Prevalence of overlap syndrome in patients with obstructive sleep apnea in a quaternary care center of Kerala.

Background: The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is termed "Overlap syndrome (OS)." Objectives: The present study aimed at estimating the prevalence of OS among patients diagnosed with OSA. Methods: It was a prospective observational study conducted on patients presenting to respiratory medicine outpatient department (sleep clinic) with symptoms of sleep-disordered breathing and was found to have OSA by overnight polysomnography. These patients were then subjected to spirometry to diagnose COPD. Results: The prevalence of OS in the study population was found to be 41.3%. Excessive daytime sleepiness was found to be higher in overlap group patients (P = 0.033), the difference was statistically significant. The mean age (59.9 ± 9.6 years) was found to be high in the OS group compared to those without the same. The mean forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC (pre- and postbronchodilator) spirometry parameters were found to be lower in patients with OS. Conclusion: The study showed that the prevalence of OS in the present study was 41.3%. Excessive daytime sleepiness and age >60 years were risk factors for OS in a patient with OSA. OS patients had lower pulmonary function values.

Impact of early pulmonary rehabilitation in postacute COVID Disease: A single-center experience from India - A quasi-experimental study.

Background: It was observed that post-COVID patients reported persistent exertional dyspnea, cough, fatigue, or chest pain. About 10%-20% of patients may progress to pulmonary fibrosis. Pulmonary rehabilitation has been proven to be useful in improving effort tolerance and quality of life in chronic respiratory diseases. Objectives: The objective of this study was to assess the effectiveness of pulmonary rehabilitation in improving 6-min walk distance (6 MWD), peak flow, fatigue, anxiety, and depression in early postacute COVID disease. Materials and Methods: This quasi-experimental study was conducted during January 2021 to March 2021. The patients who recovered from COVID-19 and having persistent exertional dyspnea and fatigue after 3 weeks of recovery were included in the study. Baseline and postintervention assessment of 6 MWD, Visual Analog Scale for Fatigue (VAS-F), peak flow, and Hamilton rating scales (HAM) scales after 4 weeks were done. Compliance was ensured with weakly telemonitoring. Results: Significant improvement in peak flow, 6 MWD, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and VAS-F (P < 0.01) after 4 weeks of pulmonary rehabilitation. Conclusion: Early pulmonary rehabilitation in post-COVID syndrome can contribute to statistically significant improvement in functional and psychological parameters as well as post-COVID fatigue.

Prognostic role of N-terminal prohormone of brain natriuretic peptide for patients in the medical intensive care unit with severe sepsis.

BACKGROUND: Sepsis is an important cause of mortality in intensive care units worldwide. The increased levels of N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) are related with dysfunction of the cardiovascular system and systemic inflammation. It is uncertain whether this increase reflects sepsis-related cardiac dysfunction that translates to poorer outcomes. AIMS AND OBJECTIVES: The primary aim of this study was to evaluate the prognostic role of NT-pro BNP on the outcome and duration of hospital stay of patients admitted with sepsis. The secondary objective was to identify other associated risk factors for mortality in sepsis. PATIENTS AND METHODS: The patients who presented to emergency room with diagnosis of suspected sepsis were studied. Risk factors associated with outcome were studied by univariate analysis. The variables having statistical significance were further included in multivariate analysis to identify the independent predictors of mortality. RESULTS: A total of 215 patients with sepsis were included in this study. In univariate analyses, NT-pro BNP, procalcitonin, need of mechanical ventilation (MV), blood culture positivity, chronic kidney disease-chronic liver disease CKD-CLD, and diabetes mellitus were predictors of prolonged hospital stay, and it was same for multivariate analysis excluding procalcitonin. In univariate analysis, NT-pro BNP, MV, and DM were risk factors associated with mortality but in multivariate analysis showed significance only with MV and DM. CONCLUSION: There was a statistically significant correlation between NT-pro BNP levels and mortality. The other factors associated with increased mortality were diabetes mellitus and need of MV. In addition to the above factors, the presence of CKD and CLD was associated with increased duration of hospital stay. There was concordance between increased NT-pro BNP and elevated trop I, s creatinine, need of MV, and CKD.

Diagnostic utility of pleural fluid carcinoembryonic antigen in patients with exudative pleural effusion.

BACKGROUND: Pleural effusion (PE) is presenting symptoms of many different diseases and is often a diagnostic challenge. Negative cytology in the malignant PE requires more complicated diagnostic procedures, such as closed pleural biopsy or thoracoscopic pleural biopsy. Not all the patients will be fit for such invasive procedures due to high risk. Tumor markers seem to be a promising alternative and have been proposed to aid in the differentiation of the PE etiology. OBJECTIVE: The objective of the study was to evaluate the diagnostic value of pleural fluid carcinoembryonic antigen (CEA) in differentiation between malignant and nonmalignant PEs and to compare adenosine deaminase (ADA) levels with respect to malignant and nonmalignant PE. METHODOLOGY: It was a prospective observational study. Patients who presented with undiagnosed exudative PE during the time period 2016-2018 were studied. Pleural fluid was subjected to all routine investigations such as sugar, protein, lactate dehydrogenase, ADA, and CEA. RESULTS: A total of 100 patients were included in the study. Fifty-one patients had malignancy. Univariate analysis showed that smoker, previous history of cancer, ADA <20, and CEA of >2.15 were variables associated with malignancy. Multivariate analysis showed pleural fluid CEA >2.15 as only independent risk factor associated with malignancy. The sensitivity of 91.5% and 65% and specificity of 92.5% and 81.4%, respectively, were found for CEA 2.15 ng/dl and ADA <16.5 U/L as plotted from receiver operating characteristic curve. The combined CEA and ADA (2.39 ng/ml and 16.5 U/L) values in pleural fluid had higher sensitivity of 100%. CONCLUSION: Our study demonstrated that pleural fluid CEA levels have a sensitivity of 93.5% and specificity of 73% in diagnosing of malignant PE. ADA levels lesser than 16.5 U/L were seen in patients with malignant PE, but less sensitive and specific compared to CEA. Combined ADA and CEA levels had higher sensitivity than CEA alone.

