Contrary to what we have been taught about nutrition in any culture, the
majority of us are still kept in the dark about what the optimum diet for us
consists of. This is not surprising when you realize that most governments that
provide us with our nutritional guidelines are connected with very powerful
organizations such as the meat, dairy, and egg industries who not only expect,
but demand that their products are promoted in the dietary guidelines. Culture
and tradition also keep us tightly glued to addictions and unhealthy habits.



Advanced Lipoprotein Fingerprinting is a more precise cholesterol test that
allows doctors to identify health risks that traditional screens miss. The
process separates lipids in the blood to create a detailed cholesterol profile
that helps doctors identify patients at risk for heart disease. The detailed
graph allows a doctor to precisely analyze a patient's overall risk profile and
monitor the effectiveness of a diet or treatment regimen.



This advanced analytical techniques that can help doctors diagnose early warning
signs for coronary heart disease, which kills more than 2,600 Americans a day,
according to the American Heart Association. High LDL cholesterol is a major
cause of coronary heart disease, according to the National Cholesterol Education
Program.



LipidLabs refined the Advanced Lipoprotein Fingerprinting Process and the
results translate to more accurate and specific data on which to make clinical
judgments and guide patient therapy and prevention at reasonable costs.

Heart disease is the number one killer of men and women in the U.S. This all
makes sense when you understand some basic principles about nutrition.



• All cholesterol in the human diet comes from animal-foods.

• The human body produces all the cholesterol it needs.

• The majority of saturated fat in the human diet comes from animal foods.

• Everything the human body requires for excellent health can be found in
plant-based foods.

• The main fuel that the human body utilizes for energy: carbohydrates and
simple sugars.

• Too much protein is linked to kidney problems.

• Eating a diet rich in animal foods has been linked with heart disease, many
cancers including breast cancer, and prostate cancer, stroke, diabetes, and an
other life taking diseases.

Dr. D.S. Merchant Resident Medicine

Gold Medalist (Anatomy & Histology)

Advanced Lipid Cholesterol Screening : Nutrition/Agriculture

Those who have concern about elevated blood cholesterol or triglyceride problems related to increased risk to coronary heart disease should adhere to a Blood Lipid Lowering Standard Diet and have a Lipoprotein Fingerprinting test accomplished through their healthcare provider.

A Blood Lipid Lowering Standard Diet contains 20% saturated (soaked) fat and more than 400 mg cholesterol and has been implicated in elevations of blood cholesterol (LDL cholesterol) and an attendant increased risk for heart disease. This diet is rich in natural complex unrefined carbohydrate and fiber while low in total cholesterol. This lipid lowering approach avoids any potential problems associated with fatty acid deficiency. This diet will provide adequate levels of the vitamins and minerals.

Advanced Lipoprotein Fingerprinting is a more precise cholesterol test that allows doctors to identify health risks that traditional screens miss. The process separates lipids in the blood to create a detailed cholesterol profile that helps doctors identify patients at risk for heart disease. The detailed graph allows a doctor to precisely analyze a patient's overall risk profile and monitor the effectiveness of a diet or treatment regimen.

This advanced analytical techniques that can help doctors diagnose early warning signs for coronary heart disease, which kills more than 2,600 Americans a day, according to the American Heart Association. High LDL cholesterol is a major cause of coronary heart disease, according to the National Cholesterol Education Program.

LipidLabs refined the Advanced Lipoprotein Fingerprinting Process and the results translate to more accurate and specific data on which to make clinical judgments and guide patient therapy and prevention at reasonable costs.

SAMPLE MENU FOR ONE DAY

Breakfast:
1/2 grapefruit
3 ounces salmon steak
1/2 cup oatmeal
1 cup skim milk

Lunch:
1 sardine sandwich (using whole grain bread)
1 cup fat-free soup
1 apple
1/3 cup cooked lentil beans

Dinner:
3 ounces broiled mackerel
1/2 cup steamed broccoli
2 teaspoons oil and vinegar dressing
1 cup skim milk
or
1 cup brown rice
1 cup salad
1 peach
1/2 cup tomato juice

Dr. D.S. Merchant Resident Medicine
Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening : Nutrition/Agriculture

Advanced Lipoprotein Fingerprinting is a more precise cholesterol test that allows doctors to identify health risks that traditional screens miss. Doctors now have a precise reading not only of a patient's cholesterol levels but other independent risk factors known to be associated with heart disease.

