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Dey M, Mishra B, Mohapatra PR, Mohakud S, Behera B. Microbiological profile of long COVID and associated clinical and radiological findings: a prospective cross-sectional study. Lab Med 2024:lmae010. [PMID: 38520687 DOI: 10.1093/labmed/lmae010] [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: 03/25/2024] Open
Abstract
OBJECTIVE To study the frequency of microbiological etiology of respiratory infections in patients with long COVID and their associated clinical and radiological findings. METHODS Nasopharyngeal swabs and sputum specimens were collected from 97 patients with respiratory illness stemming from long COVID. The specimens were assessed for their microbiological profile (bacteria and virus) and their association with the overall clinical and radiological picture. RESULTS In total, 23 (24%) patients with long COVID had viral infection (n = 12), bacterial infection (n = 9), or coinfection (n = 2). Microorganisms were detected at significantly higher rates in hospitalized patients, patients with moderate COVID-19, and patients with asthma (P < .05). Tachycardia (65%) was the most common symptom at presentation. A statistically significant number of patients with long COVID who had viral infection presented with cough and myalgia; and a statistically significant number of patients with long COVID who had bacterial infection presented with productive coughing (P < .05). Post-COVID fibrotic changes were found in 61% of cohort patients (31/51). CONCLUSION A decreasing trend of respiratory pathogens (enveloped viruses and bacteria) was found in long COVID. An analysis including a larger group of viral- or bacterial-infected patients with long COVID is needed to obtain high-level evidence on the presenting symptoms (cough, myalgia) and their association with the underlying comorbidities and severity.
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Affiliation(s)
- Monalisa Dey
- Departments of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Baijayantimala Mishra
- Departments of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prasanta Raghab Mohapatra
- Departments of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudipta Mohakud
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bijayini Behera
- Departments of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Sarkar S, Girija A, Shirgaonkar R, Mohapatra PR. Intralobar Pulmonary Sequestration. QJM 2023:hcad286. [PMID: 38113405 DOI: 10.1093/qjmed/hcad286] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Subho Sarkar
- Department of Pulmonary Critical Care Sleep Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Aswathy Girija
- Department of Pulmonary Critical Care Sleep Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Rohit Shirgaonkar
- Department of Pulmonary Critical Care Sleep Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Critical Care Sleep Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
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Kumar G, Bhalla A, Mukherjee A, Turuk A, Talukdar A, Mukherjee S, Bhardwaj P, Menon GR, Sahu D, Misra P, Sharma LK, Mohindra R, S S, Suri V, Das H, Sarkar D, Ghosh S, Ghosh P, Dutta M, Chakraborty S, Kumar D, Gupta MK, Goel AD, Baruah TD, Kannauje PK, Shukla AK, Khambholja JR, Patel A, Shah N, Bhuniya S, Panigrahi MK, Mohapatra PR, Pathak A, Sharma A, John M, Kaur K, Nongpiur V, Pala S, Shivnitwar SK, Krishna BR, Dulhani N, Gupta B, Gupta J, Bhandari S, Agrawal A, Aggarwal HK, Jain D, Shah AD, Naik P, Panchal M, Anderpa M, Kikon N, Humtsoe CN, Sharma N, Vohra R, Patnaik L, Sahoo JP, Joshi R, Kokane A, Ray Y, Rajvansh K, Purohit HM, Shah NM, Madharia A, Dube S, Shrivastava N, Kataria S, Shameem M, Fatima N, Ghosh S, Hazra A, D H, Salgar VB, Algur S, M L KY, M PK, Panda S, Vishnu Vardhana Rao M, Bhargava B. Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19. BMJ Glob Health 2023; 8:e012245. [PMID: 37816536 PMCID: PMC10565174 DOI: 10.1136/bmjgh-2023-012245] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/20/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.
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Affiliation(s)
- Gunjan Kumar
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aparna Mukherjee
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Alka Turuk
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | | | | | | | - Geetha R Menon
- National Institute of Medical Statistics, New Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, New Delhi, India
| | | | | | - Ritin Mohindra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samita S
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Himadri Das
- Medical College and Hospital Kolkata, Kolkata, India
| | | | | | - Priyanka Ghosh
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Moumita Dutta
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | | | - Deepak Kumar
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | | | | | | | | | | | | | - Sourin Bhuniya
- All India Institute of Medical Sciences, Bhubaneswar, India
| | | | | | | | | | - Mary John
- Christian Medical College and Hospital, Ludhiana, India
| | | | | | | | | | | | | | | | | | | | | | - H K Aggarwal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Deepak Jain
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Arti D Shah
- SBKS Medical Institute and Research Centre, Vadodara, India
| | - Parshwa Naik
- SBKS Medical Institute and Research Centre, Vadodara, India
| | | | | | - Nyanthung Kikon
- Department of Health and Family Welfare, Government of Nagaland, Kohima, India
| | | | - Nikita Sharma
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Rajaat Vohra
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - Rajnish Joshi
- All India Institute of Medical Sciences, Bhopal, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Bhopal, India
| | - Yogiraj Ray
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | | | | | - Nehal M Shah
- Smt NHL Municipal Medical College, Ahmedabad, India
| | | | | | | | | | | | | | - Saumitra Ghosh
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Himanshu D
- King George Medical University, Lucknow, India
| | | | - Santosh Algur
- Gulbarga Institute of Medical Sciences, Gulbarga, India
| | - Kala Yadhav M L
- Shri Atal Bihari Vajpayee Medical College and Research Institution, Bengaluru, India
| | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India
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Mohapatra PR, Mishra B. Integrating clinical judgment, advanced radiology, and molecular diagnosis: the modern ways of pneumonia management. Eur J Emerg Med 2023; 30:300-301. [PMID: 37387634 DOI: 10.1097/mej.0000000000000986] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
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Mohapatra PR, Shirgaonkar RB, Behera B, Girija A. Community-Acquired burkholderia cepacia complex (BCC) pneumonia in a lung cancer patient on erlotinib. Lung India 2023; 40:364-365. [PMID: 37417093 PMCID: PMC10401989 DOI: 10.4103/lungindia.lungindia_57_23] [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: 02/12/2023] [Accepted: 04/26/2023] [Indexed: 07/08/2023] Open
Abstract
Community-acquired Burkholderia cepacia pneumonia is uncommon. We report a 32-year-old female who was on oral erlotinib, a tyrosine kinase inhibitor, for 2 years for her lung cancer and developed community-acquired Burkholderia cepacia pneumonia, which was confirmed by blood culture. The patient improved with antibiotics.
