Introduction:Silicosis in Coimbatore district of Tamil Nadu: A passive surveillance study.Aim:This study was done to describe the level of preventive measures and level of awareness among the patients diagnosed with silicosis during a one-year period.Settings and Design:Coimbatore Medical College Hospital.Materials and Methods:This is a passive surveillance study based on patients diagnosed with silicosis in our outpatient facility for a one-year period between January 1, 2012 and December 31, 2012.Results:Seventeen cases of silicosis were diagnosed based on history of exposure to silica and radiological features. The mean age was 55 years with 16 males and one female. The average duration of exposure was 22 years. A protective mask was used by 29% of the patients and one patient had awareness about the risks of exposure to silica. Active tuberculosis was found in 12% and old tuberculosis in 47% of patients; 59% of the patients were smokers. Spirometry showed a restrictive pattern in 59% of the patients. Radiologically nodular opacities with upper-zone predominance was found in majority of the cases.Conclusion:Most patients are exposed to silica in unorganized industries. Majority of the patients lack awareness about the disease and there is a low implementation of preventive and control measures. As this study was a passive surveillance, it represents only the tip of iceberg and an active field-level surveillance could reveal the true prevalence of this disease.

Abstract

To evaluate the prevalence of Severe Asthma with Fungal Sensitization. To study the role of Itraconazole in patients of severe asthma with fungal sensitization by randomized controlled trial.METHODS: 100 patients with severe asthma were taken in for study. Aspergillus fumigatus specific skin prick test was done. Patients who showed positive skin prick test were ruled out ABPA. Absolute eosinophil count less than 1000/mm^3, Serum IgE less than 1000 IU/mL, HRCT lungs without features suggestive of ABPA were regarded as patients with SAFS. Patients with SAFS were taken in for randomised control study and were separated into 2 groups. All patients received basic asthma medications for severe category in addition group A received tablet Itraconazole 200mg BD for 12 weeks and group B received placebo. Symptomatic assessment was taken in account for the patients whether they had well controlled/ partially controlled/ uncontrolled asthma symptoms and compared with the outcome. Serial PFT was done for all patients. Serum IgE, Absolute Eosinophil count were repeated at the end of 12 weeks. RESULTS: 30(30%) participants were aged between 18 to 24 years, 23 (23%) were aged between 25 to 39 years, 40 (40%) were aged between 40 to 59 years and 7 (7%) were aged >60 years. 32 (32%) participants were male and 68 (68%) participants were female. 27 (27%) participants showed Positive Skin prick test to Aspergillus fumigatus specific antigen. Among the 27 patients, HRCT lungs showed features of allergic bronchopulmonary aspergillosis-CB in 5 (18.52%) participants and 22 (81.48%) had Normal HRCT. Based on Sr. IgE and absolute eosinophil count, 17 (62.96%) participants were categorised as having allergic bronchopulmonary aspergillosis and 10 (37.04%) participants with severe asthma with fungal sensitization. Among 10 SAFS patients 5(50%) were in group A and 5(50%) were in group B. Symptomatically all 10 patients had uncontrolled asthma. 5 participants with uncontrolled symptoms in Group A had their symptoms well controlled after 12 weeks. Among 5 participants with uncontrolled symptoms in Group B, 4 (80%) had partially controlled asthma and 1(20%) had uncontrolled asthma after 12 weeks. Out of 5 patients in Group A, PFT showed mild obstruction in 3(60%) and normal spirometry in 2(40%) after 12 weeks. In group B, PFT showed 1(20%) had mild obstruction and 3(60%) had moderate obstruction and 1(20%) had very severe obstruction after 12 weeks. Sr. IgE of patients taken at the beginning and at the end of study showed significant reduction in patients in group A with mean difference of 433.20 than group B where the mean difference was 175.56. Similarly, Absolute eosinophil count taken at the beginning and at the end of study showed significant reduction in patients in group A with mean difference of 303.60 than group B where the mean difference was 110.40. CONCLUSIONS:Patients in group A who received Itraconazole compared with group B patients who received placebo had improvement in their control of symptoms. Their pulmonary function improve...

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