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ABSTRACTS
Year : 2013  |  Volume : 27  |  Issue : 1  |  Page : 57-83

ICAAICON 2012 - Abstracts


Date of Web Publication17-Aug-2013

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How to cite this article:
. ICAAICON 2012 - Abstracts. Indian J Allergy Asthma Immunol 2013;27:57-83

How to cite this URL:
. ICAAICON 2012 - Abstracts. Indian J Allergy Asthma Immunol [serial online] 2013 [cited 2017 Mar 22];27:57-83. Available from: http://www.ijaai.in/text.asp?2013/27/1/57/116607

ICAAICON 2012

Role of Multiplanar Computed Tomography in Allergic and Autoimmune Pulmonary Pathologies

Dr. Amit Nandan Dhar Dwivedi, Dr. Shiwani Gupta


Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

An autoimmune disorder is an illness in which the body begins to attack its own healthy cells, producing inflammation and an overproduction of collagen, a naturally occurring protein that helps make up connective tissue and maintain skin elasticity. While some autoimmune diseases attack a specific part of the body, many autoimmune diseases can attack several organs in the body. The lungs are one of the most commonly affected organs. The systemic autoimmune diseases include collagen vascular diseases, the systemic vasculitis, Wegener granulomatosis, and Churg-Strauss syndrome. They can cause a variety of thoracic abnormalities that are influenced by the pathophysiologic characteristics of the underlying disease process. Although many of the abnormalities can be detected at chest radiography, high-resolution computed tomography (CT) has been shown to be superior in depicting parenchymal, airway, and pleural abnormalities. Thoracic manifestations of collagen vascular diseases include pleural disease, pulmonary fibrosis, diaphragm weakness, aspiration pneumonia, bronchiolitis obliterans organizing pneumonia, bronchiolitis obliterans, and bronchiectasis.

The lungs are particularly prone to allergic reactions because they are exposed to large quantities of airborne substances that commonly cause allergic reactions (called antigens), including dusts, pollens, fungi, and chemicals. Exposure to irritating dusts or airborne substances, often when a person is at work, may increase the likelihood of an allergic respiratory reaction. Allergic reactions involving the lungs may also occur from eating a certain food or taking a certain drug. The body reacts to an antigen by forming proteins that react with antigens (antibodies). In a normal immune response, antibodies typically bind to an antigen, thereby rendering it harmless sometimes; however, when the antibody and antigen interact, inflammation, and tissue damage occur; this is called an allergic reaction. Allergic reactions are classified by the various mechanisms that are involved in causing the tissue damage. Many allergic reactions involve a combination of more than one type of tissue damage. High-resolution CT manifestations of allergic pathologies include thickening of the bronchial wall, narrowing of the bronchial lumen, areas of decreased attenuation and vascularity on inspiratory CT scans, and air trapping on expiratory CT scans. Other findings that are seen are bronchiectasis and emphysema. Disease specific findings like in Allergic Broncho-pulmonary Aspergillosis (ABPA) include homogeneous tubular, finger-in-glove or branching endobronchial opacities and bronchiectasis involving mainly the segmental and subsegmental bronchi of the upper lobes. Findings in chronic eosinophilic pneumonia include bilateral areas of consolidation mainly affecting the peripheral regions of the middle and upper lung zones. The predominantly peripheral distribution of consolidation is evident on radiography in approximately 65% of patients and on high-resolution CT in 95% of patients.

Occupational Exposure to Airborne Fungi and Bacteria in a Garment Manufacturing Unit

Dr. Arun Jyothi Mathias, Dr. K. Manjunath 1


Department of Microbiology, Maharani's Science College for Women, 1 Department of Microbiology and Biotechnology, Bangalore University, Bangalore, Karnataka, India

Inhalation of dust released during handling of plant fibers from cotton may cause respiratory disorders in exposed workers. Around 2931 garment manufacturing units are operating in Karnataka, out of which 2638 units are located in Bangalore where women form 93% of the workforce. The present analysis concentrates both on bioaerosols and self-reported health symptoms. Air sampling was performed at five different sections of the garment manufacturing unit and a control site to assess the concentrations of bacteria and fungi. Staphylococcus aureus, Micrococcus luteus, Micrococcus roseus and Penicillum spp. were present in all sections of the garment manufacturing unit. Staphylococcus epidermidis, Micrococcus lylae, Micrococcus sedentarius, Aerococcus spp., Stomatococcus mucilaginosus, Aspergillus niger, Curvularia spp., Rhizopus spp., Mucor spp., and Yeasts were present in more than 3 sections of the examined facility. A total of 45 species or genera of bacteria and 21 species or genera of fungi were identified. From the air of the control site, 12 species or genera of bacteria and 5 species or genera of fungi were identified. Out of this, 6 species or genera of bacteria and 7 species or genera of fungi were reported to have allergenic and/or immunotoxic properties. A total 10 of administrative staff (Control), 22 workers of cutting section, 21 of sewing section, 15 of finishing section, 8 of garment sampling section and 16 of packing section responded to the questionnaire study to assess health-related symptoms. The workers reported pronounced "respiratory symptoms" "irritation symptoms" "neurological symptoms." It is necessary to come up with appropriate measures to manage these workers on a continuous basis.

Foreign Body Aspiration in Children and Its Management

Prof. A. N. Gangopadhayay, Dr. Vaibhav Pandey


Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Foreign body aspiration is a major cause of morbidity and mortality in children. Foreign body aspiration has remained a consistent problem since decades with 80% of all aspirations occurring in children. Definite history of sudden onset of choking followed by cough, respiratory distress, localized wheeze, and radiological evidence of pulmonary collapse or emphysema makes the diagnosis easy. Many cases are treated for years as recurrent or unresolved pneumonia, bronchial asthma or pulmonary tuberculosis. In such cases, initial incident is either trivial, unobserved, forgotten by parents or remains undetected due to low index of clinical suspicion by the caring physician. Impacted foreign bodies, which are undiagnosed for years cause permanent lung damage. This can result in lung abscess or bronchiectasis requiring segmental/lobar resection or pneumonectomy. Although pneumonia is the most common cause of cough and respiratory distress in children, foreign body inhalation is not an uncommon problem.

Role of Holistic Approach in the Management of COPD-De Novo Concept

Dr. Abhishek Srivastava, Dr. Nishith Kumar


Department of Pulmonary Medicine, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term to define a wide variety of disorder encompassing not only airways and lungs, but also other systems of the human body. Despite advancements in early diagnosis and management of COPD, the disease continues to be a major cause of morbidity and mortality throughout the world. The recent data is worrisome as COPD is expected to become 3 rd leading cause of death by the year 2020. Living with COPD can be challenging as the disease dramatically affects patient's daily life. Chronic airflow limitation together with muscle wasting, anxiety-depression, ongoing lung damage due to smoking/occupational exposure plays a significant role in overall impact on the disability caused due to the disease. There is a growing consensus among the researcher and practitioner alike regarding the importance of treating the disease as a whole and not just its respiratory component. Thus, apart from regular pharmacotherapy a holistic approach of treatment taking into consideration all aspects of patient's need that is physical, mental, social, and spiritual is call of the hour and can complement the existing modality of treatment.

Bronchial Asthma in Children

Dr. Abhishek Abhinay, Dr. O. P. Mishra, Dr. Rajniti Prasad


Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Asthma is a chronic inflammatory disorder of the airways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy. Airway inflammation is the result of interactions between various cells, cellular elements, and cytokines. In susceptible individuals, airway inflammation may cause recurrent or persistent bronchospasm, which causes symptoms that include wheezing, breathlessness, chest tightness, and cough, particularly at night (early morning hours) or after exercise. Airway inflammation is associated with airway hyperreactivity or bronchial hyperresponsiveness, which is defined as the inherent tendency of the airways to narrow in response to various stimuli (e.g. environmental allergens and irritants). According to world health organization (WHO) estimates, 300 million people suffer from Asthma, 255,000 people died of Asthma in 2005 (WHO 2004), and over 80% of Asthma deaths are reported from low and lower-middle income countries. Asthma creates a substantial burden on individuals and families as it is more often under-diagnosed and under-treated. In India, an estimated that 57,000 deaths were attributed to Asthma in 2004 (WHO 2004) and it was seen as one of the leading cause of morbidity and mortality in rural India. Though effective screening, evaluation, and management strategies for Asthma are well-established in high-income countries, these strategies have not been fully implemented in India as evidence had previously suggested that Asthma is not to be treated independently, but fitted into the general spectrum of respiratory diseases.Furthermore, even though medicines that treat Asthma effectively are available at affordable costs, they rarely reach more than 1% of those who would benefit from it.

Effect of CPAP Therapy on Hypertension in Patients of Obstructive Sleep Apnea Syndrome

Dr. Moosa Hussain, Dr. S. C. Matah


Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Introduction: A main cause of secondary hypertension is obstructive sleep apnea (OSA) and OSA commonly co-exist with hypertension. This hypertension results due to sympathetic nervous system over activity and oxidative stress leading to alteration of vascular structure and function. In these patients, during apneic episodes, there is an increase in systolic and diastolic pressure. And in most of the patient's blood pressure (BP) remain elevated during daytime even when breathing is normal. Continuous Positive Airway Pressure (CPAP) treatment abolishes the apneas and prevent intermittent arterial pressure surges and nocturnal variation of BP, with some beneficial effect on daytime BP. Cardiovascular risk is greatly reduced with a small decrease of BP.

Objectives: To find out the effect on BP after 6 months of CPAP therapy in non-symptomatic hypertensive patients with OSA.

Materials and Methods: A total of 23 hypternsive patients with OSA were evaluated. Patients were included if apnea hypopnea index is greater than 15/h, and if the patient was having systolic BP greater than 140 or diastolic BP greater than 90 mmHg or patient was under antihypertensive treatment. These patients were prescribed CPAP therapy after CPAP titration. BP was evaluated at baseline and at 3 and 6 month.

Results: The mean age of patients were 50.17 ± 5.46 years with a mean BMI of 30 ± 3 kg/m 2 . There was a small change in mean systolic and diastolic BP after CPAP treatment. The average decrease in systolic pressure in 6 months CPAP treatment was 1.391 (95% CI: 1.053 to 1.730) mmHg (P = 0.00) and diastolic average decrease in diastolic pressure was 1.826 (95% CI: 1.219 to 2.433) mmHg (P = 0.00). More than 4 h per night use of CPAP treatment has more effect on BP.

Conclusions: Hypertensive OSA patients when treated with CPAP for more than 4 h per night have a small decrease in BP.

Interpretation of Arterial Blood Gases: A Concise Review

Dr. J. K. Mishra, Dr. Arvind K. Misra


Department of TB and Chest, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh

Improper oxygenation, ventilation, and acid base balance may lead to several life-threatening situations. Analysis of arterial blood gases (ABG) is a very handy tool that can add to the rapid diagnosis in critically-ill and high-risk patients. It not only provides fundamental information regarding oxygenation, ventilation, and acid base status, but also informs about several other parameters such as hematocrit, serum osmolality, etc. However, at times, interpretation of ABG is confusing and time consuming. Therefore, arises the need to formulate a systematic stepwise approach that enables us to analyses ABG correctly and rapidly. This review article not only helps in understanding the salient features of methodology of ABG and disorders related to oxygenation, ventilation, and acid base balance, but also discusses the role of ABG in various situations.

Key words: Arterial blood gases analysis, anion gap, corrected anion gap, mixed acid base disorders, delta gap, hypoxia stimulation testing

Pathophysiology of Bronchial Asthma

Dr. Tariq Mahmood, Dr. Ravi Bhaskar, Dr. Surya Kant


Department of Pulmonary Medicine, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India

Asthma is characterized by intermittent airflow obstruction, airway inflammation and bronchial hyperresponsiveness, which leads to recurrent symptoms of brief duration and exacerbations. The inflammatory response in asthma is the manifestation of activation and complex interactions between many inflammatory cells and their molecular mediators within the lungs. Due to chronic inflammation, there are marked changes in structure of the bronchi, which include denuded epithelium and altered subepithelium characterized by collagen deposition, smooth muscle hypertrophy, and hyperplasia. Each cell type exerts effector and regulatory functions in the pathogenesis of asthma as described below.

Asthma and COPD: Differences in Pathophysiology and Novel Therapeutic Approaches

Dr. Pawan Yadav, Prof. J. K. Mishra


Department of TB and Chest, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Asthma and COPD are both obstructive lung diseases defined by inflammation of the airways. However, the similarities end here, their pathophysiologies and treatment responses are visibly different. The response to treatment between asthma and COPD also differ markedly. The eosinophilic inflammation in asthma is more readily suppressed by corticosteroids, which inhibit almost every aspect of the inflammatory process. Such differences are being explored increasingly in recent times to devise more specialized therapies that are effective and inflict least collateral damage. Apart from the hallmark persistent airway inflammation, the pathophysiology of COPD is characterized by protease-antiprotease imbalance and increased oxidative stress. While several new molecular targets that regulate airway inflammation such as NFkB, PI-3 kinase PDE 4, and HDAC are being defined for treating COPD strategies to curtail proteolytic/oxidant damage have emerged that includes N-acetyl cysteine and inhibitors of matrix metalloproteinases and neutrophil elastase among others. Airway hyperresponsiveness (AHR) a characteristic physiologic abnormality in asthma, is strongly linked to eosinophilic inflammation as opposed to a predominant neutrophilic infiltration in COPD. CD 4.1 T lymphocytes (T-helper type 2 cells) seem to regulate this eosinophilic inflammation and mast cell degranulation that underlies the rapid and episodic bronchoconstrictor responses of asthma. Evidently approaches to target IL5, an eosinophilic growth factor have shown promise in treatment of asthma. More interesting therapies such as TLR9 agonists that switch the unfavorable Th2 responses in asthma to the cytotoxic Th1 immune response are also being explored. Thus, with ever increasing understanding of distinct pathological processes in these airway diseases the therapeutic possibilities are also rapidly expanding. It remains to seen, however, as to how these evolving treatments impact the disease outcome.

