UAPM Journal of Respiratory Diseases and Allied Sciences
UAPM Journal of Respiratory Diseases and Allied Sciences is the official publication of the United Academy of Pulmonary Medicine (UAPM). This journal is published twice a year in both print and online formats in the English language since 2024 and features cutting-edge clinical information in the multidisciplinary specialty of Respiratory Medicine. The journal also features studies and scientific information related to basic sciences, and allied systems of pulmonary Medicine. The main aim of the journal is to disseminate scientific information related to respiratory diseases for the better well-being of mankind. This print journal publishes editorials, original articles, review articles, meta-analyses, case reports, etc., apart from radiology imaging, clinical images, brief communications, letters to the editors, book reviews, and other information related to the respiratory system. The manuscripts are accepted on the basis of significance, scientific merit, and applicability. Authors are requested to base their reports on the basis of original work carried out by themselves or with their colleagues. Title: UAPM Journal of Respiratory Diseases and Allied Sciences Frequency: Twice a year E-ISSN: 3107-4189 Owner: United Academy of Pulmonary Medicine Publisher: United Academy of Pulmonary Medicine Chief Editor: Dr Ramakant Dixit Copyright: United Academy of Pulmonary Medicine Starting year: 2024 Subject: Respiratory Medicine and allied subjects Language: English Publication format: Print + online Phone Number: 0145-2692257 Email ID: editor_uapmjournal@yahoo.com Mobile Number: 9413040257 Website: https://uapmjournal.in/index.php/uapmjrdas/index Address: C/O Daulat Ram Dixit 60-A Block O, Chandravardai Nagar Ajmer, 305001, Rajsthan.
United Academy of Pulmonary Medicine (UAPM)
Asthma in School Children: Assessment of Prevalence And Risk Factors Among Rural and Urban Settings from the Western Part of India
Background: Asthma in children remains a significant global public health challenge, contributing extensively to paediatric hospitalizations, increased healthcare utilization, missed school days, and reduced caregiver productivity, apart from the problem of underdiagnosis and undertreatment of asthma. This study aimed to assess the prevalence of asthma in school children aged 5 to 15 years in urban and rural areas of the western part of India. Methods: The study was conducted to assess the prevalence and associated risk factors of asthma among school-going children aged 5 to 15 years in urban and rural regions. The cross-sectional survey included 6,959 children, with 4,553 from urban schools and 2,416 from rural schools. Data collection was based on a modified version of a standardized and validated questionnaire developed by the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Results: Among urban children, 645 (14.2%) were found to have different allergic disorders, with a higher prevalence among females (15.9%) compared to males (11.3%). The rural population showed a lower overall prevalence of allergic disorders (5.1%), again with female predominance (6.1 vs. 4.2% in males). In urban children, asthma was present in 26% of those with allergies compared to just 0.8% among non-allergic peers. 44.7% of rural children with allergic conditions had asthma, compared to 1.2% among those without allergic conditions. In urban areas, asthma was diagnosed in 8.7% of children with environmental tobacco smoke exposure compared to 5.9% in rural children. 278 (6.1%) urban children reported biomass fuel exposure, with an asthma prevalence of 4.3% (n = 8). 48.7% (n=1177) of rural children were exposed to biomass fuel, with an asthma prevalence of 6.03% in the exposed group. Conclusion: The prevalence of allergic disorders was significantly higher in urban children compared to their rural counterparts. The overall prevalence of asthma was markedly higher among children with allergic conditions. Exposure to environmental tobacco smoke was found to be a significant risk factor for asthma in both urban and rural populations. Biomass smoke exposure was significantly associated with increased asthma prevalence among rural female children.
School children, allergic conditions, environmental tobacco smoke, biomass fuel, prevalence of asthma..
