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Harikrishna J, Pradeep V, Mohan A, Bhargav K, Chaudhury A, Devi BV, Sarma K. Aetiology, Clinical Presentation and Outcome in Patients with Community-Acquired Pneumonia Requiring Hospitalisation: A Prospective Study. Indian J Chest Dis Allied Sci 2020; 62 (3):117-125.
Background: There is paucity of reliable published data from Andhra Pradesh, India regarding aetiology, clinical presentation and outcome in patients with community-acquired pneumonia (CAP) requiring hospitalisation.
Methods: We prospectively studied 100 consecutive adult patients admitted with CAP during the period January 2018 to June 2019 at our tertiary care teaching hospital in Tirupati, Andhra Pradesh, South India.
Results: Their mean age was 54.4±15.7 years; there were 57 (57%) males. Single aetiology was found in 42% with influenza A (H1N1)pdm09 (12%), Legionella pneumophila (9%) being the most common; more than one concurrent aetiological agents were found in 31%; and no aetiological agent could be established in 27% patients. Mechanical ventilation (both noninvasive ventilation [NIV] and invasive mechanical ventilation [IMV]) were required in 65 patients. NIV was required in 58 patients, of them 38 had recovered; 20 had NIV-failure and required tracheal intubation and IMV. Sixteen patients died; 12 due to CAP and the rest due to other causes. On receiver-operator characteristic (ROC)-curve analysis acute physiology and chronic health evaluation II (APACHE II) score ≤14 (sensitivity 84.5% and specificity 56.3%), pneumonia severity index (PSI) score ≤98 (sensitivity 72.6% and specificity 68.8%) and erythrocyte sedimentation rate (ESR) ≤76 (sensitivity 73.8% and specificity 62.5%) were predictors of death. On multivariable analysis need for IMV (p<0.001) emerged as an independent predictor of death.
Conclusions: CAP can present with single or multiple concurrent aetiologies. A trial of NIV can obviate the need for IMV. On multivariable analysis, need for IMV is an independent predictor of death in patients with CAP.
Madhab Chandra Rana,
Dilip Kumar Das
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Rana MC, Naskar S, Roy R, Das DK. Survival Analysis of Tuberculosis Patients Registered in a Rural Tuberculosis Unit of Purba Bardhaman District, West Bengal, India. Indian J Chest Dis Allied Sci 2020; 62 (3):127-132.
Background: India is still a high tuberculosis (TB) burden country in the world and risk factors of the disease are also highly prevalent. Survival analysis of TB patients had not been adequately studied, especially in this part of the country. The present study was undertaken to estimate overall survival time of TB patients and to find out association of different co-variates with outcome event (death) and survival time of TB patients.
Methods: A record-based retrospective cohort study was conducted in a Tuberculosis Unit of Purba Bardhaman District, West Bengal, India. All registered TB cases in the unit, excluding resistant cases, between October 2010 to March 2016 were included as study subjects (N=3110) and followed up till June 2017 for outcome of interest. Actual data collection and analysis from relevant registers of the Tuberculosis Unit were carried out during June 2017 to November 2017. Descriptive statistics, Kaplan-Meier survival analysis, Log rank test and Cox proportional hazard model for multivariate analysis were applied.
Results: Of 3110 patients, 6.9% (214) had the outcome event of interest (death). The overall mean survival time was 518 days (95% confidence interval 480.9-555.3). Male gender, category II TB, pulmonary TB and TB with human immunodeficiency virus (HIV) were found to be significant risk factors for death due to TB.
Conclusions: Overall survival time was significantly low among males, re-treatment cases, patients with pulmonary TB and patients with HIV co-infection. Awareness generation, adherence to treatment, early diagnosis and treatment are some necessary measures to be properly implemented.
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Akhtar P, Yardi S, Tayade B, Akhtar M. Factors Affecting Quality-of-Life in Patients with Chronic Obstructive Pulmonary Disease. Indian J Chest Dis Allied Sci 2020; 62 (3):133-138.
Objectives: Multiple factors affect quality-of-life (QoL) in patients with chronic obstructive pulmonary disease (COPD). The study was done to explore possible factors which influence disease specific QoL in patients with COPD.
Methods: A cross-sectional study was carried out at our tertiary care hospital. Patients above 40 years of age, Global Initiative for Chronic Obstructive Lung Diseases (GOLD) category I-IV, irrespective of tobacco smoking status with disease duration of five years or more were included. Patients with other chronic respiratory diseases, co-morbid conditions and functional limitations, psychiatric or cognitive problems were excluded. Demographic factors, lifestyle and disease severity parameters; physical, physiological and mental factors were recorded. St. George's Respiratory Questionnaire-C (SGRQ-C) scores were used to assess the QoL. Correlation coefficient, bivariate analysis and multiple linear regression analysis were done.
Results: A total of 78 patients with a mean age of 61.6 years and male preponderance were enrolled. The mean six-minute walk distance (6MWD) test was 235.5 meters. Seventy-three patients were suffering from depression, 67 patients had anxiety and 71 had sleep disturbances. The mean SGRQ-C score was 45.4±14.7. On bivariate analysis, 6MWD, modified Medical Research Council (mMRC) dyspnoea score, depression, anxiety, and sleep disturbances were significantly correlated with the QoL scores (P<0.01). Linear regression analysis showed that 6MWD and sleep disturbance significantly correlated with QoL scores.
