Dr. Raja Dhar - Academia.edu (original) (raw)
Papers by Dr. Raja Dhar
The European respiratory journal, Dec 8, 2022
Introduction: Galactomannan (GM) is a component of Aspergillus cell wall. The usefulness of GM le... more Introduction: Galactomannan (GM) is a component of Aspergillus cell wall. The usefulness of GM levels in body fluids is still unclear. We evaluated the utility of Bronchoalveolar Lavage (BAL) GM testing in patients with suspected pulmonary Aspergillosis. Aims and Objectives: To assess the utility of BAL Galactomannan assay in diagnosis of pulmonary Aspergillus infections Methods: 90 consecutive patients with suspicion of pulmonary Aspergillosis, based on pre-defined clinic-radiological parameters, were included in our study. BAL samples obtained via fibre optic bronchoscopy were tested for routine microbiology and Galactomannan(GM). Data was collected and multivariate analysis done. Results: 50 patients (55.56 %) were found to have BAL GM >0.8, a cut off considered as positive. 13 samples were fungal smear/fungal culture positive for Aspergillus spp. and BAL GM was positive in 11 of these samples (84.62%; p=0.04794) with a mean GM of 1.65. 39 patients with negative fungal smear/culture but BAL GM positive (mean GM=0.97) were also prescribed systemic anti-fungal drugs and clinico-radiological improvement was seen in these patients. BAL GM was positive in 18 of 20 patients with bronchiectasis (90%; p=0.0011) and in up to 65 % patients with asthma or COPD. Smoking history or biomass fuel exposure also showed a trend towards positivity with BAL GM value. Conclusion: In patients with suspicion of pulmonary Aspergillosis, BAL galactomannan level was found to be a better marker than fungal smear/culture. While microbiological and histopathological evidences are gold standard to diagnose fungal infections, our study shows that in patients with negative fungal smear or culture, BAL Galactomannan can be conclusive for diagnosis.
PubMed, Feb 1, 2012
... AG Ghoshal1, Raja Dhar2, Susmita Kundu3 1Director,National Allergy Asthma Bronchitis Institut... more ... AG Ghoshal1, Raja Dhar2, Susmita Kundu3 1Director,National Allergy Asthma Bronchitis Institute, Kolkata – 700017. ... 22. Chawla, Rajesh; Khilnani, G; Suri, J; Ramakrishnan N; Mani, R; Prayag, Shirish; Nagarkar, Shruti; Kansal, Sudha; Sidhu, U; Kumar, Vijay.Guideline for ...
Clinical & Experimental Allergy, Apr 16, 2023
Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by immune‐mediated react... more Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by immune‐mediated reactions mounted against Aspergillus fumigatus. The disorder most commonly complicates the course of patients with asthma and cystic fibrosis. From its first description in 1952, significant advances have been made in understanding the pathogenesis and the diagnosis and treatment of ABPA. In the last two decades, most research on ABPA has been published from India. The prevalence and clinical presentation may differ in India from that reported elsewhere. Herein, we review the epidemiology, clinical and radiological characteristics, and distinctive features of ABPA in the Indian subcontinent. To support the review, we surveyed pulmonologists nationwide to understand the challenges in diagnosing and managing ABPA. The survey has yielded valuable insights into the practices associated with the diagnosis and management of ABPA in India.
The European respiratory journal, Jun 1, 2022
PubMed, May 1, 2017
Recent years have seen an increase in the use of nebulizers for delivering maintenance therapy in... more Recent years have seen an increase in the use of nebulizers for delivering maintenance therapy in obstructive airway diseases (OADs) such as asthma and chronic obstructive pulmonary disease (COPD). The probable factors associated with this increase at home are: convenience of drug delivery, technological advances making the nebulizer equipment more efficient and portable, increase in the prevalence of OADs and the ageing population which may impact the optimal use of handheld inhalers such as pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs). Although there is increase in the use of maintenance therapy with nebulization, there has been no such increase in the evidence base available for the appropriate use of nebulizers. The last international guidelines were published in 2001. Hence there is a need to address this knowledge gap especially with the widespread use of home nebulization in India. With this objective, we organized a consensus meeting to address certain critical questions pertaining to the use of nebulizers for maintenance treatment in OADs. This article presents the findings of the consensus panel on the use of maintenance treatment of OADs with nebulization at home.
Infection Control and Hospital Epidemiology, Dec 31, 2018
PubMed, 2012
Patients with co-existing illnesses like COPD, Diabetes Mellitus, Renal failure, Congestive Heart... more Patients with co-existing illnesses like COPD, Diabetes Mellitus, Renal failure, Congestive Heart Failure, Coronary Artery disease, malignancy, Chronic Neurological disease and Chronic liver disease have increased incidence of CAP. 2 Patients with CAP and certain co-morbidities have increased mortality. 5 These risk factors include diabetes mellitus, coronary artery disease, CHF, immunosuppression, neurologic disease, active malignancies, alcohol consumption, increasing age, bacteremia, leukopenia, hypotension, altered mental status, tachypnea, hypoxemia, aspiration pneumonia, and infections due to gramnegative organisms.
