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   2019| July-December  | Volume 33 | Issue 2  
    Online since January 28, 2020

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Allergic bronchopulmonary aspergillosis: Indian scenario
Rajendra Prasad, Rishabh Kacker, Nikhil Gupta
July-December 2019, 33(2):63-69
Aspergillus is ubiquitous, occurring in mycelial form and grows at 15-530C and humid conditions. Pulmonary aspergillosis is a clinical spectrum of lung disease caused by the fungus Aspergillus. ABPA is the commonest disease among allergic bronchopulmonary mycoses. The exact prevalence of ABPA is not known but contemporary estimates suggested that ABPA complicates 1 to 11% of all chronic cases of bronchial asthma. The basic underlying immuno-pathophysiologic process in ABPA is a hypersensitivity reaction to fungus in the bronchial tree. Patients are usually atopic with previous history of bronchial asthma. The onset is insidious with constitutional symptoms like anorexia, fatigue, weight loss, headache, generalized aches and pains, and low-grade fever. It is characterized by repeated episodes of exacerbation with periods of remission, if untreated may progress to fibrotic lung disease. Patients with chronic fibrotic disease may present with cyanosis, corpulmonale and respiratory failure. Radiologically fleeting shadows are characteristic of ABPA. Bronchiectasis, centrilobular nodules and mucoid impaction are main features of ABPA seen in CT scan thorax. Oral corticosteroid remains the cornerstone for the treatment of ABPA. Optimization of baseline asthma therapy is essential. Early diagnosis and proper treatment may alter the prognosis of disease and further prevent end stage lung fibrosis.
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A study of skin prick test sensitivity to common allergens in patients of nasobronchial allergy
Saurabh Karmakar, Kashif Raza, Rajendra Prasad
July-December 2019, 33(2):91-97
BACKGROUND: Nasobronchial allergy accounts for a significant burden of allergy all over the world. The prevalence of nasobronchial allergy is increasing, so we conducted an observational study of common allergens by skin prick test (SPT) method in this group of patients. OBJECTIVE: The objective is to study skin sensitivity to various allergens in patients of nasobronchial allergy, using SPT method. MATERIALS AND METHODS: A total of 6000 SPTs were done using 60 allergens on 100 patients of nasobronchial allergy. RESULTS: Males were the predominant group of patients, and nasobronchial allergy was most common in 21–30 years' age group in our study. Among various groups of allergens studied, insects (24%) were the most common offending allergens, followed by dust mite (20%), airborne dust (11.3%), pollens (7.75%), fungi (6%), dander (6%), silk (4%), juicy foods (2.4%), and nonjuicy foods (2.25%). Among insects, moth (30) was the common allergen. Among dust, grain dust (30) was the common allergen. Among pollens, Cassia siamea (20) was most common. Aspergillus fumigatus (16) was the most common fungus to which sensitivity was elicited. Among miscellaneous foods (juicy and nonjuicy), milk, almonds, and cashew nut (4 each) were the common allergens. CONCLUSION: Skin prick testing forms an essential part of a comprehensive approach for allergy remediation. Our study determined skin sensitivity to various allergens for avoidance therapy and immunotherapy in affected patients. Allergy to insects as found in our study to be most common is likely because of prevailing poor sanitation and overcrowded dwellings in the Indian milieu.
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Drug utilization study in patients with bronchial asthma of a tertiary care hospital in Western Maharashtra
Ruchi Doongarshi Shah, Shreyas Ramchandra Burute, Sunita Jaiprakash Ramanand, Mangala Bhaskar Murthy, Nami Dungarshi Shah, Arvind Vitthal Kumbhar
July-December 2019, 33(2):105-111
BACKGROUND: Drug utilization studies (DUS) are necessary for knowing the extent of drug use and identify variability in drug use among different regions. Bronchial asthma is known to be one of the major causes of morbidity and mortality in India. There is paucity of Indian data which evaluate the pattern of drug utilization in bronchial asthma over its entire spectrum and varying severity. Hence, the present study was designed to assess the drug utilization pattern in all bronchial asthma patients at a tertiary care hospital to understand the current prescription trends and to determine areas in need of further research. MATERIALS AND METHODS: A prospective, observational study for a period of 1 year from February 2014 to January 2015 was conducted at the outpatient and inpatient departments of medicine and pediatrics, government teaching tertiary care hospital, Maharashtra. The WHO's prescribing indicators were used for evaluating DUS. Assessment of the overall pattern of drug use and antiasthmatic drugs was done. Data were analyzed using descriptive studies. RESULTS: Data of 250 asthma patients showed a male preponderance (males vs. females 52.8% vs. 47.2%). The average number of drugs per encounter was 6.10. Only 33.9% of the drugs were prescribed by generic name, and a higher percentage (64.8%) of antibiotics were prescribed. Nearly 69.44% of the prescribed drugs were from essential drug list. The overall pattern of drug use showed that β2 agonists (100% and 97.33%) and corticosteroids (92.57% and 94.66%) were the most common classes of antiasthmatic drugs prescribed in medicine and pediatric departments, respectively. One important finding was that inhaled salbutamol and inhaled corticosteroid were prescribed less commonly. CONCLUSIONS: The present study identifies the need for prescription by generic name and improvement in prescribing practices with current recommendations or guidelines for the management of bronchial asthma. This will help ensure rational use of drugs.
