A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region.

Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.

Association of pulmonary tuberculosis and dermatological conditions among patients of a rural medical college hospital.

INTRODUCTION: Pulmonary tuberculosis (PTB) affects a significant proportion of the population. There are many contributory aetiological factors common to tuberculosis (TB) and dermatological conditions. AIM: To study the spectrum of concurrent skin conditions in patients with PTB and to compare with patients having other diseases. METHODS: All patients with PTB admitted to our Institute during the period of the study were included in the study. A comparable number of patients admitted in other departments constituted the control group. All patients were screened for skin diseases. RESULTS: There were 498 patients in each group, matched for age and gender. There were 126 patients with skin conditions in the study group as against 60 patients in the control group. Pityriasis versicolor was the commonest skin condition in both the groups. Whereas acniform eruptions and pruritis were more common in the control group. Pityriasis versicolor, herpes zoster, erythema nodosum and leprosy were significantly more frequent among patients. CONCLUSION: There is a high frequency of concurrent skin diseases in patient with PTB that should be managed along with it.

A study of flexible fiberoptic bronchoscopy aided tracheal intubation for patients undergoing elective surgery under general anesthesia.

A difficult airway complicates up to one tenths of cases of elective general anesthesia. Such situations can be anticipated and tackled by fiberoptic flexible bronchoscopy (FFB) assisted tracheal intubation. To study the indications and outcomes of FFB assisted tracheal intubation in patients with anticipated difficult airway, who are undergoing surgery under general anesthesia. Cases who were intubated using FFB assistance were included in the study. Detailed examination was done pre operatively to be able to predict the difficult airway. Intubation was done with the help of a FFB after induction of general anesthesia. There were total 52 cases. Majority were male and in the fourth decade of life. Oral submucous fibrosis was the commonest indication for the procedure. There were two cases of failure, but no significant mortality or morbidity. A difficult airway can be encountered across specialties. It can be anticipated by simple or multi factorial methods. Awake FFB aided intubation is the gold standard in cases of anticipated difficult airway. Failure rates of 4-66 % have been reported. In the present study the failure rate was less than 4 % with no morbidity or mortality. FFB assisted intubation is safe and effective in paediatric patients too. FFB assisted intubation done in an organised and skilled manner is a very important skill to have to tackle cases of difficult intubation. Hence it should be included in training programmes of anesthesia.

Immune reconstitution disease or mycobacteria other than tuberculosis or both: A dilemma in a patient of AIDS.

A 35-year-old male diagnosed as HIV with tuberculous lymphadenopathy, presented with acute increase in size of neck swelling and fever. The patient was on antiretroviral therapy and antitubercular treatment. Investigations revealed raised CD4 counts and the pus from swelling showed mycobacteria other than tuberculosis (MOTT) on bacteriological examination.The patient was started on steroids, azithromycin, and ciprofloxacin to which he responded well. We report this case to highlight the occurrence of immune reconstitution disease in HIV patients and also to bring out the fact that atypical infection like MOTT may confound the diagnosis even in regions like ours where MOTT is rarely reported.