Indian Journal of Chest Diseases & Allied Sciences

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Tuberculosis and Leprosy: A Rare Case of Dual Mycobacterial Infection
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Guliani, A; Thukral, G.
Leprosy and tuberculosis (TB) share geographic endemicity. The degree of cross-immunity of one against the other makes coinfection an uncommon clinical encounter. Here, we report a 35-year-old male patient who presented with a history of fever and cough for a month. He had ulnar claw deformity and multiple hypopigmented lesions since childhood. Chest radiograph showed left middle zone airway opacification and HR-CT revealed left lingular consolidation. Cartridge-based Nucleic Acid Amplification Test (CBNAAT) confirmed Mycobacterium tuberculosis and ulnar nerve biopsy confirmed borderline leprosy. The patient had no predisposing factors for TB other than the underlying leprosy. The dual infection was approached with WHO-recommended antitubercular treatment along with dapsone, clofazimine, and prednisolone for leprosy. Prednisolone was gradually tapered and discontinued, while the other medications were maintained. The patient’s overall health showed improvement on follow-up. The possibility of concomitant leprosy and TB must be considered by the clinicians to obtain an accurate clinical diagnosis, advise a comprehensive management plan, and avoid treatment-related complications.
A Hidden Rarity: Incidental Posterior Mediastinal Neurofibroma with Middle Mediastinal and Lung Parenchymal Extension in a 20-year-old Male with Neurofibromatosis Type 1
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Paul, B; Upadhya, P; Nadaf, Z; Ganesh, RN.
Neurofibromatosis type 1 (NF1) is a rare genetic disorder characterized by multiple benign tumors of the nerves and skin, known as neurofibromas. Mediastinal involvement in NF1, particularly with anatomical extension to both posterior and middle mediastinum along with extension into lung parenchyma, is an uncommon occurrence. Here, we present the case of a 20-year-old male with a known history of NF1 who was incidentally found to have a mediastinal mass during a pre-surgical fitness evaluation. Histopathological analysis confirmed the mass to be a neurofibroma. This case highlights the importance of considering neurofibromas in the differential diagnoses of mediastinal masses in patients with NF1, even when they are asymptomatic. The potential risk for malignant transformation into a malignant peripheral nerve sheath tumor (MPNST) warranted surgical intervention and hence the patient was referred to a thoracic surgeon.
Diffuse Large B-cell Lymphoma Presenting as Empyema: A Case Report and Review of Literature
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Rasheeka, VP; Jain, S; Agarwal, S; Bajad, P; Pahuja, S; Khanna, A.
Aim and background: Non-Hodgkin lymphoma (NHL) is the most common hematological malignancy, and diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype. It is a highly aggressive B-cell lymphoma resulting in the clonal proliferation of a germinal or post-germinal malignant B cell. The diagnosis is confirmed by biopsy of the affected node/extra-nodal site. Pleural involvement in lymphoma has a diverse presentation; however, presentation as an empyema, as in our case, has not been reported previously. Case description: We present a very rare case of a young, previously healthy female patient who presented with a right-sided pleural collection, who was initially suspected to have empyema due to characteristic findings on ultrasonography and pleural fluid appearance. Her pleural fluid cytology revealed atypical cells and was later diagnosed with an underlying anterior mediastinal mass confirmed to be DLBCL. Conclusion: Empyema may be the first harbinger of malignancy, especially in young immunocompetent patients. Timely diagnosis may be challenging but it improves the prognosis of such patients. Clinical significance: In a TB-endemic country like India, a patient with empyema poses a diagnostic dilemma. Cytology/biopsy and immunohistochemistry aid in diagnosis in such cases. Imaging also plays a key role in tumor staging, therapeutic planning, and follow-up of patients.
A Case of Complex Airway Foreign Body: Areca Nut
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Malegaonkar, SK.
Tracheobronchial foreign body (FB) aspiration to date has been described in terms of types of FB, their myriad of presentations, diagnostic evaluation, tools, and techniques for their management in various case reports and systematic reviews. However, FB extraction in some cases may be difficult due to the nature of FB, the clinical state of the patient, the unavailability of adequate tools, and the surrounding tissue response to FB. We would like to bring out the terminology of complex FB to describe the above-mentioned scenarios. In the following paper, we have enumerated one such case of complex FB based on its nature and its subsequent management.
