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This study is a cross sectional study designed to evaluate Pulmonary Function Tests (PFT) focused to evaluate Maximum Voluntary Ventilation (MVV) and Dyspneic Index (DI) in the sweepers and non-sweepers involved in 'Swachh Bharat Abhiyan in Indore City'. It is a study in which after screening of exclusion and inclusion criteria and after taking consent, samples are taken for two groups which includes 91 sweepers and 121 non-sweepers by arranging 4 camps in Nagar Nigam, Indore placed in Rajwada. Conclusion of this study shows that occupational exposure of dust has impact on lungs of sweepers of Nagar Nigam Indore, because all sweepers are diagnosed for having Obstructive Lung Diseases and in sweepers there is signicant low value of Maximum Voluntary Ventilation (MVV) and their Dyspneic Index (DI) is on border line for manifesting dyspnoea, as compared to non-sweepers of Nagar Nigam Indore. Both groups are working minimum of at least 1 year in Nagar nigam Indore.

Objectives: The objective is to determine utility of SAPS II, APACHE II, SAPS III, and APACHE IV scoring system in assessing outcome in mechanically ventilated patients in respiratory intensive care unit and to predict duration of mechanical ventilation (MV). Materials and Methods: A prospective observational study where 83 mechanically ventilated patients were grouped into Group 1 (n1 = 40, NIV) and Group 2 (n2 = 43, Invasive ventilation) was conducted. SAPS II, APACHE II, SAPS III, and APACHE IV scores based predicted mortality (PM) were collected at day 1, and day 3. Outcomes (on day 7) were grouped into negative and positive. (NIV-negative outcome = Home NIV, intubation or death; positive outcome = NIV free. Invasive group-positive outcome = Extubation; negative outcome = Death). Binary logistic regression was applied to predict duration of MV (> or < 5 days). Results: The data were analyzed using SPSS version 17.0 trials comparisons of PM on day 1 with SAPS II (P < 0.05) and APACHE IV (P < 0.007) were significant predictors of clinical outcomes in Group 1 where as in Group 2, none of the system could predict significantly. On day 3, Group 1 analysis revealed SAPS II (P < 0.002), SAPS III (P < 0.03), and APACHE IV (P < 0.004) based PM as significant predictors of outcome. APACHE II (P < 0.05) and APACHE IV (P < 0.02) PM were significant in Group 2. On day 3, APACHE IV could significantly predict (P < 0.05) duration of MV (>5 or < 5) while A-a gradient (P < 0.09) predicted poorly in Group 1. In Group 2, APACHE IV was a poor predictor (P < 0.09). Two full logistic regression models were also formulated for both the groups. Conclusion: Study concludes that day 3 severity scores are more significant predictors of outcome and duration. APACHE IV scoring system was found more effective than other systems, not only significantly differentiating outcomes of MV but also predicting duration of NIV.

Background: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms. Methods: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms. Results: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days. Conclusion: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.

ObjectiveLarge data on the clinical characteristics and outcome of COVID-19 in the Indian population are scarce. We analysed the factors associated with mortality in a cohort of moderately and severely ill patients with COVID-19 enrolled in a randomised trial on convalescent plasma.DesignSecondary analysis of data from a Phase II, Open Label, Randomized Controlled Trial to Assess the Safety and Efficacy of Convalescent Plasma to Limit COVID-19 Associated Complications in Moderate Disease.Setting39 public and private hospitals across India during the study period from 22 April to 14 July 2020.ParticipantsOf the 464 patients recruited, two were lost to follow-up, nine withdrew consent and two patients did not receive the intervention after randomisation. The cohort of 451 participants with known outcome at 28 days was analysed.Primary outcome measureFactors associated with all-cause mortality at 28 days after enrolment.ResultsThe mean (SD) age was 51±12.4 years; 76.7% were males. Admission Sequential Organ Failure Assessment score was 2.4±1.1. Non-invasive ventilation, invasive ventilation and vasopressor therapy were required in 98.9%, 8.4% and 4.0%, respectively. The 28-day mortality was 14.4%. Median time from symptom onset to hospital admission was similar in survivors (4 days; IQR 3–7) and non-survivors (4 days; IQR 3–6). Patients with two or more comorbidities had 2.25 (95% CI 1.18 to 4.29, p=0.014) times risk of death. When compared with survivors, admission interleukin-6 levels were higher (p2/FiO2 ratio 10 (9.97, 3.65–27.13, p1.0 mg/L (2.50, 1.14–5.48, p=0.022), ferritin ≥500 ng/mL (2.67, 1.44–4.96, p=0.002) and lactate dehydrogenase ≥450 IU/L (2.96, 1.60–5.45, p=0.001) were significantly associated with death.ConclusionIn this cohort of moderately and severely ill patients with COVID-19, severity of illness, underlying comorbidities and elevated levels of inflammatory markers were significantly associated with death.Trial registration numberCTRI/2020/04/024775.

ObjectivesConvalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19.DesignOpen-label, parallel-arm, phase II, multicentre, randomized controlled trial.SettingThirty-nine public and private hospitals across India.ParticipantsHospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 ≤ 93% on room air).InterventionParticipants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm.Main Outcome MeasureComposite of progression to severe disease (PaO2/FiO2< 100) or all-cause mortality at 28 days post-enrolment.ResultsBetween 22ndApril to 14thJuly 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: −0.61 to 1.83].InterpretationCP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19.Trial registrationThe trial was registered with Clinical Trial Registry of India (CTRI); CTRI/2020/04/024775.

The knowledge about the presenting characteristics, comorbidity, and outcomes of Indian patients for COVID-19 is limited.To describe the clinical characteristics and outcomes of COVID-19 patients in Central India and to evaluate risk factors leading to requirement of oxygen, mechanical ventilation and mortality.In this retrospective, we included 365 RT-PCR confirmed cases of 2019-nCoV in Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh from March 25, 2020 to May 15, 2020.A total of 365 patients - 329 adults (Median age 49 years, 58.66% males) and 36 pediatric patients (Median age 10.5 years) were included. There was presence of comorbidity in 47.11% adults with most common being hypertension (24.92%), and diabetes (25.18%). 45.28% of adult patients were asymptomatic at presentation, with fever as the most common symptom (38.29%) and epidemiological contact history present in 69.90%. During hospitalization, 14.52% adults (median age, 50 years; 49.05% male) were on oxygen support, and 13% received mechanical ventilation (median age, 54 years; 63.26% male). As of May 15 2020, 8.4% adult patients died(median age, 57 years; 67.74% male). Presence of Lymphopenia, and Comorbid condition were identified as risk factors for requirement of oxygen, mechanical Ventilation and death.This case series provides characteristics and outcomes of COVID-19 patients in Indore region.

In this write-up, we report a case of persistent hemoptysis after percutaneous transluminal coronary angioplasty (PTCA), which was diagnosed as diffuse alveolar hemorrhage (DAH). DAH is a life-threatening medical emergency that can be caused by numerous disorders and it, further, presents with hemoptysis, anemia, and diffuse alveolar infiltrates. Early diagnosis is usually required for this noninfectious cause in post PTCA patient, as it is very rare complication.

Here, we report a case of the right tracheal bronchus that presented with a right upper and middle lobe consolidation and a mild pleural effusion. Bronchoscopy revealed a right upper lobe bronchus arising from trachea. On a high suspicion of pulmonary Koch’s, antitubercular drug was started to which she responded well and was cured.

Mortality in patients with pulmonary tuberculosis remains high, especially in those who develop acute respiratory distress syndrome (ARDS). We herein, report a case of 40 year old female, with ARDS due to severe pulmonary tuberculosis. She was admitted in the intensive care unit of a tertiary care centre. Owing to very poor ABG report, she was intubated and put on Mechanical ventilator support. Bronchoscopy was performed and BAL was extracted, which showed no growth. Further deterioration of gas exchange prompted the decision to put her on ECMO. During her stay on ECMO, she developed massive inta-alveolar hemorrhage following which repeated bronchoscopic interventions were done to remove blood clots. BAL extracted on day 4 and day 8 showed growth of A. baumannii and K. pneumoniae respectively. But BALGeneXpert on day 8 came out to be positive for Mycobacterium Tuberculosis and subsequently ATT was added to her treatment regimen. Her alveolar hemorrhage continued to worsen and subsequently ECMO was removed. After 12 days of hospitalization, she went on to develop bradycardia and could not be rescued. Though the patient's life was lost, this case provided many insights on the use of ECMO in the management of ARDS due to Pulmonary tuberculosis and it should be considered as one of the treatment options.

