ABSTRACT
Background: Defaults in serious diseases like lung cancer cause significant morbidity and mortality. Thus an effort was made to know the impact of COVID-19 pandemic on the follow up of lung cancer patients. Reasons once identified may help in reducing the default rate in future during similar conditions. Methods: 115 patients of carcinoma lung on chemotherapy were enrolled and followed up till the end of the study during COVID-19 pandemic. Defaults if any was studied and analysed by questionnaire method. Results: Mean age was 54.63 (SD-12.11) majority of the patients were males 91 (79.1%), mainly from rural background (75.7%). The major histological type was adenocarcinoma 65 (56.5%). 70 (60.9%) patients were exsmokers and 45 (39.1%) were non smokers. Mean distance from home to hospital was 156.42 (SD-147.56). All the patients were of advanced cancer;i.e. stage III or IV. 68 (59.13%) patients defaulted during the study period. 77 defaults were documented, 60 patients (88.24%) defaulted once, 7 patients (10.29 %) were defaulted twice and 1 defaulted (1.47 %) thrice. Lock down in 22 (32.35%), poor health in 13 (16.88%) and fear of covid in 12 (15.58%) were the most frequent reasons. No correlation was found between ages, gender, residence, distance from home to hospital, patient education, care taker education, socio economic status, ECOG status, stage of the disease, type of chemotherapy (conventional or oral TKI) with the default rate. Conclusion: Even though the OPD and indoor services never stopped for cancer patients, still major cause of default in were covid related problems, like lock down, fear of covid, transport related problems during COVID-19 pandemic.
ABSTRACT
Background: Post COVID -19 infection has wide range of presentation, cavitation and fungal infections were very common in these patients especially when they are immune compromised. This is a case study of a post covid patient with cavitary consolidation and Rasmussen's aneurysm secondary to invasive aspergillus infection. Case Study: A 62 year old gentleman, hypertensive, diabetic and survivor of severe COVID-19 infection presented with low grade fever, breathlessness and cough with expectoration. The CT scan showed bilateral cavitary consolidation . Sputum examination showed aspergillus growth and MTB negative. Serum galactomannan was positive. While getting treated with antifungal therapy for invasive aspergillus infection, he had one episode of massive haemoptysis. CT angiography showed Rasmussen aneurysm and planned for bronchial artery embolization. But the patient was not willing for any urgent intervention and got discharged on request after stabilisation, warning signs were explained. After 5 days patient had massive haemoptysis followed by circulatory collapse. Patient could not be saved even after resuscitation measures and emergency intubation. Discussion: Rasmussen's aneurysm is a pseudo-aneurysmal dilatation of a branch of pulmonary artery secondary to chronic inflammation in a contiguous cavity. The reported incidence of such pathology is around 5% in cavitary lesions. It may ruptures into the cavity, producing massive haemoptysis. Conclusion: Rasmussen aneurysm itself is a very dangerous entity irrespective of its etiology. Early interventions to prevent the fatal haemoptysis is the management strategy as conservative treatment may not give us enough time to act at the time of emergency.