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.
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