Rajesh Bhagat - Academia.edu (original) (raw)

Papers by Rajesh Bhagat

PubMed, Dec 1, 1990

Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 a... more Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 asthmatics who had never received prednisolone. Candida albicans was repeatedly cultured from the sputa of 12 patients with CSDA. Isolation was more frequent in those patients who were receiving more than 10 mg prednisolone for more than six months. Nearly half of these patients demonstrated a positive immediate cutaneous reaction and precipitating antibodies against C. albicans. Although no pathological significance, beside colonization, could be attributed to this finding, it was felt that it would be prudent to restrict the daily dose of prednisolone to less than 10 mg, when administered for more than six moths. Two patients with allergic bronchopulmonary aspergillosis (ABPA), were identified, one from each group. The possibility of ABPA, however, remained open in two other patients with CSDA. It is probable that some patients with CSDA may be suffering from ABPA but characteristic features of the disease are masked by costicosteroid therapy, making it difficult to diagnose.

Chest, Apr 1, 1992

We report the findings in a patient with Klippel-Feil syndrome and associated agenesis of right u... more We report the findings in a patient with Klippel-Feil syndrome and associated agenesis of right upper and middle lobes, hypoplasia of the right lower lobe of the lung, and Lown-Ganong-Levine syndrome. To our knowledge, such an association has not been previously described.

Pediatric Pulmonology, May 1, 1999

... Letter to the Editor. Response by Authors. Anil K. Agarwal MD,; Rajesh Bhagat MD,; Naresh Pan... more ... Letter to the Editor. Response by Authors. Anil K. Agarwal MD,; Rajesh Bhagat MD,; Naresh Panchal MD,; SS Thukral PhD,; Ashok Shah MD. Article first published online: 30 APR 1999. DOI: 10.1002/(SICI)1099-0496(199905)27:5<356::AID-PPUL12>3.0.CO;2-V. ...

Pediatric Pulmonology, 1999

C Ce en nt tr ra al l b br ro on nc ch hi ie ec ct ta as si is s i in n a al ll le er rg gi ic c ... more C Ce en nt tr ra al l b br ro on nc ch hi ie ec ct ta as si is s i in n a al ll le er rg gi ic c b br ro on nc ch ho op pu ul lm mo on na ar ry y a as sp pe er rg gi il ll lo os si is s: : c co om mp pa ar ra at ti iv ve e e ev va al lu ua at ti io on n o of f c co om mp pu ut te ed d t to om mo og gr ra ap ph hy y o of f t th he e t th ho or ra ax x w wi it th h b br ro on nc ch ho og gr ra ap ph hy y

PubMed, Jun 1, 1996

A 47-year-old male, who presented with chronic fibrocavitary pulmonary disease, had received thre... more A 47-year-old male, who presented with chronic fibrocavitary pulmonary disease, had received three courses of antituberculous therapy over a period of 17 years without relief. Four years prior to referred he had developed hemoptysis and rhinitis. Evaluation of the patient led to the diagnosis of allergic bronchopulmonary aspergillosis with coexistent aspergilloma, a rather uncommon association. Both his pulmonary and nasal symptoms showed a remarkable response to treatment with oral prednisolone. However, the possibility of concomitant allergic Aspergillus sinusitis remained open as the patient refused to undergo any invasive procedure.

The European respiratory journal, Jun 1, 1993

A 55 year old male, who had a 12 yr history of rhinorrhoea and nasal blockage, presented with a m... more A 55 year old male, who had a 12 yr history of rhinorrhoea and nasal blockage, presented with a middle lobe syndrome. Evaluation of the patient led to the diagnosis of concomitant allergic bronchopulmonary aspergillosis with allergic AspergiUus sinusitis, a rarely reported association.

Chest, 2009

CASE PRESENTATION: A 43-year old African American male with history of right eye optic neuritis, ... more CASE PRESENTATION: A 43-year old African American male with history of right eye optic neuritis, migraine, beta thalassemia trait presented to our Institute with chronic dry cough, generalized body ache and fatigue for several months. His past history was significant for extensive ...

