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2013| October-December | Volume 30 | Issue 4
Online since
October 25, 2013
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REVIEW ARTICLE
A systematic approach to interpretation of heterogeneous lung attenuation on computed tomography of the chest
Anjali Agrawal, Anurag Agrawal, Vishal Bansal, Meenakshi Pandit
October-December 2013, 30(4):327-334
DOI
:10.4103/0970-2113.120610
PMID
:24339492
Computed tomography (CT) chest is widely used as an adjunct to clinical examination and pulmonary function tests in the evaluation of unexplained dyspnoea. In such patients, heterogeneous lung attenuation is a common finding on CT. Heterogeneous lungs can be caused by varying regional aeration, varying regional perfusion, and ground glass opacities (GGO) representing airspace or interstitial pathology. It does not serve the referring clinicians or the patients well if the radiology report simply mentions the heterogeneity of the lungs without due analysis of the cause of heterogeneity and a meaningful differential diagnosis. Therefore, it is imperative for the radiologist and the treating pulmonologist to have an in-depth understanding of the pathogenesis of pulmonary heterogeneity. This, in conjunction with clinical data, can narrow the differential diagnosis or, at times, lead to specific diagnoses. The purpose of this review is to familiarize readers with the CT representation of heterogeneities in aeration and perfusion of the lung, relate patterns of GGO to underlying pathology, and provide illustrative case studies highlighting the radiological approach to heterogeneous lungs.
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CASE REPORTS
Pleural effusion presenting as mediastinal widening
Prasanta R Mohapatra, Kranti Garg, Chikkahonnaiah Prashanth, Rupali Lahoria
October-December 2013, 30(4):354-356
DOI
:10.4103/0970-2113.120621
PMID
:24339499
We report a case of middle-aged female presenting with mediastinal widening on chest radiograph owing to pleural effusion. The pleural effusion presenting as mediastinal widening on chest radiograph is rarely reported.
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ORIGINAL ARTICLES
HIV-TB coinfection: Clinico-epidemiological determinants at an antiretroviral therapy center in Southern India
Ramachandra Kamath, Vikram Sharma, Sanjay Pattanshetty, Mohandas B Hegde, Varalakshmi Chandrasekaran
October-December 2013, 30(4):302-306
DOI
:10.4103/0970-2113.120605
PMID
:24339487
Background:
HIV-TB (tuberculosis) coinfection has emerged as a major public health threat. Given the multifactorial enabling environment in a resource-constrained setting like India, the consequences are of epidemic proportions.
Aims:
This study was aimed at identifying the clinical and epidemiological determinants underlying HIV-TB coinfection.
Settings and Design:
A retrospective review of patient records was done from the antiretroviral therapy center (ART) center at a district hospital in southern India between May and August 2012.
Materials and Methods:
Secondary data of 684 patients on ART as well as pre-ART were collected between July 2008 and June 2012 and were analyzed.
Statistical Analysis:
Descriptive analysis, χ
2
, and Wilcoxon signed rank tests were used with SPSS version 15.0 to draw significant statistical inferences.
Results:
HIV-TB coinfection was diagnosed in 18.9% with higher prevalence among males (75.3%), in the sexually active age group 31-45 years (61.3%), with less than primary education (44.15%), who were married (56.1%), laborers (42.4%), from rural backgrounds (88.2%), and having low income-earning capacity (94.4%). Transmission was predominantly through the heterosexual route. The key entry point was the integrated counseling and testing center (ICTC) (47.4%). Pulmonary tuberculosis (58.8%) was predominantly found followed by extrapulmonary tuberculosis (38.2%) and both in 3.1%. A favorable outcome was observed in 69.3% of coinfected patients with 89.2% on ART and 97.2% currently on DOTS therapy. The Wilcoxon signed-rank test found significant association between rises in CD4 counts after the 6
th
-month follow up (
P
< 0.05). Coinfected patients had a case fatality rate of 25%.
