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A rare rapidly progressive presentation of tuberculous meningitis 罕见的迅速进展的结核性脑膜炎
Pub Date : 2023-01-15 DOI: 10.18231/j.ijirm.2022.038
Swapnil Gautam, A. Agarwal, M. Desai
Tubercular Meningitis (TBM) usually presents as a sub-acute to chronic illness, with duration of symptoms ranging from weeks to months before clinical presentation. The course of disease is divided into 3 clinical stages- the stage of prodrome, phase of neurological symptoms and paretic stage, which usually progresses gradually over a period.Here we report an unusual case of TB meningitis in young female, which progressed rapidly over a period of 7-10 days from symptom onset, without any prodromal features or previous evidence of Koch’s, to reach a non-salvageable stage despite all the available diagnostic and therapeutic modalities.
结核性脑膜炎(TBM)通常表现为亚急性到慢性疾病,在临床表现前症状持续数周到数月不等。病程分为3个临床阶段:前驱期、神经症状期和麻痹期,麻痹期通常在一段时间内逐渐进展。在此,我们报告一例罕见的年轻女性结核性脑膜炎病例,该病例从症状出现开始,在7-10天内迅速发展,没有任何前症特征或既往科赫氏病的证据,尽管采用了所有可用的诊断和治疗方法,但仍达到不可挽回的阶段。
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引用次数: 0
Evaluation of massive hemoptysis with high suspicion for alveolar hemorrhage in the emergency room 高怀疑肺泡出血的大咯血在急诊室的评价
Pub Date : 2023-01-15 DOI: 10.18231/j.ijirm.2022.037
Nandha kumar Selvam, Keerthi Iyengar Bukkapatnam, Kandavel G Sivamani, Dhilip Kumar
Diffuse alveolar hemorrhage is a serious life threatening condition that has to be promptly addressed during early period of presentation to emergency room. It is usually associated with some underlying causative factor. Early identification of causative factors will help in early initiation of definitive management, thereby reducing the mortality and improving the outcome. We report a case of 64-year-old male with hemoptysis who has been identified as alveolar hemorrhage in emergency room. We also evaluated its possible causative factor by clinical suspicion, laboratory investigations and contrast enhanced computed tomography imaging. Patient started showing improvement with the initiation of face mask oxygenation, empirical IV antibiotics and IV steroid which was further augmented with bronchoscopic intervention by the pulmonology team. Flexible bronchoscopy played both a diagnostic and therapeutic role in this patient. A patient presenting to emergency room with clinical triad of cough, dyspnea and massive hemoptysis has to be approached with high suspicion for diffuse alveolar hemorrhage. Rapid evaluation for its etiology and initiating empirical treatment can prevent morbidity and mortality, thereby improving survival outcome.
弥漫性肺泡出血是一种严重危及生命的疾病,必须在就诊早期及时处理。它通常与一些潜在的致病因素有关。早期确定致病因素将有助于尽早开始明确的管理,从而降低死亡率和改善结果。我们报告一例64岁男性咯血,在急诊室确诊为肺泡出血。我们还通过临床怀疑、实验室检查和增强计算机断层成像来评估其可能的病因。患者在开始面罩氧合、经验性静脉注射抗生素和静脉注射类固醇后开始出现改善,并在肺科小组的支气管镜干预下得到进一步加强。柔性支气管镜检查在该患者中发挥了诊断和治疗的作用。以咳嗽、呼吸困难、大咯血三联征就诊的患者,应高度怀疑弥漫性肺泡出血。快速评估其病因并开始经验性治疗可以预防发病率和死亡率,从而改善生存结果。
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引用次数: 0
Prevalence of primary INH and Rifampicin resistance among treatment Naïve tuberculosis cases in tertiary care teaching hospital in Puducherry: A prospective cross-sectional study 普杜切里三级保健教学医院治疗Naïve结核病患者的原发性INH患病率和利福平耐药性:一项前瞻性横断面研究
Pub Date : 2023-01-15 DOI: 10.18231/j.ijirm.2022.035
Dharm Prakash Dwivedi, A. Shukla, V. Raveendran, M. Muthaiah
