Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
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Vol 51 No 4Oct 2004 ISSN 0019-5707

Original articles

Case reports

R.Balasuramanian,R.Rajeswari,A.C.Naik,M.Duraipandian,K.Karunakaran and P.R.Narayanan

Background: As routine culture facilities are not available in TB control programme in low income countries like India ,there is an urgent need to improve the sensitivity of sputum microscopy ,especially in diagnosis of smear negative pulmonary TB.
Methodology: In a double blind placebo controlled study ,the role of repeat sputum microscopy after antibiotics and oral salbutamol supplement in improving th diagnosis of smear negative TB suspects was investigated in an urban TB clinic .We undertook culture examination for all study patients to find out proportion of TB cases in this series
Results: Of 206 enrolled (101 salbutamol(S),105 placebo(P) groups 26 were positive by repeat sputum smear examination :similar in two groups(S16,P 10 p=0.25)In all 40(s23,P17)including 26 smear positives,were culture positive for .
Conclusions: Two thirds of initially smear negative but culture positive TB patients were smear positive on repeat sputum examination.Thus repeat sputum smear microscopy for TB suspects improved the diagnosis nevertheless oral salbutamol therapy was not beneficial.In resource poor settings,repeat sputum smear microscopy after a trial of antibiotics,could sufficiently improve the diagnosis of smear-negative PTB patients.
Indian J Tuberc 2004;51:191-198: 
Setting: Revised National tuberculosis control programme emphasizing on DDOTS in the metropolitan city of Bangalore
Objective1)To evaluate the treatment outcome of new smear positive patients supported with pre and post treatment bacteriological profile 2)To assess their bacteriological and clinical status two and half years after treatment initiation Design  A prospective cohort study of 271 new smear and culture positive patients initiated on Cat I from April to December 1999 and followed up till treatment outcome and 21/2years thereafter
Results: Treatment success(cured and treatment completed)of the study group was 67.9% as 24.7% patients defaulted from treatment.Treatment failures and deaths during treatment were 5.2% and 2.2% respectively.Initial drug susceptibility status did not influence the treatment outcome of the study group except in six patients,who were multi drug resistant.The development of drug resistance during treatment was seen in 1.3%.The proportion of bacteriological positivity and mortality during follow up was significantly higher among patients who defaulted from treatment..Relapses during the intervening period were 11.4%.
Conclusion: Fully intermittent CAR I regimen was effective in programme conditions,irrespective of the pre treatment drug susceptibility status.Treatment success of the cohort was vitiated by a high proportion of defaults in a metropolitan city ,where the programme was recently implemented.he study findings underscore the importance of strict adherence to the programme guidelines for successful completion and a lasting cure.
Indian J Tuberc 2004;51:199-208: 
V.K.Dhingra,S.Rajpal,Nishi Aggarwal,and J.K.Aggarwal

