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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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Prabha A, Lokesh KS, Chaya SK, Jayaraj BS, Malamardi S, Subbarao MVSST, Beck SC, Krishna MT, Mahesh PA. Pilot study investigating diagnostic utility of serum MMP-1 and TGF-β1 in asthma in 'real world' clinical practice in India. J Clin Pathol 2021; 75:222-225. [PMID: 33597224 DOI: 10.1136/jclinpath-2020-206821] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/18/2020] [Accepted: 01/03/2021] [Indexed: 11/03/2022]
Abstract
AIMS At a tissue level, matrix metalloproteinase-1 (MMP-1) and transforming growth factor-beta 1 (TGF-β1) contribute to allergic airway inflammation, tissue remodelling and disease severity in asthma via different pathways. Their peripheral blood levels and role in diagnosis and therapeutic monitoring has not been adequately explored. We investigated the association between MMP-1 and TGF-β in moderate and severe persistent asthma and evaluated their performance characteristics by constructing receiver operating characteristic curves. METHODS Serum MMP-1 and TGF-β1 were measured using ELISA in 75 adults; moderate persistent asthma (n=25), severe persistent asthma (n=25) and healthy community controls (n=25). Severity of asthma was determined as per Global Initiative for Asthma guidelines. Subjects were followed up for 3 months and treatment responsiveness was assessed by spirometry and symptom response. RESULTS Serum MMP-1 and TGF-β1 were significantly elevated in asthmatics compared with controls (p<0.0001 and p<0.01). While serum MMP-1 was elevated in severe asthma compared with moderate asthma (p<0.05), TGF-β1 was lower in severe asthma compared with moderate asthma (p<0.05). The performance characteristics of serum MMP-1 and TGF-β1 were promising in this cohort with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 82%, 100%, 100% and 99% and 62%, 100%, 100% and 97.8%, respectively; sensitivity of MMP-1 being superior. CONCLUSION This pilot study showed that serum MMP-1 and TGF-β1 levels are elevated in chronic asthma and may serve as a useful adjunct in differentiating moderate from severe asthma. A large multicentre study in well characterised cohort of asthmatics is warranted to investigate their role in diagnosis and therapeutic monitoring.
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Affiliation(s)
- Aswani Prabha
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India
| | - Komarla Sundararaja Lokesh
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India
| | - S K Chaya
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India
| | - B S Jayaraj
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India
| | - Sowmya Malamardi
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India
| | - M V S S T Subbarao
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India
| | - Sarah C Beck
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Padukudru Anand Mahesh
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India .,Special Interest Group - Environment and Respiratory Diseases, JSS Academy of Higher Education & Research (JSSAHER), Mysore, Karnataka, India
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Vishweswaraiah S, Ramachandra NB, Jayaraj BS, Holla AD, Chakraborty S, Agrawal A, Mahesh PA. Haplotype analysis of ADAM33 polymorphisms in asthma: A pilot study. Indian J Med Res 2020; 150:272-281. [PMID: 31719298 PMCID: PMC6886134 DOI: 10.4103/ijmr.ijmr_698_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background & objectives ADAM33 is implicated as a potentially strong candidate gene for asthma and bronchial hyper-responsiveness. Many polymorphisms of ADAM33 have been studied along with ADAM33 expression in various cells of the lungs. Haplotype analysis also showed association with asthma in different populations across the world. Therefore, the aim of this study was to perform a comprehensive screening of ADAM33 polymorphisms in adult patients with asthma. Methods Thirty five polymorphisms of ADAM33 were genotyped in 55 patients with asthma and 53 controls. The association of single nucleotide polymorphisms (SNPs) and haplotypes with phenotypes of asthma was analysed. Results The genotype, minor allele frequency, odds ratio and Hardy-Weinberg equilibrium did not show any significant difference among cases and controls. No association was found between SNPs of ADAM33 with the severity of asthma. Correlation analysis of ADAM33 SNPs to the phenotypes, based on clinical variables and allergen sensitization, did not show significant difference. Haplotype analysis showed that rs2280090 and rs2280091 were associated with asthma in the patient group. Interpretation & conclusions Haplotype analysis showed an association of the two SNP variations with asthma. These SNPs lead to amino acid change and are prone to phosphorylation, which may affect expression levels and protein function of ADAM33 and asthma susceptibility.
