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Background: In India, asthma imposes a substantial burden; though the disease still remains under-recognized, underestimated and under-treated in masses.With a global need of promoting rational drug use in healthcare, drug utilization pattern studies could provide feedback to prescribers and help in fostering rational drug usage. The present study was planned to study the drug utilization pattern in patients of asthma in a tertiary care set-up in eastern India and to evaluate it with respect to GINA guidelines. Materials and Methods: The study was carried out over a period of one year where cases with confirmed diagnosis of asthma, who gave informed consent to participate were included.Drug usage pattern was determined in the light of drugs prescribed, mean drugs per prescription, percentage of drugs prescribed in generic name and having conformation to national essential drug list. Percentage of inhalational, injectable, fixed dose combination and antibiotics per prescription were noted. Data were checked for completeness and statistically analysed. Results: The present study included 370 participants. A total of 1514 drugs were prescribed, with 4.09 drugs per prescription. 12.55% of drugs prescribed were from national essential drug list. A total of 1031 anti-asthma drugs were prescribed with 2.8 anti-asthma drugs per prescription. Among the various classes of anti-asthma drugs, maximum prescribed were inhalational corticosteroids, followed by long acting inhalational beta 2 agonist and anti-leukotriene drugs. 96.5% of total patients were on inhalational drugs, with budesonide and formeterol being majorly prescribed. Conclusion: The usage pattern as assessed in our study was in conformation to GINA guidelines. Guidelines like GINA have enlightened physicians about the rational prescribing in asthmatic patients.

Aim:To study the difference in clinical presentation, baseline laboratory parameters, radiological parameters, CSF picture, response to treatment, in-hospital outcome, nal outcome in follow up & any parameters signifying poor outcome in advance in patients of TBM both in HIV+ve& HIVve group. Material and methods:This comparative non-randomised prospective study was conducted from 16th June,2012 to 15th June,2013 in Medical College Hospital. Total 53 patients were referred where 23 patients had TB Meningitis with HIVand 30 patients had TB Meningitis without HIV. Result: In our study we have found no statistically signicant differences in age distribution, and distribution of symptoms at presentation. The classical symptoms like fever, headache, and vomiting, altered sensorium all are present in both groups and the differences are not statistically signicant. Conclusion:HIV+ve patients show relatively less intense reduction of CSF sugar level in relation to blood sugar level estimated simultaneously.Two factors with high mortality are advanced stage of TB meningitis at presentation, low CD4 count.

Aims: 1 Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2 Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. Methods Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. Results Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. Conclusions New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.

Introduction: Contrast enhanced computed tomography (CECT) thorax & Fibre Optic Bronchoscopy (FOB) are main investigations in patients of hemoptysis with normal chest X-ray. But there are limited data on their diagnostic yield especially from South East Asia. Methods : An observational study on 60 patients with hemoptysis with normal chest X -ray was conducted from April 2012 to April 2014. CECT thorax and FOB were done in all of them. Results : Out of 60 patients 38 (63.3%) were male with even age distribution. Yield of CECT was 40% (24 patients) and main diagnosis were bronchiectesis (25%) and tuberculosis (11.6%). Diagnostic yield of FOB was 47% (28 patients) with predominant diagnosis of tuberculosis (18.33%), bronchitis (18.33%) and bronchogenic carcinoma (6.66%). Overall diagnostic yield was 76.6% (46 cases). Bronchogenic carcinoma cases were all male smokers and 3 of them were more than 40 years old. Conclusion : CECT thorax and FOB are complimentary to each other in evaluation of hemoptysis with normal chest x-ray. Bronchogenic carcinoma and tuberculosis cases require specific treatment and they were diagnosed in confirm way only by FOB. So, FOB have advantage over CT scan, especially among patients with increased risk of bronchogenic carcinoma (male-smokers with age > 40 years).

Context: Hyponatraemia is one of the common electrolytic disorders which are associated with lung cancer. Hyponatraemia may influence the ECOG performance status at presentation. Also, to the best of our knowledge, we found only limited Indian studies where the ECOG score was correlated with the serum sodium status in lung cancer patients on presentation. Aim: To assess the incidence of hyponatraemia among the patients of carcinoma of the lung before putting them into the specific treatment category for cancer and to check the effects on their ECOG performance status. Settings and Design: A cross–sectional, observational study was conducted on 116 consecutive patients of lung cancer during the period from November 2011 to October 2012. Material and Methods: The patients with a histologically proven diagnosis of lung cancer were grouped initially according to their ECOG performance statuses. The serum sodium value of each patient was measured and the hyponatraemic patients were given treatment according to the protocol. The correlation of the ECOG performance status with the serum sodium of the lung cancer patients was measured. To check for any laboratory error in serum sodium, we selected (n = 58) age, sex and socioeconomic matched control patients. Results: At presentation 44.8% of the lung cancer patients showed hyponatraemia [52/116]. The ECOG score was significantly poor in the advanced clinical stages (ECOG ≤2 Vs ECOG ≥ 3 in NSCLC cases, χ2 =11.25, P=.0008). The ECOG performance status score at admission showed a negative correlation with the serum sodium status which was measured on admission among all the patients (Pearson correlation coefficient = – 0.186). The clinical stage of the lung cancer also showed a positive correlation with the ECOG score at admission in our study (Pearson correlation coefficient = 0.295). Conclusion: Hyponatraemia is not an uncommon condition and it should be suspected and screened in each patient, as it may influence the ECOG performance status score, which serves as an important factor in the prognosis of lung cancer.

