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Article ; Online: Reversible platypnoea-orthodeoxia syndrome.

Joseph, Thomas Jeo / Isaac, Barney Thomas / James, Prince / Thangakunam, Balamugesh

BMJ case reports

2023 Volume 16, Issue 10

Abstract: Platypnoea-orthodeoxia syndrome is characterised by dyspnoea and oxygen desaturation in the upright position usually caused by an extracardiac shunt and less often due to dynamic factors that accentuate an intracardiac right-to-left shunt. In our patient, ...

Abstract	Platypnoea-orthodeoxia syndrome is characterised by dyspnoea and oxygen desaturation in the upright position usually caused by an extracardiac shunt and less often due to dynamic factors that accentuate an intracardiac right-to-left shunt. In our patient, the collapse of lower lobe of left lung secondary to bronchial stenosis due to endobronchial tuberculosis and resultant mediastinal shift was the factor that led to an otherwise unrecognised intracardiac right-to-left shunt leading to platypnoea-orthodeoxia. We postulate that there would have been an increased stretching and widening of a patent foramen ovale in the upright position due to gravity resulting in an increased shunt despite normal intracardiac pressures. Once the patency of the left main bronchus was restored by deploying a stent, the left lower lobe expanded, the mediastinum returned to its normal position and there was resultant resolution of the platypnoea-orthodeoxia. This interesting observation may be useful in managing similar scenarios in the future.
MeSH term(s)	Humans ; Platypnea Orthodeoxia Syndrome ; Hypoxia/complications ; Foramen Ovale, Patent/complications ; Foramen Ovale, Patent/diagnostic imaging ; Foramen Ovale, Patent/surgery ; Dyspnea/complications
Language	English
Publishing date	2023-10-31
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2023-255587
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Tracheobronchopathia Osteochondroplastica - to Biopsy or not to Biopsy? A Relook at The Rare Disease.

Nair, Avinash A / Gupta, Richa / Irodi, Aparna / Ashwin Oliver, A / Chandran, Divya / Thangakunam, Balamugesh / James, Prince

Journal of bronchology & interventional pulmonology

2024 Volume 31, Issue 1, Page(s) 57–62

Abstract: Background: Tracheobronchopathia osteochondroplastica (TPO) is a rare idiopathic disease involving the tracheobronchial tree. It is mostly an incidental finding with non-specific clinical manifestations. It has typical bronchoscopic, radiological ... ...

Abstract	Background: Tracheobronchopathia osteochondroplastica (TPO) is a rare idiopathic disease involving the tracheobronchial tree. It is mostly an incidental finding with non-specific clinical manifestations. It has typical bronchoscopic, radiological features and biopsy is usually considered non-essential. The study aimed to determine whether biopsy makes a difference in the management of patients. Methods: All patients diagnosed with TPO in our institution over 15 years (2005 to 2020) were included in this study. Their medical records, chest computed tomography (CT), and bronchoscopy reports were retrospectively reviewed, and data were analysed. All the CT images were reviewed by a senior chest radiologist. Results: From the 20,000 bronchoscopies and 260,000 CT thorax images obtained, 28 cases were diagnosed as TPO based on either bronchoscopy or radiology or both. Among the 19 cases diagnosed through bronchoscopy, 16 underwent a biopsy. In addition to TPO features, biopsy showed additional diagnoses in 6 cases. In 9 cases, TPO was not initially diagnosed by CT but by bronchoscopy. In 8 patients, TPO was diagnosed incidentally on CT performed for other reasons. On follow-up with the treatment of underlying/co-existing concomitant aetiologies, clinical improvement was noted in all patients. None of them progressed to respiratory failure or airway obstruction until the last follow-up. Conclusion: Among patients who underwent bronchoscopic biopsy of TPO lesions, 38% had biopsy results showing an alternative aetiology, which led to changes in the treatment plan for all these patients. Hence, a bronchoscopic biopsy of TPO lesions should be performed to rule out other aetiologies.
MeSH term(s)	Humans ; Rare Diseases/complications ; Retrospective Studies ; Tracheal Diseases/diagnostic imaging ; Tracheal Diseases/complications ; Bronchoscopy/methods ; Osteochondrodysplasias/diagnostic imaging ; Osteochondrodysplasias/complications ; Biopsy
Language	English
Publishing date	2024-01-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2478320-1
ISSN	1948-8270 ; 1944-6586
ISSN (online)	1948-8270
ISSN	1944-6586
DOI	10.1097/LBR.0000000000000931
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Article: Fat emboli-Related diffuse alveolar haemorrhage (FEDAH) an acronym to remember-Case series.

