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1.
J Assoc Physicians India ; 72(6S): 25-29, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38932732

RESUMEN

Dehydration, often unnoticed, can occur in adults due to heat-related illnesses, viral infections, and upper respiratory tract infections, leading to deficits in fluids, electrolytes, and energy (FEE), even without diarrhea. This fluid deficit, in turn, impairs immunity at cellular and molecular levels. Physiologically, the immune system rapidly reacts to threats by adjusting its structural permeability, allowing water and small solutes to be passed, facilitated by proteins like aquaporins (AQPs). These AQPs are also essential for immune cell communication and adjustments of the cytoskeleton for functions like chemotaxis and phagocytosis. Apart from hydration, maintaining an optimal intake of essential micronutrients, including vitamins C and E, copper, zinc, and selenium, is also critical for supporting immune function and acting as antioxidants. Transient alterations in immune function caused by acute stressors or nondiarrheal conditions heighten vulnerability to coexisting illnesses, particularly cold and upper respiratory tract infections, while also elevating the likelihood of recurrent health issues. Supplementing fluids with known FEE content according to quality standards and enhanced taste is recommended during acute illness and until complete recovery. Thus, dehydration, caused by various acute conditions, can impair immunity and delay recovery. Prioritizing hydration and nutrition in healthcare and general settings is imperative, even when diarrhea is absent.


Asunto(s)
Deshidratación , Micronutrientes , Humanos , Fluidoterapia/métodos
2.
J Assoc Physicians India ; 72(3): 66-72, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38736120

RESUMEN

Antibiotics are the magic bullets that have saved millions worldwide. Enormous and irresponsible use of antibiotics has led to resistance to antibiotics, which is a matter of global health concern. The superbugs are responsible for life-threatening infections, treatment failure, and high mortality worldwide. The urgent healthcare threat caused by antimicrobial resistance (AMR) to nonfermenting gram-negative bacteria is being increasingly acknowledged worldwide. Antibiotic resistance found in organisms in hospital settings is now increasingly found in the community. Although antimicrobial stewardship requiring a multidisciplinary approach is developing rapidly at the hospital level, it needs more attention at the community level. New therapeutics are certainly required, but the major challenge is rapidly identifying resistant infections and tailoring treatment. This review highlights the crisis that reflects the current scenario of AMR, common resistant pathogens, and the major challenges in the fight against AMR. It also discusses potential methods and strategies to address the intricacies of antibiotic resistance.


Asunto(s)
Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Humanos , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Pandemias , Salud Global , Farmacorresistencia Bacteriana
3.
J Assoc Physicians India ; 72(5): e1-e16, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38881114

RESUMEN

Lung cancer (LC) has the highest rate of disability-adjusted life years (DALY) of all cancers in India. A large majority of patients with LC present with advanced disease, resulting in poor survival rates. Early diagnosis can improve survival outcomes as the patients can be treated with curative intent. The National Lung Screening Trial (NLST), in 53,454 persons at high risk for LC in the US, showed a 20% (95% confidence interval of 6.8-26.7; p = 0.004) relative reduction in LC-specific mortality in the patients screened with low-dose computed tomography (LDCT) compared with chest X-ray. To date, India does not have a formal LC screening (LCS) program. As a panel of experts, we reviewed a synthesis of a targeted literature search on the burden of LC, the current status of diagnosis of LC, barriers to early diagnosis, current referral pathways, LC risk patterns, use of artificial intelligence (AI) and risk calculators for risk assessment, and a multidisciplinary team (MDT) approach to diagnosis LC. We used the existing international LCS guidelines, data from published literature, and clinical experience to depict the characteristics of the population at risk of LC in India-young age (<40 years), smoking, especially the predominance of bidi smoking (an indigenous form of tobacco smoking), exposure to biomass fuel smoke, especially in rural women, and air pollution being the prominent features. LC in India is characterized by a higher rate of driver mutations and adenocarcinomatous histology. Here, we present the expert opinion on risk-based LCS in India and discuss the challenges, facilitators, and research priorities for the effective rollout of LCS in India.


