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Official publication of Indian Chest Society
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2018| March-April | Volume 35 | Issue 2
Online since
February 27, 2018
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REVIEW ARTICLE
Management of lower respiratory tract infection in outpatient settings: Focus on clarithromycin
Ashok Mahashur
March-April 2018, 35(2):143-149
DOI
:10.4103/lungindia.lungindia_262_17
PMID
:29487250
Lower respiratory tract infection (LRTI) is a broad terminology which includes acute bronchitis, pneumonia, acute exacerbations of chronic obstructive pulmonary disease/chronic bronchitis (AECB), and acute exacerbation of bronchiectasis. Acute LRTIs (ALRTIs) are one of the common clinical problems in community and hospital settings. Management of community-acquired pneumonia (CAP) and AECB may pose challenges because of diagnostic difficulty in differentiating infections caused by typical and atypical microorganisms and rising rates of antimicrobial resistance. Beta-lactam antibiotics, macrolides, and fluoroquinolones are routinely prescribed medicines for the management of ALRTIs. Macrolides are time-tested and effective agents for the treatment of LRTIs. Clarithromycin, a macrolide, offers several benefits in the management of ALRTIs. In this article, we discuss the management approach of LRTIs with focus on clarithromycin in the management of mild-to-moderate LRTIs (CAP and AECB), i.e., in outpatient settings.
[ABSTRACT]
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ORIGINAL ARTICLES
A survey of flexible bronchoscopy practices in India: The Indian bronchoscopy survey (2017)
Karan Madan, Anant Mohan, Ritesh Agarwal, Vijay Hadda, Gopi C Khilnani, Randeep Guleria
March-April 2018, 35(2):98-107
DOI
:10.4103/lungindia.lungindia_417_17
PMID
:29487243
Background:
There is a lack of contemporaneous data on the practices of flexible bronchoscopy in India.
Aim:
The aim of the study was to study the prevalent practices of flexible bronchoscopy across India.
Methods:
The “Indian Bronchoscopy Survey” was a 98-question, online survey structured into the following sections: general information, patient preparation and monitoring, sedation and topical anesthesia, procedural/technical aspects, and bronchoscope disinfection/staff protection.
Results:
Responses from 669 bronchoscopists (mean age: 40.2 years, 91.8% adult pulmonologists) were available for analysis. Approximately, 70,000 flexible bronchoscopy examinations had been performed over the preceding year. A majority (59%) of bronchoscopists were performing bronchoscopy without sedation. A large number (45%) of bronchoscopists had learned the procedure outside of their fellowship training. About 55% used anticholinergic premedication either as a routine or occasionally. Nebulized lignocaine was being used by 72%, while 24% utilized transtracheal administration of lignocaine. The most commonly (75%) used concentration of lignocaine was 2%. Midazolam with or without fentanyl was the preferred agent for intravenous sedation. The use of video bronchoscope was common (80.8%). The most common (94%) route for performing bronchoscopy was nasal. Conventional transbronchial needle aspiration (TBNA) was being performed by 74%, while 92% and 78% performed endobronchial and transbronchial lung biopsy, respectively. Therapeutic airway interventions (stents, electrocautery, cryotherapy, and others) were being performed by 30%, while endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and rigid bronchoscopy were performed by 27% and 19.5%, respectively.
Conclusion:
There is a wide national variation in the practices of performing flexible bronchoscopy. However, there has been a considerable improvement in bronchoscopy practices compared to previous national surveys.
[ABSTRACT]
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3,543
524
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Microbial etiology in hospitalized North Indian adults with community-acquired pneumonia
Reyaz A Para, Bashir A Fomda, Rafi A Jan, Sonaullah Shah, Parvaiz A Koul
March-April 2018, 35(2):108-115
DOI
:10.4103/lungindia.lungindia_288_17
PMID
:29487244
Background:
There is a paucity of literature regarding the microbial etiology of community-acquired pneumonia (CAP) in India. The current study was aimed to study the microbial etiology of hospitalized adults with CAP.
