Article by Dr. S. K. Jindal

Jindal IVF snd Sant Memorial Nursing home is pround to celebrate its 25th founders' day!

Dr. Aditya Jindal

D.M. Pulmonary and 

Critical Care Medicine (PGI Chandigarh)

Consultant Pulmonologist

Jindal Clinics

S.C.O. 21, Sec 20D,

Chandigarh. 160020

Phone no. (O) 91-172-4911000

(M) 91 9779930502

www.jindalchest.com

www.facebook.com/jindalchestchandigarh

www.jindalchest.blogspot.in

World COPD day Checkup camp today

Today is World COPD day. Jindal Clinics is organizing a medical camp on its premises. Patients are being offered free spirometry and breath carbon monoxide testing

Free Camps

Jindal Clinics is proud to announce its participation in two health camps. The first one was held by the Joshi foundation in Sec 15, Chandigarh and involved the checkup of over 2000 patients. The participants were honored by Mrs. Kiron Kher, member of parliament from Chandigarh  and the Home Secretary of Chandigarh, Mr. Anil Kumar.

The other camp was held in the town of Dhuri on 16-11-14, where over 125 patients were examined free of cost by Dr. Aditya Jindal.

What is bronchoscopy?

The lungs are host to many diseases, like tuberculosis, cancer, pneumonia, asthma, etc. In order to treat them properly, specialized diagnostic tests are required – bronchoscopy is one such test. It involves the insertion of a flexible endoscope or bronchoscope through either the mouth or the nose into the lungs and the respiratory system. The bronchoscope is connected to a camera and monitor to visualize the interior of the lungs. One can see various abnormalities like cancer growths, bleeding spots, foreign bodies, etc. Additionally, the bronchoscope is hollow – like a pipe – through which special instruments can be passed in order to take pieces (called biopsies) from abnormal areas seen inside. These pieces or biopsies are then studied under the microscope for proper and accurate diagnosis of various diseases.

Various types and sizes of bronchoscopes are available for all ages and diseases. One of the new type is called an Endo bronchial ultrasound bronchoscope or an EBUS scope. The EBUS scope has an ultrasound transducer built-in into the tip of the scope – which is the end that goes into the lungs. With the help of the ultrasound the internal structures can be accurately imaged and all biopsies taken directly under guidance of the ultrasound. This increases the safety, accuracy and yield of the procedure.

The diseases which usually need bronchoscopy for diagnosis include lung cancer, sarcoidosis, some types of tuberculosis, interstitial lung disease (lung shrinkage), etc. Another important use is the removal of foreign bodies especially in children.

Miracle drug for Ebola - ctd...

Miracle drug for Ebola - ctd...

In a follow up to the previous post ( see Miracle drug for Ebola) one of the American researchers has been declared cured of Ebola. It remains to be seen whether the cure was spontaneous or due to the administered drug.

Liberia to receive Zmapp drug to treat Ebola virus

In a new development, Liberia is likely to try out an experimental drug 'ZMAPP' for the current Ebola outbreak without the requisite human trials.  Read the previous post for more information.

Link for current post: Liberia to receive Zmapp drug to treat Ebola virus

Miracle drug for EBOLA

Two health care professionals suffering from EBOLA virus infection were miraculously saved by an experimental drug. Importantly, the drug, known as 'ZMapp' , had only been tested in animals till now! Talk about miracles.

You can read the whole story here:  http://edition.cnn.com/2014/08/04/health/experimental-ebola-serum/

"Lung dialysis"

Some things are beyond belief, though clearly plausible - as the following example illustrates.

     A male patient in the US suffering from cystic fibrosis underwent a double lung transplant followed by failure. He was posted for re-transplant but was told that his carbon dioxide levels were too high. However, his physician, who was a well read man and in contact with the bioengineering world decided to go in for something out of the ordinary. A sort of a mini ECMO machine had been developed a few years earlier, for removing carbon dioxide from the lung. Known as the Hemolung RAS, it functions by removing carbon dioxide from and adding oxygen to blood just like a dialysis machine. As it was not approved by the FDA, emergency approval was taken within 24 hrs and the patient put on the machine. Lo and behold, he improved, the carbon dioxide levels reduced to acceptable limits and he was taken up for retransplant!

Some salient points:

1. Cystic fibrosis is a sort of death sentence in general practice in India with only symptomatic treatment available
2. This patient underwent double lung transplant not once but twice
3. Emergency approval applied for and recieved within 24 hours!! (Seems like some sort of dream)
4. As the machine was not available in the US, the doctors incharge personally acquired it from across the border i.e. Canada
5. The patient remained for 20 days on the machine
6. The machine was not recommended for use by any professional society

Lessons:

1. Out of the box thinking is the key
2. Be uptodate in one's field
3. Persistence and perseverance are essential

The full article can be read here: http://medicalxpress.com/news/2014-07-patient-implanted-hemolung-lifesaving-lung.html

Thanks to Dr.Ajay Handa for updating me on this.

More than meets the eye

More than meets the eye

'There is more to this than meets the eye.' I used to think that this was just a turn of phrase; however, after joining a medical career it became a living truth for me. A recent example will suffice.

A 54 year old lady, presented to me last week, with a history of long standing asthma for the last 18 years. It was poorly controlled and managed, with her requiring frequent nebulization therapy and repeated short courses of oral steroids. She appeared to be chronically malnourished and indeed, on examination, her BMI was 17 kg/sq m. One often forgets, in this modern era of inhaled bronchodilators, what asthma can do to a person. She was a small reminder that we are only one step above the previous generation in the treatment of this disease. Although much research is going on, except for the reliable beta agonists and corticosteroids, the other medicines available are insufficient to control asthma on their own.

Coming back to the case; after taking the history and examining her - to repeat myself again - I thought "There is more to this than meets the eye" and ordered further workup. Lo and behold, she came a week later with an X-ray full of alveolar and interstitial opacities. Our patient was accompanied by her brother, who was an X-ray technician. Now, there is a tendency in our part of the world to attribute almost all X-ray abnormalities to tuberculosis, and more so in medical and para-medical staff. Even worse, this gentleman was a veteran radiographer, with over 15 years experience. I had a hard time convincing him of further workup; throughout  the consultation he kept looking at me out of the corner of his eye!

Anyway, they came after a few days with an HRCT of the chest and serological investigations. I was pleased to see that my hunch was right and she was finally diagnosed to have ABPA or Allergic broncho-pulmonary aspergillosis, which is much prevalent in this area. Her brother was all smiles!!

The 'TB' X-ray

Typical mucus plugging

Extensive bronchiectasis and centrilobular nodules

ABPA or allergic bronchopulmonary mycosis (ABPM) is an allergic reaction to colonization of the airways by fungal elements, most commonly Aspergillus species ( hence, commonly ABPA rather than ABPM!) It affects a substantial portion of asthmatics, especially those suffering from severe or difficult to control asthma. The diagnostic criteria are still evolving; also there is no clarity on whom to screen for the disease. The pointers in this case were:

1. Difficult to control disease
2. Severe disease
3. X-ray abnormalities 

However, the clinching point was the phrase - 'There is more to this than meets the eye!'