Abstract
Introduction:
Tuberculous meningitis remains the most severe and devastating form of tuberculosis with relatively severe morbidity and mortality. Risk factors for TB meningitis have not ...focused on the role of the BCG vaccine or social and food insecurity which are known to have a role in pulmonary TB.
Methods:
We prospectively conducted a Case-Control study among 65 patients with TB meningitis and 41 controls with other forms of meningitis. We evaluated the role of the BCG vaccine, the Household Food Insecurity Access Scale (HFIAS) and the Social Readjustment Rating Scale (SRRS) to look for food and social stress respectively. We also evaluated the known risk factors for TB meningitis including age, HIV co-infection, alcoholism, malignancies, use of immunosuppression, head injury among others. A bivariate followed by multivariate regression analysis was performed.
Results:
The presence of BCG scar was seen in 64.6 percent of patients with Tuberculous meningitis and 61.0 percent of control (
P
= 0.71). There was no difference in the size of the scars (
P
= 0.45) . Household food insecurity using the Household Food Insecurity Access Scale (HFIAS) ( a positive answer in any of the 9 items) was present in 16.9% of the patients in the TBM group and in 14.6% of the patients in the control group. (
P
= 0.75). Social stress assessed using the Social Readjustment Rating Score (< 150 suggest no social stress, 150 – 300 moderate social stress,> 300 high social stress) showed that a majority of the patients in both the groups reports no social stress. Only 9.8% of patients in the TBM group and 18.5% in the control group reports moderate presence of social stress whereas none of the patients had severe social stress. Logistic regression analysis suggested that only higher BMI was associated with lesser incidence of Tuberculous meningitis, odds ratio 0.83 (95% confidence interval of 0.73 – 0.930) and individuals performing clerical and unskilled and under-skilled jobs- odds ratio 0.13 (95% confidence interval of 0.02 – 0.93) had lower risk for TB Meningitis.
Conclusions:
In our sample of TB meningitis patients the BCG vaccine, food insecurity nor social stress appear to be risk factors. Bigger BMI and certain occupations appear to be possibly protective.
Abstract
Introduction:
Although pulmonary hydatid cysts can be diagnosed on computed tomography (CT), sometimes findings can be atypical. Other hypodense infective or neoplastic lesions may mimic ...hydatid cysts. We proposed that magnetic resonance imaging (MRI) may act as a problem-solving tool, aiding the definite diagnosis of hydatid cysts and differentiating it from its mimics. The aim of this study is to assess the findings of pulmonary hydatid cysts on CT and MRI and the additional contribution of MRI in doubtful cases.
Materials and Methods:
This is a retrospective study of 90 patients with suspected hydatid cysts. CT and MRI findings were noted and role of MRI in diagnosing hydatid cysts and its mimics was studied. Descriptive statistics for CT findings and sensitivity and specificity of MRI were calculated using surgery or histopathology as gold standard.
Results:
Of the 90 patients with suspected pulmonary hydatid cysts, there were 52 true-positive and 7 false-positive cases on CT. Commonest CT finding was unilocular thick-walled cyst. In the 26 patients who had additional MRI, based on T2-weighted hypointense rim or folded membranes, accurate preoperative differentiation of 14 patients with hydatid cysts from 10 patients with alternate diagnosis was possible. There was one false-positive and one false-negative case on MRI.
Conclusion:
Although hydatid cyst can be diagnosed on CT on most occasions, sometimes there are challenges with certain mimics and atypical appearances. T2-weighted MRI can act as a problem solving tool to conclusively diagnose hydatid cyst or suggest an alternate diagnosis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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 asymptomatic screening of family member can uncover such a serious disease in patients with familial interstitial fibrosis. Otherwise, clinical, radiological, and histological features are indistinguishable from those of sporadic cases. Furthermore, our work highlights the importance of compiling a thorough family history in individuals presenting with cough and dyspnoea, particularly in younger patients identified with idiopathic pulmonary fibrosis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
To study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care ...unit (RIMCU) at a tertiary care hospital in India.
We retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of H2O, and if required, inspiratory pressures were added using the bilevel positive air pressure mode. Success was defined as weaning from NIV and stepping down to the ward, and failure was defined as escalation to the intensive care unit, the need for intubation, or death.
In total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode.
Respiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Etiologic diagnosis of an eosinophilic pleural effusion (EPE) presents a diagnostic challenge when intrapleural air and blood have been ruled out as its proximate causes. Among the causes of EPE, ...those that require immunosuppression for the underlying disease include connective tissue diseases, sarcoidosis, vasculitis, and eosinophilic pneumonia. We present a case of clinically suspected Behcet's syndrome based on a 10-year history of recurrent multiple oral ulcers and human leukocyte antigen-B51 positivity who presented with only an EPE. Computed tomography pulmonary angiogram ruled out central thoracic vein thrombosis but was inconclusive in ruling out a subsegmental pulmonary embolism. The patient declined immunosuppressants and while on follow-up developed bilateral extensive acute lower limb deep venous thrombosis and pulmonary embolism. Upper infrarenal inferior vena cava demonstrated chronic thrombosis suggestive of its antecedent role in pulmonary embolism-related EPE during the first instance. Behcet's syndrome-related EPE can be associated with venous thromboembolism, and immunosuppressive therapy prevents the subsequent thrombotic episodes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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