Role of induced sputum with hypertonic saline in the early diagnosis of no / inadequate sputum or sputum smear negative suspected cases of pulmonary tuberculosis

Background: Pulmonary Tuberculosis is one of the common infections in the world, especially in developing countries like India and is a leading cause of morbidity and mortality worldwide. Therefore, early diagnosis and microbiological confirmation of pulmonary TB is important. This study was done to assess the role of induced sputum with hypertonic saline in suspected pulmonary TB patients who produce no or inadequate sputum or who are sputum for AFB smear negative.Methods: 100 patients with clinical and radiological evidence of pulmonary TB with no or inadequate sputum or who are smear negative with spontaneous sputum were included in the study. Sputum was induced with 5ml of 3% hypertonic saline delivered through nebulizer and then was sent for Ziehl Neelsen staining examination.Results: 96 patients could produce adequate sputum after sputum induction. In 47 patients, sputum for AFB smear was found positive after induction.Conclusions: Sputum induction is a safe, cheap and non-invasive procedure and offers an alternative or additional approach in the diagnosis of sputum smear-negative suspected pulmonary tuberculosis patients and would enhance sensitivity for the diagnosis of tuberculosis.

Comparative study of computed tomography guided fine needle aspiration cytology and trucut biopsy in diagnosis of lung cancer: a report of 81 cases

Background: Lung cancer is the major cause of cancer related deaths all over the world. CT guided FNAC and/or Biopsy of lung mass is an effective modality to diagnose lung cancer, especially in peripherally situated lesions. This study was planned to compare the role of CT guided lung FNAC and Biopsy in diagnosis of Lung cancer.Methods: This is a cross sectional study, done in department of respiratory medicine of a tertiary care teaching hospital of Rajasthan over a period one year. All the patients with suspected mass lesion on chest X-ray and clinical symptoms suggestive of lung cancer were included in the study. CT guided FNAC and biopsy were done in each patient after explaining the risks.Results: CT guided procedures were done in 81 patients of suspected lung cancer. CT guided FNAC yielded positive results in 75 patients while it was negative in 6 patients. CT guided lung biopsy was positive in all patients. Squamous cell carcinoma was most common type encountered malignancy.  Conclusions: CT guided lung FNAC and Biopsy is a simple and safe method with high diagnostic accuracy for diagnosis of Lung cancer

Prevalence of tuberculosis in silicosis patients in southern part of Rajasthan

Background: Silicosis is an occupational lung disease which commonly occurs in workers involved in quarrying, mining, sandblasting etc. Tuberculosis (TB) in silicosis is more common. In southern part of Rajasthan, near Udaipur a lot of mining areas are there and workers are exposed to silica dust. The main objective of carrying out this study is to bring in focus the increasing prevalence of silicosis patients and its complications in mining areas around Udaipur in southern Rajasthan, so that the necessary prophylactic and preventive measures can be taken for the workers in future.Methods: 150 patients of silicosis and old treated case of silicotuberculosis patient with respiratory symptoms were included in the study. In all the patients, sputum was sent for routine acid fast bacilli (AFB) smear examination and if it came negative then sputum was sent for GeneXpert multidrug resistant tuberculosis (MTB) and also for AFB culture examination wherever needed.Results: The mean duration of exposure to silica particles was 10 years (5 to 15 years). Tuberculosis was diagnosed by microbiological examination in 40 cases, while 25 cases which were previously treated for tuberculosis were found negative on microbiological examination. So, the overall prevalence of TB (both old treated and new or relapse microbiologically confirmed cases) among patients of silicosis was found to be 44%.Conclusions: Our study showed an increased prevalence of tuberculosis in silicosis patients. So, there should be regular health check up educational programme for all silica mines workers and all should use prophylactic measures.

Knowledge, attitude, practices of inhalational therapy among nursing staff posted at tertiary care teaching hospital

Background: Inhalational therapy for patients with chronic respiratory disorder can greatly benefit. Nurses are one of the major components of health care system of hospital and have an important role in education and training of patients. This study was planned to assess knowledge, attitude, and practices of inhalational therapy among nurses.Methods: This questionnaire based cross sectional study was conducted after taking permission from the institutional ethics committee in all the nurses of a tertiary care teaching hospital. This questionnaire consists of few socio-demographic questions and other questions for assessing level of knowledge, attitudes, and practices related to inhalational therapy. Incompletely filled questionnaire were excluded out for data analysis. Data was interpreted in percentage.Results: Total 344 (87.31%) questionnaires were analysed. 334 (97.09%) have heard the term inhalational therapy and 310 (90.12%) responded that it is preferred in respiratory disease. 117 (34.01%) nurses could not mention single side effect of inhalational therapy. 178 (51.74%) nurses always assess/observe the patient and 211 (61.34%) always train the patients for correct inhalational technique. 165 (47.97%) nurses responded that knowledge of inhaler use came from attending meetings, courses or workshops organized by scientific bodies. 163 (47.38%) nurses considered ‘Disease to be treated’ the most important variable while prescribing an inhalational device.Conclusions: The knowledge of inhalational therapy was satisfactory while the demonstration of inhaler techniques to patients was moderate in this study. So regular training courses and workshop should be conducted for the nurses about inhalational therapy practical approach

