A low-pressure cuff for tracheostomy tubes to minimize tracheal injury. a comparative clinical trial

Background and objective: Detecting latent tubercular infection (LTBI) in sarcoidosis has important treatment implications. Traditionally tuberculin skin test (TST) is relied upon for this purpose. However, sarcoidosis is known to produce tuberculin anergy, which is not affected by high prevalence of tuberculosis (TB) infection. Interferon gamma release assays (IGRAs) have a higher sensitivity and specificity for detecting Mycobacterium tuberculosis (MTB) infection than the conventional TST as they utilize antigens specific for MTB complex. However, there is limited data regarding the performance of these tests in sarcoidosis, particularly in a setting of high population prevalence of LTBI.Herein, we studied the utility of IGRAs in the diagnostic work up of patients with sarcoidosis. Patients and Methods: Prospectively enrolled, biopsy-confirmed, glucocorticoid naive cases of pulmonary sarcoidosis; pulmonary and extrapulmonary TB; and, healthy controls underwent TST using 0.1 mL (1 tuberculin unit) of purified protein derivative RT23, and IGRA using QuantiFERON-TBGold In Tube™ assay (QFT) in blood. For TST an induration ≥10 mm was taken as positive. QFT was performed and interpreted as per the manufacturer’s instructions. Results:We studied 38 patients with sarcoidosis (22 men, 16 women;mean age 42.5 years), 30 patients of TB (18 pulmonary, 12 extrapulmonary) and 30 healthy controls. Patients with sarcoidosis were more likely to have a negative TST compared to healthy controls (89.5% vs. 60%, p=0.004) or TB (89.5% vs. 23.3%, p<0.001). However, QFT positivity was not significantly different in sarcoidosis compared to controls (34.2% vs. 50%, p=0.19), but was higher in TB patients as compared to sarcoidosis (60% vs. 34.2%, p=0.03). Conclusions: There is anergy to tuberculin in sarcoidosis.However, the results of QFT are not similarly affected. QFT continues to remain positive in many patients with sarcoidosis, and thus may be more accurate to detect LTBI in these patients.

Interferon gamma release assay (QuantiFERON-TB Gold In Tube) in patients of sarcoidosis from a population with high prevalence of tuberculosis infection.

Background: Airway obstruction or tracheoesophageal fistula (TEF) near the tracheal carina requires placement of Y-shaped stents. Herein, we describe our multicenter experience with the placement of Dumon silicone Y-stents. We also conduct a systematic review for studies describing the deployment of airway silicone Y-stents. Methods: This was a retrospective analysis of consecutive subjects who underwent placement of silicone Y-stents. The clinical details including the underlying diagnosis, indication for the placement of silicone Y-stents, success of stent placement, and follow-up are presented. The PubMed and EMBASE databases were also reviewed for studies describing the placement of silicone Y-stents. Results: During the study, 27 silicone Y-stents were placed. The mean (standard deviation) age of the study population (85.2% males) was 57.7 (13.5) years. The stents were placed for airway obstruction in 77.8% and TEF in 29.6% of the patients. The most common underlying disease was carcinoma of the esophagus. The degree of airway obstruction was grade 3–4 in 18 subjects, and respiratory failure was encountered in 18 subjects. The stent was deployed successfully in all the subjects. No deaths were encountered during stent placement. Most subjects had rapid relief of symptoms following the procedure. Excessive secretions and mucostasis were the most common stent-related complications followed by the development of granulation tissue. The systematic review yielded nine studies (338 subjects with airway obstruction and/or TEF). The most common indication for silicone Y-stent placement was tracheobronchial obstruction and TEF due to malignancy. Benign disorders that necessitated stent placement included postintubation tracheal stenosis, airway malacia, and others. The stent was successfully placed in 98% with only one periprocedural death. Granulation tissue formation and mucostasis were the most common stent-related complications. Conclusion: Placement of silicone Y-stent is a safe and effective procedure that provides quick relief of symptoms in subjects presenting with airway obstruction and TEF at or near the tracheal carina.

