Rashmi Kushwaha

A study of skin sensitivity to various allergens by skin prick test in patients of nasobronchial allergy

Objective: To study skin sensitivity to various allergens in patients of nasobronchial allergy. Materials and Methods: 2880 skin prick tests with 60 allergens were performed in 48 patients of nasobronchial allergy. Results: Most common offending allergens were insects (21.2%), followed by dusts (12.0%), pollens (7.8%), animal dander (3.1%), and fungi (1.3%). The common insect antigen were locust female (33.3%) followed by locust male (25%), grasshopper (20.8%), cricket (16.7%), cockroach female (16.7%) and cockroach male (14.6%). Common dust allergens were house dust, wheat dust, cotton mill and paper dust. Among pollens, Amaranthus spinosus, Argemone mexicana, Adhatoda vasica, Ailanthus and Cannabis were found to be common allergens. In animal danders common offending allergens were cow dander and dog dander. Among fungi Aspergillus fumigatus, Aspergillus flavus, Alternaria teneis and Fusarium sodani were common allergens. Patients of bronchial asthma had associated allergic rhinitis in 80% cases. Conclusion: Common allergens in patients of nasobronchial allergy were identified. The data may prove useful in of allergen avoidance and immunotherapy in these patients.

Isolated metacarpal bone tuberculosis-a case report.

SUMMARY Tuberculous involvement of the metacarpals and phalanges is a rare presentation of extrapulmonary tuberculosis in adult. Here is a case of tubercular dactylitis in a 27 year old female presenting as discharging sinus over proximal part of third metacarpalbone of left hand.

Pulmonary and nodal multiple myeloma with a pleural effusion mimicking bronchogenic carcinoma

Multiple myeloma (MM) is a hematological malignancy characterized by the occurrence of plasma cell tumor within the bone marrow. Extramedullary plasmacytomas form a small percentage of plasma cell tumors, and although 80-90% of extramedullary lesions occur in the head and neck, pulmonary plasmacytomas are found to be a very uncommon clinical entity. Hereby, we describe a case of a patient with pulmonary plasmacytoma, who developed nodal and pulmonary MM with a pleural effusion, the radiological appearance of which mimicked bronchogenic carcinoma.

A follow up study on revised national tuberculosis control programme (RNTCP): Results from a single centre study

Objective: To know the follow up status of tuberculosis patients after 1 year of completion of treatment in RNTCP. Materials & Methods: Those patients of tuberculosis, who were registered from June 2003 to June 2004 at DOTS centre of our institution, were followed up at their homes after one year of completion of treatment between August 2005 and August 2006, with the help of health visitor. Patients were followed up clinically and symptomatic patients were also followed radiologically as well as bacteriologicalty. Results of the study were recorded in terms of number of patients remained asymptomatic, number of patients relapsed and number of patients died. Results: Out of 237 patients registered, 8 patients died during treatment period, 12 patients defaulted the treatment, the number of failures was 5 and 212 patients were declared cured/treatment completed. Out of these 212 patients 60 were unavailable for interview due to various reasons. The study observed that out of a total of 152 patients interviewed, 137 patients (90.1%) of remained asymptomatic, 11 patients (7.2%) had relapsed and 4 patients (2.6%) died during follow up. Conclusion: The study observed that majority of patients (90.1%) re-mained asymptomatic after the completion of one year of treatment under DOTS.

A study to know the knowledge, attitude, and practices of patients of bronchial asthma

Introduction: Asthma being a chronic inflammatory disease needs treatment for prolonged duration. To increase treatment compliance, each patient should know the course of disease, its precipitating factors, and management protocol. Despite the magnitude of the asthma, very little is known about its public perception. Aim: This study was done to know the knowledge, attitude, and practices of patients of bronchial asthma. Materials and Methods: In this prospective study, subjects were asthmatic patients attending the department of pulmonary medicine, KGMU Lucknow, India. A questionnaire including general understanding of asthma, its triggers and management was given to each patient and results were recorded. Results: A total of 140 patients with confirmed diagnosis of asthma were included in this study. On an average, each patient had already visited 3.2 doctors prior to coming to us. Out of 140 patients, 64% patients were ignorant regarding disease etiology, 47.1% patients thought that their disease is fatal, 30% patients were reluctant to accept the diagnosis of asthma. Regarding precipitating factors, 25.71% patients could not relate to any cause with their disease exacerbation. A total of 62.14% patients used alternative system of medicine too in the hope of getting rid of their disease. Oral medications were preferred by 62.1% patients, while 73.6% were using inhalers and out of them 71.8% were using inhalers incorrectly. Conclusion: Patient education program should augment awareness; eliminate social stigma, and misconcepts in the community regarding asthma. Knowledge about the prevailing perception in community would be the first step in achieving this.

