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Difficulties in managing lymph node tuberculosis
PR Gupta
October-December 2004, 21(4):50-53
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Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations
Dheeraj Gupta, Ritesh Agarwal, Ashutosh Nath Aggarwal, Navneet Singh, Narayan Mishra, GC Khilnani, JK Samaria, SN Gaur, SK Jindal
July 2012, 29(6):27-62
DOI:10.4103/0970-2113.99248  PMID:23019384
  50,690 18,292 10
Community acquired pneumonia - Typical or atypical ?
Rajinder Singh Bedi
July-September 2006, 23(3):130-131
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Physical signs in patients with chronic obstructive pulmonary disease
Malay Sarkar, Rajeev Bhardwaz, Irappa Madabhavi, Mitul Modi
January-February 2019, 36(1):38-47
DOI:10.4103/lungindia.lungindia_145_18  PMID:30604704
We reviewed the various physical signs of chronic obstructive pulmonary disease, their pathogenesis, and clinical importance. We searched PubMed, EMBASE, and the CINAHL from inception to March 2018. We used the following search terms: chronic obstructive pulmonary disease, physical examination, purse-lip breathing, breath sound intensity, forced expiratory time, abdominal paradox, Hoover's sign, barrel-shaped chest, accessory muscle use, etc. All types of studies were chosen. Globally, history taking and clinical examination of the patients is on the wane. One reason can be a significant development in the field of medical technology, resulting in overreliance on sophisticated diagnostic machines, investigative procedures, and medical tests as first-line modalities of patient's management. In resource-constrained countries, detailed history taking and physical examination should be emphasized as one of the important modalities in patient's diagnosis and management. Declining bedside skills and clinical aptitude among the physician is indeed a concern nowadays. Physical diagnosis of chronic obstructive pulmonary disease (COPD) is the quickest and reliable modalities that can lead to early diagnosis and management of COPD patients. Bedside elicitation of physical signs should always be the starting point for any diagnosis and therapeutic approach.
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Role of sputum cultures in diagnosis of respiratory tract infections
AK Bhattacharya
January-March 2006, 23(1):20-24
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Post-COVID lung fibrosis: The tsunami that will follow the earthquake
Zarir F Udwadia, Parvaiz A Koul, Luca Richeldi
March 2021, 38(7):41-47
The SARS-CoV-2 pandemic has already infected in excess of 50 million people worldwide and resulted in 1.2 million deaths. While the majority of those infected will not have long-term pulmonary sequelae, 5%–10% will develop severe COVID-19 pneumonia and acute respiratory distress syndrome (ARDS). The natural history of these severely affected patients is unclear at present, but using our knowledge of closely related coronavirus outbreaks like severe acute respiratory distress syndrome (SARS) and middle east respiratory syndrome (MERS), we would hypothesize that the majority will stabilize or improve over time although some patients will progress to advanced lung fibrosis or post-COVID interstitial lung disease (PC-ILD). Unlike the SARS and MERS outbreaks which affected only a few thousands, the sheer scale of the present pandemic suggests that physicians are likely to encounter large numbers of patients (potentially hundreds of thousands) with PC-ILD. In this review, we discuss the pathogenesis, natural history, and radiology of such patients and touch on clinical, laboratory, and radiographic clues at presentation which might help predict the future development of lung fibrosis. Finally, we discuss the responsible use of antifibrotic drugs such as pirfenidone, nintedanib, and some newer antifibrotics, still in the pipeline. The biological rationale of these drugs and the patient groups where they may have a plausible role will be discussed. We conclude by stressing the importance of careful longitudinal follow-up of multiple cohorts of post-COVID survivors with serial lung function and imaging. This will eventually help to determine the natural history, course, and response to therapy of these patients.
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Digital clubbing
Malay Sarkar, DM Mahesh, Irappa Madabhavi
October-December 2012, 29(4):354-362
DOI:10.4103/0970-2113.102824  PMID:23243350
Digital clubbing is an ancient and important clinical signs in medicine. Although clubbed fingers are mostly asymptomatic, it often predicts the presence of some dreaded underlying diseases. Its exact pathogenesis is not known, but platelet-derived growth factor and vascular endothelial growth factor are recently incriminated in its causation. The association of digital clubbing with various disease processes and its clinical implications are discussed in this review.
