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2.  25-Hydroxy Vitamin D, Vitamin D Receptor and Toll-like Receptor 2 Polymorphisms in Spinal Tuberculosis 
Medicine  2016;95(17):e3418.
Vitamin D deficiency and vitamin D receptor (VDR) gene abnormalities confer susceptibility to tuberculosis. Toll-like receptors (TLRs), such asTLR-2, are also important mediators of inflammatory response against Mycobacterium tuberculosis. We evaluated serum vitamin D, and VDR and TLR-2 gene polymorphisms in patients with spinal tuberculosis.
This study comprised of 3 groups: spinal tuberculosis, pulmonary tuberculosis, and controls (each with 106 subjects). Enzyme-linked immunosorbent assay was used to measure vitamin D levels, and polymerase chain reaction-sequencing method was used to analyze VDR and TLR-2 gene polymorphisms. Patients were followed up for 6 months.
Vitamin D deficiency was significantly more prevalent in patients with spinal tuberculosis (P < 0.001) and pulmonary tuberculosis (P = 0.011), versus controls. The heterozygous and mutant genotypes of VDR TaqI gene were significantly associated with spinal tuberculosis (P < 0.001; odds ratio [OR] 4.74 [2.45–9.18]) and pulmonary tuberculosis (P < 0.001; OR 3.52 [1.80–6.88]) when compared with controls. The heterozygous and mutant variants of VDR ApaI gene were significantly more common in patients with spinal tuberculosis in comparison with patients with pulmonary tuberculosis (P < 0.001; OR 2.90 [1.65–5.10]) and controls (P < 0.001; OR 6.56 [3.41–12.61]). We did not observe any significantly different results for TLR-2 gene polymorphisms. Vitamin D deficiency, VDR, and TLR-2 polymorphisms did not affect the 6-month disability.
Vitamin D deficiency and VDR gene polymorphisms are significantly more prevalent in people with pulmonary and spinal tuberculosis. They may, in isolation or collectively, confer susceptibility to pulmonary and spinal tuberculosis.
PMCID: PMC4998689  PMID: 27124026
3.  Correlation between clinical characteristics, spirometric indices and high resolution computed tomography findings in patients of chronic obstructive pulmonary disease 
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease affecting the airways, leading to significant morbidity and mortality throughout the world. There is a need to have a holistic evaluation of COPD patients, other than just measuring the level of obstruction as performed by spirometry. High resolution computed tomography (HRCT) scan of thorax partly fulfills this requirement.
Materials and Methods:
Fifty patients of COPD (confirmed on spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. Complete clinical evaluation was done. The Philips computer program for lung densitometry was used with these limits (−800/−1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes.
There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). Mean upper lobe MLD was −839.27 HU, mean lower lobe MLD was −834.91 HU and the mean MLD was −837.08 HU. The lower lobes MLD were found to be decreasing with increasing disease severity. A mild linear correlation of pre forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of Post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. A predictive model can be derived to quantify obstruction severity (FEV1).
HRCT may be an important additional tool in the holistic evaluation of COPD. HRCT can well be correlated with the spirometric and clinical features and the level of obstruction can be indirectly derived from it by measuring the MLD.
PMCID: PMC4748664  PMID: 26933306
Chronic obstructive pulmonary disease; high resolution computed tomography thorax; spirometry
4.  A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion 
South Asian Journal of Cancer  2016;5(1):27-28.
The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB).
Materials and Methods:
This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope's biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB.
46 Patients underwent this study. In all 46 patients both CPB and TPB were performed. TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular.
TPB has much greater diagnostic efficacy than CPB.
PMCID: PMC4845604  PMID: 27169119
Malignancy; pleural diseases; thoracoscopic pleural biopsy; tuberculosis
5.  Role of Serum Levels of Vascular Endothelial Growth Factor and Its Receptor in Retinopathy of Prematurity 
Iranian Journal of Pediatrics  2015;25(4):e2373.
