Revised National Tuberculosis Control Programme Research Articles

Screening for Latent and Active Tuberculosis in Paediatric Contacts of Tuberculosis Patients: A Cross-sectional Study

Introduction: Globally, World Health Organisation (WHO) estimate suggests that, one million cases of Tuberculosis (TB) occur among children (approximate 10% of the total 9.6 million TB cases). As per Revised National Tuberculosis Control Programme (RNTCP), high importance and priority is given to the household contacts and paediatric age group (especially <6 years). Since, transmission can happen at any time from index case to the contact (before diagnosis or during treatment), all contacts of TB patients should be screened. Aim: To focus on the screening of paediatric contacts of TB positive patients by Mantoux test and to find out active and latent TB. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. The duration of the study was 16 months, from February 2020 to June 2021. Participants, who were proven cases, either sputum positive or clinically diagnosed and were less than 18 years of age were included. Contacts in whom Isoniazid Preventive Therapy (IPT) had been started were excluded. The candidates who tested Mantoux positive and had symptoms of TB were further screened by following test chest X-ray, Ultrasonography (USG) abdomen, Microscopy for Acid Fast Bacilli (AFB), Cartridge Based Nucliec Acid Amplification Test (CBNAAT), Cerebrospinal Fluid (CSF) analysis and contrast Magnetic Resonance Imaging (MRI). The data collected was analysed statistically with Statistical Package for Social Sciences (SPSS) version 26.0 and the level of significance was determined p-value <0.05 as insignificant, p-value >0.05 as significant and p-value <0.001 as highly significant. Results: A total of 82 contacts were included. Out of these, 60 children had no organ system involvement, whilst 11 had lymphadenopathy, five had respiratory involvement and six had abdominal involvement. Out of 82 contacts, 23 children tested Mantoux positive and 59 tested negative. Out of 23 Mantoux positive contacts 16 (19.51%) had latent TB and only 1 (2.44%) had active TB. Conclusion: A significant number of children in contact with TB positive patients were found to have latent TB, and it is possible that, there can be activation from latent to active TB later on in these children.

Impact of diabetes mellitus on treatment outcome of newly diagnosed smear-positive pulmonary tuberculosis patients: A case–Control study

Background: Tuberculosis (TB) and diabetes mellitus (DM) are major public health problems in developing countries such as India. The link of DM and TB is more prominent in these countries where TB is endemic, and the burden of DM is increasing. Studies regarding the effect of DM on smear conversion and treatment outcome of pulmonary TB (PTB) in India are limited. Aims: The study aimed to compare the conversion and treatment success among new smear-positive PTB patients with and without DM. Materials and Methods: A case–control study was conducted in the department of pulmonary medicine of a tertiary care hospital in eastern India between October 2019 and September 2020. All newly diagnosed smear-positive drug-sensitive PTB patients visiting the outdoor or being admitted were identified, and their initial smear status, history of diabetes, and glycemic status were recorded. All the patients were treated with category I regimen of the Revised National TB Control Program. Sputum smear was followed up at the end of intensive phase and at the end of treatment and compared between diabetic and nondiabetic patients. The software SPSS version 16 was used to analyze all the data. Results: Sixty newly diagnosed smear-positive PTB patients with DM and sixty smear-positive PTB without DM were included in this study. Smear conversion was seen in 24 (40%) out of 60 diabetic TB patients and 55 (91.7%) out of 60 nondiabetic TB patients. Treatment success was seen in 40 (66.7%) out of 60 diabetic TB patients and 56 (93.3%) out of the 60 nondiabetic TB patients. Conclusion: Smear conversion and treatment success rate are lower in diabetic TB patients as compared to nondiabetic TB patients.

