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Background: Clinical presentation of coronavirus disease 2019 (COVID-19) mimics many respiratory ailments. Aim: The aim of this study was to explore the psychosocial impact of COVID-19 and subsequent state-imposed lockdown on patients presenting with respiratory complaints. Methodology: This was a prospective study on 82 outpatients at a tertiary care institute from North India during the period of strict lockdown. Baseline assessment was conducted using socioclinical pro forma, COVID-19-related questionnaire, lockdown-related questionnaire, and General Health Questionnaire-12 (GHQ-12) Hindi version. Reassessment was done twice: immediately and 41–45 days after relaxation of strict lockdown. Quality of life (QOL) at first and second follow-up versus the prelockdown times (Score A and Score C) and first follow-up versus unlockdown (Score B) was noted. Results: Psychological distress was experienced in 45.1% and 17.1% of patients at baseline and first follow-up (P < 0.001). Clinical symptoms, worry for COVID-19, negative thoughts, and total score (lockdown) decreased significantly at first follow-up. The mean C score was significantly better than the mean A score (P < 0.001). Baseline and follow-up psychological distress was significantly more in those with poorer values of total score (lockdown) and its domains. On logistic regression, follow-up GHQ-12 correlated positively with Domain 2 (P = 0.027; odds ratio [OR] = 0.7) and “worry for COVID” (P = 0.017; OR = 10.136). Conclusion: Persons presenting with respiratory complaints and experiencing “worry for COVID-19” at the start of the lockdown were more likely to also experience psychological distress, which decreased significantly but persisted for prolonged periods even after relaxation in lockdown. Policymakers, while indulging in mental health planning in pandemics, should not ignore this issue of development and perpetuation of psychological distress in such otherwise “psychologically normal” individuals.

Tuberculosis (TB) is associated with psychological distress, poor coping, deterioration in health-related quality of life (HRQL), and stigma. However, these issues have never received sufficient attention as a part of routine care. The healthcare workers and physicians of primary contact are not sensitized to use discrete screening questionnaires to identify and address these issues. A longitudinal study was hence conducted in the Department of Pulmonary Medicine in collaboration with the Department of Psychiatry. 75 microbiologically confirmed ‘new’ pulmonary TB patients were enrolled. Socio-demographic and clinical details were noted. The patients were then evaluated for psychological distress using the General Health Questionnaire-12-Hindi version (GHQ-12) and Patient Distress Thermometer (PDT); coping strategies using the Coping Strategy Check List-Hindi Version (CSCL); HRQL using the World Health Organization Quality of Life-Brief-Hindi version (WHOQOL-Bref), and stigma using the Explanatory Model Interview Catalogue-affected persons Stigma Scale (EMIC-SS), at the start of treatment. Those having a GHQ-12 score ≥3 were labeled as ‘screen positive’ for psychological distress and referred to a consultant psychiatrist for detailed psychological assessment. Treatment was given by the psychiatrist if diagnosed with a psychiatric illness. All those without the diagnosis of a psychiatric illness were counseled by a pulmonologist. All patients were called for a follow-up visit and repeat assessments on the 15th day at the end of the intensive phase, using the same instruments employed at baseline. The patients already on treatment by the psychiatrist were again evaluated for their psychiatric illness. 32 (42.7%) patients had psychological distress (GHQ-12≥3) at baseline. 20 of them (26.7%) were diagnosed with a psychiatric illness. However, only 2 (2.7%) patients had psychological distress and psychiatric illness at follow-up (p

