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Huddart S, Asege L, Jaganath D, Golla M, Dang H, Lovelina L, Derendinger B, Andama A, Christopher DJ, Nhung NV, Theron G, Denkinger CM, Nahid P, Cattamanchi A, Yu C. Continuous cough monitoring: a novel digital biomarker for TB diagnosis and treatment response monitoring. Int J Tuberc Lung Dis 2023; 27:221-222. [PMID: 36855045 PMCID: PMC9983626 DOI: 10.5588/ijtld.22.0511] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/20/2022] [Indexed: 03/02/2023] Open
Affiliation(s)
- S Huddart
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - L Asege
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - D Jaganath
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - M Golla
- De La Salle Medical and Health Sciences Institute, Center for Tuberculosis Research, City of Dasmariñas, Cavite, The Philippines
| | - H Dang
- Hanoi Lung Hospital, Hanoi, Vietnam
| | - L Lovelina
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - B Derendinger
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - A Andama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - N V Nhung
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - G Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - C M Denkinger
- Division of Infectious Diseases and Tropical Medicine, Center of Infectious Diseases, Heidelberg University, Heidelberg, Germany, German Center for Infection Research (DZIF), Heidelberg University Hospital Partner Site, Heidelberg, Germany
| | - P Nahid
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - A Cattamanchi
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - C Yu
- De La Salle Medical and Health Sciences Institute, Center for Tuberculosis Research, City of Dasmariñas, Cavite, The Philippines
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Paul A, Paul A, Subhash I, Yadav B, Jacob JR, Christopher DJ, Balamugesh T. Atrial depolarization abnormalities in pulmonary sarcoidosis. Egypt Heart J 2022; 74:74. [PMID: 36209309 PMCID: PMC9547766 DOI: 10.1186/s43044-022-00312-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac sarcoidosis, often manifested as sudden death, can be the first manifestation of sarcoidosis. Since 12-lead electrocardiogram (ECG) is recommended as an initial screening tool for cardiac sarcoidosis, the recognition of subtle abnormalities assumes utmost significance. The objective of this study was to identify the electrocardiographic abnormalities in patients with pulmonary sarcoidosis. RESULTS A detailed analysis of 12-lead ECGs obtained from sixty patients with histopathologically proven pulmonary sarcoidosis and no overt cardiac involvement was done. The findings were compared with those of an age-matched control group. Varying degrees of intraventricular conduction defects were common in the study group [67%], as well as the control group [57%] [P = 0.23]. There was a higher prevalence of biphasic P wave [P = 0.003] and bifid P wave [P = 0.029] in lead III and rsr' in lead aVF [P = 0.03] in the study group as compared to the control group. CONCLUSIONS Our study demonstrates a greater prevalence of subtle ECG abnormalities in patients with pulmonary sarcoidosis as compared to patients with other forms of pulmonary disease. Atrial depolarization abnormalities were commoner in patients with pulmonary sarcoidosis.
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Affiliation(s)
- Amal Paul
- grid.11586.3b0000 0004 1767 8969Department of Cardiology, Christian Medical College and Hospital (CMCH), Vellore, India ,grid.416265.20000 0004 1767 487XMOSC Medical Mission Hospital, Aduputty Hills, Kunnamkulam, Thrissur, Kerala 680503 India
| | - Akhil Paul
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
| | - Immanuel Subhash
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
| | - Bijesh Yadav
- grid.11586.3b0000 0004 1767 8969Department of Biostatistics, Christian Medical College and Hospital (CMCH), Vellore, India
| | - John Roshan Jacob
- grid.11586.3b0000 0004 1767 8969Department of Cardiology and Cardiac Electrophysiology, Christian Medical College and Hospital (CMCH), Vellore, India
| | - D. J. Christopher
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
| | - T. Balamugesh
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
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3
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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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Atreya S, Jeba J, Patil CR, Iyer R, Christopher DJ, Rajan S. Perspectives of Respiratory Physicians toward Need and Integration of Palliative Care in Advanced Respiratory Diseases. Indian J Palliat Care 2022; 28:314-320. [PMID: 36072243 PMCID: PMC9443121 DOI: 10.25259/ijpc_7_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/21/2022] [Indexed: 01/21/2023] Open
Abstract
Objectives: Patients with chronic life-limiting or advanced respiratory diseases often suffer from high symptom burden, requiring palliative care to alleviate symptoms, improve quality of life and restore dignity. The present study explored the perception of respiratory physicians and their current practice of integrating palliative care for adult patients with chronic advanced respiratory diseases. Materials and Methods: An exploratory survey method using Google survey forms and SurveyMonkey was emailed to respiratory physicians between December 2020 and May 2021. Results: One hundred and seventy-two respiratory physicians responded to the survey. The majority of respiratory physicians (n = 153; 88.9%) thought that early integration of palliative care early was beneficial. They did not feel referring to palliative care would result in loss of control on patient care (n = 107; 62.21%) and 66 (38.37%) strongly disagreed that the referral would result in a loss of hope in patients. Further exploration into the training needs of respiratory physicians revealed that 121 (70.35%) felt the need for training in end-of-life care. Conclusion: Respiratory physicians in our study had an inclination toward palliative care integration into their routine clinical practice. A majority of them expressed the need to enhance their skills in palliative care. Therefore, concerted efforts at integration and a mutual exchange of knowledge between respiratory physicians and palliative care physicians will ensure that patients with advanced respiratory diseases are provided high-quality palliative care.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Jenifer Jeba
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Chaitanya R. Patil
- Palliative Care Unit, Kolhapur Cancer Centre, Kolhapur, Maharashtra, India
| | - Rajam Iyer
- Department of Palliative Care, Hinduja Hospital, Mumbai, Maharashtra, India
| | - D. J. Christopher
- Department of Pulmonology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sujeet Rajan
- Department of Respiratory Medicine, Bombay Hospital and Bhatia Hospital, Mumbai, Maharashtra, India,
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Sudarsanam T, Thomas R, Turaka V, Peter J, Christopher DJ, Balamugesh T, Mahasampath G, Mathuram A, Sadiq M, Ramya I, George T, Chandireseharan V, George T. Good survival rate, moderate overall and good respirator quality of life, near normal pulmonary functions, and good return to work despite catastrophic economic costs 6 months following recovery from Acute Respiratory Distress Syndrome. Lung India 2022; 39:169-173. [PMID: 35259800 PMCID: PMC9053934 DOI: 10.4103/lungindia.lungindia_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Long-term quality of life, return to work, economic consequences following Acute Respiratory Distress Syndrome (ARDS) are not well described in India. This study was aimed to address the question. Methods: A prospective cohort study of 109 ARDS survivors were followed up for a minimum of 6 months following discharge. Quality of life was assessed using the SF-36 questionnaire. Respiratory quality was assessed using the St Georges Respiratory Questionnaire. Time to return to work was documented. Costs-direct medical, as well as indirect were documented up to 6 months. Results: At 6 months, 6/109 (5.5%) had expired. Low energy/vitality and general heath were noted in the SF-36 scores at 6 months; overall a moderate quality of life. Pulmonary function tests had mostly normalized. Six-min walk distance was 77% of predicted. Respiratory quality of life was good. It took at the median of 111 days to go back Interquartile range (55–193.5) to work with 88% of previously employed going back to work. There were no significant differences in the severity of ARDS and any of these outcomes at 6 months. The average total cost from the societal perspective was 231,450 (standard deviation 146,430 -, 387,300). There was a significant difference between the 3-ARDS severity groups and costs (P < 0.01). There were no independent predictors of return to work. Conclusion: ARDS survivors have low 6-month mortality. Pulmonary physiology and exercise capacity was mostly normal. Overall, quality of life is average was moderate, while respiratory quality of life was good. Return to work was excellent, while cost of care falls under a catastrophic heath expense.
