Browsing by Author "Aggarwal, A N"

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    Acute respiratory distress syndrome following nitrogen dioxide exposure.
    (1998-10-26) Aggarwal, A N; Ramanathan, R M; Jindal, S K
    A young laborer was accidentally exposed to toxic nitrogen dioxide fumes following an accidental explosion at work place. He developed acute respiratory distress within few hours of exposure and manifested with severe hypoxemia and permeability edema. Assistance with mechanical ventilation and corticosteroid therapy could be instituted only after 24 hours of exposure. He had shown remarkable recovery and could be weaned off after seven days. At three weeks after discharge, his lung function tests were normal.
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    Applicability of commonly used Caucasian prediction equations for spirometry interpretation in India.
    (2005-08-24) Aggarwal, A N; Gupta, Dheeraj; Behera, Digamber; Jindal, S K
    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.
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    Assessing severity of asthma: spirometric correlates with visual analogue scale (VAS).
    (2000-04-01) Gupta, D; Aggarwal, A N; Subalaxmi, M V; Jindal, S K
    BACKGROUND: Measurements of dyspnoea in asthma are difficult. Peak expiratory flow (PEF) and forced expiratory volume in first second (FEV1) are the most widely used objective measures of bronchial obstruction in asthma. Subjective continuous scales like visual analogue scale (VAS) provide a more flexible means of grading dyspnoea as perceived by the patient. METHODS: Utility of a VAS in assessing severity of bronchial asthma was evaluated in 195 previously diagnosed adult patients with bronchial asthma. Patients were asked to mark their severity as perceived by them on a continuous vertical VAS of 100 mm anchored at bottom with description no breathlessness' and at top by 'greatest breathlessness'. The distance measured from bottom in mm was taken as VAS score. This was correlated with FEV1 and PEF recorded immediately after the scale was marked. RESULTS: The mean VAS score was 31.13 (+/- 28.32) mm and had a good negative correlation with FEV1 (r = 0.5255, p < 0.01) and PEF (r = 0.4609, p < 0.01). Patients were also classified into four groups of mild, moderate, severe and acute asthma, and correlation analyzed in each group separately. The correlation was more significant in subgroups of moderate and severe asthma. Educational status of subjects had no impact on this correlation. CONCLUSION: VAS is a reasonable tool for measurement and monitoring of severity of asthma in individual patients, and may be used when more objective tests are not available.
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    Bronchial hyperresponsiveness in patients with sarcoidosis.
    (2004-01-07) Aggarwal, A N; Gupta, D; Chandrasekhar, G; Jindal, S K
    OBJECTIVE: To study bronchial hyperresponsiveness (BHR) in patients with sarcoidosis. METHODS: Twenty freshly diagnosed patients with sarcoidosis were evaluated. Progressively increasing concentrations of methacholine were administered using a standard five-breath dosimeter protocol, and spirometry performed after each challenge. BHR was expressed as PC20 (provocating concentration of methacholine resulting in 20% fall in forced expiratory volume in first second). All patients were nonsmokers, had no other concurrent cardiopulmonary disease, and were not on any specific treatment for sarcoidosis. RESULTS: Borderline (PC20 4.0-16.0 mg/mL), mild (PC20 1.0-4.0 mg/mL) and moderate to severe (PC20 <1.0 mg/mL) BHR was documented in three (15%), one (5%) and five (25%) patients respectively. Patients with BHR were similar to those having normal reactivity in terms of age, gender, disease duration and results of pulmonary function testing. All patients with endobronchial disease had BHR. CONCLUSION: BHR may be seen in several patients of sarcoidosis and could possibly contribute to decline in lung function.
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    Bronchoendoscopic involvement in patients with carcinoma of middle third of esophagus in absence of respiratory symptoms.