Retinopathy of prematurity (ROP) is a disorder of developing retina of low birth weight preterm infants which can lead to blindness. One theory attributes the fibrosis seen in ROP to deregulation of vascularization in the retina. Vascular endothelial growth factor (VEGF) is one of the important mediators involved in vascularization.
This study was carried out to assess the role of VEGF and its receptor in retinopathy of prematurity.
Patients and Methods:
Around 200 preterm infants born in SSK hospital were screened at 33 - 34 weeks. These babies were followed up according to the international classification of retinopathy of prematurity (ICROP) criteria. Those infants who developed ROP at 38 - 40 weeks were enrolled in group A while an equal number of infants who did not develop ROP were included in group B. Each group comprised of 30 subjects each. Venous sampling was carried out twice, once at 33 - 34 weeks and then again at 38 - 40 weeks. VEGF and VEGF-R2 were estimated by commercially available ELISA kits.
There was no statistically significant difference between the levels of VEGF and VEGF-R2 in both groups at first visit as well as the follow up visit. However, the intra-group difference was significant between the first and the final visit in VEGF and VEGF-R2 levels in the cases with ROP. In the control population, the VEGF levels were significantly lower in the follow up visit as compared to the initial visit.
Our study demonstrates that a significant difference is seen in the serum VEGF and VRGF-R2 in the second visit of the infants with ROP demonstrating that VEGF might be responsible for the initiation and aggravation of ROP.
PMCID: PMC4575799  PMID: 26396701
Retinopathy of Prematurity; VEGF; VEGFR; Angiogenesis
6.  A prospective study of ocular toxicity in patients receiving ethambutol as a part of directly observed treatment strategy therapy 
Background and Objectives:
India is among the largest countries to implement the revised National Tuberculosis Control Program (RNTCP). This program provides intermittent regimens to the patients, where the doses of isoniazid and ethambutol are more as compared to the daily regimen, which is a cause of concern, particularly with regard to the ocular toxicity of ethambutol. The present study was undertaken to explore the ocular toxicity in the patients registered under the program.
Materials and Methods:
This was a prospective single center cohort study of 64 patients of categories I and II, coming to the RNTCP-Directly Observed Treatment Strategy (DOTS) center at a tertiary care referral hospital. The detailed history, best corrected visual acuity, fundus examination, and color vision test were carried out in all patients at the start of treatment and then at the first and second month of treatment.
Loss in visual acuity from the baseline was noted at the second month follow up in 12 (9.4%) eyes (P = 0.001), visual field defects were seen in eight (6.3%) eyes (P = 0.0412), and optic disc abnormalities were observed in six (4.7%) (P = 0.013) eyes. Color vision abnormalities were noted in 16 (12.6%) eyes (P = 0.003), four eyes showed impairment in red–green color perception, and the others showed impairment in blue–yellow color perception as well. Patients with ocular symptoms were advised to stop ethambutol and they showed improvement in visual acuity after follow up of one to two months. The overall outcome of treatment was not affected by discontinuation of ethambutol in these patients.
Ethambutol when taken according to program could cause ocular toxicity. The early recognition of ocular symptoms is important to prevent unnecessary delay in diagnosis and probable irreversible visual loss.
PMCID: PMC4298911  PMID: 25624590
Ethambutol toxicity; ocular symptoms; revised national tuberculosis control program; visual defects
7.  Complete right lung agenesis presenting with bronchial asthma and allergic rhinitis 
BMJ Case Reports  2012;2012:bcr0120125553.
A 26 year-old lady presented with episodic breathlessness, chest tightness, recurrent nasal obstruction and excessive sneezing, mainly during change of season along with opacity of the right hemithorax on chest x-ray. Further detailed work-up including spirometry, high-resolution CT scan of the thorax and fibre-optic bronchoscopy confirmed complete right lung agenesis in patients with bronchial asthma and allergic rhinitis. Complete control of symptoms was achieved with formeterol 6 μg and mometasone 200 μg (via dry powder inhaler) and intranasal fluticasone 50 μg (nasal spray) 2 puffs twice daily and oral montelukast 10 mg with levocetirizine 5 mg once daily.
