ABSTRACT:The study involved 100 patients who presented at Department of pulmonary medicine, Alluri sitaramaraju academy of medical sciences, Eluru between December 2011 and December 2012. Also 100 normal persons were taken in to the study to compare the normal ventilatory function with the standards. There was a male preponderance in the study, about 75% of the study group were males. The mean height of males in the control group was 164.12±8.6 and 152±5.8 cm for females. The mean height (cm) of males in the cases was 162±9.2 and that of females is 149.6±4.6. (Mean±SD). The mean age (Years) of smokers in males was 49.05±12.2. The ratio of smokers to non-smokers with the study group was 3:2 while that of control group was 2:3. In both the groups, the smokers were moderate to heavy smokers. Most of the subjects in control group had 75% or above of the standard values for all the parameters studied-FVC, FEV1, FEV1/FVC%. Restrictive ventilatory defect was the most commonly observed ventilatory defect in our study. It was assosciated with most of the diseases studied-pneumonias, mass lesions of the lung, fibrocavities, pleural lesions. Obstructive ventilatory defect was prevalent among asthma and COPD as they are obstructive lung diseases. A mixed ventilatory defect was also seen in this group. Mixed ventilatory defect was seen in most of the post tubercular lesions of the lung-fibrosis, bronchiectasis and mass lesions of the lung. Grading of the severity of disease was done based on international accepted criteria like GINA, GOLD etc. Severity of the ventilatory defect correlated with the severity of various diseases. Some of the patients had normal ventilatory function even in the presence of the disease as the lung has a very large respiratory reserve. Mean FVC, FEV1 are predominant in males when compared to females in both controls and cases. This may be attributed to the well-built and nourishment among males. The ventilator function parameters (Mean FVC, FEV1) were significantly low in cases in comparision to controls. It may be due to the effect of respiratory illness. FEV1% predicted was significantly decreased in obstructive ventilatory defect in cases when compared to controls in both males and females. Spirometry is useful tool in evaluating ventilator function abnormalities in various pulmonary diseases and assessing their severity. This information is useful in management of patients, monitoring and for long term follow up. It helps to understand the physiologic working of lungs and chest mechanics.

A Cross Sectional study was carried out on 100 patients with pleural effusion from December 2013 to July 2015 at ASRAM Medical College and Hospital Department of Pulmonary Medicine,Eluru. In our study, Exudative effusion remains most common cause of pleural effusion.Tubercular effusion remains the commonest etiology of all exudative effusions, where as Congestive cardiac failure remains commonest cause among transudative effusions.Tubercular effusion affects most commonly young and is associated with cough and fever as the most common presenting symptom. Malignant effusions were seen in older age group with cough and dyspnoea as predominant symptoms.Massive effusion with hemorrhagic pleural fluid is commonly associated with malignant effusion while small to moderate effusions with straw colour pleural fluid is associated ubercular effusion where as empyema cases presented with pus. Right sided effusion was most common with male to female ratio of 3.54:1 ,with mean age of 40.5+11.3 years.Empyema was most commonly associated with high Leukocytes.Tubercular effusion was associated with lymphocytic predominant effusion where as neutophilic dominant effusion included empyema and parapneumonic effusion.Pleural fluid, with low glucose (<40 mg/dl) was seen predominantly in empyemas. Pleural LDH to serum LDH ratio >2 was seen predominantly in empyemas .A pleural fluid ADA more than 70 IU/L was associated with nearly half of Tubercular effusions , where as others with ADA levels between 30 to 70 IU/L along with clinicoradiological findings suggestive of tubercular effusion. Thus proving diagnostic importance of ADA in TB effusions.Early intiation Anitubercular drugs in TB pleural effusion, early intervention and treatment in cases of empyema and parapneumonic effusion showed improvement and signs of recovery.

