Indian Journal of Respiratory Care

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2023 | October-December | Volume 12 | Issue 4

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EDITORIAL

Swapnil Gadhave, Madhuragauri Shevade

Unleashing the Potential: Respiratory Therapists at the Crossroads of Public and Digital Health in India

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:3] [Pages No:289 - 291]

   DOI: 10.5005/jp-journals-11010-1078  |  Open Access |  How to cite  | 

167

Original Article

Vrushali A Ambhore, Manish P Shukla

Evaluating the Immediate Effect of Preextubation Chest Physiotherapy Session on Postextubated Physiological and Diagnostic Cardiorespiratory Parameters in Neonates with Pneumonia: A Randomized Controlled Trial

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:7] [Pages No:292 - 298]

Keywords: Chest, Chest physiotherapy, Extubation failure, Neonates, Physical therapy, Pneumonia

   DOI: 10.5005/jp-journals-11010-1071  |  Open Access |  How to cite  | 

Abstract

Background: Chest physiotherapy (CPT) techniques are commonly employed to remove secretions in newborns undergoing mechanical ventilation for pneumonia. However, there is a lack of studies evaluating the impact of preextubation CPT on postextubation complications in pneumonia. Materials and methods: In this randomized controlled study, a total of 68 participants were randomly assigned to either the intervention or control group. Physiological parameters, including heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2), were compared between the two groups before CPT, immediately after CPT, and at 5 and 15 minutes following extubation. Additionally, diagnostic findings and the incidence of extubation failure were recorded before and after CPT. Results: The baseline characteristics of both groups were similar. Analysis of physiological parameters revealed nonsignificant changes in HR and RR in both groups. However, the intervention group showed a significant improvement in SpO2 levels at 15 minutes postextubation (p = 0.030). Significant differences were observed between the two groups in the findings of auscultation (p = 0.018) and chest radiograph (p = 0.025). The control group exhibited a higher incidence of extubation failure, although the difference was not statistically significant (p = 0.052). Conclusion: Preextubation CPT is a safe and effective therapy option for newborns with pneumonia, regardless of their age or birth weight. It has the potential to reduce postextubation complications, as evidenced by improvements in physiological parameters and a lower incidence of extubation failure. Further research is warranted to explore the clinical implications and optimize the implementation of preextubation CPT in neonatal care.

426

Original Article

Bimal Raj Rajalingam, Priya R Panicker, Archana L Peethambaran, Alexander Jenish Babu, Ravichandran Vijayakumar

Effectiveness of Chemical Pleurodesis Using Doxycycline in Malignant and Nonmalignant Pleural Disorders: A Retrospective Study from Rural South India

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:4] [Pages No:299 - 302]

Keywords: Doxycycline, Effectiveness, Malignant, Nonmalignant, Pleurodesis

   DOI: 10.5005/jp-journals-11010-1070  |  Open Access |  How to cite  | 

Abstract

Background: Chemical pleurodesis is an important tool in the management of refractory pleural effusion. Although talc is widely used as a sclerosing agent of choice, alternative agents like doxycycline have emerged as cheaper and safer agents for chemical pleurodesis. Objective: The aim was to evaluate the effectiveness and clinical outcomes of chemical pleurodesis using doxycycline (500 mg single dose) in the treatment of malignant and nonmalignant pleural effusion and recurrent pneumothorax. Materials and methods: A total of 36 patients, of which 23 patients with malignant pleural effusion, nine patients with pneumothorax, and four patients with nonmalignant effusion, were included in the analysis. After intercostal drainage (ICD) of air or fluid, xylocaine was instilled for pleural anesthesia, and 500 mg of doxycycline was used as a sclerosant. Successful pleurodesis was defined as expanded lung with close approximation between visceral and parietal pleura and minimal to no effusion or pneumothorax at 2 weeks. Results: At the end of 2 weeks, all 23 patients with malignant pleural effusion and nine patients with refractory pneumothorax had successful pleurodesis, but four patients with hepatic hydrothorax had no response. The most common adverse events with pleurodesis included chest pain and fever. Conclusion and clinical significance: Doxycycline was found to be a safe and effective agent for chemical pleurodesis in patients with malignant pleural effusions and recurrent pneumothorax. However, the outcome of hepatic hydrothorax remained unsatisfactory.

