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)
A Study of Functional Changes of the Right Heart in Patients of COPD Acute Exacerbation with Respiratory Failure
Background: Chronic obstructive pulmonary disease (COPD) is a common and treatable disease characterized by progressive airflow limitation and tissue destruction. COPD has considerable effects on cardiac functions, primarily by affecting the pulmonary vasculature and then the right ventricle, along with the left ventricle. During acute exacerbations, hypoxemia and hypercapnia may contribute to pulmonary hypertension and right ventricular (RV) dysfunction, which adversely affect prognosis. Methods: A prospective observational study was conducted on 61 patients admitted with acute COPD exacerbations to the respiratory intensive care unit (ICU) over a period of 6 months at a tertiary care hospital. After applying exclusion criteria, 56 patients were included. All underwent arterial blood gas (ABG) analysis, spirometry, and transthoracic echocardiography to assess RV systolic pressure (RVSP), pulmonary artery systolic pressure (PASP), right atrial size, RV ejection fraction (EF), fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE). Clinical status was assessed with the modified Medical Research Council (mMRC) scale, COPD assessment test (CAT), BODE index, and GOLD ABCD tool. Results: Severe COPD patients exhibited higher PaCO₂ (72.6 ± 5.3 vs. 55.2 ± 3.5 mmHg), lower PaO₂ (56.5 ± 2.96 vs. 64.2 ± 4.6 mmHg), increased right atrial area (33.3 ± 6.5 vs. 21.5 ± 5.2 cm²), and elevated PASP (45.3 ± 3.5 vs.30.2 ± 2.3 mmHg) compared to moderate COPD. TAPSE was reduced, indicating RV dysfunction, and correlated positively with PaO₂ and negatively with PaCO₂. Conclusion: COPD exacerbations were strongly associated with pulmonary hypertension and RV dysfunction. Echocardiographic evaluation of pulmonary pressures and right heart parameters provides essential prognostic information and should be integrated into COPD management.
Copyright (c) 2026 UAPM Journal of Respiratory Diseases and Allied Sciences
The Heterogeneity of COPD: A Comprehensive Review of Clinical Phenotypes
<a href="https://uapmjournal.in/index.php/uapmjrdas/Current understanding of the epidemiology and pathogenesis of chronic obstructive pulmonary disease (COPD) is limited by difficulties in defining and classifying the different phenotypes that make up this complex group of disorders. COPD is a multi-factorial and heterogeneous disease and not every patient responds to all available drugs. In order to approach this heterogeneity, an attempt to group patients with similar characteristics that could be associated to a differential clinical outcome has been done by using the term clinical phenotype. Such in-depth phenotyping can pave the way for personalized treatment regimens, ensuring that the most suitable therapies are provided. A phenotype can be broadly defined as ‘any observable characteristic of an organism,’ while a COPD phenotype can be more specifically defined as ‘a single or combination of disease attributes that describe differences between individuals with COPD as they relate to meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death).’ Identifying such phenotypes (also described as phenotypic traits) allows grouping of patients according to their prognostic and therapeutic characteristics. Early classification of the COPD subtype will facilitate superior healthcare provision and early intervention where it is most required. The various phenotypes and associations of COPD that has been recognised in recent literature includes Emphysema phenotype, Chronic Bronchitis, Asthma-COPD overlap phenotype, Frequent Exacerbator phenotype, COPD with Bronchiectasis, Combined pulmonary fibrosis with Emphysema, COPD with Obstructive sleep Apnoea, Tuberculosis associated COPD, Respiratory Bronchiolitis with interstitial disease, HIV associated COPD, Obese COPD, nonsmoker phenotype, etc. In the recent years, clinicians also proved that the heterogeneity of COPD is associated with different clinical outcomes including symptoms, exacerbations, and responses to recommended therapy, decline of lung function and death etc.">Current understanding of the epidemiology and pathogenesis of chronic obstructive pulmonary disease (COPD) is limited by difficulties in defining and classifying the different phenotypes that make up this complex group of disorders. COPD is a multi-factorial and heterogeneous disease and not every patient responds to all available drugs. In order to approach this heterogeneity, an attempt to group patients with similar characteristics