Richa Gupta | Christian Medical College, Vellore (original) (raw)

Papers by Richa Gupta

Journal of bronchology & interventional pulmonology, 2016

To the Editor: Misclassifying transudates into exudates can lead to unnecessary investigations an... more To the Editor: Misclassifying transudates into exudates can lead to unnecessary investigations and complications, but misclassifying exudates into transudates without accounting for the cause of the transudate can be dangerous. We describe the interesting evaluation of a patient with a low-protein borderline transudative pleural effusion. A 68-year-old, nonsmoking man presented with a 2-month history of progressive breathlessness on exertion, dry cough, and dull, aching left chest pain. His past history was significant for an episode of facial soft tissue infection near the lateral canthus of the left eye 4 months ago that subsequently healed with scarring, and drooping of the left upper eyelid by traction. At presentation his signs and symptoms were suggestive of a left-sided massive pleural effusion with mediastinal shift to the opposite side. A chest x-ray confirmed the same. Diagnostic thoracentesis revealed slightly hemorrhagic pleural fluid, and biochemical tests suggested a borderline transudate-protein 1.9 g% (serum total protein 6.8 g%) and lactate dehydrogenase (LDH) 293.9U/L (serum LDH 682U/L) with upper limit of laboratory normal serum LDH being 307U/L. Pleural fluid triglyceride level was 21mg%, and presence of pleural fluid chylomicrons (5mg%) was noted. Pleural fluid cytology did not reveal any malignant cells. On the basis of the history of left facial soft tissue swelling and subsequent development of a left-sided borderline transudative pleural effusion, we proceeded to check the patency of neck veins. The left internal jugular vein demonstrated diminished flow on bedside doppler ultrasonography with presence of a suspicious intravascular echogenic material. Computed tomography of the thorax with contrast was ordered and it confirmed our suspicion of deep venous thrombosis of the left brachiocephalic vein extending into the distal part of the left internal jugular vein (Fig. 1). In addition, the computed tomography of the thorax revealed nodular pleural thickening up to 21mm in thickness with the presence of suspicious hypodensities in the left collapsed lung. Medical thoracoscopy revealed the presence of a thick, whitish punched out appearance of the parietal pleura with few discrete nodules over the costal pleura. Biopsy of these nodules revealed poorly differentiated mucin-secreting adenocarcinoma (positive for TTF-1 and CK7 immunohistochemical markers). The patient did not want any further definitive treatment at our institute and hence pleurodesis was done with povidone iodine (10%) and the patient was discharged on anticoagulation with warfarin. The parietal pleural capillary ultimately drains into the right side of the heart through the brachiocephalic veins, which drain into the superior vena cava. The visceral pleural capillaries differ in that they drain into the left side of the heart through the pulmonary veins. A back pressure on the left intercostal veins draining the parietal pleural capillaries due to a left brachiocephalic vein thrombosis leads to a leftsided transudative pleural effusion as a result of increased hydrostatic pressures in the capillaries. Such scenarios of a left brachiocephalic vein “problem” with left-sided transudative or borderline transudative pleural effusions have been described to occur as a complication of central vein catheterization,1 as a consequence of left brachiocephalic vein resection for an invasive thymoma,2 and as a complication of intrathoracic goiter compressing on the central venous structures draining into the superior vena cava.3 Malignancy (intrathoracic and extrathoracic), central venous catheterization, and other thrombophilic states account for the majority of cases of central neck vein thrombosis,4 and hence in the absence of an obvious history of central vein catheterization a diligent search of malignancy should be conducted. Malignant transudative effusions are a rare occurrence. They are usually associated with an obvious cause like renal failure, congestive cardiac failure, and superior vena caval obstruction syndrome. More often, such effusions are low in protein but meet exudative criteria by LDH (borderline transudate). If there is no evident cause for the presence of a transudative or borderline transudative effusion in a patient with a high suspicion Disclosure: There is no conflict of interest or other disclosures.

