Browsing by Author "Khilnani, G C"
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Item Air travel and supplemental oxygen therapy in patients with cardiopulmonary diseases.(2002-06-21) Khilnani, G C; Bhatta, NAir travel has become more popular in modern society and increasing number of patients with cardiopulmonary diseases are travelling by air. Although it represents a safe form of transportation, it leads to significant stress to an individual and its certain inherent risks may cause or promote hypoxia in patients with cardiopulmonary diseases. Clinicians will have to deal with situations where they will be asked to assess the fitness to travel and need for supplemental oxygen during flight. Once in a while the clinician may be required to help a co-passenger in distress during air travel. Predicting requirement of supplemental oxygen during commercial air flight requires knowledge of physiology of commercial air flight and available prediction equations. With modern pressurized aircrafts most of the patients with cardiopulmonary diseases would be able travel by air safely.Item Bronchoalveolar lavage: A forgotten tool.(2010-01) Khilnani, G C; Hadda, VijayItem Clinical and bacteriological profile and outcome of sepsis in dermatology ward in tertiary care center in New Delhi.(2011-03) Asati, D P; Sharma, V K; Khandpur, S; Khilnani, G C; Kapil, ABackground: There is paucity of data regarding the clinical and bacteriological profile of sepsis in dermatology in-patients. Aims: To study the frequency, etiology, and outcome of sepsis dermatology in-patients. Methods: The study was conducted in a 30-bedded dermatology ward of a tertiary care center. Sepsis was defined by presence of ≥2 SIRS (systemic inflammatory response syndrome) criteria along with evidence of infection (clinically obvious/culture proven infection of skin or internal organs). Patients were also assessed for known (common) risk factors of sepsis. In suspected sepsis patients, at least two samples of blood cultures by venepuncture were taken. Pus, skin swab, urine, and sputum samples were also collected for culture as needed with avoidance of contamination. Results: Among 860 admitted patients studied from November 2004 to July 2006, 103 (12%) fulfilled SIRS criteria. Of these, 63 had nonsepsis causes of SIRS positivity, while 40 (4.65%) had sepsis. Majority of the sepsis patient had vesicobullous diseases (42.5%), erythroderma (25%), toxic epidermal necrolysis (TEN) (22.5%). Severe sepsis developed in 17 (42.5%) patients, while 15 (37.5%) died. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest organism isolated (99; 25.9%) in all culture specimens followed by Acinetobacter spp. (52; 13.6%), Pseudomonas spp. (40; 10.5%), Methicillin-sensitive S. aureus (MSSA: 33; 8.7%), and Klebsiella spp. (22; 5.8%). Various risk factors affecting mortality and sensitivity patterns for various isolates were also analyzed. Conclusion: Sepsis occurred in 40 (4.65%) inpatients in dermatology ward. The frequency of sepsis was highest in TEN (90%), followed by drug-induced maculopapular rash (20.0%), erythroderma (17.5%), and vesicobullous diseases (8.5%). MRSA, acinetobacter, pseudomonas, MSSA, and Klebsiella were important etiological agents involved in sepsis in dermatology in-patients.Item Comparison between serum and urinary sulphadimidine acetylation as predictors of isoniazid acetylator status in patients with pulmonary tuberculosis.(1996-01-01) Singh, S P; Pande, J N; Khilnani, G C; Kailash, SThe acetylator status of 200 pulmonary tuberculosis patients was determined by sulphadimidine (SDM) acetylation in (1) urine and (2) serum. In both estimations, distribution of the patients with regard to the acetylation rates was found to be bimodal. Based on the percent frequency distribution of acetylated SDM, the antimode for urine and serum was 65% for the former and 45% for the latter. Patients acetylating above 65% or 45% of administered SDM were taken as rapid acetylators, while those acetylating less, were slow acetylators. The ratio of slow to rapid acetylators in urine and serum was 58 : 42 and 66 : 34 respectively. The renal clearance of acetylated fraction of SDM was considerably greater as compared to that of the unacetylated fraction. Agreement between the two methods as evaluated by the kappa statistic was 0.71. The determination of the acetylator status by the SDM acetylation test in the urine is simple to perform and has acceptable accuracy. It may be used as an acceptable substitute to serum for estimating the isoniazid inactivation status which is of considerable importance when patients are treated with daily/ intermittent/once-weekly drug regimens for tuberculosis.Item Critical illness polyneuropathy: how often do we diagnose it?