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Background: The evaluation of mediastinal lymphadenopathy and masses poses a diagnostic challenge because of a myriad of possible etiologic causes; their proximity to numerous vital structures and the difficulty of access for biopsy. Computed tomography is an excellent modality for the initial evaluation of mediastinal lymph nodes (LNs). Tissue diagnosis is of paramount importance to confirm the diagnosis of mediastinal lymphadenopathy. Of various modalities including CT-guided biopsy, mediastinoscopy is considered a gold standard for tissue acquisition, but it is associated with considerable morbidity. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method of sampling of mediastinal LNs and its role has been established in malignant cause of LN enlargement. However, its role in diagnosing benign diseases has not been studied much., Methods: In a cross-sectional observational study, we performed EBUS-TBNA of 116 patients, and the sample was evaluated by various pathological modalities., Results: Most common LN sampled was subcarinal (68%). MTB gene Xpert was positive in 45 cases, and resistance was detected in 3 cases. Most common diagnosis was tuberculous lymphadenitis (67.9%). Only five of our patients had post-operative bronchospasm, while four had peri-operative hypoxia, which was managed with oxygen therapy., Conclusion: EBUS-TBNA is an excellent modality for sampling mediastinal LNs, which is very safe and can be done on an OPD basis., Competing Interests: The authors have none to declare., (© 2022 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)

Background and Objectives: Progressive multifocal leukoencephalopathy (PML) is a viral infection affecting the central nervous system (CNS) seen mostly in advanced human immunodeficiency virus (HIV) infection. There is limited data on the epidemiology and disease course of these patients from India. This study was aimed to determine the frequency of PML in patients with HIV/acquired immunodeficiency syndrome (AIDS) and the clinical presentation and prognosis of these patients., Materials and Methods: The study was conducted at a tertiary care HIV center in New Delhi. Data of 765 patients from our anti-retroviral therapy (ART) clinic during a span of 4 years were retrospectively analyzed and reviewed. The diagnosis was based on the clinical and radiological picture and exclusion of other differential diagnosis by cerebrospinal fluid and serological studies., Results: Of 765 patients with HIV/AIDS, 12 (1.56%) were diagnosed with PML on the basis of consistent clinical and radiological features after ruling out other differential diagnosis. PML was the initial presentation of HIV infection in 8 (55.5%) patients. 11 (89%) patients had CD4 count <200/μl. Insidious onset focal limb weakness (50%) and dysarthria (50%) were common symptoms. Magnetic resonance imaging of the brain revealed characteristic white matter lesions in all the patients. The estimated median survival was 40 months (95% confidence interval, 23.88-53.19 months)., Interpretation and Conclusions: Our results show that PML is associated with high morbidity despite the institution of highly active ART (HAART), but mortality has significantly declined if ART is started early. Key to good response is early diagnosis and HAART., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Sexually Transmitted Diseases and AIDS.)

Background: Cancer in the aging population presents manifold challenges. In the resource-limited settings of developing countries, concrete steps to optimize care for older adults with cancer are required., Materials and Method: This prospective, observational study was divided in two parts. In the first part, older adults (≥60 years) with a tissue diagnosis of cancer underwent a preliminary, detailed assessment of relevant geriatric domains. The patients were followed up at 4, 12 and 24 weeks, and their survival status was recorded. In the second part a newly developed screening tool, "SCreening of the Older PErson with Cancer", Version1 (SCOPE-C) was validated on patients with similar characteristics., Results: 419 participants were enrolled in the study. The mean age of the participants was 66.6 ± 6.2 years, 75% had functional impairment, 35% had malnutrition, and 64% had more than one co-morbidity. The median survival time was 22 weeks from the index visit. Male gender, functional decline, cognitive impairment, malnutrition, and treatment modality were found to be independently associated with survival. Individual Scores on the SCOPE-C Version1 scale were correlated with survival status at 24 weeks, and a cutoff score of 64 had a 72.2% sensitivity and 77.3% specificity for better prognosis., Conclusion: The present study is a comprehensive attempt to assess older adults with cancer with limited resources in a busy health system. A preliminary assessment with a prognostic screening tool may streamline care in resource-limited settings and aid clinicians in making treatment decisions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)