Methods:
The study was conducted in a 700-bedded North Indian hospital. Consecutive adults admitted with CAP over a period of 2 years from 2013 to 2015 were recruited for the study, and apart from clinical evaluation underwent various microbiological studies in the form of blood culture, sputum culture, urinary antigen for pneumococcus and
Legionella
, serology for
Mycoplasma
and
Chlamydia
and real-time reverse transcriptase polymerase chain reaction for influenza viruses. Radiographic studies were performed in all patients and repeated as required. The patients were treated with standard antibiotic/antiviral therapy and outcomes were recorded.
Results:
A total of 225 patients (median age: 59 years) were enrolled.
Streptococcus pneumoniae
was the most common organism found (30.5%), followed by
Legionella pneumophila
(17.5%), influenza viruses (15.4%),
Mycoplasma pneumoniae
(7.2%),
Chlamydia pneumonia
(5.5%),
Mycobacterium tuberculosis
(4.8%),
Klebsiella pneumoniae
(4.8%), methicillin-resistant
Staphylococcus aureus
(3.5%),
Pseudomonas aeruginosa
(3.1%), methicillin-sensitive
S. aureus
(1.7%), and
Acinetobacter
sp. (0.8%) with 4% of patients having multiple pathogens etiologies. High Pneumonia Severity Index score correlated with the severity and outcome of the CAP but was not predictive of any definite etiological pathogen. In-hospital mortality was 8%.
Conclusion:
Streptococcus pneumoniae, Legionella
, and influenza constitute the most common etiological agents for north Indian adults with CAP requiring hospitalization. Appropriate antibiotic therapy and preventive strategies such as influenza and pneumococcal vaccination need to be considered in appropriate groups.
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Etiology of community acquired pneumonia among children in India with special reference to atypical pathogens
K Jagadish Kumar, KV Ashok Chowdary, HC Usha, Maduri Kulkarni, VG Manjunath
March-April 2018, 35(2):116-120
DOI
:10.4103/lungindia.lungindia_391_16
PMID
:29487245
Objectives:
The aim is to identify the etiology of community acquired pneumonia in children with special reference to atypical bacteria and viruses.
Materials and Methods:
A total of 94 pneumonia children were enrolled in the study. Sixty-seven did not have an etiological diagnosis by conventional culture. These children were subjected to immunofluorescence assay by Pneumoslide IgM.
Results:
Ninety-four children were evaluated for etiology by conventional culture. Twenty-seven of them had the bacteriological diagnosis. Rest 67 were further analyzed for causative organism using Pneumoslide immunofluorescence test. Among this group, 38 (56.7%) had etiological diagnosis. Atypical bacteria were identified in 23 cases, most common being
Mycoplasma pneumoniae
and which was more common between 5 months and 2 years of age. Viruses were identified in 19 cases, and the most common virus was Respiratory syncytial virus. Mixed pathogens were identified in five children.,
M. pneumoniae
was the common offending agent.
Conclusions:
Atypical bacteria and viruses play an important role as etiological agents in pneumonia in children. Pneumoslide IgM is useful for rapid detection of atypical bacteria and viruses.
[ABSTRACT]
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2,999
439
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CASE REPORT WITH SYSTEMATIC REVIEW
Clinical significance and epidemiological evolution of epitrochlear lymphadenopathy in pre- and post-highly active antiretroviral therapy era: A systematic review of the literature
Valliappan Muthu, Inderpaul Singh Sehgal, Sahajal Dhooria, Ritesh Agarwal
March-April 2018, 35(2):150-153
DOI
:10.4103/lungindia.lungindia_13_17
PMID
:29487251
Epitrochlear lymphadenopathy is believed to be associated with distinct etiologies, however the evidence for the same is lacking. We systematically reviewed the reported causes of an enlarged epitrochlear lymph node and compared them over different time periods. Epitrochlear lymphadenopathy was encountered in a wide range of diseases, and we found no association with any particular disease.
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129
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ORIGINAL ARTICLES
Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India
Irfan Ismail Ayub, Abdul Majeed Arshad, Prathipa Sekar, Natraj Manimaran, Dhanasekar Thangaswamy, Chandrasekar Chockalingam
March-April 2018, 35(2):137-142
DOI
:10.4103/lungindia.lungindia_198_17
PMID
:29487249
Background:
There is dearth of literature on asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) in India. The aim was to compare clinical characteristics between patients with ACOS and non-ACOS COPD and to identify clinical predictors of ACOS in patients with COPD.
