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2015| July-August | Volume 32 | Issue 4
Online since
June 30, 2015
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GUIDELINES
Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition)
Surendra K Sharma, Vishwa Mohan Katoch, Alladi Mohan, T Kadhiravan, A Elavarasi, R Ragesh, Neeraj Nischal, Prayas Sethi, D Behera, Manvir Bhatia, AG Ghoshal, Dipti Gothi, Jyotsna Joshi, MS Kanwar, OP Kharbanda, Suresh Kumar, PR Mohapatra, BN Mallick, Ravindra Mehta, Rajendra Prasad, SC Sharma, Kapil Sikka, Sandeep Aggarwal, Garima Shukla, JC Suri, B Vengamma, Ashoo Grover, VK Vijayan, N Ramakrishnan, Rasik Gupta
July-August 2015, 32(4):422-434
DOI
:10.4103/0970-2113.159677
PMID
:26180408
Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
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ORIGINAL ARTICLES
A study on spirometry in petrol pump workers of Ahmedabad, India
Ravi B Solanki, Anjali R Bhise, Bharat M Dangi
July-August 2015, 32(4):347-352
DOI
:10.4103/0970-2113.159567
PMID
:26180384
Background:
Lung reactions to exposure to dust, gases, and fumes at work places have been studied in different populations. The emission level of pollutants that emit particulate matter less than 10 micrometers in size (PM 10) has been found very high in Ahmedabad. Hence, petrol pump workers in Ahmedabad are likely to get exposed to a high level of air pollution along with petrol and diesel vapors. Both of these factors can affect the respiratory health of petrol pump workers.
Materials and Methods:
A cross-sectional observational study was conducted at 53 different petrol pumps of Ahmedabad. A total of 227 petrol pump workers underwent pulmonary function testing. Their spirometry parameters were compared with 227 age-matched, healthy controls.
Results:
A significant reduction (
P
< 0.001) was found in the spirometry parameters, such as,
forced vital capacity
(FVC), forced expiratory volume in the first second (FEV
1
),
forced expiratory flow
(FEF
25-75
), and
peak expiratory flow rate
(PEFR) in petrol pump workers, as compared to the controls. The mean values of FEV
1
/FVC (%) were significantly increased (
P
< 0.001). A decline in FVC was not significantly different among the workers according to the duration of exposure. As the duration of exposure increased, there was a progressive decline in FEV
1
/FVC (%) and FEF
25-75
.
Conclusion:
The study concludes that the deleterious effects of air pollution and petrol/diesel vapor inhalation on the lung function of petrol pump workers results in a restrictive type of lung function abnormality. The pattern of respiratory impairment changes to a mixed type as the duration of exposure increases.
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A novel approach for lung delivery of rifampicin-loaded liposomes in dry powder form for the treatment of tuberculosis
Jagadevappa S Patil, V Kusum Devi, Kshama Devi, S Sarasija
July-August 2015, 32(4):331-338
DOI
:10.4103/0970-2113.159559
PMID
:26180381
Background:
Lung administration of antibiotics by nebulization is promising for improved treatment efficiency for pulmonary infections, as it increases drug concentration at sites of infection while minimizing systemic side effects. For poorly soluble molecules like rifampicin, lipid particulate system may improve lung delivery.
Materials and Methods:
We investigated rifampicin-loaded freeze-dried liposomes. Various formulations were prepared with different drug lipid ratios and one formulation was optimized. Optimized colloidal liposome formulation was freeze-dried and subsequently subjected for various evaluation and characterization parameters such as
in-vitro
dissolution,
in-vitro
antitubercular activity, aerodynamic characters, surface morphology, and thermal behavior. The optimized formulation of rifampicin-loaded freeze-dried liposome and free rifampicin was subjected for the
in-vivo
drug disposition study in Wister rat model by intra-tracheal instillation in comparison with an oral route of administration.
