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   Table of Contents - Current issue
January-June 2022
Volume 36 | Issue 1
Page Nos. 1-61

Online since Thursday, February 16, 2023

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Pollen forecasting: A future necessity p. 1
Raj Kumar, Manoj Kumar
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Management of drug allergy-clinical update Highly accessed article p. 4
PC Kathuria, Manisha Rai
The new classification of drug hypersensitivity reactions (DHRs) is based on phenotypes, endotypes, and biomarkers. Immediate and delayed reactions are the clinical phenotypic presentation while endotypes are based on cellular, biological mediators, and biomarkers. Complement activation, cyclooxygenase-1 inhibition, Mas-Related G Protein-Coupled Receptor-X2 (MRGPRX2), Cytokine release syndrome (CRS) is also included in DHRs due to mast cell activation e.g., radio contrast media, nonsteroidal anti-inflammatory drugs, monoclonal antibodies, oxaliplatin and taxanes, etc. Genetic predisposition of specific human leukocyte antigen alleles has been associated with the development of T cell-mediated symptoms of severe cutaneous adverse reactions (SCAR), which includes acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necroplasia, due to antibiotics, retrovirus and anti-convulsant drugs, etc., drug desensitization (Ds), is a personalized treatment approach for immunoglobulin E (IgE), and Non-IgE mediated DHRs, for example, antibiotics, biologicals, chemotherapy, etc. This review will update on the mechanism of DHRs, the clinical approach of alternative drugs, and Ds in a high-risk patient.
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Need to raise awareness about self care practices among people living with human immunodeficiency virus infection p. 18
Ravishekar N Hiremath, Sandeep Bhalla, Sandhya Ghodke, Seema Rai, Rishi Raj, Smakshi Singh
BACKGROUND: Globally, 36.9 million people are living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Like in chronic disease, many individuals may engage in self-initiated behaviors in HIV that are useful to maintain health, quality of life and perceptions of wellbeing. All these behaviors form the part of self-care activities. METHODOLOGY: This is a hospital-based cross-sectional descriptive study carried out in a large tertiary care center. A total of 120 consecutive HIV-positive patients were included in the study. RESULTS: While 99% (101) of participants told that good diet is necessary to maintain health, only 42.2% (43) told that adherence to treatment is important. With respect to satisfactory knowledge regarding different attributes of self care, majority (79.4%) had knowledge regarding diet to be taken to stay healthy while only 37.3% had knowledge regarding precautions to be taken while preparing food, 28.4% in case suffering from diarrhea, skin problems (11.8%), fever (61.8%), cough (19.6%), vomiting (11.8%), and headache (45.6%) which were very low. With regard to overall knowledge status, 22.5% (95% confidence interval 14.9–31.89) had satisfactory score while 77.5% had unsatisfactory score. The test of significance revealed that there is statistically significant relation of knowledge regarding self-care with that of education and duration of HIV positivity. CONCLUSION: Findings showed low awareness regarding self-care to be taken, leading to low percentage of overall satisfactory knowledge level among respondents which is a matter of concern. This knowledge which is often neglected and is therefore vital for an HIV-positive person to be able to take care of himself at the right time and take the right actions to prevent the progression of the disease and improve the quality of life.
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Effectiveness of the chAdOx1 nCoV-19 vaccine in preventing COVID-19 infection p. 23
Tarana Sarwat, Devendra Kumar Singh, Neeraj Pal Singh, Satendra Pal Singh, Dalip Kumar Kakru
AIM: The study aimed to assess the effectiveness of the ChAdOx1 nCoV-19 vaccine in preventing laboratory-confirmed COVID-19. METHODS: It was a test-negative, case‒control study conducted at Sharda Hospital, Greater Noida, India, between March 2021 and May 2021. An equal number of cases and controls were included in the study after taking proper informed consent. The individuals with positive reverse transcriptase-polymerase chain reaction test reports were taken as cases, whereas those with negative reports were included as controls. Data were analyzed and the groups were compared using multivariable logistic regression to calculate the odds ratio (OR), with adjustment for gender and presence or absence of comorbidities. The effectiveness of vaccine was calculated by the formula (1-adjusted OR) ×100%. RESULTS: On analyzing the data from 560 case‒control pairs, the vaccine effectiveness was calculated as 57.46% (95% confidence interval [CI]: 53.85–61.02) and 60.09% (95% CI: 56.32–63.77) for single dose and two doses, respectively. The effectiveness of complete and single-dose vaccination against the moderate-to-severe disease was calculated as 63.79% (95% CI: 58.58–68.77) and 56.19% (95% CI: 51.30–61.0), respectively. CONCLUSION: The ChAdOx1 nCoV-19 vaccine was found to be effective against COVID-19, with protection after two doses being a little more than that after a single dose. It also proved effective in protecting against the severe form of the disease.
