Ambient air pollution and impairment of lung volumes and capacities in young inhabitants of industrial area of Kanpur.

Background: Air pollution is one of the major problem faced in developing countries like India. Chronic exposure to air pollutants can leads to hampered day today activity and increased visit to clinics. The pollutant PM10 (particulate matter size less than 10 μ) especially a risk factor associated with decreased lung functions and lung growth. The effect of particulate pollution on lung functions in young ones is still lacking in India especially in Kanpur, a highly polluted city of U.P., India. Aims and Objective: The present study was conducted to evaluate the impact of chronic exposure of air pollution on lung functions in subjects of the polluted area of the city. Material and methods: One hundred twenty male subjects, in age group of 18 to 30 years from polluted and non-polluted area of Kanpur, India were participated in the study. Anthropometric data were taken. Pulmonary function test was conducted in standing position. Pollution data of study period was taken from Central pollution control board and compared with the National ambient air quality standard. Statistics: All data presented as mean ± SD and analysed by independent sample t test by using SPSS version 15. Results: The anthropometric data were statistically not significant in two areas. The Forced Vital Capacity, Forced Expiratory Volume in 1 sec, Forced Expiratory Flow 25-75% and Peak Expiratory Flow were reduced except the FEV1/FVC ratio which was not statistically significant between the groups. Conclusion: The long term exposure of pollutant PM10 could reduce the lung function. By reducing the pollution level a change in lung function and lung growth could be obtained. Thus every attempt should be made towards lowering air pollution like car pool concept, alternate fuels such as CNG or hybrid technology.

Trends of Extra-pulmonary Tuberculosis under Revised National Tuberculosis Control Programme: A study from south Delhi.

Background & Objectives: Extra-pulmonary tuberculosis (EPTB) cases have been treated with a daily short course chemotherapy (SCC) regimens in past. Following the success of Directly Observed Treatment-Short Course (DOTS) programme over recent years, a study was carried out to determine prevalence of EPTB, to draw comparison between annual case detection of pulmonary TB (PTB) and extra-pulmonary TB and to assess outcome of DOTS in EPTB in a patient population of Delhi. Methods: All consecutive EPTB cases of Delhi, diagnosed within LRS Institute of TB and Respiratory Diseases between January 1996 to March 2003 and subsequently given DOTS at the area DOTS Centres, constituted the study group. Results: Of overall 14185 cases, 2849 (20%) had EPTB. A significantly higher prevalence was observed in females (57%) and in young age (mean + standard deviation of 23.4 + 12.8 years). Commonest involved site was lymph node (54%). Whereas number of PTB and EPTB cases have increased over successive years, percentage of former declined significantly through 84 in 1996 to 78 in 2002 and that of latter rose significantly through 16 to 22 correspondingly. EPTB to PTB ratio changed significantly from 1:5 at start to about 1:3.5 at study-conclusion. Treatment completion was observed in 94% (1775/1885) of EPTB cases. Conclusions: Under Revised National TB Control Programme (RNTCP) employing a DOTS strategy, annual case detection has improved for both pulmonary and extra-pulmonary TB. Cure of infectious disease is likely to have resulted in a relative rise of the annual EPTB case detection. DOTS effected an acceptable treatment outcome in EPTB case management.

Strategy of training under Revised National Tuberculosis Control Programme - Indian perspective.

A Directly Observed Treatment - Short Course (DOTS) strategy has been the essence of global tuberculosis (TB) control programme success. Training in DOTS has resulted in the quality assurance of various services under programme. The present article discusses about a sustained need of DOTS training, essentials of a training strategy and achievements and limitions of training programme. It gives a brief account of the role being played by key training players at national level and focuses on need to encourage both training and research in the Revised National TB Control Programme.

Performance evaluation of APACHE II score for an Indian patient with respiratory problems.

