International Archives of Integrated Medicine

1-5

Authors: Ramasamy Suresh, Victor Theophilus Premkumar

Background: Pulmonary tuberculosis is the most frequent cause of death by an infectious agent worldwide. Among the extra pulmonary presentations after tuberculous lymphadenitis, pleural TB is the second most frequent Failure to diagnose and treat pleural TB can result in progressive disease with the involvement of other organs in as many as 65% of patients. Conventional methods have proven to be insufficient for diagnosis of pleural TB. Hence, this study was aimed to determine whether combined use of pleural fluid lymphocyte neutrophil ratio and ADA activity would provide a more efficient means for diagnosing tuberculous pleurisy than the use of ADA levels. Aim: To determine whether the combined use of ADA activity and lymphocyte/neutrophil ratio would provide a more efficient means for diagnosing tuberculous pleural effusion than with the use of ADA alone. Materials and methods: Present study was hospital based prospective observational study carried out from February 2016 to July 2016. All the patients with pleural effusion admitted in medical ward at GRH Madurai. Information collected through preformed and pretested proforma. The qualifying patients were undergoing detail history, clinical examination and investigation. Patients were classified as exudative and transudative pleural effusion based on light’s criteria Patients with MRS score of 5 and 6 were declared as very poor outcome and MRS of 3 and 4 as poor outcome. Patients with MRS 0, and 1 were considered as good outcome. Statistical analysis was done by One way ANOVA, Pearson correlation and Chi square test. Results: There was significant correlation between the combined use of ADA along with L/N ratio than ADA alone for diagnosing tuberculous Pleural effusion. Conclusions: The combined use of ADA along with L/N ratio would provide a more efficient means for diagnosing tuberculous Pleural effusion than the use of ADA alone.

12-18

Authors: M. Arivumani

Introduction: Peripheral vascular disease (PVD) is one of the significant Macro vascular complications of type 2 diabetes mellitus. Peripheral vascular disease assumes importance, for prevention of morbidity and mortality related to diabetic foot. PVD is the single most important factor which raises the incidence of leg amputation risk in type 2 DM patients. While peripheral neuropathy alone leads to, trophic ulcer which has a chronic indolent course provided super added infection is prevented and controlled, the presence of PVD leads to the ischemic foot which leads to rapid spread of infection. The aim of the study: To investigate the prevalence of PVD among type 2 diabetes patients, to assess the risk factors associated with the development of pvd.to correlate the prevalence of cardiovascular risk factors and vascular complications of type 2 diabetes patients. Materials and Methods: Cross sectional observational analytical study was conducted. Patients were interviewed with a special note on elicitation of history regarding symptoms of PVD, in the form of intermittent claudication, Ischemic rest pain, history of foot ulcers in the past and present. Smoking was recorded in pack-years of cigarettes smoked. Duration of diabetes since diagnosis was recorded and they were grouped accordingly. The anthropometric measurements were recorded and the body-mass index was calculated. Waist-hip ratio was also recorded. The blood pressure was recorded in both the upper limbs and both the lower legs using the standard B.P cuff. An comprehensive physical examination was done and findings recorded. Special importance was given to foot examination. Peripheral neuropathy assessment was done using Simmel-Weiss monofilament testing and timed vibration sense perception recordings. Symptoms of peripheral neuropathy were also noted. Results: The duration of diabetes ranged from newly detected to 28 years, with a mean duration of 8.2 years + 6.24 S.D. For patients affected with PVD, the duration of diabetes was found to be longer than others. The mean FPG for the PVD sub group is 173.6mg % + 34.9 SD, while for the other subjects the mean FPG is 151.8 mg % + 36.3 SD and the difference was statistically significant. (P = 0.006). Among the hypertensive diabetic subjects (n=57), 26.3% had peripheral vascular disease and the prevalence of PVD among normotensive diabetes subjects (n = 55) was 9.1% (P = 0.0329). Smokers among Hypertensive Diabetic males had 58.3% prevalence of PVD (ABI < 1) compared to 14.3% among non – smoking Hypertensive Diabetic males. Difference in the lipid parameters above was all statistically significant. This shows that individuals with a triad of increased LDL – cholesterol, lower HDL – cholesterol (Higher LDL / HDL ratio) and increased triglycerides were more at higher risk for peripheral vascular disease. Conclusion: As the duration of diabetes increased, the risk of PVD increased. There was relatively poor glycemic control in the PVD sub-set. Hypertension, when associated with Type2 Diabetes raised the risk of PVD nearly threefold. The duration of Hypertension also significantly correlated with the risk of PVD.

