Evidence-Based Approach of Biologic Therapy in Bronchial Asthma.

The emergence of biologic agents in the treatment of bronchial asthma has a wide impact on improving quality of life, reducing morbidity, and overall health care utilization. These therapies usually work by targeting specific inflammatory pathways involving type 2 inflammation and are particularly effective in severe eosinophilic asthma. Various randomized controlled trials have shown their effectiveness by reducing exacerbation rates and decreasing required glucocorticoid dosages. One of the relatively newer agents, tezepelumab, targets thymic stromal lymphoprotein and has proven its efficacy in patients independent of asthma phenotype and serum biomarker levels. This article reviews the pathophysiologic mechanism behind biologic therapy and offers an evidence-based discussion related to the indication, benefits, and adverse effects of such therapies.

Immune Thrombocytopenic Purpura Secondary to Sarcoidosis.

Sarcoidosis is a systemic granulomatous disease involving multiple organs with predominantly pulmonary manifestations. Severe thrombocytopenia is a relatively rare hematologic manifestation of sarcoidosis. Immune thrombocytopenia is usually characterized by excessive antibody production leading to platelet destruction. There are a few reported cases of immune thrombocytopenic purpura secondary to sarcoidosis, but the pathophysiologic mechanism remains unknown. We report the case of a 65-year-old woman who presented severe thrombocytopenia and was found to have immune thrombocytopenic purpura secondary to sarcoidosis.

Evidence-Based Mechanical Ventilatory Strategies in ARDS.

Acute respiratory distress syndrome (ARDS) remains one of the leading causes of morbidity and mortality in critically ill patients despite advancements in the field. Mechanical ventilatory strategies are a vital component of ARDS management to prevent secondary lung injury and improve patient outcomes. Multiple strategies including utilization of low tidal volumes, targeting low plateau pressures to minimize barotrauma, using low FiO2 (fraction of inspired oxygen) to prevent injury related to oxygen free radicals, optimization of positive end expiratory pressure (PEEP) to maintain or improve lung recruitment, and utilization of prone ventilation have been shown to decrease morbidity and mortality. The role of other mechanical ventilatory strategies like non-invasive ventilation, recruitment maneuvers, esophageal pressure monitoring, determination of optimal PEEP, and appropriate patient selection for extracorporeal support is not clear. In this article, we review evidence-based mechanical ventilatory strategies and ventilatory adjuncts for ARDS.

Elderly Onset Sarcoidosis: A Case Report.

Sarcoidosis is a multi-organ autoimmune disease that affects females more than males. While primarily considered as a disease of the young, very few cases of sarcoidosis have been reported in patients over 65 years old. We report the case of sarcoidosis in an 80-year-old female and ultimately died from sarcoidosis-related complications. We review the literature and highlight key differences in elderly onset sarcoidosis when compared to the general population. We also advise physicians to have a high index of suspicion for sarcoidosis in the elderly who present with hypercalcemia and abnormal findings on chest imaging.

Ciprofloxacin-Induced Reaction Imitating a Lupus Flare: A Case Report.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect almost any organ in the body. It usually runs a chronic course with systemic inflammation, and age at diagnosis varies from 15 to 44 years. Laboratory reports often show high anti-nuclear antibody (ANA) levels, increased anti-double-stranded deoxyribonucleic acid (anti-dsDNA) levels, and low complement levels. 'Lupus flare' is a term used for an acute exacerbation of previously existing SLE. It usually manifests as an acute worsening of clinical signs and symptoms, along with an abrupt change in typical laboratory values. Triggers for a lupus flare include viral or bacterial infections, acute stress, and various environmental factors such as ultraviolet (UV) light. Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic used for various bacterial infections. On rare occasions, ciprofloxacin can cause adverse effects in the body, which may resemble an acute flare of SLE symptoms in patients with previously controlled disease. We have presented such a case of ciprofloxacin-induced reactions mimicking a lupus flare in an SLE patient.

Quality Of Educational Environment At Wah Medical College: Assessment By Using Dundee Ready Educational Environment Measure.

BACKGROUND: Educational environment not only has an impact on the students during the academic years but has its reflections throughout their medical career. The Dundee Ready Educational Environment Measure (DREEM) is an internationally accepted useful tool to analyse undergraduate educational environments in the health professionals. The purpose of this study was to assess how students, across all the five years in a private medical college, perceive their educational environment. METHODS: It was a cross sectional study, which used the DREEM inventory at Wah Medical College over the course of 6 months (January-June 2015). All 500 students were included in the study. The fifty items DREEM inventory, having the maximum score of two hundred indicating ideal educational environment was used for data collection. RESULTS: The questionnaire was completed by 400 undergraduate medical students (response rate 80%). The overall DREEM score was 122.63/200 (61.3%), indicating that the perception of the learning environment was more positive than negative. Among the highest scoring categories were students' participation in classes, relaxed atmosphere and confidence in passing the annual exams. However, many areas requiring improvement were also brought to attention. CONCLUSIONS: Overall, the student's perception of their learning environment at Wah Medical College was found to be positive. This study did bring to light some areas that could be improved upon. This should enable the faculty to adopt changes in their teaching methods to make the learning process more productive and enjoyable for future students.