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Obstructive sleep apnoea (OSA) is the major underlying co-morbidity in many of the non-communicable diseases (NCD) due to obesity as a common risk factor. Incidence and prevalence of OSA is on the constant rise ever since this entity came to forefront three decades ago. Precise treatment of underlying OSA is extremely important in major NCDs like diabetes mellitus, hypertension, endocrine disorders and vascular diseases. OSA is subcategorized in to mild, moderate and severe based of apnoea-hypopnea index (AHI). Based on the severity grading, treatment of OSA ranges from life style modifications to oral appliances, continuous positive airway pressure (CPAP) and surgeries. AHI system of severity grading in OSA has several inherent shortcomings and using AHI system for severity grading as the holy grail is likely to be counter-productive. AHI system equates apnoea and hypopnea as equal events, whereas physiological effects vary significantly. AHI system does not account duration of apnoea or body position during apnoeic events. We discuss at length the pitfalls of AHI system of severity grading in OSA.

Congenital pulmonary airway malformation (CPAM) is a broad spectrum of congenital cystic lung lesions caused by the arrested bronchoalveolar development. Approximately, 80% of CPAMs are diagnosed prenatally or during the neonatal period when patients present with respiratory failure and cyanosis. CPAM is often associated with other organ anomalies and aplasia, and they have poor prognoses. Many CPAMs are detected in infants and school-age children, and infections like pneumonia trigger these diagnoses. It rarely manifests in adults. These often get missed because of the superadded diseases, and hence, it is essential to have a correct approach to their diagnosis to avoid misdiagnosis.

A young adult male with no previous comorbidities presented with complaints of fever since 10 days and right cheek swelling since one week duration. Ultrasonography (USG) guided fine needle aspiration cytology (FNAC) of intraparotid lymph node showed ‘reactive lymphadenitis’. He was started on antibiotics and symptomatic treatment. He later developed breathlessness and desaturation following which he was shifted to the intensive care unit (ICU) and given non-invasive ventilation (NIV). Chest X-Ray (CXR) showed features suggestive of bilateral pneumonia. Mumps immunoglobulin-meta (IgM) was found to be positive. He improved over the next few days and was discharged.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has various known complications in its natural course of the illness. Pneumothorax is one of the emerging complications in coronavirus disease 2019 (COVID-19)-positive patients, not initiated on invasive mechanical ventilation. Case studies and autopsy reports across the globe suggest alveolar pathology to be responsible for the outcome.COVID-19 infection in humans caused by the SARS-CoV-2 virus has various known complications in its natural course of the illness. Pneumothorax is one of the emerging complications in COVID-19-positive patients. Prior identification and anticipation of such life-threatening complications aid in the treatment of COVID-19-positive patients.

Sarcoidosis is complicated by disordered vitamin D and calcium metabolism, which has important implications on disease activity and bone health. Although the majority of the patients with sarcoidosis are typically deficient in 25-hydroxyvitamin D, repletion of vitamin D is controversial in light of the hypercalcemia risk. Presently, there are no clear guidelines regarding vitamin D supplementation as a part of osteoporosis prevention in patients with vitamin D deficiency and sarcoidosis. We report a patient with sarcoidosis who presented with severe hypercalcemia following vitamin D supplementation and review the debated role of vitamin D supplementation in vitamin D-deficient sarcoid patients.

Introduction Obstructive sleep apnea (OSA) is sleep-disordered breathing characterized by repetitive episodes of partial or complete upper airway collapse in sleep leading to apnea and/or hypopnea, desaturations, sleep disruptions, and cardiovascular changes. OSA is a known cause for difficult airway, especially mask ventilation. Daytime sleepiness is one of the hallmark symptoms of OSA. So, we used the Epworth sleepiness score (ESS) in patients suspected of OSA undergoing a sleep study. Methods Overall, 44 subjects suspected to have OSA and undergoing polysomnography were included in the study. The socio-demographic details and the complaints were recorded and the Epworth sleepiness questionnaire was administered. The severity of OSA was graded as per the American Academy of Sleep Medicine using the apnea hypopnea index. Results A total of 44 patients were included in the study. Out of these, 19 were mild, 13 moderate, and 12 severe OSA cases, respectively. ESS of more than 10 showed a positive predictive value of 81.25% and specificity of 85% in screening patients with moderate and severe OSA. But the sensitivity and negative predictive value was only 54.16 and 60.71%, respectively. Conclusion ESS being a simple questionnaire can be easily used preoperatively. A score of more than 10 effectively diagnoses moderate and severe OSA, but less than 10 cannot rule out OSA

