Department Of TB Research Articles

EFFECTS OF SOCIOECONOMIC AND CLINICAL FACTORS ON TREATMENT ADHERENCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASES PATIENT: FOCUS ON INHALATION THERAPY

Objective: Chronic obstructive pulmonary disease (COPD) refers to a persistent blockage of airflow that requires bronchodilator medication for the rest of one’s life. The goal of the treatment can only be met when the patient is adhering to the prescribed medicine. This study identifies and analyzes how clinical and socioeconomic factors affect COPD patients’ drug adherence to given therapy. The impact of our findings will reduce socioeconomic inequality in COPD management which will improve adherence to drugs and overall physical well-being. Methods: The hospital-based cross-sectional studies were conducted at the Department of TB and CD for 6 months in a tertiary care hospital. A total of 55 patients diagnosed with COPD participated in the study after signing the informed constant. The individual patients were interviewed using MMAS-8 and Kuppuswamy scale questionnaires. The data were analyzed by Chi-square test to determine the correlation between medication adherence and socioeconomic status in patients with COPD. Results: Among 55 COPD patients included in the study, their mean age was 62.2(+10.76) years. Out of the total participants: Significant associations between the medication adherence scale (MMRS-8) scores and the Kuppuswamy scale were found as p<0.0001, indicating that medication adherence was influenced by the patient’s socioeconomic status. In addition, the BORG scale which is used to measure exercise tolerance in COPD that found to have a significant correlation with an MMAS-8 score of p=0.03. Conclusion: Our study found that a person with low socioeconomic levels will have poor adherence to inhaler therapy, leading to poor health outcomes like exacerbation and low physical activity due to shortness of breath.

Microbiological Profile and Antibiotic Resistance Pattern in Acuteexacerbations of COPD: A Study from Northern India

Background Chronic Obstructive Pulmonary Disorder (COPD) is a major cause of morbidity and one of the principal causes of death worldwide. The objective of this study is to identify the bacterial etiological agents in patients with acute exacerbations of COPDs by sputum culture and their antibiogram.MethodsThis is a prospective study comprising 100 diagnosed patients of COPD taken as GOLD Grade 4 who were admitted in the Department of Pulmonary Medicine, TB and Chest Hospital which comes under King George Hospital, Visakhapatnam.ResultsOut of 100 patients, 83 were males of which 87% were smokers. The most common organisms isolated were Gram negative bacilli in 51 patients and only 26 were Gram positive cocci. The most common Gram-negative isolate was Klebsiella pneumoniae 27 cases followed by Pseudomonas aeruginosa in 19 cases. The most common Gram-positive isolate was Streptococcus pneumoniae in 16 cases followed by Streptococcus pyogenes in 6 cases and Staphylococcus aureus in 2 cases.Conclusions Frequent exacerbations appear to be associated with worsening healthoutcomes and effort should focus on prompt and effective treatment of eachepisode. Bacterial pathogens, mostly Gram negative bacilli are found to be the chief etiological agents in AECOPD. Antibiotic therapy should be initiated early depending on the culture. Susceptibility patterns of that particular region should be determined to prevent antibiotic resistance and to decrease health costs.

Aetiological spectrum of patients of pleural effusion – An observational study

Background: Pleural effusion is a clinical condition that is a manifestation of various aetiologies and pathologies. The aetiologies vary in different geographical areas and different age groups. The goal of this study was to evaluate the aetiological spectrum of patients with pleural effusion presenting in the Department of TB & Respiratory Medicine. Materials and methods: 120 patients were involved in current study in which the detection of pleural effusion has been done based on the history, physical examination, and radiography. Pleural fluid was aspirated under USG guidance and then analyzed for various parameters. Results: The study showed male preponderance (70%). The commonest age group involved was between 31 to 40 years (25.83%). Most cases showed exudative effusion (96%). Tuberculosis was the most common aetiology (80%). Conclusion: Different geographical areas may have a different aetiological spectrum of pleural effusion. Tuberculosis is the most prevalent pleural effusion cause in our area involving middle age group with a male preponderance. Keywords: transudate; tuberculosis; exudate; pleural effusion; adenosine deaminase

A Study on Sputum Induction in the Diagnosis of Smear Negative or Sputum -Scarce Presumptive Tuberculosis in HIV Patients in A Tertiary Care Center

