Department Of Pulmonary Medicine Research Articles

Acute Autoimmune Leukoencephalopathy Secondary to Adalimumab Therapy

Department of Pulmonary, Critical care and Sleep Medicine, University at Buffalo, The State University of New York, Buffalo, NY The author has no conflict of interest to declare.

A Study on Treatment Defaulters in Tuberculosis Patients on Dots Therapy

Tuberculosis is an infectious airborne, chronic granulomatous bacterial disease which requires a prolonged treatment to get a complete cure and prevent death, relapse, resistance to drugs and spreading it to the community. Present study was focused on treatment defaulters among tuberculosis patients receiving dots therapy. A prospective observational study was carried out in the in-patient and outpatient department of pulmonary medicine and other departments with dots referral in a hospital setting for a period of eight months from September 2017- April 2018. During the study period all the patients who was administered with dots therapy for the treatment of tuberculosis were enrolled as per the study criteria. All the patients were interviewed to know there treatment status and also monitored there ADR to check compliance with dots therapy. All the datas were analyzed using descriptive statistics. Out of 90 patients, 21 patients interrupted the treatment, of which 12 were defaulters. The overall percentage of the default to the treatment was 13.3%. The case fatality rate was 4.4%. The mean age of defaulting was found to be 53.3 years and the highest percentage were in the age group 50-65years. Male patients, rural domicile, patients pursuing primary education, pulmonary TB patients were high among the defaulters. Distance (58.3%) transportation (25%), staying alone (16.7%), workload (25%) were the general problems felt by the defaulters. 41.7% were dissatisfied with the behavior of dots provider and 50% of them did not have family support. Patients interrupted treatment in there early phases (41.7% in intensive phase and 58% in early continuous phase). The reasons to default were feeling of wellbeing after the treatment (41.7%), side effects (25.0%). Migration, non-availability of medicines, affording transport charges, medical issues were the other reasons (8.3%). Out of 90 patients, 17 (18.9%) patients came out with a total of 24 ADRs. From this only 2 patients had defaulted from the treatment due to intolerance from the medicational Side effects. ADR monitoring improved the knowledge (from 4.9 to 8.2) and treatment (1.2 to 2.5) of the patient in the current study. From the study we came to conclude that Defaulting was seen mainly due to unawareness, carelessness, disbelief of the treatment method. This can be enhanced by patient education, interviewing them periodically, Monitoring the treatment condition and side effects. So the Clinical pharmacists is responsible in promoting the dots therapy to improve the patients adherence towards it, there by achieving a well treatment outcome

Prevalence of anxiety, depression, and their risk factors among lung cancer patients: A cross-sectional study in a tertiary care center, Kolkata

Background: Depression and anxiety disorders are common among lung cancer patients posing serious problem of treatment interruption, thereby poor prognosis and deterioration of quality of life. Objectives: The aim of the study was to find the prevalence of depression and anxiety among lung cancer patients and their respective determinants. Materials and Methods: An institution-based cross-sectional prospective study was conducted at the Department of Pulmonary Medicine of a tertiary care hospital at Kolkata over a period of 6 months. Patients were included by complete enumeration method, and an exit interview was conducted with the help of two standardized questionnaires: WHO Disability Assessment Schedule 2.0 to assess disability and Mini International Neuropsychiatric Interview English Version 5.0.0 DSM-IV to detect current major depressive episode (MDE) and generalized anxiety disorder (GAD). Collected data were entered and analyzed in SPSS 20.0 software. Results: A total of 210 patients were recruited. Nearly three-fourths of the study population (73.7%) were suffering from current GAD; a significant portion (42.1%) was suffering from current MDE. Both the disorders were diagnosed in 42.1% cases. Multivariate analyses revealed that patients who were currently unemployed or retired, time since diagnosis more than 1 month and suffering from higher degree of disability had higher risk of depression; while patients who were residing at urban area, currently not earning, financially dependent to others and suffering from higher degree of disability had greater risk of developing anxiety during the course of the disease. Conclusion: Both depression and anxiety were quite prevalent among lung cancer patients. Social and psychological supports are to be raised to achieve treatment success and a better quality of life by mitigating this problem.

