Background: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, is the major health care burden responsible for morbidity and mortality. The objective was to study the profile of adverse drug reactions (ADRs) and its outcome.Methods: It was a prospective observational study conducted in one of the RNTCP centre of Ahmedabad district. All TB patients visiting and taking short course of directly observed treatment (DOTS) were enrolled and monitored for ADRs. All the ADRs spontaneously reported or identified by the researcher were recorded and analyzed.Results: Total 974 patients screened during the study period 72 (7.79%) developed ADRs. Significantly higher occurrence of ADRs were in age group of 31- 40 years (p<0.01). Out of these 72 patients, 49 (68%) were having pulmonary TB. No statistically significant association was found between gender of patient, site of TB and occurrence of ADRs (p>0.05). Occurrence of ADRs was significantly more (p<0.05) in patients of category I TB (31, 43%). Out of the 49 (68%) pulmonary tuberculosis patients who developed ADR, 32 patients (44%) were sputum positive showing significant association (p<0.05). Gastro-intestinal side effects were most common ADRs followed by giddiness and headache. Nine patients required complete stoppage of offending agent, while 2 patients require treatment interruption and most of the patients (61) were managed with supportive medication without removing anti tubercular drug from their treatment regimen. Out of these 72 patients, majority (56) declared cured at the end of treatment.Conclusions: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

Background. Chronic obstructive pulmonary disease (COPD) is a major cause of disease burden worldwide. Patients with COPD have impaired quality-of-life due to dyspnoea, frequent exacerbations, limitation of exercise capacity, muscle dysfunction, and malnutrition. Hence, pulmonary rehabilitation should be considered as a part of management of patients with COPD. Present study emphasises on the efficacy of pulmonary rehabilitation in improving the long-term well-being of patients with COPD.Methods. Fifty patients with COPD were included and were followed up at 8, 24, 48 and 96 weeks. Patients were taught exercises to strengthen the lower limb muscles, breathing exercises along with upper limb exercises.Results. The outcomes recorded after 96 th week of rehabilitation programme were as follows: dyspnoea grade at (4.1±1.06 versus 1.6±0.6 with paired 't' test of 20.8328, p<0.0001), health-related quality-of-life (HRQoL) (57.7±11.6 versus 38.7±10.6, 't' test 75.9631, p<0.0001), forced expiratory volume in one second (FEV 1 ) (43.1±16.0 versus 40.3±16.0, 't' test 19.1064, p<0.0001) FEV 1 /forced vital capacity (FVC) (0.86±0.11 versus 0.80±0.12, 't' test 17.0750, p<0.0001). Conclusion.Pulmonary rehabilitation reduces dyspnoea, increases the exercise capacity and improves qualityof-life, reduces frequent exacerbations, thus, improves overall well-being of patients with COPD, resulting in reduction of significant cost of health burden on society indirectly.

Background. Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in patients on mechanical ventilation (MV). There is paucity of data in our country regarding incidence, crude mortality rate, clinical profile, microbiological organism profile, mortality in early and late onset VAP and mortality as well as appropriate antibiotic therapy in these patients.Methods. The study involved patients above 15 years of age with clinical suspicion of VAP, receiving MV for more than 48 hours in intensive care unit of our hospital. Patients were without evidence of pneumonia on admission. Study patients were followed until they were successfully treated and discharged from the hospital or death.Results. Out of 50 patients, 31 (62%) patients were in 4th to 6th decades of life. Incidence of VAP was 21% and crude mortality rate was 42%. Due to neurological conditions, 22 (44%) patients required MV. VAP developed in 38 (76%) patients within 15 days of initiation of MV. Mortality in late onset VAP was found to be twice as compared to mortality in early onset VAP. Mortality in inappropriately treated patients was significantly higher than that of appropriately treated patients.Conclusions. The incidence of VAP increases with increase in duration of hospital stay. There is significant morbidity and mortality in mechanically ventilated patients of VAP; if not treated appropriately early.

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INTRODUCTION: Pulmonary Alveolar Proteinosis (PAP) is a syndrome characterized by progressive accumulation of surfactant phospholipids and proteins within alveoli and terminal airways due to decreased surfactant clearance by alveolar macrophage. There are three types,1) congenital2)primary/idiopathic 3) secondary Open lung biopsy with PAS stain is gold standard for diagnosis. Other supportive investigation are chest x ray, HRCT Thorax, GM CSF antibody, hypoxia in ABGA, restrictive or normal PFT.Whole Lung Lavage is mainstay of treatment. GM CSF, plasmapheresis, lung transplantation, supportive care, anti B lymphocyte immunotherapy are other modes of treatment. Some cases shows spontaneous remission. Majority of patients do not require second cycle of WLL.