Role of Gene Xpert in smear negative pulmonary tuberculosis.

BACKGROUND: Tuberculosis is a major health problem contributing to significant morbidity and mortality. Early diagnosis and treatment is the key for TB control. Sputum microscopy is a rapid and inexpensive test but due to low and variable sensitivity, many cases can be missed. Culture is considered to be the gold standard but is time consuming. Gene Xpert is a novel and rapid cartridge based nucleic acid amplification test (CBNAAT) that can be used for prompt diagnosis. AIM: To compare the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Gene Xpert with culture in diagnosing tuberculosis in sputum smear negative patients. METHODS: The study is a prospective observational study conducted from December 2017 to January 2019 on 189 patients, who were sputum smear negative but had signs and symptoms suggestive of tuberculosis. Their respiratory samples were taken (either sputum or bronchoalveolar lavage) and sent for Gene Xpert. The results were compared with culture, which was taken as the gold standard, and diagnostic accuracy was assessed. RESULT: A total of 189 patients were included in the study. In 25 patients sputum was taken and in 164 patients BAL was taken (which included 22 patients in whom sputum Gene Xpert was negative but there was high clinical suspicion of tuberculosis). The sensitivity, specificity, PPV and NPV of Gene Xpert in diagnosing smear negative pulmonary tuberculosis was found to be 96.3%, 81.3%, 87.5% and 94.2% respectively. CONCLUSION: Gene Xpert can be used as a rapid diagnostic tool in patients who are sputum smear negative but have clinical features highly suggestive of tuberculosis. It additionally helps in detecting rifampicin resistance. But every Gene Xpert positive case does not necessarily mean an active disease, therefore, past history of tuberculosis along with radiological signs of disease activity are to be considered. In case of negative Gene Xpert but high clinico-radiological suspicion of TB, patients should be followed up on regular intervals, while awaiting their culture.

Indian Guidelines on Nebulization Therapy.

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

Clinico-radiological profile of COVID-19 in Kashmiri population: A descriptive study.

AIM: The purpose of our study was to assess the presentation of COVID-19 disease in terms of clinical and radiological features in our population. METHODS: 64 RT-PCR documented COVID-19 patients were included in the study. Clinical, biochemical, and radiological data were collected and analyzed retrospectively from last week of March to 30th April 2020. RESULTS: Out of the 64 patients, 38 (59.4%) were males, 44 (68.7%) had a history of contact with COVID-19 positive patient. 26.6%patients were in the age group of 21-30 years. 53.1% patients were asymptomatic while as cough and fever were the most common symptoms in 21.8 and 20.3% patients, respectively. Anosmia was present in four patients. Hypertension and hypothyroidism were the most common comorbid illnesses among the study population in 9.4% patients each. Lymphopenia was present in 38% of patients CRP was increased in 83% patients, LDH in 90.2%, and ferritin in 51.5% of patients. 17 (26.6%) patients had bilateral disease in CT. RUL was the most common lobe involved in 18 (28.1%) patients. GGO and consolidation were seen in 22 (34.45) and 13 (20.3%) patients, respectively. Vessel enlargement was observed in 11 (17.2%) patients. All five lobes were involved in 9 (14.1%) patients. Five patients developed severe disease with respiratory comprise; two of them eventually died. CONCLUSION: The clinical and radiological characteristics of COVID-19 patients vary among different populations. Although there are no radiological features which seems to be characteristic of COVID-19, but CT helps in evaluation of the patients as many asymptomatic ones have some radiological findings suggestive of viral pneumonia.

Spectrum of chest CT manifestations of coronavirus disease (COVID-19): A pictorial essay.

Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is an enveloped single-stranded RNA virus belonging to the family of betacoronaviruses. Chest computed tomography (CT) has helped us in understanding this new disease. Typical CT features of COVID-19 pneumonia are ground-glass opacities (GGO), crazy paving pattern and GGO with superimposed consolidation with a basal, posterior and peripheral lung predilection. Less commonly bronchial wall thickening, bronchial dilatation and pleural thickening are seen. Presence of pleural effusion, pericardial effusion and mediastinal lymphadenopathy is seen in severe cases. Reticulations, fibrous stripes, reverse halo sign and perilobular opacities are seen late (>2 weeks) in the course of illness. We aim to present a pictorial review of CT imaging findings in COVID-19 to illustrate the typical and atypical manifestations of this disease in a bid to familiarize radiologists with the myriad imaging manifestations of this disease.