CYTOMORPHOLOGY PATTERN ON FNAC AND AFB POSITIVITY IN CASES OF TUBERCULAR LYMPHADENITIS IN A TERTIARY CARE CENTRE OF CENTRAL INDIA

Background- One of the most typical diagnoses at OPDs in a developing nation like India is tuberculous lymphadenitis. Anti-tubercular therapy, however, cannot be started based solely on clinical suspicion. Along with culture, cytomorphology with acid fast staining is an effective tool for diagnosing these cases. The purpose of the study was to examine the usefulness, limits, and relationships between Ziehl-Neelsen staining in tuberculous lymphadenitis and various cytomorphological presentations using fine needle aspiration cytology. At a tertiary care facility, the study was Materials and Methods- carried out over the course of a year with a total of 146 cases. Patients who had lymphadenopathy that was clinically suspected were chosen. There were 36.3% cases of tuberculous Resultlymphadenitis out of which 66.04% cases were overall AFB positive. The most frequent cytological finding was epithelioid cell granulomas with lymphocytes, and cases with granulomas and necrosis had the highest levels of AFB positivity. Most patients first showed up in their third or fourth decade of life. Solitary lymphadenopathy, as opposed to matted lymph nodes as reported by others, was the most frequent presentation and the cervical area was the most frequently involved site. Fine needle as Conclusion- piration cytology is a highly sensitive method for diagnosing tuberculous lymphadenitis that is inexpensive, safe, and dependable. By adding acid fast staining and culture procedures to cytomorphology, the diagnostic index can be raised even higher. However, FNAC combined with methods like ELISA and PCR would improve the current landscape of diagnostic and therapeutic options.

An Uncommon Presentation of a Common Etiology : Tubercular Cerebral Abscess in Pulmonary TB

A patient, recently diagnosed with Pulmonary Tuberculosis and on ATT for the last 1 month, was initially admitted in a primary care setup with severe headache and altered consciousness for 5 days and then referred to our institute for further management. Extensive investigations and imaging led to the conclusion that the patient had a massive Tubercular Brain Abscess (TBA) in the background of Pulmonary TB

Bacille Calmette-Guérin vaccine induced lymphadenitis in infants and children masquerading with tubercular lymphadenitis at tertiary care hospital in North India

Background: Bacille calmette–guerin (BCG) vaccine containing live-attenuated Mycobacterium bovis was first used in humans to prevent tuberculosis in 1921. It is a safe vaccine. However, there can be minor adverse reactions such as pain, swelling, and redness at local injection site. The lesser known severe adverse reactions such as lymphadenitis, BCG osteitis, and disseminated BCG infection can be present after BCG vaccination. Aims and Objectives: The aim of the study was to report the cases of BCG lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) after BCG vaccination in infants and children. Materials and Methods: All the infants and children (1 month–2 years) who presented with regional lymphadenopathy for FNAC after BCG vaccination were included in the study. Results: Total 21 patients with BCG lymphadenitis were recruited. In all the cases, the lymphadenitis involved ipsilateral left axillary lymph nodes. In three patient sites of involvement included the left supraclavicular lymph nodes and in other three patients left cervical lymph nodes along with left axillary lymph node. Sixteen patients had suppurative granulomatous lymphadenitis (SGLA) on FNAC and positive for Ziehl–Neelsen (ZN) staining for acid fast bacilli (AFB), while rest nine had non-suppurative granulomatous lymphadenitis (NSGLA) with negative for ZN staining for AFB. Conclusion: Early diagnosis of BCG lymphadenitis can help in proper management. Furthermore, it can prevent unnecessary anti tubercular treatment in children.

Diagnostic utility of cancer ratio in differentiating malignant from non-malignant pleural effusions in a tertiary care centre in central Kerala

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.