Results:
The results of pharmacokinetic study for both free drug and the formulation suggested that liposomes released the drug in a controlled manner for a longer period of time. The enhanced efficiency of drug incorporated into liposomes suggested that the delivery of encapsulated drugs to macrophages was more rapid than that of free drug.
Conclusion:
Therefore, the pharmacokinetic and drug disposition studies provided a sound basis for predicting the successful treatment for tuberculosis.
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REVIEW ARTICLE
Infection control in the pulmonary function test laboratory
Shweta Amol Rasam, Komalkirti Keshavkiran Apte, Sundeep Santosh Salvi
July-August 2015, 32(4):359-366
DOI
:10.4103/0970-2113.159571
PMID
:26180386
Pulmonary function testing plays a crucial role in the diagnostic evaluation of patients with lung diseases. Cases of cross infection acquired from the pulmonary function laboratory, although rare, have been reported from various countries. It is therefore imperative to identify the risks and potential organisms implicated in cross infections in a pulmonary function test (PFT) laboratory and implement better and more effective infection control procedures, which will help in preventing cross infections. The infrastructure, the daily patient flow, and the prevalent disinfection techniques used in a PFT laboratory, all play a significant role in transmission of infections. Simple measures to tackle the cross infection potential in a PFT laboratory can help reduce this risk to a bare minimum. Use of specialized techniques and equipment can also be of much use in a set up that has a high turnover of patients. This review aims at creating awareness about the possible pathogens and situations commonly encountered in a PFT laboratory. We have attempted to suggest some relevant and useful infection control measures with regard to disinfection, sterilization, and patient planning and segregation to help minimize the risk of cross infections in a PFT laboratory. The review also highlights the lacuna in the current scenario of PFT laboratories in India and the need to develop newer and better methods of infection control, which will be more user-friendly and cost effective. Further studies to study the possible pathogens in a PFT laboratory and evaluate the prevalent infection control strategies will be needed to enable us to draw more precious conclusions, which can lead to more relevant, contextual recommendations for cross infections control in PFT lab in India.
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ORIGINAL ARTICLES
Development of a mortality prediction formula due to sepsis/severe sepsis in a medical intensive care unit
Anant Mohan, Prajowl Shrestha, Randeep Guleria, Ravindra Mohan Pandey, Naveet Wig
July-August 2015, 32(4):313-319
DOI
:10.4103/0970-2113.159533
PMID
:26180378
Background:
Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited.
Materials and Methods:
Patients fulfilling the Infectious Disease Society of America criteria of sepsis within the medical intensive care unit (ICU) were included over two years. Apart from baseline hematological, biochemical, and metabolic parameters, Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II and III (SAPS II and SAPS III), and Sequential Organ Function Assessment (SOFA) scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU.
Results:
One hundred patients were enrolled over two years (54% males). The overall mortality was 53%, (69.5% in females, 38.8% in males (
P
< 0.01). Mortality was 65.7%, 55.7%, and 33.3% in patients with septic shock, severe sepsis, and sepsis, respectively. Patients who died were significantly older than the survivors (mean age, 57.37 ± 20.42 years and 44.29 ± 15.53 years respectively,
P
< 0.01). Nonsurvivors were significantly more anemic and had higher APACHE II, SAPS II, SAPS III, and SOFA scores. The presence of acute respiratory distress syndrome and renal dysfunction were associated with higher mortality (75% and 70.2%, respectively). There was no significant difference in the duration of mechanical ventilation or ICU stay between survivors and nonsurvivors. On multivariate analysis, significant predictors of mortality with odds ratio greater than 2 included the presence of anemia, SAPS II score greater than 35, SAPS III score greater than 47, and SOFA score greater than 6 at day 1 of admission.
Conclusion:
Several demographic and laboratory parameters as well as composite critical illness scoring systems are reliable early predictors of mortality in sepsis. A sepsis mortality prediction formula (AIIMS Sepsis Score) based on SAPS II, SAPS III, and SOFA scores and hemoglobin has greater predictive power than these scoring methods individually. Routine use of critical illness scoring systems and a composite mortality prediction formula may provide useful early prognostic information in sepsis/severe sepsis.
