Objective: Right ventricular (RV) dysfunction is a commonly overlooked; but prognostically important complication of chronic obstructive pulmonary disease (COPD). Red cell distribution width (RDW) is a potential blood parameter that may have a role in the detection of RV dysfunction. The present study was conducted to evaluate the role of RDW as a screening marker for RV dysfunction in COPD. Methods: A total of 80 consecutive stable COPD patients were enrolled. After initial spirometry, patients were screened for RV dysfunction using RDW measurement. Thereafter, two-dimensional (2D) transthoracic echocardiography (2D-TTE) was performed to confirm the RV dysfunction by measuring tricuspid annular plane systolic excursion (TAPSE) and RV lateral wall tissue doppler systolic velocity (S velocity). Sensitivity, specificity and positive and negative predictive values of RDW was calculated using 2D-TTE as the reference standard. Results: The study cohort of COPD patients mainly comprised of middle-aged males (mean age: 57.1+9.3 years; M:F=6:1). Out of 80 patients, 26 (32.5%) had RDW above the cut-off value of 14%. On comparing them with the 10 patients (12.5%), diagnosed on 2D-TTE, RDW showed a sensitivity and specificity of 90% and 75%, respectively in detecting RV dysfunction. On multivariate logistic regression analysis, RDW was the only independent parameter predicting RV dysfunction (OR: 4.04; 95% CI: 1.5-10.5; p= 0.004) in COPD patients. Conclusion: Red cell distribution width is a sensitive screening marker of RV dysfunction that may be incorporated in the in diagnostic algorithm of COPD patients.

Objective: There is enough evidence concerning risks for tuberculosis (TB) morbidity and mortality associated with smoking. Directly Observed Treatment, Short-course (DOTS) programme could prove synergistic in fighting two major social health problems, TB and tobacco. The present study was done to assess the knowledge, attitude and current practices of DOTS health workers in providing tobacco cessation advice to TB patients. Methods: A cross-sectional, close-ended, questionnaire-based study was carried out amongst 209 DOTS providers and allied health workers across various Chest Clinics and DOTS Centres in Delhi to assess the knowledge, attitude and current practices of DOTS providers in tobacco cessation. Results: Sixty percent DOTS providers were aware of the diseases associated with tobacco use and overall health impact of quitting tobacco. 71% DOTS providers admitted that they were unable to help TB patients for tobacco cessation. DOTS providers believed that asking about tobacco use habit is part of their job and content related to tobacco cessation must be added in their training. Conclusion: Health workers are an ideal source of contact with the patients at the grass-root level. Development of tobacco cessation skills seems feasible and would allow DOTS creating awareness and rendering referral services for tobacco cessation. This would augment the skilled work-force to deal with the social menace of TB and tobacco together.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is usually performed under deep sedation or conscious sedation. We describe the diagnostic yield and complications of EBUS-TBNA performed under local anesthesia. Methods: Patients undergoing EBUS-TBNA at our center from February 2016 to April 2018 were evaluated retrospectively. All procedures performed under local anesthesia using lignocaine were assessed for sampling adequacy, diagnostic yield, cough during endoscopic procedure and complications. Results: Thirty-four patients underwent EBUS-TBNA under local anesthesia. Mean age was 41.1 years with male to female ratio of 1:1. Mean (standard deviation) dose of lignocaine used was 311.6 (16.4) milligram and mean (standard deviation) duration of the procedure was 23.7 (3.78) minutes. Sample adequacy rate was 88.2%. The diagnostic yield of the procedure was 60%. In 91.1% of patients, cough was absent or did not interfere with EBUS-TBNA. Complications related to EBUS were observed in three (8.8%) patients and were minor and self-limiting. None of the patients required escalation of care. Conclusion: EBUS-TBNA performed under local anesthesia was found to be safe and was associated with an acceptable diagnostic yield.

Endobronchial metastasis (EBM) from renal cell carcinoma (RCC) mimicking endobronchial obstruction due to bronchogenic carcinoma is rare. Total lung collapse due to EBM from RCC is even more uncommon. We report the case of a female patient who presented with cough, dyspnoea and collapse of the right lung. She gave a history of nephrectomy on the left side four years back for some malignant lesion. On bronchoscopy, a polypoidal mass was observed which completely occluded the right main bronchus with features of clear cell adenocarcinoma. Immunohistochemistry was positive for CD 10 as well as PAX-8 and negative for thyroid transcription factor-1 (TTF-1) and Napsin, suggestive of metastatic renal cell carcinoma. The patient had multiple metastases in the brain and the adrenal gland also. She was started on pazopanib and given intracranial radiation but died after two months. Our case highlights the importance of making a distinction between EBM from the primary lung cancers because the treatment modalities differ significantly.

We report a case of a 66-year-old male who presented nine years after thoracoplasty with a broncho-pleuro-cutaneous fistula on the left side of the chest, with recurrent pleural infections. He had previously failed surgical attempts at closure of bronchopleural fistula. He was detected to have multiple fistulae in the left upper lobe and closure of air-leak was done by the bronchoscopic implantation of covered self-expandable metallic stent which bridged the left main bronchus to the left lower lobe bronchus, thereby completely occluding the left upper lobe orifice.