Impulse oscillometry

Pulmonary function testing involves a battery of tests from the simple pulse oximetry to the cardiopulmonary exercise testing. Impulse oscillometry (IOS) is one of the newly described pulmonary function tests. It is based on the old principle of forced oscillatory technique modified and refined as per research and advances. It involves the use of sound waves during normal tidal breathing, which gives information on oscillatory pressure-flow relationships and eventually resistance and reactance. The resistance at 20 Hz (R20) represents the resistance of the large airways. The resistance at 5 Hz (R5) means the total airway resistance. (R5–R20) reflects resistance in the small airways. The reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways. Resonant frequency and area of reactance are also measured. IOS has major uses in diagnosis and control of asthma in children and the elderly, where spirometry is otherwise normal. IOS has been studied in other respiratory diseases like COPD, ILD and supraglottic stenosis

Role of GeneXpert in the diagnosis of mycobacterium tuberculosis

Introduction: GeneXpert (GX) is a novel, integrated, cartridge-based, nucleic acid amplification test with an established role for rapid diagnosis of Mycobacterium tuberculosis and detection of rifampicin resistance.Aim: To evaluate the role of GX in pulmonary and extrapulmonary tuberculosis (TB) cases.Material and methods: A prospective study was conducted in the pulmonary medicine department of a tertiary care hospital after the Ethics Comittee permission. Data of 257 presumptive TB patients was retrieved for GX, acid fast bacilli smear and cul-ture (AFB smear and culture) and drug susceptibility test (DST). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of GX in diagnosis and determination of rifampicin resistance in pulmonary and extrapulmonary TB cases were calculated and compared with culture and DST results.Results: Our study included 132 pulmonary and 125 extrapulmonary cases. On the basis of clinicoradiological and microbiological correlation, diagnosis of TB was confirmed in 104 pulmonary and 103 extrapulmonary cases. Out of a total of 104 pulmonary TB cases, 73 were rifampicin-sensitive and 31 were rifampicin-resistant cases. 103 extrapulmonary TB patients included 66 rifampicin-sensitive and 37 rifampicin-resistant cases. The sensitivity, specificity, PPV, NPV of GX in diagnosis and detection of rifampicin resistance in pulmonary TB was 95%, 93%, 98%, 84% and 96%, 100%, 100%, 96%, respectively. The sensitivity, specificity, PPV, NPV of GX in diagnosis and detection of rifampicin resistance in extrapulmonary TB cases was 79%, 86%, 96%, 47% and 97%, 95%, 97%, 95%, respectively.Conclusions: GX results are superior to smear microscopy and comparable to culture with shorter turnaround time.We recom-mend using it in routine TB diagnosis as this will expedite the management of patients with presumptive TB

Diffuse Pan Bronchiolitis Presenting with Bronchiectasis: A Case Report

Diffuse Pan Bronchiolitis (DPB) is a peculiar airway disease with its pathogenesis enrooted in a complex interplay of various genetic and environmental factors. Airway inflammation, chronic airflow limitation and suppuratives in pulmonary infections are the distinctive features of this entity. It poses a close differential to other frequently encountered pulmonary conditions like chronic bronchitis, emphysema, bronchiectasis and constrictive bronchiolitis. Deferment in diagnosis can culminate in irreversible airway remodeling and progressive respiratory failure. Hence a punctual recognition is vital. Macrolide group of drugs are prime modality of therapy and the response to therapy is benignant. We herein describe a case of DPB with development of sequelae owing to its delayed detection

Оценка заболеваний органов грудной клетки с помощью биопсии под контролем компьютерной томографии

Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology (FNAC) and fine needle aspiration biopsy (FNAB) are reliable techniques for diagnosing various thoracic diseases. These modalities are used for diagnosis in suspicious lung, pleural, mediastinal and vertebral and pulmonary lesions.The aim. We conducted a study in a Pulmonary Medicine Department of tertiary care hospital to study the efficacy and safety of CT guided FNCA/FNAB in thoracic diseases.Methods. A retrospective study was conducted at a tertiary care center with Information and Ethics committee permission within a total duration of two years. The study included patients presenting with following: 1) mediastinal mass lesions, 2) pulmonary solitary pulmonary nodules/masses, 3) pulmonary cavity, cyst and consolidation of undiagnosed etiology, 4) pleural mass, nodules, loculated collections, 5) extra-pulmonary and spinal tuberculosis suspects with pre/paravertebral abscess. Procedure details, radiological images and pathological and microbiological reports were retrieved from case record book of patients available in department.Results. Study population consisted of 108 patients. Neoplastic diseases were 85 (78.70%) and Non- neoplastic diseases 23 (21.29%). In neoplastic diseases 78.82% patients had lung Cancer of which 85.07% non small cell carcinoma and 14.92% small cell lung cancer. Out of non small cell lung cancer adenocarcinoma of lung was the commonest. The most common non neoplastic diseases was tuberculosis. CT guided biopsy procedure was performed without any complications in 61.11%. The most common complication was pneumothorax (27.77%). The yield of CT guided biopsy was 98.14%.Conclusion. Percutaneous CT-guided lung biopsy is an effective, highly accurate, and safe method of obtaining tissue for the diagnosis of indeterminate pulmonary lesions especially in neoplastic diseases and tuberculosis.Чрескожные процедуры под контролем компьютерной томографии (КТ), такие как тонкоигольная аспирационная цитология (fine needle aspiration cytology – FNAC) и тонкоигольная аспирационная биопсия (fine needle aspiration biopsy – FNAB), являются надежными методами диагностики различных заболеваний органов грудной клетки. Эти методы используются для диагностики поражений легких, плевры, средостения, позвоночника и легких.Целью исследования, проведенного в отделении пульмонологии больницы третичного уровня, явилось определение эффективности и безопасности FNCA / FNAB под контролем КТ при заболеваниях органов грудной клетки.Материалы и методы. Ретроспективное исследование проводилось в течение 2 лет в центре третичной медицинской помощи с разрешения Комитета по информации и этике. В исследование были включены следующие пациенты: 1) с новообразованиями средостения; 2) с легочными солитарными узлами / новообразованиями; 3) с полостями, кистами и консолидацией в легких невыясненной этиологии; 4) с плевральными новообразованиями, узелками, осумкованными скоплениями; 5) с плевральными массами, узелками, осумкованными скоплениями, подозрением на внелегочный туберкулез и туберкулез позвоночника с пре-, паравертебральным абсцессом. Данные о проведенной процедуре, рентгеновские снимки, патологоанатомические и микробиологические отчеты были получены из историй болезни, имеющихся в отделении.Результаты. Выборку составили 108 пациентов. Опухолевые заболевания выявлены у 85 (78,70 %), неопухолевые – у 23 (21,29 %) пациентов. У 78,82 % пациентов с опухолевыми заболеваниями выявлен рак легкого, у 85,07 % из них – немелкоклеточный, у 14,92 % – мелкоклеточный рак легкого. У больных с немелкоклеточным раком легкого наиболее часто встречалась аденокарцинома легкого. Наиболее частым неопухолевым заболеванием являлся туберкулез. Биопсия под контролем КТ выполнена без каких-либо осложнений в 61,11 % случаев. Наиболее частым осложнением (27,77 %) был пневмоторакс. Биопсия под контролем КТ позволила установить диагноз в 98,14 % случаев.Заключение. Чрескожная биопсия легкого под контролем КТ является эффективным, высокоточным и безопасным методом получения ткани для диагностики неопределенных поражений легких, особенно при опухолевых заболеваниях и туберкулезе

An Overview of CETPs: Status in India and The Challenges to be Resolved

­Rapid industrialization is adversely impacting the surroundings globally. Pollutants by using inappropriate management of commercial wastewater is one of the most important environmental troubles in India as well, especially with burgeoning small scale business zone in the country. To deal with the pollutants coming out from industries, adoption of purifier manufacturing technologies and waste minimization tasks are being advocated. Common Effluent Treatment Plants (CETPs) are taken into consideration as one of the possible solution for small to medium organisations for effective wastewater remedy. However, some of the running CETPs are not acting optimally because of various technical and managerial motives. This have a look at has made an attempt to recognize the repute of CETPs in India and issues associated with the operating CETPs and additionally test viable measures can take for improving condition, better plant performance for lowering operating value and better surroundings

Use of pigtail catheter and urosac: Numero uno for ambulatory chest drainage!

Background: Intercostal chest drainage is required for varied lung diseases with the pleural involvement. While the conventional method of intercostal drainage (ICD) insertion with the bulky underwater drain (UWD) was the gold standard for management, it had numerous disadvantages. It was time and again challenged with better ambulatory methods, although the documentation and continued use of the same are rare in practice. We studied the efficacy of ambulatory chest drainage (ACD) with pigtail and urosac against the conventional drainage methods (ICD-UWD) at a tertiary care center. Materials and Methods: This prospective, observational study included the patients requiring chest drainage grouping them as per the intervention they underwent, i.e., (1) Pigtail-Urosac (ACD group) and (2) ICD-UWD (Non-ACD group). The clinical data were recorded and analyzed for the difference in the hospital stay, the total duration of drainage, successful outcome, residual disease, and pain in both groups using unpaired t-test and Chi-square test. Results: Of the 85 patients included in the study; 45 had pigtail-urosac and 40 had ICD-UWD, consisting of 34 pleural effusions and 51 pneumothoraces. The ACD and non-ACD groups were similar in etiology. Of the 85 patients, 50 had complete lung expansion, 18 pleural thickening, 15 loculated residual disease, and two pleurocutaneous fistulae. In the ACD group, the hospital stay was less as compared to the non-ACD group, i.e., 4.06 (4.42) versus 19.68 (31.39) days (P = 0.0008). The duration of chest drainage showed a similar trend, i.e., 19.29 (66.91) versus 52.18 (46.38) days (P = 0.006). Pain (P < 0.0001) recorded was significantly less with better expansion (P < 0.0001), less pleural thickening (P = 0.0067), and residual disease (P = 0.0087) in the ACD group. Conclusion: The use of pigtail-urosac is a safe, effective, and preferred method for ACD

