Papers by jolsana augustine
International journal of mycobacteriology, Mar 18, 2022
The reported occurrence of ocular infections with nontuberculous mycobacterial (NTM) infections h... more The reported occurrence of ocular infections with nontuberculous mycobacterial (NTM) infections has been increasing in the past few decades. NTM are known to cause intraocular infections as well as infections of the ocular appendages and are often recalcitrant to medical therapy. Uveal involvement due to NTM is rare and most reported cases have predisposing factors such as cataract surgery or immunocompromised states. Diagnosis and treatment pose challenge due to difficulty in procuring sufficient clinical material to obtain microbial diagnosis and inadequate response to medical therapy. The clinical challenge is further heightened in the presence of an underlying rheumatologic disease that is known to cause uveitis. We share the case of a young gentleman with ankylosing spondylitis who was being treated with secukinumab with good response to joint symptoms. He developed sudden onset uveitis which was diagnosed to be due to NTM infection based on aqueous humor polymerase chain reaction studies. He had a good clinical response to an empirical anti-mycobacterial regime with the restoration of vision. This report narrates the first case of NTM uveitis secondary to secukinumab therapy.
International Journal of Contemporary Medical Research [IJCMR], 2018
Introduction: The first description of bronchoscopy in pediatric practice was in 1978. Current st... more Introduction: The first description of bronchoscopy in pediatric practice was in 1978. Current study aimed to record the safety and diagnostic yield of performing fibre optic bronchoscopy (FB) in children under sedation and the rate of occurrence of serious adverse events. Material and Methods: Bronchoscopy case records of 16 patients who underwent FB were accessed. 14 of them as intensivist supervised in a suite and 2 in the PICU. Baseline clinical characteristics including duration of symptoms, presence of fever, hypoxia, leukocytosis were recorded. Procedural complications and serious adverse events were noted. Microbial yield was compared with clinical and lab parameters. Results: Most of the Pediatric bronchoscopy patients present with acute indications. Cough is a universal symptoms followed by fever (50%). Commonest radiological zone of involvement is right middle followed by right upper. Microbial yield from the broncho-alveoloar lavage was close to 60%. Serious adverse event happened in only one patient. Conclusion: Pediatric bronchoscopy is a safe, high yielding procedure, which can be performed under conscious sedation under an intensivist's supervision.
Indian Journal of Tuberculosis, 2022
Respiratory Medicine Case Reports, 2021
The first possibility considered in the etiology of large lung masses is neoplastic lesions. The ... more The first possibility considered in the etiology of large lung masses is neoplastic lesions. The differential diagnoses of these masses include bronchogenic carcinoma, pulmonary sarcoma, primitive neuroectodermal tumor etc. Primary or secondary pulmonary parenchymal lymphomas presenting as large mass is distinctly rare. We share the case of a young lady who presented with a large left lung mass almost entirely replacing the left lung parenchyma, with associated intrathoracic lymphadenopathy. On evaluation she was proved to have primary mediastinal large B-cell lymphoma. Treatment with an aggressive chemotherapy regimen led to complete remission of the parenchymal and nodal disease. The uncommon radiological presentation and the excellent therapeutic response despite huge tumor load merit clinical attention.
International Journal of Mycobacteriology, 2021
Background: Establishing the etiology of exudative pleural effusions in the setting of an unrewar... more Background: Establishing the etiology of exudative pleural effusions in the setting of an unrewarding pleural fluid analysis often requires biopsies from the parietal pleura. However, it may be noted that diagnosis such as pulmonary embolism and connective tissue diseases can result in an exudative pleural effusion where a pleural biopsy can yield nonspecific results. Medical thoracoscopy (MT) is a minimally invasive procedure performed under local anesthesia or moderate sedation with excellent yield and favorable safety profile. We analyzed the diagnostic yield of MT for exudative pleural effusions after employing a rigid diagnostic algorithm. The study was undertaken to ascertain the yield of MT in establishing the diagnosis in diagnosis of exudative pleural effusions, to find out the relative contribution of pleural tuberculosis (TB) as a cause of undiagnosed exudative pleural effusion, to describe the etiology of undiagnosed exudative pleural effusion in patients undergoing MT and to determine the correlation between pleural fluid adenosine deaminase (ADA) levels and TB pleuritis in patients undergoing MT. Methods: This was a retrospective study. Patients with undiagnosed exudative pleural effusion were included in the study. MT was performed with semirigid thoracoscope (Olympus LTF 160) under local anesthesia and conscious sedation. Gross appearance and ADA level of pleural fluid were noted. Pleural biopsy material was subjected to histopathology examination and culture for mycobacteria along with cartridge-based nucleic acid amplification test for TB. The yield of MT for establishing the etiology of pleural effusion and the relative contribution of tuberculous pleuritis as a cause of undiagnosed pleural effusion was ascertained. Correlation of pleural fluid ADA levels was done with a final diagnosis of TB pleuritis in patients undergoing MT. Results: Twenty-five patients with undiagnosed exudative pleural effusion underwent thoracoscopy of which 16 were male and 9 were female. MT was able to establish the diagnosis in all cases, providing a diagnostic yield of 100%. Histopathological examination of biopsy specimens yielded a diagnosis of malignant involvement of pleura in 10 patients and granulomatous pleuritis consistent with TB in 14 patients. Pleural TB contributed to 60% of undiagnosed pleural effusions in the present study. The mean ADA value among those who turned positive was 56.338 and 35.300 among those who turned negative using genexpert, which was found to be statistically significant. A value of 31 IU/L showed a sensitivity of 93.3% and specificity of 99.8% and hence can be taken as a cut off value for the diagnosis of pleural TB based on receiver-operating characteristic analysis. Conclusion: TB contributed to 60% of undiagnosed exudative pleural effusions in the present study. MT had 100% yield in the diagnosis of undiagnosed exudative effusions. Pleural fluid ADA levels may help in differentiating TB versus malignant effusion.
