Biomedical subjects
Publications and source records attributed to D Behera.
Detailed chemical analysis of chuttas (a home made cigar) was carried out. Chutta smoke revealed a high content of nicotine and total particulate matter (TPM) as compared to the cigarette and Bidi (local hand rolled cigar). Chutta tobacco is rich in alkaloid content including nitrogen and the total carbohydrate content is low.
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Reverse smoking is a popular habit peculiarly prevalent among adults of southeastern coastal towns and villages of India. The smoking device is hand made. A few dried twigs of home grown tobacco are rolled crudely in a semi-dried tobacco leaf. The finished product is called 'chutta'. The average weight of the hand rolled chuttas varies between 1.5 g for the small one and 7.5 g for the big chuttas. During smoking the lighted end of the chutta is kept inside the mouth during inhalation. An average adult may smoke three to four chuttas per day. Reverse smoking was first highlighted by Reddy and Rao (1957) who reported a high occurrence of oropharyngeal carcinomas in chutta smokers. The cancerous changes were attributed to the heat generated inside the oral cavity and burning of tobacco (Reddy & Rao 1957). The present study was carried out to examine the frequency of symptoms of chronic respiratory disease and changes in lung function associated with this form of smoking habit.
We report a case of a young female patient with typhoid fever whose clinical course was complicated by hypotension, thrombocytopenia, encephalopathy and acute respiratory distress syndrome (ARDS). She recovered with prompt mechanical ventilatory support. ARDS in typhoid fever has generally proved to be fatal in reported cases.
OBJECTIVE: To study the effect of large volume paracentesis (LVP) on pulmonary function in patients with cirrhosis of liver and tense ascites. METHODS: Ten patients having alcoholic cirrhosis with ascites were subjected to LVP (mean 6.3 +/- 0.3 L). Pre and post paracentesis spirometry and arterial blood gas analysis were performed and compared. RESULTS: Baseline mean lung volumes and arterial pO2 were reduced from normal predicted values. Air flow was found normal. After LVP, an increase in absolute values of vital capacity, forced expiratory flow in first second (FEV1) and peak expiratory flow was observed; only the improvement in FEV1 was significant p 0.05). Arterial pO2 also showed significant (p < 0.01) improvement after LVP. CONCLUSION: LVP leads to improvement in measured pulmonary function.
Non invasive ventilation refers to the technique of providing ventilatory support without a direct conduit to the airway. It is a promising new technique, which is particularly useful in patients with COPD. Patients with COPD are prone to develop acute exacerbations, which pushes them into acute respiratory failure. Under these circumstances, tracheal intubation and mechanical ventilation is associated with significant morbidity and mortality. A number of well conducted studies support the fact that non invasive positive pressure ventilation (NIPPV) in these circumstances reduces rates of intubation, mortality, complications and duration of hospital stay. The biggest advantage of these techniques is their simplicity, ease of implementation and improved patient comfort allowing them to retain important functions like speech, cough and swallowing. NIPPV should be instituted early in the course of acute respiratory failure due to COPD before irreversible fatigue sets in. The current thinking is that NIPPV rests the respiratory muscles allowing other therapies time to be effective. Facilities for NIPPV should be available in all hospitals admitting patients with respiratory failure. Patients with severe, stable COPD who are hypercapnic and are deteriorating despite maximal conventional treatment should definitely be offered a trial of NIPPV. In such patients NIPPV has been shown to improve quality of life, reverse blood gas abnormalities, improve exercise tolerance and reduce hospital admissions. Physicians must familiarize themselves with this promising new ventilatory technique.
The effect of indoor air pollution due to domestic cooking with biomass fuel and liquefied petroleum gas (LPG) on the course of bronchial asthma was examined in one hundred non-smoking female asthmatics. The parameters for evaluation were symptoms, emergency visits, and drug requirements. The patients also measured peak expiratory flow rate (PEFR) at home five times daily over a period of one week and the levels of carboxyhaemoglobin (COHb) were estimated randomly during clinic visits. The COHb levels (%) were 4.1 +/- 0.9 and 3.5 +/- 0.6 in the two groups with 22-30% of the subjects reporting increased symptoms during cooking. The number of emergency admissions and the daily requirement of steroids were comparable in both the groups. The PEFR values were lower than the predicted values in both the groups at all times. Further, the readings after exposure to cooking fuels were lower than those before cooking in both the groups (p < 0.01) and these values were similar to those observed during early morning records at 6 AM, which were the lowest. It was concluded that exposure to biomass fuel and LPG affect pulmonary function (PEFR) in asthmatics and both types of fuels affect the airway function and symptoms of bronchial asthma in a similar manner.
