Determinats and impact of fatigue in COPD: A hospital based cross sectional study
Vijay Babu, G. S. Gaude, Bhagyashri B. Patil, Jyothi Hattiholi
Jawaharlal Nehru Medical College and Research Institute, Belgaum, Karnataka, India. E-mail: drvijay1911@gmail.com
Introduction: COPD is an important cause that leads to higher mortality in India and worldwide with airflow limitation, patient with COPD also have systemic manifestation. Dyspnoea and Fatigue are the two most common symptoms experienced by patients with COPD. Association between Fatigue in COPD and health status have been studided in many studies. This study aims at evaluating the determinants and impact of Fatigue in COPD patients.
Objective: To evaluating the determinants and impact of Fatigue in COPD patients.
Methods: This is a hospital based cross sectional study. Stable COPD patients who were diagnosed by spirometry based on GOLD guidelines, after considering inclusion and exclusion criteria were enrolled in the study. Demographic details, MMRC grading, PFT, 6MWD and oral questionnaires i.e FACIT –F, CES-D, SGRQ were conducted on the same day.
Results: 100 stable COPD patients who visited Respiratory OPD in KLEs Dr. Prabhakar Kore Hospital & MRC were evaluated. A vast majority of study population was Men (81%), most of them were smokers with mean age being 61.73± 9.72. Fatigue severeity was significantly associated with smoking, COPD duration, BMI, previous hospitalisation and GOLD staging of the disease.
Conclusion: Severe fatigue was found to impact on patients, dyspnoea level (MMRC), Excercis ecapacity (6MWD), QOL and it also leads to depression.
Pulmonary mucormycosis causing pulmonary artery pseudoaneurysm – A rare entity
V. I. Ijas, S. Yuvarajan, R. Praveen, Antonious Maria Selvam, K. Prathaban
Department of Respiratory Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherrry, India. E-mail: ijas.ibrahim@gmail.com
Background: A pseudoaneurysm is an abnormal dilatation or outpouching of the artery which is lined only by the tunica adventitia. Pulmonary artery Pseudoaneurysm is very uncommon and associated with high mortality. Usually congenital but the acquired causes include trauma and infrequently infections mainly bacterial and fungal. Pulmonary mucormycosis is a rare opportunistic fungal infection seen in immunocompromised patients with diabetes, chronic renal failure, malignancies and is one of the most uncommon causes of pseudoaneurysm. Less than 30 cases have been reported worldwide for mucormycosis causing pulmonary artery pseudoaneurysm.
Case 1: A 52 year old female who was COVID 19 positive 2 months back, admitted in RICU with recurrent hemoptysis and breathlessness. She is known Diabetic and Hypertensive. As her hemoptysis was persisting she underwent bronchoscopy and a soft mass was noticed in the right lower lobe bronchus which bleeds on touch. Bronchoalveolar lavage sent for microbiology confirmed Mucormycosis. CTPA done post bronchoscopy revealed pseudoaneurysm involving right descending pulmonary artery. Injection Amphotericin B started and surgical resection of right lower lobe done.
Case 2: A 65 year old male, diabetic presented with cough and hemoptysis for 20 days with fever. CT thorax was suggestive of necrotising pneumonia in left lower lobe. As his hemoptysis was persisting Bronchoalveolar lavage was taken and the bronchoscopy showed a small swelling in the left lowerlobe bronchus. CECT Thorax was later done which confirmed descending pulmonary artery pseudoaneurysm. Treatment was same as for case 1.
Discussion: Fungal pneumonia is a rare acquired cause of pulmonary artery pseudoaneurysm. The pseudoaneurysms are thin walled and easily ruptures producing massive hemoptysis. Infection accounts for 33% of the causes for pseudoaneurysms. Infective causes include pyogenic bacteria like S. pyogenes, S. aureus, Klebsiella and fungus like Mucor, and Aspergillus. Infection leads to chronic inflammation of vessel and leads to weakening of vessel wall which causes the internal layers to rupture. Mucor has the potential to cause direct invasion of the vessel wall leading to pseudoaneurysm.
Conclusion: Pulmonary Artery Pseudoaneurysm and Pulmonary mucormycosis are individually uncommon clinical entities, but Pulmonary Artery Pseudoaneurysm due to underlying mucormycosis is a rare condition with a limited description in the literature. A high index of suspicion for both the clinician and radiologist is required and should be suspected in patients with underlying immunosuppression who develop hemoptysis. Pulmonary Artery Pseudoaneurysm can be successfully treated with embolization, but if mucormycosis is confirmed surgical resection is the only option.
An interesting case of systemic amyloidosis with lung involvement – A case report
R. Sangavi
Government Stanley Medical College, Chennai, Tamil Nadu, India. E-mail: sangavir108@gmail.com
Introduction: Systemic amyloidosis is a rare disease with estimated incidence of 10 cases per million person-years. Amyloidosis is caused by misfolding of autologous protein and its extra- cellular deposition resulting in organ dysfunction and death.
