Unravelling the unusual: Enterococcus faecium in aspiration pneumonia complicated with lung abscess in a severely comorbid patient

Aspiration pneumonia is a common respiratory infection that can lead to complications, including lung abscess. While typical causative agents include P. aeruginosa, K. pneumoniae, and S. aureus, atypical agents must also be considered, especially in comorbid or elderly populations. This case report presents a rare instance of aspiration pneumonia caused by E. faecium that developed into a lung abscess in a patient with multiple comorbidities. The patient's medical history included left-sided hemiparesis, hypertension, and type-2 diabetes mellitus, as well as a thirty-year history of smoking and alcoholism. Radiological evaluation revealed a rounded opacity with an air-fluid level in the left lower zone, indicating a lung abscess. Microbiological evaluation confirmed the presence of Enterococcus spp. The case highlights the importance of considering atypical pathogens in aspiration pneumonia and the potential for severe complications in severely comorbid patients.

Prescription pattern of inhalational medications for chronic obstructive pulmonary disease in India: insights from cross-sectional survey of pulmonologists across India

Background: Treatment of COPD depends on disease severity, phenotype and exacerbation risk. Inhaled medications are the treatment of choice in COPD. We undertook this survey to find the most commonly prescribed inhalational medication in COPD as per the severity of the disease. Methods: It was a cross-sectional questionnaire-based survey of pulmonologists in real-world clinical practice settings conducted across India. Results: The participants included 806 pulmonologists across India. Seventy-five per cent of pulmonologists ranked symptom relief, reduction in the frequency of exacerbations and improvement in lung function as the most important treatment targets. In COPD patients falling under GOLD group A, the treatment choice by pulmonologists in descending rank order was fomroterol/glycopyrronium (32%), ipratropium (38%), and tiotropium (30%) and for gold group B, this was fomroterol/glycopyrronium (34%), followed by indacaterol/glycopyrronium (26%) and tiotropium/formoterol (40%). In the GOLD group E, triple therapy (formoterol/glycopyrronium/budesonide) was preferred by 41% of pulmonologists. In the frequent exacerbator, predominant emphysema, chronic bronchitis and concomitant asthma phenotype, 44%, 38%, 46% and 32% of pulmonologists ranked formoterol/ glycopyrronium/budesonide as their preferred 1st therapy, respectively. Among COPD patients with cardiovascular disease (CVD) comorbidity, 31% of pulmonologists selected formoterol/glycopyrronium/budesonide as 1st-preference drug therapy. Similar results were obtained for COPD patients with metabolic syndrome comorbidity. Conclusions: For the management of COPD patients, pulmonologists predominantly preferred a triple drug combination of formoterol/glycopyrronium/budesonide in GOLD group E and also in patients with cardiovascular and metabolic comorbidities. Fomroterol/glycopyrronium was the most preferred combination for GOLD group A and GOLD group B.

Clinico-pathologic profile and pattern of p53 expression of lung adenocarcinoma in non-smokers and smokers in a tertiary cancer centre

Background: Lung cancer is the most common cause of cancer mortality worldwide. Smoking is undoubtedly the major risk factor of lung cancer in both genders. Adenocarcinoma is the most common form of lung cancer in both men and women and the most prevalent subtype in non-smokers. Lung cancer in never-smokers is a distinct entity with sparse studies. We studied the clinico-pathologic profile of lung adenocarcinoma and pattern of p53 expression in smokers and non-smokers. Methods: A prospective study involving 100 lung adenocarcinoma cases from January 2020 to June 2021 examined p53 expression using immunohistochemistry. Trucut biopsies, fine needle aspiration cytology (FNAC) cell blocks, and pleural effusion were analyzed to identify the predominant morphological subtype of the lung adenocarcinoma. Results: The most common histological pattern of lung adenocarcinoma was solid, and the presenting symptoms were cough and dyspnoea in both smokers and non-smokers. The incidence of lung adenocarcinoma was higher in non-smokers in the study. p53 expression had a significant correlation with smoking but not with stage of disease or morphological subtype of lung adenocarcinoma. Conclusions: p53 mutation has a statistical correlation with smoking in adenocarcinomas in our population. Among the adenocarcinoma cases in our study, non-smokers predominate (n=53). Even though our study showed the p53 mutation has no statistical correlation with the stage of the disease or histological subtype in adenocarcinoma, more cases need to be studied to prove this observation.

