PubMed Health⌕ Search

Biomedical subjects

B Jayakrishnan

Publications and source records attributed to B Jayakrishnan.

10 recordsLinked to original sources
PubMed2005

Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis.

Although factors influencing sputum smear conversion in tuberculosis have been studied well, the effect of smoking is largely unknown. Excluding those with incomplete history or drug resistant isolates, 339 patients out of the 526 sputum positive patients registered between 1998 and 2000 were studied. At the end of 2 months, smokers and non-smokers converted with almost the same frequency to a negative sputum status {P=0.065, OR (95%CI) 0.47 (0.21-1.06)}. Although gender or age had no effect on sputum conversion with respect to smoking status, expatriate smokers as a whole showed a significant difference. (P=0.039). On applying logistic regression model, smokers with far advanced radiographic abnormalities (P<0.038) or with 3+ smear status (P=0.011), were found to have a less chance of an early smear conversion. In conclusion smoking did not influence sputum smear conversion in tuberculosis. However, as expatriate smokers and smokers with advanced disease showed a delay in smear conversion, smoking should be discouraged in patients with pulmonary tuberculosis.

Adult↗
PubMed2004

Changes in blood levels of eosinophil cationic protein and tryptase after exercise challenge in adolescents with exercise-induced asthma.

BACKGROUND: Exercise-induced asthma (EIA) is increasingly encountered among school children in Kuwait. Available evidence has shown that inflammatory mediators may be involved in the pathogenesis of EIA. Studies on release of inflammatory mediators have been carried out in adult patients with asthma in Kuwait, but no study on EIA involving children has taken place in this region. OBJECTIVE: To investigate changes in the concentration of some of the mediators involved in EIA in adolescent school children, using exercise challenge. DESIGN: Prospective, case control study. SETTING: Respiratory and Cardiology units Mubarak Hospital, Kuwait, between January and June 2001. SUBJECTS: Nine EIA and 14 non-EIA and 10 normal control subjects, designated as groups one, two and three aged between 13 and 17 years, who were non-smokers, were enrolled for the study. MAIN OUTCOME MEASURES: Blood eosinophils (EOS), eosinophil cationic protein (ECP) and tryptase were estimated pre-exercise, 5 and 30 minutes after exercise. Spirometry was measured at the same period. RESULTS: In group one, ECP and tryptase levels fell after exercise, but significant difference in the levels were obtained only in tryptase between pre-exercise and 30 minutes after exercise (4.1 microg/L Vs 3.8 microg/L) P <0.05, while the difference for ECP was not significant (P=0.09). In group two, both tryptase (6.0 microg/L Vs 5.7 microg/L) P < 0.05, and ECP (21.8 microg/L Vs 12.1 microg/L) P<0.01, fell after exercise. However, in group three, no appreciable difference was observed between pre and post exercise. Correlation between tryptase and EOS (r=0.770; P<0.05) and between tryptase and ECP (r=0.850; p<0.05) was observed pre-exercise and after exercise in groups one and two. CONCLUSION: A fall in the level of the mediators was observed after exercise challenge, but the relevance of this finding in the pathogenesis of EIA remains unclear. Further studies are required to verify this finding.

Adolescent↗
PubMed2004

Flexible fiberoptic bronchoscopy. Diagnostic yield.

