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Surinder K Jindal

Publications and source records attributed to Surinder K Jindal.

At least 19 recordsLinked to original sources

Bronchial asthma: the Indian scene.

PURPOSE OF REVIEW: Although asthma is a global disease, there are important differences in epidemiology, clinical spectrum and management practices in India. Some of these issues have been reviewed in this article. RECENT FINDINGS: The prevalence of 'ever asthma' was reported in 2.4% in a population study on 73,605 individuals conducted simultaneously at four major centres in India with the use of a single definition and uniform methodology employing a validated questionnaire. Of the several risk factors which were found to be significant, exposure to environmental tobacco smoke during childhood alone or both during childhood and adulthood was important in the development of and in increasing morbidity from asthma. Many other triggers and risk factors which include local aeroallergens and air pollutants have been identified. Allergic bronchopulmonary aspergillosis is an important cause of difficult to treat asthma and almost half of these patients receive antitubercular treatment at some stage. Simplified consensus guidelines based on international guidelines and local practices have been developed for use at the primary and secondary levels of healthcare. SUMMARY: The prevalence of asthma in India is somewhat similar to that seen in other Asian countries. Consensus management guidelines adapted from standard international guidelines adequately address the local concerns and issues.

Air Pollutants↗

Practical issues and challenges in the diagnosis and treatment of pulmonary sarcoidosis.

Sarcoidosis is a granulomatous disease with multisystem involvement. Diagnosis is generally easy to establish from the characteristic clinical and radiographic features. In India and other developing countries, tuberculosis is the closest clinical mimic and needs to be excluded before therapy for sarcoidosis is instituted. Tuberculin anergy and histopathological demonstration of characteristic compact granulomas help in the diagnosis of sarcoidosis. Corticosteroids constitute the mainstay of therapy for symptomatic pulmonary and most other forms of extrapulmonary sarcoidosis. Asymptomatic disease does not require any treatment, but milder forms may be treated with topical corticosteroids and symptomatic therapy. Alternative drugs such as cytotoxic agents, hydroxychloroquine and other agents are used either alone or in combination for the treatment of relapses and recurrences and refractoriness or in the presence of complications of corticosteroids. Treatment is usually continued for about a year, but it may need to be prolonged in patients with disease that persists and the response to therapy is delayed.

Adrenal Cortex Hormones↗

Susceptibility testing of Mycobacterium tuberculosis by broth microdilution method: a rapid alternative method.

A total of 50 clinical isolates of Mycobacterium tuberculosis were tested by the proportion method and the broth microdilution method (BMM) for primary antitubercular drugs. The results were obtained after 14 days of incubation. There was a 100% agreement for all drugs except streptomycin, which showed a 96% agreement. Thus, the BMM was found to be a rapid, reliable, and less labor-intensive method to determine MIC.

Antitubercular Agents↗

Efficacy and safety of iodopovidone in chemical pleurodesis: a meta-analysis of observational studies.

The search for an 'ideal' agent for pleurodesis continues. Iodopovidone is a topical antiseptic and has been shown to be safe and effective in many studies. The aim of this study was to evaluate the efficacy and safety of iodopovidone as an agent for chemical pleurodesis. We performed a systematic review of all the observational trials which have used iodopovidone for chemical pleurodesis. Six studies including 265 patients who had undergone chemical pleurodesis with iodopovidone were included for this analysis. Iodopovidone was used for variety of indications, which included pleural effusion (157 patients), and pneumothorax (108 patients). Pleurodesis was performed through tube thoracostomy in 144 patients and through thoracoscopy in 121 patients. The success rate of pleurodesis varied from 64.2% to 100%, and summary success rate of all the studies was 90.6% (95% confidence intervals [CI], 86.4-93.8). The success rate was independent for the procedure (tube thoracostomy [126/144; 87.5%, 95% CI 80.9-92.4] or thoracoscopy [114/121; 94.2%, 95% CI 88.4-97.6]) used for performing pleurodesis or for the indication (pleural effusion [139/157; 88.5%, 95% CI 82.5-93.1] or pneumothorax [101/108; 93.5%, 95% CI 87.1-97.4]). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in three patients in only one study. There were no deaths related to chemical pleurodesis with iodopovidone. Overall, this review supports the safety and efficacy of iodopovidone as an agent for chemical pleurodesis in cases of recurrent pleural effusions and pneumothoraces regardless of their etiology.

Anti-Infective Agents, Local↗

Performance of standard severity scoring systems for outcome prediction in patients admitted to a respiratory intensive care unit in North India.

