The Journal of Association of Chest Physicians最新文献

{"title":"Beta-blockers in obstructive airways disease","authors":"Sumit Sengupta","doi":"10.4103/jacp.jacp_34_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_34_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":"48139819","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":"Sarcoidosis, tuberculosis, and the clinical dilemma of treating granulomatous inflammation","authors":"K. Luthra, Jyoti Singh","doi":"10.4103/jacp.jacp_37_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_37_22","url":null,"abstract":"Sarcoidosis can have a varied presentation, including an overlap with tuberculosis (TB). It can precede or coexist with TB. Certain features such as cavitary consolidation, pleural effusion, and tree-in-bud nodules are highly suggestive of active TB. The perilymphatic distribution of micronodules and discrete lymph nodes are features suggestive of sarcoidosis. Identifying the coexistence of the diseases is essential, as the treatment of either disease is a paradox: immunosuppression in sarcoidosis and antitubercular therapy in TB. There are certain conditions in which immunosuppression is used in TB, e.g., tubercular meningitis, ocular TB, and TB pericarditis. This article aims to provide a better understanding of the clinical dilemma faced during the treatment of granulomatous inflammation and adds to the existing literature regarding the overlap between sarcoidosis and TB.","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":"139364741","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":"A case of primary sternal tuberculosis mimicking a lytic bone tumor lesion of anterior chest wall","authors":"Harveen Kaur, Janu Arora, N. Kajal, Dilbagh Singh","doi":"10.4103/jacp.jacp_35_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_35_22","url":null,"abstract":"Primary tuberculous osteomyelitis of the sternum is a rare entity, accounting for only 1 to 3% of cases of osteoarticular tuberculosis (TB). It usually presents in young patients as a localized swelling, with a discharging sinus tract, and is accompanied by one of the systemic symptoms in the form of fever, night sweats, weight loss, or anorexia. Due to its atypical presentation, it poses a diagnostic challenge. We report the case of a 37-year-old female with primary sternal TB mimicking a lytic bone tumor lesion of the anterior chest wall.","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":"44186094","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":"Implant tuberculosis: A rare but possible cause in nonhealing surgical wound!","authors":"S. Patil, D. Patil, Shubhangi Khule","doi":"10.4103/jacp.jacp_18_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_18_23","url":null,"abstract":"Tuberculosis is most commonly involving lungs and less than 20% cases were showing extrapulmonary involvement. Tuberculosis at surgical site is described in medical literature with very few cases in caesarean section surgical incision site. Implant tuberculosis is first time described in literature and is defined as “tuberculosis developed after implantation of mycobacterium tuberculosis bacilli by artificial means without involvement of primary organ or secondary lymphatic and/or hematogenous dissemination.” Caesarean section delivery is a common method of delivery of baby. Surgical site infections resulting to slowly healing to nonhealing wound are commonly reported and usually depend on various factors. Patient factors are immune status and comorbidities of patient. Hospital management factors such as operation theatre infection control policies, sterilization techniques for surgical instruments, and local wound care methods are established and implemented by hospital staff. In this case report, a 34-year-old female with history of caesarean delivery 1 month back presented with nonhealing wound at surgical site. We have done surgical repair with biopsy of wound margins. Wound discharge microscopy was negative for acid fast bacilli with few Gram-positive cocci. Cartridge-based nucleic acid amplification testes were positive for mycobacterium tuberculosis genome. Histopathology shows tuberculous pathology and underlying chronic infectious process for nonhealing wound. We have offered antituberculosis treatment (ATT) as per protocol and observed healing of tuberculous ulcer after 3 months with reappearance of ulcer in the 4th month of ATT. We have topically applied isoniazid and streptomycin over tuberculous ulcer along with systemic ATT. Tuberculous ulcer has responded and noted “cure” as completely healed surgical wound after 6 months of ATT.","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":"139365563","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":"A case series of three infants having pulmonary tuberculosis","authors":"Alok Chandra, Prashi Dutt, Neha Kumari, Balkrishna","doi":"10.4103/jacp.jacp_45_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_45_23","url":null,"abstract":"Progression of primary pulmonary tubercular infection to active disease is not common in infants. Bacterial pneumonia is usually an imposter and its suspicion usually delays a definitive diagnosis of pulmonary tuberculosis and starting antitubercular treatment. Although congenital tuberculosis infection from infective mother is a possibility but most commonly, they acquire postnatal disease