Real-world evaluation of the clinical safety and efficacy of fluticasone/formoterol FDC via the Revolizer® in patients with persistent asthma in India.

The combination of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs) is widely used for the management of asthma. This prospective, open-label, non-comparative, observational, 24-week multicentre study is the first real-world study from India to compare the efficacy and safety of fixed-dose combination of fluticasone/formoterol (Maxiflo® 100/6 mcg or 250/6 mcg) capsules via the Revolizer® device in patients with persistent asthma. The primary efficacy analyses included mean change in Asthma Control Test (ACT™) at 4, 8, 16 and 24 weeks. Secondary efficacy analyses included mean change in morning and evening peak expiratory flow rate (PEFR) at the end of 4, 8, 16 and 24 weeks, number of patients having symptom-free days and nights at the end of 4, 8, 16 and 24 weeks, the number and severity of exacerbations over 24 weeks and response to the Usability Preference Satisfaction Confidence questionnaire after 1 week. Overall, 385 (of 401; 96.01%) enrolled patients completed the study. The mean change in ACT™ score was 6.7 ± 3.71 (95% CI: 6.32, 7.06; p < 0.0001) at week 24. The ACT™ score at weeks 4, 8 and 16 showed progressive and statistically significant increase from baseline. A statistically significant improvement in morning and evening PEFR at weeks 4, 8, 16 and 24 was reported. The proportion of patients experiencing symptom-free days and nights continuously increased from baseline to week 24. A good safety profile over the 24-week period was observed. The Revolizer® device was preferred by 94.26% patients over their current device. Fluticasone propionate/formoterol fumarate FDC capsules administered via a single-dose dry powder inhaler ([DPI], (Revolizer®) offers a novel, well-tolerated and effective treatment option for the long-term management of asthma.

Evaluation of Efficacy of Curcumin as an Add-on therapy in Patients of Bronchial Asthma.

BACKGROUND: Bronchial asthma being a chronic inflammatory disease of airways has numerous treatment options none of which have disease modifying properties. Curcumin, a yellow dietary pigment has varied pharmacological activities, prominent among which is an anti-inflammatory activity which may be crucial in bronchial asthma as has been proved by various in vitro and in vivo animal studies. AIMS: To determine the efficacy and safety of curcumin as an 'add-on' therapy in patients of bronchial asthma. SETTINGS AND DESIGN: This study was conducted on 77 patients of mild to moderate Bronchial asthma who had a documented positive bronchodilator reversibility test with ≥15% improvement in forced expiratory volume one second (FEV1). MATERIALS AND METHODS: Seventy seven patients were recruited for the study and randomized into either of the two groups, but 17 patients were lost to follow up. Thus Group A - Receiving standard therapy for bronchial asthma for 30d (n=30) and Group B - Receiving standard therapy for bronchial asthma + Cap Curcumin 500mg BD daily for 30d (n=30). The predefined primary endpoints were clinical assessments of dyspnoea, wheezing, cough, chest tightness and nocturnal symptoms, change in the pre-bronchodilator FEV1 during the treatment and hematological improvement. The secondary end points were assessed by the change in the post-bronchodilator FEV1, C-reactive protein (CRP) concentration and incidence of adverse events. STATISTICAL ANALYSIS USED: The data was analysed by SPSS 17.0 software using one-way ANOVA or Paired t-test. RESULTS AND CONCLUSION: The results showed that curcumin capsules help in improving the airway obstruction which was evident by significant improvement in the mean FEV1 values. There was also significant improvement in the hematological parameters and absence of any clinically significant adverse events indicates dependable safety profile of curcumin capsules, though there was no apparent clinical efficacy. Therefore, it is concluded that curcumin is effective and safe as an add-on therapy for the treatment of bronchial asthma.

Clinical profile of severe malaria: study from a tertiary care center in north India.

One hundred and sixty patients having clinical features of severe malaria reported during monsoon season-August-October 2010 at this tertiary care center of north India. Of these 110 (68.75 %) had Plasmodium vivax infection, 30 (18.75 %) were infected with P. falciparum and 20 (12.5 %) had co-infection due to P. vivax and P. falciparum. The diagnosis was made using Rapid Card Test and was confirmed by peripheral smear examination of thick and thin films. Several complications such as acute kidney injury, jaundice, severe anemia, metabolic acidosis, shock, hyperpyrexia, hypoglycemia, generalized tonic-clonic convulsions etc. were found to be more prevalent in patients with P. vivax infection. These symptoms were until recently known to be associated with falciparum malaria.

Comparative study of processing of haemorrhagic body fluids by using different techniques.

BACKGROUND: Haemorrhagic fluids are samples which are commonly received for cytological examination. The diagnostic efficacy suffers when large numbers of red blood cells are present in the sample. Haemorrhagic fluids are processed by a variety of techniques and the common goal of each technique is selection and concentration of an adequate number of tumour cells with intact cell morphologies, without losing them during processing. AIM: Present study was undertaken to improve the quality of haemorrhagic fluid by using three different haemolysing agents, namely Carnoy's Fixative (CF), saline in Normal Saline Rehydration Technique (NSRT) and Glacial Acetic Acid (GAA) for haemolysis and to find out the most effective processing technique for better cytomorphological assessment. MATERIAL AND METHODS: This study was carried out on 51 haemorrhagic fluids. Processing of haemorrhagic fluid was done by using haemolysing agents, namely CF, GAA and NSRT. After processing fluids with these three techniques, three smears were prepared from each of them, out of which one was air dried and two were wet fixed. Fourth type of smear made without application of haemolysing agent was used as control.The smears were stained with Leishman's stain and wet fixed smears were stained with Hematoxylin and Eosin (H and E) , and Papanicolou's stain (Pap) respectively. RESULTS: NSRT showed lysis of red blood cells (RBCs) in 72.5% of cases, followed by that of CF in 60.8% cases and that of GAA in only 3.9% of cases. Retention of epithelial/mesothelial cells was seen in 70.5% cases with NSRT, followed by that of CF in 57.8% of cases and then by that of GAA in 50.9% of cases. Cytomorphological details were best preserved in CF in 60.6% of cases, followed by GAA in 58.8% of cases and NSRT in 52.9% of cases. CONCLUSION: The most effective method for RBC lysis in smear background and cell retention is NSRT and cytomorphological details are best preserved with CF. But, considering the overall results and procedural simplicity, it was concluded that NSRT was a better technique for processing of haemorrhagic fluid.

A case of Staphylococcus toxic shock syndrome presenting with multiple pneumatocoeles in the chest.

Staphylococcus toxic shock syndrome is a severe illness caused by infection with toxin producing Staphylococcus aureus and is associated with a poor outcome. We report a case of Staphylococcus TSS presenting with cough and expectoration along with multiple pneumatoceles visible on the chest radiograph that progressed to acute respiratory distress syndrome with eventual foci in brain. The patient was aggressively managed and recovered completely.

Influenza a infection unmasking an underlying mitral valve stenosis in a 19-year-old boy.

Infection with Influenza virus is uncommon in the present times, though a number of cases were reported during pandemics in 1918 in various regions of America. We report a case where a young male patient presented to the hospital with a clinical picture of acute respiratory distress syndrome that turned out to be a viral pneumonia caused by Influenza A virus and it aggravated an underlying yet undiagnosed mitral valve stenosis.