Comparative Study of Frailty Phenotype and Short Physical Performance Battery for Frailty Assessment in Chronic Obstructive Pulmonary Disease
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Dutta, S; Goel, N; Kumar, R.
Aim and background: Frailty is a multidimensional syndrome of physical and cognitive impairments predisposing patients to increased risk of hospitalizations and poorer health-related quality of life. We conducted this study with the aim of comparing the frailty phenotype (FP) and short physical performance battery (SPPB) methods for the assessment of frailty in chronic obstructive pulmonary disease (COPD). Materials and methods: This is a descriptive cross-sectional study conducted in 150 stable COPD patients. Frailty was assessed using the FP and SPPB methods, followed by a comparative evaluation of the two methods. Results: The prevalence of frailty was 51.33% (n = 77) by the FP method and 21.33% (n = 32) by SPPB. Frail patients in both groups had the lowest post-bronchodilator forced expiratory volume in 1 second (FEV1) (%) (p < 0.0001). The median St. George's Respiratory Questionnaire (SGRQ) score was highest in the Frail group by the FP method [43.21 (32.116–58.338)] and pre-frail group by SPPB [43.47 (30.913–59.02)] (p = 0.007). The association between FP and SPPB was significant but with poor inter-rater kappa agreement (0.196, p = 0.0001). Frailty phenotype method showed a significant positive correlation, whereas SPPB had a significant negative correlation with duration of dyspnea (r = 0.3; r = –0.269), frequency of exacerbations (r = 0.498; r = –0.548), mMRC score (r = 0.525; r = –0.408), CAT score (r = 0.478; r = –0.52) and pack-years of smoking (r = 0.301; r = –0.278). Six-minute walk test (6MWT) distance had a significant association with frailty (p < 0.0001) by both methods. Conclusion: Frailty phenotype is a more sensitive method of frailty assessment in COPD compared to SPPB and correlates better with the severity of the disease. However, both methods showed a significant positive correlation with distance covered in 6MWT. Clinical significance: The FP and SPPB both identified a group of stable COPD patients with frailty. Our study underscores the importance of early identification and timely intervention to prevent deconditioning of muscular and cardiovascular systems which can otherwise progress to frailty.
A Perspective on Alternative Forms of Tobacco
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Nagaraja, R; Ather, I; Minoshka, T; Kumar, S.
Tobacco use is a global epidemic. Smoking claims more than 8 million lives annually across the globe. Further, it even poses a threat to nonsmokers who are exposed to cigarette smoke. Tobacco is most commonly used in the form of cigarette smoking across the world. The COVID-19 pandemic has impacted smoking habits, leading to visible differences in smoking rates. The current paper highlights and discusses alternative forms of smoking. Undoubtedly in the recent years, there is an advent of forms of alternative smoking, and a variety of tobacco products have been gaining popularity beyond traditional cigarettes. These products are preferred widely by the youth. Noteworthy to mention, these alternatives raise concerns about potential health risks and addiction. There is a paucity of research on the impact of alternative form tobacco usage on human health. The paper will provide an impetus for the researchers to explore further on the perspective of alternative forms of tobacco. It will also provide some essential leads to implement measures to mitigate the impact of alternative forms of tobacco usage on human health.
An Endobronchial Aspergilloma Concealing Metastatic Renal Cell Carcinoma of the Bronchus: A Case Report
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Rai, DK; Singh, NK.
Aspergillus is a saprophytic fungus that causes various respiratory illnesses in humans, depending on their immune status. It often manifests as saprophytic growth in pre-existing lung lesions termed aspergilloma or as allergic diseases in atopic individuals. It may also lead to persistent chronic inflammation known as chronic pulmonary aspergillosis in individuals with pre-existing pulmonary diseases or to angioinvasive infections in immunocompromised patients. Endobronchial aspergilloma (EBA) is an uncommon clinical entity characterized by the noninvasive colonization of Aspergillus in the bronchus, typically occurring in cases of pre-existing endobronchial lesions or malignancies, as reported in the literature. Here, we present a case of a middle-aged male who was initially diagnosed with EBA through endobronchial cryobiopsy. However, further cryobiopsy of the deeper area and cryoextraction of the entire tissue growth revealed the presence of underlying metastatic endobronchial renal carcinoma. Therefore, whenever EBA is identified, we should consider the possibility of underlying or coexisting malignancies.
