Chest X-ray PA View Research Articles

A rare case of intracardiac hydatid cyst in the interventricular septum of the heart

Hydatid disease, also known as cystic , occurs due to tapeworm. It is an endemic disease in certain livestock-raising countries. Cardiac involvement is seen rarely, in around 0.5% to 2% of patients with hydatid disease. Interventricular septum is involved in around 4% of cardiac cases. According to Yaman et al., cardiac is a rare condition with a prevalence ranging between 0.5 to 2 percent. Here we report a case of a hydatid cyst in the heart. A 57-year-old male patient came to Gowri Gopal hospital, Kurnool, Andhra Pradesh on 29 July 2023 with complaints of shortness of breath for 6 months. He also complained about pain in the chest region for 6 months.ECG findings include sinus tachycardia, probable left atrial enlargement, left ventricular hypertrophy, nonspecific T abnormalities and ST elevation. Chest X-ray PA View revealed left mild fibrosis. Echocardiography showed a hydatid cyst sized 3x2.8 cm., grade I diastolic dysfunction and trivial mitral regurgitation. The patient underwent surgical excision and mitral valve repair. He recovered and was discharged successfully. We conclude that surgical resection, washout of the cavity with saline solution, and albendazole treatment can produce excellent outcomes in interventricular cardiac hydatid cyst cases.

CLINICAL AND ETIOLOGICAL PROFILE OF PATIENTS PRESENTING WITH ASCITES IN A TERTIARY CARE HOSPITAL

Objectives: Ascites is one of the common clinical problems confronting a physician, with a myriad of causes behind. Early detection and evaluation of the causes of ascites help in effective management and lessens complications. However, there is lack of data regarding the prevalence of causes of ascites in our set-up. Hence, this study was conducted in our tertiary care hospital to study the clinical profiles and etiological factors of patients with ascites. Methods: This prospective and observational study was carried out in the Department of General Medicine of S.C.B. Medical College and hospital, Cuttack, Odisha, India, from September 2019 to November 2021. Hundred patients of ascites of either sex >18 years of age admitted in the medicine ward fulfilling the inclusion and exclusion criteria were included in this study and were thoroughly evaluated after obtaining informed consent. All the patients were subjected to detailed history taking, thorough physical examination and routine laboratory evaluation such as complete blood count, random blood sugar, liver function test, renal function test, serum protein and albumin, serum electrolytes, prothrombin time, international standardized ratio, hepatitis B surface antigen, and antibody to hepatitis C. Hepatic encephalopathy, when present, was classified into four grades according to West Haven criteria. Ultrasonography of abdomen and pelvis, Digital chest X-ray PA view, and ECG were done in all the patients. Results: In the present study of 100 patients, major cause of ascites was found to be cirrhosis of liver (64%) followed by tuberculosis (10%), malignancy (9%), heart disease (7%), and nephrotic syndrome (3%). The major cause of the cirrhosis of liver was alcoholism (64%) followed by hepatitis B (15.6%), Non-alcoholic steatohepatitis (14.1%), Hepatitis C (4.7%), and cryptogenic (3.1%). Complications such as hepatic encephalopathy and spontaneous bacterial peritonitis were observed in 17% and 7.8% cases of ascites, respectively. Conclusion: Cirrhosis of liver was found to be the most common cause of ascites in our study followed by tuberculosis and malignancy. Alcoholism was the most common cause of cirrhosis followed by chronic hepatitis B.

Incidence of Arrhythmias in Patients with Dengue Hemorrhagic Fever Presenting in Tertiary Care Hospital