India contributes to approximately one-third of total global tuberculosis (TB) and one-fourth of all Multi-Drug Resistant TB (MDR-TB) burden respectively. The First National drug resistance survey (2014-16) showed MDRTB rates of 6.19% overall and 2.14% in newly diagnosed TB cases. With the above problem of primary drug resistance among newly diagnosed tuberculosis cases, the present study was planned to find the prevalence of Isoniazid (INH) and Rifampicin resistance in the treatment naïve new tuberculosis cases.: Study design: Prospective, cross-sectional.: Treatment naive newly diagnosed pulmonary tuberculosis cases.: 125.: After informed written consent, Sputum samples were collected and subjected to culture in MGIT 960 and positive cultures were recorded and subjected to drug sensitivity testing for INH (0.1 μg/ml) and Rifampicin (1 μg/ml) and a parallel non-drug MGIT was run as a control.: Most cases were males and belonged to the 20-59 years age group. Isoniazid (INH) resistance was found in 7 out of 125 samples, none had resistance to rifampicin. None of the categorical variables or grading of smear were having any statistically significant correlation with INH resistance.: INH resistance was found to be low (5.6%) with negligible MDR in the current study. Regular and large studies are needed to quantify and tackle the problem of primary MDR TB.
印度分别占全球结核病总负担的大约三分之一和耐多药结核病总负担的四分之一。第一次全国耐药调查(2014- 2016年)显示,耐多药结核病总发病率为6.19%,在新诊断结核病例中为2.14%。针对上述结核新发病例原发性耐药问题,本研究拟了解naïve结核新发病例中异烟肼(INH)和利福平耐药情况。研究设计:前瞻性、横断面。:治疗初发肺结核病例。: 125。经知情书面同意后,收集痰样,在MGIT 960中培养,记录阳性培养,并进行INH (0.1 μg/ml)和利福平(1 μg/ml)的药敏试验,并进行平行非药物MGIT作为对照。病例以男性为主,年龄在20 ~ 59岁。125份样品中有7份对异烟肼(INH)耐药,对利福平无耐药。没有分类变量或涂片分级与INH耐药性有统计学意义的相关性。目前的研究发现INH耐药性很低(5.6%),耐多药可以忽略不计。需要进行定期和大规模的研究,以量化和解决原发性耐多药结核病问题。
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引用次数: 0
Immunomodulation in COVID-19 COVID-19的免疫调节
Pub Date : 2023-01-15 DOI: 10.18231/j.ijirm.2022.034
Sirshendu Pal, Rupsha Dutta
Immunology forms the basis for effective treatment strategies and production of vaccines. In COVID 19 immune insufficiency may increase viral replication while uncontrolled immunity may result in tissue damage. The angiotensin converting enzyme receptors on alveolar type 2 cells of lungs act as target cells are the sites of Corona virus attack. These cells through cytokines or interferons initiate an early local response which may control the infection. However, in COVID-19 this interferon response can be subdued or lagging which may allow the COVID virus to escape detection by the innate immunity or depress the downstream reaction leading to unchecked SARS-COV-2 replication. The suppression of host responses leads to increase in pro-inflammatory cytokines and the resulting inflammatory damage leads to a release of suppressive cytokines as a counter regulatory response. This is the cytokine storm. Thus, immuneregulatory treatments that may succeed are the ones that are in real time tuned to the subject's immunophenotype, where immunosuppression may be helpful at some points while immune-stimulation in others.
免疫学是有效治疗策略和生产疫苗的基础。在COVID - 19中,免疫功能不全可能增加病毒复制,而不受控制的免疫可能导致组织损伤。肺肺泡2型细胞上的血管紧张素转换酶受体是冠状病毒攻击的靶细胞。这些细胞通过细胞因子或干扰素启动可能控制感染的早期局部反应。然而,在COVID-19中,这种干扰素反应可能被抑制或滞后,这可能使COVID病毒逃脱先天免疫的检测或抑制下游反应,导致不受控制的SARS-COV-2复制。对宿主反应的抑制导致促炎细胞因子的增加,由此产生的炎症损伤导致抑制细胞因子的释放,作为一种反调节反应。这是细胞因子风暴。因此,可能成功的免疫调节治疗是那些实时调整到受试者的免疫表型的治疗,免疫抑制在某些点可能有用,而免疫刺激在其他点可能有用。
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引用次数: 0
XBB.1.5 the most transmissible descendant yet of the omicron variant of SARS-CoV-2- Is it the beginning of a new wave of the COVID-19 pandemic? XBB.1.5是SARS-CoV-2组粒变体的最具传染性的后代-这是新一波COVID-19大流行的开始吗?
