A prospective study on tubercular fistula in ano and its management / Estudo prospectivo sobre a fístula anal tuberculosa e seu tratamento

Abstract Objective Tuberculosis fistula in ano, though less encountered, is an important clinical entity in developing countries like India. Diagnosis of TB fistula is a challenge despite of advances in diagnostic modalities and it depends upon both local and systemic clinical presentation. This prospective study aimed at to substantiate the importance of clinical diagnosis as well as medical management of tubercular fistula by antitubercular drugs. Methods and results 25 patients of fistula in ano suspected to be of tubercular origin underwent histopathology of fistulous tracks and an 8 week therapeutic trial of antitubercular treatment after getting an informed consent. Though biopsy showed positive evidence of tubercular pathology only in 52% cases, therapeutic trial showed improvement in local and systemic features in 23 (92%) cases. Of these 23 cases, 3 were cured after 18 months of anti tubercular treatment and 18 showed cure after 24 months of anti tubercular treatment while 2 cases withdrew from the study at 12 and 14 months respectively due to adverse drug reactions though their fistulous symptoms were relieved. Conclusion Meticulous clinical evaluation plays a vital role in diagnosis of tubercular fistula in addition to other diagnostic methods. Anti tubercular treatment is the mainstay of treatment in tubercular fistula with a minimum duration of 18-24 months owing to the recurrent and relapsing nature of disease.

Resumo Objetivo A fístula anal da tuberculose (TB), embora menos observada, constitui entidade clínica importante em países em desenvolvimento, como a Índia. O diagnóstico de fístula TB é tarefa desafiadora, apesar dos avanços nas modalidades diagnósticas; seu estabelecimento depende tanto da apresentação clínica local, como da apresentação sistêmica. Esse estudo prospectivo teve por objetivo consubstanciar a importância do diagnóstico clínico e também do tratamento clínico da fístula TB com medicamentos contra tuberculose. Métodos e resultados Foi realizado estudo histopatológico de tratos fistulosos em 25 pacientes com fístula anal com suspeita de origem tuberculosa; depois de obtido o consentimento livre e informado, esses pacientes foram submetidos a tratamento anti-tuberculose (TAT) durante 8 semanas. Embora a biópsia tenha revelado evidência positiva de patologia tuberculosa em apenas 52% dos casos, o curso terapêutico resultou em melhora nos aspectos local e sistêmico em 23 (92%) pacientes. Desses 23 casos, 3 e 18 casos estavam curados após 18 e 24 meses de TAT, respectivamente, enquanto que 2 pacientes desistiram do estudo após 12 e 14 meses, respectivamente, em decorrência de reações farmacológicas adversas, mesmo diante do alívio de seus sintomas fistulosos. Conclusão Juntamente com outros métodos diagnósticos, uma avaliação clínica meticulosa desempenha papel vital no diagnóstico da fístula TB. TAT é o principal procedimento terapêutico em pacientes com fístula TB, com duração mínima de 18-24 meses devido à natureza recorrente e recidivante da doença.

An evaluation of bacteriological quality of drinking water from the catchment area of a tertiary care teaching hospital.

Background: It is well-appreciated that many communities in developing countries face severe public-health problems relating to drinking-water. The supply of safe water is important to protect the health of the community people. Aim: The study aimed to evaluate the bacteriological quality of drinking water from various active sources of water utilized in the catchment area of a tertiary care teaching hospital. Material and methods: The present cross sectional study was carried out by the Department of Microbiology and Community Medicine, MSDS Medical College, Fatehgarh during 2013-14. Randomly selected 100 active water sources which were being used for drinking purpose and a fairly good number of people using that water source for drinking purpose were included in the study. National Environmental Engineering Research Institute (NEERI) guidelines for drinking water quality assessment were adopted. Culture and bacteriological tests of drinking water were performed as per standard protocols. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Out of one hundred water samples collected, fifty one, twenty seven and twenty two samples of water were collected from municipal tap water, government hand pump and water cooler respectively. Almost half of the samples were found to be unsatisfactory. E. coli was found to be responsible for 26% of samples whereas Pseudomonas in 20% of collected samples. E. coli and Klebsiella tested positive with Methyl Red whereas Pseudomonas sp. and Klebsiella tested positive with Citrate test reagent. E. coli showed positive result with Indole reagent whereas Klebsiella tested positive with Urease. Regarding mix population organisms, Escherichia coli, Klebsiella Sp. and Pseudomonas Sp. were found to be positive in 3 samples whereas Klebsiella Sp. and Pseudomonas Sp. were found to be positive only in 1 sample Conclusion: The study highlighted unsafe nature of current active sources in the study area with regard to drinking water purpose which are not fit for consumption of water. Surveillance of water sources and regular bacteriological assessment of all water sources for drinking is recommended on regular basis.