Aim and Objective:To know the biological behavior of ankle and foot tuberculosis (AFTB) and to know the reasons for delay in diagnosis and treatment of AFTB in our population.Materials and Methods:Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB) study and biopsy from wound margin/sinus tract was taken in all the cases.Results:During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases – three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year.Conclusion:AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.

Background: Ventilator associated pneumonia in critically ill patients are associated with high morbidity and mortality. Patients who are mechanically ventilated are at high risk of acquiring respiratory infections due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. To start empiric antimicrobial therapy knowledge of local antimicrobial resistance patterns are essential. Objectives of our study was to study antimicrobial sensitivity among organisms isolated from endotracheal aspirates of patients with VAP.Methods: This is a prospective observational study, done in 100 patients who were mechanically ventilated for various reasons in ICU of our hospital over a period of one year. Clinical parameters, investigation, microbiological profile and sensitive characteristics of endotracheal aspirate was recorded and analyzed.Results: Endotracheal aspirate culture and sensitivity was done in 100 patients.70 samples showed significant growth. Acinetobacter were isolated in 30 samples, Pseudomonas in 24, Klebsiella in 8, Enterobacter in 1, Citrobacter in 1 and Staphylococcus in 6 samples. Acinetobacter, Pseudomonas and Klebsiella were highly sensitive to colistin and polymyxin B, intermittently sensitive to meropenem and showed resistance to most of commonly used antibiotics.Conclusions: The commonest organism isolated endo-tracheal aspirate cultures were Acinetobacter and Pseudomonas which was highly sensitive to colistin and polymyxin B. A local antibiogram for each hospital, based on bacteriological patterns and susceptibilities is essential not only to initiate empiric therapy but also to prevent poor outcomes and help in framing the appropriate institutional antibiotic policy.

BACKGROUND Tuberculosis, an important preventable and treatable cause of death is a major health problem worldwide. However, in patients with a compatible clinical picture, sputum smear don't reveal acid-fast bacilli in all patients. So, alternative methods of obtaining sputum specimen are frequently needed in these patients. Rapid diagnosis of tuberculosis and detection of rifampicin (RIF) resistance are essential for effective disease management. CBNAAT (cartridge based nucleic acid amplification test) (DS Sowjanya, et al) 1 is a novel integrated diagnostic device for diagnosis of tuberculosis and rapid detection of RIF resistance in clinical specimen. The aim of the study is to study different diagnostic modalities in sputum smear negative patients with special reference to CBNAAT. MATERIALS AND METHODS This was an observational study done in the Department of Pulmonary Medicine, SCBMCH, Cuttack. 100 patients were selected for the study. In all patients, induced sputum was sent for smear acid-fast bacilli. Those patients whose induced sputum was negative were undergone bronchoscopy for BAL (bronchoalveolar lavage). The specimen was sent for smear acid-fast bacilli, sputum CBNAAT and culture for Mycobacterium tuberculosis.

BACKGROUNDChronic obstructive pulmonary disease is a collection of conditions characterised by persistent airflow limitation. It is recognised as an important cause of global burden of Non-Communicable Diseases (NCDs). Being a multicomponent disease characterised by abnormal inflammatory response of the lungs with systemic muscle dysfunction, a growing body of evidence has suggested a role of magnesium in exacerbations of COPD. Magnesium, owing to its ability to alleviate bronchospasm may have a role in maintaining disease stability in COPD patients. In the current study, we hypothesised that basal serum magnesium level must have some role in airway homeostasis and that a dysregulation results in decompensation.

Background: Hypothyroidism, a disease in which the thyroid gland does not make enough thyroid hormone, is the second most common endocrine disorder among women. It is important to obtain appropriate diagnostic tests to facilitate prompt diagnosis and treatment. A health history is useful to evaluate for symptoms of hypothyroidism, past treatment for hyperthyroidism, use of drugs that influence thyroid hormones, or a history of iodine deficiency. Hence; we planned the present study to assess thyroid deficient among females visiting the OPD of MMG District Hospital, Ghaziabad, Uttar Pradesh. Materials & Methods:The present study included assessment of patients attending the hospital OPD with thyroid hormone deficiencies. A total of 50 patients were included in the present study. Fresh blood samples were obtained from all the patients and Thyroid-stimulating hormone (TSH) assay was done. Complete demographic details of all the patients were recorded. We also analyzed the clinical signs and symptoms present in all the patients. All the results were recorded on Microsoft excel sheet and were analyzed by SPSS software. Results: Majority of the patients were above 50 years of age with 19 patients more than 60 years of age. We observed significant results while comparing the number of patients divided on the basis of age group and gender. We also observed significant results while evaluating the presence of type I diabetes and family history as risk factors for development of thyroid hormone deficiency. Conclusion: Thyroid hormone deficiencies disproportionately affect women and elderly patients in higher proportion.

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Pulmonary Alveolar Microlithiasis (PAM) is a very rare diffuse lung disease, affecting both lungs by intra-alveolar deposition of calcium phosphates in form of microliths. There have been about 700 cases of PAM recorded in the medical literature. The etiopathogenesis of the disease is unknown. It is now thought to be an autosomal recessive disease caused by deletion of Na-Pi cotransporter (Npt2b) in alveolar epithelial cells due to defective DNA mutation in the gene SLC34A2. The disease is slowly progressive, usually detected in 3 rd /4 th decades of life and death is due to cardiorespiratory failure. The patients detected with PAM in pregnancy are exceptional. Very few cases were reported till date. We report a pregnant lady presenting with PAM delivering vaginally a healthy female child in spite of cardiomegally and severe PAH.

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