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1. Personal exposures to particulate matter

Author

Rohan Shah, Sneha Limaye, Dhammasagar Ujagare, Sapna Madas, and Sundeep Salvi

Subjects
Air pollution, firecrackers, particulate matter, public health, Diseases of the respiratory system, RC705-779
Abstract

Introduction: Diwali or the festival of lights is the most popular festival celebrated in India when firecrackers are burnt by almost every household for 3 days. Levels of ambient air pollution are reported to be very high during the Diwali festival in India. In this study, we aimed to measure and compare the personal exposure levels to particulate matter

Published
2019
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2. Factors influencing severity of community-acquired pneumonia

Author

M Mahendra, B S Jayaraj, Sneha Limaye, S K Chaya, Raja Dhar, and P A Mahesh

Subjects
Community-acquired pneumonia, CURB-65, global initiative for methicillin-resistant Staphylococcus aureus pneumonia, methicillin-resistant Staphylococcus aureus, Pneumonia, Diseases of the respiratory system, RC705-779
Abstract

Introduction: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in India. There is a need to understand the risk factors associated with severity of CAP in our population. This study was part of the international global initiative for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia study to evaluate MRSA. Methods: A total of 100 consecutive cases of pneumonia admitted to the Department of Pulmonary Medicine in a tertiary care hospital were recruited in the study during March–July 2015. The severity of pneumonia was assessed based on the CURB-65 score. Individuals with pneumonia and CURB-65 score >2 were compared with subjects with CURB-65 score ≤2. Individuals were also evaluated for the causative organism and its resistance pattern with specific reference to the presence of MRSA. Results: Mean age of patients was 54.03 years, 66% were men. Patients were managed either in the intensive care unit (42%) or wards/high dependency unit (58%), 22% needed noninvasive ventilation and 18% needed mechanical ventilation within 24 h of admission. On multivariate analysis, prior respiratory infection (within last 1 year), obesity (body mass index >30), and alcoholism, old age (>60 years) were independently associated risk factors for severe pneumonia. There were no cases of MRSA. In 34% of cases, organisms could be identified. Most common organisms were Klebsiella (8%), influenza (8%), and Pseudomonas (5%). Conclusion: Prior respiratory infection, obesity, alcoholism, and old age (>60 years) were observed to be important risk factors for severe CAP. Prospective studies should evaluate effect of weight reduction and cessation of alcohol consumption on recurrences of pneumonia in this population and on the severity of pneumonia.

Published
2018
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3. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

Author

Raja Dhar, MD, Sheetu Singh, MD, Deepak Talwar, MD, Murali Mohan, ProfMD, Surya Kant Tripathi, MD, Rajesh Swarnakar, DNB, Sonali Trivedi, DNB, Srinivas Rajagopala, ProfMD, George D'Souza, MD, Arjun Padmanabhan, MD, Archana Baburao, DNB, Padukudru Anand Mahesh, MD, Babaji Ghewade, ProfMD, Girija Nair, ProfMD, Aditya Jindal, DM, Gayathri Devi H Jayadevappa, ProfMD, Honney Sawhney, MD, Kripesh Ranjan Sarmah, MD, Kaushik Saha, MD, Suresh Anantharaj, DNB, Arjun Khanna, DM, Samir Gami, MD, Arti Shah, DNB, Arpan Shah, DNB, Naveen Dutt, MD, Himanshu Garg, MD, Sunil Vyas, DNB, Kummannoor Venugopal, MD, Rajendra Prasad, ProfMD, Naveed M Aleemuddin, ProfMD, Saurabh Karmakar, MD, Virendra Singh, MD, Surinder Kumar Jindal, MD, Shubham Sharma, MBBS, Deepak Prajapat, MD, Sagar Chandrashekaria, DNB, Melissa J McDonnell, MSc, Aditi Mishra, MBBS, Robert Rutherford, MD, Ramanathan Palaniappan Ramanathan, ProfMD, Pieter C Goeminne, PhD, Preethi Vasudev, DTCD, Katerina Dimakou, PhD, Megan L Crichton, MFM, Biiligere Siddaiah Jayaraj, DM, Rahul Kungwani, MD, Akanksha Das, MD, Mehneet Sawhney, MBBS, Eva Polverino, PhD, Antoni Torres, ProfMD, Nayan Sri Gulecha, MBBS, Michal Shteinberg, PhD, Anthony De Soyza, ProfPhD, Anshul Mangala, MD, Palak Shah, MD, Nishant Kumar Chauhan, MD, Nikita Jajodia, MPTH, Ashutosh Singhal, MD, Sakshi Batra, MD, Ashfaq Hasan, ProfMD, Sneha Limaye, MBBS, Sundeep Salvi, MD, Stefano Aliberti, MD, and James D Chalmers, ProfPhD

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. Methods: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. Findings: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41–66] vs the European and US registries; p

Published
2019
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4. Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators

Author

Rashmi Kadam, Sanghratna Borde, Sapna Madas, Aarti Nagarkar, Sundeep Salvi, and Sneha Limaye

Subjects
Clinical research, guidelines, Indian, investigators, regulatory, Medicine, Medicine (General), R5-920
Abstract

Background: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. Objective: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. Methods: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. Results: Central registration of Ethics Committees (ECs) was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's). The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7%) disagreed to the introduction of audio-video (AV) recording of informed consent, 36.6% agreed and 12.7% were neutral. Discussion: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. Conclusion: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines.

Published
2016
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5. Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

Author

Manuela Carugati, Stefano Aliberti, Luis Felipe Reyes, Ricardo Franco Sadud, Muhammad Irfan, Cristina Prat, Nilam J. Soni, Paola Faverio, Andrea Gori, Francesco Blasi, Marcos I. Restrepo, Patricia Karina Aruj, Silvia Attorri, Enrique Barimboim, Juan Pablo Caeiro, María I. Garzón, Victor Hugo Cambursano, Adrian Ceccato, Julio Chertcoff, Florencia Lascar, Fernando Di Tulio, Ariel Cordon Díaz, Lautaro de Vedia, Maria Cristina Ganaha, Sandra Lambert, Gustavo Lopardo, Carlos M. Luna, Alessio Gerardo Malberti, Nora Morcillo, Silvina Tartara, Claudia Pensotti, Betiana Pereyra, Pablo Gustavo Scapellato, Juan Pablo Stagnaro, Florencio Varela, Sonali Shah, Felix Lötsch, Florian Thalhammer, Kurt Anseeuw, Camille A. Francois, Eva Van Braeckel, Jean Louis Vincent, Marcel Zannou Djimon, Jules Bashi, Roger Dodo, Simone Aranha Nouér, Peter Chipev, Milena Encheva, Darina Miteva, Diana Petkova, Adamou Dodo Balkissou, Eric Walter Pefura Yone, Bertrand Hugo Mbatchou Ngahane, Ning Shen, Jin-fu Xu, Carlos Andres Bustamante Rico, Ricardo Buitrago, Fernando Jose Pereira Paternina, Jean-Marie Kayembe Ntumba, Vesna Vladic Carevic, Marko Jakopovic, Mateja Jankovic, Zinka Matkovic, Ivan Mitrecic, Marie-Laure Bouchy Jacobsson, Anette Bro Christensen, Uffe Christian Heitmann Bødtger, Christian Niels Meyer, Andreas Vestergaard Jensen, Gertrud Baunbæk-Knudsen, Pelle Trier Petersen, Stine Andersen, Ibrahim El-Said Abd El-Wahhab, Nesreen Elsayed Morsy, Hanaa Shafiek, Eman Sobh, Kedir Abdella Abdulsemed, Fabrice Bertrand, Christian Brun-Buisson, Etienne de Montmollin, Muriel Fartoukh, Jonathan Messika, Pierre Tattevin, Abdo Khoury, Bernard Ebruke, Michael Dreher, Martin Kolditz, Matthias Meisinger, Mathias W. Pletz, Stefan Hagel, Jan Rupp, Tom Schaberg, Marc Spielmanns, Petra Creutz, Norton Suttorp, Beatrice Siaw-Lartey, Katerina Dimakou, Dimosthenis Papapetrou, Evdoxia Tsigou, Dimitrios Ampazis, Evangelos Kaimakamis, Mina Gaga, Mohit Bhatia, Raja Dhar, George D'Souza, Rajiv Garg, Parvaiz A. Koul, P.A. Mahesh, B.S. Jayaraj, Kiran Vishnu Narayan, Hirennappa B. Udnur, Shashi Bhaskara Krishnamurthy, Surya Kant, Rajesh Swarnakar, Sneha Limaye, Sundeep Salvi, Keihan Golshani, Vera M. Keatings, Ignacio Martin-Loeches, Yasmin Maor, Jacob Strahilevitz, Salvatore Battaglia, Maria Carrabba, Piero Ceriana, Marco Confalonieri, Antonella d'Arminio Monforte, Bruno Del Prato, Marino De Rosa, Riccardo Fantini, Giuseppe Fiorentino, Maria Antonia Gammino, Francesco Menzella, Giuseppe Milani, Stefano Nava, Gerardo Palmiero, Roberta Petrino, Barbra Gabrielli, Paolo Rossi, Claudio Sorino, Gundi Steinhilber, Alessandro Zanforlin, Fabio Franzetti, Manuela Morosi, Elisa Monge, Mauro Carone, Vincenzo Patella, Simone Scarlata, Andrea Comel, Kiyoyasu Kurahashi, Zeina Aoun Bacha, Daniel Barajas Ugalde, Omar Ceballos Zuñiga, José F. Villegas, Milic Medenica, E.M.W. van de Garde, Deebya Raj Mihsra, Poojan Shrestha, Elliott Ridgeon, Babatunde Ishola Awokola, Ogonna N.O. Nwankwo, Adefuye Bolanle Olufunlola, Segaolu Olumide, Kingsley N. Ukwaja, Lukasz Minarowski, Skoczyński Szymon, Felipe Froes, Pedro Leuschner, Mariana Meireles, Sofia B Ravara, Victoria Brocovschii, Chesov Ion, Doina Rusu, Cristina Toma, Daniela Chirita, Carmen Mihaela Dorobat, Alexei Birkun, Anna Kaluzhenina, Abdullah Almotairi, Zakeya Abdulbaqi Ali Bukhary, Jameela Edathodu, Amal Fathy, Abdullah Mushira Abdulaziz Enani, Nazik Eltayeb Mohamed, Jawed Ulhadi Memon, Abdelhaleem Bella, Nada Bogdanović, Branislava Milenkovic, Dragica Pesut, Charles Feldman, Ho Kee Yum, Luis Borderìas, Noel Manuel Bordon Garcia, Hugo Cabello Alarcón, Catia Cilloniz, Antoni Torres, Vicens Diaz-Brito, Xavier Casas, Alicia Encabo González, Maria Luisa Fernández-Almira, Miguel Gallego, Inmaculada Gaspar-GarcÍa, Juan González del Castillo, Patricia Javaloyes Victoria, Elena Laserna Martínez, Rosa Malo de Molina, Pedro J. Marcos, Rosario Menéndez, Ana Pando-Sandoval, Cristina Prat Aymerich, Jordi Rello, Silvia Moyano, Francisco Sanz, Oriol Sibila, Ana Rodrigo-Troyano, Jordi Solé-Violán, Ane Uranga, Job F.M. van Boven, Ester Vendrell Torra, Jordi Almirall Pujol, Arnauld Attannon Fiogbe, Ferdaous Yangui, Semra Bilaceroglu, Levent Dalar, Ufuk Yilmaz, Artemii Bogomolov, Naheed Elahi, Devesh J. Dhasmana, Andrew Feneley, Rhiannon Ions, Julie Skeemer, Gerrit Woltmann, Carole Hancock, Adam T. Hill, Banu Rudran, Silvia Ruiz-Buitrago, Marion Campbell, Paul Whitaker, Alexander Youzguin, Anika Singanayagam, Karen S. Allen, Veronica Brito, Jessica Dietz, Claire E. Dysart, Susan M. Kellie, Ricardo A. Franco-Sadud, Garnet Meier, Thomas L. Holland, Stephen P. Bergin, Fayez Kheir, Mark Landmeier, Manuel Lois, Girish B. Nair, Hemali Patel, Katherine Reyes, William Rodriguez-Cintron, Shigeki Saito, Julio Noda, Cecilia I. Hinojosa, Stephanie M. Levine, Luis F. Angel, Antonio Anzueto, K. Scott Whitlow, John Hipskind, Kunal Sukhija, Vicken Totten, Richard G. Wunderink, Ray D. Shah, Kondwelani John Mateyo, Lorena Noriega, Ezequiel Alvarado, Mohamed Aman, and Lucía Labra

Subjects
Medicine
Abstract

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p

Published
2018
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6. Author's reply

