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Introduction Lung cancer is the most common cancer, and it is the leading cause of cancer-related death. Smoking is the most common risk factor for the development of lung cancer. There is a lack of data on the comorbidities and outcomes of advanced non-small cell lung cancer (NSCLC) in the eastern part of India. This prospective study evaluated the impact of comorbidity scores on overall survival (OS) in these patients. Method This prospective cohort study was conducted on newly diagnosed advanced NSCLC patients between June 2020 and April 2021. These patients were given platinum-based doublet chemotherapy guided by histology and targeted therapy based on molecular studies. Comorbidities were assessed using the Charlson Comorbidity Index (CCI), Simplified Comorbidity Score (SCS), and Adult Comorbidity Evaluation-27 (ACE-27). The outcome assessed was OS. Overall survival was calculated in days from the date of start of anticancer therapy to the date of last follow-up or date of death. All enrolled patients were followed at regular intervals whenever they visited the hospital and telephonically until April 2022. The patients who were alive on April 30, 2022, were censored. The survival probability and median OS were calculated by Kaplan-Meier analysis, and group differences in comorbidity scores were analyzed with the log-rank test. A Cox proportional hazard analysis was performed to look for factors affecting overall survival. Results A total of 114 patients were enrolled in the study period, and the mean age of patients was 56.54 ± 11.03 years. Most of the patients were males (68.4%), and 52.6% were smokers. Adenocarcinoma was the most common histology (73.7%), followed by squamous cell carcinoma (25.4%). The median OS was 127 days (95% CI, 60-193 days). 33.4% of the patients had a CCI score of 0, a CCI score of 1 was seen in 57%, and ≥2 scores in 9.6%. SCS scores ≤9 and9 were seen in 92.1% and 7.9% of patients, respectively. The ACE-27 score was none in 41 subjects, mild in 59, moderate in 12, and 2 NSCLC subjects had severe ACE-27 scores. The median OS for patients with a CCI score of 0 was 275 days (95% CI, 7-543 days), 114 days (95% CI, 85-142 days) for subjects with a CCI score of 1, and 402 days (95% CI, 0-844 days) for patients with a CCI score ≥2 (log-rank p = 0.215). Individuals with an SCS score ≤9 had a median OS of 175 days (95% CI, 91-258 days), and the median OS was 92 days (95% CI, 80-103 days) for patients with an SCS score9 (log-rank p = 0.302). Median OS of the patients with ACE-27 score 0,1,2,3 were 297 days (95% CI, 76- 517 days), 117 days (95% CI, 81-152 days), 87 days (95% CI, 49-124 days) and 66 days, respectively (log-rank p=0.457). There was no statistical significance between comorbidity scores and OS. Worse OS was independently associated with poor performance status Eastern Cooperative Oncology Group (ECOG) ≥2 (hazard ratio [HR] 3.266; 95% CI 1.785-5.978; p = 0.00), neutrophil-to-lymphocyte ratio (NLR)3 (HR, 2.35 95% CI 1.18-4.702; p = 0.015) and patients who were given compassionate tyrosine kinase inhibitors (TKIs) (HR, 7.396 95% CI 3.531-15.490; p = 0.000). Conclusions In our study, the advanced NSCLC patients who were given chemotherapy or oral TKIs showed no significant influence of comorbidities on overall survival. Factors independently associated with the worst survival were poor performance status (ECOG ≥ 2), NLR3, and patients who were given TKIs on a compassionate basis.

In this retrospective observational study, we have performed a comparative analysis of the demographic, clinical and epidemiological characteristics of the HCWs affected with SARS-CoV-2 infection during first two waves in India. The overall prevalence of SARS-CoV-2 infection among HCWs was found to be 15.24% (14.20-16.33) and 23.38% (22.14-25.65) during first and second waves respectively. The second wave showed an adjusted odds ratio of 0.04(0.02-0.07) and 2.09(1.49-2.93) for hospitalization and being symptomatic, respectively. We detected significantly higher level of C-reactive protein (CRP) among admitted HCWs during the second wave (5.10 -14.60 mg/dl) as compared to the first wave (2.00 - 2.80 mg/dl). Our study found the relative risk of SARS-CoV-2 reinfection among HCWs during the second wave to be 0.68 [0.57-0.82

ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6–7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4–0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3–0.7)] were protected from in-hospital mortality.ConclusionsWHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.

ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n=3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6, 7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4, 0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3, 0.7)] were protected from in-hospital mortality.ConclusionsWHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.

BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in the electronic National Clinical Registry of COVID 19. We enrolled patients aged>18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.ResultsA total of 5865 patients, with mean age 56±15 years, with 3840/5865 (65.4%) men, were enrolled in the ICMR registry.. Overall mortality was 2535/5865 (43.5%). Non-survivors were older than survivors (58.2±15.4 years vs 53.6 ±14.7 years; P=0.001). Non-survivors had multiple comorbidities (n=1951, 52.9%) with hypertension (47.2%) and diabetes (45.6%) being the most common, higher creatinine (1.6 ± P=0.001, high D-dimer (1.56 vs 1.37, P=0.001), higher CT severity index (16.8±5.2 vs 13.5 ±5.47 ) compared to survivors. Non survivors had longer hospital and ICU stay (P=0.001). On multivariate regression analysis, high NLR (HR 1.017, 95% CI 1.005- 1.029, P=0.001), high CRP (HR 1.008, 95% CI 1.006- 1.010, P=0.001), high D dimer ((HR 1.089, 95% CI 1.065- 1.113, P=0.001) were associated with mechanical ventilation while younger age, (HR 0.974, CI 0.965-0.983, p=0.001), high D dimer (HR-1.014, CI 1.001-1.027, P=0.035) and use of prophylactic LMWH (HR 0.647, CI 0.527-0.794, p=0.001) were independently associated with mortality. ConclusionIn this large retrospective study of 5865 critically ill COVID 19 patients admitted to ICU, overall mortality was 2535/5865 (43.5%). Age, high D dimer, CT Severity score and use of prophylactic LMWH were independently associated with mortality.

Introduction Malignancy, tuberculosis, and non-tubercular pleural infections account for most exudative pleural effusion. Pleural fluid cytology, biochemical tests and even pleural fluid cell block studies may fail to yield a diagnosis in certain cases. Medical thoracoscopy is the gold standard for the diagnosis of unexplained pleural effusions. However, access to medical thoracoscopy may be limited, particularly in developing countries. Also, certain patients may not be fit to undergo the procedure because of medical conditions. An ultrasound-guided pleural biopsy is an option in such conditions. The present study is intended to compare the diagnostic yield and complications of both methods of pleural biopsy in undiagnosed exudative pleural effusion under a randomized controlled trial. Method After fulfilling all the inclusion criteria, participants were randomized to either ultrasound-guided closed pleural biopsy or thoracoscopic-guided pleural biopsy groups. The primary outcome was to compare the diagnostic yield of ultrasound-guided Tru-Cut® (Newtech Medical Devices, Faridabad, India) closed pleural biopsy versus thoracoscopic pleural biopsy, and the secondary outcomes were to compare the complications rate, duration of the procedure, and hospital stay in the patients undergoing ultrasound-guided pleural biopsy versus thoracoscopic pleural biopsy, and predictors of a positive biopsy result in both groups. Result A total of 118 patients with pleural effusion were screened; 39 of them who were eligible, randomized into the ultrasound group (20 patients) and the thoracoscopic group (19 patients). The median age of participants was 53.5 (50-58) years and 55 (45-64) years in the ultrasound and thoracoscopic groups, respectively. Pleural fluid cell count, protein, adenosine deaminase (ADA), and lactate dehydrogenase (LDH) were similar in both groups, although pleural fluid glucose was low in the ultrasound group. Diagnostic yield was 90% (18/20) and 94.7% (18/19) in the ultrasound and thoracoscopic groups, respectively, which was statistically non-significant (p=0.963). The median duration of hospital stay was 9.5 (5.3-27) days and 15 (12-22) days in ultrasound and thoracoscopic groups respectively. The thoracoscopic group had a more prolonged stay compared to the ultrasound group, but it was statistically non-significant (p=0.09). The duration of the procedure was significantly longer in the thoracoscopic group 90 (85-105) minutes, in comparison to ultrasound 47.5 (41.3-55) minutes (p=0.001). No major complications were seen in both groups. Subcutaneous emphysema was the most common complication in the thoracoscopic group (10%), followed by hemorrhage (5.3%), and respiratory failure (5.3%). Hypotension was the only complication in the ultrasound group (5%). The rate of complications was significantly higher in the thoracoscopic group (p0.01). Conclusion Ultrasound-guided closed pleural biopsy is as good as thoracoscopic pleural biopsy in undiagnosed exudative pleural effusion. It was associated with a shorter procedure duration, a shorter hospital stay, and fewer complications as compared to thoracoscopic biopsy. Both the procedures were safe in experienced hands and a hospital setup, but the thoracoscopic pleural biopsy was associated with complications.