The Indian journal of chest diseases & allied sciences

Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopath... more Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopathological support for the diagnosis was ultimately obtained in 20 patients. Fibrebronchoscopy provided the diagnosis in 17 patients, while histopathological confirmation was obtained from extrapulmonary biopsy sites in 3 patients. Transbronchial lung biopsy, attempted without fluoroscopic guidance, revealed non-caseating granulomata in 15 patients. The only complication encountered was a small pneumothorax, not requiring intervention, in one patient. Lack of fluoroscopic guidance did not compromise the diagnostic yield or increase the complication rate of the procedure. Bronchial biopsy confirmed the diagnosis in 2 patients with a non-specific lung biopsy. It was positive in 6 of 8 patients with an abnormal appearing mucosa and in 5 of 12 patients with a normal bronchial tree. Random bronchial biopsy in all patients, irrespective of mucosal changes, made an important contribution to the y...

The Indian journal of chest diseases & allied sciences

Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated... more Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated as a case of bronchial asthma for over a decade, is presented.

The Indian journal of chest diseases & allied sciences

A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral... more A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral penicillin and oral metronidazole is described. Anaerobic pathogens resistant to one or the other of the above drugs were isolated. The patient had a striking clinical response to subsequent therapy with oral clindamycin. Failure of therapy should alert physicians to the possibility of infection with resistant anaerobic pathogens and in such situations, clindamycin is considered as an effective alternative.

Pediatric Radiology, 1992

CT of the thorax done during acute severe asthma in two paediatric patients demonstrated central ... more CT of the thorax done during acute severe asthma in two paediatric patients demonstrated central bronchiectasis, a sine qua non for the diagnosis of allergic bronchopulmonary aspergillosis. Bronchography, regarded as the gold standard, was done subsequently on recovery. A comparative segmental analysis revealed that CT was able to identify immediately 24 of 27 segments which showed central bronchiectasis on bronchography. Early diagnosis with the aid of CT enabled immediate intervention which may have helped to prevent further lung damage in the paediatric patients.

Chest, Jun 1, 1995

mortality increases between 1979 to 1985 and especially in people over 60 years old. These data d... more mortality increases between 1979 to 1985 and especially in people over 60 years old. These data did not support any direct relationship between increased ,8-agonist use and asthma mortality, because these patients have many health problems 4 The likely explanation for these changes in asthma mortality is the underdiagnosis and undertreatment possibly associated with factors such as race, urban crowding, and industrialization. Consequently, the data from Greece do not support the view that inhaled drugs and especially adrenergic drug consumption is related to asthma mortality.

The Journal of Allergy and Clinical Immunology, Dec 1, 1995

Inhaled 132-agonists and allergen-induced airway responses To the Editor." We were interested to ... more Inhaled 132-agonists and allergen-induced airway responses To the Editor." We were interested to read Dr. McFadden's opinions on [32-agonist therapy (Rostrum, J ALLERO¥ CUN IMMU-NOL 1995;95:641-51). Our opinions differ in several areas. We wish, however, to point out an error in McFadden's reanalysis of our data regarding salbutamol-induced increase in the allergen-induced early asthmatic response. 1 Dr. McFadden states that reanalysis of untransformed allergen PC2o data fails to show any significant effects between salbutamol and placebo. Our investigation was designed to look for reduced functional antagonism of salbutamol versus allergen and was modeled after the study of O'Connor et al.,2 substituting allergen as a mast cell stimulus that was more clinically relevant than adenosine monophosphate. We found an unexpected increase in airway response to allergen, almost double, after 2-week treatment with inhaled salbutamol, 200 txg four times daily, compared with placebo? The tmtransformed and log-transformed data for the 11 subjects with complete data are shown in Table I. After the 2-week salbutamol treatment, 10 of 11 subjects showed increased airway response to allergen; the change in allergen PC2o was 50% or greater in five. PCao values are not normally distributed; therefore, it is not appropriate to use parametric statistics on untransformed data. However, contrary to McFadden's dakn, the calculations still show siga~qcance for untran~ormed data (p =

