Balakrishnan Menon

Mounier-Kuhn syndrome: report of 8 cases of tracheobronchomegaly with associated complications.

Mounier-Kuhn syndrome is a rare congenital abnormality characterized by atrophy or absence of elastic fibers and thinning of smooth muscle layer in the trachea and main bronchi. These airways are thus flaccid and markedly dilated on inspiration and collapsed on expiration. First- to fourth-order bronchi are affected. There is an increase in dead space, tidal volume and diminished clearing of secretions. The usual presentation is recurrent respiratory tract infections with a broad spectrum of functional impairment ranging from minimal disease with preservation of lung function to severe disease in the form of bronchiectasis, emphysema and pulmonary fibrosis, ultimately culminating in respiratory failure and death. A congenital connective tissue weakness, in combination with inhalation of irritants like cigarette smoke and air pollution, are raised as possible factors in the development of this syndrome. Eight cases of tracheobronchomegaly with its associated complications are reported. Computed tomography scan of the chest was used for the diagnosis of tracheobronchomegaly. Treatment is mainly supportive with chest physiotherapy and antibiotics; however, there are a few reported cases where insertion of a tracheal stent resulted in some success.

Systemic Inflammation and Its Response to Treatment in Patients With Asthma

BACKGROUND: Asthma is an obstructive airway disease characterized by airway inflammation. OBJECTIVE: To measure systemic inflammation in asthma patients, and to assess the effect of treatment on systemic inflammation. METHODS: In 30 newly diagnosed non-randomized adult asthma patients we measured systemic inflammation markers (serum high-sensitivity C-reactive protein, total leukocyte count, and erythrocyte sedimentation rate) before and after a 6-week standard treatment with inhaled steroids and inhaled β2 agonist. The comparison group comprised 20 healthy control subjects. All the subjects were non-smokers. RESULTS: The measured systemic inflammation markers were higher in the asthma patients: high-sensitivity C-reactive protein 4.8 ± 6.0 mg/dL vs 1.5 ± 1.4 mg/dL, P < .001; total leukocyte count 8,936 ± 2,592 cells/μL versus 7,741 ± 1,924 cells/μL, P < .001; erythrocyte sedimentation rate 24.8 ± 12.3 mm/h versus 15.3 ± 6.5 mm/h, P < .001. In the asthma patients, high-sensitivity C-reactive protein negatively correlated with percent-of-predicted FEV1 (r = −0.64, P = .001), percent-of-predicted forced vital capacity (FVC) (r = −0.39, P = .03), FEV1/FVC% (r = −0.71, P < .001), and percent-of-predicted forced expiratory flow during the middle half of the FVC maneuver (FEF25-75) (r = −0.51, P = .004). Total leukocyte count negatively correlated with percent-of-predicted FEV1 (r = −0.64, P = .001), percent-of-predicted FEV1/FVC (r = −0.74, P < .001), and percent-of-predicted FEF25-75 (r = −0.58, P = .001). Body mass index positively correlated with high-sensitivity C-reactive protein (r = 0.65, P < .001). Multiple linear regression showed significant correlation of high-sensitivity C-reactive protein (r2 = 0.75) with age (β = 0.31, P = .008), body mass index (β = 0.99, P = .001), family size (β = 0.33, P = .008), and weight (β = –0.45, P = .01). The systemic inflammation markers decreased significantly (P < .001 for all comparisons) after 6 weeks of treatment: high-sensitivity C-reactive protein decreased from 4.8 ± 6.0 mg/dL to 2.4 ± 5.4 mg/dL, total leukocyte count decreased from 8,936 ± 2,592 cells/μL to 6,960 ± 1,785 cells/μL, and erythrocyte sedimentation rate decreased from 24.8 ± 12.3 mm/h to 15.8 ± 10.1 mm/h. CONCLUSIONS: Inhaled steroids plus inhaled β2 agonist significantly reduced systemic inflammation in asthma patients.

