Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 216540

AbstractCase ReportDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : YD01 - YD03 Full Version

Tailor-made Pulmonary Rehabilitation Program Aiding Return to Preinfection Fitness in Massive Cavitatory Lung Abscess: A Case Report


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57717.16817
Gayatri Surendra Kaple, Vaishnavi Yadav, Moli Jain, Pallavi Bhakney, Vishnu Vardhan

1. Intern, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India. 2. Assistant Professor, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India. 3. Resident, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India. 4. Resident, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India. 5. Associate Professor and Head, Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India.

Correspondence Address :
Dr. Gayatri Surendra Kaple,
Ingale Nagari, Tadas Layout, Pepri, Meghe, Wardha, Maharashtra, India.
E-mail: gkaple9@gmail.com

Abstract

Lung abscess is a form of liquefactive necrosis of the lung tissue that causes the formation of cavities (greater than 2 cm) which are filled with necrotic debris and fluid because of microbial infection. Aspiration, which may happen while the patient is not conscious and end in a pus-filled cavity. It is very rare to find out lung abscess with a complicated infection of Streptococcus pneumoniae stereotype 6B. A 42-year-old male patient was referred to a tertiary care hospital with chief complaints of breathlessness of grade II on the Modified Borg Scale, cough with expectoration, and right-sided chest pain. Chest X-ray and High Resolution Computed Tomography (HRCT) High Resolution Computed Tomography (HRCT) scan of the thorax were done and the patient was diagnosed with right lower lobe lung abscess caused by Streptococcus pneumoniae. The patient was managed by bronchoscopy and bronchoalveolar lavage (washing). A complete plan of rehabilitation was designed to meet the patient's objectives, and it was executed and followed for 1 month. The patient showed considerable functional improvement in terms of aerobic capacity, endurance, and exercise tolerance ability. It was concluded that medical care combined with pulmonary rehabilitation, together as a multidisciplinary approach result in improved outcomes related to the quality of life of the patients.

Keywords

Bronchoscopy, Bronchoalveolar lavage , Liquefactive necrosis, Pus-filled cavity

Case Report

A 42-year-male farmer reported to the medicine Outpatient Department of a tertiary care hospital with the chief complaint of breathlessness, cough with expectoration and right-sided chest pain since 1 month. The patient was apparently well 1 month ago when he gradually started experiencing breathlessness accompanied by chest pain while walking for a mile and had to sit down and rest for a few seconds. After some weeks passed the patient started coughing with expectoration and there was brown colour phlegm. He was a chronic alcoholic for 10 years and had stopped consuming alcohol for 1 month. The patient’s wife also noticed a drastic change in the patient’s weight. The patient reported a loss of appetite resulting approximately 7 kgs weight loss in 1 month. Thereafter, the patient had visited a nearby local hospital and underwent radiological investigations and was found to have consolidation in the right mid-zone along the costal margin. Following which the patient was referred to the tertiary care hospital where the patient gave a history of fever (on and off), cough with mucoid brownish coloured expectoration, breathlessness (Modified Borg grade: II that is walks slower than same age people because of breathlessness) (1), and was admitted to the Respiratory Medicine Ward.

On general examination, the respiratory rate was 24 breaths/min with the abdominothoracic type of breathing, heart rate was 89 beats/minute, and oxygen saturation was 97% on 6 litres of oxygen support via nasal cannula. Pallor was present while inspecting for the positive findings. Chest expansion revealed a difference of 2 cm, 2 cm, and 1 cm at axillary, nipple, and xiphisternum levels, respectively. On percussion, the dull note was present at the right lower zone and coarse inspiratory crackles, along with liver and cardiac dullness. Additionally, the dull note was present in the traubes space. Auscultation also revealed decreased air entry on the right side at inframammary and infrascapular levels.

Blood haemoglobin levels were constantly lower than normal ranging between 8.5-9.3 gm/dL. Total red blood cells count was constantly low (i.e. below 3.07 cells/μL) whereas, the white blood cells count and platelet counts were 18,200/cumm and 1,36,000/ cumm respectively.

Several investigations such as blood tests including, Complete Blood Count (CBC), Kidney Function Test (KFT), Liver Function Test (LFT), and Optochin tests were carried out. Other diagnostic assessments such as sputum culture, and chest X-ray were also conducted. Sputum assessment revealed foul-smelling purulent brown coloured thick phlegm. The Optochin test was performed revealed that the strains were sensitive. The patient was diagnosed with cavitatory lung abscess.

