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Dheeraj Gupta

Publications and source records attributed to Dheeraj Gupta.

At least 37 records · Page 2Linked to original sources
PubMed2005

Experience with ARDS caused by tuberculosis in a respiratory intensive care unit.

OBJECTIVE: Acute respiratory distress syndrome (ARDS) is an important cause of morbidity and mortality in intensive care units. Tuberculosis (TB) commonly causes respiratory failure in patients with extensive pulmonary parenchymal involvement, but it is a rare cause of ARDS. We report our experience of TB presenting with ARDS. METHODS: Retrospective analysis of 187 patients admitted with a diagnosis of ARDS over the previous 7 years. Data are presented in a descriptive fashion using mean+/-SD or median (range). RESULTS: Nine (4.9%) of 187 patients had ARDS secondary to tuberculosis. All patients were mechanically ventilated. The diagnosis was made on clinico-radiological grounds and confirmed later using fiberoptic bronchoscopy and transbronchial biopsy in seven patients, and lymph node biopsy and examination of the joint aspirate in the remaining two. All patients were empirically started on anti-tubercular therapy with a median time to initiation of therapy being 3 days (range 2-8 days). Three patients had multi-organ dysfunction syndrome (MODS) without any evidence of bacterial infection. Seven of nine (77.8%) patients survived; two died because of severe ARDS, MODS, and respiratory failure. CONCLUSIONS: Tuberculosis is an uncommon but definite cause of ARDS, and in patients with ARDS of obscure aetiology where the clinical features suggest tuberculosis as the inciting cause, antitubercular therapy should be started empirically and the diagnosis actively pursued later.

APACHE↗
PubMed2005

Tuberculous dilated cardiomyopathy: an under-recognized entity?

BACKGROUND: Tuberculosis (TB) is a common public health problem in many parts of the world. TB is generally believed to spare these four organs-heart, skeletal muscle, thyroid and pancreas. We describe a rare case of myocardial TB diagnosed on a post-mortem cardiac biopsy. CASE PRESENTATION: Patient presented with history suggestive of congestive heart failure. We describe the clinical presentation, investigations and outcome of this case, and review the literature on the involvement of myocardium by TB. CONCLUSION: Involvement of myocardium by TB is rare. However it should be suspected as a cause of congestive heart failure in any patient with features suggestive of TB. Increasing recognition of the entity and the use of endomyocardial biopsy may help us detect more cases of this "curable" form of cardiomyopathy.

Adult↗
PubMed2005

Applicability of commonly used Caucasian prediction equations for spirometry interpretation in India.

BACKGROUND & OBJECTIVE: The applicability of Caucasian prediction equations in interpreting spirometry data in Indian patients has not been studied. The present study was undertaken to see if Caucasian and north Indian prediction equations can be used interchangeably while interpreting routine spirometric data. METHODS: Forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and FEV(1)/FVC ratio were recorded from 14733 consecutive spirometry procedures in adults. Predicted values and lower limits of normality were calculated using regression equations previously derived at this centre, and four commonly used Caucasian equations described by Knudson, Crapo, European Community for Coal and Steel (ECCS) and the Third National Health and Nutrition Examination Survey (NHANES III). For men, 90 per cent of predicted values were also derived. Kappa estimates were used to study agreement, and Bland Altman analysis was performed to quantify differences, between interpretations from Indian and Caucasian equations. Receiver operating characteristic (ROC) curves were constructed to assess utility of using a fixed percentage of Caucasian predicted values in categorizing FVC or FEV(1) as abnormal. RESULTS: The use of Caucasian prediction equations (and 90% of predicted values in men) resulted in poor agreement with Indian equation in most height and age categories among both men and women. Bland Altman analysis revealed a large bias and wide confidence limits between Caucasian and Indian equations, indicating that the two cannot be used interchangeably. ROC analysis failed to yield good results with use of any single fixed percentage of Caucasian predicted value while categorizing FVC or FEV(1). INTERPRETATION & CONCLUSION: Our results showed that the use of Caucasian prediction equations, or a fixed percentage of their predicted values, resulted in misinterpretation of spirometry data in a significant proportion of patients. There is a need to assess performance of more than one regression equation before choosing any single prediction equation.

