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Tubercle and Lung Disease: Supplement
antibiotic therapy and outcome. Microbial investigation was requested according to clinical judgement. It included cultures of sputum, blood and paired serology and in cases of slowly resolving or severe CAP (all pretreated with antibiotics) an invasive bronchoscopic sampling (bronchial aspirate, protected specimen brush, bronchoalveolar
were complicated. Right lung with right lower lobe were commonly involved. 4 cases were bilateral and 8 cases have liver involvement also. Diagnosis was based mainly on X-ray appearances. The diagnosis of complicated cysts is at times quite difficult. All were treated surgically with satisfactory results. Detailed results will be presented.
lavage) .
Microbial investigation was performed in 81/97 cases (84%) including 25 cases of slowly resolving or severe CAP (26%) which were additionally examined by bronchoscopy. An etiologic diagnosis was established in 38 cases (47%). The pathogens identified were H. influenzae (13), S. pneumoniae (7), Mycoplasma pneumoniae (6), L. pneumophila (4), Klebsiella pneumoniae (2), Influenzavirus (2) and others (7). Diagnosis was made by sputum (22), serology (11) and blood cultures (5); in only 1 case bronchoscopy proved diagnostic. Overall 17/97 cases (18 %) and 16/32 with severe CAP (50 %) died. Results of microbial investigation directed a change in antibiotic therapy in 11/82 cases (133%) and l/25 (4%) cases examined by invasive means. Routine microbial investigation was helpful in 13 % of cases. Bronchoscopic examination did not add substantially to microbial diagnostic results. We conclude that routine microbial investigation can be restricted to patients with severe CAP. Additional initially performed rapid diagnostic tests appear more promising than microbial diagnostic evaluation by bronchoscopy after pretreatment.
355 METRONIDAZOLE IN THE MANAGEMENT OF LUNG ABSCESS Jain, R. C. and Sen, M. K.
A prespective study in 60 patients of lung abscess was carried out and showed that metronidazole plays an important role in the management of lung abscess. Patients were randomly divided into Group A, who were submitted to Percutaneous Transtracheal Aspiration (T.T.A.) and the specimen thus obtained were cultured for anaerobes, or Group B, who were not submitted to T.T.A. and so no anaerobic culture was done. Both the groups were treated with metronidazole alone or in combination with other appropriate antimicrobials. All the patients made complete recovery with no relapse. However 4 patients, 2 in each group required major surgery in the form of resection or thoracoplasty. Metronidazole alone or in combination with appropriate antimicrobials found to play an important role in the management of lung abscess.
356 EMPYEMA IN CHILDREN Jain, R. C., Dewan. R. K., Singh, S.
353 AIR POLLUTION AND INFANT MORTALITY BY PNEUMONIA IN RIO DE JANEIRO METROPOLITAN AREA l976J86 Duchiade, M. P., BeltGo, K. 1.; Dept of Epidemiology, ENSPI FIOCRUZ, Rua Leopold0 BulhBes, 148Ol820. Rio de Janeiro RJ 21041-210 Brasil
The 37 administrative regions of Rio de Janeiro Metropolitan Area encompassed, during the eighties, around 9 million inhabitants and presented highly differentiated socio-economic and air quality conditions, although rather homogeneous from a climatic point of view. Pneumonia (ICD 9 Rev. 48&486) is the second cause of death among infants and the first one in the post neo-natal period. Monthly mortality rates by pneumonia were fit to a logit model, using GLIM Software and a set of socio-economic, climatic and air quality (total suspended matter) variables as covariates). Socio-economic factors were responsible for the major portion of the explained variance for both groups (neo natal and post neo natal). Air pollution, after a log transform, presented a positive association, as expected.
354 A STUDY OF PULMONARY DISEASES
HYDATID
Jain, R. C., Dewan, R. K., Singh, S.