that could be associated to a differential clinical outcome has been done by using the term clinical phenotype. Such in-depth phenotyping can pave the way for personalized treatment regimens, ensuring that the most suitable therapies are providChronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition whose epidemiology and pathophysiology remain incompletely characterized, partly due to challenges in accurately defining and classifying its diverse subtypes. COPD arises from multiple interacting factors, and affected individuals show marked variability in clinical manifestations, disease progression, and response to available therapies, making a uniform treatment approach ineffective. To address this variability, the concept of clinical phenotyping has emerged, aiming to categorize patients into subgroups with shared characteristics that are associated with distinct clinical outcomes. Phenotyping provides a framework for understanding disease heterogeneity and supports the implementation of personalized therapeutic strategies. Broadly, a phenotype refers to any observable characteristic of an organism. In COPD, a clinical phenotype is defined as a single feature or a combination of disease-related attributes that differentiate patients in terms of clinically relevant outcomes such as symptom burden, exacerbation frequency, response to treatment, rate of lung function decline, and mortality. Identification of these phenotypic traits enables prognostic stratification and guides targeted management. Early recognition of COPD subtypes may facilitate timely intervention and improved healthcare delivery. Recent literature has identified several clinically relevant phenotypes, including emphysema-predominant COPD, chronic bronchitis, asthma–COPD overlap, frequent exacerbator phenotype, COPD with bronchiectasis, combined pulmonary fibrosis and emphysema, COPD with obstructive sleep apnoea, tuberculosis-associated COPD, respiratory bronchiolitis with interstitial lung disease, HIV-associated COPD, obesity-related COPD, and COPD in non-smokers etc. Emerging evidence indicates that such phenotypic diversity significantly influences symptoms, exacerbation risk, therapeutic response, lung function decline, and survival.ed. A phenotype can be broadly defined as ‘any observable characteristic of an organism,’ while a COPD phenotype can be more specifically defined as ‘a single or combination of disease attributes that describe differences between individuals with COPD as they relate to meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death).’ Identifying such phenotypes (also described as phenotypic traits) allows grouping of patients according to their prognostic and therapeutic characteristics. Early classification of the COPD subtype will facilitate superior healthcare provision and early intervention where it is most required. The various phenotypes and associations of COPD that has been recognised in recent literature includes Emphysema phenotype, Chronic Bronchitis, Asthma-COPD overlap phenotype, Frequent Exacerbator phenotype, COPD with Bronchiectasis, Combined pulmonary fibrosis with Emphysema, COPD with Obstructive sleep Apnoea, Tuberculosis associated COPD, Respiratory Bronchiolitis with interstitial disease, HIV associated COPD, Obese COPD, nonsmoker phenotype, etc. In the recent years, clinicians also proved that the heterogeneity of COPD is associated with different clinical outcomes including symptoms, exacerbations, and responses to recommended therapy, decline of lung function and death etc.
COPD, Clinical phenotypes, Disease heterogeneity.
An Unexpected Twist: Paradoxical Pleural Effusion during Pott’s Spine Management
Paradoxical pleural effusion refers to the appearance or worsening of a pleural effusion during anti-tubercular therapy (ATT), despite initial clinical or radiological improvement. It can manifest as a new or enlarging effusion, often contralateral to the primary disease focus. Paradoxical reactions are well-recognized complications of ATT, most commonly described in lymph node and central nervous system tuberculosis. Paradoxical pleural effusion, particularly in extrapulmonary TB such as spinal disease, is rare and under-reported. We describe the case of a 34-year-old female with thoracic spinal tuberculosis who developed a right-sided pleural effusion three weeks after initiation of ATT, despite a normal baseline chest X-ray. The case emphasizes the importance of recognizing this immune-mediated phenomenon to avoid unnecessary changes in therapy or invasive diagnostic procedures.
Pott spine, Paradoxical response, Anti-tuberculosis therapy.
