Combination chemotherapy for extensive small cell lung cancer -- experience from India.
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Adult↗
Biomedical subjects
A N Aggarwal
Publications and source records attributed to A N Aggarwal.
Assessment of factors predicting outcome of acute respiratory distress syndrome in North India.
OBJECTIVES: Information on the spectrum and outcome of acute respiratory distress syndrome (ARDS) in tropical countries is scanty. This study was designed to assess the factors predicting the outcome of ARDS in North India. METHODOLOGY: Consecutive patients requiring mechanical ventilation for ARDS over a 2 year period at the Respiratory Intensive Care Unit (RICU) of a tertiary referral hospital were studied. Hospital survival was correlated with age, aetiology, disease severity scores (APACHE III, SAPS II, lung injury score) and organ failure using univariate analysis. Factors significantly influencing mortality were examined by multivariate analysis to identify factors independently affecting outcome. RESULTS: Sepsis (28.6%), followed by malaria (21.4%), were the commonest risk factors. Seven out of eight patients (87.5%) with sepsis died. The presence of sepsis, more than three organ failure prior to admission, APACHE III score > 57 and SAPS II score > 39 were significantly associated with mortality. Only APACHE III score > 57 or SAPS II score > 39 were, however, independently predictive of a poor outcome following multivariate analysis. CONCLUSIONS: Sepsis, associated with a very poor outcome, and malaria were important risk factors for the development of ARDS. APACHE III score > 57 or SAPS II score > 39 were associated with increased risk of mortality.
APACHE↗
Prevalence of bronchial asthma and association with environmental tobacco smoke exposure in adolescent school children in Chandigarh, north India.
Prevalence of asthma and its association with environmental tobacco smoke (ETS) exposure were examined among adolescent schoolchildren in Chandigarh, India. Using a previously standardized questionnaire, data from 9090 students in the 9- to 20-year age range were analyzed. There were 4367 (48%) boys, in whom the observed prevalence of asthma was 2.6%. Among 4723 (52%) girls, asthma was present in 90 (1.9%) students. Presence of one or more respiratory symptoms was reported by 31% students. More students with asthma had either parents or other family members smoking at home as compared to nonasthmatics (41% vs. 28%, p<0.0001). The odds ratio for being asthmatic for patients exposed to ETS compared to those not exposed to ETS was 1.78 (95% confidence interval 1.33-2.31). ETS was also positively associated with prevalence of all the respiratory symptoms, with odds ratios varying between 1.6 and 2.25.
Adolescent↗
Dust-induced interstitial lung disease in the tropics.
Inhalation of dusts is an important cause of interstitial lung disease in the tropical countries such as India. While dusts of organic origin, such as the cotton dust causing byssinosis, generally cause bronchial or bronchiolar involvement and hypersensitivity pneumonitis, inorganic metallic dusts cause progressive pulmonary fibrosis. Silicosis, coal workers' pneumoconiosis, and asbestosis are the three most commonly recognized forms of pneumoconiotic pulmonary fibrosis. Pulmonary tuberculosis is an important complication seen in up to 50% of patients of silicosis in some reports from India. The presentation is generally chronic, although acute and accelerated forms of silicosis are known when the exposures are heavy. Breathlessness, dry cough, and general constitutional symptoms are commonly seen. Patients with silicotuberculosis or other forms of infection may also have significant expectoration, hemoptysis, fever, and rapid progression. Respiratory failure and chronic cor pulmonale occur in the later stages. The diagnosis is easily established if the occupational history is available. Dense nodular opacities on chest roentgenograms, which may be large in patients with massive pulmonary fibrosis, are characteristic. Emphysematous changes generally appear in advanced stages or in patients who smoke. Bronchoalveolar lavage and/or lung biopsy may occasionally be required to establish or exclude other causes of interstitial lung disease. Treatment is largely palliative, although a variety of drugs including corticosteroids and procedures such as whole lung lavage have been tried. None of these methods has yet been found successful in the treatment. Preventive safety steps, including removal of the patient from the site of exposure, are the only effective strategies to control disease progression.
