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Singh M, Sinha BP, Mishra D, Deokar K, Bhatia G, Upreti G. Role of corneal collagen cross-linking in bullous keratopathy: A systematic review. Indian J Ophthalmol 2023; 71:1706-1717. [PMID: 37203022 PMCID: PMC10391445 DOI: 10.4103/ijo.ijo_1942_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Corneal cross-linking (CXL), a corneal strengthening procedure, is known to alter anterior stroma swelling behavior and is one of the treatment modalities of bullous keratopathy (BK). There are multiple studies published on the role of CXL in the treatment of BK. These articles had heterogeneous study population, different protocols used, and variable conclusions. This systematic review aimed to determine the role of CXL in the treatment of BK. The primary outcomes considered were changes in central corneal thickness (CCT) after 1, 3, and 6 months of CXL. The secondary outcome measures were changes in visual acuity, corneal clarity, subjective symptoms, and complications after CXL. We included randomized control trials (RCTs), observational and interventional studies, and case series with reports of more than 10 cases in this review. In RCTs, the mean pre-CXL CCT (794.0 ± 178.5 μm) in the intervention group (n = 37), decreased at 1 month (750.9 ± 154.3 μm) followed by a subsequent increase, but this difference was not significant during the 6-month follow-up (P- value 0.28, 0.82, and 0.82 at 1, 3, and 6 months, respectively). In noncomparative clinical studies (n = 188), the mean pre-CXL CCT (794.0 ± 178.5 μm) decreased at 1 month (710.9 ± 127.2 μm, P < 0.0001). Seven of the 11 articles included in the review reported no significant improvement in vision with CXL. The initial improvement in corneal clarity and clinical symptoms was not sustained. Current evidence suggests that CXL has short-term efficacy in the treatment of BK. More RCTs with high-quality evidence are needed.
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Affiliation(s)
- Mamta Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | | | - Deepak Mishra
- Department of Ophthalmology, RIO, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Gayatri Bhatia
- Department of Psychiatry, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Garima Upreti
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Singh M, Deokar K, Sinha BP, Keena M, Desai G. Ocular manifestations of common pulmonary diseases: a narrative review. Monaldi Arch Chest Dis 2023; 94. [PMID: 36867059 DOI: 10.4081/monaldi.2023.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Several pulmonary disorders can cause ocular involvement. Understanding these manifestations is critical for early diagnosis and treatment. Hence, we set out to examine the most common ocular manifestations of asthma, chronic obstructive pulmonary disease (COPD), sarcoidosis, obstructive sleep apnea (OSA), and lung cancer. Allergic keratoconjunctivitis and dry eye are two ocular manifestations of bronchial asthma. The inhaled corticosteroids used to treat asthma can cause cataract formation. COPD is associated with ocular microvascular changes as a result of chronic hypoxia and systemic inflammation spillover into the eyes. Its clinical significance, however, is unknown. Ocular involvement is common in sarcoidosis, occurring in 20% of cases of pulmonary sarcoidosis. It can affect nearly any anatomical structure of the eye. Obstructive sleep apnea has been linked to floppy eye syndrome, glaucoma, non-arteritic anterior ischemic optic neuropathy, keratoconus, retinal vein occlusion, and central serous retinopathy, according to research. However, while an association has been established, causality has yet to be established. The effect of positive airway pressure (PAP) therapy used to treat OSA on the aforementioned ocular conditions is unknown. PAP therapy can cause eye irritation and dryness. Lung cancer can affect the eyes through direct nerve invasion, ocular metastasis, or as part of a paraneoplastic syndrome. The goal of this narrative review is to raise awareness about the link between ocular and pulmonary disorders in order to aid in the early detection and treatment of these conditions.
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Affiliation(s)
- Mamta Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Rajkot.
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot.
| | - Bibhuti Prassan Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna.
| | - Monika Keena
- Department of Pulmonary Medicine, Railway hospital, Jodhpur.
| | - Govind Desai
- Department of Pulmonary Medicine, S.Nijalingappa Medical College and H.S.K Hospital, Bagalkot.
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Sethy G, Chisema MN, Sharma L, Singhal S, Joshi K, Nicks PO, Laher B, Mamba KC, Deokar K, Damte T, Phuka J. 'Vaccinate my village' strategy in Malawi: an effort to boost COVID-19 vaccination. Expert Rev Vaccines 2023; 22:180-185. [PMID: 36688599 DOI: 10.1080/14760584.2023.2171398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To boost COVID-19 vaccine uptake, an innovative 'vaccinate my village' (VMV) strategy using door-to-door vaccination by Health Surveillance Assistants (HSA) was adopted. In this study, we assessed the impact of the 'vaccinate my village' strategy on COVID-19 vaccine uptake. METHODS This was a cross-sectional review of the data on COVID-19 vaccination obtained from the Ministry of Health, Malawi, from 11 March 2021 to September 2022. RESULTS From March 2021-4 September 2022,091,551 COVID-19 vaccine doses were administered, out of which 2,253,546 were administered over just six months as a part of VMV as compared to 1,838,005 doses were administered over 13 months as a part of other strategies. The proportion of Malawi's population receiving at least one dose of the COVID-19 vaccine increased substantially from 4.66 to 15.4 with the implementation of the VMV strategy (p = 0.0001). District-wise coverage of the COVID-19 vaccine also increased significantly after its implementation (p = 0.0001). CONCLUSIONS Door-to-door vaccination involving HSAs benefitted the COVID-19 vaccination program in Malawi by ensuring accessibility, availability, and acceptability.
