Study of clinical, radiological, and pulmonary function characteristics of patients having asthma-chronic obstructive pulmonary disease overlap syndrome

Background: Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome defined as a syndrome characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. This overlap makes the difference between COPD and asthma with persistent airflow limitation difficult, especially in smokers and elderly people. Objective: The objective of the study was to study the clinical features, radiological and pulmonary function characteristics of patients having asthma-COPD overlap syndrome. Materials and Methods: A cross-sectional study carried out at the Department of Respiratory Medicine, Government Medical College, Baroda, attached to SSG Hospital, Vadodara. A total of 100 patients enrolled which were clinically diagnosed with chronic airway obstruction as defined in the GOLD/GINA asthma-COPD overlap syndrome (ACOS) guidelines. Results: In this study, a total of 100 patients were enrolled, out them 76 patients were male and 24 patients were female. Fifty-three patients were from urban area and 47 patients from rural area. Most patients belong to age ranging from 40 to 86. Ninety-nine patients had a breathlessness and it was the most common symptom followed by chronic cough in 93 patients, sputum production in 70 patients, wheezing in 70 patients, running nose in 65 patients, and chest tightness in 46 patients. In smoking history, 25 patients were current smoker, 49 patients were ex-smoker, and 26 patients had never smoked in their life. In pulmonary function test, 26 patients had a normal test, 13 patients had obstructive abnormality with no significant bronchodilator reversibility, 54 patients had a obstructive abnormality with significant bronchodilator reversibility, and 7 patients had a restrictive abnormality. Conclusion: Clinically diagnosed ACOS patients were mostly males, belong to middle age groups, had breathlessness, wheezing, chronic cough with sputum production, and rhinitis and sneezing as the major symptoms. The pulmonary function tests revealed majority of the patients having obstructive pattern in pulmonary function test (spirometry). Furthermore, a majority of these patients had significant positive bronchodilatory response.

The mechanics of setting up a COVID-19 response: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa

The COVID-19 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves

Rare case of parotid rhabdomyosarcoma

Sarcomas comprise only 0.6% of all cancers throughout the body and account for only 1.5% of all salivary gland tumors. The existence of these tumors has been debatable with some investigators stating that such lesions represent extensions of soft tissue sarcomas into the gland. In young patients, these tumors occur more often than the more common parenchymal tumors or the conventional soft tissue sarcomas. We are hereby presenting a case of a 5 year old male child presenting with a large parotid mass which was diagnosed as parotid rhabdomyosarcoma.

Case series – Slipped capital femoral epiphysis in three members of same family as an unusual presentation.

Slipped capital femoral epiphysis is a disorder of the hip that affects children in late childhood and early adolescence, characterized by medial and posterior displacement of the proximal femoral epiphysis on the metaphysis. Although the diagnosis and treatment of slipped capital femoral epiphysis have been well described, the search for its cause and a method of early identification continues. We have reported here an interesting case of a bilateral slipped capital femoral epiphysis as an unusual presentation in one family -father and two siblings, had no record of any hormonal imbalances or endocrine abnormalities; had good nutrition; and presented with atypical characteristics of slipped capital femoral epiphysis. epiphysis have been well described, the search for its cause and a method of early identification continues. We have reported here an interesting case of a bilateral slipped capital femoral epiphysis as an unusual presentation in one family-father and two siblings, had no record of any hormonal imbalances or endocrine abnormalities; had good nutrition; and presented with atypical characteristics of slipped capital femoral epiphysis.

A comparative study on different market samples and standard samples of Shalaparni through physicochemical methods and near infrared spectroscopy.

