Prescription pattern of inhalational medications for chronic obstructive pulmonary disease in India: insights from cross-sectional survey of pulmonologists across India

Background: Treatment of COPD depends on disease severity, phenotype and exacerbation risk. Inhaled medications are the treatment of choice in COPD. We undertook this survey to find the most commonly prescribed inhalational medication in COPD as per the severity of the disease. Methods: It was a cross-sectional questionnaire-based survey of pulmonologists in real-world clinical practice settings conducted across India. Results: The participants included 806 pulmonologists across India. Seventy-five per cent of pulmonologists ranked symptom relief, reduction in the frequency of exacerbations and improvement in lung function as the most important treatment targets. In COPD patients falling under GOLD group A, the treatment choice by pulmonologists in descending rank order was fomroterol/glycopyrronium (32%), ipratropium (38%), and tiotropium (30%) and for gold group B, this was fomroterol/glycopyrronium (34%), followed by indacaterol/glycopyrronium (26%) and tiotropium/formoterol (40%). In the GOLD group E, triple therapy (formoterol/glycopyrronium/budesonide) was preferred by 41% of pulmonologists. In the frequent exacerbator, predominant emphysema, chronic bronchitis and concomitant asthma phenotype, 44%, 38%, 46% and 32% of pulmonologists ranked formoterol/ glycopyrronium/budesonide as their preferred 1st therapy, respectively. Among COPD patients with cardiovascular disease (CVD) comorbidity, 31% of pulmonologists selected formoterol/glycopyrronium/budesonide as 1st-preference drug therapy. Similar results were obtained for COPD patients with metabolic syndrome comorbidity. Conclusions: For the management of COPD patients, pulmonologists predominantly preferred a triple drug combination of formoterol/glycopyrronium/budesonide in GOLD group E and also in patients with cardiovascular and metabolic comorbidities. Fomroterol/glycopyrronium was the most preferred combination for GOLD group A and GOLD group B.

Clinical profile of headache and cranial neuralgias.

OBJECTIVES: The present study, first of its kind from Kashmir Valley, was conducted on 2982 patients to depict the pattern of various headache types and cranial neuralgias. Besides demographic parameters, various factors influencing the frequency of headaches and cranial neuralgias were also analysed. METHODS: Patients presenting with the chief complaint of headache and facial pain were included in this study. The diagnosis of different headache types and cranial neuralgias were established after following the criteria as devised by the International Headache Society (1988). RESULTS: Mean age at presentation for all headache types/cranial neuralgias was 24.5 years (range 7-74 years) with a male:female ratio of 2:1. Tension headache and migraine was found in 1988 (66.6%) and 407 (13.6%) cases respectively. Cranial neuralgias were observed in 20 (1%) cases. CONCLUSIONS: Tension headache and migraine were the commonest forms of headache disorders. Militancy related stress and handicrafts profession were the main predisposing factors for tension and cervicogenic headaches respectively. Ramadan fasting was the prime precipitating factor for migraine.

Clinical profile of polymyositis in Kashmir valley.

OBJECTIVES: The present study is a retrospective and prospective study of 24 cases of idiopathic inflammatory myopathies from Kashmir valley. The study was conducted to depict the clinical profile of polymyositis from this part of the world. METHODS: The diagnosis of polymyositis/dermatomyositis was established by following the criteria of Bohan and Peter (1975). Besides relevant clinical examination, investigations like complete blood count, ESR, muscle enzymes, LE cell phenomenon, antinuclear antibodies and rheumatoid factor were also done. Electrophysiological study and open muscle biopsy was performed in 21 and 24 cases respectively. RESULTS: The mean age at presentation was 34 years with 62.5% cases presenting in fourth decade. Pelvic girdle weakness was observed in all the 24 cases. Male:Female ratio was 1:1.4. Four (16.8%) cases had associated collagen vascular disease. No case was associated with malignancy or childhood vasculitis. Raynauds' phenomenon was seen in seven (29.1%) cases. Creatine phosphokinase and lactic dehydrogenase was elevated in 22 (91.6%) and 12 (50%) cases respectively. Electromyography revealed myopathic features in 74.3% cases. Muscle biopsy revealed features of inflammatory myopathy in 22 (91%) cases. CONCLUSIONS: The conclusions drawn from this study are as follows: a. Younger age at presentation b. Shorter duration of illness at presentation c. Increased frequency of Raynaud's phenomenon as compared to other Indian series. d. No case of polymyositis/dermatomyositis associated with malignancy or childhood vasculitis was seen. e. Biochemical, electrophysiological and histopathological features suggestive of shorter duration of illness were observed.

Medical admissions: a confusing disease.

It is strictly for admission to undergraduate medical courses. (i) 50% of seats should be reserved for local candidate on merit of HSC, with academic year starting after the HSC results. (ii) 20% of seats should be reserved for candidates coming from rural areas, on the basis of merit at HSC, with academic year starting after HSC results. (iii) 30% of seats to be filled by an all-India competitive examination. The academic year to start 6 months after the HSC results. A ceiling of minimum number of marks and a minimum number of attempts for eligibility to the all-India PMT would make the conduct of such an examination more practical.

Intra peritoneal rectal tear: delayed presentation in a battered baby.

We report a two and a half year old child who presented with an acute abdomen two days after a spoon was forcefully inserted per rectum. The child recovered after repair of the rectal tear and a temporary sigmoid colostomy.