Author

M Mahendra, B S Jayaraj, Sneha Limaye, S K Chaya, Raja Dhar, and P A Mahesh

Subjects
Diseases of the respiratory system, RC705-779
Published
2018
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7. Bronchiectasis severity assessment tools to predict clinical outcomes in the Indian Bronchiectasis Registry

Author

James D. Chalmers, George D'Souza, Megan Crichton, Sneha Limaye, Raja Dhar, Surya Kant Tripathi, Srinivas Rajagopala, Deepak Talwar, Sundeep Salvi, Arjun Padmanabhan, Murali Mohan, Sonali Trivedi, Sheetu Singh, Rajesh Swarnakar, and Archana Baburao

Subjects
medicine.medical_specialty, Severity assessment, Bronchiectasis, business.industry, medicine, Intensive care medicine, medicine.disease, business
Published
2021

8. Long term clinical outcomes of bronchiectasis in India: Data from the EMBARC/RRNI Indian Bronchiectasis Registry

Author

Archana Baburao, Raja Dhar, Megan Crichton, Deepak Talwar, Murali Mohan, Sheetu Singh, Srinivas Rajagopala, Sonali Trivedi, Sneha Limaye, Rajesh Swarnakar, Surya Kant Tripathi, James D. Chalmers, Sundeep Salvi, Pieter Goeminne, Arjun Padmanabhan, and George D'Souza

Subjects
Pediatrics, medicine.medical_specialty, Bronchiectasis, business.industry, Medicine, business, medicine.disease, Term (time)
Published
2021

9. Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry

Author

Raja, Dhar, Sheetu, Singh, Deepak, Talwar, B V, Murali Mohan, Surya Kant, Tripathi, Rajesh, Swarnakar, Sonali, Trivedi, Srinivas, Rajagopala, George, D'Souza, Arjun, Padmanabhan, B, Archana, P A, Mahesh, Babaji, Ghewade, Girija, Nair, Aditya, Jindal, Gayathri Devi H, Jayadevappa, Honney, Sawhney, Kripesh Ranjan, Sarmah, Kaushik, Saha, Suresh, Anantharaj, Arjun, Khanna, Samir, Gami, Arti, Shah, Arpan, Shah, Naveen, Dutt, Himanshu, Garg, Sunil, Vyas, Kummannoor, Venugopal, Rajendra, Prasad, Naveed M, Aleemuddin, Saurabh, Karmakar, Virendra, Singh, S K, Jindal, Shubham, Sharma, Deepak, Prajapat, Sagar, Chandrashekar, Michael, Loebinger, Aditi, Mishra, Francesco, Blasi, Ramanathan Palaniappan, Ramanathan, Pieter C, Goeminne, Preethi, Vasudev, Amelia, Shoemark, B S, Jayaraj, Rahul, Kungwani, Akanksha, Das, Mehneet, Sawhney, Eva, Polverino, Tobias, Welte, Nayan Sri, Gulecha, Michal, Shteinberg, Anshul, Mangala, Palak, Shah, Nishant Kumar, Chauhan, Nikita, Jajodia, Ashutosh, Singhal, Sakshi, Batra, Ashfaq, Hasan, Stefano, Aliberti, Megan L, Crichton, Sneha, Limaye, Sundeep, Salvi, and James D, Chalmers

Subjects
Pulmonary and Respiratory Medicine, Settore MED/10 - Malattie dell'Apparato Respiratorio
Abstract

BackgroundIdentifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India.MethodsThe European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India (EMBARC-India) registry is a prospective observational study of adults with computed tomography-confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and decline in forced expiratory volume in 1 s.Results1018 patients with at least 12-month follow-up data were enrolled in the follow-up study. Frequent exacerbations (≥3 per year) at baseline were associated with an increased risk of mortality (hazard ratio (HR) 3.23, 95% CI 1.39–7.50), severe exacerbations (HR 2.71, 95% CI 1.92–3.83), future exacerbations (incidence rate ratio (IRR) 3.08, 95% CI 2.36–4.01) and lung function decline. Coexisting COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all end-points studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular comorbidity. Infection with Gram-negative pathogens (predominantlyKlebsiella pneumoniae) was independently associated with increased mortality (HR 3.13, 95% CI 1.62–6.06), whilePseudomonas aeruginosainfection was associated with severe exacerbations (HR 1.41, 95% CI 1.01–1.97) and overall exacerbation rate (IRR 1.47, 95% CI 1.13–1.91).ConclusionsThis study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.

Published
2022

10. Effects of Air Pollution on Allergy and Asthma

Author

Sundeep Salvi and Sneha Limaye

Subjects
Pollutant, Pregnancy, Allergy, Immune system, Innate immune system, Immunology, medicine, Epigenetics, Biology, medicine.disease, Gene, Asthma
Abstract

This chapter describes evidence generated over the years which highlights the important role of air pollution as an important contributor to the growing prevalence of allergic diseases. Exposure to air pollutants starts even before one is born. A recent study from the Netherlands showed that mothers exposed to even modest levels of air pollutants, especially particulate matter and nitrogen dioxide during pregnancy, not only have higher levels of Circulating C-Reactive Protein (CRP), a systemic inflammatory biomarker, but even babies born to them show higher levels of circulating CRP. Epigenetics refers to changes in the genome that are not coded by the genomic sequence itself, but ultimately affect the expression of gene transcripts, and determine potentially heritable changes in gene expression. Pollutants can affect the lung by altering its immune response and airway inflammation. Pollutants may differentially affect by epigenetic changes or other mechanisms, the function and/or regulation of different variants of innate immunity.

