Emphysema sequentially leads to the loss of gas exchanging surface and an abnormal shape of the d... more Emphysema sequentially leads to the loss of gas exchanging surface and an abnormal shape of the diaphragm generating dyspnea refractory to standard medical therapy. Lung volume reduction surgery (LVRS) is a surgical treatment option for patients with severe emphysema whose symptoms are uncontrolled on standard therapy. Bronchoscopic LVR (bLVR) is a process by which lung volume reduction is achieved in a minimally invasive manner using bronchoscopy-guided insertion of valves, coils, sealants, or by thermal vapour ablation like techniques. These therapies have developed over the last few years and have variable results in patients. We have summarized the current evidence available on each of these methods in this review.
The Indian Journal of Chest Diseases and Allied Sciences
Background. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammatio... more Background. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation. Limited published data are available on the effect of atopy on FeNO in allergic rhinitis. Objectives. To investigate the relationship between atopy and FeNO in patients with allergic rhinitis. Methods. Patients with allergic rhinitis were assessed for atopy and exhaled breath analysis of nitric oxide. Atopy was assessed by skin prick testing (SPT) against 58 common aero-allergens; a wheal size of 3mm or more as compared to buffer saline was considered positive. Patients were labelled to be atopic if they had at least one positive SPT result. The measurement of FeNO level was done by using NIOX chemiluminescence analyser. Results. Forty-nine participants (26 males) aged between 8-50 years were studied and 31 of them were found to be atopic. The average value of FeNO in the subjects studied (n=49) was 26.0±22.7 parts per billion (ppb) with significantly higher values being observed in atopic group as compared to non-atopic group (34.2±24.3 versus 11.9±9.0 ppb; p<0 .05). Conclusion. As FeNO is a marker of lower airway inflammation, significantly higher FeNO levels in atopic allergic rhinitis patients suggest that it may be a predictor for onset of asthma in these patients.
To The Editor, The Global Initiative for Asthma (GINA) 2021 update was published on the 28th of A... more To The Editor, The Global Initiative for Asthma (GINA) 2021 update was published on the 28th of April, 2021. There are significant changes, including treatment of mild asthma, the role of azithromycin, treatment of asthma in COVID-19 times, and role of biologics...
Chest low dose computed tomography (LDCT) is reported to be a sensitive tool for the detection of... more Chest low dose computed tomography (LDCT) is reported to be a sensitive tool for the detection of lung cancer at asymptomatic stage, thus reducing mortality. The review assesses the effect of LDCT screening on all-cause mortality, lung cancer mortality and incidence rates. We conducted literature searches of PubMed, SCOPUS, and the Cochrane Library from inception through January 2020 to identify relevant studies assessing the diagnostic accuracy of LDCT for lung cancer. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for reporting this meta-analysis and review. The inclusion criteria were a) Randomized control trials, b) Comparing LDCT to any other form of screening or standard of care, and (c) Primary outcome studied: all-cause mortality, lung cancer-specific mortality, rate of early detection of lung cancer. A total of 11 studies encompassing 97,248 patients were included. When compared with controls (no screening or CXR), LDCT screen...
Wstęp: Celem badania było porównanie ciężkości astmy, jakości życia, jakości snu, zaburzeń oddych... more Wstęp: Celem badania było porównanie ciężkości astmy, jakości życia, jakości snu, zaburzeń oddychania w czasie snu i markerów zapalenia u chorych na astmę z otyłością, z lub bez zespołu metabolicznego z analogicznymi parametrami w grupie chorych na astmę bez otyłości. Materiał i metody: Do badania włączono 60 chorych na astmę, których podzielono na równe pod względem liczebności grupy chorych bez otyłości (NOA non-obese), otyłych bez zespołu metabolicznego (OANMS, obese without metabolic syndrome) oraz otyłych z zespołem metabolicznym (OAMS, obese with metabolic syndrome). Przedmiotem oceny była ciężkość astmy, jakość życia oraz jakość snu za pomocą kwestionariuszy i stężenia markerów zapalenia (FENO, hs-CRP, IL-5, IL-6 i leptyna). Badanie uzyskało aprobatę komisji etycznej odpowiedniej dla instytucji. Wyniki: Wyniki badań wskazują, że chorzy z grupy OAMS mogą reprezentować podtyp astmy o istotnie cięższym przebiegu (p < 0,05), gorszej jakości życia (p < 0.05), większym ryzyku...
