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Jindal SK, Lee T, Agrawal A, Demers L, Schwartz AW. A National Survey on Point of Care Ultrasonography Use Among Veterans Affairs Clinicians in Home Care and Skilled Nursing Facilities. J Am Med Dir Assoc 2024:104930. [PMID: 38336356 DOI: 10.1016/j.jamda.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system. METHODS An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS. RESULTS Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use. DISCUSSION This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.
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Affiliation(s)
- Shivani K Jindal
- Cincinnati VA Medical Center, Medical Service, Cincinnati, OH, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA.
| | | | - Arushi Agrawal
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lindsay Demers
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Morgan S, Pasco JC, Demers L, Young ME, Jindal SK. Combating ageism in medical education with narrative medicine. Gerontol Geriatr Educ 2024:1-12. [PMID: 38217514 DOI: 10.1080/02701960.2024.2302594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
Ageism is common in medical trainees and difficult to overcome. The My Life, My Story program has been shown to be an effective tool for increasing empathy. We explored its use as an instrument for combating ageism by implementing it in a Geriatrics clerkship for fourth year medical students. During our evaluation, 151 students interviewed patients about their lives using a semi-structured question guide. Students completed the UCLA Geriatrics Attitudes Scale and the Expectations Regarding Aging Survey pre-and post-clerkship. We also facilitated 9 student debriefs and 5 faculty interviews. After completing My Life, My Story, students were more likely to disagree with "I would rather see younger patients than elderly ones" and "it's normal to be depressed when you are old". In qualitative analysis of the debriefs, we identified a key summative theme: "impact of the intervention on care teams". Within that, we describe three subthemes: an awareness of richness of the lives led by older people, their current value to society, and the social determinants of health they have faced. After participating in My Life, My Story, students' attitudes toward aging changed. A narrative medicine program using life stories can be a practical tool for addressing ageist stereotypes.
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Affiliation(s)
- Sarah Morgan
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - John Carlo Pasco
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Lindsay Demers
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Megan E Young
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Shivani K Jindal
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Cincinnati VA Medical Center, Cincinnati, Ohio, USA
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Jindal SK, Paniszyn L, Lee T, Kumar A, Holliday AM, Orkaby AR, Schwartz AW. Bringing age-friendly care to the wards: A feasibility study implementing a 4Ms Bundle. J Am Geriatr Soc 2023; 71:3943-3947. [PMID: 37596886 DOI: 10.1111/jgs.18550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/16/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Shivani K Jindal
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Linda Paniszyn
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Truelian Lee
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anagha Kumar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alison M Holliday
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Multicampus Geriatrics Fellowship, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Arora VK, Jindal SK, Katiyar SK, Behra D, Talwar D, Sarin R, Dhar R, Mehta P, Bhargava S, Singhal P, Joshi S, Tiwaskar M, Nikam C, Chatterjee A, Vora A. Genomic revolution: Transforming tuberculosis diagnosis and treatment with the use of Whole Genome Sequencing - A consensus statement. Indian J Tuberc 2023; 70:383-389. [PMID: 37968042 DOI: 10.1016/j.ijtb.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 11/17/2023]
Abstract
Tuberculosis (TB) is a preventable, treatable, and curable disease. However, in 2020, 9∙9 million people were estimated to have developed tuberculosis, and 1.5 million people were estimated to have died from it. Whereas in India, 2.6 million were diagnosed with TB and 436,000 succumbed to TB in 2019. India (26%) is the major contributor to the global drop in TB cases. The COVID-19 pandemic has substantially reduced access to services for the diagnosis and treatment of TB, resulting in an increase in deaths and a reversal in global progress. [1] Presently, TB incidence is falling at a rate of 2% per year, obstructed mainly by the rearing pandemic of drug-resistant tuberculosis (DRTB). Particularly concerning is multi-drug resistant TB (MDRTB), defined as resistance towards isoniazid (INH) and rifampicin (RIF). [2] The World Health Organization (WHO) targeted to reduce worldwide TB incidence by 90% until 2035. (1) Early initiation of effective treatment based on susceptibility patterns of the Mycobacterium tuberculosis complex (MTBC) is considered key to successful TB control in countries with high DRTB incidence. Worldwide MDRTB treatment outcomes are poor, with cure rates less than 60% (2) due to the lack of comprehensive Drug Susceptibility Testing (DST) in most high MDRTB burden countries. This is leading to the inadequate anti-TB activity of the provided regimens (3-5), unlike regimens advised for DST assure optimal results. (6) In addition to resistances to the established regimens, the resistance to the newer DRTB drugs is increasing. On World TB Day 2022, Academy of Advanced Medical Education, Thyrocare Technologies Limited and HyastackAnalytics - IITB along with expert pulmonologist and renowned physicians from India convened for an advisory board meeting in Delhi on 20th March 2022 to discuss the role of Whole Genome Sequencing (WGS) in the diagnosis and management of TB. Objectives and specific topics relating to WGS in MDRTB were discussed, each expert shared their views, which led to a group discussion with a commitment to putting the patient first, and increasing their collective efforts, the organizations recognized that it is possible to make this goal a reality. The organizations involved in the discussion have declared their commitment to engaging in collaborative efforts to tackle DRTB detection efficiently. They advocate for strengthening access to WGS TB services, controlling and preventing TB, improving surveillance and drug resistance management, and investing in research and development. This Round Table serves as a framework to build on and ensure that the goal of ending TB is achievable with WGS services wherever needed. Post discussion, a uniform consensus was said to be arrived if more than 80% board members agreed to the statement. The present paper is the outcome of aspects presented and discussed in the advisory board meeting.
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Affiliation(s)
- V K Arora
- Pulmonologist and Tuberculous and Chest Diseases Specialist, Delhi, India
| | - S K Jindal
- Director, Jindal Clinics, Chandigarh, India
| | - S K Katiyar
- Pulmonologist, TB & Chest Diseases Specialist, Kanpur, India
| | - Digambar Behra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Talwar
- Senior Consultant & Chairman - Metro Respiratory Center Pulmonology & Sleep Medicine, Noida, India
| | - Rohit Sarin
- Principal Consultant and Former Director, National Institute of Tuberculosis and Respiratory Diseases, Delhi, India
| | - Raja Dhar
- Department of Pulmonology C K Birla Group of Hospitals Kolkata, India
| | | | - Salil Bhargava
- Professor of Chest and TB at M G M Medical College, Indore, India
| | | | | | | | - Chaitali Nikam
- HaystackAnalytics, IITB, Mumbai, India; Thyrocare Technologies Limited, Mumbai, India
| | | | - Agam Vora
- Brahma Kumari's Global Hospital & Research Centre, Mumbai, India.
