European Journal of Molecular & Clinical Medicine

Background: Pulmonary tuberculosis is a major communicable disease worldwide. Tuberculosis and HIV is a major health problem in many parts of world. The National Tuberculosis and Leprosy Program annual report indicates that about 7% of all TB notified cases had co-infection with HIV. The incidence of Tuberculosis HIV co-infection increasing gradually.
Materials and Methods: The study is a Retrospective study conducted on 200 HIV reactive patients at ART center in a tertiary care hospital GGH Ongole. Data was analyzed for incidence of tuberculosis in HIV infected patients with CD4 counts and their association between them.
Results: Out of 200 HIV infected, 40 were detected with tuberculosis, of them 32 were pulmonary TB and 8 were extra pulmonary TB. In present study 26 (65%) of patients with CD4 count < 200 cells/μ l developed Tuberculosis, 9 (22.5%) of patients with CD4 count 200-400 cells/μl and 5 (12.5%) of patients with CD4 count > 400 cells/μl shows less number of pulmonary and Extra pulmonary TB.
Conclusion: There is a strong association between Tuberculosis and HIV. Incidence of TB is more when CD4 count less than 200 cells/μl. So it is essential to screen HIV reactive patients for TB along with CD4 count to prevent complications and mortality. This study showed that incidence of Tuberculosis pulmonary and extra pulmonary in HIV infective patients is significantly higher with CD4 count < 200 cells/µl.

Background: Tuberculosis (TB) has affected humans for most of their history and remains a major cause of mortality in adults worldwide Prevalence of Tuberculosis (TB) has been on a dangerous and positive spike for over a decade and has killed millions of people year on year. Almost, 1.3 million people in 2012 alone lost their lives to TB. As per the massive prevalence of TB, it would be incorrect to say that the disease does not poses like a pandemic. Alongside HIV, it remains a top cause of death from an infectious disease. Hence the present study was planned to evaluate the role of fiberoptic bronchoscopy in sputum negative pulmonary tuberculosis cases.
Materials and Methods: The study was carried out at Department of Pulmonary Medicine, Era's Lucknow Medical College & Hospital, Lucknow. Sputum smear negative presumptive patients of PTB. All the relevant samples were sent for Cartridge based nucleic acid amplification test (CBNAAT)/genexpert for BAL, post bronchoscopy sputum, bronchial aspirate, TBLB, Endobronchial biopsy and Transbronchial needle aspiration. Culture for Mycobacterium tuberculosis (MTB) was also obtained for all the patients. Culture is done on liquid media (MGIT).
Results: Majority of patients in the study population were adults: 21-60 years (82.6%), while only a small proportion of patients were aged ≤20 years and >60 years (8.7% each). Majority of patients in the study population presented with Cough (88.0%), Fever (78.3%), Loss of appetite (67.4%), Expectoration (63.0%) & Weight loss (56.5%). Majority of patients had negative CBNAAT (81.5%), AFB (95.7%) and Culture (77.2%) for Bronchial Aspirate. Thus indicating that fiberoptic bronchoscopy helps in establishing the diagnosis.
Conclusion: Considering the short processing time and high diagnostic efficacy, CBNAAT evaluation of bronchoalveolar lavage for detection of tuberculosis among sputum/smear negative tuberculosis cases is highly recommended

