Indian Journal of Respiratory Care

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2023 | April-June | Volume 12 | Issue 2

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EDITORIAL

Madhuragauri Shevade

It is Time that Respiratory Therapists Prioritize “Asthma Care for All”

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:2] [Pages No:107 - 108]

   DOI: 10.5005/jp-journals-11010-1042  |  Open Access |  How to cite  | 

187

Original Article

Sharath Chandra KS, Chandramouli M Thimmaiah, Giridhar B Hosmane

The Outcome of Medical Thoracoscopy in Patients with Unexplained Exudative Pleural Effusion

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:4] [Pages No:109 - 112]

Keywords: Malignancy, Nodules, Pleural effusion, Rigid thoracoscopy, Tuberculosis

   DOI: 10.5005/jp-journals-11010-1031  |  Open Access |  How to cite  | 

Abstract

Background: Exudative pleural effusion of unknown etiology is a diagnostic perplexity. Medical thoracoscopy (MT) is a less invasive procedure and has a high diagnostic utility in these patients. Objectives: The study goal was to analyze the value of MT in patients with exudative pleural effusion of unknown cause. Materials and methods: The cross-sectional observational study included clinical data of patients with unexplained pleural effusion of exudative type who had undergone MT at a tertiary care center between July 2019 and June 2022. Results: The diagnostic MT was performed on 28 patients with exudative pleural effusion, which diagnostic thoracentesis could not explain. The diagnostic yield was 96.42%. The mean age was 52.9 ± 13.5 (range 25–75) years, and 17 (60.7%) were males. Malignancy was diagnosed in 60.70% (17/28) of patients, tuberculosis in 28.60% (8/28) of patients, and nonspecific pleuritis/fibrosis in 10.70% (3/28) of patients. Out of 17 patients with malignancy, metastatic adenocarcinoma was detected in 70.58% (12/17) of patients, malignant mesothelioma in 17.64% (3/17) of patients, and poorly differentiated in 11.76 % (2/17) of patients. No major complications were observed and only three patients had minor complications. Conclusion: Medical thoracoscopy (MT) is a minimally invasive, risk-free, and effective tool for the diagnosis of unexplained exudative pleural effusion with added therapeutic advantages with high diagnostic yield and minimal complication rate.

242

Original Article

Farrokh Fathi Moghaddam, Mahnaz Amini, Milad Bahrami, Fariba Rezaeetalab, Negar Gholampoor Shamkani, Mahdi Rafiee, Mahnaz Mozdourian

Survey on the Impact of COVID-19 Mandatory Lockdown on Clinical Condition of Patients with Chronic Pulmonary Diseases

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:5] [Pages No:113 - 117]

Keywords: Coronavirus 2019, Chronic obstructive pulmonary disease, Interstitial lung disease, Asthma, Quarantine

   DOI: 10.5005/jp-journals-11010-1030  |  Open Access |  How to cite  | 

Abstract

Introduction: The coronavirus disease of 2019 (COVID-19) pandemic has prompted lockdown regulations and extreme societal restrictions worldwide. The current study intended to assess the impact of the COVID-19 mandatory lockdown on the clinical condition of patients with chronic pulmonary diseases. Materials and methods: A telephone survey was carried out on patients with chronic pulmonary diseases who were referred to Imam Reza Hospital in Mashhad, Iran, from March 2019 to June 2020. The collected information included the subjects’ demographic characteristics, their compliance with lockdown mandates, the feasibility of access to medical care and medications, exacerbation of their underlying chronic pulmonary diseases and in case of COVID-19 development, their clinical presentations, and length of hospital stay (if hospitalized). Results: A total of 500 patients, including 291 males (58.2%) and 209 females (41.8%), participated in the present study. According to the findings of interviews, 93.6% of participants strictly followed the lockdown rules, and 44.4% had a face-to-face or phone consultation with a pulmonologist. Additionally, 35.7% of patients were diagnosed with COVID-19, of whom 70.4% were hospitalized, and 15.6% died. Dyspnea, fever, cough, headache, and fatigue were the most prevalent symptoms reported by COVID-19 patients. Conclusion: The government lockdown policies have hindered access to health services, especially for those suffering from chronic pulmonary diseases. Under this condition, COVID-19 disease can further place patients with chronic pulmonary diseases at risk as infection in these patients progresses more rapidly. Therefore, in the current crisis, patients with chronic pulmonary diseases need to be supervised by specialist consultants and receive adequate medical care constantly.

