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   2019| March-April  | Volume 36 | Issue 2  
    Online since February 28, 2019

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Bundle of care approach to reduce ventilator-associated pneumonia in the intensive care unit in a tertiary care teaching hospital in North India
Varun Goel, Savita Gupta, Dakshina Bisht, Rashmi Sharma
March-April 2019, 36(2):177-178
DOI:10.4103/lungindia.lungindia_341_18  PMID:30829261
  1,472 199 -
Repeated exacerbation of asthma: An intrinsic phenotype of uncontrolled asthma
Neeraj Jain, K Satish, Nitin Abhyankar, Nila Velayudhan, Jayakumar Gurunathan
March-April 2019, 36(2):131-138
DOI:10.4103/lungindia.lungindia_434_17  PMID:30829247
Asthma is a chronic disease of the airways affecting a large number of people across the globe. Uncontrolled asthma poses an emotional as well as the physical burden on patients and results in a great economic burden. “Exacerbation-prone phenotype” asthmatics are a cluster of patients who may suffer from more frequent and severe exacerbations than other asthmatics. Factors such as inadequate symptom control, improper adherence to medications, and incorrect use of inhalers are responsible for frequent asthma exacerbations. Caring for the patient with “exacerbation-prone asthma” needs participation from both the doctor as well as the patient. Self-management, improving knowledge about the disease, control of comorbidities, and a stepwise approach with the use of a single inhaler maintenance and reliever therapy in patients with severe asthma could help in delivering better care for the “exacerbation-prone phenotype” of asthmatics.
  1,129 255 -
A pilot project: 99DOTS information communication technology-based approach for tuberculosis treatment in Rajkot district
Dharitri Thakkar, Kiran G Piparva, Suresh G Lakkad
March-April 2019, 36(2):108-111
DOI:10.4103/lungindia.lungindia_86_18  PMID:30829243
Background: 99DOTS (Directly Observed Treatment, Short course) is a low-cost, mobile phone-based technology that enables real-time remote monitoring of daily intake of treatment, first introduced by the Revised National Tuberculosis Programme under the national programme in 2015 in high-burden antiretroviral therapy (ART) centers. This project was launched for the first time in 2016 in Rajkot district, Gujarat, India, and hence this was an effort to evaluate 99DOTS. Objectives: The objective of this study was to evaluate treatment adherence rate and treatment outcome of 99DOTS-information communication technology (ICT)-based approach for tuberculosis (TB) management. Materials and Methods: Data from 99DOTS were obtained from February 2016 to September 2017 after obtaining approval from the Institutional Ethical Committee and permission from the head of the department of district TB center (DTC), Rajkot. Data were evaluated for sociodemographic pattern, adherence rate, and treatment outcome. Results: A total of total 347 registered patients, 197 (56.77%) patients diagnosed by private practitioners and 150 (43.22%) patients having HIV-TB from ART center were initiated TB treatment under 99DOTS project from nine different talukas of Rajkot district. Mean age of the registered TB patients was 36 ± 13.55 years with predominance of “new cases” (n = 275, 79.25%) and “male” gender (n = 257, 74.06%). The overall treatment adherence rate of 99DOTS was 96.03%, while adherence by “call” was 92.25% and adherence by “manual” was 32.12%. Cure rate was higher in patients with TB only (n = 113, 78.47%) as compared to patients with HIV-TB co-infection (n = 46, 67.64%). Defaulter rate (n = 19, 13.19%) was also higher in patients with TB only, while death rate (n = 14, 20.58%) was higher in patients of TB with HIV co-infection. Conclusion: 99DOTS is an effective approach for improving TB medication adherence, thereby increasing the compliance to TB treatment. It will be helpful for easy access of treatment to patients from remote areas, improve notification of patients from private practitioners, and enable differentiated care.
  1,077 141 -
Elastography in mediastinal ultrasound, where do we stand?
Malay Sharma, Piyush Somani
March-April 2019, 36(2):91-93
DOI:10.4103/lungindia.lungindia_67_19  PMID:30829240
  952 227 -
The initial steps in pulmonary rehabilitation: How it all began?