A Study on Knowledge, Attitude and Practice of Allopathic Practitioners Regarding Revised National Tuberculosis Control Programme (RNTCP) of India at Lucknow City

A Study on Knowledge, Attitude and Practice of Allopathic Practitioners Regarding Revised National Tuberculosis Control Programme (RNTCP) of India at Lucknow City

Evaluation of Revised National Tuberculosis Control Program among Ten Designated Microscopy Centers of West Tripura: A Cross-Sectional Study

Objectives Pulmonary tuberculosis (TB) is chronic communicable bacterial disease caused by Mycobacterium tuberculosis. The objective was to assess the performance in terms of knowledge and practice of pulmonary tuberculosis (PTB) program among directly observed treatment short course (DOTS) provider, lab technician, senior treatment supervisor (STS), senior tuberculosis laboratory supervisor (STLS), factors affecting knowledge and practice of PTB program, rate of detection, cure rate and to identify the gaps and underlying contributing factors in terms of supply, manpower, and infrastructure. Materials and Methods A cross-sectional study was conducted on knowledge and practice of PTB program among DOTS Provider, lab technician, STS, STLS in ten designated tuberculosis center of West Tripura from May 2018 to April 2019. Simple random sampling method was followed for selecting DOTS provider and sample size of 50 was taken. Results Majority (40.0%) of patients were in the age group of 31 to 40 years and mean age of 40.98 ± 10.13 years. Females and males were 68.0 and 32.0%, respectively. Among DOTS provider, 66.0% had served for more than 5 years of service and 84.0% of them had verified address before starting the treatment. Conclusion Majority of the DOTS provider had satisfactory knowledge and practice about PTB program. Proportion of the medical officers attending DOTS training was inadequate and there were adequate number of the health care workers who had attended DOTS training. There were no gaps found in proportion of the cases receiving the supervised treatment.

Evaluation of ‘Referral for Treatment’ System under RNTCP in a Hospital at Kolkata, India

To handle the problem of tuberculosis (TB), Government of India started the Revised National TB Control Programme (RNTCP) in 1993, whereby Directly Observed Treatment, Short-course (DOTS) was officially adopted as the strategy in 1997. The medical colleges, involved in the RNTCP programme, refer the patients to the DOTS centres near their homes, after assigning the treatment categories. This study attempts to evaluate this ‘referral for treatment’ system during the second phase of RNTCP (RNTCP-II). To achieve this objective, pertinent data regarding 758 patients referred from RG Kar Medical College, Kolkata, to various DOTS centres in West Bengal, between 01.10.2006 and 30.09.2007, were collected from the said medical college, the relevant DOTS centres, the patients themselves, using a suitable questionnaire, and also the family members and the neighbours of some patients. Chi-square test at 5% level of significance was used as an analysis tool.

A study to critically analyze Revised National Tuberculosis Control Program norms implementation at a medical college-level facility

Background: Tuberculosis (TB) control activities are implemented in the country for more than 50 years. The countrywide lockdown in 2020 adversely impacted routine health-care services including those for the management of TB. Operational research is needed to know whether Revised National Tuberculosis Control Program (RNTCP) (National Tuberculosis Elimination Program) is heading in the right direction as far as the pace and quality of implementation of the program are concerned. Aims and Objectives: The aim of the present study was to investigate the strength, weaknesses, and opportunities of RNTCP. An analysis of RNTCP was done to identify competencies and gaps. Materials and Methods: The present retroprospective and observational study was carried out at the RNTCP facility of a Government Medical College in the Central India in Madhya Pradesh during the year 2019–20. Samples of 238 patients registered under RNTCP for anti-tubercular treatment were taken in the study. Data were collected using a structured schedule from the RNTCP center and tabulated in a Microsoft Excel sheet, to assess the compliance of RNTCP norms in the management of TB. Results: The most commonly affected age was 16–49 years and the male: female ratio was 3:2. The most common basis of diagnosis was microbiological (60.92%). Follow-up sputum testing was done on time in 64.71% of patients. Adherence to anti-tubercular treatment (ATT) was regular in 78.57% of patients. All patients were telephoned while 43.14% of patients were home visited as a default action. After default action, 35.29% of patients return to regular ATT. Out of all registered patients initiated on ATT, 81.09% were treatment success, while 7.14% lost to follow-up, 2.1% became defaulters, and 4.62% patients died. Conclusion: We conclude that treatment success of TB unit was near the RNTCP norm of 85% which is below the national 88%. The probable reasons for the higher default rate and loss to follow-up rate during the study period could be the ongoing COVID-19 pandemic.

