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Saini V, Kaur J, Garg K, Gupta S, Kaur K. Serum Interleukin-33 and Soluble Suppression of Tumorigenicity 2 in Bronchial Asthma. Indian J Chest Dis Allied Sci 2019; 61 (4):171-174.
Background: Interleukin-33 (IL-33) is a member of IL-1 family of cytokines and is a ligand to the receptors of soluble suppression of tumorigenicity 2 (sST2). The IL-33/sST2 axis is involved in the promotion and maintenance of allergic inflammatory pathway in asthma; hence serum levels of these two biomarkers were studied.
Methods: This cross-sectional and observational study was conducted in Government Medical College and Hospital, Chandigarh, India. A total of 220 subjects were recruited and divided into four groups: Group A: asthmatic patients with exacerbation, Group B: asthmatic patients without exacerbation, Group C: patients with other lung diseases, like chronic obstructive pulmonary disease, community acquired pneumonia, lung cancer, etc and Group D: age and gender matched apparently healthy individuals and serum IL-33 and sST2 levels were studied.
Results: Present study showed that IL-33 and sST2 levels were significantly raised in asthmatic patients with acute exacerbation. Mean serum values of IL-33 were 37.9, 27.1, 15.2 and 14.5pg/mL in groups A, B, C and D, respectively and those of sST2 were 7.91, 7.03, 3.98 and 3.56 ng/mL in the groups A, B, C and D, respectively.
Conclusion: Serum IL-33 and sST2 can be considered as novel biomarkers in asthma severity.
Omkar K. Choudhari,
Umesh Chandra Ojha,
Ramesh Singh Pal
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Spalgais S, Gothi D, BabuSah R, Choudhari OK, Ojha UC, Pal RS. Diagnostic Yield and Complications of CT-guided Peripheral Lung Lesion Biopsy: A Pulmonologist Experience. Indian J Chest Dis Allied Sci 2019; 61 (4):175-179.
Background: To study the diagnostic yield and complications of computed tomography (CT)-guided peripheral lung lesion biopsy.
Methods: We retrospectively studied the case records of 62 patients with undiagnosed peripheral lung lesions who underwent CT-guided lung biopsy, performed by a pulmonologist at our tertiary care institute during the period January 2015 to June 2017.
Results: Their mean age (range) was 56 (32-82) years; majority 38/62 (61%) were men. Thirty-nine (63%) patients were smokers. The overall yield was (60/62) 96.8%. The diagnosis was malignant in 46 (74.2%) and benign in 14 (22.6%) cases. Only two cases remain undiagnosed. The malignant lesions were small cell carcinoma–5, non-small cell lung carcinoma (NSCLC)–39, non- Hodgkin's lymphoma (NHL) and myofibroblastoma – one each. All NSCLC were in stage IIIB/C or IVA/B. The benign lesions were tuberculosis (TB) and post-TB lesions (n=6each) and anthracosis (n=2). Nine (14.5%) developed pneumothoraces and one required intercostal drainage. The pneumothorax was significantly more common with small size (<3cm) compared with large size lesion (>3cm) (p=0.039).
Conclusions: With the increasing use of mutational analysis and personalised therapy large biopsy is required. With limited availability of interventional radiologist in our country, the art of CT-guided biopsy should be learnt by the pulmonologist, since it is a cost-effective, reliable, first-line diagnostic procedure with comparable yield and complication in hands of pulmonologist.
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Kumar R, Singh K, Nagar JK, Mavi AK, Kumar M, Kumar D. Association of Indoor Air Pollution with Allergic Respiratory Diseases in Paediatric Population Residing in National Capital Region. Indian J Chest Dis Allied Sci 2019; 61 (4):181-197.
Background: World Health Organization (WHO) has observed that around seven million people died every year globally due to indoor air pollution. The purpose of this study is to evaluate the effect of indoor air pollution on respiratory health [bronchial asthma (BA) and/or allergic rhinitis (AR)] in a paediatric population in the National Capital Region (NCR) of Delhi, India.
Methods: A cross-sectional study to assess the factors responsible for respiratory diseases (BA and/or AR) in homes in rural areas of National Capital Region (NCR), India was done. Sixty-one households where at least one child who had symptoms of BA/AR (case households; Group A) and another 61 households with children without any symptom of BA/AR (Group B) were selected for the study. A standard questionnaire was used to collect the information about the health status of children and pollution levels in these homes.
Results: A total of 95 (43.8%) children in Group A households were found to have history of allergic respiratory diseases (n=43–BA, n=19–AR) while 33 children had both BA and AR. There was a statistically significant difference in the 24-hour particulate matter concentration (24-hour) PM2.5 (P=0.01) and 6-hour concentration of PM10 (P=0.02) in Group A households as compared to Group B households. The 6-hour concentration of PM2.5 and PM1 and 12-hour concentration of volatile organic compounds (VOCs) was found to be higher in households of Group A. Group A households also had a higher number of smokers and usage of kerosene oil for lighting of lamps.
