Lokendra Dave

Clinical profile of patients having pulmonary tuberculosis and renal amyloidosis.

Objectives: This study was planned to define the clinical profile of pulmonary tuberculosis (PTB) patients having renal amyloidosis, to identify the factors responsible for development of amyloidosis, to detect the time period between onset of amyloidosis and PTB, and analyze clinical features of amyloidosis in PTB patients for early diagnosis and timely assessment. Materials and Methods: Patients of PTB having pedal edema, proteinuria, and grossly diseased kidneys on ultrasound abdomen were subjected to renal biopsy and appropriate biochemical investigations. Clinical profile of biopsy proven amyloidosis cases was analyzed. Results: There were 43 patients (32 males, 11 females, age range 20–65 years) having PTB with pedal edema, proteinuria, and renal medical disease on abdominal ultrasound where amyloidosis was confirmed by renal biopsy. The total duration of illness ranged from two months to seven years (mean 2.25 years) and was less than five years in 93% patients. All patients had significant proteinuria. Nephrotic syndrome was seen in 23, hypertension in 19, hypoalbuminemia in 33, hypercholesterolemia in 29, and deranged renal functions in 32 patients. Ninety percent patients had moderate to far advanced pulmonary lesions on chest radiography with smear positivity in 21 patients. Conclusions: Renal amyloidosis is an important complication of PTB and should be suspected clinically in patients presenting with a triad of pedal edema, proteinuria, and medical renal disease on ultrasound. Contrary to general belief, renal amyloidosis may occur in PTB patients having disease for relatively shorter duration, and even if adequately treated.

Diphenylhydantoin (phenytoin)-induced chronic pulmonary disease.

Drug-induced respiratory diseases are difficult to diagnose and therefore usually not identified, probably underestimated and under-reported. We report a case of diphenylhydantoin/phenytoin-induced chronic pulmonary disease in a 62-year-old male patient presenting with progressive dyspnea, eosinophilia, and pulmonary abnormalities. The importance of drug history in clinical history-taking and early diagnosis of drug-induced respiratory diseases is emphasized so as to prevent permanent pulmonary damage.

Biphasic pulmonary blastoma: An unusual presentation with chest wall, rib, and pleural involvement

1. Ardic I, Yarlioglues M, Celik A, Kaya MG. Vanishing or phantom tumor of the lung. Tex Heart Inst J 2010;37:730‐1. 2. Haus BM, Stark P, Shofer SL, Kuschner WG. Massive pulmonary pseudotumor. Chest 2003;124:758‐60. 3. Kim JH, Cho JH, Park MS, Chung JH, Lee JG, Kim YS, et al. Pulmonary inflammatory pseudotumor: A report of 28 cases. Korean J Intern Med 2002;17:252‐8. 4. Kataria YP, Khurshid I. Adenosine deaminase in the diagnosis of tuberculous pleural effusion. Chest 2001;120:334‐6.

A study on prevalence of diabetes and associated risk factors among diagnosed tuberculosis patients registered under Revised National Tuberculosis Control Programme in Bhopal District

Context: Tuberculosis (TB) and diabetes mellitus (DM) remains a worldwide global public health problem. About 95% of patients with TB live in the low and middle-income countries and more than 70% of patients with DM also live in the same countries, especially in South East Asia. Screening for diabetes in patients with TB will not only ensure early case detection but also better management of diabetes and will lead to better TB treatment outcome. Aims: This study aims to determine the prevalence and its associated factors of diabetes and prediabetes among diagnosed cases of TB patients registered under Revised National Tuberculosis Control Programme (RNTCP) in Bhopal city. Settings and Design: The current study was a longitudinal follow-up study conducted among registered TB patients under RNTCP in all 5 TB units of Bhopal District. Subjects and Methods: Participants were contacted and interview was conducted after obtaining consent using predesigned and pretested Performa during October 2013–September 2014. Statistical Analysis Used: Continuous variable were summarized as frequency, mean, and standard deviation. All variables were analyzed using Chi-square test of significance; P < 0.05 was taken as statically significant. Results: Out of the total 662 TB patients, 352 were male and 310 were female. Out of the total, 82 (12.39%) patients were diagnosed as diabetic and 108 (16.3%) were prediabetic. significant association found with six variables which are age, sex, body mass index, type of TB, Category of TB, and smoking. Conclusion: This study shows feasibility and importance of screening of TB patients.

Stevens Johnson syndrome due to nevirapine

Adverse drug reactions continue to be among the important cause of morbidity and at times mortality among hospital admissions. The severity of cutaneous adverse drug reaction may vary from mild rashes to severe Stevens Johnson syndrome (SJS). Nevirapine (NVP) is an important component of antiretroviral therapy for patients having acquired immunodeficiency syndrome. It usually cause mild rash in some of these patients. This report describes a case of NVP induced SJS that was reversible on withdrawal of the drug. Possible mechanisms of NVP induced SJS and its clinical implications are also briefly discussed.

Massive haemothorax in asymptomatic pseudocyst pancreas.

The case of a 35-year old man who presented with massive left sided haemothorax as a complication of an asymtomatic pancreatic pseudocyst is descibed. The diagnosis was confirmed by very high amylase content of the pleural fluid. The complications of pancreatitis and pancreatic pseudocyst are also briefly discussed. Haemothorax represents an unusual pulmonary complication of pseudocyst pancreas and should be considered in the differential diagnosis of pleural fluid collection in pancreatitis.