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REVIEW ARTICLES
Tuberculosis and nutrition
Krishna Bihari Gupta, Rajesh Gupta, Atulya Atreja, Manish Verma, Suman Vishvkarma
January-March 2009, 26(1):9-16
DOI
:10.4103/0970-2113.45198
PMID
:20165588
Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels. Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls. Malnutrition can lead to secondary immunodeficiency that increases the host's susceptibility to infection. In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting. Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. Nutritional status of patients improves during tuberculosis chemotherapy. High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations. Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.
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CASE REPORTS
Three cases of ARDS: An emerging complication of
Plasmodium vivax
malaria
Supriya Sarkar, Kaushik Saha, Chandra Sekhar Das
July-September 2010, 27(3):154-157
DOI
:10.4103/0970-2113.68323
PMID
:20931035
Plasmodium (P.) vivax
malaria is rarely associated with severe complications like acute respiratory distress syndrome (ARDS). We report three cases of ARDS, which occurred as a complication of vivax malaria, from the city of Kolkata. A middle aged man who developed ARDS along with hepatic and renal dysfunction on the day 7 after completion of antimalarial treatment; a 36-year-old man who developed ARDS on the day 5 after completion of antimalarial treatment and a 15-year-old boy who developed ARDS on day 2, before starting anti-malarial drug. In all cases, vivax malaria was diagnosed by peripheral blood film (PBF) examination. Associated
falciparum
infection was excluded by repeated PBF examination, and by negative
P. falciparum
malaria antigen tests. In all cases, ARDS was diagnosed by the presence of hypoxia with PaO
2
/ FiO
2
ratio < 200 and bilateral pulmonary infiltration, and by excluding cardiac disease by echocardiography. All cases typically had dramatic onset of ARDS, and required immediate (within hour of onset of dyspnea) institution of mechanical ventilation with high positive end expiratory pressure. All three cases recovered completely, and early ventilator support was life-saving.
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782
ORIGINAL ARTICLES
A study of skin sensitivity to various allergens by skin prick test in patients of nasobronchial allergy
R Prasad, SK Verma, R Dua, S Kant, R.A.S Kushwaha, SP Agarwal
July-September 2009, 26(3):70-73
DOI
:10.4103/0970-2113.53228
PMID
:20442839
Objective:
To study skin sensitivity to various allergens in patients of nasobronchial allergy.
Materials and Methods:
2880 skin prick tests with 60 allergens were performed in 48 patients of nasobronchial allergy.
Results:
Most common offending allergens were insects (21.2%), followed by dusts (12.0%), pollens (7.8%), animal dander (3.1%), and fungi (1.3%). The common insect antigen were locust female (33.3%) followed by locust male (25%), grasshopper (20.8%), cricket (16.7%), cockroach female (16.7%) and cockroach male (14.6%). Common dust allergens were house dust, wheat dust, cotton mill and paper dust. Among pollens,
Amaranthus spinosus, Argemone mexicana, Adhatoda vasica, Ailanthus
and
Cannabis
were found to be common allergens. In animal danders common offending allergens were cow dander and dog dander. Among fungi
Aspergillus fumigatus, Aspergillus flavus, Alternaria teneis
and
Fusarium sodani
were common allergens. Patients of bronchial asthma had associated allergic rhinitis in 80% cases.
Conclusion:
Common allergens in patients of nasobronchial allergy were identified. The data may prove useful in of allergen avoidance and immunotherapy in these patients.
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13
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Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients
Bashir Ahmed Shah, Gurmeet Singh, Muzafar Ahmed Naik, Ghulam Nabi Dhobi
April-June 2010, 27(2):54-57
DOI
:10.4103/0970-2113.63606
PMID
:20616935
The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP), as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29), followed by gram positive (10/29). In 71 cases no etiological cause was obtained.