    (2003-10-10) Aggarwal, A N; Gupta, D; Behera, D; Gupta, N M; Jindal, S K
    BACKGROUND: Bronchoscopic examination has been advocated as an essential part of evaluation of patients with newly diagnosed esophageal malignancy. The present study describes the role of routine preoperative fibreoptic bronchoscopy in staging disease and assessing resectibility in patients with malignancy involving the middle third of esophagus. METHODS: Preoperative fibreoptic bronchoscopy was performed in 125 patients with carcinoma of the middle third of esophagus. None of the patients had clinical or chest radiographic evidence of extension of disease outside the esophagus. RESULTS: Abnormalities were detected in 33 patients (25.6%), the commonest being external compression over the posterior wall of trachea in 17 (13.6%). Other abnormalities noted were left vocal cord paresis in seven (5.6%); compression over one or both major bronchi in seven (5.6%) and over the left lower lobe bronchus in one (0.8%); infiltration of the left main bronchus in two (1.6%); and growth in trachea in four (3.2%), in left main bronchus in two (1.6%) and over cricoarytenoid area in one (0.8%) patient. CONCLUSIONS: Tracheobronchial involvement, even in the absence of clinical or radiological features, is not uncommon in esophageal cancer. Preoperative bronchoscopy is useful to assess the extent of disease and resectibility in these patients.
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    Chemotherapy versus best supportive care in the management of lung cancer.
    (2003-03-04) Shajeem, O; Behera, D; Aggarwal, A N
    This study was planned to evaluate the role of chemotherapy in improving survival in patients with inoperable lung cancer. Seventy eight patients with histologically proven lung cancer were followed up for a period of one year. Thirty eight out of them received chemotherapy and 40 patients received supportive care only. Main outcome measure was survival from the date of diagnosis. The patients receiving chemotherapy had a median survival of 23.2 weeks compared to that of 10.1 weeks in patients receiving best supportive care. Among patients with non-small cell lung cancer, median survival was 27.0 weeks in chemotherapy group and 10.3 weeks in supportive care group. Patients who received cisplatin plus docetaxel combination had a better survival than those who received MIC (mitomycin, ifosfamide, cisplatin) combination. Patients with good performance status benefited more from chemotherapy, although patients with poorer performance status also had significant improvement in survival with chemotherapy. In conclusion, chemotherapy results in a modest, but significant improvement in survival in patients with inoperable lung cancer compared to best supportive care alone.
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    Development of a computer software for easy storage and analysis of fibreoptic bronchoscopy data.
    (2004-10-02) Aggarwal, A N; Gupta, D; Sood, B; Behera, D; Jindal, S K
    OBJECTIVE: To develop a simple software for management of fibreoptic bronchoscopy records. METHODS: After identification of the specific needs at our hospital, a software was developed. A graphical interface with structured data entry related to patient information and diagnosis, bronchoscopic findings and specimens obtained, and their reports were envisaged. After initial construction, the software was tested over a four-week period. The software was put to routine use after necessary corrections, and validated over the next few months through actual data entry. RESULTS: The software has various modules for input and modification of data, as well as for generation of reports, and can work both on stand-alone personal computers and on networks. With little practice, residents soon became adept at entering details correctly and quickly. The slightly increased time of data entry into the computer was more than made up by uniform and complete report generation. The database component was evaluated by analyzing 1000 consecutive records entered over a 14-month period, and no discrepancies were observed. CONCLUSION: A user-friendly software providing uniform and complete data entry regarding fibreoptic bronchoscopic procedures was developed.
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    Development of a simple computer program for spirometry interpretation.
    (2002-04-08) Aggarwal, A N; Gupta, D; Jindal, S K
    OBJECTIVES: To develop and evaluate a computer program for interpretation of spirometry. METHODOLOGY: The spirometry programme was constructed in Epi Info software using a previously defined algorithm for interpretation. The programme incorporated current American Thoracic Society guidelines on interpretation of spirometry and was based on regression equations for healthy North Indians previously derived by us. The programme was pretested for two months before being put to routine use. RESULTS: Use of this spirometry programme led to consistent interpretation of spirometry results. There was significant saving of time while preparing reports, without any additional expenditure. CONCLUSION: The use of such computer programmes accelerate the reporting of pulmonary function test results at little extra cost, and all interpretations are performed in a consistent fashion.