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Affiliation(s)
- Sangeetha Vishweswaraiah
- Department of Studies in Genetics & Genomics, Genetics & Genomics Lab, University of Mysore, Mysuru, Karnataka, India
| | - Nallur B Ramachandra
- Department of Studies in Genetics & Genomics, Genetics & Genomics Lab, University of Mysore, Mysuru, Karnataka, India
| | - B S Jayaraj
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | | | - Samarpana Chakraborty
- Center of Excellence, Translational Research in Asthma & Lung Disease, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Anurag Agrawal
- Center of Excellence, Translational Research in Asthma & Lung Disease, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Padukudru A Mahesh
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Villafuerte D, Aliberti S, Soni NJ, Faverio P, Marcos PJ, Wunderink RG, Rodriguez A, Sibila O, Sanz F, Martin‐Loeches I, Menzella F, Reyes LF, Jankovic M, Spielmanns M, Restrepo MI, Aruj PK, Attorri S, Barimboim E, Caeiro JP, Garzón MI, Cambursano VH, Ceccato A, Chertcoff J, Cordon Díaz A, de Vedia L, Ganaha MC, Lambert S, Lopardo G, Luna CM, Malberti AG, Morcillo N, Tartara S, Pensotti C, Pereyra B, Scapellato PG, Stagnaro JP, Shah S, Lötsch F, Thalhammer F, Anseeuw K, Francois CA, Van Braeckel E, Vincent JL, Djimon MZ, Nouér SA, Chipev P, Encheva M, Miteva D, Petkova D, Balkissou AD, Yone EWP, Ngahane BHM, Shen N, Xu JF, Rico CAB, Buitrago R, Paternina FJP, Ntumba JMK, Carevic VV, Jakopovic M, Jankovic M, Matkovic Z, Mitrecic I, Jacobsson MLB, Christensen AB, Heitmann Bødtger UC, Meyer CN, Jensen AV, El-Said Abd El-Wahhab I, Morsy NE, Shafiek H, Sobh E, Abdulsemed KA, Bertrand F, Brun‐Buisson C, Montmollin ED, Fartoukh M, Messika J, Tattevin P, Khoury A, Ebruke B, Dreher M, Kolditz M, Meisinger M, Pletz MW, Hagel S, Rupp J, Schaberg T, Spielmanns M, Creutz P, Suttorp N, Siaw-Lartey B, Dimakou K, Papapetrou D, Tsigou E, Ampazis D, Kaimakamis E, Bhatia M, Dhar R, D'Souza G, Garg R, Koul PA, Mahesh PA, Jayaraj BS, Narayan KV, Udnur HB, Krishnamurthy SB, Kant S, Swarnakar R, Limaye S, Salvi S, Golshani K, Keatings VM, Martin-Loeches I, Maor Y, Strahilevitz J, Battaglia S, Carrabba M, Ceriana P, Confalonieri M, Monforte AD, Prato BD, Rosa MD, Fantini R, Fiorentino G, Gammino MA, Menzella F, Milani G, Nava S, Palmiero G, Petrino R, Gabrielli B, Rossi P, Sorino C, Steinhilber G, Zanforlin A, Franzetti F, Carone M, Patella V, Scarlata S, Comel A, Kurahashi K, Bacha ZA, Ugalde DB, Zuñiga OC, Villegas JF, Medenica M, van de Garde E, Mihsra DR, Shrestha P, Ridgeon E, Awokola BI, Nwankwo ON, Olufunlola AB, Olumide S, Ukwaja KN, Irfan M, Minarowski L, Szymon S, Froes F, Leuschner P, Meireles M, Ravara SB, Brocovschii V, Ion C, Rusu D, Toma C, Chirita D, Dorobat CM, Birkun A, Kaluzhenina A, Almotairi A, Bukhary ZAA, Edathodu J, Fathy A, Enani AMA, Mohamed NE, Memon JU, Bella A, Bogdanović N, Milenkovic B, Pesut D, Borderìas L, Garcia NMB, Cabello Alarcón H, Cilloniz C, Torres A, Diaz-Brito V, Casas X, González AE, Fernández‐Almira ML, Gallego M, Gaspar‐García I, Castillo JGD, Victoria PJ, Laserna Martínez