Advanced Pulmonary Tuberculosis Research Articles

‘Destroyed Lung’: A Marker of Sequel of ‘Far Advanced’ Radiological Type of Pulmonary Tuberculosis’

Pulmonary Tuberculosis is caused by bacilli mycobacterium tuberculosis and known to infect human race since the dawn of history and archaeological evidence has traced its association in neolithic times. Tuberculosis is the most common infectious lung disease in India with significant mortality and morbidity. Tuberculosis can cause diverse thoracic presentations ranging from nodules, consolidations& cavitation, mediastinal adenopathy, pleural effusion to diffuse endobronchial disease presenting like bronchial asthma. Due to diverse presentations, diagnosis is many times delayed due to lack of suspicion by treating general physicians and rational treatment not offered in time. In spite of awareness by government organizations and considered as a ‘global health issue of concern’ by the World Health organization, tuberculosis is still considered as a social stigma. Destroyed lung is described in literature and known as a complication of pulmonary tuberculosis. Destroyed lung is defined as combination of pleural and parenchymal lung destruction with cavitation, bronchiectasis, loss of lung volume and mediastinal herniation to diseased side. In this case series, we have reported two cases with history of pulmonary tuberculosis in the past and received adequate anti-tuberculosis treatment. Both were having residual chronic lung disease and symptoms causing significant impact on quality of life with recurrent hospitalization, hospital visits and cost of care. One patient has a history of delayed diagnosis and ATT was started after maximum lung destruction due to a tuberculous process that has already occurred. In this patient tuberculosis was cured but residual lung damage or sequel presenting as destroyed lung. In the second case, tuberculosis was diagnosed in adequate time but the patient has defaulted due to adverse events of ATT and he has taken medications as per his own tolerance. Neither adherence nor compliance was acceptable in the second case and resulted in a partially treated case of pulmonary tuberculosis. Ongoing lung destruction in the second case would be the cause for destroyed lungs in absence of irrational medicines in today’s era of good quality ATT. Destroyed lung is preventable with early diagnosis, prompt evaluation with microscopy and nucleic acid amplification tests and treatment with universally available, acceptable and affordable free ATT as National guidelines. 'Destroyed lung' are having a significant impact on quality of life and health expenditure and are considered as ‘radiological stigma’ of Tuberculosis. Radiological classifications of tuberculosis are less used now, and, it can be justified in grading of disease severity and aggressive treatment planning. Radiological classifications also help in predicting complications such as ‘destroyed lung’ during evolution of advanced pulmonary tuberculosis disease which can be prevented with timely diagnosis and use of rational treatment with good clinical and radiological outcome.

Application experience of bioresorbable implants in correcting the volume of the pleural cavity and their biocompatibility assessment

Objective: To substantiate experimentally the possibility of using bioresorbable biopolymer pleural implants made of polylactide and polycaprolactone (PLA/PCL) to correct the volume of the chest. Materials and methods. Rabbits were used as experimental animals — mature females of the Chinchilla breed, age 1–1.5 years, weight 3500–4300 g. The number of individuals were 5. For studying changes in implants and local tissue reactions in vivo, as close as possible to clinical conditions, the method of intrapleural implantation was used. Bio-resorbable highly porous samples based on polylactide and polycaprolactone (PLA/PCL) with different polymer ratios and porosity degrees were used as implants. The implant and local tissue reactions were evaluated over five implantation periods: 7, 21, 54, 66 and 78 weeks. Results. The study of morphology in implants during a long experiment showed good biocompatibility, which was confirmed by the absence of necrosis in implants and surrounding tissues. In the first and second implantation periods minimal reactive changes were detected in the adjacent soft tissues (lung, pleura, soft tissues of the chest wall), existing as a focal fibrosis of muscle fibers, focal mononuclear infiltration of fibrous tissue. Conclusion: As a result of studying morphological changes in the implant and adjacent tissues of the chest wall, the absence of necrosis and purulent-inflammatory changes both in the implant itself and in the surrounding tissues of the chest wall and lung was confirmed. It has been proven that a highly porous pleural implant based on polylactide and polycaprolactone is a safe and promising material for correcting the volume of the chest, which can be in demand both in general thoracic surgery and for the surgical treatment of patients with advanced pulmonary tuberculosis.

