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Background: Although there is a growing consensus that hydroxychloroquine may not be effective in the treatment of COVID-19 patients, there is still little high-quality evidence about the prophylactic effects of this medication. In this study, we aimed to evaluate the efficiency of hydroxychloroquine in preventing COVID-19 infection among healthcare workers. Methods: In this clinical trial, 90 healthcare providers from two referral hospitals of COVID-19 were divided into the hydroxychloroquine group (400 mg/week for eight weeks) and the routine-care group. Serum CRP levels and the frequency of T-helper (CD4+ cells) and T-cytotoxic (CD8+ cells) were assessed at the beginning and end of the study. The groups were compared in terms of White Blood cells (WBCs), polymorph nuclear cells (PMNs), lymphocytes (LYM), hemoglobin (Hb), and platelets (Plt.). Results: The results revealed no significant differences between the two groups in terms of WBC, PMN, LYM, Hb, Plt., CD4, and CD8. The mean difference of the CD4:CD8 ratio showed a significantly higher decrease (P=0.05) in hydroxychloroquine group than in the control group (0.18 vs. 0.02). The incidence of COVID-19 was 15% (95%CI: 12-18%) in the control group and 10% (95%CI: 8-12%) in the intervention group; however, no significant difference was observed between the two groups in this regard (P=0.45). Conclusion: Our study findings boost an increasing level of evidence that hydroxychloroquine is not an effective prophylactic medication against COVID-19 and might even exacerbate the profile of pandemic containment efforts by adding more pain to patients’ life and healthcare services.

Purpose Central nervous system involvement by Brucella species is the most morbid form of brucellosis disease. Studies on neurobrucellosis are scarce and limited to case reports and series. Brucella is unable to infect or harm neurons without the assistance of monocytes. This raises the question of whether ceftriaxone-based regimens are effective. Methods The primary aim of this study was to identify, evaluate, and summarize the findings of all relevant individual studies in the past 30 years to help better understand the disease. To achieve this, a broad systematic search was undertaken to identify all relevant records. Epidemiological and clinical features of the disease were assessed by the pooled analysis of descriptive studies. Through a meta-analysis, the treatment period duration was compared between the ceftriaxone-based and oral regimens using Standardized mean differences to measure effect size. Results 448 patients were included in the Meta-analyses from 5 studies. A moderate positive effect was found for ceftriaxone-based regimens over oral treatments, and there was a significant difference between these two groups (SMD 0.428, 95% CI -0.63 to -0.22, I 2 = 37.64). Neurobrucellosis has a different clinical picture in pediatric patients. The disease is less chronic in children. Fever, nausea and vomiting, fatigue, and abdominal pain were significantly more prevalent symptoms in children, and Convulsions, ascites, sensorineural hearing loss, and papilledema were significantly more prevalent signs in children than adults. Conclusion It is recommended to initiate the treatment of neurobrucellosis with at least 14 days of IV ceftriaxone therapy in combination with oral therapy.

Background: Ventilator-associated pneumonia (VAP) is an infectious pulmonary disease that develops after 48 hours of ventilation. To date, several methods have been proposed to reduce VAP occurrence, such as the VAP prevention bundle, which involves raising the head of the bed, reducing sedation, avoiding deep vein thrombosis, and preventing peptic ulcer in the gastrointestinal system. The purpose of this study was to evaluate the role of personnel in hand washing, case airway suctioning, and systematic monitoring in the prevention of VAP. Methods: In the current clinical trial, 129 patients hospitalized and intubated at Vali-e-Asr Hospital ICU in Arak, Iran, were included in the study and randomized to one of the three VAP prevention methods: group A, VAP prevention bundle measures; group B, group A measures plus washing of patients’ mouth with 0.12% chlorhexidine and suction of secretion every six hours; and finally group C, group B measures plus 72-hour suction package. Demographic information, VAP diagnosis, and outcome of each patient were recorded in the special checklist. Results: The age of the patients ranged from 18 years to 93 years with a mean of 54.6 ± 21.8 years. There was no significant difference in age, sex, Clinical Pulmonary Infection Score (CPIS), and Glasgow Coma Scale (GCS) between the three groups. However, there is a significant relationship between chest X-ray (CXR) index and pneumonia in the three groups (p p Conclusion: This study showed that the application of VAP prevention bundle measures, mouthwash with chlorhexidine, personnel hand washing, airway suctioning, and systematic monitoring is an efficient approach to the prevention of VAP in ICUs.

