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Background: The prevalence of asthma has been increasing worldwide in recent years. There is a wide variation in the prevalence of asthma in various countries, varying between 1.2% and 6.3% among adults in most countries. There is a scarcity of data on the prevalence of asthma in the age group 16–20 years in India. Objective: The aim is to study the prevalence of asthma among students of 16–20 years' age group in our city. Methodology: This was a questionnaire-based cross-sectional study. A standardized questionnaire was prepared and distributed to 4600 college students. Among the students who had symptoms suggestive of asthma by the questionnaire method, 10% of them were selected for spirometry to confirm the diagnosis by a systemic random sampling method. Statistical analysis was performed using frequency and percentage method to calculate the prevalence. Chi-square test, odds ratio, and 95% confidence interval were used to measure the association between the variables, and a value of P < 0.05 was considered to be significant. Results: Out of 4600 students, 1539 (33.5%) were boys and 3061 (66.5%) were girls. 230 (5.0%) students had symptoms suggestive of bronchial asthma, of which 115 (7.5%) were boys and 115 (3.8%) were girls. 336 (7.3%) students had a family history of asthma. Out of 230 students having symptoms suggestive of asthma, only 57 (24.78%) students were taking regular medications, in which 34 (59.64%) students had symptomatic relief. The prevalence of bronchial asthma among college students (16–20) years of age was 5.0%. A family history of asthma was associated with significantly higher odds of having bronchial asthma. Conclusions: The prevalence of asthma among students of 16–20 years ago was 5.0%. A family history of asthma was associated with significantly higher odds of having bronchial asthma.

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Hemoptysis is not a common symptom in bronchial asthma. We aim to discuss the approach to a patient with uncontrolled asthma with recurrent hemoptysis in this case-based discussion. Causes in such cases include pulmonary tuberculosis, bronchiectasis, endobronchial lesions, bronchial carcinoid, factitious hemoptysis, allergic bronchopulmonary aspergillosis, granulomatosis with polyangiitis, allergic angiitis (hypersensitivity vasculitis), Churg-Strauss syndrome, and valvular heart disease which can coexist with asthma.

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Coronavirus disease 2019 after its origin in Wuhan, China, had spread globally and was declared as a pandemic by the WHO on March 11, 2020.? The WHO identifies it as a controllable pandemic with the key role existing in precautionary measures to curb the recent global crisis. The current diagnostic methodologies include the rapid antigen test, serology tests to detect antibodies, and the real-time polymerase chain reaction.? Anecdotal experiences have shown that imaging characteristics are crucial in the diagnosis and management of the disease as radiological evidence of disease appears before the clinical manifestations and evolves overtime as the disease progresses, which is useful in predicting the stage, severity, and prognosis of the disease. Owing to few specific features and early changes, computed tomography scan is more sensitive than a chest roentgenogram in highlighting these changes.

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Subacute invasive pulmonary aspergillosis (IPA) is an indolent cavitating infectious process which can mimic other chronic lung infections such as tuberculosis. This usually occurs in mildly immunosuppressed individuals and clinically evolves over weeks to months. Radiological presentation is in the form of thick-walled cavity with or without mycetoma, fibrosis, and pleural invasion. Here, a case of subacute IPA in a middle-aged female with rheumatoid arthritis is reported, highlighting a rare radiological appearance.

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Congenital pulmonary airway malformations (CPAMs) are considered part of a spectrum of bronchopulmonary foregut malformations. Diagnosis is usually made during the antenatal or neonatal period, and is rarely diagnosed in adults. The spectrum of clinical presentations varies from asymptomatic cases to recurrent respiratory tract infections or respiratory insufficiency in adulthood. Here, we report the case of an adult female who presented with a history of recurrent respiratory tract infections since childhood. Radiological findings were in favor of bilateral CPAM. Bilateral CPAM in an adult patient is extremely rare, and it is mostly managed as bronchiectasis.

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A case of fever, cough, and hemoptysis in a young female which could not be diagnosed by routine investigations is presented here. Confirmatory diagnosis was established after a long period of 2 years. Difficulty in diagnosis itself points to a rare cause for this presentation. The case is presented here with expert comments from specialists working in related specialties.

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In a country like India where the burden of tuberculosis is high, pulmonary tuberculosis is the first differential diagnosis when a patient presents with chronic cough, fever, and weight loss. However, many other infectious and noninfectious diseases also can present with similar symptoms. Infra diaphragmatic lesions also can present with chronic cough with fever and weight loss. We present a rare case of bilateral suprarenal mass diagnosed as Non-Hodgkin lymphoma presenting with chronic cough, fever, and weight loss. We aim to highlight extra thoracic causes for chronic cough with fever in this article.

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Tuberculosis (TB) can affect various organs besides the lungs. Among the extrapulmonary sites, pleura and gastrointestinal tract are the second- and sixth-most common sites, respectively. Pleural involvement usually occurs in the form of pleural effusion, and the sites most commonly involved in gastrointestinal TB are the peritoneum and ileocecal area. Here we present an interesting case of a 23-year-old female who presented to the gastroenterologist with symptoms of dysphagia, regurgitation of food, and weight loss. Esophagogastro duodenoscopy showed an esophageal ulcer which was confirmed to be due to TB. Incidentally, this patient also had multiple pleural nodules due to TB. This case is unique since there is a simultaneous occurrence of two different sites of occurrence of extrapulmonary TB.