Introduction: Lung cancer carries the highest cancer-related mortality rates worldwide. Despite all recent advances, the mortality from lung cancer is still rising. A better understanding of the risk factors may help us predict responses to chemotherapy for better management. Aim: To evaluate predictors of response to chemotherapy in advanced Non-Small Cell Lung Cancer (NSCLC) patients. Materials and Methods: This was a prospective cohort study conducted in the Department of Pulmonary Medicine at Government Medical College and Hospital, Chandigarh, India. A total of 60 confirmed cases of advanced (stage IIIB and IV) NSCLC patients were enrolled consecutively for a duration of two years. Baseline clinical parameters, routine blood tests, spirometry, exercise capacity using the 6 Minute Walk Test Distance (6MWTD), and Computed Tomography (CT)-based tumour size were recorded. Certain pre-defined patient, disease, and therapy-related factors (age, gender, dyspnoea, baseline blood tests, tumour size, histology, etc.) were evaluated for their possible role as predictors of treatment response in advanced NSCLC patients. A positive response was defined if the response to chemotherapy was Complete Response (CR) or Partial Response (PR), and a negative response if the response was Progressive Disease (PD) or Stable Disease (SD) as per revised RECIST (Response evaluation criteria in solid tumors) 1.1 criteria. Variables between the two groups were compared using the Mann-Whitney U test and Chi-square test. To find out the factors that may predict response to treatment, univariate and multivariate logistic regression analysis were used. Results: Out of a total of 60 confirmed cases of NSCLC patients, only 40 patients were able to complete the four cycles of chemotherapy. The mean age of the patients was 58.5±9.6 years. There were a total of 35 males (87.5%) and five females (12.5%) in the study. Out of 40 patients, 27 (67.5%) had squamous cell carcinoma and 13 (32.5%) had adenocarcinoma. On univariate analysis, Neutrophil-Lymphocyte Ratio (NLR) had a statistically significant association with tumour response (p3.81) NLR (p=0.002) were found as independent predictors of poor response to chemotherapy. Conclusion: Pre-treatment high NLR and advanced age are significant factors for a poor response to chemotherapy treatment in advanced NSCLC patients.

Abstract Chronic obstructive pulmonary disease (COPD) is commonly characterized by shortness of breath, coughing or expectoration. Smoking is the leading cause of COPD development, but only a small percentage of smokers develop symptoms, implying a genetic component. Glutathione S‐transferase enzymes are responsible for detoxifying cigarette smoke components. The role of glutathione S‐transferase T1 (GSTT1) and glutathione S‐transferase M1 (GSTM1) gene polymorphism was assessed with COPD susceptibility and associated clinical parameters in the North Indian population. This was a cross‐sectional study involving 200 COPD patients and 200 healthy individuals, with peripheral blood sampling and adequate questionnaires. Multiplex PCR was used for genotyping GSTT1 and GSTM1 gene polymorphism. Logistic regression was used to calculate the odds ratio and 95% confidence intervals to assess the COPD risk and GST polymorphisms. The GSTT1 gene deletion rate was higher in COPD cases (34.5%) than in healthy individuals (20.5%). A statistical relationship between the GSTT1(−) null genotype and COPD risk was observed (odds ratio = 2.04, 95% CI = 1.30–3.20, P = 0.0019). After adjusting for covariates like age, sex and smoking status, a significant association was found for GSTT1(−) null genotype and COPD risk (adjusted odds ratio = 2.90, 95% CI = 1.43–5.87, P = 0.003). The GSTT1(−) genotype was also significantly correlated with clinical parameters for COPD risk. Another primary observation was that females with the GSTT1(−) null genotype were more vulnerable to COPD than males with the same gene deletion. The GSTT1(−) null genotype strongly correlates with COPD development, while no association was observed in the GSTM1(−) null genotype in the North Indian population.

