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REVIEW ARTICLES
Tuberculoma of the brain - A diagnostic dilemma: Magnetic resonance spectroscopy a new ray of hope
Subhasis Mukherjee, Runa Das, Shabana Begum
January-June 2015, 3(1):3-8
DOI
:10.4103/2320-8775.146842
Tuberculoma of the brain is an important clinical entity. The main challenge in the management of brain tuberculoma is its diagnosis. Appearance in computed tomography (CT) scan of brain is common and consists of solitary or multiple ring-enhancing lesions with moderate perilesional edema, but these are not specific for tuberculoma as neurocysticercosis (NCC), coccidiomycosis, toxoplasmosis, metastasis and few other diseases may also have similar appearance on CT scan brain. Cerebrospinal fluid examination is often normal and biopsy and tissue culture from the lesion though the diagnosis of choice is technically too demanding and not feasible in most of the times. All these put the clinicians in a great dilemma as regard to a confidant diagnosis of tuberculoma of the brain. With advancement of imaging techniques, magnetic resonance imaging (MRI) of brain with magnetic resonance spectroscopy (MRS) has shown a great hope in this context as MRS shows a specific lipid peak in cases of tuberculoma which is not seen in any other differential diagnoses of tuberculoma. This review article is written to have an overview regarding the current diagnostic approach for brain tuberculoma with special emphasis on the role of MRS. Extensive literature review of the articles published in English was conducted using Google search, Google Scholar, PubMed and Medline using the keywords such as ring-enhancing lesions, etiology, tuberculoma, NCC, CT scan brain, MRI, MRS, images.
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1,761
ORIGINAL ARTICLES
Correlation of six minute walk test with spirometric indices in chronic obstructive pulmonary disease patients: A tertiary care hospital experience
Abhijit Kundu, Arnab Maji, Supriyo Sarkar, Kaushik Saha, Debraj Jash, Malay Maikap
January-June 2015, 3(1):9-13
DOI
:10.4103/2320-8775.146843
Background:
Six-minute walk test (6MWT) is a simple, objective, reproducible test which correlated well with different spirometric indices, and thus able to predict severity of chronic obstructive pulmonary disease (COPD) and can replace spirometry in resource poor set-up.
Aims and Objectives:
To find out correlation between spirometric indices (forced expiratory volume in 1 s (FEV
1
), forced vital capacity (FVC), and peak expiratory flow rate (PEFR)) and 6-minute walk distance (6MWD) in COPD patients, and thus to assess whether 6MWT can replace spirometry.
Settings and Design:
Institution based cross-sectional observational study.
Materials and Methods:
Eighty patients of COPD (diagnosis confirmed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010 criteria) were enrolled for the study after applying exclusion criteria. All patients underwent spirometric measurement of FEV
1
, FVC, PEFR, and ratio of FEV
1
and FVC and test repeated after bronchodilation by 200-400 μg of salbutamol. 6MWT was performed following American Thoracic Society (ATS) protocol of 6MWT and distance was measured in meters.
Results:
We found significant linear correlation of 6MWT with post-FEV
1
(r = 0.478,
P
< 0.001), post-FVC (r = 0.454,
P
< 0.001), and post-PEFR (r = 0.408,
P
< 0.001), but no correlation with FEV
1
/FVC (r = 0.250,
P
= 0.025). We also found significant correlation of 6MWT with BODE (body mass index (BMI), airway obstruction, dyspnea, and exercise capacity) index (r = −0.419,
P
< 0.001).
Conclusions:
6MWT can be a useful replacement of spirometry in assessment of severity of COPD.
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2,652
404
Prevelence of latent tuberculosis and associated risk factors in children under 5 years of age in Karachi, Pakistan
Mubashir Zafar
January-June 2014, 2(1):16-24
DOI
:10.4103/2320-8775.126504
Background:
As infected children represent a large proportion of the pool from which tuberculosis (TB) cases will arise and its associated risk factors that influence TB infection are basic cause for burden of TB.
Aim:
This study was to determine the prevalence of latent TB and associated risk factors in children less than 5 year of age in Karachi, Pakistan.
Setting and Design:
Cross-sectional study and it was conducted in tertiary care hospital in Karachi.
Materials and Methods:
In this study, children who were living in contact with individuals who had proven smear-positive pulmonary TB cases were investigated. A tuberculin skin test (TST) was performed on each child. TST sizes ≥5 and 10 mm, respectively, were considered positive.
Statistical Analysis:
A random effects logistic regression model, which takes into account the clustering of contacts within households, was used to assess the relationship between the tuberculin response of the contact and risk factors. Results are reported as unadjusted and adjusted odds ratios and their 95% confidence intervals. The likelihood ratio test was used to assess the overall significance of risk factors, tests for trend, and tests for interaction.
