GOLD Strategy Update 2023: Rationale and Clinical Implications in Indian Perspective

Chronic obstructive lung disease (COPD) is a major contributor to global disease burden with a huge socioeconomic impact. Global initiative for chronic obstructive lung disease (GOLD) strategy update 2023 is a step forward in the direction of evidence-based practice. Key topics like taxonomic classification, ABE grouping, single inhaler triple therapy, correct use of inhalers, etc. would have a positive impact on documentation and prescription practices in COPD management. The tobacco consumption habits are peculiar in India. There is a variation in prevalence estimates across diverse cultures. Non-smoking risk factors are important in Indian subcontinent especially in female and younger populations. We discuss the rationale of latest GOLD strategy update, its implications, and challenges in the management of COPD in Indian context.

Approach to Optimal Oxygen Therapy in the Management of COVID-19 Patients during Pandemic: An Indian Perspective

Background: A sudden spike in positive cases in the second wave of COVID-19 pandemic took Government, Public, and Healthcare system by surprise in India. It was bigger and deadlier than the first wave. Unsupervised oxygen delivery practiced in oxygen buses and pandals by untrained individuals was a matter of concern and should have been discouraged. This resulted in wastage of oxygen which could have led to catastrophic consequences. Awareness about the optimal use of oxygen by identifying errors in prescribing/practicing oxygen therapy will go a long way in saving lives. This article provides a quick review of oxygen therapy with a focus on the rationale use of oxygen and plausible solutions to mitigate wastage in a resource-constrained scenario, such as the COVID-19 pandemic.

Papillary tumor in pineal region: Immunohistochemistry meeting the diagnostic challenge

Papillary tumor of pineal region (PTPR) is extremely rare and poses diagnostic challenge with other central nervous system tumors having papillary architecture. Immunohistochemistry is crucial for a definitive diagnosis of PTPR.

Induced genetic variations in Cuminum cyminum through supplemental UV-B radiation

Aim: The present study was conducted to investigate the genotoxic effect of UV-B radiation on morphological, biochemical and cytological parameters of Cuminum cyminum. Methodology: The germinated roots of cumin were exposed to UV-B radiation at different intervals viz., 20 min 40 min and 60 min, respectively, and some treated seeds were sown on pots for morphological and biochemical observation. Results: Chromosomal studies divulged that UV-B radiation has substantial impact on Active Mitotic Index (AMI %). On increasing UV-B radiation dose, the chromosomal aberration rate elevated, thus AMI % moderately decreased and Total Abnormality percentage (TAB %) gradually increased. Different types of chromosomal abnormalities were ascertained, among which scattering was more prominent. The morphological observation showed that survival percentage and plant height decreased at elevated dose of UV-B. Biochemical results indicated that chlorophyll a, chlorophyll b and carotenoid contents decreased as compared to control, but proline content showed significant increment at higher doses of UV-B.Interpretation: The observation elucidates that UV-B causes chromosomal aberrations during cell division and acts as a potent genotoxic agents for roots. Thus, it can be concluded from the above experiment that UV-B rays promote plant growth at low doses but at the higher doses, it subsequently hinders plant growth by damaging important constituents of plant cell.

A rare cause of progressive neuropathy: Arachnoiditis ossificans

Arachnoiditis ossificans (AO) is a rare type of chronic arachnoiditis characterized by the presence of calcification or ossification of the spinal arachnoid which is usually associated with progressive neurological deficits. It is usually followed by prior history of trauma, surgery, infection, or myelography. Magnetic resonance imaging and computed tomography are the characteristics that are helpful in the diagnosis of most cases. Prognosis and treatment depends on the site and clinical presentation of the patients. We present a case of a young female who presented with a long-standing history of neurological symptoms and a intradural lesion mimicking a tumor.

Epidemiology of animal bites and rabies cases in India. A multicentric study.