259

Original Article

Sanjeev K Singla, Rakendra Singh, Shah Aiman, Gurmeet Brar

Various Symptoms and Complications Seen in Critically Ill Adult Substance Use Disorders Patients in Intensive Care Unit of a Tertiary Care Hospital: An Observational Study

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:5] [Pages No:118 - 122]

Keywords: Critical care unit, Delirium, Substance withdrawal, Withdrawal complications

   DOI: 10.5005/jp-journals-11010-1029  |  Open Access |  How to cite  | 

Abstract

Introduction: Substance use disorders are a common problem all over the world. Substance dependence may be associated with one or more substances at the same time and may include the use of illicit or illegal substances or misuse of legal substances like alcohol, tobacco, and prescription drugs. Common substance use disorders include tobacco products, alcohol, benzodiazepines, opioids, and derivatives. This leads to increased mortality, morbidity, medical interventions, along with hospital stays. Aim: To find the challenges like delirium, withdrawal, and its complications in adult patients with substance use disorders who are critically ill, posed to the treating staff in the critical care unit. Materials and methods: A cross-sectional observational study included 110 adult patients of both sexes, aged between 18 and 60 years, who were dependent on substances like tobacco, alcohol, opioids, and benzodiazepines and needed admission to the intensive care unit (ICU); from 15th February to 15th August 2022. Relevant data on adverse events that occurred due to substance withdrawal, any complications from substance use like local or general infection, and any comorbidity were noted. The Confusion Assessment Method for the ICU (CAM-ICU) scale was used to diagnose delirium. A urine toxicology screen was done. The data were collected, tabulated, and statistically analyzed by descriptive-analytical method. Results: A total of 429 adverse events were noted. The most common adverse event due to substance withdrawal was agitation and delirium (46.39%), followed by inconvenience to other patients in the unit 17.02%, increased requirement of sedation and analgesia (15.11%), increased hospital stay (8.39%), arrhythmias including atrial fibrillation and cardiac myopathy in (4.43%). The younger population was addicted to more than one substance intravenously than the older individuals. Conclusion: The symptoms and complications seen in substance dependents in the ICU increase the morbidity, mortality, hospital stay, number of interventions, and financial burden on a family. These patients not only harm themselves but also harm the treating staff and damage hospital equipment and also disturb other fellow patients.

226

Original Article

Priyanka Balasubramani, Abishek J Rajeshwari, Anbupriya Maharajan

Interest in Upgrading the Professional and Ethical Knowledge among Practicing Physiotherapists

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:4] [Pages No:123 - 126]

Keywords: Evidence-based practice, Interest, Knowledge, Physiotherapists, Professional ethics

   DOI: 10.5005/jp-journals-11010-1028  |  Open Access |  How to cite  | 

Abstract

Background: In the current trend, following a code of ethics and upgrading the knowledge to match the recent updates has become an essential factor in any healthcare professional to maintain professionalism. Physiotherapy is no exception where the treatment outcome depends majorly on professionalism and evidence-based practice (EBP) on par with current trends. Objective: This study aimed to find out the interest toward the upgradation of their professional and ethical knowledge on par with current trends. Materials and methods: A cross-sectional study was carried out through self-administered online questionnaire among practicing physiotherapists. Results: There is a higher rate of interest in improving the skills (4.1 ± 0.99) and increased awareness of currently accepted standards of practice (4.11 ± 0.89). Conclusion: Physiotherapists show a positive attitude in upgrading their professional and ethical knowledge. Core competency: Practice-based learning and improvement.

300

Original Article

Haishwarya Raghavi, Samundeeswari Premkumar, Ajay Padmanaban

VAP Bundle Components and Their Compliance in a Tertiary Intensive Care Unit

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:4] [Pages No:127 - 130]

Keywords: Compliance, Intensive care unit, Respiratory therapist, Ventilator-associated pneumonia bundle, Ventilator-associated pneumonia