A study of predicting factors and medical expulsion therapy for solitory lower ureteric calculi

Background: The aim of our study is to evaluate the outcome of medical expulsion therapy (MET) for lower ureteric calculi and asses the clinical, laboratory and radiological factors that predict conservative approach. We evaluated the efficacy of combined drug therapy with alpha 1 adrenergic receptor antagonist tamsulosin and corticosteroid deflazacort for MET therapy for lower ureteric calculi. Methods: A prospective randomized control study was conducted in the department of surgery urology wing on out patients (OPD) basis at IIMSR Medical College Warudi District Jalna a tertiary referral center after approval from the ethical committee. The study conducted between 01 January 2020 to 31 December 2023 over period of three years. Total 76 cases included with the age 18 years old and above. The patients were examined weekly with ultrasonography and kidney ureter bladder (KUB) for 4 weeks and the stone expulsion rate and time, pain episodes during follow-up period, total diclofenac dosage and the need for any intervention was noted close monitoring and timely follow up is mandatory counselling and selection of patient is key factor. Results: Stone expulsion with patients on MET was 84% which is higher as compare to another group 57%. Conclusions: Medical therapy with a combination of ?-adrenergic blocker and corticosteroid is associated with good stone expulsion rates and should be considered in all patients with lower ureteral stones of size less than 10 mm who are not having any contraindications for medical therapy provided close monitoring and timely follow up is mandatory counselling and selection of patient is key factor.

Scleroderma and dental implications: a case series

Systemic sclerosis (SSC) is a rare, systemic autoimmune disease of unknown etiology, which is characterized by fibrosis of visceral organs, skin and blood vessels. This disorder can be localized or systemic. It is more common in women with estimated prevalence is 250 cases in a million. Oral manifestations include xerostomia, periodontitis, decayed tooth etc. Radiographically generalized loss of bone with resorption of the mandibular angle and coronoid process can be evident in patients with scleroderma. Pressure of fibrous mucocutaneous tissues is thought to be the cause of the resorption. Decreased number of wrinkles due to sclerosis and distinct facial features because of the atrophy of ala nasi are among common clinical characteristics of this condition. The aim of this case series is to present two female patients with scleroderma who presented with signs of oral manifestations along with resorption at the angle of mandible, as well as widening of the periodontal space.

Survey on the awareness of COVID-19 virus infection among the health personnel of Sirajganj area, Bangladesh

Background: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly in resource-limited settings. Understanding the awareness and practices of health personnel regarding COVID-19 is crucial for effective infection control and patient care. This study aims to assess the awareness of COVID-19 symptoms, complications, transmission methods, and preventive practices among health personnel in Sirajganj, Bangladesh. Methods: This descriptive cross-sectional study involved 260 health personnel from Shaheed M. Monsur Ali Medical College and the 250 Beded Sheikh Fazilatunnesa Mujib General Hospital, Sirajganj. Data were collected through a semi-structured questionnaire, focusing on COVID-19 awareness and practices. The study employed purposive sampling and face-to-face interviews for data collection. Results: The study found high awareness of COVID-19 symptoms, with 96.15% recognizing fever and 97.69% identifying loss of smell. Awareness of complications like respiratory failure (80.00%) and pneumonia (60.77%) was also notable. Preventive practices such as handwashing (98.08%) and mask-wearing (98.08%) were widely adhered to. However, 36.15% of participants reported being affected by COVID-19, indicating potential exposure risks. Conclusions: The study reveals a high level of awareness and adherence to COVID-19 preventive measures among health personnel in Sirajganj. Despite this, the infection rate among participants highlights the need for enhanced protective measures and continuous education. These findings can inform strategies to strengthen healthcare responses to ongoing and future pandemics.

