Association of Low body Mass Index with Respiratory Failure in Chronic Obstructive Pulmunary Disease.

BACKGROUND: Various studies have shown that low body mass index co-relates with the severity of Chronic obstructive pulmonary disease. The reduced body mass index in these patients is thought to be due to nutritional abnormality and raised circulating inflammatory markers. The study is aimed to find the association of body mass index with respiratory failure in patient with chronic obstructive pulmunory disease. METHODS: 142 patients who attended emergency /out-patient-department in Sir Sundarlal Hospital from August 2018 to July 2020 were enrolled for the study. 81 patients in one group had chronic obstructive pulmonary disease exacerbation with Type II respiratory failure. Among this group low and normal body mass index subgroup was categorized.61 patients in another group had chronic obstructive pulmonary disease. Non-invasive ventilation was applied to case group. Categorization of body mass index was done <18.5(Low BMI) and 18.5-24.9 (Normal BMI ). RESULTS: The mean age of the study group was (63.53±9.021). There was a significant difference in the body mass index between the groups ( p=<0.001,t=15.40). Severity of respiratory failure was compared using ph and pco2 in the between the groups which showed no significant difference (p=1,chi square 0.000), (p=0.40,chi square=0.72) however it did affect the outcome. CONCLUSIONS: Our study shows that overall respiratory failure was common in low body mass index cases compared to Control. Nevertheless there was no difference among severity of respiratory failure among low and normal body mass index subgroups and however it did affect the outcome.

Performance of semi-quantitative lung ultrasound in the assessment of disease severity in interstitial lung disease.

BACKGROUND: Accurate staging of disease severity and its serial monitoring thus is central to the effective management protocols of interstitial lung disease (ILD). PURPOSE: The aim is to evaluate the effectiveness of semi-quantitative parameters of lung ultrasound (LUS) in patients of ILD as a means of staging disease severity. MATERIALS AND METHODS: LUS of 47 patients of ILD and 20 age-matched controls was performed, and findings such as B-line distance, pleural thickening, subpleural changes, decreased lung sliding, and fragmented pleural lining were charted, and an LUS score was done using these parameters. Findings were compared with the Modified Medical Research Council (MMRC) dyspnea grade and spirometry parameters. RESULTS: The presence of B-lines and fragmented pleural lining were the most common findings observed in patients of ILD. Predicted forced vital capacity (FVC) and predicted forced expiratory volume in 1 s (FEV1) showed a good correlation with all the LUS parameters. B-line distance was the most significant LUS parameter to predict the variability in predicted FEVI, FVC, and MMRC dyspnea score. LUS severity score also showed good negative correlation with predicted FEV1 (r = -0.674, P < 0.001) and predicted FVC (r = -0.65, P < 0.001). LUS severity score of 4 or more predicted MMRC dyspnea score of > 3 with 82% sensitivity and 70% specificity. CONCLUSION: Semi-quantitative LUS score and B-line distance can provide a simple but effective estimate of disease severity in ILD.

Transthoracic ultrasonography in patients with interstitial lung disease.

BACKGROUND: Transthoracic ultrasonography (TUS) is suggested as a noninvasive, radiation-free method for the assessment of interstitial lung disease (ILD). This study was designed to study TUS features of ILD. Furthermore, possible correlations of these features with parameters of spirometry, arterial blood gas (ABG) analysis and 6-min walk test (6MWT) were assessed. MATERIALS AND METHODS: Fifty patients with ILD were diagnosed based on history, examination, chest X-ray/high-resolution computed tomography, and spirometry. Each patient underwent 6MWT, ABG analysis, and TUS. TUS was also performed on 20 healthy volunteering controls. RESULTS: The TUS features among patients were B pattern in 40 patients (80.0%, P < 0.001), decreased lung sliding in 22 patients (44.0%, P < 0.001), pleural line thickening in 28 patients (56.0%, P < 0.001), pleural line irregularity in 39 patients (78.0%, P < 0.001) and subpleural changes in 22 patients (44.0%, P < 0.01). Increasing pleural line thickness was inversely correlated with forced vital capacity (FVC) percent predicted (r = -0.345, P < 0.05), pO2 (r = -0.335, P < 0.01), SpO2 at rest (r = -0.444, P < 0.01), 6-min walk distance (6MWD) (r = -0.554, P < 0.001) and distance-saturation product (DSP) (r = -0.572, P < 0.001). Increasing distance between B lines also correlated inversely with FVC percent predicted (r = -0.278), pO2 (r = -0.207), SpO2 at rest (r = -0.170), 6MWD (r = -0.209), and DSP (r = -0.214); however these correlations were not statistically significant (P > 0.05). CONCLUSION: TUS seems to be a useful imaging method for the diagnosis of ILD. It can be used to estimate the severity of ILD. It is simple, bedside, cost-effective, and radiation-free. It may be especially useful in the follow up of patients in low resource settings, pregnant females, and bed-ridden or unstable patients who cannot be shifted to radiology suite.

Effect of Oral Appliance for Snoring and Obstructive Sleep Apnea.

