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Biomedical subjects

Ashok Shah

Publications and source records attributed to Ashok Shah.

At least 19 recordsLinked to original sources
PubMed2007

Allergic bronchopulmonary aspergillosis: an Indian perspective.

PURPOSE OF REVIEW: Allergic bronchopulmonary aspergillosis is an immunologically mediated lung disease that is caused by hypersensitivity to antigens of the genus Aspergillus. This review summarizes the clinical presentation, radiologic profile, lung functions and immunologic studies on allergic bronchopulmonary aspergillosis from India. Data regarding Aspergillus sensitization in asthmatics are presented. The association of allergic bronchopulmonary aspergillosis with allergic Aspergillus sinusitis and aspergilloma is also highlighted. RECENT FINDINGS: Allergic bronchopulmonary aspergillosis is now an emerging disease in India. Sensitization to Aspergillus antigens is not uncommon in our patients with asthma. Although asthma commenced in these subjects in their early 20s, allergic bronchopulmonary aspergillosis was recognized more than a decade later. Allergic bronchopulmonary aspergillosis can also occur in patients without clinical asthma. Radiology is crucial to the diagnosis of allergic bronchopulmonary aspergillosis. The remarkable radiological similarity to pulmonary tuberculosis has important clinical implications in our country as patients with allergic bronchopulmonary aspergillosis often receive antituberculous therapy for a long time. Although oral corticosteroids still remain the cornerstone for management, itraconazole has emerged as an adjunct therapy in appropriate situations. Concomitant occurrence of allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis is now being increasingly recognized. SUMMARY: All asthmatic subjects with a positive skin prick test to Aspergillus antigens must be evaluated for allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis should be excluded.

Adrenal Cortex Hormones↗
PubMed2006

Stable atrial sensing on long-term follow up of VDD pacemakers.

BACKGROUND: The hemodynamic advantages of maintaining AV synchrony through AV synchronous pacing are widely known as compared to single chamber pacing. DDD pacemaker implantation entails higher cost and is technically more challenging than the VDD pacemaker. METHODS: Seventy one patients underwent VDD lead (Biotronik GmbH, St. Jude Medical and Medtronic Inc.) implantation at KEM hospital, Mumbai during a period of 3 years through subclavian, axillary and cephalic routes for degenerative, post-surgical or congenital high grade atrioventricular or complete heart block. They were followed up regularly for ventricular threshold and P wave amplitude of the floating atrial dipole. RESULTS: Follow up data of almost 95% of patients is available for a period of 15.8 +/- 6.7 months. P wave amplitude at implant was 2.1 +/- 0.7mV and at follow up 1.1 +/- 0.6mV with mean ventricular threshold of <0.5V at implant and <1V at follow-up. CONCLUSION: Implantation of a single lead VDD pacemaker is possible in all patients with symptomatic AV block and intact sinus node function without any technical complications. P wave sensing is reliable and consistent with floating atrial lead at an average follow up of 15.8 months, providing an excellent alternative to DDD pacemaker implantation.

Journal Article↗
PubMed2006

Subjective symptom perceptual accuracy in asthmatic children and their parents in India.

BACKGROUND: Inaccurate symptom perception is a key factor in increased morbidity and mortality in asthmatic patients. Information is sparse on whether children and their parents can accurately perceive severity of symptoms. OBJECTIVE: To determine symptom perceptual accuracy in children with asthma and either of their parents. METHODS: Fifty-two asthmatic children and either of their parents recorded independently, for 2 weeks, subjective evaluation of the child's symptoms on a 100-mm visual analog scale (VAS). Peak expiratory flow (PEF) was used as an objective measurement. Both VAS and PEF data were graded into green, yellow, and red zones. The 2 sets of VAS zones (children and parents) were separately matched with PEF zones to determine perceptual accuracy. RESULTS: Children and parents were accurate more than half of the time (60% and 62%, respectively), but accuracy decreased when the "child was unstable" (PEF <80% of personal best), with underestimation being significant (P < .001). Among the readings obtained, underestimation of severity of symptoms was significant in children with severe asthma (125 [45%] of 278 readings), those affected by environmental tobacco smoke (130 [24%] of 532), and those in the younger age group (127 [45%] of 280). Underestimation was significantly greater when PEF readings were in the yellow zone (P < .001). CONCLUSIONS: Symptom perception by children was as reliable as that by their parents. However, parents and children tended to underestimate severity when the child was unstable. An early decline in PEF readings was missed by children and their parents, which could contribute to increased morbidity and mortality in this vulnerable age group.

Asthma↗
PubMed2006

Contemporaneous occurrence of allergic bronchopulmonary aspergillosis, allergic Aspergillus sinusitis, and aspergilloma.

