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2010| October-December | Volume 27 | Issue 4
Online since
October 22, 2010
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CASE REPORTS
Unusual presentation of spontaneous pneumomediastinum
Tae jin Cho, Hoon Kim
October-December 2010, 27(4):239-241
DOI
:10.4103/0970-2113.71961
PMID
:21139723
Spontaneous pneumomediastinum (SPM) is an uncommon, self-limiting condition resulting from alveolar rupture in young adults. There are asthma, illicit drug use, and activities triggering a Valsalva maneuver as causes of developing SPM. We report two patients who were diagnosed with SPM in the absence of known predisposing factors and without any clinical sign of subcutaneous emphysema of the neck, the most common physical finding on presentation. Both of them developed dysphagia after swallowing a peach seed and boned rib of pork, respectively. SPM was suspected after performing lateral neck X-ray, and the diagnosis of SPM was confirmed by chest CT. These cases showed the importance of performing the lateral neck X-ray to screen SPM in patients with dysphagia.
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2
ORIGINAL ARTICLES
Adult thoracic empyema: A comparative analysis of tuberculous and nontuberculous etiology in 75 patients
Somenath Kundu, Subhra Mitra, Subhasis Mukherjee, Soumya Das
October-December 2010, 27(4):196-201
DOI
:10.4103/0970-2113.71939
PMID
:21139713
Background:
Thoracic empyema is a disease of significant morbidity and mortality, especially in the developing world where tuberculosis remains a common cause. Clinical outcomes in tuberculous empyema are complicated by the presence of concomitant fibrocavitary parenchymal disease and frequent bronchopleural fistulae. We performed a prospective study over a one-and-a-half-year period with the objective of comparing the clinical profiles and outcomes of patients with tuberculous and nontuberculous empyema.
Materials and Methods:
A prospective study of adult cases of nonsurgical thoracic empyema admitted in a tertiary care hospital in eastern India was performed over a period of 18 months. A comparative analysis of clinical characteristics, treatment modalities, and outcomes of patients with tuberculous and nontuberculous empyema was carried out.
Results:
Seventy-five cases of empyema were seen during the study period, of which 46 (61.3%) were of nontuberculous etiology while tuberculosis constituted 29 (38.7%) cases. Among the nontuberculous empyema patients,
Staphylococcus aureus
(11, 23.93%) was the most frequent pathogen isolated, followed by Gram-negative bacilli. Tuberculous empyema was more frequent in younger population compared to nontuberculous empyema (mean age of 32.7 years vs. 46.5 years). Duration of illness and mean duration of chest tube drainage were longer (48.7 vs. 23.2 days) in patients with tuberculous empyema. Also the presence of parenchymal lesions and bronchopleural fistula often requiring surgical drainage procedures was more in tuberculous empyema patients.
Conclusion:
Tuberculous empyema remains a common cause of empyema thoracis in a country like India. Tuberculous empyema differs from nontuberculous empyema in the age profile, clinical presentation, management issues, and has a significantly poorer outcome.
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REVIEW ARTICLE
Nebulized corticosteroids in the management of acute exacerbation of COPD
GS Gaude, S Nadagouda
October-December 2010, 27(4):230-235
DOI
:10.4103/0970-2113.71957
PMID
:21139721
Acute exacerbations in chronic onstructive pulmonary disease (COPD) are common and systemic steroids play an important role in the management of these cases along with the bronchodilators. Nebulized budesonide is being used in the acute attacks of bronchial asthma either in children or in adults. But the role of nebulized steroids in acute exacerbation of COPD is not much studied in the literature. In this clinical review we have evaluated the role of nebulized corticosteroids in the management of acute exacerbation of COPD (AECOPD). Through Medline, Pubmed and Embase we analyzed the various studies that has been done to study the role of nebulized corticosteroids in the management of acute exacerbation of COPD. The key words used for the search criteria were: acute exacerbation, COPD, nebulized corticosteroids, budesonide, fluticasone. Only eight studies were found which had evaluated the role of nebulized corticosteroids in acute exacerbations of COPD. All these studies had used nebulized budesonide in AECOPD in different dosages, and had been compared with both either parental or oral steroids, and standard bronchodilator therapy. All the studies had found the clinical efficacy of nebulized budesonide to be of similar extent to that of either parental or oral steroids in AECOPD. Side effects profile of nebulized budesonide was minimal and acceptable as compared to systemic steroids. Nebulized budesonide may be an alternative to parental/oral prednisolone in the treatment of acute exacerbations of COPD but further studies should be done to evaluate its long-term impact on clinical outcomes after an initial episode of COPD exacerbation.