Abstract Introduction Thioredoxin (Trx) is a secretory protein that acts as an antioxidant, redox regulator, anti-allergic, and anti-inflammatory molecule. It has been used to treat dermatitis and inflammation of the digestive tract. In the lungs, Trx has a significant anti-inflammatory impact. On the other hand, Chronic Obstructive Pulmonary Disease (COPD) is one of the significant causes of death in the developed world, with a tremendous individual and socioeconomic impact. Despite new initiatives and endless treatment trials, COPD incidence and death will likely escalate in the coming decades. Areas covered COPD is a chronic inflammatory disease impacting the airways, lung parenchyma, and pulmonary vasculature. Oxidative stress and protease-antiprotease imbalances are thought to be involved in the process. The most popular respiratory inflammatory and allergic disorders therapies are corticosteroids and β-receptor agonists. These medications are helpful but have some drawbacks, such as infection and immunosuppression; thus, addressing Trx signalling treatments may be a viable COPD treatment approach. This review shall cover the pathophysiology of COPD, the pharmacognosy of anti-COPD drugs, including the assets and liabilities of each, and the role and mechanism of Trx in COPD treatment. Expert opinion Limited research has targeted the thioredoxin system as an anti-COPD drug. Spectating the increase in the mortality rates of COPD, this review article would be an interesting one to research.

Psychological co-morbidities are common in chronic obstructive pulmonary disease (COPD) but remain overlooked. Psychosocial interventions are deemed to promote mental health and optimize management. This study aimed to determine the role of detailed psychological evaluation and treatment in the comprehensive management of COPD. COPD patients after screening with the general health questionnaire-12 (GHQ-12) for psychological co-morbidity were divided into three groups (26 patients each): i) group A [GHQ-12 score3, in addition, received management by a psychiatrist and counseling by a pulmonologist, respectively). At baseline and 8 weeks of follow-up, all participants were evaluated for respiratory [forced expiratory volume in the first second (FEV1), six-minute walk distance (6-MWD), St. George's respiratory questionnaire (SGRQ), modified medical research council (mMRC) dyspnea scale], and psychological [GHQ-12, patient distress thermometer (PDT), coping strategy checklist (CSCL), World Health Organization-quality of life-brief (WHOQOL-Bref-26), and depression anxiety stress scales (DASS)] parameters. Psychological distress (GHQ-12>3) decreased significantly at follow-up, with 11.5% and 53.8% of patients having psychological distress in groups B and C, respectively, versus baseline (p

Asthma is a debilitating chronic disease that renders individuals physically as well as mentally sick. The perception of stigmatization further leads to inappropriate control of asthma resulting in a bidirectional relationship. A prospective, cross-sectional study was conducted in a tertiary care centre of semi urban area of north India during 2021-2022. Three hundred cases of bronchial asthma and 50 healthy controls were enrolled. The asthma control test (ACT) was used to evaluate the control of asthma. Stigma and self-esteem were measured with the use of 28 item self-stigma scale, Rosenberg self-esteem scale, and stigma-related social problem scale (SPSS). The impact of sociodemographic and clinical profiles on stigma and self-esteem was evaluated. Correlation of different scales with each other was done along with. The mean age of asthmatic patients was 47.41±15.507 years with 56% being females; 49.3% of patients were well controlled and 36.3% were partly controlled. Positive subscales of 28 item self-stigma scale, Rosenberg self-esteem scale and SSPS showed statistically significant differences between cases and controls (p

