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India is the largest consumer of antibiotics in the world. High antibiotic consumption is linked to the emergence and community spread of multidrug-resistant bacteria. It is well-established that antibiotic overuse is one of the leading causes of antibiotic resistance, which is a major global public health challenge. Optimizing antibiotic usage is, thus, an essential issue. Before promoting and defining judicious antibiotic prescribing, it is crucial to analyze practitioners' diagnostic and prescribing practices. Hence, a nationwide retrospective questionnaire-based survey was conducted among 950 Indian doctors. This survey aimed to describe the approaches and practices of Indian doctors towards antibiotic use in upper respiratory tract infections (URTIs) and pyrexia of unknown origin (PUO) and compare practices with national guidelines. These are the most common reasons for primary health care consultations and significantly contribute to the overuse of antibiotics. According to the survey, amoxicillin-clavulanic acid remains the first-line antibiotic for URTI treatment. Third-generation cephalosporins were found to be the most prescribed antibiotics for PUO, uncomplicated typhoid and infections during pregnancy. Our survey results show that most of the clinicians in our study were well aware of the guidelines for antimicrobial use issued by Indian Council of Medical Research (ICMR) and the nationwide problem of antimicrobial resistance. This study provides an important insight into the prescribing practices of antibiotics among Indian doctors.
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Mucormycosis has emerged as an important fungal infection with high associated mortality rates. Mucormycosis causes devastating angio-invasive fungal infections, primarily in patients with underlying risk factors. The prevalence of mortality associated with invasive Mucormycosis is high (>30-50%), with 90% mortality contributed by disseminated disease. Sudden rise in Mucormycosis cases during the COVID-19 pandemic came as a surprise to all. Lowered immunity due to COVID and associated conditions like diabetes, made the population susceptible to this dreaded disease. This disease led to both increase in morbidity and mortality among the general population. Aim of the Study : To interpret in detail the causes of mortality of patients presenting with COVID Associated Mucormycosis (CAM-19) at AIIMS Patna between May-November, 2021. Materials and Methods : An observational study of all patients who were treated for mucormycosis during the period of May 2021-Nov 2021 in ENT Department, AIIMS, Patna. During the period of study, 219 patients of RhinoOrbital-Cerebral Mucormycosis (ROCM) were admitted for treatment. Five patients had gone on Leave Against Medical Advice (LAMA). So, 214 patients were included in the study. Results : Among the 214 patients, 165 patients were treated surgically through both endoscopic and open approaches along with antifungal therapy management. 41 patients died during the hospital course of the treatment. The mortality rate of ROCM stood at 19.15% in our series. Pulmonary Mucormycosis had high mortality (100%). Diabetes is the most common risk factor. Multiple co-morbidities and extensive intracranial involvement had a strong association with mortality. Conclusion : The advanced stage of ROCM was associated with more deaths. Our series mortality rate of 19.15% is lower than most of the other documented mortality rates. Our results support that early aggressive surgical approach, antifungal therapy and multidisciplinary approach has reduced the mortality
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Initial diagnosis and timely treatment of Extra Pulmonary Tuberculosis (EPTB) continues to be a challenge in all over World as well as India. First time, this analysis will discover the role of LTA4H gene and may be establishing another candidate that impacts the sensitivity to EPTB in the population of North India. This study will be the first report on LTA4H gene various diagnostic markers, expression of gene may validate as a prognostic factor in (EPTB). The diagnosis (EPTB) poses a special challenge, as it is often missed or misdiagnosed due to its atypical presentations and difficult to isolate M tuberculosis (MTB) due to the small number of organisms present at these sites. Subsequently the outcome of present study will reinforce possible use of LTA4H as biomarkers and the therapeutic utility for (EPTB). This study will be a step to decrease the analytical and therapeutic window to identify another risk factor LTA4H for EPTB. Leukotriene A4 hydroxylase (LTA4H), an enzyme which changes LTA 4 to LTB4, controls the balance amongst the anti-inflammatory lipoxins and pro-inflammatory LTB4, with directly consequences in TB-driven inflammation. In humans and will spawn new ways to protection and enhance the wellbeing status of individuals and population groups. On RT-PCR, Extra Pulmonary Patients had lower expression of LTA4H compared to the controls. Correlation of biomarkers will reveal LTA4H level correlated with age, Gender Smoking, Clinical Parameter Serum Total Protein, BMI Height and TLC, Laboratory Parameter. On ELISA kit and follow as per manufacturer protocol. CEA562Ge 96 Tests Enzyme-linked Immunosorbent Assay Kit For Leukotriene B4 (LTB4) LTB4 Protein level in Extra Pulmonary Patients, (EPTB) (2304.52pg/ml) had lower expression of gene LTB4 compared to the controls (3096.142pg/mls) (P value = 0.0012).