Experience of sarcoidosis and factors predicting relapse at a tertiary care institute in North India

Background: Sarcoidosis is a multisystem, chronic granulomatous disease of unknown etiology. The clinical course of sarcoidosis is punctuated with remission and relapses, which is unpredictable. Materials and Methods: This was a retrospective observational study in which case records of all patients with a confirmed diagnosis of sarcoidosis attending the outpatient department of pulmonary medicine department between January 2014 and December 2018 were evaluated. The diagnosis of sarcoidosis was confirmed by demonstration of noncaseating granuloma in cytopathology or histopathology along with a compatible clinical picture. Mantoux test, serum angiotensin-converting enzyme (ACE) levels, serum calcium, and 24-h urinary calcium were done. Results: Sarcoidosis was found to be more common in females. Cough, breathlessness, fever, and fatigue were the predominant symptoms. Mantoux was negative in 95.83%, raised serum ACE was seen in 65.83%, hypercalcemia in 10.83%, and hypercalciuria in 30.0% of patients, respectively. Chest radiograph revealed that 14.17% of patients presented with Stage 1, 52.50% of patients with Stage 2, 15.83% of patients with Stage 3, and 17.50% of patients with Stage 4. Mediastinal lymphadenopathy was seen in contrast-enhanced computed tomography chest in 93.33%, septal thickening with nodularity in 61.67% and fibrosis in 25.83%. Corticosteroids were started in 97.5% patients and 24.17% patients relapsed after stopping or tapering corticosteroids. Conclusion: Sarcoidosis is a common cause of bilateral hilar lymphadenopathy and interstitial lung diseases. Relapses are frequent after stopping corticosteroids, so patients should be followed up actively after stopping treatment.

Trace Elements and Sepsis: Is there a Correlation?

International Journal of Medicine and Public Health,2018,8,4,133-139.DOI:10.5530/ijmedph.2018.4.28Published:December 2018Type:Original ArticleTrace Elements and Sepsis: Is there a Correlation?Agarwal Avinash, Kumar Anand, Gutch Manish, Consul Shuchi, Mahdi Ali Abbas, Razi Mohd Razi, Kumar Sukriti, Prakash Ved, Agarwal Vivek, and Gupta Kumar Anil Agarwal Avinash1,*, Kumar Anand2, Gutch Manish1, Consul Shuchi3, Mahdi Ali Abbas4, Razi Mohd Razi5, Kumar Sukriti6, Prakash Ved7, Agarwal Vivek8, Gupta Kumar Anil9 1Associate Professor, Department of Medicine, KGMU, Lucknow, Uttar Pradesh, INDIA. 2Senior Resident, Department of Medicine, KGMU, Lucknow, Uttar Pradesh, INDIA. 3DGO, Casualty Medical Officer, KGMU, Lucknow, Uttar Pradesh, INDIA. 4Professor and Head, Department of Biochemistry, KGMU, Lucknow, Uttar Pradesh, INDIA. 5Senior Resident, Department of Endocrinology, LLRM Medical College Meerut, Uttar Pradesh, INDIA. 6Department of Radiodiagnosis, KGMU, Lucknow, Uttar Pradesh, INDIA. 7Associate Professor, Department of Pulmonary Medicine, KGMU, Lucknow, Uttar Pradesh, INDIA. 8Associate Professor, Department of Medicine, MAYO Institute of Medical Science, Lucknow, Uttar Pradesh, INDIA. 9Associate Professor, Department of PMR, KGMU, Lucknow, Uttar Pradesh, INDIA. Abstract:Background: In critical illness blood levels of trace elements vary with the acute phase reaction. Quantitative estimation of it (Serum Selenium and Serum Zinc) can be used as prognostic markers. Aim and Objective: To evaluate the correlation between trace elements and sepsis and correlate it with various other prognostic markers with mortality in sepsis. Material and Methods: It was a prospective, observational study. One hundred and fifty patients of sepsis were enrolled after using inclusion and exclusion criteria for study. Serum Selenium and Zinc were done by Perkin-Elmer Optima ICP spectrometer. Results: One hundred and fifty patients of sepsis due to various pathological causes included in study. Mortality was 37.34%. APACHE II (33.23±5.93) and SAPS II score (67.43±10.55) was found to statisticallysignificant in predicting the mortality (p<0.001). Serum selenium in expired group of patients was found to be lower (38.26±20.82) as compared to survivors (44.34±18.99). Similarly serum zinc also appears to be lower amongdeceased (65.90±54.72) as compared to survivors (71.94±54.29) but this difference was not statistically significant. Conclusion: Our study shows that the patients with sepsis with lower level of serum selenium and serum zinc have poor outcome, but levels fails to correlate with severity of illness and death statistically. Keywords:Selenium, sepsis, Trace elements, ZincView:PDF (282.12 KB)

