ABSTRACT Dasatinib, a second‐generation tyrosine kinase inhibitor, is highly effective in chronic myeloid leukaemia (CML) but is associated with pleural complications in approximately 28%–37% of patients. We report four patients with CML who developed dasatinib‐induced pleural effusion after prolonged treatment (2–10 years), including one case of chylothorax. All presented with dyspnea, and imaging with diagnostic thoracentesis confirmed exudative pleural effusions. One patient demonstrated triglyceride‐rich fluid consistent with chylothorax. Dose reduction of dasatinib to 50 mg/day led to complete clinical and radiological resolution in three patients while maintaining molecular remission. The fourth patient encountered recurrent chylothorax despite dosage modification and supportive therapy, necessitating permanent discontinuation of dasatinib and transition to nilotinib, resulting in sustained radiological resolution and continued molecular response. This case series highlights the spectrum of late‐onset dasatinib‐related pleural complications and demonstrates that timely dose modification or TKI switching can effectively manage toxicity while preserving oncological outcomes.

INTRODUCTION:There is an unmet need for a validated qualitative and quantitative tool to assess environmental exposures in patients with interstitial lung disease (ILD). This study aimed to develop and validate a comprehensive tool to systematically identify exposures in patients with ILD. METHODS:A systematic literature search was completed to identify exposures associated with more than five documented hypersensitivity pneumonitis (HP) cases. These exposures were evaluated through a two-round Delphi survey involving 39 pulmonologists from India, Sri Lanka, Pakistan and Nepal. The questionnaire was prospectively derived at one centre and validated across five centres in India and Sri Lanka. The HP South Asian Questionnaire for Exposure (HP-SAQE) was validated against the gold standard multidisciplinary discussion diagnosis, distinguishing HP from non-HP ILD. RESULTS:The literature search screened 5170 records and included 407 studies, identifying 24 exposures. A 50-item Delphi survey achieved expert consensus (>70%) on 17 qualitative and 4 quantitative items (six questions) by 39 pulmonologists. HP-SAQE score ranged from 0 to 14. After pilot testing, the questionnaire was translated into Hindi, Tamil and Sinhala. In the derivation cohort (n=40), the HP-SAQE score was significantly higher in patients with HP versus non-HP (mean: 10.2±1.6 vs 6.7±4.2; p=0.001). This finding was validated in a separate cohort (n=163; mean: 9.4±2.2 vs 4.13±4.28; p<0.001). Receiver operating characteristic curve analysis showed good diagnostic performance (area under the receiver operating characteristic curve, AUC: 0.791 derivation; 0.858 validation, centre-wise AUCs 0.705-0.967). CONCLUSION:The HP-SAQE is the first qualitative and quantitative exposure assessment tool for patients with ILD that has a good diagnostic performance.

BACKGROUND:Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pneumonia are challenging lower respiratory tract infections (LRTIs) commonly encountered in clinical practice. The oral extended-spectrum cephalosporin cefpodoxime proxetil is highly active against the bacterial pathogens commonly associated with LRTIs. AIM:To assess the role of cefpodoxime in the management of infections in Indian patients with AECOPD and LRTIs in a real-world setting, based on expert opinions. METHODOLOGY:The expert consensus meeting was convened according to an a priori protocol. Physicians were invited to participate in the discussion to frame opinion statements based on their clinical experience. A structured questionnaire was prepared regarding the role of cefpodoxime in the management of infections in patients with AECOPD and LRTIs. RESULTS:Streptococcus pneumoniae was the most common pathogen causing infections in patients with chronic bronchitis and pneumonia. Good penetration of cefpodoxime into lung tissues, high concentrations in lung tissues, and rapid resolution of symptoms make cefpodoxime the first-choice drug for treating LRTIs. Cefpodoxime is a step-down therapy of choice when switching hospitalized patients with LRTIs from parenteral antibiotics to oral antibiotics. Cefpodoxime is safe in patients with comorbid diseases and in elderly patients on polypharmacy. CONCLUSION:Cefpodoxime is the preferred first-line empiric antibiotic of choice for the treatment of community-acquired LRTIs in the real-world setting in India. Cefpodoxime has been preferred by 99% of expert chest physicians to treat infections in patients with chronic obstructive pulmonary disease (COPD), considering its broad spectrum of activity. Ninety-seven percent of experts reported that cefpodoxime, as a step-down therapy, gives satisfactory patient recovery and prevents recurrent infections.

