Background: Bronchiectasis has been considered as orphan lung disease since long. There is a geographical variation in clinical features and etiologies of Bronchiectasis. HRCT can accurately diagnose bronchiectasis, along with localizing and describing the areas of parenchymal abnormalities, and identifying bronchiolar abnormalities and mucus plugging. The aim of this present study to evaluate the etiology, clinical-radiological and microbiologicalprole of patients with bronchiectasis presenting at IRD, SMS Medical College, Jaipur. Material & Methods: This was a hospital based prospective observational study carried out on 90 bronchiectasis patients at Department of Respiratory Medicine, Institute of Respiratory Diseases, SMS medical college, Jaipur, over a period of one year (2021- 2022). Patients attending our OPD with cough, purulent expectoration, shortness of breath, fever, with/without hemoptysis and radiological features favoring bronchiectasis or previously known/evaluated cases of bronchiectasis were included in our study. A questionnaire was given to them and information was collected regarding the demographic data, childhood history, symptomatology and signicant past and personal history. Results: Our study showed that the mean age of the study population was 49.87 years with male preponderance (72.22%) as compared to females (27.78%). The mean BMI was 22.37. Majority were in the normal range of BMI (86.67%). 57.78% of our study population were non smokers with 21.11% as exsmokers and 21.11% as current smokers. 8 patients died during the study period. Most common etiology associated with mortality was post tubercular as it was the major identied cause followed by Idiopathic, COPD and post pneumonia. Out of 8 deaths, 3 patients died who had Pseudomonas as culture organism. The major complication associated with death was cor pulmonale which has a clinical as well as statistical correlation with a p value = 0.001. Conclusion: We concluded some signicant differences in patient's etiological, clinical, radiological and microbiological proles when compared to data from Western World.

We report the case of a 35-year-old, non-smoker female who presented with arthralgia, dyspnoea, chest pain, fever and cough.Chest radiograph (postero-anterior view) showed ill-defined opacities in bilateral lower lung zones.High resolution computed tomography (HRCT) of chest revealed bilateral lower lobe consolidation with air bronchogram and interstitial septal thickening with ground-glass opacity.Diagnosis of polymyositis was confirmed by high titre of Jo-1 antibody and serum creatine kinase (CK) (1216 U/L).Video-assisted thoracoscopic lung biopsy showed evidence of non-specific interstitial pneumonia.

Pulmonary artery pseudoaneurysms is a rare pulmonary entity.Pseudoaneurysm do not have a covering of all three layers of the arterial wall and are effectively contained arterial leaks considered to be at high risk of rupture.The common clinical manifestations of pulmonary artery pseudoaneurysms include cough and haemoptysis.Pulmonary artery pseudoaneurysms can also present as life-threatening haemorrhage or incidental lesions that enlarge for days, months or years.Vascular complications in the chest, involving the pulmonary as well as bronchial vasculature are known to occur due to tubercular infection. 1e present a case of a female who was diagnosed as a case of pulmonary artery pseudoaneurysm with tuberculosis as an aetiology. case reportA 28-year-old female presented with cough, haemoptysis, fever and dyspnoea since two months.She had no history of loss of appetite, loss of weight, and chest pain.Initial clinical assessment revealed normal vital signs without any obvious respiratory distress with an oxygen saturation of 98% by pulse oximetry on room air.Laboratory investigations revealed: haemoglobin 11.6g/gL, total leucocyte count 4060/ mm 3 , platelet count 2.73 lakhs/mm 3 and erythrocyte sedimentation rate of 50mm.Renal function tests, urine analysis, serum electrolytes and liver function tests were within normal limits.Human immunodeficiency virus (HIV) was non-reactive.Sputum for Ziehl-Neelsen staining and cartridge-based nucleic acid amplification test (CBNAAT) was negative.No fungus grown on culture.Two-dimensional (2D) transthoracic

