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Objectives An impaired exercise tolerance, the main feature in chronic obstructive pulmonary disease (COPD), occurs due to multiple factors. The 6-minute walk test (6MWT) is easy to perform, well-tolerated, and more reflective of activities of daily living. The facility of spirometry is unavailable in many areas of India, where 6MWT can be done easily. This study aims to compare the six-minute walk distance (6MWD) with various demographic, clinical, and spirometry parameters. Materials and Methods A total of 118 consecutive stable COPD patients fitting the criteria were included in the study. Spirometry was performed in these patients before and after giving a short-acting bronchodilator. 6MWT was performed according to the ATS guidelines. All patients underwent the 6MWT after 10 minutes of spirometry. Statistical analysis was done using GraphPad calculator and SPSS 24.0. Statistical Analysis All data were clubbed together in a single Excel chart. Statistical analysis was done using SPSS 24.0. Descriptive data are presented as mean ± standard deviation (SD). Qualitative data are presented as a percentage. Analysis of variance (ANOVA) was used to compare between means. The linear regression model was used to compare between variables. A p-value less than 0.05 was considered significant. Results The majority of the patients were > 60 years of age (mean age = 62.99 ± 6.68 years) and comprised males and females in the ratio 5.9:1. Smoking was determined to be the most important predisposing factor for the development of COPD. There was a significant negative correlation between 6MWD, age, and smoking index (p = 0.0075 and 0.0295 respectively). The 6MWD showed a significant positive correlation with FEV1 (in liters), FEV1 (%), FVC (in liters), and FVC (%). The 6MWD (meters) and % predicted 6MWD showed a significant negative correlation with a drop in SpO2 after the 6MWT (r = –0.36; p = 0.000769, r = –0.3; p = 0.004, respectively). Conclusion 6MWT can be used in cases of COPD where spirometry is unavailable as it correlates significantly with various parameters of the latter.

Introduction Toward the end of 2019, a novel coronavirus was identified as the causative organism of a cluster of pneumonia cases in Wuhan, China, spreading rapidly resulting in an epidemic throughout China, followed by a global pandemic. The initial radiological findings of coronavirus disease 2019 (COVID-19) pneumonia at the early stage on a computed tomography (CT) scan include multiple small patchy shadows and interstitial inflammation, predominantly distributed in the peripheral one-third of the lungs. Gradually, it develops into multiple ground glass opacities and infiltrates in the lungs. Furthermore, pulmonary consolidation is observed, but pleural effusion is rare. Objective From time of presentation to complete recovery, CT scans show significant morphological changes in the lesions, but very few literatures have reported cavitary lesion in the lungs. We present the case of a 64-year-old patient with COVID-19 pneumonia who had typical manifestations of the disease on a CT scan along with constantly changing small cavity in the lung. Discussion Delayed cavitation is a rarely described radiological manifestation of COVID-19. Atypical presentations of COVID-19 raise possibility of other infections or additional diagnoses. Bacterial and fungal infection should be excluded, as well as cavity-causing organisms. Although the proper mechanism of cavitation in COVID-19 pneumonia is not known, it may be due to intra- alveolar hemorrhage, diffuse alveolar damage, and necrosis of parenchymal cells based on findings of autopsy reports. Early and late complications associated with COVID-19 are yet to be defined. Conclusion Common causes of cavitary lesions must be investigated properly in all patients. Most cases are self-limited hence managed conservatively. The clinical spectrum of disease due to COVID-19 continues to evolve. Physicians must be aware of evolving radiological findings of COVID-19 and must conduct regular follow-up of convalescent patients with COVID-19 to ensure complete recovery.

Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation.It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical ResearchOut of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms such as Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates

BACKGROUND The Covid-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a public health challenge being faced by the world currently. International and national responses to combat the Covid-19 pandemic have been very prompt with the setting up of dedicated Covid-19 hospitals. In the state of Odisha, situated in the eastern part of India, Kalinga Institute of Medical Sciences (KIMS), set up the first dedicated Covid hospital of the state. This study intends to chronicle the clinical profile, radiological presentations, laboratory findings, and clinical outcome of patients admitted to the KIMS Covid hospital. METHODS A retrospective analysis of the clinical and laboratory data of patients admitted with Covid-19 diagnosis at the dedicated Covid-19 hospital from 5th April 2020 to 4th June 2020 was done. RESULTS A total number of 272 Covid-19 cases were included in this study. Majority of the patients were males (83.57 %) and most of the patients (79.04 %) were asymptomatic. The mortality rate was 1.9 %. Fever (18.38 %), cough (17.27 %), dyspnoea (16.91 %) and myalgia (14.7 %) were the major symptoms observed. Severity was mild in 78.94 % cases. Delayed viral clearance was seen in 13 % cases. The typical features of novel SARS-CoV-2 infection was seen in 12 - 13 % cases in computed tomography (CT) images of thorax. c-reactive protein (CRP) was raised as a biomarker of inflammation. Of the 5 deaths encountered, 2 had diabetes mellitus, 2 were hypertensive and 1 had chronic obstructive pulmonary disease (COPD). CONCLUSIONS Covid-19 may have a delayed viral clearance beyond two weeks. A discordance between CT images and the clinical condition may also be observed. Diabetes, hypertension, and high blood CRP levels were significantly associated with mortality. KEYWORDS Covid-19, SARS-CoV-2, Clinical Profile, Radiological Findings, Comorbidities, Fatality

Introduction: Pulmonary hypertension and other cardiac complications occur frequently due to chronic hypoxia induced by interstitial lung diseases (ILD) or due to connective tissue disorder itself. Two-dimensional (2D) echocardiography is ideal for identifying abnormalities at a given time. In this study, we tried to detect cardiovascular complications in patients with ILD using 2D echocardiography and correlate them with a 6-minute walk test (6 MWT) and spirometry. Materials and Methods: This study was carried out for 18 months including 100 consecutive cases of ILD. The diagnosis was made using the latest criteria as per the disease and high-resolution computed tomography (HRCT) thorax. All patients were evaluated with 2D echocardiography, 6 MWT, and spirometry along with routine investigations. Their results were analyzed using STATA 15.1 software. Result: Cardiovascular involvement was detected in 68% of cases. Pulmonary hypertension predominated with a prevalence of 50%. In spirometry, mean Forced expiratory volume in first second (FEV1)and Forced vital capacity (FVC) were found to be 54.96 (L) and 53.49 (L), respectively, with a predominant restrictive pattern (89%). There was a significant correlation between baseline saturation of oxygen (SpO2) and pulmonary arterial systolic pressure (PASP) with a P value of

Introduction More than 80 million people have been infected with coronavirus disease 2019 (COVID-19) infection worldwide till date with more than 17,00000 fatalities. Although COVID-19 commonly affects respiratory system in the form of cough and dyspnea, a neurotropic presentation has been described in one-third of patients. Objective We report an atypical case of COVID-19 with mild symptoms who presented to our hospital with features suggestive of severe Guillain-Barré syndrome (GBS). Discussion The mechanisms by which severe acute respiratory syndrome coronavirus 2 causes neurologic damage are multifactorial, including direct damage to specific receptors, cytokine-mediated injury, secondary hypoxia, and retrograde travel along nerve fibers. The pathogenesis of GBS secondary to COVID-19 is not yet well understood. It is hypothesized that viral illnesses-related GBS could be mediated due to autoantibodies or direct neurotoxic effects of viruses. Conclusion In this ongoing era of pandemic, it is very important for the clinicians to be aware of association of GBS with COVID-19, as early diagnosis and treatment of this complication could have gratifying results. It is also very important to differentiate GBS from critical illness neuropathy and respiratory distress secondary to COVID-19 itself, as treatment to the above conditions is quite different and inability to correctly diagnose could lead to significant increase in morbidity and mortality.

Bronchopleural fistula (BPF) is an uncommon entity in patients with coronavirus disease 2019 (COVID-19). It may arise due to various causes ranging from the disease itself to complications of treatment. If left untreated, it may increase the morbidity, hospital stay, and adversely affect the outcome. We hereby present a series of cases with a persistent pneumothorax and associated BPF due to varying etiologies. While three of our cases developed a pneumothorax while on non-invasive ventilation, other three were on oxygen therapy. One patient developed a spontaneous pyopneumothorax and septicemia and succumbed to the complications. Another patient on non-invasive ventilation died due to complications of pregnancy. The management of each case varied depending on their clinical presentation.

