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

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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 Dematolgy,
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
Lucknow
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,
Muzaffarnagar.
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,
Bengaluru.
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
Consultant
(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)
E-mail: drrajendrak1@rediffmail.com
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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 191 - 195

Comparison of the Clinical and Socio- Demographical factors in Pulmonary and Extra Pulmonary Tuberculosis patients in Yemen

GAMIL QASEM OTHMAN, MOHAMED IZHAM M IBRAHIM, YAHIA AHMED RAJA A

Dept of Social Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia. Dept of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Al Qassim, Saudi Arabia. Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen.

Correspondence Address :
Dr. Gamil Qasem Othman, MSc, School of Pharmaceutical Sciences,
Universiti Sains Malaysia, 11800 Penang, Malaysia.
E- mail: gamilqasem@yahoo.com

Abstract

This study aimed to assess the clinical and socio-demographic factors which were associated with pulmonary and extra pulmonary tuberculosis in Yemen.

A cross-sectional study was carried out among 160 Pulmonary Tuberculosis (PTB) and 160 Extra Pulmonary Tuberculosis (EPTB) patients who were diagnosed and treated in TB centres in Sana’a, the capital city of Yemen. Socio demographical, clinical and laboratory data and types of drug regimens which were used for treatment were collected from TB patients and from the medical records from the TB centres. The risk factors for the EPTB patients and the PTB patients were identified through a structured questionnaire.

The female to male ratio was 1.2 and 1.6 for PTB and EPTB, respectively. The median age for the PTB patients was 29 and it was 30 for the EPTB patients. It was also found that TB patientswith a low educational level amounted to 52% and 48% in the PTB and EPTB groups, respectively. This study illustrated that the majority of smokers were males (64% for PTB and 58% for EPTB), whose ages ranged between 15-54 years in both the PTB and the EPTB groups. This study found that more numbers of extra pulmonary tuberculosis patients were diagnosed in private hospital and clinics (41%) than the pulmonary tuberculosis patients (26%).

More numbers of females and younger patients were seen in both the EPTB and PTB groups. More numbers of extra pulmonary tuberculosis patients were diagnosed in private hospital and clinics than the pulmonary tuberculosis patients. The extra pulmonary patients had less monthly income than the pulmonary TB patients.

Keywords

clinical, extra pulmonary tuberculosis, pulmonary tuberculosis, socio-demographical, Yemen

How to cite this article :

GAMIL QASEM OTHMAN, MOHAMED IZHAM M IBRAHIM, YAHIA AHMED RAJA A. COMPARISON OF THE CLINICAL AND SOCIO- DEMOGRAPHICAL FACTORS IN PULMONARY AND EXTRA PULMONARY TUBERCULOSIS PATIENTS IN YEMEN. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Aug 21 ]; 5:191-195. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=191-195&id=1234

Mycobacterium tuberculosis (TB) is an infectious communicable disease that continues to remain as a major cause of death in the world (1).

There are two principle kinds of TB: pulmonary tuberculosis (PTB), which usually attacks the lungs, and extra-pulmonary tuberculosis (EPTB), which attacks any part of the body, such as: the lymphatic, pleural, bone and/or joint, genitourinary and the peritoneal systems, the meninges and/or the central nervous system (CNS) and all other sites combined. Pulmonary TB sometimes combines with extra pulmonary tuberculosis (2), (3).

Tuberculosis spreads through droplets from infected patients through coughing, sneezing, or during talking. In addition, closer contact with infected patients; prolonged, repeated, or intense contacts are considered as the major routes of infection for TB. Furthermore, there are other predisposing factors for TB that include: residents and employees living in congregate areas, health care workers who work with severely infected patients, low-income population, racial or ethnic minority population, children in contact with severely infected adults, and finally, persons who inject illicit drugs (2).

Extra pulmonary TB occurs outside the lungs and may spread through lymphatic or haematogenous dissemination. The TB bacteria may remain dormant for years at a particular site before causing the disease. Nearly all organs of the body can be infected by EPTB. It can also have a wide variety of clinical manifestations, thus leading to difficulty and delay in its diagnosis (4).