BACKGROUND: Influenza or the common flu is a commonly recognized cause of respiratory tract infection A high level of clinical suspicion is required before a sample can be sent and often the diagnosis is established posthumously In developing countries like India, data on disease burden of Influenza is severely lacking It is a consequence of an under-estimation of Influenza as an important cause of illness and its natural course under-simplified to be a mild self-limiting illness India was affected with a moderate severity compared to the other countries, although there was an insufficiency of epidemiological data from India during 2009 - 2010 Post-pandemic period, India was affected by major outbreaks in 2015 and 2017 We wanted to analyse the rate of positivity in a tertiary care centre amongst the total number of oropharyngeal swabs sent for Influenza virus testing We also wanted to assess the mortality rate in Influenza positive cases in a tertiary care centre METHODS: Data of oropharyngeal swabs sent for influenza virus testing through Real-Time Reverse Transcription Polymerase Chain Reaction from K S Hegde Medical Academy, Deralakatte was reviewed through a retrospective search of official influenza virus reports of Karnataka State along with the reports in Medical Records Department of K S Hegde Medical Academy in the time period of January 1st 2016 to November 22nd 2018 This study was done as a cross sectional retrospective study RESULTS: Out of 127 oropharyngeal swabs that were sent during the study time period, 24 (18 9%) were positive for influenza virus 18 (75%) cases were found to be H1N1 positive, 3 were H3N2 positive (seasonal strain) and remaining 3 were positive for Influenza B virus 9 (37 5%) out of 24 cases of influenza succumbed to the disease, of which all were H1N1 positive (50% of the total H1N1 cases) CONCLUSIONS: H1N1 related mortality is a cause for concern for every healthcare providing institution Influenza virus should be actively tested in patients with respiratory symptoms During this COVID 19 related pandemic situation, there is a higher possibility of underdiagnosing H1N1 Lessons learnt from the past should be remembered and Influenza should not be neglected

Melioidosis is an endemic infection in Southeast Asia and Northern Australia commonly manifesting with pneumonia and localized skin infection. Though most exposures do not lead to severe illness, a fulminant infection can occur among patients with risk factors. A 59-year-old male presented with cough with expectoration and fever for 1 week. He had diabetes for 10 years with poorly controlled blood sugars. Contrast-enhanced computerized tomography (CECT) of thorax showed right upper lobe consolidation with diffuse ground-glass opacities in right upper lobe along with microabscesses in liver and spleen. Sputum culture and Xpert mycobacterium tuberculosis complex and resistance to rifampin (MTB/RIF) for tuberculosis were negative. Bronchoalveolar lavage culture grew Burkholderia pseudomallei. He was treated with initial intensive therapy with injection amoxicillin-clavulanic acid for 2 weeks and subsequently started on eradication therapy with tablet trimethoprim-sulfamethoxazole. Diagnosis of melioidosis should be considered in a patient of pneumonia with multiorgan involvement in an endemic area, especially with underlying risk factors.

Introduction Lung cancer is one of the most common forms of malignancies worldwide. It is usually diagnosed in late stages due to overlapping symptoms with other respiratory illnesses. Identifying the stage at presentation to tertiary care determines the prognosis of a patient to large extent. Methods Histologically/cytologically confirmed cases of nonsmall cell lung cancer subjects were included for prospective observational study. Stages of the disease at presentation and survival duration in the patients were studied and the data were compared between two groups: those that accepted and those that refused standard treatment. Results Ninety-two percent of our patients presented either stage IIIB or stage IV disease at the time of diagnosis. Median duration of survival in the group that took standard treatment was 6 months, whereas in the group that refused standard treatment, it was 4 months. Based on their smoking status, the median duration of survival was 4 months among smokers, whereas it was 9 months among nonsmokers with a log rank test value of 3.040 and an insignificant p-value of 0.081. Conclusion More than 90% patients presented in later stages of the disease and there was no survival benefit in patients who were treated with palliative care.

