Sushma Dugad ¹, Saurabh Ambadekar ¹, Anand Singh ¹

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

Abstract

A 15 year old male was diagnosed to have central nervous system (cns) tuberculosis with ataxia. After starting him on conventional anti tuberculous treatment he deteriorated both clinically and radiologically. On investigation the diagnosis of drug resistant tuberculosis was ruled out and corticosteroid treatment was added. Eventually patient improved symptomatically and had good weight gain.

Keywords

Brain, Paradoxical reaction, Tuberculoma

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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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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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Juhi R. Kadukar ¹, Ramesh Sundrani ², Sushma Dugad ³, Gauri Suhas Kulkarni ⁴, Jaspreet Singh Khandpur ⁵, Maya Mortale ¹

Affiliations
1 Former PG Resident, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
2 Professor and Head, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
3 Associate Professor, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
4 Professor, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
5 PG Resident, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN

Abstract

Background: Respiratory symptoms of patients usually worsen, which may be beyond normal day to day variation this is nothing but an acute event of a disease leading to further change in medication. Acute exacerbation of Chronic obstructive pulmonary disease is defined as sudden worsening of symptoms like in breathlessness, chest pain, change in quantity and colour of sputum, fever, these symptoms usually last for several days. These symptoms are aggravated by environmental pollutants, bacterial and viral infections wherein infections usually lead to 75% or more of the exacerbations but improper inhaler technique is also one of the most important factors for causing exacerbation of Chronic Obstructive Pulmonary disease. Aims and Objectives: To study the risk factors for exacerbation of COPDs. Methods: Present sample consists of 51 diagnosed COPD patients who fulfilled eligibility criteria. Study was conducted in the department of Respiratory medicine from August 2016 to December2018. Detailed history along with general and respiratory system examination was done and findings were recorded. Results: Most of the study population was present between 51 to 60 years (41.2%) of age group and rest were in 41 to 50 years (29.4%) and more than 60 years (29.4%). There was male predominance (64.7%) amongst study population as compared to females (35.3%). 82.4% of study population were taking inhaler improperly. 64.7 % of study population were exposed to outdoor pollution. 43.1% of study population are exposed to indoor pollution. Conclusion: Environmental stress are also involved in acute exacerbation of chronic obstructive pulmonary disease apart from viral and bacterial infections. Improper technique of using inhaler was also the main risk. So patients are advised proper & regular use of inhaler technique. Indoor and outdoor pollution is also main risk factor for exacerbation so avoidance of exposure to biomass fuel and outdoor pollution should be considered.

Keywords

Biomass Fuel, COPD, Improper Inhaler Technique, Indoor and Outdoor Pollution

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