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ABSTRACTS FROM NAPCON 2013
Year : 2013  |  Volume : 30  |  Issue : 5  |  Page : 5-16  

Abstracts for Oral Presentation


Date of Web Publication11-Nov-2013

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How to cite this article:
. Abstracts for Oral Presentation. Lung India 2013;30, Suppl S1:5-16

How to cite this URL:
. Abstracts for Oral Presentation. Lung India [serial online] 2013 [cited 2018 Oct 17];30, Suppl S1:5-16. Available from: http://www.lungindia.com/text.asp?2013/30/5/5/121188

TB/INFECTION

Quality of life of patients suffering from pulmonary tuberculosis

Amit Dave, Tushar Sahasrabudhe, Tinku Joseph, Gauri Gadge


Department of Pulmonary Medicine,

Padmashree Dr. D. Y. Patil Medical College,

Pimpri, Pune, Maharashtra, India. E-mail: drtrs@sify.com

Introduction: Tuberculosis is known to affect young people causing high morbidity. The medications themselves contribute to morbidity. In spite of availability of good treatment, the social stigma of the disease still prevails in the society.

Aim: The aim and objective of this study was to better understand the various disease and treatment related factors having significant impact on quality-of-life (QOL) of patients suffering from pulmonary tuberculosis.

Materials and Methods: A cross-sectional study was conducted between September 2012 and September 2013 among patients suffering from pulmonary tuberculosis aged between 15 and 75 years and on treatment with directly observed treatment, short-course. Patients with any known chronic illness that might affect QOL were excluded. A total of 182 patients meeting inclusion criteria were interviewed using a pre-designed questionnaire regarding their perception about total 32 issues regarding QOL. The demographic and socio-economic profiles were also obtained.

Results: Out of total 182 patients included in the study, 70.88% were males. 74.7% of the patients belonged to 21-50 years, the productive age groups. Almost 6.59% chose to hide their diagnosis from others. After diagnosis, 58.24% were scared or worried about the disease and 10.45% patients were depressed. 87 (47.80%) patients had treatment related adverse effects. After being diagnosed as sputum positive pulmonary tuberculosis, 40.11% patients had fear of transmission, while 5.49% were not aware about how tuberculosis transmits. Nearly 46.15% patients were not able to resume their duties for 2 months. 24/53 females either postponed pregnancy or had abortion. 70.32% patients avoided social gatherings.

Conclusion:
The study highlighted some important issues affecting QOL of patients suffering from tuberculosis.

Results of xpert Mycobacterium tuberculosis/resistance to rifampicin assay in detection of tuberculosis and rifampicin resistance: Experience at a tertiary care centre

Kislay Kishore, D. Bhattacharyya, S. Bhalla,

C. D. S. Katoch


Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (Cardiothoracic Centre), Pune, Maharashtra, India. E-mail: dbhatta@rediffmail.com

Introduction: Tuberculosis (TB) is a highly prevalent disease causing significant mortality and morbidity in the developing world. The efforts to control it have suffered due to the emergence of human immunodeficiency virus infection and drug resistance. Early diagnosis of TB and multidrug resistant tuberculosis (MDR-TB) can be made with Xpert Mycobacterium tuberculosis (MTB)/resistance to rifampicin (RIF), a polymerase chain reaction based molecular test. We describe our experience with this test during past 1 year.

Aim: The aim is to determine the clinical utility of Xpert MTB/RIF conducted on various pulmonary and extra-pulmonary specimens in detecting MTB and rifampicin resistance.

Materials
and Methods: This retrospective descriptive study was conducted after compiling the results of all Xpert MTB/RIF tests conducted at our center on various pulmonary (sputum and bronchoalveolar lavage fluid) and extrapulmonary (lymph node aspirate, pus, pleural fluid, gastric aspirate and biopsy) specimens. They were compared with corresponding microscopy, culture and drug sensitivity testing reports.

Results:
Xpert MTB/RIF detects MTB and rifampicin resistance which is taken as a surrogate marker for MDR-TB. The sensitivity of Xpert MTB/RIF compared with culture in detecting MTB was better in sputum from smear positive cases as compared to sputum from smear negative cases or extrapulmonary samples. All MDR-TB cases were correctly identified as rifampicin resistant by Xpert MTB/RIF.

Conclusions:
Xpert MTB/RIF provides early and accurate diagnosis of MDR-TB facilitating an early institution of effective treatment, thus avoiding un-necessary empirical therapy and reducing the potential infectivity of such cases. We recommend wider use of this test for diagnosis of TB, especially suspected MDR-TB.

A new tuberculosis scoring: Can it be an adjunct in case detection?

D. Anuradha, K. V. V. Vijayakumar, K. Venkataramana, R. Sunil Kumar


Department of Pulmonary Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. E-mail: anuradhapmmd@gmail.com

Introduction: Tuberculosis (TB) is one of the most common infectious causes of mortality and morbidity. It has a high disease burden globally, with India having 1/5 th of the global burden.

Aim: Case detection is an important component in the control of TB. Our aim is to design a tool, which can aid in early detection of TB cases apart from the available conventional methods which can be easily implemented, thus strengthening case detection.

Materials and Methods: Initially, a questionnaire was prepared, consisting of 5 parameters which were based on body mass index, contact history, constitutional symptoms, co-morbidities and chest X-ray abnormalities. Later it was applied to a group of 60 patients suspected of having TB. Each parameter was further graded and given a score. The total score of each patient was recorded. Patients were designated as having TB by sputum microscopy and typical chest X-ray findings. Mean scores in tuberculosis and non-tuberculosis patients were noted.

Results and Discussion: The mean score observed in patients found to be having TB was 7.90 and 5.2 in patients who did not have TB and a P < 0.001 was observed. The score range was 6-11 in tubercular patients and 2-8 in non-tubercular patients.

Conclusion:
Patients with total scores in the range of 6-11 were found to have TB. Hence, it can be concluded that TB questionnaire can be applied as a screening tool to TB suspects who live in remote areas with little access to diagnostic services. Patients with high scores can be persuaded further to have diagnostic sputum microscopy done.

Does sputum microscopy at end of intensive phase for monitoring treatment of tuberculosis predict outcome?

Sanat Kumar Tripathy, Puttaswamy, Shivasankar, P. Kumar


National Tuberculosis Institute, Avalon, Bengaluru, Karnataka, India. E-mail:sanat40@hotmail.com

Introduction: Sputum smear examination at the end of intensive phase and if found positive extension for 1 month and repeat examination at the end of extension phase is a key component of monitoring tuberculosis (TB) treatment under National Tuberculosis Control Programme in India. Recently World Health Organization and International Union Against Tuberculosis and Lung Disease have recommended no further extension of intensive phase for 1 more month.