Safety and diagnostic yield of thoracic ultrasound-assisted transthoracic biopsy performed by a pulmonologist

BackgroundTransthoracic ultrasonography (US) is still not utilized to its full potential by respiratory physicians, despite being a well-established and validated imaging modality. It allows for an immediate and mobile assessment that can potentially augment the physical examination of the chest. This work aims to assess safety and diagnostic yield of thoracic US-assisted transthoracic biopsy performed by a pulmonologist . Patients and methods The present study was conducted upon 75 patients who are referred to the Pulmonary Medicine Department, Ain Shams University Hospitals with radiological assessment that reveals pleural-based mass with or without pleural effusion, anterior mediastinal mass, peripheral lung lesions or chest wall lesions. The present study was conducted upon 75 (67 male and 8 female) patients with mean±SD age 58.8±15.64.ResultsThis study showed that 31 cases were presented by peripheral pulmonary mass, 29 pleural lesions, nine mediastinal and six chest wall lesions, 57 of them diagnosed by sonar guided biopsy, 51 of them were malignant and the remaining six were benign.ConclusionTransthoracic US-assisted cutting-needle biopsy is an excellent first-line diagnostic tool for pleural-based lesions of at least 3 cm in diameter. It is a quick, low-cost, safe and well-tolerated tool in the hands of pulmonologists and has a high sensitivity for pleural-based malignancies.

Chest X ray score (Timika score): an useful adjunct to predict treatment outcome in tuberculosis.

Chest X-ray (CXR) has been used since long as an aid in the diagnosis of pulmonary tuberculosis (PTB) and also to determine the extent of the disease. The present study was conducted to evaluate the correlation of disease extent on CXR basing on the Timika CXR score with clinical and microbiological parameters at baseline, in sputum positive cases of pulmonary tuberculosis. The study was conducted at a tertiary referral centre for chest diseases in Bangalore, Karnataka from January 2017 to January 2018. This is a prospective study of new sputum smear positive pulmonary tuberculosis cases diagnosed in the department of Pulmonary Medicine. At baseline, patients' symptoms and signs on chest auscultation were recorded. The clinical scoring was done by the Karfosky performance score (KPS) and TB score I (Bandim TB score) and II. Baseline CXR- PA view of each patient was assessed independently by two chest physicians and evaluated by the Timika CXR scoring method. Routine blood investigations and sputum smear for acid fast bacilli were done. The correlation between the CXR score and other disease severity parameters was analysed. Clinical scores such as the KPS and TB score I (Bandim TB score) and II, did not correlate with the presence of cavitary disease on CXR (p > 0.05). 48.6% of patients with cavitary disease had higher baseline AFB density in sputum (i.e. sputum smear microscopy grade 3+) as compared to 40% of patients with non cavitary disease, which was not statistically significant. CXR score > 71 was significantly associated with longer duration of symptoms, higher clinical scores (KPS and TB score I, II) and lower Body Mass Index (BMI) at diagnosis of PTB (p < 0.05). 65.2% of the patients with CXR score ≤ 71 had significantly higher baseline AFB density as compared to only 32.4% with CXR result > 71 (p 0.04). CXR score > 71 also had significant association with higher ESR. Cavitary disease on CXR is associated with a higher mycobacterial load at baseline. The Timika CXR score is a simple, standard scoring system which can be used by a chest physician in a clinical setting. The CXR score significantly correlates with a broad range of clinical and microbiological measures of disease severity in PTB patients. Thus, it has a role in risk stratification, especially in patients not producing sputum or sputum negative PTB at diagnosis.

