Evaluation of radiological sequelae after treatment completion in new cases of pulmonary and pleural tuberculosis.

Background: The objective of this study was to evaluate the residual parenchymal and pleural lesions on chest X-ray posttherapy in new tuberculosis (TB) cases. Methods: This prospective study was done from January 2018 to December 2020, which involved the evaluation of medical records of 60 pulmonary or pleural TB patients who underwent successful treatment. Chest X-rays of the patients at the start and end of treatment were studied as per the guidelines by Revised National Tuberculosis Control Program. The primary outcome measures were residual chest X-ray lesions after the complete treatment of new cases of TB. Secondary outcomes measures were significant factors affecting the chest X-ray clearance. Results: Chest X-ray showed clearing in 48.33% of cases. Residual chest X-ray findings were present in 31 cases which mainly included fibrosis in 23.33% and pleural thickening in 20%. None of the clinical and demographic characters and biochemical parameters showed significant association with chest X-ray clearance (P > 0.05). Sputum microscopy was done in 45 cases of which 25 (41.66%) were positive for acid-fast bacilli. Sputum positivity showed no significant correlation with chest X-ray clearance (odds ratio [OR]: 0.734, confidence interval [CI]: 0.224-2.411, P = 0.592). Compared to nonstandardized regimen, standardized regimen showed no significant correlation with chest X-ray clearance (OR: 0.664; CI: 0.233-1.892, P = 0.426). Conclusion: Residual radiological sequelae were seen in more than half of the study subjects who were successfully treated for TB (51.67%). Demographic, clinical characteristics, sputum positivity, and treatment regimen showed no significant association with chest X-ray clearance.

Clinico- pathological profile and course of malignant pleural effusion in a tertiary care teaching hospital in western U.P. with special reference to lung cancer.

BACKGROUND: Malignant pleural effusion is a major clinical problem associated with primary and metastatic pleural malignancies. Pleural effusions from an unknown primary are responsible for 7-15% of all malignant pleural effusions. Presence of malignant pleural effusion puts the patient in advanced stage and renders the prognosis as poor. AIM: In this study we intend to find out the incidence of malignant pleural effusion, its aetiology and clinical course in patients attending a tertiary care teaching hospital. RESULTS: A total of 308 patients were included in this study. A majority of the patients were in age group 50- 70 years (median age = 58.8 years; range 32- 85 yrs). Male to female ratio was 2.5:1. The major primary cancers were lung cancer (135), lymphoma (40), breast cancer (36), female genital tract (30) gastrointestinal (21), and others (8). In 38 cases primary remained unknown. The yields of pleural fluid cytology, blind pleural biopsy, CT/USG guided pleural biopsy and thoracoscopy were 60%, 49%, 76% and 91% respectively. Chemical pleurodesis yielded complete response in 80%, incomplete response in another 13% patients. Only 136 (44%) cases could be followed up for minimum of 6 months. A majority of them (95, 69.85%) died. CONCLUSION: We conclude that malignant pleural effusion is a commonly misdiagnosed medical entity. Lung cancer is the commonest cause. Despite all efforts, in about 15% of the cases, primary remains undiagnosed. Thoracoscopy/pleuroscopy is a cost effective measure for diagnosis. Chemical pleurodesis provides expected results but mortality remains high.