Williams, Benjamin Earnest / Nair, Avinash A / James, Prince / Isaac, Barney / Gupta, Richa / Ashok, Anand

Respirology case reports

2023 Volume 11, Issue 10, Page(s) e01214

Abstract: Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopaedic surgery, which presents predominantly with pulmonary symptoms. The rapid worsening respiratory failure in a previously normal orthopaedic surgery or trauma ... ...

Abstract	Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopaedic surgery, which presents predominantly with pulmonary symptoms. The rapid worsening respiratory failure in a previously normal orthopaedic surgery or trauma patients usually get evaluated for pulmonary embolism, fat-embolism-related acute respiratory distress or transfusion related acute lung injury. Orthopaedic surgeons and clinicians need to be aware of related entity termed '
Language	English
Publishing date	2023-09-08
Publishing country	United States
Document type	Case Reports
ZDB-ID	2750180-2
ISSN	2051-3380
ISSN	2051-3380
DOI	10.1002/rcr2.1214
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Article: Evaluation of humoral immune deficiency in Indian patients with bilateral bronchiectasis with no apparent aetiology.

Rohit, K O / Thangakunam, Balamugesh / Mehta, Vinay / Christopher, Devasahayam J / James, Prince

Lung India : official organ of Indian Chest Society

2023 Volume 40, Issue 1, Page(s) 33–36

Abstract: Background: Infections continue to be the leading aetiology of bronchiectasis in developing countries like India. Among non-infectious cases, the majority will have no identifiable cause despite extensive evaluation. Recently, immunodeficiency has been ... ...

Abstract	Background: Infections continue to be the leading aetiology of bronchiectasis in developing countries like India. Among non-infectious cases, the majority will have no identifiable cause despite extensive evaluation. Recently, immunodeficiency has been recognized as an important aetiology, but data on its prevalence remain rather sparse. Objectives: The objective of this study is to evaluate the prevalence of humoral immunodeficiency in a cohort of adults with bilateral bronchiectasis with no apparent aetiology. Methods: This is the single-site study from Christian Medical College (Vellore, India) of adults with HRCT-proven non-infectious bronchiectasis. Humoral immunity was assessed through quantitative analysis of immunoglobulins and IgG subclass levels. Results: Among 158 cases, immunoglobulin deficiency was found in 15%. Low IgM was the most predominate finding (7%), followed by common variable immunodeficiency (3%) and low IgA (2.5%). In addition, IgG subclass deficiency was found in 5%. In 53% of cases, no specific aetiology could be identified. Conclusion: Humoral immune deficiency is present in a significant proportion of patients with non-infectious bronchiectasis. Routine measurement of serum immunoglobulins should therefore be considered as part of the evaluation.
Language	English
Publishing date	2023-02-02
Publishing country	India
Document type	Journal Article
ZDB-ID	2410801-7
ISSN	0974-598X ; 0970-2113
ISSN (online)	0974-598X
ISSN	0970-2113
DOI	10.4103/lungindia.lungindia_319_22
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Article ; Online: Clinical implications of high-risk mutations in drug resistant tuberculosis (DR-TB): An observational cohort study.

Thampy, Anupa / Ninan, Marilyn M / Michael, Joy S / James, Prince / Rupali, Priscilla

Indian journal of medical microbiology

2021 Volume 39, Issue 4, Page(s) 534–536

Abstract: Genotype MTBDRsl [SL-LPA] was endorsed as a tool for early diagnosis of fluoroquinolones (FQ) and injectable second-line TB drugs (SLID) resistance in DR-TB. Correlation between specific genetic mutations using this tool and clinical outcome has not ... ...

