Role of Screening Lung Function Tests in a Routine Health Checkup.

Background and objectives The lung function test is a gold standard, guideline-recommended test to detect obstructive airway diseases like asthma and COPD. It is of considerable value in detecting the presence and severity of airflow obstruction in patients with respiratory symptoms. However, the role of spirometry in a routine health checkup is controversial. Spirometry, when used in routine health checkup settings as a case-finding tool for all adults with persistent respiratory symptoms or having a history of exposure to risk factors, is likely to label a relatively large proportion of individuals as diseased with airflow obstruction. Conversely, spirometry is normal in a relatively large percentage of adults who report respiratory symptoms including dyspnea, the respiratory symptom having the greatest impact on quality of life. The objective of this study is to determine the utility of spirometry as a screening test to detect airflow obstruction in otherwise healthy subjects undergoing a routine health checkup. Methods This observational study was conducted with 538 health checkup individuals aged 18 and over. A brief history was taken prior to the test. Lung function tests were performed and interpreted as per the Global Initiative for Chronic Obstructive Lung Disease criteria. The anthropometric and spirometric data obtained were compared to other population-based spirometric studies to compare the prevalence of airflow limitation, the risk factors, and smoking history. Results Of the total 538 subjects incorporated in the study, 305 (57%) were males and 233 (43%) were females aged between 18 to 80 years with a mean age of 45 years. The male-to-female ratio was 1.3:1 with a mean BMI of 25.9. The overall yield from lung function tests in detecting airflow obstruction was 63 subjects (11.7%), of which 36 (11.8%) were males and 27 (11.5%) were females. Seventy-three subjects (13.5%) were classified as having a small airway obstruction, of which 34 were males (46.6%), and 39 were females (53.4%). The distribution of airflow obstruction by age was with eight subjects (5.4%) in the 18-35 group, 21 subjects (7.8%) in the 36-55 group, and 34 (25%) in the elderly (>55) age group. Although overall smoking history showed no significant association with developing airflow obstruction, significant association with smoking was found in the elderly (>55) age group. Interpretation and conclusions The results of the study suggest that lung function tests should be included in routine health checkups in the subset of individuals greater than 35 years of age with or without a history of smoking, in all age groups with a family history of asthma, in individuals with respiratory symptoms and in individuals greater than 55 years of age with a moderate history of smoking.

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.

Virtual bronchoscopy in the era of multi-detector computed tomography: Is there any reality?

Virtual bronchoscopy, in conjunction with axial and MPR MDCT images, can enhance diagnostic accuracy of tracheo-bronchial endoluminal pathologies. We describe a few cases highlighting the utility of virtual bronchoscopy in the diagnosis of varied tracheo-bronchial pathologies encountered in the setting of a tertiary care Armed Forces Hospital of India.

Chronic cough.

Chronic cough is often viewed as a difficult clinical problem. It can be physically and psychologically debilitating, occasionally leading to serious complications. Although there are many etiologies, an organized approach including focused history and physical examination, directed testing in select cases, and treatment trials lead to accurate, safe, and cost-effective diagnoses in most patients. Additional symptomatic treatment is frequently beneficial. Occasionally, diagnostic dilemmas, treatment failures, or more serious causative disorders necessitate referral for further testing and management.

Markers for differentiation of tubercular pleural effusion from non-tubercular effusion.

BACKGROUND: The limitations of the conventional methods for diagnosing tuberculosis (TB) have spurred multi-faceted research activities throughout the world. This study aims to explore the levels of adenosine deaminase (ADA) and interleukins in pleural effusion of tuberculous, malignant, and miscellaneous origin for differential diagnosis of tubercular and non-tubercular effusion. METHOD: Adenosine deaminase was estimated by kinetic method employing xanthine oxidase while interleukins were measured using commercially available ELISA kits in pleural fluids of tubercular and non-tubercular origin. RESULTS: Pleural fluids INF-γ, sIL-2R, TNF-α and ADA were significantly higher in TB group (n = 48) as compared to the non-TB group (n = 33) (mean ± SD: INF-γ; 1,958.7 ± 896.5 pg/mL vs 356.9 ± 733.6 pg/mL, sIL-2R; 6,101 ± 1,753.8 pg/mL vs 3,166 ± 2,611.1 ± pg/mL, TNF-α; 195.5 ± 292.1 pg/mL vs 59.7 ± 128.9 pg/mL, ADA; 123.6 ± 81.8 IU/L vs 48 ± 48.5 IU/L, P < 0.01). CONCLUSION: INF-(is more sensitive and specific than ADA for the diagnosis of TB and should be added to the armamentarium of the diagnostic workup of pleural fluids for timely and accurate diagnosis of TB and differentiation of tubercular pleural effusion from non-tubercular effusion.

