European Journal of Molecular & Clinical Medicine

Pleural effusion is a collection of fluid in the Pleural space. Determining the cause of a pleural effusion is greatly facilitated by analysis of the pleural fluid. Etiological diagnosis in of those cases is a diagnostic challenge to the clinician because even after all cumbersome work-ups some cases remain undiagnosed. Pleural effusion remains undiagnosed after routine tests in pleural fluid in many patients. so, we need a simple and safe investigative tool to evaluate undiagnosed effusion. This study is designed to diagnose the cases of undiagnosed effusions by a simple and safe investigative tool.
Materials & Methods: A hospital based prospective study done in 30 patients with exudative pleural effusion remain undiagnosed after pleural fluid analysis in department of respiratory medicine at government medical college, Bhilwara, Rajasthan during one-year period. Pleural fluid sent for basic biochemical and microbiological investigations. Pleural biopsy was performed using ABRAM’S pleural biopsy needle under strict aseptic precaution under local anesthesia and the specimen was sent for the following investigations such as histopathological examination, rt-PCR and culture for Tuberculosis by BACTEC.
Results: Histopathological examination diagnosed 46.66% of biopsy specimens as tuberculosis and 23.33% as malignancy. The rest 30% of case were left undiagnosed after histopathological examination of Pleural biopsy. Reverse Transcriptase Polymerase Chain reaction was positive in16.66% of the cases and was negative in 83.33% of the cases. Our study shows that tuberculous pleural effusion is more common in the younger age group and malignant pleural effusion more common in the elder age in both males and females. There were no false positive results with histopathological examination, BACTEC & rt PCR making the specificity and positive predictive value as 100%. The sensitivity was 70%, 10% & 25% respectively and negative predictive value was60%, 35% & 40% respectively in tuberculosis patients

Uveitis is a term used to describe inflammatory processes of the portion of the eye known as the uvea, which is composed of the iris, ciliary body and the choroid; however, any area of the eye can be inflamed. Uveitis is most often idiopathic but has been associated with traumatic, inflammatory, and infectious processes. Patients may present with concurrent systemic symptoms or infectious diseases to suggest an etiology affecting more than just the eye. Idiopathic cases of uveitis account for 48 to 70% of uveitis cases.
Materials and methods: This prospective and observational study was undertaken with all new uveitis cases attending the Department of Ophthalmology, Tertiary care Teaching hospital over a period of 1 year. A standard clinical protocol and detailed investigations were to find out the specific cause of uveitis. All patients above 18 years of age either gender having uveitis. Patients who could not be worked up completely as per protocol or did not give consent for the study were excluded.
Results: Anterior uveitis presented in 42 (60) cases, 12 (17.1%) patients were idiopathic followed by Tuberculosis in 5 (7.2%) and HLA B27 in 6 (8.7%) patients. Intermediate uveitis was idiopathic while specific diagnosis made in 2 patients; i.e. sarcoidosis in 9 (12.9%) patient and ulcerative colitis in 1 (1.4%) patient. Posterior uveitis comprised of tuberculosis associated posterior uveitis was most common etiology seen in 1 (1.4%) patients. Out of 1 patients of tuberculosis related posterior uveitis; 2 patients had multifocal choroiditis and 1 patient had tuberculoma with serous retinal detachment. Panuveitis recorded in (n=2) patients, 1 (5.7%) patient was suffering from Vogt-Koyanagi-Harada’s (VKH) disease and other was idiopathic.
Conclusion: Our study recommends that patients with uveitis should undergo comprehensive ocular and systemic investigations to find the underlying etiology. All the patients must be managed according to the type of uveitis, they are suffering from and a watch should be kept on all the possible likely complications which will help a lot in preventing blindness from uveitis

Aim: The aim of the present study was to determine the HSG findings of genital TB in infertile women.
Methods: The present study was conducted in the Department of obstetrics and Gynecology, Advanced Maternity Fertility Centre Janm IVF, Bhagalpur, Bihar, India of 100 women who had a proven genital TB.
Results: The mean age was 26.6 ± 4.4 years, mean body mass index was 24.8 kg/m2, and mean duration of infertility was 6.08 years. Primary infertility was seen in 33 (66%) women, while secondary infertility was seen in 17 (34%) women. Normal cycles were seen in 50 women, menorrhagia in 10, hypomenorrhea in 30, oligomenorrhea in 5, primary amenorrhea in 3 and secondary amenorrhea in 2 women. There was no difference in the serum FSH concentration levels. However AMH and AFC were significantly lower.
Conclusion: Both laparoscopy and molecular tests are complementary tests and together can effectively confirm the diagnosis of Genital TB. Very often, it is the HSG finding that alerts the clinician as to the presence of GTB. Though imaging findings may be highly suggestive of TB, some of the features such as tubal block and hydrosalpinx are not specific for TB and may be seen in other infective causes of tubal damage also.

