Evaluation of hepatoprotective effect of silymarin among under treatment tuberculosis patients: a randomized clinical trial

Hepatic toxicity is the most serious adverse effect of anti tuberculosis drugs. This study was performed to evaluate efficacy of silymarin as a hepatoprotective herbal agent. In a randomized double blind clinical trial 70 new cases of pulmonary tuberculosis were divided into two groups. The intervention group was assigned to receive silymarin and the control group received placebo. Tuberculosis was treated by classic regimen consisting isoniazid, rifampin, pyrazinamide and ethambutol. No statistically significant difference was found between the two groups concerning the frequency of drug induced liver injury or mild elevation of liver enzymes. Silymarin was safe without any major side effect. Our results showed no significant hepatoprotective effect of silymarin among patients on tuberculosis treatment

Multidrug-resistant tubercular appendicitis: report of a case

Acute tubercular appendicitis has remained a rare disease despite frequent cases of tuberculosis. The following study reports a patient with multidrug-resistant [MDR] pulmonary tuberculosis that developed acute appendicitis. Histopathology of the appendix was compatible with tuberculosis. The patient had a good outcome after surgery and medical therapy

Disseminated Mycobacterium kansasii in an HIV-negative patient

Disseminated Mycobacterium kansasii infection is a rare infection in non-HIV patients. This research has uncovered a very rare manifestation of disseminated M. kansasii infection in a non-HIV patient with lung and pericardial involvement

Smoking effects on clinical manifestations and drug resistance patterns in pulmonary TB patients

Considering the rising trend of tuberculosis [TB] and cigarette smoking, an evaluation of the clinical manifestations and drug resistance patterns in TB patients with regard to smoking status seemed beneficial. Clinical manifestations and drug resistance patterns were studied in 872 new pulmonary TB patients classified as non-smokers, ever-smokers, and passive smokers during 3 years at the National Research Institute of Tuberculosis and Lung Disease. Both univariate and multivariate analyses were performed. Ever-smokers were mostly male [p<0.001], Iranian [p<0.001], and drug and alcohol users [p<0.001]. They were found to have a longer patient delay [15.9 versus 8.7 and 6.3 days, p=0.008], shorter diagnostic delay [106.8 versus 132.6 and 156 days, p=0.01], greater weight loss [p=0.01], and higher sputum expectoration [p<0.001]. Notably, the degree of smear positivity was associated with smoking [p<0.001] in both univariate and multivariate analyses. No statistical significance was found for the aforementioned factors among non-smokers and passive smokers. Some of the clinical manifestations of TB are significantly different with regard to the patients' smoking status.The degree of sputum smear positivity for acid fast bacilli was higher and patient delay was longer in ever-smoker patients

Comparison of pulmonary TB patients with and without diabetes mellitus type II

There are several studies on the effect of diabetes mellitus [DM] on clinical symptoms and radiological findings of multi-drug resistant tuberculosis [MDR-TB] and bacteriological findings in pulmonary tuberculosis patients. Considering the contradictory results of these studies, this study was conducted for further investigation in this regard. This was a case-control study conducted in Masih-Daneshvari Hospital in Tehran. Forty-seven patients with tuberculosis infection and diabetes type II were selected as the case group and 102 TB cases without diabetes were considered as controls. There were significant differences in hemoptysis, dyspnea and loss of appetite between the two groups, but no significant difference was found in cough, sputum production, chest pain, night sweat, fever or weight loss. Also, there was no significant difference between the 2 groups in terms of MDR-TB and bacteriological findings. On CXR, diabetic patients had a higher prevalence of typical presentations along with cavitary lesion[s] but no significant difference was found between the 2 groups in terms of radiological presentation. In this study, diabetes type II did not have much influence on clinical symptoms and bacteriological findings of TB patients. However, PTB-DM type II cases may be considered more contagious due to the higher prevalence of cavitary lesions compared to those without DM. Prevalence of MDR-TB was the same in both groups

