Effect of pulmonary rehabilitation in patients with post-tuberculosis sequelae with functional limitation.

BACKGROUND: Pulmonary rehabilitation improves dyspnea, functional limitation and quality of life in patients with chronic respiratory disease especially Chronic obstructive pulmonary disease (COPD). Whether Pulmonary rehabilitation (PR) will have similar effect in patients with post-tuberculosis sequelae or not and whether the two morphological variants will respond similarly or not was the purpose of our study. METHODS: Adult patients fulfilling the inclusion criteria of a diagnosis of post-tuberculosis sequelae with functional limitation (modified medical research council [mMRC] grade 1 or more) were recruited over a period of two years. A baseline health assessment in the different domains of health was done at the beginning and repeated just after the completion of the rehabilitation program at 6 weeks. RESULTS: 26 patients completed the PR protocol of our study. Dyspnea improved from an mMRC grade of 1.5 to 0.7 post-PR (p < 0.001). 6MWD increased by 34 meters from a baseline value of 408.6 meters to 442.7 meters post-PR. (p-value 0.3) St. George's Respiratory Questionnaire (SGRQ) symptom score decreased by 13 points, SGRQ activity score decreased by 18 points, SGRQ impact score decreased by 18 and SGRQ total score decreased by 17 points with p-values of 0.037, 0.002, 0.004 and 0.002 for SGRQ symptom score, SGRQ activity score, SGRQ impact score, SGRQ total score respectively. Depression Anxiety Stress Scale (DASS) Stress score decreased by 6.7, DASS Anxiety score decreased by 6.6, and DASS Depression score decreased by 5.5 points. Intergroup comparison revealed both bronchiectasis predominant group and fibrosis predominant group responded similarly to PR. CONCLUSION: PR improved parameters assessing dyspnea, quality of life and mental health indices significantly. Improvement in functional capacity was not statically significant. Both the morphological variants responded similarly to the PR.

Six-Week Hospital-Based Pulmonary Rehabilitation in Covid Pneumonia ICU Survivors: Experience from a Tertiary Care Center in Central India.

OBJECTIVE: There is very limited data on the usefulness of pulmonary rehabilitation in patients with coronavirus pneumonia who have survived intensive care unit care. The primary aim was to explore the feasibility of conducting a pulmonary rehabilitation program in patients with coronavirus disease-19 pneumonia surviving intensive care. The secondary aim was to study the impact of a hospital-based 6-week pulmonary rehabilitation program on exercise capacity, quality of life, and psychological parameters in these patients. This study was conducted at the Center for Pulmonary Rehabilitation, Department of Pulmonary Medicine of the institute. MATERIAL AND METHODS: A total of 27 patients were enrolled. Among them, 14 patients who completed the desired 12 sessions over 6 weeks constituted the pulmonary rehabilitation group and 13 patients who either did not consent or defaulted within the first 2 weeks were considered as controls. Both groups had assessments at 0 and 6 weeks that included a 6-Minute Walk Test, Incremental Shuttle Walk Test, mMRC Dyspnea Scale, Baseline Dyspnea Index, and Transitional Dyspnea Index, Saint George's Respiratory Questionnaire score, and Depression, Anxiety, Stress Scale-21 score. RESULTS: Significant improvement in dyspnea by mMRC (P = .01) and exercise capacity as measured by 6-Minute Walk Test (P <.001) and Incremental Shuttle Walk Test (P = .025) was seen in the pulmonary rehabilitation group as compared to the control group. There was no significant improvement in quality of life and psychological parameters (Depression, Anxiety, Stress Scale 21 score) after 6 weeks of pulmonary rehabilitation program as measured in our study. CONCLUSION: Pulmonary rehabilitation is feasible and appears promising in coronavirus disease acute respiratory distress syndrome survivors. However, data from other centers and a larger number of patients are required to imbibe conclusive results.

Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study.