Background: Stroke accounts as one of the leading cause of morbidity and mortality and third most common cause of death worldwide. In a significant percentage of stroke patients no definite cause can be identified. These group of unknown cause, the so-called ‘cryptogenic strokes’ are associated with some novel risk factors and now a major focus for clinical discussion. Objectives: To find out conventional risk factors behind ischemic stroke and to establish correlation between ischemic stroke with elevated lipoprotein(a), Homocysteinemia, elevated High-sensitivity C-reactive protein (hs CRP),Systemic Lupus Erythematous (SLE) and chronic H.pylori infection and carotid intimo-medial thickness(CIMT). Materials and methods: Thirty (30) admitted ischemic stroke patients based on WHO definition and confirmed by axial CT and or MRI Scan. were included. Thirty (30) controls were recruited from close relatives of the patients attending the Medicine OPD without any prior history of stroke or coronary heart diseases. Risk factors were documented on the basis of biochemical tests performed. Results : Statistically significant association of ischaemic stroke with diabetes,hypertension, smoking, homocysteine, Lp(a), hsCRP, LVH, CIMT,H.pylori infection. No association of valvular heart disease, atrial fibrillation, A.N.A was found with ischaemic stroke. Conclusion: In addition to measures that include blood sugar, blood pressure and lipid control routine estimation of Lp(a), homocysteine level, monitoring of atherosclerotic changes in carotid artery by Doppler study, echocardiographic monitoring of LVH should be done so that appropriate steps can be taken to avert an attack of stroke. Lastly early detection and eradication of H.pylori is always advisable to reduce the incidence of ischemic stroke. DOI: http://dx.doi.org/10.3329/jom.v14i1.13165 J MEDICINE 2013; 14 : 11-17

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant inherited disorder of the vascular system. It can be asymptomatic but when symptomatic most common presentation being epistaxis. It can involve any organs of the body like lungs, skin, liver brain, GI mucosa etc. We are reporting a case of HHT presented to us with dyspnea and severe anemia. He had arteriovenous malformations of different visceral organs and telangiectasia of skin along with presence of similar history in first-degree relatives.

Chronic arsenic exposure causes cutaneous effects like hyperkeratosis, peripheral vascular disease, hypertension, ischemic heart disease, non-cirrhotic portal hypertension, hepatomegaly, peripheral neuropathy, respiratory involvement, bad obstetrical outcome, hematological disturbances, and diabetes mellitus. Here we present a case of a 24-year-old lady, with chronic exposure to arsenic, presenting to us with progressive dyspnea. We found pulmonary arterial hypertension (PAH) as a cause of her dyspnea. PAH can occur in arsenicosis, secondary to arsenic-induced chronic obstructive pulmonary disease (COPD), lung fibrosis, and portal hypertension, which we excluded by appropriate investigations in our case. We also excluded a familial or heritable form of PAH. Thus, with the exclusion of all these secondary causes of PAH, as well as a hereditary cause, we came to a conclusion that this PAH might be due to chronic arsenic exposure. To the best of our knowledge, no case of PAH in chronic arsenicosis has been reported to date.

Hamartoma is one of the common benign tumor of lung. These lesions represent an abnormal proliferation and mixing of the normal components of the lung tissue. Most hamartomas are asymptomatic. We report a rare case of giant pulmonary hamartoma (12 cm in diameter) occupied almost whole of left hemithorax. Computed tomography guided fine-needle aspiration cytology revealed a benign cartilaginous neoplasm, suggestive of chondroid hamartoma. Tru-cut biopsy of the tumor confirmed the diagnosis. Complete resection of the tumor was performed. Patient was on a regular follow-up postoperatively for 6 months without any clinical and radiological relapse.

Antitubercular drug (ATD) induced eosinophilic lung disease is a rare phenomenon. It usually occurs due to isoniazid and para amino salicylic acid. A 34-year-male of sputum positive pulmonary tuberculosis, on antitubercular drugs (rifampicin, isoniazid, ethambutol, and pyrazinamide) for last 3 weeks, presented with generalized arthralgia and maculopapular rash for last 2 weeks and shortness of breath for last 1 week. Chest X-ray and High resolution computerized tomographic scan thorax showed bilateral peripheral airspace opacification. Bronchoalveolar lavage revealed 51% eosinophils of total cellularity (1200/cmm) confirming the diagnosis of pulmonary eosinophilia. ATD was stopped for 2 weeks and then reintroduced one by one. Patient again developed similar kind of symptoms with reintroduction of ethambutol. According to criteria for drug induced pulmonary eosinophilia, he was diagnosed as a case of ethambutol induced pulmonary eosinophilia.

