The Rare Imitator : Pulmonary Nocardiosis Mimics Tuberculosis Reactivation

Pulmonary Nocardiosis is a rare bacterial infection of lungs, caused by a filamentous bacterium. Immunocompromised people are known to be at danger, but there are other new emerging risk factors to consider. The presentation and clinical course in such patients differ from the previous. Here the present case is aimed to underline the presentation and diagnosis in non-risk individual.

Gross Congenital Malformation at Birth in a Government Hospital.

A hospital-based cross-sectional study was undertaken to determine proportion of gross congenital malformation (GCMF) occurring at intramural births. Rate of GCMF was found to be 16.4/1000 consecutive singleton births (>28 weeks) with three leading malformation as anencephaly (44.68%), talipes equinovarus (17.02%) and meningomyelocele (10.63%). Higher risk of malformed births were noticed amongst un-booked (2.07%) in-comparison to booked (1.01%) mothers; women with low level of education (up to 8 years [2.14%] vs. at least 9 years of schooling [0.82%]); gravida status of at least 3 (2.69%) followed by 1 (1.43%) and 2 (1.0%) respectively; pre-term (5.13%) vs. term (0.66%); cesarean section (4.36%) versus vaginal delivery (0.62%). Mortality was signifi cantly higher among congenitally malformed (17.35%) than normal (0.34%) newborns. With-in study limitation, emergence of neural tube defect as the single largest category of congenital malformation indicates maternal malnutrition (especially folic acid) that needs appropriate attention and management.

Proportion of Hospitalization at a Respiratory Centre Under RNTCP.

Objective: To determine proportion of patients requiring hospitalization under RNCTP. Methodology:All area-patients registered for treatment under RNTCP at LRS Institute, New Delhi through 16 DOTS centre during the reference period (1st April 2006 to 31st Dec 2006) were listed and those patients requiring hospitalization (upto 31st Dec 2007) at LRS Institute were identified and interviewed by a single investigator using semi-structured proforma with certain inclusion and exclusion criteria’s. The data was entered into master sheet and analysis carried out using software statistical package by computing proportion (%) and chi-square test. Results: It was observed that there were 2,345 patients registered for treatment under RNTCP during the reference period, out of which, 4.22% (99) required hospitalization. The males outnumbered females in absolute numbers, however, gender related hospitalization was similar, 4.08% for males to 4.47% for females (p=0.647). Maximum case load (75.75%) was seen in economically productive age group (15-49 years). The proportion of hospitalization amongst 1- 14, 15-49, 50-60 and 61 years & above age group was 2.36%, 4.10%, 5.11% and 8.60% respectively (p=0.08); category II (7.61%) patient admissions was twice than category I (3.65%) patients (p<0.001). The proportion of hospitalization was 2.37% and 5.4% amongst patients with negative and positive sputum status respectively. Conclusion: The study was undertaken at a respiratory tertiary care centre in a metro city and within the study constraints it highlights disease severity, late presentation and minimum need for TB beds under prevailing socio-economic circumstances in the country.

Solitary fibrous tumour of lung.

Fibrous tumours arising entirely within the substance of the lung are rare. We report one such rare case in whom the diagnosis was established after surgical removal.

Prescription pattern of tuberculin skin test (TST) in a teaching hospital.

Background: Tuberculin skin test (TST) is one of the tools for the identification of latent tubercular infection and is an ancillary test for diagnosis of active tuberculosis. Aims & Objective: The objective of this study was to assess specialty department wise prescription of Tuberculin Skin Test (TST) in a government teaching hospital. Material and Methods: Considering resource constraint and feasibility, one month was randomly selected during 2012 and two working days in each week were systematically covered i.e. Mon-Tue (first week), Wed-Thus (second week), Fri-Sat (third week) and again Mon-Tue (fourth week). Selected information of all patients reporting to receive TST on these days was recorded on a pre-structured proforma. TST was administered by a single investigator using standard protocol and results observed between 48-72 hours. Results: A total of 372 ambulatory suspect TB patients reported to received TST with mean age of 25 years (±18.13); female constituted 52.4%. Specialty department wise prescription of TST was as follows: paediatrics (29.3%); general medicine (18.0%); OBG (15.9%); surgery (12.9%); chest and TB (11.3%), orthopaedics (8.1%) and others (4.6%). The results of 227 (61.02%) patients who returned for follow up were grouped into < 10 mm (54.0%) and ≥ 10 mm (45.79%). Conclusion: Proportion of age distribution of patients in study sample was found to be similar in comparison to population structure of India. Paediatric (up to 14 years) patients were in majority (29.3%) amongst study samples where TST results could be of some significance.