OBJECTIVE: Fiberoptic bronchoscopy is a minimally invasive procedure with a high diagnostic yield. The aim of this study was to document the usefulness of the procedure in the diagnosis of various respiratory disorders in a Middle East country. METHODS: Data on all bronchoscopies carried out in Chest Diseases Hospital, Kuwait from January 1996 to December 1998 were retrospectively collected. RESULTS: Out of 968 cases, only 620 (64%) patients had a full follow up. Suspected pulmonary tuberculosis (TB) (51.6%), unresolving pneumonia (16.1%), hemoptysis with a normal chest radiograph (8.4%), lung mass (7.7%) and hilar lymphadenopathy (3.2%) were the most common indications. Eleven percent of patients who underwent bronchoscopy had a normal chest radiograph, the reason being hemoptysis in 75.4%, inhalation injury in 21.8% and suspected upper airway obstruction in 2.9%. In smear negative suspected TB cases, 22.5% proved to have active disease. Acid fast bacillus was identified in bronchoalveolar lavage, either by smear or culture, in 44 (73.3%) patients with suspected pulmonary TB and in 6 (54.5%) patients with miliary shadows. An underlying cause was identified in 28 (28%) patients with unresolving pneumonia. Ninety-four percent of cases with clinical impression of bronchogenic carcinoma could be diagnosed. Transbronchial biopsy was diagnostic in 79% patients with diffuse parenchymal lung disease. No complications other than transient hypoxemia and controllable bleeding were noticed. CONCLUSION: Generally, the indications for flexible fiberoptic bronchoscopy remained similar to elsewhere. Unlike western series, the majority of the cases were for the diagnosis of pulmonary infections especially TB.

Adult↗
PubMed2003

Chronic lobar consolidation.

Lobar consolidation in a chest X-ray is often thought to be due to infection. We present the problem of a 66-year-old female with low grade non-Hodgkin's lymphoma of the mucosa associated lymphoid tissue (MALT) type who had features of lobar consolidation that persisted for years. The different causes, both infectious and non-infectious, of this kind of presentation are discussed.

Aged↗
PubMed2003

Clinicopathological and therapeutic patterns of idiopathic pulmonary fibrosis in Kuwait: a prospective study.

Though common, the exact incidence and clinical pattern of idiopathic pulmonary fibrosis (IPF) in Gulf countries are not known. The results of a four-year prospective study undertaken in two tertiary hospitals in Kuwait are presented. The mean age at diagnosis of the 52 patients studied was 55.40 +/- 11.87 years. Thirty-two (61.5%) patients were male and 22 (42.3%) were smokers. The mean duration of symptoms at diagnosis was 2.1 +/- 0.92 years. Digital clubbing was found in 34 (65%) patients. The mean FVC, TLC and TLCO were 57%, 64.4% and 55% of predicted normal, respectively. The FVC value showed a significant difference between smokers and non-smokers (p < 0.05). HRCT findings were abnormal in all patients. Typical histological and high-resolution computed tomography findings of usual interstitial pneumonia, desquamative interstitial pneumonia and non-specific interstitial pneumonia were observed. This study revealed that IPF is prevalent in Kuwait, with patterns showing some similarities to those established elsewhere. The response to treatment was not encouraging, especially in the usual interstitial pneumonia subtype.

Adult↗
PubMed2002

Effect of methotrexate on pulmonary function in patients with rheumatoid arthritis--a prospective study.

If given in high doses, methotrexate (MTX), a folate antagonist, could cause pulmonary complications. To evaluate the pulmonary effects of low-dose methotrexate, 55 newly diagnosed patients with rheumatoid arthritis (RA) prescribed with MTX were studied prospectively. A significant reduction in percent predicted values of forced expiratory volume (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), and functional residual capacity (FRC) was observed after 2 years of MTX treatment. A significant increase in the FEV(1):FVC ratio was also observed. In comparison to the normal annual decline in healthy adults, the actual reduction in observed values in the patients was significantly greater (3.2, 6.3, and 6.7 times normal for FEV(1), FVC, and TLC, respectively). PaO(2) and oxygen saturation showed marginal but significant improvement. It was concluded that low-dose MTX treatment in RA might cause an accelerated decline in lung function. Therefore, periodic monitoring of pulmonary function among RA patients started on MTX could be necessary.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Clinical patterns of diffuse parenchymal lung disease in Kuwait: a prospective study.

