Pulmonary Medicine

... Pandhi MD, FCCP* Vikram Vohra MBBS, MD Mandeep Singh MBBS Swarnjeet S. Bhullar MBBS Vinay Mohan MBBS Heena Bharti Medical Student ... 4/22) selected non-operative procedures, 23% (5/22) chemical pleurodesis via chest tube, 45% (10/22) VATS procedure (with ...

RESULTS: Majority of the patients were sputum grade 3 , between 20-39 years of age & males 83(55.33%). Cough was the major complaint in 142 (94.67%) followed by fever (93.33%), loss of appetite (84%) and loss of weight (80%). 12.67% had scanty positive sputum for AFB, ...

Pulmonary hypoplasia, a congenital malformation, is characterized by incomplete development of the lungs, leading to an abnormally less number or dimensions of bronchopulmonary segments / alveoli resulting in small fibrotic and non-functional lung. It is usually diagnosed in the neonatal period or in early childhood. Hypoplasia may be primary (idiopathic) or secondary. Primary pulmonary hypoplasia, not related to other congenital anomalies is extremely seldom diagnosed in adults. We report the case of a 32-year-old married female with two kids presented to us with chief complaints of cough and fever for past nine months. Chest radiograph showed opacification of the left hemi-thorax with decrease in its size and marked ipsilateral mediastinal displacement with an increase in volume of right lung. After investigations she was diagnosed as a case of left lung primary pulmonary hypoplasia. High level of excellent clinical judgement needed to spot and diagnose this congenital aberration, often wrongly diagnosed in adults. Hence, once confronted with an opaque hemi-thorax in a young person with ipsilateral shift of the mediastinum, differential diagnosis of " lung hypoplasia " ought to be kept in mind.

Paradoxical Upgrading Reactions (PUR), usually observed in patients undergoing treatment for tuberculosis, is a phenomenon, characterized by transient worsening of both, the clinical symptoms and the lesions during appropriate anti-tubercular therapy. This reaction is mostly observed in cases of Tubercular lymphadenitis and less frequently in Pulmonary Tuberculosis. The reaction is related to hypersensitivity response to dying mycobacteria. These pose a challenge to the physicians to exclude all the causes/reasons (drug-resistant tuberculosis, non-compliance to the prescribed regimen or concomitant disorders unrelated to Tuberculosis) known to be responsible for worsening of the condition of the patient before classifying them as PUR. We report four cases of tuberculosis (two cases of pulmonary tuberculosis, one case each of tubercular lymphadenitis and tubercular pleural effusion) who, during the course of treatment presented with varied symptoms and presence of new lesions. After detailed investigations , it was inferred that worsening of symptoms and appearance of new lesions during treatment, were due to Paradoxical upgrading reactions, a phenomenon observed in 20-30% patients of Tuberculosis. This happening, is generally self-limiting and resolves without serious sequelae.

DOTS strategy, as recommended by the WHO after declaring tuberculosis as a global emergency in 1993, is a very important landmark in the history of tuberculosis control. Supervised, intermittent chemotherapy was found to be operationally impracticable under National Tuberculosis Control Program. Hence Cost effective strategy 'directly observed intermittent chemotherapy' for tuberculosis control under RNTCP has been formulated and implemented. It has long been proved to be effective in various trials in India. Under DOTS strategy, the main emphasis is on diagnosing and treating sputum smear positive patients, thus the stress on sputum microscopy. The patients are categorized into two categories according to status of the disease and previous treatment history. Various published reports indicate a very high efficacy of treatment regimens with cure rates of 80-100% under RNTCP. However follow up reports of relapse rate on patients who have completed treatment under RNTCP are very few. Relapse rate, an important indicator of success of any treatment regimen, has not been measured under program condition. Follow up study of 203 patients was done to examine the rate of relapse among sputum smear positive pulmonary tuberculosis patients who have successfully completed treatment and declared either cured or treatment completed. Majority of 21/32 (65.6%) relapses were occurred in those who gained less than 4 kg weight gain during treatment. Further the maximum number 64% (16/25) among Category-1 patients and 71.43% (5/7) among Category-II patients relapsed within first 6 month of follow up period.

DOTS strategy, as recommended by the WHO after declaring tuberculosis as a global emergency in 1993, is a very important landmark in the history of tuberculosis control. Supervised, intermittent chemotherapy was found to be operationally impracticable under National Tuberculosis Control Program. Hence Cost effective strategy ‘directly observed intermittent chemotherapy’ for tuberculosis control under RNTCP has been formulated and implemented. It has long been proved to be effective in various trials in India. Under DOTS strategy, the main emphasis is on diagnosing and treating sputum smear positive patients, thus the stress on sputum microscopy. The patients are categorized into two categories according to status of the disease and previous treatment history. Various published reports indicate a very high efficacy of treatment regimens with cure rates of 80-100% under RNTCP. However follow up reports of relapse rate on patients who have completed treatment under RNTCP are very few. ...

Hyper-lucent one sided lung syndrome or Swyer James Macleod syndrome is uncommon entity. Sometimes it might be associated after bronchiolitis obliterans infections occurring during earlier part of life. Resultant Pulmonary hypo perfusion because of incomplete or absent development of the pulmonary arteries resulting in a reduced amount of blood flow in lungs is a characteristic feature of it. Typically, this disorder is diagnosed incidentally in recurrent childhood respiratory infections evaluations or occasionally it may follow a silent course only to be diagnosed at adulthood. Here, we report a case in a 70-year-old male person with Swyer James Macleod syndrome incidentally diagnosed while workup for a COPD differentials who presented with dyspnoea on exertion, cough with expectoration. Hence this case highlights the importance of computerized tomography in the diagnostic workup of a case of hyper-lucent lung. All smokers presented with breathlessness and huperlucent lungs may not...