Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 2530

AbstractMaterial and MethodsResultsDiscussionConclusionKey MessageAcknowledgementReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2009 | Month : February | Volume : 3 | Issue : 1 | Page : 1302 - 1306 Full Version

Pulmonary Tuberculosis And Some Underlying Conditions In Golestan Province Of Iran, During 2001-2005

Published: February 1, 2009 | DOI:

*MD,Infectious and Parasitic Diseases Research Center,Golestan University of Medical Sciences, Gorgan,(Iran).**MD, Dept of infectious diseases,5Azar hospital,Gorgan,(Iran).

Correspondence Address :
Gholamreza Roshandel,MD,Golestan Research Center of Gastroenterologyand Hepatology,Golestan University of Medical Sciences.Address:Number77,Qabooseieh passage,Valiasr street,Gorgan,Golestan province,(Iran).Tel.+98-171-2240835 Fax.+98-171-2269210,E-mail:


Context: Pulmonary tuberculosis has been a major health problem in Golestan province of Iran.
Aims: This descriptive cross-sectional study was performed to evaluate the frequency of coexisting medical conditions and their effects on some epidemiologic factors in patients with pulmonary tuberculosis.
Setting and Design: This was a descriptive cross-sectional study.
Methods and Material: Demographic information, time of admission in the hospital and coexisting medical conditions (diabetes, chronic renal failure/hemodyalysis, corticosteroids consumption and malignancies) were extracted from the patient's file.
Statistical analysis used: Chi-square test was used to assess the relationship between variables.
Results: Two hundred forty three patients with pulmonary tuberculosis during 5 years were studied. Out of all, 162 cases (66.7%) did not have any co-morbidities. Diabetes mellitus was found to be the most prevalent condition (23.05%) followed by chronic renal failure, corticosteroid consumption and malignancy ranking second, third and forth in the list (5.8%, 2.5% and 2 respectively). The mean age of the patients was 50.15±19 years old. In the group without co morbidities, male/female ratio was 1.41/1, but co morbidity with diabetes was significantly more prevalent in females (p<0.05).
Conclusions: We suggest screening of tuberculosis in patients with chronic renal failure and diabetes mellitus in our area. Also for patients with pulmonary tuberculosis, diabetes screening should be considered essential.


Pulmonary tuberculosis, Diabetes mellitus, Chronic renal failure, Corticosteroid consumption, Malignancy.

Tuberculosis is one of the most important contagious diseases in the world and approximately 2 million people (1/3 of world population) are infected with mycobacterium tuberculosis (1). The annual mortality rate of tuberculosis across the globe is 3 million (2). Frequent occurrence of co- existing morbidities in patients with tuberculosis is one of the important problems, as the odds ratio for the incidence of active tuberculosis followed by chronic renal failure (Hemodialysis), diabetes and immunosuppressive treatment, is estimated to be around 10-25, 2-4, 10 respectively. An anonymous study in 2003 showed that rate of TB specially in immunodeficient patients and high risk groups such as diabetes mellitus was higher than normal population (3), (4),(5),(6),(7), and also chronic renal failure in the other finding was increased to 6-52.5 more than normal population (8).

Several studies indicated towards a higher prevalence of TB in chronic corticosteroid consumption and malignancy patients (9),(10),(11),(12).

In Iran, the incidence of reported pulmonary tuberculosis with positive smear of sputum was 7.8 in one hundred thousand people in 2003(WHO had estimated 13 persons in one hundred populations) (13). Golestan is the second province for the incidence of tuberculosis in Iran (13). Keeping in mind the high prevalence of tuberculosis in our country and especially in Golestan province, we performed a study to evaluate the frequency distribution of general co morbidities including diabetes, chronic renal failure, corticosteroid consumption and malignancy in patients with pulmonary TB, so that we could be aware of high risk patients, and provide a proper base for future cohort studies based on evaluating the incidence of pulmonary tuberculosis in these groups.

