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Papers by Ketaki Utpat

Research paper thumbnail of The diagnostic utility of squash smear cytology in lung malignancies

The Egyptian Journal of Bronchology

Background Lung malignancy is the most common cause of death worldwide. The main role of patholog... more Background Lung malignancy is the most common cause of death worldwide. The main role of pathologist is to differentiate small cell from other cell types as treatment and prognosis varies. Although histopathology is routinely done, squash smears yield better cytomorphology. Aims and objectives To study the clinical history, evaluate the diagnostic yield by means of cytology and histopathology correlation followed by determination of sensitivity and specificity of squash smear cytology for detection of lung malignancies. Materials and methods The present study was an observational analytical study conducted over a period of 3.5 years. Total 60 squash smears were obtained by computed tomography-/bronchoscopy-guided biopsy and stained with Papanicolaou and May-Grunwald stain. Squash smears were correlated with histopathological findings. Statistical analysis Statistics in the form of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood rat...

Research paper thumbnail of Pulmonary hypertension: A simplified pulmonologists' perspective

Medical Journal of Dr. D.Y. Patil Vidyapeeth, 2021

Pulmonary hypertension (PH) is a progressive disorder of the pulmonary vasculature caused due to ... more Pulmonary hypertension (PH) is a progressive disorder of the pulmonary vasculature caused due to vasoconstriction, vasodestruction, or vaso-obliteration. PH results from heterogeneous pathophysiologic mechanisms culminating in elevation of mean pulmonary arterial pressure. Patients may either present with symptoms or with chest radiographic, electrocardiographic, or echocardiographic findings done as a part of diagnostic evaluation for the primary disease or as a part of preoperative assessment. And hence, the clinician resorted to could be a family physician, pulmonologist, cardiologist, surgeon, or anesthesiologist. Hence, there is a necessity of a basic awareness about its clinical presentations, diagnostic modalities, and the available treatment options. The diagnosis can be perplexing and warrants a stepwise evaluation. Echocardiography (ECHO) is the preliminary diagnostic modality and provides a fairly accurate judgment of the pulmonary artery pressure; however, some patients may require an invasive evaluation by right heart catheterization. The definitive management of PH depends on the underlying etiology. Pulmonary arterial hypertension has a specific set of targeted pharmacotherapy, while for other categories of PH, treatment majorly focuses on counseling, management of the underlying disorder, and cardiopulmonary rehabilitation. The 6th World Symposium on PH has catered to all these issues and has incorporated manifold pertinent modifications in all these areas. Hence, we conducted an online survey to gauge the awareness about the entity and its facets among pulmonologists and penned down this review based the current concepts about PH to bridge the gaps in the existing knowledge.

Research paper thumbnail of Bronchiectasis in a Nine Year Old Girl: A Rare Syndromic Association

Ataxia telengectasia (AT) is an unaccustomed multisystemic genome instability syndrome with an au... more Ataxia telengectasia (AT) is an unaccustomed multisystemic genome instability syndrome with an autosomal recessive pattern of inheritance. It is primarily characterized by a constellation of features including cerebellar degeneration, telangiectasias, recurrent sinopulmonary infections and increased susceptibility to malignancies. Diagnostic delays can culminate in irrevocable sequelae leading to significant morbidity. We herein report a case of a nine year old child presenting with recurrent chest infections, ataxic gait and developmental delay who was diagnosed as a case of AT with a multimodality approach.

Research paper thumbnail of Pulmonary Vocal Syndrome

The Journal of the Association of Physicians of India, 2019

Vocal cord paralysis is a common entity with diverse causes clinically manifesting as dysphonia. ... more Vocal cord paralysis is a common entity with diverse causes clinically manifesting as dysphonia. Vocal cord paralysis due to respiratory cause is due to involvement of left recurrent laryngeal nerve usually secondary to bronchogenic carcinoma. However, it can also be seen in association with other less well recognised causes such as pulmonary tuberculosis. We present to you a patient with hoarseness of voice due to left recurrent laryngeal nerve paralysis secondary to endobronchial tuberculosis.

