An epidemiological profile of chronic obstructive pulmonary disease: A community-based study in Delhi.

BACKGROUND: Different definitions used for chronic obstructive pulmonary disease (COPD) preclude getting reliable prevalence estimates. Study objective was to find the prevalence of COPD as per standard Global Initiative for Chronic Obstructive Lung Disease definition, risk factors associated, and treatment seeking in adults >30 years. METHODOLOGY: Community-based cross-sectional study was conducted in Delhi, among 1200 adults, selected by systematic random sampling. Pretested questionnaire was used to interview all subjects and screen for symptoms of COPD. Postbronchodilator spirometry was done to confirm COPD. STATISTICAL ANALYSIS: Adjusted odds ratio (aOR) was calculated by multivariable analysis to examine the association of risk factors with COPD. Receiver operating characteristic (ROC) curve was developed to assess predictability. RESULTS: The prevalence of COPD was 10.1% (95% confidence interval [CI] 8.5, 11.9%). Tobacco smoking was the strongest risk factor associated (aOR 9.48; 95% CI 4.22, 14.13) followed by environmental tobacco smoke (ETS), occupational exposure, age, and biomass fuel. Each pack-year of smoking increased 15% risk of COPD. Ex-smokers had 63% lesser risk compared to current smokers. Clinical allergy seems to preclude COPD (aOR 0.06; 95% CI 0.02, 0.37). ROC analysis showed 94.38% of the COPD variability can be assessed by this model (sensitivity 57.4%; positive predictive value 93.3%). Only 48% patients were on treatment. Treatment continuation was impeded by its cost. CONCLUSION: COPD prevalence in the region of Delhi, India, is high, and our case-finding population study identified a high rate of patients who were not on any treatment. Our study adds to creating awareness on the importance of smoking cessation, early diagnosis of COPD, and the need for regular treatment.

Allergic Rhinitis: A neglected disease - A community based assessment among adults in Delhi.

BACKGROUND AND OBJECTIVES: Allergic Rhinitis is rather erroneously viewed as a trivial disease. It is important in that it can significantly affect quality of life. There is paucity of community based prevalence studies on the disease in India. This study was planned to assess the prevalence of allergic rhinitis in adults, the proportion of asthmatics among them, risk factors associated and treatment seeking behaviour among the patients. MATERIALS AND METHODS: A community based cross sectional study was conducted in Mehrauli, South Delhi among 1200 adults, aged 30 years and over selected by systematic random sampling from two randomly selected wards. A pre-tested questionnaire was used to collect information regarding symptoms, risk factors and treatment seeking behaviour. Allergic Rhinitis was diagnosed as per ARIA guidelines. Spirometry was done to diagnose asthma among them. Multivariate logistic regression analysis was done to find the association of risk factors with disease. RESULTS: The prevalence of Allergic Rhinitis was found to be 11% (132 subjects) and 33.3% (44 patients) among them also had asthma. Overcrowding (aOR = 6.4), absence of cross-ventilation (aOR = 2.5), occupational exposure to dust/ smoke (aOR = 2.1), tobacco smoking (aOR = 2.1), family history of allergic diseases (aOR = 2.7) and clinical allergy (aOR = 10.2) were found to be independent risk factors associated with Rhinitis. More patients of Rhinitis with asthma (75%) took treatment, relative to those without asthma (40%) who, mostly relied on home remedies (42%) or, did not seek any treatment (18%) (P = 0.031). Interpretations and Conclusion: The burden of Allergic Rhinitis is high with a considerable overlap with asthma. These allergic diseases and emphasize the importance of early and regular treatment.

Modified Pauwels' intertrochanteric osteotomy in the management of nonunion of a femoral neck fracture following failed osteosynthesis.