Spirometric Changes in Patients of Allergic Rhinitis: A Prospective Study

Background: Allergy is a chronic inflammatory disease, which may affect the upper and lower airway in reversible airflow obstruction or asthma. Spirometry is a noninvasive way to assess lower airway function routinely and to detect reversible airflow obstruction. Objective: To find out prevalence of abnormal small airway function in allergic rhinitis patients without diagnosis of asthma Methods: This prospective study was conducted in the department of Pulmonary Medicine, SRMSIMS, Bareilly. Spirometric measurement of patients of allergic rhinitis. Results: One hundred and thirty nine patients of Allergic Rhinitis (AR)were included in this study.73 were males and 66 were females. Farmers and labors outnumbered the students.13/49 (26.53%) farmers and 8/20(40%) labours had decreased FEF25-75%. It was also observed that longer the duration of AR, more patients were having abnormal FEF25-75%. Conclusions: When patients with AR seek treatment, the lower airway status should always be evaluated. This study provided evidence that an early bronchial impairment might be detectable by considering the FEF25-75.

Clinical, Radiological and Bacteriological Profile of Lung Abscess - An Observational Hospital Based Study.

BACKGROUND:The incidence of lung abscess acquired in the community is unknown, but this is a common clinical problem encountered in developing countries. The incidence of lung abscess was high in the pre-antibiotic era but the advent of susceptible antibiotics it has reduced with an equal fall in mortality to 8.7%. With the emerging antibiotic resistance and change in the trends of bacteriological profile causing lung abscess, it is the need of time to reevaluate lung abscess.AIM:The study aimed to determine the clinical, radiological and bacteriological profile of lung abscess.MATERIAL AND METHOD:The study was a non-randomized prospective observational study conducted in the department of pulmonary medicine for 18 months. In the study, patients > 15 years of age with clinical features of lung abscess were recruited and were subjected to chest X-ray, routine blood test. Sputum gram stain and culture, as well as antibiotic sensitivity according to the organism, were evaluated. Reports of all investigations along with patient characteristics and risk factors were analysed statistically using SPSS 20.0.RESULTS:Forty-six cases of lung abscess were included, and the majority of patients were found to be adults with a mean age of 42.9 years with a male to female ratio of 6.6:1. The most common predisposing factor was an unhygienic oral cavity in 28% of cases with alcohol ingestion being the most important risk factor in 22% of cases. The most common organism found in lung abscess cases was Klebsiella pneumoniae, and they were sensitive to ceftazidime.CONCLUSION:Our study shows that Klebsiella pneumoniae should be considered an important pathogen in community-acquired lung abscesses.

Oscillatory positive expiratory pressure treatment in lower respiratory tract infection.