A 70-year-old male presented with complaints of fever for 10 days; associated with dry cough for one week, gradually progressive shortness of breath for five days, and non-radiating chest pain for three days. Chest examination revealed bilateral basal crepitation, and cardiac examination showed muffled first heart sound with soft systolic murmur at apex. All severity markers of COVID-19 were elevated. Twelve lead electrocardiography (ECG) showed complete heart block. Troponin-I test was negative. High resolution computed tomography (HRCT) thorax showed extensive bilateral multifocal patchy and confluent areas of ground-glass opacities distributed along with peripheral subpleural and peribronchovascular regions with interlobular septal thickening suggestive of viral pneumonia .He was started on high flow oxygen, parenteral corticosteroids, and anticoagulants with antibiotics coverage. Injection Isoprenaline infusion was started for heart block, but the patient developed atrial flutter-fibrillation with premature ventricular complexes. The patient clinically improved and was discharged on the 11th day of admission. On follow up after 2 weeks, repeat ECG showed atrial fibrillation, and 2D Echocardiography revealed global hypokinesia, severe mitral regurgitation with left ventricular systolic dysfunction (ejection fraction of 28%), and dilated left ventricle and atrium. He was planned for coronary angiography after one month. High clinical suspicion, early diagnosis, and prompt treatment with corticosteroids can yield a favorable outcome. Follow up is necessary to rule out long term complications like viral cardiomyopathy.

Tuberculosis (TB), the leading infectious cause of death worldwide, like coronavirus disease 2019 (COVID-19), is mainly transmitted through the respiratory route and affects the lungs. Though TB-COVID co-infection is not common, but might be missed due to similar clinical presentation. Therefore, a high index of suspicion of co-infections is needed so that there is prompt diagnosis and appropriate treatment. A higher mortality of 13% in cases of co infections is alarming. Here we are reporting a case series of SARS-CoV-2 - TB co-infection from Eastern India.

Obstructive sleep apnea is characterized by intermittent hypoxia and sleep disruption, leading to accelerated neurodegenerative changes and cognitive decline. Serum amyloid-beta and tau proteins, which are markers for Alzheimer's disease, have been reported to increase in patients with obstructive sleep apnea. This study compared the serum levels of amyloid-beta proteins and tau proteins in 46 cognitively normal obstructive sleep apnea patients and 30 healthy controls. Sleep parameters and severity of obstructive sleep apnea were determined using overnight polysomnography. Serum levels of Aβ40, Aβ42, total tau and phosphorylated-tau were determined by enzyme-linked immunosorbent assay. Patients with obstructive sleep apnea had significantly higher median serum levels of Aβ40 (121.0 versus 78.3 pg ml

COVID-19 has an unpredictable course with substantial percentage of infected patients developing clinical deterioration and increasing health care burden. With no specific treatment or vaccination, the current search is for drugs that can limit the disease progression. Recently Fluvoxamine has been reported to have disease modifying effects in COVID-19. We suggest the hypothesis that short term routine use of Selective Serotonin Reuptake Inhibitors (SSRIs) can prevent clinical deterioration of asymptomatic or mild COVID-19 cases by the following ways: a) anti-inflammatory actions through sigma-1 agonism and reducing release of pro-inflammatory cytokines, b) anti-coagulant action by reducing platelet aggregation, c) specific antiviral and antibacterial effects, d) Immunomodulation through Serotonin pathway and anti-oxidation. The routine short term use of SSRIs can also alleviate the psychological impact of the disease. We hope our hypothesis will encourage future clinical trials to validate the routine use of SSRIs against COVID-19.