Pulmonary tuberculosis is respiratory infection caused by M.tuberculosis bacilli which occur via
aerosol. First line drugs used in the treatment of TB are Isoniazid (H), Rifampicin (R),
Pyrazinamide (Z) and Ethambutol (E). Use of multidrug regimens has been associated with
increased incidence of adverse drug reactions, involving all the major organs. However the
frequency of occurrence of ADRs to ATT involving major organs are not well known, so in this
study we tried to find out the most commonly affected organ due to ATT.

Tuberculosis (TB) is one of the major public health problems in Pakistan. Our country ranks fifth in tuberculosis high, burden countries worldwide. Hyponatremia is considered as one of the most common and important electrolyte abnormality in Pulmonary TB (P TB) patients. This study will show the prevalence of hyponatremia in PTB in our population. This study was planned to determine the presence of hyponatremia in pulmonary tuberculosis among adults and to correlate its severity.

To study of intrapleural  fibrinolytic therapy in loculated pleural collections
Material and methods: All 50 patients of parapneumonic effusions with persistent pleural fluid and poor chest-tube drainage (less than 150ml/day) despite an appropriately positioned and patent drain; multiple loculi or fibrin strands in pleura as depicted by ultrasonography or CT scan chest were included in the study. Imaging studies with either chest radiography, ultrasonography (USG) or computed tomography (CT) were performed before the initiation of IPFT to assess the quantification of fluid the site and size of loculations and the extent of associated pleural thickening, marking of chest wall for site of insertion of chest drain.
Results: In 52% (n=26) of patients, the pleural effusion is caused by tuberculosis since these patients are primarily from rural areas and have low socioeconomic level. However, there were 10% (n=5) cases of malignant pleural effusion and 20% (n=10) cases of pneumonia with complex parapneumonic effusion. 6% of cases (n=3) involved hemothorax, while 12% involved empyema. 54% of the group under investigation needed three cycles of IPFT, followed by 46% who needed just two cycles and 10% who needed three cycles. 25 participants were found to have had a 10% improvement in FVC, while 19 patients had a 20% improvement. Only six patients saw the maximal FVC improvement of 30%. After IPFT, the FVC might reach a maximum of 70%. According to USG chest imaging, 86% of subjects had effusions resolve to residual fluid less than 50 ml.
Conclusion: Studies have demonstrated that using intrapleural fibrinolytics is a good substitute for risky surgical treatments including VATS (video-assisted thoracoscopic surgery), thoracotomy, and decortication.

Tuberculosis (TB) has been a major cause of suffering and death since time immemorial. Despite microbiological cure of TB infection, many patients develop long term lung impairment and functional disability which leads to their continued suffering. A proportion of treated TB patients suffer from Obstructive Airway Disease (OAD) which is usually attributed to structural lung damage like cavitation, bronchiectasis, lung fibrosis, bronchial stenosis, emphysema and resorptive collapse. However, in our clinical practice, we are observing many patients with history of pulmonary tuberculosis presenting with symptoms of airflow limitation despite no chest radiograph abnormality.

Background: The association between necrotizing fasciitis and tuberculosis is extremely rare. We report a case in which the initial clinical presentation of tuberculosis was that of necrotizing fasciitis proven by histopathology. Repeated adequate surgical debridement was performed and was diagnosed to have pulmonary tuberculosis later on. The diagnosis of tuberculosis should be suspected in patients with necrotizing fasciitis with recurrence or unexpected slow response to surgery.

Background: Tuberculosis is one of the oldest diseases afflicting humans with significant mortality. Several studies have shown strong association between tuberculosis and hypocholesterolaemia, hypocholesterolaemia can be both consequence of tuberculosis or a risk factor for tuberculosis.
Methods: A longitudinal observational study was conducted inDepartment of Pulmonology of MIMS, Mandya for a period of one year from April 2021 to April 2022 recruiting 107 patients. Data was collected using Pre-tested semi-structured questionnaire including sociodemographic details, diagnostic details, treatment category, lab investigation details. 
Results: This study involved 107 newly detected tuberculosis patients. Total cholesterol at the diagnosis being 136.62, at the end of IP being 163.27, which increased to 182.57 at the completion of treatment. The mean triglyceride value at the diagnosis, at the end of IP and at the completion was 115.17,  134.37 and 152.21 respectively. The mean LDL levels showed increasing trend from the point of diagnosis to completion of treatment, the values being 89.71 at the diagnosis, 101.81 at the end of IP  and 113.1 at the completion of treatment. It was also found that mean HDL, LDL , VLDL and Triglyceride levels were found to show increasing trend during the course of treatment and pairwise analysis of the lipid profile in different phases of treatment was found to be statistically significant.
Conclusion: Completion of successful tuberculosis treatment is associated with increase in blood lipid levels, the current study adds to the existing literature