Wstęp: Astma jest przewlekłym schorzeniem zapalnym dróg oddechowych. Stężenie tlenku azotu (NO) m... more Wstęp: Astma jest przewlekłym schorzeniem zapalnym dróg oddechowych. Stężenie tlenku azotu (NO) może być mierzone w sposób nieinwazyjny w wydychanym powietrzu (FeNO). Celem badania była ocena wpływu czynników antropometrycznych i czynnościowych na pomiary FeNO, a także ocena korelacji pomiędzy FeNO a wynikami badania spirometrycznego i stężeniem wybranych markerów zapalnych u chorych na astmę i nieżyt nosa. Materiał i metody: Badanie miało charakter prospektywny i obejmowało chorych na astmę (BA) i nieżyt nosa (AR), którzy zgłaszali się do poradni w latach 2011–2015. Osoby zdrowe stanowiły grupę kontrolną. U wszystkich badanych wykonano spirometrię z próbą rozkurczową, pomiar FeNO, testy skórne (prick tests), pobrano krew w celu oznaczenia bezwzględnej liczby eozynofilii we krwi obwodowej i całkowitego stężenia IgE w surowicy. Wyniki: Spośród 528 uczestników badania, u 215 rozpoznano astmę (BA), u 248 astmę i nieżyt nosa (BA-AR), a grupę kontrolną (HC) stanowiła grupa 65 osób. Średn...
Introduction Critically ill patients are predisposed to developing sleep disorders due to multipl... more Introduction Critically ill patients are predisposed to developing sleep disorders due to multiple factors like pre-existing sleep disorders, severe acute illness, sleep-altering medical interventions, and the disturbing intensive care unit (ICU) environment. In the current study, a multi-modality approach has been attempted to capture the different aspects of sleep disturbances, including insomnia (using ISI), daytime sleepiness (using ESS), sleep quality (using PSQI), sleep architecture, and SDB (using PSG). Materials and Methods The eligible ARDS survivor patients were updated about the study's design prior to hospital discharge. At admission, data regarding demographic details, clinical history, etiology of ARDS, and PaO 2 /FiO 2 (P/F) ratio at presentation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores was collected. All enrolled patients were evaluated twice (early-within 7 days of admission and late-after 6 weeks of discharge) by the Richards-Campbell Sleep Questionnaire (RCSQ), Insomnia severity index (ISI), and level 1 PSG. Additionally, ESS questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were also recorded in late evaluation. Abnormal sleep was defined if one or more of the following characteristics met: ISI > 15, ESS > 10, global PSQI > 5, AHI ≥ 5 events/h. Results Thirty patients were recruited out of the total of 88 ARDS patients screened at admission. The median (IQR) PaO 2 / FiO 2 ratio and APACHE II scores were 176 (151-191.5) and 14 (14-16), respectively. The median (IQR) duration of stay in the ICU was 10 (7.3-19.5) days. The median RCSQ score in the early and late evaluation was 42 and 69, respectively. The mean ISI score in the early evaluation was 16.67 ± 4.72, which decreased to 11.70 ± 5.03 in late evaluation (p < 0.05). ISI score > 15 (clinical insomnia) was found in 18 out of 30 subjects (60%) in early evaluation and 11 out of 30 (36%) in late evaluation. During the early evaluation, sleep efficiency was low (median 59.9% and predominantly N1 and N2) which improved in late evaluation (median 80.6%). Of the 30 patients, only 4 had AHI > 5 in early evaluation and none in late evaluation. Neither of P/F ratio, SOFA, and APACHE II scores did correlate with ICU events in the early and late evaluations. Regression analysis showed subjects with ICU stay more than 10 days, duration of IMV more than 7 days, Fentanyl more than 7 mg, duration of sedative use more than 7 days was independently associated with poor objective sleep quality (low sleep efficiency, low TST and high arousal index) during the early and late evaluations after ICU discharge compared to counterparts (p value < 0.05). Conclusion We conclude that sleep quality in ARDS survivors was poor within 7 days of ICU discharge, characterized by severe disruption of sleep architecture and sleep-disordered breathing. After 6 weeks of ICU discharge sleep quality showed significant improvement in the N3 stage and AHI, however persistent insomnia was observed even at 6 weeks. Therefore, prior identification of risk factors and early diagnosis of sleep quality disorders in post-ARDS patients is essential.