Pseudomonas
aeruginosa
was the commonest pathogen (10/29), followed by
Staphylococcus
aureus
(7/29),
Escherichia
coli
(6/29),
Klebsiella
spp. (3/29),
Streptococcus
pyogenes
(1/29),
Streptococcus
pneumoniae
(1/29) and
Acinetobacter
spp. (1/29). Sputum was the most common etiological source of organism isolation (26) followed by blood (6), pleural fluid (3), and pus culture (1). Maximum number of patients presented with cough (99%), fever (95%), tachycardia (92%), pleuritic chest pain (75%), sputum production (65%) and leucocytosis (43%). The commonest predisposing factors were smoking (65%), COPD (57%), structural lung disease (21%), diabetes mellitus (13%), and decreased level of consciousness following seizure (eight per cent) and chronic alcoholism (one per cent). Fourteen patients, of whom, nine were males and five females, died.
Staphylococcus
aureus
was the causative organism in four,
Pseudomonas
in two,
Klebsiella
in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and
s0 taphylococcus
pneumonia
and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for
legionella
,
mycoplasma
and viruses are performed the diagnostic yield would definitely be better. This emphasizes the need for further studies (including the serological tests for
Legionella
,
mycoplasma
and viruses) to identify the microbial etiology of CAP.
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1,892
CASE REPORTS
Intralobar sequestration of lung
R Prasad, Rajiv Garg, Sanjay Kumar Verma
October-December 2009, 26(4):159-161
DOI
:10.4103/0970-2113.56357
PMID
:20532005
Intralobar pulmonary sequestration is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. It lacks normal communication with tracheobronchial tree. Failure to diagnose and treat this condition can lead to recurrent pneumonia and fatal hemoptysis. The aim of this case report is to increase awareness about the condition and to review criteria of its definitive diagnosis and subsequent treatment.
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ORIGINAL ARTICLES
Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role?
Arshad Altaf Bachh, Rahul Gupta, Inaamul Haq, Hanumant Ganapati Varudkar
April-June 2010, 27(2):58-62
DOI
:10.4103/0970-2113.63607
Background
: Diagnosis of sputum/smear-negative pulmonary tuberculosis patients can be both challenging and time consuming with many patients being put on empirical anti-tubercular treatment. Fibreoptic bronchoscopy may provide a confirmative and early diagnosis in such patients.
Aims:
To assess the role of fibreoptic bronchoscopy in the diagnosis of sputum /smear-negative pulmonary tuberculosis.
Materials and
Methods:
The study was conducted on 75 suspected sputum / smear-negative pulmonary tuberculosis cases attending Pulmonary Medicine Department of Mamata Medical College and Hospital, Khammam, AP. Fibreoptic bronchoscopy was performed; culture of sputum and bronchial washings for
Mycobacterium tuberculosis
was done by BACTEC method.
Results:
A final diagnosis of sputum /smear-negative pulmonary tuberculosis was made in 60 patients. Bronchial washings smear for acid-fast bacilli (AFB) was positive in 21 patients while culture of bronchial washings was positive in 39 patients. In 29 patients, smear or culture of bronchial washing alone contributed to the final diagnosis. Total yield of bronchoscopy in diagnosis of sputum smear negative pulmonary tuberculosis was 83.33% (50/60); bronchoscopy was the only diagnostic method in 66% cases (40/60) with bronchial washings being the only diagnostic method in 48.33%. Bronchial washings smear for AFB and histopathological evidence of caseating granuloma made immediate diagnosis possible in 48.33% (29/60) patients.
Conclusion:
Our study suggests that fibreoptic bronchoscopy can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria.