The role of Chest HRCT in diagnosis active tuberculosis & lung destruction

Tuberculosis is a public health problem caused by Mycobacterium tuberculosis. In 2021 there will be 10.6 million cases in the world, and Indonesia ranks 2nd with 700,000 cases. In 2022, there will be 17,303 cases in North Sumatra Province and 2,430 cases in Medan City. In current practice, evaluation and diagnosis of active tuberculosis relies on bacteriological examination and Chest Radiographs. However, Chest Radiographs have limited specificity and high intraobserver and interobserver variability. HRCT is also not widely used as a routine option for patients suspected of suffering from tuberculosis, even though HRCT has high accuracy in detecting tuberculosis. We present a case of a patient with active pulmonary tuberculosis and lung destruction e.c. advanced pulmonary tuberculosis (MDR-Tuberculosis) (declared cured in 2018 after 2 years of treatment). This patient was evaluated with chest radiograph and chest HRCT. In this case, the initial findings on the Chest Radiograph, showed the impression of inactive tuberculosis but on further examination with chest HRCT, there was a tree in bud image which indicated active tuberculosis. This shows that there are limitations in diagnosing tuberculosis activity using Chest Radiographs. Due to the significant role of HRCT in the diagnosis of tuberculosis activity, it is necessary to consider the use of HRCT in the evaluation of patients with tuberculosis.

Radiologically Advanced Pulmonary Tuberculosis in Mogadishu, Somalia: A Review of 206 Cases with Acid Fast Bacilli Smear-Positive Sputum

Radiologically Advanced Pulmonary Tuberculosis in Mogadishu, Somalia: A Review of 206 Cases with Acid Fast Bacilli Smear-Positive Sputum

Comprehensive Treatment of Disseminated Fibrous Cavernous Pulmonary Tuberculosis with Extrapleural Thoracoplasty by Mesh Implant

The objective: to increase the effectiveness of comprehensive treatment of patients with advanced fibrous cavernous pulmonary tuberculosis using the new method of extrapleural upper-posterior thoracoplasty with a mesh implant.Subjects and Methods. It was an open, prospective, randomized, controlled study of treatment outcomes of 233 patients with fibrous cavernous pulmonary tuberculosis who had contraindications to resection surgery. Patients were divided into three groups depending on the type of thoracoplasty: thoracoplasty with a mesh implant was performed in 70 patients, thoracoplasty according to Bjork - in 60 people, and traditional upper-posterior thoracoplasty - in 103 patients.Results. In operated patients, additional support with a mesh implant during the formation of a new pleural dome reduced pathological flotation of chest organs, which prevented decreased respiratory function, the right heart overload, and protected from the development of bronchopulmonary complications in the early postoperative period. The chances of cavity healing and sputum conversion by the discharge from hospital increased by 3,3 times (OR=3,3; 95% CI 1,6-6,7), a year later by 3,0 times (OR=3,0; 95% CI 1,48-7,5); in the long-term assessment it increased chances of survival by 4,8 times (OR=4,8; 95% CI 1,4-16,4) versus the Bjork operation and traditional upper-posterior thoracoplasty.

The basics and prospects of surgical collapse treatment for advanced pulmonary tuberculosis

The paper presents the evolution of a surgical collapse approach to treating advanced pulmonary tuberculosis in circumstances where the causative agent shows a higher drug resistance and where the possibility of performing resection operations and pneumonectomies is limited. The authors show the historical aspects of development from thoracoplastic surgery to extrapleural pneumolysis, by filling the extrapleural space. They also depict stages in searchiing for effective biocompatible filling materials that provide a stable collapse of the lung tissue containing cavities and bullous deformity. The paper shows the experience with extrapleural pneumolysis via silicone implant filling, which demonstrates reliability, high efficiency and cosmetic advantage over thoracoplasty. The beneficial effect of extrapleural pneumolysis with silicone filling with silicone on respiratory function and pulmonary microcirculation was studied. Today, experience continues to accumulate in the use of extrapleural pneumolysis with silicone filling in the staged surgical treatment of advanced tuberculosis in combination with lung resections of various sizes and pneumonectomy, which considerably expands the boundaries of operability in patients with a decrease in functional indicators that have been previously considered hopeless. The prospects of the described method to treat this complex patient category necessitates further development of a wide range of issues, including the clarification of indications depending on the localization of the process and the degree of a respiratory function decrease, the improvement of equipment, the features of hospital management of the patients who have undergone surgery and their postoperative rehabilitation.