Objectives: To determine the incidence of arrhythmias in patients with Dengue Hemorrhagic fever presenting in Tertiary care Hospital. Study Design: Retrospective Observational Study. Settings: This study was done in Department of Medicine, Sir Ganga Ram hospital Lahore. Timings: From 1-10-2022 to 31-12-2022. Methods: This paper describes the number of arrhythmia cases in Dengue hemorrhagic fever patients. We separated Dengue hemorrhagic fever patients from dengue fever patients and then divide Dengue hemorrhagic fever patients in two groups: Critical phase group and Recovery phase group. We picked up and analyzed the critical phase group to see the incidence of arrhythmias. We did so by interpreting files and charts of the patients admitted to Medicine department of Sir Ganga Ram Hospital, Lahore. We confirmed dengue hemorrhagic fever by checking the capillary leak phase of the patients by looking at ultrasound of abdomen for any signs of leakage, chest X-ray PA view, hematocrit and capillary refill time of the patients and then we tabulated the data. Results: A total number of 64 patients were selected during dengue epidemics from October 2022 to December 2022. Among 64 patients, Dengue fever patients were 23 (35.9 %) and dengue Hemorrhagic fever patients were 41 (64.1 %). Dengue Hemorrhagic fever patients were with in capillary leak phase. In Dengue Hemorrhagic fever patients, 14 patients (34.14 %) were having tachycardia in critical phase and 5 patients (12 %) were having bradycardia in critical phase. The present study was done with the aim to determine the clinical profile of dengue patients and to study the cardiac manifestations in patients with Dengue fever. Arrhythmias had been reported in literature but these were reported in recovery phase of dengue hemorrhagic fever 7,15. In dengue epidemic patients seen in our set up, bradycardia was seen in critical phase of dengue hemorrhagic fever 3. Previously bradycardia was reported in recovery phase of dengue hemorrhagic fever 2,16. In critical phase of dengue hemorrhagic fever there is chance of hypotension as fluid shifts to third space due to capillary leak. So bradycardia need to monitor carefully in critical phase. Very care full attention to fluid balance and hemodynamic monitoring is required in critical phase of Dengue hemorrhagic fever. This research will be helpful for careful monitoring of arrhythmias in critical phase of dengue hemorrhagic fever patients and results in decrease morbidity in dengue hemorrhagic patients in our community. Conclusion: Dengue virus induced arrhythmias were under reported but it is an important complication in Dengue Hemorrhagic patients. Bradycardia is one of cardiac complication can be present in critical phase of Dengue Hemorrhagic fever patients. Strict monitoring of patients with bradycardia is required in critical phase of Dengue Hemorrhagic patients. Keywords: Dengue Hemorrhagic Fever, Arrhythmias, Critical Phase.

A Case Study to Evaluate the Potential of Nasya Karma and Ayurvedic Formulations against Post Covid Chronic Bronchitis.

Background- SARS-COV-2, β type corona virus affects nearly all world population after appearing in Wuhan in Nov. 2019. In Covid-19 related bronchitis there is an issue of excessive sputum production in the airways (Kaphastheevan), resulting in coughing (Kasa) and chest tightness.This recurrent cough and ongoing chest discomfort affect one’s quality of life. Aim & Objectives- Aim of this study is to create an Ayurvedic protocol (Shodhan Chikitsa -Nasya therapy and Shaman Chikitsa – Chitrak Haritaki, Sitopaladi Churna, Tankan Bhasma, Swarnavasant Malti Rasa) for treatment of post Covid19 related chronic bronchitis. Material & Methods- It is a case of 27yrs old female presented with complain of breathlessness, cough especially at night with expectoration. Assessment was done on the basis of symptoms, radiological findings (Chest X-ray PA View) and PFT (FVC & FEV1). Result- There was relief in Subjective Parameters such as Cough (Kasa), Dyspnoea (Shwasakashtata), Chest tightness (Urashool), Wheezing (Ghurghurak), Sputum and Sleep (Nidra). This Ayurvedic treatment yielded more improvement in the value of FEV1.0 (L), FVC (L), FEV1.0/FVC (%) after treatment. Discussion- Shodhan (Anu Tail Nasya) and Shaman (Chitrak Haritaki, Sitopaladi Churna, Tankan Bhasma, Svarnvasant Malti Rasa) Chikitsa have mainly VataKaphahara action. This Case study of COVID-19 related Chronic Bronchitis is highly effective in subsiding the all symptoms of Post COVID Chronic Bronchitis and also improving the Pulmonary Function.

Effectiveness of Integrated Management of Neonatal Childhood Illness (IMNCI) Tool in Chest X-Ray Positive Pneumonia Cases among Children Ages 2 Months to 5 Years A Cross-Sectional Study

