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   Table of Contents - Current issue
May-August 2021
Volume 4 | Issue 2
Page Nos. 57-89

Online since Friday, January 21, 2022

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Indian endemic in a pandemic p. 57
R Sridhar
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Assessment of quality of life in patients with lung cancer and correlation with staging of disease at time of diagnosis in a tertiary care hospital p. 58
Pallavi Periwal, Deepak Kumar Prajapat, Arjun Khanna, Deepak Talwar
Background: Lung cancer is the leading cause of the cancer-related deaths in developed countries. In India, it is usually diagnosed in the advanced stages. Quality of life (QOL) is an important factor to be assessed to aid the therapeutic decisions and know the prognosis of the disease. This study is aimed at the assessment of QOL in patients at the time of diagnosis of lung cancer and correlating them with the stage of lung cancer. There is the paucity of similar data from the Indian subcontinent and the Western world on these issues. To the best of our knowledge, this is the first such paper correlating QOL with the stage of disease, in lung cancer patients. Materials and Methods: A retrospective observational study was conducted on 87 newly diagnosed patients with lung cancer at the Department of Respiratory, Sleep, Allergy, and Critical Care Medicine at the Metro Centre for Respiratory Diseases, Metro Hospital, Noida. Data were collected between January 2015 and June 2015. The QOL data was collected using questionnaires filled at the time of diagnosis of lung cancer and were correlated with the stage of lung cancer. Results: About 81.6% of lung cancer patients were male and 81.6% of patients were smokers. Most of our patients (93.1%) presented with advanced-stage lung cancer and 61.8% already had distant metastasis at the time of presentation. Data from QOL questionnaires revealed lower scores as compared to the Western population, indicating much poorer QOL at the time of diagnosis of lung cancer. Indian patients have more severe and distressing symptoms in comparison to the Western population. Patients had worse symptoms in Stage 3 B or 4, i.e., at the onset of the diagnosis. Conclusion: Lung cancer patients are diagnosed at advanced stages of the disease and have a significantly poor QOL as compared to their Western counterparts. A majority of these patients have a poor QOL that precludes definitive therapy.
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Analysis of tuberculosis-related mortality during the first wave of the COVID pandemic at GHTM, tambaram sanatorium p. 65
R Sridhar, Vinod Kumar Viswanathan, Reetu Singh, Rafeeqa Keyzare
Introduction: Analysis of tuberculosis (TB) mortality serves to understand the impact of health delivery services and steps needed to eliminate the global burden of TB. With the advent of the COVID pandemic in 2020, there were challenges in delivery of TB services, and this study was undertaken to understand the impact of pandemic on TB mortality. Methodology: Retrospective analysis of death records of patients died due to TB in the year 2020 was done. Results: The data of 250 patients who died due to TB in GHTM in 2020 were analyzed. Most were males in the productive age group of 20 to 60 years. Sputum positivity, male gender, drug resistance, and presence of comorbidities such as DM and HIV contributed to most of the mortality. A drop in presumptive TB cases and notification of TB cases compared to the previous years was noted. Discussion: The demographic profile of patients and risk factors for TB mortality in this study was consistent with known risk factors such as male, sputum positive status, drug resistance, and comorbidities. Drop in notification of TB cases due to the pandemic was noted, and necessary steps for tracing and diagnosing these cases will help reduce mortality due to impact of the pandemic. Analysis of mortality data also reflects on the need for early diagnosis and the use of appropriate treatment protocols and need for new drugs to eliminate and reduce TB mortality. Conclusion: This study emphasises on the need for ensuring continued diagnosis and uninterrupted treatment of TB even in pandemic situations to make the goal of TB elimination a reality.
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Epidemiology and management of mucormycosis in India – Pre- and Post-COVID-19 p. 69
Nandini Sethuraman
Mucormycosis is a spectrum of highly invasive infections caused by filamentous fungi belonging to the order Mucorales. Typically known as a disease of the immunocompromised and uncontrolled diabetic host, the COVID-19 pandemic uncovered new and hitherto unknown facets of this disease. A thorough knowledge of its epidemiology, methods of diagnosis, and treatment options available is important to manage the carnage this disease has unveiled upon us in current times. This review provides an updated understanding of the existing problem of mucormycosis in India and the added burden due to the COVID-19 pandemic and provides an insight into the challenges involved in making a diagnosis and managing these debilitating infections.
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All that glitters is not gold p. 75
Vinod Kumar Viswanathan
In the midst of COVID pandemic, all cases presenting with lung infiltrates are assumed to be covid. However, other diagnoses are possible and a case of allergic bronchopulmonary aspergillosis which presented in the midst of the pandemic is highlighted here to stress the importance of clinical judgment by history taking, clinical examination, appropriate investigations, and treatment.
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Post COVID pulmonary complications – A case series p. 78
Prem Ananth Palaninathan, Divya Mary Elias, Nagarajan Nagasubramanian, Prathipa Ramakrishnan
COVID-19 patients are frequently coinfected by other microbial pathogens, adding to the severity of the cases and raising difficulty in the diagnosis, prognosis, and treatment. Pulmonary mucormycosis and invasive Aspergillosis are such life-threatening fungal infections. Risk factors include uncontrolled diabetes mellitus, hematological malignancies, solid organ transplantation, and chronic renal failure. Pulmonary emboli and pneumothorax have also been reported frequently in COVID-19 patients, especially in those who required invasive mechanical ventilation. Herein, we report four different cases of post COVID pulmonary complications. All four patients were evaluated with computed tomography thorax. Two patients had necrotizing pneumonia and sputum culture grew mucor and Aspergillus species, respectively. They were treated with intravenous antifungals. One patient had rifampicin-sensitive pulmonary tuberculosis (TB) and was started on antitubercular drugs. Both pulmonary mucormycosis and pulmonary TB patients had a segmental and subsegmental pulmonary embolism. They were managed with low-molecular-weight heparin. One patient had left pneumothorax, for which intercostal drainage was placed.
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An initial experience with antibody cocktail CASIRIVIMAB and IMDEVIMAB in a center of excellence: A retrospective case series of 3 patients and literature review p. 82
P Amal Johnson, T Suresh Babu, R Narasimhan
Regen-COV has been authorized for emergency use by the FDA under an emergency use authorization. The antibody cocktail has been shown to help these high-risk patients before their condition worsens, reduces the viral load, shortens the time to resolution of symptoms, and significantly reduces the risk of hospitalization and death. The Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial announced on June 16, 2021, that the investigational antibody combination, when given in high dose, reduces the risk of death if given to patients hospitalized with severe COVID-19 who have not mounted a natural antibody response on their own. In this article, we present a retrospective case series of 3 patients followed by literature review on Regen-COV.
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Post-COVID-19 Pneumonia Complicated with Guillain–Barre Syndrome p. 85
S Muthulakshmi, K Anupama Murthy
Guillain–Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy that is often related to a previous infectious exposure. GBS emerged as a potentially serious complication of COVID-19 infection. Here, we present the case of a 64-year-old female who presented to us with worsening respiratory failure and progressive flaccid symmetrical sensorimotor neuropathy following COVID infection. She was diagnosed to have GBS as post-COVID complication. Hence, started on intravenous immunoglobulin infusion following which she had improvement in respiratory failure and prevented from intubation and mechanical ventilation.
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Spot the abnormality p. 88
M Vishnu Sharma, Baseer Ahmmad H Walikar
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