Recurrent Peumonia in an Infant With an Esophageal Lung

Esophageal lung is a rare variety of communicatingbronchopulmonary foregut malformation with anomaolouscommunication between an isolated portion of respiratory tissueand esophagus. Children present in early life with recurrentcough and pneumonia. Majority of the reported cases areassociated with other anomalies like tracheoesophageal fistula.We report a case of a 7-month-old girl with right sidedesophageal lung who was misdiagnosed as dextrocardia withright sided pneumonitis

High incidence of zidovudine induced anaemia in HIV infected patients in eastern India.

Background & objectives: Zidovudine (ZDV) is the preferred nucleoside reverse transcriptase inhibitor in the first line antiretroviral regimen in India. It is known to be associated with life threatening toxicity like anaemia. This study was aimed at determining the prevalence of ZDV induced anaemia in HIV infected patients initiated on ZDV containing antiretroviral therapy regimen and also to find out the correlates, if any, for causing ZDV induced anaemia. Methods: This retrospective study was carried in ART Centre, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi between March 2005 to December 2007. HIV infected patients registered at ART Centre were treated according to guidelines of National AIDS Control Organization (NACO). Patients (n=1256) with haemoglobin (Hb) >8 g/dl were prescribed ZDV based antiretroviral therapy regimens. Patients developing anaemia (<8 g/dl) with other causes of anaemia excluded were recorded. Correlation of baseline characteristics (age, gender, haemoglobin levels, weight, CD4 counts and WHO clinical stage) with risk of developing anaemia was also calculated. Results: Two hundred three (16.2%) patients on ZDV regimen developed anaemia (<8 g%); 7.9 per cent (n=100) of these developed severe anaemia (<6.5 g%). Females were more prone to develop anaemia (P=0.026). Age, weight, WHO clinical stage and CD4 counts had no relation to development of anaemia. Interpretation & conclusion: High incidence of ZDV induced anaemia seen in this study indicates regular monitoring of patients, particularly women on ZDV based antiretroviral regimens.

Ultrasonography for diagnosis of abdominal tuberculosis in HIV infected people.

Background & objectives: There is an increasing incidence of abdominal tuberculosis with the advent of HIV infection. This study was aimed at determining the pattern of presentation of abdominal tuberculosis on ultrasonography (USG) in HIV positive patients. Methods: This retrospective study was carried at the ART Centre, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, between March 2005 to July 2007. HIV positive patients (n=2453) with prolonged fever, abdominal pain/distension, altered bowel habits and diarrhoea underwent ultrasonography for tuberculosis of abdomen. The different ultrasonological findings in abdominal tuberculosis were noted. CD4 counts of these patients were also recorded. Results: Of the total 2453 patients, 244 showed findings suggestive of abdominal tuberculosis. Lymphadenopathy with predominantly hypoechoic/necrotic echotexture was seen in 158/244 (64.8%) patients. Splenomegaly was seen in 68 patients with 61 of them (89.7%) showing multiple hypoechoic lesions in the parenchyma. 53 of 244 (21.7%) showed extensive abdominal involvement. Liver enlargement was seen as a part of extensive abdominal involvement. A total of 203 patients completed antitubercular treatment, of which 198 (97.5%) showed resolution of lesions in USG. CD4 counts in patients with extensive abdominal involvement were lowest compared to CD4 count in patients with others USG findings. Interpretation & conclusion: Ultrasonological findings like lymphadenopathy (≥1.5 cm) with hypoechoeic/necrotic echotexture, hypoechoic splenic lesions and extensive abdominal involvement in HIV infected patients may be suggestive of abdominal tuberculosis.

Middle lobe syndrome due to Tuberculous etiology A series of 12 cases.

The term right middle lobe syndrome (RMLS) is often used in clinical practice though it has no consistent definition. Inflammatory lesion, malignant tumors followed by bronchiectasis are considered as the most common etiological factors for RMLS. Here we describe 12 cases of RMLS due to tuberculous etiology diagnosed over a period of 6.5 years at our Institute. They were diagnosed using conventional methods and responded to anti-tubercular treatment with favourable outcome. The cases are being presented here to highlight the fact that tuberculosis, though not frequently reported in published literature, is an important etiological factor and must be considered for differential diagnosis when RMLS is evaluated particularly in regions where the prevalence of tuberculosis is high as it responds to anti-tubercular chemotherapy remarkably.

Drug resistant tuberculous osteomyelitis of small bones of foot.

Drug resistant tubercular osteomyelitis of small bones of foot is not reported frequently. The case described here had isoniazid resistant tuberculous osteomyelitis of small bones of foot. The probable mechanism was endogenous reactivation of previously disseminated foci of drug resistant bacilli from the primary site in the lung.

Diaphragmatic paralysis and hoarseness of voice due to mediastinal tuberculous lymphadenitis.

The most frequent cause of diaphragmatic paralysis and hoarseness of voice is involvement of phrenic nerve and recurrent laryngeal nerve by a thoracic malignancy. Here, we describe a patient who developed diaphragmatic paralysis and hoarseness of voice due to mediastinal tuberculous lymphadenopathy, which is not a common etiological factor leading to it.