The Indian journal of chest diseases & allied sciences, Nov 18, 2022
Background. Idiopathic pulmonary fibrosis (IPF) is a specific type of chronic fibrosing interstit... more Background. Idiopathic pulmonary fibrosis (IPF) is a specific type of chronic fibrosing interstitial lung disease (ILD) that is progressive in course. Although evidence-based guidelines for IPF are available, these are difficult to interpret for the average physician and may not be suitable for use in resource-constrained settings. There was an unmet need to formulate guidelines that are pragmatic, easy to understand and suited for application in resource-limited settings. Methods. This statement was made by a group of expert pulmonologists. Twenty-five questions regarding diagnosis and management of IPF were framed. A literature search was conducted using the PubMed and EmBase databases. The expert group discussed available evidence relevant to each question and recommendations were arrived at by consensus. Results. A thorough clinical and laboratory evaluation should be performed in patients suspected to have ILDs and potential underlying causes should be ruled out. A high resolution computed tomography (HRCT) of the chest is essential to identify the pattern of ILD. The need for a lung biopsy should be decided based on the appearance on the HRCT. Once a diagnosis of IPF is made, anti-fibrotic drugs (pirfenidone or nintedanib) should be offered after discussing the expected benefits and potential adverse effects with the patient. Recommendations have been made on other issues in the management of IPF, such as management of cough and dyspnoea, role of supplemental oxygen, mechanical ventilation and lung transplantation. Conclusion. This consensus statement provides practical and easy-to-use recommendations for the diagnosis and management of IPF in resource-limited settings. 2018;Vol.60 The Indian Journal of Chest Diseases & Allied Sciences 93 94 Consensus Statement on IPF Sahajal Dhooria et al 96 Consensus Statement on IPF Sahajal Dhooria et al Diagnosis of Idiopathic Pulmonary Fibrosis Q 4. What is the role of chest radiograph and computed tomography scanning to establish DPLD? What are the high resolution computed tomography criteria for diagnosis of IPF? Consensus Statement on IPF Sahajal Dhooria et al
The European respiratory journal, 2017
We highly appreciate the laudable desire of the European Multicentre Bronchiectasis Audit and Res... more We highly appreciate the laudable desire of the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) [1] to provoke research interests and develop study protocols to investigate bronchiectasis, a disease which has not yet received sufficient attention worldwide, particularly in China. China is a major developing country with a large population; however, there is a lack of epidemiological investigations detailing the prevalence or incidence of bronchiectasis. While we totally concur with the recommendations from European experts, we feel that additional priorities in bronchiectasis should be highlighted for future research in China.
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2013
Astrocyte, 2017
There has been an ever-expanding list of isolation of organisms in the genus Mycobacterium. Lepro... more There has been an ever-expanding list of isolation of organisms in the genus Mycobacterium. Leprosy and tuberculosis are specific diseases caused by mycobacteria; there are now several other mycobacteria that cause human diseases and can be widely found in the environment. These other mycobacteria are called as nontuberculous mycobacteria (NTM) or mycobacteria other than tubercle bacilli (MOTT) or atypical mycobacteria. They cause various human infections in the lungs, lymph glands, skin, wounds, or bone. They may also produce disseminated disease, especially in the immunocompromised. Various molecular, biochemical, and chemical techniques have been developed for rapid identification of these species. While it might be difficult to treat these infections, with duration of treatment longer than that for tuberculosis or leprosy, many drugs such as rifampicin, rifabutin, ethambutol, clofazimine, amikacin, new generation quinolones, and macrolides effective against mycobacterial infections are available that can be used in appropriate combinations and dosage to treat the NTM.