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Mechanisms of hypoxemia
Malay Sarkar, N Niranjan, PK Banyal
January-February 2017, 34(1):47-60
DOI:10.4103/0970-2113.197116  PMID:28144061
Oxygen is an essential element for life and without oxygen humans can survive for few minutes only. There should be a balance between oxygen demand and delivery in order to maintain homeostasis within the body. The two main organ systems responsible for oxygen delivery in the body and maintaining homeostasis are respiratory and cardiovascular system. Abnormal function of any of these two would lead to the development of hypoxemia and its detrimental consequences. There are various mechanisms of hypoxemia but ventilation/perfusion mismatch is the most common underlying mechanism of hypoxemia. The present review will focus on definition, various causes, mechanisms, and approach of hypoxemia in human.
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Revised national tuberculosis control programme (RNTCP) in India; current status and challenges
Navneet Singh, Dheeraj Gupta
October-December 2005, 22(4):107-111
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Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations
Dheeraj Gupta, Ritesh Agarwal, Ashutosh Nath Aggarwal, VN Maturu, Sahajal Dhooria, KT Prasad, Inderpaul S Sehgal, Lakshmikant B Yenge, Aditya Jindal, Navneet Singh, AG Ghoshal, GC Khilnani, JK Samaria, SN Gaur, D Behera, S. K. Jindal for the COPD Guidelines Working Group
July-September 2013, 30(3):228-267
DOI:10.4103/0970-2113.116248  PMID:24049265
Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.
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Sputum induction - A useful tool in diagnosis of respiratory diseases
KB Gupta, Seema Garg
April-June 2006, 23(2):82-86
Sputum induction by inhalation of hypertonic saline is a noninvasive, simple, cost effective and safe procedure to collect respiratory secre­tions from lung airways for diagnosis of various respiratory diseases. Sputum induction has higher yield in comparison to spontaneous sputum, BAL, bronchial washing and gastric lavage. It is widely used to assess airway inflammation in asthma and chronic obstructive pulmonary disease (COPD). It can be used as a complementary tool to BAL both in research and in clinical monitoring of patients with interstitial lung disease (ILD). The cells, recovered from spontaneous coughing can be used to study lung cancer, respiratory infections and in diagnosis of pneumocystis carinii pneumonia in patients infected with human immunodeficiency virus. In developing countries having high prevalence of pulmonary tuberculosis, sputum induction (SI) can increase the diagnostic yield, resulting in better categorization of patients for treatment purposes. It increases case detection rate of smear negative pulmonary tuberculosis specially in area where facili­ties for more invasive and expensive techniques are not available.
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Role of HRCT in detection and characterization of pulmonary abnormalities in patients with febrile neutropenia
Mandeep Kang, Debasis Deoghuria, Subash Varma, Dheeraj Gupta, Anmol Bhatia, Niranjan Khandelwal
April-June 2013, 30(2):124-130
DOI:10.4103/0970-2113.110420  PMID:23741093
Background: Fever is of grave concern in the management of patients with neutropenia with early detection of a focus of infection being the major goal. As lungs are the most common focus, chest imaging is of vital importance. This Institute Review Board approved prospective study was undertaken to assess the usefulness of high resolution computed tomography (HRCT) in early detection and characterization of pulmonary abnormalities in febrile neutropenia. Materials and Methods: A total of 104 consecutive patients (M:F:75:29, age range 11-66 years) with fever of 38.2°C or more with an absolute neutrophil count <500/μl underwent HRCT chest. HRCT diagnosis was compared with final diagnosis based on ancillary investigations. Results: HRCT could detect pulmonary abnormalities in 93 patients (89.4%) with air space consolidation being the predominant finding (n = 57), followed by ground-glass opacities (Ground glass opacity (GGO), n = 49) and nodules (n = 39). HRCT could correctly characterize the infective lesions in 76 patients (81.7%). Presence of random or pleural-based nodules >10 mm with or without surrounding GGO or cavitations was sensitive (95.23%) and specific (96.7%) for fungal infection, while small (1-4 mm) random or centrilobular nodules with tree-in-bud appearance was sensitive (90%) and highly specific (97.02%) for tuberculosis. Diagnosis of pyogenic infection based on presence of air-space consolidation, pleural effusion, GGO or centrilobular nodules showed a sensitivity of 84.78% and specificity of 93.84%, whereas patchy or diffuse GGO, interstitial thickening and/or air-space consolidation showed high sensitivity (86.7%) and specificity (96.8%) for Pneumocystis jiroveci pneumonia. Conclusion: HRCT chest is an excellent modality in the diagnostic work-up of patients with febrile neutropenia allowing early detection and characterization of pulmonary abnormalities.
