BLOG UPDATE- THANKS TO ALL VISITORS

MY BLOG HAS BEEN VISITED BY > 17,000 INDIVIDUALS AROUND THE WORLD FROM 101 COUNTRIES...OVER LAST 2 YEARS..............THANKS TO ALL VISITORS.................WILL UPDATE REGULARLY..NEED MORE COMMENT TO DEVELOP FURTHER............................

november 16th is to be celebrated as world COPD day

we are doing a free spirometry camp and public awarness

for doctor we are doing a spirometry workshop

....................................................

A TRIBUTE TO GREAT DR BHUPEN HAZARIKA

GREAT MUSICIAN OF ASSAM DR BHUPEN HAZARIKA IS TO BE CREMATED TODAY.......... HIS CONTRIBUTION TO THE MUSIC WILL BE REMEMBERED BY THE WORLD FOR EVER...........

.SAGAR SANGAMOT KATANA SATURILU..... TOTHAPI TO HUWA NAI KLANTA............

WORLD SPIROMETRY DAY 14TH OCTOBER 2011

14TH OCTOBER 2011 IS WORLD SPIROMETRY DAY. ITS A TIME TO INCREASE KNOWLEDGE AND AWARENESS ON USE OF SPIROMETRY.... 

New TNM staging for lung cancer

New 7th edition of TNM classification lung cancer is based on International Association for the Study of
Lung Cancer (IASLC) database. The changes from previous edition are mentioned bellow. for more detail follow ERS journal (breathe ,June 2011)

The changes in relation to T (tumor) are-

1. T1a <2cm                                                                                                prev T1

2.T1b> 2-3cm                                                                                                     T1

3. T2a>3-5cm                                                                                                     T2

4.T2b >5-7 cm                                                                                                    T2

5. T3 >7cm                                                                                                          T2

6. Additional tumor node in same lobe T3                                                             T4

7. Add tumor node in another ipsilateral lobe T4                                                   M

8. Pleural inv M1a                                                                                                T4

9. Intra thoracic metastasis M1 and extrathoracic metastasis M2                           M

N remained unchanged , however nodal zone has been changed

BRAIN DEATH GUIDELINES---NEW PEDIATRIC

FOLLOW THE LINK FOR REVISED BRAIN DEATH CRITERIA FOR INFANT AND CHILDREN



http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1511.full.pdf

GUIDELINES FOR PEDIATRICS PNEUMONIA

NEW GUIDELINES NAMED 'The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines' by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America HAS BEEN PUBLISHED IN J clinical infectious disease

follow the link for full guidelines



http://cid.oxfordjournals.org/content/early/2011/08/30/cid.cir531.full.pdf

correct inhalation tecnique

inhaled medication is a major therapeutic option for obstructive airway disease. However the correct method to use inhaler is very important for effective delivery of drugs to lung. Here the essential steps for correct use of inhaler will be given. For more detail see the article "Correct Inhalation Technique: ERS Task Force Guidelines Eur Respir J 2011; 37: 1308–1331"

pMDIs: for patients with good actuation–inhalation coordination

1) Shake four or five times if suspension formulation.

2) Take the cap off.

3) Prime the inhaler

4) Exhale slowly, as far as comfortable

5) Hold the inhaler in an upright position.

6) Immediately place the inhaler in the mouth between the teeth, with the tongue flat under the mouthpiece.

7) Ensure that the lips have formed a good seal with the mouthpiece.

8) Start to inhale slowly, through the mouth and at the same time press the canister to actuate a dose.

9) Maintain a slow and deep inhalation, through the mouth, until the lungs are full of air. This should take an adult 4–5 s.

10) At the end of the inhalation, take the inhaler out of the mouth and close the lips.

11) Continue to hold the breath for as long as possible, or up to 10 s before breathing out.

12) Breathe normally.

13) If another dose is required, repeat steps 4–12.

pMDI + spacer with facemask: for patients ≤3 yrs old or anyone who cannot breathe consciously through the mouth

1–3) Same as above for pMDIs alone.

4) Insert the mouthpiece of the pMDI into the open end of the spacer and ensure a tight fit

5) Place the facemask over the nose and mouth and be sure the fit is tight to the face.

6) Actuate one dose into the chamber of the spacer.

7) The patient should inhale and exhale normally into the spacer at least 10 times.

8) Take the facemask off the patient's face.

9) If another dose is required, repeat steps 1–8.