The process separates lipids in the blood to create a detailed cholesterol profile that helps doctors identify patients at risk for heart disease. The detailed graph allows a doctor to precisely analyze a patient's overall risk profile and monitor the effectiveness of a diet or treatment regimen.

This advanced analytical techniques that can help doctors diagnose early warning signs for coronary heart disease, which kills more than 2,600 Americans a day, according to the American Heart Association. High LDL cholesterol is a major cause of coronary heart disease, according to the National Cholesterol Education Program.

Aiming to identify early risk factors, the National Cholesterol Education Program issued guidelines calling for more comprehensive cholesterol screens as well as other risk factors not included in the cholesterol screen.

Early detection, particularly in youth, is the key to slowing down the development of heart disease in later life. Advanced cholesterol screening is a valuable tool that is gaining acceptance among medical insurers.

Texas A&M University researchers created Advanced Lipoprotein Fingerprinting as a more precise cholesterol test that allows doctors to identify health risks that traditional screens miss. LipidLabs further refined the Advanced Lipoprotein Fingerprinting Process and made Advanced Lipoprotein Fingerprinting available for commercialization. LipidLabs' results translate to more accurate and specific data on which to make clinical judgments and guide patient therapy and prevention at reasonable costs.

Clinical Highlights:

1. Screen men over age 34 and women over age 44 every five years.

2. The decision to screen men age 20 to 34 years, women age 20 to 44 years and anyone over 75 years should be based on individual preferences of patient and provider.

3. Measure cholesterol fractionation and provide nutrition and exercise assessment every five years. If likelihood of follow-up is low and patient is not fasting, consider checking total cholesterol and high-density lipoprotein (HDL) cholesterol.

General Awareness Activities:

Employer, School and Community Education Awareness Activities
Many educational and medical individuals are playing very impressive and crucial role by putting their efforts in helping to increase the number of children and adults to present themselves for appropriate lipid screenings.
Awareness initiative programming conducted includes:

• Posters for company bulletin boards
• General screening information "tents" for tables in reception areas, cafeterias, employee lounges, locker rooms, and other such places
• Incentives to increase compliance with and awareness of guideline screening recommendations Information on the importance of regular lipid screening can be included as part of a larger health promotion/disease prevention initiative which includes not only cholesterol and healthy lifestyles but aware people of heart diseases and appropriate health care utilization as well.

Health care providers should:

• Establish a process to identify those needing cholesterol screening
• Make educational brochures available at time of visit
• Select educational materials based on a nutrition and exercise assessment
• Utilize a system encouraging patients to attend classes if laboratory results suggest benefit from changing nutritional and/or exercise behaviors.

Doctors somethimes also make visits to offices and schools for conducting lipid screenings.

Total Cholesterol >200; LDL >130; HDL<40; or Triglycerides >200?
Individuals with a total cholesterol less than or equal to 200 mg/dL (and HDL-cholesterol of 40 mg/dL or above or triglycerides less than or equal to 200) have a desirable cholesterol level are advised to repeat cholesterol fractionation in five years.

© Dr. D.S. Merchant Resident Medicine
Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening : Diabetes

Facts prove the benefits of lowering cholesterol in various populations continues to grow, but questions still remain about screening and treatment of lipid disorders in women, even though data from primary prevention trials in women remain thin, recent trials demonstrating benefits of cholesterol reduction across a broad range of cholesterol levels and cardiac risk in men and women encourage the conclusion that benefits may extend to asymptomatic women who are otherwise at high risk for coronary disease.

Periodic lipid screening beginning in middle age will identify most women who are at high enough risk to merit drug therapy or more detailed consideration of age, diabetes, blood pressure, and other risk factors can more accurately estimate individual risk of coronary heart disease. Advice about healthy diet, weight control, and physical activity can benefit all women,

Advanced Lipoprotein Fingerprinting is a more precise cholesterol test that allows doctors to identify health risks that traditional screens miss. Doctors now have a precise reading not only of a patient's cholesterol levels but other independent risk factors known to be associated with heart disease.

The process separates lipids in the blood to create a detailed cholesterol profile that helps doctors identify patients at risk for heart disease. The detailed graph allows a doctor to precisely analyze a patient's overall risk profile and monitor the effectiveness of a diet or treatment regimen.

This advanced analytical techniques that can help doctors diagnose early warning signs for coronary heart disease, which kills more than 2,600 Americans a day, according to the American Heart Association. High LDL cholesterol is a major cause of coronary heart disease, according to the National Cholesterol Education Program.