A 20-year old female presented to our department with complaints of sudden-onset dyspnea and right-sided chest pain for the last month [...]

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is routinely performed for diagnostic evaluation of mediastinal lymphadenopathy due to various etiologies with excellent sensitivity and specificity. Melioidosis can have atypical features like isolated mediastinal lymphadenopathy mimicking as tuberculosis or lymphoma. Differentiation of such atypical melioidosis presentation become difficult due to similar clinical, radiological and even similar EBUS lymph node characteristics. Role of EBUS TBNA in diagnosing melioidosis is under investigated and sparsely reported. We describe two cases of melioidosis diagnosed by point of care rapid lateral flow immunoassay antigen testing and culture of EBUS-TBNA samples from necrotic mediastinal lymph nodes.

Introduction: The COVID-19 pandemic has caused unprecedented crisis in the care of non-Covid patients all across the globe and care for lung cancer patients is no exception Lung Cancer patients are at increased risks of COVID due to increased mortality from dual aggressive pathology in the lungs Our aim was to examine the impact of COVID-19 on lung cancer therapy and factors responsible delay in optimal care during the pandemic Methods: This study included all patients with a diagnosis of lung cancer being treated at our Institute, a tertiary level referral hospital in eastern part of India during on going pandemic Seven developed COVID-19, confirmed by RT-PCR method (Table 1) Results: The mean age of the patients was 49 years All the patients had metastatic lung cancer All males had history of smoking Hypertension was present in only one patient Four patients (57%) died from concomitant COVID-19 at our institution Three patients who recovered from COVID were stable One of them (positive for ROS1) was switched over to Crizotinib and other patient resumed chemotherapy only after he had recovered from COVID-19 Most of the patients acquired COVID-19 infection during the process of evaluatio/chemotherapy and that further delayed the treatment [Formula presented] Conclusion: The results were disappointing because more than half of lung cancer patients died due to COVID-19 The disease course of COVID-19 has been more severe in patients with lung cancers with Chemotherapy There have been delay in resuming treatment among survivors by few weeks Fear of aggressiveness of disease was the key factor for interruption or delay in chemotherapy Other variable factors like stage of cancer, palliative intent of chemotherapy, ECOG status were key determinants for interruption of treatment The decision to temporarily suspend chemotherapy while waiting for recovery from SARS-CoV-2 and then restart, was not easy due to the risk of cancer progression The findings amplify the importance of optimizing of lung cancer care in the context of the COVID-19 prevalence The decisions need to be taken on the basis of individual cases rather than rely on a generalized approach In resource limited country like India diverting the existing resources to an emergency leads to compromise of routine outpatient care, especially patients with chronic illness We need to be flexible in restarting of services guided by local COVID prevalence, while awaiting a definite management plan for COVID-19 Keywords: lung cancer, India, COVID-19, SARS-CoV-2

Introduction: Additional yield of Cell block over cytology in endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is under-evaluated. Aims and Objectives: To determine the diagnostic yield and sample adequacy for molecular analysis of cell block over cytology in EBUS-TBNA. Method: Single-centre cross-sectional study was done in adults undergoing EBUS-TBNA (PENTAX EB-1970UK, ECHO HD 22G needle) over last one year. Sample was processed as cytology and additional cell block using tissue coagulum clot method1. Continuous and categorical variables are described as mean ± SD and proportions respectively. Result: Of the 62 EBUS-TBNA performed, either cytology or cellblock was diagnostic in 50 patients (yield 80%). Both cytology & cellblock was available in 47 patients (mean age 51.25±12.8 years, 36 males) whose data is analysed for this study. On an average three passes were made per lymph node. The overall daignostic yield was 92% (23/25 patients) in metastatic lymphadenopathy and in 53.3% cases cellblock had added benefit of definite histology subtyping using immunohistochemistry and judged to be adequate for molecular analysis in 80% cases. Among patients with granulomatous lymphadenitis, overall yield was 85% (17/20 patients) and cytology alone was sufficient for diagnosis in 15 (75%) patients whereas additional 2 (10%) cases were diagnosed by cell block. Conclusion: Cellblock preparation of EBUS-TBNA sample should be routine to increase the diagnostic yield and for further molecular testing. Reference: 1. Yung RCW, Otell S, Illei P, Clark DP. Cancer Cytopathol. 2012; 120(3):185–195.