Abstract	Genotype MTBDRsl [SL-LPA] was endorsed as a tool for early diagnosis of fluoroquinolones (FQ) and injectable second-line TB drugs (SLID) resistance in DR-TB. Correlation between specific genetic mutations using this tool and clinical outcome has not hitherto been studied in India. We conducted a observational cohort study to evaluate the predictive value of specific mutations for bad outcome. Our study identified 15 different types of gyrA mutations, commonest being A90V and D94G. Poor outcome was associated with mutations D94G and D94N/D94Y.Most XDR-TB patients harbored the high risk mutation of A1401G. Hence information of specific mutations using SL-LPA can help prognosticate and design appropriate treatment regimens.
MeSH term(s)	Antitubercular Agents/pharmacology ; Antitubercular Agents/therapeutic use ; Fluoroquinolones/pharmacology ; Humans ; India ; Microbial Sensitivity Tests ; Mutation ; Mycobacterium tuberculosis/drug effects ; Mycobacterium tuberculosis/genetics ; Tuberculosis, Multidrug-Resistant/drug therapy
Chemical Substances	Antitubercular Agents ; Fluoroquinolones
Language	English
Publishing date	2021-06-12
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1038798-5
ISSN	1998-3646 ; 0255-0857
ISSN (online)	1998-3646
ISSN	0255-0857
DOI	10.1016/j.ijmmb.2021.05.020
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Article ; Online: ICS/Ultra LABA in the Treatment of Obstructive Airway Diseases: A Consensus of Indian Experts.

Dhar, Raja / Talwar, Deepak / James, Prince / Mishra, Ashwini / Vachaparambil, Judo / Patil, Saiprasad / Khatri, Nishtha / Bhagat, Sagar / Barkate, Hanmant

Advances in respiratory medicine

2022 Volume 90, Issue 5, Page(s) 407–424

Abstract: Inhaled corticosteroid and ultra-long-acting beta-agonist (ICS/uLABA) combination is a recent advancement in the armamentarium against obstructive airways diseases (OADs). The combination of ICS/uLABA has several advantages, creating a favorable ... ...

Abstract	Inhaled corticosteroid and ultra-long-acting beta-agonist (ICS/uLABA) combination is a recent advancement in the armamentarium against obstructive airways diseases (OADs). The combination of ICS/uLABA has several advantages, creating a favorable landscape for its utilization. Fluticasone furoate/vilanterol trifenatate (FF/Vi) is one such example of an ICS/uLABA. It offers several benefits from both drugs, such as a convenient once daily dosing schedule; high lipophilicity; high receptor affinity of fluticasone furoate along with high functional selectivity and a quick onset of action of vilanterol. However, the Global Initiative for Asthma (GINA) as well as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines do not clearly define the positioning of ICS/uLABA compared to conventional ICS/LABAs. There are a few areas of uncertainty especially around the appropriate reliever strategy with ICS/uLABA in Asthma. The current consensus was planned with a group of Indian pulmonology experts to provide more clarity on the potential use of FF/Vi in Asthma and COPD. The clinical statements highlighted in this consensus manuscript address crucial clinical questions revolving around the efficacy and safety of FF/Vi as compared to conventional ICS/LABAs and identify the ideal patient profile for its use. This consensus paper also sheds light upon the appropriate reliever to be used along with FF/Vi in Asthma and the utilization of FF/Vi-based triple therapy in OADs. Expert recommendations mentioned in this paper will serve as guidance to pulmonologists as well as consultant physicians who are involved in providing care to OAD patients and will help them weigh the various factors that need to be taken into account while prescribing ICS/uLABA combination.
MeSH term(s)	Humans ; Adrenergic beta-2 Receptor Agonists/therapeutic use ; Consensus ; Administration, Inhalation ; Drug Administration Schedule ; Adrenal Cortex Hormones/therapeutic use ; Asthma/drug therapy ; Pulmonary Disease, Chronic Obstructive/drug therapy
Chemical Substances	vilanterol (028LZY775B) ; Adrenergic beta-2 Receptor Agonists ; Adrenal Cortex Hormones
Language	English
Publishing date	2022-09-29
Publishing country	Switzerland
Document type	Guideline
ZDB-ID	2893877-X
ISSN	2543-6031 ; 2451-4934
ISSN (online)	2543-6031
ISSN	2451-4934
DOI	10.3390/arm90050051
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Article ; Online: Robustness of the Line Probe Assay for the Rapid Diagnosis and Characterization of Mutations in Extensively Drug-Resistant Tuberculosis.

