ABSTRACT
Background: Pulmonary tuberculosis is a common disease that can result in residual anatomical and functional changes despite microbiological cure. But the ideal method to identify and evaluate persons with pulmonary impairment after tuberculosis and its impact on population health are unknown. Hence the study was conducted with the aim of the present study was to Evaluate the respiratory and cardiac impairment and to assess the health related quality of life in pulmonary tuberculosis sequelae patients.Methods: This observational study was conducted on 200 patients randomly at the Institute of thoracic medicine at Chetpet and Rajiv Gandhi government general hospital, Chennai during a period of 6 months from April 2013 to October 2013. All patients were investigated for sputum for acid fast Bacillus, chest skiagram, spirometry, electrocardiogram, echo, six minute walk test and St. George respiratory questionnaire.Results: In this study, spirometry abnormalities were present in 81% of patients. No significant correlation observed between smoking index and pulmonary function abnormality (0.145). However, moderate correlation was seen between radiology and pulmonary function abnormality (0.307). 98% of the patients showed diminished exercise capacity. The prevalence of corpulmonale was increased with the degree of radiological impairment progress from grade 1 to 3 with a moderate correlation (0.385). No significant correlation (0.198) was noticed between the parameters smoking index and exercise capacity. The overall SGRQ scores mean (SD) were 54�.5, 41.7�.7, 28.9�.6 and 37.0�.1 for the symptom, activity, impact and overall scales respectively. No significant relationship was noticed between smoking index and SGRQ total score (p=0.512).Conclusions: The present study confirms that there is significant functional limitation in pulmonary sequelae, addressing the need of pulmonary rehabilitation for better quality of life. Smoking cessation therapy all can improve their quality of life after pulmonary impairment. Cardiac evaluation must be done in all post tuberculosis patients to rule out corpulmonale.
ABSTRACT
Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 � August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.