Comparison of demographic, clinical, spirometry, and radiological parameters between smoking and non-smoking COPD patients in rural Gujarat, India.

CONTEXT: A total of 20% of Chronic Obstructive Pulmonary Disease(COPD) patients are non-smokers due to preventable causes, such as biomass fuel exposure, post tuberculous sequelae, occupational exposure, air pollution, persistent chronic asthma, and genetic predisposition. AIMS: To compare smokers and non-smokers with COPD. SETTINGS AND DESIGN: An observational study was conducted at a tertiary care hospital on 60 patients diagnosed with COPD, (GOLD criteria), who were divided into smoker and non-smoker groups. SUBJECTS AND METHODS: Demographic data, clinical profile, smoking history, and radiological data were collected and compared. Exclusion criteria were individuals having active pulmonary tuberculosis and reversible air flow limitations. STATISTICAL ANALYSIS USED: Using STATA 14.2, quantitative and qualitative data were presented using descriptive statistics. RESULTS: A total of 100% of smokers were male, whereas 70% of non-smokers were female. Compared to non-smokers (16.67%), smokers (26.6%) presented with higher grade of dyspnea. A statistically significant difference was seen with more smokers diagnosed as severe (40%) and very severe (30%) COPD compared to non-smokers with mild (16.67%) and moderate (46.67%) COPD (P < 0.012), Post bronchodilator FEV1 among smokers (42.63) compared to non-smokers (56.63) (P < 0.01) and decrease in FEV1 as the grade of dyspnea increased (P < 0.002). Compared to 36.67% in non-smokers, 70% smokers showed emphysematous x-rays. CONCLUSIONS: In our study we found majority of non-smokers to be female, and smokers had a higher grade of dyspnea, more severe COPD, lower post bronchodilator FEV1, and more emphysematous changes on x-rays.

Evaluation of proficiency in using different inhaler devices among intern doctors.

CONTEXT: Doctors may have deficiencies in the ability to use different inhalers, which in turn, can result in improper technique by the patients and poorly controlled asthma and chronic obstructive pulmonary disease (COPD). AIMS: To evaluate intern doctors' proficiency in using various inhaler devices. MATERIALS AND METHODS: Seventy interns were evaluated for their proficiency in using pressurized metered dose inhaler (pMDI), pMDI with spacer, rotahaler, turbuhaler, and nebulizer. A structured assessment sheet was scored for identification and preparation of device, administration, coordination, and skill of explanation on a scale of 0-5. Common errors such as failure to shake pMDI before use, inability to identify the empty device, inadequate breath holding, and failure to advise gargles after use were recorded. RESULTS: pMDI and pMDI with spacer were identified correctly by 89% and 79% of interns. Over 90% could identify rotahaler and nebulizer whereas only 9% could identify turbuhaler. 79% and 60% could prepare pMDI and pMDI with spacer appropriately. Nebulizer preparation was performed correctly by 79% and almost all interns could not prepare turbuhaler. Only one intern administered turbuhaler correctly. About half of the participants knew the correct co-ordination for pMDI and pMDI with spacer. Two interns showed proper co-ordination in using turbuhaler. None could provide correct explanation for turbuhaler usage; whereas 76% and 70% did it for nebulizer and rotahaler, respectively. Only 43% of interns remembered to shake pMDI before use. CONCLUSIONS: Proficiency in using different inhaler devices amongst interns is poor. It is essential to provide adequate training for inhaler devices usage to medical graduates for proper management of asthma and COPD patients by those future primary care physicians and specialists.

Role of virtual and flexible bronchoscopy in the management of a case of unnoticed foreign body aspiration presented as nonresolving pneumonia in an adult female.

It is not so common to aspirate foreign body in normal adults without any predisposing factors as compared to children and those with the altered neurological state. Endobronchial foreign bodies are one of the causes of obstructive pneumonia and difficult to diagnose as signs and symptoms are often nonspecific. However, once they are diagnosed, they can generally be removed, leading to rapid and drastic resolution of symptoms. Bronchoscopy is the gold standard in the identification and localization of an airway foreign body and also for better management of the ailment. However with the help of virtual bronchoscopy one can decide the location of the foreign body before any invasive intervention and being noninvasive it can be performed in follow-up easily to check the patency of airways. It is not possible to detect the exact size of foreign body with the virtual bronchoscopy. In this article, we report a case of unnoticed foreign body aspiration in a 49-year-old female patient who was initially treated for pneumonia. However, due to nonresolution of opacity contrast enhanced computed tomography thorax with virtual and flexible bronchoscopy were performed, which revealed a foreign body in the right lower lobe bronchus that was removed with biopsy forceps in piecemeal. In her follow-up visit, she underwent virtual broncoscopy that revealed clear airways. Thus, detailed history and high index of suspicion is required for nonresolving pneumonias that may occur due to unnoticed foreign body/ies in an adult.

Isolated pulmonary hydatid cyst: Misinterpreted as metastatic pulmonary lesion in an operated case of carcinoma breast in young female.