Oesophageal carcinoma--a study of risk factors (emphasis on nutrition) in a teaching hospital of Kumaon region of Uttarakhand.

BACKGROUND: Cancer oesophagus is common in India and is the third leading cause of cancer death in males and fourth in females. Various factors are responsible for it and present study was undertaken to study the various risk factors with stress on nutritional factors associated with it. METHODS: Ninety-four cases of oesophagus cancer and matched equal number of healthy individuals (control) constituted the study. They were assessed for their dietary pattern during the preceding 10-15 years with the help of standard food frequency questionnaire method. Information regarding consumption of alcohol, smoking and tobacco chewing with or without betel leaf was taken in detail. RESULTS: Seven hundred and eighty upper GI endoscopy revealed 94 (12.05%) cases of oesophageal carcinoma. Histopathology revealed squamous cell carcinoma in 87 cases (92.50%), adenocarcinoma in 6 cases (6.30%) and one with mixed picture of adenocarcinoma and squamous cell carcinoma. Sixth (36.17%) and 7th (23.40%) decade of persons were mainly affected with male to female ratio of 2.1:1. They were mostly of lower socio-economic (82.90%) status. Various risk factors came across were less consumption of green and leafy vegetables and fruits and consuming more spicy fried and hot food and beverages. Increased risk was seen more often with consumption of alcohol (neat and without or less salad and snacks), smoking beedi and cigarette, and tobacco chewing with or without betel leaf. It is directly related to amount, frequency, mode and duration of use. CONCLUSIONS: Malignancies in general are result of multiple factors and interaction of several environmental factors. One factor cannot be blamed but combination of factors increases the risk of oesophageal carcinoma. Nutritional factor is also one of the major contributing factor increasing the risk of oesophagus cancer.

Metal concentrations in water, sediment, and fish from sewage-fed aquaculture ponds of Kolkata, India.

The concentrations of lead, cadmium, chromium, copper, and zinc were investigated in the sewage-fed pond water, sediment, and the various organs of Labeo rohita, Catla catla, Cirrhinus mrigala, Oreochromis mossambicus, and Cyprinus carpio cultured in sewage-fed ponds, Kolkata, India. Among the metals, cadmium, lead, and zinc were detected in water and, except lead, were below the water quality guideline levels for the protection of freshwater aquatic life proposed by CEQG (Canadian Environmental Quality Guidelines) and AENV (Alberta Environment). Therefore, lead could pose danger to aquatic organisms. All the five metals were detected in the sediment and, except cadmium and lead, were below the sediment quality guideline levels for aquatic life proposed by EPA (Environmental Protection Agency). Therefore, these two metals could be toxic to aquatic organisms. Significant (P > 0.05) differences were observed among the five fish species for all these metals accumulation. Also, significant (P > 0.05) differences were noticed among these metals accumulation in fish organs. Cadmium showed the least bioaccumulation, while zinc showed the highest bioaccumulation in all the fish species. Though the metal concentration in the different fish tissues was variable, the highest concentration was found in kidney and the lowest in the muscle. Concentrations of these metals in the muscle tissue of all the fish species were well below the consumption safety tolerance in fish set by WHO/FAO, and thus, so far as these metals are concerned, these sewage-fed cultured fishes are safe and suitable for human consumption.

Therapy for Cessation of Smoking.

Tobacco dependence is a chronic relapsing medical illness. Unfortunately more than 1.1 billion people worldwide smoke tobacco. Tobacco consumption rate is very high in India. Providing three minutes counseling by physicians doubles the cessation rate as compared to no intervention. Nicotine replacement products (gums, transdermal patch, nasal spray, inhaler and lozenge), bupropion and varenicline used with counseling by physicians double the cessation rates at one year. There are drugs like buspirone, naltrexone, mecamylamine and silver acetate; some of which either alone or in combination with any of the above drugs may be routinely used in near future for smoking cessation in at least some specific groups of population. The most difficult problem for patients in smoking cessation is withdrawal symptoms. Counseling with continuous support from physician, family members, friends and overall from the society will help in achieving a higher rate of smoking cessation, with the final aim of making ours a tobacco smoke-free world for future generations.

Flexible Bronchoscopy in the Evaluation of Mediastinal and Hilar Lymphadenopathy.

