Annals of the National Academy of Medical Sciences (India)

Permanent URI for this collection

https://imsear.searo.who.int/handle/123456789/162464

Editor: Dr. Sanjeev Misra
ISSN: 2454-5635

Frequency: Quarterly

Language: English

Open Access Peer-reviewed journal

Web site: https://annals-nams.in

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Now showing 1 - 20 of 162

An approach to interstitial lung disease in India.
(2013-01) Pande, J N
Interstitial lung diseases are common and have varied etiology, clinical presentation, clinical course and outcome. They pose a diagnostic challenge to physicians and pulmonologists. Patients present with dry cough, exertional dyspnoea, interstitial lesions on X-ray of the chest and restrictive ventilatory defect on spirometry. A sharp decline in oxygen saturation with exercise is characteristic. Careful evaluation of the history of the patient and physical examination help in narrowing down diagnostic probabilities. HRCT of the chest has emerged as an important tool in the evaluation of these disorders. Idiopathic Interstitial Pneumonias (IIP) are a group of conditions which are classified into several types based on pathological features. Bronchoscopic procedures are helpful in diagnosis of certain disorders but are of limited value in classification of IIP which requires surgical biopsy. Usual Interstitial Pneumonia (UIP), also referred to as Idiopathic Pulmonary Fibrosis, has a progressive course and an unfavourable outcome. Certain new drugs have recently become available for treatment of UIP. Our approach towards diagnosis and management of interstitial lung diseases based on personal experience over the past three decades is reported here.
Tryst with Integrated System of Medicine Synergy, Synthesis and Symbiosis.
(2013-01) Bajaj, J S
Technology and the Future Brain.
(2013-01) Sharma, K N
Molecular Biology provides a new interface between Ayurved & Modern Medicine.
(2013-01) Lele, R D
It is a great honour to be asked to deliver NAMS Golden Jubilee Lecture. I will introduce the subject with a quote from Pandit Jawaharlal Nehru, India's first Prime Minister (who was also the first Honorary Fellow of NAMS India). After visiting the Central Institute of Research in Indigenous System of Medicine at Jamnagar on 2nd November 1955, he observed: “A fascinating inquiry is going on in this research institute and it may well lead to very fruitful results. The only right approach has to be one of Science, that is of experiment, trial and error. In whatever type of medicine we may deal with, we cannot profit by its study unless we apply the method of Science. Nothing should be taken for granted. Every thing should be tested and proved and then it becomes a part of scientific medicine - old and new.” Charak states “The Science of life shall never attain finality. Therefore, humility and relentless industry should characterize your every endeavour and approach to knowledge. The entire world consists of teachers for the wise and enemies for the fools. Therefore, knowledge, conducive to health, longevity, fame and excellence coming even from an unfamiliar source should be received, assimilated and utilized with earnestness”. Charak Samhita Viman Sthan 8, 14. These words of wisdom should continue to guide the 600,000 practitioners of Ayurveda in India today, as well as 400,000 practitioners of modern medicine who may not have familiarity with our glorious ancient scientific heritage (1).
President, National Academy of Medical Sciences(2012-2015).
(2013-01) Bhaskaran, C S; Bajaj, J S
The Annals : From Requiem to Reveille -The Triumph of Fellowship.
(2013-01) Bajaj, J S
Clinical Research - Past, Present & Future.
(2013-01) Gulati, Om D
Clinical pharmacology/research has a very interesting history. It started in the 40's of the 20th century through the pioneering work of Harry Gold at Cornell University, New York. Clinical research is an integral part of drug development. Drug development can be hastened by a number of new techniques with reduction in cost. In addition reverse pharmacology approaches for drug discovery have come to occupy a special place. 85% of the neutral antagonists act as inverse agonists. Inverse agonists have a distinct effect on receptor regulation as opposed to neutral antagonists. Orphan receptors constitute about 50% of the GPCRs. It is estimated that now there are nearly 175 orphan receptors after 125 having been deorphanised. Targeting these orphan receptors can lead to about the same number of ligands and antagonists thereof. Polymorphism of cytochrome P450 provides the basis for the use of predictive pharmacogenomics to yield drug therapies that are more efficient and safer. It is estimated that such personalized P450 gene-based treatment would be relevant for 10- 20% of all drug therapy.
