Screening of Non-Communicable Diseases and their Risk Factors among Tuberculosis Patients in Delhi: A Mix Method Study

Background: India has the highest burden of tuberculosis in the world. It is experiencing an increasing burden of noncommunicable diseases, thereby facing a dual disease burden. Recent evidence shows an association between TB and noncommunicable diseases like diabetes, CVD and chronic respiratory infections. Aims and Objectives: To assess the feasibility of screening for NCDs and risk factors for NCDs among patients with TB in DOTS centers of a medical college in Delhi and ascertain challenges for the same among providers and patients. Methodology: It was a mixed-methods study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). Results: Among the 139 patients screened, ten new cases of hypertension and six new patients were diagnosed with DM. Outof- pocket expenditure for tests was a concern of the patients. Health care providers found the screening tool easy to use but were apprehensive about increased workload Conclusion: The study provide useful visions for incorporating NCDs into routine TB care through DOTS centers under RNTCP/NTEP.

Tuberculous granuloma and cervical lymphadenopathy in an immunocompetent patient: a case report

Tuberculosis (TB) is one of the top 10 infectious diseases causing mortality worldwide. In 2019, approximately 10 million people were diagnosed with TB, with 5.6 million men, 3.2 million women, and 1.2 million children. One of the hallmarks of the course of TBis tuberculous granuloma. In this study, we reported a case of TB granuloma and further workup to exclude other etiologies. A 52-year-old man presented with a complaint of a lump on his left neck. There was a history of prolonged productive cough, weight loss, and shortness of breath. Chest radiograph and FNAB of the lump suggested pulmonary TB while the rapid molecular test was negative. The patient was also suspected of malignancy; but the trans-thoracal biopsy did not reveal any malignant cells. The patient was eventually diagnosed with granuloma due to primary TBwith cervical lymphadenopathy.Tuberculous granuloma is one of the most common pulmonary granulomasand a hallmark of the course of TB. It is characterized by the immune system forming an environment to control the spread of the infection. In cases of tuberculous granuloma with negative rapid molecular test, further investigations should be conducted to find evidence of TB infection. Activated TB granuloma can spread to the surrounding tissues or organs.A negative rapid molecular test result does not necessarily exclude TB in endemic regions; thus, further investigations such as CT scans or histopathological examination are required to find features of TB infection.

Severe Pulmonary Tuberculosis With Organizing Pneumonia: A Diagnostic Ambiguity

@#Pulmonary TB may present insidiously and ambiguously, leaving clinicians with a diagnostic dilemma. A 30-year-old lady with underlying spinocerebellar ataxia presented with progressive shortness of breath, prolonged cough with whitish sputum, loss of appetite and weight loss of 1-year duration. Physical examination showed a cachectic, tachypnoeic female with finger clubbing and coarse crepitations on lung auscultation. Chest radiograph showed bilateral air space opacities relatively sparing the upper zone. Contrast-enhanced CT thorax revealed bilateral cavitary necrotising consolidations, multiple scattered lung nodules with surrounding ground-glass opacities. After exclusion of alternative diagnoses, cryptogenic organizing pneumonia diagnosis was made. She had a rapid clinic improvement once steroid was started. TB polymerase chain reaction (PCR) from bronchoscopic bronchial washing eventually was positive. Anti-TB treatment was started, and oral steroid was slowly tapered down. Organizing pneumonia (OP) may complicate pulmonary TB. Diagnosing OP without lung biopsy requires a multi-disciplinary approach, taking into consideration all available evidences. Early steroid therapy is lifesaving and should be considered after thorough exclusion of alternative diseases.

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.

Clinical profile of pediatric patients with tuberculosis in a tertiary care centre in India

Background: India has one of the highest TB burden globally. Children contribute a significant proportion of TB burden, in whom the diagnosis can be challenging because many childhood diseases mimic TB. Therefore, a high index of suspicion is required for early diagnosis of childhood tuberculosis to prevent poor outcome. Objectives was to evaluate the prevalence and profile of childhood tuberculosis cases and to determine the risk factorsMethods: An observational cross-sectional study was conducted over a period of 6 months at a hospital in north India and the prevalence and profile of the children admitted with the clinical suspicion of tuberculosis was studied. Case specific diagnostic approach was used for diagnosis and the appropriate treatment was instituted.Results: The prevalence of childhood TB was 2.3% among hospitalized children. Of these, 66.5% were males and 33.49% were females. The majority of cases were more than 8 years. The history of contact was present only in 31.1%. Tuberculin skin test was positive in 53.11%. Pulmonary tuberculosis was the most common type of childhood tuberculosis (45.45%) followed by neurological tuberculosis (42.8%), abdominal tuberculosis (6.45%), tuberculous lymphadenitis (2.63%), others (2.61%). Malnutrition was a potent contributing factor present in 91.86%. The mortality rate observed in the study was 9.56%.Conclusions: Owing to the high burden of tuberculosis among pediatric population in India, there is an alarming need to develop more economical and advanced diagnostic methods for better patient management and above all there is urgent need of the hour to educate the masses about the transmission and risk factors for this disease.

A study of radiological presentation in bronchogenic carcinoma along with prevelance of pulmonary TB in a tertiary center

Background: Lung cancer is most common cause of cancer related death in men and women world wise responsible for over 1 million death annually. Lung cancer is leading cause of cancer death in united states and worldwide. Lung cancer is the most common neoplasm contributing more frequent among males causing cancer related mortality in both sexes. Objective of this study was to radiological presentation in bronchogenic carcinoma along with   prevalence of pulmonary TB in a tertiary center.Methods: Total of 100 patients with histologically proven lung cancer, from July 2018 to June 2019 at a tertiary center Kota Rajasthan. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, Statistical analysis was performed using descriptive statistics of the collected data.Results: Most common age group of bronchogenic carcinomas was seen between 60-69 years of age (37%) with male predominance (82%).  smoking history present in about (80%) patients.  Most common radiological presentation was a mass lesion present in 91% patients (n=91) followed by unilateral hilar prominence present in 44% of patients (n=44). Other common finding includes mediastinal widening (38%), collapse (26%). pleural effusion (22%), metastasis (22%), cavitation (13%), consolidation (12%), bony erosion (11%), pneumothorax (5%), and pancost tumor (4%).  prevalence of pulmonary TB in bronchogenic carcinoma is 9% and this is due to high burden of pulmonary TB in India.Conclusions: In this study adenocarcinoma was found to be most common type of lung cancer. Smoking is most common risk factor. Pulmonary TB coexistence with bronchogenic carcinoma was more common. The local immunity is deteriorated in cancer cases.

Bronchoscopic Analysis in Sputum Smear Negative Pulmonary Tuberculosis Patients A Hospital based Study

Introduction: India has the highest burden of TB cases inthe world, majority of them are pulmonary tuberculosis.The method of choice for diagnosis of PTB is microscopicexamination of AFB by sputum smear. However, 30 to 50%of patients with pulmonary tuberculosis can have negativesputum report or may not produce sputum. Flexible fibreopticbronchoscopy can provide excellent material for diagnosis forpatients with suspected sputum smear negative pulmonarytuberculosis. Study aimed to evaluate the role of fiberoptic bronchoscopy in sputum smear negative pulmonorytuberculosis.Material and methods: Forty suspected cases of pulmonaryTB with clinical and radiological evidence of tb and sputumsmear negative on 2 occasions were selected for thisprospective nonrandomised observational study. Detailedexamination of the bronchial tree was done and specimensincluding bronchial aspirate and lavage was collected andsend for investigations. Post bronchoscopy sputum (PBS) wasalso collected and sent for smear microscopy.Results: In our study of 40 patients, tuberculosis wasconfirmed in 13 (32.50%) by smear examination of AFB inBroncho alveolar fluid and by post bronchoscopy sputumsmear examination in 3/40 (7.5%) cases. A definitive diagnosisof tuberculosis was possible in 23 (57.5%) of the 40 patientsby AFB culture by BACTEC MGIT960.Conclusion: Fibreoptic bronchoscopy with post bronchoscopysputum,BAL and BAL AFB culture is a useful tool fordiagnosis and can thereby prompt treatment of sputum smearnegative pulmonary tuberculosis patients.

The correlation between behavior intention and family support on adult pulmonary TB patients in Central Jakarta

@#The prevalence rate of pulmonary tuberculosis (TB) in Jakarta reaches 0.6%. It is ranked the second largest after West Java (0.7%). To deal the illness, tuberculosis patients need their family support. The general aim of this study is to measure the family support in adult pulmonary tuberculosis patients in Central Jakarta. Methods The research is an analytical research and cross sectional design. The study population are the treatment supporter of adult pulmonary tuberculosis in Central Jakarta area. The subject of the study are the treatment supporter recorded in the YARSI TB care database. The number of samples are determined by quota sampling. The data collected is quantitative data. Results The respondents involved are 51 people, aged between 17-71 years old. Male respondents are 20 people (39.2%) and female respondents are 31 people (60.3%). The majority of the respondents’ education level is senior high school (70,6%) graduates. The treatment supporters living with the patients are about 45,1%. Family support is good, about 54,9%. Bivariate analysis showed p value=0,033 (correlation between behavior intention and family support). Conclusions Behavior intention is significantly correlated with the behavior of family support in adult pulmonary tuberculosis patients Motivation and persuasive action are required to maximize the support for pulmonary tuberculosis patients.

