Necrotic mediastinal lymphadenopathy: Tuberculosis or Sarcoidosis, a diagnostic conundrum - A case report and review of the literature.

Sarcoidosis is an uncommon disease involving pulmonary parenchyma and lymph nodes. Non-necrotizing, bilaterally symmetric hilar, and right paratracheal lymph nodes are the pathognomonic imaging features of sarcoidosis. Rarely, atypical radiological findings of sarcoidosis may mimic mycobacterial infections, posing a diagnostic dilemma, especially in tuberculosis endemic countries. In this report, we have discussed the case of a 61-year-old female presenting with multiple conglomerated necrotic mediastinal lymph nodes on computed tomography that looked tubercular but eventually turned out to be sarcoidosis. It is important for primary care physicians, who are the first point of contact for patients, to keep in mind the atypical radiologic manifestations of sarcoidosis, in order to reach a timely diagnosis and help reduce the associated morbidity and mortality.

Childhood and Youth Onset Diabetes: A Single Centre Experience.

OBJECTIVES: To identify proportion of various types of diabetes and differences between type 1 and type 2 diabetes in patients with youth onset diabetes (onset below 25 completed years of age). In addition, concurrent autoimmune diseases in type 1 diabetes were studied in a subset of patients. METHODS: A total of 577 patients (192 girls) with diabetes onset at median age of 14 y (range 1 mo-25 y) with median duration of 1 y (range day of diagnosis- 43 y) were included. Clinical details, investigations and complications were recorded in a proforma. Diabetes was classified using clinical criteria supported by laboratory tests of C peptide and anti GAD-65 antibody in a subset of patients. RESULTS: Type 1 diabetes accounted for 368/421 (87.4 %) patients with age of onset <18 y and 99/156 (63.5 %) of patients with onset between 19 and 25 y of age. Proportion of type 2 diabetes was 36/421 (8.5 %) and 41/156 (26.2 %) in these two groups. Older age at onset, diabetes in one or both parents, absence of ketosis /weight loss and presence of acanthosis were significant predictors of type 2 diabetes. Hypothyroidism (TSH >10) and biopsy proven celiac disease was found in 11.6 and 9.7 % of type 1 diabetes patients respectively. CONCLUSIONS: Type 1 diabetes is the most common type of diabetes in youth, however, a significant proportion of youth have type 2 diabetes. In these patients a combination of clinical factors, biochemical parameters and course over few months helps to guide the diagnosis.

Immunotherapy for Infectious Diseases: Past, Present, and Future.

Passive immunotherapy for established infections, as opposed to active immunization to prevent disease, remains a tiny niche in the world of antimicrobial therapies. Many of the passive immunotherapies currently available are directed against bacterial toxins, such as botulism, or are intended for agents of bioterrorism such as anthrax, which fortunately has remained rare. The emergence of Ebola virus and multi-drug resistant pathogens, however, may breathe new life into the immunotherapy field as researchers seek non-antibiotic interventions for infectious diseases.