Case Report: A 63 year old male presented with complaints of breathlessness for past 3 months, bilateral swelling of legs & scrotum and abdominal distension for past 2weeks. He was diagnosed as a case of Amyloidosis (AL type)/ IgG lambda monoclonal gammapathy 2 months back. Renal biopsy s/o Amyloidosis (AL type) & Immuno-electrophoresis revealed IgG lambda monoclonal gammapathy, started on Bortezomib, Lenalidomide and dexamethasone regimen weekly. CT chest reported as interstitial lung disease. Swab for Covid19 negative. ECHO: mildly dilated right chambers, intact septae, ?corpulmonale. Urine for albumin: ++. 24 hour total urine volume and protein elevated. Bone marrow biopsy: plasma cells in clusters. IHC: CD138:10 to 15%. Sputum for AFB: negative, Mantoux: 0mm, Sputum for gram stain: gram positive cocci in pairs and short chains. Derm(o)- diffuse altered hyper and hypopigmentation (Macules of varying size) present over b/l upper and lower limb. Poikilodermic changes present. Multidisciplinary discussion done. He was treated with oxygen, albumin infusion, chemotherapy and supportive drugs.
Conclusion: Pulmonary amyloidosis can be localized or part of systemic amyloidosis. It can present as diffuse alveolar-septal amyloidosis, nodular amyloidosis, tracheobronchial amyloidosis. Pulmonary interstitial involvement along with cardiac amyloidosis can result in cardiopulmonary failure and death.
Comparative study of the pattern of psychiatric comorbidities in COPD patients attending at IRD SMS Medical College, Jaipur
Batoee Ram, Mohamed Javed Qureshi, Chand Bhandari, Janki
Institute of Respiratory Disease, SMS Medical College, Jaipur, Rajasthan, India. E-mail: drbram92@gmail.com
Background: Psychiatric comorbidities are usually under diagnosed among the Chronic Obstructive Pulmonary Disease (COPD) patients which has a negative impact on patient quality of life through restriction of activities, loss of independence, and decreased social functioning. The purpose of this study was to describe the pattern of these psychiatric comorbidities in COPD patients as compared to the general population.
Materials and Methods: A hospital-based observational comparative analytical study was conducted in COPD patients at the institute of respiratory diseases (IRD) S.M.S. Medical College Jaipur where 60 cases with COPD and 60 control where included from MAY 2020 to OCT.2021. Psychiatric comorbidities were measured by recent MINI PLUS, and results were interpreted.
Results: A total of 120 individuals participated in the study; 60 with COPD and 60 from the general population. Major depressive episode respectively for COPD patients and control 26.67%and 8.33%, generalised anxiety disorder respectively COPD patients and control 31.67 %and 13.33%, panic disorder 3.33% and 3.33% in COPD patients and control, substance abuse disorder 3.33%and 1.67% in COPD patients and control, No psychiatric comorbidities respectively COPD patients and control were 33.33 % and 73.33% Both anxiety and depression scores were statistically significant between the groups with p value 0.001.
Conclusions: Overall in psychiatric comorbidities Anxiety and depression were more common in COPD patients compared to the general population.
VATS management of Broncho-esophageal fistula
Mohan Venkatesh Pulle, Sukhram Bishnoi, Harsh Vardhan Puri, Belal Bin Asaf, Arvind Kumar
Institute of Chest Surgery, Medanta – The Medicity, Gurguram, Haryana, India. E-mail: mohanvenkateshpulle@gmail.com
Introduction: Conventionally, benign Broncho-esophageal fistula (BEF) were treated with surgery by thoracotomy. The principle of the surgery was to divide the fistula with closure of bronchial & oesophageal defect, and placing a viable tissue in between two suture line. In this study, we aim to report outcome of the novel method to close the fistula with minimally invasive method.
Methods: This study is a retrospective analysis of prospectively maintained data of operated cases of Benign Broncho-esophageal fistula (BEF) march 2012 to November 2021 which included data of 14 patients. An analysis of demographic characteristics and perioperative variables, including complications, was carried out.
Results: Patients’ age ranged from 19 to 63 years with a 9:5 male-female ratio. Most common site for fistula was with left main bronchus 9 (64.28%) and right lower 3 (21.42%), 2 with left lower lobe (14.29%). The median operative time was 124 minutes and the median intraoperative blood loss was 52 ml. Average hospital stay was 3.5 days. Average chest tube removal was 7 days. Median follow-up of 58 month with range of (6 to 96 months). On follow up, all patients were alive and no recurrence noted in any of patient. No Postoperative mortality and morbidity were observed.
