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Background: Bronchiectasis is common in patients with Chronic Obstructive Pulmonary Disease (COPD). COPD with bronchiectasis has been considered a phenotype with worse lung function and more severe exacerbations. There is scarce literature on the characteristics and optimal management of such patients.Methods:Patients with COPD reporting within the one-year study period were subjected to High Resolution Computed Tomography (HRCT) scan of the thorax. Sputum was sent for Gram-stain and culture/sensitivity for patients found to have bronchiectasis. Bronchiectasis Severity Index (BSI) was calculated using the online BSI calculator. Association between presence of bronchiectasis and gender, lung function and frequency of exacerbations was statistically analysed.Results: Total 62 patients with COPD were enrolled. Bronchiectasis was present in 11 (17.7%) patients. The most common bacterial isolate from sputum of patients with bronchiectasis was Haemophilus influenza (54.54%). The prevalence of bronchiectasis was more in females (19.45% compared to 15.4% in males), but this association was not found to be statistically significant(p=0.748). Forced Expiratory volume in 1st second (FEV1) was found to be significantly lower in patients with bronchiectasis (p<0.05). There was increased frequency of exacerbations among patients with bronchiectasis. This association was however not found to be statistically significant (p=0.765), 1 (9.1%) patient had low BSI score (0-4), 3 (27.3%) patients had intermediate BSI score (5-8) and 7 (63.3%) patients had high BSI score (?9).Conclusions:The presence of bronchiectasis in COPD is a phenotype associated with a poor clinical course. The characteristics of this co-existence are largely unknown. More studies are required to properly characterize and manage patients with this coexistence.
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Background: Drug Resistant Tuberculosis (DR-TB) is a major threat to the realization of the goal of a TB free world in the near future. It is important to study the reasons for the increasing number of such cases so that effective action can be taken to control this growing epidemic.Methods: Sputum from 36 patients diagnosed with acquired pulmonary Multidrug Resistant Tuberculosis (MDR-TB) were subjected to first- and second-line Drug Sensitivity Testing (DST) after liquid culture in mycobacterium growth Indicator Tube (MGIT). Primary MDR-TB cases were excluded. The relation of the drug sensitivity profile with the history of prior treatment taken was statistically analysed.Results: Majority of the patients had received appropriate treatment, and most had adhered to prescribed treatment. Among the 36 patients, 24(66.7%) were found to be Pre-Extensively Drug Resistant (Pre-XDR-TB) and 4(11.1%) were extensively drug resistant XDR-TB cases. Inappropriate prescription of fluoroquinolone (FQ) was found to be most common. Prior intake of any drug was not found to significantly affect subsequent resistance to that drug.Conclusions: Fluoroquinolone resistance is quite common in patients with DR-TB (66.7%). This study did not find the prior use of FQ or any other drug to significantly affect subsequent resistance to the drug. Primary drug resistance is thus a major concern. 11.1% patients were found to be XDR-TB cases. Hence DST for first- and second-line drugs should be done at the time of diagnosis to avoid failure of treatment with a predesigned regimen.
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Dysregulated response of cytokines can result in hyper-inflammatory conditions called cytokine storm,commonly seen in sepsis and septic shock..The current study assessed hemoadsorption device - CytoSorb® for its efficiency as an adjuvant in treating patients suffering from septic shock. Total 8 patients enrolled were subjected to hemoadsorption therapy along with the standard treatment.The results of the study revealed significant improvement in clinical and haemodynamic parameters before and after initiation of CytoSorb® therapy. Out of 8 patients, 6 showed a positive outcome while 2 did not survive.The results of this study show that the use of hemoadsorption therapy can be considered in critically ill ICU patients as a safe and effective adjuvant therapy along with the standard treatment for a better outcome in patients.
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Aim and Objective: To study the clinical, pathological andradiological profile of lung cancer in non-smokers in a tertiarycare center.Methods: 53 non-smokers diagnosed with lung cancerattending the Department of Respiratory Medicine, KingGeorge’s Medical College from September 2015 to August2017 were enrolled. Record of all diagnostic investigations andprocedures performed namely transthoracic fine needleaspiration cytology (FNAC) and biopsy, bronchoscopy,thoracoscopy, closed pleural biopsy, lymph-node FNAC andbiopsy, routine blood and sputum examinations and a detailedhistory were obtained. Data was analysed retrospectively.Results: The mean age of presentation was 53.8±11.6 years.Majority were females (60.4%). Most common presentingsymptom was cough (84.9%). Mean duration of symptoms was6.9 months. Pallor was the most common clinical examinationfinding (41.5%). Mass with effusion was the most commonradiological lesion (45.3%). 22.6% masses were centrallylocated. Transthoracic biopsy could diagnose 32 (60.4%)cases. Adenocarcinoma was the most common type in bothmales (76.2%) and females (78.1%). Epidermal growth factorreceptor (EGFR) mutation was positive in 46.3% ofadenocarcinoma. Exon 19 deletion was the more commonmutation.Conclusion: Lung cancer among never smokers is a distinctclass with risk factors and genetic features discrete from thoseassociated with tobacco smoke. Indoor air pollutants as well asETS are definitely implicated risk factors. Targetable mutationsare commoner in non-smokers and hence mutation testingshould always be done in such patients. It is important toconduct studies about the diverse characteristics of this entityto consolidate our knowledge of this growing group of cancer.
