Background: Diagnosis of Extra-pulmonary TB (EPTB) is a challenge. Authors wanted to assess the sites of extra-pulmonary involvement during 2013-2017 in a tertiary care hospital cum medical college. Authors also wanted to evaluate the role of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in diagnosis of EPTB and compare its efficacy with AFB Culture.Methods: Total 470 EPTB cases diagnosed between 2013 and 2017 from 840 TB treatment records maintained in designated microscopy centre. Specific samples from appropriate sites were taken up for smear for AFB, CBNAAT and AFB culture.Results: There was incremental detection and registration in both TB and EPTB cases from 96 and 50 cases in 2013 to 246 and 150 cases in 2017 respectively. Among the total 470 EPTB cases in 2013-2017 (55.9%), lymph node followed by pleura and abdomen were the organs having maximum involvement. Bone involvement was more witnessed in adult male than children (p <0.05). There was male preponderance. CBNAAT results were 100 % sensitive and 87.5% specific. Lymph node samples and pus elsewhere in the body had much better diagnostic yield than serous effusions.Conclusions: Awareness and availability of diagnostic services in tertiary care institutions has lead to increased reporting of EPTB under RNTCP services. CBNAAT can be also be utilized as a point of care testing for lymph node aspirate and pus specimen.
IntroductionChronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, which may be further aggravated by episodes of acute exacerbation of COPD (AECOPD). Electrolyte imbalances during these episodes may add to the duration of hospitalization and disease outcome.
Aims and objectivesThis study aims to compare the serum electrolyte levels of patients with AECOPD and stable COPD and correlate them with the severity of exacerbation and disease outcome.
Materials and methodsThe study was conducted as a case-control study between January 2021 and December 2022. Patients with AECOPD and stable COPD were included as "cases" and "controls," respectively. The various serum electrolyte levels were defined as per recent guidelines. Statistical analysis was performed using SPSS 20.0 (IBM Corp., Armonk, NY).
ResultsA total of 75 patients were included with 41 in the study group and 34 in the control group. The majority of people were between the ages of 61 and 70. The most frequent electrolyte abnormality found was hyponatremia. The mean serum sodium and calcium levels were lower in patients with AECOPD while the mean serum potassium levels were higher. A total of five deaths were recorded in patients with two or more electrolyte imbalances. The latter also had a requirement for home oxygen or non-invasive ventilation at the time of discharge.
ConclusionPatients of AECOPD with multiple electrolyte imbalances need scrutinized treatment as they are more prone to develop complications, have poorer outcomes, and prolonged hospital stays.
Bronchopleural fistula (BPF) is an uncommon entity in patients with coronavirus disease 2019 (COVID-19). It may arise due to various causes ranging from the disease itself to complications of treatment. If left untreated, it may increase the morbidity, hospital stay, and adversely affect the outcome. We hereby present a series of cases with a persistent pneumothorax and associated BPF due to varying etiologies. While three of our cases developed a pneumothorax while on non-invasive ventilation, other three were on oxygen therapy. One patient developed a spontaneous pyopneumothorax and septicemia and succumbed to the complications. Another patient on non-invasive ventilation died due to complications of pregnancy. The management of each case varied depending on their clinical presentation.
Background. Xpert-MTB/RIF assay or Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) helps in rapid diagnosis of tuberculosis (TB).Methods. Specific samples were collected and carried to Regional Medical Research Centre where these were taken up for CBNAAT and culture in Lowenstein-Jensen media. Appropriate samples were sent to the Designated Microscopy Centre (DMC) of our institute for acid-fast bacilli (AFB) smear examination. Diagnostic measures, such as sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Xpert-MTB/RIF were reported considering mycobacterial culture and a composite reference standard (CRS) as Gold standard.Results. We studied 335 samples. Lymph node fine needle aspirate was the most common sample (32.5%) followed by pleural fluid (29.3%). The overall sensitivity and specificity of Xpert-MTB/RIF was determined to be 26.5% (95% CI [confidence interval] 20.8-32.8) and 100% (95% CI 96.8-100), respectively. The sensitivity and specificity of CBNAAT in relation to mycobacterial culture, however, was 78.8% (95% CI 61.1-91.0) and 89.1% (95% CI 85-92.4), respectively. Both were highest for pus, cerebrospinal fluid and lymph node fine needle aspirate samples.Conclusions. Xpert-MTB/RIF may be useful for samples, like cold abscess and lymph node fine needle aspirate or biopsy specimens. However, its routine use in case of serosal fluids is not recommended because of its lower sensitivity.
Statistical AnalysisThe data were entered in Microsoft Excel spread-sheet. Comparison of means was done using Fischer's exact 't' test (with sample size less than 40) or quantify agreement with Kappa value (sample size more than 40). The Kappa value <0.4 was considered as poor agreement
Introduction:
Pulmonary hypertension and other cardiac complications occur frequently due to chronic hypoxia induced by interstitial lung diseases (ILD) or due to connective tissue disorder itself. Two-dimensional (2D) echocardiography is ideal for identifying abnormalities at a given time. In this study, we tried to detect cardiovascular complications in patients with ILD using 2D echocardiography and correlate them with a 6-minute walk test (6 MWT) and spirometry.
Materials and Methods:
This study was carried out for 18 months including 100 consecutive cases of ILD. The diagnosis was made using the latest criteria as per the disease and high-resolution computed tomography (HRCT) thorax. All patients were evaluated with 2D echocardiography, 6 MWT, and spirometry along with routine investigations. Their results were analyzed using STATA 15.1 software.
Result:
Cardiovascular involvement was detected in 68% of cases. Pulmonary hypertension predominated with a prevalence of 50%. In spirometry, mean Forced expiratory volume in first second (FEV
1
)and Forced vital capacity (FVC) were found to be 54.96 (L) and 53.49 (L), respectively, with a predominant restrictive pattern (89%). There was a significant correlation between baseline saturation of oxygen (SpO
2
) and pulmonary arterial systolic pressure (PASP) with a
P
value of <0.05. Baseline SpO
2
and distance covered in 6 MWT had a significant correlation (
P
= 0.014).
Conclusion:
A baseline or nighttime hypoxia is responsible for developing PAH. Pulmonary arterial hypertension should be suspected in patients unable to perform 6 MWT or having low baseline SpO
2
. A routine follow-up with a 6 MWT and baseline SpO
2
should be performed in each visit to identify early deterioration of the disease.
BACKGROUNDChronic obstructive pulmonary disease is a collection of conditions characterised by persistent airflow limitation. It is recognised as an important cause of global burden of Non-Communicable Diseases (NCDs). Being a multicomponent disease characterised by abnormal inflammatory response of the lungs with systemic muscle dysfunction, a growing body of evidence has suggested a role of magnesium in exacerbations of COPD. Magnesium, owing to its ability to alleviate bronchospasm may have a role in maintaining disease stability in COPD patients. In the current study, we hypothesised that basal serum magnesium level must have some role in airway homeostasis and that a dysregulation results in decompensation.
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