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   Table of Contents - Current issue
January-June 2022
Volume 10 | Issue 1
Page Nos. 1-53

Online since Tuesday, April 19, 2022

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Change in quality of life with nasal CPAP in patients with OSA p. 1
Venkateswara Rao Teela, C. Raghavendra, P. Kalyan Kumar
Background: Obstructive sleep apnea (OSA) is a major global problem, associated with increased morbidity mortality and decreased quality of life. There are many possible treatment options, but noninvasive ventilation (NIV) nasal continuous positive airway pressure (CPAP) is most commonly used and most effective modality. In this study, we evaluated and assessed 30 cases of patients with OSA. Patients and methods: A prospective study was performed by using Short Form 36 (SF-36) questionnaire; OSA was assessed pre- and post-NIV therapies for 1 month. Results and conclusion: This study demonstrated a marked impairment of the quality of life in patients with even mild OSA. One month of CPAP treatment improved the quality of life in the all domains of SF-36 health questionnaire. We concluded that health-related quality of life of patients with OSA improved remarkably with CPAP therapy.
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Profile of initial 500 COVID-19 cases at a tertiary care center of western India p. 7
Parikshit Thakare, Vishal Rakh, Ketaki Utpat, Sandeep Sharma, Unnati Desai, Kalyani Dongre, Sarika Patil, Surbhi Rathi, Shailesh Mohite, Mohan Joshi
Background: Coronavirus disease 2019 (COVID-19) pandemic occurring due to the novel corona virus has impacted the world and caused global healthcare crisis with loss of precious lives. The scarcity of data pertaining to the profile of its manifestations continues to be a hurdle to clarity in understanding, protocol formation, and hence patient management. Methods: The objective of this study is to report the initial experience with demographic profile and clinical presentation of the patients presenting at a tertiary care center in western India which is converted into a dedicated COVID hospital. This is a retrospective observational study of initial 500 cases presented to our institute between March 26 and April 30, 2020. The demography data, clinical parameters, associated comorbidities, and outcome parameters were noted and analyzed. Results: The mean age of the study population was 45.13 years with almost equal male and female preponderance. Out of total cases, 113 cases were critical. The most common comorbidities noted were hypertension and diabetes. Total 84 patients died due to COVID-19 infection. Conclusion: COVID-19 is common in adult age group with almost equal male to female preponderance. Most of the cases were stable patients. Out of the critical subgroup, more than half cases required oxygenation and one-fifth cases required ventilatory management. Majority of the cases recovered with a favorable outcome and they were either discharged or transferred to a step down facility.
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Propensity score-matched case–control study of convalescent plasma in treatment of patients with moderate and severe COVID-19 p. 11
Kislay Kishore, Sandeep Rana, Vasu Vardhan, Nishant Raman, Sandeep Thareja, K.V. Padmaprakash, J. Muthukrishnan, K. S Rajmohan, Monika Agarwal, K.K. Ashta, Anirudh Anilkumar
Background: Convalescent plasma (CP) in coronavirus disease 2019 (COVID-19) acts as a source of neutralizing antibodies that could provide passive immunity. There still exists uncertainty on the safety and efficacy of CP as a therapeutic option in COVID-19. This study reports on the effectiveness of CP therapy (CPT) in patients with moderate and severe COVID-19 in an Indian cohort. Methodology: This propensity score matched (PSM) case–control study included a total of 477 adult patients with COVID-19 (≥18 years of age) with moderate and severe disease out of which 181 patients received CP having neutralizing antibody titers ≥1:40 (PRNT/MNT). PSM with an optimal algorithm was performed, matching cases (CP recipients) on baseline patient characteristics to select (178) controls in a 1:1 ratio. Analysis included logistic regression for the whole-patient sample, conditional logistic regression for PSM sample, and competing risk approach for time-to-event analysis. Primary outcome was in-hospital all-cause mortality. Results: Greater odds of clinical improvement were observed among CP recipients on day 7, but no significant differences were observed in the clinical status on day 14. Mortality was lower in patients treated with CP; however, the difference was not statistically significant. Logistic-regression analysis for whole-patient sample and conditional logistic regression for PSM sample showed no significant mortality benefit of CP both in the unadjusted and covariate-adjusted models. No significant mortality benefit was observed among CP recipients in the survival analysis. Conclusion: CPT in COVID-19 appears to have some benefit as evinced by greater odds of clinical recovery on day 7, however, offers no survival benefit.