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Affiliation(s)
| | - Mike Nenani Chisema
- Preventive Health Services & Program Manager-Expanded Program on Immunization (EPI), Lilongwe, Malawi
| | | | - Sanjay Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Science -Rajkot, Gujarat, India
| | - Krupal Joshi
- Department of Community and Family Medicine, All India Institute of Medical Science -Rajkot, Gujarat, India
| | | | - Beverly Laher
- School of Global & Public Health, Kamuzu University of Health Sciences (Kuhes), Lilongwe, Malawi
| | | | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
| | - Tedla Damte
- Chief Health and Nutrition, Programme Health Section, UNICEF Khartoum, Sudan & PhD Scholar, LIKA UFPE Brazil
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Verma M, Singhal S, Deokar K. Is this the Start of a New Era in Medicine? Media Influences Practice and Research. Clin Oncol (R Coll Radiol) 2022; 34:819-820. [PMID: 36184468 DOI: 10.1016/j.clon.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/25/2022] [Accepted: 09/15/2022] [Indexed: 11/22/2022]
Affiliation(s)
- M Verma
- Department of Radiation Oncology, KGMU, Lucknow, India.
| | - S Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
| | - K Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
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Deokar K. Is Rivaroxaban Superior to Enoxaparin for Thromboprophylaxis in Hospitalized Patients of COVID-19? JAPI 2022. [DOI: 10.5005/japi-11001-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Parekh A, Deokar K, Verma M, Singhal S, Bhatt ML, Katoch CDS. The 50-Year Journey of Lung Cancer Screening: A Narrative Review. Cureus 2022; 14:e29381. [PMID: 36304365 PMCID: PMC9585290 DOI: 10.7759/cureus.29381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Early diagnosis and treatment are associated with better outcomes in oncology. We reviewed the existing literature using the search terms “low dose computed tomography” and “lung cancer screening” for systematic reviews, metanalyses, and randomized as well as non-randomized clinical trials in PubMed from January 1, 1963 to April 30, 2022. The studies were heterogeneous and included people with different age groups, smoking histories, and other specific risk scores for lung cancer screening. Based on the available evidence, almost all the guidelines recommend screening for lung cancer by annual low dose CT (LDCT) in populations over 50 to 55 years of age, who are either current smokers or have left smoking less than 15 years back with more than 20 to 30 pack-years of smoking. “LDCT screening” can reduce lung cancer mortality if carried out judiciously in countries with adequate resources and infrastructure.
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Deokar K, Kaliya M, Vachhani K, Singhal S, Parekh A. Is Rivaroxaban Superior to Enoxaparin for Thromboprophylaxis in Hospitalized Patients of COVID-19?`. J Assoc Physicians India 2022; 70:11-12. [PMID: 36082899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Kunal Deokar
- Assistant Professor, Department of Pulmonary Medicine
| | | | | | | | - Aneri Parekh
- Senior Resident, Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Dutt N, Shishir S, Chauhan NK, Jalandra R, kuwal A, Garg P, Kumar D, Vishwajeet V, Chakraborti A, Deokar K, Asfahan S, Babu A, bajad P, Gupta N, Khurana A, Garg MK. Mortality and Its Predictors in COVID-19 Patients With Pre-existing Interstitial Lung Disease. Cureus 2022; 14:e27759. [PMID: 36106257 PMCID: PMC9448685 DOI: 10.7759/cureus.27759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Background The data on the impact of coronavirus disease 2019 (COVID-19) on interstitial lung disease (ILD) is still limited. To the best of our knowledge, there has been no study from India to date to assess the impact of COVID-19 in patients with preexisting ILD. We undertook this study to assess the clinical outcome of ILD patients admitted to our hospital with COVID-19. Methods In this retrospective observational study, records of reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients with preexisting ILD who were admitted to the hospital in the period from May 1, 2020, to April 30, 2021, were obtained from the hospital database. The clinical outcomes of the patients were recorded. Univariate analysis was performed to find relation between various predetermined risk factors for mortality and those with significant p values (p<0.05) were subjected to multiple logistic regression to determine independent risk factors. Results In our study of 28 patients, the overall mortality was 35.7%. On comparing the parameters associated with increased mortality, there was no effect of age, gender, comorbidities, type of ILD, CT thorax findings on diagnosis, use of corticosteroids and antifibrotics in the past, spirometric findings on mortality. On multivariate analysis, the significant parameters were interleukin 6 (IL-6), p=0.02, OR=1.020 (1.006-1.043) and D-dimer, p=0.04, OR=2.14 (5.55-1.14). Conclusion COVID-19 in patients with pre-existing ILD has a comparatively higher mortality. D-dimer and IL-6 are significant predictors of mortality in ILD patients infected with COVID-19.
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Desai G, Purohit G, Borana H, Deokar K, Yogi S. Comparison of efficacy of bedaquiline and moxifloxacin in drug resistant pulmonary tuberculosis. A prospective observational study. Monaldi Arch Chest Dis 2022; 93. [PMID: 35535455 DOI: 10.4081/monaldi.2022.2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/27/2022] [Indexed: 01/19/2023] Open
Abstract
Drug-resistant tuberculosis remains a major public health concern in many countries. We compared the efficacy and safety of bedaquiline plus optimized background regimen (Bdq+OBR) with high dose moxifloxacin and optimized background regimen (Mfx(h)+OBR) for the treatment of patients with multidrug-resistant tuberculosis with additional resistance to fluoroquinolones. In this prospective observational study, newly diagnosed cases of multidrug-resistant tuberculosis with additional resistance to fluoroquinolone were enrolled. They received either Bdq+OBR or Mfx(h)+OBR and were followed up for six months. The sputum culture conversion rate at the end of six months and the time to culture conversion in each group were studied. The safety profile of both regimens was also studied. The sputum culture conversion was achieved in 41 patients (100%) in the Bdq+OBR group and 36 patients (87.8%) in the Mfx(h)+OBR group at the end of 6 months. The mean time to culture conversion was found to be 3.10±0.8 months in the Bdq+OBR group and 3.32±0.9 months in the Mfx(h)+OBR group. Mortality was 6.8% in the Bdq+OBR group and 10.8 % in the Mfx(h)+OBR group at 6 months. Raised serum lipase and dark discolouration of skin were significantly more common in the Bdq+OBR group while vomiting and ototoxicity were more common in the Mfx(h)+OBR group. Bdq+OBR was associated with higher success of sputum culture conversion at 6 months and faster sputum culture conversion rate as compared to the Mfx(h)+OBR.
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Affiliation(s)
- Govind Desai
- Department of Pulmonary Medicine, Dr Sampurnanand Medical College, Jodhpur.
| | - Gopal Purohit
- Department of Pulmonary Medicine, Dr Sampurnanand Medical College, Jodhpur.
| | - Hemant Borana
- Department of Pulmonary Medicine, Dr Sampurnanand Medical College, Jodhpur.
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot.
| | - Suresh Yogi
- Department of Pulmonary Medicine, Dr Sampurnanand Medical College, Jodhpur.
