No information is available on epidemiology of bronchial asthma in Rajasthan. A field study was therefore, undertaken to estimate prevalence of bronchial asthma and to define the risk factors influencing the disease prevalence in Jaipur district of the state using a previously validated questionnaire. Besides demographic data, information on smoking habits, domestic cooking fuel used, atopic symptoms, and family history suggestive of asthma was also collected. Multivariate logistic regression analysis was performed to calculate odds ratio of various potential risk factors. Data from 8863 respondents (5010 men, 3853 women) were analyzed after excluding children below 15 years of age. One or more respiratory symptoms were present in 5.3% of the subjects. Asthma was diagnosed in 1.86%, 1.44%, 0.51 and 0.38% of the rural male, rural female, urban male and urban female respondents respectively, with an overall prevalence of 0.96%. History of atopy in self and/or history of atopy/asthma in the first-degree relative were found to be the most important risk factor. Advancing age, usual residence in rural area and tobacco smoking, especially hookah smoking, were also associated with significantly higher odds of having asthma.

Introduction: There is still no consensus on the efficacy of BCG vaccine in the prevention of tuberculosis. This study therefore addressed the question of the magnitude of immunity afforded by BCG, by studying the effector mechanisms of protection in children. The main objectives were to assess the degree of immunity conferred by BCG vaccine in children and to identify the most immunogenic antigen(s) of BCG by conducting in-vitro studies. Materials and methods: Children in the age-group of 1 to 10 years, were categorized: (A) normal, and vaccinated with BCG during the first year, n=45, (B) normal, without scar and with no evident history of vaccination, n=31: and (C) children admitted in the hospital with a confirmed diagnosis of tuberculosis, n=31. Fractions of BCG were obtained by lysis, sonication, separation by gel chromatography, HPLC and confirmed by SDS-PAGE. In lymphoproliferative assays PBMC were cultured and stimulated with either Concanavalin-A or Tuberculin or the fractions of BCG. Stimulation indices (SI) in lymphoproliferation, CD4/CD8 cells, levels of Interferon-γ (IFN- γ) in the culture supernatants were measured by ELISA. Results: The vaccinated children displayed significantly high (P<0.05) mean values of SI in LTT, CD4/CD8 cell ratio against the unfractionated, 67kDa fraction and BCG-CF Ags. While 100% of the vaccinated children had positive lymphoproliferation indices to BCG-CF, only 8.3% of the unvaccinated children were positive. Conclusion: Some of the components of BCG induced a strong Thl cell response in children. These immunogenic antigens were present in the whole cell lysate. The use of BCG vaccine for tuberculosis is worthwhile till a new vaccine is developed.

Human immune-virus (HIV) infection is the most significant risk factor for progression of latent mycobacterium tuberculosis (MTB) infection to active tuberculosis. Tuberculosis reactivation among human immunodeficiency virus (HIV) infected cases can be prevented by anti tubercular chemoprophylaxis. This randomized controlled study compared the efficacy of 2 months of daily rifampicin and pyrazinamide and 6 months of daily rifampicin and isoniazid drug regimes in preventing active tuberculosis in HIV seropositives. It is observed that 2 months of daily rifampicin in combination with pyrazinamide is not only efficacious as that of 6 months of daily rifampicin and isoniazid combination in preventing active tuberculosis in HIV seropositives but has the advantage of better compliance, lesser side effects and prolonged post prophylactic preventive effect.

Background: Mechanical ventilation (MV) is a life saving modality. Till no method is evolved to predict the duration of this treatment. This study is undertaken to evaluate the clinical and laboratory parameters at initiation and 48 hour of the patient being treated by mechanical ventilation; and correlate these parameters with the duration of MV required. Methods: It was prospective observational study conducted in the respiratory intensive care unit (RICU) of a tertiary referral and teaching hospital. Thirty consecutive patients suffering from various medical diseases requiring MV were the participants. Clinical, laboratory, ventilatory parameters and six severity scores viz.; GCS, APACHE-II, SAPS, OSF, ALI/ARDS and Sepsis/Septic shock criteria of each patient, both at initiation and at 48 hour of MV were recorded. Correlation between various severity scores at initiation and at 48 hour of initiation with duration of mechanical ventilation was computed. Results: Based on the duration of mechanical ventilation required, the patients were divided in two groups. Those requiring mechanical ventilation <7 days and >7 days were designated Group I and Group II respectively. Three out of 6 severity scores (GCS, APACHE-II, SAPS) recorded at 48 hour of MV showed statistically significant difference between the both groups with p value of 0.010, 0.009 and 0.006 respectively. Further stepwise logistic regression analysis showed that SAPS score at 48 hour of initiation was the best predictor of duration of MV. It was found that a cut off value of 15 for SAPS score at 48 hour might predict the duration of MV i.e. <7days or >7 days. Based on linear regression analysis a simple equation was formulated by putting the SAPS value at 48 hour, the value of Y was computed. If MV required was less than 7 days, the value of Y was more than - 0.172 and if need of mechanical ventilation was more than 7 days, Y was less than -0.1720. Conclusions: For patients requiring MV the clinical, laboratory, ventilatory parameters and severity scores at 48 hour of initiation of MV were more significantly correlated to duration of MV as compared to those at initiation. So the parameters and severity score at 48 hour may help to anticipate the approximate duration of MV. Further a cut off value of 15 for SAPS score at 48 hour helped to predict the duration of mechanical ventilation. The calculation of Y from evolved equation is presumed to predict the duration of requirement of MV.

Sputum induction by inhalation of hypertonic saline is a noninvasive, simple, cost effective and safe procedure to collect respiratory secre­tions from lung airways for diagnosis of various respiratory diseases. Sputum induction has higher yield in comparison to spontaneous sputum, BAL, bronchial washing and gastric lavage. It is widely used to assess airway inflammation in asthma and chronic obstructive pulmonary disease (COPD). It can be used as a complementary tool to BAL both in research and in clinical monitoring of patients with interstitial lung disease (ILD). The cells, recovered from spontaneous coughing can be used to study lung cancer, respiratory infections and in diagnosis of pneumocystis carinii pneumonia in patients infected with human immunodeficiency virus. In developing countries having high prevalence of pulmonary tuberculosis, sputum induction (SI) can increase the diagnostic yield, resulting in better categorization of patients for treatment purposes. It increases case detection rate of smear negative pulmonary tuberculosis specially in area where facili­ties for more invasive and expensive techniques are not available.

Intrapleural administration of fibrinolytic agents has been shown to be effective and safe in the treatment of loculated parapneumonic pleural effusions. It's use in multiloculated uraemic effusion has been rarely reported. We report a case of uraemic multiloculated pleural effusion who failed to respond to standard chest tube drainage but showed dramatic and complete resolution with intrapleural streptokinase.

Allergic bronchopulmonary aspergillosis is an uncommon condition characterized by hypersensitivity to aspergillus antigen. It commonly presents as refractory asthma, fleeting pulmonary opacities and bronchiectasis. The authors describe an unusual presentation of allergic bronchopulmonary aspergillosis, when it was mistaken as bronchogenic carcinoma and review the current literature on the diagnosis and management of this rare condition.