Asbestosis↗
Multifocal skeletal tuberculosis.
Multifocal skeletal tuberculosis is an uncommonly reported entity. The article presents a series of 18 cases encountered in our institution. There clinical characteristics are analysed and compared with available international literature.
Adolescent↗
Value of different cut-off points of tuberculin skin test to diagnose tuberculosis among patients with respiratory symptoms in a chest clinic.
OBJECTIVE: To assess the utility of various cut-off points of tuberculin skin test in making a diagnosis of tuberculosis in patients with respiratory symptoms. METHODS: Tuberculin skin test was conducted on consecutive new patients attending chest clinic for various respiratory symptoms. All subjects were then investigated to establish diagnosis, and categorized into tuberculous and nontuberculous groups. Receiver operating characteristic (ROC) curve was plotted to evaluate discrimination by tuberculin skin test. Sensitivity, specificity and predictive value were also calculated at various cut-off points. RESULTS: Of 250 patients, 59 (23.6%) had tuberculosis on clinical and microbiological criteria (other than the tuberculin test). Sensitivity and specificity of tuberculin test at readings greater than 5, 10 and 15 mm were 0.8136 and 0.7068, 0.6271 and 0.8901, and 0.2034 and 0.9738 respectively. Area under ROC curve for this test was 0.80. CONCLUSION: A cut-off point of 10 mm is likely to be useful in supporting a diagnosis of tuberculosis in patients with strong clinical suspicion of tuberculosis, in other patients, 15 mm cut-off may be more suitable.
Adolescent↗
Management of respiratory failure in severe neuroparalytic snake envenomation.
Fourteen patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to respiratory critical care unit for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of anti snake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated. All patients had severe manifestations such as ptosis, extraocular muscle paresis and limb weakness along with dyspnoea. Seven patients (50%) had additional complaints of dysphagia and dysphonia. ASV was administered to all, with a median requirement of 900 ml. Mechanical ventilation was required for a median duration of 17 hours and all except one patient, who had suffered irreversible hypoxic cerebral injury prior to resuscitation, survived with complete neurological recovery. We conclude, that the timely institution of ventilatory support and anti-venom therapy in such patients, is associated with an excellent outcome.
Adolescent↗
Endobronchial vis a vis transbronchial involvement on fiberoptic bronchoscopy in sarcoidosis.
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Adult↗
Analysis of static pulmonary mechanics helps to identify functional defects in survivors of acute respiratory distress syndrome.
OBJECTIVE: To assess the utility of static lung pressure-volume measurements in identifying and categorizing pulmonary function test defects in survivors of acute respiratory distress syndrome (ARDS). DESIGN: Cross-sectional. SETTING: Pulmonary function laboratory at a tertiary referral hospital in northern India. PATIENTS: Six survivors of ARDS reporting for their first follow-up visit after discharge. MEASUREMENTS AND MAIN RESULTS: Spirometry and whole body plethysmography were performed to evaluate lung volumes and to collect static lung pressure-volume data; the latter were subjected to monoexponential analysis. Three patients had a restrictive ventilatory defect as evidenced by diminished vital capacity and total lung capacity, but only one had reduced static lung compliance. The other two patients had reduced recoil pressure at total lung capacity, suggestive of respiratory muscle weakness. Two other patients with normal lung volumes had reduced static lung compliance. Exponential analysis of pressure-volume data in the three patients with reduced static lung compliance was consistent with reduced distensibility and loss of lung units in one patient each. Additionally, two patients had high values for shape constant of the exponential curve, indicative of air space distention. CONCLUSIONS: Detailed analysis of static pressure-volume data can identify pulmonary function abnormality and categorize the dominant mechanism responsible for restrictive ventilatory defects in survivors of ARDS, even in patients with normal lung volumes. In addition to lung fibrosis, neuromuscular weakness also contributes to decline in pulmonary function.
