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Papers by prince james

The Indian Journal of Chest Diseases and Allied Sciences

Background. Thoracoscopy is usually carried out using rigid metallic instruments. Recently, video... more Background. 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. Methods. Retrospective analysis of data of patients who underwent thoracoscopy for the evaluation of pleural disease. Results. 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-related complications. Conclusion. Thoracoscopy with flex-rigid thoracoscope is a useful diagnostic tool in the evaluation of pleural effusions with negative blind pleural biopsy and cytology.

Lung India, 2021

During the times of the ongoing COVID pandemic, aerosol-generating procedures such as bronchoscop... more During the times of the ongoing COVID pandemic, aerosol-generating procedures such as bronchoscopy have the potential of transmission of severe acute respiratory syndrome coronavirus 2 to the healthcare workers. The decision to perform bronchoscopy during the COVID pandemic should be taken judiciously. Over the years, the indications for bronchoscopy in the clinical practice have expanded. Experts at the Indian Association for Bronchology perceived the need to develop a concise statement that would assist a bronchoscopist in performing bronchoscopy during the COVID pandemic safely. The current Indian Association for Bronchology Consensus Statement provides specific guidelines including triaging, indications, bronchoscopy area, use of personal protective equipment, patient preparation, sedation and anesthesia, patient monitoring, bronchoscopy technique, sample collection and handling, bronchoscope disinfection, and environmental disinfection concerning the coronavirus disease-2019 situation. The suggestions provided herewith should be adopted in addition to the national bronchoscopy guidelines that were published recently. This statement summarizes the essential aspects to be considered for the performance of bronchoscopy in COVID pandemic, to ensure safety for both for patients and healthcare personnel.

F1000Research, 2010

ABSTRACT Background / Purpose: To assess the safety and efficacy of 4 months rifampicin (4R) ther... more ABSTRACT 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.

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 ...

ABSTRACT Background / Purpose: To assess the infectious bacterial etiology of acute exacerbation ... more ABSTRACT Background / Purpose: To assess the infectious bacterial etiology of acute exacerbation of chronic obstructive pulmonary disease in India.For all patients admitted with acute exacerbation of COPD (AECOPD), sputum samples were sent for routine bacterial culture and blood samples were sent for IgM ELISA, Mycoplasma and Chalymidae pneumoniae. Main conclusion: Gram negative bacteriae (Klebsiella, Pseudomonas and H. influenzae) were the most common aerobes associated with AECOPD in our cohort. Positive sputum culture correlated significantly with a higher degree of airway obstruction and length of hospital stay.

Indian Journal of Medical Microbiology, 2021

Genotype MTBDRsl [SL-LPA] was endorsed as a tool for early diagnosis of fluoroquinolones (FQ) and... more Genotype MTBDRsl [SL-LPA] was endorsed as a tool for early diagnosis of fluoroquinolones (FQ) and injectable second-line TB drugs (SLID) resistance in DR-TB. Correlation between specific genetic mutations using this tool and clinical outcome has not hitherto been studied in India. We conducted a observational cohort study to evaluate the predictive value of specific mutations for bad outcome. Our study identified 15 different types of gyrA mutations, commonest being A90V and D94G. Poor outcome was associated with mutations D94G and D94N/D94Y.Most XDR-TB patients harbored the high risk mutation of A1401G. Hence information of specific mutations using SL-LPA can help prognosticate and design appropriate treatment regimens.

Interventional Pulmonology, 2018

Morphological appearance of Pleural nodules during thoracoscopy are not 100% diagnostic of Malign... more Morphological appearance of Pleural nodules during thoracoscopy are not 100% diagnostic of Malignancy or TB. An early definite etiological diagnosis will help to decide the further treatment plan. Methods: During Medical thoracoscopy, Pulmonologist prepared Cytology smears slides directly from parietal pleura nodule biopsy tissue. Cytologist provided the smear cytology results in one day. Data were retrospectively reviewed, and Cytology results were compared with final pleural biopsy histopathology report. Results: 40 patients underwent Medical thoracoscopy for undiagnosed pleural effusion at a tertiary care hospital in South India. 33 patients were male and the average age of patients was 58 years. The final diagnosis was Malignant pleural effusion in 35 cases (29 cases of Lung cancer, 3 cases of Mesothelioma, one case of Lymphoma and 2 cases of metastatic carcinoma) and pleural Tuberculosis in 5 patients. Nodules were found on parietal pleura in 38 cases. Smear cytology of Parietal pleura biopsy tissue was positive in 39 cases (97.5%) and perfectly matched with final histopathology report. It failed to show any significant pathology in only one case (2.5%) with pleural tuberculosis. Average time to get Pleural biopsy final histopathology report was 6 days after thoracoscopy, while smear cytology from pleural biopsy tissue provided the diagnosis within one day of thoracoscopy. During Medical thoracoscopy, Smear cytology slides from pleural biopsy tissue can provide early diagnosis. It can help in taking an early decision regarding further treatment plan like doing pleurodesis, requesting for mutation analysis or starting antiTB treatment and removal of the chest tube.

