An unusual case of hoarseness of voice.

Amyloidosis is a condition wherein there is an over-expression of specific proteins culminating in the extracellular deposition of insoluble beta pleated sheets of fibres. These deposits disrupt function of the target organ. Its aetiology remains unknown. Primary Amyloidosis localized to the trachea and bronchus is a rare entity. It produces tumour like lesion in the tracheo-bronchial tree. We hereby discuss a patient who presented with persistent hoarseness of voice who was referred to a tertiary care centre to rule out malignancy.

Primary immune deficiency in the intensive care unit: It is never too late to diagnose and treat.

Common variable immunodeficiency disorders (CVIDs), a heterogeneous group of primary immune deficiencies, can present at all age. Our patient with a hitherto undiagnosed CVID, symptomatic since middle ages, presented with severe pneumonia. Specific management of his CVID in addition to standard therapy was life-saving.

Safety and efficacy of thioridazine as salvage therapy in Indian patients with XDR-TB.

New drugs are desperately needed to combat XDR-TB as effective treatment involves at least four drugs to which the patient is sensitive or has never received in the past. Most Indian patients have received almost all second line drugs and have amplified resistance to most of the available drugs. Thioridazine has proven anti tuberculous effects in vitro and in vivo mouse models and we used this drug as salvage therapy in 4 Indian patients with XDR (near total drug resistance) with advanced disease. We found this drug to be well tolerated, even in this malnourished and ill patient population. It also resulted in clinical improvement in 3 of the 4 patients. Larger studies are being planned with this drug being added on to standardized or individualized XDR-TB regimens at an earlier stage. Because thioridazine has been used successfully for therapy of XDR-TB when in combination with antibiotics to which the patients were nonresponsive, the suggestion has been made that Thioridazine is eligible for patent as "New Use".

Pleural tuberculosis: an update.

PURPOSE OF REVIEW: Pleural tuberculosis accounts for fewer than 1% of all exudative effusions in western countries, occurring in only 3-5% of tuberculous patients. However, in developing countries like India, it is responsible for 30-80% of all pleural effusions encountered and may complicate tuberculosis in 31% of all cases. Thus, tuberculous pleuritis remains a major contributor to global morbidity and mortality. Tuberculous pleurisy presents a diagnostic and therapeutic problem due to the low sensitivity of the diagnostic tools. There have been many advances in the field that we have attempted to update. RECENT FINDINGS: Due to the limitations of conventional tests and the delay of several weeks for mycobacterial culture results, there has been a resurgence of interest in newer rapid tests and biomarkers. This review highlights the deficiencies of the traditional tests, while providing an overview of the newer tests. In addition, we provide an update on the changing epidemiology, clinical features and current treatment options. SUMMARY: Newer immunological tests and scoring systems will revolutionize the way tuberculous pleurisy is diagnosed in the years ahead. Future research needs include validating the available diagnostic tests in larger randomized studies, finding newer specific biomarkers that are simple, accurate and cost-effective for the developing world and determining treatment regimens specific for tuberculous pleurisy.

Retrospective study of interstitial lung disease in a tertiary care centre in India.

BACKGROUND: There has been a recent surge in the recognition of interstitial lung disease (ILD) in India. METHODS: We conducted a retrospective study based on the available medical records of 274 patients with biopsy proven ILD seen during the period 1994-2001 at our tertiary care referral hospital. RESULTS: Idiopathic pulmonary fibrosis (43%), sarcoidosis (22%), ILDs secondary to collagen vascular disease (19%) and extrinsic allergic alveolitis, among others, were the most common aetiological causes of ILD. The diagnostic yield from transbronchial lung biopsy (TBLB) was high (96%). CONCLUSIONS: Interstitial lung diseases (ILDs) appear to be under-reported from India. Lack of recognition and inadequate availability of diagnostic facilities, like high resolution computed tomography (HRCT) of the chest may be some of the reasons for this. The diagnostic yield from TBLB in our study was high at 96 percent. The TBLB may be used as the initial, cost-effective and safe tool for confirmation of aetiological diagnosis in most patients with diffuse parenchymal lung diseases.

Tuberculosis and diabetes mellitus: merging epidemics.

The link between tuberculosis (TB) and diabetes mellitus (DM) has occupied the center stage of discussion. Experts have raised concern about the merging epidemics of tuberculosis and diabetes particularly in the low to medium income countries like India and China that have the highest burden of TB in the world, and are experiencing the fastest increase in the prevalence of DM. There is good evidence that DM makes a substantial contribution to TB incidence. The huge prevalence of DM in India, may be contributing to the increasing prevalence of TB. This review looks at the link between these two merging epidemics. We discuss the epidemiology, clinical features, microbiology and radiology, and management and treatment outcomes of patients with tuberculosis and diabetes mellitus.

Hermansky-Pudlak syndrome.

We present a rare disease condition Hermansky-Pudlak syndrome in a 33-year-old male. He was born of a consanguineous marriage, had occulo-cutaneous albinism, nystagmus, decreased visual acuity, refractory errors, pulmonary fibrosis and granulomatous inflammation of the colon. In spite of all the classical features of this genetic disorder he was labeled to have disseminated tuberculous infection with a drug resistant strain for many years till the actual diagnosis was made on the basis of a strong clinical suspicion. We report this rare condition which might be misdiagnosed as tuberculosis.