Pulmonary hydatid is not a rare disease. But raising a suspicion for its diagnosis is limited. There are limited approaches for the diagnosis and treatment of the same. We present here four cases of pulmonary hydatid, without liver involvement, with emphasis on how it was misdiagnosed and received multiple treatment and landed into complications. Most of our cases presented with cough, sputum and hemoptysis. For these nonspecific signs and symptoms, patient is generally treated on a different line of diagnosis. Two of the cases were already treated for abscess and fungal infection. One of the patients was on antitubercular treatment. One of our cases was secondarily infected with aspergilloma. One of the cases was referred to oncologist to start chemotherapy. Interestingly, to raise a suspicion, none of our cases had liver involvement. A detailed history revealed expectoration of white salty material in sputum, living with sheep and dog and expectorating grape-like vesicles in sputum. History helped us to put hydatid as one of our differentials. Echinococcal serology was positive in three cases. Only three cases had on-table appearance of hydatid cyst. All four cases underwent surgical management for complete cure. There is need for strong suspicion and a detailed history and proper set of investigations help in timely diagnosis and management of pulmonary hydatid disease.

Introduction: As Indian patients have different predisposing morphological characteristics, we undertook this study to evaluate the clinical profile of overlap syndrome and compare them with COPD patients to find out the screening tools for obstructive sleep apnea (OSA) in Indian chronic obstructive pulmonary disease (COPD) patients. Aims and objectives: • To study the clinical profile of patients with overlap syndrome. • To compare them with COPD patients. • To develop screening tools for overlap syndrome in COPD. Materials and methods: A prospective case-control study was carried out in a tertiary care center. Overnight pulse oximetry was carried out for all COPD patients. Those having snoring or saw-tooth pattern on overnight oximetry were subjected to level 1 polysomnography. About 30 patients of overlap syndrome were compared with 65 COPD patients. Results: The mean age in overlap syndrome group (56.9 ± 6.86 years) was significantly lower (p < 0.01). The daytime PaO₂ and lowest nocturnal saturation were significantly lower in overlap group. PaCO₂ and forced expiratory volume at 1 second (FEV1) were significantly higher. For diagnosing overlap syndrome, the positive and the negative predictive values of snoring were 84.42 and 100%; of body mass index (BMI) ≥25 kg/m² were 86.67 and 98.88%; and of excessive daytime sleepiness were 37.57 and 97.86%, respectively. Conclusion: Absence of snoring and BMI <25 kg/m² virtually rules out overlap syndrome. The EDS has a high false-positive rate for predicting OSA. Patients having overlap syndrome have poor daytime and nocturnal oxygenation despite good lung functions.

We describe a case of carbon monoxide poisoning in a 54-year-old male from heavy cigarette smoking presenting as delusions. The patient has a history of methamphetamine-induced schizophrenia now in remission for 2 years, and not on any psychotropics and is drug-free.

Background and objective: Silicosis is one of the oldest occupational lung diseases. However, there are very few studies identifying the anthropometric variables associated with silicosis. The present study aimed at studying the association between body surface area (BSA), pulmonary function indices, and 6-minute walk distance (6MWD) in patients with silicosis. Materials and methods: The study was conducted on 102 male patients of silicosis. Height and weight were measured to calculate BSA. Spirometry and 6 minute-walk tests were performed. Data were analyzed using EPI info V 7 software. Student's t-test of significance (ANOVA) was applied to test the difference between means. Results: There are no significant changes found in the 6-minute walk distance with years of exposure and BSA. Statistically significant lower values of pulmonary function indices were observed in patients with BSA <1.6 sq m. Statistically significant higher values of forced expiratory volume in the first second and forced vital capacity were observed in patients with BSA >1.9 sq m in all categories of exposure. Conclusion: In conclusion, patients of silicosis with >1.9 sq m BSA had higher values of pulmonary function indices. Large body size may be of value in protection from developing occupational lung disease.