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Affiliation(s)
- Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Science-Bhubaneswar, Odisha, India
| | - Rohit Bicaro Shirgaonkar
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Science-Bhubaneswar, Odisha, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Science-Bhubaneswar, Odisha, India. E-mail:
| | - Aswathy Girija
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Science-Bhubaneswar, Odisha, India
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Behera B, Mohanty S, Mishra B, Mohapatra PR. Letter in Response to "Melioidosis in a Tertiary Care Center from South India: A 5-year Experience. Indian J Crit Care Med 2023; 27:368-369. [PMID: 37214114 PMCID: PMC10196643 DOI: 10.5005/jp-journals-10071-24466] [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] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 05/24/2023] Open
Abstract
How to cite this article: Behera B, Mohanty S, Mishra B, Mohapatra PR. Letter in Response to "Melioidosis in a Tertiary Care Center from South India: A 5-year Experience. Indian J Crit Care Med 2023;27(5):368-369.
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Affiliation(s)
- Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Krishnan A, Kumar R, Amarchand R, Mohan A, Kant R, Agarwal A, Kulshreshtha P, Panda PK, Bhadoria AS, Agarwal N, Biswas B, Nair R, Wig N, Malhotra R, Bhatnagar S, Aggarwal R, Soni KD, Madan N, Trikha A, Tiwari P, Singh AR, Wyawahare M, Gunasekaran V, Sekar D, Misra S, Bhardwaj P, Goel AD, Dutt N, Kumar D, Nagarkar NM, Galhotra A, Jindal A, Raj U, Behera A, Siddiqui S, Kokane A, Joshi R, Pakhare A, Farooque F, Pawan S, Deshmukh P, Solanki R, Rathod B, Dutta V, Mohapatra PR, Panigrahi MK, Barik S, Guleria R. Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study. Am J Trop Med Hyg 2023; 108:727-733. [PMID: 36913920 PMCID: PMC10077017 DOI: 10.4269/ajtmh.22-0705] [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: 11/13/2022] [Accepted: 01/12/2023] [Indexed: 03/15/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December-March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46-59 years, 3.4 [95% CI: 1.5-7.7]; 60-74 years, 4.1 [95% CI: 1.7-9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0-30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2-2.9]); malignancy (aOR: 3.1 [95% CI: 1.3-7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2-8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4-3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7-11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6-3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | | | | | | | | | | | - Neeraj Agarwal
- Department of Community & Family Medicine, AIIMS, Patna, India
| | - Bijit Biswas
- Department of Community & Family Medicine, AIIMS, Patna, India
| | | | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
| | - Rajesh Malhotra
- Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia, BRAIRCH, AIIMS, New Delhi, India
| | - Richa Aggarwal
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Kapil Dev Soni
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Nirupam Madan
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | | | - Mukta Wyawahare
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), India
| | | | - Dineshbabu Sekar
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), India
| | | | - Pankaj Bhardwaj
- Department of Community & Family Medicine, AIIMS, Jodhpur, India
| | | | - Naveen Dutt
- Department of Pulmonary Medicine, AIIMS, Jodhpur, India
| | | | | | | | - Atul Jindal
- Department of Paediatrics, AIIMS, Raipur, India
| | - Utsav Raj
- National Tuberculosis Elimination Program, AIIMS, Raipur, India
| | - Ajoy Behera
- Department of Pulmonary Medicine, AIIMS, Raipur, India
| | | | - Arun Kokane
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | | | - Abhijit Pakhare
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | - Farhan Farooque
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | - Sai Pawan
- Department of Medicine, AIIMS, Bhopal, India
| | | | - Ranjan Solanki
- Department of Community & Family Medicine, AIIMS, Nagpur, India
| | | | | | | | | | - Sadananda Barik
- Department of Trauma & Emergency Medicine, AIIMS, Bhubaneswar, India
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Panigrahi MK, Datta A, Bhuniya S, Bal SK, Mohapatra PR. Dextromethorphan premedication in the alleviation of cough during flexible bronchoscopy in adults: A randomized double-blind placebo-controlled trial. Respirology 2023; 28:484-490. [PMID: 36627188 DOI: 10.1111/resp.14445] [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: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Cough is invariably encountered during flexible bronchoscopy despite sedation and topical anaesthetics. The ideal cough suppressant during flexible bronchoscopy is not known. We assessed the role of dextromethorphan premedication in relieving the cough during flexible bronchoscopy in adults. METHODS In this single-centre study, we randomized patients aged ≥18 years to receive dextromethorphan syrup 30 ml (90 mg) or an equal volume of placebo 1 h before the procedure. Patients rated their cough severity and discomfort on a visual analogue scale at the end of the procedure. Bronchoscopists also rated cough severity at the end of the procedure. RESULTS Out of 112 patients screened, 94 patients (median (interquartile range [IQR]) age 51 (36.25-60.75) years, male: female 2.13:1) were randomized to either the dextromethorphan (n = 47) or placebo (n = 47) groups. The patients-rated median (IQR) cough scores at the end of the procedure were 15 (10-23) mm in dextromethorphan versus 20 (12-45.5) mm in placebo groups (p = 0.03). Patients-rated median cough scores at 1 h (5 mm vs. 6 mm, p = 0.21), discomfort scores (12.5 mm vs. 12.5 mm, p = 0.49), and midazolam and lignocaine usage were similar between the two groups. The bronchoscopist-rated median cough score was non-significantly lower in the intervention compared to the placebo (26 mm vs. 35 mm, p = 0.09) groups. CONCLUSION Dextromethorphan premedication 1 h before flexible bronchoscopy may have an additive effect on cough suppression under conscious sedation and topical lignocaine. Further trials are needed to reiterate our findings with certainty.
