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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- S K Katiyar
- Department of Tuberculosis & Respiratory Diseases, G.S.V.M. Medical College & C.S.J.M. University, Kanpur, Uttar Pradesh, India.
| | - S N Gaur
- Vallabhbhai Patel Chest Institute, University of Delhi, Respiratory Medicine, School of Medical Sciences and Research, Sharda University, Greater NOIDA, Uttar Pradesh, India
| | - R N Solanki
- Department of Tuberculosis & Chest Diseases, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Raj Kumar
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, National Centre of Allergy, Asthma & Immunology; University of Delhi, Delhi, India
| | - G C Khilnani
- PSRI Institute of Pulmonary, Critical Care, & Sleep Medicine, PSRI Hospital, Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rupak Singla
- Department of Tuberculosis & Respiratory Diseases, National Institute of Tuberculosis & Respiratory Diseases (formerly L.R.S. Institute), Delhi, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Ashok A Mahashur
- Department of Respiratory Medicine, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - A G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - D Behera
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | | - H Paramesh
- Paediatric Pulmonologist & Environmentalist, Lakeside Hospital & Education Trust, Bengaluru, Karnataka, India
| | - K B Gupta
- Department of Tuberculosis & Respiratory Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India
| | - Mohan Kumar T
- Department of Pulmonary, Critical Care & Sleep Medicine, One Care Medical Centre, Coimbatore, Tamil Nadu, India
| | - P D Motiani
- Department of Pulmonary Diseases, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - P S Shankar
- SCEO, KBN Hospital, Kalaburagi, Karnataka, India
| | - Rajesh Chawla
- Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine & Sleep Disorders, AIIMS, New Delhi, India
| | - S K Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Luhadia
- Department of Tuberculosis and Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - V K Arora
- Indian Journal of Tuberculosis, Santosh University, NCR Delhi, National Institute of TB & Respiratory Diseases Delhi, India; JIPMER, Puducherry, India
| | - V K Vijayan
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, University of Delhi, Delhi, India
| | - Abhishek Faye
- Centre for Lung and Sleep Disorders, Nagpur, Maharashtra, India
| | | | - Amit K Murar
- Respiratory Medicine, Cronus Multi-Specialty Hospital, New Delhi, India
| | - Anand Jaiswal
- Respiratory & Sleep Medicine, Medanta Medicity, Gurugram, Haryana, India
| | - Arunachalam M
- All India Institute of Medical Sciences, New Delhi, India
| | - A K Janmeja
- Department of Respiratory Medicine, Government Medical College, Chandigarh, India
| | - Brijesh Prajapat
- Pulmonary and Critical Care Medicine, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - C Ravindran
- Department of TB & Chest, Government Medical College, Kozhikode, Kerala, India
| | - Debajyoti Bhattacharyya
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, Army Hospital (Research & Referral), New Delhi, India
| | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Centre for Research and Treatment of Allergy, Asthma & Bronchitis, Department of Chest Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Lalit Singh
- Department of Respiratory Medicine, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - M K Sen
- Department of Respiratory Medicine, ESIC Medical College, NIT Faridabad, Haryana, India; Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra K Bainara
- Department of Pulmonary Medicine, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi PostGraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nilkanth T Awad
- Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Naveed N Shah
- Department of Pulmonary Medicine, Chest Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, PSRI, New Delhi, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pawan Tiwari
- School of Excellence in Pulmonary Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - R Narasimhan
- Department of EBUS and Bronchial Thermoplasty Services at Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Vijai Kumar
- Department of Pulmonary Medicine, MediCiti Medical College, Hyderabad, Telangana, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi and U.P. Rural Institute of Medical Sciences & Research, Safai, Uttar Pradesh, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care, Sleep Medicine and Interventional Pulmonology, Getwell Hospital & Research Institute, Nagpur, Maharashtra, India
| | - Rakesh K Chawla
- Department of, Respiratory Medicine, Critical Care, Sleep & Interventional Pulmonology, Saroj Super Speciality Hospital, Jaipur Golden Hospital, Rajiv Gandhi Cancer Hospital, Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - S Chakrabarti
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Surya Kant
- Department of Respiratory (Pulmonary) Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Centre for Visceral Mechanisms, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virendra Singh
- Mahavir Jaipuria Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Vishal Chopra
- Department of Chest & Tuberculosis, Government Medical College, Patiala, Punjab, India
| | - Visweswaran B
- Interventional Pulmonology, Yashoda Hospitals, Hyderabad, Telangana, India
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Rohil V, Vijayan VK, Kumar R, Joshi R, Pavani P, Paul S, Sharma A, Rahman MU. A study on the correlation of matrix metalloproteinase MMP1 in COPD and smoking in the North Indian population. Asian J Med Sci 2017. [DOI: 10.3126/ajms.v8i1.16020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by airway obstruction and destruction of lung tissue, the disease for which at present there is no cure, although the treatment can slow worsening. Nearly 90% of COPD is caused by long term cigarette smoking; however, only 25% of chronic tobacco smokers develop COPD, the exact cause of this predisposition of some smokers to acquire COPD is still poorly understood at the molecular level. Lot of studies are available showing the correlation of MMP1 and asthma but not much work has been done on its correlation with COPD especially in North India. The outcome of our study was also expected to discover MMP1 as a new target for treating COPD and its progression in smokers.Aim and Objectives: The association of COPD and smoking with MMP1 gene product and its SNP in the North Indian population was intended to be studied.Material and Methods: The proposed study was a case control study. In this study adults aged 30 years and above fulfilling the inclusion criteria (Please see Annexure I) were considered and a total of 180 subjects were taken after determining the sample size. Pulmonary function test (PFT) was performed by Spirometry. Three main groups each consisting of 60 subjects were formed on the basis of smoking history and Spirometry: Ist group: Smokers without co-morbidity with normal PFT, IInd group: Smokers with Spirometry proved COPD and without any other co-morbidity, IIIrd group: Healthy Non-smoker controls. Quantification of metalloproteinase MMP1 in all the groups were performed in the serum with ELISA kits and Single Nucleotide Polymorphism (SNP 1G-1607 2G, ID rs1799750) studies in the gene encoding MMP1 linked to COPD susceptibility in smokers was performed by DNA Sequencing Analysis. The correlation between the SNPs, gene product, smoking and COPD was studied. Results: MMP1 concentration was seen increased in serum of COPD and smokers when compared to healthy controls. And there is high negative correlation between *FEV1/FVC % (post-bronchodilator) and MMP1 in COPD compared to Smokers and Healthy Controls. However, from the results of present analysis, we could show negative correlation between MMP1 and *FEV1/FVC % in all the 3 groups but the correlation proves to be much more negative in Group II i.e. Smokers with COPD. Statistically Significant Positive Correlation of Pack Years with MMP1 conc., and Statistically Significant Negative Correlation between Pack Years and *FEV1/FVC % was seen.Conclusion:In conclusion, our present analyses did show significant association between MMP1 and COPD risk in North Indian population. MMP1 levels of COPD patients were significantly increased in smokers and may contribute to or be a marker of the pathophysiology of COPD. Asian Journal of Medical Sciences Vol.8(1) 2017 5-14
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Verma S, Sayal A, Vijayan VK, Rizvi SM, Talwar A. Caregiver's burden in pulmonary arterial hypertension: a clinical review. J Exerc Rehabil 2016; 12:386-392. [PMID: 27807515 PMCID: PMC5091052 DOI: 10.12965/jer.1632708.354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022] Open
Abstract
Caregiver’s burden is a multidimensional phenomenon affecting care-givers physically, emotionally and socially. It is critical to examine the burden of caregivers, because of the complex responsibility they have with their partners. There are relatively few studies that have examined factors linked with psychological burden amongst caregivers of pulmonary arterial hypertension (PAH) patients. Hence, it is pertinent to develop a good understanding of these factors and develop appropriate management strategies, modified to assist PAH caregivers.