Profile of tuberculosis cases attending a directly observed treatment short-course centre in North Kerala

Background: Tuberculosis (TB) is a worldwide public health problem. India has the highest TB burden in the world. India accounted for a quarter of global incident TB cases, 24% of multi drug resistance (MDR) TB cases and highest TB mortality rate in 2017. Thus it is important to understand the profile of TB patients. The objective of the study was to assess the profile of TB cases attending a directly observed treatment short-course (DOTS) center in North Kerala.Methods: A retrospective record based, descriptive study was done in the DOTS center of Government Medical College Kannur, in North Kerala, to assess the profile of TB patients who attended the centre from January 2015 to July 2018. Details of 548 patients were collected from the record maintained at DOTS center. Data was entered in Microsoft Excel and analysed using Epi info7 software.Results: The age group of 21-60 years was most affected. 68.53% of the patients were males. 45.62% of patients had extra-pulmonary TB (EPTB). Among the pulmonary TB patients, 74.27% tested positive for acid fast bacilli. Among cases of EPTB, most common type was TB lymphadenitis (40.8%) followed by tuberculous pleural effusion (22.4%). 87.59% of TB patients were started on category I treatment under DOTS.Conclusions: In our study, affected population was mostly males and those in productive age group. This is the group that has maximum chances of exposure to TB patients. 45.62% patients had EPTB. Total number of cases is on the rise each year, with maximum cases in 2018.

Assessment of adherence to anti tuberculosis medication for successful implementation of revised national tuberculosis programme at a tertiary care hospital, Shimoga: a cross-sectional observational study

Background: This study assessed level of non-adherence to anti tuberculosis (TB) therapy among pulmonary TB patients, compares various factors among adherent and non-adherent TB patients, stressing on reasons for non-adherence at a tertiary care hospital.Methods: This institution based observational and cross-sectional study was conducted interviewing patients with pulmonary TB and assessed using Moriskys medication adherence scale-8 (MMAS-8), a pre- tested structured questionnaire based scoring system of patients treated for pulmonary TB at district TB centre SIMS, Shimoga. Descriptive statistics were employed.Results: Among 70 cases analysed, 57 were males and 13 females, with mean age group of 41.32�63 and mean MMAS score of 2.23�87. 53.33% patients were on continuous phase of treatment. The level of non-adherence were as follows, high= 18%, medium= 38% and low= 44%. The common cause for non-adherence was forgetfulness (66%) reasons being: betterment of symptoms (54%), sickness after taking medication (31%), distance of travel: far (15%). Many were labourers (62%), with low literacy rate, also chronic alcoholics (72%) and smokers (73%). Female with moderate literacy and not addicted to alcohol/smoking showed high adherence compared to males (p<0.05%).Conclusions: As prevalence of non-adherence is high, especially Patients on continuous phase of TB treatment, there arises immense need for continuous and effective health education to patients� and their family regarding the adverse effects and the need for high level of adherence to treatment for the complete cure of disease. Patients who are addicted to alcohol/smoking should be targeted with interventions to quit the same, provide free transport facility to RNTCP centres and prompt treatment of ADR, will improve adherence to medication.

Diagnostic Utility of Bronchoalveolar Lavage Xpert MTB/RIF Assay in Suspected Cases of Pulmonary Tuberculosis

