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Official publication of Indian Chest Society
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2013| July-September | Volume 30 | Issue 3
Online since
August 7, 2013
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CASE REPORTS
Plastic bronchitis in beta thalassemia minor
Makaresh Yadav, Sneha Tirpude, Jyotsna M Joshi
July-September 2013, 30(3):206-208
DOI
:10.4103/0970-2113.116264
PMID
:24049256
Plastic bronchitis is a rare pulmonary disorder associated with various conditions like cystic fibrosis, asthma, pulmonary infection and characterized by formation and expectoration of cast which assumes the shape of the bronchial tree. We report a case of a 33-year-old woman with beta thalassemia minor who developed plastic bronchitis.
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EDITORIALS
Chronic obstructive pulmonary disease: Indian guidelines and the road ahead
Parvaiz A Koul
July-September 2013, 30(3):175-177
DOI
:10.4103/0970-2113.116233
PMID
:24049249
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CASE REPORTS
Reversible interstitial lung disease with prolonged use of nitrofurantoin: Do the benefits outweigh the risks?
Akashdeep Singh, Parminder Singh, US Sidhu
July-September 2013, 30(3):212-214
DOI
:10.4103/0970-2113.116271
PMID
:24049258
We describe the case summary of a 70-year-old man diagnosed with interstitial lung disease due to prolonged nitrofurantoin therapy. Despite honeycombing confirmed by computed tomography of the thorax, symptoms and radiographic findings disappeared within 1 month after withdrawal of nitrofurantoin. The case highlights the fact that nitrofurantoin-induced lung disease may run a benign course and respond favorably despite radiographic evidence of established lung fibrosis (honey combing).
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GUIDELINES
Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations
Dheeraj Gupta, Ritesh Agarwal, Ashutosh Nath Aggarwal, VN Maturu, Sahajal Dhooria, KT Prasad, Inderpaul S Sehgal, Lakshmikant B Yenge, Aditya Jindal, Navneet Singh, AG Ghoshal, GC Khilnani, JK Samaria, SN Gaur, D Behera, S. K. Jindal for the COPD Guidelines Working Group
July-September 2013, 30(3):228-267
DOI
:10.4103/0970-2113.116248
PMID
:24049265
Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.
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LETTERS TO EDITOR
Comments on editorial - Test of reversibility of airway obstruction: Time for review
HG Varudkar
July-September 2013, 30(3):224-224
DOI
:10.4103/0970-2113.116239
PMID
:24049262
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ORIGINAL ARTICLES
Regression equations for peak expiratory flow in healthy children aged 7 to 14 years from Punjab, India
Shallu Mittal, Sharat Gupta, Avnish Kumar, Kamal Dev Singh
July-September 2013, 30(3):183-186
DOI
:10.4103/0970-2113.116245
PMID
:24049251
Background:
Measurement of peak expiratory flow (PEF) is imperative for management and evaluation of asthmatic children. It is well-known that lung function parameters show wide variations with respect to regional, racial, and genetic factors.
Aim:
This study was conducted to measure PEF in healthy Punjabi children aged 7-14 years as only a few studies have evaluated the lung functions in North Indian children.
Materials and Methods:
A cross-sectional study was conducted in which PEF was measured in 366 healthy schoolchildren (186 boys and 180 girls) of Patiala district, using the Mini Wright Peak Flow Meter. Best of the three trials was recorded. All the subjects were tested in standing position after recording their age, height, and weight. SPSS v. 13 was used for the statistical analysis.
Results:
The present study showed that all the three independent variables (age, height, and weight) had a significant positive correlation with PEF, in both genders. Furthermore, height was maximally correlated with PEF in both boys (
r
= 0.970) and girls (
r
= 0.964). The mean PEF value in boys (249.34 ± 81.36 L/min) was significantly higher than girls (233.31 ± 67.06 L/min). Regression equations for PEF were also determined using age, height, and weight, separately for the genders.
Conclusion:
Equations derived from this study for estimation of expected PEF values would help the clinicians in assessing the airway obstruction in this population subset.
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Outcomes of patients with unresected stage III and stage IV non-small cell lung cancer: A single institution experience
Manpreet Singh Tiwana, Hsueh Ni Lee, Sunil Saini, SK Verma, Meenu Gupta, Madhur Gupta, Navneet Jain, Girish Sindhwani, Jagdish Rawat, Manju Saini, Neena Chauhan, Dushyant Gaur
July-September 2013, 30(3):187-192
DOI
:10.4103/0970-2113.116250
PMID
:24049252
Introduction:
To report on the demographic profile and survival outcomes of North Indian population affected with stage III and stage IV non-small cell lung cancer (NSCLC).
Materials and Methods:
From November 2008 to January 2012, 138 consecutively diagnosed NSCLC patients were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival (OS), Kaplan-Meier survival plots,
t
-test, Cox proportional hazards models were generated by multivariate analysis [MVA]) and analyzed on SPSS software (version 19.0; SPSS, Inc., Chicago, IL).
