ABSTRACT
Background: Objectives of this study were to define the role of fibreoptic bronchoscopy (FOB) in determining the etiology of haemoptysis, to determine whether bronchoscopy is useful in haemoptysis with normal chest x-ray, to determine whether early bronchoscopy is better than delayed bronchoscopy. Methods: This prospective study was conducted on 157 patients who presented with hemoptysis to the Department of Tuberculosis and Chest diseases. All these patients underwent FOB after taking proper history and examination and ruling out any contraindication to the procedure. Results: In patients with haemoptysis with normal CXR, a diagnosis was established in 54.5% by FOB while 38.6% had a normal bronchoscopy. An endoscopic diagnosis of bronchitis was made in 22.7% patients. In only 9.1% patients an endobronchial mass was seen on bronchoscopy, and all of them were more than 40 years of age. Active bleeding/bleeding site was localized in 18.1% patients. In patients with abnormal chest roentgenogram who underwent FOB, a definitive diagnosis was established in 75.4% cases with active bleeding/ bleeding site localized in 59.6%. Thirty five percent were having an endobronchial mass. Of all the patients who underwent FOB for recurrent haemoptysis, active bleeding/bleeding site was localized in 48.4% patients. Bleeding site was localized in 62.9% patients who underwent early FOB, while the yield was lower (29.4%) in patients who underwent delayed FOB. Conclusions: Fibreoptic bronchoscopy (FOB) is an important and useful investigation in patients of haemoptysis in determining the bleeding site and etiology of haemoptysis. Early FOB has higher yield in localizing the bleeding site than delayed FOB.
ABSTRACT
Background. Little information is available from India regarding prognostic factors in patients with community acquired pneumonia (CAP). Methods. Hospital-based prospective study to test the validity of pneumonia severity index (PSI) and the confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65) risk scoring systems in patients with CAP (n=150). Results. Although both CURB-65 class ³III and PSI class ³IV were 100% sensitive in predicting death, CURB-65 class ³III had a higher specificity (74.6%) than PSI class ³IV (52.2%) when used to predict death. In both PSI and CURB-65 risk scoring systems, mortality rate, need for intensive care unit (ICU) admission, prolonged need for intravenous (I.V.) antibiotics, prolonged duration of hospital stay and need for admission to ICU increased progressively with increasing scores. The PSI class ³IV was more sensitive in predicting ICU admission than CURB-65. The duration of hospital stay was found to have a weak but significant correlation with PSI and CURB-65 criteria. Defervescence time also had a very weak but significant correlation with PSI and CURB-65 criteria. Duration of I.V. antibiotics had a moderately strong correlation with CURB-65 criteria but a weak correlation with PSI criteria. Conclusions. Both PSI and CURB-65 were found to have equal sensitivity to predict death from CAP. Specificity of CURB- 65 was higher than that of PSI. However, PSI was more sensitive in predicting ICU admission than CURB-65.