A study of correlation between foot length and gestational maturity and anthropometric measurements in neonates

Background: This pinnacle抯 the importance for alternative measurements which predicts birth weight and gestational age (GA). Foot length is a simple measure and does not require expertise. The aim of this study was to study correlation of foot length and GA among preterm, term and post-term neonates.Methods: This study was a prospective observational study done in 155 babies. Anthropometric measurements were taken within the first 24 hours of life. GA estimation was done using modified Ballard score. Foot length, head circumference and chest circumference were measured and noted. Weight of the baby was recorded using electronic weighing scale.Results: Foot length statistically correlated (p<0.05) with GA assessment using NBS, weight, length, head circumference and chest circumference. The highest correlation of foot length in term SGA and term AGA babies for foot length was with head circumference (r=0.74 and 0.64 respectively). In pre-terms, foot length correlated well with head circumference and birth weight (r=0.92, 0.84 and 0.92 respectively). There were no babies in preterm LGA group and post term SGA and LGA group.Conclusions: Foot length also statistically correlated with other parameters like birth weight, length, head circumference and chest circumference.

Psychosocial correlates of depression in paediatric patients with epilepsy in a teaching hospital in Nigeria

Background: Seizures are the most common paediatric neurological disorder with most children suffering at least one seizure before the age 16yr. The psychosocial comorbidities which adversely affect quality of life especially depression, are often neglected. This study sorts to highlight the psychosocial correlates of depression among these children. Methods: Recruitment was in a paediatric neurology clinic in a tertiary-level hospital. Children were eligible for recruitment if aged 9-18 and had a diagnosis of epilepsy as confirmed by a neurologist, in care for a period of more than 3 months, and parents gave consent. Children who met the study inclusion criteria were subjected to a two- stage interview process using CES and DICA-1V tools, designed to screen and confirm depression. These instruments have previously been validated on a Nigerian population. The study was cross section and descriptive, with psychometric evaluation p-values<0.05, statistically significant. Results: A total of 400 children were offered participation, and 380 were recruited, among them, 117 (30.8%) met the clinical criteria for major depression with 40 (10%) of them in need of urgent medical attention. Males were more depressed, p=0.000, OR: 0.861, respondents aged 9-11yr showed a strong association with depression p=0.001, OR: 1.911. Living arrangements of patients, p=0.001, OR: 0.632, family size (siblings), p=0.004, marital status of mothers, p=0.001, OR: 2.373, turned out significant with mothers’ marital status showing a strong association. Duration of illness and frequency of seizures, showed a very strong association with depression p=0.023, OR:1.203, and p=0.001, OR:1.411 respectively. Conclusions: The study highlights a strong association between effects of epilepsy and psychosocial wellbeing of children and the high risk posed by unstable family settings on children’s health.

De novo late postpartum preeclampsia: a case report with review of literature

De Novo late postpartum preeclampsia is defined by many authors as new onset postpartum hypertension of ?140/90 mmHg with features of organ system malfunctioning during 48 hours to six weeks of delivery following a normotensive pregnancy and labor. Though a lesser studied condition it is responsible for more number and increased severity of maternal morbidity, mortality, and cause of post-delivery hospital admission. Its exact cause is not yet clearly defined. The incidence is 0.3-27% as noted by many authors. Patients usually present on day 7-10 with severe headaches, neurological symptoms like visual disturbances; symptoms of other organ involvement, and high blood pressure. High suspicion leads to diagnosis. Primary investigations include that for preeclampsia. The principle of management is the reduction of blood pressure, prophylactic anticonvulsants, and diuretic is considered if there are features of fluid overload. She needs constant monitoring. Post delivery women, after discharge, do not avail of home blood pressure monitoring and even the symptoms, to start with are treated with over-the-counter medication. This leads to worsening of the condition. Our patient, a primipara reported to this hospital on the 38th day of normal vaginal delivery following a normotensive pregnancy and delivery, with features of preeclampsia. The aim of publishing this case is for statistical records and create awareness of the condition. Every postpartum woman on discharge from the hospital following a normotensive pregnancy and delivery must be counseled on the significance of home BP monitoring and must consult an obstetrician on developing any new symptoms.

