A study on the effect of intraoperative continuous positive airway pressure (CPAP) on the postoperative pulmonary function in overweight patients undergoing lower limb, lower abdominal or vaginal surgeries under spinal anesthesia

Introduction: Spinal anaesthesia, supine position and higher BMI are risk factors for pulmonary atelectasis. NIV, PEEP and CPAP are employed in ICU’s to treat atelectasis postoperatively. However, we wanted to investigate whether CPAP was protective against atelectasis when used intraoperatively, in high risk patients. Material and methods: This study was a randomized controlled trial. Overweight patients, who were to undergo surgeries under spinal anesthesia were included in the study. After informed consent, 126 patients underwent preoperative pulmonary function tests (PFT: FEV1, FVC, PEFR). Following the onset of spinal anaesthesia patients were randomised into group E (n = 63, received CPAP) and control group, group C ( n =63, received nil intervention). Postoperative PFT was done at 20 minutes, 1 hour, 2 hours and 3 hours after surgery. Patients were followed up till discharge for pulmonary complications. Results: We observed significant reduction in pulmonary function (FEV1, FVC and PEFR) postoperatively compared to base-line. CPAP group had better pulmonary function when compared to control group, the difference being significant 20 minu-tes after the surgery(p < 0.05). No postoperative pulmonary complication was reported among the 126 patients studied. Conclusion: Intraoperative use of CPAP in overweight patients undergoing surgeries under spinal anaesthesia could be beneficial in improving pulmonary function in the immediate post-operative period

An unusual cause of high density radiological opacities

Introduction: Metallic mercury poisoning through intravenous injection is rare, especially as part of a suicide attempt. Diagnosis and treatment of the disease are challenging as clinical features are not specific.Material and metods: A 41-year-old male presented with dyspnea, fatigue, loss of weight, and loss of appetite over two months. Routine radiological examination by chest X-ray and CT showed randomly distributed high density opacities with Hounsfield units (HU) around 500 HU all over the body. The diagnosis was then confirmed with a urinary mercury concentration of > 1000 mcg/24 h. Results: The patient’s clinical condition was getting worse in spite of chelation therapy and hemodialysis. The patient eventually died because of respiratory failure.Conclusion: Early diagnosis and appropriate treatment are critical for intravenous mercury poisoning especially because there are no specific signs or symptoms. There should be a high level of suspicion in drug abusers. Treatment should involve the combined use of chelating agents and other treatments such as hemodialysis and plasma exchange in advanced clinical settings

Inadequate inhaler technique, an everlasting problem, is associated with poor disease control – A cross sectional study

Introduction: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique.Material and methods: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist.Results: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd’s ratio (OR) 4.13, CI 1.31–17.8], well controlled disease (OR 2, CI 1.1–3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46–9.24) had better inhaler technique.Conclusion: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to bereiterated

An overview of treatment options for COVID-19

Severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) which emerged in Wuhan initially as pneumonia of unknown origin in December 2019, later spread to whole world and became pandemic on 11th March, 2020. Many drugs have been proposed but are backed without clinical evidence. Scientific bodies are in the row to discover a reliable vaccine and effective drugs against the novel coronavirus. Many antiviral and anti-parasitic drugs which were thought to have some effect on Coronavirus disease 2019 (COVID-19) have been tried during the crisis but none have shown concrete evidence of action. Randomized clinical trials on the repurposed drugs are now registered under clinical trial registry to look at the safety profile and efficacy of the drugs to be used against SARS-CoV-2. Many meta-analyses are being conducted worldwide to frame evidence for the fight against this novel coronavirus. We are providing below a review of various drugs that have been tried for treatment of COVID-19 as well as different clinical trials which are underway

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

HIV status among presumptive tuberculosis cases attending tertiary care centre in South India

Introduction: In India, to increase human immunodeficiency virus (HIV) case detection, the National Technical Working Group onTB /HIV had made it mandatory to screen for HIV infection among presumptive tuberculosis (TB) cases. Material and methods: Our study was a cross-sectional study, conducted between June 2015 and December 2016 in a tertiarycare institute (JIPMER), in South India, to estimate the prevalence of HIV among presumptive TB cases. Results: Among the 964 presumptive TB cases who attended pulmonary medicine OPD, 189 patients were sputum acid-fastbacilli (AFB) positive. Among the 189 sputum positive cases, 9 were HIV positive. Of the 964 presumptive TB cases, 879 gaveconsent for HIV testing and 33 (3.7%) turned out to be HIV positive. If only sputum positive cases had been screened for HIV,we would have missed 24 new HIV positive cases. The number needed to screen was 27 among presumptive TB cases and 18among TB patients. Conclusions: The uptake of HIV testing (91%) and the diagnostic yield of 3.7% of HIV positive cases among the presumptiveTB patients is quite high compared to that of the Revised National Tuberculosis Control Programme (RNTCP) mechanism of Puducherry.This reinforces the need to screen all the presumptive cases for HIV infection, to increase HIV case detection so thatanti-retroviral therapy (ART) can be initiated early

