Botryomycosis in a lung cavity

Botryomycosis is a rare pyogranulomatous disease characterized by suppurative and often granulomatous bacterial infection of the skin, soft tissues and viscera. Only about 90 cases have been reported in world literature till date: 75% of them are cases of cutaneous botryomycosis. Of the 18 reported cases of primary pulmonary botryomycosis, only one had histologically proven botryomycosis in a lung cavity. We report here a case of primary pulmonary botryomycosis occurring in a lung cavity, which is to the best of our knowledge first such case from India. The index case was a 62 year old female who presented to us with recurrent episodes of non-massive streaky hemoptysis with CT chest revealing 'Air Crescent' sign with a probable fungal ball in a left upper lobe cavity. Left upper pulmonary lobectomy was done and histopathology of the cavitary tissue revealed Splendore-Hoeppli phenomenon and features suggestive of Botryomycosis. Tissue culture from the cavitary specimen grew Pseudomonas aeruginosa. Botryomycosis can mimic Aspergilloma radiologically as was seen in our case, but therapy is often a combination of both medical and surgical measures unlike Aspergilloma.

Ergonomic implementation and work station design for quilt manufacturing unit

Background:

Awkward, extreme and repetitive postures have been associated with work related musculoskeletal disorders and injury to the lowerback of workers engaged in quilting manufacturing unit. Basically quilt are made manually by hand stitch and embroidery on the quilts which was done in squatting posture on the floor. Mending, stain removal, washing and packaging were some other associated work performed on wooden table. their work demands to maintain a continuous squatting posture which leads to various injuries related to low back and to calf muscles.

Material and Methods:

The present study was undertaken in Tarai Agroclimatic Zone of Udham Singh Nagar District of Uttarakhand State with the objective to study the physical and physiological parameters as well as the work station layout of the respondent engaged on quilt manufacturing unit. A total of 30 subjects were selected to study the drudgery involved in quilt making enterprise and to make the provision of technology option to reduce the drudgery as well as musculoskeletal disorders, thus enhancing the productivity and comfortability.

Results:

Findings of the investigation show that majority of workers (93.33 per cent) were female and very few (6.66 per cent) were the male with the mean age of 24.53±6.43. The body mass index and aerobic capacity (lit/min) values were found as 21.40±4.13 and 26.02±6.44 respectively. Forty per cent of the respondents were having the physical fitness index of high average whereas 33.33 per cent of the respondents had low average physical fitness. All the assessed activities involved to make the quilt included a number of the steps which were executed using two types of work station i.e squatting posture on floor and standing posture using wooden table. A comparative study of physiological parameters was also done in the existing conditions as well as in improved conditions by introducing low height chair and wooden spreader to hold the load of quilt while working, to improve the work posture of the worker. The average working heart rate values were found to reduced by performing the activity using improved technology followed by energy expenditure (6.99 kj/min), total cardiac cost of work (1037.95 beats), physiological cost of work (103.79 beats) and rate of perceived rate of exertion to the score of 2.6 Results of postural analysis that is change in motion at cervical region reveal that range of motion in case of extension was found beyond the normal range in existing setup where as it reduced to normal range in improved work station.

Conclusion:

The finding of the study concludes that to ensure safety and to reduce occupational health hazards while performing the activity, an ergonomically designed work station by introduction of improved technology option will be a right choice which also enhances the productivity.

Congenital adrenal hyperplasia - experience from a tertiary centre in South India

Congenital adrenal hyperplasia is a group of autosomal recessive disorders caused by enzyme deficiency which leads to defects in biosynthesis of steroid precursors. Most common is 21 hydroxylase deficiency. Clinical spectrum varies from non-classical CAH to classic CAH, and it may be simple virilising form or salt-wastinfg type. 29 patients were included in our study from January 2012 to October 2012. 76% were females. Male babies typically presented with adrenal crisis between 3(rd) to 6(th) week of life. Around 20% of females were identified and appropriately treated only after late adolescence. Short stature was seen in 1/3(rd) of patients. 1/3(rd) of patients had suppressed 17 OHP levels suggestive of over-replacement therapy which may contribute to final reduction in adult height.

Megaduodenum in a patient with acromegaly

INTRODUCTION

Acromegaly is associated with enlargement of all organs including the gastro intestinal system. However, there are no previous reports of occurrence of megaduodenum in patients with acromegaly.

DISCUSSION

We present the case of a 47 year old male who was diagnosed to have acromegaly 13 years ago and had undergone transsphenoidal surgery twice with incomplete removal of the pituitary macro-adenoma and received radiotherapy following the second surgery. Patient has been on replacement therapy for hypocortisolism, hypothyroidism and hypogonadism since 10 years. Post glucose growth hormone level continued to remain unsuppressed; however, patient never received any medical therapy for acromegaly. He was evaluated with esophago-gastro-duodenoscopy for recurrent abdominal pain and distension, which showed an elongated and tortuous megaduodenum. These findings were verified with a barium study which revealed dilated stomach, first and second part of duodenum with no evidence of a distal obstruction.

CONCLUSIONS

We report this finding in view of the rare association.