Aim:
To determine the usefulness of sputum smear microscopy at the end of intensive phase and extended intensive phase in new smear positive TB patients registered in Bangalore city from 1 st October 2010 to 30 th September 2011 for predicting favorable treatment outcome.

Materials
and Methods: Cohort study was based on routinely recorded data from the treatment card of new smear positive TB patients taken treatment in Bangalore city with validation of the data by cross checking TB register for that period.

Results:
Out of 1,864 new smear positive TB patients registered during the period, 1,420 (76%) were sputum negative, 238 (13%) positive and 206 (11%) were not available for follow-up at the end of intensive phase. At the end of extended intensive phase 161 (68%) converted to negative out of 238. For predicting favorable treatment outcome, the negative predictive value was 82% and positive predictive value was 48% at the end of extended intensive phase. Failure rate was 29% among sputum positive and 5% for those negative at end of extended intensive phase (P < 0.05). The chance of favorable outcome was higher among those who were negative at end of extended intensive phase (risk ratio: 1.57; 95% confidence interval: 1.25-1.98).

Conclusion:
New sputum smear positive TB patients whose smear has converted to negative at the end of extended intensive phase is a better predictor of favorable treatment outcome.

Usefulness of fine needle aspiration cytology in the diagnosis of tubercular lymphadenitis

Aarthi Abirami, Leena Dennis, Joseph Prathiba


Department of Pathology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India. E-mail: aarthiabirami1251994@gmail.com

Introduction: Diagnosis of tubercular lymphadenopathy by histopathology is the gold standard. However, fine needle aspiration cytology (FNAC) and acid fast bacilli (AFB) staining are simple, less time consuming, inexpensive and can be performed as an out-door procedure, which can aid in a quick diagnosis.

Aims:
To assess the diagnostic role of FNAC in clinically suspected cases of tubercular lymphadenopathy.

Materials
and Methods: This was a retrospective study done over a period of 3 years. All the nodes aspirated in the Cytopathology Department, over this period were analyzed. Ethics clearance was obtained from the Institutional Ethics Committee (IEC/CSP/13/AUG/30/146). The AFB staining and results were also recorded in cases where there was granulomatous inflammation. All the results were analyzed and correlated with clinical data available.

Results:
A total of 300 cases of nodal aspirates were recorded over this period. Of this, 123 cases (41%) were of granulomatous inflammation, 83 cases (27.6%) were of reactive lymphadenitis, 61 cases (20.3%) had a metastatic deposit and in 13 cases (4.3%) it was atypical/suspicious for malignant cells. 10 cases (3%) were suboptimal and in 5 cases (1.6%) there was suppurative inflammation. Aspirates were more in females (172 cases) as compared to males (128 cases). Among the granulomatous inflammation AFB positivity was noted in 14 cases (11.4%). Neck nodes were more commonly enlarged than other locations and aspiration was done in 200 cases (66.6%).

Conclusion:
Aspirates with granulomatous inflammation and AFB positivity can be definitely diagnosed and started on anti-tubercular therapy. This reduces the cost and discomfort to the patient and thus early treatment is possible.

Impact of poor glycemic control on severity of pulmonary tuberculosis in new smear positive patients with type 2 diabetes mellitus

Avuthu Sindhuri, Vinay Mahishale, Bhagyashri B. Patil


Department of Pulmonary Medicine, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.

E-mail: drasindhuri@gmail.com

Introduction: Diabetes mellitus (DM) is a known risk factor for tuberculosis (TB). Little is known about the effect of poor glycemic control on severity and outcome of TB.

Aim:
To study the effect of poor glycemic control on severity of pulmonary TB and outcome of TB treatment.

Materials and Methods: In a tertiary care hospital, 70 patients, newly diagnosed with smear positive pulmonary TB and with coexistent type-II DM were enrolled. All patients underwent clinical, bacteriological, biochemical and radiological examinations at the initial enrolment and were followed-up for a total duration of 6 months. Clinical characteristics and outcome were compared between patients with poor glycemic control and optimal glycemic control.

Results: At initial presentation, patients with poor glycemic control (hemoglobin A1C ≥8%) had more severe disease as compared to patients with optimal glycemic control, with greater sputum mycobacterial burden (sputum grade 3 50% vs. 4%, grade 2 30% vs. 14%; P < 0.001) and far advanced lesions on chest X-ray (40% vs. 2%; P < 0.001). After 2 months, sputum microscopy showed more positive results in patients with poor glycemic control (35% vs. 5%; P < 0.004). At the end of treatment these patients had greater failure rates with sputum smear positivity (23% vs. 4.3%; P < 0.04).

Conclusions: Poorly controlled diabetes in pulmonary TB leads to severe disease with greater mycobacterial burden and far advanced lesions radiologically. It was also observed that poor diabetic control had delayed sputum conversion and increased treatment failure rates among TB patients.

Evaluation of radiological outcome after antituberculosis treatment in new cases of pulmonary, pleural and mediastinal tuberculosis

Gaki Nima, Balakrishnan Menon


Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, Delhi, India. E-mail: gakinima@yahoo.co.in

Introduction: Residual radiological lesions may persist even after successful treatment of tuberculosis. There is insufficient data as to the nature and magnitude of these opacities in treated cases of tuberculosis.

Aims
and Objectives: This study evaluates the nature and magnitude of residual radiological opacities and of complete radiological resolution in successfully treated new cases of tuberculosis.

Materials and Methods: 401 new cases of pulmonary, pleural or mediastinal tuberculosis were radiologically evaluated by chest X-ray PA view at the start and at the end of successful treatment which was as per World Health Organization, National Tuberculosis Control Programme and DOTS guidelines. Patients with previous history of tuberculosis or other lung conditions, treatment failure, retreatment cases and multidrug-resistant tuberculosis cases were excluded.

Results: Overall, residual X-ray lesions were seen in 178 cases of tuberculosis (40.36%). Complete radiological resolution was seen in 263 cases (59.64%). There were 268 pulmonary cases (60.77%) out of 441 cases of tuberculosis. Residual X-ray lesions were seen in 44.78% (120 cases) and complete resolution in 55.22% (148 cases). Pleural lesions were seen in 122 cases (27.66%). Complete resolution was seen in 65.57% (80 cases) while residual lesions were seen in 34.43% (42 cases). Mediastinal opacities were seen in 51 cases (11.56%). Residual lesions were seen in 16 cases (31.37%). Complete resolution was seen in 35 cases (68.63%).

Conclusion: Residual radiological opacities are seen in a large proportion of treated cases of tuberculosis (40%). Pulmonary lesions show more residual lesions (45%) than pleural (34%) or mediastinal lesions (31%).

