Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and their reversibility with carbimazole therapy

Objectives: Dyspnoea is a common complaint among patients with thyrotoxicosis. However, its causative mechanisms have not been identified. We assessed the role of thoracic diaphragmatic muscle weakness in dyspnoea among patients with active Graves' disease. Methods: Twenty-seven patients (19 female, 8 male) with active Graves' disease were assessed for the clinical severity of dyspnoea, functional (pressure generating capacity) and anatomical aspects (thickness and excursion) of the diaphragm at presentation. The severity of dyspnoea was assessed using a visual analogue scale (VAS) and the 6 min walk test. Lung function tests, diaphragmatic strength (sniff oesophageal pressure, SniffPoeso), maximum inspiratory and expiratory pressures, diaphragmatic thickness and movements on real time ultrasonography were evaluated during normal and deep respiration. Twenty of the 27 patients were reassessed after achieving euthyroidism with carbimazole therapy at a mean interval of 5±2 months. Results: Reevaluation after carbimazole therapy revealed a significant reduction in dyspnoea on the VAS (59±26 to 23±13%). Patients covered a similar distance during the 6 min walk before and after euthyroidism. Significant improvement was observed in the vital capacity (2.57±0.62 to 2.94±0.60 l), forced expiratory volume in the first second (2.21±0.49 to 2.45±0.47 l), total lung capacity (3.57±1.19 to 4.1±1.12 l), diaphragmatic movement during deep respiration (5.5±1.0 to 6.6±1.1 cm) and SniffPoeso (68.7±23 to 93.1±25.2 cmH2O). There was no significant change in the distance walked in 6 min, tidal volume, lung diffusion capacity and diaphragmatic thickness. There was no significant correlation between the net change in dyspnoea score and net change in lung function tests, diaphragmatic movement and SniffPoeso. Conclusions: Significant functional weakness of diaphragm muscle is present in patients with active Graves' disease. This weakness is more marked during a maximal respiratory manoeuvre, indicating a diminished diaphragmatic reserve which could be the cause of dyspnoea observed on exertion among patients with thyrotoxicosis

EFEKTIVITAS DESENTRALISASI PENDIDIKAN DALAM MENINGKATKAN PROFESIONALISME GURU DI SMA NEGERI 1 LAKEA

Skripsi ini membahas tentang efektivitas desentralisasi pendidikan dalammeningkatkan profesionalisme guru di SMA Negeri 1 Lakea dengan pokok pembahasana bagaimana deskripsi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea? dan bagaimana implikasi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea. Tujuan penelitian ini untuk mengetahuideskripsi dan implikasi desentralisasi pendidikan dalam meningkatkan prodfesionalisme guru di sekolah tersebut.Untuk menjawab permsalahan tersebut, penelitian ini menggunakan metode kualitatif dengan teknik pengumpulan data melalui observasi, wawancara dan dokumentasi, serta menggunakan teknik analisis data melalui reduksi data, penyajian data, verifikasi data dan penarikan kesimpulan.Hasil penelitian skripsi ini yaitu: deskripsi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Desentralisasi pendidikan merupakan pemberian kewenangan kepada daerah untuk mengelola pendidikannya, lalu daerah melimpahkan kepada masing-masing sekolah (2) Pemerintah pusat tetap mengontrol pendidikan yang diselenggarakan oleh pemerintah daerah dan masing-masing sekolah melalui akreditasi nasional yang dilaksanakan oleh BAN-SM (3) Aspek-aspek yang menjadi kewenangan sekolah dalam melaksanakan desentralisai pendidikan yakni: (a) Perencanaan dan evaluasi program sekolah dalam hal ini sekolah berupaya meningkatkan mutu pendidikan dengan cara merencanakan kegiatan-kegiatan yang dapat meningkatkan profesionalisme guru, misalnya mengutus guru untuk mengikuti Musyawarah Guru Mata Pelajaran (MGMP) dan merencanakan bimbingan teknis untuk meningkatkan keterampilan guru dan mengevaluasi berbagai perencaan kegiatan program sekolah (b) Aspek pengelolaan proses belajar, memberikan kewenangan kepada masing-masing guru untuk mengelola proses pembelajaran pada mata pelajaran yang dipegangnya dan kepala sekolah melukan supervisi kepada guru untuk mengevaluasi dan membimbing pelaksanaan proses pembelajaran guru tersebut (c) Aspek pengelolaan ketenagaan, SMA Negeri 1 Lakea mengelola 25 orang guru dan 3 orang tenaga administrasi, pengelolaan yang dilakukan misalnya memberikan guru mata pelajaran yang sesuai dengan keahliannya, dan mengutus guru sebagai perwakilannya dalam kegiatan seminar mapun workshop (d) Aspek pengelolaan keuangan, sekolah mengelola dana BOS dengan prosedur sesuai dengan aturan penggunaan dana tersebut yakni sebagai operasional sekolah, misalnya mengupayakan pembayaran honor guru honorer yang tidak pernah terlambat dibayarkan. Implikasi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Program sekolah dalam meningkatkan profesionalisme dapat terlaksana dengan baik (2) Masing-masing guru berupaya meningkatkan pengelolaan proses belajarnya sebagai implikasi dari pelaksanaan supervisi (3) Sekolah memiliki tenaga pendidik sesuai dengan kebutuhan dan (4) Pengelolaan keuangan yang dilaksanakan oleh sekolah dapat memotivasi guru untuk melaksanakan tugasnya dengan baik.Kata Kunci        :    Desentralisasi pendidikan, profesionalisme gur

