Comparing the Daily Versus the Intermittent Regimens of the Anti-Tubercular Chemotherapy in the Initial Intensive Phase in Non-HIV, Sputum Positive, Pulmonary Tuberculosis Patients.

BACKGROUND: Tuberculosis (TB) is a major health problem in the universe and India is no longer exempted from this crisis .The emergence of HIV and MDRTB (Multi Drug Resistant Tuberculosis) have further made the situation critical. AIMS: Our aim was to compare the efficacy of the daily and the intermittent doses of the Anti Tubercular Drug (ATD) therapy which is under the Revised National Tuberculosis Control Programme, amongst the sputum positive pulmonary tuberculosis in terms of the sputum conversion rate at the end of the initial phase , the default rate and the adverse drug reactions. METHODS: This was an observational prospective study. MATERIAL: Eighty three patients were selected from the out patient and the inpatient departments of a tertiary medical centre in India. RESULTS: Forty three cases received an intermittent regimen, where the major age group belonged to the under 40 years age group, the default rate to the therapy was 9.3%, the sputum conversion rate was 94.87% and adverse drug reactions were found in 25.58% of the patients. In the daily regimen, there was an equal proportion of the age group of the patients, both above and below 40 yrs, the sputum conversion rate was 94.74%, a default rate was found in 5% cases and adverse reactions were found in 35% of the cases. CONCLUSION: Both the intermittent and the daily regimens showed equal sputum conversion rates and the drug default cases were found more in the intermittent group. However, the adverse reactions were found more in the daily regimen category.

Chest roentgenography in tuberculous cervical lymphadenopathy.

The primary site of infection in tuberculous cervical lymphadenitis is lungs, from where bacilli reach gland through circulation. This study was done in the department of chest medicine, NRS Medical College, Kolkata, and was designed to find out chest x-ray abnormalities in apparently chest asymptomatic confirmed tuberculous cervical lymphadenitis without associate disease. The diagnosis of tuberculous cervical lymphadenitis was confirmed by fine needle aspiration cytology and/or smear for acid-fast bacillus, and chest x-ray (PA view) was done in all confirmed cases (n = 183). Normal chest x-ray was found in 132 cases (72.13%) and abnormal chest x-ray in 51 cases (27.87%). Pulmonary infiltration, the commonest radiological finding was detected in 32 cases (17.49%), hilar enlargement in 17 cases (9.29%), right paratracheal opacity in 2 (1.09%), obliteration of costophrenic angles in 3 cases (1.64%) and miliary mottling in one case (0.55%). Upper zonal predominance of lung parenchymal infiltrations was noted in 12.57% and right lung involvement in 16.39%. Single zone was affected in 9.84% cases and multiple zones were involved in 7.65% cases. We observed right hilar enlargement in 6.56%, left hilar lymphadenopathy in 4.37% and bilateral hilar lymphadenopathy in 2.73% cases. We concluded that routine chest x-ray PA view should be done in all tuberculous lymphadenitis before categorisation and starting of treatment.

Dissecting aneurysm of arch and descending thoracic aorta presenting as a left sided hemorrhagic pleural effusion.

The most common cause of massive hemorrhagic effusion is malignancy. Herein we present a case of dissecting aneurysm of descending thoracic aorta presenting initially with shortness of breath due to left sided massive pleural effusion. Effusion was hemorrhagic in nature with high hematocrit value. CT scan of thorax with CT angiogram was done and that revealed the diagnosis.

A rapid immunochromatographic assay for the detection of Mycobacterium tuberculosis antigens in pulmonary samples from HIV seropositive patients and its comparison with conventional methods.

As tuberculosis generates a highly heterogeneous antibody repertoire, its diagnosis requires tests based on cocktails of antigens. We describe a new, rapid method called rapid immunochromatographic assay (RICA) for cocktail-based diagnosis, which can detect Mycobacterial antigens in sputum specimens. Six antigenic fractions of pathogenic Mycobacterium tuberculosis were used in combination as the capture antigens in the control line of the flow-through assay. Antigen detection of 200 sputum samples from HIV seropositive patients by RICA assay gave a sensitivity of 97.9%, specificity of 99.0%, positive predictive value of 98.9%, negative predictive value of 98.0%, false positive rate of 0.9%, false negative rate of 2.0%, prevalence rate of 49%, likelihood ratio for positive results 97 and likelihood ratio for negative results 0.02. The combination of RICA and AFB staining gave a sensitivity of 100%, specificity of 100%, positive predictive value of 100%, negative predictive value of 100%, false positive rate of 0%, false negative rate of 0%, likelihood ratio for negative results 0. The assay was simple, rapid and economical for the detection of M. tuberculosis infection and suitable for large scale screening of samples in endemic areas without any sophisticated equipment. The results of the assay proved to be superior to conventional methods and combined with clinical data, could form the basis for starting an earlier course of treatment.

Current trends of opportunistic infections among HIV-seropositive patients from Eastern India.

In this report we describe the clinical and laboratory profiles of different opportunistic infections (OIs) among 125 immunocompromised patients admitted to a referral hospital in the eastern part of India. Different pathogens were isolated, identified and characterized using the laboratory gold standard methods. Oral candidiasis (88%) was found to be the most common OI, followed by tuberculosis (57%), enteropathogenic Vibrio (47%), cytomegalovirus infection (45%), cryptosporidial diarrhea (43%), Escherichia coli infection (42%) and other infections among the study subjects. Statistical analysis of the case studies shows 120/cumm median CD4+ blood cell count, and the OIs showed an inversely proportional occurrence to the CD4+ count of the immunocompromised patients. The spectrum and frequency of certain OIs highlight the urgency of studying HIV/AIDS in resource-limited countries where locally specific disease patterns may be observed. The purpose of the present investigation was the identification of such opportunistic pathogens, as we feel the HIV epidemic can be more effectively managed if physicians and health planners are aware of this information.