To Study the Association of Serum Uric Acid Levels with Severity of Chronic Obstructive Pulmonary Disease
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Sarin, BC; Grover, S; Singh, P.
Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes airflow obstruction which leads to hypoxia. Serum uric acid is increased in hypoxic states as well as in systemic inflammatory conditions. The purpose of the present study was to assess whether the higher value of serum uric acid corresponds with the severity of COPD as per spirometric classification of COPD. Material and methods: This cross-sectional study included 294 spirometry-diagnosed patients of COPD as per Global Initiative for Chronic Obstructive Lung Disease criteria. Serum uric acid levels were tested on all the patients. The patients with raised serum uric acid levels were further categorized according to severity COPD grade. Reference of normal serum uric acid levels among males was taken as 3.5?8.5 mg/dL and among females as 2.5?6.2 mg/dL. Results: In the present study of 294 patients, maximum patients, i.e., 59.5%, were in moderate COPD grade. The mean serum uric acid value in male subjects was 5.9 ± 2.066 mg/dL, while in female subjects the mean serum uric acid value was 6.31 ± 1.93 mg/dL. About 85 (22 males and 63 females) had serum uric acid values out of the normal range. In males, maximum (41.6%) were in severe COPD grade, whereas in females maximum (80.8%) were in moderate COPD grade. Severe COPD grade showed statistically significant (p = 0.037) association with raised serum uric acid levels in both male and female subjects. Conclusion: The study concludes that mean uric acid levels progressively increased as the COPD grade increased from I to IV. Since serum uric acid levels were raised in COPD patients mainly in the severe COPD grade, it serves as a useful parameter for assessing disease severity and hypoxemia in known COPD patients.
To Study the Efficacy of FF/VI Combination in Adult Asthma Patients
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Sarin, BC; Grover, S; Aulakh, JK.
Background: Long-acting beta2-agonists (LABA) and inhaled corticosteroids require twice daily administration for effective treatment of bronchial asthma. This study aims to study the efficacy of fluticasone furoate/vilanterol (FF/VI) ICS/Ultra-LABA once-daily combination therapy in patients with bronchial asthma. Materials and methods: This prospective observational study included 120 spirometry-diagnosed patients of bronchial asthma who were given FF/VI combination therapy and underwent follow-up at 2, 4, and 8 weeks of therapy. Patients were assessed during the follow-up period for the efficacy of therapy based on spirometric values. Results: In the present study 61.7% were females and 38.3% were males. The commonest presenting symptom was cough present in 95% of patients followed by wheezing which was seen in 93.3% of patients and shortness of breath in 89.17% of patients. At 8 weeks of continuous therapy, only 5% of patients had a cough, 8.33% had wheezing and only 2.5% complained of shortness of breath. Forced expiratory volume (FEV) in one second (FEV1) at baseline, was 56.60 ± 1.26, and by the end of 8 weeks, it increased to 90.36 ± 11.38. Forced vital capacity (FVC) at baseline was 64.83 ± 12.63 and it increased to 91.8 ± 1035 at 8 weeks. Forced expiratory volume in one second (FEV1)/FVC at baseline was 63.31 ± 4.90 and it increased to 74.59 ± 3.19 at 8 weeks. Forced expiratory flow (FEF) 25–75% at baseline was 35.42 ± 14.74, and at 8 weeks of continuous therapy, it increased to 76.35 ± 8.85 and all these values were statistically significant (p < 0.05). The spirometric mean values were highly significant (p < 0.001) in between 2–4 weeks and 4–8 weeks. Conclusion: Therapeutic continuity of FF/VI combination therapy is significantly effective in improving both symptoms and spirometric values in bronchial asthma patients. The safety profile and improvements in lung function irrespective of dosing time (morning or evening) strongly emphasize strict adherence to continuous once-daily use of the inhaler FF/VI to fully reverse the condition.
