Hospital-based study on demographic, hematological, and biochemical profile of lung cancer patients

Background: Lung cancer is considered as the most commonly diagnosed cancer. It is the leading cause of cancer-related mortality. Smoking and environmental pollutants act as important risk factors in majority of lung cancer cases (80%–90%). Material and Methods: This is a hospital-based study carried on in lung cancer patients of North India. Demographic profile of lung cancer patients was recorded. Hematological and biochemical profiles of lung cancer patients and healthy controls were compared. Results: Highest proportion of lung cancer was found in the age group of 46–60 years. Lung cancer was seen in highest number in male gender (76.63%) and also in those patients belonging to the rural category (84.58%). In this study, only 3.98% lung cancer patients having the past history of cancer and 5.47% showing the family history of cancer. Significant differences were found in weight and body mass index (BMI) of lung cancer patients when compared to healthy control (P < 0.0001). Hemoglobin (Hb) was found lower in lung cancer patients as compared with healthy controls. Significant difference was also observed in Hb levels of these two groups (P < 0.000). The serum protein level was lower in lung cancer patients than healthy controls. A significant difference was also observed in the protein levels of these two groups (P < 0.0001). Serum alkaline phosphatase (ALP) levels were higher in lung cancer patients in comparison to healthy controls. A significant difference was also observed in serum ALP levels in lung cancer patients as compared with healthy controls (P < 0.0001). Conclusions: Significant difference between BMI, Hb, serum albumin, and total protein was found in this study. These biomarkers may be helpful in the diagnosis of lung cancer at early stage and also in the follow-up assessment of the effects of treatment

Predictors of co-morbidities in chronic obstructive pulmonary disease patients at a tertiary care centre in north India

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.

Drug resistance profile among multi-drug resistant tuberculosis patients at diagnosis and correlation with history of anti-tubercular treatment in a tertiary care center

Background: Drug Resistant Tuberculosis (DR-TB) is a major threat to the realization of the goal of a TB free world in the near future. It is important to study the reasons for the increasing number of such cases so that effective action can be taken to control this growing epidemic.Methods: Sputum from 36 patients diagnosed with acquired pulmonary Multidrug Resistant Tuberculosis (MDR-TB) were subjected to first- and second-line Drug Sensitivity Testing (DST) after liquid culture in mycobacterium growth Indicator Tube (MGIT). Primary MDR-TB cases were excluded. The relation of the drug sensitivity profile with the history of prior treatment taken was statistically analysed.Results: Majority of the patients had received appropriate treatment, and most had adhered to prescribed treatment. Among the 36 patients, 24(66.7%) were found to be Pre-Extensively Drug Resistant (Pre-XDR-TB) and 4(11.1%) were extensively drug resistant XDR-TB cases. Inappropriate prescription of fluoroquinolone (FQ) was found to be most common. Prior intake of any drug was not found to significantly affect subsequent resistance to that drug.Conclusions: Fluoroquinolone resistance is quite common in patients with DR-TB (66.7%). This study did not find the prior use of FQ or any other drug to significantly affect subsequent resistance to the drug. Primary drug resistance is thus a major concern. 11.1% patients were found to be XDR-TB cases. Hence DST for first- and second-line drugs should be done at the time of diagnosis to avoid failure of treatment with a predesigned regimen.

Epidural Ketamine and Epidural Tramadol for Post-Operative Analgesia: A Comparative Study

Background: Epidural Ketamine and Epidural Tramadol areused for post-operative analgesia in various kinds of surgeries.Aims and Objectives: To evaluate the onset, duration andquality of post-operative analgesia by a single injection ofepidural ketamine and epidural tramadol in various types ofsurgeries as well as to study the side-effects caused byepidural tramadol and epidural ketamine respectively.Methods: Patients were divided in two groups using lotterysystem.Groups I: Patient were given epidural tramadol (preservativefree) 100 mg. in 10 ml of distilled water.Groups II: Patients were given epidural (preservative free)ketamine 30 mg diluted in 10 ml of distilled water. Drug wasgiven via epidural catheter in post- operative period on firstcomplaint of pain by the patient.Results: The mean time of onset of analgesia in group-I wasfound to be 8.90 min, 8.95 min and 8.8 min with 1st, 2nd and 3rddose respectively. In group-II it was 9.45 min 9.55 min and9.15 with 1st, 2nd and 3rd dose respectively. Difference wasstatistically found to be not significant. The mean durationof analgesia increased with every dose of tramadol HCL andketamine HCL in group-I and group-II was observed as 8.75hours, 10.50 hours and 12.40 hours with 1st, 2nd and 3rd doseof tramadol and observed as 4.05 hours, 4.9 hours and 5.75hours with 1st, 2nd and 3rd dose of ketamine respectively.Conclusion: On comparing the data of group-I with group-II, Itwas seen that the analgesic effect of 100 mg. tramadol lastedsignificantly longer than that of 30 mg ketamine.

