Solitary pulmonary nodule represents 0.2% of incidental findings in routine chest X-ray images. One of the main diagnoses includes lung cancer in which small-cell subtype has a poor survival rate. Recently, a new classification has been proposed including the very limited disease stage (VLD stage) or T1-T2N0M0 with better survival rate, specifically in those patients who are treated with surgery. However, current recommendations postulate that surgery remains controversial as a first-line treatment in this stage. We present the case of a 46-year-old female referred to our hospital with a preoperative diagnosis of a solitary pulmonary nodule. On initial approach, a biopsy revealed a small cell lung cancer. She received multimodal therapy with surgery, chemotherapy, and prophylactic cranial irradiation and is currently alive without recurrence on a 2-year follow-up.

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Congenital diaphragmatic hernia is a congenital defect of the diaphragm through which intestine and other viscera herniate into the chest. In extreme form of diaphragmatic maldevelopment, there might be a complete agenesis of diaphragm. A 45-day old male infant was presented with fever, cough and respiratory distress for a week. Chest radiograph showed right-sided congenital diaphragmatic hernia. The patient underwent surgical exploration and found to have an unusual and large defect of right hemidiaphragm. The diaphragm was absent on anterior and lateral aspects of the chest wall and only a small rim of diaphragm was present on posterior aspect. The defect was identified as agenesis of right hemidiaphragm and successfully managed by suturing the posterior rim of diaphragm to the intercostal muscles and ribs. This report describes successful management of hemidiaphragmatic agenesis without incorporating a prosthetic material.

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Marijuana abuse has been on an increasing trend worldwide in the last decade. We hereby report a case of severe bullous emphysema resulting in pneumothorax in a patient with few years of marijuana abuse. We also review the major conditions in the differential diagnosis of bullous emphysema in adults.

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Bronchial carcinoids are uncommon, slow growing, low-grade malignant neoplasms comprising 1-2% of all primary lung cancers. They are thought to arise from neuroendocrine/Kulchitsky's cells of bronchial epithelium. Histological features range from low-grade typical to more aggressive atypical carcinoids. Clinically they may be asymptomatic, present with nonresolving recurrent pneumonitis, hemoptysis, or with paraneoplastic syndromes. Central bronchial carcinoids are more common than the peripheral type and are seen as endobronchial nodule or hilar/perihilar mass closely related to the adjacent bronchus. Chest X-ray may not show the central lesion due to its smaller size as is in our case. Contrast-enhanced computerized tomography (CECT) remains a highly sensitive examination which shows an intensely enhancing small rounded endobronchial nodule. We present a case of recurrent pneumonitis and hemoptysis in a young patient who showed features of typical central bronchial carcinoid in CECT and later confirmed with histopathological examination (HPE).

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Context: Studies have revealed high morbidity and mortality among agate stone workers of Shakarpur due to silicosis. Besides the fatal disease, the workers also suffer from debilitating co-morbidities especially tuberculosis and under nutrition. Aims: The present study describes few co-morbidities and their influence in mortality in cases of silicosis that were followed for 30 months at Shakarpur. Settings and Design: Shakarpur, Khambhat of Gujarat. Materials and Methods: Spirometry for lung function, chest X-ray, anthropometry, body fat % measurement, record of tuberculosis status and ILO classification of pneumoconiosis were done among 53 chest symptomatic patients above 15 years of age who were followed for 30 months. Results: Out of 53 participants (35 men), with an average duration of exposure to free silica of 16.8 years, more than half of the male workers were underweight (BMI<18.5 kg/m ² ) at enrollment. Thirteen participants died in less than 3 years of follow up. While 11 of them were silicosis positive out of which 10 had tuberculosis. The odds ratio for association between silicosis and tuberculosis was 2.75. A majority (81.1%) of the 37 silicosis positive cases showed a mixed pattern in spirometry suggesting co-existence of restrictive and obstructive pathology. On regression analysis, TB and nutritional status were found to have strong influence on mortality. Conclusions: Screening for early diagnosis of silicosis as well as co-morbid conditions and managing them would go a long way in prolonging the lives of the agate stone workers who are prone to die early due to silicosis.