Respiratory Medicine Extra, 2006

Connective tissue disorders are a known cause of interstitial pneumonias. But we are reporting he... more Connective tissue disorders are a known cause of interstitial pneumonias. But we are reporting here a case of primary Sjogren syndrome, which presented as interstitial pneumonia. There was complete clinical and radiological improvement with treatment with Mycophenolate and Prednisolone.

The Indian journal of tuberculosis, 2010

To assess the diagnostic yield and safety of closed pleural biopsy in patients with pleural effus... more To assess the diagnostic yield and safety of closed pleural biopsy in patients with pleural effusion. In all, 48 consecutive cases of pleural effusion were evaluated with complete pleural fluid biochemical and microbiological analysis, cytology, routine bacterial and mycobacterial cultures. In all these 48 cases of pleural effusion closed pleural biopsy was done with tru-cut biopsy needle and biopsy samples were sent for histopathology and mycobacterial culture. Out of 48 cases, main causes of pleural effusion were Tuberculosis in 21(43.8%) cases, Malignancy in 14 (29.2%) cases, paramalignant effusion in six (12.5%) cases, Empyema in three (6.3%) cases, transudative effusion in three (6.3%) cases and parapneumonic effusion in one (1.9%) case. Diagnostic yield of closed pleural biopsy was 62.2% in cases of all exudative pleural effusion, 76.2% in cases of tubercular pleural effusion and 85.7% in cases of malignant pleural effusion. There was no incidence of post pleural biopsy pneumo...

Lung India : official organ of Indian Chest Society

Journal of Bronchology, 2007

Foreign body aspiration is a common problem necessitating prompt recognition and early treatment.... more Foreign body aspiration is a common problem necessitating prompt recognition and early treatment. Very rarely, foreign bodies left in situ after surgical interventions in the lung or other sites can migrate into the bronchial tree and cause symptoms. We report a case of chronic cough and hemoptysis 7 years after mitral valve replacement in whom bronchoscopy revealed an endobronchial suture, which presumably migrated from its original site in the heart. Removal of the suture was followed by prompt resolution of symptoms.

Respirology (Carlton, Vic.), Jul 27, 2018

Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion ... more Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci-bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue. We report our experience of using Xpert on thoracoscopic pleural biopsy samples. We retrospectively reviewed the records of patients who underwent thoracoscopy in our institution over a 1-year period. Relevant clinical details; indications; and results of tests on pleural tissue and fluid, including histopathology, mycobacterial cultures and Xpert, were extracted. Of the 156 patients who underwent thoracoscopy, 73 (47%) had TB, 66 (42%) malignancy a...

Background / Purpose: To assess the safety and efficacy of 4 months rifampicin (4R) therapy for L... more Background / Purpose: To assess the safety and efficacy of 4 months rifampicin (4R) therapy for LTBI.4R therapy was offered to recent tuberculin skin test (TST) converts. Main conclusion: Annual TST conversion rate was about 4% in young nursing students in South India. Among the 70% of cases of TST converts, QFT was also positive. 4 months of rifampicin therapy is safe and effective treatment of LTBI. This is first study of 4R therapy from the Indian subcontinent.

Respiratory Medicine Extra, 2006

Pulmonary cryptococcosis is usually diagnosed by detection of cryptococcal antigen or by culture ... more Pulmonary cryptococcosis is usually diagnosed by detection of cryptococcal antigen or by culture from the pleural fluid or bronchoalveolar lavage fluid (BAL), or by histopathology of the lung biopsy specimen. Diagnosis of cryptococcal pleural effusion by closed pleural biopsy (CPB) has been reported only once [Katz AS, Niesenbaum L, Mass B. Pleural effusion as the initial manifestation of disseminated cryptococcosis in acquired immune deficiency syndrome. Diagnosis by pleural biopsy. Chest 1989; 96: 440–1]. We report ...