An Assessment of Tracheal Index and Thoracic Cage Ratio in patients with Chronic Obstructive Pulmonary Disease
Introduction: Chronic obstructive pulmonary disease is a heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways and/or alveoli that cause persistent, often progressive, airflow obstruction. Objectives: The present study was undertaken to assess the tracheal index and the thoracic cage ratio in patients with COPD. Methods: Male COPD patients diagnosed in accordance with GOLD guidelines were included; all study subjects had with smoking history of ≥ 20 pack years and age ≥ 40 years. Patients who had any evidence of coexisting lung disease other than COPD were excluded. Patients having comorbid systemic disorders were also excluded. High-resolution CT scans were obtained without using any contrast. Tracheal Index, defined as the ratio of transverse/anteroposterior diameter at a plane 1-cm above the aortic arch, was analyzed. A tracheal index is < 0.67 was considered as Saber-sheath trachea. In the present study, the thoracic cage ratio was evaluated at two planes: carina and 5 cm below the carina. Results: A total of 40 COPD patients completed the study. Their mean age was 59.86 ± 9.46 years. Mean smoking history of 37.67 ± 12.26 pack years. Total duration of illness due to COPD was a mean of 14.58 ± 4.86 years. Their FEV1/FVC ratio varied from 0.49 to 0.66 and the resting oxygen saturation was 87.6 to 95.6%. Saber Sheath Trachea was assessed in 14 patients, thoracic cage ratio > 0.75 at Carina was seen in 5 patients, and Thoracic Cage Ratio > 0.75 at 5 cm below Carina was found in 11 patients. Tracheal Index had significant correlations with age, duration of illness, pack years and FEV1/FVC Ratio. Thoracic Cage Ratio at carina and that 5 cm below carina had significant correlations with age, duration of illness, pack years and FEV1/FVC Ratio Conclusion: HRCT was observed to be a useful imaging modality to detect characteristics of pulmonary hyperinflation – Tracheal index and the thoracic cage ratio. These parameters had significant correlations with the severity of the disease.
COPD, HRCT, Tracheal index, Thoracic cage ratio, Lung hyperinflation, Saber Sheath Trachea, Airways disorders
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Correlation of 5-Repetition Sit-to-Stand Test with Borg Dyspnoea Scale and GOLD Spirometric Classification in Patients with COPD
Background: Chronic obstructive pulmonary disease (COPD) is a major global health problem associated with significant morbidity and mortality. Functional assessments such as the “5-repetition sit-to-stand test (5STS)” may serve as accessible tools to estimate disease severity, especially in resource-limited settings. This study assesses the relationship between the 5STS and the Borg dyspnoea scale, along with the GOLD spirometric classification, in Indian patients diagnosed with COPD. Methods: In this cross-sectional study, 71 stable COPD patients from a tertiary care center in Mumbai were evaluated. Participants underwent spirometry, 5STS, and dyspnoea assessment using the modified Borg scale. Patients were also classified according to the GOLD spirometric classification. Statistical correlations and comparisons were performed using Spearman’s correlation, ANOVA, and post-hoc Tukey tests. Results: Participants had a mean age of 65.7 ± 8.3 years, with males comprising 80.3% of the study population. The mean 5STS completion time was 14.98 ± 3.64 seconds. The 5STS demonstrated a strong positive correlation with the Borg dyspnoea scale (r = 0.857, p < 0.001). ANOVA revealed significant differences in 5STS times across GOLD spirometric categories (p < 0.001). Cronbach’s alpha demonstrated high reliability of 5STS in reflecting symptom severity (0.829). Conclusion: The 5STS test shows a strong correlation with established COPD severity indices and is a reliable, inexpensive, and rapid assessment tool. It holds potential as a surrogate marker for disease severity in resource-constrained settings.
Chronic obstructive pulmonary disease, 5-Repetition sit-to-stand test, Borg dyspnoea scale, GOLD spirometric classification, Functional exercise capacity.
Phantom Tumor of the Lung: A Radiological Masquerader of Pulmonary Mass Lesion
Background: Phantom tumor, also referred to as a vanishing tumor or pseudotumor, is a rare radiological entity characterized by localized transudative pleural fluid accumulation within a pulmonary fissure, most often associated with congestive heart failure. Its mass-like appearance on chest radiographs can closely mimic pulmonary neoplasms, potentially leading to unnecessary diagnostic procedures if unrecognized. Case Presentation: We describe a 68-year-old male with a history of ischemic heart disease who presented with acute-onset breathlessness, orthopnea, and bilateral pedal edema. Chest radiography revealed a well-defined, homogeneous opacity in the right mid-zone, raising suspicion of encysted pleural effusion within the horizontal fissure. Electrocardiography demonstrated tachycardia with a right bundle branch block, while echocardiography revealed severe left ventricular systolic dysfunction. Following initiation of intravenous diuretic therapy for decompensated heart failure, repeat chest radiography subsequently showed complete resolution of the opacity, confirming the diagnosis of a phantom tumor. Conclusion: Phantom tumor should be considered in elderly patients with congestive heart failure presenting with fissural opacities on chest radiographs. Rapid radiological resolution after diuretic therapy is pathognomonic and aids in avoiding unnecessary investigations and interventions.