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Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I) recommendations
Ritesh Agarwal, Sahajal Dhooria, Ashutosh Nath Aggarwal, Venkata N Maturu, Inderpaul S Sehgal, Valliappan Muthu, Kuruswamy T Prasad, Lakshmikant B Yenge, Navneet Singh, Digambar Behera, Surinder K Jindal, Dheeraj Gupta, Thanagakunam Balamugesh, Ashish Bhalla, Dhruva Chaudhry, Sunil K Chhabra, Ramesh Chokhani, Vishal Chopra, Devendra S Dadhwal, George D'Souza, Mandeep Garg, Shailendra N Gaur, Bharat Gopal, Aloke G Ghoshal, Randeep Guleria, Krishna B Gupta, Indranil Haldar, Sanjay Jain, Nirmal K Jain, Vikram K Jain, Ashok K Janmeja, Surya Kant, Surender Kashyap, Gopi C Khilnani, Jai Kishan, Raj Kumar, Parvaiz A Koul, Ashok Mahashur, Amit K Mandal, Samir Malhotra, Sabir Mohammed, Prasanta R Mohapatra, Dharmesh Patel, Rajendra Prasad, Pallab Ray, Jai K Samaria, Potsangbam Sarat Singh, Honey Sawhney, Nusrat Shafiq, Navneet Sharma, Updesh Pal S Sidhu, Rupak Singla, Jagdish C Suri, Deepak Talwar, Subhash Varma
April 2015, 32(7):3-42
DOI:10.4103/0970-2113.154517  PMID:25948889
  21,724 6,180 -
Smoking Index - A Measure To Quantify Cumulative Smoking Exposure
S. K Jindal, S. K Malik
November 1988, 6(4):195-196
‘Smoking Index’ is a parameter used to express cumulative smoking exposure quantitatively. This is especially useful in defining risk ratio of a smoking related disease. The parameter is smiliar to ‘Pack Year’ but more suitable to Indian subjects.
[ABSTRACT]   Full text not available  [PDF]
  20,248 5,177 -
Management of tuberculosis in special situations
Rajinder Singh Bedi
October-December 2005, 22(4):138-141
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Diagnosing sarcoidosis : What is the value of A.C.E ?
Gurdesh S Bedi, Rajinder S Bedi
October-December 2004, 21(4):39-40
  22,285 745 -
Tuberculosis and nutrition
Krishna Bihari Gupta, Rajesh Gupta, Atulya Atreja, Manish Verma, Suman Vishvkarma
January-March 2009, 26(1):9-16
DOI:10.4103/0970-2113.45198  PMID:20165588
Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels. Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls. Malnutrition can lead to secondary immunodeficiency that increases the host's susceptibility to infection. In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting. Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. Nutritional status of patients improves during tuberculosis chemotherapy. High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations. Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.
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Recent trends in pulmonary arterial hypertension
Rajagopalan Natarajan
January-March 2011, 28(1):39-48
DOI:10.4103/0970-2113.76300  PMID:21654985
Pulmonary hypertension is a serious and unrelenting pulmonary vascular disorder that affects the functional quality of patients and significantly decreases their life span. If diagnosed early, with the number of new therapeutic options that are available, a better quality of life can be provided for a protracted length of time. It is likely that the available treatment will change the natural course of the disease and perhaps prolong survival. As symptoms are often subtle in the early stages of the disease it is imperative that physicians are aware of the manifestations of this condition. A thorough investigation of patients suspected of this condition is essential so that appropriate treatment can be initiated promptly. The routine workup of a patient suspected to have pulmonary hypertension could easily be carried out in any well-equipped peripheral hospital in many affluent and advanced countries. However, it must be mentioned that in some less advanced countries the necessary work up can only be done in major teaching hospitals. Both pulmonologists and cardiologists should be aware of the pathophysiology of pulmonary arterial hypertension, the workup and the treatment options that are available. Patients with refractory pulmonary hypertension should be referred to these research centers for enrolment into any ongoing drug trials as well as for evaluation for heart−lung, single lung, or double lung transplantation. This paper is primarily aimed at pulmonologists and cardiologists taking care of these patients. Unless indicated otherwise this paper mainly deals with WHO group 1 pulmonary hypertension which is designated pulmonary arterial hypertension. Extensive review of the literature spanning the last 30 years was made through Medline using titles such as primary pulmonary hypertension, pulmonary arterial hypertension, secondary pulmonary hypertension, and pulmonary vascular diseases.