IMNCI tool has widely been applied in many countries for screening, clinical diagnosis, and as a management tool for many common diseases, including cases of pneumonia. This study determines the effectiveness of IMNCI tools in the diagnosis of pneumonia as that of diagnosing pneumonia by gold standard method of X-ray Chest PA view besides finding out the sustainability in using the IMNCI guided antibiotics in managing cases of pneumonia from first care to the tertiary care facilities. Methodology: We conducted a prospective, cross-sectional study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at a tertiary care hospital in Pakistan and assessed CXR examinations. The primary endpoint was interrater reliability between CXR for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. Results: The study was done among 165 children aged between 2 months to 59 months who have visited Fatima Hospital, Baqai Medical University, due to their medical condition of cough OR fast breathing. Most of the mothers had been taking antibiotics for their sick children before they reached our set up and very few of them (15%) were found adherent to taking IMCI guided IMCI-guided antibiotic Amoxicillin, whereas the rest of all a huge majority of the cases were found using non-IMCI guided antibiotics constituting 85%, means other than oral Amoxicillin. A Sensitivity of 68.75% and a Specificity of 92.3% were found to IMCI tools validity in diagnosing pneumonia against X-ray chest positivity. Conclusion: This study concludes that the accuracy of IMCI tools in recognizing childhood pneumonia was good rather than the diagnosis as that to the positive findings in Xray Chest findings. However, with good sensitivity and the best specificity with high PPV, it can be the best screening tool for the early detection of pneumonia among children<5 years and can achieve a better outcome with in-time recognition, appropriate care seeking, and early intervention avoiding irrational antibiotics. Keywords: ARI: Acute Respiratory Infection, AIDS: Acquired Immunodeficiency Syndrome, BMU: Baqai Medical University, IMCI: Integrated Management of Childhood Illness, IMNCI: Integrated Management of Neonatal & Childhood Illness, WHO: World Health Organization, UNICEF: United Nations International Children’s Education Funds, MDG: Millennium Development Goal, SDG: Sustainable Development Goal, MNCH: Maternal, Neonatal & Child Health Program

A CLINICAL STUDY AND MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION

Aims And Objectives: The current study aims to review the various causes, clinical features and the outcome of surgical procedures in relation to etiological factors in 50 intestinal obstruction patients admitted at Government general hospital ,Kurnool july2020 –july2022. This study was done on 50 cases of acute intestinal obstruction Materials And Methods: that presented to emergency department of government general hospital,Kurnool(july 2020-july2022).All patients with provisional diagnosis of acute intestinal obstruction were assessed clinically in detail after admission. Investigations done included Hb, Blood counts including TC, DC, ESR, serum electrolytes ,X-ray Chest PA view, Plain X-ray abdomen erect lm & Ultrasonography abdomen, CECT abdomen. . The commonest Results: age group affected was 31-40 years. M:F ratio is 2.6:1. In our patients, the main cause of obstruction was obstructed hernia (36%). Adhesions and bands (26%) were the second most common cause of intestinal obstruction followed by sigmoid volvulus (12%), TB abdomen (8%) and malignant obstruction (6%). Surgery was the mainstay of treatment, with herniorraphy, adhesiolysis and resection - anastomosis being the most commonly performed procedures. Post-operative complications noted were wound infection (12%), respiratory infection (6%) and prolonged ileus (6%). In the present study of 50 cases, 5 patients (10%) died due to septicemia,leak and MODS. The incidence of intestinal Conclusion: obstruction is more common in males, Mode of presentation also differs in different levels of intestinal obstruction, Adhesions accounted for majority of small bowel obstruction (26%),Malignancies are common causes of large bowel obstruction.Early recognition and timely intervention is important to prevent the bowel going for gangrenous changes.Morbidity was due to anastomotic leak, would infection, chest infection. Prognosis was poor in elderly patients and , in patients with co-morbid conditions, presence of strangulated bowel that required resection & anastomosis and those whose presentation to hospital was late

Study on Hydroxychloroquinine Sulfate Being Given to the Admitted COVID -19 Positive Patients at Institute of JLNMCH, Bhagalpur, Bihar, India.