Role of fiberoptic bronchoscopy in sputum smear negative suspected cases of pulmonary tuberculosis: a study conducted in Southern part of Rajasthan

Background: Sputum smear negative pulmonary tuberculosis is a common problem faced by clinicians. Fiberoptic bronchoscopy may be very useful in diagnosing these cases which have no sputum or whose sputum smear is negative for acid fast bacilli. Objective of the current study was to assess the role of fiberoptic bronchoscopy in sputum smear negative under NTEP and radiologically suspected cases of pulmonary tuberculosis.Methods: Clinico-radiological suspected cases of pulmonary tuberculosis patients in whom two sputum smear for acid fast bacilli by Ziehl Neelsen stain under NTEP was negative were included in the study. Fiberoptic bronchoscopy was performed in all these patients and samples taken were sent for investigations.Results: Fiberoptic bronchoscopy was performed in 250 patients of suspected pulmonary tuberculosis whose sputum for AFB smear was negative. Cough was the most predominant symptom. Radiologically, right side disease was more common and upper zone was most commonly involved and infiltrates were common radiological finding. During bronchoscopy, congestion and hyperaemia (36%) and mucopurulent/mucoid secretions (32%) was seen in maximum number of cases. BAL was positive in 200 patients (80%), post bronchoscopy sputum was positive in 70 cases (28%) and biopsy was positive in 12 patients out of 16 performed biopsies (75%). The total TB positive cases after combining all the methods were 215 making the overall diagnostic yield of 86%.Conclusions: Fiberoptic bronchoscopy and post bronchoscopy sputum can be very useful for diagnosing sputum for AFB smear negative but clinico-radiological suspected cases of pulmonary tuberculosis patients

A study of bronchial asthma in school going children in Southern part of Rajasthan

Background: Asthma is a chronic and common inflammatory disease involving mainly large airways of lungs. Childhood asthma is common chronic illness among school going children and is usually underdiagnosed and undertreated. The aim of the present study was to find out of the prevalence of Bronchial asthma in school going children of age group 6-12 years in southern part of Rajasthan (India), and its relation with gender, socio-economic status and heredity.Methods: A questionnaire-based study has been carried out in 1500 children of 6 to 12 years age group in four schools of Udaipur city (Rajasthan, India) with a response rate of 60.23% (904/1500).Results: The overall prevalence of asthma observed is 4.75% (43/904). The prevalence is higher among boys (5.55%) as compared to girls (3.75%). Further the prevalence is higher in upper (7.18%) and upper middle class (7.14%) children as compared to lower middle (4.84%) and upper lower class (2.01%) socioeconomic status. The children with positive family history of asthma also have higher prevalence (26.31%) of asthma.Conclusions: The prevalence of childhood asthma in Udaipur city is relatively lower and supports the already reported relation with gender, socioeconomic status and heredity.

Comparative study of computed tomography guided fine needle aspiration cytology and trucut biopsy in diagnosis of lung cancer: a report of 81 cases

Background: Lung cancer is the major cause of cancer related deaths all over the world. CT guided FNAC and/or Biopsy of lung mass is an effective modality to diagnose lung cancer, especially in peripherally situated lesions. This study was planned to compare the role of CT guided lung FNAC and Biopsy in diagnosis of Lung cancer.Methods: This is a cross sectional study, done in department of respiratory medicine of a tertiary care teaching hospital of Rajasthan over a period one year. All the patients with suspected mass lesion on chest X-ray and clinical symptoms suggestive of lung cancer were included in the study. CT guided FNAC and biopsy were done in each patient after explaining the risks.Results: CT guided procedures were done in 81 patients of suspected lung cancer. CT guided FNAC yielded positive results in 75 patients while it was negative in 6 patients. CT guided lung biopsy was positive in all patients. Squamous cell carcinoma was most common type encountered malignancy.  Conclusions: CT guided lung FNAC and Biopsy is a simple and safe method with high diagnostic accuracy for diagnosis of Lung cancer