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Tuberculosis has a variety of hematological manifestations. Immune thrombocytopenic purpura is an uncommon manifestation of tuberculosis. We present a case of disseminated tuberculosis with isolated thrombocytopenia. While TB granulomas in the bone marrow can themselves cause hematological abnormalities, persistent thrombocytopenia refractory to anti-TB therapy may be ITP associated with TB.

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A 30-year-old male, carpenter by profession, presented with a history of dry cough and progressive shortness of breath for two months along with right-sided chest pain for one and a half months. The clinico-radiological picture was suggestive of right-sided massive pleural effusion. Computed tomography (CT) scan of the thorax showed a huge mediastinal mass occupying the entire right hemithorax with very small amount of pleural effusion. CT-guided fine needle aspiration cytology and tru-cut biopsy from the mass both revealed small round-cell tumour, possibly small cell carcinoma of the lung. However, on immunohistochemistry tumour cells expressed Mic-2 and it was consistent with a diagnosis of primitive neuroectodermal tumour.

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Extra-alveolar air in the form of subcutaneous tissue emphysema is observed in a variety of clinical settings. Spontaneous subcutaneous emphysema in the absence of pneumothorax or pneumomediastinum is very rare. We report a case of spontaneous subcutaneous emphysema secondary to cavitary pulmonary tuberculosis in the absence of pneumothorax or pneumomediastinum.

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A bifid sternum is a rare congenital anomaly generally diagnosed as asymptomatic at birth. It is sometimes associated with other congenital anomalies. The sternal defects are best corrected surgically during the neonatal period within the first month of life. Sometimes the defect may be diagnosed only in adult life. We here report a case of bifid sternum which was diagnosed incidentally in a 23-year-old male.

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Authorship is a highly sought attribute, as it is associated with recognition for creativity. In addition, it is associated with multiple benefits such as peer recognition, better evaluation and financial gains. These possibilities spur scientists to author articles, but some take recourse to unethical practice of honorary authorships. Another unethical practice is that of ghostwriting. It is a phenomenon wherein individuals who write the articles are not named as authors and are not even acknowledged to be associated with the manuscript. Reputed and renowned scientists, who have not participated in the conduct of the study or in the manuscript preparation, are enrolled by the industry to allow their names to be mentioned as authors. This phenomenon is harmful not only because it suppresses the contribution of ghost-authors but also because the guest "authors" bestow underserved credibility upon an "industry-written" paper. The readers have no way of knowing the bias that may have crept in. The journal editors, institution, and government agencies need to come together to ensure that these malpractices are curbed by employing various measures such as creating awareness amongst authors, academicians, and administrators; enunciating and implementing policies to dissuade unethical behavior, protecting whistle-blowers, and providing punishments to those indulging in malpractices. All of us should remember that if unchecked, these deviant behaviors have the potential to compromise the credibility of scientific research and scientific publications.

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Context: Bronchopleural fistula (BPF) is a communication between the pleural space and bronchial tree. Materials and Methods: A series of 9 cases are reported where BPF was identified and managed with intrabronchial instillation of glue (N-butyl-cyanoacrylate) through a video bronchoscope. Results: Out of 9 patients the BPF was successfully sealed in 8 cases (88.88%). In 1 patient of postpneumonectomy, the fistula was big, that is >8 mm who had a recurrence after the procedure. In one case of pyopneumothorax the leak reduced slowly and it took us 14 days to remove the intercostal drainage tube. Rest of the patients had a favorable outcome. No complications were observed in a follow-up of 6 months. Conclusions: In our opinion, it is a cost-effective, viable, and safe alternative compared with costly, time-consuming, and high-risk surgical procedures.