Research paper thumbnail of A study of glycemic variability in patients with type 2 diabetes mellitus with obstructive sleep apnea syndrome using a continuous glucose monitoring system

Clinical Diabetes and Endocrinology, 2020

Background Obstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (... more Background Obstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (DM) may result in increased glycemic variability affecting the glycemic control and hence increasing the risk of complications associated with diabetes. We decided to assess the Glycemic Variability (GV) in patients with type 2 diabetes with OSAS and in controls. We also correlated the respiratory disturbance indices with glycemic variability indices. Methods After fulfilling the inclusion and exclusion criteria patients from the Endocrinology and Pulmonology clinics underwent modified Sleep Apnea Clinical Score (SACS) followed by polysomnography (PSG). Patients were then divided into 4 groups: Group A (DM with OSAS, n = 20), Group B (DM without OSAS, n = 20), Group C (Non DM with OSAS, n = 10) and Group D (Non DM without OSAS, n = 10). Patients in these groups were subjected to continuous glucose monitoring using the Medtronic iPro2 and repeat PSG. Parameters of GV: i.e. mean glucose, S...

Research paper thumbnail of “Esophagomediastinal fistula presenting as drug resistant tuberculosis”

Indian Journal of Tuberculosis, 2019

Research paper thumbnail of Diagnostic Utility of Closed Needle Pleural Biopsy in Exudative Pleural Effusions

Research paper thumbnail of Clinical profile of pulmonary hypertension at a tertiary care centre, India

Pulmonary Circulation and Pulmonary Vascular Disease, 2017

Background: Pulmonary Hypertension (PH) is a pernicious disorder of the pulmonary vasculature. PH... more Background: Pulmonary Hypertension (PH) is a pernicious disorder of the pulmonary vasculature. PH is a complication of a varied spectrum of diseases referred to a pulmonologist, of which post infectious sequelae are a major emerging cause in developing countries like India. Methods: This observational study, undertaken in the department of Pulmonary Medicine at a tertiary care centre, included consecutive patients with PH as estimated pulmonary artery systolic pressure (PASP) of ≥40 mmHg by trans-thoracic two-dimensional echocardiography (corresponding to mean pulmonary artery pressure of ≥25mmHg). Clinical, functional and radiological parameters were noted. Data was analysed using Microsoft Excel software. Results: Out of 347 patients, 187 (54%) were men and 160 (46%) were women. Majority (53.5%) belonged to the age group 45 to 65 years. Dyspnea (85.8%) and loud pulmonary component of second heart sound (72%) were the commonest clinical findings. Mean six-minute walk distance, FVC, FEV1, PaO2, PaCO2, and PASP were 283.72m (±102.7), 53.6% (±15), 48.6 % (±15), 70.78 mmHg, 38.7 mmHg, and 45.6 mmHg (±15.8) respectively. Chest radiograph and electrocardiography had poor sensitivity in identification of PH. The common etiologies of PH constituted of post infectious obliterative bronchiolitis (30%), ILD (28.5%), COPD (24%), Obstructive Sleep Apnea (12.5%), HIV (1.8%), and PAH (1.5%). Conclusion: Post infectious obliterative bronchiolitis is the most common cause of PH in the Indian population.

Research paper thumbnail of Authors Response: Outcomes in multidrug resistant tuberculosis

Medical Journal of Dr. D.Y. Patil University, 2017

Research paper thumbnail of Klippel–Feil syndrome with inherited coagulopathy: A rare case report

Medical Journal of Dr. D.Y. Patil University, 2017

Klippel–Feil syndrome is a rare disease known to be associated with many musculoskeletal as well ... more Klippel–Feil syndrome is a rare disease known to be associated with many musculoskeletal as well as somatic diseases. Thromboembolism is one of the complications, which although rarely described earlier with this syndrome, can be life-threatening. Earlier case reports have attributed it to structural abnormalities seen in this syndrome. We, however, report a rare instance of inherited coagulopathy seen with Klippel–Feil syndrome, leading to pulmonary thromboembolism.

Research paper thumbnail of Bilateral tuberculous otitis media: An unique presentation

Indian Journal of Tuberculosis, 2017

Research paper thumbnail of Tropical Pulmonary Eosinophilia- an Elaborate Case Series

Journal of Evidence Based Medicine and Healthcare, 2019

Research paper thumbnail of Tuberculosis at the time of Coronavirus disease (COVID-19) lockdown - Back to the days of yore!!!

Pneumologia

Background: The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have s... more Background: The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have served as a major setback to tuberculosis (TB) control. We therefore conducted this study to assess the profile of TB patients presenting to our department immediately after COVID-19 lockdown, which was imposed in India from 24 March 2020 and continued for >3 months, and to compare it with the pre-pandemic pattern. Methods: This was an observational study conducted at the pulmonary medicine department of our tertiary care institute. We evaluated the consecutive cases of TB referred to or diagnosed new by our department as soon as the lockdown was lifted and non-COVID services resumed. The data of 2020 and 2019 during September and October month were gathered and analysed retrospectively. Results: A total of 162 patients were hospitalised from September to October 2019, while 40 non-COVID patients were hospitalised during September to October 2020 in our unit. The mean duration of sympt...