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Rustagi N, Choudhary Y, Asfahan S, Deokar K, Jaiswal A, Thirunavukkarasu P, Kumar N, Raghav P. Identifying psychological antecedents and predictors of vaccine hesitancy through machine learning: A cross sectional study among chronic disease patients of deprived urban neighbourhood, India. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
COVID-19 vaccine hesitancy among chronic disease patients can severely impact individual health with the potential to impede mass vaccination essential for containing the pandemic. The present study was done to assess the COVID-19 vaccine antecedents and its predictors among chronic disease patients. This cross-sectional study was conducted among chronic disease patients availing care from a primary health facility in urban Jodhpur, Rajasthan. Factor and reliability analysis was done for the vaccine hesitancy scale to validate the 5 C scale. Predictors assessed for vaccine hesitancy were modelled with help of machine learning (ML). Out of 520 patients, the majority of participants were female (54.81%). Exploratory factor analysis revealed four psychological antecedents’ “calculation”; “confidence”; “constraint” and “collective responsibility” determining 72.9% of the cumulative variance of vaccine hesitancy scale. The trained ML algorithm yielded an R2 of 0.33. Higher scores for COVID-19 health literacy and preventive behaviour, along with family support, monthly income, past COVID-19 screening, adherence to medications and age were associated with lower vaccine hesitancy. Behaviour changes communication strategies targeting COVID-19 health literacy and preventive behaviour especially among population sub-groups with poor family support, low income, higher age groups and low adherence to medicines may prove instrumental in this regard.
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Chauhan NK, Shadrach BJ, Dutt N, Jalandra RN, Deokar K, Garg MK, Nag VL, Bhardwaj P, Jain V, Misra S. Safe Practice of Flexible Bronchoscopy for Non-COVID-19 Indications during the SARS-CoV-2 Pandemic. Tanaffos 2022; 21:207-213. [PMID: 36879727 PMCID: PMC9985126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/17/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Flexible bronchoscopy is an aerosol-generating procedure (AGP), which increases the risk of transmission of SARS-CoV-2 infection. We aimed to find COVID-19 symptoms among healthcare workers (HCWs) involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic. MATERIALS AND METHODS The participants of this hospital-based single-center descriptive study were HCWs of our hospital involved in flexible bronchoscopies of patients with non-COVID-19 indications. These patients had no clinical features of COVID-19 and were tested negative for SARS-CoV-2 by the real-time polymerase chain reaction of nasopharyngeal and throat swabs before the procedure. The study outcome was the occurrence of COVID-19 in study participants after exposure to bronchoscopies. RESULTS Thirteen HCWs performed 81 bronchoscopies on 62 patients. Indications for bronchoscopies included malignancy (61.30%), suspected infections (19.35%), non-resolving pneumonia (6.45%), mucus plug removal (6.45%), central airway obstruction (4.84%), and hemoptysis (1.61%). The mean age of patients was 50.44 ± 15.00 years, and the majority was males (72.58%). Bronchoscopic procedures included 51 bronchoalveolar lavages, 32 endobronchial ultrasound- transbronchial needle aspiration (EBUS-TBNA), 26 endobronchial biopsies, 10 transbronchial lung biopsy (TBLB), 3 mucus plug removals, 2 conventional TBNA, and 2 radial EBUS-TBLB. Except for two HCWs who complained of transient throat irritation of non-infectious cause, none of the cases developed any clinical features suggestive of COVID-19. CONCLUSION A dedicated bronchoscopy protocol helps in minimizing the risk of transmission of SARS-CoV-2 infection among HCWs involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Nishant Kumar Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Benhur Joel Shadrach
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Ram Niwas Jalandra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
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Deokar K, Elhence P, Dutt N, Jalandra RN, Khera S, Sharma PP, Chauhan NK. Diagnostic accuracy and adequacy of rapid on-site evaluation performed by a pulmonologist on transbronchial needle aspiration specimens (DREPA): a prospective study. Adv Respir Med 2022; 90:ARM.a2022.0020. [PMID: 35099056 DOI: 10.5603/arm.a2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the bronchoscopy suite is often an issue. We aimed to study if a pulmonologist, after receiving a short period of training in cytopathology, is able to assess the adequacy of onsite samples during TBNA. MATERIAL AND METHODS A pulmonologist was initially trained by a pathologist in examining cytology slides and assessing sample adequacy on TBNA smears. During TBNA, one slide from each needle pass was stained on-site using rapid Giemsa stain and was labelled as ROSE slide. The remaining slides were sent to the pathology laboratory for definitive cytological analysis. The ROSE slides were examined by a pulmonologist and a pathologist blinded to each other's interpretation. Level of agreement between the pulmonologist and pathologist was assessed by estimating Cohen's kappa. RESULTS A total of 172 slides from 35 patients were prepared for ROSE and evaluated independently by pulmonologist and pathologist. For adequacy, the pulmonologist and pathologist agreed in 143 out of the 172 slides (83% agreement), κ 0.649 (p < 0.001). For diagnostic categories, the pulmonologist and the pathologist agreed in 143 out of the 172 slides (83% agreement); κ 0.696 (p < 0.001). The sensitivity, specificity and accuracy of ROSE performed by the pulmonologist with respect to that performed by the pathologist was 66.2%, 96.8% and 83.1% respectively. CONCLUSION After a short period of training in cytopathology, a pulmonologist can assess for adequacy of TBNA ROSE slides in the bronchoscopy suite.