International Journal of Mycobacteriology, 2020
In pulmonary practice, pleural effusion is a commonly encountered entity and has various etiologi... more In pulmonary practice, pleural effusion is a commonly encountered entity and has various etiologies. Pleural effusions in postpartum women can be an incidental self-limiting finding. The presence of systemic or respiratory symptoms, however, calls for prompt etiological workup and targeted therapy. Tuberculous pleuritis and lupus-related pleural disease are well known to flare up in the postpartum period. We describe the case of a young healthcare worker with no previous comorbidities who presented with fever, breathlessness, and chest pain 2 weeks after an uneventful confinement. Chest radiograph revealed moderate left-sided pleural effusion. Pleural fluid analysis was biochemically consistent with tubercular effusion. Pleural biopsy histological examination showed features of xanthomatous pleuritis and Cartridge based nucleic acid amplification test (CB-NAAT) showed evidence of Mycobacterium tuberculosis(MTB). She was initiated on antitubercular medicines to which she responded we...
Introduction: Invasive pneumococcal disease is cited as the commonest vaccine preventable cause o... more Introduction: Invasive pneumococcal disease is cited as the commonest vaccine preventable cause of mortality and accounts for major morbidity globally. Recommendations for pneumococcal vaccination is well adhered in paediatric population as opposed totheir adult counterparts, where the stress placed is much less. Global bodies like CDC propose pneumococcal vaccination as a mandatory strategy in all subjects aged above 65 years. In subjects less than 65 years, those withcertain medical comorbidities are targets to pneumococcal vaccination strategy. Aim: The aim of the current study was to evaluate the indications for pneumococcal vaccination in adult subjects attending the pulmonary medicineoutpatient clinic of a tertiary care facility and to examine the vaccine adherence rate. In those subjects who were not vaccinated as per guidelines, the reasons for non-compliance to vaccination guidelines were also studied. Materials and methods: The present study was carried out in the pulmonar...
Journal of Family Medicine and Primary Care, 2021
Novel corona virus pandemic in 2020 has created havoc across the world. Since its entry into Indi... more Novel corona virus pandemic in 2020 has created havoc across the world. Since its entry into Indian subcontinent in February 2020, it has become the second most affected country in the world. In this context we wish to share the case of a young man who presented with periodic paralysis was eventually diagnosed to have COVID-19 infection. During this pandemic season, one has to be vigilant and think out of the box to identify COVID-19 infections even among the least suspicious cases.
The Journal of medical research, 2018
We report the case of a young healthy gentleman who initially presented with an acute bronchitis ... more We report the case of a young healthy gentleman who initially presented with an acute bronchitis like syndrome, which rapidly evolved into sustained pyrexia with lung infiltrate. He subsequently had a rapid downhill course with progressive pulmonary and systemic involvement due to an uncommon aggressive hematological malignancy. We would like to highlight the fact that focal airspace opacity in the lung has many infectious and non-infectious differentials and accurate diagnosis holds the key.
Journal of Clinical and Diagnostic Research, 2021
Airway hamartomas are of mesenchymal tissue origin and have predominance of adipose tissue. Hamar... more Airway hamartomas are of mesenchymal tissue origin and have predominance of adipose tissue. Hamartoma refers to a tumour-like structure within an organ composed of an abnormal arrangement of tissue components normally found in that organ. The pulmonary parenchyma and airways are commonly described sites for this lesion, although endobronchial location is far less common than its parenchymal counterpart. When present within a major airway, the usual symptoms of an airway lesion like cough, wheezing, stridor, haemoptysis and postobstructive consolidation ensue. We describe the case of a 60-year-old gentleman who presented with cough of 9 months duration. On evaluation he was found to have an endobronchial lesion in the right main bronchus. The histopathology revealed features of endobronchial hamartoma which was then subjected to endobronchial intervention with electrocautery and cryoablation achieving complete removal and restoration of luminal patency. This case underscores the abil...