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Affiliation(s)
- Sameer Verma
- Department of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Abhineet Sayal
- Department of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - V K Vijayan
- Indian Council of Medical Research (ICMR), Bhopal Memorial Hospital and Research Centre (ICMR) & National Institute for Research in Environmental Health (ICMR), Bhopal, India
| | - Syed M Rizvi
- Touro College, New York School of Career and Applied Studies, New York, NY, USA
| | - Arunabh Talwar
- Department of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA
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Akhtar R, Jain S, Kumar A, Bhatia S, Joshi JC, Singh D, Shamsuzzaman M, Sharma M, Pal G, Vijayan VK, Gaur SN, Gulati K, Ray A. Evaluation of Therapeutic Efficacy of Ascorbic Acid in Patients with Bronchial Asthma. J Young Pharm 2016. [DOI: 10.5530/jyp.2016.3.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bose P, Bathri R, Kumar L, Vijayan VK, Maudar KK. Role of oxidative stress & transient receptor potential in chronic obstructive pulmonary disease. Indian J Med Res 2016; 142:245-60. [PMID: 26458340 PMCID: PMC4669859 DOI: 10.4103/0971-5916.166529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affect millions of people worldwide and is known to be one of the leading causes of death. The highly sensitive airways protect themselves from irritants by cough and sneeze which propel endogenous and exogenous substances to minimize airway noxious effects. One noxious effect of these substances is activation of peripheral sensory nerve endings of nociceptor neurons innervating these airways lining thus transmitting dangerous signals from the environment to the central nervous system (CNS). Nociceptor neurons include transient receptor potential (TRP) ion channels, especially the vanilloid and ankyrin subfamilies, TRPV1/A1 which can be activated by noxious chemical challenges in models of airways disease. As oxidative stress may activate airways sensory neurons and contribute to COPD exacerbations we sought to review the role that TRP channel activation by oxidative signals may have on airway responses. It would be prudent to target the TRP channels with antagonists and lower systemic oxidative stress with agents that can modulate TRP expression and boost the endogenous levels of antioxidants for treatment and management of COPD.
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Affiliation(s)
- Protiti Bose
- Department of Research, Bhopal Memorial Hospital & Research Centre (ICMR), Bhopal, India
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Lal D, Manocha S, Ray A, Vijayan VK, Kumar R. Comparative study of the efficacy and safety of theophylline and doxofylline in patients with bronchial asthma and chronic obstructive pulmonary disease. J Basic Clin Physiol Pharmacol 2016; 26:443-51. [PMID: 25894641 DOI: 10.1515/jbcpp-2015-0006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bronchial asthma and chronic obstructive pulmonary disease (COPD) are the major obstructive disorders that may contribute to the severity in individual patients. The present study was designed to compare the efficacy and safety of theophylline and doxofylline in patients with bronchial asthma and COPD. METHODS A total of 60 patients, 30 each with bronchial asthma and COPD, were enrolled for the study. Each group of 30 patients received standard treatment for asthma and COPD. Each group was again subdivided into two with 15 patients each, who received theophylline or doxofylline in addition to standard therapy, for a period of 2 months. Each patient was followed up fortnightly for the assessment of efficacy parameters using a pulmonary function test (PFT), clinical symptoms and emergency drug use, and safety was assessed by recording adverse drug reactions. RESULTS Both theophylline and doxofylline produced enhancements in PFT at different time intervals in both asthma and COPD patients. The maximum beneficial effects were seen at 6 weeks for asthma patients and at 8 weeks for COPD patients for both theophylline and doxofylline. CONCLUSIONS The comparative study showed that doxofylline was more effective as evidenced by improvement in PFT as well as clinical symptoms, and reduced incidence of adverse effects and emergency bronchodilator use.
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Kumar R, Goel N, Kumar S, Kushwah AS, Vijayan VK. Epidemiological Profile of Tobacco Users at Tobacco Cessation
Centre: An Indian Experience. Indian J Chest Dis Allied Sci 2016; 58:93-7. [PMID: 30179387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective. Tobacco consumption continues to rise in India with about 34.6% of adult population being tobacco users. This study was done to evaluate the epidemiological profile of the tobacco users presenting to a Tobacco Cessation Centre (TCC) in Delhi. Methods. This is a retrospective observational study of subjects seen over a period of 10 years (2001-2010) at TCC of Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India. Information from a structured questionnaire filled by all tobacco users was pooled and analysed. Results. Of a total of 4493 subjects seen in the TCC, 4370 (97.3%) were males. 2704 (60.2%) subjects were smokers and remaining were users of smokeless tobacco. The highest number of subjects attending the clinic was between the age of 31 to 40 years. The mean age of starting tobacco use was 21 years. 2518 subjects started tobacco use due to “peer group pressure”, while family history of tobacco use was observed in 2912 subjects. 3065 number of subjects attending the clinic were without any co-morbidity. Conclusions. Most of the subjects started tobacco use at a young age between 11 to 20 years. Peer pressure was the most common reason for initiation (56%). Most of the subjects (68.2%) had no co-morbidity. The present study observed that tobacco users probably want to quit smoking not only because of the consequences of co-morbidities but also because of the realisation of later harmful effects of continuing smoking.
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Abstract
Air pollution has become the world's single biggest environmental health risk, linked to around 7 million deaths in 2012 according to a recent World Health Organisation (WHO) report. The new data further reveals a stronger link between, indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischemic heart disease, as well as between air pollution and cancer. The role of air pollution in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases, is well known. While both indoor and outdoor pollution affect health, recent statistics on the impact of household indoor pollutants (HAP) is alarming. The WHO factsheet on HAP and health states that 3.8 million premature deaths annually - including stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer are attributed to exposure to household air pollution. Use of air cleaners and filters are one of the suggested strategies to improve indoor air quality. This review discusses the impact of air pollutants with special focus on indoor air pollutants and the benefits of air filters in improving indoor air quality.