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Exercise-induced desaturation in patients with chronic obstructive pulmonary disease on six-minute walk test
Archana Chauhan Dogra, Urmil Gupta, Malay Sarkar, Anita Padam
July-August 2015, 32(4):320-325
DOI
:10.4103/0970-2113.159550
PMID
:26180379
Background and Objectives:
Exercise-induced desaturation (EID) is associated with increased mortality in chronic obstructive pulmonary disease (COPD). However, the relationship of EID with anthropometric and clinical parameters of resting pulmonary function test and six-minute walk test (6MWT) in COPD remains unclear. The study was designed to assess the correlate of EID and to identify various possible predictors of EID in stable normoxemic patients of COPD.
Materials and
Methods:
Sixty patients with stable COPD diagnosed and staged as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines underwent 6MWT. A drop in standard pulse oximetry (SpO
2
) of ≥4% or nadir up to ≤88% was defined as EID. Based on EID during 6MWT, two groups were formed: desaturators (DS) and nondesaturators (NDS). DS and NDS were compared for baseline and clinical characters by the Student's
t
-test while Pearson and Spearman rho correlation coefficient assessed strength of the association of anthropometric and clinical variables with EID. The predictors of EID were identified by logistic regression and receiver operator curve analysis.
Result:
Out of 60 patients with stable COPD, 33 patients desaturated on exercise (
n
= 33/60). DS had significantly lower values of FEV
1
(
P
< 0.001), FVC (
P
< 0.01) FEV
1
/FVC (
P
< 0.01) compared to NDS. EID had significant negative correlation with FEV
1
(
r
= 0.31,
P
< 0.01), resting oxygen saturation (
r
= 0.549,
P
< 0.001) and 6MWD (
r
= 0.511,
P
< 0.001). Resting SpO
2
≤93% was found to a predictor of EID with a sensitivity and specificity of 83% and 78%, respectively.
Interpretation and Conclusion:
The 6MWT is a safe and sensitive test to recognize EID in normoxic stable COPD patients. Resting oxygen saturation is a good predictor of EID.
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EDITORIAL
Itraconazole in chronic pulmonary aspergillosis: In whom, for how long, and at what dose?
Venkata Nagarjuna Maturu, Ritesh Agarwal
July-August 2015, 32(4):309-312
DOI
:10.4103/0970-2113.159523
PMID
:26180377
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CASE REPORTS
Idiopathic pulmonary hemosiderosis presenting in an adult: A case report and review of the literature
Khalid M Sherani, Hinesh N Upadhyay, Farha K Sherani, Abhay P Vakil, Samir S Sarkar
July-August 2015, 32(4):395-397
DOI
:10.4103/0970-2113.159594
PMID
:26180395
Diffuse alveolar hemorrhage (DAH) is characterized by the presence of hemoptysis, anemia, and the presence of diffuse parenchymal infiltrates on imaging studies. Idiopathic pulmonary hemosiderosis (IPH) is an uncommon cause of diffuse alveolar hemorrhage (DAH) and is classically known to present in childhood. Adult-onset IPH is extremely rare. We report the case of a 48-year-old female patient who presented with hemoptysis and acute hypoxic respiratory failure, requiring intubation and mechanical ventilation. Imaging studies showed diffuse bilateral patchy infiltrates. Bronchoalveolar lavage (BAL) confirmed the diagnosis of DAH. Extensive workup including video-assisted thoracoscopic surgical lung biopsy (VATS) failed to reveal any vasculitis, infectious, immunological or connective tissue disorder, as the underlying cause for DAH. The patient was successfully treated with high-dose steroid therapy.