Physicians' Perspectives and Practice Patterns in India on the Diagnosis and Treatment of Interstitial Lung Disease (IN-ILD Survey)
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Rajan, Sujeet K; Meshram, Sushant; Chhajed, Prashant; Mehta, Monali; Lopez, Meena; Gogtay, Jaideep
Aim and background: Data on clinicians’ views and practice patterns regarding interstitial lung disease (ILD) management in India is currently lacking. The objective of this survey was to understand clinicians’ perspectives on the diagnosis and treatment of patients with ILDs. Materials and methods: This was a questionnaire-based survey conducted among clinicians attending continuing medical education programs on ILDs across India in February 2020. Data entry and statistical analysis were done for completed questionnaires and results are expressed in terms of percentages based on the number of responses obtained. Results: A total of 321 clinicians managing ILDs participated in this survey, of which 87.75% were pulmonologists. Chronic hypersensitivity pneumonitis was ranked as the most common ILD seen in clinical practice, followed by idiopathic pulmonary fibrosis (IPF), connective tissue-ILD, and sarcoidosis. In total 43% of respondents preferred a combination of clinical evaluation, high-resolution computed tomography, and serology for ILD diagnosis. In the case of a planned biopsy, transbronchial lung biopsy (50.17%) was most preferred for idiopathic interstitial pneumonia. For follow-up, spirometry (86.60%) and a 6-minute walk distance (78.19%) were the most commonly performed tests. Antifibrotics (63.42%) were the preferred treatment for IPF while steroids either alone or in combination with immunosuppressants were preferred for non-IPF ILDs. Only 50% of respondents opined that pirfenidone 1800 mg/day and above was tolerated by over 45% of their IPF patients. Conclusion: Management of ILD has improved significantly in India. Antifibrotic dosing remains suboptimal in IPF. In non-IPF ILDs, a significant number of clinicians now use alternative immunosuppressants to steroids.
Pulmonary MALT Cell Lymphoma Mimicking as ILD
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Gupta, Rishabh; Prajapat, Deepak; Singh, Kanishka K; Prakash, Anupam; Talwar, Deepak
Aim and background: The aim is to illustrate the diagnostic challenge posed by pulmonary mucosa-associated lymphoid tissue (MALT) cell lymphoma, which can mimic interstitial lung disease (ILD). Representing 0.5–1% of lung neoplasia cases, primary pulmonary lymphomas, particularly MALT lymphomas, present diagnostic challenges due to varied imaging features and lack of specific biological markers. This case report highlights the diagnostic complexities when pulmonary MALT cell lymphoma mimics ILD, emphasizing the need for accurate histopathological confirmation. Case description: A 50-year-old female initially diagnosed and treated for ILD based on radiological findings, presented with worsening breathlessness and a dry cough. Examination revealed fine crackles in both lung fields, and imaging indicated reticular opacities suggesting ILD. Laboratory tests showed elevated serum lactate dehydrogenase and a positive ANA in autoimmune profiling. Despite treatment, symptoms worsened. Subsequent transbronchial biopsy confirmed pulmonary MALT cell lymphoma, prompting Rituximab therapy after multidisciplinary consultation. Conclusion: This case underscores the challenge of distinguishing between pulmonary MALT cell lymphoma and ILD solely based on radiological similarities. Accurate histopathological diagnosis through biopsies is pivotal in managing such cases effectively. Multidisciplinary collaboration facilitated a precise diagnosis and appropriate therapy, emphasizing its crucial role in managing complex conditions. Clinical significance: The case demonstrates the diagnostic complexity of differentiating pulmonary MALT cell lymphoma from ILD, stressing the necessity of histopathological confirmation. An accurate diagnosis significantly influences therapy prognosis and highlights the indispensable role of multidisciplinary collaboration in managing such rare cases.