Background: Under the revised national Tuberculosis Control Programme ,patients who are sputum negative after 3 smear examinations are subjected to radiological examinations after they fail to respond to a course of antibiotics for a period of two weeks.Those shoving radiological evidence of pleural effusion are examined physically and investigated further by tuberculin testing and diagnostic aspiration.Those confirmed to be suffering from tuberculous pleural effusion by naked eye examination and,biochemical tests and cytology of pleural fluid are given a fixed schedule of drugs.The treatment is stopped after six or eight months as per category,and outcome is reported as "treatment completed."Many a time ,patients question the validity of stopping treatment without radiological examination.Physicians treating are also at times not confident themselves and often fail to reassure such patients.Presence of residual symptoms in such patients before stopping treatment creates further uneasiness among treating physicians.
Methodology and results: A study carried out among 58 patients of TB pleural effusion of which 36(62.1%)could be followed for a period of one and half years ,revealed that 63.9% were satisfied with the DOTS policy of stopping treatment without Xray at the end of treatment whereas 36.1% expressed dissatisfaction,with this policy.As many as 16.7% even got their Xrays elsewhere before stoppage of treatment for their own satisfaction
Conclusion: The one and half year follow up revealed only one case of relapse ie a relapse rate of 2.8% after DOTS therapy.Almost all (97.2%)were however satisfied with the medicines dispensed under DOTS
Indian J Tuberc 2004;51:209-212: 
Y.N.Reddy,S.V.Murthy,D.R.Krishna and M.C.Prabhakar
Background Severe oxidative stress has been reported in TB patients because of malnutrition and poor immunity.The purpose of this study was to investigate the serum lipid peroxidation products and important free radical scavenging enzymes ie super oxide dismutase (SOD),catalase and antioxidant glutathione levels and total antioxidant status in TB patients .
Methodology The subjects for this study comprised of normal human volunteers(NHV,n=25),TB patients(n=100)including untreated (TB1,n=55),under treatment(TB2,n=30)and after treatment(TB3,n=15)with anti tuberculosis therapy(ATT)
Results The levels of lipid peroxidation products malondialdehyde(MDA)were increased significantly in TB1 and TB2(P<0.001) and also in TB3(P<0.01);these levels gradually decreased with clinical improvement withATT.SOD,catalase glutathione levels and total antioxidant status were decreased significantly in TB1 and TB2(P<0.001),TB3(P<0.01) patients in comparison with NHV these levels gradually increased with clinical improvement with ATT.Oxidative stress was observed in all the TB patients (TB1,TB2,TB3),irrespective of treatment status
ConclusionsThe study showed that in TB patients free radical activity is quite high and antioxidant levels are low.A suitable antioxidant therapy may prove beneficial and nutritional antioxidant supplementation may represent a novel approach to fast recovery
[Indian J Tuberc 2004;51:213-218]: 
S.Shenai,C.Rodrigues and A.P.Mehta
Background Present scenario of tuberculosis(TB) demands a reliable method for rapid diagnosis of TB.Several newer methodologies have been introduced over last 2 decades..However clinical evaluation of all these methods is essential before bringing them into routine diagnostic practice.
Aim In the present study ,we have evaluated 3 most promising methodologies viz BACTEC460TB system(TB BACTEC)Transcription Mediated Amplification(TMA) and Phage assay for rapid detection of M.Tuberculosis complex directly from respiratory and non respiratory specimens.
Material and methods: Total 139 AFB smear positive and 41 AFB smear negative respiratory and non respiratory specimens were compared with conventional LJ method.
Results and conclusions. TMA is found to be most rapid and reliable method for detection of M.Tuberculosis complex from respiratory specimens with 93.8% sensitivity.However for non respiratory samples TB BACTEC can be the method of choice.An average detection time for TB BACTEC is found to be 13 days and 15 days ,compared to 31 days 35 days for LJ method in cases of smear positive respiratory and non respiratory specimens respectively.Phage assay is highly specific for detecting M.Tuberculosis complex and can be used as a rapid screening method for TB in cases of respiratory specimens collected from patients not receiving anti-TB therapy.As only viable TB bacilli are detected by Phage assay,it can be used as a sensitive tool to monitor treatment success. [Indian J Tuberc 2004;51:219-230]: 
Tuberculosis of skeletal muscle is very rare.A case of tuberculous abscess in rectus abdominis muscle is described in a seven year old male child.The patient presented with an abscess in the anterior abdominal wall ,which subsequently ruptured .The diagnosis was made by histological examination of the excised tissue following local debridement
[Indian J Tuberc 2004;51:231-233]: 
Shyam B Sharma and Vipul Gupta
A case of biliary tuberculosis in an eight year old female child.The clinical and radiological features suggested presence of chronic cholecystitis.Surgical exploration revealed thick walled gall bladder distended with caseous material with adherent caseating portal lymph nodes.Cholecystostomy along with antitubercular therapy resulted in satisfactory recovery.Histopathological examination of lymph node biopsy and microbial examination of pus confirmed diagnosis of tuberculosis.Authors review their experience with this rare entity and the pertinent literature.
[Indian J Tuberc 2004;51:235-237]: 
S.P.Rai,A.Shukla,M.Kashyap and R.K.Dahiya Although appendicular involvement in intestinal tuberculosis has been reported in 1.5-3% cases ,the prevalence of isolated tuberculosis of appendix is a comparative rare entity.We report a patient with provisional clinical diagnosis of appendicitis,who was found to have tuberculosis o appendix on histo pathology,after interval appendicectomy.He had no detectable tubercular focus elsewhere in the body.Post operatively ,he was treated with anti tubercular regimen with uncomplicated recovery. [Indian J Tuberc 2004;51:239-240]: 
  • For the second quarter of 2004 New sputum positive detection rate 78%
  • Patients put on treatment 3,15,437
  • Success rate of 86% of the new smear positive in the 2nd quarter of 2003
  • Sputum conversion rate and cure among the new sputum positives --89% and 86% respectively
DOTS coverage increased to 888 million in june 2004.DOTS available in 505 districts. Monitoring and supervision The overall performance has been good.There is a need to
  • Maintain and improve the performance
  • To ensure that reported figures are correct and consistent with field activities
[Indian J Tuberc 2004;51:241-243]: 

Created on ... October 18, 2004