The Efficacy of Montelukast in Reducing the Risk of Warning Signs and Subsequent Dengue Shock Syndrome in Adult Dengue Fever Patients.

BACKGROUND: Dengue fever continues to pose significant health challenges globally, with recent outbreaks in Bihar, India, prompting a search for effective therapeutic interventions. This study assesses the effectiveness of Montelukast, traditionally used for asthma, in mitigating the severity of dengue fever symptoms and its progression to dengue shock syndrome (DSS). OBJECTIVE: To evaluate the impact of Montelukast on the prevalence of dengue warning signs and the incidence of DSS in adult patients. METHODS: A prospective observational study was conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India, from August 2022 to October 2023, enrolling 500 patients diagnosed with dengue fever. Participants were divided into two groups. About 250 were treated with Montelukast and 250 received standard care. Outcomes measured included the incidence of warning signs, DSS, length of hospital stay, and 30-day mortality. RESULTS: The Montelukast group exhibited a 24% lower prevalence of dengue warning signs compared to the control group, with 90 out of 250 patients (36%) in the Montelukast group versus 150 out of 250 patients (60%) in the control group (p < 0.001). The incidence of DSS was significantly reduced in the Montelukast group, with 4 out of 250 patients (1.6%) compared to 21 out of 250 patients (8.4%) in the control group (odds ratio: 0.178, p < 0.001). Furthermore, Montelukast users experienced shorter hospital stays (average 4.52 days vs. 6.54 days, T-statistic: -7.59, p = 1.58×10-13) and a reduced 30-day mortality rate, with 5 out of 250 patients (2%) in the Montelukast group versus 12 out of 250 patients (5%) in the control group (p < 0.03). CONCLUSION: Montelukast significantly lowers the incidence of dengue warning signs and DSS, shortens hospital stays, and decreases mortality rates among dengue patients, supporting its potential integration into existing dengue treatment protocols. This study highlights the need for further clinical trials to confirm these findings and fully understand the therapeutic mechanisms of Montelukast in dengue management.

Pleural effusion guidelines from ICS and NCCP Section 1: Basic principles, laboratory tests and pleural procedures.

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.

Pulmonary function abnormality in patients recovered from Covid 19 pneumonia, in a tertiary care hospital in India.

Background: One of the most dreaded complications of COVID pneumonia is post-COVID residual lung fibrosis and lung function impairment. Objectives: To find out the extent and type of pulmonary function abnormality using spirometry, diffusion capacity, and 6-minute walk test and to co-relate with the clinical severity at the time of infection, in patients who have recovered from COVID19 pneumonia, in a tertiary care hospital in India. Materials and Methods: This is a prospective, cross-sectional study with a total 100 patients. Patients who have recovered from COVID pneumonia after one month of onset of symptoms and before 3 months who come for follow-up and have respiratory complaints undergo pulmonary function test will be recruited in the study. Results: In our study, the most common lung function abnormality detected was restrictive pattern in 55% of the patients (N = 55) followed by mixed pattern in 9% of patients (N = 9), obstructive in 5% of patients (N = 5), and normal in 31% of patients (N = 31). In our study, total lung capacity was reduced in 62% of the patients and normal in 38% of the patients and diffusion capacity of lung was reduced in 52% of the patients recovered from 52% of the individuals. Also, a 6-minute walk test was reduced in 15% of the patients and normal in 85% of the patients. Conclusion: Pulmonary function test can serve as an important tool in both diagnosis and follow-up of post-COVID lung fibrosis and pulmonary sequalae.

Economic burden of asthma among patients visiting a private hospital in South India.

BACKGROUND: The presence of asthma is associated with a socioeconomic burden due to both direct and indirect cost. AIM: This study aims to estimate the economic burden of asthma in terms of direct and indirect cost as also determine if the proper control and adherence to medication would result in reduced cost. MATERIALS AND METHODS: Direct cost was calculated in terms of medications, doctors visit, investigations, and hospitalizations. Indirect cost was calculated in terms of lost wages, termed as absenteeism. Asthma control was assessed using the asthma control test questionnaire. RESULTS: A total of 120 patients were included; 69 males and 51 females. The mean annual direct cost for asthma treatment was ₹18,737/year. The mean annual cost due to medications, doctor's visit, investigations, and hospitalization was ₹7,427, ₹2089/year, ₹1103/year, and ₹62,500/year, respectively. An asthma patient lost an average of 17 working days/year. The mean annual indirect cost for an asthma patient was ₹25,358, whereas, for the caregivers was ₹19,971. About 47.5% of patients had well-controlled asthma and 52.5% of patients had uncontrolled asthma. The mean annual direct cost among controlled and uncontrolled asthma patients were ₹13,010 and ₹23,918, respectively. Fifty-seven percent of patients were compliant with medication. The mean annual direct cost among compliant and non-compliant patients was ₹14,401 and ₹24,407, respectively. Percentage of hospitalization was less among the compliant group (6%) when compared with noncompliant group (17%). CONCLUSION: Asthma is not only associated with patient-specific impairment but also a significant economic burden to the family and society. Loss of productivity is another underappreciated source of economic loss.

Pulmonary capillary haemangiomatosis: a rare cause of pulmonary hypertension.

Pulmonary capillary haemangiomatosis (PCH) is a rare disorder of unknown aetiology, characterised by proliferating capillaries that invade the pulmonary interstitium, alveolar septae and the pulmonary vasculature. It is often mis-diagnosed as primary pulmonary hypertension and pulmonary veno-occlusive disease. Pulmonary capillary haemangiomatosis is a locally aggressive benign vascular neoplasm of the lung. We report the case of a 19-year-old female who was referred to us in the early post-partum period with severe pulmonary artery hypertension, which was diagnosed as PCH by open lung biopsy.

