A 43-year-old male using valproic acid (VA) for 2 years for seizure disorder presented with right-sided moderate pleural effusion. Pleural fluid analysis revealed exudative effusion with 42% ...eosinophils. There was no evidence of haemothorax, pneumothorax, malignancy, and parasitic infections. Suspecting a drug-related event, VA was discontinued. The patient showed clinical improvement with resolution of pleural effusion on chest radiograph three weeks later. VA is a popular drug used for variety of disorders like seizures, migraines, and schizophrenia. There is a paucity of literature on VA-induced pleural effusion. Though a rare phenomenon, clinicians should be aware of such a possibility to avoid erroneous diagnosis.
Introduction: Medical education has been adversely affected during COVID-19 pandemic. Imparting medical education through e-platforms exclusively was a novel experience both for students and ...teachers. Even though online classes have been ongoing since almost a year and half, not much data on perception and experience about e-learning among medical students is available from India. Aim: To evaluate perceptions, experiences and challenges faced by medical students regarding e-learning during lockdown period owing to COVID-19 along with their future preferences. Materials and Methods: The present study was a questionnaire based cross-sectional survey regarding use of e-learning during COVID-19 pandemic among 340 MBBS (Bachelor of Medicine and Bachelor of Surgery) and Bachelor of Science Nursing (BSc-NUR) students. Study was conducted in the Department of Pulmonary Medicine at Shri Lal Bahadur Shastri Medical College and Hospital Mandi, Himachal Pradesh, India from May-July 2021. Students perceptions’ of e-learning were assessed using the validated Technology Acceptance Model (TAM) model and responses were measured on 5-point Likert scale. Quantitative data was expressed by mean and standard deviation and significant level of differences between means were tested by Student’s t-test (unpaired). Proportions were compared by Chi-square test or Fisher’s-exact test. Results: Out of 400 students, 340 responded of which 225 were females. Of the total 340 students, 97.9% (n=333) respondents, had an idea of e-learning and more than half (n=188; 55.3%) had used any type of e-learning platform prior to onset of COVID-19. More number of MBBS students had used e-learning than BScNUR students (55% v/s 41%; p=0.033). Cell phone was the most common device (n=324; 95.3%) used. The quick sharing of material (n=258; 76%) and flexibility (n=233; 68.5%) were top rated benefits of e-learning. The key disadvantages were suboptimal practical training (n=222; 65.3%) and lack of face-to-face interactions (n=146; 43%). Majority of students voted for traditional learning (n=156; 45.9%) closely followed by blended learning (n=140; 41.2%). Conclusion: The students had an overall positive attitude towards e-learning and wanted to continue e-learning alongside traditional teaching i.e., blended learning. Exploration of merits and barriers to e-learning during pandemic can act as a guide to implement blended learning in medical curriculum for enhanced teaching/learning experience.
Despite the rapid advancement in diagnostic and therapeutic modalities, endobronchial tuberculosis (EBTB), defined as tuberculous infection of the tracheobronchial tree, continues to remain ...challenging for clinicians. Nonspecific respiratory symptoms along with normal chest radiograph in 10–20% of cases may be alleged for the diagnostic delay. Variable diagnostic yield with sputum microscopy might further compound the problem. In such cases, high resolution computed tomography (HRCT) works as a more sensitive tool and demonstrates involvement of tracheobronchial tree described classically as “tree-in-bud” appearance. Bronchoscopic biopsy is considered the most reliable method for confirmation of the diagnosis with 30% to 84% positivity in different series. Evolution of the disease is also unpredictable with frequent progression to bronchostenosis, therefore requiring regular follow-up and early intervention to halt the natural course. This review article elaborates various aspects of the disease with specific focus on diagnostic dilemma and recent advances in interventional bronchoscopy. In addition, this discussion evokes optimism for further research and introduction of innovative therapeutic modalities.
Marijuana (Cannabis sativa) has been used for recreational and medical purposes since ages. Marijuana smoking is an evil, which is on the rise with about 180.6 million active users worldwide. The ...recent legalization of marijuana in Uruguay has generated global interest. The purpose of this short review is to describe the various preparations, uses and adverse effects of medical marijuana. It also deals with the adverse effects of marijuana smoking when used for recreational purposes. ased on the current literature, medical use of marijuana is justified in certain conditions as an alternative therapy.