Tubercular splenic abscess is rare, particularly in immunocompetent patients. Diagnostic difficulties usually arise in patients with tubercular splenic abscess because of its non-specific presentation. We report an elderly male who presented with cough and fever and had pulmonary infiltrates suspicious of tuberculosis. Bronchoalveolar lavage microbiology including XpertMTB/Rif assay was non-contributory. Contrast enhanced computed tomography scan of abdomen revealed multiple non-enhancing lesions in the spleen. Ultrasound guided splenic aspirate revealed pus that was positive for Mycobacterium tuberculosis in XpertMTB/Rif assay confirming the diagnosis of tuberculosis.

Introduction: COVID-19 pandemic has led to reconsider the traditional management approach in lung cancer Oral tyrosine kinase inhibitors (TKIs) are being preferred in oncogene addicted advanced non-Small Cell Lung Cancer Methods: A young never-smoker woman presented with left hilar mass with left pleural effusion in February 2020 There was an incidental detection of thrombus in right main and descending pulmonary artery She was diagnosed to have ROS1 rearranged advanced NSCLC with pulmonary embolism She was initiated on conventional chemotherapy with carboplatin and pemetrexed along with anticoagulation After fourth cycle of chemotherapy, although there was clinical improvement attributed to reduction of amount of effusion and disappearance thrombus, RECIST 1 1 criteria suggested the progression of disease in view of appearance of adrenal metastasis Meanwhile, she had a history of high risk exposure with a patient of COVID- 19 in July 2020 Although she was asymptomatic, RT- PCR for SARS-COV2 came out to be positive Results: She remained asymptomatic for next 10 days during hospitalization Then she was started on Crizotinib and was discharged with advice on further follow up Conclusion: Although patients on cancer chemotherapy are at high risk of severe COVID-19 diseases, asymptomatic cases can happen The patients preferably should be shifted to or started on oral TKIs as per available expert recommendations Keywords: ROS1, COVID-19, TKI

We report a case of empyema due to Enterococcus faecium in a 50-year-old woman with no apparent severe immune system impairment, except for underlying thyroid disorder and hypochromic anaemia. Appropriate antibiotic therapy with parenteral amoxicillin-clavulanate with gentamicin, tube drainage and other supportive therapy resulted in a favourable outcome and the patient was discharged after 3 weeks of hospitalization. Though uncommon, the possibility of Enteroccus species should be kept in mind as a causative agent of thoracic empyema, especially in adults presenting from the community.

Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.

Introduction Scoliosis is defined as a lateral curvature of spine greater than 10 degrees as measured by the Cobb method. Idiopathic scoliosis is the most common form of scoliosis and adolescent idiopathic scoliosis is the commonest presentation which is detected after 10 years but prior to skeletal maturity. The treatment depends on the measurement of Cobb's angle and subsequent exercises, bracing and surgery. Case report A 13 years girl presented with idiopatic scoliosis, pes cavus and hand knee gait which incapacitated her ambulation. Her spine radiograph revealed thoracic scoliosis with apex T8. She was given Boston brace with corrective exercises for scoliosis both in and out brace and a pair of floor reaction AFO's with modifi cations in footplate for pes cavus. There was signifi cant improvement in the gait and posture of the girl and she started going to school after a few months. Conclusion Conservative management in the form of bracing can prevent curve progression and floor reaction AFO's can indirectly affect the remote body segments and improve gait and posture.