Background: Healthcare associated pneumonia (HCAP) is a public health problem in the era of home care of chronic illness including chronic renal disease. They have greater burden of comorbidities, immune suppression and impaired mobility. Aim of the Study: To characterise the clinical, radiological and microbiological profile of health care associated pneumonia in chronic renal disease cases including its resistance pattern and outcome in the study population. Materials and Methods: This prospective study was conducted among patients with chronic kidney disease (CKD) who had been treated in multiple hospitals across Odisha. They were subjected to history taking, clinical examination, laboratory and radiological investigations. Sputum or endotracheal tube culture were sent for gram stain and aerobic culture. All the categorical parameters were compared using Fisher’s exact test. Continuous parameters were compared using independent t-test. All the statistical analysis was carried out using the software Stata 15.1. A p-value less than 0.05 was considered significant. Results: 58 patients with an underlying chronic kidney disease were included. 54 (93.1%%) patients survived while 4 (6.9%) died. The mean age, total leucocyte count and serum urea levels were higher among patients who died in comparison to the survivors (p= 0.95, 0.334 and 0.386 respectively). Klebsiella spp (12.07%), and Acinetobacter (8.6%) were most commonly isolated. Multi-drug resistance (MDR) and extensive drug resistance (XDR) were encountered among these organisms. Death was more commonly associated in patients ≥60yrs (p= 1), TLC ≥ 11000 cells/mm3 (p= 0.0091), serum creatinine ≥ 3mg/dl (p= 0.329) and radiological involvement of ≥ 3zones (p= 1). Conclusion: CKD is an important contributor in HCAP. Data from different institutions to corroborate our findings regarding antibiotic resistance pattern of the microbes in HCAP cases is recommended.

Objective: To study the prevalence and pattern of infections causing exacerbations of obstructive airway diseases. Methods: A prospective cross sectional study which included 126 consecutive obstructive airway disease patients were enrolled for the study. All the included patients were subjected to detailed history, clinical examination and routine investigations including sputum Gram’s stain and aerobic culture after obtaining a written informed consent. Pharyngeal swab was collected and sent in Viral Transport Medium(VTM, Himedia) within 24hrs to Regional Medical Research Centre (ICMR),Bhubaneswar for detection of respiratory viruses. Samples were tested by Real Time reverse-transcription polymerase chain reaction (RT-PCR). Results: Among patients with COPD, Flu A/H3N2(9.375%) was found in highest number of patients followed by rhinovirus(7.3%). In bronchial asthma patients,virus was isolated only in 3 cases(13.6%).No virus was detected in bronchiectasis patients. Isolated bacterial infection was detected in 26 cases (20.63%).Acinetobacter baumanii and Klesiella pneumoniae were most common bacterial pathogens detected.Bacterial pathogens were commonly isolated among COPD patients.Co-infection with both bacteria and virus was detected in 12 patients (9.52%)of which 11 were diagnosed with COPD. Only 1 case of bronchial asthma reported a co-infection.Among cases with co-infection with both bacteria and virus,Acinetobacter baumanii and Pseudomonas aeruginosa were found to be most common bacterial pathogens.There was no typical pattern in viral infection among the cases throughout the year. Conclusion: The risk of exacerbation due to viral etiology is perennial but might be self limiting. Recovery from exacerbation takes a long time and patients with exacerbations have an impaired quality of life, diminished exercise capacity and loss of lung function.

Background: Tuberculosis in children reflects the prevalence of disease in adults and current transmission rate in the community. Infants and young children are more likely to develop life-threatening forms of TB than adults due to their immature immune systems. Aims and Objectives: To study the various types of presentations of tuberculosis in children and to determine the outcome of fixed dose combination ATT in this group. Materials and Methods: All newly diagnosed cases of TB or EPTB in children ≤18 years of age who were initiated on daily regimen were included in the study. The children were evaluated with clinical and radiological investigations before initiation of ATT and followed up at the end of intensive and continuation phase. Results: A total of 105 children were included in the study; M:F-1.28:1. Pulmonary tuberculosis was the most common [37(35.23%)] followed by TB lymphadenitis [33 cases (31.42%)]. Disseminated TB was detected in 20 (0.95%) cases and TB pleural effusion in 9 (8.57%). 80 patients completed CP. 69 patients (75.8%) reported a weight gain at the end of IP while 63 (78.75%) patients reported weight gain at the end of CP. 4 patients had deranged LFT during treatment. 3 (2.85%) patients reported raised uric acid levels &1 (0.95%) patient developed optic atrophy. 7 (6.66%) patients with lymphadenitis and 4 (3.8%) with pulmonary TB required extension of CP phase based on the clinical and radiological assessment. Conclusion: Daily Regimen of ATT has proved to be of great benefit in both pulmonary and extra-pulmonary tuberculosis. However in conditions like TB lymphadenitis, children are requiring extension of regimen.