Influence of the Distraction Cavity Size on the Choice of the Compression Technique in Thoracoplasty in Patients with Advanced Fibrous-Cavernous Tuberculosis

Introduction. Extrapleural upper-posterior thoracoplasty is the most common non-resectable surgery in the treatment of patients with advanced fibrous-cavernous pulmonary tuberculosis. However, there is still no unified approach in choosing the thoracoplasty and compression options of the destruction cavity.The aim of the study was to assess clinical outcomes of various compression methods in extrapleural upper-posterior thoracoplasty considering the destruction cavity size.Materials and methods. The study included 233 cases of upper posterior thoracoplasty performed in 2012-2019. All cases were fibrous-cavernous pulmonary tuberculosis when the process extended beyond one lobe and was widespread. Group 1 (n=70) involved patients with hybrid thoracoplasty with polypropylene mesh; group 2 (n=60) involved patients with modified osteoplastic thoracoplasty; group 3 (n=103) involved patients with conventional selective extrapleural upper-posterior thoracoplasty. When analysed, attention was paid to elimination of the decay cavity and bacterial excretion.Results. The publications analysed demonstrate that the main criteria for choosing a plastic surgery option are traditions of the clinic and personal preferences of a surgeon. The study evidenced the best performance of hybrid compression over conventional and modified thoracoplasty (p0,05). Obviously, the choice of thoracoplasty option and the number of resected ribs should be based on the data including the total size of the destruction cavity and the compression technique.Conclusion. The proposed distribution of upper-posterior thoracoplasty depending on the compression technique allows individually selecting the most effective treatment options for patients with widespread fibrous-cavernous tuberculosis with destruction cavities up to 6 cm localized in the upper lung.

Опыт применения пластики переднего средостения во время пневмонэктомии у больных с распространенным деструктивным туберкулезом легких*

Опыт применения пластики переднего средостения во время пневмонэктомии у больных с распространенным деструктивным туберкулезом легких*

Thyroid profile in pulmonary tuberculosis patients: a prospective study in a tertiary medical college of southern Odisha

<p class="abstract"><strong>Background:</strong> Globally, an estimated 10.0 million (range, 9.0 to 11.1 million) people infected with tuberculosis (TB). Developing country like India accounts for one fourth of the global tuberculosis burden. TB is associated with diffuse functional impairment of most endocrine organs.</p><p class="abstract"><strong>Methods:</strong> We conducted a study to evaluate the thyroid profile status in new sputum positive pulmonary tuberculosis patients, aged 12 years and above; attended and admitted to chest and TB, Medicine Department of SLN MCH, Koraput, Odisha from January 2019 to December 2019. Patients with H/o old pulmonary tuberculosis, patient with known neurological, hypothalamic-pituitary or thyroid disorders, kidney disease, malignancies and patients receiving medications known to interfere with thyroid hormone metabolism were excluded from the study. Statistical analysis was done by using SPSS version 21.0 software. Results were expressed in average±SD, frequencies and percentages. Continuous data were compared using Student’s t-test. A p value <0.05 was considered as statistically significant and p value <0.001 was considered as statistically extremely significant.</p><p class="abstract"><strong>Results:</strong> Mean age of the study group was 37.31±15.63 years. 54 patients (40.30%) were in 20 to 40 years of age group. We found, 48 (35.82%) pulmonary tuberculosis patients had sick euthyroid syndrome out of 134 pulmonary tuberculosis patients.</p><p class="abstract"><strong>Conclusions: </strong>Sick euthyroid syndrome occurs commonly in pulmonary tuberculosis patients with increasing incidence with advanced age, and also seen in patients with advanced pulmonary tuberculosis patients; therefore, requires monitoring of thyroid function test for its timely initiation of therapy.</p><p class="abstract"> </p>

4-month moxifloxacin containing regimens in the treatment of patients with sputum-positive pulmonary tuberculosis in South India - a randomised clinical trial.