Tuberculosis is an uncommon cause of acute hypoxemic respiratory failure. We present a case of a ... more Tuberculosis is an uncommon cause of acute hypoxemic respiratory failure. We present a case of a middle-aged women with near-fatal respiratory failure due to underlying tuberculosis with favorable clinical recovery. Early diagnosis and treatment are imperative to prevent morbidity, mortality, and disease transmission.
The similarities and differences between the mortality patterns of the two waves in India remain ... more The similarities and differences between the mortality patterns of the two waves in India remain largely unknown. This was a retrospective study of medical records conducted in the COVID data center of our hospital This study analyzed data of patients who died in the month of August, 2020 to October 2020 (one month before and after the peak of first wave i.e., 16th September, 2020) & April 2021 to June 2021 (one month before and after the peak of second wave i.e., 6th May, 2021), corresponding to an equal part of the pandemic during first (2020) and second (2021) wave. Out of 1893 patients in the study, 764 patients were admitted during the first wave and 1129 patients during the second wave of pandemic. In total, 420 patients died during the entire study period. Of those, 147 (35%) deaths occurred during the first wave and 273 (65%) during the second wave, reflecting a case fatality rate (CFR) of 19.2% during the first wave and a CFR of 24.18%. There were no significant differences...
We read with interest the two articles by TADOLINI et al. [1] and STOCHINO et al. [2], which desc... more We read with interest the two articles by TADOLINI et al. [1] and STOCHINO et al. [2], which described recent cohorts of either current or former tuberculosis (TB) patients with coronavirus disease 2019 (COVID-19) and studied their clinical course. India has the majority of global burden of TB, along with highest rising number of daily COVID-19 cases in the world [3, 4]. The information about COVID-19 and active/former TB co-infection reported so far is sparse, but it can be assumed that person with TB, when co-infected with COVID-19, may be at more risk of poor outcomes [1, 5]. The present study describes the first-ever cohort of current or treated TB patients co-infected with COVID-19 from a high TB burden country, recruited by a tertiary care hospital in India. This was a retrospective observational study from 1 February 2020 to 14 June 2020, during which a total of 1073 consecutive COVID-19 patients were admitted. Out of these, 22 cases with a diagnosis of active/ treated TB and COVID-19 co-infection were included in the study. Among 22 patients with COVID-19 and TB co-infection, 13 (59.1%) patients had active TB (median age (interquartile range (IQR)) 36 (27-59.5) years) and nine (40.9%) patients had been treated for TB (median age (IQR) 44 (28-51) years) in the past. Among the active TB group, 11 (84.6%) were females and among the treated TB group, all patients were females. Out of the 13 active TB patients, 12 patients were already receiving anti-TB treatment (ATT) (median duration (IQR) 2 (1-3) months) at the time of admission, while one patient was newly diagnosed with pulmonary TB within a week of admission. The demographic, clinical, radiological and laboratory investigation details, and outcomes of each of the 22 patients, are described in table 1.
The Global initiative against asthma (GINA) 2020 strategy has been released with some changes and... more The Global initiative against asthma (GINA) 2020 strategy has been released with some changes and updates. GINA recommends the continuation of medications, avoidance of nebulization and spirometry, and ensuring a written asthma action plan in COVID-19 times. GINA 2020 specifies which step of management is to be followed according to the patient's symptoms in an easy flowchart. Clinicians need to be aware of the changes and the evidence behind them.
COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden... more COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden on health resources. Evaluation of clinical and epidemiological profiles of such patients can help in understanding and managing the outbreak more efficiently. This study was a prospective observational analysis of 200 diagnosed COVID-19 patients admitted to a tertiary care center from 20th march to 8th May 2020. All these patients were positive for COVID-19 by an oro-nasopharyngeal swab-rtPCR based testing. Analyses of demographic factors, clinical characteristics, comorbidities, laboratory parameters, and the outcomes were performed. The mean age of the population was 40 years with a slight male predominance (116 patients out of 200, 58%). A majority of the patients (147, 73.5 %) were symptomatic, with fever being the most common symptom (109, 54.5%), followed by cough (91, 45.5%). An older age, presence of symptoms and their duration, leukocytosis, a high quick SOFA score, a high mod...
