The Indian Journal of Chest Diseases and Allied Sciences
Congenital lobar emphysema is a rare disorder of unknown aetiology that may present a diagnostic ... more Congenital lobar emphysema is a rare disorder of unknown aetiology that may present a diagnostic challenge. We report two cases of congenital lobar emphysema in paediatric age group who were initially treated as pleuro-pulmonary tuberculosis and recurrent pneumonias, respectively. Eventually they were diagnosed as congenital lobar emphysema following chest radiography, computed tomography and bronchoscopic evaluation.
The Indian journal of chest diseases & allied sciences, Nov 18, 2022
Primary tracheal malignancies are very rare tumours and their incidence is approximately 0.1 in e... more Primary tracheal malignancies are very rare tumours and their incidence is approximately 0.1 in every 100,000 persons per year. 1 The differential diagnosis of a tracheal mass comprises of certain malignant (squamous cell carcinoma, adenoid cystic carcinoma, and carcinoid) as well as benign tumours, such as papilloma, haemangioma, hamartoma, and neurilemmomas and neurofibromas. 2 Squamous cell carcinoma is the most common cause of intra-tracheal mass followed by adenoid cystic carcinoma and together these account for about two-thirds of adult primary tracheal tumours. 3 Benign tracheal tumours are less common than the malignant ones and among these squamous papilloma, leiomyoma and haemangiomas are most frequently seen. We describe a case of primary tracheal schwannoma which is extremely rare tumour in this report. To the best of our knowledge, only a single case has been reported till date in the Pubmed indexed Indian journals. case report A 32-year-old male, non-smoker and without any significant past medical history initially reported to a peripheral health centre with complaints of cough, breathlessness on exertion associated with wheezing for the last eight months. There were no aggravating or relieving factors. There was no history of fever, haemoptysis, joint pains, skin rashes, nasal symptoms and weight loss. He was initially diagnosed to have bronchial asthma in a peripheral health centre and was treated with inhaled corticosteroids and bronchodilators without any relief. On examination, he was dyspnoeic at rest which aggravates in supine position and had noisy breathing suggestive of
The Indian Journal of Chest Diseases and Allied Sciences
Non-Hodgkin's lymphoma can present with various clinical manifestations, such as fever, weight lo... more Non-Hodgkin's lymphoma can present with various clinical manifestations, such as fever, weight loss, lymphadenopathy, hepatosplenomegaly or some opportunistic infection. However, it has seldom been reported to be present with Pneumocystis jirovecii pneumonia in respiratory failure as initial presentation. We report a case of non-Hodgkin's lymphoma who presented with Pneumocystis jirovecii pneumonia.
The Indian Journal of Chest Diseases and Allied Sciences
Paragonimiasis has been an important food-borne parasitic zoonosis. It is caused by trematode of ... more Paragonimiasis has been an important food-borne parasitic zoonosis. It is caused by trematode of the genus Paragonimus. 1 It has been recognised as an important cause of pulmonary disease worldwide, especially in Asia, West-Central Africa, and Central and South America. 2 The clinical findings of paragonimiasis may mimic pleuro-pulmonary tuberculosis (TB), bronchitis, bronchiectasis, pneumonia, epilepsy or cerebral space-occupying lesion. It mimics pulmonary TB and requires differentiation from the same in TB endemic areas. The signs and symptoms of initial presentation are most commonly haemoptysis, pleural effusion and peripheral blood eosinophilia. Diagnosis may be missed, especially in areas not endemic for the parasite. 2 Approximately 50% to 70% of patients on initial work-up are diagnosed and treated as TB. The country of origin and dietary habit of eating raw, or partially cooked crab or crayfish are important features in a patient suspected to have paragonimiasis. 3 Hence, a high index of suspicion should be kept in mind if one comes across a patient from an endemic area who has predominantly lower respiratory tract symptoms, including persons with normal chest radiograph and those with radiograph suggestive of TB. case reports Case 1 A 34-year-old male, resident of Nagaland presented with complaints of fever, breathlessness. Physical examination revealed splenomegaly and bilateral pleural effusion. He had raised total leukocyte count with 70% eosinophilia.
