We present a case of massive generalised necrotic lymphadenopathy due to tuberculosis (TB) without any solid organ involvement. An immunocompetent man in his early 30s presented 1 year ago with weight loss, cough and a solitary cervical node. Contrast-enhanced CT scan thorax showed massive enlargement of almost all groups of mediastinal nodes with large areas of necrosis. Ultrasound examination revealed multiple necrotic abdominal nodes. Core biopsy of the supraclavicular node confirmed TB by histopathology and molecular testing. His Mantoux test was negative suggesting tuberculin anergy. Biopsy of deep nodes was avoided. He responded well to standard antitubercular treatment in weight-corrected doses along with systemic steroids which were prescribed to prevent further breakdown/rupture of nodes. After the extended TB treatment for 12 months, he is asymptomatic and has gained weight, with complete resolution of cervical node and near complete resolution of all deep nodes.
Sleep is the natural periodic suspension of consciousness during which the powers of the body are recovered. It is a natural periodic state of rest for the mind and body, in which the eyes usually close and consciousness is completely or partially lost so that there is a decrease in bodily movement and responsiveness to external stimuli. Present study was planned to study the sleep patterns in various respiratory diseases at Tertiary care Hospital in India.The present study was conducted in sleep laboratory of the Department of Pulmonary Medicine of a tertiary care hospital that caters to population of diverse groups. Patients after clinical examination and spirometry with post bronchodilator reversibility were categorized into bronchial asthma and COPD. Subsequently polysomnography was done of these patients to study the sleep pattern. Total sleep time appears to be decreased in COPD patients with mean value of 284.3 (± 43.02) minutes, with decreased sleep efficiency of 66.64 % (± 0.074). Study group patients have frequent awakenings with average of 17.73 (± 6.15). They have decreased slow wave sleep (S3 and S4 stages) with mean value for S3 is 2.81% (± 0.68) and for S4 is 6.45% (± 1.64). The mean value for REM sleep in these patients is 12.42% (± 2.72) and that for S1 and S2 is 13.99% (± 4.84) and 64.62% (± 4.72) respectively. Total sleep time appears to be decreased in asthmatic patients with mean value of 299.89 (± 45.17) minutes, with decreased sleep efficiency of 68.38% (± 0.065). Study group patients have frequent awakenings with average of 21.03% (± 7.44). In patients with Asthma & COPD, polysomnography study suggests poor sleep quality characterized by decreased total sleep time, decreased sleep efficiency, frequent awakenings, altered sleep architecture with decreased slow wave sleep and REM sleep.
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