Deciphering molecular regulation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) signalling networks in Oryza genus amid environmental stress.

The Oryza genus, containing Oryza sativa L., is quintessential to sustain global food security. This genus has a lot of sophisticated molecular mechanisms to cope with environmental stress, particularly during vulnerable stages like flowering. Recent studies have found key involvements and genetic modifications that increase resilience to stress, including exogenous application of melatonin, allantoin, and trehalose as well as OsSAPK3 and OsAAI1 in the genetic realm. Due to climate change and anthropogenic reasons, there is a rise in sea level which raises a concern of salinity stress. It is tackled through osmotic adjustment and ion homeostasis, mediated by genes like P5CS, P5CR, GSH1, GSH2, and SPS, and ion transporters like NHX, NKT, and SKC, respectively. Oxidative damage is reduced by a complex action of antioxidants, scavenging RONS. A complex action of genes mediates cold stress with studies highlighting the roles of OsWRKY71, microRNA2871b, OsDOF1, and OsICE1. There is a need to research the mechanism of action of proteins like OsRbohA in ROS control and the action of regulatory genes in stress response. This is highly relevant due to the changing climate which will raise a lot of environmental changes that will adversely affect production and global food security if certain countermeasures are not taken. Overall, this study aims to unravel the molecular intricacies of ROS and RNS signaling networks in Oryza plants under stress conditions, with the ultimate goal of informing strategies for enhancing stress tolerance and crop performance in this important agricultural genus.

Viewpoint on tuberculosis in elderly in India.

With increase in the number of the elderly population in India, the number of patients suffering from tuberculosis has shown an increased prevalence in the elderly. In many of them, the condition is linked to the reactivation of the lesions that were dormant. Immunosenescence appears to play an important role in activating the lesions. The clinical features are often non-specific and pose difficulties in the diagnosis. Radiological changes in the chest, though are suggestive, the microbiological proof is difficult. Though effective drugs are available, often they tolerate them poorly. There is poor adherence to the therapy leading to therapeutic failure. Co morbidities and physical dependency contribute to failure of therapy.

Indian Guidelines on Nebulization Therapy.

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper.

BACKGROUND: Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations. OBJECTIVE: The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India. METHODS: In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India. RESULTS: Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents. CONCLUSION: The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings.

Recent advances in the assessment and management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by an abnormal inflammatory reaction of the airways and lung parenchyma. It stems from chronic tobacco smoking, and indoor air pollution, and bronchospasm is the predominant cause of the symptoms. The condition is the result of environmental insult and host reaction that is likely to be genetically predetermined. Chronic obstructive pulmonary disease exhibits expiratory airflow limitation due to abnormalities in the airways and/or lung parenchyma. The disease begins with an asymptomatic phase and onset of the symptomatic phase develops with a fall in forced expiratory volume in one second (FEV1) below 70% of the predicted value. There is reduction in diffusing capacity, hypoxaemia and alveolar hypoventilation. However, it is intriguing why only a fraction of smokers develop clinically relevant COPD.

Alpha1-antitrypsin deficiency with diffuse bronchiectasis and cirrhosis of the liver.

The medical literature has emphasized repeatedly the association of alpha1-antitrypsin deficiency with panacinar emphysema and cirrhosis of the liver. Previous reports have linked bronchiectasis with alpha1-antitrypsin deficiency. The present case confirms this association and adds the presence of an hepatic abnormality characteristics of alpha1-antitrypsin deficiency to complete the syndrome. The patient's phenotype was found to be MDuarteZ. It has been suggested that patients with diffuse bronchiectasis should be screened for alpha1-antitrypsin deficiency. We would add that a complete assessment of hepatic function, including liver biopsy, should be carried out in those individuals with reduced levels of alpha1-antitrypsin.

Split-course radiation therapy: effects on pulmonary function in patients with bronchogenic carcinoma.