Research paper thumbnail of Evaluation of thoracic diseases with computed tomography guided biopsy

PULMONOLOGIYA

Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology ... more Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology (FNAC) and fine needle aspiration biopsy (FNAB) are reliable techniques for diagnosing various thoracic diseases. These modalities are used for diagnosis in suspicious lung, pleural, mediastinal and vertebral and pulmonary lesions.The aim. We conducted a study in a Pulmonary Medicine Department of tertiary care hospital to study the efficacy and safety of CT guided FNCA/FNAB in thoracic diseases.Methods. A retrospective study was conducted at a tertiary care center with Information and Ethics committee permission within a total duration of two years. The study included patients presenting with following: 1) mediastinal mass lesions, 2) pulmonary solitary pulmonary nodules/masses, 3) pulmonary cavity, cyst and consolidation of undiagnosed etiology, 4) pleural mass, nodules, loculated collections, 5) extra-pulmonary and spinal tuberculosis suspects with pre/paravertebral abscess. Procedure...

Research paper thumbnail of Clinical Profile, Adverse Drug Reaction, and Outcome of Category V Patients at a Drug-resistant Tuberculosis Center, Mumbai

The Indian Journal of Chest Diseases and Allied Sciences

Background: Drug regimens for the treatment of drug-resistant tuberculosis (DR-TB) are composed o... more Background: Drug regimens for the treatment of drug-resistant tuberculosis (DR-TB) are composed of salvage drugs to which a patient has never been exposed to previously. Methods: A retrospective observational study was conducted in a DR-TB Center attached to a medical college in a metropolitan city using the database of category V patients (n = 100) who were prediagnosed and referred. The clinical records of the patients were reviewed for demographic data, history, sputum examinations, co-morbidities, and adverse drug reactions (ADRs). The therapy outcomes were assessed as per Revised National Tuberculosis Control Programme (RNTCP) guidelines. Results: Their mean age was 29.1 years; there were 57 males. Mean body weight was 41.8 kg. Pediatric patients (age 12-17) constituted 13%. All the patients had pulmonary TB. Of the 100 cases, 80 were Category IV failure; 5% were defaulters of Category IV; and 15% were treated with second-line drugs adequately in private. Durg-susceptibility test (DST) showed extensively drug-resistant TB (XDR-TB) in 63 and pre-XDR-TB in 37 patients. The outcomes of Category V treatment were cure (7%), died (33%), failed on therapy (4%), transferred out (16%), lost to follow-up (2%), and still on the therapy (35%). Various comorbidities were present in 25% patients. ADRs were seen in 44%, and peripheral neuropathy (18%) was the most commonly observed ADR. Conclusions: DR-TB patients were younger and males were more affected. Mortality of Category V regimen was high (33%). Most common comorbidities were anemia and hypothyroidism. Adverse reactions were common (44%); ADR peripheral neuropathy being the most common.

Research paper thumbnail of The QT Interval: What the Pulmonologist Needs to Know

The Indian Journal of Chest Diseases and Allied Sciences

The QT interval is an electrocardiographical measurement that denotes the time interval between t... more The QT interval is an electrocardiographical measurement that denotes the time interval between the commencement and completion of the cardiac ventricular contraction process. Alterations in its value indicate abnormal cardiac rhythm and herald the risk of torsades de pointes; a fatal ventricular arrhythmia. Causes leading to a prolonged QT interval encompass a heterogeneous gamut including genetic conditions, electrolyte imbalances, hormonal imbalances, and drugs. A wide range of drugs can lead to a prolonged QT interval and these include certain crucial drugs which are routinely prescribed by a pulmonologist for infectious as well as non-infectious pulmonary indications. This becomes particularly relevant in this decade which has witnessed an excrescence in drug-resistant tuberculosis cases. Certain vital drugs employed in its management prolong QT interval significantly. In these situations, the clinician faces the predicament of cautiously prescribing these drugs to eradicate the disease microbiologically whilst balancing the risk of sudden cardiac death due to torsades de pointes. We summarise the basics of QT interval which every pulmonologist presently needs to know.