Chest, Aug 1, 1996

thymectomy. We described an alternative approach, which WoJ have found to be safe and to be able ... more thymectomy. We described an alternative approach, which WoJ have found to be safe and to be able to accomplish a complete thymectomy. Dr. Yellin raised several points in his letter. First, we regard the superior cosmetic results from the video-assisted thoracoscopic surgery(VATS) approach as a bonus, but the real advantage we have found is that by minimizing chest-wall trauma, patients are more \villing to accept early surgical treatment. Second, selective onelung ventilation is standard for VATS , and we have not found intubation with a double-lumen tube to be more "complex" or indeed associated with more complications compared with a single-lumen tube. Third, myasthenic patients \vith thymomas present a technical challenge \vith VATS, but we have found our described technique to be applicable to thymoma up to 4 em. However, we believe that this approach should only be performed b y those with considerable experience in VATS. We are cautious in advocating video-assisted thoracoscopic thymectomy for general use as our experience is still limited and our data preliminary. Nonetheless, we are encouraged b y our early results. We believe that minimizing chest-wall trauma is particularly important to the functional recovery of myasthenic patients fol-lo\ving thymectomy. More work is needed to better define the role of VATS in thymic surgery. We would like to conclude with a quotation from Roger Bacon 1 in the 13 centUJy. It is interesting how much still holds true 7 centuries later: There are in fact four very significant stumbling blocks in the way of grasping the truth which hinder every man, however l earned, and scarcely allow anyone to win a clear title to wisdom; namely, the example of weak and unworthy authority, long-standing custom, the feeling of the ignorant crowd, and the hiding of our own ignorance while making a display for our apparent knowledge. Eve1y man is involved in these things, every rank is affected. For every person, in whatever walk of life, both in application to study and in all forms of occupation, arrives the same conclusion by the three worst arguments; namely, this is a pattern set by our elders, this is the c ustom , and this is the popular belief. Therefore it should be held.

The Journal of Allergy and Clinical Immunology, Sep 1, 1998

Background: A simple laboratory method to evaluate relative potency of inhaled corticosteroids in... more Background: A simple laboratory method to evaluate relative potency of inhaled corticosteroids in asthma would be valuable. Single-dose studies with the allergen-induced late asthmatic response have failed to show a useful dose-response relationship. Treatment for several days with inhaled corticosteroids will also inhibit the allergen-induced early asthmatic response. Methods: Twelve atopic asthmatic subjects were studied during a season when no medications were required except ipratropium bromide as needed. These subjects had positive allergen and methacholine inhalation tests and FEV 1 greater than 70% of predicted value. A double-blind, randomized, crossover study compared placebo and budesonide 100, 200, and 400 µg administered by means of Turbuhaler twice daily for 7 days with 6-day washout periods. Methacholine PC 20 was measured before and after 6 days of treatment, and allergen PC 15 was measured after 7 days of treatment. Results: The allergen PC 15 (n = 11) was significantly larger (P = .0001) for all doses of budesonide compared with placebo, but there was no significant difference between the 3 doses of budesonide, and no dose response was demonstrated. The methacholine PC 20 was significantly larger after all budesonide treatments compared with placebo (P = .024), but there was no difference between the 3 doses. There was a progressive increase in the allergen PC 15 chronologically (sequence effect) that was not explained by improvement in FEV 1 or airway responsiveness; sequence effects were not seen for FEV 1 or for pretreatment or posttreatment methacholine PC 20. Statistical adjustment for sequence effect did not alter allergen PC 15 statistics. Conclusion: A 7-day course of budesonide administered by means of Turbuhaler at 200, 400, or 800 µg per day provided marked and significant inhibition of the allergen-induced early asthmatic response compared with placebo. There was, however, no difference between the 3 doses. Therefore this method with these doses is not useful for providing assessment of relative potency.