E, Molina RMD, Marcos PJ, Menéndez R, Pando‐Sandoval A, Aymerich CP, Rello J, Moyano S, Sanz F, Sibila O, Rodrigo‐Troyano A, Solé‐Violán J, Uranga A, van Boven JFM, Torra EV, Pujol JA, Feldman C, Yum HK, Fiogbe AA, Yangui F, Bilaceroglu S, Dalar L, Yilmaz U, Bogomolov A, Elahi N, Dhasmana DJ, Feneley A, Hancock C, Hill AT, Rudran B, Ruiz‐Buitrago S, Campbell M, Whitaker P, Youzguin A, Singanayagam A, Allen KS, Brito V, Dietz J, Dysart CE, Kellie SM, Franco‐Sadud RA, Meier G, Gaga M, Holland TL, Bergin SP, Kheir F, Landmeier M, Lois M, Nair GB, Patel H, Reyes K, Rodriguez‐Cintron W, Saito S, Soni NJ, Noda J, Hinojosa CI, Levine SM, Angel LF, Anzueto A, Whitlow KS, Hipskind J, Sukhija K, Totten V, Wunderink RG, Shah RD, Mateyo KJ, Noriega L, Alvarado E, Aman M, Labra L. Prevalence and risk factors for
Enterobacteriaceae
in patients hospitalized with community‐acquired pneumonia. Respirology 2019; 25:543-551. [PMID: 31385399 DOI: 10.1111/resp.13663] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. METHODS We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. RESULTS Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. CONCLUSION This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.
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Affiliation(s)
- David Villafuerte
- Division of Pulmonary Diseases and Critical Care MedicineUniversity of Texas Health – San Antonio San Antonio TX USA
- Division of Pulmonary Diseases and Critical Care MedicineSouth Texas Veterans Health Care System San Antonio TX USA
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoRespiratory Unit and Cystic Fibrosis Adult Center Milan Italy
- Department of Pathophysiology and TransplantationUniversity of Milan Milan Italy
| | - Nilam J. Soni
- Division of Pulmonary Diseases and Critical Care MedicineUniversity of Texas Health – San Antonio San Antonio TX USA
- Division of Pulmonary Diseases and Critical Care MedicineSouth Texas Veterans Health Care System San Antonio TX USA
| | - Paola Faverio
- Cardio‐Thoracic‐Vascular Department, University of Milan Bicocca, Respiratory UnitSan Gerardo Hospital, ASST di Monza Monza Italy
| | - Pedro J. Marcos
- Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC)Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC) A Coruña Spain
| | - Richard G. Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of MedicineNorthwestern University Chicago IL USA
| | - Alejandro Rodriguez
- Hospital Universitari Joan XXIII, Critical Care MedicineRovira and Virgili University and CIBERes (Biomedical Research Network of Respiratory Disease) Tarragona Spain
| | - Oriol Sibila
- Servei de Pneumologia, Departamento de Medicina, Hospital Santa Creu i Sant PauUniversitat Autònoma de Barcelona Barcelona Spain
| | - Francisco Sanz
- Pulmonology DepartmentConsorci Hospital General Universitari de Valencia Valencia Spain
| | | | - Francesco Menzella
- Department of Cardiac‐Thoracic‐Vascular and Intensive Care Medicine, Pneumology UnitIRCCS – Arcispedale Santa Maria Nuova Reggio Emilia Italy
| | - Luis F. Reyes
- Department of MicrobiologyUniversidad de la Sabana Bogota Colombia
| | - Mateja Jankovic
