Study of Depression among MDR TB Patients - A Crossectional Observational Study

Introduction: Anti tuberculosis drug resistance is a majorpublic health problem that threatens progress made in TBcare and control. Globally prevalence of MDR TB(Multidrugresistance tuberculosis i.e.resitance to Isoniazid andRifampicin) is estimated around 4.1% in new cases and 19%in previously treated cases according to WHO report. Clinicaldepression is common but often neglected problem amongTB patients. This study was conducted to know problem ofdepression among MDR Tb patients. Aims and objectives ofthis study were to determine the prevalence of depression inpeople with TB at the time of anti-TB treatment initiation andto assess factors associated with baseline depression.Material and methods: It is a observational study conductedin tertiary care centre. After obtaining proper consent andethical consent data was collected using PHQ 9 score. Datawas analysed using appropriate statistical methods.Results: Out of total 100 patients 80% were PulmonaryTuberculosis(PTB) while 20% were ExtrapulmonaryTuberculosis (EPTB). Around 56% patients were male while44% were female. Prevalence of depression was 51%.Conclusion: Depression is common problem among MDRTB which is preventable and can be managed if identified atearly stage.

Bacteriological Profile in Acute Exacerbation of Chronic Obstructive Lung Disease (AECOPD).

Background: In COPD, acute exacerbation is the common problem during natural course. Studies of sputum samples using standard culture and molecular techniques have demonstrated that it is associated with increased prevalence of bacteria. Methods: 200 clinically diagnosed cases of AECOPD of age ≥45 years were recruited. Two sputum samples each were processed by conventional methods. Preparation of media, reagents, Gram staining, identification of culture isolates, different tests, including antibiotic sensitivity tests were carried out following standard laboratory. Results: The prevalence of AECOPD was more common in the age group of fifty six to sixty five years (43%) with ratio between male and female of 2.12:1. Klebsiella pneumonia was the predominant organism isolated in 42.55%, followed by Staphylococcus aureus in 28.73%, P. aeruginosa in 14.89%, E coli in 8.51%, CONS in 4.26% and S. pneumoniae in 1.06%. Gram negative bacteria were most sensitive to meropenem, imepenem, amikacin, followed by cefotaxime ceftriaxone, levofloxacin, Cefepime and aztreonam. Gram-positive bacterial isolates were most sensitive to linezolid (34.04%) followed by vancomycin (32.98%), cefoxitin (31.91%).Conclusion: Sputum culture is a good and simple diagnostic tool to study the etiology due to bacteria in AECOPD. Antibiogram helps in the formation of the correct treatment protocol, screening resistant pathogens and better drug for treatment, thereby helping to decrease the mortality and morbidity.

Evaluation of BODE index as a predictor of Pulmonary Hypertension in COPD patients.

Background: The severity of COPD is usually assessed on the basis of a single parameter – forced expiratory volume in one second (FEV1). However, the patients with COPD have systemic manifestations that are not reflected by the FEV1. The present study was undertaken to determine the predictive value of BODE index (Body-mass index (B), the degree of airflow obstruction (O) ,dyspnea (D), and exercise capacity (E) for development of pulmonary hypertension and as a predictor of severity in COPD patients. The original BODE index is a simple multidimensional grading system which is superior to FEV1 alone for prediction of mortality and hospitalization rates among COPD patients. Methods: This study was done from January 2013 to December 2014.Total one hundred male patients who attended the chest medicine department, with the symptoms suggestive of COPD were included in this study and the study was done to evaluate the BODE index and correlated with echo-cardigraphic findings suggestive of pulmonary hypertension as a predictor of severity in patients with COPD. Result: Among patients with COPD, there were (21%) patients who had mild COPD with a BODE score between 0 – 2, Moderate COPD (BODE score of 3 – 5) were (23%), Severe COPD (BODE score more than or equal to 6) groups had (56%) patients. The study results showed that as the BODE index scores severity increases the incidence of pulmonary hypertension increases as identified by echocardiography RVSP (Right ventricular systolic pressure) findings. The average RVSP was 59.6 in severe COPD patients (BODE index more than 6) 47.2 in moderate severe COPD (BODE index 3-5), while it was less than 36 in mild groups. These values were found to be significant on comparison to other groups. Conclusion: BODE index may offer superior and alternative reliable method to predict severity in patients with COPD in terms of pulmonary hypertension and for following up after medications. Since the assessment of BODE index requires only a spirometer, which is relatively inexpensive and can easily be made available, this index could be of great practical value in a primary health care setup to identify individuals who are at need for further evaluation in a higher referral center. Thus, BODE index can be used for judicious referral of patients with COPD thereby preventing the wastage of the limited resources available.

Prevalence of Subclinical Peripheral Neuropathy in Chronic Obstructive Pulmonary Disease.

Background: Present study aimed to assess peripheral neuropathy in stable COPD patients, its prevalence, type and distribution and correlate the changes with severity of COPD. Methods: Study comprised of 60 healthy adults and 60 stable nonalcoholic and normo-glycemic COPD patients (30-70yrs) with no clinical symptoms and signs of neuropathy. Severity of COPD was classified as per WHO GOLD criteria. Nerve conduction study of four motor and four sensory nerves of upper and lower limb was done and parameters like distal latency, amplitude and conduction velocity was studied. Results: Study revealed prolonged distal latency, reduced conduction velocity and reduced amplitude in COPD patients as compared to controls. More number of nerves involved with increasing severity of disease. The observations revealed that demyelinating motor and axonal sensory neuropathy can be seen in COPD patients and neuropathy occurred even in mild COPD patients. Conclusion: Sensory polyneuropathy predominant in lower limb was present in majority of patients.