Methods:
We conducted a retrospective study by reviewing data collected from patients performing spirometry at our hospital. Those with postbronchodilator FEV
1
/FVC <70% were included in the study. Among them, those with significant reversibility (change in FEV
1
or FVC by 12% and 200 ml postbronchodilator) were diagnosed with ACOS and the rest were considered to have non-ACOS COPD. Data on the 2 groups were compared and statistical analysis was performed.
Results:
Out of a total of 324 patients, 100 of them had postbronchodilator FEV
1
/FVC <70%. Of them, 45 and 55 were diagnosed with ACOS and non-ACOS COPD, respectively. Patients with ACOS had significantly higher postbronchodilator FVC volumes and FVC % predicted values (
P
< 0.05), had higher reported wheeze (
P
= 0.02) and ankle edema (
P
< 0.05), were more likely to be smokers (
P
= 0.01) with lower smoking index (
P
= 0.03), and had frequent (≥2) ER visits (
P
= 0.04). However, very frequent (≥3 per year) hospital admissions (
P
< 0.01) with higher rates of invasive mechanical ventilation (
P
= 0.02), and pulmonary hypertension diagnosed by two-dimensional echocardiography (
P
< 0.01) were significantly higher in the non-ACOS group. The two groups did not differ with respect to history of atopy, family history of wheeze, compliance to inhaler therapy, or blood absolute eosinophil counts.
Conclusion:
Our study highlights how the ACOS phenotype may clinically differ from their counterparts elsewhere, making it a clinical challenge to identify them in India.
[ABSTRACT]
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Association of pediatric obstructive sleep apnea with poor academic performance: A school-based study from India
Abhishek Goyal, Abhijit P Pakhare, Girish C Bhatt, Bharat Choudhary, Rajesh Patil
March-April 2018, 35(2):132-136
DOI
:10.4103/lungindia.lungindia_218_17
PMID
:29487248
Background:
Pediatric obstructive sleep apnea (OSA) is a highly prevalent but often neglected disorder. There is paucity of reports on the prevalence of pediatric OSA from India. This study was done to estimate the prevalence of OSA in school children aged 5–10 years and its association with academic performance.
Methodology:
This school-based cross-sectional epidemiological study was conducted from July 2015 to November 2015. A questionnaire seeking information on sociodemographic variables, school performance, sleeping pattern, and a validated 22-item pediatrics sleep-related breathing disorder (SRBD) scale was distributed to 1820 pupils in three primary schools. The prevalence of OSA (defined as SRBD score >33%) was reported as proportion and its 95% confidence interval (CI).
Results:
We received 1520 questionnaires out of 1820 distributed and of which 1346 were complete and were analyzed. The prevalence of OSA among children in our study was 9.6% (95% CI: 8.1%–11.7%). On multivariate analysis, working mother (adjusted odds ratio [OR]: 1.8; 95% CI: 1.2–2.7), sleep bruxism (adjusted OR: 1.7; 95% CI: 1.1–2.6), and sleep talking (adjusted OR: 3.0; 95% CI: 1.9–4.7) were found to be independently associated with OSA. Students with positive SRBD were more prone to nocturnal enuresis (NE) (OR 3.48; 95% CI 2.27–5.26) and poor academic performance in all subjects.
Conclusion:
OSA is highly prevalent (9.6%) in Indian children. OSA is associated with NE and poor academic performance in all subjects. This study found association of maternal occupation and OSA which needs to be confirmed in larger studies.
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314
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CASE REPORTS
Pulmonary lymphangioleiomyomatosis presenting as spontaneous pneumothorax treated with sirolimus - A case report
Ajay Kumar Verma, Ambarish Joshi, Amritesh Ranjan Mishra, Surya Kant, Arpita Singh
March-April 2018, 35(2):154-156
DOI
:10.4103/lungindia.lungindia_60_17
PMID
:29487252
Spontaneous pneumothorax is a very common medical emergency. Patients are often treated without treating the underlying cause. Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease. Until recently, diagnosis of LAM was a challenge with nearly 100% mortality in 10 years, but better understanding of the disease through research and better radiological techniques and newer drugs such as sirolimus has improved the survival in such patients. We are presenting a rare case of LAM presenting as a secondary spontaneous pneumothorax treated with sirolimus.
