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Background: There is paucity of Indian data on nebulizer usage, patients’ and caregivers’ attitudes towards nebulization in COPD. Objective: Survey aimed to evaluate Indian adult male and female patients’ and caregivers’ attitudes and perceptions towards nebulization for COPD management. Methods: Survey was conducted from July-August 2019 among 103 COPD patients [>40 years] receiving home nebulization (>3 weeks), and their caregivers, to assess usage, satisfaction, perceived benefits and concerns with nebulizers. Results: Overall, 54% patients were on nebulizer regimen for >8 weeks (occasionally/daily) and 27% patients used nebulizers daily for home maintenance. Key benefits of nebulizers perceived by patients were easier breathing (93%), ease of use (89%) and fewer doctor visits (86%) while caregivers cited reduced hospitalization (76%), easier breathing (75%) and better control on overall symptoms (73%). Patients perceived short-term duration of effect (61%), social embarrassment (54%) and device being bulky and noisy (50%) as major concerns for nebulizers; while caregivers cited multiple uses per day (45%) and social embarrassment (43%). Among patients prescribed inhaler therapy earlier, 72% felt nebulizers gave long-term relief compared to inhalers. 61% patients opined that benefits with nebulizers outweighed the inconvenience associated with its use. Overall 99% patients reported satisfaction with nebulizers. Conclusion: This first of its kind survey demonstrated that majority of COPD patients and their caregivers were satisfied with nebulizers, with reported benefits of reduced hospitalization, better symptom control and ease of use.

Background: Electrolyte disorders are common in patients in the emergency department and intensive care unit, and have been associated with increased morbidity and mortality. In this respect sodium and potassium are the most important cations, whose improper adjustment may cause severe neuromuscular disorders. This study was designed to compare values obtained by laboratory and point-of-care testing and also to find most frequent electrolyte abnormalities.Methods: Observational Study was done on 51 patients presenting to Tertiary care Hospital emergency department with altered sensorium between 1st January 2016 to 31st May 2017 fulfilling the inclusion criteria and willing for participation by giving written informed consent. Electrolytes were tested in patients with GCS 14 or less by both point of care system and in the laboratory.Results: The distribution of mean sodium and potassium levels did not differ significantly between two techniques (P-value>0.05). The sodium and potassium levels by POC and laboratory techniques are significantly and positively correlated (P-value

Background: High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. It is an oxygen delivery system which uses air blender to deliver accurate oxygen concentration to the patient from 21% to 100% at desired temperature. It can be administered via wide bore nasal cannula or to the tracheostomy tube via connector. It can give upto 60L/min flow hence can generate positive end expiratory pressure between 2 to 7 cmH20. By providing humidified oxygen along with the high flow rates it satisfies air hunger and reduces work of breathing for the patient.Methods: This is a retrospective observational study. Patients with persistent hypoxia in spite of conventional oxygen therapy were treated with HFNC. Patients with possible need for immediate invasive ventilator support were excluded. Clinical respiratory parameters and oxygenation were compared under conventional and HFNC oxygen therapy.Results: Thirty patients, aged more than 18 years admitted in intensive respiratory care unit with acute hypoxemic respiratory failure from June 2017 to January 2018 were included in the study. Study period was of 6 months. Etiology of acute respiratory failure (ARF) was mainly pneumonia (n = 17), interstitial lung disease (n = 5), bronchial asthma (n=3) and others (n = 5). There was statistically significant reduction in respiratory rate (29.40 before Vs 23.50 after; P

Background Pleuroscopy is a minimal invasive technique which allows direct visualization of the pleura, removal of the pleural fluid and biopsy of the pleura through single skin incision. Pleuroscopy provides an accurate diagnosis in effusions of unknown aetiology. The present study aimed to investigate the safety and utility of medical pleuroscopy in diagnosis and management of patients with pleural effusion.

Till date we believed that multidrug-resistant and extensively drug resistant were our deadliest foes when dealing with tuberculosis. However, conditions commonly encountered in daily practice such as diabetes, liver, renal, psychiatric disorders, and pregnancy tend to frequently overlap with tuberculosis. These multimorbid conditions prove to be equally challenging for an average medical practitioner. Inappropriate prescriptions in the above situations prove to be a significant impediment to the overall control of tuberculosis in the community at large. The advent of solid organ transplantation and aggressive use of immunosuppressive medication for malignancies and chronic inflammatory disorders has added a new dimension to the already preexisting challenges faced by practicing clinicians, particularly in the context of treating tuberculosis in the immunocompromised and drug-drug interactions. This is another area which needs special attention. Pediatric multidrug resistant tuberculosis is a growing menace and needs to be controlled before it becomes an insurmountable problem. In addition, the emerging epidemics of metabolic syndrome, substance abuse, and drug dependence have only compounded the problem. Tuberculosis in the above populations, particularly if drug resistant can be one of the worst nightmares for the treating clinician. This article tries to highlight these prevalent issues and offers practical and evidence-based solutions to help clinicians in their endeavor to achieve a tuberculosis free world.