Chronic Obstructive Pulmonary Disease (COPD) is frequently complicated by acute respiratory acidosis during exacerbations requiring hospitalization. Non-invasive ventilation (NIV), particularly BiPAP, is a cornerstone of management. However, during hospitalization, some patients develop metabolic alkalosis, which can impair respiratory compensation and reduce the efficacy of ventilatory support.

Staphylococcus toxic shock syndrome is a severe illness caused by infection with toxin producing Staphylococcus aureus and is associated with a poor outcome. We report a case of Staphylococcus TSS presenting with cough and expectoration along with multiple pneumatoceles visible on the chest radiograph that progressed to acute respiratory distress syndrome with eventual foci in brain. The patient was aggressively managed and recovered completely.

The combination of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs) is widely used for the management of asthma. This prospective, open-label, non-comparative, observational, 24-week multicentre study is the first real-world study from India to compare the efficacy and safety of fixed-dose combination of fluticasone/formoterol (Maxiflo® 100/6 mcg or 250/6 mcg) capsules via the Revolizer® device in patients with persistent asthma. The primary efficacy analyses included mean change in Asthma Control Test (ACT™) at 4, 8, 16 and 24 weeks. Secondary efficacy analyses included mean change in morning and evening peak expiratory flow rate (PEFR) at the end of 4, 8, 16 and 24 weeks, number of patients having symptom-free days and nights at the end of 4, 8, 16 and 24 weeks, the number and severity of exacerbations over 24 weeks and response to the Usability Preference Satisfaction Confidence questionnaire after 1 week. Overall, 385 (of 401; 96.01%) enrolled patients completed the study. The mean change in ACT™ score was 6.7 ± 3.71 (95% CI: 6.32, 7.06; p < 0.0001) at week 24. The ACT™ score at weeks 4, 8 and 16 showed progressive and statistically significant increase from baseline. A statistically significant improvement in morning and evening PEFR at weeks 4, 8, 16 and 24 was reported. The proportion of patients experiencing symptom-free days and nights continuously increased from baseline to week 24. A good safety profile over the 24-week period was observed. The Revolizer® device was preferred by 94.26% patients over their current device. Fluticasone propionate/formoterol fumarate FDC capsules administered via a single-dose dry powder inhaler ([DPI], (Revolizer®) offers a novel, well-tolerated and effective treatment option for the long-term management of asthma.

Revolizer® is a single dose dry powder inhaler (SDDPI) with moderate resistance, which requires a simple inhalation technique. We report here for the first-time results of Fluticasone/Formoterol (FF) (100/6 or 250/6 mcg; Maxiflo®) twice daily delivered by the Revolizer® on asthma control in patients with persistent asthma.This was a 24 weeks, prospective, non-comparative, multi-centre, open-label, real-world observational study. Patients participating in this study were either already on FF at any dose via Revolizer® or were uncontrolled on other treatment via Revolizer® and required a change in their treatment to FF, as per treating physicians9 discretion. We assessed asthma control at baseline, Weeks 4, 8, 16 and 24 using Asthma Control Test™ (ACT). 401 patients were enrolled [mean age 41.1 ±14.36 years; 202 (50.37%) males] and 385 patients completed the study. At the end of 24 weeks asthma control was achieved in 80.78% of patients. Mean change in asthma control score from baseline to weeks 4, 8, 16 and 24 was 3, 3.8, 5.5 and 6.7, respectively (all p<0.0001). Day and night time symptoms reduced significantly (p<0.0001) over 24 weeks. Overall, FF was well tolerated, one patient was hospitalized. More than 98% patients found the Revolizer® easy to use. In a real world setting FF delivered via the Revolizer can achieve asthma control in majority of patients and is well tolerated.

In recent years Vitamin D has been shown to be effective in prevention and treatment of tuberculosis. Active primary metabolite of Vitamin D is 1,25(OH)2D which is a steroid hormone which acts as a metabolite for several Vitamin D receptors (VDR) including cell membrane receptors (mVDR) and nuclear receptor (nVDR) activating several transcription factor complex.(7,8,9)

Default is a serious problem among tuberculosis patients who are on treatment under RNTCP, leading to persistence of infection and drug resistance in society. A multi centric retrospective observational study was under taken, to find out risk factors and reasons accountable for the default of patients registered under Category- I of RNTCP in tuberculosis unit CANTT Meerut.

