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   Table of Contents - Current issue
Coverpage
July-December 2016
Volume 30 | Issue 2
Page Nos. 55-111

Online since Monday, December 05, 2016

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EDITORIAL  

Vitamin D and asthma p. 55
SN Gaur, Gulvir Singh
DOI:10.4103/0972-6691.195202  
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REVIEW ARTICLE Top

Role of proteases in pathophysiology of allergic diseases p. 57
Sagar Laxman Kale, Komal Agrawal, Naveen Arora
DOI:10.4103/0972-6691.195210  
Prevalence of allergic diseases ranges from 20% to 30% worldwide and is increasing for the last few decades. Emerging studies have implicated proteases, both endogenous and exogenous in initiating, mediating, and exacerbating allergic responses. Mast Cells (MCs) are the critical effectors of the allergic diseases and upon activation release a wide variety of mediators and account for the majority of endogenous proteases including chymase, tryptase, and MC-carboxypeptidase A (MC-CPA). The substrates of MC proteases include extracellular matrix components, proenzymes, and cell surface receptors. These proteases are stored in a fully active state and upon release contribute to the tissue injury. Along with endogenous proteases, allergens having protease activity have also been implicated in the manifestation of allergic diseases. Protease allergens are known to modulate immune responses toward Th2 by (i) disrupting protease-antiprotease balance at the epithelial surfaces, (ii) disrupting airway epithelial barrier, (iii) activating airway epithelial cells, (iv) modulating the activity of immune cells, and (v) by cleaving cell surface receptors. As proteases play crucial roles in the manifestation of allergic reactions, they can be exploited as a target for the development of new generation therapies for allergic diseases.
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ORIGINAL ARTICLES Top