Results:
The distribution of TST responses followed a bimodal pattern, with 135 (35%) children presenting a palpable induration. The risk of positive TST response in the child increased with the geographic proximity of the child to the individual with TB within the household and with the degree of activities shared with the individual with TB. Nutritional status and presence of a bacille Calmette-Guérin (BCG) scar were not independent risk factors for TST positivity in this population. On multivariate analysis, the effect of geographic proximity to the individual with TB, household size, and duration of cough in the index case persisted for TST responses ≥5 mm.
Conclusions:
Positive TST in a child reflects most probably TB infection rather than previous BCG vaccination. Contact tracing can play a major role in the control of TB in Pakistan.
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CASE REPORTS
Pseudochylopneumothorax: A rare presentation of reactivation of tuberculosis
Muzafar Ahmed Naik, Tariq Bhat, Irfan Yusuf, Mehmood Qadri
January-June 2014, 2(1):37-39
DOI
:10.4103/2320-8775.126511
A 70-year-old male with past history of treated pulmonary tuberculosis presented with clinical, radiological, and laboratory features suggestive of pseudochylopneumothorax and bronchopleural fistula. Acid-fast bacilli (AFB) staining and AFB culture of pleural fluid was positive. Pseudochylothorax is a rare sterile complication of long standing tubercular effusion. Pseudochylothorax in itself can get complicated by reactivation of tuberculosis and bronchopleural fistula. The occurrence of pseudochylopneumothorax due to bronchopleural fistula as in our case is a rare manifestation of reactivation tuberculosis.
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190
Right-sided pneumothorax and right upper lobe collapse: Two unusual presentations of allergic bronchopulmonary aspergillosis
Anirban Das, Sibes K Das, Sumitra Basuthakur
July-December 2014, 2(2):71-74
DOI
:10.4103/2320-8775.135116
Lobar or segmental collapse and secondary spontaneous pneumothorax are two unusual presentations of allergic bronchopulmonary aspergillosis (ABPA). First one is found in acute and exacerbation phases of ABPA due to "mucoid impaction" into damaged bronchi, and latter one is due to rupture of sub-pleural fibro-cystic spaces of pulmonary parenchyma, mainly in the fibrotic stage of ABPA. Clinical presentation of these two in the background of poorly controlled asthma in compliant individuals confuses the diagnosis, and ABPA should be searched for. Here, we report a rare case of right upper lobe collapse and right sided pneumothorax in separate occasions in an 18-year-old male, suffering from asthma with ABPA.
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A rare entity of tubercular mastitis with chest wall extension in a male
Ved Prakash, Virendra Kumar, Ashwini Mishra, Ajay Kumar Verma, Ambrish Joshi, Surya Kant
July-December 2015, 3(2):57-59
DOI
:10.4103/2320-8775.158857
Tuberculosis (TB) is a chronic granulomatous inflammation involving usually the lung parenchyma and hilar lymph nodes. Extrapulmonary involvement is seen in about 15-20% of all cases of TB (EPTB). But breast TB is rare form of EPTB. We present a case of an immunocompetent male presenting with tubercular mastitis associated with chest wall extension. The rarity of this case lies in the site of involvement (chest wall), the way of presentation, and because of the immunocompetent status of the patient.
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Ectopic adrenocorticotropic hormone syndrome presenting as hypokalemic metabolic alkalosis and hypertension
Mansoor C Abdulla, Jemshad Alungal
January-June 2016, 4(1):24-26
DOI
:10.4103/2320-8775.172478
The ectopic adrenocorticotropic hormone (ACTH) syndrome is an uncommon cause of hypercortisolism, which should be considered in patients with hypokalemic metabolic alkalosis and hypertension in the context of lung neoplasm. We report a 60-year-old male patient with severe hypertension, metabolic alkalosis, and hypokalemia as the initial manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic Cushing's syndrome should always be ruled out in patients with severe hypertension and hypokalemia.
