Chest 2012: American College of Chest Physicians (ACCP) Annual Meeting

Aims and objective

1. To study clinical profile of patients. 
2. To evaluate the effectiveness of DOTS regime in the terms

of cure rate, failure rate,defaulter rate and deaths.

Methodology

250 newly diagnosed patients having pulmonary or extra pulmonary Tuberculosis who are attending the DOTS centre at HAMIDIA. Hospital,BHOPAL both indoor and outdoor in year 2011 and fulfilling the inclusion and  exclusion criteria.Data was collected in pretested proformas which includes clinical symptoms,physical findings on examination,baseline investigations, sputum microscopy and chest x-rays.

Results

Pulmonary tuberculosis cases predominated and consisted of 175 (70%) cases and extra pulmonary cases accounted for 75 (30%) of the study group .Patients from all age groups were included and highest incidence of tuberculosis was observed in the age group 21-40 years 125 patients (50%) followed by 41-60 years age groups 71patients(28.3%) followed by <20yrs age group 38patients(15%)and lowest incidence was in >60yrs age group 16patients(6.7%),Cough was present in 192 (76.7%) of the patients, fever present in 104 (41.7%), patients night sweats in 59 patients (23.3%), weight loss in 192 patients (76.7) and hemoptysis in 46 patients (18.3%) and chest pain was presenting symptom in 59 patients (23.3%) were present. So most common complain was cough and weight loss. Clubbing was noted in 50 (20%)patients of these 20 patients had bilateral lung involvement,170 patients (68%) had pallor, .lymphadenopathy was noted in 100 (40%)patients these included patients with either cervical, axillary inguinal or generalized lymphadenopathy .So the most common sign on examination was pallor. Normal x-ray was present in 40 (14%) patients. Pleural effusion was present in 30 (12%) patients, hydropneumothorax was present in 5 (2%) patients, lung collapse was present in 15 (6%) patients, cavitations was seen in 23 (10%) patients. upper lobe cavitations was more common, fibrosis was present in 10 (4%) patients, unilateral consolidation was present in 77(32%) patients upper lobe consolidations was more common, bilateral fluffy shadows was present in 50(20%) patients.So the most common x ray finding was unilateral consolidation. 150 of the 175 pulmonary cases were found to be sputum AFB positive at presentation and 16 were positive at the end of the intensive phase out of which 3patients died during period of extended intensive phase and 4patients had sputum conversion from positive to negative so at end of extended intensive phase 9 patients positive for sputum AFB and 151 were negative at the end of 3 months of treatment.Sputum conversion rate at end of intensive phase was 89.33% while at end of extended intensive phase,2^nd mth of continuation phase and at end of treatment was 92%.So at end of treatment among175 Pulmonary tuberculosis patients cure rate was 77.71% i.e136 patients, failure rate was 5.14%-9 patients,defaulter rate was 4.%-7 patients, death rate was 4.57%..-8 and patients declared completed treatment. were 8.57%-15patients. Out of total 9 patients(5.14%) declared as failure cases 6 patient had HIV infection with CD4+ count of <300 cells / cmm.while 3 patient had diabetes mellitus.7 patients (4%) defaulted during treatment.15 patients were baseline  sputum negative and at the end of treatment were declared completed treatment.There were 8deaths among pulmonary cases out of which 5 patients had HIV infection with CD4 count <100/cmm.2 patients had acute hepatic failure 1 patient died due to acute Myocardial infarction.Of the 75 extra pulmonary cases 68 Patients (90%) were declared treatment completed 4 patients (5.3%) were defaulters, 3 patient died all of which had tubercular meningitis.In entire study 2 patient had hepatitis and died during the course of treatment due to acute liver cell failure. 30 patient had gastrointestinal adverse effects which did not require discontinuation of therapy.

Conclusion

Pulmonary tuberculosis cases predominated 175 (70%) cases and extra pulmonary cases accounted for 75 (30%) ,highest incidence of tuberculosis was observed in the age group 21-40 years 125 patients (50%),most common symptom was cough and weight loss 192 cases(76.7%) ,most common finding on examination was pallor 170 patients (68%), most common x ray finding was unilateral consolidation 77(32%) patients. Sputum conversion rate at end of intensive phase was 89.33% while at end of extended intensive phase,2^nd mth of continuation phase and at end of treatment was 92%.So at end of treatment among175 pulmonary tuberculosis patients cure rate was 77.71% i.e136 patients, failure rate was 5.14%-9 patients, defaulter rate was 4.%-7 patients, death rate was 4.57%..-8 and patients declared completed treatment. were 8.57%-15patients. Of the 75 extra pulmonary cases 68 Patients (90%) were declared treatment completed 4 patients (5.3%) were defaulters, 3 patient died.