Background: The most noticeable part of human body is face. The obvious boundaries on the skin known as Pigmentary Demarcation Lines (PDL) found over face and have clear borders of abrupt transition between more hyper-pigmented skin and areas of normal skin pigmentation due to differences in melanocyte distribution that may be influenced by multiple factors. Facial pigmentary demarcation lines (PDL) directly reflect on patient’s physical appearance and self-image as they may contribute to dysmorphism and even central to depressive illness in susceptible individuals posing cosmetic concern for the patient and a challenge for dermatologist. Therefore, it is important for early identification and management of facial skin disorders. Until now, nine different types of PDLs have been described which are designated as Type A to I of which Type F to H PDLs are most common on the face. Etiology involving the whole spectrum of PDL continues to be an enigma and needs further research among Indian population.
Materials and Methods: Total 304 patients between 15 to 75 years of age range were included in study lead between May 2018 to May 2020 after thorough examination for inclusion and exclusion criteria, informed consent and Ethics committee approval. Statistical analysis was done using descriptive and inferential statistical approach using Chi-square test and Fisher’s exact test and p value was calculated and considered to be significant if <0.05.
Results: Out of 304 study subjects the frequency of facial PDL type H (50.65%) was most common than type G (29.60%) and type F (19.73%) with male predisposition (79.60%) with agricultural occupations (59.86%) than females and with significant family history from father (41.44%). Most of the present study subjects were of Fitzpatrick skin type IV (50.01%) with hyper-pigmented macules (12.5%) and shown unilateral PDL symmetry (58.22%) with sharp PDL line margins (81.25%). The most common aggravating factor was prolonged exposure to sun light (56.90%) and most of (25.98%) the subjects experienced periorbital melanosis at different times. Diabetes (38.15%) and hypertension (29.60%) were the most common co morbidities observed in study subjects. Using Fishers exact test, p value was calculated and it was found to be highly significant (p=0.003).
Conclusion: Present study pronounces the incidence of facial PDL (types F-H) are sharply common especially amongst the males who are in agricultural occupations with prolonged sun exposure and with other co morbidities like diabetes, hypertension and tuberculosis. In females the prevalent type was Type H PDL during and after pregnancy. The agricultural occupations with prolonged sun exposure, diabetes, hypertension, tuberculosis and positive paternal family history were shown strong correlation with facial PDL among Indian population irrespective of gender and it was found to be highly significant (p=0.003).

Background: The present study was conducted for evaluating the prevalence of Coexisting active pulmonary tuberculosis in tuberculous spondylitis patients.
Materials &Methods: A total of 50 known cases of tuberculous spondylitis were included in the present study. Complete demographic and clinical details of all the patients was obtained. Only those patients were involved among which histological or microbiologically confirmed diagnosis of TB spondylitis among surgically confirmed TB spondylitis was present. Complete past medical history of all the patients was reviewed. Analysis of spine CT scans and magnetic resonance (MR) images was done for each affected level and reviewed chest plain radiographs and CTs to evaluate lung involvement in TB. All the results were recorded and were subjected to statistical analysis using SPSS software.
Results:A total of 50 patient with mean age of 52.3 years were analysed. Overall incidence of co-exiting active pulmonary TB among tuberculous spondylitis patients was 36 percent.
Conclusion: Since higher chances of coexisting active pulmonary tuberculosis in TB spondylitis patient can be easily overlooked, there is a chance of the possibility of nosocomial infection of TB.

Retro pharyngeal abscess is infection followed by collection of pus in retro pharyngeal space. In the adult group they are usually secondary to trauma, foreign bodies, or as a complication of dental infections. Early diagnosis and the wide spread use of antibiotics have made these infections less common today . Non-specific acute retro pharyngeal abscess most commonly occurs in infants and young children. It is rare in adults mostly associated with tuberculosis of the cervical spine. Some cases of acute retro pharyngeal abscesses have been reported in adults following foreign body ingestion and in immunocompromised individuals. The present study attempts to document acute retro pharyngeal abscess in adults following trauma. Majority of patients recovered with conservative management but some required incision and drainage.  Diabetes mellitus was the comorbidity in one third of patients.  The management of these cases is based on antibiotics and surgical drainage.

Background: Tuberculosis is among the most common opportunistic infections in people living with HIV/AIDS and is also the most common cause of peripheral lymphadenopathy. These lymph nodes revealed four different patterns on FNAC, which indirectly reflected the immune status in these people. CD4 counts, being a primary marker for immunological status in HIV people, were used to initiate ART, monitoring disease progression and management. The present study was aimed to correlate these four cytomorphological patterns with CD4 counts.
Results: In the present study we observed that CD4 counts varied significantly with different cytological patterns. Pattern 1, having a lower CD4 counts, reflects a poor immune response, whilst pattern 4, having higher CD4 counts reflected a better immune response.
Conclusion: FNAC patterns can be used to predict the CD4 counts where flow cytometry facilities for CD4 count estimation may not be available.

