Prasanta Raghab Mohapatra

Quality of life impairment in patients of obstructive sleep apnea and its relation with the severity of disease

Background: Several studies have demonstrated considerable impairment of quality of life (QOL) in obstructive sleep apnea (OSA) patients, but its relation with severity of OSA is yet unclear. Study Objectives: To investigate the effects of OSA on the QOL and its association with the disease severity. Design and Setting: Observational, prospective case-control study. Materials and Methods: QOL of 69 OSA patients and 41 healthy controls were assessed using the Calgary sleep apnea quality of life index (SAQLI) on the morning following the polysomnography (PSG) study. Statistics: All statistical analyses were performed using the SPSS 17.0 (SPSS Inc., Chicago). Differences between sleep-related symptoms and SAQLI subscales scores were assessed with the Chi-square test and the Student t-test. Due to non-normal distribution, differences between SAQLI scores of controls and OSA patients were evaluated using a non-parametric Mann-Whitney test. Spearman correlation and backward multiple regression analysis were used to analyze the association between SAQLI scores and sleep indices and anthropometric variables and PSG variables. Results: Study included 69 cases (57 male and 12 females) with a mean age, weight, height, neck circumference, and body mass index 48.45 ± 10.12 years, 83.03 ± 16.48 kg, 159.75 ± 28.29 cm, 44.01 ± 3.23 cm and 30.77 ± 6.71 kg/m2. Mean apnea-hypopnea index was 26.39 ± 16.62. The median score of four SAQLI domains daily function, social interaction, emotional, symptoms and total mean SAQLI score were 3.64 (3.46-3.90), 3.77 (3.51-3.88), 3.64 (3.53-3.83), 4.80 (4.68-5.11), 4.09 (3.88-4.09),and 1.36 (1.29-1.71), 1.38 (1.24-1.62), 1.45 (1.23-1.62), 2.00 (1.78-2.26), 1.55 (1.46-1.73) for patients and controls respectively. All the individual domain scores and the mean SAQLI scores of patients were significantly higher than the controls. Conclusion: OSA causes significant impairment of QOL, but the severity of impairment is not directly proportional to the severity of OSA.

Depression in pulmonary arterial hypertension and interstitial lung diseases

Advanced lung diseases such as pulmonary arterial hypertension (PAH) and interstitial lung diseases (ILD) are chronic diseases that cause significantly high morbidity and mortality. As a result, patients can undergo some psychological changes leading to a poor quality of life and depression. Diagnosis of depression is often obscured because fatigue and apathy, two common symptoms of depression, frequently overlap with PAH and ILD. Healthcare providers are sometimes reluctant to ask or mistakenly believe that these symptoms are part of the ongoing disease process, rather than a serious condition like depression. Screening tools are available for physicians to be well positioned in recognizing clinical depression in PAH and ILD. A MedLine/PubMED search was performed identifying all relevant articles with “PAH”, “ILD”, “screening tools” and/or “Depression” in the title. The aim of this review is to provide a brief description of some of the instruments used to screen patients and classes of psychotropic medications accessible to physicians. While pulmonary rehabilitation programs can have a positive impact on patients, physicians should also utilize cognitive behavioral therapy (CBT) as part of regular care.

Level of evidence of verbal autopsy

Verbal autopsy determines probable causes of death when neither medical records nor formal medical attention are given. Usha Ram and colleagues (December, 2015) extrapolated cause-specifi c mortality risks for men and women aged 15–69 years on the basis of deaths accessed by verbal autopsy during 2001–06 in India. But many changes have occurred in the past decade. For example, the maternal mortality ratio for India in 1992 was 437 deaths per 100 000 livebirths; it decreased to 212 deaths per 100 000 livebirths during 2007–09, and it was expected to reach 135 deaths by 2015. The Unique Identifi cation Authority of India has an identifi cation system card called Aadhaar, which is already linked to certain services such as cooking gas consumer data. This system needs to be linked to various health data and diseases (according to the International Classifi cation of Diseases), and could also be extended to cause of death due to a particular disease. Verbal autopsy has several limitations since many causes of death share similar symptoms (eg, dyspnoea or fever). The causes of death assessed by verbal autopsy only represent a small sample of the list of causes used on medical certifi cates. In the scenario of deaths due to “other and unknown” causes, the physician giving the verbal autopsy is likely to choose a cause among the causes already assessed, which can cause a bias. Lastly the usefulness of verbal autopsies depends on quality and standardisation. Quality depends on sensitivity and specificity of each diagnosis, and quality assurance is the main hurdle to overcome before we accept death reports based on verbal autopsies. In the ages of evidence-based medicine, we must know the level of evidence of verbal autopsy.