BackgroundAs the global death toll from new coronavirus illness (COVID-19) rises, the scientific community and healthcare systems are under massive pressure to manage the outbreak and develop effective medical remedies. Meanwhile, desperation has pushed practitioners, scientists, and authorities to recommend and attempt medicines with little or no proof. Despite the lack of clear and unequivocal facts supporting its efficacy and safety, hydroxychloroquine-sulfate (HCQS) has recently received substantial public and political interest in treating and prophylaxis new infectious diseases COVID-19.AimTo analyze the impact of HCQS in COVID-19-positive patients admitted at tertiary level government-owned Jawaharlal Nehru Medical College and Hospital (JLNMCH, Bhagalpur) Bihar.MethodsTwo hundred two RT-PCR-positive COVID-19 patients were included in this research. The study participants were randomly distributed into the intervention category and control category, each consisting of 101 study subjects. Study participants in the intervention category were administered hydroxychloroquine in 200 mg tablets. The control category was given placebo tablets that looked similar to tablets of hydroxychloroquine and were given in the same pattern. Chest X-ray PA view, 12 lead ECG, baseline hemogram including a concentration of CD4 cells, ratio between the concentration of CD8 cells and CD4 cells and concentration of CD8 cells, the concentration of C-reactive protein, RT PCR test of samples obtained from the oropharyngeal region and nasopharyngeal region nasopharyngeal for verification COVID-19 were done. These measurements were carried out in both the control and intervention categories at baseline and at the moment of obtaining a negative RT-PCR report.ResultsThe confirmed cases of COVID-19 was 52.9% in the intervention category and 53.4% in the control category at the end of the administration of drugs. Symptoms related to COVID-19 were observed in 11.6% of subjects in the intervention category and 13.5% in the control category. Other new symptoms were observed in 16.8% of subjects in the intervention category and 14.5% of study subjects in the control category. One death was reported in the control category. Emergency hospitalization was required for one subject in the intervention category, while two subjects in the control category required emergency hospitalization. 12.4 days was the mean duration of recovery in the intervention category, while 13.6 days were the mean duration of recovery in the control category. The recovery duration and COVID-related symptoms were lesser in the intervention category than in the control category; however, the variation between the two categories was statistically non-significant (p˃0.01).ConclusionAccording to this research, no statistically significant difference was noticed in COVID-19 incidence between the control category and intervention category, showing that hydroxychloroquine sulfate cannot be utilized as the main curative agent in the treatment of COVID-19. However, there was a reduction in recovery days and symptoms related to COVID-19 in study subjects administered with HCQS.

Procalcitonin as a predictor of severity in acute pancreatitis

Background: Outcomes and severity of acute pancreatitis is a challenging condition to diagnose. However, multiple clinico-biochemical scores, imaging, radiological imaging, and biochemical markers are used. Aims: To evaluate procalcitonin as a predictor of severity in acute pancreatitis and to correlate the levels of procalcitonin to the CT Severity Index score. Materials and Methods: In 65 study subjects, prolactin levels, CRP, blood glucose, liver function tests, BUN, creatinine, urea, CBC, and radiological investigations including whole abdomen USG, X-ray abdomen-supine and erect, and chest X-ray PA view. Following 48-72 hours of admission, a CT abdomen was done on subjects with diagnostic dilemmas. In subjects where CECT was done, necrosis scores and Balthazar grading were used for grading the CT severity index. Results: For the cut-off PCT value of 1.77 ng/ml the sensitivity, specificity, PPV, NPV, accuracy, and likelihood ratio were 74.8, 76.88, 74.8, 76.94, 74, and 15.154 respective. In the PCT cut-off value of 3.29 ng/ml, the respective values of sensitivity, specificity, PPV, NPV, accuracy, and likelihood ratio were 66.65, 84.58, 79.8, 73.31, 74, and 14.426. BCTSI score of ≥4, the respective values of sensitivity, specificity, PPV, NPV, accuracy and likelihood ratio were 62.3, 65.36, 62.3, 65.36, 65, and 3.936.

Clinico-Pathological and demographic profile of patients of cervical tubercular lymphadenitis in hilly region of Uttarakhand

Tuberculosis (TB) is a communicable disease that is a major cause of ill health. The hilly region of Uttarakhand has difficult terrain and is one of the least accessible regions of the country. This present study was to evaluate the Clinico-pathological and demographic profile of patients of cervical tubercular lymphadenitis in hilly region of Uttarakhand, India. Detailed History and physical examination was to done and all previous investigations were compiled. Routine investigations like HIV, RBS and Chest X-Ray PA view, if not done earlier, were done of every patient. Lymph nodes were assessed according to system adopted by the American Academy of Otolaryngology Head and Neck Surgery. The age of the patients ranged from 14 to 64 years with a mean age of 35 years (SD=12.27). The commonest age group was 16-30 years (42.73%). Male: Female ratio was 1:1.34. Among 110 patients, 88 (80%) presented with solid lymph nodes, 20 (18.2%) with abscess and 2 (1.8%) with discharging sinus. FNAC was done in all 110 cases and found AFB positive in 45 (40.9%) cases. Disease is relatively more common in younger patients. Constitutional symptoms were absent in some of the patients.