Hydatidosis is caused by Echinococcus granulosus. Humans may be infected incidentally as intermediate host by the accidental consumption of soil, water, or food contaminated by fecal matter of an infected animal. Hydatidosis is one of the most symptomatic parasitic infections in various livestock - raising countries. Lung is the second most commonly affected organ following the liver. The symptoms depend on the size and site of the lesion. It can present as an asymptomatic pulmonary lesion to hemoptysis, chest pain, coughing anaphylaxis, and shock. There are very few reported cases of isolated lung hydatidosis without exposure to animals or nonvegetarian diet. For hydatidosis, serology and imaging are diagnostic tools. Surgical removal and/or chemotherapy are the main-stay of treatment. Here, we discuss a case of persistent left lower lobe cystic lesion in young female with a history of operated left breast carcinoma which was thought to be of metastatic lesion but ultimately confirmed as pulmonary hydatid cyst after unintended aspiration of cystic fluid to rule out malignancy. Pulmonary hydatidosis should always be considered as a differential diagnosis when dealing with a cystic lesion on radiology.

Cannon ball appearance on radiology in a middle-aged diabetic female.

Pulmonary tuberculosis is commonly presented as cavitary lesion and infiltrations. It commonly involves upper lobe. Lower lobe involvement is less common. Various atypical presentations of tuberculosis on radiology are reported like mass, solitary nodule, multi lober involvement including lower lobes. Atypical presentations are more commo in patients with immunocompromised conditions like Diabetes Mellitus, anemia, renal failure, liver diseases, HIV infection, malignancy, patients on immunosuppressive therapy. Cannon ball presentation of pulmonary tuberculosis is extremely rare and not so common. Common causes of cannon ball presentation in lung are metastasis, fungal infections, Wegener's grannulomatosis, sarcoidosis, etc. We report here a case of middle year female with diabetes mellitus presented with atypical symptoms with cannon ball appearance on radiology and found to be of tuberculosis in origin. Thus any patients with immunocompromised condition can present with atypical manifestation of tuberculosis either clinically or radiologicaly in high endemic countries for tuberculosis.

Co-morbidities among silicotics at Shakarpur: A follow up study.

CONTEXT: Studies have revealed high morbidity and mortality among agate stone workers of Shakarpur due to silicosis. Besides the fatal disease, the workers also suffer from debilitating co-morbidities especially tuberculosis and under nutrition. AIMS: The present study describes few co-morbidities and their influence in mortality in cases of silicosis that were followed for 30 months at Shakarpur. SETTINGS AND DESIGN: Shakarpur, Khambhat of Gujarat. MATERIALS AND METHODS: Spirometry for lung function, chest X-ray, anthropometry, body fat % measurement, record of tuberculosis status and ILO classification of pneumoconiosis were done among 53 chest symptomatic patients above 15 years of age who were followed for 30 months. RESULTS: Out of 53 participants (35 men), with an average duration of exposure to free silica of 16.8 years, more than half of the male workers were underweight (BMI<18.5 kg/m(2)) at enrollment. Thirteen participants died in less than 3 years of follow up. While 11 of them were silicosis positive out of which 10 had tuberculosis. The odds ratio for association between silicosis and tuberculosis was 2.75. A majority (81.1%) of the 37 silicosis positive cases showed a mixed pattern in spirometry suggesting co-existence of restrictive and obstructive pathology. On regression analysis, TB and nutritional status were found to have strong influence on mortality. CONCLUSIONS: Screening for early diagnosis of silicosis as well as co-morbid conditions and managing them would go a long way in prolonging the lives of the agate stone workers who are prone to die early due to silicosis.

Silicosis among agate workers at Shakarpur: An analysis of clinic-based data.

BACKGROUND: There is a high prevalence of silicosis and other morbid conditions leading to early death among agate workers at Khambhat of Gujarat. AIMS: The present study describes the prevalence of X-ray positive silicosis in a sample of a high-risk group visiting a clinic at Shakarpur of Khambhat. SETTINGS AND DESIGN: A cross-sectional study among 123 clinically suspected cases was conducted over 6 months. MATERIALS AND METHODS: A chest physician and a radiologist independently evaluated the Chest X-rays of 123 clinically suspected patients of silicosis. Silicosis was confirmed if either of them rated the X-ray as positive. STATISTICAL ANALYSIS: Descriptive statistics and logistic regression were done using SPSS software version 14. RESULTS: Out of 123 cases, 85 (69.1%) were confirmed as silicosis. There was no significant difference in the prevalence between males (70.3%) and females (69.4%). Workers with more than 10 years of exposure to silica had an odd ratio of 4.8, 95% CI (1.76, 13.60) compared to those with less than 10 years of exposure. A logistic regression analysis showed that for every extra year of exposure, the odds of getting silicosis increased by about 12%. CONCLUSIONS: This study highlights the catastrophic effects of exposures to silica in agate worker, which calls for urgent protective measures for this population.

Elongated uvula and diagnostic utility of spirometry in upper airway obstruction.

Elongated uvula is relatively an uncommon condition. Upper airway obstruction is often a missed complication of such a rare condition. Clinical presentations of upper airway obstruction often mimic asthma. Hence it is very easily mis-diagnosed as asthma. Spirometry offers a very simple test to diagnose upper airway obstruction very early and easily. Once diagnosed, the management of elongated uvula, almost exclusively, is surgical excision leading to total cure. Here is a case report of such a rare condition.