Phantom tumor, Interlobar effusion, Congestive heart failure.
Treatment Outcome Analysis of Drug-Sensitive Pulmonary and Extrapulmonary Tuberculosis Among HIV Positive and HIV Negative Patients and their Correlation with CD4 Counts
Background: WHO guidelines recommended daily therapy in HIV-TB co-infected individuals. The study was aimed at comparing treatment outcomes of standard drug-sensitive anti-tuberculosis regimen in HIV seropositive and HIV seronegative patients with tuberculosis and their correlation with CD4 counts. Material & methods: The present observational and prospective study of 236 HIV-negative and 154 HIV-positive patients was conducted over two years. All the patients included in the study were reviewed regularly to enquire the compliance, symptom improvement and outcome analysis. Results: Among HIV-negative patients, pulmonary TB was more common, while among HIV-positive patients, extrapulmonary TB was observed more frequently. Notably high treatment success rate (82.6 vs. 65.5% at the end of treatment, p-value 0.002) and low mortality rate (8.0 vs. 20.1%, p-value 0.002) were observed among HIV-negative patients. Higher CD4 counts among HIV-positive patients was found to be noteworthy after 6 months treatment (194.85 vs. 288.18, p <0.001). Those HIV individuals who died had inadequate improvement in CD4 counts. Conclusions: Overall, HIV negative patients did better on the daily DOTS regimen than HIV positive patients in terms of treatment completion and success rates, treatment failure as well and mortality. Improvement in CD4 counts after treatment was statistically significant and indicates the effectiveness of combined ART and DOTS in tuberculosis treatment.
Tuberculosis, HIV infection, Treatment outcome.
Isolated Primary Tuberculosis of the Pectoralis Major Muscle
Skeletal muscle tuberculosis is an extremely rare form of extrapulmonary TB, accounting for <1% of all cases, even in TB-endemic countries. We present the case of a 45-year-old female with isolated involvement of the right pectoralis major muscle, presenting as a painful, gradually enlarging anterior chest wall swelling. Computerized tomography scan revealed a soft tissue lesion within the muscle, and fine needle aspiration cytology from the lesion confirmed tuberculosis with granulomatous inflammation and acid-fast bacilli. The patient responded completely to standard anti-tuberculosis therapy. This case highlights the importance of considering tuberculosis in the differential diagnosis of soft tissue swellings at any site of body in endemic areas.
Tuberculosis, Muscular TB, Pectoralis major, Extrapulmonary TB, Chest wall swelling.
A Challenging Case of Ethambutol-Induced Optic Neuritis Manifesting with Perioptic Cystic Changes Diagnosed by Optic MRI
A 51-year-old female with a diagnosed case of Pott’s spine has been on regular antitubercular treatment for the last 9 months and presented with complaints of progressive blurring of vision for the past 3 months. Ophthalmological examination revealed decreased visual acuity and bilateral retro-orbital pain on gentle compression of the eyeballs. This case highlights the role of MRI in the early detection of optic neuritis and demonstrates that early discontinuation of ethambutol can lead to favourable outcomes by preventing irreversible optic nerve damage.
Tuberculosis, Optic neuritis, Ethambutol, Pott’s Spine, Adverse drug reaction.
Deep Vein Thrombosis, Pulmonary Thromboembolism, and Pulmonary Infarction: All in one in a Young Male Patient with Pulmonary Tuberculosis
Pulmonary tuberculosis (PTB) is a known pro-inflammatory state that can predispose individuals to thromboembolic events. We present an uncommon case of a young male with active PTB who developed deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), and pulmonary infarction as complications during the disease course. This case underscores the critical need for prompt identification of thromboembolic events in patients with tuberculosis, the diagnostic value of Doppler and CT pulmonary angiography, and the successful use of anticoagulation alongside modified ATT in achieving favourable outcomes.
Pulmonary tuberculosis, deep vein thrombosis, pulmonary thromboembolism, pulmonary infarction, hypercoagulability, anticoagulation, CT pulmonary angiography, Doppler ultrasound, ATT modifications, venous thromboembolism.
