International Journal of Medical Research and Review

Clinical and histopathological profile of patients with exudative pleural effusion of unknown cause who undergo medical thoracoscopy

venkata suneel kumar jasti — 2025-02-19

Background: Exudative lymphocytic effusions form a significant proportion of undiagnosed pleural pathologies. This study explores the clinical and histopathological profile of exudative pleural effusion of unknown cause who undergo medical thoracoscopy.

Materials And Methods: This cross-sectional study enrolled 37 patients with exudative pleural effusion. Ultrasound-guided thoracentesis was conducted and samples were sent for pleural fluid cytology. Thoracoscopic pleural biopsy was kept as the gold standard.

Results: A total of 37 patients were included in the study. 14 (37.83%) were smokers. 19 (51.35%) were exposed to firewood smoke. Only 1 participant (2.7%) reported exposure to passive smoke.5 patients had STEMI/ recent CABG in the last 1 year.1 participant reported a history of Ayurvedic drug intake. There was no asbestos occupational exposure in any of our subjects but 5 of our subjects had mesothelioma. It can be related to an indirect exposure which is absent due to a recall bias. 2 participants reported a history of recent trauma or RTA, but it was unrelated to the final diagnosis. Histopathological profile showed adenocarcinoma in 19(51.35%), tuberculosis in 7(18.9%).Thoracoscopy pleural findings include nodules in 26(70.27%).

Conclusion: Our study concluded that pleural nodules on thoracoscopy were suggestive of malignant aetiology with good cytology yield. Pleural metastasis from lung adenocarcinoma has a good yield of cytology and is the most common cause of exudative pleural effusions that underwent medical thoracoscopy.

CORRELATION BETWEEN IMPULSE OSCILLOMETRY AND SPIROMETRY IN ASSESSMENT OF SMALL AIRWAY DYSFUNCTION IN ASYMPTOMATIC SMOKERS

Harishankar S — 2025-03-03

BACKGROUND: The traditional pulmonary function tests may be inadequate to detect Chronic Obstructive Pulmonary Disease (COPD) pathological damage and smoking-related lung disease. Therefore, more reliable methods for airway evaluation are required for patients with COPD. Impulse oscillation system (IOS) is a novel method for reactance and airway resistance measurements. It is a kind of forced oscillation, where sound waves oscillate at different frequencies, usually between 5 and 20 Hz, and propagate through the bronchial tree. It measures the proximal airway resistance (measured at 20 Hz [R20]), the peripheral airway resistance (measured at R5–R20), and the overall airway resistance (measured at 5 Hz [R5]). Resistance and reactance make up impedance. IOS provides more detailed information than spirometry on regional lung function and should be considered as being complementary to spirometry to comprehensively assess lung function in COPD. Also, small airway dysfunction (SAD), if detected early, can help in preventing progression of the disease with proper counselling and smoking cessation.

OBJECTIVES: The objective of our study is to assess the correlation between impulse oscillometry and spirometry parameters in small airway dysfunction in asymptomatic smokers in a tertiary care centre; to determine the association of smoking index with impulse oscillometry small airway dysfunction parameter R5-R20.

MATERIALS AND METHODS: Study was conducted in Department of Pulmonary Medicine, Medical college Hospital, Thiruvananthapuram. The present cross- sectional study included asymptomatic current smokers, eligible participants underwent spirometry and oscillometry and results compared.

RESULTS: Out of 45 patients studied, 44.4% (n=20), fell within the 45-60 age range. The majority of participants, comprising 37.8% (n=17), had a Smoking Index ranging from 300 to 399. Correlation analysis between FEF (25-75) vs (R5-R20) done by Pearson correlation test reported very mild negative correlation between them (r=-0.053, p=0.728). Chi square test reported significant association between smoking index & R5-R20 (p<0.05).

CONCLUSION: Impulse oscillometry is capable to detect SAD in asymptomatic smokers with preserved spirometry and with FEF(25-75) values in the normal range. We verify that IOS offers parameters that can contribute to conventional pulmonary function tests.

