1

Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases

(Autonomous Institute under Ministry of Health and Family Welfare, Govt. of India)

Sri Aurobindo Marg, New Delhi-110 030

ANNUAL REPORT

2011-2012

2

CHANGE OF GUARD

Dr D.Behera handing over the charge of Institute to our new Director Dr Rohit Sarin

Dr Sarin and Dr Behera with the entire faculty of LRS Institute

3

PREFACE It is my proud privilege and honour to take over the reins of LRS Institute of

Tuberculosis and Respiratory Diseases as its Director on 23rd May 2012. I am thankful to

the Government of India and the Governing Body of the Institute for giving me a chance to

lead this Institute which has coveted history of past 60 years since its inception as Lala

Ram Sarup TB Hospital. Ever since the up gradation of the hospital into an autonomous

Institute in 1991 by Govt. of India, the Institute has grown from strength to strength. The

Institute has the prime objectives of patient care, support to National Tuberculosis Control

Programme in the country and to provide facilities for training, teaching and research

activities. In this journey of 60 years, LRSI has made significant contribution in the field of

quality patient care, medical education and research.

I am associated with this Institute for more than 25 years and assisted in its

development process. It is now an apex institute of the country in the field of tuberculosis

and respiratory diseases. The institute is well recognized for diagnosis, treatment, training

and research both within country and neighbouring countries.

LRSI has always been craving for more - Achieving goals and creating higher

targets. As a part of our next 20 year plan Institute is now ready with a Vision Document

where we all aspire not only to modernize the hospital but to also improve the patient care,

medical education and medical research.

We are aware that society has great expectations from our Institute and accordingly

we have tried and succeeded in providing affordable specialized medical care in the region.

What we have achieved till today is the result of hard work of our team comprising faculty

and more than 500 staff including nurses and technicians and the faith people have in us.

The Annual Report of the Institute aims to provide elaborate information, to present best

practices, to highlight events and to give different perspectives in addressing the challenges

related to the patient care and medical research in India while supporting the country's TB

control programme.

The Institute has been able to provide quality care through the untiring efforts put in

by the trained faculty and the staff of its departments and sections, which are being

continuously upgraded with the latest available technology. In addition to providing DOTS

services, Institute screens for MDR TB and gives DOTS-Plus treatment to those diagnosed

4

among 6 million population of Delhi. It also supervises the IRL activities over 8 states of

India that includes areas in the North East. The Dept of Microbiology is a National

Reference Laboratory and undergoes yearly proficiency testing for culture and drug

sensitivity for the first and second line drugs by all methods through Supranational

Mycobacteriology Reference Laboratory, Institute of Tropical Medicine, Antwerpen,

Belgium. A number of equipments like BSL-III laboratory, MGIT System, Line Probe Assay

and Gene Expert have been smoothly functioning to assist the clinicians in delivering a

quality patient care and research. The department has now been certified for providing LPA

based diagnostic services under PMDT. New MDR TB wards, having a negative pressure

system, a first of its kind facility in the country, have started functioning so as to enhance

the institutional care of MDR TB cases. A state of art Thoracic Operation Theatre has been

providing services to those requiring diagnostic or therapeutic surgical interventions. Their

post-operative care is facilitated by the availability of a well equipped intensive care unit.

Availability of emergency services and research block has further enhanced the capabilities

of the Institute to provide quality critical care and facilities for research. Commencement of

specialised chest clinics has ensured better service provision to patients having lung

cancer, sleep related breathing disorders, allergy and other non-TB respiratory diseases

over the time.

Amongst the many achievements of the Institute during the year, one was the

starting of the independent operations of two new departments of Molecular

Medicine/Genetics and Biochemistry following the joining by a Molecular Biologist and a

Biochemist with their supporting staff. This is likely to give a great boost to the patient care,

education and research within the Institute. A number of CMEs/ workshops like PG CME-

2011 North India, National Task Force Workshop, Respiratory Allergy and Immunotherapy

Update and many others were held for the benefit of the medical fraternity at large. The

Institute faculty participated in a number of trainings and national level meetings, whose

decisions will guide the TB control programme of our country in future. The faculty was on

the editorial boards of many reputed national and international journals. The Institute

admitted 10 students for DNB degree course that made the total number of students

undergoing the PG training to 27 considering their enrollment of last 3 years. An elaborate

teaching curriculum was followed for them. About 2000 trainees (including the nursing

students) underwent trainings in various departments and sections of the Institute. About 75

researches (including those involving DNB students) were pursed during the year. A large

number of publications took place in several reputed national and international journals and

5

books, in addition to the regular 3-monthly publication of the Institute’s newsletter. The

Institute continued to provide all routine and many other investigations including the Digital

X-ray, spirometry, ultrasound and others free of cost to all those patients requiring them.

Even the special investigations like CT Scan were provided free of cost in appropriate

cases. A large number of high end equipments were procured during the year to strengthen

the departments and sections in enhancing the patient care and research. A new 40-bed

private ward has been constructed and is ready for use. A new 30-flat doctors hostel has

been constructed and being allotted. The construction of an Effluent Treatment Plant

(including its testing) and that of a laundry has also been completed. Besides, the old toilet

block has been renovated and the construction work of a new kitchen is in the advanced

stage of progress.

Let me take the opportunity in this report to thank all our members, medical fraternity

and friends for their great interest and most generous support to continue our efforts in the

field. It was only with and because of them that we were able to create a number of

promising programmes and activities. We mourn the sudden demise of our founder director,

Dr R.C.Jain, who passed away on 4th August last year. We have started a new Dr R.C.

Jain Memorial Oration lecture in his honour. We shall continue to make our efforts to make

the Institute an institution of international repute in patient care, training and research in the

field of tuberculosis and respiratory diseases.

Dr.Rohit Sarin

Director

6

GOVERNING BODY MEMBERS

1. Shri P. K. Pradhan Chairman Secretary (Health & Family Welfare) Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

2. Dr. Jagdish Prasad Vice Chairman Director General Health Services & Directorate General of Health Services, Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

3. Shri K. Desiraju Alternative Vice Chairman Special Secretary Ministry of Health & Family Welfare Govt. of India Nirman Bhawan, New Delhi

4. Shri R. K. Jain Member Additional Secretary & FA Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

5. Dr. R.S. Shukla Member Joint Secretary Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

6. Dr. Ashok Kumar Member DDG (TB) Directorate General of Health Services Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

7. Dr. (Mrs.) S. Brindha Member

Director (CGHS) A-545, Nirman Bhawan, Ministry of Health & Family Welfare New Delhi

8. Sri Triupati Venkatsawmy Member Deputy Secretary(Finance) Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

9. Sri Rajender Kumar Member Secretary (Health & FW) Room No.A-907, Department of Health & Family Welfare Govt. of NCT Delhi, 9th Level, A-Wing, IP Estate Delhi Secretariat, New Delhi-110002

7

10. Prof. (Ms.) Upreet Dhaliwal Member

Dean, Faculty of Medical Sciences & Head, Department of Ophthalmology University College of Medical Sciences Shahadra, Delhi – 110095

11. The Secretary Member Medical Council of India Pocket- 14 , Sector - 8, Dwarka Phase -1 New Delhi – 110077

12. Dr. S. R. Chauhan Member

Medical Commissioner (ESIC) Employees State Insurance Corporation Kotla Road, New Delhi-110002

13. Dr. S. K. Sharma Member

Prof. & Head Department of Medicine All India Institute of Medical Sciences New Delhi – 110 029

14. Dr. S.K. Jindal Member

Prof. & Head Department of Medicine Department of Pulmonary Medicine PGIMER, Chandigarh - 160012

15. Dr. V.K. Arora Member Ex-Director (LRSI) C-151, Sector – 51 Kendriya Vihar, NOIDA Uttar Pradesh

16. Dr. G.R. Khatri Member President-World Lung Foundation-South Asia 60, Regal Building Parliament Street New Delhi-110001

17. Prof. Sushma Batra Member

Head, Department of Social Work, Delhi School of Social Work University of Delhi 3, University Road Delhi-110 007

18. Dr. C.A.K. Yesudian Member Prof. & Dean (School of Health Systems Studies) Tata Institute of Social Sciences V.N.Purav Marg, Deonar, MUMBAI – 400 088

8

19. Dr. D. Behera Member Secretary

Director LRS Institute of TB & Respiratory Diseases Sri Aurobindo Marg New Delhi

9

STANDING FINANCE COMMITTEE MEMBERS 1. Shri K. Desiraju Chairman

Special Secretary Ministry of Health & Family Welfare Govt. of India Nirman Bhawan, New Delhi

2. Shri R. K. Jain Member Additional Secretary & FA Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

3. Dr. R.S. Shukla Member Joint Secretary Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

4. Dr. Ashok Kumar Member DDG (TB) Directorate General of Health Services Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

5. Dr. (Mrs.) S. Brindha Member

Director (CGHS) A-545, Nirman Bhawan, Ministry of Health & Family Welfare New Delhi

6. Shri Triupati Venkatsawamy Member Deputy Secretary (Finance) Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

7. Dr. D. Behera Convenor Director LRS Institute of TB & Respiratory Diseases Sri Aurobindo Marg New Delhi

10

ESTATE COMMITTEE MEMBERS

1. Dr. R.S. Shukla Chairman Joint Secretary Ministry of Health & Family Welfare Govt. of India Nirman Bhawan, New Delhi

2. Dr. Ashok Kumar Member DDG (TB) Directorate General of Health Services Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

3. Sri Triupati Venkatsawmy Member

Director (Finance) Ministry of Health & Family Welfare Nirman Bhawan, New Delhi

4. Senior Architect Member

Directorate General of Health Services Nirman Bhawan, New Delhi

5. Chief Engineer (NDZ) 1, CPWD Member

New Delhi 6. Dr. D. Behera Convenor

Director LRS Institute of TB & Respiratory Diseases Sri Aurobindo Marg New Delhi

11

ANNUAL REPORT CONTENTS

Page No 1. Background of Institute

1.1 Introduction 1.2 Treatment 1.3 Teaching & Training 1.4 Manpower

2. Out Patient Department

2.1 New Registrations 2.2 Distribution of Symptomatics 2.3 Distribution of TB Cases Registered under RNTCP 2.4 Age & Sex Distribution of New Smear Positive PTB Cases 2.5 Distribution of Sites of EPTB Cases 2.6 Respiratory Emergency 2.7 Total Cases in OPD (OPD load) 2.8 Paediatric OPD 2.9 Specialised Clinics (Non-TB Cases)

3. Indoor Patient Data

3.1 Total Indoor Admissions 3.2 Age & Sex Distribution of Admitted Patients 3.3 Outcome of Admitted cases 3.4 Observations on Indoor Cases

4. Departments and Sections of the Institute 4-A. Departments

4.1 Department of Anaesthesia 4.2 Department of Bio-Chemistry 4.3 Department of Epidemiology & Public Health 4.4 Department of Hospital Administration 4.5 Department of Internal Medicine 4.6 Department of Microbiology 4.7 Department of Molecular Medicine / Genetics 4.8 Department of Paediatrics 4.9 Department of Pathology 4.10 Department of Physiology 4.11 Department of Radiology 4.12 Department of TB & Respiratory Diseases 4.13 Department of TB Control & Training 4.14 Department of Thoracic Surgery and Surgical Anatomy

12

4-B. Sections

4.15 Air Pollution Related Diseases Diagnostic Centre 4.16 Anti-Retroviral Therapy Centre 4.17 Biostatistics Section 4.18 Computer Section 4.19 Fibre-Optic Bronchoscopy Unit 4.20 Health Education Section 4.21 Library 4.22 Nursing Section 4.23 Physiotherapy Section 4.24 Respiratory Intensive Care Unit 4.25 Sleep Laboratory 4.26 Integrated Counseling and Testing Centre 4.27 Yoga Therapy and Research Centre

5.0 Researches Other Than DNB Course 6.0 Awards and Achievements

7.0 Publications

8.0 Seminars/ Workshops/ CMEs/CMEs Organised

9.0 Presentations during Conferences/Seminars/CMEs/Workshops

9.1 Outside Country 9.2 Within Country

10.0 Conferences/Seminars/CMEs/Workshops Attended 10.1 Outside Country 10.2 Within Country

11.0 List of Committees

11.1 Technical Specifications Committee 11.2 Lower Purchase Committee 11.3 Higher Purchase Committee 11.4 Standing Purchase Committee 11.5 Tender Opening Committee 11.6 Quotation Opening Committee 11.7 Tender Evaluation Committee 11.8 Inspection Committee - Medical Store 11.9 Inspection Committee - General Store 11.10 Estate Committee 11.11 Condemnation Committee 11.12 Hospital Disposal Committee 11.13 Diet Committee 11.14 Hospital Infection Control Committee 11.15 Hospital Waste Management Committee 11.16 Transport Repair Committee 11.17 Equipment Repair Committee 11.18 Disaster Management Committee

13

11.19 Library Committee 11.20 Training Committee 11.21 Annual Report Committee 11.22 Research Committee 11.23 Ethical Committee 11.24 Canteen Committee 11.25 Committee to look into the complaints of sexual harassment 11.26 Official Language Implementation Committee 11.27 Public /Employees Grievance Committee 11.28 Cultural and Sports Committee 11.29 Employees Welfare Committee 11.30 Record Management Committee 11.31 Space Allotment Committee 11.32 House Allotment Committee 11.33 Medical Board 11.34 Medical Re-imbursement Board 11.35 Committee for Advance on Establishment Matters 11.36 College Council Committee 11.37 PG Committee

11.38 Medical Education Unit

12.0 Other Activities of Institute

14

1. BACKGROUND OF INSTITUTE

1.1 Introduction LRS TB hospital was established by TB Association of India in 1952. The

hospital was upgraded into an autonomous institute in 1991 by Govt. of India. The

Institute was renamed as LRS Institute of Tuberculosis & Respiratory Diseases as

an autonomous institute under the Ministry of Health & Family Welfare, Government

of India.

It is now an apex institute of the country in the field of tuberculosis and

respiratory diseases. The Institute is well recognised for diagnosis, treatment,

teaching, training and research in the field of tuberculosis and respiratory diseases.

The Institute is registered as a society under the Societies Registration Act,

1960 (XXI). The Union Minister of Health & Family Welfare is the President of the

Institute and the Union Secretary (Health) is the Chairman of the Governing Body.

Director General Health Services is the Vice-Chairman and the Additional Secretary

(Health) is the Alternative Vice-Chairman of the Governing Body of the Institute. The

Director is the Chief Executive Officer.

The Institute is spread over an area of 25 acres of land in South Delhi and has

various departments to carry out the activities in accordance with the objectives of

the Institute. These departments are :-

1. Department of Anaesthesia

2. Department of Bio-Chemistry

3. Department of Epidemiology & Public Health

4. Department of Hospital Administration

5. Department of Internal Medicine

6. Department of Microbiology

7. Department of Molecular Medicine / Genetics

8. Department of Paediatrics

9. Department of Pathology

10. Department of Physiology

11. Department of Radiology

12. Department of TB & Respiratory Diseases

13. Department of TB Control & Training

14. Department of Thoracic Surgery and Surgical Anatomy

15

1.2 Treatment

1.2.1 Outdoor The Institute runs a daily OPD and the registration is computerized. The

patients are registered as Area, Non area or Outsiders because the patients are not

only coming from the specified RNTCP area of the institute but also from whole Delhi

and adjoining states like Haryana, Rajasthan, UP, Bihar etc. Besides the routine

OPD, the Institute runs specialized clinics to focus on specific areas in Respiratory

Medicine.

1.2.2 Indoor treatment facility

The Institute provided indoor treatment to the serious patients for the

treatment of tuberculosis and respiratory diseases through the available 432 beds in

wards and ICU.

Distribution of total beds (Unit Wise) in the Institute

Type of Patient Unit-I Unit-II Unit-III Unit-IV Unit-V

Male Non-TB 13 13 13 07

Female Non-TB 4 4 4 3 2

Male TB 28 27 25 17 16

Female TB 18 18 18 07 10

MDR TB (Male + Female) 9 9 9 9 9

Empyema cases (Male) 14 14 14

Total 86 85 83 43 37

Total TB & Chest = 334 Paediatrics = 34 Surgery = 27 Emergency = 22 Sleep = 1 ICU = 14 ======================= Grand Total = 432 ----------------------------------------- In addition, a new private ward with 40 beds is ready which will enhance the

indoor bed capacity.

1.3 Teaching & Training The Institute provides teaching and guiding facilities for various post- graduate

16

(M.D. / PhD) courses of various Universities. The Institute has been recognised for

imparting training for the award of degree by Diplomate of National Board in

Respiratory Diseases since 1999. There are 27 students undergoing training at

present after the increase of the DNB seat from 6 to 10 per year.

The training is also imparted in the management of tuberculosis to the

nursing students from Rajkumari Amrit Kaur College of Nursing and the trainee

health visitors from New Delhi TB Centre every year. The Institute is actively

involved in the training of various medical and paramedical personnel who visit from

other states of our country, in implementation of strategies under Revised National

Tuberculosis Control Programme. The Institute is actively involved in organising

Continuing Medical Education (CME) programmes on different aspects of diagnosis

and management of tuberculosis and respiratory diseases.

1.4 Manpower

At present, the Institute has 51 Group-A, 189 Group-B and 249 Group-C Staff

in position. In addition, there are 23 senior residents, 27 DNB & 8 Non-DNB junior

residents working on tenure/adhoc basis.

Posts Group

A Group

B Group

C SR JR( DNB)

JR ( Non-

DNB) Total

No. of Sanctioned Staff

55 193 301 23 30 8 610

Present Staff strength 51 189 249 23 27 8 547

2.0 OUT PATIENT DEPARTMENT The Institute provides treatment for patients within the domiciliary area.

Patients also visit from non-area within Delhi and neighbouring states (outsiders).

Further the Institute has implemented RNTCP that is functioning well within its

domiciliary area through DOT cum microscopy centers and only DOT centres.

2.1 New Registrations (Chest Symptomatics)

A total of 42162 chest symptomatics attended the LRS-OPD and 6885

attended the DOTS centres within the Institute specified area other than LRS OPD.

This constituted a total of 49047 chest symptomatics under LRS Institute.

Out of 49047 patients, 20997 came from the LRS specified area and included

17

14112 attending the LRS-OPD and 6885 coming to DOTS centres. Further, 16760

came from Non-Area, while 11290 came from outside Delhi as shown in Table-1.

This indicates that majority (67% or 2/3rd) of the patients who attend the LRS-OPD

are from Non Specified area from Delhi or from outside Delhi. About 2/3rd of the

patients belonged to 15-44 years of age group as shown in Table-1a.

Table-1 : Total Chest Symptomatics (NEW OPD registrations) under LRS Institute (April-2011 -March-2012)

LOCALITY Symptomatics RNTCP Specified area of the Instt.

Symtomatics visited at RNTCP DOTS centres directly.

6885

LRS OPD computerized registration counter

Patients from DOTS area visited LRS-OPD directly

14112 42162

Beyond specified area of the Instt.

NON AREA (within Delhi)

16760

Out Siders ( Outside from Delhi

11290

Total Symptomatics under LRS Institute 49047

Table 1a : Age and Sex Distribution of Symptomatics at LRS-OPD ( April-2011 -March-2012)

Age Groups Male Female TOTAL

>0 and <5 499 1.9% 358 2.3% 857 2.0%

>=5 and <10 775 2.9% 497 3.2% 1272 3.0%

>=10 and <=14 713 2.7% 730 4.8% 1443 3.4%

>=15 and.<=24 5881 21.9% 3855 25.1% 9736 23.1%

>=25 and..<=34 6124 22.8% 3780 24.6% 9904 23.5%

>=35 and.<=44 4836 18.0% 2711 17.7% 7547 17.9%

>=45 and.<=54 3640 13.6% 1659 10.8% 5299 12.6%

>=55and .<=64 2728 10.2% 1179 7.7% 3907 9.3%

>=65 1610 6.0% 587 3.8% 2197 5.2%

TOTAL 26806 100.0% 15356 100.0% 42162 100.0%

64% 36%

18

2.2 Distribution of Symptomatics

The patients who come to the Institute for seeking treatment are investigated

and after confirmed diagnoses are referred to their respective DOTS centres or chest

clinics for further treatment of tuberculosis.

Out of 42162 symptomatics at LRS OPD, record was available for 31933

patients. Of these, a total of 18251 (43%) were diagnosed as suffering from

tuberculosis either pulmonary or extra pulmonary and 13682 (33%) were diagnosed

as Non TB Cases (Table 2 and 2a).

Table 2: Diagnosis of Symptomatics (April-2011 -March-2012) Code

Diagnosis Final Diagnosis Provisional Diagnosis Male Female Total Male Female Total

1 URTI 342 179 521 863 499 1362 2 LRTI 398 162 560 721 572 1293 3 PNEUMONIA 26 13 39 76 24 100 4 PTB 4275 1635 5910 5971 4106 10077 5 TB- Pleural Effusion 679 298 977 724 563 1287 6 POST TB SEQUELAE 657 192 849 641 343 984 7 COPD 548 64 612 967 255 1222 8 ASTHMA 349 141 490 545 399 944 9 I.L.D. 30 16 46 46 16 62 10 SARCOIDOSIS 19 5 24 20 14 34 11 CARCINOMA 59 8 67 100 24 124 12 BRONCHIECTASIS 33 14 47 50 47 97 13 PUL.ESINOPHILIA 73 16 89 54 22 76 14 OCC.LUNG DIS 5 0 5 7 0 7 15 SLEEP DISORDER 3 0 3 8 0 8 16 LUNG ABSCESS 13 1 14 3 3 6 17 EMPYEMA 63 13 76 55 27 82 18 PNEUMOTHORAX 22 2 24 19 3 22 19 HYDROPNEUMOTHORAX 37 10 47 69 26 95 20 OTHER disease 726 515 1241 823 584 1407 21 Metastasis Lung 2 1 3 1 0 1 22 AIDS 6 1 7 31 4 35 23 Smoking 20 2 22 130 8 138 24 ABD LN Tubercular 30 28 58 78 71 149 25 TB LN Tubercular 77 79 156 153 176 329 26 Miliary TB 4 3 7 5 0 5 27 Skeletal TB 19 16 35 30 14 44 28 TBM 5 3 8 5 1 6 TOTAL 8520 3417 11937 12195 7801 19996

19

Table 2a : Diagnosis of OPD Symptomatics

Diagnosed Provisional

Diagnosis

TOTAL Percentage

TB cases (PT+EPT) 6887 11364 18251 43%

Non TB cases 5050 8632 13682 33%

Not diagnosed/ Not available 10225 4 10229 24%

Total 22162 20000 42162 100%

All area cases, who came to LRS OPD, were investigated and after diagnosis

referred back to LRS-DOTS centres for follow up treatment except seriously ill

patients, who needed hospitalisation.

Table-3 shows that after diagnosis 8747 TB cases were referred out from

LRS-OPD to LRS-DOTS centers or to Chest Clinics in Delhi or to neighboring states.

Among 8747 TB cases referred out, 2241 were referred out to LRS-DOTS centres,

2849 to non-area chest clinics in Delhi and remaining 3657 to outside Delhi Chest

Clinics.

Table-3 : Total TB cases Diagnosed and Referred Out ( April-2011 -March-2012)

Patients visited from

Symptomatics at LRS OPD only

TB cases diagnosed and referred out from LRS Institute to their respective chest clinics for DOTS treatment (Patients not registered in LRS TB registers)

Area (patients from specified area of the Instt.)

14112 2241

Non Area (Non specified area of the Instt.)

16760 2849

Outsider (from outside Delhi) 11290 3657

TOTAL

42162 8747

20

Table-4 shows TB patients referred to DOTS centres and neighbouring states

for further treatment after diagnosis at LRS. Of 8747 patients, 8219 were adults and

remaining 528 were children.

