ABSTRACT
Background:Re-evaluation of the epidemiological profile of tuberculosis (TB) patients can help to eliminate the number of cases. This study was aimed to analyse the association of socio-demographic profile with type of TB among patients attending a rural DOTS centrein central Kerala.Methods: A cross sectional study was conducted among TB patients at a rural DOTS clinic in central Kerala during January 2020-June 2021. Various socio-demographic parameters such as age, gender and socio-economic status and comorbidities of patients with pulmonary and extrapulmonary TB were retrieved from the DOTS register. The data was analyzed.Results: A total of 241 patients (134 males and 107 females) were enrolled. In general, age group 41-60 years showed maximum incidence (p=0.0283). Lower middle (32.7%) and middle class (36.5%) strata constituted the majority of burden (p=0.9091). The distribution of cases was not associated to occupation (p=0.06). Extrapulmonary form (55%) was found to be predominant with very poor awareness (p=0.06). A significant delay of at least 1-3 months in recognizing the symptoms and thus the clinical diagnosis particularly in extrapulmonary cases was found. Diabetes mellitus was the most frequent comorbidity in TB patients.Conclusions: The prevalence was most common in age group 41-60 years without any association to occupation. Since the diabetes mellitus is the most frequent comorbidity in TB patients, early screening will make an effective management. Society oriented awareness programme about the extrapulmonary TB is inevitable
ABSTRACT
Background:Malignant pleural effusion (MPE) is a common clinical condition observed in patients suffering from malignant diseases. None of the tumour markers have both high sensitivity and specificity. A retrospective study on patients with pleural effusion was done to evaluate the diagnostic accuracy of Cancer ratio (CR) in diagnosing MPE.Methods:A retrospective analysis of patients with undiagnosed exudative pleural effusion was done. Results of serum Lactate dehydrogenase (LDH), pleural fluid Adenosine deaminase (ADA), pleural fluid analysis such as cytology and histopathology reports of pleural biopsy were analyzed. Serum LDH: pleural fluid ADA ratio (CR) was calculated and compared with histopathology report. Data were analyzed statistically.Results:A total of 102 patients were enrolled in the study (56 males and 46 females). The sensitivity and specificity of CR at the cut off level of >20 were 57.14% and 75.47% respectively. The positive predictive value was 68.29% and the negative predictive value was 65.57%. CR>20 (p<0.001) is statistically significant in predicting malignancy in undiagnosed exudative pleural effusions. Conclusions:CR has a high sensitivity and specificity and is a novel tool in differentiating malignant from nonmalignant pleural effusions. Patients with unconfirmed diagnosis but higher CR will identify the need for early biopsy, follow-up and frequent or repeat chest imaging to assess the progression.