The Indian Journal of Chest Diseases and Allied Sciences

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2010 | January-March | Volume 52 | Issue 1

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G. C. Khilnani

Bronchoalveolar Lavage: A Forgotten Tool!

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:3] [Pages No:5 - 7]

   DOI: 10.5005/ijcdas-52-1-5  |  Open Access |  How to cite  | 


Original Article

Bashir Ahmed Shah, Wasim Ahmed, Ghulam Nabi Dhobi, Naveed Nazir Shah, Syed Quibtiya Khursheed, Inaamul Haq

Validity of Pneumonia Severity Index and CURB-65 Severity Scoring Systems in Community Acquired Pneumonia in an Indian Setting

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:9] [Pages No:9 - 17]

Keywords: Community acquired pneumonia, CURB-65, Pneumonia severity index

   DOI: 10.5005/ijcdas-52-1-9  |  Open Access |  How to cite  | 


Background. Little information is available from India regarding prognostic factors in patients with community acquired pneumonia (CAP). Methods. Hospital-based prospective study to test the validity of pneumonia severity index (PSI) and the confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65) risk scoring systems in patients with CAP (n=150). Results. Although both CURB-65 class ≥III and PSI class ≥IV were 100% sensitive in predicting death, CURB-65 class ≥III had a higher specificity (74.6%) than PSI class ≥IV (52.2%) when used to predict death. In both PSI and CURB-65 risk scoring systems, mortality rate, need for intensive care unit (ICU) admission, prolonged need for intravenous (I.V.) antibiotics, prolonged duration of hospital stay and need for admission to ICU increased progressively with increasing scores. The PSI class ≥IV was more sensitive in predicting ICU admission than CURB-65. The duration of hospital stay was found to have a weak but significant correlation with PSI and CURB-65 criteria. Defervescence time also had a very weak but significant correlation with PSI and CURB-65 criteria. Duration of I.V. antibiotics had a moderately strong correlation with CURB-65 criteria but a weak correlation with PSI criteria. Conclusions. Both PSI and CURB-65 were found to have equal sensitivity to predict death from CAP. Specificity of CURB- 65 was higher than that of PSI. However, PSI was more sensitive in predicting ICU admission than CURB-65.


Original Article

Balamugesh Thangakunam, Devasahayam J Christopher, Prince James, Richa Gupta

Semi-rigid Thoracoscopy: Initial Experience from A Tertiary Care Hospital

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:3] [Pages No:25 - 27]

Keywords: Lung cancer, Pleural disease, Tuberculosis, Thoracoscopy

   DOI: 10.5005/ijcdas-52-1-25  |  Open Access |  How to cite  | 


Background. Thoracoscopy is usually carried out using rigid metallic instruments. Recently, video flex-rigid or semi-rigid thoracoscopes have been introduced. These have the advantage of easy maneuverability, although the biopsy samples are smaller as compared to those with rigid thoracoscopy. We have looked at the usefulness of flex rigid thoracoscope in the diagnosis and treatment of pleural diseases, remained undiagnosed after thoracentesis and closed biopsy. Methods. Retrospective analysis of data of patients who underwent thoracoscopy for the evaluation of pleural disease. Results. Thoracoscopy was done in 21 patients using a flex-rigid thoracoscope in our institution. The indication was pleural effusion with inconclusive or negative pleural fluid cytology and blind pleural biopsy in 18 of the 21 patients. Thoracoscopic biopsy was positive in 12 of the 18 patients (66.7%). Of the six who had a negative biopsy, the procedure indirectly helped in patient management in five. There were no significant procedure-related complications. Conclusion. Thoracoscopy with flex-rigid thoracoscope is a useful diagnostic tool in the evaluation of pleural effusions with negative blind pleural biopsy and cytology.