BACKGROUND & OBJECTIVES: Realising the utility of scoring systems in mortality prediction of critically ill patients admitted to intensive care units (ICUs), studies worldwide have expressed a need to validate the Acute Physiology and Chronic Health Evaluation (APACHE) II score for databases of respective countries. Literature available in this area in the Indian context is scanty. The present study was undertaken to evaluate the performance of APACHE II score in prediction of mortality risk, as well as in determination of model validity in critically ill Indian patients with respiratory problems. METHODS: The study was prospectively carried out over 18 months at respiratory ICU of a tertiary Institute in New Delhi, which admitted consecutive medical (with lung ailments) and surgical (who had undergone any elective thoracic surgical procedure under general anaesthesia) patients. Based on chief indication of ICU admission, the medical patients were further divided into sub-groups I (respiratory) and II (non-respiratory). APACHE II points were assigned to all patients for calculating their individual predicted risks of mortality. Standard mortality ratio (SMR) was computed with 95 per cent confidence intervals (CI). Calibration of model was analysed by calculating Lemeshow and Hosmer goodness of fit X(2) statistic and by plotting calibration curve, whereas discrimination was evaluated by calculating area under a receiver operating characteristic (ROC) curve. RESULTS: Of the 393 consecutive patients admitted to respiratory ICU during the study period, 63 were left out on account of exclusion criteria. Mean APACHE II score of the remaining 330 patients was 12.87+/-8.25 and range from 1 to 47. There were 287 (87%) survivors and 43 (13%) non-survivors, whose mean APACHE II scores, being respectively 11.34+/-6.75 (range 1-37) and 23.09+/-10.01 (range 5-47), were significantly different (P<0.01). The study had a predicted mortality of 7.9 per cent and an SMR value of 1.65 (95% CI from 0.4 to 3.0). Mean APACHE II score of those having medical ailments was significantly higher (P<0.01) than surgical patients. The non-respiratory sub-group had a significantly higher (P<0.01) mean APACHE II score than respiratory sub-group. 59 per cent of patients did not get APACHE II points owing to being <45 yr of age. In addition, against 10 immunocompromised patients, 77 others did not get APACHE II points despite having apparently compromised immunity due to co-existence of tuberculosis (TB), diabetes mellitus, dual pathologies or past history of anti-TB treatment. Observed and predicted mortality rose with 5-point APACHE II score, but did not correlate for patients of any comparable group. Average ICU stay of 16 days for those with medical disease was significantly longer (P<0.01) than 9.5 days for surgical patients. APACHE II scoring system showed a poor calibration and discrimination ability for Indian respiratory patients. INTERPRETATION & CONCLUSION: Despite the rise in observed and predicted mortality with 5-point APACHE II score, predicted mortality did not correlate with observed mortality for critically ill patients admitted to an Indian respiratory ICU. The scoring system also showed a poor calibration as well as discrimination. The model may be more useful for Indian patients by lowering down the cut-off value in allotment of age points and by awarding the weightage to factor like co-existing immunocompromised state.

A thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy: a rare association.

An 18-year-old boy presented with a rare association of a thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy. He was put on a Category I regimen with standard short course daily chemotherapy of four anti-tubercular drugs under the National Tuberculosis Programme. After a six-month of anti-tubercular treatment (ATT), the boy showed clinical and bacteriological improvement. The thyroid scan with Technetium 99 (Tc 99) and the chest skiagram also became normal.

Accidental condom inhalation.

A 27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve. A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe. Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed the presence of a condom. Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio.

Private-public mix: a prioritisation under RNTCP--an Indian perspective.

Success of the public directly observed treatment, short course (DOTS) programmes have been widely reported from various parts of the world and have been described from the Indian subcontinent as well. But, it is being increasingly realised that further DOTS successes can take place only by ensuring a private sector participation under the programme. While discussing behaviour-profile of patients, this review enumerates possible reasons for their averseness of a public health facility and preference for a private health. facility. Similarly, behaviour-profile of private health providers brings out the discrepancies in their clinical practices. Both types of profiles are supported with the studies from India and abroad. A comparison is drawn between available services of the public and private health facilities, with a focus on the need for prioritisation of a private-public mix (PPM) in the Revised National Tuberculosis Control Programme (RNTCP). Furthermore, the salient features of schemes recommended by the Directorate General of Health Services, New Delhi, for involvement of the private- practitioners, and the Non-Governmental Organisations are briefly outlined. The underlying obstacles for private sector participation in RNTCP and the projected solutions so as to effect a private-public mix in the Revised Programme are also dealt with. A description of few operating models, trying in the best possible manner to bring about a private sector participation in programme, is presented to make the readers aware of the efforts going on in that direction within the country. The private health sector, easily being a patient's first choice, needs to be integrally involved in RNTCP on a priority basis, feasibility of which, has been successfully documented in the operational trials conducted within the country so far.

Directly observed treatment for tuberculosis.

Directly Observed Treatment-Short Course (DOTS) has been a successful strategy in the global control of tuberculosis (TB) in adults. However, reports of implementation are scantily available in pediatric context. Present article reviews diagnostic uncertainties of TB in children commonly faced by physicians on account of the vague clinical presentations, unreliable tuberculin tests or TB score charts, non-specific hematological, biochemical or radiological evidence, difficulty in sputum expectoration and non-availability or ill-affordability of specialised tests. It also describes therapeutic problems arising due to the physician's inexpertise, child's incomprehensibility and parental anxiety. DOTS was found to be highly effective in 930 Indian children having TB over the 6-year study period, during which, a rise in number of cases with adult pattern of disease was also noted. The trend change in pediatric TB scenario is thought to have taken place due to malnutrition so widely prevalent in this country. Irrespective of the changing trend, DOTS strategy was found to be effective for all types of pediatric TB. A need, therefore, exists for quick resolution of the programme issues related to pediatric drug dispensing, physicians' reservations about acceptance of strategy in this age-group, service-utilisation of DOTS providers for the selected cases unable to visit DOTS centres and giving executional priority to children during ongoing expansion of Revised National TB Control Programme (RNTCP) in country.

Open lung biopsy in diffuse infiltrative lung disease with progressive dyspnoea: is it useful?

Eleven subjects, aged between 15 and 60 years, presenting with diffuse infiltrative lung disease (DILD) and progressive dyspnoea, underwent an open lung biopsy (OLB). The authors feel that OLB does give a confidence to the treating physician to begin with a specific therapy in the form of steroids. But, as a matter of fact, at most health care delivery centres in the country, facilities for OLB are not available. Hence, the specific therapy should be instituted presumptively following an overall suggestion of disease based upon the clinical, physiological (chiefly comprising the pulmonary function test or PFT) and the radiological criteria, so that progression of disease could be arrested at an early stage.