K Vaishali, Mukesh Kumar Sinha, Arun G Maiya, Anup Bhat
March-April 2019, 36(2):139-141
DOI:10.4103/lungindia.lungindia_101_18  PMID:30829248
Pulmonary rehabilitation plays a vital role in improving symptom, thereby enhancing health-related quality of life in patients with chronic obstructive pulmonary disease. We here with review is highlighting the landmark changes and recommendation for pulmonary rehabilitation since inception to till date. We also discuss the utilization of oxygen therapy, various measures of exercise training, and adherence strategy recommendation for betterment of the patient performance in their activity of daily living life.
  891 208 -
Craniofacial and upper airway profile assessment in North Indian patients with obstructive sleep apnea
Ayush Gupta, Rohit Kumar, Dipak Bhattacharya, BB Thukral, Jagdish Chander Suri
March-April 2019, 36(2):94-101
DOI:10.4103/lungindia.lungindia_303_18  PMID:30829241
Introduction: Upper airway imaging can often identify the anatomical risk factors for sleep apnea and provide sufficient insight into the pathophysiology of obstructive sleep apnea (OSA). Materials and Methods: We conducted a case–control, observational study at a tertiary care hospital in North India. All cases and controls underwent lateral cephalometry and magnetic resonance imaging (MRI) for craniofacial and upper airway evaluation. Only the cases had polysomnography testing for confirmation of OSA and assessing the severity of disease. Results: Forty cases and an equal number of matched controls were recruited. On X-ray cephalometry, it was observed that the cases had a significantly larger hyoid mandibular distance and soft palate length; and shorter mandibular length. The MRI cephalometric variables were significantly different, the soft palate length, tongue length, and submental fat were longer while the retropalatal and retroglossal distance was shorter amongst the cases. A statistically significant positive correlation was found between the cephalometric parameters and the indices of severity of OSA. An increased hyoid mandibular distance and soft palate length, and a decrease in the lower anterior facial height were found to be predictive of severe OSA (Apnea–Hypopnea Index –>30/h). An increased hyoid mandibular distance, soft palate length, and the tongue length and a reduced mandibular length were found to be predictive of need for continuous positive airway pressure (CPAP) pressures of ≥15 cm H2O. There were significant differences between the cephalometric parameters of the Indian OSA patients and patients from other ethnicities reported in the literature. Conclusions: OSA patients had a significantly smaller upper airway compared to age-, sex-, and body mass index-matched controls and cephalometric variables correlated with the indices of OSA severity. The cephalometric assessment was also predictive of severe OSA and the need for higher pressures of CPAP. This indicates the important role of upper airway anatomy in the pathogenesis of OSA.
  877 213 -
A retrospective study comparing the ultrathin versus conventional bronchoscope for performing radial endobronchial ultrasound in the evaluation of peripheral pulmonary lesions
Inderpaul Singh Sehgal, Sahajal Dhooria, Amanjit Bal, Nalini Gupta, Babu Ram, Ashutosh N Aggarwal, Ritesh Agarwal
March-April 2019, 36(2):102-107
DOI:10.4103/lungindia.lungindia_115_18  PMID:30829242
Background: Few studies have reported on the utility of ultrathin bronchoscopes (UTBs) for performing radial probe endobronchial ultrasound (EBUS). Herein, we describe our experience with UTB and conventional bronchoscope (CB) for performing radial EBUS. Materials and Methods: This was a retrospective study comparing the diagnostic yield of a prototype UTB (external diameter 3 mm, working channel diameter 1.7 mm) versus CBs (external diameter ≥4.9 mm) in performing radial EBUS for the evaluation of peripheral pulmonary lesions (PPLs). Fluoroscopic guidance was not available. Results: A total of 121 subjects (34, UTB; 87, CB; 69.4% males) with a mean (standard deviation [SD]) age of 55.2 (14.8) years underwent radial EBUS. The mean (SD) size of PPLs on computed tomography of the thorax was 22.2 (13.7) mm. The lesions were significantly smaller in the UTB group (16.4 vs 24.7 mm, P = 0.006). Eight lesions could be visualized within the lumen of the peripheral smaller bronchi with the UTB. The overall yield of radial EBUS was 52.9% and was similar in the two groups (UTB vs. CB, 55.9% vs. 51.7%; P = 0.7). The procedure time was significantly shorter in the UTB group. On multivariate logistic regression, the yield was similar in the two groups after adjusting for the size and location of the lesion and position of the radial probe in relation to the lesion. Conclusion: Despite smaller lesions, radial EBUS performed with the UTB was found to have similar efficacy to that performed with the CB. More lesions could be visualized endobronchially using the UTB making it an attractive alternative for performing radial EBUS.
