Subject(s)
Adult , Comorbidity , Humans , Male , Nails, Malformed/diagnosis , Osteoarthropathy, Secondary Hypertrophic/diagnosisABSTRACT
OBJECTIVE: The aim of this study was to evaluate the status of inhalation therapy in bronchial asthma in terms of frequency of its use, role of general physicians and general practitioners in prescribing inhalation therapy, role of inhaled steroids and B2 agonists, concurrent use of oral drugs, technique of using inhaler devices, use of spacer devices and peak flow monitoring. MATERIAL AND METHODS: 150 patients (76 males, 74 females) of bronchial asthma over 12 years of age referred to chest clinic of a tertiary care hospital for inadequate control were interviewed on the basis of a questionnaire and screening of prescription and case records wherever available. RESULTS: 127 (84.6%) patients were on inhalation therapy and maximum number of prescriptions was by general physicians (81%). The dosages of inhaled steroids were less than 400 mg in 60 (83.3%) cases and 26 (36%) patients discontinued it after some time. All patients were on beta-2 agonist inhalers and 74 (58.3%) patients were using these on regular basis. The concurrent use of oral short acting B2 agonist and oral steroids was seen in 107 (84%) and 41 (32.2%) patients respectively. Metered dose inhalers (MDIs) were most frequently used inhaler devices in 100 (78.7%) cases followed by rotahalers in 27 (21%) cases. The technique of using MDI and rotahalers was incorrect in 64 (64%) and 7 (25.9%) cases respectively. Spacer devices were used rarely and none of the patients were monitored by peak flow rates. CONCLUSIONS: Although inhalation therapy was being prescribed in large number of patients, more so by general physicians, yet the therapy was not being effective considering the fact that the referral to chest clinic in all the cases was for uncontrolled asthma. The main reasons for ineffective inhalation therapy were, underuse of inhaled steroids, overuse of B2 agonists and incorrect use of inhaler devices. There is an urgent need to educate general physicians especially in regards to usefulness of inhaled steroids, as on demand use of B2 agonists, demonstration of correct inhalation technique to patients, use of spaces devices and peak flow monitoring.
Subject(s)
Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-Agonists/administration & dosage , Adult , Aged , Asthma/drug therapy , Child , Female , Humans , Male , Metered Dose Inhalers/statistics & numerical data , Middle Aged , Patient Education as Topic , Surveys and Questionnaires , Receptors, Adrenergic, beta-2/drug effectsABSTRACT
A 23-year-old male presented with clinical and radiological features of left lung collapse. Fibre-optic bronchoscopy revealed a smooth globular mass almost completely occluding the left main bronchus. Needle aspiration and endobronchial biopsy from the mass revealed it to be a case of anaplastic large cell lymphoma, a subtype of non-Hodgkin's lymphoma. This report documents the rare presentation of non-Hodgkin's lymphoma as an endobronchial mass.
Subject(s)
Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy, Needle , Bronchial Neoplasms/diagnosis , Disease Progression , Fatal Outcome , Humans , Immunohistochemistry , India , Lymphoma, Non-Hodgkin/diagnosis , Male , Risk Assessment , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The management of complicated parapneumonic effusions (CPE) and empyema by chest tube drainage usually fails because of thick viscous fluid and multiple pleural space loculations. The use of intrapleural fibrinolytic agents facilitates pleural drainage and can obviate the need for more invasive surgical interventions in these types of effusions. OBJECTIVE: To evaluate the role of intrapleural fibrinolytic therapy with streptokinase (STK) as an adjunctive therapy in the management of CPE and empyema. MATERIAL AND METHODS: Thirty patients of CPE and empyema were considered for intrapleural fibrinolytic therapy when the chest tubes/catheter drainage became insignificant (i.e., less than 50 ml a day) and the tube was adequately positioned and patent. Intrapleural STK was administered eight hourly in the dosage of 2,50,000 IU in 50 ml of saline. The end points were volume of fluid drained and radiological resolution. RRESULTS:There were 24 (80%) patients with CPE and six (20%) with empyema, with a mean age of 35 years. The median of STK doses used were three in 26 (87%) cases and two in four (13%) cases. There was significant drainage (mean +/- SD) 1094 ml +/- 116 and radiological resolution in 26 (87%) cases. The only complication observed was transient chest pain in one and fever in two patients. CCONCLUSION:Intrapleural fibrinolytic therapy with STK is a safe and effective adjunctive therapy in the management of CPE and empyema.