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Volume
2 : Number 2 (May – August) 2000
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Abstracts |
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>>>>Editorial |
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Beta-Adrenergic Receptor
Agonists in Treatment of Asthma
[No
abstract available]
Remeshchandra Babu K.M.
Editor-in-Chief |
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>>>>Perspectives
in Pulmonary Medicine |
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Lung
Volume Reduction Surgery[No
abstract available]
Ravindran
P,
Senior
Consultant Pulmonologist,Cosmopolitan Hospital, Thiruvananthapuram
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>>> Unresolved
Issues |
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Theophylline
Therapy – Is it Useful ? [No
abstract available]
Narasimhan R,Senior Consultant, Department of
Respiratory Medicine,Appolo Hospitals, Chennai.
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>>>>Leading
Article |
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Acute Lung Injury
[No
abstract available]
Jose Raj R
Professor & Head, Dept.of
Respiratory Medicine,
Medical College, Alappuzha
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>>>>Original Paper |
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HIV
Seropositivity among Hospitalized Pulmonary
Tuberculosis
Patients – A Cross Sectional Survey in a Tertiary Care Setting
Kumari Indira K.S, Joshi M, Mallan K.G.R,Department of Respiratory Medicine, Medical College, Trivandrum |
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Abstract:
Introduction:
Increasing HIV seropositivity is reported among tuberculosis patients
in developing countries. Atypical clinical features cause low
probability for early suspicion for tuberculosis. Early diagnosis of
tuberculosis improves survival and reduces mortality of patients with
HIV infection and is essential for controlling nosocomial and
community transmission of tuberculosis. In Trivandrum (1993), HIV
seroprevalence of hospitalized pulmonary tuberculosis patients was
3.2%.
Objectives:
To determine HIV seroprevalence and describe clinical features of HIV
associated pulmonary tuberculosis.
Design:
Cross sectional survey
Setting:
Tertiary care (Trivandrum)
Participants:
Inpatients with confirmed pulmonary tuberculosis.
Method:
Information on sociodemographic characteristics, risk behaviour,
clinical characteristics and investigations (tuberculin, Sputum AFB
and ELISA for HIV) were recorded.
Results:
5.3% (95% CI 3.2, 8.7) HIV seroprevalence was noted (16/301).
Heterosexual promiscuity was the only identifiable cause attributable
for HIV infection. HIV seropositive patients had following
characteristics, compared to seronegative patients.
Mean
age: 35 Vs 42 (P = 0.049); upper zone lesions – 31.3% Vs 59.3%
(P = 0.065), cavities – 1.2% Vs 32.8% (P = 0.049); extrathoracic
lymphadenopathy – 56.3% Vs 13.7% (P = 0.0001); hilar adenopathy 75%
Vs 26.7% (P = 0.0001); tuberculin anergy 87.5% Vs 12.3% (P <
0.0001); AFB smear positivity 18.8% Vs 58.9% (P = 0.004). Chronic
diarrhea, pruritic dermatitis, lymphadenopathy and candidiasis were
identified as sensitive indicators of HIV seropositivity.
Conclusions:
HIV seroprevalence rate among tuberculosis patients is probably
increasing in Trivandrum. Smear negativity, tuberculin anergy and
atypical clinical and radiological features are common associations of
HIV seropositivity. To ensure early diagnosis and treatment,
clinicians should be alerted on atypical features of HIV associated
tuberculosis.
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>>>> Original
Paper |
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Study
on the Sensitivity Pattern of Antibiotics to Sputum Isolates in
Respiratory Tract Infection
Sriram
S, Mohan Kumar T, Krishnan S, Ravi TK, Senthil R
College
of Pharmacy, SRIPMS, Coimbatore &
Dept.of
Pulmonology, Sri Ramakrishna Hospital, Coimbatore.
Abstract:
Respiratory tract infections are among the most common
infections seen in both hospital and community practices. Majority of
these respiratory infections are associated with bacterial infection.
The inappropriate use of antimicrobial agents has contributed to the
growing prevalence of drug resistance among respiratory tract pathogens. Antibiotic resistant
bacteria have undoubtedly increased in hospitals among developed
countries and are mainly associated with the failure of treatment. A
detailed retrospective and prospective study about the prevalence of
various micro-organisms and the sensitivity pattern of antibiotics
against them were carried out in the sputum sample tested population
in the Department of Pulmonology, Sri Ramakrishna Hospital, Coimbatore.
