Interprofessional collaboration to manage allergic disorders in rural areas of Himachal Pradesh

Background: Allergic disorders are common and affect a large population even in rural areas. Medical care is not easily accessible to rural population especially in hilly terrain. Health camps are effective method to deliver medical care in such areas. Interprofessional collaboration involving various professions who work together as a team for management of various disorders is being studied and practiced recently. Aims and Objectives: To study the impact of interprofessional collaboration at these rural health camps to control allergies prevalent in the rural areas of the region. Methodology: Around 18 interprofessional health camps involving doctors of various disciplines – ENT, pulmonary medicine, skin, eyes, yoga experts, health and sanitation workers, public health, lab technicians, pharmacist and nursing staff were held in rural areas with an attempt to manage allergic disorders prevalent there as a team. The treatment was provided as a collaboration of various professions. Results: 608 patients of allergic disorders were identified at these camps which were more prevalent in younger and middle age group and females. The common allergens were dust mite mix, pine mix, cockroach and grass pollen. Nasal allergies were more common followed by skin and pulmonary allergies. On follow up, allergies were more controlled (48%) in patients who followed interprofessional advise and treatment as compared to (5%) in those who didn’t follow the same. Conclusion: Allergic disorders can be best managed by a holistic approach of treatment involving various professions. Health camps through interprofessional approach are an excellent method to provide medical care to rural population in difficult hilly terrain. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 96-100

A Correlational study on quality of life and disease severity among Chronic Obstructive Pulmonary Disease (COPD) clients attending a pulmonary Medicine OPD of a Tertiary care hospital, Kolkata

Chronic obstructive pulmonary disease (COPD) is recently the most common chronic lung disease and presents a serious medical, economic, and social problem for people. A correlational survey research was adopted to identify relationship between quality of life and disease severity among Chronic Obstructive Pulmonary Disease (COPD) clients attending Pulmonary Medicine OPD in a selected hospital, Kolkata with the objectives to assess the quality of life of Chronic Obstructive Pulmonary Disease (COPD) clients and to find out correlation between disease severity and quality of life among Chronic Obstructive Pulmonary Disease (COPD) clients. Purposive sampling technique was adapted to select 138 Chronic Obstructive Pulmonary Disease (COPD) clients attending Pulmonary Medicine OPD in a tertiary care hospital, Kolkata. The structured interview schedule was used to collect on demographic data and standardized WHO QOL BREF tool was used to assess Quality of Life. Standardized GOLD criteria were used to assess disease severity of COPD clients. Reliability of the demographic data collection tool was established by inter- rater method and r was 0.77. All the tools were tried out before final data collection. The finding of the study revealed statistically non-significant relationship between all the domain of QOL and disease severity of COPD patients. Total Quality of Life score is also not significantly related with COPD Disease severity score. The study results also showed that QOL is not associated with sociodemographic characteristics. The study concluded that, there is no correlation between quality of life and disease severity.

Evaluate Breathing Exercises on Improvement in Respiratory Status among Patients with Respiratory Diseases

Background: Respiratory diseases are typical issue of the airway that hampers the normal airflow and leads to airway inflammation. The impacts of breathing exercises on respiratory diseases have been concentrated to discover its role on improvement of respiratory status. Objective: To estimate breathing exercises on improvement in respiratory status among patients with respiratory diseases. Material and method: A pre experimental, one group pre-test post-test design was adopted on 50 samples with respiratory diseases selected by convenient sampling technique from Medicine (male and female), Pulmonary Medicine, CTVS ward of Guwahati Medical College and Hospital, Assam. Data collected through structured interview schedule for demographic and clinical variables and “modified respiratory status scale” for assessing respiratory status. The group received intervention for 3 minutes one time daily for 7 days. Post-test was done on 7th day. In this study, deep breathing exercise and pursed lip breathing exercise were used. Data were analyzed by using the software package SPSS 2.0 version. Results: the pre-test respiratory status mean was 7.6 and post-test respiratory status mean was 4.98 mean difference was 2.62. The difference in mean scores shows a significant improvement of Respiratory status among patients with Respiratory Diseases. The t’ value of the breathing capacity by using modified respiratory status scale (13.55) was much higher than the ‘p’ value at 0. 05 level of significance. So, Breathing Exercises (Deep Breathing Exercise and Pursed Lip Breathing Exercise) was effective which improve the respiratory status among Respiratory Disease patients. Respiratory status is associated with Gender, History of previous hospitalization and no association with clinical variables. Conclusion: The study concluded that breathing exercises is effective in improvement of respiratory status among patients with respiratory diseases.