A 48-year-old female with bronchial asthma presented with right-sided pleuritic chest pain since ... more A 48-year-old female with bronchial asthma presented with right-sided pleuritic chest pain since 20 days followed by cough with expectoration and shortness of breath since 15 days [...]
Pill aspiration depicts an unusual type of foreign body aspiration necessitating a discrete diagn... more Pill aspiration depicts an unusual type of foreign body aspiration necessitating a discrete diagnostic and therapeutic approach [...]
Diffuse alveolar haemorrhage (DAH) is characterised by diffuse pulmonary opacities, respiratory f... more Diffuse alveolar haemorrhage (DAH) is characterised by diffuse pulmonary opacities, respiratory failure, a falling haemoglobin level along with presence of hemosiderin-laden macrophages on bronchoalveolar lavage (BAL). Finding the underlying aetiology of DAH can be challenging but of importance as the treatment and prognosis are largely determined by it. We report a case of DAH with underlying cocaine abuse, a rare cause for the same.
To the EditorNovel Coronavirus disease (COVID-19) was first notified in December 2019 from Wuhan,... more To the EditorNovel Coronavirus disease (COVID-19) was first notified in December 2019 from Wuhan, China. Now, it has spread rapidly and has been declared a pandemic affecting over 200 countries with widespread morbidity and mortality. It has been postulated that the most vulnerable population are the elderly, people living in crowded areas, children and immune-compromised individuals, such as people living with human immunodeficiency virus (HIV). The correlation of tuberculosis (TB), HIV and malnutrition are well documented and hence, people with tuberculosis should be considered as special population in this pandemic. TB is an ancient disease among humans recorded as far back as seventy thousand years which was declared a global public health emergency in 1993 by the World Health Organisation (WHO). India has the highest TB burden in the world.
Pericardial cyst is a benign congenital malformation, with uncommon incidence of approximately 1 ... more Pericardial cyst is a benign congenital malformation, with uncommon incidence of approximately 1 in 100 000. It accounts for 7% of all mediastinal masses and is rarely associated with complications. Prompt discrimination of this benign lesion from metastasis in a patient with malignancy is of paramount significance in deciding exact line of management. Here, we report a case of pericardial cyst masquerading as a metastatic lung carcinoma in a patient previously treated for breast carcinoma.
Emphysema sequentially leads to the loss of gas exchanging surface and an abnormal shape of the d... more Emphysema sequentially leads to the loss of gas exchanging surface and an abnormal shape of the diaphragm generating dyspnea refractory to standard medical therapy. Lung volume reduction surgery (LVRS) is a surgical treatment option for patients with severe emphysema whose symptoms are uncontrolled on standard therapy. Bronchoscopic LVR (bLVR) is a process by which lung volume reduction is achieved in a minimally invasive manner using bronchoscopy-guided insertion of valves, coils, sealants, or by thermal vapour ablation like techniques. These therapies have developed over the last few years and have variable results in patients. We have summarized the current evidence available on each of these methods in this review.
The Indian Journal of Chest Diseases and Allied Sciences
Background. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammatio... more Background. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation. Limited published data are available on the effect of atopy on FeNO in allergic rhinitis. Objectives. To investigate the relationship between atopy and FeNO in patients with allergic rhinitis. Methods. Patients with allergic rhinitis were assessed for atopy and exhaled breath analysis of nitric oxide. Atopy was assessed by skin prick testing (SPT) against 58 common aero-allergens; a wheal size of 3mm or more as compared to buffer saline was considered positive. Patients were labelled to be atopic if they had at least one positive SPT result. The measurement of FeNO level was done by using NIOX chemiluminescence analyser. Results. Forty-nine participants (26 males) aged between 8-50 years were studied and 31 of them were found to be atopic. The average value of FeNO in the subjects studied (n=49) was 26.0±22.7 parts per billion (ppb) with significantly higher values being observed in atopic group as compared to non-atopic group (34.2±24.3 versus 11.9±9.0 ppb; p<0 .05). Conclusion. As FeNO is a marker of lower airway inflammation, significantly higher FeNO levels in atopic allergic rhinitis patients suggest that it may be a predictor for onset of asthma in these patients.
To The Editor, The Global Initiative for Asthma (GINA) 2021 update was published on the 28th of A... more To The Editor, The Global Initiative for Asthma (GINA) 2021 update was published on the 28th of April, 2021. There are significant changes, including treatment of mild asthma, the role of azithromycin, treatment of asthma in COVID-19 times, and role of biologics...