OBJECTIVE: To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease (DPLD). SUBJECTS AND METHODS: Over a 4-year period, 75 patients (41 males, 34 females), aged 13-76 years, who were referred to Mubarak Al-Kabeer and the Chest Diseases Hospitals, Kuwait with a diagnosis of diffuse lung disease, were included in the study. After a comprehensive history and physical examination, further investigations were done, including hematological and immunological profiles, sputum and bronchoalveolar lavage fluid examination, chest radiograph, high resolution computed tomography (HRCT), pulmonary function test and lung biopsy. RESULTS: Of the 75 patients 60 (80%) were over 40 years of age. The duration of symptoms in 34 patients (45%) was less than 6 months and longer than 1 year in 28 (37.7%) patients. Twenty-five of the patients were cigarette smokers. The mean forced lung capacity (FVC), total lung capacity and diffusing capacity for carbon monoxide were less than 60% of the predicted values in most patients. There was a significant difference in mean FVC value between smokers and nonsmokers (p < 0.05). The HRCT findings were at an advanced stage in 65 patients, with additional honeycombing in 21 of the 65 patients. Idiopathic pulmonary fibrosis was the most common cause of DPLD, occurring in 52 patients, followed by sarcoidosis and collagen vascular diseases. CONCLUSION: DPLD was observed predominantly in middle aged and elderly patients, due probably to increasing industrialization in the country. The role of cigarette smoking as a contributory factor remains unclear.

Adult↗
PubMedDate not supplied

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait.

OBJECTIVES: The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia (CAP) in Kuwait. SUBJECTS AND METHODS: The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team (PORT) severity index. The microbial etiology was determined using standard methods for bacteria and serological tests for atypical and viral pathogens. RESULTS: The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3+/-18 years. The severity class distribution was: class I 31%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients (35%), with one pathogen in 31 (25%), two in 9 (7%), and three or more in 4 (3%). The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients (11%), Legionella pneumophila in 10 (8%), Chlamydia pneumoniae in 8 (6%), influenza B virus in 8 (6%), influenza A virus in 5 (4%), Haemophilus influenzae in 4 (3%), Streptococcus pneumoniae in 3 (2%), Staphylococcus aureus in 3 (2%), gram-negative enterobacteria in 5 (4%), Moraxellacatarrhalis in 2 (2%), and viruses in 4 (3%). The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. CONCLUSION: Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait. Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides.

Adolescent↗
PubMedDate not supplied

Demographic pattern and clinical characteristics of patients with smear- positive pulmonary tuberculosis in kuwait.

OBJECTIVE: The aim of this study was to document various clinical factors that are likely to be of help in the control of tuberculosis in Kuwait. SUBJECTS AND METHODS: Details of patients with sputum positive for acid-fast bacilli in the period from January 1998 to December 2000 were collected retrospectively from the case records and population statistics from government sources. The data were then tabulated and analyzed. RESULTS: Of the 526 cases, 83.5% were expatriates and 16.5% Kuwaiti; 373 (70.9%) were male. Of the expatriates, 66.7% were from Asia and the Far East, 5.7% were > or =60 years. The annual incidence was 8.34 per 100,000 population. The lowest incidence was observed in the Jahrah governorate with an overall incidence of 5 (2.0 among Kuwaitis and 6.4 among expatriates) per 100,000 population. The highest incidence overall (10.2) and among Kuwaitis (4.1) was observed in the Farwaniya governorate, while the highest incidence among expatriates was seen in the Capital governorate (13.4). Radiologically, 94 (19.5%) had minimal, 246 (51.5%) had moderately advanced and 141 (29.3%) far-advanced disease. The majority of the patients (72%) had only + status for AFB in the smear. Hypercalcemia (25.7%), hyponatremia (22.15%) and hyperglycemia (29.9%) were common in the patients. Mean serum albumin was low (28.7 +/- 5.5 g/l). Two hundred and forty-seven (47.2%) were declared cured while 116 (22.2%) completed treatment. Comparison between nationals and expatriates showed a significant difference only for age, smoking status, defaulter rate and place of residence. CONCLUSION: The lowest regional incidence was found in the Jahrah governorate. Both biochemical abnormalities and radiologically advanced presentations were common. Disease pattern and response to treatment was purely individual and did not differ with respect to nationality or race.

Adult↗