Association of Low body Mass Index with Respiratory Failure in Chronic Obstructive Pulmunary Disease.

BACKGROUND: Various studies have shown that low body mass index co-relates with the severity of Chronic obstructive pulmonary disease. The reduced body mass index in these patients is thought to be due to nutritional abnormality and raised circulating inflammatory markers. The study is aimed to find the association of body mass index with respiratory failure in patient with chronic obstructive pulmunory disease. METHODS: 142 patients who attended emergency /out-patient-department in Sir Sundarlal Hospital from August 2018 to July 2020 were enrolled for the study. 81 patients in one group had chronic obstructive pulmonary disease exacerbation with Type II respiratory failure. Among this group low and normal body mass index subgroup was categorized.61 patients in another group had chronic obstructive pulmonary disease. Non-invasive ventilation was applied to case group. Categorization of body mass index was done <18.5(Low BMI) and 18.5-24.9 (Normal BMI ). RESULTS: The mean age of the study group was (63.53±9.021). There was a significant difference in the body mass index between the groups ( p=<0.001,t=15.40). Severity of respiratory failure was compared using ph and pco2 in the between the groups which showed no significant difference (p=1,chi square 0.000), (p=0.40,chi square=0.72) however it did affect the outcome. CONCLUSIONS: Our study shows that overall respiratory failure was common in low body mass index cases compared to Control. Nevertheless there was no difference among severity of respiratory failure among low and normal body mass index subgroups and however it did affect the outcome.

A prospective study on tubercular fistula in ano and its management / Estudo prospectivo sobre a fístula anal tuberculosa e seu tratamento

Abstract Objective Tuberculosis fistula in ano, though less encountered, is an important clinical entity in developing countries like India. Diagnosis of TB fistula is a challenge despite of advances in diagnostic modalities and it depends upon both local and systemic clinical presentation. This prospective study aimed at to substantiate the importance of clinical diagnosis as well as medical management of tubercular fistula by antitubercular drugs. Methods and results 25 patients of fistula in ano suspected to be of tubercular origin underwent histopathology of fistulous tracks and an 8 week therapeutic trial of antitubercular treatment after getting an informed consent. Though biopsy showed positive evidence of tubercular pathology only in 52% cases, therapeutic trial showed improvement in local and systemic features in 23 (92%) cases. Of these 23 cases, 3 were cured after 18 months of anti tubercular treatment and 18 showed cure after 24 months of anti tubercular treatment while 2 cases withdrew from the study at 12 and 14 months respectively due to adverse drug reactions though their fistulous symptoms were relieved. Conclusion Meticulous clinical evaluation plays a vital role in diagnosis of tubercular fistula in addition to other diagnostic methods. Anti tubercular treatment is the mainstay of treatment in tubercular fistula with a minimum duration of 18-24 months owing to the recurrent and relapsing nature of disease.

Resumo Objetivo A fístula anal da tuberculose (TB), embora menos observada, constitui entidade clínica importante em países em desenvolvimento, como a Índia. O diagnóstico de fístula TB é tarefa desafiadora, apesar dos avanços nas modalidades diagnósticas; seu estabelecimento depende tanto da apresentação clínica local, como da apresentação sistêmica. Esse estudo prospectivo teve por objetivo consubstanciar a importância do diagnóstico clínico e também do tratamento clínico da fístula TB com medicamentos contra tuberculose. Métodos e resultados Foi realizado estudo histopatológico de tratos fistulosos em 25 pacientes com fístula anal com suspeita de origem tuberculosa; depois de obtido o consentimento livre e informado, esses pacientes foram submetidos a tratamento anti-tuberculose (TAT) durante 8 semanas. Embora a biópsia tenha revelado evidência positiva de patologia tuberculosa em apenas 52% dos casos, o curso terapêutico resultou em melhora nos aspectos local e sistêmico em 23 (92%) pacientes. Desses 23 casos, 3 e 18 casos estavam curados após 18 e 24 meses de TAT, respectivamente, enquanto que 2 pacientes desistiram do estudo após 12 e 14 meses, respectivamente, em decorrência de reações farmacológicas adversas, mesmo diante do alívio de seus sintomas fistulosos. Conclusão Juntamente com outros métodos diagnósticos, uma avaliação clínica meticulosa desempenha papel vital no diagnóstico da fístula TB. TAT é o principal procedimento terapêutico em pacientes com fístula TB, com duração mínima de 18-24 meses devido à natureza recorrente e recidivante da doença.