Type Of Extrapulmonary Tuberculosis Research Articles

Design of RNA Polymerase Inhibitors as Therapeutics for Tuberculous Meningitis.

Tuberculosis is an infectious disease caused by Mycobacterium tuber-culosis. The current treatment protocols for pulmonary tuberculosis are quite effective, even though the treatment requires 3-6 months. The current treatment protocols for extrapulmonary tuberculosis are based on the same drugs that are used for pulmonary tuberculosis. However, the success rates are much lower for certain types of extrapulmonary tuberculosis, such as tubercu-lous meningitis. Tuberculous meningitis is one of the very few diseases attributable to bacteria that have a very high short-term mortality rate among diagnosed patients, even after treatment with antibiotics that are effective for pulmonary tuberculosis. For example, rifampicin is highly effective for the treatment of pulmonary tuberculosis, but its effectiveness for the treatment of tuberculous meningitis is much lower. The reason for the lower effectiveness of rifampicin against tuberculous meningitis is that it has low Blood-Brain Barrier (BBB) permeability, which results in lower concentrations of the drug at the required sites in the central nervous system. In this work, ligands having increased BBB permeability and pharmacokinetic and pharmacodynamic properties, either similar to or better than that of rifampicin, have been de-signed. The BBB permeability of the designed molecules was assessed by using pkCSM, a ma-chine-learning model. Pharmacokinetic properties, drug-likeness, and synthesizability were as-sessed by using SWISS-MODEL. The binding affinity of the designed drugs was assessed by using AutoDock Vina. A customized scoring function, StWN score, was used for a quantitative weighted assessment of all the properties of interest to rank the designed molecules. In this study, drug-like ligands have been designed that have been predicted to have high BBB permeability as well as high affinity for RNA polymerase  ofMycobacterium tuberculosis. The best ligands generated by the tools employed were selected as potential drugs to address the current need for better options for the treatment of tuberculous meningitis.

Relationship between TLR-2 level and clinical or radiological severity on patients with tuberculosis spondylitis in Dr. Wahidin Sudirohusodo hospital Makassar.

Spinal tuberculosis or TB spondylitis is one of the most common types of extra pulmonary tuberculosis, which is about 15% of all cases. It causes severe morbidity, neurological deficits, and severe deformities in the patients. The growth of Mycobacterium tuberculosis in culture specimens obtained from infected tissue is the single gold standard diagnostic test for spinal TB. Toll-like receptor (TLR) is one of the important receptors in the first-line defence system against microbes. TLR-2 and TLR-4 are known to be associated with tuberculosis infection. Based on this background, the researchers were interested in examining the relationship between TLR-2 levels and the clinical and radiological severity of TB spondylitis patients. A cross-sectional study was conducted with patients diagnosed with tuberculosis spondylitis at Dr Wahidin Sudirohusodo Makassar. Patients diagnosed with TB spondylitis confirmed by blood tests, GeneExpert, and magnetic resonance imaging without prior treatment were included. Data analysis were conducted by using descriptive analysis and one-way ANOVA for bivariate analysis. The mean value of TLR2 levels in TB spondylitis patients was 9.1 g/dL. TLR2 levels in paraesthesia were significantly higher than normal (P < .05). Similar trend were analyzed on the motor neurologic status with TLR2 levels in paraparesis were significantly higher than those in normal (P < .05). There is a significant relationship between the TLR2 levels in TB spondylitis and their impaired motor and sensory function. Spinal destruction has been shown to provide significant relationship with TLR2 value in spondylitis TB.

Epidemiology of extrapulmonary tuberculosis in Brunei Darussalam: a retrospective cohort study

ObjectivesWe reported the incidence and associated factors of extrapulmonary tuberculosis (EPTB).DesignA retrospective cohort study.SettingBrunei Darussalam, an intermediate tuberculosis (TB)-burden country with stagnating annual TB rates.ParticipantsAll active TB cases identified in...