Prevention of Allergy: An Ayurvedic

Prof. G. S. Tomar


Department of Kayachikitsa, SLBSS Government Ayurvedic College, Handia, Allahabad, Uttar Pradesh, India

Allergy refers to a condition of being un-usually sensitive to something eaten, breathed in and touched, in a way that causes pain or suffering. The term allergy originally included immunity and hypersensitivity both, but it is now restricted to the later. In western medicine, an allergy is supposed to be the cause of various disorders, particularly, skin diseases and respiratory problems. It is necessary here to discuss certain fundamental factors regarding concept of allergy. Nature or environment is an essential factor which influences human body at every stage. Proper or improper tuning with environment is responsible for health and disease respectively. Adaptability to environment is one of the characteristic and peculiar features of living organisms. The environment influences the individual in various ways, such as weather, geographical conditions, nature of soil, social tendencies, bacterial saturation, and similar other conditions. Charaka expresses this fact as a philosophical axiom. He has emphasized that the continued existence or otherwise of all creature is dependent on the proper, inadequate, excessive or wrong interactions between them and their environmental factors. Therefore, "Man cum Environment" is the unit study of medical sciences and life is considered as a dynamic process of continual adjustment with environment, which has time and space as its constituents.

Pulmonary Rehabilitation

Dr. G. N. Srivastava


Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

What is pulmonary rehabilitation? It is a form of individually tailored treatment strategies that includes patient and family education, breathing training, breathing exercises, physical reconditioning and in selective cases, home oxygen. In addition, pulmonary rehabilitation required attention to good nutrition, positive health habits, and a new outlook on life designed to enhance the happiness of the individual. Pulmonary rehabilitation probably does more to improve life quality than anything else and it certainly does so by keeping patients active and living at home rather than in hospitals or extended care facilities. Pulmonary rehabilitation in all its forms has shown that practically "everyone" is doing rehabilitative work with chronic and acute lung-diseased patients. A closer look reveals that "every-one;" however, is doing it in vast and varying degrees, and very few are applying all its principles and techniques. Indeed, even fewer are aware of the total spectrum available to the practitioner and his patient.

Epidemiology of Respiratory Infections and Allergies: The Indian Context

Prof. S. C. Mohapatra, Prof. Archisman Mohapatra 1


Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, and I NCLEN International, New Delhi, India

Respiratory diseases (trachea, bronchus and lung cancers, lower respiratory infections and chronic obstructive pulmonary diseases) have been noted among the top ten killers across high, middle, and low income countries by the World Health Organization (WHO, 2008). For India, the WHO had projected that chronic disease would be attributed 53% of all deaths in 2005 (WHO), 7% of which would be due to chronic respiratory diseases. Still, these have not caught the attention of epidemiologists as much as the cardio-vascular disorders or diabetes mellitus or even, morbidities such as obesity or under-nutrition; and whatever research has been conducted has mostly restricted itself to the study of pulmonary tuberculosis, asthma and Chronic Obstructive Pulmonary Disease (COPD) . The probable reason seems to be the usual non-acute presentation of most respiratory ailments (the reason why an unusual exacerbation of asthma or COPD or even a sudden flu epidemic engages so many of brains and eyes!). The detailed study of these diseases is usually taken up only when they are considered as epidemics. Consequently, mega-scale epidemiological assessments of chronic respiratory illnesses are mostly lacking in India and whatever research has been undertaken is marred with inadequate sample size and lack in uniformity of definitions, designs, methodologies and reporting techniques (Jindal, 2006). While diseases that occur in common have been described with reference to their time, place and person distributions and compared in indices of absolute numbers and proportions, relatively rare morbidities have been enumerated in the form of case studies. The economic impact and overall burden of ailments have also been highlighted by researchers. The chronicity of the conditions and incapacitating impact on the sufferer's life warrants a close look at the distribution and determinants of the common respiratory morbidities. While the Tuberculosis - human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) linkage has become the cynosure of attention of health programmer's world-wide, the figuring in the United Nations Millennium Development Goals (MDG 6: Combat HIV/AIDS, malaria and other diseases) is evidence of the concern it demands (UN).

Thus, even as, scientific characterization of the respiratory illnesses is infantile, the policy implications are quite conspicuous. As an example, respiratory system involvement in various occupational set-ups has led to redrafting of many an employee compensation act as well as development of pertinent preventive strategies. Notwithstanding, the fact that each disease and the life it impairs are important, this chapter shall discuss the epidemiology of respiratory diseases of major public health importance.

The Value of Tools to Assess Pulmonary Arterial Hypertension

Prof. S. K. Agarwal, Dr. Anuj Mehrotra


Department of TB and Chest, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Pulmonary hypertension is a common, but complex clinical problem. When suspected in an appropriate clinical setting or detected incidentally, an array of investigative tools are employed with an intent to confirm the diagnosis, define etiology, evaluate the functional and hemodynamic impairment, define treatment options, monitor the therapy, and establish long-term prognosis. However, no single tool provides comprehensive information that encompasses the aforementioned aims. Therefore, judicious use of these tools is of paramount importance, in order to maximize outcome and cost-effectiveness while minimizing the risks and redundancies. Furthermore, a number of promising tools and techniques are emerging rapidly in the arena of pulmonary hypertension. These tools augment our understanding of pathophysiology and natural history of pulmonary hypertension. There is, therefore, increasing need for validating these emerging paradigms in multicenter trials. In this review, we focus on the tools commonly used to evaluate pulmonary arterial hypertension.

Emerging Treatment Options in Asthma

Dr. Satyadeo Choubey


Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Asthma is a global health problem with approximately 300 million affected individuals. Moreover, with the changing population demographics with increasing industrialization and improving living standard of people, the number as per the hygiene hypothesis is bound to rise. Current available pharmacotherapies have apart from side-effects several limitations including difficult to treat asthma and steroid resistant asthma. These unmet needs clearly demands some improved treatment modalities. Recent therapies having US FDA approval for use in asthma are omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, and bronchial thermoplasty that involves the delivery of radio frequency energy to the airways to reduce airway smooth muscle mass. In addition, several new therapies are under development, which may come to the market in next 5 years. Important ones are biological agents targeting pro-inflammatory cytokines such as interleukin-5 and interleukin-13, inhaled ultra LABAs and once daily inhaled corticosteroids. In addition, drugs blocking various levels of arachidonic acid pathway that targets neutrophilic asthma and CRTH2 receptor antagonists that inhibit the proinflammatory actions of prostaglandin D2 may become available. This chapter is to review the recent progresses, new emerging therapies, and basic ideas behind these novel therapies.

Sleep Disordered Breathing in Patients with Allergic Rhinitis and Nasal Obstruction

Prof. S. C. Matah, Dr. Moosa Hussain, Dr. Kanika Awotar


Department of TB and Chest, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India

The first anatomical boundary of the upper airway is the nose, so any obstruction in it may cause sleep disordered breathing (SDB). SDB is found to be associated with nasal obstruction due to allergic and non-allergic causes. Allergic rhinitis is highly prevalent throughout the world and is very often associated with SDB, which is thought to decrease the quality of life in these patients. Nasal obstruction due to allergic rhinitis and other causes, such as septal deviation, enlarged inferior turbinate and nasal polyps, can cause sleep impairment. There is controversy about the role of allergic rhinitis with nasal obstruction in the pathogenesis of obstructive sleep apnea (OSA). Mechanism of SDB in nasal obstruction has been demonstrated by the several pathophysiological mechanisms, which includes inflammatory mediators, the unstable oral airway, the nasal ventilator reflex, the role of nitric oxide and from models like Starling resistor model. Studies have shown that there is no improvement of OSA with the use of nasal dilating stents, but an improvement in quality of life, daytime fatigue and sleep impairment has been found with the use of nasal decongestants of which intranasal use of steroids and montelukast have a greater role. Nasal surgery has shown to improve the quality of life and snoring in mild SDB and septal deviation, but it is not a treatment for OSA.

Key words: Allergic rhinitis, nasal obstruction, obstructive sleep apnea, sleep disordered breathing

Significance of Smaller Airways in Bronchial Asthma

Dr. J. K. Samaria


Department of Chest Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Recent advances in biopsy methods, improvements in lung function measurements and novel imaging modalities have renewed interest in the distal lung in asthma and provided better insight into the role of the small airways in asthma. The pathophysiology of asthma involves inflammatory and structural changes that have, for the most part, been described in the large airways. Due to technical considerations, it has been considerably easier to sample the large airways in human asthmatic patients, for example, by induced sputum to assess inflammation and endobronchial biopsy to evaluate the structural remodeling. However, a number of studies investigating lung tissue from autopsy and surgical resections have indicated that eosinophilic inflammation also occurs, often to a greater degree, in the small airways (<2 mm lumen diameter) of asthmatic patients. The small airways have also been shown to express increased levels of a number of key cytokines and chemokines in the distal lung, including interleukin (IL)-4, IL-5, eotaxin and monocyte chemotactic protein-4. In terms of lung function, the idea that the distal lung is a "quiet zone," which is responsible for only 10% of airway resistance, has been challenged by recent advances in the assessment of small airway resistance by frequency dependent techniques. Invasive techniques have also been further developed, such as trans bronchial biopsy, which can be used to monitor both inflammation and remodeling in the small airways of asthmatic patients. Advances have also been made in the measurement of functional parameters of the small airways.

Aerobiological and Proteomics Study of Phoenix Sylvestris Pollen Allergy

Dr. Bodhisattwa Saha, Dr. Pampa Chakraborty 1 , Dr. Naren Pandey 2 , Dr. Swati Gupta Bhattacharya


Division of Plant Biology, Acharya Prafulla, Chandra Road, Kolkata, 1 Sree Chaitanya College, Habra, 2 Allergy and Asthma, MP Birla Research Centre, Kolkata, West Bengal, India

Objective: The objective of this study is to prove that date palm (Phoenix sylvestris) pollen is an important aeroallergen causing type 1 hypersensitivity in a significant proportion of Human beings living in and around Kolkata Megacity and to identify the major allergenic protein through proteomics and other biochemical techniques.

Materials and Methods: Two year aerobiological study was conducted using the Burkard volumetric sampler. Allergenicity of Phoenix sylvestris pollen was tested through skin prick test, Lung Function Test and ELISA. Proteins from pollen grains were obtained by initially defatting and then extracted with sodium phosphate buffer and further purification by G25 column. Total protein was divided into four fractions by ammonium sulphate at 25%, 50%, 75% and 100% respectively. SDS PAGE was performed with the 50% fraction (positive result obtained from ELISA) and subsequently western blotting was performed. Two dimensional gel electrophoresis and immunoblotting was also performed from the crude protein. Glycoprotein staining was also performed to ascertain biochemical nature of the allergenic proteins.

Results: The total protein from pollen was separated on a SDS PAGE gel showed 25 prominent bands by Coomassie Blue staining. Western blot with patient specific sera gave four protein bands out of which a major band was obtained at 30 Kd. This result was obtained in more than 70% of the patients. One of the band was glycoprotein in nature. 2D gel electrophoresis of the crude protein sample was performed, which showed 109 protein spots in the PI range of 3-10 and molecular weight 14-97 Kd. Immunoblotting the 2 D gel with pooled patient specific sera showed five spots thus implying IgE reactivity. Few of the spots were also glycoprotein in nature implying that glyco moiety may be responsible for allergenicity.

Conclusion: Thus, Phoenix sylvestris pollen grains are very common in the air and are an important airborne allergen. Moreover, the 30 Kd protein may be responsible for allergenicity.

Immuno-proteomic Identification of Major Aeroallergens From a Common Indoor Mold Rhizopus Oryzae Went and Prins

Dr. Geerl Gaurab Sircar 1 , Dr. Swati Gupta Bhattacharya


Division of Plant Biology, Bose Institute, Kolkata, and 1 B. M. Birla Medical Research Center, Kolkata, West Bengal, India

Objective: The objective of this present study is to detect IgE reactive molecules from Rhizopus oryzae (RO) a predominant airborne mold in the air of Kolkata, using immuno-proteomics and to evaluate its potential as a cross reactive aeroallergen causing allergic rhinitis and nasobronchial allergy.

Materials and Methods: A total of total 132 patients were tested with crude antigenic extract by Skin Prick Test. Specific IgE titer was examined by ELISA using the sera of patients showing +ve cutaneous response. Total fungal protein was resolved in SDS-PAGE, immunoblotted with fourteen individual patient serum and Periodic Acid Schif's staining was performed to detect the IgE reactive glycoproteins. Two Dimensional gel electrophoresis was performed and also immunoblotted with pooled sera. IgE reactive spots were excised, trypsin digested and identified by Tandem Mass Spectrometry (MALDI-TOF-TOF). Periodate modification of blot was performed to study the antigenic determinant of sugar moiety. Several bioinformatic tools and comprehensive allergen databases such as Allermatch, T-coffee alignment, Full FASTA alignment with SDAP-were used for assessing the allergenicity of the major allergen. In-silico analysis was performed to predict the cellular localization and signal peptide.

Results: Nearly, 64% patients were found RO positive and 21 of them with high titer of specific IgE. Immunoblots confronted with sera of atopic individuals revealed seven IgE reactive zones of which 44 KDa was observed in overwhelming majority of sera and considered as major allergen. In 2 D immunoblot, 14 IgE reactive zones were identified. Some of these spots were identified as proteins already reported as allergen from other molds or members of allergen families and others as novel allergens. The major 44 kDa protein was identified as non-cytosolic Aspartyl endopeptidase containing 20 amino acid long signal peptide. This is a glycoprotein, but with an epitope of peptidic nature. It shows significant homology and hit identity with a cockroach allergen Bla g 2 and mold allergen Asp f 10.

Conclusions: Exposures to RO in environments where it naturally occurs may confer risk of IgE-mediated sensitization in atopic individuals and the identified proteins (major 45 kDa endopeptidase), if purified, can be used for successful allergy diagnosis and possible immunotherapy.

Aero-allergen Sensitivity among Patients Suffering from Bronchial Asthma in Bangalore, Karnataka, India

Dr. Giriyanna Gowda, Dr. Chitra Nagaraj, Dr. B. G. Parasuramalu, Dr. Huliraj


Allergy center, Kempegowda Institute of Medical Sciences, Hospital and Research Center, Bangalore

Background: Asthma is a serious public health problem throughout the world. The prevalence of asthma has increased in last two to three decades possibly due to change in indoor and outdoor environment. Allergens are one of the many factors which trigger an attack of asthma. Skin prick test is useful in identifying the offending allergen in bronchial asthma.

