To Evaluate the Effect of Vitamin E Therapy on the Oxidative Stress Markers (Nitric Oxide, SOD, Glutathione Peroxidase) & Vitamin E Levels in Pulmonary Tuberculosis Patients

Severe oxidative stress has been reported in TB patients because of infection associated with malnutrition and poor immunity. Mycobacteria can induce reactive oxygen species (ROS) production by activating phagocytes, and enhanced ROS production may promote tissue injury and inflammation. We wanted to compare the effect of antioxidant administration in the outcome of ATT treatment between the test and the control group. METHODSThis perspective study was conducted in the Departments of Biochemistry and Chest Medicine, CMC & Hospital. Hundred patients (fifty controls and fifty tests) who were diagnosed as pulmonary tuberculosis and started on DOT therapy under RNTCP during this period were included in the study. Each participant in the study was subjected to the following test at the first visit, 2nd month and 6th month follow up (biochemical markers Nitric oxide, SOD, Glutathione Peroxidase and Vitamin E levels). Statistical analysis was done using SPSS version. RESULTSThe results were based on four categories (male / female, alcoholic / non-alcoholic, smoker / non-smoker, and younger / older age group). Females had responded better with greater fall in percentage of nitric oxide values (69 %) than males (64.1 %). The mean of SOD activity (277.5 + / - 31.5) was more in smokers than non-smokers (261.3 + / - 36.0) & percentage fall of nitric oxide in smokers (65 %) & non-smokers (67 %). In alcoholics the percentage fall of nitric oxide (68.3 %) was higher with more SOD activity (Mean 278.7 + / - 27.6) than non-alcoholics (Mean 256 + / - 38.0) indicating a positive correlation of smoking & alcoholism with tuberculosis. Younger age group responded better with more fall in the percentage of nitric oxide (67 %) & mean SOD activity (265.8 + / - 30.1) than older age group. CONCLUSIONSAntioxidant supplementation reduces oxidative stress, improves the effectiveness of ATT therapy, and thus helps in improving the outcome in pulmonary tuberculosis.

A prospective study of outcome in infertility patients diagnosed with genital tuberculosis

Background: Tuberculosis is an increasing health problem worldwide with around 9.6 billion new cases reported every year. Female genital tuberculosis (FGTB) has a varying incidence ranging from a very low of 0.69% in developed nations to as high as 19% in developing nations like India. The average incidence of infertility due to tuberculosis is 5-10% worldwide.Methods: The study was a hospital based prospective clinical study, from September 2014-2017 with sample size of 355 infertility cases. Endometrial sampling and diagnostic hystero-laparoscopy were used for diagnosis. Endometrial sample subjected for both the test CBNAAT and HPR was used for confirmation of positive patients. Inclusion criteria were, infertile patients diagnosed with genital tuberculosis who were then given treatment. Patients diagnosed to have infertility due to causes other than TB were excluded from the study. Highly suspected cases and those who were willing underwent diagnostic laparoscopy.Results: Out of 355 cases of infertility, 83 were because of genital TB, received treatment out of which 32 conceived.  CBNAAT was very sensitive than histopathology or laparoscopy. The live birth rate and conception rate were 20.24% and 38.09 % respectively.Conclusions: CBNAAT is OPD based economical test (free by GOI), very sensitive and picked up more cases than histopathology or laparoscopy. The live birth rate and conception rate were found to be higher than other studies possible due to intervention at an earlier stage of the disease process. This test should be widely used by gynecologist for early detection of genital tuberculosis.

A Rare Presentation of Primary Breast Tuberculosis in a Primigravida: A Case Report.

Tuberculosis is an endemic and very common disease in India. Breast tuberculosis is often confused with breast malignancy or pyogenic abscess. We report a rare case of breast tuberculosis which is successfully managed with Anti-tubercular drugs. After six months of compliant treatment patient delivered a healthy baby.

Comprehensive review of anti-tubercular treatment induced liver injury.

The challenge in the management of tuberculosis is further compounded by the liver injury associated with anti-tubercular treatment (ATT) drugs. The problem of drug-induced liver injury (DILI) associated with ATT drugs is significant in the developing countries because of high disease burden, limited monitoring due to scarce resources and lack of awareness. There is heterogeneity in the pharmacokinetics and pharmacodynamics of the various first line ATT drugs. There are various genetic and environmental factors that affect DILI. Various guidelines have been proposed to treat and monitor DILI. This article reviews the problem, risk factors, mechanism, and management strategies of the DILI associated with ATT.

Reasons for interruption of anti-tubercular treatment as reported by patients with tuberculosis admitted in a tertiary care institute.

Setting: Department of Tuberculosis and Chest Diseases, Tertiary Level tuberculosis (TB) institute in Delhi, India. Objective: To study the reasons for interruption of Anti-Tubercular Treatment (ATT) as reported by tuberculosis patients admitted at LRSI. Design: Retrospective cohort-based analysis. Results: A total of 201 patients were enrolled (179 of pulmonary tuberculosis, eight of extra-pulmonary tuberculosis and fourteen of both pulmonary as well as extra-pulmonary tuberculosis); who had interrupted treatment 327 times. Maximum interruptions (72.17%) were found to occur by third month of ATT. More than one reason was often reported for discontinuation of treatment. In all, 366 responses were obtained from 201 patients, in response to reasons for treatment interruption. The rate of treatment interruption was higher in the private health sector (56.27%), as compared to DOTS (34.25%) and other sources of treatment (9.48%). Early improvement (30.05%) and high cost of treatment (16.39%) were found to be the two most common reasons, leading to treatment interruption. Conclusion: Early improvement and high cost of treatment were found to be the two most common reasons, leading to treatment interruption. Continuous health education should be provided to all tubercular patients emphasizing the need to continue treatment despite early improvement in symptoms.

Middle lobe syndrome due to Tuberculous etiology A series of 12 cases.

The term right middle lobe syndrome (RMLS) is often used in clinical practice though it has no consistent definition. Inflammatory lesion, malignant tumors followed by bronchiectasis are considered as the most common etiological factors for RMLS. Here we describe 12 cases of RMLS due to tuberculous etiology diagnosed over a period of 6.5 years at our Institute. They were diagnosed using conventional methods and responded to anti-tubercular treatment with favourable outcome. The cases are being presented here to highlight the fact that tuberculosis, though not frequently reported in published literature, is an important etiological factor and must be considered for differential diagnosis when RMLS is evaluated particularly in regions where the prevalence of tuberculosis is high as it responds to anti-tubercular chemotherapy remarkably.