Public health informatics in India: The potential and the challenges.

Public health informatics is emerging as a new and distinct specialty area in the global scenario within the broader discipline of health informatics. The potential role of informatics in reducing health disparities in underserved populations has been identified by a number of reports from all over the world. The article discusses the scope, the limitations, and future perspective of this novice discipline in context to India. It also highlights information and technology related tools namely Geographical Information Systems, Telemedicine and Electronic Medical Record/Electronic Health Record. India needs to leverage its "technology" oriented growth until now (e.g., few satellite-based telemedicine projects, etc.) simultaneously toward development of "information"-based public health informatics systems in future. Under the rapidly evolving scenario of global public health, the future of the public health governance and population health in India would depend upon building and integrating the comprehensive and responsive domain of public health informatics.

A clinical trial of the efficacy and safety of montelukast as monotherapy in patients with chronic stable bronchial asthma.

This study is aimed to evaluate the efficacy and safety of montelukast, as monotherapy, in the treatment of chronic stable bronchial asthma in adults. This was a multicentre, open label, non-comparative, prospective, 4-week study. Eligible patients discontinued all anti-inflammatory medication (steroids, chromoglycate sodium) 2 weeks prior to starting therapy with montelukast (10 mg daily). The primary efficacy criteria were improvements in forced expiratory volume in one second (FEV1), peak exploratory flow rate (PEFR) after 4 weeks of therapy. Secondary efficacy criteria were improvement in the patients' symptoms (assessed on an ordinal scale), decrease in discomfort levels (scored on a scale of 0-100), change in peripheral eosinophil counts, decrease in total daily dose of inhaled beta2 agonist (salbutamol). A total of 148 patients, mean age (+/- SD) 40.21 +/- 13.70 years, were enrolled into the study. At the end of the study there were significant improvements in FEV1 and PEFR (29% and 28% increase respectively from baseline values, p<0.000001). The mean total daily dose of inhaled salbutamol decreased significantly from prestudy values of 461 +/- 332 microg/day to 161 +/- 207 microg/day (p<0.000001). The mean eosinophil counts fell from 5.80 +/- 4.90% (+/- SD) to 4.84 +/- 4.42% (+/- SD) (p=0.02). Symptom scores improved significantly as did subjective assessment of discomfort. A total of 29 (19.6%) adverse events were reported, all of which were of mild to moderate intensity. Monotherapy with montelukast significantly improved parameters of asthma control. It was well tolerated with no reports of serious or severe adverse events.

A multicentric study to evaluate efficacy and safety of cefetamet pivoxyl in lower respiratory tract infections in Indian patients.

This multicentric, open label, non-comparative study was designed to evaluate the extended spectrum of third generation oral cephalosporin, cefetamet pivoxyl in the treatment of patients with lower respiratory tract infections. This study was conducted among 111 patients with clinical, radiological and bacteriological findings consistent with the diagnosis. After obtaining written informed consent, patients were given cefetamet 500 mg tablet twice a day for 7 days. Cefetamet consistently decreased all clinical signs and symptoms at post-therapy visit. All the treated patients were either cured or improved. Cefetamet was well tolerated with a low incidence of drug related adverse events. The findings of this study indicate that cefetamet pivoxyl was well tolerated and is suitable option for the treatment of patients with lower respiratory tract infection.

Clinical and pathological profile of 73 patients with lung carcinoma: is the picture changing?

OBJECTIVE: A prospective study was undertaken to study the clinical features and pathological cell type of primary lung carcinoma in our institute. METHODS: Seventy three patients were included in the study over a period of three years. These were investigated according to a study protocol which included a detailed history regarding the onset and progress of the disease, smoking habits, x-ray chest, computed tomography of the chest and upper abdomen, and flexible bronchoscopy with brushings and biopsy. RESULTS AND CONCLUSIONS: 32.85% of patients were non-smokers. The male-female ratio was 4.2:1. Male sex, age > 50 years and history of smoking are still a risk factor for lung carcinoma. Tobacco smoking of 20 pack-years or more is significantly associated with the incidence of squamous cell carcinoma compared to other cell types. Adenocarcinoma (28.8%) was the most common cell type observed. It was also the most common cell type in central location (32.8%). Adenocarcinoma was the most common cell type diagnosis amongst females (50%) and non-smokers (43.5%). Computed tomography done in 47 patients diagnosed additional eleven patients with rib or vertebral metastases in addition to the three diagnosed by chest roentgenology. Computed tomography diagnosed significant mediastinal lymphadenopathy in 16 patients in whom mediastinal lymphadenopathy was not suspected on chest roentgenology. Computed tomography confirmed liver metastases in four patients diagnosed by ultrasonography and additionally in three more patients. Bronchial brushing cytology yielded positive results in 51.72% of central tumours and 40% in peripheral tumors. Yield of endobronchial biopsy was 59% and transbronchial biopsy was sixty percent. At presentation 74.1% patients with non-small cell carcinoma were inoperable and in case of small cell carcinoma 75% had extensive disease. Fiberoptic bronchoscopy with brushings and biopsy, and computed tomography of the chest and upper abdomen are useful investigations in the diagnosis of lung carcinoma.

Bronchoalveolar lavage (BAL) in newly diagnosed patients with collagen vascular diseases.

Collagen vascular diseases (CVD) are commonly associated with interstitial lung diseases. Bronchoalveolar lavage (BAL) fluid analysis has important diagnostic value when considered in conjunction with other information. The present study was undertaken in newly diagnosed patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) at presentation to characterise BAL cellular constituents and elucidate the cellular picture in patients with and without pulmonary symptoms and in those with and without radiological (high resolution computed tomography) features of interstitial lung disease. All the patients were non-smokers and had not received any form of treatment for their diseases. The means of percentages of lymphocytes, neutrophils, and macrophages were 23.3%, 6.2%, 70.5% respectively. There was a significant BAL lymphocyte predominance in patients with pulmonary symptoms, and a lymphocyte and neutrophil predominance in those having radiological evidence of interstitial lung disease.

Approach to aerosol therapy in management of asthma at primary care level.

Present day management of bronchial asthma focuses on use of inhaled drugs. To find out the acceptability of aerosol therapy at primary care level, a questionnaire survey was conducted on practical acceptance of aerosol therapy in management of asthma. Seven clinically relevant questions were asked regarding management modalities followed in bronchial asthma. Amongst the group of general practitioners (n = 60) studied, it was found that in treatment of chronic stable asthma inhaled steroids are used by only 50% and inhaled bronchodilators by 86.7%, whereas 93.3% use oral bronchodilators and 60% use oral steroids to treat the same. During exacerbation injectable bronchodilators are preferred to inhaled drugs. Poor compliance to aerosol therapy was reported by 33.3%. Reasons for non-compliance are discussed, important ones are cost and technique. Spacer was reported to be useful by 20% and lung functions are carried out occasionally by only 5% of practitioners.