Response of influenza vaccine in chronic obstructive pulmonary disease patients p. 66
SN Gaur, Gulnar Begum, Gaurav Bhati, M Rehman
DOI:10.4103/0972-6691.195213  
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. The World health Organization has suggested that elderly individuals with chronic lung disease to be targeted for immunization. In spite of all these recommendations, influenza vaccine is underused, especially in developing countries. Objective: This study aims to study the effect of influenza vaccine in patients with COPD in reducing acute exacerbations, emergency visits, sputum quantity, hospital admission, and Intensive Care Unit (ICU) admission in a 2-year period. Materials and Methods: Twenty-five patients of COPD were selected based on their forced expiratory volume in 1 s as having mild, moderate, severe, and very severe COPD. These patients were followed and evaluated for 2 years, 1 year before vaccination, and 1 year after vaccination. The parameters studied are, the number of acute episodes, emergency visits, hospital admission, ICU admissions, sputum quantity, and chest X-rays were evaluated before and after 1 year of vaccination. Results: The vaccine showed a significant decrease in all the parameters (P < 0.001), except for chest X-rays and ICU admission. The overall effectiveness of influenza vaccine was found to be 63.12%. Conclusions: Influenza vaccine is safe and effective among moderate, severe, and very severe COPD patients. It has also been found very effective in severe COPD patients associated with comorbidities.
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Effect of diet on the respiratory health of children in rural area of Delhi-NCR p. 71
Raj Kumar, Kamal Singh, Nitesh Gupta
DOI:10.4103/0972-6691.195233  
Background: Asthma is one of the most common chronic diseases worldwide. For asthma and allergic disorders, diet has been recently established as a potential risk factor. Thus, a change in dietary habit may be postulated, as one of the unknown factors responsible for the rise in prevalence of asthma among children in rural India. Objectives: To assess the association of diet with asthma in Indian rural population. Materials and Methods: This study was a cross-sectional study of children aged <18 years residing in Khanpur Jupti village, Ghaziabad, Uttar Pradesh, during 2011-2015. A questionnaire-based survey was carried out for respiratory illness-related symptoms. It was developed on the basis of American Thoracic Society (ATS), British Medical Research Council, and the International Study of Asthma and Allergies in childhood questionnaires to detect the presence of symptoms suggestive of asthma. The age and sex, birth order, duration of breastfeeding, educational status, food habits (vegetarian and nonvegetarian), and major chronic chest symptoms (cough, sputum, shortness of breath, and wheezing) were included in the questionnaire-based survey. The diagnosis of asthma was made by the physician examining the children, based on the guidelines of ATS. Results: Of 187 houses which were surveyed, there were a total of 607 children (males n = 339 [55.84%] and females n = 268 [44.16%]). 17.1% (n = 104; males n = 59 [56.73%]) children were diagnosed as asthma. In the evaluation of dietary habits, children diagnosed with asthma had significantly higher consumption of nonvegetarian food (43.27% vs. 28.23; P < 0.05). However, age and gender distribution, educational status, birth order, and duration of breastfeeding did not show a significant difference between children diagnosed with asthma and without asthma. Conclusion: The study concluded that increased risk of asthma was associated with higher consumption of nonvegetarian food. Furthermore, breastfeeding did not have any protective effect on asthma.
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Identification of common allergens for united airway disease by skin prick test p. 76
Vikas Deep Mishra, Tariq Mahmood, Jai Krisna Mishra
DOI:10.4103/0972-6691.195237  
Objective: Identification of common allergens by skin prick test in patients of united airway disease. Materials and Methods: Skin prick test was performed in 60 patients of United Airway Disease to identify the common allergens. A total of 62 allergens consisting of 36 types of pollen, 5 fungi, 4 insects, 8 type of dusts, 4 dander, 3 fabrics, Dust mite and Parthenium leaves were tested. Result: Most common allergens were Dust mite (60%) followed by Parthenium leaves (45%), insects (18.75%), pollen (14.81%), dust allergens (8.51%), fabrics (8.33%), fungi (5.66%), dander (5%). Most common insect allergens were cockroach (female) (30%), cockroach (male) (23.33%). Common pollens were Ricinus communis (28.33%), Amaranthus spinosus (28.33%), Parthenium hysterophorus (26.66%), Eucalyptus tereticornis (26.66%) and Cynodon dactylon (25%). Common dust allergens were house dust (21.66%), paper dust (11.66%) and cotton mill dust (10%). Among fabrics kapok cotton (13.33%) showed maximum positivity. Among fungi Aspergillus fumigatus (10%) followed by A. niger (6.66%) were most common. In animal dander group common ones were cat dander followed by dog dander. Conclusion: In conclusion it can be said that the knowledge drawn by above study will help to treat patients by immunotherapy or avoidance strategy.
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Dietary pattern and lifestyle factors in asthma control p. 80
Mohammed Noufal Poongadan, Nitesh Gupta, Raj Kumar
DOI:10.4103/0972-6691.195245  
Background: The prevalence of asthma in adults varied from 0.96% to 11.03% while in children ranged from 2.3% to 11.9% in India. A number of factors including genetic predisposition, environment, and lifestyle factors including dietary habits influence the development and expression of asthma. The goal of asthma treatment is to achieve and maintain clinical control, which can be achieved in a majority of patients with pharmacologic intervention strategy. Objective: To assess the role of diet and lifestyle factors in asthma control in Indian population. Materials and Methods: Diagnosed asthma patients (aged 12-40 years) were enrolled from the outpatient clinics. All patients were followed up and reassessed after 4 weeks with asthma control test (ACT) and dietary and lifestyle questionnaire. The assessment of dietary pattern was performed by food frequency questionnaire (Nordic Nutrition Recommendations-Danish Physical Activity Questionnaire). The lifestyle factor included body mass index, smoking status, tobacco chewing, alcohol consumption, duration of travel (h/week), mental stress (visual analog scale: 0-10), sports activity - h/day, television (TV) watching/video games - h/day, duration of sleep - h/day. Results: Seventy-five asthma patients (43 males and 32 females) were divided into three groups according to ACT, 18 (24%) patients in poorly-controlled asthma, 35 (46.7%) in well-controlled asthma, and 22 (29.3%) patients with totally-controlled asthma. Increased consumption of vegetables and cereals in patients with total-controlled asthma while increased consumption of sugar, nonvegetarian, fast food, salted and fried snacks in patients with poorly-controlled asthma. Poorly-controlled asthma had the highest duration of watching TV and sleep and least duration of travel and sports, though the results failed to reach statistical significance. Conclusion: The dietary and lifestyle factors too contribute to degree of control of asthma in India.
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A cross-sectional study of clinico-immunological profile of systemic lupus erythematosus patients in a tertiary care centre in Mangalore p. 91
Neethu Kishor, Rekha Boloor, TK Sukumar
DOI:10.4103/0972-6691.195250  
Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease, which occurs frequently in women, mainly at childbearing age. This disease can affect any organ system; its presentation and course over time are highly variable. It is characterized by autoantibody response to nuclear and cytoplasmic antigens. Inadequate data on its clinico-immunological profile are available. The present study focuses on reevaluating clinical and immunological manifestations and also the management of SLE patients. Materials and Methods: The study was carried out in a tertiary care hospital for 2 years, i.e., from June 2014 to May 2016. Patients of all age groups fulfilling revised American College of Rheumatology Criteria (1997) was included in this study. Baseline investigations were done, and autoantibody profiling was done using immunoblot strips coated with 14 different antigens. Results: Over a period of 2 years, 40 patients were studied. The majority (85%) was females, and most of the patients were of the age group 15-30 years. Fever was the most common clinical manifestation (55%), followed by arthritis (33%) and dermatological manifestations (25%). Antinuclear antibody profile showed autoantibodies against nucleosomes in 19 patients (48%), followed by nRNP in 18 (45%), dsDNA in 17 (43%), Ro in 16 (40%), ribosomal P in 16 (40%), Sm in 13 (33%), and histones in 13 (33%) patients. Most of the patients (45%) were treated with a combination of corticosteroid and antimalarial. Conclusion: Clinical manifestations can vary between fever, arthritis, and skin rash to severe systemic involvement. The disease is more common in females especially during the second and third decade of life. Autoantibody profiling aids in supporting diagnosis and antimalarials along with corticosteroids are mainstay of treatment.
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The adequacy of inhaler technique in patients with chronic obstructive pulmonary disease and asthma attending a tertiary care hospital in Navi Mumbai p. 95
Akanksha Das, Abhay Uppe, Kanishk Sinha, TK Jayalakshmi, Girija Nair, Amit Nagpal
DOI:10.4103/0972-6691.195253  
Objectives: Chronic obstructive pulmonary disease (COPD) and asthma are major concerns to health-care system. Improper inhaler device used (metered dose inhaler/dry powder inhaler) is one of the major causes associated with inadequate control of the disease. This study was performed to evaluate the inhaler technique among patients and to investigate factors associated with improper use and whether age or gender was associated with poor inhaler technique. Materials and Methods: A cross-sectional study of all patients who visited the chest outpatient department with asthma and COPD over a 6-month-period in a tertiary care hospital in Navi Mumbai. Information was collected about demographic data and inhaler technique was assessed using a standard checklist. Results: There were 107 patients, 71 with asthma and 36 with COPD. Inhaler techniques of 95% of patients were found to be inadequate in some form or the other as per checklist. Of all the patients interviewed, only about 60% of patients recalled that demonstration was done by doctors or other health-care professionals. Twelve percent were instructed by pharmacists and remaining followed their friend's or relative's suggestions along with insert literature. Conclusions: The inhaler technique is inadequate among most patients. On every visit, patient's inhaler technique should be observed and adequate suggestions should be given to correct any deficiency.
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CASE REPORTS Top