Dashmoolais one of the most important groups explained in Mishrakagana. One of which, Shalaparni is a potent drug used single as well as in various formulations mentioned in classics. Adulteration in Dashmoolaplants is a very big issue now days and this is because of the lack of availability of the original drugs. In this study market samples of Shalaparni (Desmodium gangeticum DC.) collected from the different part of India; compared with the standard Shalaparni authenticated sample which was collected from the natural source; by using physicochemical parameter and near infrared spectroscopy. Results were statistically processed by PCA. The results show that there is no similarity found outbetween the standard drug and market samples of Shalaparni which were collected from different regions of India. The market samples were observed for different adulterated material having poor quality.

A Comparison of EtCO and PaCO in Laparoscopic Surgery during General Anaesthesia.

Introduction : Pneumoperitoneum leads to multiple changes in the mechanics of respiration and heart function.We decided to study the changes in arterial blood gas, EtCO and pH. We also studied hemodynamic changes due to pneumoperitoneum. Methodology : Fifty patients of ASA grade I and II, between the ages of20 to 65 years posted for elective laparoscopic surgery were selected. Arterial blood samples were collected pre-operatively.We also collected arterial blood intra-operatively at 10 min, 60 min and 120 min after insufflation of CO and soon after desufflation. Result : There was significant increase in EtCO after CO insufflation maximum at 60 minute and return to near baseline value after desufflation. There was significant rise in PaCO but within physiological range. There was significant decrease in pH maximum at the time of 120 minute. Blood pressure changes shows significant rise in diastolic blood pressure (p < 0.05). Conclusion : We concluded that diastolic blood pressure was kept under control by using volatile anesthetic agent. The EtCO PaCO and pH changes occurred significantly but remains within physiological range and corrected by increasing minute ventilation. Soon after desufflation all value returned to baseline in normal healthy patients. The EtCO correlate well with PaCO , so it is the best parameter to diagnose hypercarbia.

Results with non-operative treatment in dorsolumbar fractures with no neurological deficit: A functional assessment.

Background: The purpose of this prospective study was to assess the functional outcome of conservative treatment with early ambulation of dorso-lumbar spine fractures with no neurological deficit. Aims & Objective: The purpose of this prospective study was to identify the risk factors for dorso-lumbar spine injuries, and to assess the efficacy of non-operative treatment with early ambulation, and functional outcome of the patients. Material and Methods: From October 2008 to June 2010, 48 consecutive patients with single- level thoracolumbar spinal injury, with no neurological deficit were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months, and early ambulation was recommended. Patients were evaluated as per TLICS score, and if score was <=4 with no neurological deficit then, they were treated with conservative treatment and included in the study. The Denis Pain and Work Scale were used to assess the clinical outcome. The average follow-up period was 6.5 months (range, 4 to 11 months). Statistical analysis done by observational descriptive statistics using SPSS 19.0. Results: Radiological parameters, such as Cobb’s angle, showed loss of fracture reduction, which was not statistically significant. However, the functional outcome was satisfactory in 40 out of 48 patients, with no complications recorded on completion of treatment. Conclusion: Conservative treatment with early mobilization using TLS orthosis had good results in patients with TLICS score <4. We support the concept that TLICS is a reliable and easy-to-use classification for the conservative treatment and prognosis of thoracolumbar spinal fractures.

Anti‑inflammatory activity of root bark and stem bark of Shyonaka.

Background: Shyonaka (Oroxylum indicum Vent.; Bignoniaceae) root bark is one of the ingredients of dashamoola (a group of 10 roots), and is used for its anti‑inflammatory and analgesic action in a number of compound formulations in Ayurveda. Aim: Ayurvedic Pharmacopoeia of India (API) recommends using the stem bark instead of root bark. Material and Methods: An attempt has been made to study the anti‑inflammatory activity of both root bark and stem bark kashaya (decoction) experimentally. Conclusion: Results showed significant anti-inflammatory activity of root bark and stem bark decoction.

Electrolytes alterations in plasma and urine after 28 days repeated oral dose toxicity of mercuric chloride in wistar rat.