Results:
Median OS of stage III patients was 9.26 ± 1.85 months and 2-year survival rate of 13% while stage IV patients had median OS of 5 ± 1.5 months with a 2-year survival rate of 8%. Cox regression modeling for MVA demonstrated higher biologically equivalent dose (BED) (
P
= 0.01) in stage III while in stage IV non-squamous histology (
P
= 0.01), administration of chemotherapy (
P
= 0.02), partial responders to chemotherapy (
P
= 0.001), higher BED (
P
= 0.02), and those with skeletal metastasis alone (
P
= 0.17) showed a better OS.
Conclusion:
Our data showed that a higher BED is associated with favorable outcomes, indicating a role of dose escalated radiation therapy to the primary lesion in both stage III and essentially in stage IV NSCLC. Additionally, optimal use of chemotherapy relates to better survival. The developing, resource restrained nations need to follow an economically feasible multimodality approach.
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The role of induced sputum in the diagnosis of pulmonary tuberculosis
Saurabh Biswas, Anirban Das, Arijit Sinha, Sibes K Das, Tapan Das Bairagya
July-September 2013, 30(3):199-202
DOI
:10.4103/0970-2113.116259
PMID
:24049254
Background:
Microbiological confirmation of pulmonary tuberculosis (TB) is of paramount importance in the era of immunocompromised host and emergence of multi-drug resistance.
Objectives:
To assess the value of sputum induction (SI) with hypertonic saline nebulization as a diagnostic tool in patients with suspected pulmonary TB who have no/inadequate sputum or have a sputum smear negative for acid fast bacillus (AFB).
Materials
and
Methods:
One hundred patients with clinical and radiological evidence of pulmonary TB with no/inadequate sputum or smear negative with spontaneous sputum were studied. Sputum was induced with 20 mL of 3% hypertonic saline solution delivered through ultrasonic nebulizer. The specimens were subjected to Ziehl Neelsen staining and were examined under oil immersion lens for the presence of AFB. The specimens were also subjected to mycobacterial culture in BACTEC 460 TB system.
Results:
Ninety five patients could produce adequate sputum after SI. Sputum from thirty two patients were found to be positive both in smear and culture while sputum from another three patients were smear negative, but culture positive.
Conclusion:
SI is a safe, cheap and non-invasive procedure and provides significant yield in the diagnosis of pulmonary TB; thus, increasing the case detection rate of smear positive pulmonary TB.
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CASE REPORTS
Spontaneous resolution of post-traumatic pulmonary artery pseudoaneurysm: Report of two cases
Sandeep Goel, Atin Kumar, Shivanand Gamanagatti, Amit Gupta
July-September 2013, 30(3):203-205
DOI
:10.4103/0970-2113.116262
PMID
:24049255
Pulmonary artery aneurysm is a rare clinical entity with congenital or mycotic origin being most common causes. Post-traumatic pulmonary pseudoaneurysms are extremely rare. Unless diagnosed early and properly managed, these can be fatal. Only few cases have been reported in the literature with most (except the one) being diagnosed much later after the initial injury and managed surgically. Only one case has been reported following blunt trauma injury, which was diagnosed immediately using computed tomography scan and managed conservatively. Here, we report two cases of pulmonary artery pseudoaneurysm one following gunshot injury and other following blunt injury which was diagnosed on contrast enhanced computed tomography chest and managed conservatively.
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Pancoast syndrome: A rare presentation of non-Hodgkin's lymphoma
Anirban Sarkar, Anirban Das, Sumitra Basuthakur, Sudipta Pandit, Sibes K Das, Sabyasachi Choudhury
July-September 2013, 30(3):209-211
DOI
:10.4103/0970-2113.116266
PMID
:24049257
Pancoast syndrome is a common presentation of bronchogenic carcinoma, but other malignancies are rarely cited as its cause. Pancoast syndrome due to non-Hodgkin's lymphoma is rarely described in the literature. Here, we report a case of Pancoast syndrome due to non-Hodgkin's lymphoma to increase the awareness of the clinicians regarding essentiality of tissue diagnosis of Pancoast tumor before starting the treatment.
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Congenital cystic adenomatoid malformation of lung: Report of two cases with review of literature
Panduranga Chikkannaiah, Ranjit Kangle, Manjiri Hawal
July-September 2013, 30(3):215-218
DOI
:10.4103/0970-2113.116272
PMID
:24049259
Congenital cystic adenomatoid malformations (CCAM) also known as congenital pulmonary airway malformation is a developmental, non-hereditary, hamartomatous abnormality of lung with unknown etiology. It is a rare disease with an incidence of 1 in 25,000 to 1 in 35,000. It is a disease of infancy with most of the cases diagnosed within first 2 years of life. We report autopsy findings of two fetuses with congenital cystic adenomatoid malformation (Stocker Type II and I) with brief review of literature.