Needle Stick Injury (NSI) is one of the spread abroad and dangerous risks in nurse job that HIV, HCV and HBV are the most common infection which were transferred by blood. The aim of this study was evaluation of the education effect basis of the health belief model of knowledge and behavioral prevention of NSI. This study was a quasi-experimental that 165 nurses were selected incidentally from the hospitals they has been organized into experimental and control group. Data were collected with health belief model questionnaire and checklist before and after intervention and also for control group executive working environment was used according to universal precautions. Results showed that the mean score of knowledge and components of health belief model increased in the control group meaningfully and perceived barrier didn’t decrease meaningfully. Behaviors' scores increased and NSI decreased. Education program based on health belief model increased knowledge and most of health belief model constructs score and also improving prevention behavior and lead to decrease NSI.

Background. More than 90% of human immunodeficiency virus- (HIV-) infected patients show at least one mucocutaneous manifestation during the course of their disease. The frequency, pattern, and associated factors of these complications vary among different populations. Objective. This study was planned to evaluate the frequency of cutaneous presentations in HIV-infected patients and their association with the count of CD4 cells. Methods. A cross-sectional study was conducted on eighty-four HIV-positive patients, who attended the Behavior Consultation Center of Arak University of Medical Sciences. All subjects had a complete physical examination by an expert dermatologist. Further diagnostic procedures were performed, if necessary. Counts of CD4 were determined using flow cytometry. Results. From 84 patients who enrolled in this study, 95.2% manifested at least one type of mucocutaneous lesions. The most common presentation was xerosis, followed by seborrheic dermatitis, herpes simplex, and oral candidiasis. Oral candidiasis and furuncle were significantly associated with decrease in CD4 cell counts. Conclusions. Cutaneous manifestations are common in HIV-positive patients, some of which (oral candidiasis and furuncle) could be applicable as useful clinical indicators to predict the immune status of the patients. Therefore, regular skin examinations are recommended as routine HIV-infected patients’ healthcare programs.

Introduction: Spondylitis is a serious disease caused by a variety of pathogens. The identification of spondylitis etiologies is a very important medical issue. This study was conducted to compare clinical, laboratory and radiological features of the patients with tuberculous (TS), brucellar (BS) and pyogenic spondylitis (PS) in a central city of Iran. Methods: In this retrospective study, we obtained the data of 100 patients with spondylitis from a hospital in Arak city. The patients were divided into three groups including TS (8 cases), BS (71 cases) and PS (21 cases), based on the spondylitis etiology. Results: The mean age of cases with TS, BS, and PS was 67.25±20.26, 55.39±15.60 and 52.19±12.74 years, respectively. The most common clinical feature was back pain followed by fever. Twenty-one cases had psoas abscess which was more common in PS group. No significant difference regarding the involved vertebral regions was observed between the groups. Intravenous drug use, history of vertebral surgery and chronic renal failure were frequent in patients with PS, and all TS cases had pulmonary involvement. Conclusion: Our data showed that presence of concomitant pulmonary involvement and a confirmed history of tuberculosis are suggestive of tuberculous spondylitis. However, the distinction between TS and BS is still problematic and only a combination of clinical data, laboratory findings, radiological features and history of TB can be helpful in differentiation of TS and BS.

Introduction: Hydatid cyst is caused by an infection by the larval stage of Echinococcus granulosus. Patients with cystic echinococcosis often remain asymptomatic until the hydatid cysts grow large enough to cause symptoms and signs. The cysts grow in the course of several years before reaching maturity and the rate of growth depends on the location of the cyst. Methods: This study was conducted in the Central region of Iran and involved all patients diagnosed with hydatid disease from 2012 to 2016 with the records identifed from 10 centers for disease control. Descriptive statistics including range and percentage were used in analyzing the patient characteristics. Results: Hydatid disease was confirmed in 84 cases. The mean age of patients was (23.1±5.1) years (range: 15-53 years) and 55.9% of cases were female. Single organ involvement was found in 86.9% of cases. 98.8% cases were successfully treated. The most common sites of infection were lung (42.9%), followed by liver (38.1%), and joint liver/lung (10.7%). The diagnosis was established by abdominal ultrasound, abdominal CT, and serology in all patients. The diagnosis was confirmed by histology in 80 (95.2%) of cases. All of cases were treated with albendazole, and 80 (95.2%) of cases had surgical intervention. The prevalence of human hydatidosis in our study was 1.16 per 100,000 population. Conclusions: Hydatid disease is common in Iran and should be a focus of public health interventions. The organ sites affected in this study include lung and liver.