Introduction: Lung is a common place for the spread of tumors from within or other parts of the b... more Introduction: Lung is a common place for the spread of tumors from within or other parts of the body. Lung shadows with a diameter less than or larger than 3 cm are termed lung nodule or mass respectively. Aims: To study the histopathological spectrum of lung masses and efficacy of computerized tomography guided FNAC/biopsy in diagnosis of lung masses. Materials and Methods: Forty (40) cases picked up as lung masses on conventional screening & CT scan were subjected to CT guided FNAC/Biopsy and their pathological variations were studied. Results: A total of 40 cases were studied. The mean age of the patients was 60.57 years with 25 (62.5%) males and 15 (37.5%) females. 65% of lesions were in right lung. Malignant lesions were more common and accounted for 27 (67.5 %) cases and benign in 8 (20%) cases. Amongst the malignant lesions, adenocarcinoma was seen in 16 (59.25%), squamous cell carcinoma in 10 (37.03%) and small cell carcinoma in 1 (3.70%) case. Conclusion: FNAC is a simple, relatively safe, rapid, reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. FNAC not only distinguishes between benign and malignant lesions but also helps in tumor typing of lung cancer.
Pulmonary thromboembolism (PTE) remains the third leading cause of cardiovascular death, after a ... more Pulmonary thromboembolism (PTE) remains the third leading cause of cardiovascular death, after a heart attack and stroke. Haemodynamically unstable PTE (previously called high-risk or massive) is one of the dreaded conditions commonly found in people working in high-altitude areas. Due to the individual variations in clot characteristics and the haemodynamics, these patients offer unique therapeutic challenges by delay in access to tertiary care, being recalcitrant to the systemic thrombolysis as well as complete recanalisation by endovascular thrombectomy. We present a rare case of haemodynamically unstable right pulmonary trunk occlusion with delayed presentation and sustained right ventricular strain despite systemic thrombolysis, managed successfully by catheter-directed thrombectomy. Despite the partial recanalisation of only the right inferior pulmonary artery branches and persistent superior branch occlusion, there was an immediate clinical benefit and no recurrence of sympto...
Background A mass lesion in the lung is a common finding seen on chest radiology. The prognosis o... more Background A mass lesion in the lung is a common finding seen on chest radiology. The prognosis of patients with mass lesions in the lung is capricious as malignancy is a consideration. It is essential to diagnose the underlying aetiology at the earliest with minimally invasive procedures for prompt treatment of the case. Bronchoscopic lung cryobiopsy (BLC) is a newer interventional technique in pulmonary medicine for the diagnosis of mass lesions in the lung. Materials and methods This is a retrospective study of patients reporting to a tertiary care centre who were radiologically (by computed tomography scan of the chest) diagnosed with a mass lesion of the lung and who underwent BLC during the period from January 2018 to January 2021. We analysed the diagnostic yield of the technique defined as a positive tissue diagnosis after the histopathological examination (HPE) along with the safety of the procedure. Results During the above period, we evaluated 70 patients who were diagnosed radiologically with mass lesions of the lung and underwent BLC. We obtained tissue diagnoses for 66 cases and the result of four cases was inconclusive. The diagnostic yield of the BLC procedure was 94.29%. There was no mortality and complications were minimal bleeding and small pneumothorax. Conclusion BLC is a newer technique for obtaining lung tissue via a flexible bronchoscope obviating the need for open lung biopsy. The main advantage of the technique is providing larger tissue samples with minimal or no side effects without undergoing multiple procedures as compared to other bronchoscopic or surgical methods for obtaining a diagnosis from lung tissue. BLC is a safer and promising technique in diagnosing mass lesions of the lung with better yield.
Crystalline silica exposure occurs in a large number of industries and is associated with many di... more Crystalline silica exposure occurs in a large number of industries and is associated with many diseases like silicosis, tuberculosis, lung cancer, pulmonary tuberculosis and COPD (1). Scleroderma is an autoimmune disease which manifests as fibrosis and microvascular injury of the different organs which it involves. However, its etiology is unknown. The hallmark of this disease is characterized by thickening and tightness of the skin and subcutaneous tissues which gives a clue to the diagnosis. It affects multiple systems which is characterized by inflammation and degeneration of integument, heart, lungs, kidney, gastrointestinal tract and synovium. [2] There is a known association between scleroderma and silicosis exposure, which was first reported by Bramwel in 1914. [2] Besides affecting workers in the gold and coal mines, Erasmus syndrome was also described in other professionals, such as sculptors and individuals exposed to abrasive powders, drillers, quartz crushing worker, and dental technicians [3]. We report a case of Erasmus syndrome in a patient who had worked for 30 years in the cement factory. CONCLUSION Erasmus syndrome is a rare syndrome described in sixth decade of 20 th century when high prevalence with scleroderma in gold miners who had significant exposure to silica. It affects multiple organs, lungs being commonly involved as it is the portal of entry. The pathogenesis warrants further studies and the treatment consists of immunosuppressives and supportive therapy to alleviate the symptoms.