Published
2021

11. Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

Author

Judith Marin-Corral, Sergi Pascual-Guardia, Francesco Amati, Stefano Aliberti, Joan R Masclans, Nilam Soni, Alejandro Rodriguez, Oriol Sibila, Francisco Sanz, Giovanni Sotgiu, Antonio Anzueto, Katerina Dimakou, Roberta Petrino, Ewoudt van de Garde, Marcos I Restrepo, GLIMP investigators, Patricia Karina Aruj, Silvia Attorri, Enrique Barimboim, Juan Pablo Caeiro, María I Garzón, Victor Hugo Cambursano, V H Dr Cazaux A Adrian Ceccato, Julio Chertcoff, Florencia Lascar, Fernando Di Tulio, Ariel Cordon Díaz, Lautaro de Vedia, Maria Cristina Ganaha, Sandra Lambert, Gustavo Lopardo, Carlos M Luna, Alessio Gerardo Malberti, Nora Morcillo, Silvina Tartara, Claudia Pensotti, Betiana Pereyra, Pablo Gustavo Scapellato, Juan Pablo Stagnaro, Sonali Shah, Felix Lötsch, Florian Thalhammer, Kurt Anseeuw, Camille A Francois, Eva Van Braeckel, Jean Louis Vincent, Marcel Zannou Djimon, Jules Bashi, Roger Dodo, Simone Aranha Nouér, Peter Chipev, Milena Encheva, Darina Miteva, Diana Petkova, Adamou Dodo Balkissou, Eric Walter Pefura Yone, Bertrand Hugo Mbatchou Ngahane, Ning Shen, Jin-Fu Xu, Carlos Andres Bustamante Rico, Ricardo Buitrago, Fernando Jose Pereira Paternina, Jean-Marie Kayembe Ntumba, Vesna Vladic Carevic, Marko Jakopovic, Mateja Jankovic, Zinka Matkovic, Ivan Mitrecic, Marie-Laure Bouchy Jacobsson, Anette Bro Christensen, Uffe Christian Heitmann Bødtger, Christian Niels Meyer, Andreas Vestergaard Jensen, Gertrud Baunbæk-Knudsen, Pelle Trier Petersen, Stine Andersen, Ibrahim El-Said Abd El-Wahhab, Nesreen Elsayed Morsy, Hanaa Shafiek, Eman Sobh, Kedir Abdella Abdulsemed, Fabrice Bertrand, Christian Brun-Buisson, Etienne de Montmollin, Muriel Fartoukh, Jonathan Messika, Pierre Tattevin, Abdo Khoury, Bernard Ebruke, Michael Dreher, Martin Kolditz, Matthias Meisinger, Mathias W Pletz, Stefan Hagel, Jan Rupp, Tom Schaberg, Marc Spielmanns, Petra Creutz, Norton Suttorp, Beatrice Siaw-Lartey, Dimosthenis Papapetrou, Evdoxia Tsigou, Dimitrios Ampazis, Evangelos Kaimakamis, Mohit Bhatia, Raja Dhar, George D'Souza, Rajiv Garg, Parvaiz A Koul, P A Mahesh, B S Jayaraj, Kiran Vishnu Narayan, Hirennappa B Udnur, Shashi Bhaskara Krishnamurthy, Surya Kant, Rajesh Swarnakar, Sneha Limaye, Sundeep Salvi, Keihan Golshani, Vera M Keatings, Ignacio Martin-Loeches, Yasmin Maor, Jacob Strahilevitz, Paola Faverio, Salvatore Battaglia, Maria Carrabba, Piero Ceriana, Marco Confalonieri, Antonella d'Arminio Monforte, Bruno Del Prato, Marino De Rosa, Riccardo Fantini, Giuseppe Fiorentino, Maria Antonia Gammino, Francesco Menzella, Giuseppe Milani, Stefano Nava, Gerardo Palmiero, Barbra Gabrielli, Paolo Rossi, Claudio Sorino, Gundi Steinhilber, Alessandro Zanforlin, Ospedale San Luca, Fabio Franzetti, Manuela Carugati, Manuela Morosi, Elisa Monge, Mauro Carone, Vincenzo Patella, Simone Scarlata, Andrea Comel, Kiyoyasu Kurahashi, Zeina Aoun Bacha, Daniel Barajas Ugalde, Omar Ceballos Zuñiga, José F Villegas, Milic Medenica, Deebya Raj Mihsra, Poojan Shrestha, Elliott Ridgeon, Babatunde Ishola Awokola, Ogonna N O Adefuye Bolanle Olufunlola, Segaolu Olumide, Kingsley N Ukwaja, Muhammad Irfan, Lukasz Minarowski, Skoczyński Szymon, Felipe Froes, Pedro Leuschner, Mariana Meireles, Cláudia Ferrão, João Neves, Abel Salazar, Sofia B Ravara, Victoria Brocovschii, Doina Rusu, Cristina Toma, Daniela Chirita, Carmen Mihaela Dorobat, Alexei Birkun, Anna Kaluzhenina, Abdullah Almotairi, Zakeya Abdulbaqi Ali Bukhary, Jameela Edathodu, Amal Fathy, Abdullah Mushira Abdulaziz Enani, Nazik Eltayeb Mohamed, Jawed Ulhadi Memon, Abdelhaleem Bella, Serbia Nada Bogdanović, Branislava Milenkovic, Dragica Pesut, Luis Borderìas, Noel Manuel Bordon Garcia, Hugo Cabello Alarcón, Catia Cilloniz, Antoni Torres, Vicens Diaz-Brito, Xavier Casas, Alicia Encabo González, Maria Luisa Fernández-Almira, Medicina Interna, Miguel Gallego, Inmaculada Gaspar-GarcÍa, Juan González Del Castillo, Patricia Javaloyes Victoria, Elena Laserna Martínez, Rosa Malo de Molina, Pedro J Marcos, Rosario Menéndez, Ana Pando-Sandoval, Cristina Prat Aymerich, Alicia Lacoma de la Torre, Ignasi García-Olivé, Jordi Rello, Silvia Moyano, Ana Rodrigo-Troyano, Jordi Solé-Violán, Ane Uranga, Job Fm van Boven, Ester Vendrell Torra, Jordi Almirall Pujol, Charles Feldman, Ho Kee Yum, Inje Univ Arnauld Attannon Fiogbe, Ferdaous Yangui, Semra Bilaceroglu, Izmir Dr Levent Dalar, Ufuk Yilmaz, Artemii Bogomolov, Naheed Elahi, Devesh J Dhasmana, Andrew Feneley, Adam T Hill, Banu Rudran, Silvia Ruiz-Buitrago, Marion Campbell, Paul Whitaker, Alexander Youzguin, Anika Singanayagam, C Hancock, David Villafuerte, Karen S Allen, Veronica Brito, Jessica Dietz, Claire E Dysart, Susan M Kellie, Clement J Ricardo A Franco-Sadud, Garnet Meier, Mina Gaga, Thomas L Holland, Stephen P Bergin, Fayez Kheir, Mark Landmeier, Manuel Lois, Girish B Nair, Hemali Patel, Katherine Reyes, William Rodriguez-Cintron, Shigeki Saito, Julio Noda, Cecilia I Hinojosa, Stephanie M Levine, Luis F Reyes, Luis F Angel, K Scott Whitlow, John Hipskind, Kunal Sukhija, Vicken Totten, Richard G Wunderink, Ray D Shah, Kondwelani John Mateyo, Lorena Noriega, Ezequiel Alvarado, Mohamed Aman, Lucía Labra, Marin-Corral J., Pascual-Guardia S., Amati F., Aliberti S., Masclans J.R., Soni N., Rodriguez A., Sibila O., Sanz F., Sotgiu G., Anzueto A., Dimakou K., Petrino R., van de Garde E., Restrepo M.I., Aruj P.K., Attorri S., Barimboim E., Caeiro J.P., Garzon M.I., Cambursano V.H., Adrian Ceccato V.H.D.C.A., Chertcoff J., Lascar F., Di Tulio F., Diaz A.C., de Vedia L., Ganaha M.C., Lambert S., Lopardo G., Luna C.M., Malberti A.G., Morcillo N., Tartara S., Pensotti C., Pereyra B., Scapellato P.G., Stagnaro J.P., Shah S., Lotsch F., Thalhammer F., Anseeuw K., Francois C.A., Van Braeckel E., Vincent J.L., Djimon M.Z., Bashi J., Dodo R., Nouer S.A., Chipev P., Encheva M., Miteva D., Petkova D., Balkissou A.D., Pefura Yone E.W., Mbatchou Ngahane B.H., Shen N., Xu J.-F., Bustamante Rico C.A., Buitrago R., Pereira Paternina F.J., Kayembe Ntumba J.-M., Carevic V.V., Jakopovic M., Jankovic M., Matkovic Z., Mitrecic I., Bouchy Jacobsson M.-L., Christensen A.B., Heitmann Bodtger U.C., Meyer C.N., Jensen A.V., Baunbaek-knudsen G., Petersen P.T., Andersen S., El-Said Abd El-Wahhab I., Morsy N.E., Shafiek H., Sobh E., Abdulsemed K.A., Bertrand F., Brun-Buisson C., de Montmollin E., Fartoukh M., Messika J., Tattevin P., Khoury A., Ebruke B., Dreher M., Kolditz M., Meisinger M., Pletz M.W., Hagel S., Rupp J., Schaberg T., Spielmanns M., Creutz P., Suttorp N., Siaw-Lartey B., Papapetrou D., Tsigou E., Ampazis D., Kaimakamis E., Bhatia M., Dhar R., D'Souza G., Garg R., Koul P.A., Mahesh P.A., Jayaraj B.S., Narayan K.V., Udnur H.B., Krishnamurthy S.B., Kant S., Swarnakar R., Limaye S., Salvi S., Golshani K., Keatings V.M., Martin-Loeches I., Maor Y., Strahilevitz J., Faverio P., Battaglia S., Carrabba M., Ceriana P., Confalonieri M., Monforte A.D., Del Prato B., De Rosa M., Fantini R., Fiorentino G., Gammino M.A., Menzella F., Milani G., Nava S., Palmiero G., Gabrielli B., Rossi P., Sorino C., Steinhilber G., Zanforlin A., San Luca O., Franzetti F., Carugati M., Morosi M., Monge E., Carone M., Patella V., Scarlata S., Comel A., Kurahashi K., Bacha Z.A., Ugalde D.B., Zuniga O.C., Villegas J.F., Medenica M., Mihsra D.R., Shrestha P., Ridgeon E., Awokola B.I., Adefuye Bolanle Olufunlola O.N.O., Olumide S., Ukwaja K.N., Irfan M., Minarowski L., Szymon S., Froes F., Leuschner P., Meireles M., Ferrao C., Neves J., Abel Salazar, Ravara S.B., Brocovschii V., Rusu D., Toma C., Chirita D., Dorobat C.M., Birkun A., Kaluzhenina A., Almotairi A., Ali Bukhary Z.A., Edathodu J., Fathy A., Abdulaziz Enani A.M., Mohamed N.E., Memon J.U., Bella A., Bogdanovic S.N., Milenkovic B., Pesut D., Borderias L., Bordon Garcia N.M., Alarcon H.C., Cilloniz C., Torres A., Diaz-Brito V., Casas X., Gonzalez A.E., Fernandez-Almira M.L., Interna M., Gallego M., Gaspar-GarcIa I., Gonzalez del Castillo J., Victoria P.J., Martinez E.L., Malo de Molina R., Marcos P.J., Menendez R., Pando-Sandoval A., Aymerich C.P., Lacoma de la Torre A., Garcia-Olive I., Rello J., Moyano S., Rodrigo-Troyano A., Sole-Violan J., Uranga A., van Boven J.F., Torra E.V., Pujol J.A., Feldman C., Yum H.K., Arnauld Attannon Fiogbe I.U., Yangui F., Bilaceroglu S., Levent Dalar I.D., Yilmaz U., Bogomolov A., Elahi N., Dhasmana D.J., Feneley A., Hill A.T., Rudran B., Ruiz-Buitrago S., Campbell M., Whitaker P., Youzguin A., Singanayagam A., Hancock C., Villafuerte D., Allen K.S., Brito V., Dietz J., Dysart C.E., Kellie S.M., Ricardo A. Franco-Sadud C.J., Meier G., Gaga M., Holland T.L., Bergin S.P., Kheir F., Landmeier M., Lois M., Nair G.B., Patel H., Reyes K., Rodriguez-Cintron W., Saito S., Noda J., Hinojosa C.I., Levine S.M., Reyes L.F., Angel L.F., Whitlow K.S., Hipskind J., Sukhija K., Totten V., Wunderink R.G., Shah R.D., Mateyo K.J., Noriega L., Alvarado E., Aman M., Labra L., Marin-Corral, Judith, Pascual-Guardia, Sergi, Amati, Francesco, Aliberti, Stefano, R Masclans, Joan, Soni, Nilam, Rodriguez, Alejandro, Sibila, Oriol, Sanz, Francisco, Sotgiu, Giovanni, Anzueto, Antonio, Dimakou, Katerina, Petrino, Roberta, van de Garde, Ewoudt, I Restrepo, Marco, Investigators, Glimp, Karina Aruj, Patricia, Attorri, Silvia, Barimboim, Enrique, Pablo Caeiro, Juan, I Garzón, María, Hugo Cambursano, Victor, A Adrian Ceccato, V H Dr Cazaux, Chertcoff, Julio, Lascar, Florencia, Di Tulio, Fernando, Cordon Díaz, Ariel, de Vedia, Lautaro, Cristina Ganaha, Maria, Lambert, Sandra, Lopardo, Gustavo, M Luna, Carlo, Gerardo Malberti, Alessio, Morcillo, Nora, Tartara, Silvina, Pensotti, Claudia, Pereyra, Betiana, Gustavo Scapellato, Pablo, Pablo Stagnaro, Juan, Shah, Sonali, Lötsch, Felix, Thalhammer, Florian, Anseeuw, Kurt, A Francois, Camille, Van Braeckel, Eva, Louis Vincent, Jean, Zannou Djimon, Marcel, Bashi, Jule, Dodo, Roger, Aranha Nouér, Simone, Chipev, Peter, Encheva, Milena, Miteva, Darina, Petkova, Diana, Dodo Balkissou, Adamou, Walter Pefura Yone, Eric, Hugo Mbatchou Ngahane, Bertrand, Shen, Ning, Xu, Jin-Fu, Andres Bustamante Rico, Carlo, Buitrago, Ricardo, Jose Pereira Paternina, Fernando, Kayembe Ntumba, Jean-Marie, Vladic Carevic, Vesna, Jakopovic, Marko, Jankovic, Mateja, Matkovic, Zinka, Mitrecic, Ivan, Bouchy Jacobsson, Marie-Laure, Bro Christensen, Anette, Christian Heitmann Bødtger, Uffe, Niels Meyer, Christian, Vestergaard Jensen, Andrea, Baunbæk-Knudsen, Gertrud, Trier Petersen, Pelle, Andersen, Stine, El-Said Abd El-Wahhab, Ibrahim, Elsayed Morsy, Nesreen, Shafiek, Hanaa, Sobh, Eman, Abdella Abdulsemed, Kedir, Bertrand, Fabrice, Brun-Buisson, Christian, de Montmollin, Etienne, Fartoukh, Muriel, Messika, Jonathan, Tattevin, Pierre, Khoury, Abdo, Ebruke, Bernard, Dreher, Michael, Kolditz, Martin, Meisinger, Matthia, W Pletz, Mathia, Hagel, Stefan, Rupp, Jan, Schaberg, Tom, Spielmanns, Marc, Creutz, Petra, Suttorp, Norton, Siaw-Lartey, Beatrice, Papapetrou, Dimostheni, Tsigou, Evdoxia, Ampazis, Dimitrio, Kaimakamis, Evangelo, Bhatia, Mohit, Dhar, Raja, D'Souza, George, Garg, Rajiv, A Koul, Parvaiz, A Mahesh, P, S Jayaraj, B, Vishnu Narayan, Kiran, B Udnur, Hirennappa, Bhaskara Krishnamurthy, Shashi, Kant, Surya, Swarnakar, Rajesh, Limaye, Sneha, Salvi, Sundeep, Golshani, Keihan, M Keatings, Vera, Martin-Loeches, Ignacio, Maor, Yasmin, Strahilevitz, Jacob, Faverio, Paola, Battaglia, Salvatore, Carrabba, Maria, Ceriana, Piero, Confalonieri, Marco, d'Arminio Monforte, Antonella, Del Prato, Bruno, De Rosa, Marino, Fantini, Riccardo, Fiorentino, Giuseppe, Antonia Gammino, Maria, Menzella, Francesco, Milani, Giuseppe, Nava, Stefano, Palmiero, Gerardo, Gabrielli, Barbra, Rossi, Paolo, Sorino, Claudio, Steinhilber, Gundi, Zanforlin, Alessandro, San Luca, Ospedale, Franzetti, Fabio, Carugati, Manuela, Morosi, Manuela, Monge, Elisa, Carone, Mauro, Patella, Vincenzo, Scarlata, Simone, Comel, Andrea, Kurahashi, Kiyoyasu, Aoun Bacha, Zeina, Barajas Ugalde, Daniel, Ceballos Zuñiga, Omar, F Villegas, José, Medenica, Milic, Raj Mihsra, Deebya, Shrestha, Poojan, Ridgeon, Elliott, Ishola Awokola, Babatunde, O Adefuye Bolanle Olufunlola, Ogonna N, Olumide, Segaolu, N Ukwaja, Kingsley, Irfan, Muhammad, Minarowski, Lukasz, Szymon, Skoczyński, Froes, Felipe, Leuschner, Pedro, Meireles, Mariana, Ferrão, Cláudia, Neves, João, Salazar, Abel, B Ravara, Sofia, Brocovschii, Victoria, Rusu, Doina, Toma, Cristina, Chirita, Daniela, Mihaela Dorobat, Carmen, Birkun, Alexei, Kaluzhenina, Anna, Almotairi, Abdullah, Abdulbaqi Ali Bukhary, Zakeya, Edathodu, Jameela, Fathy, Amal, Mushira Abdulaziz Enani, Abdullah, Eltayeb Mohamed, Nazik, Ulhadi Memon, Jawed, Bella, Abdelhaleem, Nada Bogdanović, Serbia, Milenkovic, Branislava, Pesut, Dragica, Borderìas, Lui, Manuel Bordon Garcia, Noel, Cabello Alarcón, Hugo, Cilloniz, Catia, Torres, Antoni, Diaz-Brito, Vicen, Casas, Xavier, Encabo González, Alicia, Luisa Fernández-Almira, Maria, Interna, Medicina, Gallego, Miguel, Gaspar-GarcÍa, Inmaculada, González Del Castillo, Juan, Javaloyes Victoria, Patricia, Laserna Martínez, Elena, Malo de Molina, Rosa, J Marcos, Pedro, Menéndez, Rosario, Pando-Sandoval, Ana, Prat Aymerich, Cristina, Lacoma de la Torre, Alicia, García-Olivé, Ignasi, Rello, Jordi, Moyano, Silvia, Rodrigo-Troyano, Ana, Solé-Violán, Jordi, Uranga, Ane, Fm van Boven, Job, Vendrell Torra, Ester, Almirall Pujol, Jordi, Feldman, Charle, Kee Yum, Ho, Univ Arnauld Attannon Fiogbe, Inje, Yangui, Ferdaou, Bilaceroglu, Semra, Dr Levent Dalar, Izmir, Yilmaz, Ufuk, Bogomolov, Artemii, Elahi, Naheed, J Dhasmana, Devesh, Feneley, Andrew, T Hill, Adam, Rudran, Banu, Ruiz-Buitrago, Silvia, Campbell, Marion, Whitaker, Paul, Youzguin, Alexander, Singanayagam, Anika, Hancock, C, Villafuerte, David, S Allen, Karen, Brito, Veronica, Dietz, Jessica, E Dysart, Claire, M Kellie, Susan, A Franco-Sadud, Clement J Ricardo, Meier, Garnet, Gaga, Mina, L Holland, Thoma, P Bergin, Stephen, Kheir, Fayez, Landmeier, Mark, Lois, Manuel, B Nair, Girish, Patel, Hemali, Reyes, Katherine, Rodriguez-Cintron, William, Saito, Shigeki, Noda, Julio, I Hinojosa, Cecilia, M Levine, Stephanie, F Reyes, Lui, F Angel, Lui, Scott Whitlow, K, Hipskind, John, Sukhija, Kunal, Totten, Vicken, G Wunderink, Richard, D Shah, Ray, John Mateyo, Kondwelani, Noriega, Lorena, Alvarado, Ezequiel, Aman, Mohamed, Labra, Lucía, Marin-Corral, J, Pascual-Guardia, S, Amati, F, Aliberti, S, Masclans, J, Soni, N, Rodriguez, A, Sibila, O, Sanz, F, Sotgiu, G, Anzueto, A, Dimakou, K, Petrino, R, van de Garde, E, Restrepo, M, Aruj, P, Attorri, S, Barimboim, E, Caeiro, J, Garzon, M, Cambursano, V, Adrian Ceccato, V, Chertcoff, J, Lascar, F, Di Tulio, F, Diaz, A, de Vedia, L, Ganaha, M, Lambert, S, Lopardo, G, Luna, C, Malberti, A, Morcillo, N, Tartara, S, Pensotti, C, Pereyra, B, Scapellato, P, Stagnaro, J, Shah, S, Lotsch, F, Thalhammer, F, Anseeuw, K, Francois, C, Van Braeckel, E, Vincent, J, Djimon, M, Bashi, J, Dodo, R, Nouer, S, Chipev, P, Encheva, M, Miteva, D, Petkova, D, Balkissou, A, Pefura Yone, E, Mbatchou Ngahane, B, Shen, N, Xu, J, Bustamante Rico, C, Buitrago, R, Pereira Paternina, F, Kayembe Ntumba, J, Carevic, V, Jakopovic, M, Jankovic, M, Matkovic, Z, Mitrecic, I, Bouchy Jacobsson, M, Christensen, A, Heitmann Bodtger, U, Meyer, C, Jensen, A, Baunbaek-knudsen, G, Petersen, P, Andersen, S, El-Said Abd El-Wahhab, I, Morsy, N, Shafiek, H, Sobh, E, Abdulsemed, K, Bertrand, F, Brun-Buisson, C, de Montmollin, E, Fartoukh, M, Messika, J, Tattevin, P, Khoury, A, Ebruke, B, Dreher, M, Kolditz, M, Meisinger, M, Pletz, M, Hagel, S, Rupp, J, Schaberg, T, Spielmanns, M, Creutz, P, Suttorp, N, Siaw-Lartey, B, Papapetrou, D, Tsigou, E, Ampazis, D, Kaimakamis, E, Bhatia, M, Dhar, R, D'Souza, G, Garg, R, Koul, P, Mahesh, P, Jayaraj, B, Narayan, K, Udnur, H, Krishnamurthy, S, Kant, S, Swarnakar, R, Limaye, S, Salvi, S, Golshani, K, Keatings, V, Martin-Loeches, I, Maor, Y, Strahilevitz, J, Faverio, P, Battaglia, S, Carrabba, M, Ceriana, P, Confalonieri, M, Monforte, A, Del Prato, B, De Rosa, M, Fantini, R, Fiorentino, G, Gammino, M, Menzella, F, Milani, G, Nava, S, Palmiero, G, Gabrielli, B, Rossi, P, Sorino, C, Steinhilber, G, Zanforlin, A, San Luca, O, Franzetti, F, Carugati, M, Morosi, M, Monge, E, Carone, M, Patella, V, Scarlata, S, Comel, A, Kurahashi, K, Bacha, Z, Ugalde, D, Zuniga, O, Villegas, J, Medenica, M, Mihsra, D, Shrestha, P, Ridgeon, E, Awokola, B, Adefuye Bolanle Olufunlola, O, Olumide, S, Ukwaja, K, Irfan, M, Minarowski, L, Szymon, S, Froes, F, Leuschner, P, Meireles, M, Ferrao, C, Neves, J, Abel, S, Ravara, S, Brocovschii, V, Rusu, D, Toma, C, Chirita, D, Dorobat, C, Birkun, A, Kaluzhenina, A, Almotairi, A, Ali Bukhary, Z, Edathodu, J, Fathy, A, Abdulaziz Enani, A, Mohamed, N, Memon, J, Bella, A, Bogdanovic, S, Milenkovic, B, Pesut, D, Borderias, L, Bordon Garcia, N, Alarcon, H, Cilloniz, C, Torres, A, Diaz-Brito, V, Casas, X, Gonzalez, A, Fernandez-Almira, M, Interna, M, Gallego, M, Gaspar-GarcIa, I, Gonzalez del Castillo, J, Victoria, P, Martinez, E, Malo de Molina, R, Marcos, P, Menendez, R, Pando-Sandoval, A, Aymerich, C, Lacoma de la Torre, A, Garcia-Olive, I, Rello, J, Moyano, S, Rodrigo-Troyano, A, Sole-Violan, J, Uranga, A, van Boven, J, Torra, E, Pujol, J, Feldman, C, Yum, H, Arnauld Attannon Fiogbe, I, Yangui, F, Bilaceroglu, S, Levent Dalar, I, Yilmaz, U, Bogomolov, A, Elahi, N, Dhasmana, D, Feneley, A, Hill, A, Rudran, B, Ruiz-Buitrago, S, Campbell, M, Whitaker, P, Youzguin, A, Singanayagam, A, Villafuerte, D, Allen, K, Brito, V, Dietz, J, Dysart, C, Kellie, S, Ricardo, A, Meier, G, Gaga, M, Holland, T, Bergin, S, Kheir, F, Landmeier, M, Lois, M, Nair, G, Patel, H, Reyes, K, Rodriguez-Cintron, W, Saito, S, Noda, J, Hinojosa, C, Levine, S, Reyes, L, Angel, L, Whitlow, K, Hipskind, J, Sukhija, K, Totten, V, Wunderink, R, Shah, R, Mateyo, K, Noriega, L, Alvarado, E, Aman, M, and Labra, L