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EDITORIAL
Recent changes in technical and operational guidelines for tuberculosis control programme in India - 2016: A paradigm shift in tuberculosis control
Arunabha D Chaudhuri
January-June 2017, 5(1):1-9
DOI
:10.4103/2320-8775.196644
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EDITORIALS
COPD care bundles: A must know for all acute caregivers
Subhasis Mukherjee
January-June 2016, 4(1):1-3
DOI
:10.4103/2320-8775.172484
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ORIGINAL ARTICLES
Active case finding of sputum positive pulmonary tuberculosis in household contacts of tuberculosis patients in Karachi, Pakistan
Tahir Rizwan Khan, Zeeshan Ahmed, Mubashir Zafar, Nighat Nisar, Shahina Qayyum, Khalid Shafi
January-June 2014, 2(1):25-31
DOI
:10.4103/2320-8775.126507
Background:
Pakistan holds rank 8
th
among the world countries in which high prevalence of tuberculosis (TB) is present. There is evidenced that up to 30% of close contacts of TB patients become infected and at least half of them progress to active disease. The aim of this study was to screen active contacts of sputum positive pulmonary TB (SS +ve PTB) among household contacts (HHCs) of TB patients in Karachi, Pakistan.
Materials and Methods:
Cross-sectional study, which was conducted at chest clinics of Karachi. Total 750 HHCs were screened out of which 135 diagnosed smear positive TB patients was registered as index cases (ICs) from July 2012 till March 2013. Logistic regression analysis was carried out to estimate the odds ratio (OR) of different associated factors.
Results:
Prevalence among males (6.1%) compared with female (5.6%). The crude OR for age less than 15 years was 0.28 (95% confidence interval (CI) 0.14-0.55). Eighty-eight HHCs (11.73%) were found to have SS +ve TB. Disease frequency was significantly higher in HHCs who were smokers (adjusted OR 36.41; 95% CI 12.07, 109.79), had age less than 12 years (adjusted OR 3.63; 95% CI 1.68, 7.86), and who lived in houses less than 80 square yards (adjusted OR 3.77; 95% CI 1.27, 6.05).
Conclusion:
The IC with positive sputum smear constitutes great risk for TB infection and disease in HHC. There is needed for contact tracing strategy in the high-risk population.
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Adverse drug reactions in tuberculosis patients due to directly observed treatment strategy therapy: Experience at an outpatient clinic of a teaching hospital in the city of Imphal, Manipur, India
Kumarjit Sinha, Izora Trudy R Marak, W Asoka Singh
July-December 2013, 1(2):50-53
DOI
:10.4103/2320-8775.123213
Background:
As to the profile of adverse drug reactions (ADRs) due to directly observed treatment, short course (DOTS), there is no report available in patients receiving antituberculosis (anti-TB) chemotherapy in Manipur, India. One of the main reasons for non-adherence to anti-TB therapy (ATT) is ADRs, even under DOTS.
Aims:
This study aimed to determine the incidence of ADRs due to DOTS therapy with a TB population of Manipur, India.
Setting and Design:
A prospective institution-based cohort study, and performed during July 2009-December 2010.
Materials and Methods:
The study included 102 diagnosed TB patients on anti-TB treatment under DOTS. Every patient was followed-up for the duration he/she received the treatment.
Statistical Analysis:
Frequency of different ADRs was assessed and p value was determined.
Results:
Incidence of TB was more among males than female (76.47% against 23.53%). Seventy-one patients (69.01%) showed one or more ADR. Incidence of ADRs based on affected organ was: Gastrointestinal (GI) disorders in 38 patients (53.52%), generalized weakness in 12 patients (16.9%), liver dysfunction in 11 patients (15.49%), allergic skin reactions in six patients (8.45%), neurological system disorders in two patients (2.82%), and fever in two patients (2.82%). However, 30.99% did not experience any ADRs.
Conclusion:
Incidence of ADRs due to DOTS therapy was 69.01%. Majority of cases suffered from GI symptoms. This highlighted the importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely.
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A study of correlation between body mass index and GOLD staging of chronic obstructive pulmonary disease patients
Mrinmoy Mitra, Santanu Ghosh, Kaushik Saha, Arnab Saha, Prabodh Panchadhyayee, Anirban Biswas, Tarasankar Malik, Arnab Roy, Pratik Barma
July-December 2013, 1(2):58-61
DOI
:10.4103/2320-8775.123217
Background:
The association between low body mass index (BMI) and poor prognosis of patients with chronic obstructive pulmonary disease (COPD) is a common clinical observation and it varies with different stages of COPD.
Aims:
To find out any correlation between BMI and severity of obstruction (Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging) of COPD patients.
Settings and Design:
We conducted a cross-sectional, observational study among 101 male patients of COPD, attending the chest medicine department in our medical college during the period from March 2011 to February 2012.
Materials and Methods:
We classify the severity of obstruction in COPD patients according to GOLD staging through spirometry. BMI of all the patients was measured. Correlation between BMI and severity of obstruction (post bronchodilator forced expiratory volume in 1
st
second (FEV
1
) % predicted) in COPD patients was determined.
