THE STUDY ON: EFFECT OF CIGARETTE SMOKING ON HEMATOLOGICAL PARAMETERS AND PULMONARY FUNCTION TESTS By Dr. NADERA YASMEEN M.B.B.S. Dissertation submitted to the Rajiv Gandhi University of health sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of DOCTOR OF MEDICINE in PHYSIOLOGY Under the guidance of Dr. R.B. PATIL M.D Associate Professor Department of Physiology M.R. Medical College Gulbarga 2014 i Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled “The study on: Effect of cigarette smoking on hematological parameters and pulmonary function tests” is a bonafide and genuine research work carried out by me under the guidance of Dr. R.B. Patil Associate Professor, Department of Physiology, M.R. Medical College, M.D. Gulbarga. Date: / / 2013 Place: Gulbarga Dr. Nadera Yasmeen ii Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “The study on: Effect of cigarette smoking on hematological parameters and pulmonary function tests” is a bonafide research work done by Dr. Nadera Yasmeen in partial fulfillment of the requirement for the degree of M.D.(Physiology). Signature of the Guide Date: / / 2013 Place: Gulbarga Dr. R.B. Patil M.D. Associate Professor Department of Physiology M.R. Medical College, Gulbarga iii Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “The study on: Effect of cigarette smoking on hematological parameters and pulmonary function tests” is a bonafide research work done by Dr. Nadera Yasmeen in partial fulfillment of the requirement for the degree of M.D. (Physiology). Signature of the Co-Guide Date: / / 2013 Place: Gulbarga Dr. S.N. Patil M.D. Associate Professor Department of Medicine M. R. Medical College Gulbarga iv Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “The study on: Effect of cigarette smoking on hematological parameters and Pulmonary function tests” is a bonafide research work done by Dr. NADERA YASMEEN under the guidance of Dr. R.B. Patil Associate Professor, Department of Physiology, M.R. Medical M.D. College, Gulbarga. Seal and signature of the HOD Seal and signature of the Principal Dr. B. S. Mali Patil Dr. Mallikarjun B. M.D. M.D Professor and Head of the Principal, Department of Physiology, M.R. Medical College, M.R. Medical College, Gulbarga. Gulbarga. Date: / / 2013 Date: / / 2013 Place: Gulbarga Place: Gulbarga v COPY RIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka, shall have the rights to preserve, use and disseminate this dissertation / thesis in print or electronic format for academic / research purpose. Signature of the Candidate Date: / / 2013 Place: Gulbarga Dr. NADERA YASMEEN © Rajiv Gandhi University of Health Sciences, Karnataka vi ACKNOWLEDGEMENT I am extremely grateful to the Almighty for always being with me and guiding me throughout my life. It gives me immense pleasure to express my deep and heartfelt gratitude, humble and sincere thanks to my guide Dr. R.B. Patil Associate Professor, Department of M.D. Physiology M. R. Medical College Gulbarga who with his knowledge and expertise has provided able guidance, valuable advice, constant support and encouragement. I am very grateful to my co-guide Dr. S.N. Patil Associate Professor, Department M.D. of Medicine M. R. Medical College Gulbarga for his valuable suggestions, constant help and guidance. It gives me great pleasure to thank my Professor and Head of the department of Physiology Dr. B.S. Mali Patil for his constant encouragement, support and also M.D. for being a constant source of inspiration. I am extremely thankful to Dr. B. Mallikarjun Dean M.R. Medical College, for M.D. his kind permission to take up this work in the Department of Physiology. I express my sincere thanks to Dr. Ashwini Associate Professor, Department of M.D. Physiology for her valuable support. I am grateful to Dr. Ehtesham Ali Farooqui Dr. Vinod Prabhushetty . and M.D., M.D Dr. Roopa Mathapati Asst. Professors, and Dr. Shilpa Patil Tutor, M.D. M.D. Department of Physiology for their advice and suggestions. I am thankful to Shrinivas Reddy for his support and guidance in statistical work. I am thankful to my fellow postgraduate colleagues for their co-operation and timely help during my study. vii I am thankful to all the Technical and non-technical staff of the Department of Physiology, for their co-operation during my study. I thank all the subjects who have voluntarily participated in this study. My thanks to Er. Mohammed AA Arzoo for the meticulous computerized laser output of this dissertation. My sincere thanks to my parents for their abundant love, endurance support innumerable sacrifices and unceasing encouragement that has moulded me into a person I am today. I am extremely thankful to my children for their love, support, help, encouragement and co-operation during my study. I thank all my family members, for their constant encouragement. Date: / / 2013 Dr. Nadera Yasmeen. Place: Gulbarga viii LIST OF ABBREVIATIONS USED BFU-E - Blast forming unit –Erythrocyte CFU-E - Colony forming unit- Erythrocyte CFU-MK - Colony forming unit – Megakaryocyte COPD - Chronic obstructive Pulmonary Disease ESR - Erythrocyte Sedimentation Rate FEF - Mean Forced Expiratory Flow during the 25-75% middle of FVC FEV1 - Forced Expiratory Volume in 1st sec FVC - Forced Vital Capacity G-CSF - Granulocyte-Colony Stimulating Factor GM-CSF - Granulocyte Macrophage-Colony stimulating Factor Hb - Hemoglobin HDL-C - High Density Lipoprotein Cholesterol IGF-1 - Insulin like Growth Factor-1 IgE - Immunoglobulin E IL - Interleukin LDL - Low Density Lipoprotein MCV - Mean Corpuscular Volume ix MVV - Maximum Voluntary Ventilation PCV - Packed Cell Volume PEFR - Peak Expiratory Flow Rate RBC - Red blood cell SE - Standard Error TLC - Total Leucocyte Count TNF-α - Tumor Necrosis Factor-α VC - Vital Capacity x