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1. Exercise testing in assessment and management of Patients in Clinical Practice - Present situation

By Sumer S Choudhary, Sanjiw Choudhary

Key words : Exercise; heart; Interpretation; methodology; 6min walk test; testing

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2. Sleep effects on breathing and respiratory diseases
By Sumer S. Choudhary, Sanjiw R. Choudhary

Key Words: Asthma, COPD, neuromuscular, sleep

ABSTRACT
To understand normal sleep pattern and physiological changes during sleep, sleep and breathing interaction,
nomenclature and scales used in sleep study, discuss the effect of rapid eye movements and non-rapid eye movements
while sleep and to review the effects of obstructive and restrictive lung disease on gas exchange during sleep and
sleep architecture.

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3. Polysomnography: A Useful Tool in Diagnosis And Management Of Sleep Diseases
By Sumer Choudhary

ABSTRACT

Sleep diseases, of which obstructive sleep apnea is one, are one of the leading health problems in both developed and developing countries. However, education and awareness regarding diagnosis and management is still lacking among both public and treating physician. The initial work done on sleep study was done in the era of Rechtschaffen and Kates. Presently Computerized Polysomnography (PSG) incorporated with different channels is an important tool in management of patients of sleep disorders. Any sleep study which is to be performed requires a well equipped and validated sleep laboratory for proper results and interpretation of data. Nomenclatures are defined, scales have been formulated and grading of disease on the basis of PSG study has been done. Different types of sleep study like study in sleep centre, Multiple sleep latency test, maintenance of wakefulness test, and portable home monitoring tests are done routinely of which portable home based test is not encouraged. It not only helps in detecting obstructive sleep apnea but is also helpful in the management of central sleep apnea patients.  Key Words : Polymnography, sleep staging, apnea

http://www.pjms.in/index.php/panacea/search/search   -  dr sumer choudhary

4. Efficacy and treatment outcome of DOTS in RNTCP
Sumer Choudhary, B Tayade, Pinky Keshwani

ABSTRACT

Retrospective observation  analysis was carried out to evaluate the  outcome of DOTS under RNTCP at NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital Digdoh Hills Hingna Nagpur tertiary care center . Total 141 patients  were studied  under all the  categories  registered from October 2006 to  February 2008 with a follow up of one year .  Standard norms were applied  for treating  and registering  under different  categories and for outcome of treatment.  Category  1  consisted  of  96  patients  category  2  constituted  12  patients  and  category  3  had  33  patients.  All patients  were  closely  followed  up  during  treatment  phase  and  were  asked  for  a  regular  follow  up  after  completion  of treatment. Of the 141 patients 94.33% patients were declared cured/ treatment completed, 3.54% defaulted, the failure  rate  was 1.418% and  overall  death rate  was 2.128%. The  cure  /  treatment  completion  in  present study  is 97.67%  and  75%    for  new  smear  positive  and  pretreatment  patients.  Success  rate  in  terms  of  cure/  treatment completion  is  much higher  in  category  1  patients  and  slightly  higher  in  category  2  patients  as  compared  to  the national  average  of  86.50%  and  70.5%  in  new  smear  positive  and retreatment  cases    respectively . This  was comparable  to  the  other  studies  published  earlier .

Keywords:  DOTS,  RNTCP ,  Outcome,  Enhanced.

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5. Non-invasive mechanical ventilation in clinical practicecons pros and cons
Sumer Choudhary

ABSTRACT

Noninvasive  positive-pressure  ventilation  is  a  type  of  mechanical ventilation  that  does  not  require  an  artificial airway .  Studies published  in  the  1990s  that  evaluated  the  efficacy  of  this  technique  for  the  treatment  of  diseases  like chronic obstructive pulmonary disease, congestive heart failure and acute respiratory failure have generalized its use  in  recent  years.  Important  issues  include  the  selection  of  the  type  of  ventilation  interface  and  the  type  of 
ventilator . 
Currently  available  interfaces  include  nasal,  oro-nasal  and  facial  masks,  mouthpieces  and  helmets. Comparisons of the  available interfaces have  not found any one of them  to  be superior .  Both critical  care ventilators and  portable  ventilators  can  be  used  for  noninvasive  positive-pressure  ventilation;  however ,  the  choice  of  ventilator type  depends  on  the  patient's  condition  and  therapeutic  requirements.  The  best  results  (decreased  need  for intubations  and  decreased mortality)  have  been  reported  among  patients  with exacerbations  of  chronic  obstructive pulmonary  disease  and  cardiogenic  pulmonary  edema.