Tuberculoma of the brain is a dangerous disease that is becoming more common in developed countries as tuberculosis continues to spread. At first, antimycobacterial drugs are used to treat brain tuberculoma. But neurosurgery is the main part of treatment. Surgery is needed if the tuberculoma does not respond to medical treatment, if it is causing symptoms, or if there is no other way to find out what is wrong. In this paper, we talk about four cases of posterior fossa tuberculomas in people who had never had tuberculosis or a weak immune system before. Brain tuberculosis had to be treated with surgery in all cases for it to go away safely and effectively.

Background: Tuberculosis is one of the world’s potentially life-threatening communicable diseases. The disease burden is more in developing countries. Pulmonary tuberculosis can lead to several serious complications. Unilateral lung destruction and complete destruction of a major part of lung or entire lung is common, and it results from parenchymal and airway involvement. Chest radiographs & computed tomography of chest is the mainstay in the detection of the destroyed lung.
Objective: To describe the radiographic and computed tomographic findings in patients with tuberculous unilateral lung destruction.
Martial and Methods: In this report, we present a review of 50 patients withUTLD secondary to TB. Case records of the patients were retrospectively evaluated for clinical data and treatment history.Retrospective review of the images was performed by two radiologists and relevant findings were studied.  Important findings were noted.
Results: A total of 50 patients with unilateral complete lung destruction were evaluated. Age ranged from 25 to 68 years. Chest radiograph showed a small opacified hemithorax with mediastinal shift, crowding of ribs. Computed tomography showed loss of lung volume with fibrosis, bronchiectasis, and cavities. Left lung destruction was predominant (41/50, 82%). 22(44%) patients had fibrosis or cavities in contralateral lung. 16 (32%) patients had features of active disease in contralateral lung. 3(6%) patients had aspergilloma in the affected lung.
Conclusion: Males are more commonly affected. Left lung is more commonly involved compared to the right. Characteristic radiological findings are unilateral volume loss, reduced size of the ipsilateral pulmonary artery and pulmonary veins and hyperinflation and herniation of contralateral lung.

Background:Tuberculosis is an ancient disease observed during the Neolithic period and remains a serious problem in developing countries. Tuberculosis is a disease that can affect all age groups and all genders and can affect all organ systems in our body. Tuberculosis can affect most of the body's hematological parameters. TB affects hemoglobin levels, total number, red blood cell count, erythrocyte sedimentation rate, and platelet count, causing anemia, leukopenia or leukocytosis (extrapulmonary TB), thrombocytopenia, and increased ESR. Along with HIV, tuberculosis exacerbates the scenarios of thrombocytopenia, anemia, leukopenia, and pancytopenia. Aim: This study was done in NRI medical College Guntur to find out the haematological manifestation of pulmonary TB and to compare it with the hematological manifestation in HIV –TB co-infected patients.
Materials and Methods: 80 patients of more than 15 years of age group was selected for the study, who willingly consented to participate in the study. They were divided in 2 groups of 40 patients with only pulmonary TB and 40 patients with HIV – TB co-infected, according to ELISA positivity. Statistical comparison was analysed usng CHI square test.
Results: In our study, patients with tuberculosis had an elevated ESR count, but TB-HIV coinfection reduces the ESR count. 48% of TB with HIV anaemic men and 25% of women had 11 gm/dl. 46.25 percent of anaemic TB patients without HIV were male and female (27.02 percent). 56% of men had TB with HIV and 48% had TB without HIV. In the TB without HIV group, 51.1% of males and 27.9% of females had total RBC counts ≤ 3.8 million cells/cumm, compared to 51.3% of males and 35.1% of females in the TB with HIV group.
Conclusion: The study concluded that ESR is a marker of chronic inflammatory conditions such as tuberculosis and that HIV is an immunosuppressive state, and that co-infection with tuberculosis and HIV significantly reduces ESR scores in these patients.

Background: Tuberculosis (TB) remains one of the world’s deadliest diseases and has
surpassed AIDS as the leading cause of death due to infectious disease. The present
study was conducted to assess 30 cases of oral tuberculosis.
Materials & Methods: 30 cases of oral tuberculosis of both genders were involved.
Parameters such as patients’ sex, age, developmental site, clinical presentation were
obtained. All patients were diagnosed by histopathological examination.
Results: Out of 30 cases, males were 20 and females were 10. Common site involved was
tongue in 22, labial mucosa in 3, lower lip in 2 and buccal vestibule in 3 cases. Clinical
presentation was mass in 11 and painless ulcer in 19 cases. The difference was
significant (P< 0.05). Histopathological findings were non- caseating granuloma in 23
and caseating granuloma with necrosis in 7 cases. The difference was significant (P<
0.05).
Conclusion: Maximum cases of tuberculosis was seen among males. Common site
involved was as painless ulcer.