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Affiliation(s)
- Manoj Kumar Panigrahi
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ananda Datta
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Shakti Kumar Bal
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Datta A, Mohapatra PR, Bhuniya S, Mishra B. TB treatment regimen for children: is a 4-month regimen really better than the 6-month regimen? Int J Tuberc Lung Dis 2022; 26:1197. [PMID: 36447324 DOI: 10.5588/ijtld.22.0375] [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: 12/05/2022] Open
Affiliation(s)
- A Datta
- Department of Pulmonary Medicine & Critical Care, Bhubaneswar, India
| | - P R Mohapatra
- Department of Pulmonary Medicine & Critical Care, Bhubaneswar, India
| | - S Bhuniya
- Department of Pulmonary Medicine & Critical Care, Bhubaneswar, India
| | - B Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Mohapatra PR. Increasing Melioidosis Cases in India. JAPI 2022. [DOI: 10.5005/japi-11001-0088] [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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Mohapatra PR. Increasing Melioidosis Cases in India. J Assoc Physicians India 2022; 70:11-12. [PMID: 36082898] [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)
- Prasanta Raghab Mohapatra
- Professor and Head, Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Mohapatra PR, Mishra B, Dutta A, Bhuniya S. Responding to WHO´s 4-month regimen for drug-susceptible pulmonary TB. Int J Tuberc Lung Dis 2022; 26:898-899. [PMID: 35996294 DOI: 10.5588/ijtld.22.0313] [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: 11/10/2022] Open
Affiliation(s)
- P R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - B Mishra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - A Dutta
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - S Bhuniya
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
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Abstract
Melioidosis is a complex tropical disease linked with many complications. It is increasingly diagnosed in India. The clinical mimicry of this disease with several other common causes of pneumonia has kept the clinicians in ignorance. Usually, the diagnosis and appropriate management get delayed. The organism closely resembles the common contaminant Pseudomonas and is easily misidentified in microbiology laboratories. The diagnosis is often missed because of poor diagnostic sensitivity of blood culture, the gold standard of the diagnosis. All this contributes to increased morbidity and mortality. The rampant use of high-end broad-spectrum antibiotics like ceftazidime and meropenem at suboptimal dose and duration suppresses the diagnosis without eradicating the disease, leaving the chance of recurrence from its latency even after years. As an infectious disease, the cure and prevention depend on early diagnosis and treatment. An awareness of its peculiar presentations and history can differentiate clinically and suspect the condition much easily from other mimickers of tuberculosis to sepsis. Ultimately, the prevention of melioidosis remains the critical strategy. Increasing the number of cases and intricated management of this fatal but potentially curable disease had prompted us to take up the mission of preventing the disease by spreading knowledge and awareness.
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Affiliation(s)
- Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Prasanta Raghab Mohapatra, Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha - 751 019, India. E-mail:
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Mohanty M, Mishra B, Sirka CS, Mohapatra PR. Case Report: Multiple Scalp Abscesses due to Mycobacterium abscessus Infection Following Triamcinolone Injection in an Immunocompetent Person. Am J Trop Med Hyg 2022; 107:tpmd220126. [PMID: 35940200 PMCID: PMC9490647 DOI: 10.4269/ajtmh.22-0126] [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: 02/18/2022] [Accepted: 06/03/2022] [Indexed: 11/07/2022] Open
Abstract
Mycobacterium abscessus complex is a group of nontuberculous mycobacteria (NTM). The NTM may involve skin, soft tissue, and other organs like the eye and central nervous system. Clinically may mimic multidrug resistance. Here, we present a case of a 29-year man with a history of multiple scalp swellings with mild symptoms. He had undergone multiple triamcinolone acetonide injections on his scalp to stop hair fall and baldness 2 months prior. As there was a history of injections on the scalp and lesions associated with minimal symptoms, we suspected the possibility of NTM and fungal infections. As a part of treatment and obtaining a sample for investigation, lesions were aspirated with a needle. The swellings contained gelatinous material, which was sent for microscopic examination, and revealed the presence of acid-fast bacilli (AFB). Xpert MTB/RIF assay was negative for mycobacteria (MTB complex), but culture revealed NTM, identified as M. abscessus complex by line probe assay. Based on the diagnosis, the patient was treated with an injection of amikacin, moxifloxacin, and azithromycin. The lesions improved. The patient has completed over a year of follow-up with no recurrence noted. Mycobacterium abscessus, a rapidly growing NTM, has been occasionally reported to cause cutaneous soft tissue infection when injected with nonsterile medicine or needles. Therefore, a high index of suspicion for NTM infection is warranted in patients with cutaneous scalp abscess following scalp injections for hair loss.
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Affiliation(s)
- Monalisa Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chandra Sekhar Sirka
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Singh AK, Panigrahi MK, Pradhan SK, Pal D, Subba SH, Patro BK, Behera BK, Mishra B, Behera B, Mohapatra PR, Bhuniya S, Bal SK, Sarkar S, Pillai JSK, Mohanty S, Gitanjali B. Clinico-Epidemiological Characteristics of Healthcare Workers with SARS-CoV-2 Infection during the First and Second Waves in a Teaching Hospital from Eastern India: A Comparative Analysis. Hosp Top 2022:1-12. [PMID: 35852422 DOI: 10.1080/00185868.2022.2096523] [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: 06/15/2023]
Abstract
In this retrospective observational study, we have performed a comparative analysis of the demographic, clinical and epidemiological characteristics of the HCWs affected with SARS-CoV-2 infection during first two waves in India. The overall prevalence of SARS-CoV-2 infection among HCWs was found to be 15.24% (14.20-16.33) and 23.38% (22.14-25.65) during first and second waves respectively. The second wave showed an adjusted odds ratio of 0.04(0.02-0.07) and 2.09(1.49-2.93) for hospitalization and being symptomatic, respectively. We detected significantly higher level of C-reactive protein (CRP) among admitted HCWs during the second wave (5.10 -14.60 mg/dl) as compared to the first wave (2.00 - 2.80 mg/dl). Our study found the relative risk of SARS-CoV-2 reinfection among HCWs during the second wave to be 0.68 [0.57-0.82, p < 0.001)]. Although, the prevalence of SARS CoV-2 infection and risk of being symptomatic was higher during second wave, the risk of hospitalization was less when compared with the first wave.
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Affiliation(s)
- Arvind Kumar Singh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manoj Kumar Panigrahi
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Somen Kumar Pradhan
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Debkumar Pal
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sonu H Subba
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Binod Kumar Patro
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Binod Kumar Behera
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Shakti Kumar Bal
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Sarkar
- Department of Ear Nose Throat, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jawahar S K Pillai
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, India
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Das S, Mishra B, Mohapatra PR, Preetam C, Rath S. Clinical presentations of nontuberculous mycobacteria as suspected and drug-resistant tuberculosis: Experience from a tertiary care center in Eastern India. Int J Mycobacteriol 2022; 11:167-174. [PMID: 35775549 DOI: 10.4103/ijmy.ijmy_68_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: 11/04/2022] Open
Abstract
Background Nontuberculous mycobacteria (NTM) are on the rise worldwide. The diagnosis and treatment of NTM disease create a dilemma for physicians as their clinical features often overlap with that of tuberculosis (TB). The present study aims to report a series of NTM infections presenting as suspected TB. Methods It was a prospective observational study starting from December 2018 to January 2022. . A total of 1850 suspected TB patients (pulmonary = 522 and extrapulmonary = 1328) were included in this study. Clinical features, radiological findings, microbiological diagnosis, treatment, and outcome were recorded. Clinical specimens were processed for Ziehl-Neelsen staining, GeneXpert MTB/Rif assay by cartridge-based nucleic acid amplification test, and culture. The culture-positive isolates were categorized as Mycobacterium tuberculosis complex or NTM depending on the detection of MPT64 antigen by immunochromatographic test. The NTM isolates were speciated by line probe assay using GenoType® Mycobacterium common mycobacteria kit. The criteria of the American Thoracic Society/Infectious Diseases Society of America were applied to confirm NTM disease. Results Of 1850 suspected TB patients, NTM disease was diagnosed in 20 patients (pulmonary = 9, nonpulmonary = 11). Eight NTM cases presented as suspected drug-resistant-TB with a history of antitubercular therapy. Among pulmonary NTM cases, Mycobacterium scrofulaceum (n = 7) was the most common species followed by Mycobacterium kansasii (n = 1) and Mycobacterium intracellulare (n = 1). In nonpulmonary cases, Mycobacterium abscessus (n = 8) was involved in majority of cases followed by Mycobacterium fortuitum (n = 3). Cavitary lung disease and laparoscopic port site infections were most frequent pulmonary and non-pulmonary manifestations respectively. Conclusion Hence, there is an urgent need for better diagnostic and drug susceptibility testing facility along with standardized treatment protocol for NTM disease.