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    Diagnosis of tuberculous pleural effusion.
    (1999-04-07) Aggarwal, A N; Gupta, D; Jindal, S K
    Tuberculosis is a common cause of pleural effusion in India. Diagnosis can be made in a majority of patients from the clinical features, pleural fluid examination (including cytology, biochemistry and bacteriology), and pleural biopsy. Adenosine deaminase estimation in pleural fluid is occasionally useful. Newer diagnostic techniques include lysozyme or interferon gamma estimation, immunodiagnostic methods and polymerase chain reaction. Although promising, they still need to be studied further before their routine use can be recommended.
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    Diurnal variation in peak expiratory flow in healthy young adults.
    (2000-01-14) Aggarwal, A N; Gupta, D; Chaganti, S; Jindal, S K
    Diurnal variability in peak expiratory flow (PEF) was studied for three days in 152 healthy volunteers aged 20-40 years, and expressed as amplitude percent mean (A%M) and standard deviation percent mean (SD%M). The commonest pattern (74.6%) observed was that of a nadir at waking in morning, a progressive rise upto late afternoon and a plateau or a small decrease at bedtime. Mean diurnal variation in PEF on the third day was 7.23 +/- 3.48 (A%M) and 2.98 +/- 1.31 (SD%M). Both the diurnal variation and the calculated upper limits of normality were found to be lower than those reported previously for Western subjects. This knowledge of diurnal variation is important for any meaningful interpretation of PEF recordings used to monitor patients with asthma.
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    Effect of household exposure to environmental tobacco smoke on airflow mechanics in asymptomatic healthy women.
    (2004-01-05) Aggarwal, A N; Gupta, Dheeraj; Sharma, C P; Jindal, S K
    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.
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    Excess morbidity and expenditure on healthcare in families with smokers: a community study.
    (2005-05-01) Jindal, S K; Sapru, R P; Aggarwal, A N; Chaudhry, K
    BACKGROUND: There is paucity of information on health-related expenditure attributed to smoking in India. This community study estimated the expenditure on healthcare and morbidity borne by families of smokers and compared these with those of families without smokers. It was hypothesized that families with smokers were likely to have a higher health expenditure than non-smoker families attributable to the increased probability of health problems associated with smoking. METHODS: The study population comprised 1000 urban and rural families divided into two groups. Group I consisted of 500 families with one or more smoker(s) while group II comprised 500 families without a smoker. Both groups had an equal representation from the urban and rural populations (250 each). The study team used a structured, generally close-ended questionnaire, pre-tested for its validity and reliability, to interview the families. Different components of health-related expenditure and other morbidity indices were studied. Each family was studied in two phases: (i) initially, for the retrospective assessment of expenditure and other losses during the preceding one year, and (ii) prospectively, for the following 10 months on repeated visits and estimations made every two months. The data collected retrospectively were mostly incomplete and could not be used for analyses. RESULTS: The number of family members reporting sick was significantly higher in group I than in group II among both urban and rural families (p < 0.001). There was an excess expenditure of Rs 730 and Rs 141, in addition to Rs 4209 and Rs 894 on smoking products in group I families in urban and rural areas, respectively. Univariate analysis showed that the odds ratio for having any health-related expenditure for a group I family was 3.346 (95% confidence interval 2.533-4.420), which was highly significant (p < 0.0001). The differences in loss of work on account of illness and loss of man-days among members of groups I and II were not significant. However, the number of lost school days among children of group I families, loss of efficiency of its members and change of jobs due to loss of efficiency were highly significant. CONCLUSION: The direct healthcare costs as well as the indirect fiscal losses are higher in families with one or more smoker(s).
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    Experience with treatment of pulmonary alveolar proteinosis from a tertiary care centre in north India.
