OBJECTIVE:Waiting time for diagnosis and treatment of obstructive sleep apnoea (OSA) is increasing due to a lack of adequate amount of sleep labs. This study was done to find out the feasibility of daytime split Polysomnography (PSG) in patients with excessive daytime sleepiness (EDS) so as to reduce waiting time in sleep labs. METHODS:Thirty patients with EDS (defined by Epworth Sleepiness scale ≥14) underwent both dPSG (daytime) and nPSG (nighttime). Diagnostic sleep parameters, titration pressures were compared. A questionnaire consisting of 12 questions for the experience of patients, technicians, and physicians was filled out after each dPSG and nPSG. RESULTS:Thirty patients (11 females and 19 males) underwent both dPSG and NPSG. The mean age and BMI were 55.23 ± 8.1 years and 36.11 ± 7.70 kg/m², respectively. PSG parameters (sleep efficiency, total sleep time, time in bed) were not different in the two groups. During dPSG titration, optimal, good and adequate titration was achieved in 22%, 19% and 52% respectively, compared to 33%, 15% and 44% during nPSG. In the Likert scale questionnaire, patients had comparable sleep quality in both PSGs. Technicians felt more sleepy during nPSG, and most technicians preferred dPSG over nPSG. Physicians' agreement with titration done by technicians was equal in both dPSG and nPSG. CONCLUSIONS:Daytime split PSG may be a viable alternative to night PSG in patients with OSA with excessive sleepiness. This can ensure early treatment of patients with OSA.
BACKGROUND AND OBJECTIVE:There is a paucity of data comparing the direct puncture trocar technique and the Seldinger technique for the drainage of pleural fluid collections with respect to technical and clinical success rates and complication rates. METHODS:The pleural fluid collections were drained using either the direct puncture trocar or the Seldinger technique by a single operator under ultrasound guidance. Technical success rates, clinical success rates, pain scores determined using a visual analog scale, complication rates, and mortality rates were compared between the two techniques. RESULTS:A total of 94 patients were included in the analysis. Technical success was achieved in 97.87% of cases in the Seldinger group and 91.48% in the direct puncture trocar group ( P = 0.30). Clinical success was achieved in 90.09% of cases in the Seldinger group and 89.13% in the direct puncture trocar group ( P = 0.50). Patients experienced more pain with the Seldinger technique in the immediate periprocedural period (median visual analog scale [VAS] score of 6) as compared to the direct puncture trocar group (median VAS score of 5) [ P = 0.003]. Direct puncture trocar technique was significantly faster (mean procedure duration of 4.30 ± 2.41 min (direct puncture trocar group) vs 7.89 ± 2.12 min (Seldinger group) [ P = 0.00]). CONCLUSION:The direct puncture trocar technique appears to provide comparable technical and clinical success to the Seldinger technique for ultrasound-guided pleural drainage, with shorter procedural duration and lower immediate pain perception. Larger randomized studies are required to confirm these findings.
Unicentric Castleman disease (UCD) is an uncommon benign lymphoproliferative disorder that typically presents as solitary mediastinal or hilar nodal enlargement and may mimic malignant or hyper vascular lesions on imaging. We describe a case series of three women presenting with solitary, well-circumscribed mediastinal or hilar masses-two presented with chronic dry cough (one associated with anaemia) and one identified incidentally during routine screening. Contrast-enhanced computed tomography (CECT) demonstrated intensely enhancing hyper vascular nodal lesions, while positron emission tomography-computed tomography (PET-CT) revealed mild fluorodeoxyglucose uptake without additional nodal or extra nodal involvement, supporting an unicentric process. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed that was nondiagnostic in all cases, yielding reactive cytology without architectural detail. In contrast, EBUS-guided intranodal forceps or cryo biopsy was performed that resulted adequate tissue with preserved nodal architecture, helping definitive histopathological and immunohistochemical diagnosis of hyaline vascular UCD. Two patients subsequently underwent complete surgical excision followed by symptomatic resolution and favourable outcomes, while one declined surgery. This series highlights the characteristic clinic-radiologic pattern of solitary hyper enhancing thoracic nodal disease and underscores the limitations of needle aspiration cytology. Minimally invasive mediastinal nodal biopsy can establish definitive diagnosis preoperatively and facilitate timely curative management in patients with UCD.
