Indian Journal of Chest Diseases & Allied Sciences
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Item A Case of Difficult to Diagnose Intrathoracic Mass(Jaypee Brothers Medical Publishers Pvt. Ltd., 2025-03) Tapadar, SR; Nath, A.Lung masses are often frequently linked to neoplasm, but they can pose diagnostic challenges due to their varied etiologies, especially in tuberculosis (TB)-endemic regions like India, where infectious causes must not be overlooked. Here, we present a case of a 70-year-old ex-smoker male with symptoms susceptive of lung malignancy, including hemoptysis, chronic cough, shortness of breath, and chest pain. His hematological investigations were within normal limits, and imaging studies showed a solitary space-occupying lesion in the right-upper lobe. Multiple diagnostic attempts, including computed tomography-guided fine-needle aspiration cytology (FNAC) and bronchoscopy, were inconclusive. The patient was discharged upon request and advised for regular follow-up. However, upon follow-up visit, symptoms were not improved, and the patient was re-admitted for further work-up. This time, Mycobacterium tuberculosis was finally identified in bronchoalveolar lavage fluid and repeat FNAC material. Notably, the patient exhibited isoniazid monoresistant tuberculosis. The diagnosis of tuberculoma was confirmed, emphasizing the importance of considering TB when evaluating a lung mass, especially in high-prevalence areas. Collaboration between specialties and comprehensive microbiological testing proved pivotal in reaching an accurate diagnosis and initiating appropriate treatment. This case underscores the complexity of diagnosing TB when it mimics malignancy, necessitating a thorough diagnostic approach, continued monitoring, and follow-up for optimal patient management.Item Lung Abscess Caused by Chromobacterium violaceum: An Unusual Presentation(Jaypee Brothers Medical Publishers Pvt. Ltd., 2025-03) Yazhini, Y; Upadhya, P; Joseph, CG.Background: Chromobacterium violaceum is a Gram-negative coccobacilli that usually produces the pigment violacein; however, infections caused by non-pigmented strains are rarely reported. Case description: A 32-year-old male taxi driver presented with fever and hemoptysis for 3 weeks. He developed respiratory failure requiring oxygen support and was newly diagnosed with type II diabetes mellitus. Empirical antibiotics were started for suspected community-acquired pneumonia. High-resolution computed tomography of the thorax revealed bilateral multilobar cavities with air-fluid levels. Diagnostic aspiration yielded frank pus, which was sterile on culture. Pus, sputum, and blood cultures were all negative. A bronchoalveolar lavage (BAL) was also sterile, with CBNAAT negative for Mycobacterium tuberculosis. Serum procalcitonin was elevated, indicating septic shock. Despite treatment with Piperacillin-tazobactam, the patient had persistent fever spikes, leading to an escalation to Meropenem. A chest X-ray showed a right lower zone cavity with an air-fluid level. Ultrasound of the thorax showed bilateral “C-profiles” with increased echoes. Frank pus was aspirated and sent for culture. Suspecting abscess rupture with pyopneumothorax, pigtail catheterization was performed. Repeat culture using the VITEK system identified C. violaceum. The patient was treated with sensitive antibiotics for 21 days, after which his respiratory failure resolved. Discussion: Chromobacterium violaceum is associated with soft tissue infections, but necrotizing pneumonia leading to sepsis is rare. Uncontrolled diabetes mellitus in this patient likely contributed to an immunocompromised state. The non-pigmented strain required automated cultures for identification. Conclusion: This case emphasizes considering C. violaceum in immunocompromised patients with lung abscesses and highlights the need for prompt treatment. Clinical significance: A high degree of clinical suspicion, followed by sampling with advanced techniques, is required for the diagnosis of this notorious organism, C. violaceum.Item Rare Case of Pneumomediastinum with Pneumopericardium and Subcutaneous Emphysema(Jaypee Brothers Medical Publishers Pvt. Ltd., 2025-03) Gupta, S; Saini, RP; Porwal, YC; Burman, S.Pneumomediastinum, which refers to the presence of air in the mediastinum, typically occurs in association with an underlying lung disease. Pneumopericardium is presence of air or gas in the