BACKGROUND The study was carried out during July 2017 through October 2017 when there was a seasonal epidemic of influenza like illness (ILI) in Odisha. MATERIALS AND METHODS We collected data of 36 cases confirmed out of 152 suspected cases by reverse - transcriptase - polymerase chain assay of sampling of nasopharyngeal swab or pharyngeal secretions at Regional Medical Research Centre (ICMR), Bhubaneswar from clinical presentations of influenza illness. RESULTS Results of the 36 confirmed patients studied, 9 were influenza A positive H1N1neg and 27 influenza A & H1N1 (swine flu) positive. 22.2% of cases were below 19 yrs., whereas those above 60yrs in both groups were 33.3% and 25.9% respectively. In the H1N1 positive cases, diabetes mellitus and cardiovascular disease each constituted 18.5% amongst the comorbidities. All cases underwent chest radiography on admission. Bronchovascular prominence and bilateral consolidation were most frequently observed (37.1 & 33.3% respectively). HRCT performed in cases having normal chest X-ray revealed tree in bud and nodular pattern. Out of the total confirmed cases, 4 died (11.1%). Qualitative risk factors like renal failure, sepsis and ARDS were associated with mortality (p value< 0.05). Quantitative risk factors like low mean arterial pressure and raised serum creatinine were associated with mortality (p

BACKGROUND Chronic obstructive pulmonary disease is a collection of conditions characterised by persistent airflow limitation. It is recognised as an important cause of global burden of Non-Communicable Diseases (NCDs). Being a multicomponent disease characterised by abnormal inflammatory response of the lungs with systemic muscle dysfunction, a growing body of evidence has suggested a role of magnesium in exacerbations of COPD. Magnesium, owing to its ability to alleviate bronchospasm may have a role in maintaining disease stability in COPD patients. In the current study, we hypothesised that basal serum magnesium level must have some role in airway homeostasis and that a dysregulation results in decompensation. MATERIALS AND METHODS The study was conducted in the Department of Pulmonary Medicine, S.C.B. Medical College and Hospital, Cuttack, during the period of October 2012 to September 2014 and was designed on a case-control model with 40 patients in each group. RESULTS Patients with acute exacerbation of COPD had a mean serum magnesium level of 1.88 ± 0.19 mg/dL (95%, CI). Among the stable COPD patients, the mean serum magnesium level was 2.0625 ± 0.18 mg/dL (95%, CI) (p

There is a paucity of data from clinical trials in extrapulmonary tuberculosis(EPTB) and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. The Xpert MTB/RIF assay or Cartridge Based Nucleic Acid Amplification Test(CBNAAT) is a semi-automated, molecular assay, which permits rapid TB diagnosis through detection of the DNA of Mycobacterium tuberculosis. We through our study wanted to highlight the role of CBNAAT in the rapid diagnosis of EPTB. We admitted all cases with suspected EPTB during the period September,2017 to December,2018. Specific samples were collected from the patients and were forwarded to Regional Medical Research Centre (ICMR) through cold chain where they were processed and taken up for CBNAAT and culture in Lowenstein-Jensen(L-J) media. Appropriate samples were sent to our RNTCP laboratory for AFB smear examination. We compared the accuracy of CBNAAT in relation to clinical diagnosis, AFB smear and L-J culture. We examined 191 samples during the period. Pleural fluid was the most common sample(30.9%) collected followed by lymph node aspirate(24.6%). The overall sensitivity and specificity of CBNAAT was determined to be 26.77%(95% CI 19.31%-35.35%) and 100%(95% CI 94.40%-100%). The low sensitivity could be due to the low sample size and majority of the sample being pleural fluid. The sensitivity and specificity of CBNAAT in relation to mycobacterial culture, however, was 76.47%(95% CI 50.1%-93.19%) and 87.93%(95% CI 82.14%-92.37%) respectively. The sensitivity and specificity of CBNAAT was at par in comparison to mycobacterial culture. However, both were highest for lymph node aspirate and pus samples and may be recommended in initial diagnosis in these cases.

