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EDITORIAL |
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Flu and pulmonary fibrosis |
p. 95 |
Bharat Bhushan Sharma, Virendra Singh DOI:10.4103/0970-2113.110412 PMID:23741087 |
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ORIGINAL ARTICLES |
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Fat embolism syndrome in long bone trauma following vehicular accidents: Experience from a tertiary care hospital in north India |
p. 97 |
Parvaiz A Koul, Feroze Ahmad, Showkat A Gurcoo, Umar H Khan, Imtiyaz A Naqash, Suhail Sidiq, Rafi Ahmad Jan, Ajaz N Koul, Mohammad Ashraf, Mubasher Ahmad Bhat DOI:10.4103/0970-2113.110413 PMID:23741088Background: Fat embolism syndrome (FES) is a clinical problem arising mainly due to fractures particularly of long bones and pelvis. Not much literature is available about FES from the Indian subcontinent. Materials and Methods: Thirty-five patients referred/admitted prospectively over a 3-year period for suspected FES to a north Indian tertiary care center and satisfying the clinical criteria proposed by Gurd and Wilson, and Schonfeld were included in the study. Clinical features, risk factors, complications, response to treatment and any sequelae were recorded. Results: The patients (all male) presented with acute onset breathlessness, 36-120 hours following major bone trauma due to vehicular accidents. Associated features included features of cerebral dysfunction ( n = 24, 69%), petechial rash (14%), tachycardia (94%) and fever (46%). Hypoxemia was demonstrable in 80% cases, thrombocytopenia in 91%, anemia in 94% and hypoalbuminemia in 59%. Bilateral alveolar infiltrates were seen on chest radiography in 28 patients and there was evidence of bilateral ground glass appearance in 5 patients on CT. Eleven patients required ventilatory assistance whereas others were treated with supportive management. Three patients expired due to associated sepsis and respiratory failure, whereas others recovered with a mean hospital stay of 9 days. No long term sequelae were observed. Conclusion: FES remains a clinical challenge and is a diagnosis of exclusion based only on clinical grounds because of the absence of any specific laboratory test. A high index of suspicion is required for diagnosis and initiating supportive management in patients with traumatic fractures, especially in those having undergone an invasive orthopedic procedure. |
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Annual change in spirometric parameters among patients affected in Bhopal gas disaster: A retrospective observational study |
p. 103 |
Sajal De PMID:23741089Background: The involvement of respiratory system due to inhalation of methyl isocyanate (MIC) during Bhopal gas disaster was particularly severe. We retrospectively evaluated the annual changes in spirometric parameters among those who were affected in this disaster (exposed survivors) and had respiratory symptoms. Materials and Methods: Spirometry reports of exposed survivors that were carried out in our institution were retrospectively reviewed and we identified 252 subjects who had performed spirometry at least twice with interval of more than one year. The annual changes in spirometric indices of them were calculated. Results: The average age of study population was 55.7 years and 72% were male. Annual decline of FEV 1 ≥ 40 ml/yr was observed among 48% exposed survivors. The mean annual decline of FEV 1 among symptomatic exposed survivors with initial normal spirometry was 91 ml (95% CI: 52 ml to 130 ml) and this was more than the patients with initial obstructive pattern. Among fifty four patients with initial normal spirometry, ten patients (18.5%) developed obstructive and two patients (5%) developed restrictive lung function abnormalities during follow up spirometry. Conclusion: The exposed survivors with chronic respiratory symptoms had accelerated decline in lung function and they are at higher risk of developing obstructive lung function. |
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Pulmonary function tests in type 2 diabetes mellitus and their association with glycemic control and duration of the disease |
p. 108 |
Swati H Shah, Pranali Sonawane, Pradeep Nahar, Savita Vaidya, Sundeep Salvi DOI:10.4103/0970-2113.110417 PMID:23741090Background: Pulmonary complications of diabetes mellitus (DM) have been poorly characterized. Some authors have reported normal pulmonary functions and even concluded that spirometry is not at all necessary in diabetic patients. Some studies have shown abnormal respiratory parameters in patients of DM. Moreover, the duration of DM and glycemic control have varied impact on the pulmonary functions. Aims and Objectives: The study was undertaken to analyze the pulmonary function parameters in diabetic patients and compare them with age and gender matched healthy subjects. We correlated forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV 1 ) in diabetic patients with duration of the disease and glycosylated hemoglobin (HbA1c). Materials and Methods: Pulmonary function tests (PFTs) were recorded in 60 type 2 diabetic male patients and 60 normal healthy male controls aged 40-60 years