Conclusions:
The prevalence of HIV-TB coinfection recorded in this sample was 18.86%. ICTC implemented by NACO emerged as an effective entry point, while Revised National Tuberculosis Control Program referred 1.6% (
n
= 11) of the patients to the ART center. Coinfection is associated with lower CD4 counts than those with HIV alone, which could translate into increased morbidity and progression of HIV to AIDS.
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Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India
Subhakar Kandi, Surapaneni Venkateswara Prasad, P Navaneeth Sagar Reddy, Vennaposa Chenna Kishore Reddy, Rajya Laxmi, Dhanamurthy Kopuu, Kiran Kumar Kondapaka, MS Sreenivas Rao, PH Vishnu
October-December 2013, 30(4):277-279
DOI
:10.4103/0970-2113.120599
PMID
:24339482
Background:
India is one of the high tuberculosis (TB) burden countries in the world. India ranks second in harboring multi drug resistant (MDR)-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital) in Hyderabad, India.
Objectives:
Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH) resistance in this geographical area.
Materials and Methods:
An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011.
Results:
Sputum samples from 100 patients were subjected to acid fast bacilli (AFB) culture and drug sensitivity testing. Of these, 28 (28%) were MDR-TB, 42 (42%) were non-MDR-TB and 39% being INH resistance.
Conclusions:
In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.
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EDITORIALS
Issues in the management of drug resistant tuberculosis in India
D Behera
October-December 2013, 30(4):269-272
PMID
:24339480
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ORIGINAL ARTICLES
Compliance monitoring of prohibition of smoking (under section-4 of COTPA) at a tertiary health-care institution in a smoke-free city of India
Jaya Prasad Tripathy, Sonu Goel, Binod Kumar Patro
October-December 2013, 30(4):312-315
DOI
:10.4103/0970-2113.120607
PMID
:24339489
Background:
India enacted a comprehensive tobacco control law known as cigarettes and other tobacco products act (COTPA) in 2003. However, enforcement of the provisions under the law is still a matter of concern. Compliance survey is an effective tool to measure the status of implementation of the law at various public places. Smoke-free hospital campus demonstrates commitment to good health and sends a pro-healthy signal to the community.
Objective:
The objective of this study was to assess the compliance to the prohibition of smoking at public places (under section-4 of COTPA) in a tertiary health-care institution in a smoke-free city of India.
Materials and Methods:
An observational cross-sectional study was conducted at 40 different venues within a tertiary health-care institution in a smoke-free city of India. These places were observed for certain parameters of assessment by a structured checklist, which included evidence of active smoking, evidence of recent smoking, display of signages, presence of smoking aids, cigarette butts and bidi ends.
Results:
Overall compliance rate for section-4 of COTPA was found to be mere 23%. Evidence of active smoking was observed in 21 (52.5%) venues. Signages were seen at only 8 places (20%). Butt ends and other smoking aids were seen in 37 (92.5%) and 26 (65%) places respectively.
Conclusion:
These dismal findings suggest non-compliance to the provisions under COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.
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CASE REPORTS
Cystic lung disease in tuberculosis: An unusual presentation
Animesh Ray, JC Suri, MK Sen, Arjun Khanna
October-December 2013, 30(4):351-353
DOI
:10.4103/0970-2113.120620
PMID
:24339498
Cysts in the lung can arise due to large number of causes out of which tuberculosis is very rare, We report a case of tuberculosis in a young female presenting as a febrile illness and respiratory failure with radiological features of cystic lung disease. With treatment,fever and respiratory distress subsided and cysts in the lungs showed partial regression. We highlight the need to consider tuberculosis in the differential diagnoses of cystic lung disease under appropriate circumstances.
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ORIGINAL ARTICLES
Clinical profile and treatment outcomes of drug-resistant tuberculosis before directly observed treatment strategy plus: Lessons for the program
Yatin N Dholakia, Divya P Shah
October-December 2013, 30(4):316-320
DOI
:10.4103/0970-2113.120608
PMID
:24339490
Background:
Characteristics and treatment outcomes of patients with drug-resistant tuberculosis (DR TB) before introduction of directly observed treatment strategy (DOTS) plus are infrequently reported.