Context Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a very common disease, and 20% of the patients with COPD keep getting admitted with exacerbation and 33% patients are readmitted within 90 days. Early identification of these patients allows improved prognosis and reduced deaths. So PEARL score is used as a prognostic tool to identify poor prognostic patients. Aims To assess the reliability of PEARL score as compared with ADO and BODEX indices for prognosis and prediction of 90-day readmission or death after hospitalization for AECOPD. Settings and design A hospital-based prospective observational study was conducted at the Department of Respiratory Medicine in a tertiary care center of Rajasthan. Patients and methods This prospective observational study was conducted in 100 patients with AECOPD, and PEARL score calculated in all patients. Statistical analysis Data collected were entered into an excel spreadsheet, and quantitative data were expressed as number and percentage. Results Our study showed that the mean age of male was 64.02±8.487 years (range, 42–81 years) and female was 58.88±9.401 years (range, 43–81 years). The comparison of the means was statistically significant (P=0.0312). Of 100 patients, 51 patients were not admitted, 29 patients were readmitted, and 20 patients died. The mean value of ADO index was 5.294±1.221, 6.480±0.8710, and 7.150±0.9881; the mean value of BODEX index was 6.294±1.238, 7.759±0.9876, and 8.300±0.6569; and the mean value of PEARL score was 1.569±0.7281, 4.034±1.592, and 5.850±1.461 in not admitted, readmitted, and dead patients, respectively. The area under the curve cure was 0.6250 in PEARL score as compared with 0.5000 in ADO and 0.500 in BODEX index. Conclusion PEARL score was found to be superior to ADO and BODEX indices for prognosis of patients with AECOPD. Hence, PEARL score can be used as a tool to guide readmission-avoidance strategies without invasive parameters.

INTRODUCTION: The link between fungi and asthma has been extensively investigated. However, the role of fungal allergens as the primary extrinsic factor leading to asthma severity has been incompletely explored. An all-new variant of asthma has been described recently which has been named severe asthma with fungal sensitisation (SAFS). It is characterised by the presence of severe asthma and are sensitized to one or more fungi but have normal or slightly elevated IgE concentration. In this study ALQ test and spirometry was done to assess the severity of asthma. ALQ test is a simple self administered questionnaire, designed to help individuals with breathing problems to determine if they have asthma or for those already diagnosed with asthma if their asthma is under control. METHODS: A prospective observational study was done over a period of 6 months. Name, age, and demographic details collected from all bronchial asthma patients. Using SPT, the sensitization status to fungus was identified in clinically diagnosed bronchial asthma cases and asthma Severity with fungal sensitisation was analysed on the basis of asthma life quality test questionnaire and spirometry. RESULTS: Out of hundred patients studied 60 of the patients were male. Mean duration of asthma was 5years. 40 patients were positive for fungal sensitization by SPT. The most common fungus was Curvularia Lulata followed by aspergillus. 30 patients were positive for aspergillus fungus (ALQ score > 16.5 and mean FEV1 was 28±2) as compared to the 10 patients who were positive for other than aspergillus fungus( ALQ score <16.5 and mean was FEV1 65 ±2 ) severe asthma. Fungal sensitization was found to be significantly associated with uncontrolled asthma. 75% of fungal sensitized patients had uncontrolled asthma as compared to 5% of the non fungal sensitized patients. CONCLUSION: There was high prevalence of sensitization to all fungal allergens. Among all the fungal allergens, aspergillus sensitization is most commonly associated with severe asthma.

