Comparison of Clinical, Radiological and Laboratory Parameters Between Elderly and Young Patient With Newly Diagnosed Smear Positive Pulmonary Tuberculosis: A Hospital-Based Cross Sectional Study.

Introduction To compare clinical, radiological and haematological manifestations among newly diagnosed smear positive tuberculosis patients between Group I (Elderly >60 yrs) and Group II (Younger age between 13 and 60 years). Methodology This was a hospital-based cross-sectional study conducted at the out-patient department of pulmonary medicine, between March 2014 and December 2017. There were 61 patients in Group I (Elderly > 60 yrs) and 110 patients in Group II (Younger age between 13 and 60 years). Continuous variables were compared using student's t-test and Mann-Whitney test. Chi square test and Fischer test was used for analysing categorical variables. All statistics were two-tailed, and a p-value of 0.05 was considered to be statistically significant. Results The mean age for Group I (Elderly >60 yrs) was 65 ± 2 years and for the Group II (Younger age between 13 and 60 years) was 40 ± 1 years. There was a statistically significant association of cavitation with infiltrates (p = 0.007) in younger age group. Bilateral multiple zone (48, 64.86%) involvements were commonly observed in both the age groups. There was no significant difference between two groups with regard to haematological and clinical parameters. Conclusion We did not find any difference in the presentation of tuberculosis in both the groups. Radiologically, there was more of cavitating lesion in younger age group. So, they should be isolated and followed up at regular intervals.

Pulmonary Manifestations in Systemic Sclerosis: Hospital-Based Descriptive Study.

Introduction Prevalence of systemic sclerosis (SSc)-related organ injury is difficult to estimate as it occurs early in SSc, even though patients are often asymptomatic. As the patients with organ damage have a poor prognosis, all the patients should be carefully evaluated and followed­up in the initial periods. This facilitates the early identification and initiation of appropriate therapy. This study emphasizes on different clinical manifestations and early predictors of lung involvement by using clinical, radiological, and pulmonary function tests in a tertiary care centre.   Materials and methods A total of 53 SSc cases, who satisfied American College of Rheumatology (ACR) 2013 criteria, without any overlap syndromes were included in the study. All patients underwent thorough clinical examination along with Modified Rodnan Scoring (MRS) assessment, nailfold capillaroscopy (NFC), chest X-ray (CXR), HRCT thorax, 2D-echocardiography, spirometry and diffusion lung study by carbon monoxide (DLco). Results Out of 53 patients, four were male and 49 were female. Twenty-one patients had limited SSc (lcSSc) and 32 had diffuse SSc (dcSSc). Eighty-three per cent of subjects presented with skin manifestations and 34% with respiratory complaints. Reticulonodular opacities and ground glassing were the predominant radiological abnormalities suggestive of non-specific interstitial pneumonia (NSIP) followed by usual interstitial pneumonia (UIP). Pulmonary hypertension was predominant in patients with lcSSc. Thirty-eight patients had a restrictive pattern of spirometry. Forty-four patients showed deranged DLco, among which two patients showed an isolated decrease in DLco. Thirty-seven patients had abnormal NFC among which dropout pattern was predominant. MRS was significantly correlated with pulmonary involvement by DLco and HRCT. Conclusions SSc can affect the lungs even before developing obvious clinical pulmonary manifestations. DLco and HRCT play a critical role in detecting early lung involvement and predicting the outcomes in SSc. Higher modified Rodnan's score, which has a significant correlation with DLco and HRCT can be used to predict early visceral involvement in resource-limited settings.

Same-day Smear Method Compared with Conventional Sputum Method for Diagnosing Pulmonary Tuberculosis.