Bronchoscopy reports suggested mucopurulent secretions present in the right lower lobe. After the diagnosis confirmed the pharmaceutical medications was also started. Pharmacological management was done with Inj. pipracillin, tazobactam 4.5 gm i.v. (TDS), Inj. metronidazole 100 mL i.v. (TDS), tablet paracetamol 650 mg (OD), tablet levocetirizine and montelukast (HS), tablet pantoprazole 40 mg (OD), tablet acetylcysteine 600 mg (TDS), syrup ambroxol, guaifenesin, and terbutaline 10 mL (BD), nebulizer-salbutamol sulphate and ipratropium bromide (TDS) and budesonide (micronized) (BD), intravenous fluids-77 mEq/L sodium and 77 mEq/L chloride with multivitamin injection. Physiotherapeutic interventions were also started.

But when the patient’s chest condition was deteriorating then once again sputum culture was taken and an optochin test was after 10 days. The optochin test was sensitive and thereafter he was diagnosed with an infection of streptococcus pneumoniae which resulted in a complication of lung abscess on 12th day.

The bronchoalveolar lavage i.e. washing was done on 16th day. The bronchoalveolar lavage was done thrice in a span of 24 hours, the report suggested that the fluid collected was 43 mL of brownish, turbid material. The smear shows scattered acute inflammatory cells, few lymphocytes, and macrophages. This was performed in respiratory medicine examination room.

All the X-ray findings are shown in (Table/Fig 1) showing the consolidation with the arrows. The High Resolution Computed Tomography (HRCT) scan impression is presented (Table/Fig 2).

Physiotherapy management: The physiotherapy rehabilitation was initiated after the diagnosis of right-side lower lung abscess was confirmed. The goal of the physiotherapy regimen was to improve ventilation and oxygenation, bronchial hygiene, and exercise tolerance. It comprised of myriad of separate interventions, like mobilization of secretions, breathing exercises, thoracic expansion exercises, and manual pressure at the left lower zones to maintain the expansion, physical mobility exercises, and posture retraining. All the brief introduction to goals, intervention, rationale, and dosage are given in (Table/Fig 3).

Outcome measures: Sputum production quantity after airway clearance technique was 20 mL preintervention and 32 mL Postintervention.

Progression of the overall physical condition of the patient was done by Six Minute Walk Test (3) and Modified Borg Scale (1).
Modified Borg Scale:

• On 1st day of referral was II
On the time of discharge it was I
On follow-up (1 week after discharge) was I
• Six-minute walk test:
On 1st day of referral was 220 m;
On the time of discharge it was 260 m
On follow-up it was 320 m.

Bar graph showing the progression of the overall physical condition of the patient by Six-Minute Walk Test (3) and Modified Borg Scale (1) (Table/Fig 4).

Discussion

Lung abscesses account for around 0.2% of all pneumonia cases requiring hospitalization, according to Beth Israel Deaconess Medical Center's experience, however, physiotherapy care is necessary to return the patient to their usual activities of daily living. Pulmonary rehabilitation aims to improve disease-related deficits by increasing exercise tolerance capacity, ventilation, and lowering labor of breathing (4),(5),(6).

The present case was diagnosed to have a right lower lobe lung abscess based on clinical results and investigations. Pulmonary rehabilitation was delivered focusing primarily on enhancing exercise tolerance capacity, ventilation, and reducing the work of breathing, thereby improving the disease-induced impairments.

Lung abscess genesis, diagnosis, and treatment protocol have been described earlier. Antibiotics with a specific target and adequate drainage are essential for recovery. The mortality of lung abscesses has fallen to roughly 2-38.2% due to the widespread use of antibiotics (7). The patient’s age, malnutrition, comorbidities, immunity, suitable and timely antibiotics, and supportive care all play essential roles. In up to 68% of cases, postbronchoscopy fever occurs, with greater rates following bronchoalveolar lavage. Infectious problems after bronchoscopy are quite rare (8).

However, in this case, there was no postbronchoscopy fever, and the patient was identified with a causative factor for cavitatory lung abscess Streptococcus pneumoniae, which was treated by bronchoscopic drainage (9).

Long-term health effects of chronic respiratory disorders can be effectively combated with a thorough pulmonary rehabilitation program. The key interventions for rehabilitating patients with deteriorating health status due to respiratory problems include patient education, breathing methods, and graded exercise training programs. Disability results from pulmonary impairment caused by lung damage (10).

In this case, a specialized rehabilitation program was developed and implemented. A regular exercise program reduced the number of exacerbations and hospital readmissions, resulting in improved functional capacity, and dyspnoea level.