- School of Medicine, Clinic for Respiratory DiseasesUniversity Hospital Center Zagreb, University of Zagreb Zagreb Croatia
| | - Marc Spielmanns
- Internal Medicine Department, Pulmonary Rehabilitation and Department of Health, School of MedicineUniversity Witten‐Herdecke, St. Remigius‐Hospital Leverkusen Germany
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases and Critical Care MedicineUniversity of Texas Health – San Antonio San Antonio TX USA
- Division of Pulmonary Diseases and Critical Care MedicineSouth Texas Veterans Health Care System San Antonio TX USA
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Mahendra M, Jayaraj BS, Limaye S, Chaya SK, Dhar R, Mahesh PA. Author's reply. Lung India 2018; 35:538. [PMID: 30381573 PMCID: PMC6219133 DOI: 10.4103/lungindia.lungindia_354_18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- M Mahendra
- Department of Pulmonary Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India
| | - B S Jayaraj
- Department of Pulmonary Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Sneha Limaye
- Department of Clinical Trials, Respiratory Research Network of India (CRF), Pune, Maharashtra, India
| | - S K Chaya
- Department of Pulmonary Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Raja Dhar
- Department of Respiratory Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - P A Mahesh
- Department of Pulmonary Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in India. There is a need to understand the risk factors associated with severity of CAP in our population. This study was part of the international global initiative for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia study to evaluate MRSA. METHODS A total of 100 consecutive cases of pneumonia admitted to the Department of Pulmonary Medicine in a tertiary care hospital were recruited in the study during March-July 2015. The severity of pneumonia was assessed based on the CURB-65 score. Individuals with pneumonia and CURB-65 score >2 were compared with subjects with CURB-65 score ≤2. Individuals were also evaluated for the causative organism and its resistance pattern with specific reference to the presence of MRSA. RESULTS Mean age of patients was 54.03 years, 66% were men. Patients were managed either in the intensive care unit (42%) or wards/high dependency unit (58%), 22% needed noninvasive ventilation and 18% needed mechanical ventilation within 24 h of admission. On multivariate analysis, prior respiratory infection (within last 1 year), obesity (body mass index >30), and alcoholism, old age (>60 years) were independently associated risk factors for severe pneumonia. There were no cases of MRSA. In 34% of cases, organisms could be identified. Most common organisms were Klebsiella (8%), influenza (8%), and Pseudomonas (5%). CONCLUSION Prior respiratory infection, obesity, alcoholism, and old age (>60 years) were observed to be important risk factors for severe CAP. Prospective studies should evaluate effect of weight reduction and cessation of alcohol consumption on recurrences of pneumonia in this population and on the severity of pneumonia.