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Finger millet is the name commonly used to denote the crop Eleusine coracana. It is known as Ragi in many parts of India, which is an important member of the family of cereals. In fact, it is superior to many cereals like wheat and rice in terms of its micronutrient content and bioavailability. Several indigenous processing techniques may be applied to finger millets allowing it to be processed into various value-added products, which may be better in appearance, taste, flavor and acceptability. Development of value-added products that contain Ragi as one of their major components can be beneficial for food and nutrition security of Indians. Ragi may contribute to solving the issue of micronutrient deficiency and nutrition security as it is an important source of micronutrients and can be easily incorporated in various recipes and value-added products. It can therefore be a part of various nutritional programs to enhance the nutritional density of foods.
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COVID-19, the worst Pandemic of this decade caused significant morbidity and mortality in the past 3 years and still continue to hit the human kind with it’s evil skills. After the first and second COVID-19 wave the third wave has emerged with new variants and with high transmission rate and reduced efficiency of treatments and vaccines. The main treatment strategy remain same as symptomatic and supportive treatments. Oxygen therapy, Steroid, Antivirals and some repurposed drugs like Ivermectin and newer drugs including monoclonal antibodies are used in this fight against COVID-19. Ivermectin is being the game changer in many states of India, they kept this medicine in their new treatment protocol also. Vaccination including additional Booster/Precautionary Dose along with the COVID appropriate behaviours, if we are able to maintain Physical distance, Wear mask properly, Wash our hands and Prevent crowd from gathering then we will not allow the virus to spread and prevent the emergence of another wave
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Background: Lung cancer is considered as the most commonly diagnosed cancer. It is the leading cause of cancer-related mortality. Smoking and environmental pollutants act as important risk factors in majority of lung cancer cases (80%–90%). Material and Methods: This is a hospital-based study carried on in lung cancer patients of North India. Demographic profile of lung cancer patients was recorded. Hematological and biochemical profiles of lung cancer patients and healthy controls were compared. Results: Highest proportion of lung cancer was found in the age group of 46–60 years. Lung cancer was seen in highest number in male gender (76.63%) and also in those patients belonging to the rural category (84.58%). In this study, only 3.98% lung cancer patients having the past history of cancer and 5.47% showing the family history of cancer. Significant differences were found in weight and body mass index (BMI) of lung cancer patients when compared to healthy control (P < 0.0001). Hemoglobin (Hb) was found lower in lung cancer patients as compared with healthy controls. Significant difference was also observed in Hb levels of these two groups (P < 0.000). The serum protein level was lower in lung cancer patients than healthy controls. A significant difference was also observed in the protein levels of these two groups (P < 0.0001). Serum alkaline phosphatase (ALP) levels were higher in lung cancer patients in comparison to healthy controls. A significant difference was also observed in serum ALP levels in lung cancer patients as compared with healthy controls (P < 0.0001). Conclusions: Significant difference between BMI, Hb, serum albumin, and total protein was found in this study. These biomarkers may be helpful in the diagnosis of lung cancer at early stage and also in the follow-up assessment of the effects of treatment