Table -4: Patients Referred to DOTS Centres and Neighbouring States

after Diagnosis at LRS (April-2011 -March-2012) Details Sex Adults Children

TOTAL Sp+

ve Sp-ve EPT Sp+

ve Sp-ve

EPT

a) DOTS patients guided and referred to the LRS-DOTS centres:

Those who came directly to LRS-OPD

M 656 359 378 9 24 39 1465 2241

25.6

% F

254 194 227 26 25 50 776

Those who were already registered at DOTS centres and referred to LRS-OPD

- - - - - - - -

b)DOTS patients guided and referred to the Other- DOTS centres in Delhi and neighbouring states: Referred to NON AREA DOTS centres

M

821 465 394 5 31 39 1755 2849

32.6

% F

424 290 279 30 24 47 1094

Referred to neighbouring states (OUT SIDE Delhi)

M

1035 452 417 19 32 48 2003 3657

41.8

% F

791 417 366 17 27 36 1654

Total patients referred from LRS:-

TOTAL (Percentage referred)

3981 (46)

2177 (25)

2061 (24)

106 (1)

163 (2)

259 (3)

8747

8219 528 8747

21

The flow chart shows the distribution of symptomatics and cases diagnosed

and referred after diagnosis from the Institute during the year.

22

2.3 Distribution of TB Cases Registered under RNTCP

Among the total 3272 TB cases, there were 939 (29%) new smear positive

pulmonary TB, 521 (16%) new smear negative, 1065 (33%) EPTB, 6 other new

cases, 209 relapses, 50 failures, 181 Treatment after Defaults and 301 other re-

treatment cases. Among 939 new smear positives, 594 were males and 345

females.

Table-5: RNTCP (Block 1 ) All New and Re-treatment cases (April-2011 -March-2012) Age Groups

New Cases Re-treatment cases Total

New Smear Pos. Pul.TB

New Smear Neg. Pul.TB

New EPTB

Others

Relapse Failure Treatment after Default

Others

0-14 51 58 194 1 4 0 5 28 341

>=15 888 463 871 5 205 50 176 273 2931

Total 939 521 1065 6 209 50 181 301 3272

Male 594 304 576 3 141 xx xx xx Xx

Female 345 227 489 1 68 xx xx xx Xx

Total 939 531 1065 4 209 xx xx xx xx

2.4 Age and Sex Distribution of New Smear Positive PTB Cases

Table 6 shows the age and sex distribution of new smear positive TB cases

registered under RNTCP. It can be seen that majority (74%) of the new smear positive

cases belonged to 15-44 year age group.

Table-6: RNTCP (Block 2 ) Age & Sex Distribution of New Smear Positive PTB cases

(April-2011 -March-2012) Sex Age Groups (Years) Total 0-14 15-24 25-34 35-44 45-54 55-64 >=65

Male 17 184 145 91 76 47 34 594

Female 34 162 83 33 14 13 6 345

Total 51 346 228 124 90 60 40 939

23

2.5 Distribution of Sites of Extra-pulmonary Tuberculosis Cases The distribution of sites of EPTB cases are shown in Table 7. It is seen that

majority of EPT cases had Lymphadenitis (650; 51%) followed by Pleural Effusion

(369; 29%).

Table-7 : Distribution of Sites of EPTB cases (April-2011-March-2012) Sites of EPTB

Nos.

Sites of EPTB

Nos.

a)

LYMPHADENITIS :-

d)

C.N.S (Brain)

Cervical (Neck gland)

497

Tuberculoma

7

Mediastinal (Hilar)

30

Meningeal

9

Axillary

47

e)

UROGENITAL

Cold Abscess

17

Endometrium

22

Abdominal

58

f)

Renal

13

Other

1

GIT

g)

ABDOMINAL Koch's

106

b)

PLEURA h)

Pericaridial

4 Effusion

359

i)

Milliary

8

Empyema

4 j)

Others

13 Pneumothorax

6

Pyopneumothorax

-

Hydropneumothorax

-

c)

SKELETAL

Rib

1

Spine

37

Bone/ joint

30

Total EPTB cases

1269

2.6 Respiratory Emergency

As seen from table 8(a), a total of 8454 patients attended the emergency ward. Of

these, 3414 (40.4%) required to be admitted in the hospital. Table 8(b) shows that

majority (69.1%) had tuberculosis.

24

Table 8(a): Respiratory Emergency Data (April-2011 -March-2012) Total Patients attended the emergency Male Female Total

6139 2315 8454

Admitted from emergency 3414

Patients came for Nebulization only 1347

Patients came only for Injection 1650

Number of Deaths in Emergency 237

Table 8(b) : Type of patients attended the emergency

(April-2011 -March-2012) S.No Type of Disease No. % i) Tuberculosis (TB) 5840 69.1%

ii) Pneumothorax 228 2.7%

iii) Bronchial Asthma 199 2.4%

iv) COPD with Exacerbation 919 10.9%

v) Haemoptysis 938 11.1%

vi) Non Respiratory /Miscellaneous Conditions 330 3.9%

TOTAL patients in emergency 8454 100.0%

2.7 Total Cases in OPD (OPD Load)

The total number of patients who attend the LRS OPD constitute mainly four

groups: (i) New registrations (ii) Subsequent visits for diagnosis (iii) Follow- up visits

by TB patients and (iv) Follow- up visits by Non-TB patients.

Table 9 : Total patients visited LRS OPD (OPD Load)

(April-2011 -March-2012) Patient visits in OPD ADULTS CHILDREN

TOTAL Mal

e Female

Male

Female

i New OPD Registration 24821

13766 1988 1586 42161

ii Subsequent visits by patients

39665

20827 3489 2603 66584

iii Follow up visits made 1016 4317 486 368 15336

25

by TB cases after diagnosis

5

iv Patients visited LRS -OPD

74651

38910 5963 4557 124081

v Non TB patients (New+ Follow ups ) in Special Clinics 5773

vi Patients attended the emergency ward 8454

vii Staff OPD number 9929

TOTAL patients visited the LRS Institute ( Special Clinics+Emergency+ OPD)

148237

Number of working days 298

Average Number of New Registrations (Symptomatics) per day 141

Average number of total patients visited LRS per day 497

Table-9 shows that a total of 148237 patients visited LRS during the year. Of these,

42161 were new symptomatics. 66584 patients made subsequent visits for diagnosis,

15336 patients made follow up visits as TB cases.

During the year, OPD worked for 298 days. It was observed that on average, a total

of 497 cases visited LRS per day including 141 new registrations.

2.8 Paediatric OPD

Paediatric patients are seen in a Paediatric OPD daily from Monday to

Saturday. The T.B. patients from specified area of the Institute are referred to the

respective DOT centres while the others are treated at LRS OPD. The data is shown

in tables 4, 5, 6 and 9. A total number of 4478 tuberculin tests were done during the

year. Out of these, 62.4% were found to be tuberculin positive as shown in table-10.

Table -10 : Number of Tuberculin tests done (April-2011 -March-2012) <1 yr 1-2 3-5 6-10 11-14 >14 Total

Total Treated 15 145 521 637 927 2233 4478

Total Read 9 133 475 597 844 2084 4142

Positive 4 72 229 327 500 1456 2588

Negative 5 61 246 270 344 628 1554

PPD not read 6 12 46 40 84 141 329

26

2.9 Specialized Clinics (Non-TB Cases )

The Institute runs various specialised clinics, which are held periodically. The

data is shown in table -11.

TABLE-11 :- SPECIALIZED CLINICS DATA (April-2011 -March-2012)

S. No Name of the Clinic In-charge New Follow up

Number of patients

i)

Sleep Clinic Dr. Rajnish Gupta 37 65 102

ii)

Lung Cancer Clinic Dr. D. Behera / Dr. A. Jaiswal

105 280 385

iii)

Surgery Clinic Dr. R.K Dewan 176 2081 2257

iv)

Allergy Clinic Dr. A.K. Jain 135 696 831

v)

Tobacco Cessation Clinic

Dr. S.B. Singh 843 443 1286

vi)

APRD ( Air Pollution Related Disease) Clinic

Dr. J.K. Saini 22 27 49

vii)

Laser Therapy Clinic Dr. M.M. Puri 15 464 479

TOTAL 1333 4056 5389 viii) Pain Management Clinic ( Dr. Ashwini ) 384

Grand Total 5773 3.0 Indoor Patient Data

Those patients requiring hospitalisation are admitted in the Institute for the

treatment of tuberculosis and other respiratory diseases. These hospitalised

patients include cases of multi-drug resistant TB, emergencies such as haemoptysis,

pneumothorax etc., surgical and seriously ill patients of respiratory diseases, cases

with diagnostic problems and patients requiring Intensive Care management for

respiratory diseases.

3.1 Total Indoor Admissions During the period from April 2011 to March 2012, a total of 5790 patients were

admitted and 5197 were discharged.

27

3.2 Age & Sex Distribution of Admitted Cases

Table-12 shows that among the total 5790 admissions, there were 5502

(95%) adults and 288 (5%) children. Among the hospitalised adults, the maximum

were in the productive age group of 25 to 54 years.

Table-12: Age & Sex Distribution of the patients Admitted & Discharged (April-2011 -March-2012 )

Age groups (Yrs.)

Admission Discharge

Male Female Total Admission

Male Female Total Dischar

ge Children 0-5 29 15 44 24 13 37

6-10 44 25 69 36 23 59

11-14 57 118 175 51 97 148

Total children 130 158 288 111 133 244

Adults 15-24 569 398 967 494 369 863

25-34 699 319 1018 636 293 929

35-44 763 256 1019 690 222 912

45-54 838 199 1037 770 186 956

55-64 690 177 867 616 164 780

>=65 457 137 594 389 124 513

Total Adults 4016 1486 5502 3595 1358 4953

TOTAL Patients 4146 1644 5790 3706 1491 5197

28

3.3 Outcome of Admitted Cases :

Out of total 5197 indoor treated cases, 2778 (53%) were suffering from pulmonary

tuberculosis, 364 (7%) had extra pulmonary tuberculosis and 2055 (40%) were suffering

from non-tubercular disease. The outcome of these patients is given in Table-13. It is

observed that 13% of the patients died, 7% Left Against Medical Advice (LAMA), 6% were

Discharged on Request (DOR), 2% absconded, 3% referred out and remaining 3539 (68%)

were discharged after satisfactory treatment.

Table-13 : Distribution of outcome of indoor patients treated in the hospital

(April-2011 -March-2012 ) Outcome Adults Children TOTAL Grand

Total %ag

e PT EP

T NTB PT EP

T NTB PT EPT NTB

i Discharge 1695 223 1442 77 40 62 1772 263 1504 3539 68%

ii L A M A 236 20 114 8 0 1 244 20 115 379 7%

iii D.O.R. 144 21 130 5 4 7 149 25 137 311 6%

iv Absconded 73 8 37 1 1 1 74 9 38 121 2%

v Referred 67 28 64 6 4 11 73 32 75 180 3%

vi Died 450 14 185 16 1 1 466 15 186 667 13%

TOTAL 2665 314 1972 113 50 83 2778 364 2055 5197 100%

54% 6% 40% 46% 20% 34% 53% 7% 40%

4951 246 5197

3.4 Observations on Indoor Cases: On analysing the data of the discharged cases, the following observations are made:

i It is observed from Table 14 that 67% (45% Cat-II and 22% Others) of the

hospitalised pulmonary TB cases were put on retreatment regimens including

reserve drugs, thereby reflecting that most of the patients admitted are those who

are defaulters and failures and having difficulties of treatment compliance.

ii. As soon as the treatment response was observed clinically, the cases were

discharged and referred to respective DOTS centres for further treatment.

Therefore, it is observed that among the pulmonary TB cases who were

discharged after satisfactory treatment from LRS (excluding LAMA, Absconded,

DOR, Referred or Deaths, and for whom the sputum report was available), 1765

29

admitted patients with sputum positive results had still not converted to smear

negative status possibly due to a shorter duration of stay in the hospital (Table-

15).

iii Of the total TB cases, about 66.8% had no complications, while 14.3% had

complications like pneumothorax, pyoneumothorax, empyema, lung abscess etc.

(Table 16).

iv Among the 263 extra-pulmonary TB cases, majority had pleural involvement

(70%) followed by Abdominal (9.9%), Lymph Node TB (3.4%), Miliary TB (3.4%)

and Tubercular meningitis (3%) as given in table 17.

v. Among the admitted non-TB chest cases, COPD and lung cancer constituted

30% and 22% of the cases respectively (Table 18).

vi Detection of HIV-cases is also done in the Institute. Most of the cases detected

were adult males. HIV was suspected in 1543 admitted patients, of whom, 69

(4.5% ; 64 adults and 5 children) were found to be HIV positive (Table 19).

vii The patients of PTB put on treatment received 3% conventional treatment, 1%

SCC, 50% DOTS and nearly 12% reserve drugs (Table 20).

viii Among the total 622 cases admitted in ICU, there were 434 medical (including

paediatric cases) and 188 surgical cases. During the year, 131 deaths occurred

in ICU (Table 21). These are included in the total deaths of the Institute.

Table-14 : Categorywise Distribution of PTB cases (April-2011 - March-2012 )

Category Adults

Children

Total

No. Percent Cat -I 843 42 885 32%

Cat-II 1220 48 1268 45%

Cat-III 17 0 17 1%

Other than Cat-I,II,III) 585 23 608 22%

TOTAL 2665 113 2778 100%

30

Table-15 : Sputum Status of Discharged Pulmonary TB cases (Excluding LAMA/DOR/Absconded and Deaths) (April-2011 -March-2012 )

(a) Total discharged PT cases 2778

(b) Cases excluded from analysis (LAMA(244 ) +DOR(149 ) +Absconded(74 ) +Referred out(73 )+Deaths(466 ) =

1006

(c) Sputum report not available at discharge 7

(d) Data analysed for Sputum status at admission and discharge {(d) = (a) - (b+c) }

1765

Number of patients who were Positive at admission and remained Positive at Discharge

1765

Table-16 : Complications in DISCHARGED PTB Cases (April-2011 -March-2012 )

Complications Number of Patients TOTAL Percentage

Children Adult

Pneumothorax 2 54 56 3.2%

Pyopneumothorax 4 137 141 8.0%

Empyema 1 46 47 2.7%

Lung Abscess 1 6 7 0.4%

No Complications 69 1114 1183 66.8%

Not Mentioned 0 338 338 19.1%

Total 77 1695 1772 100.0%

Table-17: Distribution of Extra Pulmonary Tuberculosis cases (EPT) (April-2011 -March-2012 )

Type of cases Adults Children Total Number Percent

i Lymph Node 2 7 9 3.4%

ii Pleural effusion /Empyema 28 156 184 70.0%

iii Abdominal Koch's 3 23 26 9.9%

iv Miliary 2 7 9 3.4%

v Pericardial Effusion 0 2 2 0.8%

vi Skeletal (Bone & Joints) 1 1 2 0.8%

vii Tubercular Meningitis(CNS)

3 5 8 3.0%

viii Others 1 22 23 8.7%

TOTAL 40 223 263 100.0%

31

Table-18 : Distribution of Admitted Non TB Cases (April-2011 -March-2012)

Types of Non Tuberculosis Children Adults Total Number Percent I COPD 1 614 615 30%

II Lung Carcinoma 1 445 446 22%

III Interstitial Lung Disease 3 73 76 4%

IV Pneumonia 9 55 64 3%

V Empyema (Non Tubercular) 11 93 104 5%

VI Bronchiectasis 6 101 107 5%

VII Cor Pulmonale 0 12 12 1%

VIII Pneumothorax 1 58 59 3%

IX Bronchial Asthma 23 32 55 3%

X Lung Abscess 0 14 14 1%

XI Sarcoidosis 0 10 10 0.5%

XII Tropical Pulm Eosin (TPE) 1 1 2 0.1%

XIII Others 27 468 495 24%

TOTAL 83 1976 2059 100%

Table-19 : Detection of HIV Among Suspected Admitted Patients (April-2011 -March-2012)

HIV test Status

PTB EPTB Non TB Total

Male Female Male Female

Male Female

Male Female Total

Children

Positive

2 1 0 2 0 0 2 3 5

Negative

16 36 19 10 21 8 56 54 110

Adults Positive

41 6 6 0 7 4 54 10 64

Negative

583 208 83 49 344 97 1010 354 1364

TOTAL 642 251 108 61 372 109 1122 421 1543

893 169 481 1543 0 1543

32

Table-20 : Distribution of PTB Cases as per Treatment Given (April-2011 -March-2012)

Treatment Type Children Adult Total Number Percent Conventional 0 54 54 3%

SCC 1 11 12 1%

DOTS 58 1321 1379 50%

Reserve Drugs 18 309 327 12%

TOTAL PT cases Started treatment 77 1695 1772 66%

Trement not started due to early DISCHARGE,LAMA DOR,ABSCONDED, REEFERRED OUT,DIED Before Treatment started

36 970 1006 36%

Total PTB cases 113 2665 2778 100%

33

Table-21 : Details of I.C.U. Admissions (April-2011 - March-2012) Total Treated TOTAL Medical Patients (Adults) 427 622

Medical Patient (Paediatric) 7

Surgical Patients 188

Cumulative No. of patients treated in rooms for critical care 1847

Cumulative No. of patients treated for intermediary care in high dependency units (HDU)

2145

Patient with longest stay 3mths

Average bed occupancy in rooms for critical patients(total rooms =6) 5.0

Average bed occupancy in High dependency rooms (HDU) (total beds =8) 5.9

Average Bed Occupancy (Total beds =14) 10.9

No. of patients on Invasive Ventilator 187

Average No. of Ventilator Days / Month 67

No. of patients on Non Invasive Ventilator 304

Average No. of days / patient on NON invasive ventilator 3.8

No. of ECGs done 591

No. of ABGs done 5689

No. of Central Lines put 53

Miscellaneous procedures

ICD 71

Pleural Aspirations 33

Pleural Biopsy 7

Tru-cut Biopsy 1

Bronchoscopy 5

Ascitic Tap 13

Tracheostomy 1

FNAC 8

Outcome

Discharge 94

Transfer out 372

LAMA 15

Death 131

34

Annual Trends of LRS Institute’s Data Vs National / International Scenario

Over the years, it has been observed that amongst the symptomatics attending the LRS

OPD, more than 3/4th are aged between 15-54 years. Majority (>40%) of diagnosed cases

have TB of either pulmonary or extra-pulmonary type. About 30% of them are new smear

positive PTB cases, of whom, >80% belong to 15-54 year age-group. Even among the

hospital admissions, about 70% are aged between 15-54 years. These observations are in

line with the recent Annual Status Report of our country, which suggests that almost 70% of

TB patients are aged between 15 and 54 years of age. Since this is the most productive

period of their lives, TB causes enormous socio-economic consequences for their

households and the country at large.1

About 10% of all TB cases are in the pediatric age group, while the remaining are

adults. Globally, pediatric TB cases account for 10 to 15% of all TB cases. Similarly, the

burden of pediatric TB in our country is also assumed to be 10% of total TB load.1 Thus, the

Institute data matches with the national and international figures of pediatric TB case load.

It is seen that males constitute about 2/3rd of all symptomatics attending the LRS OPD.

They also make up about 2/3rd of all new smear positive PTB cases. The findings are

similar to those observed in the Recent Annual Status Report of our country mentioning

two-thirds of TB cases to be males.1

Over the years, proportion of EPTB case detection as compared to PTB has been

rising. However, over last 2 to 3 years, the proportion of New EPTB cases is stable i.e.

around 1/3rd of all TB cases. Since EPTB diagnosis is difficult and requires a number of

special tests including invasive techniques, there is a need to develop non-invasive tests

and incorporate them in RNTCP so that these could be utilized at the periphery itself.

1- TB India 2012

35

4.0 Departments and Sections of the Institute

LRS Institute of TB and Respiratory Diseases has several departments and sections

to carry out the activities of the Institute. Their staff (including the names of the heads / in-

charges) and activities performed by them during the year are mentioned under the

respective department and section.

4-A Departments Various departments functioning within the Institute and their heads are mentioned

below.

S. No. Name of Departments Name of the Head of Department

4.1 Department of Anaesthesia Dr. Ashvini Kumar 4.2 Department of Bio-Chemistry Dr. Devika Tayal 4.3 Department of Epidemiology & Public Health Dr. Khalid Umer Khayyam 4.4 Department of Hospital Administration Dr. Rohit Sarin 4.5 Department of Internal Medicine Dr. Upasana Agarwal 4.6 Department of Microbiology Dr. V.P. Myneedu 4.7 Department of Molecular Medicine / Genetics Dr. Paras Singh 4.8 Department of Paediatrics Dr. Sangeeta Sharma 4.9 Department of Pathology Dr. Kumud Gupta 4.10 Department of Physiology Dr. Rupak Singla 4.11 Department of Radiology Dr. Devesh Chauhan 4.12 Department of TB & Respiratory Diseases Dr. Rupak Singla 4.13 Department of TB Control & Training Dr. Rohit Sarin 4.14 Department of Thoracic Surgery and Surgical

Anatomy Dr. R. K. Dewan

Detail of each department is given below. 4.1 Department of Anesthesia Dr. Ashvini Kumar : Head of Department

Dr. Prakash Sharma : Anaesthetist

The department has a centrally air-conditioned, state of the art operation theater with

Laminar flow. The department provides services for pre anesthetic assessment, pre-

operative optimization and administration of anesthesia for various diagnostic and

therapeutic procedures. Acute pain management for patients undergoing procedures under

anesthesia is also undertaken. The department also runs a pain clinic for management of

chronic post thoracotomy pain. Other activities like providing sterilization services and

36

Oxygen supply to the entire Institute are also undertaken by the department.

4.2 Department of Bio-Chemistry Dr. Kumud Gupta : Head of Department (till 30th September 2011) Dr. Devika Tayal : Head of Department (Joined wef 1st October 2011) Dr. Amita Khiwani : Senior Resident (Joined on 5th October 2011) Department of Biochemistry is well equipped with fully automatic random access

biochemistry analyser and automatic analyser. It carries out various tests like Blood Sugar,

Urea, Creatinine, Total-Bilirubin, Direct Bilirubin, SGOT, SGPT, Alkaline Phosphatase, Total

protein, Albumin, Uric Acid, Cholesterol & Electrolytes (Sodium, Potassium and Chloride).

The procurement of other equipments like ELISA Plate Reader, Plate Washer and the

instrument for estimation of Glycated Haemoglobin is in process. The tests and data of

department is given in table 22.

Table-22 : BIOCHEMISTRY tests done (April-2011 -March-2012 )

S.No. Type of Tests Number % out of 192535

i Blood Sugar 14451 7.5%

ii Blood Urea 17912 9.3%

iii Creatinine 18388 9.6%

iv Total Bilirubin 19209 10.0%

v Direct Bilirubin 18474 9.6%

vi S.G.P.T. 19403 10.1%

vii S.G.O.T. 19403 10.1%

viii Alk PO4 19389 10.1%

ix Protein 12734 6.6%

x Albumin 11699 6.1%

xi Uric Acid 2593 1.3%

xii Cholesterol 2329 1.2%

xiii Electrolytes 16551 8.6%

Total Tests 192535 100.0%

Total Number of Samples = 45324

37

4.3 Department of Epidemiology & Public Health Dr. Khalid Umer Khayyam : Epidemiologist and HOD

Dr. Sujata Arya : Senior Research Officer (Epidemiology)

Dr. Neeta Singla : Research Officer

Department is running RNTCP with the help of staff provided by STO, Delhi. It is

coordinating with Department of TB & Respiratory Diseases in provision of DOTS to all categories

of TB patients and also establishing a linkage to the RNTCP staff for continuation of treatment at the

patient’s doorsteps.

Besides this, the department is involved in facilitating the RNTCP modular training of MOs,

MOTCs, DTOs and STOs from different parts of the country on a continuous basis. Department is

also involved in regular teaching activities of post graduate students both from within and outside the

Institute. Department is also involved in regular RNTCP teaching programme for nursing staff of

the Institute and for nursing students from other Institutes. The faculty of the department has

delivered guest lectures and has attended various conferences at both national and international level.

The department has also organized various workshops on involvement of NGO and PPs in DOTS

and DOTS-Plus. Department is also involved in developing teaching modules for nurses for DOT-

Plus.

The LRS Institute of TB & Respiratory Diseases has been entrusted the responsibility

by the Delhi Govt. of undertaking Tuberculosis Control activity in a defined geographical

area in the southern part of Delhi covering a population about 1.00 million. The domiciliary

treatment services were earlier being offered to these Area patients from the OPD of the

institute. With the introduction of the Revised Strategy for Tuberculosis Control (RNTCP)

by the Government of India the tuberculosis control services provided by the institute have

been decentralized through DOT-cum-Microscopy centres established under the RNTCP in

the area covered by the institute. At places, sub-centres (DOT-Centres) have also been

started with NGO assistance to further bring the services closer to the patients and

community. The list of the DOT-cum-Microscopy Centre is as under:-

38

Name of Centre Medical Officer Incharge Phone No.

