Community acquired pneumonia and cardiac diseases: A fatal association.

Background. Community acquired pneumonia (CAP) remains a common disease condition attributing to a significant mortality and morbidity worldwide. Acute cardiac events (ACEs) are one of the most life-threatening complications in patients with severe pneumonia. Methods. Retrospective study of burden of ACE in 105 patients admitted with CAP. Results. Twenty-five patients with (CURB-65) score ranging between 0 – 2 did not require intensive care unit (ICU) admission and were admitted in the ward and high dependency unit. Of these, 12 developed ACE and 4 required to be shifted to the ICU for further management. Eighty patients with a CURB—65 score of greater than 3 were admitted to the ICU. Of the patients admitted to the ICU, 10 with ACE died; 2 patients without ACE also died. Conclusions. Our observations suggest that ACE constitute an important cause of morbidity and mortality in patients with CAP requiring hospitalisation.

Incidence of chronic thrombo-embolic pulmonary hypertension following acute pulmonary thrombo-embolism: An Indian perspective.

Chronic thrombo-embolic pulmonary hypertension (CTEPH) remains a severe disabling disease causing a significant amount of mortality and morbidity worldwide. The incidence and severity of this condition is quite obscure. The initial inciting event, the reason of progression, the natural history of the disease and the predictors of adverse outcomes are not yet adequately clarified. From the Indian subcontinent, data regarding this disease is limited. But with the advent of the multi-detector computed tomography, the understanding of this disease is gradually improving. As most of the available data suggests, acute pulmonary embolism (PE) as the main initial trigger leading to CTEPH, we prospectively analysed all patients being admitted in our hospital with acute PE and followed them over a period of one-and-a-half years to determine the incidence of CTEPH in this group. This is just an attempt to increase the awareness about the disease pattern and determine the rate of progression, risk factors of poor outcome, so that early detection and prompt treatment can benefit the patient care.

Tobacco smoking related interstitial lung diseases.

Smoking is a leading cause of death worldwide and is the important proximate cause of the most common noncommunicable respiratory disease, chronic obstructive pulmonary disease (COPD). Smoking is causally related to the development of certain forms of interstitial lung diseases (ILDs) including desquamative interstitial pneumonia (DIP), respiratory bronchiolitis associated interstitial lung disease (RB-ILD), pulmonary Langerhans’ cell histiocytosis (LCH), idiopathic pulmonary fibrosis (IPF) and acute eosinophilic pneumonia (AEP), among others. It is important to understand this causal relationship, as well as the natural history and prognosis of these diseases. The response to treatment of ILDs in general is quite dismal. For most of the ILDs, the only definitive treatment measure remains oxygen therapy and lung transplantation. As lung transplantation is still in its infancy and is unaffordable for a majority of patients with ILD in India, most of these patients can only hope to receive palliative supportive care. However, patients with tobacco smoking related ILDs have better outcomes, and progression of these disease ceases with smoking cessation. We review here, the varied clinical, radiological, pathological features, and the progression and outcome in this group of ILDs. Better understanding of these diseases, including making “smoking cessation” a central goal of management will improve overall outcomes.

Exacerbations of chronic obstructive pulmonary disease: An Indian perspective.

Background. Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death by 2020. Recent studies reveal that pulmonary embolism (PE) may be a trigger of acute deterioration in patients with COPD. Patients with COPD have approximately twice the risk of PE than those without COPD. Objective. The primary objective was to assess the prevalence of venous thromboembolism (VTE) in patients with acute exacerbation of COPD (AE-COPD) in India. Methods. We conducted this prospective study on patients admitted for AE-COPD in a tertiary care hospital in Mumbai, India. We considered the prevalence of deep venous thrombosis (DVT) to reflect the occurrence of VTE. The screening tool used was a colour Doppler of the bilateral lower limbs. Results. One hundred patients enrolled, were in stage II to stage IV COPD; 9% had DVT. Eight of these nine patients had unilateral DVT. Two patients had developed PE and died. Conclusions. Our results show a lower prevalence of unsuspected DVT in Indian patients admitted for AE-COPD. Future prospective, randomised studies are needed to confirm the findings of the present study and to determine whether a systematic evaluation for VTE is justified in these patients, and hence, be recommended.