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Background: The Revised National Tuberculosis Control programme (RNTCP), India. Aim: To assess the impact of the expansion of the RNTCP in the case detection and treatment outcome. Materials and Methods: Reports of patients with tuberculosis (TB) diagnosed and treated under RNTCP from 2001 to 2005 under Bagbazar TB unit (TU), Kolkata, reviewed retrospectively. Results: Of 2814 cases registered between 2001 and 2005, 1268 were new smear-positive pulmonary TB (PTB), 308 were new smear-negative PTB and 536 were new extrapulmonary TB (EPTB). During that period, the new smear-positive case detection rate increased from 41 to 61 per lakh population, the annual total case detection rate increased from 87 to 142 per lakh and the treatment success rate reduced from 90% to 76%. The default and failure rates increased from 7% to 10% and from 3% to 10%, respectively. Conclusion: A steady increase was observed in the annual total case detection rate and annual new smear-positive case detection rate from 2001 to 2005, but the 3-month conversion rate and cure rate of new smear-positive patients were progressively decreased. Default rate and treatment failure rate of new smear-positive patients were also increased. So it needs extra attention and evaluation of this disappointing treatment outcome.

Tagami et al. [1], in their retrospective analysis, have contributed to further understanding of the use of corticosteroids in severe community-acquired pneumonia (CAP) and put forth an inference on the current dispute. Some issues, however, need further discussion. Defining low-dose corticosteroid in severe community-acquired pneumonia

The study by Clasen and colleagues does not have enough evidence for the effectiveness of the sanitation programme, but denotes the clear message that the health benefi ts might not be assumed only by construction of latrines. We doctors, having grown up in villages of Odisha, are aware of the practice of many people using latrines initially and then moving to a nearby pond to clean their anal orifi ce with their hand. These practices lead to contaminate water, hands, and soil. Poor adherence to toilet use at home can also be attributed to the traditional habit of defecating in the open air while visiting fi eld crops. Many children aged 6–18 months defecate on the fl oor and then take their contaminated fi ngers to their mouth. Transformation of sanitation-related knowledge into routine practice is hindered by traditional mindsets and the absence of awareness and an attitude to learn. Poverty has been described as a barrier to following safe hygiene practices. Regular use of footwear is equally important for the prevention of soil-transmitted helminth infection. Personal and domestic hygiene practices are difficult to improve without upgrading basic amenities, such as water supply, waste water disposal, and solid waste management. Health education could be a very promising approach to improve awareness and encourage the adoption of good hygienic practice. The integration of health education and practice to fi ll the gaps of understanding of what works and what does not work is needed. We also need to keep focused on the important task of winning the battle for rural sanitation.

Vorselaars et al. [1] have shown infliximab, a monoclonal antibody against tumour necrosis factor (TNF), to be an effective agent in the treatment of refractory sarcoidosis. We put forth some issues that are worth discussing among scientific societies. Diagnosis and treatment of FDG PET-positive sarcoidosis with infliximab needs caution, especially in TB endemic areas

Background: Pleural effusion remains the most common manifestation of pleural pathology. Sometimes it is difficult to differentiate between tubercular and malignant pleural effusion in spite of routine biochemical and cytological examination of pleural fluid. Aims: This study aims to evaluate the role of pleural biopsy to determine the etiology of pleural effusion and to correlate it with the biochemical and cytological parameters of pleural fluid. Settings and Design: Seventy two consecutive patients of pleural effusion were selected from the out patient and indoor department of a tertiary hospital of Kolkata. It was a prospective and observational study conducted over a period of one year. Materials and Methods: Biochemical, cytological and microbiological evaluation of pleural fluid was done in all cases. Those with exudative pleural effusions underwent pleural biopsy by Abram′s needle. Subsequently, the etiology of effusion was determined. Results: Malignancy was the most common etiology, followed by tuberculosis. Pleural biopsy was done in 72 patients. Pleural tissue was obtained in 62 cases. Malignancy was diagnosed in 24, tuberculosis in 20 and non-specific inflammation in 18, on histopathological examination. Out of 20 histological proven tuberculosis cases adenosine de-aminase (ADA) was more than 70 u/l in 11 cases. Conclusions: In our study, malignancy is more common than tuberculosis, particularly in elderly. When thoracoscope is not available, pleural fluid cytology and pleural biopsy can give definite diagnosis. Pleural fluid ADA ≥ 70 u/l is almost diagnostic of tuberculosis, where pleural biopsy is not recommended.

