Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India

Background: There is dearth of literature on asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) in India. The aim was to compare clinical characteristics between patients with ACOS and non-ACOS COPD and to identify clinical predictors of ACOS in patients with COPD. Methods: We conducted a retrospective study by reviewing data collected from patients performing spirometry at our hospital. Those with postbronchodilator FEV1/FVC <70% were included in the study. Among them, those with significant reversibility (change in FEV1or FVC by 12% and 200 ml postbronchodilator) were diagnosed with ACOS and the rest were considered to have non-ACOS COPD. Data on the 2 groups were compared and statistical analysis was performed. Results: Out of a total of 324 patients, 100 of them had postbronchodilator FEV1/FVC <70%. Of them, 45 and 55 were diagnosed with ACOS and non-ACOS COPD, respectively. Patients with ACOS had significantly higher postbronchodilator FVC volumes and FVC % predicted values (P < 0.05), had higher reported wheeze (P = 0.02) and ankle edema (P < 0.05), were more likely to be smokers (P = 0.01) with lower smoking index (P = 0.03), and had frequent (≥2) ER visits (P = 0.04). However, very frequent (≥3 per year) hospital admissions (P < 0.01) with higher rates of invasive mechanical ventilation (P = 0.02), and pulmonary hypertension diagnosed by two-dimensional echocardiography (P < 0.01) were significantly higher in the non-ACOS group. The two groups did not differ with respect to history of atopy, family history of wheeze, compliance to inhaler therapy, or blood absolute eosinophil counts. Conclusion: Our study highlights how the ACOS phenotype may clinically differ from their counterparts elsewhere, making it a clinical challenge to identify them in India

Hiccups as an unusual manifestation of tuberculosis-associated immune reconstitution inflammatory syndrome.

Andrade, Bruno de Bezerril “Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento”.Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-09-13T12:15:16Z No. of bitstreams: 1 Narendran G Hiccupus an ususual....pdf: 1031338 bytes, checksum: 374659c6ca211fb8bd05049fdc13472e (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-09-13T12:53:01Z (GMT) No. of bitstreams: 1 Narendran G Hiccupus an ususual....pdf: 1031338 bytes, checksum: 374659c6ca211fb8bd05049fdc13472e (MD5)Made available in DSpace on 2017-09-13T12:53:01Z (GMT). No. of bitstreams: 1 Narendran G Hiccupus an ususual....pdf: 1031338 bytes, checksum: 374659c6ca211fb8bd05049fdc13472e (MD5) Previous issue date: 2015Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USANational Institute for Research in Tuberculosis. Chetpet, Chennai, ÍndiaNational Institute of Allergy and Infectious. Diseases National Institutes of Health. Bethesda, Maryland, USANational Institute for Research in Tuberculosis. Chetpet, Chennai, ÍndiaNational Institute for Research in Tuberculosis. Chetpet, Chennai, ÍndiaGovernment Hospital of Thoracic Medicine. Tambaram, ChennaiRajiv Gandhi Government General Hospital. Chennai, IndiaNational Institute for Research in Tuberculosis. Chetpet, Chennai, Índia / Mayor Sathyamoorthy Road. Chetpet, Chennai, Tamil Nad

Multi-resolution analysis based data mining approach to assess vegetation dynamics in Jharkhand using time series MODIS products

Time series analysis of Enhanced Vegetation Index (EVI) data using the Multi-Resolution Analysis (MRA) based Wavelet Transforms (WT) provides capacity to characterize the inter-annual and intra-annual vegetation variability on the ground at different scales and resolutions. The MRA was performed to decompose time series EVI at level 5 in order to analyze intra-annual, inter-annual trend and human-induced activities in Jharkhand state, India during the period 2001–2018. The Mann-Kendall test and Sen’s slope were performed to identify the trend and magnitude in the vegetation dynamics, respectively. Vegetation dynamics at the intra-annual (seasonality) scale indicated 43,941 km2 of Jharkhand state showed decreasing pattern, while 41,963 km2 shows increasing pattern. Further, inter-annual variability in the vegetation cover indicated 22,393 km2 and 64,746 km2 as decreasing and increasing trends, respectively. The results from this study can serve as guidelines for policy makers for monitoring and framing effective and sustainable strategies for conservation of green cover in Jharkhand state