Research paper thumbnail of Transudative Effusion of Malignant Etiology: An Interesting Case Report

Journal of Krishna Institute of Medical Sciences University, 2018

Pleural effusion is an entity perpetually encountered by physicians, having a panorama of etiolog... more Pleural effusion is an entity perpetually encountered by physicians, having a panorama of etiologies. The occurrence of pleural effusion in a patient with malignancy adds multiple perspectives to the overall status of the patient in terms of symptomatology, staging, management and prognosis. Although effusion encountered in association with malignancies are conventionally exudative, transudative effusion can also manifest in certain singular circumstances. This conception is crucial to avoid misjudgments and delay in diagnosis. We hereby report an intriguing case of a transudative hemorrhagic pleural effusion in a patient with malignancy.

Research paper thumbnail of Birt-Hogg-Dubé Syndrome—An Unique Case Series

Advances in Respiratory Medicine, 2021

Birt-Hogg-Dubé syndrome (BHDS) is an uncommon autosomal dominant syndrome. It is also known as Ho... more Birt-Hogg-Dubé syndrome (BHDS) is an uncommon autosomal dominant syndrome. It is also known as Hornstein–Knickenberg syndrome. It is an inherited disorder culminating in mutations in folliculin coding gene (FLCN). The clinical exhibitions of the syn-drome are multi-systemic, comprising of a constellation of pulmonary, dermatologic and renal system manifestations. The most common presentations include fibrofolliculomas, renal cell carcinomas, lung cysts and spontaneous pneumothorax. The treatment is conservative with regular monitoring of the renal and lung parameters. Fibrofolliculomas may require surgical excision and recurrent events of pneumothorax may warrant pleurodesis. We reported a case series of 2 patients presenting with symptoms of progressive breathlessness along with dermatological manifestations and subsequently showing radiological manifestations of Birt-Hogg-Dubé syndrome in the form of lung cysts.

Research paper thumbnail of Pulmonary Thromboembolism and Pulmonary Fibrosis due to H1N1 Pneumonia with Acute Respiratory Distress Syndrome :: Not ALL is COVID

Gastroenterology Pancreatology and Hepatobilary Disorders, 2021

Novel influenza A H1N1 virus (pH1N1) was the predominant strain in the 2009 pandemic. It continue... more Novel influenza A H1N1 virus (pH1N1) was the predominant strain in the 2009 pandemic. It continues to circulate along with other influenza strains in the post pandemic era. This new virus is nevertheless well known for its strong association with high cardiovascular mortality and a high propensity to preferentially affect young and otherwise healthy adults, resulting in a clustering of severe and even fatal cases in patients of the productive age group. H1N1 infection is a multifaceted disease. It affects the lung parenchyma as well as the pulmonary vasculature. It also affects the multisystemic vasculature and can cause other embolic events not strictly falling in the “usual” thrombotic category. We herein present a case of H1N1 influenza pneumonia induced severe ARDS with pulmonary thromboembolism (PTE) and pulmonary fibrosis.

Research paper thumbnail of Role of spirometry with flow volume loop in the diagnosis of upper airway obstruction: A study from the pulmonary medicine department of a tertiary care center

Pneumon, 2021

INTRODUCTION Spirometry with flow volume loop (FVL) is an easy-to-use bed side test to determine ... more INTRODUCTION Spirometry with flow volume loop (FVL) is an easy-to-use bed side test to determine upper airway obstruction (UAO). The study aimed to find the prevalence of UAO and the ability of visual and quantitative criteria to detect UAO. METHODS This was retrospective study conducted for a period of two years at the pulmonary medicine department of a tertiary care center to find the proportion of UAO cases among patients undergoing spirometry, to study the profile of UAO, and to investigated the utility of spirometric indices described for UAO. The demographic data, diagnosis, relevant imaging and bronchoscopy reports of patients were noted. These comprised of Empey's index, ratio of the flow at the mid-point of the forced expiratory manoeuvre to the flow at the mid-point of the forced inspiratory manoeuvre (FEF50/FIF50), FIF50 <100 L/ min and qualitative features like flattening of inspiratory or expiratory loops, box-shaped loop and oscillations on the loop. RESULTS Mean age of the population was 43 years. Prevalence of UAO was 24 (3.1%). The most common cause of UAO was multinodular goiter (MNG) seen in 10 (39%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for Empey's index were 62.5%, 89.4%, 15.7% and 98.6%, respectively. The sensitivity, specificity, PPV and NPV for qualitative criteria of flow volume loop (FVL) visual abnormalities were 95.6%, 99.7%, 91.6% and 99.8%, respectively. The sensitivity, specificity, PPV and NPV of FIF50 <100 L/min were 79.1%, 80.4%, 11.5% and 99.1%, respectively. Variable extrathoracic UAO was seen in 17, variable intrathoracic UAO in 4, while 3 cases had fixed UAO. CONCLUSIONS Spirometry with FVL is a simple and useful screening test for UAO.