Diagnostic and therapeutic role of bronchoscopy in suspected cases of foreign bodies in tracheobronchial tree in pediatric age group

<p class="abstract"><strong>Background: </strong>Aim and objectives were to review the importance and benefits of bronchoscopy in suspected foreign body aspiration in tracheobronchial tree, prompt diagnosis and early management, and correlation between clinical and bronchoscopic findings.</p><p class="abstract"><strong>Methods: </strong>A retrospective study was conducted. Total 50 pediatric patients were enrolled in our study who were giving strong history of foreign body aspiration with sudden respiratory symptoms. Chest X-ray PA view was performed in all the patients. All the bronchoscopy done under general anesthesia.</p><p class="abstract"><strong>Results: </strong>In our study, children between 6 months to 3 years of age are the commonest victims, males are more affected than females. Classic triad of unilateral wheeze, coughing, and ipsilateral reduced air entry-is observed in less than 50% of cases.</p><p class="abstract"><strong>Conclusions: </strong>Bronchoscopy is essential in all cases of bronchial foreign body known or suspected and rigid bronchoscopy has proven over time to be safest and most efficacious to therapy. Although X-ray examination is essential for diagnosis and management, CT thorax with virtual bronchoscopy is advisable before bronchoscopy procedure in suspected cases (if general condition permits), it gives better idea about exact location, nature and type of foreign body. </p>

Study of role of vitamin C in type 2 diabetes mellitus patients

Background: Diabetes mellitus (DM) is the most common non-communicable diseases in the present millennium which has become a global public health problem. The treatment of type 2 Diabetes mellitus (T2 DM) often is initiated with monotherapy of oral antidiabetic drugs (OADs), which often do not decrease the plasma sugar levels effectively and consistently that will reduce short term and long-term complications associated with T2 DM. Hence the current study is aimed to determine the effectiveness of vitamin C supplementation with standard OADs on glycemic control.Methods: This study consisted of 120 T2 DM patients with 80 males and 40 females with a mean age of 50.88 yrs were divided into four groups with equal number of males and females in each group depending upon the OADs they received in solo or with vitamin C for 12 weeks. After the written consent, a detail clinical history, clinical examination, biochemical investigations including fasting plasma sugar (FPS), post prandial plasma sugar (PPS), glycosylated hemoglobin (HBA1c), serum creatinine, serum electrolytes, chest X-ray PA view and standard ECG were done. Repeat FPS, PPS and HBA1c were done after 4, 8 and 12 weeks of study.Results: After 12 weeks of study FBS, PPS and HBA1c decreased significantly (p<0.01) in study groups (Metformin and teneligliptin with vitamin C) as compared to control groups (OADs without vitamin C). Vitamin C supplementation with OADs found to be effective, well tolerated and devoid of any side effects.Conclusions: OADs are effective and affordable hypoglycemic agents with vitamin C supplementation.

Dysphonia: Epidemiology, Diagnosis and Risk Factors at Tertiary Health Care Center.

The physical, mental, financial, social and emotional constraints encountered by an individual having voice disorder can be easily anticipated as communication is the utmost need in day to day life and some professions. To study the clinical epidemiology of voice disorders in surrounding population and identify the risk factors. It also intended to make people aware of vocal hygiene programme. This observational, prospective, cross sectional study was conducted in Chirayu medical college and hospital, Bhopal from September 2016 to August 2017. All the patients were subjected to diagnostic flexible video laryngoscopy and stroboscopy and in some patients Chest X-ray PA view, USG Neck, Computerized tomography and Magnetic resonance imaging were advised for the confirmation. Amongst 45 patients who formed this study group, male preponderance was seen with male to female ratio of 2.2:1. Laryngeal malignancy (13 cases) was the commonest pathology, followed by vocal polyp (7 cases) and vocal cord palsy (6 cases). Rare cases of tubercular laryngitis and hemorrhage were also diagnosed. The largest group of patients belonged to labor/farming occupation suggesting the rural referral to this tertiary care center followed by housewives.

