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   Table of Contents - Current issue
Coverpage
January-April 2022
Volume 5 | Issue 1
Page Nos. 1-46

Online since Friday, August 12, 2022

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EDITORIAL  

Sarcoidosis p. 1
R Narasimhan
DOI:10.4103/japt.japt_15_22  
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ORIGINAL ARTICLES Top

Serial interleukin-6 titer monitoring in COVID-19 pneumonia: Valuable inflammatory marker in the assessment of severity, predicting ventilatory support requirement, and final radiological outcome – Prospective observational study in tertiary care setting in India p. 2
Shital Patil, Abhijit Acharya, Gajanan Gondhali, Ganesh Narwade
DOI:10.4103/japt.japt_6_22  
Introduction: Coronavirus disease 2019 (COVID-19) pneumonia is heterogeneous disease with variable effect on lung parenchyma, airways, and vasculature, leading to long-term effects on lung functions. Materials and Methods: Multicentric, prospective, observational, and interventional study included 1000 COVID-19 cases confirmed with reverse transcription-polymerase chain reaction. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography (CT) of the thorax, oxygen saturation, inflammatory marker as interleukin-6 (IL-6) at entry point and follow-up. Age, gender, comorbidity, and use bilevel positive airway pressure/noninvasive ventilation (BIPAP/NIV) and outcome as with or without lung fibrosis as per CT severity were key observations. Statistical analysis is performed using Chi-square test. Results: Age (<50 and > 50 years) and gender (male versus female) has significant association with IL-6 (P < 0.00001) and (P < 0.010], respectively. CT severity score at entry point has significant correlation with IL-6 level (P < 0.00001) IL-6 level has significant association with duration of illness (P < 0.00001). Comorbidity as diabetes mellitus, hypertension, chronic obstructive pulmonary disease, ischemic heart disease, and obesity has significant IL-6 level (P < 0.00001). IL-6 level has significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement during course hospitalization has significant association with IL-6 level (P < 0.00001). Timing of BIPAP/NIV requirement during hospitalization has significant association with IL-6 level (P < 0.00001) Serial IL-6 titer during hospitalization as compared to entry point normal and abnormal IL-6 has significant association in post-COVID lung fibrosis (P < 0.00001). Conclusions: IL-6 is easily available, and universally acceptable inflammatory marker, documented crucial role in COVID-19 pneumonia in predicting the severity of illness, progression of illness including “cytokine storm” and assessing response to treatment during hospitalization.
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Trends of chronic obstructive pulmonary disease diagnosis and treatment in rural setting in India: A large, two-center, prospective, observational study of 6000 cases in tertiary care setting in India p. 9
Shital Patil, Gajanan Gondhali, Manojkumar Bhadake, Anil Jadhav
DOI:10.4103/japt.japt_8_22  
Background: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality due to chronic respiratory illness in India. More than half of COPD patients were not getting adequate rationale inhalation treatment in primary to tertiary care setting. Materials and Methods: A prospective, observational, interview (questionnaire)-based complete workup COPD study conducted during June 2016 to June 2019 in the Department of Pulmonary Medicine, Venkatesh Chest Hospital, and MIMSR Medical College, Latur, screened 12,000 cases with chronic respiratory symptoms with cough, sputum production, and shortness of breath, and all cases were undergone spirometry and 6000 COPD cases were enrolled. In this study, we assessed disease knowledge and the methods of treatment offered to all patients before enrollment by applying questionnaire. Statistical analysis was done using single proportion test (Chi-square test). Observation and Analysis: We have observed that 3% of study cases were aware of their illness “COPD disease,” 54% are not knowing the disease or not counseled for COPD disease ever before, and 43% are not convinced as they are having COPD (categorized as “difficult patient”) (P < 0.0001). Inhalation treatment was offered in only 58% of COPD cases, levosalbutamol monotherapy in 31% of cases, levosalbutamol plus beclometasone in 18% of cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 9% of COPD cases (P < 0.0001), latter being categorized as “difficult treatment” being costlier than former ones. We also observed irrational and exuberant use of oral medicines in 42% of COPD cases, theophylline in 16%, salbutamol in 7%, and oral steroids in 19%, and these medicines were preferred by treating doctors over inhalation treatment in spite of knowledge of inhalation treatment and categorized as “difficult doctor” (P < 0.0001). Conclusion: COPD is less efficiently evaluated and halfheartedly treated in rural setting, and more emphasis should be given to spirometry training for proper diagnosis and awareness regarding advantages of inhalation treatment over oral medicines.
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REVIEW ARTICLE Top

Pleural sarcoidosis p. 17
Amitabh Banka, Aarthi Narasimhan, R Narasimhan
DOI:10.4103/japt.japt_10_22  
Sarcoidosis is a disorder that may involve multiple systems of the body and is diagnosed by confirming the noncaseating granulomas in tissues. However, pulmonary involvement is most common. Pleural involvement is very rare, and with newer advanced diagnostic modalities, it is now being diagnosed more often. In pleural involvement, it may be more common in the form of effusion, pneumothorax, thickening, and rarely in form of nodules, hydropneumothorax, and chylothorax. A definitive diagnosis needs a demonstration of noncaseating granuloma in tissue. Mostly responds to medical therapy and rarely may require surgical intervention. There have been many case reports stating pleural involvement in sarcoidosis. This review is an effort to compile all types of pleural involvement and provide it as compilation.
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CASE REPORTS Top