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Do the symptoms affect SARS-CoV-2 RT-PCR results? p. 22
Melike Aloglu, Sevtap Gulgosteren, Sukran Atikcan
Background/aim: In December 2019, a novel coronavirus was defined as a pneumonia agent in China, spread all over the world, and caused severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) pandemic. The gold standard diagnostic procedure is SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) examination, but might show false negativity. Aim of this retrospective study was to find whether symptoms of COVID-19 and SARS-CoV-2 RT-PCR positivity correlate or not, in pneumonia consistent with COVID-19. Materials and methods: Adult (≥18 years of age) patients hospitalized due to pneumonia and who had clinical and/or radiological findings (CO-RADS assessment was made) and symptoms consistent with COVID-19 were enrolled. Results: A total of 191 patients were enrolled, where 66 were females and 125 (65.4%) were males. Mean age was 59.72 ± 16.35 (range 19–89 years). Most common symptoms were dyspnea (61.8%), fever (35.6%), and cough (42.4%). Twenty-two of 191 patients had positive SARS-CoV-2 RT-PCR (11.5%). Dyspnea and fever tended to be more frequent in RT-PCR-positive cases, but in logistic regression analysis (LRA), showed no significance (P > 0.05). Conclusion: Dyspnea and fever tended to be more frequent in RT-PCR-positive cases, but in LRA, they showed no significance. Up to our results, symptoms do not matter for SARS-CoV-2 RT-PCR positivity in patients with pneumonia consistent with COVID-19.
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A study of perception of stress in COVID-19 suspected and confirmed patients during the process of screening, diagnosing, and treatment in a tertiary care center during the COVID-19 pandemic p. 26
K.U. Vivek, A.S. Deepa, B.J. Arun, C.L. Nagaraja, B.L. Shashibhushan
Importance: Coronavirus disease 2019 (COVID-19) is a disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2. Research has shown that pandemics tend to have an impact on the mental health of the community. Objective: As the COVID-19 disease continues to spread, anxieties and stress related to it continue to increase exponentially. The present study has been conducted to assess the perception of stress in COVID-19 suspected or confirmed positive patients. Design, setting, and participants: This was a prospective cross-sectional study conducted on 1000 COVID-19 suspected and confirmed patients to assess their levels of stress during the screening, diagnosis, and treatment processes. The duration of the study was 3 months. The perceived stress scale (PSS) was used to assess the participant’s levels of stress since the previous month. Results: Out of the total number of patients, 63.80% were males and 36.20% were females. Nearly half of the participants, that is, 52.60% were between 18 and 30 years of age and 42.50% of the surveyed participants had stress levels in the high perceived stress category. We concluded that there is a prevalence of perceived stress associated with COVID-19 at high levels. Conclusion and relevance: These results therefore necessitate the need for stress management and counseling therapy to cope with the psychologic distress caused due to COVID-19. Future research and surveys must be conducted to assess the psychologic impact caused in individuals due to pandemics.
