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REVIEW
Difficulties in managing lymph node tuberculosis
PR Gupta
October-December 2004, 21(4):50-53
  169,149 3,506 -
GUIDELINES
Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations
Dheeraj Gupta, Ritesh Agarwal, Ashutosh Nath Aggarwal, Navneet Singh, Narayan Mishra, GC Khilnani, JK Samaria, SN Gaur, SK Jindal
July 2012, 29(6):27-62
DOI:10.4103/0970-2113.99248  PMID:23019384
  26,800 8,982 10
CLINICAL MEDICINE
Role of sputum cultures in diagnosis of respiratory tract infections
AK Bhattacharya
January-March 2006, 23(1):20-24
DOI:10.4103/0970-2113.44426  
  33,971 1,649 -
REVIEW ARTICLES
Digital clubbing
Malay Sarkar, DM Mahesh, Irappa Madabhavi
October-December 2012, 29(4):354-362
DOI:10.4103/0970-2113.102824  PMID:23243350
Digital clubbing is an ancient and important clinical signs in medicine. Although clubbed fingers are mostly asymptomatic, it often predicts the presence of some dreaded underlying diseases. Its exact pathogenesis is not known, but platelet-derived growth factor and vascular endothelial growth factor are recently incriminated in its causation. The association of digital clubbing with various disease processes and its clinical implications are discussed in this review.
  24,005 2,205 2
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.
  17,447 3,992 1
CME
Sputum induction - A useful tool in diagnosis of respiratory diseases
KB Gupta, Seema Garg
April-June 2006, 23(2):82-86
DOI:10.4103/0970-2113.44416  
Sputum induction by inhalation of hypertonic saline is a noninvasive, simple, cost effective and safe procedure to collect respiratory secre­tions from lung airways for diagnosis of various respiratory diseases. Sputum induction has higher yield in comparison to spontaneous sputum, BAL, bronchial washing and gastric lavage. It is widely used to assess airway inflammation in asthma and chronic obstructive pulmonary disease (COPD). It can be used as a complementary tool to BAL both in research and in clinical monitoring of patients with interstitial lung disease (ILD). The cells, recovered from spontaneous coughing can be used to study lung cancer, respiratory infections and in diagnosis of pneumocystis carinii pneumonia in patients infected with human immunodeficiency virus. In developing countries having high prevalence of pulmonary tuberculosis, sputum induction (SI) can increase the diagnostic yield, resulting in better categorization of patients for treatment purposes. It increases case detection rate of smear negative pulmonary tuberculosis specially in area where facili­ties for more invasive and expensive techniques are not available.
  18,982 1,252 -
VIEWPOINT
Community acquired pneumonia - Typical or atypical ?
Rajinder Singh Bedi
July-September 2006, 23(3):130-131
DOI:10.4103/0970-2113.44406  
  15,833 669 -
Smoking Index - A Measure To Quantify Cumulative Smoking Exposure
S. K Jindal, S. K Malik
November 1988, 6(4):195-196
‘Smoking Index’ is a parameter used to express cumulative smoking exposure quantitatively. This is especially useful in defining risk ratio of a smoking related disease. The parameter is smiliar to ‘Pack Year’ but more suitable to Indian subjects.
[ABSTRACT]   Full text not available  [PDF]
  12,258 2,907 -
REVIEW ARTICLE
Recent trends in pulmonary arterial hypertension
Rajagopalan Natarajan
January-March 2011, 28(1):39-48
DOI:10.4103/0970-2113.76300  PMID:21654985
Pulmonary hypertension is a serious and unrelenting pulmonary vascular disorder that affects the functional quality of patients and significantly decreases their life span. If diagnosed early, with the number of new therapeutic options that are available, a better quality of life can be provided for a protracted length of time. It is likely that the available treatment will change the natural course of the disease and perhaps prolong survival. As symptoms are often subtle in the early stages of the disease it is imperative that physicians are aware of the manifestations of this condition. A thorough investigation of patients suspected of this condition is essential so that appropriate treatment can be initiated promptly. The routine workup of a patient suspected to have pulmonary hypertension could easily be carried out in any well-equipped peripheral hospital in many affluent and advanced countries. However, it must be mentioned that in some less advanced countries the necessary work up can only be done in major teaching hospitals. Both pulmonologists and cardiologists should be aware of the pathophysiology of pulmonary arterial hypertension, the workup and the treatment options that are available. Patients with refractory pulmonary hypertension should be referred to these research centers for enrolment into any ongoing drug trials as well as for evaluation for heart−lung, single lung, or double lung transplantation. This paper is primarily aimed at pulmonologists and cardiologists taking care of these patients. Unless indicated otherwise this paper mainly deals with WHO group 1 pulmonary hypertension which is designated pulmonary arterial hypertension. Extensive review of the literature spanning the last 30 years was made through Medline using titles such as primary pulmonary hypertension, pulmonary arterial hypertension, secondary pulmonary hypertension, and pulmonary vascular diseases.