EPTB is reported to be more often diagnosed in females and in young patients (4), (5).

Tuberculosis is still one of the major public health problems in Yemen. A majority of tuberculosis patients in Yemen are in the age group of 15-54 years (6).

Almost one-third of the tuberculosis cases in Yemen are extrapulmonary (28%); most of them (24%) reside in Sana’a city (22 provinces in Yemen). The pulmonary tuberculosis represented 72% of all the TB cases (6).

The most recent estimates of tuberculosis in Yemen by the National Tuberculosis Control Program (NTCP) (6) showed that the annual incidence of new smear-positive TB cases was 37 per 100,000 population, and that for all forms of TB cases, it was 82 per 100, 000 population, while the prevalence was 136 per 100,000 population. The purpose of this study was to assess the clinical and socio- demographical factors which were associated with EPTB and PTB.

Material and Methods

This descriptive study was designed to compare the pulmonary and extra pulmonary tuberculosis cases in TB centres and governmental health facilities in the capital city of Sana’a, Yemen.

This study was conducted during March 2008–August 2009 at TB centres and health facilities in the capital city of Yemen, Sana’a. These centres were selected for their high patient attendance. Ascompared to other cities, Sana’a is characterized as having large and rich medical TB centres with large caseloads, data availability, consultants, and with good recording and reporting systems.

A total of 320 patients (160 EPTB and 160 PTB) were compared by their ages, genders, education, residential areas, employment status, marital status, smoking, and the place of diagnosis, symptoms, vaccination and treatment.

The study populations consisted of all tuberculosis patients who started a new course of tuberculosis treatment at the TB centres in Sana’a. The study included all patients with suspected or confirmed pulmonary and extra pulmonary tuberculosis; who were investigated and recorded in the medical records during March 2008 until August 2009. The patients who had defaulted, who were transferred or those who had died were excluded.

Clinical data and demographical and socioeconomic factors were collected by a direct interview by using a structured questionnaire. This questionnaire included data like patient’s name, gender, BCG vaccination status, full address, telephone number, the medical history of the patient’s family, social status (smoking and working) and the patient’s past medical history. According to the guidelines from the WHO and the Yemen Control Programme, several anti-tuberculosis regimens were used for treating TB.

The Statistical package for the Social Sciences (SPSS), version 12, was employed for data analysis. The Chi Square test was used to compare the socio economic status in the pulmonary and extra pulmonary patients. A statistical significance level of 0.05 was used in all analyses.

Results

A total of 320 patients were included in the study. The demographical details of the patients who visited the TB centres are listed in (Table/Fig 1).

Note: Chi Square test at alpha level of 0.05 Pulmonary versus extra pulmonary tuberculosis in terms of the demographical profile: The analysis elucidates that there was no marked differences between the pulmonary and the extra pulmonary TB cases in terms of gender, age group, residential area and the level of education. On the other hand, a significant difference was shown in terms of monthly income (P=0.002) and the place of diagnosis (P=0.009), as shown in (Table/Fig 1).

Pulmonary and extra pulmonary tuberculosis in terms of clinical profile: This study illustrated no differences between the type of disease and the vaccination status. There was a significant difference between the type of disease and the symptoms (P< 0.0001), as shown in (Table/Fig 2).

Pulmonary and extra pulmonary tuberculosis in terms of treatment: In terms of treatment, the study showed that there was no difference between the types of disease and the drug regimen which was given. It was noted that the patients of PTB paid twice the number of visits to the centres as was paid by the EPTB patients. Further details are presented in (Table/Fig 3).

Discussion

The study included three hundred and twenty patients. Of these patients, only 4.7% were transferred to other health facilities, 7.5% patients defaulted and 2.5% patients died. The above mentioned study had a lower number of defaulters and deaths as compared to a study from Pakistan, which found that 27% of the patients were defaulters and that 3.5% died (7).

