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Background & objectivesAcute respiratory distress syndrome (ARDS) is a common disorder in critically ill patients and is associated with high mortality. There is a paucity of literature on this condition from developing countries. This prospective observational study was designed to find out the aetiology, outcomes and predictors of mortality in ARDS.MethodsSixty four consecutive patients who satisfied American-European Consensus Conference (AECC) definition of ARDS from medical Intensive Care Unit (ICU) of a tertiary care centre in New Delhi, India, were enrolled in the study. Demographic, biochemical and ventilatory variables were recorded for each patient. Baseline measurements of serum interleukin (IL)-1β, IL-6, tumour necrosis factor-alpha (TNF-α), procalcitonin (PCT) and high sensitivity C-reactive protein (hsCRP) were performed.ResultsCommon causes of ARDS included pneumonia [44/64 (68.7%)], malaria [9/64 (14.1%)] and sepsis [8/64 (12.5%]. Eight of the 64 (12.5%) patients had ARDS due to viral pneumonia. The 28-day mortality was 36/64 (56.2%).Independent predictors of mortality included non-pulmonary organ failure, [Hazard ratio (HR) 7.65; 95% CI 0.98-59.7, P=0.05], Simplified Acute Physiology Score (SAPS-II) [HR 2.36; 95% CI 1.14-4.85, P=0.02] and peak pressure (P peak ) [HR 1.13; 95% CI 1.00-1.30, P = 0.04] at admission.Interpretation & conclusionsBacterial and viral pneumonia, malaria and tuberculosis resulted in ARDS in a considerable number of patients. Independent predictors of mortality included non-pulmonary organ failure, SAPS II score and P peak at baseline. Elevated levels of biomarkers such as TNF-α, PCT and hsCRP at admission might help in identifying patients at a higher risk of mortality.

Byline: Viraj. Nevrekar, Prasan. Panda, Naveet. Wig, R. Pandey, Praveen. Agarwal, Ashutosh. Biswas Background: Cardiopulmonary resuscitation (CPR) should be performed as per the international guidelines; however, compliance to these guidelines [...]

Problem Antiretroviral therapy (ART) programmes have been successful in several countries. However, whether they would succeed as part of a national programme in a resource-constrained setting such as India is not clear. The outcomes and specific problems encountered in such a setting have not been adequately studied. Approach We assessed the efficacy and functioning of India's national ART programme in a tertiary care centre in northern India. All ART-naive patients started on ART between May 2005 and October 2006 were included in the study and were followed until 31 April 2008. Periodic clinical and laboratory evaluations were carried out in accordance with national guidelines. Changes in CD4+ lymphocyte count, body weight and body mass index were assessed at follow-up, and the operational problems analysed. Local setting The setting was a tertiary care centre in northern India with a mixed population of patients, mostly of low socioeconomic status. The centre is reasonably well resourced but faces constraints in health-care delivery, such as lack of adequate human resources and a high patient load. Relevant changes The response to ART in the cohort studied was comparable to that reported from other countries. However, the programme had a high attrition rate, possibly due to patient-related factors and operational constraints. Lessons learnt A high rate of attrition can affect the overall efficacy and functioning of an ART programme. Addressing the issues causing attrition might improve patient outcomes in India and in other resource-constrained countries. Problematique Les programmes de traitement antiretroviral (TARV) ont donne des resultats satisfaisants dans plusieurs pays. Neanmoins, il n'est pas certain qu'un tel programme reussisse dans le cadre du programme national d'un pays aux ressources limitees comme l'lnde. Les resultats-et les problemes specifiques rencontres dans ce type de contexte n'ont pas encore ete suffisamment etudies. Demarche Nous avons evalue l'efficacite et le fonctionnement du Programme TARV national indien dans le cadre d'un centre de soins tertiaires du Nord de l'lnde. Tous les patients auparavant naifs de traitement ARV et ayant debute ce traitement entre mai 2005 et octobre 2006 ont ete inclus dans l'etude et ont ete suivis jusqu'au 31 avril 2008. Des evaluations cliniques et analytiques periodiques ont ete effectuees conformement aux directives nationales. Les evolutions de la numeration des lymphocytes CD4+, du poids corporel et de l'indice de masse corporelle ont ete evaluees dans le cadre du suivi et les difficultes operationnelles ont ete analysees. Contexte local L'etude s'est deroulee dans un centre de soins tertiaires du Nord de l'lnde, sur une population mixte de patients, dont la plupart presentaient un faible statut socioeconomique. Ce centre etait raisonnablement bien dote en ressources, mais devait faire face a des contraintes dans la delivrance des soins, telles que le manque de personnel approprie et la forte affluence des patients. Modifications pertinentes La reponse au TARV dans la cohorte etudiee etait comparable a celles rapportes dans d'autres pays. Neanmoins, le programme presentait un taux d'attrition eleve, pouvant etre du a des facteurs lies aux patients et aux contraintes de fonctionnement du centre. Enseignements tires Un taux eleve d'attrition peut nuire a l'efficacite globale et au fonctionnement du programme TARV. Remedier aux problemes a l'origine de cette attrition pourrait ameliorer les resultats therapeutiques pour les patients en Inde et dans d'autres pays a ressources limitees. Problema Les programas de tratamiento antirretroviral (TAR) han cosechado buenos resultados en varios paises. Sin embargo, no esta claro si se desarrollarian tambien de forma satisfactoria como componente de un programa nacional en un entorno con recursos limitados como la India. Les resultados y les problemas especificos observados en esas circunstancias no han sido estudiados adecuadamente. Enfoque Se evalue la eficacia y el funcionamiento del programa nacional de TAR de la India en un centro de atencion terciaria del norte del pais. Se incluyo en el estudio a todos Ios pacientes sin tratamiento antirretrovirico previo que empezaron a tomar antirretrovirales entre mayo de 2005 y octubre de 2006, les cuales fueron sometidos a seguimiento hasta el 31 de abril de 2008. De forma periodica se Ilevaron a cabo evaluaciones clinicas y de laboratorio de conformidad con las directrices nacionales. En cada sesion de seguimiento se analizaron la variacion del recuento de linfocitos CD4+, el peso corporal y el indice de masa corporal, asi como Ios problemas operacionales surgidos. Contexto local Se trabajo en un centro de atencion terciaria del norte de la India con una poblacion diversa de pacientes, la mayoria de nivel socioeconomico bajo. EI centro cuenta con unos recursos razonables, pero ve tensionada su capacidad asistencial debido a la falta de recursos humanos apropiados y al alto volumen de pacientes. Cambios destacables La respuesta a la TAR en la cohorte estudiada fue comparable a la descrita en otros paises. Sin embargo, el programa presento una tasa de desercion elevada, posiblemente debido a factores relacionados con el paciente y a limitaciones operacionales. Ensenanzas extraidas Una alta tasa de desercion puede menoscabar la eficacia y el funcionamiento globales de Ios programas de ART. Encarando Ios problemas causantes de esas deserciones se podria conseguir que Ios pacientes evolucionaran mejor en la India y en otros paises con recursos limitados., Introduction The number of people infected with the human immunodeficiency virus (HIV) worldwide was estimated to be 33.2 million at the end of 2007. (1) The introduction of antiretroviral therapy [...]