The Indian journal of chest diseases & allied sciences

Thoracoscopy is usually carried out using rigid metallic instruments. Recently, video flex-rigid ... more Thoracoscopy is usually carried out using rigid metallic instruments. Recently, video flex-rigid or semi-rigid thoracoscopes have been introduced. These have the advantage of easy maneuverability, although the biopsy samples are smaller as compared to those with rigid thoracoscopy. We have looked at the usefulness of flex rigid thoracoscope in the diagnosis and treatment of pleural diseases, remained undiagnosed after thoracentesis and closed biopsy. Retrospective analysis of data of patients who underwent thoracoscopy for the evaluation of pleural disease. Thoracoscopy was done in 21 patients using a flex-rigid thoracoscope in our institution. The indication was pleural effusion with inconclusive or negative pleural fluid cytology and blind pleural biopsy in 18 of the 21 patients. Thoracoscopic biopsy was positive in 12 of the 18 patients (66.7%). Of the six who had a negative biopsy, the procedure indirectly helped in patient management in five. There were no significant procedure...

The Indian journal of tuberculosis, 2011

Even with the use of maximum pharmacological treatment, asthma still remains uncontrolled in some... more Even with the use of maximum pharmacological treatment, asthma still remains uncontrolled in some cases. For such cases of uncontrolled asthma, a novel therapy--Bronchial Thermoplasty (BT)--has shown some promising results over the past few years. BT is application of controlled radiofrequency heat via catheter inserted through a flexible bronchoscope, to the bronchial walls. It reduces the smooth muscle mass in bronchial wall and thus results in decreased contractility. Three major trials of BT show that it does not cause any improvement in FEV1. However, BT causes improvement the quality of life and decreases the future exacerbations and emergency hospital visits due to asthma. But the benefit observed was too small to be clinically significant. Follow up (two to five years) results of these BT trials did not show any significant long-term adverse event related to BT. However, further independent large randomized controlled trials and results of application of BT in real hospital ...

BMJ case reports, Jan 9, 2014

Medical thoracoscopy is an excellent diagnostic and therapeutic tool for management of pleural di... more Medical thoracoscopy is an excellent diagnostic and therapeutic tool for management of pleural diseases. There have been case reports of removal of foreign bodies from pleural spaces with video-assisted thoracoscopic surgery under general anaesthesia by thoracic surgeons. We present a case of successful removal of an 8 cm long metal needle from the pleural space with single port medical semirigid thoracoscopy under local anaesthesia by a chest physician. Removal of a foreign body from the pleural space is one more indication for medical thoracoscopy, however, an experienced chest physician and proper case selection are very important for safety and a successful outcome of this procedure.

The Clinical Respiratory Journal, 2010

Background and Aims: Systemic air embolism is recognized as a rare but potentially fatal complica... more Background and Aims: Systemic air embolism is recognized as a rare but potentially fatal complication of trans-thoracic needle biopsy of the lung. Methods: We report the case of a young female who developed fatal cerebral air embolism following computed tomography (CT) guided needle biopsy of a lung mass. Results: Immediately after the procedure, the patient went into cardio-respiratory arrest. Despite adequate resuscitation and ventilatory support, she showed little recovery in her neurological status and subsequently died. CT scan of the brain confirmed cerebral arterial air embolism. Conclusion: Radiologists and physicians need to be aware of this rare but potentially fatal complication of needle lung biopsy.

Clinical Rheumatology, 1998

International Journal of Tuberculosis and Lung Disease, 2009

A 24-year-old non-smoking staff nurse presented with a history of fever, cough and weight loss fo... more A 24-year-old non-smoking staff nurse presented with a history of fever, cough and weight loss for 2 months. Chest radiography showed left upper zone air space opacities. Sputum smears were positive for acid-fast bacilli (AFB). She had no history of close contact with tuberculosis patients before starting as a nursing student in a tertiary care hospital in south India. Afterwards, she worked as a staff nurse for 9 years before developing tuberculosis. She was started on a daily regimen of rifampicin, isoniazid, pyrazinamide ...

Journal of Bronchology, 2006

Abstract This 64-year-old man presented with cough, purulent expectoration, and hemoptysis for 5 ... more Abstract This 64-year-old man presented with cough, purulent expectoration, and hemoptysis for 5 years; received repeated courses of antibiotics. Computed tomography thorax revealed bronchiectasis. At flexible bronchoscopy, 2 betel nuts and a peanut were removed from both lower lobes and right upper lobe, respectively. After this, his symptoms improved. Though uncommon, multiple foreign body aspirations in different parts of the lung are possible. Bronchoscopists must perform thorough evaluation of the endobronchial tree ...