[ABSTRACT]
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2,422
270
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EDITORIAL
Pneumonia bugs and determinants of their occurrence
Bharat Bhushan Sharma, Virendra Singh
March-April 2018, 35(2):95-97
DOI
:10.4103/lungindia.lungindia_33_18
PMID
:29487242
[FULL TEXT]
[PDF]
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2,361
291
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CASE REPORTS
Pyrosequencing to resolve discrepant Xpert MTB/RIF and Mycobacterial Growth Indicator Tube 960
Kanchan Ajbani, Mubin Kazi, Jeffrey Tornheim, Swapna Naik, Rajeev Soman, Anjali Shetty, Camilla Rodrigues
March-April 2018, 35(2):168-170
DOI
:10.4103/lungindia.lungindia_71_17
PMID
:29487256
Delayed diagnosis of drug resistance has been a major obstacle to proper management and control of drug-resistant tuberculosis (TB). Expanded access to rapid molecular diagnostics such as Xpert MTB/RIF has been helpful, but has generated confusion about how to interpret genotype–phenotype discordance. Optimal management is not clearly defined for patients with rifampin resistance by Xpert MTB/RIF but rifampin susceptibility by phenotypic testing. To resolve this discrepancy, we performed pyrosequencing of discordant isolates identified at a reference laboratory over a 6-month period. We present here strategies to address genotype–phenotype discordance using sequencing.
[ABSTRACT]
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[EPub]
[PubMed]
1,919
262
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ORIGINAL ARTICLES
Body plethysmography in chronic obstructive pulmonary disease patients: A cross-sectional study
Yogesh Satyendra Gupta, Swati S Shah, Chaya K Ahire, Prathamesh Kamble, Anupam S Khare, SS More
March-April 2018, 35(2):127-131
DOI
:10.4103/lungindia.lungindia_238_17
PMID
:29487247
Background:
Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world, for which smoking is a common cause. It is preferable to diagnose COPD at an earlier stage and to assess its progression so that mortality and morbidity of the disease could be reduced. Hence, we conducted this study to assess parameters of body plethysmography in Indian population where the data are lacking and to assess whether the use of body plethysmography can detect COPD earlier.
Subjects and Methods:
The study was approved by the Ethics Committee at B. J Government Medical College, Pune. In this comparative randomized cross-sectional study, healthy control subjects (CN), smokers without COPD diagnosis (SM) who were smoking for more than 5 pack-years and smokers with COPD who were further classified depending upon GOLD criteria as mild COPD (C1), moderate COPD (C2), and severe COPD (C3) (
n
= 30 each group) were considered. All the participants were males who gave written informed consent. Subject underwent routine spirometry (FEV
1
, FVC, FEV
1
/FVC, PEFR, and FEF
25-75%
) along with body plethysmography where sGaweff, sGawtot, residual volume (RV), total lung capacity (TLC), and inspiratory capacity (IC) were recorded.
Statistical Analysis:
The differences in lung function were compared between healthy controls and smokers and also between the three groups of COPD severity (GOLD guidelines) employing univariate analysis of variance and Bonferroni's
post hoc
test.
Results:
Spirometry could not differentiate between smokers without COPD and healthy controls. However, three parameters on body plethysmography (IC, sGawtot, and sGaweff) were sensitive enough to detect differences between smokers without COPD and healthy controls.
Conclusion:
Using body plethysmography, the vexed question troubling the clinician, which of the smokers progress to COPD and who do not before they develop irreversible changes can perhaps be answered if further large-scale multicenter studies and long-term follow-up studies confirm the findings in this study.
