Clinical features of diabetes in the young as seen at a diabetes centre in south India

This study reports on the clinical pattern of 545 consecutive young diabetic patients with age at onset below 30 years attending a diabetes centre in Southern India. Three hundred and fourteen patients (57.7%) were classified as having non-insulin-dependent diabetes of the young (NIDDY), 119 (22%) as insulin-dependent diabetes (IDDM) and 28 (5%) as malnutrition-related diabetes (MRDM); 4% fibrocalculous pancreatic diabetes and 1% protein-deficient pancreatic diabetes. The remaining 84 patients could not be classified into any of the above categories. A positive family history of diabetes was more common in NIDDY compared to the other groups (P less than 0.001). While 40.3% of patients with IDDM had age at onset below 15 years, the other types of diabetes were rarely seen in patients younger than this. Body mass index (BMI) did not reliably indicate the MRDM forms of diabetes as 70% of patients with IDDM also had a BMI of less than 18, one of the criteria recommended for the diagnosis of MRDM. C-peptide levels in MRDM were intermediate between the IDDM and NIDDY groups. Microvascular complications were present in all the groups of young diabetics. The frequency was higher in NIDDY patients who also had a longer duration of diabetes. There was an increasing prevalence of complications with increasing duration of diabetes.     

Clinical features at diagnosis in 430 patients with chronic myeloid leukaemia seen at a referral centre over a 16-year period

To determine major presenting features of chronic myeloid leukaemia (CML) in current practice, we have reviewed the records of 430 patients with CML referred to the Hammersmith Hospital for allogeneic bone marrow transplantation since 1981. Approximately 20% of cases were diagnosed incidentally. Symptoms such as fatigue and weight loss were associated with greater degrees of leucocytosis and splenomegaly and lower haemoglobin levels. Most bleeding patients had normal or elevated platelet counts, suggesting that platelet dysfunction was the primary cause of haemorrhage. Although thrombocytosis was common, thrombosis was not seen. Male patients and the relatively young presented with higher WBC counts and larger spleens. The reason that these groups were diagnosed with more advanced leukaemia is not clear. Although retrospective and limited to a select group of relatively young patients, this is the largest series to be reported on CML at diagnosis, and the first such report in modern clinical practice.     

HIV seropositivity among adult tuberculosis patients in Delhi

We report HIV seropositivity among tuberculosis patients from our hospital between 1994-99. Of the 500 patients with various forms of tuberculosis, two were found to be seropositive (0.4%). This report contrasts with the HIV seropositivity reports from other parts of India where increasing HIV seropositivity has been reported. As the HIV infection is making rapid in-roads in India, it is suggested that continuous HIV sero-surveillance should be done in patients with tuberculosis.     

Clinical features of abdominal tuberculosis

The clinical features of 81 cases of abdominal tuberculosis (TB) are presented. The peritoneum was involved in 41 patients, the ileocecal area in 17, the anorectal area in 16, and mesenteric glands in 8. There was one case each involving the liver and sigmoid colon. Most patients were young women. The tuberculin reaction was significant in 83% of patients tested, and 54% had evidence of TB elsewhere. Tuberculous peritonitis was more common in native North American Indians and presented as an acute abdomen, abdominal tumor, or cirrhosis. Asians developed the majority of ileocecal and mesenteric lymph node disease and were frequently diagnosed as having Crohn's disease, appendicitis, or cancer. Anorectal cases presented with fistulae or abscesses and usually had concomitant pulmonary TB. The disease was fatal in five patients (6%), four of whom were diagnosed only after death. One noncompliant patient had a relapse. All other patients were cured after receiving treatment.     

Clinical features of diabetic patients with pulmonary tuberculosis admitted to a university hospital

Diabetes mellitus (DM) is a risk factor of tuberculosis (TB). We studied the clinical presentation of pulmonary TB among patients with DM in comparison with patients without DM who were admitted into the hospital of the University of the Ryukyus from 2006 to 2010. The clinical data were collected from medical records retrospectively. Ten cases (25%) of hospitalized patients with pulmonary TB had DM. The DM group showed lower Body Mass Index and higher incidence of chronic heart failure and chronic renal failure. The DM group also were more likely to have cavitary lesion, had longer period of hospitalization, and higher mortality. Their causes of deaths were mainly the co-morbidities and associated complications. Further studies are warranted in order to fully elucidate the relationships between pulmonary TB and DM.     

