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  Most popular articles (Since October 17, 2013)

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Approach to unequal hilum on chest X-ray
Supriya Sarkar, Debraj Jash, Arnab Maji, Anupam Patra
July-December 2013, 1(2):32-37
Hilum is a tricky part in chest X-ray (CXR) for understanding. Anatomically, pulmonary arteries and veins, major bronchi, and lymph nodes with pulmonary arteries contributed most of the radiographic density of the hila with superior pulmonary veins making a smaller contribution. Though both hila should be indistinguishable in size and density, we do not get equal hila in majority of CXRs. Rotational malpositioning must be kept in mind, while interpreting CXRs of unequal hilum. For interpreting hilum, we should search for four factors shape, radiopacity, proportionate size, absolute size, hilar angle, contour of pulmonary artery. There are numerous causes of hilar enlargement. It is the clinical presentation which will help in tapering the differential diagnosis. Asymmetric hilum is a challenging subject for pulmonologists. Interpretation of unequal hilum depends on findings of detail history, meticulous clinical examination, and appropriate investigation.
  167,464 6,143 7
Recent changes in technical and operational guidelines for tuberculosis control programme in India - 2016: A paradigm shift in tuberculosis control
Arunabha D Chaudhuri
January-June 2017, 5(1):1-9
  157,464 15,397 34
Tuberculoma of the brain - A diagnostic dilemma: Magnetic resonance spectroscopy a new ray of hope
Subhasis Mukherjee, Runa Das, Shabana Begum
January-June 2015, 3(1):3-8
Tuberculoma of the brain is an important clinical entity. The main challenge in the management of brain tuberculoma is its diagnosis. Appearance in computed tomography (CT) scan of brain is common and consists of solitary or multiple ring-enhancing lesions with moderate perilesional edema, but these are not specific for tuberculoma as neurocysticercosis (NCC), coccidiomycosis, toxoplasmosis, metastasis and few other diseases may also have similar appearance on CT scan brain. Cerebrospinal fluid examination is often normal and biopsy and tissue culture from the lesion though the diagnosis of choice is technically too demanding and not feasible in most of the times. All these put the clinicians in a great dilemma as regard to a confidant diagnosis of tuberculoma of the brain. With advancement of imaging techniques, magnetic resonance imaging (MRI) of brain with magnetic resonance spectroscopy (MRS) has shown a great hope in this context as MRS shows a specific lipid peak in cases of tuberculoma which is not seen in any other differential diagnoses of tuberculoma. This review article is written to have an overview regarding the current diagnostic approach for brain tuberculoma with special emphasis on the role of MRS. Extensive literature review of the articles published in English was conducted using Google search, Google Scholar, PubMed and Medline using the keywords such as ring-enhancing lesions, etiology, tuberculoma, NCC, CT scan brain, MRI, MRS, images.
  55,774 3,941 13
Use of corticosteroids in tuberculosis
Saurabh K Singh, Kamlesh K Tiwari
July-December 2017, 5(2):70-75
Tuberculosis (TB) is considered as a lethal disease in the present era. Effective antituberculous therapy is available, which has reduced significantly the morbidity and mortality due to TB. Literature advocates the use of corticosteroids in TB. Use of corticosteroids in conjunction with antituberculous therapy showed a reduction in mortality and morbidity in pericardial and central nervous system TB. Signs and symptoms in pleural and severe pulmonary TB improve rapidly with the addition of corticosteroids. Corticosteroid should be used cautiously with antituberculous therapy in view of drug interaction seen between them.
  39,313 2,407 4
Weaning from mechanical ventilation in chronic obstructive pulmonary disease: Keys to success
Deepak Talwar, Vikas Dogra
July-December 2016, 4(2):43-49
Invasive mechanical ventilation (IMV) for management of chronic obstructive pulmonary disease (COPD) associated respiratory failure is increasing in Intensive Care Units. However, IMV is not without its own complications. Hence, aim of managing such patients is to get them off the ventilator as early as possible. This bridging process from IMV to extubation is called weaning in which mechanical ventilation is gradually withdrawn and the patient resumes spontaneous breathing. Many objective parameters have been defined for weaning success. Many of these patients are difficult-to-wean because of various pathophysiologic mechanisms that are of particular relevance to patients of COPD. The following review focuses on these mechanisms and how to troubleshoot patients who are difficult-to-wean.
