Invasive aspergillosis in near drowning nonneutropenic patient.

Invasive aspergillosis in immunosuppressed people has been well documented, but to diagnose and treat in an immunocompetent individual after near drowning, it requires early suspicion and proper empirical treatment. We report a case diagnosed to have invasive aspergillosis with systemic dissemination of the infection to the brain, gluteal muscles, and kidneys after a fall in a chemical tank of a paper manufacturing company. He was ventilated for acute respiratory distress syndrome and managed with antibiotics and vasopressors. Due to nonresolving pneumonia and positive serum galactomannan, trans-tracheal biopsy was performed which confirmed invasive aspergillosis and was treated with antifungals. With the availability of galactomannan assay and better radiological investigative modalities, occurrence of such invasive fungal infections in cases of drowning patients should be considered early in such patients and treated with appropriate antifungals.

Acute respiratory distress syndrome due to Strongyloides stercoralis in non-Hodgkin's lymphoma.

Strongyloides stercoralis is a nematode endemic in tropical and subtropical regions. In immunocompetent subjects, pulmonary disease caused by the parasite is unremarkable but the same can be life threatening in immunocompromised subjects. Though described in literature it is rarely seen in Indian subjects. We report a patient with ARDS due to Strongyloides stercoralis complicating non-Hodgkin's lymphoma with neutropenia.

Atypical carcinoid tumour.

Carcinoid tumour is a rare entity accounting for less than two percent of bronchial neoplasms. The clinical presentation is highly variable and rarely, it may present as a solitary pulmonary nodule. More offten, it presents as a central endobronchial tumour. The peripheral type of carcinoid tumour is relatively rare.

Awareness of issues related to sleep disordered breathing amongst practicing physicians.

BACKGROUND: Most of the sleep related breathing disorders currently in India are both under diagnosed and under treated. The exact prevalence of sleep disordered breathing (SDB) in our country is not clearly known and this is partly due to lack of awareness amongst physicians and lack of formal epidemiological data from Indian subcontinent. Several international agencies have emphasised the urgent need for medical training at all levels in sleep medicine, so as to include an exposure to the broader aspects of sleep medicine. OBJECTIVE: To assess the knowledge of practicing chest physicians on the issues related to sleep disordered breathing in the local set-up. METHODS: A standardised questionnaire with strong face validity was utilised for this purpose to interview 65 physicians at their work place. RESULTS: The overall awareness about sleep disordered breathing amongst the practicing physicians in Hyderabad, Secunderabad and the neighbouring district of Warangal was poor. There was no association between professsional qualifications and level of awareness. Furthermore, the awareness was found to be similarly low both amongst young and middle aged physicians and this was statistically significant (p<0.001). CONCLUSION: The overall awareness about sleep disordered breathing amongst practicing physicians in and around Hyderabad is rather poor.

Adenoid cystic carcinoma of trachea.

A 20-year-old male, presented with cough, haemoptysis, breathlessness and wheezing for the past one month. Contrast enhanced computerised tomographic (CECT), scan of chest and fibreoptic bronchoscopy revealed an endotracheal mass that on histopathological examination showed adenoid cystic carcinoma of trachea. Magnetic resonance imaging (MRI) scan of chest confirmed involvement of adjacent prevertebral, para-oesophageal and subcarinal lymph nodes rendering the tumour inoperable.

Obstructive sleep apnea in a referral population in India.

There are few published studies of obstructive sleep apnea in the Asian subcontinent. The objectives were to describe the syndrome and evaluate the utility of computed tomography (CT) cephalometry in patients found to have obstructive sleep apnea (OSA) by polysomnography. This article reports on a retrospective case series in a referral population. A total of 880 patients (560 males and 320 females) were seen in a referral center in Hyderabad, South India, during the last 7 years. All patients with suspected obstructive sleep apnea were evaluated with 16-channel polysomnogram by overnight sleep study; 600 subjects (68%; 480 males and 120 females) underwent evaluation with CT cephalometry. Mean age was 51.4 +/- 9.5 years (standard deviation). The mean apnea-hypopnea index (AHI) was 27.93 +/- 3.8. The majority of patients had more than 10 AHI; mean percentage of sleep efficiency was 80.62 +/- 15.38; mean percentage of rapid eye movement (REM) sleep was 13.79 +/- 7.89; mean awake arterial oxygen saturation (SaO2) was 90%; mean sleep SaO2 was 84% +/- 4.4%; mean Epworth Sleepiness Scale (ESS) score was 12.3 +/- 2.8. The tongue base area (TBA) was found to be significantly associated with obstructive sleep apnea (OSA), with mean TBA 1032.8 +/- 427 mm2 compared with normal controls at 561.1 +/- 197.6 mm2 (p < 0.001). Mean gonion-gnathion-hyoid angle (Go-Gn-H) was 28.5 +/- 10.5 in OSA and 16 +/- 16.7 in controls; uvula area was 452.5 +/- 145.8 mm2 in OSA and 221.4 +/- 49.85 mm2 in controls; uvula diameter was 13.8 +/- 2.74 mm in OSA and 10.1 +/- 1.72 mm in controls. A total of 704 patients with OSA (80%) were found to be hypertensive, with daytime mean blood pressure of 160/100 +/- 8.5/4.8 mm Hg. Mean duration of reported hypertension was 2 years. The present study showed moderate to severe OSA in a majority of suspected cases referred for polysomnogram. Mild disease was seen in 20.45% of patients (n = 180). On CT cephalometry, the TBA correlated significantly with OSA; hypertension is common in patients with OSA.