Diaphragmatic breathing and pursed-lip breathing are two controlled breathing techniques that increase psychological well-being by lowering anxiety and depression (10). Six weeks of pulmonary rehabilitation on lung abscess has shown improvements in functional capacity, quality of life, and respiratory dysfunction-related outcomes, according to the study. Walking is utilized in an aerobic training program to focus on lower limb endurance (11).

On examination during follow up the patient showed improvement in Modified Borg scale from II-I and six-minute walk test was improved from 260 m at the time of discharge to 320 m.

According to popular belief, pulmonary rehabilitation should last at least 8 weeks to have a significant impact on exercise efficiency and quality of life (11),(12). In the present case, posture training and walking were offered as part of a supervised program, and after 2 weeks of unsupervised at-home instruction, telephonic follow-up was maintained.

The X-ray indicated a cavitatory lung abscess, It can be challenging to diagnose the infectious pathogens at the time of confirmation of diagnosis. It is uncommon for Streptococcus pneumoniae to be the infectious cause of lung abscesses because Staphylococcus aureus typically causes them (13).

Conclusion

The present case report described an integrated plan for the rehabilitation of lung abscess. The patient's recovery occurred during the rehabilitation program, the majority of the therapeutic objectives were met, including airway clearance to improve ventilation and saturation, improving the patient’s exercise tolerance capacity, reducing work of breathing, and increasing functional capacity through energy conservation techniques. The patient received physiotherapy, which helped him to heal faster, lower his discomfort significantly, and enhance his day-to-day tasks, something he could not do before starting physiotherapy.

Acknowledgement

Authors would like to thank the study participant for their participation and for giving their valuable time to the study. The authors are grateful to the RNPC College of Physiotherapy for their support and assistance.

References

1.
Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J Emerg Nurs. 2000;26(3):216-22. [crossref]
2.
Pryor JA, Ammani PS. Physiotherapy for respiratory and cardiac problems: Adults and paediatrics. Edinburgh: Churchill Livingstone. 3rd ed. 2002.
3.
Halliday SJ, Wang L, Yu C, Vickers BP, Newman JH, Fremont RD, et al. Six-minute walk distance in healthy young adults. Respir Med. 2020;165:105933. [crossref] [PubMed]
4.
Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015;3(13):183.
5.
Beaucoté V, Plantefève G, Tirolien JA, Desaint P, Fraissé M, Contou D. Lung abscess in critically Ill Coronavirus Disease 2019 patients with ventilator-associated pneumonia: A french monocenter retrospective study. Crit Care Explor. 2021;3(7):e0482. [crossref] [PubMed]
6.
Khoong CHL, Phua CK. Lung abscess and empyema following bronchoscopy: A case report and review of the literature. Respir Med Case Rep. 2020;30:101116. [crossref] [PubMed]
7.
Vatwani A, Margonis R. Energy conservation techniques to decrease fatigue. Arch Phys Med Rehabil. 2019;100(6):1193-96. [crossref] [PubMed]
8.
Hu L, Lin J, Li J, Cao Y, Lin L. Lung abscess secondary to lung cancer with Eikenella corrodens and Streptococcus anginosus: A case report. BMC Infect Dis. 2020;20(1):351. [crossref] [PubMed]
9.
Denu RA, Patel D, Becker BJ, Shiffler T, Kleinschmidt P. MRSA septicemia with septic arthritis and prostatic, intraretinal, periapical, and lung abscesses. WMJ Off Publ State Med Soc Wis. 2020;119(1):62-65.
10.
Ainge-Allen HW, Lilburn PA, Moses D, Chen C, Thomas PS. Antibiotic instillation for a chronic lung abscess. Respir Med Case Rep. 2020;29:100991. [crossref] [PubMed]
11.
Rochester CL, Spruit MA, Holland AE. Pulmonary rehabilitation in 2021. JAMA. 2021;326(10):969-70. [crossref] [PubMed]
12.
Cascone R, Sica A, Sagnelli C, Carlucci A, Calogero A, Santini M, et al. Endoscopic treatment and pulmonary rehabilitation for management of lung abscess in elderly lymphoma patients. Int J Environ Res Public Health. 2020;17(3):997. [crossref] [PubMed]
13.
Ko Y, Tobino K, Yasuda Y, Sueyasu T, Nishizawa S, Yoshimine K, et al. A Community-acquired Lung Abscess Attributable to Streptococcus pneumoniae which Extended Directly into the Chest Wall. Intern Med. 2017;56(1):109-13. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/57717.16817

Date of Submission: May 13, 2022
Date of Peer Review: Jun 21, 2022
Date of Acceptance: Jul 04, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 14, 2022
• Manual Googling: Jun 29, 2022
• iThenticate Software: Jun 30, 2022 (11%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com