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   Table of Contents - Current issue
July-December 2022
Volume 10 | Issue 2
Page Nos. 55-124

Online since Tuesday, December 20, 2022

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National TB Elimination Program (NTEP): at a glance Highly accessed article p. 55
Susmita Kundu, Rahul Ghosh
Abstract India has the highest burden of tuberculosis worldwide. Over the last six decades there was evolution of national programs on tuberculosis. The present national program on tuberculosis emphasized on elimination and prevention of tuberculosis.
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Pulmonary manifestations of systemic sclerosis p. 67
Supriya Sarkar
Abstract Systemic sclerosis (SSc) is an autoimmune connective tissue disease that primarily involve skin. Pulmonary involvements are important as they influence the outcome of SSc. Interstitial lung diseases (SSc-ILD), pulmonary arterial hypertension (PAH), aspiration pneumonia are common pulmonary lung diseases found in SSc.
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Etiological profile and evaluation of DPLD in real-world: the perceived impression of the ILD treating doctors in India p. 75
Parthasarathi Bhattacharyya, Sikta Mukherjee, Arindam Mukherjee, Mintu Paul, Sayoni Sengupta, Debkanya Dey, Ajoy Handa
Abstract Background The perceived etiologies and the evaluation practice of concerned physicians in the real-world are important for diffuse parenchymal lung disease (DPLD) care. Methods An identified cohort of DPLD treating physicians was given to respond to a set of questions regarding their perception of the relative presence of common etiologies of DPLD in India and also regarding the scope and pattern of evaluation of the condition by them in real-world practice with selective inquiries about the satisfaction and constraints. Results 122 physicians out of 150, mostly (93%) postgraduate and practicing in metropolitan and urban areas (86.07%), participated in the survey. There was the highest abstinence in reply for rare causes of DPLD. As per the highest number/percentage of responses, the perceived etiological distribution for idiopathic pulmonary fibrosis (IPF), non-IPF-ILD (interstitial lung disease), and connective tissue disease-associated ILD was between 11% and 25%, while that of sarcoidosis was 1% to 10 % and chronic hypersensitivity pneumonitis was 26% to 50%. The evaluation habit varied significantly from villages to urban and metropolitan cities. The access to high-resolution computed tomography (HRCT) chest and spirometry was almost universal (98.36%); it dropped to 86.06% and 47.54% for DLCO and multidisciplinary discussions (MDD) (multidisciplinary discussion), respectively. The access to other investigations was variable. The practice of HRCT was universal, but it dropped by 36.30% for spirometry, 67.41% for DLCO, and 62.51% for MDD. The overall satisfaction in evaluation and follow-up was low. Financial and logistic constraints appeared prevalent along with a lack of family support. Conclusion The perceived real-world DPLD practice appears far short of ideal and it needs further investigations to understand the reality to change for betterment.
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Knowledge, attitude, and practices regarding COVID-19 among the postgraduate medical students of a government medical college in Gujarat (India) p. 81
Aneri Parekh, Jigna Dave, Sanjay Singhal, Kunal Deokar
Abstract Objective: To assess postgraduate students’ knowledge, attitude, and practices regarding COVID-19. Methods: A self-designed online questionnaire was circulated to the postgraduate students. Mean knowledge, attitude, and practice scores were calculated and compared among different study groups with the ANOVA test. Results: Out of 254 postgraduate students approached, 220 responses were received, so the final sample size was 220. Out of 220 students enrolled, 159 (72.27%) students had good knowledge and 61 (27.73%) students had poor knowledge; 167 (75.90%) students had a positive attitude, 51 (23.18%) students had a neutral attitude, and only two (0.92%) students had a negative attitude; 196 (89.09%) students observed good practices whereas 24 (10.91%) students observed poor practices. Conclusion: Most students had good knowledge, a positive attitude, and good practices.
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25-OH vitamin D3 level in tuberculosis: A cross-sectional study in a tertiary care center p. 89
Surajit Chatterjee, Pratik Biswas, Rituparna Bose, Megha Agarwal
Abstract Introduction: The immunomodulatory role of 25-hydroxycholecalciferol (25-OH vitamin D3) has been under evaluation for a long time. As tuberculosis (TB) and MDR-TB continue to be global health problems, evaluation of the role of 25-OH vitamin D3 deficiency in TB and its relation with bacillary load may help us in formulating a preventive therapy for the disease. Aims and Objectives: To assess serum 25-OH vitamin D levels in patients suffering from TB for the first time and to find the relation between serum 25-OH vitamin D levels in patients with bacillary load in respiratory samples. Results: The serum 25-OH vitamin D level was analyzed for bacillary load in the respiratory specimen in this study, which revealed that as the serum 25-OH vitamin D level decreased, the bacillary load was found to increase in the respiratory specimen.