pericardial cavity. Pneumopericardium most commonly results from trauma (in approximately 60% of the reports). A thin built 17-year male without any previous history of chronic illness presented with complaints of throat pain, fever, cough with expectorant (white), decreased appetite, shortness of breath, retrosternal chest pain on inspiration and weight loss. On cardiac auscultation, crunching sound synchronous with heartbeat was audible (Hamman's crunch sign). Chest X-ray was suggestive of pneumomediastinum, pneumopericardium and subcutaneous emphysema. Patient was started on IV and oral antibiotics, antitubercular medication, and oxygen support with nonrebreather oxygen mask. At the time of discharge, his cough, chest pain and shortness of breath had subsided, his appetite had improved, he had gained 3 kg body weight, and repeat CXR showed significant resolution of pneumopericardium.Item Eclectic Approach to Dysphagia Management in COPD Patients: A Quasi-experimental Study(Jaypee Brothers Medical Publishers Pvt. Ltd., 2025-03) Chatterjee, N; Chatterjee, I; Kumar, S; Das, DBackground: This study aimed to investigate the effects of an eclectic, tailor-made swallowing therapy program on individuals with chronic obstructive pulmonary disease (COPD) and dysphagia. The subjects were assessed using various clinical and instrumental measures before and after the therapy sessions. Materials and methods: A quasi-experimental design was employed, and 152 COPD subjects (75 males and 77 females) aged between 40 and 65 years were selected through purposive sampling from a time period of June 2023 to October 2024 at B.P. Poddar Hospital & Medical Research LTD., Kolkata. Baseline assessments included pulmonary function tests, spirometry profiles, and subjective evaluations. Objective assessments involved pulse oximetry, the Mann Assessment of Swallowing Ability (MASA), cervical auscultation, and fiberoptic endoscopic evaluation of swallowing (FEES). The therapeutic intervention consisted of 15 sessions of individualized therapy, targeting respiratory strength, oromotor coordination, and swallow reflex. Results: Pretherapy assessments revealed moderate dysphagia and aspiration in the participants. Following the therapy program, significant improvements were observed in oxygen saturation levels, MASA scores, cervical auscultation findings, and PAS scores obtained from FEES. The posttherapy MASA scores indicated no dysphagia, demonstrating a statistically significant improvement compared to the pretherapy scores. The cervical auscultation findings showed controlled coordination between respiration and swallowing, decreased airway secretions, and improved respiratory-swallow patterns. Fiberoptic endoscopic evaluation of swallowing results indicated a reduction in penetration and aspiration, with decreased residue and improved swallow reactions. Conclusion: The swallowing therapy program resulted in significant improvements in swallowing function and respiratory-swallow coordination in individuals with COPD and dysphagia. These improvements were observed through various objective assessments, highlighting the effectiveness of the therapy program in enhancing swallowing safety and efficiency.Item Clinical Effectiveness of Triple Drug Therapy Combination Containing LABA, LAMA, and ICS Given for 12 Weeks in NS-COPD Patients(Jaypee Brothers Medical Publishers Pvt. Ltd., 2025-03) Gaude, G; Jena, P; Patil, B; Hattiholi, J; Suresh, G.Background: Non-smoking chronic obstructive pulmonary disease (NS-COPD) poses unique challenges due to its distinct etiologies, such as environmental and occupational exposures. The clinical evidence on the effectiveness of triple-drug therapy, long-acting ?2-agonist (LABA), long-acting muscarinic antagonist (LAMA), inhaled corticosteroid (ICS) in NS-COPD remains limited. Objective: To evaluate the clinical effectiveness of triple-drug therapy in NS-COPD patients. Materials and methods: A 12-month prospective observational study was conducted among NS-COPD patients treated with a single dry powder inhaler containing LABA, LAMA, and ICS combination (Fluticasone/Formoterol/Glycopyrrolate) for 12 weeks in a tertiary care hospital. The key parameters that were studied included spirometry, 6-minute walk distance(6MWD), COPD assessment test (CAT) score, St. George Respiratory Questionnaire (SGRQ), Modified Medical Research Council grading, body-mass index, obstruction, dyspnea and exercise (BODE) index, and occupational history. Results: Significant improvements were observed across all parameters after 12 weeks of therapy. Forced expiratory volume in 1 second improved from 62.3% ± 4.1 to 68.7% ± 3.9% predicted (p < 0.001), and 6MWD increased from 320.5 ± 45.2 to 365.7 ± 43.8 m (p < 0.01). The CAT score decreased significantly (18.4 ± 3.6 to 13.2 ± 3.1, p < 0.001), while SGRQ scores showed notable improvement (52.5 ± 6.7 to 44.2 ± 6.1, p < 0.001). Occupational exposure analysis indicated a significant correlation with the severity of COPD disease. Conclusion: Triple-drug therapy significantly improves respiratory functions, exercise capacity, and quality of life in NS-COPD patients, highlighting its clinical utility in this subset of patients. Further studies are warranted to study its long-term effects on exacerbations and mortality benefits.Item Effect of Carbohydrate-rich and Fat-rich Diet on Exercise Tolerance and Gas Exchange in Stable COPD Patients: A Randomized Controlled Trial(Jaypee Brothers Medical Publishers Pvt. Ltd., 2025-03) Subramanian, B; Saka, VK; Govindaraj, V; Selvarajan, S; L, MSBackground and objectives: Malnutrition in chronic obstructive pulmonary disease (COPD) is linked to poor exercise tolerance. As there is limited data on the effect of dietary changes in COPD, this study aimed to evaluate the effect of 2-week dietary intervention on exercise tolerance measured by distance covered in 6-minute walk test (6MWT), Borg dyspnea scale, and gas exchange parameters like minute ventilation (MV), volume of maximal exhaled carbon dioxide (VCO2max), volume of maximal oxygen consumption (VO2max,) VO2/kg, and respiratory quotient (RQ) in stable COPD patients. Methods: This randomized controlled trial was conducted on 90 stable COPD patients randomized into three groups (control group, fat-rich diet group, and carbohydrate-rich diet group) as 1:1:1 ratio, and individualized diet plan for 2 weeks was tailored and issued by the dietitian based on the data obtained from the diet history. Six-minute walk test and cardiopulmonary exercise testing were repeated after 2 weeks of dietary intervention and compared with baseline. All the statistical analyses were carried out at 5% level of significance, and p-value less than 0.05 was considered to be significant. Results: The baseline mean 6MWT had no significant difference between the groups. The overall mean increase in the 6MWT distance after the dietary intervention was 6.9 meters, with no statistically significant difference between groups in both the 6MWT (p = 0.23) and Borg dyspnea scale (p = 0.56). The RQ analysis revealed a significant difference in postintervention RQ between control and carbohydrate-rich diet groups (p = 0.02). But other gas exchange parameters had no significant difference between the groups. Conclusion: In this study we concluded that the exercise performance, indicated by 6-minute walk distance (6MWD), did not improve across the groups regardless of the dietary composition with no significant differences between the groups. However, the high-carbohydrate and low-fat diet significantly increased the RQ but had no significant effect on other gas exchange parameters and exercise performance.Item Prevalence of Co-infection during SARS-CoV-2 Pandemic and Association with Respiratory Infections(Jaypee Brothers Medical Publishers Pvt. Ltd., 2025-03) Khanna, M; Saini, S; Manocha, N; Goel, N.Background: The diagnostics infrastructure experienced a bottleneck during the COVID-19 pandemic. Most qPCR-based diagnostic settings have primarily aimed at detecting SARS-CoV-2 to isolate the cases and contain the spread of infection. As the number of SARS-CoV-2 cases, which shares a similar transmission mode with other common respiratory viruses surged at alarming rate. The worldwide trend showed a sharp decline in the cases of other respiratory viruses, including influenza A virus. The study aims to evaluate the circulation of different respiratory viruses in the positive and negative samples for SARS-CoV-2, collected from symptomatic individuals. Methods: The RT-qPCR-based detection assays for SARS-CoV-2 viral RNA were used in all the clinical samples collected from the symptomatic individuals. In addition, a qPCR-based diagnostic kit evaluated the prevalence of other respiratory viruses in randomly selected positive and negative samples. Results: Out of 4,123 nasopharyngeal samples tested, 622 were