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Background and Objectives: Bronchodilator reversibility and diurnal peak flow variability are considered characteristic of asthma patients. Patients with chronic obstructive pulmonary disease (COPD) show poor reversibility. But reversibility and variability in other pulmonary diseases manifesting with airflow obstruction in not known. Therefore, we assessed reversibility and peak flow variability in patients with various lung diseases to recognize the pattern. Materials and Methods : Seventy consecutive patients with a diagnosis of lung diseases manifesting with airflow obstruction were recruited in the study. These included 23 patients with asthma, 11 patients with bronchiectasis, 16 patients with post-tubercular lung disease (PTLD), and 20 patients with COPD. Ten healthy matched control subjects were also selected to pair with asthmatic patients. Bronchodilator reversibility test was done initially and peak expiratory flow rate (PEFR) was measured for a duration of 1 week by patients themselves on a chart that was given to them. The mean amplitude percentage of these records were analyzed. Results : The mean values of peak flow variability were 14.73% ± 6.1% in asthmatic patients, 11.98% ± 7.5% in patients with bronchiectasis, and 10.54% ± 5.3% in PTLD. The difference in the mean values of peak flow variability between asthma and bronchiectasis, that is, 14.73 (6.1) vs 11.98 (7.5) was not statistically significant (P > 0.05). Forced expiratory volume one second (FEV ₁ ) reversibility values were 14.77% ± 26.93%, 11.24% ± 20.43%, 10.85% ± 13.02%, 16.83% ± 22.84%, and 5.47% ± 4.99% in asthma, COPD, PTLD, bronchiectasis, and healthy subjects, respectively. Conclusion: Both reversibility and diurnal peak flow variability were higher in patients with various lung diseases compared with normal healthy subjects. Although these are characteristic of asthma, some cases of bronchiectasis and PTLD patients may also manifest asthma-like PEFR variability and reversibility.

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Aims: To evaluate the role of sputum cytology in the diagnostic work-up of patients with suspected lung cancer . Settings and Design : Spontaneously produced fresh sputum was analyzed in clinically suspected cases of lung cancer. Materials and Methods: Spontaneously produced fresh sputum was analyzed in 36 clinically suspected cases of lung cancer. It was carried out using the "fresh pick and smear" method, which employs examination of sputum for blood-tinged, discolored or solid particles and preparation of thin and even smears from these selected portions. Statistical Analysis Used : Average and means. Results: Sensitivity of sputum cytology was 60%, which increased with an increase in the number of samples examined. Conclusions: Sputum cytology in suspected cases of carcinoma of lung is a useful diagnostic tool. It may be called as a poor man's bronchoscopy.

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Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease, mainly due to tobacco smoke. Pulmonary function tests (PFTs) are mandatory to diagnose COPD which shows irreversible airway obstruction. This study was aimed at understanding the behavior of biochemical parameters such as high sensitive C-reactive protein (hs-CRP) and lactate dehydrogenase (LDH) isoenzymes in COPD. Cytoplasmic cellular enzymes, such as LDH in the extracellular space, although of no further metabolic function in this space, are of benefit because they serve as indicators suggestive of disturbances of the cellular integrity induced by pathological conditions. The lung pattern is characterized by proportional increases in isoenzymes 3, 4, and 5. Hs-CRP indicates low grade of systemic inflammation. Materials and Methods: Total (n = 45) patients of COPD (diagnosed on PFTs) were included. We followed the guidelines laid by the institute ethical committee. Investigations performed on the serum were the serum for hs-CRP, LDH isoenzymes on agarose gel electrophoresis. Results: The results obtained showed that the value of hs-CRP was 4.6 ΁ 0.42 mg/L. The isoenzymes pattern was characterized by an increase in LDH-3 and LDH-4 fractions. This is evident even in those patients with normal LDH (n = 13) levels. Interpretation and Conclusion: This study states that there is a moderate positive correlation in between CRP and LDH-3 (r = 0.33; P = 0.01). Raised LDH-3 levels do not correlate with FEV ₁ % (forced expiratory volume in first second) predicted. Moreover, it associates positively with hs-CRP and smoking status and negatively with body mass index. This underlines the potential of these parameters to complement the present system of staging which is solely based upon FEV ₁ % predicted.

