Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
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Vol 53 No 1Jan 2006 ISSN 0019-5707

Original articles

Case reports

Short communications

Aleyamma Thomas,P.G.Gopi,T.Santha,K.Jaggarajamma,Nirupa Rani Charles,E.Prabhakaran and P.R.Narayanan

Objective: To evaluate adherence to diagnostic algorithm of revised national tuberculosis control programme(RNTCP) and course of action taken by smear negative chest symptomatics(CSs)
Method: Interviewing smear-negative chest symptomatics.
Results: Of the 423 smear negative CSs interviewed,85(20%)were not prescribed antibiotics and only 133)39%)received it for more than 7 days.Of the 148 patients with persistence of symptoms,83(56%)returned for further investigations and only 39% were Xrayed.Main reasons for not returning were "not aware" or "consulted another health provider"
Conclusion: Strict adherence to diagnostic algorithm and proper counselling of patients are important for diagnosing smear negative pulmonary tuberculosis(PTB)cases.
Indian J Tuberc 2006;53:4-6: 
Objective: To estimate the proportion infected and compute annual risk of tuberculosis infection(ARTI) among children irrespective of BCG scar and compare with that among children without BCG scar.
MethodologyTuberculin survey was conducted in south zone of India as a part of the nationwide survey to estimate the ARTI in different parts of the country and ARTI was computed among children without BCG scar excluding children with BCG scar.In this exercise,the tuberculin test results of children with BCG scar and irrespective of BCG scar were considered for analysis and results were compared.
Results: The prevalence of infection and ARTI estimated among children irrespective of BCG scar aged 1-9 years were 5.7% and 1.0%(95%)C.I:0.8-1.3)respectively the corresponding figures among unvaccinated children were 5.9% and 1.0%(95% C.I:0.7-1.4 respectively.The ARTI among children irrespective of BCG scar were similar to that among unvaccinated children.
Conclusion: Estimation of proportion of children infected and computation of ARTI using mirror image technique could be undertaken among children irrespective of BCG scar among children aged either from 1-9 years or 5-9 years. Indian J Tuberc 2006;53:7-11: 
M.Muniandy,R.Rajeswari R.Balasubramanian

Background: The Indian tuberculosis control porogramme is the second largest health programme in India will require continued financial support,particularly for drugs and contractual personnel.In addition,the cause of diagnosis,supervision and salaries for regular programme personnel need to be sustained.
Objective : To measure unit provider cost for treating patients with tuberculosis.
Methods: All Government health facilities situated in one tuberculosis unit(TU)of Tiruvallur district were visited in order to evaluate daily practice of TB diagnosis and treatment.We interviewed administrators in these health facilities to gather data on modalities for diagnosis,treatment and monitoring of tuberculosis patients.In addition,relevant financial records from all health facilities were scrutinised for data collection.The cost analysis was done for diagnosis,treatment and monitoring of TB patients treated under DOTS programme in the year 2002.For this study,only the recurrent cost (Not the capital cost is considered,even though the programme puts in a lot of investment at the preparatory stage of the programme e.g upgrading of the labs and drugs stores,microscopes,motor cycles etc.Cost incurred on smear microscopy,chest XRay and drugs were classified as direct cost.Indirect cost is calculated based on proportion of staff time for TB care delivery and for supervision of TB services.The exchange rate at the time of study was 1$=46Rs Methods: Unit cost for smear microscopy was estimated to be Rs10/- for radiography Rs.25/- and drug cost for category I Rs392/-.Category I with extension of Rs495/-Category II Rs.729/-Category II with extension Rs 832/-and Category III Rs277/-.Including other recurrent expenditures like salary,materials,and maintenance,the overall unit provider cost to treat a TB patient was Rs1587/-for Category I,Rs1924/-for Category II and Rs.1417/-Category III Conclusion: TB inflicts considerable economic burden on the overall health system.This information us vital for policy makers and planners to allocate adequate to the programme Indian J Tuberc 2006;53:12-17: 
B.Mahadev,P.Kumar and M.A.Sharada
Introduction Having consistently achieved a success rate of more than 85% in the Revised National TB control Programme(RNTCP) implemented areas of the country,it is time to expand the coverage with greater involvement of the community.Against this backdrop,it was decided to conduct a study using "shopkeepers" as Directly Observed Treatment(DOT)providers under RNTCP in Bangalore Mahanagara Palike(BMP)
Objectives To study the feasibility of using shopkeepers as DOT providers ,their strengths and weaknesses and effectiveness in terms of success rate.
MethodologyAll new smear positive (NSP)and Xray active cases diagnosed from the six(6)TUs and the MCs attached to it under BMP were offered treatment facility through DOT Provider till 300 patients were enrolled.The intake criterion was by purposive sampling technique.The period of intake was from April 2002 to June 2003 and during this period the total number of patients diagnosed and registered for treatment from whole of BMP was 2009 NSP and 1371 X=Ray active cases..Following the diagnosis,the Health supervisor (HS)of National Tuberculosis Institute(NTI) and Senior Treatment Supervisors(STS) of BMP identified the potential shopkeeper in consultation with the eligible patients attending the health facilities.
Result During the process of purposive sampling ,300 patients were enrolled for treatment through DOT provider while 49 patients refused and opted for treatment from Health Facility which served as control for comparing the outcome.Among the 300 patients who were enrolled for treatment through shopkeeper ,224(74.6%)were NSP and 76(25.3%)were X-Ray active .Of the 49 (13.75%)patients who refused and opted for treatment from the Health Facility ,40(81.6%)were NSP and 9(18.4%)were X-Ray active.Out of 300 patients who opted for treatment from shopkeepers,244 took treatment continuously and their success rate was 89.3%,the patients who refused to take treatment from shopkeepers the success rate was 90% and for those who registered and took treatment from BMP during the period of the study (excluding cases treated under shopkeepers)it was 84.8%Success rate for 224 New Smear Positive cases who initially started treatment with shopkeepers was 81%
Conclusion Shopkeepers can be used as DOT providers because of their accessibility,availability,being less time consuming and the place being convenient to the patients.Shopkeepers are an example of persons drawn from the community who can play a complementary role as DOT providers.No major problem was encountered during the treatment through shopkeepers. [Indian J Tuberc 2006;53:18-26: 
Pinaki R Debnath,Rakesh Tripathi,L.B.Agarwal,Ekta Malik and Shyam B Sharma
Transverse testicular ectopia is a rare entity where one testis migrates to the other inguinal area.Genital involvement due to tuberculosis is rare in children.Tubercular involvement in transverse testicular ectopic testis has not been reported earlier.A case of tuberculosis in transverse testicular ectopic testis is reported here where the testicular mass mimic as a tumour.Histopahological examination confirmed the diagnosis
[Indian J Tuberc 2006;53:27-29]: 
  • For the third quarter of 2005 the new smear positive case detection rate was 68%%
  • Patients put on treatment 333625
  • Success rate of 86% of the new smear positive in the 3rd quarter of 2004
  • Sputum conversion rate and cure among the new sputum positives --85% and 84% respectively
Under RNTCP Phase II it is planned to establish a network of RNTCP accredited quality assured Intermediate Reference Laboratories(IRL)providing culture and DST services for the RNTCP.A total of 24 DOTS Plus sites are planned to be established across the country. [Indian J Tuberc 2005;52:221-223]: 