172

Original Article

Bhargavi K Nagabhushan, Puneet Nagendra, Sandeepa HS, Supriya Sandeepa

Hematologic Parameters and Their Limiting Values as Prognostic Factors in COVID-19

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:5] [Pages No:303 - 307]

Keywords: Coronavirus, Coronavirus disease 2019, Limiting values, Mortality, Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio

   DOI: 10.5005/jp-journals-11010-1080  |  Open Access |  How to cite  | 

Abstract

Introduction: The manifestations of coronavirus disease 2019 (COVID-19) are varied and range from asymptomatic to life-threatening cases requiring intensive care. Currently, an expeditious prediction of disease severity and outcomes in the early stages remains an unmet challenge. This study aims to critically examine the hematologic values predominantly, along with sociodemographic and clinical parameters, to identify their limiting values that can prognosticate the disease. Materials and methods: A cross-sectional retrospective study was conducted in a rural medical college hospital in Ramanagara, Karnataka. The necessary data of the inpatients were recorded from their respective case files available in the Medical Records Department (MRD). Results: Of the 442 COVID-19 cases, 402 cases were survivors, and 40 cases were nonsurvivors. A statistical significance (p-value of <0.001) was noted between these two categories for the following parameters in our study: oxygen saturation, total count, neutrophil count and lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The limiting values that were derived had an increased risk of mortality with respect to these parameters: oxygen saturation (<86.5%), NLR (>4.5), and PLR (>270.50). Conclusion: Identification and implementation of these prognostic markers are of substantial value to the physicians who continue to be challenged by COVID-19, more so in countries with limited healthcare resources.

165

Original Article

Mustafa İ Bardakci, Müfide Arzu Ozkarafakili, Mutlu Cagan Sumerkan

Evaluation of the Cardiac Status of Newly Diagnosed Chronic Obstructive Pulmonary Disease Patients at First Admission

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:7] [Pages No:308 - 314]

Keywords: Cardiovascular disease, Chest, Chronic obstructive pulmonary disease

   DOI: 10.5005/jp-journals-11010-1074  |  Open Access |  How to cite  | 

Abstract

Objective: We aimed to detect possible cardiac pathologies early by cardiologically evaluating patients newly diagnosed with chronic obstructive pulmonary disease (COPD). Materials and methods: The study included 69 newly diagnosed COPD patients who came to our outpatient clinic and 39 individuals who had smoked for at least 20 years. Both groups were evaluated in chest diseases and grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and then evaluated in the cardiology outpatient clinic. Results: Of the COPD patients included in the study, 49 (71.01%) were male, and 20 (29.99%) were female. The COPD patient group was divided into three groups based on the 2023 GOLD strategy report. There were a total of 38 (35.2%) patients in the GOLD-A group, 28 (73.7%) male and 10 (26.3%) female. The right branch block was seen in 15 (13.9%) of all participants. A total of 14 of them were in the COPD group, and one of them was in the control group. Of the COPD patients with right branch block, 10 (26.3%) were in the GOLD-A group, three (12.5%) were in the GOLD-B group, and one (14.3%) was in the GOLD-E group. Diastolic dysfunction was seen in 38 (55.1%) COPD patients and 14 (35.9%) control groups. Of the patients with COPD with diastolic dysfunction, 22 (57.9%) were in the GOLD-A group, and 20 (55.3%) of them were in grade 1. Mitral valve disease was detected in 19 (27.5%) of the patients with COPD, tricuspid valve disease in 18 (26.1%), and aortic valve disease in two (2.9%) patients. Conclusion: We have seen that a significant number of our patients have started their cardiological pathologies during the initial diagnosis. With this strategy, cardiac pathologies can be intervened early, and better results can be obtained in the management of COPD.

