Unguided bronchoscopic biopsy: Does yield increase with operator experience

BackgroundBronchoscopic Forceps biopsy (Endobronchial Biopsy (EBB) and Trans Bronchial Lung Biopsy (TBLB)) are commonly performed for diagnosis in patients with endobronchial abnormalities or diffuse parenchymal involvement. As the operator gains experience his yield of various diagnostic bronchoscopic biopsies is expected to increase, however, no studies on the subject are available in literature.AimsTo determine the effect of on- job experience on the yield of unguided bronchoscopic biopsies.Methods A total of 244 bronchoscopies were performed between Oct 2013 and Oct 2016. A retrospective analysis of all these bronchoscopies was undertaken. All patients who underwent biopsy were included in the study. Patients were divided into two groups with first group (Group A) comprising of biopsies done between Oct 2013 to Apr 2015 and second group comprising biopsies done between May 2015 to Oct 2016 (Group B). The diagnostic yield in two groups was compared.Results Total 71 bronchoscopic biopsies were performed during Oct 2013 to Oct 2016. 36 patients were included in group A and 35 patients were included in group B. The groups were matched in demographic profile, clinical diagnosis, bronchoscopic findings and type of biopsy undertaken. The biopsy was diagnostic in 31 patient (43.6 per cent) and non-diagnostic in 33 patients (46.4 per cent). There were 15 diagnostic biopsies in group A and 16 diagnostic biopsies in group B. The difference in the diagnostic biopsies between the two groups was not significant.ConclusionThere was no significant impact of on job experience on diagnostic yield of biopsies. This may be due to adequate exposure during training leading to a diagnostic plateau being reached

“To Assess the Clinical Profile and Risk Factors Associated with Myocardial Infarction In Young Adults”

Background: The Global Burden of Diseases (GBD) study reported the estimated mortality from CAD in India at 1.6 million in the year 2000. It has been predicted that by the year 2020 there will be an increase by almost 75% in the global CVD burden. Acute MI in young adults is characterized by the presence of multiple risk factors which tend to be additive in influencing morbidity and mortality. A contributory factor, which may explain the abnormalities in lipid profile of Indians, is the high risk atherosclerotic diet, which promotes over nutrition, obesity and diabetes. Methods: It is an observational study done at tertiary care center. In our study we studied 55 consecutive patients suffered with acute myocardial Infarction (AMI) between age group 15-45 years, fulfilling inclusion criteria. We assessed clinical profile and their risk factors. Results: Mean age of acute myocardial infarction was 40.6 years. Ajority of the patients were male (94.5%) and between the age group of 41-45 years (50.9%), chest pain was commonest presentation. Smoking was the most common risk factor (61.8%), followed raised homocysteine level (45.5%). Family history of Premature CAD was presents in significant number of individuals (36.4%). Obesity with raised BMI was found in 10.9% patients. Incidence of DM was 18.2%, hypertension was seen in 10.9%cases. Abnormalities in lipidprofile were seen 21.8% patients. Hyperuricemia was found in 31 %, AB positive blood group was most common and was presents in 34.5%. In most individuals single blood vessel was involved (76.4%) with good left ventricular (LV) function (49%) and over all prognoses was good in patients with door to stent time less than 60 min. The coronary arteries involved in these cases were LAD in 36.4%, LCX in 20% and RCA in 20%. Conclusion: In young MI cases conventional risk factors like diabetes mellitus, hypertension play less important role as compared to old individuals. Smoking and novel emerging risk factors like hyperhomocysteinemia, protein C & S deficiency play much prominent role in young patients with MI

HAART (Highly Active Anti-Retroviral Therapy) : An overview

Highly Active Anti - Retroviral Therapy (HAART) is a triple combination of ART drugs and is a n effective tool to control disease progression in HIV disease. HAART is not started in all patients of HIV and indication to start HAART depends on clinical symptoms, CD4 cell count, HIV viral load. Advantages of HAART includes suppression of viremia and virus shedding in semen and vaginal secretions , increased CD4 + T cell count, reduced immune activation, restoration of lymph node architecture, clinical improvement, prolonged survival, fewer opportunistic infections and HIV - associated malignancies. Problem with therapy are pill burden, non-availability of drugs, food and storage restrictions, drug-drug interactions, severe side-effects, reduction in quality of life measures, emergence of multiple drug resistance mutations

Recent update: Nonalcoholic steatohepatitis

Nonalcoholic fatty liver disease has been traditionally conceptualized as a histological disease spectrum which progresses from simple steatosis or pure fatty liver through liver fibrosis or Nonalcoholic Steatohepatitis (NASH) to cirrhosis and eventually hepatocellular carcinoma (HCC). NASH can progress to cirrhosis, has very high cardiovascular mortality and is a leading cause of HCC worldwide. Recently, the role of various genetic and environmental factors in pathogenesis and progression of the disease have evolved. The lifestyle modifications such as weight reduction, dietary changes, and few drugs with sensitization or antioxidant are available as treatment options. Several newer pharmacological agents are in different stages of clinical trial, and individualized therapy might be a reality in the near future. In view of increasing prevalence of NASH, even in a developing country like ours, a literature search was conducted in PubMed and EMBASE to identify recent publications. We intend to present the epidemiology, and recent inroads made into the pathogenesis, and management of NASH