Mycobacterium tuberculosis is an infectious bacterial disease frequently affecting the lungs. With two fatalities from tuberculosis (TB) occurring every three minutes, India has the highest disease burden. The aetiology of tuberculosis has been linked to IL-8 and IL-4RA. Thus, the impact of the IL4RAQ576R and IL8 gene polymorphism on TB susceptibility was assessed. 301 healthy and 301 TB patients participated in a cross-sectional study. PCR RFLP was performed to identify the genotype of the IL4RAQ576R and IL-8 +781C/T gene polymorphism. The odds ratio and 95% confidence intervals were calculated using logistic regression to evaluate the risk of TB with IL4RAQ576R and IL-8 +781C/T polymorphism. A significant association was found between IL-4RA (p=0.04) and IL-8 +781 C/T (p= 0.03) in tuberculosis. Further, when clinical symptoms were compared with both polymorphisms, two of them, i.e., cough in IL-4RA576R (p=0.04) and breathlessness (p=0.01) in IL-8 +781C/T, showed a significant association. Moreover, different combinations of the SNPS were made, and the 3 risk allele shows a significant protective role (p=0.02). There is considerable evidence which shows that M. tuberculosis causes TB, an infectious disease that is genetically predisposed. The results of our study also showed that IL-4 RA Q576R and IL-8 +781 C/T played a significant protective function against tuberculosis, confirming the claim mentioned earlier. However, only the cough in IL-4RA576R and the dyspnea in IL-8 +781C/T exhibited a significant co-relation in TB patients when symptoms were examined. Additionally, the combined effects of the two SNPs were investigated, and it was discovered that the 3-risk allele has a strong association with tuberculosis. Therefore, the polymorphisms mentioned earlier, which may also be influenced by ethnicity, may significantly impact the chance of developing tuberculosis.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 recommends a comprehensive multidimensional assessment for patients with chronic obstructive pulmonary disease (COPD) and stresses the need for evaluation of their health status and quality of life (QOL). COPD assessment test (CAT), clinical COPD questionnaire (CCQ) and St. George Respiratory questionnaire (SGRQ) are recommended by GOLD for such assessments. However, their correlation with spirometry in the Indian population is not known. Other similar questionnaires like COPD and sleep impact scale (CASIS), functional performance inventory-short form (FPI-SF) and COPD and asthma fatigue scale (CAFS) though used internationally as a research tool, are still in the offspring stage and have never been used in India. A cross-sectional study was hence conducted in the Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India on 100 COPD patients. Patients were assessed for health status and QOL by CAT, CCQ, SGRQ, CASIS, FPI-SF and CAFS. The relationship between these questionnaires and airflow limitation was investigated. The majority of the patients were males (n=97) and >50 years of age (n=83), illiterate (n=72), had moderate/severe COPD and belonged to group B (n=66). The mean value of forced expiratory volume in one second (%FeV1) decreased with a deterioration in CAT and CCQ score grouping (p

Background: Lung cancer patients and caregivers suffer psychological side effects that encompass poorer treatment outcomes, and are associated with negative quality of life outcomes. Therefore, psychological screening and appropriate intervention of both patients and caregiver is an essential part of advanced cancer care. Aims and Objectives: To assess for psychological distress and its correlates in newly diagnosed lung cancer patients and their caregivers. Materials and Methods: It was a cross-sectional study conducted among 40 lung cancer patients and their caregivers. The patients and caregivers were administered psychological questionnaire, and their psychological attributes were thus studied. Normality of quantitative data was checked by measures of Kolmogorov Smirnov tests. Comparisons for two groups were made by t-test. Proportions were compared using Chi-square or Fisher's exact test whichever applicable. Results: Twenty nine patients (72.5%) and twenty five caregivers (62.5%) had GHQ>=3 (P value=0.34). Nineteen patients (47.5%) and twenty one caregivers (52.5%) were diagnosed as having psychiatric diagnosis (P value=0.65). Sex, educational level, residence, and monthly income did not have any significant association with the psychological comorbidities. The other psychiatric scales used had a significant correlation with the results of GHQ and psychiatric morbidity (P value=0.00). Conclusions: Psychological comorbidities are found in lung cancer patients and their caregivers to a significant extent. The treating physicians should screen lung cancer patients and their caregivers for psychological comorbidities and manage them adequately.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterised by a modified inflammatory response to chronic irritants which is often associated with some degree of systemic inflammation. Exacerbations in COPD are characterized by exaggeration of the ongoing inflammation. A number of inflammatory mediators are found to be raised in COPD exacerbations but most of them are expensive and not readily available. The Neutrophil-lymphocyte Ratio (NLR) is a rapid, easy and cheap biomarker that has been shown to be raised in patients of COPD. Aim: To evaluate the role of NLR in patients of stable and acute exacerbation of COPD. Materials and Methods: This cross-sectional observational study was conducted in Department of Pulmonary Medicine at Government Medical College, Patiala, Punjab, India. Study included 150 patients of stable COPD, 150 patients of Acute Exacerbation COPD (AECOPD) and 100 subjects as controls. NLR was calculated from a peripheral blood sample of the study participants. Continuous variables were summarised as mean with standard deviation and compared between groups using Unpaired t-test. A p-value