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Affiliation(s)
- Vannan Kandi Vijayan
- Advisor to Director General, ICMR Bhopal Memorial Hospital and Research Centre and National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Haralappa Paramesh
- Pediatric Pulmonologist and Environmentalist, Advisor Rajiv Gandhi Institute of Public Health and Center for Disease Control of Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India
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Vermani M, Vijayan VK, Agarwal MK. Identification of Aspergillus (A. flavus and A. niger) Allergens and Heterogeneity of Allergic Patients' IgE Response. Iran J Allergy Asthma Immunol 2015; 14:361-369. [PMID: 26547703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 06/05/2023]
Abstract
Aspergillus species (A. flavus and A. niger) are important sources of inhalant allergens. Current diagnostic modalities employ crude Aspergillus extracts which only indicate the source to which the patient has been sensitized, without identifying the number and type of allergens in crude extracts. We report a study on the identification of major and minor allergens of the two common airborne Aspergillus species and heterogeneity of patients' IgE response to them. Skin prick tests were performed on 300 patients of bronchial asthma and/or allergic rhinitis and 20 healthy volunteers. Allergen specific IgE in patients' sera was estimated by enzyme allergosorbent test (EAST). Immunoblots were performed to identify major/minor allergens of Aspergillus extracts and to study heterogeneity of patients'IgE response to them. Positive cutaneous responses were observed in 17% and 14.7% of patients with A. flavus and A. niger extracts, respectively. Corresponding EAST positivity was 69.2% and 68.7%. In immunoblots, 5 allergenic proteins were identified in A. niger extract, major allergens being 49, 55.4 and 81.5 kDa. Twelve proteins bound patients' IgE in A. flavus extract, three being major allergens (13.3, 34 and 37 kDa). The position and slopes of EAST binding and inhibition curves obtained with individual sera varied from patient to patient. The number and molecular weight of IgE-binding proteins in both the Aspergillus extracts varied among patients. These results gave evidence of heterogeneity of patients' IgE response to major/minor Aspergillus allergens. This approach will be helpful to identify disease eliciting molecules in the individual patients (component resolved diagnosis) and may improve allergen-specific immunotherapy.
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Affiliation(s)
- Maansi Vermani
- Department of Respiratory Allergy and Applied Immunology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India AND Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Vannan Kandi Vijayan
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Mahendra Kumar Agarwal
- Department of Respiratory Allergy and Applied Immunology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal AG, Gothi D, Joshi J, Kanwar MS, Kharbanda OP, Kumar S, Mohapatra PR, Mallick BN, Mehta R, Prasad R, Sharma SC, Sikka K, Aggarwal S, Shukla G, Suri JC, Vengamma B, Grover A, Vijayan VK, Ramakrishnan N, Gupta R. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition). Lung India 2015; 32:422-34. [PMID: 26180408 PMCID: PMC4502224 DOI: 10.4103/0970-2113.159677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
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Affiliation(s)
- Surendra K Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Vishwa Mohan Katoch
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - Alladi Mohan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - T Kadhiravan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - A Elavarasi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - R Ragesh
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Neeraj Nischal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Prayas Sethi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - D Behera
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvir Bhatia
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Medanta Hospital, Gurgaon, Haryana, India
| | - A G Ghoshal
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Dipti Gothi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Employees' State Insurance Corporation, Post Graduate Institute of Medical Sciences and Research, New Delhi, India
| | - Jyotsna Joshi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Topiwala National Medical College, Mumbai, Maharashtra, India
| | - M S Kanwar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, New Delhi, India
| | - O P Kharbanda
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Suresh Kumar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India
| | - P R Mohapatra
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - B N Mallick
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Ravindra Mehta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Bengaluru, Karnataka, India
| | - Rajendra Prasad
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; VP Chest Institute, New Delhi, India
| | - S C Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Kapil Sikka
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Garima Shukla
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - J C Suri
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Safdarjung Hospital, New Delhi, India
| | - B Vengamma
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Ashoo Grover
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - V K Vijayan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, Bhopal, Madhya Pradesh, India
| | - N Ramakrishnan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Rasik Gupta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
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Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal AG, Gothi D, Joshi J, Kanwar MS, Kharbanda OP, Kumar S, Mohapatra PR, Mallick BN, Mehta R, Prasad R, Sharma SC, Sikka K, Aggarwal S, Shukla G, Suri JC, Vengamma B, Grover A, Vijayan VK, Ramakrishnan N, Gupta R. Consensus & Evidence-based INOSA Guidelines 2014 (First edition). Indian J Chest Dis Allied Sci 2015; 57:48-64. [PMID: 26410986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or ≥ 15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
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Abstract
Obstructive sleep apnea (OSA)-induced biological changes include intermittent hypoxia, intermittent hypercapnia, intrathoracic pressure changes, sympathetic activation and sleep fragmentation. OSA can cause metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and hypercoagulation, and neurohumoral changes. There is evidence suggesting that OSA is independently associated with metabolic syndrome. OSA has been shown to increase the risk for systemic hypertension, pulmonary vascular disease, ischemic heart disease, cerebral vascular disease, congestive heart failure and arrhythmias. Although there are evidences accumulating that there may be a causal relationship between OSA and cardiovascular disorders, there is a need for more data from randomized controlled intervention trials to confirm this relationship. Many risk factors of OSA (age, male gender and obesity) are also known risk factors for cardiovascular disease. Severe OSA-hypopnea significantly increases the risk of fatal and nonfatal cardiovascular events in both men and women, and continuous positive airway pressure treatment reduces this risk in both. Neurocognitive consequences of OSA include daytime sleepiness, loss of alertness, memory deficit, reduced vigilance, impaired executive function, increased risk for automobile and occupational accidents, and decreased quality of life.
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Affiliation(s)
- Vannan Kandi Vijayan
- Bhopal Memorial Hospital and Research Centre, Indian Council of Medical Research, Bhopal, India.
