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   Table of Contents - Current issue
January-June 2020
Volume 8 | Issue 1
Page Nos. 1-38

Online since Tuesday, February 11, 2020

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Impact of obstructive sleep apnea and sleep parameters on level of asthma control p. 1
Ramakant Dixit, Satyadeep Verma, Mukesh Goyal
Background and Objective: Several studies support high prevalence of obstructive sleep apnea (OSA) symptoms in patients with asthma. Our objective was to evaluate the relationship between OSA severity and level of asthma control if any and analyze sleep parameters in patients having different levels of asthma control. Methods: A cross-sectional study among asthma patients having symptoms of sleep-related breathing disorders. Eligible patients were assessed clinically and with sleep questionnaire including asthma control followed by level 1 Polysomnography. Results: Among 53 patients of asthma (mean age 48.16 years), OSA was present in 84.21% of uncontrolled asthma, 35% in partially controlled asthma, and 7.14% in well-controlled asthma. Uncontrolled asthma patients were associated with higher apnea/hypopnea index (AHI) (30.8±17.6 vs. 3.7±1.2; p-value < 0.0001), more time spent in non rapid eye movement (NREM) 1 stage (18.5±11.9% vs. 13.0±11.2% of total sleep time), higher nocturnal desaturation episodes (152.5±13 vs. 22.1±16.7; p-value < 0.001), and severe OSA in supine position (AHI 33.1±17.7 vs. 9.2±9.7; p-value < 0.001) compared with well-controlled asthma. Conclusion: There seems a strong relationship between desaturation events and higher AHI with poor level of asthma control, especially during supine position. OSA must be suspected in patients with uncontrolled asthma. An early detection and treatment of OSA may improve the level of asthma control as well as quality of life in such patients.
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Prognostic assessment in COPD patients: BODE index and the health-related quality of life p. 6
Kapil Sharma, Avinash Jain, Rajendra Takhar, DPS Sudan, Vipin Goyal, Nikhil Goel, Vikram Singh
Background: Chronic obstructive pulmonary disease (COPD) is a spreading epidemic of a debilitating disease impairing the health-related quality of life (HRQoL) of the patients. This study was conducted to identify the relationship between BODE (body mass index, obstruction, dyspnea, exercise capacity) index and the St George’s Respiratory Questionnaire (SGRQ) and to test the predictive value of both tools against survival. Methods: Open cohort study of 120 COPD patients were followed up to 1 year. At the time of the inclusion, clinical data, forced spirometry, 6-minute walking distance, BODE index, and SGRQ were determined. Vital status and cause of death were documented at the end of follow-up. Results: The cohort’s mean score of age, SGRQ Total (SGRQ_Tot), and BODE index was 57.82 ± 7.58, 44.77 ± 13.81, and 3.04 ± 2.06, respectively. The correlation between SGRQ_Tot and BODE index was good (r = 0.611, P < 0.001). Regression analysis determined age, BODE, comorbidity index, and activity component of SGRQ (SGRQ_A) as predictors of mortality. The area under the curve for the BODE index was 0.801 vs. 0.692 for the SGRQ_A score indicating BODE score as best predictor of mortality. The best cut-off value for predicting mortality was 4.5 for BODE index and 62.5 for SGRQ_A score. Conclusion: Evaluation of HRQoL is an important entity for improving overall disease outcome of COPD.
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Clinico-demographic characteristic of multidrug-resistant pulmonary tuberculosis presenting to tertiary care hospital of India p. 14
Deependra Kumar Rai, Abhisheka Kumar
Introduction: Multidrug-resistant tuberculosis (MDR-TB) is emerging as major problem due to poor management of drug-sensitive as well as drug-resistant TB. This study designs to assess clinical-demographic and radiological characteristic of MDR pulmonary tuberculosis. Material and method: This was a retrospective record-based study of 85 MDR pulmonary tuberculosis patients diagnosed in pulmonary medicine department AIIMS Patna between 1st Jan 2016 and 31st Dec 2017. All the socio-demographic and clinical-radiological features of MDR tuberculosis were entered in Microsoft Excel and compared. Results: Total 85 patients were diagnosed with MDR tuberculosis in 2016–2017 period. Seventy four patients fulfil inclusion criteria with mean age of 26.78±15.75. There were 56 (75.67%) males and 18 (24.32%) females. Out of 74 study patients, 19 (25.67%) occur in new cases. The most commonly present symptom in study patients was cough (100%) followed by fever, breathlessness, anorexia, and haemoptysis in decreasing order. On radiological examination, 56.75% patients had bilateral disease. The extent of chest X-ray involvement showed far advanced disease in 18.91% of the patients, moderately advanced disease in 67.56%, and 13.51% of the patients had minimal disease. HIV test result was performed in 58 patients in which 2 patients showed positive result (3.4%). Sputum for AFB was negative in 25 (34.72%) patients. Conclusion: High degree of suspicion was required even in sputum negative pulmonary tuberculosis as almost one-third of patients have sputum negative for acid base bacilli at the time of diagnosis.
