ABSTRACT
Introduction: Scrofula also known as tuberculous cervical lymphadenitis is one of the most common manifestations of tuberculosis (TB). India is a country that still remains plagued by this dreaded disease. The disease poses both diagnostic and therapeutic challenges because it mimics other pathologic processes and does not have consistent physical and laboratory findings. The monitoring of treatment in cases of cervical TB lymphadenitis is more complex due to the peculiar behavior of TB lymph nodes. Materials and Methods: The serum alkaline phosphatase (ALP) of all patients presenting with cervical TB lymphadenitis in the Revised National TB Control Programme (RNTCP) outpatient department (OPD) of MS Ramaiah Medical College was collected. An ALP level at the time of diagnosis was noted. Subsequently, serum ALP levels were measured when the patients come for Directly Observed Treatment Short to RNTCP OPD on 15th, 30th, and 60th day of starting anti-TB treatment (ATT). Results: It has been observed in the study that 72.2% of the patients with cervical tuberculous lymphadenitis had significantly elevated levels of serum ALP (>135 IU/L) at the time of presentation. Only 5.3% among the controls had high ALP, and the difference was statistically significant with a P < 0.001. With sensitivity = 72.2% and specificity of 94.5%, and assuming that the prevalence of TB is 3.2% the estimated positive predictive value is 30.3% and negative predictive value is 99.0%. Based on simple linear regression with ALP as dependent variable and time as independent variable, it is found that among the patients there is a decline in ALP values at an average of 33.4 in every 15 days. Conclusion: This study shows the significance of measurement of serum ALP as a supplementary tool in the diagnosis of cervical TB lymphadenitis. Serial monitoring of serum ALP can be used to monitor the response of ATT.
ABSTRACT
Introduction: Pneumothorax is the presence of air in the pleural space and can be due to a number of causes. Although most pneumothoraces can be managed successfully with tube thoracotomy, patients with recurring pneumothoraces should be considered for operative intervention. Methodology: All patients presenting to M. S. Ramaiah Medical College and Hospitals and diagnosed with pneumothorax during a period of 5-year were included in the study. These patients were clinically evaluated and were investigated using chest radiography/computerized tomography scan of thorax and then subjected to appropriate therapy. Fisher exact test has been used to find the significance of study parameters on a categorical scale between two or more groups. 95% confidence interval has been computed to find the significant features. A statistical analysis was done using IBM SPSS 20 statistical software. Results: The mean age of presentation in our study was 35.23 years. The majority of patients presented with chest pain (87.1%). The second most common symptom was found to be dyspnea (64.5%) followed by a cough (54.8%). Pneumothorax is usually unilateral and in our study 91.4% of cases presented with unilateral pneumothorax with 51.4% being right pneumothorax. Bilateral pneumothorax was found to be 8.6%. 62.8% of patients were diagnosed to have a spontaneous pneumothorax. The two main causes of secondary spontaneous pneumothorax were tuberculosis and pneumonia. Traumatic pneumothorax accounted for 28.5% of cases with road traffic accidents (80%) as the single largest cause. Conclusion: Primary spontaneous pneumothorax is the largest cause of pneumothorax. The most common symptom that patients present with is pleuritic chest pain. Chest radiographs are the imaging modality of choice for pneumothorax. Insertion of chest drains is the treatment of choice for pneumothoraces presenting for the 1st time. Exploratory thoracotomy and decortication are the treatment of choice for recurrent pneumothorax.