Background: In non-small cell lung cancer common driver mutations such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) are usually mutually exclusive. This study aimed to elucidate the concurrence of EGFR mutation and ALK rearrangement in eastern India patients with primary lung adenocarcinoma and assess the response of EGFR tyrosine kinase inhibitor (TKI) therapy after 6 months in primary lung adenocarcinoma. Methods: We retrospectively analyzed 198 adenocarcinomas for EGFR and ALK mutations. EGFR and ALK tests were done by real-time polymerase chain reaction and immunohistochemistry (IHC) techniques, respectively. Radiological response was assessed by Response Evaluation Criteria in Solid Tumors (version 1.1). Results: EGFR/ALK co-alteration was found in 4 adenocarcinoma patients. All were males with advanced disease. Younger patients had exon 19 deletion whereas older ones showed exon 21 mutation. The initial option of ALK-TKI in all four patients was excluded straightaway due to the high-cost burden of ALK-TKI. Two of them showed a partial response while other two had stable disease after 6 months of EGFR TKI therapy. Conclusion: EGFR/ALK co-alterations in adenocarcinomas albeit rare do exist. The challenge of monetary hurdle in developing countries with ALK TKI therapy can be handled by giving only EGFR TKI in these cases of concomitant mutations. Future perspective in research could be finding an agent with the potential of dual inhibition of ALK and EGFR.

A 40-year-old male presented with progressive breathlessness and hoarseness of voice. He denied any history of chest pain, cough, haemoptysis, palpitations or paroxysmal nocturnal dyspnoea. He was a smoker with 10 pack-year of smoking. His medical illness includes long-standing hypertension of 10 years duration controlled with oral amlodipine and atenolol. Previous echocardiography showed dilated and hypertrophied left ventricle with severe systolic dysfunction. At presentation, he was fully conscious with vitals as follows: heart rate 124/min, respiratory rate 34/min and blood pressure 110/70 mm Hg. All peripheral pulses were well felt. Chest examination revealed diminished movement of left hemithorax, reduced vocal resonance and breath sound with shift of mediastinum to right. Posteroanterior chest radiograph showed an opaque left hemithorax and a large retrocardiac opacity (arrows) with contralateral shift of mediastinum (figure 1A). Ultrasonography of thorax showed a large mixed echogenic lesion …

Introduction: Prevalence of tobacco smoking continue to increase in developing nations despite huge economic loss, high morbidity, mortality or regulatory acts to curb tobacco smoking. Aims and objectives: To assess level of exposure among tobacco smokers, understand their social background, behaviour pattern, awareness regarding risks of smoking and feasibility of introducing early smoking prevention programs. Methods: A cross-sectional study where adult patients with respiratory ailments attending Pulmonary Medicine department of a premier tertiary level hospital were interviewed using a structured questionnaire including parameters like socio-demographic data, awareness about hazards of smoking, willingness and benefits of quitting smoking. All required investigations were done, the data tabulated and analysed statistically. Results: Among the 58 patients enrolled, mean age was 53.5 years (SD:13.9). Education level of the subjects were school drop outs(29.3%), 10 th standard(27.6%), graduates(19%) and illiterate(12.1%). 53.4% were current smokers, 48% mild smokers, 12.1% heavy smokers. Among 40 regular smokers, 32.5% became regular at >22 years, 30% at 18-21 and 25% at 14-17 years of age. 95% of smokers knew it is harmful, 32.7% admitted they never bothered to read the statutory warning, 69% understood the meaning of the statutory warning, 25.8% did not have any knowledge about passive smoking. Associated respiratory ailments were COPD(63.7%), Asthma(10.3%), tuberculosis(8.6%), lung cancer(1.7%). Conclusion: Adolescents are most vulnerable to fall prey to clutches of tobacco smoking and should be primarily targeted for early smoking prevention programs including raising the education level.

A 30-year-old male, carpenter by profession, presented with a history of dry cough and progressive shortness of breath for two months along with right-sided chest pain for one and a half months. The clinico-radiological picture was suggestive of right-sided massive pleural effusion. Computed tomography (CT) scan of the thorax showed a huge mediastinal mass occupying the entire right hemithorax with very small amount of pleural effusion. CT-guided fine needle aspiration cytology and tru-cut biopsy from the mass both revealed small round-cell tumour, possibly small cell carcinoma of the lung. However, on immunohistochemistry tumour cells expressed Mic-2 and it was consistent with a diagnosis of primitive neuroectodermal tumour.