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2010| April-June | Volume 27 | Issue 2
Online since
May 24, 2010
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REVIEW ARTICLE
Mycoplasma pneumonia
: Clinical features and management
Surender Kashyap, Malay Sarkar
April-June 2010, 27(2):75-85
DOI
:10.4103/0970-2113.63611
PMID
:20616940
Mycoplasma pneumonia
is a common respiratory pathogen that produces diseases of varied severity ranging from mild upper respiratory tract infection to severe atypical pneumonia. Apart from respiratory tract infections, this organism is also responsible for producing a wide spectrum of non-pulmonary manifestations including neurological, hepatic, cardiac diseases, hemolytic anemia, polyarthritis and erythema multiforme. This review focuses on molecular taxonomy, biological characteristics, epidemiology, clinical presentation, radiology and various laboratory tools in diagnosis, differential diagnosis, treatment and prevention of mycoplasma pneumonia.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
11,439
1,968
7
EDITORIALS
Ambroxol - Resurgence of an old molecule as an anti-inflammatory agent in chronic obstructive airway diseases
PR Gupta
April-June 2010, 27(2):46-48
DOI
:10.4103/0970-2113.63603
PMID
:20616932
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
9,132
1,234
3
ORIGINAL ARTICLES
Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients
Bashir Ahmed Shah, Gurmeet Singh, Muzafar Ahmed Naik, Ghulam Nabi Dhobi
April-June 2010, 27(2):54-57
DOI
:10.4103/0970-2113.63606
PMID
:20616935
The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP), as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29), followed by gram positive (10/29). In 71 cases no etiological cause was obtained.
Pseudomonas
aeruginosa
was the commonest pathogen (10/29), followed by
Staphylococcus
aureus
(7/29),
Escherichia
coli
(6/29),
Klebsiella
spp. (3/29),
Streptococcus
pyogenes
(1/29),
Streptococcus
pneumoniae
(1/29) and
Acinetobacter
spp. (1/29). Sputum was the most common etiological source of organism isolation (26) followed by blood (6), pleural fluid (3), and pus culture (1). Maximum number of patients presented with cough (99%), fever (95%), tachycardia (92%), pleuritic chest pain (75%), sputum production (65%) and leucocytosis (43%). The commonest predisposing factors were smoking (65%), COPD (57%), structural lung disease (21%), diabetes mellitus (13%), and decreased level of consciousness following seizure (eight per cent) and chronic alcoholism (one per cent). Fourteen patients, of whom, nine were males and five females, died.
Staphylococcus
aureus
was the causative organism in four,
Pseudomonas
in two,
Klebsiella
in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and
s0 taphylococcus
pneumonia
and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for
legionella
,
mycoplasma
and viruses are performed the diagnostic yield would definitely be better. This emphasizes the need for further studies (including the serological tests for
Legionella
,
mycoplasma
and viruses) to identify the microbial etiology of CAP.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
8,116
1,779
13
Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role?
Arshad Altaf Bachh, Rahul Gupta, Inaamul Haq, Hanumant Ganapati Varudkar
April-June 2010, 27(2):58-62
DOI
:10.4103/0970-2113.63607
Background
: Diagnosis of sputum/smear-negative pulmonary tuberculosis patients can be both challenging and time consuming with many patients being put on empirical anti-tubercular treatment. Fibreoptic bronchoscopy may provide a confirmative and early diagnosis in such patients.
Aims:
To assess the role of fibreoptic bronchoscopy in the diagnosis of sputum /smear-negative pulmonary tuberculosis.
Materials and
Methods:
The study was conducted on 75 suspected sputum / smear-negative pulmonary tuberculosis cases attending Pulmonary Medicine Department of Mamata Medical College and Hospital, Khammam, AP. Fibreoptic bronchoscopy was performed; culture of sputum and bronchial washings for
Mycobacterium tuberculosis
was done by BACTEC method.