DGD – Mehrauli Dr. Jain 29961371

MCD – Fatehpur Dr. Sarkar 26653393

DGD – Chhatterpur Dr. Qayyum 26801602

DGD – Jaunapur Dr. Sunil Thapriyal 266548444

DGD – Ber Sarai Dr. Archana 26526942

DGD – Khanpur Dr. Mamta Gupta 29960981

DGD – Tigri Dr. Mamta Gupta 29960981

DGD – K-II Block, Sangam Vihar Dr. J.C Malik 26046306

DMC – I Block, Sangam Vihar Dr. Sujata Arya (MO-TC) 26517826 (Extn. 531)

DMC – J Block, Sangam Vihar Dr. Sujata Arya (MO-TC) 26517826 (Extn. 531)

DMC – G Block, Sangam Vihar Dr. Sujata Arya (MO-TC) 26517826 (Extn. 531)

DMC – I Block, Sangam Vihar Dr. Sujata Arya (MO-TC) 26517826 (Extn. 531)

LRS Institute Dr. K.K. Mathuria 26517826 (Extn. 531)

In addition to the above centres, the department is collaborating with the following

NGOs and Private Practitioners.

Name of NGOs Contact Person Phone No.

St. Marry, Aaya Nagar Dr. Joseph 011-55653587, 20913530

Vyakti Vikas Kendra India Dr. Sunita Khera 9810594753

Asha Community Health &

Devlopment

Ms. Rani 011-26716409, 26179844

Rotary Club of Delhi South Dr. B.S Khurana 9868103028

Rotary Club of Delhi Sainik

Farm

Dr. P.C Bansal 9312212736

39

The RNTCP is implemented by the DTO who is assisted by Medical Officer -TB

Control (MOTC). There are two tuberculosis units each being under one MOTC who is

assisted by Senior Treatment Supervisor (STS), Senior TB Laboratory Supervisor (STLS),

five Laboratory Technicians and five TB Health Visitors. The department also has a Data

Entry Operator. Most of the staff working in the department is on contract basis.

The RNTCP has consistently achieved the National targets of cure rate of above 85%

and case detection above 70% for the past several years. The Institute is also implementing

the DOTS Plus strategy for programmatic drug resistant cases through this department.

The Department has been involved in many publications in international and national

journals and is regularly generating data of RNTCP for discussion in monthly statistical

meetings.

RNTCP

Dr. Khalid U Khayyam : District TB Officer

Dr. Neeta Singla : Medical Officer TB control

Dr K Mathuria : Medical Officer TB control

Revised National Tuberculosis Control Programme was implemented in a phased

manner and the full fledged programme began in 1997. The programme uses the DOTS

strategy with the objective to achieve and maintain at least 85% cure rate of new sputum

smear positive and detection of at least 70% of such cases. Entire country was covered

under RNTCP in March 2006.

From when LRS was part of it?

The south zone district of Delhi was offered to this institute to implement the

national programme.

Currently LRS-RNTCP is looking after the 1 million population of land area starting

from Ber Sarai to Jaunapur and from Khanpur to Sangam Vihar. This area was divided into

40

two tuberculosis units. There are 11 designated microscopy centers and 17 DOT Centers

including NGO’s and PP’s.

RNTCP ACTIVITIES: Eleven microscopy centers are being operationalised with the help

of qualified and trained Laboratory Technician in 1 million population of South Zone of

Delhi. All the chest symptomatics undergo screening for TB by smear microscopy.

A DOT provider is available in all 17 DOT centers of our area whose functions include:-

• Initial home verification of TB diagnosed patients and provision of IEC activities to

family members.

• Initiation of DOTS as per RNTCP guidelines.

• Establishing the linkage by visiting the Institute on every Friday for timely

enrolment of the diagnosed and referred patients to their respective DOT area.

• Continuation of DOTS to patients after discharge from the Institute.

• Sending case and contacts to LRS Institute for various ongoing research projects.

• Helping the trainees during the field visits at DOT/MC Centres during their RNTCP

modular trainings.

IEC activities are done at each DOT centre on quarterly basis by 1st level of supervision. A

collaboration has been done with Department of Community Medicine of St.Stephen hospital for

training of DOT-provider regarding IEC activities at DOT Centre.

A collaboration has been done with NGOs and PPs. Among the NGOs, the St. Marry’s Medical

Centre is one of the well known organization working in tuberculosis. The ESI at Tigri and Mehrauli

patients are benefiting from DOT at ESI Centers.

A collaboration has been done with other organizations like Jamia Hamdard (Hamdard

University) for research work of M.Sc and Ph.D students.

41

LRS-RNTCP achieved the cure rate of 89% and the sputum conversion rate of smear positive

patients of 90% during the year (table-23). This achievement resulted due to the joint efforts of LRS,

NGOs, PPs and STO Delhi.

Table-23: LRS-RNTCP Outcome Data (April- 2011 to March 2012)

Indicator Yearly expected

2nd quarter 2011

3rd quarter 2011

4th quarter 2011

1st quarter 2012

Actual Year

New smear positive

950 294 220 217 288 1019

New smear Negative

950 185 168 103 121 577

Retreatment 475 207 116 181 203 707

EPT 190 413 394 206 222 1235

Total 2565 1099 898 707 834 3538

Sputum Con.

>90% 88.4% 86.28% 88% 88% 87.67%

Cure Rate >85% 89.8% 91% 88.4% 92.12% 90.33%

Default Rate

<5% 5% 4.6% 3.8% 0.6% 3.50%

Failure Rate <4% 1.9% 2.6% 2.3% 3.6% 2.6%

Death Rate <4% 2.5% 0.6% 1.5% 3.6% 2.05%

DOTS was given to a total number of 3538 patients that included 2749 of Category-I and 789

of Category-II.

DOTS-PLUS Project :

LRS Institute has been promoting National Tuberculosis Control Programme through

implementation of DOTS in 1 million populations in South Delhi, through 11 microscopy and 17

DOT centres. It has been successful in achieving the goals of the National Tuberculosis Control

Programme. The Institute started DOTS-PLUS as a pilot project in Jan’02. The project had

approval of green light committee. A total of 160 patients were enrolled in the project. The seven

year experience has also been published. This Experience of DOTS Plus project contributed

42

significantly in formulation of national DOTS Plus guidelines. Faculty of LRS Institute are also

members of National DOTS Plus committee for framing and revising the National Guidelines. LRS

Institute is now a part of National DOTS-Plus Programme.

Currently Institute is implementing National DOTS-Plus programme since Jan’09. The

activities under the programme are as follows:

• LRS institute covers a population of 6 million for screening the MDR in its National Reference

Laboratory and a population of 6 million for providing DOTS-Plus treatment. Five chest clinics

namely Malviya Nagar, Moti Nagar, RTRM, DFIT, and LRS chest clinics come under DOTS-

Plus treatment.

• The suspects for MDR are the patients who fail on CAT-I, CAT-II (any month follow-up positive)

and CAT-II initial positive under DOTS. All such patients are subjected to culture and sensitivity

free of cost by the LRS Microbiology Lab which is the national reference laboratory for

tuberculosis. Patients with proven MDR are enrolled in the programme. These patients are

treated with daily supervised regimen for a period of 2 years with the second line drugs free of

cost.

• All the patients enrolled in the programme are evaluated by a DOTS-Plus committee. Members of

the committee are specialists of chest medicine, epidemiology, internal medicine, Obs & Gynae,

ENT, Nephrology, Endocrinology, Psychiatry and microbiologist. This committee meets on a

weekly basis to discuss the enrollment related and other issues like adverse drug effects.

• Approximately 1062 patients were screened during the period and 226 patients started on

treatment. Their record was maintained on regular basis.

4.4 Department of Hospital Administration Dr. Rohit Sarin : Assistant Medical Superintendent and HOD

Dr. R.K.Dewan : Chief Administrative Officer

Dr. Kamla Verma : Chief Medical Officer (NFSG)

The Department of Hospital Administration is headed by the Assistant Medical

Superintendent, Dr. Rohit Sarin. The Dept. assists the Director in running the Institute. Other

divisions of the administration include a Chief Administrative Officer (Dr. R. K. Dewan) and an

officiating Administrative Officer (Mr.G.V.Raju). Various administrative issues are dealt by this

division. Estate Branch looks after the maintenance works of the Institute and consists of an

43

Estate Committee and a Consultant Civil Engineer on contract basis. The Medical and

General Stores, Health Education Section, Social Welfare Section, Transport Section, Medical

Record Section, Telephone Exchange, Security division, Procurement Cell, and a full fledged

Accounts Section take care of various activities of the Institute. The Institute also has a Public

Information Officer(Mr.G.V.Raju) and an Appellate Officer (Dr. Anand Jaiswal).

4.5 Department of Internal Medicine Dr. Upasna Agarwal : Head of Department

The Department of Medicine runs a daily medicine OPD and gives internal Medicine

consults to patients of Respiratory Medicine attending the Institute’s OPD and admitted in

wards and intensive care unit.

The Department of Medicine also runs a free HIV clinic under the aegis of National

AIDS Control Organization as discussed later under the Section.

The Department of Medicine hopes to provide quality care to people availing its

services and to lead in teaching, training and research activities in the future.

4.6 Department of Microbiology

Dr. V.P. Myneedu : Microbiologist and HOD

Dr. Manpreet Bhalla : Senior Research Officer

Dr. Ajoy Kumar Verma : Microbiologist

Dr. Ritu Singhal : Microbiologist

Dr. Manish Mathur : Senior Resident

NRL Staff

Dr. Niti Singh : NRL – Microbiologist

Dr. Jyoti Arora : NRL-Microbiologist

FIND Staff

Dr. Gavish Kumar : FIND – Microbiologist

The department of Microbiology is equipped to provide diagnostic and research support

44

in the areas of Mycobacteriology, Bacteriology, Mycology, Serology and Molecular Biology.

The department plays a pivotal role in the diagnosis of tuberculosis and supports the

RNTCP by performing the following.

• Smear microscopy by ZN stain and fluorescent stain on binocular, fluorescence and

Trinocular microscopes for the purpose of diagnosis and training.

• Culture, identification and drug susceptibility testing (DST) for all anti-TB drugs of

mycobacterium by conventional and MGIT 960 TB System.

• The laboratory carries out approximately 25,000 cultures/annum and DST to both first

line and second Line anti tubercular drugs.

• The laboratory is the National Reference Laboratory under RNTCP related activities and is

involved in conducting quality assurance, accreditation and training related programmes.

The department supervises the Intermediate Reference Laboratory (IRL) activities and

quality control issues of 11 states.

• Line Probe Assay (LPA) has been established in new research block to diagnose and to

detect resistance to Rifampicin and INH in 48 hours after receiving the smear positive

samples. This will help in rapid diagnosis of MDR TB Patients. Training was conducted by

Foundation for Innovative New Diagnostics (FIND) in this regard, following which, both

internal and external proficiency testing has been completed and laboratory has been

accredited by Central TB Division to use LPA as a diagnostic test for MDR TB under

DOTS Plus programme for Delhi State and other states.

• Gene-Xpert equipment has been donated by Melinda & Bill Gates Foundation for the

rapid diagnosis of TB and MDR TB. The department has evaluated the Gene-Xpert

equipment with 120 sputum samples from suspected MDR patients and the results were

compared with the results of solid and liquid cultures and DST Methods. The report of the

results has been tabulated and sent for publication in index journal.

• The Department of Microbiology has established a conventional identification for Non-

tubercular Mycobacteria isolated from various respiratory and pulmonary specimens.

• With a view to provide holistic diagnostic support for routine bacteriology, facilities of

mycology and serology also exist. The laboratory does routine serological screening for

HIV, HBsAg, HCV, Widal and Aspergillosis.

During this period, the department carried out proficiency testing of IRLs of Delhi,

45

Haryana, TB lab of PGI, Chandigarh and TB labs of Dept. of Medicine and of Dept. of Lab

Medicine of AIIMS, New Delhi. Several on-sight evaluations (OSEs) of IRLs of Manipur,

Haryana, Delhi state, Dept. of Microbiology and Govt. Medical College and Hospital,

Chandigarh were carried out. IRL of Karnal, Haryana was accredited. Other laboratories are in

various stages of accredition. During the year, microbiologists and LTs of all IRLs Haryana, TB Lab of Dept. of

Microbiology PGI, Chandigarh and TB lab of Dept. of Medicine were trained in culture and

DST of M.Tuberculosis as per RNTCP guidelines. Trainings of Lab Supervisors and Lab

Technicians from high burden Designated Microscopy Centers (DMCs) of Medical Colleges

under the Project – LIGHT of IUATLD was carried out at LRSI from December 2011 to April

2012.

Data of Microbiology Department for the year is shown in tables from 24 to 34.

Table-24: Pulmonary Smear Microscopy (Sputum examinations) (April-2011 -March-2012)

SOURCE OF SAMPLE Sputum smears made for microscopy

Sputum smears

confirmed by

Microscopy

Sputum Positives

Percentage positivity

OPD

Diagnosis

LRS RNTCP (DOTS) Area Non Area and Outsiders

33628 26387 4985 14.8%

Follow up 3867 3112 716 18.5%

Total (a) 37495 29499 5701 15.2%

INDOOR (b) 10486 9977 3107 29.6%

Culture Section

Pulmonary

OPD 14452 14452 4869 33.7%

Ward 3376 3376 983 29.1%

Extra Pulmonary 1666 1666 140 8.4%

Subtotal (c) 19494 19494 5992 30.7%

TOTAL (a)+(b)+(c) 67475 58970 14800 21.9%

46

Table-26 : CULTURE SECTION (EXTRA PULMONARY SPECIMENS) (April-2011 -March-2012 )

S.No.

TYPE OF TESTS No.of Specimen

Smear Positive

Conventional Culture

MGIT

I Pleural Fluid 374 4 342 22

Ii Pleural Pus 258 42 242 0

Iii Pus 395 57 380 43

Iv Bronchial Washings 121 2 109 0

V Lymph Node aspirate 0 0 7 67

Vi FNA 423 25 378 33

Vii Ascitic fluid 46 0 45 2

Viii Urine 12 0 8 11

Ix CSF 13 0 13 1

X Tissue Lung Biopsy 6 0 4 1

X Others 19 0 14 55

TOTAL 1667 130 1542 235

Table-25 : CULTURE SECTION (PULMONARY SPECIMEN) (April-2011 -March-2012 )

Particulars Total Samples Received

Conventional Culture

MGIT Culture

OPD 14452 8623 1891

INDOOR 3376 1209 210

Project 0 0 47

DOTS plus project 0 0 0

TOTAL 17828 9832 2148

47

Table -27 : Drug Susceptibility Results for PRIMARY DRUGS (Drug Resistance ) (CONVENTIONAL METHOD )

a. All Sensitive 217

b. Any Resistance 706

Drug No. Drug No. Drug No.

SHRE 201 SR 17 R 8

SHR 183 HR 88 S 51

HRE 11 SH 54 H 78

SHE 8 HE 4 E 1

SRE SE 1

RE 1

c. Indeterminate (Repeats ) 122

d. Quality Control 33

Total Tests Performed = (a+b+c+d) = 1078

Table- 28 : Drug Susceptibility Results (Drug Resistance results) (MGIT METHOD)

a. All Sensitive 133

Any Resistance 939

b. Drug No. Drug No. Drug No.

SHRE 333 SR S 16

SHR 200 HR 152 H 95

HRE 56 SH 48 R 4

SRE 1 HE 5 E 1

SHE 19 RE 1 I 8

c. Indeterminate (Repeats) 0

d. Quality Control 19

Total Tests Performed = (a+b+c+d) = 1091

48

Table-29 : BACTERIOLOGY ( PYOGENIC CULTURES) (April-2011 -March-2012 )

TYPE OF SAMPLES NO. TYPE OF SAMPLES No. i) Sputum / Throat swabs 1040 viii) Ascitic Fluid (AF) 20

ii) Bronchial washings 55 ix) CSF 4

iii) Pleural fluid 172 x) ET 168

iv) Pus 932 xi) Stool 5

v) Urine 938 xii) Others 32

vi) Lymph node Aspirate 8

vii) Gastric Aspirate 2

TOTAL Samples 3376

Table-31 : MYCOLOLGY (April-2011 -March-2012 ) TYPE OF SAMPLES NO. TYPE OF SAMPLES No. i) Sputum 167 vi) Urine 6

ii) Bronchial washing 35 vii) CSF 2

iii) Pleural fluid 4 viii) ET Aspirate 12

iv) Pus 17 ix) Blood 5

v) Lymph node aspirate 4 x) Biopsy 1

TOTAL 253

Table-30 : RESULTS OF PYOGENIC CULTURES (April-2011 -March-2012 ) Total number of samples = 3376

RESULTS OF SAMPLES NO. RESULTS OF SAMPLES No. i) Total Organisms isolated 2280 vii) Normal FLORA 364

ii) Gram positive 233 viii) Insignificant GROWTH 48

iii) Gram negative 2057 ix) Double/ triple growth 693

iv) Candida 137

v) Sterile 792

vi) Contaminated 20

49

Table- 32 : NAME OF THE TEST FOR MYCOLOGY

(April-2011 -March-2012) NAME OF TESTS No. NAME OF TESTS NO.

i) KOH Mount 253 iv) Germ tube test 100

ii) LPCB mount 223 v) SDA agar 253

iii) Wet mount 219 vi) SDA cc Agar 253

Table- 33 : NAME OF FUNGUS ISOLATED IN MYCOLOGY TEST : (April-2011 -March-2012

RESULTS OF SAMPLES NO. RESULTS OF SAMPLES No. i) Candida Albicans 39 vii) Aspergillus Sp 14

ii) Candida Non Albicans 32 viii) Aspergillus Terreus 1

iii) Aspergillus Fumigatus 15 ix) Aspergillus Niger 2

iv) Candida Sp 16 x) Rhizopus 1

v) Gem tube test 28 xi) Others 22

vi) Aspergillus Flavus 12 Total fungus isolated 182

Table -34 : IMMUNOLOGICAL TESTS (April-2011 -March-2012 ) TOTAL(Ward+OPD)

TESTS Number Positives

HIV 1 & 2 4269 178

HbsAg 1564 63

Widal 692 183

HCV 1245 31

Aspergilosis 144 10

TOTAL Immunology tests done = 7914

50

4.7 Department of Molecular Medicine /Genetics Dr. V.P. Myneedu : Microbiologist and HOD (till 22nd August 2011)

Dr. Paras Singh : HOD (Joined wef 23rd August 2011)

Dr. Mradula Singh : Senior Resident (Joined wef 17th September 2011)

The institute has recently constructed a new division for the purpose of molecular research

activities in regard to tuberculosis, HIV, lung cancer, and other infectious diseases. Currently,

department of Molecular Medicine is providing diagnostic facility to patients through Multiplex PCR

for identification of M. tuberculosis in pulmonary as well as paucibacillary extra-pulmonary TB

cases. Department also facilitates Real Time PCR screening assays for M. tuberculosis in pulmonary

and extra-pulmonary cases and HIV-1 Viral load testing to AIDS patients. Effort has been made for

further molecular identification of NTM by conventional PCR for diagnosis and treatment of

patients. Laboratory diagnosis of pulmonary and extra-pulmonary TB has been streamlined and has

been communicated to clinicians.

The major focus of research activities in the division is towards disease susceptibility. Hence,

the research is being focused on the biomarkers like chemokine receptors and its ligands, CCR2,

MCP-1, TLR, etc. with regard to Tuberculosis and HIV-1 infection and Vascular Endothelial Growth

Factor gene variants, XRCC4 gene variants and SNPs with regard to lung cancer. Recruitment of

healthy volunteers and TB patients has recently started for the approved projects. Two research

proposals have been approved by the Institute Research Committee and Ethics Committee, entitled

“Role of PCR in Detection of Mycobacteria in Pulmonary and Extra Pulmonary cases” and “Innate

immunity Markers: Role of Toll –like receptors Association of TLR4 with tuberculosis: Indian

Scenario”, and the work has commenced.

The vision of the department for next two years is to introduce the latest molecular tools for

identification of the pathogen in subjects with tuberculosis and respiratory / infectious diseases. A

major area of focus is pediatric tuberculosis that requires an early diagnosis and treatment. Efforts

are on to introduce CD4 Count facility to the AIDS patients. Efforts will also be made for NTM

identification by restriction fragment length polymorphism (RFLP) or Innolipa in immune-

compromised patients and further MDR/XDR identification by real time PCR assays.

The department received Conventional PCR, Real Time PCR, Gel documentation and other

equipments from the dept. of Microbiology. Many other equipments like CD4 Cell Counter, Water

Purification System, Thermal Cycler, etc. are in the process of procurement. The data of Molecular

Medicine/ Genetics for the period is given below.

51

DNA Extraction from suspected TB cases

PCR for IS6110 Gene Target in Suspected TB Patients

S. No Samples Number 1 Pleural Fluid 110 2 Ascitic Fluid 16 3 Tissue 3 4 sputum 5 5 Blood 3 6 CSF 2 7 Lymph Node 14 8 Menstrual fluid 1 9 Pus 21 10 Urine 8

Total No. of samples 183

Specimens AFB PCR for IS6110 Type No. Pos /Neg No. Positive Negative

Ascitic fluid 16 Pos - - - Neg 16 10 6

Lymph node 14 Pos 3 3 - Neg 11 6 5

Urine 8 Pos - - - Neg 8 2 6

CSF 2 Pos - - - Neg 2 2 -

Pleural Fluid 110 Pos - - - Neg 110 69 41

Pus 21 Pos 2 2 - Neg 19 13 6

Tissue 3 Pos - - - Neg 3 - 3

Sputum 5 Pos - - - Neg 4 3 1 ND 1 - 1

Menstrual fluid 1 Pos - - - Neg 1 1 -

Blood 3 NA 3 - 3 Positive Control 105 105 - Negative control 105 - 105 Total No. (Samples + Controls)

288 (183+210)

216 (111+105)

177 (72+105)

52

PCR for MPB64 Gene Target in Suspected TB Patients

Real Time PCR (Taq-Man) in Suspected TB Patients

Specimens AFB PCR for MPB 64 Type No. Pos

/Neg No. Positive Negative

Ascitic fluid 15 Pos - - - Neg 15 3 12

Lymph node 13 Pos 2 1 1 Neg 11 5 6

Urine 8 Pos - - - Neg 8 - 8

CSF 2 Pos - - - Neg 2 - 2

Pleural Fluid 107 Pos - - - Neg 107 39 68

Pus 21 Pos 2 1 1 Neg 19 7 12

Tissue 2 Pos - - - Neg 2 - 2

Sputum 5 Pos - - Neg 4 1 3 ND 1 1

Menstrual fluid 1 Pos - - - Neg 1 - 1

Blood 3 NA 3 2 1 Positive control

24 24 -

Negative control

24 - 24

Total No. (Sample + Controls)

225 (177+48)

83 (59+24)

142 (118+24)

Samples PCR results

Type No. Pos Neg Invalid Pus 6 5 1 -

Tissue 1 - 1 -

Pleural Fluid 44 11 30 3 Lymph Node 6 5 1 -

Sputum 2 - 2 -

53

Multiplex PCR for M. tuberculosis Detection 4.8 Department of Paediatrics Dr. Sangeeta Sharma : Paediatrician & Head of Department The Institute has a 34 bed paediatric ward which is headed by a paediatrician. The

department provides both domiciliary as well as institutional care by running a daily OPD

for paediatric cases having TB & Respiratory Diseases and admitting those having serious

illnesses and complications like tuberculosis with empyema, haemoptysis, meningitis, drug

failure or drug resistant cases etc. in paediatric ward or in ICU.

