Sachin Kate , B. K. Mutha , Gauri Kulkarni , Chetan Mahajan , Sushma Dugad

Abstract

Introduction: Pleural effusion is the abnormal accumulation of fluid in the pleural space. TB is the most common cause of pleural effusion worldwide (30-60%). The pleural fluid activity of adenosine deaminase (ADA) is one of the best, providing reliable basis for a treatment decision, particularly in excluding the diagnosis of tuberculosis, due to its high sensitivity. Aims and Objectives: To assess the importance of adenosine deaminase(ADA) level in the diagnosis of pleural effusion. To assess Adenosine Deaminase Activity (ADA) in tuberculosis pleural effusion and assess the sensitivity and specificity of ADA levels. Materials and Methods: This study was performed at the Department of Pulmonary Medicine at tertiary care centre. The study comprised of 75 patients of pleural effusion having Age > 14 years, Clinical and Radiological evidence of Pleural Effusions&Patients willing for ADA examination. Patients having Age > 65 years, minimal nontappable effusion, not giving consent for ADA examination patient were excluded from the study. Detailed history, thorough physical examination, radiological findings, haematological and biochemical findings were recorded in the proforma. Pleural aspiration was performed on all patients. Macroscopic findings, cytological, microbiological and biochemical analysis of pleural fluid were performed in all patients including ADA level. PCR for Mycobacterium tuberculosis was also assessed in pleural fluid. Pleural fluid Adenosine deaminase level was measured by Giusti and Galanti method. Result: In our study out of 45 patients with tuberculosis pleural effusion ADA was more than 40IU/L in 42 (93.33%) and less than40IU/L in 3 (6.66 %). Our study showed a mean ADA of 107.7 IU/L Using a cut off of greater 40IU/L we got a sensitivity and specificity of 93.3% and 90% respectively and Positive predictive value 93.3% and Negative predictive value 90%. Conclusion: Pleural fluid ADA activity has been shown to be a valuable biochemical marker that has a high sensitivity and specificity for TB diagnosis.

Keywords

ADA, Pleural Effusion, Tuberculosis.

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Gauri Kulkarni ¹, Saurabh Ambadekar ¹

Affiliations
1 Department of Pulmonary Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, IN

Abstract

Introduction: Bronchoscopy is a procedure to visualize the tracheobronchial tree. There are three types of Bronchoscopy, rigid, flexible, and virtual Bronchoscopy. Rigid bronchoscopy visualizes the proximal airways. Flexible bronchoscopy is the most common type of bronchoscopy. It visualizes the trachea, proximal airways, and segmental airways up to the third generation of branching and can be used to sample and treat lesions in those airways. Flexible bronchoscopy is generally performed in a procedure room with conscious sedation. Aims and Objectives: To study the bronchoscopic findings in patients undergoing fiberoptic bronchoscopy. To study clinical and radiological profile of patients undergoing fiberoptic bronchoscopy. To correlate the bronchoscopic findings with clinical and radiological profile of patients undergoing fiberoptic bronchoscopy. Methodology: Present study was conducted in the department of Respiratory Medicine of a Medical College and tertiary health centre. A total of 72 patients were included in this study after satisfying inclusion and exclusion criteria. The cases were recruited from the department of Respiratory and the referred cases from other department were also included. Written informed consent was taken from all the patients after explaining complications occurring during and after bronchoscopy. Procedure was done under local anesthesia. Information regarding clinical features and radiological findings were noted in predesigned proforma. Results: In this study 72 patients underwent fiberoptic bronchoscopy. Procedure was done under local anesthesia in all these patients. All these were diagnostic bronchoscopies. The bronchoscopy was done more in male (68.05%) as compared to females (31.94%). Consolidation (43.06%) was most common radiological finding followed by meditational mass lesion (26.39%). The most common finding on bronchoscopy was growth (25%) followed by secretions (22.22%). However in 27.78% patients no bronchoscopic finding was seen; these were patients with subcarinal lymph node, some cases of pneumonias, some cases of bronchiectasis. In those cases where no finding was seen bronchoalveolar lavage was taken. BAL (68 cases) was the most common procedure done, second most common was lung biopsy of the visible growth (21) However biopsy of the visible growth was more accurate with the accuracy rate of 76.91% followed by trans bronchial lung biopsy of the suspected lesion. Bronchoscopy was conclusive to give final diagnosis in 56 out of 72 cases. There was positive correlation between clinicoradiological diagnosis and bronchoscopic diagnosis. In 59.72% cases there was positive correlation between bronchoscopy and clinicoradiological findings.consolidation (43.06%) was most common radiological finding followed by meditational mass lesion (26.39%). Conclusions: Bronchoscopy is an excellent tool for the diagnosis of lung diseases, Radiological and clinical evaluation is very important prior to the bronchoscopy. There is a correlation between clinicoradiological and bronchoscopic diagnosis. A multimodality approach for the diagnosis is always helpful.

Keywords

Bronchoscopy, Clinical, Radiological.