Hand grip strength as a marker of functional impairment in chronic obstructive pulmonary disease patients

Neena R S — 2025-03-03

Background: COPD is a heterogeneous lung disease with multisystem involvement. COPD patients not only suffer from respiratory function impairment but also from peripheral muscle dysfunction which is an important manifestation that hinders day-to-day activities. Patients with a reduction in muscle strength should be detected early so that an early intervention through pulmonary rehabilitation can be done. pMDIs which is a common inhalation device in COPD require adequate hand strength for its actuation making the upper limb muscle strength an important parameter which is often ignored in COPD patients.

Objectives: To determine the hand grip strength of COPD patients objectively. To determine the association between hand grip strength with FEV1,6-minute walk distance and BODE index.

Methods: This is a cross-sectional followed by a prospective observational study conducted in the Department of Respiratory Medicine, Government Medical College, Trivandrum, Kerala. In 72 COPD patients, hand grip strength was assessed using a Camry Digital Dynamometer and was compared with the age and gender-adjusted values. Spirometry was done in all 72 patients and FEV1 measurement was recorded. A 6-minute walk distance was determined; the BODE index was calculated in these patients which comprises BMI, FEV1, Dyspnea on the MMRC scale and distance walked in 6 minutes.

Results: COPD patients were found to have a reduction in their hand grip strength compared to their age and gender-adjusted values. In COPD patients, hand grip strength was found to have a positive correlation with a 6-minute walk distance whereas grip strength was found to have a negative correlation with BODE INDEX.

Conclusion: Hand grip strength is impaired in COPD patients and it could be used as a marker of functional impairment.

PROPORTION OF OBSTRUCTIVE AIRWAY DISEASE AMONG POST PULMONARY TUBERCULOSIS SUBJECTS IN A TERTIARY CARE SETTING

Akshaya K T — 2025-03-03

Background: Pulmonary tuberculosis can affect lung function and the pulmonary function test of post-patients shows airway obstruction which is not reversible. This group of patients is in the category of post-TB obstruction syndrome with symptoms and signs similar to Chronic Obstructive Pulmonary Disease (COPD). The objectives of our study are: To determine the factors causing the development of obstructive airway disease in post-tuberculous individuals & To assess the severity of obstruction based on GOLD criteria.

Materials and Methods: The study was conducted in the Department of Pulmonary Medicine, Government Medical College Hospital, Thiruvananthapuram. This was a cross-sectional study that included patients with a history of pulmonary tuberculosis, (≥ 6 months after treatment), the pulmonary function test of each patient was assessed using spirometry as obstruction, restriction, mixed pattern or normal and in obstruction, the severity of obstruction was assessed as mild, moderate, severe, very severe based on GOLD criteria.

Results: In our study, 84% of patients had abnormal lung function, with obstruction as the predominant abnormality in 36%, 21.8% demonstrated restrictive abnormalities, and 26.1% showed mixed patterns. Among individuals with obstructive lung disease, the severity of obstruction was assessed based on their post-bronchodilator FEV1% according to GOLD grades for COPD. It was observed that 67.4% had moderate obstruction. The mean FEV1 for the moderate obstruction group, the most prevalent among obstructive cases, was 1.41 litres.

Conclusion: Patients with a history of pulmonary tuberculosis in the past, often present with signs of permanent impairment in lung function, which may manifest as obstruction, restriction, or a mixed pattern. Tuberculosis is an independent risk factor for the development of obstructive airway diseases.

CORRELATION BETWEEN AIRWAY RESISTANCE AS DETERMINED BY R20 AND SEVERITY OF OBSTRUCTIVE SLEEP APNEA AS DETERMINED BY APNEA HYPOPNEA INDEX IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA”

Aswathy Sasidharan — 2025-03-11

Background: Polysomnography is the gold standard for the diagnosis of patients with obstructive sleep apnea, but its routine use is limited by its cost. R20 measures the resistance of large central airways while R5 corresponds to total airway resistance, in large airway obstruction (as in OSA) central airway resistance (R20) increases and total resistance (R5) increases. This study aims to assess the usefulness of impulse oscillometry in the diagnosis of patients with obstructive sleep apnea, as it is a cost-effective, easy-to-perform investigation.

Materials And Methods: The present cross-sectional study included 85 patients suspected to have obstructive sleep apnea. Initial screening was done using the STOP BANG score. Specifically, patients with a score of 0 - 2 are considered at low risk for moderate to severe OSA, while those with a score of 5 -8 are classified as high risk for moderate to severe OSA and in our study those with a score ≥3 was advised to perform sleep study with their AHI index noted and subsequently impulse oscillometry noting their R20, R5 and R5-R20.

