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PubMed | Vijan Hospital, National Institute of Tuberculosis and Respiratory Diseases, Oman Al Khair Hospital, Korea Institute of Materials Science and 3 more.
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2017

Diagnosing heart failure is often a challenge for the healthcare providers due to its non-specific and usually subtle physical presentations. The outcomes for treatment are strongly related to the stage of the disease. Considering the importance of early and accurate diagnosis, it is important to have an easy, inexpensive, non-invasive, reliable and reproducible method for diagnosis of heart failure. Recent advancement in radiology and cardiology are supporting the emerging technique of lung ultrasound through B-line evaluation for identifying extravascular lung water.To establish lung ultrasound as an easy, inexpensive, non-invasive, reliable and reproducible method for diagnosing Acute Decompensated Heart Failure (ADHF) in emergency department.The study was a cross-sectional, prospective, observational, diagnostic validation study of lung ultrasound for diagnosis of acute heart failure in an emergency department and was performed at Amrita Institute of Medical Science, Kochi, Kerala, India. A total of 42 patients presenting with symptoms suggestive of acute decompensated heart failure were evaluated by plasma B-type Natriuretic Peptide (BNP), Echocardiography (ECHO) and X-ray. Lung ultrasound was done to look for the presence of B-lines.Sensitivity, specificity and predictive value of diagnostic modalities were calculated using Mc Nemars Chi-square test for the presence and absence of heart failure.Lung ultrasound showed a sensitivity of 91.9% and a specificity of 100% in diagnosing acute heart failure comparable to plasma BNP which had a sensitivity of 100% and a specificity of 60%. It was also superior to other methods of diagnosing ADHF namely X-ray and ECHO and showed a good association.Lung ultrasound and its use to detect ultrasonographic B-lines is an early, sensitive and an equally accurate predictor of ADHF in the emergency setting as compared to BNP.


Gandhi K.,National Institute of Tuberculosis and Respiratory Diseases | Gupta S.,National Institute of Tuberculosis and Respiratory Diseases | Singla R.,National Institute of Tuberculosis and Respiratory Diseases
Indian Journal of Tuberculosis | Year: 2016

Background Treatment of pulmonary tuberculosis (PTB) focuses on microbiological cure and radiological improvement. However, many patients develop pulmonary impairment after the completion of anti-tubercular therapy (ATT), which affects their quality of life (QoL). Aim and objective To study the occurrence and severity of pulmonary impairment after tuberculosis (PIAT), risk factors associated with development of PIAT and QoL after development of PIAT. Methodology 146 eligible PTB patients, who completed their ATT during January 2013 to December 2013 at National Institute of TB and Respiratory Diseases (NITRD), New Delhi and peripheral centres were enrolled after informed consent and evaluated. PIAT was graded using spirometric parameters. Severity of dyspnoea was assessed using Borg scale and Medical Research Council (MRC) scale. QoL was assessed using Seattle's Obstructive Lung Diseases Questionnaire (SOLDQ). Results 74% (108) had PIAT. On univariate analysis, smoking, education, body mass index (BMI), duration of illness prior to diagnosis of TB and number of prior ATT courses taken were the significant risk factors associated with the development of PIAT. On multiple logistic regression, patients who had taken ATT more than once was the independent risk factor associated with PIAT. Severity of dyspnoea was increased on both Borg scale and MRC scale with the increase in impairment of lung function. QoL was lower in patients with severe impairment. Conclusion After bacteriological cure of TB after treatment, significant numbers of patients have poor lung function and poor QoL. There is need for prevention and management of such sequelae under national programme. © 2016 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.


Kumar P.,All India Institute of Medical Sciences | Pandya D.,AmpliGene India Biotech Pvt. Ltd. | Singh N.,National Institute of Tuberculosis and Respiratory Diseases | Behera D.,National Institute of Tuberculosis and Respiratory Diseases | And 3 more authors.
Journal of Infection | Year: 2014

Objectives: Loop-mediated isothermal amplification (LAMP) is a newly developed molecular method that can be performed isothermally. We developed and evaluated a LAMP assay using novel primers to diagnose tuberculosis directly from clinical samples. Materials: Primers were designed to amplify the specific novel esat-6 gene target of Mycobacterium tuberculosis (MTB). Quantitated DNA was used to determine analytical sensitivity and specificity was evaluated by testing 29 NTM and 37 other bacterial species. After standardization, its sensitivity and specificity were evaluated on samples from 118 TB suspected and 31 non-TB patients and compared it with smear, culture and mPCR methods. Results: LAMP was able to detect 5fg DNA (one MTB) within 21min and found to be 10 times more sensitive than mPCR and showed 100% specificity against NTM and other bacterial species. In clinical samples, LAMP showed highest MTB detection rate (52.5%) as compared to mPCR (44%) and culture (30.5%). On culture positive and mPCR positive samples, the sensitivity of LAMP was found to be 100% (95% CI 90.2-100) and 96.1% (95% CI 86.7-99.5) respectively with 93.5% (95% CI 78.5-99.2) of overall specificity. Conclusion: LAMP was found to be more sensitive than culture and mPCR for the detection of MTB. It showed specificity comparable to mPCR but was rapid and cost effective. © 2014 The British Infection Association.


Dewan R.K.,National Institute of Tuberculosis and Respiratory Diseases | Pezzella A.T.,International Childrens Heart Fund
Asian Cardiovascular and Thoracic Annals | Year: 2016

Tuberculosis remains a major global medical challenge and concern. In the world's population of over 7.4 billion people, 8.6 million are estimated to be infected with Mycobacterium tuberculosis; another 2.2 billion have latent tuberculosis. There is an annual incidence of 16,000 new cases in the USA and 7-8 million new cases worldwide, of which 440,000 are multidrug-resistant or extensively multidrug-resistant, mainly in developing countries or emerging economies. According to the World Health Organization, the incidence of tuberculosis is 133 cases per 100,000 of the population; 3.3% new cases are drug resistant and 20% are already treated cases. Of the drug-resistant cases, 9.7% are extensively drug-resistant. The annual global mortality attributable to tuberculosis is over 1.3 million people. The association with HIV/AIDS in 430,000 people has compounded the global concern and challenge. This review presents the historical indications for surgical treatment of tuberculosis, reviews the current literature and clinical experience, and collates this into increased awareness and contemporary understanding of the indications and need for surgery in primary active tuberculosis, adjuvant surgical therapy for multidrug-resistant tuberculosis, and the complications of chronic tuberculosis sequelae or previous tuberculosis surgery. © SAGE Publications.


PubMed | All India Institute of Medical Sciences and National Institute of Tuberculosis and Respiratory Diseases
Type: | Journal: European journal of obstetrics, gynecology, and reproductive biology | Year: 2016

Evaluation of 6 patients presenting with tubo-ovarian mass or infertility with multi drug resistant (MDR) female genital tuberculosis (FGTB).It was an observational study in a tertiary referral centre, India on subjects with MDR FGTB on clinical examination and investigations. All patients were given category IV drugs using kanamycin (intramuscular), levofloxacin, pyrazinamide, cycloserine, ethionamide and ethambutol (or para aminosalicylic acid [PAS] for ethambutol resistant cases) for 6 months intensive phase followed by oral levofloxacin, cycloserine, ethionamide and ethambutol (or PAS for ethambutol resistant cases) for 18 months continuation phase. Patients were evaluated for primary end points (complete cure, partial response, no response, treatment completed) and secondary end points (recurrence rate, pregnancy rate) during treatment.There were 2 (33.3%) primary MDR FGTB patients and 4 (66.6%) secondary MDR FGTB (three pulmonary MDR and one MDR lymphadenitis) patients. Mean age was 23.6 years. Presenting features were menstrual dysfunction in all patients (100%) especially oligomenorrhea in 4 (66.6%) patients, weight loss in all the patients (100%), cough with expectoration in three patients (50%), tubo-ovarian masses in five (83.3%) patients. Endometrial biopsy showed positive culture for AFB with rifampicin and isoniazid (INH) resistance in both primary MDR FGTB patients and in two secondary MDR FGTB patients who were sexually active. In secondary MDR FGTB, three pulmonary MDR patients had positive sputum AFB culture, while the patient with MDR lymphadenitis had lymph node aspirate for AFB culture positive with all showing resistance to rifampicin and isonioazid. Gene Xpert on endometrial biopsy or sputum was positive in 5 (83.3%) patients. Three (50%) patients (one primary and two secondary) have completed therapy while other 3 (50%) are in continuation phase. All patients are asymptomatic with one having 12 weeks ongoing successful pregnancy.MDR FGTB should be thought of in women of FGTB with tubo- ovarian masses who are not responding to first line drugs. Gene Xpert can be used in early diagnosis of MDR FGTB.


PubMed | Manipal University India, Government Medical College and National Institute of Tuberculosis and Respiratory Diseases
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

The availability of the haemoglobin A1c test has been a major advance in diabetic care and its measurement has become an integral part for the management of diabetes. When glycated haemoglobin (HbA1c) is estimated by High Performance Liquid Chromatography (HPLC), one of the fractions that are eluted is known as P3 fraction which is labelled as degenerated haemoglobin. The P3 fraction is not taken into account while estimating HbA1c or HbA values.To study the effect of P3 on the final reported value of HbA1c by HPLC and the significance of this fraction in the final chromatogram. The possibility that HbA1c fraction is under reported due to increase in P3 fraction was also examined.HbA1c, various fractions of HbA1 and P3 were estimated by HPLC method in 430 subjects. Patient data was divided into 3 groups on the basis of HbA1c% (group I - <6%, group II - 6 - 12%, group III - >12%).P3% as well as P3 area increases as the HbA1c increases (p-value - <0.001). Statistical significant increase was seen as HbA1c% increases, P3% also increases and correlation (r = 0.6) became stronger with increasing HbA1c levels. HbA1a%, HbA1b% fraction increases with increase in HbA1c% and HbA1a area, HbA1b area also shows the same increase with increasing HbA1c%.From this study we conclude that sub fractions of glycated haemoglobin and P3 fraction influence the final reported value of HbA1c by HPLC. P3 fraction might indicate the possible presence of variant haemoglobin in the sample.


PubMed | National Institute of Tuberculosis and Respiratory Diseases
Type: | Journal: International journal of mycobacteriology | Year: 2017

With the introduction of novel molecular techniques that rely on rifampicin (RIF) susceptibility, resistance to isoniazid (INH) or other first-line drugs remains undetected. Such patients are prescribed first-line antituberculosis therapy and are on RIF monodrug therapy during the continuation phase, which may lead to therapeutic failure and emergence of multidrug resistance. We aimed to study INH resistance among RIF-susceptible Mycobacterium tuberculosis (MTB) isolates from retreatment patients.The Drug Susceptibility Testing data for four first-line drugs (streptomycin [SM], INH, RIF, and ethambutol [EMB]) using BACTEC MGIT 960 (Becton Dickinson, Franklin 124 Lakes, NJ ,USA) and for two drugs (INH and RIF) using line probe assay was analyzed retrospectively at the Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases (New Delhi, India).We analyzed 4910 drug susceptibility results performed using the BACTEC MGIT960 liquid culture system from 2009 to 2015. We found that 969 (19.7%) isolates were sensitive to all four first-line drugs, 3941 (80.3%) isolates were resistant to one or more drugs, and 3041 (61.9%) isolates were resistant to both RIF and INH with or without resistance to any other drug (multidrug resistant). Monodrug resistance to SM and EMB was observed in 94 (1.9%) and 8 (0.16%) isolates, respectively. RIF resistance without INH resistance was observed in 22 (0.44%) isolates. There were 776 isolates sensitive to RIF, but resistant to INH. Among these, INH resistance with EMB and/or SM was observed in 367 (7.47%) isolates, whereas 409 (8.3%) isolates were resistant to INH alone. The results of line probe assay from 2012 to 2015 were also analyzed, and the resistance to INH alone among all isolates with valid results was found to be 9.32% (1462/15,676). More than 75% of these isolates harbor mutations in the kat G gene associated with high-level resistance.INH resistance among RIF-susceptible isolates was present in 10-15% of the total cases. Among these cases, the use of RIF susceptibility alone will fail to detect INH resistance. Since higher rates of failure, relapse, or acquired resistance are linked with INH resistance, rollout of techniques focusing on RIF resistance must, therefore, be accompanied by strict monitoring for better management of patients.


PubMed | National Institute of Tuberculosis and Respiratory Diseases
Type: | Journal: International journal of mycobacteriology | Year: 2017

Surgery in DR-TB is a highly contested intervention. However, in suitable selected cases, it has a great role in improving outcomes of treatment as well as symptomatic improvement in the quality of life of the patient. Indications of surgery in this setting will be localized disease with high likelihood of persistent progression or sputum positivity despite adequate therapy. Recurrent hemoptysis, intolerance to drugs or absence of radiological and bacteriological improvement during initial 3-4months of therapy becomes additional indications for surgical intervention. A review of 11 studies published in a period from 1993 to 2013 provides enough justification for the role of surgical intervention in pulmonary tuberculosis.At the NITRD, in the last 20years a total of 107 cases have been operated upon for DR-TB. Procedures done were 70 pneumonectomies, 20 lobectomies, 5 bilobectomies, 4 nonanatomical resections and 7 thoracoplasties.Sputum negativity was achieved in 93 cases after surgery and 62 were declared cured after 4years of follow up. 6 cases of DR TB were also operated upon in March 2013 in one MSF TB surgery mission and all of them are sputum negative till March 2015.In conclusion, surgical intervention should be offered and made available for greater number of DR-TB patients.


PubMed | National Institute of Tuberculosis and Respiratory Diseases
Type: Journal Article | Journal: The Indian journal of tuberculosis | Year: 2016

Treatment of pulmonary tuberculosis (PTB) focuses on microbiological cure and radiological improvement. However, many patients develop pulmonary impairment after the completion of anti-tubercular therapy (ATT), which affects their quality of life (QoL).To study the occurrence and severity of pulmonary impairment after tuberculosis (PIAT), risk factors associated with development of PIAT and QoL after development of PIAT.146 eligible PTB patients, who completed their ATT during January 2013 to December 2013 at National Institute of TB and Respiratory Diseases (NITRD), New Delhi and peripheral centres were enrolled after informed consent and evaluated. PIAT was graded using spirometric parameters. Severity of dyspnoea was assessed using Borg scale and Medical Research Council (MRC) scale. QoL was assessed using Seattles Obstructive Lung Diseases Questionnaire (SOLDQ).74% (108) had PIAT. On univariate analysis, smoking, education, body mass index (BMI), duration of illness prior to diagnosis of TB and number of prior ATT courses taken were the significant risk factors associated with the development of PIAT. On multiple logistic regression, patients who had taken ATT more than once was the independent risk factor associated with PIAT. Severity of dyspnoea was increased on both Borg scale and MRC scale with the increase in impairment of lung function. QoL was lower in patients with severe impairment.After bacteriological cure of TB after treatment, significant numbers of patients have poor lung function and poor QoL. There is need for prevention and management of such sequelae under national programme.


PubMed | All India Institute of Medical Sciences and National Institute of Tuberculosis and Respiratory Diseases
Type: Journal Article | Journal: The British journal of radiology | Year: 2016

To evaluate the feasibility and efficacy of accelerated hypofractionated radiation with concomitant chemotherapy (AHFx-RT-CT) in locally advanced squamous cell carcinoma (SCC) of the lung.36 patients were enrolled in this study (CTRI/2013/11/004143). Patients in Arm A (n=18) received neoadjuvant chemotherapy (NACT) (paclitaxel 200mgm(-2) and carboplatin area under the curve 5) followed by external radiotherapy (60Gy/30 fractions/6 weeks). Patients in Arm B (n=18) received NACT as in Arm A followed by AHFx-RT (48Gy/20 fractions/4 weeks) with concomitant chemotherapy (cisplatin 30mgm(-2) weekly). Primary end points included comparative evaluation of overall locoregional response rates (ORRs) and progression-free survival (PFS). Secondary end points included toxicity, quality of life (QOL) and overall survival (OS).The median follow-up duration was 15 months. The ORR at first follow-up (72.2% vs 44%, p=0.06) and at 1 year after treatment completion (61% vs 5.5%, p=0.04) were superior in Arm B. The median PFS (17 vs 5.36 months; p=0.053) and OS (24.73 vs 12.33 months; p=0.007) were also superior in Arm B. Grade 3 acute pharyngitis/oesophagitis was less in Arm B (p=0.05). Improvement of emotional function, cognitive function and chest pain was observed in Arm B.The study suggests that AHFx-RT-CT is feasible for locally advanced SCC of the lung with improved response rate, survival, QOL and favourable toxicity.To the best of our knowledge, this is the first study comparing conventionally fractionated radiation with AHFx-RT-CT. Addition of low-dose weekly cisplatin as radiosensitizer may be the potential factor responsible for improved response rate, survival and favourable toxicity in the study arm despite lower biological effective dose.

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