Echinococcus granulosus is a parasitic infection that leads to the development of cysts, most commonly in the liver and lungs, and may radiologically mimic a lung tumor. Lophomonas blattarum is an emerging protozoan parasite causing bronchopulmonary infection, with the majority of reported cases from China. A 69-year-old man presented with grade 2 dyspnea, loss of appetite, vomiting, wheezing, and low-grade fever for 1 month. The patient was evaluated clinically and radiologically and was diagnosed with combined pulmonary hydatid disease and Lophomonas blattarum infection based on bronchoscopic findings. The patient was managed with oral albendazole 400 mg twice daily for 14 days and was advised surgical intervention.In this report, we present a rare case of bronchopulmonary coinfection with hydatid cyst and Lophomonas blattarum. The clinical significance of this case lies in highlighting the importance of suspecting parasitic infections in patients with eosinophilia and poor response to antibiotic therapy.
Background: In India, the incidence of airway obstruction varies from 9.0% to 13.7% across different geographical regions, from South India to Delhi. Smoking is one of the most common causes of airway obstruction. Smokers experience airflow limitation, which is later recognized as chronic obstructive pulmonary disease, a fatal and irreversible condition that causes permanent damage to the lungs. The purpose of the current study is to determine the prevalence of airway obstruction among college smokers in order to prevent lung damage in later stages of life. Objective: The objective of this study is to estimate the prevalence of airway obstruction in young collegiate smokers. Materials and methods: In this observational study, 550 young collegiate smokers in the age range of 18-35 years were recruited. Smoking habits were assessed with the Fagerstrom Test Nicotine Dependence (FND). The Vitalograph chronic obstructive pulmonary disease (COPD)-6 (TM) was used for the primary screening of the pulmonary function test of participants. An individual who was found with forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) less than 70% was called for computerized spirometry to rule out pulmonary function. Results: Out of 550 individuals, 344 (62.5%) were male, and 206 (37.4%) were female, with a mean age of 22.71 +/- 3.21. Of them, 53 (10%) were found with marked limitation in expiratory flow and had airway obstruction (FEV1/FEV6 <70%) reported. Out of 53, 11 with COPD were assessed with postbronchodilator spirometry. Conclusion: In the current study airway obstruction was found to be 10% prevalent, whereas 2% of them was diagnosed with COPD.
Background: Pulmonary hypertension is a challenging condition that often arises in conjunction with interstitial lung disease (ILD). It increases morbidity and mortality in ILDs. Consequently, any significant pulmonary hypertension in the context of ILD requires a thorough differential diagnosis. This study sought to outline pulmonary hypertension in patients with ILD and to correlate it with different radiological findings in a tertiary care facility. Materials and methods: This prospective observational study included 58 adult patients diagnosed with ILD. They were examined radiologically for ILD and were sent for a two-dimensional echocardiography (2D echo) to diagnose pulmonary hypertension. Different radiological findings and patterns were studied in peripheral regions and correlated with the severity of pulmonary hypertension. Results: Out of 58 patients in the study, the most cases occurred in the age group of more than 60 years (56.9%), with a male preponderance (60.3%). The majority of patients had etiologies of ILDs such as Idiopathic pulmonary fibrosis (44.8%), idiopathic interstitial pneumonia, and combined pulmonary fibrosis with emphysema (19.3% each). Sixty-nine percent cases had 2D echo with diagnosis of pulmonary hypertension, of which 39.7% had mild, 24.1% had moderate, and 5.2% had severe mean arterial pressure. In 51.7% cases had normal pulmonary arteries on chest tomography. We could not establish a statistically significant correlation between pulmonary hypertension and radiological findings, as well as causes of ILDs (p-values = 0.7624 and 0.5929, respectively). Conclusions: Echocardiography is an important tool for early identification and risk assessment of pulmonary hypertension in the setting of ILD