  36,467 4,643 2
Recent changes in guidelines on programmatic management of drug resistant tuberculosis in India 2019: a paradigm shift in tuberculosis control
Arunabha Datta Chaudhuri
July-December 2020, 8(2):53-63
The new version of guidelines of programmatic management of drug resistant tuberculosis in India 2019 by Revised National Tuberculosis Control Programme, Central TB Division, Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi, integrates use of the shorter MDR TB regimen and all oral longer MDR TB regimen with new drugs under RNTCP with opportunity to modify the regimen based on DST results. There are mammoth and comprehensive changes in the guidelines on programmatic management of drug resistant tuberculosis in India 2019.
  29,513 2,802 4
Fungal pneumonia in intensive care unit: When to suspect and decision to treatment: A critical review
Shelley Shamim, Abinash Agarwal, Bijan Kumar Ghosh, Mrinmoy Mitra
July-December 2015, 3(2):41-47
Fungal pneumonia is classically found in neutropenic patients. There is increase in concern about this entity in nonneutropenic critically ill patients. Aspergillus is the main offending organism. Although Candida is frequently found in respiratory sample in intensive care unit (ICU) it is always colonization rather than pneumonia. Other than neutropenia, chronic obstructive pulmonary disease and long-term steroid use are the main risk factors for invasive pulmonary aspergillosis in an ICU setting. Treatment in a nonneutropenic patient is only considered if the culture of Aspergillus comes positive in respiratory sample in the background of risk factors.
  24,648 1,978 3
Acute pulmonary embolism in young: Case reports
Sandeep Rana
January-June 2017, 5(1):46-50
Pulmonary embolism remains a disease which needs high clinical suspicion to prevent mortality and morbidity. More so in young healthy individuals, suspicion is very low as compared to old age individuals with multiple co-morbid conditions. Pulmonary embolism carries high mortality if not suspected and treatment initiated as early as possible. There are two case reports of young male individuals who presented as acute onset of breathlessness and later diagnosed and treated as a case of pulmonary thromboembolism.
  17,716 1,118 1
Interstitial lung disease: Diagnostic approach
Kaushik Saha
January-June 2014, 2(1):3-15
Interstitial lung disease (ILD) is a final common pathway of a broad heterogeneous group of parenchymal lung disorders. It is characterized by progressive fibrosis of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are non-specific (cough and progressive dyspnea on exertion) and are often attributed to other diseases, thus delaying diagnosis and timely therapy. Clues from the medical history along with the clinical context and radiologic findings provide the initial basis for prioritizing diagnostic possibilities for a patient with ILD. An accurate prognosis and optimal treatment strategy for patients with ILDs can only be after an accurate diagnosis. This review will assist pulmonary physicians and medicine specialist in recognition of ILD. Extensive literature search has been made through PubMed and also Book References has been used for writing this review.
  16,036 2,655 3
Reexpansion pulmonary edema following thoracentesis
Ansuman Mukhopadhyay, Mrinmoy Mitra, Srabani Chakrabati
January-June 2016, 4(1):30-32
Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax and pathogenesis is unknown. An elderly male patient presented to us with right-sided pleural effusion. 2 h after thoracentesis, he felt chest discomfort and increased breathlessness. His chest examination showed right-sided crackles. Chest radiograph showed right-sided heterogeneous opacity in right lower zone consistent with unilateral pulmonary edema. He was managed conservatively along with bilevel positive airway pressure ventilator support. His condition improved gradually and was discharged successfully after 2 days.
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Prevelence of latent tuberculosis and associated risk factors in children under 5 years of age in Karachi, Pakistan
Mubashir Zafar
January-June 2014, 2(1):16-24
Background: As infected children represent a large proportion of the pool from which tuberculosis (TB) cases will arise and its associated risk factors that influence TB infection are basic cause for burden of TB. Aim: This study was to determine the prevalence of latent TB and associated risk factors in children less than 5 year of age in Karachi, Pakistan. Setting and Design: Cross-sectional study and it was conducted in tertiary care hospital in Karachi. Materials and Methods: In this study, children who were living in contact with individuals who had proven smear-positive pulmonary TB cases were investigated. A tuberculin skin test (TST) was performed on each child. TST sizes ≥5 and 10 mm, respectively, were considered positive. Statistical Analysis: A random effects logistic regression model, which takes into account the clustering of contacts within households, was used to assess the relationship between the tuberculin response of the contact and risk factors. Results are reported as unadjusted and adjusted odds ratios and their 95% confidence intervals. The likelihood ratio test was used to assess the overall significance of risk factors, tests for trend, and tests for interaction. Results: The distribution of TST responses followed a bimodal pattern, with 135 (35%) children presenting a palpable induration. The risk of positive TST response in the child increased with the geographic proximity of the child to the individual with TB within the household and with the degree of activities shared with the individual with TB. Nutritional status and presence of a bacille Calmette-Guérin (BCG) scar were not independent risk factors for TST positivity in this population. On multivariate analysis, the effect of geographic proximity to the individual with TB, household size, and duration of cough in the index case persisted for TST responses ≥5 mm. Conclusions: Positive TST in a child reflects most probably TB infection rather than previous BCG vaccination. Contact tracing can play a major role in the control of TB in Pakistan.