An experiment was conducted to study the electrolytes alteration in experimentally induced mercuric chloride in wistar rat. For this rats were uniformly divided in four different dose group 0.0, 2.0, 4.0, and 8.0 mg/kg body weight ranging from asymptomatic to high dose for 28 consecutive days. In this experiment, blood was collected on 0, 14 and at the end of experiment. In mercuric chloride treated group dose dependent significant increase in plasma glucose, sodium, and chloride and creatinine level. Same parameters studied in urine showed significant increase in excretion of electrolytes and glucose in urine while urine creatinine was decrease. Mercuric chloride produced dose depended electrolytes alteration in wistar rat at given dose.

Effect of mercuric chloride on oxidative stress and target organ pathology in wistar rat.

Mercury is the highly toxic metal that exerts its adverse effect on health of human and animals through air, soil water and food. For the present study, the toxic effect was observed by oral administration of mercuric chloride daily for 4 weeks at doses ranging from of 0 to 8 mg/kg/day. Histopathology was also carried out of both for kidney and liver. Significantl increased in lipid peroxidation and decreased Superoxide dismutase enzymes were observed in treated groups as compared to control . The gross changes were characterized by swellingand paleness of kidney and liver. Microscopic examination has revealed liver revealed hemorrhage, leukocytic infiltration, hepatocyte hypertrophy, necrosis and increased vacuolization incidence and the severity increased with increase treatment dose. In addition kidney showed proteineous cast in the lumen of tubules, narrowing of lumen, infiltration and necrosis.

Peptidolytic microbial community of methanogenic reactors from two modified UASBs of brewery industries

We studied the peptide-degrading anaerobic communities of methanogenic reactors from two mesophilic full-scale modified upflow anaerobic sludge blanket (UASB) reactors treating brewery wastewater in Colombia. Most probable number (MPN) counts varied between 7.1 x 10(8) and 6.6 x 10(9) bacteria/g volatile suspended solids VSS (Methanogenic Reactor 1) and 7.2 x 10(6) and 6.4 x 10(7) bacteria/g (VSS) (Methanogenic Reactor 2). Metabolites detected in the highest positive MPN dilutions in both reactors were mostly acetate, propionate, isovalerate and, in some cases, negligible concentrations of butyrate. Using the highest positive dilutions of MPN counts, 50 dominant strains were isolated from both reactors, and 12 strains were selected for sequencing their 16S rRNA gene based on their phenotypic characteristics. The small-subunit rRNA gene sequences indicated that these strains were affiliated to the families Propionibacteriaceae, Clostridiaceae and Syntrophomonadaceae in the low G + C gram-positive group and Desulfovibrio spp. in the class d-Proteobacteria. The main metabolites detected in the highest positive dilutions of MPN and the presence of Syntrophomonadaceae indicate the effect of the syntrophic associations on the bioconversion of these substrates in methanogenic reactors. Additionally, the potential utilization of external electron acceptors for the complete degradation of amino acids by Clostridium strains confirms the relevance of these acceptors in the transformation of peptides and amino acids in these systems.

A new recurring chromosome 13 abnormality in two older patients with de novo acute myeloid leukemia: An Indian experience.

We report here two cases of trisomy 13 in acute myeloid leukemia M1 subtype. short-term unstimulated bone marrow and peripheral blood lymphocyte culture showed 47, XY, +13 in all metaphase plates and trisomy 13 was confirmed with whole chromosome paint probes. Trisomy 13 in AML-M1 is a rare numerical abnormality. This is the first Indian report of sole trisomy 13 in AML-M1. Here, we present two cases of elder male patients, which may constitute a distinct subtype.

A case of acute myeloid leukemia-M2 with trisomy 4 in addition to t(8;21).

t(8;21)(q22;q22) is the most frequently observed karyotypic abnormality associated with acute myeloid leukemia (AML), specifically in FAB-M2. Short-term unstimulated bone marrow (BM) and peripheral blood lymphocyte culture showed 47,XX, +4,t(8;21) in all metaphase plates; and interphase and metaphase results of AML-ETO fusion was positive and trisomy of 4 was confirmed with WCP probes. Trisomy 4 in AML with t(8;21) is a rare numerical abnormality. Here we present such case of patient which may constitute a distinctive subtype.

