Risk to household contacts of tuberculous patients based on Mantoux test and antibody titre

Tuberculosis, being an infectious disease, carries a risk of infection to contacts attending tuberculous patients. This study was conducted to evaluate the risk for household contacts of tuberculous patients as compared to non-contacts. The study was conducted at PGMI, Gulab Devi Hospital and Defence Housing Authority Lahore. The study included 120 household contacts and 80 non-contacts. A Cross sectional study for evaluation of antituberculous antibodies levels by ELISA method in two groups; Mantoux positive household contacts 49, Mantoux negative household contacts 71 and normal healthy persons 'non contacts' 80. Routine Haematological investigations like HB, TLC and ESR were done by conventional methods and all the sera of 200 subjects included in the study were tested for IgM, IgG and IgA anti tuberculous antibodies by enzyme linked immunosorbant assay [ELISA].Purified protein derivative 0.1 ml containing 5 TU was injected intradermally. The test was read after 72 hours by measuring the induration around injection site of forearm. There was no difference in the average age of the household contacts and non-contacts. The complaints of pyrexia, night sweats and weight loss were more in house hold contacts as compared to non-contacts. The awareness about BCG vaccination was equal in both. There were 49 contacts with positive Mantoux test while negative Mantoux test was found in 71 contacts. There were only three Mantoux positive among eighty non-contacts. There was no significant difference in the presence of IgM among household contacts as compared to non-contacts. However both IgG and IgA were present in significantly higher number of household contacts compared to non-contacts. Household contacts of patients suffering from active pulmonary tuberculosis have more chances of being infected with Mycobacterium tuberculosis as compared to the healthy non-contact, as shown by the higher levels of antituberculous antibodies and positivity of Mantoux test

Evaluation of cardiac performance in infants with ventricular septal defect: effectiveness of captopril versus propranolol therapy

The objectives of the present study were to evaluate the effects of left ventricular [LV] preload due to ventricular septal defect [VSD] on cardiac performance, and to compare the therapeutic effects of captopril versus propranolol on infants with hemodynamically significant large VSD with heart failure. The study included 60 infants with VSD, classified into: large VSD [20 infants], moderate VSD [20 infants] and small VSD [20 infants]. Twenty healthy infants served as a control group. All infants were subjected to history taking, clinical examination, X-ray chest and heart and echocardiographic evaluation [using conventional echo-Doppler and tissue Doppler imaging]. Follow up was done in infants with large VSD after 3 months of therapy for two subgroups: group A [10 infants treated with pro pranolol] and group B [10 infants treated with captopril]. The results showed LV diastolic dysfunction, but no systolic dysfunction in large VSD, with decreased EIA ratio [by pulsed transmitral Doppler] and decreased e/a ratio [by tissue Doppler]. The tissue Doppler was more sensitive than the pulsed Doppler [sensitivity 90%vs. 40%]. Comparing both drugs used in large VSD; propranolol led to significant clinical improvement [respiratory rate, heart rate and weight gain], whereas captopril led to significant hemodynamic improvement of LV myocardial function [ejection fraction and fraction shortening], LV diastolic function, decreased cardiomegaly [by X-ray], decreased size of VSD and significant decrease of pulmonary to systemic flow ratio [Qp/Qs] [P<0.05]. Conclusions: Tissue Doppler is more sensitive than pulsed transmitral Doppler in detecting LV diastolic dysfunction in infants with large VSD. Captopril improves the hemodynamics of large VSD with congestive heart failure and corrects the LV diastolic dysfunction, whereas propranolol improves the clinical manifestations with better weight gain before surgical repair