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Vijayan VK. Is the incidence of parasitic lung diseases increasing, and how may this affect modern respiratory medicine? Expert Rev Respir Med 2012; 3:339-44. [PMID: 20477325 DOI: 10.1586/ers.09.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Affiliation(s)
- Sukanya Gangopadhyay
- 1Department of Biochemistry, V.P. Chest Institute, University of Delhi,
Delhi, India
| | - Vannan Kandi Vijayan
- 2Department of Respiratory Medicine, Viswanathan Chest Hospital, V.P. Chest Institute, University of Delhi,
Delhi, India
| | - Surendra Kumar Bansal
- 1Department of Biochemistry, V.P. Chest Institute, University of Delhi,
Delhi, India
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Kumar R, Vijayan VK. Smoking cessation programs and other preventive strategies for chronic obstructive pulmonary disease. J Assoc Physicians India 2012; 60 Suppl:53-56. [PMID: 23155814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Raj Kumar
- Department of Respiratory Allergy & Applied Immunology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi
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Abstract
OBJECTIVES Erythrocyte membrane proteins reflect the prototype of multifunctional proteins of various erythroid and non-erythroid cells, which demonstrate various cellular functions. The protein profile of cells changes in various diseases. Therefore, the objective of this study was to understand the changes in protein profile of erythrocyte membranes in bronchial asthma. METHODS The study included 20 patients of bronchial asthma and 20 healthy subjects. Erythrocytes were isolated from peripheral blood, membranes were prepared followed by the determination of protein contents, and protein profile was assessed using SDS-PAGE. RESULTS In bronchial asthma, the protein contents of erythrocyte membranes in asthmatic patients were significantly higher (p < .005) than in healthy controls. Analysis of protein profile showed absence of the proteins, namely, band 4.2 and adducin subunit-II, and appearance of protein bands of molecular weights corresponding to galectin-3, glyceraldehyde 3-phosphate dehydrogenase, β-actin, dematin, band 4.1, and adducin (subunit-I) in asthmatic patients when compared with healthy controls. CONCLUSIONS In asthma, there are quantitative and qualitative changes in proteins of erythrocyte membranes. The absence of band 4.2 protein may cause impairment of the erythrocyte membrane integrity, and presence of galectin-3 may lead to the activation of various inflammatory cells. The altered protein profile may possibly lead to altered response of the inflammatory cells to the asthmogenic stimuli, which may be responsible for pathophysiology and manifestation of the symptoms of bronchial asthma.
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Affiliation(s)
- Prachi Gupta
- Department of Biochemistry, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Jindal SK, Shankar PS, Vijayan VK, Kamat SR, Deivanayagan CN. Down the memory lane: Lung India three decades. Lung India 2012; 29:205-11. [PMID: 22919156 PMCID: PMC3424856 DOI: 10.4103/0970-2113.99099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kulshrestha R, Menon BK, Vijayan VK. Role of a pattern-based approach in interpretation of transbronchoscopic lung biopsy and its clinical implications. Indian J Chest Dis Allied Sci 2012; 54:9-17. [PMID: 22779117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Transbronchial lung biopsy (TBLB) is commonly performed for confirming the tissue diagnosis of diffuse parenchymal lung diseases (DPLDs). There is an urgent need to establish guidelines for interpretation of TBLB in order to improve its diagnostic utility. METHODS We retrospectively studied 916 consecutive patients (494 males; mean age 49 years) who underwent TBLB over a 5-year period (July 2005 to July 2010) at Vallabhbhai Patel Chest Institute. RESULTS In 615 (67.1%) procedures, material obtained during TBLB was adequate for histopathology interpretation. Pathological features evaluated in each case were: alveolar architecture, inflammatory infiltrate, interstitial fibrosis, atypical cells, pigment deposition, honey-comb change and fibroblast foci. The cases were categorised on the basis of histopathology into six patterns: (1) adequate biopsy without a specific diagnostic abnormality (n = 137, 22.3%); (2) acute pneumonitis (n = 29, 4.7%); (3) neoplasia (n = 109, 17.7%); (4) chronic interstitial inflammation with or without fibrosis (n = 138, 22.4%); (5) granulomatous inflammation, (n = 186, 30.2%); and (6) other specific causes (n = 16, 2.6%). Definitive diagnosis could be made after correlation of TBLB histopathology with clinical and radiological features in 55.3% cases. CONCLUSIONS TBLB appears to be an important diagnostic tool for the diagnosis of DPLDs. The use of a pattern-based approach to TBLB adds to its diagnostic yield and can be helpful in cases where open lung biopsy is not available.
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Affiliation(s)
- Ritu Kulshrestha
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Chhabra SK, Vijayan VK, Rahman M, Mittal V, Singh PD. Regression equations for spirometry in children aged 6 to 17 years in Delhi region. Indian J Chest Dis Allied Sci 2012; 54:59-63. [PMID: 22779126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Most of the studies carried out in India to develop regression equations for spirometry in children are now several years-to-decades old and had used equipment and measurement protocols that have since changed. Prediction equations using the current standardisation protocols for spirometry are not available. The lung health of the population may have changed too. OBJECTIVE To develop regression equations for spirometry for children aged 6 to 17 years of north Indian origin in Delhi region. METHODS School children of north Indian origin, as determined by mother tongue and parentage, aged 6 to 17 years were screened by a health questionnaire and physical examination and those found "normal" underwent spirometry according to the standardised procedure recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) task force in 2005. Pearson's correlation analysis was carried out to identify the predictor variables for spirometric parameters. Prediction equations were developed using the multiple linear regression procedure. The independent variables were entered in sequence of height, age and weight. R2, adjusted R2 and R2 change, standard errors of the estimate (SEE), and estimates of regression coefficients were obtained and the goodness of fit was examined. RESULTS Data was obtained in 365 boys and 305 girls. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) peak expiratory flow rate (PEFR), forced expiratory flow rate at 50% and 75% exhalation of vial capacity (F50 and F75) and mean forced expiratory flow rate over the middle 50% of the vital capacity (F25-75) showed moderate to strong correlations with age, height and weight in both boys and girls. In both genders, the equations explained very high variability of FVC, FEV1 and PEFR as shown by the R2 values. The explained variability for flow rates was lesser, with that for F75 being the least. CONCLUSIONS Regression equations for spirometry variables for children of north Indian origin in Delhi region have been developed. These represent the first such effort from India after the publication of the ATS/ERS task force 2005 guidelines on standardisation of spirometry.
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Affiliation(s)
- S K Chhabra
- Departments of Cardio-respiratory Physiology, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Kumar R, Mahakud GC, Nagar JK, Singh SP, Raj N, Gopal K, Vijayan VK. Breath carbon monoxide level of non-smokers exposed to environmental tobacco smoke. Indian J Chest Dis Allied Sci 2011; 53:215-219. [PMID: 22128620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure is a health hazard for non-smokers. OBJECTIVE To measure breath carbon monoxide (CO) levels of non-smoking subjects exposed to ETS and of non-smoking subjects not exposed to ETS. RESULTS The study was conducted with the help of a pre-designed questionnaire. One hundred male subjects were selected for the study; group I consisted of 50 non-smokers (waiters in hotels/restaurants/bars) exposed to ETS and group II consisted of 50 non-smokers not exposed to ETS. All subjects underwent clinical examination. Breath CO levels of both the groups were measured by the Mini Smoklyzer. The mean breath CO level (ppm) was higher in group I compared to group II (9.18 +/- 2.84 versus 4.56 +/- 1.62; p < 0.001). The mean breath CO level was also significantly higher in ETS exposed subjects who worked for more than nine hours a day in bars, restaurants and hotels (p = 0.018) and in subjects suffering from respiratory diseases (p < 0.001) compared to normal subjects. CONCLUSION The abnormally high level of breath CO observed in passive smokers exposed to ETS may suggest that, these subjects may be prone to develop the tobacco related diseases.