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ORIGINAL ARTICLES
Occurrence of allergic bronchopulmonary mycosis in patients with asthma: An Eastern India experience
Anirban Sarkar, Abhijit Mukherjee, Aloke Gopal Ghoshal, Somenath Kundu, Subhra Mitra
October-December 2010, 27(4):212-216
DOI
:10.4103/0970-2113.71949
PMID
:21139717
Background:
Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi notably Aspergillus spp. that colonize the airways of asthmatics. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis.
Aims:
To study the occurrence of ABPM among asthma patients with fungal sensitization attending a chest clinic of a tertiary hospital of eastern India. The clinico-radiological and aetiological profiles are also described.
Materials and Methods:
All consecutive patients with asthma presenting to the chest clinic over a period of one year were screened for cutaneous hypersensitivity to 12 common fungal antigens. The skin test positive cases were further evaluated for ABPM using standard criteria.
Results:
One hundred and twenty-six asthma patients were screened using twelve common fungal antigens; forty patients (31.74%) were found to be skin test positive, and ABPM was diagnosed in ten patients (7.93%). Of the 10 cases of ABPM, nine cases were those of allergic bronchopulmonary aspergillosis (ABPA) and one case was identified as caused by sensitization to Penicillium spp. A majority of the cases of ABPM had advanced disease and had significantly lower FEV1 compared to non-ABPM skin test positive asthmatics. Central bronchiectasis on high resolution CT scan was the most sensitive and specific among the diagnostic parameters.
Conclusion:
There is a significant prevalence of ABPM in asthma patients attending our hospital and this reinforces the need to screen asthma patients for fungal sensitisation. This will help in early diagnosis and prevention of irreversible lung damage.
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6,316
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4
Multi-drug resistant
Acinetobacter
ventilator-associated pneumonia
Vishal B Shete, Dnyaneshwari P Ghadage, Vrishali A Muley, Arvind V Bhore
October-December 2010, 27(4):217-220
DOI
:10.4103/0970-2113.71952
PMID
:21139718
Background:
Ventilator-associated pneumonia (VAP) due to a multi-drug resistant (MDR)
Acinetobacter
is one of the most dreadful complications, which occurs in the critical care setting. Aims and objectives: To find out the incidence of
Acinetobacter
infection in VAP cases, to determine various risk factors responsible for acquisition of
Acinetobacter
infection and to determine the antimicrobial susceptibility pattern of
Acinetobacter
.
Materials and Methods:
A total of 60 endotracheal aspirate specimens from intubated patients diagnosed clinically and microscopically as VAP were studied bacteriologically. All clinical details and prior exposure to antibiotics were recorded.
Results:
An incidence of 11.6% of
Acinetobacter
VAP cases was recorded. Various underlying conditions like head injury, cerebral hemorrhage and chronic obstructive pulmonary disease (COPD) were found to be associated with
Acinetobacter
VAP.
Acinetobacter
strains exhibited MDR pattern.
Conclusion:
Strict infection control measures, judicious prescribing of antibiotics, antibiotic resistance surveillance programs and antibiotic cycling should be adopted to control infections due to these bacteria in patients admitted to intensive care units.
