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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 8 | Issue 2
Page Nos. 39-111

Online since Thursday, September 10, 2020

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REVIEW ARTICLES  

COVID 19-lung interactions: the salient points for pulmonologist p. 39
Arup Halder, Arpita Halder
DOI:10.4103/jacp.jacp_40_20  
The COVID 19 virus gains entry into body by docking to ACE2 receptors of lungs. Subsequently it deranges the balance in RAS and destabilizes oxidant-antioxidant systems. It leads to cytokine storm and endothelial dysfunction. Intially lung is compliant but patients may be hypoxic due to vasoplegia. Later typical full blown ARDS set in.
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Hypoxemia and oxygen therapy p. 42
A. G Ghoshal
DOI:10.4103/jacp.jacp_44_20  
Oxygen is a drug prescribed and administered for specific indications with different pathophysiological mechanism. Oxygen is administered to treat hypoxia not dyspnea. Furthermore, the management of hypoxia in patients with COVID-19 demands separate attention.
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Nintedanib for the treatment of idiopathic pulmonary fibrosis: An Indian perspective p. 48
Anubhuti Singh, Kislay Kishore, Ajay K Verma, Arpita Singh
DOI:10.4103/jacp.jacp_35_19  
Idiopathic pulmonary fibrosis (IPF) is a chronic disease associated with progressive deterioration of lung function and ultimately death. Until recent past, no drug therapy was approved for the management of IPF and patients either received symptomatic treatment or were enrolled in clinical trials. Since 2014, two new drugs with anti-fibrotic potential have been approved following positive outcomes in large-scale clinical trials. Nintedanib is the latest drug in this category and has recently been launched in India. Here we present a review about nintedanib, covering its mechanism of action, efficacy, adverse effect profile, cost effectiveness and implications in the Indian setting.
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Recent changes in guidelines on programmatic management of drug resistant tuberculosis in India 2019: a paradigm shift in tuberculosis control Highly accessed article p. 53
Arunabha Datta Chaudhuri
DOI:10.4103/jacp.jacp_47_20  
The new version of guidelines of programmatic management of drug resistant tuberculosis in India 2019 by Revised National Tuberculosis Control Programme, Central TB Division, Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi, integrates use of the shorter MDR TB regimen and all oral longer MDR TB regimen with new drugs under RNTCP with opportunity to modify the regimen based on DST results. There are mammoth and comprehensive changes in the guidelines on programmatic management of drug resistant tuberculosis in India 2019.
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ORIGINAL ARTICLES Top

