Conservation and management of marine fishery resources of Kerala State, India

The highly productive fisheries of Kerala, India, are suffering from overexploitation. Use of unsuitable fishing gears that result in a high level of wasteful bycatch and destruction of egg bearing and juvenile fish should be controlled. This paper makes some suggestions for monitoring and conservation of the fisheries in Kerala

Parasitic lung diseases (Editorial)

Lung diseases that result from infestations with Pleuropulmonary amoebiasis: protozoal and helminthic parasites are important public health problems worldwide. There is a renewed interest in parasitic lung diseases because of the frequent opportunistic infections especially with Pneumocytis carinii, Toxoplasma gondii and Strongyloides stercoralis in patients suffering from acquired immunodeficiency syndrome (AIDS)

Global emergency

Mycobacterium tuberculosis described by Robert Koch in 1882 is the leading infectious killer of adults (1). The World Health Organisation (WHO) has estimated that there are nearly 1.7 billion individuals infected with Mycobacterium tuberculosis throughout the world, approximately 20 million of these are active cases and three million die each year. Eight million new cases occur each year and three million of these are infectious (2). The WHO has predicted that, if worldwide tuberculosis (TB) control programme is not improved, 90 million new cases and 30 million deaths can be expected in the decade 1990-1999 (3,4). Of the 950 million inhabitants in India, 300 million are infected with M. tuberculosis, 12 million have active tuberculosis, three million are infectious and half a million die each year (5). Two decades ago, the goal of industrialized countries with low prevalence of tuberculosis was the eradication or the elimination of tuberculosis. Elimination is possible, if the rate of infection is less than 1% in the general population or there is only one smear-positive case per million inhabitants. However, in many industrialized countries, the downward trend in tuberculosis rates has been either stabilized or even slightly reversed. Several factors including the closing of TB clinics, economic crisis, demographic reasons, HIV/AIDS epidemic and population migration contributed to this phenomenon. Since Robert Koch’s discovery of TB bacilli in 1882, at least 200 million people especially those in the most economically productive years of life had died due to tuberculosis (6). Realizing the gravity of the problem, the WHO in 1993 declared tuberculosis as a global emergency. This has led to worldwide resurgence in research in tuberculosis

Cardio-pulmonary exercise testing (Editorial)

The observation by Lavoisier and LaPlace in 18th century that muscular contraction consumes oxygen (0,) and produces carbon dioxide (CO,) had made it possible to study the mechanisms of exercise performance in human beings (1). An individual’s capacity to perform increasing levels of dynamic work depends upon the amount of oxygen that can be delivered to working muscles and on the capacity of muscles to oxidize substrates. The structural and physiological integrity of the respiratory, cardiovascular and muscular systems is essential for delivery of oxygen to the tissues and removal of carbon dioxide from the body. Cardio-Pulmonary exercise testing (CPX) is one of the important investigative tools to evaluate patients with dyspnoea or exercise intolerance who have pulmonary or cardiac dysfunctions or both and in the assessment of work impairment. Exercise testing provides clinically useful information that is not available at rest. In addition, CPX is recognized as an useful noninvasive method to evaluate healthy individuals in competitive sports. In order to detect and interpret abnormalities during exercise, it is essential that one should have a knowledge of normal cardio-pulmonary and metabolic responses to exercise

Bronchial asthma - problems and challenges

The prevalence of bronchial asthma, a major public health problem is increasing world wide (1,2). Asthma was found to be more prevalent among black and poor American children (3). However, other studies had not shown such racial differences (4,5). High prevalence of asthma has been reported in urban areas and low prevalence in rural communities (3,6). prevalence of asthma is also found to be higher in boys than in girls (7). Other risk factors for developing asthma especially in children include exposure to environmental tobacco smoke and air pollution, low birth weight, and children of younger mothers (8). Several studies had demonstrated increase in morbidity and mortality from bronchial asthma (9). Over and under treatment of asthma may be responsible for high mortality rates (10). The increase in asthma deaths has been attributed to regular use of b agonists that may lead to worsening of asthma (11). The excess mortality from b agonists has been demonstrated with fenoterol but not with salbutamol (11,12). However, further long term studies are required to settle this controversy. India is a subcontinent with different geographic, racial, cultural and economic groups. It is a pity that there are no well conducted studies from India to know the exact prevalence of asthma and its influence on various geographic, socio-economic and racial factors. In this issue of the journal, Gupta provides the clinical profile of the asthma as seen in eastern India (13). Even though it is a hospital based study, it gives a glimpse of the gravity of the problem. Therefore, there is an urgent need for undertaking multicentric prevalence studies in bronchial asthma in our country