by using Helios 702 spirometer. The PFTs recorded were - FVC, FEV 1 , FEV 1 /FVC, FEF 25 , FEF 50 , FEF 75 , FEF 25-75 , FEF 0.2-1.2 , and peak expiratory flow rate (PEFR). HbA1c of all the patients was estimated by ion exchange resin method, which is a very standard method of estimation. PFTs of diabetic patients and controls were compared by applying Student's unpaired t test. Associations between FVC and FEV 1 and HbA1c and duration of illness in diabetic patients were analyzed by applying Pearson's coefficient. Results: The PFTs were significantly decreased in diabetic patients compared with the healthy controls except FEV 1 /FVC. There was no correlation found between FVC and FEV 1 and duration of illness as well as HbA1c. Conclusion: DM being a systemic disease, which also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues, reduced pulmonary elastic recoil and inflammatory changes in lungs. We found glycemic levels and duration of disease are probably not the major determinants of lung pathology, which requires further research. |
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Evaluation of cariogenic potential of dry powder inhalers: A case-control study |
p. 113 |
Navneet Godara, Megha Khullar, Ramya Godara, Virendra Singh DOI:10.4103/0970-2113.110418 PMID:23741091Objective: Dry powder inhalers (DPIs) are commonly employed in the management of asthma and other diseases with airway obstruction. A causal relationship of DPI use and occurrence of dental caries has been speculated. The present case-control study was therefore designed to examine the potential link between dental caries and specific use of dry powder inhalers in patients with bronchial asthma. Materials and Methods: The present study was conducted on 100 asthmatic patients aged between 10 and 45 years who were using DPIs for at least one year. The control group (n = 100) was selected from non-asthmatic individuals and were matched with the study group with respect to age, gender, and socio-economic status. Results: The results revealed that asthmatic subjects exhibited higher occurrence of dental caries in comparison to control group, but the difference was statistically non-significant. The mean decayed, missing, and filled teeth (DMFT) indices scores in asthmatic and control group were found to be 1.71 ± 2.34 SD and 1.46 ± 1.89 SD (P = 0.408), respectively. Likewise, the mean decayed, missing, and filled surfaces (DMFS) indices scores in both the groups were 2.41 ± 3.84 SD and 2.34 ± 4.48 SD (P = 0.90). However, increased frequency of DPI use was associated with significant risk of caries (P = 0.01). It has been observed that oral rinsing after an inhaler use limited the occurrence of dental caries to a certain extent although was non significant. Conclusions: Dry powder inhaler use in patients with bronchial asthma was not associated with significant risk of dental caries. |
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Usefulness of induced sputum eosinophil count to assess severity and treatment outcome in asthma patients |
p. 117 |
Ankan Bandyopadhyay, Partha P Roy, Kaushik Saha, Semanti Chakraborty, Debraj Jash, Debabrata Saha DOI:10.4103/0970-2113.110419 PMID:23741092Context: Currently treatment decisions in asthma are governed by clinical assessment and spirometry. Sputum eosinophil, being a marker of airway inflammation, can serve as a tool for assessing severity and response to treatment in asthma patients. Aims: To establish correlation between change in sputum eosinophil count and forced expiratory volume in one second (FEV 1 ) % predicted value of asthma patients in response to treatment. In this study, we also predicted prognosis and treatment outcome of asthma patients from baseline sputum eosinophil count. Settings and Design: A longitudinal study was conducted to determine the treatment outcome among newly diagnosed asthma patients who were classified into A (n = 80) and B (n = 80) groups on the basis of initial sputum eosinophil count (A ≥ 3% and B < 3%). Materials and Methods: After starting treatment according to Global Initiative for Asthma Guideline, both A and B groups were evaluated every 15 days interval for the 1 st month and monthly thereafter for a total duration of 12 months. In each follow-up visit detailed history, induced sputum eosinophil count and spirometry were done to evaluate severity and treatment outcome. Results: FEV 1 % predicted of group A asthma patients gradually increased and sputum eosinophil count gradually decreased on treatment. Longer time was required to achieve satisfactory improvement (FEV 1 % predicted) in asthma patients with sputum eosinophil count ≥3%. There was statistically significant negative correlation between FEV 1 % predicted and sputum eosinophil count (%) in of group A patients in each follow-up visit, with most significant negative correlation found in 8 th visit (r = −0.9237 and P = < 0.001). Change in mean FEV 1 % (predicted) from baseline showed strong positive correlation (r = 0.976) with change in reduction of mean sputum eosinophil count at each follow-up visits in group A patients. Conclusions: Sputum eosinophil count, being an excellent biomarker of airway inflammation, can serve as a useful marker to assess disease severity, treatment outcome, and prognosis in asthma patients. |
