Pulmonary & Respiratory Medicine

Pulmonary tuberculosis, a bacterial infection primarily caused by Mycobacterium tuberculosis, has been a major public health concern for centuries. Despite significant advances in medical science and global efforts to control the disease, tuberculosis continues to affect millions of people worldwide, leading to substantial morbidity and mortality. This article aims to delve into the mysteries of pulmonary tuberculosis from both a research and clinical perspective, shedding light on the latest developments, challenges, and prospects for managing this ancient disease. Pulmonary tuberculosis, often referred to as TB or consumption, has a long and storied history. The bacterium responsible for this disease was first discovered in 1882 by Robert Koch, a German physician, earning him a Nobel Prize in Physiology or Medicine. The isolation of Mycobacterium tuberculosis paved the way for a better understanding of the disease, but its impact on human populations dates back millennia.

Tuberculosis (TB) is an ancient disease that continues to plague humanity, causing significant morbidity and mortality. Despite significant progress in its diagnosis and management, TB remains a global health concern. The emergence of drug-resistant strains and co-infection with HIV has complicated the control of TB. Recent advances in diagnostic tools and treatment strategies have provided valuable insights into the complex dynamics of TB infection within the lungs. This article explores the evolving landscape of TB diagnosis and management, with a focus on insights gained from studying the lungs.

Background/Aim: Face masks are physical barriers to respiratory droplets that may enter through the nose and/or mouth and to the expulsion of muco-salivary droplets from infected individuals. The present study aimed at measuring lung function indices and oxygen saturation in subjects who wear surgical masks compared with cloth masks. Following the outbreak of the COVID-19 pandemic, the use of face masks is now widely recommended by international, national, and local authorities as a key strategy to reduce the spread of Severe Acute Respiratory Syndrome 2 (SARS-2) coronavirus.

Method: Fifty (50) male and female healthy adult volunteers (ages between 25-35 years) without any pulmonary or cardiac disease, and nonsmokers were recruited and grouped into three (3); Group 1 – (Control)- Subjects who did not wear any type of face masks; Group 2 – Subjects who wore surgical face masks; Group 3 – Subjects who wore cloth face masks Oxygen saturation and lung function indices were measured before the use of face masks and immediately after face masks were removed. The subjects wore the face masks for two (2) hours. In a standing position, the subjects’ oxygen saturation was recorded using a pulse oximeter on the subjects’ index fingers of their right hands, while the lung function indices (FVC1, FEV1, and PEFR) were measured three times using a spirometer, with the highest value chosen. Data were analyzed statistically using Graph Prism 8.1 version. Results were presented as mean+SEM, ANOVA, and Tukey’s Multiple Comparison Test were used to compare the means obtained, and P-values less than 0.05 (p<0.05) were considered statistically significant.

Results: The results showed that oxygen saturation was significantly decreased by both surgical and cloth masks compared with control, while ventilatory functions were significantly decreased by cloth masks but not by surgical masks compared with control. The decrease in oxygen saturation and ventilatory functions were however not clinically important since their decrease was minimal and not sufficient to induce hypoxia and breathing-related problems.

Conclusion: Thus, the use of face masks is safe, especially surgical facemasks. Consequently, the use of face masks is advised and recommended during an outbreak of airborne disease, but the duration of use, condition of use, and choice of mask may be important factors that should be put into consideration since masks are associated with discomfort. However, the life-saving benefits of wearing masks seem to outweigh the discomfort.

Tuberculosis (TB) is a significant disease caused by Mycobacterium tuberculosis, affecting the respiratory, gastrointestinal, lymphoreticular, central nervous, musculoskeletal, reproductive, and hepatic systems. Intestinal TB, primarily affecting the ileocecal region, can affect any part of the gastrointestinal tract. Common symptoms include abdominal pain, fever, diarrhea, constipation, blood in stool, and potential complications. Intestinal TB diagnosis is challenging due to limited diagnostic techniques. Typical approaches include radiological scans and histopathological examinations, but their sensitivity limits their accuracy. Therapeutic response is proposed as a significant factor. Microbiological analysis, including polymerase chain reaction and acid-fast bacilli, is another measure. The GeneXpert Tuberculosis Nucleic Acid Amplification Test has low sensitivity for intestinal TB diagnosis. The National TB Control Program in Bangladesh focuses on timely identification and prevention of TB cases, with the aim of establishing GeneXpert as a diagnostic tool for intestinal tuberculosis, despite limited studies in Bangladesh.

A cross-sectional study was conducted on 55 suspected intestinal TB patients aged 18 years and above in Dhaka, Bangladesh. Data was collected through face-to-face interviews and a questionnaire. Participants were given anti-TB drugs for a two-month trial and underwent colonoscopy with biopsy. Histologically confirmed and non-caseating colitis patients were diagnosed with intestinal TB. Patients not responding to the trial were diagnosed as without TB. Additional mucosal biopsies were sent for the GeneXpert MTB/RIF assay. Obtained data was analyzed by using Statistical Package for Social Sciences version 23.

A study involving 45 individuals diagnosed with intestinal TB found that common symptoms included abdominal pain, loss of appetite, weight loss, and fever. The study also found a significant relationship between ESR and intestinal TB, with a mean of 56.6 mm. Colonoscopy revealed that 60% of patients had mucosal ulceration, while histopathological findings showed granuloma in 84.4% of cases. Ultrasonography revealed abnormal findings in 33 participants, with 54.5% having ascites and 30.3% having bowel wall thickening. The study found that GeneXpert was effective in detecting intestinal tuberculosis, with positive outcomes in 11 instances and 34 false negatives. All ten individuals without the disease were accurately classified as negative. The GeneXpert test had a sensitivity of 24.4% and a specificity of 100%, making it a valuable tool for detecting the condition.

The study, establishes the role of GeneXpert in diagnosing intestinal TB, despite the absence of endoscopy, contrast radiology tests, Acid-Fast Bacilli culture, and a small sample size of suspected cases in a tertiary health facility.