PubMed, Dec 1, 1990

Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 a... more Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 asthmatics who had never received prednisolone. Candida albicans was repeatedly cultured from the sputa of 12 patients with CSDA. Isolation was more frequent in those patients who were receiving more than 10 mg prednisolone for more than six months. Nearly half of these patients demonstrated a positive immediate cutaneous reaction and precipitating antibodies against C. albicans. Although no pathological significance, beside colonization, could be attributed to this finding, it was felt that it would be prudent to restrict the daily dose of prednisolone to less than 10 mg, when administered for more than six moths. Two patients with allergic bronchopulmonary aspergillosis (ABPA), were identified, one from each group. The possibility of ABPA, however, remained open in two other patients with CSDA. It is probable that some patients with CSDA may be suffering from ABPA but characteristic features of the disease are masked by costicosteroid therapy, making it difficult to diagnose.

Chest, Apr 1, 1992

We report the findings in a patient with Klippel-Feil syndrome and associated agenesis of right u... more We report the findings in a patient with Klippel-Feil syndrome and associated agenesis of right upper and middle lobes, hypoplasia of the right lower lobe of the lung, and Lown-Ganong-Levine syndrome. To our knowledge, such an association has not been previously described.

Pediatric Pulmonology, May 1, 1999

... Letter to the Editor. Response by Authors. Anil K. Agarwal MD,; Rajesh Bhagat MD,; Naresh Pan... more ... Letter to the Editor. Response by Authors. Anil K. Agarwal MD,; Rajesh Bhagat MD,; Naresh Panchal MD,; SS Thukral PhD,; Ashok Shah MD. Article first published online: 30 APR 1999. DOI: 10.1002/(SICI)1099-0496(199905)27:5<356::AID-PPUL12>3.0.CO;2-V. ...

Pediatric Pulmonology, 1999

C Ce en nt tr ra al l b br ro on nc ch hi ie ec ct ta as si is s i in n a al ll le er rg gi ic c ... more C Ce en nt tr ra al l b br ro on nc ch hi ie ec ct ta as si is s i in n a al ll le er rg gi ic c b br ro on nc ch ho op pu ul lm mo on na ar ry y a as sp pe er rg gi il ll lo os si is s: : c co om mp pa ar ra at ti iv ve e e ev va al lu ua at ti io on n o of f c co om mp pu ut te ed d t to om mo og gr ra ap ph hy y o of f t th he e t th ho or ra ax x w wi it th h b br ro on nc ch ho og gr ra ap ph hy y

PubMed, Jun 1, 1996

A 47-year-old male, who presented with chronic fibrocavitary pulmonary disease, had received thre... more A 47-year-old male, who presented with chronic fibrocavitary pulmonary disease, had received three courses of antituberculous therapy over a period of 17 years without relief. Four years prior to referred he had developed hemoptysis and rhinitis. Evaluation of the patient led to the diagnosis of allergic bronchopulmonary aspergillosis with coexistent aspergilloma, a rather uncommon association. Both his pulmonary and nasal symptoms showed a remarkable response to treatment with oral prednisolone. However, the possibility of concomitant allergic Aspergillus sinusitis remained open as the patient refused to undergo any invasive procedure.

The European respiratory journal, Jun 1, 1993

A 55 year old male, who had a 12 yr history of rhinorrhoea and nasal blockage, presented with a m... more A 55 year old male, who had a 12 yr history of rhinorrhoea and nasal blockage, presented with a middle lobe syndrome. Evaluation of the patient led to the diagnosis of concomitant allergic bronchopulmonary aspergillosis with allergic AspergiUus sinusitis, a rarely reported association.

Chest, 2009

CASE PRESENTATION: A 43-year old African American male with history of right eye optic neuritis, ... more CASE PRESENTATION: A 43-year old African American male with history of right eye optic neuritis, migraine, beta thalassemia trait presented to our Institute with chronic dry cough, generalized body ache and fatigue for several months. His past history was significant for extensive ...

