ABSTRACTS OF PAPERS TO BE PRESENTED AT THE 69TH NATIONAL CONFERENCE ON TUBERCULSIS AND CHEST DISEASES TO BE HELD IN MUMBAI FROM 5TH TO 7TH FEBRUARY, 2015
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ORAL PRESENTATIONS
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INVESTIGATING THE FACTORS ASSOCIATED WITH MULTI DRUG RESISTANT-TUBERCULOSIS IN SURAT DISTRICT -A CASE CONTROL STUDY
Yadav Shiv K ,Damor Rahul , Kantharia S L , Patel M Z, Tiwari Mani
Introduction: - The emergence of Multi-Drug Resistant Tuberculosis (MDR-TB) has become a significant public health problem and an obstacle to effective TB control. In India prevalence of Primary MDR-TB is 2.2% (1.9–2.6%) and Secondary MDR-TB is 15% (11–19%). WHO estimates that there were about 450,000 new (incident) MDR-TB cases in the world in 2012.So the factors responsible for Causation and Emergence of MDR-TB need to be assessed.
Aims & Objective:-Investigating the factors associated with Multi Drug Resistant-Tuberculosis.
Methodology:- An Unmatched Case Control Study, Purposively Recruited 68 MDR-TB Patients as Cases and 136 non - MDR-TB Patients as Control (from Rural as well as urban Area of Surat District ) diagnosed by CBNAAT were interviewed for investigating the risk factors.
Observations:-After adjusting for otherfactorsin multivariate analysis, a model prepared (having Nagelkerke R2 -0.563) which showed Low Education level (OR-1.778), HIV-AIDS status( OR-5.913),Skilled work(OR7.249),Unskilled work(OR-0.075) Duration of stay at Present address(OR-4.762) were factors found to be significantly ( P value<0.05 ) associated with MDR-TB.
Conclusion & Recommendation:-Multivariate analysis showed important risk factors for MDR-TB. Smoking, Inadequate DOTs Therapy and Previous history of Tuberculosis have not been detected as risk factors. Detailed Multi-Centric study to identify risk factors in various socio economical groups is recommended.
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RETROSPECTIVE ANALYSIS OF MDR-TB PATIENTS REGISTERED UNDER RNTCP IN A PUBLIC SECTOR HOSPITAL OF WESTERN REGION OF INDIA
TiwariMani, Roy Arun Kumar, Patel M.Z., ShamaliyaKhyati,Yadav Shiv Kumar, Tamakuwala Grinish
Introduction:-MDR-TB is a man-made phenomenon. Poor treatment, poor drugs and poor adherence to DOTS lead to development of MDR-TB.Sputum sample collection as early as possible for DST & rapid initiation of treatment afterdiagnosis is important to prevent spread & good outcome of the treatment of MDR-TB.
Aims & Objective:Description &Exploration of the delays at various levels of management of MDR-TB.
Methodology:-Operational Research,Secondary Data analysis of 638 cases of MDR-TB Diagnosed by CBNAAT Technology registered for DOTS PLUS Therapy at Pulmonary Medicine Department ,NCHSurat from Aug 2012 to Sept 2014.
Observation:Male to female Patient ratio2:1,more in age group <30 years,HIV Seropositivity-3.6%, Majority 54.4% of patients were resident of SMC followed by 15.4% Surat,11% Navsari,10.5%Valsad & rest were of neighbouring districts & UT.Time gap between Sputum Sample Collection and diagnosis was ≤3 days in 54% patients followed by 4-7 days in 43% patients.Time gap between diagnosis and initiation of treatment was ≤1 week in 37%,1-2 weeks in 38% patients>2 weeks in 25%patients.
Conclusion&Recommendation: SMC needs active interventions. There is significant delay in diagnosis & treatment initiation. So,meticulous individual case tracking systemis likely to shorten the gap and reduce the delays in curing the MDR-TB patients.