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Background: Lung cancer is one of the most frequent types of cancer and the leading cause of cancer-related deaths. Epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase (TK) being highly expressed in lung cancers. Activation of EGFR through oncogenic mutations leads to upregulation of gene expression that may heighten the inflammatory response in certain situations. EGFR acts as a key regulator and a cellular hub for inflammatory cytokine signaling, thereby promoting tumor cell proliferation, invasion, migration, metastases, and survival. The aim of the present study is to determine the serum cytokines levels and EGFR mutation status in lung cancer patients to investigate the association between the EGFR mutation status and cytokines levels with lung cancer patients. Materials and Methods: Blood and tissue samples of lung cancer patients were collected. The EGFR mutations of lung cancer patients were determined by the immunohistochemistry (IHC) and serum cytokines levels of lung cancer patients were determined using ELISA. Results: Statistically significant association of EGFR mutations with adenocarcinoma subtypes and non-smokers were found (P < 0.05). Lung cancer patients with EGFR mutations had significantly higher tumor necrosis factor-alpha levels when compared to lung cancer patients without EGFR mutations (P < 0.01), and EGFR mutation status was not significantly associated with interleukin-6 levels (P = 0.24). Conclusion: EGFR mutation detection by the IHC method is a potentially useful tool to guide clinicians for personalized treatment of lung cancer patients of adenocarcinoma subtype, and cytokines are good biomarkers for the diagnosis, prognosis, and prediction of treatment responses in lung cancer patients as well as act as therapeutic targets. This study will provide biomarkers for lung cancer diagnosis and treatments
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Background: India has the maximum burden of both non MDR tuberculosis (TB) and Multidrug-Resistant (MDR) TB, as per data reported in Global TB Report 2018 and tuberculosis is remains one of the most common cause of pleural effusions.Methods: This was a cross-sectional study conducted in Department of Respiratory Diseases and a total of 110 patients with pleural effusion were included in the study, which were enrolled for treatment from July 2018 to June 2019.Results: One hundred and ten patients with pleural effusion were enrolled during the study period. There were 65 males (59%) and 45 (40.9%) females. The overall mean age for males and females were 44.4±18.84 years (35-87 years) and 38.28±17.66 years (35-87 years) respectively. Tuberculous Pleural Effusion group (TPE) seen in 82 patients. Right sided pleural effusion (69.5 %) were more common than left sided (30.4 %). In TPE group the mean pleural fluid ADA level were 86.41±38.08 IU/L (range: 14-195 IU/L). The Malignant Pleural Effusion (MPE) group included 21 patients. In MPE group the mean pleural fluid ADA level were 34.10±32.88 IU/L (range: 8-144 IU/L). The difference in pleural fluid ADA levels between TPE and MPE group was statistically highly significant.Conclusions: Tuberculous pleural effusion was the most common cause of pleural effusion in present study and observed in 74.5% cases.
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Background: Worldwide, Chronic obstructive pulmonary disease (COPD) is the one of the leading cause of chronic morbidity and mortality. COPD is one of the diseases in which smoking is the common and important risk factor when it is associated with Metabolic syndrome (MetS). The individual components of MetS, i.e., obesity, dyslipidemia, fasting hyperglycaemia, and hypertension were independently associated with impairment of lung function too. The objective of this study is to find out the prevalence of metabolic syndrome among COPD patients.Methods: This was a cross-sectional study conducted in department of Respiratory Diseases and a total of 70 COPD patients were included in the study, which were enrolled for treatment from July 2016 to July 2017. The severity level in patients with COPD were determined according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), 2015 guideline. International Diabetes Federation (IDF) guideline; (2005) was used in diagnosis of metabolic syndrome.Results: Seventy patients with COPD were enrolled during the study period. There were 45 males (64.2%) and 25(35.7%) females. Mean age of male patients was 58.67±9.87 years, while mean age of female patients was 57.23±10.4 years (35-87 years). Mean BMI of male was 24.33±6.64 kg/m2, while in case of female it was 30.07±6.95 kg/m2 and overall mean BMI of study population was 26.22±7.22 kg/m2. The mean waist circumference of male was 86.91±13.31 cm while in female it was 87.18±14.51 cm. The Overall prevalence of metabolic syndrome was 31.34% and most common in GOLD stage-3 (47.06%), followed by stage-2 (40%), followed by stage-4 (25.71%) and 7.4 % in GOLD stage -1.Conclusions: The presence of metabolic syndrome is common in patients with COPD and, all COPD patients should be considered for screening for it.
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Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.