Introduction: Currently, obstructive sleep apnea (OSA) is gaining popularity worldwide due to its increased prevalence and long-term complications. OSA causes various metabolic abnormalities leading to the development of metabolic syndrome. Our study aims to identify metabolic syndrome among patients with OSA and to assess disease severity. 1 Materials and methods: Our cross-sectional observational study included 144 OSA patients. Based on apnea-hypopnea index (AHI) values, they were classified as mild, moderate, or severe OSA. Among those patients, metabolic syndrome was identified based on the Modified NCERT ATP III diagnostic criteria (2005 update). Comparison was done based on baseline characteristics between the two groups: patients with metabolic syndrome and those who did not have it. ANOVA and the Chi-square tests were used to calculate statistical significance. Results: In these 144 OSA patients, the demographic distribution was 79 males and 65 females, with a mean age of 52.8 +/- 11.2 years. In our study, 64 patients (44.4%) had metabolic syndrome. Older males with higher BMI and waist circumference were seen in the metabolic syndrome group. It also showed increased prevalence of systemic hypertension, impaired fasting glucose levels, dyslipidemia, and abdominal obesity ( p < 0.051 for all). Severe OSA was strongly associated with metabolic syndrome (68.8% of cases), Chi-square analysis showed a strong relationship between OSA severity and metabolic syndrome ( X-2 = 48.23 , df = 2 p < 0.0001 ) . Conclusion: Metabolic syndrome is significantly more prevalent among severe OSA patients. Routine screening for metabolic abnormalities in patients with OSA is essential to reduce long-term cardiac risks.
Introduction: India has a large private healthcare sector, and the notification of tuberculosis (TB) cases from this sector is less compared to that of public sector. This study aims to estimate the proportion of private practitioners who diagnose, treat, and notify TB cases in private healthcare facilities, assess their knowledge regarding latest TB management guidelines, and identify factors associated with treatment and notification and identify the facilitators and barriers of TB notification among private practitioners. Materials and methods: A mixed-method study using the sequential explanatory method was done with quantitative and qualitative phases among 230 private practitioners and 20 stakeholders in TB management, respectively. Data for the quantitative study were collected through self-administered questionnaires and Google Forms, while in-depth interviews were conducted for qualitative study. The quantitative data collected were analyzed using SPSS trial version 26.0, and thematic analysis was done on qualitative data collected. Results: The proportion of private practitioners, diagnosed and treated TB was 42.2% and 34.3%, respectively. Among them, notification was practiced by 88.6% and 81.1%, respectively. Gender (p-value = 0.002), qualification (p-value = 0.039), and specialty (p-value = 0.001) were the statistically significant factors associated with the same. The major facilitating factors for notification were user-friendly NIKSHAY platform, coordinated activities of healthcare workers under National Tuberculosis Elimination Programme (NTEP), timely referral, human resources, and diagnostic support from the private sector. The major barriers were unawareness about NIKSHAY, breaching patient confidentiality, and difficulty to obtain the details of the patient. Conclusion: The study concludes that continued efforts are required to maintain the notification rates and achieve the targets for elimination of TB by addressing the barriers.
Background: Adherence to antituberculosis treatment plays a crucial role in determining microbiological and treatment outcomes. With the introduction of daily fixed-dose combination regimens under the National Tuberculosis Elimination Programme, understanding adherence behavior and its impact on treatment outcomes in routine programmatic settings is essential. Objectives: To assess adherence to daily antituberculosis treatment among newly diagnosed sputum smear-positive drug-sensitive pulmonary tuberculosis patients and to evaluate the association between adherence status and treatment outcomes. Materials and methods: This prospective observational study was conducted among newly diagnosed sputum smear-positive pulmonary tuberculosis patients initiated on daily antituberculosis treatment. Adherence was assessed based on missed doses during the treatment period. Treatment outcomes and sputum smear conversion at the end of the intensive phase and continuation phase were evaluated. The association between adherence status and outcomes was analyzed using appropriate statistical tests. Results: A majority of patients were adherent to treatment, while a considerable proportion were nonadherent. Adherent patients demonstrated significantly higher rates of sputum smear conversion at the end of both the intensive phase and continuation phase compared with nonadherent patients. Favorable treatment outcomes were observed predominantly among adherent patients. Among nonadherent patients, treatment discontinuation was associated with a higher risk of unfavorable outcomes than intermittent missed doses. Conclusion: Adherence to daily antituberculosis treatment was strongly associated with favorable microbiological and treatment outcomes. Early identification of nonadherence, particularly patterns of treatment discontinuation, may be important in improving treatment outcomes under routine programmatic conditions.
