AIMS:The emergence of drug resistance and development of multidrug resistant tuberculosis (MDR TB) has become a new but significant obstacle for TB control. As Rifampicin resistance is an important indicator for drug resistant TB, rapid diagnosis of tuberculosis and detection of Rifampicin (RIF) resistance are essential for knowing the magnitude of problem & early management of drug resistance TB. The aim of this study is to determine the pattern of rifampicin resistance in the sputum positive MDR TB suspects by using GeneXpert MTB/RIF and thus to focus on magnitude of the problem on drug resistance tuberculosis. STUDY DESIGN: A cross sectional observational study carried out over a period of 2 years in a tertiary care hospital. SUBJECTS & METHODS: In this study 428 sputum positive cases of pulmonary tuberculosis who were potential MDR suspect were included, there sputum samples were collected and tested by GeneXpert MTB/RIF assay, which is an automated cartridge based nucleic acid amplification test to detect presence of mycobacterium tuberculosis and status of Rifampicin resistance. The results are statistically analyzed. RESULTS: Out of 428 patients, mycobacterium tuberculosis was detected in 328 patients (76.63%) & out of these 328 patients, Rifampicin resistance was found in 98 cases (29.87%). Male and female ratio was 6:1 among Rifampicin resistant cases. Regarding age distribution, maximum no. of patients with Rifampicin resistance were in the age group of 21-30 yrs (26.53%) followed by 31-40 yrs (22.44%). In this study among cases of Rifampicin resistance, 23.47% of cases were new smear positive failure patients, retreatment cases smear positive at 4 months were 8.16%, 22.44% of cases were retreatment cases smear positive at diagnosis, 41.83% of cases were retreatment failure cases, 1.03% patient had history of contact with MDR TB and 3.06% patient was HIV seropositive. CONCLUSIONS: Rifampicin resistance cases are found in significant no. of MDR TB suspects. They are mostly male, 21-30 yrs. of age, predominantly retreatment failure cases whereas, new smear positive failure patients also contributes a significant disease burden. Also, HIV seropositive patients should be screened for drug resistance tuberculosis.
Objective:To evaluate the clinical spectrum of diffuse parenchymal lung diseases (DPLD) encountered in the Indian setting and to compare idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated DPLD (CTD-DPLD), the two commonest aetiologies.Materials and Methods:A prospective study of clinical, imaging and laboratory parameters of patients diagnosed as DPLD and followed up in the Pulmonary Medicine Department of a tertiary-care teaching institution in eastern India was conducted over a period of one year.Results:92 patients of DPLD were diagnosed in the study period with IPF (n = 35, 38.04%), CTD-DPLD (n = 29, 31.5%), hypersensitivity pneumonitis (n = 10, 10.9%), sarcoidosis (n = 5, 5.4%) and silicosis (n = 5, 5.4%) being the common causes. The CTD-DPLD group had a lower mean age (39.5 ± 1.86 vs 56.9 ± 1.12 years), a longer duration of symptoms (3.5 ± 0.27 vs 2.5 ± 0.26 years), more extra pulmonary manifestations, significantly more base line FVC and 6-minute-walk-distance than the IPF patients. 19 patients of IPF (54%) opted for treatment. All the IPF patients had a significant fall in FVC after six months (mean change -0.203 ± 0.01 litres) compared to the CTD-DPLD group (mean change - 0.05 ± 0.04 litres.)Conclusion:CTD-DPLD patients belong to a younger age group, with longer duration of symptoms, more extrapulmonary features, better physiological parameters and better response to therapy than IPF patients. Larger prospective epidemiological studies and enrolment in clinical trials are necessary for better understanding of the spectrum of diffuse parenchymal lung disorders and their therapeutic options.
Pleural effusion among patients of chronic kidney diseases (CKD) is an ongoing dilemma to nephrologists and Background: pulmonologists especially in developing countries where tuberculosis is a common cause of pleural effusion. Active tuberculosis is not conducive to renal transplantation while uremic effusion with recurrent collection needs intercostal tube drainage before transplantation. While uremic effusion is a diagnosis of exclusion, the sensitivity and specificity of various modalities of diagnosis of tuberculous effusion vary. The picture is even more confounding in patients of CKD (with pleural effusion) receiving high doses of diuretics where Light's criteria of transudative effusion do not always hold true. Against this background the prospective study had been undertaken to assess the incidence, causes, clinical features and management of pleural effusion in patients of CKD including renal transplant recipients.A prospective cross-sectional observational study of all adult patients of pleural effusion with either chronic kidney disease Methods: (stages 3 to 5) or renal transplant attending a tertiary-care institute in eastern India was performed over a year. An analysis of the etiological profile, clinical characteristics and treatment modalities of pleural effusion in CKD was carried out.430 CKD (stages 3 to 5) patients and 34 post renal transplant patients were evaluated during the study period. Incidence of Results: pleural effusion was 6.74% (29/430) in CKD patients and 5.88% (2/34) in post transplant patients. Mean age was 37.15± 1.76 (mean ± SEM*) with a men to women ratio of 2:1. Exudative effusion was slightly more predominant (51.6%, 16 of 31) but heart failure remained the single most common etiology (41.9%, 13 of 31).Tuberculosis (n=8, 25.8%) and uremic effusion (n=6, 19.4%) were responsible for the majority of exudative effusions, followed by empyema (n=2). Pleural effusion was bilateral in 38.7% and unilateral in 61.3% cases (Table 1). Unilateral effusion with a normal heart size had a positive predictive value of 83.3% for non heart failure etiology. Pleural fluid neutrophilic predominance was indicative of parapneumonic effusion/empyema, while high pleural fluid adenosine deaminase was suggestive of tuberculosis (Table 2).Symptomatic pleural effusion was present in 6.74% patients of CKD (stages 3 to5) and in 5.88% of post transplant patients. Conclusion:Heart failure, tuberculosis and uremic effusion accounted for 41.9%, 25.5% and 19.4% cases respectively. Differentiating tuberculosis from uremic effusion requires a combined clinico-pathological (Figures 1,2) approach and this differentiation is absolutely necessary in view of its strong therapeutic implications. * Standard error of meanPleural biopsy showing epitheloid granuloma with necrosis (x4)
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