B. K. Mutha ¹, Sushma Duggad ¹, Saurabh Ambadekar ¹, Anand Singh ¹

Affiliations
1 Department of TB & Chest, Dr. Vasantrao Pawar Medical College Hospital & Research Centre Nashik, IN

Abstract

Introduction: Lung cancer may manifest in various ways. It may have typical symptoms such as weight loss, cough, heamoptysis and can be confused with pneumonia or it may manifest as a part of paraneoplastic syndrome. Occasionally it may be detected incidentally during evaluation for other medical illness. The early detection rate of lung cancer is rising due to cancer screening programmes, improvement in resolution of Computerised tomography scanners and also refinements in bronchosocpy techniques such as endobrochial ultrasound and electromagnetic navigation, fluoroscopy guidance and virtual bronchoscopy. The aim of this study was to correlate bronchoscopic findings with clinicoradiological profile of patients with suspected lung cancer visiting our Tertiary Health Centre, Nashik. Materials and Methods: This was a prospective study, conducted in a tertiary care medical college hospital over a period of 2 years. Patients were recruited from department of pulmonary medicine and referred cases from other departments were also included. Results: Complete data records from 52 patients were available for statistical analysis. Maximum numbers of patients were in age group 41-60. All bronchoscopies were done under local anesthesia and short conscious sedation. Majority of bronchoscopies were done in males. There were no fatal complications. Biopsy of visible growth was the most useful diagnostic tool followed by bronchoalveolar fluid. Squamous cell carcinoma was the most frequent diagnosis. Conclusion: Bronchoscopy is an excellent tool to evaluate lung carcinoma and multimodality approach is always helpful. Experience of bronchoscopist is crucial and accuracy of procedure increase with experience. Incidence of adenocarcinoma is increasing in India but squamous cell carcinoma remains most frequent lung cancer. Transbronchial lung biopsy, Transbronchial needle aspiration and brush biopsy, brochoalveolar fluid aspiration are helpful tools. However the yield can be enhanced by using Endo bronchial ultrasound (ebus), fluoroscopic guidance and electromagnetic navigation, virtual brochoscopy. There is good correlation between clinicoradiological and bronchoscpoic diagnosis and early diagnosis of lung malignancy will help improve survival and quality of life of patients.

Keywords

Bronchoscopy, Clinicoradiological, Correlation.

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B. K. Mutha ¹, Gauri S. Kulkarni ¹, Sushma R. Dugad ¹, Saurabh Borgaonkar ²

Affiliations
1 Department of TB and Chest, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik - 422003, Maharashtra, IN
2 Department of TB and Chest, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik - 422003, Maharashtra, IN

Abstract

Asthma is commonly controllable but often neglected disease associated with huge burden to family and society. It is important to obtain optimal control to improve quality of life in asthmatics. The suboptimal control of disease occurs due to very poor adherence to aerosol therapy. Objective is to study the aerosol therapy compliance in bronchial asthmatics and the factors responsible for non compliance of aerosol therapy and effect of repeated health education on compliance. It is a prospective study where patient was followed up monthly for three months for collecting data and checking the compliance. This study included 113 bronchial asthmatics who were taking aerosol therapy for 1 or more years. After three months it was observed that only 45 patient (39.82%) were compliant and 68 (60.17%) were non compliant to aerosol therapy as advised by doctor, after employing various strategies, compliance improved in 22 (32.35%) of the previously compliant patients. Factors responsible for poor compliance were low level of education, patients from poor socioeconomic strata, poorly accessible pharmacy, adverse effect and fear of adverse effect (forgetfulness busy life style, ill altitude to chronic condition) felt better with medications, negligence dislike medication. Non compliance with treatment is an eminent challenge in asthma management and various compliance improving strategies can helpful to improve compliance in few patient.

Keywords

Bronchial Asthma, Compliance, Health Education.

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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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