Background
Diabetes mellitus is an important risk factor for tuberculosis (TB), and studies in high TB burden countries have shown diabetes screening to be both feasible and to have a high yield. However, scarce information is available for low TB burden countries. Diabetes screening was previously not part of our routine practice.
Aim
To screen and determine the prevalence of diabetes in the Western Australian Tuberculosis Control Program.
Methods
We measured HbA1c and random plasma glucose in patients with active TB. We also collected details on their demographics, TB and diabetes.
Results
A total of 105 patients was recruited over a year. Of those, 17 (16.2%) had diabetes. Seven cases (6.7%) were newly diagnosed diabetics. Age, cavitating disease and family history of diabetes were found to be significantly associated with diabetes. Multilobar disease, gender, body mass index, smear and culture positivity were not significantly different between groups.
Conclusion
Our study showed high prevalence of diabetes among active TB patients. Diabetes screening at diagnosis of active TB presents as a good opportunity to detect diabetes even in low prevalence country and has become part of our standard care.
With over 150 species, non‐tuberculous mycobacteria are increasingly recognized to be important human pathogens that pose diagnostic and management challenges. We report a rare case of cervical lymphadenitis and pulmonary disease caused by Mycobacterium paraffinicum in a 64‐year‐old man who presented with three‐month history of increasing right‐sided painless neck lump. His medical history included rheumatoid arthritis, which was managed with leflunomide and methotrexate. Computed tomography scans of his neck and thorax revealed a right lower neck and supraclavicular fossa cystic mass with peripheral enhancement and bilateral multiple small pulmonary nodules. M. paraffinicum was cultured from a fine‐needle aspiration of the mass. Two out of three sputa were acid‐fast bacilli smear positive but cultures did not yield any viable organism. He developed spontaneous discharge of purulent material via a sinus, which drained over two months and recovered with a completely healed sinus without any further treatment.
The cellular nature of the corneal epithelium was first described by van Leeuwenhoeck (i 693-i78), and it is now generally believed by workers who have carried out morphological studies that cells of an uncertain nature occur in the basal region of the corneal epithelium. Ranvier (I88I) described "wandering cells" that had migrated from blood vessels, but it was Virchow (i91o) who first observed that some cells appeared darker than others apparently because of compression of the cytoplasm. A different view, however, was held by Egorow (I934), who believed them to be homologous with similar cells in the mammalian epidermis, and hence called them Langerhans cells. Binder (I 951, I 952) described clear "matrix cells", which remained permanently in the basal layer and which divided to give rise to young cells which were compressed forwards into the epithelium. Cogan (I951), however, stated that the dark cells probably represented the more mature basal cells which were in the process of migrating forwards.The use of different techniques appears to have produced conflicting results. By staining with silver carbonate, Scharenberg (I955) was able to demonstrate "polymorph elemients" which penetrated the epithelium and were intimately connected with the nerves, while Pau and Conrads (I 957), using a similar technique, came to the conclusion that the so-called Langerhans cells were associated with nerve fibres and hence were analogous to Schwann cells.The first electron microscopical study was carried out by Jakus ( 1 954) on the rat cornea. She described finger-shaped processes on the surfaces of the basal cells, and these were subsequently named "basal layer branched cells" by Whitear (i960), who studied the mouse cornea electron mricroscopically and suggested that these cells were associated with the transport of metabolites. This was followed by an account of the rabbit cornea by Teng (I96I), who a year later (Teng, I962) described the human cornea. Because of the increased endoplasmic reticulum and tonofibril elements and the presence of osmophilic granules, he suggested that the more electron dense cells should be called "secretory epithelial cells", since he believed that their apocrine secretion contributed to the formation of the basement membrane. He observed that these cells, usually few in number, increased in pathological conditions for reasons which were not fully understood at that time.
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