Kiran Mathangi

Introduction: India is presently one of the high burden countries for tuberculosis and accounts for 23% of global TB burden with 2.2 million patients. Of these reported cases in India around 20% are of Extra Pulmonary Tuberculosis (EPTB).Pleural effusion due to TB is currently the second common location for EPTB next to TB lymphadenitis . The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. The present study was done to determine the role of ADA and CBNAAT both being rapid and non-invasive diagnostic methods for early detection of tuberculous pleuritis, which is essential for treatment initiation, improved patient outcome and for more effective public health intervention. Materials and Methods: An observational study was done on 100 patients presenting with clinicoradiological picture suggestive of pleural effusion, either admitted or attending OPD of Department of Pulmonary Medicine from Nov 2017 to Nov 2019 at GGH, Kakinada.  Results: Out of 100 exudative pleural effusions in study, male predominance with 80% of males and 20% females. Lymphocyte predominance is 74%, sputum AFB was positive in 6 cases. With ADA cut off as 40IU/L, 70 cases had an ADA > 40IU/L out of which 64 were tubercular, and 6 were malignant effusions .ADA has a sensitivity of 94% and specificity of 60%.Pleural fluid CBNAAT was positive in 30 cases, out of which 2 cases had an ADA < 40> Conclusion: Estimation of ADA in pleural fluid is a simple, rapid, and less expensive laboratory investigation where the diagnosis is uncertain. The sensitivity of ADA, when combined with lymphocytepredominant exudates, helps to diagnose tubercular effusions. The role of CBNAAT in diagnosing pleural TB is limited due to its poor sensitivity. Keywords: Pleural effusion, ADA, CBNAAT.

Introduction : Tuberculosis is a global health burden still causing large mortality and morbidity. According to WHO’s 2018 Global TB Report two main routes for reducing TB incidence and death are- diagnosis and treatment. The main challenging issue with TB is to obtain a rapid and accurate diagnosis for initiating early treatment. Sometimes patient with active pulmonary tuberculosis fail to produce adequate sputum resulting in increase of false-negatives. Sputum-smear negative pulmonary tuberculosis is highly infectious and remains a diagnostic challenge. Fiber-optic bronchoscopy is an important tool for early detection and confirmation of sputum smear-negative and sputum-scarce PTB as it provides high-quality biological samples like bronchoalveolar lavage (BAL) fluid. The aim of the present study was to evaluate role of in Gene Xpert MTB/RIF on bronchoscopic specimens in sputum smear negative patients with suspicion of PTB. Materials and Method: A prospective observational study was done on 100 patients with clinical suspicion of PTB who either have a negative sputum smear microscopy or unable to produce qualitative sputum attending outpatient and admitted in Pulmonology department, Government General Hospital, Kakinada. Results: Out of 100 patients, 47 were diagnosed and confirmed as pulmonary tuberculosis of which bronchial specimens smear positive were 5(10.6%),bronchial specimens smear negative but CBNAAT positive were 42(89.3%). At last as CBNAAT has dual diagnostic advantage of detecting rifampicin resistance, about 5 cases were detected as rifampicin resistance. Conclusions: CBNAAT/RIF assay on BAL specimen provides an accurate diagnosis of PTB in patients with sputum smear negative results or those who cannot expectorate sputum and superior to sputum smears in detecting rifampicin resistance. Keywords: Bronchoscopy, BAL, Gene Xpert, CBNAAT.

Introduction: Cor-pulmonale is an alteration in the structure and function of right ventricle secondary to many broncho-pulmonary vascular diseases and from different chest wall abnormalities. The development of PAH has an important prognostic role, as it significantly increases the risk of hospitalization and is associated with reduced survival. Materials and Methods: 100 patients of cor-pulmonale confirmed by clinical, radiological and electrocardiographic manifestations from outpatient and inpatients in Pulmonology Department, Government General Hospital, RMC, Kakinada, over a period of November 2018-November 2019 were included in the study. Results: Out of 100 study cases, most affected age group is 51-60 years, males were more affected than females maybe because of the fact number of smokers were male. Out of 100, seventy patients were smoker, of which 63 were male and 7 were female. Almost every patient of cor-pulmonale presented with dyspnea and cough and had features suggestive of RHF. On ECG, p-pulmonale was the most common finding followed by right axis deviation for cor-pulmonale. On ECHO, RVSP>60mmHg is found in 56?ses. Radiologically, 48% cases of cor-pulmonale were secondary to chronic bronchitis and emphysema. Conclusions: Echocardiographic screening of all patients with chronic lung disease especially the middle age males and the smokers will benefit in early detection of disease and initiation of treatment, thus improving their prognosis. A combined clinical, radiological, ECG andechocardiographic findings can give clue about progression of PAH and cor-pulmonale. Keywords: Cor-pulmonale, PAH, Chronic lung disease.

