Ruchi Dua

Clinico-pathological profile of lung cancer in Uttarakhand

Background: Lung cancer is one of the most aggressive and prevalent type of malignancy causing high morbidity and mortality. Tobacco smoking continues to be the leading cause of lung cancer worldwide. An increasing incidence of lung cancer has been observed in India. Objective: The aim of this study was to evaluate the clinico, a pathological profile of the lung cancer in hilly state of Uttrakhand. Materials and Methods: We performed a retrospective analysis of histopathologically proven cases of bronchogenic carcinoma admitted in our hospital from January 1998 to August 2005. Results: Our study included 203 patients with confirmed cases of lung cancer. Male to female ratio was 8.2:1. The common age group being 40-60 years, 9.86% of the patients were less than 40 years old age. Smoking was found to be the main risk factor in 81.77% patients. The most frequent symptom was cough (72.90%) followed by fever (58.12%). The most common radiological presentation was mess lesion (46.31%). The most common histopathological type was squamous cell carcinoma (SCC) (44.83%) followed by adenocarcinoma (19.78%) and small cell lung carcinoma (SCLC) (16.75%). The majority patients (73.29%) were diagnosed in the later stages of the disease (III B and IV). Conclusion: It was found out that SCC was the most frequent histopathological form. SCLC predominates below 40 year and SCC over 60 years of age. Smoking still remains the major risk factors in pathogenesis of lung cancer.

Five-year trend of acquired antitubercular drug resistance in patients attending a tertiary care hospital at Dehradun (Uttarakhand)

Background/Aim: To study the prevalence and trend of acquired drug resistance to the first line antitubercular drugs. Materials and Methods: Sputum of 215 previously treated adult pulmonary tuberculosis (TB) patients over a period of 2002-2006 were subjected to culture and sensitivity testing against common antitubercular drugs. Result: Growth of Mycobacterium tuberculosis was obtained from sputum specimen of 184 (85.58%) of the 215 patients who were studied; Overall, 113 (62.77%) of these were resistant to at least one antitubercular drug. Resistance to isoniazid was most common (62.22%) followed by rifampicin (57.22%). Multidrug resistance (MDR) was observed in 103 (57.22%) cases. During the five-year study period, an increasing trend in drug resistance including MDR-TB was observed. Conclusion: This study showed increasing trend in drug resistance including MDR-TB in five years.

Incidence, microbiological profile and early outcomes of ventilator associated pneumonia in elderly in a Tertiary Care Hospital in India

Objective: The aim was to study the incidence, microbiological profile and early outcomes in elderly (age >60 years) patients of ventilator associated pneumonia (VAP) admitted to Intensive Care Unit (ICU) of a Tertiary Care Hospital in Uttarakhand. Materials and Methods: Elderly patients (age >60 years) admitted to ICU who developed VAP were enrolled in the study from December 2011 to December 2012 .Their endotracheal secretions were collected and processed as per standard microbiological methods, and the results analyzed along with the early outcomes in terms of in ICU mortality of the patients. Retrospective analysis of records was also done during this period of one year to find out the incidence of VAP among elderly patients. Results: Incidence of VAP was 45.21% among elderly patients on mechanical ventilation (MV) and Gram-negative organisms were the most common etiological organisms. Mortality among elderly patients with VAP was similar to that in young. Conclusions: A higher incidence of VAP was seen among elderly patients subjected to MV though larger studies are needed. Microbiological profile of VAP among elderly and young is similar.

Role of BiPAP applied through endotracheal tube in unconscious patients suffering from acute exacerbation of COPD: a pilot study

Background and objectives Mechanical ventilation is the recommended treatment in unconscious patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and hypercapenic respiratory failure. But, in resource-poor countries, many of these patients are not able to afford this treatment due to financial constraints. The main aim of this study was to evaluate the usefulness, safety and cost-effectiveness of bilevel positive airway pressure (BiPAP) applied via endotracheal tube in such patients. Methods Twenty patients with acute exacerbation of COPD and altered sensorium, who were unable to afford ventilatory support, were intubated and BiPAP therapy was provided to these patients through the endotracheal tube. The outcome of these patients was studied. Results The BiPAP success rate and hospital mortality were 85% (17/20) and 15% (3/20) respectively. BiPAP failure was associated with high sequential organ failure assessment (SOFA) score at the time of admission (P = 0.002). Improvement in Glasgow coma scale (GCS) score (P < 0.001), pH (P = 0.001), PaCO2 (partial pressure of carbon dioxide) (P < 0.001), respiratory rate (P < 0.001), and SOFA score (P = 0.001) was observed among the responders following 2 hours of therapy. Only one of the responders developed aspiration pneumonitis, as a complication. The daily cost of BiPAP therapy was 8.75 times lower than the average cost of mechanical ventilation. Conclusion This pilot study reveals that this treatment modality could be a safe, cost-effective and efficacious method of treatment in unconscious patients with acute exacerbation of COPD.

Association of comorbid anxiety and depression with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations including psychiatric comorbidities most commonly being depression and/or anxiety. Studies regarding the association of these psychiatric comorbidities in terms of symptom scores, spirometric variables, and hospitalizations among patients of COPD are lacking, especially in India. Materials and Methods: One hundred and twenty-eight patients of COPD attending the Outpatient Department of AIIMS Rishikesh, and fulfilling inclusion criteria were screened by Hospital Anxiety and Depression Scale, and those who scored above the cutoff underwent psychiatric evaluation using the International Classification of Diseases, Tenth Edition Diagnostic Criteria for Research for confirmation of their diagnosis. All patients were then evaluated by physician-administered questionnaire for symptom scores by Modified Medical Research Council Scale (mMRC) for dyspnea, Hindi-validated Clinical COPD Questionnaire (CCQ), and for functional capacity by 6-min walk distance (6MWD) according to the American Thoracic Society Guidelines. All patients also underwent spirometric evaluation, and postbronchodilator forced expiratory volume in 1 s (FEV1), BODE index (body mass index [BMI], postbronchodilator FEV1, mMRC for dyspnea, 6MWD) and a history of hospitalization/exacerbations over the past 1 year was also obtained. Comparison of symptom scores, functional capacity in terms of 6MWD, history of exacerbations or hospitalizations over preceding 1 year and BODE index between patients of COPD with or without anxiety and/or depression was done. Results: COPD patients with comorbid anxiety and/or depression had higher dyspnea scores and CCQ scores though the proportion of current smokers, BMI, history of hospitalization over the past 1 year, FEV1, and BODE index was not statistically significant between the two groups. Conclusions: Depression is a common comorbidity and leads to higher symptom scores as well as poorer quality of life among COPD patients.