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Affiliation(s)
- Sivasankar Das
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chappity Preetam
- Department of Ear, Nose and Throat, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sutapa Rath
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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17
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Mohanty S, Mohapatra PR, Devi S, Saha S. Post-COVID-19 vaccination shoulder abscess and pleuroparenchymal pulmonary lesion due to Burkholderia pseudomallei. IDCases 2022; 27:e01457. [PMID: 35223429 PMCID: PMC8863398 DOI: 10.1016/j.idcr.2022.e01457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/19/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022] Open
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18
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Behera B, Tripathy S, Venkateshan M, Mahapatra A, Mohanty S, Gupta K, Mishra B, Rao PB, Mitra JK, Mohapatra PR, Panigrahi MK, Bhuniya S, Bal SK. Spectrum of Bacterial Pathogens in Critical COVID-19 Patients Admitted in Intensive Care Units of a Tertiary Care Hospital During the First and Second Wave of the Pandemic. J Assoc Physicians India 2022; 70:11-12. [PMID: 35436819] [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: 06/14/2023]
Abstract
OBJECTIVE This study intends to compare the clinical characteristics and the prevalence and spectrum of bacterial pathogens in COVID-19 patients admitted to ICU during the first and second waves at a tertiary care, teaching and referral hospital of eastern India. METHOD This is a hospital-based retrospective study which analysed demographic details, clinical profile and bacterial culture results of severe and critically ill COVID-19 patients admitted in intensive care units (ICU) during April -Oct 2020 (1st wave) and April -July 2021 (2nd wave). RESULT The patients admitted during the 2nd wave were comparatively older and had multiple comorbidities compared to the 1st wave. (23.8%) (45/189) and 50% (173/346) of the COVID-19 patients admitted to ICU developed bacterial infection during the 1st and 2nd wave respectively. Overall, there was predominance of multidrug resistant Gram negative bacilli in both the waves. There was increased isolation of intrinsic colistin resistant microorganisms. CONCLUSION Multidrug resistant Gram negative bacterial infections, remain a dreaded complication in severe and critically ill hospitalised COVID-19 patients requiring ICU care and high usage of colistin spirals the emergence and spread of pathogens intrinsically resistant to colistin.
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Affiliation(s)
- Bijayini Behera
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha; Corresponding Author
| | - Swagata Tripathy
- Additional Professor, Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Mahalingam Venkateshan
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Ashoka Mahapatra
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Srujana Mohanty
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Kavita Gupta
- Assistant Professor, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Baijayantimala Mishra
- Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - P Bhaskar Rao
- Additional Professor, Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Jayanta Kumar Mitra
- Additional Professor, Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | | | - Manoj Kumar Panigrahi
- Additional Professor, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Sourin Bhuniya
- Additional Professor,All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Shakti Kumar Bal
- Assistant Professor, Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
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Abstract
A 39-year-old nonsmoker male presented with complaints of cough with recurrent mild hemoptysis. Computed tomography of thorax showed nodular lesions on the right lateral wall of trachea. Fiber-optic bronchoscopy revealed multiple nodular lesions on the right lateral wall of lower one-third of trachea. Histopathological examination of biopsy specimen from the nodules was suggestive of tracheobronchopathia osteochondroplastica which is an uncommon airway disorder.
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Affiliation(s)
- Ananda Datta
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudip Ghosh
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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20
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Rahman KKM, Mohapatra PR, Panigrahi MK, Purkait S, Bhuniya S. Comparison of endobronchial ultrasound-guided transbronchial needle aspiration cytology versus cell blocks in adults with undiagnosed mediastinal lymphadenopathy. Lung India 2021; 38:425-430. [PMID: 34472519 PMCID: PMC8509166 DOI: 10.4103/lungindia.lungindia_836_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Retrospective studies have shown improved diagnostic yield of combined cytology and cell blocks specimens from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with variable additional yields in cell blocks. In this prospective study, we assessed the diagnostic performance of cytology and cell blocks in patients undergoing EBUS-TBNA. Methods This was a single-center, cross-sectional study conducted between December 2017 and November 2019 including patients aged ≥18 years with mediastinal lymphadenopathy. EBUS-TBNA was performed under conscious sedation using 22G needles. Both cytology smears and cell blocks by the tissue coagulum clot technique were prepared for each patient without rapid on-site evaluation. Results Data were analyzed for 93 patients (mean age 54.25 ± 13.7 years, 73 males) where both cytology and cell blocks were available. Sample adequacy was 100%. Overall diagnostic yield either by cytology or cell block was 83%. Cytology yield was 79.6%, whereas cell block was diagnostic in 73% of patients (P < 0.001). The overall additional yield of cell blocks was 3.2%. Cell blocks had additional yields of 1.8%, 0%, and 14.3% in malignancy, tuberculosis, and sarcoidosis, respectively. Tumor histology was better identified in 76% of positive cell blocks, and accurate histological subtyping was possible in 32.6% cases. Immunohistochemistry was feasible in 82.5% of all positive cell blocks, and these were judged to be adequate for the mutational analysis. Conclusions Compared to cytology, EBUS-TBNA cell blocks did not significantly increase the overall diagnostic yield in unselected patients. However, cell blocks are beneficial in the characterization of tumor morphology and histological subtyping of lung cancer.