Pub Date : 2023-01-15 DOI: 10.18231/j.ijirm.2022.033
S. Yadav
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引用次数: 0
Recovery from osmotic demyelination syndrome associated with pituitary macroadenoma 垂体大腺瘤相关性渗透脱髓鞘综合征的康复
Pub Date : 2023-01-15 DOI: 10.18231/j.ijirm.2022.036
M. Kumar, Suresh Ramasubban, Subhajit Sen, S. Dey
45 years old female known case of hypothyroid admitted to local nursing home with pain abdomen, vomiting and generalized weakness. She received intravenous fluids and antibiotics in a nearby hospital. She experienced hyponatremia, which hypertonic saline from 104 to 128 meq/l quickly treated. Modified Rankin scale score was >3. MRI brain done showed pituitary macroadenoma. She was transferred to our hospital after 5 days because of altered sensorium and bradykinesia of all 4 limbs with high grade fever and unexpected MRI finding. Treatment was started initially in line of meningitis but CSF study was negative. She was intubated for airway protection later tracheostomy was done. MRI brain repeated after 15 days showed pontine and extrapontine demyelination. Serum cortisol was low due to secondary adrenal insufficiency so started on steroid therapy. She improved gradually regained consciousness, started obeying commands, decannulated and discharged with Rankin score <1 after 2 months of steroid and thyronorm supplements and extensive supportive therapy.
45岁女性,因腹部疼痛、呕吐和全身无力而入院。她在附近一家医院接受了静脉输液和抗生素治疗。她出现了低钠血症,高渗盐水从104至128 meq/l迅速治疗。修正Rankin量表得分>3。脑部MRI示垂体大腺瘤。5天后因感觉改变、四肢运动迟缓伴高热及意外MRI发现转至我院。治疗开始于脑膜炎,但脑脊液研究呈阴性。她插管以保护气道,随后进行气管切开术。15天后复查MRI显示脑桥及脑桥外脱髓鞘。由于继发性肾上腺功能不全,血清皮质醇较低,因此开始类固醇治疗。患者逐渐好转,意识恢复,开始服从命令,经2个月类固醇和甲状腺激素补充及广泛的支持治疗后,停用静脉导管,Rankin评分<1出院。
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引用次数: 0
Case report of pulmonary nocardiosis in a patient of right renal transplantation 右肾移植患者肺部诺卡菌病1例报告
Pub Date : 2023-01-15 DOI: 10.18231/j.ijirm.2022.040
Anirban Ray, Sushmita Roy Choudhury, S. Unnithan, Angshuman Mukherjee, P. Mondal
Nocardiosis results from infection with bacteria of genus Nocardia, which are saprophytic aerobic actinomycetes that commonly reside in soil relatively and are inactive on standard biochemical tests. Pulmonary and systemic nocardiosis is common in adult males, almost all being sporadic, common in tuberculosis endemic regions and usually seen in individuals with deficient cell mediated immunity. It may present as pneumonia, empyema, pericarditis, mediastinitis, laryngitis, peritonitis, and meningitis. Diagnosed with sputum or pus for branching beaded gram positive filaments which are 1 micron meter wide and 50 micron meter long.A male immunocompromised patient presented with respiratory symptoms. Patient was evaluated elsewhere and received multiple courses of antibiotics. On admission in our facility HRCT thorax followed by fibre optic bronchoscopy was done. Bronchoalveolar lavage was sent for microbiological analysis.  Acid-fast in kinyoun and Ziehl Neelsen stain came positive for Nocardia and was managed with trimethoprim- sulfamethoxazole which is the treatment of choice.