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This review summarizes the state of the current literature relating to the associations of lung disease and adipokines (proteins produced by adipose tissue) in humans. The mechanistic basis for these associations in humans is not established, although a possible role for adipokines has been invoked. Leptin, a pro-inflammatory adipokine, and adiponectin, an anti-inflammatory adipokine, are causally associated with asthma in mice. Although human studies are currently inconclusive, high-serum leptin and low-serum adiponectin concentrations predict asthma, independent of obesity, in select population groups, such as premenopausal women in the United States. In contradistinction, low-serum leptin and high-serum adiponectin concentrations are associated with stable COPD, although these associations are likely confounded by fat mass. Interestingly, leptin may promote systemic and airway inflammation in stable COPD patients. On the other hand, COPD may upregulate systemic and lung adiponectin expression. The precise mechanism and significance of the associations between these adipokines and lung disease at the current stage are confusing and frankly paradoxical in places. It is now known that adipose tissue is not an inert organ simply for energy storage, but regulates systemic inflammation via a variety of secreted proteins (called adipokines). While the associations of obesity and adipokines with cardiovascular, endocrine, and rheumatological diseases are well described, the respiratory effects of obesity and adipokines are less well known. This review will focus on the effect of obesity and adipokines on asthma and chronic obstructive pulmonary disease (COPD) in humans. This area of research needs additional study that may open up novel therapeutic strategies for these lung diseases.
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Aim and Objective: To study the clinical, pathological andradiological profile of lung cancer in non-smokers in a tertiarycare center.Methods: 53 non-smokers diagnosed with lung cancerattending the Department of Respiratory Medicine, KingGeorge’s Medical College from September 2015 to August2017 were enrolled. Record of all diagnostic investigations andprocedures performed namely transthoracic fine needleaspiration cytology (FNAC) and biopsy, bronchoscopy,thoracoscopy, closed pleural biopsy, lymph-node FNAC andbiopsy, routine blood and sputum examinations and a detailedhistory were obtained. Data was analysed retrospectively.Results: The mean age of presentation was 53.8±11.6 years.Majority were females (60.4%). Most common presentingsymptom was cough (84.9%). Mean duration of symptoms was6.9 months. Pallor was the most common clinical examinationfinding (41.5%). Mass with effusion was the most commonradiological lesion (45.3%). 22.6% masses were centrallylocated. Transthoracic biopsy could diagnose 32 (60.4%)cases. Adenocarcinoma was the most common type in bothmales (76.2%) and females (78.1%). Epidermal growth factorreceptor (EGFR) mutation was positive in 46.3% ofadenocarcinoma. Exon 19 deletion was the more commonmutation.Conclusion: Lung cancer among never smokers is a distinctclass with risk factors and genetic features discrete from thoseassociated with tobacco smoke. Indoor air pollutants as well asETS are definitely implicated risk factors. Targetable mutationsare commoner in non-smokers and hence mutation testingshould always be done in such patients. It is important toconduct studies about the diverse characteristics of this entityto consolidate our knowledge of this growing group of cancer.
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Background: There were 4.1% of all new cases and 19% of previously treated patients were diagnosed with either multidrug resistant or rifampicin resistant tuberculosis in 2016. In the state of Uttar Pradesh, there were 2.16 new cases and 44,531 previously treated cases. The objectives of the study were to assess the predisposing factors, causality assessment, severity grading and avoidability of the adverse drug reactions (ADRs) of the antitubercular drugs in MDR-TB patients in a tertiary care hospital of northern India.Methods: This prospective observational study was conducted for 12 months at a tertiary care hospital. The patients with MDR tuberculosis on treatment with DOTS Plus regimen under RNTCP and who met the inclusion exclusion criteria were recruited after informed consent. ADRs were monitored daily till the patients remained admitted and thereafter monthly. Predisposing factors were recorded. Causality assessment was performed by Naranjo scale and WHO UMC scale, severity by Hartwig’s scale and avoidability by Halla’s scale.Results: There were 115 patients were recruited, 70 developed at least one ADR. 98 ADRs were reported. The commonest ADR reported were – gastrointestinal (38.76%), neurological (21.24%) and hepatobiliary (8.16%). Diabetes and HIV predisposed to development of ADRs. 58.18% ADRs were classified as possible and 37.5% as probable by Naranjo’s scale. 51.02% ADRs were classified as probable and 42.83% as possible by WHO-UMC. 56% were classified as mild, 36% moderate, and 6% severe via Hartwig’s scale. 51 ADRs were classified as avoidable and 40 ADRs were possibly avoidable.Conclusions: Monitoring and assessment of ADRs is necessary to promote awareness, curb resistance and maintain adherence.