The Indian journal of chest diseases & allied sciences

Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopath... more Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopathological support for the diagnosis was ultimately obtained in 20 patients. Fibrebronchoscopy provided the diagnosis in 17 patients, while histopathological confirmation was obtained from extrapulmonary biopsy sites in 3 patients. Transbronchial lung biopsy, attempted without fluoroscopic guidance, revealed non-caseating granulomata in 15 patients. The only complication encountered was a small pneumothorax, not requiring intervention, in one patient. Lack of fluoroscopic guidance did not compromise the diagnostic yield or increase the complication rate of the procedure. Bronchial biopsy confirmed the diagnosis in 2 patients with a non-specific lung biopsy. It was positive in 6 of 8 patients with an abnormal appearing mucosa and in 5 of 12 patients with a normal bronchial tree. Random bronchial biopsy in all patients, irrespective of mucosal changes, made an important contribution to the y...

The Indian journal of chest diseases & allied sciences

Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated... more Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated as a case of bronchial asthma for over a decade, is presented.

The Indian journal of chest diseases & allied sciences

A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral... more A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral penicillin and oral metronidazole is described. Anaerobic pathogens resistant to one or the other of the above drugs were isolated. The patient had a striking clinical response to subsequent therapy with oral clindamycin. Failure of therapy should alert physicians to the possibility of infection with resistant anaerobic pathogens and in such situations, clindamycin is considered as an effective alternative.

Pediatric Radiology, 1992

CT of the thorax done during acute severe asthma in two paediatric patients demonstrated central ... more CT of the thorax done during acute severe asthma in two paediatric patients demonstrated central bronchiectasis, a sine qua non for the diagnosis of allergic bronchopulmonary aspergillosis. Bronchography, regarded as the gold standard, was done subsequently on recovery. A comparative segmental analysis revealed that CT was able to identify immediately 24 of 27 segments which showed central bronchiectasis on bronchography. Early diagnosis with the aid of CT enabled immediate intervention which may have helped to prevent further lung damage in the paediatric patients.

Chest, Jun 1, 1995

mortality increases between 1979 to 1985 and especially in people over 60 years old. These data d... more mortality increases between 1979 to 1985 and especially in people over 60 years old. These data did not support any direct relationship between increased ,8-agonist use and asthma mortality, because these patients have many health problems 4 The likely explanation for these changes in asthma mortality is the underdiagnosis and undertreatment possibly associated with factors such as race, urban crowding, and industrialization. Consequently, the data from Greece do not support the view that inhaled drugs and especially adrenergic drug consumption is related to asthma mortality.

The Journal of Allergy and Clinical Immunology, Dec 1, 1995

Inhaled 132-agonists and allergen-induced airway responses To the Editor." We were interested to ... more Inhaled 132-agonists and allergen-induced airway responses To the Editor." We were interested to read Dr. McFadden's opinions on [32-agonist therapy (Rostrum, J ALLERO¥ CUN IMMU-NOL 1995;95:641-51). Our opinions differ in several areas. We wish, however, to point out an error in McFadden's reanalysis of our data regarding salbutamol-induced increase in the allergen-induced early asthmatic response. 1 Dr. McFadden states that reanalysis of untransformed allergen PC2o data fails to show any significant effects between salbutamol and placebo. Our investigation was designed to look for reduced functional antagonism of salbutamol versus allergen and was modeled after the study of O'Connor et al.,2 substituting allergen as a mast cell stimulus that was more clinically relevant than adenosine monophosphate. We found an unexpected increase in airway response to allergen, almost double, after 2-week treatment with inhaled salbutamol, 200 txg four times daily, compared with placebo? The tmtransformed and log-transformed data for the 11 subjects with complete data are shown in Table I. After the 2-week salbutamol treatment, 10 of 11 subjects showed increased airway response to allergen; the change in allergen PC2o was 50% or greater in five. PCao values are not normally distributed; therefore, it is not appropriate to use parametric statistics on untransformed data. However, contrary to McFadden's dakn, the calculations still show siga~qcance for untran~ormed data (p =