The department is actively involved in teaching of DNB students, nurses and other

trainees from outside the Institute. Department in-charge is involved in RNTCP training

Ascitic fluid 7 2 4 1

Blood 4 1 2 1

CSF 1 1 - -

Menstrual fluid 1 - 1 -

Urine 2 - 2 -

Positive Control 10 10 -

Negative Control 10 - 10 Total Test (samples+controls)

84 (74+10)

35 (25+10)

54 (44+10)

4 (4+0)

Specimens PCR results Type No. Positive Negative

Ascitic fluid 2 1 1 Lymph node 3 3 - Urine 1 1 - Pleural Fluid 4 3 1 Pus 2 2 - Positive control 2 2 - Negative control 2 - 2 Total No. (Sample + Controls)

16 (12+4) 12 (10+2) 4 (2+2)

54

programmes and has delivered guest lectures and attended various conferences at both

international and national level during the year, details of which are mentioned under the

appropriate section. The department provided training on MDR Paediatric TB to 3 WHO-

sponsored doctors from Bhutan on 22nd March 2012.

The department is pursuing various research activities. Results of one of these

studies involving retrospective analysis of DOTS strategy for 1098 paediatric pulmonary TB

cases was published in International Journal of Tuberculosis and Lung Diseases in January

2008.

4.9 Department of Pathology Dr. Kumud Gupta : Head of Department

Dr. Shalini Mullick : Pathologist

Senior Resident : One

The Pathology department provides its services for the outdoor and the indoor patients

of the institute through the following laboratories.

a) Haematology Lab b) Histopathology Lab and c) Cytology Lab.

Haematology Lab is equipped with Automatic Haematology Analyser. It carries out

tests of Haemoglobin, TLC, DLC, ESR, BT, CT, MP, Platelet Count, AEC and P/S

examination.

Cytology Lab is equipped with Cystopin, Centrifuges etc. Various samples, received in

cytology lab, consist of FNA-surgical lumps and masses, ultrasound & CT guided FNA, BAL,

bronchial washings, pleural fluid, ascitic fluid, pericardial fluid, peritoneal fluid, sputum, CSF

etc.

Histopathology Lab is equipped with Microtone Knife Sharpner, Wax Bath etc. It

receives mainly resected lung specimens, pleural biopsy, lymph node, skin biopsy,

bronchial biopsy, TBLB and tru-cut lung biopsy etc. Various equipments were procured for

doing immuno-histo chemistry during the year. The test is likely to be started soon following

the receipt of the chemicals and equipments in the department.

55

Table-35: HAEMATOLOGY tests done ( Pathology Lab. data ) (April-2011 -March-2012 )

OPD Emergency

Type of Tests Number % out of 90452

Number % out of 15407

i) Total Haemoglobin 23230 25.7% 4460 28.9%

ii) Total T.L.C. 23093 25.5% 4460 28.9%

iii) Total D.L.C. 23100 25.5% 4460 28.9%

iv) Total E.S.R. 729 0.8% 1

v) Total B.T. 57 0.1% -

vi) Total C.T. 57 0.1% -

Vii Total M.P. 1035 1.1% 28 0.2%

viii) Total Platelet Count 14337 15.9% 1985 12.9%

ix) Total A.E. Count 3081 3.4% 8 0.1%

x) Total PS 342 0.4% 5 0.0%

xi) PCV 3 0.0% -

xii) PT 765 0.8% -

xiii) APTT 623 0.7% -

Total Tests 90452 100.0% 15407 100.0%

Total Number of samples = 24439 4494

56

Table-36 : CYTOLOGY test done ( Pathology Lab. data)

(April-2011 -March-2012 ) S.No. CYTOLOGY TESTS Number %age out of

4370 i) Fine Needle Aspiration Cytology (FNAC) 1909 43.7%

ii) Pleural Fluid 1246 28.5%

iii) Bronchial Washing 239 5.5%

iv) Sputum for Cytology 413 9.5%

v) C.S.F. 6 0.1%

vi) Pus 73 1.7%

Vii Ascitic Fluid 58 1.3%

viii) Bronchial brush washing (smear) 64 1.5%

ix) BAL 186 4.3%

x) TBNA 72 1.6%

xi) ET aspirate 9 0.2%

xi) PericardIal Fluid 9 0.2%

xii) Peritoneal fluid 36 0.8%

xiii) Bronchial Aspirate 42 1.0%

xiv) OTHERS 8

0.2%

TOTAL 4370 100%

57

Table-37 : HISTOPATHOLOGY tests done ( Pathology Lab. data) (April-2011 -March-2012 )

Type of Histopathology tests Number %age out of 746

i) Pneumonectomy 31 4%

ii) Lobectomy 32 4%

iii) Lymph node biopsy 9 1%

iv) Transbronchial Biopsy 148 20%

v) Pleural Biopsy 279 37%

vi) Cell Block 71 10%

Vii Lung Biopsy 29 4%

viii) True Cut Biopsy 53 7%

ix) Skin Biopsy 5 1%

x) TBLB 43 6%

xi) Others 46 6%

TOTAL 746 100%

During the year, the department in-charge took classes for various batches of B.Sc. Nursing

students on investigations carried out in Pathology Lab. Monthly classes / Pathology Conference was

also moderated for DNB students in the form of case presentation. The in-charge took lectures on

HIV and cytology for candidates of Fellowship in HIV medicine. Practical work of DNB students

was supervised during their lab visits and their posting in Path lab. Processing of various lab

specimens was also taught to the newly appointed technicians.

During the year, the Department of Biochemistry got segregated from the Department of

Pathology. 3staff personnel (2 technicians and 1 lab assistant) were transferred to Biochemistry

department.

A museum of ‘resected histological specimens’ was made by mounting the specimens in jars and

by photo album.

58

4.10 Department of Physiology (PFT Lab) Dr. Rupak Singla : Officer In-charge

Dr. Sanjay Gupta : Senior Medical Officer

Resident Doctors : Posted by Rotation

The Department of Physiology (PFT Lab) is equipped with computerised complete pulmonary

functions tests machine for spirometry, lung volume and diffusion tests, portable spirometer, respirometer,

respiratory pressure meter, nebulizers etc. In order to avoid contamination of spirometry with M.

Tuberculosis, the department is equipped with a separate spirometer for tuberculosis patients. The department

is also equipped with a body plethysmograph and an oscilloscope to carry out airway resistance and

conductance studies. Bronchial provocation tests can also be done in the laboratory.

The department assists surgical unit in a preoperative assessment of the patients. The patients from

OPD are evaluated for confirmation of diagnosis of respiratory diseases, assessment of severity and response

of treatment. The department is actively participating in the research activities of the Institute and has

contributed research papers for publications also. Since 2005 onwards, Dr Rupak Singla, In-charge, PFT

Laboratory, has been regularly participating as faculty in the pre-conference PFT Workshop in the National

Conference of TB and Chest diseases (NAPCON) held once a year.

The department has been teaching and training the doctors and the staff of the Institute in the

diagnostic and therapeutic evaluation of pulmonary function tests in various respiratory disorders.

They include the postgraduate DNB students, senior residents and the other doctors and staff of the

Institute. Lectures and journal clubs are organized for the residents as per their academic schedule to

cover the subject in the teaching curriculum.

The Department has also conducted hands on workshop for post graduate students of North

India and Delhi.

Equipments: The PFT Laboratory is equipped with following equipments:-

1. Computerized complete pulmonary Function test machine for spirometry, static lung volume and

diffusion capacity measurements.

2. Body Plethysmography

3. Portable spirometer for sputum positive patients

4. Equipment for measurement of MIP and MEP

5. ECG machine

6. Respirometer

7. Other minor equipments

59

The department has participated in the following Research Projects (year wise): S

No. Year Name of

Student Research Title

1 2002

Dr. Deven Juneja

To study the impact of rescetional surgery on lung functions in patients suffering from non-neoplastic pulmonary diseases

2 2003

Dr. Meenakshi Dingra

To study the effect of thoracoplasty on lung functions in empyema patients

3 2003 Dr. V. Sailendra

Evaluation of sleep disorders in chronic obstructive pulmonary disease

4 2004

Dr. Anupam Malik

Impact of pulmonary rehabilitation on morbidity due to chronic obstructive lung disease

5 2005 Dr. Angila Dorjee

To study the alterations in lung functions and respiratory mechanics in patients of tubercular pleural effusion

6 2005

Dr. Yogesh Gupta

To determine the pattern of sleep disordered breathing among obese Indian subjects

7 2006

Dr. Brahma Prakash

Impact of chronic obstructive lung disease on activities of daily living

8 2008

Dr. Uday A. Gupta

To assess the impact of endobronchial biopsy on the diagnosis of patients suspected with pulmonary sarcoidosis and its correction with clinical, radiological and spirometry variables

9 2008 Dr. Shweta Gupta

Differentiation of Chronic Obstructive Pulmonary Disease & Asthma using Symptom based Questionnaire

10 2008 Dr. Deepak Kumar

To determine the existence and pattern of Sleep Disordered breathing in non obese adult Indian snores

11 2008 Dr. Srinath Dhandapani

Profile of patients failing to Category I treatment under RNTCP

12 2009 Dr. Roseleen Kaur Bali

To study the effects of yoga on lung function tests and quality of life in patients with COPD

13 2010 Dr. M. Shaikh

To compare six minute walk test and sit to stand test in chronic obstructive pulmonary disease patients and in healthy individuals

15 2010 Dr. Shikha Jain

Effect of follow-up in unsupervised home-based pulmonary rehabilitation program for patients with COPD-A randomized controlled trial

16 2010 Dr. Manashree

Post TB sequelac in MDR TB patients at the end of 2 years of completion of treatment

17 2010 M Qasim Effect of early mobilization combined with conventional physiotherapy treatment after 4 Hrs of lobectomy on haemodynamics ABG and PFT

18 2010 Samana Sayed

To study the clinical balance a submaximal exercise task in Indian COPD patients and its correlation with quadriceps girth Body mass index and disease severity

19 2010 Asma Rehman

Effect of inspiratory muscles stretching on chest expansion dyspnea, 6 – minute walk distance and quality of life in COPD patients

20 2010 Rajneet Kaur

Study of effectiveness of exercise component of home based pulmonary rehabilitation program in patients with

60

post tubercular squelae 21 2010 Kauser

Kapadia Effect of acupuncture transcutaneous electrical stimulation on heart rate recovery after six minute walk test in chronic obstructive pulmonary disease patients

22 2011 Saif Ullah Khan

Study of effect of ambulation and chest expansion exercises on ABG and PFT in patient with post tubercular empyema

23

2011 Hina Vaish Validity of Enright and Sherrill’s reference equation for six minute walk test in healthy north Indian adult males.

24 2011 Sumanta Ghosh

Effects of high intensity interval based inspiratory muscle training in patients with COPD undergoing a 4 week pulmonary rehabilitation programme on PFT values (FEV1, FEV1/FVC), peak inspiratory pressure, functional capacity and HRQL.

25 2011 Akmal Aslam Kothawala

Comparison of effect of flow oriented versus volume oriented incentive spirometry on PFT, chest expansion, exercise tolerance, dyspnea and quality of life in post tuberculous empyema thoracis.

26 2011 Parijat Ghatak

Effectiveness of core and diaphgramatic strengthening as exercise component of home based pulmonary rehabilitation program in post tubercular patients with dyspnea.

27 2012 Dr. Sachin Sharma

Effect of yoga in post TB sequelae patients

28 2012 Dr. Nitika Rawal

Profile of poorly controlled asthma and various factors contributing to it.

The department has published following books: 1. “Pulmonary Function Tests in Clinical Practice” published in November 2010 for post

graduate students and for general practioners for NAPCON 2010 edited by Dr Rupak Singla.

2. “Pulmonary Function Tests in Clinical Practice” published in February, 2005 for CME for

NATCON 2005 edited by Dr Rupak Singla.

3. “Spirometry in Clinical Practice” published in September, 2005 for CME for General

Practitioners, 2005 edited by Dr Rupak Singla.

The department has organised following Workshops on PFT: 1. Organised “Live Workshop on Spirometry” in CME Programme for Post Graduate Students of

North India on 16th to 17th July 2011 at LRS Institute of TB & Respiratory Diseases

2. Organized a “Live Workshop on Spirometry, Lung Volume, Diffusion Capacity and Body

Plethysmography” on 24th October 2010 at LRS Institute of TB & Respiratory Diseases

61

Total number of PFTs done during the year 2011-12 is shown in table 38.

Table- 38 : Number of procedures done in Respiratory Laboratory (PFT Lab.)

(April-2011 – March 2012) i)

Spirometry

6026

ii)

Reversibility

137

iii)

Lung Volume

158

iv)

Diffusion test

143

Total No. of PFT's done

6464

i)

VTG

104

ii)

Airway Resistance with Body Box

104

Total number of Body Plethysmographies done

208

Total No. of ECG done

2164

4.11 Department of Radiology

Dr. Devesh Chauhan : Radiologist & HOD

Dr. Anita Yadav : Assistant Professor (Radiology)

Senior Resident (Radiology) : Vacant

The department is providing diagnostic imaging services to institute with state of art

diagnostic equipments. It is having following equipments –

• Spiral CT Scan (GE) prospered Sx

• Kodak DRY LASER CAMERA

• Automatic Film processor (AFP) – Konak – Japan

• Heavy duty Automatic Film processor (AFP) – Protec – Germany

• Ultrasound machine (Siemens, G-50)

• Computed Radiography System (AGFA)

• Heliophos-D, 500mA X-ray machine + Fluoroscopy unit –(SIEMENS)

62

• 500mA X-ray machine – Philips Medical System – Installed in January 2011

• Multimobile- 10 – Installed in December 2010

• Nanomobile 100mA Portable X-ray Machine (Siemens)

• 600mA X-ray Machine (Listem Corporation KOREA)

• Temp Controlled Manual X-ray Film Processor (MEX INDIA. New Delhi)

• Digital Radiography System (procured in February 2012)

The department is carrying out conventional radiological imaging as well as image

guided (Ultrasound & CT guided) diagnostic procedures such as FNACs, biopsies,

therapeutic & diagnostic aspirations etc. The department is also providing X-ray facility

round the clock. CT scans are being carried on subsidized rates.

CT Scan (Brain) - Rs 1000/- for OPD patients, Rs 500/- for IPD patients.

CT Scan (Other body parts) - Rs 2000/- for OPD patients, Rs 1000/- for IPD patients.

Non-ionic contrast media is also being provided by Institute and is included in above

mentioned rates. In case of poor patients, CT scan is being carried out free of cost.

The department is also involved in teaching activities to DNB students and the

trainees of HIV fellowship.

Radiology data is shown in tables 39 to 41. A total of 51512 X-rays, 5025

ultrasounds and 1472 CT Scans were done during the year.

Table-39 : Number of X-rays done (April-2011 -March-2012 )

Film Sizes Number

8x10 3583

10x12 43935

12x15 1959

11x14 1798

14x14 237

14x17 -

a) Total No. of X-rays done 51512

Special procedures:

i) Barium Swallow 6

ii) Barium follow through 3

b) Total Special procedures done 9

63

Table-40 : Number of Ultrasounds done (April-2011 -March-2012 ) a) Chest+Neck 2251

b) Abdomen+KUB 2604

c) Ultrasound guided FNAC 13

Colour Doppler 98

d) Aspiration 6

Subtotal 4972

e) Ultrasounds done in ICU 53

Total Number of Ultrasounds done 5025

Table-41 : Number of CT SCANS done (April-2011 -March-2012 ) a) Chest 1138

b) Head 190

c) Abdomen 129

d) CT Scan Guided 15

Total Number of C.T.SCANS done 1472 Free CT scan =544 (37%) Paid CT scan = 928 (67%)

4.12 Department of TB and Respiratory Diseases

The Department of TB and Respiratory Diseases is actively involved in teaching,

training and research in the field of TB & Respiratory Diseases. The faculty of the

department assists the government of India in developing strategies for TB control and

in implementation of the same. The faculty has contributed significantly to the

development of national guidelines in India for management of tuberculosis, MDR- TB

and pediatric tuberculosis under the national programme. Dr D. Behera, Dr Rupak

Singla and Dr Rohit Sarin are members of various technical committees in the Central

Tuberculosis Division at the national level.

The administrative constitution of the department is as follows:-

Head of Department: Dr Rupak Singla

1. Dr Rupak Singla, Chest Specialist (Gr.-I) (SAG) Incharge Unit-II

64

2. Dr Anand Jaiswal, Chest Specialist (Gr.-I) (SAG) Incharge Unit-I

3. Dr M.M. Puri, Chest Specialist (Gr.-I) (SAG) Incharge Unit-III

4. Dr Sushil Munjal, Chest Specialist (Gr.-I)

5. Dr S.B. Singh, Chest Specialist(Gr.-I)

6. Dr Rajnish Gupta, Chest Specialist (Gr.-I)

7. Dr Lokender, Chest Specialist (Gr.-I)

8. Dr J.K. Saini, Chest Specialist (Gr.-II)

9. Dr. Amit Sharma, Chest Specialist (Gr.-II)

10. Dr. Puneet Arora, Chest Specialist (Gr.-II)

11. Dr. Prabhpreet Sethi, Chest Specialist (Gr.-II)

12. Dr. Pushpendra Kumar Verma, Chest Specialist (Gr.-II)

13. Dr. Kamla Verma, Chief Medical Officer (SAG)

14. Dr M.P. Arora, Chief Medical Officer, (NFSG)

15. Dr Sanjay Singh, Chief Medical Officer

16. Dr Rakesh Aggarwal, Chief Medical Officer

17. Dr Anil Jain, Chief Medical Officer, (NFSG)

18. Dr Sanjay Gupta, Chief Medical Officer, (NFSG)

19. Dr Vikram Vohra, Chief Medical Officer, (NFSG)

20. Dr. Kapil Mathuria, Chief Medical Officer, (NFSG)

21. Dr Alok Yadav, Medical Officer

In addition, there are 15 Senior & 38 Junior Resident doctors working on tenure

basis for the care of the patients. There are 10 seats of DNB students each year.

Special Chest Clinics: For patients suffering from various non-tuberculous chest

diseases special clinics are also run by the department such as Cancer clinic, smoking

cessation clinic, Allergy clinic, Sleep clinic, Physiotherapy Clinic, Air Pollution related

diseases clinic.

Allergy Clinic : This clinic is for evaluation of patients with Asthma, Rhinitis, Eczema

and other diseases allergic in nature. Management of allergic disorders, respiratory

allergies (Bronchial asthma and Allergic Rhinitis) are primarily dealt with in this clinic.

Skin Allergy testing is free of cost. Immunotherapy (Desensitization) is done in

selected cases. Occupation related allergies are also evaluated. Skin test against

aspergillus and other fungal allergies are also done. Clinic runs on Tuesday and Friday

between 9:00AM to 1:00 PM.

65

Lung Cancer Clinic : Lung cancer clinic is running in the Institute since January 2007.

Dr. D. Behera is the in-charge of the clinic and other team members are Dr. A. Jaiswal,

Dr. J.K. Saini and Dr. P. Sethi. During the period 2011-2012, a total of 384 lung

cancer patients attended the clinic, out of whom 105 were newly diagnosed and 279

were follow up cases. Besides, the management of lung cancer patients, junior

residents and senior residents are also trained in lung cancer management.

Postgraduate students of V.P. Chest Institute were posted in lung cancer clinic for five

days, in three batches of five students each.

Tobacco Cessation Clinic : Dr. S.B. Singh is the Incharge of this Clinic. This special

clinic is run in OPD Room No. 119 from Monday to Friday. Patients who are using

Tobacco in any form are referred from OPD and given counseling to quit their habit of

smoking. During the year, a total of 1296 patients were given counseling of quitting

tobacco habit. 31st May 2011 was observed as World No Tobacco day.

Details of Sleep Clinic, Air Pollution related Disease and Physiotherapy Clinic

are mentioned in relevant sections.

Inpatient services: The Department has indoor wards for around 450 beds. Currently

some of them are under renovation. The department provides inpatient care to

tuberculosis, lung cancer and other non-TB respiratory diseases patients and free anti-

retrovirus treatment to patients suffering from TB-HIV co-infection. For acutely ill

patients the department is equipped with 14 bedded ICU.

Emergency Services: Since 1st April 2009 institute has started emergency ward of 20

beds for care of patients reporting in emergency. This provides emergency care to the

respiratory cases.

Out Patient Services: The Department has an out-patient department (OPD) with an

average daily attendance of 400 - 500 patients. In one year more than 42000 new

chest symptomatic patients attend the OPD with a total attendance of around 1.5 lakh

patients per year. A total of around 5000- 6000 Tuberculosis cases are diagnosed

every year. The OPD runs from 9 AM to 1 PM. The registration in OPD is done from

8.45 AM to 12 noon.

Trainings: The Department is actively involved in the training of various medical and

paramedical personnel in implementation of strategies under Revised National

Tuberculosis Control Programme (RNTCP). The institute also conducts training for

Bronchoscopy, Pulmonary Function Tests, Sleep Medicine and ICU. The department is

66

actively involved in organizing Continuing Medical Education programme (CME),

seminars, conferences on different aspects of diagnosis and management of

tuberculosis and respiratory diseases. Some of the CMEs conducted during 2011-12 at

LRS Institute were:

1. CME programme PG-CME-2011 (North India) on 16th & 17th July, 2011 for PG

students of North India .

2. Workshop on PFT on 16.07.2011 in PG CME-2011 (North India) for PG students of

North India.

3. Workshop on Sleep Studies on 16.07.2011 in PG CME-2011 (North India) for PG

students of North India.

4. Workshop on Bronchoscopy on 16.07.2011 in PG CME-2011 (North India) for PG

students of North India.

5. A “Patient Awareness Program” on 03.05.2011 on the occasion of World Asthma Day.

6. A lecture by the department on ”Update on Lung Cancer” on 06.08..2011.

7. CME on Respiratory Allergy and Immunotherapy on 3rd February 2012.

Research Activities: The faculty members of the department are involved in

several multi-centric trials at international level and other research projects within the

country. Besides this all DNB students submit research projects as a part of their DNB

course. The details of the various research activities have been mentioned under

research section.

Post graduate DNB (Respiratory Medicine) Course: The DNB course in

Respiratory Medicine was started at LRS Institute of TB & Respiratory Diseases from

July,1999. The Institute was further accredited in the year 2002, 2005, 2008 and

2010. The Diplomate qualifications awarded by the National Board of Examinations

have been equated with post graduate M.D. degree qualifications of Universities by the

Government of India, Ministry of Health and Family Welfare. At present, the number of

post graduate three year training course DNB candidates are ten per year in the

January session. They are chosen as per merit of the CET followed by Centralized

counselling by the NBE. The method of selection of the candidates is as per the

guidelines of National Board of Examinations issued from time to time.

67

Dr. Rupak Singla, Head, Department of TB & Respiratory Diseases is Incharge of

DNB Course. He is assisted by Dr. Sanjay Singh Kathait, CMO (Academic) in the

Department. Various academic activities such as Faculty Lectures, Seminars, Bed Side

Classes, Grand Case Presentations, Pathology Conferences, Radiology conferences,

Journal Clubs, Statistical Meetings, External Faculty Lectures, Lab. Visits and Mortality

Meetings are regularly held for the post graduate students. The detailed academic

schedule is available on the website of the Institute.

Academic Section and DNB Course:- The academic section was established in the

Institute to oversee and streamline the ongoing and develop academic activities of the

Institute. The Academic Section is represented by:

Dr. Rupak Singla, Incharge Academic Section

Dr. Sanjay Singh, CMO (Academic)

The academic section carries out the process for the admission of DNB students

each year. The academic section prepares an elaborates Academic Schedule for the

DNB students for the whole year. This covers all the activities required for complete

DNB training. This can be viewed on the website of the Institute. It has been widely

appreciated and taken by various Institutes for incorporating in their annual academic

schedule. Having all required departments for DNB training under one roof, our

students are exposed to all types of patients procedures and Thoracic Surgery for

composite DNB training.

MD (TB and Respiratory Diseases) and DM (Respiratory Medicine) students from

V.P. Chest Institute and WHO fellows from different countries are also posted to

Department of TB & Respiratory Diseases for clinical training.

The academic section has established collaboration with ISIC Institute of

Rehabilitation Sciences and Jamia Hamdard University to further strengthen the

department of Physiotherapy. Eight students from Jamia Hamdard University and 2

from ISIC per batch per year attended the Institute to impart Physiotherapy to our

Indoor patients and intern gain practical experience. They have chosen topics and Co-

guides from our Institute to do research in their chosen field of physiotherapy.

