Day 1 :
- Lung cancer
All India Institute of Medical Sciences, India
Dr. Sukdev Nayak is the Past President of Indian Association of Palliative Care and a member Review Committee, Indian Journal of Palliative care and a Member, Curriculum Development committee in Palliative Medicine, also a member, abstract review Committee, World Cancer Congress, Melbourne, 2014 .He has received 15 fellowships from WHO/UICC etc. to 12 different countries. He is the Life Member of ISA, ISSP, IAPC, IMA, Association of UICC Fellows, Association of British Scholars and National Organization of Tobacco Control. He was the Ex- Director of AHR Cancer Centre. He is presently Prof & Head, Anaesthesiology, AIIMS, Bhubaneswar.
BACKGROUND: Lung cancer symptoms and side effects are a big problem in the post treatment phase causing fatigue, stress, low functional status & QOL and morbidity. Persistent fatigue lasting years after cancer treatment is also a common problem whose origin is unknown, and for which there are no validated treatments. Although fatigue is one of the most common and debilitating symptoms experienced by most cancer patients, it has received little systematic attention. There is evidence1 which investigated the role of ancient Indian yogic practice in helping lungs cancer patients. The study had good results in pilot study of single group of 7 patients. Yoga was tried in non-small cell lung cancer (NSCLC) survivors for the effects on sleep, mood, stress (as measured by salivary cortisol levels), and quality of life and promising results.
METHODS: It was an open Label study with a Primary Purpose to augment Supportive Care in Lungs cancer patients. In trial arm (30 patients) ancient Yoga of 30minutes in the first week followed by one hour in the subsequent 3 weeks before Chemotherapy was practiced after demonstration by an expert in the hospital. This continued for 24 weeks in the post therapy period simultaneously during the treatment. The control arm (30 patients) did not do any yoga, but watched the spiritual health TV program daily for the same period.
Grant Government Medical College, India
Rupali Parlewar has completed her MD Physiology from Topiwala National Medical College and, Mumbai. Currently, she is working as an Associate Professor in the Department of Physiology, Grant Government Medical College, Mumbai. She is also a Guide to Post-graduate students of Physiology. She has 7 publications in her academic curriculum. She works as reviewer for some journals.
COPD is multisystem disorder that is frequently associated with significant extra-pulmonary manifestations. These associations have a significant negative impact over the prognosis and health related quality of life in patients with COPD. The present study is carried out to evaluate effects of COPD on visual evoked potentials before any clinical signs and symptoms of visual impairment appear. Study was done in 50 COPD patients having disease duration of more than 5 years with stable course of illness and 50 age and sex matched healthy adults as controls. Pattern reversal visual evoked potential recording was done with monocular stimulation. There was statistically significant increase in P100 Latency of both eyes in COPD patients as compared to controls. Statistically non-significant decrease in P100 amplitude was seen. Prolongation of P100 latency in COPD patients is due to development of chronic hypoxemia leading to tissue hypoxia causing slower conduction in visual pathway suggesting demyelination.
- Respiratory Devices
Tri star continental Medical center, USA
John R. Roberts, MD, MBA is a practicing thoracic surgeon with interest in critical care and minimally invasive thoracic surgery. He has over 100 publications and two patents.
Statement of the Problem: Ventilated patients are suctioned to clear secretions. Current endotracheal suction catheters access the right main stem exclusively. Secretions accumulate on the left and leads to resistance. Several devices developed to access the left side were not successful. We tested a patented device (The Bronchial Vacuum) that accesses the desired main stem bronchi consistently. Methodology & Theoretical Orientation: We evaluated the catheters in two intubated cadavers. Hundreds of passes were made into both main stem bronchi and monitored with flouroscopy. After the cadaver studies, the catheters were adapted to ventilators and five patients (one tracheostomy) tested, each with a different catheter directed ten times to each side (total one hundred passes). All patients were intubated for port placement, flouroscopy, and bronchoscopy. All gave informed consent. Findings: The catheters worked reliably in cadavers (> 95% of passes). After several hundred passes, the catheters fatigued, and were less reliable. The catheters were modified and 100 passes into five patients, ten each to each side, were made and confirmed with flouroscopy. Ninety-nine of the one hundred passes went to the desired side. The single failure occurred pass in patient number 4. Bronchoscopy showed that the endotracheal tube was down the right main stem. It was re-positioned into the mid-trachea and all remaining passes went as directed. All twenty passes in the tracheostomy patient passed as desired. Post-procedure bronchoscopy showed some transient oozing in one patient while the other four had no significant trauma. All patients tolerated the use of the catheters without incident.
- Diagonising techniques of Respiratory disorders
University of Tlemcen, Algeria
Mohammed BENABDELLAH was born in Tlemcen (Algeria), on 1952. He graduated the Polytechnic National School, Algiers-Algeria, in 1977. Received the Magister degree in physic from Institute of Exact Science and Technology in Tlemcen (Algeria), in 1984. Received the Ph.D from the New Plan at Paul Sabatier University in Biological and Medical Engineering in Toulouse (France), in1987. Professor in the department of Biomedical engineering, Faculty of Technology, University of Abou Bakr Belkaid of Tlemcen. His research interests concern: are in the field of Telemedicine.
The telesurveillance of respiratory functions has become an essential technique of liaison between a patient suffering from chronic respiratory disease and a specialist physician to monitor the pulmonary ventilation state of the patient, in accordance with the new systems know as Intelligent Habitat for Health (IHH) or Hospitalization and care at home (HCH) or Connected Health (CH).
In this paper we conceive and realize a pneumotachographic sensor (PTG) fully compatible with the IHH, HCH and CH environment in order to acquire, display and archive the electrical signal representative of the inspired and expired spontaneously air flow at a local computer terminal(data terminal equipment DTE) connected to the patient. A numerical integration makes it possible to calculate the respiratory Tidal Volume (Vt).
This very sensitive, stable, reliable, non-invasive and bidirectional sensor detects a difference of pressure created in a pneumatic tube of the type Silverman-Lilly during the respiratory cycle using a variable reluctance of magnetic circuit. Poiseuille's law used to deduce the ventilatory flow.
The electronics associated to this sensor built around a microcontroller programmed under the MICRO C PRO FOR PIC environment and operating with the USB (Universal Serial Bus) protocol in Human Interface Device (HID) class, to ensure the data transfer from the patient to the local post.
The communication between the local post and the remote post is done using the Client-Server architecture, supported by the TCP/IP ( Transmission Control Protocol/Internet Protocol) and involving the WINSOCK component of the integrated development environment Visual Basic which also allows the implementation of the graphical user interface (GUI).
All these techniques ensure accurate and real-time information transmission of pulmonary aeration state of the monitored patient and alert supervisory physicians to respond quickly in the critical situations.
- Pulmonary function testing
Mahatma Gandhi Missions Medical college, India
Resident, Professor and HOD, Associate Professor, Assistant Professor , Department of Pulmonary medicine Mahatma Gandhi Missions Medical college & Hospital Aurangabad, Maharashtra, INDIA.
A 55 year male, newly detected diabetic with uncontrolled blood sugar levels, presented with complaints of dry cough, haemoptysis and fever intermittent since 15 days .Patients was investigated with complete blood counts ,liver function test ,Kidney function test ,serum electrolytes ,HbA1c .Sputum for AFB smear and Gram stain .His chest x-ray showed Right upper zone opacity and CECT Chest showed consolidation with central liquefaction and air foci within anterior segment of right upper lobe .
Fiber optic video bronchoscope showed soft tissue mass lesion in anterior segment of right upper lobe which bleeds profusely after taking biopsy .The biopsy sample was reported as necrotic tissue with numerous aseptate broad fungal hyphae, invasive fungal infection suggestive of -Zygomycosis. Bronchial washings were negative for AFB on smear and culture.
Patient was treated with liposomal Amphotericin-B 50mg, Patients serum creatinine and serum urea were closely monitored serial chest x-rays ware repeated, after 24 days of treatment whit Amphotericin-B it was discontinued as patients serum creatinine and serum urea were elevated, then he was started with Tab Itraconazole 200ug for a period of 3 moths .Patients showed very good clinical and radiological improvement a check bronchoscopy was performed which showed normal tracheobronchial tree.
Ifakara Health Institute, Dar es Salaam, Tanzania
Dr. Magitta received medical training from the University of Dar es Salaam in Tanzania in 2001. He obtained a PhD in Medicine from the University of Bergen in Norway in 2010, where he studied the genetics of Autoimmune Polyendocrine Syndrome Type 1. He is currently a Senior Research Scientist at Ifakara Health Institute (IHI) and a Lecturer of Biochemistry at the School of Health Sciences, University of Dar es Salaam in Tanzania. His research interest is on chronic non-communicable diseases of public health importance in Africa.
Chronic Obstructive Pulmonary Disease (COPD) is an important contributor to mortality and morbidity in developed countries but there is limited data from Africa. Apart from tobacco smoking, household air pollution is a potential risk factor for COPD, but its contribution has not been adequately studied in Africa. We aimed to provide prevalence estimates of COPD in Tanzania and further identify factors associated with risk and disease exacerbations. In this cross-sectional, descriptive survey in the rural setting of Maswa district in Tanzania, adults aged ≥ 35 years were randomly selected from 150 households across 6 villages from 2 wards. We collected data on respiratory symptoms, occupation and exposure to biomass using the BOLD questionnaire. Spirometry was performed using a 3L-syringe daily-calibrated NDD EasyOneTM spirometer with COPD defined based on post-bronchodilator FEV1/FVC<70%. Indoor carbon monoxide pollution levels were measured using the Langan T15x samplers. The pre-determined risk factors were tested for associations. A total of 869 participants (49.1% women) with a mean age of 51.8± 10.58 years completed the questionnaires. Of these 57% completed post-bronchodilator spirometry, with over 98% good quality spirometry and 25% were smokers. The prevalence of COPD was estimated at 17.5% ⦋21.7% in men, 12.9% in women⦌. COPD was associated with level of education (p<0.0001) and cigarette smoking (p<0.002). The severity of COPD was significantly associated with history of cough, phlegm production and wheezing (p<0.02, p<0.03 and p<0.002). Half of COPD patients presented with cough and 85% had mild-to-moderate airway limitation. Furthermore, over 35% of women had dyspnoea and increased exacerbations while men had poor FEV1 and FVC. Pulmonary tuberculosis was reported in about 10% of COPD patients. Intermittent aminophylline was the most commonly prescribed drug for COPD. The majority of households revealed up to 20ppm of carbon monoxide levels above the safety limits. The prevalence of COPD in Tanzania is high, with a peak at a younger age and preponderance in men. Cigarette smoking and indoor pollution are important risk factors in this population. COPD patients are largely not aware of their diagnosis and are frequently misdiagnosed.