  13,049 1,515 3
LETTERS TO EDITOR
Indexed journal: What does it mean?
Yatan Pal Singh Balhara
April-June 2012, 29(2):193-193
DOI:10.4103/0970-2113.95345  
  13,237 1,009 4
ORIGINAL ARTICLES
Adenosine deaminase (ADA) level in tubercular pleural effusion
SK Verma, AL Dubey, PA Singh, SL Tewerson, Devashish Sharma
July-September 2008, 25(3):109-110
DOI:10.4103/0970-2113.44121  PMID:20165661
Study objective : To study the value of adenosine deaminase level in tuber­cular pleural effusion. Design: A hospital based observational study. Setting : Out and In patients service of department of Tuberculosis & Chest Diseases, MLN Medical College Allahabad. Patients : 50 consecutive patients of pleural effusion, who were above the age of 12 years, were studied. RESULTS: Pleural fluid adenosine deaminase was more than 36 IU/L (36 to 229.7 IU/L) in tubercular pleural effusion (34 patients). In case of malignancy no. of patients was 08 and pleural fluid adenosine deaminase was more than 18.5 IU/L (18.5 to 87.6 IU/L). While in one case of hypoprotenemiea pleural fluid adenosine deaminase was 8.21 IU/L. If 36 IU/L is taken as cut of limit the sensitiv­ity and specificity of ADA for tuberculosis is 100 % and 77.7 %. More than 100 IU/L was exclusively seen in tubercular pleural effusion. Conclusion: ADA > 100IU/L was observed in TB only.
  12,980 1,119 -
Role of HRCT in detection and characterization of pulmonary abnormalities in patients with febrile neutropenia
Mandeep Kang, Debasis Deoghuria, Subash Varma, Dheeraj Gupta, Anmol Bhatia, Niranjan Khandelwal
April-June 2013, 30(2):124-130
DOI:10.4103/0970-2113.110420  PMID:23741093
Background: Fever is of grave concern in the management of patients with neutropenia with early detection of a focus of infection being the major goal. As lungs are the most common focus, chest imaging is of vital importance. This Institute Review Board approved prospective study was undertaken to assess the usefulness of high resolution computed tomography (HRCT) in early detection and characterization of pulmonary abnormalities in febrile neutropenia. Materials and Methods: A total of 104 consecutive patients (M:F:75:29, age range 11-66 years) with fever of 38.2°C or more with an absolute neutrophil count <500/μl underwent HRCT chest. HRCT diagnosis was compared with final diagnosis based on ancillary investigations. Results: HRCT could detect pulmonary abnormalities in 93 patients (89.4%) with air space consolidation being the predominant finding (n = 57), followed by ground-glass opacities (Ground glass opacity (GGO), n = 49) and nodules (n = 39). HRCT could correctly characterize the infective lesions in 76 patients (81.7%). Presence of random or pleural-based nodules >10 mm with or without surrounding GGO or cavitations was sensitive (95.23%) and specific (96.7%) for fungal infection, while small (1-4 mm) random or centrilobular nodules with tree-in-bud appearance was sensitive (90%) and highly specific (97.02%) for tuberculosis. Diagnosis of pyogenic infection based on presence of air-space consolidation, pleural effusion, GGO or centrilobular nodules showed a sensitivity of 84.78% and specificity of 93.84%, whereas patchy or diffuse GGO, interstitial thickening and/or air-space consolidation showed high sensitivity (86.7%) and specificity (96.8%) for Pneumocystis jiroveci pneumonia. Conclusion: HRCT chest is an excellent modality in the diagnostic work-up of patients with febrile neutropenia allowing early detection and characterization of pulmonary abnormalities.