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2
CASE REPORTS
Rheumatoid interstitial lung disease presenting as cor pulmonale
Sourya Acharya, SN Mahajan, Samarth Shukla, SK Diwan, Pankaj Banode, Nirmesh Kothari
October-December 2010, 27(4):256-259
DOI
:10.4103/0970-2113.71971
PMID
:21139729
Rheumatiod arthritis (RA) is a multisystem connective tissue disorder. The predominant presentation is polyarticular, symmetric peripheral arthritis with relative sparing of axial skeleton. Inflammatory synovitis is the pathologic hallmark. Extra-articular manifestations of RA can involve several other organ systems and amongst them pulmonary manifestations occur commonly. We report a case of rheumatoid interstitial lung disease presenting as cor pulmonale.
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Pulmonary arteriovenous malformation: An uncommon disease with common presentation
Debabani Biswas, Atin Dey, Mukul Chakraborty, Saurabh Biswas
October-December 2010, 27(4):247-249
DOI
:10.4103/0970-2113.71965
PMID
:21139726
A 45-year-old male presented with massive hemoptysis, clubbing in all limbs, disproportionate hypoxia and persistent ill-defined shadow in left lower zone in chest radiograph since his childhood. The patient received empirical anti-tuberculosis treatment and the chest X-ray finding was misinterpreted as tuberculoma. Subsequently, CT pulmonary angiography proved it to be a case of a simple type solitary pulmonary arteriovenous malformation with a saccular aneurysm in left lower lobe.
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3,349
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ORIGINAL ARTICLES
Role of pleural biopsy in etiological diagnosis of pleural effusion
Sudipta Pandit, Arunabha Datta Chaudhuri, Sourin Bhuniya Saikat Datta, Atin Dey, Pulakesh Bhanja
October-December 2010, 27(4):202-204
DOI
:10.4103/0970-2113.71941
PMID
:21139714
Background:
Pleural effusion remains the most common manifestation of pleural pathology. Sometimes it is difficult to differentiate between tubercular and malignant pleural effusion in spite of routine biochemical and cytological examination of pleural fluid.
Aims:
This study aims to evaluate the role of pleural biopsy to determine the etiology of pleural effusion and to correlate it with the biochemical and cytological parameters of pleural fluid.
Settings and Design:
Seventy two consecutive patients of pleural effusion were selected from the out patient and indoor department of a tertiary hospital of Kolkata. It was a prospective and observational study conducted over a period of one year.
Materials and Methods:
Biochemical, cytological and microbiological evaluation of pleural fluid was done in all cases. Those with exudative pleural effusions underwent pleural biopsy by Abram's needle. Subsequently, the etiology of effusion was determined.
Results:
Malignancy was the most common etiology, followed by tuberculosis. Pleural biopsy was done in 72 patients. Pleural tissue was obtained in 62 cases. Malignancy was diagnosed in 24, tuberculosis in 20 and non-specific inflammation in 18, on histopathological examination. Out of 20 histological proven tuberculosis cases adenosine de-aminase (ADA) was more than 70 u/l in 11 cases.
Conclusions:
In our study, malignancy is more common than tuberculosis, particularly in elderly. When thoracoscope is not available, pleural fluid cytology and pleural biopsy can give definite diagnosis. Pleural fluid ADA ≥ 70 u/l is almost diagnostic of tuberculosis, where pleural biopsy is not recommended.
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Serum magnesium and stable asthma: Is there a link?
Sibes Kumar Das, Arup Kumar Haldar, Indranath Ghosh, Samirendra Kumar Saha, Anirban Das, Saurabh Biswas
October-December 2010, 27(4):205-208
DOI
:10.4103/0970-2113.71944
PMID
:21139715
Background:
Although magnesium is used through intravenous and inhalation route in the management of asthma, actual prevalence of hypomagnesemia in asthma is not known. We conducted this study: 1) to detect the prevalence of hypomagnesemia in stable asthma and 2) to assess the significance of hypomagnesemia in these patients.
Design:
Prospective clinical study.
Setting:
Department of Respiratory Medicine, Calcutta National Medical College, Kolkata.
Period of Study:
Four months from January, 2007, to April, 2007.
Materials and Methods:
Fifty patients attending outpatients department of respiratory medicine with stable asthma were randomly selected. They were assessed clinically and their serum magnesium levels were measured. This was compared with the serum magnesium values of 45 nonasthmatic healthy controls.