found to be positive for SARS-CoV-2 viral RNA, indicating an overall positivity rate of 15.0%. Among these positive cases, four samples exhibited co-infection with other respiratory viruses. Notably, 34% of the samples that did not contain SARS-CoV-2 were instead found to be infected with other respiratory viruses. Conclusion: Our findings reveal that respiratory viruses, apart from SARS-CoV-2, continue to be widespread in the community. Moreover, the SARS-CoV-2 virus infection is not mutually exclusive, indicative of co-infection with other respiratory viruses. The prevalence of the influenza A virus is also notably high. Therefore, our data suggest that multiplexed-qPCR detection assays could also be employed to screen patients presenting flu-like symptoms for other respiratory viruses.Item Tuberculosis and Leprosy: A Rare Case of Dual Mycobacterial Infection(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Guliani, A; Thukral, G.Leprosy and tuberculosis (TB) share geographic endemicity. The degree of cross-immunity of one against the other makes coinfection an uncommon clinical encounter. Here, we report a 35-year-old male patient who presented with a history of fever and cough for a month. He had ulnar claw deformity and multiple hypopigmented lesions since childhood. Chest radiograph showed left middle zone airway opacification and HR-CT revealed left lingular consolidation. Cartridge-based Nucleic Acid Amplification Test (CBNAAT) confirmed Mycobacterium tuberculosis and ulnar nerve biopsy confirmed borderline leprosy. The patient had no predisposing factors for TB other than the underlying leprosy. The dual infection was approached with WHO-recommended antitubercular treatment along with dapsone, clofazimine, and prednisolone for leprosy. Prednisolone was gradually tapered and discontinued, while the other medications were maintained. The patient’s overall health showed improvement on follow-up. The possibility of concomitant leprosy and TB must be considered by the clinicians to obtain an accurate clinical diagnosis, advise a comprehensive management plan, and avoid treatment-related complications.Item A Hidden Rarity: Incidental Posterior Mediastinal Neurofibroma with Middle Mediastinal and Lung Parenchymal Extension in a 20-year-old Male with Neurofibromatosis Type 1(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Paul, B; Upadhya, P; Nadaf, Z; Ganesh, RN.Neurofibromatosis type 1 (NF1) is a rare genetic disorder characterized by multiple benign tumors of the nerves and skin, known as neurofibromas. Mediastinal involvement in NF1, particularly with anatomical extension to both posterior and middle mediastinum along with extension into lung parenchyma, is an uncommon occurrence. Here, we present the case of a 20-year-old male with a known history of NF1 who was incidentally found to have a mediastinal mass during a pre-surgical fitness evaluation. Histopathological analysis confirmed the mass to be a neurofibroma. This case highlights the importance of considering neurofibromas in the differential diagnoses of mediastinal masses in patients with NF1, even when they are asymptomatic. The potential risk for malignant transformation into a malignant peripheral nerve sheath tumor (MPNST) warranted surgical intervention and hence the patient was referred to a thoracic surgeon.Item Diffuse Large B-cell Lymphoma Presenting as Empyema: A Case Report and Review of Literature(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Rasheeka, VP; Jain, S; Agarwal, S; Bajad, P; Pahuja, S; Khanna, A.Aim and background: Non-Hodgkin lymphoma (NHL) is the most common hematological malignancy, and diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype. It is a highly aggressive B-cell lymphoma resulting in the clonal proliferation of a germinal or post-germinal malignant B cell. The diagnosis is confirmed by biopsy of the affected node/extra-nodal site. Pleural involvement in lymphoma has a diverse presentation; however, presentation as an empyema, as in our case, has not been reported previously. Case description: We present a very rare case of a young, previously healthy female patient who presented with a right-sided pleural collection, who was initially suspected to have empyema due to characteristic findings on ultrasonography and pleural fluid appearance. Her pleural fluid cytology revealed atypical cells and was later diagnosed with an underlying anterior mediastinal mass