Search

Author(s): Vineet Kashyap [1]; Srikumar Venkataraman (corresponding author) [1]; Bipin Kumar [2]; Gita Handa [1]; Ravindra M. Pandey [3] INTRODUCTION Work-related musculoskeletal disorders (WMSD) are impairments of body structures such [...], Background: There are adverse effects on the health outcomes of workers whose occupation involves prolonged standing, such as lower back pain, leg pain, cardiovascular diseases, fatigue, discomfort, and pregnancy-related health outcomes. The effectiveness of massage therapy as an intervention for managing leg pain associated with prolonged standing needs to be addressed. Aims: This study aimed to evaluate the smart dynamic fabric actuator's effectiveness in treating chronic musculoskeletal leg pain in persons with occupations involving prolonged standing. Setting: Tertiary care hospital. Design: Randomized controlled trial. Methods: Thirty participants with chronic leg pain satisfying the inclusion and exclusion criteria participated in the study. The intervention group used the device for 15 minutes for each leg once a day and stretching exercises twice a day for six weeks. The control group performed stretching exercises twice a day for six weeks. The outcome was assessed at baseline, three weeks, and six weeks with a Numeric Rating Scale for pain and fatigue, short form-McGill Pain Questionnaire for pain, and SF-36 for quality of life. Statistical Analysis: The groups were compared using the two-sample t-test with equal variances, the two-sample Wilcoxon rank-sum test, and the Chi[sup.2] exact test as appropriate. Results: Thirty medical (nursing officers and doctors) and nonmedical professionals (security guards and sales assistants) with a mean age of 32.9 ± 5.6 years (intervention group) and 36.2 ± 5.1 years (control group) participated in the study. At six weeks, a significant improvement in pain (4.80 ± 1.14 to 1.66 ± 1.04 vs 4.66 ± 0.89 to 2.6 ± 0.91, P = 0.014), quality of life (58.77 ± 9.06 to 71.76 ± 8.43 vs 51.39 ± 8.26 to 63.87 ± 7.61, P = 0.012), and reduced fatigue (5 to 2 vs 5 to 3, P = 0.003) was observed in the intervention group when compared with the control group. No adverse events were observed. Conclusion: A smart dynamic fabric actuator can be used as an adjunct to exercises for reducing leg pain and fatigue associated with prolonged standing. Keywords: Chronic pain, exercise therapy, lower extremity, massage, occupational health, quality of life

This review aims to provide a comprehensive overview of both conventional and molecular studies focusing on acrocentric chromosome association/satellite association (ACA/SA) research for assessing human health conditions including cancer as well as in evaluating exposure to genotoxic agents. It is well documented that the ACA/SA frequency in lymphocytes of patients with oral squamous cell carcinoma and gastrointestinal and breast cancer has been evaluated by many workers. Literature was searched using various combinations of keywords in different databases. The articles that appeared till March 2023 were considered depending on their relevance, and relevant information was extracted by two independent reviewers. A total of 97 studies were selected based on our criteria describing the relevant keywords, 46 studies described SAs/acrocentric association with different diseases, 35 studies demonstrated effects of genotoxic agents, 8 studies were on characteristics and general aspects of ACA/SA phenomenon, and 8 studies described the molecular mechanisms of acrocentric chromosomes. Thus, ACA/SA was crucial in assessing human health conditions, including genetic disorders and cancer, as well as in evaluating exposure to genotoxic agents. The information collected would help to promote a deeper understanding of the impact of ACA/SA on human health including cancer and emphasize the importance of integrating molecular approaches into genotoxic exposure studies. Continued research in this field will undoubtedly contribute to the advancements in medical genetics and improved patient care.

Amaranthus is considered a superfood with high nutraceutical value. It is a functional food composed of bioactive compounds crucial for sports nutrition including secondary metabolites, tocopherols, sterols, squalene, trace elements, polyphenols, peptides, polyunsaturated fatty acids, antioxidants, proteins, fat, carbohydrates, fibers, minerals, and vitamins making it a versatile supplement source. Notably, it is rich in amino acids, including branched-chain amino acids (BCAAs), natural enhancer of nitric oxide levels for improved circulation, endurance, strength, and stamina in athletes. It has been found to improve aerobic capacity, muscle recovery, and improved body composition. It is rich in fiber making it a beneficial prebiotic for athletes to maintain gastrointestinal health after intense training. Being rich in antioxidants and gluten-free, it’s ideal for special diets to reduce fat and increase muscle mass. A comprehensive overview of the ergogenic potential of Amaranthus and further research promises insights into developing Amaranthus-based dietary supplements for enhancing sports performance..

