Objective In this document, 9 Indian experts have evaluated the factors specific to LMICs when it came to Severe Asthma (SA) diagnosis, evaluation, biologic selection, non-biologic treatment options and follow-up.Data Sources A search was performed using 50 keywords., focusing on the Indian/LMICs perspective, in PubMed, Cochrane Library, and Google Scholar. The key areas of the search were focused on diagnosis, phenoendotyping, non-biological therapies, selecting a biologic, assessment of treatment response and management of exacerbation.Study Selections The initial search revealed 1826 articles, from these case reports, observational studies, cohort studies, non-English language papers etc were excluded and we short-listed 20 articles for each area. 5 relevant papers were selected by the experts for review.Results In LMICs SA patients may be referred to the specialist for evaluation a little late for Phenoendotyping of SA. While biologic therapy is now a standard of care, pulmonologists in LMICs may not have access to all the investigations to phenoendotype SA patients like Fractional exhaled nitric oxide (FeNO), Skin prick test (SPT) etc., but phenotyping of SA patients can also be done with simple blood investigations, eosinophil count and serum immunoglobulin E (IgE). Choosing a biologic in the overlapping phenotype of SA and ACO patients is also a challenge in the LMICs.Conclusion Given the limitations of LMIC, it is important to select the right patient and explain the potential benefits of biological therapy. Non-biologic add-on therapies can be attempted in a resource-limited setting where biological therapy is not available/feasible for patients.
BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) during rapid eye movement (REM) stage of sleep is gaining importance in recent years. This study was done to determine the proportion of REM-related OSA and its associated polysomnographic features. METHODS: One hundred forty-two patients were included in the study. REM-related OSA was defined based on previously established broad and strict criteria (REM apnea-hypopnea index [AHI]/non-REM [NREM] AHI ratio ≥2 and REM AHI >5 with NREM AHI <5, respectively), and its association with polysomnographic features was studied using appropriate statistical tools. RESULTS: The proportion of REM-related OSA in the study was 56.3% and 25.3% as per broad and strict criterion, respectively. The REM-related OSA group had a mean younger age (47.4 ± 13.2 years) as compared to NREM-related OSA group (52.6 ± 15.8 years). Females (34 out of 45; 75.6%) were more likely to have REM-related OSA as compared to males (46 out of 107; 47.4%). Supine AHI, arousal index, oxygen desaturation index, length of the longest event, and the lowest oxygen saturation recorded during sleep had a significant association with REM-related OSA. 74% of patients with overall AHI <5 and 87% patients with overall AHI 5 to 15 satisfied the criteria for REM-related OSA as per broad criterion. CONCLUSION: REM-related OSA was quite prevalent in the study population (56.3%) and was more common in the mild and moderate severity subgroups of OSA.
Presence of ectopic thyroid tissue in unusual locations is a rare phenomenon. Herein we present the case of a 55 year old lady, who on evaluation of dyspnoea was detected to have a mediastinal mass. Initial radiological evaluation showed the presence of a mass arising from the wall of the oesophagus which was presumed most likely to be leiomyosarcoma. She underwent surgical resection of the mass, but on histopathological examination, it turned out to be a nodular goiter which was lying within the smooth muscle layer of the oesophageal wall.
Mediastinal Diseases , Thyroid Dysgenesis , Esophagus/diagnostic imaging , Female , Humans , Mediastinum/diagnostic imaging , Middle Aged , Radiography , Thyroid Dysgenesis/diagnostic imaging
A 49-year-old male was evaluated in our hospital for chronic cough, cervical lymphadenopathy, and a testicular mass. As a part of the management, he underwent a cervical lymph node biopsy, which showed metastatic deposits from papillary carcinoma thyroid. Subsequently, he underwent orchidectomy for suspected testicular malignancy, but the biopsy showed discrete granulomatous inflammation consistent with sarcoidosis. This was followed by total thyroidectomy with neck node dissection. Nodal histopathological examination, this time, revealed a single node containing both malignancy and granulomas. Prior to the thyroid surgery, he underwent a mediastinoscopic sampling of the mediastinal nodes, which also showed granulomatous inflammation consistent with sarcoidosis. Sarcoidosis affecting the genitourinary system is a rare entity. The coexistence of sarcoidosis and thyroid malignancy poses a diagnostic challenge. A thorough review of the literature was done, and there are no reports from India on the above association. This is a unique case, which could possibly suggest an association between sarcoidosis and malignancy and highlights the importance of obtaining a tissue diagnosis in such cases.
Hematopoiesis, Extramedullary , Mediastinum/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , beta-Thalassemia , Asymptomatic Diseases , Diagnosis, Differential , Female , Hepatomegaly/diagnostic imaging , Humans , Incidental Findings , Middle Aged , Splenomegaly/diagnostic imaging , beta-Thalassemia/pathology , beta-Thalassemia/physiopathology
CONTEXT: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. AIMS: This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India. METHODS AND MATERIALS: The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry. RESULTS: Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation. CONCLUSIONS: High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.
Lung contusion usually follows blunt trauma to the chest. If not properly diagnosed and adequately treated, it could at times be fatal as well. This case is being presented to highlight the radiological findings of this condition.
Bronchopulmonary sequestration is a rare anomaly of the lung which is characterized by the presence of a mass of lung tissue which has no connection with the normal bronchopulmonary tree. Sequestration is of two types - intralobar and extralobar, of which intralobar is the more common one. Patients typically present with recurrent hemoptysis, which at times can be massive or with recurrent respiratory tract infections. This case is being presented to highlight the radiological as well as the intraoperative appearance of this rare anomaly.
