Evaluation of line-probe assay for molecular analysis and drug susceptibility of extra-pulmonary tuberculosis.

SETTING: Most epidemiological studies on Mycobacterium tuberculosis focus on pulmonary tuberculosis (TB), whereas extra-pulmonary TB (EPTB) remains poorly explored. OBJECTIVE: To study the rate of resistant EPTB cases among individuals with suspected EPTB using a commercial line-probe assay (LPA), polymerase chain reaction (PCR) and reverse hybridisation test. We also examined the molecular profile of the EPTB isolates obtained at the Himalayan Institute of Medical Sciences, Dehradun, India. DESIGN: EPTB samples were collected from 249 patients with clinical and radiological suspicion of EPTB and subjected to automated liquid culture, PCR and GenoType MDRTBplus according to the manufacturers' instructions. RESULTS: A diagnostic yield of 15% was observed among individuals with suspected EPTB using MGIT™ (Mycobacterium Growth Indicator Tubes), which increased to 38% on LPA and PCR. LPA results had 100% concordance with MGIT, with all culture-positive samples also being positive on LPA. However, 70.2% of LPA-positive samples did not grow Mycobacterium tuberculosis in liquid culture. Two (2.1%) of the culture-negative EPTB PCR-positive samples were multidrug-resistant, 20 (21.2%) were rifampicin-monoresistant and 12 (12.7%) isoniazid-monoresistant on LPA. CONCLUSION: Given the paucibacillary nature of EPTB, we demonstrated that PCR and LPA can have a vital role in establishing TB diagnosis in extra-pulmonary tissues.

Pleural haemangioma: A rare cause of recurrent pleural effusion.

A middle aged female presented with recurrent unilateral pleural effusion. Thoracoscopy revealed a vascular tumor in the apical region of pleural cavity arising from the chest wall. Biopsy from the tumor showed features of pleural hemangioma. She was successfully managed by surgical excision of the tumor. The case is being presented because of its rarity.

Anaplastic thyroid carcinoma presenting as bilateral pleural effusion.

Anaplastic thyroid cancer presenting as bilateral malignant pleural effusion is rarely reported. We present a case who presented solely with respiratory symptoms and subsequently found to be having bilateral malignant pleural effusion secondary to anaplastic thyroid cancer.

A pilot study on domiciliary pulmonary rehabilitation programme in the management of severe chronic obstructive pulmonary disease.

INTRODUCTION: Pulmonary rehabilitation is now an accepted modality of care in the management of chronic obstructive pulmonary disease (COPD) patients. However, in resource-limited settings, conventional pulmonary rehabilitation may not be feasible due to the high cost involved and the extensive infrastructure requirement. In view of these constraints, we designed a domiciliary pulmonary rehabilitation programme and evaluated its usefulness in the management of severe COPD. METHODS: A total of 20 patients suffering from severe COPD (ten patients each in the experimental and control groups) were enrolled in the study. The experimental group was subjected to domiciliary pulmonary rehabilitation along with medical management, while the control group underwent only conventional medical management. During the six-month study period, both groups were assessed for quality of life (clinical COPD questionnaire), exercise capacity (six-minute walk distance) and spirometry values (forced expiratory volume in one second and forced vital capacity). RESULTS: Statistically significant differences were observed in clinical COPD questionnaire scores in both groups from the fourth month (p-value is 0.002 and 0.001 at the end of four and six months, respectively). The results of the six-minute walk distance showed a similar trend (p-value is 0.009 and 0.001 at the end of four and six months, respectively). No significant difference was observed in either of the spirometry values. CONCLUSION: The domiciliary pulmonary rehabilitation programme improves the quality of life and exercise endurance of patients with severe COPD, and thereby acts as a substitute for conventional pulmonary rehabilitation programmes in resource-limited situations.

Five-year trend of acquired antitubercular drug resistance in patients attending a tertiary care hospital at Dehradun (Uttarakhand).

BACKGROUND/AIM: To study the prevalence and trend of acquired drug resistance to the first line antitubercular drugs. MATERIALS AND METHODS: Sputum of 215 previously treated adult pulmonary tuberculosis (TB) patients over a period of 2002-2006 were subjected to culture and sensitivity testing against common antitubercular drugs. RESULT: Growth of Mycobacterium tuberculosis was obtained from sputum specimen of 184 (85.58%) of the 215 patients who were studied; Overall, 113 (62.77%) of these were resistant to at least one antitubercular drug. Resistance to isoniazid was most common (62.22%) followed by rifampicin (57.22%). Multidrug resistance (MDR) was observed in 103 (57.22%) cases. During the five-year study period, an increasing trend in drug resistance including MDR-TB was observed. CONCLUSION: This study showed increasing trend in drug resistance including MDR-TB in five years.

Role of chest CT scan in determining etiology of primary spontaneous pneumothorax.

BACKGROUND: Spontaneous pneumothorax occurs subsequent to a disruption in the continuity of visceral pleura and escape of air into pleural space. It is usually difficult, sometimes impossible to detect evidence of pulmonary pathology by clinical or conventional radiographic methods. Computed tomography provides additional informations not obtainable with conventional diagnostic modalities. METHODS: To determine the role of CT scan in the aetiological diagnosis and subsequent management of patients with primary spontaneous pneumothorax, a perspective study was undertaken. RESULTS: A total of 40 patients with spontaneous pneumothorax with normal skiagram chest after management of pneumothorax, were included in the study. In 75% of these cases, CT revealed underlying lung pathology as a cause for primary spontaneous pneumothorax. CONCLUSION: Our study shows that CT scan is a useful imaging modality in determining the aetiology of primary spontaneous pneumothorax.