ROLE OF TRANSBRONCHIAL LUNG BIOPSY AND BRONCHOALVEOLAR LAVAGE IN DIAGNOSIS OF DIFFUSE PARENCHYMAL LUNG DISEASE

Background: Diffuse parenchymal lung diseases (DPLD) constitute a group of over 200 diverse etiologic entities which present with respiratory symptoms and diffuse lung infiltrates and account for 15% of patients seen by a pulmonary physician. Objective: To evaluate the role of transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse parenchymal lung disease. Patients and Methods: This prospective cross-sectional study was carried out at the Department of Chest, Al-Hussein University Hospital, during the period from October 2019 to October 2020, and included sixty patients admitted in the inpatient wards with undiagnosed DPLD, after detailed history taking, physical examinations, routine labs, chest X-ray PA view, HRCT chest, pulmonary function tests (PFTs) as simple spirometry, ECG, echocardiography and Arterial blood gases evaluation. All of them were subjected to fibrooptic bronchoscope, transbronchial lung biopsy and bronchoalveolar lavage. Results: As regard comparison between bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) diagnostic yield there was a statistical significant difference between TBLB positive and negative patients, as regard BAL predominant cells and BAL microbiology. the comparison of histopathology as regard TBLB diagnostic yield showed a statistical significant difference between TBLB positive and TBLB negative patients. Conclusion: Bronchoalveolar lavage was a minimally invasive procedure performed during flexible bronchoscopy. BAL cellular analysis alone was insufficient to diagnose the specific type of DPLD, except in malignancies and some rare interstitial lung diseases (ILDs), and the yield of bronchoscopic lung biopsy was high in diseases where the lesions were peri bronchial in distribution such as in sarcoidosis, hypersensitivity pneumonitis and organizing pneumonias.

Pattern of chest radiographic abnormalities and co-morbidities in newly detected sputum positive pulmonary tuberculosis cases

Background: Tuberculosis (TB) is an airborne communicable disease which one of the leading causes of morbidity and deaths worldwide (ranking above AIDS).1 Probability of detecting AFB on sputum is greatly associated by the radiological findings.8 Because of the apparent widespread difficulty in recognizing the radiographic manifestations of pulmonary tuberculosis, it will be beneficial to review the spectrum of chest x-ray abnormalities in sputum positive tuberculosis patients. Aim: To study clinical features, radiological features and comorbidities among newly detected sputum positive pulmonary tuberculosis patients. Settings and design: The hospital based cross-sectional study was conducted from the year 2016-2018 at a tertiary care teaching hospital in Mangalore. Methodology: Newly diagnosed smear positive pulmonary tuberculosis aged between 18-70 years attending OPD/IPD of Department of Respiratory Medicine, who fulfilled study eligibility criteria were included. Comprehensive clinical assessment was conducted and information regarding socio-demographic profile, comorbidities were noted. Chest x-ray PA view was performed for all patients. Statistical A nalysis: Data was analyzed in SPSS V:20. Data is presented in frequency, percentages. Chisquare, was applied to test significance of association. Results: A total of 563 (309 elderly and 254 adult) patients participated in study. Male predominance was noted (64.7%). Cough (94.1%) and expectoration (83.8%) were the most common symptoms. High bacillary load (3+) and bilateral lungs involvement were predominant among elderly patients (75.6%). Cavitary lesions were predominant among adults. Infiltration (39.6%), cavitary lesions (37.7%) and consolidation (37.5%) were most common lesions seen in chest x-ray. Cavitary lesions were found in higher percentage among patients with higher bacterial load of 2+and 3+ (36.8% and 33.0% respectively). Bilateral lesions were associated with TB patients with diabetes