Sleep disordered breathing: OSA, CSA, Pathophysiology and Diagnosis.
(2013-07) Vijayan, V K
Obstructive sleep apnea syndrome (OSAS) is a prevalent disorder that has been reported to occur in 2 to 4% of middle-aged adults. A similar prevalence of OSAS has been reported from India as well. However, this condition is frequently unrecognized and underdiagnosed. Important pathophysiological changes in patients with obstructive sleep apnea (OSA) is an alteration in human upper airway leading to a reduction in cross-sectional area of the upper airway contributing to the easy collapsibility of upper airway during sleep. Other pathophysiological changes in OSA are oxidative stress, systemic inflammation, sympathetic nerve activation, endothelial dysfunction, procoagulant activity, intrathoracic pressure changes and metabolic dysregulation. The gold standard for diagnosis of OSA is full polysomnography.
Causes of Hypersomnia – Narcolepsy.
(2013-07) Srivastav, M V Padma
The causes of hypersomnia or excessive daytime sleepiness (EDS) besides volitional sleep deprivation and obstructive sleep apnea are principally due to primary central nervous system abnormalities. Most common amongst these is Narcolepsy, a primary disorder of the neural control of wakefulness and sleep. The recent discovery of hypocretin/orexin deficiency as the main cause of narcolepsy will lead to important therapeutic advances for patients with narcolepsy and further to understanding of the control of sleep and wakefulness in general. Importantly, the excessive daytime sleepiness is not due to psychiatric conditions, but rather is always due to sleep deprivation or an underlying diagnosable and treatable sleep disorder.
Childhood Obstructive Sleep Apnea.
(2013-07) Dayal, Rajeshwar; Kumar, Pankaj; Garg, Neha
Obstructive sleep apnea (OSA) is a common condition in childhood and can result in severe complications if left untreated. It is showing a rising trend in India. A significant association with obesity has been observed; however, some children with enlarged tonsils and/or adenoids may even be underweight. The patient usually presents with snoring and other respiratory problems like mouth breathing, choking and gasping episodes in night. Poor school performance and neurocognitive deficits have been reported. Pulmonary hypertension and cor pulmonale are seen in severe cases. Besides the history and clinical examination, for definitive diagnosis an overnight polysomnographic evaluation is the gold standard. In all cases, the specific treatment ranges from simple lifestyle modifications and medications to surgeries like adenotonsillectomy. Early diagnosis is vital.
Sleep and Endocrinology: Hypothalamic-pituitary- adrenal axis and growth hormone.
(2013-07) Goswami, Ravinder
The supra-chiasmatic nucleus (SCN) is the primarily biological clock determining the circadian rhythm. The neurons of the nucleus making this clock have inherent rhythm and set in biological day and night. These periods usually corresponds to day/night, and indirectly to sleep-wakefulness cycle, in most individuals. Retino-hypothalamic tract carrying photic information from the retina provides the most important input to maintain the inherent rhythm of the SCN. The rhythmic discharges from the SCN to various neurons of the central nervous system, including pineal gland and hypothalamus, translate into circadian rhythm characteristic of several hormones and metabolites such as glucose. As a result there is a pattern of hormonal changes occurring during cycle of sleep wakefulness. Most characteristic of these changes are surge of melatonin with biological night, surge of growth hormone-releasing hormone (GHRH)􀀁at onset of sleep and surge of corticotropin-􀀁releasing􀀁hormone􀀁(CRH) during late part of the sleep. The cause and effect relationship of the hypothalamic releasing hormones and their target hormones on various phases of sleep including initial non rapid eye movement (NREM) phase at onset of sleep, and rapid eye movement (REM) phase near awakening, is an upcoming research area. Sleep electroencephalogram (EEG) determining the onset of NREM and REM sleep is an important tool complimenting the studies assessing relationship between various hormones and phases of sleep. The slow wave activity (SWA) corresponds to the intensity of sleep at its onset during the biological night of an individual. Besides, GHRH and CRH, several other peptide and steroid hormones such as growth hormone (GH), its secretagogues, ghrelin, neuropeptide Y, estrogen and dehydroepiandrosterone sulfate are associated or have the potential to change phases of sleep including initial slow wave-NREM sleep.