100 cases of chronic liver disease established on the basis of clinical profile and ultrasound evidence of decompensated chronic liver disease were studied. Majority 76% were males and rest 24% female with a mean age of 46.79±13.74 years. Viral hepatitis was the most common cause seen in 50% of patients with 29 of hepatitis B and 21 of hepatitis C respectively. Alcoholic cirrhosis was the second, most common cause seen in 47% patients, where as autoimmune, cryptogenic was seen in 2% and 1% patients respectively. The mean value of 25- OH vitamin D was 19.03±10.8ng/ml and median of 18ng/ml. 9% patients were with Child pugh's score of 5.89±.60 in category A with vitamin D levels of 14.02±7.73ng/ml, 37% in B with a mean score of 7.95±.99 and 22.08±12.72ng/ml vitamin D and 54% in C with a mean score of 11.48±1.37 and 17.81± 9.42ng/ml vitamin D levels. All these values were significant in comparison to each other with a p value of.0006, <.0001 and <.0001 respectively and there was significant negative correlation in between levels of vitamin D and child pugh's score of these patients with r= -.1 with p=.59 of Karl Pierson's coefficient.

BACKGROUND Bronchial asthma being a chronic inflammatory disease of airways has numerous treatment options none of which have disease modifying properties. Curcumin, a yellow dietary pigment has varied pharmacological activities, prominent among which is an anti-inflammatory activity which may be crucial in bronchial asthma as has been proved by various in vitro and in vivo animal studies. AIMS To determine the efficacy and safety of curcumin as an 'add-on' therapy in patients of bronchial asthma. SETTINGS AND DESIGN This study was conducted on 77 patients of mild to moderate Bronchial asthma who had a documented positive bronchodilator reversibility test with ≥15% improvement in forced expiratory volume one second (FEV1). MATERIALS AND METHODS Seventy seven patients were recruited for the study and randomized into either of the two groups, but 17 patients were lost to follow up. Thus Group A - Receiving standard therapy for bronchial asthma for 30d (n=30) and Group B - Receiving standard therapy for bronchial asthma + Cap Curcumin 500mg BD daily for 30d (n=30). The predefined primary endpoints were clinical assessments of dyspnoea, wheezing, cough, chest tightness and nocturnal symptoms, change in the pre-bronchodilator FEV1 during the treatment and hematological improvement. The secondary end points were assessed by the change in the post-bronchodilator FEV1, C-reactive protein (CRP) concentration and incidence of adverse events. STATISTICAL ANALYSIS USED The data was analysed by SPSS 17.0 software using one-way ANOVA or Paired t-test. RESULTS AND CONCLUSION The results showed that curcumin capsules help in improving the airway obstruction which was evident by significant improvement in the mean FEV1 values. There was also significant improvement in the hematological parameters and absence of any clinically significant adverse events indicates dependable safety profile of curcumin capsules, though there was no apparent clinical efficacy. Therefore, it is concluded that curcumin is effective and safe as an add-on therapy for the treatment of bronchial asthma.

One hundred and sixty patients having clinical features of severe malaria reported during monsoon season-August–October 2010 at this tertiary care center of north India. Of these 110 (68.75 %) had Plasmodium vivax infection, 30 (18.75 %) were infected with P. falciparum and 20 (12.5 %) had co-infection due to P. vivax and P. falciparum. The diagnosis was made using Rapid Card Test and was confirmed by peripheral smear examination of thick and thin films. Several complications such as acute kidney injury, jaundice, severe anemia, metabolic acidosis, shock, hyperpyrexia, hypoglycemia, generalized tonic–clonic convulsions etc. were found to be more prevalent in patients with P. vivax infection. These symptoms were until recently known to be associated with falciparum malaria.

Conventional methods for detection of Mycobacterium tuberculosis from culture can take up to 8 weeks. Simple and sensitive methods that enhance the detection of Mycobacterium tuberculosis (M.tuberculosis) from clinical specimens are needed, to achieve early diagnosis and effective treatment of pulmonary tuberculosis. To facilitate the rapid detection of Mycobacterium tuberculosis complex and its drug sensitivity pattern by line probe assay was performed in our study.