Bronchoscopy: The Last Hope When Radiology Fails to Illuminate, A Case of Subglottic Stricture
Background: Subglottic stricture is a rare cause of upper airway obstruction in adults and is often misdiagnosed as asthma or chronic obstructive pulmonary disease due to nonspecific symptoms and normal routine imaging. Case Presentation: A 55-year-old female presented with progressive shortness of breath and wheezing for three months. Routine blood investigations, chest radiography, and contrast-enhanced computed tomography of the thorax were unremarkable. Spirometry revealed flattened inspiratory and expiratory limbs on the flow–volume loop, suggestive of fixed airway obstruction, with a reduced FEV₁/FVC ratio and preserved forced vital capacity. Flexible bronchoscopy subsequently demonstrated a subglottic stricture, confirming the diagnosis. Conclusion: This case emphasizes the importance of recognizing spirometric patterns of fixed airway obstruction and the role of bronchoscopy in diagnosing subglottic stricture when routine imaging is normal. Early identification allows appropriate management and improved outcomes.
Excessive Dynamic Airway Collapse: An Unusual Cause of Refractory Cough
Expiratory central airway collapse (ECAC) is characterized by excessive narrowing of the central airways during expiration. Excessive dynamic airway collapse (EDAC), a subtype of ECAC, involves inward bulging of the posterior membranous tracheal wall with preserved cartilaginous rings and its clinical presentation closely mimics asthma and chronic obstructive pulmonary disease. EDAC is frequently underdiagnosed with spirometry and chest imaging and often requires dynamic bronchoscopy, which remains the diagnostic gold standard. We report a 63-year-old non-smoker female with hypothyroidism, treated pulmonary tuberculosis, coronary artery disease status post percutaneous transluminal coronary angioplasty, and obstructive airway disease, who presented with a three-month history of troublesome productive cough, exertional dyspnea (mMRC grade 2). Physical examination revealed bilateral polyphonic wheeze. Spirometry showed a mixed ventilatory defect with moderate obstruction and no reversibility. Despite treatment with bronchodilators and antibiotics, symptoms persisted. High-resolution computed tomography of the chest findings was not helpful in making a sound diagnosis and warranted further evaluation. Cardiac evaluation was normal. Flexible bronchoscopy performed under conscious sedation revealed significant expiratory collapse of the posterior tracheal wall, confirming EDAC. This finding explained the patient’s refractory symptoms and poor response to conventional therapy. Continuous positive airway pressure was initiated as a pneumatic stenting measure, resulting in significant symptomatic improvement. This case shows that dynamic airway disorders should be considered in patients with persistent cough and wheeze, and that bronchoscopy plays a key role in making an early and accurate diagnosis and guiding proper treatment.
Burst or Bluff: A Bulla Masquerading as Tension Pneumothorax in a 2-Year-Old Child
This case highlights the diagnostic challenge of differentiating between a pneumothorax and a congenital pulmonary bulla, particularly in a malnourished paediatric patient presenting with chronic respiratory symptoms. Despite initial management with intercostal drainage under the impression of pneumothorax, the absence of lung expansion prompted further imaging, which confirmed congenital bullous disease. Definitive surgical management with an 80 mm linear stapler resection resulted in marked clinical improvement. Early consideration of bullous lung disease in children with atypical or non-resolving pneumothorax is essential to avoid unnecessary interventions and to ensure timely surgical correction for favourable outcomes.
Giant bullae, Pneumothorax, Linear Stapler Resection
Primary Pulmonary Synovial Sarcoma: A Rare Lung Tumor
Pulmonary synovial sarcoma is an uncommon lung tumour when compared to other lung malignancies. The diagnosis of primary pulmonary sarcoma is usually made after ruling out the common primary lung malignancies and metastatic sarcomas. Metastatic pulmonary synovial sarcoma is more common than primary synovial sarcoma. The usual presentation will be cough, chest pain, breathlessness and radiologically a mass in the lung. Histopathological examination and immunohistochemical staining of the biopsy sample are needed to confirm the diagnosis; if possible genetic study should also be done. Considering the rarity of this tumour, we report a case of a 66-year-old female with a huge right lung mass with ipsilateral pleural effusion, which was diagnosed as primary pulmonary synovial sarcoma by USG-guided lung biopsy.