confirmed to be DLBCL. Conclusion: Empyema may be the first harbinger of malignancy, especially in young immunocompetent patients. Timely diagnosis may be challenging but it improves the prognosis of such patients. Clinical significance: In a TB-endemic country like India, a patient with empyema poses a diagnostic dilemma. Cytology/biopsy and immunohistochemistry aid in diagnosis in such cases. Imaging also plays a key role in tumor staging, therapeutic planning, and follow-up of patients.Item A Case of Complex Airway Foreign Body: Areca Nut(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Malegaonkar, SK.Tracheobronchial foreign body (FB) aspiration to date has been described in terms of types of FB, their myriad of presentations, diagnostic evaluation, tools, and techniques for their management in various case reports and systematic reviews. However, FB extraction in some cases may be difficult due to the nature of FB, the clinical state of the patient, the unavailability of adequate tools, and the surrounding tissue response to FB. We would like to bring out the terminology of complex FB to describe the above-mentioned scenarios. In the following paper, we have enumerated one such case of complex FB based on its nature and its subsequent management.Item Comparative Study of Frailty Phenotype and Short Physical Performance Battery for Frailty Assessment in Chronic Obstructive Pulmonary Disease(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Dutta, S; Goel, N; Kumar, R.Aim and background: Frailty is a multidimensional syndrome of physical and cognitive impairments predisposing patients to increased risk of hospitalizations and poorer health-related quality of life. We conducted this study with the aim of comparing the frailty phenotype (FP) and short physical performance battery (SPPB) methods for the assessment of frailty in chronic obstructive pulmonary disease (COPD). Materials and methods: This is a descriptive cross-sectional study conducted in 150 stable COPD patients. Frailty was assessed using the FP and SPPB methods, followed by a comparative evaluation of the two methods. Results: The prevalence of frailty was 51.33% (n = 77) by the FP method and 21.33% (n = 32) by SPPB. Frail patients in both groups had the lowest post-bronchodilator forced expiratory volume in 1 second (FEV1) (%) (p < 0.0001). The median St. George's Respiratory Questionnaire (SGRQ) score was highest in the Frail group by the FP method [43.21 (32.116–58.338)] and pre-frail group by SPPB [43.47 (30.913–59.02)] (p = 0.007). The association between FP and SPPB was significant but with poor inter-rater kappa agreement (0.196, p = 0.0001). Frailty phenotype method showed a significant positive correlation, whereas SPPB had a significant negative correlation with duration of dyspnea (r = 0.3; r = –0.269), frequency of exacerbations (r = 0.498; r = –0.548), mMRC score (r = 0.525; r = –0.408), CAT score (r = 0.478; r = –0.52) and pack-years of smoking (r = 0.301; r = –0.278). Six-minute walk test (6MWT) distance had a significant association with frailty (p < 0.0001) by both methods. Conclusion: Frailty phenotype is a more sensitive method of frailty assessment in COPD compared to SPPB and correlates better with the severity of the disease. However, both methods showed a significant positive correlation with distance covered in 6MWT. Clinical significance: The FP and SPPB both identified a group of stable COPD patients with frailty. Our study underscores the importance of early identification and timely intervention to prevent deconditioning of muscular and cardiovascular systems which can otherwise progress to frailty.Item A Perspective on Alternative Forms of Tobacco(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Nagaraja, R; Ather, I; Minoshka, T; Kumar, S.Tobacco use is a global epidemic. Smoking claims more than 8 million lives annually across the globe. Further, it even poses a threat to nonsmokers who are exposed to cigarette smoke. Tobacco is most commonly used in the form of cigarette smoking across the world. The COVID-19 pandemic has impacted smoking habits, leading to visible differences in smoking rates. The current paper highlights and discusses alternative forms of smoking. Undoubtedly in the recent years, there is an advent of forms of alternative smoking, and a variety of tobacco products have been gaining popularity beyond traditional cigarettes. These products are preferred widely