Background : This study aims to determine the effect of a combination regimen of
metformin and without metforminon the conversion of sputum smear in new cases
of pulmonary TB patients with type 2 DM.
Materials andMethods: This cross-sectional study was conducted at Wahidin Sudirohusodo
Hospital, Makassar Center for Lung Health, Kasi-Kasi, and Sudiang Community
Health Center from August 2019. This study involved 83 new cases of pulmonary
TB subjects with T2DM. New cases of pulmonary TB patients were obtained by examining AFB sputum in DM patients who had symptoms of pulmonary TB and had no history of suffering or receiving previous anti-TB drug therapy.Pulmonary TB patients receive category 1 anti-TB drugs andDM subjects were divided into 2 groups is metformin and non-metformin. Then, smear sputum is examined in the 2-month intensive phase of anti-TB drug therapy to assess the conversion of AFB sputum.
Results: From a total of 83 new cases of pulmonary TB and T2DM, 44 subjects received a combination regimen of metformin and 39 subjects non-metformin. In this study, there were 42 (95.5%) subjects who conversion sputum smear in the metformin group more higher than in the  non-metformin group but statistically it was not significant (p = 0.282).
Conclusion: There was no significant relationship between the metformin and non-metformin groups on the conversion of AFB sputum smear in new cases of pulmonary TB patients and T2DM.

Background: Tuberculosis (TB) is still a global problem. The high incidence of TB is due to the less than optimal TB risk factor interventions. This study aims to analyze the risk factors for TB incidence in the coastal area of the lake, Towuti District, East Luwu Regency.
Methods: This study used a case-control design conducted in the coastal area of the lake, Towuti District, with a sample of 34 cases and 94 controls. Bivariate analysis and logistic regression were used to analyze the risk factors for the incidence of tuberculosis.
Results: The results showed that the significant risk factors for TB incidence were family history (OR = 13,920; 95% CI: 4,36–51,23), household contacts (OR = 3.04; 95% CI: 1.188–7,809), close contact (OR = 8.382; 95% CI: 2.969–24, 852), home ventilation (OR = 14.357; 95% CI: 1.585–669.82), income (OR = 2.609; 95% CI: 1.033–6.675) . Home ventilation is the most dominant risk factor for TB incidence in the coastal area of the lake in Towuti District.
Conclusion: TB disease control strategies based on risk factors need to be implemented in coastal areas.

Liver is the most important vital organ that carries out metabolism of body e.g. formation of cholesterol and triglycerides, synthesis of glycogen, formation of blood clotting proteins and bile formation. Hepatic damage and subsequent liver failure due to both unintentional and intentional acetaminophen overdose has afflicted patients for decades and includes the metabolic cornerstone pathways that exist within hepatocytes in the microsomes. The side effects of drugs on the hepatocytes have been overlooked for years. Drug induced liver injury is the most adverse effect observed in clinical practices. It accounts for around half of acute liver disorder. Anti tuberculosis drugs and acetaminophen overdose are the main issues that result in death from curable diseases. Metabolism of isoniazid and acetaminophen (APAP) results in the formation of toxic metabolites that results in the oxidative stress and glutathione (GSH) store depletion leads to hepatocellular necrosis and steatosis. Alcohol consumption is also the most common cause of liver cirrhosis. Liver peroxidation is considered to be the major mechanism of alcohol-induced hepatotoxicity. To overcome this oxidative stress, there is need of antioxidants that can balance the redox homeostasis of liver by lowering the APAP overdose effect. Consumption of natural antioxidants derived as secondary metabolites from plants in the form of polyphenols and flavonoids prevent oxidative stress. Medicinal plants are best remedies used for hepatotoxicity caused due to oxidative stress. They are cost friendly, easily available and have no mutagenic effect. Herbal medicines form important part of traditional healthcare system of India.