Nevirapine versus efavirenz based antiretroviral treatment in naive Indian patients: comparison of effectiveness in clinical cohort.

OBJECTIVE: Our objective was to compare immunologic effectiveness of nevirapine and efavirenz based antiretroviral therapy in antiretroviral naïve HIV-1 infected Indian patients. DESIGN AND METHODS: Study was an observational, non-randomized, longitudinal cohort. Antiretroviral naive HIV-1 infected patients receiving efavirenz + 2NRTI (n=254) and nevirapine + 2 NRTI (n=857) from April 2000 were followed up at two tertiary care HIV clinics at Ahmedabad and Pune. Patients were followed up clinically monthly and CD4 was carried out every 3 monthly. All patients were examined for various side effects as well as development of various OIs. Data were analyzed using standard statistical methods. RESULTS: Baseline characteristics for both the groups (NVP and EFV) were comparable. In the random effects model, there was an increase of 40.97 (p < 0.05) units of CD4 cell counts with an unit increase in time in the NVP arm as against a 44.75 (p < 0.05) units of increase in CD4 cell counts in the EFV group with a unit increase in time, which is significant for both groups. However, at any given point of time there was no difference in the rate of increase of CD4 count between the two treatment arms (p = 0.58). Hypersensitivity reaction (6.6% in NVP vs. 2.32% in EFV, p = 0.0146) and hepatitis (3.2% in NVP vs. 0% in EFV, p = 0.0085) were more common with nevirapine, while neurologic disturbances (0.93% in NVP vs. 20.15% in EFV, p = 0.0001) were more common with efavirenz. Incidence of distal sensory neuropathy and lipid abnormalities was similar in both the groups. CONCLUSION: Use of NVP and EFV based HAART in antiretroviral naive Indian patients led to significant and durable rise in CD4 cell count. Although observational and non-randomized, our study showed equivalent immunological response amongst NVP and EFV based HAART which is in line with the results of the 2NN study.

A comparative study of subsyde-CR versus meloxicam in rheumatic disorders.

A prospective, randomised comparative clinical study was conducted in adult patients of either sex presenting with articular and non-articular rheumatic conditions commonly encountered in clinical practice Rheumatoid arthritis, osteo-arthritis, cervical spondylosis, and lumbago/sciatica were the most frequent conditions encountered in both the groups, followed by others like tenosynovitis, frozen shoulder, prolapsed disc, fibrositis, myositis, sprains, strains and so on. The drugs that were employed for therapy were diclofenac in a controlled release formulation employing the DRCM technology (subsyde-CR) and meloxicam in a standard formulation marketed in our country. Both drugs were well tolerated and found to be effective in reducing the signs and symptoms of the disease entities throughout the study period, but subsyde-CR was observed to produce a somewhat greater reduction in signs and symptoms scores that meloxicam, a difference that could be possibly attributed to the greater efficacy of subsyde-CR in non-articular rheumatic conditions. On the basis of the available literature on diclofenac and meloxicam as well as the DRCM technology in formulating subsyde-CR, it is reasonable to conclude that a controlled release formulation of diclofenac based on the DRCM technology offers a safe and effective alternative to other non-steroidal anti-inflammatory drugs such as meloxicam.

Effects of chronic ramipril treatment in streptozotocin-induced diabetic rats.