Foreign body aspiration (FBA) can be potentially fatal if the object is large enough to cause nearly complete obstruction of the upper airway. The object causing obstruction beyond the carina can result in less severe clinical presentation. FBA is rare in adults than in children. If the clinical history is not suggestive of FBA, then a high index of suspicion and flexible bronchoscopy can ensure proper diagnosis and prompt intervention. We present a case of an adult with aspirated betel nut in the left main bronchus, removed using flexible bronchoscopy with the aid of a Fogarty balloon catheter following the failure of rigid bronchoscopy.

Tuberculosis can involve most of the body parts, and tubercular lymphadenitis is common. But isolated involvement of mediastinal lymph nodes without lung parenchymal involvement is rare in adults. A 45-year-old lady presented with subcarinal lymph node enlargement. A conventional transbronchial needle aspiration done at a local hospital was inconclusive. Endobronchial ultrasound-guided transbronchial needle aspiration was done. Cytology showed epithelioid histiocytes and caseous necrosis. Stain for acid-fast bacilli and cartridge-based nucleic acid amplification test for tuberculosis were positive. Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive bronchoscopic technique to visualize and sample mediastinal lymph nodes. However, its availability is limited to specific centers and expertise is required to interpret images and take diagnostic samples.

An elderly man without history of travel presented with complaints of intermittent fever for 2 months, cough with scanty expectoration for 15 days and history of weight loss of 5 kg in 1 year. The chest X-ray and CT scan of the thorax showed dispersed centrilobular nodules and patchy subpleural consolidation in both lungs with mediastinal lymphadenopathy. He underwent bronchoscopy and bronchoalveolar lavage culture grew Pseudomonas aeruginosa. He was prescribed antibiotics based on culture sensitivity; however, patient continued to have symptoms. All relevant blood investigations were within normal limits. He underwent CT-guided biopsy of the right lung lesion during which clearing of the radio-opacities present in the initial CT scan and appearance of fresh lesions in different locations were observed. Migratory shadows were suspected. Fine-needle aspiration cytology showed features suggestive of coccidioidomycosis for which antifungals were started. After 1 month, he improved symptomatically and chest X-ray showed clearance of shadows.

Scarce data exist about the coinfection of SARS‐CoV‐2 and Mycobacterium tuberculosis (MTB). A young woman who was undergoing treatment for multiple sclerosis was brought to our hospital with a COVID-19 positive status. On further evaluation, her chest X-ray showed right upper and mid-zone opacity, which lead to the suspicion of MTB. Her sputum came positive for acid-fast bacilli (AFB) staining and cartridge-based nucleic acid amplification test (CBNAAT) confirmed it, and rifampicin resistance was not detected. She was started on an antitubercular regimen. She was discharged, and by the end of the intensive phase of treatment, her symptoms subsided, but her sputum CBNAAT still showed the presence of TB bacillus.

Introduction Among malignant diseases, lung carcinoma is the most common cancer in men worldwide in terms of both incidence and mortality. Its increasing incidence in developing countries like India is an important public health problem. This work aimed to study the demographic, clinical, radiological, and histological features of patients with confirmed lung cancer. Materials and Methods A total of 50 patients with histologically confirmed lung cancer at a tertiary care center in India from August 2016 to September 2018 were studied and analyzed. Results Out of 50 diagnosed lung cancer patients, 86% were men and 14% women; 31 (62%) patients were aged more than 60 years. Majority were smokers (84%) and all were men. Cough (94%) was the most common presenting symptom followed by dyspnea (68%), chest pain (48%), and hemoptysis (38%). Of the 50 patients, 29 (58%) had soft tissue density mass lesion on radiograph. Squamous cell carcinoma (SCC) was the diagnosed histological cell type in 24 (48%) patients and adenocarcinoma in 21 (42%) patients. Distant metastasis was observed in 20 (40%) patients. Conclusion In this study, the most common histopathological cell type is SCC. Patients aged more than 50 years and smokers are at high risk of lung cancer. Patients with a smoking history and persistent respiratory symptoms should be promptly evaluated for lung malignancy.