Shortening tuberculosis (TB) treatment duration is a research priority. We tested the efficacy and safety of 3- and 4-month regimens containing moxifloxacin in a randomised clinical trial in pulmonary TB (PTB) patients in South India. New, sputum-positive, adult, HIV-negative, non-diabetic PTB patients were randomised to 3- or 4-month moxifloxacin regimens [moxifloxacin (M), isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)] or to a control regimen (2H3 R3 Z3 E3 /4R3 H3 ) [C]. The 4 test regimens were 3R7 H7 Z7 E7 M7 [M3], 2R7 H7 Z7 E7 M7 /2R7 H7 M7 [M4], 2R7 H7 Z7 E7 M7 /2R3 H3 M3 [M4-I] or 2R7 H7 Z7 E7 M7 /2R3 H3 E3 M3 [M4-IE]. Treatment was directly observed. Clinical and bacteriological assessments were done monthly during treatment and for 24months post-treatment. The primary end point was TB recurrence post-treatment. Of 1371 patients, randomised, modified intention-to-treat (ITT) analysis was done in 1329 and per-protocol (PP) analysis in 1223 patients. Regimen M3 was terminated due to high TB recurrence rates. 'Favourable' response at end of treatment was 96-100% in the moxifloxacin regimensand 93% in the control regimen. Among these, the TB recurrence occurred in 4.1% in the M4 regimen and in 4.5% in the control regimen and demonstrated equivalence within a 5% margin (95% CI -3.68, 4.55). Similar findings were observed in modified ITT analysis. The TB recurrence rates in the M4-I and M4-IE regimens did not show equivalence with the control regimen. Sixteen (1.4%) of 1087 patients in the moxifloxacin regimens required treatment modification. The 4-month daily moxifloxacin regimen [M4] was found to be equivalent and as safe as the 6-month thrice-weekly control regimen.

Primary Laryngeal Tuberculosis Masquerading Laryngeal Malignancy

Nowadays, tuberculosis (TB) infection shows re-emergence again in many other part of the world due to HIV/AIDS- related disease, low socioeconomic as well as insurgence of multidrug resistance tuberculosis. TB is a disease which is primarily affects a lung. However it also can affect other organs as a secondary disease in a body via hematogenous or lymphatic spread. As in ENT field, TB also can manifest as a solely ear, nose or throat (ENT) diseasea such as in primary laryngeal tuberculosis (TB). In the past, laryngeal TB typically presented as a secondary disease with ulcerated laryngeal lesions in advanced pulmonary tuberculosis patient. In our case, we report a case of primary laryngeal tuberculosis masquerading as laryngeal malignancy in adult patient without pulmonary tuberculosis. In conclusion, in a patient who presented with various laryngeal symptoms, physician should be aware of the reemergence of laryngeal tuberculosis and the various manisfestation of the disease.
 Bangladesh J Otorhinolaryngol; April 2016; 22(1): 53-57

Serum human epididymis protein 4 concentrations are associated with severity of patients with pulmonary tuberculosis

BackgroundHuman epididymis protein 4 (HE4) has been recognized as a biomarker which elevated in various diseases. The aim of this study was to evaluate the value of serum HE4 in pulmonary tuberculosis (PTB). MethodsSerum HE4 concentrations were determined in 127 PTB, 88 chronic bronchitis (CHB), and 105 healthy control subjects by chemiluminescent microparticle immunoassay. Receiver operating characteristic (ROC) curves and Spearman's correlation analysis were performed for investigating value of HE4. ResultsSerum HE4 concentrations were significantly increased in PTB (62.8 pmol/L, IQR 45.8–90.7), compared with that of CHB (50.2 pmol/L, IQR 42.3–64.3, P = 0.0002) and normal control (35.4 pmol/L, IQR 31.1–42.9, P < 0.0001). ROC curve suggested that the AUC of HE4 used to discriminate PTB from CHB was 0.647 (95% CI, 0.574–0.719), with the cutoff value, sensitivity, specificity, PPV, and NPV at 71.9 pmol/L, 0.417, 0.852, 0.672 and 0.543, respectively. Meanwhile, compared with mild to moderated PTB, the levels of HE4 in advanced PTB were significantly elevated (75.8 vs. 57.7 pmol/L, P = 0.0052). What’s more, the levels of HE4 in PTB were found to be significantly associated with the albumin, CRP, and cavity (r = −0.2996, P = 0.0006, r = 0.265, P = 0.0026, r = 0.4699, P < 0.0001, respectively). ConclusionsElevated serum HE4 concentration could be used as a biomarker for the diagnosis and assessment of disease severity in PTB.

