3 research outputs found
Role of CRP in COVID-19 pneumonia: A single-center experience of 1000 cases in a tertiary care setting in India
No full textIntroduction
Robust data are available for C-reactive protein (CRP) in bacterial infection, and it can be used in this coronavirus disease 2019 (COVID-19) pneumonia pandemic for initial assessment before planning of treatment in indoor settings in comparison with other inflammatory markers and computed tomography (CT) severity.
Materials and methods
A prospective, observational, follow up study was conducted that included 1000 COVID 19 cases confirmed with RT PCR. All cases were assessed with lung involvement documented and categorized based on high resolution computed tomography (HRCT) thorax, oxygen saturation, and inflammatory markers such as CRP at the entry point and follow up. Age, sex, comorbidities, use of BIPAP/NIV (Bi-level positive airway pressure/Non-invasive ventilation), and outcomes such as with or without lung fibrosis as per HRCT severity were key observations. Statistical analysis was done using χ2 test.
Results
Age (50 years) and sex (male versus female) had a significant association with CRP in predicting severity (P < 0.00001 and P < 0.010, respectively). CT severity score at the entry point with CRP level had a significant correlation (P < 0.00001). CRP level had a significant association with duration of illness (P < 0.00001). Comorbidities had a significant association with CRP level (P < 0.00001). CRP level had a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement during hospitalization had a significant association with CRP level (P < 0.00001). Timing of BIPAP/NIV requirement had a significant association with CRP level. (P < 0.00001). Follow-up CRP titer during hospitalization as compared with the entry point normal and abnormal CRP levels showed a significant association in post-COVID lung fibrosis (P < 0.00001).
Conclusion
CRP is an easily available and universally acceptable inflammatory marker and documented to play a very crucial role in predicting timings of interventions and post-COVID lung fibrosis
Disproportionate tachycardia and tachypnea in pulmonary tuberculosis: A marker of concurrent cardiac dysfunction
No full textCardiovascular involvement in tuberculosis is not uncommon. Cardiac dysfunction is a clinical presentation due to direct or indirect affection due to tuberculosis. Cardiac dysfunction is possible without structural cardiac disease. In this case report, a 32-year-old male presented with constitutional symptoms for 6 months with acute deterioration with tachycardia and tachypnea with hypoxia 2 weeks before hospitalization. Radiological investigations documented conglomerated miliary tuberculosis and confirmed by sputum smear microscopy and Gene Xpert MTB/Rif. Cardiac investigations revealed sinus tachycardia in electrocardiogram, raised cardiac enzymes in laboratory evaluation, and “global left ventricular hypokinesia” with reduced ejection fraction in echocardiography. We have started Anti-tuberculosis treatment as per National guidelines for 6 months with steroids backup for four weeks. We have documented cardiac function improvement in one month post treatment, bacteriological cure after 2 months of ATT and near complete radiological resolution after 6 months. We recommend cardiac workup in all pulmonary tuberculosis cases with disproportionate tachycardia and tachypnea with or without hypoxia
Trends of chronic obstructive pulmonary disease diagnosis and treatment in rural setting in India: A large, two-center, prospective, observational study of 6000 cases in tertiary care setting in India
No full textBackground: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality due to chronic respiratory illness in India. More than half of COPD patients were not getting adequate rationale inhalation treatment in primary to tertiary care setting. Materials and Methods: A prospective, observational, interview (questionnaire)-based complete workup COPD study conducted during June 2016 to June 2019 in the Department of Pulmonary Medicine, Venkatesh Chest Hospital, and MIMSR Medical College, Latur, screened 12,000 cases with chronic respiratory symptoms with cough, sputum production, and shortness of breath, and all cases were undergone spirometry and 6000 COPD cases were enrolled. In this study, we assessed disease knowledge and the methods of treatment offered to all patients before enrollment by applying questionnaire. Statistical analysis was done using single proportion test (Chi-square test). Observation and Analysis: We have observed that 3% of study cases were aware of their illness “COPD disease,” 54% are not knowing the disease or not counseled for COPD disease ever before, and 43% are not convinced as they are having COPD (categorized as “difficult patient”) (P < 0.0001). Inhalation treatment was offered in only 58% of COPD cases, levosalbutamol monotherapy in 31% of cases, levosalbutamol plus beclometasone in 18% of cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 9% of COPD cases (P < 0.0001), latter being categorized as “difficult treatment” being costlier than former ones. We also observed irrational and exuberant use of oral medicines in 42% of COPD cases, theophylline in 16%, salbutamol in 7%, and oral steroids in 19%, and these medicines were preferred by treating doctors over inhalation treatment in spite of knowledge of inhalation treatment and categorized as “difficult doctor” (P < 0.0001). Conclusion: COPD is less efficiently evaluated and halfheartedly treated in rural setting, and more emphasis should be given to spirometry training for proper diagnosis and awareness regarding advantages of inhalation treatment over oral medicines