25-31

Authors: G. Indumathi

Introduction: Tobacco use has long been known to be a major risk factor for cardiovascular disease. Recent studies have identified a positive association between smoking and incidence of diabetes. The evidence that smoking is an independent risk factor for the development of diabetes is still considered preliminary. Some studies have shown a dose response association between smoking and incidence of diabetes. Aim of The Study: To assess whether smokers are more likely than non-smokers to develop clinically relevant glucose intolerance or diabetes and to assess whether total pack years’ correlates with the severity of glucose intolerance/ diabetes. Materials and Methods: We have evaluated Hundred smokers and FIFTY nonsmokers Baseline characteristics of the study were as follows; age, sex, occupation, Education status, family history of diabetes, comorbid illness of smoking. Our Baseline examination included Ht, Wt, BMI, BP, HC, WC, Waist Hip ratio (anthropometric measurements), Lab investigation – Blood sugar (F and PP) and Lipid profile. Participants were defined as current smokers and former smokers. Former smoker were those who, at baseline, reported previously using cigarettes but denied current smoking. Results: Nearly 5% of the case population were obese. Among the control population, obesity accounted for 2% of them. There was a significant statistical difference between cases and controls with respect to BMI (‘p’ = 0.0116). With regard to Blood Pressure, there was no significant statistical difference between cases and controls (‘p’ = 0.4989). Glucose Intolerance among case population were found to be 29% and among the control population, found to be 22%. Thus there was no significant statistical difference between cases and controls (‘p’ = 0.4727). 53 cases of the study group (53%) had high Triglyceride. 46% of the control group had high TG. Thus, there was no significant statistical association between study and control group (p =0.52) 13 cases of the study group (13%) had low HDL. 14% of the control group also had low HDL. Thus there was no significant statistical association between study and control group (p = 0.93). 10% of the case population had metabolic syndrome and 6% of the control population had the same. There was no significant statistical association. 10% of the case population had metabolic syndrome and 6% of the control population had the same. There was no significant statistical association. Conclusion: Smoking stimulate symathetic system, which inturnleads to anelevated catecholamine levels and there by insulin resistence.Smoking influences visceral adipose tissue and there by insulin resistance.Smokers(especially heavy smokers) are prone for unhealthy food habits and low physical activity which in turn leads to visceral fat accumulation and insulin resistance.

36-42

Authors: G. Ranjani

Introduction: Infection is a leading cause of hospitalization among diabetic patients. Diabetes is associated with increased risk of developing infection increased severity of infection and prolonged hospital stay. Urinary tract infection, respiratory tract infection and soft tissue infection are common infections with increased incidence of diabetes. Altered host defenses, vascular abnormalities, frequent hospital admissions are responsible for increased incidence. Aim of the study: To find out the prevalence of Asymptomatic Bacteriuria in type 2 diabetic women, to analyze the spectrum of organisms responsible for Asymptomatic Bacteriuria in this group and its antimicrobial sensitivity pattern. Materials and methods: There was 164 participants in the study group and 56 non-diabetic women in the control group GROUP-I: Women with type 2 diabetes were recruited randomly from the Female patients of General Medicine OPD and Diabetic OPD, Government Dharmapuri Medical College Hospital, Dharmapuri. GROUP-II: Women without diabetes were selected randomly from the general population. They were relatives and friends of inpatients admitted in general medical ward. The following laboratory data were included: fasting plasma glucose, blood urea, serum creatinine, albuminuria, glycosuria, and leucocyturia. These patients were evaluated for microvascular and macrovascular complications of diabetes. Results: Overall the prevalence of ASB was 22.56% in the study group and 5.36% in control group. Conclusion: Asymptomatic bacteriuria was significantly more among diabetics with nephropathy. Simple bedside method to screen asymptomatic bacteriuria is leucocyturia and it has a positive predictability (72.7%) to detect bacterial isolates. Among asymptomatic bacteriuria, gram-negative isolates were greater than gram-positive ones Isolates were resistant to most of the commonly used antimicrobials (Ciprofloxacin, Ofloxacin, Gentamicin, and Cefotaxime) in clinical practice.