HAEMATOLOGICAL PROFILE OF SMEAR POSITIVE NEW PULMONARY TUBERCULOSIS
Anupama Murthy, R.Karthikeyan, Selvi
Background: Tuberculosis is a major public health problem in India. Reversible peripheral blood abnormalities are commonly associated with pulmonary tuberculosis. Insight into the relationship between haematological abnormalities and mycobacterial infection has come from an understanding of the immunology of mycobacterial infection .There is a paucity of literature in the haematological changes associated with tuberculosis, though tuberculosis is a common condition.
Material and Methods: Retrospective observational study was done in Department of Respiratory Medicine at PSG Medical College and Research Centre. One hundred patients of new smear positive Pulmonary Tuberculosis were included. Disseminated tuberculosis and patients receiving ATT were excluded from this study. The various haematological parameters were studied by means of hemogram by automated cell counter and data analysed.
Results: Among 100 patients studied, data analysed, anaemia was seen in 65% of patients. Leucocytosis as a response to infection was observed in 41% patients, thrombocytosis was observed in 31% patients while thrombocytopenia was observed in 2% patients. 95% patients had increased erythrocyte sedimentation rate. 59% patients had a normal leukocyte count
Conclusion: Various haematological abnormalities have been demonstrated in all 100 patients with pulmonary tuberculosis in the present study. Which consistent with reported literature and reinforce the fact that they can be valuable tools in monitoring Pulmonary Tuberculosis such as anaemia and increased ESR, other findings such as thrombocytosis suggest the need for further studies in this field.
SMOKING
O.A. Sarma
*Warnings *Thank you for not smoking *Tobacco largest killer in 21st century *Screen sans smoke *Poison in the air *World ‘No Tobacco Day’ 31st May *Statutory Warning : Cigarette smoking is injurious to health *Magnitude of the problem *Don’t smoke away your life *Smoking : orgy in parties / get-together events *Smoking & Drinking-Twin Dangers *Smoking lifestyle oriented disorder *Lady NICOTINE *Passive smoking Environmental Tobacco smoke (ETS) *carcinoma larynx *Lungs-Chimney *Art inspired by tobacco – Lancet *Tarred by tobacco use *Smoking-Tobacco and cities *Smoking causes blinding eye disease *Smoking induces cancer *PUC checkups *Cigarette-lighter life extinguisher *Don’t puff away your life *Tobacco industry will resist smoking control measures : Tobacco field cash-crop, income for Government in country *Hook onto hookah *Unmindful of ‘World No-tobacco Day *Deaths due to Tobacco *Tobacco a killer weed *Puff that kills *Smoking : 7 letters sin *There are 1.3 billion smokersworldwide, 70% in developing countries *India World’s 2nd largest tobacco growingCountry *Smoking/chewing tobacco product is rapingpharynx, pulmone-Satanic 7 7 7 7 7 7 7 7Demonic dangers 7 7
REPORT OF INTEGRATION OF TB & HIV CONTROL PROGRAMMES (RNTCP & NACP) AT PRIVATE MEDICAL COLLEGE
K. C. Mohanty, Salil Bendre, Rathna Balakrishnan, Simhadri Naidu
INTRODUCTION:
K. J. Somaiya medical college and research centre was the first private medical college in Maharashtra to start DOTS centre in 1999 and DOTS Plus centre in 2012. Integrated screening for TB & HIV was started in K. J. Somaiya medical college since 2007.
AIMS & OBJECTIVES
To stimulate other private medical colleges t start combined RNTCP and NACP centres
METHOD
An integrated report of patients visiting K. J. Somaiya medical college at the Chest and Tuberculosis department and the ICTC since 2007. All patients diagnosed with TB were referred to the ICTC and all patients who tested positive for HIV were screened for TB.
A total of 260 patients were screened out of which 98 patients were diagnosed with HIV-TB co-infection through the ICTC. 19(19.3%) of these patients were found to be sputum positive and were referred to the DOTS centre for TB treatment. 48 patients on DOTS were diagnosed with HIV, of which 31 (64.5%) were treated with Category I, 4 (8.3%) with Category II and 5 (10.4%) with Categories 4 & 5 respectively. 5 patients (10.4%) expired while on treatment.
219 patients with HIV-TB co-infection have been hospitalised from January 2007 till October 2014 out of which 120 (54.7%) were pulmonary cases while the remaining 99 (45.6%) were extra-pulmonary cases, of which 26 patients (11.9%) expired.
CONCLUSION
With our experience we suggest that patients who require ART should be given priority after referral by DOT centres after diagnosis and assessment. All ART centres should be given information regarding DOTS & DOTS Plus.
A SUCCESSFUL EXAMPLE OF PUBLIC-PRIVATE PARTNERSHIP FOR DOTS IMPLEMENTATION
K. C. Mohanty, Salil Bendre, Nikhil Sarangdhar, Seema Ingole
DESIGN:
Retrospective analysis of 14 years data at K. J. Somaiya medical college DOT centre.
SETTING:
A teaching hospital cum medical college with 300 beds in Mumbai, with 30 beds for TB and Chest diseases, which acts as a tertiary referral institute for several specialities.The institute has got RNTCP accredited DOT centre,DMC and is on the final phase of getting accredited I.R.L. for mycobacterial culture & DST
PATINTS AND INTERVENTIONS:
A retrospective study was conducted at K.J. SOMAIYA medical college & hospital taking into consideration the performance of the DOTS centre from March 1999 up to December 2013. Patients were enrolled as per RNTCP norms into treatment categories “Partially observed treatment” was implemented where patients were administered the first dose under supervision and were given medicine packets for next 14 days. Follow-up was done every 15 days when the patient returned with empty sachets. Sputum for AFB and other investigations performed as per programmatic norms.
CONCLUSION:
Sputum conversion was observed in 747 out of 836 patients on CAT I (89.4%), 192 out of 258 patients in CAT II (74.8%). 31 patients have been enrolled so far on DOTS Plus and 11 out of 13 patients whose I.P has been completed have shown sputum conversion at end of I.P. (84.6%) . These conversion rates are better than the national average (88% in CAT I, 71 % in CAT II and 60% in DOTS Plus)
A CASE OF SILICOSIS IN A CHAKKI MILL WORKER
K. C. Mohanty, Salil Bendre, Nikhil Sarangdhar, Suhas Tiple
SUMMARY
We present a case of Silicosis in a forty-four year old male who was treated as Tuberculosis because of its clinico-radiological features. Further clinical correlation with computerised high-resolution chest tomography clinched the diagnosis and played an important role in proper management of the case. We report this case because in many such cases, the diagnosis is likely to be missed and they are likely to be mistakenly treated as Tuberculosis.
INTRODUCTION:
Silicosis is a fibrosing disease of lungs caused by the inhalation, retention and pulmonary reaction to crystalline silica or Silicon dioxide. The link between Silicosis and Tuberculosis has been recognised for nearly a century. The disease usually occurs as the chronic form which presents after a long latent period of exposure, usually up to fifteen - twenty years or more.
CASE REPORT:
In March 2014 a forty-four old male, resident of Mulund, Mumbai presented to the Chest OPD of one of the major municipal hospitals of Mumbai with complaints of chronic cough for eleven months and progressively increasing dyspnoea on exertion (MMRC Grade II) . The cough was non-productive and without expectoration or haemoptysis. There was no postural or seasonal variation. There was no chest pain, fever or weight loss.
There was no medical history of any major illness/disease and no family/contact/past history of Tuberculosis. Sleep, Appetite and Bowel/Bladder habits were normal. The patient had no addiction.