We report the outcome of 39 patients who underwent a modified Pauwels' intertrochanteric osteotomy for nonunion of a femoral neck fracture following failed osteosynthesis. There were 31 men and eight women with a mean age of 47.2 years (34 to 59). By Pauwels' classification, there were 11 Type II fractures and 28 Type III fractures. The mean follow-up was 7.9 years (2 to 19). In the 11 patients whose initial treatment had been osteotomy, union was achieved in nine (81.8%). In 28 patients whose initial treatment had been with a lag screw or a dynamic hip screw, union was achieved in 27 (96.4%). Limb lengths were equalised in 14 of 16 patients (87.5%) with pre-operative shortening. The mean neck-shaft angle improved significantly from 100.5° (80° to 120°) to 131.6° (120° to 155°) (p = 0.004). The mean modified Harris hip score was 85.6 points (70 to 97) and the mean modified Merle d'Aubigné score was 14.3 (11 to 18). Good to excellent functional outcomes were achieved in 32 patients (88.8%). A modified Pauwels' intertrochanteric osteotomy is a reliable method of treating ununited fractures of the femoral neck following failed osteosynthesis: coxa vara and shortening can also simultaneously be addressed.

Adult proximal humerus locking plate for fixation of paediatric subtrochanteric fractures.

PURPOSE: The current study was done to evaluate the outcome of paediatric subtrochanteric fractures managed by adult proximal humerus locking plate (PHLP). METHODS: This prospective study included eight children (three females and five males) with femoral subtrochanteric fractures who met the inclusion criteria and underwent open reduction and internal fixation of the fracture with ipsilateral long adult PHLP. The mean age of the patients at the time of surgery was 13 years (range 10-16 years), and the mean follow-up was 32 months (range 18-48 months). Outcome at final follow-up was assessed using the Harris hip score. RESULTS: At the time of final follow-up, all fractures united at an average of 8.75 weeks (range 6-14 weeks). The average final Harris hip score was 80.25 (range 67-90). The only complain was prominent hardware in the proximal thigh, near the trochanteric ridge, which was present in two of our patients, and one of them opted for implant removal at 10 months. CONCLUSION: Internal fixation of paediatric subtrochanteric fractures using the proximal humeral locking plate of the ipsilateral side appears to be a good treatment option for the age group of 10-16 years, though comparative studies with a larger sample size are required to further support this observation.

Retroaortic left renal vein associated with unilateral superior renal polar artery: a clinico-embryological perspective.

The aim of the current study is to report an unusual occurrence of a retroaortic left renal vein in an adult male cadaver of Caucasian origin. This unusual variant was discovered during the course of preclinical educational training programme for undergraduate medical students. The vascular anomaly was dissected and the surrounding adnexa carefully studied for associated variations. Subsequently, morphometry was performed on the specimen to measure certain important parameters. The left renal vein was found to emerge from lower part of renal hilum and traversed posterior to abdominal aorta and finally terminated into Inferior vena cava. Additionally, the left renal artery was higher in position and originated from the abdominal aorta at the level of upper border of body of Ist lumbar vertebra. This type of anomaly is very important as it may be associated with varicocoele. Furthermore, in preoperative planning for nephrectomy, partial nephrectomy and living donor nephrectomy, the surgeons should keep in mind the possibility of this vascular anomaly. It is also stated that left renal vein appears to be at the centre of a huge venous network which makes the nephrectomy hazardous and permits the spread of infectious material and neoplasms.

Superficial brachial artery with its high division.

The upper extremity arterial system shows a large number of variations attributed to the complex and multiple sites of their embryonic development. It is important to be aware of arterial variations in this region because upper extremity is a frequent site of injury. Moreover, brachial artery is of significance in cardiac catheterization for angioplasty, pedicle flaps, or arterial grafting. Accurate knowledge and relationships of major arterial conduits and their variational patterns is important in reparative surgery in the arm, forearm and hand. One such variation is superficial brachial artery with prevalence rate of 0.2-25%. In this report, the brachial artery emanated normally but coursed superficial to the median nerve and about five cm above the intercondylar line, bifurcated into its terminal branches i.e. radial and ulnar artery.

Eosinophilic ascites. A rare presentation of eosinophilic gastroenteritis.