Background Patient compliance with the two-day Revised National Tuberculosis Control Programme's (RNTCP) diagnostic process for pulmonary tuberculosis (TB) is poor in high case load settings, with a high dropout rate observed on the second day. Hence, the World Health Organization (WHO) has recommended the same-day (spot-spot) sputum test for high-burden TB countries to help reduce diagnostic dropouts. This study addresses the paucity of comparative data on the accuracy and agreement of the two methods, while the WHO recommendations are yet to be implemented by the RNTCP. The objective of this study was to assess and compare the smear positivity rates of the same-day and conventional sputum examination methods for the diagnosis of sputum smear-positive pulmonary TB. Methodology We conducted a cross-sectional, analytical, nonrandomized comparative study on presumptive TB patients attending a designated microscopy center in a tertiary care hospital. Three sputum samples were collected: a first spot, a second spot (one hour after the first spot), and an early morning sample taken on the following day. The first and the second spot samples taken one hour apart were included for microscopic analysis. The conventional (i.e., two-day sputum) method used the first spot and the early morning sputum sample taken on the following day. A positive result from any one of the three sputum samples was recorded as a proven TB case. We then compared the results of the smear microscopy obtained by the two methods. Results The same-day sputum microscopic method diagnosed 181 out of a total 189 TB cases. The conventional method diagnosed 188 cases. Thus, same-day sputum microscopy missed eight cases, whereas the conventional method missed only one case. The sputum positivity rate was 18.8% in the same-day sputum microscopy samples and 19.5% in the conventional method samples. The incremental yield of the second sputum sample in the same-day (second spot) sample was five cases (2.7%). In the conventional method (early morning sample), the yield was 12 cases (6.3%). The sensitivity of the same-day microscopy and conventional methods were 95.76% and 99.5%, respectively. Conclusion The conventional method of diagnosing sputum-positive pulmonary TB had more sensitivity compared to the same-day sputum microscopy approach.

Cytodiagnostic aspects of bronchioloalveolar carcinoma manifesting with small cell morphology on respiratory specimens: a case report.

BACKGROUND: Exfoliation of bronchioloalveolar carcinoma (BAC) cells with small cell morphology in respiratory specimens can cause a diagnostic dilemma, particularly in patients with a history of bronchorrhea. CASE: A 59-year-old man presented with cough, breathlessness, and bronchorrhea. Clinically, he was diagnosed to have right-sided pulmonary consolidation. His sputum and bronchial washing specimens examined on multiple occasions revealed a varied number of single and loose aggregates of atypical cells, along with rare micropapillary and glandlike structures. The cells were small, round, and fairly monomorphic with a high nucleus to cytoplasm ratio and scant to moderate cytoplasm. Chromatin was uniformly distributed, with no appreciable nucleoli. At places, a vague nuclear molding was noted. Clinically, bronchorrhea and the diffuse infiltrative nature of the lesion favored BAC. Cytologically, prominent small cell morphology and nuclear molding suggested a possibility of small cell neuroendocrine tumor. However, careful cytologic examination of subsequent respiratory samples and biopsy revealed features of a nonmucinous type of BAC. CONCLUSION: Despite the small cell morphology of neoplastic cells on exfoliative respiratory cytology, a clinical history of bronchorrhea should prompt a cytodiagnosis of BAC. A glandlike arrangement of cells and greater amount of cytoplasm should also assist avoiding misinterpretation in such instances.

Fine needle aspiration of follicular variant of papillary thyroid carcinoma presenting with pleural effusion: a case report.

BACKGROUND: Malignant pleural effusion in association with mesothelioma, bronchogenic carcinoma and breast carcinoma is common, although less frequently reported with other malignancies. We report a follicular variant of papillary thyroid carcinoma (FVPTC), diagnosed on fine needle aspiration cytology (FNAC) of thyroid and lymph nodes and subsequently proved to have metastasized to the pleural cavity. CASE: A 46-year-old man presented with history of breathlessness, thyroid swelling, pleural effusion and bilateral cervical lymphadenopathy. FNAC of the thyroid swelling and the lymph nodes showed features of FVPTC with cervical lymph node metastasis. Pleural fluid examination led to suspicion of pleural involvement by metastatic deposit, confirmed by subsequent pleural biopsy. CONCLUSION: Thyroid malignancies presenting with pleural effusion are rare. In this case, although pleural fluid cytology suggested involvement of pleura, a definitive diagnosis could be rendered only on pleural biopsy. An ancillary aid, such as immunocytochemistry, could have helped establish pleural involvement on routine pleural fluid cytology alone. This case emphasizes the possible existence of rare cases of FVPTC that may be associated with a dismal prognosis. In our case, initial diagnosis of FVPTC could be made only on correlating FNA features of thyroid aspirate with those of lymph node aspirate.