Clinical Features of Multicenter Autoimmune Glial Fibrillary Acidic Protein Astrocytosis / 罕见病研究

  Objective  To investigate the clinical features of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.  Methods  We collected and analyzed the clinical and laboratory data and obtained the clinical characteristics of diagnosis and treatment from fifteen patients with positive GFAP antibody tested by cerebrospinal fluid and diagnosed autoimmune GFAP astrocytopathy by the multi-centers.  Results  The mean age of the first onset of autoimmune GFAP astrocytopathy was 39.73 years old (range 4-65 years), with no significant gender difference. In terms of clinical manifestations, we found the whole brain symptoms including abnormal mental behavior, disturbance of consciousness, epileptic attack accounting for more than 50, , meningitis accounting for 66.7%, myelitis (53.3%), limb tremor (53.3%), vision loss (33.3%); systemic symptoms including fever(100%) and fatigue(86.7%). 46.7% of patients were initially diagnosed with tuberculous meningoencephalitis and were treated with diagnostic antituberculous therapy. The MRI showed 46.7% of patients showed brain linear perivascular radial gadolinium enhancement in the white matter perpendicular to the ventricle.  Conclusions  Autoimmune GFAP astrocytopathy are acute or subacute dieases and the main clinical features include encephalitis, meningitis, myelitis and optic neuritis. They are likely to be misdiagnosed as tuberculous meningoencephalitis and can manifest progressive loss of consciousness in early phase, which is even life threatening.

Paradoxical Reaction in Lymph Node Tuberculosis Presented as Shoulder Osteomyelitis

Paradoxical reactions (PRs) can be viewed as an abnormal immune response toward the anti-tubercular treatment (ATT). It is characterized by clinical worsening of the patient’s symptoms and signs following an initial improvement despite definitive treatment with ATT. Tubercular lymphadenitis is the most common extrapulmonary manifestation seen under PR. Other sites of involvement include the pleura, central nervous system, bones, and muscle. Although some paradoxical events may not require any intervention, studies have shown to have good outcomes using glucocorticoid therapy. This case reports a PR that involves tubercular lymphadenitis and osteomyelitis, which showed marked improvement of patient ailment following a 1-month course of oral steroid

Critical Cerebrospinal Fluid Adenosine Deaminase Activity In Tubercular Meningitis

Background:Tuberculosis of the central nervous system accounts for ~5% of extrapulmonary cases in the United States. It is seen most often in young children but also develops in adults, especially those infected with HIV. If unrecognized, tuberculous meningitis is uniformly fatal. This disease responds to chemotherapy.Cerebrospinal fluid (CSF) evaluation is the single most important aspect of laboratory diagnosis of meningitis. Basic studies of CSF that should be performed in meningitis include measurement of pressure, cell count and differential count, estimation of glucose and protein levels, Gram's stain and culture.Objectives:To evaluate the diagnostic significance of CSF adenosine deaminase (ADA) activity in tuberculous meningitis.Material & Methods:70 Tubercular Meningitis patients who were admitted in Department of Medicine, Victoria hospital were included. The study was approved by the Ethical Committee of Bangalore Medical College and Research Institute, Bangalore. Patients were selected after fulfilling the following inclusion and exclusion criteria.Results:The mean age of the 70 patients studied was 39.82+16.48 years. The youngest patient was 18 years old and oldestpatient was 70 years.The mean value of ADA activity in tubercular meningitis was 18.07±8.03IU/L. Cut-off value of ADA in our study was 10 IU/. The result was statistically significant with a p value<0.001. Conclusion: The test for ADA in CSF is simple and can be carried out in a central laboratory with a rapid diagnosis, thus reducing unwarranted or harmful therapy for patients.Elevated CSF-ADA level helpsin differentiating tubercular from non-tubercular meningitis.

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.

