Management of chronic obstructive pulmonary disease in India: a systematic review.

OBJECTIVES: Chronic diseases are fast becoming the largest health burden in India. Despite this, their management in India has not been well studied. We aimed to systematically review the nature and efficacy of current management strategies for chronic obstructive pulmonary disease (COPD) in India. METHODS: We used database searches (MEDLINE, EMBASE, IndMED, CENTRAL and CINAHL), journal hand-searches, scanning of reference lists and contact with experts to identify studies for systematic review. We did not review management strategies aimed at chronic diseases more generally, nor management of acute exacerbations. Due to the heterogeneity of reviewed studies, meta-analysis was not appropriate. Thus, narrative methods were used. SETTING: India. PARTICIPANTS: All adult populations resident in India. MAIN OUTCOME MEASURES: 1. Trialled interventions and outcomes 2. Extent and efficacy of current management strategies 3. Above outcomes by subgroup. RESULTS: We found information regarding current management - particularly regarding the implementation of national guidelines and primary prevention - to be minimal. This led to difficulty in interpreting studies of management strategies, which were varied and generally of positive effect. Data regarding current management outcomes were very few. CONCLUSIONS: The current understanding of management strategies for COPD in India is limited due to a lack of published data. Determination of the extent of current use of management guidelines, availability and use of treatment, and current primary prevention strategies would be useful. This would also provide evidence on which to interpret existing and future studies of management outcomes and novel interventions

Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study

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Case Report - Iatrogenic Gastric Fistula Due to Inappropriate Placement of Intercostal Drainage Tube in a Case of Traumatic Diaphragmatic Hernia

A 26-year-old, 30 weeks primigravida presented with a gastric fistula through a left intercostal drain, which was inserted for drainage of suspected haemopneumothorax following minor trauma. It was confirmed to be a diaphragmatic hernia, with stomach and omentum as its contents. On exploratory laparotomy, disconnection of the tube and fistulous tract, with reduction of herniated contents and primary suturing of stomach was carried out. Diaphragmatic reconstruction with polypropylene mesh was also carried out. Post-operative recovery was uneventful with full lung expansion by 3rd postoperative day. Patient was asymptomatic at follow-up 6 months

Case Report - Ruptured True Aneurysm of The Splenic Artery: An Unusual Cause of Haemoperitoneum

True aneurysm of the splenic artery is rare. Two cases of ruptured true aneurysm are presented. The first patient was a 62-year-old female who presented within 6 hours of the onset of symptoms. The other was a 27-year-old nonalcoholic male patient who was admitted in a state of shock after 2 days of observation in a peripheral hospital. Both patients had haemoperitoneum and were subjected to exploratory laparotomy. Anuerysmectomy was performed in both the patients in addition to left splenopancreatectomy in the first case and splenectomy in the second. However, due to the prolonged preoperative shock, the second patient succumbed on the third postoperative day

Influência do turno de rega no crescimento e produção do tomateiro no verão em Seropédica Influence of the irrigation schedule on growth and production of tomato during summer

Com o objetivo de analisar a influência do turno de rega na cultura do tomateiro para mesa (híbrido Débora tipo longa vida), realizou-se um experimento de campo, no delineamento em faixas, com quatro tratamentos e quatro repetições, de 21/09/05 a 31/01/06. Foram avaliados , o turno de rega diário (TR0); turno de rega alternado de um dia (TR1); turno de rega alternado de dois dias (TR2); e turno de rega alternado de três dias (TR3). Para todos os tratamentos foi reposto 100% da ETc. Durante o experimento, foram realizadas seis coletas para determinação da biomassa e da área foliar visando o estudo de análise do crescimento das plantas, sendo ajustadas equações para estimativa dos índices fisiológicos de crescimento da cultura. Foi possível constatar que o pico máximo de crescimento ocorreu entre 80 e 90 dias após o transplante, não sendo possível no entanto, diferenciar um tratamento que proporcionasse melhor crescimento. Os resultados obtidos indicaram que o turno de rega de três dias reduziu o número de frutos grandes (>60 mm) e aumentou o número de frutos miúdos (40 a 50 mm). Contudo, o turno de rega de dois dias proporcionou produção de tomate igual ou superior ao de turnos mais frequentes e com maior eficiência de uso de água. Para as condições de primavera-verão de 2005-2006 em Seropédica-RJ, o turno de rega alternado de dois dias mostrou-se mais favorável para recomendação aos agricultores.<br>The influence of the irrigation schedule was evaluated on the tomato culture, Debora hybrid for salad, in a field experiment, in a split plot design with four treatments and four replications, conducted from September, 21st, 2005 to January, 31st, 2006. We evaluated the irrigation every day (TR0); irrigation every two days (TR1); irrigation every three days (TR2); irrigation every four days (TR3). 100% of the ETc was applied in all treatments. During the essay, six samplings of plants were performed to determine the plant weight and leaf area to adjust equations for the estimation of the growth parameters. The maximum growth was obtained between 80 and 90 days after transplanting, but in these experimental conditions the growth analysis did not discriminate the treatments. The irrigation schedule of three days caused a reduction in the number of big fruits (>60 mm) and increase in the number of small fruits (40-50 mm). However, the irrigation frequency of two days showed the same or higher fruit quality of the smaller intervals, but with improved water use efficiency. For the spring-summer of 2005-2006 conditions, at Seropédica, Rio de Janeiro State, Brazil, the irrigation schedule of two days was the best to be recommended for the farmer