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GUIDELINES
Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations
Dheeraj Gupta, Ritesh Agarwal, Ashutosh Nath Aggarwal, Navneet Singh, Narayan Mishra, GC Khilnani, JK Samaria, SN Gaur, SK Jindal
July 2012, 29(6):27-62
DOI
:10.4103/0970-2113.99248
PMID
:23019384
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REVIEW ARTICLE
Corticosteroids and ARDS: A review of treatment and prevention evidence
GC Khilnani, Vijay Hadda
April-June 2011, 28(2):114-119
DOI
:10.4103/0970-2113.80324
PMID
:21712921
To systematically review the role of corticosteroids in prevention of acute respiratory distress syndrome (ARDS) in high-risk patients, and in treatment of established ARDS. Primary articles were identified by English-language Pubmed/MEDLINE, Cochrane central register of controlled trials, and Cochrane systemic review database search (1960-June 2009) using the MeSH headings: ARDS, adult respiratory distress syndrome, ARDS, corticosteroids, and methylprednisolone (MP). The identified studies were reviewed and information regarding role of corticosteroids in prevention and treatment of ARDS was evaluated. Nine trials have evaluated the role of corticosteroid drugs in management of ARDS at various stages. Of the 9, 4 trials evaluated role of corticosteroids in prevention of ARDS, while other 5 trials were focused on treatment after variable periods of onset of ARDS. Trials with preventive corticosteroids, mostly using high doses of MP, showed negative results with patients in treatment arm, showing higher mortality and rate of ARDS development. While trials of corticosteroids in early ARDS showed variable results, somewhat, favoring use of these agents to reduce associated morbidities. In late stage of ARDS, these drugs have no benefits and are associated with adverse outcome. Use of corticosteroids in patients with early ARDS showed equivocal results in decreasing mortality; however, there is evidence that these drugs reduce organ dysfunction score, lung injury score, ventilator requirement, and intensive care unit stay. However, most of these trials are small, having a significant heterogeneity regarding study design, etiology of ARDS, and dosage of corticosteroids. Further research involving large-scale trials on relatively homogeneous cohort is necessary to establish the role of corticosteroids for this condition.
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9,014
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ORIGINAL ARTICLES
Role played by Th2 type cytokines in IgE mediated allergy and asthma
Sudha S Deo, Kejal J Mistry, Amol M Kakade, Pramod V Niphadkar
April-June 2010, 27(2):66-71
DOI
:10.4103/0970-2113.63609
PMID
:20616938
Objective:
Recent evidence suggest that allergen type 2 helper T cells (Th2) play a triggering role in the activation/recruitment of IgE antibody producing B cells, mast cells and eosinophils. Reduced microbial exposure in early life is responsible for a shift of Th1/Th2 balance in the immune system towards the pre-allergic Th2 response. The Th1 predominantly produce IFNg and delayed type hypersensitivity while Th2 secrete IL-4, IL-5, IL-6, IL-13 and regulate B cell and eosinophil mediated responses. To assess regulatory changes in the immune system, in patients with allergy and asthma, we studied the cytokine profile in serum in comparison with normal healthy controls.
Patients and Methods:
A total of 170 patients with various allergies and asthmatic conditions were studied, for cytokines in the serum by ELISA using kits from Immunotech, and analyzed to identify the triggering factors or main contributors towards allergy and asthma.
Results:
Our study showed increase in the levels of IL-4, IL-5 and IL-6 in all groups which were non- significant. But the levels of IL-10, IL-13 and TNF α were highly significant. Besides, we found correlation of GM-CSF with IL-10. Significant correlation with different cytokines was observed. Most of these patients showed increase in IgE levels.
Conclusions:
This study gives a better understanding of how cytokines are the mediators of balance of Th1 and Th2 immune responses and IgE synthesis is controlled by cytokines. Further studies will eventually lead to improved treatment strategies in the clinical management of IgE mediated allergy.
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1,346
Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease
NK Gupta, Ritesh Kumar Agrawal, AB Srivastav, ML Ved
April-June 2011, 28(2):105-109
DOI
:10.4103/0970-2113.80321
PMID
:21712919
Background:
Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes.
Aims:
To assess the cardiac changes secondary to COPD by echocardiography and to find out the correlation between echocardiographic findings and severity of COPD, if there is any.
Materials and Methods:
A total 40 of patients of COPD were selected and staged by pulmonary function test (PFT) and evaluated by echocardiography.