When Bullae Deceive: A Rare Case of Vanishing Lung Syndrome Misdiagnosed as Pneumothorax
Background: Vanishing lung syndrome (VLS), also referred to as giant bullous emphysema, is an uncommon form of lung disease in which massive bullae replace a substantial portion (typically more than one third) of the hemithorax, leading to compression of surrounding healthy lung tissue. It typically occurs in young male smokers but may also arise in non-smokers with biomass exposure, making diagnosis and management particularly challenging. Case Presentation: We describe a case involving a 51-year-old non-smoking woman with long-term exposure to biomass fuel, who presented with dry cough, chest discomfort, and gradually worsening shortness of breath. An initial chest X-ray was interpreted as a left-sided pneumothorax, for which an intercostal chest drain was placed; however, clinical and radiological improvement was not achieved. Subsequent high-resolution computed tomography revealed a large emphysematous bulla occupying the left lower lobe and causing a contralateral mediastinal shift, findings consistent with vanishing lung syndrome. The patient underwent successful surgical management via left posterolateral thoracotomy and bullectomy, resulting in marked clinical improvement. Conclusion: This case highlights the critical need to distinguish vanishing lung syndrome from pneumothorax, particularly in individuals with non-traditional risk factors like prolonged biomass smoke exposure. Early recognition and surgical intervention can lead to substantial symptomatic and functional recovery.
Vanishing lung syndrome, Pneumothorax, Mimic, Giant bullous emphysema, Biomass exposure, Bullectomy, Hyperlucent lung.
Immotile cilia syndrome is a hereditary condition resulting in defective ciliary movement or complete ciliary immobility within the airways and other bodily regions. Kartagener syndrome is a specific subset of immotile cilia syndrome, distinguished by situs inversus viscerum. The characteristic triad of Kartagener syndrome includes bronchiectasis, situs inversus, and chronic sinusitis. This report presents an atypical case of immotile cilia syndrome in a female aged 38 years with infertility. The diagnosis was established upon a recurrent respiratory tract infection history and radiographic evidence of maxillary sinusitis, bronchiectasis, dextrocardia, and situs inversus. She had been unable to conceive despite 18 years of marriage, indicating possible infertility due to this. She was treated symptomatically with adequate medical management.
Immotile cilia syndrome, Bronchiectasis, Infertility.
Unilateral lung agenesis is an uncommon developmental anomaly stemming from the incomplete formation of the primitive lung bud. Its manifestation and onset vary widely, from asymptomatic instances to diagnoses in adulthood prompted by recurring respiratory infections. Roughly half of these cases coincide with other congenital anomalies. A 23 years female diagnosed as a case of treated pulmonary tuberculosis with right fibrocavitatory disease on the basis of chest x-rays despite negative smear microscopy of sputum for acid-fast bacilli (AFB) referred to us with a complaint of shortness of breath on exertion. She was evaluated further and on contrast, enhanced CT chest (CECT) was detected to have right lung agenesis, which was confirmed on fiber optic bronchoscopy.
Patterns of Drug-Resistant Tuberculosis in Smear Positive PulmonaryTubercular Patients Taking Drug Sensitive Anti-TubercularMedications under the DOTS or Non-DOTS Category at the TertiaryCare Hospital in Western Uttar Pradesh State
Introduction: More than half of patients with tuberculosis in India are cared for in the non-government sector. The use of inappropriate tuberculosis (TB) diagnostic and treatment measures is still seen among patients getting treatment with private practitioners, which may contribute to the problem of controlling TB and may lead to the development of resistant TB strains. Objective: To study and compare patterns of drug-resistant tuberculosis (DR-TB) among those receiving drug-sensitive tuberculosis (DS-TB) regimens among within-DOTS and outside-DOTS cohorts. Materials and Methods: Prospective observational type study, performed at the tertiary care center (Agra), on patients of eligible category. Rapid molecular diagnostic-based drug resistance testing and drug susceptibility testing (DST) of colonies grown in liquid culture media were conducted on sputum specimens. Results: RR, MDR, Pre-XDR and XDR rates are higher in the outside-DOTS cohort (i.e., those patients under the care of private practitioners on one or the other DS-TB regimen), while H mono/poly resistance pattern is higher in within-DOTS cohort (i.e., those patients under the care of the government DS-TB regimen under NTEP). The overall prevalence of DR-TB is higher among those outside the DOTS category than within the DOTS category. Conclusion: The overall prevalence of DR-TB with Pre-XDR and XDR forms of DR-TB is more in outside DOTS than within the DOTS cohort and further studies to suggest better policies in public-private partnerships to achieve the goal of tuberculosis elimination.
Tuberculosis, Rifampicin resistance, Tuberculosis elimination.