Tyrosine kinase inhibitors (TKIs) targeting epidermal growth factor receptor (EGFR) are effectively used in treatment of non-small cell lung cancer (NSCLC). Mutation profile of tyrosine kinase domain of EGFR determines the eligibility of the patients for tyrosine kinase inhibitor (TKI) therapy. Liquid biopsy, which relies on circulating tumor-derived nucleic acids, has emerged as an effective tool in lung cancer management with proven diagnostic, prognostic and predictive applications. We screened 100 subjects, suspected to have lung malignancy, for four hotspot mutations including three activating (G719S, Ex19del E746-A750 and L858R) and one acquired (T790M, de novo) in EGFR gene by droplet digital PCR (ddPCR). While 97 subjects were subsequently confirmed to have lung malignancy based on histo/cytopathological studies, three cases turned out to be non-malignant lung pathologies that were completely cured by antibiotic therapy. Intriguingly, ddPCR revealed the presence of EGFR mutations in these non-malignant subjects. Two cases showed the presence of G719S and T790M mutations respectively and another had compound mutations (T790M and L858R). The detection of EGFR mutations in non-malignant pulmonary conditions opens up a new area of research.

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.

Thoracic endometriosis is a rare entity, wherein thoracic endometrial tissue deposition occurs. Recurrent pleural effusion is one of its manifestations. Diagnosis and treatment are often challenging, owing to the rarity of the condition and recurrences. We present an interesting case of a young woman of childbearing age who presented with recurrent haemorrhagic pleural effusion. She was referred to our centre after her initial video-assisted thoracoscopic biopsy was inconclusive. She was re-evaluated, and video-assisted thoracoscopic biopsy confirmed thoracic endometriosis. She underwent pleurodesis two times and currently on hormonal treatment, maintaining well.

Context: Periodontitis and chronic obstructive pulmonary disease (COPD) are chronic progressive inflammatory conditions. Smoking has been associated with both chronic periodontitis and COPD. Hence, the present study was designed to correlate serum levels of cotinine with the severity of periodontal disease with or without COPD. Settings and Design: A total of eighty patients, twenty healthy individuals, twenty patients with chronic generalized periodontitis without smoking and without COPD, twenty patients who are smokers with chronic periodontitis without COPD and twenty patients who are smokers with chronic periodontitis and COPD in the age range of 43–65 years were selected for the study. Subjects and Methods: Serum cotinine level assessment, smoking history, and periodontal examination were done in all the patients and the data obtained were statistically analyzed. Results: The mean serum cotinine level was highest in smokers with chronic periodontitis and COPD (93.642 ± 14.727) and it differed significantly between the four groups (P < 0.001). There is a significant positive correlation between the number of cigarettes and serum cotinine levels in both groups involving smoking. There was no significant correlation between serum cotinine level and clinical attachment loss in chronic periodontitis smokers with or without COPD. Conclusions: The result of this study indicates that increased smoking with COPD causes a higher chance of progression of periodontal destruction but it is not statistically significant. Furthermore, this study indicates that the assessment of serum cotinine levels is a reliable method to evaluate smoking exposure.

The concommitant occurrence of both tuberculosis and leprosy in a single individual are not an uncommon clinical condition but is being reported infrequently in literature. We report a case of leprosy, diagnosed previously and also diagnosed as pulmonary tuberculosis.

The major contributing factors for the causation of treatment failure in cases of pulmonary tuberculosis under Category-II directly observed treatment short-course treatment (DOTS) are treatment after default, poor treatment compliance, and development of multi-drug resistant (MDR) tuberculosis. The objective of the present study is to find out the demographic profile and drug susceptibility pattern in Category-II failure patients of pulmonary tuberculosis under Revised National Tuberculosis Control Programme (RNTCP) of India. Two hundred and twenty four patients with Category-II treatment failure of pulmonary tuberculosis were enrolled from Department of Pulmonary Medicine, at Chatrapati Sahuji Maharaj Medical University, UP, Lucknow, India, from August 2003 to July 2008. Their complete bacteriological assessment in terms of sputum smear for acid-fast bacilli, culture for Mycobacterium tuberculosis and drug sensitivity pattern were done in the Department of Microbiology. Among 224 patients, 16 (7.1%) patients were lost to follow-up and the final analysis was done among 208 (92.8%) cases. The reasons for inclusion of these 224 cases in the Category II regimen were treatment failure in the previous regimen (n = 75, 33%), default in 57% (n = 129 cases), and relapse in 8.9% (n = 20 cases). Among 208 patients, culture was positive in 170 (81.7%) cases, negative in 17 (8.1%) cases and contaminated in 21 (10%) cases. The drug sensitivity pattern of culture positive cases of Category-II failure patients revealed that, 58.2% (n = 99) had MDR tuberculosis and 40.5% (n = 69) were resistant but were non-MDR tuberculosis and 1.1 % (n = 2) cases were sensitive to all first line antituberculosis drugs.