209

Original Article

Hemanth Mellahally Shivaraja, Jyothi Chakrabarty, Aarohi H Mitra

Yang–Tobin Index and Integrative Weaning Index as Predictors of Successful Weaning from Mechanical Ventilation in Intensive Care Unit

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:5] [Pages No:315 - 319]

Keywords: Extubation, Integrative weaning index, Mechanical ventilation, Rapid shallow breathing index, Weaning

   DOI: 10.5005/jp-journals-11010-1076  |  Open Access |  How to cite  | 

Abstract

Background: Weaning is the process of liberating the patient from mechanical ventilation. It has been shown that no single weaning index can accurately predict a successful weaning process. Weaning by intensive care physicians’ bedside clinical discretion alone can sometimes lead to extubation failure. Yang–Tobin index, also known as the rapid shallow breathing index (RSBI) and integrative weaning index (IWI), are two of the most commonly used weaning indices in intensive care units (ICUs). We did a comparative study between the two indices for the prediction of successful weaning in mechanically ventilated patients. Materials and methods: We studied 115 patients who were mechanically ventilated for >48 hours and were ready for extubation. We recorded RSBI and IWI at 60 and 120 minutes for all patients, along with other physiological parameters like sequential organ failure assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, age, and mechanical ventilator parameters. The receiver operating characteristic (ROC) curves were calculated to evaluate the predictive performance of both the indexes. Results: We used two different indices (RSBI vs IWI) to predict successful extubation. An RSBI score of 25 was successfully extubated. Of 10 patients who experienced weaning failure and required reintubation within 48 hours, all patients had an IWI of <24. IWI was useful in detecting those patients who passed the spontaneous breathing trial (SBT) but needed reintubation afterward. Conclusion: Results showed both the Yang–Tobin index and IWI can successfully predict the weaning outcomes from the mechanically ventilated patient. The area under the curve (AUC) for the ROC curve for both indices was almost similar, suggesting both are comparable. IWI was useful in detecting those patients who passed the SBT but needed reintubation afterward.

244

Original Article

Rachna D Arora, Madhura R Patil, Shenaz AZ Saifi, Trushna S Khude

Ultrasound Evaluation of Diaphragm Motion in Various Body Positions in Normal Adults in Age-group of 20–30 Years: A Pilot Study

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:5] [Pages No:320 - 324]

Keywords: Lung ultrasound, Respiratory muscle, Ultrasonography chest

   DOI: 10.5005/jp-journals-11010-1081  |  Open Access |  How to cite  | 

Abstract

Aims and background: Body positioning is a noninvasive therapeutic intervention used by physiotherapists, with significant effects on and benefits for pulmonary function and oxygenation. It influences ventilation distribution, perfusion, alveolar opening pressure, and diaphragmatic mechanics. This study is to assess diaphragm motion using M-mode ultrasonography (USG) in body positions of supine, side-lying, half-lying, sitting, and forward-lean sitting which are commonly used in treating respiratory patients. Materials and methods: A total of 40 healthy adults, (20 males and 20 females) nonsmokers, with normal body mass index (BMI), in the age-group of 20–30 years were enrolled after approval from the Institutional Ethics Committee. The study was conducted in collaboration with the Radiology Department of Tertiary Health Care Hospital. USG for right diaphragm motion was done using M-mode. The transducer was placed transversely on the anterior axillary line over the lower intercostal space and a three-layered image was taken. Right, diaphragm motion was assessed with subjects breathing normally and positioned supine, left-side lying, sitting, forward-lean sitting, and half-lying position. Three measurements were recorded and the highest reading was considered. Data was collected and analysis was done using Statistical Package for the Social Sciences (SPSS) version 16. Results: The right diaphragm motion was 60.04 ± 6.01 mm in supine, 39.59 ± 7.81 mm in left-side lying, 61.27 ± 5.93 mm in half-lying, 41.38 ± 7.41 mm in sitting and 38.68 ± 6.32 mm in forward-lean sitting. Diaphragm motion was highest in half-lying followed by supine, sitting, and forward-lean positions (p = 0.001). There was no significant difference between diaphragm motion in males and females (p > 0.001). Conclusion: In healthy subjects, diaphragm motion was significantly influenced by body position and was found higher in the supine and half-lying positions. Clinical significance: Ultrasonography (USG) evaluates diaphragmatic motion, useful in pulmonary rehabilitation. Diaphragm motion is highest in supine and half-lying positions, suggesting effective breathing exercises in these positions.