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Affiliation(s)
- K K Mujeeb Rahman
- Department of Pulmonary Medicine and Critical care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Manoj Kumar Panigrahi
- Department of Pulmonary Medicine and Critical care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Suvendu Purkait
- Department of Pathology and Lab Medicine, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine and Critical care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
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21
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Radhakrishnan A, Behera B, Mishra B, Mohapatra PR, Kumar R, Singh AK. Clinico-microbiological description and evaluation of rapid lateral flow immunoassay and PCR for detection of Burkholderia pseudomallei from patients hospitalized with sepsis and pneumonia: A twenty-one months study from Odisha, India. Acta Trop 2021; 221:105994. [PMID: 34118206 DOI: 10.1016/j.actatropica.2021.105994] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
Establishing a diagnosis of melioidosis based on clinical grounds is difficult in hospitalized patients with sepsis or community acquired pneumonia (CAP). We aimed to ascertain the prevalence, clinico-epidemiological and laboratory profile of melioidosis in hospitalized patients with sepsis or CAP, and to evaluate the diagnostic utility of rapid lateral flow immunoassay (LFI) and PCR in comparison with culture. In all patients with sepsis or CAP, blood, sputum/throat swab, and urine sample were subjected to culture along with other samples based on clinical presentation. In addition, PCR assay targeting the type III secretion system 1 (TTS1) and LFI was performed. Thirty-three (33/196, 17%) out of the total 196 cases were diagnosed as melioidosis by culture. The prevalence of melioidosis in patients who had only sepsis without CAP, had both sepsis and CAP, had CAP without sepsis was 31% (26/84), 22 % (4/18) and 3%(3/94) respectively. All the LFI or PCR positive cases were culture positive from at least one or more samples (blood/sputum/urine/pus). The sensitivity, specificity, positive predictive value and negative predictive value of TTS1 PCR was 78% (18/23 melioidosis patients), 100% (34/34 non-melioidosis patients), 100% (18/18 melioidosis patients) and 87% (34/39 non-melioidosis patients). The sensitivity, specificity, positive predictive value and negative predictive value of Rapid LFI was 91% (21/23 melioidosis patients), 100% (22/22 non-melioidosis patients), 100% (21/21 melioidosis patients) and 91% (22/24 non-melioidosis patients). On sample wise stratification of LFI and TTS1 with respect to culture, plasma/serum samples showed the highest discordance by PCR (9/55, 16.3%) and LFI (11/35, 31.4%). The lowest discordance was noted in respiratory tract samples (2/32, 6.2%) by PCR and pus/body fluids samples (2/14, 14.2%) by LFI and these findings are in line with previous published literature. The clinical utility of PCR and LFI needs to be further validated in a large scale study for early diagnosis of septicaemic melioidosis.
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Affiliation(s)
| | - Bijayini Behera
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India.
| | | | | | - Rajesh Kumar
- Department of General Medicine, AIIMS, Bhubaneswar Odisha, India.
| | - Arvind Kumar Singh
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India.
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22
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Radhakrishnan A, Behera B, Mishra B, Mohapatra PR. Clinico-microbiological analysis of hospitalized melioidosis cases with sepsis and/or pneumonia: A single -center, Pro- spective study from Eastern India. Indian J Med Microbiol 2021. [DOI: 10.1016/j.ijmmb.2021.08.304] [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: 11/28/2022]
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Padmaja MS, Bhuniya S, Naik S, Sable M, Ghosh S, Mohapatra PR. Uncommon presentation of osteosarcoma. Adv Respir Med 2021; 88:282-284. [PMID: 32706113 DOI: 10.5603/arm.2020.0121] [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: 01/26/2020] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Mantha Satya Padmaja
- Pulmonary Medicine and Critical Care, All India Institute of Medical sciences, Bhubaneswar, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical sciences, Bhubaneswar, India
| | - Mukund Sable
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudip Ghosh
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
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Mohapatra PR, Mishra B. Regulatory approval of COVID-19 vaccine for restricted use in clinical trial mode. Lancet Infect Dis 2021; 21:599-600. [PMID: 33508225 PMCID: PMC8063074 DOI: 10.1016/s1473-3099(21)00045-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 01/25/2023]
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25
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Mishra B, Mohapatra PR. Occult drug resistance in tuberculosis: Emerging issues, upcoming challenges & possible solutions. Indian J Med Res 2021; 151:522-524. [PMID: 32719224 PMCID: PMC7602933 DOI: 10.4103/ijmr.ijmr_316_19] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar 751 019, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751 019, Odisha, India
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26
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Abstract
There are worldwide urgency, efforts, and uncertainties for the discovery of a vaccine against SARS CoV2. If successful, it will take its own time till useful for the humans. Till the specific vaccine is available, there are evidences for repurposing existing other vaccines. It is observed that countries having a routine BCG vaccination programme, have shown to have lower incidence of COVID-19, suggesting some protective mechanisms of BCG against COVID-19 in such countries. In countries like India despite vast population density and other adversities, and growing numbers of COVID19 infections, the mortality rate and severity of COVID has been low in comparison to some TB non-endemic countries (like Europe and USA). In addition, there are evidences that BCG vaccination offers partial protection and survival in low-income countries where tuberculosis is prevalent. The nonspecific effects (NSEs) of immune responses induced by BCG vaccination protect against other infections seem to be due to its immunological memory eliciting lymphocytes response and trained immunity. The protective effect on other viral infection in humans are believed to be mediated by heterologous lymphocyte activation and the initiation of innate immune memory may be applicable to SARS CoV2. The BCG vaccination at birth does not have a protective effect beyond childhood against COVID-19. In adults, there might be other factors dampening the virulence and pathogenicity of COVID-19. In the TB endemic countries like India, with high population density, similar to BCG vaccination, the environmental Mycobacteria might be imparting some immune-protection from severity and deaths of COVID-19.
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Affiliation(s)
- Prasanta Raghab Mohapatra
- Professor & Head, Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Baijayantimala Mishra
- Professor & Head, Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Bijayini Behera
- Associate Professor, Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
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27
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Jahan R, Mishra B, Behera B, Mohapatra PR, Praharaj AK. Study of respiratory viruses and their coinfection with bacterial and fungal pathogens in acute exacerbation of chronic obstructive pulmonary diseases. Lung India 2021; 38:53-58. [PMID: 33402638 PMCID: PMC8066933 DOI: 10.4103/lungindia.lungindia_273_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)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) develop acute exacerbations (AE), with varying natural history. The exacerbation is triggered by infection, leading to increased morbidity and mortality. The study on infectious aetiology of AECOPD is largely restricted to only viral or only bacterial aetiology. There are no studies from India that have investigated multiple viral, bacterial, and fungal associations from the same group of patients. This prospective study was conducted over 2 years to estimate the incidence and profile of viral infections in AECOPD patients, their coinfection with other bacterial and fungal agents, and association of the type and pattern of infective agent with the clinical severity. Materials and Methods: Seventy-four AECOPD cases were included in the study. Multiplex polymerase chain reaction was performed from nasopharyngeal swab using Fast Track Diagnostics Respiratory Pathogens 21 Plus Kit. Ziehl–Neelsen (ZN) stain, Modified ZN, and potassium hydroxide (KOH) mount were performed for Mycobacteria, Nocardia, and fungal elements. Bacterial cultures and fungal cultures were done as per the standard techniques. Serum samples were tested for Mycoplasma and Chlamydia pneumoniae immunoglobulin M enzyme-linked immunosorbent assay. Results: The number of AECOPD events involving only viral infection, only bacterial infection, bacterial–viral coinfection, and no infection were 43 (58.1%), 32 (43.2%), 20 (27%), and 19 (25.7%), respectively. Influenza A virus was the most common virus (22/43, 51%) identified. In 26 patients, monoviral infections were found, and in 17 patients, polyviral infections were identified, the most common pattern being influenza A and B virus, followed by human rhinovirus and human parainfluenza. The most common bacteria isolated were Pseudomonas aeruginosa (9/32,28%) followed by Acinetobacter baumanii and Klebsiella pneumoniae (7/32, 21%). Among the viral–bacterial coinfection, human coronavirus NL63 infection was always associated with a bacterial infection. Conclusion: This information on the various viral and bacterial etiologies of respiratory infections in AECOPD in this part of India will improve the understanding of the management of AECOPD using a timely institution of antivirals and reduce the overuse of antibiotics and the implementation of routine influenza vaccination.
