Tuberculous pleurisy steroid

At follow-up from three to 18 months, steroids reduce deaths by almost one quarter ( RR , 95% CI to ; nine trials, 1337 participants, high quality evidence ). Disabling neurological deficit is not common in survivors, and steroids may have little or no effect on this outcome ( RR , 95% CI to ; eight trials, 1314 participants, low quality evidence ). There was no difference between groups in the incidence of adverse events, which included gastrointestinal bleeding, invasive bacterial infections, hyperglycaemia , and liver dysfunction.

Pleural fluid for pH testing should be collected anaerobically in a heparinized syringe and measured in a blood-gas machine. 3 Frank pus should not be sent for pH determination because thick, purulent fluid may clog the blood-gas machine. A low pleural fluid pH value has prognostic and therapeutic implications for patients with parapneumonic and malignant pleural effusions. A pH value less than in a patient with a parapneumonic effusion indicates the need to drain the fluid. 14 , 15 In a patient with malignant pleural effusion, a pleural fluid pH value less than is associated with a shorter survival and poorer response to chemical pleurodesis. 1 When a pleural fluid pH value is not available, a pleural fluid glucose concentration less than 60 mg per dL can be used to identify complicated parapneumonic effusions. 14

To achieve the second management goal, therapies are selected based on the underlying condition. If a patient has suspected drug-induced pleuritis or drug-induced lupus pleuritis, the causal agent should be discontinued. 16 , 17 Smoking cessation should be advised for patients with pleurisy caused by asbestosis. 32 Antimicrobial and antiparasitic agents are selected empirically based on the suspected underlying organism. Decortication is considered in cases of pleuritis associated with refractory pleural effusions resulting from malignancy, chronic renal failure, or rheumatoid pleurisy. 2 Colchicine ( to mg orally once per day, or twice per day in a divided dose) is the mainstay of treatment for familial Mediterranean fever. 18

Antituberculous drug resistance has been increasing worldwide. Treatment of resistant TB, especially MDRTB, is frequently unsuccessful, requiring the use of more toxic, expensive drugs, surgery, or both. Thus, emphasis should be on strategies developed to avoid the emergence of drug resistance. Primary resistance occurs in patients with active TB who have never received antituberculous drugs. Secondary (or acquired) resistance is the occurrence of resistance after a mutant's selection or facilitation in the presence of various antituberculous drugs. A cavitary TB lesion may contain up to 10 9 bacilli in a perfect, culture-type, aerobic environment. M. tuberculosis has low rates of spontaneous chromosomal mutations, in the range of 1 : 10 6 for INH, 1 : 10 8 for RIF and approximately 1 : 10 14 for both agents. These rates are clinically insignificant, unless suboptimal time intervals or doses of anti-TB drugs facilitate the resistant subpopulation's growth.

Tuberculous pleurisy steroid

tuberculous pleurisy steroid

Antituberculous drug resistance has been increasing worldwide. Treatment of resistant TB, especially MDRTB, is frequently unsuccessful, requiring the use of more toxic, expensive drugs, surgery, or both. Thus, emphasis should be on strategies developed to avoid the emergence of drug resistance. Primary resistance occurs in patients with active TB who have never received antituberculous drugs. Secondary (or acquired) resistance is the occurrence of resistance after a mutant's selection or facilitation in the presence of various antituberculous drugs. A cavitary TB lesion may contain up to 10 9 bacilli in a perfect, culture-type, aerobic environment. M. tuberculosis has low rates of spontaneous chromosomal mutations, in the range of 1 : 10 6 for INH, 1 : 10 8 for RIF and approximately 1 : 10 14 for both agents. These rates are clinically insignificant, unless suboptimal time intervals or doses of anti-TB drugs facilitate the resistant subpopulation's growth.

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