Impulse Oscillometry

Pulmonary function testing involves a battery of tests from the simple pulse oximetry to the cardiopulmonary exercise testing. Impulse oscillometry (IOS) is one of the newly described pulmonary function tests. It is based on the old principle of forced oscillatory technique modified and refined as per research and advances. It involves the use of sound waves during normal tidal breathing, which gives information on oscillatory pressure-flow relationships and eventually resistance and reactance. The resistance at 20 Hz (R20) represents the resistance of the large airways. The resistance at 5 Hz (R5) means the total airway resistance. (R5–R20) reflects resistance in the small airways. The reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways. Resonant frequency and area of reactance are also measured. IOS has major uses in diagnosis and control of asthma in children and the elderly, where spirometry is otherwise normal. IOS has been studied in other respiratory diseases like COPD, ILD and supraglottic stenosis

Extrapulmonary drug-resistant tuberculosis at a drug-resistant tuberculosis center, Mumbai: Our experience – Hope in the midst of despair!

Background: Drug-resistant tuberculosis (DR-TB) is a global problem with only 52% reported cure rate. Extrapulmonary (EP) DR-TB poses a formidable diagnostic, therapeutic challenge. We aimed to study their clinical profile and treatment outcomes under the programmatic setting. Materials and Methods: This retrospective observational study included the database of consecutive EPDR-TB cases enrolled at the DR-TB center from 2012 to 2014. The demographic, clinical details, drug susceptibility tests (DSTs), follow-up, therapy, adverse events (AEs), and outcome were reviewed. Statistical analysis was done using percentages and mean. Results: Of total 1743 DR-TB patients, 76 (4.4%) EPDR-TB cases were included. These consisted of 53 (69.7%) adults and 23 (30.3%) children, with female preponderance. The mean age in adults and children was 27.96 (9.63) and 12.56 (3.83), respectively. EP sites involved were lymph nodes in 39 (51.3%), spine in 15 (19.7%), other bones in 6 (7.9%), pleural effusion in 9 (11.9%), central nervous system in 2 (2.6%), and disseminated EP disease in 5 (6.6%). Forty-one (53.9%) had multi-DR-TB (MDR-TB), 29 (38.2%) MDR-TB with fluoroquinolone resistance {preextensively DR-TB (Pre-XDR-TB (FQ)), 1 (1.3%) MDR-TB with aminoglycoside resistance (Pre-XDR-TB (AM)), and 5 (6.6%) extensively DR-TB (XDR-TB) on DST. Thirteen (17.11%) had comorbidities. None had HIV. Two (2.63%) had DM. Patients were treated as per the revised TB control program – programmatic management of DR-TB guidelines. Duration of intensive (IP) was 6.55 (1.22) months. Ten (13.2%) received shorter regimens, wherein therapy was stopped at 12–18 months due to severe adverse drug reactions and treatment response. Sixty-two (81.6%) completed treatment, 8 (10.5%) defaulted, 3 (4%) died, 2 (2.6%) failed, and 1 (1.3%) was transferred out. Two-third of patients reported AE. Conclusion: The prevalence of EP cases in DR-TB was 4.4%. Treatment completion rate was very high (81.6%). Shorter regimens were efficacious

Neuroimaging in Cycloserine Induced Neurotoxicity: A Rare Case Report

Tuberculosis (TB) is an infectious disease. There is an increasing burden of Drug Resistant TB (DR-TB) which is not only difficult to treat and associated with adverse events during its treatment. Cycloserine is a broad spectrum antibiotic used as a second-line agent for DR-TB therapy. Psychiatric adverse drug reactions are well known. Neurotoxicity with the use of supplemental pyridoxine is rarely reported. We report a case of young boy who developed tilting of body to one side during therapy for DR-TB which included cycloserine. Magnetic Resonance Imaging (MRI) of the brain showed reversible bilateral symmetrical (T2/FLAIR) hyperintensity in dentate nuclei. Clinical and MRI findings were consistent with cycloserine toxicity. Symptoms resolved on withdrawing the drug. MRI findings showed marked reversibility

Dyskeratosis Congenita Associated Non-Specific Interstitial Pneumonia

Dyskeratosis Congenita (DC) is a rare inherited disorder of ectodermal dysplasia. It consists of a classical mucocutaneous triad of abnormal skin pigmentation, nail dystrophy and leukoplakia. Pulmonary disease is seen in 10-15%. It is characterized by Idiopathic Pulmonary Fibrosis (IPF), or Idiopathic Familial Pulmonary Fibrosis (IFPF). Non-specific Interstitial Pneumonia (NSIP) has been reported rarely in children with DC and in an isolated adult patient. Our patient had classical clinical presentation of DC with pancytopenia and portal hypertension and clinic-radiological features of NSIP which is a rare association