Six-Minute Walk Test Outcomes in Patients with Diffuse Parenchymal Lung Disease

The 6-minute walk test (6MWT) is used to measure exercise capacity and assess prognosis in diffuse parenchymal lung disease (DPLD). Although the 6MWT is usually considered to be a test of submaximal exercise capacity in DPLD, the physiological load imposed by this test is not well described and 6MWT outcomes are poorly understood. This study aimed to compare cardiorespiratory responses to 6MWT in people with DPLD. Methods: An observational crosssectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) who had diffuse parenchymal lung diseases. In this study, the clinical, radiological and histological data subjects was collected. 6MWT was done of all the patients and results tabulated. Result: Desaturation on 6MWT (SPo2 <88% or fall of 4% from baseline) were seen in total of 33(66%) patients with most cases being IPF in which 17 patients (89.47%) out 19 cases showed desaturation. This was followed by NSIP with 4(67%) of of 6 cases and CTD-ILD having 7(53.8%) out of 13 cases showed desaturation. More studies are required from developing countries to ascertain the spectrum of DPLDs in different geographic. Conclusion: On average, the 6MWT elicits a high but submaximal oxygen uptake in people with DPLD. Fibrosis is associated with maximum destauration in 6MWT. However the physiological load varies between individuals, with higher peak VO2 in those with more severe disease that may match or exceed that achieved on CPET. The 6MWT is not always a test of submaximal exercise capacity in people with DPLD.

Characterization of Hepatobiliary Masses: A Comparative Study of Ultrasound versus Computed Tomography

Detecting and characterization of hepatobiliary masses is one of the most confusing and controversial challenges in imaging today. Aims and objectives: To evaluate the role of Ultrasound and Computed Tomography in hepatobiliary masses and know the exact site of origin of lesion and its extension into surrounding structures. Methods: In this study, 100 cases of hepatobiliary masses were subjected to with USG and CECT abdomen. Imaging findings were evaluated and tabulated and correlated with the histopathological findings, surgical findings and follow up. The findings were checked and statistically tabulated. Results: Out of a total 100 patients included for study, most patients were in age range of 51 – 60 years. Males : Females ratio was 55 : 45. Out of 100 cases 73% were hepatic masses, 18% gall bladder masses and 8% common bile duct masses. 51 being true benign and 49 lesions being true malignant. Sensitivity (%) and Specificity (%) of diagnosing these lesions on USG was 84.5% and on 86.6% respectively. Sensitivity (%) and Specificity (%) of diagnosing these lesions on CT was 92.2% and on 94.8% respectively. Conclusion: Hepatobiliary masses remain a diagnostic challenge. These lesions are frequently caused by benign, malignant and metastatic etiologies. We conclude that USG plays an important role as an initial screening modality and as an adjunct to CECT and Triphasic CT in the evaluation of hepatobiliary masses.

Breast Tuberculosis in Patients at Tertiary Care Centre: Reveiw of Six Cases

Nearly 18 % tuberculosis patients have only extrapulmonary manifestations. Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. It accounts for less than 0.1% of breast conditions in developed countries, but reaches 3–4% in regions where the disease presents with high incidence (India, Africa). The significance of mammary tuberculosis is due to very rare occurrence and usually mistaken identity with breast cancer and pyogenic breast abscess. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tubercle bacilli under microscopy or culture. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. This review is based on the discussion on the important issues relating to the diagnosis, clinical features, and management of breast tuberculosis.

Clinicoradiological Profile of Patients with Diffuse Parenchymal Lung Disease

The profile of diffuse parenchymal lung disease (DPLD) has mainly been reported from the developed countries; the prevalence and outcome of DPLD is not studied well across India. The aim of this study is to describe the clinical radiological spectrum of various DPLDs from a tertiary care centre of a developing country. Methods: An observational cross-sectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) who had diffuse parenchymal lung diseases. In this study, the clinical, radiological and histological data subjects was collected. Results: Out of the total 50 subjects, mean age was 49.04 years with females constituting 58% of the total. Most common symptoms were gradually progressing dyspnoea (100%) followed by dry cough (76%). The commonest finding on chest radiograph in our series was reticular pattern (78%).The commonest pattern on high-resolution computed tomography was traction bronchiectasis (56%), followed by honeycombing (50%), septal thickening (46%).The commonest cause of DPLD in study was Idiopathic Pulmonary Fibrosis (38) %, followed by connective tissue – interstitial lung disease (CTD-ILD)(26%) and NSIP(12%). Smoking was one of the major risk factor associated with IPF, and 52.6% of patients with IPF were smokers (P<0.001). Conclusion: IPF (38%) was the commonest DPLD seen followed by CTD- ILD and NSIP at a tertiary center in northern India similar to the spectrum reported from developed countries. More studies are required from developing countries to ascertain the spectrum of DPLDs in different geographic