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Ferri GM, Morgan S, Pasco JC, Restrepo J, Demers L, Young ME, Jindal SK. Listening more and measuring less: Student and faculty perspectives on social narratives in care for older adults. J Am Geriatr Soc 2023; 71:E5-E8. [PMID: 36637868 DOI: 10.1111/jgs.18225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/09/2022] [Accepted: 12/18/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Grace M Ferri
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sarah Morgan
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - John Carlo Pasco
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Jessica Restrepo
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lindsay Demers
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Megan E Young
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Shivani K Jindal
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
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Dhar R, Singh S, Talwar D, Murali Mohan BV, Tripathi SK, Swarnakar R, Trivedi S, Rajagopala S, D'Souza G, Padmanabhan A, Archana B, Mahesh PA, Ghewade B, Nair G, Jindal A, Jayadevappa GDH, Sawhney H, Sarmah KR, Saha K, Anantharaj S, Khanna A, Gami S, Shah A, Shah A, Dutt N, Garg H, Vyas S, Venugopal K, Prasad R, Aleemuddin NM, Karmakar S, Singh V, Jindal SK, Sharma S, Prajapat D, Chandrashekar S, Loebinger M, Mishra A, Blasi F, Ramanathan RP, Goeminne PC, Vasudev P, Shoemark A, Jayaraj BS, Kungwani R, Das A, Sawhney M, Polverino E, Welte T, Gulecha NS, Shteinberg M, Mangala A, Shah P, Chauhan NK, Jajodia N, Singhal A, Batra S, Hasan A, Aliberti S, Crichton ML, Limaye S, Salvi S, Chalmers JD. Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry. Eur Respir J 2023; 61:13993003.00611-2022. [PMID: 36229049 PMCID: PMC9816417 DOI: 10.1183/13993003.00611-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Identifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India. METHODS The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India (EMBARC-India) registry is a prospective observational study of adults with computed tomography-confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and decline in forced expiratory volume in 1 s. RESULTS 1018 patients with at least 12-month follow-up data were enrolled in the follow-up study. Frequent exacerbations (≥3 per year) at baseline were associated with an increased risk of mortality (hazard ratio (HR) 3.23, 95% CI 1.39-7.50), severe exacerbations (HR 2.71, 95% CI 1.92-3.83), future exacerbations (incidence rate ratio (IRR) 3.08, 95% CI 2.36-4.01) and lung function decline. Coexisting COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all end-points studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular comorbidity. Infection with Gram-negative pathogens (predominantly Klebsiella pneumoniae) was independently associated with increased mortality (HR 3.13, 95% CI 1.62-6.06), while Pseudomonas aeruginosa infection was associated with severe exacerbations (HR 1.41, 95% CI 1.01-1.97) and overall exacerbation rate (IRR 1.47, 95% CI 1.13-1.91). CONCLUSIONS This study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.
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Affiliation(s)
- Raja Dhar
- Fortis Hospital Kolkata, Kolkata, India
| | - Sheetu Singh
- Institute of Respiratory Disease, SMS Medical College, Jaipur, India
| | | | - B V Murali Mohan
- Mazumdar Shaw Medical Centre, Narayana Hrudayalaya, Bangalore, India
| | | | | | - Sonali Trivedi
- Jawaharlal Nehru Hospital and Research Centre, Bhilai, India
| | | | | | | | - B Archana
- Kempegowda Institute of Medical Sciences, Bengaluru, India
| | - P A Mahesh
- JSS Medical College, JSSAHER, Mysuru, India
| | - Babaji Ghewade
- Datta Meghe Institute of Medical Sciences Wardha, Wardha, India
| | - Girija Nair
- Department of Respiratory Medicine, D.Y. Patil School of Medicine, Navi Mumbai, India
| | | | | | | | | | | | - Suresh Anantharaj
- Sundaram Medical Foundation and SRM Institute of Medical Sciences, Chennai, India
| | - Arjun Khanna
- Galaxy Hospital Delhi and Yashoda Super Speciality Hospital Kaushambi, Uttar Pradesh, India
| | - Samir Gami
- Unique Hospital Multispecialty and Research Centre, Surat, India
| | - Arti Shah
- Dhiraj Hospital, Sumandeep University, Gujarat, India
| | - Arpan Shah
- Pranayam Lung and Heart Institute and Research Centre, Vadodara, India
| | - Naveen Dutt
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | | | - Rajendra Prasad
- Era's Lucknow Medical College and Hospital, Era University, Lucknow, India
| | | | | | | | | | | | | | | | - Michael Loebinger
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Aditi Mishra
- Getwell Hospital and Research Centre, Nagpur, India
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Pieter C Goeminne
- Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Preethi Vasudev
- Kerala Institute of Medical Sciences Trivandrum, Trivandrum, India
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | - Rahul Kungwani
- Datta Meghe Institute of Medical Sciences Wardha, Wardha, India
| | - Akanksha Das
- Department of Respiratory Medicine, D.Y. Patil School of Medicine, Navi Mumbai, India
| | | | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Nayan Sri Gulecha
- Sundaram Medical Foundation and SRM Institute of Medical Sciences, Chennai, India
| | | | | | - Palak Shah
- Pranayam Lung and Heart Institute and Research Centre, Vadodara, India
| | | | | | | | - Sakshi Batra
- Era's Lucknow Medical College and Hospital, Era University, Lucknow, India
| | - Ashfaq Hasan
- Deccan College of Medical Sciences, Hyderbad, India
| | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | | | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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7
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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.
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Affiliation(s)
- S K Katiyar
- Department of Tuberculosis & Respiratory Diseases, G.S.V.M. Medical College & C.S.J.M. University, Kanpur, Uttar Pradesh, India.
| | - S N Gaur
- Vallabhbhai Patel Chest Institute, University of Delhi, Respiratory Medicine, School of Medical Sciences and Research, Sharda University, Greater NOIDA, Uttar Pradesh, India
| | - R N Solanki
- Department of Tuberculosis & Chest Diseases, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Raj Kumar
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, National Centre of Allergy, Asthma & Immunology; University of Delhi, Delhi, India
| | - G C Khilnani
- PSRI Institute of Pulmonary, Critical Care, & Sleep Medicine, PSRI Hospital, Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rupak Singla
- Department of Tuberculosis & Respiratory Diseases, National Institute of Tuberculosis & Respiratory Diseases (formerly L.R.S. Institute), Delhi, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Ashok A Mahashur
- Department of Respiratory Medicine, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - A G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - D Behera
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | | - H Paramesh
- Paediatric Pulmonologist & Environmentalist, Lakeside Hospital & Education Trust, Bengaluru, Karnataka, India
| | - K B Gupta
- Department of Tuberculosis & Respiratory Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India
| | - Mohan Kumar T
- Department of Pulmonary, Critical Care & Sleep Medicine, One Care Medical Centre, Coimbatore, Tamil Nadu, India
| | - P D Motiani
- Department of Pulmonary Diseases, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - P S Shankar
- SCEO, KBN Hospital, Kalaburagi, Karnataka, India
| | - Rajesh Chawla
- Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine & Sleep Disorders, AIIMS, New Delhi, India
| | - S K Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Luhadia
- Department of Tuberculosis and Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - V K Arora
- Indian Journal of Tuberculosis, Santosh University, NCR Delhi, National Institute of TB & Respiratory Diseases Delhi, India; JIPMER, Puducherry, India
| | - V K Vijayan
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, University of Delhi, Delhi, India
| | - Abhishek Faye
- Centre for Lung and Sleep Disorders, Nagpur, Maharashtra, India
| | | | - Amit K Murar
- Respiratory Medicine, Cronus Multi-Specialty Hospital, New Delhi, India
| | - Anand Jaiswal
- Respiratory & Sleep Medicine, Medanta Medicity, Gurugram, Haryana, India
| | - Arunachalam M
- All India Institute of Medical Sciences, New Delhi, India
| | - A K Janmeja
- Department of Respiratory Medicine, Government Medical College, Chandigarh, India
| | - Brijesh Prajapat
- Pulmonary and Critical Care Medicine, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - C Ravindran
- Department of TB & Chest, Government Medical College, Kozhikode, Kerala, India
| | - Debajyoti Bhattacharyya
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, Army Hospital (Research & Referral), New Delhi, India
| | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Centre for Research and Treatment of Allergy, Asthma & Bronchitis, Department of Chest Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Lalit Singh
- Department of Respiratory Medicine, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - M K Sen
- Department of Respiratory Medicine, ESIC Medical College, NIT Faridabad, Haryana, India; Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra K Bainara
- Department of Pulmonary Medicine, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi PostGraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nilkanth T Awad
- Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Naveed N Shah
- Department of Pulmonary Medicine, Chest Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, PSRI, New Delhi, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pawan Tiwari
- School of Excellence in Pulmonary Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - R Narasimhan
- Department of EBUS and Bronchial Thermoplasty Services at Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Vijai Kumar