Asunto(s)
Detección Precoz del Cáncer , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , India/epidemiología , Detección Precoz del Cáncer/métodos , Tomografía Computarizada por Rayos X/métodos , Femenino
4.
J Assoc Physicians India ; 72(7): 68-72, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38990590

RESUMEN

The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications. Key diagnostic investigations for edema include complete blood count, cardiovascular imaging and markers, deep vein thrombosis (DVT) assessment, along with renal, hepatic, and thyroid function tests. Edema management involves a combination of pharmacologic and nonpharmacologic interventions, including limb elevation, physiotherapy, compression therapy, fluid removal, diuretics (loop diuretics: first-line therapy), and a sodium-restricted diet. The panel believed that educating patients could foster a preventive mindset, helping to prevent the worsening of edema.


Asunto(s)
Edema , Humanos , Edema/terapia , Edema/diagnóstico , Edema/etiología , India
5.
J Assoc Physicians India ; 71(11): 11-12, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38720489

RESUMEN

Herpes zoster, commonly known as shingles, is a viral infection caused by the reactivation of the varicella-zoster virus (VZV). After primary infection with VZV, which causes chickenpox, the virus remains dormant in the sensory ganglia. However, it can reactivate later in life, leading to the development of shingles. Shingles typically presents as a painful, unilateral, and vesicular rash along the distribution of sensory nerves. The condition can be associated with significant morbidity, including severe pain, postherpetic neuralgia (PHN), and other complications. In this editorial, we will delve into the global and Indian burden of herpes zoster, explore its complications, highlight the importance of prevention, shed light on the Shingrix vaccine, discuss its composition, and present the research on safety and efficacy, including the ZOE-50 and ZOE-70 studies. Furthermore, we will review the recommendations on the Shingrix vaccine by leading global medical societies, including the esteemed Association of Physicians of India (API). How to cite this article: Vora A, Tiwaskar M. Unveiling the Uncertainties: Exploring the Utility of Herpes Zoster Vaccines. J Assoc Physicians India 2023;71(11):11-12.


Asunto(s)
Vacuna contra el Herpes Zóster , Herpes Zóster , Humanos , Herpes Zóster/prevención & control , India , Neuralgia Posherpética/prevención & control
6.
J Assoc Physicians India ; 71(7): 11-12, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37449696

RESUMEN

It is crucial to prevent and manage intensive care unit (ICU) distress caused by a pentad of pain, agitation, delirium, immobility, and sleep disturbance (PADIS) to optimize immediate and longterm recovery and outcomes of critically ill patients. This clinical practice guideline provides an update on the prevention, management, and liberation of PADIS in adult ICU patients using an integrated, evidence-based, multidisciplinary ICU protocol: the ABCDEF bundle. ABCDEF bundle incorporates assessment, prevention, and management of pain; both spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT); choice of sedation and analgesia; delirium: assessment, prevention and management, and early mobility and exercise; family involvement and empowerment (ABCDEF) together as a PADIS care bundle. This is a multidimensional ICU liberation bundle which is a patient-oriented, holistic team approach to the management of critically ill patients aimed at reducing ICU distress and immediate and long-lasting consequences of PADIS.


Asunto(s)
Cuidados Críticos , Delirio , Adulto , Humanos , Cuidados Críticos/métodos , Enfermedad Crítica/terapia , Unidades de Cuidados Intensivos , Dolor , Delirio/prevención & control , Delirio/tratamiento farmacológico , Sueño
7.
J Assoc Physicians India ; 71(11): 58-61, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38720498

RESUMEN

Allergic rhinitis (AR) is considered a trivial disease and is often self-treated with over-the-counter drugs and home remedies. However, AR is a contributing risk factor for asthma associated with complications, including chronic cough, eosinophilic esophagitis, and otitis media with effusion. In AR, inflammation is primarily mediated by histamines. Guidelines advise using second-generation oral H1 antihistamines as the primary treatment for AR. Second-generation H1 antihistamines strongly prefer the H1 receptor, limiting their ability to enter the central nervous system. Thus, they have minimal adverse effects. Among these H1 antihistamines, bilastine is highly specific for H1 receptors with a slight affinity for other receptors. It has a rapid and prolonged action, which reduces the need for frequent dosing and has better compliance. In the long term, bilastine is well-tolerated with minimal adverse effects. It is not associated with drug interactions, so dosage adjustment is unnecessary. Bilastine does not penetrate the brain and is nonsedating at 80 mg once daily. The low possibility of drug-drug interactions and pharmacokinetics of bilastine makes it suitable for elderly patients, even with compromised hepatic and renal function, without dose adjustment. This review comprehensively discusses the guidelines and the role of bilastine in treating AR. How to cite this article: Tiwaskar M, Vora A, Tewary K, et al. Role of Bilastine in Allergic Rhinitis: A Narrative Review. J Assoc Physicians India 2023;71(11):58-61.