Aims:
To study clinical characteristics and treatment outcomes of drug-resistant TB patients.
Setting:
A TB unit in Mumbai.
Materials and Methods:
A retrospective analysis of DR TB patients attending a TB unit and taking treatment at NGOs was performed. Of the 34 cases, 5 (14%) had mycobacterium other than tuberculosis, 24 were pulmonary TB, 4 extra-pulmonary TB, and one both. Three were HIV-infected, two had diabetes. Two cases were treatment naive. Of the 29 cases studied, 3 (11%) were mono-resistant, 20 (69%) were multidrug-resistant (MDR) TB with E/Z/EZ resistance; 4 were pure MDR TB. One case had XDR TB, 13 (44.8%) had resistance to at least one conventional second-line drug. Seven cases had adverse drug reaction, four requiring drug substitution. Two patients are on treatment; 14 of the remaining 27 (51%) were successfully treated, 5 (18%) died, 2 (7%) failed treatment, 5 (18%) were lost to follow-up, one migrated.
Conclusion:
DST profiles suggest high levels of drug resistance due to amplification which leads to poor outcomes. There is an urgent need for Indian Revised National TB Control Program to introduce daily DOTS for susceptible cases, DST for all new cases, and scaling up DST for second-line drugs. There is also a need to use individualized treatment for DR TB.
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2,623
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CASE REPORTS
Recovery of fluconazole sensitive Candida ciferrii in a diabetic chronic obstructive pulmonary disease patient presenting with pneumonia
Kaushik Saha, Niranjan Kr. Sit, Arnab Maji, Debraj Jash
October-December 2013, 30(4):338-340
DOI
:10.4103/0970-2113.120614
PMID
:24339494
Chronic obstructive pulmonary disease (COPD) exacerbations admitted in intensive care units (ICUs) occur rarely due to fungal respiratory tract infections, but may occur when associated co-morbidities like diabetes mellitus coexist. Candida ciferrii is a new agent, recently was isolated from lung infections but usually resistant to fluconazole. Here, we report a rare case of pneumonia due to fluconazole sensitive Candida ciferrii in a COPD patient with known diabetes, admitted in our ICU.
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ORIGINAL ARTICLES
Quality of life impairment in patients of obstructive sleep apnea and its relation with the severity of disease
Naveen Dutt, Ashok Kumar Janmeja, Prasanta Raghab Mohapatra, Anup Kumar Singh
October-December 2013, 30(4):289-294
DOI
:10.4103/0970-2113.120603
PMID
:24339485
Background:
Several studies have demonstrated considerable impairment of quality of life (QOL) in obstructive sleep apnea (OSA) patients, but its relation with severity of OSA is yet unclear.
Study Objectives:
To investigate the effects of OSA on the QOL and its association with the disease severity.
Design and Setting:
Observational, prospective case-control study.
Materials
and
Methods:
QOL of 69 OSA patients and 41 healthy controls were assessed using the Calgary sleep apnea quality of life index (SAQLI) on the morning following the polysomnography (PSG) study.
Statistics:
All statistical analyses were performed using the SPSS 17.0 (SPSS Inc., Chicago). Differences between sleep-related symptoms and SAQLI subscales scores were assessed with the Chi-square test and the Student
t
-test. Due to non-normal distribution, differences between SAQLI scores of controls and OSA patients were evaluated using a non-parametric Mann-Whitney test. Spearman correlation and backward multiple regression analysis were used to analyze the association between SAQLI scores and sleep indices and anthropometric variables and PSG variables.
