Ramakrishna Rachakonda

A twenty years old male college student came with history of hemoptysis. His chest X-ray showed diffuse infiltrative shadows and he was diagnosed as a case of a case of pulmonary tuberculosis with hemoptysis. On detailed investigations he was found to have Abernethy malformation Type-II with primitive portal vein joining extrahepatic inferior vanacava leading to cirrhosis of liver, porto-pulmonary syndrome, pulmonary arterial hypertension and hemoptysis.   Keywords: Abernethy Malformation, Hepatopulmonary syndrome, Extrahepatic shunt, Pulmonary arterial hypertension

Background: COVID-19 pandemic resulted in a death of 419 patients among total admissions of 10682 with a death rate of 3.92% in the tertiary care COVID-19 hospital. We studied the biochemical and hematological parameters among 241 patients who died of the disease. Results: CRP values were raised above 12mg/L in 58% of patients. 83% of patients had elevated LDH levels of >250 IU/L. Procalcitonin levels were above 0.5 microgram/L in nearly 66% of patients. Serum ferritin was more than 500 micrograms/L in 51% of patients. Elevated IL-6 were found in 83% of patients making it a significant inflammatory parameters. D-dimer levels were more than 500ng/ml in 74% of patients. HS Troponin I was raised in 83% of patients. Leukocytosis of more than 11000/Cu mm was seen in 38%. Leukopenia was seen in 35%. Thrombocytopenia was seen in 27% and normal platelet count was seen in 62%. Conclusions: Biochemical parameters help in assessing the severity of inflammation in COVID-19 disease. They aid in the process of treatment particularly anticoagulants and corticosteroid. Specific parameters like IL-6 can help in decision making by treating physician regarding the use of anti IL-6 drugs like Tocilizumab. Elevated HS troponin I in our study showed myocardial injury played a significant role in mortality of COVID 19 patients at our centre. Keywords: Creactive protein (CRP), Ferritin, Ddimer, Procalcitonin (PCT), Lactic dehydrogenase (LDH), IL6, HS Tropanin I.

Background: We have studied the pattern of COVID-19 epidemic in Andhra Pradesh and compared with other high burden states in India utilizing Government of India statistics. We have compared the Indian figures with the statistics in other countries. Materials and Methods: We have analyzed the data published by Ministry of Health and family Welfare Government of India, Government of Andhra Pradesh and WHO statistics as well as worldometer statistics. We have studied the hospital statistics of our tertiary care COVID center and analyzed the results. Results: The statistics revealed highest number of cases are seen in United States of America with case fatality rate of 1.74%. Mexico has highest case fatality rate of 8.5%. Italy has 3.5% and United Kingdom 2.8%.In India Maharashtra has highest number of COVID-19 casualties with case fatality of 2.52%. Indian national average of case fatality is 1.47%. Andhra Pradesh has a case fatality of 0.80%. In Andhra Pradesh the pandemic of COVID-19 peaked in the months of August and September both in terms of number of cases and deaths and then decline started. Hospital based records showed a death rate of 3.92%. Keywords: COVID 19, Corona Virus Hydroxychloroquine, Ivermectin, Remedesivir.

Background: A total of 10682 patients were admitted in our tertiary care COVID hospital from April 2020 to January 2021. 419 patients died with a mortality rate of 3.92%. We have analysed 241 deaths that have taken place till 10th September 2020. Methodology: We studied the history, symptomatology, HRCT chest, comorbidities, duration of hospital stay and special drugs administered along with the type of oxygen therapy. Results: 88% of patients have more than 30% lung burden by HRCT. All the patients have a CO-RADS score of 4 or more. 81% of the patients have CT severity index of 15/25 or more. The CO-RADS classification is a standardized reporting system for patients with suspected COVID-19 infection developed for a moderate to high prevalence setting. 71% of patients expired within first five days of admission. 23% of patients died in 5 to 10 days of admission. 80% of patients presenting with < 80> Conclusions: Patients dying of COVID-19 disease had significant CT scan changes suggestive of corona disease. Past history of lung disease was seen in only a third. Shortness of breath was the commonest symptom and majority of the patients presented with SPO2 of Keywords: COVID 19, Corona, CORADS Score, Lung burden, CT severity Index, Happy hypoxia, MMRC scale.

Background: Primary lung cancer is a leading cause of cancer related death all over the world. In Indian scenario lung cancer is increasingly diagnosed because of beedi and cigarette smoking and majority of times diagnosed in an inoperable stage resulting in poor prognosis. Materials and Methods: In this study we have analysed the diagnostic modalities and histo-pathological analysis of the specimen obtained and correlated with the smoking status and age of the patients. A total of 113 patients having clinical and radiological profile suggestive of primary lung cancer are taken in to the study. Among them only 100 patients were diagnosed as malignancy by histopathological examination. For the confirmation of the diagnosis transthoracic needle aspiration biopsy with the help of ultrasonography and CT scan, bronchoscopic biopsy and bronchial washings, lymph node biopsy and pleural fluid analysis were undertaken. Results: Positive specimens were obtained by TTNA in 54%, Bronchoscopic biopsy and washings in 30%, pleural fluid analysis in 12% and lymph node biopsy in 4% of patients. 82% are males and 18% are females. 82% are smokers and 18% are nonsmokers. 68 patients presented with mass lesions and 73% of them presented with a mass of >5cm in diameter. 27% presented as mass lesions less than 5cm in diameter. Smokers have more mass lesions and more N3 disease and the values are statistically significant. (p

