Efficacy and safety of intrapleural streptokinase in tubercular empyema thoracis - old wine in new wineskin.

Tubercular empyema thoracis continues to be one of the leading causes of morbidity in low-income countries. Despite antitubercular therapy (ATT) and thoracostomy, empyema drainage is hampered by multiple septations, loculations, debris, and blood clots leading to complications. In a comparative experimental study to estimate the efficacy and safety of intrapleural streptokinase (IPSTK) in tubercular empyema, 30 cases of chronic multiloculated tubercular empyema were compared by radiological improvement by chest radiography, duration and volume of fluid drained, and degree of dyspnoea according to the modified Borg scale, depending on whether streptokinase was used or not. The former scored on all counts; we therefore conclude that intrapleural streptokinase is a safe, efficacious intervention in tubercular empyema. It decreases morbidity and reduces the need for surgery.

Post partum dyspnoea: look beyond the lungs.

The aetiology of acute-onset dyspnoea in the post partum period is diverse. However, subtle clinical and radiological findings assist in early diagnosis and definitive management, thereby conferring better prognosis and survival. https://bit.ly/361b4qm.

Pulmonary Langerhans Cell Histiocytosis in a young Non-Smoking Female --Too many Rituals spoil the Lung.

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare idiopathic cystic interstitial granulomatous lung disease seen almost exclusively in cigarette smokers. It typically occurs between 20-40 years of age and equally distributed among both sexes. Management includes smoking cessation, avoidance of second-hand smoke, and close follow-up. Corticosteroids may be required in those with symptomatic disease with worsening lung function despite smoking cessation and progressive nodular stage of the disease. Here, we report an interesting case of biopsy-proven PLCH in a young never smoker female. Detailed questioning revealed significant exposure to incense smoke, highlighting a rare presentation of non-cigarette smoke-related PLCH. Avoidance of incense smoke combined with oral prednisolone (0.5mg/kg) tapered over 6 months led to complete resolution of symptoms, disappearance of nodules in high resolution computed tomography (HRCT) of the thorax and improvement in lung function.

Invasive pulmonary aspergillosis in a COVID-19 recovered patient: unravelling an infective sequalae of the SARS-CoV-2 virus.

Dear Editor, A 55-year-female, house wife, non-smoker, morbidly obese (BMI>35) with no other co-morbidities or pre-existing lung disease presented to the emergency room with complaints of highgrade fever, cough with minimal sputum, progressive breathlessness, streaky haemoptysis, and anorexia for the past 5 days. She was admitted in intensive care unit (ICU) for severe COVID-19 pneumonia three months back and had successfully recovered after 24 days of hospitalization....

A study of multidrug resistant tuberculosis among symptomatic household contacts of MDR-TB patients.

BACKGROUND: Diagnosis and management of multidrug-resistant tuberculosis (MDR-TB) remains a global challenge and is associated with high morbidity and mortality. Burden of TB among symptomatic household contacts of MDR-TB is not extensively studied and screening of symptomatic contacts may provide a better opportunity for optimum management and effective TB control. METHODS: This prospective observational study was conducted in the department of Tuberculosis & Chest diseases, S.N. Medical College, Agra from February 2016 to January 2018. The study recruited 271 symptomatic household contacts of 87 index MDR-TB cases. Symptomatic contacts were screened for active disease and latent TB infection. Risk factors for the spread of disease were also looked for. RESULTS: Out of 271 symptomatic household contacts, 97 (35.79%) had active TB. Among 97 diseased, 62 (22.87%) had MDR-TB and 35 (12.91%) had drug-susceptible TB. 124 contacts (45%) had latent TB infection. Risk factors associated with occurrence of TB included age less than 18 years (OR = 7160, p = 0.1908, RR = 0.8082, p = 0.1887), male sex (OR = 2.3108, p = 0.0021, RR = 1.7444, p = 0.0034), Sibling as index case (OR = 0.6404, p = 0.0804, RR = 0.7520, p = 0.0806), lack of BCG vaccination (OR = 1.7763, p = 0.0271, RR = 1.4338, p = 0.0247) malnutrition (OR = 1.8980, p = 0.0138, RR = 1.5166, p = 0.0159) and lower socioeconomic status (OR = 3.2399, p < 0.0001, RR = 2.1524, p < 0.0001). CONCLUSION: The high case detection rate by screening symptomatic household contacts shows MDR-TB is highly transmissible and household contacts are at a higher risk of developing active disease. It provides an opportunity for early diagnosis, adequate treatment, and interrupt the chain of transmission. Identifying risk factors help prevent the progression of latent TB infection to active disease.

Postpartum Cardiogenic Pulmonary Edema: The Initial Presentation of an Underlying Rheumatic Heart Disease.

How to cite this article: Shadrach BJ, Tiwari D, Shahi SS, Goel R. Postpartum Cardiogenic Pulmonary Edema: The Initial Presentation of an Underlying Rheumatic Heart Disease. Indian J Crit Care Med 2020;24(10):999-1000.