- Department of Pulmonary Medicine, MediCiti Medical College, Hyderabad, Telangana, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi and U.P. Rural Institute of Medical Sciences & Research, Safai, Uttar Pradesh, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care, Sleep Medicine and Interventional Pulmonology, Getwell Hospital & Research Institute, Nagpur, Maharashtra, India
| | - Rakesh K Chawla
- Department of, Respiratory Medicine, Critical Care, Sleep & Interventional Pulmonology, Saroj Super Speciality Hospital, Jaipur Golden Hospital, Rajiv Gandhi Cancer Hospital, Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - S Chakrabarti
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Surya Kant
- Department of Respiratory (Pulmonary) Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Centre for Visceral Mechanisms, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virendra Singh
- Mahavir Jaipuria Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Vishal Chopra
- Department of Chest & Tuberculosis, Government Medical College, Patiala, Punjab, India
| | - Visweswaran B
- Interventional Pulmonology, Yashoda Hospitals, Hyderabad, Telangana, India
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Jindal SK, Karamourtopoulos M, Jacobson AR, Pinheiro A, Smith AK, Hamel MB, Schonberg MA. Strategies for discussing long‐term prognosis when deciding on cancer screening for adults over age 75. J Am Geriatr Soc 2022; 70:1734-1744. [DOI: 10.1111/jgs.17723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/12/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Shivani K. Jindal
- New England Geriatrics Research Education, and Clinical Center, VA Boston Health Care System Boston Massachusetts USA
- Section of Geriatrics, Department of Medicine Boston University School of Medicine Boston Massachusetts USA
| | - Maria Karamourtopoulos
- Division of General Medicine and Primary Care, Department of Medicine Harvard Medical School, Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | | | - Adlin Pinheiro
- Division of General Medicine and Primary Care, Department of Medicine Harvard Medical School, Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine University of California San Francisco California USA
| | - Mary Beth Hamel
- Division of General Medicine and Primary Care, Department of Medicine Harvard Medical School, Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Mara A. Schonberg
- Division of General Medicine and Primary Care, Department of Medicine Harvard Medical School, Beth Israel Deaconess Medical Center Boston Massachusetts USA
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9
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Jindal SK, Aggarwal AN, Jindal A, Talwar D, Dhar R, Singh N, Singh V, Krishnaswamy UM, Chetambath R, Nath A, Bhattacharya P, Chaudhary D, Gupta PR, Gupta ML, Koul P, Swarankar R, Kant S, Ghoshal A. COPD exacerbation rates are higher in non-smoker patients in India. Int J Tuberc Lung Dis 2021; 24:1272-1278. [PMID: 33317671 DOI: 10.5588/ijtld.20.0253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is common among non-smokers exposed to solid fuel combustion at home. Different clinical characteristics in these patients may have significant therapeutic and prognostic implications.METHODS: We used medical record review and a questionnaire among COPD patients at 15 centres across India to capture data on demographic details, different types of exposures and clinical characteristics. Chest radiography and pulmonary function testing were performed in all 1984 cases; C-reactive protein and exhaled breath nitric oxide were measured wherever available.RESULTS: There were 1388 current or ex-smokers and 596 (30.0%) non-smokers who included 259 (43.5%) male and 337 (56.5%) female patients. Sputum production was significantly more common in smokers with COPD (P < 0.05). The frequency of acute symptomatic worsening, emergency visits and hospitalisation were significantly higher (P < 0.05) in non-smokers with COPD; however, intensive care unit admissions were similar in the two groups. There was no significant difference with respect to the use of bronchodilators, inhalational steroids or home nebulisation among smoker and non-smoker patients. The mean predicted forced expiratory volume in 1 sec in smokers (43.1%) was significantly lower than in non-smokers (46.5%).CONCLUSION: Non-smoker COPD, more commonly observed in women exposed to biomass fuels, was characterised by higher rate of exacerbations and higher healthcare resource utilisation.
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Affiliation(s)
| | - A N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh
| | | | - D Talwar
- Metro Centre for Respiratory Diseases, Metro Hospitals, Noida
| | | | | | | | | | | | - A Nath
- Pulmonary Medicine, Sanjay Gandhi Institute of Medical Sciences, Lucknow
| | | | - D Chaudhary
- Pt BDS Postgraduate Institute of Medical Sciences, Rohtak
| | - P R Gupta
- Department of Respiratory Medicine, NIMS University, Jaipur
| | - M L Gupta
- Santokba Dabhji Memorial Hospital, Jaipur
| | - P Koul
- Shere Kashmir Medical RI, Srinagar
| | - R Swarankar
- Getwell Hospital & Research Institute, Nagpur
| | - S Kant
- Department of Respiratory Medicine, King George Medical University, Lucknow
| | - A Ghoshal
- National Asthma & Allergy Centre, Kolkata, India
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10
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Jindal SK, Pandey KK, Bose PP. Dry powder inhalers: Particle size and patient-satisfaction. Indian J Respir Care 2021. [DOI: 10.4103/ijrc.ijrc_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Dhar R, Talwar D, Singh V, Dumra H, Rajan S, Jindal SK. Expert recommendations on the role of macrolides in chronic respiratory diseases. Lung India 2021; 38:174-182. [PMID: 33687013 PMCID: PMC8098884 DOI: 10.4103/lungindia.lungindia_498_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: India contributes to 32% of the total global disability-adjusted life years, due to chronic respiratory diseases. This has led to a high rate of health loss from these diseases. Antibiotics are commonly used in the management of respiratory disorders. With excellent tissue penetration, prolonged tissue persistence, and favorable side effect profile, macrolides are one of the best treatment options being recommended for respiratory, urogenital, dermal, and other bacterial infections. Still, there is a lack of clinical trial data on the use of macrolides in the management of respiratory chronic disease, and hence, there is a need for clinical guidance on their use in Indian setting. Methods: A systematic review of the literature was conducted on PubMed, Cochrane database, and Google Scholar. Existing guidelines, meta-analyses, systematic reviews, randomized controlled trials (RCTs), non-RCTs, landmark studies, and key-cited articles were selected. Recommendations were based on available evidence and expert panel's logical empiricism and consensus. Results and Discussion: This article discusses evidence-based and clinical practice based management of chronic respiratory conditions including chronic obstructive pulmonary disease, asthma, bronchiectasis, diffusive panbronchiolitis, and organizing pneumonia. The authors reviewed different respiratory conditions, role of macrolides in their management, adverse events and antimicrobial resistance associated with macrolides, evidence review of various clinical trials, guideline recommendations, and clinical recommendations.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, Fortis Hospital, Kolkata, West Bengal, India
| | - Deepak Talwar
- Respiratory Center, Pulmonology and Sleep Medicine, Metro Group of Hospitals, Noida, Uttar Pradesh, India
| | | | - Harjit Dumra
- "Sparsh" Chest Diseases Center, Ahmedabad, Gujarat, India
| | - Sujeet Rajan
- Respiratory Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - S K Jindal
- Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Meng F, Goldsammler M, Wantman E, Buyuk E, Jindal SK. Live birth rate from euploid blastocysts is not associated with infertility etiology or oocyte source following frozen-thawed embryo transfer (FET): analysis of 4148 cycles reported to SART CORS. J Assist Reprod Genet 2020; 38:185-192. [PMID: 33155088 DOI: 10.1007/s10815-020-01996-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate whether live birth rates from euploid blastocyst frozen-thawed embryo transfer (FET) cycles are associated with infertility diagnosis or oocyte source. DESIGN Retrospective analysis of FET cycles reported to SART CORS in 2014. METHODS Data from fresh IVF cycles with preimplantation genetic testing for aneuploidy (PGT-A), linked to the first FET cycles, were collected from the 2014 SART CORS database for autologous and donor oocyte cycles. Inclusion criteria were patients undergoing FET with euploid embryos (n = 4148). Demographic data including age, BMI, prior fertility, and etiology of infertility were collected from the retrieval cycle and analyzed. Patients with uterine anomalies, preimplantation genetic testing-mutation (PGT-M) for genetic diseases, gender selection, HLA determination, or systemic and immunologic disorders were excluded. The primary outcome measure was live birth (LB) rate. Potential confounders such as age, prior fertility, and maximum baseline FSH values were analyzed with regression models as indicated. RESULTS Though age, maximum baseline FSH, and infertility diagnosis were significantly different, LB was similar between patients undergoing autologous or donor oocyte FET cycles. Etiology of infertility was not significantly associated with LB in autologous cycles (p = 0.95). Potential confounders such as maternal age, prior fertility, and maximum baseline FSH were not associated with outcomes; however, maternal BMI was inversely related to LB in autologous cycles, with an odds ratio of 0.97 (95% CI: 0.96-0.98 (rho = - 0.08, p < 0.01)). CONCLUSIONS After controlling for confounding variables, a euploid embryo derived from a donor or autologous oocyte results in similar LB in women with different infertility diagnoses.
