Sputum Positive Pulmonary Tuberculosis Patients Research Articles

A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity

Background Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

Prevalence of Diabetes Mellitus Among Newly Detected Sputum Positive Pulmonary Tuberculosis Patients and Associated Risk Factors

Background and Objectives: Tuberculosis (TB) and Diabetes Mellitus (DM) co-morbidity are of rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum-positive pulmonary TB patients registered in the District Tuberculosis Centre and also to assess the risk factors of DM among TB patients. Methods: In a cross-sectional study newly detected sputum-positive pulmonary TB patients were screened for DM (those having symptoms of DM). Further, they were diagnosed by doing random blood glucose levels (≥200 mg/dl.). Mean, standard deviation (SD), Chi-square and Freeman-Halton Fisher exact test were used to know the significant association. p value less than 0.05 was considered statistically significant. Results: A total of 215 TB patients were included in the study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years), educational status, smoking habits, alcohol consumption, physical activity, presence of symptoms of DM and family H/o DM. Interpretation and Conclusion:Routine screening for DM is mandatory because of the increasing prevalence which may help in early diagnosis and also reduce the complication by proper management which in turn helps in the successful outcome of TB treatment.

WITHDRAWN: Prevalence of Diabetes Mellitus among Newly Detected Sputum Positive Pulmonary Tuberculosis Patients and Associated Risk Factors: A Cross-sectional Study

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Study of factors leading to treatment delay in new sputum positive pulmonary tuberculosis patients and its impact on sputum conversion.

Our study was done to identify patient or health system related delay in diagnosis of treatment naïve sputum positive PTB patients and its impact on sputum conversion at 2 months. A total of 280 patients were enrolled and followed up for 2 months following which repeat sputum examination was done. Detailed clinical history was taken with emphasis on duration of symptoms, day of presentation, diagnosis and starting of therapy. The median(range) of delay in treatment initiation was 15 (0-82) days, most commonly because of delay due to the health system. Patients with positive sputum at the end of two months had significantly higher delay in treatment initiation (p < 0.05). Being remote (>5 km) from a health provider, being an unskilled labourer, and visiting a private practitioner were associated with delay in diagnosis. Eradication of tuberculosis in India requires training of health professionals, intersectoral cooperation and better public outreach.

A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity

Background: Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods: In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results: A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (&gt;46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions: Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity.

Background: Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods: In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results: A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions: Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

Childhood Tuberculosis and Isoniazid Preventive Therapy Among Household Contacts of Sputum Positive Pulmonary Tuberculosis Patients: A Descriptive Observational Study.

BackgroundThe prevalence of tuberculosis (TB) disease among household contacts of adult TB patients is very high. Contact screening and isoniazid preventive therapy (IPT) are recommended for household contacts, but their uptake by families and implementation by the national TB program are poor. This study was performed to estimate the yield of tuberculosis disease, risk factors associated with disease development, and coverage of IPT in household contacts of sputum-positive pulmonary tuberculosis patients in the Aurangabad district of Maharashtra.MethodsA cross-sectional study was conducted at MGM Medical College Hospital Aurangabad. Sputum-positive adult TB patients were enrolled in the study. Their household contacts were screened for TB disease, and the status of IPT in eligible contacts was studied. Serial screening and follow-up of these contacts were performed for one year.ResultsA total of 82 contacts of 55 index cases were studied. At the one-year follow-up, 15 (18%) patients developed TB disease. Twelve had pulmonary TB, and three had extrapulmonary TB. The mean age of diseased contacts was 5.5 years. The disease was more common in contacts under six years of age. Sixty-four percent of eligible contacts received IPT. There was a statistically significant association between disease development and noncompliance with IPT (p-value 0.005913).ConclusionsThe yield of tuberculosis disease is high in children contacts with sputum-positive pulmonary TB cases. IPT implementation is inadequate in child contact.

Prevalence of diabetes mellitus among newly detected sputum positive pulmonary tuberculosis patients and associated risk factors: A cross-sectional study

Background: Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods: In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results: A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (&gt;46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions: Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

Comparison of CD4 and CD8 Counts in HIV negative Pulmonary Tuberculosis Patients with Normal Healthy Controls in and around Prayagraj

