G Ram Kumar Gupta

Abstract

Introduction: Tuberculosis is one of the most infectious public health problems for decades and has also become difficult to diagnose in recent times due to association with immunocompromised status. With the advent of the newer diagnostic technique like CBNAAT, can providing positive results even in less number of tuberculos bacilli in specimen samples. The present study was aimed to compare induced sputum and bronchial washings for CBNAAT in diagnosing sputum smear negative tuberculosis. Materials and Methods: A prospective, observational study was conducted in the Department of Pulmonary Medicine, Maharaja Institute of Medical Sciences (MIMS), Vizianagaram, Andhra Pradesh, India. A total of 43 patients with sputum negative tuberculosis were enrolled and induced sputum and BAL fluid for CBNAAT sent for analysis under RNTCP in district hospital. Results: Male patients (67.45%) were more compared to the females (32.55%). Majority belongs to 51-60 years with mean age group of 49.18 years. Most common X- ray presentation was infiltration followed by consolidation. Induced sputum CBNAAT was positive in only 07 patients compare d to bronchial washings CBNAAT in 27 patients. Conclusions: As CBNAAT can diagnose rapidly and prevent transmission and mortality in smearnegative in pulmonary tuberculosis patients, all smear-negative and immunocompromised patients should be subjected to CBNAAT. CBNAAT detects pulmonary TB in PLHIV with greater efficacy than sputum microscopy, also helping in early diagnosis in less than 2 hours, so that early therapy can be started, thus decreasing the incidence of MDR-TB and associated its mortality. Keywords: Bronchial washings, CBNAAT, Induced sputum, Pulmonary tuberculosis, Smear negative.

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Introduction: Lung is one of the commonest sites for neoplasms both primary and metastatic cancers. Identification and determination of histopathological play a major role in the diagnosis and treatment of cancer. Radiology and imaging helps in the selection of procedures to obtain a tissue sample for the diagnosis and management of lung cancer. The present study was aimed to analyze the clinic-pathological profile of primary lung cancer in the south-east coast of India. Materials and Methods: A prospective, observational study was conducted in the Department of Pulmonary Medicine, Maharaja Institute of Medical Sciences (MIMS), Vizianagaram, Andhra Pradesh, India. A total of 104 patients with primary lung cancer were enrolled. Radiological, clinico pathological profile and Histopathological analysis was done individually for all patients. Results: Male patients (70.1%) were more compared to females (29.9%). The Average age of the study population was 57.8 years. A total of 70(67.3%) study subjects had a history of smoking comprising of 61 males and 9 female subjects. Almost all study patients had clinical presentations of cough and shortness of breath (100%). Most common X-ray and CT chest radiographic feature was mass lesion (n=89 and n=91). Adenocarcinoma was identified in 79 patients (76.0%) as the most common histological type and it was also common in both smokers (n=49) and nonsmokers (n=29). Conclusions: The most common histological variant was Adenocarcinoma followed by squamous cell carcinoma. Among men, smoking is the principal risk factor in the causation of lung cancer. A precise, accurate and rapid screening method is still warranted for the diagnosis of primary lung cancer. Keywords: Adenocarcinoma, Bronchoscopy, Clinico-pathological profile, Histopathological profile, Primary lung cancer.

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Background: Pleural effusion (PE) can occur as complication of many diseases. When pleural fluid is detected, an effort should be made to determine etiology. 20% of PEs remain undiagnosed even after all investigations. The study was to identify the different etiological conditions in recurrent pleural effusion using thoracoscopy. And to determine the etiology of undiagnosed recurrent pleural effusion by thoracoscopy. Methodology: Prospective, observational study conducted in a tertiary care institute over a period of three years. 42 cases of undiagnosed recurrent pleural effusion were undergone thoracoscopy. Detailed history and physical examination, thoracocentesis and pleural fluid analysis were done in all cases. Ultrasound examination and computerized tomography done in all cases before thoracoscopy. Results: Out of the 42 cases of recurrent pleural effusions, the most common type was Adenocarcinoma followed by tuberculosis. Three cases remained undiagnosed even after thoracoscopy. Conclusions: Thoracoscopy is a simple, safe, less expensive technique with low morbidity and leads to early and quick diagnosis in recurrent pleural effusions. It was concluded in our study that thoracoscopy can establish the diagnosis in 92.85% cases of recurrent pleural effusion which were negative with pleural analysis there by decreasing morbidity and mortality due to pleural diseases. Keywords: Biopsy; Malignancy; Pleural effusion; Thoracoscopy; Tuberculosis.

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Background: Lung cancer is amongst the most commonly diagnosed major cancers. It is important to diagnose lung cancers as early as possible before the lesion has reached a visible and palpable tumor. This study was intended to find out efficacy of various diagnostic modalities in identifying pulmonary malignancies for easy and early diagnosis. Aims: To assess the efficacy of BAL and FNAC in suspected cases of pulmonary malignancy. Methodology: Prospective, observational study conducted in a tertiary care institute over a period of four years. 115 consecutive cases of suspected bronchogenic carcinoma were admitted. BAL and FNAC and biopsy were done to all the patients. Biopsy is taken as gold standard for comparison of BAL and FNAC to found the diagnostic efficacy in identifying pulmonary malignancy. Results: Out of the 107 cases of pulmonary malignancy, the most common type was Adenocarcinoma followed by squamous cell carcinoma and small cell carcinoma. Sensitivity of BAL was found to be 39.25% and FNAC was found to be 97.19%. Specificity was found to be 100% for both FNAC and BAL. Positive predictive value and negative predictive value was better with FNAC than that of BAL. Conclusions: Image guided FNAC of pulmonary lesions is a simple, safe, less expensive technique with low morbidity and leads to early and quick diagnosis when compared to trucut biopsy. In this study combination of BAL and FNAC can establish the diagnosis of bronchial carcinoma in most cases. Although histopathology remains the gold standard for diagnosis one can rely on cytology techniques for quick reporting of lung lesions. Keywords: BAL; Biopsy; FNAC; Pulmonary malignancy; Sensitivity; Specificity.

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