PMCID: PMC4542813  PMID: 23001088
8.  Comparative Study of Biofilm Formation in Pseudomonas aeruginosa Isolates from Patients of Lower Respiratory Tract Infection 
Background: This study assessed biofilm formations of P.aeruginosa which was isolated from patients with Lower Respiratory Tract Infections (LRTIs).
Objective: This study was conducted to compare different methods of biofilm formations seen in P. aeruginosa which was obtained from LRTI patients.
Materials and Methods: In this cross-sectional study, we investigated a total of 80 P. aeruginosa isolates obtained from LRTI patients by different methods. Tube method (TM), tissue culture plate (TCP) method and modified tissue culture plate (MTCP) method. They were subjected to biofilm detection methods.
Results: The MTCP method produced a higher accuracy ratio than TCP method. In terms of sensitivity and specificity, the MTCP method was considered to be superior to TM. We observed a higher antibiotic resistance in biofilm producing bacteria than in non-biofilm producers.
Conclusion: In our study, MTCP was found to be more sensitive and specific method for biofilm detection than TCP and TM.
PMCID: PMC4079995  PMID: 24995174
Biofilm formation; P. aeruginosa; Tissue culture plate; Lower respiratory tract infection
9.  Swyer–James–MacLeod syndrome with ipsilateral herniation of hyperinflated hyperlucent lung 
BMJ Case Reports  2011;2011:bcr0520114191.
Swyer–James–MacLeod syndrome is characterised by unilateral hyperlucency on chest radiograph with small or normal-sized lung on the affected side and compensatory hyperinflation of opposite lung. Hyperinflation of the affected lung is a very rarely reported entity. An adult female patient, who presented with exertional breathlessness and diagnosed to have hypoplastic left pulmonary artery with hyperlucent, hyperinflated and herniated left lung is described.
PMCID: PMC3176363  PMID: 22679043
10.  Free Radical Status in Retinopathy of Prematurity 
Retinopathy of prematurity (ROP) is a major cause of blindness in children. Free radicals are implicated in the development of this retinopathy. We studied the role of free radicals in ROP and enrolled 60 preterm neonates at 30–32 weeks age. Thirty neonates predisposed to development of ROP, were placed in study group and 30 normal neonates in control group. Malondialdehyde and antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPX) were measured in blood spectrophotometrically. Both the groups were followed-up to 40–42 weeks age. Serum MDA levels, erythrocyte SOD and plasma GPX were significantly high in study group at 30–32 weeks as compared to control group. At follow up visit significant increase in MDA level and decrease in SOD and GPX level among the study group was seen. This disturbance in equilibrium of oxidant and antioxidant status initiates an inflammatory process in retinal tissue leading to development of ROP.
PMCID: PMC3358377  PMID: 23542575
Free radicals; Antioxidants; Retinopathy of prematurity
11.  Poland sequence: Series of two cases and brief review of the literature 
Annals of Thoracic Medicine  2012;7(2):110-112.
Poland sequence is a rare congenital anomaly involving the chest wall and arm, displaying differing degrees of severity, functional and aesthetic impairments. Here we report a series of two cases that presented to us with this anomaly. These cases illustrate, for physicians, the importance of physical diagnosis and reinforce the practice of looking for additional anomalies when one is discovered.
PMCID: PMC3339202  PMID: 22558018
Aesthetic impairments; congenital anomalies; Poland sequence; Poland syndrome
12.  A comparative study on the clinical and polysomnographic pattern of obstructive sleep apnea among obese and non-obese subjects 
Annals of Thoracic Medicine  2012;7(1):26-30.