(2003-07-18) Khilnani, G C; Bansal, Ravi; Malhotra, O P; Bhatia, MNeuromuscular weakness in critically ill patients is a diagnostic challenge. Critical illness polyneuropathy, an important cause of failure to wean from assisted ventilation is often missed due to lack of suspicion and initiative to undertake regular bedside neurological and electrophysiological examinations in critically ill patients. We report two cases who developed motor weakness while receiving mechanical ventilation in whom axonal neuropathy was diagnosed on electrophysiological studies, establishing a diagnosis of critical illness polyneuropathy. Both patients had evidence of sepsis and multiorgan failure. One case could be successfully weaned off and weakness improved while other succumbed to the underlying illness.Item Effect of corticosteroid treatment on various serological & bronchoalveolar lavage abnormalities in patients with sarcoidosis.(1995-05-01) Sharma, S K; Khanna, M; Sharma, S; Srivastava, L M; Verma, K; Khilnani, G C; Pande, J NEffect of daily oral prednisolone treatment was studied in 29 patients with pulmonary sarcoidosis. Twenty normal control subjects were also studied. Pretreatment absolute lymphocyte counts and proportion of lymphocytes in peripheral blood were significantly lower in patients with sarcoidosis as compared to normal controls. Total cell count and the proportion of lymphocytes in bronchoalveolar lavage (BAL) fluid were significantly higher in sarcoidosis. The proportion of CD3+ and CD4+ was significantly lower in peripheral blood and higher in BAL fluid in patients with sarcoidosis. Immunoglobulins (IgG, A and M) and complements (C3, C4 and CH50) were significantly higher both in peripheral blood and BAL fluid. Patients with sarcoidosis were treated with daily oral prednisolone (30 mg/day). Repeat studies were performed after an interval of 4-6 months in 20 patients with sarcoidosis. A significant increase in absolute lymphocyte counts in peripheral blood and decrease in the proportion of lymphocytes in BAL fluid occurred with prednisolone treatment. Proportion of CD3+, CD4+ and B cells increased in peripheral blood and decreased in BAL fluid. Complement and immunoglobulin levels revealed a significant reduction in peripheral blood and BAL fluid. It is concluded that patients with sarcoidosis have peripheral blood lymphopaenia and lymphocytic alveolitis. They have increased levels of complement and immunoglobulins both in the peripheral blood and BAL fluid. All these abnormalities show significant improvement with prednisolone treatment.Item Fibrinolytic therapy for parapneumonic effusion and empyema.(2002-04-25) Khilnani, G CItem Guidelines for diagnosis and management of community and hospital acquired pneumonia in adults: Joint ICS/ NCCP (I) recommendations.(2012-10) Gupta, Dheeraj; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Singh, Navneet; Mishra, Narayan; Khilnani, G C; Samaria, J K; Gaur, S N; Jindal, S K; Pneumonia Guidelines Working GroupItem Hemorrhagic pseudocyst of the adrenal gland causing acute abdominal pain.(2008-05-15) Khilnani, G C; Kumar, A; Bammigatti, C; Sharma, R; Gupta, S DAcute abdominal pain is a common clinical entity with varied etiology. Hemorrhagic pseudocysts of the adrenal gland are rare lesions that might be considered in the differential diagnosis of acute abdominal pain. Herein, we report a case of young married female presenting with acute pain abdomen and fever, who was diagnosed to have hemorrhagic pseudocyst of the adrenal gland.Item Immunologic & pulmonary function abnormalities in tropical pulmonary eosinophilia.(1995-03-01) Sharma, S K; Pande, J N; Khilnani, G C; Verma, K; Khanna, MTwenty six patients (24 males and 2 females) with tropical pulmonary eosinophilia (TPE) were studied. Arterial blood gas analysis, pulmonary functions, peripheral blood examination and bronchoalveolar lavage (BAL) were performed. Peripheral blood and BAL fluid analyses were performed in healthy volunteers. Pulmonary functions revealed a mild restrictive ventilatory defect with airways obstruction. Mild hypoxaemia was observed on arterial blood gas analysis. Serum immunoglobulins IgG (P < 0.01), IgA (P < 0.001) and IgM (P < 0.001) were significantly raised as compared to normal controls. Serum complement (C3) level was higher, however, it was not significantly different as compared to normal controls. Serum haemolytic component of the complement (CH50) was significantly higher (P < 0.001) in patients with TPE compared to normal control subjects. The immunoglobulins IgG, IgA and IgM in the BAL fluid were significantly (P < 0.001) increased as compared to normal controls. The fibronectin (FN) level was also significantly increased (P < 0.001) in the BAL fluid. It is concluded that patients with TPE have mild restrictive ventilatory defect with airways obstruction and mild hypoxaemia. They have eosinophilic alveolitis with increased levels of immunoglobulins in the peripheral blood and BAL fluid. The significance of elevated FN in the BAL fluid is not clear and serial estimations may have to be done in order to clarify its role in the pathogenesis of fibrosis in chronic TPE.Item Lipoid pneumonia: An uncommon entity.