Statistical Analysis:
Analysis was carried out using Statistical Package for Social Sciences (SPSS) 20.0 software for windows. Pearson correlation, one way analysis of variance (ANOVA) analysis and
post
hoc
Turkey test were used to determine the relationship between BMI and post bronchodilator FEV
1
%predicted.
Results:
Mean age of the study subject was 58.18 ± 9.29 years. Commonest age group was 50-59 years (40%). Mean BMI of stage 1 COPD subjects was 26.21, stage 2 was 22.91, stage 3 was 20.78, and stage 4 was 15.71. One-way ANOVA showed that BMI of the patients were decreasing with increasing severity of the disease (GOLD) and it was statistically significant (
P
< 0.05). The
post
hoc
Turkey test also indicated that there were significant differences present in different GOLD stages of COPD in respect to BMI.
Conclusion:
There was positive correlation between severity of airway obstruction and BMI in COPD patients.
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REVIEW ARTICLES
Pneumothorax in human immunodeficiency virus infection
Sibes Kumar Das, Bhaswati Ghoshal
July-December 2015, 3(2):38-40
DOI
:10.4103/2320-8775.158834
Pneumothorax occurs more frequently in people with Human immunodeficiency virus infection in comparison with the general population. In most cases it is secondary the underlying pulmonary disorder, especially pulmonary infections. Though Pneumocystis jiroveci pneumonia is most common pulmonary infection associated with pneumothorax, other infections, non-infective etiology and iatrogenic causes are also encountered. Pneumothorax in these patients are associated with persistent bronchopleural fistula, prolonged hospital stay, poor success with intercostal tube drain, frequent requirement of surgical intervention and increased mortality. Optimal therapeutic approach in these patients is still not well-defined.
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Fungal pneumonia in intensive care unit: When to suspect and decision to treatment: A critical review
Shelley Shamim, Abinash Agarwal, Bijan Kumar Ghosh, Mrinmoy Mitra
July-December 2015, 3(2):41-47
DOI
:10.4103/2320-8775.158837
Fungal pneumonia is classically found in neutropenic patients. There is increase in concern about this entity in nonneutropenic critically ill patients.
Aspergillus
is the main offending organism. Although
Candida
is frequently found in respiratory sample in intensive care unit (ICU) it is always colonization rather than pneumonia. Other than neutropenia, chronic obstructive pulmonary disease and long-term steroid use are the main risk factors for invasive pulmonary aspergillosis in an ICU setting. Treatment in a nonneutropenic patient is only considered if the culture of
Aspergillus
comes positive in respiratory sample in the background of risk factors.
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2,859
585
Intensive care unit bugs in India: How do they differ from the western world?
Dhruva Chaudhry, Brijesh Prajapat
January-June 2017, 5(1):10-17
DOI
:10.4103/2320-8775.196645
Infections continue to play a significant role in the overall global mortality and disability more so in Intensive Care Units (ICUs) and plague developing countries more intensively. The ICUs are often called “the hubs” of infections owing to highly vulnerable patients’ profile. The most important nosocomial infections in the ICU are catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. The epidemiology of ICU infections in India is different from its Western counterparts in terms of prevalence and nature of microorganisms causing it. While Gram-positive infections are more prevalent in Western ICUs, Indian ICUs are commonly afflicted with Gram-negative bugs showing a high degree of antimicrobial resistance with blurring of traditional boundaries of early drug sensitive and later drug resistance infections. Increasing number of multidrug resistance organism infections in ICUs is a big public health threat and challenge both from the perspective of prevention and treatment. Therefore, blindly following the Western guidelines may not provide the optimum results in India. The need of the hour is to develop and implement an antimicrobial stewardship program based on the local epidemiological data and international guidelines to optimize the antimicrobial use among the hospitalized patients and improve their outcomes.
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2,011
394
Weaning from mechanical ventilation in chronic obstructive pulmonary disease: Keys to success
Deepak Talwar, Vikas Dogra
July-December 2016, 4(2):43-49
DOI
:10.4103/2320-8775.183839
Invasive mechanical ventilation (IMV) for management of chronic obstructive pulmonary disease (COPD) associated respiratory failure is increasing in Intensive Care Units. However, IMV is not without its own complications. Hence, aim of managing such patients is to get them off the ventilator as early as possible. This bridging process from IMV to extubation is called weaning in which mechanical ventilation is gradually withdrawn and the patient resumes spontaneous breathing. Many objective parameters have been defined for weaning success. Many of these patients are difficult-to-wean because of various pathophysiologic mechanisms that are of particular relevance to patients of COPD. The following review focuses on these mechanisms and how to troubleshoot patients who are difficult-to-wean.
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© The Journal of Association of Chest Physicians | Published by Wolters Kluwer -
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Online since 16 Oct, 2013