Vikas Dogra

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%).

Weaning from mechanical ventilation in chronic obstructive pulmonary disease: Keys to success

Invasive mechanical ventilation (IMV) for management of chronic obstructive pulmonary disease (COPD) associated respiratory failure is increasing in Intensive Care Units. However, IMV is not without its own complications. Hence, aim of managing such patients is to get them off the ventilator as early as possible. This bridging process from IMV to extubation is called weaning in which mechanical ventilation is gradually withdrawn and the patient resumes spontaneous breathing. Many objective parameters have been defined for weaning success. Many of these patients are difficult-to-wean because of various pathophysiologic mechanisms that are of particular relevance to patients of COPD. The following review focuses on these mechanisms and how to troubleshoot patients who are difficult-to-wean.

Glued lungs: Sticky and tricky

We report a male patient who underwent bronchoscopic instillation of glue to control moderate hemoptysis which later led to the development of postobstructive pneumonia and extensive foreign body reaction in the bronchial wall and the lung distal to the glue application. He continued to have intermittent hemoptysis and underwent bronchial artery embolization. However, recurrent moderate hemoptysis eventually led to pneumonectomy, which showed severe foreign body reaction in bronchi- and post-obstructive changes in the lung parenchyma and the draining lymph nodes. This case highlights a serious complication of intrabronchial cyanoacrylate gluing to control bleeding in hemoptysis, which might warrant its very cautious use in moderate hemoptysis although surgical modality is considered the definitive treatment in life-threatening hemoptysis.

Nutritional considerations in bronchial asthma

Asthma is a common chronic inflammatory disease of the airway manifesting as airway hyper‐responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing.[1] There is widespread, variable and often reversible airflow limitation. Most of the newer therapeutics are aimed at decreasing the airway inflammation. The nutritional aspect of bronchial asthma has focused attention recently as non‐pharmacologic adjuncts in management of asthma. Following review focuses on current knowledge about nutritional supplementation in bronchial asthma.