Prevalence and risk factors for chronic pulmonary aspergillosis in chronic obstructive pulmonary disease patients with acute exacerbations.

Chronic obstructive pulmonary disease (COPD) patients often experience acute exacerbations requiring hospitalization. Recently, attention has focused on Aspergillus sensitization in the airways of these COPD patients. This study aimed to assess the prevalence of chronic pulmonary aspergillosis (CPA) in COPD patients with acute exacerbations and identify associated risk factors. A cross-sectional descriptive study was conducted at the Jawaharlal Institute of Postgraduate Medical Education and Research from January 2021 to June 2022. Sixty-one COPD patients presenting with acute exacerbations were included. Demographic details, blood investigations, and sputum examinations were performed for all patients. A high-resolution computed tomography thorax was conducted for eligible patients. The prevalence of CPA among patients with an acute exacerbation of COPD was found to be 9.8%, with chronic cavitary pulmonary aspergillosis being the most common presentation (50%). Among post-tubercular COPD patients, the prevalence of CPA was significantly higher at 22.7%. Hemoptysis (p<0.001) and a previous history of tuberculosis (p=0.008) were associated with Aspergillus sensitization. This study highlights the substantial prevalence of CPA in COPD patients with acute exacerbations, particularly in those with a history of tuberculosis. Early recognition and targeted management of CPA in COPD patients may improve outcomes and reduce hospitalization rates. Further large-scale multi-center studies are needed to validate these findings and comprehensively address the impact of CPA on all COPD patients.

Co-occurrence patterns and environmental factors associated with rapid onset of Microcystis aeruginosa bloom in a tropical coastal lagoon.

The environmental factors contributing to the Microcystis aeruginosa bloom (hereafter referred to as Microcystis bloom) are still debatable as they vary with season and geographic settings. We examined the environmental factors that triggered Microcystis bloom outbreak in India's largest brackish water coastal lagoon, Chilika. The warmer water temperature (25.31-32.48 °C), higher dissolved inorganic nitrogen (DIN) loading (10.15-13.53 µmol L-1), strong P-limitation (N:P ratio 138.47-246.86), higher water transparency (46.62-73.38 cm), and low-salinity (5.45-9.15) exerted a strong positive influence on blooming process. During the bloom outbreak, M. aeruginosa proliferated, replaced diatoms, and constituted 70-88% of the total phytoplankton population. The abundances of M. aeruginosa increased from 0.89 × 104 cells L-1 in September to 1.85 × 104 cells L-1 in November and reduced drastically during bloom collapse (6.22 × 103 cells L-1) by the late November of year 2017. The decrease in M. aeruginosa during bloom collapse was associated with a decline in DIN loading (2.97 µmol L-1) and N:P ratio (73.95). Sentinel-3 OLCI-based satellite monitoring corroborated the field observations showing Cyanophyta Index (CI) > 0.01 in September, indicative of intense bloom and CI < 0.0001 during late November, suggesting bloom collapse. The presence of M. aeruginosa altered the phytoplankton community composition. Furthermore, co-occurrence network indicated that bloom resulted in a less stable community with low diversity, inter-connectedness, and prominence of a negative association between phytoplankton taxa. Variance partitioning analysis revealed that TSM (16.63%), salinity (6.99%), DIN (5.21%), and transparency (5.15%) were the most influential environmental factors controlling the phytoplankton composition. This study provides new insight into the phytoplankton co-occurrences and combination of environmental factors triggering the rapid onset of Microcystis bloom and influencing the phytoplankton composition dynamics of a large coastal lagoon. These findings would be valuable for future bloom forecast modeling and aid in the management of the lagoon.

Fungal pneumonia concealing bacterial pneumonia: a diagnostic dilemma.

We describe the case of a 61-year-old diabetic man affected by Achromobacter denitrificans. He was immunocompetent and did not have any past history of chronic lung disease. The patient was treated with sensitive antibiotic meropenem 1 g three times daily. To our knowledge, only one case of A. denitrificans pneumonia has been reported from the Indian subcontinent, in an individual with underlying lung disease, and none in a healthy person.

Tension pyopneumothorax caused by Burkholderia cenocepacia: a rare case report in an immunocompetent individual.

