Assessment of Symptomatic Post Tuberculosis Patients by Spirometry and Chest X Ray

Introduction: TB is an infectious disease caused by thebacillus Mycobacterium tuberculosis which typically affectsthe lungs. The disease is spread by the people who are sick withactive pulmonary TB. Up to half of TB survivors have someform of persistent pulmonary symptom despite microbiologiccure. The aim of the study was to assess the symptomatic posttuberculosis patients by using spirometry and chest x ray.Material and methods: The study was conducted in theDepartment of Respiratory Medicine, Rohilkhand MedicalCollege and Hospital after seeking clearance from theInstitutional Ethical Committee. The aim of the study was toassess the symptomatic post tuberculosis patients by usingspirometry and chest x ray. The study duration was from 1stNovember 2018 to 31st October 2019 and 100 patients wereenrolled in the study. Data was collected from patients whopresented with symptoms within 6 months of completing theirtreatment for tuberculosis.Results: All the patients (post tubercular) enrolled in thestudy had symptoms (in some form) even after full courseof antitubercular treatment and bacteriological cure andamong these breathlessness was the most common presentingsymptom (96%) followed by cough (58%). Maximum patientshad abnormal findings on chest examination (80%). Fibrosisfollowed by cavitary lesions were the most common findingson chest x ray in post tuberculosis patients. Maximum patientshad restriction (56%) in their spirometry followed by mixedpattern (23%).Conclusion: In patients with restriction on spirometry andhaving symptom of breathlessness and cough, reassurance andpulmonary rehabilitation may play a major role in relievingtheir symptoms whereas in patients with mixed or obstructivepattern on spirometry, bronchodilator therapy along withpulmonary rehabilitation may be helpful in relieving theirsymptoms post tuberculosis treatment.

Apical Vertebral Column Resection with Sagittal Rotation and Controlled Anterior Opening and Posterior Closing Maneuver for the Treatment of Severe Post-Tubercular Kyphosis: Case Series and Literature Review

STUDY DESIGN: Retrospective case series. PURPOSE: Describe the technique and evaluate the outcome of apical vertebral column resection (VCR) with sagittal rotation and anterior opening and posterior closing (AOPC) maneuver for correction of severe post-tubercular kyphosis (PTK). OVERVIEW OF LITERATURE: The surgical procedures described for the correction of PTK are VCR, pedicle subtraction osteotomy, transpedicular decancellation osteotomy, and closing-opening osteotomy. METHODS: We retrospectively evaluated 21 patients who had been operated on with single stage apical VCR with AOPC maneuver. Radiographs were obtained before surgery and at regular follow-up intervals. These were used to calculate the angle of kyphosis. Back pain was rated using the Visual Analog Scale (VAS) and neurological status was graded using Frankel grading. Radiological outcome was assessed by the improvement in the angle of kyphosis and fusion following surgery. Neurological status was assessed using Frankel grading. RESULTS: The study included eight males and 13 females with a mean age of 21.9 and average follow-up time of 30.4 months. The average number of vertebral bodies destroyed was 2.57. Kyphosis was improved from a mean of 68.42°±13.23° preoperative to 8.71°±4.58° postoperative. The average correction achieved was 87.10%. Preoperative VAS score improved from a mean of 6.38±0.92 preoperative to 1.38±0.49 postoperative. No patients had any sign of neurological deterioration. Seven out of eight patients with a preoperative neurological deficit improved following surgery. Two patients developed superficial wound maceration, one had persistent postoperative hypotension, and the other developed hemothorax. All patients recovered fully without a need for additional surgery. CONCLUSIONS: Single stage simultaneous anterior column lengthening and posterior column shortening is an effective method for surgical correction of severe PTK.

A Clinical Study of Post-tubercular Bronchiectasis

Pulmonary tuberculosis (PT) Tuberculosis (TB) is one of the most important communicable diseases in the world. India is the highest PT TB burden country accounting for one-fifth (21%) of the global incidence (9.4 million cases). This problem is further magnified by the after-effects of the disease—post-tubercular bronchiectasis (PTBX). As a result, the sufferers run from pillar to post with sinister symptomatology. Some of them are retreated with antituberculous treatment, although there is no definite indication. Katuri Medical College is situated in the rural Guntur surrounded by number of dusty industries like granite, quarrying, cotton crop and mills, tobacco, capsicum crop, spices besides being an agricultural area on the brink of mighty Krishna River flowing at a length of more than 700 km through three states of Karnataka, Maharashtra and Andhra Pradesh. As a result the flora and fauna is complex. Workers in this area report with variegated granulomatous lung diseases to the faculty of Pulmonology. Over and above the incidence of smoking in both sexes is rampant. The final outcome in all these morbidities is bronchiectasis. Quite a few of them have had treatment for pulmonary TB in the past. With this background the present study was undertaken to find out the vagary of post-tubercular bronchiectasis ruling out the extrinsic atmospheric factors.