The Clinical Respiratory Journal, 2010

Aim: To study the anti-tubercular drug resistance pattern among suspected cases of drug-resistant... more Aim: To study the anti-tubercular drug resistance pattern among suspected cases of drug-resistant TB. Materials and Methods: First and second line drug susceptibility data were retrospectively analysed for all suspected cases of drug-resistant tuberculosis (TB), presenting to the Pulmonary Medicine department of tertiary care hospital in South India from 2003 to 2007. Results and Discussion: Out of 177 cases of suspected drug-resistant TB, 103 (58.2%) cases were multi-drug-resistant tuberculosis (MDR-TB). Out of 75 cases of MDR-TB for whom second-line drug susceptibility test was performed, 45 (60.0%) cases met the criteria of extensively drug-resistant (XDR) TB, which is very high when compared with existing worldwide data on XDR-TB (6.6% cases of MDR-TB). In comparison with non-MDR-TB cases, MDR and XDR-TB cases had a history of significantly higher duration of anti-TB treatment (ATT) and significantly higher exposure to multiple ATT regimens. Past exposure to second-line anti-TB drugs was significantly high in XDR-TB cases than in MDR-TB and non MDR-TB cases. Conclusion: This study highlights the high burden of XDR-and MDR-TB among TB patients coming to tertiary care hospitals in India.

PLOS One, 2010

Background: Among healthcare workers in developing countries, nurses spend a large amount of time... more Background: Among healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.

Respiratory Medicine Extra, 2005

Pneumothorax is a well-known complication of transbronchial lung biopsy. But pleural space infect... more Pneumothorax is a well-known complication of transbronchial lung biopsy. But pleural space infection and empyema following TBLB, although theoretically possible, has not been documented. A 35-year-old gentleman presented with a non-resolving pneumonia of the right middle lobe. As a part of evaluation he underwent fiberoptic bronchoscopy and TBLB without fluoroscopic guidance. He developed pneumothorax, which was managed by needle aspiration. Subsequently, he developed fever and was detected to have right- ...

Journal of Bronchology, 2006

To the Editor: Bronchoscopy is regarded as a pivotal diagnostic and therapeutic tool in Pulmonary... more To the Editor: Bronchoscopy is regarded as a pivotal diagnostic and therapeutic tool in Pulmonary Medicine. It is a sufficiently safe and nontraumatic method of obtaining biopsies of the lung with an overall complication reported as 2% to 15%. 1, 2 The most common complications are Pneumothorax (0.5% to 5%) 1, 3 and local pulmonary hemorrhage. We encountered an unusual and apparently benign complication of pneumomediastinum resulting from transbronchial lung biopsy (TBLB). A 47-year-old lady presented for ...

Respirology, 2004

Prasad R, James P, Kesarwani V, Gupta R, Pant MC, Chaturvedi A, Shrivastava AN. Respirology 2004;... more Prasad R, James P, Kesarwani V, Gupta R, Pant MC, Chaturvedi A, Shrivastava AN. Respirology 2004; 9: 557-560 Objective: The present study was undertaken to explore the clinicopathological profile of bronchogenic carcinoma. Methodology: Four hundred consecutive patients with histopathologically proven bronchogenic carcinoma, hospitalized between 1985 and 1999 at a large teaching and tertiary care referral hospital at King George's Medical University in Lucknow, India, were analysed. Results: The average age of the bronchogenic carcinoma patients was 57 years; 9.8% of patients were less than 40 years of age; the ratio of male to female patients was 4.3:1.0; 71% were smokers; and 87% of the smoking patients were bidi smokers. The most common histological type was squamouscell carcinoma (46.5%), followed by adenocarcinoma (18.5%) and small-cell carcinoma (18.2%). The majority of patients (74.2%) were diagnosed in the late stages of the disease (IIIb and IV). Conclusion: Bidi smoking is an important contributory factor in the development of bronchogenic carcinoma in India, and approximately 25% of patients with bronchogenic carcinoma are nonsmokers.