Results:
A final diagnosis of sputum /smear-negative pulmonary tuberculosis was made in 60 patients. Bronchial washings smear for acid-fast bacilli (AFB) was positive in 21 patients while culture of bronchial washings was positive in 39 patients. In 29 patients, smear or culture of bronchial washing alone contributed to the final diagnosis. Total yield of bronchoscopy in diagnosis of sputum smear negative pulmonary tuberculosis was 83.33% (50/60); bronchoscopy was the only diagnostic method in 66% cases (40/60) with bronchial washings being the only diagnostic method in 48.33%. Bronchial washings smear for AFB and histopathological evidence of caseating granuloma made immediate diagnosis possible in 48.33% (29/60) patients.
Conclusion:
Our study suggests that fibreoptic bronchoscopy can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
7,640
953
11
Role played by Th2 type cytokines in IgE mediated allergy and asthma
Sudha S Deo, Kejal J Mistry, Amol M Kakade, Pramod V Niphadkar
April-June 2010, 27(2):66-71
DOI
:10.4103/0970-2113.63609
PMID
:20616938
Objective:
Recent evidence suggest that allergen type 2 helper T cells (Th2) play a triggering role in the activation/recruitment of IgE antibody producing B cells, mast cells and eosinophils. Reduced microbial exposure in early life is responsible for a shift of Th1/Th2 balance in the immune system towards the pre-allergic Th2 response. The Th1 predominantly produce IFNg and delayed type hypersensitivity while Th2 secrete IL-4, IL-5, IL-6, IL-13 and regulate B cell and eosinophil mediated responses. To assess regulatory changes in the immune system, in patients with allergy and asthma, we studied the cytokine profile in serum in comparison with normal healthy controls.
Patients and Methods:
A total of 170 patients with various allergies and asthmatic conditions were studied, for cytokines in the serum by ELISA using kits from Immunotech, and analyzed to identify the triggering factors or main contributors towards allergy and asthma.
Results:
Our study showed increase in the levels of IL-4, IL-5 and IL-6 in all groups which were non- significant. But the levels of IL-10, IL-13 and TNF α were highly significant. Besides, we found correlation of GM-CSF with IL-10. Significant correlation with different cytokines was observed. Most of these patients showed increase in IgE levels.
Conclusions:
This study gives a better understanding of how cytokines are the mediators of balance of Th1 and Th2 immune responses and IgE synthesis is controlled by cytokines. Further studies will eventually lead to improved treatment strategies in the clinical management of IgE mediated allergy.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
5,674
1,141
9
Anemia as a risk factor for childhood asthma
K Ramakrishnan, Ashwin Borade
April-June 2010, 27(2):51-53
DOI
:10.4103/0970-2113.63605
PMID
:20616934
Objective:
This prospective-(cohort) study was conducted to evaluate whether anemia is a risk factor for childhood asthma.
Materials and Methods:
Two hundred children in the age group of 2-18 years who attended the Outpatient Department with upper respiratory / lower respiratory tract infections were included in this study. One hundred children with anemia were taken as the study group and another 100, age - and sex-matched children without anemia were taken as the control.They were subjected to complete blood count (CBC) C-reactive protein (CRP) estimation, Mantoux test and chest X-ray. Pulmonary function tests (PFTs) were performed on those above six years showing evidence of asthma. Peripheral smear, serum ferritin and serum iron-binding capacity were estimated for all anemic children.
Results:
Asthma was present in 74 (74%) children in the study group and in 33 (33%) children in the control group. Iron-deficiency anemia was present in 85 (85%) anemia of chronic infection in 20 (20%) and the other five (5%) had hemolytic anemia. Anemia was found to be a risk factor for childhood asthma.
Conclusion:
Anemic children were 5.75 times more susceptible to asthmatic attacks when compared with nonanemic children.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
2,984
668
3
EDITORIALS
Lung India in PubMed
SK Jindal
April-June 2010, 27(2):45-45
DOI
:10.4103/0970-2113.63602
PMID
:20616931
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
3,082
402
2
ORIGINAL ARTICLES
Prevalence of death due to pulmonary embolism after trauma
Rodrigo Florencio Echeverria, Andre Luciano Baitello, Jose Maria Pereira de Godoy, Paulo Cesar Espada, Rogerio Yukio Morioka
April-June 2010, 27(2):72-74
PMID
:20616939
Background:
Pulmonary thromboembolism is an important cause of death affecting thousands of people worldwide. The current study aims to evaluate the prevalence of death due to pulmonary embolism after trauma.
