Clinical profile of patients with COVID-19 and tuberculosis co-infection in a tertiary care hospital

Background: Historical evidences suggest that Tuberculosis (TB) with concurrent respiratory viral infections, such as, Influenza has been associated with higher mortality. TB and COVID-19 co-infection has implications beyond mortality at the individual level. Hence there is a need to study the clinical characteristics and outcomes in COVID-19 and TB co-infection.Methods: In this retrospective observational study, COVID-19 cases admitted to Victoria Hospital, a tertiary care hospital in Bengaluru, twenty-six patients with COVID 19 and TB co-infection were observed and their clinical characteristics, radiological and laboratory parameters were recorded and analyzed for the impact of COVID-19 on TB.Results: Raised inflammatory markers, high neutrophil to lymphocyte ratio (NLR), lymphocytopenia were observed in majority of the cases. There was worsening of Tubercular lesions on Chest radiography in eighteen patients (69%). Out of the twenty six, sixteen patients (61%) needed supplemental oxygen therapy at admission, Five (19%) of them needed Assisted ventilation and intensive care. Out of the five patients who needed intensive care, two (7.6%) patients succumbed to death owing to Severe COVID-19 pneumonia, respiratory failure and other co-morbid conditions.Conclusions: Co-infection with COVID-19 and TB alters the severity, the course and management of the disease and can be associated with adverse outcomes and is associated with high mortality; a high index of suspicion is required for the detection of this co-infection and bi-directional screening of COVID-19 and TB must be carried out for the early detection and management of this co-infection.

A Study of Reproducibility of Papanicolaou Society of Cytopathology System of Reporting Respiratory Cytology-A Single Institutional Experience on Image Guided Aspiration Cytology

Abstract Background: Cytologic examination of specimens obtained from the respiratory tract is a primary and frequently the initial diagnostic technique performed in patients with pulmonary abnormalities. Fine needle aspiration (FNA) is extensively used for diagnosis of pulmonary lesions. The Papanicolaou Society of Cytopathology (PSC) issued a new classification for respiratory cytology and criteria, risk of malignancy, post-cytologic diagnosis management and follow-up. Methods: Respiratory FNA specimens obtained between January 2015 to March 2021 were reviewed and reclassified according to PSC guidelines. Cytologic category as per PSC system was assigned after reviewing by two pathologists. Risk of malignancy for each category was calculated for cases where biopsy was available for correlation. Results: Three eighty-four samples were classified as non-diagnostic (30.5%), negative for malignancy (13.3%), atypical (0.5%), neoplastic (benign/ low malignant potential) (0%), suspicious for malignancy (5.7%%) and malignancy (50%). Risk of malignancy for malignant category (Category V and Category VI) was 64.1% and for non-malignant (Category I to Category IV) cases was 35.9%. Overall, there was lesser incidence of atypical category and more specific diagnoses were possible on cytology in non-malignant category. Sensitivity and specificity for malignant cases was 99.33% and 100% respectively. Conclusion: Our study substantiates that use of PSC guidelines improves the overall reporting of respiratory cytology due to the use of standardized terminology.</jats:p

Clinical profile of patients with COVID-19 and tuberculosis co-infection in a tertiary care hospital

Background: Historical evidences suggest that Tuberculosis (TB) with concurrent respiratory viral infections, such as, Influenza has been associated with higher mortality. TB and COVID-19 co-infection has implications beyond mortality at the individual level. Hence there is a need to study the clinical characteristics and outcomes in COVID-19 and TB co-infection.Methods: In this retrospective observational study, COVID-19 cases admitted to Victoria Hospital, a tertiary care hospital in Bengaluru, twenty-six patients with COVID 19 and TB co-infection were observed and their clinical characteristics, radiological and laboratory parameters were recorded and analyzed for the impact of COVID-19 on TB.Results: Raised inflammatory markers, high neutrophil to lymphocyte ratio (NLR), lymphocytopenia were observed in majority of the cases. There was worsening of Tubercular lesions on Chest radiography in eighteen patients (69%). Out of the twenty six, sixteen patients (61%) needed supplemental oxygen therapy at admission, Five (19%) of them needed Assisted ventilation and intensive care. Out of the five patients who needed intensive care, two (7.6%) patients succumbed to death owing to Severe COVID-19 pneumonia, respiratory failure and other co-morbid conditions.Conclusions: Co-infection with COVID-19 and TB alters the severity, the course and management of the disease and can be associated with adverse outcomes and is associated with high mortality; a high index of suspicion is required for the detection of this co-infection and bi-directional screening of COVID-19 and TB must be carried out for the early detection and management of this co-infection.  </jats:p

External auditory canal osteoma with coexisting canal wall cholesteatoma: a case report and review of literature

Abstract Background Though rare, benign lesions that usually do not necessitate active intervention, osteomas of the external auditory canal, can be troublesome when they start to produce mass effect and severe obstruction to the external auditory canal. Even more insidious is the rarer phenomenon of canal wall cholesteatomas, which have been known to cause significant canal erosion and if left unchecked and spontaneous destruction of the adjacent anatomical structures, including the facial nerve, temporomandibular joint, sigmoid sinus, and skull base. The occurrence of both these exceptionally uncommon findings in the same canal is an unusual finding and may point to an undetermined interplay in pathogenesis. Case presentation Here, we describe one such case in a 39-year-old gentleman hailing from South India who presented with complaint of unilateral ear block and decreased hearing and how it was managed. Conclusions While osteomas are usually incidental findings in asymptomatic patients, the potential for mass effect and canal obstruction must be kept in mind and patients must be evaluated for development of the more sinister cholesteatoma in the deeper canal