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New onset adult asthma attributable to tuberculosis: A distinct phenotype? p. 97
Kundan Mehta, Kiran A Balani, Tushar R Sahasrabudhe
Abstract Background: In clinical practice, we encounter cases of bronchial asthma the onset of which correlates with past tuberculosis (TB), either pulmonary or extrapulmonary. Our study attempts to validate this observation and assess likelihood of new asthma that is attributable to TB. Methods: It was a single visit, cross-sectional study of persons who had TB within last 5 years (group 1). Preexisting asthma before TB, COPD cases, smokers, and persons with any active infective or diffuse lung diseases were excluded. Their spouse (group 2) and first-degree relatives (group 3) served as controls. All participants were subjected to detailed history, examination, and spirometry. Sample size was 225 (75 in each group). Results: About 62/75 participants in group 1 had intermittent or persistent symptoms suggesting obstructive airway disease that started within a year of TB diagnosis. Obstructive spirometry pattern was observed in 23/75 (30.6%) post-TB cases, compared to 6/75 (8%) in group 2 and 4/75 (5.33%) in group 3 participants. While, 11/75 (14.66%) post-TB cases in comparison to 7/150 (4.66%) controls were diagnosed as asthma after clinical correlation. About 24% of persons with post-TB lung scarring, 16% without lung scarring, and 4% with only extrapulmonary TB were diagnosed as asthma. Attributable risk for post-TB asthma was significant (0.1). Conclusion: This study suggests causative association between TB and asthma rather than just comorbidity. Further large-scale studies are warranted.
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Isolated hemorrhagic pleural effusion due to sarcoidosis in a patient with primary Sjogren syndrome p. 102
Mansoor C Abdulla
Abstract Sarcoidosis is a multisystem disease which rarely involves pleura resulting in various manifestations including pleural effusion, pneumothorax, pleural thickening, hydropneumothorax, trapped lung, hemothorax, or chylothorax. Hemorrhagic Pleural effusion secondary to sarcoidosis is extremely rare. Sarcoidosis is considered to be exclusion criteria for diagnosis of sjogrens syndrome (SS).But there are reports showing coexistence of these two disorders in the past. We present a patient with SS who presented with isolated hemorrhagic pleural effusion due to sarcoidosis.
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Bronchus sign on HRCT thorax: presenting sign of Wegener granulomatosis with lung involvement — misdiagnosed as TB in presence of acino-nodular pattern on imaging p. 105
Shital Patil1, Gajanan Gondhali
Abstract Tuberculosis is the most common diagnosis in India in presence of constitutional symptoms such as cough, fever, and weight loss with lung parenchymal abnormality irrespective of microscopy or nucleic acid amplification test abnormalities in high TB prevalent tropical settings. Pulmonary manifestations of systemic vasculitis have very diverse involvement ranging from the nodule to consolidation. Bronchus sign is classically described in lung malignancies than Wegener disease. The acino-nodular pattern is classical of pulmonary tuberculosis, sometimes documented in fungal infections. In this case report, a 45-year-old female, presented with constitutional symptoms with lung parenchymal nodules, without mycobacterial microscopic or genome documentation, received empirical antituberculosis treatment with the progression of the disease without clinical or radiological response. Bronchoscopy workup is inconclusive and tropical screen for bacterial, fungal, TB, and malignancy was negative. Vasculitis workup was done in view of the presence of persistent fever and documented PR3-ANCA positive with very highly raised titers. We have started on steroid and cyclophosphamide and clinical response documented with near-complete resolution of shadows in 12 weeks. Pulmonary manifestations of Wegener disease are rare and underestimated and early pickup of the entity in course of illness will have a good outcome with an excellent prognosis.
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Recurrent syncope with hyponatremia as presentation of COVID-19 viral pneumonia: Case report p. 112
Shital Patil, Gajanan Gondhali
Abstract Syncope is the most common neurological presentation in intensive care setting and has diverse etiological factors ranging from ischemic and nonischemic neurovascular, cardiac dysfunction related, infectious, electrolyte imbalance, inflammatory factors to simple viral fever, and other system-related illnesses. Coronavirus disease-19 (COVID-19) is known to cause pulmonary and extrapulmonary complications including effects on cardiovascular, gastrointestinal, renal, and neurovascular systems. In this case report, we have documented a 70-year-old male presented with recurrent syncope with flu-like illness, HRCT thorax suggestive of pneumonia involving bilateral lower lobe, COVID-19 real-time polymerase chain reaction (RT-PCR) positive, with abnormal laboratory parameters such as platelet count, CRP, serum sodium, and vitamin B12 level. Further investigations such as echocardiography, MRI brain and MRI angiography, and carotid Doppler were inconclusive. We have observed excellent clinical and radiological response to steroids, anticoagulants, antiplatelets, and remdesivir with other supportive care in critical care unit.
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Primary calvarial tubercular osteomyelitic abscess presenting as scalp swelling—a rare case p. 120
Ankit Bhatia, Sharad Joshi, Nitesh Tayal, Manish Vaish
Abstract Tuberculosis (TB) is a well-known endemic problem in India. Skeletal tuberculosis constitutes about 1% incidence of all cases of tuberculosis, however, tuberculosis involving the skull bones is very uncommon even in endemic areas like India. The frontal and the parietal bones are the most commonly involved bones. We, hereby, report a young male presenting to us with scalp swelling in the left temporal region after a small trauma. The radiology revealed an abscess within the left right temporal bone and an associated bony defect. A temporal craniotomy was done and Gene-Xpert as well as Mycobacterium culture confirmed tubercular pathology. There was no reoccurrence on antitubercular therapy.
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Omicron variant coronavirus disease with rapid progression to ARDS p. 123
Reddy Ravikanth
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