BMJ Case Reports, 2022
Tuberculosis (TB) is one of the greatest masqueraders in medical practice and can have manifestat... more Tuberculosis (TB) is one of the greatest masqueraders in medical practice and can have manifestations involving any organ or organ systems of the body. The presentation of disseminated TB can range from typical features like fever, weight loss and fatigue to protean manifestations. We share the case of an elderly man who presented to us with weight loss, anaemia, weakness and lymphadenopathy involving thoracic and intraabdominal locations. Work up of anaemia revealed features of Coombs-positive autoimmune haemolytic anaemia (AIHA) and evaluation of weakness showed laboratory results consistent with adrenal insufficiency. Biopsy of the abdominal lymphnode yielded caseating granulomas with CB-NAAT positivity for Mycobacterium tuberculosis. Anti-TB chemotherapy with short-term replacement dose of systemic steroids corrected the haemolysis, anaemia and addisonian crisis. The case alerts clinicians regarding the uncommon association of TB with Coombs positive AIHA and adds one more aetio...
Journal of Advanced Lung Health, 2022
Pneumothorax is one of the most common emergencies encountered in day-to-day pulmonary practice. ... more Pneumothorax is one of the most common emergencies encountered in day-to-day pulmonary practice. Early diagnosis and prompt intervention will reduce morbidity as well as mortality. The mainstay of treatment involves tube thoracostomy and drainage of pneumothorax in all except the mild cases. Proper technique and ascertaining correct tube position with follow-up imaging ensure successful lung expansion. We share the case of a gentleman who presented with nonexpansion of lung despite inserting 2 intercostal drainage tubes for the management of pneumothorax. Imaging with computed tomography thorax revealed both tubes to be coiled within the chest wall without entry into pleural space, thereby accounting for failed reexpansion. This case stresses the importance of following a structured evaluation in cases of nonexpanding lung after tube thoracostomy for pneumothorax.
MDR-TB is a growing menace and stumbling block to adequate control of TB. Inappropriate treatment... more MDR-TB is a growing menace and stumbling block to adequate control of TB. Inappropriate treatment regimens, inadequate duration of treatment and non-adherence to treatment are the leading causes for resistance. Therefore MDR-TB can be considered as a result of human errors in management. Along with protocol based treatment, adherence and tolerance to treatment has to be ensured to counter further development of resistance. The regimen recommended by WHO and PMDT India differs, but the basic principle is the same. The knowledge of treatment regimen and their adverse effects help in prescribing suitable regimens for a patient. Serious drug reactions requiring stoppage of drugs are rare. The most important aspect in dealing with MDR-TB is that the treatment should be initiated and done by an expert in the field. Demonstration of drug resistance is difficult in some cases despite having strong suspicion of MDR-TB which needs further addressal by policy makers.
Cervical lymphadenopathy is common in all age groups. Persistently enlarged cervical lymph nodes ... more Cervical lymphadenopathy is common in all age groups. Persistently enlarged cervical lymph nodes often pose a diagnostic challenge and necessitate focused clinical evaluation with targeted investigations. Pathological examination of excised node yields conclusive answer in the vast majority of cases with unsettled diagnosis. We present a case of a young man with persistent posterior cervical lymphadenopathy which on excision biopsy turned out to be Kikuchi–Fujimoto disease. With watchful follow-up, he had a self-limiting clinical course in the next few months.
BackgroundAn ICS-LABA combination has become the standard of care in asthma. Various ICS-LABAs ar... more BackgroundAn ICS-LABA combination has become the standard of care in asthma. Various ICS-LABAs are commercially available providing the clinician with many choices. A thorough understanding of the clinical efficacy and safety of various formulations will immensely benefit the prescribing doctor to decide the choice of agent. The present review compares the clinical efficacy and safety of formoterol fluticasone (FF) to other ICS/LABA combinations in asthmatics.MethodsThe review adhered to the general principles mentioned in the CRD guidance and the PRISMA statement. We searched Medline, Embase, and Cochrane Controlled Trials Register databases on the efficacy of FF in treating asthma compared with other ICS-LABAs. A total of 138 trials identified initially. Only trials comparing the efficacy and safety of FF in comparision with Salmeterol/fluticasone (SF) or Budesonide/Formoterol (BF) were selected. The outcomes compared were onset of bronchodilator action, improvement in lung functi...
Asthma is one of the most common respiratory diseases encountered in clinical practice. Although ... more Asthma is one of the most common respiratory diseases encountered in clinical practice. Although the vast majority of asthmatics can be adequately controlled with inhaled steroids and other preventer medications, a small proportion remain uncontrolled. Anti-IgE treatment with omalizumab has been proposed in patients as a preferred approach in step 5 asthma therapy according to GINA guidelines. Although therapy with this molecule is approved for patients with atopic asthma and pretreatment serum IgE levels of 30-1500 only, there have been a few reports of its efficacy in subjects outside this reference IgE range. We report the case of a middle-aged lady with severe corticosteroid-dependent asthma and low serum IgE levels who was successfully treated with 9 months of omalizumab therapy. She gained good asthma control and was tapered off steroid use by the fifth month of therapy with omalizumab. The case report stresses the need for further investigation into expanding the spectrum of ...
Indian Journal of Tuberculosis
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Papers by jolsana augustine