Biomedical subjects
Publications and source records attributed to W A Shaikh.
Klippel-Trénaunay syndrome (KTS) is an uncommon entity. This congenital malformation is characterized by the triad of soft tissue or bony hypertrophy, cutaneous vascular malformations, and atypical venous abnormalities. We report here a case of KTS and discuss the clinical features, investigations, and management of this enigmatic condition.
We report here unusual clinical manifestations in a case of kerosene poisoning. The patient presented with encephalopathy and in the course of stay in the hospital developed renal tubular acidosis, delayed first-degree burns and myocarditis. With supportivetherapy the patient recovered completely and was discharged without any sequelae.
We report here a case of a 35-year-old male who presented with multi-system disease, which on evaluation was found to be due to primary systemic amyloidosis. We present the myriad manifestations of this uncommon disease entity.
We report here the unusual case of a 64 year old male, who was incidentally found to have a patent ductus arteriosus (PDA). The patient was asymptomatic. Echocardiography revealed a moderate sized PDA with normal left ventricular function and mild pulmonary hypertension. As the patient was asymptomatic and was not willing for any form of intervention, he was discharged and is currently under close follow-up. To the best of our knowledge this is the oldest reported case of a PDA in Indian literature.
Recent times have witnessed a qualitative shift in the recognition and management of adverse drug effects. Many of them occur in organs that are unconnected to the primary target of pharmacological action. Out of these, cardiac side-effects have drawn particular attention because of their potential to cause death. Starting with the early observations on antibiotics such as macrolides, followed by fluoroquinolones and others, the focus has now shifted to the antihistamine class of drugs which are used extensively by patients all over the world, thanks to the ever increasing levels of environmental pollution. The occurrence of prolonged QTc interval following treatment with terfenadine leading to ventricular tachycardia of torsades de points variety with a potentially fatal outcome has forced many regulatory authorities of the world to clamp a ban the use of this drug. Alerted by these developments, studies on a new member, followed by fluoroquinolones and others, the focus has now shifted to the antihistamine class of drugs which are used extensively by patients all over the world, thanks to the ever incresing levels of envrionmental pollution. The occurrence of prolonged QTc interval following treatment with terfenadine leading to ventricular tachycardia of torsades de points variety with a potentially fatal outcome has forced many regulatory authorities of the world to clamp a ban use of this drug. Alerted by these developments, studies on a new member of non-sedating antihistamine class viz, fexofenadine, have been reviewed especially because of the structural similarity between terfenadine and fexofenadine. It is now clear that despite the closeness of its chemical structure to terfenadine fexofenadine behaves in a different manner and does not affect the electrophysiology of the heart muscle tissue, as proved by data from extensive clinical trials as well as membrane models in vitro. Interestingly, the solitary false alarm that was sounded on the drug by a group of workers in the Netherlands was later rectified by the same group. Clinically speaking, the cardiovascular safety of fexofenadine has been convincingly demonstrated at various dose levels and various time intervals, alone and together with other drugs of potential toxigenicity. All things put together, it appears reasonable to conclude that fexofenadine is free from cardiovascular ADRs of clinical significance. It could also be concluded that cardiac side-effects of antihistamines is not a class effect.
BACKGROUND: Budesonide, an inhaled corticosteroid and specific immunotherapy, are both routinely used in the treatment of bronchial asthma. However, there are as yet, no studies comparing the effects of budesonide vs immunotherapy. OBJECTIVE: The aim of this study is to compare the effects of budesonide with immunotherapy in patients having perennial asthma. METHODS: This study is an open, parallel, comparative trial, in which 51 young patients were administered either immunotherapy or budesonide for 1 year and their global symptom scores and FEV1 values assessed. Both treatments were abruptly discontinued after 12 months and the effects of cessation analysed. RESULTS: The use of budesonide resulted in a faster and more striking improvement during the first few months as compared to immunotherapy, with an even more rapid decline in benefits on cessation of budesonide. Immunotherapy on the other hand, resulted in slow but steady improvement which did not decline as rapidly as budesonide on cessation. CONCLUSION: Although this was an open trial, it could be concluded that relief with inhaled corticosteroids in bronchial asthma is more rapid than immunotherapy; however the decline in benefit on cessation of inhaled corticosteroid is even more rapid, a phenomenon not seen with immunotherapy.