OBJECTIVE: There are little data on the value of using severity scoring systems developed in western countries to assess critically ill patients in India. The authors evaluated the performance of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and Mortality Probability Models version II at admission and at 24 h (MPM(0) and MPM(24), respectively) in predicting patient outcomes in their Respiratory Intensive Care Unit. METHODS: Data from 459 consecutive adult admissions were collected prospectively. Standardized mortality ratios were computed as an index of the overall model performance. Model calibration was assessed using Lemeshow-Hosmer goodness-of-fit tests and through calibration curves. Model discrimination was assessed through receiver operating curve analysis and by drawing 2 x 2 classification matrices. RESULTS: Overall standardized mortality ratio exceeded 1.5 for all models. All models had modest discrimination (area under receiver-operating-characteristic curves 0.66-0.78) and poor calibration (high Lemeshow-Hosmer C and H statistic values). All models had a tendency to underpredict hospital death in patients with lower mortality probability estimates. There were no major differences between the models with regard to either discrimination or calibration performance. CONCLUSIONS: Standard severity scoring systems developed in western countries are poor at predicting patient outcome in critically ill patients admitted to a respiratory intensive care unit in Northern India. Caution must be exercised in using such models in their present form on Indian patients until either they are customized for local use or fresh models are developed from Indian cohorts.

APACHE↗

Allergic bronchopulmonary aspergillosis: lessons from 126 patients attending a chest clinic in north India.

AIMS AND OBJECTIVES: To describe the experience of screening patients with asthma for allergic bronchopulmonary aspergillosis (ABPA) presenting to a chest clinic. The clinical, serologic, radiologic, and treatment aspects including outcome of ABPA are also described. METHODS: All consecutive patients with asthma presenting to the chest clinic over a period of 2 years were screened with an Aspergillus skin test. Patients who were found to be positive were further investigated for ABPA. Patients were also arbitrarily classified as ABPA-seropositive (ABPA-S), ABPA with central bronchiectasis (ABPA-CB), and ABPA-CB with other radiologic findings (ABPA-CB-ORF) based on the high-resolution CT findings. RESULTS: Five hundred sixty-four patients were screened using an Aspergillus skin test; 223 patients (39.5%) were found to be positive, and ABPA was diagnosed in 126 patients (27.2%). There were 34 patients (27%) with ABPA-S, 42 patients with ABPA-CB, and 50 patients with ABPA-CB-ORF. Fifty-nine patients (46.8%) had received antitubercular therapy in the past. The vast majority of patients had bronchiectasis at presentation to our hospital. High-attenuation mucous impaction was noted in 21 patients (16.7%). There was no significant difference between the stages of ABPA and the duration of illness, the severity of asthma, and the serologic findings (ie, absolute eosinophil count, IgE levels [total] and IgE levels [for Aspergillus fumigatus]). The median duration of follow-up was 13 months (range, 9 to 38 months). All patients went into "remission" at 6 weeks. Twenty-five patients had a "relapse" during the course of their treatment. One hundred nine patients had "complete remission," 17 patients were classified as having "glucocorticoid-dependent ABPA," and 7 patients were classified as having "end-stage ABPA." CONCLUSIONS: There is a high prevalence of ABPA in asthmatic patients presenting at our hospital. The disease entity is still underrecognized in India; the vast majority of patients have bronchiectasis at presentation, and almost half are initially misdiagnosed as having pulmonary tuberculosis. There is a need to redefine the definitions of ABPA and the optimal dose/duration of glucocorticoid therapy. This study reinforces the need for the routine screening of asthmatic patients with an Aspergillus skin test.

Adolescent↗

Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India.

OBJECTIVE: Outcomes in patients with ARDS/acute lung injury (ALI) may be dependent on the underlying cause. We describe the case mix, clinical behavior, and outcomes of patients with ALI/ARDS resulting from pulmonary causes (ALI/ARDSp) and extrapulmonary causes (ALI/ARDSexp). DESIGN: Retrospective study conducted between January 2001 and June 2005. SETTING: Respiratory ICU (RICU) of a tertiary care hospital in northern India. PATIENTS: All patients fulfilling the criteria for ALI/ARDS and requiring mechanical ventilation for > 24 h. MEASUREMENTS AND RESULTS: Of the 180 patients (ARDS, 140 patients; ALI, 40 patients), 123 patients had ALI/ARDSp, whereas 57 patients had ALI/ARDSexp. The most common cause of ALI/ARDSp was infective pneumonia, whereas the most common cause of ALI/ARDSexp was sepsis. At ICU admission, although patients with ALI/ARDSexp were sicker than those with ALI/ARDSp, there was no difference between the two groups of patients in the development of new organ dysfunction/failure (Delta sequential organ failure assessment [SOFA] scores) or the time to develop the first organ dysfunction/failure (assessed by SOFA scores). The median length of RICU stay was similar in the two groups (5 days [interquartile range (IQR), 6 days] vs 5 days [IQR, 9.5 days], respectively, in patients with ALI/ARDSp and ALI/ARDSexp; p = 0.4). The hospital mortality rate was 47.8% and was not significantly different between the two groups (ALI/ARDSp group, 43.1%; ALI/ARDSexp group, 57.9%; p = 0.06). Multivariate analysis showed the following risk factors for death in the ICU: female gender (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25 to 0.94); SOFA scores (OR, 1.18; 95% CI, 1.07 to 1.3); and DeltaSOFA scores (OR, 1.24; 95% CI, 1.09 to 1.41). There was no significant effect of the category of ARDS on outcome (OR, 1.6; 95% CI, 0.8 to 3.2). CONCLUSIONS: Although patients with ALI/ARDSexp are sicker on ICU admission, the underlying cause of ARDS does not affect the length of ICU stay or hospital survival time.