Material and Methods

In this descriptive, cross sectional study, 500 files of TB patients were studied. We evaluated the frequency distribution of diabetes, chronic renal failure, corticosteroid consumption, malignancies, age and sex of documented pulmonary TB cases (based on definition of international tuberculosis association) during 2001-2005 in 5th Azar hospital of Gorgan, Iran. Pulmonary TB was defined on the basis of WHO prescription; positive smear pulmonary TB included patients with 2 positive sputum smears or 1 positive sputum smear in addition with radiological changes or positive sputum culture for AFB. Negative smear pulmonary TB cases included patients who did not fulfill the above mentioned criteria but were included due to specialist diagnosis and pulmonary radiographs and also those patients who didn’t have proper response to spectrum antibiotics but had proper response to antituberculosis medication , diagnosis of TB was established for them. Patients who had died without exact diagnosis or referred to other centers were excluded. Finally 243 patients were recruited. Demographic information including sex, age, co-existing morbidities (diabetes, chronic renal failure/hemodialysis, corticosteroid consumption and malignancies) and type of tuberculosis and death rate were extracted from patient's file. Patients were categorized in 6 age groups, including 13-20, 21-30, 31-40, 41-50, 51-60 and >60. Fasting blood sugar of higher than 126 mg/dl was considered as diabetes and chronic renal failure/hemodialysis considered for all hemodialized patients and also for patients who were suffering from renal failure during the 3 last month and more. Corticosteroid consumption was defined for the patients who took steroids with a dosage of more than 40 mg/day for any period of time; and malignancies were confirmed using histopathology results. All data were entered in the computer and analyzed with spss-11.5 software; then one and two dimensional tables of frequency distribution were created and explained.

Considering age and sex of patients, the patients were divided into two groups (one group with patients who had co-morbidities and the other who didn't have any co-existing morbidities) and then they were compared with each other. Chi square and Fisher exact tests were used to explain the results.


Two Hundred Forty-Three pulmonary TB patients were studied during 5 years (2001-2005). Their mean (±SD) age was 50.15 (±19) years old (Table/Fig 1). Patients included 130 men (53.5%) and 113 women (46.5%).In our study 162 patients didn't have any co-existing morbidities and 81 patients (33.3%) had at least one co-existing morbidity (Table/Fig 2). Diabetes was the most common co-existing morbidity in the study (23.05%), followed by chronic renal failure, corticosteroid consumption and malignancy (5.8%, 2.5% and 2%, respectively). In patients with tuberculosis and malignancy, cervix cancer (one case), non- Hodgkin's lymphoma (one case), bronchogenic carcinoma (one case), hepatocellular carcinoma (one case) and brain carcinoma glioblastoma (one case), were reported. Six patients consumed corticosteroids, including two cases of asthma, one case of rheumatoid arthritis, two cases of systemic lupus erythematosis (SLE) and one undiagnosed case. (Table/Fig 1) shows the frequency distribution of TB patients based on co-morbidities.(Table/Fig 3) shows the patients who didn't have any co-existing morbidities, males were found to have higher incidence than females with a ratio of 58.6/41.4. Among patients with co-existing morbidities except malignancy cases, females were found to have a higher incidence than males in diabetes, chronic renal failure and corticosteroid consumption with a range of 57.1, 57.1, and 66.7 respectively. Considering age factor patients higher than 60 years old were found to have a higher incidence of co-existing morbidities(29.6%), similar to patients with co-morbidities such as diabetes and malignancy (41.1% and 40% respectively). Among the patients with corticosteroid consumption a higher age frequency distribution was observed in patients that ranged 41-50 and higher than 60 years old (33.3%),and chronic renal failure was mostly seen in patients who were 41-50 years old (35.7%). In the patients with TB and DM, female factor play an important role as a risk factor (p<0.05) but in the other groups there weren't any significant statistical difference between male and female.


In a descriptive retrospective cross sectional study, recorded files of 243 pulmonary TB patients who were admitted in 5th Azar hospital during 2001-2005 were studied. Then the frequency distribution of disease and co-existing morbidities which were followed by tuberculosis was estimated. Overall, males formed 53.5% of the patients; predominance of male among the patients without co- morbidities was seen (58.6%) but in patients with co-morbidities (except malignancy cases), females were predominant in number.

Abbasi et al reported that males formed 53% of all TB patients (14) which is similar to the results of this study. The statistical data for sex ratio of all pulmonary TB patients in the country shows that 51% of all pulmonary TB patients were women and this difference between our study and national figures may be due to the majority of male population in Golestan province or males having more exposure than females. Immigration might be a contributing factor; but this hypothesis requires further evaluations. Evaluating other factors such as alcohol/ opium consumption, and HIV infection in Golestan population and comparing these factors in male and female population may also be of significant help, but in our study, except for malignancy co-existing morbidities (diabetes, etc) were found to be more frequent in females. National figures report a prevalence of diabetes for men as 2.41% and for women as 3.67% (15). In this study for patients with pulmonary TB and diabetes, females had a higher prevalence than males (f/m = 4/3) that was significant statistically (p<0.05). Therefore, due to higher prevalence of diabetes amongst females of this country, contemporary appearance of pulmonary TB with diabetes is to be expected more; but it seems necessary to evaluate other factors as well for incidence of tuberculosis in diabetic females. Nisapattorn and his coworkers in 2006 reported that females had a higher prevalence of coexisting TB and DM than males(4).