BACKGROUND: The diagnosis in cases of mediastinal and/or hilar lymphadenopathy with no lung parenchymal involvement is often difficult. We undertook this study to assess the diagnostic value of flexible bronchoscopy (FOB) especially transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) in these patients. METHODS: Forty eight patients with hilar and/or mediastinal lymphadenopathy without any parenchymal lung lesions, managed between 2000 to 2004 at a tertiary care centre who underwent FOB were evaluated retrospectively. RESULTS: Out of 48 patients, FOB showed widening of carina in six, widening of secondary carina in four, bulge in airways because of extrinsic compression in seven and endobronchial nodule in two patients. It was normal in rest 29 patients. TBNA was done in all patients and TBLB in 13 patients where clinico-radiologic findings were consistent with stage 1 sarcoidosis. FOB established diagnosis in 18 patients (caseating granuloma in eight, noncaseating granuloma in nine, and AFB culture positive in one). It was inconclusive in other patients. One patient developed pneumothorax requiring intercostal tube drainage. CONCLUSION: FOB especially TBNA has an important role in the diagnosis of hilar and mediastinal lymphadenopathy and should be considered before other invasive procedures.

Best Treatment Guidelines For Bronchial Asthma.

Asthma is a common disease worldwide with significant ethnic and regional variations. An increasing morbidity and mortality, as well as health care burden from asthma have been recognized lately. Several evidence based guidelines have been developed with an aim to standardize and improve the quality of management. These guidelines seek to translate the advances in the understanding of pathogenesis of asthma and in the development of new agents and strategies into practical application at all levels of healthcare. These advocate an assessment of the patients to classify the severity of diseases followed by a step-wise approach to treatment. With the current management we hope to achieve minimum or nil day time and night time symptoms, prevent acute exacerbations and attain normal or near normal lung function, thus improving the overall quality of life.

Water quality aspects of some wells, springs and rivers in parts of the Udhampur District (J & K).

Water samples were collected from wells (9 Nos.), springs (11 Nos.) and rivers/streams (6 Nos.) during pre and post monsoon seasons in the months of June and October 1999, respectively. Various physico-chemical parameters and trace elements (viz., Cu, Mn, Zn, Co, Fe, Ni, Cr and Pb) were analysed to evaluate drinking water quality on the basis of BIS and irrigation water quality on the basis of salinity, sodicity, residual sodium carbonate, and concentration of toxic elements. The study showed alkaline nature of surface and ground water. Calcium and magnesium are dominating cations and bicarbonate is major anion in the study area. At some locations the concentration of TDS, Mg, Ca, total hardness, Fe, Mn and Cr exceeded the limits set up for drinking purposes. Water quality evaluation for irrigation purposes on the basis of SAR values indicates excellent category of water.

Pulmonary Hydatid : Diagnosis and Response to Hypertonic Saline Irrigation and Albendazole.

BACKGROUND: Pulmonary hydatid is caused by larval stage of parasite Echinococcus granulosus. Although surgery still remains the definitive therapy, various workers have tried albendazole and sterilization of cysts with varying result. METHODS: 32 patients(21 males, 11 females) of pulmonary hydatid disease with average age 32.5 years(21-51 years) treated by us between Jan 97 to Apr 2001 were analysed. Diagnosis was established clinically, radiologically and by serological testing. 16 patients who had simple cyst were treated with 20 ml percutaneous hypertonic(20%) saline irrigation of the cyst along with albendazole (400 mg twice a day, 6 cycles of 4 weeks with 2 weeks drug free period between the cycles). 13 patients of complicated cysts were treated with 6 cycles of albendazole. All cases were followed up for one year. 16 patients including three fresh cases were subjected to surgical resection. RESULTS: Pleural involvement was noted in 10 patients. On chest radiography 19 patients had homogenous oval or circular cysts, 6 patients had crescent sign and 10 had water lily sign. After percutaneous hypertonic saline irrigation all patients showed initial regression in size and developed complicated cysts with water lily sign but subsequently there was no regression. Of 13 patients treated with albendazole, 3 patients showed complete resolution and 2 patients showed regression of cyst. All these 5 patients had shown regression during first cycle of albendazole. 16 patients were subjected to surgery (6 after saline irrigation, 7 after albendazole course and 3 fresh cases). No difference was noted in these groups on histopathological examination. CONCLUSION: From this study it was evident that those patients who demonstrate regression in size during first cycle of albendazole are likely to benefit and improve with further cycles of it. Those who do not respond should be subjected to surgery. Result of percutaneous hypertonicsaline irrigation as scolicidal was not encouraging.