Spectrum of interstitial lung disease at a tertiary care centre in India

Introduction: The available data on the epidemiology of interstitial lung disease (ILD) from India is sparse. Hence, the present study was undertaken with the aim to analyse the demographic profile and clinical, radiological and pathological characteristics along with physiological parameters of various subgroups of ILD patients.Material and methods: We retrospectively studied 289 patients diagnosed with ILD during the years 2001–2013 at one of the respiratory units of Vallabhbhai Patel Chest Institute.Results: Mean age at presentation was 44.24 years; females comprised 54.68% of the patients. Prior to presentation at our centre, 14.84% patients had been treated with antituberculous therapy due to misdiagnosis of tuberculosis. In the pool of ILDs analysed, sarcoidosis (37.3%) was found to be the most common subgroup, followed by IPF (27.6%) and NSIP (25.6%). Cough (92.97%) was the most common presenting symptom; exertional dyspnoea was found in 79.2% of patients. Digital clubbing was commonest in IPF, found in 30% of patients. Significant desaturation on six-minute walk test was most frequenty seen (50%) in NSIP patients. The most common pattern on chest roentgenogram was reticular/reticulo-nodular pattern (80.2%) and on HRCT — interstitial fibrosis (49.9%). Mean of predicted total lung capacity (TLC) was 64.3%, the lowest being in the IPF group (58.88%). Mean of predicted DLCO was 50.56%, the lowest being in the IPF group (42.75%). The overall diagnostic yield of bronchoscopic biopsy was 83.04%, the highest yield being among sarcoidosis patients (96.29%).Conclusions: We found sarcoidosis, IPF and NSIP to be the most common ILDs in northern India. ILDs are still frequently misdiagnosed as TB, and increased awareness, education and diagnostic facilities are required to diagnose ILDs at an early stage.Wstęp: Istnieje stosunkowo mało informacji dotyczących epidemiologii śródmiąższowych chorób płuc (ILD) w Indiach. Aktualna praca została podjęta w celu oceny danych demograficznych, kliniczno-patologicznych i fizjologicznych różnych typów chorób śródmiąższowych.Materiał i metody: Badaniem retrospektywnym objęto 289 pacjentów, u których rozpoznano ILD w latach 2001–2013 w jednym z oddziałów Vallabhbhai Patel Chest Institute (Indie, Delhi).Wyniki: Średni wiek chorych w chwili rozpoznania wynosił 44,4 roku, kobiety stanowiły 54,68% ogółu chorych. Z powodu mylnego rozpoznania gruźlicy 14,84% chorych było uprzednio leczonych przeciwprątkowo. Sarkoidozę rozpoznano u 37% chorych, a IPF i NSIP odpowiednio w przypadku 27,6 i 25,6% chorych. Najczęściej zgłaszanymi objawami były kaszel (92,97%) i duszność wysiłkowa (79,2%) a palce pałeczkowate stwierdzono u 30% chorych na IPF. Znamienny spadek utlenowania krwi w 6-minutowym teście chodu najczęściej obserwowano u chorych na NSIP (50%). Zmiany guzkowo-siateczkowe w obrazie radiologicznym uwidoczniono u 80,2% chorych, a śródmiąższowe włóknienie w badaniu HRCT wykryto u 49,9% chorych. Średnia wartość zdolności dyfuzyjnej płuc (DLCO) wynosiła 50,56% wartości należnej i była najbardziej upośledzona w grupie chorych na IPF (42,75%). Wartość diagnostyczna biopsji wykonanej podczas bronchoskopii wynosiła 83,04% i dotyczyła szczególnie chorych na sarkoidozę (96,29%).Wnioski: Autorzy pracy stwierdzili, że w północnych Indiach najczęstszymi chorobami śródmiąższowymi są: sarkoidoza, IPF i NSIP. Śródmiąższowe choroby płuc są w Indiach często rozpoznawane błędnie jako gruźlica, dlatego konieczne jest szkolenie personelu i stworzenie ułatwień diagnostycznych, aby były one trafnie rozpoznane we wczesnym stadium

Design/Development of Mini/Micro Air Vehicles through Modelling and Simulation: Case of an Autonomous Quadrotor

Design and development of an autonomous quadrotor micro aerial vehicle is undertaken following a systematic approach. A fairly detailed model was constructed and simulations were then carried out with the purpose of refining the baseline design, building a controller, and testing the flying qualities of the vehicle on a ground-based flight simulator. Following this, a smooth transition to rig and flight testing has been enabled in a cost- and time-effective manner, meeting all the design requirements.Defence Science Journal, 2011, 61(4), pp.337-345, DOI:http://dx.doi.org/10.14429/dsj.61.108