Background: Examination of specimens obtained through flexible fiberoptic bronchoscope is an important and often the initial diagnostic technique performed in patients with suspected malignant lung ...lesion. Aims: To evaluate the correlation of cytological findings of bronchial washings, bronchial brushing and imprint smear of bronchial biopsy in the diagnosis of lung tumors, with histopathology of bronchial biopsy taking the latter as the confirmatory diagnostic test. Materials and Methods: A total of 200 patients with lung mass were included in the study. Bronchial brushings were obtained from all 200 cases. In the first 100 cases, pre-biopsy bronchial washing (washing collected before the brushing and biopsy procedure) while post-biopsy washing (washing at the end of the procedure) was procured in all 200 cases. Imprint smears of bronchial biopsy were prepared in 150 cases. Results: Sensitivity and specificity of brushing was 76.58% and 77.78% respectively and that of imprint smear was 81.35% and 78.12% respectively. Pre-biopsy and post-biopsy washing showed high specificity of 88.89%, but low sensitivity of 30.14 and 36.77% respectively. No significant difference was found in sensitivity between brushing and imprint smear (Chi-square; P = 0.4187); and between pre-biopsy and post-biopsy washing (Chi-square; P = 0.7982). However, there was a significant difference between sensitivity of brushing and washing (Chi-square; P = 0.0001). The sensitivity of combination of three cytological diagnostic techniques was 87.29%. Conclusion: Bronchial brushing and washing cytology in combination with imprint cytology aids in the diagnosis of lung tumors. Therefore, all these techniques may be used concurrently along with bronchial biopsy to diagnose lung tumors.
Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with bilateral intra-alveolar calcium and phosphate deposition throughout the lung parenchyma with predominance to lower and ...midzone. Although, etiology and pathogenesis of PAM is not fully understood, the mutation in SLC34A2 gene that encodes a sodium-phosphate co-transporter in alveolar type II cells resulting in the accumulation and forming of microliths rich in calcium phosphate (due to impaired clearance) are considered to be the cause of the disease. Chest radiograph and high-resolution CT of thorax are nearly pathognomonic for diagnosing PAM. HRCT demonstrates diffuse micronodules showing slight perilobular predominance resulting in calcification of interlobular septa. Patients with PAM are asymptomatic till development of hypoxemia and cor-pulmonale. No therapy has been proven to be beneficial except lung transplantation.
Overexpression of the EZH2 gene silences several genes involved in DNA repair, cell-cell adhesion, and tumor suppressor genes, resulting in the development of several types of cancers. In the present ...study, a genetic polymorphism analysis was performed by selecting three SNPs (rs.2302427C>G, rs.3757441C>T, and rs.6950683T>C) of the EZH2 gene based on our previous in silico studies.
A total of 250 breast cancer patients and 250 healthy individuals were recruited for the study. Patients with pre-operative breast cancer with different clinical-pathological variables and age-matched healthy women were recruited for the EZH2 gene expression analysis.
The genetic polymorphism analysis revealed two SNPs (rs.2302427C>G and rs.6950683T>C) of the three studied SNPs of the EZH2 gene have a protective role in all three genetic models. The haplotype analysis predicted that two haplotypes ACGT and ACGC were significantly associated with a lower risk of breast cancer.
Three significant findings of the SNP rs.2302427C>G (Asp193His) i.e., protective role against breast cancer, survival advantage in ER+/tamoxifen treated breast cancer patients, and decreased expression due to the presence of mutant GG genotype, suggests considering it as an important prognostic biomarker for a good survival outcome of breast cancer patients treated with ER+/tamoxifen. Compared with other studies, the other SNP rs.3757441T>C was observed to have a protective effect in breast cancer biology but plays an antagonistic role in colorectal cancer (CRC) biology. To our knowledge, this is the first detailed study on computationally validated EZH2 SNPs in breast cancer.
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