Introduction: Limited data on the diagnostic accuracy of the Xpert MTB/RIF assay using bronchoalveolar lavage fluid from patients with suspected pulmonary tuberculosis have been reported in India. The aim of this study was to evaluate Xpert MTB/RIF on bronchoalveolar lavage fluid in suspected PTB patients by comparing with AFB smear microscopy and culture Material and methods: A cross sectional observational study was carried on a total of 450 bronchoalveolar lavage fluid were processed by Xpert MTB/RIF between January 2018 and December 2018. Culture results were considered as the gold standard for diagnosis of TB. Sensitivity, specificity, PPV, and negative predictive value (NPV) for the diagnosis of active PTB were calculated using the website http://vassarstats. net/clin1.html. SPSS statistics version 17.0 software (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Results: Xpert MTB/RIF had a sensitivity of 97.05% (95% CI 88.8-99.4) while the specificity of 90.05% ( 95% CI 86.4-92.7) in culture confirmed cases and those for smear microscopy was 36.7% (95% CI 25.6-49.3) and 100% (95% CI 98.7-100) respectively. Conclusion: The Xpert MTB/RIF assay is a rapid and simple technique with significantly higher sensitivity for diagnosing pulmonary TB compared to smear microscopy.(p < 0.005

Pattern Of Radiological Sequelae In New Pulmonary Tuberculosis Cases- A Peripheral Hospital's Experience

India contributes to almost 27% of global load of TB. Radiographs remain the mainstay of imaging for Pulmonary TB. Aim: In this study, we describe the pattern seen at a peripheral hospital during the Xray follow up of newly detected TB cases following completion of treatment. Methodolgy : A retrospective observational study carried out at a peripheral hospital of North India. Chest x-rays of patients were studied prior to starting the treatment and at the end of their treatment during Oct 2016- May 2018. Results: A total of 173 new cases of pulmonary, pleural, and mediastinal tuberculosis were included. Residual x-ray lesions were observed in 72 cases (41.6%); 52 (72.2% ) of the residual lesions were parenchymal in nature, 18 were (25 %) pleural lesions, and 2 (2.8 % )were mediastinal lesions. Complete radiological resolution was seen in 102 (58.9%). Conclusion: A significant proportion of patients having clinical improvement and successful completion of treatment show residual sequelae on radiographs

A study on treatment outcome of tuberculosis cases registered under RNTCP in Sonbhadra District: A Medico-Geographical Perspective

Introduction: Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis. It mostly affects the lungs (pulmonary TB) and sometime affect other sites (extra pulmonary TB). The disease is spread when people who are sick with pulmonary TB expel bacteria into the air by coughing. Overall, a relatively small proportion (5–15%) of the estimated 1.7 billion people infected with M. tuberculosis will develop TB disease during their lifetime. Objective: To assess the treatment outcome of tuberculosis patients registered under Revised National Tuberculosis Control Programme (RNTCP) and to find out spatial pattern of tuberculosis patients. Materials and Methods: A retrospective record based study was conducted based on the secondary data pertaining to the patients registered at six different tuberculosis units (TU) and 29 designated microscopic centers (DMC) in Sonbhadra district during the period from 2005 to 2015. Results: Overall 85.8% were new cases and among them 80.0% were as pulmonary cases observed. Sputum conversion rate of new sputum-positive case at 2 or 3 months after treatment was 89.9%. Cure rate for new sputum-positive pulmonary TB cases was 84.9% and out of all smear-positive cases, it was 62.4%. Default among new smear-positive cases was 5.5%. Conclusion: The observed treatment success rate in form of cured and treatment completed (91.5%) reveals that the DOTs as an effective strategy for tuberculosis treatment may be classified as better alternative for area like Sonbhadra.

Impact of CD4 count in the development of mycobacterium tuberculosis in patients with HIV infection in a tertiary care centre

Background: Patients with Human Immunodeficiency Virus (HIV) infection are predisposed to numerous opportunistic infections due to decreased cell mediated immunity, Tuberculosis being most common. Low CD4 count is associated with low immunity and higher risk of tuberculosis.Methods: Author conducted a retrospective study in the department of Pulmonary medicine in a tertiary care teaching hospital during January to December 2017. Author collected data of all the patients with HIV diagnosed with Tuberculosis from the ART centre. Author collected demographic details including age, sex, symptoms at presentation, details of diagnosis of TB including type of tuberculosis, CBNAAT results, CD4 count at the diagnosis of TB, details of ART therapy and ATT therapy and outcomes of treatment.Results: Eighty one patients with HIV-TB co- infection were included in the study. Males (70.37%) were more affected than females. Mean age of the study group was 39.97� years. Sixty one patients (75.4%) were diagnosed with Pulmonary Tuberculosis and 20 (24.6%) patients were diagnosed with extra pulmonary TB. Mean CD4 counts of the cohort was 226�0/祃. Eighty percent of patients developed Tuberculosis with CD4 count <250/祃.Conclusions: Author found in this study higher proportions of tuberculosis (80.2%) in patients with HIV infection with CD4 count <200/祃. Author also found higher proportion of pulmonary Koch抯 in patients with low CD4 count (CD4 <200/祃).