Bacillary dysentery is a major cause of children’s admission to hospitals. To assess the probiotic and prebiotic (synbiotics) effects in children with dysentery in a randomized clinical trial, 200 children with dysentery were studied in 2 groups: the synbiotic group received 1 tablet/day of synbiotic for 3–5 days and the placebo group received placebo tablets (identical tablet form like probiotics). The standard treatment was administered for all patients. Duration of hospitalization, dysentery, fever, and the weight loss were assessed in each group. It was concluded that there was no significant difference in both groups in the baseline characteristics. The mean duration of dysentery reduced (P<0.05). The mean duration of fever has been significantly reduced in the synbiotic group (1.64±0.87days) in comparison to the placebo group (2.13±0.94days) (P<0.001). Average amount of weight loss was significantly lower in the synbiotic group in comparison to that in the placebo group (129.5±23.388grams and278±28.385grams, resp.;P<0.001). There was no significant difference in the mean duration of hospitalization in both groups (P>0.05). The use of synbiotics as an adjuvant therapy to the standard treatment of dysentery significantly reduces the duration of dysentery, fever, and rate of weight losses. The trial is registered withIRCT201109267647N1.

Background: Brucellosis is one of the most common chronic diseases, with widespread distribution. In spite of cell-mediated immunity (CMI) modulated mainly via activated T-helper type 1 (Th1) cells, brucellosis can advance to chronic disease in about 10-30% of cases. Regulatory T cells (Treg cells) are involved the immune response to brucellosis; however, their role, particularly in the change from the acute to the chronic phase, have not yet been elucidated. The main hypothesis of this study was that Treg cells play critical roles in the progression of brucellosis from the acute to the chronic phase. Methods: Forty-eight unrelated subjects participated in this case-control study. The percentages of CD4+, CD25+, FoxP3+, and CD25/FoxP3+ T cells in the peripheral blood mononuclear cells (PBMCs) of acute (AB) and chronic brucellosis (CB) patients and healthy controls were determined by flow cytometry. The mean florescence intensities (MFIs) of CD4+, CD25+, and FoxP3+ T cells were also measured. Results: We found a significantly lower percentage of CD25/FoxP3+ Treg cells in CB than in the AB and control groups (p < 0.05). Also, CD4 and CD25 MFIs were significantly less in CB than in AB and controls (p < 0.05). Conclusions: We propose that the reduced number of CD25/FoxP3+ Treg cells in the CB group leads to T cell anergy and this contributes to the development of chronic infection.

Due to the lack of availability of respiratory fluoroquinolones, treatment using amoxicillin- clavulanate is recommended for community acquired pneumonia (CAP) in Iran. Cefixime offers advantages such as lower cost and improved patients compliance. The current study was designed to compare the therapeutic effects of amoxicillin- clavulanate and cefixime in patients with CAP. In a randomized controlled trial, 280 inpatients with CAP were randomized to receive either amoxicillin- clavulanate or cefixime (n = 140). Clinical signs, symptoms and chest radiography reports of patients were compared between two groups on the first visit and weeks two and four after treatment. Cure was defined as resolution of signs and symptoms in the first week and resolution of chest x-ray infiltration in the 4th week. Improvement was defined as resolution of fever on 1st and 2nd day, cough and sputum on 4th to 5th day and lung consolidation sounds in the first week. Sever and complicated CAP were excluded and considered as side effects. The amoxicillin- clavulanate group had more patients with cough in the 2nd and 4th week (p = 0.008 and 0.001, respectively), sputum and infiltrate on chest x-ray in the 4th week (p = 0.008 and 0.004, respectively) compared to cefixime. Clinical status at the end of the treatment showed cure (71.25%), improvement (24.61%) and side effects (3.87%) in the cefixime group and 66.67, 30.07, and 3.26%, respectively in the amoxicillin-clavulanate group [p = non-significant (NS)]. In our study, cefixime was more effective than amoxicillin-clavulanate in resolution of signs and symptoms of CAP. Cefixime may be an option for the treatment of CAP in countries with limited drug options. Key words: Community acquired pneumonia (CAP), cefixim, co-amoxiclave, community acquired pneumonia, switch therapy.