Asunto(s)
Piperidinas , Rinitis Alérgica , Humanos , Rinitis Alérgica/tratamiento farmacológico , Piperidinas/uso terapéutico , Piperidinas/farmacocinética , Bencimidazoles/uso terapéutico , Bencimidazoles/farmacocinética , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/farmacocinética , Antagonistas de los Receptores Histamínicos H1/administración & dosificación
8.
J Assoc Physicians India ; 71(6): 11-12, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37355845

RESUMEN

BACKGROUND: Cough has a prevalence of 9.6% globally and 5-10% in India. Though it is a reflex action, it affects an individual's quality of life (QoL) when uncontrolled. There was a need to create an integrated guidance document on managing cough focused on primary care physicians in the Indian setting. This consensus intends to bridge this gap by providing clinical recommendations to diagnose and manage cough in primary healthcare in India. MATERIALS AND METHODS: The modified Delphi method was used to arrive at a consensus on clinical statements. The panel comprised 10 experts, including pulmonologists, otolaryngologists, a pediatrician, and a general physician. The statements were discussed under the following domains: definition, etiology, diagnosis, and treatment. RESULTS: A total of 109 clinical statements were framed, with 75 reaching consensus, 13 reaching near consensus, and 21 reaching no consensus. The experts recommended empiric use of nonopioid antitussive agents for symptomatic relief of acute dry cough. The use of oral antihistamines, oral decongestants, or mucoactive agents as a part of fixed-dose combinations (FDCs) in cough associated with rhinitis or upper airway cough syndrome (UACS) can be considered for symptomatic relief. Maintaining good hydration is important to manage a productive cough. Codeine-based preparations are to be considered as a last resort in patients with an unexplained chronic cough when other treatments have failed. Additionally, insights were captured on red flag signs, nonpharmacologic therapy, special populations, and referral to higher centers. Experts have also proposed a management algorithm with an integrated care pathway approach for acute, subacute, and chronic coughs. CONCLUSION: The present consensus fills the existing need and may guide the physician to successfully diagnose and manage cough in the primary healthcare setting in India.


Asunto(s)
Tos , Calidad de Vida , Humanos , Tos/diagnóstico , Tos/etiología , Tos/terapia , Antagonistas de los Receptores Histamínicos/uso terapéutico , Enfermedad Crónica , Atención Primaria de Salud
9.
J Assoc Physicians India ; 70(6): 11-12, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35702848

RESUMEN

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.


Asunto(s)
Carcinoma Broncogénico , Infecciones Comunitarias Adquiridas , Neoplasias Pulmonares , Neumonía , Adulto , Carcinoma Broncogénico/diagnóstico , Niño , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Persona de Mediana Edad , Neumonía/diagnóstico por imagen
10.
J Assoc Physicians India ; 70(1): 11-12, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35062817

RESUMEN

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.


Asunto(s)
Carbapenémicos , Tienamicinas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Humanos , Meropenem , Pruebas de Sensibilidad Microbiana
11.
J Assoc Physicians India ; 70(7): 11-12, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35833402

