Background: To estimate the prevalence of asthma-chronic obstructive pulmonary disease (COPD) overlap among patients of asthma and COPD and to compare its frequency in both groups. Materials and methods: About 200 patients presenting to the out patient department (OPD) and in patient department (IPD) between April 1, 2021 and July 31, 2022 were enrolled and inquired about their symptoms. History regarding smoking, biomass fuel exposure, old pulmonary tuberculosis or a family history of obstructive airway disease was obtained. All these patients performed spirometry and based on GINA-GOLD guidelines, they were diagnosed as asthma, COPD, or asthma-chronic obstructive overlap (ACO). Results: About 125 patients out of a total of 200 were known cases of COPD while 75 were known cases of asthma. Post-spirometry, 112 patients were diagnosed as COPD (56%), 59 as asthma (29.5%) and 29 were labeled as ACO (14.5%). From a total of 125 COPD patients, 13 had ACO which is 10.4%. In contrast out of 75 asthma patients 16 had ACO which is 21.33%. Asthma and ACO patients belonged to a younger age group and COPD patients were older (p-value < 0.001). A male predominance was found among ACO patients with 21.8% of total male patients being diagnosed as ACO while only 5.6% of females were labeled as ACO (p-value 0.001). Conclusion: Asthma-chronic obstructive overlap patients are underdiagnosed and frequently mislabeled as either asthma or COPD. These patients have a male predominance and are younger as compared with COPD patients. Spirometry should be done in all patients having symptoms of obstructive airway disease to make a final diagnosis.

Background: The surge in income levels coupled with reduced drug costs has contributed to a notable escalation in the utilization of antibiotics among individuals, consequently fostering the emergence of antibiotic resistance. Despite the detrimental effects of antibiotic resistance on patient outcomes, there exists a significant gap in global research, particularly in middle- and low-income countries. Hence, we aimed to evaluate the burden of gram-negative multidrug-resistant (GNB-MDR) respiratory infections in mechanically ventilated patients. Materials and methods: A single center, prospective-observational study was performed in the intensive care units (ICU) of a Tertiary Care Hospital in Southern India from September 2021 to May 2022. Endotracheal aspirates were collected as per the physician's order and using the standard microbiological methods, gram-negative bacteria were identified, and their antibiotic susceptibility patterns were obtained. Demographic data of patients, clinical profile of the organism and clinical outcomes including the hospital stay, ICU stay and weaning from mechanical ventilation were documented. Results: Among the 418 admitted patients, the incidence of gram-negative bacteria was 21.5%, among which the occurrence of multidrug-resistant gram-negative bacteria (MDR-GNB) was 16.26%. Acinetobacter baumannii (57.7%) was the most commonly found species, followed by Klebsiella pneumoniae (38.8%) and Escherichia coli (6.6%). About 77.7% of the cohort were carbapenem resistant, of which 90% cases were multidrug resistant. Significantly more MDR-GNB patients have undergone simple and difficult weaning compared to non-multidrug-resistant gram-negative bacteria (NMDR-GNB) infected patients (p = 0.026). Interpretation and conclusion: The rising prevalence of antibiotic resistance, notably carbapenem resistance, emphasizes the importance of observing the trends in the resistance pattern and conducting routine surveillance in critical care settings to alleviate the associated mortality and morbidity.

Esophagobronchial fistula is a rare complication of long-standing achalasia cardia. We report the case of a 39-year-old lady with sigmoid esophagus with a esophagobronchial fistula who was managed by minimally invasive esophagectomy with gastric conduit and cervical esophago-gastric anastomosis. The esophagobronchial fistula was identified at the lower end of the dilated thoracic esophagus. The fistulous opening was primarily sutured with a cuff of esophageal wall after cauterizing the mucosa of the esophageal wall using bipolar energy source. Postoperatively, the air leak resolved spontaneously. There was no evidence of any malignancy in the resected specimen. The patient is doing well on follow-up.

Aim 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.

Endobronchial 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.

Thrombocytopenia, a rare but serious complication of rifampicin treatment, underscores the importance of timely intervention to prevent adverse outcomes. This article offers a detailed exploration of rifampicin-induced thrombocytopenia, shedding light on its causes, symptoms, diagnosis, and treatment options. Through a blend of research insights and real-life cases, we emphasize the crucial role of healthcare providers in recognizing and addressing this condition promptly. By advocating for increased awareness and vigilant monitoring, we aim to ensure the safety and well-being of patients undergoing anti-tuberculosis treatment.

One of the newer concepts and current focuses of tuberculosis management is the concept of palliative care for tuberculosis (TB) patients. Target patients for this approach include mainly patients with drug-resistant and advanced forms of tuberculosis but also drug-sensitive tuberculosis in some settings like malignancy and extra-pulmonary tuberculosis. Integral to this approach of palliative care is the concept of managing of comorbidities with tuberculosis. Addressing the various comorbidities associated with tuberculosis taking an integral approach to the management of comorbidities is the need of the hour.