  15,159 655 4
Intensive care unit bugs in India: How do they differ from the western world?
Dhruva Chaudhry, Brijesh Prajapat
January-June 2017, 5(1):10-17
Infections continue to play a significant role in the overall global mortality and disability more so in Intensive Care Units (ICUs) and plague developing countries more intensively. The ICUs are often called “the hubs” of infections owing to highly vulnerable patients’ profile. The most important nosocomial infections in the ICU are catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. The epidemiology of ICU infections in India is different from its Western counterparts in terms of prevalence and nature of microorganisms causing it. While Gram-positive infections are more prevalent in Western ICUs, Indian ICUs are commonly afflicted with Gram-negative bugs showing a high degree of antimicrobial resistance with blurring of traditional boundaries of early drug sensitive and later drug resistance infections. Increasing number of multidrug resistance organism infections in ICUs is a big public health threat and challenge both from the perspective of prevention and treatment. Therefore, blindly following the Western guidelines may not provide the optimum results in India. The need of the hour is to develop and implement an antimicrobial stewardship program based on the local epidemiological data and international guidelines to optimize the antimicrobial use among the hospitalized patients and improve their outcomes.
  12,962 1,723 17
Comparative analysis of pleural fluid biochemical parameters with cholesterol to differentiate transudates from exudates
Rohit Rungta, Rajendra K Jha
July-December 2013, 1(2):54-57
Background: Light's criteria is the gold standard to differentiate transudative pleural effusion (PE) from exudative PE, but it requires four biochemical estimations which, in developing countries such as India, may not be feasible in every patient due to economic constraints. Aims: To evaluate the comparative usefulness of pleural fluid biochemical parameters with relative usefulness of pleural cholesterol to the traditional Light' criteria. Setting and Design: Prospective institutional based study. Materials and Methods: A total of 56 cases of PE were studied consecutively, of which 34 cases were of tuberculous effusion and 22 cases of nontubercular effusion. The data obtained from the patients were collected, analyzed, and observations noted down. Statistical Analysis: Sensitivity, specificity, positive predictive value and negative predictive value of different biochemical parameters single or in combination were analyzed by SPSS 16 software. Results: According to their etiology, 7 of the effusions were transudates and 49 were exudates. Using a cutoff point of 45 mg for pleural cholesterol and values for protein and lactate dehydrogenase (LDH) of Light et al., the best diagnostic power corresponded to the combination of pleural cholesterol and LDH; cholesterol level over 45 mg/dL and/or LDH over 200 IU/L differentiate exudates from transudates with a sensitivity of 99% and a specificity of 98%. Conclusions: The measurement of pleural cholesterol and LDH permits the separation of pleural exudates from transudates with accuracy similar to the original report of Light et al., with the advantage of requiring only two laboratory determinations and no simultaneous blood sample, especially in a country like India where financial and technical constraints are immense.
  12,149 788 3
Recent innovations in mechanical ventilator support
Manu Chopra, Vasu Vardhan, Deepak Chopra
July-December 2014, 2(2):57-62
Mechanical ventilation as a means to provide basic lifesaving ventilatory support has grown leaps and bounds in the recent years. The basic modes of ventilation have seen a sea change and in addition other innovative techniques have been developed to prevent lung injury, ease of weaning and improve patient comfort. These modes and techniques though easily available are not adequately utilized for benefits of patient usually due to lack of knowledge about them. This article reviews some of these newer modes and innovations in mechanical ventilatory support.
  9,510 3,024 -
Carcinoma lung: Clinical presentation, diagnosis, and its surgical management
Farooq Ahmad Ganie, Mohd Lateef Wani, Hafeezulla Lone, Shadab Nabi Wani, Syed Abir Hussain
July-December 2013, 1(2):38-43
The aim of this article is to review the surgical management of lung carcinoma. Lung cancer is the most common cancer in the world, and a leading cause of death in men and women. By any conventional measure, the enormity of this global problem is immense. In some countries incidence and mortality rates have peaked and are beginning to decline. In many developing nations, the burden of disease is rising and will continue to rise because of aggressive tobacco industry marketing which is leading to a growing prevalence of cigarette smoking. This is also one of the major causes of cancer deaths in our Kashmir valley. The method of literature search was from articles published in PubMed and Google Scholar.