Pneumonias due to Pneumocystis carinii (PCP) commonly occur in immunocompromised hosts. Although a treatable infection, it is associated with high mortality. A case of PCP presenting in an untreated case of systemic lupus erythematosus is reported, in view of the rarity of this association.
Idiopathic pulmonary fibrosis is a chronic inflammatory disorder of unknown aetiology with a number of inflammatory cells playing a role in its pathogenesis. In this study, we have attempted to find out the possible role of nitric oxide in its pathogenesis by way of measuring the nitrite and nitrate levels in the bronchoalveolar lavage fluid. Ten patients of histologically proved idiopathic pulmonary fibrosis and 10 controls (5 with normal chest skiagrams and 5 with sarcoidosis) were included in the study Bronchoalveolar lavage was carried out in these cases. The levels of nitrates and nitrites were increased in cases of idiopathic pulmonary fibrosis (0.77+/- 0.36 and 8.93 +/- 2.63 nmol/mg of protein) compared to those in controls (0.38 +/- 0.06 and 3.80 +/- 1.11, respectively for sarcoidosis patients); (0.39 +/- 0.13 and 6.56 +/- 1.61 for subjects with normal chest skiagrams). These differences were statistically significant (p < 0.05 to 0.01). These findings suggest a possible role of nitric oxide in the pathogenesis of idiopathic pulmonary fibrosis.
Three hundred seventy three previously diagnosed patients with lung cancer, attending the Lung Cancer Clinic at this institute were studied. Chest radiographs were interpreted in all cases. Radiography was compared in different cell types. Squamous cell carcinoma 158 (42.4%), followed by small cell lung cancer 122 (32.7%), was the commonest histological subtype. Upper zone was involved in maximum number of cases 158 (42%), followed by mid zone 122 (32.7%), lower zone 60 (16%) and the entire lung 33(8.8%). Adenocarcinoma presented as a peripheral mass in 37 (61%) cases and in 23 (38.3%) as a central lesion. Presentation as a central mass (114, 72.2% cases) was more common among squamous cell carcinoma than as a peripheral lesion (44, 27.8% cases). Similarly, small cell cancer also presented more commonly as a central lesion (102, 83.6% cases) than as a peripheral lesion (20, 16.4% cases). Isolated pleural effusion was present in 3.8% in squamous cell lung cancer, 22% in adenocarcinoma and only 4% in small cell lung cancer.
BACKGROUND: Hepatitis B and C viruses are important causes of liver related morbidity and mortality. We aimed at determining the presence of hepatitis B and C virus infections in the health care workers (HCWs) and their compliance for the HBV vaccination. METHODS: Three thousand five hundred and fifty six health care workers were screened for HBsAg and 115 for anti-HCV by ELISA. HBsAg negative individual were offered HBV vaccination and record of their compliance was kept. Anti-HBs titers were determined one month after 2nd or 3rd dose of vaccine in 273 subjects. RESULTS: Out of 3556 health care workers, 61 (1.7%) were found to be positive for HBsAg. One out of 115 HCWs (0.87%) was found to be positive for anti-HCV. Fifteen percent of HCWs received only one dose, 26% received two doses 59% received three doses and 2.5% also received the booster dose of the HBV vaccine. All those tested had anti-HBs titers more than 10 mUI/ml. CONCLUSION: In HCWs, HBsAg and anti-HCV prevalence was found to be 1.7% and 0.87% respectively. HCWs in our hospital, despite the awareness on HBV and HCV infection are noncompliant for HBV vaccination.
