BACKGROUND Diabetes mellitus (DM) is a major cause of avoidable blindness in the developing and the developed countries. Diabetic patients have 25 times more chance of becoming blind than the non-diabetics.1 According to the WHO, the number of people in India affected with Diabetes Mellitus in the year 2000 was 31.7 million which is estimated to rise to 79.4 million by 2030, which would be higher than any other country in the world. 75 percent of all Type 2 diabetics and almost all Type 1 diabetics are expected to develop diabetic retinopathy (DR) over a period of time.2 Diabetic dermopathy or shin spots are the commonest dermatological manifestation in patients with Diabetes Mellitus. It is also known as pigmented pretibial patches, spotted leg syndrome or diabetic dermangiopathy.3 Both diabetic retinopathy and dermopathy are manifestations of diabetic microangiopathy. We wanted to study the association between diabetic retinopathy and diabetic dermopathy. METHODS 182 patients (between 40 - 70 years of age) having diabetes mellitus for at least five years were included in the study and were examined for retinal changes and skin changes. The study period was six months. RESULTS Of the 182 diabetic patients included in this study, 106 (58.2 %) had diabetic retinopathy. Shin spots were seen in 158 cases (86.8 %). 100 (94.3 %) cases with diabetic retinopathy had shin spots. The mean duration of diabetes mellitus in patients with diabetic retinopathy was 11.85 years and it was 8.16 years in those without diabetic retinopathy. The mean duration of diabetes mellitus in patients with shin spots was 14.88 years and it was 10.70 years in those without shin spots. CONCLUSIONS There is significant association between diabetic retinopathy and diabetic dermopathy. KEYWORDS Diabetic Retinopathy, Shin Spots, Diabetic Dermopathy

This study aimed to determine the effectiveness of treatment by laser or Intravitreal anti VEGF- Bevacizumab (IVB) or combined therapy (both laser and anti-VEGF) in diabetic macular edema (DME). A prospective observational study in which 90 eyes with diabetic macular edema (DME) were enrolled. According to patient compliance, they were divided in to 3 groups where there was 30 eyes in each group. Patients with DME who were treated with laser were observed (group A). Patients with DME who were treated with Intravitreal Bevacizuamb (IVB) were observed (group B).Patients with DME who were treated with both IVB and Laser were observed (group C). All patients underwent complete ophthalmic examination at baseline and at one and three months after treatment. The outcome measures were changes in Central macular thickness(CMT) and best corrected visual acuity(BCVA). A P value less than 0.05 considered statistically significant. One month after treatment, Group B showed more statistically significant reduction in CMT and improvement in BCVA than group A and group C(P<0.05). Three months after treatment, group C showed more statistically significant reduction in CMT and improvement in BCVA when compared to other two groups(P<0.05). Combined therapy with IVB and laser appeared to be superior to Laser alone or IVB alone in reducing macular thickness and improving visual acuity. Thus combined therapy can be considered as most effective treatment in DME.

Background: Majority of exacerbations of COPD (AECOPD) are due to infections. Usual agents causing AECOPD are gram negative bacteria, but rarely viruses and fungi are also implicated. However, the role of fungal infection, especially Aspergillus spp. in the clinical deterioration of COPD still remains unclear. This prospective observational study looks at the prevalence of aspergillus infection in AECOPD. The Objectives of this study were to analyse the prevalence and risk factors associated with Aspergillus infection in AECOPD, and to investigate the clinical outcomes.Methods: Patients admitted with AECOPD for a period of 3 months from 1st October 2017 to 31st December 2017 were prospectively included from ICU and general ward of Pulmonary Medicine department of a tertiary care hospital. Clinical, radiological and microbiological data were collected at admission and during the hospital stay. Clinical course and outcome are recorded.Results: There were 104 cases of AECOPD during the study period out of which 96 were males and 8 were females. 17 patients had evidence of aspergillus infection and diabetes was found to be an independent risk factor for aspergillus infection.Conclusions: Aspergillus infection is an important cause of COPD exacerbation and this is directly related to diabetes mellitus.

Background: Tracheobronchial anomalies are a rare clinical entity and often asymptomatic in nature. Some patients may experience symptoms such as cough, recurrent pneumonia or hemoptysis. Knowledge and understanding of tracheobronchial variations have important implications for diagnosis of symptomatic patients and performing certain procedures, including bronchoscopy and endotracheal intubation. Objective was to study the prevalence of tracheobronchial anomalies detected during routine bronchoscopy in a tertiary care setting.Methods: Retrospective analysis of hospital data of patients undergoing fibreoptic bronchoscopy for one year in a tertiary care setting.Results: There were 149 bronchoscopies evaluated. Total of 41 anomalies were detected in 34 (22.8%) subjects. The most common anomaly was bronchial diverticula.Conclusions: This retrospective study takes stock of various tracheobronchial anomalies among subjects who underwent bronchoscopy in a tertiary care hospital in Wayanad, North Malabar. This study revealed major tracheobronchial anomalies in 22.8% of subjects which is higher when compared to previous studies. This is particularly important due to the fact that Wayanad is a backward hilly district and tribal community constitutes 20% of its population.

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