Diagnostic yield of pleural biopsy in exudative pleural effusion.

To know the diagnostic role of pleural biopsy in determining underlying etiological causes of exudative pleural effusion. A total of 47 patients, aged 16-104 years with mean age of 47.36 years, of either sex, with exudative pleural effusion underwent closed pleural biopsy with Abram's needle in standard way. Average 4-6 biopsy specimens were obtained from each patient, which were sent for histopathological examination. In this study, 47 cases of exudative pleural effusion were included, among them 26 (55.31%) cases were male and 21 (44.69%) were female with mean age 47.36 years. Cough was reported by 42 (89.36%) cases, expectoration 28 (59.57%), hemoptysis 3 (6.38%), breathlessness 27 (57.44%), wheezing 3 (6.38%), chest pain 38 (80.85%) and fever by 30 (63.82%) cases. Out of 47 cases, 28 (59.57%) cases had a positive yield, whereas in 19 (40.43%) cases the result was nonspecific inflammation. Out of 28 (59.57%) cases with positive yield 21 (44.68%) were found to have granulomatous inflammation and 10 (21.28%) cases were malignant. Among malignant pleural effusion, 4 cases were squamous cell carcinoma; 3 small cell carcinoma; 1 case adenocarcinoma and 1 case found to have mesothelioma. Tuberculosis and malignancy are the two most common causes of exudative pleural effusion in our set up. Pleural biopsy is a safe, simple and well validated diagnostic tool that helps us to differentiate between malignancy and tuberculosis.

Significance of adenosine deaminase in diagnosing tuberculous pleural effusion.

Tuberculosis (TB) is a major public health problem in developing countries including Nepal. One of the common presentations of TB is pleural effusion. The diagnosis of tubercular pleural effusion can be difficult because of the low rate of detecting tubercule bacilli by direct stain and culture of pleural fluid for acid-fast bacilli (AFB). Pleural biopsy can be useful but is invasive and requires experts. In this context, pleural fluid Adenosine Deaminase (ADA) level has been proposed as easy, cheap and highly sensitive test for diagnosis of TB pleural effusion. The present study was undertaken to define the role ofpleural fluid ADA value in accurate diagnosis of TB pleural effusion. A Prospective analysis of 100 patients admitted in Nepal Medical College and teaching Hospital with pleural effusion was done. Pleural fluid ADA level was evaluated in all patients, and significance of pleural fluid ADA level in TB pleural effusion was studied. It was found that mean ADA level in pleural fluid was 105.8 +/- 67.23 U/L in cases of TB, as compared to 16.83 +/- 8.91 U/L in malignancy, 44.53 +/- 32.84 U/L in parapneumonic effusion and 15.94 +/- 4.88 U/L in patients with miscellaneous diagnosis. For a cut-off value of 42.19 U/L for diagnosis of TB pleural effusion, sensitivity was found to be 90.8% and specificity 82.8%. Almost all patients diagnosed to have TB pleural effusion responded completely to anti-tubercular treatment. So, we concluded that pleural fluid ADA analysis could be easy, cheap and highly sensitive and specific test for diagnosis of TB pleural effusion.

Tuberculosis in patients undergoing maintenance hemodialysis: one year follow up study from Nepal.

In Nepal where tuberculosis is endemic and data regarding the prevalence of tuberculosis in patients undergoing maintenance haemodialysis is not known we tried to see the cumulative incidence of tuberculosis in these higher risk groups' patients. Forty patients were followed up for one year after initial screening for tuberculosis. Among forty patients 34 (85%) were male and 6 (15%) were female. During initial screening four patients had sputum positive tuberculosis and three more patients had sputum positive tuberculosis during follow up. Among nine patients with pleural effusion two patients had pulmonary tuberculosis. One patient had tubercular cervical lymphadenitis. Two patients died during follow up and the rest improved with anti tubercular treatment. So in the part of the world where tuberculosis is endemic patients undergoing maintenance haemodialysis should be screened for tuberculosis regularly.

ECG changes in octogenarians.

Numerous studies have been done about the Electrocardiogram (ECG) in the elderly but just a few regarding the changes in ECG in octogenarians. Ageing is definitely associated with changes in the cardiac conduction and physiology. This study attempts to evaluate the ECG in octogenarians. ECG recordings from 165 octogenarian subjects were obtained from subjects aged 80-89 years, mean age was 82.75 +/- 2.41 years. ECG's were normal in 27.27 % of the study population. The major abnormalities noted were right bundle branch block 15.15%, left ventricular hypertrophy in 13.93%, Poor R-wave progression in precordial leads in 10.91%, atrial fibrillation in 8.48%, ST changes in 8.48%, sinus tachycardia in 6.66% and sinus bradycardia in 4.84% of the study population. The mean QTc was 0.41s. Because of its non-invasive nature, ECG is a least expensive, readily available diagnostic tool for evaluating cardiac health issues in the growing elderly population. We hope the observations will be helpful in future studies, in evaluating cardiac health in octogenarians and in clinical practice.

Spirometric evaluation of pulmonary function tests in clinically diagnosed patients of bronchial asthma.

The present study was undertaken to assess the difference between the normal predicted value and observed value of pulmonary function test (PFT) amongst the asthmatic patients and also to compare the aforesaid observed values between male and female asthmatic patients. Clinically diagnosed cases (male 62, female 75) of bronchial asthma attending medical out patient department of Nepal Medical College Teaching Hospital were assessed. All the pulmonary parameters showed significantly less observed values than the normal predicted values except PEFR in female and FVC in male asthmatic patients. Hence, PEFR in female and FVC in male asthmatic patients might not be considered as a valid parameter to indicate bronchial asthma. Present study also revealed that all the pulmonary variables were significantly higher in males than in females.

Fiber-optic bronchoscopy: seven-year experience at Nepal Medical College Teaching Hospital.

Fiber-optic bronchoscopy is a safe and useful diagnostic and therapeutic tool for the management of the pulmonary diseases. The purpose of this study was to find out the demographic profiles, indications, bronchoscopic findings, and diagnoses of the patients who underwent bronchoscopic examination. Retrospective analysis of 231 consecutive bronchoscopies done in Nepal Medical College Teaching Hospital over the period of seven years (January 2003 to January 2010) was done. The commonest indication was radiological opacity (90.2%), followed by diffuse pulmonary infiltrates (4.3%). Cough was the commonest presenting symptom seen in 89.8% of the patients. 79.7% of the patients were smokers and the history of smoking among the patients diagnosed to have lung cancer was 94%. The commonest bronchoscopic finding was endobronchial growth (47.8%). Histopathological examination revealed malignancy in 53.8% of the patients, of which small cell lung cancer was 22.8% and non small cell lung cancer 77.2%. Even when growth was not visualized on bronchoscopy, biopsies attempted from the segments with radiological abnormality established the diagnosis of malignancy in 10.16%, pulmonary tuberculosis in 5.1% and Sarcoidosis in 2.2% of the cases.