Journal of bronchology & interventional pulmonology, 2016

To the Editor: Misclassifying transudates into exudates can lead to unnecessary investigations an... more To the Editor: Misclassifying transudates into exudates can lead to unnecessary investigations and complications, but misclassifying exudates into transudates without accounting for the cause of the transudate can be dangerous. We describe the interesting evaluation of a patient with a low-protein borderline transudative pleural effusion. A 68-year-old, nonsmoking man presented with a 2-month history of progressive breathlessness on exertion, dry cough, and dull, aching left chest pain. His past history was significant for an episode of facial soft tissue infection near the lateral canthus of the left eye 4 months ago that subsequently healed with scarring, and drooping of the left upper eyelid by traction. At presentation his signs and symptoms were suggestive of a left-sided massive pleural effusion with mediastinal shift to the opposite side. A chest x-ray confirmed the same. Diagnostic thoracentesis revealed slightly hemorrhagic pleural fluid, and biochemical tests suggested a borderline transudate-protein 1.9 g% (serum total protein 6.8 g%) and lactate dehydrogenase (LDH) 293.9U/L (serum LDH 682U/L) with upper limit of laboratory normal serum LDH being 307U/L. Pleural fluid triglyceride level was 21mg%, and presence of pleural fluid chylomicrons (5mg%) was noted. Pleural fluid cytology did not reveal any malignant cells. On the basis of the history of left facial soft tissue swelling and subsequent development of a left-sided borderline transudative pleural effusion, we proceeded to check the patency of neck veins. The left internal jugular vein demonstrated diminished flow on bedside doppler ultrasonography with presence of a suspicious intravascular echogenic material. Computed tomography of the thorax with contrast was ordered and it confirmed our suspicion of deep venous thrombosis of the left brachiocephalic vein extending into the distal part of the left internal jugular vein (Fig. 1). In addition, the computed tomography of the thorax revealed nodular pleural thickening up to 21mm in thickness with the presence of suspicious hypodensities in the left collapsed lung. Medical thoracoscopy revealed the presence of a thick, whitish punched out appearance of the parietal pleura with few discrete nodules over the costal pleura. Biopsy of these nodules revealed poorly differentiated mucin-secreting adenocarcinoma (positive for TTF-1 and CK7 immunohistochemical markers). The patient did not want any further definitive treatment at our institute and hence pleurodesis was done with povidone iodine (10%) and the patient was discharged on anticoagulation with warfarin. The parietal pleural capillary ultimately drains into the right side of the heart through the brachiocephalic veins, which drain into the superior vena cava. The visceral pleural capillaries differ in that they drain into the left side of the heart through the pulmonary veins. A back pressure on the left intercostal veins draining the parietal pleural capillaries due to a left brachiocephalic vein thrombosis leads to a leftsided transudative pleural effusion as a result of increased hydrostatic pressures in the capillaries. Such scenarios of a left brachiocephalic vein “problem” with left-sided transudative or borderline transudative pleural effusions have been described to occur as a complication of central vein catheterization,1 as a consequence of left brachiocephalic vein resection for an invasive thymoma,2 and as a complication of intrathoracic goiter compressing on the central venous structures draining into the superior vena cava.3 Malignancy (intrathoracic and extrathoracic), central venous catheterization, and other thrombophilic states account for the majority of cases of central neck vein thrombosis,4 and hence in the absence of an obvious history of central vein catheterization a diligent search of malignancy should be conducted. Malignant transudative effusions are a rare occurrence. They are usually associated with an obvious cause like renal failure, congestive cardiac failure, and superior vena caval obstruction syndrome. More often, such effusions are low in protein but meet exudative criteria by LDH (borderline transudate). If there is no evident cause for the presence of a transudative or borderline transudative effusion in a patient with a high suspicion Disclosure: There is no conflict of interest or other disclosures.

Respiratory Medicine Extra, 2006

Connective tissue disorders are a known cause of interstitial pneumonias. But we are reporting he... more Connective tissue disorders are a known cause of interstitial pneumonias. But we are reporting here a case of primary Sjogren syndrome, which presented as interstitial pneumonia. There was complete clinical and radiological improvement with treatment with Mycophenolate and Prednisolone.