Introduction Lung transplant (LTx) is a potential treatment option for all patients with chronic, end-stage respiratory disease, who are refractory to optimal medical therapy or where no medical therapy exists. In India, LTx is still in its evolving stages and published literature is sparse. The current study was carried out to study the selection criteria for lung transplant and to evaluate the clinical and socio-economic profile of patients referred for the same at a tertiary health care facility. Methods The study was a descriptive, prospective, observational study. All adults referred for lung transplant were evaluated for clinical and laboratory profiles. All enrolled patients were assessed for presence of referral criteria, listing criteria, contraindications, and willingness for lung transplant. These patients were followed up for 2 years for transplant-free survival, and the Cox proportional hazards model was used to determine independent predictors of all-cause mortality. Results A total of 103 were included in study. The most common diagnosis was interstitial lung disease (57.2%), followed by bronchiectasis (17.5%) and COPD (13.6%). Most patients were referred for LTx at an advanced stage as 90% met listing criteria. Fifty-four (52.4%) patients had an absolute or relative contraindication to transplant; however, the majority of those contraindications were modifiable. Patients with a lower socio-economic status were less likely to be willing for LTx. The median survival was 757 days. A 6-minute walk distance (6MWD) lesser than 250 m was found to be an independent predictor of mortality. Conclusion Making patients aware about lung transplant early in their treatment may give them sufficient time to come to terms with their disease and understand the risk and benefits associated. Efforts should be focused on screening and early treatment of reversible contraindications for the eligible patients. Patients with 6MWD < 250 m are at increased risk of mortality.

Background: Narrow-band ultraviolet B (NB-UVB) is the standard therapy for vitiligo. Objective: The objective of this study is to compare the safety and clinical efficacy of a handheld NB-UVB comb device with the standard whole-body NB-UVB therapy in localized stable vitiligo. Materials and Methods: Thirty-one vitiligo patients were allocated to either daily therapy with a home-based handheld comb device (group A, n = 17) or thrice-weekly hospital-based whole-body NB-UVB therapy (group B, n = 14) for 4 months, based on their preference. The primary and secondary outcomes were assessed at each follow-up, and appropriate statistical tools were used for analysis. Results: Of the 31 patients enrolled, 26 patients (study groups A/B: 15/11) completed the study. Primary outcome: Median percentage repigmentation of the representative patch in groups A and B were 51.35% and 63.85%, respectively (P = 0.64). The median size reduction of the representative patch in both groups was statistically significant (P < 0.05). The mean difference between “per protocol analysis” and “intention to treat” showed noninferiority. Secondary outcomes: Both groups were comparable on Lund and Browder score, patient global assessment and investigator global assessment scores, adverse events, color match, and change in the quality of life. The comparison group had a significantly greater number of missed sessions (P = 0.02). The majority of patients had a “good” response in both groups. Conclusion: Handheld NB-UVB comb device daily with a fixed dose of fluence was found to be noninferior with better compliance to standard whole-body NB-UVB therapy.

Abstract ARDS in general and severe COVID ARDS (CARDS) is particularly associated with high rates of barotrauma. Two cases with severe CARDS developed bilateral pneumothorax with persistent air leak (PAL). Conservative management with prolonged chest tube drainage did not help in PAL resolution and both patients continued to be on high‐end ventilatory support. The course was further complicated by the presence of septic shock. The 1st patient was taken up for a challenging procedure after spending 23 days on the mechanical ventilator. Diagnostic pleuroscopy revealed left‐sided bullae and a surgical staple bullectomy was done. The right side showed a large bronchopleural fistula (BPF) on pleuroscopy, which was occluded using a customized endobronchial silicone blocker (CESB, described in 2018). This led to the reduction and finally, resolution of the bilateral PAL with subsequent removal of chest drains and weaning off the ventilator and oxygen. The second patient was managed with 2 CESB devices for occlusion of RUL anterior and posterior segment fistulae, followed by chest drain removal. These cases highlight effective out‐of‐the‐box multimodality treatment using a combination of interventional pulmonary techniques and surgical stapling for a life‐threatening bilateral PAL secondary to CARDS.

Abstract Background Isolated right upper lobe pulmonary agenesis is a highly uncommon congenital anomaly, usually detected at adulthood when the patient is evaluated for an incidental abnormal chest radiograph. Chest radiography findings are non-specific. Chest computed tomography with pulmonary angiography is the modality of choice for diagnosing pulmonary agenesis. Case presentation We describe a case of isolated right upper lobe agenesis in a young man who presented with mild shortness of breath and an abnormal chest radiograph. High-resolution computed tomography chest showed right upper lobe pulmonary agenesis which was initially erroneously diagnosed as right lower lobe collapse on chest X-ray. Abnormal segmentation of the middle lobe was also seen which has not been described earlier according to our literature search. Conclusions There should be a high index of suspicion for congenital anomalies on chest X-ray to recommend further imaging studies. This case highlights the importance of computed tomography with pulmonary angiography to adequately assess and characterize the congenital lung anomalies.