Assessment of demographic characteristics of patients with tuberculosis and treatment profile of revised national tuberculosis control programme in Purba Bardhaman district of West Bengal

Background: Tuberculosis is a communicable disease caused by Mycobacterium tuberculosis bacteria spread by droplet infection. India is classified to be among those with a high TB burden, contributing 26% of the total TB cases, globally. The objective of this study is to access the clinical and demographic characteristics of patients with tuberculosis to determine the nature of disease, its co-morbidities, and treatment profile of the patients attending the revised National TB control programme clinics.Method: This study was carried out with data collection from the District Tuberculosis Office (DTO) section of Purba Bardhaman district, West Bengal. Data relevant to the study were collected for four consecutive years, from 2017 to 2020, and were analysed using suitable statistical software.Results: In the year 2017, 2018, 2019 and 2020, there were 6569, 5534, 5964 and 4012 reported cases of TB, respectively. Out of the total cases, 73.78% were male patients. It was observed that 97.24% patients were aged ≥15. Majority of the patients, 73.97%, had pulmonary TB. 1.92% cases had drug resistance tuberculosis (DRTB). The comorbid conditions associated with TB revealed that 7.58% TB patients had diabetes and only 0.48% cases had TB-HIV. The rate of successful treatment was 88.49%. The average rate of mortality was found to be 5.27% of reported cases.Conclusions: There was a significantly high proportion of male patients afflicted with TB in the region under study and the patients ≥15 years were mostly affected. The average rate of mortality was had increased in each year from 2017 to 2020.

Factors responsible for default among patients under the revised national tuberculosis control programme

Tuberculosis (TB) is an infectious disease caused by bacillus Mycobacterium tuberculosis. It infects the lungs and causes pulmonary tuberculosis. But it can affect any organ in the human body. Defaulting from treatment has been one of the major obstacles to treatment management and an important challenge for tuberculosis control programmes. Defaulting from therapy is the main reason for its prevalence in our society, leading to relapse and multi-drug resistance TB cases. This study has been done to determine the causes of default among patients undergoing treatment under the Revised National Tuberculosis Control Programme (RNTCP) and their rectification.

Treatment Practices in Pulmonary Tuberculosis by Private Sector Physicians of Meerut, Uttar Pradesh

Majority of the qualified medical practitioners in the country are in the private sector and more than half of patients with tuberculosis (TB) seek treatment from them. The present study was conducted with the objective of assessing the treatment modalities in pulmonary tuberculosis by the private physicians in Meerut City, Uttar Pradesh, India. A cross-sectional study was carried out covering all the private physicians (graduates and postgraduates in Medicine and Chest Diseases) registered under the Indian Medical Association, Meerut Branch (n = 154). The physicians were interviewed by a pre-designed and pre-tested questionnaire about the treatment modalities practiced by them. Only 43.5% private physicians had attended any Revised National Tuberculosis Control Programme (RNTCP) training in the past five years. Only 33.1% of them were aware of the International Standards of Tuberculosis Care (ISTC). Fifty-three different regimens were used to treat the patients. Majority of physicians (76%) prescribed daily regimens while 24% administered both daily and intermittent treatment. None of the private physicians prescribed exclusive intermittent regimen. Eighty-seven different treatment regimens were used for the treatment of multidrug-resistant TB (MDR-TB) with none of them prescribing standard treatment under RNTCP. As majority of private practitioners do not follow RNTCP guidelines for treating TB, there is an urgent need for their continued education in this area.

