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BACKGROUND: Individualised treatment regimens for drug resistant tuberculosis have improved outcomes. This retrospective observational study examined potential factors that affect individualised treatment in an endemic region, and highlighted predictors of a successful outcome. METHODS: We examined records of proven MDR, pre-XDR and XDR TB patients diagnosed and started on treatment between 2010 and 2014, and collected the following data for each patient: age, gender, comorbidities, past history of TB, diagnosis, site of disease, drug susceptibility testing (DST) results, treatment, adverse reactions to anti-tubercular drugs, treatment changes and outcomes, which were recorded as positive, negative or neutral. Tests of association were carried out between factors and outcomes, following which multiple logistic regression analysis was done to determine the predictors of a positive outcome such as patient cured after completion of treatment at 18 months or longer. RESULTS: Fifty-nine patients completed treatment at our centre. The median age was 26 years (range 8-65 years). There were 31 (52.5%) female patients. Forty-four (74.6%) were successfully treated over a median treatment period of 23 months (range 18-30 months). Successful outcomes were associated with age less than 45 years (P=0.01, OR=6.67, 95% CI=1.73-23.47), resistance to fewer than five drugs (P=0.001, OR=9.51, 95% CI=2.50-38.18) and susceptibility to Group 4 drugs (P=0.04, OR=4.71, 95% CI=1.03-16.83). CONCLUSIONS: Age and drug susceptibility were important predictors of treatment outcome.
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Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Idoso , Criança , Doenças Endêmicas , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Medicina de Precisão , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto JovemRESUMO
BACKGROUND: Individualized treatment for multidrug-resistant tuberculosis (MDR TB) is associated with improved outcomes. Therapy needs to be tailored to drug susceptibility testing (DST) results. We present our observations on the inconsistency in DST reporting in an endemic region with a high prevalence of MDR TB. METHODS: We retrospectively analyzed 118 DST reports from 10 different laboratories. OBSERVATIONS: Of 118 patients, only 79 (67%) had DST reports with results to all first-line drugs, a fluoroquinolone (excluding ciprofloxacin), all aminoglycosides, and a polypeptide. Twenty-one (18%) isolates did not have DST reports for all first-line drugs; 4 (3%) did not have DST reports for any second-line drugs; 9 (8%) did not have DST reports for a fluoroquinolone; and 31 (26%) did not have DST reports for all second-line aminoglycosides and polypeptide. CONCLUSION: Inconsistencies were observed in several of the 118 DST reports. A case is made for sensitization toward standardization and completeness in TB DST reporting in India.
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Lung cancer is the leading cause of cancer deaths worldwide, and around 75% to 80% of lung cancers are detected in advanced stage. Multiple genetic mutations are identified and reported in adenocarcinoma of the lung. Various pulmonary samples can be tested for molecular mutations in lung cancer. However, feasibility of molecular profiling of pleuroscopic pleural biopsies in lung adenocarcinoma is not reported. We describe a case of advanced adenocarcinoma of lung with positive anaplastic lymphoma tyrosine kinase mutation on pleuroscopic pleural biopsy and improved with oral crizotinib. The current case highlights the feasibility of pleuroscopy.-guided pleural biopsies in molecular profiling of lung adenocarcinoma.
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Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Pleura/patologia , Receptores Proteína Tirosina Quinases/genética , Toracoscópios , Adenocarcinoma/terapia , Adenocarcinoma de Pulmão , Quinase do Linfoma Anaplásico , Biomarcadores Tumorais , Biópsia , Terapia Combinada , Receptores ErbB/genética , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/terapia , Pessoa de Meia-Idade , Mutação , Radiografia Torácica , Receptores Proteína Tirosina Quinases/metabolismo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Pure endobronchial neoplasms are a rare entity, and they may present with diverse pathological findings. Malignant diseases are more common than benign ones, and they mostly originate from the surface epithelium. Endobronchial tumors usually present with symptoms such as cough, hemoptysis, recurrent pneumonia, wheezing, and chest pain. Flexible bronchoscopy is necessary for diagnosis and evaluation of these endobronchial tumors. Advance bronchoscopy or definitive surgery is the modality of treatment for these tumors based on the presentation. We present a case series of patients suffering from different rare endobronchial tumors and their management along with the review of literature.
