Coronavirus disease-19 triggered systemic lupus erythematous: A novel entity.

Coronavirus disease 19 (COVID-19) has been associated with varied immunological diseases due to dysregulated immune responses. We hereby report a rare case of COVID-19 triggered Systemic lupus erythematous arising in a young healthy male, necessitating the use of immunomodulatory drugs for the remission of the disease process.

Post-nephrectomy pulmonary thromboembolism.

The association of pulmonary thromboembolism with nephrectomy is well documented in malignant conditions. However, the data for incidence of pulmonary thromboembolism following nephrectomy in nonmalignant conditions remains scarce. We report the first case of an incidence of pulmonary thromboembolism following nephrectomy in a patient with a nonfunctional kidney due to multiple renal calculi.

Clinicopathological Profile and 2 Year Relapse Rates of Non-Hodgkin's Lymphoma in Tertiary Care Center.

The aim and objectives are to study clinicopathological profiles and 2-year relapse rates of Non-Hodgkin lymphoma,Material :This prospective observational study was conducted from Jan 2017 to May 2021. All newly diagnosed patients of NHL were enrolled and received a CHOP±R regimen for 6 cycles as per B-cell or T-cell lineage. The data was and analyzed using spss software. Observation: A total of 50 patients were enrolled and followed for 2 years. The median age of presentation was 44.62±15.92. Commonest clinical presentation was lymphadenopathy (46%), followed by B symptoms (32%). Commonest clinical sign was lymph node enlargement (52%). The commonest extranodal presentation was hepatomegaly (22%) and splenomegaly (22%). On peripheral blood smear, macrocytic hypochromic anemia (12%) was the commonest presentation. CT Scan showed, nodal involvement in 86% with generalized lymphadenopathy in (40%) cases. Extranodal involvement was seen in 50%. WB PET showed nodal involvement in (90%), and extranodal involvement in 70%. PET scan (90%) was a little more sensitive for detecting lymph node involvement over CT scan (86%). On lymph node biopsy, the most common subtype was B cell NHL (84.84%) and the commonest histopathological subtype was diffuse large cell B cell lymphoma. Biopsy from the extranodal site shown B cell NHL in (93.33%). The commonest histopathological subtype was DLBCL (18%). On marrow examination and biopsy, 88% were B cell type and the commonest type was DLBCL (62%). The commonest treatment-related toxicity was febrile neutropenia (44%). At 6 months, 30% were having clinical active disease and PET imaging revealed radiologic disease activity in 32 %. At 12 months, 14% were having clinical disease, and radiologic disease activity in 14%. At 18 months, 5% were having clinical disease, and radiologic disease activity in 10%. At 24 months, 14% were having clinical disease, and radiologic disease activity in 14%. At the end of the study period, 78 % were in remission, 10% cases in relapse, 6% cases had progressive disease and 6% of cases expired. Conclusion: This study found 02-year survival post standard chemotherapy in NHL cases was 88%. The relapse rate at 24 months was 14%. The B symptoms were seen less commonly, and bulky disease was noted in one-third of cases. The role of PET in diagnosing and follow up on these cases was good but it was comparable with CT scan.

Stratified approaches for using biomarkers in phenotyping for the management of severe asthma in India.

Various respiratory societies including the Global Initiative for Asthma (GINA), European Respiratory Society (ERS) and American Thoracic Society (ATS) define severe asthma as asthma that requires or remains uncontrolled despite treatment with systemic corticosteroids or high-dose inhaled corticosteroids plus another controller such as long acting beta agonist. The management of asthma as an entity is not straightforward due to inter-individual variability in assessment parameters. With the advent of science, targeted therapies are on the emergence for management of severe asthma. A biomarker can be used as a surrogate to phenotype a patient as well as to measure the response to therapy with any drug. Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. From a resource constraint perspective like countries in India, it is imperative to use biomarkers that are easily available are affordable cost. Choosing an ideal biomarkers is also important from a perspective of choosing a particular therapy. The cost associated with the biologicals is high and it is imperative to gauge the treatment effectiveness with the therapy at the earliest considering the out of pocket spends of the patients.

Functional impairment in bronchiectasis: Spirometry parameters versus St. George's Respiratory Questionnaire scores: Any co-relation?

