{"title":"Wheezing: A possible but little mentioned clinical presentation in monkey pox","authors":"R. Mungmunpuntipantip, V. Wiwanitkit","doi":"10.4103/jacp.jacp_31_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_31_22","url":null,"abstract":"","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48448105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nonstandard alternative COVID-19 vaccination: A current practice that requires reassessment","authors":"A. Kleebayoon, V. Wiwanitkit","doi":"10.4103/jacp.jacp_24_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_24_23","url":null,"abstract":"","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kashish Dutta, Deepak Aggarwal, M. Sodhi, Surabhi Jaggi, Varinder Saini
Subcutaneous emphysema and pneumomediastinum are uncommon complications seen in COVID −19 patients that tend to worsen their prognosis. Being a new disease, management of this new complication of this disease is not well defined in the literature. We present a case series of six patients of probable/confirmed COVID who developed pneumomediastinum at varied time intervals from the onset of symptoms. Timely recognition and management led to recovery in all of them. Management done in this case series may help in providing data to formulate treatment guidelines for this potentially fatal disease.
{"title":"Pneumomediastinum in COVID Era: A case series","authors":"Kashish Dutta, Deepak Aggarwal, M. Sodhi, Surabhi Jaggi, Varinder Saini","doi":"10.4103/jacp.jacp_26_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_26_22","url":null,"abstract":"Subcutaneous emphysema and pneumomediastinum are uncommon complications seen in COVID −19 patients that tend to worsen their prognosis. Being a new disease, management of this new complication of this disease is not well defined in the literature. We present a case series of six patients of probable/confirmed COVID who developed pneumomediastinum at varied time intervals from the onset of symptoms. Timely recognition and management led to recovery in all of them. Management done in this case series may help in providing data to formulate treatment guidelines for this potentially fatal disease.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46193483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Once diagnosed with obstructive sleep apnea (OSA), a titration with either continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) is planned to know the pressure required to abolish the airflow limitation during sleep. Majority of OSA patients are treated with such positive pressure therapy (PAP) devices, but it is not the only form of therapy of OSA. The static obstruction in OSA can be counterbalanced by increasing the pressure from inside and this is being exactly done by PAP therapy. The static obstruction can also be relieved with surgery. IOD (intraoral device) or OPT (oral pressure therapy) is a device which also try to open the upper airway during sleep or prevent collapse. But a dynamic obstruction during sleep, on top of this static obstruction causes complete or partial closure of the upper airway. There are different therapies available to address dynamic obstruction during sleep. Like myofunctional therapy or devices which improve muscle responsiveness are such mode of treatment. Similarly, arousal threshold or loop gain can be addressed with different medications. Sometimes OSA occur only in a particular decubitus and can be addressed with positional therapy. The different form of therapies can be broadly divided into three categories: primary treatment, alternative treatment, and adjunctive treatment. In this review article, a brief description of different forms of therapy in OSA will be presented.
{"title":"Overview of obstructive sleep apnea treatment","authors":"Arup Haldar","doi":"10.4103/jacp.jacp_12_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_12_23","url":null,"abstract":"Once diagnosed with obstructive sleep apnea (OSA), a titration with either continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) is planned to know the pressure required to abolish the airflow limitation during sleep. Majority of OSA patients are treated with such positive pressure therapy (PAP) devices, but it is not the only form of therapy of OSA. The static obstruction in OSA can be counterbalanced by increasing the pressure from inside and this is being exactly done by PAP therapy. The static obstruction can also be relieved with surgery. IOD (intraoral device) or OPT (oral pressure therapy) is a device which also try to open the upper airway during sleep or prevent collapse. But a dynamic obstruction during sleep, on top of this static obstruction causes complete or partial closure of the upper airway. There are different therapies available to address dynamic obstruction during sleep. Like myofunctional therapy or devices which improve muscle responsiveness are such mode of treatment. Similarly, arousal threshold or loop gain can be addressed with different medications. Sometimes OSA occur only in a particular decubitus and can be addressed with positional therapy. The different form of therapies can be broadly divided into three categories: primary treatment, alternative treatment, and adjunctive treatment. In this review article, a brief description of different forms of therapy in OSA will be presented.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48982362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anmol Sharma, Sandeep Ranav, Kislay Kishore, Robin Chaudhary
Exogenous lipoid pneumonia including diesel aspiration pneumonia is a challenging scenario for the physician view varied clinical presentation and no existing treatment guidelines. Clinico-radiological profiling remains the key toward early diagnosis of the condition. We present a case of a 32-year-old car mechanic presenting post accidental aspiration of diesel vehicle while siphoning air from the fuel pipe, a common practice in Indian subcontinent; highlighting the clinical and radiological presentation and therapeutic outcomes of corticosteroids in this case. The case reemphasizes the role of good clinical history, efficient physical examination, early management, and specific radiological evaluation toward management of this entity.