A CROSS-SECTIONAL STUDY OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS

Mycobacterium tuberculosis, which causes TB, is an infectious disease that affects the lungs (pulmonary tuberculosis) and other organs (extra pulmonary tuberculosis). Therefore, it is important to pay attention to the risk factor and the treatment of tuberculosis. Aim: Studying the risk factors and treatment options for tuberculosis is the goal. Objectives: Finding out the risk factors for pulmonary and extra pulmonary tuberculosis, identifying the many types of extra pulmonary tuberculosis, and researching the various treatment options for pulmonary and extra pulmonary tuberculosis are among the objectives of this study.

A CROSS-SECTIONAL STUDY OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS

Background: Mycobacterium tuberculosis, which causes TB, is an infectious disease that affects the lungs (pulmonary tuberculosis) and other organs (extra pulmonary tuberculosis). Therefore, it is important to pay attention to the risk factor and the treatment of tuberculosis. Aim: Studying the risk factors and treatment options for tuberculosis is the goal. Objectives: Finding out the risk factors for pulmonary and extra pulmonary tuberculosis, identifying the many types of extra pulmonary tuberculosis, and researching the various treatment options for pulmonary and extra pulmonary tuberculosis are among the objectives of this study.

A CROSS-SECTIONAL STUDY OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS

Background: Mycobacterium tuberculosis, which causes TB, is an infectious disease that affects the lungs (pulmonary tuberculosis) and other organs (extra pulmonary tuberculosis). Therefore, it is important to pay attention to the risk factor and the treatment of tuberculosis. Aim: Studying the risk factors and treatment options for tuberculosis is the goal. Objectives: Finding out the risk factors for pulmonary and extra pulmonary tuberculosis, identifying the many types of extra pulmonary tuberculosis, and researching the various treatment options for pulmonary and extra pulmonary tuberculosis are among the objectives of this study.

High-dose rifampicin for the treatment of tuberculous meningitis: a meta-analysis of randomized controlled trials.

Tuberculous meningitis (TBM) is one of the most serious types of extrapulmonary tuberculosis and has caused distress to human. Effective treatment is particularly important. The aim of this meta-analysis is to compare the efficacy of high-dose and standard-dose rifampicin. Databases including PubMed, Web of Science, Embase, Scopus and the Cochrane Library databases were electronically searched to identify randomized controlled trials that reported high-dose rifampicin in treatment of patients with TBM. The retrieval time is limited from inception to June 2021. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Meta-analysis was performed by using STATA 12.0software. A total of 12studies involving 1596 patients were included. The meta-analysis results showed no significant differences in 6-month mortality, 9-month mortality, Grade I-II AE, Grade III-V AE, hepatotoxicity, hepatotoxicity Grade I-II and cardiologic events between high-dose rifampicin (or high-dose rifampicin plus moxifloxacin or levofloxacin) and standard-dose groups. The log(Cmax ) (WMD 0.69, 95%CI 0.59-0.79, p 0.001) and log(AUC0-24h ) (WMD 0.79, 95%CI 0.71-0.88, p 0.001) were higher with high-dose rifampicin. Subgroup analysis revealed the rise of log(Cmax ) in high-dose rifampicin orally was consistent with intravenous administration compared with the control (WMD 0.69, 95%CI 0.66-0.73, p 0.001). High-dose rifampicin was not a protective factor for 6-month mortality, despite increased plasma Cmax and AUC0-24h . However, the above conclusions are still required to be verified through more RCTs due to the limited quantity of included studies.