(2009-10) Khilnani, G C; Hadda, VLipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids.Item Management of severe sepsis: role of "bundles".(2009-01-26) Khilnani, G C; Hadda, VijaySepsis is the leading cause of hospital admissions, morbidity and mortality. Treating sepsis is expensive resulting in consumption of major health care resources. With development of newer and potent antimicrobial agents, moratlity due to sepsis has reduced markedly, but remains unacceptably high. Recently, various strategies like fluid therapy, low dose corticosteroids, tight glycaemic control, recombinant human activated protein C [(rhAPC), drotrecogin alfa] and lung protective ventilation have shown favourable results. Further, it is thought that combination of these strategies in the form of "bundles" can further improve the outcome. Concerted utilisation of the "sepsis bundles" is likely to improve outcome of this serious disorder.Item Mediastinal pseudocysts in chronic pancreatitis with spontaneous resolution.(2007-01-28) Santoshkumar, S; Seith, A; Rastogi, R; Khilnani, G CA 39 year old male, chronic alcoholic for 12 years, presented with recurrent abdominal pain for last 3 years. He was admitted in our hospital with history of breathlessness, chest pain and abdominal pain for last 20 days. On investigation he had raised total leukocyte count with elevated serum amylase and lipase. Chest radiograph showed mediastinal widening and ultrasound of abdomen revealed chronic pancreatitis with peripancreatic pseudocysts. CT scan revealed extensive phlegmonous collections with cyst formation in the mediastinum which extended from the level of thoracic inlet to below the level of the diaphragm. There were in addition multiple pancreatic and lesser sac pseudocysts. Patient was stable and was hence closely observed on conservative treatment with complete abstinence from alcohol. We performed no surgical, endoscopic or radiological interventions. A repeat CT performed after 14 weeks showed almost complete resolution of the mediastinal pseudocyst. Overall adequate conservative management and timely imaging follow-up before planning any intervention helped us to see that there can be spontaneous resolution of mediastinal pseudocysts.Item Multi drug resistant tuberculosis.(1994-07-01) Khilnani, G C; Sharma, S K; Pande, J NItem Neuromuscular weakness in critically ill.(2004-02-20) Khilnani, G C; Bansal, RNeuromuscular weakness in critically ill has been increasingly reported in the recent years. Occasionally it may lead to difficulty in weaning the patients from mechanical ventilation, which is difficult to diagnose clinically. Though in well-planned studies the incidence has been reported to be high, the diagnosis is often missed due to the presence of various confounding factors in the form of drug effects, underlying disorder and coexisting abnormalities of the central nervous system. A high index of suspicion with detailed neurological and electrophysiological examination is required for an early and accurate diagnosis. A wide spectrum of disorders and drugs can be responsible for the critical illness neuromuscular abnormality. The most frequent and defined disorders include; critical illness polyneuropathy (CIP) which is characterized by a sensorimotor reversible polyneuropathy presenting as distal symmetrical weakness with loss of deep tendon reflexes. Acute myopathy is another important disorder in this group which usually presents with quadriplegia often related to steroid use. Persistent blockade of neuromuscular junction is also defined in critically ill patients. It is, therefore, important to understand these disorders and their implications in the management of these patients. Some of the conditions require prolonged neuro-rehabilitation. The various acquired disorders leading to neuromuscular abnormalities in critical care, and their diagnosis and management are discussed.Item Non-invasive ventilation: current status.(2002-09-28) Khilnani, G C; Bhatta, NarendraMechanical ventilation is being increasingly used in many disciplines by specialists who manage critically ill patients. Non-invasive ventilation (NIV) refers to the method of providing assisted ventilation without endotracheal intubation. This technique requires a positive-pressure ventilator, connected by a tubing to an interface device that directs intermittent positive pressure through the upper airway and actively assists ventilation. The use of NIV is increasing for patients with acute and chronic respiratory failure, because of its convenience, lower cost and minimal complications. The greatest advantage of NIV is that endotracheal intubation is not required. Although it is an extremely useful technique, it cannot be used in all patients and correct patient selection is important. It has been extensively used in patients with chronic obstructive pulmonary