ROLE OF SEROLOGICAL DIAGNOSIS FOR TUBERCULOSIS

TUBERCULOSIS IS A MAJOR DISEASE OF HUMAN KIND AND IS STILL A MAJOR PROBLEM SPECIALLY FOR DEVELOPING WORLD. HOWEVER THERE IS STILL CERTAIN CONTROVERSY IN DIAGNOSIS MOSTLY DUE TO SEROLOGICAL TEST.

RECENTLY WORLD HEALTH ORGANISATION HAS CAME OUT WITH A POLICY STATEMENT ON USE OF SEROLOGICAL TEST FOR DIAGNOSIS OF TUBERCULOSIS

WHO HAS CLEARLY RECOMMENDED AGAIST THE USE OF THESE TESTS FOR DIAGNOSIS OF TUBERCULOSIS

THE DOCUMENT IN THEIR CONCLUSION MENTIONED THAT

"Commercial serological tests provide inconsistent and imprecise findings resulting in highly variable values for sensitivity and specificity. There is no evidence that existing commercial serological assays improve patient-important outcomes, and high proportions of false-positive and false-negative results adversely impact patient safety. Overall data quality was graded as very low and it is strongly recommended that these tests not be used for the diagnosis of pulmonary and extra-pulmonary TB"

FOR MORE DETAIL GO THROUGH THE ORIGINAL WHO DOCUMENT

PARASOMNIA

Parasomnias are a group of disorders exclusive to sleep and wake to sleep transition that encompass arousal with abnormal motor, behavioural or sensory experiences.

Types of Parasomnias

disorders from NREM
1.confusonal arousal
2. sleep waking
3. sleep terror
4.NFLE

disorders from REM
1. REM sleep behaviuor disorders
2. sleep paralysis
3.nightmare disorders

other parasomnias
1. sleep enuresis
2. sleep related groaning
3. sleep related eating disorders
4. exploding head syndrome
5. sleep related dissociative disorders

Diagnosis

Based on history, video EEG, PSG

Management

counceling and support
sleep hygine
Medications- BZD, SSRI, melatonin
behavior therapy, relaxation therapy etc

NATIONAL SLEEP MEDICINE COURSE 2011

THIS YEAR NSMC WILL BE HELD IN MUMBAI ON 10TH AND 11 TH DECEMBER...........
VENU JASLOK HOSPITAL

today is world asthma day

THEME 2011: YOU CAN CONTROL UR ASTHMA

300 million people worldwide suffer from asthma and an estimated additional 100 million persons may be expected to develop the disease by 2025

Asthma Treatment and Control

Asthma is a long-term disease that usually not cured but controlled like diabetes, hypertension. The goal of asthma treatment is to control the disease. Good asthma control will:

• Prevent chronic and troublesome symptoms such as coughing and shortness of breath
• Reduce need of quick-relief medicines  
• Maintain good lung function
• Maintain normal activity levels and sleep through the night
• Prevent asthma attacks that could result in emergency room visit or being admitted to the hospital for treatment

The steps in asthma management includes

·        Development of Patient/Doctor Partnership

·        Identify and reduce exposure to risk factors

·        Assess, Treat and Monitor Asthma

·        Manage asthma exacerbations

·        Special considerations

WORLD ASTHMA DAY 3RD MAY 2011

WORLD ASTHMA DAY IS CELEBRATE TO INCREASE AWARENESS ABOUT ASTHMA AND IMPROVED ASTHMA CARE. THIS YEAR WORLD ASTHMA DAY THEM IS 'YOU CAN CONTROL UR ASTHMA'

broncial thermoplasty

• Bronchial thermoloasty has emerged as a newer modality of treatment for asthma. 
• During the procedure radiofrequency-generated heat delivered to the airways via a catheter inserted in the bronchial tree through a flexible bronchoscope to reduce smooth muscle quantity and contractility
• It is a three stage procedure, where lower and upper lobe bronchi are treated
• Preliminary investigation in animals and human has shown promising results

A day with Prof Ashok Shah, V P C I Delhi

Indeed it was a grate day for me and doctors from Guwahati. On 13th of March 2011 Prof Ashok Shah came to deliver his excellent talk on Sarcoidosis in India and ABPA. Prof Shah is eminent speaker and teacher, had many international and national publications. We have learn a lot form him. Recent information has been updated.......... 