[Indian J Tuberc 2006;53:30-32]: 
K.Jaggarajamma,M.Muniandy,V.Chandrasekaran,Sudha.G.A.Thomas,P.G.Gopi and T.Santha
Objective To study the contribution of migration to treatment default among tuberculosis patients treated under RNTCP
Methods Retrospective study by interviewing the defaulters using semi-structured interview schedule to elicit the reasons for default including migration
Results Of the 531 patients registered under TB programme in third and fourth quarter of 2001,104(20%)had defaulted for treatment.Among defaulters,24% had migrated.The reasons for migration were:Occupational 48%%),returning to the native place (28%),domestic problems(12%)and other idleness(12%) Conclusion After initiation of treatment,patients should be encouraged to report to the provider,if they are leaving the area,to transfer treatment to the nearest centre to ensure continuity of treatment.These measures will help to reduce default on account of migration and achieve the desired outcome in RNTCP.Availability of treatment under the DOTS strategy should be popularised among patients,providers and community [Indian J Tuberc 2006;53:33-36]: 
A.Thomas,V.Chandrasekaran,T.Santa,P.G.Gopi,R.Subramani and P.R.Narayanan [Indian J Tuberc 2005;52:215-217]: 
Objective To assess the usefulness of sputum examination at two months into continuation phase(CP)to declare treatment outcome
Methodology It is a retrospective study conducted in one tuberculosis unit Truvalluvar district of TamilNadu among smear positive patients treated with Category I and Category II regimens from May 1999-December 2003
Results Sputum was collected at two months into CP from 70% of 1551 Category I and 74% of 292 Category II patients declared cured,failed or treatment completed.Results at two months CP was used for giving outcome in 112(10.3%)of 1088 Category I patients and 37 (17%) of 217 Category II patients
Conclusion In practice,sputum needs to be collected for 7.8% of the patients with smear positive at the end of intensive phase.By doing so there will be a delay of one month for 3.6% of the patients in declaring "failure".By deferring the sputum examination at two months into CP workload of laboratory technicians can be reduced by about 30% [Indian J Tuberc 2006;53:37-39]: 
Yatin Dholakia and Vijay Pawar
Background The exact burden of tuberculosis remains unknown due to the fact that there are many health care providers who continue to provide care to patients suffering from tuberculosis and remain unregulated despite the DOT strategy being implemented on a nationwide scale.RNTCP has initiated interventions to involve these providers in case reporting protocols through Public Private Mix projects
Results Our study highlights the issue concerning the reporting of cases of tuberculosis seeking private care in Mumbai where there is an Act,which makes TB a notifiable disease
Conclusion This study shows that there is a need to establish formal mechanisms for case reporting and control among all health care providers [Indian J Tuberc 2006;53:40-42]
Bina Susheel and Pai
Background The study adequately demonstrates the entire gamut of clinical presentations in AIDS.The scourge is TB followed by acute bronchitis,Pneumocystis carinii pneumonia and bacterial pneumonia.The concept 'hit hard hit early" should be adequate to treat TB is demonstrated with SCC.
Results and conclusions Patients closely monitored for compliance and safety profile of SCC and antiretroviral drugs.Gastro intestinal disturbances,peripheral neuropathy,jaundice,hepatitis,arthralgia,hyperuricemia were significantly higher in 29 HIV vs 546 non HIV patients.Sputum remained positive at end of third follow up in 86.2% HIV vs 12.2% non HIV patients in spite of the subset of HIV patients in this study not being in advanced immuno suppression,as evidenced by minimal opportunistic infections,chest x-ray findings upper lobe lesions seen predominantly in non HIV population,low incidence of ETTB
[Indian J Tuberc 2006;53:43-46]

Created on ... Feb 17, 2006