The Indian journal of tuberculosis, 2010

To assess the diagnostic yield and safety of closed pleural biopsy in patients with pleural effus... more To assess the diagnostic yield and safety of closed pleural biopsy in patients with pleural effusion. In all, 48 consecutive cases of pleural effusion were evaluated with complete pleural fluid biochemical and microbiological analysis, cytology, routine bacterial and mycobacterial cultures. In all these 48 cases of pleural effusion closed pleural biopsy was done with tru-cut biopsy needle and biopsy samples were sent for histopathology and mycobacterial culture. Out of 48 cases, main causes of pleural effusion were Tuberculosis in 21(43.8%) cases, Malignancy in 14 (29.2%) cases, paramalignant effusion in six (12.5%) cases, Empyema in three (6.3%) cases, transudative effusion in three (6.3%) cases and parapneumonic effusion in one (1.9%) case. Diagnostic yield of closed pleural biopsy was 62.2% in cases of all exudative pleural effusion, 76.2% in cases of tubercular pleural effusion and 85.7% in cases of malignant pleural effusion. There was no incidence of post pleural biopsy pneumo...

Lung India : official organ of Indian Chest Society

Journal of Bronchology, 2007

Foreign body aspiration is a common problem necessitating prompt recognition and early treatment.... more Foreign body aspiration is a common problem necessitating prompt recognition and early treatment. Very rarely, foreign bodies left in situ after surgical interventions in the lung or other sites can migrate into the bronchial tree and cause symptoms. We report a case of chronic cough and hemoptysis 7 years after mitral valve replacement in whom bronchoscopy revealed an endobronchial suture, which presumably migrated from its original site in the heart. Removal of the suture was followed by prompt resolution of symptoms.

Respirology (Carlton, Vic.), Jul 27, 2018

Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion ... more Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci-bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue. We report our experience of using Xpert on thoracoscopic pleural biopsy samples. We retrospectively reviewed the records of patients who underwent thoracoscopy in our institution over a 1-year period. Relevant clinical details; indications; and results of tests on pleural tissue and fluid, including histopathology, mycobacterial cultures and Xpert, were extracted. Of the 156 patients who underwent thoracoscopy, 73 (47%) had TB, 66 (42%) malignancy a...

Background / Purpose: To assess the safety and efficacy of 4 months rifampicin (4R) therapy for L... more Background / Purpose: To assess the safety and efficacy of 4 months rifampicin (4R) therapy for LTBI.4R therapy was offered to recent tuberculin skin test (TST) converts. Main conclusion: Annual TST conversion rate was about 4% in young nursing students in South India. Among the 70% of cases of TST converts, QFT was also positive. 4 months of rifampicin therapy is safe and effective treatment of LTBI. This is first study of 4R therapy from the Indian subcontinent.

Respiratory Medicine Extra, 2006

Pulmonary cryptococcosis is usually diagnosed by detection of cryptococcal antigen or by culture ... more Pulmonary cryptococcosis is usually diagnosed by detection of cryptococcal antigen or by culture from the pleural fluid or bronchoalveolar lavage fluid (BAL), or by histopathology of the lung biopsy specimen. Diagnosis of cryptococcal pleural effusion by closed pleural biopsy (CPB) has been reported only once [Katz AS, Niesenbaum L, Mass B. Pleural effusion as the initial manifestation of disseminated cryptococcosis in acquired immune deficiency syndrome. Diagnosis by pleural biopsy. Chest 1989; 96: 440–1]. We report ...