Assessment of minimum inhibitory concentration to vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin against methicillin resistant Staphylococcus aureus clinical isolates by antibiotic gradient strips

Background: Staphylococcus aureus infections are one of the most common and serious hospital-acquired infections seen in developing countries. Methicillin resistant Staphylococcus aureus (MRSA) is an important human pathogen and normally colonized in body parts including skin, nose, perineum and throat. MRSA is resistant not only to all ?-lactam groups but also other antibiotics including aminoglycosides, tetracycline and macrolides. In the present study the efficacy of agents used in the management of MRSA infections was determined by antibiotic gradient testing. Methods: A total of 60 clinical isolates of MRSA strains were collected from various diagnostic labs in central Kerala. Clinical isolates were reconfirmed as MRSA by gram staining, yellow-coloured colonies on mannitol salt Agar (MSA). Antibiotic susceptibility testing was done by disc diffusion method as recommended by CLSI guidelines. S. aureus isolates resistant to cefoxitin (30 µg) was identified as MRSA. Antibiotic gradient testing was performed to determine the MIC of vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin against MRSA isolates. Results: All the 60 MRSA isolates tested were sensitive to vancomycin, tigecycline, linezolid, daptomycin, ceftaroline and mupirocin (100%) and none of the MRSA isolates show resistance. Conclusions: Results of present study indicates that these agents may be used alongside vancomycin in management of infection caused by MRSA.

Antibiotic resistance pattern of Pseudomonas aeruginosa isolated from pus samples at tertiary care cancer hospital

Background: Pseudomonas aeruginosa is one of the most frequent opportunistic microorganisms causing infections in cancer patients. The aim of the study was to determine the antibiotic susceptibility of Pseudomonas aeruginosa and multidrug-resistant (MDR) isolates in cancer patients. Methods: A retrospective study was conducted from January 2022 to December 2022 at Government Cancer Hospital, Aurangabad. A total of 143 pus samples were collected from both IPD and OPD patients. Pus samples were collected as per standard procedure and were inoculated on blood and MacConkey agar. The isolates were identified by standard protocols using biochemical tests. The antibiotic susceptibility pattern of each isolate was checked as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2022 using Kirby-Bauer's disc diffusion method and VITEK 2 Automation. Data analysis was done by statical method with statistical software SPSS version 22. Results: Out of 143 clinical samples 33 samples (23%) were positive for Pseudomonas aeruginosa growth. mean age of patients was 50 years old out of 33 isolates 12 (36%) isolates were multidrug-resistant, 11 (33%) isolates were extensively drug-resistant and 1 (3%) were pan-drug-resistant. The majority of isolates were responsive to polymyxin B 32 (96%) and colistin 32 (96%); However, the resistance to gentamycin, ceftazidime, and amikacin was higher, at 66%, 60%, and 57%, respectively. Conclusions: This hospital-based retrospective study will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns among clinicians. Thus, there is a need for an antibiotic stewardship program to monitor the resistant pattern in a tertiary care cancer hospital.