诺卡菌病是由诺卡菌属细菌感染引起的,诺卡菌属细菌是腐生需氧放线菌,通常存在于土壤中,在标准生化试验中无活性。肺和全身诺卡菌病常见于成年男性,几乎都是散发的,常见于结核病流行地区,通常见于细胞介导免疫缺陷的个体。它可能表现为肺炎、脓肿、心包炎、纵隔炎、喉炎、腹膜炎和脑膜炎。诊断为痰或脓液分枝珠状革兰氏阳性细丝,宽1微米,长50微米。男性免疫功能低下患者出现呼吸道症状。患者在其他地方进行评估并接受多个疗程的抗生素治疗。入院时,我们进行了HRCT胸部检查,随后进行了纤维支气管镜检查。支气管肺泡灌洗液送去做微生物分析。金氏抗酸法和Ziehl - Neelsen染色法检测诺卡菌阳性,采用甲氧苄氨嘧啶-磺胺甲恶唑治疗。
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引用次数: 0
Correlation of neutrophil to lymphocyte with acute exacerbation in chronic obstructive pulmonary disease at tertiary care hospital in North West Rajasthan 中性粒细胞和淋巴细胞与拉贾斯坦邦西北部三级医院慢性阻塞性肺疾病急性加重的相关性
Pub Date : 2022-10-15 DOI: 10.18231/j.ijirm.2022.027
Ritumbhara, Gunjan M. Soni, Ravi Gaur, J. Khatri, K. Soni
Acute exacerbation of COPD (AECOPD), is one of the most common disease in patients with infections, having frequent hospitalization. The aim of this study is to evaluate the potential for NLR to be used as a biomarker of COPD exacerbation. The hospital based case control Study is was conduct on hospitalized 100 patient with primary and final diagnosis of AECOPD and 100 patient of stable period of COPD. Socio-demographic variable in both groups were comparable. BMI was significantly lower in AECOPD patients. The mean PACK/YR in AECOPD group was 29.52±3.70 and in Stable COPD was 23.50±2.05. FEV1was significantly lower in AECOPD patients. Mean admission per year was significantly higher in AECOPD patients. Mean neutrophil count was significantly higher in AECOPD patients (11.49±2.32) as compare to stable COPD patients (6.47±2.01). Mean lymphyocyte count was significantly higher in AECOPD patients (2.07±0.05) as compare to stable COPD patients (1.71±0.07). Mean NLR was significantly higher in AECOPD patients (5.54±2.12) as compare to stable COPD patients (3.77±0.22). The difference in both groups was found statically significant. 5.00% hospital mortality in AECOPD patients. Mean neutrophil count was significantly higher in death as compare to survived patients. Mean NLR was significantly higher in death as compare to survived patients. NLR is readily available (Available at PHC) and simple parameter, could also be used as a cost-effective marker of inflammation in AECOPD. We have concluded that the neutrophil lymphocyte ratio on the day of presenting the illness was significantly higher in AECOPD as compare to stable COPD. Those patients who had a high NLR during admission were associated with poor survival.
