Current evidence does not support a role for corticosteroids in the management of ARDS in either the early or late stages of the disease. More research is required to establish the role of steroids in specific subgroups of patients with severe sepsis and early ARDS who have relative adrenal insufficiency and patients with late ARDS 7-14 days after the onset of disease.

The results of this study suggest a possible causal relation between HBV infection and NHL which needs to be confirmed by experimental and epidemiological studies. In countries where prevalence of HBV infection is 1% or more, it may be prudent to screen patients with NHL for occult HBV infection.

Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications.

The prevalence of allergic bronchopulmonary aspergillosis (ABPA) in chronic asthma has been reported in various studies. However, no study has systematically evaluated the occurrence of Aspergillus hypersensitivity (AH) and ABPA in acute severe asthma (ASA). The aim of this study was to investigate the occurrence of AH and ABPA in patients with ASA. All patients with ASA admitted to the respiratory intensive care unit (ICU) of this institute underwent a prospective evaluation for ABPA using Aspergillus skin test (AST) as a screening tool. Patients with positive AST were labelled as AH and were further investigated for ABPA. Patients with ASA were compared with historical control group of 755 outpatient bronchial asthma patients previously reported. Of the 357 ICU admissions, 57 (43 females, 14 males; mean age 43.5 years) patients were admitted with a diagnosis of ASA. The occurrence of AH was 50.9% [95% confidence interval (CI) 38.3-63.4; 29 ⁄ 57 patients] whereas the prevalence of ABPA was 38.6% (95% CI 27.1-51.6; 22 ⁄ 57 patients) in patients with ASA. The occurrence of AH and ABPA was significantly higher in the ASA group compared with the outpatient bronchial asthma group (38.5% and 20.5%, respectively). The prevalence of serological ABPA (ABPA without central bronchiectasis) was also higher in the ASA group compared with the outpatient bronchial asthma group (45.4% vs. 23.9%). The occurrence of AH and ABPA is very high in patients with acute asthma admitted to a respiratory ICU. Furthermore, the occurrence of high percentage of serological ABPA calls for the use of AST as a routine screening tool for ABPA in all patients with acute asthma at discharge.

INTRODUCTION: We prospectively studied the frequency, spectrum, and predictors of gastrointestinal (GI) symptoms among patients with coronavirus disease-19 (COVID-19) and the relationship between GI symptoms and the severity and outcome. METHODS: Consecutive patients with COVID-19, diagnosed in a university hospital referral laboratory in northern India, were evaluated for clinical manifestations including GI symptoms, their predictors, and the relationship between the presence of these symptoms, disease severity, and outcome on univariate and multivariate analyses. RESULTS: Of 16,317 subjects tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in their oropharyngeal and nasopharyngeal swabs during April–May 2020, 252 (1.5%) were positive. Of them, 208 (82.5%) were asymptomatic; of the 44 symptomatic patients, 18 (40.9%) had non-GI symptoms, 15 (34.1%) had a combination of GI and non-GI symptoms, and 11 (25.0%) had GI symptoms only. Thirty-three had mild-to-moderate disease, 8 severe, and 5 critical. Five patients (1.98%) died. On multivariate analysis, the factors associated with the presence of GI symptoms included the absence of contact history and presence of non-GI symptoms and comorbid illnesses. Patients with GI synptoms more often had severe, critical illness and fatal outcome than those without GI symptoms. DISCUSSION: Eighty-two percent of patients with COVID-19 were asymptomatic, and 10.3% had GI symptoms; severe and fatal disease occurred only in 5% and 2%, respectively. The presence of GI symptoms was associated with a severe illness and fatal outcome on multivariate analysis. Independent predictors of GI symptoms included the absence of contact history, presence of non-GI symptoms, and comorbid illnesses. JOURNAL/cltg/04.03/01720094-202012000-00003/inline-graphic1/v/2023-10-25T013615Z/r/image-tiff

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