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Affiliation(s)
- F Meng
- OC Fertility Center, Newport Beach, CA, 92604, USA
| | - M Goldsammler
- Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
- Montefiore's Institute for Reproductive Medicine and Health, 141 S. Central Ave, Hartsdale, NY, 10530, USA.
| | - E Wantman
- Redshift Technologies, New York, NY, USA
| | - E Buyuk
- Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Reproductive Medicine Associates of New York, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S K Jindal
- Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore's Institute for Reproductive Medicine and Health, 141 S. Central Ave, Hartsdale, NY, 10530, USA
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13
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Jindal SK, Aggarwal AN, Christopher DJ, Dhar R, Jindal A. Face masks - a sustainable measure to mitigate COVID-19. Int J Tuberc Lung Dis 2020; 24:645-647. [PMID: 32552995 DOI: 10.5588/ijtld.20.0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S K Jindal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - R Dhar
- Department of Pulmonology, Fortis Hospital, Kolkata, India
| | - A Jindal
- Jindal Clinics, Chandigarh, India, ,
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14
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Shankar PS, Korukonda K, Bendre S, Behera D, Mirchandani L, Awad NT, Prasad R, Bhargava S, Sharma OP, Jindal SK. Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper. Respir Med 2020; 168:105949. [PMID: 32469706 DOI: 10.1016/j.rmed.2020.105949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations. OBJECTIVE The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India. METHODS In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India. RESULTS Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents. CONCLUSION The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings.
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Affiliation(s)
- P S Shankar
- Emeritus Professor of Medicine, & Senior CEO, KBN Institute of Medical Sciences, Kalaburagi, Karnataka, India
| | | | - S Bendre
- Respiratory Medicine, Nanavati Hospital, Mumbai, India
| | - D Behera
- Respiratory Medicine, PGIMER, Chandigarh, India
| | - L Mirchandani
- Respiratory Medicine, KJ Somaiya Medical College, Mumbai, India
| | - N T Awad
- Respiratory Medicine, LT M Medical College, Mumbai, India
| | - R Prasad
- Director Medical Education & Head Pulm Med, Era's Lucknow Medical College & Hospital, Lucknow, UP, India
| | - S Bhargava
- Respiratory Medicine, Mahatma Gandhi Medical College, Indore, MP, India
| | - O P Sharma
- National Professor of Geriatrics, Secretary: Geriatric Society of India, Delhi, India
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15
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Mohan A, Madan K, Hadda V, Tiwari P, Mittal S, Guleria R, Khilnani GC, Luhadia SK, Solanki RN, Gupta KB, Swarnakar R, Gaur SN, Singhal P, Ayub II, Bansal S, Bista PR, Biswal SK, Dhungana A, Doddamani S, Dubey D, Garg A, Hussain T, Iyer H, Kavitha V, Kalai U, Kumar R, Mehta S, Nongpiur VN, Loganathan N, Sryma PB, Pangeni RP, Shrestha P, Singh J, Suri T, Agarwal S, Agarwal R, Aggarwal AN, Agrawal G, Arora SS, Thangakunam B, Behera D, Jayachandra, Chaudhry D, Chawla R, Chawla R, Chhajed P, Christopher DJ, Daga MK, Das RK, D'Souza G, Dhar R, Dhooria S, Ghoshal AG, Goel M, Gopal B, Goyal R, Gupta N, Jain NK, Jain N, Jindal A, Jindal SK, Kant S, Katiyar S, Katiyar SK, Koul PA, Kumar J, Kumar R, Lall A, Mehta R, Nath A, Pattabhiraman VR, Patel D, Prasad R, Samaria JK, Sehgal IS, Shah S, Sindhwani G, Singh S, Singh V, Singla R, Suri JC, Talwar D, Jayalakshmi TK, Rajagopal TP. Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations. Lung India 2019; 36:S37-S89. [PMID: 32445309 PMCID: PMC6681731 DOI: 10.4103/lungindia.lungindia_108_19] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - GC Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SK Luhadia
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - RN Solanki
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - KB Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Swarnakar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SN Gaur
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pratibha Singhal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irfan Ismail Ayub
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Bansal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashu Ram Bista
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shiba Kalyan Biswal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashesh Dhungana
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Doddamani
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dilip Dubey
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avneet Garg
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tajamul Hussain
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatnarayan Kavitha
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Umasankar Kalai
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swapnil Mehta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Noel Nongpiur
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - N Loganathan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - PB Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Prasad Pangeni
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prajowl Shrestha
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jugendra Singh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejas Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandip Agarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritesh Agarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gyanendra Agrawal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Suninder Singh Arora
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Balamugesh Thangakunam
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - D Behera
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jayachandra
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhry
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Chawla
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Chawla
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Chhajed
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Devasahayam J Christopher
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - MK Daga
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjan K Das
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - George D'Souza
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Dhar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sahajal Dhooria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aloke G Ghoshal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Goel
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bharat Gopal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Goyal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - NK Jain
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Jindal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SK Jindal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surya Kant
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Katiyar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SK Katiyar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parvaiz A Koul
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jaya Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Lall
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mehta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Nath
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - VR Pattabhiraman
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dharmesh Patel
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Prasad
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - JK Samaria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shirish Shah
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Sindhwani
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetu Singh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Virendra Singh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rupak Singla
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - JC Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Talwar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - TK Jayalakshmi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - TP Rajagopal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V, Singh N, Behera D, Jindal SK, Singh V, Chawla R, Samaria JK, Gaur SN, Agrawal A, Chhabra SK, Chopra V, Christopher DJ, Dhar R, Ghoshal AG, Guleria R, Handa A, Jain NK, Janmeja AK, Kant S, Khilnani GC, Kumar R, Mehta R, Mishra N, Mohan A, Mohapatra PR, Patel D, Ram B, Sharma SK, Singla R, Suri JC, Swarnakar R, Talwar D, Narasimhan RL, Maji S, Bandopadhyay A, Basumatary N, Mukherjee A, Baldi M, Baikunje N, Kalpakam H, Upadhya P, Kodati R. Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry. Lung India 2019; 36:S1-S35. [PMID: 31006703 PMCID: PMC6489506 DOI: 10.4103/lungindia.lungindia_300_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K T Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Chawla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S N Gaur
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anurag Agrawal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Chhabra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Chopra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Dhar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aloke G Ghoshal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Handa
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirmal K Jain
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K Janmeja
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surya Kant
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G C Khilnani
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravindra Mehta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anant Mohan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P R Mohapatra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmesh Patel
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu Ram
