Background: Short burst oxygen therapy (SBOT) is widely prescribed in the UK with little evidence of benefit. A study was performed to examine whether SBOT benefits patients when undertaking normal activities at home among those who already use it. Methods: Twenty-two patients with chronic obstructive pulmonary disease (COPD) were included in the study. All regularly used SBOT at home and claimed that it helps them. Each patient chose two daily living activities for which they used SBOT for relief of breathlessness. Patients were then randomised to use either an air or oxygen gas cylinder. At least 15 min later the same activity was performed using the other gas cylinder. The same process was then repeated for the second chosen activity. The main endpoints were subjective and objective times to recovery, analysed for each activity separately or taking the average over the two activities. A paired statistical analysis was performed. Results: All patients used SBOT with nasal prongs after exercise. Using the average recovery time over two activities for each patient, the mean objective recovery time was 38 s lower (95% CI 281 to +5) using oxygen and the mean subjective recovery time was 34 s lower (95% CI 269 to +2). Five patients were correctly able to distinguish oxygen from air after both activities and there was a suggestion that their recovery times were shorter than those who did not correctly identify the gases (91 s vs 20 s using objective recovery times, and 80 s vs 22 s using subjective recovery times), although this was a subgroup analysis based on only five patients with non-significant results. Conclusions: There is some evidence that SBOT shortens recovery time after activities of daily living in a selected group of patients with COPD, but the effect is small. There appears to be a subgroup of patients who may benefit to a much greater degree.
Background:Closed pleural biopsy was previously considered a procedure of choice in cases of undiagnosed pleural effusion with good efficacy. Currently, the closed pleural biopsy has been replaced by thoracoscopic biopsy but not easily available in resource-limited setups.Objective:The objective of this study was to analyze the diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion and assessment of patients' characteristics with the yield of pleural biopsy.Design:This was a cross-sectional study.Settings:This study was conducted at Institute of Respiratory Diseases, SMS Medical College, Jaipur, a tertiary care center of West India.Patients and Methods:A total of 250 cases of pleural effusion were evaluated with complete pleural fluid biochemical, microbiological, and cytological examination. Out of these 250 patients, 59 were excluded from the study as the diagnosis could be established on initial pleural fluid examination. The remaining (191) patients were considered for closed pleural biopsy with Abrams pleural biopsy needle.Main Outcome Measures:The main outcome measure was diagnostic yield in the form of confirming diagnosis.Results:Out of the 191 patients with exudative lymphocytic pleural effusion, 123 (64.40%) were diagnosed on the first pleural biopsy. Among the remaining 68 patients, 22 patients had repeat pleural biopsy with a diagnostic yield of 59.9%. The overall pleural biopsy could establish the diagnosis in 136 (71.20%) patients with pleural effusion. The most common diagnosis on pleural biopsy was malignancy followed by tuberculosis.Conclusions:Closed pleural biopsy provides diagnostic yield nearly comparative to thoracoscopy in properly selected patients of pleural effusions. In view of good yield, low cost, easy availability, and very low complication rate, it should be used routinely in all cases of undiagnosed exudative lymphocytic pleural effusion.Limitations:There was no comparison with a similar group undergoing thoracoscopic pleural biopsy.
Reason behind such response in only selective patients is not clearly understood. We evaluated the pattern and predictors for paradoxical response(s) (PR) in patients with peripheral lymph node tuberculosis (TB). Materials and Methods: Study included patients aged > 6 years with peripheral lymphadenopathy of tubercular etiology attending a tertiary care hospital from Jan 2010 to Dec 2010. PR in our study was defined as worsening of pre-existing disease or development of new lesions in a patient who has been on anti-TB therapy for at least 2 weeks. Results
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