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/

COPD day 17th November

celebrate COPD day on 17th November by education patient and public.............

Stop smoking and prevent COPD

NEW CPR GUIDELINES AHA 2010

american heart association has published the new CPR guidelines emphasizing more on chest compression. for detail follw the AHA link

http://circ.ahajournals.org/content/vol122/18_suppl_3/


major changes are :

The newest development in the 2010 AHA Guidelines for CPR and ECC is a change in the basic life support (BLS) sequence of steps from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, Breathing) for adults and pediatric patients (children and infants, excluding newly
borns).

The BLS algorithm has been simplified, and “Look, Listen and Feel” has been removed from the algorithm. Performance of these steps is inconsistent and time consuming. For this reason the 2010 AHA Guidelines for CPR and ECC stress immediate activation of the emergency response system and starting chest compressions for any unresponsive adult victim with no breathing or no normal breathing.