Adolescent↗
Sarcoidosis in developing countries.
Sarcoidosis is seen in different parts of India and other developing countries with almost similar frequency as in the West. It was largely due to lack of awareness and non-availability of investigations for diagnosis that the disease was reported to be rare in the past. A combination of clinical, radiologic, and histologic criteria are used to diagnose sarcoidosis. A confident exclusion of other causes of granuloma formation, especially tuberculosis, is required. Absence of mycobacteria and of caseation in the histologic specimens and presence of skin anergy to tuberculin help make a diagnosis. Transbronchial lung biopsy obtained with the help of fiberoptic bronchoscopy is positive in about 80% of patients. Corticosteroids are used to treat patients with symptoms and those showing active organ involvement. Aggressive treatment is required for patients with acute and severe pulmonary, cardiac, ocular, or neurologic involvements.
Adult↗
Interferon-gamma 1b: impact of new indications (idiopathic pulmonary fibrosis).
Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive disease with inadequate response to conventional treatment with corticosteroids and/or immunosuppressive agents in most patients. Interferon-gamma (IFN-gamma), an antifibrotic agent, has been proposed as a novel therapeutic approach. Several investigators have shown a relative decrease in systemic and pulmonary IFN-gamma activity in patients with IPF. Experimental evidence from animal and human studies also suggests that IFN-gamma administration may ameliorate lung fibrosis. Clinical experience is, however, limited to a single clinical trial that showed objective functional improvement in a small number of patients treated with IFN-gamma and low-dose corticosteroids. Further research is needed to characterise the efficacy, safety and optimum route of administration of this agent before it can be recommended for use in routine clinical practice.
Humans↗
Study of the prevalence of asthma in adults in North India using a standardized field questionnaire.
Prevalence of asthma was calculated using a Hindi adaptation of the International Union Against Tuberculosis and Lung Disease (IUATLD)-1984 questionnaire. The questionnaire was administered to patients with and without asthma to select specific items to define asthma. Questionnaire validity was tested against physician-diagnosed asthma in 753 individuals in the field, with sensitivity and specificity of 63.1% and 98.8%, respectively. The field prevalence study was conducted among 958 men and 1158 women. True population prevalence, calculated from the observed prevalence using specificity and sensitivity of the questionnaire, was 3.94% in urban men, 3.99% in rural men, and 1.27% in both urban and rural women.
Adolescent↗
Statistical estimation of height from arm span in north Indian subjects.
We measured height and arm span of 400 males and 231 female subjects between 16-83 years of age. Arm span exceeded height in 82.6% subjects. Mean height to arm span ratio was 0.9711 and 0.9816 in males and females respectively, and was not significantly correlated with age. Linear regression equations were generated for both sexes for prediction of height from arm span and age. The use of height to arm span ratio was found to be a less suitable method than the use of regression equations in estimating height from arm span.
Adolescent↗
Incidence of tuberculosis among patients receiving treatment with oral corticosteroids.
OBJECTIVES: To study the incidence and pattern of tuberculosis in patients taking systemic corticosteroids (CS). METHODS: Seventy seven patients taking oral CS for various respiratory diseases and eighty patients suffering from similar diseases but not receiving steroids were followed up for one year to study the incidence of tuberculosis. RESULTS: Five patients (6.5%) receiving CS developed tuberculosis as against none amongst the controls (p < 0.05). Of these, three patients had sputum positive pulmonary tuberculosis and one each had sputum negative pulmonary tuberculosis and tubercular meningitis. All patients were treated with standard anti-tubercular therapy; four patients improved whereas one died due to complications of disease. CONCLUSION: Systemic CS therapy causes a significant increase in incidence of tuberculosis.
Administration, Oral↗
Near fatal asthma following ingestion of diclofenac sodium tablet.
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Adult↗
Familial aggregation of cancer in patients with bronchogenic carcinoma.
