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   Table of Contents - Current issue
January-June 2021
Volume 35 | Issue 1
Page Nos. 1-36

Online since Tuesday, December 7, 2021

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Allergy testing amidst COVID pandemic p. 1
Nitin Goel, Raj Kumar
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Severe asthma with fungal sensitization p. 3
Rajendra Prasad, Syed Ahmed Hussain Kazmi, Rishabh Kacker, Nikhil Gupta
Bronchial asthma is an inflammatory disease of the airways, which may be worsened due to many extrinsic factors. The most common trigger is the continuous exposure to allergens, of which fungal agents are important factors. A new phenotype of asthma called severe asthma with fungal sensitization (SAFS) has been described. It is diagnosed by the presence of severe asthma, fungal sensitization, and absence of allergic bronchopulmonary aspergillosis. SAFS is more of a diagnosis of exclusion. Treatment of SAFS initially should be similar to that of severe asthma including humanized anti-IgE monoclonal antibody and other biologics. These patients usually do not have their symptoms relieved with conventional treatment of severe asthma, i.e. high-dose inhaled corticosteroids and long-acting bronchodilators. Prolonged use of oral corticosteroids and pulse high-dose intravenous corticosteroid is effective. There are some evidence implicating the role of antifungal agents including itraconazole, but its use as a specific therapy requires further studies.
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The study of fractional exhaled nitric oxide in newly diagnosed cases of bronchial asthma and chronic obstructive pulmonary disease p. 8
V Lakshmi, Priti Meshram, Ujjwal Kumar, Vishwanath Pujari, Pinkutty Sagar
INTRODUCTION: Fractional exhaled nitric oxide (FENO) is a measurement of fractional nitric oxide (NO) concentration in exhaled breath. It is a quantitative, noninvasive, simple, and safe method to measure airway inflammation for the assessment of airways diseases. OBJECTIVE: The study was conducted at the tertiary care hospital to study the FENO levels in newly diagnosed patients of bronchial asthma and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: A total number of 105 patients were included in the study, diagnosed based on pulmonary function test and symptomatology. FENO levels were measured using Medisoft FENO machine, and the results were analyzed. RESULTS AND CONCLUSIONS: We found that both COPD and bronchial asthma are more prevalent among males. FENO levels were higher in bronchial asthma patients as compared to COPD patients. In bronchial asthma, FENO levels were higher in patients with very severe obstruction, and in COPD, patients with mild obstruction had slightly higher FENO values.
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Effect of leukotriene receptor antagonist therapy in bronchial asthma – A prospective, preliminary, hospital-based, randomized study in rural Konaseema, Andhra Pradesh p. 12
Bhargav Prasad Bathula, Pandit Vinodh Bandela, Pentakota Ravikumar, Bhima Sankar Duvvuri, Subba Rao Polimati
BACKGROUND: The role of leukotriene receptor antagonist is well documented in the management of chronic asthma. However, the efficacy in acute asthma is not yet established. AIM AND OBJECTIVES: This study was designed to evaluate the clinical efficacy of oral montelukast as an add-on drug to the standard therapy of the acute attack of bronchial asthma. MATERIALS AND METHODS: A prospective, institutional-based, single-blinded, randomized control study was done. A total of 100 (aged between 18 and 60 years) participants diagnosed with acute exacerbations due to bronchial asthma were enrolled in the study. They were divided into study and control groups randomly. The study group patients were treated with 10 mg of montelukast once in a day for 4 weeks as an add-on drug, whereas the control group received only standard medication of acute bronchial asthma (as per Global Initiative for Asthma guidelines). All the participants were monitored at baseline to every week for a month. RESULTS: All the 100 participants were assessed finally without any dropouts. The baseline characteristics were noted similarly in both groups. The mean age was 35.46 + 13.17 years in the control and 37.86 + 14.43 years in the study group. Majority were males in both the groups. At the end of the 4 weeks of oral montelukast administration, there was improvement in forced expiratory volume in 1 s (FEV1) and peak expiratory flow rate at 2 weeks and 1 month. On many occasions, there was a strong improvement in FEV1 and other clinical parameters after continuous treatment with beta-2 agonists and parenteral corticosteroids for patients with acute asthma. Even though there was no improvement in FEV1/forced vital capacity ratio among both the groups at 2 weeks and 4 weeks, statistically significant improvement was seen between 2 weeks to 1 month on baseline parameters. CONCLUSION: Administration of oral montelukast 10 mg as an add-on drug to standard therapy may help in quick recovery from acute bronchial asthma and relapse.
