Background: With an increasing prevalence rate of tobacco use in India in the last few years, Ministry of Health and Family Welfare, Government of India launched the first ever “National Tobacco Quitline Services (NTQLS)” on 30th May, 2016 at Vallabhbhai Patel Chest Institute, University of Delhi (North Campus), Delhi. This is a telephonebased tobacco cessation service, an important component of many tobacco control programmes. Methods: NTQLS is established to help a person who wants to quit his/her habit of tobacco use. Services at NTQLS are available daily from 8 AM to 8 PM through a National toll-free number 1800-11-2356 in both English and Hindi, except on Monday. Six counsellors were present at a time both during morning and evening shift. A total of 5179 callers were registered from 30th May 2016 to 31st May 2017. The comparative analysis was done between the smokers (n=1366) and smokeless tobacco users (n=3169) those registered at NTQLS using statistical package for the social sciences (SPSS, version 22). Tobacco smokers who used smokeless tobacco (n=644) were excluded from the present study. Results: A total of 1366 smokers and 3169 smokeless tobacco users were studied. Tobacco consumption was higher in males as compared to females in both the groups. Individuals in the age group of 25 to 64 years were found to be more prone to smokeless tobacco consumption as compared to smoking tobacco (69.5% versus 67.6%). Out of 1366 registered callers who smoked tobacco, the success rate of quitters was 33.9% and out of 3169 smokeless tobacco users, the success rate of quitters was 41% during the study period. Conclusions: Results of this telephone-based counselling services at NTQLS indicate this to be helpful in motivating people to quit or stop the use of tobacco. Overall findings revealed a significant reduction in number of tobacco smokers as compared to users of smokeless tobacco at the end of one year of study period after availing NTQLS services for quitting.

Background: Current multidrug-resistant tuberculosis (MDR-TB) management is associated with significant mortality which is deterrent for effective TB control worldwide. Knowledge of risk factors that predict mortality in MDR-TB is required to formulate measures to improve treatment outcomes. There is lack of data on the independent predictive factors of mortality among Indian patients being treated under programmatic conditions. Objectives: To evaluate factors predicting mortality in MDR-TB patients being treated under programmatic management of drug-resistant tuberculosis. Methods: Medical records of all MDR-TB patients who were initiated on Category IV anti-TB regimen between January 2012 and December 2014 and had declared outcome were retrospectively analysed. Information on different demographic, clinical and treatment (past and present) related parameters was retrieved. Relevant factors were analysed for their possible association with mortality using univariate and multivariate Cox regression analysis. Results: Out of total 278 patients, 61 (21.9%) died during two years of their treatment duration. The median time to death was seven months. Out of 61, 40 patients (65.5%) died during the first nine months of their treatment. On multivariate Cox regression analysis, high age, low body mass index, previous anti-TB treatment, low serum albumin levels and presence of adverse drug reactions during MDR-TB treatment were found as independent factors predicting mortality (p<0.05). Conclusions: Mortality in MDR-TB is associated with certain modifiable and non-modifiable risk factors. Appropriate knowledge and timely intervention to manage these, especially the nutritional status, may help to decrease the mortality associated with MDR-TB.

Background: The role of systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) remains to be defined. This prospective, observational study was designed to analyse the hypothesis that inflammatory biomarkers in stable COPD can be used as measure of disease severity and risk of exacerbation. Methods: We conducted a case-control study in a tertiary care, university-affiliated hospital. COPD patients and controls were matched for sex and age in a 1:1 matching ratio. All COPD patients included in the study had to be clinically stable without a history of exacerbation in the last four weeks and should not have been on oral steroid therapy (in the last 4 weeks) or on long-term oxygen therapy. We included only those patients who had quit smoking. Fibrinogen levels and pulmonary function tests were performed in both the groups. Results: The mean plasma fibrinogen level, total leucocyte count, neutrophil count and erythrocyte sedimentation rate in patients with COPD were significantly higher than that of controls (p=0.001). The study also showed a significant association between plasma fibrinogen levels with severity of COPD (p<0.001) and number of exacerbations in the previous year (p=0.001). Conclusions: Patients with COPD had significantly higher levels of inflammatory markers than healthy individuals. Plasma fibrinogen level was significantly higher in higher Global Initiative for Chronic Obstructive Lung Disease GOLD class and with more number of prior exacerbations. Hence, fibrinogen may act as a surrogate marker of disease activity in patients with COPD and may help to risk stratify COPD patients for future exacerbations.

Background: Asthma control test (ACT) is a simple, quick and accurate tool to assess asthma control. The present study was designed to investigate the correlation between, ACT, spirometry variables and markers of airway inflammation. Methods: Seventy-five patients with bronchial asthma underwent baseline spirometry, fractional exhaled nitric oxide (FeNO), serum total immunoglobulin E (TIgE), high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6, IL-10 and IL-13 measurements. After four weeks, patients were followed up with the same set of investigations. ACT questionnaire was completed without any directions. Results: Of 75 patients, bronchial asthma was controlled poorly in 18, well in 35 and totally controlled in 22. The forced expiratory volume in one second (FEV1) (%) at the second visit was lowest in the poorly control group (76.94±14.20 versus 84.06±11.95 versus 91.50±10.66; p<0.002). The ratio of FEV1 to forced vital capacity (FVC) at the second visit showed lowest values (71.99±10.59 versus 77.70±9.05 versus 85.77±8.37; p<0.001) in patients with poorly control asthma. Notably, the change in FeNO, TIgE and IL-6 levels in two visits reached significant levels (p<0.05). Using the step-wise method for regression analysis, ÄFeNO, FEV1/FVC and ÄTIgE level explain a substantial amount of the variance in the ACT score (F[1, 71] = 33.70, p<0.001, R2 = 0.58, R2 Adjusted = 0.57). The negative correlation of ÄFeNO and ÄTIgE and positive correlation of FEV1/FVC at the second visit with statistical significance at p<0.001. Conclusion: The present study emphasises on combined approach including clinical features (ACT), spirometry variable (FEV1/FVC) and airway inflammatory markers (FeNO) for documenting the precise control of asthma at the follow-up visit.

A 25-year-old young male presented with pain in chest and left shoulder for two months, dry cough, shortness of breath for one month and hoarseness of voice for 15 days. He was a non-smoker and served in the armed forces. Chest radiograph showed homogeneous opacity over the entire left hemithorax obliterating left costophrenic and cardiophrenic angles with a shift of mediastinum to the contralateral side. Contrast-enhanced computed tomography of chest and upper abdomen revealed a large mass lesion involving left upper lobe with minimal pleural effusion on the left. Bronchial washing cytology was positive for malignant cells. Endobronchial biopsy showed clusters, nests and small island of tumour cells infiltrating bronchial mucosa. Immunohistochemistry was focal positive for CK 5/6 and synaptophysin, strongly positive for pancytokeratin and Epstein-Barr virus, negative for thyroid transcription factor (TTF1) and CD 68; human leucocyte common antigen taken up by accompanying lymphoid cells confirmed the diagnosis of lymphoepithelioma like carcinoma. This variety of lung cancer is very rare, occurs mostly in Asians and has relatively better prognosis compared to non-small cell carcinomas. In young adults with lung mass; possibility of this uncommon variety of malignancy is high with a favourable outcome if diagnosed early and needs an aggressive clinical work-up.

Tracheostomy is a life-saving procedure, performed in both emergency and elective settings. Development of bilateral pneumothoraces in adults following tracheostomy is a rare complication. We report the case of a 30-year-old male who developed bilateral pneumothoraces immediately following emergency mid-level tracheostomy. The patient was treated with bilateral intercostal tube drainage. The case is being reported to emphasise the fact that the clinician should be aware of this rare but potentially dangerous complication, so that early intervention can prevent a catastrophe.