He was advised a Chest X-ray film by the consultant at the Chest OPD which revealed Bilateral micro nodular shadows in both lung fields which were present on his previous Chest radiograph dated 18th February and 12th March 2014 taken on consultation for the same complaints. The consultant advised Sputum AFB smear (from a designated microscopy centre) and screening tests for retroviral disease, both of which were negative. He was then given a diagnosis of Smear negative pulmonary tuberculosis (new case) and referred to the nearest DOTS centre for CAT-I DOTS. The patient presented to our OPD for a second opinion on 31st May 2014.
On further questioning , the patient revealed that he works in a chakki (flour mill) and that he has been working for more than thirty-five years (his father too used to work in a chakki and he would often assist his father since a very young age.
Clinical examination revealed grade I clubbing and scattered crackles. Rest of the examination was normal, including pulse oximetry. He was advised complete blood profile, Electrocardiogram, Spirometry and a high-resolution computerised tomography of the chest.
Spirometry revealed moderate airflow obstruction with partial bronchodilator reversibility and mildly reduced FVC suggestive of restriction.HRCT Chest revealed patchy consolidation in posterior segment of right upper lobe and apical segment of right lower lobe with adjoining fibrosis and fibro nodular opacities in posterior and superior segments of right upper lobe, lateral segment of right middle lobe and left upper lobe and apical segment of left lower lobe with minimal pleural thickening, along with calcified left hilar , pre-vascular and pre and para-tracheal nodes with egg-shell calcification. Rest of the investigations were inconclusive. The patient was advised bronchoscopy with biopsy which was declined. 6 minute walk test was performed which was normal.
Based on the above results he was diagnosed as a case of Silicosis and started on treatment with inhaled long acting bronchodilators and corticosteroids (Formoterol and Budesonide) via dry-powder inhaler. He was also recommended pulmonary rehabilitation and vaccination with polyvalent pneumococcal and seasonal influenza vaccines. He responded to treatment in terms of clinical improvement and keeps regular follow-up monthly since the last six months.
TREATMENT OUTCOME OF PULMONARY TUBERCULOSIS PATIENTS TAKING DOTS CATEGORY-2 OF PREVIOUSLY LOST TO FOLLOW UP FOR TREATMENT
Balbir Malhotra, N C Kajal, Nagaraja C L, Rahul Prabhu
Introduction; The effectiveness of India’s TB control programs depends critically on patient compliance and completion of full course of treatment. Discontinuing treatment prior to completion of treatment, can leave patients infectious for longer time, the emergence of multidrug resistance and consequently spread of infection.
Objectives; To explore the treatment outcome of pulmonary tuberculosis patients taking DOTS category-2 of previously lost to follow for treatment.
Methods:
Case study was conducted in a tertiary health care centre.
Results: Majority of the previously lost to follow up for treatment patients were complete the treatment (76%) successfully without interruption of treatment. Majority of male patients (13.9%) than female patients (0%) (p=0.006), rural patients (14.3%) than the urban patients (0%) (p=0.000), uneducated patients (20.3%) than the formal/primary educated patients (0%) and higher educated patients (0%) (p=0.000) and financially unstable patients (16.9%) than the financially stable patients (0%) and financially dependence on others (0%) (p=0.000) were lost to follow up for treatment. Most of higher educated patients (44.4%) and urban patients (26.7%) were shifted to MDR treatment.
Conclusion: Lost to follow up for treatment can be prevented by educating the patients and repeated retrieval actions from the RNTCP workers and attached medical officers.
STUDY OF PREVALENCE AND CLINICAL PROFILE OF DIABETES AND PRE-DIABETES AMONG 1000 TB PATIENTS DIAGNOSED AT OUR INSTITUTE
A. A. Saibannavar, M. V. Bansode
Introduction: The burden of tuberculosis and diabetes mellitus is significantly high in India. People with diabetes are at high risk (2.5 times more) of developing active tuberculosis. The main purpose of this study is to screen diabetes and pre-diabetes among TB cases. As the risks of treatment failure, deaths and reactivation are high in TB-DM patients; we have also included study of clinical profile of these patients.