Background: Primary spontaneous pneumothorax (PSP) is a common thoracic surgical emergency affecting otherwise healthy young individuals. Its treatment options range from observation to surgery in the form of video-assisted thoracoscopic surgery (VATS). Surgery, generally reserved for recurrence, is gradually being utilized for certain patients presenting with PSP for the first time. In this study, we aim to report our experience of VATS in the surgical management of first episodes of PSP. Methods: A retrospective review of prospectively maintained data on all the patients undergoing surgical management during the first presentation of PSP, over a period of 10 years, was done. Results: Over the period of 10 years, out of 95 patients who underwent thoracoscopic bullectomy for pneumothorax, a total of 42 patients had presented with PSP for the first time. Most (54%) were aged 20–40 years, with male predominance (83%); right-sided (69%); commonest symptom was shortness of breath (83.3%) with a median duration of symptoms of 5.9 days. Apical bullae were the commonest computed tomographic finding (88%). Majority of the patients underwent VATS via three ports, and multiple apical bullae were the most common intraoperative findings. Four patients (9.5%) had an air leak postoperatively, managed conservatively. Average intensive care unit stay was 23 hours; average chest tube duration was 3.6 days; and the average hospital stay was 8.2 days. There was no 30-day mortality and no recurrences were noted during a median follow-up of 2 years. Conclusion: Our initial experience with surgery for the first episode of PSP has been shown to be safe and effective. Larger and more robust studies with longer follow-ups would be necessary to better delineate the role of surgery in such patients.

Chronic obstructive lung disease (COPD) is a major contributor to global disease burden with a huge socioeconomic impact. Global initiative for chronic obstructive lung disease (GOLD) strategy update 2023 is a step forward in the direction of evidence-based practice. Key topics like taxonomic classification, ABE grouping, single inhaler triple therapy, correct use of inhalers, etc. would have a positive impact on documentation and prescription practices in COPD management. The tobacco consumption habits are peculiar in India. There is a variation in prevalence estimates across diverse cultures. Non-smoking risk factors are important in Indian subcontinent especially in female and younger populations. We discuss the rationale of latest GOLD strategy update, its implications, and challenges in the management of COPD in Indian context.

Background: An association has been described between tuberculosis (TB) and common mental disorders. We aimed to evaluate the patterns of psychiatric morbidities in patients with pulmonary TB. Methods: This was a prospective study conducted over a period of 1 year. A total of 100 patients were recruited for the study. Baseline psychiatric morbidity was assessed after 2 weeks of diagnosis and at the end of an intensive phase (IP). Results: In the present study, 56% of patients with pulmonary TB had morbid baseline psychiatric disorders. The major depressive episode was the most common morbid psychiatric disorder (39%), followed by panic disorder (9%), generalized anxiety disorder (GAD) (6%), and agoraphobia (2%). The psychiatric morbidity dropped to 15%. Major depressive episode dropped to 13%, followed by GAD and panic disorder (1%) each at the end of an IP. Conclusion: Because of high burden of psychiatric morbidity associated with pulmonary TB, there is a need for psychiatric services to be made available to these patients.

Introduction: Diffuse cystic lung diseases (CLDs) are a heterogeneous group of uncommon disorders with characteristic imaging appearance. Cystic lung disease is a significant cause of mortality and morbidity with a wide spectrum of radiological presentations and etiological differentials. Though the literature is widely available on radiological approaches to CLD, a knowledge gap exists on the etiological spectrum, especially in the Indian scenario, as it is an orphan group of lung disorders. The interest and experience among pulmonologists regarding CLD are growing with the widespread use of CT scans. Clinical, radiographic, and histological findings are often essential for proper diagnosis, and multidisciplinary approach is required for optimal management of such cases. In our study, through real-world cases, we have highlighted the clinical manifestations and diverse etiological spectrum of CLD. Since these disorders are rare, incurable, and have variable disease progression, the authors have tried to address the holistic approach of this relatively less-understood group of disorders. Aims and objectives: The aim of the study was to identify clinical characteristics and etiological spectrum of patients manifesting with diffuse cystic lung disease radiologically. Materials and methods: In this retrospective analysis, the hospital electronic database was screened with Boolean operations and keywords for cysts OR pneumothorax. Among a total of 4,479 patients admitted to the respiratory ward /ICU during the period of January 2020–September 2022 at a tertiary care center in northern India, 14 patients with radiological diagnosis of CLD matched the relevant search. All relevant data of these patients were retrieved from the records. Results: Our patients presented predominantly with symptoms of cough and breathlessness. About 4 patients had pneumothorax as the first presentation. The mean age of presentation was 42.14 (standard deviation 12.6, age range 16–62 years). About 64% (n = 9/15) patients were females. The various etiologies identified were lymphangioleiomyomatosis (LAM), lymphocytic interstitial pneumonia, Birt–Hogg–Dube syndrome, hypersensitivity pneumonitis, Pneumocystis jirovecii pneumonia, and cystic metastasis, and in one patient, no definite cause was found despite detailed evaluation. Conclusion: Cystic lung disorders are a less commonly diagnosed entity with rare etiologies. In our study, we found a female preponderance and LAM as the commonest CLD. Pneumothorax is a sentinel event and commonly the presenting complaint in CLD. Identification of the etiology can help in institution of definite therapy when available. In view of unpredictable disease progression and outcome, these diseases warrant follow-up and imaging surveillance.