Background: HIV infection and TB are two major public health problems in most of the developing countries including India. TB also the most common opportunistic infection seen in HIV infected patients in India 1,2. Tuberculosis is a significant increase in the worldwide incidence of TB which is contributed majorly by HIV infection. AIM: To study the role of Sputum Induction to aid in the diagnosis of Smear Negative or Sputum Scare Presumptive Pulmonary Tuberculosis in adults with HIV. Material & Methods: Prospective hospital based observational study. The present study was conducted in the department of TB & Respiratory medicine, Osmania Medical College, Hyderabad. The subjects of the study were selected among the HIV positive with Presumptive Pulmonary Tuberculosis patients who visited the outpatient department or had been admitted in our hospital who agreed for voluntary participation. A total of 50 Presumptive Pulmonary Tuberculosis with HIV co- infection were taken as sample size. Results: The majority of cases (38 %) were in the age group of 31-40 yrs. Mean age of the study group population is 39.76 ± 9.24. The predominant symptom in the present study was loss of appetite. Out of 50 patients 34% (17 patients) were known Diabetic and 10% (5 patients) were known Hypertensive. Most of the patients in my study are smokers (40%). The mean CD4 count in the present study is 182.68. Majority (72%) of patients in the present study did not have previous history of TB. On General examination majority of the patients had Lymphadenopathy. Out of 45 adequate Induced sputum cases, 89% (40 cases) were Negative for Sputum AFB and whereas 11% (5 cases) were Positive for Sputum AFB. Conclusion: Sputum induction is a safe, simple and valuable procedure to obtain adequate sputum samples in suspected cases of pulmonary tuberculosis and can obviate the need for much sophisticated and invasive procedures like bronchoscopy. Sputum induction improves the diagnostic yield for AFB in patients unable to expectorate adequate sputum sample.

Comparison of Treatment Outcome in EGFR Positive and Negative Patients with Non Small Cell Lung Cancer: A Longitudinal Study

Introduction: Lung cancer is one of the most common malignancies to occur worldwide. Two main subtypes of lung cancer include small cell lung cancer and Non Small Cell Lung Cancer (NSCLC). Patients with advanced stage NSCLC who achieve good response with Tyrosine Kinase Inhibitors (TKI) have been found to have Epidermal Growth Factor Receptor (EGFR) mutation. The first biomarker identified for targeted treatment in lung cancer was EGFR and patients of NSCLC with EGFR mutation have superior survival outcome when treated with targeted therapy as compared to conventional chemotherapy. Aim: To compare the outcome of targeted therapy to mutation to EGFR and conventional therapy in non mutant lung cancer patient of NSCLC. Materials and Methods: The present longitudinal study was conducted in the Department of TB and Respiratory Diseases, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India from July 2017 to November 2019 on a sample size of 80. Patients diagnosed with NSCLC and EGFR mutation status were included in the study. They were started on TKI if tumour was EGFR positive and on conventional chemotherapy (cisplatin plus paclitaxel) if no mutation was detected on histopathology. Among the study group, 35 patients were EGFR positive and started on geftinib (group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). Outcomes were measured in terms of progression-free survival, Overall Survival (OS), and toxicities. Statistical analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Among the study group, 35 patients were EGFR positive and started on geftinib (Group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). The mean age of EGFR positive patients was 58.91 years and for EGFR negative patients was 60.11 years. In group I, there was no complete response while 28.5% had partial response, 45.5% had stable disease and 25.7% had progressive disease. In group II, 15.5% patients had complete response, 33.3% had partial response,17.7% had stable disease and 33.3% had progressive disease. Mean progression-free survival in group I (5.65 months) was significantly higher than group II (4.26 months). The mean OS in group I (7.85 months) was slightly higher than group II (6.72 months). Both haematological and non haemaotlogical toxicities were significantly higher in group II. Conclusion: Patients with EGFR positive expression subjected to Gefitinib had significant mean progression-free survival with an acceptable range of non haematological toxicities and no haematological toxicities, as compared to the EGFR negative patients on conventional chemotherapy.