MDR-TB is an emerging problem of great importance to public health, with higher mortality rates than drug-sensitive TB. MDR-TB patients require treatment with more-toxic second-line drugs and remain infectious for longer than patients infected with drug-sensitive strains, incurring higher costs due to prolonged hospitalization. In a clinical trial, we studied 50 newly diagnosed sputum positive cases of pulmonary koch's, in a hospital in Meerut between 2011 and 2013. Eligible patients were men and women, who were above 18 years of age, newly diagnosed sputum positive cases with no previous history of ATT. Patients were subjected to undergo HAINES TEST, a molecular assay. It identifies the M. tuberculosis complex and simultaneously detects genetic mutations related to resistance. Primary drug resistance was found (USING RATIO METHOD) to be significantly high, i.e. 14% for isoniazid and 24% for rifampicin, MDR-TB cases were reported to be 12%. Significance was ESTIMATED BY Z-TEST FOR SINGLE SAMPLE-PROPORTION AT 5% LEVEL OF SIGNIFICANCE. LINE PROBE assays demonstrate excellent accuracy for isoniazid and rifampicin resistance, even when used on clinical specimens. More aggressive treatment with second line drugs in MDR-TB cases on time is a blessing for the patient and reduces mortality rate significantly. Together with data from demonstration projects, the meta-analysis provides evidence for policy making and clinical practice.

Infection with Influenza virus is uncommon in the present times, though a number of cases were reported during pandemics in 1918 in various regions of America. We report a case where a young male patient presented to the hospital with a clinical picture of acute respiratory distress syndrome that turned out to be a viral pneumonia caused by Influenza A virus and it aggravated an underlying yet undiagnosed mitral valve stenosis.

BACKGROUND:Haemorrhagic fluids are samples which are commonly received for cytological examination. The diagnostic efficacy suffers when large numbers of red blood cells are present in the sample. Haemorrhagic fluids are processed by a variety of techniques and the common goal of each technique is selection and concentration of an adequate number of tumour cells with intact cell morphologies, without losing them during processing.AIM:Present study was undertaken to improve the quality of haemorrhagic fluid by using three different haemolysing agents, namely Carnoy's Fixative (CF), saline in Normal Saline Rehydration Technique (NSRT) and Glacial Acetic Acid (GAA) for haemolysis and to find out the most effective processing technique for better cytomorphological assessment.MATERIAL AND METHODS:This study was carried out on 51 haemorrhagic fluids. Processing of haemorrhagic fluid was done by using haemolysing agents, namely CF, GAA and NSRT. After processing fluids with these three techniques, three smears were prepared from each of them, out of which one was air dried and two were wet fixed. Fourth type of smear made without application of haemolysing agent was used as control.The smears were stained with Leishman's stain and wet fixed smears were stained with Hematoxylin and Eosin (H and E) , and Papanicolou's stain (Pap) respectively.RESULTS:NSRT showed lysis of red blood cells (RBCs) in 72.5% of cases, followed by that of CF in 60.8% cases and that of GAA in only 3.9% of cases. Retention of epithelial/mesothelial cells was seen in 70.5% cases with NSRT, followed by that of CF in 57.8% of cases and then by that of GAA in 50.9% of cases. Cytomorphological details were best preserved in CF in 60.6% of cases, followed by GAA in 58.8% of cases and NSRT in 52.9% of cases.CONCLUSION:The most effective method for RBC lysis in smear background and cell retention is NSRT and cytomorphological details are best preserved with CF. But, considering the overall results and procedural simplicity, it was concluded that NSRT was a better technique for processing of haemorrhagic fluid.

Toxic shock syndrome is an acute febrile illness, which leads to multi-organ dysfunction and has a high mortality and morbidity. We report a case of toxic shock syndrome in a patient with underlying chronic liver disease associated with multiple satellite abscesses in elbow, peri-nephric region, psoas and neck.

Lactic acidosis is defined as increase in blood lactate levels in association with acidemia. It should be suspected in all patients presenting with shock & decreased mayocardial contractility. The patients with lactic acidosis have high mortality. However, the prognosis and case fatality are completely dependent on underlying disease in each patient with lactic acidosis being an independent indicator of severity of shock. All efforts should be directed towards treatment of underlying cause and concomitant correction of acidosis.