Research paper thumbnail of The diagnostic utility of squash smear cytology in lung malignancies

The Egyptian Journal of Bronchology

Background Lung malignancy is the most common cause of death worldwide. The main role of patholog... more Background Lung malignancy is the most common cause of death worldwide. The main role of pathologist is to differentiate small cell from other cell types as treatment and prognosis varies. Although histopathology is routinely done, squash smears yield better cytomorphology. Aims and objectives To study the clinical history, evaluate the diagnostic yield by means of cytology and histopathology correlation followed by determination of sensitivity and specificity of squash smear cytology for detection of lung malignancies. Materials and methods The present study was an observational analytical study conducted over a period of 3.5 years. Total 60 squash smears were obtained by computed tomography-/bronchoscopy-guided biopsy and stained with Papanicolaou and May-Grunwald stain. Squash smears were correlated with histopathological findings. Statistical analysis Statistics in the form of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood rat...

Research paper thumbnail of Pulmonary hypertension: A simplified pulmonologists' perspective

Medical Journal of Dr. D.Y. Patil Vidyapeeth, 2021

Pulmonary hypertension (PH) is a progressive disorder of the pulmonary vasculature caused due to ... more Pulmonary hypertension (PH) is a progressive disorder of the pulmonary vasculature caused due to vasoconstriction, vasodestruction, or vaso-obliteration. PH results from heterogeneous pathophysiologic mechanisms culminating in elevation of mean pulmonary arterial pressure. Patients may either present with symptoms or with chest radiographic, electrocardiographic, or echocardiographic findings done as a part of diagnostic evaluation for the primary disease or as a part of preoperative assessment. And hence, the clinician resorted to could be a family physician, pulmonologist, cardiologist, surgeon, or anesthesiologist. Hence, there is a necessity of a basic awareness about its clinical presentations, diagnostic modalities, and the available treatment options. The diagnosis can be perplexing and warrants a stepwise evaluation. Echocardiography (ECHO) is the preliminary diagnostic modality and provides a fairly accurate judgment of the pulmonary artery pressure; however, some patients may require an invasive evaluation by right heart catheterization. The definitive management of PH depends on the underlying etiology. Pulmonary arterial hypertension has a specific set of targeted pharmacotherapy, while for other categories of PH, treatment majorly focuses on counseling, management of the underlying disorder, and cardiopulmonary rehabilitation. The 6th World Symposium on PH has catered to all these issues and has incorporated manifold pertinent modifications in all these areas. Hence, we conducted an online survey to gauge the awareness about the entity and its facets among pulmonologists and penned down this review based the current concepts about PH to bridge the gaps in the existing knowledge.

Research paper thumbnail of Bronchiectasis in a Nine Year Old Girl: A Rare Syndromic Association

Ataxia telengectasia (AT) is an unaccustomed multisystemic genome instability syndrome with an au... more Ataxia telengectasia (AT) is an unaccustomed multisystemic genome instability syndrome with an autosomal recessive pattern of inheritance. It is primarily characterized by a constellation of features including cerebellar degeneration, telangiectasias, recurrent sinopulmonary infections and increased susceptibility to malignancies. Diagnostic delays can culminate in irrevocable sequelae leading to significant morbidity. We herein report a case of a nine year old child presenting with recurrent chest infections, ataxic gait and developmental delay who was diagnosed as a case of AT with a multimodality approach.

Research paper thumbnail of Pulmonary Vocal Syndrome

The Journal of the Association of Physicians of India, 2019

Vocal cord paralysis is a common entity with diverse causes clinically manifesting as dysphonia. ... more Vocal cord paralysis is a common entity with diverse causes clinically manifesting as dysphonia. Vocal cord paralysis due to respiratory cause is due to involvement of left recurrent laryngeal nerve usually secondary to bronchogenic carcinoma. However, it can also be seen in association with other less well recognised causes such as pulmonary tuberculosis. We present to you a patient with hoarseness of voice due to left recurrent laryngeal nerve paralysis secondary to endobronchial tuberculosis.