Fires aboard ships remain a serious hazard, posing significant risks to crew members due to the confined and often poorly ventilated environments. Modern ships, especially military vessels with airtight compartments, are particularly vulnerable to rapid accumulation of smoke, even from minor fires. In such settings, smoke inhalation-not burns-is the leading cause of fire-related mortality. This article explores the pathophysiology, clinical manifestations, and management of inhalational injuries resulting from onboard ship fires. It aims to highlight the unique challenges faced in maritime settings and propose strategies for timely diagnosis and effective treatment. Inhalational injuries on ships often involve a combination of thermal injury to the upper airway, chemical irritation from toxic gases (such as carbon monoxide, hydrogen cyanide), and particulate matter deposition. Clinical features may include hoarseness, stridor, facial burns, singed nasal hairs, carbonaceous sputum, and respiratory distress. Symptom onset may be delayed, necessitating a high index of suspicion. Prompt airway management-including early endotracheal intubation-is crucial. Supportive measures such as lung-protective ventilation, fluid resuscitation, and nebulized heparin have demonstrated improved outcomes in severe cases. Given the unique risks associated with enclosed maritime environments, training ship crews in early identification of airway compromise and standardizing evacuation protocols are essential. Improved awareness of onboard medical officers, combined with evidence-based treatment strategies, can significantly reduce morbidity and mortality associated with these injuries.
OBJECTIVE:The SWORD study examined seasonal variations in respiratory disease related hospitalisations and mortality across India. It also assessed risk factors and comorbidities influencing these outcomes. METHODS:This multicentre, questionnaire-based, point prevalence study was conducted across four seasonal weeks in 2017-2018. Data on respiratory admissions on the first day and deaths over the following week were collected. RESULTS:At 245 centres, 2,886 patients were hospitalised, and 394 deaths occurred. COPD was the leading cause of both hospitalisations and deaths, followed by tuberculosis (TB), respiratory tract infections (RTI), asthma, pleural effusion, lung cancer, bronchiectasis, and interstitial lung disease (ILD). Respiratory admissions and deaths peaked in winter (28.7% and 32.7%) and were lowest in summer (21.1% and 18.0%). COPD hospitalisations were significantly higher in winter than summer (OR: 1.39; 95% CI: 1.1-1.8), with mortality showing a similar pattern. Key risk factors for hospitalisation and death varied by disease. CONCLUSION:Respiratory hospitalisations and deaths in India follow a clear seasonal trend, with winter posing the highest risk and summer the lowest. COPD, TB, RTI, asthma, pleural effusion, lung cancer, bronchiectasis, and ILD were the most frequent causes. These findings underscore the need for targeted, season-specific strategies to manage respiratory diseases effectively.
BACKGROUND:Severe asthma accounts for disproportionate asthma-related morbidity, mortality, and healthcare costs, yet prospective data on its prevalence remain limited, particularly for developing countries. We aimed to determine the prevalence of severe asthma among subjects with difficult-to-treat asthma at a tertiary care center in North India. METHODS:Between January and December 2023, we prospectively enrolled consecutive adults with difficult-to-treat asthma that remained uncontrolled despite treatment with medium- or high-dose inhaled corticosteroids-long-acting beta-agonist (ICS-LABA) or required high-dose ICS-LABA to maintain good control. All subjects underwent systematic evaluation, including diagnosis confirmation, assessment of inhaler technique and adherence, comorbidity screening, and treatment optimization, with reassessment after 3-6 months. We diagnosed severe asthma (uncontrolled despite high-dose ICS-LABA or required high-dose ICS-LABA to maintain good control) after addressing all modifiable factors and assessed type 2 (T2)-targeted biological therapy eligibility. RESULTS:Among 240 subjects (mean age 47.4 ± 14.9 years; 68.8% female), we identified modifiable factors in 218 (90.8%), including suboptimal therapy (74.2%), poor adherence (64.2%), and incorrect technique (58.8%). Following interventions, 154 completed reassessment; 102 (66.2%) no longer met severe asthma criteria. Overall, 67 subjects had severe asthma (27.9%; 95% CI: 22.4-33.9%). Among them, 66.7% had blood eosinophils ≥150 cells/µL, and 68.7% met criteria for T2-targeted biological therapy. CONCLUSION:Approximately one-quarter of subjects with difficult-to-treat asthma have confirmed severe asthma after systematic assessment. A significant proportion improve with targeted interventions, emphasizing the importance of comprehensive evaluation. Most patients with confirmed severe asthma are candidates for T2-targeted biologicals, highlighting the need for structured assessment protocols and improved access to biological therapies.
