Study Objectives: Non-smoker Patients of asthma who are chronically exposed to the side smoke (ETS, Environmental Tobacco Smoke) from others have higher morbidity. The present study was designed to look if ETS – exposure was an important factor precipitating acute asthma. Design: Interviewing patients of asthma for exposures in the 24 hours preceding the interview to known triggers and ETS with the help of pre-designed questionnaire. Setting: Emergency Room and Chest Clinic of a 100 bed, tertiary care, referral, university-level institute. Participants: One hundred consecutive patients with acute exacerbations (Group I) and another 100 with stable, non-acute asthma (Group II). Results: There was a significant higher (p<0.01) prevalence of exposure to ETS in patients with acute exacerbations. Quantitatively, measured in ‘man-hours’, there was a higher exposure in this group. Sixty percent asthmatics had one or other symptom on acute exposure to ETS. Conclusions: Exposure to ETS causes acute worsening in non-smoker asthmatics.

Objective: To provide emergency assisted ventilatory care to needy patients in the absence of any available established intensive care unit (ICU) setup. Patients and Methods: Acutely ill patients referred from medical, surgical or any specialty wards who were considered to be in need of mechanical ventilatory support were provided round the clock assistance with ventilators and associated care in the respective wards by the Respiratory Care Unit. Main Results: A total of 1941 ventilated patients (1269 males and 612 females) with a mean age of 38.5±17.3 years were analyzed. Surgical patients were ventilated for post operative support as well as cases of complications besides cases of trauma. Medical patients included emergencies like various poisoning, snake bites, tetanus, septicemia, CVA, and acute neuroparalytic conditions etc. As many as 1209 patients expired but more importantly others especially many of those with reversible conditions survived. Analysis of physical and laboratory investigations is presented. Conclusion: The mobile respiratory service outside ICU set up could provide vital support to acutely ill patients all of whom would otherwise have faced certain death.

A study was conducted at the Institute of Thoracic Medicine, Chennai to find out the prevalence of multidrug resistant tuberculosis (MDRTB) among patients undergoing anti tuberculosis treatment for varying periods of time at four tuberculosis centres in Tamil Nadu. All patients were thoroughly interrogated with respect to their history of contact with pulmonary tuberculosis patients, previous anti tuberculosis chemotherapy, reasons for irregularity or default if any. Out of 782 cases studied, 162 were found to be bacteriologically positive. Thirty three (20.3%) of these 162 cases were found to be resistant to both isoniazid and rifampicin and belonged to the dangerous category of multidrug resistant tuberculosis. Ten (30.3%) of these 33 had history of contact with pulmonary tuberculosis patients and 28 (84.8%) had irregular and interrupted treatment. Twenty four (72.7%) of 33 cases of MDR TB reported that they had irregular and interrupted treatment because of the non-availability of drugs in various centres.

This study was carried out during the period of July 1986 to December 1994 to estimate prevalence of initial drug resistance to isoniazid (H), streptomycin (S) and rifampicin (R) and to find out its effect singly or in combination on response to short course chemotherapy (SCC) as compared to drug sensitive cases of pulmonary tuberculosis. Patients aged 15 years and above who were smear positive for acid fast bacilli (AFB) (two samples) and had not taken anti- tuberculosis treatment in the past were included in the study. Sputum samples for Mycobacterium tuberculosis culture were taken and those reported positive were subjected to drug resistance tests. Drug resistant cases were matched with drug sensitive controls for age, sex, socio-economic status, extent of disease and SCC regimens (R1 = 2HRZ/ 6TH/ or EH, R2 = 2SHRZ / 6TH or EH, R3 = 2EHRZ/ 6TH or EH) and results were analyzed by applying statistical tests. The overall prevalence of initial drug resistance (IDR) was estimated to be 25.6%. It was 24.4% for H, 13.4% for S, 0.8% for R and 11.9% for SH. Significantly high level of unfavorable results were obtained in resistant cases (15.3%) than sensitive controls (5.1%). Failure and relapse rates (F+R) were less in regimens R2 and R3 with streptomycin or ethambutol (E) in the intensive phase in addition to isoniazid, rifampicin and pyrazinamide. But this gain was not statistically significant. Of single drug resistance, H resistance caused failures and relapses in 13.3% of patients while S in 6.7% of patients. Failures and relapses were high in those with resistance to two drugs (17.3%) or three drugs (100%). Rifampicin resistance in combination with other drugs caused failure in 71.4% of patients.

This paper describes three cases of pleuropulmonary complications of amoebic abscess of liver (AAL). Early diagnosis and treatment of hepato-pleuropulmonary amoebiasis is very important in preventing serious complications and death.

A case of Kartagener’s syndrome was diagnosed in a 39 year old woman because of the presence of typical triad consisting of bronchiectasis, mirror image dextrocardia with situs inversus and chronic sinusitis. The case is presented here because of its rarity.