68

Studies carried out under DNB course during the year 2011-12:

S No. Year of start

Title of the study Student Guide/Co-guide

1. 2009 To study the actual direct observation treatment in a patient receiving intensive phase of DOTS therapy and its association with treatment outcome under programme condition

Dr. Sushil M. Kindo

Dr. M. M. Puri Dr. R. Sarin Dr. U.K.Khalid

2. 2009 To compare the response of chemotherapeutic regimens (a) Cisplatin and Docetaxel and (b) Cisplatin and Irinotecan in appropriately staged III B/ IV case of non small cell lung can cer

Dr. Akshay Dr. S. B. Singh Prof (Dr) D.Behera Dr. Anand Jaiswal

3. 2009 HIV knowledge, attitude, practice among new patients of tuberculosis attending a tertiary care TB Institute

Dr. Neeraj Dr. V. Vohra Dr. S. Munjal Dr. Upasana

4. 2009 Study of aspergilloma in post tubercular patients presenting with haemoptysis

Dr. Sandeep Katiyar

Dr. Anil K. Jain Dr. M.M. Puri Dr Anita Yadav Dr Manpreet Bhalla

5. 2009 To study the clinico-cytological and bacteriological correlation of cervical tubercular lymphadentis

Dr. N. Shashi Kumar

Dr. Rupak Singla Dr. S.B. Singh Dr. P. Visalakshi Dr. Kumud Gupta

6. 2009 To study the effects of yoga on lung function tests and quality of life in patients with COPD

Dr. Roseleen Kaur Bali

Dr. Sanjay Gupta Dr. R. Singla Dr. J. K. Saini Dr I.V.Basavaraddi

7. 2009 Study of risk behavior for HIV infection among tuberculosis patients

Dr. Ankur Gupta

Dr. S. K. Munjal Dr. R. Singla

8. 2009 To determine blood lactate levels in patients with sepsis admitted to a respiratory intensive care unit and to correlate with their hospital out comes

Dr. Amit Asati Prof(Dr) D.Behera Dr.Rajnish Gupta

9. 2010 To study prevalence of tobacco smoking among pulmonary tuberculosis patients and to find the impact of smoking cessation on treatment outcome

Dr.Prachi Saxena

Prof. (Dr) D.Behera Dr. Rupak Singla Dr. Neeta Singla

10. 2010 Comparative study of clinic-radiological profile of smokers and non smokers suffering from pulmonary tuberculosis

Dr.Deepti Rathee

Dr. Rohit Sarin Prof. (Dr) D. Behera Dr. U.K. Khalid

11. 2010 Sequel of Multi Drug Resistant Tuberculosis patients at the end of Treatment

Dr.Manashree Mallick

Dr. Rupak Singla Dr. Sushil Munjal Dr. Neeta Singla

69

12. 2010 To study clinical profile of extra-pulmonary tuberculosis among HIV infected patients and assess the utility of procedures performed

Dr.Sonam Spalgais

Dr. Anand Jaiswal Dr.Upasana Agarwal

13. 2010 Frequency and duration of treatment interruption in new sputum smear positive pulmonary tuberculosis patients and its effect on the treatment outcome

Dr. Priyanka Changmai

Dr. M.M. Puri Dr. Anand Jaiswal Dr. U.K. Khalid

14. 2010 To study and compare the efficacy of counselling Vs counselling plus NRT in the form of Nicotine Chewing Gum in quitting smoking in smokers attending the Tobacco Cessation Clinic

Dr.Meenu Kumari

Dr. S.B. Singh Dr. Rajnish Gupta

15. 2010 To study the clinical profile and outcome of patients of acute respiratory failure requiring invasive mechanical ventilator support

Dr.Kamanasish Das

Dr. Rajnish Gupta Dr Anil K. Jain

16. 2010 Evaluation of the actual technique of using inhalation device in adult patients of COPD and bronchial asthma

Dr.Piyush Arora

Dr.Lokender Kumar Dr.Vikram Vohra

17. 2010 To assess the quality of life in lung cancer patients at diagnosis and at the end of treatment

Dr.Sharon Fernandis

Dr. J.K. Saini Prof. (Dr) D. Behera Dr. Sanjay Gupta

18. 2011 To study the effect of yoga in patients with Pulmonary impariment after Tuberculosis

Dr. Sachin Sharma

Dr. Sanjay Gupta Dr. Rupak Singla Dr. U.K. Khalid

19. 2011 To study a clinical profile and treatment outcomes in patient of pyopneumothorax in tertiary care hospital

Dr. Vipin Kumar Yadav

Dr. Lokender Kumar Dr. M.M. Puri Dr. R.K. Dewan

20. 2011 To study the outcome of Directly Observed Treatment Short course-Anti-tubercular treatment in Tuberculosis patients co-infected with HIV and on concomitant anti-retroviral therapy

Dr. Ughade Deepika Prakash

Dr. D. Behera Dr. S.B. Singh Dr. Upasna Agarwal

21. 2011 Treatment outcome of multi drug resistant suspect patient of pulmonary Tuberculosis who are not multi drug resistant and to assess their clinico-radiological and bacteriological profile

Dr. Satya Ranjan Sahu

Dr. J.K. Saini Dr. Sushil Munjal Dr. Khalid U.K.

22. 2011 To determine and to compare the initial and final effective pressure levels in the Indian adult patients with obstructive sleep apnea

Dr. Pankaj Gulati

Dr. Rajnish Gupta Dr. Anand Jaiswal

23. 2011 To determine the extent and profile of Drug Resistant TB (Including XDR TB)’ patients amongst MDR suspect in LRS-RNTCP area

Dr. Ashish Ranjan

Dr. V. Vohra Dr. RohitSarin Dr. Khalid U.K. Dr. M. Bhalla

70

24. 2011 Profile of poorly controlled asthma and evaluating various factor contributing to go it

Dr. Nitika Rawal

Dr. Anil K. Jain Dr. D. Behera

25. 2011 To determine post tuberculosis squeal and one year after successful treatment completion amount new pulmonary TB patients and its correlation with extent of disease (cavitory, non-cavitory, extent of lung Zone involvement)., sputum status and degree of positinty at the initiation of treatment

Dr. Sheikh Tariq Sultan

Dr. Rohit Sarin Dr. Anil Jain

26. 2011 To study the profile of MDR TB patients and factors influencing their treatment outcome under DOTS plus in Delhi

Dr. Sagar Khade

Dr. VikramVohra Dr. R. Singla Dr. Neeta Singla Dr. Ashwini Khanna Dr. Anuj K. Bhatnagar

27. 2011 Impact of Thoracic Surgery on Pulmonary Function Test

Dr. Bhagwan Mantri

Dr. Anand Jaiswal Dr. Sanjay Gupta

4.13 Department of TB Control and Training Dr. Rohit Sarin : Head of Department

The department works in close contact with the LRS- RNTCP and Dr Sarin is the

Vice-Chairman of the Committee which oversees the RNTCP implementation. The

department is also responsible for conducting all training activities relating to the

RNTCP. One of the main objectives of the Institute is to impart training to the various

personnel on different aspects of tuberculosis as well as on the National TB Programme

and the Revised Strategy. In its efforts towards this objective, the Institute, over the years,

has been actively involved in training the key trainers from all over the country on the

Revised National Tuberculosis control Programme,. In addition, the Institute has also been

organising workshops, seminars, CME programmes and symposiums on the Revised

National Tuberculosis Control Programme. Some of the important decisions in the

formulation of the Revised Strategy in the country have emanated as a result of these

workshops and seminars. Specifically these include the areas of Management Information

System, RNTCP in tribal areas, drug doses in treatment regimen of RNTCP and seminars

with teachers and professors of medical colleges and various TB specialists to reach to a

consensus on the strategy. The National DOTS Plus strategy was pilot tested at the

Institute and subsequently, the National Guidelines were formulated. The department is

also assisting the Central TB Division for imparting training under DOTS Plus and

71

development of modules for different categories of staff involved in its implementation. The

training modules for Nurses and Private Medical Practitioners developed by the Department

have recently been approved by the Central TB Division and would now be used for training

the trainers in this Category.

The training is also imparted to the nursing students from Rajkumari Amrit Kaur

College of Nursing and the trainee health visitors from New Delhi TB Centre every year.

The training activities are carried out by the following :-

Training Committee:

Dr. Rohit Sarin Chairman Dr. Rupak Singla Member Dr. Anand Jaiswal Member Dr. Kumud Gupta Member Dr. Vikram Vohra Member Dr. Anil Jain Member Dr. Anita Yadav Member Shri M.B. Naidu Member Mrs. Anita Rani Kansal Member

Facilitators:

1. Dr. Rupak Singla Chest Physician 2. Dr. Anand Jaiswal Chest Physician 3. Dr. M. M. Puri Chest Physician 4. Dr. Sushil Munjal Chest Physician 5. Dr. S.B. Singh Chest Physician 6. Dr. Anil Kr. Jain C M O (NFSG) 7. Dr. Vikram Vohra C M O (NFSG)

8. Dr. Sanjay Gupta C M O (NFSG)

9. Dr. Kapil K. Mathuria C M O (NFSG)

10. Dr. Rakesh Aggarwal C M O

11. Dr. Lokender Kumar Chest Physician

12. Dr. J.K. Saini Chest Physician

13. Dr. Khalid U K Epidemiologist

14. Dr. Sujata Arya S R O

15. Dr. Neeta Singla R O

16. Dr. Alok Yadav MO

72

Other Resource Persons:

1 Sh. M. B. Naidu Nodal Officer In-charge 2 Mrs. Rita V. Lyall Dy. Nursing Superintendent 3 Mrs. T. Percy Dy. Nursing Superintendent

The different categories of personnel trained in the Institute during the year 2011-12

are as under:

Table-42: Training Activities done (April-2011 to March-2012)

Sr. No Name of the activity Date/Period Number of participants

1. RNTCP Modular Training 23rd May to 4th June 2011 30

2. Axshya Project(GFR-9) Managers training course in RNTCP

13th to 17th June 2011 27

3. Axshya Project(GFR-9) Managers training course in RNTCP

27th June to 1st July 2011 26

4. Axshya Project(GFR-9) Managers training course in RNTCP

01st July 2011 75

5. Workshop on TB diseases burden estimation for India

7th to 08th July 2011 20

6. RNTCP 7th Meeting of the National DOTS-Plus Committee

11th to 12th July 2011 23

7. 20th Meeting of the National laboratory committee

13th July 2011 24

8. P.G.C.M.E. Respiratory Medicine by LRSI

16th to 17th July 2011 80

9. Training Course on MDR –TB by UNION 25th to 29th July 2011 30

10. Training Course on MDR –TB by UNION 1st to 5thAugust 2011 28

11. WHO Fellows from Mynamar 8th to 12th August 2011 04

12. RNTCP Modular Training 5th to 17th Sept 2011 24

13. HIV Fellowship Medicine Students from M.A.M.C.

28th to 29th Sept 2011 12

14. State Accountants training in Financial 29th to 30th Sept 011 117

73

Management

15. Training Programme for MPhil/MPH/PHD Students from JNU

30th Sept 2011 35

16. DOTS Plus(PMDT) training in RNTCP 10th to 14th Oct 2011 26

17. DOTS Plus(PMDT) training in RNTCP 12th to 16th Dec 2011 23

18. WHO Fellows from DPR Korea 21st Nov to 15th Dec 2011 04

19. National Task-force Workshop December-2011

21st to 22nd Dec 2011 122

20. National Consultation on Diagnosis & Treatment of Paediatric TB

31st Jan to 1st Feb 2012 27

21. TB Health Visitors(Students from NDTB Centre

16th to 21st January 2012 6

22. 21,Meeting on National Standing Committee For ongoing Research under RNTCP

8th February 2012 27

23. National DOTS Plus Committee Meeting

10th February 2012 15

24. PMDT Trg. Under RNTCP 6th to 10th Feb 2012 30

25. PMDT Trg. (Bombay)Under RNTCP 27th Feb to 2nd Mar 2012 36

26. RNTCP Modular Training 12th to 24th Mar 2012 17

27. PMDT Trg. Under RNTCP(Bhutan) 19th to 27th Mar 2012 03

28. PMDT Trg. Under RNTCP (Nigeria) 26th to 30th Mar 2012 03

Total 904

4.14 Department of Thoracic Surgery and Surgical Anatomy Dr. R. K. Dewan : Head of Department

The department is well known for its excellence and attracts patients from far way

places in India. It is a unique centre in the field of thoracic surgery which is devoted

exclusively to the care of patients suffering from TB and respiratory disorders. This is so

74

because most of the other centres have practically converted themselves into cardiac

surgical units. All types of major chest surgeries like resection of lung, de-cortication,

thoracoplasty etc. are being done. This unit is also attracting patients suffering from

common paediatric emergencies like foreign body inhalation and other problems related

to the field.

The dept. is imparting training in fibre-optic bronchoscopy and other surgical

procedures to the doctors of the Institute, as well as, to those from outside the Institute.

Seven M.Ch. doctors (Cardio-thoracic surgeons) from AIIMS underwent training for one

month each between the months of April 2011 to March 2012. Surgeons from Armenia,

Afghanistan, South Africa and Egypt visited the department and worked as observers

from May 2011 to March 2012.

During the year, the department procured new equipments like thoracoscopes,

mediastinoscopes, pediatric fibre-bronchoscopes and rigid bronchoscopes with

accessories.

Data related to surgical department is shown in Table-43 (a) and (b).

Table-43 (a) : THORACIC MAJOR CHEST SURGERY (April-2011 -March-2012) i) Pneumonectomy 33 viii) Rib resection 14

ii) Lobectomy 27 ix) VATS 11

iii) Thoracoplasty 30 x) Others 10

iv) Thoracotomy 26

v) Decortication 43

vi) Open window Thoracotomy 178

vii) Bronchoscopy 57 TOTAL 429

TOTAL MAJOR PROCEDURES = 429

75

Table-43 (b) : THORACIC MINOR SURGERY PROCEDURES DONE (April-2011 -March-2012 )

PROCEDURES : Minor OT in OPD

In main OT

Total

i) Intercostal Tube drainage - 97 97

ii) FNAC 1879 1 1880

iii) Pleural Aspiration 1707 11 1718

iv) Change of I.C.D. - 27 27

vi) I & D GA - 21 21

I & D LA

vii) Dressing - 123 123

viii) Ascitic tap 3 0 3

ix) Others - 69 69

TOTAL MINOR PROCEDURES = 3589 349 3938

4.B Sections of the Institute Various sections of the Institute are given as under.

4.15 Air Pollution Related Diseases Diagnostic Centre 4.16 Anti-Retroviral Therapy Centre 4.17 Biostatistics Section 4.18 Computer Section 4.19 Fibre-Optic Bronchoscopy Unit 4.20 Health Education Section 4.21 Library 4.22 Nursing Section 4.23 Physiotherapy Section 4.24 Respiratory Intensive Care Unit 4.25 Sleep Laboratory 4.26 Integrated Counseling and Testing Centre 4.27 Yoga Therapy and Research Centre

Detail of each section is mentioned below. 4.15 Air Pollution Related Diseases Diagnostic Centre Dr J K Saini : In-Charge A total of 51 patients (25 new and 26 follow-up) were enrolled in APRD-DC during

the year 2011-12. A Chemistry Laboratory was established in the APRD-DC for analysis of

air pollutants. A Chemistry Laboratory Assistant was kept for air pollutants sampling and

analysis of air pollutants like suspended particulate matter (SPM), sulphur-di-oxide and

nitrogen oxides.

76

4.16 Anti-Retroviral Therapy Centre Dr Upasna Agarwal : In-Charge

Department of Medicine runs a free Antiretroviral Therapy Centre under the aegis of

National AIDS Control Organization. Dr. Upasna Agarwal, Specialist (Medicine) is the in-

charge of the centre. The centre is having one Senior Medical Officer (SMO), one

counselor, one peer educator, one data manager, one staff nurse, one lab technician and

one pharmacist.

Comprehensive HIV care facilities are provided at the ART Centre. These include

free of cost antiretroviral therapy, free CD 4 testing, treatment and prophylaxis of

opportunistic infections, patient and family counseling as well as pre-ART support and care

services. The centre follows stringent recording and reporting procedures and regularly

reports to the National AIDS Control Organization.

Data of ART Centre is shown in Table-44.

Table 44 : ART Centre data (April-2011 -March-2012 ) a: HIV care data: No Indicators Adults (>14 years) Children( <14

years) TOTAL

M F TG/TS M F

i) Number of persons in HIV care at the begining of this month

573 258 4 32 10 877

ii) Number of New Persons Registered in HIV care during this month

88 52 1 3 2 146

iii) Cumulative number of persons registered in HIV care at the end of the reporting month

661 310 5 35 12 1023

b: Pre ART Care: i) Cummulative number of patients

in Pre ART care 217 140 2 15 4 378

c: Patients on ART : i) Number of patients on ART at

the begining of the month 379 132 3 19 7 540

ii) New patients started ART during this month

65 28 0 1 1 95

iii) Cumulative number of patients on ART at the end of this month

444 160 3 20 8 635

77

4.17 Biostatistics Section Dr. P.P. Sharma : Statistician

The statistician is involved in research activities being carried out in the Institute. The

statistician helps the researchers in planning of the research studies, sample size

determination and critical data analysis utilizing the scientific statistical tools. Technical

and statistical assistance is also provided to the DNB students for their research thesis.

Lectures for the new DNB students are given on Basic Statistics, Sample Size

Determination, Sampling Methodologies, etc. for carrying the research during the DNB

course. The statistician is also involved as a co- investigator in the research studies.

The section collects the patient’s data from various departments of the Institute.

Reports are compiled on monthly, quarterly and annual basis. The section compiles a

monthly statistical report for internal circulation. A monthly statistical meeting is being

organized on every third Thursday of the month under the Chairmanship of the Director.

The Institute’s data is presented by the Statistician during the meeting. All the doctors &

officers attend this meeting and discuss the data of the Institute.

The statistician also imparts training to delegates at various levels like trainee health

visitors, and technicians for documentation, monitoring and preparation of various

statistical reports.

4.18 Computer Section

Mr. G.V. Raju : System Analyst (In-charge)

The computer section is actively involved in clinical data processing and dissemination

of information. To improve information transfer and access, the computer section provided

new infrastructure in terms of hardware, software and network equipments. Patient billing,

discharge summary, report, internet search and other data processing related works are

looked after by the computer section. Institute website contents are regularly updated. The

computer section also coordinates with outside agency for hardware maintenance and

internet facility on regular basis and provides technical support to various programs

78

including seminars and workshop within the Institute. There are four data entry operators

working in this section.

4.19 Fibre-Optic Bronchoscopy Unit

Dr.Anand Jaiswal : In-charge

Routine diagnostic bronchoscopies and all bronchoscopic procedures are carried in

the unit. Teaching and training in bronchoscopy is done for residents of Institute. Training of

doctors from other institutes is also done with payment of training fee.

The unit has various equipments as mentioned below.

• Fibre-optic bronchoscopes – Three (BF-3, PE- 2 series and BF-ITR)

• Video bronchoscope - One

• Pulse Oximeter

• CCD Camera with Video Output and facility for recording

• All accessories of bronchoscope, biopsy forceps, brush, TBNA etc

During the period from April 2011 to March 2012, a total of 357 bronchoscopies were

done with 641 different procedures like bronchial biopsy, trans-bronchial biopsy, bronchial

brushing, bronchial aspirate, trans bronchial needle aspiration, broncho-alveolar lavage etc.

as shown in Table-45.

The laboratory has helped in diagnosing difficult cases like lung cancer, ILD,

occupational lung disease etc. The doctors within and outside the Institute are also being

trained in performing the procedures.

Table 45 : FIBREOPTIC BRONCHOSCOPY UNIT (April-2011 -March-2012 ) Number of Scopy done : 357

Procedures carried during Bronchoscopies:- Number

i) Bronchial Aspiration 280

ii) Bronchial Brush 63

iii) Bronchial Biopsy 151

iv) Transbronchial biopsy 40

79

v) BAL 38

vi) Endo Bronchial needle Aspiration 0

vii) TBNA (Transbronchial Needed Aspiration) 69

TOTAL Procedures 641

4.20 Health Education Section

Mr. M. B. Naidu : Officer In-charge

Health education about TB & RNTCP is being given to the patients, their relatives,

friends and companions. Health Education plays a vital role in treatment of tuberculosis.

This section has developed many leaflets & pamphlets to educate patients. The health

education material is regularly distributed to the patients.

Short video films on TB, AIDS, No Smoking / Tobacco, Asthma etc. are being

screened regularly to create awareness among the patients and their relatives in OPD from

9.00 am to 1.00pm.

All doctors communicate through Public Address System (P.A. System) installed in

the OPD rooms to call patients. After diagnosis all patients attending in OPD are referred

for health education in Room no.107. After imparting health education patients are referred

to their nearby DOT Centres for further treatment.

Nursing Students from R.A.K. College of Nursing, New Delhi were posted for two

weeks in three batches for their group project in LRS Institute. During their posting, the

student nurses were trained in I.E.C. health education activities for group presentation and

they performed role play in OPD to create awareness among the patients and the relatives

on TB and its sign and symptoms, diagnosis, spread and treatment.

Our institute is celebrating every year the following days of special importance.

World TB Day - 24th March

World Asthma Day - 5th May

World No Tobacco day - 31st May

World AIDS Day - 1st December

80

On these special days, we conduct health education awareness programs for TB

patients and their companions. We organise drawing competitions, dance and song

competitions for children. We also distribute prizes for winners and children.

In our Photo Section, digital photography has been started to facilitate for I.E.C.,

Training and other Institute activities. The number of patients on whom health education

was imparted during the year is mentioned in Table-46 :

Table-46 : HEALTH EDUCATION DATA (April-2011 -March-2012) S. No Category of patients imparted Health Education TOTAL

i) Health Education to New & Follow up TB patients in the OPD 7528

ii) No. of patients imparted Health Education in the wards 3808

Total number of Patients imparted health education 11336

4.21 Library

Dr. R.K. Dewan : Chairman Mr. Jitendra Kumar : Assistant Librarian

(Joined wef 24th September 2011 ) Mr. Sachin Sharma : Library Information Assistant

( Joined wef 19th September 2011) Library has bought 80 new books, 19 National Journals and 49 International

Journals on Tuberculosis & Respiratory related diseases during the year 2011-12. Our

department provides services to resident doctors, DNB students and other staffs of the

hospital.

Along with books, we provide internet facilities through four desktop

computers to our users. There is a separate division for Hindi language in the library.

There are 1155 quality books available on Tuberculosis & Respiratory Diseases in the

library. Library functions between 8.00 AM to 10 PM on all Working days.

81

4.22 Nursing Section Nursing Superintendent : Mrs. Anita Rani Kansal

Deputy Nursing Superintendent : 02

Assistant Nursing Superintendent : 04

Nursing Sisters : 30

Staff Nurses : 145

The nursing personnel are providing quality nursing care to the critical ill, surgical,

paediatric and other patients with respiratory diseases. The section is responsible for pest control,

infection control and waste management in the Institute. Training programmes are organized for

student nurses and other nurses. More than 1000 nursing students (B.Sc. Nsg) visited our Institute for

their educational programmes as per table given below.

Nursing students who visited our Institute for their educational programmes (April – 2011 to March – 2012)

S.No Name of College / Institute Training Category

No. of Students

Dates

1. Ms. Ramaiah Institute of Nursing Education, Bangalore

4th year B.Sc(N) P.B. B. Sc

23

26

11/04/11

2. Athena College of Nursing, Mangalore, Karnataka

2nd year P.C. B. Sc. 4th Year B. Sc.