Sleep quality in patients of chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory ailment with persistent airflow limitation associated with an enhanced chronic inflammatory response in airways and lungs to noxious particles or gases. This study aims to observe the sleep quality in these cases as it is known that most of them suffer from disturbed sleep. Aims and Objectives: The aims of this study were to assess the sleep quality in stable patients of COPD and compare with healthy controls. Material and Methods: This cross-sectional observational study was approved by ICMR and IEC and conducted in the department of Physiology and the Department of TB and Chest Medicine, Lady Hardinge Medical College, New Delhi. In this study, 33 clinically stable COPD patients and 33 normal subjects as controls were included in the study. Then, a detailed history including the demographic characteristics was recorded. Then, Pittsburg Sleep Quality Index (PSQI) Questionnaire (Hindi version was obtained from MAPI organization) was recorded by direct interview before lung functions were assessed by Spirometry. Results: In his study, COPD was found predominantly in male subjects compared to females. Poor sleep was found in majority of COPD cases. The median global PSQI scores were much higher in COPD cases compared to controls and the difference between them was statistically highly significant (P < 0.001). Conclusion: This study shows that the prevalence of poor sleep quality among COPD patients of urban Delhi is very high. Limitations are small sample size and hospital-based subjects and lack of polysomnography.

A study of adverse drug reactions in tuberculosis patients in a tertiary care hospital

Background: Tuberculosis is the most rambling communicable infectious disease on earth. It is the single most common cause of death in individuals aged 15-49 years. Adverse drug reactions to antitubercular drugs causing significant morbidity, mortality, incurring substantial additional costs because of added outpatient visits, tests, and hospitalizations. Study was carried out with objectives of assessing the rate and type of adverse drug reactions (ADRs) and detecting serious and preventable ADRs with collection of demographic details of patients taking antitubercular drugs and developing ADRS.Methods: A cross sectional, prospective, observational study conducted in department of chest and TB of a tertiary Health care and teaching hospital in both IPD and OPD patients for a period of 18 months. 480 patients monitored.Results: Among 480 patients 120 i.e., 25% developed ADR. frequency being significantly higher in males (58%) and adult age group (>18 years) amongst hospitalized comparing to outdoor patients the gastrointestinal tract [GIT] (39%) followed by, generalized body disorders (19%) hepatobiliary system (17%) were organ systems most affected Majority (56%) ADRs reported in 0-2 month of starting therapy (63%) of cases were in “probable according to Naranjo causality assessment (37%) being possible. 55% ADRs were moderate in severity followed by 36% mild and 9% severe. 30% of ADRs were definitely preventable followed by 20% of probably prevented according to schumock thronstone preventability scaleConclusions: Study highlights the importance of routine monitoring and robust pharmacovigilance system for success of national tuberculosis programmes in India as well as worldwide.

STUDY OF SOCIODEMOGRAPHIC AND CLINICAL PROFILE OF SMOKER AND NON-SMOKER COPD PATIENTS ATTENDING A TERTIARY CARE CENTRE IN NORTH INDIA

COPD is the third leading cause of death worldwide and the second leading cause of death in India. There are so many factors that contribute to the development of COPD and determine its progression and severity. This study was done to know the Sociodemographic and clinical proles of smoker and non-smoker COPD patients attending a tertiary care centre in North India. This was a hospital-based prospective andMaterial and Method: observational study conducted in the Department of TB and Respiratory Diseases, S.N. Medical College, Agra. Patients were recruited for the study based on GOLD criteria (Post Bronchodilator FEV1/FVC < 0.7). Patients were evaluated based on demographic characteristics and clinical features. Results: Among the total eligible patient's prevalence of smoker COPD patients was 62.96% and the prevalence of non-smoker patients was 37.04%. Among the eligible 108 cohort patients, 70 (64.81%) were males and 38 (35.18%) were females. Female patients were higher in the non-smoker group (75%). The higher number of patients enrolled were from a rural background (60.18%). Mean age of the population was 48.8 years with a majority of patients lying in the younger age group and were malnourished (BMI<18.5). Breathlessness was the most common symptom reported (49%) and smoker COPD patients were having severe dyspnoea (46.29%). 37.04% prevalence of non-smoker COPD was noted. Early detectionConclusion: with the help of spirometry will be helpful in not only modifying the disease course but also delaying and preventing fatal complications. Hence, patients may be treated earliest by various measures like lifestyle modication, smoking cessation, etc.