Background: Pulmonary tuberculosis is a major communicable disease worldwide. Tuberculosis and HIV is a major health problem in many parts of world. The National Tuberculosis and Leprosy Program annual report indicates that about 7% of all TB notified cases had co-infection with HIV. The incidence of Tuberculosis HIV co-infection increasing gradually.
Materials and Methods: The study is a Retrospective study conducted on 200 HIV reactive patients at ART center in a tertiary care hospital GGH Ongole. Data was analyzed for incidence of tuberculosis in HIV infected patients with CD4 counts and their association between them.
Results: Out of 200 HIV infected, 40 were detected with tuberculosis, of them 32 were pulmonary TB and 8 were extra pulmonary TB. In present study 26 (65%) of patients with CD4 count < 200 cells/μ l developed Tuberculosis, 9 (22.5%) of patients with CD4 count 200-400 cells/μl and 5 (12.5%) of patients with CD4 count > 400 cells/μl shows less number of pulmonary and Extra pulmonary TB.
Conclusion: There is a strong association between Tuberculosis and HIV. Incidence of TB is more when CD4 count less than 200 cells/μl. So it is essential to screen HIV reactive patients for TB along with CD4 count to prevent complications and mortality. This study showed that incidence of Tuberculosis pulmonary and extra pulmonary in HIV infective patients is significantly higher with CD4 count < 200 cells/µl.

Background: Tuberculosis (TB) has affected humans for most of their history and remains a major cause of mortality in adults worldwide Prevalence of Tuberculosis (TB) has been on a dangerous and positive spike for over a decade and has killed millions of people year on year. Almost, 1.3 million people in 2012 alone lost their lives to TB. As per the massive prevalence of TB, it would be incorrect to say that the disease does not poses like a pandemic. Alongside HIV, it remains a top cause of death from an infectious disease. Hence the present study was planned to evaluate the role of fiberoptic bronchoscopy in sputum negative pulmonary tuberculosis cases.
Materials and Methods: The study was carried out at Department of Pulmonary Medicine, Era's Lucknow Medical College & Hospital, Lucknow. Sputum smear negative presumptive patients of PTB. All the relevant samples were sent for Cartridge based nucleic acid amplification test (CBNAAT)/genexpert for BAL, post bronchoscopy sputum, bronchial aspirate, TBLB, Endobronchial biopsy and Transbronchial needle aspiration. Culture for Mycobacterium tuberculosis (MTB) was also obtained for all the patients. Culture is done on liquid media (MGIT).
Results: Majority of patients in the study population were adults: 21-60 years (82.6%), while only a small proportion of patients were aged ≤20 years and >60 years (8.7% each). Majority of patients in the study population presented with Cough (88.0%), Fever (78.3%), Loss of appetite (67.4%), Expectoration (63.0%) & Weight loss (56.5%). Majority of patients had negative CBNAAT (81.5%), AFB (95.7%) and Culture (77.2%) for Bronchial Aspirate. Thus indicating that fiberoptic bronchoscopy helps in establishing the diagnosis.
Conclusion: Considering the short processing time and high diagnostic efficacy, CBNAAT evaluation of bronchoalveolar lavage for detection of tuberculosis among sputum/smear negative tuberculosis cases is highly recommended

Introduction: Among extrapulmonary infections, tuberculosis of the ankle joint is very uncommon. Early diagnosis of tuberculosis of the ankle joint is quite difficult because of its uncommon site, non-specific sign & symptoms, and negligence 
Case report: A 38-year-old female presented with right ankle pain and swelling for 3 months with a history of twisting injury to the right ankle 3 months back. She had no history of infection in the past ( at least for the last 1-2 years). The only complaint she had was recurrent pain and swelling of the right ankle joint for which she was being managed conservatively for the last 3 months. When she came to the outpatient clinic, presented with a swollen and tender right ankle joint and she was afebrile. Magnetic resonance imaging was not sufficient to conclude the diagnosis. TB arthritis was diagnosed by diagnostic arthroscopy. Eventually, anti-TB therapy eradicated the infection 
Conclusion: Early biopsy and synovial fluid for a polymerase chain reaction, gene Xpert should be performed in all suspicious cases to confirm the diagnosis and management

Background: In India, Tuberculosis remains a major public health problem. Tuberculosis is an infectious disease caused by Mycobacterium Tuberculi. The disease primarily affect the lungs and cause Pulmonary Tuberculosis. Present study aimed to assess effectiveness of Information Booklet on knowledge regarding Tuberculosis and importance of drug regimen. Objective- To assess effectiveness of information booklet on knowledge regarding importance of drug regimen among Tuberculosis patients attending clinic. Methodology : By using evaluative approach ,pre experimental design-one group pre test-post test design was used. Total 60 subjects selected by using Non-probability purposive sampling technique was used to select the respondents. A structured knowledge questionnaire was administered to assess knowledge of tuberculosis and importance of drug regimen among tuberculosis patients on the first day; then information booklet was administered on the same day of pre test to participants. After 7 days of administration of information booklet, structured knowledge questionnaire was administered to participants to assess the effectiveness of information booklet.