Results:
Study included 69 cases (57 male and 12 females) with a mean age, weight, height, neck circumference, and body mass index 48.45 ± 10.12 years, 83.03 ± 16.48 kg, 159.75 ± 28.29 cm, 44.01 ± 3.23 cm and 30.77 ± 6.71 kg/m
2
. Mean apnea-hypopnea index was 26.39 ± 16.62. The median score of four SAQLI domains daily function, social interaction, emotional, symptoms and total mean SAQLI score were 3.64 (3.46-3.90), 3.77 (3.51-3.88), 3.64 (3.53-3.83), 4.80 (4.68-5.11), 4.09 (3.88-4.09) ,and 1.36 (1.29-1.71), 1.38 (1.24-1.62), 1.45 (1.23-1.62), 2.00 (1.78-2.26), 1.55 (1.46-1.73) for patients and controls respectively. All the individual domain scores and the mean SAQLI scores of patients were significantly higher than the controls.
Conclusion:
OSA causes significant impairment of QOL, but the severity of impairment is not directly proportional to the severity of OSA.
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CASE REPORTS
Pulmonary cryptococcosis: An unusual presentation
Anand K Babu, Ram Gopalakrishnan, L Sundararajan
October-December 2013, 30(4):347-350
DOI
:10.4103/0970-2113.120618
PMID
:24339497
Cryptococcal infection of the lung is usually asymptomatic in immunocompetent hosts. Symptomatic cryptococcal lung infection presenting as an endobronchial mass lesion in an immunocompetent host is rare. We report our experience with an immunocompetent young patient presenting with an endobronchial mass lesion caused by cryptococcal infection. This male patient presented with left sided collapse, consolidation on computed tomography scanning, and was found to have a polypoid lesion in the left main bronchus. The diagnosis was confirmed by bronchial biopsy and the patient responded well to parenteral antifungal therapy. The case report is followed by a review of pulmonary cryptococcosis including clinical features, diagnosis, and treatment.
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ORIGINAL ARTICLES
Radiographic characteristics of asthma
Yu-Jang Su
October-December 2013, 30(4):286-288
DOI
:10.4103/0970-2113.120602
PMID
:24339484
Objectives:
A novel and interesting observation is that ribs go less sloped in asthma patients' radiograph than non-asthmatics people. The aim of this study was to investigate whether a smaller horizontal curve of the ribs is a special trait on chest radiograph of asthma patients.
Materials and Methods:
A retrospective review of the chest radiographs of 57 cases of asthma who were admitted between January 2011 and February 2011, and 57 non-asthma patients was performed. Chest radiographs were examined and lines drawn horizontally through the middle point of the sixth rib, and to where the sixth rib reaches the thoracic cage. The angle between these two lines was defined as the angle of rib curve (ARC). The ARCs were then compared between groups using the Student's
t
-test.
Results:
The mean ARC was smaller in asthma patients than in non-asthma patients (10.7 ± 4.7° vs. 14.3 ± 4.7°,
P
< 0.0001). In the asthma group, the mean male ARC was smaller than the mean female ARC (8.4 ± 4.1° vs. 11.5 ± 4.7°,
P
= 0.026); however, there was no statistical difference in gender in the non-asthma group (
P
= 0.405).
Conclusions:
This is the first study to report that the ribs of asthma patients are less sloped than in patients without asthma. This photographic trait may be helpful in daily practice for suspecting a diagnosis of bronchial asthma.
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Role of DR-70 immunoassay in suspected malignant pleural effusion
Amitabha Sengupta, Kaushik Saha, Debraj Jash, Sourindra Nath Banerjee, Nirendra Mohan Biswas, Atin Dey
October-December 2013, 30(4):321-326
DOI
:10.4103/0970-2113.120609
PMID
:24339491
Context:
A good proportion of patients with undiagnosed pleural effusion (PE) turn into malignancy over a period of time. Identification of positive biomarker may help in selecting the individuals who require close follow-up.
Aims:
The aims of this study were to evaluate the role of DR-70 immunoassay in suspected malignant PE.
Settings
and
Design:
We conducted a cross-sectional study among 89 patients of suspected malignant PE and 50 normal subjects (NS) were taken as control.
Materials
and
Methods:
Patients with exudative PE; who had pleural fluid lymphocyte count greater than 50% and adenosine deaminase less than 30 U/L were taken as cases. We had selected NSs among relatives of patients having normal blood chemistry and radiological investigations. Sensitivity and specificity of the test to differentiate malignant and non-malignant PE and also to identify PE with underlying malignancy was analyzed.