Update on 2009 pandemic influenza a [H1N1] virus

The pandemic influenza A [H1N1/2009] virus as a new challenge for health care providers has caused significant morbidity and mortality worldwide. Although many aspects of this virus are similar to other human influenza viruses, there are some disparities. This article reviews different aspects of influenza H1N1/2009 virus with focus on clinical features and management of patients

Risk factors associated with multidrug-resistant tuberculosis

Multi-drug resistant tuberculosis [MDR-TB], a form of TB resistant to isoniazid and rifampin, is considered as a major threat to TB control worldwide. Moreover, the infectivity of MDR-TB is similar to that of non-MDR TB. This study aims to find the risk factors associated with the development of MDR-TB among TB patients admitted to Masih Daneshvari Hospital, the national referral center for tuberculosis and lung diseases. The national referral institute for tuberculosis and lung diseases in Tehran [NRITLD] receives all the MDR-TB cases from all over the country. Based on this criterion alone, forty-eight pulmonary MDR-TB patients who were referred to this center between 2002 and 2005 were included in this study. For the purpose of comparison, 234 patients diagnosed with pulmonary TB were also selected randomly as the control group. The two groups were compared based on 102 demographic and clinical variables. These variables included age, sex, nationality, drug and opium use, method of referral, symptoms and etc. Immigration and refugee status as well as history of anti-TB medication were found to be the most significant among the risk factors associated with MDR-TB. Also, 95.8% of the MDR-TB cases reported a previous history of anti-TB medication. This number was 23.1% in the non-MDR group. MDR-TB was more prevalent among the Afghan patients; out of a total of 78 Afghan patients, 22 [46.8%] composed the MDR-TB category, whereas, 56 [23.9%] Afghan patients belonged to the non-TB category. All MDR-TB patients had positive smears whereas 13.2% of non-MDR-TB patients had negative smears. Dyspnea and weight loss were among other significant variables. History of close contact, diabetes, smoking, drug use, fever, and BCG scar in both MDR TB and non-MDR-TB groups were among the insignificant variables found in this study. The limited sample size and location of the study may have resulted in insignificant variables. However, based on the obtained data, patient's status as an immigrant or a refugee is an important risk factor for both MDR and non-MDR TB and is of particular concern in the growing trend of MDR-TB

[Mycobacterium tuberculosis complex strains identification with spoligotyping method in patients attending to Masih Daneshvari Hospital]

Spoligotyping is a method based on 36bp Direct Repeat [DR] chromosomal loci polymorphism which is connected to one or two 35-41 bp spacer sequences. There are 94 different intra DR spacer sequences which are identified so far and only 43 of them are used as usual. Mycobacterium tuberculosis complex strains can be identified based on lacking or having these sequences. Spoligotyping test was carried out on 238 TB smear positive patients. Primary separation of mycobacterium strains was done through Petrof 4% method and Lowenstein Jensen [LJ] media. Biochemical tests such as Niacin test/Catalase activity/Nitrate reduction were done in order to identify the strains. Drug sensitivity to INH [0.2Mg/ml]/ RIF [40Mg/ml]/ STM [10Mg/ml] and ETBl [2Mg/ml] identified by proportional method and according to that, the strains were divided into three groups: sensitive, multi drug resistance [MDR] and non MDR. Then DNA was extracted by CTAB method from the positive colonies. Sequences were amplified by PCR and after denaturizing, hybridization with Streptavidine peroxidase enzyme was performed by Line reverse blot method. Radiography was done after adding the Luminoscense and membrane onto the X-ray films. Serotypes were divided into 9 groups [Beijing/ CAS1/ Haarlem / U/ T2/ T1/ EAI3/ EAI2 and CAS2]. Most of the strains were from Haarlem [27%] and CAS1 [25%] groups. Two strains were also identified in this method that belonged to Mycobacterium bovis. Spoligotyping method is an easy, rapid and sensitive test in order to identify Mycobacterium tuberculosis complex strains

Comparison of Nramp1 gene polymorphism among TB health care workers and recently infected cases; Assessment of host susceptibility

