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Biomedical subjects

V K Arora

Publications and source records attributed to V K Arora.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Pattern of opportunistic pulmonary infections in HIV sero-positive subjects: observations from Pondicherry, India.

Prospective analysis for a period of six-and-a-half years was done in 190 patients with HIV infection, which showed post-primary tuberculosis with sputum positive for acid-fast bacilli in 65% of cases. Extrapulmonary forms of tuberculosis especially lymph nodes infection was more frequent. Cervical group of lymph node involvement was the commonest presentation. Procedures such as FNAC/biopsy of lymph nodes and pleura provided the immediate diagnostic yields. These procedures must be considered early in the course of illness of HIV infected patients with suspected extrapulmonary and disseminated tuberculosis. Tuberculosis constitutes a common pathology with an appreciable mortality in disseminated subjects. Majority of patients with tuberculosis responded to 2EHRZ/7HR therapy indicating infection by Mycobacterium tuberculosis rather than by atypical mycobacteria, without any serious adverse reactions. Retrospective analysis of two groups (February 1991-May 1994) and (June 1994-October 1997) shows a significant increase in disseminated tuberculosis and Pneumocystis carini pneumonia indicating late stage of HIV disease.

AIDS-Related Opportunistic Infections↗
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Revised National Tuberculosis Control Programme: Indian perspective.

The global tuberculosis programme has promoted the revision of National Tuberculosis Programme by strengthening the focus on Directly Observed Treatment Short-course (DOTS). National Tuberculosis Control Programme (NTCP) which was established in 1962 had less than 30 per cent treatment completion. Based on an in-depth review of the programme by a high level committee in 1992, a Revised National Tuberculosis Control Programme (RNTCP) was envisaged with a view to achieve a cure rate of at least 85 per cent amongst newly detected sputum positive cases under DOTS. By December 1999, 130 million of population had been covered in the country under DOTS. However, there are many challenges that are required to be met before RNTCP can become a success story in our country.

Female↗
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Open lung biopsy in diffuse infiltrative lung disease with progressive dyspnoea: is it useful?

Eleven subjects, aged between 15 and 60 years, presenting with diffuse infiltrative lung disease (DILD) and progressive dyspnoea, underwent an open lung biopsy (OLB). The authors feel that OLB does give a confidence to the treating physician to begin with a specific therapy in the form of steroids. But, as a matter of fact, at most health care delivery centres in the country, facilities for OLB are not available. Hence, the specific therapy should be instituted presumptively following an overall suggestion of disease based upon the clinical, physiological (chiefly comprising the pulmonary function test or PFT) and the radiological criteria, so that progression of disease could be arrested at an early stage.

Adolescent↗
PubMedDate not supplied

Role of gallium arsenide laser irradiation at 890 nm as an adjunctive to anti-tuberculosis drugs in the treatment of pulmonary tuberculosis.

BACKGROUND: Tuberculosis is a global emergency with about nine million people developing disease every year. The long duration of treatment has emerged as a major obstacle in the control of tuberculosis. There is a need for development of new drugs and or shortened therapy. METHODS: The present study was carried out to explore whether any benefit could be achieved by the addition of low level energy laser therapy (LLLT) to the conventional anti-tubercular chemotherapy. One-hundred-thirty new sputum smear positive patients of pulmonary tuberculosis were enrolled to evaluate the bio-stimulatory effects of Gallium Arsenide laser irradiation at 890 nm, as an adjuvant therapy. These patients were randomly divided into two groups to receive either LLLT or sham irradiation (control) concomitantly with anti-tuberculosis chemotherpy. RESULTS: The patients treated with semiconductor laser as an adjuvant therapy along with anti-tuberculosis drugs had a faster clearance of tubercle bacilli from the sputum as compared to the control group (P value at :45 days=0.1392, 60 days=0.0117, 75 days=0.00805, 90 days=0.00739). CONCLUSIONS: These findings provide preliminary evidence that low level laser therapy with Gallium Arsenide laser may be a promising adjunctive therapy for patients with tuberculosis. Faster conversion of sputum should prevent the development of resistant mutants.

Antitubercular Agents↗
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A case of Hodgkin's disease presenting as lymphocytic interstitial pneumonitis.

Lymphoproliferative disorders of lung have a broad clinical and pathologic spectrum. The clinical and radiographic features are non-specific. Accurate diagnosis is required to initiate appropriate therapeutic intervention. We report a case of Hodgkin's disease mimicking lymphocytic interstitial pneumonitis in a 21-year-young male.