During the period of 2 years, i.e.from Jan 1998 to Dec 1999, 70.61% of
the patients were recorded as infected. Male population was more among
infected, i.e.42.75% of cases and female 27.84% were reported. Cough,
breathlessness, chest cold, wheezing, fever and rhinitis were the
major complaints. Klebsiella species was the most widely found
organism (24.70%), followed by beta haemolytic streptococci (23.10%),
E.coli (16.72%), Pseudomonas (13.94%) and Staph.aureus (8.76%). The
quinolone antibiotics ciprofloxacin and ofloxacin stood part in
treating most of the organism infected. Next to quinolone antibiotics
the aminoglycoside antibiotics showed prominent antimicrobial
activity. The beta-lactam antibiotics showed decreased sensitivity to
most of the respiratory pathogens isolated, especially in the case of streptococcal infections, there was decrease of
11.43%. The prevalence of pseudomonas was found to have increased in
prospective study.
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>>>> Original
Paper |
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Evaluation
of Two Self Administered Six month Regimen forSmear Positive Category
1 Tuberculosis Patients
MPS Menon, Mridula Bose, Balakrishnan
Menon, Mandira Varma, Bhageerath Vashisht, Niraj Sarma V.P.Chest Institute, University of
Delhi.
Abstract:
A study using 2 daily self administered regimen of 6 months (SCC)
were evaluated in the treatment of smear positive category 1 pulmonary
tuberculosis. The regimen used were 3D (2RHZ / 4 RH) and 4 D (2 RHZE /
4 RH). Treatment was carried out on routine OPD basis with check up
and distribution of drugs every 15 days. A total of 193 patients were
included. 80% 3D group and 91% 4D group completed 6 months treatment
(100% drug intake). 12% discontinued treatment (dropped out). 165
patients (98%) of those treated were cured at the end of 6 months
(clinically, radiologically and bacteriologically). Cure rate was 100%
in 3D group and 97% in 4D group thus proving the efficacy of 2RHZ /
4RH regimen in OPD (individualized) treatment of category 1 patients.
53% of the 99 positive sputum cultures tested for drug sensitivity
proved to be resistant to one or the other drug tested (53% IDR). This
is rather very high ! Sputum of 25 patients were also tested at the
New Delhi TB Centre and 34% drug resistance was found in them thus
proving the existence of very high IDR in Delhi. 12% had RH
resistance, 34% INH resistance and 16% Rifampicin resistance (the
highest figures observed in Delhi region). All the 13 resistant cases
treated with 3D regimen got cured at 6 months (100% sputum conversion)
as compared to 90% (36 patients) of 4D group thus proving the efficacy
of 3D regimen in Initial drug resistance cases. Drug reactions were
observed in 4% of patients – none had to discontinue treatment for
more than 15 days. There was only one death among this 193 patients
(0.5%) due to massive haemoptysis. The drop out ratio was 12% and it
was mainly due to social and family reasons and our inability to trace
them. Both the regimen were well accepted by the patients – 88%,
completed 100% drug intake in 6 months. The regimen were also well
tolerated. The relapse rate at 6 months was rather low. This study
emphasizes the fact that despite high initial drug resistance 2 RHZ /
4RH regimen is sufficient to cure patients belonging to category 1 –
smear positive. This regimen is also economically cheaper to the
patients who need not have to close 3 days wage per week for 6 months
(as in DOTs).
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>>>> Original
Paper
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Radiological
Pattern of Pulmonary Tuberculosis in Diabetes Mellitus – A
Retrospective Study
Abdul Sathar AA, Ravindran C, Achuthan V
Institute of Chest Diseases, Medical College, Calicut, Kerala.
Abstract:
Design:
Retrospective Analysis
Objective:
To find out radiological pattern of lesions in pulmonary tuberculosis
in patients with diabetes mellitus
Setting:
Hospitalized
patients in the Institute of Chest Diseases, Medical College, Calicut,
Kerala, India.
Materials:
Postero-anterior view chest X-ray of 70 patients with co-existing
Pulmonary tuberculosis and diabetes mellitus.
Results:
Bilateral lesions – 55.7% cases, of which 61.54% bilateral multizone
involvement. 91.43% shows pneumonic consolidation with cavity and
remaining are nodular lesions
Conclusions:
In diabetes, tuberculosis involvement is extensive and bilateral,
pneumonic consolidation with cavity in majority of cases.
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>>>>Case Report
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Intratracheal Ectopic
Thyroid – A Rare Cause of Central Airway Obstruction
Venugopal P, Raseela Karunakaran, James PT, Joseraj R Dept.of Respiratory Medicine, Medical College, Alappuzha
Abstract:
A
rare case of intra-tracheal ectopic thyroid presenting as central
airway obstruction mimicking obstructive sleep apnoea is being
reported here.
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