A link between polymorphisms in the natural resistance -associated macrophage protein gene 1 [Nramp] and susceptibility to tuberculosis [TB] has been demonstrated worldwide. This study aimed to investigate the Nramp1 gene variants among workers exposed to TB bacilli [1-2 hours per day for 1 to 20 years] who did not develop the diseases with those who developed the disease through recent transmission. The polymorphism of Nramp1 at INT4, D543 and 3'UTR was examined in 71 newly smear-positive TB cases and 39 healthcare workers exposed to TB. Polymerase chain reaction [PCR] and restriction fragment length polymorphism [RFLP] were used to genotype Nramp1 polymorphism. Patients' clinical and demographical data were collected. The heterozygote patterns of INT4 [G/C], D543 [G/A] and 3'UTR [+/del] occurred more frequently in control subjects than in patients [P =0.012], respectively [odds: 1.9 CI95%] [1.13-3.12]. Although, the homozygous patterns of INT4 [C/C; 8.5%], D543 [A/A; 1.4%] and 3'UTR [del/del; 1.4%] were only seen in patients [sensitivity 11% and specificity 100%]. The other risk factors like gender, age, resistance and PPD were not associated with Nramp1 gene polymorphism. Individuals with homozygous type mutation have an increased risk of developing tuberculosis. Therefore, we suggest detection of Nramp1 variants in high-risk groups i.e., health workers and close contact cases

Evaluation of pseudoadrenal insufficiency in tuberculosis patients

Adrenal insufficiency following initial treatment of active tuberculosis [TB] is a rare phenomenon. It is also one of the most important causes of mortality within the first few days of TB treatment. The present study evaluated this adverse effect of anti-tuberculous treatment. A prospective study was performed on TB patients hospitalized in Masih Daneshvari Hospital between 2004 and 2005. All patients had received standard anti-TB drug regimen. We evaluated pseudo-adrenal insufficiency in these patients. The study group included 429 patients out of which 6[1.4%] developed adrenal insufficiency following anti-TB treatment. In all 6 patients, basal serum cortisol levels were measured which were below the normal range after treatment. No patient had clinical findings of adrenal insufficiency before initiation of anti-TB therapy. After treatment with dexamethasone, the general condition of patients improved. [The average response to treatment was 3.1 +/- 1.7 days]. No mortality was reported during the treatment course or follow-up period. In TB patients, the adrenal reserve/ serum cortisol reserve level is low. Standard anti-TB drug regimen including rifampicin causes rapid catabolism of cortisol in tissues specially in the liver and lungs; therefore, serum cortisol level will be more decreased and consequently the patient develops adrenal insufficiency. As a whole, despite of the low incidence rate of this adverse effect, early diagnosis and treatment is essential to save the patient's life

Pneumocystis pneumonia in patients with human immunodeficiency virus

Pneumocystis Pneumonia [PCP] caused by Pneumocystis Jjirovecii [formerly called P.Carinii] is one of the most common opportunistic infections in patients with human immunodeficiency virus [HIV]. The aim of this study was to assess PCP in HIV-infected patients at the "National Research Institute of Tuberculosis and Lung Disease" [NRITLD]. A retrospective study was performed on 12 HIV-infected patients who were hospitalized at the Masih Daneshvari Hospital [NRITLD] and diagnosed as having PCP during 2003- 2007. In patients suspected of PCP with symptoms such as exertional dyspnea, fever, cough and related radiological findings, bronchoscopy including bronchoalveolar lavage [BAL] and transbronchial lung biopsy [TBLB] were performed and high resolution computed tomography [HRCT] was obtained from all patients. Mean age of the understudy patients was 32.8 +/- 5.02 yrs. The most common symptom was exertional dyspnea [91.7% of cases]. Mean duration from the onset of symptoms until diagnosis was 27.4 +/- 18.7 days. All patients were treated with Co-Trimoxazole and no adverse effects were detected. Mortality rate was 25%. In Iran PCP is one of the common opportunistic infections in HIV-positive patients which is accompanied by a high mortality rate