Long-term virological outcome in children receiving first-line antiretroviral therapy

Abstract Background Studies relating to long-term virological outcomes among children on first-line antiretroviral therapy (ART) from low and middle-income countries are limited. Methods Perinatally HIV infected, ART-naive children, between 2 and 12 years of age, initiating NNRTI-based ART during 2010–2015, with at least 12 months of follow-up, were included in the analysis. CD4 cell counts and plasma HIV-1 RNA were measured every 24 weeks post-ART initiation. Immunologic failure was defined as a decrease in the CD4 count to pre-therapy levels or below and virologic failure as HIV-RNA of > 1000 copies/ml at 48 weeks after ART initiation. Genotypic resistance testing was performed for children with virologic failure. Logistic regression analysis was done to identify predictors of virologic failure. Results Three hundred and ninety-three ART-naïve children living with HIV [mean (SD) age: 7.6 (3) years; mean (SD) CD4%: 16% (8); median (IQR) HIV-RNA: 5.1 (3.5–5.7) log10 copies/ml] were enrolled into the study. At 48 weeks, significant improvement occurred in weight-for-age and height-for-age z-scores from baseline (all p  90% adherence to ART. At the time of virologic failure, multiple NNRTI-associated mutations were observed: 80%—K103N and Y181C being the major NNRTI mutations—observed. Sensitivity (95% CI) of immunologic failure to detect virologic failure was 7% (2–12), specificity 97% (92.4–98.9), PPV 44% (13.7–78.8) and NPV was 72% (65–77.9). There were no statistically significant predictors to detect children who will develop virologic failure on treatment. Conclusions Considerable immunological improvement is seen in children with ART initiation, but may not be an effective tool to monitor treatment response in the long-term. There is a lack of correlation between immunologic and virologic response while on ART, which may lead to a delay in identifying treatment failures. Periodic viral load monitoring is, therefore, a priority

Etiology and risk factors associated with a pruritic papular eruption in people living with HIV in India

Introduction: Papulopruritic eruption (PPE) occurs in people living with HIV in India. Understanding the risk factors associated with this disease may help decrease the prevalence of PPE. Methods: This study was a case-control study performed at the Government Hospital of Thoracic Medicine, a tertiary care hospital in Chennai, India. Cases included HIV-positive, antiretroviral (ARV) therapy-na&#x00EF;ve adults experiencing a pruritic skin eruption for longer than one month, with evidence of multiple papular or nodular lesions and biopsy consistent with arthropod bite. Controls included HIV-positive, ARV-na&#x00EF;ve patients without active skin rash. Main outcome measures were CD4 cell count, histology, and environmental exposures. We performed statistical analysis using Epi Info version 3.5.1 and SPSS version 11.0 (SPSS Inc., Chicago, IL). Categorical variables such as gender, urban versus rural residence, occupation, treatment history, CD4 count, use of insect repellents, and environmental exposures were evaluated using the &#x03C7;2 test (or the Fisher exact test when an expected value for a category was less than 5). The t-test was used to evaluate differences in age and the duration since HIV diagnosis. The Mann-Whitney test was used to compare non-normally distributed values such as CD4 cell count. A p-value that was less than 0.05 was considered to be statistically significant. Results: Forty-one cases and 149 control subjects were included. Subjects with PPE had significantly lower CD4 cell counts compared to controls (225.5 cells/&#x00B5;L vs. 425 cells/&#x00B5;L; p=0.0001). Sixty-six percent of cases had a CD4 cell count less than 350 cells/&#x00B5;L. PPE cases were less likely to use mosquito repellent techniques (odds ratio 2.81, CI = 1.45&#x2013;5.45). Discussion: PPE may be an altered and exaggerated immune response to arthropod bites in HIV-positive patients. CD4 cell count is significantly lower in patients with PPE, and therefore it may be considered a qualifying clinical finding for ARV initiation in resource-poor settings. Protective measures against mosquito bites appeared to be important in preventing PPE in subjects at risk