Aim : The aim of this study was to characterize symptomatology of patients suffering from obstruc... more Aim : The aim of this study was to characterize symptomatology of patients suffering from obstructive sleep apnea syndrome (OSAS) and investigate its correlations with severity of disease as assessed by apneahyponea index (AHI) score. Materials and methods: All patients diagnosed to be having obstructive sleep apnea syndrome (OSAS) over a period of one year in tertiary care hospital were retrospectively studied. Symptomatology was recorded and sleepiness was measured quantitatively by Epworth sleepiness scale (ESS). Symptoms were correlated with AHI score using linear correlation for continuous variables and chi –square test for discrete variables. Results : Snoring was detected to be most common symptom, seen in 28/30 (93.3%) of patients. Breathing pauses(16/30 -53.3%) and witnessed choking(13/30- 43.3%) on correlation with AHI had p value of 0.039 and 0.046 respectively. ESS scores increased linearly with the AHI (correlation coefficient 0.501, P value 0.005) Conclusion Patient...
Background: Coronavirus disease 2019 (COVID-19) can result in severe life-threatening course requ... more Background: Coronavirus disease 2019 (COVID-19) can result in severe life-threatening course requiring ventilatory support. This study highlights data pertaining to ventilated patients to enhance our understanding of COVID-19 as it evolves. Methods: A descriptive, retrospective analysis was carried out on 50 COVID-19 RT-PCR positive patients who received mechanical ventilation at a tertiary care hospital in counterinsurgency (CI) zone, from June to December 2020. Data pertaining to patient characteristics, treatment, ventilator support and outcomes was analysed. Results: Out of 50 patients, 74% were aged 50 years and above with 60% patients having comorbidities. 39 patients received non-invasive ventilation (NIV) and 04 patients received invasive mechanical ventilation (IMV) while 07 patients were converted from NIV to IMV during the hospital stay. Out of the 50 patients who received ventilator support 25 (50%) survived to discharge. The overall survival was 47.3% amongst the males while it was 58.3% for the females. The majority of survivors were in the NIV category (61.5%) while only 9.0% survived amongst those who received IMV. Average length of stay on NIV for patients was 5.3 days and for IMV was 7.5 days. All 50 patients received therapy in the form of steroids, anticoagulants, broad spectrum antibiotics and antivirals. Remdesivir was given to 40 of these patients out of which 20 survived (50%). Interleukin-6 therapy (Tocilizumab) was given to five patients of which four survived (80%).
Abstract Organising pneumonia can be idiopathic or as a result of other inciting factors such as ... more Abstract Organising pneumonia can be idiopathic or as a result of other inciting factors such as drugs. Phenytoin has been implicated in significant side effects predominantly involving extrapulmonary sites. Pulmonary side effects are reported less frequently. Hereby, we report a first case of phenytoin-induced organising pneumonia from India and evidence of significant improvement after stopping the drug.
Obstructive sleep apnoea is present when repetitive episodes of cessation of breathing or decreme... more Obstructive sleep apnoea is present when repetitive episodes of cessation of breathing or decrement in airflow occurs during sleep, associated with sleep fragmentation, arousals from sleep and fall in oxygen saturation [1]. AHI (number of apnoea and hypopnoeas per hour of sleep) is used to define as well as classify the severity of sleep apnoea. OSA syndrome is defined by AHI equal to or greater than five events/ hour and persistent complains of excessive daytime somnolence or fatigue [1]. Obstructive apnoeas cause sympathetic surges conducive to development of acute cardiovascular events (i.e., stroke, myocardial infarction and nocturnal sudden death) and chronic conditions such as systemic hypertension, coronary artery disease and heart failure [2-4]. Various studies done abroad showed that about 50% of OSA patients are hypertensive and an estimated 30% of hypertensive patients also have OSA, often undiagnosed [5-9]. However, there is insufficient Indian data describing the effect of OSA on the severity of systolic and diastolic hypertension separately, independent of confounding factor of obesity in India. To fulfill this gap in knowledge, this study was carried out to determine the prevalence of hypertension associated with OSA, and to correlate the severity of hypertension with severity of OSA in terms of AHI Score.