EGED is a rare entity; it should be kept in mind in patient of unexplained abdominal symptoms. Any age group and any part of GI tract can be involved. Eosinophillia may be absent in the peripheral smear and biopsy may be negative in up to 10% of the cases. Here we are reporting a 40 years old male who presented to us with eosinophilic ascites, a rare presentation of serosal variant of eosinophilic gastroenteritis (EGED).

Impact of tumor volume-directed involved field radiation therapy integrated in the management of recurrent ovarian cancer.

OBJECTIVES: Assess the role of involved field radiation therapy (IFRT) in recurrent ovarian cancer. METHODS: Thirty-five patients with a diagnosis of epithelial ovarian cancer received radiation therapy at LUMC between 1991 and 2001. Of these, 20 received tumor volume-directed IFRT for localized extraperitoneal recurrences (either as consolidation following debulking surgery or as attempted salvage if unresectable) and form the basis of this report. All patients were heavily pretreated with multiple chemotherapy regimens. Eleven patients had optimal debulking of their recurrences prior to radiation. IFRT was primarily with external beam (median dose 50.4 Gy). Appropriate statistical analyses evaluated association among disease-free (DFS), overall survival (OS), local recurrence-free (LRFS), and various prognostic factors. LRFS was defined as freedom from in-field recurrences and was considered as a measure of effectiveness of radiotherapy. RESULTS: Of 20 patients, 17 had a complete response after RT. The actuarial LRFS, OS, and DFS at 5 years from date of radiation were 66%, 34%, and 34%, respectively. The LRFS at 3 years was 89% for those with optimal resection vs. 42% for those with gross residual/unresectable tumor, which was significantly better (P = 0.04). The corresponding 3-year DFS was 72% vs. 22% and 5-year OS was 50% vs. 19%, respectively. Acute complication of RT was mild, half had Grade 1-2 gastrointestinal (GI) toxicity, three patients had Grade 3-4 late GI effects. CONCLUSION: IFRT is effective in controlling localized recurrences of ovarian cancer, especially after they are optimally debulked (89% local control and 50% 5-year overall survival in this subgroup), and is relatively well tolerated in these heavily pretreated patients.

HIV-1 infection is facilitated in T cells by decreasing p56lck protein tyrosine kinase activity.

Several studies have suggested an important role for the protein tyrosine kinase p56lck (Lck) in HIV infection; however, the exact nature of this role remains unclear. Using a series of well characterized Jurkat-derived cell lines having a wide range of Lck kinase activity, our results showed that, while the entry of HIV-1 into these cell lines was similar, the kinetics of virus production by these cells were very different. Cells expressing a kinase-inactive Lck showed accelerated viral replication, whereas, cells expressing Lck with normal or elevated enzymatic activity showed a delay in virus replication that was proportional to the initial level of endogenous Lck activity. The cell line having the highest initial Lck kinase activity showed the slowest rate of productive HIV-1 infection. Analysis of 2-LTR circles revealed that this inhibitory effect of Lck was not due to inhibition of reverse transcription of HIV-1 genome or migration of the proviral DNA into the nuclei. This affect of Lck was confirmed in additional studies that used either the S1T cell line lacking completely Lck or where the Lck activity was altered in Jurkat cells prior to infection. S1T cells showed a 3- to 12-fold increase in the level of infection compared to Jurkat cells despite similar CD4 and chemokine coreceptor expression and cell doubling times. Pretreatment of Jurkat with an antisense lck oligodeoxynucleotide inhibited the synthesis of functional Lck and facilitated the viral replication by the cells as did expressing a dominant-negative mutant Lck which increased the productive infection>3-fold. Conversely, whereas IL-16 had no affect on productive infection in S1T cells that lack Lck, IL-16 pretreatment of Jurkat cells resulted in an immediate (within 5 min) and sustained and gradual (over 5 h) increase in Lck activity that resulted in a reduction of HIV-1 replication that paralleled the increasing Lck kinase activity. These results show that the enzymatic activity of Lck kinase can affect viral replication, that a lack of, or decreased Lck activity facilitates viral replication. Conversely, Lck can mediate a delay in HIV-1 infection that is proportional to the initial endogenous Lck enzyme activity.