  732 160 -
Determining the optimal time to assess the reversibility of airway obstruction
Jamel El Ghoul, Maher Abouda, Meriem Triki, Abdessalem Ghourabi, Ridha Charfi
March-April 2019, 36(2):123-130
DOI:10.4103/lungindia.lungindia_184_18  PMID:30829246
Context: The optimal time to interpret bronchodilator reversibility remains controversial. This time may affect a positive diagnosis and manage asthma and chronic obstructive pulmonary disease (COPD). Aims: We sought to document the time when maximum respiratory function is reached after inhalation of salbutamol and to define the optimal time of bronchodilator response to assess the reversibility or non reversibility of airway obstruction. Subjects and Methods: This prospective analytical study was spread over 8 months and included 58 patients with asthma or COPD with airway obstruction. Spirometry was performed before and at 5, 10, 15, 20, and 30 min after salbutamol inhalation (200 mcg) administered through pressurized metered-dose inhalers and large volume spacer. Results: After salbutamol inhalation, the mean individual peak bronchodilation occurred at 20 min for the forced vital capacity and at 30 min for the forced expiratory volume in 1 s. The percentage of reversible patients in our sample was guideline dependent. It increased from 53% to 67.2% when using the American Thoracic Society/European Respiratory Society definition compared to using the Global Initiative for Chronic Obstructive Lung Disease. The maximum number of reversible patients was significantly different at 20 min compared to 5 and 10 min. Conclusions: Interpreting bronchodilator reversibility after 20 min was the ideal time to judge the reversibility or nonreversibility in obstructive ventilatory disorders in adults.
  730 120 -
Approach to malignant pleural effusions: Role of pleural manometry exemplified by case scenarios
Irfan Ismail Ayub
March-April 2019, 36(2):142-148
DOI:10.4103/lungindia.lungindia_153_17  PMID:30829249
Issues related to the management of pleural effusion in India are unique. With high incidence of tuberculosis and malignancy, managing patients with pleural effusion may not be the same between patients. Decisions on intercostal chest drain insertion, volume of fluid to be removed during therapeutic thoracentesis, and further diagnostic imaging and investigations are often taken with difficulty in low-resource settings. Pleural manometry can help resolve these issues and help in the management of such patients. Pleural manometry has been advocated as a valuable tool to characterize underlying lung behavior during thoracentesis and has been proposed to be useful in diagnosing unexpandable lung, predicting the success of pleurodesis, and preventing the development of excessively negative pleural pressures which in turn may lead to the development of reexpansion pulmonary edema. There is very little literature on pleural manometry from India and other developing countries. In this article, the utility of pleural manometry in managing patients with malignant pleural effusion is discussed.
  687 159 -
Primary salivary gland-type tumors of the lung: A systematic review and pooled analysis
Pankaj Kumar Garg, Gopal Sharma, Shreyash Rai, Ashish Jakhetiya
March-April 2019, 36(2):118-122
DOI:10.4103/lungindia.lungindia_284_18  PMID:30829245
Introduction: Primary salivary gland-type tumors of the lung (PSGTTL) are rare intrathoracic malignant neoplasms. Their description in literature is largely limited to a few case series and case reports. A systematic review and pooled analysis of the previously reported cases of PSGTTL is presented here. Methods: Electronic database of PubMed using keywords “lung neoplasm” AND “salivary gland tumors” was used to identify the papers documenting the PSGTTL. Filters (publication date from January 1, 1900–-December 31, 2015, Humans and English) were applied to refine the search. A pooled analysis of clinical, pathological, treatment, and survival data was performed. Results: The present systematic review included 5 studies and a total of 233 patients. Mean age of the patients was 41 years (range 6–80 years) and there was a male preponderance (1.3:1). Common pathological types were mucoepidermoid (MEC) (56.6%), adenoid cystic (ACC) (39.5%), and epithelial-myoepithelial cancer (3.8%). Tumors were located in the central airways (trachea and major bronchi) in 43.3% of patients. Weighted median tumor size was 4.2 cm. Surgery was the primary treatment undertaken in 82.4% of the patients, while radiotherapy and chemotherapy were also used in 15.9% and 9.4% of the patients. Lymph node involvement was seen in 15.2% of the patients. Disease recurrences were observed in 21.1% of the patients (12.9% and 37.5% in MEC and ACC, respectively). Three-, 5-, and 10-year weighted overall survival was 86.4%, 81.4%, and 73.6% (93.8%, 90.0%, and 85.0%, respectively, for MEC and 76.7%, 62.8%, and 50.5%, respectively, for ACC). Conclusion: Surgery is the primary treatment of PSGTTL to achieve long-term survival. Role of chemotherapy and radiotherapy in the management of PSGTTL warrants further studies.