Aiming to identify early risk factors, the National Cholesterol Education Program issued guidelines calling for more comprehensive cholesterol screens as well as other risk factors not included in the cholesterol screen.

Early detection, particularly in youth, is the key to slowing down the development of heart disease in later life. Advanced cholesterol screening is a valuable tool that is gaining acceptance among medical insurers.

Texas A&M University researchers created Advanced Lipoprotein Fingerprinting as a more precise cholesterol test that allows doctors to identify health risks that traditional screens miss. LipidLabs further refined the Advanced Lipoprotein Fingerprinting Process and made Advanced Lipoprotein Fingerprinting available for commercialization. LipidLabs' results translate to more accurate and specific data on which to make clinical judgments and guide patient therapy and prevention at reasonable costs.

© Dr. D.S. Merchant Resident Medicine
Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening : Women's Health / OBGYN

The only need for cholesterol screening in children and adolescents is to identify pediatric patients with familial hypercholesterolemia (FH), since early disease detection is crucial in order to facilitate treatment to prevent coronary artery disease.

Advanced Lipoprotein Fingerprinting is a more precise cholesterol test that allows doctors to identify health risks that traditional screens miss. Doctors now have a precise reading not only of a patient's cholesterol levels but other independent risk factors known to be associated with heart disease.

The process separates lipids in the blood to create a detailed cholesterol profile that helps doctors identify patients at risk for heart disease. The detailed graph allows a doctor to precisely analyze a patient's overall risk profile and monitor the effectiveness of a diet or treatment regimen.

This advanced analytical techniques that can help doctors diagnose early warning signs for coronary heart disease, which kills more than 2,600 Americans a day, according to the American Heart Association. High LDL cholesterol is a major cause of coronary heart disease, according to the National Cholesterol Education Program.

Aiming to identify early risk factors, the National Cholesterol Education Program issued guidelines calling for more comprehensive cholesterol screens as well as other risk factors not included in the cholesterol screen.

Early detection, particularly in youth, is the key to slowing down the development of heart disease in later life. Advanced cholesterol screening is a valuable tool that is gaining acceptance among medical insurers.

Texas A&M University researchers created Advanced Lipoprotein Fingerprinting as a more precise cholesterol test that allows doctors to identify health risks that traditional screens miss. LipidLabs further refined the Advanced Lipoprotein Fingerprinting Process and made Advanced Lipoprotein Fingerprinting available for commercialization. LipidLabs' results translate to more accurate and specific data on which to make clinical judgments and guide patient therapy and prevention at reasonable costs.

1. Age Between 2 and Up to 20 Years and No Prior Screening?
The guideline applies to children and young adults between the ages of two and twenty years. Children prior to the age of two years do not require lipid status assessment. Adults 20 years old or older should be screened for their lipid status
Once a child or adolescent has been screened any time between the ages of 2 to 20, they do not need to have the screening repeated.

2. Parent with Pretreatment Total Cholesterol >300?
Adult FH heterozygotes have pretreatment cholesterol levels in the 300 to 500 mg/dL range. Adult FH homozygotes have untreated cholesterol levels greater than 500 mg/dl. Increase appropriate screening for children at risk for FH.

3. Measure Total Cholesterol
Measurement of non-fasting serum total cholesterol is recommended for children and young adults who have either a first-degree relative with a history of premature CHD prior to the age of 55 years for men and 65 years for women.

4. Total Cholesterol >200?
A total cholesterol of 200 mg/dL is the cutoff for individuals at risk for FH. Total cholesterol greater than or equal to 200 mg/dL requires further clinical assessment.

5. LDL-Cholesterol >164?
An LDL-cholesterol of 164 mg/dL has been shown to be the most discriminating level for identifying FH. Borderline levels (155-175 mg/dL) should be repeated to obtain an average. Clinicians should also obtain cholesterol levels from the parents.

© Dr. D.S. Merchant Resident Medicine
Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening : Pediatrics

Other Problems to be Considered:

Blast mycosis
Cat scratch disease

• It is critical that hopitalized patients with suspected or documented TB be placed in appropriate isolation. This includes a private room with negative pressure and adequate air exchanges. Persons entering the room must wear masks or respirators capable of filtering droplet nuclei.