Chest, Aug 1, 1996

thymectomy. We described an alternative approach, which WoJ have found to be safe and to be able ... more thymectomy. We described an alternative approach, which WoJ have found to be safe and to be able to accomplish a complete thymectomy. Dr. Yellin raised several points in his letter. First, we regard the superior cosmetic results from the video-assisted thoracoscopic surgery(VATS) approach as a bonus, but the real advantage we have found is that by minimizing chest-wall trauma, patients are more \villing to accept early surgical treatment. Second, selective onelung ventilation is standard for VATS , and we have not found intubation with a double-lumen tube to be more "complex" or indeed associated with more complications compared with a single-lumen tube. Third, myasthenic patients \vith thymomas present a technical challenge \vith VATS, but we have found our described technique to be applicable to thymoma up to 4 em. However, we believe that this approach should only be performed b y those with considerable experience in VATS. We are cautious in advocating video-assisted thoracoscopic thymectomy for general use as our experience is still limited and our data preliminary. Nonetheless, we are encouraged b y our early results. We believe that minimizing chest-wall trauma is particularly important to the functional recovery of myasthenic patients fol-lo\ving thymectomy. More work is needed to better define the role of VATS in thymic surgery. We would like to conclude with a quotation from Roger Bacon 1 in the 13 centUJy. It is interesting how much still holds true 7 centuries later: There are in fact four very significant stumbling blocks in the way of grasping the truth which hinder every man, however l earned, and scarcely allow anyone to win a clear title to wisdom; namely, the example of weak and unworthy authority, long-standing custom, the feeling of the ignorant crowd, and the hiding of our own ignorance while making a display for our apparent knowledge. Eve1y man is involved in these things, every rank is affected. For every person, in whatever walk of life, both in application to study and in all forms of occupation, arrives the same conclusion by the three worst arguments; namely, this is a pattern set by our elders, this is the c ustom , and this is the popular belief. Therefore it should be held.

The Journal of Allergy and Clinical Immunology, Sep 1, 1998

Background: A simple laboratory method to evaluate relative potency of inhaled corticosteroids in... more Background: A simple laboratory method to evaluate relative potency of inhaled corticosteroids in asthma would be valuable. Single-dose studies with the allergen-induced late asthmatic response have failed to show a useful dose-response relationship. Treatment for several days with inhaled corticosteroids will also inhibit the allergen-induced early asthmatic response. Methods: Twelve atopic asthmatic subjects were studied during a season when no medications were required except ipratropium bromide as needed. These subjects had positive allergen and methacholine inhalation tests and FEV 1 greater than 70% of predicted value. A double-blind, randomized, crossover study compared placebo and budesonide 100, 200, and 400 µg administered by means of Turbuhaler twice daily for 7 days with 6-day washout periods. Methacholine PC 20 was measured before and after 6 days of treatment, and allergen PC 15 was measured after 7 days of treatment. Results: The allergen PC 15 (n = 11) was significantly larger (P = .0001) for all doses of budesonide compared with placebo, but there was no significant difference between the 3 doses of budesonide, and no dose response was demonstrated. The methacholine PC 20 was significantly larger after all budesonide treatments compared with placebo (P = .024), but there was no difference between the 3 doses. There was a progressive increase in the allergen PC 15 chronologically (sequence effect) that was not explained by improvement in FEV 1 or airway responsiveness; sequence effects were not seen for FEV 1 or for pretreatment or posttreatment methacholine PC 20. Statistical adjustment for sequence effect did not alter allergen PC 15 statistics. Conclusion: A 7-day course of budesonide administered by means of Turbuhaler at 200, 400, or 800 µg per day provided marked and significant inhibition of the allergen-induced early asthmatic response compared with placebo. There was, however, no difference between the 3 doses. Therefore this method with these doses is not useful for providing assessment of relative potency.