Allergic bronchopulmonary aspergillosis mimicking lung cancer in a nonasthmatic male patient p. 99
Arun Kannan, Sowmya Gopalan, Preetam Arthur
DOI:10.4103/0972-6691.195264  
Presentation of Aspergillus infections of the lung is varied. Allergic bronchopulmonary aspergillosis (ABPA) is one such presentation in which there is hypersensitivity reaction to Aspergillus antigens. It occurs commonly in asthmatics and patients with cystic fibrosis. We report a case of ABPA in a 55-year-old male initially evaluated for left lung cancer who had never been diagnosed with asthma.
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A case of polyserositis in a 56-year-old female patient p. 102
Aratrika T Das
DOI:10.4103/0972-6691.195267  
Polyserositis is defined as general inflammation of serous membranes associated with serous effusion due to many causes. In this case, we report polyserositis as a complication of connective tissue disorder. A 56-year-old female with a history of hypertension, hypothyroidism, and bipolar disorder having dyspnea along with pleural effusion which was repeatedly tapped and treated on suspicion of tuberculosis. She became better on steroid treatment and her respiratory distress resolved.
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Churg-Strauss syndrome: A rare cause of pleural effusion p. 105
Govind Singh Rajawat, Aashish Kumar Singh, Supreet Batra, ML Gupta, GS Yadav, Suresh Koolwal
DOI:10.4103/0972-6691.195270  
Churg-Strauss syndrome (CSS) is a rare, small-vessel vasculitis associated with a prominent allergic component, asthma, and blood or tissue eosinophilia. Granulomas, eosinophils, and palisading histiocytes in extravascular tissues are hallmarks of this disorder. The presence of asthma or allergy as well as more than 10% of eosinophils in blood is 95% sensitive and 99% specific, respectively, in distinguishing CSS among a subgroup of patients with well-documented systemic vasculitis. We present a case of pleural effusion which was finally diagnosed as CSS. Considering its rarity, this case is reported.
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Clinical profile of patients with C1-inhibitor deficiency from Eastern India p. 109
Sujoy Khan
DOI:10.4103/0972-6691.195271  
C1-inhibtor deficiency or hereditary angioedema is a rare, autosomal dominant disorder that is characterized by severe episodic attacks of angioedema that can affect any part of the body. It is caused by mutations in the C1-inhibitor gene (C1-INH or SERPING 1 gene) that is mapped to chromosome 11 (11q12-q13.1). The majority of patients have a family history although 25% of cases can be de novo mutations (i.e., no family history). Distinguishing the angioedema due to C1-inhibitor deficiency from allergic or idiopathic angioedema requires clinical acumen, and this delay in diagnosis leads to unnecessary surgical interventions, and in unfortunate cases, mortality that is now possible to prevent with easy access to screening tests and proper management.
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