Introduction: Pandemics and subsequent lockdowns affect mental health of different subgroups of populations. In Coronavirus Disease-2019 (COVID-19), caregivers of those patients who have respiratory complaints is one such subgroup which is more vulnerable to disturbances in mental health, because of the fear that their patient’s respiratory symptoms could be because of COVID-19. Aim: To assess the psychosocial impact of COVID-19 and subsequent state imposed lockdown on the caregivers of patients presenting with respiratory complaints and also to evaluate the effect of relaxation of lockdown after following-up them over a period of time. Materials and Methods: This prospective observational study was conducted in the Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India (tertiary care institute), from April 2020 to June 2020. Baseline assessment was done using socio-demographic proforma, lockdown related questionnaire {3 domains, summed as total score (lockdown)}, COVID-19 related questionnaire {total score (COVID-19)} and General Health Questionnaire-12-Hindi version (GHQ-12). Reassessment was done twice i.e., at 11-15 days and 41-45 days after relaxation of lockdown. Quality Of Life (QOL) at first and second follow-up versus prelockdown times (score A and C) and first follow-up versus unlockdown (score B) was also noted. Analysis was conducted using Statistical Package for Social Sciences (IBM, SPSS)version 22.0. Results: Total 65 caregivers were enrolled in the study. Mean age of the participants was 40.2±11.812 years with maximum caregivers 25 (41.7%) aged between 31-40 years. Majority (83.3%) were men. Psychological distress was experienced in 50% of caregivers at baseline and 23.7% caregivers at first follow-up (p-value=0.001). Worry for COVID-19 (p-value=0.035), Domain 1 scores (p-value

Objective: Early diagnosis of interstitial lung disease (ILD) is desirable not only to better define pathobiological mechanisms, but also to customize treatment protocols. As osteopontin (OPN) expression may be linked to the fibrotic remodelling in ILD, this present study was planned to evaluate the usefulness of its estimation in serum for the diagnosis of ILD. Material and Methods: Serum OPN levels were estimated by enzyme-linked immunosorbent assay in 52 diagnosed cases of ILD, that were then compared with 46 patients with chronic obstructive lung disease and 46 apparently healthy controls. Results: Median levels of serum OPN were found to be significantly higher in patients with ILD, 2.186 nanograms per milliliter (ng/ml), as compared to patients with chronic obstructive lung disease and healthy controls (1.687 and 1.923 ng/ml, respectively). The best cutoff levels of OPN, for diagnosis of ILD, was found to be >1.08 ng/ml; with a sensitivity of 88.4% and specificity of 32.6%. Of the various subtypes, serum OPN levels were found to be highest in patients with idiopathic pulmonary fibrosis and interstitial pneumonia with autoimmune features; although the difference in levels between various subgroups was not found to be statistically significant (p-value=0.495). Conclusion: Serum concentration of OPN was found to be increased in patients with ILD and may be used to aid diagnosis. This opens new avenues for future research in patients with ILD, not only for the validation of the diagnostic abilities of OPN, but also as a potential target in its treatment.