Tension pyopneumothorax is a medical emergency that occurs when air and pus build up in the pleural space. This case report describes a 47-year-old diabetic female who presented with tension pyopneumothorax due to Burkholderia cenocepacia. The patient was successfully treated with a 24-French tube thoracostomy and antibiotics. To the best of our knowledge, this is the first case of tension pyopneumothorax caused by Burkholderia cenocepacia to be reported.

Seagrasses and local environment control the bacterial community structure and carbon substrate utilization in brackish sediments.

Seagrasses are complex benthic coastal ecosystems that play a crucial role in organic matter cycling and carbon sequestration. However, little is known about how seagrasses influence the structure and carbon utilization potential of benthic bacterial communities. This study examined the bacterial communities in monospecific and mixed meadows of seagrasses and compared with bulk (unvegetated) sediments from Chilika, a brackish water coastal lagoon of India. High-throughput sequencing of 16S rRNA genes revealed a vegetation effect in terms of differences in benthic bacterial community diversity, composition, and abundances in comparison with bulk sediments. Desulfobacterales, Chromatiales, Enterobacteriales, Clostridiales, Vibrionales, and Acidimicrobiales were major taxa that contributed to differences between seagrass and bulk sediments. Seagrasses supported ∼5.94 fold higher bacterial abundances than the bulk due to rich organic carbon stock in their sediments. Co-occurrence network demonstrated much stronger potential interactions and connectedness in seagrass bacterial communities compared to bulk. Chromatiales and Acidimicrobiales were identified as the top two keystone taxa in seagrass bacterial communities, whereas, Dehalococcoidales and Rhizobiales were in bulk communities. Seagrasses and local environmental factors, namely, water depth, water pH, sediment salinity, redox potential, total organic carbon, available nitrogen, sediment texture, sediment pH, and sediment core depth were the major drivers of benthic bacterial community composition. Carbon metabolic profiling revealed that heterotrophic bacteria in seagrass sediments were much more metabolically diverse and active than bulk. The utilization of carbon substrate guilds, namely, amino acids, amines, carboxylic acids, carbohydrates, polymers, and phenolic compounds was enhanced in seagrass sediments. Metabolic mapping predicted higher prevalence of sulfate-reducer and N2 fixation metabolic functions in seagrass sediments. Overall, this study showed that seagrasses control benthic bacterial community composition and diversity, enhance heterotrophic carbon substrate utilization, and play crucial roles in organic matter cycling including degradation of hydrocarbon and xenobiotics in coastal sediments.

Comparison of efficacy of autologous blood patch pleurodesis versus doxycycline pleurodesis in the management of persistent air leak in patients with secondary spontaneous pneumothorax. A randomized control trial.

Secondary spontaneous pneumothorax (SSP) patients sometimes have a persistent air leak (PAL) that leads to increased morbidity and increased hospital stay. Further, these patients also need pleurodesis to prevent a recurrence. Autologous blood patch pleurodesis (ABPP) has been successfully tried in post lobectomy air leak cases. However, its utility in SSP patients with PAL has not been widely established. In this context, we performed a non-blinded randomized control study to compare the efficacy of ABPP vs doxycycline pleurodesis in the closure of air leak in SSP patients. This study was a non-blinded randomized control study done in 38 SSP patients with PAL. They were randomized into doxycycline arm and ABPP arm. Post pleurodesis air leak was assessed every 12 hours for cessation. Success was considered when there was a complete cessation of air leak. Post-procedural complications were noted and patients were followed up for 28 days to look for recurrence. The median time for closure was 24 hours [interquartile range (12.24)] for ABPP and 36 hours [interquartile range (24.72)] for doxycycline pleurodesis. Success rate of ABPP vs doxycycline pleurodesis is 94.7% vs 84.2% (p=0.6). Post-procedure pain was more in doxycycline group (15% vs 73%) (p<0.01). On visual analogue scale, ABPP had a lesser pain as compared to doxycycline pleurodesis (average visual analogue scale value of 2 vs scale of 7). The recurrence rate was equal in both groups (5%). Though ABPP and doxycycline have similar success rates, ABPP has an early closure of air leak and greater patient tolerability. ABPP can be tried as an alternative to doxycycline pleurodesis in SSP patients with persistent air leaks.