BACKGROUND: The clinical categories of Aspergillus-related respiratory disorders usually remain mutually exclusive. The coexistence of allergic bronchopulmonary aspergillosis (ABPA) with aspergilloma is uncommon, whereas concurrent ABPA and allergic Aspergillus sinusitis (AAS) is rare. The association of these 3 clinical entities has previously been documented only once in a patient who had earlier been operated on for an aspergilloma before the diagnoses of ABPA and AAS were established. OBJECTIVE: To describe an adult in whom ABPA, AAS, and aspergilloma were diagnosed simultaneously. METHODS: Spirometry, radiography, computed tomography, skin allergy testing with Aspergillus antigens, serum precipitins against Aspergillus, total and specific IgE, functional endoscopic sinus surgery, and fungal culture were performed. RESULTS: A 26-year-old man who had asthma and rhinitis since childhood presented with hemoptysis. Serial chest radiographs revealed transient pulmonary infiltrates and an aspergilloma. Computed tomography of the thorax confirmed the aspergilloma and showed bilateral central bronchiectasis along with patchy infiltrates. Strong bands of precipitins were detected against Aspergillus fumigatus, and intradermal testing with Aspergillus antigens elicited strong type I and III hypersensitivity reactions. Specific IgE and IgG antibodies against A fumigatus were positive, and total IgE levels were significantly elevated. Peripheral blood eosinophilia was also detected. Sinus involvement was confirmed on computed tomography, and pathologic material obtained by functional endoscopic sinus surgery demonstrated allergic mucin that contained fungal elements. In addition, A fumigatus was cultured. CONCLUSIONS: ABPA, AAS, and aspergilloma can occur simultaneously in the same patient.

Adult↗
PubMed2006

Isolated left lung aplasia with bronchial asthma.

Congenital lung anomalies are categorised as pulmonary agenesis, aplasia and hypoplasia with distinct clinical implications. An 8-year-old boy was referred for an opaque left hemithorax for which he had received antituberculous therapy. A detailed evaluation including flowing contrast computed tomography of the thorax and fiberoptic bronchoscopy led to a diagnosis of left lung aplasia. He also had wheezing dyspnea, which was confirmed as bronchial asthma. Congenital lung defects with associated asthma was reported only twice till date. A high index of suspicion is required to recognise such a patient.

Asthma↗
PubMed2005

Chronic community-acquired Acinetobacter pneumonia that responded slowly to rifampicin in the anti-tuberculous regime.

Acinetobacter baumannii is a well-known cause of hospital-acquired pneumonia. Occasionally, it can present as an acute community-acquired pneumonia with a fulminant course. However, the occurrence of the chronic form of community-acquired Acinetobacter pneumonia is yet to be highlighted. We describe a 62-year-old, HIV negative, non-diabetic male, who was referred for evaluation of consolidation and cavitation in the apicoposterior segment of the left upper lobe for 4 months. For this, he had received anti-tuberculous therapy, which included rifampicin. On investigation, a diagnosis of chronic community-acquired pneumonia due to Acinetobacter baumannii was made. The steady clinico-radiologic improvement observed was attributed to rifampicin in the anti-tuberculous regime. Subsequently, an aspergilloma formed in the cavity.

Acinetobacter Infections↗
PubMed2005

Categorization of patients with allergic rhinitis: a comparative profile of "sneezers and runners" and "blockers".

BACKGROUND: The recent Allergic Rhinitis and Its Impact on Asthma (ARIA) workshop report classified patients into "sneezers and runners" and "blockers" and described a new disease severity categorization. OBJECTIVE: To sketch the profile of these 2 groups and to evaluate the relevance of categorization. METHODS: Patients were categorized as "sneezers and runners" (group 1) or "blockers" (group 2). The patients responded to a questionnaire that sought information on symptoms and associated factors. They were then categorized into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) groups and "intermittent" and "persistent" disease groups and compared. RESULTS: A total of 114 patients (72 in group 1 and 42 in group 2) participated in the study. The significant features in group 1 were age at onset younger than 20 years (90%); birth date between June and September (61%); family history of atopy (88%); itching of skin (26%), eye (43%), ears (43%), and throat and palate (67%); and aggravation with dust (93%). History of breathlessness (90%), mouth breathing (81%), loss of smell (36%), and prior nasal surgery (31%) were significant in group 2. Significantly more patients in group 1 had SAR (54%) and moderate-severe intermittent disease (60%), whereas group 2 had PAR (81%) and mild persistent (69%) disease (P = .03). Patients classified as having SAR had intermittent disease (40, 83%) (P = .005), and those with PAR had persistent disease (51, 76%) (P < .001). Sixteen patients (24%) classified as having PAR were in the intermittent category, whereas 7 (17%) classified as having SAR were in the persistent category. CONCLUSIONS: This study demonstrated that the 2 groups had distinct clinical profiles and that it is important to categorize patients, according to the ARIA report, into intermittent and persistent allergic rhinitis groups.