Subcutaneous Emphysema Manifesting with Ginkgo Leaf Sign
Assessing the Impact of Nutrition Status as a Prognostic Factor in the Outcome of NIV therapy in Patients of Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Introduction: Chronic obstructive pulmonary disease (COPD), a progressive and irreversible lung condition, poses a significant global health burden, especially due to acute exacerbations (AECOPD). A crucial technique for treating AECOPD, reducing the need for invasive mechanical ventilation, and enhancing patient outcomes is non-invasive ventilation (NIV). However, malnutrition, common in COPD patients, can affect the success of NIV. This study highlights the influence of nutritional status (BMI) on the outcome of NIV in AECOPD patients. Methods: Patients with severe AECOPD and respiratory acidosis who were admitted to the Respiratory Medicine Department’s High Dependency Unit (HDU) and receiving NIV were subjects of the current cross-sectional and observation study. The sample size of the study population was 71. Patients were categorized on the basis of body mass index (BMI) into various groups, along with their clinical outcomes, (SpO2, pH, pCO2, and HCO3- levels at t0, 24, 48, and 72 hours) as well as the duration of hospital stay (days) were recorded after NIV application. Statistical analysis was performed to determine associations between BMI and clinical outcomes. Results: The study population exhibited a mean age of 63.10 years, with 68.6% males. Significant improvements in SpO2, pH, PaCO2 and HCO3- levels were observed across all BMI groups. The greatest SpO2 changes were seen at discharge, with 57.3% in underweight, 57.8% in normal weight, 33.1% in overweight, and 67.8% in obesity. The normal weight group showed the most rapid and consistent pH and HCO3- improvements (max. 2.1 and -28.1%, respectively), while PaCO2 decreased the most in normal weight (-45.6%). BMI didn’t significantly influence the duration of hospital stay (p = 0.387). Conclusion: Nutritional status, as assessed by BMI, influences the clinical outcomes in AECOPD patients undergoing NIV, showed significant improvements in SpO2, pH, PaCO2, and HCO3- levels across all BMI groups suggested that NIV therapy was effective regardless of BMI. The normal weight and underweight groups exhibited the fastest improvements, while the overweight and obesity groups showed delayed but substantial changes by discharge. Despite these differences, BMI did not significantly influence the overall SpO2 trajectory (p >0.005) and the duration of hospital stay (p = 0.387).
Chronic obstructive pulmonary disease, Acute exacerbation of chronic obstructive pulmonary disease, Non-invasive ventilation, Body mass index, Arterial blood gas, High dependency unit.
Giant Mediastinal Teratoma Presenting with Recurrent Pleural Effusion and Respiratory Distress: A Case Report and Literature Review
Mediastinal teratomas are rare germ cell neoplasms with an enigmatic histogenesis, harbouring tissues from all three embryonic germ layers. While predominantly gonadal in origin, their extragonadal manifestation in the mediastinum is an infrequent yet clinically significant anomaly. Most remain quiescent, detected incidentally, yet expansive lesions may exert profound mass effects, precipitating respiratory distress, dysphagia, and pleural effusions. In rare instances, rupture into the pleural or pericardial cavity can provoke life-threatening sequelae. We report the case of a 15-year-old female presenting with acute respiratory distress and a prior episode of spontaneous resolution. Imaging unveiled a voluminous anterior mediastinal mass exerting significant compression on adjacent structures, culminating in passive lung collapse. Surgical excision, though intricate due to extensive adhesions, was successfully accomplished. Postoperatively, the patient exhibited persistent partial lung collapse, necessitating intensive pulmonary rehabilitation. Histopathological analysis confirmed a benign cystic mature teratoma. This case underscores the criticality of early detection and surgical intervention in preventing catastrophic complications. Given their potential for malignant transformation and mass effect-related morbidity, mediastinal teratomas warrant vigilant clinical surveillance.
Germ cell tumor, Mediastinal teratoma, Benign mature cystic teratoma.
High-Flow Nasal Cannula (HFNC): An Advanced Respiratory Support System
High-Flow Nasal Cannula (HFNC) therapy has revolutionized oxygen delivery by providing heated, humidified oxygen at high flow rates, offering significant advantages over conventional oxygen therapy (COT) and non-invasive ventilation (NIV). Originally developed for neonates, HFNC is now widely used in adult respiratory care, particularly in managing acute respiratory failure and post-COVID-19 complications. It improves oxygenation, reduces work of breathing, and enhances patient comfort. Despite its higher cost and some limitations, HFNC has proven to be an effective and well-tolerated modality in various clinical scenarios, with ongoing research exploring its full potential.