Tuberculosis (TB) is one of those diseases which shows greater impact on public health. It causes serious infections inside the human body, if it is present in the active state. Its treatment is available in the form of vaccines, drugs etc. It is caused by Mycobacterium tuberculosis. This bacterium has the tendency to become drug-resistant by its characteristic mechanism. For better treatment on this disease, we need to collect and analyse data properly during the drug designing. Currently, many databases like Mycobacterial Database, TB Database, TubercuList, TBrowse etc are available which helps the researcher in collecting the required data. These databases play a major role in a successful research. CADD (computer aided drug design) has been utilized in creating, modifying, analysing or optimizing a design. This software is used to raise the production of designer, improve quality design, enhance communications through documenting and for the crfeation of a database to manufacture.by using CADD researchers can know about the drug molecule which have potential with the help of databases.

India accounts for 26% of the words Tuberculosis population. The WHO’s Global TB Program states that in India, the number of people newly diagnosed with TB increased by 74% when compared to other countries from 1.2 million to 2.2 million between 2013 and 2019. Tuberculosis was and still remains a disease that causes high death rates in the country. Many of these deaths can be easily prevented if diagnosed at an early stage. The easiest, cost-effective and non-invasive method of detecting tuberculosis is through a frontal chest x-ray (CXR). But this requires a radiologist to manually examine and analyse each of the X-ray, considering the heavy patient count this puts a great burden on the resources available. A computer aided diagnosis system can easily mitigate this problem and can greatly help in reducing the cost. In recent times deep learning has made great progress in the field of image classification and has produced remarkable outputs in terms of image classification in various domains. But there still remains a scope for improvements when it comes to Tuberculosis detection. The aim of this study is toapply three pre-trained convolutional neural networks that have proven record in image classification on to publically available CXR dataset and classify CXR’s that manifest tuberculosis and compare their performances. The CNN models that are used on our CXR images dataset as a part of this study are VGG-16 ,VGG-19,AlexNet ,Xception and ResNet-50. Also visualization techniques have been applied to help understand the features whose weights played a role in the classification process. With the help of this system, we can easily classify CXR’s that have active TB and even CXR’s that show mild abnormalities, thus ensuring that high risk patients get the help they require on time.

A total of 2105 patients with pulmonary tuberculosis were examined, of which 19.5% of patients were found to have concomitant pathology. It was found that in patients with concomitant pathologies, tuberculosis is severe, with severe symptoms of intoxication and respiratory manifestations. Isolation of MBT and the presence of drug resistance were higher in the group of patients with concomitant pathology. The presence of concomitant pathology adversely affects the clinical course of pulmonary tuberculosis.

Background
Tuberculosis (TB) is a problem in developing countries, because the rate of disease incidence is still high and included in the big 10 leading cause of death in the world. As TB prevalence cases increase, community participation in finding new TB cases is very important. The method that used by various countries is by community-based case finding or Active Case Finding in the community (Active Case Finding).
Purpose
Evaluating the program implementation in the discovery of new TB cases by TB careworker at the health center in an effort to control TB in DIY (Daerah Istimewa Yogyakarta, DIY).
Method
This type of research is a quantitative survey. The subjects are TB worker in Puskesmas Yogyakarta, as much 120 people. The instrument used was a questionnaire containing ways of case finding, knowledge, behavior, case finding constraints, types of activities, and main tasks. The analysis uses frequency distribution and is presented in tabular form.
Result
TB worker in Puskesmas DIY have taken several ways in carrying out new TB case finding; such as Active Case Finding, Pasive Case Finding, knock on the door, counseling, screening and screening. There are some obstacles in the implementation of the discovery of new TB cases; such as limited time and lack of personnel, lack of budget, multiple task burdens, and some areas that do not yet have cadres. The majority of TB careworker are nurses (90%). The aim of new TB cases found in DIY Province was only 48.3% from the target.

Mankind has struggled with many diseases throughout its history. Infectious diseases are especially prevalent among the population. According to its scope, such infectious diseases are called pandemics, epidemics. Among the population of Central Asia, a number of diseases, such as plague, plague, malaria, tuberculosis, and ringworm, have caused partial or mass extinction. The characteristics of the geographical distribution of these diseases largely depended on the natural and social geographical conditions of the regions, the lifestyle and traditions of the population.The effects of the Spanish flu pandemic, which has killed nearly 100 million people in the last hundred years among a wide range of diseases, have had a profound effect on the nosogeographic situation, especially in Europe and later in the Americas. Analyzes show that the deterioration of the environment, man's unlimited domination of nature, the deterioration of the ecological situation, as well as the spread of related diseases on earth pose new challenges to medical geography, which studies the causes and patterns. The rapid development of science and technology, the steady increase in human impact on nature and consequently, a number of negative changes in the natural environment have a significant impact on human health. The acceleration of the process of urbanization which in turn causes problems such: as air, water and soil pollution.