by the youth. Noteworthy to mention, these alternatives raise concerns about potential health risks and addiction. There is a paucity of research on the impact of alternative form tobacco usage on human health. The paper will provide an impetus for the researchers to explore further on the perspective of alternative forms of tobacco. It will also provide some essential leads to implement measures to mitigate the impact of alternative forms of tobacco usage on human health.Item An Endobronchial Aspergilloma Concealing Metastatic Renal Cell Carcinoma of the Bronchus: A Case Report(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Rai, DK; Singh, NK.Aspergillus is a saprophytic fungus that causes various respiratory illnesses in humans, depending on their immune status. It often manifests as saprophytic growth in pre-existing lung lesions termed aspergilloma or as allergic diseases in atopic individuals. It may also lead to persistent chronic inflammation known as chronic pulmonary aspergillosis in individuals with pre-existing pulmonary diseases or to angioinvasive infections in immunocompromised patients. Endobronchial aspergilloma (EBA) is an uncommon clinical entity characterized by the noninvasive colonization of Aspergillus in the bronchus, typically occurring in cases of pre-existing endobronchial lesions or malignancies, as reported in the literature. Here, we present a case of a middle-aged male who was initially diagnosed with EBA through endobronchial cryobiopsy. However, further cryobiopsy of the deeper area and cryoextraction of the entire tissue growth revealed the presence of underlying metastatic endobronchial renal carcinoma. Therefore, whenever EBA is identified, we should consider the possibility of underlying or coexisting malignancies.Item To Study the Association of Serum Uric Acid Levels with Severity of Chronic Obstructive Pulmonary Disease(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Sarin, BC; Grover, S; Singh, P.Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes airflow obstruction which leads to hypoxia. Serum uric acid is increased in hypoxic states as well as in systemic inflammatory conditions. The purpose of the present study was to assess whether the higher value of serum uric acid corresponds with the severity of COPD as per spirometric classification of COPD. Material and methods: This cross-sectional study included 294 spirometry-diagnosed patients of COPD as per Global Initiative for Chronic Obstructive Lung Disease criteria. Serum uric acid levels were tested on all the patients. The patients with raised serum uric acid levels were further categorized according to severity COPD grade. Reference of normal serum uric acid levels among males was taken as 3.5?8.5 mg/dL and among females as 2.5?6.2 mg/dL. Results: In the present study of 294 patients, maximum patients, i.e., 59.5%, were in moderate COPD grade. The mean serum uric acid value in male subjects was 5.9 ± 2.066 mg/dL, while in female subjects the mean serum uric acid value was 6.31 ± 1.93 mg/dL. About 85 (22 males and 63 females) had serum uric acid values out of the normal range. In males, maximum (41.6%) were in severe COPD grade, whereas in females maximum (80.8%) were in moderate COPD grade. Severe COPD grade showed statistically significant (p = 0.037) association with raised serum uric acid levels in both male and female subjects. Conclusion: The study concludes that mean uric acid levels progressively increased as the COPD grade increased from I to IV. Since serum uric acid levels were raised in COPD patients mainly in the severe COPD grade, it serves as a useful parameter for assessing disease severity and hypoxemia in known COPD patients.Item To Study the Efficacy of FF/VI Combination in Adult Asthma Patients(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-12) Sarin, BC; Grover, S; Aulakh, JK.Background: Long-acting beta2-agonists (LABA) and inhaled corticosteroids require twice daily administration for effective treatment of bronchial asthma. This study aims to study the efficacy of fluticasone furoate/vilanterol (FF/VI) ICS/Ultra-LABA once-daily combination therapy in patients with bronchial asthma. Materials and methods: This prospective observational study included 120 spirometry-diagnosed patients of bronchial asthma who were given FF/VI combination therapy and underwent follow-up at 2, 4, and 8 weeks of therapy. Patients were assessed during the follow-up