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

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.

Diagnostic Utility of Cell Block of Bronchial Brush Tip Washing in the Diagnosis of Carcinoma Lung and Application of Cytokeratin 5/6, TTF-1 & CD 56 Expression for Subclassification

Lung cancer is one of the most common malignancies worldwide with high mortality. Furthermore being one of the most insidious and aggressive neoplasm in the realm of oncology, it’s timely diagnosis and accurate subclassification becomes pre-requisite for administering appropriate and timely target therapy. In the present study, cell block from brush tip washings were prepared and immunoreactivity assessed for cytokeratin5/6, TTF-1 and CD56 with aim to diagnose and sub-classify carcinoma lung. Methods: The present study was conducted on 25 specimens of brushtip washings from suspected cases of carcinoma lung. Bronchoscopic investigation of pulmonary lesions was performed and routine brush smears were made and these brush tip were processed into cell block. Immunohistochemical staining for marker CK5/6, CD56 & TTF 1 was done and evaluated. Results: Brush smear cytology finding was mostly benign seen in 12 (48%) followed by SCC seen in 4 (16%), ADC in 3 (12%). Cell block microscopy showed SCC in 11 (44%), ADC in 5 (20%), small cell carcinoma in 3 (12%) and carcinoma in 3 (12%). It was inadequate in 3 (12%). The difference was significant (P< 0.05). Sensitivity and specificity of brush smear cytology in diagnosing lesion was 33.3 % and 52.6% respectively.Whereas for cell block microscopy in diagnosing lesion sensitivity was 91.67% and specificity 86.6%. The overall sensitivity of IHC CK 5/6 in diagnosing SCC was 100% and specificity was 52.4%. CD56, TTF1 were negative in these cases. CD56 showed 100% sensitivity in diagnosing small cell carcinoma with specificity being 24.6%, The overall sensitivity of IHC TTF 1 in diagnosing ADC was 100% & for small cell carcinoma was 40%. Conclusion: Cell block preparation is a simple method that increases diagnostic yield of flexible bronchoscopy, is cost effective & hence can be routinely used. IHC panel consisting CK 5/6, CD 56 and TTF 1 has more diagnostic value in precise subtyping of different types of lung carcinoma in adjunction to routine H&E staining.

Role of Adenosine Deaminase in Pleural Effusions and its Cytological Correlation

Diagnosis of pleural diseases creates difficulty due to overlapping features of various benign and malignant conditions. However pleural fluid cytology of closed pleural biopsy specimen is most commonly used procedure to diagnose various pleural diseases in developing country like India. Present study was conducted to establish diagnostic utility of ADA in Pleural Fluids and its correlation with cytological findings. Methods: The present study includes 100 samples of pleural fluid samples taken from patients coming to the Department of Chest and TB, Government Medical College and Hospital, Amritsar with the complaint of pleural effusion. Results: For ADA levels in pleural fluid Sensitivity is 92%, Specificity is 81.33%, Positive predictive value is 62.16% and Negative predictive value is 96.83%. For lymphocyte count in pleural fluid Sensitivity is 100%, Specificity is 16.67%, Positive predictive value is 31.25 % and Negative predictive value is 100%. In Combination of ADA and lymphocyte count to diagnose tubercular pleural effusion Sensitivity is 100%, Specificity is 77.27%, Positive predictive value is 82.14 % and Negative predictive value is 100%. Conclusion: Measurement of ADA level in pleural fluid in combination with the differential count of pleural fluid will give best results to categorize and to rule in the diagnosis of tubercular pleural effusion.