Tuberculosis Lymphadenitis in a Well Managed Case of Sarcoidosis

Differentiation between tuberculosis (TB) and sarcoidoisis is sometimes extremely difficult. Sequential occurrence of sarcoidosis and TB in the same patient is uncommon. We present the case of a young man, with a proven diagnosis of sarcoidosis who later developed TB after completion of treatment for sarcoidosis. A 32-year-old male patient presented with low-grade fever since two months. Physical examination revealed cervical lymphadenopathy. Initial fine needle aspiration cytology (FNAC) of the cervical lymph node was suggestive of granulomatous inflammation; the chest radiograph was normal. Repeat FNAC from the same lymph node was suggestive of reactive lymphoid hyperplasia. The patient was treated with antibiotics and followed-up. He again presented with persistence of fever and lymphadenopathy and blurring of vision. Ophthalmological examination revealed uveitis, possibly due to a granulomatous cause. His repeat Mantoux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. This time an excision biopsy of the lymph node was done which revealed discrete, non-caseating, reticulin rich granulomatous inflammation suggestive of sarcoidosis. The patient was treated with oral prednisolone and imporved symptomatically. Subsequently, nearly nine months after completion of corticosteroid treatment, he presented with low-grade, intermittent fever and a lymph node enlargement in the right parotid region. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. He was treated with Category I DOTS under the Revised National Tuberculosis Control Programme and improved significantly. The present case highlights the need for further research into the aetiology of TB and sarcoidosis.

Identifying predictors of treatment outcome in Tuberculosis

Background: Response to the treatment can be gauzed from the symptomatology, anthropometry, clinical parameters, and simple laboratory investigations in patients on anti-tuberculosis treatment as per Revised National Tuberculosis Control Programme (RNTCP) guidelines. Those who are not showing improvement in the parameters can then be selectively subjected to Cartridge Based Nucleic Acid Amplification Test and further intensive monitoring & follow-up. Materials and Methods:The project was undertaken in the one District of Maharashtra State from July 2017- to December 2018. The experts specifically identified parameters to be monitored in the field and specially trained Senior Treatment Supervisors workers (STS) followed up 100 newly diagnosed patients with Tuberculosis fortnightly during the Intensive Phase and monthly thereafter till completion of the 6-month treatment. Results: There was no significant difference in the patients according to age, sex, religion, education, occupation, and socio-economic status. The increase in weight, body mass index, chest circumference during inspiration and expiration, mid-arm circumference, and hemoglobin from the commencement of treatment to completion showed a significant positive correlation. A negative correlation was found with body temperature, pulse rate, respiratory rate, lymphocytic count, and Erythrocyte Sedimentation Rate. There was no correlation with the blood sugar level. Conclusion: This study has observed that objective parameters of gain in weight, reduction of fever, improvement in chest expansion, reduction in pulse and respiratory rate, respiratory rate are significantly associated with favorable outcome after a standard daily regimen under RNTCP. STS workers can easily monitor these parameters during their home visit.

To evaluate the clinical characteristics and microbiological findings in children with suspected pulmonary tuberculosis

Aim: The aim of the present study to evaluate the clinical Characteristics and Microbiological Findings in Children with Suspected Pulmonary Tuberculosis. Methods: After receiving clearance from the protocol review committee and the institutional ethics committee, the prospective observational study was carried out at the Department of......................... This research covered 100 patients. According to the Revised National Tuberculosis Control Program (RNTCP) guidelines published in the Technical and Operational Guidelines for Tuberculosis Control in India 2016, children aged 6 months to 18 years who present with constitutional symptoms such as persistent fever >2 weeks without a known cause and/or unremitting cough for >2 weeks and/or weight loss of 5% in three months or no weight gain in the previous three months along with any one of the following findings, i.e., his The radiology department performed a chest X-ray and reported findings indicative of tuberculosis, such as hilar and paratracheal lymphadenopathy, parenchymal lesions, and cavitatory lesions. Results: The study covered 100 juvenile patients with an average age of 12.044.96 years. In the research, 58 percent of the individuals were older than 11 years old. The study had a female predominance. Only 44 (44%) male patients participated in the trial, compared to 56 (56%) female patients. The most prevalent complaint was fever (84 percent), followed by cough (76 percent). Other major symptoms at the start of the disease were weight loss (88 percent), lack of appetite (86 percent), and shortness of breath (16 percent). Haemoptysis, chest discomfort, and shortness of breath were less common. Out of 100 participants, 22% tested positive for Mycobacterium tuberculosis, whereas the remaining 78 percent tested negative by both ZN staining and CBNAAT. The proportion of CBNAAT positive patients with cavitation on chest X-ray was 63 percent, which was substantially higher than the national average (p-0.0018). Conclusion: We determined that females were more likely than males to be infected with tuberculosis. The study also discovered that patients with clinical findings indicative of pulmonary Koch's do not necessarily have positive sputum CBNAAT. Sputum positivity was shown to be substantially related to a cavitatory lesion on a chest X-ray.