BACKGROUND: Tracheostomy is integral in long-term intensive care of coronavirus disease-2019 (COVID-19) patients. There is a paucity of studies on weaning outcomes and mortality after tracheostomy in COVID-19 in Indian scenario. MATERIALS AND METHODS: We conducted a retrospective, single-center, observational study of severe COVID-19 patients who underwent elective tracheostomy (n = 65) during critical care in a tertiary care institute in Central India from May 1, 2020, to April 30, 2021. Data were collected from Medical records, ICU charts, and follow-up visits by patient. A primary objective was to study the clinical characteristics, tracheostomy complications, weaning outcomes, and mortality at 28 and 60 days of ICU admission. We categorized the cohort into two groups (deceased and survivor) and studied association of clinical parameters with 28-day mortality. Cox Proportional regression analysis was applied to calculate the hazard ratio among the predictors of mortality with p value <0.05 as significant. RESULTS: Elective tracheostomy was done in 69 of 436 (15.8%) patients on invasive mechanical ventilation, of which 65 were included. Tracheostomy was percutaneous in 45/65 (69%) and surgical in 20/65 (31%) with timing from intubation as early in 41/65 and late in 24/65 with most common indication as weaning failure followed by anticipated prolonged ventilation. Tracheostomy complications were present in 29/65 (45%) patients with no difference in complication rates between timing and type of tracheostomy. Downsizing, decannulation, and weaning were successful in 22%, 32 (49%), and 35/65 (54%) patients after tracheostomy. The 28-day mortality was 30/65 (46%). The fractional inspired oxygen concentration (FiO2) requirement in survivors was lower (0.4-0.6, p = 0.015) with a higher PaO2/FiO2 ratio (118-200, p = 0.033). Early tracheostomy within 7 days of intubation was not associated with weaning or survival benefit. CONCLUSIONS: We suggest that tracheostomy should be delayed to after 7 days of intubation, especially till FiO2 reduces to 0.5 with improvement in PaO2/FiO2 for better outcomes and avoiding a wasted procedure (CTRI/2021/07/034768). STUDY HIGHLIGHTS: Tracheostomy is integral in care of COVID-19 patients needing prolonged ventilation. There is no difference in complications in early/late or percutaneous dilatational/surgical technique. We observed successful weaning post-tracheostomy in 54% patients. Mortality at 28 days was 46%. Early tracheostomy within 7 days of intubation did not improve weaning or survival. HOW TO CITE THIS ARTICLE: Karna ST, Trivedi S, Singh P, Khurana A, Gouroumourty R, Dodda B, et al. Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study. Indian J Crit Care Med 2022;26(1):85-93.

Cytologic and flowcytometric findings in a case of myelomatous pleural effusion: A rare and ominous presentation of multiple myeloma.

Plasma cell myeloma is a hematologic malignancy characterized by multifocal clonal proliferation of plasma cells usually associated with M protein secretion in serum and/or urine and evidence of organ damage. Generally, the presenting features are related to anemia, bone lesions, and renal failure. Pleural effusion is rare in multiple myeloma and when present is often due to nonmalignant causes. Myelomatous pleural effusion that is, effusions directly due to pleural infiltration by plasma cells is even rarer. We present a case of a patient presenting with dyspnea due to myelomatous pleural effusion. The fluid in such a case may be subjected to cytology examination, protein electrophoresis, flowcytometric analysis, and cytogenetics. The case highlights the utility of cytomorphology and flowcytometry in the diagnosis of myelomatous pleural effusion and also highlights that this type of presentation portends a poor prognosis to the patient.

Pulmonary rehabilitation in COVID-19 pneumonia sequelae: so near yet so far.

To evaluate the benefit of pulmonary rehabilitation, a control group is a must to mitigate the effect of confounding factors like spontaneous resolution of lung damage, learning effect and better mental status https://bit.ly/3qy5sfe.

Type-5 Bartter syndrome presenting with metabolic seizure in adulthood.

Bartter syndrome is a very rare and heterogeneous disease with variable age of onset and symptom severity. Genotypically they have inherited disorders of the thick ascending limb in the renal tubular system, which manifest phenotypically as electrolyte imbalance due to loss of sodium, chloride and potassium. Gain of function mutations in the calcium-sensing receptor has been described in some patients with Bartter's syndrome (type-5 Bartter syndrome or autosomal dominant hypocalcaemia with Bartter syndrome) associated with hypocalcaemia and hypercalciuria differentiating it from Gitelman syndrome. This phenotype has been reported to present in adulthood with metabolic abnormalities. We present a case of a middle-aged woman who presented with metabolic seizures and on evaluation was found to have profound electrolyte abnormalities which were corrected with supplements and led to the resolution of symptoms.

Primary Pulmonary Marginal Cell Lymphoma: Your Eyes See Only What Your Mind Knows.

Lung cancer is the leading cause of cancer-associated mortality, with a 5-year survival of 19% for all types of lung cancer. Lymphoid malignancies of the lung have a significantly better prognosis, with 5-year survival approaching 90%, making it very important to identify these patients. As the signs and symptoms, laboratory investigations, and radiological features are non-specific and vague and the histological confirmation is invasive, they are usually either not diagnosed or diagnosed very late. We present a case of an elderly male who was treated for months with antituberculosis treatment (ATT) before being properly evaluated and diagnosed with primary pulmonary marginal cell lymphoma. This case was unique for having gross pleural effusion as a presenting feature and having been diagnosed with the help of radial endobronchial ultrasound (EBUS).

Colors of Single-Wall Carbon Nanotubes.

Although single-wall carbon nanotubes (SWCNTs) exhibit various colors in suspension, directly synthesized SWCNT films usually appear black. Recently, a unique one-step method for directly fabricating green and brown films has been developed. Such remarkable progress, however, has brought up several new questions. The coloration mechanism, potentially achievable colors, and color controllability of SWCNTs are unknown. Here, a quantitative model is reported that can predict the specific colors of SWCNT films and unambiguously identify the coloration mechanism. Using this model, colors of 466 different SWCNT species are calculated, which reveals a broad spectrum of potentially achievable colors of SWCNTs. The calculated colors are in excellent agreement with existing experimental data. Furthermore, the theory predicts the existence of many brilliantly colored SWCNT films, which are experimentally expected. This study shows that SWCNTs as a form of pure carbon, can display a full spectrum of vivid colors, which is expected to complement the general understanding of carbon materials.

Incidence of potential adverse events during hospital-based ketogenic diet initiation among children with drug-resistant epilepsy.

OBJECTIVE: Due to the possibility of serious adverse events (AE), patients are commonly admitted to hospital for 3-5 days for ketogenic diet (KD) initiation. This study examined the incidence of potential AE during admission for KD initiation to investigate the possibility of safely initiating a KD at home. METHODS: Children with drug-resistant epilepsy (DRE) who were admitted to hospital for 5 days for KD initiation were retrospectively studied. RESULTS: A total of 66 children (59% female) were analyzed. The mean age at the initiation of the KD was 48.0 ± 38.4 months, and the mean weight was 14.6 ± 6.3 kg. The median number of anticonvulsant medications used at the time of KD initiation was 3. The etiology of the DRE was structural in 4.5%, hypoxic ischemic encephalopathy in 10.6%, genetic/metabolic in 31.8%, acquired in 10.6%, and unknown in 42.2%. The potential AE occurred in 28.7% of patients, including hypoglycemia (20%), hypoactivity (6.1%), somnolence (3%), and vomiting (7.6%). A univariate analysis of the clinical characteristics of the AE and no AE groups showed a statistically significant difference in weight (P = 0.003) and age (P = 0.033). The concurrent use of topiramate was found to have a near-significant association (P = 0.097) between the groups. The groups' urine ketone levels on all 5 days were compared, and a statistically significant difference was found on day 3 (P = 0.026). A statistically significant difference in the serum bicarbonate levels (P = 0.038) was found between the patients taking topiramate and those not taking it. SIGNIFICANCE: The incidence of AE during admission for KD initiation was found to be low. The AE either required no intervention or were easily managed with simple interventions. Thus, in carefully selected patients, it may be possible to initiate a KD at home if the parents are adequately prepared and monitored.

Scalable growth of single-walled carbon nanotubes with a highly uniform structure.

Here, a scalable floating catalyst chemical vapor deposition (FCCVD) method is developed for the production of single-walled carbon nanotubes (SWCNTs) with a controlled structure. For the first time, water is used as the growth promoter in the FCCVD process to modulate the growth of SWCNTs. At an optimum water concentration of ca. 115 ppm, the water-assisted FCCVD process synthesizes SWCNTs with a significantly narrow chirality distribution. In particular, the proportion of (9,8) and (8,7) semiconducting tubes was dramatically enhanced to 45% with 27% of the (9,8) tube in the end product. This is attributed to the changes in both the SWCNT diameter and the chiral angle. The experiment results and accurate quantum chemical molecular dynamics simulations show that the addition of water affects the nucleation and the size distribution of nanoparticle catalysts, thus resulting in the growth of SWCNTs with a highly uniform structure. This direct and continuous water-assisted FCCVD provides the possibility for the mass production of high-quality SWCNTs with a controlled structure.

Silicon Substitution in Nanotubes and Graphene via Intermittent Vacancies.

The chemical and electrical properties of single-walled carbon nanotubes (SWCNTs) and graphene can be modified by the presence of covalently bound impurities. Although this can be achieved by introducing chemical additives during synthesis, it often hinders growth and leads to limited crystallite size and quality. Here, through the simultaneous formation of vacancies with low-energy argon plasma and the thermal activation of adatom diffusion by laser irradiation, silicon impurities are incorporated into the lattice of both materials. After an exposure of ∼1 ion/nm2, we find Si-substitution densities of 0.15 nm-2 in graphene and 0.05 nm-2 in nanotubes, as revealed by atomically resolved scanning transmission electron microscopy. In good agreement with predictions of Ar irradiation effects in SWCNTs, we find Si incorporated in both mono- and divacancies, with ∼2/3 being of the first type. Controlled inclusion of impurities in the quasi-1D and -2D carbon lattices may prove useful for applications such as gas sensing, and a similar approach might also be used to substitute other elements with migration barriers lower than that of carbon.