Oscillatory positive expiratory pressure (OPEP) devices have been utilized as an adjunct therapy to conventional chest physiotherapy (CPT) to promote the clearance of respiratory secretions in individuals with impaired ability to cough, particularly in chronic diseases. However, few studies have focused on the effectiveness of OPEP in lower respiratory tract infection. In the present study, all patients with lower respiratory tract infections hospitalized in the Department of Pulmonary and Critical Care Medicine, Ruijin Hospital (Shanghai, China) between February 2016 and July 2017 were analyzed. Daily sputum quantity and purulence were recorded on the first 7 days of physiotherapy. Oxygenation index, partial pressure carbon dioxide, white blood cell count, neutrophil percentage, C reactive protein (CRP) and procalcitonin (PCT) levels before and after CPT were compared between patients who received OPEP and patients who received mechanical percussion (MP). Sputum was collected prior to and following CPT. A total of 17 patients received OPEP, while 10 received MP. The OPEP group exhibited improved postural drainage compared with the MP group after 7 days of physiotherapy. After 7 days of CPT, patients who received OPEP also exhibited a significantly improved oxygenation index, while the oxygenation index in the MP group did not improve. The improvement of partial pressure carbon dioxide was not significantly different between groups. The OPEP group also exhibited a greater decrease in white blood cell count, neutrophil percentage and CRP levels, compared with the MP group. However, the decrease in PCT level was similar in the OPEP and MP groups. Sputum culture results revealed that the rate of negative conversion was very low in both groups. There was no difference between the two groups in terms of hospitalization outcomes. In conclusion, OPEP exhibited a greater effectiveness in draining sputum, improving oxygenation and reducing inflammatory status in patients with lower respiratory tract infections compared with MP; however, it did not promote the elimination of microbes.

Providing Palliative Care in the Medical ICU: A Qualitative Study of MICU Physicians' Beliefs and Practices.

With the current and projected shortage of palliative care (PC) specialists, an integrative model of PC will be needed to meet the needs of patients in intensive care units (ICUs). Prior studies of PC interventions suggest that success depends upon meeting the needs of individual institutions or ICUs. The objective of this study was to qualitatively explore the beliefs and practices of one institution's medical ICU (MICU) physicians in regard to providing an integrative model of PC. This qualitative study used semistructured interviews of 17 physicians within a Department of Allergy, Pulmonary, and Critical Care Medicine at one large academic hospital. Interviews were conducted, transcribed, and coded according to qualitative research methods. Selected interviews were tested for interrater reliability and negotiated agreeability. All critical care physicians interviewed affirmed that providing PC was part of their job, and the majority expressed that providing PC gave them professional or personal satisfaction. Physicians also identified many ways that PC consultants enhance patient care in the MICU. They discussed several motivations for obtaining a PC consult, with the most frequently acknowledged motivation being lack of time. Developing an integrative model of PC in the ICU ought to take into account both studied interventions shown likely to be effective in the ICU setting and the specific needs and barriers to PC in that unit. This study demonstrates one way that needs and barriers can be identified and provides important findings that might be applicable to other institutions.

Impact of CD4 count in the development of mycobacterium tuberculosis in patients with HIV infection in a tertiary care centre

Background: Patients with Human Immunodeficiency Virus (HIV) infection are predisposed to numerous opportunistic infections due to decreased cell mediated immunity, Tuberculosis being most common. Low CD4 count is associated with low immunity and higher risk of tuberculosis.Methods: Author conducted a retrospective study in the department of Pulmonary medicine in a tertiary care teaching hospital during January to December 2017. Author collected data of all the patients with HIV diagnosed with Tuberculosis from the ART centre. Author collected demographic details including age, sex, symptoms at presentation, details of diagnosis of TB including type of tuberculosis, CBNAAT results, CD4 count at the diagnosis of TB, details of ART therapy and ATT therapy and outcomes of treatment.Results: Eighty one patients with HIV-TB co- infection were included in the study. Males (70.37%) were more affected than females. Mean age of the study group was 39.97±10 years. Sixty one patients (75.4%) were diagnosed with Pulmonary Tuberculosis and 20 (24.6%) patients were diagnosed with extra pulmonary TB. Mean CD4 counts of the cohort was 226±110/µl. Eighty percent of patients developed Tuberculosis with CD4 count &lt;250/µl.Conclusions: Author found in this study higher proportions of tuberculosis (80.2%) in patients with HIV infection with CD4 count &lt;200/µl. Author also found higher proportion of pulmonary Koch’s in patients with low CD4 count (CD4 &lt;200/µl).

