Role of fibreoptic bronchoscopy in haemoptysis: an analysis of 157 patients.

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.

Comparative Study Of Oxidant Antioxidants And Inflammatory Markers Between Obese And Non Obese Newly Diagnosed COPD Patients.

COPD has widespread systemic manifestations. Inflammation plays important role in its pathophysiology. Aim of the present study was to compare markers of oxidative stress and inflammation between obese and non obese COPD patients. The levels of pro inflammatory cytokines CRP, IL6 and TNF α were compared between obese and non-obese subjects by applying student’s t test. Oxidative imbalance was assessed by analyzing MDA and FRAP assay in same subjects. Correlation of BMI with the above study parameters was analyzed using Pearson’s test. Results indicated that levels of CRP, IL6 and TNF α were elevated in obese group as compared to non-obese group (p<0.001). Total antioxidant capacity estimated by FRAP assay was lower (p=0.005) but the levels of oxidants estimated indirectly by MDA was higher (p=0.01) in obese COPD patients. In all COPD patients included in present study BMI correlated inversely with FRAP (r=-0.546, p=0.013), FVC (r=0.548, p=0.012) and FEV1 (r=-0.865, p<0.001). Similarly BMI correlated positively with markers of inflammation namely CRP(r=0.526, p=0.017), IL6(r=0.865, p<0.001), TNF α (r=0.653,p=0.002). Positive correlation of BMI was found with MDA(r=0.536, p=0.015). Conclusion: there is higher inflammation in obesity resulting in oxidant antioxidant imbalance and lung function decline.

COPD in Non-smokers-Prevalence and Risk Factors.

Studies on COPD have largely focused on the smoking rather than the non-smoking population. Hence we conducted the study to identify the non-smoking causes of COPD. The study was conducted in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, AMU, Aligarh during 2011-2013 on 450 COPD patients. The aim of the study was to find out proportion of non smokers among all COPD patients, identify risk factors for COPD among non smokers and classify non-smoking COPD patients according to severity. Maximum patients (35.41%) among non smoker COPD group had more than one risk factor for COPD. Most of the patients among non smoker COPD were found to be having severe to very severe disease (63.5%). 34.4% patients had moderate COPD and very few patients had mild COPD (3%). On comparing disease severity among non-smoker and smoker COPD patients, we found that proportion of patients with very severe disease was more in smoker group (39.2% in smoker vs. 29.2% in non smoker), while proportion of patients with mild to moderate disease were more in non smoker group (35.5% in non smoker vs. 24% in smoker). Patients with severe disease in both groups were found to be of equal proportion (33.3% in non smoker vs. 36.7% in smoker).

Comparative evaluation of doxofylline and theophylline in patients of mild bronchial asthma.

Background: Asthma is common chronic disease worldwide. Methylxanthines has been used in the treatment of asthma. The study was undertaken to compare two Methylxanthines theophylline and doxofylline at doses recommended and commonly used in clinical practice in Mild Bronchial Asthma Patients. Methods: Study was conducted in patients of Mild Bronchial Asthma in TB and chest disease department of a medical college hospital. It was randomized, prospective and open label. A total of 107 patients were divided in two group .Group I was administered 400 mg theophylline SR once daily and group II was administered doxofylline 400 mg twice a day orally. Spirometric variables symptom score, and adverse effects were recorded on day 0, 7 and 21 of therapy. Data were compared and analysed using SPSS version 16. Results: Results of the study showed that there was significant improvement in spirometric variables and clinical symptom score compared to pretreatment values after medication in both groups on 7th and 21st days of treatment. But there was no statistically significant difference between improvement in theophylline and doxofylline groups with respect to spirometric variables and symptom score. There was no significant difference in two groups with respect to side effects (p>0.05). Conclusions: It is concluded in Patients of mild Bronchial Asthma Theophylline and doxofylline improve the spirometric and clinical symptoms and doxofylline has no advantage over theophylline in terms of either efficacy or safety on the doses commonly used in current clinical practice.

Comparative study of pulmonary functions and oxidative stress in smokers and non–smokers.

Chronic Obstructive Pulmonary Disorder (COPD) is projected to rank third leading cause of deaths by 2030 as per WHO. COPD is a multietiological disease. The airflow dysfunction is usually progressive, associated with an abnormal inflammatory response of the lungs to noxious particles or gasses. As the lung is exposed to high levels of oxygen, it is more susceptible to oxidants mediated injury. Gender based differences are identifiable risk factors. Smoking is found to be a major risk factor in the causation of COPD resulting in oxidative stress . The aim of the present study is to evaluate the oxidant antioxidant imbalance in healthy non smoker controls and smokers with COPD. A total of 60 control (healthy non smokers) and 121 smokers having COPD were studied. The mean age is more in smoker group as compared to healthy controls, which identifies advancing age as a risk factor for COPD. The mean BMI and weight of smoker group is reduced as compared to control group. GOLD 2008 criteria was used to assess lung functions. Lung functions namely FEV1, FVC, FEV1/FVC% and FEV1% Predicted showed significant reduction in smoker group as compared to healthy non smoker controls. MDA in control and smoker group (1.09±0.09 and 1.41±0.23 nmol/ml respectively) showed significant changes (P<0.001). Our results also demonstrate significant reduction in anti oxidant enzymes namely SOD (units/mg of serum protein), Catalase (units/mg of serum protein) and GPX (nmol of NADPH oxidized/ min/mg of serum protein) in smoker group as compared to healthy controls. On the basis of study it is concluded that smoking, gender and oxidant antioxidant imbalance are identifiable risk factors in COPD.

Trauma: an unusual aetiology of pulmonary pseudocyst.

Traumatic pulmonary pseudocyst due to blunt chest trauma is rare. It is a clinical entity that manifests itself with minor clinical and major radiological signs. We report a case of a 16-year-old girl, who during an attack by a violent cow sustained a chest impact that resulted in a traumatic pulmonary pseudocyst, confirmed with a computed tomographic (CT) scan of the chest. The patient recovered with conservative management.