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Influence of thyroid status on pulmonary functions in bronchial asthma patients p. 28
Kaushal Kumar, Aarti Sood Mahajan, Dayaram Haldwani, Dharam Pal Bhadoria, Binita Goswami
BACKGROUND: Asthma is a serious global health problem affecting all age groups. It is being recognized for its health impact on the working status of adults, and uncontrolled asthma is associated with significant morbidity, mortality, and socioeconomic problems. The knowledge of comorbidities of asthma, including thyroid disorders, is important for its management. METHODOLOGY: A case–control study was conducted in 60 diagnosed patients of bronchial asthma in the age group of 20–40 years attending medicine outpatient departments and Chest Clinic of Lok Nayak Hospital, New Delhi. Thirty controls were taken from the normal population. Pulmonary function tests using "Schiller SP1 portable top spirometer" were done, and forced vital capacity (FVC), forced expiratory volume in 1st s (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR) were analyzed. The thyroid function was assessed by estimating levels of serum thyroid-stimulating hormone (TSH), free T3, and free T4 using the Cobas e411 autoanalyzer. RESULTS: Based on TSH analysis of asthmatic patients, 25% were hypothyroid, 16.7% were hyperthyroid, and 58.3% were euthyroid. There were significant reductions in FEV1, FEV1/FVC ratio, and PEFR in asthmatics compared to controls, but no significant differences were found in these parameters among the asthmatics with different thyroid status. CONCLUSION: The thyroid functions varied in asthmatics. However, the variation in the thyroid function did not affect the pulmonary function in asthmatic patients.
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A cross-sectional study to evaluate factors responsible for uncontrolled asthma p. 34
Manoj Meena, Govind Singh Rajawat, Piyush Arora, Suresh Koolwal, Hemant Kumar Sakkarwal, Aashish Kumar Singh
INTRODUCTION: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Various triggers, lack of knowledge about the disease, and unawareness about the correct inhalation techniques lead to poor control of the disease. This study aimed to study the factors responsible for uncontrolled asthma using the asthma control test (ACT) and explore other ways to improve asthma control. MATERIALS AND METHODS: One hundred and eighty diagnosed cases of bronchial asthma according to Global Initiative for Asthma (GINA) guidelines, >18 years were enrolled for the study in an outpatient setting. The level of asthma control was assessed using the self-administered ACT. Factors responsible for uncontrolled asthma were evaluated using a questionnaire based on GINA guidelines. RESULTS: Our study noted that in the majority (66.11%) of patients, asthma was poorly controlled followed by well-controlled (24.44%). Asthma was perfectly controlled in only 9.44% of patients. The mean value of the ACT score of study subjects was 17.5 ± 4.16 with a median (25th–75th percentile) of 17 (15–20) within the range of 7–25. Smoking (P < 0.0001), poor education about asthma (P < 0.0001), social stigma regarding inhaler use (P < 0.0001), wrong inhalation techniques (P < 0.0001), environmental triggers (P < 0.0001), associated comorbidities (P = 0.005), poor adherence to treatment (P < 0.0001), inappropriate therapy (P < 0.0001), and frequent hospitalizations (P = 0.006) were the factors responsible for uncontrolled asthma. CONCLUSION: The present study identified various factors responsible for the high prevalence of asthma in an outpatient clinical setting. Common risk factors that contribute to poor asthma control were assessed in a comprehensive manner.
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Parental knowledge, attitude toward asthma, and its correlation with compliance of asthma management in children p. 40
L Caroline Silvia, J Podhini, Soundararajan Palanisamy
BACKGROUND: Asthma is one of the common chronic illnesses in children affecting about 10-15% worldwide. Proper management of asthma depends on the knowledge, attitude, and practices of the parents towards asthma which in turn will enable early intervention and prompt management. OBJECTIVE: To determine the parental knowledge, attitude towards asthma and its correlation with the compliance of asthma management in children. METHODOLOGY: It is a cross-sectional observational study carried out in a tertiary care hospital between January 2020 to December 2020. RESULTS: The study included 112 participants. Mothers were the predominant caregivers (72.3%). Family history of asthma was noticed in 42.8%. 88.4% knew that their child was suffering from asthma, 18% felt that asthma is contagious. Change in the climate (91.1%), dust (60.7%), respiratory infection (49.1%), and smoke (44.6%) were the common triggers. 15% tried an alternate system of medication. Majority (87%) had moderate knowledge, 92 (82%) showed good practices. 56 (50%) exhibited negative attitude. Nearly 60% of the participants preferred inhaler therapy. The causes for non-adherence to inhaler therapy were fear of addiction (46.7%), child refusing inhaler (40%), cost of therapy (40%) and child being symptom free in between episodes (37.8%). CONCLUSIONS: This study revealed a moderate level of knowledge and good practices towards childhood asthma among the parents of asthmatic children. Better knowledge and good practices among the parents strongly correlated with mother being the participant of the study, educational status, positive family history of asthma and persistent asthma symptoms. Better knowledge and positive attitude towards asthma was associated with adherence to inhaler therapy.
