LRS Institute of Tuberculosis and Respiratory Diseases

Delhi, India

LRS Institute of Tuberculosis and Respiratory Diseases

Delhi, India
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Behera D.,Lrs Institute Of Tuberculosis And Respiratory Diseases
The Indian journal of chest diseases & allied sciences | Year: 2010

BACKGROUND; A case-controlled study was undertaken to find out the possible relationship of biomass fuel and pulmonary tuberculosis. METHODS: Ninety-five non-smoking females with sputum positive tuberculosis (TB) and 109 healthy controls were interviewed using a questionnaire to obtain detailed information on type of fuel used in homes, duration of cooking, passive smoking, location of kitchen, socio-economic status, adequacy of ventilation, number of people per room and respiratory symptoms occurring during cooking. Odds ratio (OR) was ascertained by logistic regression analysis. RESULTS: The cases were from a low socio-economic status and the kitchens used by them were inadequately ventilated. Controls had less smoke accumulation in the rooms while cooking and cases had associated respiratory symptoms more often. Logistic regression analysis revealed that TB was significantly influenced by the location of the kitchen (OR 0.201, 95% confidence interval [CI] 0.08-0.51) and the presence of respiratory symptoms while cooking (OR 10.70, 95% CI 2.90-39.56). The odds of having TB did not differ significantly among various fuel types either on univariate (OR 0.99, 95% CI 0.45- 2.22) or multivariate analysis (OR 0.60, 95% CI 0.22-1.63). CONCLUSIONS: No association was found between type of fuel used and TB. However, low socio-economic status, smoky rooms, location of the kitchen, ventilation and associated respiratory symptoms during cooking are likely to be important contributors.

Kaur D.,LRS Institute of Tuberculosis and Respiratory Diseases | Anand S.,Medanta | Sharma P.,LRS Institute of Tuberculosis and Respiratory Diseases | Kumar A.,LRS Institute of Tuberculosis and Respiratory Diseases
Journal of Anaesthesiology Clinical Pharmacology | Year: 2012

Tracheoesophageal fistula (TEF) in adults occurs as a result of trauma, malignancy, cuff-induced tracheal necrosis from prolonged mechanical ventilation, traumatic endotracheal intubation, foreign body ingestion, prolonged presence of rigid nasogastric tube, and surgical complication. Anesthetic management for repair of TEF is a challenge. Challenges include difficulties in oxygenation or ventilation resulting from placement of endotracheal tube in or above the fistula; large fistula defect causing loss of tidal volume with subsequent gastric dilatation, atelactasis, and maintenance of one lung ventilation. The most common cause of acquired nonmalignant TEF is postintubation fistula, which develops after prolonged intubation for ventilatory support. Acquired TEF, which occurs after prolonged intubation, usually develops after 12-200 days of mechanical ventilation, with a mean of 42 days. We present a rare case of TEF that developed after 7 days of intubation. It was a difficult case to be diagnosed as patient had a history of polytrauma, followed by emergency intubation and both these conditions can contribute to tracheobronchial injury.

Behera D.,Lrs Institute Of Tuberculosis And Respiratory Diseases
The Indian journal of chest diseases & allied sciences | Year: 2011

To study the seasonality of tuberculosis (TB) in a tertiary care tuberculosis and respiratory hospital in Delhi. Data from a tertiary care respiratory hospital in south Delhi over a six years period from April 2002 to March 2008 were analysed. Symptomatics: A total of 192,863 patients were registered newly in the hospital during this period. Maximum number of symptomatic patients reported to the out-patient department during April-June and the minimum during October-December. An increase of about 25% in symptomatics was observed (p < 0.05) in the period from April to June in comparison to October to December. The amplitude of seasonal variation was estimated as 11% of the annual mean symptomatics. Tuberculosis cases: The maximum sputum-positive TB cases were diagnosed during the period from April to June and the number was least during October to December. There was an increase of about 34% in sputum-positive cases (p < 0.001) during the period from April to June against October to December. The amplitude of seasonal variation was estimated as 14.4% of the annual mean smear-positives per quarter. The extra-pulmonary TB (EPTB) cases were the maximum during April-June. Chest symptomatics of all types of TB cases were the lowest in January. A seasonal pattern of TB was observed for pulmonary TB and EPTB cases. This information would be useful for administration and managers to take extra care to arrange and provide extra facilities during the peak seasons.