Results:
On echocardiographic evaluation of COPD, 50% cases had normal echocardiographic parameters. Measurable tricuspid regurgitation (TR) was observed in 27/40 cases (67.5%). Pulmonary hypertension (PH), which is defined as systolic pulmonary arterial pressure (sPAP) > 30 mmHg was observed in 17/27 (63%) cases in which prevalence of mild, moderate, and severe PH were 10/17 (58.82%), 4/17 (23.53%), and 3/17 (17.65%), respectively. The frequencies of PH in mild, moderate, severe, and very severe COPD were 16.67%, 54.55%, 60.00%, and 83.33%, respectively. Right atrial pressure was 10 mmHg in 82.5% cases and 15 mmHg in 17.5% cases. Cor pulmonale was observed in 7/17 (41.17%) cases; 7.50% cases had left ventricle (LV) systolic dysfunction and 47.5% cases had evidence of LV diastolic dysfunction defined as A ≥ E (peak mitral flow velocity of the early rapid filling wave (E), peak velocity of the late filling wave caused by atrial contraction (A) on mitral valve tracing). Left ventricle hypertrophy was found in 22.5% cases.
Conclusion
: Prevalence of PH has a linear relationship with severity of COPD and severe PH is almost associated with cor pulmonale. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions.
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POSTGRADUATE EDUCATION DESK
Ethics in writing: Learning to stay away from plagiarism and scientific misconduct
Bharat Bhushan Sharma, Virendra Singh
April-June 2011, 28(2):148-150
DOI
:10.4103/0970-2113.80337
PMID
:21712931
Fraudulent data and plagiarized text may corrupt scientific medical literature and ultimately harm patients. By prescribing erroneous treatment to an individual, only single patient is affected; but by presenting incorrect data or transcripts, the whole scientific medical universe is affected. Although both scenarios are highly undesirable, one can assume the magnitude of the effect of latter. Writers of scientific medical literature have been found to be involved in plagiarism and other publication misconducts from time to time irrespective of social, economic and geographic structure. The reason of such behavior is not usually obvious. Easy availability of personal computers has led to widespread dissemination of medical literature. As a result, young scientists are now publishing their research more frequently and efficiently. At the same time, this has increased the tendency to submit hurriedly prepared, poorly drafted and even illegitimate publications. Use of some amount of copy-paste followed by modifications during preparation of a manuscript seems to be common. Therefore, the researchers, especially postgraduate students, should be educated continuously about ethical medical writing.
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6,046
831
CASE REPORTS
Isoniazid-induced alopecia
KB Gupta, V Kumar, S Vishvkarma, R Shandily
January-March 2011, 28(1):60-61
DOI
:10.4103/0970-2113.76304
PMID
:21654989
Isoniazid is a safe and very effective antituberculosis drug. Antimitotic agents routinely cause alopecia. Drug-induced alopecia is usually reversible upon withdrawal of the drug. Isoniazid, thiacetazone and ethionamide are the antituberculosis drugs which have been associated with alopecia. Isoniazid-induced alopecia was observed in one case and confirmed by the finding that hair growth resumed when drug removed from the regimen.
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5,757
445
ORIGINAL ARTICLES
Tuberculosis and patient gender: An analysis and its implications in tuberculosis control
Sukhesh Rao
April-June 2009, 26(2):46-47
DOI
:10.4103/0970-2113.48897
PMID
:20440394
Objective
: To analyze the profile of pulmonary tuberculosis patients with respect to gender and its implications in tuberculosis control. Setting: DOTS center at a tertiary, teaching hospital in South India.
Materials and Methods
: A retrospective study was undertaken by screening medical records of 446 patients with pulmonary tuberculosis. Data studied included age, gender, and sputum smear status. Patients with comorbid conditions were excluded. No other data were considered.
Results
: The male to female ratio in patients of pulmonary tuberculosis was 2:1, which was also maintained when smear positive and smear negative were studied separately. The ratio of smear positive to smear negative patients was statistically significant at 4.4:1. A large proportion of patients (65-68%) were in the young and reproductive age group. Approximately, one-fifth
patients were in the geriatric age group.