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Rhinosporidiosis is a granulomatous disease caused by Rhinosporidium seeberi, mostly affecting the nasal mucosa. Extranasal involvement is also reported involving eyes, oral cavity, and skin. Herein, we present a rare case of a patient with disseminated rhinosporidiosis who presented with pulmonary lesions which resembled metastasis.

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Breathlessness is a common presenting symptom in the emergency room. Focused history, clinical examination, and proper stepwise evaluations are essential for early diagnosis and treatment. The most common presenting feature of nCovid19 pneumonia is rapidly progressive breathlessness. During this pandemic, we need to differentiate nCovid19 pneumonia from other causes for breathlessness. Here, we discuss the differential diagnosis for rapidly progressive breathlessness, how to evaluate a patient with suspected nCovid19 pneumonia and the role of chest computed tomography scan in nCovid19.

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Pneumothorax is one of the most common emergencies encountered in day-to-day pulmonary practice. Early diagnosis and prompt intervention will reduce morbidity as well as mortality. The mainstay of treatment involves tube thoracostomy and drainage of pneumothorax in all except the mild cases. Proper technique and ascertaining correct tube position with follow-up imaging ensure successful lung expansion. We share the case of a gentleman who presented with nonexpansion of lung despite inserting 2 intercostal drainage tubes for the management of pneumothorax. Imaging with computed tomography thorax revealed both tubes to be coiled within the chest wall without entry into pleural space, thereby accounting for failed reexpansion. This case stresses the importance of following a structured evaluation in cases of nonexpanding lung after tube thoracostomy for pneumothorax.

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Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. Even with advancement in understanding the pathophysiology and various monitoring tools and treatment measures, sepsis still remains a major cause of mortality and morbidity in critically ill patients. Over the last three decades, significant changes were seen regarding understanding the pathophysiology of sepsis. The management of sepsis has evolved over the last two decades by the advent of the Surviving Sepsis Campaign Guidelines which recommends early recognition and prompt treatment without delay.

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Cryptococcus is a fungus that causes infections most commonly in immunocompromised patients. However, approximately one-third of cases of cryptococcosis are seen in patients who have no readily identifiable immune defects. Pulmonary cryptococcosis often manifests as isolated or multiple nodules, easily mimicking lung cancer clinically and radiologically. This case report highlights the tumor-like presentation of cryptococcosis in an immunocompetent patient.

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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.

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Tracheobronchial anomalies are often congenital and do not cause much symptoms to the individual. Majority of them are branching anomalies. Most of them are incidentally detected during bronchoscopy for unrelated diseases. However, rarely abnormal bronchi may present with symptoms. He we present two rare bronchial anomalies presenting with clinical symptoms attributed to them.

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Background and Objective: Extrapulmonary tuberculosis (EPTB) affects about 25% of patients presenting with Tuberculosis (TB). Tuberculous pleural effusion is the second-most common type of EPTB, after lymph node TB. Although the molecular TB diagnostics have lower turnaround time compared to traditional testing methods, the sensitivity in microscopy negative specimens are low. Higher cost and infrastructure requirements are other disadvantages. Truenat, developed by Mobilio diagnostics and validated by ICMR, is a rapid, polymerase chain reaction (PCR)-based diagnostic test to detect Mycobacterium Tuberculosis (MTB) and also rifampicin resistance. According to the WHO, the accuracy of Truenat is comparable to Xpert PCR. We report our experience in using Truenat for EPTB, specifically, pleural TB. Methods: We retrospectively analyzed data from thoracoscopy over the past 2 years. All data pertaining to the use of Truenat for TB in pleural fluid and thoracoscopic biopsy specimens, histopathology, and mycobacterial cultures were analyzed. Results: We had a total of 114 patients with undiagnosed pleural effusion who underwent thoracoscopy during the study. Forty-five patients (39%) had a diagnosis of TB, among the total 114 patients. The sensitivity of tissue Truenat was 51.11 (95% confidence interval [CI]: 35.77–66.30), tissue culture 37.50% (95% CI: 22.73–54.20), pleural fluid Truenat 20% (95% CI: 8.44–36.94), and fluid culture 14.29% (95% CI: 5.43–28.54). The specificities of all the confirmatory tests were 100% when compared to a reference standard which was taken as a combination of histology and culture as the reference standard with or without acid-fast bacilli in the histology samples. Tissue Truenat was significantly more sensitive than fluid Truenat (P < 0.05). Likewise, tissue culture was more sensitive than fluid culture (P < 0.05). Among all microbiology confirmatory tests performed, Truenat of pleural tissue had the highest yield (51.11). Conclusion: Thoracoscopic pleural biopsy Truenat results in improved sensitivity in cases of EPTB.

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Respiratory failure in a young adult presenting with community-acquired pneumonia usually suggests a diagnosis of acute respiratory distress syndrome (ARDS). Here, we discuss the case of a young female with pneumonia whose respiratory failure persisted despite treatment of pneumonia and ARDS.

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