Materials and Methods:
The diagnoses of the
causa mortis
of all patients treated in the Accident and Emergency Department of Hospital de Base in Sγo Josι do Rio Preto, in the period from July 2004 to June 2005, were identified from autopsy reports to check whether pulmonary thromboembolism was involved.
Result:
A total of 109 deaths due to trauma were detected in this period with pulmonary embolism occurring in 3 (2.75%) patients.
Conclusion:
Pulmonary thromboembolism is an important cause of mortality in trauma patients and so prophylactic measures should be taken during the treatment of these patients.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
2,960
338
1
CASE REPORTS
Controlling hemoptysis: An alternative approach
Rakesh K Chawla, Arun Madan, Dinesh Mehta, Kiran Chawla
April-June 2010, 27(2):99-101
DOI
:10.4103/0970-2113.63616
PMID
:20616945
Hemoptysis is a very common symptom in the practice of pulmonary physicians of India. We present a case of uncontrolled hemoptysis managed with bronchial artery embolization. Bronchial artery embolization is an effective treatment for patients with hemoptysis. Serious complications are rare, but may occur if the arterial supply to other structures is compromised.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
2,609
436
3
Unusual thoracic manifestation of metastatic malignant melanoma
K Manu Mohan, K Gowrinath
April-June 2010, 27(2):96-98
DOI
:10.4103/0970-2113.63615
PMID
:20616944
Massive pleural effusion due to metastatic malignant melanoma is rare. We report a case of bilateral (massive on left side) pleural effusion as a metastatic manifestation of cutaneous malignant melanoma. In our case, successful outcome of pleurodesis with vincristine is significant as this agent is rarely used.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
2,334
335
6
ORIGINAL ARTICLES
FEV
6
as screening tool in spirometric diagnosis of obstructive airway disease
P Adithya Malolan, Vishak Acharya, B Unnikrishnan
April-June 2010, 27(2):63-65
DOI
:10.4103/0970-2113.63608
PMID
:20616937
Context:
The use of spirometry is currently limited to the diagnosis of obstructive airway disease for tertiary centers mainly because of the unmet need for technical expertise and funding. Use in primary care asks for a simpler and cost-effective screening tool for obstructive airway disease.
Aim:
To estimate the efficacy of FEV
6
against the current standard of FVC in the spirometric diagnosis of obstructive airway disease.
Setting and Design:
The Pulmonary Function Laboratory of a tertiary care hospital in Coastal South India. It was a descriptive study.
Materials and Methods:
We analyzed 150 serial patients on ATS standardized spirometers. The patients were classified into normal subjects and those with airway obstruction, further categorized as mild, moderate and severe and those with mixed defect. Those with obstruction were also classified as having reversible and irreversible defects.
Statistical Analysis:
Data was analyzed using SPSS Software (v.11.5), statistical test ANOVA and Pearson correlation was done and P less than 0.05 considered statistically significant.
Results:
FVC and FEV
6
showed a linear correlation in all subjects. The difference in means was statistically significant in all subjects. The sensitivity and specificity of FEV
1
/FEV
6
in comparison to FEV
1
/FVC were both found to be 100%.