Medical Thoracoscopy: A Useful Diagnostic Tool for Undiagnosed Pleural effusion.

Objective. We aimed to assess the role of medical thoracoscopy in patients with undiagnosed pleural effusion. Methods. Patiens presenting with pleural effusion underwent three pleural aspirations. Patients in whom pleural fluid analysis was inconclusive underwent closed pleural biopsy for diagnostic confirmation. Patients in whom closed pleural biopsy was incolcusive underwent medical thoracoscopy using a rigid thoracoscope with a viewing angle of zero degrees was done under local anaesthesia and sedation with the patient lying in lateral decubitus position with the affected side up. Biopsy specimens from parietal pleura were obtained under direct vision and were sent for histopathological examination. Results. Of the 128 patients with pleural effusion who were studied, pleural fluid examination established the diagnosis in 81 (malignancy 33, tuberculosis 33, pyogenic 14 and fungal 1); 47 patients underwent closed pleural biopsy and a diagnosis was made in 28 patients (malignancy 24, tuberculosis 4). The remaining 19 patients underwent medical thoracoscopy and pleural biopsy and the aetiological diagnosis could be confirmed in 13 of the 19 patients (69%) (adenocarcinoma 10, poorly differentiated carcinoma 2 and mesothelioma 1). Conclusion. Medical thoracoscopy is a useful tool for the diagnosis of pleural diseases. The procedure is safe with minimal complications.

Tackling Antimicrobial Resistance: Optimizing Use of an Older Antibiotic-Amoxicillin.

Antimicrobial resistance has become a major clinical and public health problem today. It not only poses a serious threat to human health and welfare but also undermines national economies worldwide. There are major international efforts to tackle the challenge of antimicrobial resistance. Similarly, being seriously concerned about the high resistance rate in our country, ‘Chennai Declaration’ was an initiative to formulate a national policy to control the rising trend of antimicrobial resistance. In such a scenario, it is prudent to focus on first-generation antibiotics such as amoxicillin. In this review, we have highlighted the efficacy and usefulness of amoxicillin in clinical practice.

Community-acquired Pneumonia.

Despite the availability of potent new antimicrobials and effective vaccines, community-acquired pneumonia (CAP) remains a common and potentially serious illness associated with considerable morbidity and mortality, particularly in elderly patients and those with significant comorbidities. The emergence of penicillin-resistant Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, the pathogens that account for approximately 85% of CAP cases, is a serious threat to public health. Of additional concern is that penicillin-resistant organisms are also frequently resistant to other agents, particularly first-generation cephalosporins, erythromycin, tetracycline and trimethoprim-sulfamethoxazole. Cefaclor, a broad-spectrum semi-synthetic second-generation oral cephalosporin with documented activity against many gram-positive and gram-negative pathogens, as well as some anaerobes, is a good therapeutic option.

A rare case of benign isolated schwannoma in the inferior orbit.

A rare case of unilateral orbital schwannoma arising from the infraorbital nerve is presented. An excision biopsy with complete removal of the mass in the inferior orbit was performed. A definitive diagnosis was made on histopathological examination. The clinical and histological features of schwannoma are discussed. A need for early removal of such tumors is recommended to prevent complications.

Rifampicin induced thrombocytopenia.

Thrombocytopenia is an uncommon but potentially life threatening complication of certain anti-tubercular drugs and is characterized by rapid destruction of platelets whenever an offending drug is taken by a susceptible person. Here is a case report of Rifampicin induced Thrombocytopenia. This case is being reported for purpose of its rare occurrence and documentation.