DECISION MAKING FOR DEVICE CLOSURE IN ADULTS WITH ‘HYPERTENSIVE PDA’–NON-INVASIVE CRITERIA: IMMEDIATE RESULTS

Objective: To find the mean pulmonary artery pressures (PAP) in adults (>12 years) Patent Ductus Arteriosus (PDA) with ‘reversible pulmonary hypertension’ after the device closure. Residual PDA and immediate complications (embolization, pulse loss, obstruction in the aorta or pulmonary artery) are to be reported.
 Study Design: Retrospective study.
 Place and Duration of Study: Tertiary Care Referral Hospital, from Aug 2007 to Jun 2020.
 Methodology: This retrospective study is descriptive. Data collected by convenience sampling from 3 tertiary care referral hospital. 981 patients were undergone PDA device closure during the period from Aug 2007 to June 2020. After informed consent, an initial assessment was done by history, clinical examination, x-ray chest PA view, electrocardiography (ECG), and transthoracic echocardiography (TTE). Reversible pulmonary hypertension was labeled based on non-invasive criteria including room air saturation >93% and cardiomegaly on x-ray chest. Patients who had <93% and normal heart size on x-ray chest were excluded. The lower limit for age was 12 years.
 Results: Nine Hundred Eighty One patients had undergone PDA device closure. 32 (n=32/981 3.3%) had fulfilled our inclusion criteria. The mean age was 22 ± 9 (13–45) years. Mean weight was 41 ± 11 (25-66) kg. Successful device closure was done in 30 patients (93.7%). Mean diameter of PDA was 7 ± 0.1 (4.5-13 mm. Mean PAP decreased from 59 ± 13 mmHg to 38 ± 19 mmHg (p<0.05). Commonest device used was Shasma duct occluder (n=16/32 50%) followed by Occlutech Duct Occluder (n=7/32 21.9%), while 2 had muscular VSD device (n=5/32 15.6%). In 2 patients, there was an underestimation of the size of PDA so the device was retrieved and replaced with another larger one successfully. Two patients had the device fully dropped into the main pulmonary artery before it was released. Larger size device was not available at that time so the patients were referred for surgery. None of our patients had device embolization or residual shunt on echo performed next day to the procedure. Neither any patient had residual pulmonary hypertension on echocardiography. There was no significant obstruction in the aorta in any patients. Two patients had mild left pulmonary artery obstruction. There was no significant obstruction in the aorta in any of our patients. There was pulse loss in 3 patients which were treated successfully with heparin infusion with no residual damage.
 Conclusion: Device closure is a feasible option in adults with hypertensive PDA while the decision of reversibility is based on non-invasive criteria.

Utility of GeneXpert Mycobacterium tuberculosis/rifampicin assay in smear-negative pulmonary tuberculosis

Background: Tuberculosis (TB) remains one of the world's deadliest communicable diseases. An alarming rise in the incidence of Mycobacterium tuberculosis (MTB) has prompted the need for rapid diagnostic techniques. Despite low sensitivity in MTB detection, sputum microscopy remains the main diagnostic method, especially in resource-limited settings. Mycobacterial culture is the gold standard method for TB diagnosis; however, the use in clinical practice is limited due to longer time, biosafety requirements, and high cost. In December 2010, the World Health Organization (WHO) 1st endorsed the usage of Xpert MTB/rifampicin (RIF) assay. The WHO recommends that GeneXpert test could be used as a follow on test to microscopy, especially in smear-negative specimens. Objectives: To assess percentage of Tuberculosis cases and Multi Drug Resistant (MDR) case detection at diagnosis using Xpert MTB/RIF assay in smear-negative pulmonary cases. Materials and Methodology: Detailed relevant clinical history and examination were carried out for 105 pulmonary TB suspect patients. Sputum acid-fast bacilli smear two samples and human immunodeficiency virus status were checked under RNTCP; chest X-ray PA view was done. Smear-negative patients were subjected to bronchoscopy and bronchoalveolar lavage (BAL)/bronchial washing. BAL/Bronchial washing was tested for GeneXpert. Interpretation and Conclusion: MTB was detected in 21 (20%) samples out of 105 samples and RIF resistance was detected in 1 (1%) sample. Most common chest x-ray abnormalities were cavity (33.3%) and consolidation (33.3%). 8 cases (38.1%) among Gene xpert positives had past history of Tuberculosis. Comorbidities were found in 5 cases (23.8%) among Gene Xpert positives. The present study concludes that using standard clinical assessment for selection, five patients need to be tested to detect one case of smear-negative TB. Smear-negative patients could benefit from Xpert, particularly in areas where no culture is available.

Assessment of etiological, clinical and echocardiographic profile of cases with atrial fibrillation

Atrial fibrillation (AF) is commonly encountered cardiac arrhythmia accounting for one-third of the total admissions for cardiac rhythm disturbances and is associated with significant morbidity and mortality. Echocardiography is the best method to find out the causes for the development of atrial fibrillation. This study was aimed to assess the clinical and echocardiographic profile of atrial fibrillation and its associated complications. A total of 120 cases of both genders (males 62 & females 58), clinically diagnosed with atrial fibrillation between age group 21-70 years were recruited. Study participants were subjected to detailed physical, systemic, radiological (chest X-ray PA view, transthoracic ECG) and laboratory investigations (blood glucose, thyroid function tests). Majority cases were in belonging to 4th and 5th decades of age. Dyspnea (90) was a common symptom followed by palpitation (39), fatigue (18), chest pain (10) and syncope (5). The CHA2DS2-VASc score was above 2 in 64.1%, which indicates a high risk for stroke occurrence. Among 54 RHD cases, 44.4% cases had mitral stenosis, followed by MS+MR in 24.07%, MS+AS+AR in 14.8% cases, MS+MR+AS+AR in 7.40% cases and S/P MVR in 9.25% cases. Rheumatic heart disease (45%) is the most common etiological factor associated with atrial fibrillation followed by hypertension (23.3%) and coronary artery disease (18.3%). The Left atrial enlargement was seen in study participants and a structural abnormality in echocardiography was observed.