Adult↗
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Delayed presentation and surgical management of a bronchial tear.

Tracheobronchial injuries following blunt trauma to the chest can be life-threatening. However, failure to diagnose can lead to various acute or chronic complications. A delayed presentation is quite rare and its surgical correction is highly challenging. We present here two cases, which came to us after four and six months of trauma respectively. In these patients, successful surgical repair of totally obstructed right main bronchus in the first case and left main bronchus in the other was carried out. The post-operative course was uneventful with improvement in the respiratory status of both the patients. High degree of suspicion and awareness of the possibility of bronchial tear are required for proper management of such cases.

Adolescent↗
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Multi-drug resistant tuberculosis in context of RNTCP.

DOTS has been successful in improving cure rates in tuberculosis worldwide, but has remained an inefficient strategy in respect of multidrug-resistant tuberculosis (MDR TB). The present article discusses its management in context of RNTCP and focuses specially on DOTS-plus, a strategy arising out of the constitution of Green Light Committee to effectively tackle the cases of MDR TB globally.

Directly Observed Therapy↗
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Profile of geriatric patients under DOTS in Revised National Tuberculosis Control Programme.

BACKGROUND: With an increase in life expectancy and the resultant elderly population, there has been an increase in the number of tuberculosis (TB) cases including those in geriatric age as well. However using Directly Observed Treatment-Short Course (DOTS), all categories of TB patients have been sucessfully treated within the country. A need was felt to study the profile of geriatric TB patients under the Revised National Tuberculosis Control Programme (RNTCP). METHODS: A retrospective study of 7439 patients enrolled under DOTS from January 1996 to March 2001 was carried out in a tertiary care referral institute in Delhi and the profile was analysed in terms of the gender, type of TB and ratio of sputum smear-positive to negative patients for both the younger and geriatric age groups. Further, treatment outcomes of the two age groups were analysed and compared for the 2655 new sputum smear patients. RESULTS: The male : female ratio of 315 geriatric TB patients enrolled under DOTS was observed to be 3 : 1 as against the 1.4 : 1 in younger TB patients. The occurrence of pulmonary TB was significantly higher than extra-pulmonary TB in geriatric age group (16:1) as compared to the younger age group (4:1). The ratio of new smear-positive to smear-negative patients was almost similar in the two age groups. Further, the treatment outcomes of new smear-positive geriatric TB patients in comparison to younger TB patients showed significantly lower sputum conversion (75.3% vs 85.7% respectively) and cure rates (69.2% vs 80.7% respectively), significantly higher exclusion rates from DOTS (2.3% vs 0.15% respectively) and relatively higher default and treatment failure rates. CONCLUSIONS: The present study has identified certain issues in the Indian TB patients of geriatric age. These include a lower reported prevalence amongst females, poor sputum conversion as well as cure rates and higher exclusion as well as default rates. Further studies are needed to address the issues under operational conditions of Indian RNTCP.

Aged↗
PubMedDate not supplied

Haemoptysis.

Explore the source record for details and available documents.

Clinical Protocols↗
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Private-public mix: a prioritisation under RNTCP--an Indian perspective.

Success of the public directly observed treatment, short course (DOTS) programmes have been widely reported from various parts of the world and have been described from the Indian subcontinent as well. But, it is being increasingly realised that further DOTS successes can take place only by ensuring a private sector participation under the programme. While discussing behaviour-profile of patients, this review enumerates possible reasons for their averseness of a public health facility and preference for a private health. facility. Similarly, behaviour-profile of private health providers brings out the discrepancies in their clinical practices. Both types of profiles are supported with the studies from India and abroad. A comparison is drawn between available services of the public and private health facilities, with a focus on the need for prioritisation of a private-public mix (PPM) in the Revised National Tuberculosis Control Programme (RNTCP). Furthermore, the salient features of schemes recommended by the Directorate General of Health Services, New Delhi, for involvement of the private- practitioners, and the Non-Governmental Organisations are briefly outlined. The underlying obstacles for private sector participation in RNTCP and the projected solutions so as to effect a private-public mix in the Revised Programme are also dealt with. A description of few operating models, trying in the best possible manner to bring about a private sector participation in programme, is presented to make the readers aware of the efforts going on in that direction within the country. The private health sector, easily being a patient's first choice, needs to be integrally involved in RNTCP on a priority basis, feasibility of which, has been successfully documented in the operational trials conducted within the country so far.