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.drug_class, Aspiration risk, Antibiotics, Nursing home resident, Settore MED/10 - Malattie Dell'Apparato Respiratorio, Critical Care and Intensive Care Medicine, Microbiology, anaerobic, aspiration, bacteria, pneumonia, risk factors, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Community-acquired pneumonia, Taverne, Anti-Bacterial Agent, medicine, Humans, Community-Acquired Infection, 030212 general & internal medicine, Stroke, Aged, Aged, 80 and over, business.industry, Respiratory Aspiration, Middle Aged, medicine.disease, Antibiotic coverage, Anti-Bacterial Agents, Community-Acquired Infections, Hospitalization, Pneumonia, 030228 respiratory system, Risk factors, risk factor, Female, Underweight, medicine.symptom, business, Cardiology and Cardiovascular Medicine
Abstract

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P 50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

Published
2021

15. Burden of Allergic Bronchopulmonary Aspergillosis (ABPA) in the India bronchiectasis registry

Author

Kripesh Sarmah, Kummannoor Venugopal, Rajendra Prasad, Sundeep Salvi, Aditya Jindal, Aditi R. Mishra, Baburao Archana, Deepak Talwar, Harsh Saxena, Sawhney Mehneet, Sneha Limaye, Arjun Padmanabhan, Honney Sawhney, Raja Dhar, Sushma Jadhav, Preethi Vasudev, Samir Gami, Kaushik Saha, Sagar Chandrashekaria, Suryakant Tripathi, Aleemuddin Naveed, Shrikant Pawar, Sapna Madas, Girija Nair, Shubham Sharma, Nikita Jajodia, Himanshu Garg, Ashfaq Hasan, Deepak Prajapat, Arjun Khanna, Surinder K. Jindal, Naveen Dutt, George D Souza, Sheetu Singh, Arti Shah, Vipin Chaudhary, Priyanka Karumalai, Murali Mohan, Shahid Patel, Darshana Reddy, James D. Chalmers, Babaji Ghewade, Virendra Singh, Srinivas Rajagopala, Rajesh Swarnakar, and Preetibala Vijay Kumar

Subjects
Spirometry, Aspergillus, medicine.medical_specialty, Bronchiectasis, biology, medicine.diagnostic_test, business.industry, Total ige, Eosinophil, biology.organism_classification, medicine.disease, Immunoglobulin E, Dermatology, Aspergillus fumigatus, medicine.anatomical_structure, medicine, biology.protein, Allergic bronchopulmonary aspergillosis, business
Abstract

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a severe allergic inflammatory response to Aspergillus fumigatus and is often an unrecognized cause for bronchiectasis. Aims and Objectives: In this study, we aim to examine the burden of ABPA in the India bronchiectasis registry, the screening test perform and the phenotype characterization. Material and Methods: Among the 2197 cases of bronchiectasis enrolled in the Indian bronchiectasis registry, we examined the number of patients screened for ABPA and the proportion of screened positive ABPA cases. We also looked for phenotypic characterization using HRCT features, total IgE, eosinophil count, IgE and IgG specific to aspergillus and by skin prick test. Results: Out of 2197 cases of bronchiectasis cases register at 31 sites, only 387 (17%) cases were screened for ABPA 190 (49.1%) at 24 sites. Among these 190 cases, 99(52.1%) of all ABPA cases were male (mean age 44.85 ± 15.09 yr). 62.03% had the bronchiectasis for more than five years. Serum eosinophil count was raised in 115(60.5%) out of 146 (76.84%) cases. Raised IgG level was observed in 71 (74.74%) out of 95 (50%) cases. Specific IgE to aspergillus was raised in 117 (84.17%) out of 139 (73.16%) cases. Aspergillus skin prick test was tested positive in 83 (83%) out of 100 (52.63%) cases. Total IgE count was raised in 97 (54.19%) cases out of 179 (94.2%). Obstructive airways disease was found in 74 (52.5%) out of 141 (74.21%) cases tested by spirometry. The right middle lobe was involved in 66.32% cases in HRCT. Conclusion: Despite the universal screening for ABPA recommended by the ERS, only 17% were screened for ABPA of which 50% showed evidence of underline ABPA.

Published
2019

16. Phenotyping Post TB Obstructive airways disease (TOPD) in India

Author

sruthi J, Raja Dhar, Palak Shah, Shahid Patel, Sneha Limaye, Jaymohan Unnithan, Shrikant Pawar, Shobana Balasubramaniam, Ram Jana, Nisha Kale, Alpa Dalal, Sapna Madas, Vipin Chaudhary, Priyanka Karumalai, Prasad Patil, Arti Shah, Malay Sarkar, Girija Nair, Arpan Shah, Srikanth Krishnamurthy, Praveen Kumar Shahi, Srinivas Rajagopala, and Sundeep Salvi

Subjects
medicine.medical_specialty, biology, business.industry, Airways disease, Middle zone, Lama, Significant negative correlation, Airflow obstruction, biology.organism_classification, Internal medicine, medicine, Disease process, Medical prescription, business, Lung function
Abstract

Aims and Objectives: To study the characteristics, severity of airflow limitation and prescription pattern in TOPD patients in India. Introduction: There is a paucity of data reported from India on the TOPD phenotype and understanding of the disease process. Methods: A semi-structured questionnaire was prepared by Respiratory Research Network of India and was filled by the investigator at the study sites across India. Results: 103 patients were identified as having post TOPD 9 (8.7%) had mild disease, 39 (37.9%) had moderate, 37 (35.9%) severe and 18 (17.5%) were diagnosed as very severe TOPD. Significant negative correlation (r= -0.499, p value =0.021) was observed between duration of TOPD and patients with severe TOPD. The Pearson Chi square test showed a significance association (p value=0.033) between occurrence of post-TOPD and affected left middle zone. Reversibility was observed in 24 (23.3%) patients and fixed airflow obstruction was observed in 79 (76.7%) patients respectively. Prescription pattern showed that, LAMA alone was prescribed to 5 (5%), LABA and LAMA combination to 10 (10%), LABA and ICS combination to 20 (20%), LAMA and ICS to 5 (5%), LAMA, LABA and ICS combination to 60 (60%) cases. Mild disease was most commonly prescribed with LABA+ICS (66.66 %), moderate with LAMA+LABA+ICS (77%), severe with LABA+ICS (32.35%) and very severe cases with LAMA+LABA+ICS (83.3%). %). Hence the treatment regime was not in accordance with the GINA or GOLD guidelines. Conclusion: The current study emphasis on the importance of screening of post-TOPD. This study presented the association of post-TOPD on the lung function and the prescription pattern currently followed for the treatment of post-TOPD.

