Status of universal drug-susceptibility testing among sputum smear-positive tuberculosis patients diagnosed at a tertiary care centre.

Background & objectives: This study was aimed at estimating the proportion among sputum smear-positive tuberculosis (TB) patients diagnosed at a tertiary care centre in India, who did not undergo universal drug-susceptibility testing (UDST), assessing the sociodemographic and morbidity-related factors associated with it, ascertaining the reasons for not getting tested and estimating the proportion with any drug resistance (DR). Methods: TB Notification Register and TB Laboratory Register, maintained in Designated Microscopy Centre and Intermediate Research Laboratory, respectively were used to obtain the patient details and information regarding UDST and DR-TB status. Under UDST, the TB patients had undergone rapid molecular tests to check for any DR. TB patients who dropped out of this strategy (those who did not submit a sputum sample for DR testing even after being instructed) were telephonically contacted and asked regarding reasons for not getting themselves tested. Results: Of the 215 patients, 74 [34.4%, 95% confidence interval (CI): 28.1-41.2] did not undergo UDST. Of these 74 participants, 60 per cent reported the reason that they were not informed regarding the drug-susceptibility test. Among the 141 patients who underwent UDST, six (4.3%, 95% CI: 1.58-9.03) had DR. Non-UDST patients were significantly more in percentage among TB patients who were aged <30 years (adjusted prevalence ratio 2.36; 95% CI: 1.19-4.68) compared to >60 years. Interpretation & conclusions: The present findings point towards a need to sensitize healthcare workers and TB patients to improve UDST.

An unusual cause of high density radiological opacities.

INTRODUCTION: Metallic mercury poisoning through intravenous injection is rare, especially as part of a suicide attempt. Diagnosis and treatment of the disease are challenging as clinical features are not specific. MATERIAL AND METODS: A 41-year-old male presented with dyspnea, fatigue, loss of weight, and loss of appetite over two months. Routine radiological examination by chest X-ray and CT showed randomly distributed high density opacities with Hounsfield units (HU) around 500 HU all over the body. The diagnosis was then confirmed with a urinary mercury concentration of > 1000 mcg/24 h. RESULTS: The patient's clinical condition was getting worse in spite of chelation therapy and hemodialysis. The patient eventually died because of respiratory failure. CONCLUSION: Early diagnosis and appropriate treatment are critical for intravenous mercury poisoning especially because there are no specific signs or symptoms. There should be a high level of suspicion in drug abusers. Treatment should involve the combined use of chelating agents and other treatments such as hemodialysis and plasma exchange in advanced clinical settings.

High Prevalence of Chronic Respiratory Symptoms among Autorickshaw Drivers of Urban Puducherry, South India.

CONTEXT: Auto-rickshaw (three wheelers open cabin type of vehicle) drivers are exposed to traffic air pollution. Studies have demonstrated reduced pulmonary function among drivers. However, limited studies have determined the prevalence of chronic respiratory symptoms or chronic obstructive pulmonary disease (COPD) among drivers. AIMS: Among auto-rickshaw drivers of urban Puducherry to determine prevalence of (i) chronic respiratory symptoms by using Indian Study on Epidemiology of Asthma, Respiratory Symptoms, and Chronic Bronchitis (INSEARCH) questionnaire and (ii) COPD by measuring peak expiratory flow rate (PEFR). SETTING AND DESIGNS: Cross-sectional, descriptive study. SUBJECTS AND METHODS: Cluster random sampling was used to select 297 auto-rickshaw drivers. Subjects were interviewed using the INSEARCH questionnaire. PEFR was measured using Wright's peak flow meter. We also assessed exposure to tobacco smoke. STATISTICAL ANALYSIS USED: Prevalence and 95% confidence interval of chronic respiratory symptoms and COPD were calculated. RESULTS: All the auto-rickshaw drivers were male, and 75% were in the age group of 31-50 years. They spend most of the time on the roadside either driving or waiting at the auto-stand. Prevalence of nonspecific respiratory symptoms among auto-rickshaw drivers was 76% (breathlessness on exertion 68%, cough at night and phlegm in the morning 22%, wheezing 18% assessed for last 12 months). Around 28% of them had PEFR <80%. The prevalence of tobacco smoking was also high (64%), and 100% had exposure to tobacco smoke at the workplace. CONCLUSION: The nonspecific chronic symptoms were high among auto-rickshaw drivers as compared to the general population noted from a multicentric study done in India. We recommend that auto-rickshaw drivers should use personal protective equipment and would require regular screening and treatment for respiratory impairment.