Conclusion
: The observation that two-thirds of all female smear-positive patients were found in the young and reproductive age group has strong implications in tuberculosis control strategies because of higher chances of mother to child transmission and higher probability of complications because of attendant antenatal and postnatal morbidity. Geriatric patients comprise another significant group because of higher chances of default, complications, inconvenience, and existence of other comorbid conditions.
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8
3,507
725
The role of long-term doxycycline in patients of idiopathic pulmonaryfibrosis: The results of an open prospective trial
Parthasarathi Bhattacharyya, Saikat Nag, Sujan Bardhan, Dipabali Acharya, Rantu Paul, Rana Dey, Malabika Ghosh, Ratna Dey, Indranil Saha
July-September 2009, 26(3):81-85
DOI
:10.4103/0970-2113.53231
PMID
:20442842
Objective:
To evaluate the effect of long term use of doxycycline in IPF patients.
Materials and Methods:
Patients of IPF, selected randomly from out patient services and diagnosed on the basis of HRCT chest, were put on doxycycline in an open prospective trial. They were followed up with monitoring of subjective well being along with measurement of pulse rate and arterial oxygen saturation at rest and after a fixed and certain exercise, forced vital capacity, six minutes walk test, St Georges Respiratory questionnaire, and serial chest X-rays.
Results:
Out of seven patients put on doxycycline, six of them continued the drug for a mean period of 531.43 (± 328.88 days). All the patients tolerated the drug well and had shown uniform subjective and overall objective improvement in all the parameters concerned; the change in the radiological parameter being statistically significant.
Conclusion:
Doxycycline merits an appropriate clinical trial in the management of idiopathic pulmonary fibrosis. This widely used and relatively safe drug can add a new dimension to the therapeutic regimen. However, further in-depth studies will be required to evaluate its role in the management of IPF.
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8
4,502
627
Clinical profile of patients having pulmonary tuberculosis and renal amyloidosis
Ramakant Dixit, Rakesh Gupta, Lokendra Dave, Nishi Prasad, Sidharth Sharma
April-June 2009, 26(2):41-45
DOI
:10.4103/0970-2113.48896
PMID
:20440393
Objectives:
This study was planned to define the clinical profile of pulmonary tuberculosis (PTB) patients having renal amyloidosis, to identify the factors responsible for development of amyloidosis, to detect the time period between onset of amyloidosis and PTB, and analyze clinical features of amyloidosis in PTB patients for early diagnosis and timely assessment.
Materials and Methods:
Patients of PTB having pedal edema, proteinuria, and grossly diseased kidneys on ultrasound abdomen were subjected to renal biopsy and appropriate biochemical investigations. Clinical profile of biopsy proven amyloidosis cases was analyzed.
Results:
There were 43 patients (32 males, 11 females, age range 20-65 years) having PTB with pedal edema, proteinuria, and renal medical disease on abdominal ultrasound where amyloidosis was confirmed by renal biopsy. The total duration of illness ranged from two months to seven years (mean 2.25 years) and was less than five years in 93% patients. All patients had significant proteinuria. Nephrotic syndrome was seen in 23, hypertension in 19, hypoalbuminemia in 33, hypercholesterolemia in 29, and deranged renal functions in 32 patients. Ninety percent patients had moderate to far advanced pulmonary lesions on chest radiography with smear positivity in 21 patients.
Conclusions:
Renal amyloidosis is an important complication of PTB and should be suspected clinically in patients presenting with a triad of pedal edema, proteinuria, and medical renal disease on ultrasound. Contrary to general belief, renal amyloidosis may occur in PTB patients having disease for relatively shorter duration, and even if adequately treated.
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Clinico-pathological profile of lung cancer in Uttarakhand
Jagdish Rawat, Girish Sindhwani, Dushyant Gaur, Ruchi Dua, Sunil Saini
July-September 2009, 26(3):74-76
DOI
:10.4103/0970-2113.53229
PMID
:20442840
Background:
Lung cancer is one of the most aggressive and prevalent type of malignancy causing high morbidity and mortality. Tobacco smoking continues to be the leading cause of lung cancer worldwide. An increasing incidence of lung cancer has been observed in India.
