THE IMPORTANCE OF CHEST-X-RAY (TIMIKA SCORE) TO PREDICT THE CLINICO-BACTERIOLOGICAL PROFILE OF PULMONARY TUBERCULOSIS PATIENTS

2021 ◽  
pp. 55-58
Author(s):  
Surinder Pal Singh ◽  
Harjinder Singh ◽  
Komal Deep Kaur ◽  
Kailash Meena ◽  
Ashish Shukla ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Sputum Smear ◽  
Karnofsky Performance Score ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Cavitary Lesion ◽  
X Ray ◽  
Chest X Ray

Introduction: Chest x-ray (CXR) is the primary modality for diagnosis and severity assessment and monitoring the ATT response in pulmonary tuberculosis (PTB). The aim of our study was to determine the correlation between the radiographic involvement of disease on CXR based on Timika CXR score with the clinically and bacteriological specications at diagnosis and initiation of ATT in sputum smear-positive PTB patients. Material And Method: A cross-sectional study was conducted in the Department of Pulmonary Medicine, a tertiary care hospital, Punjab, from January to June 2020. Seventy new sputum smear-positive cases of PTB were included. At the time of diagnosis, the patient's baseline test, clinical signs and symptoms were evaluated using TB scores I, II, Karnofsky performance score (KPS), and body mass index (BMI). Two chest physicians, according to the Timika CXR score, evaluated the CXR of each patient Independently. Result: Cavitary lesion on CXR resulted in a signicantly higher Timika score associated with higher Mycobacterial load in sputum grading compared to non-cavitary disease. 55.17% of patients with CXR score ≥71 had statistically signicant higher baseline sputum grading compared to 9.76% of patients with CXR ≤ 71. Higher Timika CXR score ≥ 71 was signicantly associated with a longer mean duration of symptoms, lower BMI, higher TB score, lower KPS at baseline, higher ESR, low hemoglobin, low serum albumin. Discussion: The study shows that Timika CXR score signicantly correlates with radiographic involvement and extent of disease severity on CXR with the clinically and bacteriological prole of PTB patients, which a pulmonologist can use in a medical practice. A Higher CXR Timika score is associated with the patient's poor clinical condition and the severity of the disease. Cavitary lesion on CXR associated with higher sputum smear grading. It is observed that the Timika CXR score can be used to identify the PTB patients at risk of treatment failure for their more aggressive management.

scholarly journals Clinical spectrum and outcome of extra-pulmonary tuberculosis in children.

2021 ◽  
Vol 28 (09) ◽  
pp. 1336-1340
Author(s):  
Asma Mushtaq ◽  
Aysha Mansoor Lodhi ◽  
Wajiha Rizwan ◽  
Carol Ruth ◽  
Meher Muzaffar ◽  
...  
Keyword(s):  
Weight Loss ◽  
Pulmonary Tuberculosis ◽  
Lymph Nodes ◽  
Tertiary Care ◽  
Clinical Spectrum ◽  
Care Hospital ◽  
Cross Sectional ◽  
Duration Of Symptoms ◽  
Extra Pulmonary Tuberculosis ◽  
Extra Pulmonary

Objective: To determine the types, clinical spectrum and outcome of Extra-Pulmonary Tuberculosis (EPTB) in children admitted at a tertiary care hospital. Study Design: Cross Sectional study. Setting: The Children's Hospital and The Institute of Child Health, Lahore. Period: May to December 2019. Material & Methods: A total of 63 patients diagnosed with EPTB aged 1 month to 16 years were included. All patients with lung involvement were excluded from the study. Anti-tuberculous therapy (ATT) was started in all patients and outcome was monitored during the hospital stay. Results: In a total of 63 patients, mean age was 9.03+3.1 years. There were 35 (55.5%) male and 28 (44.4%) female. The mean duration of symptoms at the time of presentation was 5.93+2.4 months. The common sites of EPTB were meninges noted in 17(26.9%), pleural in 13 (20.6%), abdominal in 12 (19.04%), lymph nodes in 11 (17.4%), disseminated in 6 (9.52%) and bone and joints in 4 (6.34%) patients. The most common systemic complaints were fever in 58 (92.06%), weight loss in 48 (76.1%) and anorexia in 45 (71.4%). After treatment, fifty-four patients improved and discharged while 9 (14.2%) patients died. Conclusion: The commonest sites of EPTB were meninges, pleural, abdomen and lymph nodes. Fever, weight loss and anorexia were the most frequent systemic complaints. Most of the patients recovered while the most common cause of mortality was tuberculous meningitis.