Invasive pulmonary mycoses: Etiology, predisposing factors and outcome in a tertiary care unit

S. Veni Krishna, Asmita Mehta, V. Rajesh, V. P. Gopinathan


Department of Pulmonary Medicine, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala, India. E-mail: venikrishna07@gmail.com

Introduction: Invasive pulmonary fungal infections occur in subjects with compromised immunity and are associated with a high mortality rate. The non-specific clinico-radiological features as well as the difficulty in procuring tissue specimen in critically-ill subjects translate to considerable delay in definitive diagnosis with consequent poorer clinical outcomes. A high index of clinical suspicions and invasive diagnostic techniques play a pivotal role in early diagnosis.

Aim: The study was aimed at identifying the etiology, predisposing conditions, clinical features and outcome of invasive pulmonary mycoses.

Materials and Methods: This was an observational study. Subjects diagnosed of invasive pulmonary mycosis based on microbiological and histopathologic features were enrolled into the study. Their thorough medical history, detailed physical examination, chest radiograph and thoracic computed tomogram findings were noted. The antifungal agent administered and the outcome of therapy were determined.

Results
and Discussion: Nineteen cases of invasive fungal infections were identified. This included 5 cases of invasive aspergillosis, 4 cases of zygomycosis, 4 cases of pneumocystis pneumonia, 2 cases of penicilliosis etc. The predisposing factors were uncontrolled diabetes mellitus in 11, chemotherapy induced neutropenia in 2, post-transplant immunosuppression in 2 cases and advanced human immunodeficiency virus infection in 1 case. Three subjects were apparently immunocompetent. Eleven out of 19 cases responded to appropriate antifungals and were successfully discharged.

Conclusions:
Common invasive pulmonary mycoses included invasive pulmonary aspergillosis, pulmonary zygomycoses, penicilliosis, etc. The most common predisposing medical condition was uncontrolled diabetes mellitus. Reasonable survival rates were accomplished with invasive sampling techniques and appropriate therapy.

CRITICAL CARE

Evaluation of intensive care unit scoring systems in predicting weaning outcomes and duration of mechanical ventilation

K. S. Aziz, M. Sailal, V. Rajesh, V. P. Gopinathan


Department of Pulmonary Medicine, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala, India. E-mail: drazizksm@gmail.com

Introduction: Mechanical ventilation is a lifesaving adjunct to definitive therapy in many forms of respiratory failure. Despite extensive published literature, the role of respiratory variables as weaning predictors remains controversial. The present study assesses the ability of scoring systems in predicting weaning outcomes and duration of ventilation.

Aim:
Role of intensive care unit (ICU) scoring systems in predicting weaning outcomes and duration of mechanical ventilation.

Materials and Methods:
In an observational study, 130 mechanically ventilated patients admitted to medical ICU of a tertiary care center were scored with sequential organ failure assessment (SOFA), APACHE II and APACHE IV at intubation and at initiation of spontaneous breathing trial . Weaning failure was defined as death, failed first spontaneous breathing trial or need for re-intubation within 48 h. Relation of the scores with weaning outcomes and duration of ventilation were analyzed.

Results
and Discussion: Mean SOFA, APACHE II and APACHE IV at intubation in the successfully weaned group was 6.18, 19.51 and 53.58 as against 6.75, 20.48 and 62.25 in the failed weaning group. Corresponding mean scores at initiation of spontaneous breathing were 3.89, 11.52 and 42.40 versus 5.85, 17.4 and 58.1 for the two groups. In the weaning failure group, all scores were higher at initiation of spontaneous breath.

Conclusions:
APACHE IV score of <55 at intubation predicted a good weaning outcome. All the 3 scoring systems predicted successful weaning outcomes at initiation of spontaneous breathing. None of the scores reliably predicted duration of ventilation.

Clinical profile of patients with acute respiratory distress syndrome: A tertiary care experience

Shobitha Rao, Rahul Magazine, Ashwini Kumar Mohapatra, K. Manu Mohan


Department of Pulmonary Medicine, Kasturba Medical College, Manipal, Karnataka, India. E-mail: shobitha_25@yahoo.co.in

Aims: Acute respiratory distress syndrome (ARDS) is a common disorder seen in critically ill. Mortality due to ARDS is 35-45%. This study was designed to study the clinical profile of patients with ARDS.

Materials
and Methods: The study was done in a tertiary care center of south India. Retrospective analysis of patients who were diagnosed with ARDS as per American-European Consensus Conference during 2010-2011 was done. Data collected included baseline characteristics and severity scoring parameters (within 24 h of onset of disease).

Results:
There were 100 cases. Mean age was 41.95 ± 15. 51 patients were <40 years of age. 61% were males. 73% did not have any co-morbid illness. 81% of the cases followed an infectious cause and most common infection was pneumonia (27%). Most common non-infectious cause was perforation of abdominal viscera (5%). Mortality rate was 51%. Mean duration of hospital stay was 9.8 ± 5. APACHE II (20.33 ± 6.78 vs. 33 ± 4.4), APACHE III (84 ± 23 vs. 51 ± 3), sequential organ failure assessment (SOFA) (10.4 ± 8 vs. 6.5 ± 2), serum creatinine (2.4 ± 3 vs. 1.1 ± 0.6) were higher and PaO 2 /FiO 2 (113.7 ± 44 vs. 133.7 ± 37), urine output (859 ± 586 vs. 1733 ± 859) and serum bicarbonate (19 ± 5 vs. 21 ± 3.8) were lower among those patients who died.

Conclusion:
Most common cause of ARDS was pneumonia. However, significant cases were due to other tropical infections. Majority of patients were young and did not have any co-morbidity prior to onset of ARDS. Even then the mortality was high which signifies the socio-economic burden. APACHE II/III, SOFA scores, PaO2/FiO2, renal failure and metabolic acidosis may be used as indicators of outcome and help in guiding therapy.

Pleural effusions in the medical intensive care unit

S. U. Aroop, G. S. Gaude


Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India. E-mail: aroop4u@yahoo.co.in

Background: In most of the patients admitted to a medical intensive care unit (MICU), pleura is secondarily affected by pulmonary parenchymal disorders and dysfunction of other organ systems. These patients are at risk of developing pleural effusion due to severity of their primary disease.

bjectives:
To assess the causes and clinical significance of pleural effusions in Medical ICU patients.

Materials and Methods:
The prospective study was done in a tertiary care hospital. A total of 321 consecutive patients admitted to MICU were reviewed daily with chest X-ray and chest sonography. Diagnostic thoracentesis was performed as far as possible in all cases.