Conclusion: The rarity of the disease and lack of surgical experience among surgeons, the definitive conclusion regarding ideal approach is still questionable. VATS is feasible in such complex clinical scenario. If thoracoscopy is not feasible, procedure can be converted to open surgery.
Takayasu arteritis presenting as chronic cough with endobronchial involvement
Sujay Halkur Shankar, Animesh Ray
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. E-mail: sujay.halkurshankar@gmail.com
Background: Pulmonary complaints in Takayasu arteritis are rare without pulmonary artery involvement. We present the case of a young male presenting with chronic cough and red flag symptoms who was diagnosed with Takayasu arteritis.
Case Study: A 20-year-old male presented with dry cough for four months, weight loss and fever for three months. He was evaluated outside where HRCT chest and pulmonary function tests were normal. Flexible bronchoscopy showed granular appearance of bilateral main bronchi. Biopsy was significant for epithelioid granulomas without necrosis. Bronchoalveolar lavage was negative for mycobacterial and fungal cultures. He was initiated on empirical anti-tubercular therapy with no improvement in symptoms. On presentation to our clinic, routine investigations showed elevated ESR, CRP, and hypoalbuminemia. Mantoux test was negative. Sarcoidosis and other autoimmune diseases were ruled out. PET-CT showed metabolic activity in the aortic wall, and right carotid artery suggestive of active vasculitis. Takayasu arteritis was confirmed with CT angiogram. His symptoms resolved following initiation of prednisolone and methotrexate. A repeat bronchoscopy after two months of therapy was normal, suggestive of resolution of endobronchial lesions.
Discussion: Cough is a presenting complaint in 1.5% of Takayasu arteritis patients. Cough without pulmonary artery involvement and radiologically normal lungs is limited to case reports. We believe the cough in our case resulted from stimulation of extra-pulmonary receptors or tracheal receptors from endobronchial lesions. Endobronchial involvement as in our case is rare and limited to a single case report.
Conclusion: Takayasu arteritis has protean and non-specific complaints, and a high index of suspicion is required for early diagnosis.
Pattern of pleuroparenchymal complications in patients with acute pancreatitis
S. V. Agarwal1, M. L. Gupta2, Anurag Govil3
1Department of Medicine, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, Rajasthan, India, 2Department of Pulmonary Medicine, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, Rajasthan, India, 3Department of Gastroenterology, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, Rajasthan, India. E-mail: svinayak.agarwal8@gmail.com
Background: Respiratory complications occur in around three fourth of the cases of AP, ranging from mild undetected hypoxemia to fully developed ARDS. Of the systemic complications, acute respiratory failure is a main constituent of multiple organ dysfunction syndromes (MODS), which frequently require ventilatory support, which contributes significantly to early deaths in severe cases of acute pancreatitis i.e., deaths within the first week of admission. Although frequency, distribution and prognostic significance of various pleuroparenchymal complications are widely known and described but have shown a wide variability.
Methods: Prospective observational, cross-sectional study.
Results: Incidence of pleuroparenchymal complications associated with acute pancreatitis at the time of presentation was present in 88% while during the course it was increased to 96% patients.
Conclusion: In the current study there was significant association of pleuroparenchymal complications like atelectasis, consolidation, ARDS with acute severe pancreatitis, which is statistically significant. In the current study there was significant association of acute pancreatitis with mechanical ventilation and mortality. Those with ARDS who required mechanical ventilation during the first week had higher chances of mortality.
A rare cause of hemoptysis – Behçet’s disease
Yash Kedia, N. T. Awad, Dipak Patil, Pranavi Amin
Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and Government Hospital, Mumbai, Maharashtra, India. E-mail: yskedia@gmail.com
Background: Behçet’s disease is a rare multisystem inflammatory disorder which is characterised by oral ulcers, genital ulcers and uveitis. The systemic manifestations can be variable, depending on the organ involved. It can also present as a vasculitis and can affect small, medium as well as large vessels. Behçet’s disease can cause aneurysms in the pulmonary arterial tree that often prove to be fatal. Patients can present with cough, chest pain, breathlessness and life threatening hemoptysis. HLA-B51 is the strongest associated genetic factor with Behçet’s disease. Carriers of HLA-B51/HLA-B5 have an increased risk of developing Behçet disease compared with noncarriers.
We here present a 38 year old male patient who was started on antitubercular treatment empirically based on clinical symptoms and presence of mediastinal lymphadenopathy, presented with massive hemoptysis. Repeat CT Pulmonary angiography revealed multiple aneurysms in lobar branches of pulmonary artery with thrombosis in segmental branches of pulmonary artery. On enquiring further, patient gave history of recurrent oral ulcers and a positive HLA B51 result, lead to a diagnosis of Behçet’s disease. Patient was started on high dose methylprednisolone and cyclophosphamide and there were no further episodes of hemoptysis. The following case here emphasizes on the importance early diagnosis and treatment of this potential life-threatening disorder.