Squat-to-stand test in functional assessment of stable chronic obstructive pulmonary disease patients.

BACKGROUND: Assessment of functional status is vital for proper therapy and rehabilitation programs in chronic obstructive pulmonary disease (COPD) patients. Traditionally, 6 min walk test (6MWT) has been used but it by itself may not reflect the total functional status in these patients as it poorly correlates to the disease severity. A sit-to-stand test (STST) has been proposed as a better alternative to 6MWT but to test their ability to stand from the squatting position, i.e., a squat-to-stand test (SqTST) will be more appropriate in rural patients. MATERIAL AND METHODS: All patients, diagnosed to have stable COPD, after exclusion of asthma and other respiratory or nonrespiratory diseases were evaluated by applying 6MWT, STST, and SqTST in them. Data so obtained were statistically analyzed. RESULTS: Ninety patients and twenty healthy controls were studied. Sixteen, 24, 23, and 27 of the patients were classed as COPD risk category A, B, C, and D, respectively. The mean post bronchodilator forced expiratory volume in 1st second (PB FEV1) and body mass index (BMI) were significantly lower in category D as compared to the rest. The cutoff values for 6MWT, STST, and SqTST were derived as 184M, 11, and 07, respectively. 6MWT correlates poorly to disease severity (P = 0.109) but there was a strong correlation between disease severity and SqTST and STST (P = 0.000). CONCLUSION: SqTST is a feasible and effective tool to assess functional status of COPD patients residing in rural areas. BMI is an important surrogate marker of the functional status in these patients.

Study of factors influencing response and outcome of Cat-IV regimen in MDRTB patients.

BACKGROUND: CAT IV regimen or the standardized drug regimen (SDR) under the Revised National Control Program (RNTCP) uses six second-line anti-tubercular drugs in the initial intensive phase (IP). These drugs have many side effects and toxicity; they are less efficacious and have poor acceptability. The present study was conducted to evaluate the efficacy and outcome of Cat-IV regimen and the factors which influence the treatment outcome in MDR TB patients. METHODS: It was a prospective observational study, which was done in the CAT II treatment failure, LPA proven MDR TB patients, above the age of 18 years, who were referred to DOTS Plus center for treatment. The study was approved by the hospital ethics committee and patient consent was obtained before inclusion. RESULTS: We observed culture conversion in 63.04% and ADR in 96.5%, default in 15.65%, and death in11.3% cases. The factors which influenced outcome included low body weight, long duration of illness cavitatory disease and indulgence in both tobacco & alcohol. The radiological favorable response strongly and significantly correlated with the bacteriological and clinical response during the IP. CONCLUSION: We suggest that the efficacy can be further augmented by reducing default and controlling deaths which accounts for substantial numbers and occur mostly during IP.

Pulmonary Vasculitis: Indian Perspective.

Pulmonary vasculitis is an uncommon disease. Patients present with unexplained haemoptysis, pulmonary infiltrates and constitutional symptoms. Pulmonary vasculitis often goes undiagnosed due to lack of awareness and the disease is often mis-diagnosed as tuberculosis in India. Delayed or missed diagnosis leads to disease progression to a catastrophic event like diffuse alveolar haemorrhage which carries a high mortality. The outcome of appropriately treated cases, on the contrary, is good with excellent long-term survival. The present narrative review attempts to provide an overview of pulmonary vasculitis as it is seen in India.

CA lung presenting with vasculitis.

A 67 year old man presented to us with petechial skin rash and blebs on the legs. He was on anti-tuberculous treatment for right sided pleural effusion since 1 month. A provisional diagnosis of Rifampicin induced drug rash was made and his effusion reaspirated and sent for AFB and cytology. The pleural fluid cytology demonstrated metastasis of adenocarcinoma and biopsy of skin lesion confirmed vasculitis. There was no thrombocytopenia. CT thorax showed right lower lobe mass with right sided pleural effusion. Thus a final diagnosis of skin manifestation of carcinoma of lung was made. This was a Paraneoplastic syndrome.

Recurrent massive pleural effusion with neurosarcoidosis: a rare presentation of sarcoidosis.

49 year old female, a known case of thalassemia minor with hypothyroidism on treatment, presented with left sided massive pleural effusion. Pleural tapping revealed exudative effusion and she was started on four drug AKT. She had recurrent pleural effusions and required repeated aspirations. Thoracoscopic pleural biopsy revealed non caseating granulomas. She continued to deteriorate after 8 months of AKT and was readmitted with severe vomiting, ataxia, diplopia, weakness and weight loss. Investigations revealed miliary pattern on CXR and multiple granulomatous lesions in the brain on MRI. She responded to treatment with high dose corticosteroids. We are presenting this case to highlight sarcoidosis as one of the causes of large pleural effusion.

Bloom syndrome with lung involvement.

We report a case of a 24-year old male presented with cough and breathlessness with diabetes mellitus and diagnosed as a case of bloom syndrome. He was a product of consanguineous marriage, having short stature, dolicocephaly, polydactyly, prominent nose with telangiectasia face. The respiratory system examination revealed bilateral coarse crepitations and wheezes and the chest X-ray revealed emphysema with right middle zone inhomogenous opacity. Also, CT thorax examination revealed bilateral cystic bronchiectasis with bronchiolitis obliterans. Bloom's syndrome was diagnosed on the basis of clinical features.

Idiopathic pulmonary fibrosis with bronchogenic carcinoma.

Idiopathic pulmonary fibrosis is essentially a benign disease. We present a case of 65-year-old female patient who presented with left-sided chest pain and breathlessness. Her CT thorax revealed idiopathic pulmonary fibrosis along with a left-sided pleural-based mass. Biopsy of the mass revealed a squamous cell carcinoma. She was exposed to home wood smoke while cooking on the chulla for many years, which was possibly responsible for both the diseases.

Haemoptysis - a rare presentation of aortic ane urysm.

We report a case of a 65 year old man who presented with haemoptysis. X-ray chest PA view shows mediastinal widening suggestive of mediastinal mass. A CT scan of thorax shows a large aneurysm of ascending aorta & arch of aorta. This an-eurysm is eroding the trachea and abutting the sternum and vertebrae.The patient is VDRL reactive. Haemoptysis is a rare presentation of aortic aneurysm.