A study on procedural delay in diagnosis and start of treatment in drug resistant tuberculosis under RNTCP.

BACKGROUND: Multi-drug-resistant TB (MDR-TB) has become a significant public health problem and an obstacle to effective TB control. Rapid diagnostic tests for anti tubercular drugs sensitivity have significantly reduced total time in initiation of treatment. Still there is a significant gap between MDR diagnosis and start of category IV treatment. Delay in establishing the diagnosis may cause disease progression, transmission, lost to follow up and death. This study was planned to assess the actual delay from day one of sputum examination to the day of initiation of category IV in operational settings. METHODOLOGY: MDR-TB suspected patients attending the Respiratory medicine department, JLNMC, Ajmer from June-15 to July-16 were followed from sputum examination to sample deposition for drug sensitivity testing (LPA/CBNAAT) to MDR detection to category IV initiation, for assessment of procedural delay at various steps. RESULTS: LPA group (371 patients): Sputum smear to LPA deposition mean duration was 8.02 days, LPA deposition to LPA result upload mean duration was 3.78 days, LPA deposition to patients received LPA reports mean duration was 21.73 days and reports received to PMDT site admission (if drug resistant) mean duration was 3.61 days. Total time duration in category IV initiation was 32.63 days. CBNAAT group (50 patients): Sputum smear to CBNAAT deposition mean duration was 6.70 days, CBNAAT deposition to CBNAAT result upload mean duration was 1.13 days, CBNAAT deposition to patients received CBNAAT reports mean duration was 6.53 days and reports received to PMDT site admission (if R-resistant) mean duration was 3.8 days. Total time duration in category IV initiation was 12.4 days. CONCLUSION: Major delay seen on part of receiving sensitivity reports indicates the need to stress upon field staff motivation, appropriate training, sensitisation and expert counselling.

A study on pattern of resistance to second line anti tubercular drugs among multi drug resistant tuberculosis patients.

AIMS AND OBJECTIVES: To determine the prevalence and pattern of resistance to second line drugs among multi drug resistant (MDR) tuberculosis patients being treated on category IV regimen. METHODOLOGY: This study was conducted at Department of Respiratory Medicine, J.L.N. Medical College, Ajmer in collaboration with IRL, STDC, Ajmer. Second line anti tubercular drug sensitivity for 398 multi drug resistant tuberculosis patients (between June-2015 and June-2016) was done to find out prevalence and pattern of resistance to second line drugs. Second line drug sensitivity was performed at accredited laboratory, Microbiology department, S.M.S. Medical College, Jaipur. RESULTS: Among these 398 patients, 136 (34.17%) were resistant to fluoroquinolones (Ofloxacin) (Pre XDR); 18 (4.52%) were resistant to one of the aminoglycosides (Inj. Kanamycin, Capreomycin, Amikacin) (Pre XDR); while 22 (5.53%) patients were resistant to fluoroquinolones as well as aminoglycosides (XDR). 148 (37.18%) patients were found sensitive to both the drugs. Samples of 41 (10.3%) patients were contaminated and no growth was seen in 33 (8.29%) patients. CONCLUSION: Nearly half of the multi drug resistant (MDR) tuberculosis patients (44.22%) being treated on category IV regimen also have resistance to either fluoroquinolones or aminoglycosides or both i.e. Pre XDR or XDR. This may result in poor outcome of category IV regimen under RNTCP. There is a strong need for provision of culture sensitivity for all first line drugs and at least two second line drugs viz. Fluoroquinolones and aminoglycosides for all the patients registered as smear positive under RNTCP. There is also a need for development of rapid culture technique for sensitivity to second line drugs.

Obstructive Sleep Apnea in Bronchial Asthma Patients: Assessment of Prevalence and Risk Factors.

BACKGROUND: Sleep-related breathing disorders are group of respiratory disease among them obstructive sleep apnea (OSA) is highly prevalent and seen among those having recognized risk factors. Recent studies have shown that asthma and OSA contribute bi directional relationship where each disorder adversely influences the other one. This study was planned to assess OSA among bronchial sthma patients. METHODOLOGY: This study was conducted at Sleep lab of our department among adult patients of bronchial asthma after institutional ethical committee approval. Eligible and willing to participate patients were subjected to clinical assessment protocol that included history, clinical examination, measurement of Sleep Score, BMI, neck circumference etc followed by overnight Level 1 polysomnography. RESULTS: 50 patients with age range 30 to 68 years constituted the study population with mean age of 48.16 years. 70% patients were female with male female ratio of 1:2.3. The prevalence of OSA in asthma patients was 46%. 12% patients had mild OSA, 14% had moderate while 20% were having severe OSA. Mean BMI in our study was 27.87 Kg/m2 . OSA patients were associated with more BMI compared to patients without OSA (42% vs. 30%) (p value 0.04). Asthma patients who were smokers had more OSA symptoms compared to non-smokers (p value 0.002). Asthma patients with OSA were also associated with higher neck circumference and more snoring at night time as compared to non OSA population. Uncontrolled asthma was seen in 18 patients and 16 of them were having OSA (p=0.001). Most common co morbid illness in patients with OSA was GERD (78.26%) followed by allergic rhinitis (56%). Most of these patients (82%) were not having associated major local anatomical defect. CONCLUSION: :OSA is not uncommon in asthma patients. Careful assessment of sleep related symptoms and demographic parameters of asthma patients are essential to suspect diagnosis of OSA. Additional factors like smoking, obesity, GERD and allergic rhinitis are important contributing factor for higher risk of OSA among asthma patients. Early diagnosis of OSA in asthma patients by polysomnography may have a clinical benefit in the management of both diseases.

Parotid gland tuberculosis.

This report describes parotid gland tuberculosis in a 38-year-old female patient that presented with a firm, painless, progressively increasing swelling over the right preauricular region. Diagnostic workup including contrast enhanced computerized tomography neck and subsequent fine needle aspiration cytology of the swelling made the final diagnosis. The patient responded favorably with anti-tubercular therapy.