scholarly journals Comparison between ziehl-neelsen staining and fluorescent staining of sputum samples to detect acid fast bacilli in suspected case of pulmonary tuberculosis at tertiary care hospital, Amreli, Gujarat

2021 ◽  
Vol 8 (4) ◽  
pp. 302-307
Author(s):  
Hetvi Chawda ◽  
Chandani Surani ◽  
Sanjeev Kumar ◽  
Meghana Chauhan ◽  
Ashok Kumar Ramanuj ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Tertiary Care ◽  
Early Morning ◽  
Causative Organism ◽  
Sputum Smear ◽  
Suspected Case ◽  
Care Hospital ◽  
Fluorescent Staining ◽  
Acid Fast Bacilli ◽  
Fluorescent Stain

In India, Tuberculosis (TB) is one of the major community health problems.Pulmonary tuberculosis (PTB) is a respiratory disease. Causative organism for this is acid fast bacilli known as . It is the most ordinary disease affecting the lower socio-economic class in developing countries. Microbiological diagnosis is the heart for the effective treatment of pulmonary TB (PTB). The look forrapid and efficient method has resulted in several staining techniques. Objective of the study was to compare the results of ZN stain (RNTCP) with fluorescent stain by use of microscopy. The study was carried out in Microbiology Department, SMCGH, Amreli. 350 sputum samples (Spot and early morning sample) collected from 175 suspected case of the pulmonary tuberculosis. All 350 samples were processed by ZN stain and Fluorescent stain to detect acid fast bacilli. By use of microscope, the results of the stained smears were given according to RNTCP guideline.Out of 350 sputum smears, 52 (14.85%) and 61 (17.4%) were positive by ZN and FM staining respectively. Males are predominantly affected than females. Majority of the patients were in age above 50 years. Early morning samples were more reliable than spot samples for detection of acid fast bacilli for ZN stain, but not for fluorescent stain.Fluorescent staining with LED microscopy was more efficient than ZN staining for detection of acid fast bacilli from sputum smear.

scholarly journals 1521. Risk factors associated with complications of influenza A or B infection, southern Puerto Rico, 2016-2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S762-S763
Author(s):  
Angel L Perez-Caro ◽  
Frances Quiñones-Del Toro ◽  
Marilyn García-Burgos ◽  
Vanessa Rivera-Amill ◽  
Luisa I Alvarado-Domenech
Keyword(s):  
Puerto Rico ◽  
Influenza A ◽  
Tertiary Care ◽  
Febrile Illness ◽  
The United States ◽  
Influenza B Virus ◽  
Influenza B ◽  
Care Hospital ◽  
X Ray ◽  
Chest X Ray

Abstract Background Influenza is one of the most common viral respiratory diseases in the United States with 9–45 million cases per year. In Puerto Rico, more than 18,000 cases of influenza were reported during the 2019/20 season. The Sentinel Enhanced Dengue Surveillance System (SEDSS) conducts acute febrile illness surveillance for inpatient and outpatients at a southern Puerto Rico tertiary care hospital. Methods We performed a retrospective analysis of disease severity among laboratory-confirmed influenza cases enrolled in SEDSS. Cases with complications such as pneumonia or bronchitis evidenced by chest x-ray or clinical diagnosis were classified as severe. Results Between January 2016 and December 2019, there were 2,835 laboratory-confirmed influenza cases. More than half (1,662, 59%) were aged 0–20 years, 51% (n=1,447)were female, and 4% (n=124)required hospital admission. Among all influenza cases, influenza A virus was most common (n = 1,963, 69%) followed by influenza B virus (n = 872, 31%). Odds of having influenza A were higher among adults (OR=1.62; 95% CI:1.38-1.92). Chronic disease history among influenza cases included: asthma (n= 507, 18%), hypertension (n = 337, 12%), hypercholesterolemia (n = 157, 6%), coronary heart disease (n = 79, 3%), immunodeficiency (n = 11, 1%), and kidney disease (n = 10, 1%). Overall, 61(2%) influenza cases developed complications, 21 developed pneumonia of which 85% had chest x-ray performed. One-third of influenza cases with pneumonia or bronchitis had preexisting conditions like asthma (33%) and hypertension (34%). Seventy five percent of Influenza A cases with asthma developed bronchitis or pneumonia. The odds of having severe Influenza were higher among patients with underlying hypertension compared to those without hypertension (OR= 3.8; 95% CI:2.0–7.1). Moreover, influenza cases with asthma had a higher odd of developing pneumonia or bronchitis as compared to those without asthma (OR=2.3; 95% CI: 1.3–4.0). While asthma is a recognized risk factor for influenza complications, isolated hypertension is not. Conclusion Identifying people at risk for influenza complications provides a guide for clinicians and public health officials to implement preventive measures and improve clinical outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Brixia Chest X-ray Scoring System in Critically Ill Patients with COVID-19 Pneumonia for Determining Outcomes