Predictors of mortality of severe sepsis among adult patients in the medical Intensive Care Unit.

BACKGROUND: Sepsis is an important cause of mortality in the Intensive Care Units (ICUs) worldwide. Information regarding early predictive factors for mortality and morbidity is limited. AIMS AND OBJECTIVES: The primary objective of the study was to estimate the mortality of severe sepsis among adult patients admitted into the medical ICU. The secondary objective was to identify the predictors associated with mortality. MATERIALS AND METHODS: Adult patients admitted with severe sepsis in the medical ICU were studied. The primary outcome was the mortality among the study population. Baseline demographic, clinical, and laboratory data were recorded upon inclusion into the study. Risk factors associated with mortality were studied by univariate analysis. The variables having statistical significance were further included in multivariate analysis to identify the independent predictors of mortality. RESULTS: Out of eighty patients, 54 (67.5%) died. Univariate analysis showed that age >60 years, tachycardia, hypotension, elevated C-reactive protein (CRP) and lactate, thrombocytopenia, need of mechanical ventilation, and high Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment scores were variables associated with high mortality. The independent predictors of mortality identified by multivariate regression analysis were platelet count below 1 lakhs, serum levels of CRP >100, APACHE II score >25 on the day of admission to the ICU with severe sepsis, and the need for invasive mechanical ventilation. CONCLUSIONS: Low platelet count, elevated serum levels of CRP, APACHE score >25, and the need for invasive mechanical ventilation were found to be independent predictors of mortality of severe sepsis among adult patients with severe sepsis in the medical ICU.

Congenital Cystic Adenomatoid Malformation: A Tertiary Care Hospital Experience.

INTRODUCTION: Congenital Cystic Adenomatoid Malformation (CCAM) is an uncommon developmental deformity affecting the terminal respiratory structures. It is characterized by broncho pulmonary foregut malformations. The reason behind it is an arrest in lung development between 4th and 7th week of fetal life. AIM: The present study was conducted to assess the clinical and radiological profile and also to study the role of surgical intervention in patients with CCAM. MATERIALS AND METHODS: All patients with clinical suspicion or provisional diagnosis of CCAM were included in the study. A clinical questionnaire was prepared to collect data. Computed Tomography (CT) chest with High Resolution Computed Tomography (HRCT) was done for all the patients. Patients were assessed by paediatric surgeon and eligible patients were operated. The procedure conducted was usually open thoracotomy under general anaesthesia. The affected lobes were removed and specimens were sent for histopathological analysis. All included patients were followed up prospectively to find out about their current level of health. Via telephonic interview they were asked about their overall growth, quality of life, activity, rate of respiratory infections and requirement of hospital admission. RESULTS: Total 15 patients with diagnosis of CCAM were included in the study. Of them, 8 (53.3%) were male. The commonest presentation was cough 13(86%), breathing difficulty 11(73%), fever 9(60%), recurrent pneumonia 4(26%), hypoxia requiring oxygen supplementation 6(40%), others 2(12%). Thirteen patients required surgical intervention and underwent lobectomy. There were 2 cases of type I, one each of type II and III, 3 case of type IV while 5 were intermediate type. There was no procedure related mortality. The median duration of hospital stay and all were successfully discharged with median duration of stay 11±16 days. CONCLUSION: The study concludes that if recognized early, surgical removal of affected lung prevents the complications like recurrent pulmonary infections. The surgery is well tolerated without any post-operative mortality or morbidity.

The Role of Gefitinib in Patients with Non-small-cell Lung Cancer in India.

BACKGROUND: Gefitinib, an epidermal growth factor receptor-tyrosine kinase inhibitor, represents a new treatment option for patients with advanced non-small-cell lung cancer (NSCLC). We analyzed the data of patients who received Gefitinib for NSCLC in a tertiary care center in South India. MATERIALS AND METHODS: Sixty-three patients with advanced NSCLC who had received Gefitinib either after failure of conventional chemotherapy or were previously not treated as they were unfit or unwilling for conventional treatment were included in the analysis. RESULTS: The median follow-up for the cohort was 311 days (range 11-1544 days). Median time to progression was 161 (range 9-883) days. Complete and partial remission was seen in 1 (2%) and 6 (9%) patients, respectively, with overall response rate of 11%. Twenty-four (38%) patients had stable disease. Gefitinib was well tolerated with no significant side effects. CONCLUSION: Gefitinib shows anti-tumor activity in pretreated or previously untreated patients with advanced NSCLC. It has a favorable toxicity profile and is well tolerated. Gefitinib should be considered as a viable therapy in patients with NSCLC.