The number of pulmonary tuberculosis (PTB) cases in Indonesia is second ranks in the world. South Sulawesi contributes significantly to the increase of PTB cases in Indonesia. This study explored the spatial dynamics of PTB cases in the highlands and lowlands of Gowa regency, South Sulawesi. This study aimed to present spatial patterns of TB spread in highland and lowland areas in gowa district based on environmental health parameters that will assist in formulating prevention policies and regional-based control strategies.This study used quantitative with spatial analysis approach. The respondents of this study were all registered PTB patients on medical records in the PTB control unit at Health Center in the highlands and lowlands of Gowa regency. Total sample of this research was 156 respondents, derived from 57 in highland and 99 in lowland. Territorial analysis was applied to detect PTB spatial patterns in two regions with different elevation. The variables in this study focused on environmental characteristics in each region.PTB Prevalence in lowland was relatively higher than highland. Temperature and density of occupancy were the determinants of the high prevalence of PTB in the lowlands. At the highland, humidity factor, ventilation area, floor and wall condition were high contributing to PTB incidence (more than 60%). meanwhile, on the lowland, those factors were not significant.This study identified the PTB spatial distribution of highland and lowland by analyzing cases per 100,000 peoples and could be used to develop effective strategies for PTB prevention and control by exploring environmental health factors of public health.

Background:In 2017, East Java Province was ranked second in Indonesia to discover tuberculosis (TB) patients. The Southern Regional Health Center of Kediri City was ranked fifth out of 27 cases.
Objectives of the study: This study aims to analyze the problem and prioritize health issues of TB in the Southern Regional Health Center of Kediri in 2019.
Methods: The observation was carried out using performance assessment for the Southern Regional Health Center data in 2018 with the ultrasound and fishbone methods.
Results: It was noticed that all TB cases were found and treated, including the discovery of suspected TB cases and the successful treatment of all TB cases (Success Rate/SR). The main problems in the Southern Regional Health Center in 2019 were that the suspected tuberculosis sputum pot was not returned, the people’s lack of knowledge, and less active TB cadres.
Conclusion: Some of the problems found are the lack of knowledge regarding TB, less active TB cadres, lack of coordination among TB cadres, limitation of people who are willing to become TB cadres, and the time limitation of TB cadres.

Background:In 2017, East Java Province was ranked second in Indonesia to discover tuberculosis (TB) patients. The Southern Regional Health Center of Kediri City was ranked fifth out of 27 cases.
Objectives of the study: This study aims to analyze the problem and prioritize health issues of TB in the Southern Regional Health Center of Kediri in 2019.
Methods: The observation was carried out using performance assessment for the Southern Regional Health Center data in 2018 with the ultrasound and fishbone methods.
Results: It was noticed that all TB cases were found and treated, including the discovery of suspected TB cases and the successful treatment of all TB cases (Success Rate/SR). The main problems in the Southern Regional Health Center in 2019 were that the suspected tuberculosis sputum pot was not returned, the people’s lack of knowledge, and less active TB cadres.
Conclusion: Some of the problems found are the lack of knowledge regarding TB, less active TB cadres, lack of coordination among TB cadres, limitation of people who are willing to become TB cadres, and the time limitation of TB cadres.

Tuberculosis is a contagious syndrome that leads to death Worldwide. In majority of the developing countries, the access to the diagnostic tool and the test usage is relatively poor. Now the recent advancement in the field of Artificial Intelligence may help them to fill this technology gap. Computer Aided Detection and Diagnosis helps in diagnosing the diseases through some clinical symptoms as well as X-ray images of the patients. Nowadays many strategies are formulated to increase the classification accuracy of tuberculosis diagnosis using AI and Deep Learning approaches. Our survey paper, focus to describe the wide AI and deep learning approaches employed in the diagnosis of tuberculosis.