Tuberculous meningitis masquerading as acute ischemic stroke in young adult

Tubercular meningitis (TBM) constitute 5% of all cases of extra pulmonary tuberculosis but a presentation leading to an ischemic stroke in a young adult is a rare clinical entity. In a case of TB vasculopathy, vasculitis, venous thrombosis and aneurysm may be the underlying events leading to a stroke. Stroke in TBM is seen in the tubercular zone which encompasses internal capsule, thalamus and caudate nucleus. Inflammatory mediators like TNF alpha, Interferon gamma and vascular endothelial growth factor have been implicated in the pathogenesis of arteritis. Imaging modalities like MRI show lesions which are usually bilateral in the territory of the perforating vessels. We report a case of 24 year old Asian male who presented with complaints of headache, projectile vomiting and altered sensorium. On examination his Glasgow Coma Scale (GCS) was 10/15, with left oculomotor and left facial nerve palsy, and hypotonia of all 4 limbs with bilateral plantar reflexes being mute. Contrast MRI of brain showed acute infarct, meningeal enhancement and basal exudates. He was started on Anti-tubercular therapy and steroids, but had a poor clinical outcome, due to his late presentation.

Role of biochemistry, cytology, and biopsy in the etiological diagnosis of pleural effusion- a clinical study

Introduction:Pleural effusion is the most common pleural disorder. It refers to excessive or abnormal accumulation of fluid in the pleural space. It is a commonly occurring medical problem caused by various pathological conditions. To treat patients appropriately, it is important to establish an accurate etiological diagnosis. Material and Method: This is an observational study conducted at a tertiary health care center. The pleural effusion was assessed clinically, biochemically, bacteriologically, cytologically, and histopathologically. Result: Tuberculosis was the most common etiology, followed by malignancy. A pleural biopsy was done in 70 patients. Pleural tissue was obtained in 65 cases. On histopathology,Malignancy was diagnosed in 15, tuberculosis in 35, and non-specific inflammation in 13 cases. Out of 35 histological proven tuberculosis cases, 26 cases had adenosine de-aminase (ADA) more than 70 u/l. Conclusion:Every pleural effusion is not due to tuberculosis but can be due to other causes, malignancy should always be excluded. Pleural fluid cytology and biopsy can give a definite diagnosis in a significant number of cases of pleural effusion. Tuberculosis is still the most common cause of pleural effusion followed by malignancy.

Levels of vitamin D in tuberculosis and comparison of vitamin D level in severe variant of tuberculosis like tubercular meningitis, miliary tuberculosis, disseminated tuberculosis with non severe variant of tuberculosis like pulmonary tuberculosis, tubercular lymphadenitis etc in paediatric age group

Background: Tuberculosis is deadliest disease killing nearly 2 million people every year. Before the etiologic cause of TB was determined by Koch, cod liver oil and sunlight, both sources of vitamin D, were used in treatment of tuberculosis. After discovery of antibiotics, anti-infectious value of vitamin D was ignored until increasing cost of antibiotics and rise in resistance led to the need to search for alternative and antibiotic-independent therapeutic strategies. This study shed light on vitamin D, which is very safe and inexpensive by adding vitamin D to antibiotic treatment, immune system can be boosted to help body to clear TB, rather than relying on antibiotics.Methods: A prospective, observational, comparative study in which 62 TB patients were taken and vitamin D level were estimated.Results: The results of study show that out of total 62 patients, 31 (50.00%) had deficient(<20ng/ml) vitaminD,23(37.10%) had insufficient(20-30ng/ml) vitamin D, 8(12.90%) had sufficient (>30ng/ml) vitamin D level. Out of 62 patients, 10(62.13%) had severe variety of TB and 52(83.87%) had' nonsevere TB. Among the 52 patients, 24(46.2%) had deficient vitamin D, 20(38.5%) had insufficient vitamin D and 8(15.4%) had sufficient vitamin D. Among the 10 patients with severe TB, 7(70.00%) had deficient vitamin D, 3(30.00%) had insufficient vitamin D and none had sufficient vitamin D level.Conclusions: Majority of children with tuberculosis demonstrated low serum levels of vitamin D (deficient and insufficient levels) suggest that vitamin D deficiency is' risk factor of tuberculosis and very low levels of vitamin D were noted in severe variant of TB then non severe suggest that in severe form of tuberculosis vitamin D levels were less compared to nonsevere variant.