   DOI: 10.5005/jp-journals-11010-1032  |  Open Access |  How to cite  | 

Abstract

Introduction: Ventilator-associated pneumonia (VAP) adversely increases cost and outcomes in the intensive care unit (ICU). VAP bundle is regularly practiced in ICUs to prevent VAP. While the VAP bundle is routinely utilized, the degree of adherence to its various components is often a suboptimal variable, and definite data is lacking. Identification of bundle components with poor compliance and implementation of specific processes to improve them may have a significant impact on overall VAP rates. Aim: To conduct an audit to evaluate the compliance rates of individual elements of the VAP bundle in a tertiary ICU. Materials and methods: The audit was performed in a 24-bedded tertiary level ICU by a single designated respiratory therapist (RT). The audited VAP bundle comprised six evidence-based components. Before implementation, the eligibility of each VAP bundle component was ensured first, and then the compliance rate of each of the components was checked by RT once a day at random times, either during morning or afternoon shifts. Results: A total of 97 patients were audited for VAP bundle compliance during the study period (564 ventilator days). The eligibility for most of the VAP bundle elements was >90%, except for subglottic suction drainage (80.4% eligibility) and daily sedation vacation (59.1% eligibility). The bundle compliance rates of each component were—head of bed (HOB) elevation—96.7%, endotracheal (ET) cuff pressure measurement—95.5%, daily sedation vacation—93.6%, hand hygiene—87.1%, subglottic suction drainage—84.1%, and oral hygiene—81.1%, respectively. Overall, VAP bundle compliance was 89.6%. Our study found a VAP rate of 7.09/1,000 ventilator days. Conclusion: The compliance rate of the VAP bundle was high. However, the adherence to the practice of individual components varied, with the least compliance found in oral hygiene and subglottic suctioning practices. Many patients were not candidates for daily sedation vacation due to medical acuity. Clinical significance: Focused interventions targeting components with lower compliance rates may augment the efficacy of the VAP bundle.

1,127

Original Article

Sonal Mestry, Raziya M Nagarwala, Rachana Dabadghav

Cardiovascular Fitness: Using Individualized Adjustable Step Test in Healthy Young Indian Population

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:4] [Pages No:131 - 134]

Keywords: Adjustable step test, Harvard step test, Maximal oxygen uptake, Modified Harvard step test, Physical fitness index

   DOI: 10.5005/jp-journals-11010-1043  |  Open Access |  How to cite  | 

Abstract

Aims and background: Modified Harvard step test (mHST) checks the aerobic fitness of an individual with a fixed step height of the stepper, which can be an advantage for taller people to perform mHST. Biomechanical characteristics change with each individual. Hence, by simply modifying the step height, the test can be individualized. Therefore, the aim of the study is to check whether an individualized change in the height of the stepper according to the hip joint angle affects the cardiorespiratory fitness index. Materials and methods: This is a comparative type of study conducted on 70 healthy young adults. Participants performed mHST using a stepper of height of 40 cm for males and 33 cm for females and an adjustable step test using a stepper with individualized calculated step height with a fixed hip angle of 70°. Outcome measures were physical fitness index (PFI) and maximal oxygen uptake (VO2 max). Results: This study shows that there is a significant difference between the adjustable step test and mHST for PFI (p = 0.000) and VO2 max (p = 0.000). The effect size of the adjustable step test for PFI and VO2 max was large (r = 0.705; r = 0.629, respectively). Conclusion: Our study concludes that the height-adjustable step test estimates better PFI and shows better oxygen consumption or better VO2 max. Clinical significance: Height adjustable step test estimates better PFI and shows better oxygen consumption or better VO2 max.

272

Original Article

G Sundareshan, Poonam Sherwani, Anjum Syed, Prasan K Panda, Mahendra Singh

Temporal Evolution of Imaging Findings on High-resolution Computed Tomography Chest in COVID-19 Patients: A Tertiary Care Experience

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:4] [Pages No:135 - 138]

Keywords: Consolidation, Coronavirus disease 2019, Consolidation, Fibrosis, Ground-glass opacity, High-resolution computed tomography chest

   DOI: 10.5005/jp-journals-11010-1038  |  Open Access |  How to cite  | 

Abstract

Introduction: Coronavirus disease 2019 (COVID-19), is an infectious illness caused by the coronavirus strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We set out to monitor the evolution of lung changes in individuals who survived COVID-19 infection, investigate prospectively in the Indian population, and determine their predictive factors. None of the studies was conducted on the Indian people for long-term follow-up prospectively. Materials and methods: We enrolled patients who had been treated for COVID-19 at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. At the time of admission and 3-monthly follow-up visits, high-resolution computed tomography (HRCT) chest was done to look at the evolution of lung changes. Results: At the 3-month follow-up CT, 28 of the 50 participants (56%) (group I) showed fibrotic changes with or without residual consolidation/ground-glass opacity (GGO). In contrast, the remaining 22 people (44%) (group II) did not show fibrotic changes and had either complete radiologic resolution or only residual GGO consolidation. Conclusion: Common findings noted on admission were predominant consolidation and predominant GGO. Post-COVID-19 lung fibrosis was observed in about half of the survivors. Consolidation in the initial chest CT scan was linked to a higher risk of developing post-COVID-19 lung fibrosis. These fibrotic changes were linked to an older age, male patient, and acute respiratory distress syndrome at admission.