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Affiliation(s)
- Raj Kumar
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Girdhar A, Kumar V, Singh A, Menon B, Vijayan VK. Systemic inflammation and its response to treatment in patients with asthma. Respir Care 2011; 56:800-5. [PMID: 21679494 DOI: 10.4187/respcare.00601] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is an obstructive airway disease characterized by airway inflammation. OBJECTIVE To measure systemic inflammation in asthma patients, and to assess the effect of treatment on systemic inflammation. METHODS In 30 newly diagnosed non-randomized adult asthma patients we measured systemic inflammation markers (serum high-sensitivity C-reactive protein, total leukocyte count, and erythrocyte sedimentation rate) before and after a 6-week standard treatment with inhaled steroids and inhaled β(2) agonist. The comparison group comprised 20 healthy control subjects. All the subjects were non-smokers. RESULTS The measured systemic inflammation markers were higher in the asthma patients: high-sensitivity C-reactive protein 4.8 ± 6.0 mg/dL vs 1.5 ± 1.4 mg/dL, P < .001; total leukocyte count 8,936 ± 2,592 cells/μL versus 7,741 ± 1,924 cells/μL, P < .001; erythrocyte sedimentation rate 24.8 ± 12.3 mm/h versus 15.3 ± 6.5 mm/h, P < .001. In the asthma patients, high-sensitivity C-reactive protein negatively correlated with percent-of-predicted FEV(1) (r = -0.64, P = .001), percent-of-predicted forced vital capacity (FVC) (r = -0.39, P = .03), FEV(1)/FVC% (r = -0.71, P < .001), and percent-of-predicted forced expiratory flow during the middle half of the FVC maneuver (FEF(25-75)) (r = -0.51, P = .004). Total leukocyte count negatively correlated with percent-of-predicted FEV(1) (r = -0.64, P = .001), percent-of-predicted FEV(1)/FVC (r = -0.74, P < .001), and percent-of-predicted FEF(25-75) (r = -0.58, P = .001). Body mass index positively correlated with high-sensitivity C-reactive protein (r = 0.65, P < .001). Multiple linear regression showed significant correlation of high-sensitivity C-reactive protein (r(2) = 0.75) with age (β = 0.31, P = .008), body mass index (β = 0.99, P = .001), family size (β = 0.33, P = .008), and weight (β = -0.45, P = .01). The systemic inflammation markers decreased significantly (P < .001 for all comparisons) after 6 weeks of treatment: high-sensitivity C-reactive protein decreased from 4.8 ± 6.0 mg/dL to 2.4 ± 5.4 mg/dL, total leukocyte count decreased from 8,936 ± 2,592 cells/μL to 6,960 ± 1,785 cells/μL, and erythrocyte sedimentation rate decreased from 24.8 ± 12.3 mm/h to 15.8 ± 10.1 mm/h. CONCLUSIONS Inhaled steroids plus inhaled β(2) agonist significantly reduced systemic inflammation in asthma patients.
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Affiliation(s)
- Ankur Girdhar
- Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida 32209, USA.
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Sadasivam K, Patial K, Vijayan VK, Ravi K. Anti-oxidant treatment in obstructive sleep apnoea syndrome. Indian J Chest Dis Allied Sci 2011; 53:153-162. [PMID: 21838198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To investigate whether oral intake of N-acetylcysteine (NAC) is a treatment option in patients with obstructive sleep apnoea syndrome (OSAS). METHODS Twenty patients with OSAS were enrolled in the study. After polysomnography (PSG), they were randomly assigned to receive a placebo (n = 10) and NAC (n = 10). A repeat PSG was done after the treatment period of 30 days. Fasting venous samples were collected for various biochemical analysis. RESULTS In the patients of NAC group, compared to their baseline values, slow wave sleep as sleep percent time (27.9 +/- 2.7 vs 42.3 +/- 4.2; p < 0.01) and sleep efficiency (90.8 +/- 1.3 vs 94.4 +/- 1.5; p < 0.05) improved considerably. The apnoea-hypopnoea index (61.2 +/- 8.5 vs 43.1 +/- 8.6; p < 0.05), apnoea related arousals (22.2 +/- 7.6 vs 11.6 +/- 4.7; p < 0.05), longest apnoeic episode duration (seconds) (54.9 +/- 7.1 vs 37.8 +/- 5.6; p < 0.01), oxygen desaturation events per hour (51.8 +/- 7.7 vs 37 +/- 7.8; p < 0.01) and epworth sleepiness score (16.6 +/- 0.8 vs 9.2 +/- 0.9; p < 0.001) decreased significantly. The relative snore time (%) (10.2 +/- 2.9 vs 4.9 +/- 1.9; p < 0.01), number of snore episodes (63.8 +/-23.9 vs 28.2 +/- 9.9; p < 0.05) and duration of longest snore episode (min) (2.5 +/- 0.7 vs 0.6 +/- 0.1; p < 0.05) also decreased significantly. Such responses were not evident in the placebo group. N-acetylcysteine produced significant decrease in lipid peroxidation and increase in total reduced glutathione. CONCLUSIONS Oral NAC administration appears to have a therapeutic potential in the treatment of OSAS. It is proposed that long-term treatment with NAC in patients with OSAS may reduce their dependency on continuous positive airway pressure therapy.
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Affiliation(s)
- K Sadasivam
- Department of Physiology, V.P. Chest Institute, University of Delhi, Delhi, India
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Singh TD, Patial K, Vijayan VK, Ravi K. Role of nitric oxide in the diuresis and natriuresis occurring in patients with obstructive sleep apnoea syndrome. Indian J Chest Dis Allied Sci 2011; 53:11-20. [PMID: 21446219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine whether nitric oxide (NO) has any role in the diuresis and natriuresis observed in patients with obstructive sleep apnoea syndrome (OSAS). METHODS We measured 12-hour urine volume in the day and in the night in patients with OSAS (n=20) and determined the concentrations of urinary sodium and nitrate. The frequency of urination in the night was also noted. The measurements were done again after two nights of continuous positive airway pressure (CPAP) therapy and after putting the patients on oral anti-oxidant treatment (vitamin C-100 mg BD and vitamin E-400 IU BD) for 45 days. Ten healthy normal subjects underwent the same protocol except the CPAP therapy. RESULTS In patients with OSAS, the night urine volume and sodium concentration were similar and the nitrate levels were higher compared to those in the day. After CPAP therapy, while the urine volume and sodium concentration decreased, the nitrate level became similar to that in the day. Such effects were not observed after anti-oxidant treatment. The frequency of urination was decreased in both the instances. The effects observed after CPAP therapy were similar to those observed in control subjects with or without anti-oxidant treatment. CONCLUSION Renal NO promotes diuresis and natriuresis in patients with OSAS.
