Background. Pleural effusions have always been a challenge to manage. We discuss a cost-effective way of managing pleural effusions using a fiberoptic bronchoscope, through an intercostal drain (ICD). Methods. Sixty consecutive patients with undiagnosed pleural effusions underwent fiberoptic bronchoscopic pleuroscopy in a tertiary care multi-speciality referral hospital in South India. Under local anesthesia and conscious sedation, ICD were introduced into the intercostal space to allow insertion of the FOB. The parietal pleura, lung surface, diaphragm were visualised and multiple parietal pleural biopsies were taken. Results. The diagnostic yield of the procedure was 97%. Amongst 60 patients, 29 were diagnosed with malignancy (27 adenocarcinoma, 1 mesothelioma, and 1 breast carcinoma), 27 had tuberculosis pleurisy, two had chronic inflammation secondary to autoimmune disease and in two cases the procedure was indeterminate. Conclusion. Fiberoptic bronchoscopy can be used for pleural biopsy instead of a semi-rigid pleuroscope/rigid thoracoscope in resource-limited settings.

Objective. Asthma life quality (ALQ) test has been used in many countries for the diagnosis of asthma and it has been proved to be useful also. The present study aimed to validate the ALQ test for the positive diagnosis of asthma and to assess its severity. Methods. Two hundred doctor-diagnosed bronchial asthma patients and 200 control subjects were studied. Standard form of ALQ test was used. Patients with bronchial asthma were categorised into mild-to-moderate and severe asthma categories. Receiver operating characteristic curve was plotted to determine the cut-off for ALQ score to assess the severity of asthma among adults in Delhi. Results. The mean (± standard deviation) values for ALQ score were higher in patients with asthma compared to control subjects (15.0±3.9 versus 0.7±0.9; p<0.001). Significantly higher mean ALQ score was seen in patients with severe asthma compared to those with mild-moderate asthma compared to those with severe asthma (18.1±2.0 versus 13.1±3.5; p<0.001). At a cut-off value of 16.5, ALQ had a sensitivity of 79% and specificity of 84%, area under curve was 0.887 (p<0.001) for the diagnosis of severe asthma. Conclusions. Asthma life quality test appears to be a useful tool to diagnose and assess severity of bronchial asthma.

Background. One of the important reasons for the emergence of drug-resistant tuberculosis (TB) has been inadequate knowledge and practice of the treatment of TB. The present study was designed to assess the knowledge, attitude and practice of allopathic practitioners of Lucknow with regard to the Revised National Tuberculosis Control Programme (RNTCP) of India. Methods. All allopathic doctors in the city who have experience of more than six months, who see more than five cases of TB per month were interviewed in this questionnaire-based, cross-sectional study. Results. A total of 772 doctors were interviewed. Only 119 (15.4%) claimed to be trained in RNTCP; more than half (n = 452; 58.5%) did not want to take training. Although 88.1% said that clinical examination and sputum testing are required to make the diagnosis, 76.3% doctors said that three sputum samples are required for the diagnosis. Only 43.3% were aware that more than two weeks of cough is a criteria for suspecting TB. Nearly half of the doctors (49.8%) believed that in order to label a patient sputum smear-positive, the chest radiograph should be abnormal. The correct knowledge about categorisation as Category I and Category II was done by 20.4%, and 10.1% respectively; 21.2% still believed that Category III existed. Majority of doctors (92.1%) had a good attitude about RNTCP. Conclusions. Most of the practitioners were aware about RNTCP; however, they did not get training from RNTCP. They should be trained time to time for better services of RNTCP.

Though metastasis to the lung is common, isolated extensive pulmonary metastasis with complete replacement of the entire lung is unusual. We present the fatal case of a 60-year-old female patient in whom the entire left lung parenchyma was replaced by a greyish-white solid mass at autopsy. There was no evidence of tumour elsewhere in the body. She had undergone modified radical mastectomy for phyllodes tumour of the right breast 10 years back. The unusual feature of our case was the presentation of the metastasis occurring 10 years after modified radical mastectomy and completely replacing the whole of a contralateral lung mimicking a primary lung tumour, with no other organ involvement.

Spontaneous diaphragmatic hernia without any apparent predisposing factor is a very rare condition. We report a case of 28-year-old male who presented with complaints of abdominal pain and gradually increasing breathlessness. Chest radiograph was suggestive of left-sided hydropneumothorax. Diagnosis of diaphragmatic hernia was confirmed by computed tomography. The defect was repaired by open thoracotomy and patient had an uneventful postoperative recovery.

Pseudochylous effusion or chyliform effusions are uncommon with less than 200 cases reported in the literature. The possibility of tuberculosis has to be considered in diagnosis and treatment of such cases. The two most common causes of pseudochylous effusion are tuberculosis and rheumatoid pleuritis. We present a case of a 23-year-old man with a history of pleural tuberculosis with pseudochylothorax.

A severe allergic reaction to intravenous co-amoxiclav in a patient of chronic obstructive pulmonary disease who had previously tolerated oral and intravenous co-amoxiclav is being reported. Patient went into a cardio-respiratory arrest within a minute of receiving intravenous co-amoxiclav. Patient was revived with timely administration of epinephrine and mechanical ventilation. Prompt administration of epinephrine is the most important decision in the treatment of anaphylaxis. Other adjunctive treatment as histamine receptor antagonists and corticosteroids do not substitute for epinephrine.