Objective:
The aim of this study was to evaluate the clinico, a pathological profile of the lung cancer in hilly state of Uttrakhand.
Materials and Methods:
We performed a retrospective analysis of histopathologically proven cases of bronchogenic carcinoma admitted in our hospital from January 1998 to August 2005.
Results:
Our study included 203 patients with confirmed cases of lung cancer. Male to female ratio was 8.2:1. The common age group being 40-60 years, 9.86% of the patients were less than 40 years old age. Smoking was found to be the main risk factor in 81.77% patients. The most frequent symptom was cough (72.90%) followed by fever (58.12%). The most common radiological presentation was mess lesion (46.31%). The most common histopathological type was squamous cell carcinoma (SCC) (44.83%) followed by adenocarcinoma (19.78%) and small cell lung carcinoma (SCLC) (16.75%). The majority patients (73.29%) were diagnosed in the later stages of the disease (III B and IV).
Conclusion:
It was found out that SCC was the most frequent histopathological form. SCLC predominates below 40 year and SCC over 60 years of age. Smoking still remains the major risk factors in pathogenesis of lung cancer.
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An alternative therapy for idiopathic pulmonary fibrosis by doxycycline through matrix metalloproteinase inhibition
Amartya Mishra, Parthasarathi Bhattacharya, Sumit Paul, Rantu Paul, Snehasikta Swarnakar
July-September 2011, 28(3):174-179
DOI
:10.4103/0970-2113.83972
PMID
:21886950
Background:
Idiopatiic pulmonary fibrosis (IPF) is a disease of dysregulated fibrogenesis with abnormal matrix metalloproteinase (MMPs) activity, angiogenesis, and profibrotic milieu wherein MMPs inhibition appears to be target-based therapy. We evaluated the role of doxycycline as a nonspecific inhibitor of MMPs in IPF patients.
Materials and Methods
: Patients of IPF diagnosed on the basis of ATS-ERS consensus criteria were put on oral doxycycline in an open prospective trial. They were followed up for long term with spirometry, 6 min walk test (6MWT), St. Georges respiratory questionnaire (SGRQ), forced vital capacity (FVC), and repeat bronchoscopy while on doxycycline monotherapy for over 24 weeks. Both the initial and follow-up broncho alveolar lavage fluids (BALF) from IPF patients (
n
= 6) and control subjects (
n
= 6) were looked for MMP-9, -3, tissue inhibitor of metalloproteinase (TIMP)-1 and vascular endothelial growth factor (VEGF) expression. Additionally, doxycycline's action on MMP activities
in vitro
was tested in BALF of IPF patients.
Results:
Doxycycline intervention showed significant improvement in IPF patients in terms of change in 6MWT, SGRQ, FVC, and quality of life. The level of MMP-9, -3, TIMP-1 and VEGF in the BALF were found significantly higher in the IPF patients compared to the controls while doxycycline therapy reduced those parameters nearer to control value. Doxycycline also showed a significant dose-dependent reduction in the
in vitro
MMPs activities in BALF.
Conclusion:
Doxycycline shows significant prospect in the treatment of IPF through its anti MMPs activities. This is the first report on a case series of long-term doxycycline monotherapy in IPF patients.
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REVIEW ARTICLE
Mycoplasma pneumonia
: Clinical features and management
Surender Kashyap, Malay Sarkar
April-June 2010, 27(2):75-85
DOI
:10.4103/0970-2113.63611
PMID
:20616940
Mycoplasma pneumonia
is a common respiratory pathogen that produces diseases of varied severity ranging from mild upper respiratory tract infection to severe atypical pneumonia. Apart from respiratory tract infections, this organism is also responsible for producing a wide spectrum of non-pulmonary manifestations including neurological, hepatic, cardiac diseases, hemolytic anemia, polyarthritis and erythema multiforme. This review focuses on molecular taxonomy, biological characteristics, epidemiology, clinical presentation, radiology and various laboratory tools in diagnosis, differential diagnosis, treatment and prevention of mycoplasma pneumonia.