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Role of HRCT in detection and characterization of pulmonary abnormalities in patients with febrile neutropenia  |
p. 124 |
Mandeep Kang, Debasis Deoghuria, Subash Varma, Dheeraj Gupta, Anmol Bhatia, Niranjan Khandelwal DOI:10.4103/0970-2113.110420 PMID:23741093Background: Fever is of grave concern in the management of patients with neutropenia with early detection of a focus of infection being the major goal. As lungs are the most common focus, chest imaging is of vital importance. This Institute Review Board approved prospective study was undertaken to assess the usefulness of high resolution computed tomography (HRCT) in early detection and characterization of pulmonary abnormalities in febrile neutropenia. Materials and Methods: A total of 104 consecutive patients (M:F:75:29, age range 11-66 years) with fever of 38.2°C or more with an absolute neutrophil count <500/μl underwent HRCT chest. HRCT diagnosis was compared with final diagnosis based on ancillary investigations. Results: HRCT could detect pulmonary abnormalities in 93 patients (89.4%) with air space consolidation being the predominant finding (n = 57), followed by ground-glass opacities (Ground glass opacity (GGO), n = 49) and nodules (n = 39). HRCT could correctly characterize the infective lesions in 76 patients (81.7%). Presence of random or pleural-based nodules >10 mm with or without surrounding GGO or cavitations was sensitive (95.23%) and specific (96.7%) for fungal infection, while small (1-4 mm) random or centrilobular nodules with tree-in-bud appearance was sensitive (90%) and highly specific (97.02%) for tuberculosis. Diagnosis of pyogenic infection based on presence of air-space consolidation, pleural effusion, GGO or centrilobular nodules showed a sensitivity of 84.78% and specificity of 93.84%, whereas patchy or diffuse GGO, interstitial thickening and/or air-space consolidation showed high sensitivity (86.7%) and specificity (96.8%) for Pneumocystis jiroveci pneumonia. Conclusion: HRCT chest is an excellent modality in the diagnostic work-up of patients with febrile neutropenia allowing early detection and characterization of pulmonary abnormalities. |
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Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey |
p. 131 |
Aripta Jingar, Gopala Krishna Alaparthi, K Vaishali, Shyam Krishnan, Zulfeequer , B Unnikrishnan DOI:10.4103/0970-2113.110421 PMID:23741094Background and Objective: Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs) and wards in terms of assessment and treatment. Materials and Methods: A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients. Results: A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards. Conclusion: Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary very little with respect to certain measures taken. Assessment predominantly focused on respiratory impairment measures, followed by dyspnea-quantifying measures, with little attention given to functional exercise capacity and health-related quality of life measures. Treatment techniques given were concentrated on dyspnea-relieving strategies, airway clearance techniques and upper and lower extremity exercises, with little attention given to strength training. |
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Level of awareness about tuberculosis in urban slums: Implications for advocacy and communication strategy planning in the National program |
p. 139 |
Palanivel Chinnakali, Jayalakshmy Ramakrishnan, Kavita Vasudevan, Jayanthi Gurumurthy, Ravi P Upadhyay, Krishna C Panigrahi DOI:10.4103/0970-2113.110422 PMID:23741095Background: Tuberculosis (TB) remains as an important public health problem in India. Awareness about the disease, its diagnosis, and treatment among public will help in controlling the killer disease. This study aims at arriving at an educational diagnosis about TB in an urban poor community. Materials and Methods: A cross-sectional study was conducted in an urban slum in South India using a structured, pretested questionnaire. Domains identified were knowledge about TB, symptoms, spread, diagnosis, treatment, and prevention of TB. Results: A total of 395 households were interviewed. Of them, 370 (94%) respondents had heard about TB. Regarding the symptoms of TB, 82% were aware that cough is a symptom of TB. Among the 79% of study subjects who reported any test to diagnose TB, sputum examination as a method of diagnosis was known to only 40%. However, 84% of the subjects were aware of the free treatment available for TB under National program. Conclusion: Level of awareness about TB among urban poor in a slum area is good. Knowledge about "free treatment" and "duration of treatment" has to be stressed during health education activities. |
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REVIEW ARTICLE |
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Pulmonary alveolar microlithiasis |
p. 143 |
