ABSTRACT
Background: More than fifty percent of the cured cases of pulmonary tuberculosis develop some form of chronic pulmonary dysfunction. It can present with varying degrees of lung damage, ranging from minimum functional abnormalities to severe forms of dysfunction that can be an important cause of death. Objective of the study to identify the various Post Tuberculosis Lung Diseases (PTBLDs) and to study impact of the patient and disease related factors on its occurrence.Methods: Cross-sectional, observational study was conducted in 134 adult, post tuberculosis patients, aged between 18-65 years, who have completed at least one year after the end of anti-tubercular treatment. All symptomatic post TB lung disease patients coming to the pulmonology out-patient clinic at the Apollo Institute of Medical sciences and Research were included in the study.Results: Majority were more than 50 years (35.3%) and males (59.4%). Majority were from urban areas (70.7%), low social class (72.2%), and unskilled workers (56.4%). Most common symptom was cough in 74.4% cases. Majority of the cases had symptoms from one week to one month i.e. 47.4%. Only eight cases were found out to be very prompt in reporting their symptoms. 39 cases had some or the other co-morbidity. Current chest X-ray status was normal in only three cases. Mean FEV1 was 1.38 which increased to 1.52; mean FVC was 1.23 which increased to 1.58; mean FEV1/FVC was 67.37 which increased to 72.76 after giving the bronchodilator. 78(58.6%) cases had obstructive and 27(20.3%) had restrictive lung disease. In 30 cases the disease was reversible. Majority of the cases were of pulmonary fibrosis followed by bronchiectasis.Conclusion: Further studies are needed to develop approaches for the prevention, care and treatment of patients with post TBLD.
ABSTRACT
Background: Study of risk factors help make patients aware about them and they can be taught to take proper precautions to prevent the exacerbation of asthma. Objective was to study factors influencing bronchial asthma exacerbations with special emphasis on inhaler usage.Methods: A hospital based cross sectional study was carried out over a period of three months among 218 eligible patients with asthma who could give written informed consent and willing to participate in the present study and the data was recorded in a pre tested, semi structured study questionnaire. The data was recorded in the Microsoft Excel Worksheet and analyzed using proportions and mean+2SD.Results: We found that advanced age, exposure to dust, fumes and allergens, lower social class, presence of other co-morbidities, irregular use of inhalers, and not demonstrated the technique of proper inhaler use were significantly associated with exacerbation of bronchial asthma. Other factors like mean duration of illness, mean duration of use of inhalers, gender, presence of allergic rhinitis, type of device used for inhalation and taking consultation from pulmonologist were not significantly associated with exacerbations of asthma.Conclusions: Demonstrating and teaching the patient on how to use the device of inhaler plays a significant role in reducing the risk of exacerbation of bronchial asthma.
ABSTRACT
Background: Tracheal strictures are known to recur after dilatation, so they need stenting to prevent recurrence. The objective was to study role of air way stenting (Duman- silica stent) in benign stricture trachea management.Methods: A hospital based prospective study was carried out among 15 cases (as these cases are very rare, author could study only 15 cases) presented with various clinical features suggestive of tracheal strictures. They were examined and managed by putting tracheal stent for up to eight months period. All cases were followed at regular intervals till 14months after the stent was placed. The outcome was studied.Results: The tracheal strictures have been found to be more in the age group of 25-30 years. The male to female ratio was 4:1 i.e. for everyone female case there were four male cases. Thus, the tracheal strictures have been more common among the males compared to the females. All of the patients presented with severe stridor, breathing difficulty, and poor exercise tolerance. Most common cause of tracheal stricture was prolonged mechanical ventilatory support >8 days due to organo phosphorus poisoning in past 3months and all of them were males. All cases had good outcome at the end of 14months of follow up. All cases had normal findings. No one developed foreign body reaction, nor did no one develop granuloma formation at the stent site. After stent removal flexible bronchoscopy repeated after 3rd month and 6th month.Conclusions: Tracheal stenting is very useful procedure in the management of air way strictures
ABSTRACT
Background: To obtain the good amount of specimen by biopsy for proper diagnosis, thoracoscopy is a very good tool. Using thoracoscopy the diagnostic accuracy can reach 100% whereas the diagnostic accuracy of the closed pleural biopsy is around 51-79%. Aim: To study role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions. Material and Methods: A hospital based cross sectional study was carried out among 50 study subjects aged > 45 years. All were cases of pleural effusion. Thoracoscopic pleural biopsy was performed in all cases. The samples were sent for histopathology after biopsy. Results: Majority of the study subjects were found to be in the age group of 45-55 years i.e. 60%. Males outnumbered females as the pleural effusion may be more common in males above the age of 45 years than among the females. Tuberculosis was more in females (60%) than males (40%). But malignancy – adenocarcinoma spreading to pleura was more common in males (90.5%) than females (9.5%). Only one female was found to have Meigs syndrom (ovarian tumor with secondaries pleura). Mesothelioma was seen in three cases and all of them were males. Normal histopathology finding was seen in five cases and all of them were males. It has been documented that pleural effusion due to tuberculosis was more common in females in the present study. Kiran Grandhi, Jayasri Helen Gali, Kokiwar PR. Role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions: A hospital based cross sectional study. IAIM, 2019; 6(1): 83-88. Page 84 Conclusion: Thoracoscopic pleural biopsy diagnostic yield is high. Low ADA level in pleural fluid does not rule out kochs, incidence more in females.