Key  Words:  Non  Invasive,  Mechanical Ventilation,  Respiratory,  Interfaces.

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6. Pulmonary function tests in clinical practice: importance, requirements and limitations
Sumer Choudhary

ABSTRACT

Pulmonary  function  tests  have  progressed  from  initially  used  water  seal  types  to  modern  era  electronic  computerized  versions.  The newer  software  are  comparatively  easier  to  operate  and  less  time  consuming.  They  are  patient  friendly  and  easier  to  understand.  However  there  are  limitations  to  pulmonary  function  tests,  as  the  pattern  of  abnormality  indicates  type  of  problem  however  they  do  not  provide  anatomic  diagnosis.  Battery  of  tests  is  available  which  help  in  evaluation  of  different  aspects  of  pulmonary  function.  It  is  possible  to  monitor  the  progression of disease and effect of management. However no single test can evaluate all aspects of pulmonary  function.  Pulmonary function test can be carried out at bedside in critically ill patients with the help of portable spirometers in addition to the routine clinical tests. Commonly performed pulmonary function tests are dynamic  studies  –pre  and  post  bronchodilator  tests,  evaluation  of  lung  volumes  with  body  plethysmography ,  nitrogen  washout or helium dilution methods, diffusion capacity of the  lung  carbon monoxide  by single  breath analysis,  arterial blood gases and pulse oximetry . Other commonly performed tests are maximal expiratory and inspiratory  pressure, exercise induced(T readmill)or allergen induced  bronchoprovocative tests, shunt studies and Dead space  measurements.  If  the  pulmonary  function  tests  are  done  with  quality  assurance,  validation  of  the  equipment,  proper technique,  reference values and applying right  ethnic  correction factors,  the  data generated are most of the  times  accurate  and  reproducible.

http://www.pjms.in/index.php/panacea/search/search   -  dr sumer choudhary

7. Obstructive sleep apnea therapy: Treatment and reliever in co-morbid diseases
Sumer Choudhary

ABSTRACT

Obstructive sleep apnea (OSA)-induced biological changes include intermittent hypoxia, intermittent hypercapnia, intrathoracic pressure changes, and sympathetic activation and sleep fragmentation. OSA can cause metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and hypercoagulation, and neurohumoral changes. Important comorbidities associated with OSA are cardiovascular system i.e. hypertension, cardiac arrhythmias, coronary artery disease, cardiac failure and stroke, respiratory system i.e. pulmonary hypertension, asthma ,COPD, central nervous system i.e. erectile dysfunction, seizure disorders, strokes, psychiatric illness and other systemic diseases like obesity, sudden infant death syndrome, chronic renal failure, diabetes mellitus, GERD. The diagnosis of OSA is based on polysomographic studies. PAP treatment has been found to have beneficial effects in many of these consequences. There is also a need to identify other modalities of treatment. Certainly, the treatment of OSA can greatly improve or even revert some of the co morbid conditions.

Keywords: Sleep apnea, Co-morbid, Asthma, Cardiovascular, Obesity, Diabetes, Epilepsy, GERD, Erectile.

http://www.pjms.in/index.php/panacea/search/search   -  dr sumer choudhary

8. Dr Sumer Choudhary. Recent Advances In Diagnosis Tuberculosis.Update AFB NEWS The Tuberculosis Bulletin.January To June 2013 Vol 1-Issue 1.Page 25 to 28. Indexed 1SSN 2321-7901 Click Here

9. Dr Sumer Choudhary.Tuberculosis and HIV:Step towards resolving the drug interaction between antiretrovirals and antituberculars. Review Article. AFB News The Tuberculosis Bulletin.July To December 2013 Vol 1-Issue 2.Page 10 to 19. (Indexed 1SSN 2321-7901) - Click Here

10. Dr. Sumer Choudhary A Study of Treatment Outcome,Performance and Response of Patients On DOTS under RNTCP Original Article AFB NEWS The Tuberculosis Jan - June 2014, Vol 2 - Issue I Click Here