Paliwal N.,LRS Institute of Tuberculosis and Respiratory Diseases
The Indian journal of chest diseases & allied sciences | Year: 2013

Mature teratoma is a common anterior mediastinal tumour. However, occurrence of transformed malignant component within it is very rare. We report a case of a 32-year-old female presenting with dry cough and chest pain. Contrast-enhanced computed tomography (CT) showed a large thin-walled cystic lesion measuring 11.4 cm x 10.6 cm x 10.0 cm in the anterior mediastinum. Right postero-lateral thoracotomy was performed and the tumour was completely excised. Histopathological examination of the excised specimen was suggestive of mature teratoma with transformed malignant component, adenocarcinoma (somatic-type malignancy).

Dewan R.K.,LRS Institute of Tuberculosis and Respiratory Diseases
The Indian journal of chest diseases & allied sciences | Year: 2012

To review the surgical management of congenital malformations of lung parenchyma in a thoracic surgery unit over a period of 15 years. We carried out a retrospective analysis of records of all patients who had surgery for congenital malformations of lung parenchyma between 1995 and 2010. Forty-five patients underwent surgery for congenital lung lesions out of 3735 thoracotomies performed during the study period. The lesions included 29 lung sequestrations, 12 bronchogenic cysts, 3 congenital lobar emphysema and one congenital cystic adenomatoid malformation. Only 26 (26%) cases were diagnosed preoperatively. Twenty-eight (62.2%) patients underwent lobectomy, 5 (11.1%) patients had pneumonectomy, and 10 (22.2%) patients had removal of cyst while 2 (0.45%) patients had lung resection with repair of the oesophageal connection. No mortality was recorded. One patient had post-operative complication of oesophageal fistula which was successfully managed conservatively. The follow-up was between 8 months to 14 years. All patients were asymptomatic and had no physical limitations during the follow-up. Surgery is curative and produces good long-term result in patients with congenital malformations of lung parenchyma. It should be offered to patients as a therapeutic option where indicated and feasible.

Gupta S.,Lrs Institute Of Tuberculosis And Respiratory Diseases
The Indian journal of chest diseases & allied sciences | Year: 2011

Spontaneous acquired diaphragmatic hernia without any apparent history of trauma is a very rare condition and is very difficult to diagnose. We present a case of a 21-year-old male who presented with abdominal pain for one month and four episodes of vomiting for one day. Clinical suspicion, chest radiography with nasogastric tube in situ and computed tomography (CT) confirmed the diagnosis. The diaphragmatic defect was repaired surgically. The patient had an uneventful post-operative recovery.

Agarwal U.,LRS Institute of Tuberculosis and Respiratory Diseases | Kumar A.,LRS Institute of Tuberculosis and Respiratory Diseases | Behera D.,LRS Institute of Tuberculosis and Respiratory Diseases | French M.A.,University of Western Australia | Price P.,University of Western Australia
AIDS Research and Therapy | Year: 2012

Background: Tuberculosis (TB) is the most common co infection in HIV-infected persons in India, requiring concomitant administration of anti TB and antiretroviral therapies. Paradoxical worsening of tuberculosis after anti-retroviral therapy (ART) initiation is frequently seen.Objective: To study the frequency, clinical presentation and outcome of paradoxical tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) in HIV infected patients in a TB hospital in North India.Design: A retrospective chart review of HIV-infected TB patients on anti-tubercular treatment (ATT) at time of ART initiation over a 3 year period. Medical records were reviewed for clinical manifestations and outcome in patients who developed TB-IRIS.Results: 514 HIV-infected patients were enrolled between January 2006 and December 2008. Thirteen (12.6%) of 103 patients who had received ART and ATT simultaneously developed paradoxical TB-IRIS. Clinical presentations of paradoxical TB-IRIS included new lymphadenopathy (n = 3), increase in size of existing lymphadenopathy (n = 3), worsening of existing pulmonary lesions (n = 2), appearance of new pleural effusion (n = 1) and prolonged high grade fever (n = 2). Four patients developed new tubercular meningitis as manifestation of TB-IRIS. Our cases developed TB-IRIS a median of 15 days after starting ART (IQR 15-36). TB-IRIS patients were older (> 35 years) than those with no IRIS (P = 0.03), but were not distinguishable by CD4 T-cell count, duration of ATT before ART or the outcome of TB treatment. Eight (62%) patients had a complete recovery while 5 (38%) patients with TB-IRIS died, of which majority (n = 3) had meningitis.Conclusions: Paradoxical TB-IRIS is a frequent problem during concomitant ATT and ART in HIV-TB co infected patients in north India. Meningitis is a potentially life threatening manifestation of TB-IRIS. © 2012 Agarwal et al.; licensee BioMed Central Ltd.

