1. "Tuberculosis Pathogenesis: Tobacco Smoking Increases Risk in
Indian Men" TB & Outbreaks Weekly (01.14.03)::Michael Greer

2. Indian J Med Sci 2002 Jan;56(1):16-8
DOTS strategy for control of tuberculosis epidemic.

3. Indian J Pediatr 2002 Nov;69 Suppl 1:S50-6
Priorities in tuberculosis research in India.

4. Indian J Pediatr 2002 Nov;69 Suppl 1:S39-43
Aspiration cytology for diagnosis of tuberculosis--perspectives in
India.

____________


"Tuberculosis Pathogenesis: Tobacco Smoking Increases Risk in
Indian Men"
TB & Outbreaks Weekly (01.14.03)::Michael Greer
Indian researchers warn that tobacco smoking dramatically
increases the risk of tuberculosis. C. Kolappan and colleagues at
the Tuberculosis Research Center in Chennai and the Indian
Council of Medical Research in New Delhi found evidence linking
cigarette smoking to heightened TB risk. The report states that
the prevalence of TB in adult men in India is two to four times
higher than in women. Cigarette smoking in India is primarily a
male habit.
The investigators examined the association between smoking
habits and TB risk among male TB patients and healthy controls in
the Tiruvallur district of Tamil Nadu. Cigarette-smoking men,
they found, were almost two-and-a-half times more likely to
contract pulmonary TB.
Furthermore, the researchers found that heavy smokers were
more likely to develop TB than men who smoked less. Those who
smoked 10 or fewer cigarettes a day, the report states, had a TB
risk 1.75-fold greater than nonsmokers. Those who smoked more
than 20 cigarettes a day saw their risk increase 3.68 times,
according to study data. The authors also found similar
correlations between the duration of smoking habits and TB risk.
Kolappan and colleagues reported their findings in "Tobacco
Smoking and Pulmonary Tuberculosis," published in Thorax (2002;
57(11):964-966).
"There is a positive association between tobacco smoking and
pulmonary (bacillary) tuberculosis," the authors concluded. "The
association also shows a strong dose-response relationship."

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Indian J Med Sci 2002 Jan;56(1):16-8
DOTS strategy for control of tuberculosis epidemic.

Murali MS, Sajjan BS.

Department of Community Medicine, Kasturba Medical College, Mangalore.

The article reviews the elements of the DOTS strategy to control the
tuberculosis epidemic WHO declared TB" a global emergency" in 1993,
the impact of which is worsened by the emergence of multi drug-
resistant TB (MDR-TB) and the spread of HIV/AIDS. DOTS (directly-
observed treatment, short-course) is an intermittent, supervised
system of drug-intake by patient, which eliminates drug-default. It
has been described by WHO as "the most important public health
breakthrough of the decade in terms of lives saved" The 5 major
components of DOTS are i) Political will, ii) High-quality
microscopy, iii) Uninterrupted supply of short-course chemotherapy
drugs, iv) Directly--observed chemotherapy regimen use, v) Systemic
monitoring using the TB cure rate. Standardized, intermittent DOTS
regimens are classified using three categories of disease. The main
advantages of DOTS are (i) Cure rates of upto 95%, (ii) Prevention of
MDR--TB emergence, (III) Improvement of longevity of AIDS patients by
TB control, (iv) It is "one of the most cost-effective of all health
interventions", according to World Bank.

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Indian J Pediatr 2002 Nov;69 Suppl 1:S50-6
Priorities in tuberculosis research in India.

Ganguly NK, Walia K.

Indian Council of Medical Research, New Delhi, India.

India accounts for nearly 30% of all tuberculosis cases in the world
today and more adults in India die from TB than from any other
infectious disease. The problems of HIV and multidrug resistance will
make tuberculosis epidemic in India much worse unless urgent action
is taken. DOTS is being applied on individual basis in the country.
Maintaining the momentum in order to achieve national coverage in a
phased manner, while maintaining the quality of services will require
constructive commitment from all sectors, both within and outside
government. This much be accompanied by additional research inputs
and critical data analysis. Operational research provides programme
managers the data and tools they need to analyse continuously improve
services they offer, hence this must be strengthened with an overall
aim to improve diagnosis and treatment of TB patients by translating
the results of research into policy and practice. At the same time
one should aim to strengthening biomedical research which promises
convenient diagnostic tests, new and cost effective drugs and safe an
effective vaccines, shortening of treatment, improved treatment of
latest infection and overcoming threat of MDR-TB. The challenge is
how to achieve this formidable goal as well as gear up to efficiently
handle the growing burden of HIV-TB infected patients. The key to
success lies in making available to all what we already have, by
strengthening operational aspects of programme and at the same time
not focus on the research efforts being done in basic science. The
solution lies in the link between basic science and public health.
________________________

Indian J Pediatr 2002 Nov;69 Suppl 1:S39-43
Aspiration cytology for diagnosis of tuberculosis--perspectives in
India.

Verma K, Kapila K.

All India Institute of Medical Sciences, New Delhi, India.
icverma@...

Tuberculosis (TB) a common cause of mortality can readily be
diagnosed by fine needle aspiration. The technique is a simple, cost
effective, out patient procedure with a high diagnostic accuracy both
in adults and children. The diagnostic morphologic findings comprise
of epithelioid cell granulomas and giant cells with or without
necrosis. Often an acute inflammatory exudate is obtained. Stain for
acid fast bacilli immensely augments diagnosis especially in cases
where necrosis or an inflammatory exudate is obtained. Culture
studies on aspirated material are time consuming though diagnosis is
enhanced. PCR can be applied to detect mycobacterial DNA and has been
applied on aspirated material and found to be more sensitive in the
detection of tuberculosis. In children TB of lymph nodes is readily
identified and so also from other sites such as bone and soft
tissues. In children FNAC also plays a role in detection of BCG
adenitis, infection with atypical mycobacteria and co-existing
infections such as HIV and AIDS.