Hemoptysis is a common post pulmonary tuberculosis complication. It is usually due to bronchial artery involvement. Hemoptysis due to pulmonary artery pseudoaneurysm in a tuberculosis cavity is very rare. Such pseudoaneurysm is called Rasmussen's aneurysms which are commonly seen in upper lobes. We are able to demonstrate a big left lower lobe Rasmussen's aneurysm in a 55 years old diabetic male by CT pulmonary angiogram and it was treated successfully by a wedge resection of involved pulmonary segments.
Multidrug resistant tuberculosis (MDR TB) is essentially a man-made phenomenon and arises mainly due to inadequate treatment of drug-sensitive TB. Drug resistance is seen in 1-3% of new cases and 12% of re-treated tuberculosis. Material and Methods: We studied 291 cases of multidrug resistant tuberculosis registered at drug resistant tuberculosis (DRTB) center, Mysore. Patients were treated according to programmatic management of drug resistant tuberculosis (PMDT) guidelines by DRTB committee of the hospital. Results: Out of 291 treated cases of MDR TB, 41 were diagnosed when they were on Category I regimen of revised national tuberculosis control program. Thirty cases were treatment after lost to follow-up. Twenty-one cases were co-infected with tuberculosis and human immune deficiency virus. Conclusion: Treatment outcome was available in 275 patients. Out of which 16 cases completed treatment, 106 were cured, 55 cases stopped treatment, 84 died, treatment was stopped in 3 patients due to some reason and 11 cases were switched to extensively drug resistant tuberculosis (XDR) regimen. Our study concluded that despite adequate drugs with well-organized program the treatment outcome of MDR tuberculosis was still low.
Background: Diabetes mellitus and tuberculosis are a dual burden of disease, and diabetes is associated with a threefold risk of developing tuberculosis. Though India is considered to have an abundance of sunlight, the prevalence of deficiency of vitamin D is high, which is shown to cause impairment in the macrophage-initiated immune response against Mycobacterium tuberculosis. Methods: Our study estimated the prevalence of mean levels and determinants of vitamin D deficiency in patients with tuberculosis or diabetes and those with both tuberculosis and diabetes. A cluster analysis was performed to identify whether these patients belong to distinct clusters and evaluate whether vitamin D levels were significantly different between clusters. Results: The study observed that the lowest vitamin D levels were observed among subjects with both pulmonary tuberculosis and diabetes. Multinomial logistic regression analysis observed that higher levels of vitamin D were protective against both diabetes and pulmonary tuberculosis and while higher body mass index lowered odds of pulmonary tuberculosis, it increased the odds of diabetes. The cluster analysis identified five distinct clusters with different characteristics of pulmonary tuberculosis, diabetes mellitus, sputum mycobacterial load, age distribution, body mass index, vitamin D, serum albumin and serum calcium. Conclusion: In South India, among patients with pulmonary tuberculosis and diabetes or either disease alone, hypovitaminosis D is a common phenomenon. The cluster analysis plays an important role in future research on biomarkers to identify specific phenotypes in patients with tuberculosis and diabetes.
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