  722 108 -
Pleural effusion in acute pulmonary embolism in Bahrain: Radiological and pleural fluid characteristics
Amit Panjwani, Thuraya Zaid, Sughra Alawi, Dalal Al Shehabi, Eman Safar Abdulkarim
March-April 2019, 36(2):112-117
DOI:10.4103/lungindia.lungindia_58_18  PMID:30829244
Background and Objectives: Pleural effusion is seen in around half of the cases of pulmonary embolism (PE). There are no data on the incidence of pleural effusion in cases of PE in the Kingdom of Bahrain. This study was done to determine the frequency and radiological features of pleural effusion in cases of acute PE and also to characterize the pleural fluid biochemistry and cell type in patients subjected to diagnostic thoracentesis. Methods: This was a retrospective, observational single-center study. All the data of patients subjected to computed tomography pulmonary angiography (CTPA) in suspected cases of acute PE over a 4-year period were analyzed. Results: A total of 1756 patients were subjected to CTPA from January 2013 to December 2016. A diagnosis of acute PE was made in 200 patients (11.4%). Pleural effusion was identified in 70 cases (35%). Majority of the effusions were small to moderate in size, bilateral, and associated with peripheral emboli. Consolidation, atelectasis, and ground glass attenuation were common associated findings on CTPA in these patients. Consolidation was more common in patients of PE associated with pleural effusion as compared to those with PE alone (62.85% and 33.8%, respectively, odds rato: 3.279 and 95% confidence interval: 1.798–6.091, P < 0.001). Diagnostic thoracentesis was done in 6 (8.6%) of the cases. All the patients had an exudative effusion with normal glucose values and neutrophil predominance. Conclusion: PE was associated with pleural effusion in around one-third of the patients in Bahrain. The effusions were mainly small and bilateral. The emboli in cases associated with pleural effusion were mostly peripheral. Consolidation was the parenchymal abnormality detected on CTPA which was significantly associated with the presence of pleural effusion. Most of the pleural effusions were not suitable for thoracentesis. In patients subjected to fluid analysis, the effusions were exudative, neutrophilic predominant, and associated with normal glucose levels.
  641 143 -
Poison in the air: Declining air quality in India
Mayank Mishra
March-April 2019, 36(2):160-161
DOI:10.4103/lungindia.lungindia_17_18  PMID:30829253
Air pollution is a burgeoning environmental problem with potential for climate change. The worst-hit areas are the rapidly developing capital cities of low- and middle-income countries across the globe. Delhi, the capital of India, is no exception. In fact, Delhi was the most polluted of more than 1600 cities in the world according to the WHO's 2014 database for outdoor air pollution. The recent declaration of a public health emergency in and around the city speaks volumes about the declining air quality in India. Introspection into the various causes and mechanisms responsible for this sorry state of affairs, its impact on human health, and possible solutions to the problem is being reported.
  633 128 -
Pulmonary capillary hemangiomatosis: An unusual cause of primary pulmonary hypertension in a child with characteristic computed tomography imaging features
D Manjubashini, K Nagarajan, B Rajesh Kumar
March-April 2019, 36(2):157-159
DOI:10.4103/lungindia.lungindia_122_18  PMID:30829252
Pulmonary capillary hemangiomatosis (PCH) is a rare cause of primary pulmonary hypertension (PPH) diagnosed in children and young adults with a nonspecific clinical presentation of dyspnea, cough, chest pain, and fatigue. It is characterized by extensive proliferation of pulmonary capillaries within alveolar septa. The imaging features include diffuse centrilobular ground-glass opacities with features of pulmonary hypertension. We present a case of PCH in an 11-year-old boy who was diagnosed with PPH in echocardiography and referred for diagnostic imaging.
