Effect of Chronic Nasal Obstruction on Pulmonary Function

Introduction: Upper and lower respiratory diseases are closelyrelated which has been well documented in literature. Eventhough a relationship between upper and lower airway diseasehas been described, altered pulmonary function in patientswith upper airway diseases is still not fully understood. Thepresent study was conducted to assess the effect of chronicnasal obstruction on pulmonary function and to compare thepulmonary function in same patients after surgical relief ofnasal obstruction.Material and methods: The present study was carried outin the Department of ENT and Head and Neck Surgery andDepartment of Respiratory Medicine, Rohilkhand MedicalCollege and Hospital, Bareilly between November 2017to October 2018. 56 patients with chronic nasal obstructiondue to either deviated nasal septum or chronic rhinosinusitiswith or without nasal polyp underwent pulmonary functiontesting pre and post-operatively at 6 weeks and results werecompared.Results: The most common age group affected was less thanthirty years accounting for more than 50%. Mean age of totalsample size was 24.2 ± 6.98 years. Thirty three (58.9%) patientswere males while 23(41.07%) patients were females. Out of56 subjects, 34(60.71%) patients underwent septoplasty, while22(39.28%) patients underwent functional endoscopic sinussurgery. Clinically and statistically significant improvement inFEV1 and FVC was observed irrespective of age, gender orduration of obstruction.Conclusion: Patients with bilateral nasal obstruction hadworse pulmonary function initially and more significantimprovement after surgery, suggesting an association ofbilateral obstruction with bad prognosis.

Benzimidazole derivatives: search for GI-friendly anti-inflammatory analgesic agents

Non-steroidal anti-inflammatory drugs (NSAIDs) have been successfully used for the alleviation of pain and inflammation in the past and continue to be used daily by millions of patients worldwide. However, gastrointestinal (GI) toxicity associated with NSAIDs is an important medical and socioeconomic problem. Local generation of various reactive oxygen species plays a significant role in the formation of gastric ulceration associated with NSAIDs therapy. Co-medication of antioxidants along with NSAIDs has been found to be beneficial in the prevention of GI injury. This paper describes the synthesis and biological evaluation of N-1-(phenylsulfonyl)-2-methylamino-substituted-1H-benzimidazole derivatives as anti-inflammatory analgesic agents with lower GI toxicity. Studies in vitro and in vivo demonstrated that the antioxidant activity of the test compounds decreased GI toxicity.

Curcumin sensitizes lung adenocarcinoma cells to apoptosis via intracellular redox status mediated pathway.

The present study demonstrates that curcumin acts as pro-oxidant and sensitizes human lung adenocarcinoma epithelial cells (A549) to apoptosis via intracellular redox status mediated pathway. Results indicated that curcumin induced cell toxicity (light microscopy and MTT assay) and apoptosis (AnnexinV-FITC/PI labeling and caspase-3 activity) in these cells. These events seem to be mediated through generation of reactive oxygen species (ROS) and superoxide radicals (SOR) and enhanced levels of lipid peroxidation. These changes were accompanied by increase in oxidized glutathione (GSSG), reduced glutathione (GSH) and -glutamylcysteine synthetase (-GCS) activity, but decrease in GSH/GSSG ratio. The induction of apoptosis and decrease in GSH/GSSG ratio was also accompanied by sustained phosphorylation and activation of p38 mitogen activated protein kinase (MAPK). On the other hand, addition of N-acetyl cysteine (NAC), an antioxidant, blocked the curcumin-induced ROS production and rescued malignant cells from curcumin-induced apoptosis through caspase-3 deactivation. However, L-buthionine sulfoximine (BSO), a GSH synthesis blocking agent, further enhanced curcumin-induced ROS production and apoptosis in A549 cells. Decreased GSH/GSSG ratio seems to be a crucial factor for the activation of MAPK signaling cascade by curcumin. The study therefore, provides an insight into the molecular mechanism involved in sensitization of lung adenocarcinoma cells to apoptosis by curcumin.

The impact of HIV/AIDS on the quality of life: a cross sectional study in north India.

OBJECTIVE: To determine the impact of Human Deficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) on the quality of life (QOL) on such patients in North India. DESIGN: A cross sectional study. SETTING: Outpatient setting and wards, Department of Medicine at a premier tertiary health care center, North India. PARTICIPANTS: Sixty-eight consecutive HIV/AIDS patients attending Medicine out patient department and/or admitted to the wards of All India Institute of Medical Sciences were administered a structured questionnaire by the HIV nurse coordinator. QOL was evaluated using the WHOQOL-Bref (Hindi) instrument. ANALYSIS: One way Analysis of Variance (ANOVA) was performed to find out significant difference between the clinical categories and socio-demographic variables on QOL domains. RESULTS: The overall QOL mean score on a scale of 0-100 was found to be 25.8. Similarly, on the scale of 0-100 the mean scores in the four domains of QOL in descending order were social (80.9); psychological (27.5); physical (17.7) and environmental domain (11.65). There was a significant difference of quality of life in the physical domain between asymptomatic patients (14.6) and patients with AIDS (10.43) defining illnesses (p< 0.001) and asymptomatic and early symptomatic (12) patients (p=0.014). QOL in the psychological domain was significantly poorer in early symptomatic (12.1) (p< 0.05) and AIDS patients (12.4) (p< 0.006) as compared to asymptomatic individuals (14.2). A significant difference in QOL scores in the psychological domain was observed with respect to the educational status (p< 0.037) and income of patients (p< 0.048). Significantly better QOL scores in the physical (p< 0.040) and environmental domain (p< 0.017) were present with respect to the occupation of the patients. Patients with family support had better QOL scores in environmental domain. CONCLUSIONS: In our study, QOL is associated with education, income, occupation, family support and clinical categories of the patients.