The first case of relapsing polychondritis (RP) was described in 1923, and yet it remains a “medical mystery”, a much “overlooked” entity. It is an uncommon systemic disorder causing inflammation of cartilage affecting ear, nose, laryngotracheobronchial tree, eyes, joints, heart, blood vessels, kidney, and skin. Being a rheumatological entity presenting with ear and joint involvement most frequently, these patients land up in Otolaryngology and Rheumatology clinics mostly, though tracheobronchial involvement is among the most serious manifestation causing substantial morbidity and mortality. Herein, we report a case of RP and discuss available diagnostic techniques and airway interventions under the ambit of a pulmonologist, as airway involvement severely limits its prognosis.

Urinothorax is a very rare occurrence of urine in the pleural space. Urinothorax can occur as a consequence to percutaneous nephrolithotomy (PCNL), ureterorenoscopic lithotripsy (URSL) or shock wave lithotripsy (SWL). We herewith report a rare case of Urinothorax in a 35 years old male patient and discuss its current knowhow and clinical management.

Cryptic tuberculosis is a rare and atypical clinical presentation of disseminated hematogenously spread tuberculosis, in which the usual diagnostic criteria for tuberculosis, especially the roentgenographic evidence, are lacking. Here we report a case of an elderly female with prolonged respiratory distress, persistent anaemia, with thrombocytopenia and hypoproteinaemia; inspite of long term treatment and normal X-ray chest. Diagnosis of cryptic tuberculosis was established only after histopathology report of a late appearing axillary lymph node during the course of treatment. The incidence of these occult forms of tuberculosis, where diagnosis is often established too late or entirely missed, is significant. This possibility must be kept in mind in severe infectious conditions and pyrexia of unknown origin without obvious aetiology.

Bronchsocopy is an integral part of the diagnostic armamentarium of a clinician in diagnosing and typing lung malignancy. The ability of sampling and visualizing lung lesions with a bronchoscope in a single procedure with the use of bronchial washing, brushing & biopsy. Our study performed in a tertiary care setting medical college revealed a higher yield with both procedures done simultaneously rather than individually. Individually biopsies give a higher yield as compared to brushings.

Tuberculosis remains a prominent cause of social stigma and is predominantly associated with lower socio economic strata and illiteracy. Predominantly male subjects were identified in both RNTCP & Non RNTCP groups with non RNTCP groups comprised mostly of the literate and higher socio economic strata & RNTCP groups of the literate and lower socio economic population . The female population of the RNTCP group was predominantly illiterate and from the lower socio economic strata

Extensive clinical experience has shown that rifampicin is well tolerated, but on rare occasions, it can cause life-threatening adverse reactions such as acute renal failure and thrombocytopenia. Throbocytopenia is mostly encountered with isoniazid and pyrazinamide. Rifampicin is an essential component of the treatment regimen for tuberculosis. We are reporting a case of rifampicin-induced thrombocytopenia which was being treated for pulmonary tuberculosis. The physician treating tuberculosis patients must be aware of this rare life-threatening complication.

Insurgence of Maggot's is an uncommon feature of colostomy site. Maggots' infestation has been reported over sites like nose, ear, orbit, tracheotomy wound, face, gums and serous cavities. We report a case of maggots infestation surrounding the colostomy site, which to the best of our knowledge, is the first reported case in the review of the literature. A patient of advanced inoperable adenocarcinoma rectum presented with complaints of constant vague pain, discomfort and foul smelling discharge over colostomy site. On exploration, maggots were identified as the cause and patient was relieved of his agony by their meticulous eradication. We emphasize that Stoma Care should be constantly monitored to prevent Maggot infestation and prevention counseling should be included in the stoma care protocol in tropical countries.