Anti-tuberculosis immunity involves a cellular immune response for their control. A critical marker of immunologic integrity is the CD4 and CD8 cell counts. Tuberculosis may be a cause of non-HIV associated CD4 and CD8-T cell lymphopenia. This study compares mean CD4, CD8 cell count and CD4:CD8 Ratio in pulmonary tuberculosis patients never had treatment for tuberculosis, pulmonary tuberculosis patients had received anti-tuberculosis treatment for more than one month and normal healthy controls. A case control study done in Prayagraj from October 2019 to October 2020 includes HIV negative, sputum positive pulmonary tuberculosis patients never had treatment for tuberculosis(n=25), pulmonary tuberculosis patients had received anti-tuberculosis treatment for more than one month(n=24), and normal healthy controls(n=36). We collected details including age, sex, symptoms of pulmonary tuberculosis, anti-tuberculosis treatment and investigated for HIV testing by ELISA, Sputum for AFB, Sputum for CBNAAT, CD4 and CD8 cell count determined by flow cytometrically. The mean CD4 and CD8 cell count was significantly lower in HIV negative pulmonary tuberculosis patients never had treatment for tuberculosis than in normal healthy controls (p value&lt;0.001) and CD4:CD8 ratio also lower (p value=0.013). The mean CD4 and CD8 cell count higher in pulmonary tuberculosis patients who have received anti-tuberculosis treatment for more than one month than in pulmonary tuberculosis patients never had treatment for tuberculosis (p value&lt;0.001) and CD4:CD8 ratio also higher (p value=0.013). CD4 and CD8 lymphopenia is an acceptable phenomenon in HIV negative pulmonary tuberculosis patients and such lymphopenia improves with anti-tuberculosis drug regimens as per protocol. This study highlights the importance of CD4, CD8 cellular immune response conducted by T- lymphocytes in outcome of pulmonary tuberculosis.

Pattern of chest radiographic abnormalities and co-morbidities in newly detected sputum positive pulmonary tuberculosis cases

Background: Tuberculosis (TB) is an airborne communicable disease which one of the leading causes of morbidity and deaths worldwide (ranking above AIDS).1 Probability of detecting AFB on sputum is greatly associated by the radiological findings.8 Because of the apparent widespread difficulty in recognizing the radiographic manifestations of pulmonary tuberculosis, it will be beneficial to review the spectrum of chest x-ray abnormalities in sputum positive tuberculosis patients. Aim: To study clinical features, radiological features and comorbidities among newly detected sputum positive pulmonary tuberculosis patients. Settings and design: The hospital based cross-sectional study was conducted from the year 2016-2018 at a tertiary care teaching hospital in Mangalore. Methodology: Newly diagnosed smear positive pulmonary tuberculosis aged between 18-70 years attending OPD/IPD of Department of Respiratory Medicine, who fulfilled study eligibility criteria were included. Comprehensive clinical assessment was conducted and information regarding socio-demographic profile, comorbidities were noted. Chest x-ray PA view was performed for all patients. Statistical A nalysis: Data was analyzed in SPSS V:20. Data is presented in frequency, percentages. Chisquare, was applied to test significance of association. Results: A total of 563 (309 elderly and 254 adult) patients participated in study. Male predominance was noted (64.7%). Cough (94.1%) and expectoration (83.8%) were the most common symptoms. High bacillary load (3+) and bilateral lungs involvement were predominant among elderly patients (75.6%). Cavitary lesions were predominant among adults. Infiltration (39.6%), cavitary lesions (37.7%) and consolidation (37.5%) were most common lesions seen in chest x-ray. Cavitary lesions were found in higher percentage among patients with higher bacterial load of 2+and 3+ (36.8% and 33.0% respectively). Bilateral lesions were associated with TB patients with diabetes

Adverse drug reactions among new sputum positive pulmonary tuberculosis patients on daily treatment regimen: a prospective study from Haryana, India

Background: Daily regimen anti-tuberculosis treatment was adopted by Revised National Tuberculosis Control Programme (RNTCP) as a step to achieve tuberculosis elimination by 2025 in India. The change was implemented prior to completion of pilot study, which necessitated this study to note the self-reported Adverse Drug Reactions (ADRs).Methods: A prospective study with concurrent sampling design was carried on from June 2018 to June 2020 in the state of Haryana, India. Pre-tested semi-structured schedule was used to collect data based on RNTCP outcome definitions through two monthly (four visits) home visits. Mean±standard deviation, percentage, proportion and chi-square test was used. The p-value of &lt;0.05 was considered as statistically significant.Results: Amongst 122 study participants 74 (60.7%) were males and 48 (39.3%) were females with mean age of 39.4±18.9 years. Majority were urban residents 87 (71.3%) and 35 (28.7%) rural residents. There were 25 (20.5%) tobacco smokers, nine (7.4%) alcohol consumers, and three (2.5%) smokeless tobacco users. Forty-five participants had ADRs and 54 ADR events had occurred, but none required change in treatment regimen. Sixteen (13.1%) reported loss of appetite followed by 10 (8.2%), flu-like symptoms, eight (6.6%) nausea, seven (5.7%) pain in joints, three (2.5%) abdomen pain, three (2.5%) headache, two (1.6%) itching and rash, one (0.8%) burning in hands and feet and one (0.8%) giddiness. Daily regimen ADR cases (36.9%) and events (44.3%) when comparatively higher than intermittent regimen (25.6%).Conclusions: The ADRs cases and events had occurred in higher proportion but were mild and hence did not require any regimen change.

