Background. The use of Childhood Asthma Control Test (C-ACT) has been advised for monitoring asthma control by the Global Initiative for Asthma (GINA) guidelines. Objective. To validate the tool C-ACT for the assessment of control of asthma and to examine the correlation between C-ACT score and lung function assessed by forced expiratory volume in one second (FEV1). Methods. This was a prospective observational study conducted between January 2010 to January 2011. Children diagnosed to have bronchial asthma and aged 5 to 14 years, were enrolled in the study. Asthma severity and control status were classified according to the National Asthma Education and Prevention Programme (NAEPP) and GINA guidelines, respectively. Patients were followed-up at three and six months and C-ACT and spirometric measurements were obtained. Results. Significant positive correlations were found between C-ACT score and FEV1 at enrollment (r=0.772) (p<0.001), three months (r=0.815) (p<0.001) and at six months follow-up (r=0.908) (p<0.001). Baseline C-ACT score was useful for predicting the levels of control of asthma upto three months (0.004), but not at six months follow-up (0.787). A cut-off C-ACT value of > 19 had a sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) 98.5%, 89.1%, 94.9%, 96.6%, 0.717, respectively for the control of asthma. Conclusion. C-ACT is a simple and feasible tool to assess and predict the levels of control in children with bronchial asthma upto three months.

Objective. Indoor air pollution measured in terms of particulate matter <2.5ìm in diameter (PM2.5), is an important cause of respiratory illness in children. Therefore, PM2.5 levels in rural households and its correlation with respiratory illness-related symptoms in children were studied. Methods. A questionnaire-based survey of children for respiratory illness-related symptoms was conducted in 37 households of a village (Khanpurjupti, Delhi-NCR, India) from September 2011 to October 2011. Assessment of 24-hour PM2.5 level was done using University of California-Berkeley Particle and Temperature Sensor (UCB-PATS). Results. Thirty-seven households in a rural area were studied. These were divided into 20 respiratory households, i.e. those with children with respiratory illness-related symptoms and 17 control households. The 24-hour PM2.5 was measured in all the houses. The average minimum and maximum PM2.5 levels were 7.24mg/m3 and 22.70mg/m3, respectively (mean=10.47mg/m3) among the 20 respiratory households. The average minimum and maximum PM2.5 levels were 1.10mg/m3 and 18.17mg/m3, respectively (mean=4.99mg/m3) in the 17 control households. The PM2.5 levels were significantly greater (p<0.05) in houses where children had respiratory symptoms compared to the control households. Further, biomass fuel use and number of family members were significantly associated with respiratory illness in children. Conclusion. Increased PM2.5 levels, biomass fuel use and number of family members were found to be associated with increased occurrence of respiratory illness in children.