11. Interstial Lung Diseases [ILD]: Simplified, Advances, What's New
Sumer Sanjiw Choudhary

ABSTRACT

Interstitial lung disease (ILD) is a diverse collection of disorders characterized by impaired gas exchange,restricted physiology on lung function testing, and diffuse parenchymal lung infiltrates on radiography. Although the interstitial lung diseases are many in routine clinical practice, the most commonly encountered in practice are sarcoidosis, idiopathic pulmonary fibrosis (IPF), and connective tissue disease-associated interstitial lung diseases.In immune-compromised patients, infection is the most common cause of diffuse lung infiltrates and must be ruled out before any attempt to treat with immune altering agents like corticosteroids. There are many new agents available for managing ILD, lung transplantation and pulmonary rehabilitation is also available treatment option however we require an orchestrated effort towards simplif ying, for a better understanding and treatment of this complex life threatening group of diseases. This review will focus on the more clinically significant recent advances and recommendations in the field of interstitial lung disease. Recent advances in diagnostic techniques and treatment interventions represent a signi?cant step forward in our understanding and management of ILD.

Keywords: Interstitial lung diseases,Idiopathic pulmonary fibrosis,Lung transplantation,Gap index.

http://www.pjms.in/index.php/panacea/search/search   -  dr sumer choudhary

12. Outcome And Comparison of Adult and Childhood Tuberculosis in RNTCP: A Retrospective Study
Sumer Sanjiw Choudhary, BO Tayade, Shafee Khan, R Giri, Parthiv Shah, Virag Doshi

ABSTRACT

Retrospective observation analysis from Tuberculosis Unit (T.U.) Nagpur register to evaluate the outcome of DOTS under RNTCP at NKP Salve Institute of Medical Sciences And Lata Mangeshkar Hospital Digdoh Hills Hingna Nagpur a tertiary care centre..Total 545 patients were studied under all the categories registered from January 2009 to December 2013.Standard norms were applied for treating and registering under different categories and for outcome of treatment. The total mean age of patients was 35.11 years (S.D 15.99), the mean of Adult patients were 37.87 years (S.D 14.06) and Paediatric patients were 8.373 years (S.D 4.891). 494 (90.64%) patients were Adults and 51(9.36%) Paediatrics In Adult patients, 449(90.89%) had favorable outcome, 45(9.11%) patients had unfavorable outcome. All 51 (100%) patients in paediatric group had favorable outcomes. Maximum patients were registered under Category 1, i.e 448 patients of which 398 patients were Adults and 50 patients were in Paediatric age group.. Of the 545 patients 337(61.83%) were male and 208((38.17%) were female In both the age groups there were higher number of males compared to females. Of the 545 patients 500(91.74%) patients were declared favorable outcome. 198(95.19%) Females had favorable and 10 (4.81%) had unfavorable outcome.174 were in Adult and 24 in Paediatric age group in favorable outcome of females. 302 (89.61%) Males had favorable of which 275 were Adults and 27 were paediatric and 35 (10.39%) male had unfavorable outcomes all in Adult age group. 391(71.74%) were of pulmonary tuberculosis and 154(28.26%) were of Extra pulmonary Tuberculosis, the ratio between the two was 2.5:1.The ratio of smear positive to smear negative was 1.35:1. 45(8.26%) patients had unfavorable outcomes of which12 (2.2%) defaulted, the failure rate was 0.75%, 4 patients, overall death rate was 18(3.3%), 11(2.05%) patients were transferred out and all Adults. Success rate in terms of cure/treatment completion is 94.19% and 78% is much higher in category 1 patients and slightly higher in category 2 patients as compared to the national average of 86.50% and 70.5% in new respectively. This was comparable to the other studies published earlier. The registration of childhood TB was better than national average. There were differences in presentation and treatment outcomes among children and adult patients. Category 1 and sputum was significant predictor in childhood tuberculosis.

http://www.pjms.in/index.php/panacea/search/search   -  dr sumer choudhary

13. Outcome of fiber optic bronchoscopy in sputum smear negative pulmonary tuberculosis
Sumer Choudhary, BO Tayade, Shahank Kharbade, Anil Sontakke, Shaifee Khan, Rini Abraham