Differentiation Of Lung Masses With Radiodensity Determined Contrast Enhanced Computed Tomography

Lung cancer remains the leading cause of cancer-related death in both males and females. The disease has a poor prognosis with an overall 5-year mortality rate of approximately 84% (1). Twenty patients with lung cancer, 25 with pulmonary tuberculosis (TB) and 5 with inflammatory lung pseudotumors diagnosed by CTand confirmed by pathology in our hospital were selected. There were no significant differences in the radiodensities of the masses detected by plain CTamong patients with lung cancer, TB and inflammatory lung pseudotumors (P> 0.05). However, there were significant differences (P< 0.01) between all the groups in terms of radiodensities of masses detected by contrast enhanced CT. The radiodensities of lung masses detected by contrast enhanced CTcould potentially be used to differentiate between lung cancer, pulmonary TB and inflammatory lung pseudotumors.

Clinical profile and treatment outcomes of childhood extra-pulmonary tuberculosis in a Children’s Medical Center

Background@#Extra-pulmonary tuberculosis comprises 1.1% of all tuberculosis (TB) cases notified in the Philippines.34 Its diagnosis poses a challenge for clinicians due to the protean ways in which the disease presents. Monitoring its treatment outcome is essential to evaluate the effectiveness of the intervention. @*Objective@#This study aims to determine the clinical profile and treatment outcomes of children with extra-pulmonary tuberculosis in a children’s medical center. @*Methods@#This is a retrospective cross-sectional study conducted in a children’s medical center. The medical records of children less than 15 years with extrapulmonary tuberculosis from 2010 to 2014 were reviewed. Demographic, clinical data and treatment outcome were noted. @*Results@#A total of 140 charts were reviewed. Male to female ratio is 2.3:1. The most common age group was 0-4 years and central nervous system (CNS) was the most predominant site. New cases were 96.4% and 97.1% were clinically diagnosed. History of TB contact was elicited in 36.4% and tuberculin skin test was positive only in 39.3%. The most common presenting symptoms were in association with the site of infection. Results of the different diagnostic modalities used have contributed significantly in establishing the diagnosis. Treatment outcome was favorable at 79.3% while deaths were seen in 11.4% of cases. @*Conclusion@#The study has shown that proportion of patients with extra-pulmonary tuberculosis was 3%. Treatment outcome was satisfactory at 79.3% but was not significantly associated with the site of infection.

Study Of Sociodemographic & Clinical Features Of Tuberculosis Cases In HIV Patients.

Background: Infection with HIV is the most potent risk factor for progression to active tuberculosis. Mycobacterium tuberculosis only have an approximately 10% lifetime risk of developing TB compared with 60% or more in persons infected with HIV and TB. Methodology: 100 HIV infected patients having symptoms of Tuberculosis were taken up for the study for a period of 18 months, meeting the criteria for the present study. Diagnosis of tuberculosis was based on clinical evaluation, sputum smear. Results: 100 HIV patients studied for period of 18 months . Majority of patients were in the age group of 30-41 years. 64% were males and 36% females. Labourers are commonly affected. Common presenting symptoms were fever(74%) cough (72%) and weight loss(62%). Associated clinical findings were pallor(63%), (12%) and oral thrush(14%). Pulmonary TB (69%) is the most common form. Conclusion: Majority of patients were in the age group of 30-41 years, 64% were males 36% females. Most common occupation affected was labourers. Fever (74%), cough (72%) and weight loss (62%), pallor (63%), lymphadenopathy (12%) and oral thrush (14%). Most common form of tuberculosis was pulmonary TB (69%). Among extra pulmonary tuberculosis pleural effusion (8%) was the most common presentation.

The role of gene polymorphisms of glutamate-cysteine ligase catalytic (GCLC) enzyme against antioxidants and oxidative stress status of Individual who had contacted infectious tuberculosis

