Evaluation of proficiency in using different inhaler devices among intern doctors.

CONTEXT: Doctors may have deficiencies in the ability to use different inhalers, which in turn, can result in improper technique by the patients and poorly controlled asthma and chronic obstructive pulmonary disease (COPD). AIMS: To evaluate intern doctors' proficiency in using various inhaler devices. MATERIALS AND METHODS: Seventy interns were evaluated for their proficiency in using pressurized metered dose inhaler (pMDI), pMDI with spacer, rotahaler, turbuhaler, and nebulizer. A structured assessment sheet was scored for identification and preparation of device, administration, coordination, and skill of explanation on a scale of 0-5. Common errors such as failure to shake pMDI before use, inability to identify the empty device, inadequate breath holding, and failure to advise gargles after use were recorded. RESULTS: pMDI and pMDI with spacer were identified correctly by 89% and 79% of interns. Over 90% could identify rotahaler and nebulizer whereas only 9% could identify turbuhaler. 79% and 60% could prepare pMDI and pMDI with spacer appropriately. Nebulizer preparation was performed correctly by 79% and almost all interns could not prepare turbuhaler. Only one intern administered turbuhaler correctly. About half of the participants knew the correct co-ordination for pMDI and pMDI with spacer. Two interns showed proper co-ordination in using turbuhaler. None could provide correct explanation for turbuhaler usage; whereas 76% and 70% did it for nebulizer and rotahaler, respectively. Only 43% of interns remembered to shake pMDI before use. CONCLUSIONS: Proficiency in using different inhaler devices amongst interns is poor. It is essential to provide adequate training for inhaler devices usage to medical graduates for proper management of asthma and COPD patients by those future primary care physicians and specialists.

Cannon ball appearance on radiology in a middle-aged diabetic female.

Pulmonary tuberculosis is commonly presented as cavitary lesion and infiltrations. It commonly involves upper lobe. Lower lobe involvement is less common. Various atypical presentations of tuberculosis on radiology are reported like mass, solitary nodule, multi lober involvement including lower lobes. Atypical presentations are more commo in patients with immunocompromised conditions like Diabetes Mellitus, anemia, renal failure, liver diseases, HIV infection, malignancy, patients on immunosuppressive therapy. Cannon ball presentation of pulmonary tuberculosis is extremely rare and not so common. Common causes of cannon ball presentation in lung are metastasis, fungal infections, Wegener's grannulomatosis, sarcoidosis, etc. We report here a case of middle year female with diabetes mellitus presented with atypical symptoms with cannon ball appearance on radiology and found to be of tuberculosis in origin. Thus any patients with immunocompromised condition can present with atypical manifestation of tuberculosis either clinically or radiologicaly in high endemic countries for tuberculosis.

Role of virtual and flexible bronchoscopy in the management of a case of unnoticed foreign body aspiration presented as nonresolving pneumonia in an adult female.

It is not so common to aspirate foreign body in normal adults without any predisposing factors as compared to children and those with the altered neurological state. Endobronchial foreign bodies are one of the causes of obstructive pneumonia and difficult to diagnose as signs and symptoms are often nonspecific. However, once they are diagnosed, they can generally be removed, leading to rapid and drastic resolution of symptoms. Bronchoscopy is the gold standard in the identification and localization of an airway foreign body and also for better management of the ailment. However with the help of virtual bronchoscopy one can decide the location of the foreign body before any invasive intervention and being noninvasive it can be performed in follow-up easily to check the patency of airways. It is not possible to detect the exact size of foreign body with the virtual bronchoscopy. In this article, we report a case of unnoticed foreign body aspiration in a 49-year-old female patient who was initially treated for pneumonia. However, due to nonresolution of opacity contrast enhanced computed tomography thorax with virtual and flexible bronchoscopy were performed, which revealed a foreign body in the right lower lobe bronchus that was removed with biopsy forceps in piecemeal. In her follow-up visit, she underwent virtual broncoscopy that revealed clear airways. Thus, detailed history and high index of suspicion is required for nonresolving pneumonias that may occur due to unnoticed foreign body/ies in an adult.

Isolated pulmonary hydatid cyst: Misinterpreted as metastatic pulmonary lesion in an operated case of carcinoma breast in young female.

Hydatidosis is caused by Echinococcus granulosus. Humans may be infected incidentally as intermediate host by the accidental consumption of soil, water, or food contaminated by fecal matter of an infected animal. Hydatidosis is one of the most symptomatic parasitic infections in various livestock - raising countries. Lung is the second most commonly affected organ following the liver. The symptoms depend on the size and site of the lesion. It can present as an asymptomatic pulmonary lesion to hemoptysis, chest pain, coughing anaphylaxis, and shock. There are very few reported cases of isolated lung hydatidosis without exposure to animals or nonvegetarian diet. For hydatidosis, serology and imaging are diagnostic tools. Surgical removal and/or chemotherapy are the main-stay of treatment. Here, we discuss a case of persistent left lower lobe cystic lesion in young female with a history of operated left breast carcinoma which was thought to be of metastatic lesion but ultimately confirmed as pulmonary hydatid cyst after unintended aspiration of cystic fluid to rule out malignancy. Pulmonary hydatidosis should always be considered as a differential diagnosis when dealing with a cystic lesion on radiology.

Is Alcohol an independent risk factor for Oro-Pharyngeal and Pulmonary Carcinogenesis - An Acetaldehyde concentrations based Double Blinded Randomized Control Trial.

BACKGROUND: There is increasing evidence that a major part of the tumour-promoting action of alcohol is mediated via its first, toxic and carcinogenic metabolite acetaldehyde. MATERIALS & METHODS: The double blinded randomized control trial was designed for 82 male volunteers aged 20-29 years. Exclusion criteria were individual under antibiotic therapy, smokers, mutant Aldehyde Dehydrogenase deficient subject or any other systemic disease. Subjects were randomized in experimental (alcohol + soft drink) and control group (soft drink) from each pair of equal body weighted volunteers. The amount of alcohol consumed was calculated to be equivalent to 0.7 g alcohol/kilogram of body weight. Samples of breath for Acetaldehyde concentration (AC) were captured with the aid of a highly reproducible fuel cell gas-sampling device (PST-M1; Lions Laboratories, Cardiff, Wales). In Statistical analysis, mean AC was compared among both groups at different interval using paired t-test and Analysis of variance. RESULTS: Mean acetaldehyde level was recorded higher ([Formula: see text]) among interventional group which can be produced from ethanol during metabolism or by oro-pharyngeal microbes. After 15 minutes of drink, the AC was [Formula: see text] in ethanol group compared to [Formula: see text] in soft-drink group. There was significant increase in AC after 1 hour ([Formula: see text]) which was [Formula: see text] in ethanol group compared to [Formula: see text] in soft-drink group. CONCLUSION: Although acetaldehyde is metabolite of alcohol, its organ specific production with risk for oro-pharyngeal and pulmonary carcinogenesis makes alcohol an independent risk factor of carcinogenesis. How to cite this article: Dagli RJ, Kulkarni S, Duraiswamy P, Dagli NR, Khara NV, Khara BN. Is Alcohol an independent risk factor for Oro-Pharyngeal and Pulmonary Carcinogenesis - An Acetaldehyde concentrations based Double Blinded Randomized Control Trial. J Int Oral Health 2013; 5(4):62-67.