The Indian Journal of Chest Diseases and Allied Sciences

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Volume 66, Number 1, January-March 2024
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Original Article

Raj Kumar, Kamal Singh, Anil K Mavi, Jitendra K Nagar, Sukriti Raj, Manoj Kumar, Ravishankar Nagaraja

Combustion of Biomass Fuel and Chronic Obstructive Pulmonary Disease in Rural Population of India

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:6] [Pages No:1 - 6]

Keywords: Biomass fuel, Chronic obstructive pulmonary disease, Indoor air pollution, Particulate matter

   DOI: 10.5005/jp-journals-11007-0108  |  Open Access |  How to cite  | 

Abstract

Background: Globally, chronic obstructive pulmonary disease (COPD) has a substantial and growing burden. Thus, among rural adults in Delhi National Capital Region (Delhi NCR), the study examines the prevalence of COPD among nonsmokers and the relationship between biomass fuel (BMF) use and COPD. Materials and methods: This cross-sectional study, conducted among adults in rural Delhi NCR areas with or without COPD, was community based. Enrolment comprised 1,564 individuals from 561 households. Information was gathered using a standard questionnaire, indoor particulate matter (PM) (PM1, PM2.5, and PM10) aerosol spectrometers were used to measure the concentrations, and pulmonary function tests (PFTs) were performed using a portable spirometry (GRIMM). Results: In adults in rural areas of Delhi NCR, 8.95% prevalence of COPD were found in which females were found significantly high COPD as compared with males (7.1% males and 92.9% females, p < 0.001). The concentration levels of PM10 (249.28 ± 189.33 vs 174.54 ± 76.40; p < 0.003), PM2.5 (134.78 ± 95.25 vs 108.66 ± 53.67; p = 0.039), and PM1 (107.22 ± 82.65 vs 89.51 ± 51.43; p = 0.025) were found significantly high in households of COPD patients as opposed to controls. Only COPD patients had airway obstruction (64.1%) as opposed to controls. Indoor air factors, that is, BMF smoke (p = 0.042), exhaust fan (0.047), and poor ventilation (p = 0.003), were found significantly associated with COPD. Conclusion: Factors such as combustion of BMF, kerosene oil, lack of exhaust fan, poor ventilation, and increased concentration of indoor PM, that could be very important in the onset of COPD in adults, especially in women and old age persons.

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Original Article

Soumitra Mondal, Sabyasachi Choudhury, Kaushik Saha, Subir K Dey, Sibes K Das, Gopal Sasmal

A Cross-sectional Study on Assessment of Estimated Glomerular Filtration Rate in Patients with Stable Chronic Obstructive Pulmonary Disease

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:4] [Pages No:7 - 10]

Keywords: Chronic obstructive pulmonary disease, Estimated glomerular filtration rate, Global Initiative for chronic obstructive lung disease stage, Renal involvement

   DOI: 10.5005/jp-journals-11007-0104  |  Open Access |  How to cite  | 

Abstract

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.

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Original Article

Saurabh Karmakar, Priya Sharma, Vatsal B Gupta, Ameet Harish

A Pulmonologist Perspective in Post-COVID-19 Fungal Lung Infection: Data from Tertiary Institute

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:4] [Pages No:11 - 14]