Introduction: Influenza is known to cause annual seasonal epidemics. Swine origin influenza was first recognized in the border area of Mexico and United States in April 2009. 1 The currently circulating strain of Swine origin influenza virus of the H1N1 strain has undergone triple re-assortment and contains genes from the avian, swine and human viruses and is known for the rapidity with which it spreads to the community. 2 Materials and Methods: 400 cases suspected with influenza like illness from in and out patient units of department of Pulmonary Medicine, Government General Hospital, Kakinada were included in the study. 70 patients were subjected to RT-PCR. Medical records of 42 patients who were admitted, who were suspected clinically as H1N1 and confirmed by RT-PCR method, were examined thoroughly in the present study. An ethical committee approval and consent was taken from all patients before included in the study. Results: out of 400 cases 250 are of category A and 80 patients are of category B. Out of Category C patients, 42 are H1N1 positive by RT-PCR. Among 42 cases, most common affected age group is 51-60 years (37.40%). Males are more involved (52.38%). The common presenting symptoms were breathlessness, cough, and fever. 59.52% of positive cases were associated with various comorbidities. Conclusions: Most of patients with influenza like illness belongs category A and B. In our area H1N1 prevalence of is high in elderly age group and in males. Most of the patients recovered well with Oseltamivir and symptomatic treatment. Proper preventive measures, personal care and hygiene and isolation of patients and admission to designated swine flu ward can be helpful in preventing the spread of infection with in the community. Keywords: Influenza infection, H1N1, Swine flu.

Background: COPD is presently the fourth major reason for mortality and further increments in its predominance and mortality can be anticipated in the coming decades. COPD represents a significant number of visits to a pulmonologist and other specialists. Methodology: 101 patients are selected for the study, from in & out patient departments & causality in GGH, Kakinada attending with COPD from June 2016 to October 2018. Results: The present investigation included 101 patients with stable COPD going to medical OP or admitted to the different wards in GGH Kakinada. Increasing hematocrit (HB%, PCV) dictates further management of COPD in the form of LTOT. The occurrence of ECG and echocardiographic discoveries are progressively normal as the sickness term and seriousness increase and echocardiography is better than ECG in the diagnosis of RV dysfunction in COPD. Conclusions: COPD is a fairly common disease in the world now. It is more common in males and in the 5th and 6th decade. Most of the patients have fairly advanced disease at presentation. In perspective of the extremely huge negative relationship of FEV1/FVC% with the expanding frequency of electrocardiographic variations from the standard an inexorably strong approach to manage treat the COPD patients can be taken with the goal that the beginning of corpulmonale would be postponed as long as possible. Keywords: COPD; Cor-pulmonale; P-pulmonale; Right ventricular systolic pressure (RVSP).

Introduction: Postoperative pulmonary complications (PPCs) following abdominal surgery are frequent and associated with increased morbidity and mortality and hospital length of stay. Incidence rates vary dramatically, ranging from 2% to 40%. The incidence of pleuro-pulmonary complications shows wide variations & has the diversity of various influencing factors, including patient existing lung conditions, habitual history, selection of surgery, anaesthetic risks and post-surgical recovery. Material and Methods: 100 patients are selected from in & out patient department & causality in GGH, Kakinada attending for abdominal surgical conditions. It is a prospective- observational, cross sectional study. Results: In the studied group of 100 person’s total of 27 persons affected with pulmonary complications in overlapped manner. Following pulmonary complications observed with incidence rates respectively in the order of ATELECTASIS (74.07%), PLEURAL EFFUSION (62.96%), PNEUMONIA (62.96%), RESPIRATORY FAILURE (11.11%). Conclusion: The incidence of postoperative pleuropulmonary complications of abdominal surgeries in our study in GGH, Kakinada is 27%, which includes atelecasis as the predominant one (74%) followed by pleural effusion and pneumonia each carrying equal incidence (62.96%) and finally respiratory failure that occupied least. Early prediction of postoperative pulmonary complications is possible to have the early interventions to reduce the post op morbidity, hospital length of stay and cost. Keywords: Atelectasis, Pleural effusion, Pneumonia, Respiratory failure.