Effects of multicultural model health education on the treatment compliance, cancer-related fatigue and nursing satisfaction in elderly patients with non-small cell lung cancer in Xinjiang

Objective To observe the effects of multicultural model health education on the treatment compliance, cancer-related fatigue and nursing satisfaction in elderly patients with non-small cell lung cancer (NSCLC) in Xinjiang district. Methods A total of 108 elderly patients with NSCLC who received treatment in the NO.1 Department of Pulmonary Medicine of the Third Clinical Medicine School of Xinjiang Medical University (Affiliated Cancer Hospital) from January 2016 to February 2017 were collected as observational objects by convenience sampling method and randomly divided into control group (n=54) and observation group (n=54) . The control group was given conventional health education, while the observation group was given health education of multicultural model. A self-made medical compliance questionnaire, the Revised Piper Fatigue Scale (PFS) and a self-made satisfaction questionnaire were applied to assess patients' medical compliance, cancer-related fatigue and nursing satisfaction respectively. Results After intervention, in comparison with the control group, patients' medical compliance improved (P<0.01) . Patients' emotion, severity of behavior, perception, cognition and other items of PFS of the observation group were all lower than those of the control group (P<0.05) . The satisfaction of the observation group was higher than that of the control group (P<0.05) . All the differences were statistically significant. Conclusions Health education of multicultural model has good application effects in elderly patients with NSCLC in Xinjiang. In addition, it can increase the treatment compliance, improve cancer-related fatigue and promote nursing satisfaction. It is worthy of clinical promotion. Key words: Carcinoma, non-small-cell lung; Aged; Medication adherence; Multicultural model; Health education; Cancer-related fatigue; Nursing satisfaction

Spectrum of diffuse parenchymal lung diseases: An Experience from A Tertiary Care Referral Centre From South India

Background Diffuse parenchymal lung diseases (DPLDs) include the idiopathic interstitial pneumonias, hypersensitivity pneumonitis, connective tissue disease-related interstital lung disease (ILD), lymphangioleiomyomatosis, sarcoidosis, etc. The prevalence and outcome of DPLD is not studied well across India. The current study was aimed at studying clinical radiological spectrum of DPLD in India. Aim The primary objective was to study the clinical radiological spectrum of DPLD, and the secondary objective was to identify the occurrence of idiopathic pulmonary fibrosis (IPF) and risk factors combined with IPF in a study population. Materials and methods All patients diagnosed with DPLDs in department of pulmonary medicine during the study period were included. SPSS 20 version was used for doing statistical analysis. P value of less than 0.05 was considered statistically significant. Results Mean age of the study cohort was 55±15.45 years. There were 83 (63.4%) female patients, and 11.6% of the patients gave history of prior antituberculosis medicine. Most common symptoms were gradually progressing dyspnoea (94.5%) followed by dry cough (78.29%). The commonest finding on chest radiograph in our series was reticulonodular pattern (80.2%). The commonest pattern on high-resolution computed tomography was fibrosis in interstitum (49.9%). The commonest cause of DPLD in study was connective tissue disorder (34.9%) followed by IPF (23.25%) and sarcoidosis (17.05%). Of all patients, 47 showed improvement on the six-minute walk test. Smoking was one of the major risk factor associated with IPF, and 66.7% of patients with IPF were smokers (P<0.001). The other risk factor associated with IPF was gastro esophageal reflux disease (GERD) (P=0.003). Conclusions Connective tissue disease (CTD)-related ILD was the commonest DPLD followed by IPF and non specific interstitial pneumonitis (NSIP) in the present study. IPF was present in 23% of the cases. Smoking and GERD were the commonest risk factors associated with IPF.