ABSTRACT

Bronchoscopy is very useful for diagnosing Sputum smear-negative pulmonary tuberculosis (SSN-PTB). Our aim is to find out the diagnostic yield of fiber optic bronchoscopy in sputum smear negative under RNTCP and radio logically suspected new cases of pulmonary tuberculosis and the complications of fiber optic bronchoscopy. A cross-sectional prospective study in which consecutive 108 patients was carried out in patients whose two sputum smear for Acid Fast Bacilli was negative and chest X-ray suggestive of pulmonary tuberculosis were included into the study. Fiber optic bronchoscopy was carried out in all patients. The yield for tuberculosis was 78 %( 85/108) i.e. made a final diagnosis of tuberculosis.29 (26.85%), 41(37.96%) and 30(27.78%) patients had positive AFB smear on Bronchial brush, Broncho alveolar lavage and post bronchoscopy sputum of which 11(12.94%), 22(25.88%) and 13(15.29%) patients had exclusive diagnosis from the respective procedures. The immediate yield combining positive smear samples from different procedures and histopathological evidence of caseating granuloma in present study is 56%(61/108). In Broncho alveolar lavage culture 57/108(57.08%) were confirmed tuberculosis diagnosis and 24(28.4%) patients had exclusive diagnosis on bronchial culture. Bilateral, advanced, and non cavitatory disease had 52, 53 and 64 patients diagnosed as pulmonary tuberculosis and was more as compared to different site, extent and type of disease on chest x-ray which were initially negative for tuberculosis. Our study suggests that fibre-optic bronchoscopy and its procedure can provide excellent material for early as well as confirming the diagnosis in suspected patients of pulmonary tuberculosis when smears of expectorated sputum do not reveal mycobacteria and helps in diagnosing different diseases and disorders having clinical picture mimicking tuberculosis.

14.CAT Score in Chronic Obstructive Pulmonary Disease, Impact on Health: Assessment in Our Region
Sumer Choudhary, Abraham Rini, Tayade B, Shafee Khan, Virag Doshi, Vishal More

ABSTRACT

COPD is a disease state that causes lot of human suffering, is now recognized as a common disease in developing countries and is one of the fastest growing chronic cause of death. Pulmonary function tests are essential for the diagnosis and evaluation of the severity of COPD but other measures of functional status such as dyspnoea, exercise performance and health status are important components of COPD that cannot be measured by this method. The COPD assessment test (CAT) is a new eight-item specific questionnaire and is intended to provide a short, simple and self-administered test for evaluating symptoms, in assessing the impact of COPD on health status (Quality Of Life) .This study shows the usefulness of CAT score in our region. The clinical characteristics, Gold Severity and FEVI 1 % of present study were compared with earlier studies of different countries. Total 70 patients with COPD were studied from May 2014 to September 2014. Detail clinical history was obtained. Assessment of symptom severity was made based on the CAT questionnaire. They were subjected to pulmonary function test (pre and post bronchodilator therapy) and oxygen saturation measurement. Majority of the patients were Male 42(60%). Total 41(58.6%) patients were smokers of which 36 (87.8%) were males. 18(25.7%) patients had positive history of Chula exposure of which 17(94.4%) were females Mean age of patients was 60.3 years SD 9.9, Mean FEV1 62.33 SD 18.2, and SPO2 94.2 SD 2.27. Patients were classified into two groups. Group 1 of low symptoms having CAT Score <10 and high symptoms Group2of patients having CAT score >10. More than half of the patients 80% had a high CAT score of >10 of Group 2. Most of the patients were of moderate obstruction50%. Patients in whom Forced expiratory volume in 1 s percent (FEV1%) predicted was significantly decreased had a significantly increased the CAT score (t = 2.67 p= .009). Patients with severe stage of the disease (as GOLD criteria) had high CAT score i.e. have a positive correlation whereas CAT score and FEVI % had inverse co relation. The mean FEV1% predicted was similar to France where as high compared to Germany, Netherlands, Spain and USA and lower than Belgium. The CAT questionnaire proves to be a sensitive test in detecting COPD health status as a simple and reliable tool. By the help of CAT questionnaire the patients and clinician’s awareness of COPD would be improved to make an early diagnosis thus providing a useful and objective tool for early recognition and long-term clinical and therapeutic monitoring of COPD patients especially in the clinical settings where spirometry is not yet available.