• Patients should remain in isolation until sputum becomes smear-negative; however, patients ordinarily should not be kept in the hospital for the sole purpose of providing isolation, Special arrangements are necessary for patients who live with children, individuals infected with HIV, patients returning to a closed-group setting (eg, nursing home, correctional facilities, residential facility, homeless shelter).

Further Outpatient Care:

• Patients diagnosed with active TB should have sputum examined for M tuberculosis weekly until sputum conversion is documented. Monitoring for toxicity includes baseline and periodic liver enzymes, complete blood count, and serum creatinine.

• In addition, patients on pyrazinamide should have baseline or periodic serum uric acid determinations, and patients on long-term ethambutol therapy should have baseline or periodic visual acuity and red-green color perception testing. The latter can be performed with a standard test such as Inhihara test for color blindness.

Deterrence/Prevention:

• Patients with a clinically significant result on tuberculin skin testing (see other tests) should be given a course of therapy once active infection and disease is ruled out. Guidelines published by the CDC in 2000 now refer to this as treatment of latent TB. The recommended regimens are listed below:

o INH daily for 9 months
o INH twice weekly for 9 months (given as DOT)
o INH daily for 6 months (should not be used in patients with fibrotic lesions on chest radiograph, patients with HIV, or children)
o INH twice weekly for 6 months (given as DOT, should not be used in patients with fibrotic lesions on chest radiograph, patients with HIV, or children)
o Rifampin daily for 4 months
o Rifampin plus pyrazinamide daily for 2 months

• Children should be given INH for 9 months. In addition, children younger than 5 years who have closed contact to an active case of TB should be started on INH even of skin testing is negative; preventive therapy can be stopped if repeat skin testing is negative 3 months after last contact with a culture positive source case.

• Patient exposed to MDR-TB may be given ethambutol plus pyrazinamide for 6 – 12 months or pyrazinamide plus levofloxacin for 6 – 12 months; the index isolate should be susceptible to all drugs used.

• Recommended regimens in patients with HIV infection include pyrazinamide plus rifampin daily for 2 months, rifampin alone daily for 4 months, or 9 months of INH (daily or twice weekly). Patients on antiretroviral therapy may need rifabutin in place of rifampin.

© Dr. D.S. Merchant Resident Medicine AKUH
 Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening

CLINICAL

History:

Pulmonary TB: Typical symptoms of pulmonary TB include a productive cough, fever, and weight loss. Occasionally, patients may presents with hemoptysis or chest pain. Other systemic symptoms include anorexia, fatigue, or night sweats.
Tuberculous meningitis: Patients may present with a headache that is either intermittent or persistent for 2-3 weeks. Subtle mental status changes may progress to coma over a period of days to weeks. Fever may be low-grade or absent.
Skeletal TB: The most common site of a involvement is the spine (Pott disease). Symptoms include back pain or stiffness. Lower extremity paralysis occurs in as many as half the patients with undiagnosed Pott disease. Tuberculous arthritis usually involves only 1 joint. Although any point may be involved, the hip of the knee is affected most commonly, followed by the ankle, elbow, wrist, hip or the knee is affected most commonly, followed by the ankle, elbow wrist and shoulder. Pain may precede radiographic changes by weeks to months.
Genitourinary TB: Reported symptoms include flank, pain, dysuria, or frequency. In men, genital TB may present as epididymitis or a scrotal mass. In women, genital Tb may mimic pelvic inflammatory disease. TB causes approximately 10% of sterility in women worldwide and approximately 1% in industrialized countries.
Gastrointestinal TB: Any site along the gastrointestinal tract may become infected. Symptoms are ferable to the site infected, to include the following: nonhealing ulcers of the mouth or anus; difficulty swallowing with esophageal disease; abdominal pain mimicking peptic ulcer disease with stomach or duodenal infection; malabsorption with infection of the small intestine; and pain, diarrhea, hematochezia with infection of the colon.
Tuberculosis lymphadenitis (scrofula): The most common site is in the neck along the sternocleidomastoid muscle. It usually is unilateral. It usually is unilateral, with little or no pain. Advanced disease may suppurate and form a draining sinus.
Cutaneous TB: Direct inoculation may result in an ulcer or wartlike lesion. Contiguous spread from an infected lymph node typically results in a draining sinus. Hematogeneous spread may result in a reddish brown plaque on the face or extremities (lupus vulgaris) or tender nodules or abscesses.
Physical: Finding upon physical examination depend on the organs involved.