Pulmonary function studies were made in 15 patients with unresectable bronchogenic carcinoma treated by split-course megavoltage radiation. Forced vital capacity and forced respiratory volume per second were measured before starting each of the first and second phases of the split-course therapy, and at 2 weeks and 12 weeks after completion of treatment. Improvement in ventilatory functions was noted in more than half of the patients. Adverse effects on lung function appeared to be minimal.

Bronchogenic carcinoma associated with chronic lymphatic leukemia.

This report pertains to the development of bronchogenic carcinoma in 4 elderly patients with chronic lymphatic leukemia. The abnormal radiologic shadows in the lung (confined to the upper lobes and hili) were noted 30-60 months after recognition of the hematologic abnormality. Spread to ipsilateral or contralateral lymph nodes was common. After the appearance of lung carcinoma, the patient's course was downhill, with an average survival period of 2 months. The development of a new pulmonary lesion in any patient with chronic lymphatic leukemia should arouse the suspicion of malignancy and lead to prompt investigation.

Laryngeal carcinoma with synchronous or metachronous bronchogenic carcinoma.

Primary carcinoma of the lung may accompany or follow primary carcinoma of the larynx. This relationship was noted in 2 patients in whom the tumors occurred synchronously, and in 3 in whom they occurred metachronously. The lung cancer with bronchopulmonary symptoms in the synchronous group, and with an abnormal radiographic shadow (1 to 5 years after treatment for laryngeal carcinoma) in the metachronous group. The lung growth (squamous-cell carcinoma) was confined to the upper lobes. The patients were all heavy cigarette smokers. The epithelium of the entire respiratory tract seems susceptible to malignant change. Patients who have undergone treatment for laryngeal carcinoma should be followed by periodic radiologic examination, as they are at greater risk for the development of a new malignant lesion in the lung. Moreover, patients with bronchogenic carcinoma require routine laryngoscopic examination to discover or rule out any coexistent primary growth in the larynx.

Synchronous dual primary lung carcinomas.

Synchronous dual primary lung carcinomas were found in 8 of 482 patients with lung cancer, an incidence of 1.6 percent. Of the 8 cases, 7 were unilateral and one bilateral. Three showed dissimilar histologic patterns occurring in combinations of squamous-cell carcinoma and adenocarcinoma. In 5 cases, two separate tumors were noted with identical histologic patterns in combinations of squamous-cell, giant-cell, large-cell, adeno-. and undifferentiated carcinoma. The patients were heavy smokers and this possibly may have been a factor in the development of carcinoma at more than one site.

Ventilation corrected oxygen tension in lethal pulmonary embolism.

Lethal pulmonary embolism is associated with hypoxemia and hypocapnia in the vast majority of cases. The easily calculated ventilation corrected oxygen tension was a very sensitive test in patients breathing air. It yielded no normals, four percent mild hypoxemia, and 96 percent moderate to extreme hypoxemia. The alveolar-arterial oxygen tension difference and oxygen ratio were equally sensitive during air breathing. During oxygen inhalation, alveolar-arterial oxygen difference was most sensitive; oxygen ratio was second best; and oxygen saturation was the least sensitive test.

Legionnaires' disease with severe hypoxemia and saddleback fever.

In the case of Legionnaires' disease described, severe respiratory problems necessitated mechanical ventilatory support, tracheal intubation, and positive end-expiratory pressure. Fever was eliminated with erythromycin therapy but returned after five days, and lung infiltrates spread. After supplementary treatment with other antibiotics and methylprednisolone sodium succinate, both the fever and the infiltrates disappeared. We feel that the multisystem involvement and the recrudescence of fever in our patient emphasize the wide spectrum of characteristics of Legionnaires' disease and the importance of continuation of antibiotics for a prolonged period to eradicate infection.

Transient diabetes following chicken pox.

The paper describes two individuals presenting with acute insulin dependent diabetes mellitus for a brief and transient period. Both had had chicken pox infection in the immediate past. After establishing good diabetic control, insulin was withdrawn over a few weeks. Follow-up for the next two years did not reveal recurrence of diabetes. A causal relation between varicella zoster virus and the onset of diabetes is suggested.