In Gulbay et al's study which was done in a hospital of Ankara during 5 years (1999-2004) period, there wasn't any clear difference in sex ratio of TB patients with and without diabetes (16). Perz-Guzman and his group compared 202 pulmonary TB patients with co-existing diabetes with 226 patients of pulmonary tuberculosis who didn't have diabetes; and their results showed that diabetes was more prevalent among females aged 50 years or old (17) and this study showed approximately similar results. In pulmonary TB patients with chronic renal failure females were found to have a higher prevalence with 57.1% and amongst pulmonary TB patients who had consumed corticosteroids female population had double the prevalence as compared to males. Incidence of most collagen vascular diseases in females, which accompanies corticosteroid consumption, supposedly plays an important role in making females more prone to have pulmonary TB than males. Sazaki and his coworkers in 2000 (18) performed a study on pulmonary TB patients who had received corticosteroids as a treatment for collagen vascular disease; in their study females had a higher prevalence similar to that of our study (f/m =1.5/1). Female gender might be a significant factor for increasing the incidence of pulmonary TB in individuals with corticosteroid consumption, chronic renal failure and diabetes, but this hypothesis requires further evaluations. In 13 year article's of Coantril and his group in dialytic patients (1986-1999) 24 cases of pulmonary TB reported equal sex ratio(19). On the other hand another study reported pulmonary TB in 26 dialytic patients that included 6 women and 20 men (20) which is not in confirmation with the results of this study. In review of these studies we couldn't find any relation between sex and chronic renal failure. Males were more prevalent pulmonary TB patients with malignancy by a fraction of F/M =2/3. In Karnak and his coworker's study in 1993-1995 which was about pulmonary TB patients who had malignancy, males were prevalent with a fraction of 4/6.9=f/m; this result is also similar to our results (21). The mean age of patients without co-morbidities was lower than mean age of all patients (47.3 against 50.15), against the patients with co–morbidities (for example in diabetes 58.4 against 50.15) which is due to higher occurrence of co-morbidities in elderly age. Higher age frequency distribution of TB patients in groups without co- morbidity, patients with diabetes and malignancy was over 60 years old (29.6%, 41.6% and 40% respectively), but in TB patients with chronic renal failure and corticosteroid consumption the higher age frequency distribution was 41-50 years old (35.7% and 33.3%, respectively). This study showed that although co-morbidities like diabetes and malignancy have an increased incidence in higher mean age TB patients than TB patients without co-morbidity, factors like chronic renal failure and corticosteroid consumption are more prevalent in a lower mean age group.

In Gulbay and coworker's study (16) simultaneous prevalence of pulmonary TB with diabetes for patients with mean age 50 years or older (21.3%) was more than for other age groups. In Perz-Guzman and his group's study (17) diabetes had higher incidence of tuberculosis in patients with age more than 50 years. Accompaniment of diabetes with tuberculosis in our study was 23.8% which was higher in Gulbay's study(17.7%) (16) and in Yamagishi's study(13.2%) (22); this might be because of higher prevalence of pulmonary TB in Golestan province than the total national prevalence. In 2003 the incidence of pulmonary TB with positive smear was 7.8 for 1,00,000 patients in Iran and was reported 22 of 100000 patients in Golestan province (13). Amongst the four common co-morbidities accompanying tuberculosis, chronic renal failure was the second most common with a prevalence of 6%. In 1999, Leung and his coworkers in Hong Kong reported the prevalence of pulmonary TB in long term consumers of corticosteroid to be 1.2% (23), while this amount in Cobashy study in 1999 on 162 patients was reported as almost 3.1% (9). Our findings about corticosteroid consumption and it’s relation with pulmonary TB was situated between these two ranges (2.5%). Another common co-morbidity in our patients was malignancy with a prevalence of 2%. In Kamboj study in 2006 the rate of TB among solid organ and blood cancers were reported 102 and 457/100000 cases respectively, although this rate in normal New York population was 24-39/100000 (12).

Leung and coworker's study in 1999 found 4.2% of TB patients with co-existing malignancy (23). This incidence was 10% in Jihad's study in Saudi Arabia (24).

Restrepo BI et al in their study found preliminary evidence of an altered immune response to M. tuberculosis in type 2 diabetes, especially type 2 diabetes involving chronic hyperglycemia.


The results of this study are similar to studies performed in other Asian countries such as Saudi Arabia, Korea and Japan regarding the prevalence of co-existing morbidities with pulmonary TB.

Considering the higher prevalence of TB in this region, regular screening of TB patients for DM and Renal Failure should be considered. Also screening for possible co-existing pulmonary TB in high risk groups (DM, malignancy, chronic renal failure, corticosteroid treatment) by means of chest radiography and sputum smear should be considered.