  19,364 2,007 3

October 2015, 32(8):43-81
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Impulse oscillometry: The state-of-art for lung function testing
Koundinya Desiraju, Anurag Agrawal
July-August 2016, 33(4):410-416
DOI:10.4103/0970-2113.184875  PMID:27578934
Impulse oscillometry (IOS) is a variant of forced oscillation technique, described by Dubois over 50 years ago, which permits passive measurement of lung mechanics. In this method, sound waves are superimposed on normal tidal breathing, and the disturbances in flow and pressure caused by the external waves are used to calculate parameters describing the resistance to airflow and reactive parameters that mostly relate to efficient storage and return of energy by the lung. It requires minimal patient cooperation and can be done easily in subjects who are unable to perform spirometry. Importantly, IOS can differentiate small airway obstruction from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. It has been used to study various respiratory disorders, especially asthma and is suitable for measuring bronchodilatory response as well as bronchoprovocation testing. IOS parameters seem to be able to pick up early changes in lung functon such that they are superior to spirometry in predicting loss of control in asthmatic patients and possibly in identifying early airway disease in smokers. Such comparisons, especially for chronic obstructive pulmonary disease, are made difficult by widespread use of spirometric parameters as the diagnostic gold standard. Here, we discuss the principles and technique of IOS and review its application in obstructive airway diseases.
  17,276 3,383 -
Indexed journal: What does it mean?
Yatan Pal Singh Balhara
April-June 2012, 29(2):193-193
  17,804 1,972 4
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.
  17,262 2,129 1
Nasopharyngeal wash in preventing and treating upper respiratory tract infections: Could it prevent COVID-19?
Sheetu Singh, Neeraj Sharma, Udaiveer Singh, Tejraj Singh, Daya Krishan Mangal, Virendra Singh
May-June 2020, 37(3):246-251
DOI:10.4103/lungindia.lungindia_241_20  PMID:32367847
Rapid transmission of the severe acute respiratory syndrome coronavirus 2 has led to the novel coronavirus disease 2019 (COVID-19) pandemic. The current emphasis is on preventive strategies such as social distancing, face mask, and hand washing. The technique of nasopharyngeal wash to prevent the virus from inhabiting and replicating in the nasal and pharyngeal mucosa has been suggested to be useful in reducing symptoms, transmission, and viral shedding in cases of viral acute respiratory tract infections. In rapid systematic review, we found studies showing some improvement in prevention and treatment of upper respiratory tract infections. We postulate that hypertonic saline gargles and nasal wash may be useful in prevention and for care of patients with COVID-19. The present evidence emphasizes the need of randomized controlled trials to evaluate the role and mechanism of nasopharyngeal wash in COVID-19.
  16,661 1,235 -
Laryngeal tuberculosis clinically similar to laryngeal cancer
SK Verma, Sanjay Kumar Verma, Sanjay
July-September 2007, 24(3):87-89
Laryngeal tuberculosis is a rare disease. The presenting features are usually hoarse­ness or dysphagia with other vague and nonspecific symptoms. Laryngoscopic fea­tures mimic malignancy in many cases. There are no noninvasive tests which can confirm a diagnosis of laryngeal tuberculosis. Biopsy of the primary growth itself is diagnostic and may show caseating granulomatous inflammation. Microbiologi­cal confirmation, though desirable, may not always be possible. The response to antitubercular treatment is good. We report a 52 year old man who presented to us with hoarseness of voice, haemoptysis and a proliferative growth in the epiglottis and was diagnosed to have laryngeal tuberculosis on histopathology. He had an excellent response to antituberculosis therapy and is now asymptomatic.
  16,886 667 -
Chronic obstructive pulmonary disease: Indian guidelines and the road ahead
Parvaiz A Koul
July-September 2013, 30(3):175-177
DOI:10.4103/0970-2113.116233  PMID:24049249
  15,112 2,220 2