The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer

The role of vitamin D (VitD) in calcium and bone homeostasis is well described. In the last years, it has been recognized that in addition to this classical function, VitD modulates a variety of processes and regulatory systems including host defense, inflammation, immunity, and repair. VitD deficiency appears to be frequent in industrialized countries. Especially patients with lung diseases have often low VitD serum levels. Epidemiological data indicate that low levels of serum VitD is associated with impaired pulmonary function, increased incidence of inflammatory, infectious or neoplastic diseases. Several lung diseases, all inflammatory in nature, may be related to activities of VitD including asthma, COPD and cancer. The exact mechanisms underlying these data are unknown, however, VitD appears to impact on the function of inflammatory and structural cells, including dendritic cells, lymphocytes, monocytes, and epithelial cells. This review summarizes the knowledge on the classical and newly discovered functions of VitD, the molecular and cellular mechanism of action and the available data on the relationship between lung disease and VitD status

Extramedullary myeloid cell tumour: presentation as anterior chest wall mass during AML relapse

Acute myeloid leukaemia is an uncommon but an important cause of soft tissue swellings. Such extrameningeal, extramedullary leukaemic infiltrates are called extramedullary myeloid cell tumours. Despite their large size they may respond well to chemotherapy and local radiotherapy, as is demonstrated in this case.


Keywords: myeloid cell tumour; acute myeloid leukaemi

Pigmentary changes in chronic Myeloid leukemia patients treated with imatinib mesylate

This article does not have an abstract

Acute promyelocytic leukemia: an experience from a tertiary care centre in North India

Background: There are very limited data reported about acute promyelocytic leukemia (APL) from developing countries. We reviewed the clinical course and treatment outcome of APL patients treated at our center. Materials and Methods: Between January 1997 and December 2007, 33 patients with APL received induction therapy using ATRA + daunorubicin (n = 26), As = 26), As2O3 (n = 4) or daunorubicin + cytosar ( n = 3). Results: Median age was 30 years with a male to female ratio of 1.68. Twenty seven patients (82%) achieved CR. Complications during induction therapy were febrile neutropenia (33%), ATRA syndrome (30%), bleeding (58%), and diarrhea in (6%) patients. During induction and follow up, 8 (24.24%) patients died, 6 (18.18%) during induction, 1 (3%) during maintenance, and 1 (3%) after relapse. Median OS is 128 months while median EFS is 61 months. Four patients relapsed at a median time of 61 months. At the time of censoring, 25 patients were alive at a median follow up of 13 months (range 0.6 -127 months); 21 in CR1, 3 in CR2, 1 in CR3. Comparisons among the risk groups (CR and relapse rate and survival statistics) were not statistically significant. Conclusions: APL is a highly curable malignancy. Our results confirm the findings of the published literature from larger cooperative studies from the West. We may further improve outcome with quicker diagnosis and more efficient supportive care system

Acute promyelocytic leukemia: An experience from a tertiary care centre in north India

Background: There are very limited data reported about acute promyelocytic leukemia (APL) from developing countries. We reviewed the clinical course and treatment outcome of APL patients treated at our center. Materials and Methods: Between January 1997 and December 2007, 33 patients with APL received induction therapy using ATRA + daunorubicin (n = 26), As = 26), As2O3 (n = 4) or daunorubicin + cytosar ( n = 3). Results: Median age was 30 years with a male to female ratio of 1.68. Twenty seven patients (82%) achieved CR. Complications during induction therapy were febrile neutropenia (33%), ATRA syndrome (30%), bleeding (58%), and diarrhea in (6%) patients. During induction and follow up, 8 (24.24%) patients died, 6 (18.18%) during induction, 1 (3%) during maintenance, and 1 (3%) after relapse. Median OS is 128 months while median EFS is 61 months. Four patients relapsed at a median time of 61 months. At the time of censoring, 25 patients were alive at a median follow up of 13 months (range 0.6 -127 months); 21 in CR1, 3 in CR2, 1 in CR3. Comparisons among the risk groups (CR and relapse rate and survival statistics) were not statistically significant. Conclusions: APL is a highly curable malignancy. Our results confirm the findings of the published literature from larger cooperative studies from the West. We may further improve outcome with quicker diagnosis and more efficient supportive care system