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Gauri Kulkarni ¹, Deependra Chaudhary ¹, Anup Bhoyar ¹, Sushma Dugad ¹

Affiliations
1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is an important cause of disability and death globally and scenario has been infact worsened. Acute exacerbation of COPD (AECOPD) is associated with airway inflammation resulting in increased air trapping, further obstruction of airways and deterioration of gas diffusion. Objectives: The objective of this study is to find out the bacteriological profile and their antibiogram in AECOPD and to study the clinical presentation of AECOPD patients. Materials and Methods: This is a cross sectional study comprising of 45 patients diagnosed with AECOPD. Before starting on antibiotics all patients sputum was sent for culture and sensitivity. All patients were instructed to collect early morning, deep coughed sputum into a sterile sputum container (preferably two). Results: The present study reveals that total 45 cases, 89% were males and 11% were females. The most common organisms isolated were gram negative bacilli (71%) and gram positive bacilli (29%). Pseudomonas aueroginosa was the commonest bacteria isolated (26.7%) followed by streptococcus pneumonia (22.2%), Klebsiella pneumoniae (20%). The drug sensitivity testing revealed that Ciprofloxacin with amikacin is the best empirical antibiotic followed by Cephalosporin with amikacin. Conclusion: AECOPD is more common in adult males above the age of fifty five years secondary to smoking practices. As an empirical therapy in AECOPD patients the best choice of antibiotic therapy would be Ciprofloxacin with amikacin. Other best monotherapy antibiotic would be piperacillin with tazobactam or cefoperazone with sulbactum

Keywords

AECOPD-Acute Exacerbation of Copd.

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Sushama Dugad ¹, Pankaj Bhandare ², Gauri Kulkarni ¹, Sunil Patil ³

Affiliations
1 Department of Pulmonary Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN
2 Department of Pulmonary Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
3 Department of Community Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN

Abstract

A chillum consist a mixture of Cannabis and tobacco.Cannabis, also known as marijuana; it is a psychoactive drug from the Cannabis plant intended for medical or recreational use; nowadays widely being abused for getting high and temporary relaxation. Sputum examination of chillum smokers may indicate harmful effects of chillum smoking on lungs. Objectives of present study were to study the sputum characteristics and differential cell count of chillum smoking Sadhus of Kumbh Mela. Present descriptive observational study was conducted among fifty Sadhus of Kumbh Mela of Nashik. Participants were selected using purposive sampling method. In present study all sputum samples showed raised differential cell count and statistically significant association was observed between differential cell like Neutrophils, Lymphocytes and Macrophages with different content present in chillum.

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Sushama Dugad ¹, Pankaj Bhandare ², Ramesh Sundrani ³, Gauri Kulkarni ¹, Nilesh Patil ²

Affiliations
1 Associate Professor, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon - 422003, Nashik, Maharashtra, IN
2 PG Resident, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon - 422003, Nashik, Maharashtra, IN
3 Professor & Head, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon - 422003, Nashik, Maharashtra, IN

Abstract

Background: Our knowledge on reasons of non-acceptance and complication to H1N1 Vaccination by health care workers is limited. A better understanding of factors having significance in vaccine acceptance is crucial. With this background in mind present study was conducted at tertiary care centre to determine the Acceptance, Compliance, and Complication of anti-H1N1 seasonal vaccine among Health Care Workers (HWCs). Materials and Methods: Prospective Observational study was conducted to observe the rate of acceptance, compliance and complications of anti H1N1 seasonal vaccine among 100 health care workers in the period of December 2015 to December 2017 in Tertiary Health Care Centre. All participants were counselled 3 times at interval 6 months (0, 6, and 12 months) regarding H1N1 vaccine. Result: Vaccine acceptance rate among health care workers was only 03% before counseling. The main cause for not acceptance of vaccination was fear of adverse effects reported by 27% health care workers followed by cost of vaccine (12%) and work pressure (10%) or non-availability of time. Conclusion: As counseling sessions progressed health care workers also started accepting vaccination. After completion of third counseling session rate of vaccine acceptance increased from 3% to 71% and also negative and doubtful conception of health care workers were and changed completely. After counseling their knowledge regarding influenza vaccine was increased. Even though some post vaccination complications had been reported by recipient; those symptoms lasted for short duration of time and there was no serious adverse effect of H1N1 vaccine.

Keywords

Health Care Workers, H1N1 Vaccine.

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Sushama Dugad ¹, Pankaj Bhandare ², Ramesh Sundrani ³, Gauri Kulkarni ¹, Nilesh Patil ²

Affiliations
1 Associate Professor, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon - 422003, Nashik, Maharashtra, IN
2 PG Resident, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon - 422003, Nashik, Maharashtra, IN
3 Professor & Head, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon - 422003, Nashik, Maharashtra, IN

Abstract

Background: Our knowledge on reasons of non-acceptance and complication to H1N1 Vaccination by health care workers is limited. A better understanding of factors having significance in vaccine acceptance is crucial. With this background in mind present study was conducted at tertiary care centre to determine the Acceptance, Compliance, and Complication of anti-H1N1 seasonal vaccine among Health Care Workers (HWCs). Materials and Methods: Prospective Observational study was conducted to observe the rate of acceptance, compliance and complications of anti H1N1 seasonal vaccine among 100 health care workers in the period of December 2015 to December 2017 in Tertiary Health Care Centre. All participants were counselled 3 times at interval 6 months (0, 6, and 12 months) regarding H1N1 vaccine. Result: Vaccine acceptance rate among health care workers was only 03% before counseling. The main cause for not acceptance of vaccination was fear of adverse effects reported by 27% health care workers followed by cost of vaccine (12%) and work pressure (10%) or nonavailability of time. Conclusion: As counseling sessions progressed health care workers also started accepting vaccination. After completion of third counseling session rate of vaccine acceptance increased from 3% to 71% and also negative and doubtful conception of health care workers were and changed completely. After counseling their knowledge regarding influenza vaccine was increased. Even though some post vaccination complications had been reported by recipient; those symptoms lasted for short duration of time and there was no serious adverse effect of H1N1 vaccine.

Keywords

No Keywords.

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