Clinical Characteristics and Outcomes of Interstitial Lung Disease in Primary Sjögren's Syndrome: A Retrospective Cohort Study.

Objectives: To describe the characteristics of primary Sjögren's syndrome (pSS) patients with interstitial lung disease (ILD) and to assess treatment response. Methods: All patients of pSS from 2010 to 2019 were retrospectively identified. Lung function tests, high resolution computed tomography (HRCT) findings, and treatment outcomes were analysed. Results: Out of 550 patients with pSS, ILD was detected in 33 patients (frequency of 6 %). The mean(±SD) age at the diagnosis of pSS was 50 (± 9.3) years. 28/33(84.8%) were females. ILD onset preceded pSS diagnosis in 2 (6%) patients, simultaneously diagnosed in 21 (63.6%) patients and developed after pSS onset in 10 (30.3%) patients. 5 patients (15.15 %) were asymptomatic for ILD. Non-specific interstitial pneumonia (NSIP) accounted for the most frequent ILD subtype, in 15 patients (45.5%). Mycophenolate mofetil (MMF) was the most frequently used steroid sparing agent, in 25 patients (75.7%). 7 patients were lost to follow up. Response was seen in 22 patients, whereas 3 patients were non responders. There was one mortality due to lower respiratory tract infection-related sepsis. Presence of sicca symptoms [91.5% vs 8.7% (p<0.001)], NSIP pattern of ILD [90% vs 10% (p = 0.002)], and absence of Raynaud's phenomenon [91.7% vs 8.3% (p<0.001)] were significantly associated with responder status when compared to non-responders. Conclusion: ILD in primary Sjögren's syndrome is not an uncommon entity, and immunosuppression with steroids along with steroid-sparing agents led to good clinical outcomes of ILD in a majority of the patients in our cohort.

Osimertinib-induced radiation recall pneumonitis.

Radiation recall pneumonitis (RRP) is a type of radiation induced lung injury that develops in a previously irradiated lung field and is triggered by administration of chemotherapeutic or immunomodulating agents. To our knowledge there is only one report of Osimertinib induced RRP. The predominant symptoms include dyspnea and cough which usually resolve after stopping the inciting agent and with glucocorticoids. We describe a 52-year-old lady with lung cancer who developed Osimertinib induced RRP. She had significant dyspnoea and cough despite stopping Osimertinib and treatment with corticosteroids. She was referred to specialist palliative care team for alleviation of symptoms. Her symptoms responded well with non-pharmacological measures and pharmacological agents including opioids and mirtazapine. This is the first report on the effect of supportive care interventions on symptom relief in Osimertinib induced RRP.

Asymptomatic bacteriuria of pregnant women in a tertiary care centre.

BACKGROUND: Asymptomatic bacteriuria (ASB) is commonly seen during pregnancy due to the various morphological, hormonal, and physiological changes the body undergoes. If left undiagnosed, it can lead to conditions such as pyelonephritis and preterm delivery which could culminate in causing maternal and fetal morbidity and mortality. Therefore, this study aims to determine the prevalence, risk factors, microbial profile, and antibiotic susceptibility patterns associated with ASB in a tertiary healthcare center. MATERIALS AND METHODS: A cross-sectional study was carried out where 150 urine samples were obtained from pregnant women within the gestational age of 13-36 weeks. Randomized stratified sampling was the method of sampling used. A questionnaire was also administered to them to determine potential risk factors. The samples were cultured and identified using biochemical tests. Antibiotic susceptibility tests were carried out by Kirby-Bauer disc diffusion method. Statistical analysis was carried out using Chi-square test. The graphs and tables were generated using Microsoft Excel and Word. RESULTS: Out of the 150 samples that were obtained, 8 samples had significant bacteriuria which is a prevalence of 5.33%. Escherichia coli was the most frequently isolated organism accounting to 45% of the isolates. The other organisms that were isolated were Enterococcus, Klebsiella pneumoniae, Coagulase negative staphylococcus (CONS), Candida albicans, and Group B Streptococcus which measured to 11% of the total distribution each. In the antibiotic sensitivity tests, among the gram-negative isolates, marked resistance to Ampicillin and Amoxycillin along with sensitivity to Cotrimoxazole and Nitrofurantoin. Of the gram-positive isolates, there was sensitivity to Ampicillin and Nitrofurantoin. A positive correlation was seen between the age groups of 23-27 and the prevalence of ASB. CONCLUSION: The prevalence of ASB in this study shows that ASB is not uncommon in the population. Despite the World Health Organization (WHO) guidelines and National Health Mission recommendations to make urine check-ups a routine, it not carried out, possibly due to cost implications. However, it poses a risk for severe maternal and fetal outcomes and hence, should be screened for on a regular basis. Thus, this study emphasizes the importance of screening pregnant women for ASB for promoting better maternal and fetal health.

A rare cause of early neonatal cyanosis: absent right pulmonary artery.

Unilateral absent right pulmonary artery is a rare developmental anomaly that usually presents in late childhood and adolescence as recurrent respiratory tract infections, dyspnoea and haemoptysis. We report a case of a 2-day-old baby with respiratory distress and differential cyanosis. Echocardiogram showed pulmonary hypertension with absent right pulmonary artery. The findings were confirmed by CT angiogram. The baby improved with pulmonary vasodilators and antifailure medications.