Pulmonary Manifestations in Patients of Rheumatoid Arthritis and its Correlation with Severity of Disease

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by symmetric, peripheral polyarthritis. RA has a prevalence of 1–2% in the general adult population. The mortality rate in patients with RA increases during the course of the disease, with a tendency to accelerate after 15 years. Aim: To study the pulmonary manifestations and their severity using [Disease Activity Score (DAS)—28 score] in patients of RA. Materials and methods: Present study was conducted in the Department of Medicine, Sardar Patel Medical College and Associated Group of Hospitals Bikaner, Bikaner, Rajasthan, India, on 100 patients. This study was a cross-sectional, observational study conducted over 1 year. Consecutive cases of RA patients attending the outpatient department or admitted to the medicine wards were selected according to the inclusion and exclusion criteria. Results: Pulmonary manifestation was present in a total of 38% of cases, while the remaining 62% of cases had no pulmonary manifestation. The presence of comorbidity and C-reactive protein (CRP) was significantly associated with pulmonary manifestation in RA patients. On high-resolution computed tomography (HRCT), the most common finding was interstitial lung disease (ILD) (60.5%), with usual interstitial pneumonia (UIP) as the most common pattern. On performing a pulmonary function test (PFT), 33 patients (86.84%) had an abnormal result, with restrictive as the most common pattern. Conclusion: The patients of RA, especially those with advanced age, long duration of disease, male sex, and associated comorbidity, should be screened for pulmonary complications of RA using X-ray chest and PFT, supplemented by HRCT chest wherever required.

To Compare the Effect of Dexmedetomidine and Clonidine as Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Background and Aim: Alpha-2 agonists as adjuvant to local anaesthetic agents for PNB enhance the quality and duration of analgesia. Aim of this prospective, double blind, randomised placebo controlled study was to compare the affect addition of Dexmedetomidine and clonidine to Ropivacaine with respect to onset, peak, and duration of sensory-motor block and duration of analgesia in Supraclavicular brachial plexus block. Materials and methods: Ninety ASA grade I or II patients of either sex, aged 18-60 years age scheduled for elective upper limb surgery were equally divided in three groups (n=30).Group R received 0.75% Ropivacaine 30 ml + 1ml NS, Group RC received 0.75% Ropivacaine 30ml +1µgm/kg of clonidine, Group RD received 0.75% Ropivacaine 30ml + 1µgm/kg of Dexmedetomidine in Supraclavicular plexus block by using nerve locator. Ashish Kumar Narolia, Kanta Bhati, Kuldeep Saini, Anita Pareek, Meera Kumari. To Compare the Effect of Dexmedetomidine and Clonidine as Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery. IAIM, 2017; 4(9): 82-90. Page 83 Results: Onset (sensory=7.6± 1.56, 6.13± 1.59, 4.13±1.35, in motor 10.23± 1.79, 9.03± 2.31, 6.50± 1.57 respectively), peak(sensory 17.33±2.89, 13.66±3.16, 10.63 ±2.89, in motor 21.76±2.56, 18.46±3.0, 15.66±3.20 respectively) and duration(sensory 239.83±39.96, 322.0±58.21, 375.0±53.69, in motor 206.0±40.71, 285.0±56.30, 332.50±57.84 respectively) of sensorimotor block and duration of analgesia (279.0±43.67, 357.16±55.85, 412.16±50.06 respectively)were prolonged in Dexmedetomidine group as compared to other both group. VAS and sedation score was better in dexmedetomidine group than clonidine group. Hemodynamic stability was comparable in all three groups and no complications were seen in any of the group. Conclusion: Dexmedetomidine (1µg/kg) is better than clonidine as adjuvant to 0.75% Ropivacaine in supraclavicular brachial plexus block for upper limb surgeries.

Obstructing mass lesion of epiglottis: it can be tubercular.

We report a case of 60-year old male who had difficulty in breathing as well as in swallowing. On examination, he was found to be having proliferative growth of epiglottis and right aryepiglottic fold mimicking neoplasm. So emergency tracheostomy was performed and biopsy taken. He was found to be having asymptomatic miliary mottling on routine x-ray chest PA view. Further on HRCT, it turned out to be lesion suggesting tubercular etiology. Histopathology (epiglottic biopsy) report confirmed the whole process as tubercular. The patient recovered promptly in due course with anti-tubercular treatment. Point remains to be seen that if we can avoid tracheostomy and its complications in such cases.