Conclusion:
FEV
6
is an excellent screening tool in the diagnosis of airway obstruction but, there is a necessity for further research to confirm our findings. There is also a need for reference values in an Indian setting to find out the efficiency of this new parameter. Our sample size is relatively small and comprises of a very high proportion (70%) of subjects with airway obstruction and so our results may not be applicable for use in general population.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
2,038
404
4
CASE REPORTS
Acute respiratory failure as a first manifestation of syringomyelia
Ali Al Bashapshe, Harsha Bhatia, Shahid Aziz
April-June 2010, 27(2):93-95
DOI
:10.4103/0970-2113.63614
PMID
:20616943
A 40 year old woman presented with a short history of acute onset of breathlessness to the ER of our hospital and after initial evaluation for acute pulmonary embolism which was ruled out after carrying out the appropriate investigations, she was diagnosed to be afflicted with syringomyelia based on her neurological symptoms and clinical findings, which was confirmed by doing an MRI scan, which was her basic diagnosis that was complicated by acute hypercapnic respiratory failure. This case is being reported to highlight syringomyelia as an unusual cause of acute respiratory failure, which manifested clinically in this patient as its first presentation and the underlying neurological diagnosis has been found to be present in very few reported cases (less than 0.01% of case reports) in the available literature as the basic disease in the absence of its classical presenting features. Problems associated with acute respiratory failure in the setting of syringomyelia are discussed.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
1,997
294
6
Basidiobolus: An unusual cause of lung abscess
Ravindran Chetambath, MS Deepa Sarma, KP Suraj, E Jyothi, Safreena Mohammed, Beena J Philomina, S Ramadevi
April-June 2010, 27(2):89-92
DOI
:10.4103/0970-2113.63613
PMID
:20616942
Non-resolving pneumonia leading to lung abscess is always a challenge to the treating physician especially in a diabetic patient. Atypical radiological features of lung abscess should raise the suspicion of unusual organisms. This is a case report of a 42 year old diabetic male presented with features suggestive of lung abscess and multiple target organ damage. Subsequent work up revealed that the etiological agent is a rare fungus - Basidiobolus. To the best of our knowledge this is the first case of Basidiobolus lung abscess reported from India.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
1,721
341
3
Mediastinal bronchogenic cyst presenting with dysphagia and back pain
Manish Kumar Tiwari, Rajkumar Yadav, Rajendra Mohan Mathur, Chandra Prakash Shrivastava
April-June 2010, 27(2):86-88
DOI
:10.4103/0970-2113.63612
PMID
:20616941
The presentation of the bronchogenic cyst is variable, making pre-operative diagnosis difficult. Majority of them are either asymptomatic or discovered incidentally. The most common presenting symptoms are cough, fever and dyspnea. We discuss the case of a large bronchogenic cyst in the posterior mediastinum causing oesophageal compression and impinging on the left atrium. The patient presented with dysphagia and back pain and was extensively investigated by various physicians before being diagnosed as having bronchogenic cyst. We concluded that the backache was due to stretching of nerves in the parietal pleura. This case demonstrates the need for detailed investigations prior to treatment of patients with such symptom complex as a bronchogenic cyst may be the cause of such symptoms.
[ABSTRACT]
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
1,748
299
1
EDITORIALS
Can DOT improve treatment-seeking behavior of TB patients?
Rajiv Paliwal
April-June 2010, 27(2):49-50
DOI
:10.4103/0970-2113.63604
PMID
:20616933
[FULL TEXT]
[PDF]
[CITATIONS]
[PubMed]
1,660
384
1
CASE REPORTS
Thoracic malignant schwannomma in adults
GS Gaude, PR Malur, R Kangale, V Dhorigol, S Anurshetru
April-June 2010, 27(2):102-104
DOI
:10.4103/0970-2113.63617
PMID
:20616946
A rare case of thoracic malignant schwannomma, in an adult, is presented here. This case shows an aggressive, rapid progression, which is characteristic of the disease. In spite of the best surgical and chemotherapy treatment, the patient died within four months of diagnosis.
[ABSTRACT]
[FULL TEXT]
[PDF]
[PubMed]
1,161
234
-
LETTER TO EDITOR
Sewing needle in the lung
M Emmanuel Bhaskar, Preetam Arthur
April-June 2010, 27(2):105-106
DOI
:10.4103/0970-2113.63618
PMID
:20616947
[FULL TEXT]
[PDF]
[PubMed]
906
238
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