Adolescent↗
PubMed2004

Characteristics and outcome for admissions to adult, general critical care units with acute severe asthma: a secondary analysis of the ICNARC Case Mix Programme Database.

INTRODUCTION: This report describes the case mix, outcome and activity (duration of intensive care unit [ICU] and hospital stay, inter-hospital transfer, and readmissions to the ICU) for admissions to ICUs for acute severe asthma, and investigates the effect of case mix factors on outcome. METHODS: We conducted a secondary analysis of data from a high-quality clinical database (the Intensive Care National Audit and Research Centre [ICNARC] Case Mix Programme Database) of 129,647 admissions to 128 adult, general critical care units across England, Wales and Northern Ireland over the period 1995-2001. RESULTS: Asthma accounted for 2152 (1.7%) admissions, and in 57% mechanical ventilation was employed during the first 24 hours in the ICU. A total of 147 (7.1%) patients died in intensive care and 199 (9.8%) died before discharge from hospital. The mean age was 43.6 years, and the ratio of women to men was 2:1. Median length of stay was 1.5 days in the ICU and 8 days in hospital. Older age, female sex, having received cardiopulmonary resuscitation (CPR) within 24 hours before admission, having suffered a neurological insult during the first 24 hours in the ICU, higher heart rate, and hypercapnia were associated with greater risk for in-hospital death after adjusting for Acute Physiology and Chronic Health Evaluation II score. CPR before admission, neurological insult, hypoxaemia and hypercapnia were associated with receipt of mechanical ventilation after adjusting for Acute Physiology and Chronic Health Evaluation II score. CONCLUSION: ICU admission for asthma is relatively uncommon but remains associated with appreciable in-hospital mortality. The greatest determinant of poor hospital survival in asthma patients was receipt of CPR within 24 hours before admission to ICU. Clinical management of these patients should be directed at preventing cardiac arrest before admission.

APACHE↗
PubMed2004

Effect of household exposure to environmental tobacco smoke on airflow mechanics in asymptomatic healthy women.

BACKGROUND & OBJECTIVES: Exposure to environmental tobacco smoke (ETS) can lead to airflow limitation, similar to that seen in smokers. However, the effects have not been conclusively proven. In the present study an attempt was made to characterize the effect of ETS exposure at home on airflow mechanics in asymptomatic healthy women. METHODS: Fifty women volunteers with no apparent health related problem, exposed to household ETS (group I), and 50 age-matched women not exposed (group II) were studied. Vital capacity (VC), forced expiratory flow in first second (FEV1), FEV1/VC ratio, peak expiratory flow (PEF), maximal midexpiratory flow (FEF(25-75%)), airway resistance (R(aw)) and specific airway conductance (sG(aw)) were measured, and compared between the two groups. Conditional logistic and linear regression analysis were done to assess contribution of household ETS exposure to decreased lung function. RESULTS: FEV1 and PEF values were marginally lower among women in group I (mean difference 0.13 l and 0.20 l/sec respectively). FEF(25-75%), R(aw) and sG(aw) were significantly impaired in this group. Ten (20.0%) women in group I and five (10.0%) in group II had abnormal R(aw) (adjusted odds ratio 6.72, 95% confidence limits 1.15-39.42), while eight (16.0%) women in group I and one (2.0%) in group II had abnormal sG(aw) (adjusted odds ratio 21.08, 95% confidence limits 1.30-341.05). Cumulative life time ETS exposure was, not significantly related to a reduction in FEV1, VC, PEF, FEF(25-75%), R(aw) or sG(aw) after adjustments for potential confounders. INTERPRETATION & CONCLUSION: Exposure to household ETS resulted in subtle impairment of airflow mechanics in asymptomatic women, possibly attributed to small airway narrowing. Further investigations are required to study the progression of this impairment with time.

Adult↗
PubMed2004

The relationship between tobacco smoke & bronchial asthma.