Similarly, a study from India indicated that 20% of the patients were defaulters, 2.6% had failed to be treated and that 7.6% had died (8). In Malaysia, on the other hand, only 3.4% of the patients were defaulters, 2.2% had died and 13.4% were transferred patients (9).

This study showed that females constituted the majority of the patients, whether with pulmonary tuberculosis (54%) or with extra pulmonary tuberculosis (62%); this result was consistent with the findings made by other studies (10), (3); they reported that females occupied the first place as far as extra pulmonary tuberculosis was concerned. The findings of this study were however different from those reported from studies which were conducted in Netherlands (11) and in Malaysia (9), who indicated that the majority of the patients were males, figuring out 63% and 74.2%, respectively. The majority of our patients were females because women often face some obstacles such as high females illiteracy, childcare, housework and economic dependency, which allow them only little access to health care. Other possible factors might be biological sex differences and socio-cultural risk factors which are related to gender roles, which may be the main reasons that made women more susceptible to the disease. Moreover, some mothers feed their children on the expense of their own nutrition. This differential access to food by the females may be an additional factor that may relatively lead them to be more malnutritious than the males. The immunity of the females to tuberculosis may be weakened due to early marriages, pregnancy, multi-pregnancy, births, abortion and lactation, with a lesser time interval between successive pregnancies and lactational stress. The infection with extra pulmonary tuberculosis was usually found to occur in females of the reproductive age group, whose ages ranged between 15–45 years. All the above causes were found to be consistent with the findings made by other studies (3), (12).

The present study noticed that there was a strong association between pulmonary tuberculosis and extra pulmonary tuberculosisand young age. The median age of the extra pulmonary tuberculosis patients was 30 years; while in pulmonary tuberculosis, it was 29 years. The findings of the present study were consistent with those of a study which was conducted in Nepal, with regards to extra pulmonary tuberculosis patients (aged 28.5 years) and they were not consistent with the findings on pulmonary tuberculosis patients (aged 47 years) (3).

A study which was conducted in the United States found no connection between the extra pulmonary tuberculosis cases and young age (10).

The pulmonary TB cases in this age group were found to increase due to the exposure to infected people in crowded places such as markets and public transports and unhealthy working conditions. These may play an important role in the transmission of both pulmonary and extra pulmonary tuberculosis. Mario et al. (13) reported that age is an important determinant of the risk of disease after infection. Among infected persons, the incidence of tuberculosis was highest during late adolescence and early adulthood; the reasons are unclear.

In terms of age distribution, this study found that the majority of tuberculosis patients were within the economically productive age group whose ages ranged between 15-54 years old (14), who registered a percentage as high as 90% in pulmonary tuberculosis, whereas it was 93% for extra pulmonary tuberculosis. This was similar to that which was reported by other studies (15), (7) which revealed that tuberculosis patients within this age group were 85.9% and 85.2% in the pulmonary and the extra pulmonary groups, respectively. On the other hand, another study (12), (9) revealed a lower proportion of patients falling within this age group, figuring out at 70% and 66.2% of the pulmonary and the extra pulmonary cases, respectively.

A matter that was proved by the current study was that smoking was associated with pulmonary tuberculosis, a finding that was inconsistent with the findings from other studies (3), (16).

The current study reported that male smokers constituted a majority of the pulmonary and the extra pulmonary tuberculosis patients, as indicated by the following percentages: 64% and 58%, respectively. This finding was inconsistent with those of the studies which were carried out in Turkey, which found that male smokers accounted for 64.9% of both types of TB cases (17).

On the other hand, a study which was carried out in Hong Kong reported that the smoking rate was 56% in tuberculosis patients and that the incidence of extra pulmonary tuberculosis was higher among non-smokers (18).

A study from India, added that the smoking was found to increase the percentage of mortality in tuberculosis patients (19).

Another study from India proved that there was a relationship between smoking and pulmonary tuberculosis among the Indian males, the percentage being 75% in pulmonary tuberculosis cases (20).

