Long Term Oxygen Therapy in Patients of COPD in Kashmir - Adherence and Barriers to Adherence

COPD is a growing global threat considering its increasing prevalence, morbidity and mortality. The only modality of treatment that has been proven to alter the late course of this disease is the long term oxygen therapy (LTOT). Considering that an increasing number of COPD patients are getting a prescription of LTOT, this study was done to recognize the common barriers that prevent its adequate compliance.METHODSA pre-set questionnaire was administered to patients and their caregivers regarding LTOT prescription, compliance to LTOT and reasons for their poor compliance to LTOT.RESULTS58 COPD patients included in the study completed the questionnaire. Only 12 (21.4%) patients used the recommended oxygen for more than 15 hours per day to give them the therapeutic benefit. 21 (37.5%) patients received recommended advice for the duration of using supplemental oxygen each day from their treating physicians. None of the patients received education about the correct use of using oxygen therapy at home.CONCLUSIONSOxygen usage among patients who have been prescribed home oxygen therapy is far from optimal, and both patient and physician related factors are responsible for it. Thus, the knowledge of major factors responsible for poor compliance of LTOT stresses upon the need for proper education of the treating physician and proper advice and counselling for this treatment modality at the time of prescription, for the patient.

Role of bronchoalveolar lavage, transbronchial needle aspiration with bronchial biopsy correlation in lung tumours and immunohistochemistry wherever required

Background: Lung cancer is most frequently diagnosed major cancer in the world and the most common cause of cancer mortality worldwide. It comprises about 17% of the total new cancer cases in males and 23% of the total cancer deaths. The objectives of this study were to compare bronchial biopsy, BAL and TBNA in diagnosing lung malignancies and IHC wherever required.Methods: The study was conducted at Sher-i-Kashmir Institute of Medical Sciences Srinagar, India in the department of Pathology. It was a prospective study over a period of 1½ years from June 2015 to December 2016. All patients clinically/ radiologically suspected of lung malignancies who presented between June 2015 to December 2016 and underwent bronchial biopsy, BAL (washings) and TBNA were included in the study. The study included only those cases where BAL, TBNA and bronchial biopsy were done simultaneously.Results: Out of a total 117 clinically suspected cases of lung cancer, tumor was found in 103 cases (103/117) by biopsy, 51 cases by BAL (51/117) and 64 cases by TBNA (64/117). The total number of false positive cases and false negative cases by BAL were 6 and 58. Sensitivity of BAL was found to be 43.69% and specificity 57.14%. The total number of false positive cases and false negative cases by TBNA were 7 and 46. Sensitivity and specificity of TBNA was found to be 55.34% and 50.0%.Conclusions: Thus, in the present study yield of diagnosis was highest with the bronchoscopic biopsies and in maximum number of cases with a sensitivity of 88.034%, and specific histologic diagnosis was made by biopsies and IHC only. Though BAL and TBNA were inferior to bronchial biopsy in diagnosing lung malignancies but these were effective for peripheral lung malignancies and when the patient was at risk of haemorrhage.

Vitamin D toxicity in adults: a case series from an area with endemic hypovitaminosis D

Vitamin D deficiency state is endemic to the Kashmir valley of the Indian subcontinent. Physicians often treat patients with high doses of vitamin D for various ailments and on occasion the prescribed doses far exceed the requirements of the patients. Ten cases of hypercalcemia due to vitamin D intoxication are presented with features of vomiting, polyuria, polydipsia, encephalopathy and renal dysfunction. All the patients had demonstrable hypercalcemia and vitamin D levels were high in nine of the 10 cases. The patients had received high doses of vitamin D and no other cause of hypercalcemia was identified. Treatment of hypercalcemia resulted in clinical recovery in nine cases. We conclude that hypervitaminosis D must be considered in the differential diagnosis of patients with hypercalcemia in endemically vitamin D deficient areas. A careful history and appropriate biochemical investigation will unravel the diagnosis in most of the cases

Do the Cyclooxygenase-2 inhibitors accentuate the cognitive activities?

Cognition is a process of knowing. When it is impaired, reviving is needed. Studies to bustle off the psychomotor activities using non steroidal anti-inflammatory drugs revealed variable results. The aim of this study is to evaluate the effects of single oral dose of celecoxib and meloxicam on cognitive activity in healthy, young volunteers. Fourteen healthy young volunteers were participated, allocated into two groups. After a7-day washed-out period, each volunteer was randomly given a single oral dose of either celecoxib or meloxicam or placebo. Psychomotor tests were performed to record participants' sensory and motor reactions. placebo-administered subjects had non-significant changes in both choice reaction time and critical flicker fusion. Celecoxib-administered participants had a significantly reduced recognition reaction time without a significant effect on motor reaction time. While meloxicam-administered participants had a significant reduction in motor reaction time without a significant effect on recognition reaction time. All drug-given participants had a non-significant change in choice reaction time when compared with corresponding baseline and placebo values. Cox-2 inhibitors have no place in improving the cognition

Comparison and agreement between venous and arterial gas analysis in cardiopulmonary patients in Kashmir valley of the Indian subcontinent

