Objectives/Hypothesis: To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea-hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea-hypopnea index (AHI). Study Design: Consecutive patients with obstructive sleep apnea-hypopnea syndrome who were evaluated in a public otorhinolaryngology center were studied. Methods: Adult patients evaluated previously with polysomnography met the inclusion criteria. All subjects underwent clinical history and otolaryngological examination and filled out a sleepiness scale. Physical examination included evaluation of pharyngeal soft tissue, facial skeletal development, and anterior rhinoscopy. Results: Two hundred twenty-three patients (142 men and 81 women) were included (mean age, 48 ± 12 y; body mass index, 29 ± 5 kg/m 2 ; AHI, 23.8 ± 24.8 events per hour). Patients were distributed into two groups according to the AHI: snorers (18.4%) and patients with sleep apnea (81.7%). Sleepiness and nasal obstruction were reported by approximately half of patients, but the most common complaint was snoring. There was a statistically significant correlation between AHI and body mass index (P <.000), modified Mallampati classification (P = .002), and ogivale-palate (P <.001). The retrognathia was not correlated to AHI, but the presence of this anatomical alteration was much more frequent in patients with severe apnea when compared with the snorers (P =.05). Other correlations with AHI were performed considering multiple factors divided into two groups of anatomical abnormalities: pharyngeal (three or more) and craniofacial (two or more) abnormalities. There was a statistically significant correlation between pharyngeal landmarks and AHI (correlation coefficient [r] = 0.147, P =.027), but not between craniofacial landmarks and AHI. The combination of pharyngeal anatomical abnormalities, modified Mallampati classification, and body mass index were also predictive of apnea severity. Conclusions: Systematic physical examination that was used in the present study indicated that, in combination, body mass index, modified Mallampati classification, and pharyngeal anatomical abnormalities are related to both presence and severity of obstructive sleep apnea-hypopnea syndrome. Hypertrophied tonsils were observed in only a small portion of the patients. The frequency of symptoms of nasal obstruction was high in sleep apnea patients. Further studies are needed to find the best combination of anatomical and other clinical landmarks that are related to obstructive sleep apnea.

Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome

Background: The prevalence of childhood bronchial asthma and allergic disease has increased in developed countries. Studies have identified asthma among Indian children. Still, there is paucity of information on the overall prevalence of childhood asthma in India. Objective: To assess time trends and the overall prevalence rate of bronchial asthma among Indian children. Materials and Methods: Literature search for data sources was done through an extensive search in indexed literatures and website-based population survey reports. Fifteen epidemiological studies were identified on the development of asthma in Indian children from 300 potentially relevant articles. A broad criterion to define both allergic and non-allergic descriptions of asthma in Indian children was formed. Moreover, in the absence of universally accepted criteria by reporting of prevalence by researchers, weighted average data was considered during calculations of prevalence rates, irrespective of the criteria for diagnosis. Statistical analyses used were mean and median. Results: Wide differences in samples, primary outcome variables, lack of consistency in age category, rural-urban variation, criteria for positive diagnosis, and study instruments confounded the outcome variables. The mean prevalence was 7.24 ± SD 5.42. The median prevalence was 4.75% [with IQR = 2.65 - 12.35%]. Overall weighted mean prevalence was found to be 2.74. Childhood asthma among children 13 - 14 years of age was lower than the younger children (6 - 7 years of age). Urban and male predominance with wide inter-regional variation in prevalence was observed. Conclusions: Our findings indicate that the burden of bronchial asthma in Indian children is higher than was previously understood.

Prevalence of bronchial asthma in Indian children.

To compare the health related quality of life (HRQoL) between pulmonary and extrapulmonary tuberculosis (PTB and EPTB) patients at pre- and post-intensive phases of treatment. A total of 173 PTB and 160 EPTB patients were selected from the TB centers in Sana’a, Yemen. The patients were given DR-12 questionnaire, measuring three domains: symptoms, life activities and social activities. DR-12 was subjected for internal consistency, reliability and linguistic validation. Quality of life was measured at onset, after one month, and at the end of intensive phase of treatment. Patients with PTB had significantly worse HRQoL score compared to EPTB (P < 0.05). The greatest difference was observed in the dimension reflecting symptoms, during the intensive phase. The improvement in HRQoL for both PTB and EPTB patients for the three domains, after one month and at the end of intensive phase compared to the baseline were statistically significant (P < 0.001). The HRQoL did not improve in PTB patients who failed to convert at the end of the intensive phase compared to the first month. At baseline, PTB patients have significantly lower HRQoL than EPTB. Both PTB and EPTB patients significantly improved after onset of treatment. The converted PTB patientsimproved in symptoms as compared to the non converted PTB patients.