{"title":"A case of exogenous lipoid pneumonia: Diesel aspiration pneumonitis","authors":"Anmol Sharma, Sandeep Ranav, Kislay Kishore, Robin Chaudhary","doi":"10.4103/jacp.jacp_2_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_2_23","url":null,"abstract":"Exogenous lipoid pneumonia including diesel aspiration pneumonia is a challenging scenario for the physician view varied clinical presentation and no existing treatment guidelines. Clinico-radiological profiling remains the key toward early diagnosis of the condition. We present a case of a 32-year-old car mechanic presenting post accidental aspiration of diesel vehicle while siphoning air from the fuel pipe, a common practice in Indian subcontinent; highlighting the clinical and radiological presentation and therapeutic outcomes of corticosteroids in this case. The case reemphasizes the role of good clinical history, efficient physical examination, early management, and specific radiological evaluation toward management of this entity.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Bhattacharyya, Soumen Das, D. Saha, P. Bhattacherjee
Background: The inhibition of matrix metalloproteinases and IgE could be a prospective target of treating inflammation and remodelling of asthma. Doxycycline, a known antibiotic may qualify for the job for having both the properties. Objective: To look for effect on long term add-on oral doxycycline in patients of asthma. Methods: In an open prospective, real-world observation, a cohort of asthmatics was given to choose treatment either with a “standard” therapy (long-acting β-2 agonist + inhaled corticosteroid) or with the same and add-on long term doxycycline orally. The changes in postbronchodilator FEV1, FEV1/FVC, and FEF25–75 were noted for comparison with repeat spirometry after nearly a year. Results: The two groups (standard therapy alone [n = 73] and standard therapy plus doxycycline [n = 72]) were similar (p < 0.05) as regards to age and BMI, but the subjects opting for add-on doxycycline had significantly lower baseline postbronchodilator FEV1 (1.25 ± 0.50 and 1.66 ± 0.73 Litres; p < 0.0001). Both the groups had received treatment for similar length of time (346.89 ± 269.61 and 335.82 ± 274.51 days, respectively). The add-on doxycycline group had a significant improvement in absolute value of postbronchodilator FEV1 (130 mL [p = 0.0000]), whereas the subjects on standard therapy alone showed a reduction (70 mL [p = 0.027]) compared to the baseline values. There was a parallel increase in FEV1/FVC (p < 0.005) and FEF25-75 (p < 0.0001) in the doxycycline-treated patients, suggesting an overall improvement in airflow limitations. Conclusion: The add-on oral doxycycline tolerated well on long term and resulted in a significant improvement in spirometric indices of airflow limitations in the asthmatics. The observation deserves further validation.