236

Original Article

Youssef Motiaa, Tannouche B Mohammed, Zyani Adil, Ounci Es-saad, Mohammed Aabdi, Hanane Khalki, Marieme Benkacem, Maryam Assem, Siham Alaoui Rachidi, Hicham Sbai, Smael Labib

Comparison of ICU Patients’ Characteristics across Two Waves of COVID-19: A Monocentric Cohort Study

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:7] [Pages No:139 - 145]

Keywords: Comorbidities, Coronavirus disease 2019, First wave, Intensive care unit, Morbidity, Mortality, Second wave, Severity

   DOI: 10.5005/jp-journals-11010-1047  |  Open Access |  How to cite  | 

Abstract

Background: Morocco, like the rest of the globe, has undergone multiple waves of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) pneumonia. This study included the patients managed during two different waves, which included 494 patients treated in the intensive care unit (ICU) of Tangier, Morocco. Materials and methods: A retrospective cohort study was conducted, including COVID-19 patients who were hospitalized in the ICU during two periods. The first period extended from 26th March to 17th September 2020, and the second period from 1st July to 30th September 2021. Results: Overall, data from 494 patients have been analyzed, 221 of them included during the first wave and 273 during the second wave. Patients admitted during the second wave had more diabetes mellitus (26.3 vs 25%, p = 0.007) and chronic obstructive pulmonary disease (COPD) (1.1 vs 0.5%, p < 0.001). They were clinically more severe [acute physiology and chronic health evaluation (APACHE II)—12 (9; 15) vs 10 (5; 14)/p < 0.001), and the respiratory status as shown by the following vital signs—oxygen saturation: 80% (68; 88%) vs 93% (85; 96%)/p < 0.001, respiratory rate—35/minute (30; 40) vs 30/minute (25; 35)/p < 0.001, heart rate—96 bpm (88; 103) vs 90 bpm (82; 100)/p = 0.005, and diastolic blood pressure (DBP)—70 mm Hg (60; 80) vs 70 mm Hg (70; 80)/p = 0.026]. They had evidence of more lung damage [70% (50; 80) vs 60% (45; 70), p < 0.001] and pulmonary embolism at admission [3.7 vs 3.2% (p < 0.001)]. Complications were also more frequent during the second wave—ICU stay [5 (3.9) vs 3 (2.9), p = 0.001], bacterial superinfection pneumonia [27.4 vs 12.7%, p < 0.001], acute respiratory distress syndrome (ARDS) [52.4 vs 18.6%, p < 0.001], and septic shock [17.9 vs 5.9%, p < 0.001]. ICU mortality was also higher—72.5 vs 49.5%, p < 0.001. Conclusion: Coronavirus disease 2019 (COVID-19) patients admitted to the ICU during the second wave had significantly higher morbidity and mortality compared to patients admitted during the first wave.

216

Original Article

Youssef Motiaa, Rim Essaoud, Mohammed T Bennani, Abdellah Darraz, Lamyae Y Martahe, Mohammed Aabdi, Siham A Rachidi, Ounci Es-saad, Smael Labib, Hicham Sbai

Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema in COVID-19 Patients: A Monocentric Cohort Study

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:5] [Pages No:146 - 150]

Keywords: Coronavirus disease 2019, Pneumomediastinum, Pneumothorax, Subcutaneous emphysema