This study was designed to compare the pattern of obstructive sleep apnea (OSA) among obese and nonobese subjects regarding clinical and polysomnographic data obtained for a polysomnographic study.
A cross-sectional retrospective descriptive study was conducted by analyzing polysomnographic data in 112 consecutive patients underwent a sleep study at our sleep laboratory from January 2009 to July 2010. Out of them, 81 were diagnosed to have OSA (apnea-hypopnoea Index ≥5). These patients were classified in two groups with body mass index (BMI) < 27.5 kg/m2 as nonobese and BMI≥27.5 kg/m2 as obese. Clinical as well as polysomnographic data were evaluated and compared between the two groups. Patients were also evaluated for other risk factors such as smoking, alcoholism, and use of sedatives. Data were subjected to statistical analysis (χ2-test, P value <0.05 considered to be significant). The Fisher Exact test was applied wherever the expected frequency for a variable was ≤5.
Of 81 patients with OSA, 36 (44.4%) were nonobese with a mean BMI of 26.62 ± 2.29 kg/m2 and 45 (55.6%) were obese with a mean BMI of 35.14 ± 3.74 kg/m2. Mean AHI per hour was significantly more in the obese than in the nonobese group (50.09 ± 29.49 vs. 24.36 ± 12.17, P<0.001). The use of one or more sedatives was more in nonobese as compared to obese (58.3% vs. 24.4%, P=0.002). The obese group had significantly higher desaturation and arousal index (P<0.001). The minimal oxygen saturation was lower in the obese than the nonobese group (68.5 ± 13.00 vs. 80.3 ± 7.40, P<0.001) and was well below 90% in both groups. Overall, the OSA in nonobese patients was mild-to-moderate as compared to that of the obese and no significant differences were observed between them as regard to age, gender, mean neck circumference, excessive daytime sleepiness, adenoid or tonsillar enlargement, smoking, and remaining polysomnographic parameters.
Obstructive sleep apnea can occur in nonobese persons though with less severity as compared to obese leading to a concept that OSA is not restricted to obese persons only and there is a high demand of its awareness regarding evaluation, diagnosis, and management in such individuals.
PMCID: PMC3277037  PMID: 22347347
Body mass index; obesity; obstructive sleep apnea
13.  Cavitary Pulmonary Zygomycosis Caused by Rhizopus homothallicus▿  
Journal of Clinical Microbiology  2010;48(5):1965-1969.
We report the first two proven cases of cavitary pulmonary zygomycosis caused by Rhizopus homothallicus. The diagnosis in each case was based on histology, culture of the causal agent, and the nucleotide sequence of the D1/D2 region of the 28S ribosomal DNA.
PMCID: PMC2863885  PMID: 20200286
14.  Parotid tuberculosis 
Tuberculosis of the parotid gland is a rare condition. We describe a case of tuberculosis of right parotid gland in a 17-year-old male patient. Diagnosis was made by early suspicion and confirmed by demonstration of epitheloid granulomas on fine needle aspiration cytology (FNAC). Patient was successfully treated with daily regimen of four drugs (rifampicin, isoniazid, pyrazinamide, ethambutol) for first two months followed by two drugs (rifampicin and isoniazid) for last four months.
PMCID: PMC2988182  PMID: 21139728
Parotid gland; salivary gland; tuberculosis
15.  Intralobar sequestration of lung 
Intralobar pulmonary sequestration is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. It lacks normal communication with tracheobronchial tree. Failure to diagnose and treat this condition can lead to recurrent pneumonia and fatal hemoptysis. The aim of this case report is to increase awareness about the condition and to review criteria of its definitive diagnosis and subsequent treatment.
PMCID: PMC2876708  PMID: 20532005
Intralobar; lung; sequestration
16.  Lessons from patients with hemoptysis attending a chest clinic in India 
Annals of Thoracic Medicine  2009;4(1):10-12.
To evaluate the various etiologies of hemoptysis.