Microbial Drug Resistance, 2019

INTRODUCTION Extensively drug-resistant tuberculosis (XDRTB) is a public health concern. We evalu... more INTRODUCTION Extensively drug-resistant tuberculosis (XDRTB) is a public health concern. We evaluated the diagnostic accuracy of Genotype® MTBDRsl for detection of resistance to fluoroquinolones (FQs) and second-line injectable drugs (SLIDs) and characterized mutations seen. MATERIALS AND METHODS MTBDRsl was carried out either directly on sputum samples or indirectly on culture isolates (n = 100) from known multidrug-resistant tuberculosis (MDRTB) patients from July 2015 to September 2017. Diagnostic accuracy for the detection of resistance to FQs and SLIDs was calculated in comparison with conventional culture-based drug susceptibility testing. Mutations at the gyrA and rrs loci, as well as discrepant phenotypic and genotypic results, were studied. A subset of isolates underwent pyrosequencing. RESULTS Out of 100 MDRTB samples/isolates tested, 59% were pre-XDRTB and 7% were XDRTB. The sensitivity and specificity for the detection of resistance to FQs were 96.6% [95% confidence interval (CI): 88.3-99.6] and 80% [95% CI: 64.4-90.9] and those for SLIDs were 70% [95% CI: 34.8-93.3] and 100% [95% CI: 95.9-100]. The most frequent mutations were the absence of wild type 3 with corresponding mutation 3c (20/66) at the gyrA locus, and absence of wild type 1 and corresponding mutation 1 (6/7) at the rrs locus. The absence of a wt2 band with a corresponding mutation at the gyrA locus was seen in four of eight patients with discrepant genotypic and phenotypic results for FQ resistance. All isolates tested by pyrosequencing (n = 5) were concordant with the line probe assay for FQ resistance with identical mutations (D94G) and four of five isolates were concordant with SLIDs with identical mutations (A1401G). CONCLUSION The MTBDRsl is a useful test for accurate diagnosis of XDRTB and may help to tailor therapy.

Lung India, 2019

Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue fo... more Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. Methodology: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on

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...

Lung India : official organ of Indian Chest Society

Idiopathic pulmonary fibrosis (IPF), a chronic progressive interstitial lung disease (ILD), Occas... more Idiopathic pulmonary fibrosis (IPF), a chronic progressive interstitial lung disease (ILD), Occasionally, IPF occurs in families. Familial interstitial lung disease has been reported worldwide, limited information is available on the disease among Indian patients. A 59-year-old woman presented with a 2-year history of progressive dyspnoea. Based on clinical and radiological features, our patient was diagnosed with idiopathic pulmonary fibrosis. Several family members of her first and second generations had died from respiratory failure. Her sister also diagnosed as IPF based on typical High resolution computed tomography (HRCT) finding though she was asymptomatic and came for screening. In addition, another male patient also had similar history and diagnosed as familial IPF based on HRCT and genetic testing in spite of significant occupational exposure. Genetic study revealed SFTPA1 gene was associated with susceptibility to idiopathic pulmonary fibrosis. Our report illustrates that...

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 international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2009

Abstract A 24-year-old non-smoking staff nurse presented with a history of fever, cough and weigh... more Abstract 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 ...

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...

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.

ABSTRACT Objectives: Estimate the prevalence of LTBI among health professional trainees at a refe... more ABSTRACT Objectives: Estimate the prevalence of LTBI among health professional trainees at a referral hospital in India, using Tuberculin skin test (TST) and Quantiferon TB Gold In-tube, (QFT). Methods: From November 2009 to February 2011, students in health professional programs (except medical and nursing students) were approached for consent. In addition to a detailed questionnaire on TB exposure, participants underwent TST (10 mm) and the QFT-GIT (0.35 IU/ml). Results: 164 students completed testing. Mean age was 21.5 yrs, 48.8% were female and 59.15% had BCG. Mean time in health care was 11.5 months, and 21.6% recalled contact with PTB cases. Seventy-nine (48.2%, 95%CI: 40.3-56.1%) were positive by TST, and 38 (23.2%, 95% CI: 16.9-30.4%) were positive by QFT. In a cohort of nursing students from the same institution, prevalence was estimated at 40.3% (TST) and 17.04% (QFT), thus lower than the health professional cohort. Possible explanations include a higher proportion of male students compared with nursing, also present cohort were less likely to own a car or house as compared with nursing students, suggesting lower SES. Multivariate logistic regression showed age was associated with QFT positivity but not TST (OR=1.24, 95%CI: 1.01-1.52). Length of time in health care, family income, direct contact with TB all showed no association with either test. Participating in sputum collection and/or processing showed a trend towards QFT positivity (but not TST positivity), although this did not reach statistical significance (OR=1.1 (95%CI: 0.89-1.4). Conclusions: LTBI is common among health professional trainees in India, however, risk factors appear to be better correlated with QFT.

Objectives: To estimate the concordance between the Tuberculin skin test (TST) and Quantiferon TB... more Objectives: To estimate the concordance between the Tuberculin skin test (TST) and Quantiferon TB Gold In-tube, (QFT) among health professional trainees at a referral hospital in India, and to evaluate risk factors associated with discordant results. Methods: From November 2009 to February 2011, students registered in various health professional programs (with the exception of medical and nursing students) were approached to participate. In addition to a questionnaire on TB exposure, participants underwent TST (10 mm cutoff) and the QFT-GIT (0.35 IU/ml cut off). Results: 164 students completed. Mean age was 21.5 yrs (Range: 17-34), 48.8% were female and 59.15% had BCG scars. Mean time in health care was 11.5 months, and 21.6% recalled direct contact with PTB. Prevalence of LTBI by TST or QFT was 48.2% and 23.2% respectively. Agreement between tests was 71.3% (kappa=0.415). The predominant discordance was TST +/QFT- (43/164, 26.2%). Using multivariate logistic regression we evaluated whether discordant results were associated with any particular risk factors, including: age, sex, education, family income, time in health care setting, days spent in high risk wards, performing high risk procedures, pre-existing medical illness, BCG, and known TB exposure. No factors were associated with discordant results, however, age was associated with concordant positives (OR=1.27, 95%CI: 1.03-1.59), and higher family income was protective (OR=0.67, 95%CI:0.45-0.99). Conclusions: There was fair to weak agreement between TST and QFT in this population. Concordant positives were associated with older age, and lower family income. Discordant results were not associated with any known risk factors.