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.

Brucellosis presenting as pyrexia of unknown origin in an international traveller: a case report.

INTRODUCTION: In this era of globalization frequent traveling across the world is common. It has resulted in exchange of knowledge and expertise among medical professionals around the world which has a visible positive impact. However, this predisposes the travelers to the risk of acquiring an 'alien' disease endemic to a particular country. This may be a great challenge for the treating physicians to manage such patients due to lack of facility for diagnosis and experience in handling such disease. We present a similar case scenario and problems we faced in managing that patient. CASE PRESENTATION: A 40-year-old man visited to Africa, developed a skin rash over ankle after an insect bite. This was followed by high grade fever. He was investigated in Kenya, however, returned to India pending results. Later he developed sleepiness and coarse tremors. Work up for the cause of fever was inconclusive. He was diagnosed with trypanosomiasis based on reports from Kenya. In absence of alternate diagnosis and clinical setting, we treated him for trypanosomiasis. This therapy resulted no improvement in patient's condition. Finally, at request of the patient's attendants he was referred to Belgium where he was diagnosed as brucellosis and treated successfully. CONCLUSION: Our patient was indeed suffering from neurobrucellosis. Brucellosis is a frequently missed cause of pyrexia. Our case highlights that in this era, taking help from our professional colleagues over the globe is easy which can improve patient care greatly.