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Sharma
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupak Singla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J C Suri
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Swarnakar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Talwar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Lakshmi Narasimhan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Maji
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankan Bandopadhyay
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nita Basumatary
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arindam Mukherjee
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Milind Baldi
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandkishore Baikunje
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hariprasad Kalpakam
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratap Upadhya
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kodati
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Guleria R, Dhar R, Mahashur A, Ghoshal AG, Jindal SK, Talwar D, Prabhudesai P, Abhayankar N, Paramesh H, Balamurugan S. Indian Consensus on Diagnosis of Cough at Primary Care Setting. J Assoc Physicians India 2019; 67:92-98. [PMID: 30935190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi
| | - Raja Dhar
- Director and Consultant Pulmonologist, Fortis Hospital Anandapur, Kolkata, West Bengal
| | - Ashok Mahashur
- Consultant Pulmonologist, Hinduja Hospital, Mumbai, Maharashtra
| | - A G Ghoshal
- Medical Director, National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal
| | - S K Jindal
- Consultant Pulmonologist, Jindal Chest Clinic, Chandigarh
| | - Deepak Talwar
- Director and Chair, Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh
| | | | - Nitin Abhayankar
- Consultant Chest Physician, Poona Hospital and Research Centre, Pune, Maharashtra
| | - H Paramesh
- Chairman, Pediatric Pulmonologist, Lakeside Center for Health Promotion and Lakeside Education Trust, Bangalore, Karnataka
| | - S Balamurugan
- Consultant Chest Physician, Rakshit Hospital, Chennai, Tamil Nadu
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Baughman AW, Cain G, Ruopp MD, Concepcion C, Oliveira C, O'Toole R, Saunders S, Jindal SK, Ferreira M, Simon SR. Improving Access to Care by Admission Process Redesign in a Veterans Affairs Skilled Nursing Facility. Jt Comm J Qual Patient Saf 2018; 44:454-462. [PMID: 30071965 DOI: 10.1016/j.jcjq.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inefficient and inadequate nursing home screening processes can delay care transitions from hospitals to post-acute care facilities and result in inappropriate and delayed transfers. The increased volume of admission requests and need for efficient and effective transfers between care settings converged to make the Community Living Center (CLC; skilled nursing facility in the Department of Veterans Affairs) admission screening process an organizational priority for improvement. A quality improvement (QI) project was conducted to develop a new process for a 112-bed CLC and improve efficiency and access to care. METHODS The Model for Improvement was used to complete a 13-month continuous QI project. The multidisciplinary QI Workgroup developed aims and measures, analyzed work flow processes, and identified problem areas. Interventions were rapidly tested using Plan-Do-Study-Act cycles. Successful interventions were sustained by developing standard operating procedures and local policy. RESULTS Several interventions were implemented that focused on standardization, automation, and streamlining. The final result was a new hybrid model that included an Admissions Team consisting of a unit nurse manager, a social worker, and administrative staff. The time from bed request to patient transfer improved from a median of 3.3 days in the baseline period to 2.3 days in the final month of the project. CONCLUSION A highly structured and team-based QI approach enabled rapid redesign of an admission screening process that improved efficiency and decreased the time from request to admission. This redesign strategy provides instruction for other facilities interested in improving screening processes and access to care.
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Saraswat S, Rout PK, Kharche SD, Jindal SK, Goel AK. Molecular expression of caprine estrogen receptor gene 1 in reproductive and non-reproductive tissues. Reprod Domest Anim 2016; 51:1049-1054. [DOI: 10.1111/rda.12774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S Saraswat
- ICAR-Central Institute for Research on goats; Mathura India
| | - PK Rout
- ICAR-Central Institute for Research on goats; Mathura India
| | - SD Kharche
- ICAR-Central Institute for Research on goats; Mathura India
| | - SK Jindal
- ICAR-Central Institute for Research on goats; Mathura India
| | - AK Goel
- ICAR-Central Institute for Research on goats; Mathura India
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Kumar N, Rai B, Bhat SA, Kharche SD, Gangwar C, Jindal SK, Chandra S. Effect of management system and season on semen freezability in Jakhrana bucks. Vet World 2016; 9:199-202. [PMID: 27051208 PMCID: PMC4819372 DOI: 10.14202/vetworld.2015.199-202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/30/2015] [Accepted: 01/12/2016] [Indexed: 11/16/2022] Open
Abstract
AIM The objective of the study was to determine the effect of the management system (intensive and semi-intensive) and season (autumn and winter) on semen freezability in Jakhrana bucks. MATERIALS AND METHODS A total of 24 Jakhrana bucks of same body weight and age (BW=30 kg, age=1 year) were randomly allotted into two groups, viz., Group I (intensive system, 12 bucks) and Group II (semi-intensive system, 12 bucks). These two groups were statistically tested for their homogeneity with respect to age and BW. Semen was collected twice weekly using an artificial vagina during two seasons: autumn (September-November) and winter (December-February). A total of 240 semen samples (120 from each group and season) were evaluated for post-thaw motility (PTM), viability, abnormality, functional membrane integrity (hypo-osmotic swelling [HOS]) response and acrosomal integrity. RESULTS The mean values of PTM and acrosomal integrity of spermatozoa were significantly (p<0.01) higher in Group II as compared to Group I. The mean values of viability and abnormality were also differed significant (p<0.05) between groups. However, the mean values of HOS response were found non-significant (p>0.05) between groups. The season showed a significant effect on all parameters except viability and HOS response. The PTM and acrosomal integrity of spermatozoa were significantly (p<0.01) higher in winter as compared to autumn season. Abnormality of spermatozoa was significantly (p<0.05) lower in winter season. CONCLUSIONS This study indicates that both management system and season influence semen freezability. The semen collected from bucks reared under the semi-intensive system and winter season showed better semen freezability characteristics.
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Affiliation(s)
- Narendra Kumar
- Department of Livestock Production and Management, ICAR - National Dairy Research Institute, Karnal - 132 001, Haryana, India
| | - B Rai
- Department of Physiology Reproduction and Shelter Management, ICAR- Central Institute for Research on Goats, Mathura - 281 001, Uttar Pradesh, India
| | - Showkat A Bhat
- Department of Livestock Production and Management, ICAR - National Dairy Research Institute, Karnal - 132 001, Haryana, India
| | - S D Kharche
- Department of Physiology Reproduction and Shelter Management, ICAR- Central Institute for Research on Goats, Mathura - 281 001, Uttar Pradesh, India
| | - Chetna Gangwar
- Department of Physiology Reproduction and Shelter Management, ICAR- Central Institute for Research on Goats, Mathura - 281 001, Uttar Pradesh, India
| | - S K Jindal
- Department of Physiology Reproduction and Shelter Management, ICAR- Central Institute for Research on Goats, Mathura - 281 001, Uttar Pradesh, India
| | - Subhash Chandra
- Department of Livestock Production and Management, ICAR - National Dairy Research Institute, Karnal - 132 001, Haryana, India
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Jindal SK. Air Pollution and Asthma: Is There a Doubt? Indian J Chest Dis Allied Sci 2016; 58:85-87. [PMID: 30168302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Pancholy A, Jindal SK, Singh SK, Pathak R. Association of growth related seedling traits in Acacia senegal under arid environment of western Rajasthan. J Environ Biol 2015; 36:941-946. [PMID: 26364473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Climatic models and predictions indicate increase in aridity world over due to global warming. Arid environments occupy about one third land area of the world. A. senegal is the most important dryland resource of western Rajasthan desert ecosystem. The seeds of 13 low and high seed yielding exotic and indigenous provenances were evaluated for diversity and interrelationship among growth related seedling traits targeting establishment and end use of this species. Under the present study most of the growth related seedling traits varied within and amongst provenances. Highly significant correlation of dry biomass per plant of more than 72% with root length (73.3%), collar diameter (72.2%), shoot dryweight (99.7%), root dry weight (95.7%) and seedling length (79.9%) under the present study may be used for early selection. Similarly, highly significant positive correlation of seedling length with seven out of 12 growth related seedling traits validate strong inherent association of these traits under strong genetic control and are amenable for selection. Significant negative correlation in number of nodules per plant with root/shoot length ratio (-57.6%) and no correlation with 10 out of 12 growth related seedling traits tested advocate emphasis on other growth related seedling traits in selection of elite A. senegal genotypes for afforestation. The non significant associations suggest that per cent germination was independent of other characters and could be selected separately.
