Neglected tracheo-bronchial foreign bodies in adults

Background: Neglected tracheobronchial foreign body in adults is quite rare in clinical practice. The present paper describes our experience of four adult patients who had chronic chest Symptoms (Cough, Chest Discomfort recurrent pneumonia) caused by foreign body inhalation, undetected for 3 months -15 years.Methods: This was a short retrospective study. Four adult patients with neglected trachaeobronchial foreign bodies which were removed in our medical college in the past 1 year were included in this short study. Case sheets were scrutinized for clinical features, X-ray findings, CT findings and bronchoscopic findings.Results: The diagnosis of foreign body was made by radiology (X-ray + CT) in 3 patients and FOB in one patient. In all 4 patients foreign body was removed by fiber optic   bronchospocopy. Endo bronchial electrocautery was used in one patient to cut the web above the FB. Foreign bodies removed were whistle top, end of IV cannula, scarf pin and maize corn.Conclusions: Study concludes that chronic, unexplained respiratory complaints should warrant further investigations to exclude foreign body and despite no history of Foreign Body and normal X-Ray, early diagnosis and intervention would avoid complications.

Pearl pin inhalation accidents: an emerging tracheobronchial challenge to surgeons

Background: The practice of wearing head scarf pin or pearl pins is very common among young Muslim girls and wrong habit of holding a number of pins in the mouth and utilize them one by one to fix the scarf leading to accidental inhalation has emerged a frequently seen entity in our practice now and managing the tracheobronchial pearl pin foreign body poses a lot more different challenges to surgeon than conventional foreign bodies. The study presented an experience with pearl pin inhalation and discussed the unique clinical characteristics of this problem and challenges in management.  Methods: A cross sectional hospital based observational study was conducted in tertiary care hospital (SMHS), department of ENT for period of 2 years August 2013 to July 2015.Results: Total of 36 (34 females and 2 males) patient were considered with mean age of 14.2 years (range 6-32 years). The average duration of reporting to our emergency department was 5 hours with delayed presentation ranging from 24 to 36 hours. In 31 patients the pin was successfully removed with rigid bronchoscope and in 2 cases fibreoptic bronchoscopy was needed, thorocotomy for more distal location was done successfully in two cases and another one gastroenterologist consultation was sought for reverse ingestion in to the abdomen.Conclusions: Pearl pins behave as floating or/are mobile in nature especially in the early phase of inhalation and initial Immediate pre-op x-rays are beneficial. The removal can encounter certain difficulties and the surgeon needs to be vigilant & skilful.

Role of fibreoptic bronchoscopy in haemoptysis: an analysis of 157 patients

Background: Objectives of this study were to define the role of fibreoptic bronchoscopy (FOB) in determining the etiology of haemoptysis, to determine whether bronchoscopy is useful in haemoptysis with normal chest x-ray, to determine whether early bronchoscopy is better than delayed bronchoscopy.Methods: This prospective study was conducted on 157 patients who presented with hemoptysis to the Department of Tuberculosis and Chest diseases. All these patients underwent FOB after taking proper history and examination and ruling out any contraindication to the procedure.Results: In patients with haemoptysis with normal CXR, a diagnosis was established in 54.5% by FOB while 38.6% had a normal bronchoscopy. An endoscopic diagnosis of bronchitis was made in 22.7% patients. In only 9.1% patients an endobronchial mass was seen on bronchoscopy, and all of them were more than 40 years of age. Active bleeding/bleeding site was localized in 18.1% patients. In patients with abnormal chest roentgenogram who underwent FOB, a definitive diagnosis was established in 75.4% cases with active bleeding/ bleeding site localized in 59.6%. Thirty five percent were having an endobronchial mass. Of all the patients who underwent FOB for recurrent haemoptysis, active bleeding/bleeding site was localized in 48.4% patients. Bleeding site was localized in 62.9% patients who underwent early FOB, while the yield was lower (29.4%) in patients who underwent delayed FOB.Conclusions: Fibreoptic bronchoscopy (FOB) is an important and useful investigation in patients of haemoptysis in determining the bleeding site and etiology of haemoptysis. Early FOB has higher yield in localizing the bleeding site than delayed FOB.