Atomic-Scale Deformations at the Interface of a Mixed-Dimensional van der Waals Heterostructure.

Molecular self-assembly due to chemical interactions is the basis of bottom-up nanofabrication, whereas weaker intermolecular forces dominate on the scale of macromolecules. Recent advances in synthesis and characterization have brought increasing attention to two- and mixed-dimensional heterostructures, and it has been recognized that van der Waals (vdW) forces within the structure may have a significant impact on their morphology. Here, we suspend single-walled carbon nanotubes (SWCNTs) on graphene to create a model system for the study of a 1D-2D molecular interface through atomic-resolution scanning transmission electron microscopy observations. When brought into contact, the radial deformation of SWCNTs and the emergence of long-range linear grooves in graphene revealed by the three-dimensional reconstruction of the heterostructure are observed. These topographic features are strain-correlated but show no sensitivity to carbon nanotube helicity, electronic structure, or stacking order. Finally, despite the random deposition of the nanotubes, we show that the competition between strain and vdW forces results in aligned carbon-carbon interfaces spanning hundreds of nanometers.

Floating catalyst CVD synthesis of single walled carbon nanotubes from ethylene for high performance transparent electrodes.

We have developed the floating catalyst chemical vapor deposition (FCCVD) synthesis of single walled carbon nanotubes (SWCNTs) using C2H4 hydrocarbon as a carbon source and iron nanoparticles as the catalyst in an environmentally friendly and economical process. For the first time, ethylene was used as the only carbon source in FCCVD with N2 as the main carrier gas. No sulphur and less than 15% H2 in a N2 carrier gas were used. By varying the ferrocene concentration, the diameter of the SWCNTs was tuned in the range of 1.3-1.5 nm with the optimized control of ferrocene concentration. The process produced SWCNTs with an average length of 13 µm and with a low level of bundling, that is a high proportion (28%) of individual tubes. The electron diffraction (ED) pattern indicated a random chirality distribution of the tubes between armchair and zigzag structures. The ED analysis also revealed that 35-38% of tubes are metallic. As a result of having long SWCNTs with a low level of bundling and a high fraction of metallic tubes, we produced a highly conductive transparent film with a sheet resistance of 51 Ohm per sq. for 90% transmission at 550 nm after HNO3 treatment, this being one of the lowest sheet resistance values reported for SWCNT thin films.

Wafer-Scale Thermophoretic Dry Deposition of Single-Walled Carbon Nanotube Thin Films.

We report the direct and dry deposition of transparent conducting films (TCFs) of aerosol-synthesized single-walled carbon nanotubes (SWNTs) using a thermophoretic precipitator (TP) designed for the uniform and efficient deposition of aerosol-synthesized nanomaterials on 50 mm wafers or similarly sized polymer substrates. The optical and electrical performance of the fabricated TCFs match or surpass the published results achieved using a filter-based collection of aerosol-synthesized SWNTs, and TCFs with sheet resistances of 60 Ω/sq. at 87.8% transmittance and 199 Ω/sq. at 96% transmittance on flexible polymer substrates are demonstrated. The precipitator design is immediately applicable in roll-to-roll fabrication of SWNT TCFs or other functional coatings of aerosol-synthesized nanomaterials.

Highly conductive and transparent single-walled carbon nanotube thin films from ethanol by floating catalyst chemical vapor deposition.

Single-walled carbon nanotube (SWCNT) films have great potential to replace indium tin oxide films for applications in transparent and conductive electronics. Here we report a high yield production of SWCNT transparent conducting films (TCFs) by the floating catalyst chemical vapor deposition method using ethanol as the carbon source. To the best of our knowledge, this is the first report regarding SWCNT TCFs using ethanol as the carbon source. The fabricated uniform SWCNT TCFs exhibit a competitive sheet resistance of 95 Ω sq-1 at 90% transmittance after doping with AuCl3. The SWCNT TCFs possess high quality and the mean length of SWCNT bundles is approximately 27.4 µm. Furthermore, the concentration of semiconducting SWCNTs is 75-77%. Additionally, the chirality maps obtained from electron diffraction analysis demonstrate that our SWCNTs are biased towards the armchair type.