Background: Hydroxychloroquine (HCQ) had generated considerable interest for coronavirus disease 2019 (COVID-19) prophylaxis. We conducted a prospective observational study at a tertiary care hospital in India, with dedicated COVID-19 care facilities. Objectives: Primary objective was incidence of adverse effects, secondary objective being efficacy in preventing COVID-19. Methods: Healthcare workers were recruited and grouped based on voluntary HCQ prophylaxis as per national guidelines. Side effects in HCQ group were graded in accordance with national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) version 5.0. At 3–7-week follow-up, groups were compared for COVID-19 exposure, symptoms development and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR results. Results: Among 358 participants recruited, 216 (60.3%) were males and mean age was 31.2 ± 6.6 years. Chemoprophylaxis was initiated by 258 (72%) participants. After loading dose, 7 (2.7%) reported grade 2 and 1 (0.4%) grade 3 adverse effects. Discontinuation of HCQ due to side effects was reported in 11 (4.3%) participants. Electrocardiogram was done by 50 (19.4%) participants on HCQ; no abnormalities were noted. A total of 106 (41%) among those taking and 63 (63%) among those not taking HCQ were tested for SARS-CoV-2 due to influenza-like illness or significant exposure. Among all participants, 25 (6.9%, 95% confidence interval [CI] 4.3–9.6) developed COVID-19 during the study period. In the group taking HCQ, 10 (3.9%) tested positive compared to 15 (15%) in the group not taking HCQ (P < 0.001). Odds ratio with HCQ intake was 0.34 (95% CI 0.13–0.83, P = 0.01) and the number needed to treat was 12. Conclusion: HCQ is safe at the recommended dose for pre-exposure prophylaxis of COVID-19. [ABSTRACT FROM AUTHOR]

Objective: The objective was to study the sensitivity, specificity, and diagnostic accuracy of various computed tomography (CT) chest findings in diagnosing recurrence among pulmonary tuberculosis (PTB) suspects. Materials and Methods: A prospective observational study was conducted in a tertiary care hospital in New Delhi. A total of 130 suspects with a past history of treatment for PTB, who presented with any of the symptoms suggestive of recurrence were included. Sputum-positive, HIV-positive patients, pregnant females, and patients aged <18 years were excluded. Patients underwent CT chest followed by bronchoalveolar lavage (BAL). Results: A total of 62 patients were there in the final analysis. The median age of the patients with recurrent PTB was 27.5 years. Cough was the universal symptom in all these patients (>90%). Hemoptysis was the predominant symptom among patients with chronic pulmonary aspergillosis (66.6%). Necrotic mediastinal lymph nodes had good diagnostic accuracy of 88.71% with area under the curve of 0.806, P < 0.001 in diagnosing recurrent TB. BAL GeneXpert and mycobacteria growth indicator tube had good sensitivity (83.33% and 84.62%, respectively), specificity (100% for both), and excellent diagnostic accuracy (95.16% and 96.36%, respectively) for diagnosing recurrence in sputum negative and sputum scarce patient, (P < 0.001) when compared with composite reference standard. For culture-positive cases, BAL GeneXpert MTB/RIF had 100% sensitivity and 97.73% specificity in diagnosing recurrent PTB patients. Conclusion: The presence of mediastinal necrotic lymph node is the most accurate CT finding that can differentiate recurrent TB from post-TB sequelae. No other single chest CT scan finding had reliable diagnostic accuracy in comparison to microbiological tools in diagnosing recurrence among sputum negative or scarce previously treated PTB suspects. [ABSTRACT FROM AUTHOR]