Results:
Out of 50 patients, 14 had hypomagnesemia. Possible relationship of hypomagnesemia with tachycardia, tachypnoea, severity of asthma, medication use, and previous and future exacerbations were analyzed.
Conclusion:
There was statistically significant association of hypomagnesemia with tachypnoea, severe asthma, use of long-acting b
2
-agonist, inhaled corticosteroids, theophylline, use of ≥ 3 medications, previous and future exacerbations but not with tachycardia or use of short-acting β
2
-agonist or montelukast.
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3,026
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2
CASE REPORTS
Pulmonary alveolar microlithiasis with calcified pleural plaques
Balbir Malhotra, Raghu Sabharwal, Mandeep Singh, Amarjeet Singh
October-December 2010, 27(4):250-252
DOI
:10.4103/0970-2113.71967
PMID
:21139727
Pulmonary alveolar microlithiasis (PAM) is a rare disease. Herein we report a case of pulmonary alveolar microlithiasis who was suspected to have the disease on chest X-ray and was confirmed on high resolution CT and transbronchial lung biopsy. These investigations showed characteristic features of pulmonary alveolar microlithiasis with diffuse interstitial pulmonary fibrosis.
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3,156
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3
A young non-immunocompromised woman with diffuse alveolar opacities
Prem Parkash Gupta, Manish Verma, Dipti Agarwal, Sanjay Kumar, Atulya Atreja
October-December 2010, 27(4):236-238
DOI
:10.4103/0970-2113.71959
PMID
:21139722
Diffuse alveolar opacities (DAO) due to pulmonary tuberculosis are usually described in immunocompromised patients. In adult patients residing in high endemic areas such as India, alveolar opacities are not reported frequently in non-immunocompromised pulmonary tuberculosis patients. We describe a twenty-five-year-old woman who presented with bilateral diffuse alveolar opacities and initial diagnostic work up was directed to non-tuberculosis etiologies. Her sputum was not suggestive of tuberculous or any other infective etiology. However, histopathological examination of specimen from fine needle aspiration cytology through percutaneous route suggested chronic granulomatous disease with detection of mycobacterium. Polymerase chain reaction test in BAL and FNAC specimen confirmed tubercular etiology. Though not frequent, pulmonary tuberculous etiology is worth considering in the differential diagnosis of DAO as not only tuberculosis is fully treatable but also early detection shall help to avoid unnecessary invasive tests and cut down transmission to contacts.
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3,166
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ORIGINAL ARTICLES
Silicosis among agate workers at Shakarpur: An analysis of clinic-based data
Nayanjeet Chaudhury, Ajay Phatak, Rajiv Paliwal, Chandra Raichaudhari
October-December 2010, 27(4):221-224
DOI
:10.4103/0970-2113.71955
PMID
:21139719
Background:
There is a high prevalence of silicosis and other morbid conditions leading to early death among agate workers at Khambhat of Gujarat.
Aims:
The present study describes the prevalence of X-ray positive silicosis in a sample of a high-risk group visiting a clinic at Shakarpur of Khambhat.
Settings and Design:
A cross-sectional study among 123 clinically suspected cases was conducted over 6 months.
Materials and Methods:
A chest physician and a radiologist independently evaluated the Chest X-rays of 123 clinically suspected patients of silicosis. Silicosis was confirmed if either of them rated the X-ray as positive.
Statistical Analysis:
Descriptive statistics and logistic regression were done using SPSS software version 14.
Results:
Out of 123 cases, 85 (69.1%) were confirmed as silicosis. There was no significant difference in the prevalence between males (70.3%) and females (69.4%). Workers with more than 10 years of exposure to silica had an odd ratio of 4.8, 95% CI (1.76, 13.60) compared to those with less than 10 years of exposure. A logistic regression analysis showed that for every extra year of exposure, the odds of getting silicosis increased by about 12%.
Conclusions:
This study highlights the catastrophic effects of exposures to silica in agate worker, which calls for urgent protective measures for this population.