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Affiliation(s)
- Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ram Niwas Jalandra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sudeep Khera
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prem Prakash Sharma
- Department of Community medicine and Family medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nishant Kumar Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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Singhal S, Deokar K, Verma M. Commercial screening tests: Beneficial or a hypnosis to advertisements? J Postgrad Med 2022; 68:231-232. [PMID: 36255016 PMCID: PMC9841549 DOI: 10.4103/jpgm.jpgm_300_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- S Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India,Address for correspondence: Dr. Singhal S, E-mail:
| | - K Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - M Verma
- Department of Radiation Oncology, KGMU, Lucknow, Uttar Pradesh, India
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Agarwal M, Sharma KK, Bharti N, Deokar K. Nephrotic syndrome leading to recurrent pulmonary embolism: A report of two cases. Acta Biomed 2022; 93:e2022024. [PMID: 35315427 PMCID: PMC8972887 DOI: 10.23750/abm.v93i1.10762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Mehul Agarwal
- Department of Pulmonary Medicine, Eternal Hospital Care Center, Jaipur, Rajasthan, India
| | - Krishna Kumar Sharma
- Department of Pulmonary Medicine, Eternal Hospital Care Center, Jaipur, Rajasthan, India
| | - Neha Bharti
- Department of Anaesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Chawla G, Kumar N, Kansal A, Deokar K, Niwas R, Abrol N, Asfahan S, Garg S, Keena M. Air flow limitation in smokers – A cause of concern. J Family Med Prim Care 2022; 11:6807-6811. [PMID: 36993056 PMCID: PMC10041201 DOI: 10.4103/jfmpc.jfmpc_1159_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/08/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction In India smoking is a common habit prevalent in both urban and rural areas irrespective of mode of smoking i.e., cigarettes, bidis, pipes, cigar, hookah etc., Spirometry can be helpful to determine effects of smoking on pulmonary functions. We aimed to study the effect of smoking on the pulmonary function tests. Materials and Methods This study was conducted on 300 subjects including 150 smokers and 150 non-smokers aged between 25 and 60 years attending a tertiary health care center in northern part of our country. Quantification of tobacco smoking was performed by calculating smoking index. All the study subjects underwent spirometry. Results All the spirometric variables (FVC, FEV1, PEFR, FEF 25-75%) were lower in smokers as compared to non-smokers and this difference was statistically significant. 76% of the smokers had obstructive, 10.7% had normal, 6.7% had restrictive, and 6.7% had mixed pattern on spirometry. 65.3% of the non-smokers had normal, 28.7% had obstructive and 6% had restrictive pattern on spirometry. Conclusion Almost all the pulmonary function parameters were significantly reduced in smokers compared to non-smokers and obstructive impairment was common amongst smokers. As early quitting is associated with improved survival, it is important that these asymptomatic smokers are identified early and helped to quit. Primary care physicians being the first point of contact, can play a major role.
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Parekh A, Deokar K, Singhal S. A simple concept of fluid balance can be harder in the intensive care unit. J Integr Nurs 2022. [DOI: 10.4103/jin.jin_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Goel R, Singh GV, Shadrach BJ, Deokar K, Kumar S, Rajput KS. Efficacy and safety of intrapleural streptokinase in tubercular empyema thoracis - old wine in new wineskin. Trop Doct 2021; 52:23-26. [PMID: 34870518 DOI: 10.1177/00494755211050193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tubercular empyema thoracis continues to be one of the leading causes of morbidity in low-income countries. Despite antitubercular therapy (ATT) and thoracostomy, empyema drainage is hampered by multiple septations, loculations, debris, and blood clots leading to complications. In a comparative experimental study to estimate the efficacy and safety of intrapleural streptokinase (IPSTK) in tubercular empyema, 30 cases of chronic multiloculated tubercular empyema were compared by radiological improvement by chest radiography, duration and volume of fluid drained, and degree of dyspnoea according to the modified Borg scale, depending on whether streptokinase was used or not. The former scored on all counts; we therefore conclude that intrapleural streptokinase is a safe, efficacious intervention in tubercular empyema. It decreases morbidity and reduces the need for surgery.
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Affiliation(s)
- Rishabh Goel
- Department of Tuberculosis & Chest Diseases, 30036Sarojini Naidu Medical College, Agra
| | - Gajendra Vikram Singh
- Associate Professor, Department of Tuberculosis & Chest Diseases, 30036Sarojini Naidu Medical College, Agra
| | - Benhur Joel Shadrach
- Department of Tuberculosis & Chest Diseases, 30036Sarojini Naidu Medical College, Agra
| | - Kunal Deokar
- Attending Consultant, Department of Pulmonary Medicine, Sapphire Hospital, Mumbai
| | - Santosh Kumar
- Professor and Head, Department of Tuberculosis & Chest Diseases, 30036Sarojini Naidu Medical College, Agra
| | - Karamvir Singh Rajput
- Department of Tuberculosis & Chest Diseases, 30036Sarojini Naidu Medical College, Agra
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18
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Niwas R, Shadrach BJ, Deokar K, Dutt N, Jain P. A Curious case of Vasovagal Shock following Transesophageal Endobronchial Ultrasound-Guided Needle Aspiration (EUS-B-NA). Acta Biomed 2021; 92:e2021133. [PMID: 34747376 PMCID: PMC10523043 DOI: 10.23750/abm.v92is1.10412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022]
Abstract
Esophageal ultrasound-guided bronchoscopic needle aspiration (EUS-B-NA) is a relatively safe procedure with rare complications. A vasovagal attack after EUS-B-NA has not been reported to date. Usually benign and self-limiting, it can cause refractory bradycardia and sudden cardiac arrest. Timely intervention reduces morbidity and mortality. Here, we report a novel case of vasovagal attack after EUS-B-NA and was managed successfully. Management includes identifying the triggering event and keeping the patient in the Trendelenburg position. Atropine is reserved for refractory cases. (www.actabiomedica.it).
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Affiliation(s)
- Ram Niwas
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur .
| | - Benhur Joel Shadrach
- Pulmonary, Critical care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Kunal Deokar
- Pulmonary, Critical care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Priyank Jain
- Pulmonary, Critical care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
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19
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Agarwal M, Gupta ML, Deokar K, Bharti N, Jain P. Paraquat lung - a rare cause of diffuse parenchymal lung disease. Acta Biomed 2021; 92:e2021270. [PMID: 34212926 PMCID: PMC8343721 DOI: 10.23750/abm.v92i3.10226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mehul Agarwal
- All India Institute of Medical Sciences, Jodhpur, India.
| | | | - Kunal Deokar
- a:1:{s:5:"en_US";s:66:"All India Institute of Medical Sciences, Jodhpur, Rajasthan, India";}.
| | - Neha Bharti
- All India Institute of Medical Sciences, Jodhpur, India.
| | - Priyank Jain
- All India Institute of Medical Sciences, Jodhpur, India.
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20
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Chawla G, Ish P, Garg A, Deokar K. Mediastinal germ cell tumour masquerading as loculated pleural effusion. Adv Respir Med 2021; 88:360-361. [PMID: 32869271 DOI: 10.5603/arm.a2020.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/25/2022]
Abstract
Benign mediastinal teratomas often discovered while patients are still asymptomatic. Almost all arise in the anterosuperior mediastinal compartment. Most symptoms result from compression of adjacent structures. We report a case of a large teratoma arising from the anterior mediastinum that presented a confusing clinical picture of loculated pleural effusion which was successfully diagnosed and treated by surgical excision.