Bronchial asthma is a common disease and an important cause of morbidity among both children and adults. Tobacco smoking, both active and passive i.e., exposure to environmental tobacco smoke (ETS) has got important effects on asthma. Smoking by adults causes bronchial irritation and precipitates acute episodes. It also increases bronchial responsiveness and causes airway sensitization to several occupational allergens. Smoking may also increase the disease severity. Continued smoking by adult asthmatics is the likely cause of irreversibility of airway obstruction and development of chronic obstructive pulmonary disease. ETS exposure affects asthma in a similar fashion. Parental smoking is commonly associated with increased asthma symptoms, respiratory infections, acute episodes and frequent hospitalization of children. Bronchial responsiveness and airway sensitization may also increase. Childhood exposure to smoking is also considered as a risk factor for the development of asthma. Similarly, in utero exposure to maternal smoking may be independently responsible for early onset asthma. ETS exposure in adult asthmatics from smoking by spouses, siblings or colleagues is equally troublesome. There is increased morbidity and poorer asthma control. Asthmatic symptoms sharply decline after the ETS exposure is reduced.

Adult↗
PubMed2003

Anergy to tuberculin in sarcoidosis is not influenced by high prevalence of tuberculin sensitivity in the population.

BACKGROUND AND AIM: To study the pattern of tuberculin sensitivity and its interpretation to diagnose sarcoidosis in the presence of a high prevalence of Mantoux positivity in the general population in India. METHODS: Tuberculin sensitivity was examined in two groups of subjects: Group I included 50 newly diagnosed patients with pulmonary sarcoidosis and two control subjects with pulmonary ailments other than sarcoidosis or tuberculosis for each case; Group II included 62 new patients with sarcoidosis and 130 healthy volunteers as control subjects. Mantoux test was performed using 1 TU tuberculin. The test was repeated with 5 TU tuberculin for those cases and controls who were anergic to 1 TU among the group II subjects. Sensitivity and specificity for a "negative Mantoux test" in sarcoidosis were calculated at different cutoff points. The influence of prior BCG vaccination status on the performance of Mantoux test was also studied. MEASUREMENTS AND RESULTS: Forty-six (92%) of the 50 patients with sarcoidosis in Group I and 55 of the 62 (88.7%) in Group II did not show any reaction to Mantoux test, compared to 32 (32%) and 21 (16.2%) controls, respectively in groups I and II (P < 0.001). Thirty-nine (70.9%) of the 55 patients and 6 (28.6%) of the 21 controls from the group II subjects who were tested again with 5 TU did not show any reaction. A negative Mantoux test had a high sensitivity value at all the cut off points for the diagnosis of sarcoidosis. BCG vaccination administered during childhood had no correlation with a negative Mantoux reaction. CONCLUSIONS: Tuberculin anergy in sarcoidosis is not influenced by the rate of Mantoux positivity in the general population. A positive Mantoux test (irrespective of the size of reaction) in a suspected case of sarcoidosis should arouse strong suspicion of an alternate or an additional diagnosis of tuberculosis.

Adult↗
PubMed2002

Adult respiratory distress syndrome in the tropics.

Today ARDS is more frequently recognized and managed in tropical countries, although published data from most locations is meager. The spectrum of disorders causing ARDS in tropical countries includes virtually all conditions encountered in the West. Additionally, tropical infections and other disorders are seen far more commonly. In particular, malaria and TB are important infections that predispose patients to ARDS in the tropics. Both of these illnesses give lead to severe forms of disease, such as falciparum malaria, acute miliary TB or TB bronchopneumonia, and may cause ARDS. Awareness of the complications helps in early recognition and differential diagnosis from several similar manifestations. Although earlier reports painted a gloomy picture of the outcome of these patients in general--mainly due to financial and logistic constraints--the scenario is improving quickly with better and wider availability of newer diagnostic and management tools.

Adult↗
PubMed2002

Diurnal variability of peak expiratory flow.

Diurnal variation in peak expiratory flow (PEFvar) has been suggested as a surrogate for bronchial hyperreactivity, and may be a useful tool in the management of bronchial asthma. Several indices have been postulated to measure PEFvar; however, the number of daily measurements and the timing of recordings are not clearly established. Although several investigators have defined ranges for PEFvar in healthy individuals, clear cutoff values that differentiate asthmatics from others are not available. Despite this shortcoming, PEFvar is an important measurement in screening and diagnosis of asthma in population-based studies, as well as for assessing disease severity and prognosis. Treatment of asthma with either inhaled corticosteroids or bronchodilators may influence the magnitude of PEFvar in a complex fashion. Therefore, PEFvar should only be interpreted in conjunction with other clinical and laboratory information.

