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Balaji R.,SRM University | Parasuramalu B.G.,Kempegowda Institute of Medical science and Research Center | Gangaboraiah,Kempegowda Institute of Medical science KIMS
Allergologia et Immunopathologia

Background: Conventional immunotherapy for allergy with 3-5 years of treatment period has poor compliance. Ultra-rush sublingual immunotherapy with a shorter period of treatment can have better compliance. There are very few studies on ultra-rush sublingual immunotherapy all over the world. Objectives: (1) To determine allergen sensitivity among allergic rhinitis patients. (2) To assess safety, tolerability and clinical efficacy of ultra-rush sublingual immunotherapy. Methods: The present study was conducted in Allergy clinic, KIMS Hospital & Research Centre, Bangalore, India from January 2010 to June 2011. After obtaining Institutional Ethics Committee approval, 40 allergic rhinitis patients (according to ARIA guidelines) in the 18-60 years age group who were positive for aeroallergens in skin prick test were recruited for ultra-rush sublingual immunotherapy (20. min initial phase and 4-month maintenance phase) and followed for 8 months with symptom and treatment diary. Results: Out of 40 patients, the majority, 36 (90.00%) patients were sensitive to house dust mites. Six patients had seven immediate adverse reactions and seven patients had eight delayed adverse reactions. All subsided without medication or with symptomatic oral medications. All patients tolerated ultra-rush SLIT and there was significant decrease in both symptom-score and treatment received in these patients. Conclusion: Ultra-rush SLIT regimen has excellent safety, tolerability and clinical efficacy among allergic rhinitis patients. © 2012 SEICAP. Source

Kumaraswamy G.,Kempegowda Institute of Medical science and Research Center | Ramaiah V.,Kempegowda Institute of Medical science and Research Center | Pundarikaksha H.P.,Kempegowda Institute of Medical science and Research Center | Anjanappa J.,Abhaya Hospitals
National Journal of Physiology, Pharmacy and Pharmacology

Background: Alcohol abuse is a chronic behavioral problem that can further develop as a progressive disease. Disulfiram is the most extensively used deterrent drug for clinical management of alcoholism. A supervised disulfiram-ethanol reaction (DER) test is carried out in patients who are willing for it, and who are skeptical of the effect of disulfiram in causing a DER. Objective: The aim of this work was to study the possible cardiovascular changes and complications during disulfiram-ethanol reaction in persons fulfilling the inclusion and exclusion criteria. Materials and Methods: After written informed consent was obtained, 60 subjects underwent alcohol detoxification and received disulfiram 250 mg BD orally for 5 days. On 5th day, alcohol challenge was carried out with constant monitoring of all the vital parameters. Cardiovascular changes were monitored and recorded during the DER. Results: Disulfiram was generally well tolerated and DER started to occur within 10-15 minutes and lasted for 90-240 minutes. Cardiovascular changes observed were blood pressure changes [hypotension (n=16, 26.67%) and hypertension (n=3, 5%)] and ECG changes [sinus tachycardia (n=22, 36.67%), transient ischemic changes (n=13, 21.67%), occasional atrial ectopics (n=1, 1.67%) and junctional rhythm (n=1, 1.67%)]. Only 23 subjects (38.33%) did not show any significant ECG changes. All subjects recovered with no residual ECG changes except those who developed hypotension (n=16) who required intervention with IV fluids. Conclusion: Cardiovascular complications can occur even in properly selected subjects having no baseline cardiovascular impairment, which could be serious and potentially life threatening. Based on the results of the present study, disulfiram-ethanol challenge test appears to be a relatively safe procedure if carried out under standardized conditions and using a safe maintenance dose of disulfiram. Source

Satish Kumar R.,Kempegowda Institute of Medical science and Research Center | Madhu Shankar L.,Kempegowda Institute of Medical science and Research Center | Nataraj Naidu R.,Kempegowda Institute of Medical science and Research Center | Gupta Amit M.,Kempegowda Institute of Medical science and Research Center | Vupputuri H.,Kempegowda Institute of Medical science and Research Center
Biomedicine (India)

Introduction: Liver abscess is though a relatively rare condition is a very challenging condition for any clinician due to the close resemblances both clinically and radiologically of the various differential diagnosis within it, the most frequent dilemma being, the etiology being a bacterial or an amoebic one. Off late many serological tests are available to differentiate between the two conditions. One such test is Entamoeba IgG antibody testing which has been proved in various studies to be sensitive to the extent of 100% and specific to an extent of 95% (1). Aim: The aim of the study was to analyse the value of this in a population in which Entamoeba histolytica was endemic and the clinical value of the test in deciding the course of management of a liver abscess. Materials and Methods: The data for this prospective study was obtained from 100 patients diagnosed to have Liver Abscess. Serology for amoebic antigen was sent immediately on presentation. Pus was aspirated and sent for gram's stain and culture and sensitivity. And the results of pus culture and serology were compared. Results: Out of 100 cases 8 5 cases were analyzed and 10 cases were kept as negative control and one as positive control and the results were positive in 76/85 cases (92.94% cases). Out of 76 patients 54 patients pus cultures yielded no growth suggestive of amoebic etiology and all were positive for amoebic serology (100%). Out of 10 negative controls 5 showed positive for amoebic serology (50%). Out of 31 culture positive cases of Pyogenic liver abscess 22 cases came as amoebic serology positive (70.9%). Conclusion: Though there is a strong correlation between amoebic serology testing and amoebic liver abscess which is statistically significant but in an endemic country like India or any third world country where EntamoebaSpp is endemic, the role of serology testing is limited to ruling out amoebic etiology in a liver abscess and cannot aid in diagnosing an amoebic liver abscess. The finding of this study assume significance as they directly contradict the findings of multiple other studies (1, 2, 3). However the value of this test cannot be undermined in the western countries where Entamoebaspp is not endemic. Furthermore the alternative diagnostic options like antigen testing in stool and serum are to be evaluated for a better alternative. Source

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