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Alpha1-antitrypsin (AAT) is one of the major circulating anti-protease whose levels in circulation are raised during excessive amount of proteases, especially neutrophil elastase (NE) released during the course of inflammation. Proteolytic attack of NE on peripheral organs, more exclusively on lung parenchyma has severe consequence that may precipitate pulmonary emphysema. Normally, human body has its own molecular and physiological mechanisms to synthesize and regulate the production of anti-protease like AAT to mitigate the extent of inflammatory damage. AAT coded by serine-protease inhibitor (SERPINA1) is predominantly expressed in hepatocytes and to some extent by macrophages, monocytes, lung tissue etc. The observation that persons with AAT deficiency developed chronic obstructive pulmonary disease (COPD) and early-onset of emphysema proposed a role for pathways connecting AAT in pathogenesis. Extensive studies have been done till now to bridge a connection between numerous genetic polymorphisms of SERPINA1 gene and the early onset of COPD. Here in this review, we have comprehensively discussed some of the variants of SERPINA1 gene discovered till date and their association with the exacerbation of obstructive pulmonary disease.

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Anemia is a common concern in geriatric age group in developing countries. The purpose of this study was to identify the common causes and types of anemia in elderly patients in educationally backward region with limited access to quality health care. This was an observational study was done in Shri Maharaja Hari Singh (SMHS) Hospital of Government Medical College Srinagar, over a period of two years. 2000 patients above 60 years of age attending the outpatient clinic were screened for anemia based on WHO criteria. A random and non-consecutive selection of 100 anemic patients was done to study the morphological type and cause of anemia. 1160 (58%) patients were males and 840 (42%) were females. Total 812 out of 840 (96.67%) females and 738 out of 1160 (63.62%) males were found to be anemic. Maximum numbers of anemic patients were found in the age group 60-69 years. Mean age was 74.5 years. All the types of anemia based on peripheral smear were evident, normocytic being the commonest constituting 77.5%, followed by microcytic hypochromic 11.1%, macrocytic 7.05% and dimorphic 4.35%. 21% were lost to follow up and almost one fourth of the patients (24%) needed further evaluation before labelling them as having anemia due to old age. The common causes of anemia noted were gastrointestinal malignancy (31%), renal insufficiency (15%) and tuberculosis (9%). The inability to evaluate anemia in elderly individuals can lead to delay in the diagnosis of treatable as well as threatening disease conditions.