Assessment Of Respiratory Muscle Strength Using Maximal Inspiratory Pressure And Maximal Expiratory Pressure In Patients With Chronic Obstructive Pulmonary Disease: A Study On Indian Population

Chronic Obstructive Pulmonary Disease (COPD) is a common disease seen in Indian population. It is most commonly seen in the lower strata where beedi and cigarette smoking is most prevalent and starts at an early age. Smoke arising from cooking stoves during cooking is the cause of COPD in females. Though the number of males suffering from COPD is much larger than females, we observed a proportionate number of females in all age group suffering from this disease. It is the leading cause of mortality and should be studied in detail so as to avoid complications in such patients. We have studied the strength of respiratory muscles in such patients using newer techniques like Maximal Inspiratory Pressure (MIP) and 7 8 Maximal Expiratory Pressure (MEP). Terzano et al. (2008) and Khalil et al.(2014) have carried out similar studies in COPD patients. We have checked correlation between anthropometric measurements and strength of respiratory muscles, correlation between airway resistance and muscle strength and also compared the sensitivity and specificity of this technique using ROC (receiver operating Curve) as compared to the age old spirometry. These techniques may help in monitoring the status of COPD patients and assessing muscle weakness.

Incremental yield in sputum smear positivity by examining a second early morning sputum specimen in follow-up patients on dots: 7 year analysis of RNTCP laboratory register.

Background: Patients receiving DOTS undergo periodic follow-up sputum examination, which aids in monitoring response to treatment. Continued or new smear positivity at follow up examination entails extension of intensive phase or change in treatment category and the need for culture and drug susceptibility test. Setting: Tuberculosis microscopy centre at a tertiary care teaching hospital, Mumbai, India. Objective: To determine the incremental yield in sputum smear positivity by examining a second early morning sputum specimen in follow-up patients on DOTS. Design: Retrospective analysis of follow up sputum microscopy results recorded in tuberculosis laboratory register for the period 2002-2008. Results: During the study period, 5015 follow-up patients submitted two early morning sputum specimens, of which 501(9.99 %) patients were detected to be smear-positive. Out of smear positive patients under study, 324 patients had both specimens positive, 79 patients had only first specimen positive and 98 patients had only second specimen positive. The incremental yield was 1.95 % of total and 19.5 % of smear positives. Conclusion: Discordant smears were present in nearly a third of patients detected smear positive during follow-up. More than half of these patients were detected only by examining second specimen. The incremental yield by examining the second early morning specimen was 1.95 % of total and 19.5 % of smear positive specimens. It is important to detect each possible smear positive follow-up patient as they are likely to benefit from altered treatment. The inclusion of a second early morning sputum specimen examination is essential to maximize their detection.

Bronchoscopic closure of bronchopleural fistula using gelfoam.

Management of a persistent bronchopleural fistula (BPF) can be a therapeutic challenge. The etiological factors responsible for BPF include pulmonary tuberculosis, post-thoracic resection surgeries, trauma, malignancy, necrotising infections and rupture of lung abscess. The immediate management of BPF is drainage of the pleural cavity with insertion of an intercostal drainage tube. Patients with BPF may also require surgical intervention in the form of a wedge resection or lobectomy or muscle flap surgery. We report a case of a peripheral BPF secondary to a bacterial infection, which was successfully managed by the instillation of gelfoam via flexible bronchoscopy.