Results:
Mean value of DR-70 in NS was found to be 0.83 ± 0.273 mg/L without any significant difference between males (0.82 mg/L) and females (0.85 mg/L). Mean value of DR-70 in PE with underlying cancer was 5.03 ± 3.79 mg/L. Sensitivity (80%) and specificity (77.78%) of the test was maximum in PE with underlying cancer using cut-off value of 2 mg/L. Mean value DR-70 in malignant PE was 5.18 ± 3.75 mg/L and in non-malignant PE was 3.73 ± 3.74 mg/L without any statistically significant difference (
P
= 0.08).
Conclusions:
DR-70 assay has high sensitivity in detecting underlying lung cancer, but has no role in differentiating malignant PE from non-malignant PE.
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2,642
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2
LETTERS TO EDITOR
Differentiating pulmonary lymphangioleiomyomatosis from pulmonary langerhans cell histiocytosis and Birt-Hogg-Dube syndrome
Himanshu Bhardwaj, Bhaskar Bhardwaj
October-December 2013, 30(4):372-373
DOI
:10.4103/0970-2113.120611
PMID
:24339506
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2,578
426
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CASE REPORTS
An unusual masquerade of community acquired pneumonia: Left-side unilateral pulmonary edema
Akashdeep Singh, Gupreet Singh Wander
October-December 2013, 30(4):344-346
DOI
:10.4103/0970-2113.120617
PMID
:24339496
The diagnosis of pneumonia is clinical, based on the history of lower respiratory tract symptoms, physical, and/or radiographic signs of consolidation. Several diseases such as congestive heart failure, pulmonary embolism, and chemical pneumonitis may present with similar symptoms, signs, and chest radiographs, thus delaying the definitive diagnosis and initiation of appropriate treatment. Unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first as a focal lung disease. We have presented an unusual case of left-sided UPE in a 76-year-old man who developed acute heart failure resulting from dietary and pharmacological noncompliance. The patient was successfully managed with decongestive therapy and non-invasive mechanical ventilation.
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2,623
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LETTERS TO EDITOR
Spectacle sign
Binit Sureka, Mahesh Kumar Mittal, Aliza Mittal, Brij Bhushan Thukral
October-December 2013, 30(4):378-378
DOI
:10.4103/0970-2113.120630
PMID
:24339513
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2,583
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ORIGINAL ARTICLES
Noninvasive mechanical ventilation: An 18-month experience of two tertiary care hospitals in north India
Ajay K Verma, Mayank Mishra, Surya Kant, Anand Kumar, Sushil K Verma, Sudhir Chaudhri, J Prabhuram
October-December 2013, 30(4):307-311
DOI
:10.4103/0970-2113.120606
PMID
:24339488
Background:
Noninvasive mechanical ventilation (NIMV) is the delivery of positive pressure ventilation through an interface to upper airways without using the invasive airway. Use of NIMV is becoming common with the increasing recognition of its benefits.
Objectives:
This study was done to evaluate the feasibility and outcome of NIMV in tertiary care centres.
Materials and Methods:
An observational, retrospective study conducted over a period of 18 months in two tertiary level hospitals of north India on 184 consecutive patients who were treated by NIMV, regardless of the indication. NIMV was given in accordance with the arterial blood gas (ABG) parameters defining respiratory failure (Type 1/Type 2).
Results:
The most common indication of NIMV in our hospitals was acute exacerbation of chronic obstructive pulmonary disease (AE-COPD 80.43%), and 90.54% AE-COPD patients were improved by NIMV. Application of NIMV resulted in significant improvement of pH and blood gases in COPD patients, while non-COPD patients showed significant improvement in partial pressure of oxygen (PaO
2
) alone. The mean duration of NIMV was 8.35 ± 5.98 days, and patients of interstitial lung disease (ILD) were on NIMV for the maximum duration (17 ± 8.48 days). None of the patients of acute respiratory distress syndrome were cured by NIMV; 13.04% patients on NIMV required intubation and mechanical ventilation.