[ABSTRACT]
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1,898
251
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Computed tomography of solitary fibrous tumor of the pleura abutting the mediastinum: A diagnostic challenge
Luciano Cardinale, Giorgia Dalpiaz, Ilaria Pulzato, Francesco Ardissone
March-April 2018, 35(2):121-126
DOI
:10.4103/lungindia.lungindia_375_17
PMID
:29487246
Background:
Solitary fibrous tumor of the pleura (SFTP) arising from the mediastinal pleura may be confused with primary mediastinal tumors. We studied the computerized tomographic (CT) findings of patients with SFTP that could suggest a diagnosis of SFTP.
Materials and Methods:
At our hospital from January 1995 to June 2012, 39 patients with histologically confirmed SFTP were surgically treated; seven of them abutting the mediastinal pleura. The study group included seven patients aged between 53 and 81 years. Baseline CT scans were retrospectively reviewed to identify radiological findings suggestive of SFTP including: (1) smooth and sharply delineated contours; (2) obtuse, acute, or tapering angles between the lesion and the mediastinum depending on the size; (3) homogeneous soft-tissue attenuation; (4) “geographic pattern” due to the contemporary presence of large vessels, necrosis, and calcifications; (5) displacement of the lung parenchyma; (6) presence of a cleavage plane; and (7) absence of lymphadenopathy or pleural methastasis.
Results:
All tumors formed acute angles with the pleura. Six out of the seven presented smoothly tapering margins, three had a “geographic pattern” of attenuation and displaced the anterior junction line; one showed an outside junction line development. Four cases had a clear pleural origin.
Conclusions:
The possibility of SFTP should be taken into account when a mass abuts the mediastinum projecting inside the thoracic cavity in the presence of an intense and “geographical pattern” of enhancement without lymphoadenopathy or pleural metastasis. These findings assume greater significance in the presence of discrepancy between the size of the lesion and the clinical presentation.
[ABSTRACT]
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1,833
197
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CASE REPORTS
Histological transformation of adenocarcinoma to small cell carcinoma lung as a rare mechanism of resistance to epidermal growth factor receptor-tyrosine kinase inhibitors: Report of a case with review of literature
Monalisa Hui, Shantveer G Uppin, Bala Joseph Stalin, G Sadashivudu
March-April 2018, 35(2):160-163
DOI
:10.4103/lungindia.lungindia_347_17
PMID
:29487254
A subset of non-small cell lung carcinoma (NSCC) harbor active mutations of epidermal growth factor receptor (EGFR). In these, EGFR tyrosine kinase inhibitors (EGFR-TKIs) are recommended as the first-line treatment. Though drug resistance is inevitable, histological transformation to small cell lung carcinoma (SCLC) is a rare mechanism for acquired resistance. Here we report one such rare case of histological transformation of pulmonary adenocarcinoma to small cell lung carcinoma in 46 year old male treated with Gefitinib.
[ABSTRACT]
[FULL TEXT]
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1,557
240
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Paclitaxel-induced dermal hypersensitivity lesions: 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography
Inci Uslu Biner, Ebru Tatci, Berna Akinci Ozyurek, Ozlem Ozmen
March-April 2018, 35(2):157-159
DOI
:10.4103/lungindia.lungindia_189_17
PMID
:29487253
Paclitaxel is frequently used for the treatment of patients with nonsmall cell lung cancer. Hypersensitivity reactions (HSRs) have been one of the toxicities observed with administration of paclitaxel. Here, we presented a case of a 49-year-old man with a history of right lung mass proven by biopsy to be a nonsmall cell lung cancer (squamous cell carcinoma) who developed HSR during therapy. In addition to the hypermetabolic primary malignancy, a positron emission tomography/computed tomography (PET/CT) scan showed multiple hypermetabolic skin lesions at several parts of the body. These cutaneous lesions were resolved in the restaging PET/CT scan performed after completion of the six cycles of chemotherapy. This is the first documented case of comparative PET/CT findings of a paclitaxel-induced hypersensitivity.