OBJECTIVE:Surgical resection of lung metastases in patients with colorectal cancer (CRC) can provide long-term survival in selected cases. This study aimed to evaluate the prognostic factors affecting survival after pulmonary metastasectomy (PM) performed for lung metastases due to CRC. METHODS:Data from 70 patients who underwent PM for CRC-related lung metastases at our center between 2007 and 2021 were retrospectively analyzed. Demographic data, primary tumor characteristics, number, size, and localization of metastases, time to metastasis, and survival data were evaluated. RESULTS:The 5-year overall survival (OS) rate was 54.8%, with a median OS of 73 months (95% confidence interval: 50.8-95.1). Factors adversely affecting survival included a history of liver metastasis, short (disease-free interval ≤13 months), left colon primary tumor localization, number of metastases ≥2, and metastasis size >4 cm. CONCLUSION:PM for CRC-related lung metastases can offer a significant survival advantage in selected patients. Specific prognostic factors should be considered when selecting candidates for surgery.
BACKGROUND AND OBJECTIVE:The objectives of this study were to assess the yield of multiplex PCR testing in LRTI and its utility in antimicrobial streamlining. Establishing the microbial aetiology is of paramount importance for tailored antimicrobial therapy in lower respiratory tract infections (LRTI). Multiplex PCR panels (FilmArray Pneumonia Plus Panel [FAPP]) have been shown to provide better diagnostic yield in LRTI. METHODS:A total of 103 patients hospitalized with LRTI were enrolled. The culture isolates, their sensitivity pattern, and antimicrobial resistance were noted. Time taken for availability of FAPP results as well as culture positivity was documented. Antibiotic modification made based on identification of the pathogens along with their resistant gene patterns from appropriate samples and time taken to reach that decision was noted and compared between conventional culture and FAPP. RESULTS:FAPP detected at least one pathogen in (92/103) of tested specimens. Conventional culture detected at least one pathogen in 36 (34.9%) cases only. The mean duration of antibiotic therapy in FAPP-positive cases was 4.89 ± 1.84 days versus 7.2 ± 3.83 days in cases where FAPP was negative ( P value of 0.019). Similarly, the duration of hospital stay in FAPP-positive cases versus -negative cases was 5.136 ± 1.73 days versus 7.6 ± 3.36 days, respectively ( P value 0.007). Mean turnaround time (TAT) for the FAPP was strikingly low with FAPP. Antimicrobial modification guided by FAPP was achieved in 83 out of 103 patients (80.6%), substantially higher than with conventional culture. CONCLUSION:In hospitalized patients with LRTI, FAPP provided better diagnostic sensitivity, better detection of resistance, faster TAT, higher potential for antimicrobial modification, lesser days of antibiotic use, and shorter hospital stay compared to culture.
INTRODUCTION:Pneumococcal disease, caused by Streptococcus pneumoniae , is a major public health burden with high morbidity and mortality across all age groups in India. Limited adult pneumococcal vaccination policies, evolving serotype patterns, and delayed herd protection from paediatric immunization continue to challenge effective prevention of pneumococcal disease in adults. METHODS:This retrospective laboratory surveillance study includes Streptococcus pneumoniae isolates from adults (>18 years) collected between January 2018 and May 2025 at Christian Medical College, Vellore and were serotyped using the Quellung and co-agglutination method. Percentage of serotype coverage for PCV20, PCV21, and PPSV23 was analysed. RESULTS:Among 1,065 adult pneumococcal isolates, PCV20 covers 66.5% of invasive pneumococcal disease (IPD) serotypes, including emerging serotypes such as 15B and 11A, while PCV21 aligns poorly with the local epidemiology, covering only 46.5% of adult IPD serotypes. PPSV23 offers limited additional relevant serotype coverage beyond PCV20 and is limited by lower immunogenicity and hyporesponsiveness to multiple doses. DISCUSSION:Our findings highlight significant gaps between the circulating serotypes in adults in India and those covered by current vaccines. PCV20 shows promise for broader adult protection; however, further multi-centre studies, cost-effectiveness analyses, and enhanced surveillance are needed to inform policy and optimize immunization strategies in resource-limited settings.