Silicotuberculosis – An Updated Overview
Purpose of Review: This review focusses on the burden of the problem of silicotuberculosis, clinical scenario and challenges encountered in its management. Recent Findings: In accordance to the Indian Council of Medical Research (ICMR), approximately 3.0 million workers are at high risk of silica exposure; of these, 1.7 million work in mining or quarrying activities, 0.6 million in non-metallic product manufacturing (such as refractory products, structural clay, glass, and mica), and 0.7 million in the metals industry. In addition, over 5.3 million construction workers are in danger of silica exposure. Because of differences in silica concentrations and duration of exposure in the workplace, the reported prevalence of silicosis and silico-TB in India varies greatly. Summary: Silicotuberculosis, a condition where tuberculosis develops as a complication of silicosis, underscores a critical public health concern, particularly prevalent in low- and middle-income countries where prolonged exposure to crystalline silica particles is widespread. This exposure heightens the vulnerability of workers to tuberculosis infection, exacerbating the already substantial burden of both diseases. Management of silicotuberculosis involves a multifaceted approach. These strategies include controlling silica dust exposure, ensuring continuous TB treatment, implementing occupational health management by professionals and policy making by the government.
Silicotuberculosis, Public health concern, Silica particles.
Adverse Drug Reactions in the Treatment of Drug-Resistant Tuberculosis: A Narrative Review
Drug-resistant tuberculosis (DR TB), which includes ‘multidrug-resistant TB’ (MDR TB) and ‘extensively drug-resistant TB’ (XDR TB), is a significant global health challenge. The treatment response and outcomes are even more challenging in regions with high poverty, malnutrition, and high rates of HIV co-infection. Despite advancements in treatment regimens, ‘adverse drug reactions’ (ADRs) are still a critical barrier to treatment success, contributing to non-compliance, regimen modifications, and treatment failure. This review investigates the occurrence, severity, and types of ADRs related to DR-TB treatment, highlighting their impact on patient outcomes. Specific ADRs linked to commonly used second-line anti-TB drugs include peripheral neuropathy, anaemia, and optic neuritis with linezolid; tendinitis with fluoroquinolones; QT prolongation and hepatotoxicity with bedaquiline; skin discoloration with clofazimine; psychiatric disorders and seizures with cycloserine; hypothyroidism, gynecomastia, and gastrointestinal side effects with ethionamide; nephrotoxicity and vestibular toxicity with amikacin/kanamycin; and hypothyroidism and hepatitis with para-amino salicylic acid (PAS). The complexity, cost, and duration of current treatment regimens exacerbate these challenges, undermining the WHO’s target of an 80% treatment success rate. Enhanced pharmacovigilance, patient-centered care, and tailored regimens are crucial to managing ADRs and ensuring adherence to therapy. Developing safer therapies and effective mitigation strategies is crucial for enhancing treatment outcomes for DR-TB and advancing global initiatives to control and eradicate tuberculosis.
Adverse drug reactions, Drug resistance, Tuberculosis.
Chilaiditi’s Sign in a Silicosis Patient
Chilaiditi’s sign is a rare radiological phenomenon where the transverse colon interposes between the liver and the right hemidiaphragm. Described in 1910, this is typically asymptomatic but can mimic conditions like pneumoperitoneum. Diagnosis is made through imaging, with CT being the gold standard. While asymptomatic cases require no treatment, symptomatic cases may need conservative care or, rarely, surgery. This communication describes incidental findings of Chilaiditi’s sign on a chest x-ray in a patient having a prolonged history of occupational exposure to silica dust. The diagnosis was further confirmed by the CT scan examination. The importance of this phenomenon and awareness of this finding is also stressed among clinicians in their routine practice.
Chilaiditi sign, Chest radiology, Gas under diaphragm, Silicosis
Lobar Agenesis with Cross Ectopic Lung in a Middle-Aged Male Masquerading Sequels of Pulmonary Tuberculosis: Extremely Rare and Challenging Case for Clinician
Pulmonary agenesis is a rare congenital anomaly. It usually presents in childhood with high mortality due to the involvement of other systems of the body. Here, we report a case of a 53-year-old male presented with left upper lobe pulmonary type 2 lobar agenesis complicated with recurrent pulmonary infection masquerading sequels of pulmonary tuberculosis.
Agenesis, Aplasia, Congenital anomaly, Lung.