Clothing for robots can help expand a robot's functionality and also clarify the robot's purpose to bystanders. In studying how to design clothing for robots, we can shed light on the functional role of aesthetics in interactive system design. We present a case study of designing a utility belt for an agricultural robot. We use reflection-in-action to consider the ways that observation, in situ making, and documentation serve to illuminate how pragmatic, aesthetic, and intellectual inquiry are layered in this applied design research project. Themes explored in this pictorial include 1) contextual discovery of materials, tools, and practices, 2) design space exploration of materials in context, 3) improvising spaces for making, and 4) social processes in design. These themes emerged from the qualitative coding of 25 reflection-in-action videos from the researcher. We conclude with feedback on the utility belt prototypes for an agriculture robot and our learnings about context, materials, and people needed to design successful novel clothing forms for robots.

We analyzed the issue of a young woman who wanted our opinion regarding uncontrolled hypertension. Her hypertension was discovered to have a highly unusual origin, but it is fairly prevalent in nations like India.A 19-year-old woman who complained of blurred vision was presented to an ophthalmologist, who diagnosed her with grade IV hypertensive retinopathy. Her 2D ECHO was normal, hence a thorough screening for secondary hypertension was carried out. A left paravertebral tumor that may have squeezed the left renal artery and contributed to her hypertension was discovered during the workup by a CECT chest and abdomen scan. She also exhibited widespread lymphadenopathy; a condition known as granulomatous pathology. She was started on anti-TB medication, and after six months of treatment, her radiological and clinical conditions improved. This case highlights a rare instance of TB causing excessively elevated blood pressure.

Key message Hydatid disease is a zoonotic parasitic infestation caused by tapeworms, particularly Echinococcus granulosus. The lung is the second most site followed by liver accounting for 10%–30% of the cases. Rupture of hydatid cyst can occur into pleura or bronchus. Surgery remains the mainstay of treatment for pulmonary hydatid.

BACKGROUND:The prevalence of programmed cell death ligand-1(PD-L1) expression in non-small cell lung cancer (NSCLC) within unselected populations remains a research topic, though PD-L1 expression is important in guiding treatment decisions. OBJECTIVES:The study objective was to ascertain the prevalence of PD-L1 expression in patients of NSCLC and its association with clinicopathological characteristics and other gene mutations. METHODS:Samples from patients with NSCLCs were analyzed in the study to determine the expression of PD-L1 through immunohistochemistry (IHC) using rabbit anti-human PDL-1/CD274 monoclonal antibody. Correlation analysis was done using Pearson's correlation coefficient (r). The study analyzed the association between PD-L1 expression and clinicopathological features. RESULTS:A total of 245 consecutive patients (154 men with 62.9%) with NSCLCs were subjected to PD-L1 testing, and 30.6% (n=75) were identified to be positive. It was twice as prevalent in men than women, with 154 men and 91 females, respectively. The PD-L1 expression failed to demonstrate any statistical significance with age, gender, smoking status, type of materials, location of biopsy, Eastern Cooperative Oncology Group Performance Status, and Epidermal Growth Factor Receptor mutation. High PD-L1 expression with tumor proportion score (TPS ≥ 50) was observed in 38.8% of patients, and it was more prevalent in female patients 29 (38.7%), smokers 59 (78.7%), stage IV tumors 44 (58.7%), and stage III tumors 28 (37.3%). CONCLUSIONS:Our study in Kerala showed PD-L1 expression in NSCLC patients, correlated with clinicopathologic factors. Males, COPD, ALK+, and advanced-stage tumors had higher expression. Females, smokers, poorly differentiated tumors, and stage IV tumors had high PD-L1.