Clinicoradiological Profile of Patients with Connective Tissue related Diffuse Parenchymal Lung Disease

Diffuse Parenchymal Lung Disease (DPLD) is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality. Although the various CTDs associated with DPLD often are considered together because of their shared autoimmune nature, there are substantial differences in the clinical presentations and management of DPLD in each specific CTD. Methods: An observational crosssectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) of DPLD and amongst them patients having connective tissue diseases associated DPLD (CTD)-DPLD were studied.In this study, the clinical, radiological data of the subjects was collected. Results & Conclusion: Out of 50 patients, 13 patients turned out to be CTD-DPLD. The most common of these was Rheumatoid arthritis (53.8%) followed by Systemic sclerosis (38.4%) and sjogresn syndrome (7.7%). The average age in CTD-DPLD came out to be 47.8 years as opposed to 49.04 in DPLD patients. The average age in RA was 58.6 years, Systemic sclerosis was 40 years and Sjogrens syndrome was 45 years. Majority (92.3%) were females.

A Prospective Comparative Study of High Resolution Ultrasound and MRI in the Diagnosis of Rotator Cuff Tears

Aim: Comparing the role and finding sensitivity and specificity of ultrasonography with that of conventional MRI techniques in patients presenting with rotator cuff injury. Methods: 50 patients who presented with shoulder pain and/or disability and clinically suspected rotator cuff tears in orthopedic out patient department (OPD) of Guru Nanak Dev Hospital, Amritsar, referred to department of Radiodiagnosis and imaging for ultrasonography and magnetic resonance imaging. Results: USG shows sensitivity of 83.7%,specificity of 100%,PPV of 100% and NPV of 68.4% for partial thickness tear and 100% sensitivity,specificity ,PPV and NPV in complete thickness tear. The strength of agreement between USG and MRI for diagnosis of rotator cuff tear was found to be (k= 1.0) for full thickness tears (very good agreement) and good agreement for partial thickness tears. Conclusions: From our study, USG is proven to be an effective imaging modality with results comparable with MRI in patients presenting with shoulder pain and /or disability and clinically suspected case of rotator cuff tendon tears.ultrasound by an experienced radiologist should be considered as a primary diagnostic tool for imaging the rotator cuff pathologies. At present, MRI can be reserved for patients with suspicious USG results.

Starry sky appearance in Neurocysticercosis

Endemic in India, Neurocysticercosis (NCC) is perhaps one of the oldest known and perhaps the most common parasitic infections of the human nervous system. It is a major cause of epilepsy and neurological disease in many developing countries. In 2015, the WHO Food borne Disease Burden Epidemiology Reference Group identified T. solium as a leading cause of deaths from food-borne diseases, resulting in a considerable total of 2.8 million disability-adjusted life-years (DALYs). T. solium cysticercosis was added by WHO to the list of major neglected tropical diseases in 2010. The diagnosis is imaging based which shows characteristic “starry sky” appearance in heavy infestation cases.

Saliva as a diagnostic tool

Salivary diagnostics is an emerging field that has progressed through several important developments in the past decade, including the publication of the human salivary proteome and the infusion of federal funds to integrate nanotechnologies and microfluidic engineering concepts into developing compact point-of-care devices for rapid analysis of this secretion. In this article, we discuss some of these developments and their relevance to the prognosis, diagnosis and management of periodontitis, as an oral target, and cardiovascular disease, as a systemic example for the potential of these biodiagnostics. Our findings suggest that several biomarkers are associated with distinct biological stages of these diseases and demonstrate promise as practical biomarkers in identifying and managing periodontal disease, and acute myocardial infarction. The majority of these studies have progressed through biomarker discovery, with the identified molecules requiring more robust clinical studies to enable substantive validation for disease diagnosis. It is predicted that with continued advances in this field the use of a combination of biomarkers in multiplex panels is likely to yield accurate screening tools for these diagnoses in the near future