INTRODUCTION: Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated lung disease, predominantly in patients with asthma and is caused by hypersensitivity to colonized dimorphic fungus Aspergillus, commonly Aspergillus fumigatus. Early diagnosis with recognition and treatment of chest radiographic infiltrates appears to prevent progression to end stage fibrosis. Many cases are mistreated as pulmonary tuberculosis or recurrent pneumonia and are deferred for specific treatment of ABPA. AIM AND OBJECTIVES: This study aims to know the clinical, radiological, and immunological profile of patients diagnosed with ABPA reporting to the Institute of Respiratory Disease, SMS College, Jaipur and Mahatma Gandhi Medical College, Jaipur. MATERIALS AND METHODS: Hospital-based prospective, observational, cross-sectional study was conducted in 48 Patients having history of bronchial asthma, pulmonary infiltrate/shadows on chest X-ray were subjected to routine investigations, immunological tests including modified skin prick test with specific IgE against A. fumigatus and specific precipitins against A. fumigatus. RESULT: In this study, maximum predominance with age group of 21–40 years irrespective of sexpattern. Maximum patients were having bronchial asthma of 2–10 years duration. Cough, breathlessness, and wheezing were main clinical features. In 80% cases, total eosinophilic counts were more than 1000.58.4% sputum were fungal culture positive, maximum for A. fumigatus. All cases showed modified kinprick test positivity against A. fumigatus. Maximum patients high-resolution computed tomography chest had central bronchiectasis. 37% cases had raised total serum IgE (range 1000–5000). Specific IgE against A. fumigatus were positive in 24 patients. 87.5% patients were positive for specific precipitins. CONCLUSION: In this study, ABPA was found more commonly in people with chronic asthma of productive age group, i.e., 20–40 years and farmers by occupation. Most of the people were diagnosed as having pulmonary tuberculosis and deferred specific treatment for a long time. More knowledge about ABPA to physicians could possibly cut short the time between suffering, diagnosis, and proper treatment of these patients.

Context: Acute exacerbation of COPD is very common disease and 20% of the COPD patients keep getting admitted with exacerbation. Serum procalcitonin (PCT) measurement is important to discriminate bacterial infection from other causes of AECOPD. Quick recognition along with prompt intervention may be the only action that prevents respiratory failure. Aims: To correlate serum PCT level with bacteriological profile and their need for ventilatory support in patients with AECOPD. Settings and Design: Hospital-based comparative type of cross-sectional study was conducted at the department of respiratory medicine in a tertiary care center of Rajasthan. Methods and Material: This comparative type of cross-sectional study was conducted between 45 AECOPD patients and 35 stable COPD patients. Serum PCT levels and sputum pyogenic culture were noted in all subjects. Statistical Analysis Used: Data collected were entered into excel spreadsheet and quantitative data were expressed as number and percentage. Results: There was a highly statistically significant difference of mean PCT value (P value < 0.003) between AECOPD patients (1.34 ± 2.53 ng/ml) and stable COPD patients (0.07 ± 0.05 ng/ml). Also, we found a statistically significant difference of mean PCT value (P value < 0.001) between AECOPD patients infected with Pseudomonas aeruginosa (3.64 ng/dl) and with other bacteria. A statistically significant difference (P value < 0.001) was present among AECOPD patients that needed invasive ventilation (5.41 ± 4.01 ng/ml), non-invasive ventilation (0.65 ± 0.81 ng/ml) and those did not need mechanical ventilation (0.27 ± 0.25 ng/ml) regarding the mean values of PCT. Conclusions: Our study found that higher PCT levels in severe AECOPD patients were associated more with bacterial infection and necessity of ventilatory support. Serum PCT can be used as good biomarker for intensive care unit admission.

Background: Lung cancer is one of the most common cancer and leading cause of cancer mortality worldwide. We study an epidemiological profile of non small cell lung carcinoma at tertiary care hospital, Jaipur. Methods: This was a hospital based prospective and observational study carried out on Cases detected as non small cell carcinoma on histopathological examination of lung tissue biopsy of lung carcinoma patients attending OPD or hospitalized at Department of Respiratory Medicine during the year 2018-2019. Institute of Respiratory Diseases is a tertiary care center for tuberculosis and Respiratory diseases in Rajasthan. Results: Maximum numbers of cases were seen in male gender with age group 60-69 years accounting for 21 cases while number of females of this age group was also maximum comprising of 9 cases. Maximum male cases were smokers for more than 10 years and their number was 36 out of 95 cases while maximum number of female smokers was 8 with a history of smoking less than 10 years. Males with negative history of smoking were 14 while females were 5. Conclusion: Maximum male cases with lung carcinoma had history of smoking exposure more than 10 years as compared to females. Keywords: Lung carcinoma, Smoking, Male

