Background and objectives: There is wide variation in clinical presentations of sarcoidosis across different ethnic groups and geographical areas. Methods: Ninety-six patients with histopathologically proven sarcoidosis from Punjab were studied during the period January 2012 to January 2016 at the teaching hospital attached to our medical college. Results: Their mean age was 46.6±10.6 years; there were 51 (53.1%) females. All the patients were symptomatic at the time of presentation; 64.6% presented with predominantly respiratory symptoms while 35.4% had prominent extra-pulmonary symptoms. The various extra-pulmonary features presenting as the initial manifestations of sarcoidosis in the present study included prolonged pyrexia (13.5%); acute kidney injury (5.2%); neurological (5.2%); salivary gland (5.2%) and ocular (3.1%) involvement. About 10% of our patients had presented with life threatening manifestations as the sole presentation of the disease. The chest radiograph at presentation revealed stage 0 in 5.2%; stage 1 in 51.1%; stage 2 in 26% and stage 3 in 17.7% patients. Conclusions: In our study female preponderance was noted and the disease peaked during the late fourth decade of life. All the patients were symptomatic at the time of presentation and extra-pulmonary manifestations were the presenting feature in around one-third of the patients. Prolonged pyrexia, anicteric cholestasis, salivary gland involvement and AKI were uncommon, but important salient clinical manifestations in patients presenting with sarcoidosis from Punjab.

Background: Researchers have linked chronic obstructive pulmonary disease (COPD) to potential mechanisms increasing arterial stiffness. However, clinically the presence of COPD as risk factor for cardiovascular diseases is still unclear. The present study is aimed at assessing the COPD have an association with the risk of increased arterial stiffness. Methods: This hospital-based, multi-group, case-control study comprised of three groups of patients: Group I: 50 COPD patients; Group II: 50 non-COPD smokers; and Group III: 50 normal healthy individuals who were nonsmokers. Arterial stiffness of study subjects were measured by using non-invasive volume plethysmographic apparatus periscope. Results: The mean brachio-ankle pulse wave velocity (baPWV) (cm/s) of COPD patients was found to be higher in comparison to healthy non-smokers (1696.4±341.3 versus 1405.4±622.7; p=0.005). The mean carotid femoral PWV was also significantly higher among COPD patients compared to control group (1197.7±273.5 versus 857.8±175.0; p<0.001). A weak negative correlation was found between forced expiratory volume in one second and baPWV among COPD patients (r=-0.024; p=0.871), however, for Global Initiative for Chronic Obstructive Lung Disease (GOLD) 3&4 patients it was statistically significant (r=-0.450;p=0.016). Conclusion: Chronic obstructive pulmonary disease have no significant association with cardiovascular diseases independently, though in advance stage it can be consider as a strong predictor of increase in arterial stiffness.

Background: The diagnostic focus for exudative pleural effusion is to recognise the aetiology of intra-pleural disease. We describe our experience in the outcome and analysis of medical thoracoscopy in undiagnosed pleural effusion. Methods: A prospective, cross-sectional study was conducted from April 2016 to March 2017 using Olympus (LTF-160) semi-rigid thoracoscope. Results: Forty-eight patients with undiagnosed pleural effusion underwent medical thoracoscopy; out of whom 36 patients (75%) were males. The diagnostic yield of medical thoracoscopy in our study was 89.6%. Malignancy was the most common histological diagnosis in 54.2% of cases, 35.4% were diagnosed with tuberculosis and 10.4% with non-specific pleuritis. There were no major complications. Conclusions: Medical thoracoscopy is an extremely useful diagnostic modality that can often contribute crucially to accurate clinical decision making in patients with undiagnosed pleural effusion. The greatest advantage is the ease in handling the semi-rigid thoracoscope by bronchoscopist which is essentially similar to the use of flexible bronchoscope.

Hydatid disease, caused by Echinococcus granulosus usually affects liver. Pulmonary hydatidosis deserves special mention because isolated involvement of lungs is rare and patients with isolated pulmonary hydatidosis often remain asymptomatic. We report the case of a 24-year-old male who presented with vomiting, pain in the epigastric region, left upper abdomen and chest that was followed by high-grade fever of one day duration following a binge of beer drinking. Chest radiograph and computed tomography of chest revealed well defined cavitatory lesion with wall calcification and air fluid level in the lingular segment of left lung with left minimal pleural effusion. Sputum cytopathological examination revealed echinococcus hooklets. The patient was diagnosed to have ruptured hydatid cyst in lung. The present case highlights the importance of sputum cytopathological examination in confirming the diagnosis in patients with clinically suspected ruptured pulmonary hydatid cyst. This case also brings to light the uncommon occurrence of pulmonary aspergillosis along with hydatid disease of lung. This association in an immunocompetent individual has rarely been reported.

In some cases of congestive heart failure (CHF), localisation of pleural fluid in the pulmonary fissures with tumour like appearance on chest radiography (termed as vanishing tumour or Phantom tumour or pseudotumour) and its resolution with diuretic treatment is well documented. But localisation of fluid in the right para-mediastinal pleural space in CHF simulating a mediastinal tumour is very rare and to the best of our knowledge has not been published before in India. We report a case of a localised right-sided para-mediastinal transudative pleural effusion in an elderly woman with left ventricular failure. Anti-cardiac failure treatment including intravenous diuretic led to rapid clinical improvement and spontaneous disappearance of para-mediastinal effusion after four days. Right paramediastinal effusion re-appeared in the same area once cardiac failure returned after anti-hypertensive treatment was discontinued for about a month. Vanishing tumour associated with cardiac failure may occur anywhere in the pleural space if there is a predisposing factor favouring its localisation and recur if the underlying cause, like CHF returns.

Background: Idiopathic pulmonary fibrosis (IPF) is a specific type of chronic fibrosing interstitial lung disease (ILD) that is progressive in course. Although evidence-based guidelines for IPF are available, these are difficult to interpret for the average physician and may not be suitable for use in resource-constrained settings. There was an unmet need to formulate guidelines that are pragmatic, easy to understand and suited for application in resource-limited settings. Methods: This statement was made by a group of expert pulmonologists. Twenty-five questions regarding diagnosis and management of IPF were framed. A literature search was conducted using the PubMed and EmBase databases. The expert group discussed available evidence relevant to each question and recommendations were arrived at by consensus. Results: A thorough clinical and laboratory evaluation should be performed in patients suspected to have ILDs and potential underlying causes should be ruled out. A high resolution computed tomography (HRCT) of the chest is essential to identify the pattern of ILD. The need for a lung biopsy should be decided based on the appearance on the HRCT. Once a diagnosis of IPF is made, anti-fibrotic drugs (pirfenidone or nintedanib) should be offered after discussing the expected benefits and potential adverse effects with the patient. Recommendations have been made on other issues in the management of IPF, such as management of cough and dyspnoea, role of supplemental oxygen, mechanical ventilation and lung transplantation. Conclusion: This consensus statement provides practical and easy-to-use recommendations for the diagnosis and management of IPF in resource-limited settings.