Conclusion: Results of the present study showed that functional capacity as measured by 6MWD and sleep disturbances were the two strongly correlated factors associated with QoL in patients with COPD.
Background: The concomitant occurrence of moderate-to-severe chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) is reportedly around 60% attributing to worse prognosis in this subset of population. The present study was undertaken to ascertain the prevalence and implications of OSA in patients of COPD and compare it with those of patients of COPD without OSA.
Methods: Fifty diagnosed patients of moderate-to-severe COPD of age ≤40 years were screened for OSA using a selfreported questionnaire (STOP BANG Questionnaire). Out of these 30 patients who were found to be at risk of OSA (STOP BANG score > 2) were included in the study. These 30 patients then underwent (in lab) Type 1 diagnostic polysomnography (PSG) and inflammatory markers interleukin (IL)-4, IL-5,IL-6,IL-13, high sensitivity c-reactive protein [hs-CRP] and fractional exhaled nitric oxide [FeNO] testing. Their quality-of-life was evaluated with St. George's Respiratory Questionnaire (SGRQ) score, body-mass index, airflow obstruction, dyspnoea and exercise (BODE) index and COPD assessment test (CAT) score.
Results: After PSG, OSA apnoea-hypopnoea index (AHI ≤5/hour) was found in 22 (73.3%) out of 30 moderate-to-severe COPD cases. In moderate COPD, 9 (69.2%) out of 13 patients and in severe COPD 13 (76.4%) out of 17 cases were diagnosed to have OSA (P=0.61). On evaluation with the parameters of pulmonary function test (PFT); significantly lower forced vital capacity (FVC) was found in COPD cases with OSA (P=0.03). No statistically significant difference was found for the level of inflammatory marker based on the presence of OSA (P>0.05). The patients of COPD with OSA fared poorly in CAT, BODE index, modified Medical Research Council (mMRC) scale and SGRQ score in comparison to those with COPD alone (P<0.02)
Conclusions: Our study indicates high prevalence of OSA in patients with moderate-to-severe COPD which negatively affects the quality of sleep and symptoms associated with COPD which further leads to poor quality-of-life. Clinicians should maintain a high index of suspicion for OSA while evaluating a patient of poorly controlled COPD.
Central nervous system tuberculosis accounts for 1% of all tuberculosis cases, and often gets complicated leading to excessive morbidity and mortality. We present a case of a 36-year-old female who presented with tubercular ventriculitis; a rare complication of tuberculous meningitis. Despite prompt clinical diagnosis and appropriate timely management, patient succumbed to the disease. The underlying cause of death could be infection due to multidrugresistant Mycobacterium tuberculosis. This case reinforces the importance of not only early diagnosis of tuberculous meningitis; but also effective anti-tuberculosis therapy following drug susceptibility testing for a favourable outcome.
A 76-year-old male, cotton mill worker by occupation, “never smoker”, reported to us with complaints of fever, dry cough, breathlessness, loss of weight and loss of appetite of one month duration. He had no other co-morbid illness. He was evaluated elsewhere and on the basis of clinical presentation and chest radiographic findings, he was started on Category I therapy under Directly Observed Treatment, short-course (DOTS) for possibile miliary tuberculosis (TB). After three weeks of anti-TB treatment, patient came to our department with increasing breathlessness, persistent fever and cough. Physical examination revealed fever, low oxygen saturation on pulse oximetry, bilateral crepitations in the chest and hepatomegaly. High resolution computed tomography (HRCT) of the chest showed bilateral nodular opacities with few reticular shadows involving all the lobes Serological testing for rickettsia and dengue was negative. Fibreoptic bronchoscopy was performed and testing of bronchial washings for bacteria, fungi, Mycobacterium tuberculosis were all negative. He gave history of consuming raw milk for many years. Liver biopsy showed granulomatous hepatitis. Standard agglutination test for Brucella antibody was positive, and the patient was treated with oral rifampicin and doxycycline for six weeks. Patient had clinical improvement within two weeks of therapy. A repeat chest radiograph and CT at four weeks showed near total resolution of the shadows. We document this case with miliary pattern as an uncommon manifestation of brucellosis. The present case highlights the fact that, in endemic areas, brucellosis should be considered in the differential diagnosis of pulmonary diseases, especially when there is a history of consumption of raw milk.
Uma Maheswari Krishnaswamy,
Pulmonary strongyloidiasis is an unusual manifestation of Strongyloides stercoralis infection typically seen in the immunocompromised patients. We report a case of Strongyloides hyperinfection in a patient with chronic obstructive pulmonary disease (COPD) who presented with bilateral pneumothoraces and pneumomediastinum. This is a rare presentation of the parasitic infection. An incidental finding of Strongyloides larvae in the respiratory secretions unexpectedly clinched the diagnosis and helped manage the patient optimally.