OBJECTIVES: Bronchiectasis is a common respiratory disease which has significant morbidity and mortality. Health-related quality of life scores are not routinely used for the assessment of bronchiectasis. The present study was undertaken with an aim to assess the clinical profile and functional impairment using spirometry in patients with bronchiectasis and to co-relate functional impairment with their St. George's Respiratory Questionnaire (SGRQ) score. METHODOLOGY: This was a cross-sectional study carried out on 102 patients of bronchiectasis. All patients were assessed for clinical profile, spirometry, and SGRQ scores. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC were measured and compared with SGRQ scores. Data analysis was done using SPSS version 20.0 and MS-Excel. RESULTS: Obstruction was found in 62.7% and significant bronchodilator reversibility was observed in 30.4%. All spirometry parameters individually and combined showed a negative co-relation which was stastically significant (P < 0.001). Best co-relation was with FEV1 r = -0.809; symptom score, r = -0.821; activity score, r= -0.849; impact score and r = -0.873 total score. FVC% versus symptoms score r = -0.735; activity score r = -0.729, impacts score r = -0.778; total score r = -0.792. FEV1/FVC versus symptoms score r = -0.227, activity score r = -0.278, impacts score r = -0.263, total score r = -0.274. CONCLUSION: SGRQ scores have shown good correlation with functional impairment. It can be used as a modality to evaluate health status of patient in resource constraint settings.

Bronchial challenge test in patients with a history suggestive of bronchial asthma with normal spirometric studies.

BACKGROUND: Bronchial hyper-responsiveness (BHR) is the hallmark of bronchial asthma, characterized by clinical features of cough, wheeze, breathlessness and chest tightness which are confirmed by spirometry showing obstructive pattern and reversibility to bronchodilators. In individuals having features of bronchial asthma but normal spirometry, demonstration of BHR with bronchial challenge test (direct or indirect) confirms/ rules out the diagnosis. The aim of this study was to assess BHR in patients (methacholine challenge) with a history suggestive of bronchial asthma but normal spirometry and its role in diagnosis of bronchial asthma. METHODS: This study was conducted at tertiary care respiratory center. Patients having clinical features of bronchial asthma but spirometry not confirming obstructive disorder and or reversibility were included in the study. After written consent, methacholine challenge test with methacholine chloride and exercise spirometry was done in all patients as per the American Thoracic Society protocol. RESULTS: A total of 50 (n) patients were included in the study. Among them, 42 patients had clinical features suggestive of bronchial asthma but having normal spirometry and eight patients were diagnosed as they had bronchial asthma in the past but asymptomatic and off drugs were included in the study. At PC20 4mg/ml 32 (64%) patients had a positive test, 28(66%) symptomatic patients and four (50%) asymptomatic asthmatics. There were no significant side effects with methacholine test. CONCLUSION: Airway hyper-responsiveness is an important aspect of bronchial asthma and its demonstration with bronchial challenge (direct and indirect) test is an important diagnostic tool. Methacholine challenge test is a safe procedure to perform under supervision.

Management of primary pulmonary alveolar proteinosis: A multicentric experience.

BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by alveolar accumulation of surfactant material with reduced lung function and resulting hypoxemia. It is characterized by a variable clinical course, and whole lung lavage (WLL) is the standard treatment. Herein, we report our multicentric experience of management of primary PAP. MATERIALS AND METHODS: This retrospective study included patients with PAP managed at various armed forces respiratory centers from 2009 to 2019. The diagnosis of primary PAP was based on histopathologic confirmation on transbronchial lung biopsy or open lung biopsy and absence of causes of secondary PAP. We analyzed the response to WLL in these patients as well as the safety of the procedure. RESULTS: During the above-specified period, ten patients with a diagnosis of PAP were admitted to various armed forces respiratory centers. The median age of the patients was 34.5 years (range 23-59); there were nine males (90%). The mean duration (± standard deviation) of symptoms was 10.8 (±2.70) months. For management, WLL was done for eight patients with a median volume of 23.5 L (range 18-45) per patient. All the patients showed significant symptomatic response as well as improvement in physiological parameters with no major complications. The median follow-up of all patients was 18 (range 5-44) months. CONCLUSIONS: WLL is a safe, effective therapy in an experienced setting in patients with PAP and provides long-lasting benefits.

Electrical injury: an unusual cause of pneumothorax and a review of literature.

Electrical injuries are a common occurrence and can be minor or even fatal depending on the voltage to which an individual has been exposed to. Electrical current causes tissue damage by producing heat due to local tissue resistance. Serious electrocution may manifest with cutaneous burns, visceral injuries, organ perforation, and cardiac and respiratory effects. Pneumothorax as a complication of electrical injury is a very rare entity. We report one such case of electrical burn injury with right-sided pneumothorax as an immediate complication.

Artesunate-Induced Severe Autoimmune Hemolytic Anemia in Complicated Malaria.