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Background: Between 2006 and 2015, the prevalence of MDR-TB has been found to be as high as 39.9% in some states. Approximately 35.8% of all previously treated patients developed MDR-TB. The objective of the present study was to identify demographic and health characteristics of patients as well as incidence and pattern of the adverse drug reactions caused by antitubercular drugs in MDR-TB patients in a tertiary care hospital of northern India.Methods: This 12 months study of observational study was conducted at a DOTS centre. MDR-TB diagnosed patients treated with DOTS Plus regimen were enrolled after getting informed consent. Patient information was recorded. Patient follow-up was conducted to identify the incidence and pattern of ADRs.Results: A total of 115 patients were enrolled. Maximum number of cases were in the 31-40 age group (25.21%) followed by the 41-50 age group (20.86%). 76 (66.08%) were males and 39 (33.91%) were females. 52 patients (45.21%) had concomitant diseases, out of which 15 (13.04%) were HIV positive and 21 (18.26%) were diabetic. 70 patients (60.86%) developed ADRs. The adverse drug reaction that were seen are -38 (38.76%) cases of gastrointestinal adverse drug reactions, 8 (8.16%) jaundice/hepatitis, 7 (7.14%) impaired hearing/vertigo, 21 (21.24%) central nervous system adverse drug reaction, 6 (6.12%) peripheral neuropathy, 6 (6.12%) rash and itching, 5 (5.10%) arthralgia, 3 (3.06%) renal impairment, 2 (2.04%) hypothyroidism and 2 (2.04%) blurred vision.Conclusions: Determining which population groups are affected most by ADRs can help physicians to better monitor and make an early diagnosis to reduce ADR-related morbidity and mortality.
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Retroperitoneal Lymphangiomas are rare and account for only 1% of lymphangiomas. They usually present in infancy, rarely they may present symptomatically in adulthood. We present a case of a 19-year old female with a symptomatic retroperitoneal lymphangioma. It was treated with complete surgical excision. Retroperitoneal lymphangiomas are rare. Imaging alone cannot differentiate them from other retroperitoneal cystic masses. Surgical excision is the treatment of choice and required for final diagnosis.
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Coexistence of tuberculosis and cheek malignancy is a rare phenomenon and it has never been reported to the best of our knowledge. Here, we present a case of carcinoma cheek with tuberculosis in a 50 year old male patient who was successfully managed by multimodality approach by combining anti-tubercular therapy with chemotherapy and radiotherapy.
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Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability worldwide. Its prevalence is increasing globally, especially in countries with high frequencies of smoking combined with signifi cant environmental exposures to pollutants and biomass smoke. Currently COPD is the third leading cause of death worldwide, after ischemic heart disease and stroke. Efforts have been made to design a standard protocol for treatment of the disease, and these efforts are still in the process. Methods: The study was done on 100 subjects to assess whether steroid (inhaled or oral) actually have any role in decreasing the decline in forced expiratory volume in 1 sec and to compare the effect of both to fi nd out which one is superior. Patients were divided into two arms, inhaled steroids group (according to GOLD guidelines), and the other group was oral prednisolone 10 mg in addition to standard treatment except inhaled steroid. The effects were studied with appropriate statistical tests. Results: Our study data showed that oral steroids are more effective on symptom control as compared to inhaled steroids. Symptoms such as cough (64% vs. 82%) and breathlessness (76% vs. 94%) signifi cantly improved in the oral corticosteroids group. The rate of exacerbation also improved (22% vs. 12%) in the test group. Conclusion: The use of steroids has ever been a subject of divergence of views ever since its role in the treatment of COPD was fi rst described. Although, overall steroid in any form is benefi cial in symptomatic/subjective and objective improvements in COPD, oral steroids stand a better chance as compared to inhaled steroids.