Sunil Kumar Chhabra

Pulmonary Hypertension Associated with Chronic Obstructive Pulmonary Disease

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:12] [Pages No:29 - 40]

Keywords: Chronic obstructive pulmonary disease, Smoking, Endothelial dysfunction

   DOI: 10.5005/ijcdas-52-1-29  |  Open Access |  How to cite  | 


Pulmonary hypertension (PH) is likely to complicate chronic obstructive pulmonary disease (COPD) in a large proportion of patients, especially those with severe disease. Majority of patients have a mild to moderate elevation in the pulmonary artery pressure that usually does not require specific treatment. A small subset of patients, however, develops severe PH that is “out-of-proportion” to the severity of COPD. Generally considered a consequence of chronic hypoxaemia, endothelial dysfunction has now been recognised to play an important role in the pathogenesis of PH in COPD. Pulmonary vessels remodelling characterised by intimal enlargement with proliferating smooth muscle cells, medial hypertrophy, arteriolar muscularisation and endothelial cell proliferation, especially affecting the small arterioles and arteries, leads to permanent changes in the vascular structure and function. Clinical recognition of PH is difficult. Echocardiography is used for screening while right heart catheterisation is the gold standard for diagnosis. In patients who have a moderate degree of chronic hypoxaemia, long term oxygen therapy is indicated and is the only therapeutic measure so far known to retard the progress of PH. Newer therapies targeting the specific abnormalities of vasoconstrictor-vasodilator balance, arising as a consequence of endothelial dysfunction, are under investigation and may offer a management option especially in severe PH associated with COPD.


Radiology Forum

Snehal Jadhav, J M Joshi

Diffuse Panbronchiolitis Associated with Malignant Thymoma

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:2] [Pages No:41 - 42]

   DOI: 10.5005/ijcdas-52-1-41  |  Open Access |  How to cite  | 



Alok Nath, Ashutosh N. Aggarwal, Ruchi Gupta

Diffuse Panbronchiolitis: Report of a Rare Disease from India

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:3] [Pages No:43 - 45]

Keywords: Diffuse panbronchiolitis, Lungs, Bronchiectasis

   DOI: 10.5005/ijcdas-52-1-43  |  Open Access |  How to cite  | 


Initially described by a group of Japanese clinicians and pulmonary pathologists to distinguish it from other chronic obstructive lung diseases, diffuse panbronchiolitis (DPB) is an uncommon disorder which has been reported largely from the eastern world. It is imperative to recognise this condition because of its potentially treatable nature. Recently, long-term macrolide therapy has revolutionised its management. Herein, we describe a 65-year-old male who was being managed as a case of chronic bronchitis before this diagnosis was suspected and proved.



L. Fekih, S. Fenniche, H. Hassene, H. Abdelghaffar, S. Yaalaoui, F. EL Mezni, D. Belhabib, A. Zidi, M.L. Megdiche

Multiple Myeloma Presenting with Multiple Thoracic Manifestations

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:3] [Pages No:47 - 49]

Keywords: Multiple myeloma, Pleural effusion, Bronchial neoplasm, Mediastinal lymph nodes, Lytic lesion

   DOI: 10.5005/ijcdas-52-1-47  |  Open Access |  How to cite  | 


Multiple myeloma is a malignant proliferation of plasma cells that affects mainly bone marrow but may also involve other organs as well. We report thoracic involvement in the form of left-sided pleural effusion, osseous lesions, bronchial infiltration, and mediastinal lymphadenopathy in a 61-year-old woman, non-smoker presented with chest pain, dyspnoea, cough and deterioration in general health over the preceding seven months. Immunoelectrophoresis and immunofixation showed raised kappa-light chain immunoglobulin G (IgG) in serum and pleural fluid. Bronchial and pleural biopsies documented myelomatous infiltration and bone marrow aspirate revealed extensive plasma cell infiltration. At eight months, following the fourth cycle of melphalan, endoxan and prednisone based chemotherapy, the patient died.