Drug-Induced interstitial pneumonitis in a case of breast malignancy p. 21
Hemalatha Padmanathan, Hema Murugesan, Sugumar Kumaran, Rithika Selvam, Venkatakrishnaraj Pandian, Vinod Kumar Viswanathan
DOI:10.4103/japt.japt_5_22  
Drugs used in the treatment of diseases including malignancy are known to cause various lung injuries, including interstitial pneumonitis. With increasing incidence of malignancies and advent of newer and newer chemotherapy and immunological treatments, it is prudent on the part of the pulmonologist to identify such complications at the earliest so that appropriate treatment can be initiated and reduce morbidity and mortality due to such causes. Herewith is presented a case of a patient with invasive ductal carcinoma of the breast who developed interstitial pneumonitis after 2 weeks of treatment with docetaxel and trastuzumab and was managed successfully.
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Reversible rheumatological syndrome with acute febrile respiratory illness secondary to COVID vaccination p. 25
Shital Patil, Ganesh Narwade, Abhijit Acharya
DOI:10.4103/japt.japt_12_22  
Rheumatological manifestation with acute febrile respiratory illness known to occur after coronavirus disease 2019 (COVID-19) pneumonia and presenting as long COVID disease, its occurrence with COVID vaccination is not very well associated or described in the literature. In this case report, a 45-year-old female, presented with constitutional symptoms, persistent fever, and lung parenchymal infiltrates, without mycobacterial microscopic or genome documentation, received empirical anti-tuberculosis treatment with the progression of disease with little clinical or radiological response. Bronchoscopy workup was inconclusive and tropical screen for bacterial, fungal, Tuberculosis, and malignancy were negative. Vasculitis workup was inconclusive and rheumatological workup documented highly raised ANA titers. We have started her on steroid and hydroxychloroquine and clinical response documented with near-complete resolution of shadows in 12 weeks. Rheumatological syndrome which is a rare vaccine-related adverse event, reversible, and easily treatable with routinely available medicines and importantly, it is having excellent prognosis. Minimal systemic adverse events are known to occur with all viral vector vaccines, but its occurrence is rare and it should not impact on routine vaccinations; as vaccination is a key step in this pandemic to protect humankind.
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A rare case of hepatic tuberculoma in an immunocompetent patient p. 31
Hema Murugesan, Hemalatha Padmanathan, Rithika Selvam, Sugumar Kumaran, Vinod Kumar Viswanathan
DOI:10.4103/japt.japt_7_22  
Hepatic tuberculoma is an uncommon form of extrapulmonary tuberculosis (TB). It is usually a part of disseminated disease such as miliary TB. Localized TB of the liver in the form of macronodular tuberculoma or an abscess is rare.[1] Clinicians should be aware of the possibility of tuberculous infection in all patients who have nonresolving liver abscesses, particularly in regions with high prevalence. Presented here is a case of an immunocompetent patient with tuberculoma of the liver, which was diagnosed by percutaneous ultrasonography-guided liver biopsy.
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Isolated pulmonary hypertension without interstitial lung disease with progressive dyspnea in young female needs connective tissue diseases workup: A case report with review of the literature p. 34
Shital Patil, Ganesh Narwade, Abhijit Acharya
DOI:10.4103/japt.japt_11_22  
Obstructive airway disease is the leading cause of breathlessness in young patients and in the absence of atopy or chest radiograph abnormalities such as nontubular heart and enlarged pulmonary artery mandates more workup. Pulmonary manifestations of mixed connective tissue disease (MCTD) range from bronchiolitis and bronchiectasis to interstitial lung disease and pulmonary hypertension. In this case report, a 25 year old female, presented with progressive dyspnoea and received treatment in line of obstructive airway disease with inhaled bronchodilators with inhaled corticosteroids with clinical worsening and no treatment response even after 24 months with good compliance. Radiological workup documented cardiomegaly with enlarged pulmonary artery in chest X-ray, multidetector computed tomography (MDCT) thorax documented grossly enlarged pulmonary arteries with dilated right heart chambers, and echocardiography documented severe pulmonary hypertension with dilated right atrium and right ventricle. Vasculitis and connective tissue diseases (CTD) workup was documented as strongly positive antinuclear antibody (ANA) with very highly raised titers, with other parameters in ANA blot documented positive antigens such as U1-small nuclear ribonucleoprotein particle, SSA/RO, single-strand DNA, and Scl-70. We have started on tadalafil, ambrisentan, and diuretics, and documented clinical response with increased work performance with improved quality of life with stabilization of pulmonary artery pressures on echocardiography at 12 weeks of treatment. We recommend young female genders with progressive dyspnea with nontubular heart on chest radiograph with or without enlarged pulmonary artery needs prompt workup such as high-resolution computed tomography/MDCT thorax, echocardiography, and ANA blot for early pickup of underlying CTD/MCTD to have successful treatment outcome.
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Abnormal chest skiagram in a normal individual a case report on orphan lung disease – Pulmonary alveolar microlithiasis p. 41
D Suresh Kumar, K Gokul
DOI:10.4103/japt.japt_3_22  
Pulmonary alveolar microlithiasis (PAM) is a rare inherited disorder of sodium phosphate cotransporter which causes accumulation of microliths in alveoli. This is a case report of a 46-year-old female, came for surgical fitness for laparoscopic cholecystectomy with abnormal chest skiagram. Chest skiagram showed typical sand storm appearance. Since the patient had no respiratory complaints, high-resolution computed tomography chest was taken which showed diffuse micronodular calcifications suggestive of PAM.
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RADIOLOGY QUIZ Top

Aspirated foreign body - Fish bone p. 45
Ajay Narasimhan, Vignesh Ashokan
DOI:10.4103/japt.japt_18_22  
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