Background: Tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) is still a major public health concern around the world. Prompt detection of active tuberculosis cases helps in timely therapeutic intervention and reduces community transmission. Despite limited sensitivity, conventional microscopy is still used to diagnose pulmonary tuberculosis in high-burden nations such as India. This study, therefore, was aimed at assessing the diagnostic performance of microscopy by Ziehl Neelsen (ZN) and auramine (AO) staining in the diagnosis of pulmonary tuberculosis. Materials and methods: A prospective comparative study was done on the sputum samples of 2,395 adult patients from November 2018 to May 2020 suspected of having pulmonary tuberculosis visiting the Designated Microscopic Centre of SGT Medical College, Budhera, Gurugram. Each sample was subjected to ZN staining, and AO staining as per NTEP guidelines. Results: Out of the 2,395 samples studied, 161 (6.76%) and 224 (9.35%) were positive by ZN and AO staining methods respectively. Pauci-bacillary cases detected by AO were more than ZN staining. There were 63 more sputum samples detected by AO staining which were missed by ZN microscopy. Conclusion: When compared to conventional ZN staining, the auramine staining technique is more sensitive and takes less time to diagnose pulmonary tuberculosis.

Background: Around 2.6 billion people cook their food using biomass fuel (BMF), kerosene oil, and coal fuel, by which each year, 4 million people die prematurely from household air pollution or by this inefficient cooking practices. So, this study was planned to measure the effect of interventions of cooking fuel (BMF to LPG) to reduce the indoor air pollution in asthmatic children of rural India. Methods: Prospective observational study was done by door-to-door survey, among school-age children. Households of asthmatic children were encouraged to change their cooking fuel to more secure and were followed up for a period of 9 months. The intervention was in the form of a change of cooking fuel (from BMF to LPG) and proper education. The levels of indoor pollutants (PM₁₀, PM_2.5, and PM₁) were measured before and after 3 months of follow-up. Result: A total of 56 asthmatic children from 42 households were followed-up for the following 9 months at every 3 months visit. The mean age was 9.27 ± 3.94 years with an equivalent sex ratio. There was at least one smoker in 73.81% of households of asthmatic children. Nearly, 45% of children were living in 101–500 square yard area and 67.86% with the inhabitation of ≤ 3/room. The level of all particulate matter decreased significantly at 3 months (p < 0.05). At 3, 6, 9 months of follow-up, respiratory symptoms and morbidity significantly diminished. Conclusion: The change in cooking fuel to more secure was found to be one of the factors decreasing indoor pollutants and respiratory symptoms/morbidity among asthmatic children in rural areas.

Tobacco-free society is one of the goals and cherished vision of the World Health Organization (WHO). The health-related ill effects of tobacco are devastating and have ruined families due to multiple health morbidities and economic consequences thereby. Prevention of tobacco habit and tobacco cessation are key methods that should be adopted to avoid such devastation. Amongst various strategies adopted and recommended for tobacco cessation, advice given by very young children for tobacco cessation seems to be an innovative tool especially when one elder in the family are addicted to tobacco. We have come across such families where the young children of these families advised their parents to leave the habit of tobacco. Such an initiative from the young generation can have long-lasting influence on tobacco prevention strategies.