   DOI: 10.5005/jp-journals-11010-1048  |  Open Access |  How to cite  | 

Abstract

Background: Pneumomediastinum (PMD) and pneumothorax (PNO) associated with subcutaneous emphysema (SCE) were described as complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Macklin effect and diffuse alveolar damage due to coronavirus disease 2019 (COVID-19) are the main implicated pathophysiological mechanisms. These complications are associated with hyperinflammation reactions leading to a high-risk of morbidity and mortality. The aim of this article is to describe our series of COVID-19 patients admitted to the intensive care unit (ICU) and conventional hospitalization. Materials and methods: We conducted a retrospective study in Duc de Tovar and Mohammed VI hospitals in Tangier, Morocco, that included all COVID-19 patients hospitalized from 14th March 2020 to 21st March 2021 who developed on admission or during their hospital stay a PMD, a PNO, and or an SCE. Results: Of 216,96 patients who tested positive for SARS-CoV-2, 25 were included and analyzed. The median age was 59-year-old (49–65.5) with male predominance. Diabetes and cardiovascular diseases were the most encountered comorbidities. Our patients were critically ill with a median respiratory rate of 30 breaths/minute, a median oxygen saturation of 77%, and a median lung damage of 60% (30, 75) of the pulmonary parenchyma. Laboratory investigations showed various abnormalities [high levels of C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), neutrophils/lymphocytes ratio, D-dimers, and low levels of lymphocytes], which are independent risk factors of mortality. Some of these factors allowed for predicting the development of these complications. Conclusion: Pneumomediastinum (PMD) in COVID-19 patients reflects diffuse alveolar damage due to hyperinflammation. It can be isolated or associated with PNO and/or SCE. These complications were reported in most seriously-ill COVID-19 patients. Comparative studies are needed to identify predictive and prognosis factors.

268

Original Article

Chris S Mathew, Edwin Dias, Duane Wong, Manjush Karthika

Lung Ultrasound in Respiratory Therapy: A Pre- and Post-Training Analysis

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:12] [Pages No:151 - 162]

Keywords: Lung ultrasound, Respiratory therapists, Training

   DOI: 10.5005/jp-journals-11010-1050  |  Open Access |  How to cite  | 

Abstract

Background: Lung ultrasound (LUS) is a bedside diagnostic tool to assess the pulmonary status of patients in diverse scenarios of acute care and is typically performed and interpreted by physicians. Within the multidisciplinary group of clinicians, respiratory therapists (RTs) are considered to be one of the principal caregivers for patients who require comprehensive respiratory support. However, the practice and use of LUS by RTs over other healthcare professionals is still in its infancy. Hence this study aimed to look at the outcome of a 2-day training offered to RTs in terms of their acquired knowledge and practical skill. Methodology: This is a pilot study of a doctoral thesis that explores the scope of LUS in the respiratory therapy profession. The study was designed with a pre and posttraining analysis to determine the effectiveness of the skillset of RTs before and after training. The RTs were selected based on their participation consent, and the training was approved by the Department of Allied Health (respiratory therapy), Sidra Medicine, Qatar. The training program included didactic theory sessions and application sessions for 16 hours (2 days). The sociodemographic data was measured, and the analysis was based on a questionnaire, which measures the techniques and terminologies of LUS and its clinical applications. In addition, the competency of the RTs was determined, and a comparative study was done with their different levels of educational qualifications and years of experience. Results: The demographic data revealed the age, gender, educational qualification, and years of experience of the RTs. The pretest results showed that only five out of 24 participants (21%) scored >60%, whereas, in the posttest, it was observed that 23 out of 24 (96%) scored >60% of the total score, reflecting the importance of didactic theory sessions and practical sessions. The competency results revealed that even RTs who had >10 years of experience also needed some ongoing education and training periodically, as few of them failed to identify the clinical signs. This study indicates that irrespective of educational qualification and years of experience; RTs require continuing education, periodic assessment, and hands-on training sessions to upgrade their skill set in performing LUS. Conclusion: We conclude that our study has proven to be beneficial in terms of the knowledge and skills attained by RTs on LUS. Acquiring such skills sets a benchmark in the current practice of RTs, and this may reduce adverse events, specifically in ventilated patients, leading to improved patient care and safety.

329

REVIEW ARTICLE

Harish M Maheshwarappa, Snehali Majumder

Critical Appraisal of Randomized Controlled Trials: An Overview

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:6] [Pages No:163 - 168]

Keywords: Critical Appraisal, Narrative Review, Randomized Control Trials

   DOI: 10.5005/jp-journals-11010-1040  |  Open Access |  How to cite  | 

Abstract

Randomized Control Trials (RCTs) are the major source of information on the efficacy and safety of new and repurposed therapeutic agents and treatments. Therefore, it becomes essential that RCTs are of good quality and free of any biases. In the ever-evolving field of healthcare, making the correct clinical decision is important. Critical appraisal of new medical findings is therefore of utmost importance since clinical judgments are made based on the evidence provided by the publications and trial reports. In this review, we analyze the process of critically appraising RCTs using various researcher-developed guidelines and The Critical Appraisal Skills Programme (CASP) checklist for RCTs.