Association of Vitamin D Deficiency and Newly Diagnosed Pulmonary Tuberculosis.

Introduction Vitamin D has a significant role in host immune defense against Mycobacterium tuberculosis. It has been suggested that pulmonary tuberculosis may be associated with lower levels of vitamin D. Present study was therefore undertaken to identify the association between vitamin D deficiency and pulmonary tuberculosis. Methods A case-control study was conducted in a tertiary care hospital from 2014 to 2016, including 50 adult newly diagnosed sputum positive pulmonary tuberculosis patients as cases and 50 age and sex-matched healthy participants as control groups. All participants in the study group had undergone detailed clinical examination and routine laboratory investigations, including vitamin D, calcium, and sputum for AFB. The clinical characteristics, X-ray findings, sputum AFB, and vitamin D levels were analyzed and compared with data obtained from healthy controls. Results In both groups, the majority were men (88%). BMI was significantly (<0.0001∗) lower in the tuberculosis group (19.40 (17.20, 22.0) vs. 24.00 (22.50, 25.47)). Serum vitamin D levels were significantly lower (P = 0.012) in the tuberculosis group (19 (7.75, 27.25) ng/dl) as compared to the control group (25 (19.75, 32.00) ng/dl). Out of 50 TB patients, 27 (54%) had vitamin D deficiency, while among healthy controls, only 13 (26%) had vitamin D deficiency. Among vitamin D deficient PTB patients, 44% had 3+/hpf AFB in sputum smear examination. Conclusion The prevalence of vitamin D deficiency in pulmonary tuberculosis cases is very high. Hypovitaminosis D was associated with more severe clinical symptoms, higher sputum smear positivity, and extensive lesions in chest radiograph among pulmonary tuberculosis patients.

Clinico-haematological Profile in Acid Fast Bacilli Positive Pulmonary Tuberculosis Patients at Tertiary Care Centre in Raichur, Karnataka

Introduction: Tuberculosis (TB) is a major public health problem in India and it remains an epidemic, affecting one third of the population. It manifests with diversified haematological manifestations of varying severity like anaemia, leukocytosis, thrombocytosis and raised erythrocyte sedimentation rate levels. Therefore, monitoring clinical and haematological alterations in sputum positive Pulmonary Tuberculosis (PTB) patients necessitates the need for deliberation of supportive care and varied treatment options that would amplify the treatment outcome. This study was carried out to explore the early changes and the relationship between the social risk factors like smoking, alcohol intake and the haematological profile of TB patients which will help in early identification of altered haematological parameters and in minimising the risk of transmission among susceptible population. Aim: To do analysis of various haematological manifestations in sputum positive PTB patients and to evaluate diagnostic and prognostic significance. Materials and Methods: A prospective study was conducted over a period of six months between November 2019 to April 2020 on 50 PTB patients referred by Department of Respiratory Medicine, Navodaya Medical College, Raichur. Patients who were on Anti-Tubercular Treatment (ATT), extra-PTB patients, pregnant women and those with any other major co-morbid condition were excluded from the study. All patients were thoroughly examined clinically and investigated with plain chest x-ray, complete blood count; ESR, PS examination and sputum for acid-fast bacilli stained with Ziehl-Neelsen (Z-N) stain and AFB grading charts were used according to Revised National Tuberculosis Control Programme (RNTCP). Data collected was analysed by SPSS software version 16.0 and Chi-square test was used to calculate the sample size. Results: Of total 50 cases of PTB, there were 30 males and 20 females and mean age of patient was 44 years. Commonest haematological parameters raised were ESR (48 cases; 96%) followed by anaemia (45 cases; 90%), neutrophilia (36 cases; 72%), leukocytosis (24 cases; 48%) and thrombocytosis (12 cases; 24%). The frequent peripheral smear picture was Microcytic Hypochromic Anaemia (MHA) (27 cases; 54%) followed by normocytic normochromic anaemia (21 cases; 42%) and least common was macrocytic anaemia (2 cases; 4%). There was significant improvement in all haematological parameters after three months of treatment, with sputum conversion of PTB cases (75%). Conclusion: TB can lead to heterogenous and diversified haematological abnormalities like anaemia, leukocytosis, neutrophilia, thrombocytosis and raised ESR. These haematological parameters can be a guide to assess the improvement of TB patients after ATT which indirectly speaks about the improvement in immune response.