Materials and Methods: The study was conducted at allergy center, Kempegowda Institute of Medical Sciences Hospital and Research Center, Bangalore from January 2011 to December 2011. Skin Prick Test was performed in 139 patients suffering from bronchial asthma diagnosed based on GINA guidelines. Skin Prick Test was performed using 49 allergens extracts after taking informed consent from the patients. Allergen extracts included 19 pollens, 10 fungi, 5 dusts, 2 dust mites (Dermatophagoides farinae and Dermatophagoides pteronyssinus), 10 insects and 3 epithelia.

Results: Out of 139 patients who underwent skin prick test, 40% (56) were males and 60% (83) were females. Majority i.e. 60% were in the age group of 21-40 years. 43% (60) had family history of asthma/atopy. Nearly, 80 % (111) had allergic rhinitis, 24% (34) had chronic urticaria and 24% (33) had allergic conjunctivitis. Out of 139 patients 100 (71.94%) were sensitive for one or more allergens. The common offending allergens found in the study were dust mites (DF and DP)-49.28%, dusts-7.2%, pollens-6.77%, insects-6.62%, fungi-4.53%, epithelia-1.92%. Comparison of asthmatics between those with positive skin prick test and negative skin prick test is performed. Those with positive skin prick test had age of onset <20 years and family history of asthma compared to negative skin prick test patients and found statistically significant (P < 0.05).

Conclusion: The most common allergens in bronchial asthma were dust mites followed by dusts and pollens.

"Ayurism" a Clear Cut Ayurvedic and Yogic Scientific Concept of Holistic Living Medicine and Environmental Health Maintenance

Dr. Vaidya Gyaneshwarsing Guddoye


IPGT and RA and PGDYN from MPIYNER, Gujarat Ayurved University, Jamnagar, Gujarat, India

Ayurveda has been the first system of holistic medicine since time immemorial in Bharat with the clear cut holistic parameters and health maintenance based on environmental understanding. Life-style disorders like diabetes mellitus, hypertension, obesity, heart diseases, and world threatening diseases such as acute respiratory infections, diarrhea etc. are nicely, cheaply and with no side effect holistically manage through Ayurvedic drugs and life-style. This special and unique approach of this life-style living program with Ayurvedic holistic drugs have a great potential, which need to be scientifically expose to the world population as a great potential in propagation of cheap holistic medicine through environmental understanding.

Materials and Methods: A clear cut plan through a 4 level modules in a living camp and assessing its improvement through (1) a quality life scale (2) an Ayurvedic scoring chart for Swasthaya, which can be used to evaluate its holistic effect on our health.

Result Potential: The results obtained from 1000 participants can be assessed, evaluated, and can be used as one of the platform for generating policies in country of the world where holistic medicine program has not been recognized or implemented for enhancing the quality of life.

Discussion: This scientific evaluated module needs to get implemented through a World Holistic Medicine committee with WHO and in collaboration with respective Non Government Organization (NGO) in local countries. Then, there will be a great potential for visualizing global holistic health-care through environmental understanding if persistently working together.

Key words: Ayurism, clear cut, global health care potential, holistic medicine

Respiratory Allergy Related to Hospitalization

Dr. Himadri Shekhar Chakrabarti, Dr. Swati Gupta-Bhattacharya


Division of Plant Biology, Bose Institute, Kolkata, India

In India more than 70% of the total allergic patients are suffering from respiratory allergy, of which 35% are due to fungal aeroallergen. The aims of this study were (1) To study the prevalent fungal aero-allergenic fungal species (both qualitative and quantitative) in the air of Kolkata analyzing their periodic patterns and determinant climatic factors; (2) to develop a weekly prediction model of aerospores (3) to study the clinical contribution to manifestation of respiratory allergic symptoms amonglocal population as well as related hospitalization, and (4) to identify as well as characterize the major allergen in Trochoderma harzeanum.

Materials and Methods: Andersen and Burkard 7-days volumetric sampler were used for aerospora monitoring in 2006 to 2011. Their allergenic activities were studied by skin prick tests, Pulmonary Function Test (PFT) and ELISA. Detailed medical history of allergic patients and hospitalization data were collected from allergy clinics and hospitals. Different biochemical methods such as, Periodic acid Schiff staining, Periodate modification, 2D-Immunoblotting and MALDI-TOF-TOF were used to identify and characterize the allergen.

Conclusion: The studied area is highly contaminated with fungal aeroallergens, which are significant causative agents for severe respiratory allergy. The spore calendar and prediction model can be useful from allergological point of view, especially for the right diagnostics and treatment of inhalant allergy. T. harzeanum carries a 34.5 kDa protein, which is highly allergenic in nature.

Pollen of Alstonia Scholaris: A Source of Aeroallergen in West Bengal, India

Dr. Mir Musaraf Hussain, Dr. Kashinath Bhattacharya


Department of Botany, Visva-Bharati University, Santiniketan, West Bengal, India

A Burkard personal one day volumetric sampler was used at two sites (Sriniketan-a suburban township and Durgapur-an industrial township of West Bengal, India) to record the occurrence and frequency of airborne Alstonia scholaris pollen grains for two consecutive years. A correlation was made between the meteorological factors and the pollen concentration in the atmosphere. The present paper reports Alstonia scholaris pollinosis by in vivo skin prick test in a group of patients. Among the 140 patients tested 28.57% patients showed skin test positivity. The allergic potential of this pollen type was also investigated by in vitro (ELISA and dot-blotting) analyses and immunoblotting. The result of ELISA was expressed in terms of P/N value (ratio of OD of patient sera with respect to control). A total of 16 patients sera and a non-allergic serum as control were tested against Alstonia scholaris crude pollen extracts. The P/N value was obtained in the range of 2.88-3.87. Among these sixteen sera, high IgE titer (P/N value more than 3.5) were found in 11 sera. The patients sera gave specific spot with the Alstonia scholaris pollen antigen while negative control sera did not show any spot, confirming the presence of low IgE titer in negative control serum. Biochemical analysis showed that this pollen is rich in proteins. Total soluble protein components of the pollen was analyzed by 12% SDS-PAGES, showing 12 protein bands with a range of molecular components (94.4 kDa to 13.3 kDa). One band of Alstonia scholaris pollen of molecular weight 29.9 kDa showed IgE binding epitope against all the sera of patients showing positive reaction to skin prick tests and this protein has been identified as major allergen of Alstonia scholaris pollen. This component can be used for further work in diagnostic and therapeutic purpose in a susceptible individual.

Buckwheat: A Boon for Health as Holistic Medicine

Dr. Mani Mishra, Dr. Shashi Jain


Department of Food and Nutrition, College of Home Science, Maharana Pratap University of Agriculture and Technology, Udaipur, Rajasthan, India

Buckwheat is the fruit seed of a plant originally from Asia and is known for driving the evil away from homes. Common buckwheat or Kuttu (Fagopyrum esculentum Moench) is a broad-leafed herbaceous annual. It belongs to the family Polygonaceae, which is generally referred to as the buckwheat, rhubarb or sorrel family. However, because its seed structurally and chemically resembles the cereal grains, buckwheat is usually handled and classed with the cereals. Buckwheat is a common food consumed in China, Russia, Ukraine, France, USA. as regular diet. In India, it is less in the daily diet and not common; however, is consumed as religious food during the fasting in "Durga Puja" and "Lord Krishna Janmashtmi celebration. Buckwheat contains linoleic acid, vitamins (B1, B2, B3, B5, E, P), essential amino acids, minerals-chromium, copper, manganese, folic acid- and is an excellent source of magnesium. In the absence of gluten type proteins, buckwheat flour can be an important ingredient in gluten-free diet for people suffering from the celiac disease. Amino acids in buckwheat help to regulate the hepatic LDL receptors, and thereby lowering the serum cholesterol, and indirectly helping to prevent the formation of arteriosclerosis. Buckwheat proteins, like dietary fiber, can suppress the development of colon cancer. Owing to the quantity of magnesium contained, buckwheat has a relaxing effect over blood vessels, improving circulation, and decreasing blood pressure (BP). Because, it contains plenty of vitamins with B complex, buckwheat is recommended in cases of liver disorders and sugary diabetes, Due to the fact that it lacks sugary substances makes buckwheat ideal for those who need to keep a restrictive diet. Thus, buckwheat is a nutritious food having therapeutic role in diseases such as diabetes, cancer, constipation, celiac disease, and makes it a boon for health.

Key words: Celiac disease, gluten free diet, LDL receptors

Allergenic Significance of Airborne Aspergillus nidulans

Dr. Gaurab Sircar 1 , Dr. Naren Pandey 1 , Dr. Swati Gupta Bhattacharya


Division of Plant Biology, Bose Institute, Kolkata, and 1 B. M. Birla Medical Research Center, Kolkata, West Bengal, India

Background: Airborne molds are significant constituents of atmospheric bioaerosol, are well-known source of allergens and can cause allergic rhinitis and bronchial asthma in sensitive subjects. Aspergillus nidulans is a widely distributed filamentous ascomyceteous mold. Although a significant exposure risk is assumable in an indoor environment, the role of this fungus in provoking allergic symptoms in pre-sensitized individuals; however, was poorly investigated. We conducted this study to monitor airborne A. nidulans and to evaluate its potential as an aeroallergen causing nasobronchial allergy in sensitized individuals for the first time.

Materials and Methods: Seasonal periodicity of A. nidulans was studied for three years (May, 2010 April, 2012) by Andersen air sampler. The relationships between meteorological parameters and airborne A. nidulans concentration were explored by linear regression models. The allergic potential of A. nidulans extract was studied on 289 respiratory allergic patients by performing skin prick tests (SPT) and measuring the allergen-specific IgE levels in SPT positive patient's sera by ELISA. SDS-PAG E and immunoblotting with 10 individual patient's sera were performed to identify its IgE-binding components.

Results: Airborne A. nidulans concentration range was 6-57 CFU/m 3 around the year and reached the peak concentration in December. Relative humidity and rainfall were found to be a significant predictor for occurrence of A. nidulans in air. Positive skin reaction was observed in 105 patients (27%) including 10 (9.5%) showing markedly high (2+ to 3+) skin sensitization. Crude antigenic extract of A. nidulans was resolved in 38 protein bands in the molecular weight range of 12 to 97 kDa on SDS-PAGE (12% gel). Four IgE reactive bands (52, 46, 48, 55 kDa) were revealed by immunoblot analysis.

Conclusions: Exposures to A. nidulans in environments where it naturally occurs may confer risk of IgE-mediated sensitization in sensitive individuals.

Clinical Study on the Efficacy of Vamana Karma in the Management of Shitapitta with Special Reference to Acute Urticaria

Dr. E. D. T. P Gunarathna, Dr. O. P Singh 1 , Dr. D. P. P. S De Silva 2 , Dr. Y. A. U. D Karunarathna 3


Department of Nidana Chikitsa, Institute of Indigenous Medicine, University of Colombo, Sri Lanka, 1 Department of Kayachikitsa, Institute of Medical Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, 2 Ayurvedic Hospital, Narammala, 3 Department of Prasuti Tantra Kaumarabrithya, Institute of Indigenous Medicine, University of Colombo, Sri Lanka
"Acute Urticaria" is a global health problem, suffers about 4-5% of persons of all ages, which is characterized by superficial swelling of the epidermis and mucous membranes with itchy, pale red, and raised skin bumps. There is a complex release of inflammatory mediators, including histamine from cutaneous mast cells. Many different substances in the environment may cause urticaria including; medications, food, certain fragrances, bee or wasp stings and physical agents, but in approximately half the cases the trigger is unknown. Though, it is not a life threatening disease but, it makes worried to the patient due to its appearance, severe itching disturbing daily routine. Urticaria appears relatively mild and recurrent, but it may manifests as part of a spectrum of systemic anaphylaxis, which may be life-threatening. According to the symptomatology and causative factors, Acute Urticaria can be correlate with 'Shitapitta' in Ayurvedic system of medicine. "Ayurveda" is the science of life, which described the "Hita" (favorable) and "Ahita" (unfavorable) to "Ayu"(life). "Shitapitta" is one of disorder, caused by "Asatmya Sevana" (Exposure to allergens and antibody). Due to heavy industrialization and consumption of spicy and fast food (Viruddhahara) ultimately it leads to "Dhatudurbalya" (lower immunity), which causes sensitization toward allergens as well as antibodies and produces various types of allergic reactions. Modern medicine not having any remedy for permanent cure for Urticaria. However, remission of the disease can be achieved by administering the medicine.

Vamana karma is a prime therapeutic procedure described in Ayurvedic system of medicine for management 'Shitapitta" by providing better and permanent relief. So far no scientific studies have been performed to evaluate the efficacy of Vamana Karma in the management of Shitapitta. A total of 15 patients with a history of more than 1 weeks and less than 6 weeks having Red weal with Itching, Scratching, Burning sensation, pain, and recurrent attacks were selected for the study. After one day treatment period, patients were advised to report weekly for follow-up study, which was carried out for 3 months. Before and after one day of treatment, serum immunoglobulin IgE, ESR and DLC, were measured.

The response to the treatment was recorded and therapeutic effect was evaluated through symptomatic relief of the patients. Statistically significant reduction was observed in symptoms and signs. Serum IgE, ESR, and DLC levels decreased significantly.

In view of this observation and results, it is concluded that Vamana Karma is very effective therapeutic procedure in the management of Shitapitta providing rapidly potent action in controlling allergic reaction.

Key words: Allergy, shita pitta, vamana karma, IgE

Role of IV Magnesium Sulphate as an Adjunct in Treatment of Acute Asthma

Dr. Arjunsa H. Satapute, Dr. Balbir Malhotra, Dr. N. C. Kajal, Dr. Avneet Garg


Department of Chest and TB, Government Medical College, Amritsar, India

Asthma is a chronic respiratory disease that is characterized by periods of relative control and episodes of deterioration, which are referred to as exacerbations. Exacerbations range in severity from mild to severe (status asthmaticus), and can result in visits to health-care providers and emergency departments (EDs), and may at times require hospitalization. Here, we present a study involving 50 (25 study and 25 control cases) patients of acute severe asthma and role of magnesium sulphate in management of this.