Adenosine deaminase activity was estimated in 75 patients of pleural effusions of different etiologies. Patients were classified into three groups Tuberculosis (55), malignant (10) transudates (7), purulent effusion (3), based on diagnosis made on fluid examination and other investigations. The diagnosis was made independent of ADA activity. Out of 55 cases of tuberculous pleural effusions 54 have ADA activity of >40IU/1 Mean ADA activity in Tuberculous pleural effusions is significantly higher (66.41±29.31) than that of malignant pleural effusions (p<0.001). Mean ADA activity in malignant pleural effusions (17.32±2.641) is significantly higher than that of Transudative pleural effusions (11±3.12) (p< 0.001). ADA activity has no relation to the radiological extent of effusion and sputum status for AFB. There is no significant difference in ADA activity between males and females. All malignant pleural effusions have mean ADA levels less than 40 IU/1. The sensitivity, specificity and positive predictive values obtained for tuberculous pleural effusions in the present study are 98.8%, 100%., 100% respectively (taking 40 IU/1 as a cut off limit to discern tuberculous from non-tuberculous effusions). The results of the present study confirm that the ADA activity in pleural fluid is a very good parameter for the differential diagnosis of pleural effusions, compared to the conventional tests. ADA estimation is simple, low cost and least invasive and should be considered in the routine study of pleural effusions, particularly if diagnosis of tuberculosis is contemplated and in places where prevalence of this disease is still high.

ABSTRACT:The study was carried out in ASRAM hospital, eluru, over a period of 2 years from August 2012 to august 2014. The study was designated as prospective, observational, cohort study, which includes 100 cases of CAP selected on the basis of full filling the inclusion and exclusion criteria. Community acquired pneumonia continues to be a common clinical problem especially in elderly people. Males were more commonly affected than females but it was statistically not significant. Community acquired pneumonia is one of the common diagnosis in patients admitted in ICU and Emergency settings.DM and COPD are the most common co morbidities followed by rhinitis and smoking is the commonest risk factor for CAP. Cough, fever and expectoration are common and classical symptoms of pneumonia and significant number of patients with CAP can present with GI symptoms. Tachycardia, Tachypnea, Altered Mental Status, Hypotension, Cyanosis, acidosis, low albumin levels are few signs which indicate that illness is severe and critical and crepitations over chest on auscultation was the most common finding. Mean duration of stay was 8.99 days indicating it can cause significant loss in the form of economic loss if earning member of family is affected. Duration of stay was also prolonged in patients who are aged 65 and above, in patients who are undernourished, in patients with COPD and in patients who were treated with antibiotics prior to hospitalization but statistically these findings were not significant. In radiography Lower zones are most common site of involvement followed by mid and upper zones, Right lower zone was most common among all. Neutrophilic leucocytosis was the most common finding in haemogram. Gram positive organisms were more commonly seen than gram negative organisms on sputum gram's staining. Complications noticed were a)Need for ventilatory support both invasive or Non Invasive, b)Need for inotropic support for septic shock, c)Renal failure and need of temporary renal replacement, d)Sepsis and MODS, e) Prolonged ventilator support and need for Tracheostomy. CAP is a disease with significant mortality-18% in our study. It seems the resistance to penicillins and simple antibiotics may be rising. And need of extended spectrum pencillins and a higher antibiotic is also rising but there is a need for larger studies to confirm the same. CURB-65 class >3, PSI class>4 class were having sensitivity of 41.67% and 91.67% in predicting ICU admission with a specificity of 89.5% and 59.21 % respectively. Their sensitivity in predicting death was 44.40% and 88.9% with a specificity of 87.80% and 54.88% respectively. In both PSI scoring systems, mortality rate, need for intensive care unit (ICU) admission increased progressively with increasing scores but CURB-65 score did not show this correlation. PSI class of 4 and above is most sensitive and CURB 65 class of 3 and above is most specific in predicting both death and ICU admission. Both PSI and CURB 65 are complementary to each other in predicting mortality and ICU admiss...