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Background: Type 2 diabetes mellitus is known to cause serious progressive macro and micro vascular complications leading to end organ damage like retinopathy, nephropathy and neuropathy. Pulmonary complications due to collagen and elastin changes as well as microangiopathy has also been demonstrated in type 2 diabetes mellitus but prevalence in most of population is unknown and its possible correlation with duration of disease and degree of glycemic control is not studied more in our population. Aims and objectives: To compare Pulmonary Function Tests (PFT) in type 2 diabetes mellitus with control group and to evaluate possible correlation of PFT with status of sugar control and duration of disease. Methods: Consecutively consenting 120 subjects who satisfied the inclusion criteria were recruited over one year duration. These 120 subjects are categorised into two i.e. healthy volunteers recruited as controls (n=60) and type 2 diabetic patients (n=60). Results: Both group compared and studied with each other. Diabetic patients showed a significant reduction in Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) and pulmonary diffusion capacity for carbon monoxide (DLCO) relative to their matched controls and these values were further reduced in diabetic patients with uncontrolled glycemic status. Conclusion: Our study concluded that lung functions in type2 diabetes mellitus are impaired with restrictive pattern of respiratory abnormality. Duration of diabetes did not influence on pulmonary function and diffusion capacity.
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Background: Lung cancer is the leading cause of cancer deaths globally in which about 40% patients reporting in advanced stage disease. Both platinum and non platinum combinations have been shown to be equally effi cacious as initial fi rst-line treatment of advanced non-small cell lung cancer (NSCLC), however because of the toxicity of cisplatin, combination treatment can only be administered to a minority of patients in good general health. Gemcitabine could be combined with one of the other new agents to create novel non-platinum-doublet combinations with effi cacy and/or toxicity profi le superior to that of standard platinum based combinations. Hence, this study was conducted to compare the toxicity profi les of gemcitabine monotherapy and the cisplatin/etoposide combination therapy. Methods: This was a randomized prospective study, which included 96 patients selected on the basis of histologically or cytologically confi rmed Stage III B or IV of NSCLC. Study was divided into two arms-Arm A received gemcitabine monotherapy in a dose of 1000 mg/m2 on day 1 and 5 of the cycle and repeated after every 3 weeks while Arm B received cisplatin (25 mg/m2 on day 1, 2 and 3) + etoposide (100 mg/m2). Patient were evaluated for adverse events by following World Health Organization grading of toxicity. Results: Out of the 96 patients enrolled in the study, 74 (77.0%) patients were eligible and were analyzed. Of these, 36 (37.5%) patients belonged to Arm A and 38 (39.5%) to Arm B. Transient vomiting (45.8% vs. 37.5%), leukopenia (33.3% vs. 8.3%) were seen more in Arm A, while thrombocytopenia (33.3% vs. 12.5%), patchy hair loss (68.4% vs. 16.6%) was seen more in Arm B. Nephrotoxicity was seen almost similarly in both the groups. Conclusions: Single-agent gemcitabine appears to have a safer toxicity profi le than the combination cisplatin-etoposide in the fi rst-line chemotherapy of advanced NSCLC. With less toxic anticancer drugs like gemcitabine, the physician now has greater choice in choosing treatment, which can have better effect on the patients concerned.
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Obesity is an important risk factor of Obstructive Sleep Apnea Syndrome (OSAS). Previous studies suggested Leptin Receptor (LEPR) gene Polymorphisms is associated with obesity and OSAS. Study was conducted to asses association of LEPR gene polymorphism K109R, Q223R and K656N with OSAS in North Indian subjects. Genotyping and estimation of serum Leptin levels were done in 190 subjects. Polysomnography, anthropometrical measures and biochemical investigations were done in all the subjects who qualified for inclusion in the study. We observed significant association of Q223R gene polymorphism with blood pressure (BP) (P<0.05) and nocturnal max pulse rate (P<0.05). K656N gene polymorphism was associated with AHI (P<0.05), average desaturation levels (P<0.05) and HDL-C (P<0.05). No association was observed in genotype distribution of these subjects according to obesity and disease severity. These findings suggest that LEPR Q223R and K656N gene Polymorphism may influence BP, Max Pulse rate, AHI, Average desaturation levels and HDL levels in these Subjects.