Extrapulmonary Tuberculosis and Its Association with HIV in Patients Hospitalized in a Tertiary Care Center

Context: Extrapulmonary tuberculosis (EPTB) presentation can be unusual, and the diagnosis may often be challenging when associated with HIV. Aims: This study was conducted to find out the pattern of newly diagnosed EPTB in hospitalized patients, the diagnostic modalities used to arrive at the diagnosis, frequency of HIV positivity among them, and its association with CD4 counts. Settings and Design: All patients newly diagnosed to have EPTB admitted in a tertiary care medical college hospital in various departments over 1 year were included. Methods and Materials: Clinical presentation, comorbidities, and investigations done to arrive at diagnosis of EPTB were recorded. They were classified based on the affected site. HIV was tested for all patients, and CD4 counts in positive patients. Results: A total of 230 patients were newly diagnosed to have EPTB. The median age was 35 years (IQR 29–45), and the proportion of males was 127 (55%). Imaging was used alone in 47 (20%) patients and in combination with cytology or biopsy in 133 (57.8%) patients to establish the diagnosis. Pleural effusion, 50 (21.7%) patients, peripheral lymph node TB (LNTB), 44 (19.1%) patients, and CNS TB, 37 (16.1%) patients, were the most common forms. HIV was associated in 61 (26.5%) patients and diabetes in 27 (11.5%) patients. Both diseases influenced the presentation of EPTB. There was an association between HIV positivity and type of EPTB with peripheral LNTB being the most common in HIV patients. High CD4 counts were associated with pleural effusion and low counts with disseminated forms. Statistical Analysis Used: chi-square, ANOVA, and Student t test. Conclusion: The pattern of EPTB changes with HIV and vigilance is required to detect severe and disseminated forms of EPTB with lower CD4 counts.

Beware of Pleural Thickening and Calcification: An Enlightenment from a Case of Tuberculous Pleurisy

Tuberculous pleurisy, a type of extra-pulmonary tuberculosis, is the pleural inflammation caused by hypersensitive response of the pleural cavity stimulated by mycobacterium tuberculosis and its metabolites. If the patient does not receive timely and effective treatment and intervention, a large amount of fibrin will be deposited which will cause pleural thickening, adhesions, and even calcification. At present, clinical cases of typical pleural thickening and calcification have been rarely reported. In this paper, we will report a case of significant pleural thickening and calcification caused by tuberculous pleurisy; moreover, the patient earliest got tuberculous pleurisy about in 20 years ago and had received anti-tuberculous treatment at that time. The patient’s typical crescent-shaped shadow created by pleural thickening and calcification is very rare in the domestic and international literature.

Pancreatic Tuberculosis: A Rare Type of Extra Pulmonary Tuberculosis

Tuberculosis is a serious health problem not only in Indonesia, but worldwide. Each year, it occurs in nearly 9.7 million people and claims about 2 million lives worldwide. Pancreatic tuberculosis is a rare type of extra pulmonary tuberculosis that only occur less than 4.7% worldwide. The most common symptoms is abdominal pain and most of the patients shows abdominal tenderness on palpation. Diagnosis of pancreatic tuberculosis consist of tuberculin skin test, ultrasonography, computed tomography-scan, magnetic resonance imaging and biopsy. Diagnosing pancreatic tuberculosis is a challenge because of its rarity and it has similar symptoms as more common pancreatic condition such as pancreatic malignancy. Understanding of pancreatic tuberculosis will increased the clinical awareness that may guide clinicians to avoid unnecessary diagnostic or therapeutic procedures and early diagnosis.

Asymptomatic Isolated Cervical Tubercular Lymphadenopathy, How to Proceed?: A Case Series

Tuberculosis is a highly prevalent disease in developing countries, the majority of cases are pulmonary and rest are extra-pulmonary. Cervical LN tuberculosis is one of the most common types of extra-pulmonary tuberculosis. Isolated cervical tubercular Lymphadenitis without accompanying pulmonary tuberculosis or another form of tuberculosis in the body is rare and, when present, requires thorough clinical examination and investigation. In the investigation of such patients, FNAC plays a major role, and aspirate should be tested for AFB through ZN stain and CBNAAT (PCR). Cervical tubercular Lymphadenitis is mainly a disease of young with a female predominance. All patients of cervical tubercular Lymphadenitis must receive antitubercular therapy with strict follow up for compliance and possible side effects from treatment.

