Long-Lasting Insecticidal Net Coverage and Utilization in Burla Town of Sambalpur District: A Cross-Sectional Study.

Background Vector-borne diseases continue to significantly contribute to mortality and morbidity, especially in developing nations. Vector management is a key pillar in combating these diseases, and long-lasting insecticidal nets (LLINs) are cost-effective tools. The Government of India, under the National Vector Borne Disease Control Programme (NVBDCP), has distributed LLINs for free to increase coverage and utilization. This study aims to estimate the coverage and utilization of LLINs in Burla town. Method This cross-sectional study was conducted from October to December 2022 in Burla town of Sambalpur in Odisha, India. The estimated sample size was 510 households, assuming 50% coverage. Multi-stage cluster sampling was adopted to select the Anganwadi centers and households. A pretested questionnaire was utilized for data collection by trained personnel through Epicollect5 (Centre for Genomic Pathogen Surveillance, Oxford, UK). Logistic regression was used to identify predictors for LLIN usage. Results The survey covered 516 households with 2,541 individuals and 1,165 nets. Household-level coverage was 94.2%, and regular utilization was 45.74%. Skin reactions (35.7%) were the most common reason for non-usage, followed by low mosquito density (12%). Logistic regression showed that the number of rooms (adjusted odds ratio (AOR) = 0.663, p = 0.012), number of bed nets (AOR = 2.757, p < 0.001), knowledge of malaria (AOR = 2.92, p = 0.04), adopting other measures for mosquito control (AOR = 0.295, p < 0.001), and washing the net (AOR = 1.92, p = 0.028) significantly predicted sleeping under mosquito net. Conclusion Our study has depicted high coverage of LLINs in Burla town, but utilization needs further improvement. Counseling regarding proper use can decrease the skin reactions responsible for non-usage. Regular health education programs are required to emphasize the benefits of LLIN use, along with regular monitoring and supervision.

Treatment outcome among Post TB obstructive airways diseases and COPD: A prospective cohort study.

CONTEXT: Post Tubercular Obstructive Airways Diseases (Post-TB OAD) is a sequela of Pulmonary TB but diseases progression may not same like Chronic Obstructive Pulmonary Diseases (COPD). AIM: To compare the frequency and severity of exacerbations, change of FEV1, frequency of hospitalization and mortality among COPD and post TB OAD patients. SETTING AND DESIGN: Hospital-based prospective cohort study. METHODS AND MATERIAL: COPD cohort was diagnosed based on symptoms, history of exposure to risk factors and post bronchodilator FEV1/FVC ratio <70%. Post TB OAD cohort was diagnosed like COPD along with past history of Pulmonary TB. Both cohorts were followed up every 3-monthly intervals for up to 12 months. STATISTICAL ANALYSIS: Comparison of categorical variable was done by Chi-square test and continuous variable by unpaired t test. Longitudinal data of FEV1% were analyzed by repeated measure ANOVA test. RESULTS: Totally, 68 patients with Post TB OAD and 66 COPD patients were taken into this study. The frequency of exacerbation (3.52 ± 1.84 verses 2.70 ± 1.37), number of severe exacerbation (56 verses 24) and frequency of hospitalization (1.37 ± 0.81 verses 0.97 ± 0.94) more seen in post-TB OAD cohort in compared to COPD cohort which is statistically significant. Mortality more seen in post-TB OAD group (14 verses 6). Rate of decline FEV1 per year more seen in Post-TB OAD (0.27 ± 0.28 lit verses 0.17 ± 0.26 liter) as compared to COPD. There was overall decreasing trend of FEV1% over period of 12 month but without any difference among two cohort. CONCLUSION: There was more in frequency of exacerbations, number of severe exacerbations, frequency of hospitalization and number of mortalities among post TB OAD compared to COPD.

Diagnosis and treatment of pulmonary tuberculosis in one day: Way forward for END TB Strategy 2015.

BACKGROUND: According to Revised National Tuberculosis Control Program (RNTCP), diagnosis of pulmonary tuberculosis (TB) in India requires examination of two sputum samples collected over 2 days, that is, "spot" and next day "morning" samples. OBJECTIVE: To assess the feasibility of diagnosing pulmonary TB by examining two spot sputum samples in 1 day and to compare this approach with the current RNTCP protocol. MATERIALS AND METHOD: A total of 375 subjects having cough >2 weeks were enrolled into the study. Three sputum samples were collected from each of the study participant; first spot (S1), second extra-spot (S2) sample 1 h after collection of the first sample, and third morning (M) sample collected next day morning. These specimens were subjected to standard sputum smear microscopy for acid-fast bacilli as per RNTCP guidelines. For 1-day protocol, results of "S1 and S2" samples and for 2-day protocol results of "S1 and M" samples were considered. RESULTS: The number of sputum-positive pulmonary TB cases diagnosed with standard 2-day protocol was 119, whereas the experimental 1-day protocol diagnosed 120 cases (P = 0.7). Comparing with standard 2-day protocol, this new 1-day protocol had sensitivity 98.32%, specificity 100%, positive predictive value 100%, and negative predictive value 99.17%. CONCLUSION: Single-day method can be adopted as the standard diagnostic approach for pulmonary TB after large-scale multicenter randomized controlled trials.