Evaluation of Fine Needle Aspiration Cytology of Cervical Lymphadenopathies at Tertiary Care Center

Background: Lymphadenopathies in the neck region is the most frequently sent for the cytology evaluation from the clinicians, involvement in regional and systemic diseases and their easy accessibility make the FNAC as a primary workup. Inflammatory and immune reactions are the most frequent causes of lymph node enlargement and are self limiting in majority of cases. Tuberculosis can also be diagnosed by cytology of affected lymph nodes. With the advent of FNAC, most of the inflammatory, reactive and neoplastic conditions can be diagnosed without biopsy. It has the advantage that it can be done safely, rapidly and cheaply with minimal trauma at an outpatient setup or at the bedside. Methods: This study was conducted at cytology section of pathology department of our institute. Patients from ENT, Surgery, Medicine, Pulmonary medicine departments were referred for FNAC. Written informed consent was obtained from all patients. It included patients with lymphadenopathies in cervical region. FNAC was conducted with the help of a 24 guage disposable needle attached to a 10cc syringe. Smears were fixed in methanol and stained with Haematoxylin and Eosin as well as Papanicolaou stains. MGG stain was done on air dried smears. The results expressed as percentage were tabulated. Result: Maximum numbers of patients were diagnosed with Reactive Lymphadenopathy 67/266 (25%), followed by Chronic Granulomatous Inflammation 59/266 (22 %), Metastatic 52/266(20%), Acute Suppurative 37/266 (14%), Tuberculous 27/266 (10%), Non Specific 14/266 (5 %), Lymphoma (primary) 8/266 (3%) and miscellaneous 2/266 (1%) consists Sinus Histiocytosis & Kawashaki disease. Histopathological correlation was available in 25/266 cases. Conclusion: FNAC is a safe, simple & inexpensive primary immediate diagnostic procedure and workup for lymph node enlargements, especially in cervical lymphadenopathies where biopsies are not done routinely. DOI: 10.21276/APALM.1527

Editorial introductions

Editorial introductions

Diagnostic and Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Early and Late Phase of Sepsis.

Objective:Early diagnosis of sepsis is necessary to decrease morbidity and mortality. This study aims to evaluate neutrophil-to-lymphocyte ratio (NLR) as diagnostic and prognostic of early and late phase of sepsis.Methods:It was a prospective, observational study, conducted in Intensive Care and High Dependency Unit (Daycare) of the Department of Pulmonary and Critical Care Medicine (tertiary care center), Rohtak, from January 2017 to December 2017. A total of 56 cases of newly diagnosed cases of sepsis were included in the study and 20 healthy adults were taken as controls. Daily NLR was calculated in cases till the primary outcome.Results:The results suggested that NLR seems to have promising role as diagnostic and prognostic marker (with P = 0.001 and P = 0.045, respectively) in sepsis.Conclusion:The study suggests that NLR can be a useful diagnostic and prognostic marker in sepsis.

Comparison of physicians' knowledge regarding radiation exposure and risks in common radiological investigations - A cross-sectional study

Background: Radiations have been proven to increase the risk of cancer, heritable defects, and radiation associated non-cancer diseases. Inappropriately advised radiology investigations can lead to avoidable radiation exposures and expenses. The referring physician is overall responsible to prescribe the most appropriate imaging procedure for the patient clinical condition, by providing supporting data justifying that choice. Clinical Imaging Referral Guidelines (CIGs) have, therefore, been established or adopted in some countries to support the physicians’ referral for the most suitable imaging procedure. However, there is a strong unmet need in advocating acceptance of these guidelines among referring physicians. As most of the investigations are initiated by non-radiologists, it is imperative that they have adequate knowledge of radiation exposure and risks. Radiologists play a key role in locally educating their non-radiology colleagues on the associated radiation imaging hazards. Objectives: The objectives of the study were to compare the knowledge of radiologists and non-radiologists regarding ionizing radiation exposure and risks in common radiological investigations and to increase awareness of risks of various imaging techniques, among non-radiological physicians. Materials and Methods: A total of 200 physicians working in tertiary hospital were enrolled in the study. A pretested questionnaire was prepared and given to the participants after taking their consent. Questionnaire included demographic details and questions relating to radiation exposure during diagnostic imaging. Results: The highest mean correct score in the radiology group was 15.70% (range 11–20) standard deviation (SD) 2.32, while the lowest mean correct score in the non-radiology was 9.56% (range 5–14) SD 2.50 P < 0.001. All other departments except pulmonary medicine, orthopedics and urology department differed significantly in their mean correct scores compared to the radiology department. 19.4% and 16.4%, of non-radiology physicians also wrongly associated (overestimated) magnetic resonance imaging and ultrasound with ionizing radiation, respectively, and 20% were not aware of the radiation dose. Conclusion: Non-radiologists underestimated the real radiation doses, and their knowledge of the risks was inadequate. It may be possible that physicians tend to order more radiological investigations due to increased patient load. Awareness of radiation dose of imaging procedures and their risk to exposure must be increased among all medical professionals. Therefore, training on radiation protection and local adoption of CIGs has become necessary. A large multi-centric nation-based study will not only help in assessing the gaps in knowledge but also help build consensus and encourage adoption of clinical imaging referring guidelines on a national level.