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Jindal SK. Professor Dheeraj Gupta. Indian J Chest Dis Allied Sci 2015; 57:66. [PMID: 26410987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Sinha S, Singh J, Jindal SK, Birbian N, Singla N. Role of TLR4 C>1196T (Thr399Ile) and TLR4 A>896G (Asp299Gly) polymorphisms in a North Indian population with asthma: a case-control study. Int J Immunogenet 2014; 41:463-71. [PMID: 25331070 DOI: 10.1111/iji.12115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/25/2014] [Accepted: 02/09/2014] [Indexed: 02/06/2023]
Abstract
Toll-like receptor 4 (TLR4) is the most important TLR among the pattern recognition receptors which recognizes lipopolysaccharide of gram-negative bacteria. They identify a highly conserved structure of microbes called pathogen-associated molecular patterns and activate immune and inflammatory responses that have been shown to be involved in the pathogenesis of asthma. The role of TLR4 gene polymorphisms in asthma was detected in a total of 964 individuals, including 483 healthy controls and 481 asthma patients from a North Indian population. The genotyping was carried out using polymerase chain reaction-restriction fragment length polymorphism method. Statistical analysis revealed that the heterozygous genotype as well as the mutant (T) allele of the TLR4 C>1196T (Thr399Ile) polymorphism shows resistance towards asthma with OR = 0.70, 95% CI (0.49-0.99), P corrected value = 0.046 and OR = 0.72, 95% CI (0.52-0.98), P corrected value = 0.039, respectively. However, no association was found between the TLR4 A>896G (Asp299Gly) polymorphism and asthma patients (P > 0.05). This is the first study conducted in India conferring TLR4 (Thr399Ile) polymorphism resistance towards asthma, while lack of association was found between TLR4 (Asp299Gly) polymorphism and asthma in the studied North Indian population.
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Affiliation(s)
- S Sinha
- Department of Biotechnology, Panjab University, Chandigarh, India
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Singh SK, Pancholy A, Jindal SK, Pathak R. Effect of co-inoculations of native PGPR with nitrogen fixing bacteria on seedling traits in Prosopis cineraria. J Environ Biol 2014; 35:929-934. [PMID: 25204069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Prosopis cineraria significantly contribute to sand dune stabilization, soil fertility rejuvenation and is an integral component of agro-forestry systems in arid regions of India. Effect of different rhizobacterial seed treatments on seed germination and seedling traits in two genotypes of P. cineraria (HPY-1) and (FG-1) were tested. Observations on seed germination (%) and seedling traits viz., root length (cm), shoot length (cm), seedling weight (g) and seedling length of different treatments were recorded. Whereas, germination index (GI), seedling vigour index (SVI) and root/shoot length ratio were derived from the observed data. The scarification treatment with sulphuric acid for 10 minutes substantially enhanced germination from < 20% to 80-82% in control treatments. Treatments with co-inoculations of Bacillus licheniformis and Sinorhizobium kostiense or S. saheli supported the maximum seed germination and seedling growth and vigour. The maximum germination per cent (92.5%), seedling length (10.94 cm), seedling vigour index (10.12) and germination index (7.97) were recorded with treatment (V2T6) wherein seeds of high pod yielding genotype were co-inoculated with Bacillus licheniformis and S. kostiense. The higher positive correlations of seedling length v/s shoot length followed by SVI v/s seedling length, SVI v/s root length and seedling length v/s root length is a fair indicative of inter dependency of these characteristics. Higher R2 values of root length v/s shoot length followed by that of SVI v/s GI indicates that a regression line fits the data well and future outcomes of observed seedling traits are likely to be predicted by the model.
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Affiliation(s)
- Elise M Chambers
- Chief Resident, Internal Medicine, University of Cincinnati Academic Medicine Center
| | - Shivani K Jindal
- Chief Resident of Quality and Safety, Cincinnati VA Medical Center
| | - Renee Hebbeler-Clark
- Assistant Professor of Medicine, University of Cincinnati Academic Medicine Center
| | - Eric J Warm
- Program Director, Categorical Internal Medicine, University of Cincinnati Academic Medicine Center
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Jindal SK. Effects of smoking on asthma. J Assoc Physicians India 2014; 62:32-37. [PMID: 25327058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tobacco smoking has several adverse associations with asthma.The odds ratios for prevalence of asthma are high for both active smoking and ETS exposures. In-utero exposure of foetus from maternal smoking, as well as its tertiary exposure from maternal passive-smoking are also known to be responsible for development of asthma in childhood. Smoking adversely affects the health and treatment-outcomes of asthma. There are increased requirements of drugs for smoker and ETS exposed asthmatics. Smoking is also an important factor in the development of airway remodelling, fixed airway obstruction and an exaggerated lung function decline.
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Aggarwal AN, Gupta D, Janmeja AK, Jindal SK. Assessment of health-related quality of life in patients with pulmonary tuberculosis under programme conditions. Int J Tuberc Lung Dis 2014; 17:947-53. [PMID: 23743314 DOI: 10.5588/ijtld.12.0299] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Newly diagnosed pulmonary tuberculosis (PTB) patients starting treatment under the Revised National Tuberculosis Control Programme (RNTCP) in a North Indian city. OBJECTIVE To quantify impairment in health-related quality of life (HRQoL) of PTB patients at the time of diagnosis and during treatment, and to assess the utility of these assessments as a measure of outcome under programme conditions. DESIGN HRQoL was assessed using the Hindi version of the 26-item World Health Organization Quality of Life (WHOQOL-BREF) scale at the start and end of the intensive phase and at completion of treatment. Four domain scores-physical, psychological, social relationships and environment-were calculated and compared between groups, based on different patient and disease characteristics. Psychometric evaluation was conducted by assessing acceptability, validity and responsiveness of the questionnaire. RESULTS A total of 2654 HRQoL assessments were performed among 1034 patients. Domain scores were generally better among men, urban residents, younger patients, patients with higher socio-economic status and those with less severe disease. The WHOQOL-BREF demonstrated good psychometric properties, and domain scores improved with treatment. Residual HRQoL impairment was noted in some patients even at treatment completion. CONCLUSION HRQoL is impaired in patients with PTB, and improves rapidly and significantly with programme-based treatment. HRQoL assessment can be used as an adjunct outcome measure for patients treated by the RNTCP.
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Affiliation(s)
- A N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, Sehgal IS, Yenge LB, Jindal A, Singh N, Ghoshal AG, Khilnani GC, Samaria JK, Gaur SN, Behera D, Jindal SK. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: joint recommendations of Indian Chest Society and National College of Chest Physicians (India). Indian J Chest Dis Allied Sci 2014; 56 Spec No:5-54. [PMID: 24974625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society and the National College of Chest Physicians (India) have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analysed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definition, epidemiology and disease burden, (b) disease assessment and diagnosis, (c) pharmacologic management of stable COPD, (d) management of acute exacerbations; and (e) non-pharmacologic and preventive measures.
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Abstract
Use of the Flexi-Seal fecal management system, a safe and effective means of fecal diversion in patients with fecal incontinence and diarrhea, can be associated with rare, life-threatening complications. For example, a critically ill patient had 2 episodes of massive rectal bleeding associated with use of the system that required transfusion of blood products. Hemorrhage was controlled during the first episode by angiography with selective coil embolization; the second required colonoscopy with suture ligation of the affected lesion. A literature review revealed 9 other cases that were managed endoscopically, surgically, or with angiography. Although none of the patients died, they experienced obvious complications that required transfusion of blood products, endoscopy, surgery, use of conscious sedation or general anesthesia, angiography, and exposure to intravenous contrast material. Patients receiving therapeutic doses of anticoagulation and antiplatelet drugs, which may precipitate or aggravate hemorrhaging, are particularly at risk for complications with the Flexi-Seal system.