Despite all studies which were conducted to assess the association between smoking and TB, the exact mechanism is not known, and it may be attributed to the nicotine content in tobacco, which might be interfering with the immunity of the patients. The situation in Yemen is still worse; there are less opportunities for health education, neither is there any application of laws to control the sale of cigarettes; a matter that has popularized such an important public health problem.

This study found that 85% of the patients were not employed,
a result that was inconsistent with the findings of studies from
Malaysia (9) and South Africa (21), which found that tuberculosis

patients who were not employed constituted 53% and 62% of all the TB cases, respectively. This high percentage of unemployment was attributed to a high percentage of illiteracy and a low education status, which were the main reasons that made Yemen to be considered as the poorest country.

As far as the educational status of the patients was concerned, they were classified into three different categories: low educational level, which referred to the primary and secondary school level; high educational level, i.e., patients at the university level; and no educational level, which denoted the patients who did not have any type of formal education.

This study indicated that the tuberculosis patients with low educational levels accounted to 52% and 48% cases in the pulmonary tuberculosis and the extra pulmonary tuberculosis groups, respectively. Furthermore, highly educated TB patients accounted for 11% cases in the pulmonary tuberculosis and 10% cases in the extra pulmonary tuberculosis groups, while the uneducated TB patientsaccounted for 37% and 42% cases in the pulmonary tuberculosis and the extra pulmonary tuberculosis groups, respectively. The percentage of uneducated and low educated patients in the two types of TB groups was 85%, which equalled the percentage of the no income patients. Therefore, the findings of this study were consistent with the reports from the WHO (14), which confirmed that tuberculosis patients were from vulnerable groups and were unemployed.

In terms of monthly income, this study found the extra pulmonary tuberculosis patients had less monthly income than the pulmonary tuberculosis patients. This finding can be attributed to the fact that tuberculosis was associated with poverty and that most of the extra pulmonary tuberculosis patients came from rural areas; most of the people in the rural areas drank non pasteurized milk, which was considered to be one of the most important methods for the transmission of tuberculosis. Dankner et al. (22) reported that outbreaks of the infection with M. bovis were still an important public health problem among children and adults in developing countries in which non pasteurized milk was consumed.

In terms of the place of diagnosis, this study found that more numbers of extra pulmonary tuberculosis patients were diagnosed in private hospitals and clinics than the pulmonary tuberculosis patients. This finding can be attributed to the fact that extra pulmonary tuberculosis presents more diagnostic and therapeutic problems than pulmonary tuberculosis which are less familiar to most of the clinicians (4), (23).

In addition, the clinical signs are not specific and so they arouse a high amount of suspicion on the part of the physicians (24).

In other words, the signs and symptoms of pulmonary TB are typical and known (cough and sputum), whereas extra pulmonary TB is difficult to be identified not only by the population, but also by the clinicians themselves. Therefore, patients who are suspected to have pulmonary TB, seek medical care in public hospitals in order to get free medication. On the other hand, extra pulmonary TB patients usually consult the nearest clinic or private hospital for their unknown illness.

Our study had a few limitations. Firstly, the study was conducted only in the urban centres in Sana’a and hence, the findings of this study cannot be generalized to the entire population of Yemen. Secondly, this study only compared the two categories of TB. Finally, our study did not take into consideration the different kinds of extra pulmonary TB.

In conclusion, females constituted the majority of the patients, whether with pulmonary tuberculosis (54%) or with extra pulmonary tuberculosis (62%). A strong association was noticed between PTB and EPTB with age; the median age of the extra pulmonary tu-berculosis patients was 30 years, while in pulmonary tuberculosis, it was 29 years. In terms of age distribution, this study found that the majority of tuberculosis patients were within the economically productive age group that ranged between 15-54 years. Finally, this study found that more numbers of extra pulmonary tuberculosis patients were diagnosed at private hospitals and clinics than the pulmonary tuberculosis patients.

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