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   Table of Contents - Current issue
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July-December 2021
Volume 9 | Issue 2
Page Nos. 53-84

Online since Wednesday, August 4, 2021

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ORIGINAL ARTICLES  

Diagnostic accuracy, indications, and negative predictive value of EBUS-TBNA procedure: retrospective observational study from a referral cancer institute p. 53
Kunal Luthra, Jyoti Singh
DOI:10.4103/jacp.jacp_47_19  
Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is minimally invasive procedure for the evaluation of mediastinal mass and lymph nodes. Aim: This study was conducted as an internal audit to determine diagnostic accuracy, false-negative rate of a costly, invasive procedure EBUS-TBNA performed under conscious sedation or deep/general anesthesia. Methods: Forty-nine patients who underwent EBUS-TBNA procedure at our institute were included in this retrospective study. Sensitivity, diagnostic accuracy, and negative predictive values were calculated considering clinical radiological assessment till 6 months as gold standard. Results: Forty-nine patients (27 females and 22 males) with mean age of 47.88 years underwent EBUS-TBNA during a period of 8 months. The most common indication was extrathoracic malignancy metastasis in 26 (53.1%) patients. EBUS-TBNA was performed for diagnosing malignancy lung in 11 patients, granulomatous disease in 8 patients, and mediastinal mass in 4 patients. A total of 74 nodes were sampled in 49 patients. Adequate samples were obtained in 46 patients (93.9%). Diagnostic accuracy was overall 91.8%. There were no procedure-related complications or mortality noted in any patient. Out of 17 negative cases, false negatives were 4, and negative-predictive value was 76.5%. The diagnostic accuracy, sensitivity, and negative predictive value were higher in procedures performed under deep sedation/general anesthesia. Conclusion: Diagnosing extrathoracic malignancy metastasis and malignancy lung are major indications for the EBUS-TBNA procedure at our institute. The diagnostic accuracy overall was 91.8%. The negative-predictive value, diagnostic accuracy, and sensitivity were higher for procedures performed under deep sedation/general anesthesia versus conscious sedation.
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Differential white blood cell count predicting severity and mortality in patients with COVID-19 p. 59
Sutravey Sesha Sai, K. Vishwa Vijeth, A.S. Hemalatha
DOI:10.4103/jacp.jacp_3_21  
Background: In coronavirus disease 2019 (COVID-19), the excessive inflammation is known to cause changes in blood parameters including differential white blood count and derived ratios such as neutrophil–lymphocyte ratio (NLR) and lymphocyte–monocyte ratio (LMR). Aim: To compare and analyze the association between differential white blood cell count and COVID-19 disease severity and mortality. Materials and methods: The study was a retrospective, observational study including 508 patients with confirmed COVID-19. Patients were divided into three groups based on severity. The laboratory parameters of all patients were collected and analyzed. Results: Among 508 patients, 75.6% were in mild, 9.1% were in moderate, and 15.4% were in severe categories. About 5.5% of the patients died during the treatment. The mean age of patients who got discharged was 42.47 ± 17.32 years and mean age of those who have died was 66.46 ± 14.37 years (P<0.001). When compared between all three groups and, between discharged and deceased, there were significant differences in mean neutrophils, lymphocytes, monocytes, NLR, and LMR (P<0.001). Neutrophilia, lymphopenia, and monocytopenia were associated with severe disease and increased mortality. Basophil count had no association with severity and mortality. A receiver operating characteristic curve of NLR for severe patients (area under the curve [AUC]: 0.951) and for deceased patients (AUC: 0.952) showed the ratio is significantly accurate in predicting severity and mortality, while that of LMR showed inverse association with severity and mortality. Conclusion: In patients with COVID-19, advanced age, neutrophilia, lymphopenia, and monocytopenia are associated with increased severity and mortality. High NLR and low LMR can be used as a marker for predicting the severity of the disease and mortality.
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Microalbuminuria and serum CRP: potential biomarkers for cardiovascular risk among stable COPD p. 65
Ajith Kumar M S, Jai Kumar Gaur, Agnihotri SP
DOI:10.4103/jacp.jacp_2_21  
Background: Cardiovascular disease is one of the major causes of mortality in chronic obstructive pulmonary disease (COPD) patients. Both microalbuminuria (MAB) and raised serum C-reactive protein (CRP) levels have strong association with cardiovascular events as they reflect generalized endothelial vascular dysfunction. The objectives of the study are (i) to assess the prevalence of MAB and serum CRP levels in stable COPD patients and (ii) to find out the relationship of MAB and serum CRP with clinical and physiological parameters in COPD patients. Methods: This comparative cross-sectional study was carried out on COPD patients attending OPD at Institute of Respiratory Diseases, Jaipur during the year from 2019 to 2020. Forty stable COPD patients and 40 healthy controls were enrolled in the study. Spot urinary albumin/creatinine ratio, serum CRP levels, smoking history, spirometry, blood gases, body mass index, and BMI, Obstruction (FEV1% predicted), Dyspnea (mMRC grading), Exercise Capacity (6 MWD) (BODE) index were assessed. Results: Out of 40 cases, 23(56%) had MAB and 38 (95%) had serum CRP levels >3 mg/L. There was a negative correlation between forced expiratory volume in one second (FEV1), partial pressure of oxygen in arterial blood (PaO2) levels and 6 MWD with both MAB levels and S.CRP levels respectively. There was a positive correlation between BODE Index and modified British Medical Research Council grading with both MAB levels and serum C reactive protein (S.CRP) levels respectively. There was a positive correlation between BODE index and modified British Medical Research Council grading with both MAB and S.CRP levels. Conclusion: COPD patients of varying severity should be screened regularly with MAB and serum CRP levels to determine the risk and progression of cardiovascular consequences so that adequate decision of interventional strategies can be taken out to prolong survival in COPD patients.
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Pattern of co-morbidities in patients of chronic obstructive pulmonary disease p. 71
Devendra Kumar Singh, Sanjeev Anand, Abhinit Kumar, Santosh Kumar, Anuj Kumar Pandey, Ajay Kumar Verma
DOI:10.4103/jacp.jacp_49_20  
Background: Chronic obstructive pulmonary disease (COPD), a disease of the elderly population is continuously increasing across the globe. COPD can be associated with the comorbidities, which in turn affect the course or severity of the disease. Objectives: To study the pattern of comorbidities in stable patients of COPD, and their comparison with apparently healthy attendant of the age of ≥35 years. Materials and Methods: A total of 121 COPD patients and 130 healthy attendants of patients coming to the respiratory disease department were enrolled in the study. All participants were evaluated for detailed clinical history, physical examinations, laboratory investigations, Hamilton depression rating scale, polysomnography, echocardiography, and ophthalmological tests to get the different variables. Results: Comorbidities in the case group having COPD were found more prevalent. Prevalence of hypertension (cases [n = 32], control [n = 12], odds ratio = 3.53, P = 0.004), depression (cases [n = 38], control [n = 18], odds ratio = 2.85, P = 0.0013), bronchiectasis (cases [n = 14], control [n = 3], odds ratio = 5.54, P = 0.0046), tuberculosis (cases [n = 20], control [n = 9], odds ratio = 2.66, P = 0.0187), ischemic heart diseases (cases [n = 19], control [n = 9], odds ratio = 2.5, P = 0.043), and musculoskeletal disorder including arthritis, peri-arthritis, and osteoporosis (cases [n = 28], control [n = 13], odds ratio = 2.70, P = 0.0060) found statistically significant in COPD patients in comparison to healthy controls. Other comorbidities such as diabetes, cataract, dyslipidemia, and uterine prolapsed were more common in COPD patients but these differences were not statistically significant. Also, 85.98% of COPD patients had at least one comorbidity. Conclusion: Our data showed that comorbidities viz hypertension, depression, bronchiectasis, tuberculosis, ischemic heart diseases, and musculoskeletal disorders are prevalent in COPD patients compared to healthy individuals.
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CASE REPORTS Top

