Association of Vitamin D Deficiency and Newly Diagnosed Pulmonary Tuberculosis.

INTRODUCTION: Vitamin D has a significant role in host immune defense against Mycobacterium tuberculosis. It has been suggested that pulmonary tuberculosis may be associated with lower levels of vitamin D. Present study was therefore undertaken to identify the association between vitamin D deficiency and pulmonary tuberculosis. METHODS: A case-control study was conducted in a tertiary care hospital from 2014 to 2016, including 50 adult newly diagnosed sputum positive pulmonary tuberculosis patients as cases and 50 age and sex-matched healthy participants as control groups. All participants in the study group had undergone detailed clinical examination and routine laboratory investigations, including vitamin D, calcium, and sputum for AFB. The clinical characteristics, X-ray findings, sputum AFB, and vitamin D levels were analyzed and compared with data obtained from healthy controls. RESULTS: In both groups, the majority were men (88%). BMI was significantly (<0.0001∗) lower in the tuberculosis group (19.40 (17.20, 22.0) vs. 24.00 (22.50, 25.47)). Serum vitamin D levels were significantly lower (P = 0.012) in the tuberculosis group (19 (7.75, 27.25) ng/dl) as compared to the control group (25 (19.75, 32.00) ng/dl). Out of 50 TB patients, 27 (54%) had vitamin D deficiency, while among healthy controls, only 13 (26%) had vitamin D deficiency. Among vitamin D deficient PTB patients, 44% had 3+/hpf AFB in sputum smear examination. CONCLUSION: The prevalence of vitamin D deficiency in pulmonary tuberculosis cases is very high. Hypovitaminosis D was associated with more severe clinical symptoms, higher sputum smear positivity, and extensive lesions in chest radiograph among pulmonary tuberculosis patients.

Endogenous Endophthalmitis in Patients with MRSA Septicemia: A Case Series and Review of Literature.

PURPOSE: To report the presentation, predisposing factors, clinical features and outcome in 6 eyes of 3 patients with endogenous endophthalmitis secondary to methicillin resistant staphylococcus aureus (MRSA) septicaemia. METHODS: Retrospective review of case records of 3 patients who were treated for endogenous endophthalmitis secondary to MRSA septicaemia in a tertiary referral institution. RESULTS: All three patients had systemic predisposition to endogenous endophthalmitis (diabetes, urosepsis). Two patients presented within 1 week of onset of visual symptoms and the third after 3 months. Blood culture was positive for MRSA in all patients. Visual and anatomical improvement was noted in two patients who presented early. The third patient's visual outcome despite early treatment with intravitreal antibiotics and vitrectomy was not satisfactory. CONCLUSION: Endogenous endophthalmitis by MRSA is a rare but serious condition. Early and specific therapy based on reliable detection of the underlying microorganism is needed for good anatomical and functional outcome.

A novel screening tool (Karanth's test) for vitamin B12 deficiency: a pilot study.

BACKGROUND: No practical tests are currently available for screening vitamin B12 deficiency because the available techniques are invasive, expensive, and require a particular level of infrastructure and service that is not available in all places such as rural areas. Thus, we have examined the efficacy of a novel method (Karanth's test) for identifying people with vitamin B12 deficiency as part of a pilot study. METHODS: An observer-blind study was conducted on 83 consenting patients from a tertiary teaching hospital whose blood was drawn for estimation of serum vitamin B12 over a 2-month period. All of these patients completed the study. In the Karanth's test, the skin color tone is measured at the interphalangeal joint and the phalanx using the Von Luschan skin tone chart. The test result is obtained from differences in the values obtained. This test was performed on the day blood was drawn to measure the serum vitamin B12 levels in the study patients and on every day until discharge for patients tested to be deficient. RESULTS: Of the 83 patient subjects, 20 showed deficient vitamin B12 levels in the blood test. The Karanth's test readings were significantly different for patients with normal and deficient levels of vitamin B12 (95 % CI, 0.838-2.153). ROC curve analysis suggested that a difference greater than 1.5 should be considered positive. The sensitivity and specificity of the test were determined to be 80 and 84.1 %, respectively. Patients were grouped further according to the Fitzpatrick scale. There were no type I, II or III patients and insufficient IV cases to determine sensitivity and specificity. Sensitivity and specificity were determined to be 57.1 and 94.6 % in type V and 92 and 63.6 % in type VI, respectively. We found that 87 % of our patients who tested positive had normal values on discharge. CONCLUSION: The Karanth's test is a useful screen for a vitamin B12 deficiency and warrants further evaluation in a larger study population.

Sitagliptin-induced hemolysis.

Sitagliptin is a newer oral hypoglycemic drug of the dipeptidyl peptidase-IV inhibitor class. It appears to be a promising newer oral hypoglycemic agent. The advantages are the absence of hypoglycemia when used as monotherapy and they cause less gain weight. We report a case of sitagliptin-induced hemolysis, a rare side effect, not reported in the literature. As sitagliptin is widely used in type 2 diabetes mellitus physicians should be aware of the possibility of this rare but potentially serious adverse drug reaction.