ABSTRACT
Tuberculosis (TB) is not only a major public health problem of developing countries like India, since its incidence is increasing due to increasing immune-depressive states including HIV, malignancies and cytotoxic chemotherapy. Laryngeal TB occurs usually a secondary to associate with pulmonary disease, and primary form is very rare in immune-competent people. We report a 49‑years‑old non-smoker, non-diabetic, immunocompetent man presenting with chronic dry cough and hoarseness without any constitutional symptoms, family or contact history of TB. The chest X-ray was normal. Laryngoscopy showed congested larynx without any ulcer or mass and normal vocal cords. Biopsy from aryepiglottic fold was suggestive of TB, but caseation was absent. Diagnosed to be primary laryngeal TB, he responded well to anti-tubercular therapy. Primary laryngeal TB without pulmonary TB can mimick chronic laryngitis. Before anti-tubercular drug use, in the 1950’s, it was a common and frequently fatal disease but it’s clinical features, age group involved and prognosis has changed over the last few decades. It is more infectious than pulmonary form primarily due to delayed diagnosis. It can mimick a common condition like chronic laryngitis, although different macroscopic lesions are described. Diagnosis needs a high index of suspicion, confirmed by histological examination, as it still can occur occasionally in immunocompetent persons. Response to specific treatment is good after diagnosis.
ABSTRACT
The true incidence of functional physical disorders is higher in general practice including functional bowel disorders. It leads to a high socio-economic burden by way of delayed diagnosis. ROME III criteria are used to diagnose these disorders. Although there are specific clinical diagnostic features, definite diagnostic investigations are unavailable. Recent scientific studies link the mind and body as part of a system where their dysregulation can produce illness and disease where psycho-social factors do play a role in addition to genetic susceptibility and environmental factors. The brain-gut axis is now an area of intense research in studying these functional disorders and psychotherapy behavioral modification and psycho-pharmacotherapy are are becoming increasingly important to manage such disorders.
ABSTRACT
Background: Diabetes mellitus is assuming an epidemic form in India. Non-alcoholic fatty liver disease worldwide is increasing too and is a major cause of liver transplant in the west. Diabetes is a strong risk factor for non-alcoholic fatty liver disease, and some of them go on to develop steatohepatitis which is associated with a more rapid disease progression leading to chronic liver disease including hepatocellular carcinoma. This association of diabetes with fatty liver disease is least investigated. Liver biopsy is not routinely done in clinical practice and various non-invasive markers for fatty liver or steatohepatitis are used frequently to identify patients at risk of fatty liver disease. Methods: 116 Type 2 Diabetics Mellitus on therapy with oral anti-diabetic drugs and atorvastatin for at least 3 months’ duration were included and sonologically evaluated for fatty liver after proper exclusion of other causes of fatty liver. Serum hsCRP, an acute phase reactant, was measured in them. Liver function tests, BMI and other necessary investigations were done. 144 healthy controls were also taken. Results: The absolute risk of developing fatty liver was significantly high in T2 diabetics compared to controls. hsCRP was significantly associated with fatty liver and uncontrolled glycemic status. In addition AST/ALT > 1 also showed significant differences amongst the same groups. Conclusions: High hsCRP is a cheap, easily available laboratory marker to suspect fatty liver and possibly steatohepatitis in T2 Diabetics in our region. It can identify a subgroup of diabetic patients in whom liver biopsy may be advisable to confirm steatohepatitis which is important for prognosis and therefore need aggressive intervention.