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Haemoptysis may be due to pulmonary tuberculosis, fungal infections or malignancy of lung. Clubbing of fingers is found in patients, with carcinoma lungs, bronchiectasis and pyothorax. Bronchiectasis is suspected when pneumonitis remains unresolved and when history of foul smelling sputum with change of posture and blood streaks in the sputum are elicited. Suppurative lung disease with brain abscess presents with mental symptoms like acute confusional state. Malignancies of lung are common in smokers and those exposed to asbestos.

Pulmonary tuberculosis occurs more frequently than expected. It may present with haemoptysis. Often no active signs are encountered in the old. E.S.R. is raised and sputum shows acid fast bacilli and x-ray chest reveals fluffy infiltrations.

The patient must be educated about the importance of a complete course of therapy for 9 months. The drug regimen is as follows.

First 3 months

1. Cap. Rifampicin 450 to 600 mg as single dose early in morning in empty stomach.
2. INH 300 mg as single dose early morning.

Second 3 months

1. Pyradzinamide 35 mg/ kg per day in single or divided dose.
2. INH 4-10 mg/ kg per day single dose early in the morning.

Third 3 months

1. Ethambutol for 6 weeks 25 mg/ kg/ day in single or divided dose. For next 6 weeks 15 mg/ kg/ day in single or divided dose.
2. INH 4-10 mg/ kg/ day single dose in early morning.

THE ABOVE PROGRAMME WAS SCHEDULED INTO TWO SESSIONS OF ONE HOUR EACH. AT THE END, TWO CASES OF BILATERAL PULMONARY TUBERCULOSIS, ONE CASE OF PLEURAL EFFUSION AND THREE CASES OF UPPER RESPIRATORY TRACT INFECTION WERE DEMONSTRATED.

-M. Chandramohan

DIABETES MELLITUS

It is a common illness in the elderly. Polyurea, polydipsia, repeated infections like bronchitis, chronic ulcers over gluteal region, groin, legs are the common presenting complaints. Certain features are characteristic of diabetes mellitus in the elderly. Viz. (i) the maturity onset type of diabetes mellitus may only occur. (ii) Hyperosmolar non-ketotic type of coma occurs more commonly than the other types. (iii) Diabetic coma ranks second to cerebrovascular accidents among the causes of death in the elderly. (iv) acute myocardial infarction with failure occurs with no anginal pain. (silent infarction) (v) there is an increase in the renal threshold for excretion of urine sugar due to interglomerular sclerosis and this can be inappropriately rated as improvement

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