Background: Pneumocystis jirovecii pneumonia (PCP) is classically associated with HIV infection and solid-organ transplantation, where prophylaxis is routinely recommended. However, PCP is increasingly reported among non-HIV patients receiving immunosuppressive therapies, in whom Jawareness and implementation of prophylaxis remain inconsistent. Methods: We report a case series of 7 non-HIV patients diagnosed with PCP at a tertiary care hospital in western Maharashtra. Clinical features, radiological findings, diagnostic modalities, treatment, and outcomes were analyzed. Results: All patients presented with acute respiratory symptoms, and definitive diagnosis was established using bronchoalveolar lavage (BAL). Four patients survived and were discharged without oxygen requirement, while 3 succumbed to their illness. Early initiation of therapy based Ion clinicoradiological suspicion was associated with significantly better outcomes. Conclusion: PCP in non-HIV patients often presents with severe respiratory failure and rapid clinical deterioration. This case series highlights the Ineed for heightened clinical suspicion, early treatment initiation, and broader consideration of PCP prophylaxis in non-HIV patients receiving immunosuppressive therapy.
Aims and background: Drug-resistant tuberculosis (DR-TB) is still a major threat to public health around the world, making it hard to treat and control the illness. The most prevalent type of tuberculosis (TB) in children is pulmonary tuberculosis. India is among the countries with a significant burden of tuberculosis. The purpose of the study was to assess the prevalence of rifampicin-resistant pulmonary TB in pediatric patients. Materials and methods: A hospital-based retrospective study was conducted from January 2023 to December 2024 at the microbiology laboratory at Government Medical College and Hospital (GMCH), Chhatrapati Sambhajinagar. The study comprised pediatric patients (aged 0-18 years) who were clinically suspected to have pulmonary TB, including both outpatient and inpatient. A total of 1,389 gastric aspirates/sputum samples were processed as per the National Tuberculosis Elimination Program (NTEP) guidelines. Results: A total of 1,389 clinically suspected pulmonary TB samples from pediatric patients were received; of these, 140 (10.08%) were positive for Mycobacterium tuberculosis (MTB), out of which 96 (68.57%) were females and 44 (31.43%) were males. Among these positive patients, 135 (96.43%) were rifampicin-sensitive, whereas 5 (3.57%) were resistant. Conclusion: Overall, the frequency of rifampicin resistance in the study population was low. The previous TB treatment history and contact history were found to be significantly associated with rifampicin resistance in our study, underscoring the necessity for enhanced efforts in TB treatment and surveillance programs in the study area. Improving the socioeconomic and environmental circumstances of communities and paying attention to childhood nutrition are expected to have a big impact on the spread of TB to children.
Pulmonary granular cell tumor (PGCT) is an uncommon, benign neoplasm that rarely occurs in the lungs; it is more frequently found in the skin or breast. Symptoms may vary depending on the location and size of the tumor; it is often located in the bronchus, and persistent cough is a common symptom. The sensitivity of chest radiographs is low in PGCTs, whose radiological features may also vary according to the location and size, while thoracic computed tomography (CT) and fiberoptic bronchoscopy (FOB) are considered the gold standard methods for diagnosis. When the literature is examined, there is no consensus or guideline on the treatment of PGCTs of the lung since there is very little data on PGCTs of the lung, which are mostly retrospective studies or case reports. The general approach is surgical resection. In this article, we report a 48-year-old patient who had cough for 1 year; the thorax CT was reported as dilated bronchial structure and infected bronchiectasis, but was diagnosed as PGCT with endobronchial lesion on FOB and treated surgically.