Adolescent↗
PubMed2005

Sensitization to Aspergillus antigens and occurrence of allergic bronchopulmonary aspergillosis in patients with asthma.

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA), which is predominantly a disease of asthmatic subjects, is caused by hypersensitivity to Aspergillus antigens. Screening for Aspergillus sensitization in asthmatic subjects could identify those who are at risk for ABPA. Few studies have shown that fungal sensitization could be an important risk factor for asthma severity. We sought to determine the frequency of sensitization to Aspergillus antigens in asthmatic subjects and its effect on disease severity. We also determined the occurrence of ABPA in these subjects. DESIGN: Prospective study of consecutive patients with asthma. SETTING: Tertiary university referral hospital, outpatient department. PATIENTS AND METHODS: One hundred five asthmatic subjects and 26 volunteers underwent skin testing with aeroallergens, including Aspergillus, serum precipitins against Aspergillus antigens, and specific IgG against Aspergillus fumigatus, total serum IgE levels, and routine blood and radiologic investigations. ABPA was diagnosed when all eight major criteria were fulfilled. RESULTS: Thirty patients (28.5%) had a positive skin reactivity to Aspergillus antigens. Eleven patients (10.4%) had positive specific reactions to IgG, and 8 patients (7.6%) demonstrated positive reactions to serum precipitins. Eight of these 30 patients (26.6%) received diagnoses of ABPA, which was 7.6% of the total. None of the control subjects were sensitized to Aspergillus antigens. The patients were classified into the following four groups: negative skin test results; positive reactions to aeroallergens other than Aspergillus; positive reactions to aeroallergens including Aspergillus antigens; and patients with ABPA. Based on clinical and serologic parameters, patients with Aspergillus-sensitive asthma and ABPA had a significantly more severe form of the disease. CONCLUSIONS: Sensitization to the mold Aspergillus increases the severity of asthma. ABPA should be excluded in all patients with Aspergillus-sensitive asthma.

Adolescent↗
PubMed2005

Klippel-Feil syndrome with associated agenesis of lung and gall bladder presenting with asthma and allergic rhinitis.

Klippel-Feil syndrome KFS, a triad of short neck, limitation of neck movement and low posterior hairline, is characterized by presence of congenitally fused cervical vertebrae and is often associated with multiple congenital anomalies. A 35-year-old male was referred for evaluation of an opaque hemithorax. This led to a diagnosis of KFS, agenesis of left lung and gall bladder. The patient had history of wheezing dyspnea with nasal symptoms, which were diagnosed as asthma and allergic rhinitis. A high index of suspicion is required to recognize such a patient, and efforts should be made to seek other congenital anomalies.

Abnormalities, Multiple↗
PubMed2004

Use of a synthetic peptide epitope of Asp f 1, a major allergen or antigen of Aspergillus fumigatus, for improved immunodiagnosis of allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically complex allergic disorder caused by the fungal pathogen Aspergillus fumigatus. Elevated levels of total immunoglobulin E (IgE), specific IgE, and IgG antibodies in sera are important immunodiagnostic criteria for ABPA. International reference standards or standardized immunodiagnostic assays are not available due to a lack of well-defined diagnostic antigens. The present study was carried out to identify and evaluate the immunodiagnostic relevance of synthetic epitopic peptides of Asp f 1, a major allergen, antigen, or cytotoxin of A. fumigatus. Five overlapping peptides were synthesized from the N terminus of Asp f 1, one of the potential immunodominant regions predicted by algorithmic programs. The 11-amino-acid synthetic peptide (P1) significantly inhibited both IgG binding (89.10% +/- 4.45%) and IgE binding (77.32% +/- 3.38%) of the standardized diagnostic antigen (SDA) (a well-defined pool of diagnostically relevant allergens and antigens of A. fumigatus). With a panel of sera of ABPA patients, allergic patients with skin test negativity to A. fumigatus, and healthy individuals, P1 showed a higher diagnostic efficiency than SDA (specific IgG, 100%; specific IgE, 98.3%). The diagnostic efficiency of P1 could be attributed to the presence of homologous epitopes in various immunodominant allergens or antigens of A. fumigatus. The ability of P1 to induce histamine release from sensitized mast cells and a Th2 type of cytokine profile in peripheral blood mononuclear cells of ABPA patients suggests its potential for use in intradermal testing. P1 could be further explored for development of a standardized, specific, and sensitive immunodiagnostic test for aspergillosis.

Allergens↗
PubMed2004

Multidrug resistant miliary tuberculosis and Pott's disease in an immunocompetent patient.