Conclusion:
This study demonstrates and encourages the use of NIMV as the first-line ventilatory treatment in AE-COPD patients with respiratory failure. It also supports NIMV usage in other causes of respiratory failure as a promising step toward prevention of mechanical ventilation.
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2,074
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EDITORIALS
Does climate mould the influence of mold on asthma?
Ashutosh Nath Aggarwal, Arunaloke Chakrabarti
October-December 2013, 30(4):273-276
DOI
:10.4103/0970-2113.120594
PMID
:24339481
[FULL TEXT]
[PDF]
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2,058
411
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CASE REPORTS
A case of spontaneous pneumothorax following radiation therapy for non-small cell lung cancer
Himanshu Bhardwaj, Bhaskar Bhardwaj, Houssein A Youness
October-December 2013, 30(4):360-362
DOI
:10.4103/0970-2113.120624
PMID
:24339501
Spontaneous pneumothorax (SPTX) is a potentially devastating rare complication of the thoracic radiation therapy. Most of the cases in the medical literature, have been described in lymphoma patients receiving radiation therapy. The pathogenesis of this adverse event remains undefined although different mechanisms have been proposed. We present a case of post-radiation therapy SPTX in a non-small cell lung cancer (NSCLC), following intensity modulated radiation therapy (IMRT), which to our knowledge is the first such reported case related to this newer mode of radiation therapy. This report highlights the importance of keeping a close eye for this complication as timely treatment with chest tube insertion and drainage of the pneumothorax can be a lifesaving in these patients.
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2,162
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Fruiting bodies of Aspergillus: An unusual finding in histopathology
KR Anila, Thara Somanathan, Anitha Mathews, K Jayasree
October-December 2013, 30(4):357-359
DOI
:10.4103/0970-2113.120623
PMID
:24339500
A-62-year-old lady presented with complaints of cough, dyspnea and hemoptysis of 3 months duration. A radiological evaluation revealed a mass lesion in the left lung along with significant lymphadenopathy. With a clinical and radiological diagnosis of carcinoma of the lung, the patient was taken up for biopsy. The specimen consisted mainly of grey-white friable soft-tissue, which on histopathological evaluation showed small cell carcinoma, which was confirmed with immunohistochemistry. Apart from the carcinomatous component, many hyphae and fruiting bodies of Aspergillus were also seen. We are reporting this case because, though the finding of hyphal forms of Aspergillus is not so uncommon in lung biopsies, detection of fruiting bodies of Aspergillus in histopathological section is an extremely rare finding. The hyphal forms of Aspergillus can be confused with the hyphal forms of other fungi, but when fruiting bodies are present a definite diagnosis is possible at the histopathology level itself. We would also like to highlight that contamination should be excluded before labeling a case as Aspergillosis because of the potentially toxic medication implicated in the treatment.
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2,154
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ORIGINAL ARTICLES
Is serum cholesterol a risk factor for asthma?
Karthikeyan Ramaraju, Srikanth Krishnamurthy, Smrithi Maamidi, Anupama Murthy Kaza, Nithilavalli Balasubramaniam
October-December 2013, 30(4):295-301
DOI
:10.4103/0970-2113.120604
PMID
:24339486
Background:
Proinflammatory role of serum cholesterol in asthma has been recently explored with contradicting results. Clarity on the link between serum cholesterol and asthma may lead to new evolutions in planning management strategies. The objective of our study was to examine the relationship between the serum cholesterol, asthma and its characteristics.
Materials and Methods:
A total of 40 asthmatics and 40 normal subjects were examined cross-sectionally and their serum fasting cholesterol and serum high sensitivity C reactive protein (hsCRP) levels were measured along with other baseline investigations. All subjects were non-smokers.