Results:
The prevalence of pleural effusion was 47% with 44% of effusions being detected at time of admission, while remaining 56% had developed effusion after admission. Chest ultrasonography was performed in 80% and the result correlated with chest radiograph interpretation in 87% of patients. About 75% of effusions were small. Diagnostic thoracentesis was successful in 95% of cases and revealed that 63% of patients had transudative and 34% of patients had exudative pleural effusions. The important causes of effusion were heart failure (32%), parapneumonic effusion (14%), hepatic hydrothorax (14%), pancreatitis (9%) and chronic renal failure (8%). Transudative pleural effusions resolved with the treatment of primary disease. Infectious pleural effusions (18%) were treated with parental antibiotics with or without thoracostomy procedure. 10% of patients required tube thoracostomy. Only 17% of pleural effusions completely resolved at the time of MICU discharge. The patients having pleural effusion had longer MICU stay and prolonged mechanical ventilation. A total of 7% patients with pleural effusion died due to primary pathology.

Conclusions:
Pleural effusions in MICU patients are common. Most of these are small and two-thirds are due to non-infectious causes and they can be detected by careful review of chest X-rays taken in erect or semi-erect position. Most of the effusion resolved completely with the treatment of the primary disease.

COPD/SMOKING

Acute exacerbations of chronic obstructive pulmonary disease requiring in-patient care: Clinical characteristics and outcome

K. Sunil Kumar, V. Rajesh, Asmita Mehta, V. P. Gopinathan


Department of Pulmonary Medicine, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala, India. E-mail: drsunguna@gmail.com

Introduction: Acute exacerbations punctuate the course of chronic obstructive pulmonary disease (COPD) with varying frequency and severity. These events are associated with significant morbidity, mortality and healthcare resource utilization. Severe exacerbations often need intensive care unit admission along with assisted ventilation and have grave implications in outcome. The clinical characteristics of subjects with severe exacerbations and their outcomes are of substantial interest in therapeutic decision making and prognostication.

Aim:
To study the medical comorbidities, need for intensive care utilization, need for assisted ventilation and clinical outcome in in-patient subjects with COPD exacerbations.

Materials and Methods:
This was a prospective study conducted between November 2010 and August 2013. 323 patients with acute exacerbation of chronic obstructive pulmonary disease requiring hospitalization were evaluated with detailed history and review of medical records to assess comorbidities. Intensive care unit (ICU) admission, assisted ventilation and medical therapy were extended based on GOLD guidelines supplemented by institutional protocol. Duration of hospitalization and in-hospital mortality were recorded.

Results
and Discussion: Mean age of study population was 67.3 years. Mean duration of COPD was 6.8 years. Common comorbidities included hypertension in 48.9%, diabetes mellitus in 34% and ischemic heart disease in 25.3%. 203 study subjects (63.9%) required ICU admission. 198 patients (61.3%) had respiratory failure at presentation. 154 patients (47.6%) were managed with non-invasive ventilation whereas 42 subjects (13%) required mechanical ventilation. 52 patients (16.1%) expired during hospital stay.

Conclusions:
A substantial proportion of subjects with severe COPD exacerbation have medical comorbidities and majority required initial ICU stabilization. More than half of the subjects needed assisted ventilation. Mortality rate was low with appropriate therapy.

To assess correlation of BODE index with AECOPD and pulmonary hypertension

C. Siddhuraj, R. Srinivasan, Aruna Shanmuganathan, G. Thilagavathy


Department of TB and Chest Medicine, Meenakshi Medical College Hospital and Research Institute, Enathur, Kanchipuram, Tamil Nadu, India. E-mail: drsiddhuraj03@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) is characterized by an incomplete or partially reversible airflow limitation. Forced expiratory volume (FEV 1 ) is often used to grade the severity of COPD. However many patients with COPD have systemic manifestations that are not reflected by FEV 1 alone. The development of pulmonary hypertension (PHT) in COPD adversely affects survival, exercise capacity and is associated with increase morbidity and mortality. The BODE index is a multi-dimensional tool taking into account body mass index, severity of obstruction, dyspnoea grading and 6MWT to assess severity of COPD. Hence, this study was undertaken to assess the BODE index severity as a predictor of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and development of PHT.

Aim:
The aim of the study was to investigate the association of BODE index severity to AECOPD and development of PHT.

Materials
and Methods: It was a prospective study conducted in patients attending TB and Chest OPD. 55 patients diagnosed as COPD (clinically, radiologically, spirometry) were taken in the study after excluding comorbidities. BODE index was calculated using four parameters and Echocardiography was done to assess PHT.

Results:
Out of 55 patients, BODE index severity was mild in 15 (27.27%), moderate in 23 (41.81%) and severe in 17 (30.90%). Approximately 58% of patients had more than three exacerbations per year which correlated with severity of BODE index. Incidence of PHT was 47% which also showed positive correlation with severity of BODE index.

Conclusion:
It is evident from our study that BODE index, used as a multi-dimensional tool in assessment of COPD, showed a positive correlation with number of exacerbations and the development of PHT.

Early diagnosis of pulmonary arterial hypertension using transthoracic doppler echocardiography in patients with chronic obstructive pulmonary disease

Ankit Rathi, Vinay Mahishale


Department of Pulmonary Medicine, JLN Medical College, Kle University, Belgaum, Karnataka, India. E-mail: rathiankit333@gmail.com

Introduction: Pulmonary arterial hypertension (PAH) is a common and potentially serious complication of chronic obstructive pulmonary disease (COPD). PAH exerts significant impact on both quality of life and survival in COPD patients. It is difficult to diagnose PAH as signs and symptoms in patients with COPD are overlapping. Echocardiography provides a rapid, non-invasive, portable and accurate method to evaluate pulmonary arterial pressure.

Aims:
(1) The aim of this study is to study the prevalence of PAH in COPD patients using transthoracic Doppler Echocardiography, (2) to find its correlation with severity of COPD and hypoxemia.

Materials
and Methods: 130 COPD patients were enrolled in the study after spirometry and staged according to GOLD guidelines. Two dimensional transthoracic Doppler echocardiography and arterial blood gas was performed and patients having systolic pulmonary arterial pressure) ≥30 mm of Hg were classified as having PAH.

Results:
The prevalence of PAH in COPD patients was found to be 40% (52/130), among which prevalence of mild, moderate and severe PAH was 23.07% (30/130), 6.1% (8/130) and 10.7% (14/130), respectively. The frequency of PAH in mild, moderate, severe and very severe COPD was 23% (6/26), 22.2% (8/36), 50% (24/48) and 70% (14/20), respectively. There was statistically significant correlation between severity of COPD and PAH (P < 0.001).

Conclusions:
(1) PAH was present in significantly higher number of patients with COPD and it showed a linear relationship with severity of COPD, (2) echocardiography is an efficient tool for early diagnosis of PAH in COPD patients. Early detection helps in intensifying pharmacotherapy and pulmonary rehabilitation, leading to favorable outcome in COPD patients.