Role of Combined Approach with Radiotherapy and Metallic Stent in Palliation of Advanced Cases of Carcinoma Esophagus -APilot Study

Carcinoma esophagus presents with dysphagia and in 60% of patients, the aim of treatment is palliation. ThIs study was done to evaluate the feasibility and role of planned combined approach using radiotherapy with metallic stent in palliation of malignant dysphagia. Ten patients with histologically proven, locoregionally advanced esophageal carcinoma were selected. All patients underwent external radiotherapy followed by brachytherapy. The self-expanding metallic stent was placed under combined endoscopic and fluoroscopic guidance. A predetermined questionnaire to assess dysphagia, pain, reflux symptoms and quality of life was administered before the procedure, and thereafter at monthly intervals until death or last follow-up. 10/10 patients had grade III dysphagia at presentation. 4/10 patients underwent stent placement prior to any radiotherapy (group A), 4/1 0 patients had stent placement after external radiotherapy (group 8) and 2/1 0 had stent after completion of brachytherapy (group C). There was no difficulty in placing the stent despite the post-radiotherapy ulcerations and stricture in all the patients in group 8 and C. 8/8 patients in groups A and 8 had no difficulty in placing esophageal bougie for brachytherapy. The mean follow-up after stent placement was 9 months (4-24 months). There was complete disappearance of dysphagia in 4/4 patients in group A, 2/4 patients in group Band 0/2 patients in group C. The rest of patients had significant improvement in dysphagia score by atJeast two grades. For dysphagia grade. the mean progression free interval was recorded as 5 months for group A, 3 months for group Band 2 months for group C. Combining radiotherapy and metallic stent is a safe, simple and effective means to palliate malignant dysphagia. This raises an issue whether all patients with advanced carcinoma esophagus should preferably be pre planned for stent placement followed by radiotherapy for best results.

Primary Non-Hodgkin's Lymphoma ofWaldeyer's Ring-A Retrospective Analysis

Tweny -five newly diagnosed cases of primary Waldeye!'s Ring (WR) Non-Hodgkin's lymphoma (NHL) registered from 1989-99 were analysed. These comprised 5% of tota! NHL cases. The most common site was tonsil (44%). followed by nasopharynx (20%), base of tongue (20%). nasal cavity (12%) and palate (4%). All the patients were staged thoroughly according to Ann Arbor staging system and -40% patients were stage I. 36% patients stage II. 4% stage IIl and 20% stage IV. Eighty-eight per cent patients were high grade at presentation and 12% were intermediate grade. Three patients absconded without treatment. Patients were treated with radiotherapy alone (4/22 patients). chemotherapy with CHOP regimen alone (9/22 patients) or a combination of both (9/22 patients). On comparison. complete response was recorded in 4/4 patients treated with radiotherapy alone. 5/9 patients treated with chemotherapy alone and 7/9 patients treated with combination of radiation and chemotherapy (p>O.05). The range of Follow up period was 1-10 years with median 20 months. Overall 16/22 evaluable patients were with no evidence of disease on last follow up and the primary site was the most common site of first failure. A combined modality treatment except for stage Ia seems to be the treatment of choice for this relatively (Uncommon entity of Primary Waldeyer's Rjng NHL.

Plasmacytoma of the Mandible

We describe a patient with an extramedullary plasmacytoma (EMP) of the mandible. which presented a diagnostic and therapeutic challenge on several levels. We discuss herein the clinical presentation surgery and the role of radiotherapy in this rare case.

Comparative Evaluation of Concurrent Chemotherapy & Hyperfractionated radiotherapy Versus Conventional Radiotherapy alone in the Treatment of Locally Advanced Carcinoma Cervix-A Prospective Randomised Study

The aim of this study was to determine whether the addition of concurrent cisplalin and hyperfractionation in external pelvic radiotherapy improves local control and survival in patients with locally advanced carcinoma cervix as compared to treatment with conventional radiptjerapy alone. The morbidity of two treatment protocols was also compared. Sixty patients of newly diagnosed squamous cell carcinoma cervix, FIGO stage 118 and III were randomised into the following two treatment protocols: Group A (study group): Cisplatin30 mg/m2 weekly x 5 courses and external beam pelvic radiotherapy 50 Gy/33#4.5 weeks with hyperfractionation in first and following weeks. Group B (control group) : External beam pelvic radiotherapy 46 Gy/23#/4.5 weeks. Patients in both the group were then treated with intracavitary brachytherapy by LDR/MDR Selectron and a dose of 28 Gy was delivered to point A. The patients who were not suitable for intracavitary treatment were treated by supplementary external beam pelvic radiotherapy 20 Gy/ 10#/2" ceks. The actuarial local control at 4 years was 60% in group A and 42% in Group 8 9p<0.05). The a Cluarial disease free survival at 4 years was 52% in Group A and 35% in Group 8 (p<0.05). Only grade I acute and delayed haematological toxicity and grade I nausea and vomiting as acute toxicity "ere significantl) higher for Group A patients as compared to Group 8. Concomitant chemotherapy with hyperfraclionated radiotherapy is well tolerated and seems to offer potential benefit for imprOl ing the locoregional control in locally advanced carcinoma of cervix.