2021 ◽  
Author(s):  
Nishant Agrawal ◽  
Samruddhi Dhanaji Chougale ◽  
Prashant Jedge ◽  
Shivakumar Iyer ◽  
John Dsouza
Keyword(s):  
Scoring System ◽  
Early Stage ◽  
Tertiary Care ◽  
Categorical Variables ◽  
P Value ◽  
Care Hospital ◽  
X Ray ◽  
Lung Abnormalities ◽  
Chest X Ray ◽  
The Mean

Introduction: In early stage of disease of Coronavirus Disease 2019 (COVID-19) infection chest Computed Tomography (CT) imaging is considered as the most effective method for detecting lung abnormalities. A Brixia Chest X-ray (CXR) scoring system which uses an 18-point severity scale to grade lung abnormalities due to COVID-19 was developed to improve the risk stratification for infected patients. Aim: To ascertain the validity of Brixia scoring system and to measure the outcome in COVID-19 patients. Materials and Methods: A retrospective study was conducted from 1st April 2020 to 31st July 2020, at a tertiary care hospital in India. Baseline CXR of COVID-19 patients were scored based on Brixia scoring system. The lungs were divided into six equal zones. Subsequently, scores (from 0-3) were assigned to each zone, based on lung abnormalities. A group comparison was implemented using Chi-Square test for categorical variables. Whereas an independent t-test was applied for continuous variables that followed normal distribution. Results: The study included 130 patients. The mean age was 57.09±13.73 years, 70.8% patients included were males. Out of 130 patients, 79 patients died. Among patients who died the mean CXR score was calculated to be 12.13±2.50. The mean CXR score was calculated to be 11.18±2.30 in patients who recovered and got discharged. During the process of comparison of CXR scores with the outcomes, the t-value came out to be 2.20 and the resulting p-value was 0.03 (statistically significant). Conclusion: Brixia score more than 12 was associated with increased mortality due to COVID-19, with p-value of 0.03.

scholarly journals Evaluation of risk factors associated with the development of MDR- and XDR-TB in a tertiary care hospital: a retrospective cohort study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10826
Author(s):  
Amna Saifullah ◽  
Tauqeer Hussain Mallhi ◽  
Yusra Habib Khan ◽  
Muhammad Shahid Iqbal ◽  
Nasser Hadal Alotaibi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Previous Treatment ◽  
Care Hospital ◽  
X Ray ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Mdr Tb ◽  
Chest X Ray

Background Drug resistant tuberculosis (DR-TB) infringes substantial burden in terms of longer treatment duration, morbidity and mortality. Timely identification of patients at risks of DR-TB will aid individualized treatment. Current study was aimed to ascertain several factors associated with DR-TB among patients attending a tertiary care hospital. Methods This retrospective study was conducted among patients with confirmed diagnosis of DR-TB and drug susceptible TB (DS-TB) seeking medical care from a tertiary care hospital during 2014–2019. The types of DR-TB included were rifampicin resistant tuberculosis (RR-TB), Multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB). Appropriate statistical methods were implied to evaluate the factors associated with DR-TB. Results Out of 580 patients, DS-TB was diagnosed in 198 (34.1%) patients while DR-TB was present in 382 patients. Of resistance cases, RR-TB, MDR-TB and XDR-TB were diagnosed in 176 (30.3%), 195 (33.6%) and 11 (1.9%) patients, respectively. Significant differences (P < 0.05) in demographics and clinico-laboratory characteristics were observed between patients with DS-TB and DR-TB. Logistic regression analysis revealed age ≤38 years (OR: 2.5), single marital status (OR: 11.1), tobacco use (OR: 2.9), previous treatment (OR: 19.2), treatment failure (OR: 9.2) and cavity on chest X-ray (OR: 30.1) as independent risk factors for MDR-TB. However, XDR-TB was independently associated with age group of ≤38 years (OR: 13.6), students (OR: 13.0), previous treatment (OR: 12.5), cavity on chest X-ray (OR: 59.6). The independent risk factors associated with RR-TB are age ≤38 years (OR: 2.8), females (OR: 5.7), unemployed (OR: 41.5), treatment failure (OR: 4.9), previous treatment (OR: 38.2) and cavity on chest X-ray (OR: 4.3). ROC curve analysis accentuate the excellent predictive accuracy of all logistic regression models as shown by AUC (0.968, P < 0.001) for MDR-TB, AUC (0.941, P < 0.001) for XDR-TB and AUC (0.962, P < 0.001) for RR-TB. Conclusions Current study demonstrates a sizeable extent of resistant cases among pulmonary TB patients. This study presaged significant risk of DR-TB among females, young adults, unemployed, smokers, patients with previous treatment failure and cavitation on chest X-ray. Timely identification of high risk patients will give pronounced advantages regarding appropriate choices of prevention, treatment and disease control.