Rabies, a disease of antiquity continues to be a major public health problem in India. Multiple factors contribute to high mortality and morbidity due to animal bites. An effective strategy for control of rabies takes into account the epidemiology of animal bites, rabies and factors influencing post exposure treatment. The study was carried out as a part of Agreement for Performance of Work (APW) from World Health Organization (WHO) during the period April 2001 to September 2002. Two sets of proformae were developed and used after field testing to interview cases of animal bites and get retrospective information about rabies cases. The study was carried out at six selected centres across the country viz. Delhi, Hyderabad, Raipur, Jamnagar, Coonoor and Rajahmundry and was co-ordinated by National Institute of Communicable Diseases (NICD), Delhi. The officials engaged in the study work were thoroughly trained in the study methodology before the start of the study itself. To maintain quality and uniformity supervisory checks were done during the survey. A total of 1357 fresh animal bite victims were interviewed (exit interview) from the anti-rabies centres (ARCs). Dog bites caused maximum morbidity (92%). Second most common biting animal was monkey (3.2%), followed by cat (1.8%), fox (0.4%) etc. Most bites (64.3%) were unprovoked bites by stray (64.7%) animals. In this study 72.4% animal bite victims were males and 47.5% were children in age group of 2-18 years. 63% had Category III exposure as per the WHO classification. Before coming to ARCs 58.5% people had washed the wound with water/soap or water alone. Some of the bite victims (10.8%) had also applied chillies, salt, turmeric powder, lime, snuff powder, paste of leaves, acid, ash given by Peer Baba (magician) etc. These practices varied from one region to another. The practice of wound washing at the ARC which is an important component of animal bite management was being practiced at only one of the six centres. Of the six centres, Rabies Immunoglobulin (RIG) was available and was being used at only two centres. The study was conducted in public sector ARCs where Nervous Tissue Vaccine (NTV) was available free of cost. All the centres were using NTV except Coonoor, which is using indigenously produced Tissue Culture Vaccine along with NTV. Analysis of 192 case records of rabies cases, from two centres, revealed that dog bites caused maximum mortality (96.9%). Nearly 40% were children below 15 years of age and 78.6% were males indicating that it is an exposure related disease. In all cases, failure to seek timely and appropriate treatment led to development of disease. This paper provides an overview of epidemiology of animal bites and retrospective information about rabies patients. There is a need to strengthen Information, Education and Communication (IEC) programme regarding merits of local wound management including "do's and don'ts". ARCs should be strengthened in terms of facilities and availability of safe and effective anti rabies immunobiologicals. There is a need to create awareness regarding epidemiology and at-home and hospital management of animal bites among the service providers and general community.

Oral ulcer as an unusual feature of visceral leishmaniasis in an AIDS patient.

Leishmaniasis, a globally prevalent parasitic disease, occurs in three forms, viz, visceral, cutaneous and mucocutaneous. It is transmitted by female Phlebotomus sandflies. Human immunodeficiency virus (HIV) infection is increasing worldwide and several reports indicate a rising trend of VL / HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. India is one of the countries having the largest burden of leishmaniasis; nevertheless, there are very few HIV / leishmania co-infection cases reported so far. We report a 35-year-old homemaker infected with the human immunodeficiency virus; she presented with an oral ulcer. The investigations carried out on her revealed that she was afflicted by visceral leishmaniasis and the oral ulceration was a part of the same. This is only the second such case from the Indian subcontinent and more significantly from a non-endemic area.

Safety and immunogenicity of the intradermal Thai red cross (2-2-2-0-1-1) post exposure vaccination regimen in the Indian population using purified chick embryo cell rabies vaccine.

PURPOSE: To test the immunogenicity of the WHO recommended "2-2-2-0-1-1" post-exposure rabies vaccination regimen in Indian subjects to determine the feasibility of replacing crude sheep brain nerve tissue rabies vaccine with modern tissue culture rabies vaccine at major anti-rabies treatment centers throughout India. METHODS: Purified chick embryo cell vaccine (PCECV) was administered in the dosage of 0.1 mL per site to 53 Indian subjects. RESULTS: All subjects produced rabies antibodies above 0.5 IU/mL by day 14 post-vaccination. Only minor adverse reactions including swelling (6.6%), erythema (5.4%) and pain (1.4%) were observed for which no treatment was required. CONCLUSIONS: This study demonstrated that PCECV is safe and highly immunogenic in Indian subjects when administered intradermally as 0.1 mL/site using the "2-2-2-0-1-1" post-exposure regimen.

Epidemic dropsy: a study of cutaneous manifestations with histopathological correlation.

Clinical and histopathological features of epidemic dropsy were studied in 19 patients. Bilateral pitting pedal oedema, erythrocyanosis and tachycardia without fever were the predominant clinical features. Histology revealed deposition of hyaline material on the walls of dermal blood vessels.

Isolated common bile duct tuberculosis.

We report a patient with isolated involvement of common bile duct by tuberculosis. The diagnosis was established by histological examination of the resected specimen. Surgery and antitubercular chemotherapy resulted in complete recovery.

Five-year longitudinal study of efficacy and safety of purified Vero cell rabies vaccine for post-exposure prophylaxis of rabies in Indian population.

Three hundred and nine (309) persons, vaccinated against rabies with Purified Vero-cell Rabies (PVR) vaccine from 1991-1995, were included in this five-year longitudinal study. This study was conducted to observe the consistency, immunogenicity, inocuity, safety and efficacy of this vaccine under field conditions. All the 309 persons attended our centre after taking post-exposure vaccination following bites by suspected rabid animals or contact with hydrophobia patients for antirabies antibody titre estimation. The vaccine was very well tolerated by vaccinees with only 7 per cent, complaining of mild to moderate side reactions. On an average, every year 70-100 vaccinees reported at this centre after PVR vaccination. The epidemiological characteristics of rabies based on above data are also discussed in this paper. Serological response, i.e., antirabies antibody titre following vaccination in all these persons were found to be satisfactory with mean antibody titre of 4.25 I.U./ml.

