Alpha-1-antitrypsin level as a predictor of acute exacerbations in chronic obstructive pulmonary disease: a prospective observational study

Background: This prospective study investigated if alpha-1-antitrypsin (AAT) levels could predict chronic obstructive pulmonary disease (COPD) exacerbations needing hospitalization. Methods: 106 COPD subjects hospitalized for acute exacerbations were enrolled. Past 2-years’ records were evaluated for prior exacerbation hospitalizations. AAT levels and post-stabilization FEV1 were assessed during current hospitalization. Exacerbation frequency correlated to current AAT levels and lung function. Results: Significant inverse association found between AAT levels and hospitalized exacerbations, indicating utility as a predictive biomarker for COPD patients prone to recurrent severe flares requiring admission. Patients with lower AAT levels also exhibited poorer lung function per lower FEV1 values. Conclusions: Monitoring AAT levels may promote timely interventions in high risk individuals susceptible to relapsing catastrophic exacerbations needing inpatient care. Further research warranted to validate findings and explore if supplementing deficient AAT reduces exacerbation frequency, thereby improving prognosis in this debilitating disease

Lung involvement in accident victims: report of three cases

Lungs are target organ for damage during accidents and contribute significantly to the mortality of the victims. Here we present three different types of accidental injury to the lungs leading to respiratory failure and their varied presentations

Prevalence of tracheobronchial anomalies among patients undergoing fibreoptic bronchoscopy: a retrospective analysis from a tertiary care hospital in Wayanad, Kerala, India

Background: Tracheobronchial anomalies are a rare clinical entity and often asymptomatic in nature. Some patients may experience symptoms such as cough, recurrent pneumonia or hemoptysis. Knowledge and understanding of tracheobronchial variations have important implications for diagnosis of symptomatic patients and performing certain procedures, including bronchoscopy and endotracheal intubation. Objective was to study the prevalence of tracheobronchial anomalies detected during routine bronchoscopy in a tertiary care setting.Methods: Retrospective analysis of hospital data of patients undergoing fibreoptic bronchoscopy for one year in a tertiary care setting.Results: There were 149 bronchoscopies evaluated. Total of 41 anomalies were detected in 34 (22.8%) subjects. The most common anomaly was bronchial diverticula.Conclusions: This retrospective study takes stock of various tracheobronchial anomalies among subjects who underwent bronchoscopy in a tertiary care hospital in Wayanad, North Malabar. This study revealed major tracheobronchial anomalies in 22.8% of subjects which is higher when compared to previous studies. This is particularly important due to the fact that Wayanad is a backward hilly district and tribal community constitutes 20% of its population

Bilateral morgagni hernia in a case of Weill-Marchesani syndrome-a rare association

Morgagni hernia constitutes only about 2% of all diaphragmatic hernias and bilateral Morgagni hernia is extremely rare. Here we present a 75 year old female patient with morphometric features of Weill-Marchesani syndrome who has bilateral Morgagni hernia. This association is reported for the first time in literature

Aspergillus spp. infection as a cause of acute exacerbations of chronic obstructive pulmonary disease: a prospective observational study

Background: Majority of exacerbations of COPD (AECOPD) are due to infections. Usual agents causing AECOPD are gram negative bacteria, but rarely viruses and fungi are also implicated. However, the role of fungal infection, especially Aspergillus spp. in the clinical deterioration of COPD still remains unclear. This prospective observational study looks at the prevalence of aspergillus infection in AECOPD. The Objectives of this study were to analyse the prevalence and risk factors associated with Aspergillus infection in AECOPD, and to investigate the clinical outcomes.Methods: Patients admitted with AECOPD for a period of 3 months from 1st October 2017 to 31st December 2017 were prospectively included from ICU and general ward of Pulmonary Medicine department of a tertiary care hospital. Clinical, radiological and microbiological data were collected at admission and during the hospital stay. Clinical course and outcome are recorded.Results: There were 104 cases of AECOPD during the study period out of which 96 were males and 8 were females. 17 patients had evidence of aspergillus infection and diabetes was found to be an independent risk factor for aspergillus infection.Conclusions: Aspergillus infection is an important cause of COPD exacerbation and this is directly related to diabetes mellitus

Decentralising drug-resistant tuberculosis centre services by offering virtual consultancy- a Kozhikode model

Background: Programmatic management of Drug Resistant Tuberculosis (PMDT) recommends one week and one month hospitalisation for pre-treatment evaluation and initiation of second line medications to MDR and XDR patients respectively. Our experience in dealing with these patients prompted us to resort to decentralising DOTs plus services by offering a virtual consultancy to those cases which did not actually require hospitalisation. Aim of the study was to analyze the feasibility of decentralisation strategy adopted in DOTs plus patients to recommend it as a nationwide strategy.Methods: The study was an observational analysis conducted in the Department of Pulmonary Medicine in 373 MDR-TB patients enrolled under DOTs Plus programme for CAT-IV regime during the period between February 2009 and April 2013 and analysed the strategy of decentralization using the internet and expertise of Medical officers at the periphery.Results: The percentage utilisation of virtual consultancy was 83.7% which emphasises the fact that this is a feasible operational modification. Adverse events reported to this DRTB centre were 29.2% in the pre-proposed model period which is comparable to the model group (30.2%).Conclusions: This study shows that in a properly functioning DRTB centre decentralising the services to its peripheral centres is a feasible option utilising the virtual consultancy model as proposed

Subacute invasive pulmonary aspergillosis

Subacute invasive pulmonary aspergillosis (IPA) is an indolent cavitating infectious process which can mimic other chronic lung infections such as tuberculosis. This usually occurs in mildly immunosuppressed individuals and clinically evolves over weeks to months. Radiological presentation is in the form of thick-walled cavity with or without mycetoma, fibrosis, and pleural invasion. Here, a case of subacute IPA in a middle-aged female with rheumatoid arthritis is reported, highlighting a rare radiological appearance