Rajiv Gandhi University of Health Sciences Karnataka



From, Date: 23-10-2013

Dr.Kushal.D.P Place: Bellary

Post Graduate Student in General Medicine,

Vijayanagar Institute of Medical Sciences, Bellary.

To,

The Principal,

Vijayanagar Institute of Medical Sciences,

Bellary.

THROUGH PROPER CHANNEL

Respected Sir,

Sub: Submission and forwarding of Synopsis for Registration of Dissertation Topic.

In accordance with the below cited topic, I, the undersigned studying in Post Graduate course in MD General Medicine has been allotted the dissertation topic “SIX MINUTE WALK TEST IN COPD AND ITS CORRELATION WITH SPIROMETRY AND ECHO” under the guidance of Dr.GADWALKAR SRIKANT.R, Professor & HOD , Department of General Medicine, VIMS, Bellary.

I am requesting you to forward the dissertation topic in the prescribed form to the Registrar, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka for approval.

Thanking you,

Yours faithfully

(Dr.KUSHAL.D.P)

Signature of the guide Signature of the HOD

Dr.GADWALKAR SRIKANT.R Dr. GADWALKAR SRIKANT.R

Professor & HOD, Professor & HOD,

Dept of General Medicine, Dept of General Medicine

VIMS, Bellary. VIMS, Bellary.

From, Date: 23-10-2013

The Professor & Head, Place: Bellary

Department of General Medicine,

Vijayanagar Institute of Medical Sciences, Bellary.

To,

The Registrar,

Rajiv Gandhi University of Health Sciences,

Bangalore.

THROUGH PROPER CHANNEL

Sir,

Sub: Submission of synopsis for registration and forwarding.

As per the regulation of the University for Registration of dissertation topic, the following Post Graduate student in M.D. (General Medicine) has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guide of the Department of General Medicine.

| NAME |TOPIC |GUIDE |

|DR.KUSHAL.D.P |“SIX MINUTE WALK TEST IN COPD AND ITS CORRELATION |DR.GADWALKAR SRIKANT. R |

|Post Graduate, |WITH SPIROMETRY AND ECHO” |Professor & HOD |

|Department of | | |

|General Medicine , | |Department |

|VIMS, Bellary. | |of General Medicine , |

| | |VIMS, Bellary. |

Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.

Thanking you,

Yours faithfully,

[Dr. GADWALKAR. SRIKANT. R.]

The Professor & HOD

Department of General Medicine,

VIMS, BELLARY.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1 |NAME OF THE CANDIDATE AND |DR.KUSHAL.D.P |

| |ADDRESS |POST GRADUATE IN GENERAL MEDICINE, |

| | |VIMS, BELLARY. |

|2 |NAME OF THE INSTITUTION |VIJAYANAGARA INSTITUTE OF |

| | |MEDICAL SCIENCES, BELLARY. |

|3 |COURSE OF THE STUDY AND SUBJECT |MD in GENERAL MEDICINE |

|4 |DATE OF ADMISSION TO THE COURSE | 31-07-2013 |

|5 |TITLE OF THE TOPIC |“SIX MINUTE WALK TEST IN COPD AND ITS CORRELATION WITH SPIROMETRY AND ECHO” |

|6 |BRIEF RESUME OF INTENDED STUDY |

| | |

| |6.1 NEED FOR STUDY |

| | |

| | |

| |Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death all over the world. It is the fourth and|

| |the only leading cause of death showing increase in prevalence worldwide. In India, it was reported a median COPD prevalence |

| |of 5 percent in males and 2.7 percent in females in adults of 30 years age and above. The 5-year mortality rate for patients |

| |with COPD varies from 40% to 70%. Spirometry is the present gold standard for diagnosing COPD. FEV1/FVC ratio is generally |

| |used to define the presence or absence of airflow limitation, but FEV1 is used to define the severity of the disease. FEV1 |

| |correlates weakly with dyspnea, accounting for only 12% of the variability in dyspnea as measured by the Baseline Dyspnea |

| |Index (BDI). Once FEV1 is reduced to 35% of predicted, there is a wide spectrum of ability; some patients are not very limited|

| |in their activities, whereas others are confined to wheelchairs. This enigma points to the need for other assessment tools. |

| |6-min walk distance (6MWD) test is a sub maximal exercise test, used to assess the functional status of patients with COPD. |

| |6MWD test had proved to be reliable, inexpensive, safe and easy to apply. It evaluates global and integrated response of all |

| |systems involved during exercise like pulmonary, cardiovascular, musculoskeletal and neuromuscular. As spirometry depends on |

| |effort, all patients may not be comfortable in doing the test. If there is correlation between 6MWD and FEV1, 6MWD test can be|

| |used for assessing the severity of COPD where spirometry cannot be done. |

| |Pulmonary hypertension (PH) is the major cardiac complication of the disease; it is defined by a mean pulmonary artery |

| |pressure at rest (mPAP) above 25 mmHg, as assessed by right heart catheterization. Due to the high prevalence of COPD, PH |

| |associated with COPD is one of the most frequent causes of PH. PH due to COPD is a predictor of mortality, independent of the |

| |pulmonary obstruction severity. PH has been associated with an increased risk of severe acute exacerbation, and therefore with|

| |higher healthcare costs; it also additionally impairs the quality of life of these patients. It is therefore important to |

| |assess PH in COPD patients in the clinical management of the disease. In current practice the detection of PH is made mostly |

| |by echocardiography, as right heart catheterization, the “gold standard” diagnostic method for PH, is an invasive and |

| |expensive procedure, considered only in patients referred to surgical procedures. |

| | |

| |6.2 REVIEW OF LITERATURE |

| |DEFINITION: COPD is defined as a common preventable and treatable disease characterised by persistent airflow obstruction that|

| |is progressive and characterised by chronic inflammatory response in the airways/lung to noxious particles or gases. |

| |Exacerbations and comorbidities contribute to overall mortality in these patients. It includes emphysema,chronic bronchitis |

| |and small airway disease. |

| |PREVALANCE: 400 MILLION people are affected worldwide and 15 million in INDIA. |

| |BURDEN: copd was the 6th leading cause of death in 1990, and will be the 3rd by 2020.In india COPD causes 5 lakh deaths per |

| |year. RISK FACTORS: |

| |tobacco smoking , passive smoking, indoor air pollution, occupational exposure,airway hyperresponsiveness,respiratory |

| |infections and genetic. |

| |PATHOLOGY: In large airways there is goblet cell hyperplasia, in small airways(major site of airway obstruction) there is |

| |goblet cell metaplasia and in parenchyma there is destruction of gas exchanging air spaces. |

| |PATHOGENESIS: Cigarette smoking causes inflammatory cell recruitment which in turn release proteinases leading to airspace |

| |destruction and emphysema. PATHOPHYSIOLOGY: characterised by airflow |

| |obstruction, hyperinflation and impaired gas exchange. |

| |CLINICAL FEATURES: |

| |Symptoms: middle aged patients with exertional dyspnea, chronic cough and sputum production. |

| |Signs: nicotine staining, barrel chest, tripod position,cyanosis, wasting, hoover’s sign,hyperresonant note on |

| |percussion,wheeze and decreased intensity of breath sounds on auscultation. Signs of right heart failiure(raised JVP, tender |

| |hepatomegaly, pedal oedema, loud P2) can be present. |

| |Spirometry: a postbronchodilator FEV1/FVC ................
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