Respirology, Apr 19, 2021
Understanding the aetiology and characteristics of patients with bronchiectasis is vital for deve... more Understanding the aetiology and characteristics of patients with bronchiectasis is vital for developing strategies to reduce the burden of disease; however, geographical variations in these characteristics, which may have important implications for diagnosis and treatment, 1,2 make it difficult to formulate a uniform strategy for investigation. Here, we describe the burden of illness and treatment among Korean bronchiectasis patients and compare the results with those from three geographically and ethnically diverse regions: Australia, Europe and India. The Korean Multicentre Bronchiectasis Audit and Research Collaboration (KMBARC) is a prospective, noninterventional observational study. 3 Data were collected from 598 patients enrolled in the KMBARC registry between August 2018 and December 2019. The KMBARC registry design and data collection fields are closely aligned with those used by other registries. Detailed information on
The Journal of Association of Chest Physicians, 2016
The European respiratory journal, Dec 8, 2022
Introduction: Galactomannan (GM) is a component of Aspergillus cell wall. The usefulness of GM le... more Introduction: Galactomannan (GM) is a component of Aspergillus cell wall. The usefulness of GM levels in body fluids is still unclear. We evaluated the utility of Bronchoalveolar Lavage (BAL) GM testing in patients with suspected pulmonary Aspergillosis. Aims and Objectives: To assess the utility of BAL Galactomannan assay in diagnosis of pulmonary Aspergillus infections Methods: 90 consecutive patients with suspicion of pulmonary Aspergillosis, based on pre-defined clinic-radiological parameters, were included in our study. BAL samples obtained via fibre optic bronchoscopy were tested for routine microbiology and Galactomannan(GM). Data was collected and multivariate analysis done. Results: 50 patients (55.56 %) were found to have BAL GM >0.8, a cut off considered as positive. 13 samples were fungal smear/fungal culture positive for Aspergillus spp. and BAL GM was positive in 11 of these samples (84.62%; p=0.04794) with a mean GM of 1.65. 39 patients with negative fungal smear/culture but BAL GM positive (mean GM=0.97) were also prescribed systemic anti-fungal drugs and clinico-radiological improvement was seen in these patients. BAL GM was positive in 18 of 20 patients with bronchiectasis (90%; p=0.0011) and in up to 65 % patients with asthma or COPD. Smoking history or biomass fuel exposure also showed a trend towards positivity with BAL GM value. Conclusion: In patients with suspicion of pulmonary Aspergillosis, BAL galactomannan level was found to be a better marker than fungal smear/culture. While microbiological and histopathological evidences are gold standard to diagnose fungal infections, our study shows that in patients with negative fungal smear or culture, BAL Galactomannan can be conclusive for diagnosis.
PubMed, Feb 1, 2012
... AG Ghoshal1, Raja Dhar2, Susmita Kundu3 1Director,National Allergy Asthma Bronchitis Institut... more ... AG Ghoshal1, Raja Dhar2, Susmita Kundu3 1Director,National Allergy Asthma Bronchitis Institute, Kolkata – 700017. ... 22. Chawla, Rajesh; Khilnani, G; Suri, J; Ramakrishnan N; Mani, R; Prayag, Shirish; Nagarkar, Shruti; Kansal, Sudha; Sidhu, U; Kumar, Vijay.Guideline for ...
Clinical & Experimental Allergy, Apr 16, 2023
Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by immune‐mediated react... more Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by immune‐mediated reactions mounted against Aspergillus fumigatus. The disorder most commonly complicates the course of patients with asthma and cystic fibrosis. From its first description in 1952, significant advances have been made in understanding the pathogenesis and the diagnosis and treatment of ABPA. In the last two decades, most research on ABPA has been published from India. The prevalence and clinical presentation may differ in India from that reported elsewhere. Herein, we review the epidemiology, clinical and radiological characteristics, and distinctive features of ABPA in the Indian subcontinent. To support the review, we surveyed pulmonologists nationwide to understand the challenges in diagnosing and managing ABPA. The survey has yielded valuable insights into the practices associated with the diagnosis and management of ABPA in India.
The European respiratory journal, Jun 1, 2022
PubMed, May 1, 2017
Recent years have seen an increase in the use of nebulizers for delivering maintenance therapy in... more Recent years have seen an increase in the use of nebulizers for delivering maintenance therapy in obstructive airway diseases (OADs) such as asthma and chronic obstructive pulmonary disease (COPD). The probable factors associated with this increase at home are: convenience of drug delivery, technological advances making the nebulizer equipment more efficient and portable, increase in the prevalence of OADs and the ageing population which may impact the optimal use of handheld inhalers such as pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs). Although there is increase in the use of maintenance therapy with nebulization, there has been no such increase in the evidence base available for the appropriate use of nebulizers. The last international guidelines were published in 2001. Hence there is a need to address this knowledge gap especially with the widespread use of home nebulization in India. With this objective, we organized a consensus meeting to address certain critical questions pertaining to the use of nebulizers for maintenance treatment in OADs. This article presents the findings of the consensus panel on the use of maintenance treatment of OADs with nebulization at home.
Infection Control and Hospital Epidemiology, Dec 31, 2018
PubMed, 2012
Patients with co-existing illnesses like COPD, Diabetes Mellitus, Renal failure, Congestive Heart... more Patients with co-existing illnesses like COPD, Diabetes Mellitus, Renal failure, Congestive Heart Failure, Coronary Artery disease, malignancy, Chronic Neurological disease and Chronic liver disease have increased incidence of CAP. 2 Patients with CAP and certain co-morbidities have increased mortality. 5 These risk factors include diabetes mellitus, coronary artery disease, CHF, immunosuppression, neurologic disease, active malignancies, alcohol consumption, increasing age, bacteremia, leukopenia, hypotension, altered mental status, tachypnea, hypoxemia, aspiration pneumonia, and infections due to gramnegative organisms.