An interesting case of tonsillar tuberculosis in a 10-year-old boy

Tuberculosis of the tonsils is a rare type of extra pulmonary tuberculosis. The secondary form is more common than the primary, usually caused by the contact with the infected sputum or saliva from a sputum smear positive case of tuberculosis. We report a primary form of tonsillar tuberculosis in 10-year-old boy, with no remote history suggestive of documented pulmonary tuberculosis. Local examination revealed Grade IV tonsillar hypertrophy and congestion of posterior pharyngeal wall. Management included, Coblation assisted adenotonsillectomy under general anaesthesia. Histopathological examination revealed features suggestive of chronic adenotonsillitis, multiple epithelioid granulomas with caseous necrosis, langhans type of giant cells with scant inflammatory infiltrate in the background.

Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis.

Background: Tuberculous meningitis (TBM) is one of the most serious types of extrapulmonary tuberculosis. However, low sensitivity of culture of cerebrospinal fluid (CSF) increases the difficulty in clinical diagnosis, leading to diagnostic delay, and misdiagnosis. Xpert MTB/RIF assay is a rapid and simple method to detect tuberculosis. However, the efficacy of this technique in diagnosing TBM remains unclear. Therefore, a meta-analysis was conducted to evaluate the diagnostic efficacy of Xpert MTB/RIF for TBM, which may enhance the development of early diagnosis of TBM.Methods: Relevant studies in the PubMed, Embase, and Web of Science databases were retrieved using the keywords ‘Xpert MTB/RIF’, ‘tuberculous meningitis (TBM)’. The pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, summary receiver operator characteristic curve, and area under the curve (AUC) of Xpert MTB/RIF were determined and analyzed.Results: A total of 162 studies were enrolled and only 14 met the criteria for meta-analysis. The overall pooled sensitivity of Xpert MTB/RIF was 63% [95% confidence interval (CI), 59–66%], while the overall pooled specificity was 98.1% (95% CI, 97.5–98.5%). The pooled values of positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 20.91% (12.71–52.82%), 0.40% (0.32–0.50%), and 71.49% (32.64–156.56%), respectively. The AUC was 0.76.Conclusions: Xpert MTB/RIF exhibited high specificity in diagnosing TBM in CSF samples, but its sensitivity was relatively low. It is necessary to combine other high-sensitive detection methods for the early diagnosis of TBM. Moreover, the centrifugation of CSF samples was found to be beneficial in improving the sensitivity.

Comparing tuberculosis in children aged under 5 versus 5 to 14\u2009years old in a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study

BackgroundThere are few data available about childhood tuberculosis (TB) in rural hospitals in low-income countries. We assessed differences in epidemiological characteristics and treatment outcomes in children with TB aged 0–4 versus 5–14 years in rural Ethiopia.MethodsFor this retrospective cross-sectional study, we analyzed childhood TB registers from a rural Ethiopian hospital. We collected data on the number of cases, type of TB, and treatment outcomes using standard definitions. By means of binary and logistic regression analyses, data were compared from 1998 to 2015 in children aged under 5 versus those aged 5–14 years.ResultsWe included 1282 TB patients: 583 (45.5%) were under 5 years old, and 699 (54.5%) were aged 5–14 years. More than half (67.2%, n = 862) had pulmonary TB (PTB), which was more common in younger children (82.5%, 481/583) than in older ones (54.5%, 381/699; p < 0.001). Most cases of PTB (87.5%, 754/862) were smear negative, including virtually all (99.6%, 479/481) younger children and most older ones (72.2%, n = 275/381; p < 0.001). The most common types of extrapulmonary TB (EPTB) were TB adenitis (54.5%, 229/420) and bone TB (20%, 84/420). Children under five showed a lower prevalence of adenitis TB (9.9% [58/583] versus 24.5% [171/699], p < 0.001), bone TB (2.9% [17/583] versus 9.6% [69/699], p < 0.001), and abdominal TB (0.9% [5/583] versus 6.3% [44/699], p < 0.001). Most diagnoses were new cases of TB (98.2%, 1259/1282). Overall, 63.5% (n = 814) of the children successfully completed treatment (< 5 years: 56.6%, 330/583; 5–14 years: 69.2%, 489/699; p < 0.001). In total, 16.3% (n = 209) transferred to another center (< 5 years: 19.4%, 113/583; 5–14 years: 13.7%, 96/699; p = 0.006). Thirteen percent of patients (n = 167) were lost to follow-up (< 5 years: 16.0%, 93/583; 5–14 years: 10.4%, 74/699; p = 0.004). Fifty-two (4.1%) children died (no age differences). Being aged 5–14 years was independently associated with successful treatment outcomes (adjusted odds ratio 1.59; 95% confidence interval: 1.16, 1.94, p = 0.002).ConclusionsWe observed a very low diagnostic yield for spontaneous sputum smear in children with TB. In this rural setting in Ethiopia, very young children tend to present with new cases of smear-negative PTB. They have less EPTB than older children but more TB meningitis and show lower rates of treatment success.

