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Endobronchial tuberculosis (EBTB) is characterized by tuberculosis infection of the tracheobronchial tree. It has variable presentation but tumorous growth-like presentation in bronchus is very rare. The clinical and radiological features are non-specific, which creates a diagnostic dilemma. Bronchoscopy and biopsy of the lesion are mandatory to confirm the diagnosis. In this case series, we are presenting three unique cases of endobronchial growth diagnosed as EBTB after biopsy and evaluation of bronchoalveolar lavage (BAL) with cartridge-based nucleic acid amplification test (CBNAAT) and other ancillary investigations for tuberculosis. Four patients presented to the outpatient department with non-specific symptoms of fever, cough, hoarseness of voice, and hemoptysis. They were evaluated with chest radiograph (CXR), contrast-enhanced computed tomography (CECT) thorax, and bronchoscopy. Bronchoscopy revealed growth in the bronchus in all three cases. A biopsy was taken and BAL was performed. All cases turned out to be EBTB in histopathological examination and BAL CBNAAT. They were treated with anti-tubercular drugs and all responded well to treatment. Endobronchial tuberculosis presenting as tumorous growth in the tracheobronchial tree is rare. There should be a high index of suspicion while dealing with patients with non-specific clinical and radiological features of tuberculosis. EBTB can be misdiagnosed as malignancy in most cases. Therefore, it should be kept as a differential diagnosis while encountering a mass lesion in the trachea or bronchus during bronchoscopy.

Introduction: Coronavirus Disease-2019 (COVID-19) had devastating effects on the healthcare and economic sector worldwide. India stands second in the list of most number of COVID-19 cases. Most of the deaths due to COVID-19 were seen in patients with associated co-morbidities like hypertension, diabetes, chronic kidney disease and obesity. This study would like to examine specific co-morbidities in relation to the COVID-19 disease progression and outcomes. Aim: To compare the clinicoradiological profile and outcome of COVID-19 in patients with and without co-morbidities (diabetes and hypertension). Materials and Methods: The present observational, cross-sectional study was conducted at Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh between June 2020 to September 2020, after obtaining Institutional Ethics Committee (IEC) approval. A total of 148 patients with COVID-19 were included in the study. The COVID-19 patients admitted in the hospital were divided into four groups as those having only diabetes, only hypertension, both diabetes and hypertension, and those without any co-morbidities. Those with any other co-morbidity were excluded from the study. The general clinical characteristics, laboratory parameters, disease severity, morbidity and mortality were compared among various groups and the data was analysed. Categorical data were analysed using the Chi-square test. Results: A total of 148 patients with COVID-19 were included in the study, of which 26 patients were diabetic, 36 were hypertensive, 24 were both hypertensive and diabetic and 62 patients did not had any significant co-morbidity. Severe COVID-19 disease was most commonly observed in those with diabetes 14 (53.8%). The highest proportion of patients requiring oxygen (84.6%) and Non Invasive Ventilator (NIV) support (46.1%) was also seen among diabetics. The presence of diabetes, severe disease and leukocytosis at presentation increased the risk of mortality. The association of hypertension with COVID-19 does not seem to affect the in-hospital mortality. Conclusion: The COVID-19 in diabetics is associated with both increased risk of severe disease and increased odds of death. In diabetics, those with uncontrolled diabetes were more prone to severe disease and death than those with good glycaemic control. Hypertension, on the other hand, showed no association.