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ORIGINAL ARTICLES
Clinico- pathological profile and course of malignant pleural effusion in a tertiary care teaching hospital in western U.P. with special reference to lung cancer
Anurag Agrawal, Rajeev Tandon, Lalit Singh, Aakanksha Chawla
July-August 2015, 32(4):326-330
DOI
:10.4103/0970-2113.159551
PMID
:26180380
Background:
Malignant pleural effusion is a major clinical problem associated with primary and metastatic pleural malignancies. Pleural effusions from an unknown primary are responsible for 7-15% of all malignant pleural effusions. Presence of malignant pleural effusion puts the patient in advanced stage and renders the prognosis as poor.
Aim:
In this study we intend to find out the incidence of malignant pleural effusion, its aetiology and clinical course in patients attending a tertiary care teaching hospital.
Results:
A total of 308 patients were included in this study. A majority of the patients were in age group 50- 70 years (median age = 58.8 years; range 32- 85 yrs). Male to female ratio was 2.5:1. The major primary cancers were lung cancer (135), lymphoma (40), breast cancer (36), female genital tract (30) gastrointestinal (21), and others (8). In 38 cases primary remained unknown. The yields of pleural fluid cytology, blind pleural biopsy, CT/USG guided pleural biopsy and thoracoscopy were 60%, 49%, 76% and 91% respectively. Chemical pleurodesis yielded complete response in 80%, incomplete response in another 13% patients. Only 136 (44%) cases could be followed up for minimum of 6 months. A majority of them (95, 69.85%) died.
Conclusion:
We conclude that malignant pleural effusion is a commonly misdiagnosed medical entity. Lung cancer is the commonest cause. Despite all efforts, in about 15% of the cases, primary remains undiagnosed. Thoracoscopy/pleuroscopy is a cost effective measure for diagnosis. Chemical pleurodesis provides expected results but mortality remains high.
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CASE REPORTS
Granulomatosis with polyangiitis and associated pulmonary emphysema: Breathtaking vasculitis
Shruti K Gadre, James K Stoller, Atul C Mehta
July-August 2015, 32(4):367-369
DOI
:10.4103/0970-2113.159576
PMID
:26180387
Pulmonary emphysema occasionally occurs in the absence of smoking or noxious exposures. Other than through a known association with alpha-1 antitryspin deficiency, to our knowledge, no reports implicate granulomatosis with polyangiitis (GPA) in causing airflow obstruction with small airway involvement and severe air trapping. To extend available experience, we report a 51-year-old male with biopsy-proven cytoplasmic-antineutrophilic cytoplasmic antibody proteinase 3 (ANCA PR3)-positive GPA who developed centrilobular emphysema and airflow obstruction during a phase of active vasculitis. He was a lifelong non-smoker and had a normal alpha-1 antitrypsin level and a PI*MM phenotype. Treatment with corticosteroids and cyclophosphamide caused clinical remission of his vasculitis which was associated with improvement in his respiratory symptoms. However, to date, structural changes of emphysema have persisted for over 9 years of follow-up. Clinicians should remain vigilant to the possibility of emphysema in patients with pulmonary vasculitis.
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ORIGINAL ARTICLES
Pulmonary function of adolescents from Tripura, a North-eastern state of India
Dipayan Choudhuri, Balaram Sutradhar
July-August 2015, 32(4):353-358
DOI
:10.4103/0970-2113.159568
PMID
:26180385
Objective:
Spirometric evaluation of pulmonary function has been evolved as clinical tool in diagnosis, management, and follow-up of respiratory disorders. There are very few studies on normative reference values of pulmonary function parameters for adolescents from Tripura, a North-eastern state of India. The present study was aimed to evaluate pulmonary function and their predictors in male and female adolescents of Tripura.
Materials and Methods:
A total of 640 (320 from tribal and 320 non-tribal) healthy, non-smoking male and female school children (age 10-14 years) from four different districts of Tripura were randomly sampled for the study. The pulmonary function parameters analysed included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV
1
), peak expiratory flow rate (PEFR), forced expiratory flow between 25% and 75% expired volume (FEF
25-75%
), ratio of FEV
1
/FVC and maximum voluntary ventilation (MVV).