Background: Recent studies have shown a positive correlation between Helicobacter pylori (H. pylori)infection and migraine headache. Objective: To study the impact of H. pylori eradication on migraine headache. Study Design: Double blind, randomized, controlled clinical trial. Setting: Sixty-four patients diagnosed with migraine-type headache were included in the study. The patients were randomly allocated into 2 groups: a treatment group that received migraine treatment and H.pylori eradication treatment, and a control group that received migraine treatment and a placebo in place of H. pylori eradication treatment. Methods: There were 25 women and 7 men in the treatment group and 22 women and 10 men in the control group. The MIDAS (Migraine Disability Assessment) questionnaire was used to assess the severity of symptoms, before and after treatment. Result: There was no significant difference between treatment group patients and control group patients with respect to age (44.6 ± 8.8 vs. 43.8 ± 13.8), clinical symptoms and signs. In the beginning of the study, patients in the treatment group had a higher MIDAS compared to patients in the control group (28.87 ± 6.18 vs. 25.43 ± 7.13, P < 0.05). There was no significant difference between the treatment and control groups, with respect to the MIDAS, after treatment (20.09 ± 1.14 vs. 20.00 ± 1.150, P = 0.5). General linear model, repeated measures demonstrated that the reduction in the MIDAS score was more prominent in the treatment group (Mean Square 164.25, F: 2.02, P = 0.05). Limitations: Short-term follow up. Conclusion: H. pylori eradication may have a beneficial role on migraine headache. This shows the significance of H. pylori treatment in the management of migraine headache among Iranian patients. Key words: Helicobacter pylori, migraine headache

The relationship between personality traits and AIDS in patients with human immunodeficiency virus Salehi, B.a, Zarinfar, N.b , Noori, H.c Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran Department of Infectious Diseases, Arak University of Medical Sciences, Arak, Iran Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran Abstract This study carried out to survey the relationship between personality traits and Acquired Immunodeficiency Syndrome (AIDS) in patients with human immunodeficiency virus. This case-control study was conducted on 79 AIDS patients of Triangle Clinic in Arak (case group) and 80 healthy people of Valiasr Hospital in Arak (control group). Demographic information checklist and Cloninger' Temperament and Character inventory (TCI) were two instruments applied in the study. SPSS software V.19 and tests independent t-tests, Chi squared and Spearman correlation coefficient were used for data analysis with significant level of

Current mainstay of treatment for human immunodeficiency virus (HIV)-infected patients is highly active antiretroviral therapy (HAART) but little is known about the long-term clinical outcome for HIV-infected patients who have received HAART. Determining factors associated with longterm survival in the course of treatment may allow modification to be made for patients who are at a greater risk of treatment failure. In this study patients who were under HAART from March 2002 to September 2003 were evaluated. They were visited from 2 to 5 times and clinical and lab findings and CD4 count on every visit were recorded. Rates of progression from the initiation of HAART to treatment failure, defined as constant decline of CD4 numbers, occurrence of AIDS criteria and death, were determined. Forty three patients, 31 male and 12 female, with an average age of 39.6 were selected. The most common finding on initiation of treatment in these patients was wasting syndrome (16.3%). Overall, treatment failure occurred in 37.2%. Mean time to treatment failure was 13.3 months. There was correlation between baseline CD4 and survival of patients with history of monotherapy (P

This study explored the prevalence and related risk behaviors for hepatitis C (HCV), hepatitis B (HBV), and human immunodeficiency virus (HIV) among a sample of male injection drug users (IDU) in Arak, Iran. One hundred male IDU attending methadone maintenance clinics between April and September, 2012 were enrolled and evaluated for HCV, HBV, and HIV infection. The majority of study participants (56%) had evidence of HCV exposure, 6% had evidence of HBV, and 19% were HIV-infected. Co-infections were frequent; 15% had evidence of HIV and HCV, 6% had evidence of HBV and HCV, and 5% had serologic markers for all three infections. Most (84%) were susceptible to HBV infection. A history of any syringe sharing (54%) and syringe sharing in prison (25%) were common. In bivariate analyses, a history of any syringe sharing and syringe sharing in prison were both associated with all three viral infections. The high prevalence of HCV, HBV, HIV, and co-infections among IDU in Arak is concerning and indicates rapid disease spread outside of Iran’s main urban centers. Prevention efforts should expand vaccination for IDU who are non-immune to HBV and continue to target syringe sharing with efforts such as needle exchange programs, including inside prisons.

