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INTRODUCTION: Critically ill patients are predisposed to developing sleep disorders due to multiple factors like pre-existing sleep disorders, severe acute illness, sleep-altering medical interventions, and the disturbing intensive care unit (ICU) environment. In the current study, a multi-modality approach has been attempted to capture the different aspects of sleep disturbances, including insomnia (using ISI), daytime sleepiness (using ESS), sleep quality (using PSQI), sleep architecture, and SDB (using PSG). MATERIALS AND METHODS: The eligible ARDS survivor patients were updated about the study's design prior to hospital discharge. At admission, data regarding demographic details, clinical history, etiology of ARDS, and PaO2/FiO2 (P/F) ratio at presentation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores was collected. All enrolled patients were evaluated twice (early-within 7 days of admission and late-after 6 weeks of discharge) by the Richards-Campbell Sleep Questionnaire (RCSQ), Insomnia severity index (ISI), and level 1 PSG. Additionally, ESS questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were also recorded in late evaluation. Abnormal sleep was defined if one or more of the following characteristics met: ISI > 15, ESS > 10, global PSQI > 5, AHI ≥ 5 events/h. RESULTS: Thirty patients were recruited out of the total of 88 ARDS patients screened at admission. The median (IQR) PaO2/FiO2 ratio and APACHE II scores were 176 (151-191.5) and 14 (14-16), respectively. The median (IQR) duration of stay in the ICU was 10 (7.3-19.5) days. The median RCSQ score in the early and late evaluation was 42 and 69, respectively. The mean ISI score in the early evaluation was 16.67 ± 4.72, which decreased to 11.70 ± 5.03 in late evaluation (p < 0.05). ISI score > 15 (clinical insomnia) was found in 18 out of 30 subjects (60%) in early evaluation and 11 out of 30 (36%) in late evaluation. During the early evaluation, sleep efficiency was low (median 59.9% and predominantly N1 and N2) which improved in late evaluation (median 80.6%). Of the 30 patients, only 4 had AHI > 5 in early evaluation and none in late evaluation. Neither of P/F ratio, SOFA, and APACHE II scores did correlate with ICU events in the early and late evaluations. Regression analysis showed subjects with ICU stay more than 10 days, duration of IMV more than 7 days, Fentanyl more than 7 mg, duration of sedative use more than 7 days was independently associated with poor objective sleep quality (low sleep efficiency, low TST and high arousal index) during the early and late evaluations after ICU discharge compared to counterparts (p value < 0.05). CONCLUSION: We conclude that sleep quality in ARDS survivors was poor within 7 days of ICU discharge, characterized by severe disruption of sleep architecture and sleep-disordered breathing. After 6 weeks of ICU discharge sleep quality showed significant improvement in the N3 stage and AHI, however persistent insomnia was observed even at 6 weeks. Therefore, prior identification of risk factors and early diagnosis of sleep quality disorders in post-ARDS patients is essential.
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Pulmonary alveolar microlithiasis (PAM) is a rare inherited disorder in which patients present with either nonspecific signs and symptoms or are asymptomatic. Clinical-radiological dissociation is a commonly seen feature of the disease. Majority of cases are diagnosed in second and third decade of life, although presentation in paediatric and elderly population is also reported. Pathognomonic radiological findings, with normal calcium and phosphate levels can confirm the diagnosis without the need of further investigations in large number of cases. A high index of suspicion and knowledge of the disease is of paramount importance as it has a wide range of presentation and variable course thus posing a diagnostic challenge. We present two cases of this rare disease in elderly females with distinct presentations although with similar and characteristic radiological findings along with a brief review of literature of the disease.
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Calcinosis , Enfermedades Pulmonares , Anciano , Calcinosis/diagnóstico por imagen , Niño , Femenino , Enfermedades Genéticas Congénitas , Humanos , Pulmón , Enfermedades Pulmonares/diagnóstico por imagen , NieveRESUMEN
COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden on health resources. Evaluation of clinical and epidemiological profiles of such patients can help in understanding and managing the outbreak more efficiently. This study was a prospective observational analysis of 200 diagnosed COVID-19 patients admitted to a tertiary care center from 20th march to 8th May 2020. All these patients were positive for COVID-19 by an oro-nasopharyngeal swab-rtPCR based testing. Analyses of demographic factors, clinical characteristics, comorbidities, laboratory parameters, and the outcomes were performed. The mean age of the population was 40 years with a slight male predominance (116 patients out of 200, 58%). A majority of the patients (147, 73.5 %) were symptomatic, with fever being the most common symptom (109, 54.5%), followed by cough (91, 45.5%). An older age, presence of symptoms and their duration, leukocytosis, a high quick SOFA score, a high modified SOFA score, need for ventilator support, an AST level more than 3 times the upper limit of normal (ULN), and a serum creatinine level of 2 mg/dl or greater were at a significantly higher risk of ICU admission and mortality. Presence of diabetes mellitus, AST > three times ULN, serum creatinine 2 mg/dl or higher, and a qSOFA score of 1 or higher were all associated with significantly greater odds of critical care requirement. Triage and severity assessment helps in deciding the requirement for a hospital stay and ICU admission for COVID-19 which can easily be done using clinical and laboratory parameters. A mild, moderate and severe category approach with defined criteria and treatment guidelines will help in judicious utilization of health-care resources, especially for developing countries like India. *Other members of the Safdarjung Hospital COVID-19 working group: Balvinder Singh (Microbiology), MK Sen (Pulmonary Medicine), Shibdas Chakrabarti (Pulmonary Medicine), NK Gupta (Pulmonary medicine), AJ Mahendran (Pulmonary Medicine), Ramesh Meena (Medicine), G Usha (Anaesthesiology), Santvana Kohli (Anaesthesiology), Sahil Diwan (Anaesthesiology), Rushika Saksena (Microbiology), Vikramjeet Dutta (Microbiology), Anupam Kr Anveshi (Microbiology).