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Affiliation(s)
- Rahat Jahan
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashok Kumar Praharaj
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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28
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Purohit G, Mishra B, Mohapatra PR. Comparison of Conventional versus Molecular Semi-Quantitative Assay in Presumptive Pulmonary Tuberculosis Cases: A Study from Eastern India. J Glob Infect Dis 2020; 12:235-236. [PMID: 33888968 PMCID: PMC8045534 DOI: 10.4103/jgid.jgid_179_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Geetarani Purohit
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Mohapatra PR, Sahoo S, Bhuniya S, Panigrahi MK, Majumdar SKD, Mishra P, Patra S. Concomitant echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase rearrangement and epidermal growth factor receptor mutation in non-small cell lung cancer patients from eastern India. J Cancer Res Ther 2020; 16:850-854. [PMID: 32930129 DOI: 10.4103/jcrt.jcrt_678_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/20/2022]
Abstract
Background In non-small cell lung cancer common driver mutations such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) are usually mutually exclusive. This study aimed to elucidate the concurrence of EGFR mutation and ALK rearrangement in eastern India patients with primary lung adenocarcinoma and assess the response of EGFR tyrosine kinase inhibitor (TKI) therapy after 6 months in primary lung adenocarcinoma. Methods We retrospectively analyzed 198 adenocarcinomas for EGFR and ALK mutations. EGFR and ALK tests were done by real-time polymerase chain reaction and immunohistochemistry (IHC) techniques, respectively. Radiological response was assessed by Response Evaluation Criteria in Solid Tumors (version 1.1). Results EGFR/ALK co-alteration was found in 4 adenocarcinoma patients. All were males with advanced disease. Younger patients had exon 19 deletion whereas older ones showed exon 21 mutation. The initial option of ALK-TKI in all four patients was excluded straightaway due to the high-cost burden of ALK-TKI. Two of them showed a partial response while other two had stable disease after 6 months of EGFR TKI therapy. Conclusion EGFR/ALK co-alterations in adenocarcinomas albeit rare do exist. The challenge of monetary hurdle in developing countries with ALK TKI therapy can be handled by giving only EGFR TKI in these cases of concomitant mutations. Future perspective in research could be finding an agent with the potential of dual inhibition of ALK and EGFR.
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Affiliation(s)
| | - Satyajeet Sahoo
- Department of Pulmonary Medicine, AIIMS, Bhubaneswar, Odisha, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine, AIIMS, Bhubaneswar, Odisha, India
| | | | | | | | - Susama Patra
- Department of Pathology, AIIMS, Bhubaneswar, Odisha, India
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Rahman K K M, Bhuniya S, Behera B, Mohapatra PR, Kumar R, Radhakrishnan A. Utility of endobronchial ultrasound guided trans-bronchial needle aspiration in diagnosis of melioidosis - case series and review of literature. Monaldi Arch Chest Dis 2020; 90. [PMID: 32657107 DOI: 10.4081/monaldi.2020.1221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/18/2020] [Indexed: 11/23/2022] Open
Abstract
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is routinely performed for diagnostic evaluation of mediastinal lymphadenopathy due to various etiologies with excellent sensitivity and specificity. Melioidosis can have atypical features like isolated mediastinal lymphadenopathy mimicking as tuberculosis or lymphoma. Differentiation of such atypical melioidosis presentation become difficult due to similar clinical, radiological and even similar EBUS lymph node characteristics. Role of EBUS TBNA in diagnosing melioidosis is under investigated and sparsely reported. We describe two cases of melioidosis diagnosed by point of care rapid lateral flow immunoassay antigen testing and culture of EBUS-TBNA samples from necrotic mediastinal lymph nodes.
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Affiliation(s)
- Mujeeb Rahman K K
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar.
| | - Sourin Bhuniya
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar.
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar.
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar.
| | - Rajesh Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar.
| | - Anjuna Radhakrishnan
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar.
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Mohakud S, Sethy M, Naik S, Mohapatra PR. Giant cervicomediastinal thymic cyst in an elderly: diagnosis by multimodality imaging and fine-needle aspiration cytology with immunocytochemistry. BMJ Case Rep 2020; 13:13/7/e235425. [PMID: 32636229 DOI: 10.1136/bcr-2020-235425] [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: 11/04/2022] Open
Abstract
A 65-year-old woman, a non-smoker, presented to the pulmonary medicine outpatient department with chest pain, mild dyspnoea, right side neck swelling and mild facial puffiness. The cervical swelling was soft, non-tender and fluctuant on palpation. Multimodality imaging revealed a large, thin-walled cervicomediastinal cystic lesion with septations, haemorrhage, septal calcification and without any solid component. Image-guided fine-needle aspiration cytology from the septa with immunocytochemistry helped to establish the thymic origin and benign nature of the cyst preoperatively and differentiate it from cystic thymoma, lymphangioma, thymic carcinoma or lymphoma with confidence. As the haemorrhage resolved, the size of the swelling was significantly reduced, and the patient became asymptomatic due to which she deferred surgery but remained on close follow-up and was doing well. Thymic cysts can occur in a cervicomediastinal location, rare in elderly age, usually asymptomatic and clinically apparent when intracystic haemorrhage leads to an increase in size and chest pain.
