One-third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT). Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB) is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti-TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report three cases of DVT associated with pulmonary TB who were diagnosed due to high index of suspicion as the risk factors for the development of DVT were present in these cases.
Diaphragmatic hernias are commonly congenital and usually present in childhood. In adults presentation may differ from being asymptomatic to presenting with life-threatening complications, like obstruction or strangulation. Hernias with omentum as content may be misdiagnosed as mass lesions. Chest radiograph helps in establishing the diagnosis only in one-third of cases as radiographic picture varies depending on the content of hernia. Although with the use of helical computed tomography (CT) the sensitivity of detection of diaphragmatic defects has increased considerably but magnetic resonance imaging due to its multiplanar imaging capability and superior soft tissue contrast is the most reliable diagnostic modality in cases with uncertain CT diagnosis. We report a case of an anterior diaphragmatic hernia presenting as a large homogeneous opacity in an adult female.
A 35-year-old non-smoker, labourer, admitted in our hospital with complaints of low-grade, intermittent fever with exertional dyspnoea for the last two months and left-sided pleuritic chest pain for one month. He had taken anti-tuberculous treatment in 2009 for pulmonary tuberculosis under directly observed treatment, shortcourse (DOTS) for six months and improved clinically. He had suffered a blunt trauma to the chest (right lateral) six months back before admission when a cow struck him with its hooves. On examination, the patient was afebrile with a mediastinal shift to the right. There was tympanic note in the upper part of bilateral hemithorax and stony dull note in the lower part with a horizontal upper border bilaterally with absent breath sound all over the areas.
Background:The audio signal in the conventionally accepted protocol of shuttle walk test (SWT) is not well-understood by the patients and modification of the audio signal may improve the performance of the test.Objectives:The aim of this study is to study the validity and reliability of an audio signal modified SWT, called the Singla-Richa modified SWT (SWTSR), in healthy normal adults.Patients and Methods:In SWTSR, the audio signal was modified with the addition of reverse counting to it. A total of 54 healthy normal adults underwent conventional SWT (CSWT) at one instance and two times SWTSR on the same day. The validity was assessed by comparing outcomes of the SWTSR to outcomes of CSWT using the Pearson correlation coefficient and Bland–Altman plot. Test-retest reliability of SWTSR was assessed using the intraclass correlation coefficient (ICC). The acceptability of the modified test in comparison to the conventional test was assessed using Likert scale.Results:The distance walked (mean ± standard deviation) in the CSWT and SWTSR test was 853.33 ± 217.33 m and 857.22 ± 219.56 m, respectively (Pearson correlation coefficient - 0.98; P < 0.001) indicating SWTSR to be a valid test. The SWTSR was found to be a reliable test with ICC of 0.98 (95% confidence interval: 0.97–0.99). The acceptability of SWTSR was significantly higher than CSWT.Conclusions:The SWTSR with modified audio signal with reverse counting is a reliable as well as a valid test when compared with CSWT in healthy normal adults. It better understood by subjects compared to CSWT.
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