Background: The present study was conducted for evaluating the prevalence of Coexisting active pulmonary tuberculosis in tuberculous spondylitis patients.
Materials &Methods: A total of 50 known cases of tuberculous spondylitis were included in the present study. Complete demographic and clinical details of all the patients was obtained. Only those patients were involved among which histological or microbiologically confirmed diagnosis of TB spondylitis among surgically confirmed TB spondylitis was present. Complete past medical history of all the patients was reviewed. Analysis of spine CT scans and magnetic resonance (MR) images was done for each affected level and reviewed chest plain radiographs and CTs to evaluate lung involvement in TB. All the results were recorded and were subjected to statistical analysis using SPSS software.
Results:A total of 50 patient with mean age of 52.3 years were analysed. Overall incidence of co-exiting active pulmonary TB among tuberculous spondylitis patients was 36 percent.
Conclusion: Since higher chances of coexisting active pulmonary tuberculosis in TB spondylitis patient can be easily overlooked, there is a chance of the possibility of nosocomial infection of TB.

Background: The most noticeable part of human body is face. The obvious boundaries on the skin known as Pigmentary Demarcation Lines (PDL) found over face and have clear borders of abrupt transition between more hyper-pigmented skin and areas of normal skin pigmentation due to differences in melanocyte distribution that may be influenced by multiple factors. Facial pigmentary demarcation lines (PDL) directly reflect on patient’s physical appearance and self-image as they may contribute to dysmorphism and even central to depressive illness in susceptible individuals posing cosmetic concern for the patient and a challenge for dermatologist. Therefore, it is important for early identification and management of facial skin disorders. Until now, nine different types of PDLs have been described which are designated as Type A to I of which Type F to H PDLs are most common on the face. Etiology involving the whole spectrum of PDL continues to be an enigma and needs further research among Indian population.
Materials and Methods: Total 304 patients between 15 to 75 years of age range were included in study lead between May 2018 to May 2020 after thorough examination for inclusion and exclusion criteria, informed consent and Ethics committee approval. Statistical analysis was done using descriptive and inferential statistical approach using Chi-square test and Fisher’s exact test and p value was calculated and considered to be significant if <0.05.
Results: Out of 304 study subjects the frequency of facial PDL type H (50.65%) was most common than type G (29.60%) and type F (19.73%) with male predisposition (79.60%) with agricultural occupations (59.86%) than females and with significant family history from father (41.44%). Most of the present study subjects were of Fitzpatrick skin type IV (50.01%) with hyper-pigmented macules (12.5%) and shown unilateral PDL symmetry (58.22%) with sharp PDL line margins (81.25%). The most common aggravating factor was prolonged exposure to sun light (56.90%) and most of (25.98%) the subjects experienced periorbital melanosis at different times. Diabetes (38.15%) and hypertension (29.60%) were the most common co morbidities observed in study subjects. Using Fishers exact test, p value was calculated and it was found to be highly significant (p=0.003).
Conclusion: Present study pronounces the incidence of facial PDL (types F-H) are sharply common especially amongst the males who are in agricultural occupations with prolonged sun exposure and with other co morbidities like diabetes, hypertension and tuberculosis. In females the prevalent type was Type H PDL during and after pregnancy. The agricultural occupations with prolonged sun exposure, diabetes, hypertension, tuberculosis and positive paternal family history were shown strong correlation with facial PDL among Indian population irrespective of gender and it was found to be highly significant (p=0.003).

INTRODUCTION: Tuberculosis is one of the oldest disease and affected globally involving lungs but also studies have shown that tuberculosis affects  bone marrow which causes significant haematological abnormalities These haematological changes acts as a potential marker for the diagnosis and persistent excretion of acid fast bacilli,which is associated with failure of these indices to return to normal.In addition ,these changes have correlation with severity of clinical findings of pulmonary tuberculosis.
AIMS AND OBJECTIVES:To evaluate haematological parameters  among pulmonary tuberculosis patient.
MATERIALS AND METHODS:This is a case control study was carriesd out for a period of 1year from January 2018 to April 2019. A total of 50 patients who are diagnosed with Pulmonary Tuberculosis were taken up as cases.  The control group consisted of 50 healthy individuals who were selected by purposive sampling. About 2 ml  EDTA tube was used for haematological analysis. Sysmex haematology analyser with 6 part  as well as peripheral smear examination was used for analysis. The remaining 2 ml of blood was used for determining ESR by westergren tube method.