period for the efficacy of therapy based on spirometric values. Results: In the present study 61.7% were females and 38.3% were males. The commonest presenting symptom was cough present in 95% of patients followed by wheezing which was seen in 93.3% of patients and shortness of breath in 89.17% of patients. At 8 weeks of continuous therapy, only 5% of patients had a cough, 8.33% had wheezing and only 2.5% complained of shortness of breath. Forced expiratory volume (FEV) in one second (FEV1) at baseline, was 56.60 ± 1.26, and by the end of 8 weeks, it increased to 90.36 ± 11.38. Forced vital capacity (FVC) at baseline was 64.83 ± 12.63 and it increased to 91.8 ± 1035 at 8 weeks. Forced expiratory volume in one second (FEV1)/FVC at baseline was 63.31 ± 4.90 and it increased to 74.59 ± 3.19 at 8 weeks. Forced expiratory flow (FEF) 25–75% at baseline was 35.42 ± 14.74, and at 8 weeks of continuous therapy, it increased to 76.35 ± 8.85 and all these values were statistically significant (p < 0.05). The spirometric mean values were highly significant (p < 0.001) in between 2–4 weeks and 4–8 weeks. Conclusion: Therapeutic continuity of FF/VI combination therapy is significantly effective in improving both symptoms and spirometric values in bronchial asthma patients. The safety profile and improvements in lung function irrespective of dosing time (morning or evening) strongly emphasize strict adherence to continuous once-daily use of the inhaler FF/VI to fully reverse the condition.Item Physicians' Perspectives and Practice Patterns in India on the Diagnosis and Treatment of Interstitial Lung Disease (IN-ILD Survey)(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-06) Rajan, Sujeet K; Meshram, Sushant; Chhajed, Prashant; Mehta, Monali; Lopez, Meena; Gogtay, JaideepAim and background: Data on clinicians’ views and practice patterns regarding interstitial lung disease (ILD) management in India is currently lacking. The objective of this survey was to understand clinicians’ perspectives on the diagnosis and treatment of patients with ILDs. Materials and methods: This was a questionnaire-based survey conducted among clinicians attending continuing medical education programs on ILDs across India in February 2020. Data entry and statistical analysis were done for completed questionnaires and results are expressed in terms of percentages based on the number of responses obtained. Results: A total of 321 clinicians managing ILDs participated in this survey, of which 87.75% were pulmonologists. Chronic hypersensitivity pneumonitis was ranked as the most common ILD seen in clinical practice, followed by idiopathic pulmonary fibrosis (IPF), connective tissue-ILD, and sarcoidosis. In total 43% of respondents preferred a combination of clinical evaluation, high-resolution computed tomography, and serology for ILD diagnosis. In the case of a planned biopsy, transbronchial lung biopsy (50.17%) was most preferred for idiopathic interstitial pneumonia. For follow-up, spirometry (86.60%) and a 6-minute walk distance (78.19%) were the most commonly performed tests. Antifibrotics (63.42%) were the preferred treatment for IPF while steroids either alone or in combination with immunosuppressants were preferred for non-IPF ILDs. Only 50% of respondents opined that pirfenidone 1800 mg/day and above was tolerated by over 45% of their IPF patients. Conclusion: Management of ILD has improved significantly in India. Antifibrotic dosing remains suboptimal in IPF. In non-IPF ILDs, a significant number of clinicians now use alternative immunosuppressants to steroids.Item Pulmonary MALT Cell Lymphoma Mimicking as ILD(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Gupta, Rishabh; Prajapat, Deepak; Singh, Kanishka K; Prakash, Anupam; Talwar, DeepakAim and background: The aim is to illustrate the diagnostic challenge posed by pulmonary mucosa-associated lymphoid tissue (MALT) cell lymphoma, which can mimic interstitial lung disease (ILD). Representing 0.5–1% of lung neoplasia cases, primary pulmonary lymphomas, particularly MALT lymphomas, present diagnostic challenges due to varied imaging features and lack of specific biological markers. This case report highlights the diagnostic complexities when pulmonary MALT cell lymphoma mimics ILD, emphasizing the need for accurate histopathological confirmation. Case description: A 50-year-old female initially diagnosed and treated for ILD based on radiological