Sleep apnoea and road traffic accidents.
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Accidents, Traffic↗
Biomedical subjects
R Guleria
Publications and source records attributed to R Guleria.
Idiopathic pulmonary fibrosis: newer concepts and management strategies.
Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic fibrosing interstitial pneumonia limited to the lung and associated with the histologic appearance of usual interstitial pneumonia (UIP) on lung biopsy. It is characterized by progresive dyspnea, worsening of pulmonary function and radiographically, by patchy subpleural interstitial infiltrates with minimal ground glass appearance predominantly affecting the lung bases. The etiology is unknown and no therapy has been clearly shown to prolong survival. The diagnosis, which earlier was difficult to establish, is now based on guidelines of American Thoracic Society. Newer insight into its etiopathogenesis, particularly the mechanisms involved including T helper 1 (Th1) and T helper 2 (Th2) types of responses occurring after the initial and repetitive lung insults and the ineffectiveness of conventional modes of therapy has prompted clinicians worldwide to look for alternative modes of therapy. Conventional therapy for this disorder has been steroids and immunosuppressives. Immunomodulators (Interferon gamma 1b) and antioxidants (Glutathione and its precursor N-acetyl cysteine) are promising results in this, otherwise, uniformly fatal condition.
Humans↗
Role of pleural fluid cholesterol in differentiating transudative from exudative pleural effusion.
BACKGROUND: Pleural fluid cholesterol has been reported to be useful in distinguishing between transudative and exudative pleural effusion. However, the difference in lipid profile between tubercular and non-tubercular pleural effusion has not been studied. METHODS: The lipid profile of pleural fluid in 50 patients with exudative (25 tubercular and 25 non-tubercular) and 25 with transudative effusion was studied. The diagnosis was based on clinical criteria and/or a positive diagnosis from another site. RESULTS: The criteria that best identified an exudative pleural effusion were pleural fluid cholesterol > or = 60 mg/dl, pleural fluid to serum cholesterol ratio > or = 0.4, pleural fluid triglyceride > or = 40 mg/dl and pleural fluid to serum triglyceride ratio > or = 0.3. Pleural fluid cholesterol had a sensitivity of 88% and a specificity of 100% for exudates with an accuracy of 92%. Pleural fluid to serum cholesterol ratio had a sensitivity of 98% and a specificity of 84%. These results were superior to the criteria proposed by Light et al. (sensitivity 98% and specificity 80%). CONCLUSION: Pleural fluid cholesterol estimation is an effective and cost-efficient method of differentiating exudative from transudative pleural effusion. The lipid profile does not help in diagnosing tubercular effusion.
Adult↗
Effect of single inhalation of a salbutamol, ipratropium bromide and beclomethasone on mucociliary clearance in patients with chronic obstructive airway disease.
BACKGROUND: Chronic obstructive airway disease (COAD) is associated with hyperplasia and hypertrophy of the mucus producing glands. The beneficial effect of inhaled drug may be due to improved mucociliary function. The present study was done to evaluate the effect of salbutamol, ipratropium bromide and beclomethasone dipropionate inhalation on mucociliary clearance in patients with COAD. METHODS: Ten patients of COAD were taken up, two patients however did not complete the study. Salbutamol, ipratropium bromide, beclomethasone dipropionate and placebo inhalation were given randomly to each patient on four separate days. Radioaerosol inhalation lung cine-scintigraphy after inhalation of the different drugs was followed up to two hours and than after 24 hours. RESULTS: There was no significant visually noticeable increased mucociliary clearance on any of the days. Two patients showed definite steep slope in the time activity curves with salbutamol as compared to other drugs or placebo. All the quantitative indices analysed at the end of one hour and two hours for the three drugs were comparable to placebo. CONCLUSIONS: A single dose of inhaled salbutamol, ipratropium bromide and beclomethasone dipropionate has no appreciable effect on mucociliary clearance in patients with COAD.
Administration, Inhalation↗
Domiciliary mechanical ventilation in a patient with severe chronic obstructive lung disease and respiratory failure.
A patient of chronic obstructive pulmonary disease (COPD) with cor-pulmonale and chronic respiratory failure, who was given intermittent positive pressure ventilation at home, is reported. The patient did remarkably well on home mechanical ventilatory support. We believe this to be the first case report of domiciliary mechanical ventilation in a patient of COPD from India.
Home Care Services↗
Posterior mediastinal teratoma.
A patient with benign posterior mediastinal teratoma which is a rare site for teratomas is reported. Chest skiagram and CT of the thorax established the diagnosis. Complete removal of the mass was not possible on surgery as it was adherent to the pericardium and the esophagus. The patient remained asymptomatic one year after the surgery. There was no evidence of recurrence of the tumor.
Adolescent↗
Bronchial hyperreactivity in chronic obstructive airways disease.
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Bronchial Hyperreactivity↗
Domestic cooking fuel and lung functions in healthy non-smoking women.
OBJECTIVE: The objective of this study was to compare the pulmonary functions in healthy non-smoking women who used either biomass or liquified petroleum gas (LPG) as their sole cooking fuel. The effects of passive smoking, ventilation, over crowding and cooking index were also taken into account. METHODOLOGY: The study was conducted over a period of two years from January 1994. One hundred healthy non-smoking women were included 50 cooked solely with biomass and 50 cooked with LPG. A standardised respiratory symptoms questionnaire was administered to all the subjects and spirometry was carried out. RESULTS: Passive smoking showed no significant difference between the two groups. No statistically significant differences was found in lung functions in the two groups except for the PEFR, which was significantly lower (P < 0.01) in women using biomass. No correlation was observed between different variables and pulmonary functions. The step-wise multivariate linear regression analysis showed no correlation between cooking fuel and the pulmonary functions. CONCLUSION: The absence of the expected adverse effects of biomass on pulmonary functions was possibly due to better ventilation in the kitchens of subjects in the biomass group compared to previous studies.