Metagenomic analysis reveals genetic insights on biogeochemical cycling, xenobiotic degradation, and stress resistance in mudflat microbiome.

Mudflats are highly productive coastal ecosystems that are dominated by halophytic vegetation. In this study, the mudflat sediment microbiome was investigated from Nalabana Island, located in a brackish water coastal wetland of India; Chilika, based on the MinION shotgun metagenomic analysis. Bacterial, archaeal, and fungal communities were mostly composed of Proteobacteria (38.3%), Actinobacteria (20.7%), Euryarchaeota (76.1%), Candidatus Bathyarchaeota (6.8%), Ascomycota (47.2%), and Basidiomycota (22.0%). Bacterial and archaeal community composition differed significantly between vegetated mudflat and un-vegetated bulk sediments. Carbon, nitrogen, sulfur metabolisms, oxidative phosphorylation, and xenobiotic biodegradation were the most common microbial functionalities in the mudflat metagenomes. Furthermore, genes involved in oxidative stresses, osmotolerance, secondary metabolite synthesis, and extracellular polymeric substance synthesis revealed adaptive mechanisms of the microbiome in mudflat habitat. Mudflat metagenome also revealed genes involved in the plant growth and development, suggesting that microbial communities could aid halophytic vegetation by providing tolerance to the abiotic stresses in a harsh mudflat environment. Canonical correspondence analysis and co-occurrence network revealed that both biotic (vegetation and microbial interactions) and abiotic factors played important role in shaping the mudflat microbiome composition. Among abiotic factors, pH accounted for the highest variance (20.10%) followed by available phosphorus (19.73%), total organic carbon (9.94%), salinity (8.28%), sediment texture (sand) (6.37%) and available nitrogen (5.53%) in the mudflat microbial communities. Overall, this first metagenomic study provided a comprehensive insight on the community structure, potential ecological interactions, and genetic potential of the mudflat microbiome in context to the cycling of organic matter, xenobiotic biodegradation, stress resistance, and in providing the ecological fitness to halophytes. These ecosystem services of the mudflat microbiome must be considered in the conservation and management plan of coastal wetlands. This study also advanced our understanding of fungal diversity which is understudied from the coastal lagoon ecosystems.

Varied foci of primary benign schwannoma of the thorax: a case series.

Schwannomas are the most common tumor of peripheral nerves. It comprises 1 to 2% of total thoracic tumor. Posterior mediastinum is the most common site in thorax. Hereby we are reporting two cases of schwannoma with different sites of origin. The classical presentation of schwannoma is an asymptomatic mass found on chest radiograph. This tumor is usually benign and slow growing. Imaging followed by histopathological examination is key to the diagnosis of this neoplasm. Resection of tumor cures the disease.

Obstructive sleep apnea in non-dialysis chronic kidney disease patients.

There is an enormous increase in the burden of chronic kidney disease both in developing and developed countries. There is a paucity of data on obstructive sleep apnea (OSA) in chronic kidney disease (CKD) patients in India. We used a cross-sectional prospective observational study to determine the prevalence of OSA in non-dialysis CKD patients. Of the 647 CKD patients 302 patients were in stage II, III and IV. The study population was screened using the Berlin questionnaire and 87 patients were positive for OSA (28%). Among the 87, 37 patients were excluded based on the exclusion criteria. Fifty patients underwent a split night sleep study. Stage II, III CKD patients were clubbed as early CKD or group one and stage IV CKD patients were clubbed as late CKD or group two. The spilt night study revealed an 88% incidence of OSA of varying severity. A sub group analysis was done to assess the severity of OSA. A statistical significance (p<0.05) between early and late CKD group was observed with respect to AHI and ODI. An improvement in the late CKD is observed and the Z values for AHI and ODI are 4.273 and 2.307, respectively. The prevalence and incidence of OSA was found to be 28% and 88% in non-dialysis CKD patients, respectively and the risk and severity of OSA increased with the progression of CKD stages and thus necessitating the need for screening the non-dialysis CKD population.

Distinct community assembly processes and habitat specialization driving the biogeographic patterns of abundant and rare bacterioplankton in a brackish coastal lagoon.

