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Pulmonary Lymphangitis carcinomatosis is an unusual metastatic manifestation of Oesophagogastric carcinoma and it occurs due to diffuse spread of the tumour to the pulmonary lymphatic system. We described a case of a 28 year old woman, presenting with gradually progressive dyspnoea and cough where results of Chest X-ray and HRCT thorax were consistent with features of Lymphangitis carcinomatosis. Upper GI endoscopic evaluation showed a tumour originating from oesophagogastric junction and extending to cardia of stomach. Biopsy from tumour revealed adenocarcinoma. As there is no definitive therapy to this condition, patient was managed conservatively only to succumb few days after hospitalisation. [ABSTRACT FROM AUTHOR]

Background: Bacterial infections are the most common reason for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This can range from self-limited disease to respiratory failure requiring mechanical ventilation and is associated with increased mortality and morbidity in survivors., Aim: To ascertain common antibiotics effective in AECOPD using sputum bacterial culture and antibiotic susceptibility testing. Materials and Methods: In the present cross-sectional observational study, we analysed the sputum antibiogram in 237 patients who had not received antibiotics in the past 48 hours. Statistical analysis was performed, and the χ 2 test was used to determine the associations between categorical variables. A P value ≤0.05 was considered significant., Results: Of 237 sputum samples, 77.2% were mucoid in nature, followed by purulent and mucopurulent sputum in 16.9% and 5.9% of cases, respectively. In the purulent/mucopurulent samples, 85.2% showed positive growth on culture compared to 35% of mucoid samples. Cultures grew single pathogens in 108 cases, and 2 grew multiple pathogens; in 127 cases, no pathogenic organisms were isolated. In all, 41 (37.96%) isolates grew Gram-positive and 67 (62.04%) grew Gram-negative organisms. The most effective antibiotic against Gram-negative bacteria was imipenem (50%) and that against Gram-positive bacteria was vancomycin (70.59%). All isolates were resistant to ampicillin., Conclusion: Sputum culture is a good and simple tool to study the aetiology and complications caused by bacteria in AECOPD. The antibiogram helps in identifying the correct treatment and timely initiation of appropriate antimicrobial therapy, thereby helping reduce mortality and morbidity., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

Context: Post Tubercular Obstructive Airways Diseases (Post-TB OAD) is a sequela of Pulmonary TB but diseases progression may not same like Chronic Obstructive Pulmonary Diseases (COPD)., Aim: To compare the frequency and severity of exacerbations, change of FEV1, frequency of hospitalization and mortality among COPD and post TB OAD patients., Setting and Design: Hospital-based prospective cohort study., Methods and Material: COPD cohort was diagnosed based on symptoms, history of exposure to risk factors and post bronchodilator FEV1/FVC ratio <70%. Post TB OAD cohort was diagnosed like COPD along with past history of Pulmonary TB. Both cohorts were followed up every 3-monthly intervals for up to 12 months., Statistical Analysis: Comparison of categorical variable was done by Chi-square test and continuous variable by unpaired t test. Longitudinal data of FEV1% were analyzed by repeated measure ANOVA test., Results: Totally, 68 patients with Post TB OAD and 66 COPD patients were taken into this study. The frequency of exacerbation (3.52 ± 1.84 verses 2.70 ± 1.37), number of severe exacerbation (56 verses 24) and frequency of hospitalization (1.37 ± 0.81 verses 0.97 ± 0.94) more seen in post-TB OAD cohort in compared to COPD cohort which is statistically significant. Mortality more seen in post-TB OAD group (14 verses 6). Rate of decline FEV1 per year more seen in Post-TB OAD (0.27 ± 0.28 lit verses 0.17 ± 0.26 liter) as compared to COPD. There was overall decreasing trend of FEV1% over period of 12 month but without any difference among two cohort., Conclusion: There was more in frequency of exacerbations, number of severe exacerbations, frequency of hospitalization and number of mortalities among post TB OAD compared to COPD., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Context: Biomarkers can be used for screening lung cancer and the clinician can decide for further invasive workup for diagnosis., Aims: To know the diagnostic sensitivity and specificity of Carcinoembryonic antigen (CEA) in Broncho Alveolar Lavage Fluid (BALF) and serum of bronchogenic carcinoma., Settings and Design: Case-Control study was conducted in the Medical College Hospital during a period of 2 years., Methods and Material: We randomly selected 50 cases and 50 controls subjects. Cases were the patients with proven malignancy by biopsy or cytology, and controls were other non-malignant pulmonary diseases. All patients' CEA of Broncho Alveolar Lavage Fluid and serum was done., Statistical Analysis: The mean and receiver operating curve were done for CEA of serum and BAL fluid, and based on the cut-off values, sensitivity and specificity were calculated., Results: Mean value of CEA in both BALF and serum in non-smoker patients of the malignant lesion was significantly higher than the non-malignant lesion. Mean value of CEA in both BALF and serum in smoker patients of the malignant lesion was higher than the benign lesion, but statistically not significant. The cut-off value for Serum CEA is 1μg/l, whereas for BALF CEA is 2μg/l. Sensitivity, specificity of CEA of Serum and BALF combined were 92% and 62% respectively., Conclusions: Determination of CEA in the BALF and serum may be helpful as a screening tool for further workup for malignancy., Competing Interests: There are no conflicts of interest.