Correlation of severity in chronic obstructive pulmonary disease with serum tumor necrosis factor-α levels and anthropometric measurements

Abdul Majeed Arshad, M. Sangeetha, Koushik Muthuraja, B. Rajagopalan


Department of Pulmonary Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. E-mail: dr.arshad.majeed@gmail.com

Aim: To assess the correlation of serum tumor necrosis factor (TNF)-a levels with anthropometric measurements in patients with chronic obstructive pulmonary disease (COPD).

Materials and Methods: This was a prospective study involving 44 patients, admitted to chest ward and diagnosed to have COPD by spirometry as per GOLD guidelines. These patients were subjected to routine blood investigations, serum TNF-a level assays and anthropometric measurements namely BMI and skin fold thickness. The severity of the obstruction, measured with spirometry was correlated with TNF-a levels and anthropometry using Pearson's correlation.

Results:
42 patients were males and 2 were females. 13.6% had mild, 31.8% had moderate, 34.1% had severe and 20.5% had very severe obstruction. As the severity of the disease increased, the serum TNF-a levels also increased linearly. Patients with high TNF-a levels also had more number of exacerbations per year, reduced skin fold thickness and low body mass index (BMI).

Conclusion: TNF-a has been associated with cachexia, skeletal muscle atrophy and weakness in COPD patients in various studies. In this study, the value of anthropometric measurements and TNF-a level showed a positive association and linear correlation implying that bedside anthropometry can be a reliable substitute to the expensive TNF-a levels.

Smoking scenario amongst medical and non-medical youth: Fads, facts and effects

Shivanshu Raj Goyal, Uday Kiran, D. Srinath, A. D. Nageswari, Diksha Goyal


Department of Pulmonary Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. E-mail: shivanshu.goyal@gmail.com

Introduction: Smoking is prevalent among youth in 17-24 years of age but little is known about group specific prevalence and impact especially in south India. This study was undertaken in a multi stream university with large student population.

Aim:
To determine and compare knowledge, attitude and practice of smoking among medical and non-medical students along with assessment of smoking on lung health of students using spirometric values.

Materials
and Methods: A cross sectional observational study was conducted among 1675 university students (1069 non-medical and 506 medical). A 30 point questionnaire was prepared using core components of World Health Organization global youth tobacco survey. Spirometry was performed among 300 students of which 105 were current smokers and for them Fagerstrom scoring was also done.

Results
and Discussion: Total smokers were 482 with higher prevalence among non-medicos 24.6% versus 14.2% (P < 0.001). More medicos were occasional smokers as compared to non-medicos 27.8% versus 11.8%. Non-medicos found it difficult to quit smoking 29.3% versus 20.2% as professional help was sought more among medicos. Both considered relaxation and losing weight as main motives for smoking (41.3%). Spirometry values: Forced expiratory volume in 1 s/forced vital capacity, FEF 25-75 and peak expiratory flow were lower among smokers than non-smokers (P < 0.001) and Fagerstrom score was significantly correlated in them.

Conclusion: Study showed that students start smoking simultaneously but medical education helps in bringing down consumption levels and boosts quitting ability. Cigarette smoking and Fagerstrom scoring is directly related to lung function deterioration.

POLLUTION

Lung functions among traffic and non-traffic police officers in Galle division, Sri Lanka

L. K. Hirimuthugoda, G. K. Vasirirasu, N. K. Randombage, K. L. I. Amith, K. P. Jayanethi Kumar


Elpitiya Southern Province Research Center and Base Hospital, Robolgoda, Bentota, Sri Lanka. E-mail: krishan824@yahoo.com

Background: Police officers spend much of their working hours on the roads exposing themselves to polluted air and thus are at a risk of developing impairment in respiratory functions. Among them, traffic police officers are still more at risk as they work in heavily polluted traffic roads most of their time.

Aim:
The aim of this study was to compare lung function among traffic and non-traffic police officers.

Materials and Methods:
Lung function was assessed in 100 traffic police officers and 100 non-traffic police officers randomly selected from the Galle division, Sri Lanka. Self-administered questionnaire was used to gather socio-economic data and respiratory symptoms along with anthropometric parameters were measured. Respiratory functions were measured using the mini-spirometer.

Results:
Both the groups were comparable in age and body mass index. Traffic police officers had a significantly reduced forced expiratory volume (FEV 1 ) (P = 0.008), forced vital capacity (P = 0.001) and peak expiratory flow rate (P = 0.001). There was no significant difference between two groups in other lung function parameters [FEF25% (P = 0.13), FEF50% (P = 0.37) and maximal mid-expiratory flow (P = 0.38)]. There was a significant difference in the prevalence of eczema (P = 0.022) and allergic rhinitis (P = 0.009) between two groups with a higher prevalence among traffic police officers.

Conclusion:
The findings suggest that there is an increased deterioration of lung function in traffic police officers when compared to non-traffic police officers possibly because the traffic police officers are more exposed to polluted air. For the same reason the prevalence of eczema and allergic rhinitis were also high among traffic police officers.

Household air pollution: Implications for chronic respiratory disease burden

Sankar Sambandam, Kalpana Balakrishnan, Krishnendu Mukhopadhyay, Santu Ghosh, Arulselvan Sadasivam, Rengaraj Siva, Satish Madhav, Padmavathi Ramaswamy, Priscilla Johnson, Vijayalakshmi Thanasekaraan


Department of Environmental Health Engineering, SRMC, Chennai, India. E-mail: sankars@ehe.org.in


Background:
Cleaner cook-stoves are considered to be an important class of interventions for reducing exposures resulting from household air pollution and improving health in populations dependent on solid cook fuels. Few field based evaluations have however been performed to assess their efficacy.

Aim:
To measure exposure reductions for select market models of improved biomass cook stoves in 2 Indian states and analyze implications for reducing burden of respiratory disease.

Materials and Methods:
Paired measurements of 24-h kitchen concentrations of particulate matter less than 2.5 μm in diameter (PM2.5) and carbon monoxide (CO) were performed before and after installing the improved biomass cook stoves in 72 households. Six commercial models were selected to cover stove technologies that used free/forced convection and/or fuel processing respectively.

Results:
The median 24-h kitchen concentrations of PM 2.5 were 300 μg/m 3 (inter-quartile range: 533 μg/m 3 ) and 161 μg/m 3 (inter-quartile range: 261 μg/m 3 ) while using traditional and improved cook stoves respectively. Corresponding, median 24-hr kitchen concentrations of CO were 5.88 ppm (inter-quartile range: 8.7 ppm) and 3.4 ppm (inter-quartile range: 5.69 ppm) while using traditional and improved cook stoves respectively. Stove use patterns suggested considerable stacking (use of traditional and cleaner cook stoves together) and decrease in levels of cleaner cook-stove use over time.

