Isolated pulmonary cavitary mucormycosis in uncontrolled diabetic, diagnosed by fiber-optic bronchoscopy and completely managed medically

Pulmonary mucormycosis is rare life‐threatening infection affecting mostly immunocompromised individuals such as diabetes mellitus, hematological malignancies, chronic renal failure, post transplantation etc. Based on the anatomic site involved, mucormycosis can be one of several forms, such as rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon presentations that include endocarditis, osteomyelitis, peritonitis, and renal infection. Pulmonary infection is the most common form of mucormycosis recognized in patients with hematological malignancy and remains the second most common presentation after rhinocerebral infection in diabetic patients. Its presentation in the lungs may mimic cavitary diseases like tuberculosis, mass lesions as in malignancies and non-resolving pneumonias. Here we report a case of isolated pulmonary mucormycosis in an uncontrolled diabetic male patient with a cavitary lesion. Diagnosis was made with a bronchoscopic biopsy and treatment was completely medical with liposomal amphotericin B

Presentation of pulmonary tuberculosis in diabetics and response to anti-tuberculosis therapy

Background: Diabetes and Tuberculosis are known to be mutually affective. In high tuberculosis and Diabetes burden country like ours, it is essential that we understand all the aspects concerning both these diseases individually and in mutual coexistence, in order to improve the management of this unhealthy partnership.Methods: This is a prospective hospital based observational study, in which 100 patients with coexisting Diabetes and new sputum confirmed pulmonary tuberculosis with no other comorbidities were included. Detailed history, examination and appropriate investigations were done evaluating the clinical and radiological presentation and treatment response in terms of sputum conversion at follow up visits.Results: Predominant symptoms were anorexia, fever and cough with sputum, majority with duration of more than 4 weeks. About half of them had diabetes duration of less than 1 year, most being newly diagnosed. All cases had upper lobe involvement; two thirds of them had lower lung field and multiple lobe involvement. Confluent consolidation, cavitary lesions and fluffy infiltrates were common. 27 of the 100 cases had a delayed sputum conversion. Longer duration of diabetes, maintenance on oral hypoglycaemic drugs alone and uncontrolled diabetes had delayed sputum conversion.Conclusions: Presenting symptoms of tuberculosis in diabetics is more or less similar to that in non-diabetics. Atypical radiological presentation with lower lung field involvement and confluent consolidation mimicking pneumonia is common. Delay in sputum conversion is common in dual disease and is increased with increasing DM duration and poor glycemic control. Better results may be obtained with insulin therapy

A clinical trial for evaluation of leech application in the management of Vicarcikā (Eczema)

Background: Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. Eczema is such a skin ailment which cause psychological, social and financial burden on the patient and their families. Management of eczema with antibiotics, antihistamines, steroids etc., are available but even after their use relapses, recurrences and other complications are very common. Aim : The aim of this study was to assess the efficacy of leech application in the management of vicarcikā0 (Eczema) with standard clinical parameters viz. Eczema Area and Severity Index (EASI) score, SCORing of Atopic Dermatitis (SCORAD) Index and Dermatology Life Quality Index (DLQI). Materials and Methods : An open labeled clinical trial study without control group was conducted with 27 patients having the classical symptoms of vicarcikā (Eczema), selected as per the inclusion and exclusion criteria from outpatient department and inpatient department sections of Shalya Department, S.V. Ayurvedic Hospital, Tirupati. Minimum four sittings of leech application were carried out with 7 days interval. Pre- and post-treatment evaluation of the patient was done with Eczema Area and Severity Index (EASI) score, SCORing of Atopic Dermatitis (SCORAD) Index and Dermatology Life Quality Index (DLQI). Statistical Analysis : Analysis of the data was done with Student′s paired t-test. Results : The total EASI score showed considerable reduction up to 54.45% (P < 0.01) and the SCORAD Index significantly reduced by 55% (P < 0.01). The life quality of the patient calculated by DLQI improved significantly by 62.36% (P < 0.01). Conclusion : Leech application gives significant relief for the symptoms of eczema. The life quality of the patient also improved significantly after leech therapy. No adverse reactions were reported during the entire course of study