Intradermal augmentation with expanded polytetrafluoroethylene (Gore-Tex) for facial lines and wrinkles.

BACKGROUND: Many materials--from bovine and porcine collagen to autologous fat--have been used to augment tissue for wrinkle correction or to correct cosmetic defects. However, none of them has proved completely satisfactory because of host immune response or lack of staying power. OBJECTIVE: To describe the use of expanded tetrafluoroethylene (Gore Tex E-PTFE Soft Tissue Patch) in the correction of deep nasolabial folds, facial wrinkles, and lip contour irregularities. METHODS: The physicochemical and biological characteristics of Gore-Tex E-PTFE (inert material with highly porous structure) allow the penetration of cells and vessels with minimal inflammatory reaction. Small pieces of Gore-Tex patches or threads were inserted underneath the wrinkle to fill it out. To avoid the appearance of the thread's end through the needle puncture in the skin, the accordion technique of insertion was used. RESULTS: Expanded polytetrafluoroethylene has been used as a subdermal implant for the correction of deep nasolabial folds, facial wrinkles, and lip contour irregularities in 53 cases with satisfactory results. CONCLUSIONS: It is concluded that Gore-Tex E-PTFE is a new thread augmentation advance in the solution of facial skin irregularities that yields satisfactory and permanent results.

Cryptogenic hemoptysis: role of fiberoptic bronchoscopy.

Fiberoptic bronchoscopy (FOB) was performed for recurrent hemoptysis in 79 patients with normal chest roentgenograms. Seventy per cent were females with a mean age of 31.93 years. Normal findings were obtained in 60 patients. In 19 patients with abnormal findings on bronchoscopy underlying malignant disease was discovered in 3 patients following bronchoscopy. All these patients were elderly male smokers. In three patients unexplained left recurrent laryngeal nerve palsy was discovered. Thus, FOB as a diagnostic aid for cryptogenic hemoptysis is useful only in elderly male smokers.

[Cutaneo-mucous precancer, treatment using CO2 laser]. / Precáncer cutaneomucoso, tratamiento con láser de CO2.

It indicates the methodologic in work and study, that the compose 51 patients constituted for 20 cases with queratomas, 10 of cheilitis, 13 of leucoplasias and 8 of melanosis precancerous of Dubreuilh. Immediately, it described the fundamentals of the laser carbon dioxide its bases parametrica in the treatment especially for those pathologic precancerous of the skin and the results obtained, with its advantages and disadvantages.

Pulmonary aspergilloma--radiological observations.

The radiological appearances of 49 cases of aspergilloma seen over a period of 6 years among 36,340 hospital admissions are described. All the 49 patients had pulmonary tuberculosis as underlying disease with 6 (12.2%) having bacteriologically active disease. One patient had concomitant allergic bronchopulmonary aspergillosis (ABPA). Upper zone distribution, large cavity size, moderately thick cavity wall and overlying pleural thickening were some of the prominent features observed. Two cases of multiple (3 each) and 4 of bilateral aspergilloma were seen. Of 57 aspergillomas 47 were round or oval, 7 oblong, 2 polypoidal and 1 lobulated. Positional movement was observed in 30 cases. Spontaneous lysis was seen in one case. Tomography and lordotic view were found to be very useful techniques when postero-anterior films were unrevealing. The radiologic diagnosis of aspergilloma was confirmed by demonstration of serum precipitins against aspergilli in 44 cases.

Solitary uncommon pulmonary nodule in a child.

An eleven-year-old boy attended this hospital with complaints of low grade fever and dry cough of three months duration. There was no history of any prolonged illness in the past. Child had BCG and other immunisation at appropriate age. General physical examination, respiratory system, cardiovascular system and other systems revealed no abnormal findings.