Dharm Prakash Dwivedi

Abstract

Pulmonary cavitary lesions with pneumothorax are very common in chest imaging and usually pose diagnostic challenge to clinicians Pneumothorax with a cavitary lesion is a rare occurrence in primary and metastatic lung cancer. A 40-year-old male presented with cough with whitish expectoration, right loin pain, loss of weight and appetite for 3 months and difficulty in breathing for 2 days. Chest x-ray was suggestive of right-side pneumothorax with bilateral nodular opacities in all zones. Contrast-enhanced computed tomography (CECT) thorax and abdomen revealed a non-homogenous large mass in the right kidney with hydronephrotic changes with cavitary lesions in bilateral lungs. Urine cytology was suggestive of urothelial carcinoma. Thus, a diagnosis of urothelial cancer with cavitating metastasis leading to secondary spontaneous pneumothorax was made. Herein, we aim to highlight that cavitating metastasis should be considered in a case of pneumothorax with bilateral lung nodules.   Keywords: Secondary spontaneous pneumothorax, Urine cytology, Urothelial carcinoma, Metastasis, Lung cancer

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Abstract

X-ray flips and wrong labelling has been uncomfortably common, and often results in wrong side intervention. Wrong side surgery is indeed the most dramatic and visible form of human errors. Until the 1999 Institute of Medicine report ‘To Err is Human’, the medical fraternity was largely unaware of such preventable medical errors and near misses. We herein, describe a case where X-ray flip and mislabelling led to wrong side intervention in a COVID-19 ICU. Active errors in human performance are inevitable while practising medicine in the current COVID-19 pandemic where difficulties in performing comprehensive systemic examination with the protective gear on, long working hours, work stress, emotions, and fatigue interplay with the errors in technology and increase the chances of errors. We propose the use of point of care ultrasound (POCUS) in COVID-19 ICU’s to aid in the diagnosis and management.   Keywords: Xray flips, mislabelling, POCUS, COVID19, novel coronavirus

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Abstract

Background: India contributes to approximately one-third of total global tuberculosis (TB) and one-fourth of all Multi-Drug Resistant TB (MDR-TB) burden respectively. The First National drug resistance survey (2014-16) showed MDRTB rates of 6.19% overall and 2.14% in newly diagnosed TB cases. With the above problem of primary drug resistance among newly diagnosed tuberculosis cases, the present study was planned to find the prevalence of Isoniazid (INH) and Rifampicin resistance in the treatment naïve new tuberculosis cases. Materials and Methods: Study design: Prospective, cross-sectional. Subjects: Treatment naive newly diagnosed pulmonary tuberculosis cases. Sample Size: 125. Procedure: After informed written consent, Sputum samples were collected and subjected to culture in MGIT 960 and positive cultures were recorded and subjected to drug sensitivity testing for INH (0.1 ?g/ml) and Rifampicin (1 ?g/ml) and a parallel non-drug MGIT was run as a control. Results: Most cases were males and belonged to the 20-59 years age group. Isoniazid (INH) resistance was found in 7 out of 125 samples, none had resistance to rifampicin. None of the categorical variables or grading of smear were having any statistically significant correlation with INH resistance. Conclusions: INH resistance was found to be low (5.6%) with negligible MDR in the current study. Regular and large studies are needed to quantify and tackle the problem of primary MDR TB.   Keywords: Primary MDR TB, Tuberculosis, MGIT, Treatment naïve TB.

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