Patra S.,UCMS and GTB Hospital | Sharma S.,LRS Institute of Tuberculosis and Respiratory Diseases | Behera D.,PGi
Indian Journal of Tuberculosis | Year: 2012

Background: Passive smoking and biomass fuel use most probably are more harmful to children than adults for two reasons. The first one is children's respiratory and immune systems are not fully developed. Secondly, they spend more time at home and are, therefore, likely to experience more intense and prolonged smoke exposure. Aims: This study was planned to find out if there is any association between childhood tuberculosis and exposure to passive smoking and biomass fuel. Methods: A hospital-based case control study was done. All registered consecutive newly diagnosed pediatric tuberculosis cases (0-14 years) from the outpatient department of a tertiary care hospital were recruited as cases. Age and sex matched controls were recruited from a public general hospital of the same locality. A semi-structured, pre-coded interview schedule was administered to parents or legal caregivers of all subjects after obtaining informed written consent. Results: A total of 200 cases and 200 controls were recruited in the study period. The factors which were significantly associated with development of tuberculosis were education of the mother, (OR 1.411, 95% CI 0.888-2.243, p-0.001), a family member having tuberculosis in the last two years and residing in the same house (OR 2.797, 95% CI 1.353-5.789; p-0.004), being a passive smoker (OR 1.725, 95% CI 1.142-2.605; p-0.009). No association between biomass cooking fuel use and development of tuberculosis was found. Conclusion: Passive smoking is associated with development of childhood tuberculosis. This requires health education programmes and medical antitobacco advice and services.

Lavania M.,TLM Community Hospital | Jadhav R.S.,Government Institute of Science | Turankar R.P.,TLM Community Hospital | Chaitanya V.S.,TLM Community Hospital | And 2 more authors.
Clinical Microbiology and Infection | Year: 2013

Earlier studies indicate that genotyping of Mycobaterium leprae based on single-nucleotide polymorphisms (SNPs) is useful for analysis of the global spread of leprosy. In the present study, we investigated the diversity of M. leprae at eight SNP loci using 180 clinical isolates obtained from patients with leprosy residing mainly in Delhi and Purulia (West Bengal) regions. It was observed that the frequency of SNP type 1 and subtype D was most predominant in the Indian population. Further, the SNP type 2 subtype E was noted only from East Delhi region and SNP type 2 subtype G was noted only from the nearby areas of Hoogly district of West Bengal. These results indicate the occurrence of focal transmission of M. leprae infection and demonstrate that analysis by SNP typing has great potential to help researchers in understanding the transmission of M. leprae infection in the community. © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Gupta V.,All India Institute of Medical Sciences | Jaiswal A.,Lrs Institute Of Tuberculosis And Respiratory Diseases | Behera D.,Lrs Institute Of Tuberculosis And Respiratory Diseases | Prasad H.K.,All India Institute of Medical Sciences
Human Immunology | Year: 2010

Dendritic cell (DC) subsets, myeloid DCs (mDCs), and plasmacytoid DCs (pDCs) play a fundamental role in immune response to Mycobacterium tuberculosis (M. tuberculosis). Flow-cytometric estimation of DC subsets showed differences in the ratio of these subsets in untreated, smear-positive pulmonary tuberculosis patients compared with healthy family contacts (HFC, p < 0.05). The percentage of pDCs (0.14 ± 0.01) was higher than mDCs (0.12 ± 0.01) in patients, whereas in HFC, mDCs (0.15 ± 0.01) was higher than pDCs (0.1 ± 0.01). The percentage of mDCs (0.15 ± 0.01) and pDCs (0.11 ± 0.01) was restored in treated patients. Alteration in the DC subsets before and after chemotherapy was confirmed in the follow-up of acid-fast bacilli (AFB)-positive patients. This reversal in the percentage of mDC vs pDCs implicates the influence of active disease on circulating DC subsets. The cytokine bead array revealed an inverse relationship in the circulating levels of IL-12 and IFN-γ. High IL-12 (37.9 ± 15.2) and low IFN-γ (11.09 ± 3.6) was seen in HFCs derived serum samples compared with that of patients (p < 0.05). The higher percentage of mDCs and elevated IL-12 levels was found to be associated with high risk HFCs investigated. Furthermore CpG/LPS-stimulated whole-blood culture of untreated patients expressed high IFN-α in pDCs and less IL-12 in mDCs compared with those of treated patients. © 2010 American Society for Histocompatibility and Immunogenetics.

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