Utility of intrapleural streptokinase in management of chronic empyemas.

BACKGROUND: The nonsurgical medical approach with use of fibrinolytic agent is an alternative modality in management of chronic empyemas. With the introduction of purer forms of streptokinase, there has been renewed interest generated in the use of intrapleural thrombolytics with documented successful drainage of difficult to drain chronic empyemas. To evaluate the utility of streptokinase in the management of chronic difficult to drain empyemas in a single blind randomized case control study. MATERIAL AND METHODS: Twenty four cases of chronic/multiloculated empyema were included which had cases preferred having loculations or multiloculations and failure of drainage via thoracostomies for less than 100 ml during last 24 hours. Cases were randomized into two groups as 12 cases of streptokinases group and 12 cases of placebo group. Streptokinase given as 2.5 lac units in 100 ml of normal saline instilled intrapleurally for 6 consecutive days. In control group, 100 ml of normal saline without streptokinase was instilled intrapleurally through intercostal drain for 6 days. They were assessed by amount of drainage through intercostal drain for six days after instillation of streptokinase/placebo, duration of intercostal drainage in situ, and radiological improvement by standard x-ray chest. RESULTS: The study revealed increased drainage through intercostal drain in streptokinase group compared to control group. The mean duration of intercostal drainage in situ was shorter in streptokinase group compared to control group. Radiologically, streptokinase group revealed score 3 improvement in eight out of twelve cases and score 2 improvement in rest of the four cases. In control group, score 1 improvement was seen in two out of twelve cases and no improvement was seen in rest of the 10 cases. The observation difference is found to be highly significant statistically (p <0.001). No major adverse effects were noted in the streptokinase group. CONCLUSION: The study concludes the safety, efficacy, reduced hospital stay and decreased morbidity in patients treated with intrapleural streptokinase as compared to control group.

A study on opportunistic enteric parasites in 80 HIV seropositive patients.

AIDS is characteristically associated with several opportunistic enteric protozoal infestations that cause chronic and at times fatal diarrhoeas. A study is undertaken to isolated opportunistic enteric parasites in 80 HIV seropositive patients. An attempt is made to correlate and signify the presence of coexistent oral candidosis and enteric pathogens.

Multiple myeloma complicating HIV-infection. A case report.

A case of multiple myeloma associated with HIV disease and hepatosplenomegaly presented to us as pyrexia of unknown origin, is reported. Because of paucity of such cases in the literature, the case is dealt in detail and the literature reviewed briefly.

A study on interrelationship of 60 HIV positive cases with coexistent oral candidosis and tuberculosis.

Sixty HIV seropositive cases studied of inter-relationship of coexistent infections with tuberculosis and oral candidosis. Presence of oral candidosis either symptomatic/asymptomatic as revealed on microbiological studies have been recorded and the significance discussed. Presence of oral candidosis apparent of nonapparent with heavy growth, yield on culture in HIV seropositive cases could be considered a pointer of conversion of HIV infection to a disease. This observation needs further evaluation. Relevant literature reviewed briefly.

Churg Strauss syndrome-clinicopathological aspects--report of a case.

An elderly person presented with exertional dyspnoea, cough, rhinorrhea and multiple swelling in submandibular region. This case was found to have marked eosinophilia with upper, as well lower respiratory tract involvements. Erroneous treatment patient received in past for pulmonary tuberculosis without any beneficial result. Open lung biopsy was undertaken, revealed evidence of vascultitis and perivascular inflammatory changes. The case findings and histopathological discussions are reviewed briefly.

Protean manifestations of malaria--(multi organ dysfunction syndrome).

Malaria may present with Multi System Organ Failure (MSOF) or Single System Organ Failure (SSOF). Thirteen cases of malaria are presented for their protean manifestations. Five patients presented for chronic urticaria with or without polyarticular arthritis, another mimicking acute rheumatic arthritis. A case of reactivation of pulmonary tuberculosis and the other to with apparent chloroquin resistant malaria who responded to combination of verapamil and chloroquin. A case developing Guillain Barre syndrome and another complicating into dilated cardiomyopathy are the rarities. All the cases are described and the pathogenesis is discussed in detail.

Oral candidal carriage in young insulin dependent diabetics.

Fifty patients with insulin-dependent diabetes mellitus (IDDM) in the age group of 5-20 years were assessed for oral candidal carriage state and other related oral manifestations. The control group showed 16% Candida carrier state, whereas the IDDM group showed 92% candida carrier state. The candidal count was significantly higher in the IDDM group. Other associated oral manifestations like dry mouth, burning sensation, and painful fissures were also observed in the IDDM subjects.

HIV-1 seropositivity in pulmonary tuberculosis (study of 340 cases from Marathwada).

An investigative study was carried out in 340 cases of established pulmonary and presumed pleural tuberculosis for co-occurrence of HIV-1 infection in them. Confirmatory screening for HIV-1 was carried out with both ELISA (Vironostika) and Serodia commercial kits in all reactive samples on first screening. In all, 16 cases proved to be having HIV-1 coexistent infection with pulmonary tuberculosis. Their preliminary vital clinical observations and roentogenic finding are summarized and literature reviewed briefly.