214

Original Article

Arjun Khanna, Pradeep Bajad, Sourabh Pahuja, Satyam Agarwal, Isham Goel

Analysis of Physician Prescription Patterns in Patients with Advanced Chronic Obstructive Pulmonary Disease

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:5] [Pages No:325 - 329]

Keywords: Chronic obstructive pulmonary disease, Management, Physician

   DOI: 10.5005/jp-journals-11010-1079  |  Open Access |  How to cite  | 

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a worldwide health problem that is increasing in prevalence. There are practice differences between general physicians and respiratory physicians, and it is expected that not everyone would follow the prescribed guidelines fully. Objectives: The objective of the study was to examine the practice standards of general physicians with postgraduate medicine degrees and evaluate their influence on disease control in COPD patients. Materials and methods: A retrospective, observational study among 60 consecutive patients with advanced COPD patients who were seen at a tertiary care center in North India at the Department of Respiratory and Critical Care Medicine over a period of 6 months from February to July 2022. Results: In this study, data from 60 patients were retrieved who were undergoing treatment from a randomly selected doctor of medicine/diplomate of national board (MD/DNB) physicians. Very few physicians prescribed spirometry to diagnose COPD; however, most patients had undergone a high-resolution computed tomography (HRCT) chest. Around 93.3% of patients continued using both nebulization and handheld inhalers. Around 96.6% of the study patients were prescribed short-acting bronchodilators (SABAs). None of the patients were given any prescription for smoking cessation and pulmonary rehabilitation. Influenza and pneumococcal vaccination were also prescribed to a small number of patients. Conclusion: Overall, it appears that general physicians continue to treat COPD patients with traditional forms of treatment, and very few treat patients as per the updated guidelines.

227

Original Article

Hala M Elsabagh, Amira AR Moawad, Salwa A Atlam

E-cigarette Perception and Intended Behavior among Medical Students, Egypt

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:9] [Pages No:330 - 338]

Keywords: Awareness, Education, Interpretation, Pollutants, Respiratory health

   DOI: 10.5005/jp-journals-11010-1082  |  Open Access |  How to cite  | 

Abstract

Objectives: Electronic cigarettes (E-cigarettes) are relatively new devices developed for decreasing tobacco craving and reducing harm when they replace regular cigarettes. They are cheaper than ordinary cigarettes and have an enhanced taste and smell, so many individuals try to use them instead of ordinary cigarettes. Population knowledge and attitudes toward its benefits and harms have become a subject of research interest. The aim of this study is to explore the medical students’ beliefs, attitudes, and intended behavior about E-cigarettes at Tanta University, Egypt. Methods: A cross-sectional questionnaire-based study among medical students at Tanta University, Egypt, during March 2022 included 814 students. Results: About 66.8% of participants were male, with mean age 21.88 ± 1.59. About 17.4% were smokers, 74% were nonsmokers, and 8.6% were ex-smokers. About 78.6% of participants had heard about E-cigarettes. Media was the main source of knowledge in 57.9%. Two-thirds of them were interested in learning more about E-cigarette. Only 29.9% of students had moderate to high knowledge about electronic smoking (E-smoking). About 64.8% agreed that E-cigarettes may lead to conventional smoking. About 63.0% of the students agreed that it needs regulation at work and public places. While 57.6% consider it safer than regular cigarette, it is significantly higher in males and younger age <25 years. As a smoking cessation tool, 53.7% recommend it, especially female and younger age group. Older students aged ≥25 years had significantly higher negative attitude toward E-smoking (p = 0.001). Female and older students ≥25 years reported that they were extremely likely to counsel patients or their family members about E-cigarettes. Conclusion: Student knowledge about E-cigarette is still poor, and media ads are the main source of knowledge. Older students had a significantly higher negative attitude. It is important to increase awareness levels about E-cigarette, especially among school students and adolescents.