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Affiliation(s)
- T D Singh
- Department of Physiology, V. P. Chest Institute, University of Delhi, Delhi, India
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Abstract
BACKGROUND Sphingomyelin (SM), a major lipid constituent of outer leaflet of plasma membranes, with cholesterol, constitutes microdomains, which are termed as lipid rafts. These rafts provide support to proteins, receptors, enzymes, and so on and organize and orient them to conduct cellular functions including transmembrane signaling to substances in external milieu. The SM contents are regulated by its metabolism, changes in which may affect the composition of lipid rafts and cell response to the triggers of asthma which may lead to the pathophysiology. For studying changes in membranes, erythrocytes, which contain lipid rafts, are considered to be the best cell type. Hence, this study was conducted on plasma membrane of erythrocytes of asthmatic patients. OBJECTIVE The objective is to understand the changes in SM metabolism in asthma. METHODS The study included 50 subjects (25 asthmatics and 25 healthy subjects). Erythrocytes were isolated from the peripheral blood and membrane prepared. This was followed by determination of total cholesterol, phospholipids, SM, and sphingomyelinase activity. P < .05 was considered significant. RESULTS AND CONCLUSIONS In asthmatics, there was a significant decrease in cholesterol contents (p < .05), decrease in total phospholipid contents (p < .005), increase in SM (p < .01), decrease in cholesterol: SM ratio (p < .001) and increase in sphingomyelinase activity (p < .001) in erythrocyte membranes. We conclude that in asthma, the increase in SM contents is associated with increased sphingomyelinase activity which shows an imbalance in SM metabolism, directed toward its accumulation. The ratio of cholesterol to SM, critical for maintenance of lipid rafts, was significantly lower in asthmatics. This indicates changes in structure of lipid rafts which may lead to the pathophysiology and development of asthma. Regulation of SM metabolism may help in disease regulation and its control.
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Affiliation(s)
- Prachi Gupta
- Department of Biochemistry, V. P. Chest Institute, University of Delhi, Delhi, India
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Abstract
Many lung infestations from established and newly emerging parasites have been reported as a result of the emergence of HIV/AIDS, the increasing use of immunosuppressive drugs, increasing organ transplantations, the increase in global travel, and climate change. A renewed interest in parasitic lung infections has been observed recently because many protozoal and helminthic parasites cause clinically significant lung diseases. The diseases caused by these parasites may mimic common and complicated lung diseases ranging from asymptomatic disease to acute respiratory distress syndrome requiring critical care management. The availability of new molecular diagnostic methods and antiparasitic drugs enables early diagnosis and prompt treatment to avoid the morbidity and mortality associated with these infestations. Good hygiene practices, improvement in socioeconomic conditions, vector control measures, and consumption of hygienically prepared and properly cooked food are essential to reduce the occurrence of parasitic infestations.
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Affiliation(s)
- Vannan Kandi Vijayan
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India.
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Bansal S, Caroli R, Goel N, Vijayan VK. Chronic Obstructive Pulmonary Disease as a Risk Factor for Insulin Resistance. Chest 2010. [DOI: 10.1378/chest.10235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kumar P, Kumar B, Gupta A, Sharma B, Vijayan VK, Khare S, Singh V, Daga MK, Chadha MS, Mishra AC, Kaur H, Khanna M. Diagnosis of Novel Pandemic Influenza Virus 2009 H1N1 in Hospitalized Patients. Indian J Virol 2010; 21:45-9. [PMID: 23637477 DOI: 10.1007/s13337-010-0005-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
A real-time RT-PCR assay was standardized and evaluated for the detection of the recent pandemic 2009 H1N1 strain that circulated around the world causing colossal loss of human life. We amplified the conserved regions of the hemagglutinin (HA) gene of 438 clinical specimens using real-time RT-PCR assay for rapid identification of pandemic influenza virus. The real-time RT-PCR was optimized and the primers and probes were tested against a panel of known negative and positive controls. RNA isolated from the HeLa cell line served as quality control. The conventional RT-PCR which is an established method of influenza virus diagnosis was compared to real-time RT-PCR. Of 438 clinical specimens tested, 212 specimens were found positive for influenza A virus (SD 46.669) in which 139 specimens were diagnosed positive for the pandemic 2009 H1N1 while 73 were the seasonal influenza viruses. We report that the real-time RT-PCR assay offers both, a high sensitivity and specificity when compared with the traditional identification method. The real-time RT-PCR assay allows rapid identification of the pandemic swine 2009-H1N1 at very low viral loads that are negative by the traditional RT-PCR. This optimized assay can be a very useful tool to assist both epidemiologists and the clinicians.
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Affiliation(s)
- P Kumar
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Khanna M, Ray A, Rawall S, Chandna S, Kumar B, Vijayan VK. Detection of influenza virus induced ultrastructural changes and DNA damage. Indian J Virol 2010; 21:50-5. [PMID: 23637478 DOI: 10.1007/s13337-010-0004-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 05/20/2010] [Indexed: 11/28/2022]
Abstract
The influenza virus generally causes damage to epithelial cells of respiratory tract and infection of cells with this virus often results in cell death with apoptotic characteristics. Reports are available implicating influenza virus as a causative agent of chromosomal aberrations in cells and culture. The objective of this study was to analyze the process of cell death caused by influenza virus (A/Udorn/317/72, H3N2) infection in cultured HeLa cells by electron microscopy and comet assay. The apoptotic study was performed using light microscopy electron microscopy and comet assay to observe the changes in cell morphology and DNA fragmentation. HeLa cells, infected with influenza virus were harvested at various time periods to observe the ultrastructural changes. This infection gave rise to nuclear fragmentation and chromatin condensation accompanied by chromosomal DNA fragmentation into oligonucleosomes. The pattern of comet assay revealed that the apoptosis occurred due to fragmentation of the DNA of the cells which reached the maximum level at 36 h post infection. Ultrastructural study showed extensive chromatin condensation and nuclear fragmentation which are the characteristic features of apoptosis.
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Affiliation(s)
- M Khanna
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, 110 007 India
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Gulati K, Ray A, Vijayan VK. Assessment of protective role of polyherbal preparation, Livina, against anti-tubercular drug induced liver dysfunction. Indian J Exp Biol 2010; 48:318-322. [PMID: 21046988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The present study evaluated the possible protective role of Livina (a polyherbal preparation) against anti-tubercular therapy (ATT)-induced liver dysfunction in patients of pulmonary tuberculosis. Patients were given intensive phase treatment with 4-drugs (rifampicin, INH, pyrazinamide and ethambutol) used for anti-tubercular therapy for 2 months, followed by a 4-month continuous phase treatment with 2 drugs (rifampicin and INH) under clinical advice and supervision. Both qualitative and quantitative measures of liver function were assessed, at different time intervals, before and after ATT. Analysis of data showed that the incidence of qualitative manifestations of liver dysfunction were greater in the placebo treated group as compared to the test drug group. None of the patients of either group showed clinical jaundice. Most signific changes ant were observed in the SGOT and SGPT levels in the placebo group, wherein the levels of both enzymes were higher at 4 and 8 weeks post-ATT, as compared to the respective baseline (0 week) values. When Livina (2 capsules twice daily) was given with ATT drugs, incidence of qualitative manifestation of liver dysfunction was insignificant and SGOT and SGPT levels were also significantly lower than the placebo+AITT drugs treated group. These results indicate that the test drug (Livina) was efficacious, against ATT-induced hepatic dysfunction in patients of pulmonary tuberculosis.