Background: Lower respiratory tract (LRT) sampling through bronchoscopy has been done sparingly in COVID-19 acute respiratory distress syndrome (ARDS) due to the high aerosol risk for the health-care workers (HCWs). Valuable information can be gained by a detailed evaluation of bronchoscopic LRT samples. Methods: LRT samples were obtained by bedside bronchoscopy severe COVID-19 ARDS patients on mechanical ventilation. Microbiological, cellular, and cytological studies including LRT COVID-19 reverse transcription-polymerase chain reaction were analyzed. Results: A total of 100 samples were collected from 63 patients, 53 were males (84%). Forty-three patients (68%) had at least 1 comorbidity. 55% of cases had a secondary bacterial infection, commonly with multidrug-resistant organisms (94.5%). The most common organisms were Klebsiella pneumoniae and Acinetobacter baumannii in 56.3% and 14.5% of cases, respectively. Fungal superinfection was observed in 9 patients (14.3%). Bronchoscopy helped confirm COVID-19 diagnosis in 1 patient and helped rule out COVID-19 in 3 patients. The median bronchoalveolar lavage fluid (BALF) white blood cell (WBC) count was 953 (inter quartile range; 400–2717), with mean neutrophil count 85.2% (±13.9) and mean lymphocyte count 14.8% (±13.9). Repeat sampling done in some patients showed a progressive increase in the total WBC count in BALF, an increase in neutrophil percentage, and a higher chance of isolating an organism on the culture. Rate of superinfection increased with a longer duration of illness. Bronchoscopic LRT sampling contributed significantly to modifying antibiotic coverage and discontinuing steroids in 37% of cases. Conclusions: Our study provides a detailed analysis of bronchoscopic LRT sampling in critically ill COVID-19 patients, augmenting disease understanding and contributing to clinical management.

The explosive rise in angioinvasive mucormycosis (MM) in India and other parts of the world has been described as the “epidemic following the COVID-19 pandemic,” with the majority being rhino-orbital-cerebral MM. We report a case series of five COVID-19-associated pulmonary MM (CAPM) with an aggressive clinical course. Clinical and radiological clues were limited, and the initial suspicion of CAPM was the morphological appearance on bronchoscopy, which led to the diagnosis. Histopathology was consistently positive in all cases, while other microbiological and molecular tests had varying sensitivity. Most patients had a fulminant and fatal course. Also noted was dual fungal infection in 3/5 cases with coexisting multidrug resistant bacterial infection in all cases. CAPM is the hidden part of the COVID-MM epidemic and warrants a high degree of suspicion with early diagnosis and treatment.

Introduction: Elastography is a non-invasive tool that may allow differentiation between benign and malignant lymph nodes during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA). In tuberculosis (TB) endemic areas, clinicoradiological features of mediastinal TB and sarcoidosis often overlap, rendering an accurate diagnosis challenging. There is interest in the identification of modalities to aid in this differentiation. There are currently no published data on the utility of EBUS-elastography in differentiating between TB and sarcoidosis. Methods: Subjects undergoing EBUS-TBNA were prospectively enrolled, and elastography features were observed. Subjects with definitive diagnosis of TB or sarcoidosis were enrolled. The elastography features recorded included the three-colour classification patterns and strain ratio. Results: We enrolled 96 subjects with a definitive diagnosis (53 with TB and 43 with sarcoidosis). Of the 27 patients in whom the lymph nodes were classified as type 1 on endobronchial ultrasound elastography colour pattern, 17 had a diagnosis of TB (62.9%), while 10 were sarcoidosis (37%). For type 2 lymph nodes, 20/45 (44.4%) were TB and 25/45 (55.6%) were sarcoidosis. Type 3 lymph nodes were TB in 16/24 (66.7%) and sarcoidosis in 8/24 (33.3%). In classifying type 1 as 'sarcoidosis' and Type 3 as 'tubercular', the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 48.5%, 55.6%, 66.7%, 37%, and 0.51, respectively. The strain ratio (Median [IQR]) was 1.29 (0.37–5.98) in TB and 2.10 (0.83–4.52) in sarcoidosis group (P = 0.48). Conclusion: Ultrasound elastographic lymph node characteristics have a poor diagnostic utility to differentiate between TB and sarcoidosis during EBUS-TBNA.

Abstract Background Extramedullary plasmacytoma is a rare monoclonal plasma cell neoplasm that originates from tissues other than the bone marrow and constitutes only 3%–5% of all plasma cell neoplasms. Most cases involve the upper respiratory tract. Extramedullary plasmacytoma involving the lung is extremely rare. Primary pulmonary plasmacytoma is a rare type of extramedullary plasmacytoma, usually presenting with a nodule or mass in hilar region. Literature search has shown very few cases of immunohistochemically confirmed cases of pulmonary plasmacytoma. Diffuse pulmonary infiltration is an unusual presentation. Case presentation We report the case of a 56 year old lady with history of cough and breathlessness since one month. Computed Tomography revealed diffusely scattered multiple cavitating nodules and consolidation in both lungs. Computed Tomography guided biopsy of one of the lung nodules was done. Histopathologic examination and immunohistochemistry showed features of pulmonary plasmacytoma .This is an unique case of primary pulmonary plasmacytoma with the rare presentation as diffusely scattered multiple cavitating nodules and consolidation. According to our literature search, primary pulmonary plasmacytoma manifesting as cavitating nodules is being reported for the first time. Conclusions Primary pulmonary plasmacytoma should be also be considered in the differential diagnosis of multiple diffusely scattered cavitating lung nodules.