Results: In our study majority of participants (64.3%) fell within the 51-60 age range, which aligns with typical findings indicating a higher prevalence in middle-aged adults. The majority of participants,70 individuals were obese. In our study hypertension was the most prevalent comorbidity associated with OSA Among the 84 study subjects 63.1% of the sample, reported having Type 2 Diabetes Mellitus. 60 participants, making up 71.4% of the sample, reported that they do snore and we demonstrated a good correlation between the severity of OSA and snoring.

Conclusion: Impulse oscillometry can be a useful,easy-to-perform test in the evaluation of patients with OSA though further studies are needed.

Individualized Homoeopathic Medicines Alleviated the Recurrent Epistaxis in Identical Twins with Severe von Willebrand Disease and Haemophilia A: A Duo Case Report.

Omkar Kumat — 2025-02-18

Background: von Willebrand Disease (vWD) is an inherited genetic bleeding disorder that prevents the blood from clotting. Prevalence of vWD is estimated to be approximately 1% of the population (or 10,000 cases per million population). The vWF binds and stabilizes blood clotting factor (FVIII) in circulation and therefore it helps in clot formation.

Case Profiles: This duo case report is the classical example of association of vWD with haemophilia A in identical twins, where both the patients shared the same disease pattern and manifestations like recurrent epistaxis & ecchymotic patches. But when it came to homoeopathic prescription both of them were prescribed 2 different constitutional medicines on the basis of their behavior, constitution, etc.

Result & Discussion: ISTH-BAT (International Society on Thrombosis and Haemostasis-Bleeding Assessment Tool) scale was used to measure the frequency of epistaxis and bruises which reduced from 6 to 1 in the elder twin and from 7 to 4 in the younger one. Modified Naranjo Criteria in Homoeopathy was used to assess the homoeopathic result with the score of 10 for the elder twin and 8 for the younger twin. This Duo Case Report signifies the role of two different Individualized Homoeopathic Medicines in the identical twins though sharing the similar disease pattern.

Conclusion: Homoeopathic medicines prescribed on the basis of individualization alleviated the genetic disease symptoms and improved the quality of life of the patients’ and the family members.

Six interesting case discussions of adult type 1 diabetes from Karnataka, South India

Anil kumar R — 2025-03-20

Type 1 diabetes can affect adults, although it is more common in children and young adults. We are presenting six cases of adult onset type 1diabetes. The etiology was autoimmune in five persons and idiopathic in one person. Two persons had diabetic ketoacidosis at presentation and four persons had symptoms of hyperglycemia. Fasting c-peptide was measured after blood glucose control and all six persons had very low c-peptide levels. Diabetes may present at any age so when there is strong clinical suspicion of type 1 diabetes in adults, physicians should do fasting C-peptide levels to diagnose type1 diabetes for management.

Human Metapneumovirus (HMPV) - A Comprehensive Review of Clinical Impact, Epidemiology, and Management Approaches.

RUPALI VERMA RUPALI — 2025-02-14

Human Metapneumovirus (HMPV) is an important viral agent responsible for a range of respiratory diseases, especially among vulnerable populations such as young children, the elderly, and those with weakened immune systems. This review highlights the clinical features, epidemiology, diagnostic challenges, and therapeutic strategies related to HMPV infections. The absence of specific antiviral treatments and vaccines for HMPV represents a significant challenge in clinical practice. Understanding its pathogenesis, refining diagnostic methods, and advancing research into vaccines and therapeutics are essential to better manage and prevent this infection.

Understanding Generation Z nursing students and Role of Nursing Faculty and Educators :A Narrative review

Anjali Sancha — 2025-02-18

The nursing education landscape is undergoing a significant transformation due to generational shifts. A widening gap exists between Generation Y educators and Generation Z and Alpha students, impacting teaching methodologies and curriculum design. Students' readily available access to online information contrasts sharply with educators' past experiences of in-depth research. This necessitates a paradigm shift in teaching approaches to accommodate the unique learning styles and technological proficiency of younger generations. Understanding the sociocultural influences shaping Gen Z students' worldviews, and embracing technology in the classroom, are crucial for effective nursing education and preparing the future nursing workforce. Faculty development focusing on technology integration is essential to bridge the generational divide and ensure successful student learning.