Screening patients with tuberculosis for diabetes mellitus in Ampara,Sri Lanka

Given the well-known linkage between diabetes mellitus (DM) and tuberculosis (TB), the World Health Organization recommends bidirectional screening. Here we report the first screening effort of its kind from a chest clinic in the Ampara district of Sri Lanka. Of 112 TB patients registered between January 2013 and October 2014, eight had pre-existing DM. Of those remaining, 83 (80%) underwent fasting plasma glucose testing, of whom two (2%) and 17 (20%) were found to have diabetes and impaired fasting glucose, respectively. All of these were enrolled in care. Screening TB patients for DM was found to be feasible at the district level. Further studies at the provincial/country level are required before making any decision to scale up bidirectional screening.     

Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study

Background  

Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008.     

Simulated torsional disparity disrupts horizontal fusion and stereopsis.

PURPOSE: To investigate how increasing torsional disparity affects clinical measures of the quality of binocular single vision. METHODS: Synoptophore targets were adjusted to present varying degrees of torsional disparity (relative to the fusion-free rest position of the eyes) such as might be observed in a patient with excyclotropia. This disparity was increased in 2 degrees increments up to 10 degrees in 21 normal subjects. The fusional divergence and convergence amplitudes and random-dot stereoacuity were measured at each level of torsional disparity. RESULTS: Horizontal fusional vergence was not significantly altered from the baseline measures at 2 degrees and 4 degrees of torsional disparity. However, both the divergence and the convergence amplitudes declined and were significantly different than the baseline measures at 6 degrees . A similar decline in the random-dot stereoacuity measurements was evident. Fine levels of stereopsis were decidedly affected at greater than 4 degrees of torsional disparity, while more gross levels were similarly affected beyond 6 degrees . CONCLUSIONS: Although human binocular vision can demonstrate the sensory capacity for cyclofusion beyond 10 degrees , torsional disparity of 6 degrees or more significantly degrades horizontal fusional vergence and stereopsis. Torsion in excess of this degree might therefore be a barrier to asymptomatic and comfortable binocular single vision and may require appropriate attention in the planning of more successful surgery for superior oblique palsy and cyclovertical incomitant strabismus.     

Coexistence of myelodysplastic syndrome and multiple myeloma

We describe the simultaneous presentation of myelodysplastic syndrome (MDS) and multiple myeloma (MM). Our patient had MDS (RAEB type) and bone marrow infiltration (40% plasma cells), as well as biclonal paraprotein. Patients with MM, MDS have been reported after chemotherapy but few cases documenting the coexistence of MDS and MM at diagnosis have been reported in the literature.     

Arrhythmias and conduction abnormalities in children after repair of tetralogy of Fallot

AIM: To find out types and frequency of cardiac arrhythmias and conduction abnormalities in the group of children who underwent surgery for tetralogy of Fallot (TOF). METHODS: Forty-six pedicatric patients who underwent a complete repair of TOF at the age of 1 to 13 (mean 2.89+/-2.36) were studied Thirty-eight (82.60%) had total correction and 8 (17.40%) had palliative operation first, and total correction afterwards. Twenty-four-hour Holter ECG monitoring was performed in all 46 pediatric patients aged from 1 to 16 yrs (mean 6.48+/-4.04) after surgery as follows: in 1 patient (2.17%) after a year, in 20 patients (43.477%) after 2 to 5 years and in 25 patients (54.34%) after 5 years. Mean age of patients on Holter monitoring was 9.25+/-4.39 (range 4-19). Twenty of them (43.47%) were girls and 28 (56.53%) were boys. All the patients were evaluated by standard methods (clinical signs, clinical findings, ECG before surgery, ECG before Holter monitoring and 2D Doppler echocardiography. RESULTS: Types of heart rhythm found out by Holter monitoring were: sinus nodus dysfunction in 1 child (2.17%), significant premature atrial contraction (PAC) in 8 (17.39%), supraventricular paroxysmal tachycardia in 3 (6.535), transient nodal rhythm in 2 (4.34%), premature ventricular contraction (PVC) Lown grade 1-III in 9 (19.56%) and Lown grade IV in 2 (4.34), atrioventricular (AV) block grade I in 2, right bundle branch block (RBBB) in all 46 (100%) and RBBB + left anterior hemiblock (LAH) in 4 (8.96%). There was no presence of atrial flutter, ventricular tachycardia or complete A V block. None of them experienced sudden death. Using cross procedure statistical methods, it was found that all the patients with PVC had right ventricular dilatation. There was no relation of other types of arrhythmia found on Holter monitoring to the other parameters from echocardiography, neither to the other standard methods. Children did not need the pace-maker, but 36.95% of the them required antiarrhythmic drugs. CONCLUSION: Twenty-four hour Holter ECG is a noninvasive and very sensitive method for discovering heart rhythm disturbances in children after the repair of tetralogy of Fallot, especially in asymptomatic patients. The patients after the repair of this congenital heart disease needed a long-term follow-up for early recognition of serious heart rhythm disturbances and their treatment.