The 6-min walk test (6MWT) is a simple, inexpensive test of functional exercise capacity. The 6MWT distance (6MWD) in healthy adults varies geographically, emphasizing the need for population-specific reference equations. The purpose of the present study was to investigate the influences of the habitual physical activity (HPA) score and other anthropometric and demographic parameters on the variability of the 6MWD among healthy adults and to propose a reference equation.This was a prospective, cross-sectional, observational study. The 6MWT was conducted in a 30-m hospital corridor on 201 healthy volunteers, 125 men and 76 women, aged 20-60 years. The HPA in the previous 6 months was assessed using Baecke's questionnaire. Univariate analysis followed by multiple regression analysis was performed to analyze the significance levels of different probable predictors.The 6MWD was significantly greater in more active than in less active subjects (663.8±55.4m vs. 599.9±67.8m, p0.001). The regression analysis showed that the subject's age in years (p=0.017), gender (p=0.006), height in cm (p=0.004), weight in kg (p0.001), total activity score (TS) (p0.001), and absolute difference in heart rate before and after exercise (p0.001) could explain 48.9% of the variability in the 6MWD in healthy adults.The HPA score is probably the most appropriate variable to include in the reference equation predicting the 6MWD in healthy adults from the Indian subcontinent.

In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent. Keywords: Arsenicosis, chronic diarrhoea, chronic eosinophilic pneumonia, noncirrhotic portal fibrosis.

Testicular tuberculosis (TB) is a rare form of genitourinary TB. It is usually presented as painful or painless testicular swelling with or without scrotal ulceration or discharging sinus. Infertility may occur. Epididymal involvement is usually seen in testicular TB. In most cases, genital TB is associated with TB involvement of kidneys or lower urinary tract. Ultrasound (USG) and USG-guided fine needle aspiration cytology of testicular swelling confirm the diagnosis. Anti-TB chemotherapy is the mainstay of treatment to ensure the complete resolution of the lesion. However, in very few cases, orchidectomy is required for both diagnosis and treatment. Here, we report a very rare case of left sided isolated testicular TB in a 20-year-old male who was completely cured with 6 months regimen of anti-TB chemotherapy.

Context: A good proportion of patients with undiagnosed pleural effusion (PE) turn into malignancy over a period of time. Identification of positive biomarker may help in selecting the individuals who require close follow-up. Aims: The aims of this study were to evaluate the role of DR-70 immunoassay in suspected malignant PE. Settings and Design: We conducted a cross-sectional study among 89 patients of suspected malignant PE and 50 normal subjects (NS) were taken as control. Materials and Methods: Patients with exudative PE; who had pleural fluid lymphocyte count greater than 50% and adenosine deaminase less than 30 U/L were taken as cases. We had selected NSs among relatives of patients having normal blood chemistry and radiological investigations. Sensitivity and specificity of the test to differentiate malignant and non-malignant PE and also to identify PE with underlying malignancy was analyzed. Results: Mean value of DR-70 in NS was found to be 0.83 ± 0.273 mg/L without any significant difference between males (0.82 mg/L) and females (0.85 mg/L). Mean value of DR-70 in PE with underlying cancer was 5.03 ± 3.79 mg/L. Sensitivity (80%) and specificity (77.78%) of the test was maximum in PE with underlying cancer using cut-off value of 2 mg/L. Mean value DR-70 in malignant PE was 5.18 ± 3.75 mg/L and in non-malignant PE was 3.73 ± 3.74 mg/L without any statistically significant difference (P = 0.08). Conclusions: DR-70 assay has high sensitivity in detecting underlying lung cancer, but has no role in differentiating malignant PE from non-malignant PE.

Breast metastases from extramammary neoplasm are uncommon with an incidence of 0.5% to 3% of patients with extramammary malignancy. We reported an extremely rare case of breast metastasis from squamous cell lung carcinoma. A 60-year-old woman suffered from dry cough with shortness breath for one month with simultaneous development of breast lump. The histological diagnosis, achieved by bronchoscopic lung biopsy with the aid of immunohistochemistry was squamous cell lung carcinoma. Breast lump was a metastasis from lung, confirmed by histopathology and immunohistochemistry after core needle biopsy. Secondary malignancy metastatic to the breast is uncommon, yet this entity does exist. In view of the therapeutic implication, a metastatic breast lesion should not be mistaken for a primary breast carcinoma. Only with the awareness of such a possibility can prompt diagnosis and optimal treatment be achieved.

A 18 year old Hindu boy presented with left sided chest pain, shortness of breath, high fever and swelling of left side of chest and left arm. He was anaemic with fea-tures of Superior Venacaval (SVC) Obstruction. CT Scan of Thorax revealed huge heterogeneous anterior mediastinal mass. He had very high level of serum alpha fetoprotein. CT guided Fine Needle Aspiration Cytology (FNAC) gives the diagno-sis of Yolk sac tumour . As USG of abdomen and testes were normal, it is a case of primary mediastinal Yolk sac ( Endodermal sinus ) tumour. Although nonseminomatous germ cell tumour is 30-40% more common in Klinefelter′s syndrome [1] , Karyotyping of this patient was normal.