The ecological diversity patterns and community assembly processes along spatio-temporal scales are least studied in the bacterioplankton sub-communities of brackish coastal lagoons. We examined the biogeographic patterns and relative influences of different assembly processes in structuring the abundant and rare bacterioplankton sub-communities of Chilika, the largest brackish water coastal lagoon of India. Rare taxa demonstrated significantly higher α- and ß-diversity and biogeochemical functions than abundant taxa in the high-throughput 16S rRNA gene sequence dataset. The majority of the abundant taxa (91.4 %) were habitat generalists with a wider niche breadth (niche breadth index, B = 11.5), whereas most of the rare taxa (95.2 %) were habitat specialists with a narrow niche breadth (B = 8.9). Abundant taxa exhibited a stronger distance-decay relationship and higher spatial turnover rate than rare taxa. ß-diversity partitioning revealed that the contribution of species turnover (72.2-97.8 %) was greater than nestedness (2.2-27.8 %) in causing the spatial variation in both abundant and rare taxa. Null model analyses revealed that the distribution of abundant taxa was mostly structured by stochastic processes (62.8 %), whereas deterministic processes (54.1 %) played a greater role in the rare taxa. However, the balance of these two processes varied across spatio-temporal scales in the lagoon. Salinity was the key deterministic factor controlling the variation of both abundant and rare taxa. Potential interaction networks showed a higher influence of negative interactions, indicating that species exclusion and top-down processes played a greater role in the community assembly. Notably, abundant taxa emerged as keystone taxa across spatio-temporal scales, suggesting their greater influences on other bacterial co-occurrences and network stability. Overall, this study provided detailed mechanistic insights into biogeographic patterns and underlying community assembly processes of the abundant and rare bacterioplankton over spatio-temporal scales in a brackish lagoon.

Cocaine-Induced Steroid Resistant Organising Pneumonia in a Young Male: The Lows of Getting High.

Organizing pneumonia (OP) is a diffuse parenchymal lung disease occurring due to injury to the alveoli leading to typical histopathological features. Infections, connective tissue disorders, and medications are common aetiologies of OP. Cocaine-induced OP is uncommon. The patient had a fever and sore throat for two days corresponding to crack inhalation, followed by breathlessness that rapidly progressed to acute hypoxemic respiratory failure within one week. Radiology showed bilateral consolidation and ground glass opacities but did not respond to empiric treatment with antibiotics. After a multidisciplinary discussion, he was provisionally diagnosed as OP and treated with an intravenous methylprednisolone pulse dosage followed by oral prednisolone. OP was confirmed by surgical lung biopsy with the detection of Masson bodies. In view of progressive respiratory failure, steroid-resistant OP was diagnosed, and rituximab was administered as a second-line agent, but unfortunately, succumbed to respiratory failure. OP should be considered a differential in patients with consolidation who are non-responsive to initial conventional treatment. Multidisciplinary discussion and early lung biopsy to initiate immunosuppressants in the inflammatory stage of OP are emphasized for a possible better response.

Active Case Finding for Tuberculosis among Health Care Workers in a Teaching Hospital, Puducherry, India.

Background: Health care workers (HCWs) are at risk of acquiring tuberculosis (TB) infection and disease due to occupational exposure. But there are no national guidelines on routine screening for TB (active case finding (ACF)) among HCWs and understand its implementation and feasibility. Methods: This study was conducted among HCWs in a teaching hospital in India. We used symptom screening to identify those with presumptive TB and were further evaluated for diagnosis of TB. Results: A total of 1,001 HCWs were screened over a period of 18 months. In our study, 51 (5.1%) HCWs were found to have presumptive TB and on further evaluation, 5 (0.5%) of these patients were diagnosed with active TB. The number needed to screen (NNS) for one active TB among the HCWs was 200. Alcohol use was significantly associated with both presumptive TB (P = 0.037) and active TB (P = 0.035) among HCWs, and exposure to active TB patients (P = 0.014) in the family and workplace and increased frequency of exposures (P = <0.001) were associated with presumptive TB. Conclusion: ACF for TB among HCWs had a good yield in our study. ACF utilizing routine national TB program guidelines is feasible to be implemented among HCWs to aid in the early diagnosis and treatment of TB in this high-risk group.

