Geographic information system-based mapping of air pollution & emergency room visits of patients for acute respiratory symptoms in Delhi, India (March 2018-February 2019)

Background & objectives: Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)2.5 concentrations and air quality index (AQI) with emergency room (ER) visits of patients having acute respiratory symptoms in Delhi using the geographic information system (GIS) approach. Methods: The daily number of ER visits of patients having acute respiratory symptoms (less than or equal to two weeks) was recorded from the ER of four hospitals of Delhi from March 2018 to February 2019. Daily outdoor PM2.5 concentrations and air quality index (AQI) were obtained from the Delhi Pollution Control Committee. Spatial distribution of patients with acute respiratory symptoms visiting ER, PM2.5 concentrations and AQI were mapped for three seasons of Delhi using ArcGIS software. Results: Of the 70,594 patients screened from ER, 18,063 eligible patients were enrolled in the study. Winter days had poor AQI compared to moderate and satisfactory AQI during summer and monsoon days, respectively. None of the days reported good AQI (<50). During winters, an increase in acute respiratory ER visits of patients was associated with higher PM2.5 concentrations in the highly polluted northwest region of Delhi. In contrast, a lower number of acute respiratory ER visits of patients were seen from the ‘moderately polluted’ south-west region of Delhi with relatively lower PM2.5 concentrations. Interpretation & conclusions: Acute respiratory ER visits of patients were related to regional PM2.5 concentrations and AQI that differed during the three seasons of Delhi. The present study providessupport for identifying the hotspots and implementation of focused, intensive decentralized strategies to control ambient air pollution in worst-affected areas, in addition to the general city-wise strategies.

Role Of Non-Invasive Ventilation In Management Of Plasmodium Vivax Malaria Presenting As Acute Respiratory Distress Syndrome: A Case Report

Plasmodium vivax malaria has been rarely found to be associated with acute respiratory distress syndrome (ARDS), and very few cases have been reported with ARDS as the presenting complication. In majority of the reported cases, invasive mechanical ventilation has been used for the management of respiratory failure in P. vivax-associated ARDS. We report a case of vivax malaria presenting as ARDS which was managed successfully with antimalarial drugs and non-invasive ventilation.

A Case Of Pleural Neurofibroma: A Rare Pleural Tumor

Neurofibromas (NFs) are benign tumors involving any nerve from the root level to the smallest branch. They may enlarge locally and cause a pressure effect on thoracic structures such as trachea, superior vena cava, and esophagus. Pulmonary and pleural involvement is very rarely seen. We have reported a case of a pleural effusion secondary to lymphatic obstruction due to remnant NF for which patient had undergone surgical resection in the past.

Unilateral Reexpansion Pulmonary Edema After Tube Thoracostomy: A Case Report

We report a case of unilateral reexpansion pulmonary edema (RPE) in a patient of secondary spontaneous pneumothorax of 2 days’ duration developed after tube thoracostomy. RPE is an unusual but life-threatening complication. It may result in variable degree of hypoxemia and hypotension. Prognosis depends on early diagnosis and prompt management.