Atypical Presentation of Lepidic Adenocarcinoma Lung in a Healthy Female: A Case Report
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Yadav, Sapna; Chandra, Mithilesh
Aim: To report unusual clinical and radiological presentation of adenocarcinoma in a healthy female. Background: Adenocarcinoma is the most common subtype in nonsmokers. The radiological presentation may range from solitary nodules to large masses and multilobar consolidations. In the present case, radiological presentation mimicked miliary tuberculosis but it turned out to be lepidic adenocarcinoma on further evaluation. Lepidic adenocarcinoma is characterized by the proliferation of tumor cells along the lines of alveolar walls with or without evidence of stromal, vascular, and pleural invasion. Case description: A 60-year-old female patient with no known comorbidities presented to the outpatient department with nonspecific complaints of mild chest and abdominal discomfort and uneasiness. Chest X-ray showed diffuse multiple numerous randomly distributed sharply marginated nodules in bilateral lung parenchyma suggesting the possibility of miliary nodules, and small air space consolidation in both upper lobes. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy was performed. Investigations for Tuberculosis, Fungal, and Bacterial infections were negative. Transbronchial lung biopsy histopathology and immunohistochemistry (IHC) [Napsin A and cytokeratin 7 (CK-7)] revealed features suggestive of primary minimally invasive adenocarcinoma lung – lepidic type. The patient was referred to the medical oncology department. Conclusion: Adenocarcinoma lung is the most common subtype of non-small lung cancer. Clinical and radiological presentation can mimic other infective or nonmalignant diseases. A high index of suspicion and further evaluation is required in concerned patients to identify it at the earliest.
A Case of Mediastinal Lymphoma that was Missed on EBUS-TBNA but Correctly Diagnosed after EBUS-TBCNB
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Rai, Deependra K; Singh, Niraj K; Vinay, V
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a breakthrough in diagnosing mediastinal diseases. However, it is less sensitive in diagnosing some mediastinal diseases, where diagnosis largely depends on a larger tissue sample with preserved tissue architecture, such as lymphoproliferative diseases of the mediastinum. Another newer approach, endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy (EBUS-TBCNB), can overcome the limitations of EBUS-TBNA and provide larger samples with preserved tissue architecture. Here we present a case of an elderly female with multiple mediastinal lymphadenopathy who underwent EBUS-TBNA two times, despite adequate sampling, the diagnosis remains inconclusive. We were only able to make a diagnosis of mediastinal lymphoma after EBUS-TBCNB under conscious sedation. Endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy is a safe and effective procedure that can be used in the successful diagnosis of mediastinal pathologies where EBUS-TBNA remained inconclusive, or it may be used as a combined procedure with EBUS-TBNA in cases of diagnostic uncertainty.
A Little More Than Just Air and Fluid: An Uncommon Case of Hydropneumothorax
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Sengupta, A; Dutta, S
Pulmonary lymphangioleiomyomatosis (PLAM) is among one of the rarest diseases classified under diffuse parenchymal lung diseases. Sporadic LAM is extremely rare, while in patients with diagnosed tuberous sclerosis (TSC) incidence of LAM is quite high with few studies finding it in over 30–40% of TSC patients. Here we describe a case of a young female of 25 years of age presenting at a tertiary hospital in rural West Bengal, for the first time with apparently spontaneous hydropneumothorax and without any neurological features suggestive of TSC. When evaluated for the cause of hydropneumothorax, her thoracic imaging raised the suspicion of lymphangioleiomyomatosis of the lung. Thereafter she was screened for radiological and clinical features of TSC which would explain and establish her affliction with PLAM and she was eventually diagnosed as a case of PLAM associated with TSC. This underscores the importance of giving emphasis on apparently unrelated clinical findings; in this case, a papulonodular rash on her face, that may ultimately prove to be key in deciphering the underlying cause of the current clinical manifestations. Keywords: Case report, Diffuse parenchymal lung disease, Hydropneumothorax, Lymphangioleiomyomatosis, Rare interstitial lung diseases, Tuberous sclerosis, Tuberous sclerosis–lymphangioleiomyomatosis
Esophagobronchial Fistula: A Rare Complication of Long-standing Achalasia Cardia
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Deshpande, Gayatri A; Tirpude, Bhupesh; Bhanarkar, Hemant; Kodape, Girish; Gajbhiye, Raj
Esophagobronchial fistula is a rare complication of long-standing achalasia cardia. We report the case of a 39-year-old lady with sigmoid esophagus with a esophagobronchial fistula who was managed by minimally invasive esophagectomy with gastric conduit and cervical esophago-gastric anastomosis. The esophagobronchial fistula was identified at the lower end of the dilated thoracic esophagus. The fistulous opening was primarily sutured with a cuff of esophageal wall after cauterizing the mucosa of the esophageal wall using bipolar energy source. Postoperatively, the air leak resolved spontaneously. There was no evidence of any malignancy in the resected specimen. The patient is doing well on follow-up.