Iran is one of the endemic regions with high prevalence of brucellosis. Several serological markers for diagnosis and response to treatment are available. Serum level of Soluble Interleukin-2 Receptor alpha (SIL-2Ralpha) is a new marker to assess response to therapy and clinical relapse of brucellosis. This study intends to investigate the serum levels of SIL-2Ralpha before and after treatment, to evaluate this marker for patients responding to treatment of brucellosis.This study is an analytical cross-sectional study. Forty patients who had clinical signs of brucellosis and serological tests confirmed the disease have been treated with standard antibiotics for 6 weeks. 2ME and SIL-2Ralpha levels were measured before and after treatment and these values were compared.Among the 40 patients, 27 patients (67.5%) had improvement in symptoms and 13 patients (32.5%) had no symptoms after treatment. In Comparing serum levels of SIL-2Ralpha and 2ME before and after treatment, decreasing of both markers after treatment was significant (p0.001). In patients with false positive for 2ME, SIL-2Ralpha in 57% of patients had a reduction, but in patients with false negative for 2ME, SIL-2Ralpha in only 28% of patients increased.Not only is Serum level of SIL-2Ralpha useful for predicting response to treatment of brucellosis, but also in cases of false positive of 2ME can be helpful.

Recent studies have shown a positive correlation between Helicobacter pylori (H. pylori)infection and migraine headache.To study the impact of H. pylori eradication on migraine headache.Double blind, randomized, controlled clinical trial.Sixty-four patients diagnosed with migraine-type headache were included in the study. The patients were randomly allocated into 2 groups: a treatment group that received migraine treatment and H.pylori eradication treatment, and a control group that received migraine treatment and a placebo in place of H. pylori eradication treatment.There were 25 women and 7 men in the treatment group and 22 women and 10 men in the control group. The MIDAS (Migraine Disability Assessment) questionnaire was used to assess the severity of symptoms, before and after treatment.There was no significant difference between treatment group patients and control group patients with respect to age (44.6 ± 8.8 vs. 43.8 ± 13.8), clinical symptoms and signs. In the beginning of the study, patients in the treatment group had a higher MIDAS compared to patients in the control group (28.87 ± 6.18 vs. 25.43 ± 7.13, P0.05). There was no significant difference between the treatment and control groups, with respect to the MIDAS, after treatment (20.09 ± 1.14 vs. 20.00 ± 1.150, P = 0.5). General linear model, repeated measures demonstrated that the reduction in the MIDAS score was more prominent in the treatment group (Mean Square 164.25, F: 2.02, P = 0.05).Short-term follow up.H. pylori eradication may have a beneficial role on migraine headache. This shows the significance of H. pylori treatment in the management of migraine headache among Iranian patients.

Background: Brucella is a well-known intracellular bacterium entailing acute and chronic illnesses in humans and domestic animals. The infection chronicity may be affected by the cell-mediated immunity and cytokine patterns. Objective: To evaluate the patterns of T-helper cytokines in patients suffering from chronic and acute brucellosis. Methods: In this cross-sectional study, 22 individuals with acute brucellosis, 21 individuals with chronic brucellosis, and 21 healthy individuals with the same genetic background were recruited from October 2015 to April 2016. Peripheral lymphocytes were isolated and stimulated by phytohemagglutinin (PHA) and brucella antigen in cell culture. The lymphocyte proliferation was detected by MTT assay. After collecting the supernatants, and through the use of ELISA method, we quantified the interferon gamma (IFN-γ), interleukin (IL)-5, IL-17 and transforming growth factor–beta (TGF-β). Results: Patients with chronic brucellosis had a lower level antigen-specific stimulation index compared to those suffering from acute brucellosis (p=0.0001). Cases with chronic brucellosis had a lower level of IFN-γ compared to cases with acute brucellosis (p=0.001). Finally, patients with chronic brucellosis had higher levels of IL-5 and TGF-β in comparison with the acute group (p=0.01 and p=0.04, respectively).Conclusion: Chronic brucellosis reduces lymphocyte proliferation and TH1 cytokine secretion, but it enhances IL- 5 and TGF-β production. Polarizing the immune responses plays a crucial part in the progression and development of chronic diseases.

