ABSTRACT
Introduction: Since the discovery of HIV in the 1980's,there has been an alarming upsurge of Tuberculosis acrossthe globe. TB is the most common and usually the firstopportunistic infection in people living with HIV. BothHIV and TB together form the cursed duet, each one fastforwarding the progression of the other. Aims & Objectives:To study the epidemiology & various determinants of HIV-TBco-infection in HIV positive patients attending ART center atGoa Medical College (GMC), Goa. To study the prevalence ofHIV- TB co-infection. Settings and Design: It was a three yearrecord based retrospective observational study carried out atthe antiretroviral therapy center of a tertiary care Hospital inthe state of Goa.Material and methods: Study group comprised of 342 casesof HIV-TB co-infected patients above 15 years of age, and thecontrol group was formed by equal number of non TB, HIVinfected patients diagnosed during the same period. Variousdeterminants like age, gender, occupation, educational status,mode of transmission of HIV, addictions, CD4 counts etcwere compared. Statistical analysis: was done by calculatingpercentages and proportion by SPSS 14.0 version and Chisquare test was used for statistical significance, with P valuesless than 0.05 considered as statistically significant.Results: The prevalence of HIV-TB co-infection during thestudy period was found to be 26.6%. The incidence of coinfection was found to be higher in males (60.8%), in thosewho were semiskilled workers and with level of education upto secondary school and all these were found to be statisticallysignificant. Alcohol consumption, low CD4 counts and Comorbid illness like anemia were also found to be statisticallysignificant.Conclusions: Higher HIV-TB co-infection prevalence ratein the state warrants upgradation of disease control programswith efforts to increase awareness about the prevention andspread of both the diseases and their effective management.
ABSTRACT
Background: Multidrug resistant tuberculosis (MDR TB) requires treatment with expensive, toxic, anti-tubercular drugs over a longer duration. Adverse drug reaction (ADR) to second line anti tubercular drugs affect compliance and hence treatment outcome. The primary objective of this study was to analyse ADRs and if these resulted in change or permanent suspension of drug. We also analysed treatment outcome, treatment adherence and co morbidities associated with MDR patients.Methods: A retrospective study was carried out at DOTS plus site in department of Pulmonary Medicine, Goa Medical College on registered MDR cases from November 2011 to October 2016. Socio demographic profile, diagnosis, treatment and ADRs were evaluated, ADRs were evaluated for frequency, causative drugs, management aspect and impact on treatment outcome.Results: Out of 201 MDR cases, 99 cases had 167 ADRs. Majority of patients having ADRs were in age group of 30-50 years with mean眘tandard deviation 36.82�.47, 59 (59.59%) males and 40 (40.40%) females, 92 (92.92%) retreatment cases and 7 (7.07%) newly diagnosed. Majority of ADRs were vomiting 31(18.56%), joint pain 31 (18.56%), gastritis 21 (12.57%), hearing impairment 16 (9.58%), numbness in leg 14 (8.38%), depression 12 (7.18%). Treatment outcome of cases with ADR was cured 45 (45.45%), treatment completed16 (16.16%), progressed to XDR 6 (6.06%), transferred out 5 (5.05%), defaulter 14 (14.14%), death 13 (13.13%).Conclusions: It is very important to recognise at the earliest and treat the ADRs with least modification of the treatment regimen to have a good treatment outcome.
ABSTRACT
Introduction: COPD is a major cause of morbidity andmortality worldwide Besides lungs it has systemic effects,co morbidities. These co morbidities increase the risk ofexacerbation, reduce health status and increase risk ofmortality. The primary objective of this study was to assesthe various co morbidities in COPD patients, to study thedifference in proportion of co morbidities in smokers ascompared to the non-smokers and to study the proportion ofvarious co morbidities according to GOLD stageMaterial and methods: We studied 55 consecutive COPDpatients who presented to the department of pulmonarymedicine, Goa Medical College from August 2016 to July2017.Results: Out of the 55 patients included in the study 34(61.8%) were males and 21(31.8%) were females, age (meanand SD) 67.32±9.46, FEV1% (mean and SD) 47.45±12.78,FEV1/FVC% (mean and SD) 57.05±9.11, 36(65.4%) weresmokers with pack /year (mean and SD) 26.08±17.55, and19(34.5%) had biomass exposure with Biomass exposureindex (mean and SD)104.54±71.05 and Hb (mean and SD)was 12.83±2.19. The most frequent co morbidties werehypertension 54.5% (30 cases), followed by psychologicaldisturbance like depression 43.6% (24 cases). Percentage ofco morbidities were higher in the COPD patients exposed totobacco smoke as compared to biomass smoke. Percentage ofco morbidities were higher in the very severe stage of COPDas compared to the other stages of COPD.Conclusion: We recommend as a general practice to assesco morbidities in all COPD patients and vise versa as the comorbidities play a important role in exacerbation, reducinghealth status and increasing risk of mortality