Foreign body aspiration in children

A case series descriptive study,was carried out from September 2007 to September 20010 at Paediatrics unit Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. The aim of the study was bronchoscopic evaluation of children suspicious of inhaled foreign body [FB] such as beetlenut, seeds, peanuts, tiny objects and fragments of tooth and presented with persistent cough. Fory [n-40] children [male and female] in age range of 1-3 years [toddlers] presented with persistent cough with no history of foreign body [FB] aspiration were included. The chronic persisting cough was defined as cough lasting for 30 days or >30 days as guided by WHO. They had bouts of cough mimicking pertussis and had clinical findings of decreased air entry with rales and rhonchi. Oxygen saturation was monitored by pulse oxymetry. X-rays chest were obtained. The pulmonary tuberculosis, pertussis and other chronic lung diseases were ruled out by history, clinical examination and investigations available in hospital laboratory. The cases with suspicion of FB inhalation were subjected to bronchoscopy. Rigid broncoscope was an essential tool for investigation and removal of FB in study. The data were processed in soft wear SPSS 16.Male: Female ratio was 2:1 and had height and weight above 10[th] percentile and vaccinated as per EPIschedule. The clinical examination of chest revealed dull or hyper resonant, decreased or no air entry with or without rales and rhonchi on the side of chest where FB lodged the lung. X-rays chest had no radio opaque FB, hyper inflation in cases 15 [n-15] and collapse in 10 cases [n-10] were the main findings. The clinical and radiological findings supported the empirical diagnosis of foreign body aspiration [FBA] and these children underwent rigid bronchoscopy. Bronchoscopically visualized FB were retrieved and the air ways were cleared of inflammatory debris and pus. The oxygen saturation retuned to normal and marked clinical improvement occurred soon after bronchoscopy. The commonest FB in our study was the beetle nut [Chalia/Supari]. The radiological changes were also seen after bronchoscopy. FBA should be considered in children presenting with persisting cough and after thorough clinical and radiological examination the suspected cases be evaluated by rigid bronchoscopy

Features of pulmonary tuberculosis in patients with diabetes mellitus: a comparative study

To compare the demographic features, radiological findings and the response to anti-tuberculous therapy of diabetic pulmonary tuberculosis patients with non-diabetic tuberculosis patients. This is a retrospective study. Records of 105 diabetic and 104 non-diabetic patients diagnosed as pulmonary tuberculosis at pulmonology ward B.V. Hospital, Bahawalpur during 2005 - 2006 were reviewed. A population-based sample of patients coming to Pulmonology OPD from Bahawalpur. The diabetic and non-diabetic patients with newly diagnosed pulmonary tuberculosis at pulmonology ward B.V. Hospital. Demographic information including age and sex, information on symptoms, time interval between the diagnoses of diabetes mellitus and onset of tuberculosis, anti-diabetic medications used, bacteriological and radiological findings at the initial stage and after two months of therapy were assessed from each record. Male/Female ratios of the 105 diabetic patients were 55/50. Male patients showed a peak in the 50 to 60 age group and the females in the over 60s. The non-diabetic group included 56 males and 48 females with a homogenous distribution between 20-50 years of age in males and a peak in the 20-30 age grouping the females. Tuberculosis was diagnosed within the first 5 years of the diagnosis of diabetes in 61[58%] of the patients. Lower lung field involvement was present in only 4 [3.5%] diabetic patients. Seventy seven [67%] diabetic and Seventy two [69%] non-diabetic patients had cavitary disease. Forty nine of the 66 [47%] smear [+] diabetic tuberculous patients became negative by the end of initial therapy while 79 of the 104 [76%] non-diabetics were bacteriologically cured at this time. In this population-based study. the results indicate that tuberculosis disease tends to occur at a more advanced age in diabetics, that there is a tendency to develop tuberculosis in the first years of the diagnosis of diabetes mellitus, that the diabetic state does not alter the radiological features of tuberculosis significantly and while radiological improvement is similar in both groups, the bacteriological cure rate is significantly higher in the non-diabetics

Comparison of pulmonary tuberculosis in elderly with young patients

To compare the clinical and radiologic features of pulmonary tuberculosis in young adults and the elderly and determine if any differences exist between both groups. Prospective recruitment of 100 patients, having diagnosis of pulmonary tuberculosis. Pulmonology OPD, Bahawal Victoria Hospital Bahawalpur. A total of 100 consecutive patients whose disease was diagnosed during January to December 2006. Standardized data collection of symptoms, bacteriology, and review of radiology by two readers blind to the clinical data. There were 52 young adult patients and 48 elderly patients. The young adults had a mean age of 31.2 years and the elderly group had a mean age of 68.4 years of age. General ill health [80%], weight loss [60%], anorexia [60%] were more common in elderly people as compared to symptoms like cough [60%], expectoration [60%], fever [60%], chest pain [40%] and hemoptysis [19%] which were more common among young patients. In Group A radiological examination of chest showed pneumonic patch without cavitations [40%], the lesions were bilateral in [52%] and lower lung opacities were present in [35%] of cases, while compared to this, apical lesions with unilateral cavitations [56%] were more common in Group B patients. In Group. A concomitant diseases like diabetes mellitus [40%], Hypertension [10%], COPD [12%], Cancer [1.8%] were more common than in Group B where Diabetes Mellitus [2%], Bronchial Asthma [2%], Hypertension [0%], COPD [0%], cancer [0%] were present as accompanying disease. It is concluded from the study, young adults were more likely to have hemoptysis, fever, and cough and elderly patients have mainly general ill health, weight loss and anorexia. diabetes mellitus, COPD and cancer were significantly associated as a risk factor in the older age group