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Effect of duration of exposure on health complaints, systemic inflammatory responses, immunological markers, and pulmonary function tests among workers working at the vegetable market p. 47
Kalahasthi Ravibabu, Vinay Kumar Adepu, Jamalpur Ravi Prakash, Raju Nagaraju, Jakkam Surendar
BACKGROUND: The vegetable markets are a rich source of organic dust and bioaerosol exposure. The effect of duration of exposure on health complaints, systemic inflammatory responses (SIR), immunological markers, and pulmonary function tests (PFT) among loading and unloading workers at the vegetable market was not explored. OBJECTIVE: The current study was undertaken to assess the effect of duration of exposure on health complaints, SIR, immunological markers, and PFT among workers working at the vegetable market. MATERIALS AND METHODS: The study design is descriptive, 45 male participants with no smoking habit and having more than 3 years of experience were enrolled in the study. The study participants were categorized into low (n = 23) and high (n = 22) exposure groups based on the median duration of exposure, which is the multiplication of years of exposure and working hours per day. The demographic details, health complaints, SIR, immunological, and PFT parameters were investigated and compared between low and high exposure groups. RESULTS: Workers with a prolonged duration of exposure have reported a considerable increase in musculoskeletal disorders, eye irritation, and skin allergies. SIR such as serum albumin, high sensitivity C-reactive protein, lymphocytes, white blood cell count, and immunological markers (immunoglobulin E and immunoglobulin A) were considerably increased, and PFT were significantly decreased in the high exposure group as compared to the low-exposure group. CONCLUSIONS: Contemporary study revealed that high duration of exposure contributes to augmented health complaints, SIR, immunological markers, and reduced competence of PFT among loading and unloading workers at vegetable markets. Therefore, this study suggests workplace hygiene practices with the use of personal protective equipment might lower the health effects and inflammation markers.
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Relevance of skin prick test, serum total immunoglobulin E, and absolute eosinophil counts in asthma patients p. 54
Manoj Kumar, Rajesh Kumar Gupta, Anil Kumar Mavi, Kamal Singh, Raj Kumar
BACKGROUND: Asthma is a multifaceted condition defined by chronic airway inflammation. Skin prick test (SPT), serum total immunoglobulin E (tIgE), and absolute eosinophil counts (AEC) estimation are commonly available tools for evaluating allergen sensitization. OBJECTIVE: The present study evaluates the sensitivity to common aeroallergens and also compares serum tIgE and AEC levels with spirometry in Indian individuals with a history of allergy symptoms. MATERIALS AND METHODS: An observational prospective study was conducted in the Outpatient Department of Viswanathan Chest Hospital, VPCI, Delhi, between 2017 and 2019. Two hundred asthma patients diagnosed as per the Global Initiative for Asthma guidelines undergo SPT against a battery of common aeroallergens and measured serum tIgE and AEC. RESULTS: Out of 200 cases, the overall prevalence of common aeroallergens sensitization was found to be 57% (114) in asthmatic patients (atopic). SPT positivity to common aeroallergens was highest in people between the ages of 21 and 30 and lowest in people over 50. The most prevalent annoying aeroallergens were found to be weed pollens (14%), house dust mites (11%), fungi (10.5%), tree pollen (9.5%), dust (6%), kapok cotton (5.5%), grass pollen (3.5%), silk (1.5%), and wool (1%). The mean tIgE was higher in atopic asthmatic patients than in nonatopic asthmatic patients (553.25 ± 218.12 IU/ml and 489.1 ± 251.16 IU/ml; P = 0.056). CONCLUSION: In the present study, we found that insects are the most common offending aeroallergens with higher SPT sensitivity and serum tIgE in atopic patients. Spirometry severity is not affected by allergens sensitivity in asthma patients.
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People living with HIV/AIDS (PLHAs) Knowledge regarding progression of HIV infection: A cross-sectional study p. 60
Ravishekar N Hiremath, Sandhya Ghodke
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