Rifampicin Induced Deep Vein Thrombosis: A Case Report

Rifampicin is an established and effective antibiotic and is the gold standard in the treatment of tuberculosis (TB). Its use is reserved for serious bacterial infections, such as active and latent leprosy. Tuberculosis is the most prevalent infectious disease worldwide as well as in India. Therefore, despite recent progress tuberculosis remains an important global public health problem. According to WHO, TB statistic 2020, the global incidence of TB was 15.6 million and in India, it was 5.6 million. In India, most of the antituberculosis regimens under the Revised National Tuberculosis Control Programme (RNTCP) are rifampicin-based. Deep Vein Thrombosis events are a rare side effect of rifampicin, which has been reported in a few parts of the world. Here we report a case of a male patient with pulmonary tuberculosis initiated on ATT drug regimen presented with deep vein thrombosis due to rifampicin.

A study on performance evaluation, roles and challenges faced by the DOTS providers in treatment adherence of TB patients in Tumkur city an untouched area

Non-governmental personnel such as Anganwadi workers, Asha workers and community volunteers have been used as directly observed treatment (DOT) providers in the revised National Tuberculosis Control Programme (RNTCP), challenges faced by them were not addressed, which is important to improve their performance.A cross-sectional study conducted using semi structured questioner which contains Socio-demographic characteristics of the DOTS provider and the questions to evaluate the performance of DOTS provider, his role in treatment adherence and also the challenges faced by him/her. DOTS providers are traced by information obtained from DTC. Data will be entered and analysed in SPPSS version 16.0About 99% of DOTS providers have received training regarding TB and DOTS. About 70% believed that the reason of failure was due to incomplete treatment and 15% believed that the failure was due to incomplete treatment and failure of preventive measures. 98% of them trace the patients when they don’t come to take DOTS. About 91.1% of them had no history of TB in their families and 7.9% of them had a history of TB in their family. About 53.5% of DOTS provider handled the drug reaction. About 38.6% of them were cured and declared sputum negative. About 94.1% of them had no defaulters and 4% of them had one defaulter under them. About 11.9% of them had one relapse. About 93.1% of them had no failures, 5% of them had one failure and 1% of them had 2 failures. About 95% of them used counseling as an aid to motivate patients. Educating and creating awareness regarding disease and its prevention plays a major role in reducing the burden if disease, addressing the barriers and difficulties of dots provider helps them to give better service and care to patients.

Determinants of treatment interruption and outcome among smear-positive pulmonary tuberculosis patients in a tuberculosis unit of Purba Bardhaman district of West Bengal.

Context:The adoption of directly observed treatment short course (DOTS) in Revised National Tuberculosis Control Programme has given impressive results with higher treatment success. But interruption of treatment has been one of the major obstacles to treatment of tuberculosis.Aims:The aim of the study was to evaluate the determinants of treatment interruption and outcome. It also evaluated the impact of treatment interruption on treatment outcomes.Settings and Design:The study was carried out in the area covered under Bhatar tuberculosis unit (TU) of Burdwan district of West Bengal. The study was a descriptive cross-sectional study.Methods and Material:Smear-positive pulmonary tuberculosis patients were taken as study subjects in both the components of study. Complete enumeration technique, rather than sampling, was followed in this study. Data were collected in a predesigned and pretested schedule.Statistical Analysis Used:Data were analyzed by percentages and proportion. Chi-square test was used to find the association between variables.Results:Gender, religion, and substance abuse were found to be statistically significant factors with interruption. It was also observed that treatment outcome was not statistically significant with age, gender, religion, and category of treatment. In the study, 84.6% of the study subjects with interruption less than 1 week had favorable outcome. But in study subjects with longer duration of interruption (≥2 weeks), only 12.5% had favorable outcome. Not only interruption, duration of interruption was found to be adversely affecting the treatment outcome.Conclusions:Interruption had an impact on the treatment outcome in the present study. Unfavorable outcomes were significantly more frequent among patients with interruption as compared to those without any interruption.

