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 sensitivity1. 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.
Asthma is commonly controllable but often neglected disease asscociated 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.
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 sensitivity1. 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.
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.
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.
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