Sleep in Epilepsy.
(2013-07) Radhakrishnan, Kurupth
The relationship between sleep and epilepsy is bidirectional. While certain types of seizures occur almost exclusively during sleep, sleep deprivation can precipitate seizures and can activate interictal epileptiform discharges (IEDs) in the electroencephalogram (EEG). While non-rapid eye movement sleep is an activator of IEDs and seizures, rapid eye movement sleep suppresses them. Nocturnal seizures need to be distinguished from parasomnias. Epileptic seizures and IEDs result in changes of sleep architecture, while antiepileptic drugs have variable effect on sleep and wakefulness. Nearly one-third of patients with epilepsy complain day time somnolence. In addition to nocturnal seizures and antiepileptic drugs (AEDs), associated sleep disorders such as sleep apnoea and restless leg syndromes might be responsible for daytime sleepiness in persons with epilepsy.
Sleep and Stroke.
(2013-07) Srivastava, M V Padma
Circadian variations in conjunction with sleep-related heart rhythm changes and sleep disordered breathing (SDB) are contributing risk factors for stroke. Strong scientific evidence now exists indicating that SDB contributes to systemic hypertension, a prominent risk factor for stroke, and compelling circumstantial evidence is present suggesting that SDB raises the risk for development of stroke through other circulatory mechanisms as well. Preliminary evidence indicates that post-stroke patients have a higher prevalence of SDB, which is likely to compromise their rehabilitation outcomes. Since SDB is modifiable with the application of CPAP and other treatment modalities, there is practical value in investigating patients at risk of stroke or post stroke for presence of SDB. Successful application of CPAP or BiPAP therapy may improve the outcome in both instances.
Physiology of Normal Sleep: From Young to Old.
(2013-07) Kumar, V Mohan
Human sleep, defined on the basis of electroencephalogram (EEG), electromyogram (EMG) and electrooculogram (EOG), is divided into rapid eye movement (REM) sleep and four stages of non–rapid eye movement (NREM) sleep. Collective monitoring and recording of physiological data during sleep is called polysomnography. Sleep which normally starts with a period of NREM alternates with REM, about 4-5 times, every night. Sleep pattern changes with increasing age. Newborns sleep for about 14-16 hours in a day of 24 hours. Although there is a wide variation among individuals, sleep of 7-8.5 hours is considered fully restorative in adults. Apart from restorative and recovery function, energy conservation could be one of the functions of sleep. The role of sleep in neurogenesis, memory consolidation and brain growth has been suggested. Though progress in medical science has vastly improved our understanding of sleep physiology, we still do not know all the functions of sleep.
Quality of Life in Obstructive Sleep Apnea.
(2013-07) Dutt, Naveen; Mohapatra, Prasanta Raghab; Chauhan, Nishant Kumar; Kuwal, Ashok; Chaudhary, Kirti
Obstructive sleep apnea (OSA) is associated with significant cardiovascular and cerebrovascular morbidity and mortality. Usual parameters studied in sleep laboratory are unable to measure overall impact of OSA on human life. Consequently, it is important to measure Quality of Life (QoL) in OSA. QoL can be measured with generic instruments like SF-36 or OSA specific questionnaires like Calgary Sleep Apnea Quality of Life (SAQLI) questionnaire. Most of the studies suggest that there is significant impairment of QoL in patients of OSA. But the present evidence suggests that impairment in QoL is not proportional to severity of OSA. There is no consensus on the question of improvement in QoL with Continuous Positive Airway Pressure (CPAP) therapy. A recent Cochrane review concluded that CPAP improves QoL in people with moderate and severe OSA.
Determination of Satisfaction Index as a tool in evaluation of CME Program.
(2013-07) Singh, Kuldeep; Sharma, Baldev; Misra, Sanjeev; Bajaj, J S