Tubercular Prostatitis: A rare case of Genitourinary Tuberculosis

Genitourinary tuberculosis is the second most common type of extra-pulmonary tuberculosis after tubercular lymphadenitis. Tuberculosis of the prostate is a relatively rare condition and most cases are diagnosed on histology following prostatectomy or prostatic biopsy. Probably several cases of tubercular prostatitis remain undiagnosed. Therefore it requires a high index of suspicion. Here we report a rare case of tubercular prostatitis in a 49 years old man who presented with features of lower urinary tract symptoms. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 65-67

Clinical profile and outcome of extrapulmonary tuberculosis in children in Indonesia

Context: Tuberculosis (TB) is a significant problem among children in Indonesia. While pulmonary TB has been widely reported, information on extrapulmonary TB (EPTB) among children in Indonesia has not been well documented. Aims: The aim of this study is to document demographic and clinical characteristics and outcome of EPTB in children. Settings and Design: A retrospective study was conducted in Dr. Sardjito Hospital, Yogyakarta, Indonesia. Subjects and Methods: Medical records were reviewed for all children aged younger than 18 years diagnosed with EPTB and admitted to this hospital between 2009 and 2015. Results: Fifty-three patients with EPTB were admitted to the hospital during the study period. EPTB was more common in children aged >5 years, with median (interquartile range) age of presentation at 12.5 years (4.1–14.7 years). Major presenting symptoms were fever (72%), cough (55%), and weight loss (38%). Common types of EPTB were meningitis (28%), miliary TB (23%), and osteoarthritis (20%). The diagnosis was confirmed by either acid-fast bacilli smear or GeneXpert MTB/rifampicin (RIF) in 13 patients. Evidence of TB infection was documented in 26 % of children with positive result of tuberculin skin test. Mycobacterium TB was detected by GeneXpert MTB/RIF in 23% of children. The mortality rate was 19% which mostly occured in children with meningitis (60%). Conclusion: EPTB was commonly seen in older children, and tuberculous meningitis was both the most common type and cause of death of EPTB in our setting.

Patterns, trends and treatment outcomes of extra-pulmonary tuberculosis in Sohag, Upper Egypt

ObjectiveTuberculosis (TB) is one of the main health issues in Egypt. Nationwide collective data on the current trends of infection are scarce. The aim of the study was to evaluate the patterns and trends of extrapulmonary tuberculosis (EPTB) cases in Sohag, Upper Egypt. MethodsCross-sectional study involving a retrospective review of all TB cases registered as extra-pulmonary TB (EPTB) from 2010 to 2014, the age and sex of the patients and the categories and types of EPTB registered their treatment outcomes. ResultsFrom 2010 to 2014, 500patients were registered with EPTB, of whom 36.6% were male, and 85% were new EPTB cases. TB lymph node enlargement and pleural effusion were the two most common types of EPTB, accounting for 58%, followed by spinal/bone, abdominal TB and kidney disease. The overall treatment success rate was 90%, and was generally similar with respect to sex, age and different types of EPTB. ConclusionsSohag has a high proportion of patients registered as having EPTB, for whom treatment outcomes are satisfactory. Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.