Our experience of thoracic surgery during COVID19 pandemic p. 64
Amitabha Chakrabarti, Manujesh Bandyopadhyay
DOI:10.4103/jacp.jacp_38_20  
COVID19 pandemic has badly affected thoracic surgical services. In this difficult time Thoracic surgeons all over the world are boldly managing thoracic malignancies and life-threatening problems of benign thoracic diseases. Infection control, safety of patients & healthcare personnel remains the cornerstone. In this article we present our experience of Thoracic surgery during this pandemic. Our results & experience are similar to the guidelines & survey reports published by thoracic surgeons till date.
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Group III Pulmonary Hypertension: relative frequency of different etiologies in a referral pulmonary OPD p. 69
Parthasarathi Bhattacharyya, Sayoni Sengupta, Dipanjan Saha, Mintu Paul, Priyanka Choudhury, Sanjukta Dasgupta
DOI:10.4103/jacp.jacp_3_20  
Background: The prevalence of pulmonary hypertension (PH) in India remains unknown. The literature is scanty from the country regarding different types of PH. The etiological distribution of Group III PH in a pulmonologist’s practice, therefore, will be worthwhile to note. Method: We included patients with pulmonary hypertension following convenience sampling from those been diagnosed with PH in our pulmonary OPD services on the basis of a novel clinico-radio-echocardiographic criteria. They were then evaluated for the apparent and predominant underlying etiology. Patients with clear and defined diagnosis of COPD, asthma, DPLD, OSA and CTEPH were charted along with those having no obvious etiology but a history of treatment of tuberculosis in the past, along with a group marked as the “others” that consisted of a number of known (sarcoidosis, rheumatic heart disease, etc.) and some incompletely evaluated patients. Results: A total of 356 patients were recruited. The relative frequencies have been accounted to 35.81%, 20.66% and 13.77% for COPD, DPLD and asthma respectively. The patients with a history of TB without any other forthcoming etiology formed 12.67% of the group. The patients with OSA and CTEPH accounted for 2.75% of the group and the “Others” group occupied the rest 14.32%. Conclusion: Group III PH is found not infrequent in pulmonary practice and COPD tops the etiological list.
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A cross-sectional study on tobacco use prevalence and reasons for its use among male youth in a resettlement colony of Delhi p. 76
Vikas Yadav, Deepti Dabar
DOI:10.4103/jacp.jacp_32_19  
Introduction: It is estimated that 5,500 adolescents started using tobacco every day in India. The prevention of tobacco use in young Indians appears to be one of the largest opportunities for controlling this ever-growing epidemic. In India, like in other developing countries, the most susceptible time for initiation of tobacco is during youth, that is in the age group of 15–24 years. Material and Methods: This cross-sectional study was conducted in Kalyanpuri, a resettlement colony in New Delhi, India. The study included males aged 15–24 years residing in the study area at the time of survey. A semi-structured interview schedule was designed and translated into Hindi to elicit information on tobacco use. Results: Prevalence of tobacco use (ever user) was found to be 31.3%. Among ever users, 225 (27.7%) were current users and 9 (3.6%) were past users. Peer pressure (140, 62.2%) was found to be most common reason for initiation, whereas habit (143, 63.5%) of having tobacco was most common reason for continuation of tobacco use.
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Is chronic obstructive pulmonary disease under-diagnosed in patients with coronary artery disease? A tertiary care centre experience from central India p. 81
Kislay Kishore, Anubhuti Singh, M.S. Barthwal, Debjyoti Bhattacharyya, C.D.S. Katoch, Rahul Tyagi, Sandeep Rana
DOI:10.4103/jacp.jacp_43_19  
Context: Although worldwide studies are available regarding the prevalence of COPD in CAD patients, data from India are sparse. Aims: The purpose of this study was to determine the prevalence of undiagnosed and therefore, untreated COPD in patients suffering from CAD. It would also attempt to establish the need for screening of patients diagnosed with CAD for COPD. Settings and Design: A cross-sectional, observational study carried out at the respiratory out patients department (OPD) of a tertiary care centre of armed forces over a period of one year. Methods and Material: 79 patients with angiographically proven CAD underwent spirometry to assess the prevalence of COPD. Statistical Analysis Used: Data analysis was done using SPSS (Statistical Package for Social Sciences) version 21.0. Results: The mean age of the patients was 62.49 years (±8.77). Mean smoking index was 235.88. Nine patients (11.39 %) were diagnosed to have COPD. All the patients diagnosed as COPD were male, >60 years old and had normal BMI. 88.9 % patients with COPD were smokers. On comparing the patients with and without COPD, a significant co-relation was found with LVEF (%) (P = 0.044). 44.4% patients had never been diagnosed with COPD. Conclusions: The prevalence of missed diagnosis of COPD is significant in our study. We recommend that at the time of diagnosis of CAD, the initial evaluation should include a detailed history, clinical examination and evaluation of lung function by spirometry.
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Echocardiographic evaluation of stable chronic obstructive pulmonary disease (COPD) patients p. 88
Hemant Kumar, Ajay Kumar Verma, Anuj Kumar Pandey, Utkarsh Kumar Srivastava, Manoj Kumar Pandey, Rishabh Chaudhary, Surya Kant
DOI:10.4103/jacp.jacp_40_19  
Context: Chronic obstructive pulmonary disease (COPD) is the second leading cause of mortality in India, cardiovascular disease (CVD) comorbidity further increases morbidity and mortality of COPD. Early detection of CVD by echocardiography in COPD helps to reduce mortality and morbidity. Objective: We aimed to assess the echocardiographic findings in stable COPD patients. Materials and Methods: Patients with stable COPD, confirmed by spirometry, were recruited from the two tertiary care centre of India between August 2017 and August 2019. After thorough clinical examinations, patients have undergone echocardiography for CVD evaluation. Results: A total of 110 COPD patients were recruited, 91 male and 19 female. On echocardiographic evaluation, pulmonary arterial hypertension (PAH) was seen in 45.5% of COPD with mild, moderate, severe 14.5%, 11% and 20% respectively. Cor-pulmonale was seen in 9.1%. Left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD) and left ventricular systolic dysfunction (LVSD) was seen in 11%, 39.1% and 13.6% of COPD respectively. CVD involvement was more common in very severe COPD (40.1%). Conclusion: In this study, 78.2% of COPD have at least one form of CVD as co-morbidity. A simple, cheaper, non-invasive, widely an available investigation like echocardiography is useful to detect CVD at an early stage.
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Serum procalcitonin in predicting bacterial exacerbation of COPD and need for ventilatory support p. 92
Yogendra Rathore, Anshika Jindal, Vinod Joshi, Shubhra Jain, Shweta Bhati
DOI:10.4103/jacp.jacp_1_20  
Context: Acute exacerbation of COPD is very common disease and 20% of the COPD patients keep getting admitted with exacerbation. Serum procalcitonin (PCT) measurement is important to discriminate bacterial infection from other causes of AECOPD. Quick recognition along with prompt intervention may be the only action that prevents respiratory failure. Aims: To correlate serum PCT level with bacteriological profile and their need for ventilatory support in patients with AECOPD. Settings and Design: Hospital-based comparative type of cross-sectional study was conducted at the department of respiratory medicine in a tertiary care center of Rajasthan. Methods and Material: This comparative type of cross-sectional study was conducted between 45 AECOPD patients and 35 stable COPD patients. Serum PCT levels and sputum pyogenic culture were noted in all subjects. Statistical Analysis Used: Data collected were entered into excel spreadsheet and quantitative data were expressed as number and percentage. Results: There was a highly statistically significant difference of mean PCT value (P value < 0.003) between AECOPD patients (1.34 ± 2.53 ng/ml) and stable COPD patients (0.07 ± 0.05 ng/ml). Also, we found a statistically significant difference of mean PCT value (P value < 0.001) between AECOPD patients infected with Pseudomonas aeruginosa (3.64 ng/dl) and with other bacteria. A statistically significant difference (P value < 0.001) was present among AECOPD patients that needed invasive ventilation (5.41 ± 4.01 ng/ml), non-invasive ventilation (0.65 ± 0.81 ng/ml) and those did not need mechanical ventilation (0.27 ± 0.25 ng/ml) regarding the mean values of PCT. Conclusions: Our study found that higher PCT levels in severe AECOPD patients were associated more with bacterial infection and necessity of ventilatory support. Serum PCT can be used as good biomarker for intensive care unit admission.
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CASE REPORTS Top