Angiographic anatomy of the coronary sinus venous system in adult Kashmiri population

Background: Knowledge of the coronary sinus venous anatomy is an important factor because of its relevance in electrophysiological procedures such as chronic resynchronisation therapy, mapping and ablation of arrhythmias. The advent of advanced invasive and interventional cardiac treatment and management tools for common disorders like heart failure has made understanding of coronary sinus anatomy necessary. The aim was to study the angiographic anatomy of coronary sinus and its tributaries in adult Kashmiri population and provide anatomical basis for cannulation of coronary sinus and its tributaries.Methods: Authors analysed the levophase angiogram of 150 subjects undergoing routine coronary angiography in the right anterior oblique and left anterior oblique view with the necessary caudal or cranial angulations.Results: The coronary sinus was formed by the union of GCV+LMV in 93.3% of subjects and by the union of GCV+PLV in 6.7% of subjects. The GCV and the MCV were the most consistent tributaries present in all the subjects. The mean length of CS was 71.70±9.7 mm when it was formed by GCV+LMV and 70.18±14.98 mm in case of GCV+PLV. The diameter of the CS ostium was 8.48±1.21mm. The mean diameter of GCV was 2.90±1.24 mm, MCV was 2.76±1.08 mm, LMV was 2.23±0.51 mm and the PLV was 2.25±0.53 mm. The opening angle of GCV was obtuse in all the cases, MCV drained at an acute angle in 62% subjects and LMV draining angle was acute in 31.33% cases. The valve of the CS was present in 32.7% subjects and absent in 67.3% subjects. The tortuosity was absent in 75.3%. The distance between CS ostium and the ostium of the vein ideal for lead implantation was between 10-40 mm in 76% subjects.Conclusions: The basic knowledge of coronary sinus and its tributaries play a significant role during electrophysiological procedures. The data obtained from the study can be utilised by interventional cardiologist for cannulation of coronary sinus in Kashmiri population

Transthoracic ultrasound guided fine needle aspiration cytology of peripheral lung lesions: an experience of a pulmonologist

Background: Ultrasound (USG) guided fine needle aspiration cytology (FNAC) is a simple and cost-effective method for the diagnosis of various peripheral lung lesions. Being radiation free and easily available in most of centres, it has become an important diagnostic modality for early diagnosis of peripheral lung lesions. Besides procedure is simple and complications if occur, can be managed by a pulmonologist effectively. This study was aimed to evaluate the role of Transthoracic ultrasound guided FNAC in diagnosis of peripheral lung lesion.Methods: This prospective observational study was conducted at Government Chest Diseases Hospital Srinagar over a period of one year from January 2018-December 2018. 61 patients who fulfilled inclusion criteria were included in this study. After properly explaining the procedure and taking informed consent, USG guided FNAC was done in patients with peripheral lung lesions under local anaesthesia. Radiological and cytological data of enrolled patients was collected prospectively and analysed.Result: About 61 patients were included in this study comprising of 39 males and 22 females in age range of 17- 90 years. Malignancy was the most common cytological diagnosis (78.57%). while as benign diagnosis was reached in 21.43%. In 8.19% of patients, FNAC was inconclusive. Among the malignant group, adenocarcinoma (47.72%) was most common cytological diagnosis. The overall diagnostic yield of USG guided FNAC in this study was 91.8%.Conclusion: USG guided FNAC of peripheral lung lesions is a simple procedure with high accuracy and less complication rate which can be performed by a pulmonologist for diagnosis

Role of danazol in management of mastalgia: a tertiary care experience from North India

Background: Mastalgia is one of the most common complains, for which women consult their general practitioner. Majority of the patients presented with fear of cancer so patient education and availability of quality radiological and pathological services are crucial in the management of patients with mastalgia. This study is aimed to assess the efficacy of danazol on cyclical and non-cyclical mastalgia.Methods: The study was conducted at Sher-I-Kashmir institute of medical sciences (SKIMS), Srinagar between January 2018 to July 2019. All the patients with mastalgia between 19 to 45 years presenting to surgical OPD were considered eligible for the study. After standard triple assessment, all our patients received 100 mg of danazol twice a day for a period of 3 months. Data was collected and analyzed.Results: All the patients with mastalgia between 19 to 45 years presenting to surgical OPD were considered eligible for the study. 72% of our patients presented with cyclic mastalgias while as 28% had non cyclic symptoms. 89.65% of patients in cyclic group had responded to cap. Danazol 100 mg twice daily and 81.81% had shown improvement in non-cyclic group. 19 of our patients had side effects due to medications.14 of our patients developed recurrence after discontinuation of medication.Conclusions: Danazol is very effective in the management of both cyclical and non-cyclical mastalgias. However, cost of the drug and side effects limits its use. Further studies are needed to examine the long-term effectiveness and sustainability of the effects after stopping the treatment