Aims and Objectives: To evaluate the role of IV magnesium sulphate as an adjunct in the treatment of acute asthma. Those who satisfied with the inclusion and exclusion criteria were taken for the study. The trial was conducted in a well-lit and ventilated EDs. Prior to initiation of medical therapy three FEV1measurements were taken of each patient and best of three values of test was recorded on study data form. FEV1 was recorded using the spirometry of our EDs. A total of 25 control cases received standard therapy with high flow oxygen, nebulized salbutamol 5 mg and ipratropium 500 mcg, intravenous methyl prednisolone (2 mg/Kg body weight) and 100 ml of normal saline infused over a period of 20-30 min as a placebo. A total of 25 study cases received 40 mg/kg body weight of magnesium sulphate (2 g i. v adult dose) in 100 ml of normal saline infused over a period of 20-30 min in addition to standard treatment. Each patient was monitored at 0, 20, 60 min for pulse rate, SPo 2 , respiratory rate, knee jerk, blood pressure (BP), and urine output. Three FEV1 values were taken preferably after 3 h of giving the treatment and best of the three values were recorded on study data form. The results, thus obtained in study and control groups of FEV1 values were compared, put to statistical analysis and compiled to reach valid conclusion. Results: Out of all patients included the mean FEV1 on EDs arrival was 22.9% predicted. At 180 min, patient receiving magnesium had a mean FEV1 48.2% of predicted compared to 43.5% of the control group (mean difference, 4.7%; 95% confidence interval (CI), 0.29 to 9.3%; P = 0.045). A regression model confirmed the effect of magnesium sulphate compared to control group in a patients with a lower initial FEV1 (P and lt; 0.05). If the initial FEV1 was and lt; 25% of predicted the final FEV1 was 45.3% predicted in magnesium treated group and 35.6% in the control group (mean difference, 9.7%; CI, 4.0 to 15.3%; P = 0.001). If the initial FEV1 was =25% predicted the magnesium sulphate was not beneficial; the final FEV1 51.1% predicted in the magnesium treated group and 53.9% in the control group (mean difference, −2.9%, 95% CI, −9.4 to 3.7; P = not significant).

Clinical Study on the Efficacy of Pitawakkadi Kashaya (A Sri Lankan Traditional Decoction) on the Management of Bronchial Asthma

Dr. Y. A. U. D. Karunarathne, Dr. E. D. T. P. Gunarathne, Dr. R. S. Jayawardane


Institute of Indigenous Medicine, University of Colombo, Sri Lanka

Bronchial asthma is a serious global health problem, suffers about 5-10% of persons of all ages. It is a chronic inflammatory disease of the airways characterized by bronchial hyper reactivity and a variable degree of airway obstruction. Recurrent episodes of acute shortness of breath, typically occurring at night or in the early morning hours are the cardinal manifestation of bronchial asthma. Further, symptoms include cough, wheezing, and a feeling of tightness in the chest. An atopic diathesis, i.e. a genetic predisposition toward the production of IgE antibodies in response to pollen, house dust mites, fungi or animal-derived proteins, is the most important risk factor for bronchial asthma. In childhood, bronchial asthma is usually due to allergies; on the other hand, in 30% to 50% of adults with asthma, no allergy can be identified. A total of 75 patients suffering from corticosteroid - dependent asthma took part in a trial of Pitawakkadi Kashaya in order to investigate its effects on their clinical condition as well as upon certain spirometric and immunological indices. The study took place between January 2009 and June 2010. Patients were treated with 120 ml of decoction twice a day morning at 6.00 am with empty stomach and evening at 6.00 pm. Duration of treatment was 30 days with 4 visits and follow-up period was 4 months. Before and after 1 month of treatment spirometric determination of FVC and FEV1 values was undertaken, and levels of serum immunoglobulin IgE, IgG, IgA and IgM were measured. PEFR measured in every visit.

Serum IgE levels decreased significantly in the patients treated with decoction while IgA, IgG and IgM levels were not significantly changed. All patients were shown significant reduction of their symptoms and signs. Mean corticosteroid dosage of patients was reduced from 2.2 to 1.2 mg/day. During the follow-up period 15% recurrence observed; however, intensity of attack was less than previous.

It is concluded that Pitawakkadi Kashaya can improve the clinical condition of corticosteroid-dependent asthmatic patients, which can lead to a reduction in corticosteroid usage and therefore less adverse effects experienced through their use.

Hence, Pitawakkadi Kashaya leading to better symptomatic control, reduction of the number of asthma attacks and emergency situations and improved quality of life.

Key words: Bronchial asthma, chronic inflammatory disease, Pitawakkadi Kashaya

Immunological Study of Seronegative Spondyloarthritis

Dr. Shailja Singh, Dr. Usha, Dr. Manoj Kumar Paswan, Pramod Kumar Verma, Dr. N. K. Singhand 1 , Dr. S. K. Saraf 2


Departments of Pathology, 1 Medicine, and, 2 Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Seronegative Spondyloarthritides (SSA) are group of disorder, which involves lower spine and sacroiliac joint. Most of these cases are positive for HLA -B27. Aim of the present study is to observe serological profile of SSA cases.

Materials and Methods: A total of 90 cases of SSA and 43 healthy controls were studied. Only HLAB27 positive SSA cases were taken while HLAB27 negative SSA cases were excluded. While in controls all 43 cases were HLAB27 negative. Anti CCP2 Ab, Rheumatoid factor, Anticordiolipin Ab, ANA, ds DNA Ab were performed by ELISA technique.

Result: Anti CCP2 Ab was non significantly positive in SSA, Anti CCP2 Ab was more positive in SSA (16.2%) who had pain in small joints of hand and feet. IgM RF, IgA RF were positive in 5.5% and 8.9% cases while IgG RF was positive in 37.8 % patients and this was statistically significant as compared to controls. ANA positivity in SSA patients was significantly high (13.3%) while ds DNA Ab rise was statistically non-significant. No correlation of RF IgM, RF IgG, RF IgA, Anti CCP2 Ab and ANA, dsDNA, APLA was found with age of the patients. Thus, our study concludes that SSA is not truly seronegative. IgG RF and ANA can be found positive in SSA patients also.

Key words: ANA, ankylosing spondylitis, anticardiolipin ab, rheumatoid factor, seronegative spondyloarthritides

Holistic Diamension of Integrated

Dr. Nagendra P. Dubey


World Association of Integrated Medicine Richmond Hill, NY, 11419, USA

Universe is a unique creation of Almighty GOD. With mere thoughts, He created the Five Elements, which is the pre-cursor of all livings and non-livings in this universe. Medicine is a contribution of the Nature to keep all the existing healthy in this universe. It is available in one or the other form since inception of the life on the earth in the entire Globe either as medicine or as healing in the name of Traditional Medicine and or Healing. The Traditional Medicine gave the birth of modern western medicine, which is now official System of treatment in most of countries the World though we know that:

1. None of the medical system is perfect,

2. None of the medical system is useless,

3. Every medical system has merits and demerits,

4. Every medical system has its limitation and,

5. Our tradition is to respect all.

In spite of the above facts, the modern medicine got more popularity in its short period of its origin due to certain merits. Thought modern medicine has a strain of certain aspects and traditional medicine has stress of its certain aspects. Based on the facts pertaining to modern and traditional medicines the Integrated Medicine has been developed by the World Association of Integrated Medicine. The World Association of Integrated Medicine has given the five components i.e. Teaching, Training, Treatment, Research and National Implementation. Our designed program has been made in order to provide the Comprehensive Holistic Health Care for Universal Care. The existing Integrated Medicine has the merits both modern and traditional medicine. The merits of Integrated Medicine, we call it "Nine GEMS" of Integrated Medicine. The detail shall be discussed in the conference.

Management of Chronic Urticaria: An Update

Dr. Manish Bansal


Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Urticaria is a disturbing allergic disease characterized by itchy wheals and/or angioedema associated with pruritus. Mostly a benign disease, but can present with life threatening laryngeal edema besides having a great negative impact on the quality of the life of the patients. Various etiological factors have been proposed including physical, allergic, hereditary, autoimmune, and idiopathic. Laboratory investigations are mostly inconclusive. Treatment of the chronic urticaria is a must seeking its symptoms and impact on the quality of life. An ideal and appropriate stepwise approach is necessary and has better results. An updated review of the pathogenesis and various treatments available and the approach toward patients presenting with chronic urticaria and angioedema will be discussed in detail.

Curcumin Affects Airway Remodeling in Murine Model of Chronic Asthma

Dr. Preeti S. Chauhan, Dr. Subhashini, D. Dash 1 , Dr. Rashmi Singh


Department of Zoology, Mahila Mahavidyalaya, Banaras Hindu University, 1 Department of Biochemistry, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Asthma, a chronic inflammatory disorder of airways is considered to be growing problem in the world due to rapid rise in asthmatic cases in recent decades, its morbidity and mortality. Chronic inflammation of the airways leads to abnormal structural changes in asthma. Airway inflammation due to the activation of inflammatory cells such as mast cells, eosinophils, neutrophils, lymphocytes, and other resident cells are responsible for structural alterations, which are associated with severity of the disease. Repeated cycles of cellular inflammation and structural changes result in the imperfect remodeling of the airways. These structural changes include subepithelial fibrosis, airway wall thickening and increased mucous glands, which result in the alteration of lung tissue and declination of lung function. Despite of the available medications, a high proportion of asthma cases are still severe and difficult to manage due to greater side effects. This has led to the exploration of highly targeted novel alternative therapies, which are associated with least side-effects. Curcumin, a non-steroidal phytochemical derived from the rhizome of turmeric (Curcuma longa) has been shown to have variety of anti-inflammatory, anti-allergic and anti-asthmatic properties without any side-effect. Therefore, present study deals with the exploration of curcumin in a murine model of chronic asthma. Balb/c mice were sensitized and challenged with ovalbumin (OVA) to reproduce feature of chronic asthma. OVA-sensitized groups were daily given Curcumin up to 5 weeks through intra nasal route. Mice sensitized and challenged with ovalbumin showed features of chronic asthma with cellular inflammation, bronhoconstriction and sub epithelial fibrosis. Histological studies have shown efficiency of curcumin in preventing airway inflammation, subepithelial fibrosis, and bronchoconstriction by H and E, and masson trichome staining respectively. Curcumin being an anti-inflammatory polyphenolic compound may be protective in preventing sub epithelial fibrosis and maintaining structural integrity of the lungs if taken for longer times in chronic cases of asthma.

Bioavailability of Curcumin: A Study on Asthma in Murine Model

Prof. Rashmi Singh


Department of Zoology, Mahila Mahavidyalaya, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Curcumin, a polyphenolic product derived from common spice turmeric that is safe and beneficial in several ailments including asthma. It has shown considerable pharmacological activity, including anti-inflammatory and thereby effective in allergic asthma but its poor bioavailability and rapid metabolization have limited its applications. Administration through parenteral route has increased its effectiveness and minimized the metabolization. Therefore, studies done so far have shown its effectiveness through parenteral route as anti-asthmatic agent. The objective of the present study is to improve curcumin bioavailability by administering curcumin via the nasal route in order to deliver curcumin through the olfactory mucosa and to reduce the dose required for its beneficial effect. This mode of delivery will also pass less curcumin into the circulation, and so will result in lower plasma concentrations of metabolites of curcumin, and therefore, fewer side-effects. This is the first report on effectiveness of curcumin through nasal route and is comparable to intraperitoneal route of curcumin administration at lower doses. Nasal mucosa is known for its high vascularity and as curcumin is highly lipophilic, it can easily pass through the olfactory mucosa. Intranasal delivery will improve drug bioavailability and since, it can cross the blood brain barrier by passive diffusion through the olfactory mucosa, thereby avoiding extensive hepatic first-pass metabolism, which significantly lowers the plasma and brain concentrations of curcumin administered orally. Therefore, small doses of curcumin can be administered which will result in fewer side-effects, and the drug will be more tolerable and more effective. Lipophilic drugs such as curcumin generally achieve higher brain levels after intranasal administration than after oral or intravenous administration. Therefore, the nasal route of administration of curcumin may help to enhance the effectiveness of curcumin in the lungs as it directly reaches to the site of action. In addition as curcumin is heavily metabolized by the liver, administration by the nasal route may help to reduce drug interactions with other drugs that are also extensively metabolized by the liver. Lastly, because intranasally administered curcumin will passively diffuse through the olfactory mucosa and effectiveness is enhanced by inhibiting inflammation another asthmatic features.

Role of BacT/ALERT 3D Culture System for Early Diagnosis of Tubercular Meningitis

Dr. Rahaman S. H, Dr. Kumar K


Department of Medicine, Institutes of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Aims: The etiological diagnosis of TB and tuberculous meningitis (TBM) at an early stage of infection is of utmost importance as appropriate therapy is required for better outcome. We evaluated the role of BacT/ALERT 3D culture system for early diagnosis of TBM and compared it with CSF PCR for Mycobacterium tuberculosis.

Materials and Methods: A total of 50 cases of clinically suspected and CSF suggestive cases of TBM comprised the study. A total of 20 healthy controls (CSF collected from patient otherwise healthy undergoing operation under spinal anesthesia) also included in the study. CSF was cultured in BacT/ALERT-MP culture bottle. Simultaneously nested PCR was done both from CSF and positive BacT/ALERT-MP culture bottles using the insertion sequence IS6100 was the target of PCR.

