BackgroundTuberculosis (TB) notification in India by the Revised National TB Control Programme (RNTCP) provides information on TB patients registered for treatment from the programme. There is limited information about the proportion of patients treated for TB outside RNTCP and where these patients access their treatment.ObjectivesTo estimate the proportion of patients accessing TB treatment outside the RNTCP and to identify their basic demographic characteristics.MethodsA cross sectional community-based survey in 30 districts. Patients were identified through a door-to-door survey and interviewed using a semi-structured questionnaire.ResultsOf the estimated 75,000 households enumerated, 73,249 households (97.6%) were visited. Of the 371,174 household members, 761 TB patients were identified (∼205 cases per 100,000 populations). Data were collected from 609 (80%) TB patients of which 331 [54% (95% CI: 42–66%)] were determined to be taking treatment ‘under DOTS/RNTCP’. The remaining 278 [46% (95% CI: 34–57%)] were on treatment from ‘outside DOTS/RNTCP’ sources and hence were unlikely to be part of the TB notification system. Patients who were accessing treatment from ‘outside DOTS/RNTCP’ were more likely to be patients from rural areas [adjusted Odds Ratio (aOR) 2.5, 95% CI (1.2–5.3)] and whose TB was diagnosed in a non-government health facility (aOR 14.0, 95% CI 7.9–24.9).ConclusionsThis community-based survey found that nearly half of self-reported TB patients were missed by TB notification system in these districts. The study highlights the need for 1) Reviewing and revising the scope of the TB notification system, 2) Strengthening and monitoring health care delivery systems with periodic assessment of the reach and utilisation of the RNTCP services especially among rural communities, 3) Advocacy, communication and social mobilisation activities focused at rural communities with low household incomes and 4) Inclusive involvement of all health-care providers, especially providers of poor rural communities.

Primary non-Hodgkin's lymphoma (NHL) of the oral region is rare. Oral manifestations are present in 3-5% of cases of NHL and oral lesions are rarely the initial manifestation. We describe a 40 year old male who presented with a mass lesion primarily involving the tongue and was diagnosed as diffuse large B cell lymphoma. The patient was treated with CHOP chemotherapy with complete disappearance of lesion after first cycle. Pertinent literature is being reviewed.

Introduction:Primary salivary gland-type tumors of the lung (PSGTTL) are rare intrathoracic malignant neoplasms. Their description in literature is largely limited to a few case series and case reports. A systematic review and pooled analysis of the previously reported cases of PSGTTL is presented here.Methods:Electronic database of PubMed using keywords “lung neoplasm” AND “salivary gland tumors” was used to identify the papers documenting the PSGTTL. Filters (publication date from January 1, 1900–-December 31, 2015, Humans and English) were applied to refine the search. A pooled analysis of clinical, pathological, treatment, and survival data was performed.Results:The present systematic review included 5 studies and a total of 233 patients. Mean age of the patients was 41 years (range 6–80 years) and there was a male preponderance (1.3:1). Common pathological types were mucoepidermoid (MEC) (56.6%), adenoid cystic (ACC) (39.5%), and epithelial-myoepithelial cancer (3.8%). Tumors were located in the central airways (trachea and major bronchi) in 43.3% of patients. Weighted median tumor size was 4.2 cm. Surgery was the primary treatment undertaken in 82.4% of the patients, while radiotherapy and chemotherapy were also used in 15.9% and 9.4% of the patients. Lymph node involvement was seen in 15.2% of the patients. Disease recurrences were observed in 21.1% of the patients (12.9% and 37.5% in MEC and ACC, respectively). Three-, 5-, and 10-year weighted overall survival was 86.4%, 81.4%, and 73.6% (93.8%, 90.0%, and 85.0%, respectively, for MEC and 76.7%, 62.8%, and 50.5%, respectively, for ACC).Conclusion:Surgery is the primary treatment of PSGTTL to achieve long-term survival. Role of chemotherapy and radiotherapy in the management of PSGTTL warrants further studies.

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Objectives:To study the prevalence of respiratory morbidity and its associated factors in urban Delhi.Study Design and Setting:A cross-sectional, house-to-house survey was conducted in an urban upper middle class locality.Materials and Methods:All the residents aged 18 years or more were administered a questionnaire to identify the major symptoms of chronic respiratory tract disease — chronic cough, chronic phlegm, dyspnea and wheezing. The prevalence of all these symptoms in different groups was calculated. Chi square test and logistic regression were applied to determine the significant factors.Results:A total of 3465 individuals were interviewed of which 1756 (50.68%) were males and 1709 (49.3%) were females. Only 9.05% of the men smoked. The overall prevalence of chronic cough, chronic phlegm and dyspnea was 2.0%, 1.2% and 3.4%, respectively. The prevalence of wheezing was 3.2%. All the symptoms increased with age (P < 0.05). No significant difference was observed in these symptoms between males and females. Less educated and retired individuals were more likely to have respiratory symptoms. The prevalence of chronic cough, chronic phlegm, dyspnea and wheezing was 5.8%, 2.9%, 9.9% and 8.7%, respectively, among smokers, which was significantly higher than that observed in nonsmokers. Logistic regression analysis revealed that age and smoking remained significant factors for occurrence of all the respiratory symptoms.

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Cystosarcoma phyllodes or phyllodes tumor are rare fibroepithelial neoplasm accounting for only about 1% of the breast lesions in children and adolescents. Whether benign, borderline or malignant, they have high potential of recurrence. These biphasic tumors are having very low rate of bilateral occurrence and in that event they tend to be asynchronous. The definitive treatment of the benign entity is either wide local excision or mastectomy depending upon size and age of the patient. Ours is a case of 16 years old, orphan low socio-economic status female having bilateral giant phyllodes tumors that were confirmed on Fine needle aspiration cytology of both breasts. Wide local excision of the tumor could be done on the right side, and patient was discharged on 10 th post-operative day with advice to report after 6 weeks for possible surgery on the left enlarged breast. The histopathology report was consistent with the findings of benign phyllodes of the breast. Patient reported for the second surgery after 10 months of the first surgery and was subjected in wide local excision on the left side also. The case under report finds rarity due to its huge size, bilateral presentation in an unmarried adolescent female where the decision making regarding its definitive management becomes extremely difficult.