  11,334 1,000 4
Adverse drug reactions in tuberculosis patients due to directly observed treatment strategy therapy: Experience at an outpatient clinic of a teaching hospital in the city of Imphal, Manipur, India
Kumarjit Sinha, Izora Trudy R Marak, W Asoka Singh
July-December 2013, 1(2):50-53
Background: As to the profile of adverse drug reactions (ADRs) due to directly observed treatment, short course (DOTS), there is no report available in patients receiving antituberculosis (anti-TB) chemotherapy in Manipur, India. One of the main reasons for non-adherence to anti-TB therapy (ATT) is ADRs, even under DOTS. Aims: This study aimed to determine the incidence of ADRs due to DOTS therapy with a TB population of Manipur, India. Setting and Design: A prospective institution-based cohort study, and performed during July 2009-December 2010. Materials and Methods: The study included 102 diagnosed TB patients on anti-TB treatment under DOTS. Every patient was followed-up for the duration he/she received the treatment. Statistical Analysis: Frequency of different ADRs was assessed and p value was determined. Results: Incidence of TB was more among males than female (76.47% against 23.53%). Seventy-one patients (69.01%) showed one or more ADR. Incidence of ADRs based on affected organ was: Gastrointestinal (GI) disorders in 38 patients (53.52%), generalized weakness in 12 patients (16.9%), liver dysfunction in 11 patients (15.49%), allergic skin reactions in six patients (8.45%), neurological system disorders in two patients (2.82%), and fever in two patients (2.82%). However, 30.99% did not experience any ADRs. Conclusion: Incidence of ADRs due to DOTS therapy was 69.01%. Majority of cases suffered from GI symptoms. This highlighted the importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely.
  10,026 1,140 9
Asthma and chronic obstructive pulmonary disease
Supriya Sarkar
January-June 2017, 5(1):26-30
Asthma and chronic obstructive pulmonary disease (COPD) have striking differences but the similarities are also striking. Some scientists consider them as different expression of same disease. Some COPD patients show reversibility; on the other hand, asthma, a basically reversible disease, may lose its reversible nature by the process of airway remodeling and thereby blurring their differences. Although both are inflammatory diseases, they differ in the nature of inflammation and spectrum of inflammatory mediators. Clinically, most physicians can differentiate between two diseases, but the overlap also is widely recognized. The question remains whether any physiological test, among plethora available, can definitely differentiate asthma from COPD. Apart from overlap between asthma and COPD, it is now a well-established fact that asthma is a risk factor for the development of COPD. Only future can say, “whether Dutch or British hypothesis is right.”
  9,959 880 -
Pulmonary tuberculosis and lepromatous leprosy co-infection in a single individual: A Case report
Satyadeo Choubey, Mukesh Sharma, Bharat Agrawal
January-June 2014, 2(1):40-42
The concomitant occurrence of the two oldest mycobacterial diseases that is tuberculosis and leprosy in a single individual is not rare but has been infrequently reported. Herein, we report a case of 34-year-old laborer who concomitantly presented with both sputum positive pulmonary tuberculosis and lepromatous leprosy. The diagnosis of the two diseases was made simultaneously, which is again infrequent in literature. The treatment of leprosy warrants screening of individual for tuberculosis because multi-drug therapy for leprosy may lead to acquired drug resistance for rifampicin, which is a mainstem of anti-tubercular therapy.
  9,836 630 4
Pleura: In connective tissue diseases
Kaushik Saha
January-June 2016, 4(1):6-9
Connective tissue diseases (CTDs) (or collagen vascular diseases) represent a heterogeneous group of immunologically mediated disorders that affects many organs of the body including pleura. Frequency, presentation, and prognosis of pleural involvement depend on the underlying CTD. Connective tissue disorders may be heritable such as Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta; and autoimmune such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis, mixed connective tissue disease (MCTD), Sjögren's syndrome (SS), dermatomyositis (DM), and polymyositis (PM). The subject of this review is to describe the variety of pleural disorders observed in the most frequent types of CTD: SLE, RA, scleroderma, SS, DM, PM, and MCTD.