Lower urinary tract symptoms evaluation with uroflowmetry in patients with benign prostatic hyperplasia

Background: Uroflowmetry, a non-invasive urodynamic technique, is commonly employed in evaluating patients with potential lower urinary tract dysfunction. Accurate assessment of the severity of lower urinary tract symptoms (LUTS) can be achieved through the utilization of various validated questionnaires, such as the International Prostate Symptom Score (IPSS). The objective of this study was to investigate the correlation between uroflowmetry parameters and the severity of symptoms. Methods: Fifty patients with LUTS caused by benign prostatic hyperplasia were evaluated by using uroflowmetry, IPSS, prostate volume estimation from May 2022 to December 2023. The correlations between these parameters were quantified by means of Spearman correlation co-efficients. Results: Significant statistical correlations were identified between the IPSS and uroflowmetry outcomes, including peak flow rate, average flow rate, and post-void residual urine. However, no correlation was observed between the IPSS and measurements of prostate volume. Conclusions: A positive correlation was observed between the measured peak flow rate through uroflowmetry and the severity of lower urinary tract symptoms.

Antenatal care at rivers state university teaching hospital, southern Nigeria: who and when?

Background: Antenatal care prepares pregnant women physically and psychologically for birth and parenthood. It also prevents, detects and manages health problems affecting mothers and their babies. Objectives were to identify and characterise those attending antenatal care at RSUTH and when they register for antenatal care. Methods: A retrospective study conducted from 1st January, 2015-31st December, 2020 at ANC of RSUTH. Records of 9990 pregnant women who booked for antenatal care were retrieved and reviewed. Socio-demographic characteristics and gestational age at booking were studied. Data was analyzed using SPSS version 23.0. P value <0.05 was statistically significant. Results: During the study period, 9990 pregnant women booked for antenatal care. Most (23.3%) registered in 2016. Mean age at booking was 31.4�7 years. Highest age group (62.4%) was 30-39 years. Modal parity was para 0 and majority (37.5%) were para 2-4. Mean gestational age at booking was 20.5�5 weeks. More than 70% had tertiary education and 67.9% were traders and civil servants. More than 97% were married and 58.3% registered in their second trimester. When gestational age at booking was compared with the various socio-demographic parameters, those with the differences statistically significant and associated with late booking were educational level, age, parity, occupation and employment status. Conclusions: Most women at booking were in their thirties, second trimester, married, multiparous, working class and had tertiary level of education. Most socio-demographic parameters showed statistically significant differences when compared with the gestational age at booking.

Caregiver burden of the elderly in a selected urban community, Chittoor district, Andhra Pradesh

Background: In India, families are the primary source of support in caring for the elderly, whereas the potential group of family caregivers is shrinking. Caregivers need greater recognition and support to help them care for the elderly and to maintain their own health and well-being. Assessment of the perceived burden of caregivers helps identify those in need of support. Methods: A cross-sectional questionnaire-based study was conducted to estimate the perceived level of caregiver burden in families of elderly and to identify the association between selected socio-demographic characteristics of the caregivers and the level of caregiver burden. The caregivers of 50 elderly people categorized as mild and moderate dependents as per the Katz index of Independence were included in the study. The Zarith caregiver burden scale was used to evaluate their perceived level of caregiver burden. Results: Thirty-two (64%) caregivers were found to experience a mild to moderate perceived level of caregiver burden. An ordinal regression analysis between other burdens/responsibilities (predictor) of the caregiver and the perceived level of caregiver burden showed a significant association (?2; p=0.009) between the two. An odds ratio of 6.7 (95% CI, 2.22 to 22.7; p=0.00115) showed that as the predictor increased, the event (caregiver burden) increased as well. Conclusions: The majority of the caregivers suffer from a mild to moderate perceived level of caregiver burden. They experience more burden when they hold additional responsibility of caring for the elderly.