Comparative study of serum copper, zinc, Cu/Zn ratio in pulmonary tuberculosis patients with normal subjects

Introduction: Tuberculosis (TB) is an important global health problem. It has more impact on developing and underdeveloped countries. The impact of tuberculosis can be seen by the fact that in 1993, the world Health Organization (WHO) declared tuberculosis a Global Emergency. WHO estimated that tuberculosis infects about one-third of world’s population. Every year, 8 million people contract tuberculosis, of which 95% are in the developing world.1 Aims and Objectives: To estimate and compare serum Copper, Zinc levels, and Cu/Zn ratio in newly detected pulmonary tuberculosis patients with healthy volunteers. To estimate Total Protein and Albumin levels to rule out hypoproteinemia. Materials and Methods: The study included 40 newly detected sputum positive pulmonary tuberculosis patients and 40 healthy volunteers. Serum copper and zinc was estimated by colorimetric method using RA-50 semi autoanalyser. Total protein was estimated by biuret method and Albumin, by bromocresol green method using automated analyser. Results and Conclusions: There was a significant increase in serum copper levels in pulmonary tuberculosis patients when compared to control group (P) Keywords: Pulmonary Tuberculosis, Copper, Zinc, Cu/Zn Ratio, Total Protein, Albumin

Pharmacokinetics interaction of calcium on the treatment of sputum positive pulmonary tuberculosis patients

Tuberculosis (TB) in children is a neglected aspect of the TB epidemic despite it constituting 20% or more of all TB cases in many countries with high TB incidence. Tuberculosis constitutes a serious global health problem with nearly 10 million new cases of tuberculosis (2011) and 1.4 million deaths every year. In pharmacokinetic studies, co-administration of various inhibitors of this enzyme (e.g., erythromycin, antifungal substances, protease inhibitors, and grapefruit juice) raised plasma phosphate concentrations by up to 500%. Materials and Methods: The study was conducted in Chennai tuberculosis hospital from January 2012 through July 2015 in seven target groups, with consecutive recruitment. The first group consisted of otherwise deselected patients who are presented with suspected tuberculosis to the tuberculosis hospital in Chennai. Blood samples were collected from the subjects of tuberculosis Hospital at Chennai. To non-treatment and treatment variations, fasting blood samples were collected from 8 AM - 9 AM. Experiments were carried out as soon as possible. Whenever there was a delay in experiments, samples were stored at -10° to -15°C for a maximum of 1 day. Blood samples thus collected using standard sampling techniques were centrifuged to get the serum that was analysed phosphorus levels by Phosphomolybdate method. The study protocol was approved by the Institutional ethics committee and was carried out in accordance with the principle of the declaration of Helsinki. Results: In the study, mean serum phosphorus level in newly diagnosed patients was 13 ± 3.30 mg/dl, after first month treatment to sixth month treatment the level was 13 ± 3.60mg/dl, 11 ± 3.30 mg/dl, 10.50 ± 3.30 mg/dl, 11 ± 3.30 mg/dl, 11.20 ± 2.80 mg/dl and 10.20 ± 2.80 mg/dl respectively. Six-month treatment 20 patients were get the hyperphosphatemia for include female 9 patients. One study suggests that Estrogen may act directly to suppress sodium-dependent phosphate absorption in the renal proximal tubules inducing phosphaturia and decreased serum phosphate; women who are post-menopausal and Estrogen deficient would be at increased risk for hyperphosphatemia Low serum phosphate levels are associated with reduced cardiac output and also with risk for arrhythmia. Conclusion: Our findings offer the possibility that early intervention will help achieve calcium and phosphorus conversion and ultimately a successful treatment outcome. In order for us to update guidelines and optimize patient care, some gaps in the evidence base need to be addressed. Although available data demonstrate the association between hyperphosphatemia and increased risk of mortality, it remains a challenge in the clinic to achieve and maintain recommended serum phosphorus concentrations. Keywords: Hyperphosphatemia, Phosphomolybdate Method, Pulmonary Tuberculosis

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

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 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 &amp;lt;0.05 was considered as statistically significant and p value &amp;lt;0.001 was considered as statistically extremely significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

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.