  13,171 840 -
CLINICAL REVIEW
Revised national tuberculosis control programme (RNTCP) in India; current status and challenges
Navneet Singh, Dheeraj Gupta
October-December 2005, 22(4):107-111
  11,377 759 -
REVIEW ARTICLES
Tuberculosis and nutrition
Krishna Bihari Gupta, Rajesh Gupta, Atulya Atreja, Manish Verma, Suman Vishvkarma
January-March 2009, 26(1):9-16
DOI:10.4103/0970-2113.45198  PMID:20165588
Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels. Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls. Malnutrition can lead to secondary immunodeficiency that increases the host's susceptibility to infection. In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting. Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. Nutritional status of patients improves during tuberculosis chemotherapy. High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations. Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.
  9,177 2,650 21
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
  9,802 1,693 2
CASE REPORTS
Unusual presentation of spontaneous pneumomediastinum
Tae jin Cho, Hoon Kim
October-December 2010, 27(4):239-241
DOI:10.4103/0970-2113.71961  PMID:21139723
Spontaneous pneumomediastinum (SPM) is an uncommon, self-limiting condition resulting from alveolar rupture in young adults. There are asthma, illicit drug use, and activities triggering a Valsalva maneuver as causes of developing SPM. We report two patients who were diagnosed with SPM in the absence of known predisposing factors and without any clinical sign of subcutaneous emphysema of the neck, the most common physical finding on presentation. Both of them developed dysphagia after swallowing a peach seed and boned rib of pork, respectively. SPM was suspected after performing lateral neck X-ray, and the diagnosis of SPM was confirmed by chest CT. These cases showed the importance of performing the lateral neck X-ray to screen SPM in patients with dysphagia.
  10,671 453 2
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.
  9,188 1,691 7
A systematic approach to interpretation of heterogeneous lung attenuation on computed tomography of the chest
Anjali Agrawal, Anurag Agrawal, Vishal Bansal, Meenakshi Pandit
October-December 2013, 30(4):327-334
DOI:10.4103/0970-2113.120610  PMID:24339492
Computed tomography (CT) chest is widely used as an adjunct to clinical examination and pulmonary function tests in the evaluation of unexplained dyspnoea. In such patients, heterogeneous lung attenuation is a common finding on CT. Heterogeneous lungs can be caused by varying regional aeration, varying regional perfusion, and ground glass opacities (GGO) representing airspace or interstitial pathology. It does not serve the referring clinicians or the patients well if the radiology report simply mentions the heterogeneity of the lungs without due analysis of the cause of heterogeneity and a meaningful differential diagnosis. Therefore, it is imperative for the radiologist and the treating pulmonologist to have an in-depth understanding of the pathogenesis of pulmonary heterogeneity. This, in conjunction with clinical data, can narrow the differential diagnosis or, at times, lead to specific diagnoses. The purpose of this review is to familiarize readers with the CT representation of heterogeneities in aeration and perfusion of the lung, relate patterns of GGO to underlying pathology, and provide illustrative case studies highlighting the radiological approach to heterogeneous lungs.
  9,453 1,294 1
CME
Management of tuberculosis in special situations
Rajinder Singh Bedi
October-December 2005, 22(4):138-141
  9,325 1,269 -
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
  8,088 1,103 3
ORIGINAL ARTICLES
Sputum cytology in suspected cases of carcinoma of lung (Sputum cytology a poor man's bronchoscopy!)
AS Ammanagi, VD Dombale, AT Miskin, GL Dandagi, SS Sangolli
January-March 2012, 29(1):19-23
DOI:10.4103/0970-2113.92356  
Aims: To evaluate the role of sputum cytology in the diagnostic work-up of patients with suspected lung cancer . Settings and Design : Spontaneously produced fresh sputum was analyzed in clinically suspected cases of lung cancer. Materials and Methods: Spontaneously produced fresh sputum was analyzed in 36 clinically suspected cases of lung cancer. It was carried out using the "fresh pick and smear" method, which employs examination of sputum for blood-tinged, discolored or solid particles and preparation of thin and even smears from these selected portions. Statistical Analysis Used : Average and means. Results: Sensitivity of sputum cytology was 60%, which increased with an increase in the number of samples examined. Conclusions: Sputum cytology in suspected cases of carcinoma of lung is a useful diagnostic tool. It may be called as a poor man's bronchoscopy.