A qualitative study of HIV testing and referral practices of private hospital doctors treating patients with TB in Chennai, India.

OBJECTIVE: In India, 50%-80% of patients with tuberculosis (TB) seek private care. This study set out to explore HIV testing and referral practices of private hospital doctors treating patients with TB. METHODS: Interviews were conducted with private hospital doctors (n = 15). Interviews covered HIV testing, linking HIV-positive patients with TB to HIV care, and coordination of care for co-infected patients. RESULTS: Doctors did not routinely refer patients with TB to government HIV testing facilities as per national policy guidance. If deemed appropriate, then testing was conducted privately. Testing was more common when a facility guideline mandated testing or a public-private initiative for TB management was in place. Otherwise, testing was based on doctors' judgement. Patients accustomed to private care who could not afford treatment were reportedly reluctant to shift to public facilities. A lack of communication between public and private doctors was found to undermine co-management. CONCLUSIONS: In this sample, private provider practices were influenced by both the social and the health systems contexts in which they operated. An understanding of patient perceptions of HIV, private doctors concerns for retaining patients, and the contrasting philosophies of private medicine versus public health objectives was found to be critical to explain HIV testing and referral behaviours. The government has proposed to scale up HIV testing and treatment among patients with TB, yet operationalising this will require engagement with the realities of a large, diverse private sector. It will also require considering what role government policies can have on shaping private practice and how to potentially integrate public and private care.

Polymyositis presenting with respiratory failure.

Polymyositis is a systemic autoimmune disorder characterised by inflammatory myopathy of the skeletal muscles predominantly affecting the proximal muscles and associated with extra-muscular manifestations like dysphagia and skin involvement. In this case report, we describe the occurrence of diaphragmatic weakness and respiratory failure due to polymyositis with relatively well preserved power in limb muscles.

A video-simulation study of the management of asthma exacerbations by physicians in India.

INTRODUCTION: Despite efforts to improve the management of asthma worldwide, few options exist for evaluating the specific needs or the success of these activities in a manner free from bias. OBJECTIVES: To examine the management of asthma exacerbations by physicians using standardized audiovisual presentations of asthma. METHODS: Practitioners (n = 70) in Chennai, India were shown the International Study of Asthma and Allergies in Childhood video questionnaire and asked to describe the clinical investigations, emergency treatments and prescription therapy they would recommend for each of the five scenes. RESULTS: Practitioners varied significantly in their investigation and treatment of the exacerbations. Those who identified asthma as a possible cause of the scenes were more likely to recommend investigations and treatment congruent with international guidelines, as were those with additional postgraduate training and with specialty training in respiratory disease. Approaches differed significantly for scenes depicting wheeze compared with those depicting cough. CONCLUSION: The management of asthma exacerbations varies significantly depending on whether practitioners identify asthma as a possible cause of the presentation. Standardized audiovisual depictions of asthma offer a useful tool to assess patterns of clinical practice, and to design and evaluate activities to raise the quality of care for asthma.

International Primary Care Respiratory Group (IPCRG) Guidelines: management of asthma.

Worldwide, most patients with asthma are treated in primary care. Optimal primary care management of asthma is therefore of considerable importance. This IPCRG Guideline paper on the management of asthma in primary care is fully consistent with GINA guidelines. It is split into two sections, the first on the management of adults and schoolchildren, and the second on the management of pre-school children. It highlights the treatment goals for asthma and gives an overview of optimal management including the topics which should be covered by the primary care health professional when educating a patient about asthma. It covers the classification of the disease, the stepwise approach to pharmacologic therapy, disease monitoring, the management of exacerbations, and the identification of patients at risk of asthma death.

Prevalence of asthma in urban and rural children in Tamil Nadu.

BACKGROUND: There are very few community-based studies on the prevalence of asthma in Indian children. We aimed to estimate the prevalence of asthma in children under 12 years of age and to study possible differences in the prevalence of childhood asthma in urban and rural areas of Tamil Nadu. METHODS: A total of 584 children from Chennai and 271 children from 25 villages around Chennai formed the urban and rural groups, respectively. From November 1999 to February 2000, data were collected using a simplified version of the ISAAC questionnaire, which was administered by trained students. Symptoms suggestive of asthma or hyperreactive airways disease in children under 12 years of age were recorded from the selected urban and rural populations by questioning the parents. The results were analysed separately for children 0-5 and 6-12 years of age. RESULTS: Of the 855 children studied, the overall prevalence of breathing difficulty (including asthma) was 18% and the prevalence of 'diagnosed' asthma was 5%. Twenty-two per cent of urban and 9% of rural children 6-12 years of age reported breathing difficulty 'at any time in the past' (p < 0.01). A significantly higher proportion of 6-12-year-old urban children also reported nocturnal drycough (28.4% v. 18.7%, p < 0.05). Urban children reported recent wheeze more often than rural children (92% v. 77%, p = 0.01). CONCLUSIONS: Symptoms suggestive of asthma were present in 18% of children under 12 years of age. Though the prevalence of diagnosed childhood asthma was about 5% in both urban and rural areas, the prevalence of 'breathing difficulty' and nocturnal cough was significantly higher among urban children in the age group of 6-12 years. Children living in urban areas also reported 'recent wheeze' more often than rural children. Our data suggest that the actual prevalence of asthma and other 'wheezy' illnesses may be higher than that previously documented. Further studies are needed to confirm the difference in prevalence between urban and rural children and also to identify possible causes that could account for the higher urban prevalence of asthma in Tamil Nadu.