthma patients in improving health impairment using St. Georges Respiratory Questionnaire (SGRQ). Methods: Sixty stable asthma patients (34 females) receiving optimal treatment at our institute for 3 months or more as per the Global Initiative for Asthma guidelines were included in the study. They performed seven breathing exercises under supervision at yoga center of our institute for 3 months in addition to their regular medications. SGRQ (1 month symptoms version) was used to assess the quality of life before and after breathing exercises intervention for following subsets: Symptom score, activity score, impact score, and total score to assess the efficacy of breathing exercises. Results: Of 60 asthma patients, 34 were females and 26 were males, and their mean age was 25.45 ± 5.41 years. Their baseline spirometric values were as follow: Forced expiratory volume in 1 s (FEV1) - 2.492 ± 0.358 L and peak expiratory flow rate (PEFR) - 283.82 ± 51.12 L/min. The SGRQ scores after breathing exercises intervention decreased from 45.98 ± 5.61 to 38.78 ± 4.92 for symptom subset, from 15.45 ± 3.33 to 12.34 ± 2.39 for activity subset, from 17.95 ± 4.22 to 12.12 ± 3.82 for impact subset, and from 25.83 ± 8.31 to 19.20 ± 7.09 for total scores. All these reductions were statistically highly significant (P < 0.001). Decrease in symptoms, activity, and total SGRQ scores each was significantly correlated with FEV1, FEV1/forced vital capacity (FVC) ratio, and PEFR; decrease in impact score was significantly related only with FEV1/FVC ratio. Conclusions: Breathing exercises significantly decreased all component scores of SGRQ, signifying a global improvement in health impairment due to asthma; this improvement was in addition to that was achieved with optimal asthma therapy alone.

Improvement in pulmonary functions and clinical parameters due to addition of breathing exercises in asthma patients receiving optimal treatment

Background: Breathing exercises have been described to be useful in asthma management. Objective: The aim of this study is to detect the efficacy of breathing exercises (Pranayamas) in asthma patients using spirometric indices, clinical symptoms parameters, and requirement of rescue medications. Methods: A total of 60 stable asthma patients (34 females) diagnosed and received optimal asthma treatment for 3 months or more according to the GINA guidelines were enrolled. All patients continued their respective medications and in addition performed seven breathing exercises (Surya Bhedana Pranayama, Nadi Shuddi Pranayama, Bhramari Pranayama, Surya Nadi Pranayama, Kapal Bhati, Bhastrika, and Om Chanting) under supervision at Yoga center at our Institute for 3 months after inclusion to study. Spirometry, nocturnal symptoms, and the requirement of rescue medicines were assessed before and after breathing exercise intervention. Visual analog scale (VAS) was used to assess the dyspnea and wheezing in the study participants. Results: The mean age of asthma patients was 25.45 ± 5.41 years. After breathing exercise intervention, mean forced expired volume in one second increased from 2.492 ± 0.358 L to 2.745 ± 0.343 L and mean peak expiratory flow rate increased from 283.82 ± 51.12 L/min to 336.23 ± 51.47 L/min; the increases were statistically significant. The mean nocturnal symptoms score decreased significantly from 1.416 ± 1.619 to 0.067 ± 0.362. The requirement of rescue medications decreased significantly from 6.23 ± 2.95 to 0.90 ± 1.25 puffs/week. VAS scores for breathlessness and wheezing were significantly decreased. Conclusions: Breathing exercises provided significant improvements in spirometric parameters and significant reduction in breathlessness, wheezing, and nocturnal symptoms as well as requirements of rescue medicines in asthma patients who were receiving optimal asthma treatment.

Chilhood onset familial nemaline rod myopathy: A report of two siblings

Aims: Nemaline rod myopathy (NRM) is a rare form of congenital myopathy characterized by slowly progressive or non progressive muscle weakness and pathognomonic rod-like structures within the muscle fibers. Muscle weakness and hypotonia are apparent from the neonatal period. We report a rare presentation of NRM seen in two siblings with similar symptoms. Both had slender physique, delayed motor milestones including delayed walking, normal language and cognitive milestones, difficulty in fast movements and change of posture, difficulty in getting to standing from sitting posture and slowly progressive weakness and positive family history. Study Design: Two siblings i.e. a brother and sister with provisional diagnosis of Nemaline Rod Myopathy were tested for all relevant diagnostic protocol with results analysed and discussed. Place and Duration of Study: Department of Physiology, Pt. B.D. Sharma Post-Graduate Institute of medical Sciences, University of Health Sciences, Rohtak, Haryana, India. Methodology: Investigations included CPK levels, motor-sensory conduction velocities, EMG