Background: Tuberculosis is among the most common opportunistic infections in people living with HIV/AIDS and is also the most common cause of peripheral lymphadenopathy. These lymph nodes revealed four different patterns on FNAC, which indirectly reflected the immune status in these people. CD4 counts, being a primary marker for immunological status in HIV people, were used to initiate ART, monitoring disease progression and management. The present study was aimed to correlate these four cytomorphological patterns with CD4 counts.
Results: In the present study we observed that CD4 counts varied significantly with different cytological patterns. Pattern 1, having a lower CD4 counts, reflects a poor immune response, whilst pattern 4, having higher CD4 counts reflected a better immune response.
Conclusion: FNAC patterns can be used to predict the CD4 counts where flow cytometry facilities for CD4 count estimation may not be available.

Background: Tuberculosis is one of the world’s potentially life-threatening communicable diseases. The disease burden is more in developing countries. Pulmonary tuberculosis can lead to several serious complications. Unilateral lung destruction and complete destruction of a major part of lung or entire lung is common, and it results from parenchymal and airway involvement. Chest radiographs & computed tomography of chest is the mainstay in the detection of the destroyed lung.
Objective: To describe the radiographic and computed tomographic findings in patients with tuberculous unilateral lung destruction.
Martial and Methods: In this report, we present a review of 50 patients withUTLD secondary to TB. Case records of the patients were retrospectively evaluated for clinical data and treatment history.Retrospective review of the images was performed by two radiologists and relevant findings were studied.  Important findings were noted.
Results: A total of 50 patients with unilateral complete lung destruction were evaluated. Age ranged from 25 to 68 years. Chest radiograph showed a small opacified hemithorax with mediastinal shift, crowding of ribs. Computed tomography showed loss of lung volume with fibrosis, bronchiectasis, and cavities. Left lung destruction was predominant (41/50, 82%). 22(44%) patients had fibrosis or cavities in contralateral lung. 16 (32%) patients had features of active disease in contralateral lung. 3(6%) patients had aspergilloma in the affected lung.
Conclusion: Males are more commonly affected. Left lung is more commonly involved compared to the right. Characteristic radiological findings are unilateral volume loss, reduced size of the ipsilateral pulmonary artery and pulmonary veins and hyperinflation and herniation of contralateral lung.

Retro pharyngeal abscess is infection followed by collection of pus in retro pharyngeal space. In the adult group they are usually secondary to trauma, foreign bodies, or as a complication of dental infections. Early diagnosis and the wide spread use of antibiotics have made these infections less common today . Non-specific acute retro pharyngeal abscess most commonly occurs in infants and young children. It is rare in adults mostly associated with tuberculosis of the cervical spine. Some cases of acute retro pharyngeal abscesses have been reported in adults following foreign body ingestion and in immunocompromised individuals. The present study attempts to document acute retro pharyngeal abscess in adults following trauma. Majority of patients recovered with conservative management but some required incision and drainage.  Diabetes mellitus was the comorbidity in one third of patients.  The management of these cases is based on antibiotics and surgical drainage.

Tuberculoma of the brain is a dangerous disease that is becoming more common in developed countries as tuberculosis continues to spread. At first, antimycobacterial drugs are used to treat brain tuberculoma. But neurosurgery is the main part of treatment. Surgery is needed if the tuberculoma does not respond to medical treatment, if it is causing symptoms, or if there is no other way to find out what is wrong. In this paper, we talk about four cases of posterior fossa tuberculomas in people who had never had tuberculosis or a weak immune system before. Brain tuberculosis had to be treated with surgery in all cases for it to go away safely and effectively.

Background:Tuberculosis is an ancient disease observed during the Neolithic period and remains a serious problem in developing countries. Tuberculosis is a disease that can affect all age groups and all genders and can affect all organ systems in our body. Tuberculosis can affect most of the body's hematological parameters. TB affects hemoglobin levels, total number, red blood cell count, erythrocyte sedimentation rate, and platelet count, causing anemia, leukopenia or leukocytosis (extrapulmonary TB), thrombocytopenia, and increased ESR. Along with HIV, tuberculosis exacerbates the scenarios of thrombocytopenia, anemia, leukopenia, and pancytopenia. Aim: This study was done in NRI medical College Guntur to find out the haematological manifestation of pulmonary TB and to compare it with the hematological manifestation in HIV –TB co-infected patients.
Materials and Methods: 80 patients of more than 15 years of age group was selected for the study, who willingly consented to participate in the study. They were divided in 2 groups of 40 patients with only pulmonary TB and 40 patients with HIV – TB co-infected, according to ELISA positivity. Statistical comparison was analysed usng CHI square test.
Results: In our study, patients with tuberculosis had an elevated ESR count, but TB-HIV coinfection reduces the ESR count. 48% of TB with HIV anaemic men and 25% of women had 11 gm/dl. 46.25 percent of anaemic TB patients without HIV were male and female (27.02 percent). 56% of men had TB with HIV and 48% had TB without HIV. In the TB without HIV group, 51.1% of males and 27.9% of females had total RBC counts ≤ 3.8 million cells/cumm, compared to 51.3% of males and 35.1% of females in the TB with HIV group.
Conclusion: The study concluded that ESR is a marker of chronic inflammatory conditions such as tuberculosis and that HIV is an immunosuppressive state, and that co-infection with tuberculosis and HIV significantly reduces ESR scores in these patients.

