Effect of chemotherapy on cell counts in peripheral blood & bronchoalveolar lavage of patients with pulmonary tuberculosis.

Cell counts in peripheral blood and bronchoalveolar lavage fluid were estimated in 38 patients with active tuberculosis; 12 patients with tuberculosis who had successfully completed more than 9 months of chemotherapy with isoniazid, rifampicin, and ethambutol; 10 Mantoux negative bronchitic subjects; and 6 control subjects. There were 50 males and 16 females aged 16-50 yr. Age, haemoglobin, total and differential serum proteins, were comparable in the various groups. Patients with active tuberculosis had higher ESR and significantly raised absolute (2.24 +/- 0.13 x 10(3); P less than 0.05), B (0.56 +/- 0.03 x 10(3); P less than 0.01) and Null lymphocyte counts (0.56 +/- 0.05 x 10(3); P less than 0.01) in blood. After chemotherapy there was no significant change in lymphocyte counts (2.43 +/- 0.21; P greater than 0.05). In bronchoalveolar lavage (BAL) total cell counts were increased five fold in patients with active disease (40.8 +/- 5.79 x 10(4)/ml) and although these showed considerable reduction after therapy they were higher (18.33 +/- 4.73 x 10(4)/ml) than those in controls (8.3 +/- 1.2 x 10(4)/ml; P greater than 0.05). In bronchitic subjects, total cell counts and macrophage counts in BAL fluid were elevated (P less than 0.01; less than 0.05 respectively) but lymphocyte counts were comparable to controls (3.4 +/- 1.35 x 10(4)/ml vs 1.09 +/- 0.19 x 10(4)/ml; P greater than 0.05). Lymphocytosis in the bronchoalveolar lavage fluid of patients with pulmonary tuberculosis persisted even after adequate treatment.

Monocyte/macrophage functions & humoral response in blood & bronchoalveolar lavage fluid of pulmonary tuberculosis patients.

Subsegmental bronchoalveolar lavage (BAL) was performed in 33 patients with active pulmonary tuberculosis and five control subjects. Phagocytosis by monocytes and alveolar macrophages was studied, and in addition serum and BAL immunoglobulin and complement levels were also determined. The phagocytic activity of blood monocytes was depressed in pulmonary tuberculosis patients as compared to controls, 37.8 +/- 2.3 per cent; 50.7 +/- 4.2 per cent and 32.9 +/- 3.6 per cent for sheep RBC's, latex and Staphylococcus aureus respectively compared to 66.7 +/- 6, 54.8 +/- 2.2 and 68.3 +/- 3.5 per cent respectively in controls; the differences being significant for sheep RBC's (P less than 0.05) and Staph. aureus (P less than 0.001). However, phagocytosis was not impaired in BAL macrophages (P greater than 0.05). In patients no significant alteration in serum immunoglobulin and complement levels was observed except that levels of C4 component of complement were increased in patients with far advanced lesions (98.5 +/- 33.7 mg/dl compared to 78.7 +/- 7.9 mg/dl; P less than 0.05). While IgM and C4 component of complement could not be detected in BAL fluid the levels of IgA were significantly increased in pulmonary tuberculosis patients (65.5 +/- 50.5 mg/dl compared to 39.9 +/- 13.3 mg/dl in control; P less than 0.05). Since IgA secreted in the BAL fluid is mostly synthesised locally, increased levels of this immunoglobulin could be of value in determining activity of the disease.

Pattern of tobacco smoking in north Indian adults.

An exploratory study was conducted among 200 apparently healthy current smokers aged 15-45 years to determine their attitudes and behaviour regarding tobacco smoking by using a precoded questionnaire specifically designed for the purpose. Females constituted 10% of the study group and the 73 participants who smoked cigarettes exclusively were from urban backgrounds and were noted to inhale the smoke more frequently than bidi or hukka smokers. Parental and peer group influence, as well as curiosity in late teenage were the major reasons for starting smoking which was however continued mainly to obtain the stimulatory and or relaxing effects of nicotine. Health hazards of smoking, particularly lung cancer and heart disease, were widely known and fear of these constituted the most important reason for smokers wishing to quit the habit. One-half of the subjects attempted to stop but could not succeed due to withdrawal symptoms and lack of a suitable substitute. The divergence between attitude and behaviour of smokers is highlighted by this study since smokers continued to smoke despite being averse to smoking and disapproval of their habit by their family members. There were important differences in the pattern of smoking and perceptions of various groups of smokers regarding the societal permissiveness, awareness of health hazards, and measures to control smoking.

Bronchodilator effect of terbutaline aerosol in asthmatic: comparison of two spacer devices.

The degree of bronchodilation achieved with aerosolised bronchodilators may partly depend on correct usage of a particular inhaler device. The effect of two puffs of 0.25 mg each of terbutaline aerosol using either of two spacer devices--a tube spacer and conical spacer with inhalation valve (Nebuhaler)--in a randomised manner were compared in 20 patients with bronchial asthma. All participants (11 male, 9 female) aged 16 to 50 years had clinically stable baseline airway obstruction responsive to bronchodilators. The maximum per cent increase of PEFR and FEV1 were significantly higher after inhalation via Nebuhaler than tube spacer (44.93 +/- 21.15% vs 26.67 +/- 13.17%; 74.0 +/- 17.87 vs 47.65 +/- 15.74% respectively, p less than 0.01). The increase noted at each time interval was significantly higher and more sustained with Nebuhaler. In terms of bronchodilator effect Nebuhaler had definite advantage over tube spacer in our study. There were no significant changes in pulse rate nor in blood pressure.

Perceptions and attitude towards tobacco smoking among doctors in Chandigarh.

Two hundred and eighteen randomly selected doctors drawn from among the faculty and students of Postgraduate Institute of Medical Education and Research; Interns and staff at the General Hospital; and General practitioners of the Chandigarh city, were administered a structured questionnaire. Among them 31.6% were current smokers whereas 23.3% had stopped smoking (ex-smokers). All but one of the smokers were men who smoked cigarettes. Spirit of experimentation and peer influence were important initiating factors whereas the habit was continued mainly to concentrate on work/study. Doctors were uniformly aware of the detrimental effects of smoking, particularly its association with lung cancer, chronic bronchitis and coronary artery disease, and this was the major reason for their abstaining or wanting to quit the habit. The relation of smoking with oral cancer, laryngeal cancer, emphysema and peripheral vascular disease was not well appreciated. Counselling patients about hazards of smoking was practised significantly less often by smoking doctors and surgeons. The options favoured by doctors for preventing smoking included a ban on tobacco advertising, specific health warning on cigarette/bidi packs, and restriction of smoking in public places, particularly hospitals and clinics.