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Affiliation(s)
- Aaron M. Mulhall
- Aaron M. Mulhall is a pulmonary/critical care fellow and Shivani K. Jindal is a chief resident in quality and patient safety initiative, Department of Internal Medicine, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Shivani K. Jindal
- Aaron M. Mulhall is a pulmonary/critical care fellow and Shivani K. Jindal is a chief resident in quality and patient safety initiative, Department of Internal Medicine, University of Cincinnati Academic Health Center, Cincinnati, Ohio
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Jindal SK. Challenges of training in pulmonary medicine in India. Indian J Chest Dis Allied Sci 2013; 55:73-74. [PMID: 24046995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Jindal SK, Aggarwal AN, Gupta D, Ahmed Z, Gupta KB, Janmeja AK, Kashyap S, Singh M, Mohan A, Whig J. Tuberculous lymphadenopathy: a multicentre operational study of 6-month thrice weekly directly observed treatment. Int J Tuberc Lung Dis 2013; 17:234-9. [PMID: 23317960 DOI: 10.5588/ijtld.12.0333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Eight operational locations for the Revised National Tuberculosis Control Programme in six Indian states. OBJECTIVE To assess the 6-month efficacy of an intermittent thrice-weekly directly observed treatment (DOT) regimen for tuberculous peripheral adenopathy and the need for prolongation of treatment to 9 months for non-resolution of lymphadenopathy. DESIGN Patients aged >5 years with tuberculous lymphadenopathy were included in the study. Patients were evaluated for resolution at repeat visits following treatment. Those with poor resolution at 6 months were randomised to extended treatment up to 9 months or observation without additional treatment. RESULTS Resolution of lymphadenopathy was observed at the end of 6 months in 517/551 (93.8%) patients. There was a significant difference in response among patients with and those without the presence of systemic symptoms. There was no association between treatment response and number, size, site, consistency and matting of lymphadenopathy. No differences in response were seen in the remaining 34 patients with or without extended treatment. CONCLUSION The operational efficacy of 6-month thrice-weekly DOT for peripheral tubercular lymphadenopathy was satisfactory. There was no evidence of additional benefits of prolonging treatment to 9 months.
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Affiliation(s)
- S K Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, Chaudhry K, Shah B. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis 2012; 16:1270-7. [PMID: 22871327 DOI: 10.5588/ijtld.12.0005] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Field sites in 12 districts in different parts of India. OBJECTIVE To determine the nationwide population prevalence of and risk factors for asthma and chronic bronchitis (CB) in adults. DESIGN A standardised validated questionnaire based on the International Union Against Tuberculosis and Lung Disease's 1984 questionnaire was used to assess asthma and CB prevalence. Multivariate logistic regression analyses were performed to determine the risk factor associations. Estimates standardised to the 2011 population projection estimates for India were used to calculate the national disease burden. RESULTS A total of 85,105 men and 84,470 women from 12 urban and 11 rural sites were interviewed. One or more respiratory symptoms were present in 8.5% of individuals. The overall prevalence of asthma and CB was respectively 2.05% (adults aged ≥15 years) and 3.49% (adults aged ≥35 years). Advancing age, smoking, household environmental tobacco smoke exposure, asthma in a first-degree relative, and use of unclean cooking fuels were associated with increased odds of asthma and CB. The national burden of asthma and CB was estimated at respectively 17.23 and 14.84 million. CONCLUSION Asthma and CB in adults pose an enormous health care burden in India. Most of the associated risk factors are preventable.
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Affiliation(s)
- S K Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Sharma SK, Sethi S, Mewara A, Meharwal S, Jindal SK, Sharma M, Tewari R, Katoch VM. Genetic polymorphisms among Mycobacterium tuberculosis isolates from patients with pulmonary tuberculosis in northern India. Southeast Asian J Trop Med Public Health 2012; 43:1161-1168. [PMID: 23431822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Restriction fragment length polymorphism (RFLP) based on IS6110 is considered the gold standard for Mycobacterium tuberculosis molecular typing. It is useful to discriminate among M. tuberculosis strains, investigate outbreaks and distinguish between reactivation and re-infection. We studied polymorphisms among M. tuberculosis isolates from northern India using RFLP to determine the presence of a correlation between IS6110 based fingerprints and drug resistance and to look for relapse and transmission among patients and their contacts. RFLP patterns of PvuII digested genomic DNA of 100 M. tuberculosis isolates were analyzed using southern blotting with a 245 bp IS6110 probe. Drug sensitivity testing (DST) was conducted for rifampicin (40 microg/ml), isoniazid (1 microg/ml), ethambutol (2 microg/ml) and streptomycin (4 microg/ml) using the proportion method. A high degree of polymorphism was seen among the M. tuberculosis isolates and the number of IS6110 copies varied from 0 to 14, with a predominance of isolates with 11 bands. Seventy-five isolates had a high number of bands, 9 had an intermediate number, 6 isolates had a low number and 10 isolates had no bands. No correlation between IS6110 band numbers and RFLP banding patterns was found with drug resistance or for any particular geographical area, although clustering was seen amongst MDR-TB cases. No cases of relapses or transmissions were seen.
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Affiliation(s)
- Shiv Kumar Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jindal SK. Research in clinical sciences. Indian J Chest Dis Allied Sci 2012; 54:175-182. [PMID: 23008925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The scope and spectrum of medical research, including that in clinical sciences has tremendously expanded. It now extends from simple clinical observations to gathering of epidemiological data to the study of molecular mechanisms of diseases to evaluation of effects of therapeutic interventions. It is more meaningful to engage in multi-disciplinary and collaborative arrangements for the better achievements in health research. Translational approach involves the direct application of results of laboratory experiments to clinical use for benefit of patients. Besides clinical and experimental research, it is equally important to strengthen operational research for efficient implementation of health programmes and policies in the hospitals as well as in the community. There are several difficulties and constraints related to ethical principles, patient's safety, confidentiality and costs. It is critically important to adhere to ethical principles and guidelines to maintain the moral and social perspectives. It is equally important to follow the scientific research methodology for the maximum gains from research experiments and projects. Interpretation of results of clinical experiments are hardly ever unequivocal, hence, there is a need for repetitive studies, systematic reviews and meta-analyses to reach definitive conclusions. It is important for busy physicians to adopt a scientific temper of logic and engage themselves in searching for answers to different research questions. It is always gainful to spare some time and resources for research out of a busy clinical practice. It is also worthwhile to go through a formal training programme in research methodology to improve capacity and competence to conduct meaningful research.
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Affiliation(s)
- S K Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Jindal SK. COPD: the unrecognized epidemic in India. J Assoc Physicians India 2012; 60 Suppl:14-16. [PMID: 23155807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- S K Jindal
- Department of Pulmonary Medicine, WHO Collaborating Centre for Research and Capacity Building in Chronic Respiratory Diseases, Postgraduate Institute of Medical Education and Research, Chandigarh
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Jindal SK, Shankar PS, Vijayan VK, Kamat SR, Deivanayagan CN. Down the memory lane: Lung India three decades. Lung India 2012; 29:205-11. [PMID: 22919156 PMCID: PMC3424856 DOI: 10.4103/0970-2113.99099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mootha VK, Agarwal R, Singh N, Aggarwal AN, Gupta D, Jindal SK. Medical thoracoscopy for undiagnosed pleural effusions: experience from a tertiary care hospital in north India. Indian J Chest Dis Allied Sci 2011; 53:21-24. [PMID: 21446220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS Medical thoracoscopy, also called pleuroscopy, has received renewed interest in the recent past for diagnostic as well as therapeutic uses. In this study, we describe our experience with thoracoscopy for undiagnosed pleural effusions. METHODS In a retrospective analysis of thoracoscopic procedures we performed between January 2007 and December 2008, yield of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed pleural effusions, defined as pleural effusions with adenosine deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy on three occasions was evaluated. Complications of thoracoscopy were also analysed. RESULTS Overall diagnostic yield of thoracoscopic pleural biopsy was 74.3% in patients with undiagnosed pleural effusions. Pleural malignancy was diagnosed in 48.6% of patients. There was only one case of mesothelioma and the rest were due to pleural metastasis. Lung cancer and breast cancer were the most common sites of primary malignancy. Tuberculosis was diagnosed with pleural biopsy in 22.8% of patients. We had low complication rate after thoracoscopy. Only two cases of empyema were observed. CONCLUSION Medical thoracoscopy is a safe procedure and has good diagnostic yield in patients with undiagnosed pleural effusions.