Clinical Epidemiology of Multidrug Resistant Tuberculosis in a Nodal Drug Resistant- TB Centre in Southern Odisha: A Cross-sectional Study

Introduction: Multidrug-Resistant Tuberculosis (MDR-TB) is a significant public health problem. The number of MDR-TB cases is very high in India and the management is inadequate due to resource constraints. The assessment of MDR-TB burden has to be reliable for programmatic management of MDR-TB under the Revised National Tuberculosis Control Program (RNTCP) of India. Aim: To find the clinico-demographic profile and pattern of MDR-TB among the tuberculosis patients reporting to a nodal tuberculosis centre in Southern Odisha, India. Materials and Methods: The patient record based cross-sectional study was carried out on a convenience sample of 125 sputum positive MDR-TB cases admitted to the Directly Observed Treatment Short-course (DOTS) plus centre of the Nodal Tuberculosis Centre at Berhampur, Odisha, India, during the period from April 2017 to March 2018. A predesigned case record form was used to collect data on the socio-demographic profile, addictions, co-morbidity, Human Immunodeficiency Virus (HIV) status, Bacille Calmette-Guerin (BCG) immunisation status, pattern of drug resistance, history of anti-TB treatment, presenting symptoms at admission, adverse drug reactions observed during the treatment for MDR-TB. The data was analysed using GraphPad Prism trial version 7.0. Descriptive statistics were used to present the final data. Results: Highest number of study participants (95, 76%) were within 18-45 years age group and 90 (72%) of the patients were males. Rural habitation (90, 72%), engagement in labour works (65, 52%), low socio-economic status (75, 60%) were the common socio-economic characteristics. Resistance to rifampicin was the commonest variety 101 (80.8%) and 80 (64%) were newly diagnosed cases of tuberculosis. The commonest presenting symptom was cough in 97 (77.6%) patients and gastrointestinal upset was the commonest adverse drug reaction encountered during therapy. Conclusion: The MDR-TB affects the population in their most productive age. Rifampicin resistant TB was the predominant variety observed in the study population. The MDR-TB can be successfully treated with maximally effective and complete drug regimes.

Effect of video-Assisted Teaching Module (VATM) on knowledge of ASHAs regarding RNTCP in Kuchinda Block of Sambalpur (Odisha)

Infectious disease is a major public health issue for both developed and developing countries. Among infectious diseases, tuberculosis (TB) is most prevalent in the develop- ing countries. India is the highest TB burden country in the world and accounts for nearly one fifth (20%) of global burden of tuberculosis. A pre-experimental design where pre- and post-test without control group with experimental approach was undertaken in Kuchinda block of Sambalpur district (Odisha) with the objectives to assess effectiveness of Video-assisted Teaching Module (VATM) on knowledge of Accredited Social Health Activists (ASHAs) regarding Revised National Tuberculosis Control Programme (RNTCP) Data were collected from 52 ASHAs, selected by systematic random sampling technique through structured questionnaire. The overall mean score in pre-test was 23.31±3.07 which is 58.27 percent of maximum score and good knowledge whereas it was 34.35±3.56 while post-test it was 85.87 percent of maximum score during post-test showing a difference of 27.6 percent effectiveness. Highly significant (p<0.01) differ- ence was found between pre- and post-test knowledge score and no significant (>0.05) association was found between post-test knowledge score when compared to all the demographic variables of ASHAs.

Ethambutol-induced optic neuritis in a case of pulmonary tuberculosis

Ethambutol hydrochloride (EMB) is one of the integral first-line antitubercular agents used in both intensive and continuation phase as per Revised National Tuberculosis Control Programme guidelines. Although usually well tolerated, reports of ocular toxicity secondary to ethambutol have not been rare. The toxicity is dose and duration dependent, and is reported to be usually reversible if detected early, followed by drug stoppage. The present case discusses ethambutol-induced optic neuritis in a male patient diagnosed with pulmonary tuberculosis.

Diagnostic and treatment delay among new pulmonary tuberculosis patients in Southern India: A cross-sectional study.