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2,902
464
5
CASE REPORTS
Dissecting aneurysm of arch and descending thoracic aorta presenting as a left sided hemorrhagic pleural effusion
Shelley Shamim, Sumitra Basu Thakur, Amitava Sengupta, Sujit Kumar Bhattacharyya, Niranjan Sit
October-December 2010, 27(4):244-246
DOI
:10.4103/0970-2113.71963
PMID
:21139725
The most common cause of massive hemorrhagic effusion is malignancy. Herein we present a case of dissecting aneurysm of descending thoracic aorta presenting initially with shortness of breath due to left sided massive pleural effusion. Effusion was hemorrhagic in nature with high hematocrit value. CT scan of thorax with CT angiogram was done and that revealed the diagnosis.
[ABSTRACT]
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ORIGINAL ARTICLES
Clinical profile of pulmonary aspergilloma complicating residual tubercular cavitations in Northen Indian patients
PR Gupta, Aruna Vyas, RC Meena, Shivraj Sharma, N Khayam, IM Subramanian, D Kanoongo, V Solanki, A Bansal
October-December 2010, 27(4):209-211
DOI
:10.4103/0970-2113.71947
PMID
:21139716
Background:
Little is known regarding the clinical profile of Aspergilloma in Indian patients. Such a study was undertaken at Hospital for Chest and TB, Jaipur.
Materials and Methods:
Old, treated patients of pulmonary tuberculosis showing ball like lesion/s inside cavity/ies or a recent thickening of cavity wall were enrolled. Morning sputa samples were collected in the patients who were able to raise sputum and were examined by KOH mount and fungal culture. Serum anti-aspergillus antibodies were estimated in all the patients. Twenty normal healthy subjects were included to serve as control. All patients showing a positive or borderline positive serology were diagnosed as pulmonary aspergilloma (PA group). The remaining patients formed the non-aspergilloma group (Non PA group).
Results:
A total of 98 study patients could be classified as PA group (54 patients by serology alone, 44 patients by serology as well as sputum culture). The remaining 152 patients were classified as non PA group. Hemoptysis alone or along with other chest symptoms was significantly more common in PA group as compared to non PA group patients (
P
<0.001), more so in those with ball like lesions. But chest symptoms other than hemoptysis were more common in non PA group. Within the PA group, 21 (13 with ball like lesions and 8 with thickening of cavity wall) had clinical symptoms suggestive of CNPA and two patients (one each with ball like lesions and thickening of cavity wall) had clinical symptoms suggestive of ABPA.
Conclusion:
The clinical profile of pulmonary Aspergilloma in Indian patients is very protean ranging from saprophytic disease to CNPA and less commonly to ABPA.
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3
CASE REPORTS
Parotid tuberculosis
Rajiv Garg, Sanjay Kumar Verma, Sumit Mehra, AN Srivastawa
October-December 2010, 27(4):253-255
DOI
:10.4103/0970-2113.71969
PMID
:21139728
Tuberculosis of the parotid gland is a rare condition. We describe a case of tuberculosis of right parotid gland in a 17-year-old male patient. Diagnosis was made by early suspicion and confirmed by demonstration of epitheloid granulomas on fine needle aspiration cytology (FNAC). Patient was successfully treated with daily regimen of four drugs (rifampicin, isoniazid, pyrazinamide, ethambutol) for first two months followed by two drugs (rifampicin and isoniazid) for last four months.
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1
EDITORIALS
Molds and the lungs
Bharat Bhushan Sharma
October-December 2010, 27(4):194-195
DOI
:10.4103/0970-2113.71937
PMID
:21139712
[FULL TEXT]
[PDF]
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2,168
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ORIGINAL ARTICLES
Proinflammatory cytokines in Egyptian elderly with chronic obstructive pulmonary disease
Moatassem S Amer, Hoda M.F Wahba, Samiha S.A Ashmawi, Randa Reda Mabrouk, Ahmad A.E Sharaf Eldeen, Sarah A Hamza
October-December 2010, 27(4):225-229
DOI
:10.4103/0970-2113.71956
PMID
:21139720
Background:
The pulmonary component of chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases
. Hypothesis:
The levels of the proinflammatory cytokines, interleukin 1 beta (IL-1β), tumor necrosis factor alfa (TNF-α), and C-reactive protein (CRP), in elderly patients suffering from COPD are increased.