scholarly journals Improved Diagnosis of Pulmonary Tuberculosis using Bleach (Sodium hypochlorite) Concentration Technique at Tertiary Care Hospital

2021 ◽  
Vol 1 (2) ◽  
pp. 15-22
Author(s):  
Saroj Kumar Thakur ◽  
Vishvesh Prakashchandra Bansal ◽  
Jyotsna Mishra ◽  
M.P. Bansal ◽  
Iswari Sapkota ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Sodium Hypochlorite ◽  
Direct Method ◽  
Tertiary Care ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Care Hospital ◽  
Case Detection ◽  
Acid Fast Bacilli ◽  
Concentration Method

Introduction: In the Revised National Tuberculosis Control Program (RNTCP), microscopic examination of sputum for acid-fast bacilli (AFB) is currently the backbone for the diagnosis of pulmonary tuberculosis. Studies have shown liquefaction and concentration of sputum by 5% sodium hypochlorite is useful in providing increased sensitivity and safety for the handling of specimens. Objective: To assess the utility of the 5% Sodium hypochlorite concentration method in increasing the sensitivity of smear microscopy for detection of AFB for diagnosis of pulmonary tuberculosis. Methods: The study included a total of 1000 sputum samples from 500 patients with suspected pulmonary tuberculosis. Direct smears were prepared from the sputum samples as per RNTCP guidelines. The remaining sputum was used for bleach concentration and smears prepared from the concentrated material. Both smears were stained by Ziehl-Neelsen staining and screened for acid-fast bacilli and graded according to the RNTCP guidelines. Results: A total of 158 samples (15.8%) from 89 patients were positive by a routine direct method whereas by concentration method 236 samples (23.6%) from 143 patients were found positive diagnosing additional 54 patients. The gain in sputum smear positivity of 7.8% over the routine method is highly significant (p=0.0000, χ2= 270) with a 10.8% increase in case detection. Conclusions: Improvement in the sensitivity of smears microscopy will be useful in case detection of tuberculosis especially in resource-poor countries. The increased positivity of microscopy by bleach method indicates that would prove useful if included in the RNTCP to improve case detection. Keywords: Concentration; smear positivity; sodium hypochlorite; tuberculosis.

scholarly journals Concordance of two sputum smear microscopy for diagnosis of presumptive pulmonary tuberculosis in a tertiary care hospital

2017 ◽  
Vol 4 (8) ◽  
pp. 2686
Author(s):  
Star Pala ◽  
Kyrshan G. Lynrah
Keyword(s):  
Pulmonary Tuberculosis ◽  
Tertiary Care Hospital ◽  
Sputum Sample ◽  
Tertiary Care ◽  
Positive Sample ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Care Hospital ◽  
Sputum Smear Microscopy ◽  
Tuberculosis Case

Background: Under revised National tuberculosis control program two sputum samples are to be collected for diagnosis of presumptive pulmonary tuberculosis case. The objective of this study is to find the concordance of both sputum smear microscopy samples at a tertiary care hospital. Methods: Hospital based record was collected from designated microscopy center laboratory register. The data collected were from January 2015 to November 2016. Results: A total of 2117 paired of sputum sample were collected for the year 2015-16 in one of the DMC of a tertiary care hospital. A total of 183 patient (at least one sputum sample) were positive (8.64%) and 1934 were both negative. Among the positive sample concordance for both spot and morning samples were 89% (163/183) and discordance where spot sample positive and morning sample negative was 4.91% (9/183) and where spot sample negative and morning sample positive was 6.01% (11/183). Overall discordance between spot and morning samples were only 0.94% (20/2117). Conclusions: There is a good concordance of two sputum samples. Discordance of two sputum samples were <1% in a tertiary care hospital. One sample may be sufficient for operational purpose for diagnosis of pulmonary Tb. But to have a robust recommendation a RCT will be required to see the extent of discordance by ruling out bias in sputum smear examination.  

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