Administration, Inhalation↗
PubMed2002

Assessment of diurnal variability of peak expiratory flow in stable asthmatics.

Five daily readings of peak expiratory flow (PEF) were obtained for three days on 100 patients with chronic stable asthma. The variability of PEF was calculated as the amplitude percent mean (A%M) from the readings obtained on the third day, and compared to previously reported data from 152 healthy Indian adults. Patients with severe asthma exhibited significantly higher A%M than patients with both mild and moderate asthma (p < 0.05), but there was considerable overlap across disease categories. The area under the receiver operating characteristic curve plotted to assess the performance of PEF variability as a discriminator in diagnosing asthma was 0.826, with best discrimination at a value of 12.5 (sensitivity 0.640, specificity 0.941). Using a cut-off value of 16.5 (as proposed earlier by us) improved specificity to 0.987 but reduced sensitivity to 0.510. Using a traditional cut-off of 20, specificity remained almost unchanged (0.993), but sensitivity dropped further to 0.440. Thus A%M>16.5 is a useful marker of bronchial asthma in epidemiological studies in India. However, its use in population screening, clinical diagnosis, or in the assessment of the severity of asthma in individual patients has serious limitations because of poor sensitivity.

Adolescent↗
PubMedDate not supplied

Role of simple needle aspiration in the management of pneumothorax.

OBJECTIVES: To determine the role of simple needle aspiration in the management of pneumothorax. DESIGN: All patients presenting with a pneumothorax requiring intervention were included in this prospective study. Patients who were very sick or had tension pneumothorax were treated with direct intercostal chest tube drainage (ICTD) and others were subjected to simple aspiration. The procedure was deemed successful, if after aspiration the lung expanded completely or symptoms were relieved with residual pneumothorax of less than 15% of hemithorax. In case of failed aspiration ICTD was carried out. RESULTS: Fifty-seven patients with 59 pneumothoraces were included in the study. Of these, 24 were treated with direct ICTD; 35 (12 spontaneous, 11 secondary and 12 iatrogenic pneumothoraces) were subjected to simple aspiration. Ten (83.3%) of the primary, 1 (9.6%) of the secondary and 11 (91.7%) of the iatrogenic pneumothoraces responded to simple aspiration. There were no significant complications. The pain perceived and the duration of hospital stay was significantly lesser in the simple aspiration group. CONCLUSIONS: Simple aspiration should be the initial modality of treatment for primary spontaneous and iatrogenic pneumothoraces. For secondary spontaneous pneumothorax and in conditions where pleurodesis is indicated, ICTD remains the treatment of choice.

Adolescent↗
PubMedDate not supplied

Circulating D-dimers as a marker of disease activity in pulmonary sarcoidosis.

BACKGROUND AND AIMS: The search is on to find an easily measurable marker of disease activity in sarcoidosis. The present study was carried out to evaluate the utility of plasma D-dimer as a marker of disease activity in sarcoidosis. METHODS: Thirty newly diagnosed cases of sarcoidosis with clinical indications for treatment and an equal number of matched healthy controls were studied for the presence of D-dimers (DD) in the plasma before starting treatment with oral prednisolone and after clinical remission. Semi-quantitative estimations of DD were done using the latex agglutination slide test method (Commercial Kit - Diagnostica Stago, France) as per the manufacturer's recommendations. RESULTS: The mean age of cases and controls were 45.43 +/- 8.5 (range 34-60) and 46.16 +/- 8.07 (range 32-61) years, respectively. Of the 30 patients, nine (30%) were DD positive at baseline. The DD positive patients presented more often with dyspnoea, had radiological stage III (7 out of 9) disease and abnormal spirometry compared to patients with no detectable DD in their plasma. Of the 16 patients re-evaluated after clinical remission, eight (50%) were D-dimer positive. Two of the five patients initially DD positive had become negative and five additional patients who were negative at baseline had become positive. CONCLUSIONS: Plasma D-dimers, which were positive in 30% of untreated patients of sarcoidosis, indicate patients with significant pulmonary parenchymal involvement; but have no correlation with clinical disease remission.

Adult↗