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   Table of Contents - Current issue
September-December 2020
Volume 3 | Issue 3
Page Nos. 119-148

Online since Wednesday, April 28, 2021

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Total intravenous anaesthesia for pulmonary interventions p. 119
R Narasimhan
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Approach to lung cancer p. 120
T Suresh Babu, R Sridhar, Ria Lawrence, Balasubramaniam Ramakrishnan, R Narasimhan
Aim: This study was done to study the utility of various biopsy techniques in diagnosing lung cancer and also to study the clinical/pathological and radiological features of lung cancer. Materials and Methods: This is a prospective and cross-sectional study, conducted in Apollo Main Hospital, in which confirmed cases of lung carcinoma were included in the study. These patients were admitted during 1 year from 2019 to 2020. Data such as demographics (age of the patients and sex), smoking status, histopathological type, clinical presentation, radiological features, and clinical stage of the disease were obtained. Patients had undergone one or more biopsy techniques based on clinical, radiological features decided by treating physician. Results: Thirty-one patients undergone bronchoscopy with narrow band imaging (NBI) in which findings were, 13 patients showed endobronchial growth, 7 showed extrinsic growth, no abnormal gross appearance in 11 patients, 11 were NBI negative, and 20 were NBI positive. Out of 28 bronchial wash cytology samples, 21 showed no atypical cells and 7 showed positive for atypical cells. Twenty-three patients had undergone bronchial biopsy in which 14 showed malignancy in Histopathological examination (HPE) and no evidence of malignancy in eight patients. Twenty-eight patients undergone computed tomography (CT)-guided lung biopsy, in which 27 patients tested positive for malignancy. Conclusions: The result of the study demonstrates that CT-guided lung biopsy is an effective procedure in diagnosing peripherally located lung cancer with the low rate of complications with an accuracy of 96.4%.
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Seroprevalence of SARS-CoV-2-specific neutralizing antibodies in COVID-19 pneumonia patients p. 124
Sivanthi Sapna Rajendran, R Sridhar, R Narasimhan
Aim: The aim is to know the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific neutralizing antibody responses in COVID-19 pneumonia patients and correlation of antibody titer values with COVID-19 pneumonia Category, cyclic threshold values of COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test, and computed tomography (CT) chest severity score. Material and Methods: Using serologic assay, SARS-CoV-2 antibody titers were measured in 65 patients with COVID-19 pneumonia symptoms with either positive or negative COVID-19 RT-PCR tests and radiological changes in CT chest during COVID-19 Pandemic period. About 3–5 ml of venous blood was collected and blood samples were tested using Abbott SARS-COV 2 immunoglobulin G (IgG) assay. This assay detects IgG Antibody against SARS-CoV-2 nucleocapsid protein and has a sensitivity of 100% and a specificity of 99.6%. Sixty-five patients were enrolled for this study and their clinical data, comorbid conditions, laboratory RT-PCR test reports, SARS-COV-2 antibody titers, and CT chest severity score were assessed cross-sectionally. Results: The study was done on 65 hospitalized patients. Among them, 39 were male (60.9%) and 25 were female (39.1%). Most common comorbidities among them were systemic hypertension (16.7%), chronic obstructive pulmonary disease (36.1%), diabetes mellitus (5.6%), coronary artery disease (22.2%), and bronchial asthma (27.8%). Among 65 patients, 36 (56.3%) tested COVID-19 RT-PCR positive and 28 (43.8%) tested COVID-19 RT-PCR negative. 24 patients belong to category B1 (55.8%), 11 patients belong to category B2 (25.6%), and 8 patients belong to category C (18.6%). A high seroprevalence of SARS-CoV-2 IgG antibody after 2 weeks were observed-17% among Category B1 patients, 26% among Category B2 patients, and 43% among category C patients. CT chest severity score was correlated with serum antibody titers by Pearson correlation which revealed a positive correlation that is statistically significant (0.01). Cycle Threshold value of COVID-19 RT-PCR reports was correlated with serum antibody titers by Pearson correlation which revealed a negative correlation that is statistically insignificant. Conclusion: This study found a high seroprevalence of SARS-CoV-2 specific IgG antibodies among COVID-19 pneumonia patients and positive correlation of antibody titers with clinical COVID-19 pneumonia category and with CT Chest Severity score.
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New order of the ages: Anesthesia in bronchoscopy – current clinical practice p. 128
P Amal Johnson, A Ganapathy, R Narasimhan
The advent of advanced diagnostic bronchoscopy has shown an increased demand for anesthesiologists to administer anesthesia in the bronchoscopy suite. Although many of these procedures can be accomplished under conscious sedation, there has been a shift toward general anesthesia especially for complex interventions. The administration of general anesthesia provides an immobile patient, which is often needed by the pulmonologist and results in higher satisfaction for both, the patient and the pulmonologist. This review elaborately discusses the recent practice guidelines used along with the drugs, both old and new used in the current setup.