Background: Evidence regarding the role of non-invasive marker of airway inflammation, fractional... more Background: Evidence regarding the role of non-invasive marker of airway inflammation, fractional exhaled nitric oxide (FeNO) to guide asthma treatment is equivocal. We aimed to evaluate if the use of FeNO to adjust inhaled corticosteroid treatment resulted in reduced daily corticosteroid use and lesser exacerbations. Methods: 100 patients of bronchial asthma in the age group of 12-70 years were randomised to receive inhaled corticosteroids based on either FeNO measurements (n = 50) or as per Global Initiative for Asthma (GINA) guidelines. Follow up was done every 2 months for period of 12 months. Results were compared in terms of mean daily inhaled corticosteroid use and number of exacerbations. Results: After the follow up period of 12 months, mean daily dose of ICS (SD) required in FeNO group was 267.5 mg (126.29), as opposed to control group in which mean daily dose of steroid was 320.00 mg (138.69). However this observed difference in steroid dose was statistically insignificant (p value = 0.061). The estimated mean (SD) rate of asthma exacerbation experienced in follow up period of 12 months in FeNO group was 0.3 episodes (0.54) per patient per year (95% confidence interval, 0.145-455) and 0.4 episodes (0.61) per patient per year in control group (95% confidence interval, 0.228-572). However this difference in rate of exacerbations between the two study groups was not statistically significant (p = 0.387). Conclusion: FeNO guided management strategy for asthma did not result in statistically significant reduction in dose of inhaled corticosteroids or number of asthma exacerbations.
The Indian Journal of Chest Diseases and Allied Sciences
Congenital lobar emphysema is a rare disorder of unknown aetiology that may present a diagnostic ... more Congenital lobar emphysema is a rare disorder of unknown aetiology that may present a diagnostic challenge. We report two cases of congenital lobar emphysema in paediatric age group who were initially treated as pleuro-pulmonary tuberculosis and recurrent pneumonias, respectively. Eventually they were diagnosed as congenital lobar emphysema following chest radiography, computed tomography and bronchoscopic evaluation.
The Indian journal of chest diseases & allied sciences, Nov 18, 2022
Primary tracheal malignancies are very rare tumours and their incidence is approximately 0.1 in e... more Primary tracheal malignancies are very rare tumours and their incidence is approximately 0.1 in every 100,000 persons per year. 1 The differential diagnosis of a tracheal mass comprises of certain malignant (squamous cell carcinoma, adenoid cystic carcinoma, and carcinoid) as well as benign tumours, such as papilloma, haemangioma, hamartoma, and neurilemmomas and neurofibromas. 2 Squamous cell carcinoma is the most common cause of intra-tracheal mass followed by adenoid cystic carcinoma and together these account for about two-thirds of adult primary tracheal tumours. 3 Benign tracheal tumours are less common than the malignant ones and among these squamous papilloma, leiomyoma and haemangiomas are most frequently seen. We describe a case of primary tracheal schwannoma which is extremely rare tumour in this report. To the best of our knowledge, only a single case has been reported till date in the Pubmed indexed Indian journals. case report A 32-year-old male, non-smoker and without any significant past medical history initially reported to a peripheral health centre with complaints of cough, breathlessness on exertion associated with wheezing for the last eight months. There were no aggravating or relieving factors. There was no history of fever, haemoptysis, joint pains, skin rashes, nasal symptoms and weight loss. He was initially diagnosed to have bronchial asthma in a peripheral health centre and was treated with inhaled corticosteroids and bronchodilators without any relief. On examination, he was dyspnoeic at rest which aggravates in supine position and had noisy breathing suggestive of
The Indian Journal of Chest Diseases and Allied Sciences
Non-Hodgkin's lymphoma can present with various clinical manifestations, such as fever, weight lo... more Non-Hodgkin's lymphoma can present with various clinical manifestations, such as fever, weight loss, lymphadenopathy, hepatosplenomegaly or some opportunistic infection. However, it has seldom been reported to be present with Pneumocystis jirovecii pneumonia in respiratory failure as initial presentation. We report a case of non-Hodgkin's lymphoma who presented with Pneumocystis jirovecii pneumonia.