Evaluation of P40 and Napsin A in the Differential Diagnosis of Non Small Cell Bronchogenic Carcinoma on Small Lung Biopsies

BACKGROUND :- Lung cancer is the leading cause of cancer-related mortality over word wide, Although the pathological diagnosis of lung carcinoma is limited as only small specimen available for diagnosis.the availability of targeted therapies has created a need for precise subtyping of non-small cell lung carcinoma . Several recent studies have demonstrated that the use of Immunohistochemical markers can be helpful in differentiating lung squamous cell carcinoma (LSCC) from lung adenocarcinoma (LAC) not on surgically resected material but also on small biopsy samples and cytology.
 AIM (1) To classify the non small cell lung carcinoma into major categories like squamous cell carcinoma (LSCC) and adenocarcinoma (LAC) and other categories by applying immunohistochemicalmarker like p40 (truncated p63) and Napsin A
 (2) To analyse the sensitivity and specificity of p40 and Napsin A in light of histomorphology and/or other relevant immunohistochemical markers available, using appropriate statistical tests.
 Material and methods:- This study was a one and half year (18 months) prospective study from Jan 2017 to June 2018, conducted in department of pathology on patients attending the outpatient and inpatient department of TB and respiratory disease, a total of 210 bronchoscopic guided biopsies / transthoracic (CT/MRI /guided) small tissue biopsies from the patients suspected of lung malignancy were incorporated in the study. 20 corresponding resection specimens (wedge resection and lobectomy) were also included in the study for correlation of morphology and immunohistochemical findings on small biopsies.
 RESULTS:-In our study IHC for both p40 and napsin –A aided in subtyping of 71.9% cases of non small cell lung carcinoma and this diagnostic accuracy was found to be statistically significant with p-value < 0.05.,on statistical analysis we found that napsin-A had a sensitivity of 90% and specificity of 80%. Also, positive predictive value and negative predictive value were seen to be 88.0% and 81.8% respectively.
 

CLINICO-RADIOLOGICAL PATTERN OF PULMONARY TUBERCULOSIS AMONG ELDERLY AND YOUNG ADULTS IN A TERTIARY CARE CENTER.

Background: Clinical and radiographic manifestation of tuberculosis in elderly patients varies from young adults and not specic, often mistaken with other disease which may cause delay of therapy. For this we conducted study on clinical and radiographic manifestation of pulmonary tuberculosis in elderly patients. This study Methods: analyzed 100 pulmonary tuberculosis cases. We divided these patients in 2 groups i.e young adults (aged <60 years) and elderly(aged ≥60 years). This study was conducted in the Department of TB & Respiratory Diseases, RNT Medical College, Udaipur and analyzed by using Microsoft excel. We found that this study is Result: dominated by male patients. Chest pain, cough, dyspnoea, hemoptysis were found in-signicantly, while expectoration was found signicantly higher in young adults (p < 0.01). Fever was more in young whereas anorexia was more common in elderly group and in physical signs, icterus was found signicantly more in young adults as the p value is <0.05. Radiological bilateral involvement was found more in elderly group compared to adults (p = 0.67). Mixed and upper zone in adult patients consist majority patients. Elderly patients of PTB presented Conclusion: with recognized clinical and radiological features of disease.

Status of fungal and insects allergy in patients of rhinitis with or without asthma reporting from the desert area

Background: The most effective diagnostic test to detect IgE mediated type I allergic reactions like allergic rhinitis, atopic asthma, acute urticaria, food allergy, etc. is skin prick test (SPTs). SPTs are performed to check allergic sensitivity and functional for devising immunotherapy as the therapeutic modality. Methodology: Present study was performed in the Department of TB and Respiratory Diseases, S.P. Medical College, Bikaner (Rajasthan). A total of 118 patients suffering from allergic rhinitis with and without bronchial asthma were included in this study. SPT was performed to check reactivity against fungal and insect allergens in the desert areas. Results: Suggested that maximum cases (3/4th) were having both rhinitis and asthma. Around (3/4th) were belonging to rural area. Maximum cases (95%) were belonging to 15-45 years of age group. In fungal group max positivity was seen with Alternaria, Curvularia and Aspergillus fumigatus. In insects group cockroach reactivity was most common. Conclusions: Comparative analysis showed that maximum reactivity was seen with insect allergens than fungal allergens. Among which maximum reactivity was seen against cockroach male. There was significant relief in the severity of symptoms, medication intake with the help of allergen immunotherapy. Keywords: Allergic rhinitis; Asthma; Fungal allergy; Insect allergy; Immunotherapy.