47-53

Authors: G. Ranjani

Introduction: Hypertension remains the leading cause of death worldwide and one of the world's great public health problems (WHO). Affecting 1 billion people worldwide, systemic hypertension remains the most common, readily identifiable and reversible risk factor for myocardial infarction, stroke, heart failure, atrial fibrillation, aortic dissection and peripheral arterial disease. In this study, total serum calcium levels and corrected serum calcium levels of essential hypertension patients are compared and correlated with matched normotensive controls. Aim of the study: To compare the total and corrected serum calcium levels among patients with newly detected essential hypertension and normotensive controls. Materials and methods: This study was a cross sectional study, with cases and controls enrolling 100 newly detected essential hypertension patients as cases and 50 suitable healthy individuals with normal blood pressure as controls, as per JNC-8 guidelines. Cases were selected from those who visited hypertension clinic and those who were admitted in wards during the study period. Controls were selected from those who attended medical outpatient department for minor ailments and healthy volunteers. Serum calcium and phosphorus levels were estimated using standard levels and the interpretation was done with blood pressure values. Results: Group A was the study group which included 100 newly detected essential hypertensive patients. Group B was the control group which included 50 normotensive individuals. In Group A, 52 (52%) were males and 48 (48%) were females and in Group B, 26 (52%) were males and 24 (48%) were females. There was a negative correlation noted between the total and corrected serum calcium levels as against the systolic blood pressure. There was no correlation noted between the total and corrected serum calcium levels as against the diastolic blood pressure. Conclusion: The total and corrected serum calcium levels were found to be significantly lowered in cases when compared to controls. Also, a significant negative correlation between the calcium levels and systolic blood pressure was noted while there was no correlation noted with the diastolic blood pressure in the cases. This study also noted that there is no significant difference in both the calcium levels with age, sex, BMI, lifestyle, smoking, alcohol, family H/o hypertension in newly detected essential hypertensive patients.

59-66

Authors: Meena M, Mantan K, Saxena M, Dhawan S, Sethia S, Meena A

Background: Percutaneous nephrolithotomy (PCNL) is usually done under general anesthesia (GA). However, it can be done under spinal anesthesia (SA) which can have advantages like less bleeding, less postoperative pain, low dose analgesic requirement and less drug intake. Aim: In our study, we had compared the efficacy and safety of general versus Spinal Anaesthesia in PCNL. Materials and methods: In prospective randomized study, 100 patients undergoing PCNL were randomly assigned into two groups; group A (n = 50) underwent PCNL under GA, by injecting thiopentone, succinylcholine and vecuronium and group B (n = 50) received SA, by injecting bupivacaine and fentanyl in spinal space L4 in sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the table was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique. Results: Hemodynamic stability was more in SA group. Heart rate and mean arterial pressure intraoperatively at 5, 10, 15 mins and at 60 mins and postoperatively at 0, 2 and 6 hours was significantly less in SA group (P < 0.05) as compared to GA group. The VAS score was 5.29±0.62 in GA group and 0.98±0.89 in SA group at 0 hour, 5.58±0.49 in GA group and 1.88±0.84 in SA group at 2 hours and 4.26±1.30 in GA group and 2.10±1.02 in SA group at 6 hours which was significantly lower in SA group in comparison with GA group (P < 0.05). Mean analgesic requirement within 24 hours was lower in SA group (76±36.05) than GA group (140±28.57) and it was statistically highly significant (p<0.001). Postoperative nausea and vomiting was more in GA group than SA group. Conclusion: Spinal anaesthesia is a safe alternative to GA for PCNL with better pain relief, less analgesic requirement, less side effects.

75-81

Authors: Cervical Lymphadenopathy, FNAC, Tuberculosis, Malignancy, Lymphoma.

