ABSTRACT
Background: The aim of pleural effusion management is to provide symptomatic relief by draining excessive fluid in the pleural space and stable the patient before the surgical and therapeutic intervention of underlying disease. Intrapleural fibrinolytic therapy is an effectively adjunct to improve the drainage of loculated effusion in complicated empyema especially in cases who fail chest tube drainage. Aim and Objectives: The aim of the study was to compare the efficacy of intrapleural instillation of 2-mercaptoethane sulfonate sodium (MESNA) and conservative approach in the management of loculated parapneumonic effusion and thoracic empyema. Materials and Methods: A total of 50 cases with loculated parapneumonic effusion and empyema above 21 years of age were recruited. Cases were randomly divided into two groups, that is, Group 1 managed with intrapleural instillation of MESNA for adhesiolysis of loculations through tube thoracostomy and Group 2 managed with conservative approach through tube thoracostomy. Results: Effusion in 84–80% and empyema in 16–20% were observed in Group 1 and Group 2, respectively. The mean value of number of days in ICD was 14.98 days in Group 1 and 19.5 days in Group 2. The amount of fluid drained (125.3–95.6 ml) and mean duration of hospital stay (22.2–28.5) was statistically significant between study groups. No adverse complications were noticed; however, cough and pain at the site of injection were reported in two cases each. Around, 32–64% cases required surgical intervention in Group 1 and Group 2, respectively. Conclusion: The intrapleural fibrinolytic therapy by 2-MESNA has better efficacy than conservative thoracostomy. The MENSA has better outcome in regard to breaking loculations, limited requirement of surgical intervention, less duration of hospital stay, and faster absorption of pleural fluid in effusion and empyema.
ABSTRACT
Background: Pulmonary tuberculosis and diabetes mellitus are major public health concerns in India. Pulmonary tuberculosis in cases with diabetes shows an unusual radiographic pattern and higher frequency for cavitation. Aim and Objectives: To evaluate the impact of glycemic control on the clinico-radiological profile of pulmonary tuberculosis in cases with diabetes mellitus. Materials and Methods: A total of 126 cases clinically confirmed and microbiologically diagnosed as pulmonary tuberculosis above 21 years of age were recruited. Based on the blood glucose levels cases were divided into prediabetics, newly diagnosed diabetics, and known diabetics. Clinical and radiological examinations were conducted. Results: Cough was the most prevalent clinical symptom followed by fever, loss of appetite, loss of weight, and dyspnea. In the radiographic examination, lower lung field was most commonly involved in newly diagnosed and known diabetes cases. Cavitary lesions were commonly noticed in multiple zone implication, multiple cavities, and bilateral cavity involvement was observed more often in newly diagnosed and known diabetic cases. Among the diabetic cases (94), satisfactory glycemic control was observed in 39 cases and poor glycemic control was seen in 55 cases. The mean symptom score in the cases with satisfactory glycemic control was 3.87 and in poor glycemic control was 3.99. Conclusion: Diabetic cases with lower lung field lesions may be an indication of tuberculosis which needs immediate diagnosis and management. In this study, poor glycemic control influence the radiological manifestations of pulmonary tuberculosis cases with diabetes.