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Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgia , Broncoscopia , Adulto , Biomarcadores , Biópsia , Broncoscopia/métodos , Gerenciamento Clínico , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Parasite infections are increasing worldwide due to increasing migration and traveling. Parasitic infections can affect lungs and present as a focal or diffuse lung diseases. High index of suspicion and detailed history are most important. We present a case of interstitial pneumonitis caused by parasite infestation, which was diagnosed on transbronchial lung biopsy.
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INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the initial modality of choice in sampling mediastinal lymphadenopathy. It is possible to obtain both cytological and histological samples using both 21-gauge and 22-gauge EBUS-TBNA needles. The current study was undertaken to compare the diagnostic yield of cytology and histology samples obtained by the same EBUS-TBNA 21-gauge needle. PATIENTS AND METHODS: One hundred sixty-six consecutive patients who underwent EBUS-TBNA with a 21-gauge EBUS-TBNA needle over a period of 3 years were included in this retrospective analysis. The diagnostic yields of EBUS-TBNA histology (EBUS-TBNA-H) and EBUS-TBNA cytology (EBUS-TBNA-C) specimens were compared using the McNemar test. RESULTS: The overall sensitivity and specificity of EBUS-TBNA were 89% and 100%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of EBUS-TBNA were 100% and 53%, respectively. The overall sensitivity and specificity of EBUS-TBNA-H were 85% and 100%, respectively. The PPV and NPV of EBUS-TBNA-H were 100% and 43%, respectively. The overall sensitivity and specificity of EBUS-TBNA-C were 65% and 100%, respectively. The PPV and NPV of EBUS-TBNA-C were 100% and 14%, respectively. The diagnostic yield of EBUS-TBNA-H over EBUS-TBNA-C was statistically significant (P < 0.0001). CONCLUSION: EBUS-TBNA-H with 21-gauge needle significantly improves the diagnostic yield of EBUS-TBNA. EBUS-TBNA-H improves the NPV of EBUS-TBNA. The combination of EBUS-TBNA-H and EBUS-TBNA-C improves the overall diagnostic yield of EBUS-TBNA.
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Biópsia com Agulha de Grande Calibre , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Linfonodos/patologia , Mediastino/patologia , Adolescente , Adulto , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Criança , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Humanos , Doenças Linfáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Lung cancer is one of the most prevalent types of cancer in the world. A complete diagnosis of lung cancer involves tissue acquisition for pathological subtype, molecular diagnosis and accurate staging of the disease to guide appropriate therapy. Real-time endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is minimally invasive and relatively safe procedure, which can be done on an outpatient basis under moderate sedation. EBUS-TBNA has been shown to be a safe modality to obtain tissue for diagnosis, staging and molecular profiling in lung cancer. EBUS-TBNA stands out in comparison with other modalities for tissue acquisition in lung cancer. EBUS-TBNA performed with the patient under moderate sedation yields sufficient tissue for sequential molecular analysis in most patients. In this review, we describe the role of EBUS-TBNA in various aspects of diagnosis and staging of lung cancer in the present era along with its future aspects.
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Broncoscopia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Pulmonares/patologia , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Broncoscópios , Broncoscopia/instrumentação , Sedação Consciente , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Desenho de Equipamento , Humanos , Neoplasias Pulmonares/química , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/terapia , Técnicas de Diagnóstico Molecular , Estadiamento de Neoplasias , Valor Preditivo dos TestesAssuntos
Ciclofosfamida/uso terapêutico , Neoplasias Laríngeas/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisolona/uso terapêutico , Vincristina/uso terapêutico , Idoso , Antineoplásicos Fitogênicos/uso terapêutico , Broncoscopia , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Neoplasias Laríngeas/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Mediastinal lymphadenopathy in patients with malignancy may not be always metastatic disease. We present three patients with proven thoracic or extra thoracic malignancies with mediastinal lymphadenopathy which were subsequently proven as granulomatous lymphadenitis by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). The objective of the current report is to emphasise that granulomatous lymphadenitis should be considered as an important differential diagnosis in such patients especially in tuberculosis endemic countries like India.