Bilateral Tubercular Mastitis: A Rare Entity
Bilateral involvement of the breast in tuberculosis is rare. We present a case involving a young multiparous woman with microbiologically confirmed secondary tuberculosis affecting both breasts. The patient showed improvement with anti-tuberculous treatment and needed only minimal surgical intervention.
Tubercular mastitis, Breast tuberculosis, Secondary, Bilateral.
Alveolar Concretions (Microlithiasis): A Review Article on Lung Involvement
Alveolar concretions or also known as pulmonary alveolar microlithiasis (PAM), a disease with variable inheritance. This disease is very rare and this article represents work on PAM till end of the December 2023 by means of a full reviewing the total articles and case reports from available literature. A total of more than 1100 cases of PAM have been reported worldwide. Turkey, Chinese, Japanese, Indian, Italian populations accounting approximately 52.4% of total cases worldwide. Clinical features of PAM family history, clinical course, genetic association, prognosis and recent advancement in diagnosis and treatment have all been analyzed from all case reports and available review articles.
Pulmonary alveolar microlithiasis, SLC34A2, Sandstrom appearance, Stony lung, Rare lung disease.
Outcome Analysis of Shorter Regimen of Rifampicin Resistant Tuberculosis
Introduction: Globally, about half a million new cases of rifampicin-resistant TB (RR-TB) were found in 2019. Out of them, 78% had confirmed multidrug-resistant tuberculosis (MDR-TB). In the year 2020, a total of 18,05,670 TB cases were notified. Out of these, 49,679 were diagnosed as MDR/RR TB patients. Management of drug-resistant TB requires a longer duration of treatment with second-line anti-TB drugs that cause more side effects. WHO introduces the shorter regimen for RR-TB with a total duration of 9-11 months consisting of 4 to 6 months of intensive phase and 5 months of continuation phase. Aim and material & method: This is an observational study conducted on 129 patients of rifampicin-resistant tuberculosis admitted at the PMDT site at the Department of Respiratory Medicine from July 2018 to October 2020 to assess treatment outcomes of shorter regimens in RR-TB. Approval from the ethical committee was obtained. Result and conclusion: A favorable outcome was observed in 52.7% of patients; however, 51.12% of patients experienced at least one side effect. Treatment outcome was not affected in patients with HIV and a past history of anti-TB drugs. Diabetic patients were more likely to have treatment failure than non-diabetic patients. (p-value <0.005).
Tuberculosis, Rifampicin-resistance, Shorter regimen.
Pattern of Infection in Patient Admitted in Respiratory High Dependency Unit at Tertiary Care Hospital
Introduction: Respiratory infections remain a leading cause of morbidity in hospital settings, particularly in respiratory high-dependency care units (RHDCUs). Patients admitted to RHDCUs are highly vulnerable to bacterial and fungal infections due to weakened immune systems and co-existing respiratory conditions. This study focuses on identifying infection patterns and antibiotic resistance in RHDCUs. Objective: The study aimed to evaluate the pattern of infections in patients admitted to a tertiary care hospital’s RHDCU and assess the antibiotic sensitivity of isolated organisms. Methods: A prospective study was conducted on 180 patients admitted to the RHDCU with respiratory symptoms indicative of infection. Biological samples, including sputum and blood, were analyzed for bacterial and fungal infections. Bacterial culture, gram staining, and antibiotic sensitivity tests were obtained. Data on patient demographics, clinical presentation, and infection profiles were collected and analyzed using descriptive statistics. Results: Of the 180 patients, Bacterial cultures showed 35.6% of samples to be sterile. Among the rest, the most common organisms isolated were Pseudomonas aeruginosa (24.4%), Klebsiella oxytoca (12.2%), and Escherichia coli (10%). Gram-negative bacilli were present in 64.4% of cases. Antibiotic sensitivity results revealed high resistance to ceftazidime (39.4%) and doxycycline (36.1%), while gentamicin showed the lowest resistance (22.2%). Conclusion: The findings highlight the prevalence of gram-negative bacterial infections in RHDCUs, with P. aeruginosa being the most frequent pathogen. The large-scale antibiotic resistance observed emphasizes the need for tailored antimicrobial therapy and stringent infection control practices to improve patient outcomes.
Respiratory infections, RHDCU, Antibiotic resistance, Pseudomonas aeruginosa, Gram-negative bacilli, Ceftazidime, Gentamicin.
