Background: Tobacco Quitline Services have the potential to reach a large number of tobacco users with the sole objective to provide telephone-based, information, advice, support, and referrals for tobacco cessation and is available free in most developed countries. India too now joins the international tobacco cessation movement with its own National level Tobacco Quitline Service. The purpose of this study is to evaluate the impact and success of National Tobacco Quitline Services (NTQLS) in the first year of its inception Methods: Collection of data was done by telephonic interview method and was extracted from the National Tobacco Quitline Services (NTQLS) database from May 30, 2016 to May 31, 2017. The tobacco users call at NTQLS tollfree number, assigned to receive four proactive calls from NTQLS. The proactive calls are set according to quit date. The registered subjects require furnishing of details about their tobacco use, history and personal information like name, age, address and other demographic data. The study evaluated the subject's tobacco dependence level. The subjects were offered sessions of counselling and choice to receive self-help material. The severely tobacco dependent subjects were referred to nearest tobacco cessation center. Results: A total of 60,222 calls hit the IVR (Interacted Voice Response System) of the NTQLS. 16,548 inbound calls were received and 94,900 outbound calls were made by the counsellors. The highest number of callers (46.5%) were from the state of Uttar Pradesh followed by Delhi (11.8%), Maharashtra (8.4%), Madhya Pradesh (4%), Rajasthan (3.8%), Haryana (3.4%), Gujarat (3.0%), Bihar (2.8%), West Bengal (2.8%), Punjab (2.4%), Karnataka (1.8%), Himachal Pradesh (1.3%), Odisha (1.3%), Jammu and Kashmir (0.8%), Telangana (0.7%), Jharkhand (0.6%), Tamil Nadu (0.5%), Andhra Pradesh (0.4%) and Kerala (0.3%). The north-eastern region including Nagaland, Mizoram, Meghalaya, Sikkim and Tripura contributed only 14 calls (0.3%). A total of 5179 callers were registered. There were 5067 (97.8%) male callers and 112 (2.2%) female callers for enrolling in the tobacco cessation programme. Smokeless form of tobacco use was the most prevalent than smoking (61.2% versus 26.4%). Both forms of tobacco (smoking and smokeless) was used by 12.4% of the callers. Khaini (47%) was found as the most prevalent smokeless tobacco product followed by Gutkha (43%). The number of cigarette smokers was found to be 73% followed by bidi smokers (25%). 17% of the registered subjects were found to be severely dependent on tobacco, 44% were moderately dependent whereas 39% had low dependence. Nearly 68% of the callers had already made an attempt to quit tobaccco; but were not successful. 2010 callers (38.81 %) successfully quit tobacco upto the last follow-up (proactive call – 4). Successful quitters (89%) did not have any difficulty or very less difficulty in managing withdrawal symptoms. Conclusions: Our obseevations suggest that the National Tobacco Quitline Services is freely accessible to the whole country. It is the easiest and most convenient way of tobacco cessation. The response showed that almost 40% of successful quitters were able to maintain tobacco cessation till the last proactive call during the first year of the start of the NTQLS.

Background: Infections are the common cause of death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A prospective cohort study was conducted on 100 patients with AECOPD in a tertiary care hospital in Hyderabad city in South India. Sputum culture of 100 patients was evaluated for the presence of Gram-positive and Gram-negative micro-organisms. Sensitivity and resistance patterns of the micro-organisms against commonly used antibiotics were also investigated. Results: During the period October 2015 to April 2016, 67% of the patients had sputum culture positive for the presence of pathogenic micro-organisms. Pathogens, most commonly, isolated were Gram-negative organisms like Klebsiella oxytoca (13%), followed by Klebsiella species (11%) and Klebsiella pneumoniae (10%). Amikacin was found to be the most effective antibiotic against all micro-organisms. A significantly higher proportion of organisms were pathogenic compared to non-pathogenic organisms (p=0.0014). Among pathogenic organisms, a significantly higher proportion of Gram-positive organisms were found compared to Gram-negative organisms (p=0.0180). Pathogenic microorganisms showed a high resistance rate to commonly used antibiotics. Except few strains of Klebsiella, Pseudomonas and Streptococcus, overall 62.9% strains were sensitive to doxycycline. Conclusions: Our observations suggest that doxycycline can be used as an empirical antibiotic in the treatment of AECOPD.