Chest low dose computed tomography (LDCT) is reported to be a sensitive tool for the detection of... more Chest low dose computed tomography (LDCT) is reported to be a sensitive tool for the detection of lung cancer at asymptomatic stage, thus reducing mortality. The review assesses the effect of LDCT screening on all-cause mortality, lung cancer mortality and incidence rates. We conducted literature searches of PubMed, SCOPUS, and the Cochrane Library from inception through January 2020 to identify relevant studies assessing the diagnostic accuracy of LDCT for lung cancer. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for reporting this meta-analysis and review. The inclusion criteria were a) Randomized control trials, b) Comparing LDCT to any other form of screening or standard of care, and (c) Primary outcome studied: all-cause mortality, lung cancer-specific mortality, rate of early detection of lung cancer. A total of 11 studies encompassing 97,248 patients were included. When compared with controls (no screening or CXR), LDCT screen...
Wstęp: Celem badania było porównanie ciężkości astmy, jakości życia, jakości snu, zaburzeń oddych... more Wstęp: Celem badania było porównanie ciężkości astmy, jakości życia, jakości snu, zaburzeń oddychania w czasie snu i markerów zapalenia u chorych na astmę z otyłością, z lub bez zespołu metabolicznego z analogicznymi parametrami w grupie chorych na astmę bez otyłości. Materiał i metody: Do badania włączono 60 chorych na astmę, których podzielono na równe pod względem liczebności grupy chorych bez otyłości (NOA non-obese), otyłych bez zespołu metabolicznego (OANMS, obese without metabolic syndrome) oraz otyłych z zespołem metabolicznym (OAMS, obese with metabolic syndrome). Przedmiotem oceny była ciężkość astmy, jakość życia oraz jakość snu za pomocą kwestionariuszy i stężenia markerów zapalenia (FENO, hs-CRP, IL-5, IL-6 i leptyna). Badanie uzyskało aprobatę komisji etycznej odpowiedniej dla instytucji. Wyniki: Wyniki badań wskazują, że chorzy z grupy OAMS mogą reprezentować podtyp astmy o istotnie cięższym przebiegu (p < 0,05), gorszej jakości życia (p < 0.05), większym ryzyku...
Wstęp: Astma jest przewlekłym schorzeniem zapalnym dróg oddechowych. Stężenie tlenku azotu (NO) m... more Wstęp: Astma jest przewlekłym schorzeniem zapalnym dróg oddechowych. Stężenie tlenku azotu (NO) może być mierzone w sposób nieinwazyjny w wydychanym powietrzu (FeNO). Celem badania była ocena wpływu czynników antropometrycznych i czynnościowych na pomiary FeNO, a także ocena korelacji pomiędzy FeNO a wynikami badania spirometrycznego i stężeniem wybranych markerów zapalnych u chorych na astmę i nieżyt nosa. Materiał i metody: Badanie miało charakter prospektywny i obejmowało chorych na astmę (BA) i nieżyt nosa (AR), którzy zgłaszali się do poradni w latach 2011–2015. Osoby zdrowe stanowiły grupę kontrolną. U wszystkich badanych wykonano spirometrię z próbą rozkurczową, pomiar FeNO, testy skórne (prick tests), pobrano krew w celu oznaczenia bezwzględnej liczby eozynofilii we krwi obwodowej i całkowitego stężenia IgE w surowicy. Wyniki: Spośród 528 uczestników badania, u 215 rozpoznano astmę (BA), u 248 astmę i nieżyt nosa (BA-AR), a grupę kontrolną (HC) stanowiła grupa 65 osób. Średn...