Introduction: Bronchial hyper-responsiveness is the manifestation of excessive bronchoconstriction in response to diverse types of stimuli both physical and chemical. It is the most characteristic feature of bronchial asthma; it also occurs in a spectrum of other diseases like Chronic Obstructive Pulmonary Disorders (COPD) and reactive airway syndrome and may be provoked by a variety of stimuli like histamine and methacholine. Patients of healed pulmonary Tuberculosis (TB) show varying extent of lung impairment such as fibrosis, collapse, emphysema and broncho alveolar destruction. Aim: To assess the incidence and severity of obstructive airway diseases in previously treated TB patients. Materials and Methods: This was a prospective case control study, carried out in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from September 2017 to September 2019, this study included 120 patients of previously treated TB, who were divided into two groups. The case group (71) included patients who completed treatment for TB and had dyspnoea. The control group (49) consisted of patients who completed the treatment but did not have dyspnoea. The patients were subjected to spirometry, histamine bronchial challenge test and computed chest tomogram along with routine investigations including sputum for Acid Fast Bacilli (AFB). Results: The present study showed significant histamine hypersensitivity among post TB patients. In the case group, 34 (56%) patients showed positive response to bronchial challenge test with histamine; while in control group only 7 (14%) showed a positive response (p-value=0.004). Pulmonary function test (spirometry) showed an obstructive pattern in 35 (49%) case group patients, while normal pattern was the most common finding seen in 23 (47%) in the control group followed by obstruction in 10 (21%) patients. Among the cases, the mean Forced Expiratory Volume in the first second (FEV1) was 65.77±15.98, while among the controls, it was 80.02±8.81. The case group had a mean Forced Expiratory Volume in the first second/Forced Vital Capacity (FEV1/FVC) of 78.09±15.75, as against 81.33±16.79 in the control group. Conclusion: Airway bronchial hyper-reactivity is a prominent feature in previously treated tubercular patients. This underlines the need for proper attention towards post-tubercular lung function impairment and proper treatment of such patients so as to lessen the impact of bronchial hyper-reactivity on patient symptoms and their quality of life.

Context: India has 18% of the global population and an increasing burden of chronic respiratory diseases. The prevalence of Metabolic syndrome (MS) was found to be as high as 39.7% among Indian population. Metabolic syndrome is found to be more common in Chronic Obstructive Pulmonary Disease (COPD) when compared to the general population. This study was done to assess the prevalence of metabolic syndrome in COPD and the association of systemic inflammation in COPD patients with metabolic syndrome. Methodology: This study enrolled 150 consecutive consenting patients of stable COPD attending the outpatient pulmonology department. Detailed history, clinical examination, spirometry, and relevant routine laboratory investigations including complete blood count, fasting blood sugar, and lipid profile were done. In addition, hsCRP, Serum lactate and Vitamin D level was assessed in all patients. Diagnosis of COPD and Metabolic syndrome was done according to GOLD guidelines, 2018 and the International Diabetes Federation criteria respectively. Result: The prevalence of metabolic syndrome was found to be 27.3% in our COPD patients. The frequency of metabolic syndrome in GOLD stage I, II, III, and IV was 75%, 32%, 17%, and 13.5%, respectively. Logistic regression analysis showed a significant relationship of blood leucocyte count (OR = 0.342, CI = 0.171-0.686), hs-CRP (OR = 0.020, CI = 0.003-0.122), pack years (OR = 1.083, CI = 1.026-1.14) and vitamin D levels (OR = 1.219, CI = 1.093-1.359) with metabolic syndrome in COPD patients. Conclusion: Metabolic syndrome is a co-morbidity that is very often overlooked in patients of COPD. Systemic inflammation which is a common characteristic of both COPD and Metabolic syndrome has been found to be an important contributor towards cardiovascular morbidity and mortality.

Context: The global scenario of illness is shifting from infectious diseases to non-communicable diseases, with chronic conditions such as heart diseases, stroke and Chronic Obstructive Pulmonary Disease (COPD) now being chief causes of death globally and more than 90% of deaths due to COPD occur in low and midline income countries.[1] Low serum vitamin D level is associated with various lung diseases and decreased lung function.[2] Aims: This study was designed to study the serum vitamin D level and its correlation with severity of COPD as assessed by spirometry, COPD assessment test (CAT) and exercise capacity and BMI of COPD patients. Settings and Design: Observational cross sectional study conducted on patients of COPD attending the outpatient department. Materials and Methods: One hundred sixty consecutive patients of COPD attending the outpatient Department were included in the study. Pack years, CAT score, 6 minute walk distance, post bronchodilator spirometry values and BMI was recorded along with complete history and physical examination. Statistical Analysis Used: Data analysis was done using IBM SPSS 23 software. Descriptive statistics, Independent sample t test, ANOVA and Pearson correlation were applied. Results: A significant positive correlation was found between FeV1% of predicted and serum Vitamin D level(r = 0.291; P < 0.001). A negative correlation was found between serum Vitamin D level and severity of COPD as assessed by CAT score (r = -0.355; P < 0.001). Also, a significant positive correlation was found between vitamin D levels and exercise capacity as assessed by 6 minute walk test (6MsWT) (r = 0.648; P < 0.001). Conclusions: COPD patients with more severe disease tend to have lower serum Vitamin D levels. As it is an immunomodulator affecting various inflammatory pathways, it is imperative that we give due consideration to Vitamin D levels in managing patients of COPD.