The Indian journal of chest diseases & allied sciences

Thoracoscopy is usually carried out using rigid metallic instruments. Recently, video flex-rigid ... more Thoracoscopy is usually carried out using rigid metallic instruments. Recently, video flex-rigid or semi-rigid thoracoscopes have been introduced. These have the advantage of easy maneuverability, although the biopsy samples are smaller as compared to those with rigid thoracoscopy. We have looked at the usefulness of flex rigid thoracoscope in the diagnosis and treatment of pleural diseases, remained undiagnosed after thoracentesis and closed biopsy. Retrospective analysis of data of patients who underwent thoracoscopy for the evaluation of pleural disease. Thoracoscopy was done in 21 patients using a flex-rigid thoracoscope in our institution. The indication was pleural effusion with inconclusive or negative pleural fluid cytology and blind pleural biopsy in 18 of the 21 patients. Thoracoscopic biopsy was positive in 12 of the 18 patients (66.7%). Of the six who had a negative biopsy, the procedure indirectly helped in patient management in five. There were no significant procedure...

The Indian journal of tuberculosis, 2011

Even with the use of maximum pharmacological treatment, asthma still remains uncontrolled in some... more Even with the use of maximum pharmacological treatment, asthma still remains uncontrolled in some cases. For such cases of uncontrolled asthma, a novel therapy--Bronchial Thermoplasty (BT)--has shown some promising results over the past few years. BT is application of controlled radiofrequency heat via catheter inserted through a flexible bronchoscope, to the bronchial walls. It reduces the smooth muscle mass in bronchial wall and thus results in decreased contractility. Three major trials of BT show that it does not cause any improvement in FEV1. However, BT causes improvement the quality of life and decreases the future exacerbations and emergency hospital visits due to asthma. But the benefit observed was too small to be clinically significant. Follow up (two to five years) results of these BT trials did not show any significant long-term adverse event related to BT. However, further independent large randomized controlled trials and results of application of BT in real hospital ...

BMJ case reports, Jan 9, 2014

Medical thoracoscopy is an excellent diagnostic and therapeutic tool for management of pleural di... more Medical thoracoscopy is an excellent diagnostic and therapeutic tool for management of pleural diseases. There have been case reports of removal of foreign bodies from pleural spaces with video-assisted thoracoscopic surgery under general anaesthesia by thoracic surgeons. We present a case of successful removal of an 8 cm long metal needle from the pleural space with single port medical semirigid thoracoscopy under local anaesthesia by a chest physician. Removal of a foreign body from the pleural space is one more indication for medical thoracoscopy, however, an experienced chest physician and proper case selection are very important for safety and a successful outcome of this procedure.

The Clinical Respiratory Journal, 2010

Background and Aims: Systemic air embolism is recognized as a rare but potentially fatal complica... more Background and Aims: Systemic air embolism is recognized as a rare but potentially fatal complication of trans-thoracic needle biopsy of the lung. Methods: We report the case of a young female who developed fatal cerebral air embolism following computed tomography (CT) guided needle biopsy of a lung mass. Results: Immediately after the procedure, the patient went into cardio-respiratory arrest. Despite adequate resuscitation and ventilatory support, she showed little recovery in her neurological status and subsequently died. CT scan of the brain confirmed cerebral arterial air embolism. Conclusion: Radiologists and physicians need to be aware of this rare but potentially fatal complication of needle lung biopsy.

Clinical Rheumatology, 1998

International Journal of Tuberculosis and Lung Disease, 2009

A 24-year-old non-smoking staff nurse presented with a history of fever, cough and weight loss fo... more A 24-year-old non-smoking staff nurse presented with a history of fever, cough and weight loss for 2 months. Chest radiography showed left upper zone air space opacities. Sputum smears were positive for acid-fast bacilli (AFB). She had no history of close contact with tuberculosis patients before starting as a nursing student in a tertiary care hospital in south India. Afterwards, she worked as a staff nurse for 9 years before developing tuberculosis. She was started on a daily regimen of rifampicin, isoniazid, pyrazinamide ...

Journal of Bronchology, 2006

Abstract This 64-year-old man presented with cough, purulent expectoration, and hemoptysis for 5 ... more Abstract This 64-year-old man presented with cough, purulent expectoration, and hemoptysis for 5 years; received repeated courses of antibiotics. Computed tomography thorax revealed bronchiectasis. At flexible bronchoscopy, 2 betel nuts and a peanut were removed from both lower lobes and right upper lobe, respectively. After this, his symptoms improved. Though uncommon, multiple foreign body aspirations in different parts of the lung are possible. Bronchoscopists must perform thorough evaluation of the endobronchial tree ...