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Erasmus Syndrome: Co-existence of silicosis and progressive systemic sclerosis in a 55 year old male p. 19
Jitendra Jalutharia, Ramakant Dixit
The Erasmus syndrome describes the association of generalised progressive scleroderma following exposure to silica with or without silicosis. We report a case of Erasmus Syndrome in a 55-year old labourer presenting with shortness of breath, arthralgia, Raynaud’s phenomenon, skin tightening and microstomia along with pulmonary arterial hypertension. Among investigations, serological markers were strongly positive, high-resolution computed tomography chest showed evidence of interstitial lung disease (ILD) with mediastinal lymphadenopathy and histopathology of skin biopsy were suggestive of systemic sclerosis. Correlating the occupational history, clinical features, haematological investigations and histological findings, a diagnosis of Erasmus syndrome was safely made.
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Pulmonary actinomycosis presenting as a pleural tumour p. 23
Neeraj Kumar Keyal, Raju Shrestha, Niru Nepal, Manish Nakarmi
Pulmonary actinomycosis is a rare gram positive higher prokaryotic bacterial infection. We hereby present a case of 78-year old male presented with non-specific symptoms like cough, shortness of breath (SOB) and chest pain mimicking as pulmonary tuberculosis, fungal infection and lung cancer but was diagnosed to have pulmonary actinomycosis. From this, we want to emphasize that pulmonary actinomycosis should be evaluated in all patients that are not responding to anti-tubercular and lung cancer treatment.
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Disseminated Multidrug-Resistant Tuberculosis in a Young Patient: A Rare Case Report p. 26
Ritu Dadra, Nirmal Chand Kajal, Balbir Malhotra, Prasanth Pandiyaraj, Lakhvir Kaur, Gurleen kaur
Drug resistance is a persistent threat to tuberculosis (TB) control program worldwide. Patients infected with multiple drug-resistant strains are less likely to become cured. Management of resistant cases is complex and presents therapeutic limitations. Patients with multidrug-resistant strains are more prone to treatment failure and progress to more chronic forms of the disease and death. According to the Global Tuberculosis Report 2018, about 3.5% of newly diagnosed patients had multidrug-resistant tuberculosis (MDR-TB) and 18% of previously treated TB cases were estimated to have MDR-TB. This case presented a rare occurrence of disseminated MDR-TB in a diabetic patient. A case of a 14-year-old female, who was an old-treated case of abdominal TB, presented with 5 months of history of fever, breathlessness, and pain in the abdomen with diabetes mellitus, in whom disseminated MDR-TB was documented with fine-needle aspiration cytology of abdominal lymph nodes and bronchoalveolar lavage fluid that showed drug-resistant TB. So this case emphasizes the importance of screening all extrapulmonary TB patients for drug resistance especially if the patient also has associated comorbid conditions.
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A rare case of granulomatosis with polyangiitis (Wegener’s) presenting with tracheo-bronchial involvement p. 30
Pragyan Rout, Bijay Meher, Garima Markam, Kiran Sabat
Granulomatosis with polyangiitis (Wegener’s) (GPA) is a form of systemic vasculitis that involves primarily the upper and lower airways and the kidneys. Although the pulmonary involvement of GPA is well described, the lower airway findings are rarely involved, and only various descriptions have been reported. The most frequent airway manifestations include subglottic stenosis and inflammation, and tracheal and bronchial stenoses. We, hereby, report a case of GPA presenting with fever, cough and haemoptysis with bronchoscopy showing markedly inflamed bronchial mucosa.
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An unusual case of Salmonella enterica subtype Typhi causing pneumonia, synpneumonic effusion, and septic shock in an immunocompetent pregnant patient p. 33
Arun Agarwal, Pooja Parab, Madan Mohan Sharma
Salmonellosis may present with varying clinical manifestations ranging from fever, malaise, abdominal discomfort, and gastroenteritis to nonspecific symptoms related to febrile syndromes. Pneumonia, however, is an atypical site for Salmonellosis. More severe infections can invade into the blood stream and cause bacteremia with the possibility of disseminated focal infection. We report a case of a 29-year old pregnant immunocompetent patient with atypical extraintestinal symptoms in the first week of typhoid illness. She presented with high-grade fever with chills, dry cough, and breathlessness developing extensive lobar pneumonia along with synpneumonic effusion and shock. Her blood culture was positive for Salmonella enterica serotype Typhi. She was diagnosed with community-acquired pneumonia with pleural effusion due to Salmonella enterica serotype Typhi without any gastrointestinal symptoms.
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Doxycycline orally on long term is well tolerated and may be beneficial in DPLD p. 37
Parthasarathi Bhattacharyya, Mintu Paul
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