Published
2019

18. Tuberculosis associated Obstructive Lung disease- A Pilot Study

Author

Sneha Limaye, Raja Dhar, Beauty Biswas, Aloke Gopal Ghoshal, and Tarang Kulkarni

Subjects
medicine.medical_specialty, Tuberculosis, business.industry, Internal medicine, Medicine, business, medicine.disease, Obstructive lung disease
Published
2018

19. Mother's level of education and knowledge about asthma is a major determinant of asthma control in children: A multicenter study by Respiratory Research Network of India

Author

Rajendra Kumar, Sanjay Bafna, Prasad Muley, Barnali Bhattacharya, Sapna Madas, Shruti Sahasrabudhe, Sneha Limaye, Premalatha Ramaswamy, Jagadish Dhekne, Reyaz Malik, Sundeep Salvi, Nilofer Mujawar, Suhas Kulkarni, Sasidharan Bindusha, and Mohammed Haseeb

Subjects
Pediatrics, medicine.medical_specialty, Multicenter study, business.industry, Asthma control, medicine, Respiratory system, medicine.disease, business, Asthma
Published
2018

20. Phenotypes in Bronchiectasis from the EMBARC India Registry

Author

Preethi Vasudev, Padukudru Anand Mahesh, Palak Shah, Arpan Shah, Sagar Chandrashekariah, K R Venugopal, Rahul Kungwani, Nikita Jajodia, Saurabh Karmakar, Rajendra Prasad, Leena Johnson, Sunil Vyas, Aditya Jindal, Kripesh Sarmah, Devi H.J. Gayathri, Archana Baburao, Anshul Mangla, Kaushik Saha, Arjun Khanna, Raja Dhar, Shubham Sharma, Himanshu Garg, B.S. Jayaraj, Deepak Talwar, Sundeep Salvi, S. Alberti, Shivani Saxena, Sheetu Singh, Samir Gami, Girija Nair, Virendra Singh, Anantharaj Suresh, Srinivas Rajagopala, Honney Sawhney, Babaji Ghewade, Surya Kant, Sneha Limaye, Naveen Dutt, Rajesh Swarnakar, Sonali Trivedi, Akanksha Das, George D'Souza, Harsh Saxena, James D. Chalmers, Padmanabhan Arjun, and Arti Shah

Subjects
medicine.medical_specialty, Bronchiectasis, business.industry, Sputum Production, Disease, medicine.disease, Natural history, FEV1/FVC ratio, Quality of life, Internal medicine, Cohort, medicine, Etiology, business
Abstract

Introduction: Bronchiectasis is a heterogeneous disease. Previous phenotyping of this disease has been based solely on 5 European databases which do not really account for the remaining world population. Aims and Objectives: This study looked at the Indian EMBARC Registry to try and identify discrete patient groups with different clinical and biological characteristics. Methodology: Principal component and cluster analyses were performed using demographics, co-morbidities, clinical, radiological, physiological and microbiological variables collected during the stable disease state. Results: The data from 1368 prospectively enrolled outpatients from 33 centres in India from the EMBARC India Registry were included for the cluster analysis. Among these patients (mean age 54 years, 60% men) six clusters were identified. Our clusters were driven by patient demographics (age and sex), BMI (median BMI 21.48), aetiology of Bronchiectasis (Idiopathic 22.9%, post TB 34.3%, Post infectious 21.3%, ABPA 9.9%) Lung function (mean FEV1 53.36%, FVC 63.71%). Patients in the six clusters showed significant differences in terms of quality of life, exacerbations and hospitalisations. This is in complete contrast to the European cohort where four clusters were identified driven by the presence of chronic infection with Pseudomonas Aeruginosa or other pathogens and daily sputum production. Conclusion: Hence this is the first effort to define discrete phenotypes of Bronchiectasis patients in an Asian population. Identification of six clinical phenotypes in Bronchiectasis could favour focused treatments in future interventional studies designed to alter the natural history of the disease.

Published
2018

21. Post-Tuberculosis Bronchiectasis in India:Outcomes of the Indian EMBARC Registry

Author

Palak Shah, S. Alberti, Anshul Mangla, George D'Souza, Sagar Chandrashekariah, B.S. Jayaraj, Sapna Madas, Sneha Limaye, Raja Dhar, Padukudru Anand Mahesh, Naveen Dutt, Shubham Sharma, Samir Gami, Himanshu Garg, Rajesh Swarnakar, Aditya Jindal, Babaji Ghewade, Kaushik Saha, Kripesh Sarmah, Devi H.J. Gayathri, Girija Nair, Padmanabhan Arjun, Harsh Saxena, K R Venugopal, Honney Sawhney, Anantharaj Suresh, Preethi Vasudev, Sonali Trivedi, Deesha Ghorpade, Arpan Shah, Sunil Vyas, Archana Baburao, Akanksha Das, Saurabh Karmakar, Sheetu Singh, Shivani Saxena, Virendra Singh, Deepak Talwar, Nikita Jajodia, Srinivas Rajagopala, Arti Shah, Rahul Kungwani, Sundeep Salvi, Arjun Khanna, Surya Kant, Rajendra Prasad, and James D. Chalmers

Subjects
0301 basic medicine, medicine.medical_specialty, Bronchiectasis, Tuberculosis, business.industry, Middle Lobe, 030106 microbiology, medicine.disease, 03 medical and health sciences, FEV1/FVC ratio, Lung disease, Internal medicine, Cohort, medicine, Sputum, Risk factor, medicine.symptom, business
Abstract

Introduction and Methods: The European Multicenter Bronchiectasis Audit and Research Collaboration (EMBARC) network established across 23 European countries was extended to India to explore unique features of Non-cystic fibrosis Bronchiectasis in this sub-continent. 34 investigator sites located across different parts of India contributed to 2062 cases of Non-CF Bronchiectasis, of which post-tuberculosis lung disease was identified as the biggest risk factor contributing to 34.7% (N=717) cases. The aim of this study was to describe the unique features of Post-TB Bronchiectasis observed on HRCT in this Indian cohort. Results: The mean (± SD) age of the 717 cases of Post-TB Bronchiectasis was 54.9 ± 14 yrs with a M:F ratio of 60:40. The location of Bronchiectasis was 71% (67.7,74.3) in the upper lobes, 66% (62.5,69.5) in the middle lobe/lingula and 60% (56.4,63.6) in the lower lobes. The cystic type was the most common 56% (53.1,60.4), followed by cylindrical 46% (42.3,49.6) and varicose 8.9% (6.8,10.9). More than 43.8% had bilateral disease. 13.6% (11.3,16.3) of the cases presented with hemoptysis that required hospitalization. Sputum microbiological samples collected in 39.8% of the cases isolated Pseudomonas in 17.1% during stable disease and 18.9% during exacerbations, while Klebsiella was isolated in 4.5% and 16.0% of cases respectively. Myco TB was isolated in the sputum in 5% of cases. 39.5% of the subjects had FEV1/FVC values Conclusion: Post TB lung disease is the commonest cause for Non CF Bronchiectasis in India and presents with unique features that are distinct from those reported in the western world.

Published
2018

22. Air pollution health research priorities for India: Perspectives of the Indo-U.S. Communities of Researchers

Author

Kalpana Balakrishnan, Terry Gordon, Sagnik Dey, Vasu Kilaru, Sneha Limaye, Sanjay Rajagopalan, Randeep Guleria, Sundeep Salvi, George D. Thurston, Anurag Agrawal, Jonathan Thornburg, Srikanth S. Nadadur, and Gwen W. Collman

Subjects
Pollution, 010504 meteorology & atmospheric sciences, media_common.quotation_subject, ComputingMilieux_PERSONALCOMPUTING, ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION, Air pollution, ComputerApplications_COMPUTERSINOTHERSYSTEMS, 010501 environmental sciences, medicine.disease_cause, 01 natural sciences, Article, Environmental protection, ComputerApplications_MISCELLANEOUS, medicine, Environmental science, InformationSystems_MISCELLANEOUS, Biomass burning, 0105 earth and related environmental sciences, General Environmental Science, media_common
Abstract

No abstract available Keywords: Biomass burning; India; Indoor and outdoor air pollution; Pollution sources.

Published
2018

23. Field Testing of Alternative Cookstove Performance in a Rural Setting of Western India

Author

Thomas E. Sussan, D'Ann L. Williams, Sneha Limaye, Sanjay Juvekar, Veena Muralidharan, Shyam Biswal, Patrick N. Breysse, Ana M. Rule, Sundeep Salvi, and Kirsten Koehler

Subjects
Energy-Generating Resources, Accident prevention, 020209 energy, Health, Toxicology and Mutagenesis, Poison control, India, improved cookstove, lcsh:Medicine, 02 engineering and technology, Rural Health, 010501 environmental sciences, 01 natural sciences, World health, Article, carbon monoxide, Toxicology, Air pollutants, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Humans, 0105 earth and related environmental sciences, particulate matter, Air Pollutants, biomass, business.industry, lcsh:R, Public Health, Environmental and Occupational Health, Rural setting, Cooking and Eating Utensils, 3. Good health, Rural village, 13. Climate action, Stove, Air Pollution, Indoor, Fuel efficiency, business, wood
Abstract

Nearly three billion people use solid fuels for cooking and heating, which leads to extremely high levels of household air pollution and is a major cause of morbidity and mortality. Many stove manufacturers have developed alternative cookstoves (ACSs) that are aimed at reducing emissions and fuel consumption. Here, we tested a traditional clay chulha cookstove (TCS) and five commercially available ACSs, including both natural draft (Greenway Smart Stove, Envirofit PCS-1) and forced draft stoves (BioLite HomeStove, Philips Woodstove HD4012, and Eco-Chulha XXL), in a test kitchen in a rural village of western India. Compared to the TCS, the ACSs produced significant reductions in particulate matter less than 2.5 µm (PM2.5) and CO concentrations (Envirofit: 22%/16%, Greenway: 24%/42%, BioLite: 40%/35%, Philips: 66%/55% and Eco-Chulha: 61%/42%), which persisted after normalization for fuel consumption or useful energy. PM2.5 and CO concentrations were lower for forced draft stoves than natural draft stoves. Furthermore, the Philips and Eco-Chulha units exhibited higher cooking efficiency than the TCS. Despite significant reductions in concentrations, all ACSs failed to achieve PM2.5 levels that are considered safe by the World Health Organization (ACSs: 277–714 μg/m3 or 11–28 fold higher than the WHO recommendation of 25 μg/m3;).

Published
2015

24. Phenotype characterization of non-cystic fibrosis bronchiectasis in India

Author

Sushant Meshram, Aditya Jindal, Padukudru Anand Mahesh, Stefano Aliberti, Samir Gami, Girija Nair, Deepak Talwar, Archana Baburao, Devi H.J. Gayathri, Sundeep Salvi, Srinivas Rajagopalan, Raja Dhar, Surya Kant, Naveen Dutt, Virendra Singh, Rajesh Swarnakar, Sneha Limaye, George D'Souza, James D. Chalmers, Babaji Ghewade, Sagar Chandrashekariah, and Kaushik Saha

Subjects
Spirometry, medicine.medical_specialty, Bronchiectasis, medicine.diagnostic_test, business.industry, Influenza vaccine, medicine.disease, Comorbidity, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Pneumococcal vaccine, Internal medicine, Diabetes mellitus, Etiology, Medicine, 030212 general & internal medicine, Medical prescription, business
Abstract

Background: The Indian Bronchiectasis registry is an extension of EMBARC Registry started in 2015 by Respiratory Research Network of India to get better insights into its demographics, aetiology, co-morbidities and treatment practices in India. Methods: 18 investigator sites of the RRNI across India completed a web-based registry case report comprising of demographic details, risk factors, aetiology, HRCT, spirometry and treatment. Results: 964 patients of non-CF bronchiectasis were enrolled in this registry, of which 581(60.27%) were males. The mean age of participants was 52.59±15.32 years. The commonest pattern on HRCT was Cystic Bronchiectasis (66%) followed by cylindrical(41.2%) and varicose(12.7%) types. Cardiovascular disease was the commonest comorbidity(17%) followed by diabetes(15.8% ). The commonest aetiology for Bronchiectasis was Post TB(32.16%), followed by Idiopathic(23.5%) and post Infective(22.5%). ABPA related Bronchiectasis was seen in 11.4% cases. The quality of life (MRC Dyspnoea scale) was worst when the aetiology was TB(MRC≥3= 65%). Majority were never-smokers(70.6%) with only 5.7% being current smokers. The commonest inhaled prescriptions were ICS/LABA combination(71.75%) followed by Tiotropium(22.54%) and LABA(22.11%). Only 241 patients were prescribed antibiotics, of which 55.19% patients received low-dose macrolides(Azithromycin-31.1%), while cyclical antibiotic therapy was given to 29.4% patients. The commonest non-respiratory prescription was PPI(33%) followed by a statin(8.6%). 41.90% patients received pneumococcal vaccine. 44.09% received Influenza vaccine in last 1 year. Conclusions: EMBARC India Registry offers novel insights into non- CF Bronchiectasis in India.