Placement of tracheobronchial silicone Y-stents: Multicenter experience and systematic review of the literature

Background Diagnostic tests are critical to management when the clinical picture is unclear. We analyzed the records of patients in whom the initial diagnosis of cutaneous tuberculosis was doubtful to evaluate the utility of the Mantoux test in this setting.



Materials and methods  Of 375 patients with cutaneous tuberculosis seen in our department, the initial clinical diagnosis was doubtful in 90 patients. A Mantoux test was performed with 5 TU of purified protein derivative using standard techniques and read after two days. Patients also underwent skin biopsy and other laboratory tests and received treatment with antitubercular drugs. Patients who had case notes recording satisfactory improvement following antitubercular therapy were classified as having cutaneous tuberculosis; those with evidence of another diagnosis based on the laboratory tests and response to therapy were categorized as non-tuberculosis cases. Patients with inadequate evidence for a diagnosis of either cutaneous tuberculosis or another disorder were classified as unresolved diagnosis.



Results  Readings were available in 79 patients: 39 were categorized as tuberculosis; 16 as non-tuberculosis; while a final diagnosis could not be reached in 24 cases. Readings ranged from 0 to 40 mm in the cases and from 0 to 30 mm in non-cases. The area under the receiver-operating characteristic curve was 0.66 (95% CI 0.55–0.81). Using a cut-off of 10 mm, the sensitivity and specificity of the tests were 58.97 and 62.50%, respectively.



Conclusion  The Mantoux test is of low accuracy in the diagnosis of doubtful cases of cutaneous tuberculosis.

How useful is the Mantoux test in the diagnosis of doubtful cases of cutaneous tuberculosis

OBJECTIVE: To establish the efficacy of antitubercular therapy in patients with erythema nodosum with a highly positive Mantoux test.METHODS: A retrospective analysis of all patients diagnosed with idiopathic erythema nodosum with a highly positive Mantoux reaction between 1988 and 2001 was undertaken. In the absence of any other clinical or investigative evidence of active tuberculosis they were treated with antitubercular therapy.RESULTS: Out of a total of 52 patients diagnosed with idiopathic erythema nodosum with a strongly positive Mantoux test (average of 19 mm), data could be analyzed in only 47 patients. After treatment with antitubercular drugs, new lesions stopped appearing in 45 patients within 6–8 weeks and subsided in two. The therapy was well tolerated except for jaundice in one patient and transient urticarial lesions in another.CONCLUSIONS: Antitubercular therapy definitely has a role in the management of patients with erythema nodosum, even in the absence of a detectable focus of tubercul...

Erythema nodosum and antitubercular therapy.

Background Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. Methods Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. Results Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign post-intubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. Conclusions Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.

Initial experience of endobronchial silicon stents from a tertiary care centre in North India.

OBJECTIVE To assess the utility of various cut-off points of tuberculin skin test in making a diagnosis of tuberculosis in patients with respiratory symptoms METHODS Tuberculin skin test was conducted on consecutive new patients attending chest clinic for various respiratory symptoms All subjects were then investigated to establish diagnosis, and categorized into tuberculous and nontuberculous groups Receiver operating characteristic (ROC) curve was plotted to evaluate discrimination by tuberculin skin test Sensitivity, specificity and predictive value were also calculated at various cut-off points RESULTS Of 250 patients, 59 (236%) had tuberculosis on clinical and microbiological criteria (other than the tuberculin test) Sensitivity and specificity of tuberculin test at readings greater than 5, 10 and 15 mm were 08136 and 07068, 06271 and 08901, and 02034 and 09738 respectively Area under ROC curve for this test was 080 CONCLUSION A cut-off point of 10 mm is likely to be useful in supporting a diagnosis of tuberculosis in patients with strong clinical suspicion of tuberculosis, in other patients, 15 mm cut-off may be more suitable

Value of different cut-off points of tuberculin skin test to diagnose tuberculosis among patients with respiratory symptoms in a chest clinic.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

B Kumar

Author Tools

Chat about Author

Papers

Initial experience of endobronchial silicon stents from a tertiary care centre in North India.

Value of different cut-off points of tuberculin skin test to diagnose tuberculosis among patients with respiratory symptoms in a chest clinic.