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Adenocarcinoma/patologia , Neoplasias Pulmonares/patologia , Metástase Linfática/patologia , Neoplasias Ovarianas/patologia , Tuberculose dos Linfonodos/patologia , Tuberculose Pulmonar/patologia , Adulto , Idoso , Biópsia , Diagnóstico Diferencial , Diagnóstico por Imagem , Feminino , Humanos , Índia , Linfonodos/patologia , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
This is a case report of a young adult presenting with hemorrhagic pleural effusion. Chest CT scan showed loculated pleural effusion with pleural nodule. Whole body PET scan showed thickening of pleura with multiple enhancing pleural nodules with different metabolic activity. Pleural nodule was biopsied which on histopathology showed pleural synovial sarcoma.
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Neoplasias Pleurais/patologia , Sarcoma Sinovial/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Humanos , Masculino , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/tratamento farmacológico , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/diagnóstico , Biópsia por Agulha Fina/métodos , Broncoscopia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/secundário , Mediastino/diagnóstico por imagem , Sarcoidose/diagnóstico , Sarcoidose/diagnóstico por imagem , Tuberculose/diagnóstico , Tuberculose/diagnóstico por imagem , UltrassonografiaAssuntos
Neoplasias Brônquicas/cirurgia , Broncoscopia/métodos , Tumor Carcinoide/cirurgia , Lasers Semicondutores/uso terapêutico , Pulmão/cirurgia , Adulto , Neoplasias Brônquicas/diagnóstico , Tumor Carcinoide/diagnóstico , Humanos , Pulmão/patologia , Masculino , Terapia Neoadjuvante , Toracotomia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Transcutaneous measurement of carbon dioxide is routinely done at the earlobe site. In patients receiving non invasive ventilation or in the intensive care setting with necklines, an alternate measurement site would be useful. We started to use the infraclavicular site for transcutaneous measurements of carbon dioxide using a new digital sensor. AIM: Comparison of transcutaneous carbon dioxide with arterial carbon dioxide at the infraclavicular site. METHODS: We retrospectively compared transcutaneous carbon dioxide at the infraclavicular site with arterial carbon dioxide in 50 samples. The Sentec Digital Monitoring System (Sentec AG, Therwil, Switzerland) was used. The V-Sign digital sensor was placed on the infraclavicular site at the medial two third and one third point from the sternoclavicular joint and acromioclavicular joint. RESULTS: When comparing P(c)CO(2) with P(a)CO(2) values, the Bland-Altman analysis revealed a bias of 0.02 kPa (95% CI: [- 0.1; 0.14]) with a precision of 0.42 kPa. Linear regression analysis describes the relationship between the two methods. The slope of the linear model was 0.85 ± 0.04 and the intercept was 0.77 ± 0.21 (RSE = 0.37, R(2) = 0.91). CONCLUSION: The measurement of transcutaneous carbon dioxide at the infraclavicular site is feasible with a digital sensor and has a good correlation with the carbon dioxide values obtained from the arterial blood gas. The findings of the current study form the basis for further clinical studies for its regular application in clinical use.
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Monitorização Transcutânea dos Gases Sanguíneos/métodos , Clavícula/metabolismo , Clavícula/irrigação sanguínea , Cuidados Críticos , Humanos , Modelos LinearesRESUMO
We report a case of interrupted inferior vena cava (IVC) as a rare developmental defect. Inferior vena cava interruption is usually accompanied with azygos and hemiazygos continuation, and is asymptomatic. Consequently, venous blood from the caudal part of the body reaches the heart via the azygous vein and superior vena cava. A 50 year old female who came for routine health check-up was found to have pulmonary hypertension on two dimensional echocardiography. On further investigations she also had restriction on pulmonary function test. When computed tomography pulmonary angiography was done, showed dilated azygous vein without pulmonary embolism. Computed tomography of the abdomen demonstrated interrupted inferior vena cava. Such patients are at increased risk of deep vein thrombosis and pulmonary embolism.
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Veia Ázigos/anormalidades , Hipertensão Pulmonar/diagnóstico , Baço/anormalidades , Esplenopatias/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Angiografia , Veia Ázigos/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Esplenopatias/congênito , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagemRESUMO
We report a case of pulmonary carcinoid presenting as massive hemoptysis in a pregnant patient. In our patient, diagnosis of carcinoid tumor was suspected after ruling out other probable and possible causes of hemoptysis. It was confirmed provisionally on flexible fiber optic bronchoscopy and later confirmed on histopathology. Our patient had two consecutive emergency surgeries, emergency cesarean section on one day followed by emergency pneumonectomy on next day. The lives of both, the mother and baby could be saved. At three month follow up, the mother did not have any symptoms.