Clinical Profile of Connective Tissue Disease- related Interstitial Lung Diseases at a Tertiary Care Center in Western India

Connective tissue disorders (CTDs) are one of the common causes of interstitial lung diseases (ILDs). This prospective observational study included around 51 patients of CTD-ILDs, and their demographic, clinical, radiological, and laboratory profiles were studied. The most common type of CTD-ILD in our study is rheumatoid arthritis-related ILD. On high-resolution computed tomography (HRCT) thorax, nonspecific interstitial pneumonia (NSIP) was the most common pattern seen in 30 patients (59%), followed by usual interstitial pneumonia (UIP) seen in 20 patients (39%). Even though CTD-ILDs are similar to other idiopathic ILDs in clinical and radiological presentation, patients with CTDs have to be evaluated clinically and radiologically for early diagnosis. Early treatment initiation and pulmonary rehabilitation help in delaying the progression of disease. Among all ILDs, CTD-ILDs are associated with better prognosis and survival

The effects of high heeled shoes walking in on energy expenditure and oxygen consumption in healthy young female

Background: Walking in high-heeled shoes is widespread dress behavior of women of modern society. It increases lower limb muscles activity and energy cost. The need to generate larger muscular forces during walking increases the metabolic demand, thus oxygen consumption (VO2) is increased when wearing high heels. Aims and Objectives: To access effect of high-heeled shoes on Energy Expenditure (EE) and VO2 in Healthy Young female. Materials and Methods: This cross-sectional study was conducted among fifty apparently healthy female students between the ages of 20 and 26 yrs. Resting arterial blood pressure and heart rate (HR), VO2, heat production, and EE were recorded. Then, subjects walked barefooted a distance of 76.5 meters in 2 min. Following the barefooted walk, cardiac and metabolic parameter were recorded again. The subjects walked 76.5 meters in high-heeled shoes of 2, 4, and 6 inches. These parameters were recorded immediately after 76.5 meters of walking in high-heeled shoes. Results: The results from the present study indicate that walking a distance of 76.5 meters barefooted resulted in a significant increase only in mean arterial pressure, HR and rate pressure product. The EE and VO2 after walking a distance of 76.5 meters in high-heeled shoes of 2, 4, and 6 inches heel heights was significantly higher than walking a distance of 76.5 meters barefooted. Conclusion: Walking barefooted required lesser effort than walking in high-heeled shoes of different heel heights. Effort should therefore be made to encourage women to reconsider the habitual use of high-heeled shoes.

Results of simple limbal epithelial transplantation in unilateral ocular surface burn

Purpose: This study aimed to report the long-term outcomes of autologous Simple Limbal Epithelial Transplantation (SLET) performed for unilateral limbal stem cell deficiency (LSCD) following chemical burn at a tertiary eye center in North India. Methods: This was a single-center prospective interventional case series of patients who developed unilateral LSCD after suffering from ocular surface burns and who underwent SLET between October 2012 and May 2016 with a follow-up period of at least 6 months. The primary outcome measure was restoration of a completely epithelized, stable, and avascular corneal surface. The secondary outcome measure was percentage of eyes, which reported visual gain. Results: The study included 30 eyes of 30 patients, 18 adults and 12 children, at a median follow-up of 1.1 years (range: 6 months to 3.5 years), 21 of 30 eyes (70%; 95% confidence interval, 53.6%–86.2%) maintained successful outcome. Visual acuity gain was seen in 71.4% of successful cases. The clinical factors associated with failure were identified as acid injury, severe symblepharon at the time of presentation, and SLET combined with penetrating keratoplasty (PK). Conclusion: Autologous SLET is an effective limbal cell transplantation technique for the treatment of unilateral LSCD. It is especially beneficial for centers where cell cultivation laboratory is unavailable. Presence of severe symblepharon, which requires PK peroperatively , has poor outcome.

Hydatid Cyst Presenting With Endobronchial Rupture.

Diagnosis of lung hydatidosis becomes difficult with unusual radiographic findings especially with rupture of hydatid cyst. Here we present the case of a patient who presented with hydatid cyst with endobronchial rupture. A 40-year-old woman presented with a 3-year history of cough with mucoid expectoration, breathlessness on exertion, intermittent fever and leftsided chest pain. Chest radiograph and computed tomography of chest showed a mass obstructing the left main bronchus and post-obstructive cavity formation. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed uptake [maximum standardised uptake value (SUVmax) 2.5 G/mL) in left lower lobe cavity. Fibreoptic bronchoscopy showed obstruction of the left main bronchus with white gelatinous material. After the bronchoscope was withdrawn, the patient expectorated large quantities of this material. Histopathological examination of the aspirated membrane showed laminated acellular layer and focal inner germinal layer suggestive of hydatid cyst.