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Estimation of prevalence of bronchial asthma in preschool and prepubertal children using international study of asthma and allergies in childhood criteria in Raipur Chhattisgarh p. 17
Renu Kale, Raghavendra S Khachhawaha
OBJECTIVE: Bronchial asthma is the most common chronic disease affecting children and young adults. The prevalence of asthma is on the rise worldwide with increasing levels of pollution. The epidemiology of asthma is a growing area of research. There is a paucity of data from central India, especially from Raipur, which has become the capital of Chattishgarh since the year 2000. This community-based study was conducted to estimate the prevalence of bronchial asthma in school going children aged between 6–7 years and 13–14 years. MATERIALS AND METHODS: A cross-sectional study using ISSAC questionnaires was conducted across 12 schools in Raipur, selected on a random basis. The required sample size of 1000/age group was needed according to International Study of Asthma and Allergies in Childhood criteria, so a total of 2029 children were recruited in both age groups. Data were managed in Microsoft Office Excel and were analyzed using tests of proportion. RESULT: Out of 2029 children evaluated, 153 (7.54%) had a positive history of wheezing throughout their lives and the relative number of wheezy girls was 7.56% as compared to boys 7.52%. Comparison between two age groups 6–7 and 13–14 years, wheezing incidence of 7.37% and 7.71% was similar with no significant difference. Confirmed asthma was detected in 2.32% of cases. No significant difference was noted in both age groups, i.e. 1.97% in 6–7 and 2.67% in 13–14 years. Higher incidence of exercise-induced wheeze was noted in older age group (13–14 years) children 5.04% versus 4.23%. CONCLUSION: The prevalence of bronchial asthma was 2.32% in children in Raipur. Increasing trends in prevalence due to increasing pollution needs environmental measure to control pollution.
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Diagnostic accuracy of respiratory impedance parameters to detect airflow obstruction in adults p. 22
Sajal De
OBJECTIVE: The present study was aimed to evaluate the diagnostic accuracy of impedance parameters to detect airflow obstruction and the severity of airflow obstruction in adults. METHODS: The spirometry parameters (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], FEV1/FVC, FVC3/FVC, and FEF25-75) and respiratory impedance parameters (R5, R19, R5-19, and X5) measured by forced oscillation technique of consecutive 299 adults (male: 186) were included in the present analysis. The Spearman correlation coefficient (ρ) was used to assess the correlations of impedance parameters with spirometry indices. The area under the curve (AUC) was used to assess respiratory impedance parameters' diagnostic accuracy. RESULTS: The mean age of the study population was 54.1 ± 12.3 years, and 99 individuals (33%) had airflow obstruction (FEV1/FVC < 0.70) in spirometry. All spirometry indices (% of predicted) showed a weak negative correlation with R5, R19, R5-19, and weak positive correlation with X5. The R5 >142% predicted and X5 >136% predicted had the maximum AUC (0.75) with a sensitivity of up to 56% and specificity up to 86% to identify airflow obstruction. The impedance parameters showed low concordance with the severity of airflow obstruction. CONCLUSION: Respiratory impedance parameters had insufficient sensitivity to diagnose airflow obstruction and the severity of obstruction in adults. Thus, impedance parameters cannot a substitute for spirometry in diagnosing obstructive lung function.
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A rare case of allergic bronchopulmonary aspergillosis with allergic fungal rhinosinusitis masquerading as granulomatous vasculitis p. 27
Sudhir Kumar, Deependra Kumar Rai, Subhash Kumar
The combination of allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatosis with polyangiitis (EGPA) or Grnaulomatosis polyangitis (GPA) has been well described in the literature, but this is the first case report of ABPA with allergic fungal rhinosinusitis (AFRS) mimicking as granulomatous vasculitis (EGPA and GPA) as per the authors. A 25-year-old woman, symptomatic for the past 4 years and initially treated for bronchial asthma, presented with worsening dyspnea, cough, fever, anorexia, and leg pain. There were increasing pulmonary opacities in the chest radiograph, and a computed tomography scan demonstrated left hilar adenopathy and consolidation. The patient was diagnosed with ABPA after the initial workup and prescribed oral prednisolone with itraconazole. The patient also had nasal polyposis, sinusitis, mucin in sinuses, and fungal growth in mucin favoring the diagnosis of AFRS. Fiberoptic bronchoscopy showed plaque-like endobronchial lesions and bronchial stenosis, and histopathologic examination of the biopsy from the nodular lesion demonstrated eosinophilic bronchitis. Normal serum angiotensin-converting enzyme levels, positive Mantoux test, and the eosinophilic inflammation in the endobronchial biopsy ruled out the possibility of sarcoidosis. Both cytoplasmic and perinuclear antineutrophil cytoplasmic antibodies (c- and p-ANCA, respectively) were found positive in a vasculitis panel test, the positive p-ANCA favoring the diagnosis of EGPA, while the combination of endobronchial lesion, sinus abnormality, and nonresolving consolidation along with positive c-ANCA favoring the diagnosis of GPA as well. However, in the absence of histopathological evidence of vasculitis, ANCA may be false positive. Accordingly, a final diagnosis of ABPA combined with AFRS was made. The patient responded well to oral prednisolone along with inhaled asthma medications. Our case highlights the overlapping clinical features of eosinophilic lung diseases and small-vessel vasculitis, which may coexist, and the need to investigate thoroughly for better clinical outcomes.
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Imaging findings in common variable immunodeficiency p. 33
Suhail Rafiq, Sumiaya Kiran, Musaib Ahmad Dar, Uroosa Shabir, Sanna Birjees, Obaid Ashraf
Common variable immunodeficiency is characterized by decreased levels of immunoglobulins leading to repeated infections of chest, gastrointestinal tract, etc., Radiological findings and clinical suspicion could be helpful in diagnosing common variable immunodeficiency thereby decreasing mortality and morbidity associated with disease. We present radiological findings in a 20-year-old patient with laboratory findings supporting the diagnosis of common variable immunodeficiency.
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