No abstract

BACKGROUNDHypothyroidism can cause a wide variety of haematological disorders and anaemia could be its first manifestation. Numerous mechanisms are involved in the pathogenesis of this anaemia that can be microcytic, macrocytic and normocytic. Microcytic anaemia is usually ascribed to malabsorption of iron and loss of iron by menorrhagia. Macrocytic anaemia is caused by malabsorption of vitamin B12, folic acid, pernicious anaemia and inadequate nutrition. Normocytic anaemia is characterised by reticulopenia, hypoplasia of erythroid lineage, decreased level of erythropoietin; mainly regular erythrocyte survival. We designed this study to investigate the incidence of anaemia and its morphological pattern in hypothyroidism patients in rural population.

In India, the burden of allergic rhinitis (AR) is enormous, comprising 55% of all patients with allergies. Intranasal corticosteroids are the recommended first-line therapy for patients with moderate-to-severe AR, particularly when nasal congestion is the predominant symptom. However, second-generation antihistamines are the first line of treatment in mild AR and effectively improve symptoms, such as sneezing, itching, and rhinorrhoea. Bilastine is a second-generation H1-antihistamine indicated for the symptomatic treatment of allergic rhinoconjunctivitis in adults and adolescents over 12 years of age. Though it is an effective individual molecule for the management of AR, studies have shown that synergistic combination therapy of bilastine-montelukast has a dual action on early- and late-phase allergic reactions in AR patients with concomitant asthma. An advisory board meeting was conducted (on a virtual platform) to gain insights from Indian experts on the following: (i) burden of AR and AR with concomitant asthma in Indian settings; (ii) current unmet needs; and (iii) role and positioning of bilastine and bilastine plus montelukast combination in the management of AR and AR with concomitant asthma in adults and adolescents over 12 years of age. The experts shared their opinions based on the available scientific evidence and/or clinical expertise or experience. In this article, we have summarized the highlights of the expert panel discussion and available evidence for each of these topics.

Community-acquired respiratory tract infections are one of the commonest infections seen in the clinical practice and an important cause of mortality and morbidity, especially in patients with immune-compromised states. Two cases of antibiotic resistant community-acquired lower respiratory tract infections in a 42-year-old male and a 68-year-old male are reported. Both had presented with lower respiratory tract symptoms, previously treated with antibiotics. The patients were immunecompromised and suffered from conditions such as Diabetes and COPD. Along with this, they had an infection caused by resistant bacteria. The clinical history, investigations and the appropriate line of treatment selected in order to resolve complications in the present cases are detailed here.

Background: We designed this randomised, open-label, parallel group, multi-centre study to investigate the efficacy and safety of glycopyrronium/formoterol, a long-acting muscarinic antagonist/long-acting β2-agonist fixed dose combination, delivered through a dry powder inhaler (DPI) in patients with chronic obstructive pulmonary disease (COPD). Material and Methods: We randomised (1:1) patients with moderate to severe COPD (N = 356) to receive glycopyrronium 25 µg/formoterol 12 µg via DPI twice daily (GF-DPI) or glycopyrronium 50 µg monotherapy via DPI once daily (G-DPI). The primary study endpoint was the mean change from the baseline in pre-dose trough-forced expiratory volume in one second (FEV 1 ) at 12 weeks. Results: At week 12, the mean increase from the baseline in pre-dose trough FEV 1 was higher in the GF-DPI group (120 ml) than in the G-DPI (60 ml) group. The mean difference (MD) between treatment groups was 0.06 L (95% CI: 0.00–0.12 L, P < 0.0001 for non-inferiority). At week 12, the mean pre-dose forced vital capacity (FVC), 1 hour post-dose FEV 1 , and post-dose FVC increased significantly from the baseline only in the GF-DPI group (p < 0.0001). The reduction in the COPD assessment test score was greater in the GF-DPI group (p = 0.0379). The average daily number of puffs of rescue medication and the reduction in mean modified Medical Research Council scale, COPD, and Asthma Sleep Impact Scale score at week 12 were similar between groups (p > 0.05). Overall, 35 adverse events and two serious adverse events unrelated to study drugs were reported. Both groups had similar results for overall drug safety. Conclusion: The results demonstrate efficacy and safety of GF-DPI in Indian patients with moderate to severe COPD. Treatment with GF-DPI significantly improved the lung function and quality of life and was well tolerated.