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Aim:To evaluate the utility of fiberoptic bronchoscopy in order to find out the etiology in various lung conditions.Materials and Methods:Fiberoptic bronchoscopy was performed in 120 adult patients who had persistent opacities on chest radiography in the form of collapse, consolidation, hilar mass and cavity with proper antibiotic course of 1 to 3 months. Bronchoscopic aspirates, brushing and biopsy (as and when required) were taken. Patient with known lung cancer, sputum positive pulmonary TB, recent myocardial infarction, allergic diseases and blood dyscrasias were excluded.Results:Fiberoptic bronchoscopy was diagnostic in 90 (75%) patients. Bacterial pneumonias were found in 32 (26.66%), malignancy in 28(23.33%), pulmonary TB in 20 (16.66%), fungal pneumonia in 6(5%) and foreign bodies in 4(3.33%) patients. In 30(25%) patients no specific diagnosis was made.Conclusion:We conclude that fiberoptic bronchoscopy was found to be extremely useful in finding specific etiology of various lung diseases.

Historically, economic studies on tuberculosis estimated out-of-pocket expenses related to tuberculosis treatment and catastrophic cost, however, no study has yet been conducted to understand the post-treatment economic conditions of the tuberculosis patients in India. In this paper, we add to this body of knowledge by examining the experiences of the tuberculosis patients from the onset of symptoms till one-year post-treatment. 829 adult drug-susceptible tuberculosis patients from general population and from two high risk groups: urban slum dwellers and tea garden families were interviewed during February 2019 to February 2021 at their intensive and continuation phases of treatment and about one-year post-treatment using adapted World Health Organization tuberculosis patient cost survey instrument. Interviews covered socio-economic conditions, employment status, income, out-of-pocket expenses and time spent for outpatient visits, hospitalization, drug-pick up, medical follow-ups, additional food, coping strategies, treatment outcome, identification of post-treatment symptoms and treatment for post-treatment sequalae/recurrent cases. All costs were calculated in 2020 Indian rupee (INR) and converted into US dollar (US$) (1 US$ = INR 74.132). Total cost of tuberculosis treatment since the onset of symptom till one-year post-treatment ranged from US$359 (Standard Deviation (SD) 744) to US$413 (SD 500) of which 32%-44% of costs incurred in pre-treatment phase and 7% in post-treatment phase. 29%-43% study participants reported having outstanding loan with average amount ranged from US$103 to US$261 during the post-treatment period. 20%-28% participants borrowed during post-treatment period and 7%-16% sold/mortgaged personal belongings. Therefore, economic impact of tuberculosis persists way beyond treatment completion. Major reasons of continued hardship were costs associated with initial tuberculosis treatment, unemployment, and reduced income. Therefore, policy priorities to reduce treatment cost and to protect patients from the economic consequences of the disease by ensuring job security, additional food support, better management of direct benefit transfer and improving coverage through medical insurances need consideration.

Background: Lung cancer is the commonest cancer mortality in the world. In targeted therapy era, precise cytohistological diagnosis is offered traditionally by FNAC, Cell Block (CB) and Core Needle Biopsy (CNB). However, little is known whether one technique is superior to other or all the three techniques complement each another. Therefore, this is a unique study as no other study has compared these techniques together till date. The objective of the study was to evaluate performance of FNAC, Cell block (CB) and Core Needle Biopsy (CNB) individually and comparing them with each other.Methods: This was a prospective study of 50 cases who underwent two passes-1st for FNAC smears and Cell Block and 2nd for CNB.Results: Material was Inadequate in 8 cases by FNAC 16 with Cell Block and 02 with CNB. When adequate, diagnosis and typing was possible by Cell Block (32) and CNB (48). In 08 FNAC cases having adequate material, cytological typing wasn’t possible. These 08 cases were typed by cell block as 07 malignant and 01 pre-malignant. The combined inadequate cases with cyto-technique (FNAC and Cell Block) were 04 compared to 02 cases on CNB. Combined sensitivity of Cyto-techniques was 95.4% compared to 97% on CNB. The specificity was 100% for both Cyto-techniques and CNB.Conclusions: Diagnostic adequacy and test parameters improved and approached CNB when both cyto-techniques are combined. So, we strongly recommend that Cell Block be made routine diagnostic procedure in all the government institutions especially for guided FNAC.

Objective:To assess the performance of fine needle aspiration cytology (FNAC) in the diagnosis of tuberculosis mastitis.Materials and Methods:Diagnostic test performance evaluation using two methods—as compared to an alloyed gold standard as well as in the absence of a gold standard. Alloyed gold standard combined the results of acid fast bacilli in cytology smears, histopathological confirmation, and response to treatment. Bayesian estimation of test parameters was done in the absence of the gold standard.Results:FNAC was carried out in 6,496 consecutive cases of breast lump and 104 cases of granulomatous mastitis were detected. Both methods of test parameter estimation identified a high specificity of FNAC for the diagnosis of tuberculosis mastitis (98.9% and 98.4%, respectively). Estimation of sensitivity was falsely high (100%) using the alloyed gold standard because of a workup bias and falsely low (8.41%) using the Bayesian estimation because of low prevalence. Likelihood ratios by both methods suggested that FNAC has good discriminatory capability.Conclusion:In situations where prevalence of tuberculosis is high and where facilities for histopathological evaluation do not exist, FNAC can offer an optional alternative to base the therapeutic decision for starting antitubercular treatment.