  596 107 -
Endobronchial ultrasound elastography in mediastinal lymphadenopathy: Report of two cases and systematic review of literature
Saurabh Mittal, Anant Mohan, Vijay Hadda, Karan Madan
March-April 2019, 36(2):149-153
DOI:10.4103/lungindia.lungindia_349_17  PMID:30829250
Endobronchial ultrasound elastography is new ultrasound technology that is being reported recently for the evaluation of mediastinal lymphadenopathy during endobronchial ultrasound-guided (EBUS) transbronchial needle aspiration. This modality is based on the assessment of tissue stiffness that may be useful in differentiating benign from malignant lesions. Image generation leads to colored images with different colors signifying varying degrees of stiffness. The utility of this technique has been studied to differentiate between benign and malignant lymph nodes and various methods for representation of results which include visual color estimation, quantitative color estimation, and strain ratios have been described. Herein, we report two patients with mediastinal lymphadenopathy wherein EBUS elastography was employed. We also systemically review the studies describing this technique in differentiating benign from malignant lymph nodes.
  569 104 -
Radiolucent right paratracheal mass: Incidental detection of an uncommon entity
Lokesh Singh, Uma Debi, Vikas Bhatia, Manavjit S Sandhu
March-April 2019, 36(2):162-163
DOI:10.4103/lungindia.lungindia_452_18  PMID:30829254
  517 109 -
“Pearl” in the lung: Hydatid membrane
Milind Baldi, Sahajal Dhooria, Ritesh Agarwal, Inderpaul Singh Sehgal
March-April 2019, 36(2):176-176
DOI:10.4103/lungindia.lungindia_287_18  PMID:30829260
  501 104 -
Learning curve: Endobronchial ultrasound-guided needle aspiration
Nishtha Singh, Sheetu Singh, Virendra Singh
March-April 2019, 36(2):178-179
DOI:10.4103/lungindia.lungindia_434_18  PMID:30829262
  503 88 -
A rare complication of endobronchial ultrasound-guided transbronchial needle aspiration: Pericardial empyema
Muhammet Sayan, Huseyin Arpag
March-April 2019, 36(2):154-156
DOI:10.4103/lungindia.lungindia_262_18  PMID:30829251
Endobronchial ultrasound (EBUS)-guided transbronchial biopsy procedure is widely used for the diagnosis of mediastinal lymphadenopathy. İt is a safe method and the complication rate of procedure is <1%. Rarely, the fatal complications may develop after the intervention. Here, we present a case of pericardial empyema occurred as a complication of EBUS-guided transbronchial biopsy procedure
  493 89 -
Clotted hemothorax: An uncommon presentation of dengue fever
Vikrant Panwar, Ashok Kumar Grover, Roman Dutta, Purneetha Singh
March-April 2019, 36(2):171-172
DOI:10.4103/lungindia.lungindia_204_18  PMID:30829258
  502 69 -
The puzzle of lymphoma among the granulomatous disorders
Akhil Paul, DJ Christopher, Balamugesh Thangakunam
March-April 2019, 36(2):164-166
DOI:10.4103/lungindia.lungindia_395_17  PMID:30829255
  445 72 -
Localized laryngotracheobronchial amyloidosis: Management issues
Desh Deepak, Manjari Kishore, Minakshi Bhardwaj, Parkash Chander Chugh
March-April 2019, 36(2):173-175
DOI:10.4103/lungindia.lungindia_138_18  PMID:30829259
  447 62 -
Partners in stridor: An uncommon cause for central airway obstruction
Irfan Ismail Ayub, Abdul Majeed Arshad, Hemanth Lakshmaiah, Natraj Manimaran, Dhanasekar Thangaswamy, Chandrasekar Chockalingam
March-April 2019, 36(2):168-170
DOI:10.4103/lungindia.lungindia_280_18  PMID:30829257
  442 63 -
Interventional management of extensive pulmonary metastasis in adamantinoma
Vallandramam R Pattabhiraman, Pavan Yadav, Arjun Srinivasan, Mahadevan Sivaramakrishnan, Annapoorni Shankar
March-April 2019, 36(2):166-168
DOI:10.4103/lungindia.lungindia_203_18  PMID:30829256
  418 64 -