Pulmonary aspergilloma is the most common form of aspergillus infection in patients with pre-existing cystic or cavitary lung disease. Extrapulmonary aspergilloma, specifically, in the mediastinum, is an unusual pathologic manifestation of this organism. Aspergilloma presenting as superior vena cava (SVC) obstruction has rarely been seen. Here, we report a case of mediastinal aspergilloma in a 30-year-old female patient presented with signs and symptoms of SVC obstruction. The patient had a history of cough with expectoration along with progressive dyspnea on exertion for 3 months. A computerized tomographic chest showed a soft tissue density mass involving the mediastinum and compressing the SVC. Computed tomography-guided fine-needle aspiration cytology and trucut biopsy were performed, and the samples were examined histopathologically and subjected to culture, which yielded the growth of Aspergillus fumigatus. The patient responded well with itraconazole, with serial imaging showing a near complete resolution of the mass.

Context: An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common condition seen in emergency. Clinical conditions which mimic AECOPD are congestive heart failure, pneumonia, pneumothorax, pleural effusion, and pulmonary embolism (PE). Early recognition of PE can be difficult due to overlap in clinical symptoms of AECOPD. This should prompt clinicians to enhance PE suspicion in AECOPD patients of unknown origin. Aims: The aim of the study was to assess the prevalence of PE in unexplained acute exacerbation of COPD, severity, duration of hospital admission, and to explore factors associated with co-existing disease. Patients and Methods: This was a hospital-based cross-sectional study, conducted at a tertiary care center of Rajasthan. One hundred and ten cases of AECOPD of unknown origin hospitalized in the department of pulmonary medicine during the study period were included after conforming to the inclusion and exclusion criteria. Results: In our study, the prevalence of PE in unexplained AE-COPD was 18%. Clinically, chest pain and hemoptysis were present in 80% and 12% of the patients with PE, compared with 49% and 5% of the patients without PE, respectively. The mean duration of hospital stay of AECOPD patients without PE was 2.69 ± 1.08 compared to 6.65 ± 1.56 in PE, which is a highly statistically significant difference (P < 0.001) in the study population. Conclusion: Clinicians should be alert toward the presence of PE in patients with unexplained AECOPD, especially when chest pain, hemoptysis, disproportionate tachycardia, and signs of right ventricular failure are present and no clear infectious origin can be identified.

Cryptogenic organizing pneumonia (COP) is less common interstitial lung disease with varying clinical picture. It can be misdiagnosed as lung cancer as COP usually presents with malaise, fever, weight loss, and myalgia, which overlap with clinical features of lung cancer. Here, we present a rare case of a 68-year-old male smoker admitted with cough, hemoptysis, arthralgia, fever, and chest pain. On chest X-ray, unilateral homogenous opacity was seen. Blood culture and sputum for Ziehl–Neelsen stain were negative. High-resolution computed tomography chest revealed consolidation in middle and lower zone of the left lung with ground-glass opacity with centrilobular nodules. Bronchoalveolar lavage specimen was negative for bacteria, Mycobacterium tuberculosis, and atypical cells. Transbronchial lung biopsy showed evidence of OP. The patient responded well to steroids.