by contact with an infectious adult source. We are sharing our experience of three infants referred to our side who were being treated as bronchopneumonia for a period of 15 to 20 days, and subsequently were diagnosed with post primary pulmonary tuberculosis for a period of 1 year.","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":"139366024","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":"Association of common mental disorders with pulmonary tuberculosis: A cross-sectional study","authors":"Nikhil Goel, Vipin Goyal, Ritika Girdhar, Sapna Goel, Vipin Kumar","doi":"10.4103/jacp.jacp_17_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_17_22","url":null,"abstract":"Objectives: Tuberculosis (TB) and mental illness share few similar factors, for example, poverty, malnutrition, and stress. Our objective was to determine the association of TB among mentally ill patients. Methods: A cross-sectional study was conducted at a tertiary care center located in rural area. All patients having respiratory symptoms were screened for TB, and the patients diagnosed with TB were taken as subjects and those who did not tested positive for TB were taken as controls. Sociodemographic proforma and Self Report Questionnaire (SRQ-20) were used as study tools. Result: Presence of pulmonary TB was treated as outcome (dependent variable) while common mental disorders (CMD) as independent variable; both were categorized as present or absent. We found statistically significant (P = 0.005) association between overall CMDs and TB (OR: 2.16, 95% CI 1.32–3.55). Conclusion: TB among mentally ill patients is very high, and we recommend that TB care and prevention services be integrated into mental health centers.","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":"49059854","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":"SARS-CoV-2 RT-PCR positivity rate and predictor factors for RT-PCR results in COVID-19 disease","authors":"Melike Badoglu, S. Gulgosteren, Ş. Atikcan","doi":"10.4103/jacp.jacp_36_21","DOIUrl":"https://doi.org/10.4103/jacp.jacp_36_21","url":null,"abstract":"Background/Aim: In December 2019, a novel coronavirus was identified and caused the SARS-CoV-2 (COVID-19) pandemic. The gold standard diagnostic method is the detection of nucleic acid in respiratory tract samples by real-time polymerase chain reaction (RT-PCR). But there might be false-negative results. The aim of this retrospective study was to find the SARS-CoV-2 RT-PCR positivity rate in patients hospitalized due to viral pneumonia consistent with COVID-19 disease and to find predictor factors for RT-PCR results. Materials and methods: Adult (≥18 years of age) patients hospitalized due to viral pneumonia consistent with COVID-19 were enrolled. Results: One hundred ninety-one patients were enrolled in the study. Sixty six (34.6%) were female, and 125 (65.4%) were male. The mean age was 59.7. The RT-PCR positivity rate was 11.5%. Smoking status, confirmed fever, bronchial changes, left lower lobe involvement, and ≥3 affected lobes in CT, leukopenia, high PCT level, and <3 RT-PCR examinations per patient were found to be independent factors for the PCR result (P < 0.05). Conclusion: We found independent predictors for SARS-CoV-2 RT-PCR positivity and negativity in viral pneumonia consistent with COVID-19. Despite false negative results, COVID-19 patients could be diagnosed with the help of clinical, laboratory, and radiological findings.","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":"47307203","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":"Cardiac dysfunction and final outcome in correlation with serum cortisol level in active pulmonary tuberculosis: A single-center experience","authors":"S. Patil, Sachin Babhalsure, G. Gondhali, Abhijit Acharya","doi":"10.4103/jacp.jacp_9_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_9_23","url":null,"abstract":"Introduction: Although cardiac involvement is extremely rare in tuberculosis (TB), cardiac dysfunction is not uncommon. We have studied the prevalence of cardiac dysfunction in pulmonary TB with special emphasis on echocardiography, serum cortisol, and its correlation in cases with unstable cardiorespiratory parameters. Methods: A prospective observational and interventional study conducted in Pulmonary Medicine, MIMSR Medical College and Venkatesh Chest Hospital, Latur, India during July 2015 to December 2020, which included 800 cases of active pulmonary TB confirmed microscopically or with GeneXpert MTB/RIF, documented MTB genome in respiratory specimens’ sputum/induced sputum and bronchoscopy-guided bronchial wash, or bronchoalveolar lavage whenever necessary. Cases with known risk factors for cardiac disease and taking cardiac medicines and cases with pericardial effusion were excluded from study. Disproportionate tachycardia and tachypnea with or without shock and hypoxia were the key entry point criteria in this study. Chest radiograph, pulse oximetry, electrocardiography (ECG), sputum examination, cardiac enzyme studies (creatine phosphokinase MB [CPK-MB] and cardiac troponins), serum cortisol test, and echocardiography are done in all study cases during enrollment at 2 and 6 months of treatment with anti-TB medicines. Statistical analysis was carried out by chi-square test. Observations and analysis: Of the 800 cases with active pulmonary TB, cardiac dysfunction