Keywords: Aspergillus, Coronavirus disease-2019, Fungal infection, Mucormycosis

   DOI: 10.5005/jp-journals-11007-0099  |  Open Access |  How to cite  | 

Abstract

Invasive fungal disease (IFD) is a serious complication of coronavirus disease-2019 (COVID-19), with a high mortality rate. This study aimed to determine the incidence, risk factors, and impact of IFD in adult moderate to severe COVID-19 patients. A retrospective study was conducted of 44 patients with a recent history of moderate to severe COVID-19 pneumonia and radiological evidence of cavitary lung disease. Bronchoalveolar lavage (BAL) galactomannan, fungal smear and culture, and histopathological examination of transbronchial lung biopsy (TBLB) were performed. The mean age of the patients was 59.68 years. The most common comorbidity was diabetes (45.4%). Bronchoalveolar lavage galactomannan was positive in 45.4% of patients. The most common imaging finding was cavitating consolidation. Total of 12 patients (27.27%) died during the follow-up period. The study found that BAL galactomannan can be a useful diagnostic tool for IFD in post-COVID-19 patients. Cavitating consolidation is a common imaging finding in patients with IFD. Patients with cavitating consolidation who have been recently discharged from the hospital with COVID-19 should be considered for empirical antifungal therapy. This study provides important insights into the diagnosis and management of IFD in post-COVID-19 patients. These findings can help clinicians to identify and treat patients with these infections more effectively.

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CASE REPORT

Akash Sengupta, Saikat Dutta

A Little More Than Just Air and Fluid: An Uncommon Case of Hydropneumothorax

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:5] [Pages No:15 - 19]

Keywords: Case report, Diffuse parenchymal lung disease, Hydropneumothorax, Lymphangioleiomyomatosis, Rare interstitial lung diseases, Tuberous sclerosis, Tuberous sclerosis–lymphangioleiomyomatosis

   DOI: 10.5005/jp-journals-11007-0105  |  Open Access |  How to cite  | 

Abstract

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.

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CASE REPORT

Sapna Yadav, Mithilesh Chandra

Atypical Presentation of Lepidic Adenocarcinoma Lung in a Healthy Female: A Case Report

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:3] [Pages No:20 - 22]

Keywords: Adenocarcinoma lung, Bronchoscopy, Case report, Cytokeratin 7, Lepidic, Lung, Lung cancer, Miliary nodules, Napsin A

   DOI: 10.5005/jp-journals-11007-0106  |  Open Access |  How to cite  | 

Abstract

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.

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CASE REPORT

Bhupendra Jatav, Avani Jain

A Case of Tropical Pulmonary Eosinophilia

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:4] [Pages No:23 - 26]

Keywords: Case report, Diethylcarbamazine, Filarial, Hyper eosinophilic syndrome, Lung disease, Tropical pulmonary eosinophilia

   DOI: 10.5005/jp-journals-11007-0100  |  Open Access |  How to cite  | 

Abstract

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 non-endemic locations, and indicates the efficacy of DEC in treating this illness.

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CASE REPORT

Aparna S Kilani, Raghu Srikanti, Sankari P Arulmozhi Palaniraj, Bhaskara R Nalamala, Priyanka Boppe, Sudheer Diyya, Kalyan Kumar V Penumuchu, Sivaprasad Chilaka, Kaviya Balaji, Raja Annadurai, Eunice Gera, Yashwanth Gunti, Navya S Imadabathuni

A Rare Cause of Respiratory Failure: Anti-immunoglobulin-like Cell Adhesion Molecule 5 Disease

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:4] [Pages No:27 - 30]

Keywords: Anti-immunoglobulin-like cell adhesion molecule 5 disease, Autoimmunity, Case report, Hypercapnic respiratory failure, Noninvasive ventilation, Nonrapid eye movement, Obstructive sleep apnea, Rapid eye movement related, Sleep apnea, Slow-wave sleep