Hughes et al. [1] should be commended for their interesting short study on evaluating the efficacy of linezolid in drug-resistant tuberculosis (TB). However, there are some points of concern that need to be discussed. A recent systematic review and meta-analysis cautions the use of linezolid in multidrug-resistant (MDR) TB because of the frequency and severity of adverse events ( i.e. peripheral and optic neuropathy, myelosuppression and gastrointestinal disorders), despite its excellent efficacy. This robust study recommends the use of linezolid in only severe and difficult-to-treat cases but under strict supervision [2]. The use of linezolid should be preserved for XDR-TB and complicated drug-resistant-TB only

Lahousse et al. [1] have conducted an interesting study to investigate the association of chronic obstructive pulmonary disease (COPD) with various gait domains and explored a potential risk with falling. They have stressed the temporal gait parameter (rhythm) and have concluded that people who fall with COPD had worse rhythm. However, they have not tried to evaluate the other probable causes of disturbed rhythm in their subjects. The causes resulting in falls or disordered rhythm in COPD patients, could also be present primarily in the musculoskeletal and neurological systems because most of the subjects enrolled in the study were elderly, and problems related to musculoskeletal and neurological systems are more common in an elderly population [2]. The exclusion of such groups of people from the study has not been mentioned in the exclusion criteria. There were 152 participants with physical inability but the nature of physical inability is obscure. It would have been more rational or rather elucidative to assess other probable causes resulting in falls or decreased cadence in such elderly population with COPD. Association of poor gait and falling in Rotterdam study may be due to factors that were not considered

Context: Non-resolving pneumonia is often an area of concern for pulmonologists. Fiber optic bronchoscopy (FOB) may have a special role in etiologic evaluation of non-resolving pneumonias. There is paucity of recent studies in this field. Aims: This study aimed to assess the patients of non-resolving or slowly resolving pneumonia with special emphasis on efficacy of FOB and computed tomography (CT)-guided fine needle aspiration cytology (FNAC) in diagnosis. Settings and Design: Prospective, observational study conducted in a tertiary care institute over a period of one year. Materials and Methods: After fulfilling the definition of non-resolving pneumonia by clinical and radiological parameters, patients were evaluated by FOB with relevant microbiological, cytological, histopathological investigations and CT scan of thorax. CT-guided FNAC was done in selected cases where FOB was inconclusive. Results: Sixty patients were enrolled in the study. Mean age was 51.33 ± 1.71 years with male to female ratio 2:1. Right lung was more commonly involved (65%), and right upper lobe was the commonest site (25%). Pyogenic infection was the commonest etiology (53.3%), bronchogenic carcinoma and tuberculosis accounted for 26.7% and 16.7% cases, respectively. Both, FOB (85.7%) and CT-guided FNAC (91.67%) were very useful for etiological diagnosis of non-resolving pneumonia. Both the procedures were safe, and no major complication was observed. Conclusions: Because of the high yield of FOB, it is very useful and safe diagnostic tool for evaluation of non-resolving pneumonia. CT-guided FNAC also gives good yield when cases are properly selected.

Reexpansion pulmonary edema (RPE) is an important cause of unilateral pulmonary edema that rarely occurs following drainage of pleural effusion or pneumothorax. Most patients develop symptoms within an hour of lung expansion. The presentation is usually rapid and dramatic and may be fatal at times. The duration of lung collapse more than 3 days, large-size pneumothorax, rapidity of lung expansion, and application of negative pleural suction are well-known risk factors for the development of RPE. We present here an elderly male with diabetes mellitus who presented with a large pneumothorax and developed RPE shortly after insertion of a chest tube.

