The absorption of rifampin, isoniazid, and D-xylose in patients with human immunodeficiency virus (HIV) infection and diarrhea, in patients with HIV infection and tuberculosis (TB), in patients with pulmonary TB alone, and in healthy subjects was studied. Percentage of dose of the drugs, their metabolites, and D-xylose excreted in urine were calculated. A significant reduction in the absorption of drugs and D-xylose in both the HIV infection/diarrhea and HIV infection/TB groups was observed (P<.05), and the correlation between them was significant. Our results indicate that patients with HIV infection and diarrhea and those with HIV infection and TB have malabsorption of rifampin and isoniazid.

Indroduction: National Aids control Organisation in India implementing National AIDS control program uses WHO's immunological criteria to screen virological failure. Using immunological criteria to detect virological failure has to be assessed. Predicting virological failure with immunological criteria in resource limited settings had low sensitivity. Factors that influence the outcome are studied. Methods: Retrospective study in tertiary care centre for HIV and TB, Chennai, India. Out of 35,044 on ART between January 2008 and September 2009, 452 suspected immunological failures were referred. 273 screened for virological failure. Frequency, sensitivity/specificity, positive/negative predictive values, chi-square test, odds-ratio, independent sample t test for viral load greater than 10,000 and 1000 of each immunological criterion using Epi-Info and SPSS version 19. Results: 172 had virological failure (62.09%). Average age of failed was 37.33. Single criteria's sensitivity was 60 to 84 for detecting virolological failure. Two or more criteria had specificity 55 to 79. Combination of two or more criteria increased odds ratio for virological failure. Positive predictive value was above 63 for all criteria. PPV was above 80 to the criterion all three positive. Conclusions: ART naive patients with >95% adherence the sensitivity of immunological criteria to detect virological failure is three times than earlier studies. Combination of criteria is more significantly associated with virological failure. Odds ratio doubled for two or more combination of criteria. Immunological criteria is affordable/acceptable for screening virological failure, with adherence > 95% and longer the duration of ART.

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HIV infection has changed the scenario of infectious disease. HIV-associated immunodeficiency resulted in a wide spectrum of new opportunistic infections. After introduction of antiretroviral therapy (ART), immune reconstitution inflammatory syndrome (IRIS) became an important challenge in management of 10% to 25% of the patients. Meta-analyses of IRIS from various reports published worldwide by Monika Muller et al described 12% IRIS incidence and 15.7% IRIS tuberculosis. Among IRIS tuberculosis, central nervous system involvement with IRIS tuberculous meningitis forms only 7%. Only 9 cases of tuberculous brain abscess is reported in patients with AIDS so far. The IRIS tuberculous brain abscess is very rare, and so far only 1 case is reported as a paradoxical reaction after ART initiation. Here, we report a case of recurrent IRIS tuberculosis meningitis and brain abscess.

Introduction: Pleural effusion occurs when extra fluid accumulates in the pleural space of the body. Pleural effusion is a symptom of underlying pathology caused by lung, pleural, and systemic diseases. In approximately 75% of patients, cytobiochemical and microbiological investigation of pleural fluid can provide an etiological diagnosis. Despite thoracentesis diagnostics and its concerned workup, the root cause remains unidentified. Despite primary tests, medical thorocoscopy plays an important role in undiagnosed pleural effusion. This study is planned in order to appraise as to what would be the diagnostic yield on implementing medical thoracoscopy in a tertiary care centre where patients were being treated for pleural effusion of unknown etiology.   Methodology: From June 2021 to June 2022, Saveetha Medical College and Hospital in Thandalam, Kanchipuram, initiated a prospective, interventional, and non-randomised study. Our institution conducted a study on pleural effusion cases that were not diagnosed following the initial biochemical and cytological analysis of their respective pleural fluids.   Results: This study included 53 patients with pleural effusion. 42 patients(79.25%) had definitive diagnosis and 11 patients(20.75%) had inconclusive histopathological report. It was noted that 30 (56.6%) patients with definitive diagnosis had cancer, 10 (18.9%) had tuberculosis, and 2 (3.8%) had empyema. In our investigation, the diagnostic yield on implementing medical thoracoscopy was 79.25%. The overall sensitivity in our study was 89.36%, with specificity at 100%, positive predictive assessment at 100%, and negative predictive assessment at 54.5%.   Conclusion: Medical thoracoscopy is a minimally invasive, well-tolerated, and safe process that aids in the accurate identification of pleural effusion of unknown etiology. It also allows for the provision of therapeutic approaches such as pleurodesis and adhesiolysis. As a consequence, patients having pleural effusion in which the etiology is not known should opt for medical thoracoscopy.