512

INVITED ARTICLE

Raghavendra Deshpande, Ajith Kumar A K, Nishchitha Shetty, Narayana S Moola

Asthma in Pregnancy: A Concise Review

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:6] [Pages No:169 - 174]

Keywords: Asthma, Critical asthma syndrome, Near fatal asthma, Pregnancy

   DOI: 10.5005/jp-journals-11010-1041  |  Open Access |  How to cite  | 

Abstract

Respiratory disorders affect pregnancy; asthma is the common cause of respiratory disorders. It affects maternal and fetal outcomes when not managed properly. Pregnancy also influences the course of asthma through physiological respiratory, immune, and hormonal changes. Asthmatic exacerbations are an important feature of asthma; some may need intensive care admission. Managing critical asthma syndrome (CAS) and near-fatal asthma (NFA) remains challenging. Immediate and prompt intervention with medications and supportive care will reduce exacerbations and symptoms of asthma. The purpose of this article is to provide an overview of asthma in pregnancy and summarize the current knowledge. This review aims to create awareness among patients and physicians on the importance of managing asthma during pregnancy. To conclude, early and prompt detection of asthma and its exacerbations, optimal control of asthma, and prevention of its adverse effects will help both mother and fetus. Educating mothers on the importance of antiasthmatic therapy, avoiding triggers, and frequently monitoring symptoms are sine qua non for good asthma management.

309

CASE REPORT

Shreya Jayaram, Pushpa Kini

The Tale of an Areca Nut...Years Down the Line: Case Report of Complete Reversal of Bronchiectasis Following Removal of a FB

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:175 - 177]

Keywords: Aspiration, Bronchiectasis, Foreign body, High-resolution computed tomography, Reversible

   DOI: 10.5005/jp-journals-11010-1033  |  Open Access |  How to cite  | 

Abstract

Introduction: Bronchiectasis is the clinical condition of irreversible widening of the airways, which can occur due to any cause of obstruction, recurrent infections, aspirations, anatomical variations of airways, etc. Under certain conditions, a retained foreign body (FB) in the airways can lead to secondary bronchiectasis, which can completely resolve once the removal is performed completely. Here, we discuss the case of a 4-year-old patient who presented with recurrent episodes of cough and fever for 4 years. Case description: There was history of FB (areca nut) ingestion during the first year of life, and bronchoscopic removal of the same was carried out at a hometown hospital. His symptoms still persisted and at 4 years of age computed tomography (CT) thorax showed evidence of residual piecemeal FB with a secondary left-lower lobe bronchiectasis. Complete removal was done and his symptoms regressed. Repeat CT thorax revealed full reversal of bronchiectasis. There were no further complications.

189

CASE REPORT

Jithin K Sreedharan, Yasmeen F Mirza, Saad M AlRabeeah, Abdullah S Alqahtani, Jaber S Alqahtani, Meshal Alenezi, Siju K George, Mohammed Regal

An Unusual Case of Thoracic Empyema Secondary to Streptococcus anginosus: A Case Report

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:4] [Pages No:178 - 181]

Keywords: Bronchopleural fistula, Empyema, Parapneumonic effusion, Streptococcus anginosus

   DOI: 10.5005/jp-journals-11010-1036  |  Open Access |  How to cite  | 

Abstract

Few incidences of adult patients with rapidly progressing empyema complicated by bronchopleural fistula related to Streptococcus anginosus have been documented. A 53-year-old male with a history of smoking 20 packs/year. He was admitted with 5 days history of worsening cough, respiratory distress, fever, headache, and pleuritic chest pain. Thoracic ultrasound was done, showing septated right-sided pleural effusion, confirming empyema. After decortication, pus culture showed heavy growth of Streptococcus anginosus. The drug susceptibility test revealed susceptibility to penicillin, erythromycin, cephalosporin, and piperacillin/tazobactam. The patient was successfully treated with piperacillin/tazobactam and early open thoracotomy decortication surgery was performed and discharged within 11 days. Although the number of empyema cases infected with Streptococcus anginosus is low, patients should be managed early depending on accurate diagnosis using the right antibiotics, optimal drainage, and surgical intervention if necessary. Further knowledge and research on the clinical presentation and the pathogenesis of thoracic Streptococcus anginosus are needed to have better clinical outcomes in future cases. The specific classification of empyema is suggested using lung ultrasound for the best management options.

