Impact of socio-economic status, rural background and gender on the prevalence of chronic obstructive pulmonary disease.

Background: Prevalence of COPD and resistance towards drugs available for its treatment are increasing day by day. Objectives: To assess the impact of socio-economic status, rural background and gender on the prevalence of Chronic Obstructive Pulmonary Disease. Methods: This observational, prospective, open study was conducted in the Department of Chest & TB Rajindra Hospital, Patiala. A total of 250 patients were included in the study over a period of 1 year of mild to very severe stage of COPD according to GOLD guidelines for COPD 2011. Impact of rural background, household medium of cooking food, male: female ratio of disease occurrence, and patient’s socio-economic status were evaluated using modified kuppuswami grading. Results: In the rural population 100 patients out of 215 patients were males and 115 patients were females showing the rising trend of COPD in females of rural background and using biomass combustion and kerosene stove as the medium for cooking food, moreover most of the patients were living in the overcrowding. According to modified kuppuswami classification of socio-economic status, 170 patients were in the lower lower class, and 45 patients were in lower middle class socio-economic status in the rural background. Conclusion: Highest prevalence of COPD was seen in 51-60 years age group and among the patients of rural background with 215 patients (86%) affected with COPD out of 250 patients. With modified kuppuswami grading of Socio-economic status (SES), we found out that maximum patients in the rural background were from lower lower class SES thus signifying that poor socio-economic status can be a link to COPD.

Recent and emerging trends in Pharmacotherapy of neuropathic pain.

Neuropathic pain is a type of chronic pain caused by a lesion or disease of the somatosensory nervous system. The pathophysiology of neuropathic pain is very complex, not fully understood and different from that somatic pain. It has a deleterious effect on health related quality of life, and leads to increased health-care costs and its management is extremely difficult. The response to currently available treatments is less promising, so newer agents with better efficacy and safety are needed. Currently tricyclic antidepressants and anticonvulsants like gabapentin and pregabalin are considered as the 1st line drugs but these are not able to produce complete relief. Various recent drugs are: high dose capsaicin patch, topical lidocaine, botulinum toxin A, lacosamide, Selective Serotinin Reuptake inhibitorss, NMDA antagonists. Certain new targets like endocannabinoid system and various neurotrophic factors like BDNF, NT3, NT4, and GDNF are undergoing preclinical and clinical trials and their role in the treatment of neuropathic pain is still emerging.

Comparative efficiency of commercial and improvised spacer device in acute bronchial asthma.

OBJECTIVE: To compare the efficacy of a commercial spacer device versus an improvised spacer device in delivering aerosolized beta-2 agonist through metered dose inhaler in an acute exacerbation of bronchial asthma. DESIGN: Randomized controlled trial. SETTING: Urban tertiary care teaching hospital. METHODS: 60 children between 1 to 12 years of age with acute asthma were prospectively enrolled and randomized into two groups. Detailed history, clinical evaluation and appropriate laboratory investigations were recorded on a pretested proforma. One group received inhaled salbutamol using metered dose inhaler via commercial spacer device (Group 1), while the other received it via improvised spacer device (Group II). The response was sequentially assessed after 20, 40 and 60 minutes of institution of therapy. RESULTS:The two groups were comparable with respect to various parameters at presentation (p > 0.05). All the outcome parameters showed a significant improvement with time in both groups (p < 0.05). There was no statistical difference between the response in the two groups (p< 0.05). CONCLUSION: Metered dose inhaler with improvised spacer device is equivalent in efficacy and a more cost effective alternative to metered dose inhaler with commercial spacer for administration of beta-2 agonist in acute asthma.

Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.

OBJECTIVE: To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI). DESIGN: Prospective cohort study. SETTING: Urban tertiary care teaching hospital. METHODS: 201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework. RESULTS: The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality). CONCLUSION: Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.

Non-oliguric acute renal failure in gout.

Four patients of pure gouty nephropathy are presented. Gout was of over five years duration and asymptomatic nephropathy manifested as non-oliguric acute renal failure. Diseases commonly associated with it like uric acid stones, urinary tract infections, hypertension, diabetes mellitus, hyperlipidemid, obesity and nephrosclerosis were absent. Reduction in serum uric acid level resulted in prompt improvement in renal functions. Early detection and control of hyperuricemia may help in restoration of renal functions.

Sphincteric involvement in organophosphorus poisoning.

Neurological complications like type II paralysis are well described in organophosphorus poisoning. Sphincteric involvement is not described. We report two patients of organophosphorus poisoning who had sphincteric involvement as an unusual manifestation of type II paralysis.

Naturally occurring anti-native DNA antibodies in SLE binding Z-DNA.

A high degree of specificity of circulating anti-DNA antibody for double stranded DNA in the sera of SLE patients was found, as compared to single stranded polymer. The antibody recognized brominated DNA, a polymer that appears to attain Z-conformation as indicated on the basis of UV absorption characteristics. The existence in native DNA of regions undergoing B----Z transition has been detected.

Uveal changes in leprosy.

A total of 424 leprosy patients were screened for uveal involvement. Uveal changes were found in 11.2% of these patients. Uveal involvement was more common in patients with greater duration of the disease and in patients on irregular Dapsone therapy. Of the patients with uveal involvement 82% were lepromatous, 16% were borderline and 2% were of tuberculoid leprosy. Uveal changes in form of active iridocyclitis (21.3%), healed iridocyclitis (58.5%), iris atrophy (10.6%), iris pearls (7.4%), small irregular pupil (46.7%), pupil refractory to dilatation (56.3%) were seen. Posterior segment involvement was rare. Lepromatous and borderline leprosy patients with no clinical evidence of uveal involvement had decreased power of accommodation as compared to normal subjects.

The histopathology of type I (lepra) and type II (ENL) reactions in leprosy.

The histopathological features in type I (lepra) reaction comprised a loose and disorganised granuloma in the upper and mid-dermis, dermal edema and variable cellular contents, namely, epithelioid cells, lymphocytes, giant cells, and macrophages. While ENL reactions, were characterised by predominant involvement of subcutaneous vessels, vasculitis, and polymorphonuclear infiltration in and around the blood vessels.

Trace elements in the sera of leprosy spectrum.

Serum zinc, copper, calcium and magnesium levels were estimated by atomic absorption spectrophotometry in 56 leprosy patients comprising 14 BT, 12 BB, 11 BL and 19 LL. These findings were evaluated in comparison to 42 normal subjects serving as controls. A significant elevation of serum copper was recorded while reduction in zinc, calcium and magnesium was noted throughout the leprosy spectrum. The findings of our study are of considerable importance and need to be taken note of in the light of delineating these alterations to be the cause or effect of the disease.