    (2012-04) Khan, A; Agarwal, R; Aggarwal, A N; Bal, Amanjit; Sen, Indu; Yaddanapuddi, L N; Puri, G D
    Background. Pulmonary alveolar proteinosis (PAP) is a disorder characterised by accumulation of lipids and proteins in the alveoli, with the resultant symptoms ranging from indolent subclinical disease to progressive respiratory failure. Methods. We retrospectively studied five patients with PAP managed at our center between January 2007 and April 2010, with whole lung lavage (WLL) and/or subcutaneous granulocyte macrophage-colony stimulating factor (GM-CSF) therapy. Patients undergoing WLL under general anaesthesia were supplemented with three months of GM-CSF therapy. Pre- and post-lavage symptom assessment was performed with a 10-point, symptom-based visual analogue scale. Results. Their mean age was 37.6±7.0 years; there were four males. Diagnosis of PAP [idiopathic (n=3); secondary to Nocardia (n=1)] was established by surgical lung biopsy in four patients who presented with respiratory failure. Three patients with idiopathic PAP (n=3) were treated with a combination of GM-CSF and WLL; one patient with secondary PAP was treated with antibiotics alone. In another patient transbronchial lung biopsy was used to diagnose PAP and GM-CSF alone was administered. All patients were followed up for a median period of two years (range 0.5-3 years). Significant improvement was achieved in all the patients with therapeutic WLL and/or GM-CSF. Conclusions. Whole lung lavage appeared to be an effective and safe therapy in patients with PAP. Efficacy of simultaneous administration of GM-CSF and WLL in the treatment of PAP merits further study.
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    Familial aggregation of cancer in patients with bronchogenic carcinoma.
    (2000-03-23) Gupta, D; Aggarwal, A N; Vikrant, S; Jindal, S K
    History of cancer among first degree relatives was obtained in 124 patients with bronchogenic carcinoma [probands] and 248 controls, and differences in familial aggregation evaluated by calculation of odds ratio [OR] and their 95 percent confidence intervals [95% CI]. Probands were more likely than controls to have relatives with cancers [OR 1.27, 95% CI 0.49-3.10], both among smokers and nonsmokers [OR 1.31, 95% CI 0.27-6.79 and OR 1.21, 95% CI 0.12-6.16 respectively]. Sisters of probands were particularly at a higher risk [OR 8.72, 95% CI 0.85-430.08]. A genetic component, possibly independent of smoking habits, may be important in the causation of lung cancer.
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    Guidelines for management of asthma at primary and secondary levels of health care in India (2005).
    (2005-10-01) Jindal, S K; Gupta, D; Aggarwal, A N; Agarwal, R; ,; ,
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    Haematological abnormalities in patients of sarcoidosis.
    (2002-10-20) Gupta, D; Rao, V Madhava; Aggarwal, A N; Garewal, G; Jindal, S K
    OBJECTIVE: To study the presence and pattern of haematological abnormalities in patients with sarcoidosis in India. METHODS: Haematological investigations including complete blood cell counts, ESR and peripheral smear examination were carried out in 30 consecutive freshly diagnosed cases of sarcoidosis and compared with equal number of age and sex matched healthy controls. Coagulation parameters such as prothrombin time (PT), prothrombin index (PTI), partial thromboplastin time (PTTK) and fibrinogen levels were also studied. RESULTS: There were 15 men (mean age 40.4 +/- 10.15 years) and equal number of women (mean age 38.6 +/- 12.14 years) in the study group. Haematological abnormalities were present in 11 (36.66%) of the patients. Four cases (13.33%, all females) were found to have anaemia and in three of them no other cause for this was evident. Lymphopenia (lymphocyte count <1500/cu mm) was present in eight (26.66%) patients and three (10%) controls (P<0.05). Only one patient (3.3%) had leucopenia. Number of subjects with raised ESR and the mean ESR was higher in the study group as compared to the controls. No coagulation abnormalities were encountered. CONCLUSIONS: Different haematological manifestations in total are common in Indian patients, leucopenia is relatively rare while anaemia, lymphopenia and raised ESR are common
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    Household environmental tobacco smoke exposure, respiratory symptoms and asthma in non-smoker adults: a multicentric population study from India.