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BACKGROUND: Ephedrine nasal wash (0.25% to 1%) was once used in the treatment of sinusitis and other nasal and paranasal symptoms, but there are no reported controlled trials in allergic rhinitis. METHODS: In a blinded study, 118 patients with perennial allergic rhinitis were randomly divided into two groups of 65 and 53 patients, respectively, and administered either a placebo or a 1% ephedrine-saline nasal wash once every 48 hours for a period of 4 weeks. These groups were then crossed over after a 4-week interval, and their weekly symptom scores and peak nasal inspiratory flow rates were monitored. RESULTS: Use of ephedrine-saline nasal wash resulted in significant improvement in symptom scores and peak nasal inspiratory flow rates as compared with placebo (p < or = 0.001). A statistically significant difference between the two groups began in the second week. The effects of treatment lasted for more than 2 weeks after the study, without notable side effects, in most patients. CONCLUSION: A 1% ephedrine-saline nasal wash is an inexpensive and effective treatment for allergic rhinitis.
Eighty-one Indian patients received immunotherapy for allergic diseases during 109 pregnancies. Their allergy clinic records were analysed retrospectively and this revealed an incidence similar to or less than the general population with regard to abortion, perinatal mortality, prematurity, toxaemia and congenital malformation. A control group of 60 contemporary Indian patients (82 pregnancies) who refused immunotherapy were also analysed retrospectively and this revealed a higher incidence of abortion, prematurity and toxaemia as compared with those treated with immunotherapy. It is concluded that immunotherapy for allergic diseases is safe in pregnancy. Immunotherapy is safe even when it is initiated for the first time in a pregnant patient, an aspect not reported in any study until now.
Inhaled beclomethasone dipropionate (BDP) has been used with few side-effects in the treatment of bronchial asthma for 2 decades. Until now the manifestation of tuberculosis (TB) in patients on inhaled BDP has not been reported. Eight patients with allergic asthma, of a total of 548 asthmatics (1.46%) seen over a 2-year period, developed active TB following the use of inhaled BDP. All were sputum-positive for acid-fast bacilli (AFB) on smear and/or culture, all responded well to a combination of anti-TB drugs, and none showed evidence of immunological or pituitary-adrenal suppression. Two patients agreed to a repeat administration of BDP; both developed TB again within 2 weeks and are again on anti-TB treatment.
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Budesonide, an inhaled corticosteroid is used routinely in the treatment of bronchial asthma and rhinitis. Although inhaled corticosteroids in therapeutic doses are unlikely to result in systemic side effects, there is as yet skepticism about their routine and prolonged use. The aim of this study was to determine whether budesonide inhalation through a metered dose inhaler, when exhaled through the nose could result in a reduction in the dose requirement of budesonide metered nasal spray in patients having perennial allergic asthma with rhinitis. This study was an open, parallel, comparative, crossover trial in which 49 young patients having perennial allergic asthma with rhinitis were divided into two groups and administered either a combination of budesonide metered dose inhaler with a budesonide nasal spray or a budesonide inhaler alone, which was to be exhaled through the nose. Both groups were later crossed over and weekly symptom scores and peak nasal inspiratory flow rates were monitored during each phase of the study. Finally, patients who volunteered from both groups were instructed to note the reduction in dose requirement of budesonide nasal spray while using a budesonide inhaler and exhaling it through the nose. The results of this study reveal that when a budesonide inhaler is exhaled through the nose, it results in an improvement in symptom scores and peak nasal inspiratory flow rates, which were significantly less than those obtained in the group using both a budesonide nasal spray and a metered dose inhaler. In addition, exhaling budesonide through the nose results in a 40.1% reduction in the dose requirement of a budesonide nasal spray, which is statistically significant (p < 0.001).
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