Evaluation of Loop mediated isothermal amplification (LAMP) assay in the diagnosis of Tubercular lymphadenitis: A pilot study

Tubercular lymphadenitis (TBLA) contributes to 30-40% of extrapulmonary TB cases in the immunocompetent individuals and 40-50% in people with HIV. Current diagnostic methods for TBLA like Gene-Xpert or PCR are costly and conventional methods like fine needle aspiration cytology, histopathology lack sensitivity and specificity. Culture which is considered as gold standard require high turnaround time. Loop mediated isothermal amplification (LAMP) assay has been developed as a novel technique for nucleic acid amplification and has shown promising results in the diagnosis of pulmonary tuberculosis. Present study evaluated the Nu-LAMPTM TB Kit (RAS Life Sciences Pvt. Ltd, a bioMerieux group company) for diagnosis of TBLA comparing with conventional tests (cytology, ZN smear, culture). The sensitivity, specificity, PPV and NPV of LAMP assay was found to be 33.3%, 91.2%, 40% and 88.57% as compared to 100%, 76.5%, 42.9% and 100% of ZN staining and 100%, 73.5%, 40% and 100% of cytopathology. The low sensitivity of LAMP assay in the present study addresses the need for comparison and validation of the commercially available LAMP kits before used for patient diagnosis.

Actively caseating endobronchial tuberculosis successfully treated with intermittent chemotherapy without corticosteroid: a report of 2 cases

Tuberculous infection of the tracheobronchial tree confirmed by microbiological or histopathological evidence with or without parenchymal involvement is known as endobronchial tuberculosis. Chronic cough is the predominant symptom. Expectorated sputum examination for acid fast bacilli is often negative leading to delay in diagnosis. Therefore, bronchoscopy is crucial for early diagnosis and evaluation of the extent of disease. Bronchostenosis is a significant complication of endobronchial tuberculosis that may be present at the time of diagnosis or develops during the course of treatment. Previously, corticosteroids have been used along with antitubercular therapy to prevent or reduce the extent of bronchostenosis; however, their role is debatable as bronchostenosis often develops despite the use of corticosteroids. Furthermore, the duration of treatment varied from 6-9 months of daily therapy in previous series and little is known about efficacy of intermittent antituberculous therapy. Here we report two cases of actively caseating endobronchial tuberculosis successfully managed with six months of intermittent oral antitubercular therapy without corticosteroids.

Pulmonary Strongyloidiasis Masquerading as Exacerbation of Chronic Obstructive Pulmonary Disease

Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.

Reexpansion Pulmonary Edema Following Tube Thoracostomy for Spontaneous Pneumothorax in an Elderly Male

Reexpansion pulmonary edema (RPE) is an important cause of unilateral pulmonary edema that rarely occurs following drainage of pleural effusion or pneumothorax. Most patients develop symptoms within an hour of lung expansion. The presentation is usually rapid and dramatic and may be fatal at times. The duration of lung collapse more than 3 days, large-size pneumothorax, rapidity of lung expansion, and application of negative pleural suction are well-known risk factors for the development of RPE. We present here an elderly male with diabetes mellitus who presented with a large pneumothorax and developed RPE shortly after insertion of a chest tube.

Managing FDG PET-positive sarcoidosis: "a riddle wrapped in a mystery inside an enigma".

Vorselaars et al. [1] have shown infliximab, a monoclonal antibody against tumour necrosis factor (TNF), to be an effective agent in the treatment of refractory sarcoidosis. We put forth some issues that are worth discussing among scientific societies. Diagnosis and treatment of FDG PET-positive sarcoidosis with infliximab needs caution, especially in TB endemic areas http://ow.ly/U0de5

Effectiveness of a rural sanitation programme: finding the gaps

The study by Clasen and colleagues does not have enough evidence for the effectiveness of the sanitation programme, but denotes the clear message that the health benefi ts might not be assumed only by construction of latrines. We doctors, having grown up in villages of Odisha, are aware of the practice of many people using latrines initially and then moving to a nearby pond to clean their anal orifi ce with their hand. These practices lead to contaminate water, hands, and soil. Poor adherence to toilet use at home can also be attributed to the traditional habit of defecating in the open air while visiting fi eld crops. Many children aged 6–18 months defecate on the fl oor and then take their contaminated fi ngers to their mouth. Transformation of sanitation-related knowledge into routine practice is hindered by traditional mindsets and the absence of awareness and an attitude to learn. Poverty has been described as a barrier to following safe hygiene practices. Regular use of footwear is equally important for the prevention of soil-transmitted helminth infection. Personal and domestic hygiene practices are difficult to improve without upgrading basic amenities, such as water supply, waste water disposal, and solid waste management. Health education could be a very promising approach to improve awareness and encourage the adoption of good hygienic practice. The integration of health education and practice to fi ll the gaps of understanding of what works and what does not work is needed. We also need to keep focused on the important task of winning the battle for rural sanitation.

Defining low-dose corticosteroid: the pendulum still oscillates.

Tagami et al. [1], in their retrospective analysis, have contributed to further understanding of the use of corticosteroids in severe community-acquired pneumonia (CAP) and put forth an inference on the current dispute. Some issues, however, need further discussion. Defining low-dose corticosteroid in severe community-acquired pneumonia http://ow.ly/OazzW