345

CASE REPORT

Sneha Leo, Ramasubramaniam Kottaisamy, Madhusmita M Mohapatra, Srinivas H Bheemanathi

Bacterial Pneumonia Concealing Pulmonary Granulomatosis with Polyangiitis: A Diagnostic Difficulty

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:182 - 184]

Keywords: Granulomatosis with polyangiitis, Hemoptysis, Klebsiella pneumoniae, Pulmonary vasculitis, Wegener's granulomatosis

   DOI: 10.5005/jp-journals-11010-1035  |  Open Access |  How to cite  | 

Abstract

Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis which primarily involves upper respiratory tract, lungs and kidneys. Lung involvement is bilateral parenchymal nodules which may cavitate. We present a case of a 60-year-old male with cough, hemoptysis, and fever. Clinical and radiological examination revealed bilateral multilobar cavitating consolidation. Diagnostic bronchoscopy was performed, and bronchial wash grew Klebsiella pneumoniae. Despite sensitive antibiotics, the patient worsened. On further investigations, granulomatosis with polyangiitis (GPA) was proved by serology and histopathological examination of lung biopsy. The patient succumbed to respiratory failure before specific treatment initiation. As there was overlapping Klebsiella infection, underlying pulmonary vasculitis was overlooked. Hence in all cases with hemoptysis and a cavitating consolidation, pulmonary vasculitis should be worked up in order to avoid poor outcomes.

292

CASE REPORT

M N Pradhan

Coronavirus Disease 2019 Severity in Patients with Adenocarcinoma of the Left Lung: A Case Report

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:185 - 187]

Keywords: Coronavirus disease 2019, Intensive care unit, Lung cancer, Mortality

   DOI: 10.5005/jp-journals-11010-1044  |  Open Access |  How to cite  | 

Abstract

Patients with cancer are the most vulnerable population against coronavirus disease 2019 (COVID-19), as they need continuous medical care and regular contact with hospital environments, which put them at risk of COVID-19 disease. We describe a case of a 62-year-old male patient presented with severe COVID-19 who is being admitted to our intensive care unit (ICU) and diagnosed with adenocarcinoma of the posterobasal segment in the left lower lobe of the lung. For lung cancer (Ca lung) patients, refined and individualized management is needed during the COVID-19 epidemic to maximize benefits.

199

CASE REPORT

Sheik Abdullah, KC Dhinesh, Mahnoor Jaffar

Anesthetic Management in a Child with Incidental Finding of Congenital Scoliosis for a Urology Procedure: A Case Report

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:3] [Pages No:188 - 190]

Keywords: Hypoxemia, Lung volume, Pediatric, Scoliosis

   DOI: 10.5005/jp-journals-11010-1046  |  Open Access |  How to cite  | 

Abstract

Congenital scoliosis is a three-dimensional spine deformity that includes a frontal plane deviation of the spine caused by vertebral and rib malformations. Even in mild cases of formation failures in the first 3 years of life, early intervention is recommended; a conservative approach may also be beneficial. Such cases for semi-emergency procedures necessitate a thorough examination of the pulmonary system. In mild cases, we recommend looking for pulmonary reserve as well as ways to improve lung function. The goal of this case report is to document the pulmonary changes that must be dealt with intraoperatively while maintaining spontaneous breathing.

200

BRIEF RESEARCH COMMUNICATION

Sonali Vadi, Tanmay Charaniya, Priya Wani, Catherine Cooke, Abhijit Raut

Characteristics Associated with Successful Weaning from High-flow Nasal Cannula and Factors influencing Survival for COVID-19-associated Acute Respiratory Failure: A Retrospective Study

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:8] [Pages No:191 - 198]

Keywords: Acute respiratory failure, Coronavirus disease 2019, High-flow nasal cannula, Predictors of weaning from high-flow nasal cannula

   DOI: 10.5005/jp-journals-11010-1045  |  Open Access |  How to cite  | 

Abstract

Introduction: To identify characteristics associated with successful weaning from high-flow nasal cannula (HFNC) and survival in patients with coronavirus disease 2019 (COVID-19)—associated acute respiratory failure. Methods: In this retrospective, observational study performed at a tertiary care center in Mumbai, we evaluated patients with COVID-19-associated acute respiratory failure (C-ARF) who were managed with HFNC. The primary outcome was the proportion of patients who were successfully weaned from HFNC. Secondary outcomes were factors that influenced weaning and survival. Failure of HFNC was defined as those who required invasive ventilation after initial HFNC. Results: Respiratory rate-oxygenation (ROX) 6 was positively correlated to ROX24 (r = 0.5 and p < 0.0001), ROX48 (r = 0.44 and p < 0.0001), and ROX72 (r = 0.29 and p = 0.002). In multivariable logistic regression, average C-reactive protein (CRP) [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.008–1.12], average neutrophil to lymphocyte ratio (NLR) (OR = 1.04, 95% CI: 1.004–1.08), average platelet count (OR = 0.99, 95% CI: 0.99–0.999), and average fluid balance (OR = 1.01, 95% CI: 1.002–1.02) were associated with the need for intubation. Average NLR (OR = 1.04, 95% CI: 1.005–1.08) and average platelet count (OR = 0.99, 95% CI: 0.98–0.99) were associated with mortality. Conclusion: High-flow nasal cannula (HFNC) is a suitable option in patients with C-ARF. Prospective studies are needed to validate the associated variables for the need for invasive ventilation in this group of patients.