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Affiliation(s)
- Gopal Chawla
- All India Institute of Medical Sciences, Jodhpur, India.
| | - Pranav Ish
- Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Avneet Garg
- All India Institute of Medical Sciences, Delhi, India
| | - Kunal Deokar
- All India Institute of Medical Sciences, Jodhpur, Basni, India
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21
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Shadrach BJ, Goel R, Deokar K, Jain A. Invasive pulmonary aspergillosis in a COVID-19 recovered patient: unravelling an infective sequalae of the SARS-CoV-2 virus. Monaldi Arch Chest Dis 2021; 91. [PMID: 33849262 DOI: 10.4081/monaldi.2021.1664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Dear Editor, A 55-year-female, house wife, non-smoker, morbidly obese (BMI>35) with no other co-morbidities or pre-existing lung disease presented to the emergency room with complaints of highgrade fever, cough with minimal sputum, progressive breathlessness, streaky haemoptysis, and anorexia for the past 5 days. She was admitted in intensive care unit (ICU) for severe COVID-19 pneumonia three months back and had successfully recovered after 24 days of hospitalization....
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Affiliation(s)
- Benhur Joel Shadrach
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Rishabh Goel
- Department of Pulmonary Medicine, Shahi Global Hospital, Gorakhpur.
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Anukool Jain
- Department of Pulmonary Medicine, Pushpanjali Hospital, Agra.
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22
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Agarwal M, Gupta ML, Deokar K, Shadrach BJ, Bharti N, Sonigra M. Clinico-radiological profile of connective tissue disease related-interstitial lung diseases from a tertiary care centre of India: a cross sectional study. Monaldi Arch Chest Dis 2021; 91. [PMID: 33840179 DOI: 10.4081/monaldi.2021.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Interstitial lung diseases (ILDs) are a frequently occurring pulmonary manifestation in patients of connective tissue diseases (CTD). Detailed understanding of this subset of lung diseases is vital, hence the study was conducted to analyze the clinico-radiological characteristics of CTD-ILD. The present study was conducted between March 2017 to February 2018 at a tertiary care teaching hospital from western India. A total of 100 patients having respiratory symptoms suggestive of ILD, who were either diagnosed cases of CTD or had clinical manifestations of underlying CTD, were included in the study. 27% of patients belonged to age group 41-50 years and 78% were females. Chief respiratory complaints were dyspnea and cough. Clubbing was present in 29% patients. The most common CTDs were rheumatoid arthritis [RA] (26%), systemic sclerosis [SSC] (21%), mixed connective tissue disorder [MCTD] (19%) and Sjogren's syndrome [SS] (16%). Restrictive defect on spirometry was seen in 58% cases and was most significant among patients with RA (65%) and SS (62%). Pulmonary arterial hypertension was seen in 40% cases and was most evident in MCTD (78%) and SSC patients (58%). Chest radiograph was normal in 47% of subjects. Most common radiological pattern on high resolution computed tomography (HRCT) thorax was non-specific interstitial pneumonia (42%) followed by usual interstitial pneumonia (21%). ILD is a common manifestation of CTD. Work-up for an underlying CTD should be offered to all ILD patients and vice versa.
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Affiliation(s)
- Mehul Agarwal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Manohar Lal Gupta
- Department of Pulmonary Medicine, Santokba Durlabhji Memorial Hospital, Jaipur.
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Benhur Joel Shadrach
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Neha Bharti
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Maldev Sonigra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
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23
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Chauhan NK, Elhence P, Deokar K, Dutt N, Sharma PP, Kuwal A, Kumar S, Niwas R. Vascular patterns on narrow band imaging (NBI) video bronchoscopy of lung cancer patients and its relationship with histology: an analytical cross-sectional study. Adv Respir Med 2021; 89:30-36. [PMID: 33660246 DOI: 10.5603/arm.a2021.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Narrow band imaging (NBI) video bronchoscopy provides better visualisation of submucosal vascular patterns in malignant airway lesions compared to white light bronchoscopy. This analytical cross-sectional study was aimed to look for any relationship between these NBI vascular patterns and the histologic type of lung cancer. MATERIAL AND METHODS After screening 78 patients with suspected lung cancer, 53 subjects underwent video bronchoscopy. Thirty-two patients showing abnormal bronchial mucosa or endobronchial growth with any of the NBI vascular patterns on bronchoscopy were enrolled in the study. These abnormal areas were then biopsied and sent for histologic examination. RESULTS NBI bronchoscopy revealed a dilated tortuous vascular pattern in 54.8% of the patients, a non-specific pattern in 32%, a dotted pattern in 9.7% and an abrupt ending vessels pattern in 3.2% of the patients. We did not find any statistically significant relationship between a dilated tortuous pattern and squamous-cell carcinoma (p = 0.48), adenocarcinoma (p = 0.667) or small-cell carcinoma (p = 1); between a dotted pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 0.54) or small-cell carcinoma (p = 1), and between an abrupt ending capillary pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 1) or small-cell carcinoma (p =1). CONCLUSION No relationship exists between NBI vascular patterns and the histology of lung cancer. Endobronchial lesions showing any vascular pattern on NBI needs to be adequately sampled for proper histologic and molecular studies in lung cancer patients.
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Affiliation(s)
| | - Poonam Elhence
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Kunal Deokar
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | - Naveen Dutt
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
| | | | - Ashok Kuwal
- Pacific Institute of Medical Sciences, Udaipur, India
| | - Sunil Kumar
- Pacific Medical College and Hospital, Udaipur, India
| | - Ram Niwas
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
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Shadrach BJ, Tiwari D, Deokar K, Shahi SS, Agarwal M, Goel R. Post partum dyspnoea: look beyond the lungs. Breathe (Sheff) 2021; 17:200114. [PMID: 34295387 PMCID: PMC8291952 DOI: 10.1183/20734735.0114-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022] Open
Abstract
The aetiology of acute-onset dyspnoea in the post partum period is diverse. However, subtle clinical and radiological findings assist in early diagnosis and definitive management, thereby conferring better prognosis and survival. https://bit.ly/361b4qm.