Abstract Background: Baricitinib is a Janus-kinase inhibitor with known anti-inflammatory effects with beneficial outcomes in COVID-19 management. We aim to assess the efficacy and all-cause mortality among moderate-to-severe COVID-19 patients who received baricitinib as an add-on to the standard of care. Methods: The retrospective case–control study recruited moderate-to-severe COVID-19 patients receiving baricitinib therapy for at least 72 h as cases from April 2021 to October 2021. Age- and severity-matched COVID-19 patients receiving standard of care without baricitinib served as control. The clinical and demographic data of the study groups were collected. Study outcomes evaluated included all-cause mortality, clinical improvement as assessed by the WHO Ordinal Scale scores, multiorgan dysfunction syndrome, thrombotic events, and secondary infections. Results: Among 527 moderate-to-severe COVID-19 patients in the study period, 75 patients each were recruited into the case and control groups who fulfilled the study eligibility criteria. The average age was found to be 60.82 ± 13.03 and 61 ± 13.48 years in case and control groups, respectively. All-cause mortality was 42.7% (64), with 27 (36%) and 37 (49.3%) deaths in the case and control groups, respectively ( P = 0.09). Kaplan–Meier survival analysis revealed the survival distributions to be significantly different between case and control groups (Log-rank: P =0.048). Clinical improvement was observed in 35 (47%) and 28 (37.7%) patients among cases and controls, respectively ( P = 0.32). Conclusion: The study demonstrated improved clinical outcomes, including mortality reduction and higher proportion of patients attaining clinical improvement as measured by at least 1-point improvement of the WHO ordinal scale, though a statistical significance was not observed.

By performing design research in the field, designers can better understand the target context, needs, values, and concerns of their users, and iterate on potential solutions. This, in turn, helps designers apply their work to unexplored territories. We illustrate the opportunities and requirements of this method through a case study of the development of a multi-purpose utility belt for an agriculture robot. We benefited from being able to observe current practices, collaborating to test prototypes with on-site roboticists and farmers, and sharing documentation in the moment. On the other hand, it could be challenging to improvise space for the design work or to find the right times to interrupt locals, and to negotiate the documentation activity with people who have concerns about being recorded.

By performing design research in the field, designers can better understand the target context, needs, values, and concerns of their users, and iterate on potential solutions. This, in turn, helps designers apply their work to unexplored territories. We illustrate the opportunities and requirements of this method through a case study of the development of a multi-purpose utility belt for an agriculture robot. We benefited from being able to observe current practices, collaborating to test prototypes with on-site roboticists and farmers, and sharing documentation in the moment. On the other hand, it could be challenging to improvise space for the design work or to find the right times to interrupt locals, and to negotiate the documentation activity with people who have concerns about being recorded.

Key message Tracheobronchopathia osteochondroplastica (TO) is a disorder caused by the accumulation of calcium phosphate in the submucosa of large airways. Benign proliferation of bone and cartilage lead to the narrowing of airways. Bronchoscopy is the diagnostic test for TO. It shows characteristic smooth nodules emerging from tracheal rings that never involves the posterior membranous wall.