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CASE REPORTS
Acute respiratory failure as a first manifestation of syringomyelia
Ali Al Bashapshe, Harsha Bhatia, Shahid Aziz
April-June 2010, 27(2):93-95
DOI
:10.4103/0970-2113.63614
PMID
:20616943
A 40 year old woman presented with a short history of acute onset of breathlessness to the ER of our hospital and after initial evaluation for acute pulmonary embolism which was ruled out after carrying out the appropriate investigations, she was diagnosed to be afflicted with syringomyelia based on her neurological symptoms and clinical findings, which was confirmed by doing an MRI scan, which was her basic diagnosis that was complicated by acute hypercapnic respiratory failure. This case is being reported to highlight syringomyelia as an unusual cause of acute respiratory failure, which manifested clinically in this patient as its first presentation and the underlying neurological diagnosis has been found to be present in very few reported cases (less than 0.01% of case reports) in the available literature as the basic disease in the absence of its classical presenting features. Problems associated with acute respiratory failure in the setting of syringomyelia are discussed.
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Unusual thoracic manifestation of metastatic malignant melanoma
K Manu Mohan, K Gowrinath
April-June 2010, 27(2):96-98
DOI
:10.4103/0970-2113.63615
PMID
:20616944
Massive pleural effusion due to metastatic malignant melanoma is rare. We report a case of bilateral (massive on left side) pleural effusion as a metastatic manifestation of cutaneous malignant melanoma. In our case, successful outcome of pleurodesis with vincristine is significant as this agent is rarely used.
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6
2,778
374
LETTERS TO EDITOR
Adverse drug reaction and causality assessment scales
Syed Ahmed Zaki
April-June 2011, 28(2):152-153
DOI
:10.4103/0970-2113.80343
PMID
:21712934
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6
5,211
708
ORIGINAL ARTICLES
Lung cancer in the Kashmir valley
Parvaiz A Koul, Satish Kumar Kaul, Mohammad Mushtaq Sheikh, Reyaz A Tasleem, Azra Shah
July-September 2010, 27(3):131-137
DOI
:10.4103/0970-2113.68309
PMID
:20931030
Background:
Lung cancer has been found to be the second commonest cancer according to a hospital-based data from Kashmir, India. However, no incidence studies are available.
Objective:
To ascertain the incidence of lung cancer in Kashmir.
Materials and Methods:
All newly histologically diagnosed cases of lung cancer seen in various hospital and private laboratories of the Kashmir valley were registered over a period of two years (January 1, 2004 to December 31, 2005). Also included were patients attending the various oncological service areas of the institute and those diagnosed from any other laboratory outside the state. The incidence rate was calculated using the January 2005 population as the reference population estimated using the census-based projected populations.
Results:
Four hundred and sixty-two incident cases of lung cancer were seen during the study period. The crude incidence rate, age standardized (world) and truncated age adjusted (40-69 years, world) incidence rates for lung cancer per 100 000 population were 4.01, 6.48 and 15.28 respectively (males 6.55, 10.09 and 23.94 respectively and females 1.19, 2.14 and 4.65). The age adjusted rates for males in district Srinagar was 19.34 per 100 000. One hundred and fifty nine (69.8%) of the 221 had a history of Hukkah smoking.
Conclusions:
Even though Kashmir as a whole is a low incidence area for lung cancer (ASR of < 15), Srinagar district has the highest incidence of lung cancer among the males in Kashmir. The data presented is assumed to be the closest approximation to a population-based data registry and the geographical incidence maps of ICMR need appropriate updating
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6
9,863
686
Respiratory effects of air pollutants among nonsmoking traffic policemen of Patiala, India
Sharat Gupta, Shallu Mittal, Avnish Kumar, Kamal D Singh
October-December 2011, 28(4):253-257
DOI
:10.4103/0970-2113.85685
Background:
Air pollution due to road traffic is a serious health hazard and thus the persons who are continuously exposed, may be at an increased risk. Although several studies have confirmed the ill effects of air pollutants on the lung function of traffic policemen, only a few have investigated the relationship between respiratory health and duration of exposure in this category of occupationally exposed persons.
