Mohan K Manu

Protective effect of metformin against tuberculosis infections in diabetic patients: an observational study of south Indian tertiary healthcare facility

BACKGROUND World Health Organization estimated that people with diabetes (DM) are at 2-3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes. OBJECTIVES To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB. METHODS A case-control study was conducted over 8 months, where cases and controls were selected based on the inclusion and exclusion criteria of the study. The diabetics diagnosed with TB were selected as study group (SG=152) and without TB were as control group (CG=299). Exposure status of metformin in both groups were analyzed. RESULTS The mean (SD) age of both CG and SG were 55.54±11.82 and 52.80±11.75, respectively. Majority of the subjects in the study were males. The mean hospital stay of SG and CG were 7 days and 6 days, respectively. Poor glycemic control (HbA1c>8) observed in SG (51.7%) vs CG (31.4%). HbA1c value <7 is associated protective factor for TB occurrence [OR=0.52 (95% CI 0.29-0.93)]. The protective effect of metformin against TB was 3.9-fold in diabetics (OR=0.256, 0.16-0.40). CONCLUSION Poor glycemic control among diabetics is a risk factor for TB occurrence. The result shows metformin use is a protective agent against TB infection in diabetics. Hence, incorporation of metformin into standard clinical care would offer a therapeutic option for the prevention of TB.

Influence of Pseudomonas aeruginosa on exacerbation in patients with bronchiectasis

Background: A majority of the studies done on the western population have shown that Pseudomonas aeruginosa causes many severe infections in patients with bronchiectasis as compared to other pathogens. There is scarcity of similar data from the Asian population. Materials and Methods: A prospective study was undertaken to identify the various pathogens isolated from the respiratory samples of 117 patients with bronchiectasis from south India and to compare the clinicomicrobiological profile of infections caused by P. aeruginosa and other respiratory pathogens. Results: The respiratory pathogens were isolated from 63 (53.8%) patients. P. aeruginosa was the most common isolate (46.0%) followed by Klebsiella pneumoniae (14.3%) and other pathogenic bacteria. Patients included in the P. aeruginosa group had a higher number of exacerbations (p: 0.008), greater number of hospital admissions (p: 0.007), a prolonged hospital stay (p: 0.03), and poor lung function, compared to the patients infected with the non-Pseudomonas group. Conclusion: It is necessary to investigate the etiology of respiratory tract infections among bronchiectasis patients followed by the prompt management of cases diagnosed with P. aeruginosa infections, so as to lower the morbidity and have a better prognosis.

Rifampicin-induced lichenoid eruptions

A 65-year-old man presented with generalised pruritic skin lesions of 1 month duration. He had a positive pulmonary tuberculosis smear and was on antituberculosis therapy, which included isoniazid, rifampicin, ethambutol and pyrazinamide, for 1 month. His medical history was otherwise unremarkable. He had no significant skin ailments or allergic tendencies in the past. General physical examination revealed multiple erythematous, pruritic eruptions over the patients back (figure 1), anterior chest and arms. Haemogram showed marked peripheral eosinophilia (26.8%) with an absolute eosinophil count of 3042. The rest …

Ortner’s syndrome

A 42-year-old man with a significant smoking history presented with chronic expectorative cough and exertional shortness of breath with recent-onset hoarseness. Chest examination was essentially normal and cardiovascular examination was suggestive of aortic regurgitation. Ears, nose and throat evaluation showed left vocal cord palsy and CT scan revealed an aortic arch aneurysm. Ortners syndrome refers to hoarseness due to recurrent laryngeal nerve palsy secondary to a cardiovascular abnormality. Aortic aneurysms usually present with chest pain, back pain or epigastric pain, depending on the site of the aneurysm. An aortic arch aneurysm presenting as hoarseness is extremely rare.

Herniation of unruptured tuberculous lung abscess into chest wall without pleural or bronchial spillage.

A 22-year-old unmarried man presented to the chest outpatient department with a history of productive cough of two-month duration. He also complained of pain and swelling on the anterior aspect of right side of chest of one-month duration. Imaging studies of the thorax, including chest roentgenography and computerized tomography, revealed an unruptured lung abscess which had herniated into the chest wall. Culture of pus aspirated from the chest wall swelling grew Mycobacterium tuberculosis. He was diagnosed to have a tuberculous lung abscess which had extended into the chest wall, without spillage into the pleural cavity or the bronchial tree. Antituberculosis drugs were prescribed, and he responded to the treatment with complete resolution of the lesion.

