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Journal of Tuberculosis, Lung Diseases and HIV/AIDS Print ISSN 1818-9741 Online ISSN 2091-0959 SAARCSAARC Vol. XVII, No. 2, Year 2019 (South Asian Association for Regional Cooperation) Journal of Tuberculosis, Lung Diseases and HIV/AIDS EDITORIAL Original Articles 1. DIAGNOSTIC YIELD OF BRONCHOALVEOLAR LAVAGE XPERT MTB/RIF ASSAY (GENE XPERT ®) IN SPUTUM SMEAR NEGATIVE PULMONARY TUBERCULOSIS PATIENTS - A ONE YEAR CROSS SECTIONAL STUDY 1 Gaude GS, Samskruti S, Hattiholi J, Patil B 2. IMPACT OF EDUCATION AND MEDIA EXPOSURE ON TUEBRCULOSIS RELATED AWARENESS AMONG INDIAN ADULTS: A STUDY BASED ON NFHS-3 8 Barman, P 3. ASSESSMENT OF HEALTH RELATED QUALITY OF LIFE AMONG TUBERCULOSIS PATIENTS WITH AND WITHOUT DIABETES IN WESTERN REGION OF NEPAL 15 Yadav DK, Shrestha N, Yadav RK , Gurung SC 4. THE PREVALENCE AND DETERMINANTS OF ACTIVE TUBERCULOSIS AMONG DIABETES PATIENTS IN TERTIARY CARE HOSPITALS OF NEPAL 2018 22 Kharel RK, Sultana R, Bichaa RP, Pant RP, Weerakoon AP, Karki KB Case Study 5. A COMMON DISEASE WITH UNCOMMON PRESENTATION : SPINA VENTOSA 29 Dixit R, Goyal M, Pawar K, Chandra V The official peer reviewed journal of SAARC TB and HIV/AIDS Centre SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS Vol. XVII No. 2 Year 2019 Editorial Board EDITORIAL Chief Editor Original Articles Ramesh Kumar Kharel 1. DIAGNOSTIC YIELD OF BRONCHOALVEOLAR Editor LAVAGE XPERT MTB/RIF ASSAY (GENE XPERT Rabeya Sultana ®) IN SPUTUM SMEAR NEGATIVE PULMONARY Advisory Board TUBERCULOSIS PATIENTS - A ONE YEAR CROSS SECTIONAL STUDY -----------------------1 National TB Control Programme Gaude GS, Samskruti S, Hattiholi J, Patil B Mohammad Khaled Seddiq, Afghanistan 2. IMPACT OF EDUCATION AND MEDIA Md. Shamiul Islam, Bangladesh Ugyen Dendup, Bhutan EXPOSURE ON TUEBRCULOSIS RELATED K.S. Sachdeva, India AWARENESS AMONG INDIAN ADULTS: A Abdul Hameed Hasan, Maldives Sagar Kumar Rajbhnadari, Nepal STUDY BASED ON NFHS-3 -----------------------8 Aurangzaib Quadir, Pakistan Barman, P H.D.B. Herath, Sri Lanka 3. ASSESSMENT OF HEALTH RELATED QUALITY National HIV/AIDS Control Programme OF LIFE AMONG TUBERCULOSIS PATIENTS Mohammad Basir Hamidi, Afghanistan WITH AND WITHOUT DIABETES IN WESTERN Md. Shamiul Islam, Bangladesh REGION OF NEPAL --------------------------------- 15 Lekey Khandu, Bhutan Yadav DK, Shrestha N, Yadav RK , Gurung SC Sanjeeva Kumar, India Abdul Hameed Hasan, Maldives Anuj Bhattachan, Nepal 4. THE PREVALENCE AND DETERMINANTS OF Abdul Baseer Khan Achakzai, Pakistan ACTIVE TUBERCULOSIS AMONG Rasanjali Hettiarachchi, Sri Lanka DIABETES PATIENTS IN TERTIARY CARE HOSPITALS OF NEPAL 2018 --------------------- 22 Published and distributed by: Kharel RK, Sultana R, Bichaa RP, Pant RP, Weerakoon AP, Karki KB SAARC Tuberculosis and HIV/AIDS Centre (STAC) Thimi, Bhaktapur Case Study G.P.O. Box 9517, Kathmandu, Nepal Tel.: 00977-01-6632601, 6632477, 6631048 Fax: 00977-1-6634379 5. A COMMON DISEASE WITH UNCOMMON E-mail: [email protected] PRESENTATION: SPINA VENTOSA ----------- 29 Website: www.saarctb.org Dixit R, Goyal M, Pawar K, Chandra V AIMS AND SCOPE: The SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS is the official journal of the SAARC TB and HIV/ AIDS Centre (STAC). The Journal’s main aim is to continuing education of personnel and the dissemination of the most up-to-date information in the field of tuberculosis, lung diseases and HIV/AIDS. It is devoted to dissemination of knowledge concerning various aspects of tuberculosis, lung diseases and HIV/AIDS. All articles and health research relevant to the practice of this Journal are published. This Journal is a forum for the publication of articles concerning the social, economic, public health, epidemiology, diagnostics, genetics etc. in the area of tuberculosis, lung diseases and HIV/AIDS. The scientific manuscripts presenting the results of public health importance are encouraged. The novel case reports which adds to the existing knowledge and consistent with the scope of Journal will be considered for publication. The Journal accepts review/mini-review, case report, short communications, and letters to editors within the scope. DISCLAIMER: Any opinions expressed or policies advocated do not necessarily reflect those of the STAC. INSTRUCTIONS TO AUTHORS: Instructions on manuscript submission can be obtained from the STAC website www.saarctb.org FULL TEXT VERSION ONLINE: The full text of the Journal is published online. Free access to all published issues. Address: www.saarctb.org/ stacjournal.php Copyright © the STAC 2019, all rights reserved, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without prior permission of the STAC. Print ISSN 1818-9741 Online ISSN 2091-0959 Editorial As a result of population ageing; urbanization; changes in diet; reduced physical activity, the prevalence of diabetes mellitus (DM) has increased worldwide. Moreover about 80% of the Global 415 million estimated DM cases are from low and middle income countries where the DM prevalence is estimated to rise most steeply with