208

SHORT COMMUNICATION

Saurabh R Shrivastava, Prateek S Shrivastava

Advocating the Use of Loop-mediated Isothermal Amplification Assay to Improve the Rates of Diagnosis of Pulmonary Tuberculosis in Resource-constraint Settings

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:2] [Pages No:199 - 200]

Keywords: Loop-mediated isothermal amplification, Tuberculosis, World Health Organization

   DOI: 10.5005/jp-journals-11010-1037  |  Open Access |  How to cite  | 

Abstract

Tuberculosis (TB) continues to remain one of the top infectious diseases on a global scale. Acknowledging the gains observed, specific targets have been set as a part of the Sustainable Development Goals, and global leaders are hoping for significant improvement by 2030. In order to achieve this goal, an end TB strategy has been proposed, and great emphasis has been given toward enhancing case detection. Realizing the need, the World Health Organization (WHO) has given more attention toward the development and evaluation of new diagnostic tools and drug susceptibility testing. A molecular assay based on loop-mediated isothermal amplification (LAMP) has been developed to promote the detection of the Mycobacterium tuberculosis (M. tb) TB complex. This test can be easily performed at a peripheral level, requires minimal laboratory infrastructure and limited biosafety standards, is easy to use, and results are available in <1 hour. To conclude, there is an indispensable need to adopt newer methods to strengthen the diagnostic aspect of the disease. This need becomes even more important in resource-poor settings, and hence it is of utmost importance to implement cost-effective diagnostic tools to promote early detection and prompt initiation of treatment.

163

RETROSPECTIVE COHORT STUDY

Nilesh Mahale, Purushotham Godavarthy, Priyanka Bahikar, Mrunalini Jagadale, Divya Choudhary

Prospective Analysis of Incidence of Ventilator-associated Pneumonia Associated with Active and Passive Humidification in SARS-CoV-2 Patients

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:5] [Pages No:201 - 205]

Keywords: Active humidification, Passive humidification, Ventilator-associated pneumonia

   DOI: 10.5005/jp-journals-11010-1049  |  Open Access |  How to cite  | 

Abstract

Aim: Comparison of the incidence of ventilator-associated pneumonia (VAP) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients requiring mechanical ventilation using active and passive humidification. Materials and methods: The prospective study was carried out by the Department of Critical Care Medicine in a tertiary care hospital. Subjects were divided into two groups. Baseline demographic data was collected for both groups. In both the groups, the clinical pulmonary infection score (CPIS), which included—temperature, white blood cell (WBC) count, tracheal aspirate quantity, alveolar oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio, chest ray, and any pathogenic bacterial growth from tracheal aspirate, was documented, and the final score was analyzed, which predicted the incidence of VAP. The secondary outcomes studied were the independent variables, such as duration of ventilator support, mortality rate, and endotracheal tube (ETT) patency in both groups. Results: The intergroup distribution of primary outcome, including the distribution of CPIS parameters, did not differ significantly in both groups; that is, the VAP rate remained the same in both groups. Secondary outcomes, including duration of ventilator support and mortality rate, remained the same, whereas airway occlusion and peak pressure were higher in the patients receiving passive humidification. Conclusion: The incidence of VAP remained the same in both groups with the use of either active or passive humidification systems. Extended use of both systems resulted in the curtailment of ETT patency, whereas the use of a heated humidifier (HH) lowered the risk for artificial airway occlusion.

269

Correspondence

Mahmood D Al-Mendalawi

Prevalence of Metabolic Syndrome in Chronic Obstructive Pulmonary Disease and Its Correlation with Body Mass Index Airflow Obstruction Dyspnea and Exercise Index and C-reactive Protein

[Year:2023] [Month:April-June] [Volume:12] [Number:2] [Pages:1] [Pages No:206 - 206]

   DOI: 10.5005/jp-journals-11010-1039  |  Open Access |  How to cite  | 

Abstract

 

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