findings, presented with worsening breathlessness and a dry cough. Examination revealed fine crackles in both lung fields, and imaging indicated reticular opacities suggesting ILD. Laboratory tests showed elevated serum lactate dehydrogenase and a positive ANA in autoimmune profiling. Despite treatment, symptoms worsened. Subsequent transbronchial biopsy confirmed pulmonary MALT cell lymphoma, prompting Rituximab therapy after multidisciplinary consultation. Conclusion: This case underscores the challenge of distinguishing between pulmonary MALT cell lymphoma and ILD solely based on radiological similarities. Accurate histopathological diagnosis through biopsies is pivotal in managing such cases effectively. Multidisciplinary collaboration facilitated a precise diagnosis and appropriate therapy, emphasizing its crucial role in managing complex conditions. Clinical significance: The case demonstrates the diagnostic complexity of differentiating pulmonary MALT cell lymphoma from ILD, stressing the necessity of histopathological confirmation. An accurate diagnosis significantly influences therapy prognosis and highlights the indispensable role of multidisciplinary collaboration in managing such rare cases.Item Atypical Presentation of Lepidic Adenocarcinoma Lung in a Healthy Female: A Case Report(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-03) Yadav, Sapna; Chandra, MithileshAim: To report unusual clinical and radiological presentation of adenocarcinoma in a healthy female. Background: Adenocarcinoma is the most common subtype in nonsmokers. The radiological presentation may range from solitary nodules to large masses and multilobar consolidations. In the present case, radiological presentation mimicked miliary tuberculosis but it turned out to be lepidic adenocarcinoma on further evaluation. Lepidic adenocarcinoma is characterized by the proliferation of tumor cells along the lines of alveolar walls with or without evidence of stromal, vascular, and pleural invasion. Case description: A 60-year-old female patient with no known comorbidities presented to the outpatient department with nonspecific complaints of mild chest and abdominal discomfort and uneasiness. Chest X-ray showed diffuse multiple numerous randomly distributed sharply marginated nodules in bilateral lung parenchyma suggesting the possibility of miliary nodules, and small air space consolidation in both upper lobes. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy was performed. Investigations for Tuberculosis, Fungal, and Bacterial infections were negative. Transbronchial lung biopsy histopathology and immunohistochemistry (IHC) [Napsin A and cytokeratin 7 (CK-7)] revealed features suggestive of primary minimally invasive adenocarcinoma lung – lepidic type. The patient was referred to the medical oncology department. Conclusion: Adenocarcinoma lung is the most common subtype of non-small lung cancer. Clinical and radiological presentation can mimic other infective or nonmalignant diseases. A high index of suspicion and further evaluation is required in concerned patients to identify it at the earliest.Item A Case of Mediastinal Lymphoma that was Missed on EBUS-TBNA but Correctly Diagnosed after EBUS-TBCNB(Jaypee Brothers Medical Publishers Pvt. Ltd., 2024-09) Rai, Deependra K; Singh, Niraj K; Vinay, VEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a breakthrough in diagnosing mediastinal diseases. However, it is less sensitive in diagnosing some mediastinal diseases, where diagnosis largely depends on a larger tissue sample with preserved tissue architecture, such as lymphoproliferative diseases of the mediastinum. Another newer approach, endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy (EBUS-TBCNB), can overcome the limitations of EBUS-TBNA and provide larger samples with preserved tissue architecture. Here we present a case of an elderly female with multiple mediastinal lymphadenopathy who underwent EBUS-TBNA two times, despite adequate sampling, the diagnosis remains inconclusive. We were only able to make a diagnosis of mediastinal lymphoma after EBUS-TBCNB under conscious sedation. Endobronchial ultrasound-guided transbronchial mediastinal cryonodal biopsy is a safe and effective procedure that can be used in the successful diagnosis of mediastinal pathologies where EBUS-TBNA remained inconclusive, or it may be used as a combined procedure with EBUS-TBNA in cases of diagnostic uncertainty.