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Bermingham WH, Bhogal R, Nagarajan S, Mutlu L, El-Shabrawy RM, Madhan R, Maheshwari UM, Murali M, Kudagammana ST, Shrestha R, Sumantri S, Christopher DJ, Mahesh PA, Dedicoat M, Krishna MT. 'Practical management of suspected hypersensitivity reactions to anti-tuberculosis drugs.'. Clin Exp Allergy 2021; 52:375-386. [PMID: 34939251 DOI: 10.1111/cea.14084] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/07/2021] [Accepted: 12/09/2022] [Indexed: 11/28/2022]
Abstract
Tuberculosis (TB) is the commonest cause of death by a single infectious agent globally and ranks amongst the top ten causes of global mortality. The incidence of TB is highest in Low-Middle Income countries (LMICs). Prompt institution of, and compliance with, therapy are cornerstones for a favourable outcome in TB and to mitigate the risk of multiple drug resistant (MDR)-TB, which is challenging to treat. There is some evidence that adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) to anti-TB drugs occur in over 60% and 3-4% of patients respectively. Both ADRs and HSRs represent significant barriers to treatment adherence and are recognised risk factors for MDR-TB. HSRs to anti-TB drugs are usually cutaneous and benign, occur within few weeks after commencement of therapy and are likely to be T-cell mediated. Severe and systemic T-cell mediated HSRs and IgE mediated anaphylaxis to anti-TB drugs are relatively rare, but important to recognise and treat promptly. T-cell mediated HSRs are more frequent amongst patients with co-existing HIV infection. Some patients develop multiple sensitisation to anti-TB drugs. Whilst skin tests, patch tests and in vitro diagnostics have been used in the investigation of HSRs to anti-TB drugs, their predictive value is not established, they are onerous, require specialist input of an allergist and are resource-dependent. This is compounded by the global, unmet demand for allergy specialists, particularly in low income countries (LICs) / LMICs and now the challenging circumstances of the SARS-CoV-2 pandemic. This narrative review provides a critical analysis of the limited published evidence on this topic and proposes a cautious and pragmatic approach to optimise and standardise the management of HSRs to anti-TB drugs. This includes clinical risk stratification and a dual strategy involving sequential re-challenge and rapid drug desensitisation. Furthermore, a concerted international effort is needed to generate real-time data on ADRs, HSRs, safety and clinical outcomes of these interventions.
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Affiliation(s)
- W H Bermingham
- Department of Allergy & Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Bhogal
- Department of Pharmacy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Nagarajan
- Department of Allergy and Immunology, Mallige Hospital, Bangalore, India
| | - L Mutlu
- Department of Allergy & Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - R Madhan
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS AHER, Mysuru, India
| | - U M Maheshwari
- Department of Respiratory Medicine, St Johns Medical College, Bengaluru, India
| | - M Murali
- Division of Allergy and Clinical Immunology, Department of Medicine, Massachusetts General hospital, Boston, MA, 02114, USA
| | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Honorary Consultant Paediatrician, Teaching hospital, Peradeniya, Sri Lanka
| | - R Shrestha
- Departments of Clinical Pharmacology, Dhulikhel Hospital, Kathmandu University Hospital, Nepal
| | - S Sumantri
- Department of Internal Medicine, Universitas Pelita Harapan, Siloam Academic Hospital Lippo Village, Tangerang, Banten, Indonesia
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - P A Mahesh
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysuru, India
| | - M Dedicoat
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M T Krishna
- Department of Allergy & Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Chawla RK, Christopher DJ, Dhar R, Yuvarajan S, Chopra K, Samaria JK, Singh V, Gupta N, Kaul P, Swarankar R, Madan A, Kumar M, Chawla AK, Sharma S, Chaudhary G, Chawla MK. Thoracoscopic practices in India-a survey by Indian chest society. Indian J Tuberc 2021; 68:485-490. [PMID: 34752318 DOI: 10.1016/j.ijtb.2021.02.011] [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: 01/13/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diagnostic thoracentesis is the initial diagnostic investigation in the workup of an undiagnosed Pleural effusion. However, a significant percentage of pleural effusions remain undiagnosed after this step and after closed pleural biopsy. Medical thoracoscopy (MT) has a high diagnostic yield in these patients. MT is now widely practised in India. This survey endeavours to study the practice of this technique by respiratory physicians in India. METHODS An electronic survey called 'Indian Thoracoscopy survey' was prepared and conducted under the aegis of Indian Chest Society. In all there were 63 Questions in English prepared and disseminated as a "Google Form" to conduct this survey. The subjects were recruited from the e-mail lists of the three major professional surgeries that serve the interests of the respiratory physicians. The participation in the survey was voluntary and no incentive of any sort was offered to the participants. The survey link was kept open for a 3-month period. RESULTS There were total 659 respondents, whose mean age was 41.5 years and majority of them were males (n = 564, 85.6%). The largest group of respondents practiced in corporate/private hospitals (n = 315, 47.8%). Only 311 (47.2%) respondents performed MT. Of these, 190 (61.1%) used flex-rigid/semi rigid thoracoscopes. Undiagnosed pleural effusions (N = 194; 62.4%) and recurrent pleural effusions (N = 117; 37.6%) were the most common indications for performing MT. Majority of the thoracoscopists (222, 71.4%) used conscious sedation and a combination of Midazolam and Fentanyl was the most preferred combination (n = 238; 76.5%). Most follow the manufacturer's recommendation for thoracoscope cleaning and disinfection and had safety check lists in place. CONCLUSION Our survey captures the practice of MT in India. MT seems to be increasing in popularity with significant numbers of respiratory physicians performing the procedure. Respondents felt that MT was a valuable investigation that was underused and more of them wanted to learn. It is safe to perform MT under conscious sedation and local anaesthesia and a boon to patients who required surgical procedures for evaluation of difficult to diagnose pleural diseases. The setup cost is significant and would not justify installation in all centres. The lack of opportunities for training is something that needs to be looked in to.
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Affiliation(s)
- Rakesh K Chawla
- Sr. Consultant Respiratory Medicine - Jaipur Golden Hospital, Saroj Super Speciality Hospital, India.
| | | | - Raja Dhar
- Respiratory Medicine, Fortis Hospital, Calcutta, India.
| | - S Yuvarajan
- Respiratory Medicine, SMVMCH, Pondicherry, India.
| | | | - J K Samaria
- Respiratory Medicine, Banaras Hindu University, India.
| | | | - Neeraj Gupta
- Respiratory Medicine, JLN Medical College, India.
| | | | | | - Arun Madan
- Respiratory Medicine, Hindu Rao Medical College, India.
| | | | - Aditya K Chawla
- Respiratory Medicine, Jaipur Golden Hospital, Saroj Super Speciality Hospital, India.
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Christopher DJ, Coelho V, Ebby GS, Shankar D, Gupta R, Thangakunam B. Incremental yield of Xpert ® MTB/RIF Ultra over Xpert ® MTB/RIF in the diagnosis of extrapulmonary TB. Int J Tuberc Lung Dis 2021; 25:939-944. [PMID: 34686237 DOI: 10.5588/ijtld.21.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
BACKGROUND: Extrapulmonary TB (EPTB) comprises approximately 15-20% of TB cases worldwide, and its diagnosis is difficult. The sensitivity of Xpert® MTB/RIF (Xpert) in the diagnosis of EPTB is low on account of its paucibacillary nature. Xpert® MTB/RIF Ultra (Ultra) was developed to improve sensitivity.OBJECTIVE: To compare the sensitivity of Ultra test with that of Xpert against MGIT™ (Mycobacteria Growth Indicator Tube) culture and a composite reference standard (CRS).METHODS: We recruited consecutive treatment-naïve patients with suspected EPTB. Demographic information, clinical and relevant laboratory data were collected.RESULTS: From January 2019 to November 2019, 210 patients provided 250 samples. Against MGIT culture, the sensitivity of Ultra was significantly higher than Xpert (72% vs. 51.1%; P = 0.04), the specificity was lower (87.8% vs. 95.1%). Against the CRS also, the sensitivity of Ultra was significantly higher than Xpert (45.4% vs. 25.2%; P = 0.002); however, the specificities were similar (98.2% vs. 99.1%). The trend towards higher sensitivity of Ultra compared to Xpert was seen in most of the individual samples. The sensitivities against MGIT and CRS were as follows: lymph node (68.1% vs. 31.8%; P = 0.01) and (59.5% vs. 23.8%; P = 0.001), pleural biopsy (80.0% on both; P = NS) and (53.8% vs. 46.2%; P = NS) and pleural fluid (66.7% vs. 50%; P = NS) and (22.5% vs. 9.6%; P = NS), respectively.CONCLUSIONS: Xpert Ultra showed a significantly higher sensitivity in diagnosing EPTB than Xpert.
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Affiliation(s)
- D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - V Coelho
- Department of General Surgery - Unit IV, Christian Medical College, Vellore, India
| | - G S Ebby
- Department of Gastroenterology, Christian Medical College, Vellore, India
| | - D Shankar
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - R Gupta
- Respiratory Medicine, Christian Medical College, Vellore, India
| | - B Thangakunam
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
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Chhajed PN, Nene A, Abhyankar N, Akkaraju J, Agarwal R, Arora S, Bhat R, Chawla R, Christopher DJ, Chowdhary SR, Dhar R, Dhooria S, Goyal R, Gupta R, James P, Koul PA, Khader AKA, Madan K, Marwah V, Mehta R, Mohan A, Nangia V, Patel D, Pattabhiraman VR, Sehgal IS, Singh S, Srinivasan A, Swarnakar R, Tampi S. Conventional flexible bronchoscopy during the COVID pandemic: A consensus statement from the Indian Association for Bronchology. Lung India 2021; 38:S105-S115. [PMID: 33686993 PMCID: PMC8104343 DOI: 10.4103/lungindia.lungindia_953_20] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
During the times of the ongoing COVID pandemic, aerosol-generating procedures such as bronchoscopy have the potential of transmission of severe acute respiratory syndrome coronavirus 2 to the healthcare workers. The decision to perform bronchoscopy during the COVID pandemic should be taken judiciously. Over the years, the indications for bronchoscopy in the clinical practice have expanded. Experts at the Indian Association for Bronchology perceived the need to develop a concise statement that would assist a bronchoscopist in performing bronchoscopy during the COVID pandemic safely. The current Indian Association for Bronchology Consensus Statement provides specific guidelines including triaging, indications, bronchoscopy area, use of personal protective equipment, patient preparation, sedation and anesthesia, patient monitoring, bronchoscopy technique, sample collection and handling, bronchoscope disinfection, and environmental disinfection concerning the coronavirus disease-2019 situation. The suggestions provided herewith should be adopted in addition to the national bronchoscopy guidelines that were published recently. This statement summarizes the essential aspects to be considered for the performance of bronchoscopy in COVID pandemic, to ensure safety for both for patients and healthcare personnel.