  7,923 718 5
REVIEW ARTICLE
Chronic obstructive pulmonary disease and peripheral neuropathy
Prem Prakash Gupta, Dipti Agarwal
January-March 2006, 23(1):25-33
DOI:10.4103/0970-2113.44427  
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death world-wide and a further increase in the prevalence as well as mortality of the disease is predicted for coming decades. There is now an increased appreciation for the need to build awareness regarding COPD and to help the thousands of people who suffer from this disease and die prematurely from COPD or its associated complication(s). Peripheral neuropathy in COPD has received scanty attention despite the fact that very often clinicians come across COPD patients having clinical features suggestive of peripheral neuropathy. Electrophysiological tests like nerve conduction studies are required to distinguish between axonal and demyelinating type of disorder that cannot be analyzed by clinical examination alone. However, various studies addressing peripheral neuropathy in COPD carried out so far have included patients with COPD having markedly varying baseline characteristics like severe hypoxemia, elderly patients, those with long duration of illness, etc. that are not uniform across the studies and make it difficult to interpret the results to a consistent conclusion. Almost one-third of COPD patients have clinical evidence of peripheral neuropathy and two-thirds have electrophysiological abnormalities. Some patients with no clinical indication of peripheral neuropathy do have electrophysiological deficit suggestive of peripheral neuropathy. The more frequent presentation consists of a polyneuropathy that is subclinical or with predominantly sensory signs, and the neurophysiological and pathological features of predominantly axonal neuropathy. The presumed etiopathogenic factors are multiple: chronic hypoxia, tobacco smoke, alcoholism, malnutrition and adverse effects of certain drugs.
  7,982 579 4
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.
  6,802 1,548 13
Lung cancer in the Kashmir valley
Parvaiz A Koul, Satish Kumar Kaul, Mohammad Mushtaq Sheikh, Reyaz A Tasleem, Azra Shah
July-September 2010, 27(3):131-137
DOI:10.4103/0970-2113.68309  PMID:20931030
Background: Lung cancer has been found to be the second commonest cancer according to a hospital-based data from Kashmir, India. However, no incidence studies are available. Objective: To ascertain the incidence of lung cancer in Kashmir. Materials and Methods: All newly histologically diagnosed cases of lung cancer seen in various hospital and private laboratories of the Kashmir valley were registered over a period of two years (January 1, 2004 to December 31, 2005). Also included were patients attending the various oncological service areas of the institute and those diagnosed from any other laboratory outside the state. The incidence rate was calculated using the January 2005 population as the reference population estimated using the census-based projected populations. Results: Four hundred and sixty-two incident cases of lung cancer were seen during the study period. The crude incidence rate, age standardized (world) and truncated age adjusted (40-69 years, world) incidence rates for lung cancer per 100 000 population were 4.01, 6.48 and 15.28 respectively (males 6.55, 10.09 and 23.94 respectively and females 1.19, 2.14 and 4.65). The age adjusted rates for males in district Srinagar was 19.34 per 100 000. One hundred and fifty nine (69.8%) of the 221 had a history of Hukkah smoking. Conclusions: Even though Kashmir as a whole is a low incidence area for lung cancer (ASR of < 15), Srinagar district has the highest incidence of lung cancer among the males in Kashmir. The data presented is assumed to be the closest approximation to a population-based data registry and the geographical incidence maps of ICMR need appropriate updating
  7,336 518 6
CASE REPORTS
Laryngeal tuberculosis clinically similar to laryngeal cancer
SK Verma, Sanjay Kumar Verma, Sanjay
July-September 2007, 24(3):87-89
Laryngeal tuberculosis is a rare disease. The presenting features are usually hoarse­ness or dysphagia with other vague and nonspecific symptoms. Laryngoscopic fea­tures mimic malignancy in many cases. There are no noninvasive tests which can confirm a diagnosis of laryngeal tuberculosis. Biopsy of the primary growth itself is diagnostic and may show caseating granulomatous inflammation. Microbiologi­cal confirmation, though desirable, may not always be possible. The response to antitubercular treatment is good. We report a 52 year old man who presented to us with hoarseness of voice, haemoptysis and a proliferative growth in the epiglottis and was diagnosed to have laryngeal tuberculosis on histopathology. He had an excellent response to antituberculosis therapy and is now asymptomatic.
  7,486 355 -
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