Aims: Glutamate cysteine ligase (GCL) enzyme is involved in the synthesis of glutathione, which functions as an antioxidant. Polymorphisms in the sequence of amino acids making up the gene GCLC will cause differences in enzyme expression and GCLC activity. Gene expression that is influenced by oxidative stress can be used to measure markers such as F2-isoprostanes. This study aims to examine the association between the polymorphism in the GCLC gene with glutathione plasma level and F2-isoprostanes in contacts of person with infectious tuberculosis (TB). Methodology and results: Samples are taken from the family members of pulmonary TB patients who seeks treatment at the Pulmonary Centre (Lung Health Center for Public = BBKPM) and Policlinic of Dr Wahidin Sudirohusodo Hospital, Makassar. Total of approximately 4 mL of venous blood are taken from each person with pulmonary TB contacts and furtherly analyzed using genomic PCR-RFLP method and ELISA. Our results described that contacts of person with infectious TB for approximately 6 months have polymorphism C/C genotype at 80.3%, C/T of 18.3% and T/T for 1.4% of the total 71 samples with high levels of glutathione from 0.167 to 0.548 mM/mL and F2-isoprostanes level 72.4 - 1343.9 pg/mL. Conclusion, significance and impact of study: There are no significant association between GCLC gene polymorphism with glutathione and F2-isoprostanes levels of individual who had contacted infection TB. In this study the elevation of F2-isoprostanes equal to the decrease levels of glutathione.

Socio demographic profile of pediatric tuberculosis patients of north Gujarat region, India: a cross sectional study.

Background: Tuberculosis continues to be one of the most important public health problems worldwide. It infects one third of the world’s population at any point of time. Children are especially vulnerable to the effects of tuberculosis, which is often difficult to diagnose and therefore difficult to treat effectively. Pediatric TB results from failure of TB control in adults. The objective of the study was to study socio demographic profile of pediatric tuberculosis patients. Methods: This cross sectional observational, descriptive epidemiological study was conducted at GMERS medical college and hospital Dharpur-Patan located in north Gujarat during January 2015 to June 2015. The study was conducted among all the 151 pediatric TB patients who were currently under treatment at selected Hospital. Parents of the patient were informed about the purpose of the study and their informed written consent was taken. By interviewing them on the basis of pre-designed and pre tested proforma, socio demographic information was collected. The collected data was analyzed using statistical package for social science (SPSS 17 Trial version). Results: Out of 151 pediatric patients 87 (57.6%) were male. Age range of the children was 1 to 14 years. In our study mean age of children was 8.41±2.86 years. 68 (45.0%) patients were adolescents. 127 (84.1%) patients were from rural area. 63 (41.7%) heads of the family of patients were illiterate. 116 (76.8%) of the patients lived in joint family. 89 (58.9%) patients had kuccha house. Overcrowding was present in 86.7% of the patients. Family history of TB was present in only 23.2 % of the patients. 76.8% of the patients belonged to social IV and V according to modified Prasad’s classification. 105 (69.5%) patients had extra pulmonary TB. Category-1 constituted 125 (82.7%) cases. 3 % patients had HIV infection. Conclusions: Apart from pharmacological treatment, poor housing condition and illiteracy of the parents of these patients need to be addressed.

Effects of CD4 count level on patterns of respiratory tract infections of HIV-infected patients in Western India.

Background: Individuals with HIV infection are at increased risk for tuberculosis (TB) and other respiratory tract infections (RTIs). The altered CD4 T-cell homeostasis induced by HIV infection may play a key role in the development of respiratory tract infections in HIV -infected patients. Aim: Finding out of mean CD4 count of HIV patients at which they were at higher risk of developing various RTI and accordingly when HAART is to be started in this part of the world. Material and methods: All the 961 HIV infected patients and 300 300 HIV sero-negative patients’ three early morning sputum were screened for routine bacterial and fungal pathogens and even examined for AFB and few of the samples were even cultured on LJ medium All sputum samples’ smears were also examined for PMNLs in Gram’s staining. Results: Out of all these 961 HIV patients, in 349 patients with probable viral RTI etiology, the mean CD4 count was found to be 474.62 + 114.89, followed by mixed polymicrobial RTI (80 patients) with mean CD4 about 392.26 + 87.14. The patients with pure fungal etiology (66), the mean CD4 count was found to be 377.29 + 268.29 followed by 466 patients with pure monomicrobial bacterial RTI the mean CD4 count was about 223.07+_83.21. Conclusion: Very vague co-relationship between pattern of RTIs and CD4 counts had been attempted. Only Fungal and Bacterial RTIs were seen first to establish in even HIV infected patients at very high mean CD4 counts of about 377 + 268.29 and 223.07 + 83.21 respectively, but in both very high prevalence rate had been observed when compared with HIV non-infected patients with probability values of <0.05 and <0.001 respectively. Probable viral etiology of RTI was significantly high in HIV-non infected subjects when compared to HIV -infected RTI patients with probability value P < 0.001.