Bronchoscopy in immediate diagnosis of smear negative tuberculosis

Wstęp: Gruźlica jest poważnym problemem zdrowia publicznego. Prawie u 30% chorych na gruźlicę bezpośrednie badanie plwociny na prątki jest ujemne. Prowadzi to do niezamierzonych opóźnień w leczeniu tych przypadków. W niniejszym badaniu zaplanowano ocenę roli bronchoskopii w szybkim rozpoznaniu gruźlicy u tych chorych.Materiał i metody: Niniejsze badanie jest retrospektywną analizą 132 chorych z podejrzeniem gruźlicy, u których nie stwierdzono prątków w bezpośrednim badaniu plwociny i którzy zostali poddani bronchoskopii w okresie 2002–2013.Gruźlicę rozpoznawano na podstawie stwierdzenia prątków w wydzielinie oskrzelowej lub w płukaniu oskrzelowo-pęcherzykowym względnie w materiale uzyskanym z biopsji. Rozpoznawano również gruźlicę na podstawie stwierdzenia martwicy serowatej w materiale z biopsji.Wyniki: Wynik niniejszego badania wykazał, że w wyniku bronchoskopii było możliwe ustalenie rozpoznania w 68,2% przypadków, w których badanie plwociny było negatywne. Potwierdzenie uzyskano po stwierdzeniu prątków w wydzielinie oskrzelowej lub płukaniu oskrzelowo-pęcherzykowym w 51,5% przypadków a na podstawie badania materiału z biopsji w 16,5%.Wnioski: Wyniki niniejszego badania wskazują na ważne miejsce bronchoskopii w szybkiej diagnostyce gruźlicy u chorych z ujemnym bezpośrednim badaniem plwociny. Pozwala to na uniknięcie opóźnień w rozpoznawaniu gruźlicy i nas zybkie podjęcie odpowiedniego leczenia.Background: Tuberculosis is a major public health problem. Almost 30% of cases of tuberculosis are known to be sputum smear negative. There is a diagnostic dilemma in such cases leading to inadvertent delays in management of these cases. The present study was planned to assess the role of bronchoscopy in immediate diagnosis of smear negative pulmonary tuberculosis.Material and methods: The present study is a retrospective analysis of 132 sputum smear negative tuberculosis suspects who underwent bronchoscopic evaluation during the period 2002–2013. The diagnosis of tuberculosis was based on the finding of bacilli in aspirate or in tissue biopsy or the demonstration of caseous necrosis on tissue biopsy.Results: The present study showed that bronchoscopy could lead to immediate, accurate diagnosis in 68.2% of suspected smear negative cases. Bronchial aspirate and bronchoalveolar lavage alone were diagnostic in 51.5% of such cases while tissue biopsy added to the yield in another 16.5% cases.Conclusions: The results of the present study suggests an important place of bronchoscopy in immediate diagnosis of suspected smear negative tuberculosis, thus avoiding inadvertent delays in diagnosing and instituting appropriate treatment

UROPATHOGENS: ISOLATION AND ANTIBACTERIAL SUSCEPTIBILITY PATTERN

Objective: To find the antibiotic sensitivity pattern of uropathogens. Methods: A total of 100 urine samples of clinically suspected urinary tract infection were collected from May 2016 to July 2016. The samples were inoculated on cystine lactose electrolyte deficient agar and incubated at 37°C for 24 hrs. Results: A total of 77 (77%) samples were positive showing microbial growth. Among all isolates, Escherichia coli was 36.36%, followed by Klebsiella spp. (35.06%), Citrobacter spp. (6.49%), Staphylococcus aureus (6.49%), Pseudomonas spp. (5.19%), Enterococcus faecalis (3.90%), and Acinetobacter spp. (1.30%). For Gram-positive isolates, the most effective antibiotic was nitrofurantoin followed by sulphafurazole. For Gram-negative isolates, the most effective antibiotic was nitrofurantoin followed by gentamicin and piperacillin/tazobactam. Conclusion: In this study, nitrofurantoin was the most effective antibiotic for Gram-positive and Gram-negative uropathogen

Evaluation of Pressure Drop and Particle Sphericity for an Air-rock Bed Thermal Energy Storage System

Abstract The pressure drop of a packed bed thermal energy storage system with irregular shaped solid pellets and tank-to-particle diameter ratio of 10.4 is investigated. The bed height to diameter ratio is 2. The particle sphericity is calculated and used to compare pressure drop correlations to the measured values in the particle Reynolds number range of 353 ≤ Re p ≤ 5206

Efficacy and safety of systemic hydrocortisone for the prevention of bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis

Early lung inflammation has been implicated in the pathogenesis of bronchopulmonary dysplasia (BPD). We aimed to establish the efficacy and safety of systemic hydrocortisone for the prevention of BPD. A systematic review and meta-analysis were undertaken, with a detailed electronic literature search. Trials involving preterm infants were included if they were randomised to receive systemic hydrocortisone or a placebo. The primary outcome was the composite of survival without BPD at 36-week postmenstrual age (PMA). Results are presented as relative risk (RR) or risk difference (RD) with 95%confidence intervals (CIs), along with numbers needed to treat (NNT) or harm (NNH). After filtering, 12 studies using early (within 1 week of birth) and two using late hydrocortisone were identified. Early systemic hydrocortisone significantly increased the chances of survival without BPD (RR 1.13, 95% CI [1.01, 1.26], NNT 18), and survival without moderate-to-severe neurodevelopmental impairment (1.13 [1.02, 1.26], NNT 14). Infants who received hydrocortisone had a higher risk of intestinal perforation (1.69 [1.07, 2.68], NNH 30), primarily with concurrent treatment for patent ductus arteriosus. Conclusion: Early systemic hydrocortisone is a modestly effective therapy for the prevention of BPD in preterm infants, although some safety concerns remain. No conclusions could be drawn for late hydrocortisone due to the paucity of studies