Can combined non-invasive methods improve diagnosis of lung cancer?

Background: Lung cancer is the most common malignancy in both gender. Early diagnosis is needed to reduce morbidity and mortality. There is a debate about the most accurate investigating modality for the diagnosis of lung cancer. Methods: It is a retrospective cohort analysis to determine whether an approach of combined contrast-enhanced computed tomography (CECT) thorax with bronchoscopy method has higher sensitivity and specificity than combined CECT thorax with sputum cytology method. Records of patients with lung cancer who had visited the hospital within the last 6 months were retrospectively analyzed for their diagnostic modality. SPSS version 19 software was used for statistical analysis of the data. CECT scan thorax, bronchoscopy, and sputum cytology for lung cancer patients were analyzed. The CECT thorax plus bronchoscopy method was compared with the CECT thorax plus sputum cytology method. Their sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing lung cancer were analyzed. Results: Sixty-two patients were considered, including 62.9% males with a mean age of 55.5 years. In patients diagnosed with lung cancer, CECT thorax combined with bronchoscopy method was found to have a sensitivity of 96.67% than CECT thorax combined with sputum cytology method with a sensitivity of 90% and the difference in sensitivity between all individual approaches as well as the combined method was statistically significant with a P = 0.00001 and Chi-square value of 86.5909 owing to the low sensitivity of sputum cytology. CECT thorax combined with sputum cytology approach had a better specificity than CECT thorax combined with bronchoscopy. Conclusion: Combined CECT thorax with sputum cytology method has a better specificity in diagnosing lung cancer than combined CECT thorax with bronchoscopy method.

Association of Selected Cardiovascular Markers With Tuberculosis: Community-Based Exploratory Cross-Sectional Analytical Study in Puducherry.

Introduction India accounts for one-fourth of the global tuberculosis (TB) burden and also faces a rising burden of non-communicable diseases. Only a few have studied the association between the infective pathogenesis of TB and cardiovascular diseases (CVD). Methods A cross-sectional exploratory analytical design was used to compare CVD risk factors and immunological and radiological parameters. This was a pilot study conducted in two primary health centers in urban Puducherry between February 2020 and March 2021. Household contacts (HHC) were either spouses or siblings of the newly diagnosed pulmonary tuberculosis (PTB) patients selected for comparison as their exposure to infection would be similar to those who were diseased yet did not develop illness. Assuming a difference of 5% in CVD risk between the general population and TB patients, with a 95% confidence interval, the sample size calculated was 153 in each group by nMaster v2.0. Considering the feasibility and resource constrain, we recruited 50 newly diagnosed PTB patients, their age- and gender-matched 50 HHC and 50 PTB patients who completed treatment a year before. CVD risk factors were compared using chi-square or Fisher exact test. Interleukins-6 (IL-6), interferon-gamma (INF-γ), highly specific - C reactive protein (hs-CRP), and carotid intima-media thickness (CIMT) were compared using ANOVA or Kruskal-Wallis test. Results Most participants from each group belonged to lower socio-economic strata and were males (40/50). Alcohol intake was higher among newly diagnosed and treatment-completed PTB patients (82.5% vs 72.5%). Excess salt intake (58%) was present more in newly diagnosed PTB patients. General and abdominal obesity were seen more among HHC (64% and 84%) and treatment-completed PTB patients (50% and 74%). IL-6 was higher in newly diagnosed PTB patients, whereas INF-γ and hs-CRP were higher in treatment-completed PTB patients. The largest proportion of those having high CIMT values was also in the treatment-completed PTB patients. Conclusion Levels of immune markers hint at the role of inflammation due to TB disease being related to the high CIMT values among the newly diagnosed and treatment-completed PTB patients. CVD risk was higher among TB patients even if they had completed treatment and were declared cured.

Haematological and Inflammatory Biomarkers Among Stable COPD and Acute Exacerbations of COPD Patients.