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Affiliation(s)
- V K Mootha
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta D, Singh AD, Agarwal R, Aggarwal AN, Joshi K, Jindal SK. Is tobacco smoking protective for sarcoidosis? A case-control study from North India. Sarcoidosis Vasc Diffuse Lung Dis 2010; 27:19-26. [PMID: 21086901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND While tobacco smoking is commonly believed to be negatively associated with the occurrence of sarcoidosis, the relationship of environmental tobacco smoke (ETS) exposure with sarcoidosis is largely un-explored. We studied the impact of active smoking and ETS exposure on disease severity in newly diagnosed cases of sarcoidosis from India. METHODS Data on demographic variables, smoking habits and exposure to environmental tobacco smoke (ETS) among non-smoker sarcoidosis patients was collected prospectively. Presence of smoking and ETS exposure were compared among cases and controls. Among the sarcoidosis patients, clinical manifestations, radiology, spirometry and histopathological grading of lung biopsy were compared between the smokers vs. non-smokers and ETS exposed vs. not-exposed. RESULTS We studied 98 newly diagnosed cases of sarcoidosis and 196 age, sex and religion- matched healthy volunteers. The study group comprised of 62 (63%) men and 36 (37%) women. The prevalence of smoking was similar in cases and controls (12.2% vs. 15.3%, p = 0.48). Among the never smoker patients with sarcoidosis, 20 (23%) reported ETS exposure vis-a-vis 57 (34%) in the matched controls. A conditional logistic regression analyses showed insignificant negative association with active smoking (OR 0.75; 95% CI, 0.35-1.56) or ETS exposure (OR 0.58; 95% CI, 0.32-1.06) after adjusting for age, gender, religion, and education. There were no differences in the clinical manifestations, radiological staging, spirometry and histopathological grading of lung biopsy in any of the group comparisons studied. CONCLUSION Smoking or ETS exposure may not have significant negative association with sarcoidosis. Also, tobacco smoke might not have any effect on the clinical behavior or disease severity in sarcoidosis. The belief that smoking is protective for sarcoidosis is not substantiated in this study and appears to be misfounded.
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Affiliation(s)
- D Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Sodhi KS, Gulati M, Aggarwal R, Kalra N, Mittal BR, Jindal SK, Khandelwal N. Computed tomographic pulmonary angiography: utility in acute pulmonary embolism in providing additional information and making alternative clinical diagnosis. Indian J Med Sci 2010; 64:26-32. [PMID: 22301806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the role of computed tomographic (CT) pulmonary angiography (CT-PA) in detecting additional information that may help in making an alternative clinical diagnosis in patients referred to CT for a suspected acute pulmonary embolism (PE). MATERIALS AND METHODS 50 patients (34 males, 16 females) in the age group of 18-72 years (mean 42.3 years), having high clinical suspicion of PE, underwent CTPA over a 2 year period. Chest x-ray, arterial blood gas (ABG) analysis, echocardiography were done in all patients. All patients underwent at least one other imaging examination besides CTPA: ventilation perfusion scan, Doppler ultrasound or compression ultrasound (for DVT). All patients were followed for 3 months after completion of the diagnostic work up at baseline. The final diagnosis was achieved by a combination of clinical, imaging, and laboratory analysis, after adequate imaging, laboratory tests, and follow up. RESULT CTPA helped correctly identify 29 of 30 patients with PE. In the remaining 20 patients (with no evidence of PE), CT-PA provided additional information (that suggested or confirmed alternate clinical diagnosis) in 15 patients (75%): pleural effusion (n=8), mediastinal or hilar lymphadenopathy (6), pneumonia/airspace consolidation (5), atelectasis/collapse (2), aspergilloma (1), malignancy (1), and others (2). CONCLUSION CT-PA is highly specific and sensitive for diagnosis of PE. In addition, in a majority of patients who do not have PE, it also provides important ancillary additional information and helps in making an alternative clinical diagnosis.
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Sodhi K, Aggarwal R, Mittal BR, Khandelwal N, Gulati M, Kalra N, Jindal SK. Computed tomographic pulmonary angiography: Utility in acute pulmonary embolism in providing additional information and making alternative clinical diagnosis. ACTA ACUST UNITED AC 2010. [DOI: 10.4103/0019-5359.92484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sodhi KS, Virmani V, Jindal SK, Khandelwal N. Pulmonary Hamartoma. Ann Acad Med Singap 2009. [DOI: 10.47102/annals-acadmedsg.v38n12p1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Virmani
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sodhi KS, Virmani V, Jindal SK, Khandelwal N. Pulmonary hamartoma. Ann Acad Med Singap 2009; 38:1110. [PMID: 20052452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Bal A, Mishra B, Singh N, Das A, Jindal SK. Fulminant parvovirus B19-associated pancarditis with haemophagocytic lympho-histiocytosis in an immunocompetent adult. APMIS 2009; 117:773-7. [PMID: 19775347 DOI: 10.1111/j.1600-0463.2009.02528.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myocarditis is a common cardiac disease that is identified on routine postmortem examinations. Initially, coxsackie viruses, other enteroviruses and adenoviruses were thought to be more common causes of myocarditis; however, recently, parvovirus B19 (PVB19) as well as human herpesvirus 6 (HHV6) have entered the arena. We describe autopsy findings of a patient who had a lethal myocarditis with haemophagocytic lympho-histiocytosis in a course of systemic PVB19 infection. The present case illustrates the unusually severe and rapid course of PVB19 myocarditis with associated haemophagocytic lympho-histiocytosis leading to death.
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Affiliation(s)
- Amanjit Bal
- Departments of Histopathology, Virology and Pulmonary Medicine, PGIMER, Chandigarh, India.
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Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis. Int J Tuberc Lung Dis 2009; 13:936-944. [PMID: 19723372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The prevalence of Aspergillus hypersensitivity (AH) and allergic bronchopulmonary aspergillosis (ABPA) in bronchial asthma is reported differently in various studies. OBJECTIVE To determine the prevalence of AH and ABPA in asthma using a systematic review. METHODS We searched the MEDLINE and EMBASE databases for studies published from 1965 to 2008 and included studies that report the prevalence of AH/ABPA in asthma. We calculated the proportions with 95% confidence interval (CI) to assess the prevalence of AH/ABPA in the individual studies and pooled the results using a random effects model. RESULTS Our search yielded 21 eligible studies. The prevalence of AH in bronchial asthma was 28% (95%CI 24-34), and was higher with an intradermal test vs. a prick test (28.7% vs. 24.8%, P = 0.002), but did not vary with the type of antigen used (indigenous or commercial). The prevalence of ABPA in bronchial asthma and Aspergillus-hypersensitive bronchial asthma was respectively 12.9% (95%CI 7.9-18.9) and 40% (95%CI 27-53). There was a wide variation in the criteria used for the diagnosis of ABPA. There was significant statistical heterogeneity assessed by the I(2) test and Cochran Q statistic in all the outcomes. CONCLUSIONS There is a high prevalence of AH and ABPA in patients with bronchial asthma. Careful screening should therefore be performed in all patients with bronchial asthma. Intradermal tests are more sensitive than prick tests for the diagnosis of AH. Finally, there is a need to adopt a uniform methodology and criteria for the diagnosis of AH/ABPA.
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Affiliation(s)
- R Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Jindal SK. World′s super scientists. Lung India 2009. [DOI: 10.4103/0970-2113.45203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jindal SK. From the Editor′s desk. Lung India 2009; 26:99. [PMID: 20531987 PMCID: PMC2876710 DOI: 10.4103/0970-2113.56339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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