Aditya Chawla

Removal of self expandable metallic airway stent: A rare case report

Covered self expandable metallic airway stents (SEMS) have been used for benign tracheal stenosis, post intubation tracheal stenosis, tracheal burn or trauma, tracheo-broncho-malacia, and extrinsic compression of trachea. Their placement is considered to be permanent, with open surgery the only way to remove the stent, though there are few cases reports of their removal with the bronchoscope, but the complications after their removal are very high. In our patient, one and a half years after placement of SEMS, she developed cough with dyspnoea, video bronchoscopy showed stenosis above the level of stent with granulation tissue inside the stent, stent fracture in lower part and stent migration to right main bronchus, thus she had all conceivable complications of stent placement. The stent was removed with the help of rigid bronchoscope under general anaesthesia. She was discharged the following day. The case is being reported because it was unique in having all the possible complications of stent placement, and rare as we could take out the stent in Toto. Thirdly, the stent could be removed without any complication.

Glue therapy in hemoptysis: A new technique

Hemoptysis is defined as the spitting of blood derived from the lungs or bronchial tubes as a result of pulmonary or bronchial hemorrhage. There is a large chunk of patients with hemoptysis who do not respond to conservative treatment including use of cough suppressants, antibiotics, vitamin C, hemostatics, and anxiolytics. The advanced management of such a situation is bronchial artery embolization (BAE) or open thoracic surgery, which is often not possible. We have attempted a cheap, effective, and safe alternative in the form of intrabronchial instillation of glue (n-butyl cyanoacrylate) under vision with the help of a therapeutic video bronchoscope (OLYMPUS T-180). The glue is instilled through a polyethylene catheter placed through the working channel of the video bronchoscope.

Healthcare associated infections: A menace-role of management at a multi-super-specialty hospital in North West Region of Delhi

Background: Healthcare-associated infections (HAIs) are usually related to a procedure or treatment used to diagnose or treat the patient′s initial illness or injury. Aim: To find and compare the incidence of HAI in different Intensive Care Units (ICU′s) of Hospital A. To show a correlation, between HAI with mortality, morbidity and average length of stay (ALOS). Materials and Methods: The study was carried out at three ICU′s of Hospital A in North-West Delhi-Surgical Intensive Care Unit (SICU), Respiratory Intensive Care Unit (RICU) and Medical Intensive Care Unit (MICU). All patients admitted were followed from admission to 2 days after discharge from the ICU during a period of January 2010-December 2011-December-2012. The total sample amounted to 35,582 patient device days-13,051 for 2010 and 11,659 for 2011 and 10,872 for 2012. Continuous training was there from 2011 onwards for bundle approach and hand hygiene monitoring. Results: The rate of ventilator-associated pneumonia (VAP) from 55.93 per 1000 device days to 7.91 per 1000 device days from 2010 to 2012, catheter-associated urinary tract infection (CAUTI) decreased from 6.33 per 1000 device days to 1.43 per 1000 device days but catheter-related bloodstream infection (CRBSI) increased from 8.46 per 1000 device days to 21.80 per 1000 device days. There is a significant correlation between mortality and HAI P value 0.03 with no significant correlation between morbidity and HAI P value 0.74 also no significant correlation in ALOS and HAI P value 0.17. Conclusion: The trend in VAP and CAUTI in 3 ICU′s from 2010 to 2012 shows a decreasing trend, the trend of CRBSI in 3 ICU′s from 2010 to 2012, which shows a decreasing trend in MICU with no trend in SICU and RICU. There is a significant correlation between mortality and HAI with no significant correlation between morbidity and HAI also no significant correlation in ALOS and HAI.

Hemoptysis secondary to actinomycosis: A rare presentation

We present a 70-year-old female patient who had the history of hypertension and presented with massive haemoptysis. She had been complaining of cough with expectoration and mild streaking of blood in sputum for about 3 days with only crepts in right infrascapular and infra-axillary regions as positive clinical findings. Bronchoscopy revealed a cauliflower-like lesion in the upper- right lobe bronchus; bronchial aspirate showed occasional colonies of gram positive filamentous bacteria surrounded by neutrophils. The Trucut biopsy showed sheets of neutrophils with colonies of filamentous bacteria consistent with actinomycotic infection. She was started on intravenous benzyl penicillin 20 million units 6 hourly. She recovered with no further bouts of hemoptysis and was discharged on amoxicillin + clavulanic acid in a stable condition and she remained under similar condition for more than a year on follow up. Actinomycosis is a rare disease caused by a harmless commensal species, Actinomyces. Diagnosis of actinomycosis is a challenging situation, and more so, very few cases causing hemoptysis have come to light so far.