Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation.

Shrinath V, Marwah V, Jyothis MC. Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation. Indian J Crit Care Med 2024;28(3):309-310.

Cough RIB Fracture: An Uncommon Upper Respiratory Cause.

Cough is a whole-sole dynamic housekeeper of the airways. Although a run-of-the-mill symptom, chronic cough frequently forces the patient to seek medical help. It can persist for years end on, and not only makes the patient anxious about underlying illness, but may cause vomiting, exhaustion, impaired sleep, urinary incontinence, and social embarrassment. The propulsive effort made by the patient to clear the noxious stimuli irritating the airways can at times disrupt the integrity of the chest wall and result in rib fractures. We present a case who was detected to have cough fracture during the evaluation of symptoms of chronic cough with pleuritic chest pain. He was evaluated for the aetiology of chronic cough and was diagnosed to have laryngopharyngeal reflux which even though a common aetiology for chronic cough is a very uncommon cause of cough rib fracture. The importance of small innocuous diseases causing severe debility, even in patients with no comorbid illness or contributing risk factors is emphasized by this case report.

Anti-Jo1 Syndrome: Understanding a Rare Cause of Interstitial Lung Disease.

Background: Anti-Jo1 syndrome is one of the most common amongst the various anti synthetase syndromes (ASS), which forms a subgroup of the idiopathic inflammatory myositis (IIM). It is characterised by myositis, interstitial lung disease (ILD), fever, Raynaud's phenomenon, and mechanic's hands; associated with the presence of anti-Jo1 antibodies in serum. Being an orphan disease, the clinical diagnosis is often delayed. Materials and methods: In this retrospective study, all patients diagnosed as Anti-Jo1 syndrome, from two tertiary care hospitals in Western Maharashtra, between 01 January 2019 - 31 December 2020, were enrolled. The parameters studied included demographic data, clinical features at presentation, laboratory parameters, spirometry, and radiographic findings, along with treatment instituted. Result: A total of 17 patients (8 males, 9 females) qualified for inclusion in the study. The mean age of diagnosis was 40 (±13) years with mean time to diagnosis being 2 years (± 0.6 years), from first clinical presentation. The most common presenting symptoms encountered were arthritis (n = 12, 70.5%), fever (n = 16, 70.5%), myositis (n=11, 64.7%) and breathlessness (n=10, 58.8%).10 patients had ILD at presentation on high resolution computerised tomography of chest (n=10, 58.8%) with restrictive lung defect on spirometry. Six patients required induction of immunosuppression using pulse methylprednisolone (n=6) and Rituximab (n=6), while 11 were managed with oral steroids. Mycophenolate mofetil (n=10) and Azathioprine (n=7) were used as maintenance immunosuppression. Conclusion: Anti-Jo1 syndrome is a myositis syndrome, presenting with a multitude of clinical features. Steroids and disease modifying anti rheumatic drugs form mainstay of therapy.