Image guided biopsy of the pleura: a useful diagnostic tool even when fluid is minimal

A man in his late thirties presented with left-sided chest pain, recurrent fever and cough. Radiographical study revealed left pleural effusion which on ultrasonic imaging was minimal and non-tappable. Image guided trucut pleural biopsy yielded pleural specimens which helped in confirming the diagnosis of tuberculosis.

Chryseobacterium indologenes pneumonia in a patient with non-Hodgkin's lymphoma.

A 42-year-old man diagnosed with gastric non-Hodgkins lymphoma 2 years earlier, for which he had undergone treatment, presented with expectorative cough, exertional shortness of breath and left-sided chest pain of 3 months duration. Respiratory system examination was suggestive of left-sided pneumonia with pleural effusion. Routine haemogram showed leukocytosis with high erythrocyte sedimentation rate. Chest radiograph showed blunting of left-sided cardiophrenic angle. Sputum culture grew Chryseobacterium indologenes. Diagnostic thoracocentesis was suggestive of lymphomatous metastasis. Pleural fluid culture was sterile. Contrast-enhanced CT (CECT) of the thorax showed left lower lobe consolidation with bilateral pleural effusion. The patient was treated with antibiotics, following which his cough improved and total leukocyte count normalised. Sputum culture repeated after the antibiotic course showed no growth of C. indologenes. However, the pleural effusion soon aggravated along with features suggestive of multiple metastasis. The patient finally succumbed to his underlying advanced malignancy.

The effect of 6 months or longer duration of chronic obstructive respiratory disease medication on the oral health parameters of adults: COPD MEDICATIONS AND ORAL HEALTH

The objectives of this study were to study the effect of COPD medication of 6 months or more duration on oral health parameters of adult patients. A cross-sectional study was conducted to assess and compare the decayed, missing, and filled teeth (DMFT), oral hygiene index-simplified (OHI-S), periodontal disease index (PDI) scores, and presence of candida (colony-forming units [CFU]) among adult patients aged 20-45 years who had a history of 6 months or longer duration usage of chronic respiratory disease medications, with controls. A total of 170 participants each were taken in both the groups. Oral health parameters like DMFT scores (p ≤ 0.002), OHI-S (p ≤ 0.001), calculus scores (p ≤ 0.001), plaque scores (p ≤ 0.001), and CFU/ml of candida species (p ≤ 0.001) were higher among cases than controls. DMFT scores and candida presence were significantly higher among those whose treatment duration was greater than 5 years as compared to those with lesser duration. Gingival-periodontal component scores of PDI were lower among cases than controls (p ≤ 0.001). Our findings suggest the need for regular oral health maintenance for those under COPD treatment and for greater research into the possible protective role of inhaled corticosteroids in limiting periodontal disease among patients.

Tuberculous lymphadenitis and borderline leprosy in a patient with isolated unconjugated hyperbilirubinaemia

A 35-year-old man was diagnosed with tuberculous lymphadenitis and multibacillary borderline tuberculoid leprosy. On investigation, isolated unconjugated hyperbilirubinaemia was detected and evaluation led us to conclude that the probable cause was Gilberts syndrome. He was successfully managed by administration of chemotherapy for the treatment of both the mycobacterial infections, with no adverse effects on liver function tests.

A rare case of coexisting left pulmonary hypoplasia and right tracheal bronchus

A 23-year-old woman presented with a 10-year history of recurrent breathlessness and cough. Her medical history was unremarkable except for asthma, which was under control. General physical examination was normal. A respiratory system examination revealed mediastinal shift to left with features of volume loss of the left hemithorax. Breath sounds were reduced and a dull percussion note was present over the left basal areas. Routine blood investigations were normal. Chest radiograph (figure 1) revealed mediastinal shift to left with volume loss of the left hemithorax and elevated left hemidiaphragm. Sputum Ziehl-Neelsen staining for mycobacteria and bacterial culture were negative. Contrast-enhanced CT (CECT) …