Background and Objectives:There has been a rapid expansion of the directly observed treatment short-term (DOTS) under the revised national tuberculosis control program throughout India in the last decade. Few reports exist detailing individual DOTS centers’ experiences with regard to extrapulmonary tuberculosis (EPTB) in a medical college hospital setting.Materials and Methods:This is a retrospective, record-based study of patients with the diagnosis of EPTB, in all age groups. Data on all consecutive EPTB cases diagnosed at the K. S. Hegde Medical College and Hospital, Deralakatte, Mangalore from 1 January 2005 to 31 December 2011 at the DOTS centre attached to this hospital were collected, analyzed by Mantel-Haenszel Chi square for linear trend and described in proportion or percentages.Results:Among 1267 cases registered for treatment of all forms of tuberculosis, 528 (41.67%) had EPTB. Around half of the cases of EPTB (269, 51%) were among adult age groups and the majority of cases (342, 64.77%) received Category-I treatment. Pleural TB was the commonest type of EPTB (n = 148, 28.03%), followed by lymph node TB (n = 131, 24.81%). Involvement of lymph nodes was the commonest manifestation among the less than 14 years’ age group (27, 58.7%), while involvement of pleura was more common among > 65 years’ age group (23, 45.1%). The difference in the occurrence of EPTB by site between males and females is statistically significant with a P value of <0.005. There is a significant increase in the number of cases of tuberculosis affecting bones and joints, and other forms of tuberculosis over the years.Conclusion:The burden of EPTB is more among the productive age group. Increase in the trend of bone and joint tuberculosis, and other rare forms of EPTB is a point of concern highlighting the importance of strengthening the services towards this group.

Obstructive sleep apnoea (OSA) is the major underlying co-morbidity in many of the noncommunicable diseases (NCD) due to obesity as a common risk factor. Incidence and prevalence of OSA is on the constant rise ever since this entity came to forefront three decades ago. Precise treatment of underlying OSA is extremely important in major NCDs like diabetes mellitus, hypertension, endocrine disorders and vascular diseases. OSA is subcategorized in to mild, moderate and severe based of apnoea-hypopnea index (AHI). Based on the severity grading, treatment of OSA ranges from life style modifications to oral appliances, continuous positive airway pressure (CPAP) and surgeries. AHI system of severity grading in OSA has several inherent shortcomings and using AHI system for severity grading as the holy grail is likely to be counter-productive. AHI system equates apnoea and hypopnea as equal events, whereas physiological effects vary significantly. AHI system does not account duration of apnoea or body position during apnoeic events. We discuss at length the pitfalls of AHI system of severity grading in OSA.

Background: Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis. The prevalence and the mortality due to tuberculosis are reducing in India, with an increasing number of suspects being examined and treated under Revised National Tuberculosis Control Program (RNTCP). Aim: The primary objective of this study was to describe the basic demographic, clinical characteristics, trends of various types of tuberculosis and program specified treatment protocols of patients registered for TB treatment in this single center attached to medical college hospital under RNTCP. Materials and Methods: This was a retrospective, record-based study of patients of all types of tuberculosis from January 1995 to December 2010 in all age groups, evaluated at K. S. Hegde Medical College and Hospital, Deralakatte, Mangalore, Karnataka, India. Results: A total of 1058 cases were registered and treated under Directly Observed Treatment Short-course (DOTS) during this period. Males (689, 65.12%) contributed to more number of cases than females (369, 34.88%). Of 1058 cases, 400 (37.81%) were found to be smear positive and among them 297 (74.25%) were males and 103 (25.75%) were females. Among 400 smear positive cases, 322 were new smear positive cases and 78 were Re-treatment Smear Positive cases. The Sputum Positive Ratio was ranging between 7.8% and 23% during the study period. 621 cases (58.7%) were classified as Pulmonary and 437 (41.3%) were classified as Extra Pulmonary. Among 621 Pulmonary cases, 221 (35.59%) were treated according to radiological criteria alone (X-ray positive alone). 778 cases received Cat-I treatment, 135 cases received Cat-II treatment, and 141 cases received Cat-III treatment. CXR positive+ EPTB cases contributed to 62.2% (n = 658) of total tuberculosis cases registered for treatment. Conclusion: High proportion of TB patients with EP-TB and its increasing trend along with higher reporting of sputum smear-negative PTB is a major concern for the health authorities in this area.

We hereby report a patient with seizure disorder who was on long term carbamazepine, admitted with features of thyrotoxicosis and cerebellar dysfunction. Anticonvulsant medications are cerebellar toxins; but in this case, reversal of cerebellar dysfunction was noted upon treatment of thyrotoxicosis with antithyroid drugs.