Background and Objectives: Tracheoesophageal/bronchoesophageal fistula is a rare clinical condition, and occurs due to a variety of disease processes. This report describes the clinical profile, management, and outcome of bronchoesophageal fistulas due to tuberculosis in five patients. Patients and Methods: Patients diagnosed with esophageal tuberculosis over the last eight years were included. Details regarding the demographics, symptomatology, barium swallow, upper GI endoscopy, with biopsy and high resolution computed tomography of the chest were recorded for patients with tracheoesophageal fistula. The diagnosis was confirmed by acid fast bacilli (AFB) positive fluid aspirate/brush cytology from the fistula, lymph node biopsy showing caseous necrosis or AFB bacillus and tissue tuberculosis culture and polymerase chain reaction (PCR). Results: There were five patients (four males and one female) with a mean age of 43.8 ± 17 years (range, 17 to 59 years). The mean duration of symptoms was 38 ± 7 days. The most common symptom was coughing on swallowing followed by dysphagia. Two patients had concomitant pulmonary tuberculosis; two had human immunodeficiency virus (HIV) infection, and one was a post-renal transplant. The diagnosis of tuberculosis was established in all five patients with esophageal cytology, lymph node biopsy, and tissue tuberculosis PCR. All the patients were successfully treated with a combination of antituberculous drugs (five patients), glue application on fistula (one patient), Percutaneous endoscopic gastrostomy (PEG) tube insertion (three patients), and surgery (one patient). Conclusions: Tuberculous bronchoesophageal fistula is a rare complication and can be successfully managed predominatly with a combination of antituberculous treatment, PEG tube placement, and rarely surgery.

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Introduction: Inflammation has been associated with tumor proliferation and metastasis in breast cancer. Yoga is an ancient therapy that helps in reducing inflammation and improves the patient's quality of life (QoL) and fatigue. In the current study, we investigated the effects of long-term yogic intervention at different time points on the level of inflammatory cytokines and oxidative stress, along with the symptomatic scale and QoL in stage II/III breast cancer patients.Methods: Ninety-six stage II/III breast cancer patients receiving chemotherapy and/or radiotherapy were enrolled and divided into two groups, non-yoga (Group I) and yoga (Group II). Participants in Group II practiced yoga five days per week for 48 weeks. The European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC-QLQ30) was used to measure the QoL and symptomatic scale. Serum levels of pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α), interferon-γ (IFN-γ) and granulocyte macrophage colony-stimulating factor (GM-CSF), and oxidative stress markers, superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), and nitric oxide (NO) were measured at baseline, 16, 32, and 48 weeks in both groups.Results: Yoga significantly (p<0.05) reduced the level of IFN-γ, TNF-α, and MDA and improved QoL (p<0.001) and symptomatic scale (p<0.05) in Group II patients compared to Group I. NO was upregulated in Group I whereas in Group II, it was neither decreased nor increased.Conclusion: These findings suggest that yoga may reduce levels of inflammatory cytokines and improve QoL and symptomatic scale in breast cancer patients receiving chemotherapy and/or radiotherapy. Yoga can be an important additional therapy during cancer treatments to cope with treatment side effects including fatigue, depression, and immunological profile, which directly affects the patient's quality of life.

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To the Editor: Down syndrome (DS) is the most common chromosomal abnormality with a prevalence of 1.72 per 1,000 total births [1]. The congenital anomalies in Down syndrome can involve any system with varying degree of severity and thus, requires active referral on part of clinician to improve the standard of care in such group of DS patients. At present, screening for renal and urinary tract anomalies is not standard care during the initial evaluation of newborns with DS. To answer this question, we undertook the present study to look for structural anomalies of kidney and urinary tract in cases with Down syndrome. Forty children with chromosomal diagnosis of Down syndrome were enroled in the study over a period of two months. The age group of patients was birth to 18 y. All patients were screened for any urinary complaints according to predesigned performa. Subjects were further evaluated by ultrasonography of kidney, ureter, and bladder region (KUB) for any structural anomalies. Further DTPA scan, micturating cystourethrography (MCU) were performed in cases where it was indicated. Frequency of urinary symptoms in decreasing order were dysuria (11/40), increased frequency (7/40), incontinence (6/40), hesitancy (6/40), poor urinary stream (3/40), hematuria (2/40) and post micturition dribbling (2/40). Incidence of Renal and Urinary Tract Anomalies (RUTA) were hydronephrosis (20 %), renal parenchymal thickening, dilatation of ureter, renal hypoplasia, vesicoureteric reflux, pelvi-ureteric junction obstruction, renal calculi and neurogenic bladder as seen in previous studies [2,3].Unlike previous studies, we found a high prevalence of RUTAs in DS pediatric population, supporting our hypothesis [4,5]. The higher incidence of RUTA in our study may be attributed to small sample size and limited screening of DS patients brought to health facility. Another limitation of our study is that we did not include the derangements in kidney function test and pathological findings like renal hypoplasia, immature glomeruli and tubular dilation. Despite these limitations, our study points to significant abnormality in KUB region of these patients. This needs to be further authenticated by a large population based study so that clinical guidelines are formulated for better care of DS patients in resource poor countries like ours.