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The effect of single educational intervention on improving nurses' proficiency in using different inhaler devices in a tertiary care setting
Jaishree Ganjiwale, Ravish Manmohan Kshatriya, Yoshaan Joshi, Somashekhar Nimbalkar
July-December 2019, 33(2):86-90
CONTEXT: Inhalation medications are administered by different inhalers such as pressurized metered-dose inhaler (pMDI) with or without the spacer, dry-powder inhaler (DPI), and nebulizer. Many health-care providers including nurses may have deficiencies in knowledge about using inhalers. This can result in improper techniques of using inhalers adapted by patients, which may lead to wastage of time, medicine, and money and thereby poor outcome in terms of relief. AIMS: The aim is to study the proficiency of inhalers in nurses and the effect of educational intervention to improve the same. SETTINGS AND DESIGN: It was a hospital-based educational interventional type of study. SUBJECTS AND METHODS: Technique of usage of inhalers in 87 nurses was assessed. The steps assessed were as follows (1) Preparation, (2) Administration, (3) Inhalation, (4) Coordination, and finally, (5) Instructions given to patients. Important and necessary steps such as able to identify empty device, advising mouth gargles after administration of the drug via the inhaler device and proper breath holding were also assessed. After an initial assessment, nurses were given an individualized educational session regarding the correct usage of various inhaler devices. They were again reevaluated after one month for the same. STATISTICAL ANALYSIS USED: The proportion of the participants performing the steps properly before and after the intervention was calculated and compared with Z-test for proportions. The relationship between the years of experience and score for task post intervention was seen through Karl Pearson's correlation coefficient (r). RESULTS: After the intervention, the proficiency of nurses with the use of each device improved as follows: for pMDI from 21.8% to 36.8%, for DPI from 21.8% to 62.18%, for pMDI with spacer from 2.3% to 21.%, and for nebulizer from 33.3% to 53.21%. For important steps such as identification of empty MDI, only 28.7% of the nurses did it correctly, which improved to 64.4% after the intervention. For proper holding of the device, the proficiency of nurses increased from 29.9% to 69.7%. For proper coordination, the proficiency increased from 18.39% to 67.1%. About 11.4% of the nurses held breath correctly before, which improved to 60.5% after teaching. About 40.2% of the nurses advised gargles after using inhalers before the intervention, which improved to 86.8% afterward. CONCLUSIONS: Our individualized training has made a difference and improved knowledge as well as skills regarding the use of different inhaler devices in nurses, although there is still a lot of scope for further improvement.