A comparative assessment of daily dosage regimen versus intermittent treatment regimen of tuberculosis at the RNTCP centres in Chitradurga district

The treatment of pulmonary tuberculosis is quite challenging. The national tuberculosis programs are shifting the trend to adopt daily regimen than the intermittent regimen. Hence, this study was undertaken to study the effectiveness and adverse drug reactions of the daily and intermittent regimens.A retrospective study was conducted in the department of Chest and TB in Basaveshwara Medical College and Hospital, Chitradurga and District Tuberculosis Centre, Chitradurga, India. About 55 patients on daily regimen and 50 patients on intermittent regimen constituted the study sample. The details regarding the age, sex, initiation and termination of the treatment, outcome and adverse drug reactions were collected using a predesigned proforma.Majority of the patients in daily regimen were 56 – 65 years and intermittent regimen was aged between 26 – 35 years. More number of the cases in both the regimen were males. Vomiting was the main adverse drug reaction in patients on daily regimen and Abdominal pain in intermittent regimen. About 54.5% of the patients on daily regimen and 62% on intermittent regimen were cured. The death and defaulter rate was higher in patients on intermittent regimen.Even though the cure rate is good in intermittent regimen, the adverse reactions are quite high in this study.

Bedakvilino ir delamanido vartojimas vaistams atspariai tuberkuliozei gydyti. Kokių šalutinių poveikių galima tikėtis?

Tyrimo tikslas. Ištirti, ar naujųjų medikamentų nuo tuberkuliozės (TB) – bedakvilino (BDQ) ir delamanido (DLM) vartojimas klinikinėje praktikoje yra saugus. Tyrimo metodai. Atlikta retrospektyvioji 32 vaistams atsparia (VA) TB sergančių pacientų, gydytų BDQ ir (arba) DLM nuo 2016 m. antrojo pusmečio iki 2019 m. pirmojo ketvirčio pabaigos Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų filialo Romainių TB ligoninės Rezistentinės TB skyriuje, ligos istorijų analizė. Vertinti tiriamųjų duomenys bei naujųjų medikamentų nuo TB sukelti šalutiniai poveikiai. Rezultatai. Didžioji dalis tiriamųjų buvo santykinai jauno amžiaus (mediana – 50 metų) vyrai. 59,38 proc. pacientų buvo piktnaudžiaujantys alkoholiu. 56,3 proc. pacientų, gydytų naujaisiais vaistais nuo TB, sirgo ypač vaistams atsparia TB. Dažniausiai radiologiškai rastas abipusis plaučių pažeidimas (68,75 proc.). Pusei tiriamųjų pasireiškė bent vienas galimas šalutinis poveikis. Dažniausi galimi šalutiniai poveikiai: QTc intervalo prailgėjimas, išbėrimas, pykinimas arba vėmimas. Rečiau pasireiškė periferinė neuropatija, viduriavimas, širdies plakimo pojūtis. Dėl kliniškai reikšmingų pokyčių elektrokardiogramoje vienam pacientui nutrauktas gydymas DLM. Trimis (9,38 proc.) atvejais neabejota, jog šalutinį poveikį sukėlė BDQ arba DLM. Gydymo metu statistiškai reikšmingo ryšio tarp amžiaus, lyties bei alkoholio vartojimo ir galimų šalutinių poveikių pasireiškimo nenustatyta (p>0,05). Statistiškai reikšmingo QTc intervalo prailgėjimo ryšio su amžiumi bei lytimi taip pat nepavyko nustatyti (p>0,05), tačiau tai imtyje buvo būdinga tik vyrams. Išvados. Gydymas naujaisiais prieštuberkulioziniais vaistais yra pakankamai saugus. Siekiant nustatyti įvairių veiksnių įtaką šalutinių poveikių pasireiškimui, tikslinga atlikti tyrimą su didesne imtimi.

