Prevalence of latent tuberculosis in end stage renal disease patients at Baghdad teaching hospital

Background: Tuberculosis [TB] is one of the oldest diseases known to affect humans, it caused by infection with Mycobacterium Tuberculosis [MTB]. MTB is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei. End Stage Renal Disease [ESRD] patients are exposed to a variety of infections, including TB. The standard test for detecting Latent TB infection [LTBI] is tuberculin skin test [TST]

Objective: Determination the prevalence of latent tuberculosis among end stage renal disease patients in hemodialysis unit in Baghdad teaching hospital, and assessing its correlations with various conditions

Methods: A stratified random sampling technique was used to select a sample of 71 patients of ESRD in hemodiaylsis unit in Baghdad teaching hospital. The selected patients were interviewed using a structured pretested questionnaire. Two units of PPD [0.1mL] had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was considered positive if [>=10mm induration] developed

Results: The study showed the rate of tuberculin reactivity among End Stage Renal Disease [ESRD] patients is 28.57%. About 57.14% of patients were male; mean age of patient was 54.34 +/- 15.25 years. The major cause of renal impairment were diabetes mellitus [DM] 52.86%, followed by hypertension 15.71%, duration of dialysis more than 6 months was 46.67%. History of contact with active tuberculosis patient was 62.5%

Conclusion: Significant relationship between history of contact with active TB patients, duration of dialysis, and age of patients with TST positivity

Rate of tuberculin reactivity among health care workers in Ibn Zuhur and Ibn Alkhateeb Hospitals

Background: Tuberculosis is one of the oldest diseases known to affect human, it caused by infection with Mycobacterium Tuberculosis, which is part of a complex organisms including M.bovis [reservior cattle] and M.africanum [reservior human]. Mycobacterium Tuberculosis is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei which are aerosolized by coughing, sneezing or speaking. Health care workers are exposed to a variety of infections, including TB. The standard test for detect latent TB infection is tuberculin skin test [Mantox test] using purified protien derivatives if Mycobacterium Tuberculosis

Objective: Is to estimate the rate of TB transmission from patients with active disease to the Health care workers, and also to study the relation of different variables to the transmission risk including [Gender, Vaccinations, and Duration of contact or occupation duration]

Subjects and Methods: Cross sectional descriptive study done in Ibn Zuhur hospital and Ibn alkhateeb hospital between April and May 2013. One hundred and two health care workers were included in this study [50] HCWs from Ibn zuhur hospital and [52] health care workers from Ibn alkhateeb hospital. 5 units of PPD [0.01 ml] had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was cinsidered positive if [> = 10 mm induration] developed

Results: The study shows the rate of tuberculin reactivity among health care workers 25.5% [26/102] a significant relationship between duration of work in hospital and tuberculin reactivity among HCWs. 50] HCWs from Ibn zuhur hospital their age ranging between 24-48 years mean 36 year, 34[86%] were male and 16[32%] female and 52 HCWs from Ibn Alkhateeb hospital their age ranging between 21-43 years mean 32 year, 42 [81%] were male and 10 [19%] female in Ibn zuhur hospital 32% [16/50] Ward nursing staff 5-10 years work duration shows the higher rate [38.5] followed by laboratory staff 5-10 years [28.57%] and then doctors < 5 year's work [25%] ,service workers 2-5 years' work shows [22.22%]. While in Ibn Alkhateeb hospital 19% [10/52] Ward nursing staff 5-10 years work duration shows the higher rate [27%] followed by laboratory staff [20%] and then service workers 2-5 years' work shows 12.5% while doctors < 5 years work duration shows 8.5%

Conclusion: Health care workers have high rate of latent TB infection. Their positivity correlated with the duration of their job. Health care workers with negative tuberculin skin test should be immunized with BCG vaccine

Relationship between FEV1 and PEF in patients with obstructive airway diseases

Spirometry is the recommended investigation for diagnosis and categorization of the severity of the air flow limitation, however Spirometer is not widely available, while Peak-flow meter is cheap, portable, and easy to operate and maintain, so the PEF is frequently proposed as alternative to FEV1 for this purpose, and widely used in general practice as a surrogate for FEV1 in assessment of airway obstruction diseases. To determine effect of FEV1 and PEF in obstructive airway diseases. This study was took place between 1[st] December 2006 and 1[st] July 2007 in Baghdad teaching hospital. A total of 100 patients with history suggestive of obstructive airway diseases [symptoms of cough, wheezes, shortness of breath, and chest tightness], and their pulmonary function test show obstructive pattern [FEV1/FVC <70%] were included. They were [60%] male and [40%] female, and their age ranged from 16 to 82 years. In screening for obstructive airway diseases, there was a significant relationship [P value 0.05] between FEV1% and PEF%, [94%] of patients with obstructive airway disease as assessed by FEV1% [FEV1%< 80%] had PEF%< 80%.In severity categorization, the PEF% and FEV1% were concordant in only [60%] of patients, with better concordance as severity of obstruction [based on FEV1%] became more. In patients with mild to moderate airway obstruction [FEV1%>40%], PEF% tended to underestimate FEV1%; while in patients with more severe obstruction [FEV1%< =40%], PEF% tended to overestimate FEV1%. For the entire study population, PEF% underestimated FEV1% by mean of only 0.35%. However, limits of agreement were wide and exceeded-/+ 14.5. In our study 70% of patients had discordance more than 5% apart between PEF% and FEV1%, [which could be considered clinically important error for estimation of severity of airway obstruction], and this discordance more marked in women, short patients, and in patients with mild airway obstruction. The PEF% can reliably exclude airway obstruction, when normal value is present. Assumption of parity between PEF% and FEV1% must be avoided especially in categorization of severity of air way obstruction

prevalence of weight loss assessed by body mass index in patients with stable chronic obstructive pulmonary disease

The association between chronic obstructive pulmonary disease [COPD] and weight loss has long been recognized and is a common clinical observation and it is one of the systemic manifestations of COPD. A number of studies have identified weight loss and low body mass index [BMI] as independent predictors of mortality and worse prognosis. We have undertaken this study to confirm the association between BMI, weight loss and COPD and the relation to its severity. A cross section study of 100 patients with stable COPD have been identified and classified according to Global initiative for Chronic Obstructive Lung Disease [GOLD] guideline. BMI have been calculated according to the formula: BMI=Body Weight [kg]/Height[2] [kg/m[2]] Subjects; were classified according to the BMI in to three groups using World Health Organization guideline: underweight, normal weight and overweight also classified as current cigarette smokers and ex smokers. It had been shown in this study that the underweight more common in COPD [23%],compared with the control subjects only [7%].low BMI significantly associated with more severe stages of COPD and in current smoker than in Ex-smoker and with increase in age, but there is no significant difference between gender and nutritional status. Weight loss is a prevalent condition in patients with COPD and BMI can be used to assess this relationship there was an interaction between smoking habits and BMI in COPD patients. BMI correlates well with FEV1 and COPD severity and can be used by every clinician because it is a simple, inexpensive, readily available tool