Research paper thumbnail of A study of glycemic variability in patients with type 2 diabetes mellitus with obstructive sleep apnea syndrome using a continuous glucose monitoring system

Clinical Diabetes and Endocrinology, 2020

Background Obstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (... more Background Obstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (DM) may result in increased glycemic variability affecting the glycemic control and hence increasing the risk of complications associated with diabetes. We decided to assess the Glycemic Variability (GV) in patients with type 2 diabetes with OSAS and in controls. We also correlated the respiratory disturbance indices with glycemic variability indices. Methods After fulfilling the inclusion and exclusion criteria patients from the Endocrinology and Pulmonology clinics underwent modified Sleep Apnea Clinical Score (SACS) followed by polysomnography (PSG). Patients were then divided into 4 groups: Group A (DM with OSAS, n = 20), Group B (DM without OSAS, n = 20), Group C (Non DM with OSAS, n = 10) and Group D (Non DM without OSAS, n = 10). Patients in these groups were subjected to continuous glucose monitoring using the Medtronic iPro2 and repeat PSG. Parameters of GV: i.e. mean glucose, S...

Research paper thumbnail of “Esophagomediastinal fistula presenting as drug resistant tuberculosis”

Indian Journal of Tuberculosis, 2019

Research paper thumbnail of Diagnostic Utility of Closed Needle Pleural Biopsy in Exudative Pleural Effusions

Research paper thumbnail of Clinical profile of pulmonary hypertension at a tertiary care centre, India

Pulmonary Circulation and Pulmonary Vascular Disease, 2017

Background: Pulmonary Hypertension (PH) is a pernicious disorder of the pulmonary vasculature. PH... more Background: Pulmonary Hypertension (PH) is a pernicious disorder of the pulmonary vasculature. PH is a complication of a varied spectrum of diseases referred to a pulmonologist, of which post infectious sequelae are a major emerging cause in developing countries like India. Methods: This observational study, undertaken in the department of Pulmonary Medicine at a tertiary care centre, included consecutive patients with PH as estimated pulmonary artery systolic pressure (PASP) of ≥40 mmHg by trans-thoracic two-dimensional echocardiography (corresponding to mean pulmonary artery pressure of ≥25mmHg). Clinical, functional and radiological parameters were noted. Data was analysed using Microsoft Excel software. Results: Out of 347 patients, 187 (54%) were men and 160 (46%) were women. Majority (53.5%) belonged to the age group 45 to 65 years. Dyspnea (85.8%) and loud pulmonary component of second heart sound (72%) were the commonest clinical findings. Mean six-minute walk distance, FVC, FEV1, PaO2, PaCO2, and PASP were 283.72m (±102.7), 53.6% (±15), 48.6 % (±15), 70.78 mmHg, 38.7 mmHg, and 45.6 mmHg (±15.8) respectively. Chest radiograph and electrocardiography had poor sensitivity in identification of PH. The common etiologies of PH constituted of post infectious obliterative bronchiolitis (30%), ILD (28.5%), COPD (24%), Obstructive Sleep Apnea (12.5%), HIV (1.8%), and PAH (1.5%). Conclusion: Post infectious obliterative bronchiolitis is the most common cause of PH in the Indian population.

Research paper thumbnail of Authors Response: Outcomes in multidrug resistant tuberculosis

Medical Journal of Dr. D.Y. Patil University, 2017

Research paper thumbnail of Klippel–Feil syndrome with inherited coagulopathy: A rare case report

Medical Journal of Dr. D.Y. Patil University, 2017

Klippel–Feil syndrome is a rare disease known to be associated with many musculoskeletal as well ... more Klippel–Feil syndrome is a rare disease known to be associated with many musculoskeletal as well as somatic diseases. Thromboembolism is one of the complications, which although rarely described earlier with this syndrome, can be life-threatening. Earlier case reports have attributed it to structural abnormalities seen in this syndrome. We, however, report a rare instance of inherited coagulopathy seen with Klippel–Feil syndrome, leading to pulmonary thromboembolism.

Research paper thumbnail of Bilateral tuberculous otitis media: An unique presentation

Indian Journal of Tuberculosis, 2017

Research paper thumbnail of Tropical Pulmonary Eosinophilia- an Elaborate Case Series

Journal of Evidence Based Medicine and Healthcare, 2019

Research paper thumbnail of Tuberculosis at the time of Coronavirus disease (COVID-19) lockdown - Back to the days of yore!!!

Pneumologia

Background: The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have s... more Background: The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have served as a major setback to tuberculosis (TB) control. We therefore conducted this study to assess the profile of TB patients presenting to our department immediately after COVID-19 lockdown, which was imposed in India from 24 March 2020 and continued for >3 months, and to compare it with the pre-pandemic pattern. Methods: This was an observational study conducted at the pulmonary medicine department of our tertiary care institute. We evaluated the consecutive cases of TB referred to or diagnosed new by our department as soon as the lockdown was lifted and non-COVID services resumed. The data of 2020 and 2019 during September and October month were gathered and analysed retrospectively. Results: A total of 162 patients were hospitalised from September to October 2019, while 40 non-COVID patients were hospitalised during September to October 2020 in our unit. The mean duration of sympt...