Background: Infectious disease outbreaks following natural disasters are reported in literature. Outbreaks were documented following natural disasters in many countries including Haiti. Such possibility following 2015 Nepal earthquake was a public health concern. Risk factors needed evaluation by post-disaster outbreak investigation. Hence, present study was undertaken to investigate potentials for such outbreak and to generate evidence for public health intervention., Methods: The study was conducted between April - May, 2015, with the cooperation of National Public Health Laboratory, Epidemiology and Disease Control Division, Nepal Health Research Council and the Chinese team. Rapid Response Teams visited earthquake affected districts and collected samples for analysis. Syndromic surveillance approach was followed. Samples were collected from syndromic patients under supervision. Those sick prior to earthquake or receiving treatment were excluded. Blood, stool and throat swab samples, as indicated, were collected. Drinking water and food samples including captured live mosquitoes from inhabited areas were obtained for study with the help of EDCD. Laboratory analysis was performed at the NPHL., Results: Total samples were 360 (114 biological, 246 environmental). Salmonella spp. was detected in two and Varicella zoster in one blood sample. Influenza B virus was detected in one throat swab. Rota virus was detected in two, Shigella dysenteriae in one and Salmonella spp. in one stool sample. No pathogen detected in water or food samples. Mosquitoes tested negative for dengue virus., Conclusions: Post-earthquake outbreak investigated in disaster phase-2. Diarrheal, enteric fever pathogens and Influenza B virus were detected. Environmental samples tested negative for pathogens. Vigilance is necessary for other risk factors.

Introduction: Tuberculosis is a public health problem in developing countries and in spite of receiving adequate anti-tuberculous therapy, patients often continues to have several post-tuberculous sequelae, especially airflow limitation., Aim: To evaluate pulmonary function by spirometry among post-tuberculosis cases with airway obstruction and their relationship with smoking., Materials and Methods: All patients who presented to the pulmonary medicine Outpatient Department (OPD) with symptoms of obstructive airway disease and had completed adequate anti-tuberculous therapy for pulmonary tuberculosis were taken up for study. They were initially evaluated with sputum smear for Acid Fast Bacilli (AFB) and chest X-ray. Patients without evidence of active tuberculosis underwent spirometry and those having post-bronchodilator Forced Expiratory Volume in first second (FEV1)/ Forced Vital Capacity (FVC) FEV1/FVC<0.7 were taken up for final analysis. Spirometric parameters were compared between smokers and non-smokers., Results: Out of 138 finally selected cases, 84.06% were male and 71.01% were within age range of 40-69 years. Significant positive association was found between extent of radiologic lesion and severity of airflow obstruction. Purely obstructive pattern was found in 27.54% cases and 72.46% showed mixed pattern. Patients with mixed ventilatory abnormality had worse pulmonary function and poorer bronchodilator reversibility than patients with pure obstruction. Comparison of post-bronchodilator FEV1, FVC, Peak Expiratory Flow (PEF) and Forced Expiratory Flow (FEF) 25-75 between smokers and non-smokers did not show statistically significant difference., Conclusion: Majority of patients with post-tuberculous obstructive airway disease have associated restrictive component. But smoking did not cause significant alteration in pulmonary function among such patients.

A 59-year-old male smoker presented with persistent wheezing and occasional coughing that had been ongoing for two years and had been unsuccessfully treated with an inhalational β2 agonist, an anticholinergic and an inhalational steroid in the last year. On clinical examination, a left-sided wheeze was detected. The initial chest X-ray was normal. A computed tomography (CT) scan of thorax demonstrated a mass lesion in the left main bronchus. On subsequent bronchoscopy, an endobronchial polypoid mass was detected in the left main bronchus, completely occluding the bronchial lumen. A biopsy taken from the mass revealed features of bronchial carcinoid. Bronchial carcinoid can present uncommonly with wheezes, resulting in misdiagnosis as bronchial asthma or chronic obstructive pulmonary disease (COPD). If an asthma or COPD patient does not respond to conventional therapy, a CT scan and subsequent bronchoscopy is warranted.

A patient with clinical diagnosis of pulmonary tuberculosis and right sided hydropneumothorax found to have fistulous connection of pleura with oesophagus as evidenced by upper GI endoscopy and intrapleural instillation of radio-opaque dye. He was managed with intercostal chest tube drainage, antibiotics, antitubercular regimen and nasogastric tube feeding, resulting in eventless recovery subsequently.