RESUMEN

Monkeypox was a zoonotic infection, first detected in parts of northern Africa in the 1970s. Monkeypoxvirus, the causative agent of monkeypox, is a species of genus Orthopoxvirus and is closely related to long-eradicated smallpox caused by variola virus. Outbreaks in the West (in USA, UK, and Ireland) along with periodic re-emergence of the disease in parts of Africa have generated concern among global health bodies due to the existent deficiency of guidelines for management of the disease. Genetic variations and altered mechanisms favoring better survival of the virus have made early identification of the disease during screening difficult, particularly in resource-limited settings like rural areas of Africa. Through evidences gathered from experimental studies conducted after these outbreaks, the virus is known to be transmitted from several animal reservoirs along with human-to-human contact of blood, body fluids, or aerosol. Early diagnosis through immunoassays and polymerase chain reaction (PCR) tests, although not very specific, allows early treatment and subsequently better patient survival and recovery. Presence of lymphadenopathy along with fever, sore throat, and a vesiculopustular rash is diagnostic. The virus affects the gastrointestinal, hematological, ocular, and respiratory systems, in like manner producing afflictions of the specific system. Treatment, through experimental data, has been preferred to be symptomatic, with the aim to prevent superinfections. Antivirals like cidofovir and tecovirimat have been studied upon and used in clinical trials with favorable outcomes. Antiviral immunoglobulins have also been used with success in certain patients for postexposure prophylaxis.


Asunto(s)
Mpox , Animales , Cidofovir , Brotes de Enfermedades , Humanos , Mpox/diagnóstico , Mpox/tratamiento farmacológico , Mpox/epidemiología , Monkeypox virus/genética , Zoonosis/epidemiología
12.
J Assoc Physicians India ; 70(2): 11-12, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35436829

RESUMEN

Patients suffering from end stage renal disease (ESRD) often present to the emergency with breathlessness, mostly due to fluid overload. We report a rare case of recurrent unilateral massive pleural effusion in an ESRD patient on maintenance hemodialysis (MHD). The patient was on MHD thrice weekly for the last 2 years with right internal jugular vein (IJV) tunneled cuffed catheter (TCC). Chylothorax was identified as the cause of recurrent pleural effusion which was due to superior vena cava stenosis (SVCO). It was managed successfully by balloon venoplasty of SVC and anticoagulation. SVCO is a rare but a serious complication in patients on long term indwelling dialysis catheters. Physicians involved in the care of dialysis patients must be aware about complications of long term dialysis catheters like central vein stenosis. A strong suspicion of chylothorax should be reserved for a patient with recurrent unilateral pleural effusion and long term dialysis catheters.


Asunto(s)
Cateterismo Venoso Central , Quilotórax , Fallo Renal Crónico , Derrame Pleural , Cateterismo Venoso Central/efectos adversos , Quilotórax/etiología , Quilotórax/terapia , Constricción Patológica , Disnea/etiología , Femenino , Humanos , Venas Yugulares , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Derrame Pleural/etiología , Derrame Pleural/terapia , Diálisis Renal/efectos adversos , Vena Cava Superior
13.
J Assoc Physicians India ; 69(12): 11-12, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35057598

RESUMEN

Apart from the individual diseases, some patients also show overlapping manifestations of asthma and COPD. Nevertheless, the diagnosis of COPD is often delayed due to inaccessibility to spirometry; the prevalence of the asthma COPD overlap phenotype is rather high given the exposure to biomass smoke. Furthermore, the rates of exacerbations are twice as high compared to the patients with either of the diseases. A treatment strategy that would reduce the risk of exacerbations would contribute immensely to the management of such patients. Evidence of eosinophilia (marker of inflammation) in patients with asthma, asthma COPD overlap phenotype or COPD alone should prompt treatment with a combination of inhaled corticosteroids (ICS)/ long-acting ß-agonists (LABA); several studies have shown improvement in the airflow limitation and reduction in the rate of exacerbations with salmeterol-fluticasone combination (SFC). Considering the association of COPD and cardiovascular diseases (CVD), it is critical to determine the cardiovascular safety of the LABA in such patients. Salmeterol is a highly selective partial b-2 agonist; the TORCH study and the studies comparing formoterol and salmeterol infer that there is no increased risk of new cardiovascular adverse events either with Salmeterol or SFC. Furthermore, the combination may provide certain degree of cardio-protection. Since COPD per se increases the risk of CVD, the cardio-safety of salmeterol outweighs its onset of action. SFC has well substantiated benefits in patients with asthma, COPD and high-risk patients such as those with an overlap of COPD and asthma symptoms, patients with elevated eosinophils and pre-existing CVD. An advisory board was hence conducted, which discussed the role of combination of salmeterol and fluticasone (SFC) not only in asthma and COPD but also in asthma COPD overlap phenotype. Based on the panel's clinical experience and the expertise derived thereof, the propositions regarding the place of SFC therapy in patients with stable and uncontrolled asthma, asthma COPD overlap phenotype and COPD has been put forth.