Background: Tuberculosis (TB) remains one of the world’s deadliest diseases and has
surpassed AIDS as the leading cause of death due to infectious disease. The present
study was conducted to assess 30 cases of oral tuberculosis.
Materials & Methods: 30 cases of oral tuberculosis of both genders were involved.
Parameters such as patients’ sex, age, developmental site, clinical presentation were
obtained. All patients were diagnosed by histopathological examination.
Results: Out of 30 cases, males were 20 and females were 10. Common site involved was
tongue in 22, labial mucosa in 3, lower lip in 2 and buccal vestibule in 3 cases. Clinical
presentation was mass in 11 and painless ulcer in 19 cases. The difference was
significant (P< 0.05). Histopathological findings were non- caseating granuloma in 23
and caseating granuloma with necrosis in 7 cases. The difference was significant (P<
0.05).
Conclusion: Maximum cases of tuberculosis was seen among males. Common site
involved was as painless ulcer.

Background : This study aims to determine the effect of a combination regimen of
metformin and without metforminon the conversion of sputum smear in new cases
of pulmonary TB patients with type 2 DM.
Materials andMethods: This cross-sectional study was conducted at Wahidin Sudirohusodo
Hospital, Makassar Center for Lung Health, Kasi-Kasi, and Sudiang Community
Health Center from August 2019. This study involved 83 new cases of pulmonary
TB subjects with T2DM. New cases of pulmonary TB patients were obtained by examining AFB sputum in DM patients who had symptoms of pulmonary TB and had no history of suffering or receiving previous anti-TB drug therapy.Pulmonary TB patients receive category 1 anti-TB drugs andDM subjects were divided into 2 groups is metformin and non-metformin. Then, smear sputum is examined in the 2-month intensive phase of anti-TB drug therapy to assess the conversion of AFB sputum.
Results: From a total of 83 new cases of pulmonary TB and T2DM, 44 subjects received a combination regimen of metformin and 39 subjects non-metformin. In this study, there were 42 (95.5%) subjects who conversion sputum smear in the metformin group more higher than in the  non-metformin group but statistically it was not significant (p = 0.282).
Conclusion: There was no significant relationship between the metformin and non-metformin groups on the conversion of AFB sputum smear in new cases of pulmonary TB patients and T2DM.

India accounts for 26% of the words Tuberculosis population. The WHO’s Global TB Program states that in India, the number of people newly diagnosed with TB increased by 74% when compared to other countries from 1.2 million to 2.2 million between 2013 and 2019. Tuberculosis was and still remains a disease that causes high death rates in the country. Many of these deaths can be easily prevented if diagnosed at an early stage. The easiest, cost-effective and non-invasive method of detecting tuberculosis is through a frontal chest x-ray (CXR). But this requires a radiologist to manually examine and analyse each of the X-ray, considering the heavy patient count this puts a great burden on the resources available. A computer aided diagnosis system can easily mitigate this problem and can greatly help in reducing the cost. In recent times deep learning has made great progress in the field of image classification and has produced remarkable outputs in terms of image classification in various domains. But there still remains a scope for improvements when it comes to Tuberculosis detection. The aim of this study is toapply three pre-trained convolutional neural networks that have proven record in image classification on to publically available CXR dataset and classify CXR’s that manifest tuberculosis and compare their performances. The CNN models that are used on our CXR images dataset as a part of this study are VGG-16 ,VGG-19,AlexNet ,Xception and ResNet-50. Also visualization techniques have been applied to help understand the features whose weights played a role in the classification process. With the help of this system, we can easily classify CXR’s that have active TB and even CXR’s that show mild abnormalities, thus ensuring that high risk patients get the help they require on time.

A total of 2105 patients with pulmonary tuberculosis were examined, of which 19.5% of patients were found to have concomitant pathology. It was found that in patients with concomitant pathologies, tuberculosis is severe, with severe symptoms of intoxication and respiratory manifestations. Isolation of MBT and the presence of drug resistance were higher in the group of patients with concomitant pathology. The presence of concomitant pathology adversely affects the clinical course of pulmonary tuberculosis.