To analyze therapeutic and clinical efficacy of mandibular advancement device (MAD) on snoring and obstructive sleep apnea (OSA). Thirty patients with OSA were recruited on the basis ofpolysomnography with an Apnea and Hypopnea Index (AHI) greater than 5 but less than 30. Repeat polysomnography was performed in follow up with the appliance in place. MAD used in the study is Medical Dental Sleep Appliance (MDSA). It is a titratable appliance. With the appliance in position, the mandible was advanced to an extent that did not exceed 70% of maximum protrusion capacity; Vertical opening did not exceed on an average 3-4 mm beyond freeway space. Comparison of pre AHI scores (diagnostic PSG) with post AHI scores (PSG with OA in-situ) showed a decrease from Mean +/- SD 26.2367 +/- 6.53 to 13.7111 +/- 627. A highly significant (p < 0.001) improvement in AHI was observed. Pre and post ESS score showed a mean decrease from 14.2333 +/- 5.00 to 6.1481 +/- 2.46 MDSA is effective in reducing apnea hypopnea index scores and improving oxygen saturation level.

Illness perception in tuberculosis by implementation of the Brief Illness Perception Questionnaire - a TBNET study.

How patients relate to the experience of their illness has a direct impact over their behavior. We aimed to assess illness perception in patients with pulmonary tuberculosis (TB) by means of the Brief Illness Perception Questionnaire (BIPQ) in correlation with patients' demographic features and clinical TB score. Our observational questionnaire based study included series of consecutive TB patients enrolled in several countries from October 2008 to January 2011 with 167 valid questionnaires analyzed. Each BIPQ item assessed one dimension of illness perceptions like the consequences, timeline, personal control, treatment control, identity, coherence, emotional representation and concern. An open question referred to the main causes of TB in each patient's opinion. The over-all BIPQ score (36.25 ± 11.054) was in concordance with the clinical TB score (p ≤ 0.001). TB patients believed in the treatment (the highest item-related score for treatment control) but were unsure about the illness identity. Illness understanding and the clinical TB score were negatively correlated (p < 0.01). Only 25% of the participants stated bacteria or TB contact as the first ranked cause of the illness. For routine clinical practice implementation of the BIPQ is convenient for obtaining fast and easy assessment of illness perception with potential utility in intervention design. This time saving effective personalized approach may improve communication with TB patients and contribute to better behavioral strategies in disease control.

Primary and acquired drug resistance patterns of Mycobacterium tuberculosis isolates in India: a multicenter study.

Tuberculosis is the most prevalent infection worldwide. The emergence of drug-resistant Mycobacterium tuberculosis (M. tuberculosis) isolates emphasizes that it is necessary to monitor drug resistance of the organism against anti-tubercular drugs. We analyzed 327 M. tuberculosis isolates from patients who were cared for at three different health care centers, hereinafter known as study areas (SAs), in North India. Of the 327 total M. tuberculosis isolates, 255 were from a tertiary health care center (Varanasi, Uttar Pradesh [SA-1]), 48 were from a District tuberculosis center (Sawai Madhopur, Rajasthan [SA-2]), and 24 were from a different District tuberculosis center (Buxar, Bihar [SA-3]). Drug susceptibility testing against first-line antibiotics (viz. isoniazid, rifampicin, streptomycin, and ethambutol) was conducted for all the isolates using 1% proportional method. We found that the rates of acquired resistance were consistently higher than the rates of initial drug resistance. In new, untreated cases, a higher degree of MDR-TB was observed at SA-1 (13.3%) and SA-3 (25.0%), whereas it was observed in only 7.1% of the isolates at SA-2. In previously treated patients, MDR cases were found in 35.7% of the isolates from SA-1, 66.6% of the isolates from SA-2, and 43.8% of the isolates from SA-3. Resistance to a single drug was found at a much lower rate, ranging from 0.0 to 6.3% in new cases as well as previously treated cases. In conclusion, the primary resistance of M. tuberculosis is low, but acquired drug resistance is slightly higher in North India.

Seven steps of gradual cessation of smoking--an example from India.

BACKGROUND/AIM: [corrected] One sixth of smokers in the world live in India. The National Family Health Survey showed that individuals with no education were 2.69 times more likely to smoke and chew tobacco than those with postgraduate education. Whether the physicians' interaction with public can cause the smoking cessation or habit by detailing the harmful effects as well as benefits of cessation without any withdrawal effects? Our aim was, therefore, to help people to stop smoking step by step. METHODS: The study was conducted at the University Student Health Care Centre, Banaras Hindu University, Varanasi, India, from June 2004 to February 2005. A total of 1,200 students smokers (graduate, post graduate or research scholars) participated. They were from 17 to 32 years old (mean age, 26 years). All were male sex. Each and every student was explained in details risks and hazards, and benefits of cessation, focusing this latter on immediate and substantial benefits at any sex and age; their every question and quarries were explained. All were told that either they should stop smoking immediately or minimized step by step. The seven steps were explained to them. RESULTS: The smoking duration was one year and more in all the participants ranging from one to 15 years; the average period of smoking was five years and six months; the number of smoked cigarettes per day was 12 on average (5-20). In 450/1200 (37.50%) students, either of any family members were smoking while 200 (16.66%) students have been inspired from their friends. The majority of 780/1200 (65%) gave-up smoking at any step as advised. The followup could not be done in 80/1200 (6.6%) students who did not report at any of the stages. Finally, 340/1200 (28.0%) students either reduced the number or failed to give-up smoking. CONCLUSION: The results of the study are very encouraging. Such interaction type of doctors with smokers will not only help to the concerned person but also to the society.