	 

	Key words: Yemen, DR-12 questionnaire, health-related quality of life, tuberculosis.

Health related quality of life of pulmonary and extrapulmonary tuberculosis patients in Yemen

To assess the association between serum 25 hydroxy vitamin D levels and asthma and its control in Indian children. This was a prospective case–control study conducted in tertiary care hospital. Cases of asthma and healthy age-matched controls were included, aged 1–15 y, who had not received any vitamin D supplementation in the last year and had no other co-morbidity, after obtaining written informed parental consent. 25 hydroxy vitamin D insufficiency was taken below level of ≤ 30 ng/mL. Fifty asthmatics and 25 age-matched controls were recruited from August 2011–July 2012. 25 hydroxy vitamin D insufficiency was associated with occurrence of asthma (OR = 13.5; 95 % CI = 4.25–42.85: p = 0.000). With decreasing level of asthma control there was increasing strength of association with 25 hydroxy vitamin D insufficiency [χ
 2 for trend = 24.96 (p = 0.000)]. 25 hydroxy vitamin D insufficiency is associated with bronchial asthma as well as its level of control.

Serum 25 hydroxy vitamin D insufficiency associated with bronchial asthma in Lucknow, India

Department of Gen. Pathology and Microbiology, Dental College and Hospital, Bharati Vidyapeeth Deemed University, Pune 411043, Maharashtra, India Department of Dravyaguna Vigyan, College of Ayurved, Bharati Vidyapeeth University, Pune 411043, Maharashtra, India Department of Periodontology, Dental College and Hospital, Bharati Vidyapeeth Deemed University, Pune 411043, Maharashtra, India Department of Microbiology, Medical College, Bharati Vidyapeeth Deemed University, Pune 411043, Maharashtra, India *Corresponding author

https://www.ijcmas.com/vol-3-1/Korhalkar%20Anagha,%20et%20al.pdf

Antimicrobial activity of Yashtimadhu (Glycyrrhiza glabra L.) - A Review

After a steady decline throughout the 20th century, the incidence of tuberculosis (TB) in industrialized countries has started to rise again. However, in developing countries like India, the menace of TB had never been controlled. Gastrointestinal (GI) TB is rare, and the GI tract is considered only the sixth most frequent site of extrapulmonary TB. Esophageal TB (ET) is still rarer. This is a case report of a rare form of ET in a patient presenting with dysphagia. The patient was subjected to upper GI endoscopy, which revealed an ulcerative growth in the distal esophagus. Histopathology revealed ET. The patient was managed conservatively with anti-TB treatment (ATT). In spite of the rare nature of the disease, it can be managed effectively with ATT to avoid complications (fistula, stricture, and esophageal perforation), which might warrant surgery.

Esophageal tuberculosis: A rare case report.

Prevalance of Bronchial Asthma among school children in urban and rural areas

Background: Approximately 15% to 20% of tuberculosis (TB) cases in India are estimated to have extrapulmonary tuberculosis, and tuberculous effusion being the second most common extrapulmonary manifestation after tuberculous lymphadenitis. Due to its paucibacillary nature, it is difficult to demonstrate tubercle bacilli by the standard staining procedures which is the gold standard for diagnosis, thus leading to a large number of cases being undiagnosed or misdiagnosed. Now, it has further been complicated by the emergence of multidrug resistance. In December 2010, World Health Organization endorsed the Gene Xpert MTB/RIF technology for diagnosis of mycobacterium tuberculosis and rifampicin resistance which is providing result within 2 hour. Aims: This study was done with an aim to know the role of Gene Xpert in the diagnosis of tubercular pleural effusion. Results: A total of 136 patients of pleural effusion with strong clinico-radiological and pathological suspicion of tubercular etiology were included in our study and their pleural fluid was examined for Gene Xpert MTB/RIF. In 20.58%(28) patients, Mycobacterium tuberculosis was detected and out of these, 21%(6) had rifampicin resistance. Conclusion: Because of its rapidity, simplicity, and sensitivity, Gene Xpert MTB/RIF technology is emerging as a novel and promising technique to diagnose tuberculous effusion and rifampicin resistance, which was undiagnosed most of the time . Although, it has limited availability at present, and for this more research studies should be conducted.

/pdf/role-of-gene-xpert-mtb-rif-assay-in-diagnosis-of-tubercular-3dtg6bm80v.pdf

Nirmal C. Kajal

Papers

Esophageal tuberculosis: A rare case report.

Prevalance of Bronchial Asthma among school children in urban and rural areas

Role of gene Xpert MTB/ RIF assay in diagnosis of Tubercular Pleural Effusion

Health Related Quality of Life(HRQL) Scoring in Tuberculosis

Role of sonography in diagnosis of pleural and lung diseases