Giant cell interstitial pneumonia in a 60-year-old female without hard metal exposure

Giant cell interstitial pneumonia is a form of pulmonary fibrosis usually caused by exposure to hard metals. We report a case of giant cell interstitial pneumonia in a 60-year-old female office worker who was a non-smoker and did not have any exposure to hard metals.

Evaluation of the radiological sequelae after treatment completion in new cases of pulmonary, pleural, and mediastinal tuberculosis

Background: Residual radiological lesions may persist even after successful treatment of tuberculosis. There is insufficient data as to the nature and magnitude of these opacities in the treated cases of tuberculosis. Aims and Objectives: This study evaluates the nature and magnitude of residual radiological opacities and of complete radiological resolution in new successfully treated cases of tuberculosis. Design: Four hundred and forty one new cases of pulmonary, pleural or mediastinal tuberculosis were radiologically evaluated by chest x-ray, PA view, at the start and end of a successful treatment, which was as per the World Health Organization (WHO), Revised National Tuberculosis Control Program (RNTCP), and Directly Observed Treatment, Short-Course (DOTS) guidelines. Patients with a previous history of tuberculosis or other lung conditions, treatment failure, retreatment cases, and multidrug tuberculosis (MDR-TB) cases were excluded. Results: Residual x-ray lesions were seen in 178 cases of tuberculosis (40.36%). Complete radiological resolution was seen in 263 cases (59.64%). Of the residual lesions, 67.4% were parenchymal were parenchymal in nature, 23.59% were pleural lesions and 8.99% were mediastinal lesions. Out of the 126 sputum-positive cases, 70% (n = 88)had residual lesions on chest x-ray whereas of the 315 sputum-negative cases 28.5%, (n = 99) had radiological residual lesions. Conclusion: Residual radiological opacities are seen in a large proportion of treated cases of tuberculosis (40%). Pulmonary lesions show more residual lesions (67%) than pleural (23%) and mediastinal lesions (9%).

Comparison of nutritional status in chronic obstructive pulmonary disease and asthma

Introduction: The loss of body mass leading to cachexia is known to exist in chronic obstructive pulmonary disease (COPD). However, the role of body composition in asthmatics has not been widely explored. Materials and Methods: Body weight (BW), body mass index (BMI), percentage of ideal BW (PIBW), fat mass (FM), fat free mass index (FFMI), and midthigh cross-sectional were evaluated in COPD (n = 40) and asthma (n = 40) and compared with 20 healthy controls. Socioeconomic status served as a marker of dietary adequacy. Results: Weight (P < 0.001), BMI (P < 0.01), FMI (P < 0.05), and FFMI (P < 0.001) differed significantly among socioeconomic classes. Significant intergroup differences of weight and FFMI in the upper (P < 0.05) and BMI and PIBW in the upper-middle class (P < 0.05) were seen. BW in COPD was lower than bronchial asthma (BA) (P < 0.001) and controls (P < 0.001). BMI in COPD was lower than BA (P < 0.000) as were PIBW (P < 0.000) and FM (P < 0.001), whereas neither study group differed from controls. FFMI in COPD was lower than BA (P < 0.004) and controls (P < 0.01). No parameter differed between BA and control groups. Comparing by severity of airflow obstruction, all parameters were reduced in COPD, but statistical significance (P < 0.05) was noted for BMI and FFMI in mild/moderate cases and weight, BMI, PIBW, and FM in severe/very severe cases. No significant differences were noted when assessed with respect to severity of either disease. Correlations were noted between FFMI and post bronchodilator forced expiratory volume in the 1 st second (FEV) 1 (r = 0.342) and weight and post bronchodilator FEV 1 (r = 0.322) in COPD. Conclusion: COPD produces malnutrition with regards to both fat and fat free components, irrespective of the severity of the disease, whereas asthma bears no such association.