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Affiliation(s)
- Prashant Nemichand Chhajed
- Lung Care and Sleep Centre; Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Amita Nene
- Department of Respiratory Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Nitin Abhyankar
- Department of Respiratory Medicine, Poona Hospital, Pune, Maharashtra, India
| | - Jayachandra Akkaraju
- Department of Respiratory Medicine, Virinchi Hospital, Hyderabad, Telangana, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Rakesh Chawla
- Department of Respiratory Medicine, Jaipur Golden Hospital, New Delhi, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sushmita Roy Chowdhary
- Department of Respiratory Medicne, Apollo Gleaneagles Hospital, Kolkata, West Bengal, India
| | - Raja Dhar
- Department of Pulmonary Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Goyal
- Department of Respiratory Medicine, Jaipur Golden Hospital and Rajiv Gandhi Cancer Hospital, New Delhi, India
| | - Richa Gupta
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prince James
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - A K Abdul Khader
- Department of Pulmonary Medicine, KMCT Medical College, Kozhikode, Kerala, India
| | - Karan Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Army Institute of Cardiothoracic Sciences (AICTS), Pune, Maharashtra, India
| | - Ravindra Mehta
- Department of Respiratory Medicine, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Nangia
- Institute of Respiratory, Critical Care and Sleep Medicine, Max Hospital, Saket Complex, New Delhi, India
| | - Dharmesh Patel
- City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | - V R Pattabhiraman
- Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetu Singh
- Department of Chest and Tuberculosis, Institute of Respiratory Disease, Jaipur, Rajasthan, India
| | - Arjun Srinivasan
- Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Rajesh Swarnakar
- Department of Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Shyamsunder Tampi
- Department of Respiratory Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
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Pandey A, Brauer M, Cropper ML, Balakrishnan K, Mathur P, Dey S, Turkgulu B, Kumar GA, Khare M, Beig G, Gupta T, Krishnankutty RP, Causey K, Cohen AJ, Bhargava S, Aggarwal AN, Agrawal A, Awasthi S, Bennitt F, Bhagwat S, Bhanumati P, Burkart K, Chakma JK, Chiles TC, Chowdhury S, Christopher DJ, Dey S, Fisher S, Fraumeni B, Fuller R, Ghoshal AG, Golechha MJ, Gupta PC, Gupta R, Gupta R, Gupta S, Guttikunda S, Hanrahan D, Harikrishnan S, Jeemon P, Joshi TK, Kant R, Kant S, Kaur T, Koul PA, Kumar P, Kumar R, Larson SL, Lodha R, Madhipatla KK, Mahesh PA, Malhotra R, Managi S, Martin K, Mathai M, Mathew JL, Mehrotra R, Mohan BVM, Mohan V, Mukhopadhyay S, Mutreja P, Naik N, Nair S, Pandian JD, Pant P, Perianayagam A, Prabhakaran D, Prabhakaran P, Rath GK, Ravi S, Roy A, Sabde YD, Salvi S, Sambandam S, Sharma B, Sharma M, Sharma S, Sharma RS, Shrivastava A, Singh S, Singh V, Smith R, Stanaway JD, Taghian G, Tandon N, Thakur JS, Thomas NJ, Toteja GS, Varghese CM, Venkataraman C, Venugopal KN, Walker KD, Watson AY, Wozniak S, Xavier D, Yadama GN, Yadav G, Shukla DK, Bekedam HJ, Reddy KS, Guleria R, Vos T, Lim SS, Dandona R, Kumar S, Kumar P, Landrigan PJ, Dandona L. Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019. Lancet Planet Health 2021; 5:e25-e38. [PMID: 33357500 PMCID: PMC7805008 DOI: 10.1016/s2542-5196(20)30298-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND The association of air pollution with multiple adverse health outcomes is becoming well established, but its negative economic impact is less well appreciated. It is important to elucidate this impact for the states of India. METHODS We estimated exposure to ambient particulate matter pollution, household air pollution, and ambient ozone pollution, and their attributable deaths and disability-adjusted life-years in every state of India as part of the Global Burden of Disease Study (GBD) 2019. We estimated the economic impact of air pollution as the cost of lost output due to premature deaths and morbidity attributable to air pollution for every state of India, using the cost-of-illness method. FINDINGS 1·67 million (95% uncertainty interval 1·42-1·92) deaths were attributable to air pollution in India in 2019, accounting for 17·8% (15·8-19·5) of the total deaths in the country. The majority of these deaths were from ambient particulate matter pollution (0·98 million [0·77-1·19]) and household air pollution (0·61 million [0·39-0·86]). The death rate due to household air pollution decreased by 64·2% (52·2-74·2) from 1990 to 2019, while that due to ambient particulate matter pollution increased by 115·3% (28·3-344·4) and that due to ambient ozone pollution increased by 139·2% (96·5-195·8). Lost output from premature deaths and morbidity attributable to air pollution accounted for economic losses of US$28·8 billion (21·4-37·4) and $8·0 billion (5·9-10·3), respectively, in India in 2019. This total loss of $36·8 billion (27·4-47·7) was 1·36% of India's gross domestic product (GDP). The economic loss as a proportion of the state GDP varied 3·2 times between the states, ranging from 0·67% (0·47-0·91) to 2·15% (1·60-2·77), and was highest in the low per-capita GDP states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, and Chhattisgarh. Delhi had the highest per-capita economic loss due to air pollution, followed by Haryana in 2019, with 5·4 times variation across all states. INTERPRETATION The high burden of death and disease due to air pollution and its associated substantial adverse economic impact from loss of output could impede India's aspiration to be a $5 trillion economy by 2024. Successful reduction of air pollution in India through state-specific strategies would lead to substantial benefits for both the health of the population and the economy. FUNDING UN Environment Programme; Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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11
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Nair AA, Christopher DJ, Moidu F, Chandran D. Superior vena caval obstruction: a rare presentation of Behcet's disease. BMJ Case Rep 2020; 13:13/12/e236658. [PMID: 33334747 DOI: 10.1136/bcr-2020-236658] [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] [Indexed: 11/04/2022] Open
Abstract
A 25-year-old Indian man presented with low-grade fever followed by gradually increasing swelling of neck and face. Physical examination showed bilateral neck swelling, facial swelling and dilated veins in the upper chest. Superior vena cava (SVC) obstruction due to an underlying malignancy was suspected. CT thorax showed large saccular aneurysm with thrombosis of bilateral subclavian arteries of which the right one caused external compression of right innominate vein draining into the SVC. A history of recurrent oral and scrotal ulcers was obtained following which skin pathergy test was done, which was suggestive of a diagnosis of Behcet's disease (BD). He responded to treatment with steroids and azathioprine. This report illustrates that rare nonmalignant cause such as BD could also present with SVC obstruction.
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Affiliation(s)
- Avinash Anil Nair
- Respiratory Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - D J Christopher
- Pulmonary Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Fazil Moidu
- Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Divya Chandran
- Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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12
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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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Raina SK, Kumar R, Galwankar S, Garg S, Bhatt R, Dhariwal AC, Christopher DJ, Parekh BJ, Krishnan SV, Aggarwal P, Gilada I, Bodhankar U. Are we prepared? Lessons from Covid-19 and OMAG position paper on epidemic preparedness. J Family Med Prim Care 2020; 9:2161-2166. [PMID: 32754465 PMCID: PMC7380759 DOI: 10.4103/jfmpc.jfmpc_384_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/12/2022] Open
Abstract
Covid-19 has once again brought into focus our limited preparedness to deal with epidemics. Most nations, across the globe, have responded with a resolve to come stronger out of this crisis and leaderships across the world have shown great commitment to protecting its people from Covid-19. Covid-19 has also taught us a few things for the future. One such learning has been that a strong shift in focus towards non-communicable diseases driving health infrastructure across the globe for the last few decades has come at neglect of communicable diseases. In that sense, therefore, the current pandemic has been a wake-up call. Organised Medicine Academic Guild (OMAG), an umbrella organization of professional associations gathered a group of health experts to develop a policy document on epidemic preparedness to limit the influence of epidemics like Covid-19.