The global incidence of lung cancer among women is rising. By 2030, lung cancer in women is expected to increase by 43%. The factors thought to predispose women to lung cancer are exposure second hand smoke, air pollution and biofuels used for cooking. Our objectives was to study the clinical and pathological features of lung cancer in women. Material: A retrospective review of medical records of women with lung cancer who attended Amrita institute of medical sciences, Kochi, between 2015-2019 was done. Data was collected using our institution's Electronic medical records (EMR). Demographic details and clinicopathologic features were extracted from the EMR manually. Data was tabulated using Microsoft Excel. Categorical variables were expressed as frequencies and percentages., Observation :Out of the 1683 lung cancer cases seen during 2015-2019, 389 (23.1%) were females. 250 patients for whom complete data was available was included in this study. Majority of the women were above 50 years old (N= 216, 86.4%). The median age of diagnosis was 64 years (range 33- 95 years). 14 patients (5.0%) had history of pulmonary tuberculosis. The median duration of symptoms was 8.7 weeks (IQR 4.3 -13). Cough (N=173, 69.2%), dyspnoea (N=117, 46.8%) and chest pain (N = 105, 42%) were the most common symptoms. Data regarding the use of cooking medium used (biofuel/LPG) was available only in 107 patients. 15/107 (14%) patients were using biofuels for cooking. 75.2% of them presented in advanced stages (Stage IV N=188). The most common sites of metastasis were bone (N=88, 35.2 %), lung (N = 55, 22%), lymph nodes (N=55, 22%) brain (N= 38, N= 15.2%), liver (N=32, 12.8%) and adrenal gland (N=31, 12.4%). 113 patients had one and 77 patients had multiple metastatic sites. The site of primary tumour was-right upper lobe N=67 (26.8%), Right middle lobe N =11 (4.4 %%), Right Lower lobe N=46 (18.4%), Left upper lobe N=65 (25%) and left lower lobe N=52(20.8%). Adenocarcinoma was the predominant histological type (N=224, 89.6%) followed by squamous cell carcinoma (N=12, 4.8%). Actionable mutations observed were EGFR in 44% and ALK 2% and BRAF 1.2%. Conclusion: Male to female ratio in our study (4.3:1) was higher compared to the lung cancer demographics from other states in India. This finding along with rising global incidence warrants special attention and screening for women with suspicious symptoms. The incidence of EGFR mutation was also high (44%) compared to other studies from India.

Sarcoidosis is a multi-system granulomatous disorder characterized by involvement of multiple systems with or without lymphadenitis. Pulmonary complications are common and may lead to morbidity. Breast cancer is one of the commonest malignancy among women across the world. There is an increased risk of malignancies in sarcoidosis. This association with cancer creates a diagnostic dilemma due to the predominant involvement of nodes and organ systems in both conditions. Here we report three cases of sarcoidosis with breast cancer diagnosed over one year.

Background:The change in FEV1 after administration of a short-acting bronchodilator has been widely used for diagnosis of obstructive airway diseases. Many factors can influence the post bronchodilator reversibility. Aim:The aim of the present study was to estimate the presence of reversibility among the patients of obstructive airway disease and to identify the factors affecting it. Methods:Patients who presented to the department of respiratory medicine with symptoms of dyspnea were evaluated with spirometry. Spirometry and post bronchodilator reversibility (BDR) was defined as per international guidelines. SPSS 17 was used for statistical analysis and P < 0.05 was considered significant. Results:Out of 100 patients studied, 33 had BDR. Median age of the population was 58 ± 17 years. There were 72 non-smokers and 58 men. A total of 32 had chronic obstructive pulmonary disease (COPD), 56 had asthma, and 12 had normal spirometry. The median pre and post bronchodilator FEV1 was 1.34L/Sec and 1.46 L/sec respectively. Twenty-seven of asthma (41%) and 6 of COPD (19%) had BDR (P = 0.05). Other factors associated with BDR were smoking (P = 0.035). There was no statistically significant correlation found between eosinophilia, gender, severity of obstruction, BMI, height, weight and age. Conclusion:The prevalence of post BDR in the study population was 33%. The factors affecting BDR were smoking status, and asthma. The study did not show any significant correlation between BDR and eosinophilia, gender, height and age.

Background: Lymph node tuberculosis (TB) is the most common form of extrapulmonary TB in India. Standards for TB care in India recommend microscopy/culture/CBNAAT/molecular test/histopathology examination and drug sensitivity testing on appropriate specimens from the presumed sites of involvement for all patients with presumptive extrapulmonary TB. Objectives: To analyze the utility of Xpert MTB/Rif assay in lymph node TB. Methods: All patients who underwent lymph node sampling between July 2014 and June 2017 and for whom Xpert MTB/Rif assay was done were included. Demographic profile, Xpert MTB/Rif assay result, histopathology/cytology findings, smear acid-fast bacillus (AFB), and AFB culture results were noted. A composite reference score (CRS) was made. Results: Xpert MTB/Rif assay was positive in 63 of the 81 patients. Xpert had a sensitivity of 82.14% and specificity of 86.18%when compared against AFB culture and 75.61% and 98.97% when compared against CRS. Conclusion: Xpert MTB/Rif assay is a valuable test for rapid diagnosis of lymph node TB.