Research paper thumbnail of Evaluation of thoracic diseases with computed tomography guided biopsy

PULMONOLOGIYA

Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology ... more Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology (FNAC) and fine needle aspiration biopsy (FNAB) are reliable techniques for diagnosing various thoracic diseases. These modalities are used for diagnosis in suspicious lung, pleural, mediastinal and vertebral and pulmonary lesions.The aim. We conducted a study in a Pulmonary Medicine Department of tertiary care hospital to study the efficacy and safety of CT guided FNCA/FNAB in thoracic diseases.Methods. A retrospective study was conducted at a tertiary care center with Information and Ethics committee permission within a total duration of two years. The study included patients presenting with following: 1) mediastinal mass lesions, 2) pulmonary solitary pulmonary nodules/masses, 3) pulmonary cavity, cyst and consolidation of undiagnosed etiology, 4) pleural mass, nodules, loculated collections, 5) extra-pulmonary and spinal tuberculosis suspects with pre/paravertebral abscess. Procedure...

Research paper thumbnail of Clinical Profile, Adverse Drug Reaction, and Outcome of Category V Patients at a Drug-resistant Tuberculosis Center, Mumbai

The Indian Journal of Chest Diseases and Allied Sciences

Background: Drug regimens for the treatment of drug-resistant tuberculosis (DR-TB) are composed o... more Background: Drug regimens for the treatment of drug-resistant tuberculosis (DR-TB) are composed of salvage drugs to which a patient has never been exposed to previously. Methods: A retrospective observational study was conducted in a DR-TB Center attached to a medical college in a metropolitan city using the database of category V patients (n = 100) who were prediagnosed and referred. The clinical records of the patients were reviewed for demographic data, history, sputum examinations, co-morbidities, and adverse drug reactions (ADRs). The therapy outcomes were assessed as per Revised National Tuberculosis Control Programme (RNTCP) guidelines. Results: Their mean age was 29.1 years; there were 57 males. Mean body weight was 41.8 kg. Pediatric patients (age 12-17) constituted 13%. All the patients had pulmonary TB. Of the 100 cases, 80 were Category IV failure; 5% were defaulters of Category IV; and 15% were treated with second-line drugs adequately in private. Durg-susceptibility test (DST) showed extensively drug-resistant TB (XDR-TB) in 63 and pre-XDR-TB in 37 patients. The outcomes of Category V treatment were cure (7%), died (33%), failed on therapy (4%), transferred out (16%), lost to follow-up (2%), and still on the therapy (35%). Various comorbidities were present in 25% patients. ADRs were seen in 44%, and peripheral neuropathy (18%) was the most commonly observed ADR. Conclusions: DR-TB patients were younger and males were more affected. Mortality of Category V regimen was high (33%). Most common comorbidities were anemia and hypothyroidism. Adverse reactions were common (44%); ADR peripheral neuropathy being the most common.

Research paper thumbnail of The QT Interval: What the Pulmonologist Needs to Know

The Indian Journal of Chest Diseases and Allied Sciences

The QT interval is an electrocardiographical measurement that denotes the time interval between t... more The QT interval is an electrocardiographical measurement that denotes the time interval between the commencement and completion of the cardiac ventricular contraction process. Alterations in its value indicate abnormal cardiac rhythm and herald the risk of torsades de pointes; a fatal ventricular arrhythmia. Causes leading to a prolonged QT interval encompass a heterogeneous gamut including genetic conditions, electrolyte imbalances, hormonal imbalances, and drugs. A wide range of drugs can lead to a prolonged QT interval and these include certain crucial drugs which are routinely prescribed by a pulmonologist for infectious as well as non-infectious pulmonary indications. This becomes particularly relevant in this decade which has witnessed an excrescence in drug-resistant tuberculosis cases. Certain vital drugs employed in its management prolong QT interval significantly. In these situations, the clinician faces the predicament of cautiously prescribing these drugs to eradicate the disease microbiologically whilst balancing the risk of sudden cardiac death due to torsades de pointes. We summarise the basics of QT interval which every pulmonologist presently needs to know.

Research paper thumbnail of Transudative Effusion of Malignant Etiology: An Interesting Case Report

Journal of Krishna Institute of Medical Sciences University, 2018

Pleural effusion is an entity perpetually encountered by physicians, having a panorama of etiolog... more Pleural effusion is an entity perpetually encountered by physicians, having a panorama of etiologies. The occurrence of pleural effusion in a patient with malignancy adds multiple perspectives to the overall status of the patient in terms of symptomatology, staging, management and prognosis. Although effusion encountered in association with malignancies are conventionally exudative, transudative effusion can also manifest in certain singular circumstances. This conception is crucial to avoid misjudgments and delay in diagnosis. We hereby report an intriguing case of a transudative hemorrhagic pleural effusion in a patient with malignancy.