Results: Majorities were of age group 15-30 years (60%). Males (56%) marginally outnumbered females. Fever, headache, vomiting, and altered sensorium were present in >50% of cases and 34% showed papilledema. BacT/ALERT MP culture on CSF showed 76% (38/50) positivity in TBM cases; few controls 3/20 showed false positivity. PCR on CSF of TBM showed positivity 46/50 (92%) and among healthy controls, 5% (1/20) gave false positive >PCR. When CSF BacT/ALERT MP culture vis-a-vis CSF-PCR is compared, out of 38 Samples with positive culture, 36 also showed positivity with CSF-PCR. Cases, which had positive CSF culture with BacT/ALERT, nested PCR done on them showed positivity only in 12/38 and none of negative culture showed positivity with PCR, possible due to inhibitors of PCR developed in the culture media. Sensitivity/specificity of BacT/ALERT MP culture (76/85) are comparable with CSF PCR (92/95).

Conclusions: Although CSF-PCR has extremely high sensitivity and specificity, it has no role in detection of drug sensitivity for which culture is a must. Therefore, present study strongly suggests that BacT/ALERT 3D Culture System has a significant role in early diagnosis of TBM in the era of MDR and XDR tuberculosis.

An Epidemiological Study of Occurrence, Prognosis and Predisposing: Factors of Tamaka Shvasa Vis-a-vis Bronchial Asthma

Dr. Shashi Kant Tiwar, Dr. A. C. Kar, Dr. J. K. Mishra


Department of Vikriti Vigyan, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Bronchial asthma is a common, chronic disease of airways that manifests with recurrent episodes of coughing, breathlessness, wheezing, and chest tightness. These episodes are associated with airflow obstruction that is at least partially reversible. Tamaka Shvasa is a disease described in Ayurveda, which has a close resemblance with Bronchial asthma. Tamaka Shvasa is a "Swatantra" Vyadhi and having its own etiology, pathology and management. It is mentioned as one of the varieties among five types of Shvasa and as Yaapya Vyadhi i.e. chronic in nature. Asthmatics harbor a special type of inflammation in the airways that makes them more responsive than non-asthmatics to a wide range of triggers, leading to excessive narrowing with consequent reduced airflow and symptomatic wheezing and dyspnea. It has proved difficult to agree on a definition of asthma, but there is good agreement on the description of the clinical syndrome and disease pathology. Until the etiologic mechanisms of the disease are better understood, it will be difficult to provide an accurate definition. Asthma is a heterogeneous disease with interplay between genetic and environmental factors. Understanding of Nidana Panchaka of Tamaka Shvasa is very important for its diagnosis and treatment. Critical understanding of etiopathogenesis of Tamaka Shvasa is very much essential to incorporate with current medical knowledge for its diagnosis. Thus, in this paper, effort has been made to understand Tamaka Shvasa by with special reference to Bronchial Asthma to update the Ayurvedic concepts and give ways of its management by Ayurvedic methods.

An, Open Label, Prospective Study: Association of Chronic Urticaria with Autoimmune Thyroid Disorders

Dr. Tulika Rai, Dr. Satyendra Kumar Singh


Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Objectives: To study the association of chronic urticaria with autoimmune thyroid disorders.

Materials and Methods: All patients of chronic urticaria who presented in skin Out Patient Department (OPD) of S. S Hospital during the month of July, 2012 was enrolled for the study. Chronic urticaria is defined as urticaria persisting for more than 6 weeks. The serum thyroid stimulating hormone level (TSH) and anti-thyroid peroxidase antibodies (anti-TPO Ab) were measured in all patients and an endocrinology reference was performed when there were derangements in the investigation reports.

Result: A total of 20 patients were enrolled for the study. A total of 8 patients were males and 12 patients were females. Out of 8 male patients, 1 patient had isolated raised anti-TPO antibody titer, 1 patient had raised TSH and anti-TPO levels and was diagnosed as a case of hypothyroidism. One male patient had very low serum TSH level and anti-TPO Ab levels (5 times the normal) and was diagnosed to have Grave's disease. Out of 12 female patients, 2 were already known cases of hypothyroidism and were on oral thyroxine. Three female patients had isolated raised serum anti-TPO levels. Three patients had both serum TSH and anti-TPO raised and were diagnosed as hypothyroid.

Conclusion: Chronic urticaria has a definite association with autoimmune thyroid disorders.

Impact of Chronic Illness on Mental Health of Parents of Children with Bronchial Asthma

Dr. Vasundhara Kumari, Dr. S. K. Upadhayay, Dr. Vineeta Gupta, Dr. K. Satya Piplani 1 , Dr. B. D. Bha


Departments of Pediatrics, and 1 Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Introduction: Bronchial asthma is one of the most common chronic illnesses during childhood. It is a chronic lung disorder characterized by inflammation in the airways. Most of the asthmatic children need regular assessment and long-term follow-up. Caring for a child with bronchial asthma may have an impact on parent's mental health. In view of the above, the present study was undertaken to assess and compare psychopathological symptoms in parents of children with bronchial asthma compared to the matched counterparts.

Materials and Methods: Sixty children parents with bronchial asthma were selected from Asthma Clinic, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi and 60 parents of children with minor ailments as control from Pediatric Out-patient Department. Symptom Check-list-90 R and Ways of Coping Questionnaire were administered to assess psychopathological symptoms and coping strategies in parents. Data were analyzed using the SPSS software.

Results: Parents of children with bronchial asthma had significantly higher mean value for the dimension of somatization, depression, anxiety and hostility when compared to their matched counterparts (P < 0.001). Regression analysis showed that accepting responsibility was the main coping techniques used by these parents to meet their mental distress (P < 0.01).

Conclusion: Bronchial asthma in children affects psychological health of their parents. Such parents are in a greater need for professional counseling.

Key words: Bronchial asthma, children, mental health, parents

Combating the Bronco Nasal Allergies with Ayurveda

Dr. Vinod Kumar


Department of Shalakya, SLBSS Government Ayurvedic College Handia, Allahabad, Uttar Pradesh, India

Keeping the distance from natural environment has made us more intolerant to naturally occurring substances such as pollen or dust, etc. that is reflected as some common symptoms such as sneezing, itching, dyspnea, and skin eruptions of variable intensity is known as allergy. Allergic manifestations in human beings have been recognized by physicians of ancient India in very early days of civilization. It is well-documented in the Indian medical literature such as Charak, Sushruta Samhita and Astang Sangraha, etc. Tamak Shwas and Pratishyay are the classical examples of bronco nasal allergy. Incidences of Bronco nasal allergy are experienced all around the year with the abrupt rise in flowering season. Today, the management of allergy has become limited to use of mast cell stabilizing drugs, antihistamines, and immunosuppressive drugs such as Corticosteroids. Side-effect on the long-term use of these drugs has put to physicians in to a blind street. Therefore, this is the need of the hour to develop a holistic approach to control the increasing number of allergy incidence. Ayurveda has postulated the genuine and scientific approach to overcome such incidences of Bronco nasal allergy Improve the body threshold to antigenic response (Improvement of Bala). Identify the antigenic substance and make it more tolerant to the body by gradually increasing the dose of its consumption.(Oka Satmya by Padanshik Krama) Gradual and periodical removal of metabolic waste or dialysis of accumulated doshas (Seasonal Vaman and Virechan) Modify the metabolic or biochemical processes sufficient enough to produce non-antigenic metabolic products (Prevention of auto-immune disorders by Correction of Agni Vyapar) Use of drugs to relieve the symptoms Thus, Ayurvedic management is directed toward the prevention and treatment of allergy by immunomodulation.

Key words: Agni Vyapar and immunomodulation, immunosuppressive, mast cell stabilizing, oka satmya, pratishyay and vicharchika antihistamines, tamak shwas, vaman and virechan

Anti-Allergic and Medicinal Effects of Job's Tears (Coix Lacryma-Jobi)

Dr. Mani Mishra, Dr. Shashi Jain


Department of Food and Nutrition, College of Home Science, Maharana Pratap University of Agriculture and Technology, Udaipur, Rajasthan, India

An allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid. Allergic reactions are distinctive because of excessive activation of certain white blood cells called mast cells and basophils by a type of antibody called Immunoglobulin E (IgE). Job's tears is a tall grain-bearing tropical plant of the family Poaceae (grass family) native to Southeast Asia, but elsewhere cultivated in gardens as an annual. Job's Tears (Coix Lacryma-Jobi or Coix agrestis Lour) is a cereal crop as a food that has not been excavated. In fact, this plant has the potential to be processed into various food products, pharmaceuticals or industrial raw materials. Job's Tears seeds contain 58-62% soluble carbohydrate, mainly starch, 9.5-23% albuminoid, and 5% fat. According to the Nutrition Directorate of the Indonesia Ministry of Health (1981), 100 g Job's Tears energy contains 289 cal, 11.0 g protein, 4.0 g fat, 61 g carbohydrates, 213 mg calcium, phosphorus 176 mg, 11 mg of iron, thiamin 0:14 mg, and 23 g of water. In many seeds contain coixol, coixenolide, coicin, and the amino acid leucine, tyrosine, lisine, glutamic acid, arginine, and histidine. Another benefit of Job's Tears plant is its usefulness as a medicine for many diseases. Parts of plants that can be used as a drug is Job's Tears seeds and roots. Some diseases can be aided his recovery, among others, pain of appendicitis, inflammation of the intestine (enteritis), chronic infections and urinary tract stones, urinary bit, purulent urine, swelling (edema), cough and shortness of breath. The plant has also been used for centuries in folk medicine to treat dozens of conditions from arthritis to smallpox. One of the traditional uses for Job's Tears is to treat allergies, including topical preparations of plant extracts for an allergic skin condition called contact dermatitis.

Respiratory Allergy: Clinical Diagnosis

Dr. Rajendra Prasad


Department of Pulmonary Medicine and Director, U. P. Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India

Allergy encompasses a wide range of immunological reactions that generally have adverse consequences involving one or many organ systems of the body. The term "Allergy" was coined by Clemens von Pirquet in 1906 to describe a state of altered reaction of the immune system resulting in immunity or hypersensitivity. The term "Atopy" was coined in 1923 by Coca and Cooke to describe clinical allergy of inherited nature. However, isolation of IgE from the serum of allergy patients by Ishizaka and Ishizaka in 1966 was the important landmark in the medical history in the development of allergic research. The increasing prevalence of allergic disorders has been specially noticeable in the past two decades, with almost one in the two people in the developed world exhibiting an allergic response to some common environmental factor. In India, more than 10% of the population is reported to have one or other type of allergic disorder. Two studies conducted in Bombay, concluded that incidence of atopy in the Indian population is as high as 25.3%. On the basis of careful epidemiological studies, changes to maternal and infant diets, reduced exposure to antibiotics in infancy and avoidance of indoor air pollutants and aeroallergens have all been suggested as steps to reverse the rising trends. Allergic diseases are probably among the most misdiagnosed and mismanaged disease entities of the modern era. The mainstay of diagnosis in allergic disorder is based on accurate clinical history supplemented by various diagnostic tests (skin test, challenge test, RAST, ELISA). The history of allergic patients differs from usual medical history in at least one respect. In allergy, diagnosis is often apparent; hence history is not directed primarily at establishing the ultimate diagnosis, but rather at discovering the underlying cause.

Pulmonaty Function Test in Clinical Practice

Dr. S. K. Pathak


Breathe Easy Chest Care Centre, and Heritage Hospital, Assi, Varanasi, Uttar Pradesh, India

Pulmonary function test (PFT) is method of determining how well lungs and airways are working. It gives to pulmonologist a series of numbers, which allows them to compare each patient lung function with predicted value based on age, sex, race, and height. Components of PFT are spirometery, body plethysmography, peak expiratory flowmetry, pulse oxymetry, arterial blood gases (ABG), Exercise testing (6-12 min), Single breath Nitrogen washes out method, Multiple breath nitrogen wash out method, Close circuit helium method, Progressive Ergometric stress test, PFT for gas exchange and diffusion (DLCO), Maximum inspiratory pressure, and Physiological testing during the sleep. Spirometery is one of the important parameter to know about lung function, which is routinely used in chest practice. The indications of Spirometery are-to establish base line pulmonary function, to detect disease like COPD; Asthma; ILD; RLD, to follow course of disease, to monitor treatment, evaluation of impairment, identification of high-risk group-smoker (serial Spirometery), Occupational survey, environmental hazard detection, drug exposure related lung disease, pre-employment screening, and physical fitness. Indications of spirometry in day today clinical practice are - Diagnosis of Bronchial asthma, Assessment severity, Monitoring response of treatment during acute exacerbation and chronic therapy, Detection of asymptotic deterioration at home in self-managed program, Identifying trigger factor, Occupational asthma, Detection of COPD, and Evaluation of dyspnea. Spirometric grading of Bronchial asthma is based upon PEFR, whereas COPD grading is based on FEV1 and FVE1/FVC and restrictive lung disease grading is based on FVC. PFT is also indicated for pre-operative assessment of surgical patient-having age more than 70 years, thoracic surgical patient, abdominal surgery patient, patient with history of tobacco use, known or suspected cardiopulmonary disease, patient who need prolong surgery during anesthesia. PFT value that indicates increased risk of post-operative complication are - FEV1 < 2 L, FEV1 25-75 < 40% of predicted; <1.2 L of predicted, FEV1 200-1200 < 200 L/ min, MVV <50% of predicted, ABG Pa CO 2 > 45 mmHg.

Preclinical Studies of a Pteridophyte-Diplazium Esculentum Retz. On Allergic Asthma and Mast Cell Stabilization

Dr. Biswadeep Das, Dr. Tania Paul, Dr. K. G. Apte, Dr. P. B. Parab, Dr. R. Chauhan, Dr. R. C. Saxena


Allergic asthma has become an endemic disease of the 21 st century. In the present world of pollution, we are surrounded by dust particles and myriads of allergen, which cause allergic asthma. This ailment provokes symptoms such as rhinitis, wheezing, dyspnea, and chest tightness along with bout of cough or anaphylaxis. In anaphylaxis and allergic disorders mast cells play a protective role in defending the intruding pathogens by release of histamine and other chemical mediators. In the present study, the investigations were carried out to evaluate the anti-anaphylactic and mast cell stabilizing activity of Diplazium esculentum. Retz, which is commonly known as vegetable fern. Ferns or Pteridophytes with ample diversity of more than 12,000 species have found little application in modern medicine as compared to angiosperms. The present study was thus undertaken to provide rational of proposing various in vivo and in vitro models for emphasizing the allergic asthmatic conditions and provide significant remedy in managing the manifestation of allergic asthma. In this study, Wistar rats were sensitized by conventional method by injecting horse serum and triple antigen. The globulin fraction of the horse serum is considered to be an environmental allergen in provoking the allergic reactions. The aqueous extract at 250 mg/kg and 500 mg/kg showed intact mast cells 72.83% and 76.67% while the ethanolic extract at the same dose showed 69% and 71.67% respectively (P < 0.001). Both extracts at two different doses also showed protective activity in in vitro passive anaphylaxis. The treatment performed by aqueous and ethanolic extracts of the fern also showed marked protection against mast cell degranulation induced by Compound 48/80, to further understand its therapeutic potential the Nitric Oxide and Myeloperoxidase, two markers of inflammation were monitored, which showed a significant reduction (P < 0.001) in the treated groups. The results clearly substantiate the anti-allergic effects of the vegetable fern, Diplazium esculentum in allergic asthma.