{"title":"Can long term add-on doxycycline improve lung function in asthma: The result of an open prospective real-world observation","authors":"P. Bhattacharyya, Soumen Das, D. Saha, P. Bhattacherjee","doi":"10.4103/jacp.jacp_7_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_7_22","url":null,"abstract":"Background: The inhibition of matrix metalloproteinases and IgE could be a prospective target of treating inflammation and remodelling of asthma. Doxycycline, a known antibiotic may qualify for the job for having both the properties. Objective: To look for effect on long term add-on oral doxycycline in patients of asthma. Methods: In an open prospective, real-world observation, a cohort of asthmatics was given to choose treatment either with a “standard” therapy (long-acting β-2 agonist + inhaled corticosteroid) or with the same and add-on long term doxycycline orally. The changes in postbronchodilator FEV1, FEV1/FVC, and FEF25–75 were noted for comparison with repeat spirometry after nearly a year. Results: The two groups (standard therapy alone [n = 73] and standard therapy plus doxycycline [n = 72]) were similar (p < 0.05) as regards to age and BMI, but the subjects opting for add-on doxycycline had significantly lower baseline postbronchodilator FEV1 (1.25 ± 0.50 and 1.66 ± 0.73 Litres; p < 0.0001). Both the groups had received treatment for similar length of time (346.89 ± 269.61 and 335.82 ± 274.51 days, respectively). The add-on doxycycline group had a significant improvement in absolute value of postbronchodilator FEV1 (130 mL [p = 0.0000]), whereas the subjects on standard therapy alone showed a reduction (70 mL [p = 0.027]) compared to the baseline values. There was a parallel increase in FEV1/FVC (p < 0.005) and FEF25-75 (p < 0.0001) in the doxycycline-treated patients, suggesting an overall improvement in airflow limitations. Conclusion: The add-on oral doxycycline tolerated well on long term and resulted in a significant improvement in spirometric indices of airflow limitations in the asthmatics. The observation deserves further validation.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48504647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jisna Jith, Shyam K, Ayana K, Priyadarshini Raykar
Pulmonary agenesis is a rare congenital anomaly that results from the unsuccessful growth of the primitive lung buds. A case of lung agenesis was first reported in 1673 during an autopsy. Pulmonary agenesis includes agenesis, aplasia, and hypoplasia as the three most common types. The survival rate is <50% by the age of 5 years in case of agenesis. Fifty percent of the cases of lung agenesis are associated with various congenital defects such as cardiovascular, central nervous system, gastrointestinal, genitourinary, skeletal, Down syndrome, and Klippel–Feil syndrome. Here is the case of a 28-year-old male who presented with on-and-off cough and dyspnea for 3 years. On systemic examination, the patient had signs suggestive of loss of right lung volume. Chest x-ray showed right side volume loss with ipsilateral mediastinal shift with compensatory hyperinflation of the left lung. Computed tomography (CT) thorax with abdomen was suggestive of dextroposition with absent right upper lobe parenchyma, right upper lobe bronchus, right upper lobe artery, and superior pulmonary vein with the absence of hemiazygos vein with ectopic left kidney in the pelvis. Early identification of pulmonary agenesis is vital in preventing fibrosis in patients with unilateral lungs which might develop as a result of recurrent chest infections. Caution and vigilance will lead to a good prognosis.
{"title":"Right upper lobe agenesis associated with dextroposition of heart and ectopic kidney in an adult patient attending pulmonary medicine outpatient department: A rare case report from South India","authors":"Jisna Jith, Shyam K, Ayana K, Priyadarshini Raykar","doi":"10.4103/jacp.jacp_44_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_44_22","url":null,"abstract":"Pulmonary agenesis is a rare congenital anomaly that results from the unsuccessful growth of the primitive lung buds. A case of lung agenesis was first reported in 1673 during an autopsy. Pulmonary agenesis includes agenesis, aplasia, and hypoplasia as the three most common types. The survival rate is <50% by the age of 5 years in case of agenesis. Fifty percent of the cases of lung agenesis are associated with various congenital defects such as cardiovascular, central nervous system, gastrointestinal, genitourinary, skeletal, Down syndrome, and Klippel–Feil syndrome. Here is the case of a 28-year-old male who presented with on-and-off cough and dyspnea for 3 years. On systemic examination, the patient had signs suggestive of loss of right lung volume. Chest x-ray showed right side volume loss with ipsilateral mediastinal shift with compensatory hyperinflation of the left lung. Computed tomography (CT) thorax with abdomen was suggestive of dextroposition with absent right upper lobe parenchyma, right upper lobe bronchus, right upper lobe artery, and superior pulmonary vein with the absence of hemiazygos vein with ectopic left kidney in the pelvis. Early identification of pulmonary agenesis is vital in preventing fibrosis in patients with unilateral lungs which might develop as a result of recurrent chest infections. Caution and vigilance will lead to a good prognosis.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41308330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculosis (TB) is a major public health problem, with India alone accounting for one-fifth of the global disease burden. Lymph node TB (LNTB) refers to Mycobacterium tuberculosis (MTB) infection of the lymph nodes and may occur as the sole manifestation of TB infection or alongside pulmonary or miliary TB. LNTB is the most common form of extrapulmonary TB (EPTB) in India, accounting for around 35% of EPTB cases, with cervical lymphadenopathy being the most common site, followed by mediastinal lymphadenopathy. Tubercular mediastinal lymphadenopathy, however, in the absence of a parenchymal lesion, is a rare presentation and is seen in only 0.25 to 5.8% cases. Often associated with mild or no symptoms, these cases are often diagnosed incidentally. This case report summarizes an unusual occurrence of massive tubercular mediastinal lymphadenopathy simultaneously in two members of a family.
