quiz of month

A 60-year-old male is seen in the pulmonary clinic for evaluation of dyspnea. He underwent single-lung transplantation 3 years ago for idiopathic pulmonary fibrosis and did well until the last 5 months,
when he noted that his exercise tolerance had decreased as a result of shortness of breath. He denies fevers, chills, weight loss, or medication noncompliance. The patient does have an occasional dry cough. His current medications include immune supressant, trimethoprim-sulfamethoxazole (TMP-SMX), pantoprazole, diltiazem, and mycophenolate mofetil. He has past history of tobacco use. Physical examination show dry crackles on the side of the origin lung and decreased breath sounds on the side of the transplanted lung. Review of pulmonary function testing shows an FEV1/FVC ratio of 55% of the predicted value and an FEV1 of 0.90 L. Additionally, FEV1 has fallen by 31% progressively over the last 1-1/2 year. Which of the following can ameliorate the fall in FEV1 in this patient?
A. Augmented immunosuppression
B. Reduced immunosuppression
C. Antifungal therapy
D. Antiviral therapy
E. Administration of α1 antitrypsin
F. None of the above

Variants of DENND1B Associated with Asthma in Children

Background Asthma is a complex disease that has genetic and environmental causes. The genetic factors associated with susceptibility to asthma remain largely unknown.

Methods We carried out a genomewide association study involving children with asthma. The sample included 793 North American children of European ancestry with persistent asthma who required daily inhaled glucocorticoid therapy and 1988 matched controls (the discovery set). We also tested for genomewide association in an independent cohort of 917 persons of European ancestry who had asthma and 1546 matched controls (the replication set). Finally, we tested for an association between 20 single-nucleotide polymorphisms (SNPs) at chromosome 1q31 and asthma in 1667 North American children of African ancestry who had asthma and 2045 ancestrally matched controls.

Results In our meta-analysis of all samples from persons of European ancestry, we observed an association, with genomewide significance, between asthma and SNPs at the previously reported locus on 17q21 and an additional eight SNPs at a novel locus on 1q31. The SNP most strongly associated with asthma was rs2786098 (P=8.55x10^–9). We observed replication of the association of asthma with SNP rs2786098 in the independent series of persons of European ancestry (combined P=9.3x10^–11). The alternative allele of each of the eight SNPs on chromosome 1q31 was strongly associated with asthma in the children of African ancestry (P=1.6x10^–13 for the comparison across all samples). The 1q31 locus contains DENND1B, a gene that is expressed by natural killer cells and dendritic cells and that encodes a protein that interacts with the tumor necrosis factor receptor.

Conclusions We have identified a locus containing DENND1B on chromosome 1q31.3 that is associated with susceptibility to asthma.

DNB Final Examination (RESPIRATORY DISEASES) Previous Years Question Papers

this the link for previous years Q papers of DNB respiratory medicineexam

http://natboard.edu.in/notice_for_dnb_candidates/RESPIRATORY%20DISEASES.pdf

The Sequential Organ Failure Assessment (SOFA) Score

The SOFA system was created in a consensus meeting of the European Society of Intensive Care Medicine in 1994 and further revised in 1996. The SOFA is a six-organ dysfunction/failure score measuring multiple organ failure daily. Each organ is graded from 0 (normal) to 4 (the most abnormal), providing a daily score of 0 to 24 points. The objective in the development of the SOFA was to create a simple, reliable, and continuous score easily obtained in every institution.

Sequential assessment of organ dysfunction during the first few days of ICU admission is a good indicator of prognosis. Both the mean and highest SOFA scores are particularly useful predictors of outcome. Independent of the initial score, an increase in SOFA score during the first 48 hours in the ICU predicts a mortality rate of at least 50%.

FOUR Score for Comatose Patients

Eye response

4 = eyelids open or opened, tracking, or blinking to command

3 = eyelids open but not tracking

2 = eyelids closed but open to loud voice

1 = eyelids closed but open to pain

0 = eyelids remain closed with pain

Motor response

4 = thumbs-up, fist, or peace sign

3 = localizing to pain

2 = flexion response to pain

1 = extension response to pain

0 = no response to pain or generalized myoclonus status

Brainstem reflexes

4 = pupil and corneal reflexes present

3 = one pupil wide and fixed

2 = pupil or corneal reflexes absent

1 = pupil and corneal reflexes absent

0 = absent pupil, corneal, and cough reflex

Respiration

4 = not intubated, regular breathing pattern

3 = not intubated, Cheyne–Stokes breathing pattern

2 = not intubated, irregular breathing

1 = breathes above ventilator rate

0 = breathes at ventilator rate or apnea

FOUR = Full Outline of UnResponsiveness.

Respiratory examination video link

following is the link that will lead to respiratory system examination videos in youtube

http://www.youtube.com/watch?v=hWGzi5h2UR8&feature=player_embedded

this will be useful for young doctors

imprtant journals for respiratory critical care and sleep

American journal of respiratory and critical care medicine
Chest
Eroupean respiratory journal
Thorax
Current opinion in respiratory medicine
Critical care medicne
Indian journal of sleep medicine
Sleep medicine

link will be post soon

Respiratory Medicine in India in the 21st Century

In the first half of the 20th century tuberculosis was the main focus of attention for respiratory physician and was still known as TB specialist rather than pulmonologist. but with time role of respiratory physician is growing. Currently sleep medicine and critical care medicine has became integral part of respiratory medicine. Now respiratory specialist require greater knowlege and more active participation in multi-organ involved cases. At present in India there is course in diploma in respiratory medicine, MD in respiratory medicine, DM in pulmonary medicine and DNB in respiratory medicine. After completion on MD respiratory medicine one is elligible for DM pulmonary medicine, DM cardiology and Fellowship DNB in critical care. In days to come we will see a greater role of pulmonologist in disease management.

welcome

i welcome you all to this new blog on respiratory, critical care and sleep medicine.