Background Diabetes mellitus (DM) increases the risk of tuberculosis (TB) disease. Knowledge of the impact of DM on TB treatment outcomes is primarily based on retrospective studies. Methods We conducted a prospective cohort study of new pulmonary TB patients with and without DM (TB-DM and TB-only) in India. The association of DM with a composite unfavorable TB treatment outcome (failure, recurrence, mortality) over 18 months was determined and the effect of DM on all-cause mortality and early mortality (death during TB treatment) was assessed. Results Of 799 participants, 574(72%) had TB-only and 225(28%) had TB-DM. The proportion of patients with DM who experienced the composite outcome was 20% as compared to 21% for TB only participants (adjusted hazard ratio 1.13, 95% CI 0.75–1.70). Mortality was higher in participants with DM (10% vs. 7%), and early mortality was substantially higher among patients with DM (adjusted hazard ratio [aHR] 4.36; 95% CI:1·62–11.76). Conclusion DM was associated with early mortality in this prospective cohort study, but overall unfavorable outcomes were similar to participants without DM. Interventions to reduce mortality during TB treatment among people with TB-DM are needed.

SUMMARY SETTING: Pune, India. OBJECTIVES: To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB). DESIGN: Screening for DM was conducted among adults (age ⩾ 18 years) with confirmed TB between December 2013 and January 2017. We used multinomial regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c] ⩾ 5.7–6.5% or fasting glucose 100–125 mg/dl) and DM (HbA1c ⩾ 6.5% or fasting glucose ⩾ 126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease. RESULTS: Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM (P < 0.001). DM (adjusted OR [aOR] 4.94, 95%CI 2.33–10.48) and each per cent increase in HbA1c (aOR 1.42, 95%CI 1.01–2.01) was associated with >1+smear grade or ⩽9 days to TB detection. CONCLUSION: Over half of newly diagnosed TB patients had DM or pre-DM. DM and increasing dysglycemia was associated with higher bacterial burden at TB diagnosis, potentially indicating a higher risk of TB transmission to close contacts.

Background: Tuberculosis is one of the most common chronic infections globally, especially in developing countries like India and is a leading cause of morbidity and mortality. Therefore, early diagnosis, and microbiological confirmation of pulmonary TB is important to break the chain of transmission. This study was carried out to study usefulness of fiberoptic bronchoscopy in sputum smear negative and CBNAAT negative patient of presumptive tuberculosis.Methods: It was an observational study in the Department of Respiratory medicine for duration of 2 years (Sept 2018- Aug 2020) among 100 adults cases of presumptive tuberculosis whose sputum were negative on sputum AFB and CBNAAT. Cases with relative or absolute contraindication for bronchoscopy were excluded from study.Results: Mean age of study subjects was 47.31±12.29 years; M:F was 1.2:1 and 5% had past history of tuberculosis. Most common findings on chest X-ray was alveolar opacities (40%), inhomogeneous opacity (24%), cavitary lesions (20%), cystic lesion (8%) and fibrosis (6%) in different zones of lung. BAL sent for CBNAAT testing detected 15% mycobacterial TB, 2% mycobacterial TB with Rif resistance. Zn staining testing detected 10% AFB, on culture 14% showed AFB growth,4% had malignant cell findings. Diagnostic efficacy of Zn staining of BAL showed 42.86% sensitivity, 95.35% specificity, 60% PPV, 91.11% NPV and 88% diagnostic accuracy. BAL CBNAAT testing had 78.57% sensitivity, 93.02% specificity, 64.71% PPV, 96.39% NPV and 91% diagnostic accuracy. Most common complication was bronchospasm and hypoxia.Conclusions: Fiberoptic bronchoscopy is useful investigation in establishing accurate and early diagnosis of lower respiratory tract infection.

This review was carried out to understand various issues concerned with the patients of sickle cell disease (SCD). An attempt has been made to review the literature with respect to the multiple complications experienced by the SCD patients, variety of pharmacological therapies used throughout the world for SCD management. The literature highlighted the lack of reliable prevalence statistics, lower use of diagnostic measures, especially in rural areas. The literature indicated that varieties of medicinal plants are used regularly for the management of SCD related complications, such as sickling, infections, pain crisis, etc. Although, Bone marrow transplant, the only curative therapy and genetic counselling, have shown promising results for effective management of SCD, now a days people are using alternative pharmacological therapies for SCD management.