Anatomical Variation in the Fissurization of Lung with Embryological and Clinical correlations- A Case Report

Lungs are paired conical organs present in the thoracic cavity, which are responsible for gaseous exchange for oxygenation of blood. Both the lungs are divided into lobes by fissures. The right lung is divided into upper, middle and lower lobes by two fissures. The fissures are horizontal and oblique fissure whereas the left lung is divided into upper and lower lobes by oblique fissure. The left lung is divided into upper and lower lobe by oblique fissure. Both the lungs have ten bronchopulmonary segments (structurally separate and functionally independent units). Embryological evidence showed that the lungs developed from the endodermal counterpart of the foregut. Around 22 days of embryonic period, diverticulum are develop, then between 26-28 days lung buds develop. The right bronchial buds and left bronchial buds are branched into secondary and tertiary buds at 5th and 6th week of embryonic life consecutively. During routine anatomy dissection and demonstration in the Department of Anatomy, a 50 year old male cadaver showed anatomical variation in the right lung. The present study observed that the right lung showed partial horizontal fissure. The reason for partial or incomplete fissure formation is due to incomplete or absence of obliteration of prenatal fissure which indicates partial fusion of lobes, generally fissures separating the broncho-pulmonary segments in prenatal life. The reports says that incomplete fissures of the lung may lead to spread of infection like pneumonia to adjacent lobe and collapse in endobronchial lesions and gradation of the fissures of the lungs are very important for lung surgeries. The present study concludes that the knowledge of anatomical variation of lung is of utmost important in the field of pulmonary medicine.

Aspect of Thoracoscopic Biopsy in Pleural Malignancy

BACKGROUND Medical thoracoscopy, in the educated fingers of a pulmonologist, is a secure and powerful process for the diagnosis and treatment of many pleural diseases. If the centres for thoracoscopy are available, thoracoscopy should be carried out on those undiagnosed sufferers due to its excessive sensitivity in malignant and tuberculous pleural effusions. That is why the ultimate decade witnessed an interest in thoracoscopy as a diagnostic device for pleural diseases. In the existing study, we wanted to describe our experience with the function of thoracoscopic biopsy in patients who underwent thoracoscopy for diagnostic purposes. METHODS The study protocol and ethical approval were taken by the Institutional Review Board for human studies of B. J. Medical College, Gujarat. It was a prospective study conducted in the Department of Pulmonary Medicine, B. J. Medical College, Ahmedabad, between July 2014 and November 2016. 39 patients who underwent medical thoracoscopy for undiagnosed pleural effusions were enrolled in this study. Undiagnosed pleural effusion was defined as failure to achieve a diagnosis by initial pleural fluid analysis including pleural fluid adenosine deaminase (ADA) levels and at least three pleural fluid analyses negative for malignant cells. Diagnostic pleural fluid aspiration was done to obtain pleural fluid specimens. RESULTS In the present study with the help of thoracoscopy, 36 (92.31 %) patients were diagnosed successfully while only 3 patients remained undiagnosed. In the present study, on thoracoscopic examination 21 (53.85 %) patients had pleural nodules, 5 (12.82 %) patients had pleural thickening, 5 (12.82 %) patients had pleural plaquelike erythema. The remaining patients had other uncommon findings e.g. nonspecific pleuritis 3 (7.69 %). CONCLUSIONS Among all the patients with undiagnosed exudative pleural effusion, irrespective of smoking status which fails to respond to conventional medical management, diagnostic thoracoscopy should be considered as early as possible. The diagnostic yield of thoracoscopy for pleural pathology remains very high (92.3 %). KEYWORDS Diagnosis, Malignant Pleural Effusion, Thoracoscopy.

Correlation of Imprint and Crush cytology with Bronchoscopic biopsy in the diagnosis of Bronchogenic carcinoma

Introduction: Lung carcinoma is the most common cancer with 2.1 million (11.6%) newly diagnosed cases in 2018. Over the years, many cytotechniques have been developed but their combination with histology is still an area of controversy. Imprint and crush cytology are considered simple, rapid and cost effective for a low resource setting in the early diagnosis and management of lung cancer. Here, we aimed to assess the diagnostic accuracy of imprint and crush cytology and compare them with histopathology. Method: A prospective study was conducted from May 2017 to April 2018 at the Pulmonary medicine unit and Department of Pathology at National Academy of Medical Sciences (NAMS), Bir Hospital. A total of 53 patients were enrolled in the study who showed visible mass on bronchoscopy. Three to five bits of tissue were obtained, imprint and crush smear were prepared from them and the tissue were then sent for histopathological examination. The level of significance selected was p < 0.005. Results: The most common age group affected was 60-69 years. 91% cases were smokers, with a male predominance. The most common location of endobronchial growth was left upper lobe. 43 cases were malignant in biopsy. The sensitivity, specificity, accuracy and positive predictive value of imprint cytology was 71.05%, 87.50%, 73.91% and 96.43% respectively while that for crush cytology was 74.36%, 75%, 74.47% and 93.55% respectively. The diagnostic yield of imprint, crush smear and forceps biopsy were 52.8%, 58.4% and 81.1% respectively. Squamous cell carcinoma was the most common carcinoma in this study. Conclusion: Imprint and crush cytology yield additional information that can be complementary to endobronchial biopsy. They are convenient, do not burden the patients and thus can be carried out wherever possible during bronchoscopy.