Results:
The results revealed that body weight, body mass index (BMI), PEFR, FEF
25-75%
and MVV are significantly high among male tribal children in comparison to non-tribal children. Height, weight, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), PEFR and MVV were found to be significantly more in tribal girls. In case of adolescents from Tripura, most of the pulmonary function parameters correlated with anthropometric parameters of the subject like height, weight, BMI, WHR, and WHtR.
Conclusion:
From the present study, it can be concluded that both anthropometric and pulmonary function status of tribal and non-tribal adolescents from Tripura are comparable. The computed regression norms may be used to predict pulmonary function of adolescents from Tripura by using anthropometric indices.
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A comparative study of itraconazole in various dose schedules in the treatment of pulmonary aspergilloma in treated patients of pulmonary tuberculosis
Prahlad Rai Gupta, Shubhra Jain, Jai Prakash Kewlani
July-August 2015, 32(4):342-346
DOI
:10.4103/0970-2113.159563
PMID
:26180383
Introduction:
The optimal dose, duration, and efficacy of itraconazole in Indian patients of pulmonary aspergilloma (PA) are not clearly defined. Therefore, a study was carried out, to resolve these issues in diagnosed cases of PA complicating old treated patients of pulmonary tuberculosis.
Materials and Methods:
The study patients randomly received itraconazole either in a fixed dose schedule of 200 mg (group I), 200 mg twice daily (group II) or a variable dose schedule (group III), for 12 months. All the patients were followed up for the entire duration of the study for clinical, radiological, and immunological response. The side effects were recorded as and when reported by the patients and managed symptomatically.
Results:
A total of 60 patients were enrolled, 20, in each group. There were no intergroup differences with regard to age, sex, body weight, smoking status, alcohol intake, symptoms, Potassium hydroxide (KOH) mount, fungal culture, pattern of radiological lesions or anti-aspergillus antibodies (anti-Asp-Ab) titers. The radiological response was poor in group I patients, as compared to the other groups, at two months (
P
< 0.05). The dose of itraconazole was increased in five of the patients in group I due to poor response. A higher number of group II patients suffered side effects and the dose of itraconazole had to be decreased in three of these patients, but none of the patients on a variable dose schedule required a change in dose schedule.
Conclusion:
Thus, a weight-based variable dose schedule of itraconazole was found to be a more effective and safer modality in the management of PA than a fixed dose schedule.
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CASE REPORTS
Bilateral chylothorax as a complication of internal jugular vein cannulation
Puneet Saxena, Subramanian Shankar, Vivek Kumar, Nardeep Naithani
July-August 2015, 32(4):370-374
DOI
:10.4103/0970-2113.159579
PMID
:26180388
Central venous catheterization is one of the most prevalent procedures in the Intensive Care Unit. Complications are reported in about 15% of the patients and usually comprise of infection, arterial puncture, malpositioning, pneumothorax, local hematoma, hemothorax, and so on. Chylothorax is a rare complication of this procedure. We present a 42-year-old lady, who developed bilateral massive chylothorax after cannulation of her left internal jugular vein (IJV), due to direct injury to the thoracic duct during the procedure. The patient was successfully managed with bilateral chest tube drainage and omission of oral feeds for four days. Development of bilateral chylothorax as a complication of IJV cannulation is rare, but merits reporting, in view of a large number of central venous cannulations being undertaken. Critical care professionals should be aware of this rare complication of a common procedure to facilitate early identification and institute appropriate therapy.