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Background: Patients suffering from drug-resistant tuberculosis (DR TB) avail of private care since Programmatic Management of DR TB (PMDT) is not universally available in India. Management of DR TB is challenging and involves great expertise. Chest physicians (CPs) play a major role in this area. The study was undertaken with the objective to see whether the practices of CPs comply with current guidelines and to identify areas where they could be involved to improve access to PMDT. Materials and Methods : For this cross-sectional study, CPs from Mumbai and Nagpur, Maharashtra, India, were given pretested questionnaires to be filled in and returned. Observations : Of 70 enlisted CPs, 29 (41%) responded. Twenty-six (89%) respondents used the drug susceptibility test (DST) for diagnosis: private labs and hospitals were preferred; 9 (31%) used standard treatment, 15 (51%) switched to individual treatment after starting standard therapy and 12 (41%) started empirical treatment later switched to individual treatment as per the WHO guidelines. Seven consultants (10%) used in addition drugs from alternative systems of medicine for immune modulation and adverse drug effects. Eighty-six per cent CPs monitored treatment by smear examination, 51% by culture and 93% used X-rays. Reported case holding in the form of regular follow-up consultation visits was around 70%, treatment success estimated to be between 30% and 70%, and deaths around 30%. Adverse drug reactions were reported in around 30% cases. Conclusion : This study shows that most private CPs generally comply with current guidelines for management of DR TB. Accreditation of private labs for DST, involving CPs in diagnosis, treatment and monitoring of patients through public private partnerships can improve access to PMDT.

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Context : Chronic diseases like asthma have significant effects on patients' health-related quality of life (HRQoL). HRQoL measures additional indices as compared to objective measurements like spirometry. Aims: To assess and compare disease-specific quality of life in asthma patients using St. George's Respiratory Questionnaire (SGRQ) receiving fluticasone, beclomethasone, and budesonide (BUD). Settings and Design: A prospective, open label, randomized, parallel group study conducted at a tertiary care teaching hospital in South India. Materials and Methods: A 6-month follow-up of 277 patients with mild, moderate, and severe persistent asthma was randomized to receive fluticasone propionate (FP), BUD, or beclomethasone dipropionate (BDP) in equipotent doses according to their global initiative on asthma (GINA) severity. Statistical analysis used: Data analyzed using SPSS version: 13.0. General linear-repeated measures using the post-hoc bonferroni method assessed significance between treatment groups. Results: Significant decrease (P < 0.05) in each SGRQ domains and total scores as well as improvement in FEV ₁ (P < 0.05) was observed in all study subjects. A significant early response (P < 0.05) was noted after 15 days treatment in patients receiving FP with respect to SGRQ (activity, impact and total) scores and dyspnea indices, but not FEV ₁ . This improvement with FP was due to its greater effect in patients with moderate and severe persistent asthma. No difference was noted subsequently in all outcome measures studied until 6 months. Conclusions: There was evidence for an early QoL improvement to FP as compared to BUD or BDP in moderate and severe persistent asthma. Subsequently, the three ICS showed similar improvements in lung functions and dyspnea indices throughout the study.

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Because of limitations associated with the conventional treatment of various chronic diseases a growing attention has been given to the development of targeted drug delivery systems. Pulmonary route of drug delivery gaining much importance in the present day research field as it enables to target the drug delivery directly to lung both for local and systemic treatment. Over the last 2 decades, the systemic absorption of a broad range of therapeutics after pulmonary application has been demonstrated in animals as well as in humans. This review was prepared with an aim to discuss the technical, physiological, and efficacy aspects of the novel pulmonary route of drug targeting. The review also focuses on the mechanisms of pulmonary drug administration along with compatibility of the excipients employed, devices used, and techniques of particulate dosage production. This review was prepared based on the method of extensive literature survey on the topics covering all the aspects discussed in the present subject. Hence, the better understanding of complexes and challenges facing the development of pulmonary drug delivery system offer an opportunity to the pharmaceutical scientist in minimizing the clinical and technical gaps.

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