As per GLOBOCAN 2020, out of all malignancies, 11.4% is contributed by lung malignancy, and mortality is around 1.8 million. Thoracic malignancies range from mediastinal adenopathies to lung malignancies. Here, we present a few uncommon pathological and radiological presentations of lung malignancies. The first and second cases show primary pulmonary synovial sarcoma diagnosed by lung biopsy, and on immunohistochemistry (IHC), cells were positive for CK, EMA, BCL2, vimentin, and CD99. The treatment of choice was complete surgical resection. The third case patient presented with bilateral extensive disease with features of consolidation and ground-glass opacities. In lung malignancies, one can expect such radiological findings in lepidic adenocarcinoma, but the histopathological examination revealed papillary and acinar patterns, which was suggestive of a moderately differentiated mixed adenocarcinoma. The fourth case is primary mediastinal seminoma. Its first-line treatment is chemotherapy and radiation irrespective of the size of the tumor, and surgical intervention is reserved for those tumors unsuccessful with the former.
Background and aim: Asthma represents a diverse set of pulmonary symptoms encompassing wheezing, dyspnea, chest congestion, and cough that evolve in severity and expiratory airflow resistance over time. Fluticasone furoate/vilanterol (FF/Vi) is used for asthma treatment globally. Currently, studies evaluating the efficacy of FF/Vi combination in asthmatic patients from India are scarce. This study aimed to evaluate the effectiveness of (FF/Vi) (100/25 mu g) in asthma patients by measuring health-related quality of life (HRQoL) through the St George Respiratory Questionnaire (SGRQ) and spirometry. Materials and methods: The current study was a 6-month prospective observational monitoring of 65 asthma patients conducted in a tertiary care hospital in Hyderabad. FF/Vi (100/25 mu g) was given once daily at the same time every day to all the asthma patients as a dry powder oral inhalation. Spirometry, demographic, and HRQoL data were collected. The mean difference (MD) and its 95% confidence interval (CI) were calculated. Results: Statistically significant improvements from baseline to final time point was observed in (SGRQ) scores (MD 19.18; 95% CI: 19.08-19.29), forced expiratory volume in 1 second% predicted (FEV1%pred) value (MD 10.88; 95% CI: 9.46-12.31), and forced vital capacity (FVC) value (MD 16.13; 95% CI: 17.49-14.77). Cough and shortness of breath were found to have statistically significant improvements over time. In the multinomial logistic regression model, FEV1% predicted, shortness of breath, male gender, and comorbidities were found to have a statistically significant effect on SGRQ score. Conclusion: FF/Vi improved asthma symptoms and HRQoL with modest improvements in FEV1%pred and FVC%pred. These findings suggest that FF/Vi may be an effective inhaled corticosteroid (ICS)/long-acting beta 2-agonist (LABA) treatment option for symptomatic asthma patients.