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Affiliation(s)
- Benhur Joel Shadrach
- Dept of Pulmonary medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Tiwari
- Dept of Cardiology, Shahi Global Hospital, Gorakhpur, India
| | - Kunal Deokar
- Dept of Pulmonary medicine, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Mehul Agarwal
- Dept of Pulmonary medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rishabh Goel
- Dept of Pulmonary Medicine, Shahi Global Hospital, Gorakhpur, India
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25
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Deokar K, Meshram S, Chawla G, Kunjir N, Meshram C, Abrol N, Gaikwad P. Obstructive sleep apnea, intermittent hypoxemia and prothrombotic biomarkers. Sleep Sci 2021; 13:230-234. [PMID: 33564369 PMCID: PMC7856672 DOI: 10.5935/1984-0063.20190147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To study the serum levels of fibrinogen and d-dimer in patients with obstructive sleep apnea (OSA) and its correlation with apnea hypopnea index (AHI), oxygen desaturation index (ODI), minimal oxygen saturation and arousal index. Methods It was a case control study in which 23 cases of OSA and 23 controls were enrolled. Morning fasting serum fibrinogen and d-dimer were measured in cases of OSA and controls. Results Serum fibrinogen levels among OSA patients (268.47±53.11mg/dl) were elevated as compared to the levels in controls (221.52±65.84mg/dl) (p<0.05). Serum fibrinogen co-related positively with AHI (r=0.6381, p=0.0011) and ODI (r=0.7434, p=0.0000), negatively with minimal oxygen saturation (r=-0.4461, p=0.0329). There was no statistically significant correlation of fibrinogen with arousal index (r=0.2697, p=0.2133). There was no statistically significant difference between mean fasting d-dimer level in cases (0.12mg/L, 0.06±0.18mg/L) and controls (0.12mg/L, 0.02±0.22mg/L) (p=0.8926). Conclusions The observation of elevated fibrinogen levels with the increasing severity of OSA and hypoxemic events makes OSA one of the important risk factor for cardiovascular disorders.
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Affiliation(s)
- Kunal Deokar
- Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India
| | - Sushant Meshram
- Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India
| | - Gopal Chawla
- All India Institute of Medical Sciences, Pulmonary Medicine and Sleep Disorders - New Delhi - Delhi - India
| | - Nana Kunjir
- Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India
| | - Chetna Meshram
- Government medical college, Pharmacology - Nagpur - Maharashtra - India
| | - Nupur Abrol
- All India Institute of Medical Sciences, Anaesthesia - Delhi - Delhi - India
| | - Priyanka Gaikwad
- Bhaktivedanta hospital, Paediatrics - Mumbai - Maharashtra - India
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Shadrach BJ, Deokar K, Agarwal V, Jain A, Goel R. Systemic sclerosis-interstitial lung disease with coexistent subacute invasive pulmonary aspergillosis: a rare association. Adv Respir Med 2021; 89:75-76. [PMID: 33471357 DOI: 10.5603/arm.a2020.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Benhur Joel Shadrach
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kunal Deokar
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | | | - Anukool Jain
- Department of Pulmonary Medicine, Pushpanjali Hospital, Agra, India
| | - Rishabh Goel
- Department of Pulmonary Medicine, Shahi Global Hospital, Gorakhpur, India.
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Deokar K, Agarwal M, Dutt N, Chauhan N, Niwas R, Shadrach BJ, Chawla G. A review of Ciclesonide in COVID-19. Still a long way to go. Adv Respir Med 2021; 89:79-81. [PMID: 33471354 DOI: 10.5603/arm.a2020.0173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
As no definitive therapy or vaccine is yet available for COVID-19, in a desperate attempt repurposed drugs are being explored as an option. A drug repurposing study identified Ciclesonide as a potential candidate. We reviewed the available evidence and clinical trials on the use of Ciclesonide in COVID-19. At present the evidence is limited to a report of three cases. However, five clinical trials are underway, and their results will help in elucidating the role of Ciclesonide in COVID-19.
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Affiliation(s)
- Kunal Deokar
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
| | - Mehul Agarwal
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Naveen Dutt
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Nishant Chauhan
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Ram Niwas
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Benhur Joel Shadrach
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Gopal Chawla
- Pulmonary, Critical Care & Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
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28
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Deokar K, Shadrach BJ, Chawla G, Asfahan S, Dutt N, Niwas R, Agarwal M, S AS. Low dose radiotherapy for COVID pneumonia: Irradiate to Eradicate - Will it be possible? Acta Biomed 2021; 92:e2021023. [PMID: 33682811 PMCID: PMC7975953 DOI: 10.23750/abm.v92i1.10369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Gopal Chawla
- All India Institute of Medical Sciences, Jodhpur, India.
| | - Shahir Asfahan
- All India Institute of Medical Sciences, Jodhpur, India.
| | - Naveen Dutt
- All India Institute of Medical Sciences, Jodhpur, India.
| | - Ram Niwas
- All India Institute of Medical Sciences, Jodhpur, India.
| | - Mehul Agarwal
- All India Institute of Medical Sciences, Jodhpur, India.
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29
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Agarwal M, Gupta ML, Deokar K, Bharti N. Asymptomatic patient with "lumpy and bumpy" airways. A case of pulmonary MALToma. Adv Respir Med 2020; 88:615-619. [PMID: 33393656 DOI: 10.5603/arm.a2020.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/04/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
Abstract
Primary pulmonary lymphoma is a rare disease. The most frequent primary pulmonary lymphoma (PPL) is extranodal marginal zone B-cell lymphoma of MALT. About half of the patients are asymptomatic at diagnosis. We report a case of a 62-year-old male referred to us for preoperative assessment of surgery for Benign Prostatic Hyperplasia (BPH). He had no respiratory complaints but on evaluation was detected to have Pulmonary MALToma. Our case highlights the importance of tissue diagnosis.