Background: Swellings of thyroid are frequently encountered in surgical practice. With clinical evaluation it is difficult to distinguish early malignant lesions from common benign goiters. Surgical excision is the only means by which a definitive diagnosis is obtained based on HPE. An alternative approach is called for other than surgery as most cases are benign. FNAC is a simpler and safer procedure carried out in the OPD with minimal equipment and has good patient compliance. The present study aims at correlating the cytological diagnosis with the final histological diagnosis to evaluate the sensitivity, specificity and accuracy of FNAC smears, thereby its role in preoperative diagnosis in planning proper management. Aim: To determine the accuracy and the role of fine needle aspiration cytology (FNAC) as a diagnostic modality in the diagnosis and treatment of thyroid diseases. Materials and methods: A proforma was drafted for the study of all patients presenting with history of palpable thyroid swelling and undergo surgery in our hospital. Clinical presentations, FNAC and histopathology of all cases were documented. Results: 100 cases who presented with thyroid swellings were studied and their histopathological diagnosis was compared with the FNAC. Of the 86 cases which were seen benign by FNAC, 82 were confirmed by histopathology. Of the 18 cases which were proved to be malignant by histopathology 14 were only seen as malignant by FNAC. The sensitivity of FNAC in the diagnosis of benign lesions was found to be 77.78%, specificity was 100%, positive predictive value 100% and accuracy is 96%. Conclusion: Most of our patients were between third and fourth decade, with females being predominant. Most cases were benign of which multinodular goiter being the most dominant pathology (25%). Among the malignancies, majority being papillary carcinoma (78.94%). The sensitivity, specificity and predictive value of positive smears being 77.78%, 100%, and 100% respectively. FNAC was of greater help in the preoperative management of thyroid swellings. Multinodular goiters and colloid goiters were distinguished easily by FNAC but confusion prevailed in cases of follicular adenomas. In patients who cannot be followed up regularly clinical suspicion should be one of the indications for surgery despite of FNAC being negative. FNAC is simpler, safer, quicker and more informative, when compared with other sophisticated methods in the diagnosis of thyroid lesions.

91-97

Authors: C. Arun Babu, Somanatha Sharma, Gnana Sezhian

Context: Hernia is defined as an abnormal protrusion of viscus through normal openings in the body. The lowness of pubic tubercle is associated with narrow origin of internal oblique muscle from lateral inguinal ligament which fails to protect the deep inguinal ring. The structural anatomy is altered i.e. the obliquity of the inguinal canal gets decreased, arching of conjoint tendon gets narrowed, and the shutter mechanism of internal oblique gets diminished leading on to the ineffective defence mechanism ending up in the development of inguinal hernia. Aim: To find out the prevalence of inguinal hernia in low lying pubic tubercle at our tertiary hospital setup. Materials and methods: The ST and SS Line measurements of the case were compared with those of controls to find out whether there was tendency of having low lying pubic tubercle in case of inguinal hernia. An attempt was also made to observe any correlation between ST segment and height, weight of the patients. The quantitative variables were summarized as mean and standard deviation while qualitative variables as percentage and proportion. To the statistical significance between the two independent two groups student ‘t’ test while in more than two groups ANOVA (one way) was applied and to show correlation Pearson’s correlation applied. The difference was considered significant when p value was less than 0.05. The statistical package used was SPSS 23. Results: This study showed that the people with low lying pubic tubercle have a reduction in efficiency of shutter mechanism of inguinal canal leading to the development of inguinal hernia. Conclusion: Group of people with low lying pubic tubercle are at high risk of developing inguinal hernia.

105-109

Authors: P.S. Ganesh Babu, T.M Balakirshnan, Ramadevi

Introduction: Tracheo Oesophageal Fistula (TEF) is a major cause of morbidity and mortality necessitating complex clinical evaluation and decision making for optimal management. It is best treated in a specialty tertiary care setting by a multidisciplinary team approach. In acquired non-malignant causes of airway-oesophageal fistulas, the patients suffer from significant morbidity due to recurrent pulmonary sepsis. These diseases are complex and mandate critical preoperative evaluation for optimal management. Prolonged endotracheal intubation combined with a nasogastric tube may lead to a TEF. This results from pressure necrosis generated by a ventilating cuff in the trachea and a prolonged feeding tube in the esophagus. Aim of the study: To study the results of function preserving pedicled perforator based sternocleidomastoid muscle as an inter position flap after primary repair of cervical trachea-oesophageal fistula. Materials and methods: The study was conducted from the period of one year from 2015-2016 at IRRH and Plastic Surgery Department of Government Stanley Medical College, Chennai. Totally 15 patients were included in the study. Patients with clinical presentation were evaluated, a pre operative investigation like Bronchoscopy, OGD MRI, CECT of the neck was taken. All patients with tracheal oesophageal fistula in the cervical region following corrosive poisoning (organophosphates) on prolonged intubation who under went closure with the pedicled sternocleidomastoid muscle as an interposition flap. Results: All patients diagnosed with Tracheo oesophageal fistula following corrosive poisoning on prolonged intubation were included. (N = 15). The study period was from 2015 to 2016. Patient’s demographic data and clinical course were closely monitored and recorded. All Patients recovered well. Oral feeding started (liquids) on 4th post-operative day after doing gastro Graffin study, and solids on the 10th day. No recurrence in 1 year follows up. Conclusion: In our technique, we maintained the intramuscular cock screw perforators from the transverse cervical artery. This constant anatomy favored us to use sternal head component separate from the clavicular head and interposed them between the repaired trachea and esophagus. Preserving the clavicular head of SCM maintains the form and function of the muscle. The vascularized muscle flap prevents both tracheal and oesophageal strictures and stenosis.