Hypersensitivity Pneumonitis Following Exposure to Lovebirds.

A 54-year-old man was referred for evaluation of respiratory symptoms of cough and breathlessness of 4 years. The symptoms had a temporal relationship with keeping lovebirds (Agapornis roseicollis) as pets. His vital parameters were within normal limits. Physical examination revealed clubbing, exercise desaturation and bilateral bibasilar crackles on chest auscultation.

Primary achalasia with pneumoesophagus and bronchopleural fistula causing right lung collapse and bronchiectasis.

A 35-year-old male non-smoker, presented with a history of recurrent respiratory tract infections, associated with intermittent haemoptysis and haematemesis since childhood. His vital parameters were normal with pulse oximetry saturation of 97% on room air. On physical examination, clubbing was observed. Chest auscultation revealed tubular type of bronchial breath sounds over the right hemithorax.

Pneumoconioses.

Occupational lung diseases are caused or made worse by exposure to harmful substances in the work-place. “Pneumoconiosis” is the term used for the diseases associated with inhalation of mineral dusts. While many of these broadspectrum substances may be encountered in the general environment, many occur in the work-place for greater amounts as a result of industrial processes; therefore, a range of lung reactions may occur as a result of work-place exposure. Physicians in metropolitan cities are likely to encounter pneumoconiosis for two reasons: (i) patients coming to seek medical help from geographic areas where pneumoconiosis is common, and (ii) pneumoconiosis caused by unregulated small-scale industries that are housed in poorly ventilated sheds within the city. A sound knowledge about the various pneumoconioses and a high index of suspicion are necessary in order to make a diagnosis. Identifying the disease is important not only for treatment of the individual case but also to recognise and prevent similar disease in co-workers.

Doughnut sign on FDG-PET scan in a ruptured lung hydatid cyst.

A 13-year-old girl, complained of fever and cough with mucoid expectoration associated with episodes of streaky haemoptysis. Past history was not significant. On examination vital signs were normal with a pulse oximetry saturation of 98 percent. Chest examination revealed decreased breath sounds in the left mammary and infra-mammary area.

An outbreak of acute hepatitis caused by hepatitis e virus in Surendranagar.

Background: Objective : To study clinical presentation and various laboratory parameters of acute viral hepatits caused by Hepatitis E virus in surndranagar district. Study Design : Retrospective cross sectional study was carried out from Jan 2011 to March 2011. Data of 1500 patients were collected and analysed. Result : In this study majority of patients had higher Serum bilirubin and SGPT level. Serum bilirubin in patients was ranging from 1mg/dL to 45 mgdL . SGPT was also higher ranging from 15 IU/L to >4000 IU/L. HEV Ig M by ELISA method was positive in 95% of all advised cases. They had symptoms of acute viral hepatitis like nausea, abdominal pain, jaundice, diarrhea and vomiting. Conclution : In this outbreak of acute viral hepatitis Hepatits E virus was an important attributing factor. Hepatitis E virus was transmitted through feco – oral rout. Patients’ symptoms were similar to other viral hepatitis.

Pulmonary rehabilitation in resource poor settings.

Pulmonary rehabilitation is an important component in the management of chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases. The goal of rehabilitation is to evaluate various systems, treat optimally, improve dyspnoea and health-related quality of life. It is a multi-disciplinary approach and involves a physician, a psychiatrist, a dietician and a physiotherapist. However, in a resource-poor setting, even an experienced physician alone may suffice. Exercise training is the backbone of pulmonary rehabilitation, which may be hospital-based or home-based. Though, the previous trials have shown benefit with hospital-based rehabilitation, several recent studies have demonstrated significant improvement in the 6-minute walk test and quality of life even with unsupervised, home-based pulmonary rehabilitation. In the resource-poor settings, the goal of rehabilitation may be achieved by incorporating regular unsupervised exercise in daily routine. This is not only better accepted and more suitable but is also more feasible for the lifelong maintenance of rehabilitation.

Ambulatory chest drainage.

Chest drainage is usually performed using the underwater drain consisting of re-usable glass units attached to the intercostal tube. Ambulatory chest drainage devices that use a mechanical one-way valve are an alternative to the traditional underwater drain. These devices consist of the flutter valve, flutter bags, chest seals and stoma bags. They are less bulky and allow the patient to be ambulatory, thus, reducing the risk of complications from immobility. Recent evidence shows that the ambulatory devices may be safe and effective for treatment of both pneumothorax and pleural effusion and even in out-patient care.