What happens when oral tuberculosis is not treated?

Pulmonary tuberculosis (TB) is the most important form of the disease, although infection may also occur by way of the intestinal tract, tonsils and skin. Oral lesions consist of persistent ulcers or granulomatous masses. A 50 year old man had been diagnosed “necrotising granulomatous inflammation” following a biopsy of a lesion on lower lip, 21 months before at a medical centre. A chest-X-ray had not been performed and he had not been given any advise in respect of treatment. He was admitted to the hospital with cough, sputum, weakness, weight loss and lesions on his lower lip. In radiology, it was detected that he had supraclavicular, submental, cervical, mediastinal lymphadenopathies, pulmonary infiltrations with cavities, thickening and roughness on left oropharengial tonsil, thickenning on inner parts of larynx and bilateral surrenal thickening. The biopsy of lesions on larynx, tonsil and epiglottis revealed “necrotising granulomatous inflammation” and histopathology supported TB infection. Sputum acid-fast bacilli was positive and culture was positive for Mycobacterium tuberculosis complex. Two months of combination treatment resulted in a gradual relief of the symptoms, radiological response, disappearing of neck swelling and healing of lesions on lip, tonsil and larynx. Although unusual oral cavity manifestations of TB are rare, clinicians should be aware of possible occurrance

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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COPD patients with severe diffusion defect in carbon monoxide diffusing capacity predict a better outcome for pulmonary rehabilitation

Purpose: The aim of this study was to compare the effects of pulmonary rehabilitation (PR) on six-minute walk test (6mWT) between chronic obstructive pulmonary disease (COPD) patients with moderate or severe carbon monoxide diffusion defects. We also evaluated dyspnea sensation, pulmonary functions, blood gases analysis, quality of life parameters and psychological symptoms in both groups before and after pulmonary rehabilitation. Methods: Patients with COPD underwent a comprehensive 8-week out-patient PR program participated in this study. Patients grouped according to diffusion capacity as moderate or severe. Outcome measures were exercise capacity (6mWT), dyspnea sensation, pulmonary function tests, blood gases analysis, quality of life (QoL) and psychological symptoms. Results: A total of 68 patients enrolled in the study. Thirty-two (47%) of them had moderate diffusion defect [TlCO; 52 (47â61) mmol/kPa] and 36 (53%) of them had severe diffusion defect [TlCO; 29 (22â34) mmol/kPa]. At the end of the program, PaO2 (p = 0.001), Modified Medical Research Council dyspnea scale (p = 0.001), 6mWT (p < 0.001) and quality of life parameters improved significantly in both groups (p < 0.05). Also the improvement in DlCO (p = 0.04) value and FEV1% (p = 0.01) reached a statistically significant level in patients with severe diffusion defect. When comparing changes between groups, dyspnea reduced significantly in patients with severe diffusion defect (p = 0.04). Conclusion: Pulmonary rehabilitation improves oxygenation, severity of dyspnea, exercise capacity and quality of life independent of level of carbon monoxide diffusion capacity in patents with COPD. Furthermore pulmonary rehabilitation may improve DlCO values in COPD patients with severe diffusion defect. Keywords: 6-Minute walk test, Pulmonary rehabilitation, Pulmonary function tests, DLCO, Quality of life, Dyspne