Continuing Medical Education is an indispensable part of physician's learning. Well designed program based on andragogy principles can enhance learning by motivating the learner and providing platform to encourage self directed learning. The present study aimed to explore the impact of program “NAMS-AIIMS Regional Symposium on Sleep Medicine” in changing the behavior and attitude of participants using “Satisfaction Index” and descriptive analysis of responses as evaluation tools for program effectiveness. This descriptive cross sectional study captured the response of participants through a pre-tested and validated questionnaire administered at the end of symposium. The result showed almost equal sex distribution (M: F- 27: 34) with majority being UG students (86%). Reliability of data showed Cronbach's Alpha of 0.98 indicating high reliability. Satisfaction index (SI) calculated as per WHO Educational Handbook for Health Personnel showed highest satisfaction for conducive environment of symposium (87.87 %) followed by provision for time to seek clarifications (87.21%), provision of appropriate Learning Resource material (85.90 %) and handling of critical comments by organizers (85.57%). Descriptive analysis showed majority responses as highly positive to our questionnaire with suggestions for more such activity, inclusion of clinical cases and other aspects of practical relevance.
Endocrine and Metabolic Aspects of OSA.
(2013-07) Goswami, Ravinder
Obstructive sleep apnea (OSA) is characterized by repeated spells of apnea. Collapsibility of hypopharynx due to multiple factors involving pharyngeal dilator muscles and deposition of fat or fluid in the surrounding soft tissues are important contributing factors in its pathogenesis. OSA commonly affects obese individuals. Males are more commonly affected than the females probably due to the disturbing effect of testosterone on sleep. The impact of OSA on human health include disturbances in endocrine and metabolic system affecting hypothalamic-pituitary-gonadal axis, adrenocorticotrophic-cortisol axis, growth hormone, antidiuretic hormones and insulin resistance. There is a tendency for predisposition of the metabolic syndrome or its components including glycemic dysregulation, hypertension, hyperlipidemia and physical parameters related to adiposity. On the other hand, several endocrine disorders such as hypothyroidism, growth hormone excess, polycystic ovarian disease and testosterone replacement are associated with increased prevalence of OSA. There is limited information on the effect of treatment of OSA by continuous positive airway pressure (CPAP) on the endocrine and metabolic disturbances. There is a need to conduct randomized controlled trials using CPAP therapy in patients with OSA and to study its cause and effect relationship with endocrine and metabolic disturbances.
Co-morbidities associated with obstructive sleep apnea.
(2013-07) Vijayan, V K
There are many co-morbid conditions that are associated with obstructive sleep apnea (OSA). Though a causative relationship between OSA and some of the co-morbidities is well established or strongly associated, many risk factors of OSA (age, male gender and obesity) are also known risk factors especially for cardiovascular diseases. Other important co-morbid conditions associated with OSA are neurocognitive dysfunction and, erectile dysfunction. Recently there are reports that ocular manifestations are associated with OSA. It is expected that more co-morbidities will be reported in OSA as the research in this area progresses.
Management of Obstructive Sleep Apnea.
(2013-07) Vijayan, V K
Obstructive Sleep Apnea (OSA) is an important public health problem and is associated with considerable morbidity and mortality. Therefore, treatment of this condition is of paramount importance. The treatment of OSA includes general and behavioural measures, mechanical measures including continuous positive airway pressure (CPAP), Bilevel positive airway pressure (BiPAP) and Oral Appliances (OA), pharmacological treatment and surgical procedures. Continuous positive airway pressure (CPAP) treatment reverses the repetitive upper airway obstruction of sleep apnea and associated daytime sleepiness and is the most effective treatment for OSA. However maintaining patient adherence to CPAP therapy is a challenge. Weight loss should be recommended to overweight patients with OSA, as it has been shown that weight reduction has additional health benefits. Treatment of underlying medical conditions such as hypothyroidism or acromegaly has profound effect on apnea/hypopnea index. A subset of patients with OSA may benefit from supplemental oxygen and positional therapy. Presently, there are no effective pharmacotherapeutic agents for treatment of patients with OSA and the role of surgical treatment in OSA is controversial. However, pharmacological treatment of persisting residual sleepiness, despite adequate positive airway pressure therapy delivery and adherence, is indicated and may improve daytime sleepiness.
Sleep Medicine Perspective, Potential, and Prospect.
(2013-07) Bajaj, J S

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