Occurrence of concurrent multiple primary malignancies with different histopathological presentations of the same organ at the same time is often not diagnosed and rarely reported in the literature. We present a case of multiple primary lung cancers with hepatic metastasis where the patient had a moderately differentiated adenocarcinoma of the right lower lobe and a moderately differentiated squamous cell carcinoma of the right upper lobe.

A 70-years-old male presented with blackening of both hands and face for last six months which was progressive and attended dermatology outpatients department. Dermatologist opined the skin lesions as acanthosis nigricans. He was referred to our department to evaluate for any underlying internal malignancy as he was a smoker. His chest X-ray revealed right sided hilar prominence with a mid zone cavity with fluid level. Fibreoptic bronchoscopy was done, there was one ulcerative growth in right middle lobe bronchus. Biopsy from the ulcer revealed probable squamous cell carcinoma. CT scan of thorax was also done and CT guided FNAC of Rt lung lesion yielded non small cell carcinoma. His skin lesions were also biopsied and diagnosis of acanthosis nigricans was confirmed. Here we report a case of acanthosis nigricans associated with non-small cell cancer of lung.

A 34-year-old male presented with right sided chest pain, shortness of breath and a swelling over his left foot. Chest radiology revealed a mass lesion in the right middle lobe which on CT guided biopsy showed features of spindle cell sarcoma. Surgical excision of both the lung and foot masses were done, both of which on histopathological examination proved to be spindle cell sarcoma.

Context: Prevalence of tuberculous pleural effusion is very high in the Asian subcontinent but very few studies have come up from this part of the world about the course of recovery of pulmonary functions after institution of anti-tubercular therapy (ATT) and thoracentesis. Aims: To study initial lung function impairment, changes over time after institution of ATT and thoracentesis and residual abnormalities left at the end of six months of treatment. Settings and Design: Randomized open level interventional study over two years in 52 patients at a tertiary level teaching hospital. Methods: The study population was divided into two equal groups, A (therapeutic thoracentesis) and B (diagnostic thoracentesis). Spirometry, chest radiograph and ultrasonography of thorax were done initially and at each follow-up visit up to six months. Statistical analysis was done (P value < 0.05 considered significant). Results: Both groups were comparable initially. After six months none in group A and five patients in group B had minimal pleural effusion. During follow up, mean percentage predicted of FEV1 and FVC increased more in A than in B and the differences were statistically significant (P < 0.05). Pleural thickening, initially absent in both groups, was found to be more in B as compared to A at subsequent follow-up visits and this was statistically significant (P < 0.05). Conclusions: Thoracentesis should be considered in addition to anti-TB treatment, especially in large effusions, in order to relieve dyspnea, avoid possibility of residual pleural thickening and risk of developing restrictive functional impairment.

Background : Sputum for acid fast bacilli (AFB) is seldom looked for in the etiological diagnosis of tuberculous pleural effusion usually due to the absence of any parenchymal lesion radiologically, but presence of tubercle bacilli in sputum may have important epidemiological and therapeutic implication. Aims : This study aims to evaluate the role of sputum examination for AFB in the patients of tuberculous pleural effusion with no apparent lung parenchymal lesion radiologically. Settings and Design : Forty-five consecutive indoor patients of suspected tuberculous pleural effusion having no apparent lung parenchymal lesion on chest radiography were selected for our study. It was a prospective and observational study conducted over a period of 1 year. Materials and Methods : After confirming the etiology of pleural effusion as tuberculous by biochemical, cytological, histopahtological, and microbiological tests, emphasis was given on sputum examination for AFB by smear examination and culture for Mycobacterium tuberculosis. Results : Sputum was bacteriologically (smear and /or culture) positive for tuberculosis in 10 out of 30 cases (33.33%) in which tuberculous etiology was confirmed by histology and /or bacteriology (definite tuberculosis). No sputum AFB (smear and culture) was found in 15 cases of probable tuberculosis where tuberculous etiology was established by indirect methods like Adenosine de aminase level more than 40 unit/l and other relevant investigations. Over all, sputum was bacteriologically smear and/or culture positive in 10 out of 45 cases (22.22%). Conclusion : Careful and thorough sputum examination in cases of tuberculous pleural effusion may help as a diagnostic tool and it has therapeutic and epidemiological implications.