Relapsing polychondritis in an asthma clinic: a pulmonologist perspective p. 76
Ravi Dosi, Gaurav Jain, Kamendra Singh Pawar, Nirmal Jain, Parvez Khan
DOI:10.4103/jacp.jacp_53_20  
The first case of relapsing polychondritis (RP) was described in 1923, and yet it remains a “medical mystery”, a much “overlooked” entity. It is an uncommon systemic disorder causing inflammation of cartilage affecting ear, nose, laryngotracheobronchial tree, eyes, joints, heart, blood vessels, kidney, and skin. Being a rheumatological entity presenting with ear and joint involvement most frequently, these patients land up in Otolaryngology and Rheumatology clinics mostly, though tracheobronchial involvement is among the most serious manifestation causing substantial morbidity and mortality. Herein, we report a case of RP and discuss available diagnostic techniques and airway interventions under the ambit of a pulmonologist, as airway involvement severely limits its prognosis.
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Primary tuberculous pyomyositis in an immunocompetent individual p. 80
Jayabal Pandiaraja, Arumugam Shalini
DOI:10.4103/jacp.jacp_60_20  
Tuberculous pyomyositis is a rare complication of Mycobacterium tuberculosis infection. The reported incidence is around 1% of musculoskeletal tuberculosis. In most cases, tuberculous pyomyositis is misdiagnosed as malignancy or autoimmune disorder due to its nonspecific presentation. The incidence of extrapulmonary tuberculosis is more common in patients with diabetes mellitus and immunocompromised individuals. The reported incidence of mortality in tuberculous pyomyositis is more than 30%. We report a patient of primary tuberculous pyomyositis of the back extending up to right hypochondrium. He was diagnosed with histopathological examination and microbiological examination of aspirate from the muscle. Prompt diagnosis and treatment can save the patient’s life in tuberculous pyomyositis.
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LETTER TO EDITOR Top

Managing a problematic decannulation of tracheostomy: use of high flow nasal cannula in ICU p. 83
Pradip Kumar Bhattacharya, Jay Prakash, Mohd. Saif Khan, Raman Kumar
DOI:10.4103/jacp.jacp_63_20  
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