Esophago-pleural fistula (EPF) is an uncommon condition, despite of an anatomical proximity of these structures. Causes of EPF include pneumonectomy for suppurative or tubercular disease of lung and carcinoma lung, malignancy of esophagus. Benign EPF is rare and may be due to trauma or infection. The most common infectious cause is tuberculosis. Spontaneous development of fistula between esophagus and pleura is rarely described in literature. We, hereby present a spontaneous case of such a rare entity in a middle-aged male.

Osteomyelitis is an infection of the bones caused by pyogenic organisms. The ribs are an extremely uncommon site for osteomyelitis, occurring in less than 1% cases. The main causative organisms are Gram-positive bacteria, such as Staphylococcus aureus and Hemophilus influenzae. Gram-negative bacteria like E. coli have been rarely reported. Authors hereby present a case of an immune-competent patient who presented with an osteomyelitis of the ribs caused by the latter. In developing countries, tuberculosis is considered as the primary cause of osteomyelitis and pleural effusions. However, other organisms should also be considered in patients who present with fulminant infections.

Background: Healthcare Associated Infections (HCAI) are associated with longer hospitalisations and increased morbidity and mortality. Lower respiratory infections including Pneumonia is an entity among healthcare associated infections mostly witnessed in nursing home residents, patients on long term care and patients receiving home or hospital based intravenous therapy and undergoing dialysis. Aim of the study to assess the prevalence and risk factors of resistance among the patients developing lower respiratory infections as a consequence of Healthcare Associated Infection.Methods: The study was conducted as a prospective cohort model. All the eligible patients were subjected to detailed history taking, clinical examination, laboratory and radiological investigations. All the categorical parameters were compared using Fisher’s exact test. Continuous parameters were compared using independent t-test. All the statistical analysis was carried out using the software Stata 15.1.Results: Majority of the patients were older than 60 yrs (73%). Death was significantly seen in persons under 60 years and associated pulmonary consolidation equal to or more than three zones (p

Background: Diagnosis of Extra-pulmonary TB (EPTB) is a challenge. Authors wanted to assess the sites of extra-pulmonary involvement during 2013-2017 in a tertiary care hospital cum medical college. Authors also wanted to evaluate the role of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in diagnosis of EPTB and compare its efficacy with AFB Culture.Methods: Total 470 EPTB cases diagnosed between 2013 and 2017 from 840 TB treatment records maintained in designated microscopy centre. Specific samples from appropriate sites were taken up for smear for AFB, CBNAAT and AFB culture.Results: There was incremental detection and registration in both TB and EPTB cases from 96 and 50 cases in 2013 to 246 and 150 cases in 2017 respectively. Among the total 470 EPTB cases in 2013-2017 (55.9%), lymph node followed by pleura and abdomen were the organs having maximum involvement. Bone involvement was more witnessed in adult male than children (p

Background: Onset of tuberculosis is high among diabetic mellitus patients in relation to non-diabetic patients. Due to weakened immune system there is a greater risk of tuberculosis seen among type 2 diabetes mellitus patients. As a result, affected patients have difficulty in responding to any kind of treatment when compared to healthy individuals. The objective was to study the clinical and radiological profile of pulmonary tuberculosis among patients having diabetes mellitus (DM). Methods: The study was conducted at the department of pulmonary medicine, in a tertiary health care centre in Eastern India. The study included smear positive pulmonary tuberculosis (PTB) patients with diabetes mellitus and the patients who were smear positive for pulmonary tuberculosis (control group) who met the criteria to participate in the study after a thorough examination. Informed written consent was obtained from all patients before enrolment. Results: A total of 80 patients (15 to 65 years and above) were enrolled in the study with equal numbers being diagnosed with diabetes who had elevated blood sugar values (refer to Table 1). Classical clinical signs were totally correlated with radiography and 57.5% cases showed pulmonary lesions. Among the radiological findings, infiltration was most common in both groups, but more significant in PTB DM group (75 %) followed by cavity (52.5%) in PTB DM group. Conclusions: It can be concluded from the study that in diabetic patients the pattern of pulmonary tuberculosis was significantly different from non-diabetic patients. Pre-treatment bacillary load was high in diabetic patients with pulmonary tuberculosis.