Asunto(s)
Asma , Enfermedad Pulmonar Obstructiva Crónica , Asma/tratamiento farmacológico , Fluticasona , Combinación Fluticasona-Salmeterol , Humanos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Xinafoato de Salmeterol/uso terapéutico
14.
J Assoc Physicians India ; 69(12): 11-12, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35057603

RESUMEN

Coronavirus disease 2019 (COVID-19) is a highly hypercoagulable viral infection complicated as COVID-inflicted coagulopathy (CIC), that is associated with increased risk of morbidity and mortality. International guidelines recommend low molecular weight heparin (LMWH) to treat CIC in both in-hospital and in-home settings. However, in India, using subcutaneous LMWH may not be a feasible option for a vast majority of patients under home management. Additionally, while some evidence advocates the use of novel oral anticoagulants (NOACs), in hospitalized settings, most guidelines find no role of NOACs in hospital settings. On the other hand, the resource crunch faced in recent COVID-19 pandemic in India forced physicians to treat many patients in home settings. These patients had been usually prescribed NOACs for ease of administration and adherence. Therefore, there is a need to form a consensus on the use of NOACs to manage CIC in India.


Asunto(s)
COVID-19 , Heparina de Bajo-Peso-Molecular , Administración Oral , Anticoagulantes/uso terapéutico , Consenso , Humanos , India/epidemiología , Pandemias , SARS-CoV-2
15.
J Assoc Physicians India ; 69(4): 11-12, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34470194

RESUMEN

For decades, short acting beta agonists (SABAs) have been prescribed for giving symptomatic relief to asthmatics. However, this symptomatic benefit perceived by the patient leads to the overuse and dependency of the patient to the SABA inhaler and underusage of the inhaled corticosteroid (ICS) containing controller inhalers resulting in destabilizing disease control and increased risk of exacerbations. In order to address this issue, the 2019 update of the Global Initiative for Asthma (GINA) strategy document no longer recommends the use of SABA inhalers as the preferred reliever for asthma due to concerns around poor outcomes and safety. Instead, it strongly supports the use of a combined ICS-fast acting beta agonist as a reliever also termed as an Anti-inflammatory Reliever Therapy (AIR). In this review we discuss the extent of SABA overusage and its impact on asthma outcomes, the resultant change in the recommendations in the GINA document and finally the evidence supporting the use of formoterol- budesonide as AIR therapy.


Asunto(s)
Antiasmáticos , Asma , Administración por Inhalación , Corticoesteroides , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Budesonida/uso terapéutico , Combinación de Medicamentos , Etanolaminas/uso terapéutico , Fumarato de Formoterol/uso terapéutico , Humanos , Nebulizadores y Vaporizadores
16.
J Assoc Physicians India ; 69(9): 11-12, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34585893

RESUMEN

Acute undifferentiated febrile illnesses (AUFIs) are associated with specific characterizations like fever of less than two weeks' duration with no organ-specific symptoms at onset. These range from mild and self-limiting disease to progressive, life-threatening illness. Acute undifferentiated febrile illnesses are classified into malaria and non-malarial illnesses on the basis of microscopy or malariadiagnostic tests. Various challenges, such as comorbidities, geriatrics, pregnancy, and immune-compromised profile of the patient, impede the treatment regimen. Identifying the root cause of undifferentiated fever becomes critical and involves correct diagnostic tests along with empirical treatment initiation. Doxycycline, being a broad-spectrum antibiotic, confers activity against many Gram-positive, Gram-negative, and "atypical" bacteria. Apart from antimicrobial activity, Doxycycline demonstrates the potential to inhibit dengue virus replication and exhibits anti-inflammatory activity by down-regulating proinflammatory cytokine levels. As coronavirus disease 2019 (COVID-19) spreads, the clinical management of associated cytokine storm remains unanswered. Considering the probable beneficial effect of doxycycline, it has been recommended by the national and international experts for the empirical management of COVID-19.


