The analysis of the drinking habits and the incidence of pulmonary tuberculosis has shown a relatively high percentage (47%) among patients with pulmonary tuberculosis taking alcoholic beverages compared to 15% among age and sex matched controls. The incidence of pulmonary tuberculosis is high among those drinking regularly or frequently and in moderate or heavy amount of alcohol. Often they exhibit moderately advanced or far advanced disease. Alcoholism decreases host resistance to infection from malnutrition, impaired bronchial clearance and defective neutrophil chemotaxis. It is necessary to look for pulmonary tuberculosis among regular, heavy drinkers of alcohol.

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In a series of 128 cases with bilateral hilar lymphadenopathy (BHL) studied during 1957-82 (investigated by a single author), 43 cases (34%) were due to sarcoidosis; tuberculosis was seen in 16 (12%) and lymphoma or malignancy in 17 (13%). Fourteen cases (11%) had a triad of BHL, erythema nodosum and arthralgia and sarcoidosis was diagnosed later in eight. Those having a pentad combination of arthralgia, hepatomegaly, respiratory symptoms. Fever and remarkable dissociation between gross changes in chest x-ray with BHL and scanty physical signs numbered 19 (15%). Most of triad and pentad cases were possible cases of sarcoidosis. In another 19 cases (15%) no diagnosis could be made possibly owing to prior steroid therapy. It is concluded that most cases of BHL in non-paediatric age-group in Eastern India are due to sarcoidosis.

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A policy trial was conducted to determine to what extent the intermittent short Course chemotherapy was effective in regard to efficacy of treatment; particularly with intermittent regimens containing Streptomycin (S), lsoniazid (H), Rifampicin (R) and Pyrazinamide (Z). Ninety-five bacteriologically proved pulmonary tuberculosis patients were drawn for the study. There remained 89 patients for the main analysis after exclusion of six patients. The treatment regimen was SHRZ on alternate days for two months followed by twice-weekly SHRZ for another five months. Default rate was minimal. Regularity in drug collection during these seven months treatment was quite satisfactory in this easily accessible closed population. Bacteriological assessment revealed 100% bacteriological conversion in freshly diagnosed patients Radiological assessment with regard to clearance of lesion and cavity closure were also studied; 53% of patients showing complete or two third clearance. Adverse reaction to drugs were very infrequent. Follow up of 55 patients revealed encouraging results. Thus, at the end of 17 months only four of 55 patients showed relapse with positive smear results.

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A total of 212 smear positive patients suffering from pulmonary tuberculosis were randomly allocated to two anti-tuberculous drug regimens. Ten out of 107 (9.3%) patients on drug regimen 1 (2 SHR/6 TH) developed hepatitis as compared to 13 out of 105 (12.3%) patients on drug regimen II (2 SHRZ/6 TH). Onset of anorexia during therapy was always specific of hepatitis. Clinical jaundice developed in four and eight patients respectively (p>0.05). The hepatitis was of severe type (ALT >125 units) in two and four patients respectively (p>0.05). Thus, the risk of hepatitis is not significantly increased by addition of pyrazinamide to rifampicin-isoniazid combination. However, withdrawal of drugs should be effected immediately if a patient on these drugs develops anorexia.

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Sarcoidosis has a world wide distribution. It appears to be uncommon in less developed countries (James, 19691). However, sarcoidosis is being increasingly recognized in India (Gupta et al, 19822). Multiple discrete nodes of varying sizes were removed from the superior mediastinum in a 40 year old woman who underwent thoracotomy. There was difficulty in deciding whether the clinical and histopathological features were consistent with tuberculosis or sarcoidosis. There was a dilemma whether to start or withhold antituberculous treatment. The clinical response to a trial of antituberculous treatment was good. The conflicting views in the literature regarding the relationship between tuberculosis and sarcoidosis are discussed.

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Klebsiella pneumonia were cultured in 26 out of 423 bronchial aspirates obtained using a selective collection technique. Eighteen patients were males and eight females. Antecedent upper respiratory tract infection or oral sepsis, previous antibiotic therapy, history of smoking, alcoholism, associated diabetes mellitus, malignancies and chronic lung diseases in the middle aged or elderly patient were common pre-disposing factors. Radiologically the disease predominantly presented as lobar infiltrates in upper lobes with frequent caviatation and abscess formation, while lobular infiltrates and isolated cavitation were present in a few. Kanamycin, Gentamycin, Streptomycin, and Chloramphenicol were the most effective antibiotics. After appropriate treatment, radiological regression with clinical improvement was observed in half of the cases, while rest had a prolonged course with residual pulmonary disease and a mortality of 12%.

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A case of neuropathy predominantly motor in nature of acute onset during antitubercular therapy in an alcoholic is reported. isoniazid possibly precipitated a subclinical alcohol neuritis in this patient.

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A total of 510 questionnaires was distributed to all the undergraduate students of Topiwala National Medical College to collect data on the practice of tobacco smoking and its relation with respiratory tract infection. The questionnaires were filled on the spot under supervision. The total percentage of smokers is estimated as 21.0%. It is found that respiratory infections are more common among smokers and there is a strong association between history of adenoidectomy or tonsillectomy in students to parental smoking habits.

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Forced Vital Capacity (FVC), Forced Expiratory Volumes in 0.75 and 1.0 seconds, (FEV0.75 and FEV1) and Forced Expiratory Flow Rate over the middle half of FVC (FEF25-75%) were determined with a McKesson Vitalor. American school boys between 8 and 11 years of age were taller and heavier and had higher function values than Indian school boys of the corresponding age. Indian school boys of approximately similar physical build had spirometric values similar to the American boys but were about two years older by the time they attained the same stature and function values. It appears that a part of the ethnic spirometric variations are due to anthropologic ethnic differences.

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