Clinical profile of 128 HIV positive cases with abdominal tuberculosis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tuberculosis and HIV co-infection remains a major public health challenge throughout the world. An extra 25% of deaths among TB patients are attributable to co-infection with HIV according to the WHO 2009 TB report. TB is often the first opportunistic infection and a leading cause of death in HIV infected persons. The main objective was to study the clinical profile of the patients co-infected with HIV and abdominal tuberculosis in Government Medical College, Aurangabad.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Patients co-infected with HIV and abdominal tuberculosis were included in this observational study. Patients were either HIV positive and later diagnosed to have abdominal tuberculosis or diagnosed to be HIV positive when investigations were done after the diagnosis of abdominal TB. The common presenting symptoms were weight loss, fever, loss of appetite, pain in the abdomen and chronic diarrhoea. Ultrasound and routine chest X-ray were done along with other routine blood investigations including CD4 count.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We studied 407 cases of HIV-TB co-infected patients out of whom 248 (61%) were of extra-pulmonary tuberculosis. Out of 248, 128 cases (51.6%) were diagnosed to have abdominal tuberculosis which was the commonest type of extra pulmonary tuberculosis in HIV –TB co- infected patients. They had higher morbidity, but we found that 96.06% patients completed anti-tubercular treatment and responded. Mortality rate of abdominal TB was lowest (3.94%) among all types of extra-pulmonary and also pulmonary TB in HIV co -infected patients. So we can conclude that HIV TB co infected patients show good response to anti- tubercular treatment if we diagnose this condition early.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Abdominal tuberculosis is the commonest type of extra pulmonary tuberculosis in HIV patients. On ultrasonography, the common abnormalities seen were intra-abdominal lymphadenopathy, splenic abscesses, ascites etc. All the patients who were diagnosed within few weeks of symptoms recovered with anti tubercular therapy, similar to HIV negative patients.&lt;/p&gt;

