Background:Long-term mechanical ventilation in an Intensive Care Unit (ICU) exposes the patient to fungal colonization and invasive fungal disease due to the presence of indwelling catheters, administration of broad-spectrum antibiotics, and intravenous corticosteroids. A study is hence required to study the risk factors and incidence of fungal infection in these patients.Methods:A prospective observational study was carried out in the respiratory ICU of a tertiary care hospital for a period of approximately 1 year in which patients on mechanical ventilation (>7 days) were enrolled. Blood, urine, and endotracheal aspirate (ETA) of these patients were sent for fungal culture on day 1 and day 7 of mechanical ventilation. Fiberoptic bronchoscopy was done on day 7 and bronchoalveolar lavage along with transbronchial lung biopsy (TBLB) were sent for fungal culture.Results:During 7 days of ventilation, there was a statistically significant increase in the proportion of culture-positive ETA and urine samples. Overall, Candida albicans emerged as the most common colonizer. Blood candidemia was seen in 10% of patients on day 7 of mechanical ventilation. Fungal invasion of the lung, as evidenced by fungal culture-positive TBLB specimens, was seen in 17% of patients. Diabetes was found to be a statistically significant risk factor for respiratory and urinary tract colonization as well as invasive fungal disease.Conclusion:Long-term mechanical ventilation (>7 days) is strongly associated with fungal colonization of the respiratory tract and urinary tract. Appropriate prophylactic antifungals may be given and infection control practices to be observed to ensure minimum colonization and therefore infection in such settings.

Sleep-disordered breathing (SDB) is highly prevalent in patients with cancer and affects their prognosis. However, data on SDB in lung cancer patients are lacking, and few studies have conducted level I polysomnography (PSG) in this patient population. This study aimed to measure SDB in newly diagnosed lung cancer patients at the sleep clinic of a tertiary respiratory institute in New Delhi, India, for eight months. This study included 30 patients. Participants received a clinical examination, completed a sleep questionnaire, and then underwent overnight PSG. We scored sleep parameters according to the American Academy of Sleep Medicine guidelines. Both descriptive and inferential statistics were used to analyze the data. We used univariate analysis with chi-square testing, and p<0.05 was considered significant. SDB and obstructive sleep apnea (OSA) were found in 66.6% and 56.6% of patients, respectively. Mild, moderate, and severe OSA were seen in 26.6%, 16.6%, and 13.3% of patients, respectively. Nocturnal oxygen desaturation (NOD) or NOD90 (i.e., when >30% of sleep time was spent with oxygen saturation levels <90%) was seen in 13.3% of patients. Adenocarcinoma was the most common histological variant of cancer. Tumor-node-metastasis staging was significantly associated with the presence of OSA (p=0.045). Lung cancer patients should receive routine PSG to identify and manage patients with SDB, especially given that symptoms of SDB such as easy fatigability and non-refreshing sleep are overlooked as symptoms of lung cancer. Proper management of SDB or OSA would help improve patients' quality of life and improve their overall prognosis.

Blood urea nitrogen and serum albumin levels are independent risk factors for poor clinical outcome in CAP. However, there is a paucity in the literature on the role of Blood urea nitrogen and albumin ratio(B/A) in CAP. This was a prospective observational study in which 112 admitted patients with the diagnosis of CAP underwent routine blood examinations, ABG, procalcitonin and Chest X-ray. Univariate analysis among various risk factors, CURB-65 scores, blood parameters including B/A ratios and clinical outcomes were carried out followed by multiple logistic regression. Cox regression was done to look at B/A values and time to mortality. In the logistic regression, age, CURB -65 score, B/A ratio and procalcitonin came out to be independent risk factors for ICU admission and mortality. Odds ratio of B/A in predicting mortality and ICU admission came out to be 67.8 (49.2-95.4) and 11.2 (8.4-14), respectively. Cox regression showed B/A values were also found to have a statistically significant relationship with time to mortality (p=0.001). B/A ratio has the potential to become a veritable predictor of poor clinical outcomes in patients with CAP.

BackgroundThe data on the impact of coronavirus disease 2019 (COVID-19) on interstitial lung disease (ILD) is still limited. To the best of our knowledge, there has been no study from India to date to assess the impact of COVID-19 in patients with preexisting ILD. We undertook this study to assess the clinical outcome of ILD patients admitted to our hospital with COVID-19. MethodsIn this retrospective observational study, records of reverse transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients with preexisting ILD who were admitted to the hospital in the period from May 1, 2020, to April 30, 2021, were obtained from the hospital database. The clinical outcomes of the patients were recorded. Univariate analysis was performed to find relation between various predetermined risk factors for mortality and those with significant p values (p<0.05) were subjected to multiple logistic regression to determine independent risk factors. ResultsIn our study of 28 patients, the overall mortality was 35.7%. On comparing the parameters associated with increased mortality, there was no effect of age, gender, comorbidities, type of ILD, CT thorax findings on diagnosis, use of corticosteroids and antifibrotics in the past, spirometric findings on mortality. On multivariate analysis, the significant parameters were interleukin 6 (IL-6), p=0.02, OR=1.020 (1.006-1.043) and D-dimer, p=0.04, OR=2.14 (5.55-1.14). ConclusionCOVID-19 in patients with pre-existing ILD has a comparatively higher mortality. D-dimer and IL-6 are significant predictors of mortality in ILD patients infected with COVID-19.

Our study was done to identify patient or health system related delay in diagnosis of treatment naïve sputum positive PTB patients and its impact on sputum conversion at 2 months. A total of 280 patients were enrolled and followed up for 2 months following which repeat sputum examination was done. Detailed clinical history was taken with emphasis on duration of symptoms, day of presentation, diagnosis and starting of therapy. The median(range) of delay in treatment initiation was 15 (0–82) days, most commonly because of delay due to the health system. Patients with positive sputum at the end of two months had significantly higher delay in treatment initiation (p < 0.05). Being remote (>5 km) from a health provider, being an unskilled labourer, and visiting a private practitioner were associated with delay in diagnosis. Eradication of tuberculosis in India requires training of health professionals, intersectoral cooperation and better public outreach.

Tuberculosis is a state of immunosupression which exposes the patients to further opportunistic pathogens like fungus. Methods: 102 newly diagnosed sputum positive pulmonary tuberculosis cases were enrolled. Significant fungal isolates were seen in 31/102 (30.4%) patients. Aspergillus spp. were isolated in 13/31(41.9%) of the positive fungal cultures while Candida spp. were isolated in 15/31 (48.4%). Low body mass index, duration of symptoms, haemoptysis, severity of radiological features and IgG Aspergillus antibodies were independent risk factors for positive fungal culture. Significant proportion of patients with PTB have fungal colonisation of their airways which can lead to poor clinical outcomes. Few easily ascertained clinical parameters can help the clinician to determine patients who are at a higher risk of fungal colonisation.

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