Triple therapy (Long Acting Muscarinic Antagonist (LAMA), Long Acting β 2 Agonist (LABA), Inhaled Corticosteroid (ICS)) for Chronic Obstructive Pulmonary Disease (COPD) is available as single or separate inhalers. There is a dearth of studies in real-world scenario comparing them. Materials and Methods: We followed up 33 moderate to severe COPD patients each on single inhaler (Tiotropium-Formoterol-Ciclesonide) and two separate inhalers (Tiotropium; Formoterol-Budesonide) for triple therapy for a period of three months. We compared socio-demography, Test of Adherence to Inhalers (TAI) score, baseline and improvement in FEV1, FEV1/FEV, St George Respiratory Questionnaire score (SGRQ) and Euro Qol 5 Dimension Scale score (EQ-5D) by independent t-test or Mann Whitney U test. The change in each group was compared with their baseline by paired t-test or Wilcoxon Signed Rank test. Results: The groups were comparable at the baseline with respect to age, gender, smoking, FEV1/FEV, SGRQ, EQ-5D; TAI but, separate inhaler group was worser than single inhaler group with respect to baseline FEV1 (Severe COPD -61% Vs. 30%) and spacer use (70% Vs. 100%) (p<0.05). Each group improved significantly on FEV1, FEV1/FEV, SGRQ and EQ-5D (p<0.05). Improvement in the group on separate inhalers was significantly (p<0.05) higher compared to group on single inhaler for FEV1 (median 5% Vs. 1%), FEV1/FEV (median 0.04 Vs. 0.02), SGRQ (mean -50.1 Vs. -25.5) and EQ-5D (median -3 Vs.-1). Conclusion:Triple therapy improves patients by single or separate inhalers. Patients on separate inhalers had more improvement than patients on single inhaler without considering the confounding factors.
Calculous cholecystitis is the most common lesion of the gallbladder. Pain abdomen is the common clinical presentation.Calculous and acalculous cholecystitis are the most common indications for cholecystectomy. Gross and microscopic examination of the gall bladder indicates the outcome of the lesions. The various histological findings will reveal the type of the disease entity and prognosis. Retrospective study was done, total 120 cases of cholecystectomy specimens were received in pathology department. Formalin fixed specimens were analysed. After processing, H&E stained sections were studied.Chronic calculous cholecystitis is the most common non-neoplastic lesion. calculous cholecystitis(92 cases), acalculous cholecystitis (21 cases), follicular cholecystitis (4 cases), empyema gallbladder (1 case), xanthogranulomatous cholecystitis (1 case), eosinophilic cholecystitis (1 case). Among premalignant lesions, cholecystitis with metaplasia was seen in 40 (33.3%) cases. Pyloric metaplasia (25 cases), Intestinalmetaplasia (15 cases). Chronic calculous cholecystitis was the most common lesion. Histopathological evaluation plays an important role in identifying the metaplastic, dysplastic and incidental carcinoma of the gallbladder. .
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