Introduction Critically ill patients are predisposed to developing sleep disorders due to multipl... more Introduction Critically ill patients are predisposed to developing sleep disorders due to multiple factors like pre-existing sleep disorders, severe acute illness, sleep-altering medical interventions, and the disturbing intensive care unit (ICU) environment. In the current study, a multi-modality approach has been attempted to capture the different aspects of sleep disturbances, including insomnia (using ISI), daytime sleepiness (using ESS), sleep quality (using PSQI), sleep architecture, and SDB (using PSG). Materials and Methods The eligible ARDS survivor patients were updated about the study's design prior to hospital discharge. At admission, data regarding demographic details, clinical history, etiology of ARDS, and PaO 2 /FiO 2 (P/F) ratio at presentation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores was collected. All enrolled patients were evaluated twice (early-within 7 days of admission and late-after 6 weeks of discharge) by the Richards-Campbell Sleep Questionnaire (RCSQ), Insomnia severity index (ISI), and level 1 PSG. Additionally, ESS questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were also recorded in late evaluation. Abnormal sleep was defined if one or more of the following characteristics met: ISI > 15, ESS > 10, global PSQI > 5, AHI ≥ 5 events/h. Results Thirty patients were recruited out of the total of 88 ARDS patients screened at admission. The median (IQR) PaO 2 / FiO 2 ratio and APACHE II scores were 176 (151-191.5) and 14 (14-16), respectively. The median (IQR) duration of stay in the ICU was 10 (7.3-19.5) days. The median RCSQ score in the early and late evaluation was 42 and 69, respectively. The mean ISI score in the early evaluation was 16.67 ± 4.72, which decreased to 11.70 ± 5.03 in late evaluation (p < 0.05). ISI score > 15 (clinical insomnia) was found in 18 out of 30 subjects (60%) in early evaluation and 11 out of 30 (36%) in late evaluation. During the early evaluation, sleep efficiency was low (median 59.9% and predominantly N1 and N2) which improved in late evaluation (median 80.6%). Of the 30 patients, only 4 had AHI > 5 in early evaluation and none in late evaluation. Neither of P/F ratio, SOFA, and APACHE II scores did correlate with ICU events in the early and late evaluations. Regression analysis showed subjects with ICU stay more than 10 days, duration of IMV more than 7 days, Fentanyl more than 7 mg, duration of sedative use more than 7 days was independently associated with poor objective sleep quality (low sleep efficiency, low TST and high arousal index) during the early and late evaluations after ICU discharge compared to counterparts (p value < 0.05). Conclusion We conclude that sleep quality in ARDS survivors was poor within 7 days of ICU discharge, characterized by severe disruption of sleep architecture and sleep-disordered breathing. After 6 weeks of ICU discharge sleep quality showed significant improvement in the N3 stage and AHI, however persistent insomnia was observed even at 6 weeks. Therefore, prior identification of risk factors and early diagnosis of sleep quality disorders in post-ARDS patients is essential.
Tuberculosis is an uncommon cause of acute hypoxemic respiratory failure. We present a case of a ... more Tuberculosis is an uncommon cause of acute hypoxemic respiratory failure. We present a case of a middle-aged women with near-fatal respiratory failure due to underlying tuberculosis with favorable clinical recovery. Early diagnosis and treatment are imperative to prevent morbidity, mortality, and disease transmission.
The similarities and differences between the mortality patterns of the two waves in India remain ... more The similarities and differences between the mortality patterns of the two waves in India remain largely unknown. This was a retrospective study of medical records conducted in the COVID data center of our hospital This study analyzed data of patients who died in the month of August, 2020 to October 2020 (one month before and after the peak of first wave i.e., 16th September, 2020) & April 2021 to June 2021 (one month before and after the peak of second wave i.e., 6th May, 2021), corresponding to an equal part of the pandemic during first (2020) and second (2021) wave. Out of 1893 patients in the study, 764 patients were admitted during the first wave and 1129 patients during the second wave of pandemic. In total, 420 patients died during the entire study period. Of those, 147 (35%) deaths occurred during the first wave and 273 (65%) during the second wave, reflecting a case fatality rate (CFR) of 19.2% during the first wave and a CFR of 24.18%. There were no significant differences...
We read with interest the two articles by TADOLINI et al. [1] and STOCHINO et al. [2], which desc... more We read with interest the two articles by TADOLINI et al. [1] and STOCHINO et al. [2], which described recent cohorts of either current or former tuberculosis (TB) patients with coronavirus disease 2019 (COVID-19) and studied their clinical course. India has the majority of global burden of TB, along with highest rising number of daily COVID-19 cases in the world [3, 4]. The information about COVID-19 and active/former TB co-infection reported so far is sparse, but it can be assumed that person with TB, when co-infected with COVID-19, may be at more risk of poor outcomes [1, 5]. The present study describes the first-ever cohort of current or treated TB patients co-infected with COVID-19 from a high TB burden country, recruited by a tertiary care hospital in India. This was a retrospective observational study from 1 February 2020 to 14 June 2020, during which a total of 1073 consecutive COVID-19 patients were admitted. Out of these, 22 cases with a diagnosis of active/ treated TB and COVID-19 co-infection were included in the study. Among 22 patients with COVID-19 and TB co-infection, 13 (59.1%) patients had active TB (median age (interquartile range (IQR)) 36 (27-59.5) years) and nine (40.9%) patients had been treated for TB (median age (IQR) 44 (28-51) years) in the past. Among the active TB group, 11 (84.6%) were females and among the treated TB group, all patients were females. Out of the 13 active TB patients, 12 patients were already receiving anti-TB treatment (ATT) (median duration (IQR) 2 (1-3) months) at the time of admission, while one patient was newly diagnosed with pulmonary TB within a week of admission. The demographic, clinical, radiological and laboratory investigation details, and outcomes of each of the 22 patients, are described in table 1.