[ABSTRACT]
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1,330
161
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Pulmonary artery leiomyosarcoma: A clinical dilemma
Nilgün Yilmaz Demirci, Nurgül Naurzvai, Ismail Kirbaş, Nalan Akyürek, Gül Gürsel, Can Öztürk
March-April 2018, 35(2):164-167
DOI
:10.4103/lungindia.lungindia_137_17
PMID
:29487255
Leiomyosarcomas are rare neoplasms of the smooth muscles. Primary pulmonary leiomyosarcomas, which constitute approximately 0.2%–0.5% of all primary lung malignancies, are extremely rare and highly lethal. They may originate from the smooth muscle cells of the bronchial wall, the blood vessels, or the pulmonary interstitium, and their rare occurrence, localization, and nonspecific clinical symptoms mean that correct diagnosis and proper management are often delayed. Here, we report a rapidly growing primary pulmonary leiomyosarcoma, which invaded the right atrium, vena cava superior, mediastinum, right hilar area, and left pulmonary artery within 4 months. On histopathology, a transthoracic needle biopsy of the mass confirmed leiomyosarcoma, and delayed presentation meant that there was a local spread to the neighboring structures at the time of diagnosis.
[ABSTRACT]
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1,347
137
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CASE LETTERS
Surgical management of endobronchial hamartoma
Sukhram Bishnoi, Belal Bin Asaf, CL Vijay, Arvind Kumar
March-April 2018, 35(2):179-181
DOI
:10.4103/lungindia.lungindia_209_17
PMID
:29487261
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,314
96
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LETTERS TO EDITOR
Solitary pulmonary nodule: Increasing diagnosis and accuracy of biopsy by biparametric MR imaging
Michele Scialpi, Corrado Maria Malaspina, Valeria Rondoni, Emanuele Orlandi, Luigia Coppola, Teresa Pusiol, Barbara Palumbo
March-April 2018, 35(2):182-183
DOI
:10.4103/lungindia.lungindia_424_17
PMID
:29487262
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,267
139
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PICTORIAL QUIZ
A 45-year-old man presenting with chest pain
Sheetu Singh, Arpita Jindal
March-April 2018, 35(2):171-172
DOI
:10.4103/lungindia.lungindia_298_17
PMID
:29487257
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,133
182
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LETTERS TO EDITOR
Barriers to building an effective workforce for respiratory research in India: A survey of American Thoracic Society Methods in Epidemiologic, Clinical, and Operations Research India 2017 participants
Angira Dasgupta, Lalita Fernandes, Vishal Chopra, Prabu Rajkumar
March-April 2018, 35(2):184-186
DOI
:10.4103/lungindia.lungindia_427_17
PMID
:29487263
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,132
104
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RADIOLOGY QUIZ
A rare clinical case presenting as right lower zone shadow
Ravindran Chetambath, Jabeed Parengal, Mohammed Aslam, Sanjeev Shivashankaran
March-April 2018, 35(2):173-175
DOI
:10.4103/lungindia.lungindia_99_17
PMID
:29487258
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,071
161
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LETTERS TO EDITOR
Intrathoracic liposarcoma: Case report with emphasis to histogenesis and site of origin classification problems
Teresa Pusiol, Irene Piscioli, Valeria Rondoni, Michele Scialpi
March-April 2018, 35(2):186-187
DOI
:10.4103/lungindia.lungindia_332_17
PMID
:29487264
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,066
101
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CASE LETTERS
Pulmonary adenocarcinoma presenting with symptoms of ectopic adrenocorticotropic hormone production
Diya Rachel George, K Mohanan, Paul V Puthussery, KP Janfir Babu
March-April 2018, 35(2):176-178
DOI
:10.4103/lungindia.lungindia_162_17
PMID
:29487259
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,052
111
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Spontaneous rupture of hepatocellular carcinoma with tumor embolism in pulmonary arteries
Ashish Chawla, Vishal Gaikwad, Shobhit Swarup, Tahira Kumar
March-April 2018, 35(2):178-179
DOI
:10.4103/lungindia.lungindia_327_17
PMID
:29487260
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
1,005
103
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LETTERS TO EDITOR
Tracheoesophageal fistula diagnosis during open tracheostomy
Cesar Augusto Simões, Isabela Tavares Ribeiro, Josenir Francisco De Souza Medeiros, Ney P Castro Neto, Osmar Clayton Person, Rogério Aparecido Dedivitis, Cláudio Roberto Cernea
March-April 2018, 35(2):187-189
DOI
:10.4103/lungindia.lungindia_368_17
PMID
:29487265
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
45
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