49

48

07/04/11

3. Government College of Nursing, Bangalore 4th year B.Sc 42 08/04/11 4. Ellen Thoburn Cowen Memorial Hospital,

Kolar 4th year B.Sc 30 06/04/11

5. K.V.S. College of Nursing, Bangalore 2nd & 3rd year B.Sc 4th Year B.Sc.

03

17

27/05/11

6. Smt. Narayani D. R. Karigowda College of Nurisng

B.Sc. 62 13/05/11

7. Faith Institutions, Bangalore B.Sc.(N) 41 31/05/11 8. Masood College of Nursing, Mangalore M.Sc (N) 24 11/06/11 9. Unity Academy of Education College of

Nursing, Mangalore B.Sc(N) 37 28/06/11

10. P. H. Hindui National Hospital & Medical Research Center Andheri (East) Mumbai-400059

B.Sc.-M.Sc 49 21/10/11

11. National Institute of Mental Health and Neuro Science Bangalore.

4th year B.Sc 24 14/10/11

12. Kempe Gawada College of Nursing Bangalore 4th year B.Sc 53 03/11/11 13. R.A.K. College of Nursing Lajpat Nagar Josip

Broz Marg, New Delhi-24 B.Sc.(N) 22 18/11/11

14. Canara College of Nursing Kundapur Karnataka

M.Sc(N) 81 24/11/11

82

15. City College of Nursing Mangalore B.Sc 60 02/12/11 16. Kailkese Rakmini Shelly Memorial College of

Nursing Mangalore -575016. 4th year B.Sc 29 08/12/11

17. Laxmi Memorial College of Nursing, A. J. Towers, Mangalore -575002

4th Year B.Sc. 37 10/01/12

18. Laxmi Memorial College of Nursing, A. J. Towers, Mangalore -575002

4th Year B.Sc. 87 11/01/12

19. M.M.M. College of Nursing No.-3 Sakltu Nagar, Nolambar Mangappair, West Chennai-60095

4th year B.Sc. 37 27/01/12

20. Jaslok, College of Nursing Mumbai 4th year B.Sc. 30 02/12/12 21. Althena College of Nursing Falnir Road

Mangalore 4th year B.Sc. 48 17/01/12

22. Masood College of Nursing M.Sc. 58 22/12/11 23. M.M. College of Nursing Mullana Ambaka M.Sc. 07 14/02/12 24. Bel-ani college of Nursing Panchgnai Satara 4th year B.Sc. 48 23/02/12 Total 1027

A research study related to the nurse’s knowledge regarding TB and RNTCP is also in

progress.

4.23 Physiotherapy Section Dr M. M. Puri : In-charge

Mr. Prabhu Lal Jat : Physiotherapist

The physiotherapy section of the Institute is actively involved in patient care in OPD,

ICU, post surgical wards and in general wards. Physiotherapy treatment to patients

helps them in early recovery from the disease.

The section has various machines like Ultrasound Therapy Machine, machines for

Electric Stimulation and TENS (Trans-cutaneous Electric Nerve Stimulation), Shoulder

Wheel, Static Cycle, Manual Traction Set, Traction Machine, Postural Drainage Table,

Incentive Spirometer, Wax Bath Machine etc. Physiotherapy is given to patients

suffering from COPD, bronchiectasis, empyema, lung abscess, pleural thickening, joint

contractures etc., as well as, to post-operative patients in ICU and wards. The patients

who received physiotherapy treatment during the year are shown in table –47(a) and

(b).

83

Table 47(a) : PHYSIOTHERAPY Data (April-2011 -March-2012 ) DETAILS New Follow UP

TOTAL MALE FEMALE MALE FEMALE

Number of patients attended OPD for physiotherapy

302 177 426 362 1267

Number of calls attended from the wards and ICU for physiotherapy

621 244 1587 704 3156

Total patients received physiotherapy

923 421 2013 1066 4423

1344 3079

Table 47 (b): Physiotherapy Data based on Modality (April-2011 -March-2012 ) Type of Electrotherapy and Therapeutic Exercises Number of

sittings Shortwave Diathermy 127

Ultrasound Therapy 276

Vibrator Therapy 842

Wax Bath 109

Lumbar and Cervical Traction 40

Postural Drainage 39

Therapeutic Exercises 1267

Total Modalities 2573

* Shortwave diathermy machine not working since Sept-2011.

4.24 Respiratory Intensive Care Unit

Dr. Rajnish Gupta : In-charge

Dr. P. Sethi : Chest Specialist (Posted for 3 months wef 1st June-11)

Dr. Pushpendra Verma : Chest Specialist (Posted for 3 months wef 1st Sept-11)

Dr. Amit Sharma : Chest Specialist (Posted for 3 months wef 1st Dec-11)

Dr. Puneet Arora : Chest Specialist (Posted for 3 months wef 1st March-12)

84

Dhanvantari Respiratory Intensive Care Unit (ICU), functional since August 1996, is

a 14-bed unit for providing critical care to patients with respiratory illnesses. The building

was constructed under the auspices of Shri Adya Katyayini Shakti Peeth Mandir Chattarpur,

New Delhi, and has state- of-art equipment for managing acutely ill respiratory patients.

The ICU provides round the clock diagnostic and treatment facilities in the form of

invasive / non-invasive mechanical ventilatory support and appropriate intensive measures

to all those patients having critical medical illnesses of a pre-dominant respiratory nature

and to those who have undergone thoracic surgical interventions within the Institute as

mentioned in Table-21. The medical care is supervised by the In-charge ICU, the respective

Unit In-charges and other specialists. Trained senior and junior residents, nursing staff and

other supporting staff are available on round the clock basis. Availability of a

physiotherapist, a psychologist and a medical social worker facilitates early mobilisation

and psychological care of the patients. More than 500 seriously ill patients are being treated

in ICU every year. Delivery of intensive care is facilitated by the regular procurement and

maintenance of critical care equipments, medicines and other essential items from time to

time. Two portable monitors were procured for ICU during the year.

Regular teaching and training on critical care management is being imparted to the

senior residents, DNB students, junior residents, other doctors and nursing staff during their

ICU postings. Lectures, seminars, journal clubs and case presentations are organized for

the residents as per their academic schedule to cover the subject in the teaching

curriculum. Training is being given in endo-tracheal intubations, handling of invasive / non-

invasive mechanical ventilation, performing various procedures like insertions of central

venous catheterizations etc. and in taking critical clinical management decisions at crucial

times.

Research projects are carried out regularly in ICU. During the year, two DNB

research projects entitled “To determine blood lactate levels in patients with sepsis admitted

to a respiratory intensive care unit and to correlate with their hospital out comes” and “To

study the clinical profile and outcome of patients of acute respiratory failure requiring

invasive mechanical ventilator support” were carried out in ICU.

85

4.25 Sleep Laboratory

Dr. Rajnish Gupta : In-charge

A Sleep Lab has been fully operational within the Institute since May 2004. A Chest

specialist-in-charge looks after the various activities of the sleep lab and is assisted in the

work by trained staff.

Sleep Lab is diagnosing patients with sleep related breathing disorders. All

suspected cases of sleep disordered breathing (like obstructive sleep apnoea etc.), referred

from the out-patient department of the Institute or from the other hospitals, are enrolled in

the Sleep Clinic run every week on Tuesdays. Detailed findings of their history and the

general examination are recorded in a specially designed proforma. Relevant investigations

are carried out and necessary instructions given to them. In order that they get acquainted

with the Sleep Lab, they are made to visit the lab at least once before the conduct of the

study. On the scheduled date, an overnight polysomnography is conducted in the sleep lab

on the Compumedics E-Series software. Following the recording, it is analyzed both

automatically and manually, interpreted and reported with specific recommendations.

All diagnosed cases of sleep disordered breathing are taken up for the requisite

Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BIPAP)

titrations simultaneously with a polysomnography. Following the titration, the study is

analyzed both automatically and manually, interpreted and reported with specific

recommendations including advice to use the optimal pressure during sleep. Subsequently,

they are called for the follow-up sleep studies and given appropriate instructions. 71 sleep

studies including the CPAP/ BIPAP titrations were performed during the year as shown in

table-48.

The diagnostic and therapeutic evaluation of sleep related breathing disorders is being

taught to the doctors and the staff including the postgraduate DNB students, senior

residents and the other doctors and the staff of the Institute. The subject is also covered in

the teaching curriculum of residents as per their academic schedule through lectures,

journal clubs etc. Teaching and training on the subject is also carried out for the benefit of

the trainees from other Institutes as well. A Workshop on Sleep Studies was carried out on

16th July 2011 during the PG CME-2011 North India organised at the Institute. A

Polysomnography training of 15 days was also carried out for 3 doctors of Dr. M. L. Chest

Hospital, G.S.V.M. Medical College, Kanpur and 2 staff of the Institute from 30th January

86

12 to 13th February 12.

Research projects on the subject are carried out regularly. A DNB research study

entitled “To determine and to compare the initial and final effective pressure

levels in the adult patients with obstructive sleep apnoea” was pursued during the

year.

Table 48 : Polysomnography data ( sleep lab. Study Data) : (April-2011 -March-2012 )

Number of cases = 71

Cases with Apnoeas

Obstructive 21

Central 0

Mixed 0

Cases with Hypopnoeas 23

Cases with significant RDI /hr.

Mild 6

Moderate 4

Severe 18

Cases with Noctural Hypoxaemia 30

Other findings 1

Cases put on CPAP Trial 30

4.26 Integrated Counseling and Testing Centre (ICTC)

Dr. Sushil Munjal - In-charge

A centre for Integrated Counseling for HIV testing has been operational in the

Institute. During the period from April-11 to March-12, a total of 4198 patients were

imparted pretest counseling and 4028 came for post test counseling. A total of 170 patients

were found positive for HIV (Table –49).

87

Table-49 Voluntary Counselling and Testing Centre (ICTC)

(April-2011 -March-2012 ) Adults Children TOTAL

M F MC FC

Pretest counselling

From OPD & Wards 2282 1038 432 412 4164

Voluntarily and from NGO

5 19 8 2 34

Total Number of pretest counselling

2287 1057 440 414 4198

Number of post test counselling 2275 936 435 382 4028

Number of patients refused consent 6 12 0 22 40

Number of patients reported HIV Positive

112 48 6 4 170

Number of HIV+ve patients who did not collect the report

3 1 0 0 4

Referral Frrom VCTC to RNTCP 1 0 2 0 3

The L.R.S. Institute is running a Post Graduate Fellowship Training in HIV Medicine

in collaboration with Maulana Azad Medical College, New Delhi since 2006. The In-Charge

is the Course Coordinator at LRS institute for Post Graduate HIV Medicine Fellowship

Programme. Every year, 16-18 fellows come for training. During the year, 12 fellows were

trained in the fellowship programme. The Contact Course II conducted in month of July

2011 was of 2 days duration. The Contact Course III conducted in October 2011 was of 3

days duration.

4.27 Yoga Therapy and Research Centre A centre for collaborative therapy and research in Yoga was inaugurated in the

Institute on 24th May 2007 in partnership with Morarji Desai National Institute of Yoga, New

Delhi. The Centre comprises of 4 staff - a Yoga Physician, Dr Gita Sharma, a male and a

female Yoga Instructor and a general duty attendant. The Institute is offering yoga services

to both outdoor and indoor patients of COPD, bronchial asthma and those requiring

respiratory rehabilitation, as well as, to hospital staff. A DNB research study has also been

conducted on the subject in patients of COPD.

Data of the centre for the year is shown in Tables – 50 (a) , (b) & (c).

88

YOGA THERAPY AND RESEARCH CENTRE ( In Collaboration with Morarji Desai National Institute of Yoga ,New Delhi)

Table 50(a ) : Yoga Services for the month of (April-2011 -March-2012) Patients detail

New Enrollment Old Enrollment (Follow ups)

Total

M F M F i) Patients treated at OPD 545 130 300 54 1029

ii) Patients treated at IPD 215 147 151 125 638

iii) General participants in Foundation Course

15 14 40 57 126

TOTAL 775 291 491 236 1793 1066 727 1793

Table 50(b) : Type of Patients Received Yoga Services (April-2011 -March-2012)

Type of Patients OPD IPD i) General Well Being /Preventive 12 56

ii) Bronchial Asthma 151 16

iii) COPD 286 44

iv) Post TB Sequelae 261 63

v) Pleural Effusion 13 14

vi) PTB 0 24

vii) Hydro-pneumothorax/ Pneumothorax 6 92

viii) Empyema 11 72

ix) Post-operative Rehabilitation 16 185

x) Sarcoidosis 5 0

xi) Arthiritis 13 0

xii) Pl. Thickening 62 0

xiii) Obesity 4 0

xiv) Lumbar Spondylosis / Back Pain 23 0

xv) Bronchiectasis 18 3

xvi) Miscellaneous 45 21

TOTAL 926 590

89

Table 50( c ): Details of Yoga Classes

(April-2011 -March-2012 ) Class Details Number i) Total Number of attendance 13834

ii) Total Number of Working days 298

iii) Average number of participants per day 46

iv) Total Number of Yoga classes 5303

v) Average number of classes per day 18

vi) Average number of participants per class 3

vii) Average duration of the class 30 min.

5.0 Researches Other Than DNB Course The L.R.S. Institute has rich clinical resources and is actively involved in

research in the field of TB & Respiratory Diseases. In addition to indoor

facilities, the Institute has a well developed outreach system of treating patients

in the field conditions under supervision. The TB patients under the specified

area of the Institute are being treated in the peripheral health centers (DOTS

centers). At DOTS centers, details of each patient are properly recorded till the

full treatment. Sputum examinations are done at pre-defined intervals and

recorded. Patients are given supervised treatment. The outcome of each patient

is recorded. Home visits are done for patients who fail to turn up for treatment.

This forms a very strong cohort group for any prospective research study.

The Institute assists the Government of India in developing strategies for

TB control and in implementation of the same. Based on operational research

the faculty of the Institute has contributed significantly to the development of

national guidelines in India for management of tuberculosis, MDR-TB and

pediatric tuberculosis under national programme.

The Institute has a Research Committee and an Ethical Committee for the

evaluation of the research proposals. The Institute at present is having

International / National collaboration. Several rapid diagnostic tests for the

90

diagnosis of tuberculosis are already being field tested in collaboration with

international agencies such as FIND (Foundation for Innovative Diagnostics).

LRS Institute has already signed MOU with ICGEB (International Centre for

Genetic Engineering and Biotechnology).

The long-term goal of the Institute will be to develop a centre of

excellence providing a platform for clinical immunological work in the field of tuberculosis and other respiratory diseases. The research focus would be priority to work on the diagnosis, monitoring and evaluation of various newer therapeutic modalities like drugs and vaccines besides studying the immune pathogenesis and development of tuberculosis and other respiratory diseases. The institute will focus on the proteomics and genomics to achieve the above objectives. The facility will focus on discovering antigens, antibodies and immunological biomarkers for rapid and early diagnosis of tuberculosis, HIV-TB co-infection, MDR-TB and XDR-TB and on developing cost-effective devices for rapid detection of tuberculosis. This in a long run will help in the field evaluation and application of technology in tackling these diseases and will supplement the Revised National Tuberculosis Control Programme.

Researches Other Than DNB carried during the year 2011-2012

S.No. Title of the study Name of

Researcher 1. A randomised double blind, placebo-controlled study to evaluate

the long-term safety and efficacy of Darbepoetin Alfa administered at 500 µg once-every-3-weeks to a hemoglobin ceiling of 12.0 g/dl in anemic subjects with advanced stage non-small cell lung cancer receiving multicycle chemotherapy

Dr. D. Behera, Dr. A. Jaiswal, Dr. Rajnish Gupta, Dr. J.K.Saini

2. A phase 2, multicenter, open label, randomized trial of AMG 706 or Bevacizumab in combination with Paclitaxel and Carboplatin for advanced non squamous Non-small Cell lung Cancer

Dr. D. Behera, Dr. A. Jaiswal

3. Study A4021016 Randomized open label, Phase III Trial of CP-751,871 in combination with paclitaxel and carboplatin versus paclitaxel and carboplatin in patients with non- small cell lung cancer

Dr. D. Behera, Dr. A. Jaiswal, Dr. Lokender

4. Annual Risk of Tuberculosis Infection (ARTI) in the slum population covered under RNTCP by LRS Institute

Dr. Rohit Sarin, Dr. D. Behera, Dr. Vikram Vohra, Dr. Khalid U.K.

5. Efficacy and safety of Immunomodulator (Mw) in Cat.II Pulmonary TB patients (Collaboration with DBT)

Dr. Rohit Sarin, Dr Neeta Singla

91

6. Repeat zonal level tuberculin survey for estimating annual risk of tuberculosis infection in East Zone (collaboration with NTI Bangalore)

Dr. Rohit Sarin, Dr. V. Vohra, Dr. Khalid U.K.

7. Molecular characterization of mycobacterium tuberculosis isolates from seven states of North-East India using spoligotyping

Dr. V.P. Myneedu, Dr. D. Behera, Dr. M. Bhalla, Dr. Ritu Singhal, Dr. Niti Singh

8. Prevalence of multi-drug resistant mycobacterium tuberculosis in North-East states, Delhi and Punjab using Line-probe assay in various subsets of RNTCP patients.

Dr. V.P. Myneedu, , Dr. Ritu Singhal, Dr. D. Behera, Dr. Niti Singh, Dr. Jyoti Arora, Dr. M. Bhalla

9. Role of voltage gated calcium channels and Suppressors of Cytokine Signaling (SOCS) in regulating immune responses to Mycobacterium tuberculosis (collaboration with ICGEB).

Dr K. Natarajan, Dr R. Singla, Dr Khalid U.K.

10. Identification of biomarkers and pathogen regulated targets for tuberculosis infection (collaboration with ICGEB).

Prof. V.S. Chauhan, Dr. D. Behera, Dr. R. Singla, Dr Khalid U.K.

11. Functional analysis of IL – 12R mutation in tuberculosis. Dr. Anand Jaiswal, Dr. D. Behera, Dr. Sangeeta Sharma, Dr. J S Tyagi, Mr. Vikas Kumar Sharma, Dr. H. Krishna Prasad

12. To study interleukin – 12 and its receptor polymorphism in TB patient and controls.

Dr. Anand Jaiswal, Dr. D. Behera, Dr. Sangeeta Sharma, Dr. J S Tyagi, Dr. Rajiv Kr. Jha, Dr. H. Krishna Prasad

13. Profile of tuberculosis among house hold contacts of MDR tuberculosis registered under DOTS Plus (Central TB Division funded)

Dr. Neeta Singla, Dr. D. Behera, Dr. R. Singla, Dr. P. Visalakshi

14. Deciphering dendritic cell function during Mycobacterium tuberculosis infection by RNA interference (in collaboration with Dr. B R Ambedkar Centre for Biomedical Research, University of Delhi)

Dr. Rupak Singla, Dr. D. Behera, Dr. K. Natarajan, Dr. Neeta Singla

15. Delays and constraints in diagnosis and initiation of DOTS-Plus treatment in MDR-TB patients at a DOTS Plus site, Delhi

Dr. Neeta Singla, Dr. D. Behera, Dr. Rupak Singla, Dr. P. Visalakshi

16. A study on smoking behaviour, attributable risk of smoking to pulmonary tuberculosis and efficacy of smoking cessation among tuberculosis patients

Dr. Neeta Singla, Dr. D. Behera, Dr. Somdatta Patra,

92

Dr S.B.Singh, Dr. G. R. Khatri

17. Evaluation and diabetes as determinant of tuberculosis : A matched controlled study

Dr. Neeta Singla, Dr. Rajendra Tandon, Dr. D. Behera, Dr. Roopa S

18. Study of Adverse of Adverse Drug Reaction in MDR TB patients under DOTS plus program (2011)

Dr. Neeta Singla, Dr. Rupak Singla, Mr. Anurag Gautam, Dr. D. Behera

19. Radiological pattern in Pulmonary TB in Children Dr. Sangeeta Sharma, Dr. Anita Yadav

20. To study HIV status of pediatric Pulmonary & Extra Pulmonary patients

Dr. Sangeeta Sharma, Dr S.K. Munjal

21. To study the menstrual pattern of adolescent girls in pulmonary & extra-pulmonary TB

Dr. Sangeeta Sharma

22. To study the association of indoor environmental risk factors and childhood tuberculosis

Dr. D. Behera, Dr. Sangeeta Sharma Dr. Somdatta Patra

23. Surveillance of drug resistance at LSRI TB & RD New Delhi DOTS Area

Dr. V.P. Myneedu, Dr Ritu Singhal, Dr M. Bhalla, Dr Khalid U.K., Mr P.P.Sharma

24. Profile of Mycobacterium tuberculosis at LRSI – A retrospective study

Dr V.P.Myneedu

25. Evaluation of real time PCR for the diagnosis of pulmonary and extra-pulmonary specimens and its comparison with conventional IS6110 PCR, MGIT 960 TB system, conventional culture & Smear Microscopy

Dr D. Behera, Dr M. Bhalla, Dr Jyoti Arora, Dr Tamanna Sharma

26. Study the impact of TB on HIV activity in dually infected patients using RT-PCR Assay

Dr Tamanna Sharma, Dr. M. Bhalla, Dr. Upasana Agarwal

27. Utility of PCR for diagnosis of pulmonary and extra pulmonary TB in comparison with smear microscopy, conventional culture and MGIT 960 system

Dr. M. Bhalla, Dr Tamanna Sharma, Dr. D. Behera, Dr Jyoti Arora

28. Evaluation of performance and suitability of Light Emitting Diode (LED) fluorescence microscope for detection of Acid Fast Bacilli in sputum for tuberculosis diagnosis (Funded by OLMPUS Magnus analyticus)

Dr. M. Bhalla, Dr P.P.Sharma

29. Studies on Aspergillus fumigatus proteome for identification of novel unknown immunogens

Dr. D. Behera, Dr. J.K. Saini,

93

Dr. G.L. Sharma

30. Molecular analysis of MDR and XDR strains of Mycobacterium tuberculosis isolated from a tertiary care hospital (ICMR funded)

Dr Urvashi B.Singh, Dr. D. Behera, Dr Jyoti Arora, Dr. M. Bhalla

31. Validation and clinical studies for methods for diagnosis of tuberculosis by smear microscopy, culture and polymerase chain reaction using processed clinical samples and kit thereof (DBT funded)

Dr. M. Bhalla, Dr Jaya Tyagi

32. Study of the influence of stress and micro-nutrients deficiency on human immuno-competent cells and its implication to mycobacterium tuberculosis

Dr. H.K. Prasad, Ms Savita Singh, Dr. D. Behera, Dr Anand Jaiswal

33. Use of the BACTEC Mycobacteria Growth Indicator Tube 960 Automated System for recovery of mycobacteria from extrapulmonary specimens and typing of isolates using Spoligotyping

Dr. M. Bhalla, Dr. Jyoti Arora, Dr. D. Behera

34. Tobacco consumption in youth attending OPD in a tertiary care respiratory hospital in Delhi.

Dr. Sujata Arya, Dr. Khalid U. K., Dr. D. Behera

35. To study the feasibility and usefulness of multiple samples collected same day for smear microscopy in the diagnosis of pulmonary TB at LRSI

Dr. Ajoy Kumar Verma, Dr. V.P. Myneedu

36. Evaluation and justification of phenol-Ammonium sulphate precipitation / sedimentation smear microscopy method for diagnosis of pulmonary tuberculosis : an effective, safe and reliable alternative for direct smear microscopy in microscopy centers

Dr. Ritu Singhal, Dr. M. Bhalla, Dr. V. P. Myneedu, Dr. D. Behera

37. Molecular epidemiology and genetic characterization of M. tuberculosis from HIV seronegative and HIV seropositive patients

Dr. Niti Singh, Dr. D. Behera, Dr. Tamanna Sharma, Prof.Sarman Singh

38. Role of modifications in routine fine needle aspiration cytology for increasing the diagnostic yield in extra-pulmonary tuberculosis

Dr. Shalini Mullick, Dr. Nidhi Paliwal, Dr. Sapna Thakur, Dr. Kumud Gupta

39. Molecular epidemiology of Extensively Drug Resistant TB (XDR-TB) and development of a rapid diagnostic technique.

Chhavi Gupta, Dr. Rupak Singla

40. Identification & evaluation of Mycobacterium tuberculosis antigens as biomarkers in clinical samples from tuberculosis patients & comparative analysis with other diagnostic methods

Amit Kaushik, Dr. Rupak Singla

41. A study to assess the need for training of nurses regarding management of TB patients receiving DOTS and DOTS Plus under RNTCP in selected hospitals and outreach facilities in Delhi

Mrs. Anita Kansal, Dr. D. Behera, Dr. R. Mahal

42. What is time taken and reasons for delay in the diagnosis and treatment in patients with lung cancer attending a tertiary care hospital in Delhi?