http://www.pjms.in/index.php/panacea/search/search   -  dr sumer choudhary

15.Chronic Obstructive Pulmonary Disease: The future
Sumer Choudhary

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality across the world. Almost 90% of COPD deaths are occurring in low and middle - income countries.(1,2) Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.(3) This refined definition includes the impact of symptoms and developmental origins. Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the world but is projected to be the 3rd leading cause of death by 2020. The Global burden of COPD is estimated to be 384 million with a global prevalence of 11.7%. Females are at a higher risk of developing the disease with equivalent exposure as compared to males. COPD is now not an untreatable disease, over the past few decades management have improved drastically with research growing exponentially. COPD was considered predominantly a smoking-related disease, however 25%–45% of patients suffering from the disorder have never smoked. The risk factors attributed to the disease that can affect at different life stages are —in utero due to maternal smoking/exposure to air pollution, in childhood because of respiratory tract infections and in adulthood due to indoor biomass fuels, outdoor air pollution. In India, 90% of rural population houses and 32% of urban population houses cook their meals on a biomass stove,(4,5) only 25% of the cooking being done with cleaner alternative gases,(6,7) indicating biomass fuels a major cause of COPD. Mosquito coils used in the night are emitting particulate matter equivalent to around 100 cigarettes is also a major risk factor for development of non-smokers COPD.(8) Lack of awareness of the disease, its symptoms or implications is one of the major reasons that the people at risk are not seeking help from their primary care physicians. Even if a symptomatic patient visits his general practitioners, there is increases chances of under diagnosis as spirometries are not routine and diagnosis is largely symptom based. The inhalational devices are generally prescribed at the ‘terminal stage’ of the disease and these devices have a virtual stigma in rural setting. It is now well appreciated that COPD is much more than the combination of chronic bronchitis and emphysema. Chronic lung inflammation and remodeling of small airways can produce COPD, even in the absence of bronchitic symptoms or radiographic evidence of emphysema. The refined ABCD assessment tool adopts three step approach 1) diagnosis based on FEV1/FVC <0.7, 2) Airflow limitation assessment 3) Assessment of symptoms and risk of exacerbation.(3) Due to the complexity of COPD, patients are best managed by a multidisciplinary team, which include clinicians, dietitians, educators, psychologist and respiratory therapists. The multidisciplinary team can educate patients to understand their disease and help in making self-management plans. TRILOGY is an important options in pharmacotherapy management for severe disease, bringing down the cost of treatment which still needs to be a priority in many parts of the world.(9) Two Cochrane Reviews, one of admission avoidance hospital at home(10) and the other of early discharge hospital at home(11) were carried out on COPD patients. Higher admission rates were noted in patients of early discharge as compared to hospital at home. Fernando Martinez and colleagues report the results of the REACT trial, which shows that roflumilast, can reduce exacerbations and hospital admissions in patients with severe COPD and chronic bronchitis who are also receiving recommended therapy—a fixed inhaled corticosteroid and long acting β2agonist combination.(12) We need to make protocols for the use of systemic corticosteroids, antibiotics, and, in hypercapnic individuals, noninvasive mechanical ventilation, which can accelerate recovery from exacerbations. COPD patients frequently have co-morbidities like heart disease, osteoporosis, cachexia, and depression as result of or in conjunction with their COPD. These co morbidities severely impair the patient’s health status, quality of life and must be treated aggressively. In spite of optimal therapy, few of the patients will experience exacerbations requiring urgent care. Clinical trials have proved that inhaled bronchodilators therapy along with pulmonary rehabilitation improve out come in terms of functional capacity and quality of life and may reduce mortality rates.(13,14) The benefit of oxygen supplementation has been proven in persons with severe resting hypoxemia, and lung volume reduction surgery is recommended for a subgroup of emphysematous patients.(13-15) The availability of effective treatments makes early intervention increasingly important. Pneumococcal and Influenza vaccination prevents lower respiratory tract infection and may reduce the infective exacerbations. Despite of all our efforts, some patients will die due to COPD. Hence the, end-of-life issues should be discussed with patients and their families, especially in advanced disease, before they face a life-and-death crisis. This will ensure that the patient knows what would happen and patient’s wishes can be respected during periods of medical crisis. Scientific research is advancing rapidly. After decades of modest progress, researchers currently are making rapid advances using modern methods of genetics, genomics, and molecular pathology to better understand COPD.(13,14) These new advances in knowledge show the importance of protecting young, developing lungs from insults, including tobacco smoke The renewed interest in COPD research provides hope that novel therapies with the potential for modifying the disease process will soon be identified. All guidelines aim to improve health care processes and outcomes through minimization of practice variation, and optimization of resources.(16) In low and middle income countries, with resource limitations, future research initiatives should be considered on how to improve compliance, adherence, accessibility and implementation of new treatments, where the burden of COPD disease is great.