Four hundred and seventy-six consecutive patients of hemoptysis who were admitted to the Department of Pulmonary Medicine between January 1996 and December 2002 were included in this study. Hemoptysis was categorized as mild (< 100 ml/day), moderate (100–400 ml/day), and massive (>400 ml/day). We also categorized the patients according to the primary etiology of the hemoptysis.
Of the 476 patients with hemoptysis included in this study, 352 were males and 124 were females. Pulmonary tuberculosis was the leading cause of hemoptysis. There were 377 (79.2%) patients in the pulmonary tuberculosis group, 25 (5.7%) in the neoplasm group, 19 (4.0%) in the chronic bronchitis group, 18 (3.8%) in the bronchiectasis group, and 35 (7.3%) patients with hemoptysis due to other causes. About one-third of the patients with hemoptysis had been misdiagnosed by the referring doctor as having active pulmonary tuberculosis.
Although pulmonary tuberculosis is the most important cause of hemoptysis in India, it may also occur due to a variety of other causes. Awareness should be increased among general physicians about the various etiologies of hemoptysis in pulmonary tuberculosis patients.
PMCID: PMC2700474  PMID: 19561915
Diagnosis; hemoptysis; mortality; treatment; tuberculosis
17.  A rare case of benign isolated schwannoma in the inferior orbit 
Indian Journal of Ophthalmology  2008;56(6):514-515.
A rare case of unilateral orbital schwannoma arising from the infraorbital nerve is presented. An excision biopsy with complete removal of the mass in the inferior orbit was performed. A definitive diagnosis was made on histopathological examination. The clinical and histological features of schwannoma are discussed. A need for early removal of such tumors is recommended to prevent complications.
PMCID: PMC2612976  PMID: 18974528
Infraorbital; orbital; schwannoma
18.  Extraconal cavernous hemangioma of orbit: A case report 
Cavernous hemangioma is the most common benign noninfiltrative neoplasm of the orbit. Most cavernous hemangiomas are intraconal and lateral in location. We present a case of a cavernous hemangioma with an unusual extraconal and superomedial location.
PMCID: PMC2747469  PMID: 19774188
Extraconal; hemangioma; orbit
19.  Isoniazid- and ethambutol-induced psychosis 
Annals of Thoracic Medicine  2008;3(4):149-151.
Most cases of antituberculous agent–associated psychoses were caused by isoniazid (INH), with ethambutol (EMB)-induced psychosis being rare. The concomitant occurrence of INH- and EMB- induced psychosis and in a single individual is extremely uncommon. We report a case of 28-year-old male who developed psychotic symptoms on start of EMB initially and later on INH also. He was prescribed rifampicin, pyrazinamide, and ofloxacin and had no further psychotic symptoms.
PMCID: PMC2700450  PMID: 19561898
Ethambutol; isoniazid; psychosis
20.  Spontaneous pneumothorax: An unusual complication of pregnancy - A case report and review of literature 
Annals of Thoracic Medicine  2008;3(3):104-105.
Spontaneous pneumothorax complicating pregnancy is rare. Only 55 cases have been reported till now. We describe a case of a 30-year-old Indian woman with spontaneous pneumothorax during her 28th week of pregnancy.
PMCID: PMC2700443  PMID: 19561889
Pneumothorax; pregnancy; spontaneous
Pulmonary Mucormycosis is an uncommon disease caused by fungi of class Zygomycetes. It occurs predminantly in an immunodeficient host most common risk factor being diabetes mellitus. The lesions are localized in the lungs or the mediastinum. We are reporting a case of 70 years old male, having cough, haemoptysis, fever and chest pain. He was on antituberculosis treatment (RHEZ) for last 10 days and was later found to have Pulmonary Mucormycosis on further evaluation.
PMCID: PMC2822332  PMID: 20165666
Pulmonary; Mucormycosis; Tuberculosis
22.  Proboscis lateralis 
PMCID: PMC3451486  PMID: 23119493

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