慢性阻塞性肺病急性加重(AECOPD)是感染患者中最常见的疾病之一,经常住院治疗。本研究的目的是评估NLR作为COPD恶化的生物标志物的潜力。以医院为基础的病例对照研究对100例初、终诊断为AECOPD的住院患者和100例稳定期COPD患者进行了研究。两组的社会人口统计学变量具有可比性。AECOPD患者的BMI显著降低。AECOPD组平均PACK/YR为29.52±3.70,稳定期组平均PACK/YR为23.50±2.05。AECOPD患者fev1显著降低。AECOPD患者的年平均住院率明显高于AECOPD患者。AECOPD患者的平均中性粒细胞计数(11.49±2.32)明显高于稳定期COPD患者(6.47±2.01)。AECOPD患者的平均淋巴细胞计数(2.07±0.05)明显高于稳定期COPD患者(1.71±0.07)。AECOPD患者的平均NLR(5.54±2.12)明显高于稳定期COPD患者(3.77±0.22)。两组的差异具有统计学意义。AECOPD患者住院死亡率5.00%。死亡患者的平均中性粒细胞计数明显高于存活患者。平均NLR死亡率明显高于存活患者。NLR很容易获得(PHC可用),参数简单,也可以作为AECOPD炎症的经济有效的标志物。我们的结论是,与稳定型COPD相比,AECOPD患者在发病当天的中性粒细胞淋巴细胞比率显著高于稳定型COPD。入院时NLR高的患者生存率较差。
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引用次数: 0
TB Champions- An important initiative in the direction of TB elimination from India 结核病冠军——印度消除结核病方向的一项重要举措
Pub Date : 2022-10-15 DOI: 10.18231/j.ijirm.2022.023
S. Yadav
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引用次数: 0
A cross-sectional study on knowledge about transmission and prevention of HIV in patients of Tuberculosis attending a DOTS center of a tertiary care hospital 某三级医院直接督导下短程化疗中心结核病患者艾滋病毒传播和预防知识的横断面研究
Pub Date : 2022-10-15 DOI: 10.18231/j.ijirm.2022.028
T. Talukdar, Shweta Sharma, Prof Vikas Kumar, Kanishk Sinha, Anjali Soin, P. Ish
TB-HIV coinfection imposes a double-edged sword effect on the patient’s health. Awareness about HIV among the TB patients is very essential for prevention, early detection and appropriate therapy. We aimed to evaluate the knowledge about HIV prevention and transmission among TB patients.A cross sectional study was done among the patients of Tuberculosis who attended the DOTS center at a tertiary care hospital. Patients who were HIV-TB coinfected were excluded. A pretested questionnaire consisting of 13 questions regarding the HIV transmission, methods to avoid HIV, misconceptions and treatment was used. 53 patients were enrolled in the study. It was a predominantly young (mean age was 34.69 ± 14.18 years) and male dominated (64%) population.Out of 53 enrolled patients, 42 (79.2%) were familiar with HIV infection. Among these 42 patients, more than 80% patients were aware about multiple transmission routes of HIV infection. Homosexual and mother to child transmission were less known. Awareness about use of condoms was present in 85.7% patients. On the contrary, misconceptions about HIV transmission (coughing, sneezing, shaking hands, use same toilets) was prevalent in 40% patients. Very few patients (12%) were aware about the Indian national HIV program. There was no difference in the knowledge and awareness among males and females. Literate patients and patients living in urban area had heard of HIV more as compared to their counterparts (p<0.05).Myths and misconceptions about HIV transmission are widely persistent among TB patients even in urban cities of India. There is still a long way to go regarding the spread of awareness about HIV among TB patients despite its paramount significance in prevention, early diagnosis, and early appropriate therapy for the same.
结核病-艾滋病毒合并感染对患者的健康造成了双刃剑效应。结核病患者对艾滋病毒的认识对预防、早期发现和适当治疗至关重要。我们的目的是评估结核病患者对艾滋病预防和传播的知识。在一家三级保健医院DOTS中心接受治疗的结核病患者中进行了一项横断面研究。HIV-TB合并感染的患者被排除在外。使用了一份预测问卷,包含13个问题,涉及艾滋病毒传播、预防艾滋病毒的方法、误解和治疗。53名患者参加了这项研究。以年轻为主(平均34.69±14.18岁),男性为主(64%)。在53名入组患者中,42名(79.2%)熟悉HIV感染。在这42例患者中,80%以上的患者知道HIV感染的多种传播途径。同性恋和母婴传播则鲜为人知。85.7%的患者了解避孕套的使用。相反,对艾滋病毒传播的误解(咳嗽、打喷嚏、握手、使用相同的厕所)在40%的患者中普遍存在。很少有患者(12%)知道印度国家艾滋病规划。男性和女性在知识和意识上没有差异。文化程度高的患者和生活在城市地区的患者对HIV的听说率较高(p<0.05)。即使在印度的城市中,关于艾滋病毒传播的神话和误解在结核病患者中也广泛存在。尽管艾滋病毒对结核病患者的预防、早期诊断和早期适当治疗具有至关重要的意义,但在结核病患者中传播艾滋病毒意识仍有很长的路要走。
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引用次数: 0
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IP Indian Journal of Immunology and Respiratory Medicine
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