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Affiliation(s)
- M Mahendra
- Department of Pulmonary Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India
| | - BS Jayaraj
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Sneha Limaye
- Department of Clinical Trials, Respiratory Research Network of India(CRF), Pune, Maharashtra, India
| | - SK Chaya
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Raja Dhar
- Department Of Respiratory Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - PA Mahesh
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
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7
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Mahendra M, Jayaraj BS, Lokesh KS, Chaya SK, Veerapaneni VV, Limaye S, Dhar R, Swarnakar R, Ambalkar S, Mahesh PA. Antibiotic Prescription, Organisms and its Resistance Pattern in Patients Admitted to Respiratory ICU with Respiratory Infection in Mysuru. Indian J Crit Care Med 2018; 22:223-230. [PMID: 29743760 PMCID: PMC5930525 DOI: 10.4103/ijccm.ijccm_409_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/22/2023] Open
Abstract
Aim of Study: Respiratory infections account for significant morbidity, mortality and expenses to patients getting admitted to ICU. Antibiotic resistance is a major worldwide concern in ICU, including India. It is important to know the antibiotic prescribing pattern in ICU, organisms and its resistance pattern as there is sparse data on Indian ICUs. Materials and Methods: We conducted a prospective study from August 2015 to February 2016. All patients getting admitted to RICU with respiratory infection who were treated with antibiotics were included into study. Demographic details, comorbidities, Clinco-pathological score (CPI) on day1 and 2 of admission, duration of ICU admission, number of antibiotics used, antibiotic prescription, antimicrobial resistance pattern of patients were collected using APRISE questionnaire. Results: During study period 352 patients were screened and 303 patients were included into study. Mean age was 56.05±16.37 and 190 (62.70%) were men. Most common diagnosis was Pneumonia (66%). Piperacillin-tazobactam was most common empirical antibiotic used. We found 60% resistance to piperacillin-tazobactam. Acinetobacter baumanii was the most common organism isolated (29.2%) and was highly resistant to Carbapenem (60%). Klebsiella pneumoniae was resistant to Amikacin (45%), piperacillin (55%) and Ceftazidime (50%). Conclusion: Piperacillin-tazobactam was the most common antibiotic prescribed to patients with respiratory infection admitted to ICU. More than half of patients (60%) had resistance to the empirical antibiotic used in our ICU, highlighting the need for antibiogram for each ICU. Thirty six percent of patient had prior antibiotic use and had mainly gram negative organisms with high resistance to commonly used antibiotics.
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Affiliation(s)
- M Mahendra
- Pulmonary Medicine, Shimoga Institute of Medical Sciences, Shivamogga, India
| | - B S Jayaraj
- Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - K S Lokesh
- Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - S K Chaya
- Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | | | - Sneha Limaye
- Respiratory Research Network of India, Chest Research Foundation, Pune, Maharashtra, India
| | - Raja Dhar
- Pulmonary Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Rajesh Swarnakar
- Pulmonary Medicine, Getwell Hospital and Research Institute, Dhantoli, Nagpur, Maharashtra, India
| | - Shrikant Ambalkar
- Department of Clinical Microbiology & Infection, King's Mill Hospital, Sherwood Forest Hospitals NHS Trust, Sutton in Ashfield, Nottinghamshire NG17 4JL, UK
| | - P A Mahesh
- Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
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Raeiszadeh Jahromi S, Mahesh PA, Jayaraj BS, Holla AD, Vishweswaraiah S, Ramachandra NB. IL-10 and IL-17F Promoter Single Nucleotide Polymorphism and Asthma: A Case-Control Study in South India. Lung 2015; 193:739-47. [PMID: 26108303 DOI: 10.1007/s00408-015-9753-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/15/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Several studies have assessed the association between IL-17F and IL-10 promoter polymorphisms and asthma, but the results were conflicting. Furthermore, few studies have evaluated the association of cytokine polymorphisms with asthma and its clinical phenotypes. OBJECTIVE This study was conducted to evaluate the association of IL-10 (interleukin 10) and IL-17F (interleukin 17F) promoter polymorphisms (rs1800871, rs1800896 and rs1889570) with asthma and its clinical phenotypes including severity, atopic status, spirometric parameters, and response to treatment in south Indian population. A sub-study was conducted to assess cytokine levels in subjects with different gene variants. METHODS IL-10 and IL-17F polymorphisms were genotyped in 419 asthmatic patients and 393 controls using Mass ARRAY. RESULTS Our results showed an association between IL-10 SNPs and mild asthma. No association was found with any of three SNPs in moderate to severe asthma. Comparison of genotype distribution of IL-17F rs1887570 AA variant among atopic and non-atopic patients showed significant difference (p = 0.024). Correlation analysis of IL-10 and IL-17F SNPs to clinical variables showed a positive correlation between IL-17F rs1887570 AA and number of allergen sensitized (rs = 0.142, p = 0.004). Significant improvement in lung function was observed after 2 months of ICS (Inhaled corticosteroids) and LABA (long acting β2 agonist) treatment in all subjects with no statistically significant difference among SNPs variants. Cytokines levels were similar in different SNP variants. CONCLUSION We observed an association between IL-10 rs1800871 and rs1800896 SNPs and mild asthma, as well as IL-17F rs1887570 AA variant and number of allergens sensitized.