BACKGROUND: Bronchoscopic examination has been advocated as an essential part of evaluation of patients with newly diagnosed esophageal malignancy. The present study describes the role of routine preoperative fibreoptic bronchoscopy in staging disease and assessing resectibility in patients with malignancy involving the middle third of esophagus. METHODS: Preoperative fibreoptic bronchoscopy was performed in 125 patients with carcinoma of the middle third of esophagus. None of the patients had clinical or chest radiographic evidence of extension of disease outside the esophagus. RESULTS: Abnormalities were detected in 33 patients (25.6%), the commonest being external compression over the posterior wall of trachea in 17 (13.6%). Other abnormalities noted were left vocal cord paresis in seven (5.6%); compression over one or both major bronchi in seven (5.6%) and over the left lower lobe bronchus in one (0.8%); infiltration of the left main bronchus in two (1.6%); and growth in trachea in four (3.2%), in left main bronchus in two (1.6%) and over cricoarytenoid area in one (0.8%) patient. CONCLUSIONS: Tracheobronchial involvement, even in the absence of clinical or radiological features, is not uncommon in esophageal cancer. Preoperative bronchoscopy is useful to assess the extent of disease and resectibility in these patients.
The epidemiology, aetiopathogenesis, diagnostic methods and management of lung cancer in India have been reviewed based on the published data from this country. Over the years, the incidence has been increasing and the disease is being recognized more often. Smoking is the most important aetiological factor. Beedi smoking which is a common practice in this country is equally, if not more, harmful than cigarette smoking in causing lung cancer. Tremendous improvement has been made in various diagnostic techniques. Cytological methods, fiberoptic bronchoscopy and percutaneous lung aspiration are being used more frequently. At the treatment front, although radiotherapy and chemotherapy are being used, the results are not very encouraging. Except in few cases, surgery is usually not feasible because of advanced disease. Prevention of lung cancer by anti-smoking measures should be the main goal of solving the problem in this country.
BACKGROUND: Combination chemotherapy has been demonstrated as one of the best active regimens in patients with non-small cell lung cancer (NSCLC). METHODS: A total of 206 patients with advanced unresectable NSCLC stage III B or stage IV were enrolled to receive combination chemotherapy with mitomycin, ifosfamide and cisplatin. About a third of them (n=63) did not continue therapy after the first course either because of toxicity, lack of affordability, or death. The remaining 143 patients (121 males) received two or more cycles of chemotherapy. RESULTS: Nearly half of all followed-up patients showed a partial or complete radiological response. Overall performance status (Karnofsky scale) worsened in 28 (19.6%) and improved in 44 (30.8%). While 50 patients (35%) gained weight, 65 (45.5%) lost weight during follow-up. Overall median survival was 20 weeks [95% confidence interval (CI), 16 to 24 weeks]. However, overall survival improved progressively with the number of chemotherapy cycles administered. Median survival in patients receiving at least three, four and five chemotherapy cycles was 23 (95% CI, 19-27); 27 (95% CI, 24-30) and 35 (95% CI, 28-42) weeks respectively. Survival at the end of three, six, nine and 12 months was 64.3%, 29.4%, 14.7% and 9.8%) respectively. Survival had no association with age of the patient, but was significantly correlated with baseline performance status (Pearson's correlation coefficient 0.29 p<0.01). The cost of each course of chemotherapy was a little over 100 US dollars. The side effects were minimal and acceptable, and the regimen was tolerated well by all the patients. CONCLUSION: Ifosfamide regimen containing mitomycin and cisplatin is a chemotherapeutic combination for treating patients with advanced NSCLC.
A case with diagnosis of non-Hodgkin's lymphoma and superior vena cava obstruction on chemotherapy, presented with respiratory distress and massive pleural effusion of right hemithorax. On removal of 3.5 litres of fluid, he developed pulmonary edema of the same side and hypotension.
Thirty-four patients with non small cell lung cancer were treated with a combination of vinblastin and mitomycin-C. Major radiological response was observed in 61.5% of cases. Median survival of the treated patients was 6 months and it was 7 months for those showing a major response. Fourteen of the 21 responders survived for 6 months or more, and 4 survived for more than a year. Leucopenia was a common side effect, and it did not produce any major infective complication. We did not find any advantage of this regimen over other less expensive drugs used in our earlier trials.