Darshan Kumar Bajaj

Tip of nose tuberculosis: A rare presentation of extra pulmonary tuberculosis

Tuberculosis is notorious that it affects various sites of the human body and presents in different ways. One of the uncommon or rather rare presentation of extra pulmonary tuberculosis is nasal tuberculosis. The nose apart from its physiological functions also contributes to facial aesthetics and gives a defined appearance and its deformity imparts cosmetic disfigurement and unsightly appearance. Both primary and secondary forms of nasal tuberculosis are rare but should be considered in the differential diagnosis of ulcerative or crusting lesions of the nose. Here we report such a case of nasal tuberculosis, which presented as an ulcerative and crusting lesion over the tip of the nose in a female child. The patient was given antituberculous chemotherapy after establishing the diagnosis and responded well to treatment.

Incidental case of left lung hypoplasia in a postabortal young female

Congenital malformations of the lung are extremely rare with an incidence of pulmonary hypoplasia around 1–2/12,000 births. Boyden has categorized three degrees of malformation including (i) agenesis in which there is complete absence of the lung and bronchus and no vascular supply to the affected side, (ii) aplasia in which there is the presence of rudimentary bronchus with the absence of pulmonary parenchyma, and (iii) hypoplasia in which there are variable amounts of bronchial tree, pulmonary parenchyma, and supporting vasculature. Here, we present an incidental case of pulmonary hypoplasia in a young female.

Multiple abdominal abscesses – A not so common presentation of NTM

Non-tuberculous Mycobacteria/Mycobacterium other than tuberculosis (MOTT) are ubiquitous organisms. They are acid fast bacilli often giving trouble to the physician to distinguish it from Mycobacterium tuberculosis. These organisms are a menace for the treating physician as when to treat and when not to treat. They are often difficult to diagnose and may present in a variety of forms with propensity to cause number of infections of different body parts and organs. They are more common in immunocompromised individuals e.g. HIV infection. Here we are reporting a not so common manifestation of NTM which presented as multiple abdominal abscesses in a middle aged female probably secondary to surgical site infection, however she responded dramatically to the designed treatment.

Two cases of eyelid tuberculosis – An uncommon presentation of ocular tuberculosis

Mycobacterium tuberculosis apart from being the causative agent of pulmonary tuberculosis is also notorious to cause tuberculosis at various sites in the human body and ocular tuberculosis is one of the extra pulmonary manifestations of this organism. The most common presentation of ocular tuberculosis is anterior uveitis or choroiditis caused by hematogenous infection or hypersensitivity after another organ infection. Eyelid involvement by tuberculosis is most of the times secondary to orbital involvement and often seen in the form of drainage sinus. Isolated eyelid tuberculosis is however uncommon. Here we report two such cases of eyelid tuberculosis in different age groups; first case in a young female and second case of an old aged female with different presentation. Fortunately both of them responded well to the antitubercular treatment.

Obstructive sleep apnea risk for driving license applicants in India – A community based study

OBJECTIVES To determine the risk of obstructive sleep apnea (OSA) for male permanent driving license (DL) applicants of Lucknow, India. MATERIAL AND METHODS In this cross-sectional community based, study body mass index, waist-hip ratio, blood pressure of each subject were determined as an anthropometric parameter along with the history of habit of smoking, tobacco chewing, alcohol consumption. STOP-Bang (Snoring, Tired or sleepy, Observed apnea, high blood Pressure, Body mass index, Age, Neck, Gender) Questionnaire - a scoring risk assessment tool - was applied for assessment of OSA risk (high OSA risk defined by score ≥ 3) for 542 male DL recipients at 2 Regional Transport Office (RTO) centers in Lucknow, India. The statistical software SPSS 17.0 was applied to the testing. RESULTS In total 23% (N = 125) of participants were found with the risk of OSA. High blood pressure (≥ 140/90 mm Hg) was found for the maximum number of participants (40.5%) followed by neck circumference > 40 cm (17.1%), age (> 50 years old) (15.3%), snoring (12.3%) and tired/sleepy (10.5%). Mean values of age, anthropometric measurements and blood pressure were observed significantly higher (p < 0.001) for participants with the OSA risk. In this population the risk of OSA risk (STOP-Bang score ≥ 3) was observed for 6.7% of young (< 35 years old), 34% of middle (35-45 years old) and 73% of elder age adults (> 45 years old). CONCLUSIONS In view of findings of this study a high number of male driving license applicants were observed with the risk of OSA. Therefore efforts should be made to develop a national screening guideline/protocol for the OSA risk assessment for driving license applicants in India. This may reduce the possibility of road traffic accidents due to the OSA-associated fatigue and drowsiness behind the wheels. Int J Occup Med Environ Health 2018;31(1):25-36.

Prospects of mandibular advancement device (MAD) as a preferred treatment of obstructive sleep apnea in India: a systematic review

Obstructive sleep apnea (OSA) is an independent risk factor for increased cardiovascular and cerebro-vascular morbidity and mortality. OSA leads to loss of human life and huge economical burden to our Society worldwide. The adults prevalence of OSA ranges between 9.3-13.5% in India. India is the second largest populated country of the world and by the end of 2030 it may become the most populated nation. This developing nation is already known as the worlds capital of T2 DM, and other non-communicable diseases like Obesity, Hypertension, Stroke, Ischemic heart diseases (IHD), Hypercholesterolemia congestive heart failure are on a rising trend. These cardiovascular disorders were found to be associated with OSA. OSA treatment may improve these co-morbid conditions. Continuous positive airway pressure (CPAP) is a preferred choice for OSA treatment in western and developed countries. In India, where CPAP is out of the reach of most of the OSA affected population due to high cost and other socio-economic and cultural factors, MAD may become a preferred treatment option. MAD is cheaper than CPAP and generally equally effective. The patients suffering from sleep-related breathing disorder (SBD) may have an alternative to CPAP or surgery for their disease management. Mandibular Advancement Device (MAD) may become an additional standard treatment of OSA in India, and has great potential for reducing associated undesirable cardiovascular co-morbidities and mortalities. This review highlights the prospects of MAD as a preferred treatment of Obstructive Sleep Apnea in India by extensively researching scientific literature, PubMed, Google Scholar, scientific, and academic web portals.

Pulmonary artery pseudoaneurysm: An uncommon fatal complication associated with tubercular empyema

Vascular sequelae in the thorax because of tuberculosis (TB) involve the pulmonary as well as bronchial vasculature. Tubercular empyema-associated pulmonary artery pseudoaneurysm is a sparsely reported clinical entity in the literature. We report a rare case of pulmonary artery pseudoaneurysm associated with tubercular empyema in a patient. However, the patient died after intercostal drainage, because of massive hemoptysis followed by refractory shock, before any intervention could be done for the aneurysm.