European Journal of Molecular & Clinical Medicine

To determine the clinical and radiological features of pulmonary TB in diabetic mellitus patients.
Methods and materials: After receiving approval from the ethics council, the study was conducted on 100 individuals with DM and PT. A comprehensive history, clinical examination, sputum analysis for acid fast bacilli, and chest radiography were used to diagnosis PT. The clinical profile, pertinent tests, and radiological data were collated and analysed.
Results: Males made up 55 percent of the study sample, while females made up 45 percent. Cough (75%), fever (65%), and anorexia (77%) were the most common symptoms reported. Other symptoms included hemoptysis (13%), weight loss (51%), dyspnea (21%), chest discomfort (21%), and night sweats (41%). 24% of the patients had a history of tuberculosis, 13% had related hypertension, 9% had associated ischemic heart disease, 67% of male patients were smokers, and 9% had a family history of tuberculosis. Right sided lung lesions were found in 45% of patients over 45 years old and 31.67% of cases under 45 years old, whereas left sided lesions were found in 27.5% of cases under 45 years old and 28.33% of cases over 45 years old. Bilateral lesions were seen in 27.5% of individuals under the age of 45 and 40% of cases beyond the age of 45. Lesions in the lower lung field were seen in 43% of the patients. The chest x-ray revealed a cavity in 30% of the patients, a fibrous cavity in 11% of the patients, and an infiltrative lesion in 9% of the patients. Consolidation (7%), pleural effusion (7%), hydro pneumothorax (3%), parenchymal opacity (2%), and bronchiectasis (4%) were also seen.
Conclusion: Severe hyperglycemia seems to be a risk factor for diabetics developing pulmonary TB. Diabetes seems to have no influence on the presenting characteristics of pulmonary TB.

Comparative study on the effect of VIT-D supplementation on the treatment course of pulmonary tuberculosis.
Material and methods: Patients presenting with sign and symptoms suggestive of pulmonary TB, diagnosed as TB and who were receiving the treatment from the study institute. TB Score, Smear Conversion, Health Related Quality of Life, Changes in the level of C-Reactive Protein, Erythrocyte Sedimentation Rate (ESR), and Haemoglobin concentration and Serum Vitamin D levels were measured. At the beginning of the treatment patients were divided in the following two groups based on the mutual decision of the treating physician and the participants. 100 patients were include in this study and divided into two equal groups.  Supplementation Group: Patients advised category I DOTS therapy and Vitamin D supplementation. Routine Care Group: Patients advised category I DOTS therapy.
Results: The mean time to sputum conversion was shorter among patients given Vitamin- D (9.7 weeks) in comparison to control group (11.2 weeks), however, the difference was not statistically significant (p=0.0621). After being on treatment for 8 weeks; the TB score decreased to 4.90 in the Vit-D group and 6.6 in control group, the difference was statistically significant. (p-0.0012). However, there was no statistically significant difference in the TB score at 12 weeks of treatment (p=0.342). After taking the treatment for 8 weeks, the quality-of-life score was 15.1 in Vit D group and in control it was 13.4, the difference is statistically significant (p-0.004). At 12 weeks also the difference in QoL score was significant (p<0.001) among the two groups. Consequently, the overall change in Quality-of-life score was also statistically significant. (p<0.001). The change in Serum Vit-D values was almost similar between both the test and control groups at 0 weeks (42.979 and 40.788 respectively) and the difference is not statistically significant. (p=0.213). At 8 weeks duration the Serum Vit-D level was 62.419 in the test group and in control it was 37.788, the difference is statistically significant. (p<0.0001) and at 12 weeks also the change is significant. (p<0.0001).
Conclusion: The rate of seroconversion was faster among Vitamin D group. Vitamin D supplementation can safely and efficiently raise the proportion of sputum smear and culture conversion. However, it may not have enough positive impacts on the time to sputum conversion. The participants who received vitamin D saw a speedier improvement in quality of life and a quicker reduction in the intensity of TB-related symptoms.

Background: India is the world's largest TB epidemic country, with approximately 2-3 million new cases of TB. Diabetes mellitus (DM) is an emerging chronic health condition of developed and developing countries. It increases the risk of developing active TB by a factor of 2–3 compared with normal population. Materials And Methods: Patients with sputum smear positive pulmonary tuberculosis with diabetes mellitus were enrolled for a prospective observational study at GMC Jammu in India. Diagnosis of Diabetes Mellitus was based on the following criteria: Blood Sugar Fasting > 126 mg/dl, Blood Sugar (after 2 hrs during OGTT) > 200mg/dl and HbA1C > 6.5%. Results: Persons with diabetes mellitus (DM) have a 3-fold increased risk of developing tuberculosis. The median age of the Diabetic patients was significantly higher than the non-diabetics. Magee et al reported that TB–DM patients were significantly more likely to be older. After 2 months of treatment, the sputum positivity decreased in both the groups. There were significantly more Diabetics (28%) as compared to non- diabetics for AFB (P<0.05).  Conclusion: After anti-TB treatment, the sputum positivity decreased in both the diabetics and non-diabetics. However, decrease was less in diabetic patients at 2 months of treatment. Increasing age was an independent risk factor of increased risk of symptoms. Patients having both tuberculosis and DM should be screened for TB in early stages.