Results:
Serum total cholesterol (mean ± SD) among asthmatics was 176.45 ± 30.77 mgs/dL as compared to 163.33 ± 26.38 mgs/dL among normal subjects (
P
< 0.05). This higher serum cholesterol level was found to be associated with asthma independent of age, gender, body mass index (BMI), socio-economic status and serum hsCRP levels. However, the association was only modest (adjusted odds ratio 1.033; 95% confidence interval [CI] 1.008-1.059). There was no association between the serum cholesterol and asthma characteristics such as duration of illness, intake of inhaled steroids and frequency of emergency department visits. Other risk factors identified were poor ventilation (adjusted odds ratio 9.27; 95%CI 1.83-46.99) and overcrowding (adjusted odds ratio 41.9; 95% CI 3.15-557.46) at home.
Conclusion:
Our study found a modest but significant association between higher levels of serum cholesterol and asthma, which is independent of age, gender, BMI, socio-economic status and serum hsCRP. Future research is required in a larger population to substantiate above association and its clinical implications. Poor ventilation and overcrowding at home are risk factors for asthma possibly facilitating increased exposure to indoor allergens.
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PICTORIAL QUIZ
Difficult to treat bronchial asthma with radiological opacities
Swapnil Kulkarni, Vinaya Karkhanis, Jyotsna Madanmohan Joshi
October-December 2013, 30(4):370-371
DOI
:10.4103/0970-2113.120631
PMID
:24339505
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
2,009
313
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ORIGINAL ARTICLES
A local perspective to asthma management in the accident and emergency department in Malta
Caroline Gouder, Josef Micallef, Rachelle Asciak, Justine Farrugia Preca, Richard Pullicino, Stephen Montefort
October-December 2013, 30(4):280-285
DOI
:10.4103/0970-2113.120601
PMID
:24339483
Aim:
This study was performed to assess the management of adult patients presenting to the Mater Dei Hospital Accident and Emergency (A&E) department with acute asthma.
Subjects and Methods:
Asthmatic patients age 14 or older who presented to A&E department between January and October 2010 with asthma exacerbations were included. Data were collected from the clinical notes and analyzed.
Results:
A total of 244 patients (67.2% females) were included, 126 (51.6%) were admitted, 97 (39.8%) discharged and 21 (8.6%) discharged themselves against medical advice. There was a decline in the presentations between January and July, followed by an upward trend until October (
P
= 0.42). Pulse oximetry was performed in 207 patients (84.8%), arterial blood gases in 133 (54.5%), peak expiratory flow rate in 106 (43.4%) and chest radiography in 206 (84.4%) patients. The respiratory rate was documented in 151 (61.8%), heart rate in 204 (83.6%) and ability to complete sentences in 123 (50.4%) patients. One hundred and ninety six patients (80.3%) were given nebulized bronchodilators, 103 (42.2%) intravenous corticosteroids, 7 (2.87%) oral corticosteroids, 109 (44.7%) oxygen, 28 (11.5%) antibiotics and 9 (3.69%) magnesium. Systemic corticosteroids and antibiotics were more commonly prescribed to patients admitted (
P
< 0.001).
Conclusion:
Management of acute asthma in Malta requires optimization in order to compare with international guidelines.
[ABSTRACT]
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2,022
290
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LETTERS TO EDITOR
Specimen collection from chest tubes: A novel method
Milind Baldi, Varun Giri, Jairaj Nair, Amita Athavale
October-December 2013, 30(4):374-374
DOI
:10.4103/0970-2113.120613
PMID
:24339507
[FULL TEXT]
[PDF]
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[PubMed]
1,879
249
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RADIOLOGY QUIZ
A young smoker with hemoptysis
Sanyal Kumar, Bhawna Satija, Dipti Gothi, Nimisha Yadav
October-December 2013, 30(4):365-367
DOI
:10.4103/0970-2113.120627
PMID
:24339503
A young man presented with complaints of dry cough, right lower chest pain, and streaky hemoptysis for duration of 3 months. A nonresolving opacity on chest radiograph and mass-like consolidation on computed tomography (CT), led to biopsy of the mass under CT guidance. Histopathology provided the diagnosis. The radiological features were retrospectively evaluated.