Vitorino Modesto dos Santos, Herberth Vera Cruz Furtado Marques Jr, Camila do Carmo Lima, Thiago Zavascki Turra, Pedro Robério de Melo Nogueira Jr, Lia Nogueira Lima

Yellow Nail Syndrome and Adnexal Tumour: Causal or Casual Association?

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:3] [Pages No:51 - 53]

Keywords: Yellow nail syndrome, Oedema, Respiratory infection, Adnexal tumour, Association

   DOI: 10.5005/ijcdas-52-1-51  |  Open Access |  How to cite  | 


The yellow nail syndrome is an uncommon condition characterised by dystrophic nails, pulmonary disturbances and lymph oedema. In Brazil as well as in India, this syndrome has been scarcely described, at least in part due to diagnosis pitfalls related with darker skin pigmentation. A case of adnexal malignancy developing several decades after initial signs of yellow nail syndrome is reported in a 61-year-old Brazilian female admitted for evaluation of peripheral oedema. She reported recurrent sinusitis and bronchitis, and three antecedent pneumonias. Physical examination showed yellow thickened nails and lower limb oedema, and a painless huge adnexal mass. Diverse tumours have been described associated with yellow nail syndrome; however, associations can also occur by chance. The present report attempts to raise the awareness about casual co-existence of malignancy and the syndrome.



I. Ramya, K.P. Mathews, K. Pichamuthu, Shyamkumar N. Keshava S., T. Balamugesh, M. Ramamani, V. Surekha, T. Mammen

Endotracheal Tuberculous Stenosis: Ventilation Rescue and Bronchography Guided Stenting

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:4] [Pages No:55 - 58]

Keywords: Endotracheal tuberculosis, Tracheal stenting, Fluroscopy

   DOI: 10.5005/ijcdas-52-1-55  |  Open Access |  How to cite  | 


We present the case of a 16-year-old female patient who presented with dyspnoea, cough and noisy breathing that progressed further in hospital with the development of stridor and severe respiratory compromise requiring mechanical ventilatory support. Investigations were consistent with a diagnosis of endotracheal tuberculosis with tracheal and bronchial stenosis. Despite adequate anti-tuberculous therapy and ventilation the patient had high airway pressures, low tidal volumes and hypercapnia, which prevented weaning from mechanical ventilation. Balloon dilatation and stenting of the 4.5cm long, 2.3mm diameter stenotic tracheal segment was performed under radiological guidance. The patient was weaned successfully from the ventilator post-procedure. This report illustrates the successful management of an uncommon presentation of a common disease with modern endoscopic therapy.



Cyrus Chargari, Dhara MacDermed, Pierre-Emmanuel Tardo-Dino, Pierre Castadot, Nicolas Magne

Cannon Ball Lucencies from Last Century: Lucite Balls Used to Treat Pulmonary Tuberculosis

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:1] [Pages No:59 - 59]

   DOI: 10.5005/ijcdas-52-1-59  |  Open Access |  How to cite  | 



J.S. Pandey, A.P. Mishra, U.K. Sur, M. Tembhare, R. Kumar, S.R. Wate

How to Plan for Methane Mitigation and Utilisation Strategies?

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:2] [Pages No:60 - 61]

   DOI: 10.5005/ijcdas-52-1-60  |  Open Access |  How to cite  | 


Abstracts' Service

Abstracts' Service

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:4] [Pages No:62 - 65]

   DOI: 10.5005/ijcdas-52-1-62  |  Open Access |  How to cite  | 


Panel of Reviewers–2009

Panel of Reviewers–2009

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:1] [Pages No:66 - 66]

   DOI: 10.5005/ijcdas-52-1-66  |  Open Access |  How to cite  | 


Guidelines to Authors

Guidelines to Authors

[Year:2010] [Month:January-March] [Volume:52] [Number:1] [Pages:5] [Pages No:67 - 71]

   DOI: 10.5005/ijcdas-52-1-67  |  Open Access |  How to cite  | 


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