THE VOICE OF TB: A CASE OF PRIMARY LARYNGEAL TB IN AN IMMUNOCOMPETENT HOST

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Historically associated with poor prognosis seen in advanced pulmonary tuberculosis (TB), laryngeal TB is a rare manifestation of TB that represents only 1% of all cases. The increase in the number of documented cases of laryngeal TB in recent years pose a serious public health concern. This trend correlates with rising prevalence of human immunodeficiency virus (HIV) and mounting anti-tuberculous drug resistance. We present a rare case of primary laryngeal TB with descending tracheobronchial involvement in an immunocompetent 71-year-old female nurse who developed progressive dysphonia over several months with unintentional weight loss and non-productive cough. CASE PRESENTATION: Non-contrast enhanced computed tomography (CT) revealed clustering of subcentimeter stellate nodules in the right upper lung field with an enlarging ground glass opacity in the right lower lung but did not show structural abnormalities within the neck. Positron emission tomography (PET) showed pathologic fluorodeoxyglucose (FDG) uptake within the larynx and trachea with extension into the left mainstream bronchus as well as the proximal left upper and lower lobe bronchi. Diffuse standardized uptake value (SUV) was greatest in the larynx (20.5) consistent with primary laryngeal TB. Polymerase chain reaction (PCR) on bronchoscopic sputum specimen confirmed Mycobacterium tuberculosis. She was started on a 4-drug regimen comprising of isoniazid, rifampin, ethambutol and pyrazinamide with good response. Her close contacts were treated as well. DISCUSSION: This case highlights the unusual cause of dysphonia arising from primary laryngeal TB in an immunocompetent host. CONCLUSIONS: Early diagnosis can limit adverse complications and unnecessary exposure of healthcare workers. Reference #1: Jeana L. Benwill & Juan C. Sarria (2014) Laryngeal tuberculosis in the United States of America: A forgotten disease, Scandinavian Journal of Infectious Diseases, 46:4, 241-249, DOI: 10.3109/00365548.2013.877157 DISCLOSURES: No relevant relationships by Akshay Avula, source=Web Response No relevant relationships by Wissam Mansour, source=Web Response No relevant relationships by Rabih Maroun, source=Web Response No relevant relationships by Sam Ngu, source=Web Response No relevant relationships by Sami Pervaiz, source=Web Response

OC 8711 EARLY BIOMARKERS OF LUNG INFLAMMATION AND FUNCTION IN TRIALS OF HOST-DIRECTED TUBERCULOSIS THERAPIES (TB-HDT)

BackgroundPermanent lung injury and impaired function are common despite TB cure. Host-directed anti-inflammatory therapies may prevent this injury. Early biomarkers of lung inflammation and function can facilitate their evaluation.MethodsIn an ongoing study supported by the Bill and Melinda Gates Foundation, HIV-uninfected patients with radiographically moderately or far advanced sputum smear-positive pulmonary tuberculosis receive rifabutin-substituted standard therapy plus either CC-11050 (phosphodiesterase inhibitor), everolimus (mTOR inhibitor), auranofin (gold salt), cholecalciferol, or control, during months 1–4. Study leadership is blinded as to assigned treatments. 18F-fluorodeoxyglucose positron emision tomography (PET) and computed tomography (CT) are performed at baseline and at week 8. Total lung glycolytic activity (SUVbw*ml) and radiodensity (modified HU*ml) are measured using MIM software. Sputum culture, spirometry, 6 min walk test (6MWT), and other biomarkers are performed at multiple time points. Follow-up continues to month 18. This analysis includes only baseline and week 8 data.ResultsPresently, 160/200 participants are enrolled. At baseline, patients have a high burden of infection (median time to detection [TTD] in automated liquid culture 5 days). Median baseline FEV1% of predicted (63%) and 6MWT (402 meters) are typical of moderate to severe chronic lung disease. Baseline TTD, PET, CT, FEV1% and 6MWT are all highly correlated (median rank test p=0.0018). All 5 parameters changed significantly during 8 weeks of treatment (p&lt;0.001). Analysis of adjusted log change from baseline shows PET and CT remain highly correlated (p&lt;0.001), and weakly correlated with FEV1% and 6MWT. TTD shows no correlation with any other endpoint.ConclusionQuantitative markers of infection, inflammation, and function are markedly abnormal and highly correlated at baseline in patients with pulmonary tuberculosis. Quantitative CT may substitute for PET as a more readily-performed measure of lung inflammation. The dissociation of microbiologic responses from inflammation and function supports a role for HDTs in TB.