The epidemiologic evidence linking COPD and cardiovascular morbidity and mortality is strong. Even after adjustments for traditional cardiovascular risk factors such as serum total cholesterol Hypertension, obesity and smoking, patients with COPD have a two- to threefold increase in the Risk of cardiovascular events including death. We concluded that more severe the stage of COPD more is the risk of cardiovascular morbidity & mortality. Stable COPD patients are 1.5 (males) & 1.4 (females) times at risk to develop cardiovascular disease as compared to the general population. Among the established risk factors studied: - Age> 60 yrs, Positive Smoking History, Left Ventricular Hypertrophy, and Body Mass Index > 30 Kg/M2 are found in a statistical significant correlation with progressively worsening stages of COPD.A positive but statistically insignificant correlation was demonstrable between the family history of cardiovascular disease in first degree relatives of Stable COPD patients, and increasing cardiovascular morbidity & mortality. In stable COPD patients, Systemic hypertension with resultant Left ventricular Hypertrophy predisposes the patient to an increased risk of Myocardial infarction & correspondingly increased CVS morbidity & mortality. Progressively decreasing FEV1, decreasing FVC, decreasing FEV1/FVC ratio, have a statistically significant correlation to cardiovascular mortality & morbidity. Se CRP levels provide an accurate indicator for assessment of severity of cardiovascular morbidity & mortality in Stable COPD patients. Significant correlations were demonstrated between the treatment that patient requires for stability & cardiovascular disease. Patients on Home Oxygen therapy, oral steroids & bronchodilators despite being Stable COPD should be under closer surveillance for cardiovascular complications. Cardiovascular disease is an important but underrated cause of COPD morbidity & mortality .Hence should be addressed to improve overall disease outcome.

Total of 104 patients were studied with an average age of 47.952 + 16.9112, with 77% of the patients being male. The maximum no of patient were of the middle aged adult males age group 31 - 40.The study comprised of 104 individuals of which 79 patients were males and 25 were females. The average weight of the 104 patients was 68.615 kg . The body mass index of our patients had a mean of 26.146 with a minimum BMI of 14.382 a maximum BMI of 48.828. Forced expiratory volume in 1 st second in our OBESE asthmatics was 1.78 ± 0.8150.& Forced vital capacity in the obese group was 2.102 ± 0.8638 .FEV1% was > 70 % in all the patients of the study population demonstrating no fixed airflow limitation in patients of our study population . ERV in the obese groups was .441 ± 0.2190 liters. The inspiratory capacity in the obese group was 1.771 ± 0.6628 liters . No significant statistical correlation was demonstrated in between the obese and no obese group . Significant correlation was demonstrated between BMI & Waist Circumference. BMI correlated with FEV1, FVC, FEV1% in the study population and a negative correlation was demonstrable. A statistically significant co relation could not be established between BMI & the dynamic spirometric variables. BMI correlated with ERV & VC in the study population and a negative correlation was demonstrable. A statistically significant co relation could not be established between BMI & the static spirometric variables. Waist circumference correlated with the FEV1, FVC, FEV1% in the study population and a negative correlation was demonstrable. A statistically significant co relation could not be established between waist circumference & the dynamic spirometric variables. Waist circumference correlated with ERV & VC in the study population and a negative correlation was demonstrable. A statistically significant co relation could not be established between waist circumference & the static spirometric variables.

To determine the effect of adjunct therapy, we carried out a prospective cohort study on 190 patients with tuberculous pleural effusion during May 2003–April 2004. Patients were divided into 3 groups. All groups were treated with anti-tuberculosis (TB) drugs for 6 months; in group 2 (n = 46) prednisolone, 30 mg/day for 10 days, was added; group 3 (n = 78) were given paracentesis to remove fluid. Fever and constitutional symptoms disappeared faster in group 2 (P > 0.05). After 10 days, there was a significantly greater reduction in the size of pleural effusion in group 2, but after 6 months the difference was not statistically significant. We found steroids and therapeutic paracentesis are not necessary in the management of TB pleural effusion.

Background: The six-minute walk test is one of the most powerful test used to measure the functional capacity in various chronic conditions such as in Obesity. There are very few reported studies on SMWT on Obese population all over the world, and there is no reference equation for SMWD. The aim of present study is to propose a Reference equation which could predict the distance walked in SMWT by obese individuals.Methods: 150 obese individuals free from any cardiorespiratory disease were randomized into 2 groups. SMWT data from group A was used to propose the reference equation and SMWD for Group B was predicted. Significance of difference between predicted and original values for group B was found.Results: Mean SMWD for Group A was 304.56 (SD= 68.28) which significantly correlated to (by using linear regression method) age (r = -0.32, p