Settings and Design:
A case control study involving 90 elderly participants from the outpatient clinics of Ain Shams University hospitals.
Materials and Methods:
The 90 subjects were subdivided into three equal groups - group I (control), group II (patients with COPD), and group III (patients with COPD and cardiovascular complications). Comprehensive clinical assessment, pulmonary functions, and echocardiography were performed. The levels of IL-1β, TNF-α, and CRP were measured in the patients' serum and compared.
Statistical analysis:
SPSS (Statistical Package for Social Science) version 10.
Results:
IL1-β and CRP were significantly higher in the third group than the first group (
P
<0.05). There was a similar significant difference between the second and third group as regards IL1-β and CRP (
P
< 0.05). Positive significant correlation between CRP and TNF-α with stage of COPD according to FEV1 (
P
<0.05) were found.
Conclusions:
Complicated cases of COPD had higher levels of IL1-β and CRP and the more severe the cases, the higher the levels of CRP and TNF-α.
[ABSTRACT]
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2,122
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CASE REPORTS
Conservative management of post traumatic thoraco diaphragmatico biliary fistula
NC Kajal, Babu Lal, Sandeep Gupta, Ramesh Attri, Onkar Gupta, Nadia Kajal
October-December 2010, 27(4):242-243
DOI
:10.4103/0970-2113.71962
PMID
:21139724
We report herein a case of thoraco diaphragmatico biliary fistula in a 24-year-old male who was managed conservatively with antibiotics and tube thoracostomy and had complete radiological clearance.
[ABSTRACT]
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2,104
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LETTERS TO EDITOR
Prescription for asthma
Vishal Sharma, Sourabh Aggarwal, Alka Sharma
October-December 2010, 27(4):260-260
DOI
:10.4103/0970-2113.71973
PMID
:21139731
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1,574
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EDITORIALS
From Editors' Desk
Virendra Singh
October-December 2010, 27(4):193-193
DOI
:10.4103/0970-2113.71934
PMID
:21139711
[FULL TEXT]
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1,417
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LETTERS TO EDITOR
Diagnosing sputum/smear negative pulmonary tuberculosis
Sivaraman Vengattaraman
October-December 2010, 27(4):263-263
DOI
:10.4103/0970-2113.71979
PMID
:21139735
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[PDF]
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1,256
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1
Why "covering all" in the DOTS program is not necessarily "all being covered" by the DOTS program
Lancelot Mark Pinto, Zarir Farokh Udwadia
October-December 2010, 27(4):261-261
DOI
:10.4103/0970-2113.71975
PMID
:21139732
[FULL TEXT]
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1,268
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FEV
6
as screening tool in diagnosis of obstructive airway disease
Sourabh Aggarwal
October-December 2010, 27(4):262-262
DOI
:10.4103/0970-2113.71976
PMID
:21139733
[FULL TEXT]
[PDF]
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[CITATIONS]
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1,233
224
1
Controlling hemoptysis: An alternative approach
MS Barthwal
October-December 2010, 27(4):264-264
DOI
:10.4103/0970-2113.71981
PMID
:21139737
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1,170
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1
Author's reply
Awanish Pandey, Poonam Tripathi, RD Pandey
October-December 2010, 27(4):260-260
PMID
:21139730
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1,205
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Authors' reply
P Adithya Malolan, Vishak Acharya, B Unnikrishnan
October-December 2010, 27(4):262-262
PMID
:21139734
[FULL TEXT]
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1,230
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Authors' reply
Rakesh K Chawla, Arun Madan, Dinesh Mehta, Kiran Chawla
October-December 2010, 27(4):265-265
PMID
:21139738
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1,187
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Author's reply
Arshad A Bachh
October-December 2010, 27(4):263-264
PMID
:21139736
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
969
174
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