Obstructive sleep apnea (OSA) is a multifactorial disorder resulting from the interaction of anatomical compromise, pharyngeal dilator muscle dysfunction, ventilatory control instability, and a low arousal threshold. Although continuous positive airway pressure (CPAP) remains the standard treatment, poor long-term adherence highlights the need for effective non-invasive alternatives. This review consolidates physiotherapy-based interventions that target the underlying mechanisms of OSA. A comprehensive narrative review approach was adopted to examine physiotherapy-based, non-pharmacological interventions for OSA, focusing on their mechanisms, therapeutic rationale, and available evidence. Physiotherapy includes a spectrum of interventions with a strong physiological basis, such as myofunctional therapy, exercise training, inspiratory muscle training, yoga-based practices, positional therapy, upper airway strengthening techniques, and breathing retraining. These strategies may enhance upper airway muscle tone, stabilize ventilatory control, improve dysfunctional breathing patterns, and address modifiable risk factors associated with OSA. Lifestyle interventions, including weight reduction, sleep hygiene optimization through advanced monitoring devices, and activity-based strategies, may further contribute to symptom reduction. Behavioral change therapy can promote treatment compliance, while improved adherence to CPAP supports sustained airway patency and better clinical outcomes. Emerging evidence indicates improvements in apnea–hypopnea index, daytime sleepiness, and quality of life; however, considerable variability in intervention protocols persists across studies. Overall, physiotherapy-based interventions demonstrate promising potential as adjuncts or alternatives to conventional OSA therapy. Nevertheless, further well-designed clinical trials and greater standardization of treatment protocols are required to strengthen the evidence base and support clinical implementation. These strategies may provide accessible, non-invasive, and sustainable management options for individuals with OSA, particularly for those with poor CPAP tolerance, by targeting modifiable physiological mechanisms and improving long-term outcomes.
Background: Respiratory distress in infants poses a significant health challenge, with diverse causes including various respiratory illnesses and congenital heart diseases. Despite its prevalence, studies on the clinic-etiological profile of infants presenting with respiratory distress in emergency settings, particularly in India, are limited. Our study aims to fill this gap, improving diagnostic precision and enhancing clinical outcomes. Materials and methods: This cross-sectional study was conducted at the Department of Pediatrics in a tertiary hospital located in New Delhi, India, in which 50 children <12 months of age presenting with respiratory distress were included. Results: In our study involving 50 infants aged 4-12 months, a male-to-female ratio of 2.57 was observed, with 64% exhibiting malnutrition indicators. Chief symptoms included tachypnea (88%), fever (86%), and cough. Clinical examination revealed prevalent signs such as tachycardia (98%) and chest retractions (92%). Abnormal chest X-rays were present in 80% of cases, with hyperinflation (28%), infiltrates (26%), consolidation (26%), and cardiomegaly (32%). Severity assessment using the SpO(2) to FiO(2) (SF) ratio indicated 46% with moderate respiratory distress, 26% with severe distress, and 24% with a normal SF ratio. Age-wise etiological analysis identified pneumonia (66.67%) in infants under 6 months and bronchiolitis (71.42%) in those over 6 months as major causes. Bronchiolitis exhibited distinctive clinical features, including a higher prevalence of fever, fast breathing, tachycardia, tachypnea, chest retractions, and wheezing compared to nonbronchiolitis cases. These findings provide a comprehensive overview of respiratory distress in infants, emphasizing the need for nuanced clinical assessment and tailored interventions. Conclusion: Our study aligns with existing research on demographic, clinical, and etiological aspects of pediatric respiratory distress. Comprehensive understanding informs effective treatment, emphasizing early recognition and management for improved outcomes.
Asthma and chronic obstructive pulmonary disease (COPD) are globally widespread chronic respiratory diseases, with about 358 million people suffering from asthma and 174 million with COPD. In the Indian context, these diseases represent a total of 35 million. Asthma and COPD are not curable but treatable and are not life-threatening. Patients need continuing treatment to sustain their health. Asthma deaths in India are found to be significantly higher than those reported in many other countries. Identified causes of high mortality among Indians include underdiagnosis and inadequate or neglected care. Inhaled corticosteroids are crucial medications that patients have to use for the rest of their lives. Patients in India can get free treatment in government-run primary health centers. Asthma patients, however, are at a disadvantage because the crucial medicine for treatment—inhaled corticosteroids—is not listed among free medicines in the primary health centers, leaving patients to buy them out of pocket. Free consultations provided do not please the patients, as the continuing medications, which they have to buy, are expensive. Management of asthma and COPD in India is woefully inferior, as a disproportionate 42% of the global asthma deaths occur in India. In India, public health spending is lower than in many other nations and has been proven inadequate to meet treatment needs. The general population, which is not covered by some form of health insurance, finds it difficult to meet the costs. This is partly responsible for most patients not following the right treatment regime and continuing with short-term medications, facing complexities and eventualities. There is a need for the authorities to review and improve the present system of healthcare delivery, including the budgeting system, so that budgeting and service provisions are need-based and made on a realistic assessment of the burden of the diseases.
