S.V.Ghorpade’s scientific contributions

Introduction: India is the highest Tuberculosis (TB) burden country accounting for 1/5th (21%) i.e. 2 million cases of the global annual incidence of 9.4 million. Poor adherence to anti-tubercular treatment is a major barrier to disease control leading to defaulters.This study aimed to know the reasons of treatment interruption among the tuberculosis cases under Revised National Tuberculosis Programme (RNTCP) in Nagpur. Methods: All the TB patients registered under RNTCP in Nagpur corporation which includes five tuberculosis units (TU) & two tertiary care centers, in one year, who interrupted treatment, were included in this study. Defaulter patientswere analyzed on basis of their records and cause for their treatment interruption was noted. Results: Out of the total 2457 TB patients, 118 (4.8 %) defaulted. Reasons for treatment interruption were:migration - 30 (25.42%), alcoholism-17 (14.41%), unwillingness-18 (15.25%), side effects- 17 (14.41 %), shift of pathy 12 (10.17%), as asked by doctor/DOTS provider (medical reasons) in3(2.54%), work related reasons in 4 (3.39%)& pregnancy- 1 (0.85%).In 16(13.56 %) patients the cause was not recorded. Conclusion: Migration was the most common cause of treatment interruption amongst the cases in our study followed by other causes like alcoholism, unwillingness, side effects, shift of pathy, medical reasons etc. Clinical implication: The RNTCP needs to effectively address the reasons for treatment interruption right at the start of treatment and ensure effective check mechanisms during the course of treatment to avoid any potential treatment interruption. If we can decrease the proportion of patients interrupting treatment, then this may well help in improving the treatment outcomes under RNTCP.

Introduction: Non-resolving pneumonia is always a challenging clinical scenario where various diagnostic modalities are greatly required to reach the diagnosis. We aimed to study the role of fiberoptic bronchoscopy in non-resolving pneumonia along with the various comorbidities associated with the disease condition. Materials and Methods: A cross sectional study in a tertiary care hospital was undertaken. A total of 60 patients diagnosed with non-resolving consolidation were recruited for diagnostic fiberoptic bronchoscopy. Results: The overall diagnostic yield of fiberoptic bronchoscopy in non-resolving pneumonia was 96.66%. The causes of non-resolving pneumonia were tuberculosis (40 (66.67 %), bacterial pneumonia (8 (13.33 %)), malignancy (6 (10%)), fungal pneumonia (3 (5 %)) and foreign body (1 (1.66 %) in order of decreasing proportions. 2 cases (3.33 %) were undiagnosed. 29 (48.33%) patients had a significant past history which also revealed associated co morbid conditions. Chronic obstructive pulmonary disease (COPD) (14 (23.33 %)) and diabetes (10 (16.66%)) were the leading comorbid conditions. Conclusion: Fiberoptic bronchoscopy is a great utility tool in reaching the diagnosis in patients with non-resolving pneumonias.

A rare case report of Pulmonary Tuberculosis with Anterior Mediastinal Mass presenting with SVC obstruction. Anterior Mediastinal Mass was finally confirmed to be a case of primary mediastinal yolksac tumor. To the best of our knowledge, this is the first case of a non seminomatomaus primary mediastinal germ cell tumor showing granulomas, which has previously been reported in seminomatomaus germ cell tumor only.

Background: The incidence of isolated pancreatic tuberculosis is extremely rare. We report here a case of pancreatic tuberculosis which presented as a mass. Case Report: A 45-year-old married male, who was a chronic smoker, presented with pain in abdomen, low grade fever along with loss of appetite and weight since 3 months. Physical examination was unremarkable. Investigations revealed a raised erythrocyte sedimentation rate and a positive Mantoux test. Ultrasonography (USG) abdomen showed a hypoechoic lesion in the head and neck of pancreas which was confirmed on computed tomography scan of abdomen as a lobulated non-enhancing mass lesion of 5.3 cm × 3 cm size. There was no evidence of tuberculosis elsewhere in the body. USG guided fine needle aspiration cytology (FNAC) revealed caseating necrosis and positive acid fast bacilli stain. BACTEC culture of FNAC revealed mycobacterium tuberculosis complex. Patient was initiated on anti-tubercular chemotherapy under revised national tuberculosis control program anti-tubercular treatment category I regime, which was extended for 3 months. Patient symptomatically improved after completion of treatment and USG at the end of treatment revealed complete resolution of the mass. Conclusion: Tuberculosis should be included in the differential diagnosis of a pancreatic mass and confirmation of diagnosis by histopathological and microbiological methods needs to be done in today's era of evidence based medicine. Also, a good response to anti-tubercular chemotherapy can be expected in such cases thereby obviating the need for a major surgery with its accompanying morbidity.

Background: The incidence of isolated pancreatic tuberculosis is extremely rare. We report here a case of pancreatic tuberculosis which presented as a mass. Case Report: A 45-year-old married male, who was a chronic smoker, presented with pain in abdomen, low grade fever along with loss of appetite and weight since 3 months. Physical examination was unremarkable. Investigations revealed a raised erythrocyte sedimentation rate and a positive Mantoux test. Ultrasonography (USG) abdomen showed a hypoechoic lesion in the head and neck of pancreas which was confirmed on computed tomography scan of abdomen as a lobulated non-enhancing mass lesion of 5.3 cm × 3 cm size. There was no evidence of tuberculosis elsewhere in the body. USG guided fine needle aspiration cytology (FNAC) revealed caseating necrosis and positive acid fast bacilli stain. BACTEC culture of FNAC revealed mycobacterium tuberculosis complex. Patient was initiated on anti-tubercular chemotherapy under revised national tuberculosis control program anti-tubercular treatment category I regime, which was extended for 3 months. Patient symptomatically improved after completion of treatment and USG at the end of treatment revealed complete resolution of the mass. Conclusion: Tuberculosis should be included in the differential diagnosis of a pancreatic mass and confirmation of diagnosis by histopathological and microbiological methods needs to be done in today's era of evidence based medicine. Also, a good response to anti-tubercular chemotherapy can be expected in such cases thereby obviating the need for a major surgery with its accompanying morbidity.