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Affiliation(s)
- Mehul Agarwal
- Department of Respiratory Medicine, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | | | - Kunal Deokar
- Department of Pulmonary Medicine, Sapphire Hospitals, Thane, India.
| | - Neha Bharti
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
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30
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Chawla G, Kansal AP, Deokar K. A young non-smoker with high ADA pleural effusion. It's not always tuberculosis. Adv Respir Med 2020; 88:464-465. [PMID: 33169822 DOI: 10.5603/arm.a2020.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 11/25/2022]
Abstract
Lung cancer is posing an ever-increasing medical and social problem due to its increasing morbidity and mortality. Here we report a case of a young male who was being treated as tubercular pleural effusion but was ultimately diagnosed with non-small cell carcinoma. While considering the diagnosis of pleural effusion, in the context of country endemic for tuberculosis like India, it is not surprising that many clinicians rather prefer to consider pulmonary tuberculosis as the first differential, while keeping diagnosis of malignancy as the least likely differential diagnosis in the young patient.
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Affiliation(s)
- Gopal Chawla
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India.
| | | | - Kunal Deokar
- All India Institute of Medical Sciences, Rajasthan, Jodhpur, India
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31
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Shadrach BJ, Deokar K, Agarwal M, Dutt N. Quarantine of Health Care Workers in the COVID-19 Crisis: Why and How Long? Acta Biomed 2020; 91:e2020174. [PMID: 33525247 PMCID: PMC7927517 DOI: 10.23750/abm.v91i4.10680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Benhur Joel Shadrach
- DM Fellow, Pulmonary, Critical care and Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Kunal Deokar
- DM Fellow, Pulmonary, Critical care and Sleep Medicine, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Mehul Agarwal
- Senior Resident, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
| | - Naveen Dutt
- Additional Professor, Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur.
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32
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Deokar K, Chawla G, Shadrach BJ, Dutt N. Convalescent plasma therapy in COVID 19: Every dark cloud has a silver lining. J Anaesthesiol Clin Pharmacol 2020; 36:419-423. [PMID: 33487918 PMCID: PMC7812959 DOI: 10.4103/joacp.joacp_523_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gopal Chawla
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Benhur Joel Shadrach
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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33
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Deokar K, Niwas R, Chawla G, Chauhan N. Post partum female with sudden-onset breathlessness. Breathe (Sheff) 2020; 16:190366. [PMID: 33304398 PMCID: PMC7714549 DOI: 10.1183/20734735.0366-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 31-year-old, married female was admitted with complaints of sudden-onset shortness of breath and dry cough since that morning. It was not associated with chest tightness, wheezing or pleuritic chest pain. There was no history of fever, running nose or haemoptysis. The patient had undergone lower-segment caesarean section 2 weeks previously and had reduced mobility since then. She was known to have hypothyroidism for the past 3 years, which was well controlled on thyroxine. On admission, the patient had a respiratory rate of 30 per min, pulse rate of 130 per min, blood pressure of 110/70 mmHg and oxygen saturation by finger pulse oximetry of 89% on room air. Arterial blood gases on ambient air revealed pH of 7.48, carbon dioxide tension of 30 mmHg, oxygen tension of 58 mmHg and bicarbonate of 22 mEq·L−1. Chest radiography did not reveal any significant abnormality. ECG revealed sinus tachycardia, right-axis deviation and T-wave inversion in leads V1–V4. Management of pulmonary embolism in post partum females is a challenge. Lower segment caesarean section in past 3 weeks is a contraindication to systemic thrombolysis. Heparin, fondaparinux and warfarin can be safely used in breast-feeding mothers.http://bit.ly/39Nr7qY
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Asfahan S, Deokar K, Dutt N, Niwas R, Jain P, Agarwal M. Extrapolation of mortality in COVID-19: Exploring the role of age, sex, co-morbidities and health-care related occupation. Monaldi Arch Chest Dis 2020; 90. [DOI: 10.4081/monaldi.2020.1325] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022] Open
Abstract
We used a publicly available data of 44,672 patients reported by China’s centre for disease control to study the role of age, sex, co-morbidities and health-care related occupation on COVID-19 mortality. The data is in the form of absolute numbers and proportions. Using the percentages, retrospective synthetic data of 100 survivors and 100 deaths were generated using random number libraries so that proportions of ages, genders, co-morbidities, and occupations were constant as in the original data. Logistic regression of the four predictor factors of age, sex, co-morbidities and occupation revealed that only age and comorbidities significantly affected mortality. Sex and occupation when adjusted for other factors in the equation were not significant predictors of mortality. Age and presence of co-morbidities correlated negatively with survival with co-efficient of -1.23 and -2.33 respectively. Odds ratio (OR) for dying from COVID-19 for every 10-year increase in age was 3.4 compared to the previous band of 10 years. OR for dying of COVID-19 was 10.3 for the presence of any of the co-morbidities. Our findings could help in triaging the patients in the emergency room and emphasize the need to protect the elderly and those with comorbidities from getting exposed.
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Khera PS, Chauhan N, Garg PK, Choudhary R, Deokar K, Niwas R. Hemothorax secondary to ruptured pulmonary arteriovenous malformation: A combined stitch in time saves nine. Lung India 2020; 37:272-274. [PMID: 32367853 PMCID: PMC7353951 DOI: 10.4103/lungindia.lungindia_321_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Pushpinder S Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nishant Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ramkaran Choudhary
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ram Niwas
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Deokar K, Shaikh A, Chawla G. Gynecomastia in Multi-Drug Resistant Tuberculosis—Ethionamide the Villain. Adv Respir Med 2020; 88:162-163. [DOI: 10.5603/arm.2020.0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/30/2020] [Indexed: 11/25/2022]
Abstract
A 59-year-old married male, a known case of line probe assay-confirmed multidrug-resistant pulmonary tuberculosis was treated with kanamycin, levofloxacin, ethionamide, ethambutol, pyrazinamide and cycloserine for seven months [...]
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Chawla G, Kansal AP, Deokar K, Abrol N, Chopra V, Ish P, Sharma V, Kumar N, Bhatti K. Effects of stage-matched repeated individual behavioural counselling session (RIBCS) as an intervention for decreased and stopping smoking. Monaldi Arch Chest Dis 2020; 90. [PMID: 32253889 DOI: 10.4081/monaldi.2020.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/18/2020] [Indexed: 11/23/2022] Open
Abstract
We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was <0.05. The point prevalence of abstinence rate (questionnaire validated) 1 month to 6 months was almost 4 times. Our intervention (RIBCS) succeeded in increasing the abstinence rates during the study period among smokers with a lower motivation to quit (pre-contemplators and contemplators) as well as those ready to quit (preparators). This is significant because of most existing smoking-cessation interventions target only motivated smokers, with few having a positive effect in smokers with a lower motivation to quit.