Research paper thumbnail of Birt-Hogg-Dubé Syndrome—An Unique Case Series

Advances in Respiratory Medicine, 2021

Birt-Hogg-Dubé syndrome (BHDS) is an uncommon autosomal dominant syndrome. It is also known as Ho... more Birt-Hogg-Dubé syndrome (BHDS) is an uncommon autosomal dominant syndrome. It is also known as Hornstein–Knickenberg syndrome. It is an inherited disorder culminating in mutations in folliculin coding gene (FLCN). The clinical exhibitions of the syn-drome are multi-systemic, comprising of a constellation of pulmonary, dermatologic and renal system manifestations. The most common presentations include fibrofolliculomas, renal cell carcinomas, lung cysts and spontaneous pneumothorax. The treatment is conservative with regular monitoring of the renal and lung parameters. Fibrofolliculomas may require surgical excision and recurrent events of pneumothorax may warrant pleurodesis. We reported a case series of 2 patients presenting with symptoms of progressive breathlessness along with dermatological manifestations and subsequently showing radiological manifestations of Birt-Hogg-Dubé syndrome in the form of lung cysts.

Research paper thumbnail of Pulmonary Thromboembolism and Pulmonary Fibrosis due to H1N1 Pneumonia with Acute Respiratory Distress Syndrome :: Not ALL is COVID

Gastroenterology Pancreatology and Hepatobilary Disorders, 2021

Novel influenza A H1N1 virus (pH1N1) was the predominant strain in the 2009 pandemic. It continue... more Novel influenza A H1N1 virus (pH1N1) was the predominant strain in the 2009 pandemic. It continues to circulate along with other influenza strains in the post pandemic era. This new virus is nevertheless well known for its strong association with high cardiovascular mortality and a high propensity to preferentially affect young and otherwise healthy adults, resulting in a clustering of severe and even fatal cases in patients of the productive age group. H1N1 infection is a multifaceted disease. It affects the lung parenchyma as well as the pulmonary vasculature. It also affects the multisystemic vasculature and can cause other embolic events not strictly falling in the “usual” thrombotic category. We herein present a case of H1N1 influenza pneumonia induced severe ARDS with pulmonary thromboembolism (PTE) and pulmonary fibrosis.

Research paper thumbnail of Role of spirometry with flow volume loop in the diagnosis of upper airway obstruction: A study from the pulmonary medicine department of a tertiary care center

Pneumon, 2021

INTRODUCTION Spirometry with flow volume loop (FVL) is an easy-to-use bed side test to determine ... more INTRODUCTION Spirometry with flow volume loop (FVL) is an easy-to-use bed side test to determine upper airway obstruction (UAO). The study aimed to find the prevalence of UAO and the ability of visual and quantitative criteria to detect UAO. METHODS This was retrospective study conducted for a period of two years at the pulmonary medicine department of a tertiary care center to find the proportion of UAO cases among patients undergoing spirometry, to study the profile of UAO, and to investigated the utility of spirometric indices described for UAO. The demographic data, diagnosis, relevant imaging and bronchoscopy reports of patients were noted. These comprised of Empey's index, ratio of the flow at the mid-point of the forced expiratory manoeuvre to the flow at the mid-point of the forced inspiratory manoeuvre (FEF50/FIF50), FIF50 <100 L/ min and qualitative features like flattening of inspiratory or expiratory loops, box-shaped loop and oscillations on the loop. RESULTS Mean age of the population was 43 years. Prevalence of UAO was 24 (3.1%). The most common cause of UAO was multinodular goiter (MNG) seen in 10 (39%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for Empey's index were 62.5%, 89.4%, 15.7% and 98.6%, respectively. The sensitivity, specificity, PPV and NPV for qualitative criteria of flow volume loop (FVL) visual abnormalities were 95.6%, 99.7%, 91.6% and 99.8%, respectively. The sensitivity, specificity, PPV and NPV of FIF50 <100 L/min were 79.1%, 80.4%, 11.5% and 99.1%, respectively. Variable extrathoracic UAO was seen in 17, variable intrathoracic UAO in 4, while 3 cases had fixed UAO. CONCLUSIONS Spirometry with FVL is a simple and useful screening test for UAO.