Parvo virus infection − an unusual cause of pleural efusion in an immunocompetent patient p. 99
Arjun Khanna
DOI:10.4103/jacp.jacp_25_18  
Pleural and pulmonary manifestations of Parvo virus infection are exceedingly rare. Here, we describe an immunocompetent patient with Parvo virus infection who presented with lymphocytic, exudative effusion. Though, this presentation is rare, it may be looked for, if a patient presents with rash and pleural effusion.
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Solitary pulmonary nodule − Pulmonary hamartoma p. 102
Pooja Khari, Shalini Mullick, Devesh Chauhan
DOI:10.4103/jacp.jacp_11_20  
Pulmonary hamartomas are rare, benign tumours of lung and are composed of an abnormal mixture of epithelial and mesenchymal elements. They usually present as single, round nodules with distinct boundaries and are mostly asymptomatic. We present a case of 45 years old female who presented with cough, chest pain and dyspnea with few episodes of hemoptysis. Computed tomography (CT) scan of thorax showed a well-defined non enhancing mass lesion measuring 4 × 3.2 cm seen in the left lower lobe. Wedge resection was done. Histopathological examination confirmed the diagnosis of pulmonary hamartoma.
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A case of chronic cavitory pulmonary aspergillosis, a rare entity p. 106
Sibes Kumar Das, Soumyadeep Ghosh, Gopal Sasmal
DOI:10.4103/jacp.jacp_2_20  
Aspergillus species cause a wide spectrum of pulmonary disease including allergic, saprophytic, semi-invasive and invasive aspergillosis. Host immune system is the major determinant of the pattern of illness in human beings. Several chronic forms of Aspergillus infections have been described which include chronic cavitary pulmonary aspergillosis (CCPA), chronic fibrotic pulmonary aspergillosis (CFPA) and chronic necrotizing pulmonary aspergillosis (CNPA). Chronic cavitary pulmonary aspergillosis usually runs a progressive course, affects apparently immunocompetent individuals with a pre-existing lung disease. Diagnosis depends on presence of constitutional and pulmonary symptoms, suggestive radiological changes and microbiological or serological evidence of Aspergillus infection. We hereby present a case of 28 years immunocompetent male who had prior history of pulmonary tuberculosis and was subsequently diagnosed as chronic cavitary pulmonary aspergillosis.
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LETTER TO EDITOR Top

Corrosive esophageal injury caused by impacted button battery p. 110
Charulatha Ravindran, Sripriya R., Gobinath Jayaraman
DOI:10.4103/jacp.jacp_41_19  
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