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Affiliation(s)
- Sunil Kumar Raina
- Department of Community Medicine, Dr. R.P. Government Medical College, Tanda, Himachal Pradesh, India
| | - Raman Kumar
- Academy of Family Physicians of India, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital Florida State University, Florida, USA
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Ramesh Bhatt
- Department of Dermatology, Father Muller Medical College, Manglore, Karnataka, India
| | - Akshay C Dhariwal
- National Vector Borne Disease Control Programme (NVBDCP), Directorate General of Health Services, Ministry of Health and Family Welfare, Govt. of India, Vellore, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - Bakul J Parekh
- Bakul Parekh Children's Hospital, Near Rajawadi Signal, Ghatkopar East, Mumbai, India
| | - S Vimal Krishnan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | | | - Ishwar Gilada
- India Unison Medicare and Research Centre, Alibhai Premji Marg, Grant Road-E, Mumbai, Maharashtra, India
| | - Udhay Bodhankar
- Bodhankar Childrens Hospital, Sharhari, Central Bazaar Road, Nagpur, Maharashtra, India
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14
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Dandona R, Kumar GA, Henry NJ, Joshua V, Ramji S, Gupta SS, Agrawal D, Kumar R, Lodha R, Mathai M, Kassebaum NJ, Pandey A, Wang H, Sinha A, Hemalatha R, Abdulkader RS, Agarwal V, Albert S, Biswas A, Burstein R, Chakma JK, Christopher DJ, Collison M, Dash AP, Dey S, Dicker D, Gardner W, Glenn SD, Golechha MJ, He Y, Jerath SG, Kant R, Kar A, Khera AK, Kinra S, Koul PA, Krish V, Krishnankutty RP, Kurpad AV, Kyu HH, Laxmaiah A, Mahanta J, Mahesh PA, Malhotra R, Mamidi RS, Manguerra H, Mathew JL, Mathur MR, Mehrotra R, Mukhopadhyay S, Murthy GVS, Mutreja P, Nagalla B, Nguyen G, Oommen AM, Pati A, Pati S, Perkins S, Prakash S, Purwar M, Sagar R, Sankar MJ, Saraf DS, Shukla DK, Shukla SR, Singh NP, Sreenivas V, Tandale B, Thankappan KR, Tripathi M, Tripathi S, Tripathy S, Troeger C, Varghese CM, Varughese S, Watson S, Yadav G, Zodpey S, Reddy KS, Toteja GS, Naghavi M, Lim SS, Vos T, Bekedam HJ, Swaminathan S, Murray CJL, Hay SI, Sharma RS, Dandona L. Subnational mapping of under-5 and neonatal mortality trends in India: the Global Burden of Disease Study 2000-17. Lancet 2020; 395:1640-1658. [PMID: 32413293 PMCID: PMC7262604 DOI: 10.1016/s0140-6736(20)30471-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND India has made substantial progress in improving child survival over the past few decades, but a comprehensive understanding of child mortality trends at disaggregated geographical levels is not available. We present a detailed analysis of subnational trends of child mortality to inform efforts aimed at meeting the India National Health Policy (NHP) and Sustainable Development Goal (SDG) targets for child mortality. METHODS We assessed the under-5 mortality rate (U5MR) and neonatal mortality rate (NMR) from 2000 to 2017 in 5 × 5 km grids across India, and for the districts and states of India, using all accessible data from various sources including surveys with subnational geographical information. The 31 states and groups of union territories were categorised into three groups using their Socio-demographic Index (SDI) level, calculated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study on the basis of per-capita income, mean education, and total fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using the coefficient of variation. We projected U5MR and NMR for the states and districts up to 2025 and 2030 on the basis of the trends from 2000 to 2017 and compared these projections with the NHP 2025 and SDG 2030 targets for U5MR (23 deaths and 25 deaths per 1000 livebirths, respectively) and NMR (16 deaths and 12 deaths per 1000 livebirths, respectively). We assessed the causes of child death and the contribution of risk factors to child deaths at the state level. FINDINGS U5MR in India decreased from 83·1 (95% uncertainty interval [UI] 76·7-90·1) in 2000 to 42·4 (36·5-50·0) per 1000 livebirths in 2017, and NMR from 38·0 (34·2-41·6) to 23·5 (20·1-27·8) per 1000 livebirths. U5MR varied 5·7 times between the states of India and 10·5 times between the 723 districts of India in 2017, whereas NMR varied 4·5 times and 8·0 times, respectively. In the low SDI states, 275 (88%) districts had a U5MR of 40 or more per 1000 livebirths and 291 (93%) districts had an NMR of 20 or more per 1000 livebirths in 2017. The annual rate of change from 2010 to 2017 varied among the districts from a 9·02% (95% UI 6·30-11·63) reduction to no significant change for U5MR and from an 8·05% (95% UI 5·34-10·74) reduction to no significant change for NMR. Inequality between districts within the states increased from 2000 to 2017 in 23 of the 31 states for U5MR and in 24 states for NMR, with the largest increases in Odisha and Assam among the low SDI states. If the trends observed up to 2017 were to continue, India would meet the SDG 2030 U5MR target but not the SDG 2030 NMR target or either of the NHP 2025 targets. To reach the SDG 2030 targets individually, 246 (34%) districts for U5MR and 430 (59%) districts for NMR would need a higher rate of improvement than they had up to 2017. For all major causes of under-5 death in India, the death rate decreased between 2000 and 2017, with the highest decline for infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects, although the magnitude of decline varied widely between the states. Child and maternal malnutrition was the predominant risk factor, to which 68·2% (65·8-70·7) of under-5 deaths and 83·0% (80·6-85·0) of neonatal deaths in India could be attributed in 2017; 10·8% (9·1-12·4) of under-5 deaths could be attributed to unsafe water and sanitation and 8·8% (7·0-10·3) to air pollution. INTERPRETATION India has made gains in child survival, but there are substantial variations between the states in the magnitude and rate of decline in mortality, and even higher variations between the districts of India. Inequality between districts within states has increased for the majority of the states. The district-level trends presented here can provide crucial guidance for targeted efforts needed in India to reduce child mortality to meet the Indian and global child survival targets. District-level mortality trends along with state-level trends in causes of under-5 and neonatal death and the risk factors in this Article provide a comprehensive reference for further planning of child mortality reduction in India. FUNDING Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Jasper A, Gibikote S, Kirupakaran H, Christopher DJ, Mathews P. Is routine pre-entry chest radiograph necessary in a high tuberculosis prevalence country? J Postgrad Med 2020; 66:90-93. [PMID: 32270779 PMCID: PMC7239409 DOI: 10.4103/jpgm.jpgm_462_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/11/2019] [Revised: 12/03/2019] [Accepted: 01/31/2020] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Chest radiographs have been used worldwide as a screening tool before employment and training, by various healthcare and other government and nongovernment institutions. Many studies done in the past have demonstrated a relatively low yield for tuberculosis detection and therefore, the authors have questioned this practice. AIMS To compare the value of the preadmission/employment chest radiograph in two groups, namely, those who have been previously exposed to a healthcare setting (post-exposure group) and those who have not been exposed (pre-exposure group) and to determine if there is a significant difference in tuberculosis detection between these two groups. SETTINGS AND DESIGN A retrospective review of the reports of the chest radiographs of all candidates appearing for admission to various undergraduate and postgraduate courses in our institute between 2014 and 2017 was performed. MATERIALS AND METHODS The various abnormalities detected were recorded and the findings in the two groups were compared. STATISTICAL ANALYSIS USED Chi-square test was used to compare between two group proportions. RESULTS Thirty out of 4333 (0.69%) candidates in the pre-exposure group and 53 out of 3379 (1.57%) candidates in the post-exposure group showed abnormalities on chest radiographs involving the lung parenchyma, mediastinum, heart, or pleura. In the pre-exposure group, six (0.14%) were found to have underlying cardiac disease and one (0.02%) had tuberculosis. Among the six candidates in the post-exposure group who underwent further investigations in our institute, five (0.15%) were diagnosed to have tuberculosis. Although there was no statistically significant difference in tuberculosis detection between the groups (P = 0.051), there is a trend towards higher detection of tuberculosis in the post-exposure group. CONCLUSIONS In a country where the prevalence of tuberculosis is high, the pre-employment chest radiograph may still have a role in detecting tuberculosis in the post-exposure group.