Published
2017

25. Obesity and Asthma

Author

Sneha Limaye and Sundeep Salvi

Subjects
Pollutant, business.industry, Immunology, Air pollution, Risk factor (computing), medicine.disease_cause, medicine.disease, Obesity, Environmental health, medicine, Immunology and Allergy, business, Asthma, Indoor air pollutants
Abstract

Air pollution is a well-known risk for lung diseases, including asthma. Growing evidences suggesting air pollution as a novel risk factor for the development of obesity. Several Epidemiological studies have ascertained an association between various ambient and indoor air pollutants and obesity by medium of endocrine disruptive chemicals that can disrupt the normal development and homeostatic controls over adipogenesis and energy balance and induce obesity. Several obesity-induced mechanisms have been proposed that increases this vulnerability of obese individuals to harmful effects of air pollution rendering them more susceptible to developing air-pollution driven incident asthma or worsening of already existing asthma.

Published
2014

26. Clinical evaluation of fluticasone/formoterol twice daily delivered via a single dose dry powder inhaler in patients with persistent asthma

Author

George D'Souza, Sudhir Bhatnagar, Ashish Kumar Deb, Pradyut Waghray, Mayank Agarwal, Aloke Gopal Ghoshal, Raja Dhar, Sujeet Rajan, Manish Jain, Sneha Limaye, Akash Balki, Sharad Tikkiwal, Ashish Goyal, Mahip Saluja, Abhijit Vaidya, and Jaideep Gogtay

Subjects
business.industry, Anesthesia, medicine, Fluticasone-formoterol, Observational study, In patient, Formoterol, Persistent asthma, business, Clinical evaluation, Dry-powder inhaler, Fluticasone, medicine.drug
Abstract

Revolizer ® is a single dose dry powder inhaler (SDDPI) with moderate resistance, which requires a simple inhalation technique. We report here for the first-time results of Fluticasone/Formoterol (FF) (100/6 or 250/6 mcg; Maxiflo®) twice daily delivered by the Revolizer® on asthma control in patients with persistent asthma.This was a 24 weeks, prospective, non-comparative, multi-centre, open-label, real-world observational study. Patients participating in this study were either already on FF at any dose via Revolizer® or were uncontrolled on other treatment via Revolizer® and required a change in their treatment to FF, as per treating physicians9 discretion. We assessed asthma control at baseline, Weeks 4, 8, 16 and 24 using Asthma Control Test™ (ACT). 401 patients were enrolled [mean age 41.1 ±14.36 years; 202 (50.37%) males] and 385 patients completed the study. At the end of 24 weeks asthma control was achieved in 80.78% of patients. Mean change in asthma control score from baseline to weeks 4, 8, 16 and 24 was 3, 3.8, 5.5 and 6.7, respectively (all p

Published
2016

27. Antibiotic prescription patterns for treating respiratory infections across intensive care unit (ICUs) in India

Author

Sapna Madas, Murali Mohan B, Rajesh Swarnakar, Suryakant Tripathi, Babaji Ghewade, Amit Khomane, P.H. Manjunath, Shrikant Ambalkar, Padukudru Anand Mahesh, Anand Srivastava, Nishtha Singh, Aditi Joshi, Yusra Iqbal, Smaran Claudius, Deepak Muthreja, Prasad Chelluri, Sneha Limaye, Girija Nair, Sundeep Salvi, Virendra Singh, Sushant Meshram, Niranjan Kulkarni, Nikita Jalan, and B.S. Jayaraj

Subjects
medicine.medical_specialty, Pediatrics, ARDS, Bronchiectasis, Respiratory tract infections, medicine.drug_class, business.industry, Antibiotics, medicine.disease, Intensive care unit, law.invention, Pneumonia, Respiratory failure, law, Internal medicine, medicine, Medical prescription, business
Abstract

BACKGROUND: Respiratory infections are a major challenge in ICUs across India. An audit of antibiotic prescribing patterns is an important indicator of the quality and standard of clinical practice. We aimed to assess the antimicrobial prescribing practices for treating respiratory tract infections in ICUs across 5 states in India. METHODOLOGY: Prospective multicentre, observational study was conducted across 9 sites of Respiratory Research Network of India. On obtaining written consent for participation, patient who were prescribed antibiotics were included in the study. Information was captured on the Questionnaire consisting of demographics, diagnosis & antibiotic prescription patterns. RESULTS: Prescription of 361 patients admitted over a period of 6 months were analysed. The mean age was 53.94 years (±17.99). 65% patients were males. 35% were females. The infections included Pneumonia (43%), Obstructive Airway Disease - OAD (37.8%), Respiratory Failure - RF (16.9%), Pleural Disease (13%), Tuberculosis (13%), Acute Respiratory Distress Syndrome - ARDS (8%), Bronchiectasis (5%), Interstitial Lung Disease (2.2%) and others (5%). The prescribed antibiotics for pneumonia, OAD, RF and ARDS has been mentioned as CONCLUSION: Penicillin and Cephalosporin are the most widely prescribed antibiotics for respiratory infections among patients admitted to the ICU9s In India.

