Phenotyping of Airway Diseases – ‘One Size Fits the Most – But Some Are Different’
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:2] [Pages No:5 - 6]
DOI: 10.5005/ijcdas-61-1-5 | Open Access | How to cite |
Aetiology and Predictors of Outcome in Patients Presenting with Acute Respiratory Failure Requiring Mechanical Ventilation in a Medical Intensive Care Unit
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:5] [Pages No:7 - 11]
Keywords: Acute respiratory failure, Aetiology, Outcome, Mechanical ventilation
DOI: 10.5005/ijcdas-61-1-7 | Open Access | How to cite |
Background: Sparse published data are available regarding the aetiology, course, complications and outcome in patients presenting with acute respiratory failure requiring mechanical ventilation from India. Methods: Retrospective study of 116 patients with acute respiratory failure requiring mechanical ventilatory support (AcRFMV) in the medical intensive care unit (ICU) at our tertiary care teaching hospital in South India. Results: Patients with AcRF-MV (mean age 44.5±19.5 years; 52.6% females) constituted 23.9% of the 486 patients admitted to the medical ICU during the study period of 18 months. Aetiological causes included sepsis syndrome (46.6%), acute deliberate selfpoisoning (22.4%), acute exacerbation of chronic obstructive pulmonary disease (15.5%), snake bite and tuberculosis (5.2% each), severe complicated malaria (3.4%), among others. The median (interquartile range [IQR]) duration (days) of mean hospital stay and medical ICU stay were 10 (4-13.8) and 7 (4-11), respectively. Median (IQR) duration of mechanical ventilator support was 5 (3-8) days. Complications observed during medical ICU stay were ventilator-associated pneumonia (13.8%), bed sore (7.8%), pneumothorax (2.6%); 12.1% patients required tracheostomy. Fifty-eight (50%) patients died. On multivariable analysis using binary logistic regression (forward conditional method) shock at initial presentation (odds ratio [OR] = 3, 95% confidence intervals [CI] 1.638-5.493, p<0.001) emerged as independent predictor of death. Conclusions: Acute respiratory failure requiring mechanical ventilatory support is an important cause of admission to medical ICU and is associated with high mortality. Intense search for and monitoring of predictor variables can help clinicians in reducing the mortality.
A Study of Fine Needle Aspiration Cytology and Biopsy of Thoracic Masses with Special Reference to Clinical Staging and Performance Status of Patients with Lung Cancer
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:6] [Pages No:13 - 18]
Keywords: Thoracic mass, Computed tomography, FNAC, Biopsy, Adenocarcinoma, Pneumothorax
DOI: 10.5005/ijcdas-61-1-13 | Open Access | How to cite |
Background: Intra-thoracic mass is a common presentation in the chest out-patient department necessitating diagnostic procedures, like fine needle aspiration cytology (FNAC) and biopsy with variable results and complications. The present study was designed to study the clinical, cytopathological, histopathological spectrum of thoracic mass lesions and evaluation of complications arising out of these procedures. Methods: One hundred-and-twenty patients were studied in respect to clinical and radiological data, computed tomography (CT) guided FNAC (n=120); subsequently 88 of these patients underwent core needle biopsy and 12 bronchoscopic biopsies were done. In all the patients with bronchogenic carcinoma, clinical staging and Eastern Cooperative Oncology Group (ECOG) scoring were done. Results: Computed tomography guided FNAC (n=120) yielded positive results in 110 cases and subsequently biopsy was done in 100 cases; 92.5% cases were malignant, 5% were benign, and 2.5% were of infective aetiology. Overall sensitivity of CT-guided FNAC was found to be 91.7%; however, the sensitivity for anterior mediastinal mass was 75%. Adenocarcinoma was the most common malignancy (36.6%). Cytology and histopathology showed good concordance. Most of the patients with malignancy presented with late stage (ECOG 3 or more). Pneumothorax developed in 2.5% cases following FNAC and in 6.6% cases following biopsy. Conclusions: Adenocarcinoma was found to be the most common primary lung cancer. FNAC had a high sensitivity with high concordance with histopathology. Pneumothorax is an infrequent complication of FNAC and true-cut biopsies.