Aim:
The study was carried out with the aim of evaluating the extent of impairment in lung function in traffic policemen in respect to an unexposed control group having the same age group.
Materials and Methods:
A cross-sectional study was conducted in which the spirometric parameters of a group of 100 nonsmoking traffic policemen, aged 20-55 years, working in and around Patiala city, were compared with those obtained in an age-matched control group, consisting of 100 healthy males, serving in the Punjab Police, who have never done traffic duty and are thus not exposed to traffic pollution. Lung function was done with MEDSPIROR. The data on the overall health status of the subjects was collected using the standard Respirator Medical Evaluation Questionnaire. The statistical analysis was carried out with SPSS PC software version 13.
Results:
Traffic policemen recorded a significant decline in various parameters, such as forced vital capacity (FVC), forced expiratory volume in one second (FEV
1
), and peak expiratory flow rate (PEFR) when compared with controls, and is probably due to exposure to vehicular pollution. It was also observed that in traffic policemen with >8 years of exposure, the values of FVC (2.7 L), FEV
1
(1.8 L), and PEFR (7.5 L/s) were significantly lower than those obtained in traffic policemen with <8 years of exposure, in whom the values were 2.9 L, 2.3 L, and 7.7 L/s for FVC, FEV
1
, and PEFR, respectively.
Conclusion:
The effect of pollution by vehicular exhausts may be responsible for these pulmonary function impairments.
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797
Effect of upper limb, lower limb and combined training on health-related quality of life in COPD
Subin , Vaishali Rao, V Prem, Sahoo
January-March 2010, 27(1):4-7
DOI
:10.4103/0970-2113.59260
PMID
:20539763
Objectives:
To study the effect of unsupported upper limb and lower limb exercise training and their combined influence on the exercise performance and health-related quality of life in COPD patients.
Materials and Methods:
Thirty patients were randomly assigned to one of the three groups, through block randomization. Of the three groups, group A received upper limb training, group B received lower limb training, and group C received both upper and lower limb training. Patients in group A, B, and C underwent exercise training five times a week for four weeks. The outcome measures used in the study were unsupported upper limb endurance test (UULEX),
Six-Minute Walk Test (6-MWT), and a Chronic Respiratory Questionnaire. Statistical analysis was performed with analysis of variance, Wilcoxon scale, and a Kruskal Wallis one way ANOVA test, and a
P
value of .05 was used in the study.
Conclusion:
The combined upper limb and lower limb training group showed a significant improvement in the exercise performance and health-related quality of life.
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1,102
REVIEW ARTICLE
Tuberculosis chemotherapy in the 21
st
century: Back to the basics
Jyotsna M Joshi
July-September 2011, 28(3):193-200
DOI
:10.4103/0970-2113.83977
PMID
:21886955
The key to successful elimination of tuberculosis (TB) is treatment of cases with optimum chemotherapy. Poor chemotherapy over time has led to drug-resistant disease. Drug resistance of
Mycobacterium tuberculosis
develops by the selective growth of resistant mutants. The incidence of drug-resistant cases depends on the number of bacilli and the drug-resistant mutants in the lesion. The latter is low for individual drugs and even lower for two and three drugs. Therefore, use of combination chemotherapy with three or more drugs results in cure. However, irregular treatment, inadequate drugs, inadequate drug doses or addition of a single drug to a failing regimen allows selective growth of resistant mutants and acquired drug-resistant TB. Contacts of these resistant cases develop primary drug resistant TB. Thus, drug resistance in tuberculosis is a "man-made problem". Anti-TB chemotherapy must be given optimally by (i) ensuring adequate absorption of drugs, (ii) timely diagnosis and management of drug toxicities and (iii) treatment adherence. New classes of anti-TB drugs are needed; but are unlikely to become available soon. It is vital that the 21
st
century physicians understand the basic principles of TB chemotherapy to ensure efficient use of available drugs to postpone or even reverse epidemics drug-resistant TB.
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