Key words: Allergic asthma, Compound 48/80, diplazium esculentum, mast cell degranulation, Retz

Behavioral Assessment of Children with Bronchial Asthma

Dr. Aparna Singh, Dr. S. K. Upadhyay, Dr. Vineeta Gupta


Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

The aim of this study is to evaluate behavioral disturbances in children with bronchial asthma.

Materials and Methods: A total of 40 children with asthma were included in the study group by consecutive sampling and compared to 40 normal children matched for age, sex, and of similar socio-economic status. Age ranged between 6 years and 14 years. Childhood Psychopathology Measurement Schedule (CPMS); adapted from Child Behavior Check-list was administered for behavioral assessment.

Result: Nearly, 22.5% of children with asthma had a CPMS score of >10 as against 2% in the control group. Children with asthma had higher scores in factors of low intelligence with behavioral problems and physical illness with emotional problems. The mean CPMS score was 6.4 ± 3.0 (range 2-13) in asthma group and 4.8 ± 2.7 (range 1-12) in the control group. The difference was statistically significant (P < 0.01).

Conclusion: This study highlights the significantly higher psychopathology in children with asthma and emphasizes the need of psychological treatment, which covers psycho-educational self-management programs, relaxation therapy, biofeedback and family therapy for improving the quality of life of these patients.

The Basic Tenets of Ayurvedic Immunology

Prof. R. H. Singh


Department of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Ayurveda is the ancient Indian system of life science and Medicine, its historicity going back to the Vedas. Its classical knowledge and practice is based on its own physics and biology, its unique pronature holistic health and disease concepts and diagnostics as well as its own material medica. The ancient classical knowledge-base of Ayurveda is available today in the form of a robust ancient classical literature, the principal ones being the Brihattrayi (Caraka, Susruta, Vagbhatta) and Laghuttrayi (Madhav Nidana, Sharandhara and Bhavaprakash) texts, which are considered the most respected and authentic source books. Brihattrayis are prechristian writings while the Laghuttayis are the creation of medieval and subsequent period of Indian history. All these texts exist originally in Samskrit language, but are now translated in Hindi and English.

Although the contemporary practice of Ayurveda is largely based on its classical foundations, one may find great impact of contemporary biomedical sciences and medical practices today. In view of the pressing demand for evidence based practice of Ayurveda by the society and science stream now lot of attempts are being made to conduct research in theory and practice of Ayurveda besides validation of the safety and efficacy of its medications and their quality assurance. An over view of the science of Ayurveda indicates that the Ayurvedic seers of classical age had really an advanced knowledge of Genetics specially epigenomics and Immunology. Almost everything what we know today in modern biomedical sciences about genetics and immunology, was known in principles to ancients and is described in classical texts in their own language and words, which is not difficult to decode today if we follow a genuine reverse innovation and translational study. There is a possibility of getting leads for further research, which could enrich modern Immunogenetics. The author of this communication will attempt to describe in brief the basic tenets of Ayurvedic Immunology as described in Ayurvedic classics.

Role of Holistic Approach in the Management of COPD-De Novo Concept

Dr. Abhishek Srivastava, Dr. Nishith Kumar


Department of Pulmonary Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India

COPD is an umbrella term to define a wide variety of disorder encompassing not only airways and lungs, but also other systems of the human body. Despite advancements in early diagnosis and management of COPD the disease continues to be a major cause of morbidity and mortality throughout the world. The recent data is worrisome as COPD is expected to become 3 rd leading cause of death by the year 2020. Living with COPD can be challenging as the disease dramatically affects patient's daily life. Chronic airflow limitation together with muscle wasting, anxiety-depression, ongoing lung damage due to smoking/occupational exposure plays an important role in overall impact on the disability caused due to the disease. There is a growing consensus among the researcher and practitioner alike regarding the importance of treating the disease as a whole and not just its respiratory component. Thus, apart from regular pharmacotherapy a holistic approach of treatment taking into consideration all aspects of patient's need that is physical, mental, social, and spiritual is call of the hour and can complement the existing modality of treatment.

Advances in Management of Bronchial Asthma in Children

Dr. Abhishek Abhinay, Dr. O. P. Mishra, Dr. Rajniti Prasad


Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Asthma is a chronic inflammatory disorder of the airways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy. Airway inflammation is the result of interactions between various cells, cellular elements, and cytokines. In susceptible individuals, airway inflammation may cause recurrent or persistent bronchospasm, which causes symptoms that include cough, wheezing, breathlessness, and chest tightness, particularly at night (early morning hours) or after exercise. Airway inflammation is associated with airway hyperreactivity or bronchial hyper-responsiveness (BHR), which is defined as the inherent tendency of the airways to narrow in response to various stimuli. According to World Health Organisation (WHO) estimates, 300 million people suffer from asthma, 255,000 people died of Asthma in 2005 and over 80% of Asthma deaths are reported from low and lower-middle income countries. Asthma creates a substantial burden on individuals and families as it is more often under-diagnosed and under-treated. In India, about 57,000 deaths were attributed to Asthma in 2004 (WHO 2004) and it was seen as one of the leading cause of morbidity and mortality in rural India. Though effective screening, evaluation, and management strategies for asthma are well established in high-income countries, these strategies have not been fully implemented in India as evidence had previously suggested that Asthma is not to be treated independently, but fitted into the general spectrum of respiratory diseases. Furthermore, even though, medicines that treat Asthma effectively are available at affordable costs, they rarely reach more than 1% of those who would benefit from it.

Management of Chronic Urticaria: An Update

Dr. Manish Bansal


Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Urticaria is a disturbing allergic disease characterized by itchy wheals and/or angioedema associated with pruritus. Mostly a benign disease, but can present with life-threatening laryngeal edema besides having a great negative impact on the quality of the life of the patients. Various etiological factors have been proposed including physical, allergic, hereditary, autoimmune, and idiopathic. Laboratory investigations are mostly inconclusive. Treatment of the chronic urticaria is a must seeking its symptoms and impact on the quality of life. An ideal and appropriate stepwise approach is necessary and has better results. An updated review of the pathogenesis and various treatments available and the approach toward patients presenting with chronic urticaria and angioedema will be discussed in detail.

Immunological Study of Seronegative Spondyloarthritis

Dr. Shailja Singh, Dr. Usha, Dr. Manoj Kumar Paswan, Pramod Kumar Verma, Dr. N. K. Singhand 1 , Dr. S. K. Saraf 2


Departments of Pathology, 1 Medicine, and, 2 Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Seronegative Spondyloarthritides (SSA) are a group of disorder which involves lower spine and sacroiliac joint. Most of these cases are positive for HLA B27. Aim of the present study is to observe serological profile of SSA cases.

Materials and Methods: A total of 90 cases of SSA and 43 healthy controls were studied. Only HLAB27 positive SSA cases were taken while HLAB27 negative SSA cases were excluded. While in controls all 43 cases were HLAB27 negative. Anti CCP 2 Ab, Rheumatoid factor, Anticordiolipin Ab, ANA. ds DNA Ab were performed by ELISA technique.

Result: Anti CCP2 Ab was non significantly positive in SSA, Anti CCP2 Ab was more positive in SSA (16.2%) who had pain in small joints of hand and feet. IgM RF, IgA RF were positive in 5.5 % and 8.9% cases while IgG RF was positive in 37.8 % patients and this was statistically significant as compared to controls. ANA positivity in SSA patients was significantly high (13.3%) while ds DNA Ab rise was statistically non-significant. No correlation of RF IgM, RF IgG, RF IgA, Anti CCP2 Ab, ANA. dsDNA, APLA was found with age of the patients. Thus, our study concludes that SSA is not truly seronegative. IgG RF and ANA can be found positive in SSA patients also.

Key words: ANA, ankylosing spondylitis, anticardiolipin ab, rheumatoid factor, seronegative spondyloarthritides

Clinical Study on the Efficacy of Pitawakkadi Kashaya (A Sri Lankan Traditional Decoction) on the Management of Bronchial Asthma

Dr. Y. A. U. D. Karunarathne, Dr. E. D. T. P. Gunarathne, Dr. R. S. Jayawardane


Institute of Indigenous Medicine, University of Colombo, Sri Lanka, India

Bronchial asthma is a serious global health problem, suffers about 5-10% of persons of all ages. It is a chronic inflammatory disease of the airways characterized by bronchial hyper reactivity and a variable degree of airway obstruction. Recurrent episodes of acute shortness of breath, typically occurring at night or in the early morning hours, are the cardinal manifestation of bronchial asthma. Further, symptoms include cough, wheezing, and a feeling of tightness in the chest. An atopic diathesis, i.e. a genetic pre-disposition toward the production of IgE antibodies in response to pollen, house dust mites, fungi or animal-derived proteins, is the most important risk factor for bronchial asthma. In childhood, bronchial asthma is usually due to allergies; on the other hand, in 30-50% of adults with asthma, no allergy can be identified. Serum IgE levels decreased significantly in the patients treated with decoction while IgA, IgG and IgM levels were not significantly changed. All patients were shown significant reduction of their symptoms and signs. Mean corticosteroid dosage of patients was reduced from 2.2 to 1.2 mg/day. During the follow-up period 15% recurrence observed; however, intensity of attack was less than previous. It is concluded that Pitawakkadi Kashaya can improve the clinical condition of corticosteroid dependent asthmatic patients, which can lead to a reduction in corticosteroid usage and therefore, less adverse effects experienced through their use. Hence, Pitawakkadi Kashaya leading to better symptomatic control, reduction of the number of asthma attacks and emergency situations and improved quality of life.

Key words: Bronchial asthma, chronic inflammatory disease, Pitawakkadi Kashaya

Role of Intravenous Magnesium

Dr. Arjunsa H. Satapute, Dr. Balbir Malhotra, Dr. N. C. Kajal, Dr. Avneet Garg


Department of Chest and TB, Government Medical College, Amritsar, India

Asthma is a chronic respiratory disease that is characterized by periods of relative control and episodes of deterioration, which are referred to as exacerbations. Exacerbations range in severity from mild to severe (status asthmaticus), and can result in visits to health-care providers and emergency departments (EDs), and may at times require hospitalization. Here, we present a study involving 50 (25 study and 25 control cases) patients of acute severe asthma and role of magnesium sulphate in management of this. Asthma is a world-wide problem with 300 million affected individuals. Global prevalence of asthma ranges from 1% to 18% in the population of different countries. The WHO has estimated that

15 million disability adjusted life years (DALYs) are lost annually due to asthma representing 1% of total global disease burden. Annual world-wide death from asthma have been estimated to be 250,000 and mortality does not appear to correlated well with prevalence. Current asthma reported to be 1.2 to 6.3% in adults of most countries. The overall burden of asthma in India is estimated to be more than 15 million patients. The prevalence of asthma in school going children is 4-19% in the different geographical areas of India. Presently standard treatment for the management of acute severe asthma in adults is O 2 inhalation, nebulize B2 agonists and IV steroids as per GINA guidelines. In additional therapeutic options for acute exacerbations magnesium sulphate 2 g I. V. is considered to be one of the treatment of choice. Magnesium was proposed to be a treatment for asthma in 1936. Magnesium sulphate as IV form has been suggested as a treatment for certain emergency conditions for more than 60 years and it is currently proposed to be beneficial in treating asthma, pre-eclampsia, eclampsia, myocardial infarction, and cardiac arrhythmia. Intravenous magnesium sulphate has been successfully used in the treatment of acute severe asthma. There is evidence that magnesium sulphate can provide additional bronchodilatation when given in conjunction with standard bronchodilating agent and corticosteroids. Magnesium is relatively inexpensive, readily available, easy to administer with minor side-effects such as light headedness, lethargy, transient flushing, burning at the IV site. Transient urticaria resolving with discontinuation of magnesium has been reported. Magnesium sulphate causes relaxation of bronchial muscle. This can occur by modulating calcium ion movement both within the cell and through calcium membrane channels. Magnesium also known to decrease the amount of neurotransmitter released at motor nerve terminal diminish depolarizing action of acetylcholine at motor end plate and depress excitability of smooth muscle membrane. There is evidence that prostaglandin mediated vascular muscle dilatation is magnesium dependent. Magnesium decreases superoxide production in neutrophils obtained from adult asthmatics; therefore, providing some evidence that magnesium has antiinflammatory effect.

Effect of CPAP Therapy on Hypertension in Patients of Obstructive Sleep Apnea Syndrome

Dr. Moosa Hussain, Dr. S. C. Matah


Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Introduction: A main cause of secondary hypertension is obstructive sleep apnea (OSA) and OSA commonly co-exist with hypertension. This hypertension results due to sympathetic nervous system over activity and oxidative stress leading to alteration of vascular structure and function. In these patient during apneic episodes there is an increase in systolic and diastolic pressure. And in most of the patient's blood pressure (BP) remain elevated during daytime even when breathing is normal. CPAP treatment abolishes the apneas and prevent intermittent arterial pressure surges and nocturnal variation of BP, with some beneficial effect on daytime BP. Cardiovascular risk is greatly reduced with a small decrease of BP.

Objectives: To find out the effect on BP after 6 months of CPAP therapy in non-symptomatic hypertensive patients with OSA.