Primary pulmonary synovial sarcoma: A reappraisal.

Synovial sarcoma (SS) is a malignant mesenchymal tumor with variable epithelial differentiation that affects mostly young adults and can arise at any anatomic site. Primary intrathoracic SS is very rare accounting for <0.5% of all lung tumors. Most commonly, it arises from the lung followed by pleura and mediastinum. Primary pulmonary SS (PPSS) affects both sexes equally with no preference for any hemithorax. The morphology, immunostaining properties, cytogenetic features, and management strategy of PPSS are similar to that of soft tissue SS. Histologically, there are two main types of SS - monophasic and biphasic with a feature of poor differentiation seen in both types. Most patients present with large intrathoracic masses with or without ipsilateral pleural effusion. Bone invasion or mediastinal adenopathy is very rare. SS is characterized by a specific chromosomal translocation producing SS18-SSX fusion gene in more than 90% of cases. Identification of this fusion gene remains the gold standard for the diagnosis in the presence of consistent histology and immunophenotype. Multimodality treatment including wide excision, chemotherapy, and radiotherapy is the mainstay of therapy. SS is relatively chemosensitive, and ifosfamide-based regimen showed improved survival in metastatic disease. Generally, SS is considered as high-grade tumors with a poor prognosis. Novel therapies targeted at fusion oncogene, SS18-SSX-derived peptide vaccine, epidermal growth factor receptor, and vascular endothelial growth factor are the future hope in SS. We describe a prototype case and present an elaborate review on primary SS of lung.

Actively caseating endobronchial tuberculosis successfully treated with intermittent chemotherapy without corticosteroid: a report of 2 cases.

Tuberculous infection of the tracheobronchial tree confirmed by microbiological or histopathological evidence with or without parenchymal involvement is known as endobronchial tuberculosis. Chronic cough is the predominant symptom. Expectorated sputum examination for acid fast bacilli is often negative leading to delay in diagnosis. Therefore, bronchoscopy is crucial for early diagnosis and evaluation of the extent of disease. Bronchostenosis is a significant complication of endobronchial tuberculosis that may be present at the time of diagnosis or develops during the course of treatment. Previously, corticosteroids have been used along with antitubercular therapy to prevent or reduce the extent of bronchostenosis; however, their role is debatable as bronchostenosis often develops despite the use of corticosteroids. Furthermore, the duration of treatment varied from 6-9 months of daily therapy in previous series and little is known about efficacy of intermittent antituberculous therapy. Here we report two cases of actively caseating endobronchial tuberculosis successfully managed with six months of intermittent oral antitubercular therapy without corticosteroids.

Tracheal bronchus presenting with recurrent haemoptysis in an adult female.

Abnormal bronchus arising directly from the trachea or the main bronchus is a rare developmental anomaly of the tracheobronchial tree. In general, tracheal bronchus has been reported in less than 1% of adult patients undergoing bronchoscopy with a male predominance. Tracheal bronchus is classified as - 'displaced' and 'supernumerary', the former being the most common type reported. Most patients are asymptomatic; however, cases presenting with cough, haemoptysis or recurrent lung infections are not uncommon. The diagnosis is usually made through computed tomography or bronchoscopy. Awareness of this anomaly may help in timely identification or prevention of perioperative complications during general anaesthesia or resectional thoracic surgery. Herein we report a case of right-sided displaced tracheal bronchus in an adult female presenting with recurrent haemoptysis.

Pulmonary Strongyloidiasis Masquerading as Exacerbation of Chronic Obstructive Pulmonary Disease.

Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.

A case of systemic melioidosis: unravelling the etiology of chronic unexplained fever with multiple presentations.

Melioidosis, caused by the environmental saprophyte, Burkholderia pseudomallei, is an important public health problem in Southeast Asia and Northern Australia. It is being increasingly reported from other parts, including India, China, and North and South America expanding the endemic zone of the disease. We report a case of systemic melioidosis in a 58-year-old diabetic, occupationally-unexposed male patient, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute. A strong clinical and microbiological suspicion for melioidosis should be considered in the differential diagnosis of acute pyrexia of unknown origin, acute respiratory distress syndrome and acute onset of sepsis, especially in the tropics.