119-124

Authors: Mohammed Abdul Azhar

Introduction: Mandibular swelling are common entity in dental and general surgery practice requiring prompt intervention, imaging techniques such as plain radiography and especially multi-detector computed tomography (MDCT) which offer the potential to improve the outcome buy increasing the accuracy of diagnosis. Materials and methods: In the present study, 30 patients with clinically diagnosed mandibular swelling were evaluated with conventional radiography; MDCT and HPE wherever performed to establish the value of MDCT and to evaluate the role of MDCT in establishing the diagnosis. Results: In the present study, majority of the cases were in the age group of 21-30 years with an male: female ratio of 1:1.5. Most commonly found lesions were odontogenic lesions (27 out of 30 cases) accounting about 90% of all the mandibular swellings. Among the odontogenic lesions ameloblastomas was the most common diagnosis followed by odontogenic keratocyst constituting 48%and 29% respectively in the present study, unilocular ameloblastoma were more common than multiocular ameloblastomas i.e. 7 out 13 cases (53.85%) among non-odontogenic lesions, central ossifying fibroma was the common diagnosis i.e. 2 out of 3 cases (67%) in the present study, being lesions were common than malignant i.e. 28 out of 30 cases (93.3%) and 2 out of 30 cases (06.66%) were malignant. Conclusions: MDCT provided excellent visualization and delineation of mandibular anatomy when compared to plain radiography. MDCT images ideal for pre-operative evaluation as they provide thin sections (

133-135

Authors: Singh Y, Pasha A, Suhail Bin Ahmed

Background: The prevalence of thyroid dysfunctions is encountered high in known diabetic patients. It is quiet commonly understood that patients who has one autoimmune problem generally tends to develop another. Materials and methods: Three hundred twenty known diabetic patients who attended the Department of Internal Medicine were taken up for the study. This study was done in the Department of Internal Medicine, Deccan Medical College, Hyderabad. Results: Both hypothyroidism and hyperthyroidism was significantly seen in known diabetics. Conclusion: Hypothyroidism was the most common kind of thyroid disorder encountered in our study.

145-155

Authors: Naveen Kumar S, Vidyadhara Rani P

Background: Thyroid ultrasound has undergone a dramatic transformation from the cryptic deflections on an oscilloscope produced in A-mode scanning, to barely recognizable B-mode images, followed by initial low resolution gray scale, and now modern high resolution images. Aim: The aim of the present study was to evaluate the diagnostic role of ultrasonography (USG) and multi-detector computed tomography (MDCT) in thyroid swellings, compare the ultrasonographic findings with multi-detector computed tomographic findings and to correlate the radiological findings with histopathological examination (HPE). Materials and methods: The present study was carried out in the Department of Radiology, Kamineni Institute of Medical Sciences, Narketpally. In this study, 50 patients with thyroid gland swellings diagnosed clinically, referred to Radiology Department were selected during the period from October 2008 to September 2010. Histopathological examination was acquired in 35 cases. The study was carried out to observe the sensitivity, specificity and diagnostic accuracy of USG and MDCT in thyroid gland swellings. Results: Maximum number of patients belonged to the age group of 21-40 years that was 27 cases (54.00%) and maximum number of patients were females – 41 cases (82.00%). Most common diagnosis was multi-nodular goitre on USG-16 cases (32.00%) and MDCT- 14 cases (28.00%), solitary thyroid nodule is common in the right lobe of thyroid by USG -5 cases (62.50%) and MDCT-5 cases (62.50%). Most common malignancy was papillary carcinoma of thyroid -5 cases (62.50%) and most common inflammatory disorder was hashimoto’s thyroiditis -5 cases (10.00%). Conclusion: The present study has concluded that USG is the fast and cost-effective modality of imaging investigation of choice in thyroid diseases and for differential diagnosis of thyroid nodules. MDCT is superior to ultrasound in evaluating retrosternal extension, relations and infiltrations in large lesions. It is also very helpful in evaluating extra-capsular, mediastinal, vascular invasion, lymph nodal involvement and metastasis. MDCT is very crucial in preoperative planning in malignancies of thyroid and large benign lesions.