Dr. J.K. Saini, Dr D. Behera, Dr. Anand Jaiswal

43. Synergistic drug medium of INH and Rifampicin for identification of MDR Mycobacterium tuberculosis

Manoj Kumar, Dr M. Bhalla, Dr. Ritu Singhal

44. Study of the modulation of cell surface receptors by mycobacterium and defined recombinant antigens in human immune-competent

Ms. Harshita Mittal, Dr. S.K. Munjal

94

cells and its functional significance

45. Effects of high intensity interval based inspiratory muscle training in patients with COPD undergoing a 4 weeks Pulmonary Rehabilitaion Programme on PFT values (FEV1/FVC), Peak inspiratory pressures, dyspnea score, functional capacity and HQRL

Mr. Sumanta Ghosh, Dr. S.K. Munjal

46. Comparative effects of chair sitting and forward lean with cross legged sitting position on Cardio Respiratory parameters during recovery after six minute walk test in COPD patients

Md. Mumtaz Uddin, Dr. S.K. Munjal

47. “Comparison of effect of flow oriented versus volume oriented incentive spirometry on PFT, chest expansion, exercise tolerance, Dyspnea and Quality of life in Post Tuberculous Empyema Thoracis”

Mr. Akmal Aslam Kothawala, Dr. S.K. Munjal

6. Awards and Achievements : S.No. Details of Awards and Achievements

1. Dr. D. Behera delivered Achanta Lakshmipathi Oration on “Drug Resistant Tuberculosis (MDR/XDR-TB) in India-issues and solutions” in 51st Annual Conference of Medical Sciences at SUM Hospital, Bhubaneswar from 14th to 16th October 2011. He also delivered Dr. P. C. Sen Gold Medal Oration and Presidential address in NATCON 2011 from 18th to 20th November 2011 at Dehradun.

2. Dr. Rohit Sarin became Vice Chairman of Tuberculosis Association of India and Chairman of New Delhi TB Centre from August 2011. As Vice Chairman, he organized NATCON 2011 at Dehradun, Uttarakhand. He was the Editor of Indian Journal of Tuberculosis and Member on the Editorial Boards of Indian Medical Prescriber, Journal of Delhi TB Association and Indian Journal of Tuberculosis and Chest Diseases. He was a Member of the National Joint Monitoring Mission for reviewing the RNTCP at periodic intervals. He was a Technical Member of various National-level Committees including National DOTS Plus Committee and National Infection Control Committee under the Ministry of Health and Family Welfare, Govt. of India to frame & revise the national guidelines. He was also the Member of the National Operational Research Committee for RNTCP. He was expert member of National Committee for Paediatric TB Guidelines. He was a Member of National Writing Group for TB-HIV Collaborative Activities. He was a Member of National Committee for reviewing and revising the Training Modules for Medical Officers in National TB Control Programme. He was a Coordinator for development of training modules for Nurses under DOTS Plus Programme.

3. Dr. Rupak Singla was nominated by Central TB Division as Technical member of the working group on “Treatment of TB including Drug Resistant TB” for developing National Strategic Plan for India for the period 2012-17. He is a Technical member of various national committees including National DOTS Plus committee and National Airborne Infection Control committee under the Ministry of Health and Family Welfare, Govt. of India to frame & revise the national guidelines. He is a member of the Project Review Committee of ICMR involved in review of various research projects related to tuberculosis and leprosy. He published seven papers in indexed International Journals and two papers in indexed National Journals and Contributed “Atelectasis and Pulmonary Fibrosis” chapter for the 9th Edition of API Text Book of Medicine 2011.

4. Dr. R. K. Dewan was named as a member of the Editorial Board of the Indian Journal of Chest Diseases and Allied Sciences.

5. Dr. Sangeeta Sharma was Chief Editor “Pediatrics Today”. She was the Reviewer for the

95

International Journal of TB and Lung Diseases and Indian Journal of Tuberculosis. She was expert member and Member, Document Writing Committee for Revised Pediatric TB Guidelines from 31st January to 1st February 2012. She was also Expert Member of Techno-Commercial Evaluation Committee for Procurement of PPD, MOHFW, GOI on 11.05.2011. She was the member editorial board of the Journal Pediatrics and Obstetrics Gynecology.

6. Dr. Sushil Munjal was the Peer Reviewer for SAARC Journal of TB, Lung Diseases and HIV/AIDS.

7.0 Publications

S.No. Author’s Name Title of the paper/ chapter

published Journal/Month/Volume/ Page

No/ Impact Factor (if any)/ Book/ Chapter in Book

1. Myneedu VP, Visalakshi P, Verma AK, Behera D, Bhalla M.

Prevalence of XDR-TB cases - A retrospective fact finding from a tertiary care TB hospital.

Indian J Tuberc 2011;58(2):54-9.

2. Puri MM, Srivastava A, Jain AK, Behera D.

Pneumatocele formation in adult Escherichia coli pneumonia

Ann Thorac Med 2011;6:101-2. (IF:1.06)

3.

Kumar L, Gupta R, Puri M M, Jaiswal A, Srinath, Murar A, Behera D.

Unilateral and painless development of isoniazid induced gynecomastia during retreatment of pulmonary tuberculosis.

J Assoc Physicians India 2011; 59:733-5.

4.

Srivastava V, Vashishta M, Gupta S, Singla R, Singla N, Behera D, Natarajan K.

Suppressors of cytokine signaling inhibit effector T cell responses during Mycobacterium tuberculosis Infection.

Immunol Cell Biol 2011; 89(7):786-91.

5. Behera D, Sharma PP. A retrospective study of seasonal variation in the number of cases diagnosed at a tertiary care tuberculosis hospital.

Indian J Chest Dis Allied Sci 2011; 53(3):145-52.

6. Singla N, Singla R, Jain G, Habib L, Behera D.

Tuberculosis among household contacts of multidrug-resistant tuberculosis patients in Delhi, India.

Int J Tuberc Lung Dis 2011;15(10): 1326-30. (IF:2.557)

7. Shen G, Singh K, Chandra D, Serveau-Avesque C, Maurin D, Canaan S, Singla R, Behera D, Laal S.

LipC (Rv0220) is an immunogenic cell surface esterase of Mycobacterium tuberculosis.

Infect Immun 2012; 80(1): 243-53. (IF:4.098)

8. Singla R, Caminero JA, Jaiswal A, Singla N, Gupta S, Bali RK, Behera D.

Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India.

Eur Respir J 2011 Sep 29. (Epub ahead of print). (IF:5.922)

96

9. Arora J, Singhal R, Bhalla

M, Reza S, Visalakshi P, Behera D, Myneedu VP.

Diagnostic utility of Capilia TB assay for identification of mycobacterium tuberculosis complex.

Current Res Tuberc, 2011 ISSN 1819-3366/DOI:10.3923/crt.2011© 2011 Academic Journals Inc.

10. Behera D. TB and diabetes – the dual epidemic: is it a matter of concern? (Editorial)

Indian J Tuberc 2011;58(4):143-7.

11. Myneedu VP, Verma AK, Sharma PP, Behera D.

A pilot study of same day sputum smear examination, its feasibility and usefulness in diagnosis of pulmonary TB.

Indian J Tuberc 2011;58(4):160-7.

12. Siddiqi S, Ahmed A, Asif S, Behera D, Javaid M, Jani J, Jyoti A, Mahatre R, Mahto D, Richter E, Rodrigues C, Visalakshi P, Rüsch-Gerdes S.

Direct drug susceptibility testing of mycobacterium tuberculosis for rapid detection of multidrug resistance using the Bactec MGIT 960 system: a multicenter study.

J Clin Microbiol. 2012;50(2):435-40. Epub 2011 Dec 7 (IF:4.22)

13. Blumenschein GR Jr, Kabbinavar F, Menon H, Mok TS, Stephenson J, Beck JT, Lakshmaiah K, Reckamp K, Hei YJ, Kracht K, Sun YN, Sikorski R, Schwartzberg L; Motesanib NSCLC Phase II Study Investigators. Collaborators (56) Au AK, Cheng CK, Mok TS, Tung Y, Behera D, Chacko R, Lakshmaiah K, Menon H, Nirni S, Pathak A, Thirumulai R, Arena F, Beck JT, Belman N, Blumenschein GR, Boccia R, Chan D, Clowney B, Davidson S, Del Prete S, Dudek A, Fain J, Hagenstad C, Henry D, Hoang T, Holladay C, Hu E, Kabbinavar F, Kaywin P, MacLaughlin W, March R, Marsland T, Meza L, Mott F, Page R, Paschold E, Patel G, Patel R, Prow D, Reckamp K, Rosen P, Sabbath K, Samuels B, Schwartzberg L, Shah M, Shtivelband M, Singh J, Stephenson J,

A phase II, multicenter, open-label randomized study of motesanib or bevacizumab in combination with paclitaxel and carboplatin for advanced nonsquamous non-small-cell lung cancer

Ann Oncol 2011;22(9):2057-67.

97

Subramaniam D, Swanson P, Thomas M, Webb R, Hassan A, Quednau BD, Wake C, Melara R.

14. Mehta PK, Kalra M, Khuller GK, Behera D, Verma I.

Development of an ultrasensitive polymerase chain reaction-amplified immunoassay based on mycobacterial RD antigens: implications for the serodiagnosis of tuberculosis.

Diagn Microbiol Infect Dis 2012; 72(2):166-74.

15. Das S, Duggal P, Roy R, Myneedu VP, Behera D, Prasad HK, Bhattacharya A.

Identification of hot and cold spots in genome of mycobacterium tuberculosis using Shewhart Control Charts.

Sci Rep 2012;2:297. (Epub 2012 Mar 2)

16. Sarin R. Guidelines for programmatic management of drug-resistant tuberculosis 2011 Update.

Geneva: World Health Organization, 2011 (WHO/HTM/TB2011.6)

17. Dewan RK, Kesieme EB, Ramchandani R.

Surgical treatment for trachea-bronchial carcinoid tumours: A 16-year experience.

Asian Cardiovasc Thorac Ann 2012;20:53-7.

18. Dewan RK, Ramchandani RK, Sisodia A, Verma P.

Delayed presentation of traumatic bronchial tear and successful repair.

Indian J Thoracic Cardiovascular Surgery (14 December 2011), pp. 1-3, doi:10.1007/s12055-011-0122-4

19. Gupta S, Bali RK, Das K, Sisodia A, Dewan RK, Singla R.

Rare presentation of spontaneous acquired diaphragmatic hernia.

Indian J Chest Dis Allied Sci 2011; 53:117-9.

20. Banday KM, Pasikanti KK, Chan EC, Singla R, Rao KV, Chauhan VS, Nanda RK.

Use of urine volatile organic compounds to discriminate tuberculosis patients from healthy subjects.

Anal Chem. 2011; 83(14): 5526–5534.

21. Mukherjee A, Singla R, Saha I, Sarkar A and Bhattacharyya P.

Difference in the outcome of patients with different grades of initial sputum positivity under the Revised National Tuberculosis Control Programme.

Indian J Chest Dis Allied Sci 2011; 53(4): 241-2.

22. Paliwal N, Thakur S, Mullick S, Gupta K.

FNAC in tubercular lymphadenitis: Experience from a tertiary level referral centre.

Indian J Tuberc 2011; 58: 102-7.

23. Bisht D, Verma AK, Bhardwaj HHD.

Intestinal parasitic infestation among children in a semi-urban population.

Tropical Parasiotology 2011;1(2):104- 7.

98

24. Tayal D, Goswami B, Koner BC, Mallika V.

Role of homocysteine and lipoprotein (A) in atherosclerosis: An update.

Biomedical Research 2011;22(4): 391-405.

25. Tayal D, Goswami B, Tyagi S, Chaudhary M, Mallika V.

Interaction between dyslipidemia, oxidative stress and inflammatory response in patients with angiographically proven coronary artery disease.

Cardiovascular J Africa 2012; 23(1): 23-7.

26. Varma- Basil M, Kumar S, Arora J, Angrup A, Zozio T, Banavaliker JN, Singh UB, Rastogi N, Bose M.

Comparison of spoligotyping, mycobacterial interspersed repetitive units typing and IS6110-RFLP in a study of genotypic diversity of Mycobacterium tuberculosis in Delhi, North India.

Mem Inst Oswaldo Cruz 2011; 106(5):524-35.

27. Sharma Sangeeta MDR TB in Children – LRS Experience.

Chapter in Abstract Book PEDICON 2012.

9.0 Presentations during Conferences/ Seminars/Workshops : 9.1 Outside Country : S.No. Title of the paper presented/ Session

chaired

Name of Participant

Venue

Dates

1. Co-ordinated and attended an Indo-Swiss bilateral workshop on “Infectious Diseases” at EPFL.

Dr D. Behera Lausanne, Switzerland

2nd to 3rd May 2011

2. Attended 14th World Conference on Lung Cancer and presented a paper on “Cisplatin and irinotecan combination chemotherapy in non-small cell lung cancer patients attending a TB hospital in India”.

Dr D. Behera Amsterdam, Netherlands

3rd to 7th July 2011

3. Attended 42nd Union World Conference on Lung Health and presented a paper entitled “An analysis of causes of mortality in patients with tuberculosis in North Indian hospital”.

Dr D. Behera Lille, France 26th to 30th October 2011

4. Presented a paper on “Molecular diagnosis of non-tuberculosis mycobacteria”.

Dr. Ajoy Verma

New York, USA

28th November 2011

99

9.2 Within Country : S.No. Title of the paper presented/ Session

chaired

Name of Participant

Venue

Dates

1. Delivered lecture in “Dr. Rajendra Prasad Oration” on Foundation Day Celebration of Department of Pulmonary Medicine of CSMMU.

Dr D. Behera Lucknow 29th April 2011

2. Delivered a lecture on “Progress in Management of Lung Cancer” at Shere-Kashmir Institute of Medical Sciences Respiratory and Critical Care Update.

Dr D. Behera Srinagar 29th June 2011

3. Attended Zonal Task Force Workshops under RNTCP in different Zones as Resource Person and Chairperson, National Task Force.

Dr D. Behera August and September 2011

4. Delivered Achanta Lakshmipatahi Oration on the topic entitled “Drug Resistant Tuberculosis (MDR/XDR-TB) in India-issues and solutions” in 51st Annual Conference of Medical Sciences & SUM Hospital.

Dr D. Behera Bhubaneswar 14th to 16th October 2011

5. Delivered lecture on “RNTCP…. Recent Issues” in the State Conference of the Association of Physician of India, Tripura branch.

Dr D. Behera Agartala 13th November 2011

6. Delivered Dr. PC Sen Gold Medal oration by Tuberculosis Association of India and Presidential Address in NATCON 2011 and delivered lecture on “Status and Updates on RNTCP including Drug Resistance TB”.

Dr D. Behera Dehradun 18th to 20th November 2011

7. Attended HIV-TB performance review meeting at ART Centre SCB Medical College, Cuttack and delivered a talk on HIV-TB.

Dr D. Behera Cuttack 21st November 2011

8. Attended NAPCON 2011 and delivered lecture on “RNTCP-Targets and Achievements” at VPCI.

Dr D. Behera Delhi 28th to 30th November 2011

9. Attended “Pulmo Rehab 2012” and delivered a lecture on the topic ‘Chronic Lung Diseases Burden in India’.

Dr D. Behera Coimbatore 21st to 22nd January 2011

10. Delivered a lecture on the topic ‘Diagnosis work up of Lung Cancer’ in symposium on Lung CA organized at SMS Medical College under the auspices of Rajasthan Cancer Society.

Dr D. Behera Jaipur 4th February 2012

11. Delivered a talk on the topic ‘MDR- Dr D. Behera Cuttack 11th to 12th

100

TB’ as a Guest Speaker in the 8th CHESTCON ODISHA organized by the Department of Pulmonary Medicine, S.C.B. Medical College & Hospital.

February 2012

12. Attended CME cum workshop on Common Respiratory Disorders in Children at PGIMER and delivered a key-note-address in the inauguration of the RNTCP workshop.

Dr D. Behera Chandigarh 18th to 19th February 2012

13. Attended Workshop to formulate National Guidelines for Diagnosis and Management of Pneumonia in Adults organized by PGIMER.

Dr D. Behera Chandigarh 19th March 2012

14.

Delivered a guest lecture on MDR/XDR-TB at European Respiratory Society – 2011 Workshop.

Dr Rohit Sarin

Kolkatta 17th June 2011

15. Attended meeting on the proposal from Principal Secretary (Medical Education), Govt. of Karnataka for Upgrading its Autonomous SDS Tuberculosis Research Centre (SDSTRC) and Rajiv Gandhi Institute of Chest Diseases (RGICD), Bengaluru as “National Institute of Chest Diseases” in the line of NIMHANS.

Dr Rohit Sarin

Bangalore 03rd October 2011

16. Attended a Symposium on Improving Tuberculosis Care and Control at and delivered a lecture on “XDR TB – An Emerging Challenge at AIIMS.

Dr Rohit Sarin

New Delhi 4th November 2011

17. Organised inauguration of National TB Seal Campaign by Hon’ble Union Health Minister Sh. Gulam Nabi Azad.

Dr Rohit Sarin

New Delhi 5th October 2011

18.

Attended NATCON 2011 as Vice-Chairman and delivered Guest Lecture on “Airbone Infection Control in TB” and “XDR-TB” and Chairperson for various award sessions.

Dr Rohit Sarin

Dehradun 18th to 20th November 2011

19. Facilitated National DOTS Plus training

Dr Rohit Sarin

New Delhi 06th to 10th February 2012

20.

Facilitated the World TB Day and Dr. R.C. Jain Memorial Lecture at LRS Institute of TB R.D.

Dr Rohit Sarin

New Delhi 24th March 2012

21. Participated as Member in the National Task Force in relation to Medical College Involvement in RNTCP at LRS Institute of TB & R.D.

Dr Rohit Sarin

New Delhi 21st to 22nd December 2011

22. Participated in National Paediatric Consultation meeting as a Member at LRS Institute of TB & R.D.

Dr Rohit Sarin

New Delhi 31st January to 01st February 2012

101

23. Participated in National OR Committee meeting as a Member at LRS Institute of TB & R.D.

Dr Rohit Sarin

New Delhi 08th February 2012

24. Participated in National DOTS Plus meeting as a Member at LRS Institute of TB & R.D.

Dr Rohit Sarin

New Delhi 10th February 2012

25. Attended the 58th Annual Conference of Indian Association of Cardiovascular Thoracic Surgeons and Moderated a symposium on “Surgery for Pulmonary Tuberculosis”.

Dr. R. K. Dewan

Kolkata 9th to 12th February 2012

26. Attended the 4th Asia Pacific Conference on Bronchology and Chaired one session & delivered a Guest Lecture on “Bronchoscopy in TB Sequel.”

Dr. R. K. Dewan

Jaipur 19th to 21st January 2012

27. Attended CT-CME (Thoracic) and Delivered three Guest Lectures on “History of Thoracic Surgery”, “Empyema Management” and “Bronchoplasty and Sleeve Resections”.

Dr. R. K. Dewan

Hyderabad 10th to 11th December 2011

28. Attended NAPCON 2011 and delivered a talk on “Management of Chronic Empyema”

Dr. R. K. Dewan

New Delhi 27th November 2011

29. Chaired a session on Pediatric Chest in Pediatric Surgery Update 2011 held in Maulana Azad Medical College

Dr. R. K. Dewan

New Delhi 27th March 2011

30. Delivered an Extension Lecture on “Role of Surgery in Pulmonary Tuberculosis” in the department of Surgery, JNMCH, AMU

Dr. R. K. Dewan

Aligarh 30th March 2011

31. Participated as Panelist in Panel discussion on MDR/XDR TB and infection control issues in PG CME – 2011 (North India) on for PG students of North India at LRS Institute of TB & Respiratory Diseases.

Dr. Rupak Singla

New Delhi 16th to17th July 2011

32. Delivered a lecture on “MDR-TB Implementation in India and current status” in Training of trainers regarding DOTS Plus for doctors from Mynamar under WHO

Dr. Rupak Singla

New Delhi 08th to 12th August 2011

33. Presented a talk on “Management of XDR-TB: LRS Institute Experience” in North Zone Task Force Workshop at MAMC.

Dr. Rupak Singla

New Delhi 15th September 2011

34. Presented a talk on “Management of XDR-TB: LRS Institute Experience in a symposium on Improving Tuberculosis Care and Control at

Dr. Rupak Singla

New Delhi 04th November 2011

102

AIIMS. 35. Delivered a lecture on “Interpretation

of Spirometry in “Workshop on PFT” in “NAPCON-2011”

Dr. Rupak Singla

New Delhi 27th November 2011

36. Training of trainers under RNTCP held in LRS Institute.

Dr. Rupak Singla

New Delhi 23rd May to 4th June 2011

37. Acted as Facilitator in Comprehensive courses on Clinical Management of Drug Resistant Tuberculosis in India conducted by International Union against Tuberculosis and Lung Diseases (The Union) held at LRS Institute.

Dr. Rupak Singla

New Delhi 25th to 29th July 2011

38. Acted as Facilitator in Comprehensive courses on Clinical Management of Drug Resistant Tuberculosis in India conducted by International Union against Tuberculosis and Lung Diseases (The Union) held in LRS Institute.

Dr. Rupak Singla

New Delhi 01st to 05th August 2011

39. Acted as facilitator in Training of trainers regarding DOTS Plus for doctors from Mynamar under WHO.

Dr. Rupak Singla

New Delhi 08th to 12th August 2011

40. Facilitator for Training Programme for Trainees from DPR Korea doctors.

Dr. Rupak Singla

New Delhi 21st November to 16th December 2011

41. Facilitator for Training of Medical students of Sweden.

Dr. Rupak Singla

29th November to 02nd December 2011

42. National Facilitator for Training of trainers under Programmatic Management of Drug Resistant TB held at LRS Institute.

Dr. Rupak Singla

New Delhi 12th to 16th December 2011

43. Delivered a lecture entitled “COPD – Update on Management” on 19.11.2011 at 66th National Conference on TB & Chest Diseases 2011 organized by Tuberculosis Association of India.

Dr. M.M. Puri

Dehradun 18th to 20th November 2011

44. Delivered a lecture entitled “Allergic Rhinitis and Asthma” in CME on Respiratory Allergies and Immunotherapy at LRS Institute of Tuberculosis and Respiratory Diseases.

Dr. M.M. Puri

New Delhi 3rd February 2012

45. Presented poster entitled “ FNAC in Tuberculous Lymphedenitis: experience from a tertiary level referral centre” at 26th Annual Conference of

Dr. Nidhi Paliwal, Dr. Sapna Thakur, Dr.

New Delhi 17th April 2011

103

Delhi Chapter of IAPM. Shalini Mullick, Dr. Kumud Gupta

46. Presented poster entitled “Adeno Carcinoma in Mature Teratoma of Anterior Mediastinum” at 27th Annual Conference of Delhi Chapter of IAPM.

Dr. Nidhi Paliwal, Dr. Kumud Gupta, Dr. R.K.Dewan, Dr. Shalini Mullick

New Delhi 25th February 2012

47. Delivered a lecture entitled “Obstructive Sleep Apnoea Syndrome – A Step by Step approach to diagnosis” at NATCON 2011 organised by TB Association of Uttarakhand under auspices of TAI.

Dr. Rajnish Gupta

Dehradun 19th November 2011

48. Delivered a talk on “Role of National Reference Laboratory in Tuberculosis Care and Control” at the Symposium on Improving TB Care & Control at AIIMS

Dr. Manpreet Bhalla

New Delhi 4th November 2011

49. Poster Presentation on “Predominance of Beijing genotype in XDR M. Tuberculosis isolates from a tertiary care hospital” in IAMM Delhi Chapter Meeting organised by UCMS & GTB Hospital at India Habitat Center.

Dr. Manpreet Bhalla

New Delhi 3rd December 2011

50. Delivered a talk on “Fluorescent Microscopy usefulness and utility in diagnosis of TB” at LRS Institute of TB & R.D.

Dr. Ajoy Verma

New Delhi February and March 2012

51. Presented a paper on “Drug Susceptibility pattern of tuberculosis isolates in eight states of India – Data from a National Reference Laboratory” at 66th National Conference on TB & Chest Diseases (NATCON 2011).

Dr. Niti Singh, Dr Ritu Singhal

Dehradun 18th to 20th November 2011

52. Presented a paper on “Evaluation and justification of Phenolammonium sulfate precipitation / sedimentation smear microscopy method for diagnosis of pulmonary tuberculosis” at 66th National Conference on TB & Chest Diseases (NATCON 2011).