Background: To study the clinical and radiological profile of patients diagnosed to have primary lung cancer in our tertiary care centre. Methodology: 100 patients diagnosed as primary lung cancer were studied by clinical, radiological, biochemical and histopathological examination. Results: 82% patients are males and 18% are females. Average age of the patients was 57.6. 82% of them are smokers and 18% are non smokers. Non smoking females gave the history of exposure to passive smoking or biological fuel. All the patients were symptomatic at the time of diagnosis and commonest symptom was cough. Hemoptysis was seen in 22%. History of Pulmonary tuberculosis was seen in 19.5% of males and 11.1% of females. 79% of patients belong to above 51 years of age. 87.82% of patients gave a smoking history of more than 20 pack years. Right lung, upper and middle lobes are commonly involved. 68% of patients presented with mass lesions. Predominant symptom was cough present in all patients followed by shortness of breath and chest pain. Mass and intrathoracic lymphadenopathy were common presentation. 74% patients presented with contralateral hilar. Sub-carinal, contralateral mediastinal or supraclavicular lymphadenopathy suggesting inoperability. Single or multiple site extra-pulmonary metastasis was seen in liver, bone, brain and adrenals. Conclusions: Primary lung cancer is a disease of 6th decade. Smoking is a significant causative factor. Most of the patients presented in inoperable state. Measures to discourage smoking habits among youth can prevent the dreadful disease to some extent. Keywords: Primary lung cancer; Hemoptysis; Mass lesion; Lymphadenopathy; Metastasis.

Introduction: Idiopathic interstitial pulmonary fibrosis is an important debilitating disease among the interstitial lung diseases, frequently diagnosed with the help of HRCT among the symptomatics. Materials and Methods: We have studied a total of 48 cases of IPF over a span of two and half years. Among a total of 104 ILDs attending our tertiary care centre IPF constituted 48 cases accounting for 46%. IPF cases are diagnosed on the basis of clinical history and hRCT findings. Results: There is a female preponderance of 1.4:1. Mean age of IPF patients in our study is 57.9 years. Mean age in females is 60.71 and 53.9 in males.Among our 48 cases of radiologically diagnosed IPF forty patients had definite UIP Pattern and 8 patients have possible UIP pattern as defined by the radiologist. The frequency of difinite IPF cases increased with severity of symptoms as measured by MMRC scale and the association is statistically significant. More than 90% of patients expressed tiresomeness and breathlessness. Cough was seen in 60% and pain chest was found in 45% of IPF patients. There is a statistically significant correlation of disease severity measured by MMRC scale with decrease in DLCO. BAL fluid lavage showed predominant neutrophils in >90% of IPF patients. Severity of IPF measured by MMRC correlated with decrease in 6 minute walk distance(p Summary and Conclusion: Idiopathic interstitial pulmonary fibrosis is a debilitating disease. Constitutes significant proportion of ILDs. Females outnumbered males. Tiresomeness and breathlessness are predominat symptoms. Disease occurred at a much earlier age in males. Active and passive smoking possibly contributes to the severity of IPF. MMRC grade correlates significantly with DLCO, 6 minute walk distance and definite UIP. There is no statistically significant correlation of MMRC grade with severity of PAH and FVC values. Keywords: Interstitial Lung Disease (ILD); Idiopathic Pulmonary Fibrosis (IPF); MMRC Grade, Desaturation; Broncho alveolar lavage; DLCO.

Introduction: Interstitial Lung Diseases are frequent causes of morbidity and mortality and are frequently diagnosed because of the usage of High Resolution Computerised Tomography (HRCT). Interstitial Lung Diseases (ILDs) result from known and unknown causes and result in variable amount of interstitial and pulmonary parenchymal inflammation and fibrosis. Material and Methods: A total of 104 patients diagnosed on the basis of clinical and radiological criteria as interstitial Lung disease attending Katuri Medical College Hospital, Guntur from June 2015 to June 2018 above 18 years of age were taken in to the study. Results: Predominant interstitial lung disease was idiopathic interstitial fibrosis (IPF) (46%). Non-IPF interstitial lung diseases constituted 56%. Females outnumbered males in our study with a ratio of 1.7:1. Mean age of the ILD patients was 50.19. Cough and breathlessness were universal in our ILD patients. There are equal number of smokers and nonsmokers. > 75% of patients presented with Grade II MMRC or more. 75% of our patients of ILD desaturated on 6 minute walk testing. PFT revealed restrictive pattern in 69%, mixed pattern in 26.92% and obstructive pattern in 4%. 50% of patients had DLCO of more than 60%. Smoking history correlated with decrease in DLCO. BAL fluid analysis suggested neutrophilic preponderance in 42% and lymphocytic preponderance in 58%.Basing on the clinical and radiological criteria IPF was diagnosed in 46%, NSIP in 21%, NSIP CTD in 12% and Hypersensitivity Pneumonitis in 14%. 62.5% had associated pulmonary arterial hypertension. Smoking history correlated with presence of PAH. Conclusions: ILDs are common in clinical practice. Diagnosed predominantly after the frequent usage of HRCT in symptomatic patients. History analysis, clinical examination, chest X-ray, bronchoscopy, bronchoalveolar lavage (BAL), pulmonary Function Testing, six minute walk test, echocardiography, carbon dioxide diffusion capacity (DLCO) testing help in the diagnosis. Keywords: Desaturation; Sarcoidosis; Hypersensitivity pneumonitis; Pulmonary arterial hypertension.