A study to know the various causes of pleural effusion and role of pleural fluid adenosine deaminase enzyme in tuberculous pleural effusion

Background: India has the maximum burden of both non MDR tuberculosis (TB) and Multidrug-Resistant (MDR) TB, as per data reported in Global TB Report 2018 and tuberculosis is remains one of the most common cause of pleural effusions.Methods: This was a cross-sectional study conducted in Department of Respiratory Diseases and a total of 110 patients with pleural effusion were included in the study, which were enrolled for treatment from July 2018 to June 2019.Results: One hundred and ten patients with pleural effusion were enrolled during the study period. There were 65 males (59%) and 45 (40.9%) females.  The overall mean age for males and females were 44.4±18.84 years (35-87 years) and 38.28±17.66 years (35-87 years) respectively. Tuberculous Pleural Effusion group (TPE) seen in 82 patients. Right sided pleural effusion (69.5 %) were more common than left sided (30.4 %). In TPE group the mean pleural fluid ADA level were 86.41±38.08 IU/L (range: 14-195 IU/L). The Malignant Pleural Effusion (MPE) group included 21 patients. In MPE group the mean pleural fluid ADA level were 34.10±32.88 IU/L (range: 8-144 IU/L). The difference in pleural fluid ADA levels between TPE and MPE group was statistically highly significant.Conclusions: Tuberculous pleural effusion was the most common cause of pleural effusion in present study and observed in 74.5% cases.

Landouzy Sepsis (Atypical ARDS like Features) and Paradoxical Reaction of Tubercular Meningitis Complications, in a Case of Disseminated Extrapulmonary Tuberculosis

Introduction: Chronic Obstructive Pulmonary Disease(COPD) is a major health problem globally. Spirometry is theGold standard for the diagnosis of COPD and it also gradesit’s severity. 6MWT is a simple reproducible test to assess thepatient’s functional capacity. It is of help in management andprediction of prognosis. Objective: This study was done to findcorrelation between 6MWT results with patient’s clinical andspirometric parameters. The study also assessed if 6 minutewalk distance (6MWD) can be an alternative to spirometry inpredicting severity of COPD in resource poor setup.Material and methods: This was a hospital based crosssectional study. 60 consecutive confirmed patients of COPD(by GOLD guidelines) were included in the study afterapplying inclusion and exclusion criteria. Severity wasassessed by pre and post-bronchodilator spirometry test. Thiswas followed by 6MWT as per ATS guidelines. 6MWD wasrecorded and % predicted 6MWD was also calculated. Resultsof 6MWT were correlated with spirometric and clinicalparameters of the patients.Results: 6MWD had statistically significant (p <.05) positivecorrelation with following parameters: Height, FEV1, %predicted FEV1, FVC, FEV1/FVC and PEFR. Correlationwith age, weight and BMI was not significant. % 6MWDsignificantly correlated with Height, FEV1, % predictedFEV1, FVC and PEFR. Distances in meters walked bydifferent severity groups were as follows: Mild: 410 + 15;Moderate: 367.66 + 57.71; Severe: 364.60 + 62.91 and Verysevere: 281.21 + 55.99. On one way analysis of variance(ANOVA) these differences were found significant (p <.01)Conclusion: In this study 6MWD and percent 6MWD hadsignificant positive correlation with patients’ parameters(Height, FEV1, %FEV1, FVC and PEFR). The severity ofCOPD may be assessed with 6MWT.

Dual lesion margins on fundus autofluorescence associated with paradoxical worsening following treatment for tubercular serpiginous-like choroiditis

A 31-year-old male presented with decreased vision in the right eye associated with an active plaque-like serpiginoid choroiditis. The lesion showed a unique feature of dual margins of hyperautofluorescence of the lesion on fundus autofluoresence (FAF) imaging. Systemic investigations suggested a tubercular etiology. He was started on antitubercular treatment and a conventional dose of oral corticosteroids (1mg/kg body weight). However, the lesions showed paradoxical worsening and required increased immunosuppression in the form of local steroids and oral immunomodulators. The presence of dual margins of hyperautofluorescence could suggest increased inflammatory activity leading to paradoxical worsening on treatment requiring increased immunosuppression.