Dr. Niti Singh, Dr Ritu Singhal

Dehradun 18th to 20th November 2011

53. Trainer for the STLS and LTs from Medical Colleges of India conducted by International Union of Tuberculosis and Lung Disease (IUTALD) in LED fluorescent Microscopy at LRS Institute.

Dr. Niti Singh

New Delhi 13th to 17th February and 27th to 29th March 2012

104

54. Presented a paper on “Newer diagnostic methods of diagnosis of drug resistant tuberculosis” at NATCON 2011

Dr Ritu Singhal

Dehradun 18th to 20th November 2011

55. Presented a paper on “Pattern of tobacco consumption among youth in a tertiary care respiratory hospital of Delhi” at NATCON 2011

Dr Sujata Arya

Dehradun 19th November 2011

56. Presented a POSTER on “Knowledge, attitude and practices of tobacco consumption among youth in a tertiary care respiratory hospital of Delhi” at NATCON 2011

Dr Sujata Arya

Dehradun 20th November 2011

57. Presented a paper on “Tobacco and alcohol consumption among youth attending OPD in a tertiary care respiratory hospital of Delhi” at IPHACON 2012

Dr Sujata Arya

Kochi 11th February 2012

58. Presented an interesting case of Haemoptysis in a Nepalese origin young male patient diagnosed on bronchoscopy at NATCON 2011

Dr Pushpender Verma

Dehradun 20th November 2011

59. Facilitator for LPA Training at New Delhi TB Center

Dr. Jyoti Arora

New Delhi 28th March to 2nd April 2011

60. Facilitator for LPA TOT at ICELT Dr. Jyoti Arora

Delhi 12th to 17th December 2011

61. Facilitator for Fluorescent Training at LRS Institute

Dr. Jyoti Arora

New Delhi 20th to 23rd March 2012

62. Attended Mid Term Summer CME by Infectious Diseases Chapter of IAP, Kolkata and delivered guest lecture on Conventional V/S Newer Diagnostic Methods of TB”

Dr. Sangeeta Sharma

Kolkata 24th April 2011

63. Delivered a Guest Lecture on “Diagnosis of Pediatric TB” in NATCON – 2011

Dr. Sangeeta Sharma

Dehradun 18th November 2011

64. Delivered a Lecture on “MDR TB in Children- LRS Experience” in PEDICON 2012 during 49th Annual Conference of Indian Academy of Pediatrics. Chaired an invited guest lecture “TB or Not TB” by Prof. Nigel Curtis. Also Judged two sessions on “Intercostal Tube V/S/ Video Assisted Thoracoscopy” and “DOTS V/S Non-DOTS – which is better”.

Dr. Sangeeta Sharma

Gurgaon 21st January 2012

65. Delivered a lecture on “Bronchial Asthma” in Nehru Homeopathy College for their faculty doctors.

Dr. S. K. Munjal

New Delhi 25th April 2011

66. Delivered a lecture on “Psychosocial Issues in HIV/AIDS” in Department

Dr. S. K. Munjal

New Delhi 26th July 2011

105

of Community Medicine at MAMC. 67. Chaired a session on Misc. Talks at

NAPCON-2011. Dr. S. K. Munjal

New Delhi 29th November2011

68. Delivered a lecture on “HIV/TB Co-infection” at Conference Hall, Delhi University

Dr. S. K. Munjal

New Delhi 14th May 2011

69. Delivered a lecture on “HIV/TB Co-infection” at Conference Hall, Delhi University , under Global Fund to AIDS Tuberculosis & Malaria R-7 Project (GFATM R-7)

Dr. S. K. Munjal

New Delhi 4th July 2011 and 11th February 2012

70. Delivered a lecture on “TB-HIV Collaboration” at LRS Institute of TB and Respiratory diseases , in Training Programme for Trainees from DPR Korea Doctors.

Dr. S. K. Munjal

New Delhi 15th December 2011

71. Delivered a talk on Sensitization of class IV employees of LRSI on HIV/AIDS for Sensitization programme from DSAC.

Dr. S. K. Munjal

New Delhi 28th to 29th March 2012

72. Chaired a session CME “Respiratory Allergy and Immunotherapy at LRSI.

Dr. S. K. Munjal

New Delhi 3rd February 2012

106

10. Conference / Workshop/ Seminar/Training Attended :-

10.1 Outside Country : S.No. Conference / Workshop/

Seminar/Training attended

Name of Participant

Venue

Dates

1. Attended Annual Board Retreat of International Union against Tuberculosis and Lung Disease (IUALTD).

Dr D. Behera Paris, France 15th to 17th April 2011

2. Participated in International WHO Training for Drug Resistant Tuberculosis Consultants.

Dr Rohit Sarin Lesotho, South Africa

07th to 11th November 2011

3. Attended AITRP training program on molecular diagnosis of NTM at NYU.

Dr. Ajay Kr. Verma

New York, USA 1st September to 30th November 2011

4. Attended Comprehensive Clinical TB Course at Southeaster National Tuberculosis Center, Lantana.

Dr. Ajay Kr. Verma

Florida, USA 12th to 15th September 2011

5. Attended Comprehensive Clinical TB Course at National Jewish Health Center, Denver.

Dr. Ajay Kr. Verma

Colorado, USA 12th to 15th October 2011

6. Attended Diagnosis of Non-tuberculous Mycobacteria by Molecular Methods (PCR, RTPCR, PRA) at Florida Department of Health, Bureau of Laboratories, Mycobacteriology Laboratory, Jackson Ville

Dr. Ajay Kr. Verma

Florida, USA 16th to 30th October 2011

7. Attended Molecular diagnostic methods for diagnosis of TB at Wordsworth Center, New York State Dept. of Health, Dandaxdord Inst. 120, New Scotland Avenue, Albany.

Dr. Ajay Kr. Verma

New York, USA 16th to 26th November 2011

107

10.2 Within Country : S.No. Conference / Workshop/

Seminar/Training attended Name of

Participant Venue Dates (From –

to) 1.

Attended 16th Annual Conference of Environment and Pulmonary Diseases (NESCON 2011)organized under the auspices of Environment and Medical Association ‘Our Environment, Our Responsibility’.

Dr. D. Behera Mumbai 23rd to 24th April 2011

2. Attended 25th Annual Pulmonary and Critical Care Update (The Chest) at PGIMER.

Dr. D. Behera Chandigarh 08th October 2011

3. Attended 67th Annual Conference of Association of Physicians of India 2012.

Dr. D. Behera Kolkata 12th to 15th January 2012

4. Attended Indo Swedish Conference ‘Post Genomic Opportunities in Tuberculosis and other mycobacterial diseases’ organized by School of Life Sciences & Computation & Integrative Sciences, JNU.

Dr. D. Behera New Delhi 29th to 31st January 2012

5. Attended OR Workshop-cum-CME organized by State Task Force, UP.

Dr. D. Behera SAIFAI, U.P.

28th February 2012

6. Attended “NAPCON-2011” at India Habitat Centre.

Dr. Rupak Singla

New Delhi 27th to 30th November 2011

7.

Attended 66th National Conference on Tuberculosis and Chest Diseases (NATCON 2011).

Dr. M. M. Puri Dehradun 18th to 20th November 2011

8. Attended 13th NAPCON 2011 organised by V.P.Chest Institute

Dr. Rajnish Gupta

New Delhi 27th to 30th November 2011

9. Attended 20th Meeting of National Lab Committee at LRS Institute

Dr. Manpreet Bhalla

New Delhi 13th July 2011

10. Attended TB Diagnostics in India – Conference / workshop From Importation & Initiation to Innovation at St. John’s Research Institute

Dr. Manpreet Bhalla

Bangalore 25th to 26th August 2011

11. Attended PMDT Training – DOTS Plus at LRS Institute

Dr. Manpreet Bhalla

New Delhi 10th to 14th October 2011

12. Attended seminar on Accreditation – Strive for Excellence, organised by UCMS & GTB Hospital at India Habitat Center

Dr. Manpreet Bhalla

New Delhi 3rd December 2011

13. Attended Seminar on ‘Improving Tuberculosis Care and Control’ at AIIMS

Dr. Manpreet Bhalla

New Delhi 4th November 2011

14. Attended IUATLD Training – Project Light at LRS Institute

Dr. Manpreet Bhalla

New Delhi January to March 2012

15. Attended MICRODCON, IAMM Delhi Chapter 2012 at AIIMS

Dr. Manpreet Bhalla

New Delhi March 2012

16. Attended practical course on cartridge Dr. Ajay Kr. New Delhi 21st to 23rd

108

based automated nucleic acid amplification test (CBANAAT) at LRS Institute

Verma March 2011

17. Attended training on Fluoroscope Microscopy at LRS Institute

Dr. Ajay Kr.Verma

New Delhi February to March 2012

18. Attended ICAAICON – 2011 Dr. Puneet Arora

Aurangabad 16th to 18th December 2011

19. Attended 26th Annual Conference of Delhi Chapter IAPM

Dr. Shalini Mullick

Delhi 17th April 2011

20. Attended 27th Annual Conference of Delhi Chapter IAPM

Dr. Shalini Mullick

Delhi 25th February 2012

21. Attended National Conference on advances in coagulation and Thrombosis

Dr. Shalini Mullick

New Delhi 2nd March 2012

22. Attended User Group Meeting on Flow Cytometer

Dr. Shalini Mullick

Gurgaon 12th August 2011

23. Attended IRL Microbiologist workshop at New Delhi organized by USAID, CTD and PATH for the microbiologists and State Head quarter Consultants of Selected IRLs.

Dr. Niti Singh New Delhi 30th June to 1st July 2011

24. Completed Training in Line Probe assay for MDRTB (LPA for MDRTB Plus) in Deptt. Of Microbiology at LRS Institute

Dr. Niti Singh New Delhi 23rd to 27th August 2011

25. Participated in RNTCP National DOTS Plus Training organized by STDC, Kerala , CTD and Trivandum, Kerala WHO

Dr. Niti Singh Kerala 26th to 30th September 2011

26. Attended MICRO-DCON 2012, IAMM at AIIMS.

Dr. Ritu Singhal

New Delhi March 2012

27. Attended NATCON 2011. Dr. Ritu Singhal

Dehradun 18th to 20th November 2011

28. Attended Tuberculosis Care and Control Symposium at AIIMS.

Dr. Ritu Singhal

New Delhi 4th November 2011

29. Attended PMDT training DOTS-Plus. Dr. Ritu Singhal

Hyderabad November 2011

30. Attended IUTALD training Project LIGHT at LRS Institute.

Dr. Ritu Singhal

New Delhi February to March 2012

31. Attended 66th NATCON 2011. Dr. Sujata Arya

Dehradun 18th to 20th November 2011

32. Attended 56th Annual National Conference of Indian Public Health Association (IPHA).

Dr. Sujata Arya

Kochi, Kerala

10th to 12th February 2012

33. Attended Pre-conference CME on “Impact Evaluation of Public Health Programme”.

Dr. Sujata Arya

Kochi, Kerala

9th February 2012

34. Attended National Oncology Congress on Lung Cancer.

Dr. Pushpendra Verma

Delhi 29th January 2012

35. Attended 1st Annual Conference-cum-Workshop on Research Methodology

Dr. Pushpendra

Delhi 9th October 2011

109

and Art of Scientific Paper Writing at MAMC.

Verma

36. Attended Medicine Update 2012 at AIIMS.

Dr. Pushpendra Verma

Delhi 12th February 2012

37. Attended 5th Conference Best of ACC, Cardio-vascular Medicine.

Dr. Pushpendra Verma

Delhi 14th to 15th May 2011

38. Attended New Horizons in Caner Research : Biology to Prevention to therapy.

Dr. Devika Tayal

Gurgaon 13th to 16th December 2011

39. Attended Opening New Horizons in Clinical Bio-Chemistry at Sir Ganga Ram Hospital.

Dr. Devika Tayal

New Delhi 21st January 2012

40. Attended DOTS-Plus Training. Dr. Jyoti Arora Ahmedabad 12th to 16th September 2011

41. Attended MRI Update Dr. Devesh Chauhan

Mumbai 16th to 18th December 2011

42. Attended National Conference of Radiology

Dr. Devesh Chauhan

Hyderabad 28th to 31st January 2012

In addition, the faculty members and residents also attended all CMEs/ Workshops organized within

the Institute like PG CME – 2011 North India from 16th to 17th July 2011, National Task Force

Workshop for involvement of Medical Colleges in RNTCP from 21st to 22nd December 2011, CME

on Respiratory Allergy and Immunotherapy on 3rd February 2012, Dr. R.C.Jain Memorial Lecture on

World TB Day on 24th March 2012, etc.

110

11.0 LIST OF COMMITTEES [2011 - 2012]

1. TECHNICAL SPECIFICATION COMMITTEE (For equipment(s) upto cost of Rs.10.00 Lacs)

Dr. V.P. Myneedu Chairman Dr. Rajnish Gupta Member Dr. Anil Jain Member Dr. Amit Kumar Sharma Member Dr. Prabhpreet Sethi Member HOD/Section Incharge concerned Member-Convener

(For equipment(s) costing more than Rs.10.00 Lacs, one outside expert to be invited.)

2. LOWER PURCHASE COMMITTEE Dr. Sangeeta Sharma Chairperson Dr. Lokender Member Dr. M.P. Arora Member Dr. Anita Yadav Member Shri Vijay Khera Member Incharge Procurement Cell Member-Convener

3. HIGHER PURCHASE COMMITTEE Dr. Rohit Sarin Chairman Dr. Kumud Gupta Member Dr. Anil Jain Member Dr. S.B. Singh Member Dr. Pushpendra Kr. Verma Member Dr. Ritu Singhal Member Shri Atul Kumar Srivastava Member Incharge Procurement Cell Member-Convener

4. STANDING PURCHASE COMMITTEE Dr. D. Behera Chairman Dr. Rohit Sarin Member Dr. Rupak Singla Member Dr. M.M. Puri Member Dr. S.K. Munjal Member Dr. Manpreet Bhalla Member Representative of IFD, M/o Health & FW Member Shri Atul Kumar Srivastava Member Incharge Procurement Cell Member-Convener

5. TENDER OPENING COMMITTEE Dr. Khalid Chairman Dr. M.P. Arora Member Dr. Alok Yadav Member Mrs. T. Percy Member A nominee of Account Section Member A nominee of Administrative Section Member

111

6. QUOTATION OPENING COMMITTEE (For Estate, Hospital & Others)

Dr. Puneet Arora Chairman Shri Vijay Khera, JAO Member Mrs Pawan Banga, Store Superintendent Member Shri Vijay Bhatt, Office Superintendent Member

7. TENDER EVALUATION COMMITTEE

Dr. Anand Jaiswal Chairman Dr. Rakesh Agarwal Member Dr. Prakash Sharma Member Dr. Devesh Chauhan Member Dr. Prabhpreet Sethi Member Dr. Shalini Mullick Member A nominee of user department Member

8. INSPECTION COMMITTEE (Medical Store)

Dr. Lokender Chairman Dr. K.K. Mathuria Member Dr. Amit Sharma Member Dr. Alok Yadav Member A nominee of user department Member

9. INSPECTION COMMITTEE (General Store)

Dr. Devesh Chauhan Chairman Dr. Ajoy Kumar Verma Member Dr. Shalini Mullick Member A nominee of user department Member

10. ESTATE COMMITTEE

Dr. K. Khalid Chairman Dr. M.P. Arora Member Dr. Ajoy Kumar Verma Member Dr. Amit Sharma Member Shri Atul Kumar Srivastava Member Consultant (Civil) Member-Convener Assistant Enginner (Civil)/Junior Engineer Electrical

Member

11. CONDEMNATION COMMITTEE

Dr. Prakash Sharma Chairperson Dr. Amit Sharma Member Mrs. Rita V. Lyall Member Shri Vijay Khera Member

112

12. HOSPITAL DISPOSAL COMMITTEE Dr. Lokender Chairman Dr. Rakesh Agarwal Member Mrs. T. Percy Member Shri Vijay Khera Member

13. DIET COMMITTEE Dr. Kamla Verma Chairperson Dr. Sanjay Gupta Member Mrs. Anita Kansal Member Shri Atul Kumar Srivastava Member Incharge Kitchen Member

14. HOSPITAL INFECTION CONTROL COMMITTEE

Dr. V.P. Myneedu Chairman Dr. S.K. Munjal Member Dr. Vikram Vohra Member Dr. Neeta Singla Member Mrs. Anita Rani Kansal Member

15. HOSPITAL WASTE MANAGEMENT COMMITTEE

Dr. Rohit Sarin Chairman Dr. S.K. Munjal Member Dr. Sangeeta Sharma Member Dr. Puneet Arora Member Dr. Sujata Arya Member Mrs. T. Percy Member

16. TRANSPORT REPAIR COMMITTEE

Dr. Rajnish Gupta Chairman Dr. Alok Yadav Member Administrative Officer Member

17. EQUIPMENT REPAIR COMMITTEE

Dr. S.K. Munjal Chairman Dr. Anil Jain Member Dr. Prakash Sharma Member Dr. Pushpendra Kr. Verma Member Nominee of user department Member-Convener Shri Vijay Khera Member

18. DISASTER MANAGEMENT COMMITTEE

Dr. Rupak Singla Chairman Dr. Kamla Verma Member Dr. Anil Jain Member-Convener Mrs. Anita Rani Kansal Member Administrative Officer Member

113

Shri Nandlal, Havaldar Member

19. LIBRARY COMMITTEE

Dr. R.K. Dewan Chairman Dr. Upasna Agarwal Member Dr. S.B. Singh Member Dr. Alok Yadav Member Shri Vijay Khera Member

20. TRAINING COMMITTEE

Dr. Rohit Sarin Chairman Dr. Rupak Singla Member Dr. Anand Jaiswal Member Dr. Kumud Gupta Member Dr. Vikram Vohra Member Dr. Anil Jain Member Dr. Anita Yadav Member Shri M.B. Naidu Member Mrs. Anita Rani Kansal Member

21. ANNUAL REPORT COMMITTEE

Dr. Rajnish Gupta Chairman Dr. Ajoy Kumar Verma Member Dr. Sujata Arya Member Shri G.V. Raju Member Shri P.P. Sharma Member-Convener Administrative Officer Member

22. RESEARCH COMMITTEE

Dr. D. Behera Chairman Dr. Rohit Sarin Member Dr. V.P. Myneedu Member Dr. Anand Jaiswal Member Dr. M.M. Puri Member Dr. Sushil Munjal Member Dr. Manpreet Bhalla Member Dr. Shalini Mullick Member Dr. Upasna Agarwal Member- Convener

23. ETHICAL COMMITTEE

Dr. V.K. Vijayan, Director, VPCI Chairman Dr. J.N. Banvalikar, Medical Superintendent, RB TB Hospital, Delhi

Member

Dr. Rohit Sarin Member-Convener Dr. Anand Jaiswal Member Dr. R.K. Dewan Member Dr. Rajnish Gupta Member Dr. Thangsing Chinkolal Member Director- NDTBC Member

114

Secretary General, TAI Member Dr. Pratibha Mishra Member Shri Ravi Sikri Member

24. CANTEEN COMMITTEE

25. COMMITTEE TO LOOK INTO THE COMPLAINTS OF SEXUAL HARASSMENT

26. OFFICIAL LANGUAGE IMPLEMENTATION COMMITTEE

Dr. R.K. Dewan Chairman Shri Atul Kumar Srivastava Member Junior Hindi Translator Member-Convener

27. PUBLIC/EMPLOYEES GRIEVANCE COMMITTEE

Dr. Rupak Singla Chairman Dr. Rakesh Agarwal Member Dr. Prabhpreet Sethi Member Dr. Pushpendra Kr. Verma Member Dr. Alok Yadav Member Administrative Officer Member

28. CULTURAL AND SPORT COMMITTEE Dr. Sangeeta Sharma Chairperson Dr. Neeta Singla Member Mrs. Anita Rani Kansal Member Administrative Officier Member Ms. Seema John Member Shri N. Singh Member-Convener

29. EMPLOYEES WELFARE COMMITTEE Dr. D. Behera Chairman Dr. Rohit Sarin, AMS Member Dr. R.K. Dewan, CAO Member Dr. Khalid, CEC Member Dr. Upasna Agarwal, Specialist Grade- I Member

Dr. R.K. Dewan Chairman Dr. Neeta Singla Member Shri G.V. Raju Member Shri P.P. Sharma Member Administrative Officer Member

Dr. Kamla Verma Chairperson Dr. Neeta Singla Member Dr. Anita Yadav Member Mrs. Anita Rani Kansal Member Dr. Pratibha Mishra Member

115

Mrs. Anita Rani Kansal, NS Member Shri Atul Srivastava, Account Officer Member Administrative Officer Member Mrs. Manju Rani Aggarwal, Staff Nurse Member Mrs. Valsalla Manoj, Staff Nurse Member Shri Yogender, DEO Member Shri Rajesh Belwal, UDC Member Shri S. D. Kaushik, LDC Member Shri Anand Singh, Ward Boy Member Shri Raj Singh, Safai Karamchari Member Shri Rakesh – II, Safai Karamchari Member

30. RECORD MANAGEMENT COMMITTEE

Dr. Kamla Verma Chairperson Dr. Sanjay Gupta Member Dr. Puneet Arora Member Dr. Ritu Singhal Member Administrative Officer Member

31. SPACE ALLOTTMENT COMMITTEE

Dr. Anand Jaiswal Chairman Dr. Sanjay Gupta Member Dr. Devesh Chauhan Member Administrative Officer Member

32. HOUSE ALLOTMENT COMMITTEE

Dr. Kamla Verma Chairman Dr. Rajnish Gupta Member Shri Vijay Khera Member Administrative Officer Member

33. MEDICAL BOARD

Dr. Upasna Aggarwal Chairperson Dr. Sanjay Gupta Member Dr. Anita Yadav Member Dr. Alok Yadav Member

34. MEDICAL REIMBURSEMENT BOARD Dr. Sanjay Singh Chairman Dr. Ritu Singhal Member Dr. Sujata Arya Member Dr. Alok Yadav Member Shri Vijay Khera Member

116

35. COMMITTEE FOR ADVANCE ON ESTABLISHMENT MATTERS Dr. R.K. Dewan Chairman Shri Atul Kumar Srivastava Member Administrative Officer Member Shri Vijay Bhatt Member

36. COLLEGE COUNCIL COMMITTEE

Dr. D. Behera Chairman All HODs and Specialists Members All Medical Officers Members Dr. Rupak Singla Member-Convenor

37. PG COMMITTEE

Dr. D. Behera Chairman Dr. Rupak Singla Member Dr. Anand Jaiswal Member Dr. M.M. Puri Member

38. MEDICAL EDUCATION UNIT Dr. Rupak Singla Chairman Dr. Anand Jaiswal Member All other specialists Members HOD Microbiology Member HOD Pathology Member HOD Radiology Member

117

12.0 Other Activities of Institute

Dr M.M.Puri, Senior Chest Specialist, giving a talk on the occasion of World Asthma Day on 3rd May 2011

The Director, Dr D.Behera, lighting the lamp on the occasion of Nurse’s Day on 12th May 2011

118

Prof. K. K. Talwar, Chairman, Board of Governors, Medical Council of India, inaugurated the PG CME-2011 for Post Graduate Students of North India held at LRSI on 16th and 17th July 2011. Workshops on PFT, Bronchoscopy and Sleep Studies were conducted on 16th July 2011.

Director General Health Services, Dr Jagdish Prasad, inaugurated the National Task Force Workshop of Involving Medical Colleges in RNTCP held on 21st and 22nd December 2011

119

Dr Anil Jain, Chief Medical Officer (NFSG), deliberating in CME on Respiratory Allergy and Immunotherapy on 3rd February 2012

Hindi Pakhwada was celebrated from 14th to 28th October 2011

120

The faculty and the staff with the nursing students on the occasion of World TB Day on 24th March 2012. A number of educative activities were organized on the day.

Dr. Rajan Santosham being awarded the Dr. R. C. Jain Memorial Oration Lecture on 24th March 2012, World TB Day to commemorate our Founder Director who passed away last year

121

122

123

124

125

The Director, Dr D. Behera, hoisting the National Flag on the occasion of Republic Day

126