Image Guided Fine Needle Aspiration Cytology of Thymic Lesions: A Four-Year Study
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:5] [Pages No:19 - 23]
Keywords: Thymoma, Thymic carcinoma, Mediastinal lesions, FNAC, Cell block, Immunohistochemistry, Cytopathology
DOI: 10.5005/ijcdas-61-1-19 | Open Access | How to cite |
Background: Image-guided fine needle aspiration cytology (FNAC) has been used to evaluate mediastinal lesions. Methods: Case records of 28 patients with thymic lesions who had undergone computed tomography (CT) - or ultrasonographyguided FNAC of thymic lesions over a period of four years (January, 2012 – December, 2015), retrieved from the cytology register, were retrospectively studied. Malignant lymphomas were excluded. Four smears were prepared for each case; two were stained with Papanicoulaou (Pap) stain and two were stained with May-Grunwald Giemsa (MGG) stain. A cell block was prepared in cases where adequate material was available using formalin fixation and agar method. Immunohistochemistry on cell block was done wherever required and feasible. Final diagnosis was made on the basis of the cytological and histopathological findings (in those cases that underwent biopsy/surgery), and considering the clinical and radiological findings. Results: Thymoma accounted for the majority of the cases (n=19; 67.8%), thymic carcinoma (n=6; 21.4%), thymic hyperplasia (n=1; 0.04%), thymolipoma (n=1; 0.04%) and thymic neoplasia (n=1; 0.04%). Conclusions: Image-guided FNAC with ancillary tests can be a powerful diagnostic tool in the diagnosis of thymic neoplasms. Although a diagnosis by FNAC has often proved challenging in this area, image guided FNAC along with ancillary techniques can provide an accurate diagnosis, especially in thymic neoplasms.
Oral Health Status of Patients with Bronchial Asthma Reporting to a Tertiary Health Care Centre: A Cross-sectional Study
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:6] [Pages No:25 - 30]
Keywords: Oral health, Asthma, Anti-asthmatic medications, Hygiene
DOI: 10.5005/ijcdas-61-1-25 | Open Access | How to cite |
Background: Bronchial asthma is one of the growing public health problems around the world including India. In addition to its effects on general health, asthma has been reported to cause poor oral health. Methods: Two hundred and seventy-seven patients with asthma were evaluated for dentition status, periodontal status, loss of attachment, dental erosion and xerostomia. Demographic details, oral hygiene practices and details pertaining to duration of the disease, medications of all the study patients were recorded by direct face-to-face interview and type of medication was obtained from medical records. Results: A statistically significant difference was found for all the outcome variables with duration of the disease and medication. However, no such difference could be established with various drug combinations. Conclusion: The results of the present study advocates relationship between asthma and oral health status.