Conclusions: Tobacco smoking, use of kerosene oil for lighting and combustion of solid fuel for cooking results in an increased level of particulate matter and VOCs in indoor air and are the major contributing factors for respiratory illness in the paediatric population.
Background: Tuberculosis (TB) empyema is a chronic infection of pleural space which carries a significant morbidity and mortality.
Methods: A retrospective study of clinical, radiological, bacteriological features and management of 54 patients with TB pyothorax admitted to a medical college tertiary care teaching hospital at Cuttack, Odisha.
Results: Their mean age was 43.2 years; there were 45 (83.3%) males. History of TB was available in 13 (24%) patients, among whom two patients had multidrug-resistant TB. Cough (92.5%), expectoration (87%), fever (75.9%), chest pain (66.6%), were most common presenting symptoms; pallor (46.2%), digital clubbing (44.4%) were the most frequently evident signs. Thirtyone (57.4%) patients had underlying comorbid conditions; diabetes mellitus, alcoholism (n=11 each), were the most frequently present. TB empyema occurred on the right-side in 30 (55.5%), left side in 21 (38.9%) and was bilateral in three patients. Direct smear of pus and sputum revealed acid-fast bacilli in four (7.4%) and eight (14.8%) patients, respectively; mycobacterial culture of pus was positive in 11 (20.3%) cases. Six patients were managed with simple aspiration, 47 patients required tube thoracostomy, one patient was managed with open drainage; two patients were referred to thoracic surgery for the decortication. Category I, II and IV anti-TB treatment was administered to 41 (76%), 11 (20.3%) and two patients, respectively. Secondary bacterial infection in pleural fluid occurred in 26 (48%).
Conclusion: Drainage of pyothorax using tube thoracostomy along with effective anti-TB drugs results in good outcome, and many patients may not require surgery.
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Tamburrini M, Desai U, Mazza F, Gothi D, Sulfaro S, Giol L, Zuccon U. Synchronous Primary Lung Cancer — Adenocarcinoma and Oncocytoma: The Rarest of Rare Duet. Indian J Chest Dis Allied Sci 2019; 61 (4):203-205.
Multiple primary lung cancers are uncommon. These are divided as synchronous and metachronous. Synchronous primary lung cancers (SPLCs) are usually described on autopsy. The availability of rapid onsite evaluation (ROSE) in our case helped us reach early diagnosis. We present a rare case of SPLC having the combination of adenocarcinoma and oncocytoma. To the best of our knowledge, this rare duet has never been previously described in literature.
Congenital lobar emphysema is a rare disorder of unknown aetiology that may present a diagnostic challenge. We report two cases of congenital lobar emphysema in paediatric age group who were initially treated as pleuro-pulmonary tuberculosis and recurrent pneumonias, respectively. Eventually they were diagnosed as congenital lobar emphysema following chest radiography, computed tomography and bronchoscopic evaluation.
Fungal empyema is rare but severe infection with high mortality. Candida spp are the most common isolates among all fungal empyema patients. Candida glabrata (older name: Torulopsis glabrata) is often the second or third most common cause of candidiasis after Candida albicans. Candida glabrata infections can be mucosal or systemic and are common in immunocompromised patients, especially in patients with diabetes mellitus. We report a case of fungal pyopneumothorax in a patient having underlying diabetes mellitus and cirrhosis of the liver. Candida glabrata, being an uncommon pathogen for fungal pyopneumothorax was the causative agent in the present case.
Pleuroparenchymal fibroelastosis (PPFE) is a rare variant of interstitial lung disease (ILD). PPFE is characterizsed by peculiar clinical, radiological and histological features. Initially considered an idiopathic entity, this disease is now classified in the rare category of the recent classification of idiopathic interstitial pneumonias (IIPs). However, it largely continues to be underdiagnosed owing to the lack of awareness about this condition. PPFE may be misdiagnosed as the other commonly diagnosed ILDs, especially IIP. The diagnosis is clinched with lung biopsy. We report a case of PPFE diagnosed by transbronchial lung biopsy.
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Marwah V, Govind R, Shergill S, Vasan A. Pneumocystis Jiroveci Pneumonia and H1N1 Co-infection in an Immunocompetent Patient. Indian J Chest Dis Allied Sci 2019; 61 (4):219-220.
Pneumocystis jiroveci pneumonia is frequently diagnosed in immunocompromised patients but it has rarely been reported in immunocompetent individuals without any predisposing factors. Immunocompetent individuals who are exhibited steroids or other immune-suppressive drugs, may become susceptible and may develop clinical Pneumocystis carnini pneumonia (PCP) infection. Cases of co-infection of P. jiroveci and H1N1 influenza in patients with human immunodeficiency virus (HIV) infection and organ transplant recepients have been reported. However, case reports of P. jiroveci and H1N1 influenza co-infection are rare in immunocompetent individuals. We report a case of a young immune-competent man diagnosed with H1N1 influenza and P. jiroveci pneumonia which posed significant diagnostic and management dilemma.