Extent of delay in diagnosis in new smear positive patients of pulmonary tuberculosis attending tertiary care hospital

India is the highest tuberculosis [TB] burden country accounting for one-fifth of the global incidence. It is estimated that, annually, 1.9 million cases are from India and about 0.8 million are infectious, new smear, positive pulmonary TB cases. The present study was a cross-sectional study conducted in a tertiary care hospital to determine the extent of delay in diagnosis and initiating the treatment after diagnosis in new smear, positive pulmonary TB patients attending a tertiary care hospital of Haryana during a 1-year period. A total of 204 patients were interviewed after being diagnosed as new sputum, positive TB [NSP-TB] by the treating doctor at the tertiary care hospital and re-interviewed at their home after initiation of anti-TB treatment. Chi-square test and analysis of variance [ANOVA] were used for statistical analysis. More than half of the study patients delayed their first consultation with a health care system. The mean and median patient delay was 32.97 and 16 days, respectively. Lack of awareness of the disease was the leading cause for the patient delay. The mean duration of delay at peripheral health care provider was 60.46 days. The mean and median delay at tertiary care hospital was 8.35 and 4 days, respectively. Most of the patients delayed for diagnosis as per revised national TB control program [RNTCP] guidelines. The mean total delay in diagnosis was 75.71 days. There is an urgent need to scale up the information education communication activities to decrease the patient delay. Doctor at all level of health care need to be actively involved for subjecting the suspects to sputum examination at the earliest possible, as per RNTCP guidelines

Massive subcutaneous emphysema secondary to rigid bronchoscopy in a child

Massive subcutaneous emphysema is a rare complication of interventional bronchoscopy. Complications reported include laryngeal and bronchial spasm, hematorrhea, arrhythmia, airway obstruction, tracheoesophageal fistula, and pneumothorax. Massive subcutaneous emphysema is a rare complication of rigid bronchoscopy. There has been no case report mentioned in the literature till date to the best of our knowledge. We report an eighteen months old female child who developed emphysema involving upper third of her chest, neck and face after rigid bronchoscopy, which increased progressively threatening closure of the airways but was successfully managed conservatively. The details of this case and the management are discussed