Effectiveness of Streetplay Based Learning over Regular Classroom Learning in Students of MBBS I ii in the Department of Tb and Chest

Effectiveness of Streetplay Based Learning over Regular Classroom Learning in Students of MBBS I ii in the Department of Tb and Chest

Diagnosis of pulmonary tuberculosis with cartridge based nucleic acid amplification test and light emitting diode fluorescent microscopy: a comparative study

Background: Due to low sensitivity and inability to detect drug resistance, smear microscopy limits its impact on TB control. Culture methods and drug susceptibility testing is complex, time consuming, and takes around 6-8 weeks. A new diagnostic test, cartridge based nucleic acid amplification test (CBNAAT) was developed based on real-time polymerase chain reaction (RT PCR). Objective of this study to compare the results of CBNAAT for diagnosis of pulmonary tuberculosis with LED fluorescent microscopy and sputum culture.Methods: A cross-sectional study was conducted in the department of Chest and TB, CIMS, Bilaspur. Each Sputum sample of presumptive TB patients were tested with CBNAAT, sputum smear microscopy by light emitting diode (LED) fluorescent microscopy (FM) and solid and liquid culture for diagnosis of Tuberculosis. Results of CBNAAT, Fluorescent Microscopy and Culture for detection of Mycobacterium Tuberculosis were compared.Results: The sensitivity and specificity for CBNAAT were 97% and 100% respectively; while that for Fluorescent microscopy were 70% and 100% respectively. The positive and negative predictive value for CBNAAT was 100% and 96% respectively. The positive and negative predictive value for Fluorescent microscopy was 100% and 73% respectively.Conclusion: CBNAAT is having high sensitivity and specificity for diagnosis of pulmonary tuberculosis. It should be routinely used under national health programme to detect a tuberculosis case efficiently.

An Evaluated Study on Tuberculosis Cases Attending Pulmonary Diseases Department in Tertiary Care Teaching Hospital

Background: The RNTCP (Revised National Tuberculosis Control Programmed) in India provide a strong framework for the outpatient management of tuberculosis yet very less literature is available on tuberculosis in hospitalized patients. Several factors including the clinical and socio- economic status contribute to the burden of hospitalization in tuberculosis. Methods: 150 total numbers of cases were included who had infection of tuberculosis. This study was conducted in the Department of TB & Respiratory Diseases, Shri Dev Suman Subharti Medical College, Dehradun.Results: ‘Among the all cases we found that, 40% having extra pulmonary, 37.3% pulmonary, disseminated 22.7% tuberculosis infection. Conclusion: This study concludes that extra pulmonary TB was most common followed by pulmonary TB.

A prospective observational pharmacovigilance study of adverse drug reaction monitoring in patients of tuberculosis receiving category I and II treatment regimens at tertiary care hospital

Background: First line Anti-TB therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol / streptomycin is very effective. However, major adverse reactions to antituberculous drugs can cause significant morbidity and mortality. One of the main reasons for non‑adherence to anti‑TB therapy (ATT) is ADRs, even under DOTS. Present study was carried out in tertiary care hospital. The objective of the study was to evaluate types and frequency of ADRs in intensive and continuation phase of category I and II Anti-TB medication.Methods: A prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the TB patients reporting at DOTS Center of institute were enrolled and monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire.Results: Total, n = 241 tuberculosis patients on DOTS therapy were enrolled for the study. Out of 241 patients, 17 were dropouts so 224 patients assessed for ADRs. 127 (56.69%) developed adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40 yrs followed by 21-30 yrs, ADRs were more common in men. Pulmonary TB (73.66%) cases were more common than extra pulmonary TB. Majority of adverse drug reactions were Gastrointestinal (GI) problems (30.92%), followed by Liver dysfunction and Hepatotoxicity (20.39%) and skin problems (17.10%). The causality of ADRs, in majority cases were found to be Probable (56.57%). Around 19 patients require treatment interruption and most of the patients were managed with supportive medication without removing anti tubercular drug from regimen.Conclusions: ADRs are major limiting factor for completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

Comparison of Z. N. staining & fluorescent microscopy in detection of M. Tuberculosis bacilli in Fine needle aspiration smears