Materials and Methods: A total of 23 hypternsive patients with OSA were evaluated. Patients were included if apnea hypopnea index is greater than 15/h, and if the patient was having systolic BP greater than 140 or diastolic BP greater than 90 mmHg or patient was under antihypertensive treatment. These patients were prescribed CPAP therapy after CPAP titration. BP was evaluated at baseline and at 3 and 6 month.

Results: The mean age of the patients were 50.17 ± 5.46 years with a mean BMI of 30 ± 3 kg/m 2 . There was a small change in mean systolic and diastolic BP after CPAP treatment. The average decrease in systolic pressure in 6 months CPAP treatment was 1.391 (95% CI: 1.053 to 1.730) mmHg (P = 0.00) and diastolic average decrease in diastolic pressure was 1.826 (95% CI: 1.219 to 2.433) mmHg (P = 0.00). More than 4 h per night use of CPAP treatment has more effect on BP.

Conclusions: Hypertensive Obstructive Sleep Apnea (OSA) patients when treated with CPAP for more than 4 h per night have a small decrease in Blood Pressure (BP).

Pathophysiology of Bronchial Asthma

Dr. Tariq Mahmood, Dr. Ravi Bhaskar, Dr. Surya Kant


Department of Pulmonary Medicine, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India

Asthma is characterized by intermittent airflow obstruction, airway inflammation and bronchial hyperresponsiveness, which leads to recurrent symptoms of brief duration and exacerbations. The inflammatory response in asthma is the manifestation of activation and complex interactions between many inflammatory cells and their molecular mediators within the lungs. Due to chronic inflammation, there are marked changes in structure of the bronchi, which include denuded epithelium and altered subepithelium characterized by collagen deposition, smooth muscle hypertrophy, and hyperplasia. Each cell type exerts effector and regulatory functions in the pathogenesis of asthma as described below.

Foreign Body Aspiration in Children and Its Management

Prof. A. N. Gangopadhayay, Dr. Vaibhav Pandey


Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Foreign body aspiration is a major cause of morbidity and mortality in children. Foreign body aspiration has remained a consistent problem since decades with 80% of all aspirations occurring in children. Definite history of sudden onset of choking followed by cough, respiratory distress, localized wheeze and radiological evidence of pulmonary collapse or emphysema makes the diagnosis easy. Many cases are treated for years as recurrent or unresolved pneumonia, bronchial asthma or pulmonary tuberculosis. In such cases, initial incident is either trivial, unobserved, forgotten by parents or remains undetected due to low index of clinical suspicion by the caring physician. Impacted foreign bodies, which are undiagnosed for years cause permanent lung damage. This can result in lung abscess or bronchiectasis requiring segmental/lobar resection or pneumonectomy. Although pneumonia is the most common cause of cough and respiratory distress in children, foreign body inhalation is not an uncommon problem.

Pulmonary Rehabilitation

Dr. G. N. Srivastava


Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

What is pulmonary rehabilitation? It is a form of individually tailored treatment strategies that includes patient and family education, breathing training, breathing exercises, physical reconditioning and in selective cases, home oxygen. In addition, pulmonary rehabilitation required attention to good nutrition, positive health habits, and a new outlook on life designed to enhance the happiness of the individual. Pulmonary rehabilitation probably does more to improve life quality than anything else and it certainly does so by keeping patients active and living at home rather than in hospitals or extended care facilities. Pulmonary rehabilitation in all its forms has shown that practically "everyone" is doing rehabilitative work with chronic and acute lung-diseased patients. A closer look reveals that "every-one;" however, is doing it in vast and varying degrees, and very few are applying all its principles and techniques. Indeed, even fewer are aware of the total spectrum available to the practitioner and his patient.

Asthma and COPD: Differences in Pathophysiology and Novel Therapeutic Approaches

Dr. Pawan Yadav, Prof. J. K. Mishra


Department of TB and Chest, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Asthma and COPD are both obstructive lung diseases defined by inflammation of the airways. However, the similarities end here, their pathophysiologies and treatment responses are visibly different. The response to treatment between asthma and COPD also differ markedly. The eosinophilic inflammation in asthma is more readily suppressed by corticosteroids, which inhibit almost every aspect of the inflammatory process. Such differences are being explored increasingly in recent times to devise more specialized therapies that are effective and inflict least collateral damage. Apart from the hallmark persistent airway inflammation, the pathophysiology of COPD is characterized by protease-antiprotease imbalance and increased oxidative stress. While several new molecular targets that regulate airway inflammation such as NFkB, PI-3kinase PDE4 and HDAC are being defined for treating COPD strategies to curtail proteolytic/oxidant damage have emerged that includes N-acetyl cysteine and inhibitors of matrix metalloproteinases and neutrophil elastase among others. Airway hyperresponsiveness (AHR) a characteristic physiologic abnormality in asthma, is strongly linked to eosinophilic inflammation as opposed to a predominant neutrophilic infiltration in COPD. CD4.1 T lymphocytes (T-helper type 2 cells) seem to regulate this eosinophilic inflammation and mast cell degranulation that underlies the rapid and episodic bronchoconstrictor responses of asthma. Evidently approaches to target IL5, an eosinophilic growth factor have shown promise in treatment of asthma. More interesting therapies such as TLR9 agonists that switch the unfavorable Th2 responses in asthma to the cytotoxic Th1 immune response are also being explored. Thus, with ever increasing understanding of distinct pathological processes in these airway diseases the therapeutic possibilities are also rapidly expanding. It remains to seen; however, as to how these evolving treatments impact the disease outcome.

Pulmonaty Function Test in Clinical Practice

Dr. S. K. Pathak


Breathe Easy Chest Care Centre, and Heritage Hospital, Assi, Varanasi, Uttar Pradesh, India

Pulmonary function test (PFT) is the method of determining how well lungs and airways are working. It gives to pulmonologist a series of numbers, which allows them to compare each patient lung function with predicted value based on age, sex, race and height. Components of pulmonary function test are-Spirometery, Body Plethysmography, Peak expiratory Flowmetry, Pulse Oxymetry, arterial blood gases (ABG), Exercise testing (6-12 min), Single breath Nitrogen washes out method, Multiple breath nitrogen wash out method, Close circuit helium method, Progressive Ergometric stress test, PFT for gas exchange and diffusion (DLCO), Maximum inspiratory pressure, Physiological testing during the sleep. Spirometery is one of the important parameter to know about lung function, which is routinely used in chest practice. The indications of Spirometery are-to establish a base line pulmonary function, to detect disease like COPD; Asthma; ILD; RLD, to follow course of disease, to monitor treatment, evaluation of impairment, identification of high-risk group-smoker (serial Spirometery), Occupational survey, environmental hazard detection, drug exposure related lung disease, pre-employment screening, and physical fitness. Indications of spirometry in day today clinical practice are - Diagnosis of Bronchial asthma, Assessment severity, Monitoring response of treatment during acute exacerbation and chronic therapy, Detection of asymptotic deterioration at home in the self-managed program, Identifying trigger factor, Occupational asthma, Detection of COPD, and Evaluation of dyspnea. Spirometric grading of Bronchial asthma is based upon PEFR, whereas COPD grading is based on FEV1 and FVE1/FVC and restrictive lung disease grading is based on FVC. Pulmonary function test is also indicated for pre-operative assessment of surgical patient-having age more than 70 years, thoracic surgical patient, abdominal surgery patient, patient with a history of tobacco use, known or suspected cardiopulmonary disease, patient who need prolong surgery during anesthesia. PFT value that indicates increased risk of post-operative complication are FEV1 < 2 L, FEV1 25-75 < 40% of predicted; <1.2 L of predicted, FEV1 200-1200 < 200 L/ min, MVV <50% of predicted, ABG Pa CO 2 > 45 mmHg.

Preclinical Studies of a Pteridophyte-Diplazium Esculentum Retz. On Allergic Asthma and Mast Cell Stabilization

Dr. Biswadeep Das, Dr. Tania Paul, Dr. K. G. Apte, Dr. P. B. Parab, Dr. R. Chauhan, Dr. R. C. Saxena


Allergic asthma has become an endemic disease of the 21 st century. In the present world of pollution, we are surrounded by dust particles and myriads of allergen, which cause allergic asthma. This ailment provokes symptoms such as rhinitis, wheezing, dyspnea, and chest tightness along with bout of cough or anaphylaxis. In anaphylaxis and allergic disorders mast cells play a protective role in defending the intruding pathogens by release of histamine and other chemical mediators. In the present study, the investigations were carried out to evaluate the anti-anaphylactic and mast cell stabilizing activity of Diplazium esculentum. Retz, which is commonly known as vegetable fern. Ferns or Pteridophytes with ample diversity of more than 12,000 species have found little application in modern medicine as compared to angiosperms. The present study was thus undertaken to provide rationale of proposing various in vivo and in vitro models for emphasizing the allergic asthmatic conditions and provide significant remedy in managing the manifestation of allergic asthma. In this study, Wistar rats were sensitized by conventional method by injecting horse serum and triple antigen. The globulin fraction of the horse serum is considered to be an environmental allergen in provoking the allergic reactions. The aqueous extract at 250 mg/kg and 500 mg/kg showed intact mast cells 72.83% and 76.67% while the ethanolic extract at the same dose showed 69% and 71.67% respectively (P < 0.001). Both extracts at two different doses also showed protective activity in in vitro passive anaphylaxis. The treatment performed by aqueous and ethanolic extracts of the fern also showed marked protection against mast cell degranulation induced by Compound 48/80, To further understand its therapeutic potential the Nitric Oxide and Myeloperoxidase, two markers of inflammation were monitored which showed significant reduction (P < 0.001) in the treated groups. The results clearly substantiate the anti-allergic effects of the vegetable fern, Diplazium esculentum in allergic asthma.

Key words: Allergic asthma, compound 48/80, diplazium esculentum, mast cell degranulation, Retz

Behavioral Assessment of Children with Bronchial Asthma

Dr. Aparna Singh, Dr. S. K. Upadhyay, Dr. Vineeta Gupta


Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

The aim of this study is to evaluate behavioral disturbances in children with bronchial asthma.

Materials and Methods : A total of 40 children with asthma were included in the study group by consecutive sampling and compared to 40 normal children matched for age, sex, and of similar socioeconomic status. Age ranged between 6 years and 14 years. Childhood Psychopathology Measurement Schedule (CPMS); adapted from Child Behavior Check-list was administered for behavioral assessment.

Result: Nearly, 22.5% of children with asthma had a CPMS score of >10 as against 2% in the control group. Children with asthma had higher scores in factors of low intelligence with behavioral problems and physical illness with emotional problems. The mean CPMS score was 6.4 ± 3.0 (range 2-13) in asthma group and 4.8 ± 2.7 (range 1-12) in the control group. The difference was statistically significant (P < 0.01). Conclusion: This study highlights the significantly higher psychopathology in children with asthma and emphasizes the need of psychological treatment, which covers psycho-educational self-management programs, relaxation therapy, biofeedback, and family therapy for improving the quality of life of these patients.

The Basic Tenets of Ayurvedic Immunology

Prof. R. H. Singh


Department of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Ayurveda is the ancient Indian system of life science and Medicine, its historicity going back to the Vedas. Its classical knowledge and practice is based on its own physics and biology, its unique pronature holistic health and disease concepts and diagnostics as well as its own material medica. The ancient classical knowledge-base of Ayurveda is available today in the form of a robust ancient classical literature, the principal ones being the Brihattrayi (Caraka, Susruta, Vagbhatta) and Laghuttrayi (Madhav Nidana, Sharandhara and Bhavaprakash) texts, which are considered the most respected and authentic source books. Brihattrayis are pre-chiristian writings while the Laghuttayis are the creation of medieval and subsequent period of Indian history. All these texts exist originally in Samskrit language but are now translated in Hindi and English. Although the contemporary practice of Ayurveda is largely based on its classical foundations, one may find great impact of contemporary biomedical sciences and medical practices today. In view of the pressing demand for evidence based practice of Ayurveda by the society and science stream now lot of attempts are being made to conduct research in theory and practice of Ayurveda besides validation of the safety and efficacy of its medications and their Quality assurance. An over view of the science of Ayurveda indicates that the Ayurvedic seers of the classical age had really an advanced knowledge of Genetics specially epigenomics and Immunology. Almost everything what we know today in modern biomedical sciences about genetics and immunology, was known in principles to ancients and is described in classical texts in their own language and words, which is not difficult to decode today if we follow a genuine reverse innovation and translational study. There is a possibility of getting leads for further research, which could enrich modern Immunogenetics. The author of this communication will attempt to describe in brief the basic tenets of Ayurvedic Immunology as described in Ayurvedic classics.

Role of Holistic Approach in the Management of COPD-De Novo Concept

Dr. Abhishek Srivastava, Dr. Nishith Kumar


Department of Pulmonary Medicine, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India

COPD is an umbrella term to define a wide variety of disorder encompassing not only airways and lungs, but also other systems of the human body. Despite advancements in early diagnosis and management of COPD the disease continues to be a major cause of morbidity and mortality throughout the world. The recent data is worrisome as COPD is expected to become 3 rd leading cause of death by the year 2020. Living with COPD can be challenging as the disease dramatically affects patient's daily life. Chronic airflow limitation together with muscle wasting, anxiety-depression, ongoing lung damage due to smoking/occupational exposure plays an important role in overall impact on the disability caused due to the disease. There is a growing consensus among the researcher and practitioner alike regarding the importance of treating the disease as a whole and not just its respiratory component. Thus, apart from regular pharmacotherapy a holistic approach of treatment taking into consideration all aspects of patient's need that is physical, mental, social, and spiritual is call of the hour and can complement the existing modality of treatment.

