Spectrum of Bacterial Pathogens in Critical COVID-19 Patients Admitted in Intensive Care Units of a Tertiary Care Hospital During the First and Second Wave of the Pandemic

Objective: This study intends to compare the clinical characteristics and the prevalence and spectrum of bacterial pathogens in COVID-19 patients admitted to ICU during the first and second waves at a tertiary care, teaching and referral hospital of eastern India. Method: This is a hospital-based retrospective study which analysed demographic details, clinical profile and bacterial culture results of severe and critically ill COVID-19 patients admitted in intensive care units (ICU) during April -Oct 2020 (1 st wave) and April –July 2021 (2 nd wave). Result: The patients admitted during the 2 nd wave were comparatively older and had multiple comorbidities compared to the 1 st wave. (23.8%) (45/189) and 50% (173/346) of the COVID-19 patients admitted to ICU developed bacterial infection during the 1 st and 2 nd wave respectively. Overall, there was predominance of multidrug resistant Gram negative bacilli in both the waves. There was increased isolation of intrinsic colistin resistant microorganisms. Conclusion: Multidrug resistant Gram negative bacterial infections, remain a dreaded complication in severe and critically ill hospitalised COVID-19 patients requiring ICU care and high usage of colistin spirals the emergence and spread of pathogens intrinsically resistant to colistin.

Concomitant echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase rearrangement and epidermal growth factor receptor mutation in non-small cell lung cancer patients from eastern India

Background: In non-small cell lung cancer common driver mutations such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) are usually mutually exclusive. This study aimed to elucidate the concurrence of EGFR mutation and ALK rearrangement in eastern India patients with primary lung adenocarcinoma and assess the response of EGFR tyrosine kinase inhibitor (TKI) therapy after 6 months in primary lung adenocarcinoma. Methods: We retrospectively analyzed 198 adenocarcinomas for EGFR and ALK mutations. EGFR and ALK tests were done by real-time polymerase chain reaction and immunohistochemistry (IHC) techniques, respectively. Radiological response was assessed by Response Evaluation Criteria in Solid Tumors (version 1.1). Results: EGFR/ALK co-alteration was found in 4 adenocarcinoma patients. All were males with advanced disease. Younger patients had exon 19 deletion whereas older ones showed exon 21 mutation. The initial option of ALK-TKI in all four patients was excluded straightaway due to the high-cost burden of ALK-TKI. Two of them showed a partial response while other two had stable disease after 6 months of EGFR TKI therapy. Conclusion: EGFR/ALK co-alterations in adenocarcinomas albeit rare do exist. The challenge of monetary hurdle in developing countries with ALK TKI therapy can be handled by giving only EGFR TKI in these cases of concomitant mutations. Future perspective in research could be finding an agent with the potential of dual inhibition of ALK and EGFR

Quality of Life in Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is associated with significant cardiovascular and cerebrovascular morbidity and mortality. Usual parameters studied in sleep laboratory are unable to measure overall impact of OSA on human life. Consequently, it is important to measure Quality of Life (QoL) in OSA. QoL can be measured with generic instruments like SF-36 or OSA specific questionnaires like Calgary Sleep Apnea Quality of Life (SAQLI) questionnaire. Most of the studies suggest that there is significant impairment of QoL in patients of OSA. But the present evidence suggests that impairment in QoL is not proportional to severity of OSA. There is no consensus on the question of improvement in QoL with Continuous Positive Airway Pressure (CPAP) therapy. A recent Cochrane review concluded that CPAP improves QoL in people with moderate and severe OSA.

Factors associated with hospital admission in patients with acute exacerbation of chronic obstructive pulmonary disease.

Background. Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) impair quality of life (QOL), accelerate the decline in lung function and often require hospitalisation, and thus, leading to increased healthcare burden. By identifying factors that may be associated with AE-COPD and managing them rationally, not only the hospital admissions could be avoided but progression of the disease may also be slowed. Objective. The aim of the present study was to determine the factors associated with hospital admissions among adults with AE-COPD. Methods. Seventy-three patients admitted with AE-COPD were administered a structured questionnaire during their hospital stay. Data on body mass index (BMI), smoking, symptoms, co-morbidities course of the disease, spirometry management and outcomes during the hospitalisation were obtained. Factors associated with hospital admissions were analysed. Results. The hospitalisation due to AE-COPD was significantly associated with the reduced forced expiratory volume in one second (FEV1), and peak expiratory flow rates, increasing sputum purulence, number of hospitalisations during previous year for COPD and presence of co-morbidities. Conclusions. The study shows that both disease and healthcare-related factors are predictors for hospitalisation. Identification of risk factors and appropriate management may reduce hospitalisation due to AE-COPD.

Endobronchial tuberculosis.

Endobronchial tuberculosis (EBTB) is defined as tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence. It is seen in 10-40% of patients with active pulmonary tuberculosis. More than 90% of the patients with EBTB have some degree of bronchial stenosis. Ten to 20 percent have normal chest radiograph. Therefore, a clear chest radiograph does not exclude the diagnosis of EBTB. Bronchoscopic sampling has been the key to the diagnosis producing more than 90% yield on smear as well as on culture. Bronchoscopy and computed tomography are the methods of choice for accurate diagnosis of bronchial involvement and assessment for the surgical interventions. Characteristic HRCT findings of FBTB are patchy asymmetric centrilobular nodules and branching lines (tree-in-bud appearance). Early supervised antituberculosis therapy results in minimal structural and functional residua. Corticosteroid therapy may not influence the outcome of endobronchial tuberculosis. Early diagnosis and prompt treatment, before the development of fibrosis is important to prevent complications of endobronchial tuberculosis, such as bronchostenosis.