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Affiliation(s)
- Sareh Raeiszadeh Jahromi
- Genetics and Genomics Lab, Department of Studies in Zoology, University of Mysore, Manasagangotri, Mysore, Karnataka, India
| | - P A Mahesh
- Department of Pulmonary Medicine, J.S.S. Medical College, Mysore, Karnataka, India
| | - B S Jayaraj
- Department of Pulmonary Medicine, J.S.S. Medical College, Mysore, Karnataka, India
| | | | - Sangeetha Vishweswaraiah
- Genetics and Genomics Lab, Department of Studies in Zoology, University of Mysore, Manasagangotri, Mysore, Karnataka, India
| | - Nallur B Ramachandra
- Genetics and Genomics Lab, Department of Studies in Zoology, University of Mysore, Manasagangotri, Mysore, Karnataka, India.
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Raeiszadeh Jahromi S, Mahesh PA, Jayaraj BS, Madhunapantula SRV, Holla AD, Vishweswaraiah S, Ramachandra NB. Serum levels of IL-10, IL-17F and IL-33 in patients with asthma: a case-control study. J Asthma 2014; 51:1004-13. [PMID: 24960440 DOI: 10.3109/02770903.2014.938353] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The development of inflammation in asthma involves an intricate network of cytokines that recruit and activate numerous immune cells. This study was aimed to compare serum levels of IL-10, IL-17F, and IL-33 in asthmatic patients and non-asthmatic controls and correlate cytokine levels to asthma severity and various clinical, spirometric, and laboratory variables. METHODS Using ELISA, serum levels of IL-10, IL-17F, and IL-33 were evaluated in 44 asthmatics (14 mild persistent, 15 moderate persistent, and 15 severe persistent) and 44 controls. RESULTS This is one of the first reports showing a significant difference in serum levels of asthma-associated cytokines, anti-inflammatory IL-10, and pro-inflammatory IL-17F and IL-33, in the same subset of asthmatic patients. Our results showed diminished level of IL-10 and elevated levels of IL-17F and IL-33 in asthmatics than in controls (p < 0.001). Assessment of cytokine levels between subjects of different gender, age group, and BMI showed non-significant differences. Correlation analysis of cytokine levels to clinical variables showed that IL-17F is associated negatively to FVC % predicted (forced vital capacity) and FEV1% predicted (forced expiratory volume in one second) and positively to number of allergens sensitized and FEV1 reversibility. A strong negative correlation was found between IL-10 and IL-33 levels (p = 0.001). CONCLUSIONS Negative correlation between IL-10 and IL-33 levels may reflect a converse relationship between anti-inflammatory and pro-inflammatory cytokines in an individually balanced pattern. The association between IL-17F level and asthmatic phenotypes such as reduced FVC and FEV1, higher degree of sensitization, and post-bronchodilator reversibility needs further assessments.