Ninan, Marilyn M / Rupali, Priscilla / James, Prince / Michael, Joy S

Microbial drug resistance (Larchmont, N.Y.)

2019 Volume 25, Issue 6, Page(s) 799–804

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Antitubercular Agents/therapeutic use ; Biological Assay/methods ; Extensively Drug-Resistant Tuberculosis/diagnosis ; Extensively Drug-Resistant Tuberculosis/drug therapy ; Extensively Drug-Resistant Tuberculosis/genetics ; Fluoroquinolones/therapeutic use ; Genotype ; Humans ; Microbial Sensitivity Tests/methods ; Mutation/genetics ; Mycobacterium tuberculosis/drug effects ; Sensitivity and Specificity
Chemical Substances	Antitubercular Agents ; Fluoroquinolones
Language	English
Publishing date	2019-03-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1290490-9
ISSN	1931-8448 ; 1076-6294
ISSN (online)	1931-8448
ISSN	1076-6294
DOI	10.1089/mdr.2018.0268
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Article ; Online: Imprint Cytology of Thoracoscopic Pleural Biopsy Tissue for Early Etiological Diagnosis of Pleural Effusion: A Pilot Study From India.

Gupta, Richa / Arul, Ashwin Oliver / Sasikumar, Jebin Roger / Prabhu, Anne Jennifer / James, Prince

Journal of bronchology & interventional pulmonology

2020 Volume 28, Issue 2, Page(s) 98–102

Abstract: Thoracoscopic pleural biopsy provides the highest diagnostic yield in both malignant and tubercular pleural effusions. However histopathologic report takes 3 to 5 days to provide the diagnosis, resulting in a delay of further management plans like ... ...

Abstract	Thoracoscopic pleural biopsy provides the highest diagnostic yield in both malignant and tubercular pleural effusions. However histopathologic report takes 3 to 5 days to provide the diagnosis, resulting in a delay of further management plans like pleurodesis or chest tube removal. Imprint cytology of biopsy tissue can provide early information about the etiological diagnosis. Thus, we conducted this pilot study in 66 patients of exudative pleural effusions undergoing medical thoracoscopy. One or 2 biopsy pieces obtained during medical thoracoscopy from pleural nodules were used to prepare imprint cytology slides in the thoracoscopy suite. In comparison to thoracoscopic pleural biopsy, the diagnostic yield of imprint cytology of pleural tissue was 92% (49 of 53 cases) in cases of malignant pleural effusion and 75% (9 of 12 cases) in cases of tuberculosis pleural effusions. Imprint cytology provided a definite idea about the type of diagnosis, about 2.5 days before the histopathology results. By providing early etiological diagnosis, it may also decrease the duration of hospital stay and health care expenditure. A large prospective trial has been planned in our center to confirm this hypothesis.
MeSH term(s)	Biopsy ; Humans ; India/epidemiology ; Pilot Projects ; Pleural Effusion/diagnosis ; Pleural Effusion, Malignant/diagnosis ; Prospective Studies ; Thoracoscopy
Language	English
Publishing date	2020-10-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2478320-1
ISSN	1948-8270 ; 1944-6586
ISSN (online)	1948-8270
ISSN	1944-6586
DOI	10.1097/LBR.0000000000000724
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Article ; Online: Contextual equipoise

Nick Sevdalis / Charlotte Hanlon / Martin James Prince / Tim Colbourn / Nadine Seward / Sridhar Venkatapuram / Jamie Murdoch

BMJ Global Health, Vol 5, Iss

a novel concept to inform ethical implications for implementation research in low-income and middle-income countries

2020 Volume 12

Abstract: The call for universal health coverage requires the urgent implementation and scale-up of interventions that are known to be effective, in resource-poor settings. Achieving this objective requires high-quality implementation research (IR) that evaluates ... ...