Autoimmune hemolytic anemia (AIHA) is a very rare cause of anemia in a case of malaria and drug-induced AIHA is even rarer. A 50-year old patient with a history of fever for 8 days was diagnosed with a case of complicated malaria with mixed infection having initial parasite index of 45%. He showed good response on initial therapy with artesunate (parasite count reduced to <1%) but his haemoglobin (Hb) continued to drop from 12 g% to 4.9 g% over a course of 11 days. Direct coombs test was positive with reduced haptoglobin and increased lactate dehydrogenase suggesting AIHA. The patient was put on steroids and transfused with saline washed O-negative blood. He gradually recovered over 8 weeks with Hb level rising up to 12 g%. This is a rare case of AIHA following treatment of severe malaria with parenteral artesunate suggesting of the drug immune-related mechanism.

Junctional Rhythm: A Rare Sign in Leptospirosis.

Leptospirosis is an important re-emerging infectious disease. Leptospirosis has been estimated to affect tens of millions of humans annually with a case fatality rate ranging from 5% to 25%; however, it is underreported due to the lack of clinical suspicion and barriers to diagnostic capacity. A 33-year-old healthy male presented with a history of fever of 2-day duration. His examination revealed icterus. His workup did not show any significant findings except for a mild transaminitis and a rise in serum creatinine by 0.5 mg/dl. Later, the patient developed bradycardia. An ELISA test for Leptospira antibodies was positive. The patient recovered after a course of intravenous antibiotics. Leptospirosis should be considered early in the diagnosis of any patient who presents with acute, nonspecific febrile illness with multiorgan involvement. Our case had an atypical presentation with involvement of the cardiovascular system in the form of junctional rhythm.

Thoracic Sarcoidosis: Imaging with High Resolution Computed Tomography.

INTRODUCTION: Sarcoidosis is a disease of unknown aetiology that primarily affects the lungs. Clinical and radiological findings with demonstration of non caseating granulomas on pathology is utilised for diagnosing the disease. AIM: To assess and evaluate the features of thoracic sarcoidosis on High Resolution Computed Tomography (HRCT) chest. MATERIALS AND METHODS: A total of 40 (31 males and 9 females) cases of pulmonary sarcoidosis in a period of three years were included in this study. Patients underwent detailed clinical evaluation, imaging, Pulmonary Function Tests (PFT) and pathological confirmation of disease. Chest radiograph was obtained in all patients. HRCT was done on 16 slice Computed Tomography (CT) using 1 mm slice thickness and high spatial frequency algorithm for image re-construction. Images were viewed and evaluated using appropriate lung and mediastinal windows. The lymph nodes were classified as hilar and mediastinal with Maximum Short Axis Diameter (MSAD) more than 10 mm taken as cut-off for enlargement. Pulmonary opacities were classified as nodules (micronodules 1-4 mm and macronodules >5 mm), reticular opacities, fibrotic lesions, ground glass opacities and consolidations. Nodule distribution classified as perilymphatic centrilobular and random. Repeat scanning done on follow up or as clinically indicated. RESULTS: A total of five patients had Stage I disease, 24 patients had Stage II disease, eight patients had Stage III disease and three patients had stage IV disease. Mediastinal lymphdenopathy present in 29 patients. Bilateral hilar adenopathy was the predominant pattern seen in 22 patients. Lung parenchymal lesions excluding end stage disease noted in 32 patients. The characteristic HRCT lung parenchymal involvement of micronodules with a perilymphatic distribution was seen in 26 patients. HRCT features of predominant upper and middle lobe distribution seen in majority of patients. Documented atypical lesions and the characteristic features of end stage lung disease on HRCT noted in a small subset of patients. HRCT was superior to chest radiography for evaluating the features, pattern and distribution of the parenchymal lesions and mediastinal lymph nodes, for assessing the stage and activity of the disease and in aiding detection of subtle parenchymal lesions which are liable to be missed on conventional imaging. CONCLUSION: Thoracic sarcoidosis can have varied presentations. HRCT is superior to conventional CT for the detection and characterisation of the lung parenchymal lesions.

Pulmonary sarcoidosis: An important differential diagnosis in transbronchial lung biopsies.

BACKGROUND: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Lungs and lymphatics are the principal sites affected by this disease. The disorder is often not suspected by physicians. MATERIALS AND METHODS: This was a retrospective study done on 140 transbronchial lung biopsies received for histopathological examination in the Department of Pathology for 1 year in a multispeciality tertiary care hospital, in Delhi. RESULTS: Out of 140 transbronchial lung biopsies studied, 13 cases of sarcoidosis were diagnosed histopathologically. In these patients a clinical, pathological, and radiological corelation was done. And a final diagnosis of sarcoidosis was given after excluding other granulomatous lesions. CONCLUSION: Transbronchial lung biopsies have become an important tool in the diagnosis of sarcoidosis in present time. Hence sarcoidosis should be considered as a differential diagnosis when dealing with granulomatous lesions in lung biopsies.