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Affiliation(s)
- Sareh Raeiszadeh Jahromi
- Genetics and Genomics Lab, Department of Studies in Zoology, University of Mysore , Manasagangotri, Mysore, Karnataka , India
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Mahdi B, Mahesh PA, Mysore RS, Kumar P, Jayaraj BS, Ramachandra NB. Inheritance patterns, consanguinity & risk for asthma. Indian J Med Res 2010; 132:48-55. [PMID: 20693589] [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: 05/29/2023] Open
Abstract
BACKGROUND & OBJECTIVES Family history is an important risk factor for the development of asthma, contingent upon genetic and environment interaction. Since there is paucity of data on asthma inheritance in Indian population, the present study was undertaken to investigate the inheritance patterns of asthma and the effect of family history and consanguineous marriage on asthma inheritance. METHODS A total of 200 families, 100 index children and 100 index adults with clinically diagnosed asthma, along with 400 non-asthmatic children and adults as controls were selected for the present study. Information about the family history of each patients and controls was collected and analyzed pedigrees were also constructed. RESULTS A history of asthma in any member of the family was observed in 44.5 per cent of cases and 5.3 per cent of controls (P<0.001). A differential risk of developing asthma was noted in family history of asthma in different first and second degree relatives of children and adult patients. Consanguineous marriage was also noted in parents in 24.5 per cent of cases and 12.3 per cent of controls (P<0.001). The most common mode of asthma inheritance was recessive. INTERPRETATION & CONCLUSIONS Our results showed that consanguineous marriage and family history of asthma are important determinants in the development of asthma in the offspring.
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Affiliation(s)
- Bijanzadeh Mahdi
- Department of Studies in Zoology, University of Mysore, J.S.S. Medical College, J.S.S. Hospital, Mysore, India
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Mahesh PA, Vedanthan PK, Holla AD, Jayaraj BS, Prabhakar AK. Time interval and the factors associated with the development of asthma in patients with allergic rhinitis. Lung 2009; 187:393-400. [PMID: 19806402 DOI: 10.1007/s00408-009-9179-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 09/09/2009] [Indexed: 11/28/2022]
Abstract
Rhinitis and asthma commonly coexist and studies have shown a positive association between rhinitis and asthma in both atopic and nonatopic adults. Longitudinal studies have shown that in many cases rhinitis precedes the onset of asthma. The aims of this study were to study the time interval for the development of asthma after the onset of rhinitis, to determine the proportion of patients in whom rhinitis precedes asthma, and to study the factors associated with the development of asthma in patients with allergic rhinitis compared to patients who continue to have allergic rhinitis alone. This was a cross-sectional study done at a tertiary care allergy center in Mysore, South India. It included consecutive patients between 2004 and 2006 with allergic rhinitis and/or asthma. We used a structured questionnaire, clinical evaluation, spirometry, and skin-prick testing. A total of 1,141 subjects were included in the study. Among them, 700 had allergic rhinitis for varying intervals before developing asthma and 355 had rhinitis without asthma. In subjects aged 20 years or younger, logistic regression analysis confirmed an independent association with a family history of allergic rhinitis and sensitization to house dust mites as risk factors and ever-used nasal steroids as protective against developing asthma in subjects with allergic rhinitis. In subjects older than 20 years, a family history of allergic rhinitis, atopy, and sensitization to house dust mites and trees were risk factors and ever-user of nasal steroids was protective. Rhinitis often preceded asthma and a high proportion of patients, both children and adults, developed asthma within 2 years after the onset of rhinitis. A family history of allergic rhinitis, atopy, and sensitization to house dust mites and trees are associated with the development of asthma in patients with allergic rhinitis.
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Affiliation(s)
- P A Mahesh
- JSS Medical College and Hospital, Ramanuja Road, Mysore, 570004, Karnataka, India.
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Bijanzadeh M, Ramachandra NB, Mahesh PA, Savitha MR, Manjunath BS, Jayaraj BS. Lack of association between asthma and ABO blood group. Lung 2009; 187:389-92. [PMID: 19771478 DOI: 10.1007/s00408-009-9175-1] [Citation(s) in RCA: 9] [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: 07/11/2009] [Accepted: 09/01/2009] [Indexed: 12/30/2022]
Abstract
ABO is the most important blood group system in transfusion and transplantation practices. Glycosyltransferases are controlled by the ABO system which is helpful in building oligosaccharide structures on the cell surface of erythrocytes and vascular endothelium and in the exocrine secretion system, including the respiratory tract. We analyzed the ABO blood group of 200 children and adults with asthma as well as that of 2000 healthy subjects as controls. The most common blood group among the patients and controls was "O" (43.5% and 43.6%, respectively), followed by B, A, and AB. In the distribution of different blood groups, nonsignificant difference between patients and controls was observed (p = 0.931). We conclude that ABO blood group status has a nonsignificant association with asthma among the population of Mysore, Karnataka, South India.