   DOI: 10.5005/jp-journals-11007-0107  |  Open Access |  How to cite  | 

Abstract

Background: Anti-immunoglobulin-like cell adhesion molecule 5 (anti-IgLON5) disease is a strange disorder with a complex interplay between autoimmunity and neurodegeneration. The first case with severe air-flow disturbance and sleep apnea associated with the presence of anti-IgLON5 in cerebrospinal fluid (CSF) or serum was described in 2014. The initial common presentation among these patients is sleep apnea with respiratory failure. Case description: A 68-year-old man presented with excessive daytime sleepiness, loud snoring, nocturnal awakening, breathlessness, involuntary movements, and difficulty in swallowing for 1 year. His arterial blood gas (ABG) showed hypercapnic respiratory acidosis. Both CSF analysis and magnetic resonance imaging (MRI) brain were normal. Polysomnography (PSG) showed sleep apnea and rapid eye movement (REM) behavioral disorders. He was tested positive for myasthenia gravis and treated accordingly. Neurological involvements are explained by the presence of serum anti-IgLON5 antibodies. Case discussion: The IgLON5 proteins are cell adhesion molecules involved in neuroplasticity. Patients with anti-IgLON5 disease present with obstructive sleep apnea (OSA), REM, and nonrapid eye movement (NREM) parasomnia, chorea, cognitive decline, and sleep-disordered breathing with stridor and bulbar symptoms. Respiratory failure is explained by bulbar symptoms, sleep apnea, and respiratory muscle fatigue due to myasthenia gravis. Detection of anti-IgLON5 antibodies is crucial for diagnosis. Patients with anti-IgLON5 disease were treated with steroids and immunosuppressants. Conclusion: The variable clinical presentation of neurological symptoms makes it difficult to distinguish the anti-IgLON5 disease from other neurological diseases. When a patient presents with heterogeneous neurological symptoms including distinctive sleep disorders with respiratory failure often accompanied by bulbar symptoms, the anti-IgLON5 disease should always be suspected.

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EXPERT VIEW/REVIEW PAPER

Mohankumar Thekkinkattil

Optimal Oxygen Therapy Strategies for COVID-19 Positive Pregnant Women: A Comprehensive Review

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:4] [Pages No:31 - 34]

Keywords: COVID-19, Oxygen, Pregnancy

   DOI: 10.5005/jp-journals-11007-0103  |  Open Access |  How to cite  | 

Abstract

COVID-19 infection during pregnancy presents unique challenges, particularly in managing respiratory distress. Oxygen therapy emerges as a pivotal intervention, warranting meticulous attention and tailored strategies. This review explores the significance of oxygen therapy in mitigating hypoxemia, examining its implications, potential complications, and the imperative for meticulously structured protocols. With an emphasis on optimizing maternal–fetal outcomes, this comprehensive analysis underscores the need for evidence-based approaches, close monitoring, and individualized protocols for pregnant women combating COVID-19-associated respiratory compromise. This abstract encapsulates the focus on oxygen therapy's significance, the complexities surrounding its use, and the necessity for precisely defined protocols in managing COVID-19 in pregnant individuals, utilizing scientific language and keywords to appeal to a specialized readership.

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VIEWPOINT

Deependra K Rai

Challenges in Differentiating Asthma and Chronic Obstructive Pulmonary Disease for Treatment: A Simplified Algorithm Based on Spirometry and Blood Eosinophil

[Year:2024] [Month:January-March] [Volume:66] [Number:1] [Pages:2] [Pages No:35 - 36]

Keywords: Asthma, Chronic obstructive pulmonary disease, Peripheral blood eosinophil count, Spirometry

   DOI: 10.5005/jp-journals-11007-0102  |  Open Access |  How to cite  | 

Abstract

Treatment of both chronic obstructive pulmonary disease (COPD) and asthma now shifted from conventional to personalized therapy and a one-size-fits-all approach is ineffective in all cases. Treatment of both chronic obstructive disease treatment is driven by the history of symptoms, exacerbation, and blood eosinophil level, while asthma is by symptoms, airflow limitation, and blood or sputum eosinophil level. Although understanding of asthma and COPD has been deeper and deeper in the last few years, the treatment seems to be still complicated. Treatment of both diseases seems to be interrelated and overlapping and there is an unmet need for a simplified approach. Bronchial asthma patients may have fixed airflow obstruction (FAO), may have neutrophilic inflammation, may have inhaled corticosteroids (ICS) resistance, similarly, COPD patients may have reversible airflow limitation, eosinophilic inflammation, and ICS responsiveness. Treatment of both diseases depends upon the severity of symptoms, FAO, and blood eosinophil level. I am putting here a simplified approach to the treatment of asthma and COPD based on blood eosinophils and spirometry which would be a great help to clinicians in deciding the treatment.

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