The Indian Journal of Chest Diseases and Allied Sciences
Paragonimiasis has been an important food-borne parasitic zoonosis. It is caused by trematode of ... more Paragonimiasis has been an important food-borne parasitic zoonosis. It is caused by trematode of the genus Paragonimus. 1 It has been recognised as an important cause of pulmonary disease worldwide, especially in Asia, West-Central Africa, and Central and South America. 2 The clinical findings of paragonimiasis may mimic pleuro-pulmonary tuberculosis (TB), bronchitis, bronchiectasis, pneumonia, epilepsy or cerebral space-occupying lesion. It mimics pulmonary TB and requires differentiation from the same in TB endemic areas. The signs and symptoms of initial presentation are most commonly haemoptysis, pleural effusion and peripheral blood eosinophilia. Diagnosis may be missed, especially in areas not endemic for the parasite. 2 Approximately 50% to 70% of patients on initial work-up are diagnosed and treated as TB. The country of origin and dietary habit of eating raw, or partially cooked crab or crayfish are important features in a patient suspected to have paragonimiasis. 3 Hence, a high index of suspicion should be kept in mind if one comes across a patient from an endemic area who has predominantly lower respiratory tract symptoms, including persons with normal chest radiograph and those with radiograph suggestive of TB. case reports Case 1 A 34-year-old male, resident of Nagaland presented with complaints of fever, breathlessness. Physical examination revealed splenomegaly and bilateral pleural effusion. He had raised total leukocyte count with 70% eosinophilia.
Introduction: Lung is a common place for the spread of tumors from within or other parts of the b... more Introduction: Lung is a common place for the spread of tumors from within or other parts of the body. Lung shadows with a diameter less than or larger than 3 cm are termed lung nodule or mass respectively. Aims: To study the histopathological spectrum of lung masses and efficacy of computerized tomography guided FNAC/biopsy in diagnosis of lung masses. Materials and Methods: Forty (40) cases picked up as lung masses on conventional screening & CT scan were subjected to CT guided FNAC/Biopsy and their pathological variations were studied. Results: A total of 40 cases were studied. The mean age of the patients was 60.57 years with 25 (62.5%) males and 15 (37.5%) females. 65% of lesions were in right lung. Malignant lesions were more common and accounted for 27 (67.5 %) cases and benign in 8 (20%) cases. Amongst the malignant lesions, adenocarcinoma was seen in 16 (59.25%), squamous cell carcinoma in 10 (37.03%) and small cell carcinoma in 1 (3.70%) case. Conclusion: FNAC is a simple, relatively safe, rapid, reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. FNAC not only distinguishes between benign and malignant lesions but also helps in tumor typing of lung cancer.
Pulmonary thromboembolism (PTE) remains the third leading cause of cardiovascular death, after a ... more Pulmonary thromboembolism (PTE) remains the third leading cause of cardiovascular death, after a heart attack and stroke. Haemodynamically unstable PTE (previously called high-risk or massive) is one of the dreaded conditions commonly found in people working in high-altitude areas. Due to the individual variations in clot characteristics and the haemodynamics, these patients offer unique therapeutic challenges by delay in access to tertiary care, being recalcitrant to the systemic thrombolysis as well as complete recanalisation by endovascular thrombectomy. We present a rare case of haemodynamically unstable right pulmonary trunk occlusion with delayed presentation and sustained right ventricular strain despite systemic thrombolysis, managed successfully by catheter-directed thrombectomy. Despite the partial recanalisation of only the right inferior pulmonary artery branches and persistent superior branch occlusion, there was an immediate clinical benefit and no recurrence of sympto...