Abstract	The call for universal health coverage requires the urgent implementation and scale-up of interventions that are known to be effective, in resource-poor settings. Achieving this objective requires high-quality implementation research (IR) that evaluates the complex phenomenon of the influence of context on the ability to effectively deliver evidence-based practice. Nevertheless, IR for global health is failing to apply a robust, theoretically driven approach, leading to ethical concerns associated with research that is not methodologically sound.Inappropriate methods are often used in IR to address and report on context. This may result in a lack in understanding of how to effectively adapt the intervention to the new setting and a lack of clarity in conceptualising whether there is sufficient evidence to generalise findings from previous IR to a new setting, or if a randomised controlled trial (RCT) is needed. Some of the ethical issues arising from this shortcoming include poor-quality research that may needlessly expose vulnerable participants to research that has not been adapted to suit local needs and priorities, and the inappropriate use of RCTs that denies participants in the control arm access to treatment that is effective within the local context.To address these concerns, we propose a complementary approach to clinical equipoise for IR, known as contextual equipoise. We discuss challenges in the evaluation of context and also with assessing the certainty of evidence to justify an RCT. Finally, we describe methods that can be applied to improve the evaluation and reporting of context and to help understand if contextual equipoise can be justified or if significant adaptations are required. We hope our analysis offers helpful insight to better understand and ensure that the ethical principle of beneficence is upheld in the real-world contexts of IR in low-resource settings.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	170
Language	English
Publishing date	2020-12-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
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Article ; Online: Challenges in the management of slowly growing non-tuberculous mycobacteria causing pulmonary disease: Perspectives from a high burden country.

Gnanadurai, Roshina / Ninan, Marilyn M / Arul, Ashwin Oliver / Sam, Ann Susan / James, Prince / Gupta, Richa / Michael, Joy S

Indian journal of medical microbiology

2021 Volume 39, Issue 4, Page(s) 446–450

Abstract: Purpose: There is a dearth of data on epidemiology, diagnosis and management of slow growing non tuberculous mycobacteria(NTM) in India, despite being a TB endemic country. This study aims to describe the geographic distribution, risk factors, and the ... ...

Abstract	Purpose: There is a dearth of data on epidemiology, diagnosis and management of slow growing non tuberculous mycobacteria(NTM) in India, despite being a TB endemic country. This study aims to describe the geographic distribution, risk factors, and the challenges in management of slow growing NTM causing pulmonary infections. Methods: Over a period of 3 years, all slow growing NTM received from pulmonary specimens at a tertiary care centre were further studied from electronic hospital records to correlate non tuberculous mycobacteria species with demographics, geographic location, describe comorbidities including immunosuppression, radiologic findings and treatment regimes. Results: M.intracellullare was found in the majority of isolates with significant geographic variation and M.simiae the second commonest found exclusively in southern states. Common comorbidities included a previous history of treatment for tuberculosis, structural lung disease as well as systemic risk factors. Disseminated disease only occurred in immunocompromised hosts as was expected, but at a high rate of 44%. Treatment completion and outcomes were difficult to attain in our population. Conclusion: The burden of NTM infection and its management in India remain a challenge. Ensuring it is made a notifiable disease may improve the current situation.
MeSH term(s)	Humans ; India/epidemiology ; Lung Diseases/epidemiology ; Lung Diseases/microbiology ; Lung Diseases/therapy ; Mycobacterium Infections, Nontuberculous/epidemiology ; Mycobacterium Infections, Nontuberculous/therapy ; Nontuberculous Mycobacteria/pathogenicity
Language	English
Publishing date	2021-08-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1038798-5
ISSN	1998-3646 ; 0255-0857
ISSN (online)	1998-3646
ISSN	0255-0857
DOI	10.1016/j.ijmmb.2021.07.005
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