Prevalence of initial drug resistance in tuberculosis patients attending a chest hospital.

Sputum samples from pulmonary tuberculosis patients attending a hospital for chest diseases and tuberculosis at Jaipur, India were directly subjected to sensitivity tests to detect drug resistance to streptomycin (S), isoniazid (I), rifampicin (R) and ethambutol (Emb) by slide culture technique. Drug resistance was observed to one or more drug in 19.9 per cent of the patients. I resistant organisms were present in 10.1 per cent of patients, S resistance in 7.6 per cent, R resistance in 3.0 per cent and Emb resistance in 2.6 per cent. Resistance was limited to a single drug in 16.7 per cent patients. Drug resistance was unrelated to age and sex of the patients.

Is combined therapy of sympathomimetics and theophylline indicated?

Bronchodilator effect and toxicity of theophylline 300 mg twice a day (R1), salbutamol 4 mg tid (R2), their combination in higher (200/4mg, R3), and lower doses (100/2mg R4), and placebo (calcium lactate 300 mg) tid (R5) were compared in 25 patients with bronchial asthma in a randomized crossover trial. Statistically significant improvement in forced expiratory volume in one second (FEV1) was observed in all the active treatment groups (R1 to R4) compared with placebo (R5). The mean improvement in FEV1 was 29.0%, 22.0%, 28.0%, 30.0%, and 0.73% in regimen R1, R2, R3, R4, and R5, respectively day 1, and corresponding improvement was 30.0%, 24.0%, 29.0%, 34.0%, and 4.4% on completion of one week therapy. On intergroup statistical comparison, mean improvement in pulmonary function test values were statistically significant or highly significant in regimens R1 to R4, as compared with placebo. However, improvement between any two regimens was not statistically significant in any of the regimens (R1-R4). Almost all the regimens were tolerated well and no patient showed major adverse reactions or cardiotoxicity necessitating withdrawal of the drug. On the other hand, minor adverse reactions were common and the high dose combination (R3) was found to have more adverse reactions than the low dose combination and either drug used alone.

Influence of prior information of drug toxicity on patient compliance.

Sixty patients with pulmonary tuberculosis, who had not received any chemotherapy in the past, were divided into two groups. All the patients were put on isoniazid, rifampicin and pyrazinamide for 8 weeks followed by isoniazid and rifampicin for another 18 weeks. Group A patients were informed of the likely occurrence of anorexia and/or vomiting but Group B patients were not. Routine and default retrieval home visits were given to ensure maximal drug compliance. Drug toxicity related early defaults were significantly less common in Group A patients (1 of 30) as compared to Group B (6 of 30).

Airway obstruction in bronchiectasis and its reversibility--a study of 38 patients.

Thirty-eight patients (20 males and 18 females) with bronchiectasis were studied for the evidence of airway obstruction and its reversibility in response to subcutaneous terbutaline. There was an improvement in VC (8.56%), FEV1 (6.36%), PEFR (15%) and PEF 25-75% (18%) respectively. The difference being statistically significant in VC and highly significant in FEV1, PEFR and FEF25-75 as compared to initial values and in 6 patients the improvement in FEV1 was more than 15%. The improvement in airway obstruction was not related to the character of expectoration. It is suggested that all the patients of bronchiectasis should be assessed for the reversibility of airway obstruction and those showing a reversible pattern be treated accordingly.

Calcium channel blockers and terbutaline--a positive interaction.

The role of two calcium channel blockers, nifedipine and verapamil was investigated in patients of bronchial asthma. Both the drugs given orally produced an insignificant rise in PEFR, FEF25-75% and FEV1. Given along with terbutaline, however, these drugs produced significantly greater increase in PEFR, FEF25-75% and FEV1 as compared to patients receiving terbutaline alone. The two calcium channel blockers also inhibited the terbutaline induced tremors and palpitation.

Hepatopulmonary amoebiasis. Efficacy of various treatment regimens containing dehydroemetine and/or metronidazole.

Thirty three patients with hepatopulmonary amoebiasis were studied. Pulmonary involvement was observed in 55%, pleuro-pulmonary lesions in 30%. Typical chocolate coloured sputum was obtained in 24% and pleural fluid in 21% of patients. Entamoeba histolytica were demonstrable in the sputum in only 6% and in the pleural fluid in 15%. The best therapeutic results were obtained with a combination of dehydroemetine and metronidazole. However, metronidazole was found to be nearly as effective as dehydroemetine, and metronidazole 400 mg and 800 mg were equally effective.

Bronchogenic carcinoma. A study of 109 cases.

The clinical profile of 109 cases of bronchogenic carcinoma has been studied. Definite histopathological typing of malignancy was possible in 61 patients, squamous cell carcinoma being the commonest tumour in 27 followed by small cell carcinoma in 16, adenocarcinoma in 11 and large cell carcinoma in 7. Another 23 patients showed changes suggestive of malignancy on histological/cytological examination. Definitive diagnosis was obtained in half of the patients by bronchial biopsy, in 16% by bronchial aspiration fluid cytology, in 13% by pleural biopsy, in 11% by lymph node biopsy and in others by pleural fluid cytology, lung biopsy and skin biopsy. Commonest radiological involvement among different cell types was hilar involvement in small cell carcinoma in 62%, evidence of bronchial obstruction (collapse/consolidation) in squamous cell carcinoma in 56%, peripheral mass in adenocarcinoma in 54% and cavitation in a mass in squamous cell carcinoma in 15% cases.

Attempted suicide following treatment with isoniazid.

A patient is reported who developed mild depression 35 days after isoniazid administration and attempted to commit suicide four days after the onset of the psychosis.

Thoracoplasty with intercostal myoplasty for closure of an empyema cavity and bronchopleural fistula.

Intercostal myoplasty with thoracoplasty was performed in 42 patients with tubercular and bacterial empyema, after the failure of conventional therapy with antibiotics, antitubercular drugs and closed drainage. In the 18 cases with bronchopleural fistula, this was closed and the drainage tube was removed after 23 to 51 days. The procedure was well-tolerated by all the patients, and is safe and effective in patients with chronic empyema with or without bronchopleural fistula where resectional surgery or decortication is not possible due to extensive bilateral disease or low cardiorespiratory reserve. Successful ligation and closure of bronchopleural fistula without any mortality was a unique feature of this procedure.

Pleuroscopy in the diagnosis of pleural effusion using a fiberoptic bronchoscope.

Forty patients with undiagnosed pleural effusions were investigated by pleuroscopy, using a fiberoptic bronchoscope. Pleural biopsies diagnostic of tuberculosis were obtained in 17 cases, and in 12 of these tubercle bacilli were cultured from the pleural fluid. Pleural biopsy at thoracoscopy is superior to the percutaneous intercostal route and for this purpose the fiberoptic bronchoscope is preferable to the rigid thoracoscope.