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   2014| July-December  | Volume 28 | Issue 2  
    Online since September 15, 2014

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Monitoring of indoor particulate matter during burning of mosquito coil, incense sticks and dhoop
Raj Kumar, Nitesh Gupta, Deepak Kumar, Anil Kumar Mavi, Kamal Singh, Manoj Kumar
July-December 2014, 28(2):68-73
Background: Indoor combustion source, like incenses, are commonly used for aesthetic and religious purposes in various indoor as well as outdoor environments. The combustion leads to the production of a large amount of smoke, which can pose a health risk due to inhalation exposure of particulate matter (PM). Objective: Monitoring of PM (PM 10 , PM 2.5 , and PM 1 ) during the preburning, burning and postburning phases of incenses (agarbatti and dhoop) and mosquito coil in the indoor environment. Materials and Methods: The monitoring of PM was carried out using the Grimm Portable Laser Aerosol Spectrometer and dust monitor model 1.108/1.109. The substances used were mosquito coil, incense (sandal), incense (floral sticks) and dhoop. The data were analyzed using the SPSS statistical package version 14.0 for windows (SPSS, Chicago, IL, USA), using one-way analysis of variance to compare the PM 10 , PM 2.5 and PM 1.0 concentration levels. Results: The mean concentrations of PM 10 (1879.7 μ/m 3 ), PM 2.5 (1775.4 μ/m 3 ) and PM 1 (1300.1 μ/m 3 ) during burning phase were highest for dhoop. The mean concentrations of PM 10 , PM 2.5 and PM 1 during burning of mosquito coil were 259.2 μ/m 3 , 232.4 μ/m 3 and 214.0 μ/m 3 respectively. The burning of incense (flora) had PM 10 (854.1 μ/m 3 ), PM 2.5 (779.8 μ/m 3 ) and PM 1 (699.8 μ/m 3 ), which were higher, in comparison to burning of incense (sandal). The particulate emission during the burning of dhoop (PM 10, PM 2.5, PM 1 ) was significantly higher (P < 0.05) than incense (sandal and flora) and mosquito coil. The concentrations of PM 10 , PM 2.5 and PM 1 even during postburning phase were significantly higher for dhoop in comparison to other three products, resulting in prolonged exposure even after the cessation of burning phase. Conclusion: The study suggests burning of dhoop, incense sticks and mosquito coil in the indoor environment emit quiet higher respirable PM, which may accumulate on prolonged exposure and lead to respiratory illnesses.
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Comparison of blood absolute eosinophil count and nasal smear eosinophils with symptoms and severity of clinical score in patients of allergic rhinitis
Anand K Patel, Tapan P Nagpal
July-December 2014, 28(2):74-77
Introduction: Allergic rhinitis is one of the most common chronic conditions with a significant impact on the quality of life. The association between eosinophils and allergic disease has been known for many years. Nasal smear eosinophilia (NSE) (normal septal motion [NSM]) is a valuable test for the diagnosis of allergic rhinitis. Objective: The objective was to compare NSM and blood absolute eosinophil count (AEC) with the severity of the clinical score and to see the levels in patients with different symptoms and different group of patients with allergic rhinitis. Materials and Methods: In this prospective study, all patients aged more than 12 years presented to our institute; with a clinical diagnosis of allergic rhinitis were enrolled after taking written consent. Then, all patients were subjected for blood AEC and nasal smear for eosinophils. Results: There was a good correlation of NSE with severity of clinical score. There was no correlation of blood AEC with severity of clinical score and majority (94.29%) of the patients had no eosinophilia. The mean values of blood AEC, NSE, and clinical severity score were much higher in group of patients having nasal and respiratory system involvements as compared to only nasal and nasal with ocular system involvement. Conclusions: Nasal smear cytology is a simple, economical, and semi-invasive procedure having good correlation with severity of clinical score should be used routinely. There is a need to revise the normal standard value and grading of blood AEC.