The azygos lobe, an uncommon anatomical variation in the right lung that was initially described by Heinrich Wrisberg in 1877, presents a unique structural anomaly that challenges both radiological interpretation and surgical intervention. Unlike true accessory lobes, it lacks an independent bronchus and vascular supply, arising instead from an aberrant course of the azygos vein during embryogenesis. This deviation leads to the formation of the azygos fissure, a distinctive pleural separation composed of four layers. While typically asymptomatic, the azygos lobe holds significant clinical relevance, often mimicking pathological conditions such as pneumothorax or pulmonary bullae on imaging. High-resolution computed tomography (HRCT) enhances its visualization, distinguishing it from disease processes that may prompt unnecessary interventions. Surgically, its presence alters thoracic anatomy, complicating procedures such as video-assisted thoracic surgery (VATS) and lung resections. Despite these challenges, malignancies confined to the azygos lobe have been successfully managed with minimally invasive techniques. This comprehensive review delves into the embryology, anatomy, radiology, clinical implications and surgical considerations of the azygos lobe, underscoring its importance in both diagnostic accuracy and operative planning.
Azygos lobe, Azygos vein, Azygos fissure
Clinical and Radiological Profile of Pulmonary Tuberculosis Among Patients Having Occupational Exposure to Silica Dust: An Observational Study
Background: Silicotuberculosis, a condition where tuberculosis develops as a complication of silicosis, is a critical public health concern, particularly prevalent in low- and middle-income countries where prolonged exposure to crystalline silica particles is widespread. This dual impact amplifies the complexity of managing these conditions, posing significant challenges for healthcare systems. By leveraging a combination of radiographic techniques and clinical expertise, healthcare providers can optimize the diagnostic process, enabling timely intervention and improving outcomes for individuals affected by silicosis-associated tuberculosis. Material & Methods: A hospital-based prospective observational study was done over 18 months with 65 TB patients having occupational exposure to silica dust, who have met the inclusion and exclusion criteria, were included in the study. A detailed demographic, occupational and clinical history were recorded for these patients and all were subjected to chest x-ray imaging to assess their radiological profile. Results: Among the TB patients with occupational silica dust exposure, the mean age of distribution was 43.56 ± 12.5 years with a greater number of patients between the 31 to 40-year age group (32.3%), males more in proportion (97%) with more population from a rural background (95.4%), about 62% study population belongs to upper lower socioeconomic status. The most common type of occupational exposure was seen in stone drilling (32.3%) and a majority of the patients (47.6%) had duration of exposure >10 years. The most common symptoms experienced by these patients were cough (96.9%) along with fever (90.8%), and shortness of breath (90.8%). Among the clinical signs, pallor (43.1%) and pedal edema (32.3%) were predominantly exhibited by these patients. Among the study population, most patients predominantly exhibit bilateral lung disease (92.3%), with a significant proportion having cavitary disease (60%). Moderate and far advanced disease was more common (46.1% moderate and 43.1% far advanced) in these patients. Conclusion: A comprehensive, multifaceted approach is needed to better manage TB in the context of occupational silica exposure, which includes active surveillance for early TB detection in individuals with silicosis, and the development of enhanced diagnostic methods.
Obstructive Sleep Apnea and Chronic Pulmonary Diseases: Hidden Associate?
Tuberculosis and Pregnancy: Present Status
Tuberculosis (TB) remains a significant global health concern, particularly in pregnant women, where it poses serious risks to both maternal and fetal health. The physiological and immunological changes during pregnancy can alter TB presentation, leading to delayed diagnosis and increased complications. This review explores the epidemiology, pathophysiology, clinical manifestations, and diagnostic challenges of TB in pregnancy. Special emphasis is placed on the safety and efficacy of anti-tubercular therapy (ATT), drug interactions, and potential teratogenic effects. We also discuss the impact of TB on pregnancy outcomes, including preterm birth, low birth weight, and perinatal transmission. Management strategies, including screening protocols, and treatment modifications, are reviewed in light of current guidelines. Given the rising burden of TB in endemic regions, a multidisciplinary approach involving obstetricians, pulmonologists, and infectious disease specialists is essential to ensure optimal maternal and fetal outcomes.
Tuberculosis in pregnancy, Maternal TB, Extrapulmonary TB in pregnancy, Perinatal tuberculosis, TB and HIV in pregnancy, The impact of pregnancy on TB, Anti-tubercular therapy (ATT), Drug-resistant TB, TB and fetal outcomes, TB screening in pregnancy, Maternal-fetal complications, TB treatment guidelines India.