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   Table of Contents - Current issue
September-December 2022
Volume 2 | Issue 3
Page Nos. 81-123

Online since Wednesday, August 17, 2022

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Impact of obesity on respiratory health p. 81
Safreena Mohamed
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Innovations help when there is unexpected demand p. 83
Ravindran Chetambath
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Evaluation of anaphylaxis: A simplified approach p. 85
Vidushi Rathi, Pranav Ish
Anaphylaxis has been defined as a serious allergic reaction that can even amount to death. However, the approach to the patient remains grossly individualized. Treatment aims at rapid intervention to prevent mortality. This review gives a detailed yet simplified approach to anaphylaxis, its diagnosis, and management.
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Self working water-based instrument for positive expiratory pressure by resistance device and its effectiveness in improving oxygenation in acute pulmonary edema, during the COVID 19 pandemic: A pilot study p. 92
Akhil Paul, Susana Mathew
Background: About 20% to 67% of COVID 19 infected patients who are admitted to the hospitals and 100% of mechanically ventilated patients suffer from acute respiratory distress syndrome. Extrinsic positive expiratory pressure (PEP) can improve oxygenation by direct and indirect mechanisms, thus reducing the need of medical oxygen. But high-budget and sophisticated machines are required to provide this positive airway pressure, adding on to the treatment cost of the patient and investment expenditure by the health-care facilities. We have designed a simple self-working device called self-working water-based instrument for positive expiratory pressure by resistance (SWIPER) device which can provide a PEP. The objective of this study was to assess the effectiveness of this device in improving oxygenation in patients with acute pulmonary edema, which was quantified using pulse oximetry. Methods: Patients who were admitted to the medical intensive care unit during the study period, with an acute pulmonary edema-a diagnosis which was made clinico-radiologically, were chosen as the subjects for the study. Once the patients were critically stabilized by the already existing treatment protocols, the SWIPER device was applied. Results: The device was introduced on 15 patients who were selected after applying the inclusion-exclusion criteria of the study. The mean age of the study group was 65 years (men-64 years, Women-66 years). Eight of them had cardiogenic pulmonary edema whereas seven of them had nephrogenic pulmonary edema. The median baseline SpO2level was 90% (86%, 94%) and the median plateau SpO2level after using the SWIPER device was 94% (91%, 99%) (*P < 0.001). The mean rise in SpO2on using the device was 6% (1.89) which was clinically significant. Conclusion: SWIPER device is effective in significantly increasing the SpO2 in patients with acute pulmonary edema by providing a PEP. This device is not a replacement for the existing positive airway pressure-providing electrical devices. However, SWIPER devices will definitely come in handy in resource-limited settings in providing better treatment and care till the standard therapeutic measures are obtained. It will also help in significantly reducing the medical oxygen consumption in managing such patients.
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The pain of pills: The lived experiences of cured tuberculosis patients p. 98
Janmejaya Samal
Background: Tuberculosis (TB) continues to be a major public health threat in India. Management of TB requires intake of multiple pills during the entire treatment period with strong repugnance by the patients and the family members as well. Objective: The main objective was to understand the difficulties and challenges faced by TB patients while undergoing TB treatment. Materials and Methods: Cured TB patients from urban slums in one of the cities of Chhattisgarh were interviewed in depth by the help of an open-ended semi-structured questionnaire. The interviews were transcribed verbatim and subsequently underwent an inductive thematic analysis. Results: Of the 12 study participants, 25% constituted female patients; 16.6% constituted relapse cases; 16.6%, 8.3%, and 75% of the cases were diagnosed through chest X-ray, cartridge-based nucleic acid amplification test, and sputum examination, respectively. All the cases belong to an urban slum and are pulmonary TB cases. Two major thematic areas and 2 sub-themes were identified; (a) Pain of Pills (1. Load of pills, 2. Adverse effects of anti-TB drugs) and (b) Social Stigma (1. Concealment of treatment status, 2. Concealment of treatment success). Owing to the long duration of treatment, TB patients develop strong aversion toward pills and wish to complete the treatment before prescribed time-limit. Despite the progress made, TB patients are still being stigmatized in communities and many TB sufferers neither want to share their status as TB patients nor want to share the treatment success in their neighborhood. Sometimes, these patients feel exhausted, isolated and live with solitude with self-discrimination. Conclusion: Health-care workers should be compassionate toward the stigma and aversion for treatment that becomes a part of many TB patient's life.
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COVID-19 vaccine-related immunological adverse event presented as reversible autoimmune disease with rheumatological feature and pulmonary infiltrates p. 105
Shital Patil, Ganesh Narwade
Rheumatological manifestation with acute febrile respiratory illness known to occur after coronavirus disease 2019 (COVID-19) pneumonia and presenting as long COVID disease, its occurrence with COVID vaccination is not very well associated or described in the literature. In this case report, a 45-year-old female presented with constitutional symptoms, persistent fever, and lung parenchymal infiltrates, without mycobacterial microscopic or genome documentation, received empirical antituberculosis (TB) treatment with the progression of disease with little clinical or radiological response. Bronchoscopy workup was inconclusive and tropical screen for bacterial, fungal, TB, and malignancy was negative. Vasculitis workup was inconclusive and rheumatological workup documented highly raised antinuclear antibodies titers. We have started her on steroid and hydroxychloroquine and clinical response documented with near-complete resolution of shadows in 12 weeks. Rheumatological syndrome which is a rare vaccine-related adverse event, reversible and easily treatable with routinely available medicines and importantly it is having excellent prognosis. Minimal systemic adverse events are known to occur with all viral vector vaccines, but its occurrence is rare and it should not impact on routine vaccinations as vaccination is a key step in this pandemic to protect humankind.
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Pulmonary alveolar microlithiasis: Lungs of stone! p. 112
N Neenu, Ketaki Utpat, Unnati Desai, Gautam Sarawade
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disorder characterized by diffuse bilateral deposition of calcispherites in lung alveoli due to mutations in the SLC34A2 gene. Here, we presented a case of PAM in a young male who had been referred to our center to rule out miliary tuberculosis due to his chest radiography findings of bilateral extensive reticulonodular opacities. Possibility of PAM was considered here due to clinicoradiological dissociation and was confirmed with high-resolution computed tomography of the chest, which showed findings of Stage 2 PAM. Even though PAM has pathognomonic unique chest radiographic findings, it always poses a diagnostic challenge for physicians as it closely resembles other diseases including miliary tuberculosis, pneumoconiosis, and sarcoidosis. This case shows the need for thorough knowledge about PAM that physicians should have to reach at early prompt diagnosis and to avoid unnecessary need for invasive procedures.
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Smoker with unilateral enlarged breast p. 115
Vishnu M Sharma
Intrathoracic tumors can present with paraneoplastic manifestations. We discuss a paraneoplastic manifestation as an interactive discussion. We have focused the discussion on clinical approach to the case.
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An unusual site for chest wall trauma p. 119
Ravindran Chetambath, NK Sneha, TS Maneesha
Blunt chest trauma can injure ribs, vertebra, or sternum and, in turn, lead to lung injury of various severities. However, trauma to the scapula is very rare and it suggests heavy impact on the chest wall during fall. Here, we discuss a case of a traffic accident where multiple ribs and scapula on the right side are fractured. This, in turn, precipitated contusion of the lung.
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High attenuation mucus p. 122
Vishnu Sharma Moleyar, Nisha Thomas
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