CD8 expression in B chronic lymphocytic leukemia: A case of immuno-phenotypic aberrancy

Immuno‐phenotyping forms an integral part of laboratory work up of Chronic lymphocytic leukemia (CLL). Aberrant antigen expressions are a known phenomenon in leukemic blasts, however cross lineage antigen expression is rarely seen in mature B cell leukemia, the reported percentages varying from 1% to 3% in Europe and North America.

Patients’ perceptions about the implementation of Revised National Tuberculosis Control Programme of India

INTRODUCTION Revised National Tuberculosis Control Programme (RNTCP) was launched by the Government of India in 1993. The present study has attempted to analyze the perceptions of patients regarding the implementation of RNTCP. MATERIALS AND METHODS The present study was done in a teaching hospital in North India. All patients attending the hospital between March 2014 and July 2014 were included. The study design was cross-sectional using a pre-designed and tested questionnaire. The patients were questioned by personal interviews after obtaining an informed verbal consent. RESULTS 74.5% patients were not aware about the kind of disease they were suffering from. 80% patients said that they were not talked in detail about their disease. 64.79% patients said that their doctor was the source of knowledge regarding DOTS prior to treatment. Despite an average distance of 4.75km between their home and DOTS centre, 90.5% patients said that they did not have any problem in travelling to the DOTS centre for medications. 91.5% and 93.5% patients felt the DOT provider behaviour was supportive and satisfactory respectively. CONCLUSION 64% patients said that they were completely satisfied with the treatment under DOTS, 28.5% were partially satisfied and 7.5% were not satisfied with the treatment.

Correlation between clinical characteristics, spirometric indices and high resolution computed tomography findings in patients of chronic obstructive pulmonary disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease affecting the airways, leading to significant morbidity and mortality throughout the world. There is a need to have a holistic evaluation of COPD patients, other than just measuring the level of obstruction as performed by spirometry. High resolution computed tomography (HRCT) scan of thorax partly fulfills this requirement. Materials and Methods: Fifty patients of COPD (confirmed on spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. Complete clinical evaluation was done. The Philips computer program for lung densitometry was used with these limits (−800/−1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes. Results: There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). Mean upper lobe MLD was −839.27 HU, mean lower lobe MLD was −834.91 HU and the mean MLD was −837.08 HU. The lower lobes MLD were found to be decreasing with increasing disease severity. A mild linear correlation of pre forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of Post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. A predictive model can be derived to quantify obstruction severity (FEV1). Conclusion: HRCT may be an important additional tool in the holistic evaluation of COPD. HRCT can well be correlated with the spirometric and clinical features and the level of obstruction can be indirectly derived from it by measuring the MLD.

Severe anemia due to parvovirus B19 in a silver haired boy

Griscelli syndrome (GS) is a rare autosomal recessive immunodeficiency disorder in which the affected children present with characteristic silvery-white hairs. The hair microscopy of these children is characteristic and is helpful in differentiating GS from Chediak-Higashi syndrome which also presents with immunodeficiency and silver hairs. We report a 17-month-old boy with GS type 2 who presented with severe anemia. Bone marrow examination of the child suggested parvovirus B19 as the cause of severe anemia, which was later confirmed by DNA polymerase chain reaction.

Accelerated Phase of Chediak-Higashi Syndrome at Initial Presentation: A Case Report of an Uncommon Occurrence in a Rare Disorder.

Chediak-Higashi syndrome (CHS) is an uncommon and fatal congenital disorder. The characteristic features of CHS are partial oculocutaneous albinism, increased vulnerability to infections, presence of abnormal large granules in leukocytes and an accelerated lymphohistiocytic phase. Accelerated phase at initial presentation is rarely seen as it is usually preceded by repeated episodes of infections. Hence this interesting case of a four-month-old Indian child born to consanguineous parents in accelerated phase at initial presentation is described. The boy presented with fever, hepatosplenomegaly, and cleft lip. Clinical diagnosis was leukemia or a lysosomal storage disorder. Cytopaenias, lymphohistiocytic infiltration in bone marrow, and the characteristic large granules in leucocytes helped in the diagnosis, emphasizing the importance of bone marrow in diagnosis of unusual presentation of this rare disorder.