Background
Tuberculosis (TB) is a problem in developing countries, because the rate of disease incidence is still high and included in the big 10 leading cause of death in the world. As TB prevalence cases increase, community participation in finding new TB cases is very important. The method that used by various countries is by community-based case finding or Active Case Finding in the community (Active Case Finding).
Purpose
Evaluating the program implementation in the discovery of new TB cases by TB careworker at the health center in an effort to control TB in DIY (Daerah Istimewa Yogyakarta, DIY).
Method
This type of research is a quantitative survey. The subjects are TB worker in Puskesmas Yogyakarta, as much 120 people. The instrument used was a questionnaire containing ways of case finding, knowledge, behavior, case finding constraints, types of activities, and main tasks. The analysis uses frequency distribution and is presented in tabular form.
Result
TB worker in Puskesmas DIY have taken several ways in carrying out new TB case finding; such as Active Case Finding, Pasive Case Finding, knock on the door, counseling, screening and screening. There are some obstacles in the implementation of the discovery of new TB cases; such as limited time and lack of personnel, lack of budget, multiple task burdens, and some areas that do not yet have cadres. The majority of TB careworker are nurses (90%). The aim of new TB cases found in DIY Province was only 48.3% from the target.

Mankind has struggled with many diseases throughout its history. Infectious diseases are especially prevalent among the population. According to its scope, such infectious diseases are called pandemics, epidemics. Among the population of Central Asia, a number of diseases, such as plague, plague, malaria, tuberculosis, and ringworm, have caused partial or mass extinction. The characteristics of the geographical distribution of these diseases largely depended on the natural and social geographical conditions of the regions, the lifestyle and traditions of the population.The effects of the Spanish flu pandemic, which has killed nearly 100 million people in the last hundred years among a wide range of diseases, have had a profound effect on the nosogeographic situation, especially in Europe and later in the Americas. Analyzes show that the deterioration of the environment, man's unlimited domination of nature, the deterioration of the ecological situation, as well as the spread of related diseases on earth pose new challenges to medical geography, which studies the causes and patterns. The rapid development of science and technology, the steady increase in human impact on nature and consequently, a number of negative changes in the natural environment have a significant impact on human health. The acceleration of the process of urbanization which in turn causes problems such: as air, water and soil pollution.

The number of pulmonary tuberculosis (PTB) cases in Indonesia is second ranks in the world. South Sulawesi contributes significantly to the increase of PTB cases in Indonesia. This study explored the spatial dynamics of PTB cases in the highlands and lowlands of Gowa regency, South Sulawesi. This study aimed to present spatial patterns of TB spread in highland and lowland areas in gowa district based on environmental health parameters that will assist in formulating prevention policies and regional-based control strategies.This study used quantitative with spatial analysis approach. The respondents of this study were all registered PTB patients on medical records in the PTB control unit at Health Center in the highlands and lowlands of Gowa regency. Total sample of this research was 156 respondents, derived from 57 in highland and 99 in lowland. Territorial analysis was applied to detect PTB spatial patterns in two regions with different elevation. The variables in this study focused on environmental characteristics in each region.PTB Prevalence in lowland was relatively higher than highland. Temperature and density of occupancy were the determinants of the high prevalence of PTB in the lowlands. At the highland, humidity factor, ventilation area, floor and wall condition were high contributing to PTB incidence (more than 60%). meanwhile, on the lowland, those factors were not significant.This study identified the PTB spatial distribution of highland and lowland by analyzing cases per 100,000 peoples and could be used to develop effective strategies for PTB prevention and control by exploring environmental health factors of public health.

Background:In 2017, East Java Province was ranked second in Indonesia to discover tuberculosis (TB) patients. The Southern Regional Health Center of Kediri City was ranked fifth out of 27 cases.
Objectives of the study: This study aims to analyze the problem and prioritize health issues of TB in the Southern Regional Health Center of Kediri in 2019.
Methods: The observation was carried out using performance assessment for the Southern Regional Health Center data in 2018 with the ultrasound and fishbone methods.
Results: It was noticed that all TB cases were found and treated, including the discovery of suspected TB cases and the successful treatment of all TB cases (Success Rate/SR). The main problems in the Southern Regional Health Center in 2019 were that the suspected tuberculosis sputum pot was not returned, the people’s lack of knowledge, and less active TB cadres.
Conclusion: Some of the problems found are the lack of knowledge regarding TB, less active TB cadres, lack of coordination among TB cadres, limitation of people who are willing to become TB cadres, and the time limitation of TB cadres.