The present investigation was undertaken to study the effects of chronic oral ramipril (1 mg/kg) treatment in streptozotocin (STZ) induced diabetic rats. Single tail vein injection of STZ (45 mg/kg, i.v.) produced a diabetic state exhibiting all the cardinal symptoms such as loss of body weight, polydipsia, polyuria, glucosuria, polyphagia, hypoinsulinaemia and hyperglycaemia. The diabetic state was also found to be associated with bradycardia, hypothyroidism, cardiac depression and cardiomyopathy. Ramipril treatment prevented STZ-induced hypertension, bradycardia, hypothyroidism, hyperchosesterolaemia and partially the cardiomayopathy. Ramipril treatment could not, however prevent STZ-induced loss of body weight, polyuria, polydipsia, polyphagia, hyperglycaemia, hypoinsulinaemia, hypertriglyceridaemia and cardiac depression. Our data suggests that ramipril has a few beneficial effects in the STZ-treated diabetic rats.

Two stage reconstruction for the Shepherd's crook deformity in a case of polyostotic fibrous dysplasia.

Polyostotic fibrous dysplasia leads to progressive and disabling deformity involving the proximal femur. Conventional methods of treatment have been ineffective in controlling this problem. Two stage reconstruction was carried out in a case of polyostotic fibrous dysplasia with bilateral shepherd's crook deformity. Bilateral subtrochanteric osteotomies with intramedullary fixation in the first stage and intertrochanteric osteotomies in the second stage with nail plate fixation was done to provide definitive control of the deformity. Bone graft was not used.

100 years of Widal test & its reappraisal in an endemic area.

A reappraisal of the Widal test was made for its diagnostic utility in typhoid fever in an endemic area of Central India. The significant basal antibody level in the normal population based on 1200 voluntary/relative blood donors at the cut-off titre of 80 or above was observed in 13.83 and 8.0 per cent for 'O' and 'H' antigens of Salmonella typhi respectively. A retrospective study (1991-1995) over 138 bacteriologically proven cases of typhoid showed a positivity of 64.49 and 78.26 per cent respectively for 'O' and 'H' antibodies at the titre of 80 or above and 44.2 and 63.04 per cent at the titre of 160 and above. The retrospective data also showed a greater positivity (46.41%) in 1991 which decreased to 25 per cent in 1995 and appeared to follow the incidence of multi drug resistant S. typhi over the period. The detection of 'H' antibodies is no less important than the 'O' antibodies in the present study. Our data bring out the diagnostic limitations of Widal test done on single samples collected in the early phase of illness (4-10 days) from patients suspected to have typhoid in an endemic area of Central India.

The relation of exposure to asbestos and smoking habit with pulmonary function tests and chest radiograph.

Environmental cum medical study was conducted in asbestos cement factory. The environment was evaluated for asbestos fiber by the methods recommended by BIS. Total 355 exposed and 312 suitably matched control workers were investigated by spirometer, Wright's peak flow meter and full sized postero-anterior chest radiograph. The levels of asbestos fiber were 2 to 3 times higher than TLV i.e. 2 f/ml in pipe cutting dept., crude fiber grinding inlet count was more than the ACGIH recommended limit i.e. 5 mpccf of air in pipe cutting dept. and silica mill. In the rest of the department, fiber level as well as dust particle count were below prescribed limit. The comparison of mean values of PFT parameters of workers with 16-20 years exposure history with control one was showing statistically significant decline in mean values of FVC only suggesting restrictive type of PFT impairment in this group of workers. But in workers with more than 20 years exposure, the mean values of all the parameters studied were reduced as compared to control one suggesting combined type of PFT impairment. When the mean values of PFT parameters of exposed smokers were compared with exposed non-smokers there was statistically no significant difference. This can be due to marginal contribution of smoking habit in impairment of PFT parameters of exposed smokers. The percentages of workers with parenchymal and pleural changes due to asbestos exposure were nearly two times more in more than 20 years exposure groups as compared to 11-20 years exposure groups. The parenchymal and pleural changes due to asbestos exposure were more common in exposed smokers as compared exposed non-smokers. However the detailed analysis revealed that if smoking contributes to the development of interstitial fibrosis, the contribution is a marginal one in comparison to the effect of asbestos dust exposure.