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Affiliation(s)
- Mahdi Bijanzadeh
- Human Genetics Laboratory, Department of Studies in Zoology, University of Mysore, Manasagangothri, Mysore, 570 006, India
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Mahesh PA, Jayaraj BS, Prahlad ST, Chaya SK, Prabhakar AK, Agarwal AN, Jindal SK. Validation of a structured questionnaire for COPD and prevalence of COPD in rural area of Mysore: A pilot study. Lung India 2009; 26:63-9. [PMID: 20442838 PMCID: PMC2862508 DOI: 10.4103/0970-2113.53226] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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: 11/06/2022] Open
Abstract
BACKGROUND The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in India and there is a need to study the prevalence of COPD, particularly in the rural areas, which may be most affected due to their lifestyle. MATERIALS AND METHODS FIRST STAGE: Validation of the questionnaire-105 consecutive patients underwent administration of the structured questionnaire and spirometry was used as a gold standard for the diagnosis of COPD. Second stage: Adults above 40 years (n = 900) in two villages of Mysore district were administered with the validated questionnaire, Knowledge and Attitude questionnaire and Fagerstorm questionnaire, to assess nicotine dependency. RESULTS The questionnaire was found to have a sensitivity of 62.5% and specificity of 87.6% to diagnose COPD. Of the total 900 adults surveyed (Males: 453, Females: 447), the total prevalence of COPD was 7.1%. Males had a higher prevalence (11.1%) compared to females (4.5%). The prevalence of smoking was very high among men at 71.9% and all the women were nonsmokers. The prevalence of COPD was 14.7% in smokers, 19.3% had mild to moderate nicotine dependency and 12.8% were highly dependent. Of the women exposed to regular biomass fuels, the prevalence of COPD was 3.9%, which increased to 4.8% on addition of regular passive smoking. In smoking, male gender and age were significantly associated with COPD (P < 0.05). CONCLUSION The structured questionnaire is a useful tool for the screening of COPD in field studies. Smoking and biomass fuel exposure are important risk factors for COPD.
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Affiliation(s)
- P. A. Mahesh
- Department of Pulmonary Medicine, JSS Medical College and Hospital, Mysore - 570004, Karnataka, India
| | - B. S. Jayaraj
- Department of Pulmonary Medicine, JSS Medical College and Hospital, Mysore - 570004, Karnataka, India
| | - S. T. Prahlad
- Department of Pulmonary Medicine, JSS Medical College and Hospital, Mysore - 570004, Karnataka, India
| | - S. K. Chaya
- Department of Pulmonary Medicine, JSS Medical College and Hospital, Mysore - 570004, Karnataka, India
| | - A. K. Prabhakar
- Department of Pulmonary Medicine, JSS Medical College and Hospital, Mysore - 570004, Karnataka, India
| | - A. N. Agarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 017, India
| | - S. K. Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 017, India
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Basavana GH, Siddesh G, Jayaraj BS, Krishnan MG. Ruptured hydatid cyst of lung. J Assoc Physicians India 2007; 55:141-5. [PMID: 17571745] [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: 05/15/2023]
Abstract
We report a case of 26 year old woman who had ruptured hydatid cyst of the right lung. The chest radiograph and CT features were suggestive of a ruptured hydatid cyst with detached and collapsed endocyst within the exocyst. Intraoperatively communication between cyst and bronchus could be demonstrated. Interesting CT appearance and demonstrable communication of cyst with bronchus is the reason for this case report.
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