Changes in pulmonary function in victims of Bhopal tragedy

Clinical, pulmonary function and blood gas studies carried out in symptomatic Methyl Iso-cyanatc exposed individuals 1-2 months after exposure had revealed that 40% of them had ventilatory impairment. The predominant type of ventilatory defect was combined obstruc-tion and restriction. Five percent of patients with normal physical findings and. normal chest X-rays had abnormal pulmonary function. Arterial hypoxia (PaO2 < 85 mm Hg) was obseived in 69% °f patients in whom blood gas analyses were done. Arterial hypoxia and ventilatory abnormalities were predominantly seen in severely exposed patients. Further studies are re-quired to identify the sub-group of patients with Reactive Airways Dysfunction Syndrome. Long term follow up is essential to identify the pulmonary syndromes due to MIC exposure

Drug-induced respiratory diseases

Drug-Induced respiratory diseases are becoming increasingly apparent, as more than 40 commonly used drugs are reported to cause pulmonary parenchymal tissue injury(1,2). Drug - induced interstitial lung diseases can be acute or chronic. Due to irreversible damage that may result from drugs, treatment, for lethal diseases have to be withdrawn prematurely. It is difficult to estimate the true incidence of drug induced pulmonary disease because of the lack of specific markers, histologic findings or diagnostic clinical features and also because of sporadic nature of many of these reactions. Pharmacologic agents that may cause pulmonary parenchymal injury can be classified into 2 group (Table 1). The first group involves cytoloxic drugs and the second non cytoloxic drugs

Chronic obstructive pulmonary diseases: Recent trends

Chronic obstructive pulmonary disease (COPD) which includes chronic bronchitis and emphysema is a major cause of morbid i t y a n d m o r t a l i t y i n industrialised countries. An increasing prevalence of the disease has been observed in our country as well. Chronic bronchitis, emphysema and bronchial asthma are the major causes of obstruction to airflow from the lungs. Unlike Bronchial asthma, t h e a i r f l o w l i m i t a t i o n i n C O P D i s persistent. A CIBA symposium in 1959 defined chronic bronchitis, as a c o n d i t i o n o f s u b j e c t s w i t h chronic or recurrent excessive mucous secretions i n t h e b r o n c h i a l s i t e w i t h o u t a demonstrable cause, either local or general occurring most on most of the days for at least three months in the, year during last two years. National Heart lung a n d B l o o d I n s t i t u t e i n Intermittent positive pressure Breathing trial defined emphysema morphologically as a condition of the lung characterised by abnormal permanent enlargement of t h e a i r s p a c e s d i s t a l t o the terminal bronchioles a c c o m p a n i e d b y d e s t r u c t i v e changes of the alveolar walls and without obvious fibrosis

Allergic broncho-pulmonary helmintyhiasis (ABPH)

Infestations with helminths (cestodes, nematodes and trematodes) are the commonest causes of pulmonary eosinophilia in tropical countries (1-3). Other causes of pulmonary eosinophilia include Allergic Broncho-Pulmonary Aspergillosis (ABPA) (4), chronic eosinophilic pneumonia (5), cryptogenic pulmonary fibrosis (6), Wegener’s granulomatosis (7), lymphomatoid granulomatosis (8) eosinophilic granuloma of lung (9), the Churg-Strauss syndrome (10), drug hypersensitivity reactions (11) and infections such as brucellosis (12), coccidioidomycosis (13), corynebacterium pseudotuberculosis (14) and tuberculosis (15)

Tropical Eosinophilia - The Indian Scene

Tropical eosinophilia, an occult form of filariasis, results from immunolog i c hyperresponsiveness to the human filarial parasites, Wuchereria bancrofti and Brugia malayi. The clinical syndrome is characterised by cough, dyspnoea, nocturnal wheezing and chest discomfort and is occasionally accompanied by constitutional symptoms such as weight loss, anorexia and fever. Chest radiographs show-diffuse reticulo-nodular infiltrates and pulmonary function reveals restrictive ventilatory defect with mild obstruction. Laboratory studies are characterised by marked peripheral blood eosinophilia and high serum levels of IgE and filaria-specific IgG and IgE antibodies. The hallmark of the syndrome is markedly elevated eosinophils in the lower respiratory tract and interstitial lung fibrosis develops if left untreated. Although patients respond rapidly following a standard 3-week course of diethylcarbamazine, there is incomplete reversal-of clinical, hematological, radiological, physiological and pathological changes despite treatment. Therefore other therapeutic modalities such as the addition of corticosteroids to the DEC regimen have to be evaluated in controlled clinical trials