Acute Disease↗

The relationship between FEV1 and peak expiratory flow in patients with airways obstruction is poor.

STUDY OBJECTIVES: To evaluate the correlation between FEV1 and peak expiratory flow (PEF) values expressed as a percentage of their predicted value, and to assess factors influencing differences between the two measurements. DESIGN: Cross-sectional. SETTING: Pulmonary function laboratory at a tertiary-level teaching hospital in northern India. PARTICIPANTS: A total of 6,167 adult patients showing obstructive pattern on spirometry over a 6-year period. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: There was considerable variability between percentage of predicted FEV1 (FEV1%) and percentage of predicted PEF (PEF%). Locally weighted least-square modeling revealed that PEF% underestimated [corrected] FEV1% in patients with less severe obstruction and overestimated [corrected] it in those with more severe obstruction. Using Bland-Altman analysis, PEF% underestimated FEV1% by a mean of only 0.7%; however, limits of agreement were wide (- 27.4 to + 28.8%), indicating that these two measurements cannot be used interchangeably. PEF% and FEV1% were > 5% apart in approximately three fourths and differed by > 10% in approximately one half of the patients. On multivariate analysis, discordance > 5% was significantly influenced by female gender (odds ratio, 1.26; 95% confidence interval [CI], 1.01 to 1.58) and increasing FEV1% (odds ratio, 1.09 for every 10% increase; 95% CI, 1.04 to 1.14) but not by height or age. CONCLUSIONS: FEV1% and PEF% are not equivalent in many patients, especially women and those with less severe airflow limitation. Assumptions of parity between PEF% and FEV1% must be avoided.

Adolescent↗

Comparison of fixed percentage method and lower confidence limits for defining limits of normality for interpretation of spirometry.

BACKGROUND: The use of the lower 90% confidence limit of the lower limit of normal (LLN(CI)), rather than a fixed percentage of the predicted value (LLN(%)), appears to be statistically more appropriate for interpretation of spirometry results. There has been no comparative assessment of these 2 definitions of the LLN in routine clinical practice. METHODS: We studied results of spirometry interpretations made with these 2 approaches, and assessed various factors that influence discordant classification of spirometry results. Spirometry records from 18,112 consecutive adult patients referred for spirometry were interpreted as normal, obstructive, or restrictive, based on both LLN(CI) and LLN(%). Discordant results were analyzed using multiple logistic regression techniques to identify variables that significantly affected discordant classification of results. RESULTS: Overall, 11.7% of the results were discordant between the 2 methods. Agreement between the 2 methods, calculated using the kappa estimate, was poorer with spirometry values from women and from patients at the extremes of height and age. Age, sex, and height independently influenced discordant classification. Limits of agreement between LLN(CI) and LLN(%) were wide for all the spirometric variables studied--more so in women and in shorter and older patients. CONCLUSIONS: LLN(CI) and LLN(%) yielded different interpretations of spirometry data in several instances, and the 2 methods cannot be used interchangeably. When interpreting spirometry data in routine clinical practice, LLN(CI) should be preferred over LLN(%).

Adolescent↗

Epidemiology, risk factors and outcome of nosocomial infections in a Respiratory Intensive Care Unit in North India.