The Global initiative against asthma (GINA) 2020 strategy has been released with some changes and... more The Global initiative against asthma (GINA) 2020 strategy has been released with some changes and updates. GINA recommends the continuation of medications, avoidance of nebulization and spirometry, and ensuring a written asthma action plan in COVID-19 times. GINA 2020 specifies which step of management is to be followed according to the patient's symptoms in an easy flowchart. Clinicians need to be aware of the changes and the evidence behind them.
COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden... more COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden on health resources. Evaluation of clinical and epidemiological profiles of such patients can help in understanding and managing the outbreak more efficiently. This study was a prospective observational analysis of 200 diagnosed COVID-19 patients admitted to a tertiary care center from 20th march to 8th May 2020. All these patients were positive for COVID-19 by an oro-nasopharyngeal swab-rtPCR based testing. Analyses of demographic factors, clinical characteristics, comorbidities, laboratory parameters, and the outcomes were performed. The mean age of the population was 40 years with a slight male predominance (116 patients out of 200, 58%). A majority of the patients (147, 73.5 %) were symptomatic, with fever being the most common symptom (109, 54.5%), followed by cough (91, 45.5%). An older age, presence of symptoms and their duration, leukocytosis, a high quick SOFA score, a high mod...
A 48-year-old female with bronchial asthma presented with right-sided pleuritic chest pain since ... more A 48-year-old female with bronchial asthma presented with right-sided pleuritic chest pain since 20 days followed by cough with expectoration and shortness of breath since 15 days [...]
Pill aspiration depicts an unusual type of foreign body aspiration necessitating a discrete diagn... more Pill aspiration depicts an unusual type of foreign body aspiration necessitating a discrete diagnostic and therapeutic approach [...]
Diffuse alveolar haemorrhage (DAH) is characterised by diffuse pulmonary opacities, respiratory f... more Diffuse alveolar haemorrhage (DAH) is characterised by diffuse pulmonary opacities, respiratory failure, a falling haemoglobin level along with presence of hemosiderin-laden macrophages on bronchoalveolar lavage (BAL). Finding the underlying aetiology of DAH can be challenging but of importance as the treatment and prognosis are largely determined by it. We report a case of DAH with underlying cocaine abuse, a rare cause for the same.
To the EditorNovel Coronavirus disease (COVID-19) was first notified in December 2019 from Wuhan,... more To the EditorNovel Coronavirus disease (COVID-19) was first notified in December 2019 from Wuhan, China. Now, it has spread rapidly and has been declared a pandemic affecting over 200 countries with widespread morbidity and mortality. It has been postulated that the most vulnerable population are the elderly, people living in crowded areas, children and immune-compromised individuals, such as people living with human immunodeficiency virus (HIV). The correlation of tuberculosis (TB), HIV and malnutrition are well documented and hence, people with tuberculosis should be considered as special population in this pandemic. TB is an ancient disease among humans recorded as far back as seventy thousand years which was declared a global public health emergency in 1993 by the World Health Organisation (WHO). India has the highest TB burden in the world.
Pericardial cyst is a benign congenital malformation, with uncommon incidence of approximately 1 ... more Pericardial cyst is a benign congenital malformation, with uncommon incidence of approximately 1 in 100 000. It accounts for 7% of all mediastinal masses and is rarely associated with complications. Prompt discrimination of this benign lesion from metastasis in a patient with malignancy is of paramount significance in deciding exact line of management. Here, we report a case of pericardial cyst masquerading as a metastatic lung carcinoma in a patient previously treated for breast carcinoma.
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Papers by NITESH GUPTA