Conclusion:
Although some models showed promise, stoves would need to be benchmarked against WHO Air Quality Guidelines to be labeled as improved as compared to traditional open fires. This is further complicated by perhaps limited use of the "improved stove" and the stove" staying improved" over time to achieve desired health benefits for exposed members of the household.

ILD

Impact of pulse i.v. cyclophosphamide on scleroderma related interstitial lung disease: An Indian experience

Suman Paul, Susmita Kundu, Rajesh Agarwal, K. Hariprasath


Department of Pulmonary Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India. E-mail: suman_paul86@yahoo.co.in

Introduction: Systemic Sclerosis (SSc) is a rare connective tissue disorder of unknown etiology with characteristic involvement of lungs, skin, heart, kidneys and the gastrointestinal tract, but pulmonary involvement contributes maximally to its mortality.

Aim of the Study: Cyclophosphamide (CYC) is generally accepted as the most promising therapy for Systemic Sclerosis associated Interstitial Lung Disease (SSc-ILD), but the ideal dosage and length of treatment continues to remain elusive. Similar studies in the Indian scenario are scarce. Our objective was to evaluate the effect of a 6-month pulse intravenous CYC therapy on SSc-ILD.

Materials
and Methods: In a single-center, prospective, observational study, 9 patients (8 females) with SSc-ILD were given pulse intravenous cyclophosphamide at monthly intervals (600 mg/m 2 body surface area) for 6 cycles with oral prednisolone (10 mg daily). Over the next 6 months, Azathioprine (2-3 mg/kg) was administered along with Prednisolone. Primary end points were forced vital capacity (FVC) and high-resolution computed tomography scan of thorax. Secondary end-points were quality of life as measured by health assessment questionnaire-disability index and dyspnea score as measured by transition dyspnea index and 6-min walk test.

Results
and Discussion: 6-month and 12-month-follow-up have been completed in 7 and 4 patients respectively. Statistical analysis of FVC showed significant improvement (P = 0.003), with statistical significance between 6 months and baseline and also between 12 months and baseline. The therapy was well tolerated.

Conclusion:
Pulse IV CYC for 6 months produces improvement in FVC and disability which was sustained upto 12 month follow-up.

Correlation of radiological findings with clinical morbidity in patients of diffuse parenchymal lung disease

Nishtha Singh, Rakesh C. Gupta, Neeraj Gupta, Ramakant Dixit


Department of Respiratory Medicine, J.L.N. Medical College and Hospital, Ajmer, Jaipur, Rajasthan, India. E-mail: nishtha_singh@yahoo.co.in

Introduction: The importance of high-resolution computed tomography (HRCT) in diagnosis of diffuse parenchymal lung disease (DPLD) is emphasized by the fact that open lung biopsy has been replaced by a multidisciplinary approach with integration of radiological, pathological and clinical data for diagnosis.

Aims: The objective of our study was to find out the correlation between degree of HRCT abnormality and clinical morbidity indices which include New York Heart Association (NYHA) functional classification of dyspnea, distance covered in 6-min walk test (6 MWT), degree of desaturation during 6 MWT and forced vital capacity (FVC) measured by spirometry in patients with DPLD.

Materials and Methods: It was a cross-sectional study. Eighty-six consecutive patients of DPLD were recruited in the study. DPLD patients underwent detailed clinical history, examination and investigations such as spirometry and 6 MWT. The main outcome variables were the extent of lesions on HRCT, NYHA grade of dyspnea, distance walked during 6 MWT, fall in oxygen saturation during 6 MWT and FVC measured by spirometry.

Results: Amongst 86 patients, the mean duration of disease was 3.5 year. 39 (45.34%) had dyspnea NYHA grade 2 and 7 (8.13%) had dyspnea grade 4. 12 (13.95%) patients showed mild restriction and 30 (34.88%) showed severe restriction on spirometry. On HRCT, 43 (50%) showed minimal disease, 29 (33.72%) moderate disease and 11 (12.79%) showed severe disease.

Conclusion: HRCT abnormalities correlate well with NYHA dyspnea grade but its role as a morbidity index needs to be investigated further.

Case series of single lung transplantation in India: Our experience

Vijil Rahulan, Govini Balasubramanium, Vadivelu Sreenivasan


Department of Pulmonology, Institute of Pulmonary and Critical Care Medicine, Global Hospital and Health City, Chennai, Tamil Nadu, India. E-mail: vkrahulan@gmail.com

Introduction: Lung transplantation is an accepted modality in end stage pulmonary disease worldwide. However in India due to non-availability of cadaveric organs as well as lack of awareness and training among doctors, the experience is quite limited.

Aim of the Study: To study the outcome of patients undergoing single lung transplantation (SLT) for end stage pulmonary diseases.

Materials
and Methods: We selected patients who were having end stage pulmonary disease. Pulmonary function test, exercise oximetry, bronchoscopy, perfusion scan and coronary angiography were performed in all the patients as pre-op evaluation.

Results and Discussion: Nine patients underwent SLT. Majority had interstitial lung disease and Lymphangio-leio-myomatosis. Among them four patients took up graft well and the rest five died. All the four surviving patients showed marked improvement in functional status. Among them few complications were observed and managed, namely delayed acute rejection, bronchial stenosis and pulmonary and ocular aspergillosis. Among those patients who didn't survive, the plausible reasons were: Postop bleeding from disseminated intravascular coagulation, hemolysis while on extra corporeal membrane oxygenation, primary graft dysfunction, overwhelming sepsis and cardiac arrest during transplantation. Longest survivor has crossed 2 years and is on regular follow-up.

Conclusion: Carefully selected patients with end stage lung disease, either primary or secondary diseases may benefit from lung transplantation. With close monitoring they can hope for a good survival with better quality-of-life.

LUNG CANCER

Computed tomography guided fine-needle aspiration biopsy versus CT guided biopsy in radiologically suspicious lung malignancy

Kalpesh Panchal, Savita Jindal, Nalin T. Shah, Kusum V. Shah


Department of Pulmonary Medicine, BJMC, Ahmadabad, Gujarat, India. E-mail: dr_kalpesh_1988@yahoo.com

Introduction: For patients with radiologically suspicious lung malignancy, a histologic or cytologic confirmation of malignancy is required before treatment. Flexible bronchoscopy has high sensitivity for the diagnosis of central lesions and low sensitivity for the diagnosis of peripheral lesions. Transthoracic needle biopsy is usually performed under imaging guidance for patients with peripheral lesions or in whom flexible bronchoscopy is not possible. The two transthoracic biopsy techniques currently being used are fine-needle aspiration biopsy ( fnab0 ) and computed tomography (CT) guided core-needle biopsy (CNB). The sensitivity and specificity of both techniques for diagnosing lung cancer have been reported to be high, with acceptable complication rates.