OBJECTIVE: To determine the epidemiology, risk factors and outcome of infections in a Respiratory Intensive Care Unit (RICU) of a tertiary care institute in northern India. METHODOLOGY: Prospective, observational clinical study. RESULTS: The study included 201 patients (1285 patient days) admitted to RICU over a period of one-and-a-half years. A total of 77 infections were identified in 67 patients (33.5%). The infections included pneumonia (23%), sepsis of unknown origin (10.5%), bacteremia (7.5%), urinary tract infections (1.5%), catheter related blood stream infections (1%) and Clostridium difficile colitis (1%). The most commonly identified organisms were the Acinetobacter species (34.8%), Pseudomonas aeruginosa (23.9%) and Escherichia coli (15.2%). The median length of stay in patients with and without infection was 13 days (interquartile range, IQR, 28) and 4 days (interquartile range, IQR, 3), respectively (p<0.0001). Multivariate analysis showed the following risk factors for ICU-acquired infection: the admitting diagnosis of infection (odds ratio [OR] 3.3; 95% confidence intervals [CI] 1.06-10.1), length of stay in the RICU (OR, 1.2; 95% confidence intervals [CI] 1.1-1.33); renal failure (OR, 4.7; 95% CI, 1.52-14.41) and institution of parenteral nutrition (OR, 16.9; 95% CI, 1.07-269.03). Multivariate analysis showed the following risk factors for death in ICU: APACHE II scores (OR, 1.06; 95% CI, 1.01-1.11), and endotracheal intubation (OR, 5.07; 95% CI, 1.24-20.65). CONCLUSIONS: This study clearly documents a high prevalence rate of infections in the ICU, and the data suggest that occurrence of infections was associated with a prolonged ICU stay but had no significant effect on the final outcome.

Anti-Bacterial Agents↗

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↗

Coeliac disease as a cause of unusually severe anaemia in a young man with idiopathic pulmonary haemosiderosis.

Idiopathic pulmonary haemosiderosis (IPH) is characterized by a triad of recurrent episodes of alveolar haemorrhage, haemoptysis and iron deficiency anaemia. The combination of IPH and coeliac disease (CD) is extremely rare though both diseases may have a common pathogenetic link. As illustrated by our case CD should be specifically looked for in patients with IPH, especially those in whom the severity of anaemia is disproportionate to radiologic findings even in the absence of gastrointestinal symptoms since both diseases may benefit from a gluten-free diet.

Adult↗

Autoimmunity and interstitial lung disease.

PURPOSE OF REVIEW: The pathogenesis of idiopathic pulmonary fibrosis as well as that of several other interstitial lung diseases is poorly understood. The role of autoimmunity in interstitial lung diseases associated with connective tissue disorders such as systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis as well as the vasculitides is well established. There is at least some evidence in the literature that supports the role of autoimmunity as one of the mechanisms of alveolar injury responsible for idiopathic pulmonary fibrosis. This review is an attempt to summarize the studies on this subject. RECENT FINDINGS: Repeated extraneous insults and exposures are considered to be responsible for recurrent alveolar injury, inflammation, dysregulated tissue repair, and fibroproliferation resulting in pulmonary fibrosis. The presence of autoantibodies in the sera of patients with idiopathic pulmonary fibrosis has been demonstrated in a few studies. Several autoantibodies, including anti-Sm antibodies, antibodies to U1 ribonucleoproteins, and antibodies to U3 ribonucleoproteins, have been demonstrated in connective tissue disorders, many of which are associated with interstitial lung involvement. Autoimmunity has been also suggested as a possible mechanism of rejection caused by bronchiolitis obliterans after lung transplantation. SUMMARY: It might seem that the role of autoimmunity in interstitial lung disease has been underestimated or even underinvestigated. The subject requires further investigation, especially with regard to the problems of lung allograft rejection due to bronchiolitis obliterans of nonalloimmunity origin and the failure of patients with idiopathic pulmonary fibrosis to respond to most forms of currently available therapy.

Antirheumatic Agents↗

Association of outdoor air pollution with chronic respiratory morbidity in an industrial town in northern India.

A cross-sectional study was performed in one industrial (study) and one non-industrial (reference) town in Punjab State, northern India. Ambient air quality samples were collected and analyzed each week for 2 yr. Subjects were 3,603 individuals >15 yr old who were interviewed and whose lung functions were measured spirometrically. Their biomarkers were categorized in terms of obstructive or restrictive defects. Levels of total suspended particulates, nitrogen oxides, sulfur oxides, carbon monoxide, and ozone were significantly higher in the study town than in the reference town. The prevalence of chronic respiratory symptoms (cough, phlegm, breathlessness, or wheezing) was 27.9 and 20.3% in the study and reference towns, respectively (p < 0.05). That of obstructive ventilatory defect was 24.9 and 11.8% (p < 0.05), respectively. Logistic regression analysis showed that residence in the study town was independently associated with chronic respiratory symptoms (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2, 1.8; p < 0.001) and spirometric ventilatory defect (OR = 2.4; 95% CI = 2.0, 2.9; p < 0.001) after controlling for other demographic effects.

Adolescent↗

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↗

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↗

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↗