When pulmonary embolism mimics pneumonia: An interesting case report

The classic presentation of pulmonary embolism is rather uncommon. The lack of pathognomonic signs and symptoms makes the diagnosis of PE difficult. Here, we report a patient presented with symptoms suggestive of pneumonia and ultimately diagnosed as PE. A 75 years old male patient with no known co-morbidity, presented with of breathlessness for 1 week, cough for one week, productive in type, with scanty sputum, chest pain since one week, sharp, aggravated on coughing. His respiratory system examination revealed increased VF/VR in right mammary and left infrascapular areas, equal air entry with normal vesicular breath sounds, crepitations in the right mammary and left infrascapular areas. He was initially treated as pneumonia but did not respond. His chest X-ray PA view showed probable mass lesion in the right para cardiac region, ECG– sinus tachycardia with right axis deviation and RV strain pattern. CECT Thorax- Intraluminal thrombus in Rt and Lt pulmonary artery consistent with acute pulmonary thromboembolism.The patient was lysed with Inj. Streptokinase and subsequently improved over the next 6 days. Whilst established criteria aid in ruling in or out the diagnosis in a setting, the gestalt of a clinician is the most appropriate defence against a missed diagnosis especially in settings of confounded presentation. Therefore, until conclusively proven with the help of imaging and lab-work, PE should be a diagnosis that needs be considered in any case of atypical pneumonia who is not responding to first line therapies.

Congenital Cystic Adenomatoid Malformation of Lung in an Infant

Congenital Cystic Adenomatoid Malformation (CCAM) is considered a hamartomatous lesion of lung with excessive proliferation of bronchial structure without alveoli. We have treated a child of 12 months who presented with difficulty in breathing after birth and chest x-ray PA view shows increase lucency in the right upper zone suggestive of CCAM. Patient underwent right upper lobectomy under general anaesthesia and now she is fine.
 JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 235-236

A Prospective Study on Epidemiology, Clinical Profile and Outcome of Hospitalized Cases of Swine Flu (H1N1) During 2018-2019 Outbreak in North West Zone of Rajasthan

Background: Since World Health Organization declared H1N1 (Swine flu) a pandemic disease on April 29, 2009, it is continuing to be a major public health problem and it has significant regional and seasonal variation. Therefore, this study was planned to evaluate epidemiology, clinical profile, course of illness and their outcome. Material and Method: Present prospective crosssectional study was conducted on RT-PCR confirmed cases of swine flu admitted in dedicated swine flu ward in the Department of Medicine, S.P. Medical College & Associated Group of P.B.M. Hospitals, Bikaner. All patients were subjected to detailed clinical examination and relevant investigation as per proforma. Clinical and epidemiological data were collected. All patients subjected for routine lab examination including complete blood count, renal function test, liver function test, fasting blood sugar, ABG, X-ray chest PA view and other specific investigation as per requirement. Result: Most females belonged to age group 18-35 years and most of the malesbelonged to age group >55 years. Most of cases belonged to category C (62%) and urban residential area (55.7%). Most common symptom was cough (98.7%) followed by fever (91.1%), sore throat (86.1%), sputum (83.5%), nasal discharge (73.4%), breathlessness (72.2%), headache (58.2%), chest pain (27.8%) and palpitation (16.5%). Our study shows multiple organ involvement during the course of swine flu as indicated by increasing blood urea (36.7%), serum direct bilirubin (19%), serum creatinine (18.9%), SGOT (68.3%), SGPT (37.8%) and decreasing serum albumin (63.3%). Overall mortality rate in our study was 8.8%.It was high in females (9.1%) as compare to males(8.6%).All deceased belonged to category C and cough was the most common presenting symptom followed by sore throat, nasal discharge, sputum and fever. Conclusion: Our study shows there are certain factors which can affect outcome in the cases of swine flu. Female gender, elderly age, co morbidity and the duration of illness(6-10 days) are the important factors associated with poor outcome. Early recognition and alertness is important to reduce morbidity and mortality. Patients should also be screened for multiple organ involvement at the time of hospitalization by laboratory test like CBC, RFT, LFT for early diagnosis of multiple organ involvement so as to treat appropriately to prevent multiple organ failure and mortality.