Aims. To determine the incidence of central line associated bloodstream infections (CLABSIs) in the medical intensive care unit (ICU) and ward setting at All India Institute of Medical Sciences (AIIMS), New Delhi. Settings and Design. The study was conducted in the medical ICU, a 9-bedded ICU at the AIIMS, a tertiary care teaching hospital. The study design was a prospective observational study. Methods. One hundred patients admitted to medical ICU and the ward at AIIMS with an indwelling, non-tunnelled central venous catheter (CVC) in place at admission and those with a hospital stay with indwelling CVC for more than 48 hours were monitored. These patients were followed daily for the development of new onset sepsis 48 hours after insertion of CVC, in which case three sets of blood samples for culture were drawn over a span of 24 hours. Statistical Methods. Incidence of CLABSIs was measured per 1000 central line days. Results. One hundred patients hospitalised for an aggregate 1119 days acquired 29 hospital-acquired infections (HAIs), a rate of 38.8% or 31.2 HAIs per 1000 hospital days. The incidence of bloodstream infections (BSIs) in this group was 6.8%. No case of laboratory confirmed CLABSIs could be demonstrated. Incidence of clinical sepsis was 27.6% or 8.2 per 1000 CVC days. There were 9 cases out of the 29 patients (39.7%) who had evidence of HAIs with no apparent focus of infection. Only one of these cases had evidence of BSI with isolation of Staphylococcus aureus in both CVC tip culture and the simultaneous blood culture; however the antibiograms were different. Conclusions. The low rate of BSIs in the present study and the absence of occurrence of a laboratory confirmed CLABSI should be interpreted in the light of the small sample size of the study and the multitude of antibiotics received before the development of HAI.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are recognised clinically as episodes of increased breathlessness and productive cough requiring a more intensive treatment. A subset of patients with this disease is especially prone to such exacerbations. These patients are labelled as ‘frequent exacerbators’. Though yet poorly characterised in terms of host characteristics, including any genetic basis, these patients are believed to represent a distinct phenotype as they have a different natural history with a more progressive disease and a poorer prognosis than those who get exacerbations infrequently. Most exacerbations appear to be associated with infective triggers, either bacterial or viral, although ‘non-infective’ agents, such as air pollution and other irritants may also be important. Susceptibility to exacerbations is determined by multiple factors. Several risk factors have been identified, some of which are modifiable. Chronic obstructive pulmonary disease (COPD) exacerbations are major drivers of health status and patient-centered outcomes, and are a major reason for health care utilisation including hospitalisations and intensive care admissions. These are associated with considerable morbidity and mortality, both immediate and long-term. These episodes have a negative impact on the patient and the disease including high economic burden, increased mortality, worsening of health status, limitation of activity, and aggravation of comorbidities including cardiovascular disease, osteoporosis and neuro-psychiatric complications. Exacerbations also increase the rate of progression of disease, increasing the annual decline in lung function and leading to a poorer prognosis. Evaluation of risk of exacerbations is now included as a major component of the initial assessment of a patient with COPD in addition to the traditionally used lung function parameter, forced expiratory volume in one second (FEV1). Decreasing the risk of exacerbations and their prevention is a major therapeutic goal of management in COPD.

A 50-year-old male, a tobacco smoker, who was known to have ulcerative colitis presented with dry cough, chest pain, dysponea and frequent passage of blood and mucous mixed stools. Physical examination revealed clubbing, subcutaneous emphysema of upper chest and auscultatory findings of crunching sound over pre-cordial area and basal crepitations. Spirometry was suggestive of restrictive pattern. High resolution computed tomography (HRCT) of thorax revealed pneumomediastinum, subcutaneous emphysema, bilateral diffuse centrilobular nodules and ground-glass haziness with mosaic pattern along with posterior basal fibrotic changes. The present case documents the uncommon pulmonary involvement of spontaneous pneumomediastinum and subcutaneous emphysema diffuse parenchymal lung disease, in a patient with ulcerative colitis.

Primary spontaneous haemopneumothorax (PSHP) is a rare condition. Potentially grave consequences do occur as a result of a failure to reach the diagnosis early. We report a case of a 17-year-old male who presented with a picture of PSHP but was later also found to have a component of haemothorax. He underwent thoracoscopy which was converted to thoracotomy. A torn vascular adhesion was the source of bleeding which was clipped and haemostasis was achieved.

Chilaidit's syndrome is a rare condition characterised by the interposition of the colon between the liver and the right hemidiaphragm. We present a case of 20-year-old male who reported with breathlessness and epigastric pain, and he was diagnosed radiologically to have Chilaiditi's syndrome

Diaphragmatic agenesis is the most extreme form of congenital diaphragmatic defect, and it may be unilateral or bilateral. Diaphragmatic agenesis is a rare diagnosis, typically made early in infancy and is generally associated with other genetic anomalies, especially anueploidy syndromes. It is associated with a high mortality, if not treated in infancy. However, a few patients have survived till adulthood. In this report, we describe the case of an adult female who presented with progressive shortness of breath during third trimester of pregnancy with complete agenesis of the right side of the diaphragm. A new diaphragm was created using polypropylene mesh after which she improved symptomatically and the lung showed good expansion.

Embryonal cell carcinoma affects young males in the prime of their life with majority of tumours already having metastasised at the time of diagnosis. Subcutaneous metastasis from embryonal carcinoma is rare and is associated with widespread disease and poor prognosis. We report a case of 22-year-old male who presented with haemoptysis and skin nodules. Fine needle aspiration cytology of skin nodules and the lung lesion led to the diognosis of testicular embryonal cell carcinoma.