Asunto(s)
COVID-19 , Malaria , Pruebas Diagnósticas de Rutina , Fiebre/etiología , Humanos , Malaria/diagnóstico , Malaria/tratamiento farmacológico , SARS-CoV-2
17.
J Assoc Physicians India ; 69(9): 11-12, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34585899

RESUMEN

India has a disproportionately high burden of acute and chronic pulmonary diseases. In India, 65 million suffer from non-communicable respiratory diseases. The outbreak of the novel coronavirus disease 2019 (COVID-19) had worsened the situation. Patients affected with COVID-19 with a previous history of comorbidities, such as COPD and chronic lung diseases, had the worst prognosis, resulting in adverse outcomes, such as acute respiratory distress syndrome (ARDS) and pneumonia. Immune modulation strategies have since gained a lot of traction amongst practitioners. Modulation of the immune system with Pidotimod along with standard-of-care (SOC) treatment has proven efficacious in the past two decades in patients with recurrent respiratory tract infections (RRTIs), bronchitis, COPD, and pneumonia. In this article, we have reviewed the current unmet needs in the management of COPD in India and evaluated the usage of Pidotimod in adult COPD patients based on expert panel discussion.


Asunto(s)
COVID-19 , Enfermedad Pulmonar Obstructiva Crónica , Adulto , Testimonio de Experto , Humanos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Ácido Pirrolidona Carboxílico/análogos & derivados , SARS-CoV-2 , Tiazolidinas
18.
J Assoc Physicians India ; 68(8): 82-88, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32738847

RESUMEN

Epidemiologically the burden of asthma in India is alarming with a median prevalence of 7%. As the symptoms of asthma ascend the severity ladder, the prediction of the cause of asthma is important from the treatment point of view. The GINA 2020 states that the management of asthma should be individualized as per the patient depending on patient phenotype. The goal of asthma treatment is to achieve good control of symptoms, to reduce exacerbations and to improve quality of life. Guidelines recommend adapting the level of treatment to the level of disease severity, and this approach has been demonstrated to be effective in the majority of asthma patients overall. However, it is known that a small but significant proportion of patients do not achieve adequate control despite optimized treatment, and these patients are frequently prescribed high doses of oral steroids in an attempt to achieve control. For patients with severe uncontrolled asthma, monoclonal antibodies (mAbs) against IgE or IL-5 are available as add-on treatments to inhaled corticosteroid (ICS) plus long-acting ß2-agonist (LABA) therapy. With a plethora of available modalities, the fact still remains that there is a large treatment gap and the number of people living with asthma in India is predicted to be around 30 million. This article reviews the phenotypes/endotypes of asthma described in India and the current therapies for management.


Asunto(s)
Antiasmáticos/uso terapéutico , Asma , Administración por Inhalación , Corticoesteroides , Quimioterapia Combinada , Humanos , India , Calidad de Vida
19.
J Assoc Physicians India ; 72(6S): 6, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38932729
20.
J Assoc Physicians India ; 65(9): 100-104, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29313589

RESUMEN

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in under-developing and developing countries. As per current estimations, COPD will become the third leading cause of death globally, by 2030. Long-acting anti-cholinergic agents, ß2-agonists, inhaled corticosteroids, antibiotics and mucolytics are few of the agents currently used in the treatment of COPD, which improve the symptoms and overall quality of life. Several of the important classes of antibiotics are used in the management of COPD including penicillins, cephalosporins, tetracyclines, fluoroquinolones, sulphonamides, aminoglycosides and macrolides. Macrolide antibiotics such as erythromycin, clarithromycin and azithromycin have a variety of physiological activities other than their antimicrobial effects, ultimately helping in preventing exacerbations and reducing mortality rates. Clinical studies indicate that long term use of clarithromycin is effective in the treatment of COPD exacerbations with lower incidence of adverse effects. This descriptive review on the role of the clarithromycin in treatment of COPD exacerbations will highlight these properties of clarithromycin in detail.


Asunto(s)
Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Antibacterianos/farmacología , Claritromicina/farmacología , Humanos
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