Surender Kashyap, Prasanta R Mohapatra DOI:10.4103/0970-2113.110424 PMID:23741096Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with bilateral intra-alveolar calcium and phosphate deposition throughout the lung parenchyma with predominance to lower and midzone. Although, etiology and pathogenesis of PAM is not fully understood, the mutation in SLC34A2 gene that encodes a sodium-phosphate co-transporter in alveolar type II cells resulting in the accumulation and forming of microliths rich in calcium phosphate (due to impaired clearance) are considered to be the cause of the disease. Chest radiograph and high-resolution CT of thorax are nearly pathognomonic for diagnosing PAM. HRCT demonstrates diffuse micronodules showing slight perilobular predominance resulting in calcification of interlobular septa. Patients with PAM are asymptomatic till development of hypoxemia and cor-pulmonale. No therapy has been proven to be beneficial except lung transplantation. |
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CASE REPORTS |
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Spontaneous pneumopericardium an unusual complication in a patient of HIV and pulmonary tuberculosis |
p. 148 |
Vishal Chopra, Nishi Garg, Parul Mrigpuri DOI:10.4103/0970-2113.110425 PMID:23741097Pneumopericardium is defined as a collection of air or gas in the pericardial cavity. It is a rare entity and spontaneous pneumopericardium is even rarer. It is a rare complication of tuberculosis and human immunodeficiency virus and just three cases have been reported so far. |
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Alveolar hemorrhage in a case of fat embolism syndrome: A case report with short systemic review |
p. 151 |
Sananta Kumar Dash, Avdesh Bansal, Bhushan Sudhakar Wankhade, Rakesh Sharma DOI:10.4103/0970-2113.110427 PMID:23741098Fat embolism and fat embolism syndrome (FES) are well-known complications of long bone fracture and surgery involving manipulation of skeletal elements. Many non-traumatic causes of FES have been suggested but they constitute only a small portion. FES presents with classical symptoms of petechiae, hypoxemia, central nervous system symptoms along with other features such as tachycardia and pyrexia. Diagnosis of FES relies on clinical judgment rather than objective findings such as emboli present in the retinal vessels on fundoscopy, fat globules present in urine and sputum, a sudden inexplicable drop in hematocrit or platelet values, increasing erythrocyte sedimentation rate. |
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Recurrent hemoptysis in a 62-year-old smoker |
p. 155 |
Karanam Gowrinath, Baddukonda Appala Ramakrishna, Vissa Shanthi, Gogineni Sujatha DOI:10.4103/0970-2113.110428 PMID:23741099Tracheal papillary adenoma is a rare benign tumor. We report a case of papillary adenoma in a 62-year-old male smoker who presented with recurrent hemoptysis. The tumor was located in the upper third of trachea and forceps biopsy through flexible bronchoscopy was uncomplicated and diagnostic. |
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Pleural effusion: An unusual cause and association |
p. 158 |
Alam K Navaz, Madhusudan P Raikar, Vishak Acharya, Sanmath K Shetty DOI:10.4103/0970-2113.110431 PMID:23741100Filaria has a wide spectrum of presentation. We hereby present a case of Filarial pleural effusion that is a rarity in itself. Filarial lung involvement is usually in the form of tropical pulmonary eosinophilia with pulmonary infiltrates and peripheral eosinophilia, unlike our case where isolated pleural effusion of Filarial etiology was detected. Microfilaria has been isolated from Pleural fluid in very few cases, and ours was one such. Of late, there have been many incidental detections of Filarial parasites from varied anatomical sites in association with malignancy. Even in our case, we had one such unusual association. |
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RADIOLOGY QUIZ |
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Progressive dyspnea with a classic radiological sign |
p. 161 |
Amar Udare DOI:10.4103/0970-2113.110432 PMID:23741101 |
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PICTORIAL QUIZ |
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Sudden onset of dyspnea in a woman with skin lesions and lung cysts |
p. 164 |
Akashdeep Singh, Jaspreet Singh DOI:10.4103/0970-2113.110433 PMID:23741102 |
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PICTORIAL CME |
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Flow volume loop as a diagnostic marker |
p. 166 |
Vinaya S Karkhanis, Unnati Desai, Jyotsna M Joshi DOI:10.4103/0970-2113.110435 PMID:23741103 |
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LETTERS TO EDITOR |
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Cognitive functions in nonhypoxemic chronic obstructive pulmonary disease (COPD) |
p. 169 |
Sunil Kumar Raina DOI:10.4103/0970-2113.110437 PMID:23741104 |
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Authors' reply |
p. 170 |
Prem Parkash Gupta, Sushma Sood, Atulya Atreja, Dipti Agarwal |
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Organizing pneumonia as a pulmonary sequela of swine flu |
p. 171 |
Gláucia Zanetti, Bruno Hochhegger, Edson Marchiori DOI:10.4103/0970-2113.110440 PMID:23741106 |
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