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Background: Chronic respiratory diseases are becoming a challenge to public health due to its high morbidity and mortality. Most of these diseases are preceded by variable periods of chronic respiratory symptoms. If chronic respiratory symptoms can be diagnosed and managed properly and timely, we can reduce the incidence and complication of chronic respiratory diseases.Methods: A community based cross sectional survey was conducted in 20 electoral wards of Calicut corporation of Northern Kerala among the adult resident population of 20-70 years to assess the prevalence of chronic respiratory symptoms such as chronic cough, phlegm, wheezing, breathlessness and nasal allergy and the factors associated with these chronic symptoms. The information was collected from 1384 eligible subjects selected by cluster sampling using British research council respiratory questionnaire.Results: About 9.2% (n=95) of study population had at-least one of the chronic respiratory symptoms. 1.8% (n=19) had all the chronic respiratory symptoms. Prevalence of various chronic respiratory symptoms was chronic cough (8.7%), Phlegm (14.3%), wheezing (8.5%), breathlessness (2.2%) and nasal allergy (14.5%). Advancing age, current smoking, family history and past history of various respiratory diseases are significantly associated with the development of chronic respiratory symptoms. Female gender, longer duration of stay in Calicut corporation and regular alcoholism were significantly associated with chronic phlegm in the study population. Wheezing, breathlessness and chronic nasal allergy was significantly higher among lower socio economic status.Conclusions: Prevalence of chronic respiratory symptoms is high among the urban population of Northern Kerala. Older age group, smoking, past and family history of respiratory diseases are the major risk factors associated with these respiratory symptoms.
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Background: Spirometry is an important diagnostic monitoring tool for various lung disorders. Ventilatory function can be assessed by spirometry. Also, we can find whether it is obstructive or restrictive disease. An appropriate technique is essential to ensure accurate results. Spirometry requires proper understanding and cooperation of the patient while doing the test. The objective was to evaluate the efficacy and utility of spirometry data in elderly (>65years) individuals with or without lung diseases.Methods: A hospital based cross sectional study was carried out among 199 subjects who were then divided into 100 controls and 99 cases. Spirometry was carried out among all subjects. The values of spirometry were compared among cases and controls as well as across age and sex groups. Student’s t-test was applied.Results: After studying the spirometric data in elderly population with or without lung disease, there was significant difference between cases and controls as far as pack years of smoking was concerned. There was significant difference in FEV1, FVC and FEV1/FVC between the cases and controls. As the age increased the spirometric values decreased. The spirometry was normal in controls in majority compared to none in cases.Conclusions: Spirometry should be used by all primary care and specialist physicians even in elderly population.
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Endometrial stromal tumors (EST) arise from stromal component of endometrium and are rare and common in peri or postmenopausal age group. EST are partially estrogen dependent tumors and their histopathology resemble the stromal cells of normal proliferative endometrium. They present in varied forms pathologically ranging from most begin to most mligrant variants. Diagnosis essentially is by histopathology and prognosis is based on the mitotic activity of the tumor. We have presented here a case of EST presenting in a young nulliparous woman.
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Birdshot retinochoroidopathy (BSRC) is a distinct type of posterior uveitis originally described in the 1940s. Its characteristics include minimal anterior segment inflammation and diffuse posterior choroidopathy with vitritis and retinal vasculitis. The precise etiology of this disease is yet to be elucidated. However, various treatment modalities have been employed with the ultimate goal of durable remission of this vision threatening intraocular disease. The purpose of this review is not only to emphasize the importance of recognizing BSRC, but also to discuss the new discoveries, immune mediators, current and new therapies, and techniques applied to monitor and accomplish disease remission.
Retinocoroidopatia do tipo "birdshot" é um tipo de uveíte posterior originalmente descrita na década de 1940. Achados característicos incluem inflamação mínima do segmento anterior, retinocoroidopatia difusa associada à vitreíte e vasculite retiniana. A etiologia da doença ainda não foi completamente definida, entretanto várias modalidades de tratamento têm sido utilizadas com o objetivo de atingir a remissão. O objetivo desta revisão é enfatizar não só a importância do reconhecimento da doença como também discutir novas descobertas relacionadas a mediadores imunes, formas de tratamentos e como monitorar a doença.