Pulmonary rehabilitation (PR) is being used in the routine management of patients of obstructive sleep apnea (OSA) at some centers. However, the studies documenting benefits of PR in OSA lack standardization in terms of outcome measures. A study was hence planned to determine the efficacy of PR on exercise capacity, health related quality of life (HRQOL), day time sleepiness and sleep-quality of life (QOL) in patients of OSA. As a part of comprehensive therapy, patients diagnosed with OSA are managed with continuous positive airway pressure (CPAP), 8 weeks thrice weekly outpatient hospital-based PR and medical treatment at the Pulmonary Medicine Department, Government Medical College and Hospital, Chandigarh. However, some patients refuse for PR because of time constraints and travel issues. Patients with newly diagnosed OSA without co-existing respiratory disease, who agreed for the CPAP, PR and medical management were enrolled in group A. The patients who refused for PR but were ready for CPAP and medical management were enrolled in Group B; 30 patients were taken in each group. Exercise capacity, HRQOL, day time sleepiness and sleep-QOL were determined at baseline and at 8-weeks follow-up by 6-minute walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ) and compared amongst the two groups. Four patients from group A were excluded as they did not complete PR; 26 patients from group A and 30 patients from group B were finally analyzed. At baseline, both groups were matched with respect to age, gender, apnea-hypopnea index (AHI), body mass index (BMI), FEV1%predicted, 6MWD, SGRQ, ESS and FOSQ. At follow up at 8 weeks, BMI, 6MWD, SGRQ, ESS and FOSQ improved significantly from baseline in group A (p

Introduction: Coronavirus Disease 2019 (COVID-19) appropriate behaviour and vaccination are two critical defenses in the fight against this pandemic. As these need to be followed religiously, this preventive behaviour should be thoroughly investigated. Aim: To examine the COVID-19 vaccine behaviour amongst people attending tertiary care centre at Patiala, Punjab, India. Materials and Methods: A cross-sectional study was conducted on 200 individuals attending the Outpatient Department of Government Medical College at Patiala, Punjab, India, from 15th July to 22nd July 2021. Individuals were administered socio-demographic questionnaire, General Health Questionnaire-12-Hindi version (GHQ-12), and COVID-19 vaccine related and COVID-19 appropriate behavior related questionnaire. Actual observation by the clinician regarding proper use of face masks, hand hygiene and social distancing was done and objectively scored on 0-10 for each item with a scale interval of 2. Analysis was conducted using IBM Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Only 40% individuals were vaccinated. After eligibility, there was a mean delay of 4.20±3.51 weeks (median: 4 weeks) and 13.40±3.33 weeks (median: 12 weeks) in the vaccinated and unvaccinated individuals. Out of 120, 86 unvaccinated participants planned to get vaccinated in future. Significantly lower scores were obtained for actually observed COVID-19 appropriate behaviour (proper mask usage, hand hygiene and social distancing) as noted by the clinician vs the scores as reported by the participants. Conclusion: There were few takers for the COVID-19 vaccine, even weeks after eligibility. The COVID-19 appropriate behaviour was largely not being followed properly and the false sense of following the same complicated issues further. With multiple waves of the pandemic one after the other, and booster doses of vaccination, there is still an urgent need to sensitise the population at the grass root level regarding the COVID-19 vaccine behaviour to fight this pandemic.

Determination of viral load through cycle threshold (Ct) values may act as a predictor of severity and outcomes in patients with corona virus disease 2019 (COVID-19). However, variable literature is available regarding this relationship. Our study attempted to explore this association and the effect of various socio-demographic and clinical parameters on severity and outcome of COVID-19. Retrospective analysis of records of 731 patients whose nasopharyngeal/ oropharyngeal swabs were subjected to cartridge based nucleic acid amplification (CBNAAT) on Cepheid Xpert Xpress SARS-Cov-2 was done. Cycle threshold (Ct) values of N2 and E genes were studied in relation to severity and outcome of COVID-19. The viral load as determined by Ct values was classified as high (32). Association of socio-demographic and clinical parameters with respect to severity and outcome was also studied. Severity and mortality were significantly more in elder individuals, those belonging to the rural background, those with symptoms >7 days in duration before presentation and those with increasing number of co-morbidities (Severity: p32, in comparison when it was upto 25, and when between 25.1 and 32 (severity: p=0.032 and 0.003 respectively, mortality: p=0.018 and

