Bhagyashri Patil

Prevalence of Smoking and Its Impact on Treatment Outcomes in Newly Diagnosed Pulmonary Tuberculosis Patients: A Hospital-Based Prospective Study

There is growing evidence that tobacco smoking is an important risk factor for tuberculosis (TB). India, with a population of 1.26 billion, has the highest number of both TB patients and smokers. The convergence of these two important health hazards is likely severely affecting Indias TB control programs. This study was carried out to determine the prevalence of smoking in newly diagnosed pulmonary TB patients and the impact of smoking on disease outcomes in a tertiary care hospital. All patients newly diagnosed with pulmonary TB as per the Revised National Tuberculosis Program of India (RNTCP) 2013 criteria were enrolled in the study. On the basis of their self-reported smoking status, the participants were classified as never smokers, current smokers, and ex-smokers. Patients were started on anti-TB treatment and were followed for 2 years. Among the 2350 subjects (1,758 males and 592 females), 1,593 patients (67.78%) were never smokers. Current and ex-smokers numbered 757 (32.21%), of which 751 (31.95%) were males and 6 (0.26%) were females. Smoking was associated with more extensive lung disease, lung cavitation, and positive sputum smear and culture results at baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Ex-smokers and current smokers had significantly high rates of defaults, treatment failures, and relapses. The prevalence of smoking is very high in TB patients. Tobacco smoking is associated with a considerably increased risk of advanced and more severe disease in the form of lung cavitations, positive sputum smear and culture results, and slower smear and culture conversion after initiation of treatment. Smoking has a great negative effect on treatment completion, cure rates, and relapse rates in patients with pulmonary TB.

Clinical profile of patients presenting with acute pulmonary thromboembolism in a tertiary care hospital in India: A retrospective study

Objective: To study the clinical profile in patients with acute pulmonary embolism. Methods: Retrospective study of clinical profile and management of patients presenting with acute pulmonary embolism from January 2015 to January 2016. Results: 53 patients who were newly diagnosed to have acute pulmonary thromboembolism with a mean age of 47.2 years with 91% being males were included in the study. It was found that majority of the patients had atleast 1 risk factor for embolisation(58.5%) with smoking being the most important risk factor. Dyspnea (71.7%) and syncope (17.0%) were the predominant symptoms. 39.6% patients had tachycardia and 22.6% had hypotension. Echocardiography was done in all patients. 45 patients (84.9%) had pulmonary arterial hypertension, 31 patients (58.4%) had evidence of RA/RV dysfunction and 3 patients (5.7%) had evidence of thrombus in heart. CT pulmonary angiogram was done in all patients. 32(60.3%) patients underwent anticoagulataion with unfractionated heparin, 10(18.7%) patients were thrombolysed and 6(11.3%) patients underwent embolectomy. 5 patients underwent both thrombolysis and anticoagulation. However independent of the mode of treatment, most patients had good treatment outcomes with the mortality rate being only 7.5%. Conclusion: Pulmonary embolism can have multiple presentations in terms of clinical symptoms, signs and investigations. Early diagnosis and aggressive management is the key to successful outcome.

Risk of depression in patients with chronic obstructive pulmonary disease and its determinants

Background and Objectives: Depression is an important comorbid condition of chronic obstructive pulmonary disease (COPD). There is a risk of undertreatment for depression in patients with COPD as depressive symptoms, including suicidal tendencies, can erroneously be conceptualized as an understandable reaction to COPD and not as signs of an independent depressive disorder. The exact prevalence of depression in COPD patients among the Indian population is unknown. Aim: This study aims to know the prevalence of depression in COPD patients attending tertiary care hospital. Materials and Methods: A total of 120 COPD patients were enrolled in the study according to Global initiative for COPD (GOLD) criteria 2015. They were screened for depression as per Becks depression score. Results: Eighteen patients in stage 1, 66 patients in stage 2, 29 patients in stage 3, and 7 patients in stage 4 of the COPD were enrolled. The prevalence of depression in the study population was 55%. Conclusion: The prevalence of depression in COPD is very high. The factors associated with depression in COPD patients were the duration of the disease, body mass index, GOLD stage, and smoking. Duration of the disease and smoking was the most significant factors associated with depression in COPD. Patients with COPD should be screened for depression and those with higher depression score should undergo further evaluation. Further studies involving larger number of subjects from several centers are required to study the prevalence of depression in Indian patients with COPD.

Endobronchial pulmonary mucormycosis diagnosed by fiberoptic bronchoscope: A rare case report

Pulmonary mucormycosis is relatively uncommon, but a life-threatening infection affecting mostly individuals with diabetes mellitus, hematological malignancies, chronic renal failure, posttransplantation and other immunocompromised states. Mucormycosis of the lung has a wide range of clinical and radiological manifestations. Very few cases of pulmonary mucormycosis presenting as a fungal ball, cavity resembling tuberculosis, nonresolving, and recurrent pneumonia in patients with diabetes mellitus or other immunosuppressive conditions, were reported from India. We report a case of pulmonary mucormycosis in an adult male patient with uncontrolled diabetes.