317

Original Article

Azita Tangestaninezhad, Alireza Jafarinezhad, Shaghayegh Hoseindoust, Habib Islami

Investigation of the Pulmonary Function of Patients with Asthma and Chronic Obstructive Pulmonary Disease Following COVID-19 Infection

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:6] [Pages No:339 - 344]

Keywords: 6-minute walk test, Asthma, Chronic obstructive pulmonary disease, Coronavirus disease of 2019

   DOI: 10.5005/jp-journals-11010-1083  |  Open Access |  How to cite  | 

Abstract

Aims and background: In this present study, we aimed to investigate the pulmonary function of patients with asthma and chronic obstructive pulmonary disease (COPD) following coronavirus disease of 2019 (COVID-19) infection. Materials and methods: All data of 266 COVID-19 patients with and without a history of asthma/COPD who were referred to the Razi Hospital, Rasht, Iran, from 2021 to 2022 were collected. Patient self-assessment of the impact of COVID-19 on health using the COPD assessment test (CAT) score criterion in both study groups, asthma control test (ACT) in asthma patients, and modified Medical Research Council (mMRC) in COPD patients were evaluated. All data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26 with a significant level of <0.05. Result: According to our results, the mean age of patients was 51.7 ± 14.1 years old; 51% of them were female, and most of the patients were obese. Hypertension and diabetes were the most common comorbidities. The frequency of 6-minute walking test (6MWT) was higher in patients with asthma/COPD at the time of discharge. From the first to second and third follow-ups, forced expiratory volume in 1 second (FEV1) increased in asthma/COPD groups, and FEV1/forced vital capacity (FVC) decreased in the control group. Also, the CAT score in the first and second follow-ups was worse in asthma/COPD groups compared to the control group. In both studied groups, the self-evaluation of patients using all three questionnaires shows a significant improvement process. Conclusion: A significant improvement in shortness of breath and self-assessment tests was observed in patients with asthma/COPD. However, the results of the 6MWT and self-assessment tests at the time of discharge in these patients were more concerning compared to the control group. Clinical significance: Patients with asthma/COPD were at a similar risk of COVID-19 infection compared to the general population. Females and obese individuals were the majority of the patients. FEV1 in asthma/COPD groups showed improvement in long-term follow-up.

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Original Article

Ajai Kumar Tentu, Samruddhi P Deshpande, Nilesh P Phole, Rongala Laxmivandana

Hypersensitivity Pneumonitis with Environmental Exposure Manifesting as Fibrotic and Nonfibrotic Forms at a Tertiary Care Center in Western Maharashtra

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:7] [Pages No:345 - 351]

Keywords: Avian droppings, Bronchoalveolar lavage, Exposure history, Forced vital capacity, High-resolution computerized tomography

