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Various pulmonary diseases, both benign as well as malignant, manifest in the form of endobronchial lesions on bronchoscopy. Malignancy is frequently the provisional diagnosis in the mind of a chest physician undergoing an endobronchial biopsy. Other benign diseases, however, may present similarly on bronchoscopy and computerized tomography (CT) scan. This observational study was conducted to better understand why there is such a wide range of endobronchial lesions with even more diverse radiological and pathological presentations. The research was carried out at the Department of Respiratory Medicine, Himalayan Institute of Medical Science (HIMS), Swami Ram Nagar, Dehradun. Subjects were recruited from HIMS, Dehradun patients over a 12-month period (August 2020 to July 2021). The study included patients (over the age of 18) who had a fibreoptic bronchoscopy and were found to have an endobronchial lesion. After a thorough history, examination, and application of the inclusion and exclusion criteria, 120 patients were enrolled. The majority of patients were between the ages of 56 and 65, with males outnumbering females. The majority of the patients were smokers, and the most common complaint was shortness of breath. Poorly differentiated carcinoma and squamous cell carcinoma were the most common endobronchial lesions in men, while small cell carcinoma was the most common in women. A mass lesion was the most common radiological finding, followed by mediastinal lymphadenopathy, and an exophytic lesion was the most common endobronchial lesion detected in bronchoscopy. We looked at the diseases that cause endobronchial lesions and their clinicoradiological and histopathological profiles. This study clearly demonstrates the importance of studying the histopathological profiles of patients with endobronchial growth, which can mimic malignancy in rare cases. [ABSTRACT FROM AUTHOR]

Introduction: Pleural effusion is a typical extrapulmonary cause of Tuberculosis (TB). The routine culture experiences an absence of affectability. Numerous markers in pleural fluid are assessed to analyze tubercular pleural fluid, yet no one is perfect. We have contemplated Adenosine deaminase (ADA), protein (CRP C - responsive) and Lymphocyte/Neutrophil (L/N) ratio in amalgamation for the determination of pleural effusion of tubercular origin. Material & Methods: All patients presented with pleural effusion were put through thoracentesis and differentiated into transudative and exudative using Light's criteria. Patients with exudative pleural effusion aetiology were further bisected into two groups with a sample size of 30 patients. Group I consisted of patients with tubercular cause, and Group II comprised other than tubercular. ADA, CRP and L/N ratio of these subjects were estimated in pleural fluid. The sensitivity, specificity and predictive values were calculated. Results: The ADA, CRP, and L/N ratio's sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 83.3%, 90.0%, 89.29%, 84.37%, 76.67%, 90.0%, 88.46%, 79.41%, 96.67%, 43.33%, 63.04%, and 92.86%. The conjunction of ADA and CRP exhibited the highest specificity for pleural effusion caused by Tuberculosis; however, both ADA and CRP showed comparable specificity on their own. Conclusions: Diagnosing tubercular from non-tubercular individuals was made easier with the help of Pleural fluid ADA and CRP. Combining ADA, CRP, and L/N ratio does not offer any significant advantages beyond just combining ADA and CRP. [ABSTRACT FROM AUTHOR]

Laryngeal tuberculosis (TB) is not a very common laryngeal pathology, therefore it can be easily missed. Laryngeal TB and Cancer of Larynx can have similar clinical presentations. Here we discuss a case of a 57-year-old female presenting in outpatient department with complaints of Hoarseness of voice since 6 months and shortness of breath since 3 months. Patient was further evaluated and diagnosed as a case of laryngeal tuberculosis. Treatment was started with fixed dose anti tubercular drugs and patient showed improvement on follow up. [ABSTRACT FROM AUTHOR]