The Indian journal of chest diseases & allied sciences, Nov 18, 2022
Background. Idiopathic pulmonary fibrosis (IPF) is a specific type of chronic fibrosing interstit... more Background. Idiopathic pulmonary fibrosis (IPF) is a specific type of chronic fibrosing interstitial lung disease (ILD) that is progressive in course. Although evidence-based guidelines for IPF are available, these are difficult to interpret for the average physician and may not be suitable for use in resource-constrained settings. There was an unmet need to formulate guidelines that are pragmatic, easy to understand and suited for application in resource-limited settings. Methods. This statement was made by a group of expert pulmonologists. Twenty-five questions regarding diagnosis and management of IPF were framed. A literature search was conducted using the PubMed and EmBase databases. The expert group discussed available evidence relevant to each question and recommendations were arrived at by consensus. Results. A thorough clinical and laboratory evaluation should be performed in patients suspected to have ILDs and potential underlying causes should be ruled out. A high resolution computed tomography (HRCT) of the chest is essential to identify the pattern of ILD. The need for a lung biopsy should be decided based on the appearance on the HRCT. Once a diagnosis of IPF is made, anti-fibrotic drugs (pirfenidone or nintedanib) should be offered after discussing the expected benefits and potential adverse effects with the patient. Recommendations have been made on other issues in the management of IPF, such as management of cough and dyspnoea, role of supplemental oxygen, mechanical ventilation and lung transplantation. Conclusion. This consensus statement provides practical and easy-to-use recommendations for the diagnosis and management of IPF in resource-limited settings. 2018;Vol.60 The Indian Journal of Chest Diseases & Allied Sciences 93 94 Consensus Statement on IPF Sahajal Dhooria et al 96 Consensus Statement on IPF Sahajal Dhooria et al Diagnosis of Idiopathic Pulmonary Fibrosis Q 4. What is the role of chest radiograph and computed tomography scanning to establish DPLD? What are the high resolution computed tomography criteria for diagnosis of IPF? Consensus Statement on IPF Sahajal Dhooria et al
The European respiratory journal, 2017
We highly appreciate the laudable desire of the European Multicentre Bronchiectasis Audit and Res... more We highly appreciate the laudable desire of the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) [1] to provoke research interests and develop study protocols to investigate bronchiectasis, a disease which has not yet received sufficient attention worldwide, particularly in China. China is a major developing country with a large population; however, there is a lack of epidemiological investigations detailing the prevalence or incidence of bronchiectasis. While we totally concur with the recommendations from European experts, we feel that additional priorities in bronchiectasis should be highlighted for future research in China.
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2013
Astrocyte, 2017
There has been an ever-expanding list of isolation of organisms in the genus Mycobacterium. Lepro... more There has been an ever-expanding list of isolation of organisms in the genus Mycobacterium. Leprosy and tuberculosis are specific diseases caused by mycobacteria; there are now several other mycobacteria that cause human diseases and can be widely found in the environment. These other mycobacteria are called as nontuberculous mycobacteria (NTM) or mycobacteria other than tubercle bacilli (MOTT) or atypical mycobacteria. They cause various human infections in the lungs, lymph glands, skin, wounds, or bone. They may also produce disseminated disease, especially in the immunocompromised. Various molecular, biochemical, and chemical techniques have been developed for rapid identification of these species. While it might be difficult to treat these infections, with duration of treatment longer than that for tuberculosis or leprosy, many drugs such as rifampicin, rifabutin, ethambutol, clofazimine, amikacin, new generation quinolones, and macrolides effective against mycobacterial infections are available that can be used in appropriate combinations and dosage to treat the NTM.
Respirology, Apr 19, 2021
Understanding the aetiology and characteristics of patients with bronchiectasis is vital for deve... more Understanding the aetiology and characteristics of patients with bronchiectasis is vital for developing strategies to reduce the burden of disease; however, geographical variations in these characteristics, which may have important implications for diagnosis and treatment, 1,2 make it difficult to formulate a uniform strategy for investigation. Here, we describe the burden of illness and treatment among Korean bronchiectasis patients and compare the results with those from three geographically and ethnically diverse regions: Australia, Europe and India. The Korean Multicentre Bronchiectasis Audit and Research Collaboration (KMBARC) is a prospective, noninterventional observational study. 3 Data were collected from 598 patients enrolled in the KMBARC registry between August 2018 and December 2019. The KMBARC registry design and data collection fields are closely aligned with those used by other registries. Detailed information on
The Journal of Association of Chest Physicians, 2016