Tubercular infection in children living with adults receiving Directly Observed Treatment Short Course (DOTS): a follow up study.

BACKGROUND: Children living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up. METHOD: Children (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6-14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done. RESULTS: At recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73). CONCLUSION: About half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.

Vitamin D Deficiency in Medical Patients at a Teaching Hospital in North India.

BACKGROUND: While vitamin D is critical for calcium homeostasis, current literature also highlight role of vitamin D deficiency (VDD) in diseases other than the metabolic bone disorders. Only few studies on role of vitamin D in tuberculosis have been done in Asian populations. There is paucity of literature addressing this issue in Indian population as well. AIM: We planned to study prevalence of vitamin D deficiency in patients with tuberculosis and to compare it with patients who had non-tuberculosis medical illnesses and healthy individuals with the hypothesis that patients with tuberculosis might have higher prevalence of hypovitaminosis D. METHODS: In this descriptive cross-sectional study, there were three groups of study participants. Group 1 consisted of newly diagnosed sputum-positive pulmonary tuberculosis patients of either sex aged 18-60 years. Group 2 comprised of age and sex matched hospitalized patients of other medical illnesses. In group 3 healthy controls were recruited from the general population amongst patient's attendants and hospital staff with the same socio-economic status and ethnic background as that of the patients.Their routine hematological and biochemical parameters along with vitamin D status was assessed. RESULTS: Mean vitamin D levels were significantly low (11.2 ± 6.5 ng/ml) and prevalence of hypovitaminosis D was highest (92%) in patients with pulmonary tuberculosis than other groups. Sputum smear conversion time revealed a significant negative correlation with vitamin D levels (Spearman's p coefficient -0.24, P = 0.02). CONCLUSION: vitamin D deficiency is highly prevalent among hospitalized patients especially patients with pulmonary tuberculosis as compared to patients with other illnesses and healthy individuals. Hypovitaminosis D might be linked to severity of the tuberculosis and also response to treatment.

Impact of overlap syndrome on severity of acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: The severity of exacerbation in chronic obstructive pulmonary disease (COPD) due to the overlap of obstructive sleep apnea syndrome (OSAS) is not known. AIMS: To find out the 1) severity of acute exacerbation of COPD (AECOPD) in patients with overlap syndrome compared to only COPD, 2) prevalence of overlap syndrome in AECOPD, and 3) clinical characteristics of COPD compared to overlap syndrome. MATERIALS AND METHODS: Fifty-one patients admitted with AECOPD were classified into; Mild exacerbation: Normal arterial blood gases (ABG) treated with antibiotics, Moderate: Normal ABG treated with parenteral corticosteroids, Severe: Type 1 respiratory failure, Very severe: Type 2 respiratory failure with normal pH and Life-threatening: Type 2 respiratory failure with pH <7.35. They were evaluated for OSAS with full polysomnography after the exacerbation subsided and analysed depending on presence or absence of overlap syndrome. RESULTS: The majority of only COPD cases (26/38) had mild and moderate exacerbations whereas majority of overlap patients (9/13) had severe, very severe and life-threatening exacerbations (statistically significant, P = 0.021). Of 51 patients, 13 had OSAS i.e. the prevalence of overlap in AECOPD was 25.5%. The mean BMI in only COPD and overlap syndrome was 20.70 ± 8.03 kg/m(2) and 31.82 ± 5.80 kg/m(2) (P < 0.001), respectively. Metabolic syndrome was recorded in 2/36 (5.3%) patients in only COPD and 6/13 (46.2%) patients in overlap (P < 0.001). CONCLUSION: Overlap syndromes are more likely have respiratory failure compared to only COPD during AECOPD. AECOPD have a high prevalence of OSAS. Overlap syndrome have significantly higher likelihood of obesity and metabolic syndrome compared to only COPD.

Correlation of BMI and oxygen saturation in stable COPD in Northern India.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with clinically relevant extra pulmonary manifestations; one of them is weight loss. However, there are very few studies from North India available in relation to body mass index (BMI) and Oxygen saturation (SpO2) with COPD. AIMS: To study the prevalence of undernutrition among stable COPD patients and correlation of COPD severity with SpO2 and BMI. SETTINGS AND DESIGN: A prospective study was carried out at a tertiary care hospital. SUBJECTS AND METHODS: COPD patients were diagnosed and staged as per global initiative for chronic obstructive lung disease (GOLD) guidelines. SpO2 was measured using pulse oxymeter and BMI categorization was done as per new classification for Asian Indians (2009). Statistical analysis was done using Statistical Package for Social Sciences Version 15.0. RESULTS: Out of 147 COPD patients, 85 (57.8%) were undernourished. The prevalence of undernourished BMI was 25%, 50.8%, 61.7%, and 80% in stage I, II, III and IV respectively; statistically significant (P < 0.050). The mean SpO2 was 95.50 ± 1.41, 95.05 ± 2.42, 94.37 ± 2.28 and 93.05 ± 1.39 in stage I, II, III and IV respectively; statistically significant (F = 4.723; P = 0.004). CONCLUSIONS: The overall prevalence of under nutrition among COPD patients was 57.8%. With increasing COPD stage the BMI and median SpO2 value decreased in progressive manner. Association of SpO2 and COPD stages could be explored further in order to suggest an additional marker of disease severity that would add a new dimension in the management of COPD.

Benign fibrous histiocytoma of larynx: A rare cause of acute airway obstruction.

Fibrous histiocytoma of larynx is a rare entity. We herein present a 35-year-old femaleof benign fibrous histiocytoma oflarynx with severe airway obstruction that requiring urgent endotracheal intubation followed by tracheostomy. We also report the good long-term survival of this case after such a critical condition.