Rare Presentations on Fibroptic Bronchoscopy

Flexible bronchoscopy is a brief procedure routinely performed under local anaesthesia or under sedation by pulmonologist. These days flexible bronchoscopy is more widely used for diagnostic as well as therapeutic purposes without much morbidity or complications. Flexible bronchoscopy gives better access to the tracheo-bronchial tree with its more flexible tip to reach upper lobe areas and greater patient comfort as compared to rigid bronchoscopy. Here, we present few cases of infectious as well as non-infectious diseases who were diagnosed only after diagnostic bronchoscopy was done. All patients have typical presentation on bronchoscopy. Diagnostic bronchoscopy should be done at the earliest for early diagnosis and better disease outcome.

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.

A Case of Pulmonary Hydatid Cyst Misdiagnosed as Encysted Effusion

Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cystor develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material andsecondary immunological reactions that develop from cyst rupture.

A Case of Asthma COPD Overlap

Asthma and COPD are the pulmonary diseases most frequently encountered in clinical practice. Usually, each disease is caused by a different etiology and shows a different clinical picture and course. However, these two diseases sometime present within the same patient, and it is now recognized that asthma and COPD can coexist as asthma COPD overlap (ACO), which is clinically important for several reasons. First, it is estimated that the number of patients with ACO will increase significantly together with the recent increase in numbers of patients with asthma and COPD. Secondly, patients with ACO are prone to experience more frequent and severe exacerbations. Patients who have asthma with a COPD component tend to present with severe hypoxia because of Irreversible/fixed airway obstruction and impairment of the alveolar diffusion capacity by emphysematous changes. In contrast, patients with COPD who have an asthma component not only have exertional dyspnea but also develop paroxysmal wheezing or dyspnea at night or in the early morning. Here we report a case of 60 yr old male diagnosed as a case of asthma COPD overlap.

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.

To Study Clinico-Radiological Profile of Multi-Drug Resistant Tuberculosis Patients

Drug resistance is a threat to TB control program worldwide. Patient 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, progresses to more chronic forms of the disease and death. In most areas of the world, the routine use of drug susceptibility tests, let alone cultures to diagnose tuberculosis or multidrug resistant tuberculosis is beyond the scope of health care resources. According to Global Tuberculosis Report 2015, about 3.3% of newly diagnosed patients had multidrug resistant tuberculosis and 20% of previously treated Tuberculosis cases were estimated to have Multidrug resistant Tuberculosis (MDR-TB). This present study was conducted in the department of chest and TB, Government medical college, Amritsar, with an aim to study the clinico-radiological profile of patients with multidrug resistant tuberculosis. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 100 diagnosed patients of Multidrug Resistant Tuberculosis. Clinicoradiological profile of these patients was determined. Results: Out of 100 study population, maximum number of patients belonged to the age group of 21-30 years i.e. 26% followed by 22% in the age group of <20 years. Most common symptom was cough with expectoration which was present in 94 (94%) patients. 97 (97%) patients were having previous history of ATT, 3 (3%) patients were not having any previous history of ATT. On radiology unilateral disease was present in 48 (48%) patients, bilateral disease present in 52 (52%) patients. Parenchymal infiltration was present in 79 (79%) patients. Cavitation was present in 23 (23%), Fibrocavitary disease was present in 37 (37%) study subjects. Previous history of ATT had significant association with extent of lesion on chest x- ray (p < 0.05). Conclusion: clinico-radiological characteristics should always be determined where appropriately administered drugs have not achieved necessary drug levels to deal with all the population of mycobacteria, to timely modify and strengthen the national programs, and evaluation of trends in drug resistance pattern.

To Study The Percentage of HIV Seropositivity in Smear Positive Tuberculosis Cases

Tuberculosis is the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries and accounts for about 40% of all manifestations seen in HIV patients. Correct diagnosis and treatment of tuberculosis helps to reduce burden of TB. However there are difficulties in achieving this goal such as difficulties in diagnosing tuberculosis in HIV infected patients due to unusual clinical picture with increase in smear negative AFB pulmonary tuberculosis and atypical findings on chest radiography. There is a paucity of literature regarding determination of percentage of HIV seropositivity in smear positive tuberculosis cases in Northern India. Hence, this study was planned to study the correlation and burden of HIV seropositivity in smear positive tuberculosis cases. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 150 smear positive tuberculosis cases. HIV seropositivity was determined in all the patients. Results: In our study, the HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India. Conclusion: The HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India.