Sputum culture conversion with moxifloxacin-containing regimens in the treatment of patients with newly diagnosed sputum-positive pulmonary tuberculosis in South India.

BACKGROUND: Rapid sputum culture conversion at 2 months indicates the sterilizing capacity and potential of regimens to shorten duration of tuberculosis treatment. We compared results of sputum culture conversion by moxifloxacin and control regimens and identified factors affecting sputum culture positivity after 2 months of treatment. METHODS: Human immunodeficiency virus-uninfected adults with newly diagnosed smear-positive pulmonary tuberculosis were randomized to receive a 3- or 4-month moxifloxacin regimen (moxifloxacin [M], isoniazid [H], rifampicin [R], pyrazinamide [Z], ethambutol [E]) or the control regimen (RHZE thrice weekly). Bacteriological assessments were done at 15, 30, 45, and 60 days of treatment. Because all patients in the moxifloxacin groups received 2 months of daily RHZEM, they were grouped together for analysis. Statistical methods included χ(2) test and logistic regression analysis. RESULTS: Sputum culture conversion was analyzed in 780 (616 in the moxifloxacin group and 164 in the control group) of 801 enrolled patients. Ninety-five percent of 590 patients in the moxifloxacin group and 81% of 151 patients in the control group had negative sputum cultures at month 2 (P < .001). The control regimen, age (≥35 years), initial sputum culture grade (2+ or 3+), and male sex were significantly associated with higher odds of positive sputum cultures at 2 months. CONCLUSIONS: A 5-drug daily regimen with moxifloxacin results in significantly higher sputum culture conversion in the first 2 months compared with a thrice-weekly, 4-drug regimen in patients with newly diagnosed sputum-positive pulmonary tuberculosis.

Assessment of COVID-19 RT-PCR Positive Symptomatic Patients With Clinical, Hematological, and Radiological Parameters Among Three Groups: A Comparative Study.

BACKGROUND: Nearly 70.1 million individuals have been infected by the pandemic viral disease known as coronavirus disease 2019 (COVID-19), which was first discovered in China and is caused by a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2). This disease is responsible for the deaths of 6 million people. India ranks third in the total number of cases. The purpose of this study was to classify COVID-19 patients according to several criteria and to determine which clinical, hematological, and radiological indicators were most important in their care. MATERIALS AND METHODS: An analytical cross-sectional study was conducted on a total of 70 symptomatic patients who tested positive for COVID-19 reverse transcription polymerase chain reaction (RT-PCR) and were hospitalized at the Saveetha Medical College and Hospital in Chennai, Tamil Nadu, India, for the duration of the study. Comorbidities and oxygen reliance were taken into consideration while classifying patients into one of three categories. Initial symptoms, as well as hematological (interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), D-dimer, serum ferritin, and total cell counts) and radiographic (X-ray and computed tomography (CT) of the thorax) characteristics, were taken and analyzed among the different groups. RESULTS: According to our research, the symptom of fever was the most common, accounting for 84.3% of all cases. This was followed by breathlessness (55.7%), myalgia (31.4%), dry cough (27.1%), sore throat (24.3%), cough with expectoration (20%), loose stools (12.9%), loss of taste (12.9%), and smell (11.4%). Although there was a large amount of variation in D-dimer, with Category C having the highest values, there was only a minor amount of variation in ESR and CRP. The X-ray and CT scans of the chest showed substantial differences between the groups, with CT findings such as COVID-19 Reporting and Data System (CO-RADS) and CT severity score, consolidation, crazy paving pattern, and vascular dilatation showing a wide range of differences between the groups. CONCLUSIONS: To facilitate easier treatment and place more attention on radiological characteristics using D-dimer, treating physicians are required to categorize COVID-19 patients into several groups. Patients who need oxygen support were included in this category.

A rare case of primary disseminated multi-drug resistant tuberculosis

Tuberculosis (TB) is the commonest cause of infection-related death globally. Disseminated tuberculosis (TB) is a life-threatening disease which results from the hematogenous spread ofMycobacterium tuberculosis. Genitourinary tuberculosis(GUTB) is usually caused as a result of the hematogenousspread of the mycobacteriaduring the initial infection. The patient's clinical presentation may vary from asymptomatic to non-specific symptoms related to the organ involved and may also overlap with urinary tract infections caused by other pathogens hence delaying the diagnosis. Here we report one such case where the vague symptoms of the patient and absence of respiratorysymptoms delayed the diagnosis of primary disseminated multi-drug resistant(MDR) tuberculosis.

