Setting: Two tertiary care hospitals and 12 peripheral health institutions (PHIs) in Trivandrum, Kerala, India. Objective: To determine factors associated with the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients and examine differences in the proportion of new DM cases among TB patients diagnosed at tertiary care centres and PHIs. Design: A descriptive study: TB patients diagnosed during March-September 2012 were screened for known DM. Those with unknown DM status were tested for random blood glucose and fasting blood glucose (FBG); FBG ⩾ 126 mg/dl was diagnosed as new DM. Results: Of 920 TB patients, 689 (72%) were male and the mean (standard deviation) age was 47.6 (16.4) years. Of these, 298 (32.4%) were diabetic: 235 (26%) had previously known DM and 63 (7%) were newly diagnosed. During the screening at PHIs and tertiary care hospitals, respectively 30/183 (16.4%) and 33/737 (4.5%) were newly diagnosed with DM (OR 3.71; 95%CI 2.17-6.32). Overall, age >50 years and pulmonary tuberculosis were independently associated with a higher prevalence of diabetes. Conclusion: As nearly one in three TB patients had DM, we recommend that TB patients should be routinely screened for DM in Kerala. As the proportion of new DM was higher among TB patients diagnosed at PHIs, we would recommend that specific attention and investment be directed to PHIs. India, the country with the highest number of tuberculosis (TB) cases in the world (an estimated 2.2 million cases in 2011), 1 also has a very high burden of diabetes mellitus (DM), with an estimated 63 million cases in 2012. 2 In India, 15% of pulmonary tuberculosis (PTB) cases have been estimated to be attributable to DM. 3 DM also affects TB treatment outcomes and may delay sputum conversion, increase case fatality rates during treatment, lead to increased failure rates in non-drug-resistant cases and also increase relapse rates of TB after successful completion of treatment. 4,5 Given this scenario, it has been felt that active screening for DM in TB patients may allow identifi cation of previously undiagnosed DM and improve TB treatment outcomes through improved DM care.Diabetes is common in Kerala, a state in South India with a population of 34.6 million, with an estimated community prevalence of 16-20%. 6 TB patients, with a recent study reporting a prevalence of 44%. 9 As standardised procedures for DM screening among TB patients for use in hospitals and TB units (TUs)-a sub-district level tuberculosis programme management unit covering a population of 500 000, made up of varying numbers of peripheral health institutions (PHIs)-were not available in India, a monitoring tool linked to the TB registration and quarterly reporting system was developed and implemented, starting in multiple centres in India in 2012. The fi ndings of this pilot study 10 showed that the screening procedures worked well, and the overall prevalence of DM in over 8000 screened TB patients was 13%. Trivandrum, in Kerala, was one of the sites that implemented screening at both ...
Stress is a universal phenomenon and an important component in our life. Yoga is one of the few stress relief tools that have a positive effect on all the body systems involved in body age.Yoga should be made accessible and relevant to anybody so that anyone with the desire can practice yoga. Yoga in this approach can be adapted to the individual requirements, needs and goals age and health capability which denotes that there is no barrier at all. A study was conducted to examine the effectiveness of yoga therapy on the level of Stress among Chronically hospitalised patients in a selected hospital. Quasi experiment one group pre test post test design was found to be appropriate to meet the objectives of the study. The sample size of the present study was 60 hospitalized patients and they were selected through stratified random sampling technique. They were asked to complete the geriatric stress scale and the scores were analysed.Yoga therapy was implemented to the patients for a period of three weeks. A post test was conducted to assess the effectiveness of the intervention. Appropriate statistical technique was employed to test the hypothesis and to analyse the findings. The result showed that there is a significant decrease in the level of stress among the hospitalized patients after implementing yoga therapy. The study revealed that the yoga therapy was found to be effective on the level of stress among chronically hospitalized patients in selected hospital.
We present a case of a 47-year-old female with three primary malignancies. This is an unusual presentation and highlights the dilemmas in the workup and formulation of treatment plans. Genetic studies to identify mutations may help explain the pathophysiology.
BACKGROUND Evaluation of intra-abdominal/intrathoracic lymphadenopathy in the absence of enlarged peripheral nodes has always been a challenging problem for clinicians, especially with unfavourable general conditions of the patient where surgical interventions are difficult. Endoscopic ultrasound-guided FNA has been used for the last two decades for tissue acquisition from patients with such deep-seated lesions. But its use in the diagnosis of lymphoma has always been challenging. However, the addition of fine needle core biopsy into this procedure has given promising results. In this study, we wanted to evaluate the effectiveness of EUS-FNA/FNB as an alternative to invasive open surgical procedures. METHODS We exhibit a case series of 6 patients who presented with mediastinal and/ or intraabdominal lymphadenopathy in whom EUS-FNA & FNB were done simultaneously to obtain tissue for histological and ancillary studies. RESULTS Clinically these lymph nodes were detected by CECT and there was no peripheral lymphadenopathy. In this case series, we were able to make a diagnosis of lymphoma in all 6 cases. With the help of immunohistochemistry, 2 cases were further classified into Hodgkin’s lymphoma and one case was diagnosed as ALK-positive anaplastic large cell lymphoma. All three patients underwent treatment from our hospital and are on follow-up. CONCLUSIONS Our experience with this case series report suggests that EUS-FNA/FNB is a minimally invasive procedure which can be tried effectively as an alternative to invasive open surgical procedures.
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