Laryngeal Tuberculosis or Malignancy: A Masquerade

Laryngeal tuberculosis (TB) is not a very common laryngeal pathology, therefore it can be easily missed. Laryngeal TB and Cancer of Larynx can have similar clinical presentations. Here we discuss a case of a 57-year-old female presenting in outpatient department with complaints of Hoarseness of voice since 6 months and shortness of breath since 3 months. Patient was further evaluated and diagnosed as a case of laryngeal tuberculosis. Treatment was started with fixed dose anti tubercular drugs and patient showed improvement on follow up

Retrospective study of clinical profile and management of patients with swine flu at tertiary care hospital

Background: The first isolation of a swine influenza virus from a human occurred in 1974. There are no unique clinical features that distinguish swine influenza in humans from typical influenza. Thus, clinical course and management were recorded as per a planned pro forma and analysed. This type of study has not been done previously in Himalayan region.Methods: Retrospective observational study done in a group of patients diagnosed with swine flu admitted in department of pulmonary medicine at the tertiary care hospital from November 2016 to July 2017.Results: Out of 30 patients, 53.3% were male, mean age was 48.8±17.7, history of travel or contact to infected person was only 13.3%. Most common symptom recorded was fever (83.3%), followed by dyspnoea, cough, throat pain. Most common co-morbidity was diabetes and presence were significantly associated with admission in an ICU (P<0.05). Bilateral lung infiltrate seen in 53.3% on chest X-ray. Organ involved other than respiratory were renal followed by liver involvement. 40% of patients received corticosteroid for an average of 6days, mostly given in patients with sepsis, septic shock, multi organ involvement. Out of 40%, 16.6% patient expired, 6.6% left against medical advice and 16.6% were discharged, corticosteroid doesn’t help in reducing mortality.Conclusions: A multivariate model to identify independent predictors associated with mortality in swine flu were the use of vasopressor, respiratory failure, requirement of mechanical ventilation and number of organ failure. Use of corticosteroid is controversial

Adenosine deaminase and interferon-gamma in diagnosis of tubercular pleural effusion

Background: Pleural effusion is a common extrapulmonary manifestation of tuberculosis (TB). The conventional culture suffers from lack of sensitivity. Many pleural fluid markers have been evaluated to diagnose tubercular pleural fluid but none has proved to be an ideal. We have studied Adenosine deaminase (ADA), Interferon gamma (IFN) and their combination for diagnosis of tubercular pleural effusion.Methods: All consecutive patients with pleural effusion were subjected to thoracentesis and segregated into transudative and exudative using Light`s criteria. Patients with exudative pleural effusion were enrolled and divided into two groups. Group-I comprised of patients with tubercular etiology, Group-II- non-tubercular etiology. 45 patients were selected for each group. ADA and IFN in pleural fluid of these patients were measured. The sensitivity, specificity and predictive values were calculated.Results: The  sensitivity, specificity, positive predictive value, negative predictive value of ADA and IFN were 88.89%, 99.85%, 86.96%, 99.87%; 97.78%, 97.78%, 97.78%, 97.78% respectively. Combination of ADA and IFN didn’t improve the sensitivity or specificity compared to IFN alone.Conclusions: Pleural fluid ADA, IFN were found to be useful in differentiating tubercular from non-tubercular patients. Combination of ADA and IFN doesn’t give additional benefit over IFN alone

Skin Prick Test in Naso-Bronchial Allergies: A Cross Sectional Study

Allergy is defined as an overreaction of the immune system in response to the ingestion of certain foreign chemicals. The disease has been found to be more prevalent in males with predilection towards young adults who are less than 40 years of age. Indoor, outdoor or occupational agents are the most common classification for aero-allergens.&nbsp; “Skin Prick Test (SPT)” is the most definite and reliable methodology for diagnosing various allergic diseases which are mediated by IgE, in a patient with Naso-Bronchial allergies. Material and Methods: Cross sectional study was conducted on 120 patients with Naso-Bronchial allergy. Detailed clinical history, examination was done and SPT was performed using 25 allergens.” Results: It was observed that insects were the most common allergen followed by mites, pollens and food respectively. Animal dander was the least common allergen. Amongst insects, Cockroach was the most common. Conclusion: On the basis of this study, we conclude that skin prick test is one of the most reliable, easily accessible and diagnostic test to detect IgE mediated allergic reactions.

Adenosine deaminase and interferon-gamma in diagnosis of tubercular pleural effusion

Background: Pleural effusion is a common extrapulmonary manifestation of tuberculosis (TB). The conventional culture suffers from lack of sensitivity. Many pleural fluid markers have been evaluated to diagnose tubercular pleural fluid but none has proved to be an ideal. We have studied Adenosine deaminase (ADA), Interferon gamma (IFN) and their combination for diagnosis of tubercular pleural effusion.Methods: All consecutive patients with pleural effusion were subjected to thoracentesis and segregated into transudative and exudative using Light`s criteria. Patients with exudative pleural effusion were enrolled and divided into two groups. Group-I comprised of patients with tubercular etiology, Group-II- non-tubercular etiology. 45 patients were selected for each group. ADA and IFN in pleural fluid of these patients were measured. The sensitivity, specificity and predictive values were calculated.Results: The  sensitivity, specificity, positive predictive value, negative predictive value of ADA and IFN were 88.89%, 99.85%, 86.96%, 99.87%; 97.78%, 97.78%, 97.78%, 97.78% respectively. Combination of ADA and IFN didn’t improve the sensitivity or specificity compared to IFN alone.Conclusions: Pleural fluid ADA, IFN were found to be useful in differentiating tubercular from non-tubercular patients. Combination of ADA and IFN doesn’t give additional benefit over IFN alone

Uncommon etiology of chronic wheeze

Endobronchial tuberculosis (TB) refers to TB infection of the tracheobronchial tree. We report the case of a 62-year-old immunocompetent patient of chronic cough with normal X-ray. She did not have any systemic complaints suggestive of TB. Her diagnosis was made when she underwent bronchoscopy to look for any endobronchial cause of cough. It revealed complete caseation in the airways. Microscopically and pathologically, it was confirmed to be tubercular. The patient improved clinically on antitubercular therapy

An Unusual Presentation of Granulomatosis with Polyangiitis

The granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a pauci-immune vasculitis involving small- and medium-sized blood vessels. Classically, the patients inflicted with this disease present with a triad of necrotizing granulomatous inflammation of the respiratory tract, cutaneous necrotizing vasculitis, and glomerulonephritis (GN). The antinuclear (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) are considered as relatively specific markers of the disease. Herein, we presented the case of a patient who initially presented with sepsis but did not respond to the conventional antibiotics and later diagnosed with GPA.The granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a pauci-immune vasculitis involving small- and medium-sized blood vessels. Classically, the patients inflicted with this disease present with a triad of necrotizing granulomatous inflammation of the respiratory tract, cutaneous necrotizing vasculitis, and glomerulonephritis (GN).The antinuclear (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) are considered as relatively specific markers of the disease. Herein, we presented the case of a patient who initially presented with sepsis but did not respond to the conventional antibiotics and later diagnosed with GPA

A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center of Himalayan Region

Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47). Malignancy was diagnosed histopathologically in 70.2% (33/47) patients (both primary & metastatic pleural carcinoma) and tuberculosis in 10.6% (5/47). There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion