Screening Parameters for COPD-OSA Overlap Syndrome in COPD Patients: Indian Perspective

Introduction: As Indian patients have different predisposing morphological characteristics, we undertook this study to evaluate the clinical profile of overlap syndrome and compare them with COPD patients to find out the screening tools for obstructive sleep apnea (OSA) in Indian chronic obstructive pulmonary disease (COPD) patients. Aims and objectives: • To study the clinical profile of patients with overlap syndrome. • To compare them with COPD patients. • To develop screening tools for overlap syndrome in COPD. Materials and methods: A prospective case-control study was carried out in a tertiary care center. Overnight pulse oximetry was carried out for all COPD patients. Those having snoring or saw-tooth pattern on overnight oximetry were subjected to level 1 polysomnography. About 30 patients of overlap syndrome were compared with 65 COPD patients. Results: The mean age in overlap syndrome group (56.9 ± 6.86 years) was significantly lower (p < 0.01). The daytime PaO2 and lowest nocturnal saturation were significantly lower in overlap group. PaCO2 and forced expiratory volume at 1 second (FEV1) were significantly higher. For diagnosing overlap syndrome, the positive and the negative predictive values of snoring were 84.42 and 100%; of body mass index (BMI) ?25 kg/m2 were 86.67 and 98.88%; and of excessive daytime sleepiness were 37.57 and 97.86%, respectively. Conclusion: Absence of snoring and BMI <25 kg/m2 virtually rules out overlap syndrome. The EDS has a high false-positive rate for predicting OSA. Patients having overlap syndrome have poor daytime and nocturnal oxygenation despite good lung functions.

Obstructive Sleep Apnea with Insomnia Overlap: An Under-recognized Entity

Introduction: The association between obstructive sleep apnea (OSA) and insomnia is relatively common but is underrecognized. There are important diagnostic and therapeutic implications of comorbid OSA杋nsomnia overlap but there is no data available from India. Objectives: (1) To find out the prevalence of insomnia among patients with OSA; (2) To compare the demographic characteristics, Epworth sleepiness scale (ESS) scores and the presence of comorbidities among patients of OSA with insomnia vs OSA without insomnia. Materials and methods: It was a prospective observational study involving 250 patients with suspected OSA. A total of 189 patients had OSA based on type I polysomnography and were further analyzed. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Results: The prevalence of insomnia among OSA was 15.34% (29/189). Overlap was seen in 22.45 and 12.86% of women and men respectively among patients with OSA. The prevalence of overlap increased with decreasing severity of obesity and OSA. Those with OSA杋nsomnia overlap had significantly lower ESS scores as compared to OSA without insomnia (12.31 vs 15.24; p = 0.019). A total of 10.34% (3/29) of patients of overlap had depression whereas none from OSA alone had depression. Conclusion: There is a high prevalence of insomnia among patients with OSA (15.34%), similar to findings worldwide. Insomnia is more common among women with OSA. Overlap patients have lower ESS scores and are likely to be depressed.

Clinico-radiological and Pathological Characteristics of Lung Cancer and its Correlation with their Occupational Profile among Patients of� Employees State Insurance (ESI) Hospital� A Tertiary Care Center in North India

Introduction: Occupational exposure is an important risk factor for lung cancer in never smokers contributing to 10�% of lung cancers. We conducted this study to evaluate the clinico-radiological and pathological profile of occupational lung cancer among patients of Employees State Insurance (ESI) Hospital, a tertiary care center. Materials and methods: This was a cross-sectional observational study conducted over 6 years on patients diagnosed with lung malignancy at ESI Hospital and Postgraduate Institute of Medical Sciences and Research (PGIMSR), Basai Darapur, New Delhi. The details regarding their clinical history including onset and progress of the disease were interviewed. Also, the details of whole life, past, and present occupational history in a chronological order were recorded for all subjects. Results: Our study included 171 patients with mean age of 58.34 � 11.52 years and 137 (80%) men. About 80.7% of the patients had a smoking history. The most common histological type was adenocarcinoma seen in 35.09%, followed by squamous cell carcinoma (SCC) in 23.39% of patients. About 70.19% (120/171) patients had occupational exposure. The most common exposure was of polycyclic aromatic hydrocarbons (PAH) seen in 24.8% cases. Others being silica, diesel fumes, organic dust, metal fumes, etc. Fourteen patients had occupational exposure alone in the absence of smoking. Those with pure occupational exposure in the absence of smoking had a significantly lower mean age compared to the nonexposed group (52.21 � 11.92 vs 58.65 � 13.93, p-value = 0.017). SCC was significantly more common in the exposed group compared to the nonexposed (37/120 vs 3/51, p-value = 0.0004). Conclusion: Occupational exposure was found in 70.19% of patients with lung cancer. The occupational lung cancer manifests at an early age and is more commonly associated with squamous cell lung cancer compared to nonoccupation-related cancer

Isolated Index Finger Dactylitis with Hilar Adenopathy

Dactylitis due to tuberculosis (TB) is an extremely uncommon manifestation of TB. We report a unique case of isolated index finger dactylitis with right hilar adenopathy due to TB in a 15-year-old immunocompetent student. High index of clinical suspicion, radiological findings and histological confirmation helped in the diagnosis. Anti-tuberculous therapy remains the cornerstone for the management of these cases.

A rare case of subcutaneous mucormycosis due to Syncephalastrum racemosum: Case report and review of literature.

Zygomycosis represent a group of uncommon but potentially fatal fungal infections. The incidence of zygomycosis has increased manifold in recent years. Despite aggressive treatment, it can lead to a highly invasive disease state with fatal outcomes, especially among immuno‑compromised. Syncephalastrum racemosum is a fungus belonging to Zygomycetes. Very few cases of human disease caused by this particular fungus have been documented. However, it has been clearly implicated in causing highly invasive disease in recent reported cases. Knowledge about the pathogenicity and clinical presentation of this rare fungal infection will alert the clinicians for instituting an early appropriate therapy leading to better outcomes.