Published
2016

28. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study

Author

Stefano Aliberti, Luis F Reyes, Paola Faverio, Giovanni Sotgiu, Simone Dore, Alejandro H Rodriguez, Nilam J Soni, Marcos I Restrepo, Patricia Karina Aruj, Silvia Attorri, Enrique Barimboim, Juan Pablo Caeiro, María I Garzón, Victor Hugo Cambursano, Adrian Ceccato, Julio Chertcoff, Florencia Lascar, Fernando Di Tulio, Ariel Cordon Díaz, Lautaro de Vedia, Maria Cristina Ganaha, Sandra Lambert, Gustavo Lopardo, Carlos M Luna, Alessio Gerardo Malberti, Nora Morcillo, Silvina Tartara, Claudia Pensotti, Betiana Pereyra, Pablo Gustavo Scapellato, Juan Pablo Stagnaro, Sonali Shah, Felix Lötsch, Florian Thalhammer, Jean Louis Vincent, Kurt Anseeuw, Camille A Francois, Eva Van Braeckel, Marcel Zannou Djimon, Jules Bashi, Roger Dodo, Simone Aranha Nouér, Peter Chipev, Milena Encheva, Darina Miteva, Diana Petkova, Adamou Dodo Balkissou, Eric Walter Pefura Yone, Bertrand Hugo Mbatchou Ngahane, Ning Shen, Jin-fu Xu, Carlos Andres Bustamante Rico, Ricardo Buitrago, Fernando Jose Pereira Paternina, Jean-Marie Kayembe Ntumba, Vesna Vladic Carevic, Marko Jakopovic, Mateja Jankovic, Zinka Matkovic, Ivan Mitrecic, Marie-Laure Bouchy Jacobsson, Anette Bro Christensen, Uffe Christian Heitmann Bødtger, Christian Niels Meyer, Andreas Vestergaard Jensen, Gertrud Baunbæk-knudsen, Pelle Trier Petersen, Stine Andersen, Ibrahim El-Said Abd El-Wahhab, Nesreen Elsayed Morsy, Hanaa Shafiek, Eman Sobh, Kedir Abdella Abdulsemed, Fabrice Bertrand, Christian Brun-Buisson, Etienne de Montmollin, Muriel Fartoukh, Jonathan Messika, Pierre Tattevin, Abdo Khoury, Bernard Ebruke, Michael Dreher, Martin Kolditz, Matthias Meisinger, Mathias W Pletz, Stefan Hagel, Jan Rupp, Tom Schaberg, Marc Spielmanns, Petra Creutz, Norton Suttorp, Beatrice Siaw-Lartey, Katerina Dimakou, Dimosthenis Papapetrou, Evdoxia Tsigou, Dimitrios Ampazis, Evangelos Kaimakamis, Mohit Bhatia, Raja Dhar, George D'Souza, Rajiv Garg, Parvaiz A Koul, P A Mahesh, B S Jayaraj, Kiran Vishnu Narayan, Hirennappa B Udnur, Shashi Bhaskara Krishnamurthy, Surya Kant, Rajesh Swarnakar, Sneha Limaye, Sundeep Salvi, Keihan Golshani, Vera M Keatings, Ignacio Martin-Loeches, Yasmin Maor, Jacob Strahilevitz, Salvatore Battaglia, Maria Carrabba, Piero Ceriana, Marco Confalonieri, Antonella d'Arminio Monforte, Bruno Del Prato, Marino De Rosa, Riccardo Fantini, Giuseppe Fiorentino, Maria Antonia Gammino, Francesco Menzella, Giuseppe Milani, Stefano Nava, Gerardo Palmiero, Roberta Petrino, Barbra Gabrielli, Paolo Rossi, Claudio Sorino, Gundi Steinhilber, Alessandro Zanforlin, Fabio Franzetti, Manuela Carugati, Manuela Morosi, Elisa Monge, Mauro Carone, Vincenzo Patella, Simone Scarlata, Andrea Comel, Kiyoyasu Kurahashi, Zeina Aoun Bacha, Daniel Barajas Ugalde, Omar Ceballos Zuñiga, José F Villegas, Milic Medenica, E M W van de Garde, Deebya Raj Mihsra, Poojan Shrestha, Elliott Ridgeon, Babatunde Ishola Awokola, Ogonna N O Nwankwo, Adefuye Bolanle Olufunlola, Segaolu Olumide, Kingsley N Ukwaja, Muhammad Irfan, Lukasz Minarowski, Skoczynski Szymon, Felipe Froes, Pedro Leuschner, Mariana Meireles, Cláudia Ferrão, João Neves, Sofia B Ravara, Victoria Brocovschii, Chesov Ion, Doina Rusu, Cristina Toma, Daniela Chirita, Carmen Mihaela Dorobat, Alexei Birkun, Anna Kaluzhenina, Abdullah Almotairi, Zakeya Abdulbaqi Ali Bukhary, Jameela Edathodu, Amal Fathy, Abdullah Mushira Abdulaziz Enani, Nazik Eltayeb Mohamed, Jawed Ulhadi Memon, Abdelhaleem Bella, Nada Bogdanovic, Branislava Milenkovic, Dragica Pesut, Luis Borderìas, Noel Manuel Bordon Garcia, Hugo Cabello Alarcón, Catia Cilloniz, Antoni Torres, Vicens Diaz-Brito, Xavier Casas, Alicia Encabo González, Maria Luisa Fernández-Almira, Miguel Gallego, Inmaculada Gaspar-GarcÍa, Juan González del Castillo, Patricia Javaloyes Victoria, Elena Laserna Martínez, Rosa Malo de Molina, Pedro J Marcos, Rosario Menéndez, Ana Pando-Sandoval, Cristina Prat Aymerich, Alicia Lacoma de la Torre, Ignasi García-Olivé, Jordi Rello, Silvia Moyano, Francisco Sanz, Oriol Sibila, Ana Rodrigo-Troyano, Jordi Solé-Violán, Ane Uranga, Job FM van Boven, Ester Vendrell Torra, Jordi Almirall Pujol, Charles Feldman, Ho Kee Yum, Arnauld Attannon Fiogbe, Ferdaous Yangui, Semra Bilaceroglu, Levent Dalar, Ufuk Yilmaz, Artemii Bogomolov, Naheed Elahi, Devesh J Dhasmana, Andrew Feneley, Rhiannon Ions, Julie Skeemer, Gerrit Woltmann, Carole Hancock, Adam T Hill, Banu Rudran, Silvia Ruiz-Buitrago, Marion Campbell, Paul Whitaker, Alexander Youzguin, Anika Singanayagam, Karen S Allen, Veronica Brito, Jessica Dietz, Claire E Dysart, Susan M Kellie, Ricardo A Franco-Sadud, Garnet Meier, Mina Gaga, Thomas L Holland, Stephen P Bergin, Fayez Kheir, Mark Landmeier, Manuel Lois, Girish B Nair, Hemali Patel, Katherine Reyes, William Rodriguez-Cintron, Shigeki Saito, Julio Noda, Cecilia I Hinojosa, Stephanie M Levine, Luis F Angel, Antonio Anzueto, K Scott Whitlow, John Hipskind, Kunal Sukhija, Vicken Totten, Richard G Wunderink, Ray D Shah, Kondwelani John Mateyo, Lorena Noriega, Ezequiel Alvarado, Mohamed Aman, Lucía Labra, Aliberti, S., Reyes, L. F., Faverio, P., Sotgiu, G., Dore, S., Rodriguez, A. H., Soni, N. J., Restrepo, M. I., Aruj, P. K., Attorri, S., Barimboim, E., Caeiro, J. P., Garzon, M. I., Cambursano, Vh., Ceccato, A., Chertcoff, J., Lascar, F., Di Tulio, F., Cordon Diaz, A., de Vedia, L., Ganaha, M. C., Lambert, S., Lopardo, G., Luna, C. M., Malberti, A. G., Morcillo, N., Tartara, S., Pensotti, C., Pereyra, B., Scapellato, P. G., Stagnaro, J. P., Shah, S., Lotsch, F., Thalhammer, F., Vincent, J. L., Anseeuw, K., Francois, C. A., Van Braeckel, E., Djimon, M. Z., Bashi, J., Dodo, R., Aranha Nouer, S., Chipev, P., Encheva, M., Miteva, D., Petkova, D., Balkissou, A. D., Pefura Yone, E. W., Mbatchou Ngahane, B. H., Shen, N., Xu, J. F., Bustamante Rico, C. A., Buitrago, R., Pereira Paternina, F. J., Kayembe Ntumba, J. M., Vladic Carevic, V., Jakopovic, M., Jankovic, M., Matkovic, Z., Mitrecic, I., Bouchy Jacobsson, M. L., Bro Christensen, A., Heitmann Bodtger, U. C., Meyer, C. N., Vestergaard Jensen, A., Baunbaek-Knudsen, G., Trier Petersen, P., Andersen, S., El-Said Abd El-Wahhab, I., Elsayed Morsy, N., Shafiek, H., Sobh, E., Abdulsemed, K. A., Bertrand, F., Brun-Buisson, C., de Montmollin, E., Fartoukh, M., Messika, J., Tattevin, P., Khoury, A., Ebruke, B., Dreher, M., Kolditz, M., Meisinger, M., Pletz, M. W., Hagel, S., Rupp, J., Schaberg, T., Spielmanns, M., Creutz, P., Suttorp, N., Siaw-Lartey, B., Dimakou, K., Papapetrou, D., Tsigou, E., Ampazis, D., Kaimakamis, E., Bhatia, M., Dhar, R., D'Souza, G., Garg, R., Koul, P. A., Mahesh, P. A., Jayaraj, B. S., Narayan, K. V., Udnur, H. B., Krishnamurthy, S. B., Kant, S., Swarnakar, R., Limaye, S., Salvi, S., Golshani, K., Keatings, V. M., Martin-Loeches, I., Maor, Y., Strahilevitz, J., Battaglia, S., Carrabba, M., Ceriana, P., Confalonieri, M., d'Arminio Monforte, A., Del Prato, B., De Rosa, M., Fantini, R., Fiorentino, G., Gammino, M. A., Menzella, F., Milani, G., Nava, S., Palmiero, G., Petrino, R., Gabrielli, B., Rossi, P., Sorino, C., Steinhilber, G., Zanforlin, A., Franzetti, F., Carugati, M., Morosi, M., Monge, E., Carone, M., Patella, V., Scarlata, S., Comel, A., Kurahashi, K., Aoun Bacha, Z., Barajas Ugalde, D., Ceballos Zuniga, O., Villegas, J. F., Medenica, M., van de Garde, Emw., Raj Mihsra, D., Shrestha, P., Ridgeon, E., Ishola Awokola, B., Nwankwo, Ono., Olufunlola, A. B., Olumide, S., Ukwaja, K. N., Irfan, M., Minarowski, L., Szymon, S., Froes, F., Leuschner, P., Meireles, M., Ferrao, C., Neves, J., Ravara, S. B., Brocovschii, V., Ion, C., Rusu, D., Toma, C., Chirita, D., Dorobat, C. M., Birkun, A., Kaluzhenina, A., Almotairi, A., Bukhary, Zaa., Edathodu, J., Fathy, A., Mushira Abdulaziz Enani, A., Eltayeb Mohamed, N., Ulhadi Memon, J., Bella, A., Bogdanovic, N., Milenkovic, B., Pesut, D., Borderias, L., Bordon Garcia, N. M., Cabello Alarcon, H., Cilloniz, C., Torres, A., Diaz-Brito, V., Casas, X., Encabo Gonzalez, A., Fernandez-Almira, M. L., Gallego, M., Gaspar-GarcIa, I., Gonzalez Del Castillo, J., Javaloyes Victoria, P., Laserna Martinez, E., Malo de Molina, R., Marcos, P. J., Menendez, R., Pando-Sandoval, A., Prat Aymerich, C., Lacoma de la Torre, A., Garcia-Olive, I., Rello, J., Moyano, S., Sanz, F., Sibila, O., Rodrigo-Troyano, A., Sole-Violan, J., Uranga, A., van Boven, J. F., Vendrell Torra, E., Pujol, J. A., Feldman, C., Kee Yum, H., Fiogbe, A. A., Yangui, F., Bilaceroglu, S., Dalar, L., Yilmaz, U., Bogomolov, A., Elahi, N., Dhasmana, D. J., Feneley, A., Ions, R., Skeemer, J., Woltmann, G., Hancock, C., Hill, A. T., Rudran, B., Ruiz-Buitrago, S., Campbell, M., Whitaker, P., Youzguin, A., Singanayagam, A., Allen, K. S., Brito, V., Dietz, J., Dysart, C. E., Kellie, S. M., Franco-Sadud, R. A., Meier, G., Gaga, M., Holland, T. L., Bergin, S. P., Kheir, F., Landmeier, M., Lois, M., Nair, G. B., Patel, H., Reyes, K., Rodriguez-Cintron, W., Saito, S., Noda, J., Hinojosa, C. I., Levine, S. M., Angel, L. F., Anzueto, A., Whitlow, K. S., Hipskind, J., Sukhija, K., Totten, V., Wunderink, R. G., Shah, R. D., Mateyo, K. J., Noriega, L., Alvarado, E., Aman, M., Labra, L., Aliberti S., Reyes L.F., Faverio P., Sotgiu G., Dore S., Rodriguez A.H., Soni N.J., Restrepo M.I., Aruj P.K., Attorri S., Barimboim E., Caeiro J.P., Garzon M.I., Cambursano VH., Ceccato A., Chertcoff J., Lascar F., Di Tulio F., Cordon Diaz A., de Vedia L., Ganaha M.C., Lambert S., Lopardo G., Luna C.M., Malberti A.G., Morcillo N., Tartara S., Pensotti C., Pereyra B., Scapellato P.G., Stagnaro J.P., Shah S., Lotsch F., Thalhammer F., Vincent J.L., Anseeuw K., Francois C.A., Van Braeckel E., Djimon M.Z., Bashi J., Dodo R., Aranha Nouer S., Chipev P., Encheva M., Miteva D., Petkova D., Balkissou A.D., Pefura Yone E.W., Mbatchou Ngahane B.H., Shen N., Xu J.F., Bustamante Rico C.A., Buitrago R., Pereira Paternina F.J., Kayembe Ntumba J.M., Vladic Carevic V., Jakopovic M., Jankovic M., Matkovic Z., Mitrecic I., Bouchy Jacobsson M.L., Bro Christensen A., Heitmann Bodtger U.C., Meyer C.N., Vestergaard Jensen A., Baunbaek-Knudsen G., Trier Petersen P., Andersen S., El-Said Abd El-Wahhab I., Elsayed Morsy N., Shafiek H., Sobh E., Abdulsemed K.A., Bertrand F., Brun-Buisson C., de Montmollin E., Fartoukh M., Messika J., Tattevin P., Khoury A., Ebruke B., Dreher M., Kolditz M., Meisinger M., Pletz M.W., Hagel S., Rupp J., Schaberg T., Spielmanns M., Creutz P., Suttorp N., Siaw-Lartey B., Dimakou K., Papapetrou D., Tsigou E., Ampazis D., Kaimakamis E., Bhatia M., Dhar R., D'Souza G., Garg R., Koul P.A., Mahesh P.A., Jayaraj B.S., Narayan K.V., Udnur H.B., Krishnamurthy S.B., Kant S., Swarnakar R., Limaye S., Salvi S., Golshani K., Keatings V.M., Martin-Loeches I., Maor Y., Strahilevitz J., Battaglia S., Carrabba M., Ceriana P., Confalonieri M., d'Arminio Monforte A., Del Prato B., De Rosa M., Fantini R., Fiorentino G., Gammino M.A., Menzella F., Milani G., Nava S., Palmiero G., Petrino R., Gabrielli B., Rossi P., Sorino C., Steinhilber G., Zanforlin A., Franzetti F., Carugati M., Morosi M., Monge E., Carone M., Patella V., Scarlata S., Comel A., Kurahashi K., Aoun Bacha Z., Barajas Ugalde D., Ceballos Zuniga O., Villegas J.F., Medenica M., van de Garde EMW., Raj Mihsra D., Shrestha P., Ridgeon E., Ishola Awokola B., Nwankwo ONO., Olufunlola A.B., Olumide S., Ukwaja K.N., Irfan M., Minarowski L., Szymon S., Froes F., Leuschner P., Meireles M., Ferrao C., Neves J., Ravara S.B., Brocovschii V., Ion C., Rusu D., Toma C., Chirita D., Dorobat C.M., Birkun A., Kaluzhenina A., Almotairi A., Bukhary ZAA., Edathodu J., Fathy A., Mushira Abdulaziz Enani A., Eltayeb Mohamed N., Ulhadi Memon J., Bella A., Bogdanovic N., Milenkovic B., Pesut D., Borderias L., Bordon Garcia N.M., Cabello Alarcon H., Cilloniz C., Torres A., Diaz-Brito V., Casas X., Encabo Gonzalez A., Fernandez-Almira M.L., Gallego M., Gaspar-GarcIa I., Gonzalez Del Castillo J., Javaloyes Victoria P., Laserna Martinez E., Malo de Molina R., Marcos P.J., Menendez R., Pando-Sandoval A., Prat Aymerich C., Lacoma de la Torre A., Garcia-Olive I., Rello J., Moyano S., Sanz F., Sibila O., Rodrigo-Troyano A., Sole-Violan J., Uranga A., van Boven J.F., Vendrell Torra E., Pujol J.A., Feldman C., Kee Yum H., Fiogbe A.A., Yangui F., Bilaceroglu S., Dalar L., Yilmaz U., Bogomolov A., Elahi N., Dhasmana D.J., Feneley A., Ions R., Skeemer J., Woltmann G., Hancock C., Hill A.T., Rudran B., Ruiz-Buitrago S., Campbell M., Whitaker P., Youzguin A., Singanayagam A., Allen K.S., Brito V., Dietz J., Dysart C.E., Kellie S.M., Franco-Sadud R.A., Meier G., Gaga M., Holland T.L., Bergin S.P., Kheir F., Landmeier M., Lois M., Nair G.B., Patel H., Reyes K., Rodriguez-Cintron W., Saito S., Noda J., Hinojosa C.I., Levine S.M., Angel L.F., Anzueto A., Whitlow K.S., Hipskind J., Sukhija K., Totten V., Wunderink R.G., Shah R.D., Mateyo K.J., Noriega L., Alvarado E., Aman M., Labra L., Aliberti, S, Reyes, L, Faverio, P, Sotgiu, G, Dore, S, Rodriguez, A, Soni, N, and Restrepo, M

Subjects
Male, antibiotic resistance, Prevalence, MRSA, medicine.disease_cause, pneumonia, staphylococcus aureus, Global Health, Cohort Studies, 0302 clinical medicine, Community-acquired pneumonia, Risk Factors, Retrospective Studie, Community-Acquired Infection, 030212 general & internal medicine, education.field_of_study, Cross Infection, Respiratory tract infections, Methicillin-Resistant Staphylococcus aureu, Staphylococcal Infections, Hospitals, Community-Acquired Infections, Infectious Diseases, Infectious diseases, Female, Human, Methicillin-Resistant Staphylococcus aureus, medicine.medical_specialty, Population, Admission, staphylococcus aureu, Settore MED/10 - Malattie Dell'Apparato Respiratorio, 03 medical and health sciences, Hospital, Internal medicine, medicine, Humans, Risk factor, education, Intensive care medicine, Staphylococcal Infection, Retrospective Studies, Aged, business.industry, Risk Factor, Odds ratio, Pneumonia, medicine.disease, Methicillin-resistant Staphylococcus aureus, 030228 respiratory system, Methicillin Resistance, Cohort Studie, business
Abstract

BACKGROUND: Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are available on the worldwide prevalence and risk factors for MRSA pneumonia. We aimed to determine the point prevalence of MRSA pneumonia and identify specific MRSA risk factors in community-dwelling patients hospitalised with pneumonia.METHODS: We did an international, multicentre study of community-dwelling, adult patients admitted to hospital with pneumonia who had microbiological tests taken within 24 h of presentation. We recruited investigators from 222 hospitals in 54 countries to gather point-prevalence data for all patients admitted with these characteristics during 4 days randomly selected during the months of March, April, May, and June in 2015. We assessed prevalence of MRSA pneumonia and associated risk factors through logistic regression analysis.FINDINGS: 3702 patients hospitalised with pneumonia were enrolled, with 3193 patients receiving microbiological tests within 24 h of admission, forming the patient population. 1173 (37%) had at least one pathogen isolated (culture-positive population). The overall prevalence of confirmed MRSA pneumonia was 3·0% (n=95), with differing prevalence between continents and countries. Three risk factors were independently associated with MRSA pneumonia: previous MRSA infection or colonisation (odds ratio 6·21, 95% CI 3·25-11·85), recurrent skin infections (2·87, 1·10-7·45), and severe pneumonia disease (2·39, 1·55-3·68).INTERPRETATION: This multicountry study shows low prevalence of MRSA pneumonia and specific MRSA risk factors among community-dwelling patients hospitalised with pneumonia.FUNDING: None.