Indoor air pollution and asthma in children at Delhi, India

Introduction: Several studies in developed countries have shown association between indoor air pollution and asthma in children. The present research was undertaken to study this association at Delhi, India. Material and methods: This study took place at Delhi, capital of India. Eight locations based on the source of pollution such as industrial, residential and villages were included. Recording of the demographic profile and clinical examination of each child was conducted at their residence. Indoor SO2, NO2 and SPM (suspended particulate matter) levels were measured by using Handy Air Sampler (Low Volume Sampler). Results: A total of 3104 children were examined of which 60.3% were male and 39.7% were female. 32.4% children were exposed to environmental tobacco smoke. 31.5 % children’s families were using biomass fuels for cooking. History of respiratory symptoms included cough (43.9%), phlegm production (21.9%), shortness of breath (19.3%) and wheezing (14.0%). 7.9% children were diagnosed as having asthma, which was highest in industrial areas (11.8%), followed by residential (7.5%) and village areas (3.9%). The mean indoor SO2, NO2 and SPM levels were 4.28 ± 4.61 mg/m3, 26.70 ± 17.72 mg/m3 and 722.0 ± 457.6 mg/m3 respectively. Indoor SPM was the highest in industrial area followed by residential area and urban village area. Indoor SPM level was significantly (p < 0.001) higher in the asthmatic children’s houses. Conclusion: This study suggests that industry plays an important role in increasing the concentration of indoor suspended particulate matter and occurrence of asthma in children in developing countries like India.Introduction: Several studies in developed countries have shown association between indoor air pollution and asthma in children. The present research was undertaken to study this association at Delhi, India. Material and methods: This study took place at Delhi, capital of India. Eight locations based on the source of pollution such as industrial, residential and villages were included. Recording of the demographic profile and clinical examination of each child was conducted at their residence. Indoor SO2, NO2 and SPM (suspended particulate matter) levels were measured by using Handy Air Sampler (Low Volume Sampler). Results: A total of 3104 children were examined of which 60.3% were male and 39.7% were female. 32.4% children were exposed to environmental tobacco smoke. 31.5 % children’s families were using biomass fuels for cooking. History of respiratory symptoms included cough (43.9%), phlegm production (21.9%), shortness of breath (19.3%) and wheezing (14.0%). 7.9% children were diagnosed as having asthma, which was highest in industrial areas (11.8%), followed by residential (7.5%) and village areas (3.9%). The mean indoor SO2, NO2 and SPM levels were 4.28 ± 4.61 mg/m3, 26.70 ± 17.72 mg/m3 and 722.0 ± 457.6 mg/m3 respectively. Indoor SPM was the highest in industrial area followed by residential area and urban village area. Indoor SPM level was significantly (p < 0.001) higher in the asthmatic children’s houses. Conclusion: This study suggests that industry plays an important role in increasing the concentration of indoor suspended particulate matter and occurrence of asthma in children in developing countries like India

Predicting extubation outcomes - a model incorporating heart rate characteristics index

Objective To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics index (HRCi) can be combined with a clinical model for predicting extubation outcomes in neonates. Study design HRCi and clinical data for all intended intubation-extubation events (episodes) were retrospectively analyzed between June 2014 and January 2015. Each episode started 6 hours pre-extubation or at the time of primary intubation if ventilation duration was shorter than 6 hours (baseline). The episodes ended at 72 hours postextubation for successful extubations or at reintubation for failed extubations. Mean of 6 hourly epoch HRCi-scores (baseline) or fold-changes (postextubation) were analyzed. Results are expressed as medians (IQR) for continuous data and proportions for categorical data. Multivariable logistic regression mixed model was used for statistical analysis. Results Sixty-six infants contributed to 96 episodes (18 failed extubations, 78 successful extubations) in the study. Failed extubations had significantly longer duration of ventilation (65.3 hours, 19.94-158.2 vs 38.4, 16.5-71.3) and more culture positive sepsis (33.3% vs 3.8%) than successful extubations. Baseline HRCi scores (1.68, 1.29-2.45 vs 0.95, 0.54-1.86) and postextubation epoch-1 fold changes (1.25, 0.94-1.55 vs 0.94, 0.82-1.11) were higher in failed extubations compared with successful extubations. Multivariable linear mixed-effects regression was used to create prediction models for success of extubation, using relevant variables. Conclusions The baseline and postextubation HRCi were significantly higher in neonates with extubation failure compared with those who succeeded. Models using HRCi and clinical variables to predict extubation success may add to the confidence of clinicians considering extubation