Anirban Sarkar

Gender differences in notification rates, clinical forms and treatment outcome of tuberculosis patients under the RNTCP

Introduction: An increased notification rate of tuberculosis (TB) in men is seen in the SAARC region. In India, the Revised National Tuberculosis Control Programme (RNTCP) detects nearly three times more male than female TB patients. Gender differences have also been reported in the clinical forms of tuberculous disease and in treatment adherence and cure rates in patients undergoing treatment for tuberculosis. The present study was undertaken to find out the sex differences in the notification rates and treatment outcomes of TB patients registered under the RNTCP in a rural tuberculosis unit (TU) in West Bengal. Materials and Methods: A retrospective record-based study was carried out among a total of 3605 cases registered under the RNTCP between January 1999 and June 2005. Notification rates of TB, clinical forms of TB and disease treatment outcomes recorded in the registers were analyzed based on genders. Outcomes were defined in accordance with the standard RNTCP definitions. The Z-test for proportion (for comparing differences in proportions), Student t-test (for comparing mean), and χ2 test (to see association) were performed for statistical analysis. Results: Among the total of 3605 patients, 2498 (69.3%) were male and 1107 (30.7%) were female with a male female ratio of 2.25:1. In patients less than 20 years of age, the notification rates among males and females were similar. In the other age groups, males were more likely to be notified compared to females and the difference was statistically significant. While new smear positive and retreatment cases were significantly more than in males, among females, new smear negative and new extrapulmonary cases were significantly higher. Among the new smear positive patients 89.4% of females were cured compared to 85.8% of males which was again significant statistically (Z=1.70, P<0.05). Male patients outnumbered females in all the unfavorable outcomes like death, failure, and default although none of the differences were statistically significant (P>0.05). Conclusion: The present study demonstrates a gender difference in the notification rates, clinical presentations and treatment outcomes of patients with tuberculosis. Integrated research is necessary to find the reasons for these differences. Such studies will be helpful in improving the efficacy of the RNTCP.

Unilateral pulmonary agenesis presenting in adulthood

Agenesis of lung,a rare congenital anomaly,may present in adult life with features of recurrent chest infections and radiologically may mimic many common conditions presenting as opaque hemithorax with ipsilateral shifting of mediastinum.Here, a case of a young man presenting with frequent attacks of cough expectoration and progressive dyspnoea since childhood,proved to be a case of left pulmonary agenesis on CT scan and bronchoscopy, is to be discussed.

Occurrence of allergic bronchopulmonary mycosis in patients with asthma: An Eastern India experience.

Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi notably Aspergillus spp. that colonize the airways of asthmatics. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Aims: To study the occurrence of ABPM among asthma patients with fungal sensitization attending a chest clinic of a tertiary hospital of eastern India. The clinico-radiological and aetiological profiles are also described. Materials and Methods: All consecutive patients with asthma presenting to the chest clinic over a period of one year were screened for cutaneous hypersensitivity to 12 common fungal antigens. The skin test positive cases were further evaluated for ABPM using standard criteria. Results: One hundred and twenty-six asthma patients were screened using twelve common fungal antigens; forty patients (31.74%) were found to be skin test positive, and ABPM was diagnosed in ten patients (7.93%). Of the 10 cases of ABPM, nine cases were those of allergic bronchopulmonary aspergillosis (ABPA) and one case was identified as caused by sensitization to Penicillium spp. A majority of the cases of ABPM had advanced disease and had significantly lower FEV1 compared to non-ABPM skin test positive asthmatics. Central bronchiectasis on high resolution CT scan was the most sensitive and specific among the diagnostic parameters. Conclusion: There is a significant prevalence of ABPM in asthma patients attending our hospital and this reinforces the need to screen asthma patients for fungal sensitisation. This will help in early diagnosis and prevention of irreversible lung damage.

Pancoast syndrome: A rare presentation of non‑Hodgkin's lymphoma

Pancoast syndrome is a common presentation of bronchogenic carcinoma, but other malignancies are rarely cited as its cause. Pancoast syndrome due to non-Hodgkins lymphoma is rarely described in the literature. Here, we report a case of Pancoast syndrome due to non-Hodgkins lymphoma to increase the awareness of the clinicians regarding essentiality of tissue diagnosis of Pancoast tumor before starting the treatment.

A rare case of pleural lymphoma.

We present a case report of a 20 years old male who had low grade fever, weight loss of about 10 kg and left-sided chest pain increasing in intensity over a year. Clinically, it mimicked left sided pleural effusion with a tender, soft, parietal swelling in left in-fraaxillary area. Chest x-ray and Computerized Tomography-scan of thorax showed pleura based mass in left hemi thorax. Computerized Tomography guided Fine Needle Aspiration Cytology confirmed the diagnosis of non Hodgkin Lymphoma, diffuse large B cell type, high-grade.

Diagnosis of three cases of endobronchial tuberculosis presenting as unresolved pneumonia, following fiberoptic bronchoscopic biopsy

Nowadays, endobronchial tuberculosis is of rare occurrence. This article presents three such cases. All of them presented as unresolved pneumonia with collapse-consolidation in chest X-ray. All the three patients were sputum smear negative for acid fast bacilli. Diagnosis was possible only with fiberoptic bronchoscopy and bronchial biopsy.