Patient with pulmonary TB have abnormal breath sounds, especially over the upper lobes or areas invovled.
Sign of extrapulmonary TB differ depending on the tissues involved. Signs may include confusion, coma, neurologic deficit, chorioretinitis, lymphadenopathy and cutaneous lesions (as described above).
Postnatal TB is contraced via the airbone route. The most common findings are adenopathy and a lung infiltrate. However, the chest radiography findings can be normal in infants with disseminated disease. Many experts increase treatment time to 9 or 12 months because of the possible impaired immune system in children younger than 12 months. Bacille Calmette-Guerin vaccine is no longer recommended for infants.
Causes: M tuberculosis is a slow-growing organism, requiring 4-8 weeks for visible growth on solid medium. The organism grows in parallel groups called cords (see Image 1). It retains many stains after decoloration with acid-alcohol, which is the basis of acid-fast stains.

© Dr. D.S. Merchant Resident Medicine AKUH
Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening :  Health Articles

Background: Tuberculosis (T is the number one infections disease killer worldwide. The World Health Care Organization estimates that 2 billion people have latent TB, while another 3 million people worldwide die each year due to TB.

On average, the isoniazid (INH) resistance rate is approximately 10% and the rifampin resistance rate is approximately 1%, with lower numbers in countries with good TB programs and higher numbers in the countries with poor TB programs.

Pathophysiology: Humans are the only known reservoir for Mycobacterium tuberculosis. TB is transmitted by airborne droplet nuclei, which may contain fewer than 10 bacilli. Exposure to TB occurs by sharing common airspace with a patient who is infectious. When inhaled, droplet nuclei are deposited within the terminal airspaces of the lung. Upon encountering the bacilli, macrophages ingest and transport the bacteria to regional lymph nodes.

The bacilli have 4 potential fates:
1. They may be killed by the immune system.
2. They may multiply and cause primary TB.
3. They may become dormant and remain asymptomatic, or
4. They may proliferate after a latency period (reactivation disease). Reactivation disease may
occur following either 2. or 3. above.

Frequency:

In The US: Beginning in 1985, a resurgence of TB was noted. The increase was observed primarily in ethnic minorities and especially in persons infected with HIV. TB control programs were revamped and strengthened across the United States. After peaking at 25,287 (1993), the number of reported cases began to fall again. In 2001, 15,989 cases of TB were reported to the US Centers for Disease Control and Prevention (CDC). An estimated 10-15 million people have latent infection. Among foreign immigrants, 74% of cases reported in 1998 were related to 7 countries:
1. Vietnam
2. Philippines
3. India
4. China
5. South Korea
6. Mexico
7. Haiti
Foreign born persons account for a steadily increasing proportion of all reported TB cases.

Internationally: An estimated 20-33% of the world's population is infected with M tuberculosis. Countries with the highest prevalence include Russia, India, Bangladesh, Pakistan, Pakistan, Indonesia, Philippines, Vietnam, Korea, China, Tibet, Hong Kong, Egypt, most Sub Saharan African countries, Brazil, Mexico, Bolivia, Peru, Colombia, Dominican Republic, Ecuador, Puerto Rico, El Salvador, Nicaragua, Haiti, Honduras, and areas undergoing civil war (e.g. Balkan Countries). Countries in Eastern Europe have an intermediate prevalence. Costa Rica, western and northern Europe, the United States, Canada, Israel, and most countries in the Caribbean have the lowest prevalence.
Mortality / Morbidity: The case fatality rate for TB was 50% for untreated patients before the advent of antibiotic therapy. Deaths worldwide are are estimated at 3 million per year. In United States, the mortality rate dropped from 12.4 deaths per 100,000 population (1953) to 0.6 deaths per 100,000 population (1993); this is approximately 7% per newly identified case.

Multidrug resistant during tuberculosis (MDR-T cases have a higher reported mortality rate. Patients with underlying diseases predisposing to active TB also have higher morality rates.
Morality of untreated congenital TB is 50%.
TB can mimic congenital syphilis or cytomegalovirus (CMV) infection.
Race: Based on 1990 CDC data, case rates were 10 times higher for Asians and Pacific Islanders; 8 times higher for non Hispanic blacks; and 5 times higher for Hispanics, Native Americans, and Native Alaskans, as compared to non Hispanic whites. However, race may not be an independent risk factor. Risk is best defined on the basis of social, economic, and medical factors.