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Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Neumonía Viral/sangre , Neumonía Viral/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Anemia/sangre , Aspartato Aminotransferasas/sangre , Betacoronavirus , COVID-19 , Niño , Preescolar , Comorbilidad , Enfermedad de la Arteria Coronaria/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Tos/fisiopatología , Creatinina/sangre , Diabetes Mellitus/epidemiología , Femenino , Fiebre/fisiopatología , Humanos , Hipertensión/epidemiología , Hipoxia/fisiopatología , India/epidemiología , Lactante , Recién Nacido , Unidades de Cuidados Intensivos , Tiempo de Internación , Recuento de Leucocitos , Leucocitosis/sangre , Linfopenia/sangre , Linfopenia/fisiopatología , Masculino , Persona de Mediana Edad , Mialgia/fisiopatología , Puntuaciones en la Disfunción de Órganos , Pandemias , Faringitis/fisiopatología , Recuento de Plaquetas , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Estudios Prospectivos , Respiración Artificial , SARS-CoV-2 , Taquipnea/fisiopatología , Centros de Atención Terciaria , Factores de Tiempo , Tuberculosis/epidemiología , Adulto JovenAsunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Tuberculosis , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Estudios Retrospectivos , SARS-CoV-2 , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiologíaRESUMEN
Dear Editor Long years of respiratory medicine practice lets one develop a clinical instinct which certainly aids in diagnostic acumen...
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Percusión/métodos , Neumotórax/diagnóstico , Neumología/normas , Tórax/fisiología , Diagnóstico Precoz , Humanos , Masculino , Médicos , Pleura/cirugía , Pleurodesia/métodos , Neumotórax/cirugía , Autoexamen/métodos , Cirugía Torácica Asistida por Video/métodos , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Not available.
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Betacoronavirus , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Posición Prona/fisiología , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria/terapia , Vigilia , COVID-19 , Humanos , Pandemias , SARS-CoV-2RESUMEN
The corona virus disease 2019 (COVID-19) outbreak started in December 2019 in Wuhan, China, and spread all over the world leading to declaration of a pandemic by World Health Organization (WHO) on 11th March 2020. Most countries around the world have been on lockdown in an effort to halt the spread of virus. People around the world have been pushed into uncharted waters of uncertainty, fear, anxiety, stress and depression due to economic crash down, job losses and fear for their own health and that of their loved ones. There is a known association between anxiety/stress and sleep disturbances and vice versa. The most vulnerable population in this isolation like condition, in this lockdown, are the chief earning member of the family, women, young ones, and people with psychiatric illness.
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Infecciones por Coronavirus/psicología , Neumonía Viral/psicología , Trastornos del Sueño-Vigilia/etiología , Aislamiento Social/psicología , COVID-19 , Infecciones por Coronavirus/prevención & control , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Higiene del Sueño , Trastornos del Sueño-Vigilia/prevención & control , Trastornos del Sueño-Vigilia/psicología , Estrés Psicológico/complicaciones , Estrés Psicológico/etiologíaRESUMEN
To the Editor Novel Coronavirus disease (COVID-19) was first notified in December 2019 from Wuhan, China. Now, it has spread rapidly and has been declared a pandemic affecting over 200 countries with widespread morbidity and mortality. It has been postulated that the most vulnerable population are the elderly, people living in crowded areas, children and immune-compromised individuals, such as people living with human immunodeficiency virus (HIV). The correlation of tuberculosis (TB), HIV and malnutrition are well documented and hence, people with tuberculosis should be considered as special population in this pandemic. TB is an ancient disease among humans recorded as far back as seventy thousand years which was declared a global public health emergency in 1993 by the World Health Organisation (WHO). India has the highest TB burden in the world.