English

INTRODUCTION: Right iliac fossa mass may arise from parietal wall or intraperitoneum or retroperitoneum. Mass may arise from right iliac regional structures or extended from adjacent structures. Appendicular pathology is commonest cause for right iliac fossa mass (either appendicular mass or abscess). Other common causes are ileo-caecal tuberculosis and carcinoma caecum. Appendicular mass is formed by inflamed appendix adherent with dilated ileum, greater omentum and caecum. Appendicular abscess due to suppuration in an acute appendicitis or suppuration in an already formed appendicular mass. Abdominal tuberculosis is common in developing countries like India. It is sixth most common type of extra pulmonary tuberculosis. Its incidence is high in HIV infected patients. Ileo-caecal tuberculosis is commonest type of abdominal tuberculosis due to presence of Peyer's patches and stasis of luminal contents favoured by ileo-caecal valve. Commonest type of carcinoma in caecum is adenocarcinoma. Third common site in large bowel carcinoma (12%). Diet with lack of fibres and high fat increases risk. Dietary vitamins A, C, E (antioxidants) and Zinc and high fibre diet reduce the risk. Diagnosis of right iliac fossa mass mainly depends on complete clinical examination, radiological, biochemical, microbiological and pathological investigations. Commonest cause of right iliac fossa mass in our country is appendicular mass or abscess, ileo-caecal tuberculosis and carcinoma caecum. OBJECTIVES: To study the aetiology, pattern of presentation, management and complications in patients with right iliac fossa mass in our institution. MATERIALS AND METHODS: This retrospective study was carried out in our institution over a period of two years from October 2010 to October 2012. All patients who are provisionally diagnosed to have mass in the right iliac fossa by clinical evaluation are included in the study. All data including age, gender, relevant history, investigations (complete blood count, Blood grouping and Rh typing, HIV I & II, Chest radiograph, Ultrasound abdomen and pelvis, CT Scan abdomen and pelvis, IVP and barium follow through and enema, FNAC, BIOPSY) were done to conclude the final diagnosis and appropriate treatment and postoperative complications and final histopathological reports were recorded in the standard forms. Cases are selected by following Inclusion and exclusion criteria; Inclusion criteria: All the cases admitted with Right iliac fossa mass in our institution. Exclusion criteria: Female patients with gynaecological diseases. Paediatric age group (<12 years) patients with right iliac fossa mass. CONCLUSION: Right iliac fossa mass was common in 20 to 50 years of age group. Overall incidence was more common in males as compared to females (1.1:1).Appendicular pathology and Carcinoma caecum was more common in males as compared to females. Ileo-caecal tuberculosis was more common in females. The diseases were more in people from low socio –economic status and the commonest symptom was pain in abdomen. Appendicular pathology (60%) either in the form of appendicular mass (32.5%) or appendicular abscess (27.5%) were the commonest cause of mass in the right iliac fossa. Ileo-caecal tuberculosis (20%), carcinoma caecum (12.5%) was the other common causes of mass in the right iliac fossa. Ultrasound abdomen was the essential investigation and it had a sensitivity of greater than 95%. Normal levels of serum CRP titer essentially ruled out appendicular pathology. Serial titers were helpful in assessing the treatment response of ileo-caecal tuberculosis and in prognosis of carcinoma caecum. In patients with appendicular mass, initial conservative management followed by interval appendicectomy had better results with minimal complications. In patients with appendicular abscess, abscess drainage combined with appendicectomy in the same procedure, had high morbidity compared to patients who underwent interval appendicectomy following abscess drainage. 44% of the patients with ileo-caecal tuberculosis were managed conservatively with anti-tubercular therapy (DOTS-I). Surgery was required in another 56 % of the patients, of which 25 % of the patients presented with acute complications needing immediate surgery. 31 % of the patients presented with sub-acute intestinal obstruction due to adhesions and strictures following the initiation of anti-tubercular therapy, which later required surgical intervention. 80 % of the patients with carcinoma caecum underwent successful surgical resection. 20 % of the patients presented with acute surgical problem requiring immediate surgery. 10 % of the patients presented with advanced disease. Most of the parietal wall and retroperitoneal conditions were treated surgically. Early evaluation and intervention is needed to improve the patients’ outcome and to reduce the morbidity and mortality.

Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011.

Background:Regarding cases of infectious diseases tuberculosis (TB) is the most important cause of death and according to the DALY criteria, this disease has the seventh position in global disease ranking. In this study, we aim to determine the risk factors, which have a significant effect on the treatment completion and mortality of TB patients.Methods:This study is a retrospective cohort study. The sample is made up of registered TB patients in the Isfahan Province from 2006 to 2011. Information of the patients was collected from their files in health centers in the Isfahan Province. Variables such as age, sex, weight, nationality, residence, type of TB, imprisonment, human immunodeficiency virus, TB case were measured. Descriptive statistics (including frequency, percentage, mean and standard deviation) and statistical analysis (including Cox proportional hazard model) were used.Results:The result showed that imprisonment (hazard ratio [HR] = 4.76, P = 0.019), age (HR = 4.44, P = 0.001) and the TB case (HR = 2.73, P = 0.037) of pulmonary TB had significant impacts on mortality of the patients, also in the case of treatment completion, the TB case (HR = 0.34, P < 0.001) proved to have a significant impact on completion of the treatment. Type of extra-pulmonary TB in extra-pulmonary TB patients also had an effect on treatment completion.Conclusions:We can conclude that factors such as age, imprisonment, TB case and type of extra-pulmonary TB are effective on the treatment completion and mortality of the patients. It may be useful for policy makers to make more control of high-risk patients.