Localizing small damages often requires sensors be mounted in the proximity of damage to obtain high Signal-to-Noise Ratio in system frequency response to input excitation. The proximity requirement limits the applicability of existing schemes for low-severity damage detection as an estimate of damage location may not be known a priori . In this work it is shown that spatial locality is not a fundamental impediment; multiple small damages can still be detected with high accuracy provided that the frequency range beyond the first five natural frequencies is utilized in the Frequency response functions (FRF) curvature method. The proposed method presented in this paper applies sensitivity analysis to systematically unearth frequency ranges capable of elevating damage index peak at correct damage locations. It is a baseline-free method that employs a smoothing polynomial to emulate reference curvatures for the undamaged structure. Numerical simulation of steel-beam shows that small multiple damages of severity as low as 5% can be reliably detected by including frequency range covering 5–10 th natural frequencies. The efficacy of the scheme is also experimentally validated for the same beam. It is also found that a simple noise filtration scheme such as a Gaussian moving average filter can adequately remove false peaks from the damage index profile.

Pulmonary involvement is common in patients with systemic sclerosis. The most common underlying histology is Non Specific Interstitial Pneumonia (NSIP). Disrupted immunity from the disease or associated medication may render such patients prone to develop tuberculosis infection. A 55-year-old female patient presented with chief complaints of shortness of breath from past five years which was gradually progressive, cough initially dry later with minimal expectoration, low grade fever from past two months. She also gave history of bluish discolouration of fingers tips on exposure to cold water. On examination there was restrictive mouth opening, thickened skin over hands, forearm, face, neck and trunk on pinching. Sclerodactyly was present with clubbing grade 2. On auscultation bilateral fine crepts were present. Serum ANA was highly raised and Scl 70 was positive. PFT was suggestive of restrictive ventilatory abnormality. Sputum smear for AFB was found to be positive. HRCT thorax was suggestive of NSIP. Patient was put on antituberculer treatment under DOTS category 1; nifedipine, pentoxyphylline and nitroglycerine gel was started for raynauds phenomenon. Chemotherapy for systemic sclerosis was given with cyclophosphamide infusion in six cycles every four weeks.

Introduction: Traditional viva voce lacks objectivity, reliability and validity. Structured viva voce on the other hand has all these qualities. If introduced from the beginning of the course, it will impart an educational impact to the students. Aim: To develop structured oral viva voce for BDS first year students. Compare the marks obtained by traditional viva voce examination with the marks obtained by structured viva voce examination. To analyse the perception of students and faculty towards structured viva voce examination. Materials and Methods: Topic wise structured viva cards were prepared and validated by four subject experts. A total of 29 students were divided into four groups and each group faced the structured as well as traditional viva voce examination. Marks obtained in both the exams were compared. Feedback was taken from students as well from faculty by 5-point Likert scale questionnaires. Results: The marks scored by students in structured and conventional viva were Group A (n=8) 7.11±0.78, 5.67±0.86 (p=0.0001); Group B (n=7) 7.29±0.75, 5.29±1.12 (p=0.001); Group C (n=7) 8.43±0.53, 7.43±0.53 (p= N.S); Group D (n=7) 8.00±0.89, 6.16 ±1.47 (p=0.002) respectively. The variation in marks ranged from 4 to 8 in conventional and 6 to 9 in structured viva voce. Students and faculty also accepted structured viva voce well. Conclusion: The structured viva voce is a better assessment tool. Marks scored and student’s feedback was favorable towards Structured Viva Voce and they found it more objective, student friendly and felt more confident. Faculty also appreciated it as a better scoring method.

Patients with laryngeal cancer have a high risk of developing lung cancer in the future. A patient presented with a complaint of left-sided chest pain for the last 3 months. Chest X-ray posterior-anterior view showed a homogeneous opacity in the left upper lung field with elevation of the diaphragm on the left side. CECT thorax revealed a heterogeneously enhancing soft tissue density mass lesion in the superior segment of the lingular lobe. On histopathological examination of the mass lesion, it was diagnosed as adenocarcinoma of the lung. About 10 months previously, the patient was treated for a laryngeal squamous cell carcinoma. Patients with laryngeal cancer should be routinely screened during follow-up with chest X-ray or CT scan for the early detection of lung cancer.