Background:In 2017, East Java Province was ranked second in Indonesia to discover tuberculosis (TB) patients. The Southern Regional Health Center of Kediri City was ranked fifth out of 27 cases.
Objectives of the study: This study aims to analyze the problem and prioritize health issues of TB in the Southern Regional Health Center of Kediri in 2019.
Methods: The observation was carried out using performance assessment for the Southern Regional Health Center data in 2018 with the ultrasound and fishbone methods.
Results: It was noticed that all TB cases were found and treated, including the discovery of suspected TB cases and the successful treatment of all TB cases (Success Rate/SR). The main problems in the Southern Regional Health Center in 2019 were that the suspected tuberculosis sputum pot was not returned, the people’s lack of knowledge, and less active TB cadres.
Conclusion: Some of the problems found are the lack of knowledge regarding TB, less active TB cadres, lack of coordination among TB cadres, limitation of people who are willing to become TB cadres, and the time limitation of TB cadres.

Background: Tuberculosis (TB) is still a global problem. The high incidence of TB is due to the less than optimal TB risk factor interventions. This study aims to analyze the risk factors for TB incidence in the coastal area of the lake, Towuti District, East Luwu Regency.
Methods: This study used a case-control design conducted in the coastal area of the lake, Towuti District, with a sample of 34 cases and 94 controls. Bivariate analysis and logistic regression were used to analyze the risk factors for the incidence of tuberculosis.
Results: The results showed that the significant risk factors for TB incidence were family history (OR = 13,920; 95% CI: 4,36–51,23), household contacts (OR = 3.04; 95% CI: 1.188–7,809), close contact (OR = 8.382; 95% CI: 2.969–24, 852), home ventilation (OR = 14.357; 95% CI: 1.585–669.82), income (OR = 2.609; 95% CI: 1.033–6.675) . Home ventilation is the most dominant risk factor for TB incidence in the coastal area of the lake in Towuti District.
Conclusion: TB disease control strategies based on risk factors need to be implemented in coastal areas.

Tuberculosis is a contagious syndrome that leads to death Worldwide. In majority of the developing countries, the access to the diagnostic tool and the test usage is relatively poor. Now the recent advancement in the field of Artificial Intelligence may help them to fill this technology gap. Computer Aided Detection and Diagnosis helps in diagnosing the diseases through some clinical symptoms as well as X-ray images of the patients. Nowadays many strategies are formulated to increase the classification accuracy of tuberculosis diagnosis using AI and Deep Learning approaches. Our survey paper, focus to describe the wide AI and deep learning approaches employed in the diagnosis of tuberculosis.

Liver is the most important vital organ that carries out metabolism of body e.g. formation of cholesterol and triglycerides, synthesis of glycogen, formation of blood clotting proteins and bile formation. Hepatic damage and subsequent liver failure due to both unintentional and intentional acetaminophen overdose has afflicted patients for decades and includes the metabolic cornerstone pathways that exist within hepatocytes in the microsomes. The side effects of drugs on the hepatocytes have been overlooked for years. Drug induced liver injury is the most adverse effect observed in clinical practices. It accounts for around half of acute liver disorder. Anti tuberculosis drugs and acetaminophen overdose are the main issues that result in death from curable diseases. Metabolism of isoniazid and acetaminophen (APAP) results in the formation of toxic metabolites that results in the oxidative stress and glutathione (GSH) store depletion leads to hepatocellular necrosis and steatosis. Alcohol consumption is also the most common cause of liver cirrhosis. Liver peroxidation is considered to be the major mechanism of alcohol-induced hepatotoxicity. To overcome this oxidative stress, there is need of antioxidants that can balance the redox homeostasis of liver by lowering the APAP overdose effect. Consumption of natural antioxidants derived as secondary metabolites from plants in the form of polyphenols and flavonoids prevent oxidative stress. Medicinal plants are best remedies used for hepatotoxicity caused due to oxidative stress. They are cost friendly, easily available and have no mutagenic effect. Herbal medicines form important part of traditional healthcare system of India.

Tuberculosis (TB) is one of those diseases which shows greater impact on public health. It causes serious infections inside the human body, if it is present in the active state. Its treatment is available in the form of vaccines, drugs etc. It is caused by Mycobacterium tuberculosis. This bacterium has the tendency to become drug-resistant by its characteristic mechanism. For better treatment on this disease, we need to collect and analyse data properly during the drug designing. Currently, many databases like Mycobacterial Database, TB Database, TubercuList, TBrowse etc are available which helps the researcher in collecting the required data. These databases play a major role in a successful research. CADD (computer aided drug design) has been utilized in creating, modifying, analysing or optimizing a design. This software is used to raise the production of designer, improve quality design, enhance communications through documenting and for the crfeation of a database to manufacture.by using CADD researchers can know about the drug molecule which have potential with the help of databases.