Real time endobronchial ultrasound guided transbronchial needle aspiration of intrathoracic lymphadenopathy: an initial experience

Background: Conventional TBNA has been used in the evaluation of intrathoracic lymphadenopathy with varied success rates depending upon size, site and aetiology of the node. Although mediastinoscopy has higher successes but it comes at the cost of general anaesthesia, more complications and limited access to the inferior and posterior mediastinum. Endobronchial ultrasound guided transbronchial needle aspiration has the advantage of real time nodal sampling with good success rates and minimal complications. The aim of our study was to assess the diagnostic yield and safety of EBUS TBNA in the evaluation of intrathoracic lymphadenopathy.Methods: This prospective observational study was conducted at government chest diseases hospital Srinagar over a period of two years from January 2016-December 2018 on 100 consecutive patients who underwent EBUS TBNA procedure for evaluation mediastinal and hilar lymphadenopathy. The data was collected and analysed for diagnostic yield and safety profile.Results: Out of the 100 subjects included in the study 52% were males and 48% were females. Mean age of the study population was 48.5±16.65 years. Most of the nodes sampled were subcarinal in location followed by paratracheal and hilar group. Granulomatous pathology (tuberculosis and sarcoidosis) was present in 41 patients followed by malignancy in 39 patients. Anthracosis was the cause of lymphadenopathy in 4 of the patients. There were no major complications in our study.Conclusions: EBUS TBNA is an effective and safe procedure for evaluation of mediastinal and hilar lymphadenopathy

Medical thoracoscopy in evaluation of undiagnosed pleural effusion

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia.  Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates

To study the effectiveness of DOTS at J N Medical College Aligarh

<b>Background:</b> Tuberculosis remains the major cause of morbidity and mortality in India and affects largely the most productive members of the society. The major concern is increasing number of MDR TB cases due to inadequate and improper treatment of primary and post primary TB cases. However Directly observed ther-apy, short course (DOTS) is emerging as standard of care for the majority of TB patients and results from various parts of country are encouraging. <b>Objective:</b> To study the effectiveness of directly observed therapy and to compare it with self administered therapy in patients with tuberculosis. <b>Design:</b> Prospective randomized uncontrolled study The study was conducted on the patients attending the OPD or indoor patients at J N Medical College and hospital A M U Aligarh from October2004 to June 2006. Patients included pulmonary and extra-pulmonary TB cases diagnosed on the ba-sis of sputum smear, culture, chest radiograph, cytological and histopathological examination. Patients were assigned into two groups to receive either treatment under DOTS or self administered treatment. We compared the treatment outcomes in these patients between the two groups. <b>Results:</b> Patients treated by directly observed therapy DOT (n=495) had a similar cure rate compared with patients treated by self- administered therapy (n=450) (81&#x0025; vs 81.6&#x0025;, p &gt; 0.05). The overall default rate was significantly more in the self administered group when compared to DOT (7.5&#x0025; vs 5.3&#x0025;, p &lt; 0.05), but this was mainly due to high default rate among category II patients while the default rate among category I &#x0026; III patients was comparable in the two groups. In our study mortality rate was found to be significantly high in the DOT group compared to SAT group (4&#x0025; vs. 1.8&#x0025;, p&#60; 0.01).This was also attributed largely by the category II patients with mortality rate 13.4&#x0025; among the DOT compared to 6.2&#x0025; in The SAT group (p&#60; 0.01). Mortality rates in the category I &#x0026; III patients were comparable in the two groups. Rates of treatment failure, relapse and acquired drug resistance were similar between the two groups. <b>Conclusion:</b> Patients treated by DOT have excellent cure rates with lesser default rates. Thus we conclude that treatment plans that emphasize directly observed therapy from the start of treatment, have greatest success in improving tubercu-losis treatment outcomes, thereby preventing the transmission of disease in com-munity

Correction: Stigma in coronavirus disease-19 survivors in Kashmir, India: A cross-sectional exploratory study.

[This corrects the article DOI: 10.1371/journal.pone.0240152.]