   DOI: 10.5005/jp-journals-11010-1077  |  Open Access |  How to cite  | 

Abstract

Aims and background: Hypersensitivity pneumonitis (HP) is a complex immune-mediated disease affecting the lung, leading to fibrosis on recurrent exposure to organic/inorganic antigens. The sources of antigens include avian droppings, avian feathers, cotton fibers, metal particles, chemical fumes, etc. Materials and methods: This study comprises 27 adult individuals presenting with HP symptoms like shortness of breath, cough, chest tightness, fatigue, and wheezing who were assessed for clinical, radiological, functional, and bronchoscopic alveolar lavage evaluation. Results: The mean age of 27 patients diagnosed with HP in our study is 67.4 years which comprises 11 males and 16 females. Out of 27 (92.6%), 25 patients had prior comorbidities, of which hypertension (HTN) (44.4%) and type 2 diabetes mellitus (33.3%) were major contributors. Among 27 patients, 55.56% were diagnosed with fibrotic HP and 44.44% with nonfibrotic HP. The average percent predicted forced vital capacity (FVC) of patients was 61.9. The most common high-resolution computerized tomography (HRCT) chest abnormalities were ground glass opacities (GGOs) (27%). In this study, four out of 12 patients reported positive for the HP panel test. The p-value of 0.031 established a statistically significant association between type of HP and history of avian exposure in patients. Conclusion: The prevalence of HP was found to be in patients of older age, and the association of avian exposure in patients has a statistical significance in determining the type of HP. Clinical significance: This study emphasizes the importance of identifying antigen sources related to disease prognosis among HP patients.

262

CASE REPORT

Mohit Bhatia, Gowthami Balasubramanian, Vijay Kumar, Priya Rajvansh

Left-sided Poland Syndrome Presenting as Chronic Respiratory Symptoms without Hand Deformity: A Rare Case Report

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:3] [Pages No:352 - 354]

Keywords: Case report, Chest wall deformity, Chronic respiratory symptoms, Poland syndrome

   DOI: 10.5005/jp-journals-11010-1069  |  Open Access |  How to cite  | 

Abstract

A 31-year-old male presented with chronic respiratory symptoms (recurrent cough with expectoration, chest pain, and breathlessness) for the last 3 years. On physical examination, there was a chest wall deformity showing depression in the left-sided anterior chest wall with the absence of nipple on the left side. Chest X-ray showed decreased translucency on the left side. Further computed tomography (CT) of the thorax revealed nonvisualization of the left pectoralis major and minor muscles, with volume loss of left upper lobe and hypoplastic left anterior second rib and mild hypoplasia of body and xiphoid process of sternum. Spirometry showed a restrictive pattern of disease. So, diagnosis of Poland syndrome of left hemithorax was made. Patient was treated symptomatically and referred to a plastic surgeon for correction.

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CASE REPORT

Kankana D Samanta, Arindam Kar

A Case Report on Use of Anesthetic Conserving Device in a Patient with Bullous Cystic Lung Disease

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:3] [Pages No:355 - 357]

Keywords: Anesthetic conserving device, Case report, Chronic obstructive pulmonary disease, Hypercarbia, Mechanical ventilator, Weaning

   DOI: 10.5005/jp-journals-11010-1073  |  Open Access |  How to cite  | 

Abstract

Aim and background: Mechanical ventilation is a lifesaving intervention used in critically ill patients with respiratory failure. However, it is not without risks, as it can cause harm to the lungs, increase the need for sedatives and analgesics, and prolong the time patients spend on mechanical ventilation. One way to mitigate these risks is by using an anesthetic conserving device (ACD). With the use of ACD, the use of volatile anesthetics like sevoflurane has been available for intensive care unit (ICU) critically ill patients having chronic pulmonary diseases for faster awakening, preventing critical myopathy and quicker weaning from the ventilator. Case description: In this case study, a 42-year-old female patient presented to the emergency room (ER) with a complaint of breathlessness persisting for 2 days. The patient had a medical history of left recurrent pneumothorax and bullous cystic lung disease. Upon admission to the ER, the patient exhibited drowsiness and hypotension, and arterial blood gas (ABG) analysis revealed severe respiratory acidosis. Consequently, the medical team decided to intubate the patient using pressure-regulated volume control (PRVC) ventilation while administering sedation and paralysis with atracurium, fentanyl, and a ketamine infusion. The use of ketamine infusion was initiated due to the acute exacerbation of chronic obstructive pulmonary disease (COPD), specifically type II respiratory failure. Employing an ACD proved to be highly beneficial in enhancing gas exchange and achieving more effective sedation. This approach facilitated quicker awakening and smoother weaning trials, a significant advantage when dealing with chronic pulmonary patients on mechanical ventilation. Remarkably, the patient was successfully transitioned to pressure support ventilation mode within just 4 days of implementing the ACD. Subsequently, the patient was extubated and placed on noninvasive ventilation, marking a successful outcome. Conclusion: This is a case study on the use of an ACD that facilitated quicker awakening and improved gas exchange, thereby reducing hypercarbia and peak airway pressures. Ultimately, this led to quicker weaning from the ventilator. Clinical significance: By utilizing an ACD, it has become possible to administer volatile anesthetics such as sevoflurane to critically ill patients in the ICU who suffer from chronic pulmonary diseases. This approach facilitates quicker awakening, helps prevent critical myopathy, and expedites the process of weaning patients from ventilatory support.