164-170

Authors: G. Elango, C. Ramesh, D.D. Venkataraman

Background: Chronic kidney disease (CKD) is emerging as a major public health problem in India. The links between CKD and Tuberculosis have long been established but the exact nature of interaction is poorly understood. Bulk of the association was studied on subjects undergoing dialysis or renal transplantation, with limited studies on CKD subjects without dialysis. The amount of data is further scarce on Indian population. Hence the present study was conducted to assess the prevalence and profile of pulmonary tuberculosis in CKD patients presenting to a tertiary care teaching hospital in south India Materials and methods: The present study was a prospective study of all the CKD patients presenting to a tertiary care teaching hospital in south India diagnosed with chronic renal failure, as per the hospital protocol. The data was collected from the prospective case records of all the CKD patients diagnosed between April 2015 to 2017. Results: There were a total of 2927 patients with CKD, who satisfied the inclusion criteria and were included in the study. The average prevalence of tuberculosis among the study population was 1.16%. The age distribution of the tuberculosis cases have shown that highest proportion of subjects (47.05%) was aged above 60 years. There was a high male preponderance in study population, as 88.23% affected by tuberculosis were males and 11.77% were females. The most common x-ray finding was infiltration seen in 12 (35.29%) of the patients with TB. Cavities were present in 14 (41.17%) subjects- fibrosis was seen in 4 (11.76%) subjects. There was no statistically significant difference in blood urea nitrogen (BUN) or serum creatinine values between the two groups (P value > 0.05) Conclusion: Chronic Kidney disease patients are at high risk of tuberculosis, as the prevalence in CKD patients is higher than that of general population. Considering the alterations in the immune system, the immunological response of the host to tuberculosis infection is altered in CKD patients- this makes routine investigations like sputum examination and manteaux test less reliable in CKD patients. Chest-X-ray may be more useful in these patients.

178-186

Authors: Dharani Sudha G, Nirmala P, Ramanathan R, Sylvia S

Back ground: Impetigo is the most common bacterial infection in children. This acute, highly contagious infection of the superficial layers of the epidermis is primarily caused by Staphylococcus aureus or Streptococcus Pyogenes. The Objective of this study is to find out the role of probiotic among children suffering from impetigo. Materials and methods: This was a prospective, randomized, single-blinded interventional study, conducted in Paediatric OPD, Dermatology OPD and Paediatric Ward in Rajah Muthiah Medical College and Hospital for a period of 6 months. A total of 50 patients were enrolled in the study as per the inclusion criteria. They were treated with probiotic (50 million spores of Lactobacillus sporegenes, Streptococcus faecalis 30 million spores, Clostridium butyricum 2 million spores, Bacillus mesentericus 1 million spores) twice daily for 5 days. As a conventional treatment, Azithromycin 10 mg/kg/day once a day for 5 days given along with probiotic. Microbiological examination of pus from the first swab was used to prepare smears and was stained by Gram’s method. The pus from the second swab was inoculated on blood agar and Mc Conkey’s agar. Results: Bacteriological response and the clinical response were highly significant from baseline to the fifth day of treatment with probiotic along with azithromycin. Conclusion: The result of our study explores a new possibility in the horizon of treatment of impetigo. Since the adverse effects caused by probiotic are minimal and tolerable, it could be further exploited for the treatment of other inflammatory or immune conditions that are refractory to treatment with current chemotherapeutic agents.

191-194

Authors: Arun Prasath R, Krishnapriya R, R. Srinivasan

Pulmonary siderosis or Welder’s lung is a rare occupational lung disease which occurs due to long term inhalation of iron compounds. It is most commonly seen in arc-welders. Most of the patients are asymptomatic with mild or no functional impairment. We report a case of pulmonary siderosis with symptomatic respiratory disease and restrictive pattern in pulmonary function test.