Objectives: This study aimed to assess the variation in the levels of the neutrophil lymphocyte ratio (NLR) and platelet indices in patients with stable chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) patients and its association with GOLD stages. COPD is heterogeneous in nature. AECOPD is diagnosed clinically, which is subjective, and clinical judgement may vary from clinician to clinician. Since chronic inflammation underlies the pathogenesis of COPD, markers of inflammation have generated considerable interest in their potential to be used as biomarkers of COPD. Methods: This prospective analytical study was carried out at the Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from December 2018 to July 2020. A total of 64 subjects (32 stable COPD, 32 AECOPD) who satisfied the study criteria were included. Blood samples were taken from stable and AECOPD patients and were compared. Results: It was observed that the NLR, the platelet distribution width, the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) increased in AECOPD patients compared to stable COPD patients (P <0.001). A positive correlation was observed between the neutrophil lymphocyte ratio, the platelet distribution width, the ESR and the CRP (P <0.001). Conclusion: The NLR and platelet distribution width values increased significantly in AECOPD patients compared to stable COPD patients.

Metabolic Syndrome in Post-Pulmonary Tuberculosis-Associated Obstructive Airway Disease: A Cross-Sectional Analytical Study.

Background The aim of this study is to assess the prevalence of metabolic syndrome in tuberculosis-associated obstructive airway disease (TOPD) patients, as well as the association of its components with the severity of airflow obstruction. Methodology In this cross-sectional analytical study, we evaluated the clinical profile, spirometry, waist circumference, blood pressure, lipid profile, fasting plasma glucose, and the association of each component with the severity of airflow obstruction. Results The prevalence of metabolic syndrome in TOPD was found to be was 25.77% (95% confidence interval = 18.11-35.28) among study participants. Reduced high-density lipoprotein was the deranged component and was associated with increased severity in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II compared to GOLD stage IV. Conclusions The prevalence of metabolic syndrome in TOPD has a severe impact on patients' treatment, outcomes, and complications. However, in our study, tuberculosis-associated metabolic syndrome was the same as the general population. Low high-density lipoprotein levels were associated with the severity of the airflow obstruction.

All necrotizing nodes are not tuberculosis - A report of two cases.

INTRODUCTION: Kikuchi-Fujimoto disease is a benign and self-limiting systemic disorder of unknown aetiology characterised by fever, superficial lymphadenopathy and leukopenia. In highly endemic & low-resource country like India, it is frequently misdiagnosed as tuberculosis. CASE REPORT: Both the cases were diagnosed as necrotizing lymphadenitis by fine-needle aspiration cytology. Tuberculin skin prick test (TST) was positive for one case and negative for the other case. Cartridge based nucleic acid amplification test (CBNAAT) from lymph node aspirate was negative for mycobacterium tuberculosis in both the cases, later on histopathology of lymph node showed diagnosis of Kikuchi-Fujimoto disease. CONCLUSION: Kikuchi Fujimoto is a self-limiting disease systemic disease of unknown aetiology. A definite diagnosis can be established by incisional/excisional biopsy of the lymph node. When dealing with cases of tubercular lymphadenitis, Kikuchi-Fujimoto disease should be kept as differential diagnosis.

Endocrine paraneoplastic syndromes in lung cancer: a respiratory physician's perspective.

Lung malignancy is known to be one of the leading causes of cancer-related mortality. Endocrine paraneoplastic syndromes in lung cancer are common. These are due to secretion of various substances and not because of direct tumour invasion or me-tastasis. These syndromes have also been associated with lung cancer prognosis. This review describes the many endocrine paraneoplastic syndromes seen in lung cancer and narrates their incidence, biology, clinical features, diagnosis, and management.

Streptomyces pneumonia in an immunocompetent adult - a rare isolate.

Streptomyces belongs to the Actinomycetes group of bacteria which are gram-positive non acid-fast bacilli, widely recognised for their potential to produce antimicrobials active against bacterial, mycobacterial, parasitic and fungal infections. They commonly cause cutaneous infections following traumatic inoculation. Visceral infections are relatively rare and limited to immunocompro-mised hosts. We describe a case of Streptomyces pneumonia in a healthy immunocompetent female, who when investigated for voluntary kidney donation, resulted in the isolation of Streptomyces species from bronchial wash cultures. Streptomyces, a potential pathogen in immunocompetent hosts is frequently underdiagnosed. Once isolated, both physicians and microbiologists should pay attention to differentiate true infection from contamination.