Hydatid disease has been reported from all the countries and after liver, lung is the commonest site. 100 patients of pulmonary hydatid disease admitted, treated surgically, were studied with a view to find out the clinical features, value of various investigations in the diagnosis and results of surgical treatment. Out of the 100 patients, 68 were males and 76% of the patients were in the age group of 11-40 years. 36 cases were non complicated, and 64 cases
Empyema as an acute infection in children is still quite a common condition and at times life threatening. 200 patients of empyema in children admitted to RB TB Hospital and L.R. S. TB Hospital in Delhi have been studied to find out the etiology, clinical features, bacteriology and results of various forms of treatment. Out of the 200 patients of empyema, the disease was evenly distributed in all the age groups with sex ratia male to female 2.3 : 1, right side was affected more. The pneumonic illness was the commonest primary illness in 75 % children, fever (66%), cough (90%), breathlessness (45%) were the commonest symptoms. Staphylococcus (25 %), pseudomonas (20 % ), kleibseilla (10 %) and anaerobes (15%) were the commonest organisms. Various forms of treatment, which cured the patients, were intercostal intubation (80 %), ribresection (7 %), major surgery (6%), aspiration (5%) alongwith antibiotics 4 children died. Detailed results will be presented.
357 ACUTE RESPIRATORY INFECTIONS (A. R. I.) IN AN OUTLYING HEALTH FORMATION: EPIDEMIOLOGY AND CARES Andrianarisoa, A. C. F., Ravelonirina, M. A., Rakotoniaina, P.; Fault& de Midecine, B. P. 375, Universit6 Antananarivo, Madagascar
The study, driven in 4 health sectors about 5043 children aged 0 up to 5 years, states the predominance of acute respiratory infections among children aged less than 11 months (41,40%). They are favoured by unfavourable socio-economic conditions (78,35 %), by malnutrition (62%), by a low level of education of the mothers (60%) and during prewinter and presummer times. Home smoke pollution is strongly marked: charcoal stove or cooking wood (93,81%), oil lamp (73,29%).
Tubercle and Lung Disease: Supplement
antibiotic therapy and outcome. Microbial investigation was requested according to clinical judgement. It included cultures of sputum, blood and paired serology and in cases of slowly resolving or severe CAP (all pretreated with antibiotics) an invasive bronchoscopic sampling (bronchial aspirate, protected specimen brush, bronchoalveolar
were complicated. Right lung with right lower lobe were commonly involved. 4 cases were bilateral and 8 cases have liver involvement also. Diagnosis was based mainly on X-ray appearances. The diagnosis of complicated cysts is at times quite difficult. All were treated surgically with satisfactory results. Detailed results will be presented.
lavage) .
Microbial investigation was performed in 81/97 cases (84%) including 25 cases of slowly resolving or severe CAP (26%) which were additionally examined by bronchoscopy. An etiologic diagnosis was established in 38 cases (47%). The pathogens identified were H. influenzae (13), S. pneumoniae (7), Mycoplasma pneumoniae (6), L. pneumophila (4), Klebsiella pneumoniae (2), Influenzavirus (2) and others (7). Diagnosis was made by sputum (22), serology (11) and blood cultures (5); in only 1 case bronchoscopy proved diagnostic. Overall 17/97 cases (18 %) and 16/32 with severe CAP (50 %) died. Results of microbial investigation directed a change in antibiotic therapy in 11/82 cases (133%) and l/25 (4%) cases examined by invasive means. Routine microbial investigation was helpful in 13 % of cases. Bronchoscopic examination did not add substantially to microbial diagnostic results. We conclude that routine microbial investigation can be restricted to patients with severe CAP. Additional initially performed rapid diagnostic tests appear more promising than microbial diagnostic evaluation by bronchoscopy after pretreatment.