In a high tuberculosis TB prevalence country, mortality due to miliary TB is not unknown but the treatment outcome in general is good. We describe a previously healthy man with miliary TB who did not respond to 2-months antituberculous therapy with 4 drugs. Persistent complaints of backache, which antedated chest symptoms, resulted in a diagnosis of Pott's disease. Culture of bronchial aspirate yielded multidrug resistant Mycobacterium tuberculosis that responded slowly to streptomycin, ethionamide, cycloserine, clofazimine, ofloxacin, paraaminosalicylic acid and isoniazid. The association of multidrug resistant miliary TB with Pott's disease in an immunocompetent patient is yet to be highlighted.

Drug Therapy, Combination↗
PubMed2003

Allergic bronchopulmonary and sinus aspergillosis: the roentgenologic spectrum.

Allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS) are the best recognized manifestations of Aspergillus-associated hypersensitivity respiratory disorders. These conditions occur predominantly in atopic individuals. Roentgenologic techniques play a pivotal role in the diagnosis of these two conditions. ABPA, on imaging, is characterized by fleeting pulmonary infiltrates often confused with pulmonary tuberculosis. However, central bronchiectasis on computed tomography (CT) is considered to be the hallmark of the disease. Though the diagnosis of AAS is primarily based on histopathology, roentgenology is essential for the diagnosis. Haziness of one or more paranasal sinuses is almost always seen on plain roentgenograms. However, CT proffers more reliable information with characteristic features that include heterogeneous densities and serpiginous areas of increased attenuation on non-contrast scans. Early diagnosis, with the help of roentgenologic techniques, and appropriate therapy could alter the natural history of these diseases.

Aspergillosis↗
PubMed2003

Regression of fibrosis in chronic hepatitis C after therapy with interferon and ribavirin.

Interferon and ribavirin decrease necroinflammation in chronic hepatitis C with or without virological clearance; however, reversibility of fibrosis remains to be established. We evaluated the effect of combination therapy on virological and liver histopathological outcomes in 52 naive patients and 79 patients unresponsive to interferon monotherapy with predominantly genotype 1 chronic hepatitis C. One hundred four patients completed interferon and ribavirin treatment after 24-48 weeks. Fifty-six paired liver biopsies (mean biopsy interval 28 months) were assessed by the Ishak score. Sustained virological responses were 37% in naive patients and 22% in re-treated patients. In virological responders and nonresponders, fibrosis and necroinflammation scores decreased by -0.91 (P = 0.04) and -0.5 (P = 0.02) and by -2.8 (P = 0.001) and -0.66 (P = 0.06), respectively. Interferon and ribavirin had greater benefit on fibrosis when associated with clearance of HCV RNA. Treatment strategies in virological nonresponders who show fibrosis regression should include consideration of maintenance therapy, if such treatment eventually proves to benefit histological outcomes.

Adult↗
PubMed2003

Association of polymorphisms in the collagen region of SP-A2 with increased levels of total IgE antibodies and eosinophilia in patients with allergic bronchopulmonary aspergillosis.

BACKGROUND: Studies from our group have shown a protective role of pulmonary surfactant protein A (SP-A) against lung allergy and infections caused by Aspergillus fumigatus. OBJECTIVE: Present study investigated the association of polymorphisms in the collagen region of SP-A1 and SP-A2 (genes encoding SP-A) with allergic bronchopulmonary aspergillosis (ABPA) and its clinical markers. METHODS: Genomic DNA was extracted from blood samples of patients with ABPA and age-matched, unrelated control subjects. The polymorphisms were detected by means of PCR amplification and sequencing of the collagen region of SP-A1 and SP-A2. RESULTS: Two exonic (SP-A2 G1649C and SP-A2 A1660G, 10 patients and 11 control subjects) and 2 intronic (SP-A2 T1492C, 8 patients and 8 control subjects; SP-A1 C1416T, 5 patients and 7 control subjects) polymorphisms in the collagen region of SP-A2 and SP-A1 showed significant association with patients with ABPA. A significantly higher frequency of the AGA allele (A1660G) of SP-A2 was observed in patients with ABPA in comparison with control subjects (P =.0156, odds ratio [OR] = 4.78, 95% CI = 1.23 < OR < 18.52). This polymorphism, when existing along with a nonredundant polymorphism, SP-A2 G1649C (Ala91Pro) resulted in a stronger association with ABPA (A1660G and G1649C: P =.0079, OR = 10.4, 95% CI = 1.62 < OR < 66.90). Patients with ABPA with GCT and AGG alleles showed significantly high levels of total IgE and percentage eosinophilia versus patients with ABPA with CCT and AGA alleles. CONCLUSION: The results indicated that SP-A2 G1649C and SP-A2 A1660G, polymorphisms in the collagen region of SP-A2, might be one of the contributing factors to genetic predisposition and severity of clinical markers of ABPA.

Adolescent↗