The quality of life in successful live-related renal allograft recipients in India.

BACKGROUND. The high cost of maintenance of haemodialysis makes most patients in India and elsewhere opt for a renal transplant. The degree of rehabilitation can best be assessed by evaluating the quality of life in successful recipients. METHODS. We studied vocational rehabilitation, social relations, sexual and married life, psychological status and life satisfaction in 51 successful live-related renal allograft recipients using Schwab's depressive scale, Bigot's life satisfaction index and the Kamofsky physical scale. RESULTS. Eight-four per cent of our patients had returned to their original jobs. Ninety-eight per cent of patients had a Kamofsky scale of 90-100 and 81% were leading a normal married life. Ninety-four per cent of them led an active social life. CONCLUSION. Successful live-related renal transplantation is associated with a good quality of life and should be the treatment of choice for patients with end-stage renal disease.

Ten year longitudinal study of efficacy and safety of purified chick embryo cell vaccine for pre- and post-exposure prophylaxis of rabies in Indian population.

One thousand three hundred and seventy-five (1375) persons, who were vaccinated against Rabies with Purified Chick Embryo Cell (PCEC) vaccine from 1984 to 1993, were included in this ten-year longitudinal study, conducted to observe the consistency, immunogenicity, inocuity, safety and efficacy of PCEC vaccine under controlled trial and field conditions. The study period was divided into three phases. Phases I and II covered the premarketing controlled trial and Phase III the post-marketing serosurveillance study of the vaccine. During Phase I, fifteen healthy volunteers were given a pre-exposure regime of vaccine on Day 0, 7 and 21, and the rest 15, simulated post-exposure regime on Day 0, 3, 7, 14, 30 and 90. All the subjects had satisfactory antirabies antibody response with mean titres, of 7.08 and 5.72 I.U./ml respectively, and minimal side reactions. In the Phase II, from 1984-85, 56 persons with proven rabid animal bites were given post-exposure vaccination and all had satisfactory antibody titres with mean titre of 4.45 I.U./ml after 6th dose of vaccine and with minimal side reactions. 19 to 36 months follow up after vaccination revealed no vaccine failures. In the Phase III post-marketing field study conducted from 1985 to 1993, 1289 persons reported to our Centre for consulation and antirabies antibody titre estimation following PCEC vaccination. One thousand two hundred and fifty-two (1252) persons took post-exposure vaccination following bites by rabid animals, contact with an hydrophobia patient and 37 high risk personnel took pre-exposure vaccination.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical evaluation of purified vero-cell rabies vaccine in patients bitten by rabid animals in India.

Fifty-five individuals bitten by rabid animals were administered purified vero-cell rabies vaccine (PVRV) at WHO Collaborative Centre for Rabies Epidemiology for South-East Asia at National Institute of Communicable Diseases, Delhi to test its immunogenicity, inocuity, safety and clinical efficacy. Fifty-two (94.5 per cent) of these individuals underwent complete course of treatment. Sera samples collected prior to the commencement of treatment showed all these persons to be sero-negative for antibody against Rabies virus. However mean titre of 2.44 I.U./ml, 7.76 I.U./ml and 10.77 I.U./ml were detected after third, fourth and sixth injections, respectively of PVRV. Persistance of protective titres of this antibody could be demonstrated even after 15 months of treatment. Of 327 inoculations, local and general reactions were observed after 10.6 per cent inoculations. All these cases were followed up for periods between 7 and 25 months and were, alive and healthy till the end of observation period, thereby proving the efficacy of the vaccine in preventing rabies.

Immunogenicity and feasibility of purified chick embryo cell vaccine.

Two hundred seventy-one children reported at the WHO Collaborative Centre for Rabies Epidemiology for South-East Asia at National Institute of Communicable Diseases, Delhi, for advice and antirabies antibody assessment after post-exposure prophylaxis with purified chick embryo cell (PCEC) antirabies vaccine from January 1986 to October 1992. Vaccine was very well tolerated by these children and only 7% complained about mild to moderate side reactions like pain, induration, fever or rash. On an average, every year 50-55 children had reported at this Centre after post-exposure vaccination with PCEC vaccine excepting years 1986 and 1987. One hundred and forty-four children underwent complete course of post-exposure prophylaxis, i.e., 5 or 6 doses on day 0, 3, 7, 14, 30 and 90 (optional) of PCEC vaccine were administered, forty-three (43) children received 4 doses on day 0, 7, 14 and 30 (day 3 dose was omitted) and eighty-four (84) children received 2 to 3 doses as the biting animals were alive for 10 days in these cases. Two hundred and twenty-nine children (84.5%) were bitten by dogs and in 10%, the dog was proven rabid by laboratory examination of dog brain. One hundred and forty-nine (55%) had Class III bite. Serological response, i.e., antirabies antibody titre in all these children were satisfactory (> 0.5 IU/ml) with mean titre of 1.98 IU/ml irrespective of doses of PCEC vaccine administered. No vaccine failure was observed in this study.