The initial step in the diagnosing of PTB is by sputum microscopy and chest radiography under the National Tuberculosis elimination program (NTEP) in patients with presumptive Koch. Examination of the sputum smear is very simple and remains very economical as only minimum training of the technician is needed, and is available in most of the healthcare facilities, free of the coast and is less cumbersome to the patients because of the availability of the results on the very same days. Patients who had less than 1 ml of sputum were defined as having poor sputum- scarce disease. A confirmed case of pulmonary tuberculosis was one in which Mycobacterium tuberculosis (MTB) grew on mycobacterial cultures by solid or liquid culture medium, which was taken as the gold standard. Patients of either gender aged above 12 years of age, that had suspected pulmonary tuberculosis on clinical or radiological grounds, were included in the study. Smear-positive cases, those with disseminated or extrapulmonary tuberculosis patients were excluded from the study. Majority of the study subjects had a cough, 81.3% had expectorations, 82.5% subjects had a loss of appetite, 68.8% had a loss of weight, 36.3% subjects had dyspnea, 18.8% subjects had hemoptysis, 63.8% subjects had evening rise in temp.

Background: Occurrence and risk of tuberculosis is more among diabetes mellitus patients in relation to non-diabetic patients due to weakened immune system. As a result, affected patients have difficulty in responding to any kind of treatment when compared to healthy individuals.
Objective: To study the clinical and radiological profile of pulmonary tuberculosis among diabetic and non-diabetic patients.
Methods: The prospective study was conducted at the department of General Medicine, in Mahatma Gandhi Medical College and Hospital Jaipur a tertiary health care centre in Rajasthan. In the study patients were grouped into one having PTB with DM and other group PTB without DM. Informed written consent was obtained from all patients and their clinical, radiological features were recorded.
Results: A total of 60 patients (20 to >60 years) were enrolled in the study with equal numbers being grouped in the 2 categories. In our study majority of diabetic patients are males with more occurrence in >30 yrs age group having more sputum positivity with consolidation as major findings
Conclusions: Diabetes is a well-known risk factor for pulmonary tuberculosis. All patients of pulmonary tuberculosis should be screened for Diabetes especially above 30 years age group and early and prompt treatment should be started.

Background: There is an increase in incidence of tuberculosis (TB) despite successful implementation of directly observed treatment, short course (DOTS) in India. The burden of diabetes and tuberculosis is more in developing countries and these diseases often coexist. Suboptimal control of diabetes predisposes the patient to tuberculosis and is one of the common causes of poor response to anti-tubercular treatment.
Objective: To study the efficacy of DOTS therapy in newly diagnosed patients of pulmonary tuberculosis with and without associated diabetes.
Methods: The prospective study was conducted at the department of General Medicine, in Mahatma Gandhi Medical College and Hospital Jaipur a tertiary health care centre in Rajasthan. In the study patients were grouped into one having PTB with DM and other group PTB without DM. Informed written consent was obtained from all patients and their clinical features were recorded. DOTS treatment was initiated and patient were followed up monthly for sputum conversion and weight gain.
Results: A total of 60 patients (20 to >60 years) were enrolled in the study with equal numbers being grouped in the 2 categories i.e. PTB with DM and PTB-non DM. More sputum positivity 21(70%) was associated with diabetic group. Sputum conversion were seen in 3 patients in diabetic group whereas it is seen in 1 patient in non-diabetic group in 2-3 months. Average weight gain is more in non-diabetic as compared to diabetic patients.
Conclusions: Good glycaemic control is needed for effectiveness of DOTS therapy. Early screening and diagnosis of Diabetes in patients of pulmonary tuberculosis will definitely help in management of both the disease.