Background: There is a gap in the demand and supply for pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD). Methods: A randomised controlled trial that included 67 cases and 34 controls. The evaluable parameters were 6-minute walk test (6MWT), Borg scale, Airway questionnaire 20 (AQ20) and body-mass index, airflow obstruction, dyspnoea, and exercise capacity (BODE) index. These were evaluated at baseline and follow-up visits for three months. The home-based rehabilitation with unsupervised exercises, like walking, climbing stairs, getting up from squatting position, wall push up were advised for the case group in two sessions daily for 30 minutes each. Results: Fifty-four cases and 31 controls could be analysed. The cases and controls were matching in age, sex and spirometry. The evaluable parameters were better in the controls at the baseline but these improved in the end for the cases. The 6MWT in cases improved significantly from 286.9±104.4 to 397.2±90.1 meters (p<0.0001). Whereas, in controls, 6MWT did not improve significantly, i.e. 342.8±75.8 meters at baseline and 352.4±71.0 meters at the end of the study (p=0.1443). Borg scale, AQ20 and BODE index in the cases also improved from 6.0375±1.517 to 3.648±1.184 (p<0.0001), from 14±2.984 to 8.462±3.155 (p<0.001) and from 5.815±2.075 to 4.204±1.709 (p<0.0001), respectively. Conclusion: ‘No cost’ pulmonary rehabilitation, which can be delivered by even a primary care physician, is useful in patients with COPD.

Background: Anthracosis has been recently identified as a cause of bronchitis and bronchial stenosis in both developing and developed countries in the world. However, its exact nature whether as an innocent bystander or pathogenic agent for parenchymal lung disease is unknown. Methods: We retrospectively analysed 384 transbronchial lung biopsies (TBLBs) received at Department of Pathology over a seven-year period (August 2010 to August 2016). Thirteen TBLBs showed normal lung parenchyma were taken as controls; 32 (8.3%) TBLBs showed deposition of anthracotic pigment, with or without fibrosis and were further studied. Masson-Trichrome and Ziehl-Neelsen stains were used to confirm the diagnosis of fibrosis and tuberculosis, respectively. Results: The TBLBs were histopathologically categorised into: Group 1 normal lung parenchyma, (controls, n=13, 3.4%); Group 2: pigment deposition with fibrotic parenchymal reaction (n=11, 34.4%); Group 3: pigment deposition with inflammatory parenchymal reaction (n=11, 34.4%); and Group 4: pigment deposition with granulomatous parenchymal reaction (n=10, 31.3%). In two cases of Group 2 and one case of Group 3, parenchymal deposits of silicate crystals were also identified by polarising microscopy. Conclusions: Anthracosis does not appear to be an innocent bystander and needs to be meticulously assessed for its role as pathogenic agent for parenchymal lung disease in all cases. Our observations suggest that identifying the pigment deposited and correlation with the underlying pathology in the limited tissue sample available can help in reaching a definitive diagnosis.

Fistula arising from ruptured sinus of Valsalva aneurysm is an uncommon cause of congestive heart failure, and it is even rarer in the absence of an aneurysm. We present the case of a female patient with acute idiopathic rupture of the right sinus of Valsalva to the right ventricle and atrium in the absence of typical aneurysm. This anomaly resulted in a left-to-right shunt leading to rapidly progressive heart failure.

Urinothorax is a rare cause of pleural effusion, and is typically the result of either obstructive uropathy or injury to the kidney or urinary tract either traumatic or iatrogenic. A case of moderate pleural effusion in a post-operative patient of percutaneous nephrolithotomy and cystolithotripsy is being reported here. The patient was referred back for surgical repair which resulted in resolution of the pleural effusion.

Achalasia is a rare neurodegenerative disorder with deranged oesophageal peristalsis and lower oesophageal sphincter function. We report a case of achalasia cardia in 12-year-old child, who presented with respiratory tract infections. This patient was misdiagnosed as a case of mediastinal tuberculosis and anti-tuberculosis drugs were given for three months. However, she was diagnosed having achalasia cardia later with barium contrast studies and managed successfully with surgical intervention.