Химиотерапия и хирургическое лечение поздно выявленного распространенного деструктивного туберкулеза легких у подростков

Химиотерапия и хирургическое лечение поздно выявленного распространенного деструктивного туберкулеза легких у подростков

DISPENSARY FOLLOWUP AND MEDICAL REHABILITATION OF TB/HIV CO- INFECTED PATIENTS

We have presented the data from a two-year dispensary follow-up carried out by a TB dispensary. We observed a cohort of 178 new TB patients co-infected with HIV. Out of them 79,8% were injecting drug users and suffered from viral hepatitis B and C; 86,5% did not receive antiretroviral therapy (ART); and 34,3% had CD4+ cell count less than 50 cells/μL of blood. Most common forms of TB were disseminated (28,8%) and infiltrative (30,5%) pulmonary TB; in 41,6% it was accompanied by extrapulmonary TB and in 29,2% — by other secondary diseases. Complex therapy resulted in clinical cure in 9% of patients in significant improvement in 53,9% of patients in 6,7% the disease was progressing and 30,3% of patients died during the follow-up. Disease progressing and lethal outcome were associated with low antiretroviral therapy adherence, drug addiction, severe and advanced pulmonary tuberculosis with extra pulmonary tuberculosis and other HIV-associated diseases.

Increasing likelihood of advanced pulmonary tuberculosis at initial diagnosis in a low-incidence US state.

Arkansas, USA. To investigate the relationship between an increase in the proportion of cases with advanced disease at first diagnosis and the recently observed slowing of the decline in tuberculosis (TB) incidence in low-incidence US states. We conducted descriptive statistical analyses of de-identified surveillance data of 1246 culture-confirmed TB patients reported in Arkansas during 1996-2013. We then fitted stepwise, multivariate logistic regression models to identify predictors for advanced disease at diagnosis, defined as having either smear-positive sputum or lung cavitation. From 1996 to 2013, the proportion of new cases with positive sputum smear and cases with lung cavitation increased from 51.6% to 75% and from 37.7% to 50%, respectively. Patients diagnosed during 2006-2013 were more likely to have positive sputum smears (adjusted odds ratio [aOR] 2.55, 95%CI 1.95-3.35) or lung cavitation (aOR 1.49, 95%CI 1.14-1.95) than those diagnosed during 1996-2005. During 1996-2013, age 15-64 years and excessive alcohol use were predictive of positive sputum smear or lung cavitation. Measures to reduce the proportion of cases with advanced disease at first diagnosis may be helpful to achieve further decline in TB incidence in low-incidence settings.

Bedside inflammatory mediators in pulmonary tuberculosis

BackgroundMonitoring of pulmonary tuberculosis (PTB) especially in poor countries is a major challenge aiming to find cheap valuable indices.ObjectiveThe objective of this study was to evaluate the use of simple laboratory parameters as complete blood count (CBC), especially platelet (PLT) indices, for assessment and monitoring of PTB activity.Patients and methodsTotally, 140 PTB patients in addition to 30 healthy individuals as a control group were included in this case–control study. Patients were divided into three groups: 66 newly diagnosed active patients (group I), 39 patients after sputum and culture conversion (group II), and 35 patients defined as cured cases (group III). On the basis of chest radiography, only active PTB patients were classified into minimal, moderate, and far advanced cases. Laboratory parameters including CBC with PLT indices, erythrocyte sedimentation rate, and C-reactive protein (CRP) were performed for all enrolled participants.ResultsCompared with the control group, hemoglobin, mean PLT volume, and platelet distribution width (PDW) were significantly lower in group I and increased after treatment in groups II and III. On the other hand, PLT count, platelet crit %, CRP, and erythrocyte sedimentation rate were significantly higher in group I compared with the control group and decreased after treatment. In addition, there were significant correlations between CRP and all PLT indices. Regarding radiological extension, hemoglobin and mean PLT volume were significantly lower in far advanced PTB compared with both moderate and mild PTB, whereas PLT crit was significantly higher in moderate PTB compared with minimal PTB.ConclusionCBC, especially PLT indices, could be considered valuable cheap markers in assessment and monitoring of PTB activity.