{"title":"Simultaneous occurrence of tubercular cervical and mediastinal lymphadenopathy in two members of the same family","authors":"Rajeev Tandon, Anoushka Agarwal, Prabhat Kumar","doi":"10.4103/jacp.jacp_25_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_25_23","url":null,"abstract":"Tuberculosis (TB) is a major public health problem, with India alone accounting for one-fifth of the global disease burden. Lymph node TB (LNTB) refers to Mycobacterium tuberculosis (MTB) infection of the lymph nodes and may occur as the sole manifestation of TB infection or alongside pulmonary or miliary TB. LNTB is the most common form of extrapulmonary TB (EPTB) in India, accounting for around 35% of EPTB cases, with cervical lymphadenopathy being the most common site, followed by mediastinal lymphadenopathy. Tubercular mediastinal lymphadenopathy, however, in the absence of a parenchymal lesion, is a rare presentation and is seen in only 0.25 to 5.8% cases. Often associated with mild or no symptoms, these cases are often diagnosed incidentally. This case report summarizes an unusual occurrence of massive tubercular mediastinal lymphadenopathy simultaneously in two members of a family.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Anand, Mahismita Patro, D. Gothi, Nipun Malhotra, Anshul Jain
COVID-19 was first identified as a new disease in December 2019. It’s now more than 2 years since its discovery and much research has been done. Still, there are some aspects in the pathogenesis and management that have not been completely understood. The cornerstone of therapy lies in the supportive treatment to maintain oxygenation. To the best of our knowledge, there are no earlier reports of severe COVID-19 with respiratory failure that have recovered without supplemental oxygen therapy. We present three unique cases of severe COVID-19 who were managed at home despite hypoxemia. The scarcity of oxygen during the second wave in Delhi deprived them of essential oxygen therapy. The patients survived and recovered well. Happy hypoxemia and hypoxic preconditioning played their role in symptoms tolerance. Therapeutically, the role of awake proning and steroid in the management cannot be undermined. Lastly, the technology in terms of video consultation definitely was useful in allaying the anxiety and guiding the right treatment.
{"title":"COVID-19: Two years in the history and still a mystery! A case series of three interesting cases","authors":"S. Anand, Mahismita Patro, D. Gothi, Nipun Malhotra, Anshul Jain","doi":"10.4103/jacp.jacp_38_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_38_22","url":null,"abstract":"COVID-19 was first identified as a new disease in December 2019. It’s now more than 2 years since its discovery and much research has been done. Still, there are some aspects in the pathogenesis and management that have not been completely understood. The cornerstone of therapy lies in the supportive treatment to maintain oxygenation. To the best of our knowledge, there are no earlier reports of severe COVID-19 with respiratory failure that have recovered without supplemental oxygen therapy. We present three unique cases of severe COVID-19 who were managed at home despite hypoxemia. The scarcity of oxygen during the second wave in Delhi deprived them of essential oxygen therapy. The patients survived and recovered well. Happy hypoxemia and hypoxic preconditioning played their role in symptoms tolerance. Therapeutically, the role of awake proning and steroid in the management cannot be undermined. Lastly, the technology in terms of video consultation definitely was useful in allaying the anxiety and guiding the right treatment.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Minimizing the risk of development of lung cancer by reducing exposure to indoor radon","authors":"P. Shrivastava","doi":"10.4103/jacp.jacp_46_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_46_22","url":null,"abstract":"","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48872255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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