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Sleep patterns in table chronic obstructive pulmonary disease patients at a tertiary care center: a hospital-based observational study p. 32
Abhisek Singh, Sudhir Chaudhri, Anuj Kumar Pandey, Ajay Kumar Verma, Navneet Kumar, Surya Kant, Shyam Chand Chaudhary
Introduction: Sleep has significant adverse consequences for breathing and gas exchange in patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess sleep patterns in patients with stable COPD. Patients and methods: Patients with stable COPD were recruited from a tertiary care hospital. Data collected included demographic profile, clinical characteristics of COPD, neck circumference, Epworth sleepiness scale (ESS) score, and sleep variables using polysomnography. Results: Of recruited 40 patients, 12 fulfilled the inclusion criteria. The mean age of the patients was 57.42 ± 10.98 years and 11 were males. Eight patients (66.7%) had moderately severe COPD, three mild, and one severe COPD. Eleven patients had a normal ESS score. None had excessive day-time sleepiness. High numbers of arousal and sleep-stage change characterized major sleep fragmentation were reported in these individuals. Apnea–hypopnea index was normal, that is, 3.2 ± 1.9 (mean ± standard deviation [SD]). The total sleep time with hemoglobin saturation under 90% (T90) was 48.17 ± 5.79 minutes (mean ± SD). Hemoglobin saturation fell more in rapid eye movement (REM) sleep (87.1% ± 5.5%) than non-REM sleep (88.6% ± 4.8%). Sleep-onset latencies were 19.21 ± 4.68 (mean ± SD) minutes and REM latency was 126 ± 9.39 (mean ± SD) minutes. The mean %wake stage, mean% Stage 1 sleep, and mean% Stage 2 sleep were prolonged in most patients, whereas REM sleep was decreased in all patients. Conclusion: Sleep is characterized by major sleep fragmentation even in patients with stable COPD. Extent and duration of desaturation during sleep are significant. Wake stage, Stage 1, and Stage 2 sleep are prolonged in most patients. REM sleep is decreased in all patients.
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Diffuse alveolar hemorrhage secondary to immune thrombocytopenic purpura: a case report and literature review p. 40
Sheetal Chaurasia, Ramya Raghavan, Manjunath Thimmappa
Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening disease that can be caused due to several underlying disorders. The diagnosis and management of DAH remains challenging given its nonspecific presentation and lack of uniform criteria for the diagnosis. The management of DAH involves treating the causative underlying condition. On extensive review of the literature, only fewer than 10 cases of DAH associated with immune thrombocytopenic purpura (ITP) were found. The outcomes in DAH associated with ITP were also found to be variable in the reported cases, ranging from clinical recovery to mortality. We present a 45-year-old man with ITP who developed DAH, and a review of the available literature.
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Pulmonary mucormycosis: a rare case report p. 43
Deepen Sharma, Varuna Jethani, Suchita Pant, Sanket Joshi
Mucormycosis is a rare fungal infection caused by Mucorales order fungi. It is observed in patients with hematologic malignancies, diabetes mellitus, and immunocompromised states. Clinical diagnosis is difficult in pulmonary mucormycosis, and early diagnosis is needed for this life-threatening infection. We report a case of pulmonary mucormycosis in a 52-year-old male with type 2 diabetes diagnosed on bronchoscopic-guided biopsy. We aim to illustrate the need for a high clinical suspicion for the diagnosis of mucormycosis and to report the importance of early and aggressive initiation of antifungal therapy.
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COVID-19 and tuberculosis − a double trouble p. 46
Muniza Bai, G. Vishnukanth, A. Ramyapriya, Manju Rajaram
The coronavirus pandemic has currently overtaken every other healthcare issue across the globe and even stole the limelight of World Tuberculosis (TB) Day. The coronavirus disease disease 2019 (COVID-19) has resulted in diagnostic confusion and many missed diagnoses of presumptive TB owing to the confounding symptoms. There is a diversion of material and manpower from the TB control programs and support systems resulting in an inevitable shift of focus toward COVID-19 and neglect of TB. This has badly impacted the active case finding, diagnosis, management, and follow-up of TB. Late diagnosis also leads to increased severity of the disease. We herein describe two such cases where severe acute respiratory syndrome-related coronavirus 2 and Mycobacterium tuberculosis coexisted and discuss a whole realm of facts and ideas that need to be implemented to curb this complex coexistence. We highlight the importance of bidirectional screening for early diagnosis and prompt management and the importance of teleconsultation or telephonic follow-up in this COVID era.
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Chest image: bilateral pneumothorax p. 50
Rohit Bansal, Priya Bansal
Patients presenting with spontaneous pneumothorax usually have an underlying lung disease. We present a case of bilateral pneumothoraces in a patient with no known co-morbidity or risk factors, except a recent history of lower respiratory tract infection. We wish to highlight post-infective cysts as a cause of this presentation.
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Intubation of COVID-19 patients with catheter mount and heat and moisture exchanger filter preconnected to endotracheal tube p. 52
Sonali Vadi, Pandurang Tekawade
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