Demographic Profile, Smoking Cessation Interventions and Continuous Abstinence of Tobacco Users at Two Years
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:7] [Pages No:31 - 37]
Keywords: Tobacco cessation, Counselling, Pharmacotherapy, Abstinence rate
DOI: 10.5005/ijcdas-61-1-31 | Open Access | How to cite |
Background: Vallabhbhai Patel Chest Institute, Delhi is providing tobacco cessation services since November 2001. Since then many tobacco users visited and availed these services. Objectives: This study was undertaken to assess the demographic profile and the abstinence rate of the tobacco users at two years, outcomes of a cessation clinic in India, its success rate, type of people enrolling for cessation services, type of tobacco and tobacco dependence. Methods: Tobacco cessation counselling and pharmacotherapy, if required, were provided to tobacco users registered at Tobacco Cessation Centre (TCC) of our Institute from November 2001 to December 2016. During counselling, demographic details and details of tobacco use were obtained. Brief intervention strategies of RAJKUMAR (R=Reaching to the subject, A=assess the stage of change, J=Judge the severity, K=Know the risky situations, U=Use coping skills, M=Medication required or not, A=Arrange follow up, R=Re-evaluation) were applied. Results: Out of a total 7231 registered tobacco users, 7010 (97%) were males with a mean age (±SD) of 42.2 (±14.9) years. Most of the subjects (81%) belonged to urban areas. Majority of them (58.8%) were smokers, with 21.7% severly dependent on tobacco. Overall, continuous abstinence rate was observed to be 53.7%, 47.7%, 38.7%, 31%, 29.5%, 28.8% and 24% at 1, 3, 6, 9, 12, 18 and 24 months, respectively. In non-pharmacotherapy group, continuous abstinence rate for the same period was 55.3%, 46.1%, 35%, 23.9%, 22.4%, 22% and 18.3%, respectively, while in the pharmacotherapy group it was 51.1%, 50.1%, 44.5%, 41.8%, 40.3%, 36.4%, and 32.3%, respectively. Conclusions: Present study showed that tobacco users in the age group of 30-40 years are more interested to quit tobacco. A significant number of tobacco users (24%) continuously abstain from using tobacco for more than two years. Our results suggest that those using pharmacotherapy for tobacco cessation achieve a higher rate of abstinence. A 10-minute behavioural counselling was also found to be effective in reducing and/or quitting tobacco use.
A Case of Tension Pyopneumothorax Mimicking as Gastric Herniation
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:2] [Pages No:39 - 40]
DOI: 10.5005/ijcdas-61-1-39 | Open Access | How to cite |
Dyskeratosis Congenita Presenting with Idiopathic Pulmonary Fibrosis: A Rare Case Report
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:2] [Pages No:41 - 42]
Keywords: Dyskeratosis congenita, Idiopathic pulmonary fibrosis, Leucoplakia
DOI: 10.5005/ijcdas-61-1-41 | Open Access | How to cite |
Dyskeratosis congenita is an inherited bone marrow failure syndrome, characterised clinically by the classical triad of abnormal nails, reticular skin pigmentation, and oral leucoplakia and associated with very high risks of developing aplastic anaemia, myelodysplastic syndrome, leukemia and solid tumours. Though rare, it is diagnosed relatively easily when the clinicians suspect it. We present a case of a 70-year-old male presenting with pulmonary fibrosis alongwith dyskeratosis congenita. To the best of our knowledge after extensive research of the literature so far no such case has been reported from India.
Primary Tracheal Schwannoma Masquerading as Bronchial Asthma: A Case Report and Review of Literature
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:3] [Pages No:43 - 45]
Keywords: Tracheal schwannoma, Fixed airway obstruction, Electrocautery
DOI: 10.5005/ijcdas-61-1-43 | Open Access | How to cite |
We report an unusual case of primary tracheal schwannoma and related treatment challenges in a 30-year-old male who was symptomatic with breathlessness on exertion for the last one year. On computed tomography (CT) an intra-tracheal mass lesion was detected. Fibreoptic bronchoscopy revealed an intra-tracheal polypoid mass obstructing more than 80% of the lumen and histopathology of bronchoscopic biopsy diagnosed it as benign nerve sheath tumour. It was managed effectively with electrocautery through fibreoptic bronchoscopy.
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:3] [Pages No:46 - 48]
DOI: 10.5005/ijcdas-61-1-46 | Open Access | How to cite |
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:1] [Pages No:50 - 50]
DOI: 10.5005/ijcdas-61-1-50 | Open Access | How to cite |
[Year:2019] [Month:January-March] [Volume:61] [Number:1] [Pages:6] [Pages No:51 - 56]
DOI: 10.5005/ijcdas-61-1-51 | Open Access | How to cite |