was documented in 26% cases, 44% were females, and 56% cases were older than 50 years. Echocardiographic abnormalities were documented such as global hypokinesia in 62% cases; depressed left ventricular systolic and diastolic function in 44 and 28% cases, respectively; dilated right atrium and right ventricle in 32% cases; and pulmonary hypertension in 6% cases. Serum cortisol level was significantly lower in cases with cardiac dysfunction (P < 0.00001). Hypoxia had significant association with right and left heart dysfunction (P < 0.00001). Cachexia, anemia, and hypoalbuminemia were documented to have significant association with cardiac dysfunction (P < 0.00001). Treatment outcome showed significant improvement in cardiac function (P < 0.00001). Coronary angiography did not show significant coronary artery lesions, and computed tomography (CT) pulmonary angiography did not show pulmonary embolism. Conclusion: Cardiac dysfunction in active pulmonary TB is underestimated and less evaluated routinely; disproportionate tachycardia and tachypnea with or without shock are clinical indicators to suspect early, especially in cases with risk factors such as advanced pulmonary TB on chest radiograph, cachexia with body mass index (BMI) <18, advanced age, females, cases with anemia, and hypoalbuminemia. Echocardiography shows “global hypokinesia” as a predominant cardiac dysfunction in study cases, and right or left heart dysfunction depends on with or without hypoxia, respectively. Serum ","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":"139365270","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":"Combined pulmonary fibrosis with emphysema in nonsmokers needs connective tissue disease workup: A case report","authors":"S. Patil, S. Toshniwal","doi":"10.4103/jacp.jacp_8_23","DOIUrl":"https://doi.org/10.4103/jacp.jacp_8_23","url":null,"abstract":"Combined pulmonary fibrosis and emphysema (CPFE) is a heterogenous lung disease documented in smokers, which includes emphysema in upper lobes and pulmonary fibrosis in lower lobes. CPFE in nonsmokers is rare, and very few literatures are available. In this case report, we have reported an 80-year-old male presented with progressive shortness of breath with fatigability and hypoxia treated as emphysema with inhaled bronchodilators. Response to medical treatment was not satisfactory with worsening of shortness of breath and fatigability. Clinical examination revealed bilateral basal velcro crepitations with resting oxygen saturation was 88% at room air. High-resolution computerized imaging documented emphysema in upper lobes with honeycombing and tractional bronchiectasis in lower lobes. Echocardiography documented pulmonary hypertension with dilated right atrium and ventricle. Connective tissue disease (CTD) panel documented workup positive for polymyositis. We have treated with oxygen supplementation during rest and ambulation, long-acting inhaled bronchodilator medicines, antifibrotic nintedanib, anti-inflammatory methylprednisolone, and pulmonary vasodilator tadalafil. Improvement in cardiopulmonary parameters including in 6-minute walk distance was significant with bronchodilators, mycophenolate mofetil, tadalafil, and antifibrotics.","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":"139366166","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":"Diagnostic and prognostic utility of serum adenosine deaminase in tuberculosis: Worth a revisit or are we flogging a dead horse?","authors":"Deeptika Agarwal, A. Yadav, Neeraj Sharma","doi":"10.4103/jacp.jacp_33_22","DOIUrl":"https://doi.org/10.4103/jacp.jacp_33_22","url":null,"abstract":"Background Measurement of adenosine deaminase (ADA) activity in body fluids is one of the biochemical methods for the diagnosis of tuberculosis (TB). While the role of ADA levels in pleural fluid and cerebrospinal fluid for diagnosis of TB has been established, the role of serum ADA is yet to be established. Aims To study the role of serum ADA levels in diagnosis and prognosis of TB. Settings and Design This prospective observational study was carried out at a hospital in central India. All TB patients managed at the center in 2021 were included in the study. Materials and Methods Two hundred and thirty-three TB patients who met the inclusion criteria were recruited for the study. The subjects were divided into various study groups on the basis of TB subtypes. The study subjects were treated with first-line DOTS antitubercular therapy (ATT). The subjects underwent analysis of serum ADA levels at 0, 2, and 5 months of ATT initiation. Various factors affecting serum ADA levels were studied. Results There was no statistically significant difference in mean serum ADA levels among all study groups (I–IV) at month 0 (treatment initiation). The mean serum ADA levels of TB patients in all study groups (17.8 ± 5.1) were significantly higher than in the control group (10.1 ± 1.2). Mean serum ADA levels showed a sustained fall from month 0 to month 5 of treatment in all study groups. Low vitamin D levels (below 20 ng/mL), Mantoux negativity, and sputum smear status were not found to affect serum ADA levels. Conclusion Serum ADA levels can be used to evaluate response to ATT and for disease prognostication.","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":"139364942","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}