Background: To assess and evaluate the incorrect use of inhalers in patients with asthma and chronic obstructive pulmonary disease (COPD) in the outpatient department of pulmonary medicine at RUHS college of medical sciences Jaipur, Rajasthan, India.Methods: Patients visiting the outpatient department of respiratory medicine were asked to demonstrate the inhaler technique and were assessed by the physician.Results: The study included 200 patients with Asthma or COPD. Among patients with COPD, 80 (63.4%) were males and 46 (36.5%) were females. In the asthma group, there were 50 (67.5%) females and 24 (32.4%) males. Patients with COPD were in the age group between 46-82 years with a mean age of 64 years while patients with asthma were in the age group between 18-70 years with a mean age of 44 years. Only 28 (14%) patients could perform all steps correctly in use of inhaler devices. 172 patients (86%) were unable to use inhalers properly. Most common error for metered dose inhalers (MDIs) was in step 7 that is (i.e.) not holding breath for 10 seconds which was seen in 46 patients (51.7%). The most common error seen for dry powder inhalers (DPIs) was in step 5 i.e. exhalation to residual volume before inhalation seen in 50 patients (47.1%).Conclusions: This study revealed that majority of patients use the inhaler devices incorrectly. Proper education regarding inhaler use is crucial for effective treatment with use of these inhaler devices.
Polyautoimmunity or multiple autoimmune syndrome (MAIS) is increasingly being recognized in pediatric clinical practice, often in conjunction with systemic lupus erythematosus (SLE). Besides multi-organ autoimmunity, children with SLE are often at a higher risk of developing infections including tuberculosis. The tendency to develop infections and multiple autoimmune diseases in childhood SLE often occurs in the absence of monogenic primary immunodeficiency disease. Conversely, children with inborn errors of immunity, of which selective IgA deficiency (sIgAD) is the most common, may develop recurrent infections and autoimmune disorders including SLE. Herein, we report a child with MAIS (including SLE) and sIgAD who developed drug-resistant tuberculosis, which was managed successfully with second-line antitubercular drug therapy. To the best of our knowledge, this combination of rare findings has not been reported previously in the pediatric literature. Although a majority of patients with sIgAD are either asymptomatic or have mild infections/autoimmunity, the index child had a myriad of infectious illnesses and multi-organ autoimmunity.Our case highlights the prudence of thoroughly evaluating children with SLE for other autoimmune diseases and vice versa. Given the higher probability of inherited disorders, including early complement deficiencies and monogenic interferonopathies, in childhood SLE compared with adult SLE, it may be prudent to perform a basic immunological workup (for example, immunoglobulin levels, 50% hemolytic complement) in such patients. A more extensive immunological and genetic evaluation (including next-generation sequencing) may also be required in the presence of unusual clinical or laboratory features, a positive family history, or a complicated clinical course.
Aluminium phosphide (ALP) is a common agrochemical pesticide poisoning with high mortality rate. Primary manifestations are due to myocardial and gastrointestinal involvement. Pleural effusion in ALP poisoning is occasionally reported. We report a case of pleural effusion that developed after ALP ingestion and resolved along with recovery from poisoning.
Allergic bronchopulmonary aspergillosis (ABPA) and tropical pulmonary eosinophilia (TPE) are common lung diseases presenting with peripheral blood eosinophilia. Although these have been widely reported both from India and outside, simultaneous co-occurrence of the two diseases has not been reported so far. We hereby present a case of an elderly male, a known case of asthma, who was diagnosed to have concurrent ABPA and TPE. Partial clinical response as well as the persistence of eosinophilia after ABPA treatment raised the suspicion that subsequently led to the diagnosis of TPE. The concurrent treatment of both conditions led to satisfactory clinical and serological improvement.
Introduction: Folates perform an integral task in DNA synthesis, methylationand repair. Methylenetetrahydrofolate Reductase (MTHFR) potrays a key part in the metabolism of folate and regulates the equilibrium between the various forms of folate for DNA synthesis and DNA methylation. MTHFR irrevocably transforms 5,10 methylenetetrahydrofolate to 5-methyltetrahydrofolate, the principal circulating folate and the carbon donor for remethylation processes. MTHFR is vastly polymorphic in the general population. Materials and Methods: It was a case-control study conducted during March 2010 to September 2011 in the Department of Pulmonary Medicine in collaboration with the Department of Biochemistry at Government Medical College and Hospital, Chandigarh, to see whether any association exists between the variants of one carbon metabolism, MTHFR polymorphisms (C677T and A1298C), and lung cancer. Twenty biopsy proven lung cancer patients and 20 age and sex matched cancer-free controls were selected. Results: The mean serum folate in cases was higher (12.84 ng/mL±7.527 ng/mL) as compared to controls (4.46 ng/mL±1.346 ng/mL), suggesting that high levels of serum folate are associated with lung cancer. There was no significant variance in the levels of vitamin B12 and plasma homocysteine between cases and controls. No MTHFR polymorphism C677T was seen in the blood and the bronchial biopsy samples of all cases as well as blood samples of all the controls. The MTHFR polymorphism A1298C was present in the blood as well as bronchial biopsy samples of cases as well as blood of controls. Thus, in the present study, there was no relation of this polymorphism with lung cancer. Conclusion: Polymorphisms in MTHFR may contribute to lung cancer. More research on the basis of cellular and molecular mechanisms of lung cancer is urgently needed to aid in understanding of pathogenesis of the disease.
Aim: This review intends to recapitulate the knowledge about pulmonary alveolar proteinosis (PAP) and insight into the advances in the pathogenesis and treatment of this condition.Background: A PAP is a seldom occurring disease with numerous possible etiologies. Review results:The disease has an insidious onset and the opinion is mostly delayed due to the fact that patients present late when there is abundant surfactant assimilation in alveoli to diminish gas exchange and cause dyspnea. An appropriate history, typical chest radiographic and high resolution computed tomography (HRCT) findings together with characteristic bronchoalveolar lavage (BAL) fluid help to elucidate the diagnosis in most cases. However, transbronchial lung biopsy (TBLB) or open lung biopsy may be rarely needed for dif ficult to diagnose cases. Treatment is needed for patients with symptomatic disease and whole lung lavage is the treatment of choice. Conclusion:A PAP is a rare disease entity with variable natural history. The clinical course varies from respiratory failure to spontaneous resolution.Clinical significance: This review will help to furnish an outline of the various aspects of this disease in light of fresh scientific advancements in the pathogenesis and treatment of this condition. Knowledge about the disease will serve to better define the role of alternative and new therapies for the same.
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