Fungal pneumonia concealing bacterial pneumonia: a diagnostic dilemma

We describe the case of a 61-year-old diabetic man affected by Achromobacter denitrificans. He was immunocompetent and did not have any past history of chronic lung disease. The patient was treated with sensitive antibiotic meropenem 1 g three times daily. To our knowledge, only one case of A. denitrificans pneumonia has been reported from the Indian subcontinent, in an individual with underlying lung disease, and none in a healthy person

Zakażenie wirusem HIV u pacjentów z podejrzeniem gruźlicy diagnozowanych w ośrodku specjalistycznym w południowych Indiach

WSTĘP: W celu zwiększenia wykrywalności zakażenia wirusem HIV w Indiach narodowa grupa robocza ds. zakażenia wirusem HIV i gruźlicy wprowadziła obowiązek badań przesiewowych w kierunku zakażenia wirusem HIV u wszystkich chorych z podejrzeniem gruźlicy. MATERIAŁ I METODY: Badanie miało charakter przesiewowy i miało na celu ocenę występowania zakażenia wirusem HIV wśród chorych z podejrzeniem gruźlicy. Przeprowadzono je w okresie od czerwca 2015 do grudnia 2016 roku w trzeciorzędowym ośrodku referencyjnym JIPMER w południowych Indiach. WYNIKI: Spośród 964 chorych z podejrzeniem gruźlicy przyjętych w poradni pulmonologicznej, u 189 chorych stwierdzono dodatni wynik plwociny w kierunku prątków kwasoodpornych (AFB). Spośród 189 chorych z dodatnim wynikiem plwociny u 9 stwierdzono zakażenie wirusem HIV. Spośród 879 chorych, którzy wyrazili zgodę na badanie w kierunku zakażenia wirusem HIV, u 33 wynik był dodatni (3,7%). Gdyby zbadano jedynie chorych z dodatnim wynikiem plwociny, nie wykryto by 24 nowych przypadków zakażenia wirusem HIV. Liczba badań, które należałoby wykonać, aby wykryć jeden przypadek zakażenia wirusem HIV (number needed to screen), wynosi 27 dla chorych z podejrzeniem gruźlicy i 18 dla chorych z potwierdzoną gruźlicą. WNIOSKI: Wykrywalność zakażenia HIV (91%) i skuteczność diagnostyczna 3,7% w grupie chorych z domniemaną gruźlicą jest wysoka w porównaniu z danymi zaktualizowanego programu narodowego kontroli gruźlicy. W związku z tym w celu zwiększenia wykrywalności zakażenia wirusem HIV konieczne jest objęcie badaniami przesiewowymi również chorych z podejrzeniem gruźlicy, aby można było wcześnie wdrożyć leczenie anty-retrowirusowe.WSTĘP: W celu zwiększenia wykrywalności zakażenia wirusem HIV w Indiach narodowa grupa robocza ds. zakażenia wirusem HIV i gruźlicy wprowadziła obowiązek badań przesiewowych w kierunku zakażenia wirusem HIV u wszystkich chorych z podejrzeniem gruźlicy. MATERIAŁ I METODY: Badanie miało charakter przesiewowy i miało na celu ocenę występowania zakażenia wirusem HIV wśród chorych z podejrzeniem gruźlicy. Przeprowadzono je w okresie od czerwca 2015 do grudnia 2016 roku w trzeciorzędowym ośrodku referencyjnym JIPMER w południowych Indiach. WYNIKI: Spośród 964 chorych z podejrzeniem gruźlicy przyjętych w poradni pulmonologicznej, u 189 chorych stwierdzono dodatni wynik plwociny w kierunku prątków kwasoodpornych (AFB). Spośród 189 chorych z dodatnim wynikiem plwociny u 9 stwierdzono zakażenie wirusem HIV. Spośród 879 chorych, którzy wyrazili zgodę na badanie w kierunku zakażenia wirusem HIV, u 33 wynik był dodatni (3,7%). Gdyby zbadano jedynie chorych z dodatnim wynikiem plwociny, nie wykryto by 24 nowych przypadków zakażenia wirusem HIV. Liczba badań, które należałoby wykonać, aby wykryć jeden przypadek zakażenia wirusem HIV (number needed to screen), wynosi 27 dla chorych z podejrzeniem gruźlicy i 18 dla chorych z potwierdzoną gruźlicą. WNIOSKI: Wykrywalność zakażenia HIV (91%) i skuteczność diagnostyczna 3,7% w grupie chorych z domniemaną gruźlicą jest wysoka w porównaniu z danymi zaktualizowanego programu narodowego kontroli gruźlicy. W związku z tym w celu zwiększenia wykrywalności zakażenia wirusem HIV konieczne jest objęcie badaniami przesiewowymi również chorych z podejrzeniem gruźlicy, aby można było wcześnie wdrożyć leczenie anty-retrowirusowe

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention