The time required to diagnose and treat lung cancer in Delhi, India: an updated experience of a public referral center

Background: Delays that postpone the evaluation and management of malignancy may lead to considerable morbidity. The primary objective of this study was to assess the time required to diagnose and treat lung cancer at an Indian public referral center that predominantly serves lower-income patients. Methods: A review of patients diagnosed with lung cancer between January 2008 and December 2016 was completed. We computed the median time intervals and inter-quartile ranges between symptom onset, definitive diagnostic investigation, confirmed histologic diagnosis, and chemotherapy initiation. Median intervals were correlated with baseline demographics and disease characteristics using Kruskal-Wallis test. Results: One thousand, three hundred and-seventy patients were selected. A majority (94.5%) with non-small cell lung cancer were diagnosed with advanced disease. After developing symptoms, patients required 101 [56­168] days to undergo a definitive diagnostic study, 107 [60­173] days to confirm a diagnosis, and 126 [85­196.8] days to initiate treatment. Patients who were previously treated for tuberculosis required more time to receive chemotherapy compared to those who were not (187 [134­261.5] days vs. 113 [75­180] days, p < 0.0001). A specialty Lung Cancer Clinic was implemented in 2012, and the mean referrals per month increased nearly four-fold (p < 0.0001), but the time required to administer treatment was not shortened. Conclusion: Among lower-income Indian patients, the most prominent delays occur prior to diagnosis. Efforts should be directed toward encouraging physicians to maintain a high index of clinical suspicion and educating patients to report concerning symptoms as early as possible.

Effective Diagnostic Techniques in the Identification of Medically Important Fungi: A Developing World Perspective

Aims: To review current and effective techniques of identifying fungi as against the error prone traditional methods being solely depended on by the developing world and recommend steps to improve fungi identification. Fungi are eukaryotes with cell walls composed of chitin with or without cellulose. They are ubiquitous and are estimated to be over 250,000 species, of which about 150 have been shown to cause disease in humans. These species that cause disease in humans are regarded as medically important fungi and are of six categories namely zygomycetes, hyalohyphomyces, dematiaceous fungi, dermatophytes, dimorphic fungi and yeasts. Accurate and rapid identification of pathogenic fungi is critical to disease treatment as the outcome borders on life or death. Traditional techniques in the identification of medically important fungi include the use of stains, macroscopic and microscopic morphology, biochemical tests, histopathology and antibody detection but are plagued with limitations which have necessitated the advancement of more effective techniques that address the limitations of the traditional methods. Three of these effective techniques currently in use in the developed science world are Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS), Loop Mediated Isothermal Amplification (LAMP) and Rolling Circle Amplification (RCA) techniques. For the developing world, identifying medically important fungi in order to intervene in treating their resultant infections is still a tedious and rudimentary task. The techniques, equipment and trained personnel is still on the “to do list” while the true culprits of fungi diseases remain unidentified or at best misidentified. Conclusion: The developing world needs to consciously move away from sole dependence on the traditional methods of identifying fungi by being innovative and align itself with current and effective identification methods in order to make a progressive impact in the fight against medically important fungi.

Results of the Treatment of Talar Neck Fractures in a West African Hospital

Talar neck fractures (TNFs) are complex injuries and treatment is fraught with complications. We retrospectively studied 18 patients with TNFs: 6 Hawkins type I, 7 type II, 4 type III, and 1 type IV. Five patients with type I and 2 with type II fractures were treated conservatively. The remaining 11 patients underwent operative treatment. Open reduction via posterolateral approach was performed in 10 patients while closed reduction was used in one patient. All operatively reduced fractures were stabilized