History of cancer among first degree relatives was obtained in 124 patients with bronchogenic carcinoma [probands] and 248 controls, and differences in familial aggregation evaluated by calculation of odds ratio [OR] and their 95 percent confidence intervals [95% CI]. Probands were more likely than controls to have relatives with cancers [OR 1.27, 95% CI 0.49-3.10], both among smokers and nonsmokers [OR 1.31, 95% CI 0.27-6.79 and OR 1.21, 95% CI 0.12-6.16 respectively]. Sisters of probands were particularly at a higher risk [OR 8.72, 95% CI 0.85-430.08]. A genetic component, possibly independent of smoking habits, may be important in the causation of lung cancer.
Adenocarcinoma↗
Treatment issues in interstitial lung disease in tropical countries.
Management of interstitial lung disease, especially idiopathic pulmonary fibrosis, is both difficult and unsatisfactory. In many patients, only supportive therapy can be instituted. Attempts have been made to use anti-inflammatory therapy to reverse inflammation, provide symptomatic relief, stop disease progression, and prolong survival; the results of such treatment have varied from no improvement to significant prolongation of survival. Corticosteroids are the most frequently used anti-inflammatory agents. Cytotoxic drugs, such as oral azathioprine or intermittent intravenous cyclophosphamide, have also been shown to be effective both alone and in combination with low-dose oral corticosteroids. Of the other antifibrotic drugs that have been used, colchicine seems to provide some benefit. It is especially useful in aged persons and those with corticosteroid-induced problems or concomitant illnesses that are likely to be worsened by steroids. Anti-inflammatory therapy is costly to administer and monitor, particularly in the developing world. It is therefore important to consider these issues before instituting treatment. Younger patients and patients with less-severe disease of recent onset are most likely to respond to treatment. Similarly, patients with lymphocytic alveolitis or desquamative interstitial pneumonia respond better. Despite the use of newer strategies for treatment, the overall prognosis for patients with interstitial lung disease has not really changed, and the median population survival remains almost the same as it was about 30 years ago.
Adrenal Cortex Hormones↗
Interpreting spirometric data: impact of substitution of arm span for standing height in adults from North India.
STUDY OBJECTIVE: To evaluate if direct substitution of arm span for height during interpretation of spirometry data leads to any significant statistical or clinical differences in Indian adults, and to compare this method with the use of height estimated indirectly from arm span. DESIGN: Cross-sectional. SETTING: Respiratory laboratory of a tertiary referral hospital in North India. PARTICIPANTS: Two hundred twenty-eight subjects referred for spirometry. MEASUREMENTS AND RESULTS: Standing height and arm span were measured for all subjects. Spirometry measurements included FVC, FEV1, FEV1/FVC, peak expiratory flow, and maximal midexpiratory flow. Predicted values for each parameter were calculated separately for height, arm span, and height estimated from fixed height:arm span ratio. Results were classified into normal, obstructive, and restrictive defects for each height, arm span, and estimated height measurement, and any abnormality was categorized as mild, moderate, or severe. Arm span exceeded height in 182 (79.82%) subjects. Thirty-seven (16.2%) and 32 (14.0%) results were classified or categorized incorrectly when arm span and estimated height were substituted respectively, for actual height, with a kappa estimate of agreement 0.779 and 0.808, respectively; 17.4% and 11.0% normal results were classified, respectively, as restrictive defects using arm span and estimated height. Limits of agreement, which were almost equally wide for both sets of data, were more than the permissible intraindividual variability for FVC and FEV1. CONCLUSIONS: The substitution of arm span for height introduces statistically significant changes in spirometry results. Use of height estimated from arm span using fixed ratio also leads to misclassification of data, though less than that caused by use of arm span alone. Height estimated from arm span can be substituted for actual height in patients in whom height cannot be measured reliably. Where racial/ethnic norms for height and arm span correlation are not available, arm span is a reasonable surrogate for standing height.
Adolescent↗