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

Evaluation of serum mineral micronutrients (Zn, Cu, Fe, Mg) and their correlation with clinical parameters (gingival index, probing pocket depth, clinical attachment loss) in chronic periodontitis patients

Background: Nutrition especially micro-mineral nutrients plays a major role in the etiology of chronic periodontitis. Serum levels of micro-mineral nutrients can be used as markers for the incidence of periodontitis and may also be used as indicators for dietary supplementation. Aims and Objectives: The aim of the study was to estimate the serum levels of Zn, Cu, Fe, and Mg of chronic periodontitis patients and normal healthy controls., to measure the clinical parameters (gingival index, probing pocket depth [PPD], and clinical attachment loss) in chronic periodontitis patients and normal healthy controls., to compare the levels of serum Zn, Cu, Fe, and Mg levels of chronic periodontitis patients and healthy controls and to correlate the levels of serum micronutrients with clinical parameters (gingival index, PPD, and clinical attachment loss) in chronic periodontitis patients and healthy controls. Materials and Methods: A total of 110 subjects, 55 subjects with chronic periodontitis and 55 healthy control subjects in the age group 35–65 years were selected for the study. Serum micronutrient levels of Cu, Fe, Zn, Mg, and the clinical parameters were measured. Results: Serum concentrations of Cu and Fe showed statistically significant increase and serum Zn and Mg showed a significant decrease in peridontitis patients as compared to normal healthy controls. Copper and Fe showed a significant positive correlation and Zn and Mg showed a significant negative correlation with clinical parameters (gingival index, PPD, and clinical attachment loss). Conclusion: The present study supports and extends the view that the assessment of serum mineral micronutrient can serve as possible biomarkers or indicators for an inflammatory condition like chronic periodontitis

Use of Cooking Fuels and Cataract in a Population-Based Study: The India Eye Disease Study.

BACKGROUND: Biomass cooking fuels are commonly used in Indian households, especially by the poorest socioeconomic groups. Cataract is highly prevalent in India and the major cause of vision loss. The evidence on biomass fuels and cataract is limited. OBJECTIVES: To examine the association of biomass cooking fuels with cataract and type of cataract. METHODS: We conducted a population-based study in north and south India using randomly sampled clusters to identify people ≥ 60 years old. Participants were interviewed and asked about cooking fuel use, socioeconomic and lifestyle factors and attended hospital for digital lens imaging (graded using the Lens Opacity Classification System III), anthropometry, and blood collection. Years of use of biomass fuels were estimated and transformed to a standardized normal distribution. RESULTS: Of the 7,518 people sampled, 94% were interviewed and 83% of these attended the hospital. Sex modified the association between years of biomass fuel use and cataract; the adjusted odds ratio (OR) for a 1-SD increase in years of biomass fuel use and nuclear cataract was 1.04 (95% CI: 0.88, 1.23) for men and 1.28 (95% CI: 1.10, 1.48) for women, p interaction = 0.07. Kerosene use was low (10%). Among women, kerosene use was associated with nuclear (OR = 1.76, 95% CI: 1.04, 2.97) and posterior subcapsular cataract (OR = 1.71, 95% CI: 1.10, 2.64). There was no association among men. CONCLUSIONS: Our results provide robust evidence for the association of biomass fuels with cataract for women but not for men. Our finding for kerosene and cataract among women is novel and requires confirmation in other studies. Citation: Ravilla TD, Gupta S, Ravindran RD, Vashist P, Krishnan T, Maraini G, Chakravarthy U, Fletcher AE. 2016. Use of cooking fuels and cataract in a population-based study: the India Eye Disease Study. Environ Health Perspect 124:1857-1862; http://dx.doi.org/10.1289/EHP193

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Bilateral congenital pulmonary airway malformation in an adult: Report of a rare case

Congenital pulmonary airway malformations (CPAMs) are considered part of a spectrum of bronchopulmonary foregut malformations. Diagnosis is usually made during the antenatal or neonatal period, and is rarely diagnosed in adults. The spectrum of clinical presentations varies from asymptomatic cases to recurrent respiratory tract infections or respiratory insufficiency in adulthood. Here, we report the case of an adult female who presented with a history of recurrent respiratory tract infections since childhood. Radiological findings were in favor of bilateral CPAM. Bilateral CPAM in an adult patient is extremely rare, and it is mostly managed as bronchiectasis