Key Message

Pulmonary tuberculosis should be considered in the management of chronic diseases in our area.


The Authors would like to thank the Dr Abbasali Keshtkar and Mrs S. Samadzadeh.


. Mandell GL, Bennett JE, Dolin R , 2005. Principles and Practice of Infectious Diseases. 6th ed., USA, Churchill livingstone, pp: 2863-66.
. Center for Disease Control and prevention. Statement from the center for disease control and prevention in response to WHO world TB day Atlanta GA: CDC update ,1998.
. Yamagishi F, Shimokata K. Tuberculosis in compromised hosts. Kekkaku 2003; 78: 717–22.
. Nissapathorn V, Kuppusamy I, Josephine FP, et al. Tuberculosis: A resurgent Disease in immunosuppressed patients. SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH 2006, 37: 153-60.
. Ponce-De-Leon A, Olaiz-Fernandez G, Rojas R, et al. Tuberculosis and diabetes in southern Mexico. Diabetes Care 2004, 27: 1584-90 .
. Bacakoglu F, Basoglu K, Cok G, et al. Pulmonary tuberculosis in patients with diabetes mellitus . Respiration 2001, 68: 595-6000.
. Stevenson RC, Critchley AJ, Forouhi GN, et al. Diabetes and the risk of tuberculosis: a neglected threat to public health .chronic. Illness 2007, 3: 228-45 .
. Hussein M, Mooij MJ, Roujouleh H. Tuberculosis and chronic renal disease. Semin Dial 2003, 16: 38-44.
. Kobashi Y, Matsushima T. Clinical analalysis of pulmonary tuberculosis in association with corticosteroid therapy. Int Med 2002, 41: 1103-10.
. Pal D, Behera D, Gupta D, et al. Tuberculosis in patients receiving prolonged treatment with oral corticosteroids for respiratory disorders. Ind J Tub 2002, 49: 83-86.
. Pandey M, Abraham KE, Chandramohan K, et al. Tuberculosis and metastatic carcinoma coexisting in axillary lymph node: a case report. World J surgical Oncology 2003, 1: 1-3.
. Kamboj M, Sepkowitz AK. The risk of tuberculosis in patients with cancer. Clin Infect Dis 2006, 42: 1592-95.
. Salek S. Special letter for national day of TB prevention. Association calendar in care system of tuberculosis. Disease administration center, 2004.
. Abbasi A, Moradi A, K MJ. Characteristics of pulmonary tuberculosis patients in Golestan province of Iran in 2000-2005. Journal of medical science 2006, 6: 698-700.
. Guya MM. Diabetes in Iran. Report from Center for Disease Control (CDC) of Iranian ministry of health, 2006.
. Gulbay EB, Erol S, Arsalan F, et al. The coexisting pulmonary tuberculosis and diabetes mellitus, Ankara, Turkey, 1999-2004. Difficult tuberculosis cases, 2004. htpp:// 06/files/28.pdf.
. Prez-Guzman C, Vargas HM, Padilla RJ, et al. Diabetes modifies the male: female ratio in pulmonary tuberculosis. Int J Tuberc Lung Dis 2003, 7: 354–8.
. Sasaki Y, Yamagishi F, Yagi T, et al. A clinical study in the collagen disease patients developed pulmonary tuberculosis during corticosteroid administration. kekkaku 2000, 75: 569-73.
. Quantrill JS, Woodhead AM, Bell EC, et al. Side effects of antituberculosis drug treatment in patients with chronic renal failure. Eur Respir J 2002, 20: 440-43.
. Cengiz K. Increased incidence of tuberculosis in patients undergoing hemodialysis. Nephron 1996, 73: 421-24.
. Karnak D, Kayacan O, Beder S. Reactivation of pulmonary tuberculosis in malignancy. Tumori 2002, 88: 251-4.
. Yamagishi F, Suzuki K, Sasaki Y, et al. Prevalence of coexisting diabetes mellitus among patients with pulmonary tuberculosis. Kekkaku 1996, 71: 569-72.
. Leung CC, Tam MC. Comorbidities among patients with tuberculosis in Hong Kong. HK Pract 2002, 24: 114-31.
. AL –Jahadli H, AL –Zahrani K, Amene P. Clinical aspect of miliary tuberculosis in Saudi adults. Int J tuber lung Dis 2000, 4: 252-55.
. Restrepo BI, Fisher-Hoch SP, Pino PA, Salinas A, Rahbar MH, Mora F,, McCormick JB.Tuberculosis in poorly controlled type 2 diabetes: altered cytokine expression in peripheral white blood cells.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)