Adult↗
Non small cell lung cancer (NSCLC): current status and future prospects.
The incidence of lung cancer is rising dramatically and it is now the commonest cause of mortality and morbidity not only in the industrialised countries, but in developing nations like India as well. Tobacco smoking has consistently been demonstrated to be an important aetiological factor, though lung cancer occurs in non-smokers also. In spite of great advances in radiological and molecular diagnostic techniques, the ideal screening marker for early detection of lung cancer has still not been found. Histological diagnosis and staging is essential for selecting the mode of therapy in patients with lung cancer. Stages I and II are amenable to surgery. However, advanced stage III and IV need an individualised combination of surgery, chemotherapy and radiotherapy. With a better understanding of the cellular mechanisms operating in carcinogenesis, newer target specific modalities are being developed and tested in order to stem this disease, which threatens to assume epidemic proportions.
Carcinoma, Non-Small-Cell Lung↗
Unilateral pulmonary agenesis: an uncommon cause of lower zone lung opacity.
Congenital abnormalities of the lung are rare and are often misdiagnosed. We report the case of a young girl who was initially diagnosed to have pleural effusion with collapse. After detailed evaluation including computerised tomographic (CT) scan and fiberoptic bronchoscopy, a final diagnosis of unilateral pulmonary agenesis was made. This condition must be suspected in differential diagnosis in a young person presenting with features of lung collapse.
Adolescent↗
Human pneumocystosis.
Pneumocystis is an atypical fungus causing pneumonia in immuno-compromised individuals. Though previously termed as Pneumocystis carinii, the recent taxonomy has considered human derived Pneumocystis to be a different species Pneumocystis jiroveci. The organism is the most common cause of opportunistic infections among patients with acquired immunodeficiency syndrome (AIDS) in developed countries. Incidence of Pneumocystis pneumonia or pneumocystosis in developing countries including India continues to be low. Microscopy of appropriate clinical samples has been the mainstay of diagnosis of pneumocystosis. Amplification techniques are now being evaluated for detection of P. jiroveci. This review attempts to give a recent update on P. jiroveci with special focus on epidemiology, taxonomy, current diagnostic modalities and recommended immuno-prophylaxis.
Humans↗
Mycoplasma pneumonia associated with rhabdomyolysis and the Guillain-Barre syndrome.
A 25-year-old housewife who presented with Mycoplasma pneumonia who developed acute respiratory distress syndrome (ARDS) and required assisted ventilation. During her hospital stay, she developed acute renal failure because of rhabdomyolysis and was put on haemodialysis. She also had difficulty in weaning from ventilator because of acute motor-sensory axonal neuropathy (AMSAN) variant of the Guillain-Barre syndrome. The patient was treated with antibiotics and corticosteroids. The patient recovered from both the complications gradually.
Acute Kidney Injury↗
Cardiac sarcoidosis: an uncommon presentation of sarcoidosis in India.
Cardiac involvement in sarcoidosis is uncommon. The manifestations of cardiac sarcoidosis are protean and vary from benign ectopics to life threatening ventricular tachycardias. High index of suspcion and early aggressive intervention is required for the diagnosis and treatment of this condition. Early diagnosis is essential since ventricular tachycardia is the most common terminal event in these patients if left untreated. Corticosteroids are needed early in these patients which along with other antiarrhythmic management strategies including intracardiac defibrillator form the backbone of treatment. We describe four patients who were diagnosed to have pulmonary and cardiac sarcoidosis. Their varied presentations highlight the difficulties that may occur in the diagnosis. Furthermore, the need for proper management is stressed, as a delay in diagnosis may be fatal.
Adult↗
Tracheo-bronchial stenosis--report of 3 cases.
Three cases of large airway stenosis of different aetiologies are reported. In the first case, tracheal stenosis occurred after endotracheal intubation. The second case developed bronchial stenosis as a sequelae to pulmonary tuberculosis. The third case had localized stenosis of the left main bronchus for which no cause could be found. The first case responded completely to dilatation while the 2nd case demonstrated only partial response. Third case did not improve significantly with dilatation.
Adolescent↗
Systemic lupus erythematosus during isoniazid therapy.
A case of systemic lupus erythematosus (SLE) in a young female which developed during the course of isoniazid therapy for pulmonary tuberculosis is described. SLE in this case is believed either to be induced or precipitated by isoniazid. Pertinent literature has been reviewed.
Adolescent↗
Pulmonary hydatid disease presenting as non-resolving bilateral consolidations.
A 45-year-old female, post menopausal, presented with extensive bilateral radiological opacities in the lungs. Diagnosis of hydatid diseases was confirmed through open lung biopsy. Treatment with albendazole showed striking improvement in clinical symptoms as well as clearing of radiological shadows.
Albendazole↗
Correlation of lung function tests with dyspnoea scale, 12 minute walking test and visual analogue scale in patients with COPD.
Twenty-five patients with chronic bronchitis and emphysema were studied in an attempt to evaluate clinical methods for rating dyspnoea. Whereas the Medical Research Council (MRC) dyspnoea scale and the 12-minute walking test showed good correlation with pulmonary function tests, the visual analogue scale (VAS) did not. When the dyspnoea scales were compared with one another, the MRC scale and the VAS and the MRC scale and 12 minute walking test showed good correlation with one another.
Adult↗
Adenoid cystic carcinoma in a bronchial washing. A case report.
A case of adenoid cystic carcinoma of the trachea and bronchi diagnosed on a bronchial washing is reported. This tumor has characteristic cytomorphology best elucidated by May-Grünwald-Giemsa stain.
Adult↗