Aims: To compare ZN stain method with Fluorescent method for detection of tuberculous bacilli in FNA smears in terms of sensitivity & feasibility. Settings and Design: A Prospective study was conducted in the department of Pathology at tertiary care center. FNAC done from lymph node lesion in clinically suspected cases of tuberculosis attending the Department of Medicine, Surgery, ENT, TB and Chest. Methods and Material: Fine-needle aspiration was performed in the Department of Pathology from January 2016 to February 2017. Out of 409 overall FNAC samples, there are 193 FNAC Lymph nodelesions, out of them 65 clinically suspected cases were processed for direct microscopy using conventional ZN staining and routine cytology and compared with the findings of the modified fluorescent method. Statistical analysis used: Simple statistical analysis done by using χ2 test. Results: Out of the 65 Tuberculous positive aspirates, the smear positivity for AFB on the ZN method was 43.07% (28/65) while the positivity increased to 87.69% (57/65) on the Auramine-Rhodamine fluorescent method. Conclusions: Fluorescent microscopy is rapid, simple, easy method with high detection rate for AFB as compared to ZN method.

A prospective observational pharmacovigilance study of adverse drug reaction monitoring in patients of MDR-TB at tertiary care hospital

Background: The emergence of drug resistant mycobacteria has become a significant public health problem world over creating an obstacle to effective TB control. ADRs are common in patients of MDR-TB on DOTs-Plus drug regimen. Present study was carried out in tertiary care hospital. Identification of types and frequency of adverse drug reactions in Intensive and continuation phase of MDR-TB Patients.Methods: It was a prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the MDR-TB patients admitted at the directly observed treatment, short course plus (DOTS plus) Center at Medical College Hospital were enrolled and were monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire, respectively.Results: A total of 121 tuberculosis patients of MDR-TB on DOTS therapy were enrolled for the study. Out of 121 patients, 13 were dropouts, 6 died, 7 defaulted so 108 patients assessed for ADRs, 48 patients developed 61 (56.48%) adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40yrs followed by 21-30yrs which were more common in men. Majority of adverse drug reactions were Gastrointestinal (GI) problems 32 (52.45%), followed by Ototoxicity 7 (11.48%) and Psychiatric Manifestations 6 (9.84%) and skin problems 3 (4.92%). On evaluation of the causality of ADRs, majority were found to be Possible (59.02%). The severity assessment showed that most of the patients ADRs were of moderate level (50.82%).Some patients required treatment withdrawal and replacement with other drug and most of the patients were managed with supportive medication without removing anti-tubercular drug from their treatment regimen.Conclusions: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

Evaluation of Left Ventricular Function, Contractility and Ejection Fraction in COPD Patients by Echocardiography

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. According to global initiative for chronic obstructive lung disease, COPD is defined as FEV1/FVC<70% by spirometry. COPD affects pulmonary blood vessels, right ventricle as well as left ventricle, leading to development of pulmonary hypertension, cor-pulmonale, right ventricular dysfunction as well as left ventricular dysfunction. The significance of the right ventricular performance is recognized as one of the factors determining the clinical course and prognosis in COPD, but a potential role of the left ventricle is, however, less studied. The aim of this study was primarily to evaluate left ventricular function in COPD patients by echocardiography and to study the correlation between echocardiography findings and the severity of COPD based on GOLD1 criteria. A total of 100 patients were selected for this study, including 72 male patients and 28 female patients, aged 50–70 years, from outpatient department of medicine department, medical wards, TB and chest ward of Dr Baba Sahib Ambedkar Hospital, Delhi, considering the exclusion and inclusion criteria. In mild COPD group, only one patient was found to have systolic dysfunction out of 52 patients (1.92%), in moderate COPD group, 2 patients had systolic dysfunction out of 32 patients (6.25%), whereas in severe COPD, six patients had systolic dysfunction out of 16 patients (37.5%). So, in total, 9% patients had systolic dysfunction. 28% of patients were found to have left ventricular diastolic dysfunction in our study. COPD patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. A clear correlation was found between value of fractional shortening (FS) of left ventricle (a measure of contractility), and severity of COPD and FS value significantly decreased as the severity of COPD increased. In this study, ejection fraction (EF) was found to be preserved in mild and moderate COPD, albeit mean EF was found to be reduced in moderate COPD. In severe COPD group, EF was significantly lowered.