Background: Tuberculosis, a chronic disease causing high morbidity and mortality with multiple host related and socio-demographic risk factors. Incidence is 3-4 times among in diabetics. HIV is considered to be a most powerful risk factor other being malnutrition, Tubercular contacts, smoking habits and alcoholism. Many ecological and societal threats increase a vulnerability to infection and succession of the disease. Objective was to study and compare various clinico-radiological presentations and clinical risk factors for pulmonary tuberculosis in the young (<50yrs) and elderly (>50yrs) patients.Methods: Total 300 pulmonary tuberculosis patients each admitted in hospital during 1999 (group ‘A’) and 2016 (group ‘B’) respectively were included in our study. Socio-demographic risk factors and presence of any existing co morbidities and clinical as well radiological presentation data were evaluated.Results: Majority patients in both group ‘A’ and ‘B’ were males (67% and 61.3%), younger (71.3% and 63.3%) patients. Elder patients had more smokers in both groups (48.8% and 33.6%). COPD trends seems to be receding in group ‘B’ as compared to group ‘A’ in younger (6.3% vs. 8.9%) as well elder (13.6% vs. 29.1%) but on the contrary lifestyle disease trends like DM increased in group ‘B’ than group ‘A’ patients more in elder subgroup (30% vs. 9.3%). HIV infected was more in younger 2.1 % (elder 0.9%) group ‘B’ patients. Haemoptysis (17.8% and 18.6% vs. 13.7% and 9.1%) and cough (~87% vs. ~85%) were almost similar but fever (~90% vs. ~65%) was seen significantly higher in the young patients. Radiologically bilateral upper lobe cavitations (15%-30%) was a higher in group A patients as compared to negligible less than ~3% cavitations in group B, on the contrary infiltrations (15%-32%) was more in group B.Conclusions: Young adults are more likely to have fever while haemoptysis cough and advanced lung field involvement is more common in elderly. Elderly patients had a higher number of co-morbidities like COPD and DM. The present study reveals that various demographic, socioeconomic and clinical risk factors have a potential role in causation/augmentation of pulmonary tuberculosis hence life style modification, prevention and timely management of these risk factors could be helpful to reduce the burden of disease.

Multidrug resistant tuberculosis (MDR TB) is defined as resistance to isoniazid and rifampicin. The recent Global Project on drug-resistant TB confirmed that multidrug-resistant TB was found in all regions of the world. Misdiagnosis of MDR tuberculosis due to laboratory related errors has been reported recently and hence susceptibility results alone should not dictate treatment and careful clinical correlation is necessary. Drug-susceptible TB can be cured in six to eight months with first-line anti-TB drugs. However, incorrect or partial treatment results in drug-resistant TB. WHO has recommended that multidrug resistant tuberculosis should be considered after failure of fully supervised category II or I treatment regimen.In a retrospective study of 55 cases of MDR pulmonary TB referred to our centre treated with kanamycin, ethionamide, cycloserine and PAS (KCEP) +/-quinolones, 38 (69.09%) patients completed treatment, 11 defaulted and 6 died. 31/38 (81.57%) cases were cured and 7/38 (18.4%) failed on therapy. All cases that failed had received one or more second line drugs previously. The cost of treatment ranged from $1000 to $3000. Adverse drug effects were seen in 8/55 patients (14.54%).Second line drugs for tuberculosis have been now listed under the WHO essential drugs list and are available through the Green Light Committee. Adherence to the strict guidelines will result in proper management of existing cases of MDR-TB.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterised by a modified inflammatory response to chronic irritants which is often associated with some degree of systemic inflammation. Exacerbations in COPD are characterized by exaggeration of the ongoing inflammation. A number of inflammatory mediators are found to be raised in COPD exacerbations but most of them are expensive and not readily available. The Neutrophil-lymphocyte Ratio (NLR) is a rapid, easy and cheap biomarker that has been shown to be raised in patients of COPD. Aim: To evaluate the role of NLR in patients of stable and acute exacerbation of COPD. Materials and Methods: This cross-sectional observational study was conducted in Department of Pulmonary Medicine at Government Medical College, Patiala, Punjab, India. Study included 150 patients of stable COPD, 150 patients of Acute Exacerbation COPD (AECOPD) and 100 subjects as controls. NLR was calculated from a peripheral blood sample of the study participants. Continuous variables were summarised as mean with standard deviation and compared between groups using Unpaired t-test. A p-value <0.05 was considered statistically significant. Results: The mean age in AECOPD group was 61.7±10.4 years, in stable COPD group was 63.1±8.9 years and 63.2±7.8 years in controls. Mean NLR was found to be highest in AECOPD group (4.0±1.7) followed by stable COPD (2.9±0.8) and then control (1.8±0.4).NLR showed good predictive value for predicting exacerbations in stable COPD patients with sensitivity and specificity of 75.3% and 70.7% respectively (cut-off 3.4 and AUC=0.806). Conclusion: NLR is an easily available biomarker of inflammation and can be used as a predictor of exacerbation in patients of COPD.

No abstract

Background: Tuberculosis (TB) is one of the common communicable disease affecting human beings since ancient times. Though effective chemotherapy emerged during 20th century had raised hope towards eliminating TB burden, it still remains as a distant goal. Awareness about TB among close contacts of active disease is of paramount importance in preventing its spread and promoting early diagnosis and treatment. This study aimed to assess the knowledge about tuberculosis among caregivers of tuberculosis patients.Methods: This was a cross sectional study that enrolled 300 subjects who were then caregivers of tuberculosis patients admitted in the Department of Pulmonary Medicine. Subjects were interviewed according to a predesigned panel of questions meant to assess their basic knowledge and perceptions about tuberculosis symptomatology, diagnostic modalities, treatment and prevention.Results: About 90.3% (n=271) of subjects had heard about TB previously and about 37.7% (n=113) considered themselves to be well aware of it. Most of them believed TB to be communicable (90.3%, n=271). Majority believed that TB affects lungs only (n=206, 68.7%), with most commonly perceived symptom being cough (n=285, 95%). Knowledge regarding disposal of sputum was poor (n=110, 36.7%). About 168 (56%) subjects considered usage of face mask by the patient as an effective tool for TB prevention.Conclusions: Caregivers of tuberculosis patients lack proper knowledge about major aspects of the disease. Public awareness and care giver education programs needs to be implemented along with standard TB care to reduce transmission of TB among close contacts.