Delay in diagnosis and treatment enhances tuberculosis (TB) transmission and mortality. Understanding causes for delay can help in TB elimination by 2025, the stated goal of India. Estimate diagnostic and treatment delay in Ernakulam district of Kerala, identify associated factors, and determine health-seeking behavior and knowledge regarding TB among new pulmonary TB patients. Community-based cross-sectional study among the new pulmonary TB patients registered under Revised National TB Control Program. Patients interviewed in-person and data collected using pretested semi-structured questionnaire. Descriptive statistics expressed as frequency, percent, interquartile range, median, and mean. The Chi-square test was used to assess statistical significance (P < 0.05) of association. Backward conditional method logistic regression done using variables with P < 0.2 in univariate analysis and adjusting for possible confounders. Two hundred and twenty-nine patients interviewed and the median patient, health-care system, and treatment delay were 25 days, 22 days, and 1 day, respectively. While the patient delay (>30 days) and treatment delay (>2 days) were seen in 47.6% and 41% of patients, respectively, health-care system delay was seen in 79.9% of the patients. Choosing pharmacy for initial treatment (adjusted odds ratio [aOR] = 5.217), unskilled occupation (aOR = 3.717), female gender (aOR = 3.467), previously not heard about TB (aOR = 3.410), and lower education level (aOR = 2.774) were the independent predictors of the patient delay. Visiting two or more doctors (aOR = 5.855) and initially visiting a doctor of undergraduate qualification (aOR = 3.650) were the independent predictors of health-care system delay. The diagnosis in private sector (aOR = 8.989), not being admitted (aOR = 3.441), and age above 60 years (aOR = 0.394) was the independent predictors of treatment delay. Initial treatment from pharmacy, consulting multiple physicians, and diagnosis by private sector cause significant delay in diagnosis and treatment of pulmonary TB.

Role of Corticosteroids in Tubercular Pleural Effusion: A Prospective Interventional Study from a Tertiary Care Teaching Hospital, Telangana, India

Introduction: Tuberculosis is a major public health problem in majority of the developing countries. Pleural effusion develops when fluid accumulates between the parietal and visceral pleura. Aim: To evaluate the efficiency of corticosteroids in rapid clinical and radiological resolution of TPE. Also to study the recurrence of pleural effusion and find incidence of pleural fibrosis in patients treated with corticosteroids. Materials and Methods: This prospective interventional study was conducted at Government Chest Diseases and TB hospital (tertiary care teaching hospital), Telangana, India, from October 2014 to October 2016. Total 80 patients with TPE were divided into two groups. Steroid group (n=40), patients received standard Antitubercular Treatment (ATT) that was alternate day regimen along with prednisolone 0.75 mg/kg body weight per day for 2 weeks there after tapering of the dose done every 2nd weekly in next 4 weeks. Non steroid group (n=40), patients received standard ATT alone that was alternate day regimen under Directly Observed Treatment Short course (DOTS) therapy based on Revised National TB Control Programme (RNTCP) guidelines respectively. All patients were followed in the Outpatient Department at the end of second, fourth, sixth, 24th week. At every follow-up visit, history obtained from patients regarding symptoms and chest radiographs for comparison of reabsorption of pleural fluid between two groups. At the end of treatment ultrasound of the chest was performed to confirm the presence of pleural thickening seen on chest radiograph. Descriptive measures obtained included as mean and standard deviation. The association between two categorical variables done by using Chi-square test. The p-values&lt;0.05 was considered as statistically significant. Results: There was early initiation of symptomatic relief in patients treated with steroid group as compared to non steroid group (p-value &lt;0.001). Average duration for symptomatic relief in steroid group was 3.42 days (range 1-7 days) and in non steroid group 8.3 days (range 1-42 days). There was significant difference between two groups in duration taken for symptomatic relief (p-value &lt;0.001). Conclusion: Results of the present study suggest that corticosteroids still play some role in the treatment of TPE. Addition of the corticosteroids to the standard ATT exerts more rapid relief of clinical symptoms. The rapidity in pleural fluid absorption is not influenced significantly by adding corticosteroids to the ATT. There was no recurrence of pleural effusion after addition of corticosteroids to ATT. The incidence of pleural thickening was not influenced by steroids.