الفهرس 
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Abstract
This work aimed to discuss the effect of type 2 diabetes mellitus in clinical presentation, site, extension and outcome in pulmonary tuberculosis cases. In addition to the influence of type 2DM in incidence of pulmonary TB.
Patients were divided to 3 groups
group 1: patients with DM and pulmonary tuberculosis (50 patients)
group 2: patients with only pulmonary tuberculosis (50 patients)
group 3: patients with DM and no pulmonary tuberculosis (20 patients)
Patients admitted to El Mahalla chest hospital and Dots centers in it.
All patient subjected to the following
1-Meticulous history taking with special attention to:
• Personal history (age – gender –smoking – drug addiction).
• History of present illness.
• History of co-morbid disease.
• History of diabetes mellitus:
2- Complete clinical examination with special attention to:
• General examination.
• Chest examination.
3-Radiological investigation:
• Postero-anterior, lateral chest x-ray
• CT chest if needed.
4-Laboratory investigation:
• Complete blood count (CBC).
• Erythrocyte sedimentation rate (ESR).
• Fasting and two hours post-prandial blood sugar.
• HBA1c
• Liver functions: - S.G.P.T, S.G.O.T., Total proteins, Albumin.
• Renal functions: Serum creatinine, Blood urea.
• Sputum examination: direct smear examination using Ziehl-Neelsen stain (3 sputum samples).
• HIV testing (rapid test).
-All diabetic patients with or without type2 DM (70cases) divided according to their HbA1c to 3 groups
• Good controlled with HbA1c (5.5-6.7) %
• Fairly controlled with HbA1c (6.8-7.6) %
• Poor controlled with HbA1c (>7.6) %
- All prospective cases have followed up for smear conversion in six months.
- The first sputum examination was after 2 months.
- Most of DMTB cases were still on treatment with the end of study.
- In this study there was difference between DMTB group and TB group according to age with mean 53.36 years and 38.84 respectively.
- In this study there were no differences in special habits between DMTB group and TB group.
- There were no differences between DMTB cases and TB cases in the clinical presentation.
- There were no differences between DMTB cases and TB cases in the distribution of lesion.
- The study suggested atypical radiological presentation in presence of more than Type of lesion in the same radiological film, and presence of extra pulmonary pleural extension in DMTB group which not evident in TB group.
- The study suggested delay in smear conversion and delay response in DMTB group with no other effect in the outcome which not related to glycemic state of the patients.
- The study showed differences in blood glucose profile between DMTB group and TB group indicate the hyperglycemic state in DMTB group.
- The study showed no differences in the CBC and ESR values between DMTB group and TB group.
- The study included predominance of males in DMTB group versa predominance in females in DM group.
- The study showed no difference in age between DMTB group and DM group.
- The study showed difference in weight between the DMTB group and DM group which may explained with the effect of TB in the BMI by its microbial activity and by increase hyperglycemic state.
- The study showed differences in the special habits between the DMTB group and DM group.
- The study showed no differences in glycemic state, or in co-exiting complication between DMTB group and DM group
- The study showed difference in the line of diabetic treatment which indicated poorly controlled on oral hypoglycemic agents, it is necessary to switch to insulin in DMTB cases. The choice of insulin regime should be based on efficacy, safety, tolerability and convenience.
- The study showed no differences in CBC except in platelets count which increased in DMTB group than DM group due to presence of infection and significant elevation of thrombopiotein especially during acute phase.
- The study showed differences in ESR with bigger values in DMTB group rather than DM group which explained by presence of inflammatory process.
- The study suggested that type2 DM isn’t independent risk factors without other risk factors as smoking and exposure.