Introduction: Osteoporosis is one of the extrapulmonary effects of Chronic Obstructive Pulmonary Disease (COPD). Osteoporosis is characterized by low bone mineral density (BMD) resulting in an increased risk of fracture thereby causing significant morbidity and mortality. Aims and Objectives: To determine association between BMD and severity of COPD and association between steroid intake and bone mineral density Material and Methods: 100 new COPD patients were recruited in this study. Diagnosis and severity grading of COPD patients were according to the GOLD guidelines. BMD (at the lumbar spine and at the femoral neck) was performed using Dual energy X-ray absorptiometry (DEXA). BMD was expressed in g/cm2 and standardized T-score and Z-score. Results: Conclusion: There was significant derangement in BMD and T-score in COPD patients which leads to osteoporosis and osteopenia. Patients with history of long term use of oral corticosteroids had more negative values of T –scores at both lumbar spine and femoral neck when compared to inhaled steroids. It is advised to screen for osteoporosis in COPD patients with long term steroid use and who had severe disease.

Introduction: Bullous lung disease is a common presentation in patients with chronic obstructive pulmonary disease (COPD). The giant pulmonary bulla occupies one third of involved hemithorax and characterized by the existence of centrilobular emphysema in non bullous lung. Sometimes air reabsorbs spontaneously leading to shrinkage and regression of bulla known as autobullectomy. Mechanism of autobullectomy remains unclear. Here, we report a patient with infected bulla who experienced complete resolution after antifungal treatment. Case History: A 63 year old mal with history of twenty pack years of tobacco smoking came to the pulmonary outpatient department with complains of left side chest pain, cough with mild expectoration and low grade fever since five days. Patient also had blood tinged sputum since three days. His chest X-Ray PA view showed a thin walled cavity with air fluid level on the left upper zone with a few calcified parenchymal foci. Patient had symptomatic improvement after two weeks of antifungal treatment. Repeat skiagram chest and CECT chest showed complete resolution of bulla. Discussion: There are two hypotheses which can explain occurrence of bulla: Conclusion: Spontaneous resolution of giant bulla also known as autobullectomy is an ignorant event and follows an infection trigger. The early suspicion and diagnosis by the treating physician can avert the need for a surgical bullectomy in these patients and decline the morbidity and mortality. Our case is of interest not only because of the rarity with which spontaneous regression has been reported in the literature but also because the source of infection was fungal.

Context: Clinical studies about detailed spectrum of aspergillosis in treated tuberculosis (TB) patients are lacking. Hence, a study was undertaken at the Institute of Respiratory Disease, Jaipur, Rajasthan, India. Treated patients of pulmonary TB having any symptom such as hemoptysis, cough with expectoration, weight loss, and whose chest X-ray showed residual cavitation were enrolled for the study. Aims: This study aimed to determine the prevalence of pulmonary aspergillosis in treated cases of pulmonary TB and to study the social, demographical, and clinical characteristics of these patients. Settings and Design: A descriptive type of observational study was conducted at the Department of Respiratory Medicine in a tertiary care center of Rajasthan. Subjects and Methods: This descriptive type of observational study was conducted on seventy patients, whose sputum or bronchial wash showed isolation of Aspergillus. Demographic details, predisposing factors, and clinical findings were noted. Statistical Analysis Used: Data collected were entered into Excel spreadsheet and quantitative data were expressed as number and percentage. Results: The presentation of pulmonary aspergillosis in treated cases of pulmonary TB varies from aspergilloma (57%) to chronic necrotizing pulmonary aspergillosis (36%) to allergic bronchopulmonary aspergillosis (7%). The most common symptom was recurrent hemoptysis. Most of the patients were farmers by occupation, but no significant comorbid illness was seen. X-ray chest missed about 70% of cases. The most common species were Aspergillus fumigatus; others were Aspergillus terreus (13%), Aspergillus flavus (13%), and Aspergillus niger (7%). Conclusions: All treated cases of pulmonary TB presenting with recurrent hemoptysis and/or cough with expectoration should be evaluated in detail for pulmonary aspergillosis as chest X-ray alone can miss the diagnosis.

Miliary mottling is most commonly seen in tuberculosis. Clinical features of tuberculosis mimic many other lung diseases. Here we report a 40 yr old male with clinical features suggestive of tuberculosis, miliary mottling on skiagram chest and granulomatous hepatitis on histopathology. Case was finally diagnosed as sarcoidosis on liver biopsy and improved on oral corticosteroid.