Study of inflammatory markers in sputum positive patients of pulmonary tuberculosis and its response to anti-tubercular treatment

Introduction: Tuberculosis, a common communicable infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis and around one third of the world9s population is thought to have been infected with it. Aim: To evaluate the immulogical markers viz, serum CRP and IFN-¥ levels in cases of active pulmonary tuberculosis and effect of anti -tubercular treatment on the level of these markers. Methods: A cross sectional study was conducted on total of 54 patients of sputum positive pulmonary tuberculosis and 10 healthy controls. CRP and INF-¥ was performed on sputum and blood by ELISA method. Results: Mean Serum CRP level in Controls was 2.15±1.3 mg/dl. In cases it was 21.71±6.73 mg/dl at baseline. Levels decreased further at 2 months to 7.70±4.29 mg/dl and 2.41±1.5 mg/dl at end of 6 months (p Mean Serum IFN-¥ levels in cases at baseline was 41.47±43.25 pg/ml compared to controls 1.81±1.6 pg/ml (p Mean sputum IFN-¥ levels at baseline was 24.92±16.53 pg/ml. It decreased after 2 months of treatment to 7.68±5.17 pg/ml and at end of 6 months to 3.86±3.12 pg/ml (p Conclusion: Patients with pulmonary TB have significantly elevated serum CRP and IFN-¥ levels compared to normal controls and levels of these makers decrease significantly with treatment. Hence serum CRP and IFN-¥ (serum and sputum) may be useful in early detection of disease and in monitoring response.

Reason for non-compliance to inhaled medications among adult patients of asthma and COPD attending outpatient department in a tertiary care hospital

INTRODUCTION: Although medical treatment of COPD and ASTHMA has advanced, non adherence to prescribed medication poses a significant barrier to optimal management. This results in worsening of symptoms and increased hospital admissions. AIMS: To look into the reasons for non-compliance for inhaled medications [MDI & DPI] in adult asthma and COPD patients. METHODS: This was an open labeled questionnaire based study involving 200 adult subjects of asthma and COPD in outpatient setting. The pre-validated questionnaire comprised of 18 questions. The socioeconomic status of patients was assessed as per Kuppuswamy scale. RESULTS: There were 118 males and 82 females subjects with a mean age of 41 years. 67% belonged to middle socioeconomic group. 75 subjects (37.5%) were compliant to inhaled medications while 125 (62.5%) were non compliant. The most common reason for non compliance was patient9s belief that medications were not needed during symptom free period (26.5%), followed by forgetfulness (24%), social embarrassment in using inhalers (9.5%) and travel (4%). The other reasons included affordability, difficulty using inhalers, inadequate instructions, fear of side effects, religious practice like fasting, laziness in men and marital discord in women. CONCLUSION: Causes of non compliance to medications is multi factorial and not merely economic. Improvement of symptoms leads to further increase in the non compliance rate. Further health care initiatives such as educating patients, frequent follow up visits and telephonic calls by health workers are required to improve the compliance of patient for inhaled medications.

Evaluation of vitamin D in asthma: Its effect on inflammatory markers and clinical profile

Introduction: Vitamin D has been shown to have anti inflammatory properties. In our study we observed the effect of vitamin D supplementation on inflammatory mediators as well as pulmonary function. Methods: 40 asthmatics and 40 controls were recruited. Baseline values of serum ECP, IL=10. IL-13, vitamin D(25 hydroxy cholecalciferol), IgE, asthma control test(ACT) , AEC (absolute eosinophil count) and spirometry were measured. standard therapy according to GINA guidelines were given for 2 weeks. All parameters were measured again. For another 8 weeks half the group received 400 IU of oral vitamin D3 along with standard treatment(group A), the other half continued on same treatment(group B).All parameters were measured at end. Results: The mean value of vitamin D in study group was 15.5±8.2 and control was 16.7±5.4ng/ml. At end of 10 weeks vitamin D levels in group A had increased to 16.9±8ng/ml.IL-10, IL-13 and ECP decreased significantly. ACT, FEV1, FVC and FEV1/FVC increased significantly(table 1). In group B, the change in values were not significant. Conclusion: Supplementation of vitamin D can be useful in poorly controlld asthmatics together with recommended pharcologic therapy.