Evaluation of mental health in chronic lung diseases like interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) has always been neglected and underrated. The aim of the study was to determine the psychological morbidity in patients of ILD and to determine its various socio-clinical and psychological correlates. A cross-sectional clinic based descriptive study with 50 ILD patients, 30 COPD patients and 30 healthy controls was undertaken. Psychological distress was assessed using different psychological scales, like General Health Questionnaire-12 (GHQ-12), Patient Distress Thermometer (PDT), Coping Strategy Checklist (CSCL), WHO Quality of Life-Brief-26 (WHOQOL-Bref-26) and Depression Anxiety Stress Scale (DASS). The patients with a GHQ-12 score of ≥3 were considered as experiencing psychological distress and additionally referred to consultant psychiatrist for further detailed evaluation and management. Fifty-eight percent of ILD patients and 60% of COPD patients experienced psychological distress after screening with GHQ-12; 40% of all the ILD and COPD patients were ultimately diagnosed with a psychiatric disorder, after evaluation by the psychiatrist. Patients of ILD and COPD had significantly higher scores on GHQ-12, CSCL and DASS, and significantly lower scores on WHOQOL-Bref-26 when compared with healthy controls. However, these scores, including PDT did not differ significantly between ILD and COPD patients. The scores on all these scales in the patients of ILD and COPD who were experiencing psychological distress (GHQ ≥3) were significantly poorer than those without psychological distress (GHQ

Tuberculosis (TB) and leprosy are two age-old infections, which we are facing even today. With drug-resistant TB on the rise, we report a case of multidrug-resistant TB with leprosy, which has never been reported previously. The peculiar course of this case forces us to rethink about the upcoming challenges due to their cooccurrence.

Pulmonary nocardiosis is a rising bacterial infection, with a high propensity for misdiagnosis. On account of a paucity of prospective studies, there is limited understanding on various aspects of its diagnosis and treatment. We present three patients with pulmonary nocardiosis, with emphasis on the predisposing factors, variable disease course, and treatment issues. There is a need to understand the basis of these discrepancies so as to rationalize the management of this potentially fatal infection.

Foreign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a case of 60-year-old male who came for surgical management of cholelithiasis. During his workup, X-ray chest revealed right paracardiac opacity. Fibre-optic bronchoscopy showed a mass lesion in right main bronchus. It was taken out of the airways by flexible bronchoscope but could not be retrieved. Subsequent chest radiographs showed marked improvement.

Chilaiditi sign is the peculiar radiographic presentation of interposition of colon between diaphragm and liver. When associated with symptomatology, it is called as chilaiditi’s syndrome. Though rare, respiratory symptoms may be present. In such cases, it becomes difficult to determine if the symptomatology is due to the syndrome only, or there is some underlying lung involvement, until this is specifically considered in the differential diagnosis. We present a male patient, where thorough investigations revealed Interstitial Lung Disease (ILD), along with Chilaiditi sign on chest radiograph. Respiratory symptomatology responded partially to the management of underlying ILD. It is left for discussion, whether the Chilaiditi syndrome was also contributing to the overall clinical presentation or the respiratory complaints were solely due to ILD and Chilaiditi sign was an incidental finding.

We report a case of middle-aged female presenting with mediastinal widening on chest radiograph owing to pleural effusion. The pleural effusion presenting as mediastinal widening on chest radiograph is rarely reported.

Aluminium phosphide (ALP) is a common agrochemical pesticide poisoning with high mortality rate. Primary manifestations are due to myocardial and gastrointestinal involvement. Pleural effusion in ALP poisoning is occasionally reported. We report a case of pleural effusion that developed after ALP ingestion and resolved along with recovery from poisoning.