355 METRONIDAZOLE IN THE MANAGEMENT OF LUNG ABSCESS Jain, R. C. and Sen, M. K.
A prespective study in 60 patients of lung abscess was carried out and showed that metronidazole plays an important role in the management of lung abscess. Patients were randomly divided into Group A, who were submitted to Percutaneous Transtracheal Aspiration (T.T.A.) and the specimen thus obtained were cultured for anaerobes, or Group B, who were not submitted to T.T.A. and so no anaerobic culture was done. Both the groups were treated with metronidazole alone or in combination with other appropriate antimicrobials. All the patients made complete recovery with no relapse. However 4 patients, 2 in each group required major surgery in the form of resection or thoracoplasty. Metronidazole alone or in combination with appropriate antimicrobials found to play an important role in the management of lung abscess.
356 EMPYEMA IN CHILDREN Jain, R. C., Dewan. R. K., Singh, S.
353 AIR POLLUTION AND INFANT MORTALITY BY PNEUMONIA IN RIO DE JANEIRO METROPOLITAN AREA l976J86 Duchiade, M. P., BeltGo, K. 1.; Dept of Epidemiology, ENSPI FIOCRUZ, Rua Leopold0 BulhBes, 148Ol820. Rio de Janeiro RJ 21041-210 Brasil
The 37 administrative regions of Rio de Janeiro Metropolitan Area encompassed, during the eighties, around 9 million inhabitants and presented highly differentiated socio-economic and air quality conditions, although rather homogeneous from a climatic point of view. Pneumonia (ICD 9 Rev. 48&486) is the second cause of death among infants and the first one in the post neo-natal period. Monthly mortality rates by pneumonia were fit to a logit model, using GLIM Software and a set of socio-economic, climatic and air quality (total suspended matter) variables as covariates). Socio-economic factors were responsible for the major portion of the explained variance for both groups (neo natal and post neo natal). Air pollution, after a log transform, presented a positive association, as expected.
354 A STUDY OF PULMONARY DISEASES
HYDATID
Jain, R. C., Dewan, R. K., Singh, S.
Hydatid disease has been reported from all the countries and after liver, lung is the commonest site. 100 patients of pulmonary hydatid disease admitted, treated surgically, were studied with a view to find out the clinical features, value of various investigations in the diagnosis and results of surgical treatment. Out of the 100 patients, 68 were males and 76% of the patients were in the age group of 11-40 years. 36 cases were non complicated, and 64 cases
Empyema as an acute infection in children is still quite a common condition and at times life threatening. 200 patients of empyema in children admitted to RB TB Hospital and L.R. S. TB Hospital in Delhi have been studied to find out the etiology, clinical features, bacteriology and results of various forms of treatment. Out of the 200 patients of empyema, the disease was evenly distributed in all the age groups with sex ratia male to female 2.3 : 1, right side was affected more. The pneumonic illness was the commonest primary illness in 75 % children, fever (66%), cough (90%), breathlessness (45%) were the commonest symptoms. Staphylococcus (25 %), pseudomonas (20 % ), kleibseilla (10 %) and anaerobes (15%) were the commonest organisms. Various forms of treatment, which cured the patients, were intercostal intubation (80 %), ribresection (7 %), major surgery (6%), aspiration (5%) alongwith antibiotics 4 children died. Detailed results will be presented.
357 ACUTE RESPIRATORY INFECTIONS (A. R. I.) IN AN OUTLYING HEALTH FORMATION: EPIDEMIOLOGY AND CARES Andrianarisoa, A. C. F., Ravelonirina, M. A., Rakotoniaina, P.; Fault& de Midecine, B. P. 375, Universit6 Antananarivo, Madagascar
The study, driven in 4 health sectors about 5043 children aged 0 up to 5 years, states the predominance of acute respiratory infections among children aged less than 11 months (41,40%). They are favoured by unfavourable socio-economic conditions (78,35 %), by malnutrition (62%), by a low level of education of the mothers (60%) and during prewinter and presummer times. Home smoke pollution is strongly marked: charcoal stove or cooking wood (93,81%), oil lamp (73,29%).