Liquid biopsies are newer diagnostic tests conducted on blood samples to detect biomarkers shed by tumors, such as cancer cells or portion of tumor DNA. Liquid biopsies are not to replace surgical biopsies but are complementary in the diagnosis and treatment of cancer. The circulating tumor DNA and intact circulating tumor cells are the two main components that are targeted during a liquid biopsy. Information from the liquid biopsy is used to determine the best-individualized cancer therapy to track how a patient is responding to treatment, or to discover whether there is recurrence of cancer. This review summarizes the main techniques and applications of liquid biopsy in cancer.

Background: Tracheobronchial anomalies are rare clinical entities and often asymptomatic in nature. Some patients may experience symptoms such as cough, recurrent pneumonia, or hemoptysis. Tracheal bronchus is one of the rarer forms of tracheobronchial anomalies, which may be seen during routine bronchoscopy. Knowledge and understanding of tracheal bronchus is important for diagnosing symptomatic patients and performing certain procedures, including bronchoscopy and endotracheal intubation. Objective: The objective is to study the clinical profile, diagnosis, and management of tracheal bronchus detected during routine bronchoscopy in a tertiary care setting. Methods: This study was a retrospective analysis of hospital data of patients undergoing fiberoptic bronchoscopy for 2 years in a tertiary care setting. Results: There were 150 bronchoscopies performed during the period. A total of 42 anomalies were detected in 35 (23.33%) patients. Three patients had tracheal bronchus (2%). Conclusions: This retrospective study evaluated the presence of tracheal bronchus among patients who underwent bronchoscopy in a tertiary care hospital in Kerala, India. This study revealed that tracheal bronchus was present in 2% of all bronchoscopies done during that period.

Introduction: The pulmonary manifestations of covid-19 disease may range from mild pneumonia to severe acute respiratory distress syndrome (ARDS) complicated by shock or multiorgan failure. Proper selection and utilization of oxygen delivery system is the key factor in treating the hypoxemic respiratory failure in severe covid-19 disease. Here by, we present a retrospective observational study of utility of NRBM (Non Rebreathing Mask) in 1876 moderate to severe hypoxemic Covid-19 pneumonia patients in a single centre and its outcome. Objectives: To study the utility of NRBM in moderate to severe hypoxemic COVID-19 pneumonia Patients. Material and Methods: This was a single centre retrospective observational study. Out of 5024 microbiologically confirmed (by Rapid antigen test/RTPCR/TRUENAT) covid-19 pneumonia patients admitted since September, 2020 to May 2021,1876 patients of age >14 years admitted in the department of Respiratory medicine with moderate to severe hypoxemia (SpO2 <90%) and respiratory rate <30/min who were provided supplemental oxygen by NRBM with or without associated Co-morbidities were included in the study. These patients were provided oxygen Supplementation by NRBM according to their SpO2 levels (<90 %) by starting with a minimum flow rate of 10 L/ min to maximum of 15 L/min. Results: Out of 5024 microbiologically confirmed covid-19 patients who were admitted in respiratory ICU and ward,1876 patients were provided supplemental oxygen by NRBM. Patients were distributed according to their duration of onset of symptoms, mode of oxygen delivery, number of days of supplemental oxygen and number of patients expired accordingly and results were observed and analyzed. Majority of the patients belongs to the age group 45 to 60 yrs. The average duration of presentation to ER with worsened symptoms for oxygen requirement was 6.4 days from the onset of symptoms. 1703 (90.77%) patients recovered well without any further deterioration with NRBM. The average duration of days for weaning from NRBM to simple face mask or nasal prongs were 4.5 days based on their respective SpO2 >90% (corresponds to Pao2 >60 mmhg), respiratory rate (<16/min) and heart rate <100 bpm. About 9.3% of the patients (173) who were provided NRBM support who further deteriorated or showed poor response even after maximum period of 7 days were provided with NIV support (130 patients i.e. 6.92%), HFNC support (14 patients i.e. 0.74%) and invasive mechanical ventilation (29 patients i.e. 1.54%).66 patients who were initially provided NRBM support, recovered and 107 patients (2.129%) succumbed to their illness. smoking (table-4)has been observed to be the major risk factor in majority of the patients (43.7%). As per the data of this study there is significant correlation between the utilization of NRBM and advanced age, early initiation of NRBM rather than directly initiating NIV/HFNC/Invasive mechanical ventilation and duration of presentation to the hospital with symptoms. Smokers were observed to be associated with more severe presentation and longer time for weaning. Hypertension and Diabetes were observed to most commonly associated comorbidities in the study population. Hypoxemic covid-19 patients who were provided NRBM support were having better outcome and reduced mortality risk compared to patients who were provided NIV/HFNC/Invasive mechanical ventilation. Conclusion: In reference to the results in our study, we recommend the use of NRBM in moderate to severe hypoxemic patients of covid-19 disease at the early course of the disease.

Pulmonary manifestations of mixed connective tissue disease (MCTD) include as bronchiolitis, bronchiectasis, and interstitial lung disease with or without pulmonary hypertension. Tuberculosis (TB) is the most common diagnosis in India in the presence of constitutional symptoms such as cough, fever, and weight loss with lung parenchymal abnormality, irrespective of microscopic or nucleic acid amplification test abnormalities due to high tuberculosis prevalent tropical setting. In this case report, a 35 year old female presented with constitutional symptoms and lung parenchymal nodules, interstitial involvement with lung fibrosis and pulmonary hypertension. Mediastinal window documented necrotic mediastinal lymph nodes, without negative mycobacterial microscopic (smear examination) or genome documentation (Gene Xpert MTB/RIF). She had received empirical anti tuberculosis treatment for three months without clinical or radiological response, resulted in progression of disease with clinical and radiological worsening and referred to our unit for further workup. Bronchoscopy guided evaluation for tropical screen including bacterial, fungal and tuberculosis with malignancy was inconclusive. Vasculitis and CTD workup documented antinuclear antibody (ANA) test strongly positive with very highly raised titres, with positive antigen as U1 small nuclear ribonucleoprotein particle, SSA/RO, single strand DNA, and Scl 70. Treatment initiated with systemic steroids, tadalafil, mycophenolate and diuretics, and satisfactory clinical response documented as near complete resolution of pulmonary parenchymal abnormalities in 24 weeks and pulmonary hypertension in 12 weeks. Pulmonary manifestations of MCTD are common, underestimated in the presence of constitutional symptoms, and early pickup of entity in course of illness will have good outcome with excellent prognosis.

Intra thoracic tumors can lead to a variety of para-neoplastic manifestations which is often overlooked. Awareness about the para-neoplastic manifestations and the possible intra thoracic causes for the same will lead to early diagnosis and appropriate management. In this self assessment quiz we have discussed regarding the para-neoplastic manifestations in Carcinoid tumor.

Abstract-Right hypochondrium pain with air-fluid level in chest X-ray can have a long list of differential diagnosis. A meticulous evaluation of history with appropriate investigations can help make the correct diagnosis.