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Affiliation(s)
- A Jasper
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - S Gibikote
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - H Kirupakaran
- Department of Staff-Student Health Services, Christian Medical College, Vellore, Tamil Nadu, India
| | - DJ Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - P Mathews
- Department of Geriatric Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Dhar R, Ghoshal AG, Guleria R, Sharma S, Kulkarni T, Swarnakar R, Samaria JK, Chaudhary S, Gaur SN, Christopher DJ, Singh V, Abraham G, Sarkar A, Mukhopadhyay A, Panda J, Swaminathan S, Nene A, Krishnan S, Shahi PK, Sarangdhar N, Mishra N, Chowdury SR, Halder I, Katiyar SK, Jain VK, Chawla R, Koul PA. Clinical practice guidelines 2019: Indian consensus-based recommendations on influenza vaccination in adults. Lung India 2020; 37:S4-S18. [PMID: 32830789 PMCID: PMC7703812 DOI: 10.4103/lungindia.lungindia_270_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/21/2023] Open
Abstract
Influenza, a common cause of acute respiratory infections, is an important health problem worldwide, including in India. Influenza is associated with several complications; people with comorbidities and the elderly are at a higher risk for such complications. Moreover, the influenza virus constantly changes genetically, thereby worsening therapeutic outcomes. Vaccination is an effective measure for the prevention of influenza. Despite the availability of global guidelines on influenza vaccination in adults, country-specific guidelines based on regional variation in disease burden are required for better disease management in India. With this aim, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The discussion was aimed at delineating evidence-based recommendations on adult influenza vaccination in India. The present article discusses expert recommendations on clinical practice guidelines to be followed in India for adult influenza vaccination, for better management of the disease burden.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, Fortis Hospital, Kolkata, West Bengal, India
| | - Aloke Gopal Ghoshal
- Department of Pulmonary Medicine, National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shubham Sharma
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Tarang Kulkarni
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care and Sleep Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - J K Samaria
- Department of TB and Chest Diseases, Centre for Research and Treatment of Allergy, Asthma and Bronchitis, Varanasi, Uttar Pradesh, India
| | - Sudhir Chaudhary
- Department of Pulmonology, Kulwanti Hospitals and Research Center, Kanpur, Uttar Pradesh, India
| | - S N Gaur
- Department of Respiratory Medicine and Tuberculosis, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Asthma Bhawan, Shastri Nagar, Jaipur, Rajasthan, India
| | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Anirban Sarkar
- Department of Pulmonology, Zenith Superspeciality Hospital, Kolkata, West Bengal, India
| | - Ansuman Mukhopadhyay
- Department of Pulmonology, National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Jayant Panda
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | | | - Amita Nene
- Department of Chest Medicine, Bombay Hospital, Mumbai, Maharashtra, India
| | - Shyam Krishnan
- Department of Chest Medicine, Apollo Hospital, Bengaluru, Karnataka, India
| | - Praveen Kumar Shahi
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, Lung Clinica, Andheri West Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, MKCG Medical College, Berhampur, Odisha, India
| | | | - Indranil Halder
- Department of Pulmonary Medicine, College Of Medicine & JNM Hospital, Kalyani, Nadia, Uttar Pradesh, India
| | - S K Katiyar
- Chest Care Center, Kanpur, Uttar Pradesh, India
| | - V K Jain
- Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Rakesh Chawla
- Dr Rakesh Chawla's Chest, Asthma Allergy and Sleep Clinic, Delhi, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Dhar R, Ghoshal AG, Guleria R, Sharma S, Kulkarni T, Swarnakar R, Samaria JK, Chaudhary S, Gaur SN, Christopher DJ, Singh V, Abraham G, Sarkar A, Mukhopadhyay A, Panda J, Swaminathan S, Nene A, Krishnan S, Shahi PK, Sarangdhar N, Mishra N, Chowdury SR, Halder I, Katiyar SK, Jain VK, Chawla R, Koul PA. Clinical practice guidelines 2019: Indian consensus-based recommendations on pneumococcal vaccination for adults. Lung India 2020; 37:S19-S29. [PMID: 32830790 PMCID: PMC7703813 DOI: 10.4103/lungindia.lungindia_272_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/14/2022] Open
Abstract
Similar to the global scenario, pneumococcal diseases are a significant health concern in India. Pneumococcal diseases occur frequently among adults and are largely preventable through vaccines. Globally, several guidelines and recommendations are available for pneumococcal vaccination in adults. However, owing to wide variations in the disease burden, regulatory landscape, and health-care system in India, such global guidelines cannot be unconditionally implemented throughout the country. To address these gaps, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The aim of the discussion was to lay down specific evidence-based recommendations on adult pneumococcal vaccination for the country, with a view to further ameliorate the disease burden in the country. This article presents an overview of the closed-door discussion by the expert members on clinical practice guidelines to be followed for adult pneumococcal vaccination in India.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, Fortis Hospital, Kolkata, West Bengal, India
| | - Aloke Gopal Ghoshal
- Department of Pulmonary Medicine, National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shubham Sharma
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Tarang Kulkarni
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care and Sleep Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - J K Samaria
- Department of TB and Chest Diseases, Centre for Research and Treatment of Allergy, Asthma and Bronchitis, Varanasi, Uttar Pradesh, India
| | - Sudhir Chaudhary
- Department of Pulmonology, Kulwanti Hospitals and Research Center, Kanpur, Uttar Pradesh, India
| | - S N Gaur
- Department of Respiratory Medicine and Tuberculosis, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Asthma Bhawan, Shastri Nagar, Jaipur, Rajasthan, India
| | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Anirban Sarkar
- Department of Pulmonology, Zenith Superspeciality Hospital, Kolkata, West Bengal, India
| | - Ansuman Mukhopadhyay
- Department of Pulmonology, National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Jayant Panda
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | | | - Amita Nene
- Department of Chest Medicine, Bombay Hospital, Mumbai, Maharashtra, India
| | - Shyam Krishnan
- Department of Chest Medicine, Apollo Hospital, Bengaluru, Karnataka, India
| | - Praveen Kumar Shahi
- Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, Lung Clinica, Andheri West Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, MKCG Medical College, Berhampur, Odisha, India
| | | | - Indranil Halder
- Department of Pulmonary Medicine, College Of Medicine & JNM Hospital, Kalyani, Nadia, Uttar Pradesh, India
| | - S K Katiyar
- Chest Care Center, Kanpur, Uttar Pradesh, India
| | - V K Jain
- Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Rakesh Chawla
- Dr Rakesh Chawla's Chest, Asthma Allergy and Sleep Clinic, Delhi, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Bhatt AN, Tharyan P, Michael JS, Christopher DJ, Varghese GM, Sathyendra S, Rajan SJ, George K, Prasad JH. Treatment outcomes with daily self-administered treatment and thrice-weekly directly-observed treatment in two cohorts of newly-diagnosed, sputum-positive adults with pulmonary tuberculosis. Indian J Tuberc 2020; 67:105-111. [PMID: 32192603 DOI: 10.1016/j.ijtb.2017.05.012] [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: 01/10/2017] [Accepted: 05/11/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Revised National Tuberculosis Control Program (RNTCP) envisages shifting from thrice-weekly to a daily anti-tuberculosis treatment (ATT) regimen. The potential merits and demerits of both regimens continue to be debated. METHODS This retrospective study compared treatment outcomes in 191 HIV-negative, newly diagnosed, sputum-positive adults with pulmonary tuberculosis from Vellore district of Tamil Nadu who were treated at a private medical college during 2009 to 2012 with intermittent Directly Observed Treatment Short Course (intermittent DOTS cohort, n=132) or who opted for daily Self-Administered Treatment (daily SAT cohort, n=59). Treatment outcomes obtained from medical records were supplemented by interviews with consenting, traceable patients. RESULTS The rates for the RNTCP-recommended sputum smear examinations were suboptimal (42% for daily SAT and 72% for intermittent DOTS). However, treatment success with daily SAT and intermittent DOTS (76.2% vs. 70.4%); default (11.9% vs. 18.2%); death (6.8% vs. 5.3%); treatment failure (5.1% vs. 4.6%); and relapse (0% vs. 1.5%) did not significantly differ. CONCLUSIONS While evaluable treatment outcomes were not significantly different with daily SAT and intermittent DOTS, rates for timely smear examinations and for treatment success were lower, and for default higher, in both cohorts than comparable RNTCP data from Vellore district. Further strengthening of RNTCP facilities within private medical colleges and regular, real-time audits of performance and outcomes are needed if daily ATT regimen under the RNTCP is to succeed.
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Affiliation(s)
- Arun N Bhatt
- Post Graduate Resident, Community Health Department, Christian Medical College, Vellore 632002, Tamil Nadu, India
| | - Prathap Tharyan
- Professor & Director, B. V. Moses Centre for Evidence-Informed Health Care & Health Policy, Christian Medical College, Vellore, India
| | - Joy S Michael
- Professor, Department of Microbiology, Christian Medical College, Vellore, India
| | - D J Christopher
- Professor, Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - George M Varghese
- Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Sowmya Sathyendra
- Associate Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Sudha Jasmine Rajan
- Associate Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Kuryan George
- Professor, Department of Community Health, Christian Medical College, Vellore, India
| | - Jasmin Helan Prasad
- Professor, Department of Community Health, Christian Medical College, Vellore, India.