156例肺结核患者临床及影像学特征回顾性分析

目的对156例肺结核患者临床及影像学特征进行分析。方法对2009年6月至2011年4月在安徽医科大学第二附属医院住院的156例确诊肺结核患者临床及影像学特征进行分析。结果 156例肺结核中咳嗽咳痰者114例;发热62例,咯血44例,胸痛胸闷61例;纳差盗汗乏力者33例;其他症状者14例。影像学表现位于两上肺者89例;右中叶者17例,左舌叶8例;两下肺者51例。片状渗出或干酪实变影136例;团片状或结节状增生63例;空洞37例;纤维条索影49例及钙化20例;间质样改变者7例。合并其他基础疾病者16例。结论肺结核临床及影像学特征呈多样性及不典型性趋势,临床需综合分析,减少误诊。     

Economic burden of tuberculosis in patients attending DOT centres in Delhi

Tuberculosis inflicts a negative impact on global socioeconomic prosperity. Though India carries one third of the global burden of the disease, few studies have focussed in the country on this aspect. The present study was therefore, framed to estimate economic loss amongst TB patients. A total of 156 patients attending two DOT centres were interviewed in depth, regarding economic loss due to tuberculosis, using a semi structured pretested interview schedule during a period of 5 months. More than 75% of the subjects belonged to the age group of 15-44 years of which 71.6% were males. 34.6% of patients were housewives and 10.9% were students. Mean expenditure before registration in DOT centre was Rs. 3385.5 irrespective of all socioeconomic classes. The upper lower socio-economic class of patients incurred maximum mean expenditure of Rs. 9782.0. Mean duration of wage loss was found to be 47.1 days. Study participants incurred economic loss both in terms of direct and indirect costs, more so in lower socio-economic group, besides delay in attending DOT centres for treatment. Awareness campaign focussing on treatment availability and DOT centre could help in reducing such economic loss.     

Clinical and radiographic features of pulmonary tuberculosis in non-AIDS immunocompromised patients.

SETTING: Department of Chest Diseases, Istanbul Faculty of Medicine, Istanbul University. OBJECTIVE: To determine the clinical and radiographic presentation of pulmonary tuberculosis in non-AIDS immunocompromised patients (ICP). DESIGN: A retrospective review of medical records of 143 patients (63 immunocompromised patients and 80 immunocompetent patients) with pulmonary tuberculosis from 1992 to 2001. RESULTS: In ICPs, fever was more frequently observed (84.1% vs. 40%, P = 0.0000002), tuberculosis was more frequently disseminated (23.8 vs. 3.8%, P = 0.0008), and lung infiltrations were more often lobar or segmental consolidation (20.6% vs. 0%, P = 0.00007) and miliary lesions (17.5 vs. 3.8%, P = 0.014) than in the control patients. Hilar and/or mediastinal adenopathy was also more frequently documented in ICPs (14.3% vs. 2.5%, P = 0.01). CONCLUSION: Fever, atypical chest radiograph and disseminated disease are common findings of pulmonary tuberculosis in ICPs.     

Clinical features of male genital tuberculosis in Uzbekistan

The clinical course of genital tuberculosis was studied in 126 males treated at the Phthisiourology Unit (in 1992-1997). Case histories of 505 more patients (in 1974-1988) were examined. It was ascertained that there was an increase in the incidence of this disease in an old age group (51-60 years) from 9.7% (1974-1988) to 21.4% (1992-1997) and a reduction in a young age group (31-40 years) from 33.1 to 22.2%, respectively. Most (92.8%) patients aged 21 to 60 years had the greatest manifestations of the disease at the present-day stage while those (92.5%) aged 21 to 50 years fell ill with this disease in 1974-1988. There was an increase in the incidence of fistulous tuberculosis of the male genitals from 8.7% (in 1974-1988) to 20.6% (in 1992-1997), which confirms altered pathomorphism and deteriorated epidemiological situation. The diagnostic minimum which may render a great assistance to general practitioners in timely recognizing the disease and referring patients with this disease to a specialized facility.     

Enrolment under of Nikshay Poshan Yojana among tuberculosis patients in a tertiary care hospital of Delhi

To mitigate malnutrition among tuberculosis burden, Government of India launched Nikshay Poshan Yojana in 2018, providing incentive of INR500 per month to each enrolled patient. Our study tried to find out the status of the scheme and its target benefits amongst the beneficiaries in a tertiary care hospital in Delhi, and also the facilitating factors and barriers towards enrolment, and their knowledge, attitude and practice towards nutrition in TB.MethodsA cross-sectional study was undertaken at a tertiary care hospital involving a calculated sample of 188 patients. The subjects were interviewed on a pre-designed, semi-structured, validated questionnaire and data was analysed on SPSS v.21.ResultsEnrolment rate for the scheme was 81.4%, of which only 10% of the participants received any benefit. Of the 35 participants who were not enrolled or were not aware of their enrolment status, 22 were interested in enrolment. The reason for non-enrolment by the 21 participants who were not enrolled were lack of awareness, lack of time or lack of a bank account.ConclusionThe study found that most of the patients attending DOTS treatment were enrolled under the scheme, but 90% were not receiving any incentive promised under it.