high Tuberculosis (TB) incidence over the next 30 years. The increase in the DM patients where TB is also endemic has led to the importance of DM as a risk factor for TB. This association these two diseases and their synergistic role in causing public health concern DM increases the risk of TB by two to three times and adversely affects TB treatment outcomes. The combination of tuberculosis and diabetes mellitus is a health threat to the increasing populations which are at the risk for both of these diseases. In 2030, it is estimated that 12.6% of new TB cases in ten highest TB burden countries, will be attributable to DM, which is increase of 25.5% compared to 2010. DM affects the natural history of TB and related with the worse treatment outcomes. It is associated with the delayed sputum conversion and a higher probability of treatment failure. Therefore, it is important that the people with diabetes are screened for tuberculosis and vice-versa using cost effective screening strategies available. Taking in consideration, SAARC TB and HIV/AIDS Centre has recently completed a research on “The prevalence and determinants of active tuberculosis among diabetes patients in tertiary care hospitals of Nepal, 2018.”The objective of the research was to assess the burden of active tuberculosis among the people with diabetes and describe the risk for the same attending the selected diabetic clinics of the tertiary care centers across the country. With 70 participants from the seven study sites, a total of 490 samples from the patients were used for data analysis. The study showed that the overall prevalence of TB among the diagnosed DM patient is 4.42% which is comparable with others studies conducted in Asia. Meta-analysis shows that the overall median prevalence of DM among TB patients in Asia is 17%. The study also shows the other co-morbidities related to diabetes such hypertension, nephritis, neuropathy and dyslipidemia as significant risk factors to develop TB. Patients with TB are vulnerable to high degree of co-morbidity and are at high risk of adverse effects of intensive glucose control. Therefore, more researches are necessary to examine whether the diagnosis and treatment of diabetes in TB patients may improve TB outcomes and the patient survival. Chief Editor Director, STAC SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS DIAGNOSTIC YIELD OF Bronchoalveolar lavage XPERT MTB/RIF Assay (GENE XPERT ® IN SPUTUM SMEAR Negative Pulmonary TUBERCULOSIS Patients – A ONE YEAR CROSS SECTIONAL STUDY Gaude GS1, Samskruti S1, Hattiholi J1 , Patil B1 1Department of Respiratory Medicine, KATHER’s J.N. Medical College, Belgaum, India ABSTRACT Introduction: Tuberculosis remains a major public health issue and is one of the top ten causes of death worldwide. Seven countries worldwide account for 64% of the total incidence and India leading the count. Only about 50-60% of the cases are sputum smear positive, while rest are sputum scare or smear negative cases. Since December 2010, WHO has recommended the use of Xpert MTB/RIF assay due to its high-quality performance, as compared to microscopy in the diagnosis of tuberculosis. The present study was done to evaluate the early diagnosis of sputum smear negative pulmonary tuberculosis patients using Xpert MTB/RIF assay test in broncho-alveolar fluid and to evaluate prevalence of rifampicin resistance in these patients. Methods: This was a one year cross section study conducted in a tertiary care hospital. A total of 143 suspected cases of pulmonary tuberculosis patients who were sputum smear negative were included in the study. All patients underwent bronchoscopy and the BAL specimen was subjected for Xpert MTB/RIF assay, smear by ZN staining and AFB Culture using MGIT 960 medium. The sensitivity and specificity of the Xpert MTB/RIF assay was compared to AFB culture which is considered as the gold standard method for diagnosing TB was calculated. Results: Majority of the patients were males (74.83%) and under the age group of 30 years (26.57%). Out of 143 suspected, the final diagnosis of PTB was done in 93 patients. Out of 93 cases of PTB, 87(93.5%) patients were Xpert MTB/RIF assay positive, 80(86.0%) were AFB culture positive and 39(41.9%) patients were AFB smear positive. The sensitivity and specificity of BAL Xpert MTB/RIF assay was 92.5% and 79.37% respectively (p <0.0001). Conclusion: The Xpert MTB/RIF assay is more sensitive and specific than smear microscopy for the diagnosis of PTB in sputum smear negative on specimens obtained from broncho-alveolar lavage (BAL). Keywords: Xpert MTB/RIF assay, BAL, PTB, smear negative. HIV/AIDS1. India is one among the six countries that INTRODUCTION account for 60% of all new TB cases worldwide. Tuberculosis due to Mycobacterium Universal access to high-quality, patient-centered tuberculosis remains a major public health issue. treatment for all TB patients is emphasized by 2 For the past 5 years, it has been the leading cause of WHO’s Stop TB Strategy .
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