Published
2016

29. Factors influencing severity of community-acquired pneumonia

Author

Padukudru Anand Mahesh, Raja Dhar, B.S. Jayaraj, Sneha Limaye, M Mahendra, and S K Chaya

Subjects
0301 basic medicine, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Community-acquired pneumonia, medicine.medical_treatment, 030106 microbiology, Population, methicillin-resistant Staphylococcus aureus, medicine.disease_cause, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, medicine, 030212 general & internal medicine, education, lcsh:RC705-779, CURB-65, Mechanical ventilation, education.field_of_study, business.industry, Respiratory infection, lcsh:Diseases of the respiratory system, Pneumonia, medicine.disease, Intensive care unit, Methicillin-resistant Staphylococcus aureus, Original Article, business, global initiative for methicillin-resistant Staphylococcus aureus pneumonia
Abstract

Introduction: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in India. There is a need to understand the risk factors associated with severity of CAP in our population. This study was part of the international global initiative for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia study to evaluate MRSA. Methods: A total of 100 consecutive cases of pneumonia admitted to the Department of Pulmonary Medicine in a tertiary care hospital were recruited in the study during March–July 2015. The severity of pneumonia was assessed based on the CURB-65 score. Individuals with pneumonia and CURB-65 score >2 were compared with subjects with CURB-65 score ≤2. Individuals were also evaluated for the causative organism and its resistance pattern with specific reference to the presence of MRSA. Results: Mean age of patients was 54.03 years, 66% were men. Patients were managed either in the intensive care unit (42%) or wards/high dependency unit (58%), 22% needed noninvasive ventilation and 18% needed mechanical ventilation within 24 h of admission. On multivariate analysis, prior respiratory infection (within last 1 year), obesity (body mass index >30), and alcoholism, old age (>60 years) were independently associated risk factors for severe pneumonia. There were no cases of MRSA. In 34% of cases, organisms could be identified. Most common organisms were Klebsiella (8%), influenza (8%), and Pseudomonas (5%). Conclusion: Prior respiratory infection, obesity, alcoholism, and old age (>60 years) were observed to be important risk factors for severe CAP. Prospective studies should evaluate effect of weight reduction and cessation of alcohol consumption on recurrences of pneumonia in this population and on the severity of pneumonia.

Published
2018

30. Study of 793 COPD patients treated by general practitioners (GPs), intensivists (IPs) and pulmonologists (Ps) across India

Author

Suryakant Tripathi, Sneha Limaye, C. Prasad, Devasahayam J. Christopher, Raja Dhar, Padukudru Anand Mahesh, Sundeep Salvi, Renu Sorte, Mahavir Modi, Sapna Madas, Parthssarthy Bhattacharyya, and Rajesh Swarnakar

Subjects
Spirometry, medicine.medical_specialty, COPD, Pediatrics, medicine.diagnostic_test, business.industry, Medical record, Phlegm, Pulmonologist, medicine.disease, respiratory tract diseases, Wheeze, Emergency medicine, medicine, medicine.symptom, business, Pulmonologists, Cause of death
Abstract

Background: Despite being the 2nd leading cause of death in India, COPD remains poorly diagnosed, investigated and treated. We aimed to study the diagnosis, use of spirometry and patient's satisfaction with treatment received from previous GPs, Ps and Is, in COPD patients visiting a Pulmonologist from the Respiratory Research Network of India. Methodology: Eight Pulmonologists from different locations in India collected medical records and information of 793 COPD patients from India. Results: The mean age of 793 COPD subjects was 61.8±9.7yrs, 82% were smokers with males contributing 87%. Their mean FEV1 was 47.66%+14.8%. The common presenting symptoms were: breathlessness (88%), cough (74%), phlegm (47%), wheeze (17%) and chest tightness (12%) The mean number of COPD exacerbations was 1.79+1.62. Diagnosis of COPD was not made in 47% of patients. Spirometry was done in only 15.78% COPD patients. 48.61% of patients visited the pulmonologist because of dissatisfaction with the previous doctor's treatment. ![Figure][1] Conclusion: COPD remains poorly diagnosed and treated by GPs and Intensivists in India. There is a need to upgrade the knowledge base and skill set of practicing physicians in India. [1]: pending:yes

Published
2015

31. Indoor Particulate Matter2.5 μm in Mean Aerodynamic Diameter and Carbon Monoxide Levels During the Burning of Mosquito Coils and Their Association With Respiratory Health

Author

Sneha Limaye, Sundeep Salvi, Devashri Salvi, Jyoti Londhe, Sapna Madas, Sanjay Juvekar, Veena Muralidharan, and Shyam Biswal

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, Rural Population, Health Status, Respiratory System, Prevalence, 010501 environmental sciences, Critical Care and Intensive Care Medicine, 01 natural sciences, Mosquito coil, law.invention, Toxicology, 03 medical and health sciences, 0302 clinical medicine, Indoor air quality, law, Smoke, Surveys and Questionnaires, Medicine, Animals, Humans, Biomass, Particle Size, 0105 earth and related environmental sciences, Burning Sensation, Carbon Monoxide, business.industry, Protective Devices, Particulates, Cross-Sectional Studies, Culicidae, 030228 respiratory system, Breath Tests, Air Pollution, Indoor, Ventilation (architecture), Female, Particulate Matter, Cardiology and Cardiovascular Medicine, business, Bedroom, Follow-Up Studies
Abstract

Background An estimated 700 million people suffer from mosquito-borne diseases worldwide. Various types of mosquito repellents are widely used to prevent mosquito bites. The objectives of this study were (1) to measure the indoor levels of particulate matter 2.5 ) and carbon monoxide (CO) during the burning of mosquito coils (MCs) and study the impact of indoor ventilation patterns; and (2) to study and compare the prevalence of respiratory ailments in homes using different types of mosquito repellents. Methods Indoor PM 2.5 and CO levels were measured inside a bedroom during the burning of MCs keeping the window and/or door open/closed over a 6-h duration. A cross-sectional survey was conducted in three villages where 465 individuals were administered a questionnaire that captured demographic details, type and duration of mosquito repellents used, and prevalence of respiratory symptoms and diseases. Results Fifty-three percent of the subjects burned MCs on most days of the week, and 63% did so with their doors and windows closed. Burning of MCs produced very high levels of PM 2.5 (1,031 μg/m 3 mean, 1,613 μg/m 3 peak) and CO (6.50 parts per million (ppm) mean, 10.27 ppm peak) when both the door and window were closed. These levels reduced by around 50% when the window was opened and > 95% when both the window and the door were opened. The prevalence rates of respiratory symptoms and diseases were higher in subjects using MCs, although not statistically significant. Those living in smaller homes and using MCs had significantly greater morbidity. Conclusions Burning of MCs produces indoor levels of PM 2.5 and CO that are higher than those reported during the burning of biomass fuels for cooking purposes and may be associated with respiratory morbidity.

Published
2015

32. Obesity and asthma: the role of environmental pollutants

Author

Sneha, Limaye and Sundeep, Salvi

Subjects
Organotin Compounds, Prevalence, Animals, Humans, Environmental Pollutants, Obesity, World Health Organization, Asthma, United States, Body Mass Index
Abstract

Air pollution is a well-known risk for lung diseases, including asthma. Growing evidences suggesting air pollution as a novel risk factor for the development of obesity. Several Epidemiological studies have ascertained an association between various ambient and indoor air pollutants and obesity by medium of endocrine disruptive chemicals that can disrupt the normal development and homeostatic controls over adipogenesis and energy balance and induce obesity. Several obesity-induced mechanisms have been proposed that increases this vulnerability of obese individuals to harmful effects of air pollution rendering them more susceptible to developing air-pollution driven incident asthma or worsening of already existing asthma.

Published
2014

33. Development of Novel Antioxidants

Author

Sneha Limaye, Subhabrata Moitra, and Bill Brashier

Subjects
Drug, Antioxidant, biology, business.industry, Drug discovery, media_common.quotation_subject, medicine.medical_treatment, Interstitial lung disease, Disease, Bioinformatics, medicine.disease_cause, medicine.disease, Pathogenesis, Superoxide dismutase, medicine, biology.protein, business, Oxidative stress, media_common
Abstract

Oxidative stress is the cornerstone in the pathogenesis of all chronic inflammatory diseases. Although, this has been known to science for a long time, its implication in the disease pathophysiology was never clear. This was more so with chronic inflammatory diseases of the lungs which emerged as medical interest to the pharmaceutical industries recently. In the history of drug discovery, lots of resources have been utilized, and also being utilized, in identifying new molecules, which can arrest the inflammatory process in the disease, however, without much success. But, it is now being realized that outcome of inflammatory process “oxidative stress” may be responsible for anti-inflammatory-drug refractoriness in most chronic inflammatory pathways. Indeed, the transformation of interstitial lung disease treatment from steroids few years back to antioxidant now is one of the intriguing examples of this realization. Now active research is being focused on deciphering new antioxidant molecules which can change the course of the chronic inflammatory diseases. The biggest hurdle in development of antioxidant drug is the complexity of oxidative stress pathways. However, with understanding of role of most ubiquitously prevalent antioxidant molecules such as glutathione, catalase, superoxide dismutase, and pleiotropic transcription factors such as NF-κB there have been now some successful attempts in development of new antioxidant molecules, which may have potential role in the management of chronic inflammatory disease of the lung. However, the antioxidant developmental pharmacology is still at very nascent stage and restricted to animal and in vitro experiments.

Published
2014

34. Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators

Author

Sneha Limaye, Sapna Madas, Sundeep Salvi, Aarti Nagarkar, Rashmi Kadam, and Sanghratna Umakant Borde

Subjects
medicine.medical_specialty, media_common.quotation_subject, Operating procedures, Alternative medicine, lcsh:Medicine, 030226 pharmacology & pharmacy, Clinical research, 03 medical and health sciences, 0302 clinical medicine, Informed consent, Perception, Medicine, guidelines, 030212 general & internal medicine, media_common, lcsh:R5-920, Government, business.industry, lcsh:R, Indian, Ethics committee, General Medicine, Management, Clinical trial, Family medicine, Original Article, investigators, regulatory, lcsh:Medicine (General), business
Abstract

Background: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. Objective: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. Methods: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. Results: Central registration of Ethics Committees (ECs) was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's). The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7%) disagreed to the introduction of audio-video (AV) recording of informed consent, 36.6% agreed and 12.7% were neutral. Discussion: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. Conclusion: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines.

Published
2016

35. Challenges in recruitment and retention of clinical trial subjects

Author

Sanghratna Umakant Borde, Sneha Limaye, Sapna Amol Madas, Rashmi Kadam, and Sundeep Salvi

Subjects
retention, subjects, medicine.medical_specialty, lcsh:Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Outpatient clinic, 030212 general & internal medicine, Adverse effect, lcsh:R5-920, business.industry, Clinical study design, lcsh:R, Indian, General Medicine, Clinical trial, Clinical research, recruitment, Physical therapy, Clinical research coordinator, Original Article, investigators, lcsh:Medicine (General), business, 030217 neurology & neurosurgery, Patient education
Abstract

Background: Successful recruitment of patients is known to be one of the most challenging aspects in conduct of randomized controlled trials. Inadequate patient retention during conduct of trial affects conclusive results. Objective: To assess the level of challenges faced by Indian investigators in recruitment and retention of trial subjects. Methods: We developed a survey questionnaire on challenges encountered by investigators in subject recruitment and retention which was hosted on a web portal. Results: Seventy-three investigators from India participated in the survey. The frequently encountered challenges in subject recruitment were complexity of study protocol (38%), lack of awareness about clinical trials in patients (37%), and sociocultural issues related to trial participation (37%). About 63% of participants strongly agreed that creating a positive awareness about clinical trials among people through press and media, having a dedicated clinical research coordinator for trial (50.7%), and designing a recruitment strategy prior to study initiation (46.6%) would enhance recruitment. Almost 50.7% of participants agreed that interacting with medical community in vicinity of the study site and educating patients about clinical trials during routine outpatient department visits (46.6%) would enhance recruitment. Experiencing a serious adverse event, subject′s fear for study procedures (47%) and side effects (44%) were thought to have a moderate effect on subject retention. Conclusion: Our survey has put forth factors related to negative publicity by media, lack of patient education about clinical trials; complex study designs are barriers to clinical trial recruitment in India. It is essential to devise innovative and effective strategies focusing on education of public and mass media about clinical research in India.

Published
2016

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