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ORIGINAL ARTICLES
Pattern of drug resistance of
Mycobacterium tuberculosis
clinical isolates to first-line antituberculosis drugs in pulmonary cases
Deepika Kalo, Surya Kant, Kanchan Srivastava, Ajay K Sharma
July-August 2015, 32(4):339-341
DOI
:10.4103/0970-2113.159561
PMID
:26180382
Context:
Mycobacterium tuberculosis
(MTB), the human pathogen causes Tuberculosis (TB). It is a highly infectious and globally pandemic disease. The severity increases when the MTB becomes resistant to antituberculosis drugs. India is reported to be in the second place, with the highest number of drug-resistant TB cases. The treatment of drug-resistant TB is even more complicated.
Materials and Methods:
The present study comprises of 159 TB patients, in which 88 are reported to have drug-resistant TB (55.3%). All the patients are in the age group of 18-70 years. Patients having extrapulmonary TB and diabetes were excluded from the study. The collected samples were processed and stained for acid fastness and smear positivity. They were subjected to inoculation on Lowenstein-Jensen (LJ) slants.
Results:
The results showed that out of the four drugs - Streptomycin, Isoniazid, Rifampicin, and Ethambutol - the resistant cases reported in Streptomycin were 45 (24.9%), whereas, in Isoniazid, Rifampicin, and Ethambutol, the resistant cases were 62 (34.2%), 27 (14.9%), and 47 (26.0%), respectively. Isoniazid showed the highest percentage of resistance among the patients.
Conclusion:
Effective measures such as convincing the patients to take the prescribed drugs and follow the five major strategies under the Directly Observed Treatment, Short Course (DOTS), could help in managing such cases.
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CASE REPORTS
A rare case of pulmonary arterio-venous malformation with recurrent anemia: Hereditary hemorrhagic telangiectasia
Kamalesh Tagadur Nataraju, Tirthankar Mukherjee, Ramachandra Prabhu Hosahalli Doddaiah, Nagesh Gabbadi Nanjappa, Lakshmikanth Narasegowda
July-August 2015, 32(4):384-388
DOI
:10.4103/0970-2113.159587
PMID
:26180392
Arteriovenous malformation (AVM) is a rare vascular anomaly of the lung, which manifests predominantly as dyspnea (due to right to left shunting) and paradoxical embolism. Hereditary Hemorrhagic Telangiectasia (HHT) being a rare genetic disorder is one of the most common causes of pulmonary arteriovenous malformation (PAVM). Here we report an interesting case of recurrent anemia in an elderly female, who was subsequently found to have multiple cutaneous and mucosal telangiectasias and a large pulmonary AVM.
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A rare pleural effusion in a young male
Shabana Begum, Subhasis Mukherjee, Debabani Biswas, Amartya Kumar Misra, Priyanka Ghosh, Pulakesh Bhanja
July-August 2015, 32(4):389-391
DOI
:10.4103/0970-2113.159589
PMID
:26180393
A 28-year-old male presented with fever with right-sided chest pain for 2 weeks. Clinicoradiological picture was suggestive of right-sided pleural effusion. He had history of polytrauma following a road traffic accident and had to undergo emergency laparotomy a month ago. Microscopic and culture examination of the pleural fluid showed neutrophilia, high bilirubin content and presence of gram-negative bacilli. Ultrasound of the abdomen showed the presence of biloma in the liver and right subdiaphragmatic space with fistulous communication into the right thoracic cavity. The patient was managed successfully with complete recovery.
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CASE LETTERS
Endobronchial metastasis in benign giant cell tumor of bone in a 25-year male -Second case report with literature review
Shiv Sagar Gupta, Nishith Kumar, Bandna Mehrotra
July-August 2015, 32(4):409-410
DOI
:10.4103/0970-2113.159610
PMID
:26180400
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1,970
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CASE REPORTS
Extralobar sequestration of lung associated with congenital diaphragmatic hernia and malrotation of gut
Kalpana Ranjitsingh Sulhyan, Nayan Anant Ramteerthakar, Alka Vikas Gosavi, Arti Rameshrao Anvikar
July-August 2015, 32(4):381-383
DOI
:10.4103/0970-2113.159585
PMID
:26180391
Extralobar sequestration of lung is a rare congenital malformation frequently diagnosed during repair of congenital diaphragmatic hernia. However, the combined association of congenital diaphragmatic hernia with both pulmonary sequestration and malrotation of gut is rare. We report a case of a 1-year-old girl with extralobar sequestration of lung and malrotation of gut detected during the repair of diaphragmatic hernia. The histopathological examination of the sequestered lobe revealed dilated bronchioles, alveolar ducts and alveoli along with dilated subpleural and peribronchiolar lymphatics and areas of type II congenital pulmonary airway malformation.
