Applications of ultrasonography in respiratory intensive care.

Emerging evidence suggests that ultrasonography of lung is a fast, inexpensive, widely available bed-side diagnostic tool which is useful for quick and early diagnosis of respiratory diseases. It is useful in the differential diagnosis of pulmonary infiltrates and has good accuracy in identifying consolidation and alveolar-interstitial syndrome. This technique can also be useful in the immediate evaluation of patients with dyspnoea or acute respiratory failure in the respiratory intensive care unit and helps in monitoring treatment response. Ultrasonography of lung has also been found to be useful in the diagnosis of pulmonary embolism, traumatic lung contusion and lung consolidation as well. There is a need for developing specific guidelines for establishing the standards of training and education regarding lung ultrasonography in India.

Impact of comorbidities and inflammatory markers on mortality of COVID-19 patients.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes coronavirus disease 2019 (COVID-19) is a serious global health concern. The severity of the disease can be determined by serologic indicators such as C-reactive protein, lactate dehydrogenase, D-dimer, ferritin, and interleukin-6. (IL-6). Patients with preexisting conditions such as respiratory, cardiovascular, and pulmonary disease could be at risk of adverse outcomes. It is crucial to provide adequate medical care to manage these patients and increase their chances of survival. AIM: The study examined the impact of comorbidity and inflammatory markers on the severity and mortality of hospitalised COVID-19 patients. MATERIALS AND METHODS: This retrospective study included 101 COVID-19 patients who had comorbidities and were hospitalised from April 2021 to April 2022. RESULTS: Patients with a severe COVID-19 infection could be anticipated to have higher levels of inflammatory markers in their blood. Patients with chronic kidney and coronary artery disease have a worse prognosis than those with other comorbidities (P value <0.001). However, tuberculosis had no statistically significant effect on mortality and showed a minimal chance of death (P value = 0.303). In addition, tocilizumab performed poorly and was ineffective against the COVID-19 treatment. However, ivermectin exhibited a statistically significant probability of survival in COVID-19 patients. CONCLUSION: The inflammatory markers D-dimer, ferritin, and IL-6 were identified as valuable indicators of disease severity. Further, chronic kidney disease and coronary artery disease were identified as risk factors for mortality, while tuberculosis showed potential protective effects. The study showed that higher neutrophil levels were linked to mortality in tocilizumab-treated patients, while ivermectin showed promise in increasing survival rates.

Follow-up ICD generator explantation in tuberculous myocarditis induced ventricular tachycardia patient.

A rare case of ventricular tachycardia caused by extrapulmonary tuberculosis has been followed up. Automatic implantable cardioverter defibrillator implantation was done at the time of presentation. Following this, the patient is clinically well without any episodes of ventricular tachycardia and is considered for an implantable cardioverter defibrillator explantation.

Role of mepolizumab in severe allergic asthma with vocal cord polyp.

Interleukin (IL)-5 plays an important role in development, recruitment, and survival of eosinophils, thereby causing debilitating signs and symptoms associated with severe eosinophilic asthma. Mepolizumab is a humanized monoclonal antibody (mAb) against IL-5 which selectively inhibits eosinophilic inflammation and reduces the amount of eosinophils. This reduction is seen in both sputum and blood, resulting in a reduction in exacerbations and in time the need for using systemic steroids. The role of mepolizumab and its effect is still not fully known as there are less real-life studies available. We herewith present a case of severe eosinophilic asthma with vocal polyp managed by mepolizumab.

Emerging applications: Screening OSA by Modified Pictorial Epworth Sleepiness Scale in Indian subjects.

BACKGROUND: The Epworth Sleepiness Scale (ESS) is a widely used scoring to measure excessive daytime sleepiness. This scale was designed to be self-completed by the subjects, but unfortunately in a developing country with low literacy this had affected its outcome interpretation. The Traditional ESS has been translated into a Modified Pictorial version for easy comprehension by the patients. METHOD: Subjects were evaluated for their competence to self-complete the ESS (Conventional and Pictorial) in Sleep Clinic at Respiratory Department of Santosh Medical College and Hospital, Ghaziabad. Modified Pictorial representations were designed along with 5 newer questions incorporated as sub-questions in 8 original domains prepared and labelled as Pictorial Scale. The Traditional (ESS) and Pictorial (Modified) representations were compared for agreement by receiver operating curve and the area under curve. RESULTS: It was found that time taken to complete the Traditional ESS was significantly higher in comparison to Modified Pictorial Epworth Sleepiness Scale with reduced errors (Pictorial ESS 4.67min than Traditional ESS 14.43min). CONCLUSIONS: Modified pictures scale showed statistically significant improvements over ESS and hence can be used as an alternative for subjects with low literacy level.