“When Freedom Comes”: Maria Parker, the Women’s Department, and the West Virginia State Penitentiary

“When Freedom Comes”: Maria Parker, the Women’s Department, and the West Virginia State Penitentiary1 Katy Ryan After the Civil War, West Virginia used the labor of people in custody to build the West Virginia State Penitentiary, a castellated gothic fortress in Moundsville. The state prison, modeled on Stateville in Illinois, was surrounded by twenty-five-feet-high walls of solid masonry. The design was intended to intimidate and to terrify—in order to redeem. The complex served as the state prison until 1995 when, unable to meet minimum standards for health and safety, the penitentiary was closed by federal order. Women were confined at Moundsville as early as 1873 (the superintendent’s report that year mentioned an “entirely deranged” white female)2 and remained a presence until 1947 (when a separate facility opened at Pence Springs). But few records remain of their experiences. The records supervisor at Mount Olive Correctional Center, where materials were sent after the penitentiary closed, confirmed that most files related to women had never arrived.3 A fleeting women’s column in Work & Hope, an ephemeral magazine housed in the West Virginia and Regional History Center, provides entry into the largely unknown history of women at the West Virginia State Penitentiary.4 Published monthly inside the prison during the 1920s and advertised as “THE PRISONER’S ONLY VOICE TO YOU,” Work & Hope contains articles, poems, short stories, and drawings by imprisoned people as well as reprinted articles from local and national newspapers.5 Between January 1929 and January 1931, an African American schoolteacher named Maria Parker wrote a women’s column for the publication. Parker’s name appears as the author on fifteen of the twenty-three women’s columns during this two-year period. Seven are unsigned or signed “Female Department,” and one, a poem, is credited to Marion E. Williams.6 James McGrath Morris observes in Jailhouse Journalism: The Fourth Estate Behind Bars that until Wilbert [End Page 1] Rideau became editor of the Angolite in 1975, no black person had occupied a “position of authority on a prison newspaper.”7 However, fifty years earlier, Parker wrote most, if not all, of the articles from the women’s department in Work & Hope. Click for larger view View full resolution West Virginia Penitentiary 1922. West Virginia and Regional History Center, West Virginia University Libraries. After January 1931, the women’s column abruptly ceased without explanation. Around this time, Parker was transferred to the State Colored Tuberculosis Sanitarium in Denmar. Four years later, on June 22, 1935, Parker died of advanced pulmonary tuberculosis. She was thirty-six years old. Like many sent to the penitentiary, Parker was effectively sentenced to death. Over a thousand people died while serving time at Moundsville, many from tuberculosis, pneumonia, and other sicknesses exacerbated by the lack of ventilation, inadequate food, and lousy medical care. Many people killed themselves. Ninety-four men were executed.8 When reading work composed in state captivity, insufficiently critical practices can mask, as Dylan Rodriguez argues, the violence of incarceration and normalize the conditions of terror out of which imprisoned people write.9 This erasure may be especially tempting with prison publications that typically cannot report on unsafe conditions and mistreatment.10 On the surface, Parker’s writing is breezy, upbeat, conversational. She emphasizes the power of Christianity, forgiveness, and the good a smile can do. She also manages, [End Page 2] through indirection and understatement, to indict a coercive, threatening, and silencing environment. Her column subtly communicates the severity of everyday life and the consequences of long-term sentencing. Although Parker does not address racism explicitly, she refers in her column to God’s wish for peace and goodwill, “regardless of race, color, or creed.”11 She cites the New Testament injunction to love one’s neighbor and adds that this “includes all classes, colors and kinds of people.”12 To be beautiful, she writes, is to “be pleasant, willing to serve, and know how to meet people of all classes and treat each person with due respect, to help lift anothers burden.”13 In her work on nineteenth-century black women’s spiritual writing, Joycelyn Moody observes that participation in Judeo-Christian...

Primary Laryngeal Tuberculosis Masquerading Laryngeal Malignancy

Nowadays, tuberculosis (TB) infection shows re-emergence again in many other part of the world due to HIV/AIDS- related disease, low socioeconomic as well as insurgence of multidrug resistance tuberculosis. TB is a disease which is primarily affects a lung. However it also can affect other organs as a secondary disease in a body via hematogenous or lymphatic spread. As in ENT field, TB also can manifest as a solely ear, nose or throat (ENT) diseasea such as in primary laryngeal tuberculosis (TB). In the past, laryngeal TB typically presented as a secondary disease with ulcerated laryngeal lesions in advanced pulmonary tuberculosis patient. In our case, we report a case of primary laryngeal tuberculosis masquerading as laryngeal malignancy in adult patient without pulmonary tuberculosis. In conclusion, in a patient who presented with various laryngeal symptoms, physician should be aware of the reemergence of laryngeal tuberculosis and the various manisfestation of the disease.Bangladesh J Otorhinolaryngol; October 2015; 21(2): 122-128