Antitubercular Agents↗
PubMedDate not supplied

Accidental condom inhalation.

A 27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve. A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe. Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed the presence of a condom. Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio.

Adult↗
PubMedDate not supplied

A thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy: a rare association.

An 18-year-old boy presented with a rare association of a thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy. He was put on a Category I regimen with standard short course daily chemotherapy of four anti-tubercular drugs under the National Tuberculosis Programme. After a six-month of anti-tubercular treatment (ATT), the boy showed clinical and bacteriological improvement. The thyroid scan with Technetium 99 (Tc 99) and the chest skiagram also became normal.

Abscess↗
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Hydrocarbon pneumonitis following diesel siphonage.

In our country, siphoning of diesel/petrol from fuel tanks is a common practice. We describe a 50-year-old farmer, who accidentally aspirated fuel while siphoning from his tractor. A diagnosis of diesel induced aspiration pneumonitis was confirmed by the presence of foam cells on bronchial biopsy. The patient showed gradual recovery with the symptomatic therapy. However two weeks later, he developed sudden chest pain and irregularly irregular pulse that proved fatal. Diesel aspiration leading to bilateral pneumonitis is yet to be reported in our country.

Air Pollutants↗
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Improved case detection of tuberculosis through a public-private partnership.

Case detection of tuberculosis under public DOTS programmes is still low and there is currently a search for new ways to improve these programmes. We investigated the impact of a public-private partnership DOTS programme on tuberculosis case detection in New Delhi, India. Time series of case detection in an intervention and a control area were analysed through segmented linear regression modelling. We found that a significant positive trend shift occurred in the intervention area as compared to the control area after the partnership was initiated. The study indicates that public-private partnership is feasible way to improve TB case detection.

Directly Observed Therapy↗
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Influence of pre-treatment bacillary load on treatment outcome of pulmonary tuberculosis patients receiving DOTS under revised national tuberculosis control programme.

OBJECTIVE: To study the influence of initial bacillary load on sputum conversion rates and treatment outcome of new smear positive pulmonary tuberculosis patients. METHODS: A retrospective study was done among 2938 new smear positive pulmonary tuberculosis patients, registered at the peripheral centres, covering a population of 1.6 million in Delhi, India. The patients pre-treatment sputum smears were graded as 1+, 2+ or 3+ based on three samples. Patients were given intermittent short-course chemotherapy under supervision and the treatment outcome was analysed. RESULTS: Sputum conversion rates among patients graded as sputum 3+ and rest of the patients (combined graded sputum 1+ and 2+) at the end of two months were 62.2% and 76.8% respectively (p<0.001), and at the end of three months were 81.3% and 89.5% respectively (p<0.001). Cure rates among same group of patients were 76.6% and 85.1% respectively (p<0.001), and failure rates were 7.7% and 4.5% respectively (p<0.001). CONCLUSIONS: Under field conditions even with directly observed treatment (DOT) new smear positive patients with heavy bacillary load showed statistically significant poor sputum conversion rates at two and three months and higher failure rates as compared to patients with lesser bacillary load. To investigate possible reasons for this poor response and possible solutions further studies are needed.

Adolescent↗
PubMedDate not supplied

Emphysematous pyelonephritis: a consequence of adenocarcinoma of urinary bladder in a nondiabetic patient.

Emphysematous pyelonephritis (EP) is a life threatening condition of acute necrotising renal parenchymal infection that encompasses a much wider spectrum of complicated urinary tract infections such as renal abscesses, emphysematous pyelitis, pyelonephritis, acute renal papillary necrosis, and sepsis. We report an unusual case of adenocarcinoma bladder in a middle aged nondiabetic patient, presenting with EP. Emphysematous pyelonephritis was the initial symptom in this case with an underlying carcinoma of the bladder. The role of imaging is prime in management of such cases, if an early diagnosis is to be made and a potentially devastating outcome is to be avoided. The literature regarding EP has been reviewed and discussed. The goals of managing EP should be (1) early institution of parenteral antibiotics and a (2) a staged nephrectomy (preceded by a temporary percutaneous drainage particularly with antibiotic resistant septicemia) so as to maximize survival rather than proceeding directly to emergency nephrectomy.

Adenocarcinoma↗