Role of Antihistamine in Allergic Disorders : A Review and Consensus Statements by Indian Medical Association

Background : 20-30% of the Indian population suffers from at least one allergic disease that can have an adverse impact on the quality of life of the patients. Aim : To develop expert opinion-related guidance for the diagnosis and management of allergic disorders. Methodology : An advisory board meeting (hybrid mode) was conducted with 11panel members of the Indian Medical Association (IMA). The panel members discussed issues related to the management of allergic disorders based on the Delphi method. Result : Spirometry is helpful in selected patients of allergic rhinitis where the coexistence of asthma is suspected. In patients with urticaria second-generation antihistamines are preferred for both adults and children due to their low side effects, less drug-drug interaction, anticholinergic effects, longer duration of action, and higher safety. Diagnosis of allergic contact dermatitis can be made based on occupational and exposure history. In atopic dermatitis, patient education about lifestyle changes can prevent flare-ups. In patients with asthma, patients must be educated about the use of the peak flow meter. The diagnosis of food allergy can be made by correlating the food intake timing withthe patient history and the results of allergy testing. Allergic drug reactions can be treated with oral antihistaminic drugs, emollients, and if needed topical corticosteroids. Conclusion : The diagnosis of allergic disorders requires the clinician to consider the clinical presentation, patient history, presence of triggers, and comorbid conditions. Patient education and the new generation of antihistaminic drugs can improve the quality of life of patients with allergic disorders

Monkeypox: What do we know so far? A short narrative review of literature

Objective: Exercise and physical activity are integral aspects for the effective management of diabetes. Unsupervised home exercise although very accessible is limited by poor adherence, risk of injury, and a higher dropout rate of participants. A fitness assessment by a qualified physiotherapist can help in understanding the baseline fitness of individuals and thus generating appropriate exercise prescriptions. The current study assesses the feasibility of video call-based fitness assessment for people with diabetes. The study also assesses the effect of current physical activity status and pain on performance in physical fitness tests. Methods: One hundred participants with type II diabetes (T2D) underwent 6-minute walk test (6MWT), 1-minute push-up test, wall sit test, 1-minute sit-up test, and V-sit and reach test for measuring different components of physical fitness such as aerobic capacity, upper body strength, lower body strength, core strength, and flexibility, respectively. The performance in physical fitness of participants was analyzed after the video consult along with pain complaints and current exercise status. Results: All the participants underwent the physical fitness test safely based on video call. Out of all the participants, a good range score was achieved by 52% in 6MWT, 17% in push-up test, 1% in wall sit test, 6% in sit-up test, and 9% in V-sit and reach test. Current physical activity status (aerobic exercise for minimum 20 minutes) did not show any association with performance in fitness tests (p = 0.89 for push-up test, p = 0.50 for wall sit test, p = 0.23 for sit-up test, and p = 0.10 for V-sit and reach test). Presence of upper body and lower body pain affected the performance in push-up test and wall sit test with 71.4% and 95.6% of participants achieving scores in poor to below-average range (p-value < 0.001). Conclusion: The study showed the safety and feasibility of conducting video call-based assessment of physical fitness by physiotherapists. The study also highlighted the poor glycemic control, high cardiovascular risk, and poor level of physical fitness in people with diabetes in India. Insights based on physical fitness, current physical activity status, and pain can help in developing personalized exercise plans for people with diabetes.

Community-acquired round Pneumonia in a 63-year-old Female

Round pneumonia is a radiological manifestation of pulmonary lesion. This is found as spherical or oval-shaped radio-opacity on chest X-ray. Round pneumonia has been reported in literature uncommonly. Round pneumonia was first time reported in the radiology literature in 1954 (Wagner et al., 1998). It was first recognized in children. In 1973, Rose and Ward reviewed 21 cases of round pneumonia in children. Radiological findings resembled pulmonary and mediastinal masses. Since then, time and again, round pneumonia has been reported in children; but, this is also found rarely in adults. There are many causes of round pneumonia in adults, for example, infectious and noninfectious. It may mimic pulmonary neoplasms due to its radiological appearance. Hence, the usual diagnostic challenge of round pneumonia is to differentiate pneumonia from bronchogenic carcinoma. Here we present an interesting case of round pneumonia in an adult female.

Clinical Spectrum of Tuberculosis

Being the second leading cause of mortality due to infectious diseases, the burden of tuberculosis is huge globally as well as in India. Therefore, timely diagnosis and treatment are essential to improve the clinical outcomes of the disease. It is therefore essential to create awareness and educate all concerned regarding the clinical spectrum of the disease which includes both pulmonary and extrapulmonary manifestations. Apart from typical systemic manifestations, depending on the organ affected infected patients may present with atypical signs and symptoms. The challenge is establishing definitive diagnosis in absence of discrete symptoms. Also, the EPTB generally are insidious in onset and diagnosis usually occurs in advanced stages. Therefore, a high index of suspicion is necessary particularly in absence of fever, weight loss and fatigue to avoid delay in diagnosis and thereby reduce risk of complications. It is worth mentioning that apart from high-risk individuals with HIV, chronic kidney failure, poor glycemic control, patients being treated with immunosuppressants, and both pediatric and geriatric populations who are immunocompromised, TB can be reactivated and EPTB can occur regardless of the individuals’ immune status. This review article elucidates different clinical presentations of patients with both pulmonary and extra-pulmonary TB which may facilitate early management even in settings with lack of advanced diagnostic evaluation or additionally offer a right direction to perform appropriate investigations

A Rare Cause of Breathlessness in a Patient on Hemodialysis

Background: The possibility of recurrence in COVID-19 is very rare and hence mostly underdiagnosed. In the face of pandemic, this can lead to circulation of the virus like a hidden iceberg. Better understanding about this topic can improve our knowledge of the COVID-19 pathogenesis and ways to control the transmission. Case presentation: A 41 year old male with no known comorbidities was admitted five times during a period of 7 months each time after being detected RTPCR positive for SARS-CoV-2 and more symptomatic than previously. He had no contact with other COVID-19 patients and was asymptomatic in between admissions. Despite this, he did not develop antibodies against SARS- CoV-2. Later on, he was diagnosed with thymoma on biopsy of the anterior mediastinal mass. Patient’s condition deteriorated on last hospitalization and he died, despite the treatment. Here we present an interesting report on multiple times recurrent COVID-19 infection, probably a case of reactivation and different plausible explanations on the role of thymoma. Conclusion: Acknowledging the potential of SARS-CoV-2 to cause recurrence is very important during the pandemic as a part of the long term transmission mitigation. The case report shows that previous infection does not guarantee complete immunity from COVID-19, especially in immuno-compromised patients. Hence, despite the status of prior infection, vulnerable individuals who recovered from COVID-19 should be under surveillance.

Biapenem

Biapenem is a novel parenteral broad spectrum carbapenem primarily used for the treatment of complicated infections like sepsis, lower respiratory infections, urinary tract infections, intra-abdominal and genitourinary infections etc. in Japan, Thailand and China since two decades, has been recently approved in India. Biapenem shows good bactericidal activity against Gram-positive bacteria including streptococcus pneumoniae, pyogenes and methicillin-susceptible staphylococcus aureus (MSSA). It also shows antibacterial activities against Gram-negative bacteria including resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Evidence from international studies confirmed that biapenem can be used as effectively and safely as meropenem or imipenem/ cilastatin in the treatment of various infectious diseases. This article summarizes the milestones, unique structure, mechanism of action, pharmacokinetics, special pharmacological properties and spectrum of in vitro activity of biapenem. The results of comparative clinical trials on Biapenem are also described, as is the patient safety and tolerability observed during these studies.