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.

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.

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.

NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes