Pulmonary vein stenosis:Etiology,diagnosis and management

Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.

Etiology and an Integrated Management of Severe Hemoptysis Due to Pulmonary Tuberculosis

Background: It is very important to enhance the therapeutic effect and prognosis of severe tuberculous hemoptysis after the determining of its etiological cause and the source of bleeding. The etiology and integrated curative effect of severe hemoptysis due to pulmonary tuberculosis among 112 inpatients were analyzed. Materials and Methods: The cause was retrospectively analysed. The integrated management effect after the follow-up of mean three years in 112 cases with severe hemoptysis being resulted from pulmonary tuberculosis from June 2008 to July 2012 was described. Active pulmonary tuberculosis ranked the first cause of lower respiratory tract bleeding (32/112, 28.5%), followed by old pulmonary tuberculosis (28/112, 25.0%), tuberculous bronchiectasis (25/112, 22.3%), purified tuberculous cavity (12/112, 10.7%), fungal infection in old pulmonary tuberculosis cavity (9/112, 7.1%), or broncholithiasis (6/112, 5.4%). Almost all suffers with severe hemoptysis were treated by an integrated management, including psychology, anticoagulants, vasoconstrictor agents. Etiological treatment including anti-tuberculosis and anti-infection was simultaneously or subsequently involved. Sixty-four inpatients with severe hemoptysis being failed to be cured by medical treatment were then received selective bronchial artery embolization. Four patients were received surgical wedge resection, lobectomy or pneumonectomy. The total cure rate added up to 98.2% after mean three years’ follow-up. The mortality was 1.8%. Conclusions: Active pulmonary tuberculosis was still responsible for the severe hemoptysis in the southeast region of China. Severe hemoptysis of pulmonary tuberculosis was also resulted from stable tuberculosis, tuberculous bronchiectasis, tuberculosis cavity, fungal infection, or broncholithiasis. Better clinical therapeutic effect could be attained by early etiological diagnosis and comprehensive treatment strategy.

Comparative analysis of pulmonary and extrapulmonary tuberculosis:A seven-year experience from a refugee host country,Turkiye

Objective:To investigate and compare the demographic characteristics,clinical findings,and laboratory results of pulmonary tuberculosis(PTB)and extrapulmonary tuberculosis(EPTB)patients,among Turkish citizens,and foreign nationals.Methods:This study included patients aged 18 and over,both Turkish citizens and foreign nationals,diagnosed with PTB or EPTB between 2016 and 2022.All patients were divided into PTB and EPTB group,and demographic characteristics,clinical findings,and laboratory results were compared.Patients with both PTB and EPTB were not included in the comparison.Multivariate logistic regression analysis was conducted to identify potential risk factors for PTB.Results:Among the 261 TB cases included,46 patients(17.6%)had PTB,and 188(72%)had EPTB.The percentage of female patients was significantly higher(P=0.003)in EPTB compared to PTB group.While the prevalence of diabetes mellitus(P=0.002),hypertension(P=0.017),coronary obstructive pulmonary disease(P=0.001),congestive heart failure(P=0.005),coronary artery disease(P=0.001)and immunosuppressive medication use(P=0.017)were significantly higher in PTB patients than in EPTB patients.Multivariate logistical analysis reveals that male(OR 2.6,95%CI 1.3-5.5,P=0.009),diabetes mellitus(OR 2.7,95%CI 1.2-6.1,P=0.015),and asthma(OR 6.3,95%CI 1.2-33.9,P=0.032)were associated with an increased risk of PTB.Social security coverage(P<0.001)and regular employment status(P<0.001)were found to be lower and the presence of multidrug resistance(P=0.002),isoniazid resistance(P=0.012),and rifampin resistance(P=0.012)were found to be significantly higher in foreign-national TB patients comparing with Turkiye citizens.Conclusions:Patients with PTB need to be evaluated for comorbidities and PTB should be investigated in men,in patients with diabetes mellitus or asthma if there are clinical findings suspicious for TB.TB screening for foreign nationals upon entry into the country is essential for TB control and elimination.

Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus

BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Organizing pneumonia secondary to pulmonary tuberculosis:A case report

BACKGROUND Organizing pneumonia secondary to pulmonary tuberculosis is rare.Moreover,the temporal boundary between pulmonary tuberculosis and secondary organizing pneumonia has not been defined.We report a case of secondary organizing pneumonia associated with pulmonary tuberculosis occurring after nine months of antituberculosis treatment.CASE SUMMARY A 54 years old man,previously diagnosed with pulmonary tuberculosis and tuberculous pleurisy,underwent nine months of antituberculosis treatment.Follow-up lung computed tomography revealed multiple new subpleural groundglass opacities in both lungs,and a lung biopsy confirmed organizing pneumonia.Treatment continued with anti-tuberculosis agents and hormone therapy,and subsequent dynamic pulmonary computed tomography exams demonstrated improvement in lesion absorption.No disease recurrence was observed after corticosteroid therapy discontinuation.CONCLUSION When treating patients with active pulmonary tuberculosis,if an increase in lesions is observed during anti-tuberculosis treatment,it is necessary to consider the possibility of tuberculosis-related secondary organizing pneumonia,timely lung biopsy is essential for early intervention.

Identification of pathological characteristics in pulmonary tuberculosis using polarization-sensitive optical coherence tomography

The low detection rate of Mycobacterium tuberculosis in clinical practice leads to a high rate of missed diagnosis for pulmonary tuberculosis(PTB).As a noninvasive,high-resolution,real-time imaging technology,polarization-sensitive optical coherence tomography(PS-OCT)may be feasible for the rapid identification of pathological feature.This study aimed to explore the feasibility of using PS-OCT to identify pathological features of PTB.In the experiments,PTB samples containing some surrounding lung tissues were imaged using PS-OCT.It is demonstrated that PS-OCT images showed good consistency with the corresponding pathological images and were able to identify PTB-related characteristic pathological regions.We think PS-OCT can serve as an effective supplement for the diagnosis of PTB,enabling rapid and accurate diagnosis,and aiding in the understanding of the pathological characteristics and pathophysiological processes of PTB.

Computed tomography imaging and clinical significance of bacterium-positive pulmonary tuberculosis complicated with diabetes

BACKGROUND The increasing prevalence of tuberculosis(TB)and diabetes on a global scale poses a significant health challenge,particularly due to their co-occurrence,which amplifies the severity,recurrence and mortality rates associated with both conditions.This highlights the need for further investigation into their interrelationship.AIM To explore the computed tomography(CT)imaging and clinical significance of bacterium-positive pulmonary TB(PTB)combined with diabetes.METHODS There were 50 patients with bacterium-positive PTB and diabetes,and 50 with only bacterium-positive PTB.The latter were designated as the control group.The CT imaging of the two groups of patients was compared,including lesion range,shape,density and calcification.RESULTS No significant differences were observed in age,gender,smoking and drinking history,high blood pressure,hyperlipidemia and family genetic factors between the groups.However,compared to the patients diagnosed solely with simple bacterium-positive PTB,those with concurrent diabetes showed a wider range of lesions and more complex and diverse morphology on CT images.Among them,intrapulmonary tuberculosis lesions were often accompanied by manifestations of pulmonary infection,such as cavity formation and bronchiectasis.At the same time,diabetes-related signs were often seen on CT images,such as pulmonary infection combined with diabetic pulmonary lesions.Logistic regression analysis identified age and medical history as significant factors influencing the degree of pulmonary infection and CT imaging outcomes in patients with both TB and diabetes.This suggests that older age and specific medical histories may increase the risk or severity of pulmonary damage in these patients.CONCLUSION CT imaging reveals more complex lesions in PTB patients with diabetes,emphasizing the need for careful evaluation and comprehensive analysis to enhance diagnostic accuracy.

Carrimycin in the treatment of acute promyelocytic leukemia combined with pulmonary tuberculosis: A case report

BACKGROUND Pulmonary tuberculosis(PTB)is prevalent in immunocompromised populations,including patients with hematologic malignancies,human immunodeficiency virus infections,and chronic diseases.Effective treatment for acute promyelocytic leukemia(APL)combined with PTB is lacking.These patients show an extremely poor prognosis.Therefore,studies should establish efficient treatment options to improve patient survival and prognosis.CASE SUMMARY A 60-year-old male with pain in the right side of his chest and a fever for 4 d visited the outpatient department of our hospital.Peripheral blood smear revealed 54%blasts.Following bone marrow examinations,variant APL with TNRC18-RARA fusion gene was diagnosed.Chest computed tomography scan showed bilateral pneumonitis with bilateral pleural effusions,partial atelectasis in the lower lobes of both lungs,and the bronchoalveolar lavage fluid gene X-Pert test was positive,indicative of PTB.Carrimycin,ethambutol(EMB),and isoniazid(INH)were administered since he could not receive chemotherapy as the WBC count decreased continuously.After one week of treatment with carrimycin,the patient recovered from fever and received chemotherapy.Chemotherapy was very effective and his white blood cells counts got back to normal.After being given five months with rifampin,EMB and INH and chemotherapy,the patient showed complete remission from pneumonia and APL.CONCLUSION We report a case of PTB treated successfully with carrimycin with APL that requires chemotherapy.

Perianal tuberculous ulcer with active pulmonary,intestinal and orificial tuberculosis:A case report

BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.CASE SUMMARY Here,we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis,intestinal tuberculosis and orificial tuberculosis.This is an extremely rare case of cutaneous tuberculosis of the anus,which was misdiagnosed for nearly a year.The patient received conventional treatment in other medical institutions,but specific treatment was delayed.Ultimately,proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.CONCLUSION For skin ulcers that do not heal with repeated conventional treatments,consider ulcers caused by rare bacteria,such as Mycobacterium tuberculosis.

Prevalence of Pulmonary Tuberculosis and HIV Co-Infection among Women in Bogodogo, Burkina Faso

Introduction: The tuberculosis (TB) and HIV co-infection is a deadly combination, each accelerating the progression of the other. TB, caused by Mycobacterium tuberculosis (M. tuberculosis), is the leading cause of deaths among people living with HIV, accounting for around 40% of all HIV-positive deaths. The aim of this study was to estimate the prevalence of the tuberculosis-HIV co-infection in women. Material and Methods: The study population consisted of all suspected patients visiting the laboratory of the Bogodogo University Hospital, from May 2023 to January 2024, to be screened for M. tuberculosis. This was a descriptive cross-sectional study. Socio-demographic data were collected during individual interviews with consenting patients. M. tuberculosis was identified using the GeneXpert device, and HIV was diagnosed using the Abbott Determine diagnostic test. Results: Our study population was aged, on average, 37 ± 17.5 years. The overall tuberculosis infection rate was 65%, and 35% were married. Housewives were the most infected with 22.5%. The most infected age group was the ]20 - 40], with 32.5%. Some 37.5% of the women were anorexic and 45% had asthenia. Of the suspected cases, 47.5% were people who had contact with infected persons. TB/HIV co-infection was 5%. Conclusion: Tuberculosis is still rife in many parts of the world. It infects both men and women very quickly. HIV-tuberculosis co-infection is a reality, with HIV accelerating the progression of tuberculosis and vice versa. Raising awareness of HIV and tuberculosis should be done in tandem, as their co-infection leads to a poor vital prognosis.

Pulmonary alveolar proteinosis complicated with tuberculosis:A case report

BACKGROUND Pulmonary alveolar proteinosis(PAP)is a rare lung disease characterized by the accumulation of phospholipoproteinaceous material in the alveoli.Cases of PAP complicated with tuberculosis are much more complex and have rarely been well recorded.CASE SUMMARY We describe a 21-year-old Han Chinese patient with suspicious lung infection associated with mild restrictive ventilatory dysfunction and diffusion reduction.High resolution computed tomography revealed a“crazy-paving”appearance and multiple pulmonary miliary nodules around the bronchi.Bronchoalveolar lavage demonstrated a small amount of periodic acid-Schiff positive proteinaceous materials.A serological test for the presence of a Mycobacterium tuberculosis antibody and an interferon-gamma release assay were both positive.The patient received a standard course of first-line anti-tuberculosis treatment after diagnostic bronchoalveolar lavage.To date,clinical remission has been achieved and maintained for five years.CONCLUSION In summary,the diagnosis of PAP complicated with tuberculosis was supported by a combination of clinical manifestations,imaging,pulmonary function,laboratory examinations,bronchoalveolar lavage,etc.This case highlighted that diagnostic bronchoalveolar lavage in combination with anti-tuberculosis treatment is a safe and effective option for mild PAP patients with tuberculosis.

DIAGNOSIS AND TREATMENT OF THE MALIGNANT GESTATIONAL TROPHOBLASTIC TUMOR WITH PULMONARY METASTASIS COMPLICATED WITH PULMONARY TUBERCULOSIS

Objective. To evaluate the diagnosis and treatment for malignant gestational trophoblastic tumor(MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis. Methods. To analyze ten cases of MGTT with pulmonary metastasis complicated with pulmonary tuberculosis in our hospital from 1980 to 1997 retrospectively. Results.From the x ray film, there are great resemblances between MGTT with pulmonary metastasis and pulmonary tuberculosis. Of 10 patients, 7 of them were examined out pulmonary tuberculosis during the chemotherapy of MGTT. Pulmonary tuberculosis appeared six months before chemotherapy in three cases. All of the patients were treated with multiagent chemotherapy. Seven patients achiceved a complete remission, 2 patients developed drug resistance and died of cerebral haemorrhage and cerebral herniation, 1 woman who had achieved a complete remission from MGTT for 14 months died of miliary tuberculosis. Conclusion. It is very important to make differential diagnosis of the MGTT with pulmonary metastasis complicated with pulmonary tuberculosis. Trying to avoid excessive anti tumor treatment owing to mistake pulmonary tuberculosis for pulmonary metastasis, and avoiding missing an opportunity of anti tuberculosis treatment because of missed diagnosis should be emphasized.

Pneumonia,Multiple Pulmonary Infarction and Abscess Caused by a Bamboo Stick Accidentally Piercing into Chest:a Case Misdiagnosed as Pulmonary Tuberculosis

Computed tomography(CT)examination is the major measure for detecting and diagnosis of foreign bodies in human body.Although CT has high sensitivity in diagnosis of foreign body,some interference factors may still lead to missed diagnosis or misdiagnosis.Here we report a rare case that a bamboo stick accidentally pierced into the left chest of a young man who was drunk and unware of this hurt.The patient experienced cough,chest pain,fever,hemoptysis,and was misdiagnosed as primary and secondary tuberculosis based on chest CT examinations at a local hospital,although no tubercular bacillus detected by sputum smear.He subsequently received anti-tuberculous treatments in the following three years,but no improvement of his symptoms was observed.Until one month before his death,the bamboo stick was detected by spiral CT examination as well as three-dimensional image reconstruction at another hospital.Postmortem examination revealed pneumonia,pulmonary infarction,and abscess as the causes of his death.We analyze the potential reasons of misdiagnosis in this case,aiming to provide reference for the diagnosis and treatment of pulmonary inflammation associated with foreign body in the future.

Diagnostic Value of Spiral CT Chest Enhanced Scan in Adult with Active Pulmonary Tuberculosis

Aim:To explore the diagnostic value of spiral CT chest enhanced scan for adults with active pulmonary tuberculosis.Methods:The clinical data of 60 adult patients with active pulmonary tuberculosis who were treated in our hospital from January 2018 to November 2019 were retrospectively analyzed.All patients underwent conventional chest radiography and spiral CT chest enhanced scan.The number of tuberculosis diagnosis,the detection rate of special site lesions,and the detection rate of active pulmonary tuberculosis signs by the two methods were compared.Results:In 60 patients,the pathological results confirmed the existence of 75 tuberculosis lesions.The detection rate of spiral CT was 98.67%,which was not statistically significant compared with the detection rate of 92.00%(P>0.05)in the conventional chest X-ray.The detection rate of spiral CT enhanced scans for tuberculosis lesions in special sites was 100.00%,which was significantly higher than that of conventional chest X-ray of 7.69%,and the accuracy rate of active pulmonary tuberculosis signs was 98.85%higher than that of conventional chest X-ray of 79.31%.P<0.05).The difference was statistically significant(P<0.05).Conclusion:Spiral CT chest enhanced scan can not only find special tuberculosis lesions that cannot be detected by conventional chest radiography,but also accurately determine active pulmonary tuberculosis in adults,which is of high diagnostic value.

Risk of Active Pulmonary Tuberculosis among Patients with Coal Workers'Pneumoconiosis:A Case-control Study in China

The aim of this study was to estimate the association between occupational, environmental, behavioral risk factors, and active pulmonary tuberculosis（PTB） among coal workers＇ pneumoconiosis（CWP） patients. A matched case-control study was conducted in 86 CWP patients with active PTB and 86 CWP controls without TB. A standardized questionnaire was used for risk factors assessment. Conditioned logistic regression analysis was used to identify associations between the risk factors and active PTB among CWP patients. The results showed that the stage of CWP, poor workplace ventilation, family history of TB, and exposure to TB were independent risk factors for active PTB in patients with CWP with which recommendations for improving work environments, and for case finding activities in patients with CWP could be made.

Comparison of Two Molecular Assays For Detecting Smear Negative Pulmonary Tuberculosis

Objective To compare the performance of MTBDRplus V2 and Xpert MTB/RIF for detecting smear negative pulmonary tuberculosis （PTB）. Methods Clinical PTB suspects were enrolled consecutively in Anhui Chest Hospital and Xi＇an Chest Hospital from January to December in 2014. The sputum samples of smear negative PTB suspects were collected and decontaminated. The sediment was used to conduct MTBDRplus V2, Xpert MTB/RIF and drug susceptibility test （DST）. All the samples with discrepant drug susceptibility result between molecular methods and phenotypic method were confirmed by DNA sequencing. Results A total of 1973 cases were enrolled in this study. The detection rates of Mycobacterium tuberculosis complex （MTBC） by MTBDRplus V2 and Xpert MTB/RIF were 27.67% and 27.98%, respectively. When setting MGIT culture result as a gold standard, the sensitivity and specificity of MTBDRplus V2 were 86.74% and 93.84%, and the sensitivity and specificity of Xpert MTB/RIF were 86.55% and 93.43%, respectively. For the detection of the resistance to rifampin, the sensitivity and specificity of MTBDRplus V2 were 94.34% and 96.62%, and the sensitivity and specificity of Xpert MTB/RIF were 88.68% and 95.96%, respectively. For the detection of the resistance to isoniazid, the sensitivity and specificity of MTBDRplus V2 were 77.38% and 98.02%, respectively. Conclusion MTBDRplus V2 and Xpert MTB/RIF can be used to detect MTBC in smear negative samples with satisfactory performance.

-592 and -1082 interleukin-10 polymorphisms in pulmonary tuberculosis with type 2 diabetes

Objective:To determine the polymorphisms of Interleukin-10(IL-10)(-592,-1082) in pulmonary tuberculosis(PTB)with and without type 2 diabetes(T2D).Methods:We studied a Mexican mestizo population of 37 patients with TB in remission(TBr) and 40 with active pulmonary TB (PTB),21 patients with TB + T2D.47 blood donors accepted,and 13 healthy health-care workers with tuberculin skin lest positive.Determination of IL-10 polymorphisms was performed by real-lime Polymerase chain reaction.Results:IL-10-592C/A presented in a greater proportion in healthy individuals than in patients with type 2 diabetes and TB in a not quite significant statistically manner.IL-10-1082A/A presented more frequently in the group of patients with both diseases,not being statistically significant in comparison with the group of healthy subjects. Conclusions:This study describes two important new findings.First,it reveals that the IL-10 (-592 A/A and -592 C/C) polymorphisms were found in a greater proportion in a group of patients with T2D and TB than in healthy subjects.Second,the study provides evidence that the(-1082 G/G) polymorphism presented with greater frequency in healthy individuals than in patients with both ol these diseases.

Association of TNF-α-238G/A and 308 G/A Gene Polymorphisms with Pulmonary Tuberculosis among Patients with Coal Worker’s Pneumoconiosis

Objectives Tumor necrosis factor-α （TNF-α） may play an important role in host＇s immune response to mycobacterium tuberculosis （M. tuberculosis） infection. This study was to investigate the association of TNF-α gene polymorphism with pulmonary tuberculosis （TB） among patients with coal worker＇s pneumoconiosis （CWP）. Methods A case-control study was conducted in 113 patients with confirmed CWP complicated with pulmonary TB and 113 non-TB controls with CWP. They were matched in gender, age, job, and stage of pneumoconiosis. All participants were interviewed with questionnaires and their blood specimens were collected for genetic determination with informed consent. The TNF-α gene polymorphism was determined with polymerase chain reaction of restriction fragment length polymorphism （PCR-RFLP）. Frequency of genotypes was assessed for Hardy-Weinberg equilibrium by chi-square test or Fisher＇s exact probability. Factors influencing the association of individual susceptibility with pulmonary TB were evaluated with logistic regression analysis. Gene-environment interaction was evaluated by a multiplieative model with combined OR. All data were analyzed using SAS version 8.2 software. Results No significant difference in frequency of the TNF-α-308 genotype was found between CWP complicated with pulmonary TB and non-TB controls （2,2=5.44, P=-0.07）. But difference in frequency of the TNF-α-308 A allele was identified between them （2,2-5.14, P=0.02）. No significant difference in frequencies of the TNF-α-238 genotype and allele （P=0.23 and P=0.09, respectively） was found between cases and controls either, with combined （GG and AA） OR of 3.96 （95% confidence interval of 1.30-12.09） at the -308 locus of the TNF-α gene, as compared to combination of the TNF-α-238 GG and TNF-α-308 GG genotypes. Multivariate-adjusted odds ratio of the TNF-α-238 GG and TNF-α-308 GA genotypes was 1.98 （95% CI of 1.06-3.71） for risk for pulmonary TB in patients with CWP. There was a synergic interaction between the TNF-a-308 GG genotype and body mass index （OR=4.92）, as well as an interaction between the TNF-α-308 GG genotype and history of BCG immunization or history of TB exposure. And, the interaction of the TNF-α-238 GG genotype and history of BCG immunization or TB exposure with risk for pulmonary TB in them was also indicated. Conclusions TNF-α-308 A allele is associated with an elevated risk for pulmonary TB, whereas TNF-α-238 A allele was otherwise.

High Incidence of Pulmonary Tuberculosis in ART Naive Remunerated Blood Donors with Human Immunodeficiency Virus Type-1 Infection: Possible Role of Iron Overload

Iron overload is reported to be associated with immune alterations and increased susceptibility to infections. HIV infection is characterized by progressive immunodeficiency leading to invasion by opportunistic pathogens. It was of interest to find out if disease course in HIV type-1 infection could have any relation with alteration in body iron status among individuals with history of oral iron intake. A follow-up study of immunologic and virologic markers in relation to disease progression was undertaken on asymptomatic HIV-1 positive blood donors with history of oral iron intake (subgroup I) compared to those without such history (subgroup II). High serum iron was associated with elevated levels of Th2 category of cytokines, heightened immune activation, faster decline in CD4 + T lymphocyte count and higher viral set point. Pulmonary tuberculosis (PT) was the most common AIDS related illness (ARI) (>70%) recorded among subgroup I compared to non-PT category of ARI. Median ARI free duration (months) was shorter among those who developed PT compared to those developing non-PT category of ARI i.e. 30 (95% CI as 26,32) versus 67(95% CI as 60,71) in subgroup I and 47 (95% CI as 42,49) versus 80 (95% CI as 72,87) in subgroup II (P P < 0.001 for PT versus non-PT in both subgroups). The present study indicates that body iron overload resulting from excess intake of iron may be associated with qualitative defects in cell mediated immunity at early stage of HIV-1 infection that may facilitate subsequent acquisition of pulmonary tuberculosis, shorter ARI free duration and reduced survival.

Drug Resistance Pattern in Pulmonary Tuberculosis Patients and Risk Factors Associated with Multi-Drug Resistant Tuberculosis

Introduction: Anti-tuberculosis drug resistance is a major problem in tuberculosis (TB) control programme, particularly multi-drug resistance TB (MDR-TB) in Nepal. Drug resistance is difficult to treat due to its associated cost and side effects. The objective of this study was to assess the drug resistance pattern and assess risk factor associated with MDR-TB among pulmonary tuberculosis patients attending National Tuberculosis Center. Methodology: The comparative cross sectional study was conducted at National Tuberculosis Center during August 2015 to February 2015. Early morning sputum samples were collected from pulmonary tuberculosis suspected patients and subjected to Ziehl-Neelsen staining and fluorochrome staining and culture on Lowenstein-Jensen (LJ) medium. Drug Susceptibility test was performed on culture positive isolates by using proportion method. Univariate and multivariate analysis was computed to assess the risk factors of MDR-TB. Results: Out of 223 sputum samples, 105 were fluorochrome staining positive, 85 were ZN staining positive and 102 were culture positive. Out of 102 culture positive isolates, 37.2% were resistance to any four anti-TB drugs. 11 (28.9%) were initial drug resistance and 28 (43.7%) were acquired drug resistance. The overall prevalence of MDR-TB was 11.7%, of which 2 (5.3%) were initial MDR-TB and 10 (15.6%) were acquired MDR-TB. Univariate and multivariate analysis showed female were significantly associated (P = 0.05) with MDR-TB. Conclusion: Drug resistance TB particularly MDR-TB is high. The most common resistance pattern observed in this study was resistance to both isoniazid and rifampicin. Female were found to be associated with MDR-TB. Thus, early diagnosis of TB and provision of culture and DST are crucial in order to combat the threat of DR-TB.