Material and Methods: We have done a prospective study over a period of two years. Study size is 1000 TB patients diagnosed at our institute. All willing patients above the age of 12 years are included in our study. We followed WHO criteria with fasting blood glucose level (FGL) for diagnosis of diabetes and pre-diabetes status. TB patients with FGL>110mg/dl are evaluated in details to study their clinical profiles. Outcomes of these patients are noted from TB registers/records.
Results: Out of 1000 TB patients, 212(21.2%) have impaired FGL>110mg/dl. Among them, 80 TB patients have diabetes and 132 TB patients have pre-diabetes status. They have male predominance, low socio economic status and older age group. Pulmonary TB with sputum positive status is most common presentation among these TB patients. Pleural effusion is the most common type of extra pulmonary TB seen in them. Bilateral lung infiltration is commonly seen on XRC. Symptoms are same as that of non diabetes TB patients. Out of 212, 7 patients died before completion of DOTS.
Conclusion: In our study, prevalence rates of diabetes and pre-diabetes among TB patients are 8% and 13.2% respectively. This study reveals that those with TB-DM were more likely to have the infective form of TB. Outcome of these patients on DOTS is significantly good with mortality rate of 3.5%. Screening patients with TB for FGL estimation will help in early detection of DM.
DIRECT OBSERVATION (DO) FOR DRUG-RESISTANT TUBERCULOSIS: DO WE REALLY DO?
Stella Smith, Petros Isaakidis, Mrinalini Das, Sonakshi Jadhav, Jennifer Furin, Zarir Udwadia, Tony Reid
Background
Direct-observation (DO) is recommended for drug-resistant tuberculosis (DR-TB) patients during their entire treatment duration. However, there is limited published evidence on implementation of direct-observation in field. This study aims to detail whether directly-observed therapy(DOT) was followed by DR-TB patients under DOT-providers in Médecins Sans Frontières(MSF) tuberculosis programme, Mumbai, India.
Methods
This was a cross-sectional, questionnaire-based survey/audit of DR-TB patients on treatment, their DOT-providers and MSF-health-staff involved during June-August 2014. Patients were defined as ‘following DOT’ if DOT provider had seen the patient swallow his/her medications ‘every day’ or ‘most of the days’ on average during treatment. If DOT was not followed(i.e. directly-observed ≤half of the time), barriers to follow DOT were also recorded.
Results
A total of 71 DR-TB patients, 65 DOT-providers and 21 MSF-health-staff were included in the study. About 55% patients were co-infected with HIV and majority (41%) had Pre-XDR TB. Most of the patients (78%) were registered for DOT at nearby clinic. Among all patients, 34% (24/71) followed DOT during treatment. However, DOT providers mentioned 46% (30/65) of patients followed DOT. In contrast, MSF-staff reported none of the patients complied with DOT. Time involved, adverse drug-reactions during treatment and closed-clinic were common barriers to follow DOT.
Conclusion
Direct-observation was not followed by two-thirds of the patients in our study. However, they were successfully continuing treatment. We believe alternate strategies and innovative monitoring tools may be adopted by tuberculosis programme, to help similar non-DOT patients in treatment compliance.
TUBERCULOSIS TREATMENT OUTCOMES IN SUBSTANCE-ABUSE PATIENTS OF NAGALAND, INDIA
Rahul Shenoy, Mrinalini Das, Homa Mansoor, Rey Anicete, Loshan, Imyangluba Ao, Peter Saranchuk, Petros Isaakidis
Background
The national tuberculosis (TB) programmes have been adopting many strategies to achieve universal coverage of TB treatment among vulnerable population groups. However, substance-abuse TB patients including Intravenous drug users (IDUs) still remain a challenge towards global TB elimination. This study aimed to detail experiences of a Médecins Sans Frontières (MSF) tuberculosis programme attended by substance-abuse patients in Mon district, Nagaland, India.