201

CASE REPORT

Islahuzzama S Ansari, Sachinkumar S Dole

An Unusual Case of Retropharyngeal Tubercular Abscess Due to Cervical Pott's Spine with Mediastinal Tubercular Lymphadenopathy: A Case Report

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:4] [Pages No:358 - 361]

Keywords: Case report, Lymphadenopathy, Pott's spine, Recurrence, Retropharyngeal abscess, Tuberculosis

   DOI: 10.5005/jp-journals-11010-1075  |  Open Access |  How to cite  | 

Abstract

Introduction: Tuberculosis (TB) including extrapulmonary tuberculosis is one of the most common diseases in developing countries like India. Spinal tuberculosis (Pott's spine) usually involves thoracolumber spine and rarely affects cervical spine. In addition retropharyngeal abscesses of tubercular origin are also one of rare presentations of cervical spine tuberculosis. Case description: We present a rare case of a 27-year-old female with a history of tubercular retropharyngeal abscess (RPA) associated with spinal tuberculosis (TB) (Pott's spine) involving the cervical spine. The patient was successfully managed with drainage of the abscess and antitubercular treatment (ATT). She later on had a recurrence of extrapulmonary TB in the form of mediastinal lymph node mass (drug-sensitive TB), which is rare in adults and was treated successfully with ATT. Such recurrence of extrapulmonary TB (drug-sensitive) in previously successfully treated cases of retropharyngeal tubercular abscess is an uncommon presentation of TB. Conclusion: Retropharyngeal abscess is one of the rare presentations of cervical Pott's spine. Despite its rarity, it should be aggressively treated due to life threatening complications. In case of its recurrence; other extrapulmonary lesions like mediastinal lymphadenopathy should be considered in diagnostic workup.

176

CASE SERIES

Jerin Paul P, Suresh Kumar D, Srinivasan R

Divulging the Pandora Box: A Case Series of Abnormal Chest X-ray in Asymptomatic Patients

[Year:2023] [Month:October-December] [Volume:12] [Number:4] [Pages:4] [Pages No:362 - 365]

Keywords: Asbestosis, Asymptomatic patients, Case report, Chest X-ray, Pneumoconiosis, Sarcoidosis, Silicosis, X-ray artifact

   DOI: 10.5005/jp-journals-11010-1072  |  Open Access |  How to cite  | 

Abstract

Chest X-ray is a rapid, noninvasive, and easily accessible diagnostic tool to diagnose chest diseases. We are presenting five cases of abnormal chest X-rays in asymptomatic patients. First is a case of classical hilar adenopathy with parenchymal infiltrates in stage two sarcoidosis. Second case is an abnormal chest X-ray due to hair plait artifact. Third and fourth cases carry evidence of pneumoconiosis in apparently normal patient. Fifth patient had abnormal chest X-ray due to extrapulmonary cause of Morgagni hernia. Although chest X-ray plays an important role in diagnosis of various diseases, proper history taking and clinical examination are mandatory before landing up in a diagnosis.

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