  17,062 503 3
Assessment of inhalation technique of bronchial asthma and chronic obstructive pulmonary disease patients attending tertiary care hospital in Jaipur, Rajasthan
Roopam Sehajpal, Astha Koolwal, Suresh Koolwal
July-December 2014, 28(2):78-82
Context: Prevalence of chronic obstructive pulmonary diseases (COPD) and bronchial asthma is on the rise all over the world. Inhalation therapy is the most recommended and efficient therapy for these respiratory diseases, but incorrect inhalation technique can cause poor disease control and increase the burden on health care resources. Aims: The aim was to evaluate the inhalation technique of COPD and bronchial asthma patients using pressurized metered dose inhaler and to investigate the determinants of incorrect inhalation technique. Settings and Design: Hospital-based cross-sectional study. Subjects and Methods: Consecutive nonrandom sampling method was used to enroll study subjects. Basic sociodemographic information of the study subjects was collected. The inhalation technique was visually observed and scored on checklist. Statistical Analysis Used: Chi-square test and Fisher exact test. Results: Among the 85 patients observed, 64 (75.29%) were males. Correct technique was observed in only 18 (21.17%) patients. The step at which maximum number of patients committed mistake was exhalation (65.88%) followed by breath holding (45.88%). No significant correlation was found between accuracy of the technique and the guide who taught the technique, age, sex, education status, or area of residence of the patients. A significant correlation (P = 0.002) was found between duration of device usage and correctness technique. Conclusions: It was found that substantial errors were made in the inhalation technique hence proper training and follow-up of the patients is required to achieve the desired effects of the inhaled medications.
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Cultural factors impacting asthma management in Asian Indian children
Naveen Mehrotra, Maya Ramagopal, Sunita Dodani
July-December 2014, 28(2):63-67
Introduction: Asthma is the most common chronic disease found in young children. Asian Indians are second largest Asian immigrant population and the fastest growing group in the United States. As this segment of the population in the US grows and utilizes the health care system, more physicians will encounter increased burden of asthma cases. Objective: To outline the cultural factors and health beliefs in the Asian Indian population which impact the care and outcome of these patients. Methods: Three cases are described in which the care of the child with asthma had been impacted due to cultural factors or limitations resulting from health beliefs. The common cultural factors researched in the reported literature along with the experiences of various physicians are outlined. Result: Reported beliefs include concern and denial in Asian Indian mothers when given a diagnosis of asthma in their child. Due to the fear of use of preventive medications such as inhaled corticosteroids and not being completely confident in the medical system, they may not feel comfortable with the recommendations that are made for control of their asthma. Conclusion: Enhanced knowledge with empowerment of the provider will improve communication and compliance of the patient and an improved collaboration between the patient and health care provider leading to better health outcomes in Asian Indian patients with asthma.
  5,445 265 1
A prospective study of comparison of efficacy and safety between levocetirizine and olopatadine in chronic idiopathic urticaria
Dhirendra Kumar Mahawar, Madan L Aseri, Sunil Mathur, Suchitra Gaur, Sanjay Sankhla, Bhagwan Dass
July-December 2014, 28(2):86-92
Aims and Objective: The aim was to compare efficacy and safety of olopatadine with levocetirizine in patients of chronic idiopathic urticaria (CIU). Materials and Methods: This was a prospective, open, parallel, comparative randomized study. After assessing inclusion and exclusion criteria, patients were randomized and divided into two treatment groups: Group A (n = 77) received levocetirizine 5 mg once a day orally, and Group B (n = 77) received olopatadine 5 mg twice a day orally for 6 weeks. Patients were evaluated in terms of parameters under study that is, urticarial activity score (UAS), dermatological life quality index (DLQI), visual analog scale (VAS) (daytime sedation), and adverse drug reactions monitoring at every (2 weeks) visit. Statistical Analysis: We used the Student's t-test and the analysis of covariance for comparison of the results and the Chi-square test for comparison of incidence of adverse effects . Results: Both drugs reduced UAS significantly (P < 0.05) at all visits and olopatadine reduced UAS more than levocetirizine at 2 weeks (P < 0.05). Both drugs altered VAS at all visits significantly; however, inter-group differences were not significant. Each drug reduced DLQI score significantly. Levocetirizine reduced more DLQI than olopatadine, but the difference was not significant (P > 0.05). Olopatadine was associated with more side-effect profile, and most common side-effect was somnolence in both groups. Conclusion: Levocetirizine is a marginally superior drug as compared with olopatadine for long-term treatment of CIU in Indian population.