Asthma-chronic Obstructive Pulmonary Disease Overlap (ACO) among Patients of Asthma and Chronic Obstructive Pulmonary Disease in a Tertiary Care Center
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Sarin, Bipan C; Grover, Sunil; Khattra, Misha K
Background: To estimate the prevalence of asthma-chronic obstructive pulmonary disease (COPD) overlap among patients of asthma and COPD and to compare its frequency in both groups. Materials and methods: About 200 patients presenting to the out patient department (OPD) and in patient department (IPD) between April 1, 2021 and July 31, 2022 were enrolled and inquired about their symptoms. History regarding smoking, biomass fuel exposure, old pulmonary tuberculosis or a family history of obstructive airway disease was obtained. All these patients performed spirometry and based on GINA-GOLD guidelines, they were diagnosed as asthma, COPD, or asthma-chronic obstructive overlap (ACO). Results: About 125 patients out of a total of 200 were known cases of COPD while 75 were known cases of asthma. Post-spirometry, 112 patients were diagnosed as COPD (56%), 59 as asthma (29.5%) and 29 were labeled as ACO (14.5%). From a total of 125 COPD patients, 13 had ACO which is 10.4%. In contrast out of 75 asthma patients 16 had ACO which is 21.33%. Asthma and ACO patients belonged to a younger age group and COPD patients were older (p-value < 0.001). A male predominance was found among ACO patients with 21.8% of total male patients being diagnosed as ACO while only 5.6% of females were labeled as ACO (p-value 0.001). Conclusion: Asthma-chronic obstructive overlap patients are underdiagnosed and frequently mislabeled as either asthma or COPD. These patients have a male predominance and are younger as compared with COPD patients. Spirometry should be done in all patients having symptoms of obstructive airway disease to make a final diagnosis.
A Cross-sectional Study on Assessment of Estimated Glomerular Filtration Rate in Patients with Stable Chronic Obstructive Pulmonary Disease
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Mondal, S; Choudhury, S; Saha, K; Dey, SK; Das, SK
Background: Chronic obstructive pulmonary disease (COPD) is a systemic disease with several extrapulmonary comorbidities. However, studies to find out the relationship between COPD and renal impairment are scarce. This study aimed to assess the relationship of estimated glomerular filtration rate (eGFR) with chronic obstructive pulmonary disease assessment test (CAT) score, modified medical research council (mMRC) scale, 6-minute walking test (6MWT), and postbronchodilator forced expiratory volume (FEV1) in COPD and to compare the reduction of eGFR in different GOLD stages. Materials and methods: A total of 240 stable COPD patients attending the outpatient department (OPD) were randomly selected between November 2019 and October 2020. Participants had spirometry, Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging, CAT score, mMRC grading, and 6MWT. Serum creatinine was obtained and eGFR was calculated. The interpretation was made by comparing the results of the eGFR and GOLD stages with different parameters. Results: In patients with normal eGFR, the mean mMRC score was 2.00 ± 0.86, 6MWD was 324.98 ± 47.08 m, and CAT score was 14.23± 6.09. With reduced eGFR, the mean mMRC score was 2.32 ± 1.17, 6MWD was 278.30 ± 75.98 m, and CAT scoring was 19.38 ± 9.05. These were statistically significant (p = 0.0145, p < 0.0001, and p < 0.0001, respectively). A negative correlation was found between eGFR vs GOLD stages; the Pearson correlation coefficient (r) was ?0.014. Conclusion: Reduction of eGFR was seen in stable COPD patients with higher GOLD stages. Patients with reduced eGFR had higher mMRC grade, increased CAT score, and reduced 6MWD. So, routine estimation of eGFR in patients of stable COPD is advocated to assess renal involvement.