Aim:
To compare CT guided FNAB with CT guided core biopsy in patients with radiologically suspicious lung malignancy.

Materials and Methods:
A retrospective analysis of 115 patients, presented over a period of 6 months, with radiologically suspicious lung malignancy and who were subjected to both CT guided FNAB and CT guided core biopsy were included in the study.

Results:
Sensitivity, specificity and accuracy of FNAB were 52%, 100% and 100%, respectively while sensitivity, specificity and accuracy of CNB were 97%, 100% and 100%, respectively.

Conclusion:
In our study, CT guided core needle biopsy was found to be more sensitive and equally specific and accurate when compared to CT guided FNAB.

Expression of epidermal growth factor receptor and anaplastic lymphoma kinase protein in primary adenocarcinoma of lung

Arjun Dang, S. Shanmugapriya, B. Rajagopalan, B. Hari Prasad, D. Prathiba


Department of Pulmonary Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. E-mail: arjundang7@gmail.com

Introduction: Non-small cell lung carcinoma (NSCLC) account for 80-85% of all lung carcinomas and adenocarcinoma is the predominant histologic type. The prognosis remains poor with an overall 5 year survival rate less than 15%. Targeted therapy with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI) has revolutionized the treatment of adenocarcinoma. However primary resistance to this therapy due to involvement of more than one molecular pathway has necessitated the need to develop newer targets for therapy. A subset of patients resistant to EGFR-TKI therapy have shown EML4-anaplastic lymphoma kinase (ALK) fusion gene. Immuno-histochemical expression of these markers may serve as a preliminary pretreatment assessment screening procedure.

Aims: To evaluate EGFR expression in primary adenocarcinoma of lung. To delineate the EGFR negative cases and evaluate ALK expression in these cases.

Materials
and Methods: The NSCLC cases were reviewed for the past 4½ years. Subtyping was carried out in poorly differentiated carcinomas using histochemical staining for TTF1 and P63. Adenocarcinoma cases were immunostained for EGFR protein. EGFR negative cases were immunostained for ALK protein. The results were analyzed.

Results:
A total of 149 cases were retrieved. Of these 63 (42%) were adenocarcinomas. EGFR immunostain was performed in 42 of these cases. 90% of these were EGFR positive, of which 45% showed 3+ positivity. All the EGFR negative cases were also ALK protein negative. Antonicelli et al. in their study have reinforced the importance of EGFR assessment in NSCLC. A very low percentage of ALK positivity is reported in the literature in adenocarcinoma lung.

Conclusion
: EGFR overexpression was noted in majority of the adenocarcinomas. EGFR negative cases were also negative for ALK protein expression.

BRONCHOSCOPY/CT

Role of fiber optic bronchoscopy in the diagnosis of bronchial carcinoma: A Bangladesh perspective

Firdous Wahid, Kazi Saifuddin Bennoor, Ali Hussain, Rashid-ul-Hassan


National Institute of Diseases of the Chest, Mohakhali, Dhaka, Bangladesh. E-mail: fwahid2010@gmail.com

Background: Bronchial carcinoma currently ranks among the leading cause of cancer related deaths in men and women. At the time of diagnosis, the majority of lung cancers have progressed to an advanced state, so early diagnosis is essential. Fibre optic bronchoscopy (FOB) exerts its role in this regard.

Materials
and Methods: This observational study was carried out in the NIDCH, Mohakhali, Dhaka, Bangladesh from January to December, 2012. A total of 1190 patients underwent FOB, bronchial biopsy, brushings and bronchoalveolar lavage were obtained and sent for investigations.

Results:
There was male preponderance (9:1). More than 76% patients were aged 40 years and above. Mitotic lesions were detected in 243 cases (20%), inflammatory lesions in 70% cases and remaining patients had other rare findings. Histopathology revealed that 36% had squamous cell carcinoma and 13% had adenocarcinoma.

Conclusion:
Bronchoscopy is a useful investigation in the diagnostic workup of bronchogenic carcinoma. It can provide histological confirmation, extent of the disease and evidence of inoperability. But newer technique like endobronchial ultrasound, simultaneous autofluorescence endoscopy, etc. should be introduced to increase further diagnostic yield.

Bronchoscopic management of benign tracheal stenosis

Vaibhav Chachra, Pratibha Gogia, Rajiv Goyal


Department of Respiratory Medicine, Jaipur Golden Hospital, New Delhi, India. E-mail vaibhavchachra@gmail.com

Introduction: The most common etiology for acquired benign tracheal stenosis (BTS) is post tracheal intubation or tracheostomy. Management of BTS varies with the type, extent and severity of the disease. Tracheal stenosis is a potentially life threatening situation and patients usually present in the emergency as stridor. We investigated various minimally invasive bronchoscopic procedures for management of BTS and the long term follow-up of these patients to study the final outcome.

Materials and Methods:
Patients with symptomatic BTS were taken for flexible/rigid bronchoscopy. Therapeutic modalities included: Controlled radial expansion balloon dilatation followed by electro-cauterization and placement of Dumon silicon stent or Montgomery stent; Mitomycin was injected locally to inhibit fibrosis and restenosis.

Results:
A total of 10 young patients with BTS with a mean age of 25 were treated between March 2013 and August 2013. Their underlying etiologies for BTS were post-endotracheal intubation (2), post-tracheostomy (3), post endobronchial tuberculosis (2) and idiopathic BTS (3). Stent was placed in 5 patients while in other 5, balloon bronchoplasty was combined with electrocautery alone. Complications were minimal and included granulation tissue formation (1) and restenosis (1). The overall success rate was 90% in a median follow-up of 5 months (range 1-9 months).

Conclusions:
Benign tracheal stenosis can be safely and effectively managed by flexible bronchoscopic treatment modalities like balloon bronchoplasty, electrocautery, followed by stenting. The use of Mitomycin to prevent granulation tissue formation after electrocautery and before stent placement is promising.

Does cell-block of bronchial washings enhance diagnostic yield of lung cancer? A comparative analysis with smear cytology of bronchial washings

Rohit Vadala, Uday C. Kakodkar, A. M. Mesquita, Suresh Mandrekar


Department of Pulmonary Medicine, Goa Medical College, Caranzalem, Goa, India. E-mail: vrohit_05@yahoo.in

Introduction: Bronchoscopy is a safe and effective means of diagnosing bronchogenic carcinoma with varying diagnostic yields. Cell-block of bronchial washings has been shown to increase the diagnostic yield of bronchoscopy further when compared with washings-smears alone. Our aim was to evaluate whether cell-block increased diagnostic yield or not.

Materials and Methods:
102 patients of suspected bronchogenic carcinoma were subjected to bronchoscopic procedures as per standard protocol. Smears of bronchial washings were prepared immediately and another aliquot was sent for cell-block preparation and results were analyzed.