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Affiliation(s)
- Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Madhusmita Sethy
- Pathology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
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Mohapatra PR, Mishra B, Behera B. Immunity and protection from COVID-19-Environmental mycobacteria play a role. J Med Virol 2020; 93:122-123. [PMID: 32579301 PMCID: PMC7361588 DOI: 10.1002/jmv.26214] [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: 06/03/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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33
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Jagaty SK, Rahman M, Dhanurdhar Y, Mohapatra PR. An unusual case of right upper zone pneumonic patch. Adv Respir Med 2020; 88:160-161. [PMID: 32383470 DOI: 10.5603/arm.2020.0092] [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: 08/05/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Mujeeb Rahman
- All India Institute of Medical Science, Bhubaneswar, India
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Abstract
Haemoptysis is an often encountered respiratory symptom. The amount of haemoptysis varies from mild to life-threatening severity and may indicate the underlying pulmonary disorder. Herein, we report a 50-year-old male smoker who presented with occasional streaky to mild haemoptysis for last 1 year. He had pulmonary tuberculosis 10 years ago and had received adequate treatment. Chest radiograph was suspicious of a mass lesion in left upper lung. Contrast-enhanced CT scan of thorax revealed pulmonary artery pseudoaneurysm suggestive of Rasmussen's aneurysm. Unlike this case, Rasmussen's aneurysm usually manifests as life-threatening haemoptysis and portends a high mortality.
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Affiliation(s)
- Satyajeet Sahoo
- Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Manoj Kumar Panigrahi
- Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Suprava Naik
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Prasanta Raghab Mohapatra
- Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
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35
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Affiliation(s)
- Satyajeet Sahoo
- Department of Pulmonary Medicine and Critical Care, AIIMS, Bhubaneswar, Odisha, India
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36
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Mishra B, Mohapatra PR. Expand the RRDR hotspot to improve GeneXpert results. Int J Tuberc Lung Dis 2019; 23:1043. [PMID: 31657297 DOI: 10.5588/ijtld.19.0103] [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: 11/10/2022] Open
Affiliation(s)
- B Mishra
- Department of Microbiology* and Department of Pulmonary Medicine & Critical Care All India Institute of Medical Sciences, Bhubaneswar, India
| | - P R Mohapatra
- Department of Microbiology* and Department of Pulmonary Medicine & Critical Care All India Institute of Medical Sciences, Bhubaneswar, India
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37
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Sahoo S, Mohapatra PR, Das Majumdar SK, Chhatria M. Cystic transformation of cannon ball metastases in response to EGFR TKI. Adv Respir Med 2019; 87:199-200. [PMID: 31282564 DOI: 10.5603/arm.2019.0032] [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] [Received: 04/25/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Satyajeet Sahoo
- All India Institute of Medical Sciences, Bhubaneswar, 751019 Bhubaneswar, India
| | | | | | - Mantyu Chhatria
- All India Institute of Medical Sciences, Bhubaneswar, 751019 Bhubaneswar, India
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38
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V, Singh N, Behera D, Jindal SK, Singh V, Chawla R, Samaria JK, Gaur SN, Agrawal A, Chhabra SK, Chopra V, Christopher DJ, Dhar R, Ghoshal AG, Guleria R, Handa A, Jain NK, Janmeja AK, Kant S, Khilnani GC, Kumar R, Mehta R, Mishra N, Mohan A, Mohapatra PR, Patel D, Ram B, Sharma SK, Singla R, Suri JC, Swarnakar R, Talwar D, Narasimhan RL, Maji S, Bandopadhyay A, Basumatary N, Mukherjee A, Baldi M, Baikunje N, Kalpakam H, Upadhya P, Kodati R. Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry. Lung India 2019; 36:S1-S35. [PMID: 31006703 PMCID: PMC6489506 DOI: 10.4103/lungindia.lungindia_300_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K T Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Chawla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S N Gaur
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anurag Agrawal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Chhabra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Chopra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Dhar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aloke G Ghoshal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Handa
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirmal K Jain
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K Janmeja
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surya Kant
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G C Khilnani
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravindra Mehta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anant Mohan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P R Mohapatra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmesh Patel
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu Ram
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Sharma
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupak Singla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J C Suri
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Swarnakar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Talwar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Lakshmi Narasimhan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Maji
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankan Bandopadhyay
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nita Basumatary
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arindam Mukherjee
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Milind Baldi
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandkishore Baikunje
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hariprasad Kalpakam
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratap Upadhya
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kodati
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Synovial sarcoma (SS) is a malignant mesenchymal tumor with variable epithelial differentiation that affects mostly young adults and can arise at any anatomic site. Primary intrathoracic SS is very rare accounting for <0.5% of all lung tumors. Most commonly, it arises from the lung followed by pleura and mediastinum. Primary pulmonary SS (PPSS) affects both sexes equally with no preference for any hemithorax. The morphology, immunostaining properties, cytogenetic features, and management strategy of PPSS are similar to that of soft tissue SS. Histologically, there are two main types of SS - monophasic and biphasic with a feature of poor differentiation seen in both types. Most patients present with large intrathoracic masses with or without ipsilateral pleural effusion. Bone invasion or mediastinal adenopathy is very rare. SS is characterized by a specific chromosomal translocation producing SS18-SSX fusion gene in more than 90% of cases. Identification of this fusion gene remains the gold standard for the diagnosis in the presence of consistent histology and immunophenotype. Multimodality treatment including wide excision, chemotherapy, and radiotherapy is the mainstay of therapy. SS is relatively chemosensitive, and ifosfamide-based regimen showed improved survival in metastatic disease. Generally, SS is considered as high-grade tumors with a poor prognosis. Novel therapies targeted at fusion oncogene, SS18-SSX-derived peptide vaccine, epidermal growth factor receptor, and vascular endothelial growth factor are the future hope in SS. We describe a prototype case and present an elaborate review on primary SS of lung.
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Affiliation(s)
- Manoj Kumar Panigrahi
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Gourahari Pradhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nibedita Sahoo
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pritinanda Mishra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Sahoo S, Panigrahi MK, Bhuniya S, Mohapatra PR. Unusual cause of opaque hemithorax. Thorax 2017; 73:395-396. [PMID: 29030408 DOI: 10.1136/thoraxjnl-2017-210418] [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: 04/23/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Satyajeet Sahoo
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manoj Kumar Panigrahi
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Panigrahi MK, Pradhan G, Mohapatra PR. Tracheal bronchus presenting with recurrent haemoptysis in an adult female. Adv Respir Med 2017; 85:155-157. [PMID: 28667657 DOI: 10.5603/arm.2017.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/09/2017] [Revised: 02/24/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
Abnormal bronchus arising directly from the trachea or the main bronchus is a rare developmental anomaly of the tracheobronchial tree. In general, tracheal bronchus has been reported in less than 1% of adult patients undergoing bronchoscopy with a male predominance. Tracheal bronchus is classified as - 'displaced' and 'supernumerary', the former being the most common type reported. Most patients are asymptomatic; however, cases presenting with cough, haemoptysis or recurrent lung infections are not uncommon. The diagnosis is usually made through computed tomography or bronchoscopy. Awareness of this anomaly may help in timely identification or prevention of perioperative complications during general anaesthesia or resectional thoracic surgery. Herein we report a case of right-sided displaced tracheal bronchus in an adult female presenting with recurrent haemoptysis.