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COMMENTARY
Minimum inhibitory concentration, pharmacokinetics/pharmacodynamics and therapeutic drug monitoring: An integrated approach for multidrug-resistant tuberculosis
Shashikant Srivastava
July-August 2015, 32(4):402-403
PMID
:26180397
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1,785
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PICTORIAL CME
Asymptomatic thoracic esophageal duplication cyst in a young adult with bronchiectasis
Laxmikant Ramkumarsingh Tomar, Velmurugan Mannar, Sonal Pruthi, Amitesh Aggarwal
July-August 2015, 32(4):404-405
DOI
:10.4103/0970-2113.159603
PMID
:26180398
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1,774
188
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CASE REPORTS
Nephrobronchial fistula and lung abscess secondary to Xanthogranulomatous pyelonephritis
Abhay Uppe, Ravindra Nikalji, Manish Dubey, Nilesh Kadu
July-August 2015, 32(4):392-394
DOI
:10.4103/0970-2113.159590
PMID
:26180394
There are multiple causes of lung abscess, but the differential rarely includes pyelonephritis as a primary cause leading to lung abscess resulting from the development of a nephrobronchial fistula. The patient had no urinary symptoms or abdominal pain and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.
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1,718
187
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CASE LETTERS
Hodgkin's lymphoma presenting as lytic sternal swelling
Sheetu Singh, Rajendra Kumar Jenaw, Arpita Jindal, Chand Bhandari
July-August 2015, 32(4):410-412
DOI
:10.4103/0970-2113.159612
PMID
:26180401
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1,670
205
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CASE REPORTS
Multi-vesicular pulmonary hydatid cyst, the potent underestimated factor in the formation of daughter cysts of pulmonary hydatid disease
Mohsen Sokouti, Babak Sokouti, Behrooz Shokouhi, Mohammad Hossein Rahimi-Rad
July-August 2015, 32(4):375-377
DOI
:10.4103/0970-2113.159583
PMID
:26180389
Pulmonary multi-vesicular hydatid disease (HD) with
Echinococcus granulosus
is rare. A 28-year-old woman presented to our center with cough and respiratory distress. Chest x-ray and computerized tomography scan revealed bilateral giant cysts with water-lily sign (ruptured hydatid cysts). The left cyst was in vicinity of heart. With thoracotomy cysts of both lungs were removed. Thousands of translucent, homogenized small daughter cysts were discovered from the left side cyst. Pathologic examinations revealed the ruptured hydatid cysts of both lungs with daughter cysts on the left lung cyst. To best of our knowledge probably this is the first report of multi-vesicular HD in lung. We suppose that the heart pulsation was effective in the formation of daughter cysts.
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1,615
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A tale of synchronous lung carcinoma and diffuse large B-cell lymphoma of ileum: A rare combination
Daphne Fonseca, Bharati Musthyala, Faiq Ahmed, Sudha S Murthy, K. V. V. N. Raju
July-August 2015, 32(4):398-401
DOI
:10.4103/0970-2113.159598
PMID
:26180396
The occurrence of multiple malignancies in the same patient being synchronous or metachronous is a rare event. The incidence of multiple malignancies varies with age, sex, geographic origin, and site and type of tumors. The pathogenetic etiology may be multifactorial and include genetic predisposition, immunodeficiency, radiation therapy, chemotherapy and various infectious agents. It is crucial to recognize synchronous malignancies because course of treatment and management is difficult. The synchronous occurrence of pulmonary squamous cell carcinoma and ileal diffuse large B-cell lymphoma (DLBCL) is not reported in the Indian medical literature until today; hence, we publish this case for its rarity.
