K Prasanna Purna

Abstract

Background: The aim of this study was to determine whether, non-invasive ventilation (NIV) may be an effective as well as a safe alternative to invasive mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD) with acute severe respiratory failure who meet criteria for mechanical ventilation. Methodology: The sample size was a total of 40 subjects; 20 subjects for each of the two groups. Group 1 was given NIV trial and the group 2 was given Endotracheal Tube Mechanical Ventilation or (ETMV). Results: Mean age of NIV group was 59.5 ± 6.25 years, and ETMV group was 62.7 ± 7.3 years. The mean Respiratory rate of NIV group was 35.2 ± 3.4 breaths per minute and ETMV group was 37.2 ± 2.4 breaths per minute. The mean pH level of NIV group was 7.2 ± 0.02, and ETMV group was 7.17 ± 0.04. There was a marked improvement in pH after intubation, but there was not much of a significant change with NIV management. The mean PCO2 level of NIV was 69.4 ± 7.4 mmHg, and ETMV was 78.1 ± 13.12mmHg. The mean PaO2 level of NIV was 64.3 ± 13.9mmHg, and ETMV was 75.65 ± 19.12mmHg. In the total of 20 subjects in this group, 8 had recovered from NPPV, and 12 were intubated, in which there were 4 mortalities and 8 had recovered after being intubated. The NIV in this group had failed, was reached. However, the overall complications and outcome had been better resulted than expected, when compared to the ETMV group. The complications in the NIV group were dryness of mouth (10%), Pneumonia (10%), and Multi-organ failure (5%). In ETMV group, in the total of 20 subjects in this group, out of which there were 6 mortalities and 14 recovered. Conclusion: The results of this study show that the NIV trial failed. However, this type of ventilation has an advancement when it is presented in an ICU setup, as complications can be avoided and managed. Even though it is a slightly inconvenient preference, it is preferred over ETMV. This preference comes as an inclination due to its cost effectiveness and fewer complications when compared to ETMV. Keywords: COPD; Non-Invasive Ventilation; Non-invasive Positive-Pressure Ventilation.

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Aim: Current study focuses to analyse the advantage of the technique which uses the autologous blood for sutureless securing the conjunctival autograft post pterygium excision. Materials and Methods: This is non-invasive study consists forty patients underwent primary pterygium surgery. After excision of pterygium, the patient’s conjunctival autograft from supero-temporal quadrant and patient’s autologous blood to attach the graft without sutures. 6 months of follow up data collected. Results: In total 40 patients, male to female number observed as 11: 29. In those, grade I, II and III were observed in 7, 25, and 8 patients respectively. During surgery, there were no complications observed. Two patients with subconjunctival hemorrhage, two patients with graft retraction, one patient with graft loss and one patient with pterygium recurrence were recorded. 34 (85%) patients had good recovery and cosmesis was also observed excellent. Conclusion: Non-invasive conjunctival autograft with patient’s autologous blood using technique without sutures observed to be safe and the best outcome, and also consumes less time and cost effective. Keywords: Pterygium excision, Autograft, Conjunctiva.

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Introduction: Micronutrients deficiency is supposed to impair the overall immune function and causes increased resistance to infection. Such a relationship exists even in tuberculosis. A major threat is multidrug resistant tuberculosis (MDR-TB). In India, few studies are available to discuss about risk factors and serum zinc and selenium status in MDR-TB. Material and Methods: A case control study of 25 diagnosed MDR-TB patients from Damian foundation and 25 healthy controls from Narayan Medical College were recruited after laboratory tests, chest X-ray and clinical history. 5 ml of blood collected and serum zinc and selenium levels were assessed for both groups and correlated with demographic factors, duration of treatment, and BMI. Results: The results indicate that the MDR-TB patients have altered profile of the serum zinc and serum selenium in their sera and this could be more due to the active disease, causing oxidative stress which depletes the micronutrients. In this study, the mean serum zinc levels were 79.08 ± 14.2 ?g/dL and 91.1 ± 15.2?g/dL in case and control groups respectively. Serum selenium levels were 56.2 ± 11.1 ?g/dL and 65.2 ± 4.2 ?g/dL in case and control groups respectively. In both the groups micronutrient levels showed statistical significant. Conclusions: The risk factors in our study, such as lower level of serum zinc was one of the concern for the development of MDR-TB and an attempt to minimize them might contribute to control the upward slope of MDR-TB. Keywords: Immune status; Serum zinc; Serum selenium; TB.

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Background: If untreated, HIV mortality will be high from the cause of acute respiratory infections in neonatal stage up to one year of age. Here, the study was conducted to determine the prevalence of spirometric abnormalities in HIV positive children. Methodology: A cohort of 20 children in the age group of 10 to18 years with a diagnosis of HIV was included. Spirometry measurements carried out to analyze the forced expiratory volume at one second (FEV1), forced vital capacity (FVC), FVC/FEV1 ratio, and forced expiratory flow 25% to 75% (FEF25-75) and pulse oximetry. The PFT data were analyzed in correlation with the age and blood parameters. Results: 20 HIV-infected participants with a mean age 15.5 years were recruited. 17 children were on antiretroviral therapy. The mean CD4 count was 496±235.22 (151-1088) cells/µl. Mean Hb% value observed was 9.96±2.5 and mean total leucocyte count was 3785±2087.37. We found mean FEV1 as 71.05±9.2, mean FVC as 71.6±8.5 and ratio FEV1/FVC as 98%±0.11. The total lung capacity was observed as 73%-117%. Conclusions: Clinicians evaluating HIV infected children with respiratory symptoms must first determine whether those symptoms are a result of common bacterial symptoms or opportunistic infections. Keywords: Antiretroviral therapy (ART); Chronic lung disease; HIV; Pulmonoray function test.

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