A case of right sided pulmonary hypoplasia is described. A 20 years male was admitted in our department with complaints of recurrent chest infections since childhood. Clinical examination revealed smaller right hemithorax. Serial chest X­ rays showed nonprogressive lesions over several years. Bronchoscopy and CT scan thorax confirmed the diagnosis of right sided pulmonary hypoplasia. It was not associated with any other developmental anomaly.

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Setting: The tuberculosis referral center of a tertiary care hospital. Objective: To determine human immunodeficiency virus (HIV) seropositivity, diabetes mellitus (DM), treatment outcome, cost, and adverse drug reaction in patients with multi­drug resistance (MDR) pulmonary tuberculosis. Design: 56 cases of MDR tuberculo­sis from April 2001 to April 2003 were included. Fasting blood sugar and three-step rapid immunoassay test for HIV was performed in all cases. 45/56 patients were able to arrange for second line drugs with the help of Medical Social Worker. Results: 1/56(1.8%) and 7/56 (12.5 %) cases were positive for HIV and DM respec­tively. Of the 45 cases started on second line drugs, 5 (11.1%) defaulted, 9 (20%) patients died, 31 patients (68.8%) completed treatment of which 19 (61%) were cured and 9 (39%) failed therapy. 17/19 (89%) who were cured had never received any second line drug previously (P=0.004 i.e. less than 0.5). The cost of therapy was $1000-2000. Adverse drug effects were seen in 13/45 patients (28.8%). Con­clusions: Successful outcome of therapy was associated with absence of previous treatment with one or more second line drugs. Treatment with second line drugs was expensive and toxic

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The present study was conducted in the Department of Medicine, Assam Medical College and Hospital, Dibrugarh for a period of one year from 1st of August 2004 to 31st July 2005 on patients of tuberculosis with associated diabetes to assess the efficacy of DOTS in pulmonary tuberculosis. Glycemic control was achieved with the use of insulin and most patients showed fair control of hyperglycemia. Though the study group lagged behind in the initial weeks all the cases and controls im­proved clinically at the end of 2 months. The diabetic population lagged behind in radiological improvement at the end of 3 months. Sputum conversion was achieved at the end of 3 months in all cases after giving extended treatment in the respective cases. This study showing efficacy of DOTS in pulmonary TB and Diabetes is the first of its kind in this region.

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The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random­ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured interview schedule, Asthma Symptom Checklist, Asthma di­ary, Asthma Bother Profile, Hospital Anxiety & Depression Scale, AQLQ and Peak Expiratory Flow Rate. Within group comparison showed significant improvement in both groups at the post assessment. Between group comparisons showed that CBT group reported significantly greater change than that of SM group. Cognitive behavior therapy helps in improving the managment of asthma.

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A middle aged male presented to us with right side pneumothorax. Two hours after insertion of intercostals tube he felt discomfort and increased breathlessness. His chest examination showed crepitations. Chest radiograph showed partial expansion of right lung with opacity in right lower zone consistent with unilateral pulmonary edema. He was managed conservatively and improved with complete resolution on chest radiograph. Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax and patho­genesis is unclear.

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A case of yellow nail syndrome is described in a forty year old male patient who presented with classical triad of this syndrome i.e. deformed yellow nails, lymph­edema and chronic recurrent pleural effusion. The practical problems in the di­agnosis are also briefly discussed with emphasis on awareness of this rare clinical entity.

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Objectives : To find the pattern of initial drug resistance in fresh sputum culture positive cases of pulmonary tuberculosis and its impact on maintenance phase of short course chemotherapy (SCC) and treatment outcome. Methods : Case records of all patients of initial drug resistance treated by us be­tween Jan 2001 to May 2004 were analyzed retrospectively. Pattern of drug resis­tance leading to modification of maintenance phase of anti-tubercular treatment (ATT) and treatment out-come in these patients were analyzed. After treatment all cases were followed up for a minimum of six months duration, for relapse. Results : Out of 769 cases of culture positive pulmonary tuberculosis , drug resis­tance was seen in 138 patients. Out of total 203 individual drug resistance, resis­tance was present to isoniazid in 22, rifampicin in 27, ethambutol in 23, streptomy­cin in 16, pyrazinamide in 36 and ciprofloxacin in 79 cases. Among them 5 drugs resistance was seen in 4 patients, 4 drugs resistance in 3 patients, 3 drugs resistance in 9 patients, 2 drugs resistance in 22 patients and single drug resistance in 100 patients, Multi drug resistance (MDR) was observed in 12 patients. One patient died of hemoptysis after 4 months of ATT. Four patients continued to be sputum positive even after one year of second line ATT. They were subsequently lost to follow up. All the remaining patients achieved cure and had no relapse at the end of six months follow up. Conclusion: This study highlights the importance of initial drug resistance in modifying maintenance phase of short course chemotherapy, thereby improving success rates and helps in preventing multidrug resistance tuberculosis.

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Idiopathic pulmonary fibrosis (IPF), a progressive fibrosing lung condition is a ther­apeutic medical challenge. The etiopathogenesis of IPF is complicated and hitherto not adequately understood. However, the concept, of late, is shifting from fibrosis as a result of inflammation to a mechanism of primarily dysregulated fibrogenesis. A class of enzymes called matrix metallo proteinases (MMPs) appear important in the pathogenesis of IPF. The heightened activity of MMPs are derived out of an imbalance between them (MMPs) and their tissue inhibitors (TIMPs). This leads to breakdown of interstitial matrix and triggering of certain growth factors which play an important mechanistic role in the pathogenesis of IPF. Understanding of the role of MMPs in pathogenesis of IPF may open up a new horizon of therapeutic intervention of the desease.

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