  9,308 771 -
Correlation of six minute walk test with spirometric indices in chronic obstructive pulmonary disease patients: A tertiary care hospital experience
Abhijit Kundu, Arnab Maji, Supriyo Sarkar, Kaushik Saha, Debraj Jash, Malay Maikap
January-June 2015, 3(1):9-13
Background: Six-minute walk test (6MWT) is a simple, objective, reproducible test which correlated well with different spirometric indices, and thus able to predict severity of chronic obstructive pulmonary disease (COPD) and can replace spirometry in resource poor set-up. Aims and Objectives: To find out correlation between spirometric indices (forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), and peak expiratory flow rate (PEFR)) and 6-minute walk distance (6MWD) in COPD patients, and thus to assess whether 6MWT can replace spirometry. Settings and Design: Institution based cross-sectional observational study. Materials and Methods: Eighty patients of COPD (diagnosis confirmed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010 criteria) were enrolled for the study after applying exclusion criteria. All patients underwent spirometric measurement of FEV 1 , FVC, PEFR, and ratio of FEV 1 and FVC and test repeated after bronchodilation by 200-400 μg of salbutamol. 6MWT was performed following American Thoracic Society (ATS) protocol of 6MWT and distance was measured in meters. Results: We found significant linear correlation of 6MWT with post-FEV 1 (r = 0.478, P < 0.001), post-FVC (r = 0.454, P < 0.001), and post-PEFR (r = 0.408, P < 0.001), but no correlation with FEV 1 /FVC (r = 0.250, P = 0.025). We also found significant correlation of 6MWT with BODE (body mass index (BMI), airway obstruction, dyspnea, and exercise capacity) index (r = −0.419, P < 0.001). Conclusions: 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.
  8,857 963 4
Noninvasive ventilation in hypoxemic respiratory failure
Raja Dhar, Dipansu Ghosh, S Krishnan
July-December 2016, 4(2):50-55
Noninvasive ventilation (NIV) refers to positive pressure ventilation delivered through a noninvasive interface (nasal mask, facemask, or nasal plugs) etc. Over the past decade its use has become more common as its benefits are increasingly recognized. This review will focus on the evidence supporting the use of NIV in various conditions resulting in acute hypoxemic respiratory failure (AHRF), that is, non-hypercapnic patients having acute respiratory failure in the absence of a cardiac origin or underlying chronic pulmonary disease. Outcomes depend on the patient's diagnosis and clinical characteristics. Patients should be monitored closely for signs of noninvasive ventilation failure and promptly intubated before a crisis develops. The application of noninvasive ventilation by a trained and experienced team, with careful patient selection, should optimize patient outcomes.
  8,219 1,300 -
Totally drug resistant-tuberculosis in India: The bad just got worse
Zarir F Udwadia
July-December 2016, 4(2):41-42
  5,317 4,182 5
The shorter regimen for MDR TB: Myth or reality
Kaushik Saha
July-December 2017, 5(2):65-66
  7,651 1,807 -
Smoking cessation: How to achieve
Kaushik Saha
July-December 2013, 1(2):27-31
  4,900 4,422 -
Diffuse pulmonary meningotheliomatosis: A literature review of a rare diffuse parenchymal lung disease with unclear clinical significance
James B Gleason, Ramon Valentin, Patricia Almeida, Nydia Martinez, Pablo A Bejarano
January-June 2017, 5(1):18-25
Introduction: Diffuse pulmonary meningotheliomatosis is a rare disease, with unclear clinical significance and very few reported cases in the literature. In this study, we review the demographics, presentation, imaging, diagnostic workup, and histologic findings of the 25 patients previously published in the literature with an outline of the disease history. Materials and Methods: We conducted a review of the literature through July 2016 for studies reporting cases of diffuse pulmonary meningotheliomatosis by searching multiple scholarly databases. Results: Of the 25 cases identified 2 were male (8%), and 23 were female (92%). Ages ranged from 37 to 73 with a median age of 59.5 years at diagnosis. 15 (60%) were asymptomatic and imaging abnormalities were discovered incidentally. 8 (32%) had unexplained respiratory complaints. 11 (44%) had history of or active malignancy. 3 (12%) were diagnosed by transbronchial biopsy while the remainder had surgical lung biopsies. Conclusion: Diffuse pulmonary meningotheliomatosis should be considered in all patients with diffuse bilateral pulmonary nodules on HRCT. The condition is more prevalent in females and its clinical significance is unclear, although nearly half of those diagnosed had a history of malignancy. CT imaging and surgical lung biopsy are the modalities of choice for diagnosis but transbronchial biopsies have recently been used obtain the diagnosis. Additional research needs to be done to further characterize the nature of this condition and the clinical scenarios in which is presents.
  8,516 754 4