Background: Tuberculosis is one of the most common chronic infections globally, especially in developing countries like India and is a leading cause of morbidity and mortality. Therefore, early diagnosis, and microbiological confirmation of pulmonary TB is important to break the chain of transmission. This study was carried out to study usefulness of fiberoptic bronchoscopy in sputum smear negative and CBNAAT negative patient of presumptive tuberculosis.Methods: It was an observational study in the Department of Respiratory medicine for duration of 2 years (Sept 2018- Aug 2020) among 100 adults cases of presumptive tuberculosis whose sputum were negative on sputum AFB and CBNAAT. Cases with relative or absolute contraindication for bronchoscopy were excluded from study.Results: Mean age of study subjects was 47.31±12.29 years; M:F was 1.2:1 and 5% had past history of tuberculosis. Most common findings on chest X-ray was alveolar opacities (40%), inhomogeneous opacity (24%), cavitary lesions (20%), cystic lesion (8%) and fibrosis (6%) in different zones of lung. BAL sent for CBNAAT testing detected 15% mycobacterial TB, 2% mycobacterial TB with Rif resistance. Zn staining testing detected 10% AFB, on culture 14% showed AFB growth,4% had malignant cell findings. Diagnostic efficacy of Zn staining of BAL showed 42.86% sensitivity, 95.35% specificity, 60% PPV, 91.11% NPV and 88% diagnostic accuracy. BAL CBNAAT testing had 78.57% sensitivity, 93.02% specificity, 64.71% PPV, 96.39% NPV and 91% diagnostic accuracy. Most common complication was bronchospasm and hypoxia.Conclusions: Fiberoptic bronchoscopy is useful investigation in establishing accurate and early diagnosis of lower respiratory tract infection.
Sleep is the natural periodic suspension of consciousness during which the powers of the body are recovered. It is a natural periodic state of rest for the mind and body, in which the eyes usually close and consciousness is completely or partially lost so that there is a decrease in bodily movement and responsiveness to external stimuli. Present study was planned to study the sleep patterns in various respiratory diseases at Tertiary care Hospital in India.The present study was conducted in sleep laboratory of the Department of Pulmonary Medicine of a tertiary care hospital that caters to population of diverse groups. Patients after clinical examination and spirometry with post bronchodilator reversibility were categorized into bronchial asthma and COPD. Subsequently polysomnography was done of these patients to study the sleep pattern. Total sleep time appears to be decreased in COPD patients with mean value of 284.3 (± 43.02) minutes, with decreased sleep efficiency of 66.64 % (± 0.074). Study group patients have frequent awakenings with average of 17.73 (± 6.15). They have decreased slow wave sleep (S3 and S4 stages) with mean value for S3 is 2.81% (± 0.68) and for S4 is 6.45% (± 1.64). The mean value for REM sleep in these patients is 12.42% (± 2.72) and that for S1 and S2 is 13.99% (± 4.84) and 64.62% (± 4.72) respectively. Total sleep time appears to be decreased in asthmatic patients with mean value of 299.89 (± 45.17) minutes, with decreased sleep efficiency of 68.38% (± 0.065). Study group patients have frequent awakenings with average of 21.03% (± 7.44). In patients with Asthma & COPD, polysomnography study suggests poor sleep quality characterized by decreased total sleep time, decreased sleep efficiency, frequent awakenings, altered sleep architecture with decreased slow wave sleep and REM sleep.
Obstructive sleep apnea if remains untreated can lead to excessive daytime sleepiness, diminished performance and overall poor quality of life. Factors that increase vulnerability of sleep apnea include age, male sex, obesity, family history, craniofacial abnormalities and certain health behaviors such as alcohol abuse and smoking. Previously diagnosed cases of COPD and bronchial asthma (as per guidelines) having symptoms of obstructive sleep apnea were also included in this study. This present study was planned to study assessing of severity of sleep apnea in obstructive airway diseases patients.The present study was conducted in sleep laboratory of the Department of Pulmonary Medicine of a tertiary care hospital that caters to population of diverse groups. Patients after clinical examination and spirometry with post bronchodilator reversibility were categorized into bronchial asthma and COPD. Subsequently, polysomnography was done of these patients to study the sleep pattern. Amongst patients with COPD, 11 (16.42%) had mild COPD, 26 (38.80%) had moderate COPD, 22 (32.84%) had severe COPD and 08 (11.94%) patients had very severe COPD. 38.71% and 29.03% that is 12 and 09 out of 31 patients had moderate and severe asthma respectively. Again 19.36% and 12.90% that is 06 and 04 patients had mild persistent and intermittent asthma respectively. 17(25.37%) patients of COPD were found to have obstructive sleep apnea and 09 (29.03%) patients of asthma had obstructive sleep apnea. In patients with overlap syndrome had more severe hypercapnia (mean PaCO 48.88 ±0.017), and nocturnal desaturation (mean 85.35% ±0.022) Patients having moderate COPD had severe OSA. Patients having severe asthma had severe OSA with correlation coefficient R = -0.527 with p value <0.001 meaning negative linear correlation between AHI and % FEV1 of predicted of asthma patients.
Primary lung adenocarcinoma usually presents as a mass with spiculated margins with post-contrast enhancement or an endobronchial lesion.The unusual presentation of lung adenocarcinoma in a nonsmoker without any preexisting lung disease are described here. 3cases in this series with presentation as organizing pneumonia, miliary mottling pattern, and pleural effusion. A diffuse pneumonic type can mimic the clinical presentation of an infectious lung disease Thus, it can represent a diagnostic challenge, especially in the setting of rapidly progressive respiratory failure
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