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19
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Paul A, Christopher DJ, Thangakunam B. The puzzle of lymphoma among the granulomatous disorders. Lung India 2019; 36:164-166. [PMID: 30829255 PMCID: PMC6410593 DOI: 10.4103/lungindia.lungindia_395_17] [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: 11/06/2022] Open
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20
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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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Balakrishnan K, Dey S, Gupta T, Dhaliwal RS, Brauer M, Cohen AJ, Stanaway JD, Beig G, Joshi TK, Aggarwal AN, Sabde Y, Sadhu H, Frostad J, Causey K, Godwin W, Shukla DK, Kumar GA, Varghese CM, Muraleedharan P, Agrawal A, Anjana RM, Bhansali A, Bhardwaj D, Burkart K, Cercy K, Chakma JK, Chowdhury S, Christopher DJ, Dutta E, Furtado M, Ghosh S, Ghoshal AG, Glenn SD, Guleria R, Gupta R, Jeemon P, Kant R, Kant S, Kaur T, Koul PA, Krish V, Krishna B, Larson SL, Madhipatla K, Mahesh PA, Mohan V, Mukhopadhyay S, Mutreja P, Naik N, Nair S, Nguyen G, Odell CM, Pandian JD, Prabhakaran D, Prabhakaran P, Roy A, Salvi S, Sambandam S, Saraf D, Sharma M, Shrivastava A, Singh V, Tandon N, Thomas NJ, Torre A, Xavier D, Yadav G, Singh S, Shekhar C, Vos T, Dandona R, Reddy KS, Lim SS, Murray CJL, Venkatesh S, Dandona L. The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017. Lancet Planet Health 2019; 3:e26-e39. [PMID: 30528905 PMCID: PMC6358127 DOI: 10.1016/s2542-5196(18)30261-4] [Citation(s) in RCA: 260] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/18/2018] [Accepted: 11/02/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017. METHODS We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure-response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss. FINDINGS The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0-112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. The proportion of population using solid fuels in India was 55·5% (54·8-56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09-1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55-0·79) from ambient particulate matter pollution and 0·48 million (0·39-0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6-1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana. INTERPRETATION India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state. FUNDING Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Christopher DJ. Manual of tuberculosis. Indian J Med Res 2017. [PMCID: PMC5719600 DOI: 10.4103/0971-5916.219022] [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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Abstract
A 33-year-old patient, Known case of chronic kidney disease on maintenance dialysis presented with complaints of low-grade fever and weight loss of 2 months duration. Computed tomography (CT) revealed bilateral mild pleural effusion with significant mediastinal and abdominal adenopathy. CT-guided fine-needle aspiration cytology of abdominal lymph nodes and bone marrow culture was suggestive of tuberculosis. The patient was started on four drug anti-tubercular therapy, post 6 weeks of initiation he developed new onset fever and chest X-ray revealed moderate right pleural effusion. Diagnostic thoracocentesis was suggestive of chylothorax. To the best of our knowledge, this is the first case report of chylothorax due to the paradoxical reaction in the HIV-negative tuberculous patient.
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Affiliation(s)
| | - S Saheer
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - T Balamugesh
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Ramachandran K, Thankagunam B, Karuppusami R, Christopher DJ. Physician Related Delays in the Diagnosis of Lung Cancer in India. J Clin Diagn Res 2016; 10:OC05-OC08. [PMID: 28050418 DOI: 10.7860/jcdr/2016/22737.8823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/26/2016] [Accepted: 09/02/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Lung cancer is associated with a poor prognosis, if detected late in the disease course. Delay in seeking health care, wrong diagnosis and delay in specialist referral can contribute to delay in diagnosis. AIM This study was done to assess physician related delays in the diagnosis of lung cancer and the treatments given before presenting to our center. MATERIALS AND METHODS A total of 96 consecutive patients diagnosed with lung cancer were enrolled in this study. Details of previous physician consultations, their specialization, diagnoses made and treatments given were obtained from records available with the patients. RESULTS Patients, on an average consulted two physicians before presenting to our center. Less than half of the physicians (45%) suspected lung cancer during their evaluation. Around 18% of physicians made an incorrect diagnosis of tuberculosis, out of whom, 88.6% had prescribed anti-tuberculous therapy. Only 27% of physicians referred the patients to higher medical centres for evaluation. Pulmonology Specialists (PS) were the most likely to diagnose lung cancer (p<0.0001). General Medicine Specialists (GMS) were the most likely to misdiagnose cancer as tuberculosis, followed by General Practioners (GP) when compared to PS (p-value =0.0422). CONCLUSION Our study demonstrates that, many physicians have a low index of suspicion to diagnose lung malignancy and most commonly misdiagnose it as tuberculosis. It is likely that most patients failed to seek the services of PS directly or through referral either due to a shortage of PS or due to other reasons.
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Affiliation(s)
- Krishnappriya Ramachandran
- Assistant Professor, Department of Respiratory Medicine, Meenakshi Medical College Hospital and Research Institute , Enathur, Kanchipuram, Tamil Nadu, India
| | - Balamugesh Thankagunam
- Professor, Department of Pulmonary Medicine, Christian Medical College and Hospital , Vellore, Tamil Nadu, India
| | - Reka Karuppusami
- Senior Demonstrator, Department of Biostatistics, Christian Medical College and Hospital , Vellore, Tamil Nadu, India
| | - D J Christopher
- Professor and Head, Department of Pulmonary Medicine, Christian Medical College and Hospital , Vellore, Tamil Nadu, India
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Abstract
Owing to the burden of multidrug-resistant tuberculosis, molecular techniques have been approved by the WHO for the rapid diagnosis of the same. The objectives of this prospective, diagnostic study, conducted at Christian Medical College, a tertiary care center in South India, were to compare the performance of line probe assay (GenoTypeMTBDRplus) with culture, as well as the Xpert MTB/Rif assay on sputum samples. Ninety-one consecutive suspects of multidrug-resistant pulmonary tuberculosis patients from January 2013 to June 2013 were enrolled in this study and the results of line probe assay compared to culture and Xpert MTB/Rif. Compared to culture, the assay demonstrated a sensitivity and specificity of 81.5% (95%CI 67.4-91.1%) and 87.5% (95%CI 71-96.5%) for the detection of tuberculosis, with sensitivity and specificity of 100% (95%CI 85.2-100%) and 93.8% (95%CI 69.8-99.8%), respectively, for rifampicin resistance. For isoniazid resistance, sensitivity and specificity were 89.3% (95%CI 71.8-97.7%) and 100% (95%CI 71.5-100%), respectively. Compared to Xpert MTB/Rif assay, the assay showed a sensitivity of 80% (95%CI 68.2-88.9%) and specificity of 100% (95%CI 85.8-100%) for the detection of tuberculosis a sensitivity of 94.3% (95%CI 80.8-99.3%) and specificity of 94.1% (95%CI 71.3-99.9%) for rifampicin resistance was attained. This assay performed well on smear positive samples, but poorly on smear negative and scanty samples, and can serve as a rapid diagnostic tool, particularly in isoniazid monoresistant cases of tuberculosis, which are not diagnosed by Xpert MTB/Rif.
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Affiliation(s)
- Marilyn M Ninan
- Department of Microbiology, Christian Medical College and Hospital, Vellore, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, India
| | - D. J. Christopher
- Department of Pulmonary Medicine, Christian Medical College and Hospital, Vellore, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, India
| | - Joy S. Michael
- Department of Microbiology, Christian Medical College and Hospital, Vellore, India
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Schumacher SG, Thangakunam B, Denkinger CM, Oliver AA, Shakti KB, Qin ZZ, Michael JS, Luo R, Pai M, Christopher DJ. Impact of point-of-care implementation of Xpert ® MTB/RIF: product vs. process innovation. Int J Tuberc Lung Dis 2015; 19:1084-90. [DOI: 10.5588/ijtld.15.0120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Saheer S, Immanuel S, Balamugesh T, Christopher DJ. Disseminated Salmonella Infection Coexisting with Thymoma. Indian J Chest Dis Allied Sci 2015; 57:39-40. [PMID: 26410983] [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
A 21-year-old boy presented with high grade fever, diffuse chest pain and exertional breathlessness of one month duration. Radiologically he had a large lobulated anterior mediastinal mass with necrotic thick enhancing septaes. Histopathology of the mass was suggestive of thymoma and culture from the necrotic aspirate yielded Salmonella typhi. The same pathogen was isolated in subsequent blood and sputum cultures. This current report describes the rare association of salmonella infection with thymoma.