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A case of bronchial artery aneurysm causing hemoptysis - A rare case report p. 133
Ria Lawrence, R Sridhar, Pritam Chatterjee, R Ravikumar, R Narasimhan
Hemoptysis is one common presenting complaint in respiratory clinics. Bronchial artery aneurysm is one of the rare causes of hemoptysis. Here, we present a case of a 64-year-old male, asthmatic, and hypertensive with a previous history of tuberculosis presented with hemoptysis. On bronchial angiogram, he was found to have a right bronchial artery aneurysm which was treated with bronchial artery coiling.
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A rare case of anti-jo1 syndrome presenting as a interstitial lung disease p. 136
A Kirubanandam, R Sridhar, R Narasimhan, VL Arulselvan
Antisynthetase syndrome is a rare entity and can be missed if not specifically looked in patients whose initial presentation is with Interstitial Lung Disease. Prognosis is altered when patients presenting with Interstitial Lung Disease. A 45 years old lady with no known comorbidities came with complaints of fever, breathlessness and cough for 4 months. She also had history of muscle weakness. She was treated as COVID pneumonia with oral steroids as her CT chest showed bilateral GGO's. When she came to our hospital she was afebrile, hemodynamically stable, SPo2-88% on room air. She was negative for COVID and COVID antibodies were also negative. On Investigations her CPK, Aldolase, CKMB were elevated. Her ENA profile showed positive anti-Jo1 and anti Ro 52 antibodies. Electromyography and Muscle biopsy suggestive of Inflammatory Myopathy. PFT showed restrictive pattern with reduced Diffusing Capacity of Lung for Carbon Monoxide(DLCO). She was treated with high dose oral steroids and cyclophosphamide. She responded well to the treatment and discharged. Though antisynthetase syndrome is a rare disease, we should keep in mind when patients presenting with interstitial Lung disease. Patients presenting with ILD have guarded prognosis.
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Dual malignancy: Carcinoma of different cells in different organs p. 139
R Sridhar, R Narasimhan
Incidence of multiple primary cancers, though uncommon, is being frequently reported nowadays, owing to better diagnostic techniques, the prolonged life span, and the increased incidence of long-term survival of cancer patients. In our case, lung mass in a patient with prior history of transitional cell carcinoma (TCC) of the urinary bladder on evaluation turned to be small cell carcinoma. Dual malignancy of different cells in different organs is rare, and very few case reports are reported. We report a rare case of novel combination of multiple primary carcinomas reported as TCC of the bladder and small cell carcinoma of the lung.
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Recurrent tuberculosis due to subtherapeutic levels of antitubercular treatment p. 142
A Kirubanandam, V Arunshankar, A Mahilmaran
Most patients with tuberculosis respond well to treatment. Even in patients with good compliance to DOTS and sensitive to first-line drugs, treatment failure or relapse still occurs, the phenomenon of cryptic adherence needs careful evaluation. We present a case of frequent recurrence due to possible subtherapeutic levels of isoniazid (INH) and rifampicin. A 32-year-old male with no other comorbidities came with complaints of cough with expectoration with constitutional symptoms. He was treated for the primary complex at the age of 12 years and declared as cured. In 2006, he was diagnosed as right axillary TB lymphadenitis which was confirmed by histopathological examination and treated with Anti tubercular treatment (ATT) for 9 months. After 2 years (2008), he had developed left axillary lymphadenitis for which he was treated again with Anti tubercular treatment empirically. In 2016, he was diagnosed as smear-negative pulmonary tuberculosis (PTB) whose chest X-ray suggestive of PTB. Hence, he was treated with Anti tubercular treatment for 6 months, declared as cured. Now (2018), he was diagnosed as sputum-positive PTB with INH and rifampicin sensitive. Hence, we did a pharmacokinetics study, which revealed subtherapeutic levels of rifampicin and isoniazid. The patient responded well after increasing the dosage of drugs. Slow responders and patients with complications warrant the need of therapeutic drug monitoring (TDM). Drug concentrations which may be help resolve the problem of slow response to Anti Tuberculosis Therapy. TDM however is not routinely indicated in each case.
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An unusual case report of Streptococcus mitis causing complex empyema thoracis p. 144
Ria Lawrence, R Sridhar, R Narasimhan
Empyema is the collection of pus within the pleural space. The most common infective etiology of empyema is the Gram-positive organisms such as Streptococcus pneumonia and Staphylococcus aureus. Streptococcus mitis which is an oral commensal is known to cause serious infections in cancer patients receiving chemotherapy and in immunosuppressed individuals. However, there are very few case reports of S. mitis causing a complex empyema in a middle-aged woman with type 2 diabetes. Here, we discuss the case of a 58-year-old lady, a known case of type 2 diabetes mellitus under regular medication, who presented with complaints of loin pain on the right side for 1 week and breathlessness for 3 days. On evaluation, she had complex empyema on the right side with culture showing S. mitis.
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Radiology quiz on mediastinal mass p. 147
A Kirubanandam, R Narasimhan
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