  3,661 265 2
Immunotherapy in parthenium dermatitis
VP Jerath, Prashant Jerath, Megha Sood, Richa Nishchal
July-December 2014, 28(2):83-85
Introduction: Plant dermatitis is most commonly caused by compositae family plants and Parthenium hysterophorus belongs to the same family. Parthenium hysterophorus is the commonest cause of plant dermatitis in India. Parthenium dermatitis is a contact sensitization to parthenium antigen and the response is mediated by a series of cellular and molecular mechanisms. Pathenium dermatitis is caused by dried leaves and trichomes. Materials and Methods: Our study includes the data on 30 patients of parthenium dermatitis. Patch tests with acetone extracts and prick tests with parthenium antigen were done. Results: 30 patients were included in the study out of which 10 were lost to follow-up and only 20 patients completed the study.
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Nutritional considerations in bronchial asthma
Shailendra Nath Gaur, Vikas Dogra
July-December 2014, 28(2):61-62
  2,661 285 -
Diet and asthma: An observational study
Astha Koolwal, Harit Kapoor, Roopam Sehajpal, Suresh Koolwal
July-December 2014, 28(2):93-97
Introduction: Asthma as we know has multiple etiologies and risk factors. Among the noncommunicable diseases, asthma remains a global giant, a disease that has numerous predictors some proven and some under scrutiny. Linking diet with asthma has been crucial and treacherous for long. With all the studies that have been undertaken, some clearly state the protective effects/adverse effects of certain foods, while others deepen the dilemma. This study has been undertaken in order to enlarge the spectrum of studies performed in this regard. The study evaluates the dietary habits (vegetarian and nonvegetarian) as a whole of 554 school going children and categorizes them into asthmatics (along with allergic disorders) (both physician diagnosed) and nonasthmatics. Aims and Objectives: The aim was to establish the correlation between diet and physician diagnosed asthma (and allergic disorders) in school going children. Materials and Methods: A questionnaire inspired by the International study for Asthma and Allergy in Children questionnaire was used to evaluate the dietary habits and disease status of the 554 school going children of urban areas of Jaipur. The children had to fill the questionnaire under parental/teachers' guidance. Results: Asthma and allergic disorders were found to be more prevalent in those consuming a lacto-ovo vegetarian diet (odds ratio [OR]: 0.289, P - 0.004). Junk food was also significantly correlated (OR: 1.643, P - 0.004), as well as a positive family history (OR: 0.585, P - 0.002). Conclusion: Although studies linking a vegetarian diet to be protective against asthma are numerous, our study shows a different picture. The school of thought that considers vegetarian diet to be protective may lay its basis on the high antioxidant levels in the blood, which according to a new hypothesis, on the contrary may be related to increased risk of allergies too.
  2,313 166 1
Clinical and radiological properties of common variable immunodeficiency patients: Case series
Ayse Aktas, Zeynep Akcali, Serdar Tarhan
July-December 2014, 28(2):98-102
This study includes three cases with common variable immunodeficiency and bronchiectasis who have several respiratory symptoms and recurrent airway infections for long-term. The pulmonary function tests and findings of high-resolution computed tomography have been presented and discussed with literature.
  1,979 98 -
The text book of allergy for the clinicians
AB Singh
July-December 2014, 28(2):107-107
  1,722 205 -
Allergies - Changes over time
Dilip Vishnu Maydeo
July-December 2014, 28(2):103-106
15 years old youth with upper and lower airway symptoms for 5 years underwent Allergy Testing in September 1985 and was detected to be having polysensitizations. He was desensitized in 1990 for 6 months to achieve satisfactory control for more than 20 years. He reported back with recurrence and underwent repeat allergy testing in July 2013. He demonstrated evidence of protection by desensitization to Holoptelia, Lawsonia, Aspergillus Tamari and Cladosporium even after more than 25 years. However newer allergies developed to Acacia, Adathoda, Rumex, A.Fumigatus, Ration Shop Dust, insects including House dust Mite, non-vegetarian food items as Beef, Mutton, Chicken, Prawn and vegetarian food item Pea. His sensitivity to Ant, Rice had remained status quo.
  1,719 133 -
Atlas of fiberoptic bronchoscopy
SN Gaur
July-December 2014, 28(2):108-108
  1,170 120 -