Glycemic control and radiographic manifestations of pulmonary tuberculosis in patients with type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is a risk factor for tuberculosis (TB) and may modify its presenting features. Atypical radiologic images of pulmonary TB are common in DM. Many studies have compared the radiological manifestations of TB between patients with and without DM. Aim of the Study: To study the impact of poor glycemic control on radiographic manifestations of the newly diagnosed smear-positive pulmonary TB patients with type 2 DM. Materials and Methods: In a tertiary care hospital, 70 patients newly diagnosed with smear-positive pulmonary TB and with coexisting type 2 DM were enrolled. Glycemic control was assessed by glycosylated hemoglobin (HbA1 C ). A pretreatment chest radiograph was read independently by two qualified pulmonologists blinded to patients′ diabetic status. Films with any discordant reading were read by a third reader. Radiological lesions on chest radiograph were classified into minimal, moderately advanced and far advanced as per American Thoracic Society criteria. Results: Of 70 patients, 47 (67.1%) had their HbA1c level ΃7%. Patients with poor glycemic control (HbA1c ΃7%) were more likely to have lower lung field involvement (29.8% vs. 13.04%; P < 0.01), far advanced lesions (40% vs. 4%; P < 0.001) and cavitary disease on chest radiograph (76.6% vs. 43.4% P < 0.05). Conclusion: Poor glycemic control significantly influences radiographic manifestations of pulmonary TB in patients with DM. Uncontrolled diabetics seem to have multiple and large cavities. Also isolated lower lung field involvement is more common in uncontrolled diabetics than in optimal control patients. High index of suspicion is, therefore, required in uncontrolled diabetics when radiological patterns are atypical.

A rare case of lymphangioleiomyomatosis with recurrent pneumothorax

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown etiology that traditionally affects young women of childbearing or premenopausal age. It is characterized by proliferation of atypical smooth muscle cells, preferentially along bronchovascular structures that cause progressive respiratory failure. Owing to its unusual and nonspecific presenting symptoms, patients often receive missed or delayed diagnosis. This disease occurs sporadically or in association with the genetic disease-tuberous sclerosis complex. Recurrent pneumothorax is the hallmark of LAM. We present a 16-year-old young female having recurrent pneumothorax with LAM.

Screening of Chronic Obstructive Pulmonary Disease Patients for Pulmonary Arterial Hypertension Using Two-Dimensional Transthoracic Doppler Echocardiography in Tertiary Care Hospital in India

Background: Chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension (PAH) are common and underdiagnosed medical conditions in India. Prevalence of these chronic diseases is high both in rural and urban areas. However, the exact prevalence of PAH in Indian COPD patients is unclear. Comorbid conditions like PAH have a great impact on the outcome of COPD in the form of severity, exacerbations, morbidity, and mortality. Right heart catheterization remains the gold standard test for diagnosis of PAH, but it is invasive and practically not feasible. Aims and objectives: The present study objective was to screen COPD patients for PAH using two-dimensional transthoracic Doppler echocardiography (ECHO) in Tertiary Care Hospital. Results: A total of 2040 patients with a confirmed diagnosis of COPD were enrolled in the study. Among these patients, 1509 were males (73.9%), 531 were females (23.06%), and 1428 were known or ex-smokers (70%). None of the females were smokers, but there was a history of biomass fuel exposure for >10 years. As per global initiative for chronic obstructive lung disease criteria, mild, moderate, severe, and very severe COPD was noted in 525,629,511, and 375 patients, respectively. When they were screened using ECHO, prevalence of PAH was 41.96% as 856 subjects had PAH. Prevalence of PAH among mild, moderate, severe, and very severe COPD was 23.8%, 34.81%, 48.53%, and 70.4%, respectively. There was a linear relationship between PAH and severity of COPD. Conclusion: PAH is very common in COPD patients in India. As the severity of COPD increased, the frequency and degree of PAH also increased. ECHO is an excellent tool for detection of PAH in COPD patients. All patients with severe to very severe COPD should be routinely screened by ECHO for PAH and with mild to moderate COPD, who have dyspnea out of proportion to their clinical condition should also be screened for PAH.

Lymphangioleiomyomatosis: A rare case report

Lymphangioleiomyomatosis (LAM) is a rare disease of unknown etiology that traditionally affects young women of child bearing or premenopausal age. It is characterized by proliferation of atypical smooth muscle cells, preferentially along bronchovascular structures that causes progressive respiratory failure. Due to its unusual and nonspecific presenting symptoms, patients often receive missed or delayed diagnosis. This disease occurs sporadically or in association with the genetic disease tuberous sclerosis complex (TSC). We present 34-year-old young premenopausal woman with LAM.