Addressing Comorbidities in Palliative Care of Tuberculosis and It's Interdisciplinary Approach
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Viswanathan, Vinod Kumar
One of the newer concepts and current focuses of tuberculosis management is the concept of palliative care for tuberculosis (TB) patients. Target patients for this approach include mainly patients with drug-resistant and advanced forms of tuberculosis but also drug-sensitive tuberculosis in some settings like malignancy and extra-pulmonary tuberculosis. Integral to this approach of palliative care is the concept of managing of comorbidities with tuberculosis. Addressing the various comorbidities associated with tuberculosis taking an integral approach to the management of comorbidities is the need of the hour.
Test-retest Repeatability and Minimal Detectable Change of 1-minute Sit-to-Stand Test for the Ability to Detect Exercise-induced Oxygen Desaturation in Patients with Interstitial Lung Diseases
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Panjiyar, Vickey; Sharma, Prakhar; Banerjee, Saikat; Sanjan, Ganesh; Bahurupi, Yogesh A; Joshi, Narayan; Dua, Ruchi; Saini, Lokesh K; Mishra, Mayank; Sindhwani, Girish
Background: While methods like the 6-minute walk test, shuttle walk test, and cardiopulmonary exercise testing (CPET) are available to assess exercise limitation, they need a large space to perform/advanced lab settings which makes 1-minute sit-to-stand test (1STST) a feasible option in office practice. Data on test-retest reliability and the minimal detectable change (MDC) of 1STST is lacking in both national and international literature. Materials and methods: In this prospective observational study, our objective was to assess test-retest reliability and the MDC of the 1STST in patients with ILD and to determine the correlation of 1STST with the severity of interstitial lung disease (ILD) by spirometry and mGAP index. Results: A total of 65 ILD patients underwent 1STST during the study duration. The mean number of repetitions during the test retest 1STST and were 20 ± 6 and 21 ± 6 respectively (p = 0.029). The intraclass correlation coefficient (ICC) between a number of repetitions during 1STST and retest 1STST was 0.914 with SEM of 1.551 repetitions and a MDC of 4 repetitions. Statistically significant poor correlation was observed between test and retest 1STST repetitions with diffusion capacity of lung for carbon monoxide (DLCO) predicted z score (r = 0.428 and p = 0.006). modified gender age lung physiology index score (r = –0.195, p = 0.142), SpO2 drop (r = –0.301; p = 0.013), BMI of patients (r = –0.287; p = 0.02), and baseline hemoglobin level (r = –0.095; p = 0.504) had a negative poor correlation with number of repetitions during 1STST. Conclusion: The 1-minute sit-to-stand test is a valuable tool for detecting exercise-induced desaturation in ILD patients, showing reliability and a MDC of approximately 4 repetitions.
A Case of Tropical Pulmonary Eosinophilia
(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Jatav, B; Jain, A
Background: Tropical pulmonary eosinophilia (TPE) is a prominent feature of lymphatic filariasis caused predominantly by lymphatic-dwelling filarial infections (e.g., Wuchereria bancrofti, Brugia malayi, Brugia timori). While some filarial species are endemic in tropical and subtropical regions, worldwide travel and immigration have resulted in incidences in non-endemic areas. Case description: A 26-year-old laboratory worker with a 3-month history of nonproductive cough, dyspnea, and intermittent fever. Initially diagnosed with asthma, but symptoms continued despite medication. Eosinophilia, increased immunoglobulin E (IgE) levels, and reticulonodular lung opacities were discovered in laboratory tests. Spirometry revealed restrictive as well as obstructive behaviors. Clinical criteria validated the diagnosis of TPE, and therapy with diethylcarbamazine (DEC) led to significant symptom alleviation and laboratory improvements. Discussion: Tropical pulmonary eosinophilia is difficult to diagnose due to its diverse appearance, miming illnesses such as asthma and allergic bronchopulmonary aspergillosis. Clinical factors such as residence/travel history, paroxysmal cough, eosinophilia, increased IgE, lung infiltrations, and response to DEC are used to make an accurate diagnosis. Furthermore, differential diagnoses include a variety of eosinophilic lung disorders. Clinicians should be cautious in non-endemic areas and rule out other illnesses caused by helminth infections, such as Loeffler syndrome. Conclusion: This case emphasizes the necessity of including TPE in the differential diagnosis of respiratory symptoms, particularly in nonendemic locations, and indicates the efficacy of DEC in treating this illness.

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