Background Prevalence of diabetes mellitus (DM), though believed to be high among patients with tuberculosis (TB), remains unclear for the want of systematic studies and unequivocal methods of diagnosing DM. This study was done to determine the prevalence of prediabetes and DM in adult patients with TB. Methods This prospective study of one year's duration, carried out at a tertiary care centre included 313 consecutive adult patients diagnosed (either microbiologically, histologically or based on clinical presentation) with pulmonary or extrapulmonary TB. Those without a history of pre-existing DM were subjected to oral glucose tolerance test (OGTT) with 75 g glucose. Results In this cohort 85 (27%) patients had pre-existing DM. The remaining 228 patients not diagnosed earlier with DM underwent a 75 g OGTT, of which 63 (28%) were found to have newly detected prediabetes (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT] alone in 36 and 10 patients respectively and both IFG and IGT in a further 17) and DM was diagnosed in 9 (4%) patients (fasting blood glucose [FBG] ≥ 126 mg/dl in 1 and both FBG ≥ 126 mg/dl and 2-h plasma blood glucose [PLBG] ≥ 200 mg/dl in 8 patients). The total prevalence of (newly diagnosed) DM and prediabetes, therefore, was 32% (72 patients); the overall prevalence of DM was 30% (94 patients). Conclusions This study found high prevalence of prediabetes and diabetes among patients with TB. This underscores the need for a bidirectional screening strategy to improve diagnosis and outcome of both TB and DM.

In this age of enhanced diagnostics and improved turnaround time, immune thrombocytopenic purpura (ITP), a disease primarily diagnosed by exclusion, is expected to be straightforward to diagnose. However, during a full-fledged dengue outbreak, the health-care system can be overwhelmed, and as a result, ITP can be underdiagnosed. The clinician should be aware of the various imitations that ITP can present with. Various clinical indicators have to be kept in mind while dealing with such an outbreak to avoid unnecessary health-care expenditure and prolonged hospital stays. In this case series, we present two patients diagnosed to have ITP during the dengue outbreak, each unique in its presentation and course, demonstrating the multiple patterns ITP can present itself.

Hypoglycemia can be effortless to treat. Its evaluation on the other hand, needs a thorough appraisal. The studied patient had recurrent episodes of hypoglycemia post-delivery which were unprovoked. These conspicuous episodes of hypoglycemia prompted an evaluation and a swift arrival at the diagnosis. In hindsight, she had multiple, typical risk factors predisposing her to develop a Sheehan’s syndrome. This was an acute presentation of a familiar disease

Hypertriglyceridemia is a familiar issue a physician and his patients face. Writing a prescription for the same may be effortless, but without a thorough evaluation, we may miss out on a number of concealed diseases. Treating the underling secondary disease, avoids an unnecessary pill burden, eventually decreasing healthcare costs also. Unearthing prevalent diseases like diabetes mellitus (DM) is rewarding in its own way and pays dividends multifold. The physician must be aware that secondary causes of hypertriglyceridemia manifesting as lipemia can commonly be seen in disorders like obesity, primary hypothyroidism and DM. The studied patient presented to us obviously shaken with a long history of weight gain and lipemia during a blood draw. She turned out to have the commonest risk factors for hypertriglyceridemia - Obesity, hypothyroidism and DM causing the alarming lipemia. It was an oddly interesting presenting symptom of hypertriglyceridemia, obesity, hypothyroidism and DM which resulted in an appropriate and prompt management of her underlying diseases.

Scrub typhus may be a very a familiar reason for an acute undifferentiated fever. Although there has been an improvement in the diagnostics as well as an increased awareness regarding this disease, it still remains belatedly diagnosed and eventually turns fatal. We present a male patient who was brought to us with jaundice, tender hepatomegaly and distinctly no history fever who turned out to have a Scrub typhus infection and was salvaged owing to a diverse empirical antibiotic coverage. This represents an atypical clinical presentation of a very familiar infection: Tropical rickettsioses infection presenting with afebrile jaundice in an immunocompetent patient. It also brings into perspective the wavered nature of its disease presentation, the significant merit of procuring a good patient history and a change in empirical antibiotic policies especially in areas endemic for scrub typhus