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Affiliation(s)
- Kavita Gulati
- Department of Pharmacology and Clinical Research Centre, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 10 007, India
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Khanna M, Kumar B, Gupta N, Kumar P, Gupta A, Vijayan VK, Kaur H. Pandemic swine influenza virus (H1N1): A threatening evolution. Indian J Microbiol 2010; 49:365-9. [PMID: 23100799 DOI: 10.1007/s12088-009-0064-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022] Open
Abstract
"Survival of the fittest" is an old axiom laid down by the great evolutionist Charles Darwin and microorganisms seem to have exploited this statement to a great extent. The ability of viruses to adapt themselves to the changing environment has made it possible to inhabit itself in this vast world for the past millions of years. Experts are well versed with the fact that influenza viruses have the capability to trade genetic components from one to the other within animal and human population. In mid April 2009, the Centers for Disease Control and Prevention and the World Health Organization had recognized a dramatic increase in number of influenza cases. These current 2009 infections were found to be caused by a new strain of influenza type A H1N1 virus which is a re-assortment of several strains of influenza viruses commonly infecting human, avian, and swine population. This evolution is quite dependent on swine population which acts as a main reservoir for the reassortment event in virus. With the current rate of progress and the efforts of heath authorities worldwide, we have still not lost the race against fighting this virus. This article gives an insight to the probable source of origin and the evolutionary progress it has gone through that makes it a potential threat in the future, the current scenario and the possible measures that may be explored to further strengthen the war against pandemic.
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Affiliation(s)
- Madhu Khanna
- Department of Respiratory Virology, V. P. Chest Institute, University of Delhi, Delhi, India
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Kumar R, Prakash S, Kushwah AS, Vijayan VK. Breath carbon monoxide concentration in cigarette and bidi smokers in India. Indian J Chest Dis Allied Sci 2010; 52:19-24. [PMID: 20364610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To measure and compare the breath carbon monoxide (CO) levels in cigarette and bidi smokers in India. METHODS Breath CO was measured in 389 smokers (241 cigarette smokers,148 bidi smokers) using portable breath CO analyser (Bedfont-England, Smokelyzer). Tobacco contents and length of single stick of different brands of cigarette and bidi were also measured. RESULTS Their mean age was 38.7 +/- 13.4 years. The average duration of smoking was 18.2 +/- 13.0 years. Average breath CO levels were 15.6 +/- 7.0 ppm in smokers and 4.07 +/- 1.16 ppm in non-smokers. Average breath CO level was significantly higher in bidi smokers (18.9 +/- 7.7 ppm) compared to cigarette smokers (13.6 +/- 5.8 ppm) when total consumption of cigarette/bidi was more than five pack-years (p = 0.002). Average tobacco weight of bidi (216.8 mg) was significantly less than cigarette (696 mg). CONCLUSIONS Bidi is equally or more harmful than cigarette smoking. One bidi may be considered to one cigarette for calculating "pack-years" of smoking.
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Affiliation(s)
- Raj Kumar
- Department of Respiratory Medicine, V.P. Chest Institute, University of Delhi, Delhi, India.
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Singh TD, Patial K, Vijayan VK, Ravi K. Oxidative stress and obstructive sleep apnoea syndrome. Indian J Chest Dis Allied Sci 2009; 51:217-224. [PMID: 20073373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
RATIONALE Even though oxidative stress has been proposed as an underlying mechanism for the symptoms in patients with obstructive sleep apnoea syndrome (OSAS), little information is available on the effects of anti-oxidant treatment on their improvement. OBJECTIVES To observe the effects of anti-oxidant treatment on polysomnographic parameters and oxidative stress markers in OSAS patients. METHODS Polysomnography (PSG) was performed on 20 male patients. They were administered continuous positive airway pressure (CPAP) therapy for two nights followed by oral intake of vitamin C (100 mg BD) [DOSAGE ERROR CORRECTED] and vitamin E (400 IU BD) for 45 days and a repeat PSG was done. Ten healthy normal subjects underwent the same protocol excepting the CPAP therapy. RESULTS In OSAS patients, plasma lipid peroxidation increased significantly and whole blood reduced glutathione decreased significantly. The CPAP therapy as well as anti-oxidant treatment reduced the lipid peroxidation and restored the reduced glutathione concentrations. After anti-oxidant intake, OSAS patients slept better with decrease in Epworth sleepiness score and the number of apnoeic episodes. They spent more time in stages 3 and 4 of sleep. The optimum pressure of CPAP device was significantly lowered also. CONCLUSIONS Oxidative stress contributes to sleep behaviour in OSAS patients, and anti-oxidant intake improves the quality of sleep in them.
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Affiliation(s)
- T D Singh
- Department of Physiology, V P Chest Institute, University of Delhi, Delhi, India
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Prati PS, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. J Postgrad Med 2009; 54:78-9. [PMID: 18480516 DOI: 10.4103/0022-3859.40766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Srivastava V, Rawall S, Vijayan VK, Khanna M. Influenza a virus induced apoptosis: inhibition of DNA laddering & caspase-3 activity by zinc supplementation in cultured HeLa cells. Indian J Med Res 2009; 129:579-586. [PMID: 19675388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND & OBJECTIVE The pathogenesis of influenza virus infection involves virus replication in epithelial cells of the respiratory tract and the consequent degeneration of infected cells. Influenza virus induces cellular degeneration following infection of cultured cells in vitro, and the cytopathic effect (CPE) occurs principally through apoptotic cell death. This study was undertaken to fi nd out the effect of zinc on influenza virus induced apoptosis in cultured HeLa cells. METHODS The sub-confluent monolayer HeLa cells were used to study the effect of zinc on influenza virus induced apoptosis. The apoptotic markers viz., caspase-3 activity, phagocytic index, morphological changes, and DNA fragmentation were assayed. RESULTS When HeLa cells were infected with a cell adapted pathogenic strain of influenza A (A/Udorn/ 317/72H(3)N(2)) virus, DNA fragmentation was observed in virus infected cells by 24 h post infection and caspase-3 activity was maximum at 4 h post infection after which it reached to plateau. Treatment of cells with 0.1 5mM concentration of zinc till 8 h post infection inhibited DNA fragmentation and also caspase 3 activity was decreased significantly up to 2 h post infection. INTERPRETATION & CONCLUSION When the infected HeLa cells were incubated with adherent macrophages, efficient phagocytosis occurred and the release of virus into the culture medium was inhibited. These results suggested that inhibitory effect on influenza virus induced apoptotic death of cultured cells can be determined at an early stage of the infection by treatment of zinc.
