Gastro Oesophageal Reflux Diseases In Chronic Obstructive Pulmonary Disease Patients.

BACKGROUND: There is an association of Gastroesophageal reflux disease (GERD) with chronic obstructive pulmonary disease (COPD). This study was designed to determine the frequency of GERD in COPD patients. METHODS: This descriptive, cross-sectional study was conducted in the Pulmonology Unit Ayub Teaching Hospital Abbottabad. Patients more than 40 years of age of both genders presenting with features of COPD such as cough and breathlessness for more than 6 months and confirmed by spirometry were included in the study. A total of 118 consecutive patients were included in the study. Patients who had spirometry showing FEV1 <70% predicted & FEV1/FVC ratio <70% were included. Patients of asthma, with known oesophageal disease such as cancer, stricture, achalasia or active peptic ulcer disease, Pregnancy (precipitates GERD) and those patients who had used proton pump inhibitors (PPI) in the last 15 days were excluded. RESULTS: The mean age of COPD patients was 65.25 years. Among COPD patients 89 (75.4%) were males. Fifty-five (46.6%) patients had moderate COPD (FEV1:50-69%). Frequency of smokers was 68.6% with mean duration of 12.5years and mean number of cigarettes smoke per day were 13.4. Thirty-five (29.75%) had GERD; 27% in males and 30% in females. CONCLUSIONS: Our study shows that a higher proportion of gastro oesophageal reflux (GERD) symptoms are present in COPD patients and it also shows that GERD is more common in severe COPD patients.

Diagnostic Utility Of Pleural Fluid Adenosine Deaminase Level In Tuberculous Pleural Effusion.

BACKGROUND: Early diagnosis and management of tuberculosis is essential for decreasing the disease burden. Pakistan is one of the few countries of world with a very high burden of tuberculosis. Many diagnostic tests are available for detection of tuberculosis but each is fraught with certain limitations of its own. METHODS: This study was a cross sectional validation study that sought to determine the validity of pleural fluid adenosine deaminase levels for diagnosis of tuberculous pleural effusion. RESULTS: A total of 160 patients with exudative lymphocytic pleural effusions were enrolled in this study. The mean pleural fluid ADA level was 52.18±1.98 U/L. The mean pleural fluid ADA level in patients diagnosed to have tuberculosis on pleural biopsy/histopathology was higher as compared to patients who did not have tuberculous pleural effusion 52.16±2.4 U/L vs 38.6±3.14 U/L. The difference was found to be statistically significant between the two groups (p<0.05). The sensitivity, specificity, ppv and npv of pleural fluid ADA level were 88.88%, 77.04%, 86.28% and 81.04% respectively. CONCLUSIONS: Despite wide variations in the reported sensitivity and specificity of pleural fluid ADA level, it can be used as a surrogate for pleural biopsy when the latter is not feasible.

Common risk factors for the development of anti tuberculosis treatment induced hepatotoxicity.

BACKGROUND: Tuberculosis is a global pandemic which affects millions of people every year. The treatment of tuberculosis consists of simultaneous use of a number of drugs for a prolonged period of time, therefore anti-tuberculosis treatment induced toxicity is a real problem. Many risk factors which make a tuberculosis patient prone to the development of hepatotoxicity associated with the anti-tuberculosis treatment have been identified. The aim of this study was to determine common risk factors responsible for precipitation of hepatotoxicity following treatment with anti-tuberculosis drugs. METHODS: This cross-sectional study was conducted in the Department of Pulmonary Medicine, Ayub Teaching Hospital, Abbottabad from 20th April 2013 to 19th March 2014. Patients -' , who were newly diagnosed cases of tuberculosis in whom treatment of tuberculosis with first line anti-tuberculosis drugs was initiated and were 20 years or older, were included. The precipitation of drug induced hepatotoxicity was diagnosed with detailed history taking and physical examination followed by laboratory investigations, i.e., Liver Function tests (LFT). RESULTS: Of the total 179 patients included in this study, 100 (55.8 %) were males and 79 (44.2 %) were females. Out of them 23 (12.85%) developed hepatotoxicity. Drug induced hepatotoxicity was observed in the older patients. No relationship was found with the sex, body mass index (BMI), and pre-existing liver disease. CONCLUSION: The study showed that the risk of development of drug-induced hepatotoxicity following treatment with first line anti-tuberculosis treatment increased with the age of the patient.

Diagnostic yield of biopsies via fibre-optic bronchoscopy.

BACKGROUND: Priority of all bronchoscopies has been diagnostic yield and various techniques have been introduced to improve it. Transbronchial biopsy (TBB) and transbronchial aspirates (TBA) also play an important role in improving diagnostic yield. The aim of the study was to determine the diagnostic yield of biopsies via fibre optic bronchoscopy (FOB) in 108 cases in which it was indicated. METHODS: This was a cross-sectional study conducted in the Pulmonology department of Ayub teaching Hospital Abbottabad. Patients of all ages, sex and occupation on whom bronchoscopies were performed were included in the study. Bronchial biopsies were taken. RESULTS: Out of 108 patients, who were biopsied, malignancy was confirmed in 48%, benign lesions in 49% and only 3% were non-diagnostic biopsies. CONCLUSION: Diagnostic yield of FOB is good and is very useful for the diagnosis of pulmonary lesions.

Kartagener syndrome: a not so rare phenomenon.

BACKGROUND: Kartagener Syndrome is characterized by ciliary dyskinesia and is inherited in autosomal recessive manner. It occurs in 1:20,000-30,000 live births in general population. Its prevalence varies from region to region. METHODS: This case series describes four patients of Kartagener Syndrome who were diagnosed in the departments of medicine and pulmonology between year 2009 and 2013. RESULTS: The age of youngest patient was 15 years while the oldest patient was 19 years old. All of them were males. Mean age was 17.5 years. They had presented with history of shortness of breath and productive cough. One of them had presented with rhinorrhea and nasal blockage as the main symptom. CONCLUSION: Although Kartagener Syndrome is often thought of as a rare disorder, yet it might not be as rare as it is thought of. Considering this and the fact that half of the patients with Kartagener Syndrome do not have situs inversus, large scale studies with family trees are required to trace patients with Kartagener Syndrome.