Introduction: Iatrogenic Cushing's syndrome develops due to chronic exposure to excess glucocorticoids and is associated with increased morbidity and mortality if it remains unrecognized and untreated. Cushing's syndrome resulting from long-term use of exogenous glucocorticoids is the commonest cause of iatrogenic Cushing's syndrome. In India, cases of iatrogenic Cushing's syndrome are commonly encountered, owing to the steroid abuse for respiratory conditions and chronic pains along with poor access to health care. Method and materials: This study was conducted in the Department of Respiratory Medicine, Himalayan Institute of Medical Science (HIMS), Swami Ram Nagar, Dehradun. Over a period of 12 months, subjects were recruited from the patients presenting to HIMS, Dehradun" with the primary diagnosis of obstructive airway disease after taking written informed consent. Result: After a detailed history and examination and applying the inclusion and exclusion criteria, 384 consecutive patients diagnosed with Obstructive airway "disease were enrolled. Demographic data was recorded. Diagnosis of Iatrogenic Cushing syndrome was made on the basis of history of use of glucocorticoids and clinical examination. Most of the patients in the study population were > 60 years of age (34.29%) There was a male predominance in our study with 243 (63.28%) males and 141 (36.72%) females. Smoking was the major risk factor for COPD in comparison to biomass fuel, present in 85.05% and 15.95%, of patients respectively. Conclusion: In our study, prevalence of iatrogenic Cushing syndrome in obstructive airway disease was 7.81%. This study highlights role of screening for iatrogenic Cushing syndrome in patients with obstructive airway disease with early intervention to prevent the side effects of chronic indiscriminate use of steroids. [ABSTRACT FROM AUTHOR]

Sarcoidosis is an idiopathic, noncaseating granulomatous disorder with wide systemic involvement. Lungs, eyes, and skin are the organs most commonly affected. Bone involvement, which is very rare, was reported as present in 3 to 13% of affected cases. Here we present a case of young female with ribs, vertebrae and pulmonary involvement, lesion mimicking as metastasis or tuberculosis thus emphasizing the importance of differential diagnosis. [ABSTRACT FROM AUTHOR]

Anti-tuberculosis medications can cause various side effects, including drug rash. When a patient on anti-tuberculosis treatment (ATT) develops rash, we usually stop all medicines, rechallenge the patient with medications individually, and find the offending agent. It should be mentioned that drug rash can be also a manifestation of other diseases. Herein, we report a case of tuberculosis who developed rash while on ATT regimen but was later diagnosed to be concomitantly suffering from leprosy. [ABSTRACT FROM AUTHOR]

Chronic cough and chest pain should be dealt seriously in a young adult. Sometimes we may miss a diagnosis in such patients. We present a case of Pulmonary Langerhans Histiocytosis who presented with complaints of cough and chest pain. [ABSTRACT FROM AUTHOR]

The granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a pauci-immune vasculitis involving small- and mediumsized blood vessels. Classically, the patients inflicted with this disease present with a triad of necrotizing granulomatous inflammation of the respiratory tract, cutaneous necrotizing vasculitis, and glomerulonephritis (GN). The antinuclear (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) are considered as relatively specific markers of the disease. Herein, we presented the case of a patient who initially presented with sepsis but did not respond to the conventional antibiotics and later diagnosed with GPA. [ABSTRACT FROM AUTHOR]

Background: Tracheobronchomalacia (TBM) refers to a condition in which structural integrity of cartilaginous wall of trachea is lost. Excessive dynamic airway collapse (EDAC) is characterized by excessive invagination of posterior wall of trachea. In both these conditions, airway lumen gets compromised, especially during expiration, which can lead to symptoms such as breathlessness, cough, and wheezing. Both these conditions can be present in obstructive lung diseases; TBM due to chronic airway inflammation and EDAC due to dynamic compressive forces during expiration. The present study was planned with the hypothesis that TBM/EDAC could also produce expiratory wheeze in patients with obstructive airway disorders. Hence, prevalence and factors affecting presence of this entity in patients with obstructive airway diseases were the aims and objectives of this study. Materials and Methods: Twenty-five patients with obstructive airway disorders (chronic obstructive pulmonary disease [COPD] or bronchial asthma), who were stable on medical management, but having persistent expiratory wheezing, were included in the study. They were evaluated for TBM/EDAC by bronchoscopy and computed tomographic scan of chest. The presence of TBM/EDAC was correlated with variables including age, sex, body mass index (BMI), smoking index, level of dyspnea, and severity of disease. Results: Mean age of the patients was 62.7 ± 7.81 years. Out of 25 patients, 14 were males. TBM/EDAC was found in 40% of study subjects. Age, sex, BMI, severity of disease, frequency of exacerbations and radiological findings etc., were not found to have any association with presence of TBM/EDAC. Conclusion: TBM/EDAC is common in patients with obstructive airway disorders and should be evaluated in these patients, especially with persistent expiratory wheezing as diagnosis of this entity could provide another treatment option in these patients with persistent symptoms despite medical management. [ABSTRACT FROM AUTHOR]

Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47). Malignancy was diagnosed histopathologically in 70.2% (33/47) patients (both primary & metastatic pleural carcinoma) and tuberculosis in 10.6% (5/47). There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion. [ABSTRACT FROM AUTHOR]