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Affiliation(s)
- Vikram Srivastava
- Department of Respiratory Virology, V.P. Chest Institute, University of Delhi, Delhi, India
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Mahajan B, Vijayan VK, Agarwal MK, Bansal SK. Serum interleukin-1beta as a marker for differentiation of asthma and chronic obstructive pulmonary disease. Biomarkers 2009; 13:713-27. [PMID: 19096964 DOI: 10.1080/13547500802655367] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are diseases of airway inflammation with clinical and physiological similarities, making their differentiation difficult. Airway inflammatory changes are associated with systemic changes. However, no serum marker is known for their differentiation. Therefore, serum interleukin (IL)-1beta levels were determined. Out of a total of 1023 patients screened, we included in the study ten patients each with atopic asthma, non-atopic asthma and COPD and ten healthy subjects. Skin prick tests with 14 inhalant allergens were performed on each patient. Blood was collected in the symptomatic and asymptomatic phases of the diseases and serum IL-1beta and IgE levels were determined. Our results showed that in the symptomatic phase in asthmatics, serum IL-1beta levels were higher (P<0.05) than in patients with COPD. Serum IgE levels were higher (P<0.05) in atopic asthmatics than in non-atopic asthmatics and in COPD patients. We conclude that serum IL-1beta level determination during the symptomatic phase of the diseases may help to differentiate asthmatics from patients with COPD. Serum IgE levels may differentiate atopic asthmatics from non-atopic asthmatics and COPD patients.
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Affiliation(s)
- Bhawna Mahajan
- Department of Biochemistry, V. P. Chest Institute, University of Delhi, Delhi, India
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Kulshrestha R, Vijayan VK. Immunohistochemical staining on fine needle aspiration biopsy-cell block specimens in the differential diagnosis of lung cancers. Indian J Chest Dis Allied Sci 2009; 51:21-25. [PMID: 19317359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Fine needle aspiration biopsy [FNAB] is used extensively in the clinical work-up of radiologically detected lung lesions. However, categorisation of lung cancer by computed tomography guided FNAB alone is limited by overlapping morphological features. AIM To examine further the utility of immunohistochemical panel of antibodies to thyroid transcription factor [TTF-1], synaptophysin, chromogranin A [CgA], cytokeratin-pan, cytokeratin-7 [CK-7], cytokeratin-20 [CK-20], leucocyte common antigen [LCA], and carcinoembryonic antigen [CEA] in cytologic cell block samples in the differential diagnosis of lung cancer. METHODS Twenty-nine FNABs of newly diagnosed cases of lung cancer were studied. Immunohistochemistry was done on paraffin embedded cell block sections using Dako monoclonal antibodies. RESULTS Morphological diagnosis of non-small cell carcinoma (NSCLC) was made in 22/29 [76%] and small cell carcinoma in 7/29 (24%) cases. Five of the seven (71.4%) cases of small cell carcinoma were CgA+/TTF-1+, 14.3% [1/7] were CgA+/ synaptophysin+/TTF-1-negative. In one case, LCA positivity lead to the diagnosis of non-Hodgkins lymphoma. The NSCLC was categorised further into well differentiated 11/22 [50%], moderately differentiated 7/22 [31.8%] and poorly differentiated 4/22 [18.2%] cases. Cytokeratin-pan positivity in squamous cell carcinomas [n=15] was seen to be related to cellular differentiation. All the three cases of adenocarcinoma were CK-7+/CK-20 negative. In one case with large cell carcinoma, CgA-positivity lead to recategorisation as large cell neuroendocrine carcinoma. CONCLUSIONS Our results suggest that the proposed panel of immunohistochemical markers might help further classification of lung carcinomas even in small FNAB material and permit more consistent patient enrollment for trials with targeted treatments.
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Affiliation(s)
- Ritu Kulshrestha
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Singh PP, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. Indian J Cancer 2008; 45:39-40. [PMID: 18626145 DOI: 10.4103/0019-509x.41767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Singh PP, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. J Vector Borne Dis 2008; 45:81-82. [PMID: 18592836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Singh PP, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. Natl Med J India 2008; 21:105-106. [PMID: 19004138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Singh PP, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. Indian J Ophthalmol 2008; 56:177-8. [PMID: 18417816 PMCID: PMC2636126 DOI: 10.4103/0301-4738.40354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Singh PP, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. Indian J Med Sci 2008; 62:132-133. [PMID: 18445978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Satyanarayana K, Sharma A, Parikh P, Vijayan VK, Sahu DK, Nayak BK, Gulati RK, Parikh MN, Singh PP, Bavdekar SB, Sreehari U, Sahni P. Statement on publishing clinical trials in Indian biomedical journals. Indian J Med Res 2008; 127:104-105. [PMID: 18403785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Vijayan VK. Tropical parasitic lung diseases. Indian J Chest Dis Allied Sci 2008; 50:49-66. [PMID: 18610690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Though parasitic lung diseases are frequently seen in tropical countries, these are being increasingly reported from many parts of the world due to globalisation and travel across the continents. In addition, the emergence of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), the frequent use of immunosuppressive drugs in many diseases and the increasing numbers of organ transplantations have resulted in a renewed interest in many tropical parasitic lung diseases. This review outlines the recent developments in the pathogenesis, diagnosis and management of common and rare parasitic lung diseases.
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Affiliation(s)
- V K Vijayan
- Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Vijayan VK. Indian Journal of Chest Diseases and Allied Sciences: 50 years of publication. Indian J Chest Dis Allied Sci 2008; 50:5-6. [PMID: 18610685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Talwar A, Liman B, Greenberg H, Feinsilver SH, Vijayan VK. Sleep in the intensive care unit. Indian J Chest Dis Allied Sci 2008; 50:151-162. [PMID: 18610699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Sleep is commonly disrupted in intensive care unit patients. The causes of this sleep disruption include the underlying medical illness itself, intensive care unit (ICU) environment, psychological stress, and effects of many medications and other treatments used to help those who are critically ill. The purpose of this review is to discuss the relevant literature in this regard, in order to improve the knowledge and recognition of this problem by health care providers. Also general and specific integrative steps to improving sleep of patients in the ICU is also described.
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Affiliation(s)
- Arunabh Talwar
- Division of Pulmonary Critical Care and Sleep Medicine, North Shore Long Island Jewish Health System, USA.
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Bansal A, De S, Patial K, Dwivedi S, Vijayan VK. DO PATIENTS OF RIGHT-SIDED HEART FAILURE DUE TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE HAVE INCREASED RISK OF DEVELOPING CENTRAL SLEEP APNEAS AND CHEYNE-STOKES RESPIRATION? Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.651a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Bansal A, De S, Patial K, Dwivedi S, Vijayan VK. SLEEP-BREATHING DISORDERS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COR PULMONALE COMPARED TO THAT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COR PULMONALE. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.524b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Bansal A, Patial K, Vijayan VK. SEVERITY OF OBSTRUCTIVE SLEEP APNEA-HYPOPNEA SYNDROME IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WHO HAVE DEVELOPED COR PULMONALE AND IN THOSE WHO HAVE NOT: A COMPARATIVE STUDY. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.651c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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