Arterial blood gas [ABG] analysis is routinely performed for sick patients but is fraught with complications, is painful, and is technically demanding. To ascertain agreement between the arterial and peripheral venous measurement of pH, pCO[2], pO[2], and bicarbonate levels in sick patients with cardiopulmonary disorders in the valley of Kashmir in the Indian subcontinent, so as to use venous gas analysis instead of arterial for assessment of patients. Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, a 650-bedded tertiary care hospital in North India located at an altitude of 1584 m. One hundred patients who required ABG analysis were admitted. Peripheral venous blood was drawn within 5 min of an ABG measurement, and the samples analyzed immediately on a point of care automated ABG analyzer. Finger pulse oximetry was used to obtain oxygen [SpO[2]] saturation. Data were analyzed using Pearson correlation and bias [Bland Altman] methods. The venous measurements of pH, pCO[2], pO[2] and bicarbonate, and the digital oxygen saturation were highly correlated with their corresponding arterial measurements. Bland Altman plots demonstrated a high degree of agreement between the two corresponding sets of measurements with clinically acceptable differences. The difference in pO[2] measurements was, however, higher [-22.34 +/- 15.23] although the arterial saturation and finger oximetry revealed a good degree of agreement with clinically acceptable bias. Peripheral venous blood gas assessment in conjunction with finger pulse oximetry can obviate the routine use of arterial puncture in patients requiring ABG analysis

Outcome as a measure of quality of care in oncology: experience at Sultan Qaboos University Hospital, Oman

Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital [SQUH], Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman. The cancers included non-Hodgkin's lymphoma [NHL], Hodgkin's lymphoma [HL], breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies. For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5%; 24% for the non-metastatic group. The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting withadvanced stage disease and several adverse prognostic factors

Kaposi sarcoma in a non HIV patient

We report a case of a 45 year old non HIV infected female, who presented with multiple painful, livid reddish brown plaques, papules and nodules on both lower limbs and left index finger. The cutaneous nodular lesions on biopsy showed characteristic features of Kaposi's sarcoma. This case is reported due to paucity of Kapsi's sarcoma in non HIV persons. It is typically a disease of older men from European and Mediterranean region. Here we present a case report of classic Kaposi's Sarcoma in a young Indian female

Acetylator phenotype in Iraqi patients with allergic contact dermatitis

Few studies have been done on acetylator status in ACD. This study determined acetylator status in Iraqi patients with allergic contact dermatitis [ACD] in comparison to a matched control group. The study included 35 ACD patients and 67 healthy volunteers. The ACD patients were diagnosed clinically and the diagnosis was confirmed by patch test. A detailed history was taken from the patients. After an overnight fast, each control subject and each patient received a single oral dose of 100 mg of dapsone. A blood sample was collected after 3 hours and plasma was separated for determination of dapsone and monoacetyldapsone by HPLC. Twenty-six of the 35 ACD patients returned for follow up. The frequency of slow acetylators in healthy individuals was 71.6%, while the frequency of rapid acetylators was 28.4%. The frequency of slow acetylators in ACD patients was 60.0% while the frequency of rapid acetylators was 40.0%. There was no association between the acetylator status, personal history of allergy, patch-test positivity or sites of dermatitis in ACD patients. A rapid acetylator status might predispose to ACD, but does not seem to influence other features of the disease

Prevalence of vancomycin and high level aminoglycoside resistant enterococci among high-risk patients.

Enterococci have been recognized as clinically important pathogens in high-risk populations of hospitalized patients. The role of enterococci in nosocomial infections is being recognized with increasing frequency. The main source of these infections is usually fecal carriage of the microorganisms. In this study, gastrointestinal colonization with vancomycin resistant enterococci (VRE) and high-level aminoglycoside resistant enterococci among 316 high-risk hospitalized patients were investigated. One hundred and ninety-eight enterococci strains were isolated from stool specimens. All strains were identified to species level and 90 of the isolates were identified as Enterococcus faecalis (45%), 85 as E. faecium (21.5%), 14 as E. avium (7%), 7 as E. raffinosus (3.5%), 1 as E. durans (0.5%) and 1 as E. hirae (0.5%). Eleven of 198 strains were found to be moderately sensitive to vancomycin (MIC: 8-16 microg/ml) by the agar dilution method according to the National Committee for Clinical Laboratory Standards (NCCLS) recommendations, and the rest of these strains were found to be sensitive (MIC < or = 4 microg/ml). Twenty-eight strains showed high-level resistance to streptomycin (2,000 microg/ml) and 26 strains were found to have high-level resistance to gentamicin (500 microg/ml). Twelve of these strains had high-level resistance to both aminoglycosides. By the disk diffusion tests, 53 of 198 strains were found to be resistant to erythromycin, 51 to penicillin, 37 to ampicillin, 18 to ciprofloxacin, 14 to norfloxacin and 3 to nitrofurantoin. No beta-lactamase production was detected in 198 studied strains.

IgG response to some mycobacterial antigens in selected leprosy patients.

Serum samples from selected leprosy patients with putative tuberculosis were tested by indirect ELISA to determine the level of IgG antibody against six mycobacterial antigen preparations. PCR-positive leprosy patients were confirmed with PGL-I ELISA. A ratio of antibodies to antigens of tuberculosis and leprosy was found to be a valuable serological marker for tuberculosis in long-treated leprosy patients.

PCR to detect Mycobacterium tuberculosis DNA in sputum samples from treated leprosy patients with putative tuberculosis.

In this study of leprosy patients with putative tuberculosis, the polymerase chain reaction (PCR), one of the most reliable and sensitive molecular diagnostic methods, was carried out for the specific detection of Mycobacterium tuberculosis DNA. Sputum samples from 43 patients at Baba Baghi Leprosarium in Iran were tested. The DNA extraction method was based on the lysing and nuclease-inactivating properties of guanidinium thiocyanate (GuSCN) together with the nucleic acid binding properties of diatoms or silica particles. Primers for a 123-base pair (bp) fragment of the repetitive DNA sequence of M. tuberculosis were used for the PCR assay. The results of PCR were compared with direct microscopy and culture. In total, 14% of the patients in this study were found to be PCR positive for M. tuberculosis. No positive results were found by direct microscopy for acid fast bacilli (AFB) and culture. It was thought probable that the positive PCR results indicated the tuberculosis (TB) in such treated leprosy patients.