    (2006-01-18) Gupta, D; Aggarwal, A N; Chaudhry, K; Chhabra, S K; D'Souza, G A; Jindal, S K; Katiyar, S K; Kumar, R; Shah, B; Vijayan, V K; ,
    BACKGROUND: Exposure to environmental tobacco smoke (ETS) is a risk factor for childhood asthma. Its association with asthma in adults is less clear. METHODS: In a multicentric population study on asthma prevalence in adults, specific enquiries were made into childhood and adulthood exposure to household ETS, and its relationship with asthma diagnosis were analysed. RESULTS: From a total of 73605 respondents, 62109 were studied after excluding current or past smokers. Overall observed prevalence of asthma was 2.0% (men 1.5%,women 2.5%, p < 0.001). Of all asthma patients, history of ETS exposure was available in 48.6 percent. Prevalence of asthma in the ETS exposed subjects was higher compared to non-exposed individuals (2.2% vs 1.9%, p < 0.05). Multiple logistic regression analysis showed a higher risk of having asthma in persons who were exposed to ETS compared to those not exposed (odds ratio [OR] 1.22, 95% CI 1.08-1.38) after adjusting for age, gender, usual residence, exposure to biomass fuels and atopy. Stratification of ETS exposure revealed that exposure during childhood and both during childhood and adulthood were significantly associated with asthma prevalence. Exposure only in adulthood was not a significant risk factor (OR 1.13, 95% CI 0.95-1.33). Persons reporting combined environmental tobacco smoke exposure from parents during childhood and spouse during adulthood had highest risk of having asthma (OR 1.69, 95% CI 1.38-2.07). Environmental tobacco smoke exposure was also significantly associated with prevalence of respiratory symptoms such as wheezing, cough and breathlessness. CONCLUSIONS: Environmental tobacco smoke exposure during childhood is an important risk factor for asthma and respiratory symptoms in non-smoking adults.
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    Ifosfamide containing regimen for non-small cell lung cancer.
    (2004-01-12) Behera, D; Aggarwal, A N; Sharma, S C; Gupta, D; Jindal, S K
    BACKGROUND: Combination chemotherapy has been demonstrated as one of the best active regimens in patients with non-small cell lung cancer (NSCLC). METHODS: A total of 206 patients with advanced unresectable NSCLC stage III B or stage IV were enrolled to receive combination chemotherapy with mitomycin, ifosfamide and cisplatin. About a third of them (n=63) did not continue therapy after the first course either because of toxicity, lack of affordability, or death. The remaining 143 patients (121 males) received two or more cycles of chemotherapy. RESULTS: Nearly half of all followed-up patients showed a partial or complete radiological response. Overall performance status (Karnofsky scale) worsened in 28 (19.6%) and improved in 44 (30.8%). While 50 patients (35%) gained weight, 65 (45.5%) lost weight during follow-up. Overall median survival was 20 weeks [95% confidence interval (CI), 16 to 24 weeks]. However, overall survival improved progressively with the number of chemotherapy cycles administered. Median survival in patients receiving at least three, four and five chemotherapy cycles was 23 (95% CI, 19-27); 27 (95% CI, 24-30) and 35 (95% CI, 28-42) weeks respectively. Survival at the end of three, six, nine and 12 months was 64.3%, 29.4%, 14.7% and 9.8%) respectively. Survival had no association with age of the patient, but was significantly correlated with baseline performance status (Pearson's correlation coefficient 0.29 p<0.01). The cost of each course of chemotherapy was a little over 100 US dollars. The side effects were minimal and acceptable, and the regimen was tolerated well by all the patients. CONCLUSION: Ifosfamide regimen containing mitomycin and cisplatin is a chemotherapeutic combination for treating patients with advanced NSCLC.