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1,603
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An unknown cause of hemoptysis-Left anterior descending coronary artery to left upper lobe bronchus fistula
Yadvir Garg, Ashok K Rajput, Calicut M Sreedhar, Vikas Marwah
July-August 2015, 32(4):378-380
DOI
:10.4103/0970-2113.159584
PMID
:26180390
We report a case of left anterior descending coronary artery to left upper lobe bronchus fistula arising out of the coronary artery aneurysm, secondary to drug eluting balloon angioplasty done for in-stent restenosis in the left anterior descending coronary artery in a 54-year-old male. This is an unreported entity yet.
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1,566
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BOOK REVIEW
Atlas of fiberoptic bronchoscopy
Bharat Bhushan Sharma, Virendra Singh
July-August 2015, 32(4):421-421
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1,112
661
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LETTERS TO EDITOR
Jarcho-Levin syndrome with association of unilateral pulmonary hypoplasia and diastometamyelia: A case illustration
Subramanyam Padma, Palaniswamy Shanmuga Sundaram
July-August 2015, 32(4):416-418
DOI
:10.4103/0970-2113.159636
PMID
:26180405
[FULL TEXT]
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1,409
181
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RADIOLOGY QUIZ
An extremely rare case of synchronous intrathoracic and intra-abdominal tumors
Preeti Goyal, Binit Sureka, Devendra Laddha
July-August 2015, 32(4):406-408
DOI
:10.4103/0970-2113.159607
PMID
:26180399
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1,405
181
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CASE LETTERS
A rare case of scapular metastasis from bronchogenic carcinoma with ipsilateral malignant pleural effusion
Anirban Das, Sabyasachi Choudhury, Sumitra Basuthakur, Angshuman Mukhopadhyay
July-August 2015, 32(4):412-414
DOI
:10.4103/0970-2113.159614
PMID
:26180402
[FULL TEXT]
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1,423
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LETTERS TO EDITOR
Comments on "Value of past clinical history in differentiating bronchial asthma from chronic obstructive pulmonary disorder in male smokers presenting with shortness of breath and fixed airway obstruction"
Armin Ahmed, Afzal Azim, Arvind Kumar Baronia
July-August 2015, 32(4):418-419
DOI
:10.4103/0970-2113.159637
PMID
:26180406
[FULL TEXT]
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1,264
291
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Assessment of spontaneous pneumothorax in adults in a tertiary care hospital
Aparup Dhua, Arunabha Datta Chaudhuri, Susmita Kundu, Sumit Roy Tapadar, Sourin Bhuniya, Bijan Ghosh, Subhasis Mukherjee, Soumya Bhattacharya
July-August 2015, 32(4):415-416
DOI
:10.4103/0970-2113.159635
PMID
:26180404
[FULL TEXT]
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1,296
227
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Response to comments on Value of past clinical history in differentiating bronchial asthma from chronic obstructive pulmonary disorder in male smokers presenting with shortness of breath and fixed airway obstruction
Prahlad Rai Gupta, Anupam Singh, Ashok Kumar Mehrotra, Trilok Kumar Khublani, Shradha Soni, Asif Feroz
July-August 2015, 32(4):419-420
DOI
:10.4103/0970-2113.159639
PMID
:26180407
[FULL TEXT]
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1,324
185
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Response to assessment of spontaneous pneumothorax in adults in a tertiary care hospital
Arjun Srinivasan, Mahadevan Sivaramakrishnan, Pattabhi Raman R Vallandramam, Pavan Yadav
July-August 2015, 32(4):415-415
DOI
:10.4103/0970-2113.159631
PMID
:26180403
[FULL TEXT]
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1,178
158
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