OBJECTIVES: Bacterial infections are the major cause of acute exacerbation of COPD (AE-COPD). The relationship between lung functions and respiratory failure (arterial blood gas parameters) with the etiology of AE-COPD has not been clearly understood. We conducted this study to determine the bacterial profile in AE-COPD and to identify the associated risk factors and drug sensitivity pattern. MATERIAL AND METHODS: Seventy-two patients hospitalized for AE-COPD were prospectively evaluated. Quantitative sputum culture, blood gas analysis, and drug sensitivity testing were performed at the time of admission, and pulmonary function testing was performed 6 weeks after discharge as per standard guidelines. RESULTS: Bacterial pathogens were isolated in 34 (47.22%) cases. Pathogens isolated were Pseudomonas aeruginosa (38.23%), Klebsiella pneumoniae (29.41%), Staphylococcus aureus (23.53%), Streptococcus pneumoniae (5.88%), and Acinetobacter spp. (2.94%). Isolation of bacterial pathogen was observed in patients with advancing age (p=0.02), frequent exacerbations (p<0.001), systemic steroid use (p=0.005), and deranged lung function (p=0.02). Binary logistic regression analysis revealed that higher partial pressure of carbon dioxide (PaCO2) was independently associated with isolation of K. pneumoniae (p=0.025) and P. aeruginosa (p=0.001). Additional independent factors that favor isolation of K. pneumoniae were age >55 years (p=0.017) and systemic steroid use (p=0.017). Antibiotic sensitivity testing showed that ciprofloxacin and piperacillin/tazobactum were effective in 27/34 (79.41%) of isolates followed by gentamycin in 26/34 (76%). CONCLUSION: Hypercapnic respiratory failure is an independent risk factor for isolation of K. pneumoniae and P. aeruginosa in addition to advanced age and systemic steroid use. These findings may be an important adjunct in deciding the initial antibiotic therapy.

Several occupational hazards, especially exposure to silica, have been implicated as causal factors for the development of scleroderma-like disorders. Compared to other connective tissue disorders, silica-associated systemic sclerosis (SA-SS) is relatively rare. Silica-induced scleroderma is indistinguishable from idiopathic systemic sclerosis. However, the former expresses a high predisposition of pulmonary involvement and anti-Scl-70 antibody. We report the case of a 42-year-old male, stone cutter by occupation, who was diagnosed as simple chronic silicosis and developed systemic sclerosis.

Background & study objectives: Infection is the major cause of acute exacerbation of COPD (AE COPD) of which bacteria are responsible for 30%-50% of cases (Murphy TF. Am Rev Respir dis 1992). There are limited data on bacterial etiology of AE COPD in India. We aimed our study to investigate the frequency of bacterial infection in hospitalized patients of AE COPD, the responsible pathogens and to assess patient9s lung function in relation to pathogen isolated. Method: We prospectively evaluated 72 patients admitted to our institute with AE COPD over one year. Sputum samples were collected and were processed for gram staining and bacterial culture. Pulmonary function testing was done at follow up after 6 weeks (GOLD guidelines 2011). Results: Bacterial pathogen was isolated in 34 (47.22%) cases. P. aeruginosa (38.23%) was the most predominant organism followed by Klebsiella spp. (29.41%), S. aureus (23.53%), S. pneumonae (5.88%) and Acinetobactor spp (2.94%). There was statistically significant difference observed in relation to age, sputum purulence, number of exacerbations in previous year (p <0.001) and compromised lung function (p <0.05) between patients with and without bacterial infection. Gram negative bacilli (GNB) were predominating in patients with stage III and stage IV COPD (FEV1<50%). Conclusion: Bacteria are responsible for nearly 50% of AE COPD. Bacterial etiology is different in India from that of western literature. Patients with advanced COPD and compromised lung function had a higher chance of infection with pseudomonas and other GNBs suggesting that such patients may need different pharmacotherapy than those with less severe disease.