disease with acute or acute-on-chronic respiratory failure. It has also been found to be useful in acute respiratory distress syndrome, acute cardiogenic pulmonary oedema and acute severe asthma. All patients with respiratory failure need to be considered for NIV if they fulfil the requisite criteria. Patients who are unable to protect the upper airway, those with severe life-threatening hypoxaemia, or major associated organ dysfunction are unlikely to benefit from this technique. Despite these limitations, NIV can be useful in many conditions that lead to respiratory failure. NIV is a relatively new technique and has not found a place in all intensive care units. It is expected that this modality will be used more frequently in the near future.Item Outdoor air pollution and emergency room visits at a hospital in Delhi.(2002-01-16) Pande, J N; Bhatta, Narendra; Biswas, Dilip; Pandey, Ravindra M; Ahluwalia, Gautam; Siddaramaiah, Naveen H; Khilnani, G CSeveral reports from large metropolitan cities have indicated significant association between acute morbidity and mortality from cardio-respiratory disorders and daily levels of major pollutants in the ambient air. Despite the wide-spread public concern about the adverse health effects of air pollution, there is substantial uncertainty regarding the effects of these pollutants at a concentration typical of Delhi, which is one of the ten most polluted cities in the world and the most polluted city in India. This study was undertaken to correlate the daily levels of various pollutants with the number of patients visiting the All India Institute of Medical Sciences (AIIMS, New Delhi) casualty for aggravation of certain defined cardiorespiratory disorders. Daily counts of patients visiting the emergency room of the AIIMS for acute asthma, acute exacerbation of chronic obstructive airway disease (COAD) and acute coronary event was obtained in prospective manner from January 1997 to December 1998. Daily mean levels of ambient CO, NOx and SO2 were monitored along with temperature and humidity. Data was analysed using one day time lag for events of interest. Time series analysis was undertaken using Poisson regression and population averaged general estimation equation, correcting for auto-correlation, days of the weak and season. The ambient levels of pollutants exceeded the national air quality standards on most of the days, over the two year period. Further, emergency room visits for asthma, COAD and acute coronary events increased by 21.30%, 24.90% and 24.30% respectively on account of higher than acceptable levels of pollutants. It is concluded that there is considerable burden of cardiorespiratory diseases in Delhi due to high levels of ambient air pollution.Item Peak expiratory flow rate in school-going children.(1997-04-01) Pande, J N; Mohan, A; Khilnani, S; Khilnani, G CPeak expiratory flow rate (PEFR) was measured with mini Wright's peak flow meter in 783 children (aged 6-17 years) from a school in urban Delhi and 523 children (aged 6-15 years) from another school in Nellore, Andhra Pradesh. In all the children, age in completed years, sex, height, weight, chest circumference at full inspiration and maximum chest expansion were recorded. Age, sex, height and weight were independent predictors of PEFR in children from Nellore. Age, sex and height, were independent predictors of PEFR in boys from Delhi while height alone was an independent predictor of PEFR in Delhi girls. Common prediction equations for predicting PEFR in boys and girls have been developed for both regions based on age and height. For the same height and age, boys had higher PEFR than girls. In the females, the PEFR seemed to have a plateaux effect after the age of 14 years; such an effect was, however, not seen in the boys in the age range studied. The PEFRs of children from both parts of the country were similar, and were lower than those reported for American white children.Item Primary pulmonary lymphoma presenting as lung mass.(2003-01-10) Khilnani, G C; Kumar, Arvind; Malhotra, O P; Datta Gupta, S; Bhatta, NarendraThe commonest cause of lung mass in an elderly patient is bronchogenic carcinoma. We are reporting an unusual case of lung mass that was diagnosed following exploratory thoracotomy and pneumonectomy. Sputum examination, bronchoscopy and percutaneous fine needle aspiration cytology were inconclusive. On histopathology, a diagnosis of non-Hodgkin's lymphoma (NHL) was made. There was no involvement of any other site on detailed work up. The patient was advised chemotherapy.Item Prolonged pyrexia in a diabetic due to systemic aspergillosis.(1997-11-07) Nagarkar, K M; Dey, A B; Ray, R; Chaudhury, D; Khilnani, G C; Kumar, VImmuno-compromised patients are susceptible to a variety of opportunistic infections. Systemic aspergillosis is one such common infection in neutropenic subjects. A case of primary cutaneous aspergillosis with fungimia in a diabetic is reported.