Evaluation of anti-inflammatory effects of the aqueous extract of Stephania rotunda in experimental animals

Background: The objective of the current study was to analyse the anti-inflammatory effects of the aqueous extract of Stephania rotunda in experimental animals. Methods: It was an experimental study conducted in the experimental laboratory with 30 acclimatized healthy albino rats and mice divided into 5 groups namely A, B, C, D, and E fed with the aqueous extract of Stephania rotunda in laboratory conditions to assess the anti-inflammatory property using Carrageenan induced rat paw oedema for acute inflammation, granuloma pouch for sub-acute inflammation and Formaldehyde induced arthritis for chronic inflammation from 17th December 2019 to 22nd January 2021. Aspirin was taken as the standard drug. Data was analysed using Chi-square test. Results: In assessment for acute inflammation, the aqueous extract of Stephania rotunda in the doses of 500 mg/kg, 1000 mg/kg and 2000 mg/kg for groups B, C and D respectively produced 17.12%, 17.12% and 18.78% inhibition of paw oedema which was statistically significant when compared to 22.65% inhibition produced by 100mg/kg of the standard drug aspirin in group E. The groups B, C and D with the extract doses of 500mg/kg, 1000mg/kg and 2000mg/kg produced 43%, 60% and 77% inhibitions of exudate formation respectively which statistically was significant as compared to the Standard aspirin of group E which produced 62% inhibition of exudate formation. In chronic inflammation testing, both the extract and standard drugs produced highly significant inhibition of paw oedema when compared to inhibition produced by the Control. Conclusions: The aqueous extract of Stephania rotunda was found to be a potent anti-inflammatory drug when compared with Aspirin. Further tests are required in a larger scale so as to ascertain the effects for human consumption.

Linezolid susceptibility in MRSA isolates: insights into resistance and concordance in phenotypic detection methods

Background: Methicillin-resistant staphylococcus aureus (MRSA) poses persistent threat, affecting both healthcare environment and communities, with substantial impact on infection rates, morbidity, mortality, and healthcare costs. Vancomycin, a longstanding cornerstone in MRSA treatment, but with the emergence of vancomycin resistant MRSA (VRSA), necessitating alternative antimicrobial solutions. Linezolid, stands out as a promising candidate. It has unique advantages such as an absence of renal toxicity and improved lung parenchymal diffusion compared to vancomycin, making it an appealing choice, especially for healthcare-acquired pneumonia by MRSA. Methods: This cross-sectional study investigated linezolid susceptibility in 158 MRSA isolates using both disk diffusion and agar dilution method. Results: Results indicated that the majority of isolates exhibited linezolid susceptibility, with 53.16% showing a minimum inhibitory concentration (MIC) of ?2 礸/ml. However, two MRSA isolates, constituting 1.27% of the sample, displayed a MIC of 8 礸/ml, named them as a linezolid-resistant MRSA (LRSA). These findings align with previous research, mirroring resistance rates observed in different regions. Notably, vigilance against linezolid resistance is crucial, particularly due to its status as a last-resort MRSA treatment. Conclusions: Remarkably, a 100% concordance was found between the disk diffusion and MIC methods for detecting linezolid resistance in MRSA, suggesting that the disk diffusion method may be practical choice for laboratories with heavy workloads. However, adherence to CLSI guidelines is essential, and cases of resistance by disk diffusion should be confirmed using MIC methods. Emergence of linezolid-resistant MRSA is a worrisome development, necessitating ongoing surveillance and vigilance.

Advancements in early cancer diagnosis using blood-based biomarkers and a machine learning approach

Mutations that promote aberrant cell growth are the root of the condition known as cancer. There are over a hundred distinct forms of cancer that have been identified, with lung, colon, pancreatic, breast, kidney, and prostate cancer being the most prevalent. The likelihood that a patient will survive cancer is significantly improved by early identification. Most techniques used to detect cancer are invasive, which may be painful and uncomfortable for patients and prevent them from seeking treatment. As a result, cancer is frequently discovered only after substantial symptoms have developed and it may then be too late for treatment. In this review, we will discuss several methods for detecting cancer through blood tests, different elements that serve as biomarkers, and machine learning algorithms for predicting outcomes.