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Zwerling A, Pai M, Michael JS, Christopher DJ. Serial testing using interferon- release assays in nursing students in India. Eur Respir J 2014; 44:257-60. [DOI: 10.1183/09031936.00011914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Singh RK, Thangakunam B, Isaac B, Christopher DJ. Cannonball shadow in the lungs and pulmonary embolism in a young man. BMJ Case Rep 2013; 2013:bcr-2012-007541. [PMID: 23853007 DOI: 10.1136/bcr-2012-007541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ranjit Kumar Singh
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
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Nambiar A, Christopher DJ, Mammen J, David T, Kang G, David S. Informed consent among nursing students participating in biomedical research. Indian J Med Ethics 2013; 9:186-9. [PMID: 22864079 DOI: 10.20529/ijme.2012.062] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For consent in biomedical research, it is essential that research participants understand the need for research, the study protocol, the risk and benefits of participation, the freedom to participate or decline and the right to leave the study at any time. A structured questionnaire was used to assess understanding and knowledge among nursing trainees participating in a cohort study investigating exposure and latent tuberculosis at a tertiary care hospital. Data were collected for 138 participants. While 97% were aware of their enrollment into a research protocol, only 78% could state that it was a study on tuberculosis. Approximately two-thirds were aware of plans for blood collection, but not all of them knew the timings or number of samples. The majority (59%) participants had consulted others before making the decision to participate, and only 73% felt that their participation was completely voluntary. Even among healthcare trainees, emphasis needs to be placed on testing both the knowledge and understanding of participants to ensure the principle and practice of truly informed consent.
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Affiliation(s)
- Anupama Nambiar
- Centre for Stem Cell Research, Christian Medical College, Vellore, Tamil Nadu, India.
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Suzana S, Shalini B, Rupali P, Venkatesh K, Christopher DJ, Michael JS. Rapid diagnosis of extra pulmonary tuberculosis by automated Xpert MTB/RIF assay. BMC Infect Dis 2012. [PMCID: PMC3344727 DOI: 10.1186/1471-2334-12-s1-p32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Thomas R, Christopher DJ, Balamugesh T, James P, Thomas M. Endobronchial pulmonary cryptococcosis and tuberculosis in an immunocompetent host. Singapore Med J 2012; 53:e32-e34. [PMID: 22337198] [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: 05/31/2023]
Abstract
Pulmonary cryptococcosis presenting as an endobronchial tumour-like growth has rarely been described. We report the case of a male patient with normal immune function who presented with a right upper lobe mass lesion. Bronchoscopy revealed a tumour-like growth that completely occluded the anterior segment of the right upper lobe bronchus. Bronchial biopsy and computed tomography-guided lung biopsy revealed Cryptococcus, and culture of lung biopsy specimen grew Cryptococcus neoformans and Mycobacterium tuberculosis. The patient responded clinically to amphotericin B, fluconazole and anti-tuberculous therapy. However, chest radiographic response was unremarkable. A presentation of pulmonary cryptococcosis and tuberculosis, along with endobronchial tumour-like growth in the same patient, is unusual and has not been previously described.
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Affiliation(s)
- R Thomas
- Department of Pulmonary Medicine, Christian Medical College, Vellore 632002, Tamil Nadu, India
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Abstract
Common differential diagnosis of lung and hilar opacity includes infectious pathology or a mitotic lesion. Behcet's disease (BD) is a rarely diagnosed disease in Indian subcontinent. BD is a multisystem inflammatory disorder that presents with recurrent orogenital ulceration, uveitis, and erythema nodosum. We present here the case of a patient who presented with recurrent hemoptysis with radiological picture of hilar mass, during the evaluation of which the diagnosis of BD was established.
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Affiliation(s)
- Asmita A Mehta
- Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Mehta AA, Gupta R, Balamugesh T, Christopher DJ. Chylous ascites and chylothorax: a case study. Libyan J Med 2010; 5. [PMID: 21483569 PMCID: PMC3066756 DOI: 10.3402/ljm.v5i0.5298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 07/01/2010] [Accepted: 08/14/2010] [Indexed: 11/25/2022] Open
Affiliation(s)
- Asmita A Mehta
- Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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James P, Gupta R, Christopher DJ, Balamugesh T. Evaluation of the diagnostic yield and safety of closed pleural biopsy in the diagnosis of pleural effusion. Indian J Tuberc 2010; 57:19-24. [PMID: 20420040] [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]
Abstract
AIM To assess the diagnostic yield and safety of closed pleural biopsy in patients with pleural effusion. METHODS In all, 48 consecutive cases of pleural effusion were evaluated with complete pleural fluid biochemical and microbiological analysis, cytology, routine bacterial and mycobacterial cultures. In all these 48 cases of pleural effusion closed pleural biopsy was done with tru-cut biopsy needle and biopsy samples were sent for histopathology and mycobacterial culture. RESULTS Out of 48 cases, main causes of pleural effusion were Tuberculosis in 21(43.8%) cases, Malignancy in 14 (29.2%) cases, paramalignant effusion in six (12.5%) cases, Empyema in three (6.3%) cases, transudative effusion in three (6.3%) cases and parapneumonic effusion in one (1.9%) case. Diagnostic yield of closed pleural biopsy was 62.2% in cases of all exudative pleural effusion, 76.2% in cases of tubercular pleural effusion and 85.7% in cases of malignant pleural effusion. There was no incidence of post pleural biopsy pneumothorax or hemothorax, underlining the safety of pleural biopsy procedure. CONCLUSION Closed pleural biopsy provides the highest diagnostic yield in cases of pleural tuberculosis and malignancy, the two most important causes of exudative pleural effusion. In view of low cost, easy availability and very low complication rates, it is a very important diagnostic tool in the hands of a trained pulmonary physician in India.
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Affiliation(s)
- Prince James
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu.
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James P, Christopher DJ, Balamugesh T, Gupta R. Death of a health care worker with nosocomial extensively drug-resistant tuberculosis in India. Int J Tuberc Lung Dis 2009; 13:795-796. [PMID: 19460260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Thangakunam B, Christopher DJ, Kurian S, Thomas R, James P. Endogenous excess cortisol production and diabetes mellitus as predisposing factors for pulmonary cryptococcosis: a case report and literature review. Lung India 2008; 25:155-7. [PMID: 21264083 PMCID: PMC3019345 DOI: 10.4103/0970-2113.45281] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pulmonary cryptococcosis usually occurs as an opportunistic infection in immunocompromised patients. Endogenous Cushing's syndrome is associated with cortisol excess and can predispose to development of cryptococcal infections. We report a case of diabetic patient with ACTH secreting pituitary tumour who developed a cavitating lung mass. Computed tomography-guided biopsy of the lesion revealed mucicarminophilic budding forms of cryptococcus. Broncheoalveolar lavage culture grew Cryptococcus neoformans. There was radiological response to treatment with liposomal Amphotericin, but patient ultimately succumbed to septicemia and multiorgan failure. Opportunistic infections with organisms like Cryptococcus neoformans, should be considered in patients with endogenous Cushing's syndrome and a pulmonary infiltrate.
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Affiliation(s)
- B Thangakunam
- Department of Pulmonary Medicine and Pathology , Christian Medical College, Vellore, Tamil Nadu, India
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Balamugesh T, Christopher DJ, George B, Rajesh T. Strongyloidosis hyperinfection in a neutropenic host diagnosed by bronchoalveolar lavage. Indian J Chest Dis Allied Sci 2007; 49:37-9. [PMID: 17256565] [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: 05/13/2023]
Abstract
Opportunistic disseminated strongyloidosis is an important cause of morbidity and mortality in immunocompromised patients. In addition to a high index of clinical suspicion, alerting the microbiologist will help in diagnosing this condition early and institute therapy. We report a 51-year-old male who developed pulmonary infiltrates during the period of chemotherapy-induced neutropenia. Strongyloidosis larvae were found on bronchoalveolar lavage fluid and stool specimens. The patient responded to treatment with albendazole.
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Affiliation(s)
- T Balamugesh
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
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Ayyappan AP, Thomas R, Kurian S, Christopher DJ, Cherian R. Multiple cavitating masses in an immunocompromised host with rheumatoid arthritis-related interstitial lung disease: an unusual expression of cytomegalovirus pneumonitis. Br J Radiol 2006; 79:e174-6. [PMID: 17065281 DOI: 10.1259/bjr/17487872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cytomegalovirus is a known opportunistic infection in immunocompromised individuals. We document multiple cavitating lung masses caused by cytomegalovirus in a patient with rheumatoid arthritis-induced interstitial lung disease on immunosuppressant medication, an unusual expression of CMV pneumonitis. With increasing use of immunosuppressive therapy and increase in AIDS, pulmonary cytomegalovirus infection is expected to be a more frequently encountered disease and familiarity with its uncommon radiological manifestations will be advantageous.
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Affiliation(s)
- A P Ayyappan
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632 004 India.
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Thomas R, Christopher DJ, Roy A, Rose A, Chandy ST, Cherian RA, Rima J. Chylothorax following Innominate Vein Thrombosis: A Rare Complication of Transvenous Pacemaker Implantation. Respiration 2005; 72:546-8. [PMID: 16210897 DOI: 10.1159/000087683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Accepted: 05/18/2004] [Indexed: 11/19/2022] Open
Abstract
A case of chylothorax following innominate vein thrombosis, which developed as a late complication of transvenous pacemaker implantation, is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. The aetiological workup showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge this is the first report of a case of this nature.