Assessment of factors associated with drainage duration and hospital stay of nontuberculous empyema in a tertiary care hospital of West Bengal: A prospective study

Context: Empyema thoracis is a common cause of morbidity and mortality. A number of factors could affect the treatment outcome of empyema cases. Aims: To assess the clinical and microbiological characteristics of non-tuberculous empyema and the factors associated with duration of chest drainage and hospital stay. Settings and Design: The Department of Pulmonary Medicine of a teaching institution in eastern India. A prospective observational study. Material and Methods: The study was conducted among the admitted non tuberculous empyema cases over the period of 18 months. The demographic profile, clinical features, duration of chest drainage and hospital stay of 80 cases who were admitted during the data collection period was recorded. Statistical analysis used: Data were analysed using unpaired t test, Bivariate Correlation, Chi square test and Fisher's exact test with the help of SPSS 22.0 software. Results: Majority of cases were male and from rural area. Mean duration of intercostal chest tube drainage and hospital stay were 16 ± SD 5.2 and 17.7 ± SD 5.1 days respectively which were significantly increased with prolongation of interval between symptom onset and chest drain insertion (P = 0.000 and P= 0.000) and in presence of comorbidity (P = 0.022 and P= 0.026), pleural fluid loculations (P = 0.015 and P= 0.029), positive culture growth (P= 0.012 and P= 0.021) and presence of gram negative organism (P =0.005 and P = 0.008) in pleural fluid. Conclusions: Chest drain duration and hospital stay could be used as surrogate indicators for treatment outcome measures.

Factors influencing severity of community-acquired pneumonia.

Introduction:Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in India. There is a need to understand the risk factors associated with severity of CAP in our population. This study was part of the international global initiative for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia study to evaluate MRSA.Methods:A total of 100 consecutive cases of pneumonia admitted to the Department of Pulmonary Medicine in a tertiary care hospital were recruited in the study during March–July 2015. The severity of pneumonia was assessed based on the CURB-65 score. Individuals with pneumonia and CURB-65 score >2 were compared with subjects with CURB-65 score ≤2. Individuals were also evaluated for the causative organism and its resistance pattern with specific reference to the presence of MRSA.Results:Mean age of patients was 54.03 years, 66% were men. Patients were managed either in the intensive care unit (42%) or wards/high dependency unit (58%), 22% needed noninvasive ventilation and 18% needed mechanical ventilation within 24 h of admission. On multivariate analysis, prior respiratory infection (within last 1 year), obesity (body mass index >30), and alcoholism, old age (>60 years) were independently associated risk factors for severe pneumonia. There were no cases of MRSA. In 34% of cases, organisms could be identified. Most common organisms were Klebsiella (8%), influenza (8%), and Pseudomonas (5%).Conclusion:Prior respiratory infection, obesity, alcoholism, and old age (>60 years) were observed to be important risk factors for severe CAP. Prospective studies should evaluate effect of weight reduction and cessation of alcohol consumption on recurrences of pneumonia in this population and on the severity of pneumonia.