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Affiliation(s)
- Manoj Kumar Panigrahi
- Assistant Professor Pulmonary Medicine All India Institute of Medical Sciences, Bhubaneswar.
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Mohapatra PR, Vivek KU, Panigrahi MK, Bhuniya S. Managing FDG PET-positive sarcoidosis: "a riddle wrapped in a mystery inside an enigma". Eur Respir J 2017; 47:346-7. [PMID: 26721967 DOI: 10.1183/13993003.01154-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Manoj Kumar Panigrahi
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sourin Bhuniya
- Dept of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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Garg K, Mohapatra PR, Aggarwal D, Gupta R, Janmeja AK. Interstitial Lung Disease with Chilaiditi Syndrome. J Clin Diagn Res 2017; 10:TD04-TD05. [PMID: 28208974 DOI: 10.7860/jcdr/2016/23577.9074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/16/2016] [Accepted: 09/20/2016] [Indexed: 11/24/2022]
Abstract
Chilaiditi sign is the peculiar radiographic presentation of interposition of colon between diaphragm and liver. When associated with symptomatology, it is called as chilaiditi's syndrome. Though rare, respiratory symptoms may be present. In such cases, it becomes difficult to determine if the symptomatology is due to the syndrome only, or there is some underlying lung involvement, until this is specifically considered in the differential diagnosis. We present a male patient, where thorough investigations revealed Interstitial Lung Disease (ILD), along with Chilaiditi sign on chest radiograph. Respiratory symptomatology responded partially to the management of underlying ILD. It is left for discussion, whether the Chilaiditi syndrome was also contributing to the overall clinical presentation or the respiratory complaints were solely due to ILD and Chilaiditi sign was an incidental finding.
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Affiliation(s)
- Kranti Garg
- Assistant Professor, Department of Pulmonary Medicine, D block, Level 5, Government Medical College and Hospital , Chandigarh, India
| | | | - Deepak Aggarwal
- Associate Professor, Department of Pulmonary Medicine, Government Medical College and Hospital , Chandigarh, India
| | - Robin Gupta
- Senior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital , Chandigarh, India
| | - Ashok Kumar Janmeja
- Professor and Head, Department of Pulmonary Medicine, Government Medical College and Hospital , Chandigarh, India
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Pradhan G, Behera P, Panigrahi MK, Bhuniya S, Mohapatra PR, Turuk J, Mohanty S. Pulmonary Strongyloidiasis Masquerading as Exacerbation of Chronic Obstructive Pulmonary Disease. Tuberc Respir Dis (Seoul) 2016; 79:307-311. [PMID: 27790284 PMCID: PMC5077736 DOI: 10.4046/trd.2016.79.4.307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/01/2015] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.
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Affiliation(s)
- Gourahari Pradhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Priyadarshini Behera
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manoj Kumar Panigrahi
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Jyotirmayee Turuk
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Affiliation(s)
- Sourin Bhuniya
- Dept Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | | | - Manoj Kumar Panigrahi
- Dept Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Priyadarshini Behera
- Dept Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Gourhari Pradhan
- Dept Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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Mohanty S, Pradhan G, Panigrahi MK, Mohapatra PR, Mishra B. A case of systemic melioidosis: unravelling the etiology of chronic unexplained fever with multiple presentations. Pneumonol Alergol Pol 2016; 84:121-5. [DOI: 10.5603/piap.2016.0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Indexed: 11/25/2022] Open
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Kashyap S, Mohapatra PR, Solanki A, Negi RS, Sarkar M. Spectrum of Clinical Presentation of Pulmonary Alveolar Microlithiasis: Case Series from North India. Indian J Chest Dis Allied Sci 2016; 58:39-43. [PMID: 28393512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We describe five cases of pulmonary alveolar microlithiasis (PAM) from North India with characteristic radiological and histopathological features. All patients were symptomatic with variable severity and duration of the symptoms and one patient developed cor-pulmonale during the course of follow-up. Diagnosis of PAM was suspected on the basis of classical sand-storm appearance on radiological examination and confirmed by transbronchial lung biopsy in four of the five cases. Apart from other features, presence of pleural and pericardial calcification in one case makes this discussion valuable. Awareness of this specific entity among the clinicians is essential to avoid unnecessary investigations.
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Mohapatra PR, Pradhan G, Behera P, Bhuniya S, Panigrahi MK, Aggarwal D. Defining low-dose corticosteroid: the pendulum still oscillates. Eur Respir J 2015; 46:574. [DOI: 10.1183/09031936.00023615] [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: 11/05/2022]
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Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal AG, Gothi D, Joshi J, Kanwar MS, Kharbanda OP, Kumar S, Mohapatra PR, Mallick BN, Mehta R, Prasad R, Sharma SC, Sikka K, Aggarwal S, Shukla G, Suri JC, Vengamma B, Grover A, Vijayan VK, Ramakrishnan N, Gupta R. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition). Lung India 2015; 32:422-34. [PMID: 26180408 PMCID: PMC4502224 DOI: 10.4103/0970-2113.159677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
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Affiliation(s)
- Surendra K Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Vishwa Mohan Katoch
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - Alladi Mohan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - T Kadhiravan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - A Elavarasi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - R Ragesh
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Neeraj Nischal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Prayas Sethi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - D Behera
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvir Bhatia
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Medanta Hospital, Gurgaon, Haryana, India
| | - A G Ghoshal
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Dipti Gothi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Employees' State Insurance Corporation, Post Graduate Institute of Medical Sciences and Research, New Delhi, India
| | - Jyotsna Joshi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Topiwala National Medical College, Mumbai, Maharashtra, India
| | - M S Kanwar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, New Delhi, India
| | - O P Kharbanda
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Suresh Kumar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India
| | - P R Mohapatra
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - B N Mallick
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Ravindra Mehta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Bengaluru, Karnataka, India
| | - Rajendra Prasad
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; VP Chest Institute, New Delhi, India
| | - S C Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Kapil Sikka
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Garima Shukla
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - J C Suri
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Safdarjung Hospital, New Delhi, India
| | - B Vengamma
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Ashoo Grover
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - V K Vijayan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, Bhopal, Madhya Pradesh, India
| | - N Ramakrishnan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Rasik Gupta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
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