Results
and Conclusions: Overall diagnostic yield by combining all sampling techniques was 90.19%. Yield of cell-block of bronchial washings (45.09%) was higher than bronchial washings-smears (37.25%). Cell-blocks detected additional 8 cases of malignancy where corresponding bronchial washings-smears were negative. In limited resource settings, cell-block preparation is simple method that increases diagnostic yield, is cost effective and hence can be routinely used.

Bronchoscopic evaluation of patients presenting with hemoptysis in a tertiary level hospital: A prospective study

Ankit Singhal, Shailendra Singh, Mahip Saluja, Shafali Nandwani


Department of Respiratory Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India. E-mail: singhal.ankit2010@gmail.com.

Introduction: Hemoptysis accounts for 10-30% fiberoptic bronchoscopy referral cases.

Aim: To evaluate the various causes of hemoptysis by bronchoscopic sampling.

Materials
and Methods: Over a period of 19 months, 100 patients presented with hemoptysis aged >18 years out of which 35 underwent fiberoptic bronchoscopy after carefully considering inclusion and exclusion criteria. All patient of active hemoptysis were followed for 6 months.

Results and Conclusions:
There were 27 males (77.2%) and 8 females (22.8%). The mean age of the patients was 51 ± 2.92 years. Pulmonary tuberculosis (25.7%) was found to be leading cause of hemoptysis in our study group. Eight (22%) of the 35 patients had malignancy. Majority of the patients were in non-carcinoma group including tuberculosis, pneumonia, bronchiectasis, mitral stenosis, chronic bronchitis and idiopathic. In decreasing order of significance, male sex, active smoking, moderate amount of bleeding, abnormal chest X-ray, duration of hemoptysis ≥1 week and history of previous episode significantly predicted a diagnosis of bronchogenic carcinoma (P < 0.01). Carcinoma was not evident in any of the non-smoker patient in our study.

Computed tomography guided management of pain in non cardiac thoracic lesions using paravertebral block

A. Saranya, Deepthi Morasis, Bhawna Dev, R. Santosham


Department of Radiology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India. E-mail: saranya_thiru@yahoo.com

Introduction: Thoracic paravertebral block is a peripheral nerve block technique which blocks the thoracic somatic spinal nerves in paravertebral space. However, access to this thin space by the side of the vertebra close to the pleura was found to be extremely difficult without image guidance which led to unwanted complications and failed procedures. The paravertebral space can be accessed with precision under computed tomography (CT) guidance and we have been performing the procedure under CT guidance to manage non-cardiac unilateral thoracic pain with success.

Materials and Methods: Eleven patients were taken for this study. Procedure was done using multislice CT and 26 Gauge Chiba needle. Medication used for benign conditions was a mixture of Bupivacaine, Lignocaine, Triamcinolone acetate and contrast media. Injection used for malignant conditions was 60% alcohol mixed with contrast media.

Results: Procedure was done on patient with post thoracotomy pain, fractured ribs, pleuritic pain after pleurodesis, chest wall invasion by metastatic malignancies and post herpetic pain. Out of 11 patients 1 patient with malignancy did not respond to the block. One patient had extradural leak at the level of D6.

Conclusion: Thoracic paravertebral block is an extremely useful and minimally invasive procedure for alleviating unilateral non-cardiac thoracic pain and its accuracy and safety is significantly enhanced when done under CT guidance.

SLEEP

Is the Berlin questionnaire a better screening tool than the Epworth sleepiness scale for Indian patients with obstructive sleep apnea?

C. Madhavan, B. Suganthi, S. Das, K. H. Kisku


Department of Physiology, Pondicherry Institute of Medical Sciences, PIMS, Kalapet, Puducherry, India. E-mail: mrithyu86@gmail.com

Aim: To compare Epworth Sleepiness Scale with Berlin Questionnaire for their ability to screen Obstructive Sleep Apnea (OSA) in the Indian population.

Introduction:
Obstructive sleep apnea remains an underdiagnosed condition for which the apnea-hypopnea-index (AHI), as determined by polysomnography, is the gold standard. Since polysomnography is an expensive investigation, prior screening of patients with oral questionnaire becomes cost effective. The most popular screening tool for OSA are the Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ). The purpose of this study was to investigate which questionnaire is the better tool for screening OSA.

Materials
and Methods: Patients with symptoms suggestive of OSA, referred from Pulmonology department were asked to fill up the ESS and BQ. Their anthropometric parameters and vital signs were recorded and subsequently they underwent level 1 polysomnography and scored manually as per AASM criteria. The AHI thus obtained was used to compare the ESS and BQs for their sensitivity to screen OSA.

Results
and Conclusion: Out of a total of 55 patients of OSA, 34 true positives were detected by ESS and 46 by BQ, their sensitivities were 68% and 92% respectively. It was found that BQ had better sensitivity when compared to ESS in screening for OSA in our study population.

Clinical and polysomnographic profile of sleep disordered breathing

V. S. Hariprasad, S. Vinod Kumar, M. K. Panigrahi, S. K. Narayan


Department of Pulmonary Medicine, JIPMER, Puducherry, India. E-mail: hariprasadkalpakam@yahoo.com

Introduction: Obstructive sleep apnea (OSA) is a leading public health problem both in the developed and developing nations. However, awareness regarding diagnostic options, management and consequences of untreated OSA remains inadequate.

Aim:
This study was undertaken to observe the polysomnographic profile of sleep disordered breathing (SDB) in subjects presenting with features of sleep apnea and to analyze the anthropometric measures, risk factors and comorbidities associated with SDB.

Materials and Methods:
A prospective clinical study was conducted by analyzing polysomnographic data in 56 consecutive patients who underwent a sleep study at our sleep laboratory from September 2011 to July 2013. Clinical as well as polysomnographic data were evaluated. Anthropometric data body mass index (BMI) and neck circumference were collected. Patients were also evaluated for other risk factors such as smoking, DM, HT, pulmonary Hypertension. All the patients underwent pulmonary function test.

Results:
A total of 56 patients who presented with features of sleep disordered breathing participated in study, out of which 39 had OSA. The mean age of patients with OSA was 47.95 and was significantly higher when compared to subjects without OSA. The association of clinical factors with OSA showed that Hypertension and Smoking were significantly higher in patients with OSA. It was found that BMI, neck circumference, LDL and triglyceride levels were found to be significantly higher in the OSA patients (P < 0.05). Waist-hip ratio, although higher in OSA patients, was not statistically significant in our study.

Conclusions:
This study demonstrated that the risk factors for OSA are similar to those in the West, but neck circumference and BMI might be a better predictor of OSA than waist-hip ratio in our population.




 

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