Characteristics of lumbar canal stenosis patient at Koja district hospital year 2011-2021

Background:Since there are too many cases of lumbar canal stenosis in Indonesia. The aim of the study was to discover all the factors that influence the incidence of lumbar canal stenosis.Methods:This study used all cases of lumbar canal stenosis in Koja District Hospital in Jakarta from 2011 to 2021. This was a medical record-based retrospective study in which files of patients with the diagnosis of lumbar canal stenosis were reviewed. A descriptive analytic test was used to analyze results was presented in the form of a table.Results:There were 48 lumbar canal stenosis cases in male patients out of 66 total patients. Incidents of lumbar canal stenosis occurred more frequently in anatomical locations L4-5 than in other locations. There were 48 lumbar canal stenosis cases with anatomical locations L4-5 in 50 patients from 66 patients. Incidents of lumbar canal stenosis occur in people with obesity more frequently than in people without obesity. There were 48 lumbar canal stenosis cases in people with obesity patients out of 66 total patients. The incidence of lumbar canal stenosis with a moderate VAS score was greater than that with a mild or severe VAS score. There were 48 lumbar canal stenosis patients with a moderate vas score out of 66 patients. There were 59 lumbar canal stenosis patients who got surgery out of 66 patients, and 7 of them had no surgery. Lumbar canal stenosis more frequently occurred in men than women, with more frequent anatomical lesions in L4-L5, and more frequently in people with obesity than in people without obesity. Most of them had a moderate VAS score and got surgery.Conclusions:According to this study, males had more lumbar canal stenosis incidents than females.

Delayed diagnosis of disseminated tuberculosis in pregnancy: a case report

Miliary tuberculosis (TB) is a lethal form of TB, if left untreated. Miliary TB accounts for <2% of all cases of TB in immunocompetentindividuals. Intracranial tuberculoma is a rare manifestation ofMycobacterium tuberculosis(MTB), seen in only 1% of TB patients. It can occur as single or multiple lesions, most commonly located in the frontal and parietal lobes. Clinical features mimicthat of any space-occupying lesion in the brain.In pregnant women, diagnosis of TBmay be delayed by the non-specific nature of early symptoms and because they are often attributed to pregnancy.Here we report one such case where the diagnosis of TBwas delayed due to the non-specific nature of her symptoms in ante-natal period.

Endobronchial tuberculosis simulating a tumor: an interesting case report

Endobronchial tuberculosis(EBTB)is a special form of TB which is associated with significant morbidity and potential mortality. EBTBis the infection of tracheobronchial tree, and continues to remain challenging for clinicians to diagnose. The incidence of EBTBhas been reported to be 5.8% to 30% in people with pulmonary TB. 60-year-old male, chronic smoker presented with complaints of dyspnea, cough with expectoration and sore throat for 2 weeks. General examination showed patient to have pallor and respiratory system examination showeddecreased breath sounds in left infraaxillary region and bilateral crepitations. Routine blood investigations done showed decreased hemoglobin levels, elevated total leukocyte count, ESR. Sputum AFB was negative. Mantoux-15mm induration. Chest X-ray showed homogenous opacities over the left lower zone and elevated right diaphragm. CT thorax done showed a subsegmental peripheral soft tissue density 4.3×2.2 cm in the inferior lingula segment. Bronchoscopy showed whitish plaques over the anterior tracheal wall near carina and over left main bronchus. Endobronchial tissue growth seen occluding the lingula bronchus. Biopsy was taken and histopathology showed a granulomatous lesion, BAL Gene Xpert was positive for MTB. Patient was started on 3 tablets ATT. Clinicians need to be vigilant in patients who are AFB smear negative, with symptoms; bronchoscopy should be considered in those selected cases.

A study of correlation between prevalence of pulmonary artery hypertension with severity of bronchiectasis

Background:Pulmonary artery hypertension (PAH) dreadful complication in bronchiectasis. The 6thworld symposium on pulmonary hypertension have taken mPAPof 20 mmHg as normal. Not much studies have been done based on the current cut off values, so we have incorporated values based on the new guidelines and made following observations. Methods: Thisstudy was designed as an observational cross-sectional study consisting of 27 patients, who were admitted in Pulmonary medicine department. Results:Out of 27 study subjects 15 were female抯 and 12 were males. It was found that 70.3% had less than 5 segments involved and 29.6% had more than 5 segments involved. Mean value of PAH was 34.48�.06 mmHg. Analysis showed a significant correlation (r=0.67) between number of segments involved and incidence of pulmonary hypertension. Conclusions: Itis essential to evaluate the cardiac status of bronchiectasis patients at the time of diagnosis as cardiac manifestations are one of the dreadful complications.