Advances in Management of Bronchial Asthma in Children

Dr. Abhishek Abhinay, Dr. O. P. Mishra, Dr. Rajniti Prasad


Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Asthma is a chronic inflammatory disorder of the airways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy. Airway inflammation is the result of interactions between various cells, cellular elements, and cytokines. In susceptible individuals, airway inflammation may cause recurrent or persistent bronchospasm, which causes symptoms that include cough, wheezing, breathlessness and chest tightness, particularly at night (early morning hours) or after exercise. Airway inflammation is associated with airway hyperreactivity or bronchial hyper-responsiveness (BHR), which is defined as the inherent tendency of the airways to narrow in response to various stimuli. According to World Health Organization (WHO) estimates, 300 million people suffer from asthma, 255,000 people died of Asthma in 2005 and over 80% of Asthma deaths are reported from low and lower-middle income countries. Asthma creates a substantial burden on individuals and families as it is more often under-diagnosed and under-treated. In India, about 57,000 deaths were attributed to Asthma in 2004 (WHO 2004) and it was seen as one of the leading cause of morbidity and mortality in rural India.

Though effective screening, evaluation, and management strategies for asthma are well-established in high-income countries, these strategies have not been fully implemented in India as evidence had previously suggested that Asthma is not to be treated independently, but fitted into the general spectrum of respiratory diseases. Furthermore, even though medicines that treat Asthma effectively are available at affordable costs, they rarely reach more than 1% of those who would benefit from it.

Management of Chronic Urticaria: An Update

Dr. Manish Bansal


Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Urticaria is a disturbing allergic disease characterized by itchy wheals and/or angioedema associated with pruritus. Mostly a benign disease but can present with life-threatening laryngeal edema besides having a great negative impact on the quality of the life of the patients. Various etiological factors have been proposed including physical, allergic, hereditary, autoimmune, and idiopathic. Laboratory investigations are mostly inconclusive. Treatment of the chronic urticaria is a must seeking its symptoms and impact on the quality of life. An ideal and appropriate stepwise approach is necessary and has better results. An updated review of the pathogenesis and various treatments available and the approach towards patients presenting with chronic urticaria and angioedema will be discussed in detail.

Immunological Study of Seronegative Spondyloarthritis

Dr. Shailja Singh, Dr. Usha, Dr. Manoj Kumar Paswan, Dr. Pramod Kumar Verma, Dr. N. K. Singhand 1 , Dr. S. K. Saraf 2


Departments of Pathology, 1 Medicine, and, 2 Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Seronegative Spondyloarthritides (SSA) are group of disorder which involves lower spine and sacroiliac joint. Most of these cases are positive for HLA B27. Aim of the present study is to observe serological profile of SSA cases.

Materials and Methods: A total of 90 cases of SSA and 43 healthy controls were studied. Only HLAB27 positive SSA cases were taken while HLAB27 negative SSA cases were excluded. While in controls all 43 cases were HLAB27 negative. Anti CCP 2 Ab, Rheumatoid factor, Anticordiolipin Ab, ANA, ds DNA Ab were performed by ELISA technique.

Result: Anti CCP2 Ab was non-significantly positive in SSA, Anti CCP2 Ab was more positive in SSA (16.2%) who had pain in small joints of hand and feet. IgM RF, IgA RF were positive in 5.5% and 8.9% cases while IgG RF was positive in 37.8% patients and this was statistically significant as compared to controls. ANA positivity in SSA patients was significantly high (13.3%) while ds DNA Ab rise was statistically non-significant. No correlation of RF IgM, RF IgG, RF IgA, Anti CCP2 Ab, ANA. dsDNA, APLA was found with age of the patients. Thus our study concludes that SSA is not truly seronegative. IgG RF and ANA can be found positive in SSA patients also.

Key words: ANA, ankylosing spondylitis, anticardiolipin ab, rheumatoid factor, seronegative spondyloarthritides

Clinical Study on the Efficacy of Pitawakkadi Kashaya (A Sri Lankan Traditional Decoction) on the Management of Bronchial Asthma

Dr. Y. A. U. D. Karunarathne, Dr. E. D. T. P. Gunarathne, Dr. R. S. Jayawardane


Institute of Indigenous Medicine, University of Colombo, Sri Lanka

Bronchial asthma is a serious global health problem, suffers about 5-10% of persons of all ages. It is a chronic inflammatory disease of the airways characterized by bronchial hyper reactivity and a variable degree of airway obstruction. Recurrent episodes of acute shortness of breath, typically occurring at night or in the early morning hours, are the cardinal manifestation of bronchial asthma. Further symptoms include cough, wheezing, and a feeling of tightness in the chest. An atopic diathesis, i.e. a genetic pre-disposition toward the production of IgE antibodies in response to pollen, house dust mites, fungi or animal-derived proteins, is the most important risk factor for bronchial asthma. In childhood, bronchial asthma is usually due to allergies; on the other hand, in 30-50% of adults with asthma, no allergy can be identified. Serum IgE levels decreased significantly in patients treated with decoction while IgA, IgG and IgM levels were not significantly changed. All patients were shown significant reduction of their symptoms and signs. Mean corticosteroid dosage of patients was reduced from 2.2 to 1.2 mg/day. During the follow-up period 15% recurrence observed; however, intensity of attack was less than previous. It is concluded that Pitawakkadi Kashaya can improve the clinical condition of orticosteroiddependent asthmatic patients, which can lead to a reduction in corticosteroid usage and therefore, less adverse effects experienced through their use. Hence, Pitawakkadi Kashaya leading to better symptomatic control, reduction of the number of asthma attacks and emergency situations and improved quality of life.

Key words: Bronchial Asthma, chronic inflammatory disease, pitawakkadi Kashaya

Role of IV Magnesium Sulphate as an Adjunct in Treatment of Acute Asthma

Dr. Arjunsa H. Satapute, Dr. Balbir Malhotra, Dr. N. C. Kajal, Dr. Avneet Garg


Department of Chest and TB, Government Medical College, Amritsar, India

Asthma is a chronic respiratory disease that is characterized by periods of relative control and episodes of deterioration, which are referred to as exacerbations. Exacerbations range in severity from mild to severe (status asthmaticus), and can result in visits to health-care providers and emergency departments (EDs), and may at times require hospitalization. Here, we present a study involving 50 (25 study and 25 control cases) patients of acute severe asthma and role of magnesium sulphate in management of this. Asthma is a world-wide problem with 300 million affected individuals. Global prevalence of asthma ranges from 1% to 18% in the population of different countries. The WHO has estimated that 15 million disability adjusted life years (DALYs) are lost annually due to asthma representing 1% of total global disease burden. Annual world-wide death from asthma have been estimated to be 250,000 and mortality does not appear to correlated well with prevalence. Current asthma reported to be 1.2-6.3% in adults of most countries. The overall burden of asthma in India is estimated to be more than 15 million patients. The prevalence of asthma in school going children is 4-19% in the different geographical areas of India. Presently standard treatment for the management of acute severe asthma in adults is O 2 inhalation, nebulize B2 agonists and IV steroids as per GINA guidelines. In additional therapeutic options for acute exacerbations magnesium sulphate 2 g IV is considered to be one of the treatment of choice. Magnesium was proposed to be a treatment for asthma in 1936. Magnesium sulphate as IV form has been suggested as a treatment for certain emergency conditions for more than 60 years and it is currently proposed to be beneficial in treating asthma, pre-eclampsia, eclampsia, myocardial infarction, and cardiac arrhythmia. Intravenous magnesium sulphate has been successfully used in the treatment of acute severe asthma. There is evidence that magnesium sulphate can provide additional bronchodilatation when given in conjunction with standard bronchodilating agent and corticosteroids. Magnesium is relatively inexpensive, readily available, easy to administer with minor side-effects such as light headedness, lethargy, transient flushing, burning at the IV site. Transient urticaria resolving with discontinuation of magnesium has been reported. Magnesium sulphate causes relaxation of bronchial muscle. This can occur by modulating calcium ion movement both within the cell and through calcium membrane channels. Magnesium also known to decrease the amount of neurotransmitter released at motor nerve terminal diminish depolarizing action of acetylcholine at motor end plate and depress excitability of smooth muscle membrane. There is evidence that prostaglandin mediated vascular muscle dilatation is magnesium dependent. Magnesium decreases superoxide production in neutrophils obtained from adult asthmatics; therefore, providing some evidence that magnesium has antiinflammatory effect.

Effect of CPAP Therapy on Hypertension in Patients of Obstructive Sleep Apnea Syndrome

Dr. Moosa Hussain, Dr. S. C. Matah


Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Introduction: A main cause of secondary hypertension is obstructive sleep apnea (OSA) and OSA commonly co-exist with hypertension. This hypertension results due to sympathetic nervous system over activity and oxidative stress leading to alteration of vascular structure and function. In these patient during apneic episodes there is an increase in systolic and diastolic pressure. And in most of the patient's blood pressure (BP) remain elevated during daytime even when breathing is normal. CPAP treatment abolishes the apneas and prevent intermittent arterial pressure surges and nocturnal variation of BP, with some beneficial effect on daytime BP. Cardiovascular risk is greatly reduced with a small decrease of BP.

Objectives: To find out the effect on BP after 6 months of CPAP therapy in non-symptomatic hypertensive patients with OSA.

Materials and Methods: A total of 23 hypternsive patients with OSA were evaluated. Patients were included if apnea hypopnea index is greater than 15/h, and if the patient was having systolic BP greater than 140 or diastolic BP greater than 90 mmHg or patient was under antihypertensive treatment. These patients were prescribed CPAP therapy after CPAP titration. BP was evaluated at baseline and at 3 and 6 month.

Results: The mean age of the patients were 50.17 ± 5.46 years with a mean BMI of 30 ± 3 kg/m 2 . There was a small change in mean systolic and diastolic BP after CPAP treatment. The average decrease in systolic pressure in 6 months CPAP treatment was 1.391 (95% CI: 1.053 to 1.730) mmHg (P = 0.00) and diastolic average decrease in diastolic pressure was 1.826 (95% CI: 1.219 to 2.433) mmHg (P = 0.00). More than 4 h per night use of CPAP treatment has more effect on BP.

Conclusions: Hypertensive OSA patients when treated with CPAP for more than 4 h per night have a small decrease in BP.

Pathophysiology of Bronchial Asthma

Dr. Tariq Mahmood, Dr. Ravi Bhaskar, Dr. Surya Kant


Department of Pulmonary Medicine, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India

Asthma is characterized by intermittent airflow obstruction, airway inflammation and bronchial hyperresponsiveness, which leads to recurrent symptoms of brief duration and exacerbations. The inflammatory response in asthma is manifestation of activation and complex interactions between many inflammatory cells and their molecular mediators within the lungs. Due to chronic inflammation, there are marked changes in structure of the bronchi, which include denuded epithelium and altered subepithelium characterized by collagen deposition, smooth muscle hypertrophy and hyperplasia. Each cell type exerts effector and regulatory functions in the pathogenesis of asthma as described below.

Foreign Body Aspiration in Children and Its Management

Prof. A. N. Gangopadhayay, Dr. Vaibhav Pandey


Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Foreign body aspiration is a major cause of morbidity and mortality in children. Foreign body aspiration has remained a consistent problem since decades with 80% of all aspirations occurring in children. Definite history of sudden onset of choking followed by cough, respiratory distress, localized wheeze and radiological evidence of pulmonary collapse or emphysema makes the diagnosis easy. Many cases are treated for years as recurrent or unresolved pneumonia, bronchial asthma or pulmonary tuberculosis. In such cases, initial incident is either trivial, unobserved, forgotten by parents or remains undetected due to low index of clinical suspicion by the caring physician. Impacted foreign bodies, which are undiagnosed for years cause permanent lung damage. This can result in lung abscess or bronchiectasis requiring segmental/lobar resection or pneumonectomy. Although pneumonia is the most common cause of cough and respiratory distress in children, foreign body inhalation is not an uncommon problem.

Pulmonary Rehabilitation

Dr. G. N. Srivastava


Department of TB and Respiratory Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

What is pulmonary rehabilitation? It is a form of individually tailored treatment strategies that includes patient and family education, breathing training, breathing exercises, physical reconditioning and in selective cases, home oxygen. In addition, pulmonary rehabilitation required attention to good nutrition, positive health habits, and a new outlook on life designed to enhance the happiness of the individual. Pulmonary rehabilitation probably does more to improve life quality than anything else and it certainly does so by keeping patients active and living at home rather than in hospitals or extended care facilities. Pulmonary rehabilitation in all its forms has shown that practically "everyone" is doing rehabilitative work with chronic and acute lung-diseased patients. A closer look reveals that "every-one;" however, is doing it in vast and varying degrees, and very few are applying all its principles and techniques. Indeed, even fewer are aware of the total spectrum available to the practitioner and his patient.

Asthma and COPD: Differences in Pathophysiology and Novel Therapeutic Approaches

Dr. Pawan Yadav, Prof. J. K. Mishra


Department of TB and Chest, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Asthma and COPD are both obstructive lung diseases defined by inflammation of the airways. However, the similarities end here, their pathophysiologies and treatment responses are visibly different. The response to treatment between asthma and COPD also differ markedly. The eosinophilic inflammation in asthma is more readily suppressed by corticosteroids, which inhibit almost every aspect of the inflammatory process. Such differences are being explored increasingly in recent times to devise more specialized therapies that are effective and inflict least collateral damage. Apart from the hallmark persistent airway inflammation, the pathophysiology of COPD is characterized by protease-antiprotease imbalance and increased oxidative stress. While several new molecular targets that regulate airway inflammation such as NFkB, PI- 3kinase PDE4 and HDAC are being defined for treating COPD strategies to curtail proteolytic/oxidant damage have emerged that includes N-acetyl cysteine and inhibitors of matrix metalloproteinases and neutrophil elastase among others. Airway hyperresponsiveness (AHR) a characteristic physiologic abnormality in asthma, is strongly linked to eosinophilic inflammation as opposed to a predominant neutrophilic infiltration in COPD. CD4.1 T lymphocytes (T-helper type 2 cells) seem to regulate this eosinophilic inflammation and mast cell degranulation that underlies the rapid and episodic bronchoconstrictor responses of asthma. Evidently approaches to target IL5, an eosinophilic growth factor have shown promise in treatment of asthma. More interesting therapies such as TLR9 agonists that switch the unfavorable Th2 responses in asthma to the cytotoxic Th1 immune response are also being explored. Thus, with ever increasing understanding of distinct pathological processes in these airway diseases the therapeutic possibilities are also rapidly expanding. It remains to seen; however, as to how these evolving treatments impact the disease outcome.




 

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