Treatment Outcomes for Isoniazid-Resistant Pulmonary Tuberculosis Using a Shorter Regimen at a Tertiary Care Centre from the Western Part of India
Background: Drug-resistant tuberculosis has been associated with higher rates of morbidity and mortality. A global total of an estimated 4 lakh people with ‘multidrug resistant/rifampicin resistant’ tuberculosis (MDR/RR-TB) were detected and notified in 2023. In India, 63,929 MDR/ RR TB cases were diagnosed, with 23,019 patients diagnosed with isoniazid (H)-mono/poly drug-resistant tuberculosis (DR-TB). Objective: This study analyses the outcome of ‘Isoniazid Mono Resistance’ Tuberculosis patients and the adverse drug reaction (ADR) among those put on isoniazid (H) mono/poly regimen treatment. Method: ‘Isoniazid-mono-poly’ DR TB regimen duration is 6 to 9 months and started according to drug sensitivity testing (DST) among eligible patients. Follow-ups were done every two months for clinical, bacteriological and radiological parameters. Outcomes observed were cure, treatment completed, treatment failure, died, lost to follow-up, not evaluated, switch to another regimen and transfer out, etc., as per standard protocol. Results: 88 isoniazid-mono/poly patients were enrolled over the last two years. There were 62 male and 26 were females. Outcome for isoniazid mono/poly regimen was cure among 40 (45.5%), treatment completed in 34 (38.6%), lost to follow up in 2 (2.3%), treatment failure in 1 (1.1%), died in 9 (10.2%) and switched to another regimen in 2 (2.3%). The prevalence of katG mutation (High level Isoniazid resistance) was more than inhA (Low level Isoniazid resistance). A more favorable treatment outcome was observed among those with minimal/moderate lung disease compared to those with far advance disease with large cavitation (p = 0.029). This was also in line with better sputum conversion. Conclusion: Treating isoniazid ‘mono-resistant’ TB patients with levofloxacin, rifampicin, ethambutol, and pyrazinamide (LfxREZ) resulted in satisfactory outcomes and low toxicity. Ruling out the isoniazid drug resistance pattern is important for all bacteriologically confirmed TB cases.
Fungal Sensitization in Bronchial Asthma: Epidemiological Insights and Clinical Correlates from an Indian Cohort
Background: Fungal sensitization is increasingly recognized as an important contributor to poor asthma control and disease severity, particularly in patients with severe asthma. Data from Indian populations remains limited, necessitating region-specific epidemiological and clinical insights. Objectives: To determine the prevalence of fungal sensitization in patients with bronchial asthma and to evaluate its association with clinical severity, spirometric parameters, and immunological markers. Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine at a tertiary care center in western India. About 70 diagnosed bronchial asthma patients aged ≥12 years were enrolled. Clinical assessment, spirometry with bronchodilator reversibility testing, skin prick testing for fungal allergens, absolute eosinophil count, and serum IgE levels were performed. Asthma severity scores were correlated with lung function and immunological parameters using appropriate statistical analyses. Results: Fungal sensitization was identified in 11 patients (15.7%). Aspergillus fumigatus was the most common sensitizing fungus (11.43%), followed by Mucor mucedo (5.71%), while no sensitization was observed to several other fungal species. Spirometric indices showed significant improvement post-bronchodilator, confirming reversible airflow obstruction. Fungal sensitization demonstrated a strong positive correlation with asthma severity and an inverse relationship with lung function parameters, particularly FEV₁/FVC. Absolute eosinophil count and serum IgE levels showed significant positive correlations with both fungal sensitization and asthma severity, highlighting an underlying IgE-mediated inflammatory mechanism. Conclusion: Fungal sensitization, especially to A. fumigatus, is present in a significant subset of asthma patients and is associated with increased disease severity and impaired lung function. Early identification of fungal sensitization, along with immunological profiling, may aid in better phenotyping and targeted management of bronchial asthma in the Indian setting.
Psychogenic Cough, Substance Abuse and Intellectual Disability- A Diagnostic Dilemma?
Psychogenic cough, substance abuse, and borderline intellectual functioning are distinct clinical entities that may coexist, complicating diagnosis and management. This case report explores the clinical presentation, diagnostic challenges, and therapeutic approach in an adolescent male exhibiting all three conditions simultaneously, emphasizing the importance of multidisciplinary evaluation.
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
Copyright (c) 2025 UAPM Journal of Respiratory Diseases and Allied Sciences
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.