Background A mass lesion in the lung is a common finding seen on chest radiology. The prognosis o... more Background A mass lesion in the lung is a common finding seen on chest radiology. The prognosis of patients with mass lesions in the lung is capricious as malignancy is a consideration. It is essential to diagnose the underlying aetiology at the earliest with minimally invasive procedures for prompt treatment of the case. Bronchoscopic lung cryobiopsy (BLC) is a newer interventional technique in pulmonary medicine for the diagnosis of mass lesions in the lung. Materials and methods This is a retrospective study of patients reporting to a tertiary care centre who were radiologically (by computed tomography scan of the chest) diagnosed with a mass lesion of the lung and who underwent BLC during the period from January 2018 to January 2021. We analysed the diagnostic yield of the technique defined as a positive tissue diagnosis after the histopathological examination (HPE) along with the safety of the procedure. Results During the above period, we evaluated 70 patients who were diagnosed radiologically with mass lesions of the lung and underwent BLC. We obtained tissue diagnoses for 66 cases and the result of four cases was inconclusive. The diagnostic yield of the BLC procedure was 94.29%. There was no mortality and complications were minimal bleeding and small pneumothorax. Conclusion BLC is a newer technique for obtaining lung tissue via a flexible bronchoscope obviating the need for open lung biopsy. The main advantage of the technique is providing larger tissue samples with minimal or no side effects without undergoing multiple procedures as compared to other bronchoscopic or surgical methods for obtaining a diagnosis from lung tissue. BLC is a safer and promising technique in diagnosing mass lesions of the lung with better yield.
Crystalline silica exposure occurs in a large number of industries and is associated with many di... more Crystalline silica exposure occurs in a large number of industries and is associated with many diseases like silicosis, tuberculosis, lung cancer, pulmonary tuberculosis and COPD (1). Scleroderma is an autoimmune disease which manifests as fibrosis and microvascular injury of the different organs which it involves. However, its etiology is unknown. The hallmark of this disease is characterized by thickening and tightness of the skin and subcutaneous tissues which gives a clue to the diagnosis. It affects multiple systems which is characterized by inflammation and degeneration of integument, heart, lungs, kidney, gastrointestinal tract and synovium. [2] There is a known association between scleroderma and silicosis exposure, which was first reported by Bramwel in 1914. [2] Besides affecting workers in the gold and coal mines, Erasmus syndrome was also described in other professionals, such as sculptors and individuals exposed to abrasive powders, drillers, quartz crushing worker, and dental technicians [3]. We report a case of Erasmus syndrome in a patient who had worked for 30 years in the cement factory. CONCLUSION Erasmus syndrome is a rare syndrome described in sixth decade of 20 th century when high prevalence with scleroderma in gold miners who had significant exposure to silica. It affects multiple organs, lungs being commonly involved as it is the portal of entry. The pathogenesis warrants further studies and the treatment consists of immunosuppressives and supportive therapy to alleviate the symptoms.
Aim : The aim of this study was to characterize symptomatology of patients suffering from obstruc... more Aim : The aim of this study was to characterize symptomatology of patients suffering from obstructive sleep apnea syndrome (OSAS) and investigate its correlations with severity of disease as assessed by apneahyponea index (AHI) score. Materials and methods: All patients diagnosed to be having obstructive sleep apnea syndrome (OSAS) over a period of one year in tertiary care hospital were retrospectively studied. Symptomatology was recorded and sleepiness was measured quantitatively by Epworth sleepiness scale (ESS). Symptoms were correlated with AHI score using linear correlation for continuous variables and chi –square test for discrete variables. Results : Snoring was detected to be most common symptom, seen in 28/30 (93.3%) of patients. Breathing pauses(16/30 -53.3%) and witnessed choking(13/30- 43.3%) on correlation with AHI had p value of 0.039 and 0.046 respectively. ESS scores increased linearly with the AHI (correlation coefficient 0.501, P value 0.005) Conclusion Patient...