[ABSTRACT]
[FULL TEXT]
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[EPub]
[PubMed]
1,813
312
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CASE REPORTS
Rifampicin induced adrenal crisis in an uncommon setting
Animesh Ray, JC Suri, Mansi Gupta
October-December 2013, 30(4):363-364
DOI
:10.4103/0970-2113.120626
PMID
:24339502
Adrenal crisis occurs when there is decreased secretions of steroid hormones (mainly cortisol) from the adrenal glands due to varied reasons. It may arise due to a primary adrenal condition or due to decreased hormonal signals from the pituitary secondary to a hypofunctioning pituitary. Hypopituitarism may result due to direct causes like trauma, tumour, infection or it may be due to some vascular insult as seen in Sheehan syndrome. We report an unusual presentation of Sheehan syndrome in the form of life-threatening adrenal crisis precipitated by the usage of rifampicin.
[ABSTRACT]
[FULL TEXT]
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[CITATIONS]
[PubMed]
1,754
347
1
Aspergillus colonization in hydatid cyst: Addition of a case
Meetu Agrawal, Megha S Uppin, P Lakshmi Manasa, Shantveer G Uppin, M Phani Chakravarty, RC Mishra, Sundaram Challa
October-December 2013, 30(4):335-337
DOI
:10.4103/0970-2113.120612
PMID
:24339493
Aspergillus is a common saprophytic fungus that causes invasive or non-invasive disease in humans. It commonly colonizes pre-existing lung cavities. It has been earlier reported to coexist in previously operated or ruptured hydatid cysts. However there have been only few case reports of its occurrence in previously unoperated cysts in immunocompetent hosts. The present case adds to this category.
[ABSTRACT]
[FULL TEXT]
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[PubMed]
1,759
270
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PICTORIAL QUIZ
Unilateral hyperlucent lung: Always think ACROSS
Mahesh Jansari, Vinaya Karkhanis, JM Joshi
October-December 2013, 30(4):368-369
DOI
:10.4103/0970-2113.120629
PMID
:24339504
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,522
330
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CASE REPORTS
Internal mammary artery pseudoaneurysm: A rare fatal complication of tubercular empyema
Mukesh K Yadav, Anmol Bhatia, Susheel Kumar, Niranjan Khandelwal
October-December 2013, 30(4):341-343
DOI
:10.4103/0970-2113.120615
PMID
:24339495
Vascular complications in the chest due to tuberculosis (TB) involve the pulmonary as well as bronchial vasculature. Mycotic pseudoaneurysms of internal mammary artery (IMA) are a sparsely reported clinical entity in the literature occurring due to TB. We report a rare case of IMA pseudoaneurysm due to the tubercular empyema in a patient with massive hemoptysis who was treated by endovascular coil embolization; however, the patient died due to refractory shock.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,507
229
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LETTERS TO EDITOR
Pulmonary alveolar microlithiasis
Mohammad Ashkan Moslehi
October-December 2013, 30(4):375-375
DOI
:10.4103/0970-2113.120616
PMID
:24339508
[FULL TEXT]
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[EPub]
[CITATIONS]
[PubMed]
1,187
285
1
Organizing pneumonia in swine flu
Beuy Joob, Viroj Wiwanitkit
October-December 2013, 30(4):376-377
DOI
:10.4103/0970-2113.120625
PMID
:24339511
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
1,021
176
1
Filariasis and pleural effusion
Somsri Wiwanitkit, Viroj Wiwanitkit
October-December 2013, 30(4):376-376
DOI
:10.4103/0970-2113.120622
PMID
:24339510
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
856
168
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Authors' reply
Gláucia Zanetti, Bruno Hochhegger, Edson Marchiori
October-December 2013, 30(4):377-378
[FULL TEXT]
[PDF]
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[EPub]
736
107
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Authors' reply
Surender Kashyap, Prasanta R Mohapatra
October-December 2013, 30(4):375-376
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
698
121
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