The Clinical Respiratory Journal, 2010

Aim: To study the anti-tubercular drug resistance pattern among suspected cases of drug-resistant... more Aim: To study the anti-tubercular drug resistance pattern among suspected cases of drug-resistant TB. Materials and Methods: First and second line drug susceptibility data were retrospectively analysed for all suspected cases of drug-resistant tuberculosis (TB), presenting to the Pulmonary Medicine department of tertiary care hospital in South India from 2003 to 2007. Results and Discussion: Out of 177 cases of suspected drug-resistant TB, 103 (58.2%) cases were multi-drug-resistant tuberculosis (MDR-TB). Out of 75 cases of MDR-TB for whom second-line drug susceptibility test was performed, 45 (60.0%) cases met the criteria of extensively drug-resistant (XDR) TB, which is very high when compared with existing worldwide data on XDR-TB (6.6% cases of MDR-TB). In comparison with non-MDR-TB cases, MDR and XDR-TB cases had a history of significantly higher duration of anti-TB treatment (ATT) and significantly higher exposure to multiple ATT regimens. Past exposure to second-line anti-TB drugs was significantly high in XDR-TB cases than in MDR-TB and non MDR-TB cases. Conclusion: This study highlights the high burden of XDR-and MDR-TB among TB patients coming to tertiary care hospitals in India.

PLOS One, 2010

Background: Among healthcare workers in developing countries, nurses spend a large amount of time... more Background: Among healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.

Respiratory Medicine Extra, 2005

Pneumothorax is a well-known complication of transbronchial lung biopsy. But pleural space infect... more Pneumothorax is a well-known complication of transbronchial lung biopsy. But pleural space infection and empyema following TBLB, although theoretically possible, has not been documented. A 35-year-old gentleman presented with a non-resolving pneumonia of the right middle lobe. As a part of evaluation he underwent fiberoptic bronchoscopy and TBLB without fluoroscopic guidance. He developed pneumothorax, which was managed by needle aspiration. Subsequently, he developed fever and was detected to have right- ...

Journal of Bronchology, 2006

To the Editor: Bronchoscopy is regarded as a pivotal diagnostic and therapeutic tool in Pulmonary... more To the Editor: Bronchoscopy is regarded as a pivotal diagnostic and therapeutic tool in Pulmonary Medicine. It is a sufficiently safe and nontraumatic method of obtaining biopsies of the lung with an overall complication reported as 2% to 15%. 1, 2 The most common complications are Pneumothorax (0.5% to 5%) 1, 3 and local pulmonary hemorrhage. We encountered an unusual and apparently benign complication of pneumomediastinum resulting from transbronchial lung biopsy (TBLB). A 47-year-old lady presented for ...

Respirology, 2004

Prasad R, James P, Kesarwani V, Gupta R, Pant MC, Chaturvedi A, Shrivastava AN. Respirology 2004;... more Prasad R, James P, Kesarwani V, Gupta R, Pant MC, Chaturvedi A, Shrivastava AN. Respirology 2004; 9: 557-560 Objective: The present study was undertaken to explore the clinicopathological profile of bronchogenic carcinoma. Methodology: Four hundred consecutive patients with histopathologically proven bronchogenic carcinoma, hospitalized between 1985 and 1999 at a large teaching and tertiary care referral hospital at King George's Medical University in Lucknow, India, were analysed. Results: The average age of the bronchogenic carcinoma patients was 57 years; 9.8% of patients were less than 40 years of age; the ratio of male to female patients was 4.3:1.0; 71% were smokers; and 87% of the smoking patients were bidi smokers. The most common histological type was squamouscell carcinoma (46.5%), followed by adenocarcinoma (18.5%) and small-cell carcinoma (18.2%). The majority of patients (74.2%) were diagnosed in the late stages of the disease (IIIb and IV). Conclusion: Bidi smoking is an important contributory factor in the development of bronchogenic carcinoma in India, and approximately 25% of patients with bronchogenic carcinoma are nonsmokers.