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Original papers

Is there delay in diagnosis of pulmonary tuberculosis in an intermediate-to-low TB incidence setting

Milica Malbasa1, Dragica Pesut2,3
Is there delay in diagnosis of pulmonary tuberculosis in an intermediate-to-low TB incidence setting

ABSTRACT

A cross-sectional study on pulmonary TB diagnosis delay in an intermediate TB incidence setting showed average patientfs delay of 44±61.65days and total delay of 103±148days. Alcoholism, lack of TB cases in family, diabetes mellitus, relapse, cough or tachycardia (p<0.01), absence of hemoptysis, dyspnea and anemia (p<0.01), age .40 (p<0.05), negative auscultation and positive sputum smear findings (p<0.05) were significantly associated with patientfs delay >30 days. Age <40 years, negative auscultation and sputum smear findings (p<0.01), female sex, city as residence (p<0.05), absence of cough, sputum, weight loss, fever, excavation (p<0.01), and night sweats (p<0.05) were significantly associated with total delay > 103 days. Further population education and continual medical education are waranted.

Keywords: tuberculosis; diagnosis; delay; infectiousness; public health

Mini-mediastinotomy under local anesthesia for biopsy of anterior mediastinal masses with airway compression

Rahim Mahmodlou1, Vahid Mohtazeri2, Mohammad Hossein Rahimi-Rad3, Mohsen Sekoti4
Mini-mediastinotomy under local anesthesia for biopsy of anterior mediastinal masses with airway compression

ABSTRACT

Introduction. Management strategies for anterior mediastinal masses (AMMs) depend strongly on the histopathological diagnosis. The manifestations of these masses sometimes are an emergency because of large airway or great vessel compression which make general anesthesia challenging and hazardous and many authors have emphasized the dangers of general anesthesia in such patients. Methods. This prospective study carried on 23 patients with AMMs and large airway or vessel compression via mini-mediastinotomy under local anesthesia for taking histological biopsy. Results. A definite histolopathological diagnosis was made in all cases. Morbidity was seen in one patient with entering the pleural cavity, there was no mortality. Out of 23 patients, 9 patients had already undergone less invasive procedures without definite diagnosis. Conclusions. Mini-mediastinotomy under local anesthesia for diagnostic biopsy in AMMs with airway compression is safe, minimally invasive, effective, and is useful in therapeutic decision making for AMMs.

Keywords: mini-mediastinotomy, anterior mediastinal masses, airways compression, great vessel compression, local anesthesia

Clinical and evolutive characteristics of patients with tuberculosis requiring intensive care

M. Roca1,2, G. Iosep1, T. Mihaescu1,2
Clinical and evolutive characteristics of patients with tuberculosis requiring intensive care

ABSTRACT

Background. To describe the characteristics of patients with tuberculosis (TB) requiring intensive care and to identify the risk factors for mortality. Methods. We conducted a retrospective, cohort study, between January 2006 and December 2009. The patients with TB, admitted in Pneumology Clinic

Hospital, Iasi, requiring advanced life support in intensive care unit (ICU), were included. We assessed different clinical parameters to identify the factors that predict in-hospital mortality. The primary outcome was the in-hospital mortality. Results. During the study period, 27 patients with TB

required intensive care. Of them, 16 (59.3%) had acute respiratory failure and 6 (22.2%) required mechanical ventilation. Eighteen (66.7%) patients died. Acute respiratory failure, acute hepatic failure and mechanical ventilation significantly correlate with a high in-hospital mortality rate. Conclusions.

In this study we found a high mortality rate in TB patients requiring intensive care, identifying some risk factors.

Keywords: tuberculosis, intensive care, mortality, mechanical ventilation