Health care seeking behaviour of pulmonary tuberculosis patients in Jabalpur district, Madhya Pradesh

Background: Successful tuberculosis control requires specific behaviors from patients and health providers. Therefore, understanding behaviors is fundamental to design interventions to strengthen tuberculosis control programs, including communication interventions. The aim of this study was to assess the healthcare-seeking behavior of pulmonary tuberculosis (PTB) patients in Jabalpur district.Methods: Cross-sectional study was conducted among category I new sputum positive PTB patients identified from nine designated microscopy centres from November 2013 to October 2014. Calculated sample size of 135 with a multistage random sampling method was used. Student’s t-test and Chi-square test were used along with descriptive statistics.Results: Mean age of patients was 33.87 (14.3) years, males constituted 66.7%, 72.5% patients belonged to below class IV socioeconomic status. Cough was experienced by 91.1% subjects, followed by fever (69.6%). First action was consulting a health care provider (HCP) in 41.5% followed by self-medication (21.5%). It took two attempts for 76% of patients to reach a formal health care provider. Private health care providers were consulted as first choice among HCPs by 86.7% patients, initial diagnosis was made by them in 25.9% cases. Sixty-three percent of patients were not satisfied with care at government hospitals, 41.5% had not heard of tuberculosis before their diagnosis, 59.5% of patients got information about tuberculosis from their relatives suffering from it.Conclusions: Cough is the most common and earliest symptom responsible for seeking care in pulmonary tuberculosis. Government health facilities contribute maximum to diagnosis but private health facility is the first choice for initial consultation. Patients’ perception of suggestive symptoms needs to be changed.

Seroprevalence of Toxoplasma gondii IgG and IgM Antibodies and Associated Risks Factors in Tuberculosis Patients Admitted at the Bamenda Regional Hospital, NW Cameroon

Background: Toxoplasmosis is a zoonotic disease with a worldwide distribution amongst warm-blooded animals and can affect anyone in contact with the parasitic oocysts or tissue cysts. Tuberculosis (TB) and T. gondii coinfection is a serious public health problem to the health of these patients in developing countries. We determined the seroprevalence of Toxoplasma gondii IgG and IgM antibodies and associated risk factors among newly diagnosed sputum positive pulmonary TB patients. Materials and methods: This was a cross sectional study including 158 TB patients. Laboratory analyses were based on quantification of anti T.gondii IgM and IgG antibodies test using sandwich ELISA. A questionnaire captured known risk factors for toxoplasmosis among participants. Risk factors for toxoplasmosis were analyzed in a binary logistic model. The results presented as odds ratios were used to assess association of toxoplasmosis and potential risk factors. A p-value < 0.05 was considered statistically significant. Result: Of the 158 participants, 87.97% [139/158] were seropositive for Toxoplasma gondii IgM and IgG antibodies. Eating cat meat [P=0.009, OR=4.2498, 95%CI=1.4300-11.1997] and water source [P=0.026, OR=5.4983, CI=1.2189-23.5827], were significant risk factors associated with T. gondii infection. We noted a threefold increase in the risk of toxoplasmosis among TB patients having farming as occupation. Conclusion: The prevalence of toxoplasmosis IgM and IgG antibodies among sputum positive pulmonary TB patients in the Bamenda Regional Hospital, North West Cameroon was found to be 87.97%. The principal risk factor associated with Toxoplasma gondii among TB patients was consumption of Cat meat and untreated water sources.

The Prevalence of Absolute and Functional Iron Deficiency Anemia in New Cases of Smear-positive Pulmonary Tuberculosis and Their Sputum Conversion Rate at the End of Intensive Tuberculosis Treatment Phase.

About one third of the population is infected with tuberculosis (TB). On the other hand, iron deficiency is the most common micronutrient deficiency in the world. A number of studies have documented anemia in patients with TB, however, this study aimed to assess the prevalence of iron deficiency anemia (IDA) in patients with acid-fast bacilli (AFB) sputum smear-positive, and sputum conversion in these two groups of patients with absolute and functional IDA at the end of the second month of anti-TB therapy in Zahedan, Iran. The results of this study revealed that 91 out of 198 (45.9%) sputum positive pulmonary TB patients were anemic, and among those 72 (79.1%) had iron deficiency anemia. The overall prevalence of IDA in this study was 36.3%. In 72 patients with IDA, 54 (75%) had functional while the remainder had absolute IDA 18 (25%). Twenty-one out of 72 (29.2%) of patients with IDA remained sputum positive and among 126 non IDA patients 47 (37.3%) had positive sputum smear at the end of intensive TB treatment phase (p=0.278). Approximately, less than half of patients with tuberculosis had anemia among them 79% had iron deficiency anemia. The frequency of functional IDA was three times more than absolute IDA. There was no statistically significant difference in sputum conversion between two groups of IDA and non-IDA patients after intensive phase of anti-TB therapy.