PREVENTION OF VAP >>>> UPCOMING DEVICES

Over recent time some devices has been found to reduce Ventilator Associated Pneumonia. Studies have shown significant reduction in incidence of VAP and has been recommended in recent guidelines. These devices are-

1. Endrothracheal tube with subglottic secretion drainage (SSD)

2. ET tube with ultrathin cuff membrane

3. ET tube coated with anti-microbial agent

4. ET tube with SSD, LVLP cuff and constant cuff inflation pressure 

SYNDROME Z

WHAT IS SYNDROME Z??
SYNDROME Z IS A SYNDROME IN RELATION TO METABOLIC SYNDROME. OR SYNDROME X. SYNDROME X IS CHARACTERISED BY PRESENCE OF ANY OF THE 3 CRITERIA-

1. CENTRAL OBESITY , WAIST CIR >40 INCH MALE, >35 INCH FEMALE
2. FASTING INCREASE LEVEL OF TG EQUAL OR> 150 MG/DL
3.HDL CHOLESTEROL <40 MG/DL MALE, <50MG/DL FEMALE
4. BP EQUAL OR > 130/80 mmHg
5. FBS EQUAL OR > 110MG/DL

WHEN THIS METABOLIC SYNDROME CO-EXIST WITH OBSTRUCTIVE SLEEP APNEA IT IS TERMED AS SYNDROME Z

Adenosine Deaminase ( ADA) facts in tubercular pleural effusion

SOME FACT ABOUT ADA

• >ADA is an enzyme in purine salvage pathway that catalyzes the conversion of adenosine and deoxyadenosine to inosine and deoxyinosine
• >Abundant in activated T lymphocytes 
• >An ADA level >70 IU/L is highly suggestive of TB while a level < 40 IU/L virtually excludes the diagnosis of tuberculosis 
• >Meta-analysis of 40 studies from 1966 to 1999 showed the ADA sensitivity to vary between 47.1% to 100% and specificity between 0 to 100% 
• >Specificity increases when lymphocyte to neutrophil ratio in pleural fluid (>0.75) is considered in conjugation with an ADA concentration >50 IU/L 
• > In low prevalence setting (i.e. <1%) positive predictive value may be as low as 15% however negative predictive value increases 
• >In high prevalence of tuberculosis, ADA measurement is inexpensive, minimally invasive, rapid and readily accessible test that has sensitivity and specificity of 95% and 90% respectively 
• >Elevated ADA in lymphocyte rich pleural fluid has been reported in other diseases, such as rheumatoid arthritis, bronchoalveolar carcinoma, mesothelioma, mycoplasma and chlamydia pneumonia, psittacosis, paragonimiasis, infectious mononucleosis, brucellosis, mediterrianes fever, histoplasmosis, cocoidiodomycosis  and in most patient with empyema 
• >Two isoenzymes ADA1 and ADA2 
• >ADA1 is found in all cells with the highest activity observed in lymphocytes and monocytes.
• >ADA2 isoenzyme is predominantly found in monocytes/macrophages
• >ADA2 isoenzyme is primarily responsible for increase ADA activity in TB pleural effusion with a median contribution of 88% 
• >Pleural effusions with high ADA level and ADA1/total ADA ratio <0.45 makes the diagnosis of TB highly likely 
• >In immune compromised person ADA hold similar significance

RESPIRATORY UPDATE 2011 IN GUWAHATI

DEPARTMENT OF TB AND RESPIRATORY MEDICINE ALONG WITH INDIAN CHEST SOCIETY GOING TO ORGANIZE RESPIRATORY UPDATE 2011 IN GUWAHATI. ASSAM.

MOST LIKELY List of topics

1.       Evaluation and management  of pneumonia in health care setting

2.       Extra pulmonary manifestation of COPD

3.       Rational and controversies in management of obstructive airway  disease

4.       Clinical approach and treatment  of  non tubercular mycobacterium infection

5.       Diagnosis and treatment protocol for ILD

6.       Role of NIV in respiratory diseases

perfomance status of lung cancer

for more detail log on to WHO or ECOG web site

CONFERENCE ON INTERVENTIONAL PULMONOLOGY

4TH ASIA-PACIFIC CONGRESS ON BRONCHOLOGY AND INTERVENTIONAL PULMONOLOGY
JAIPUR 2012


FOR DETAIL LOG ON TO
http://www.apcb2012.com

updated recommendation on pneumoccal vaccination 2010 CDC

There are certain changes in recommendation of pneumoccal vaccination. Patients with asthma and smokers are also included in new recommendation. for detail please see CDC link below

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm

RESPIRATORY DECADE

After the success of year of the lung 2010 now its respiratory decade 2011- 2020. lets create awareness and improve knowlege


follow the blog on respiratory decade


http://respiratorydecade.blogspot.com/