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.

Adverse drug reactions in patients taking anti tuberculosis therapy from directly observed treatment short course centre at Mandya Institute of Medical Sciences, Mandya: a cross sectional study

Background: Ending the tuberculosis (TB) epidemic by 2030 is among the health targets of the sustainable development goals. Side effects to anti-TB drugs are common and may lead to reduced compliance to treatment. These adverse effects must be recognized early to reduce associated morbidity and mortality. Objective of this study was to determine the adverse drug reactions (ADR) to anti-tubercular therapy among patients visiting directly observed treatment, short-course (DOTS) centre MIMS, Mandya.Methods: A cross sectional study was conducted at DOTS Centre MIMS, Mandya. TB patients registered at DOTS Centre during the year 2018 were selected for the study. Verbal informed consent was taken from the TB patients and interviewed using pretested semi-structured questionnaire. Data analysis was done using descriptive statistics and chi square test.Results: Among the study population (n=90), 67 (74.4%) experienced ADR among which 47.7% took treatment for ADR and the remaining 52.3% patients were given reassurance. In this study, gastrointestinal manifestations (42.3%) were the most common adverse drug reaction (ADR). Of the TB patients who experienced ADR, 9.0% of them had interrupted ATT, however they completed full course of ATT.Conclusions: A considerable number of TB patients taking ATT experience ADRs and some of them may have to interrupt treatment. However, they need to be counselled or supervised with caution to complete their course of treatment to reduce the chances of treatment default and also reduce the occurrence of drug resistance.

Assessment of Symptomatic Post Tuberculosis Patients by Spirometry and Chest X Ray

Introduction: TB is an infectious disease caused by thebacillus Mycobacterium tuberculosis which typically affectsthe lungs. The disease is spread by the people who are sick withactive pulmonary TB. Up to half of TB survivors have someform of persistent pulmonary symptom despite microbiologiccure. The aim of the study was to assess the symptomatic posttuberculosis patients by using spirometry and chest x ray.Material and methods: The study was conducted in theDepartment of Respiratory Medicine, Rohilkhand MedicalCollege and Hospital after seeking clearance from theInstitutional Ethical Committee. The aim of the study was toassess the symptomatic post tuberculosis patients by usingspirometry and chest x ray. The study duration was from 1stNovember 2018 to 31st October 2019 and 100 patients wereenrolled in the study. Data was collected from patients whopresented with symptoms within 6 months of completing theirtreatment for tuberculosis.Results: All the patients (post tubercular) enrolled in thestudy had symptoms (in some form) even after full courseof antitubercular treatment and bacteriological cure andamong these breathlessness was the most common presentingsymptom (96%) followed by cough (58%). Maximum patientshad abnormal findings on chest examination (80%). Fibrosisfollowed by cavitary lesions were the most common findingson chest x ray in post tuberculosis patients. Maximum patientshad restriction (56%) in their spirometry followed by mixedpattern (23%).Conclusion: In patients with restriction on spirometry andhaving symptom of breathlessness and cough, reassurance andpulmonary rehabilitation may play a major role in relievingtheir symptoms whereas in patients with mixed or obstructivepattern on spirometry, bronchodilator therapy along withpulmonary rehabilitation may be helpful in relieving theirsymptoms post tuberculosis treatment.