Background: Sepsis is a rapidly progressive and life-threatening syndrome. It is defined as a systemic inflammatory response syndrome (SIRS). In order to achieve acceptable clinical outcomes and reduce mortality and morbidity associated with sepsis, accurate and timely diagnosis of this syndrome is very important. The aim of this study was to evaluate the validity of one of the most common tests used in the diagnosis of sepsis (blood culture) with SIRS in teaching hospitals in Arak, Iran. Methods: In this analytical study, 289 patients who had been admitted to teaching hospitals in Arak and consented to participate were evaluated. Patients were only included if they had received intravenous antibiotics for less than 24 hours and their blood culture was performed during the past 24 hours. The results of blood cultures were evaluated in two groups of SIRS+ and SIRS-. The sensitivity and specificity of the test were then determined. Findings: Of 289 studied samples, 215 (74.6%) patients were SIRS+ and 74 (25.6%) were SIRS-. In cultured samples, 29 (10.03%) were positive but only 6.9% were true positive. However, 3.1% of the samples were contaminated. The sensitivity and specificity of blood culture were 9.3% and 87.84%, respectively. Conclusion: According to the importance of accurate and timely diagnosis of sepsis and low sensitivity of blood culture, it seems that decision making based on clinical symptoms and testing indications and standards is essential. Keywords: Blood culture validity, Blood culture, Sepsis, Systemic inflammatory response syndrome

One of the fundamental issues of infectious disease treatment is drug resistance. The aim of the present study was to investigate the first-line anti-tuberculosis drug resistance rates and determine the risk factors related to multidrug resistant mycobacterium tuberculosis.From March 2011 to September 2012, mycobacterial strains were collected from one hundred fifteen diagnosed smear positive patients in the central province of Iran and tested for drug susceptible against ethambutol, rifampicin, isoniazid and streptomycin and the risk factors influencing the development of drug resistance were determined.The mean age of patients was 52.23±19.75 years. The rate of multi-drug resistant tuberculosis (MDR-TB) was 7.8%. Our study revealed that there were significant associations between prior treatment, age45 years, positive smear result at the end of the second month and positive smear result at the end of the third month. However, there was no association found between gender, inhabitant, nationality, close contact with TB patient, HIV infection and size of mantoux test.The results show that about 8% of TB cases in Arak are MDR TB. The age under 45 years, previous TB treatment and positive smear at the end of the second and third months of treatment were the main factors in the development of MDR-TB.

Introduction: Tuberculosis is an old disease that today becomes a re-emerging disease. AIDS,immigration and drug resistance have caused the change of the epidemiology of tuberculosis duringthe recent years. The aim of this study was to examine epidemiology of tuberculosis (TB) in Arak(Iran) during 1998-2008.Materials and Methods: This is a descriptive study based on the recorded epidemiologicinformation of TB patients in the health centers of Arak city during 10 recent years. At the first aquestionnaire was completed for each TB patient; based on his/her epidemiologic informationrecorded by the experts of Arak health centers.Results: Total number of TB patients in Arak city between the years 1998 and 2008 was 789persons. The most frequent number of patients was in the year 1999 and the least was in 2007. Amongthem, there were 301 men and 488 women. The mean of patient’s age was 52.91. 1% had jailexperience and 0.4% also suffered from AIDS, 68.1% suffered from pulmonary TB and 31.6%suffered from intrapulmonary TB. The outcome of treatment is as following: 86.2%were cured. Therewas 18.4% death due to TB and 1.4% death due to other reasons. Also, there were 1.4% transferred,0.5% interrupted treatment and 15% failure treatment.Conclusion: Although it seems that the incidence of disease has decreased, but this decrement isnot significantly different. AIDS has no significant effect on the epidemiology of tuberculosis inrecent ten years. According to our findings, declining the successful treatment and raising the rate ofdeath due to TB shows the necessity of better patient finding, early diagnosis and perfect cure.