Aims and background: When there is excessive accumulation of fluid in pleural cavity, it is known as pleural effusion and classified as transudative or exudative on the basis of etiology. Distinguishing between them is critical for diagnosis and treatment. Light's criteria, an invasive method, remains the standard for classification. The purpose of this study is to ascertain how well computed tomography (CT) attenuation values distinguish between transudative and exudative pleural effusions. Materials and methods: Over the course of 18 months, a cross-sectional study was carried out in the Department of Pulmonary Medicine, SAMC & PG Institute, Indore. A total of 100 patients with pleural effusion detected on CT scan were recruited based on inclusion criteria. Patients having prior chest tube placement, poor image quality, or sampling not done in the first week were excluded. CT scans were performed using a 64-slice multidetector CT (MDCT) scanner, and attenuation values [Hounsfield units (HUs)] were recorded. Pleural fluid was analyzed based on Light's criteria for classification into transudate and exudate. SPSS (Statistical Package for Social Sciences) software (version 2.0) was used for statistical analysis and p-value < 0.05 was considered as significant. Results: Out of 100 patients, 57% had exudative and 43% had transudative effusions. The mean CT attenuation value for exudative effusions was 33.29 +/- 12.23 HU, while for transudative effusions, it was 17.90 +/- 8.26 HU (p < 0.01). A 22 HU was the optimal cutoff value to distinguish transudate from exudate as accuracy at this level was 79%, sensitivity 74.42%, and specificity 82.46%. The area under the receiver operating characteristic (ROC) curve was 0.729, which indicated fair discriminative ability. Conclusion and clinical significance: CT attenuation values provide a noninvasive method to differentiate pleural effusions with a reasonable accuracy. A cutoff value of 22 HU effectively classifies pleural effusions, potentially decreasing the chance for invasive diagnostic procedures such as thoracocentesis. Further studies having large sample size with advanced imaging techniques are warranted to enhance diagnostic precision.
Background: Health care facilities worldwide require supplementary diagnostic modalities to identify the highly contagious coronavirus disease 2019 (COVID-19) infection during this alarming pandemic. High-resolution computed tomography (HRCT) chest, an easily accessible and timely reporting tool, thus became a requisite at this status quo. Objectives:This study evaluates the diagnostic accuracy of HRCT chest and its correlation with reverse transcription-polymerase chain reaction (RT-PCR) status in diagnosing COVID-19. It also imparts knowledge about the diagnostic testing accuracy of HRCT thorax in COVID-19 cases. Materials and methods: A hospital-based retrospective study was performed on 110 patients suspected of pulmonary infection due to COVID-19 at the Department of Radiodiagnosis in a tertiary care center. All of the participants underwent RT-PCR and HRCT chest simultaneously. The statistical analysis was done by software named Statistical Package for the Social Sciences (SPSS) 22.0. Results:The mean age of the study population was 47.3 +/- 7.5 years.The majority of the patients were males (70%).This studyfound a significant statistical difference between RT-PCR and HRCT with a p-value < 0.05. The sensitivity of HRCT was 93.8%, the specificity was 41.3%, and the accuracy of 80%. Clinical significance:The current study emphasizes the utilization of HRCT chest scans as an auxiliary tool in diagnosing COVID-19 pneumonia sufferers.