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A study to compare pulmonary function in apparently healthy females exposed to biomass fuel combustion versus clean fuel combustion in Allahabad District
Tariq Mahmood, Ashish Kumar Jain, Arvind Kumar Verma, Pundarik Dwivedi
July-December 2019, 33(2):79-85
BACKGROUND: Life in a typical Indian household revolves around the cooking area, and Indian women spend much of their time there. Cooking stoves in biomass fuel users are nothing more than a pit, a chulha, or three pieces of brick. Cooking under these conditions entails high levels of exposure to cooking smoke. AIMS AND OBJECTIVES: (1) To compare the pulmonary function parameters of biomass fuel users with clean fuel users. (2) To evaluate the pulmonary function test (PFT) among individuals exposed to biomass fuel combustion. MATERIALS AND METHODS: Three hundred and fourteen nonsmoking women without any history of any major chronic illness in the past were selected for this study. The study group comprised of 68 women exposed to biomass fuel combustion, 105 women exposed to clean fuel combustion, and 141 women exposed to mixed fuel (earlier using biomass fuel but now gradually shifting to clean fuel). All women were evaluated for PFTs MIR spirolab III. OBSERVATION AND RESULTS: The lung function parameters were significantly lower in the women exposed to biomass fuel in comparison to the clean fuel users and mixed fuel users forced expiratory volume 1 (FEV1) (P < 0.05); FEV1/forced vital capacity (FVC) (P < 0.05); FVC (P < 0.05); peak expiratory flow rate (PEFR) (P < 0.05); the lung function parameters were also significantly reduced in group of mixed fuel users in comparison to the group of clean fuel users FEV1 (P < 0.05); FEV1/FVC (P < 0.05); FVC (P < 0.05); PEFR (P < 0.05). The evaluation of PFTs suggested the increased risk to the obstructive type of pulmonary disease in biomass users. CONCLUSION: The reduction in the pulmonary function in the biomass-exposed women could be due to high exposure to biomass pollutants with inadequate ventilation in cooking area.
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B cell counterpart of Treg cells: As a new target for autoimmune disease therapy
Myong-Guk Ri, Chol-Ho Kang
July-December 2019, 33(2):70-78
B cells have been considered a positive immune regulator by producing antibodies and presenting antigens to T cells. Recently, it has been shown that B cells comprise rare but potent subset capable of inhibiting immune responses via diverse regulatory mechanisms. This subset of B cells, known as regulatory B cells (Bregs), negatively regulates immune responses and contributes to immune tolerance. Among several regulatory B cell subsets, interleukin 10 (IL-10)-producing regulatory B cells are intensively investigated. Studies in experimental animal models, as well as in patients with autoimmune diseases, have identified Breg subsets exhibiting a powerful therapeutic tool for severe immune disorders. Now, human regulatory B cells are becoming an active area of research. Clear criteria to identify these cell subsets and the key molecular mechanisms underlying their physiological features are required for understanding the complete picture of regulatory B cells. This review highlights the current knowledge on regulatory B cells, mainly IL-10-producing regulatory B cells.
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Global warming and allergy
Shailendra Nath Gaur
July-December 2019, 33(2):61-62
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A study of various investigative modalities in establishing the cause of chronic urticaria
N Naseerudeen, Sandeep Khuraiya, Vinod Kumar Jain, Rajeev Khullar, Dilip Kachhawa
July-December 2019, 33(2):98-104
INTRODUCTION: Urticaria is a transient eruption of erythematous or edematous swellings of the dermis and is usually associated with itching. Angioedema consists of transient swellings in the deeper dermal, subcutaneous, and submucosal tissues. Urticaria and angioedema occur as clinical manifestations of various immunological and inflammatory mechanisms, or they may be idiopathic. MATERIALS AND METHODS: The study included 500 patients of chronic urticaria who were recruited from the outpatient department. The detailed history, cutaneous, and systemic examination was done. All patients should be subjected to a complete blood count, absolute eosinophil count, ESR, urine analysis, stool examination, liver function test, blood sugar, and renal function test. In the patients where history will be suggestive of any specific disease, screening for hepatitis B and C, antinuclear antibody test, and rheumatoid factor. Autologous serum skin test (ASST) will be performed in all the patients with chronic urticaria. RESULTS: Out of 500 patients, 211 were female and 289 were male. Most common age group was 21–40 years (58%). Most cases (60%) of chronic urticaria were of 2–6 months duration. Most patients (47%) were worse in the evening and night time. A personal history of atopy was present in 6.6% patients. A total of 38 (7.6%) had chronic urticaria with evidence of a focus of infection. In the present study, food items were observed to be aggravating chronic urticaria in 10 (2%) patients. 19 patients of chronic urticaria were found to have concomitant systemic disease, which included 16 with thyroid disease and 3 with rheumatoid arthritis. ASST was found to be positive in 172 patients with raised serum IgE levels in 120 patients. CONCLUSION: The present study demonstrates that an extended diagnostic workup may be helpful in patients with chronic urticaria in addition to thorough history taking and physical examination for proper treatment.
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Dr. VK Vijayan (19.06.1948–29.01.2019)
AB Singh
July-December 2019, 33(2):114-115
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An inconspicuous agent causing bronchospasm perioperatively: A report on toilet disinfectant liquids
Priyanka Gupta, Mridul Dhar, Vamshi Krishna, Amiya Kumar Barik
July-December 2019, 33(2):112-113
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