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Affiliation(s)
- Rajesh Thomas
- Department of Pulmonary Medicine, The Christian Medical College, Vellore, India
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Thomas R, Christopher DJ, Roy A, Rose A, Chandy ST, Cherian RA, Rima J. Chylothorax following Innominate Vein Thrombosis – A Rare Complication of Transvenous Pacemaker Implantation. Respiration 2005; 74:338-40. [PMID: 17561535 DOI: 10.1159/000087365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A case of chylothorax following innominate vein thrombosis which developed as a late complication of transvenous pacemaker implantation is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be a chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. Aetiological work-up showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge, this is the first report of a case of this nature.
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Affiliation(s)
- Rajesh Thomas
- Department of Pulmonary Medicine, The Christian Medical College, Vellore, India
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Balamugesh T, Christopher DJ, Rajesh T, Prince J. Fibrinolysis of loculated pleural effusion in malignant mesothelioma. Singapore Med J 2004; 45:594-5. [PMID: 15568123] [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: 05/01/2023]
Abstract
Surgical resection is not feasible in most cases of malignant mesothelioma and palliation of symptoms remains the mainstay of treatment. When a pleural effusion is loculated, the standard treatment methods of intercostal tube drainage and pleurodesis may not be helpful. We report a 49-year-old man with malignant mesothelioma in whom intrapleural fibrinolysis was performed using streptokinase. It was successful in breaking the locules and draining the effusion. Intrapleural fibrinolysis should be considered in cases of loculated pleural effusion due to malignant mesothelioma, as it may provide symptom relief and palliation.
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Affiliation(s)
- T Balamugesh
- Department of Pulmonary Medicine, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India.
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Khan S, Roy A, Christopher DJ, Cherian AM. Prevalence of bronchial asthma among bank employees of Vellore using questionnaire-based data. J Indian Med Assoc 2002; 100:643-4, 655. [PMID: 12797634] [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: 03/03/2023]
Abstract
Asthma and related allergic disorders are reported to be rare in poor and developing countries and their prevalence is expected to rise with urbanisation. Investigation was carried to see the prevalence of asthma and asthma-related symptoms by using a simple questionnaire-based data collection. One hundred and twenty bank employees were studied in the age group 25-55 years in 4 centres of Vellore town. A one-page questionnaire in English regarding asthma and allergic symptoms was used to assess the prevalence and the details of medical care utilisation by those who were asthmatics. The prevalence of self-reported bronchial asthma was 8.3% and that of asthma-related symptoms 15.8%. A significant number of subjects with symptoms suggestive of asthma self-reported themselves as non-asthmatic. There was a significant association between those who had symptoms of asthma and a positive family history of asthma. Most of the asthmatic subjects using allopathic medicines reported a poor quality of life, despite treatment. The prevalence of asthma in Vellore town is more than that reported in other studies carried out at different centres in India. The prevalence may actually be higher since a significant number of subjects with symptoms suggestive of asthma reported themselves as non-asthmatic subjects. As expected, positive family history was forthcoming in subjects with asthma symptoms. Most asthmatic subjects have not experienced a significant improvement in their quality of life, which could indicate sub-optimal management. These findings can form the basis for further studies to investigate factors that lead to these variations.
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Affiliation(s)
- Sujoy Khan
- Department of Pulmonary Medicine, Christian Medical College, Vellore 632004
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Ruffin RE, Wilson DH, Chittleborough CR, Southcott AM, Smith B, Christopher DJ. Multiple respiratory symptoms predict quality of life in chronic lung disease: a population-based study of Australian adults. Qual Life Res 2001; 9:1031-9. [PMID: 11332224 DOI: 10.1023/a:1016689729722] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVES Previous studies have shown that it is possible to improve the health-related quality of life (HRQoL) of chronic lung disease (CLD) patients without a concurrent change in morbidity. A valid CLD index that discriminates between different levels of CLD severity and is associated with HRQoL status is an important tool for primary care settings. In this study a symptom-based CLD index was assessed for its validity and relationship with HRQoL in a representative Australian population sample. The study also measured the prevalence of self-reported CLD. DESIGN Representative population survey of adults aged 18 years and over using a multistage, systematic, clustered area sample. SETTING Metropolitan Adelaide and country centres in South Australia with a population of over 1000 persons. PARTICIPANTS Three hundred twenty-nine adults with CLD identified through a representative population survey of 3010 South Australians. MEASUREMENTS AND RESULTS The CLD index and the SF-36 were administered to participants to assess the association between each subscale of the CLD index with each HRQoL scale. The CLD index was also used to assess the prevalence of CLD and the distribution of severity in self-reported CLD in the South Australian population. Each symptom sub-scale of the CLD index was significantly correlated with all scales of the SF-36. The prevalence of CLD as measured by the CLD index was 7.7% (mild), 2.2% (moderate) and 1.0% (severe). CONCLUSIONS In the Australian context the CLD index is a reliable patient interview instrument that can be used to assess the effects of CLD on general HRQoL, improve assessment, and lead to interventions for physicians and their patients.
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Affiliation(s)
- R E Ruffin
- Department of Medicine, University of Adelaide, Queen Elizabeth Hospital Campus, South Australia, Australia.
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Subhash HS, Christopher DJ, Roy A, Cherian AM. Pulmonary nocardiosis in human immunodeficiency virus infection: a tuberculosis mimic. J Postgrad Med 2001; 47:30-2. [PMID: 11590288] [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: 02/21/2023] Open
Abstract
Patients with human immunodeficiency virus (HIV) infection are prone to develop pulmonary infections like nocardiosis. It is often misdiagnosed as pulmonary tuberculosis since the manifestations are similar. A twenty-seven years old male presented with fever, cough with expectoration and weight loss for two months. Chest radiograph showed opacity in the right mid zones. Sputum smears were negative for acid fast bacilli (AFB) and revealed gram positive branching filamentous organisms resembling Nocardia species. Subsequently, Nocardia was grown on sputum culture. HIV antibody was positive by ELISA test. He was treated with co-trimoxazole. If sputum is repeatedly tested negative for AFB in the setting of radiological suspicion of tuberculosis, testing for Nocardia species should be considered in the HIV-infected patients.
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Affiliation(s)
- H S Subhash
- Department of Medicine and Respiratory Medicine, Christian Medical College and Hospital, Vellore - 632 004, Tamilnadu, India.
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Christopher DJ, Peter JV, Cherian AM. Blind pleural biopsy using a Tru-cut needle in moderate to large pleural effusion--an experience. Singapore Med J 1998; 39:196-9. [PMID: 9713223] [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: 02/08/2023]
Abstract
BACKGROUND Pleural biopsy is invaluable for the etiological diagnosis of pleural diseases in the presence of an exudative pleural effusion. Conventionally, pleural biopsy is either performed with the Cope's or the Abrams pleural biopsy needles. A few investigators have used the Tru-cut biopsy needle with or without ultrasound guidance. We report our experience in performing closed pleural biopsy using a Tru-cut needle without ultrasound guidance in moderate to large exudative pleural effusion. We used a perpendicular approach to biopsy the pleura instead of the tangential approach described earlier. METHODS Closed Tru-cut biopsy was performed in 27 consecutive patients with exudative pleural effusion who volunteered to undergo the procedure. The biopsy specimen was sent for histopathology. Pleural fluid analysis and other relevant investigations required to obtain a specific diagnosis were carried out. RESULTS A specific diagnosis of tuberculosis was obtained on histopathology of pleural tissue in 12 out of 16 patients (diagnostic yield 75%) and in 5 out of 7 patients with malignancy (diagnostic yield 71%). Among the other 4 patients, other causes of exudative pleural effusion were detected in 3 and in 1 patient, no specific diagnosis could be made, despite extensive investigation. CONCLUSION Closed pleural biopsy using a Tru-cut needle is effective for the specific diagnosis of exudative pleural effusion. The use of a perpendicular approach to biopsy the pleura does not seem to increase the complication in moderate to large pleural effusion.
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Affiliation(s)
- D J Christopher
- Department of Thoracic Medicine & Medicine Unit-II, Christian Medical College & Hospital, Vellore
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Thomas RV, Christopher DJ, Nair S, Seshadri MS, Cherian AM. Behcet's disease: a case report. J Indian Med Assoc 1995; 93:151-153. [PMID: 8699044] [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: 05/22/2023]
Affiliation(s)
- R V Thomas
- Department of Medicine II, Christian Medical College and Hospital, Vellore
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Ray D, Christopher DJ, Jairaj PS. Giant emphysematous bullae of the lung. Indian J Chest Dis Allied Sci 1992; 34:219-23. [PMID: 1302756] [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: 12/26/2022]
Abstract
Emphysematous bullae may at times assume large proportions. We report a case of symptomatic giant bullae in a female which were removed surgically. The relevant literature has also been reviewed.
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Affiliation(s)
- D Ray
- Department of Chest Diseases, Christian Medical College, Vellore
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