Background: Coronavirus disease 2019 (COVID-19) can result in severe life-threatening course requ... more Background: Coronavirus disease 2019 (COVID-19) can result in severe life-threatening course requiring ventilatory support. This study highlights data pertaining to ventilated patients to enhance our understanding of COVID-19 as it evolves. Methods: A descriptive, retrospective analysis was carried out on 50 COVID-19 RT-PCR positive patients who received mechanical ventilation at a tertiary care hospital in counterinsurgency (CI) zone, from June to December 2020. Data pertaining to patient characteristics, treatment, ventilator support and outcomes was analysed. Results: Out of 50 patients, 74% were aged 50 years and above with 60% patients having comorbidities. 39 patients received non-invasive ventilation (NIV) and 04 patients received invasive mechanical ventilation (IMV) while 07 patients were converted from NIV to IMV during the hospital stay. Out of the 50 patients who received ventilator support 25 (50%) survived to discharge. The overall survival was 47.3% amongst the males while it was 58.3% for the females. The majority of survivors were in the NIV category (61.5%) while only 9.0% survived amongst those who received IMV. Average length of stay on NIV for patients was 5.3 days and for IMV was 7.5 days. All 50 patients received therapy in the form of steroids, anticoagulants, broad spectrum antibiotics and antivirals. Remdesivir was given to 40 of these patients out of which 20 survived (50%). Interleukin-6 therapy (Tocilizumab) was given to five patients of which four survived (80%).
Abstract Organising pneumonia can be idiopathic or as a result of other inciting factors such as ... more Abstract Organising pneumonia can be idiopathic or as a result of other inciting factors such as drugs. Phenytoin has been implicated in significant side effects predominantly involving extrapulmonary sites. Pulmonary side effects are reported less frequently. Hereby, we report a first case of phenytoin-induced organising pneumonia from India and evidence of significant improvement after stopping the drug.
Obstructive sleep apnoea is present when repetitive episodes of cessation of breathing or decreme... more Obstructive sleep apnoea is present when repetitive episodes of cessation of breathing or decrement in airflow occurs during sleep, associated with sleep fragmentation, arousals from sleep and fall in oxygen saturation [1]. AHI (number of apnoea and hypopnoeas per hour of sleep) is used to define as well as classify the severity of sleep apnoea. OSA syndrome is defined by AHI equal to or greater than five events/ hour and persistent complains of excessive daytime somnolence or fatigue [1]. Obstructive apnoeas cause sympathetic surges conducive to development of acute cardiovascular events (i.e., stroke, myocardial infarction and nocturnal sudden death) and chronic conditions such as systemic hypertension, coronary artery disease and heart failure [2-4]. Various studies done abroad showed that about 50% of OSA patients are hypertensive and an estimated 30% of hypertensive patients also have OSA, often undiagnosed [5-9]. However, there is insufficient Indian data describing the effect of OSA on the severity of systolic and diastolic hypertension separately, independent of confounding factor of obesity in India. To fulfill this gap in knowledge, this study was carried out to determine the prevalence of hypertension associated with OSA, and to correlate the severity of hypertension with severity of OSA in terms of AHI Score.
Background: Evidence regarding the role of non-invasive marker of airway inflammation, fractional... more Background: Evidence regarding the role of non-invasive marker of airway inflammation, fractional exhaled nitric oxide (FeNO) to guide asthma treatment is equivocal. We aimed to evaluate if the use of FeNO to adjust inhaled corticosteroid treatment resulted in reduced daily corticosteroid use and lesser exacerbations. Methods: 100 patients of bronchial asthma in the age group of 12-70 years were randomised to receive inhaled corticosteroids based on either FeNO measurements (n = 50) or as per Global Initiative for Asthma (GINA) guidelines. Follow up was done every 2 months for period of 12 months. Results were compared in terms of mean daily inhaled corticosteroid use and number of exacerbations. Results: After the follow up period of 12 months, mean daily dose of ICS (SD) required in FeNO group was 267.5 mg (126.29), as opposed to control group in which mean daily dose of steroid was 320.00 mg (138.69). However this observed difference in steroid dose was statistically insignificant (p value = 0.061). The estimated mean (SD) rate of asthma exacerbation experienced in follow up period of 12 months in FeNO group was 0.3 episodes (0.54) per patient per year (95% confidence interval, 0.145-455) and 0.4 episodes (0.61) per patient per year in control group (95% confidence interval, 0.228-572). However this difference in rate of exacerbations between the two study groups was not statistically significant (p = 0.387). Conclusion: FeNO guided management strategy for asthma did not result in statistically significant reduction in dose of inhaled corticosteroids or number of asthma exacerbations.
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Papers by Yadvir Garg