Lung India最新文献

We present a case of tracheal necrosis due to mucormycosis in a young diabetic male. He presented with stridor due to airway obstruction from the necrosed tracheal wall. We used a silicon tracheal stent to maintain airway patency and support the airway. This case highlights the use of tracheal stenting to stabilize the airway in an extremely necrosed and friable trachea, which is not fit for surgical resection due to the involvement of the long segment of the trachea. To the best of our knowledge, the use of stents to stabilize necrosed tracheal walls in cases of mucormycosis has not been reported so far.

The burden of autoimmune diseases is rising worldwide. The expansion of the population of patients eligible for severe asthma biological therapy we are seeing in clinical practice could lead to the simultaneous use of different monoclonal antibodies. We present the case of biological combination therapy with ustekinumab and benralizumab in a patient with ulcerative colitis and severe eosinophilic asthma. The patient, already undergoing biological treatment for colitis, began to suffer from uncontrolled severe asthma. Since benralizumab was administered, the patient has not experienced any exacerbations requiring oral corticosteroids, emergency department visits, or hospital admissions, and the control of asthma symptoms and respiratory function considerably improved. Twelve months after the initiation of the combination, both diseases are well controlled, without any side effects or blood test abnormalities. To our knowledge, this is one of the first reported cases of patients simultaneously receiving a combination of biological therapy for ulcerative colitis and asthma.

Background and objective: We evaluated the DR-TB component of the National Tuberculosis Elimination Program (NTEP) in a high-burden district in Kerala to identify the programmatic gaps, if any, in screening, diagnosis, treatment, and follow-up of notified DR-TB patients.

Methods: A mixed-methods design was used, and the evaluation was performed in two steps. In the first step, we reviewed the program documents and conducted stakeholder interviews to develop a detailed description of the program design and developed a logical framework to evaluate program performance. Consequently, in the next step, we conducted programmatic data reviews, facility surveys, and in-depth interviews with key stakeholders to identify the programmatic gaps in implementation, guided by the logic framework.

Results: Of the 494 microbiologically confirmed TB patients during 2021-22, 342 (69%) were tested for drug sensitivity, and 30 DR-TB patients were identified. There was no separate district DR-TB treatment center with airborne infection control facilities, and only 16% (66/422) of the various categories of staff were trained in recent guidelines. Only 30% (9/30) of DR-TB patients were provided with any psychological assessment. The favorable treatment outcome was 80% Interviews revealed poor readiness and motivation from the private sector for screening, contextual barriers in human resource availability, transportation, and financial barriers to the beneficiary despite providing financial benefits.

Conclusion: Prioritizing the establishment of a district DR-TB treatment center and sputum transport mechanism, posting a clinical psychologist dedicated to counseling patients on therapy, and training all categories of staff on DR-TB management guidelines will significantly contribute to improving program outcomes.