Erythrocyte sedimentation rate and plasma viscosity in pulmonary tuberculosis.

Erythrocyte sedimentation rate (ESR) and plasma viscosity (PV) are non-specific indices for screening, diagnosis and follow up to some disease. This prospective study of ESR and PV reports on 21 patients of pulmonary tuberculosis and 45 healthy. The mean and standard deviation of ESR in diseases and healthy were 80.1+35.4 and 11+7 mm/hr compared with PV 2.07+0.17 and 1.69+0.07 mPaS. After three months of complete treatment of pulmonary tuberculosis in six patients, the ESR returned from 69.2+25.9 to 21.3+16.8 mm/hr, the PV returned from 2.08+0.22 to 1.75+0.15 mPaS. Both tests gave good result in supporting diagnosis and follow up, however the PV is probably superior to ESR because of better quality control and precision, longer plasma reservation in room temperature. It is recommended that PV may have a role in clinical practice as well as ESR.

HLA antigen and ventilatory drive in Thais with chronic obstructive pulmonary disease.

Studies of HLA antigens in 15 Thai patients with chronic obstructive pulmonary disease revealed a significant increase in HLA-Bw 60 frequency in the group with low ventilatory drive to carbondioxide using unstimulated airway pressure. The finding suggests an immunogenetic role of HLA-Bw 60 on the control of ventilation in COPD.

Clinico-physiological status of Thai COPD patients.

We examined the relationships between certain clinical and physiological data from 56 patients with chronic obstructive pulmonary disease, and have formulated 15 relevant equations from which various respiratory indices can be estimated. Multiple linear regressions thus obtained evidently suggest that airway resistance and ventilatory drive are the main factors in the control of breathing among Thai COPD subjects; the exercise tolerance test showed some correlation with airflow obstruction and with respiratory muscle strength. Clinical implementation of certain findings has been outlined.

Ventilatory control, exercise tolerance and respiratory dysfunction in Thai COPD patients.

This study was designed to investigate a group of Thai COPD patients for their respiratory centre sensitivity while breathing room-air and during CO2 rebreathing, and tests to determine exercise tolerance and degrees of respiratory dysfunction. Results in 56 patients as compared with 45 age-matched healthy subjects disclosed comparable data between both subject groups, with the single exception that one-third (35.7%) of the patients experienced stronger ventilatory drive while breathing room-air and a lower musculo-ventilation transfer index during room-air breathing as well as CO2 rebreathing. According to the base-line dyspnoea index, the majority of Thai COPD patients in this study suffered from a very severe respiratory dysfunction, which correlated well with results of their basic physiologic tests.

Respiratory centre sensitivity and exercise tolerance in healthy Thais.

To determine the range of normal values of respiratory centre sensitivity and exercise tolerance in Thais, 69 healthy subjects, 18 to 72 years of age, participated in a series of tests, i.e. ventilatory drive, ventilatory response, musculo-ventilation transfer and the two-minute walking test with rating of the breathing sensation on a visual analogue scale. Our results showed higher end-tidal Pco2 and tidal volume response to CO2 and less exercise tolerance in the elderly than in the young. Only in young males was the ventilatory response to CO2 higher than in females. No attempt has yet been made to explain the lower ventilatory response in Thais as compared with Americans. Apparently, the defective respiratory apparatus, viz. increased airways resistance and not the blunting of respiratory centre sensitivity, contributes principally to relative hypoventilation and exercise limitation in the elderly. The compensation, with high tidal volume response to CO2, seems ineffective in maintaining normo-ventilation.

Oxygen desaturation during fibreoptic bronchoscopy.

One hundred consecutive patients, who underwent bronchoscopic examination for diagnostic purposes, were studied with regard to various aspects of possible SaO2 deterioration. Relevant findings are as follows: (1) The pulse oximeter is as good as the conventional blood gas analyser for quantitating SaO2; (2) oxygen desaturation in the range of 1 to 25 per cent (median 5, mean 5.6 +/- 4) occurred in approximately 97 per cent of the bronchoscopy examinees; recuperation time of SaO2 was 1 to 34 minutes (median 6, mean 8.2 +/- 6.5); (3) the factor aggravating desaturation included the examination of patients in the sitting position; the fact that bronchial washing was connected with greater SaO2 deterioration in the non-hypoxaemic group of patients needs further investigation with regard to its role in the mechanism of oxygen desaturation; (4) the amount of fluid instilled intra-tracheally, bronchial biopsy and duration of the procedure were not related to the decline in SaO2. Based on the results of the present study, the authors suggest that all procedures ought to be performed on patients undergoing examination in the supine position, and that the patients should be supplemented with low-flow oxygen.

Experiences from a one-year supervision of pulmonary tuberculosis patient and Their associates.

Monthly scheduled follow-ups of 28 sputum-smear-culture-positive tuberculosis patients and 110 members of their families revealed 14 suspected cases of pulmonary tuberculosis and several interesting findings: (1) the incidence of tuberculosis was mostly among poor families with unsuitable shelter; (2) assessing family members and close associates of patients proved to be a fruitful approach for case-finding; (3) several BCG-vaccinated persons were found to have developed tuberculosis; (4) despite enthusiastic supervision of patients undergoing treatment, the defaulter rate was high (19.5%); and (5) all the antituberculotic regimens prescribed in this paper proved effective, as indicated by negative sputum examination from the fourth month of therapy onwards and a relapse rate of only 3.0 percent. Suggestions are made for improving the control of tuberculosis among the general public.

HLA antigen profiles in Thai tuberculosis patients.

HLA antigens were studied in 35 Thai patients suffering from active pulmonary tuberculosis. An increase in the frequency of HLA-Bw46 and -DR4 and a decrease in the frequency of HLA-B12 were found when compared with the matched controls. These findings suggest that the pathogenetic role of HLA-B12 is to confer resistance and that HLA-Bw46 and -DR4 are associated with susceptibility. In addition it provided further information on HLA antigen profiles in pulmonary tuberculosis patients in another ethnic group (viz. Thais). Conclusions regarding genetic control over therapeutic efficacy must await further study.

Asbestos air pollution in Bangkok metropolis.

In order to substantiate the hypothesis of airborne pollution as the contributing source of asbestos bodies in the lungs of Thais, a further investigation was carried out in the Bangkok area during the period from March through December 1984. Two hundred and three samples were collected from 10 different main streets during week-day rush hours (8:30-9:30 a.m. and 3:30-4:30 p.m.). The results of the study showed an absolute absence of asbestos fibres. Although the negative findings do not indicate an inhalation route of asbestos entry into the lungs, there remains the possibility of occasional contamination of the air from potential sources of asbestos pollution in some localities during extremely rough weather. Ingestion of contaminated food and drinks could also be a route of entry.