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Affiliation(s)
- Gopal Chawla
- Government Medical College and Hospital, Patiala, Punjab.
| | | | - Kunal Deokar
- Government Medical College, Nagpur, Maharashtra.
| | - Nupur Abrol
- All India Institute of Medical Sciences, New Delhi.
| | - Vishal Chopra
- Government Medical College and Hospital, Patiala, Punjab.
| | - Pranav Ish
- Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Vinod Sharma
- Sawai Man Singh Medical College, Jaipur, Rajasthan.
| | - Naresh Kumar
- Government Medical College and Hospital, Patiala, Punjab.
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Abstract
A 25-year-old male is admitted with complaints of dry cough for the past 5 years, and increased thirst, urinary frequency and output for the past 18 months. He also complains of shortness of breath on climbing a flight of stairs, and itchy lesions on the scalp and back for the past 2–3 months. There is no history of bone pain or abdominal pain. He has history of bilateral recurrent pneumothoraxes, twice on the right and once on the left side, in the past month. Pleurodesis with povidone iodine is performed on left side and the patient is transferred to your hospital with persistent right pneumothorax with air leak, with an intercostal drainage tube in situ. The patient is a never-smoker with no family history of pneumothorax. On general examination, he has small papules, 1–2 mm in diameter, with scaling over scalp and back. Onycholysis, onychoschisis and subungual splinter haemorrhages are present (figure 1). The causes of cystic lung diseases are varied. Proper evaluation is required for appropriate management.http://bit.ly/37J7dvE
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Affiliation(s)
- Kunal Deokar
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Ram Niwas
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Nishant Chauhan
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Dutt
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Priyank Jain
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Shahir Asfahan
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rajani Kumawat
- Dept of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
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Deokar K, Niwas R, Chauhan N, Chawla G. Defying the paradigm - rescue thrombolysis in a postoperative patient with pulmonary embolism. Adv Respir Med 2020; 88:36-37. [PMID: 32153008 DOI: 10.5603/arm.2020.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
Abstract
Parenteral anticoagulation is recommended for patients of intermediate - high early mortality risk pulmonary embolism. Rescue reperfusion is considered if signs of hemodynamic decompensation appear. Recent surgery is a contraindication to thrombolysis. Percutaneous catheter directed thrombolysis and surgical embolectomy can be done in such patients. However, they are not readily available. We hereby report a case of rescue thrombolysis in a post lower segment caesarean section (LSCS) patient with pulmonary thromboembolism. We could successfully achieve thrombolysis in our patient with improvement in clinical and hemodynamic parameters and with no major bleeding from any site.
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Affiliation(s)
- Kunal Deokar
- All India Institute of Medical Sciences, Jodhpur, India
| | - Ram Niwas
- All India Institute of Medical Sciences, Jodhpur, India.
| | | | - Gopal Chawla
- All India Institute of Medical Sciences, Jodhpur, India
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Chawla G, Dutt N, Deokar K, Meena VK. Chest pain without a clue-ultrasound to rescue occult multiple myeloma: A case report. World J Radiol 2019; 11:144-148. [PMID: 31885830 PMCID: PMC6901384 DOI: 10.4329/wjr.v11.i12.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chest pain is one of the most common symptoms with which a patient presents to a doctor. Differentials include, but are not limited to, cardiac pulmonary, gastrointestinal, psychosomatic and musculoskeletal causes. In our case, ultrasound of the chest wall paved the way for the diagnosis of multiple myeloma, which occultly presented with chronic chest pain.
CASE SUMMARY Here we report a case of 50-year-old man with chronic chest pain without anemia or renal failure who was diagnosed with multiple myeloma, despite negative bence jones protein and M band electrophoresis. An ultrasound of the chest wall showed cortical irregularities along with a hypoechoic mass in the sternum and left 5th rib, which helped us in clinching the diagnosis.
CONCLUSION Ultrasound of bone can often aid in reaching a diagnosis indirectly if not directly.
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Affiliation(s)
- Gopal Chawla
- Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Naveen Dutt
- Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Kunal Deokar
- Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Virender Kumar Meena
- Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Udaipur 342005, India
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Gadewad N, Deokar K, Ghorpade S. Clinical Profile of Patients Presenting with Malignant Pleural Effusion to a Tertiary Health Care Centre. J Assoc Physicians India 2017; 65:28-31. [PMID: 28799302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Malignant pleural effusions are one of the leading causes of exudative pleural effusions. We studied the clinical profile of patients presenting with malignant pleural effusion, their cytological and histopathological features and the efficacy of pleurodesis in preventing recurrence. MATERIALS AND METHODS 100 patients who were positive for malignant cells in pleural fluid cytology or pleural biopsy were recruited. After history and clinical examination, Chest radiographs, Computed tomography of chest were performed. After diagnostic thoracocentesis and Pleural biopsy, Tube thoracostomy was done. Pleurodesis was performed in 40 patients. RESULTS Most of the patients (65%) were in the age group of 61 to 70 years with a male to female ratio of 1.5:1. Most common presenting symptoms were breathlessness (86%) and cough (86%). All (100%) of the malignant pleural effusions were exudative. Pleural fluid cytology was positive in 86% while pleural biopsy was positive only in 44%. Pleural biopsy was positive only in 17% of patients with negative cytology. Adenocarcinoma (59%) was the most common type of cytological diagnosis. Pleurodesis was performed in 40 patients of which 30% had recurrence. CONCLUSIONS In our tertiary health care centre, malignant pleural effusions presented as large pleural effusions. Most common presenting symptoms were breathlessness and cough. They were exudative, lymphocytic predominant with low ADA levels. Thoracocentesis and cytologic study should be the initial diagnostic approach to malignant pleural effusions. Adenocarcinoma of the lung was the most common cause of malignant pleural effusion. Pleurodesis with oxytetracycline was successful in majority of cases.
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Affiliation(s)
- Nitin Gadewad
- Senior Registrar, Fortis Hospital, Mumbai, Maharashtra
| | - Kunal Deokar
- Consultant Pulmonologist, Sapphire Hospitals, Thane, Maharashtra
| | - Shivhari Ghorpade
- Professor and Head, Dept. of Pulmonary Medicine GMC, Nagpur, Maharashtra
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