Background:Tuberculosis is most commonly found among people living in poor
conditions and in deprived areas, especially in elderly people and those with unstable
social or psychiatric backgrounds, such as hostel dwellers, street dwellers, alcoholics,
and drug misusers, as well as in immunocompromised patients.The present study was
conducted to assess fluoroquinolone resistance among pulmonary tuberculosis patients.
Materials & Methods:58 pulmonary TB patients of both genders were included. All
patients were subjected to DST for first-line drugs (FLDs) and second-line drugs. FQs
DST was also performed using automated Mycobacterial Growth Indicator Tube-960
liquid culture technique. The immunochromatographic assay was performed to
distinguish Mycobacterium tuberculosis complex (MTBC) from non-MTBC
Results: Out of 58, males were 38and females were 20. One drug resistance such as
Ofloxacin was seen in 28, levofloxacin in 3 cases, moxifloxacin in 1 and Kanamycin in 1
case. Two drug resistance such as Kanamycin+ Ofloxacin in 2 and Levofloxacin+
Ofloxacin in 1 case. Three drug resistance such as Ofloxacin+
Levofloxacin+Moxifloxacin in 1 and Ofloxacin+ Levofloxacin+ Kanamycin in 1 case and
all sensitive isolates was seen in Ofloxacin+ Levofloxacin+ Kanamycin+ Moxifloxacin in
20 cases. The difference was significant (P< 0.05).
Conclusion: Fluoroquinolone resistance among drug sensitive and multidrug resistance
tuberculosis isolates was high

Background: Tuberculosis, a public health emergency, has continued to be burden for society both in terms of mortality and morbidity. Once diagnosed, the follow up for assessment is usually done clinically or methods which are not very effective or require expertise.

Tuberculosis is a contagious bacterial infection which primarily affects the lung parenchyma
but it can affect any other part of the body. Mycobacterium tuberculosis complex is mainly
responsible for majority of cases in India and worldwide, but other species are also
responsible for causing tuberculosis among which includes M. bovis, M. africanum, M.
microti, M. Canetti. We retrospectively reviewed 40 patients of histologically or
microbiologically proven diagnosis of TB spondylitis from the time period of January 2020 to
October 2021 in the Radio-Diagnosis and Imaging Department of Pacific Medical College
and Hospital, Udaipur, Rajasthan, India. Findings such as cavitation, consolidation, tree in
bud opacities, miliary nodules are suggestive of pulmonary tuberculosis. Out of 5 patients
suffering from active pulmonary tuberculosis, cavitation was seen in 20% (1 patient) on chest
skiagram whereas 40% (2 patients) showed cavitation on HRCT chest. Consolidation was
seen in 60% (3 patients) on chest skiagram whereas it was seen in 80% (4 patients) on HRCT
chest.

The main reason for this high mortality is the lack of proper diagnosis at the right time. This
is particularly important in patients with HIV and TB co-infection; especially with extra
pulmonary TB as the detection rates are low. There is an urgent need to implement newer
diagnostic modalities for the detection of TB especially in highly HIV prevalent areas.
Patients satisfying inclusion criteria i.e. HIV positive patients clinically and/or radiologically
suspected of pulmonary tuberculosis whose sputum AFB is reported negative were subjected
for CBNAAT. This was done with the intention of identifying yield of CBNAAT over
microscopy. Among patients with abnormal chest x-ray, 84.6% had positive CBNAAT while
in those with normal chest X-ray, 81.1% had negative CBNAAT. Hence majority of patients
with abnormal chest X-ray findings had positive CBNAAT while majority of those with
normal chest x-ray had negative CBNAAT.

Background: TB and HIV form a lethal combination, as each fuels the progress of the other in the infected patients. This study assessed the haematological parameters of pulmonary tuberculosis (PTB) patients with and without HIV infection attending the shyam shah medical college, Rewa. Aims: To study hematological parameter namely Hb (Hemoglobin), total RBC count, Total WBC count, ESR (Erythrocyte Sedimentation Rate) and platelets in pulmonary tuberculosis. Methods: To analytical study of all 120 (TB with HIV 60 / TB without HIV 60)  TB patients who were attending Department of Medicine, Shyam Shah Medical College, Rewa (M.P.). And patientsrefered from Anti-retroviral therapy centre, with sputum positivity for AFB (acid fast bacillius).Results: In our study, 83.3% were males and 16.6 % were females in the TB with HIV group. 70% of patients were in the age group of 25 – 45 years in the TB with HIV group, whereas 86.6% of patients were in age group of 25 – 45 years in the TB without HIV. 90% of patients were underweight with BMI less than 18.5, in TB with HIV group, and 73.3% of patients were underweight in TB without HIV group. 80% were anemic in the TB with HIV and 66.6% were anemic in TB without HIV group. 63.4% of patients with TB and HIV had thrombocytopenia, whereas only 10% of patients had thrombocytopenia in TB without HIV group. patients with tuberculosis per se have increased ESR count, whereas TB-HIV coinfection has drastically reduced the ESR count. Among patients with TB and HIV 83.3% of patients had ESR less than 60 mm/hr., whereas 96.6% of TB without HIV patients had ESR greater than 60 mm/hr. since, ESR is a marker of chronic inflammatory states like TB and HIV is a immunosuppressive state, the co-infection of TB with HIV has drastically reduced ESR values in these patients.Conclusion:ESR values are drastically reduced in TB patients with HIV, rather TB patients per se. hence, an ESR less than 60 mm / hr in pulmonary tuberculosis patients should arouse a suspicion of underlying immunocompromised state.