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EDITORIALS
Optimizing the management of lung cancer: Role of the pulmonologist in India
Prasanta R Mohapatra
July-September 2013, 30(3):173-174
DOI
:10.4103/0970-2113.116230
PMID
:24049248
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LETTERS TO EDITOR
Author's Response
Sunil K Chhabra
July-September 2013, 30(3):225-225
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Same-day sputum microscopy: The road ahead in tuberculosis diagnosis
Sitanshu Sekhar Kar, Archana Ramalingam
July-September 2013, 30(3):226-227
DOI
:10.4103/0970-2113.116242
PMID
:24049264
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ORIGINAL ARTICLES
High altitude pulmonary edema among "Amarnath Yatris"
Parvaiz A Koul, Umar Hafiz Khan, Tajamul Hussain, Ajaz Nabi Koul, Sajjad Malik, Sanaullah Shah, Sajjad Rajab Bazaz, Wasim Rashid, Rafi Ahmad Jan
July-September 2013, 30(3):193-198
DOI
:10.4103/0970-2113.116254
PMID
:24049253
Background:
Annual pilgrimage (Yatra) to the cave shrine of Shri Amarnath Ji' is a holy ritual among the Hindu devotees of Lord Shiva. Located in the Himalayan Mountain Range (altitude 13,000 ft) in south Kashmir, the shrine is visited by thousands of devotees and altitude sickness is reportedly common.
Materials
and
Methods:
More than 600,000 pilgrims visited the cave shrine in 2011 and 2012 with 239 recorded deaths. Thirty one patients with suspected altitude sickness were referred from medical centers en-route the cave to Sher-i-Kashmir Institute of Medical Sciences, a tertiary-care center in capital Srinagar (5,000 ft). The clinical features and the response to treatment were recorded.
Results:
Thirty-one patients (all lowlanders, 19 male; age 18-60 years, median 41) had presented with acute onset breathlessness of 1-4 days (median 1.9 d) starting within 12-24 h of a rapid ascent; accompanied by cough (68%), headache (8%), dizziness and nausea (65%). Sixteen patients had associated encephalopathy. Clinical features on admission included tachypnea (
n
= 31), tachycardia (
n
= 23), bilateral chest rales (
n
= 29), cyanosis (
n
= 22) and grade 2-4 encephalopathy. Hypoxemia was demonstrable in 24 cases and bilateral infiltrates on radiologic imaging in 29. Ten patients had evidence of high-altitude cerebral edema. All patients were managed with oxygen, steroids, nifedipine, sildenafil and other supportive measures including invasive ventilation (
n
= 3). Three patients died due to multiorgan dysfunction.
Conclusions:
Altitude sickness is common among Amaranath Yatris from the plains and appropriate educational strategies should be invoked for prevention and prompt treatment.
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Predictors of requirement of mechanical ventilation in patients with chronic obstructive pulmonary disease with acute respiratory failure
S Kumar, GC Khilnani, A Banga, SK Sharma
July-September 2013, 30(3):178-182
DOI
:10.4103/0970-2113.116238
PMID
:24049250
Background and Objective:
Acute exacerbation of chronic obstructive pulmonary disease (COPD) leads to increased morbidity, mortality and requirement of invasive mechanical ventilation (MV). The aim of this study was to identify predictors of need of MV in these patients.
Materials and Methods:
Clinical symptomatology, demographic profile, biochemical parameters including renal functions, liver functions and acid base parameters, and acute physiology and chronic health evaluation II (APACHE II) score at the time of admission were recorded in 100 patients of COPD exacerbation. Various parameters were compared between patients in whom MV was required with those managed with medical therapy.
Results:
MV was required in 73% of the patients. Parameters found to be independent predictors of need of MV were: Admission APACHE-II score ≥ 11.5 {adjusted odds ratio (OR) [95% confidence interval (CI)]: 1.42 [1.08-1.86];
P
= 0.012}, first day pH ≤ 7.28 (adjusted OR [95% CI]: 1.09 [1.02-1.15];
P
= 0.008), first day PaCO
2
≥ 68.6 mmHg (adjusted OR [95% CI]: 1.09 [1.02-1.15];
P
= 0.004) and worse premorbid functional status (adjusted OR [95% CI]: 17.01 [1.95-148.68];
P
= 0.01).
Conclusions:
Underlying disease severity as assessed by premorbid functional status and APACHE-II score, and the acuity of respiratory system decompensation as assessed by the admitting arterial pH and PaCO
2
, are independent predictors of need of MV in patients with exacerbation of COPD.
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RADIOLOGY QUIZ
Potato swelling of sternum
Rakesh K Chawla, Arun Madan, Rahul Madoiya, Aditya Chawla
July-September 2013, 30(3):219-221
DOI
:10.4103/0970-2113.116234
PMID
:24049260
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A rare case of interaorticobronchial diverticulum of esophagus in a case of scleroderma
Argha Chatterjee, Sudipto Chaudhury
July-September 2013, 30(3):222-223
DOI
:10.4103/0970-2113.116236
PMID
:24049261
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1,056
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