http://www.pjms.in/index.php/panacea/search/search   -  dr sumer choudhary

16.Study of patients with restrictive spirometry having significant bronchodilator response
Sumer S Choudhary., Tayade B.O., Rini Abraham., Vishal More., Anchit Bhatnagar and Sonal Arsude

ABSTRACT

Introduction: Obstructive airway disease is characterized by reversibility on bronchodilator therapy measured by pulmonary function tests; however this is not often seen is restrictive diseases. We studied the clinical significance of bronchodilator reversibility in patients of restrictive pattern of spirometry. Materials and Methods: 30 patients with restrictive spirometry having significant bronchodilators response, were included in our study. Restiction was defined as decreased FVC and FEV1, with normal FEVI/FVC and a bronchodilator response as improvement of 12% and 200ml in FEV1 and FVC. Patients demographics, clinical history, treatment history, X-Ray characteristics, spirometry, diffusing lung capacity, and lung volumes measurements on Body Plethysmography were recorded. Results: The mean age was 48.60 + 14.06 years, majority of the patients were male 70 % and 22.23 + 3 .59 was females BMI slightly higher than males .40% were smokers, with shortness of breath the most common symptom, followed by cough, wheeze and chest pain..Asthma was the most common diagnosed medical condition and most of them were on bronchodialtors. The mean post bronchodilator FEV1% and FVC% was 66.88 + 24.28 and 70.95 + 24.99, with a reversibility of 12.91%.The FEV1/FVC% was 96.80+16.95. The mean TLC was normal whereas the RV, TLC, RV/TLC was increased. Conclusions: It can be concluded that post bronchodilator reversibility in patients of restrictive spirometry may be because of decrease elastic recoil resulting in early airway closure leading to air trapping and low FVC. Even though the numbers of such patients are low if symptomatic they would be benefited with bronchodilator therapy.

http://recentscientific.com/study-patients-restrictive-spirometry-having-significant-bronchodilator-response

17.COPD, A RISING CONCERN FOR NON SMOKERS! IS IT TRUE?
Sumer Choudhary, Jaydeep Nayase., Shubham Telang and Tayade B.O

ABSTRACT

Introduction: Chronic obstructive pulmonary disorder is the leading cause of morbidity and mortality worldwide. In clinical practice non smokers COPD patients are on rise, the risk factors which are important in its development were evaluated Methods: This observational cross sectional study included a total 298 patients, with age above 18 years, diagnosed clinically and on spirometry as per Gold guidelines fulfill inclusion criteria. Results: Of the 298 patients 150(50•34%) were nonsmokers and 49•66%) were smokers. Males were the predominant gender, most of them more than 60 years, with comparable mean age.COPD were found at an early age in smoker’s population. Most of the patients in non-smokers group had moderate obstruction (73•34%).Statically significant risk factors identified were occupational exposure (86•67%),education level (55•34%), biomass exposure (39•34%),associated conditions of pulmonary tuberculosis (22•67%) and chronic asthma (16%)(P-0•001). Other risk factors like outdoor air pollution (70%), childhood admissions (13•34%) though not statistically significant, contributed in development of non-smokers COPD. BMI in non-smoker’s population was lower than smokers 22.08+2.11. Most of the patients 50 (84•75%) of non-smokers population having biomass exposure had index more than sixty. Patients were classified according to gold stage and compared. The predominant gender was male in both groups with almost similar mean age and most of them above sixty years. The Gold Stage II+ group had higher outdoor air pollution (95%), occupational exposure (17•5%), biomass exposure (47•5%), passive smoking years 28 + 0•75 P < 0•001). Conclusion: It can be concluded that significant proportion of COPD patient in our region and early diagnosis can be made by identifying the risk factors

http://journalijcar.org/issues/copd-rising-concern-non-smokers-it-true   -  dr sumer choudhary