Comparison of wide-field swept source optical coherence tomography angiography and fundus autofluorescence in tubercular serpiginous-like choroiditis

Purpose: To evaluate the potential clinical utility of wide-field swept source optical coherence tomography angiography (SS-OCTA) using a prototype device compared to a wide-field fundus autofluorescence (FAF) for analysis of the disease activity in eyes with tubercular serpiginous-like choroiditis (TBSLC). Methods: Using a prototype SS-OCTA device (PLEX Elite, Carl Zeiss Meditec, Dublin, CA), 17 eyes of 12 consecutive patients with TBSLC were imaged and multiple 12 mm � 12 mm OCTA scans were captured, which were montaged to create wide-field montage OCTA images scans. A wide- FAF (Eidon, CenterVue, Padova, Italy) was performed in the same sitting. Two masked graders independently analyzed OCTA and FAF images for the presence of choroidal lesions, recorded the number of lesions identifiable, and provided a subjective grading for the activity of individual lesion, which were then compared. Results: The total number of lesions identified on FAF were 282 (posterior pole lesions, n = 129 and peripheral lesions n = 153) and on wide-field SS-OCTA were 230 (posterior pole lesions, n = 108 and peripheral lesions n = 122). Active choroidal lesions were comparable on the two machines (n = 28 on FAF and n = 28 on SS-OCTA, respectively); whereas numerous healed lesions were identified on FAF (n = 219) as compared to SS-OCTA (n = 170). There was good correlation among the devices for healed lesions (Pearson correlation, r = 0.82) and active lesions (r = 0.88). Conclusion: There was good correlation between FAF and wide-field SS-OCTA for detection of disease activity in TBSLC; however, FAF depicted greater number of healed lesions compared to wide-field SS-OCTA.

Serial pulmonary function test abnormality in tuberculous pleural effusion

Background: Pleural effusion is a common clinical problem that frequently causes dyspnoea and poor ventilatory function. In addition to fluid, pleural thickening, septations and calcifications can add to the functional deterioration of lungs. The drainage of pleural effusion is very effective in improving the functionality of lungs. Large volume pleural fluid tapping results in immediate hemodynamic improvement and relief from dyspnoea.Methods: The aim of the present study was to estimate the impact of tubercular pleural effusion on the ventilatory function of the lungs and to find out the correlation between the effect of pleural tapping and functional effect on the lungs. The study comprised of thirty tubercular pleural effusion cases. They were observed for six months by doing serial chest X-rays and pulmonary function test.Results: It was observed that tuberculous pleural effusion causes a restrictive abnormality and small airway obstruction. These abnormalities improve gradually over a period of six months when the patient is on anti-tubercular treatment. The role of any therapeutic intervention towards decreasing these lung function abnormalities will be subject of separate large-scale prospective study.Conclusions: Functional defects and residual pleural thickening has no correlation with the initial severity of pleural effusion.

A rare case report: successful outcome of a patient at near term pregnancy with maternal chronic obstructive hydrocephalus due to tubercular meningitis

The incidence of tubercular meningitis leading to obstructive hydrocephalus is extremely rare accounting for 1% cases and is even rarer during pregnancy. A 20-year-old 2nd Gravida presented at 32 weeks gestation with complaints of intermittent headache, decreased vision since 3 months and irrelevant talks and agitated behavior since 1 day. On examination patient had stable vital signs but constant irritable behavior. Obstetric examination revealed a pregnancy corresponding to 32 weeks with a live fetus. Patient had a past history of Anti-tubercular therapy taken 2 years back for tubercular meningitis. Neurological examination revealed a GCS of 12/15 and Ophthalmologic examination revealed patient to be having only Perception of Light with optic atrophy on fundoscopy. NCCT head revealed moderate dilatation of bilateral ventricles and 3rd ventricle without any periventricular ooze suggestive of Chronic Obstructive Hydrocephalus. Supportive therapy was instituted with Dexamethasone and Mannitol infusion after Neurosurgical consultation along with antenatal care. Decision for termination of pregnancy was taken at 35 weeks by an elective caesarean section with simultaneous ventriculo-peritoneal shunt insertion by neurosurgical team under general anesthesia. A live male baby of 2.25 kg was delivered. Patient with baby was discharged on 10th post-operative day. Obstructive hydrocephalous developing post tubercular meningitis in pregnancy is a rare event. Caesarean section was done along with shunt surgery in our case. Very few cases have been reported in the medical literature so far.