Sex: Despite the fact that TB rates have declined in both sexes in the United States, certain differences exist. TB rates in women decline with age; in men, they increase with age. Men are more likely to have a positive tuberculin skin test. The reason for these differences may be social rather than biological in nature.

Age: In the 1997 CDC data for the United States, more than 60% of cases occurred in persons aged 25-64 years. The age specific risk was highest in persons older than 65 years. Infection in infants and young children (up to 5years) always indicates recent transmission. If left untreated, it may result in life threatening meningitis or disseminated disease, Elderly patients may not have typical signs and symptoms of infection because they may not mount a good immune response. In elderly patients, an active tuberculosis infection may present as an non resolving pneumonitis.

© Dr. D.S. Merchant Resident Medicine AKUH
Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening :  Cardiovascular

Introduction:
Sarcoidosis with a prevalence of 10/100,000, is a multisystem disease of unknown etiology characterized by non-caseating granulomas.i It involves virtually any organ, lungs, thoracic lymph nodes, skin liver, central nervous system, eyes, kidneys and heart, and is more common in Afro-Americans. There is no sex predilection but some manifestations of the disease are more common is females. ² It begins in the third or fourth decade and tends to be rare in children and the elderly.? We are presenting a case of sarcoidosis of the lungs which should be considered in the differential diagnosis of tuberculosis, common in countries like Pakistan.

Discussion:
Considering the common disease first which is tuberculosis, long-standing history of low grade fever, weight loss and persistent cough not responding to anitibiotics along with raised ESR and positive PPD(13 mm) supports tuberculosis put PPD is not reliable in developing countries as a tool for diagnosis.

Diagnostic procedure performed was an endobronchial biopsy. ² Histopathological examination showed multiple granulomas, composed of epitheloid histiocytes, with occasional Langerhan’s giant cell and no necrosis. According to one study endobronchial biopsy increased the yield of fibreoptic bronchoscopy by 20.6%.4 Fungal stain, AFB stains and cultures, were negative (Table II).

The patient had X-ray findings consistent with stage II disease. 1,5 Unilateral hilar adenopathy is an atypical manifestation of sarcoidosis in initial stage. 6 Her ACE level was raised about three folds, serum calcium was in upper normal range and ESR was persistently raised (Table I) supported by radiological findings, which favour sarcoidosis. PPD is negative in sarcoidosis are anergic to PPD tuberculin but distribution of memory T-cells in the blood and humoral immune response are normal and opportunistic infections are rare.¹

Fifty percent of sarcoid cases have clinically silent involvement of organs, which is one of the hallmarks.¹ 20-40% of symptomatic patients have respiratory symtoms and 10-40% have eye pain, rashes arthralgia and other symptoms while 20-30% with constitutional symptoms like weight loss and fatigue.¹

Sarcoidosis may present atypically as Lofgrens and HeerFordt’s syndrome.¹ Sarcoidosis in younger patients with spontaneous remission and less than two years duration of symptoms are classified as subacute while chronic form have more than two years duration with insidious onset and presents with constitutional symptoms, pulmonary fibrosis and nephrocalcinosis.¹

In one study in which histopathological diagnosis required presence of non-caseating granuloma, bronchoscopic biopsy yielded diagnosis in 60% of patients with stage I disease, tranbronchial needle aspiration yielded diagnosis in 53% and two procedures in combination yielded 83% of diagnosis. 7,8 In stage II disease probability of obtaining a positive result with a single specimen was 46%, the yielded with more specimens followed a logarithmic curve and increased to 90% with four specimen, at which point the yield approached a plateau for additional specimen. 7,8 The suggests that four biopsy specimens are sufficient to make diagnosis. Biopsy of gastrocnemius muscle is another sensitive and specific tool for diagnosis. 9 If transbronchial biopsies are non-diagnostic, mediastinal lymph node biopsies are diagnostic in 8-90% of case. 10 Finally , the patient was kept on steroids (Deltacortil) 40mg/day in divided doses and He/She responded well with remarkable improvements. 11 His/Her ESR came down to 13mm, chest X-ray showed remarkable improvement as infiltrates and bilateral hilar adenopathy disappeared altogether.

We kept His/Her on the same dose of Deltacortil till 8 weeks, and then it was trapered off to 7.5mg/day without recurrence.

© Dr. D.S. Merchant Resident Medicine AKUH
 Gold Medalist (Anatomy & Histology)
Advanced Lipid Cholesterol Screening