The effect and approach of dentures on the nutritional state of the elderly

The absence of natural teeth presents considerable hurdles in consuming certain foods that demand efficient chewing, rendering elderly individuals vulnerable to malnutrition. Studies have reported malnutrition rates among this group ranging from 2% to 10%. Several factors contribute to this issue, including tooth loss itself, diminished masticatory function, and age-related alterations in taste sensitivity and saliva production. This review delves into the significant effect of dentures on the nutritional well-being of elderly individuals, shedding light on the challenges posed by edentulism, or complete tooth loss. The review underscores the crucial role of integrating dietary guidance into the prosthodontic treatment of edentulous patients. Personalized dietary counselling emerges as a vital strategy to rectify nutrient imbalances and enhance oral and overall health. Key recommendations encompass embracing a diverse array of foods while also moderating salt, fat, and sugar consumption. Furthermore, promoting the intake of hydrating fluids such as water, juice, and milk is essential. Continuous monitoring and support are emphasized as indispensable components for ensuring enduring dietary improvements among this vulnerable population. In conclusion, this review underscores the imperative of addressing the nutritional implications of dentures in the elderly and advocates for a comprehensive approach to safeguarding their dietary health.

Understanding perspectives of asthma among pulmonologists in Indian settings: results from a questionnaire-based survey

Background: Asthma is associated with high morbidity and mortality in India. This survey was undertaken to explore the perspectives of pulmonologists towards in-clinic management of patients with asthma. Methods: It was a cross-sectional survey of pulmonologists conducted across India. It was formulated to provide unbiased observations of real-world clinical practice focusing on methods of diagnosis of asthma and its treatment preferences. Results: The participants included 805 pulmonologists, with the majority primarily treating patients with asthma (62%), chronic obstructive pulmonary disease (19%) and allergic rhinitis (19%). More than 86% of pulmonologists consider clinical symptoms, history of childhood asthma, family history, and chronic allergic rhinitis for initial diagnosis. About 19-23% prefer spirometry alone or in combination with family history for confirmation of asthma. The preferred inhaled corticosteroids-long-acting bronchodilator (ICS-LABA) combination was budesonide-formoterol amongst 83% of pulmonologists. For both dry powder inhaler (DPI) and metered dose inhaler (MDI) devices, fine particle fraction per cent and delivered dose were ranked as the two most important attributes. Conclusions: Asthma is the most prevalent diagnosis among patients treated by pulmonologists on the basis of clinical presentation and medical history. The most commonly used pharmacotherapy for the treatment of asthma comprises ICS-LABA, with budesonide-formoterol being the preferred combination. Fine particle fraction per cent and magnitude of delivered dose influence the choice of asthma inhaler prescriptions the most.

CETP gene polymorphisms and haplotypes are explanatory variables for HDL cholesterol level in sickle cell disease

Variations in lipid profile have been observed in sickle cell disease (SCD) and understanding their relationship with disease severity is crucial. This study aimed to investigate the association of polymorphisms of the CETP gene and laboratory markers of disease severity with lipid profile in a pediatric population with SCD. Biochemical and anthropometric analyses and CETP and alpha-thalassemia genotyping were performed. The study included 133 children and adolescents with sickle cell anemia (SCA) or hemoglobin SC disease (SCC), in steady-state. The SCA and no hydroxyurea (no HU) groups had higher values of ApoB, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) compared to the SCC and HU groups. However, there were no significant differences in ApoA1 and HDL-C levels between the groups based on genotype. Furthermore, the groups with altered levels of ApoA1, HDL-C, and the triglyceride/HDL ratio exhibited lower hemoglobin (Hb) levels and higher white blood cell counts. Hb level was associated to HDL-C levels. Analysis of CETP gene variants showed that the minor alleles of rs3764261 (C>A), rs247616 (C>T), and rs183130 (C>T), as well as the TTA haplotype, are explanatory variables for HDL-C levels. These findings suggested that dyslipidemia in SCD, specifically related to HDL-C levels, may be influenced by individual genetic background. Additionally, further investigation is needed to determine if clinical manifestations are impacted by CETP gene variants.