18.Systemic lupus erythematous (sle) with hydro pneumothorax: a rare case report
Sumer.S.Choudhary., Samruddhi.B.Tayade and Nalini .R. Humaney

ABSTRACT

Introduction: SLE an autoimmune disease, also known as lupus in which immune system affects healthy tissue of various regions of the body i.e. a multiorgan disease. Lung involvement is a common presentation in SLE; however life threatening pneumothorax is a rare occurrence in this disease. We describe a 26 year old young female diagnosed as SLE presenting with spontaneous pneumothorax. Intercostal tube was inserted and patient was given BIPAP ventilation and started on corticosteroids along with supportive treatment for underlying co-morbidities. Pneumothorax though not a common presentation in SLE can be life threatening with high mortality.

http://dx.doi.org/10.24327/23956429.ijcmpr20180499   -  dr sumer choudhary

19.Unfamiliar happening of dermal tuberculosis over tattoo mark
Dr Sumer S Choudhary, Dr Preetam Dhande and Dr B

ABSTRACT

Introduction: Even though tuberculosis is a global epidemic with increasing prevalence, the number of dermal tuberculosis encountered in outpatient department is comparatively few. It can manifest itself due to endogenous or exogenous factors and present to us in variety of forms. Even if diagnosis is made confirmation is relatively difficult though advances in investigation techniques. Lupus vulgaris a type of skin tuberculosis a very rare phenomenon. Here we report a 23yr old engineer presenting with fungating growth atop tattoo mark, done few months back at a fair. Diagnosis was confirmed microbiologically as well as histopathology. Patient was started on anti-tubercular drugs following which his lesions subsided.

http://journalcmpr.com/issues/unfamiliar-happening-dermal-tuberculosis-over-tattoo-mark   -  dr sumer choudhary

20.Asthma control test (act) score: effectiveness, validation, reliability, and response in opd patients of our place
Dr Sumer S Choudhary, Jaydeep G Nayse, Dr B O Tayade, Dr Samrudhi Tayade,Dr Shriyansh Singh, Dr Preetam Dhande and Dr GopalGondchar

ABSTRACT

Introduction: The Asthma control Test (ACT), Asthma Control Questionnaires (ACQ) and GINA Scales are widely used clinical and scientific tool to evaluate asthma, but not yet validated nor reliability studied in different population Aims: Study is conducted to evaluate usefulness of ACT scores in initiation or treatment change in asthma patients, its reliability and to correlate ACT score with GINA guidelines and ACQ. Setting and Design: This hospital based cross sectional study at department of Pulmonary Medicine, NKP Salve Institute of Medical Sciences, Nagpur. Methods and Material: Our participants were patient’s age 12 years and above, asthma diagnosed according to GINA guidelines, literate to complete questionnaire. We compared ACT score with GINA asthma control, ACQ, and asthma severity. Statistical analysis used: EPI Info Software version 7. Results: Total 111 adult patients with new or previous diagnosed case of asthma who fulfilled the inclusion and exclusion criteria were included. The group of patients having ACT score >20 and < 15 had an agreement with GINA controlled and uncontrolled group. The group of patients having ACQ score of < 0.75 had fair agreement with ACT score >20.ACQ >1.5 had a moderate agreement with corresponding ACT score of < 20. The FEV1 % predicted had a positive correlation with ACT score Asthma control as defined by GINA was highly correlated with asthma severity. Most patients with severe persistent asthma were uncontrolled. Conclusions: Using appropriate cut off point’s agreement can be observed between numerical and categorical scale. The choice of the scale to evaluate current asthma control may have a significant impact on the control status of an individual patient.

http://journalcmpr.com/issues/asthma-control-test-act-score-effectiveness-validation-reliability-and-response-opd-patients   -  dr sumer choudhary