Abstracts for NAPCON 2025

Abstract No. 01: Exploring the pattern and preferences of anti-inflammatory reliever in asthma management across India

Abhishek D. Sabale 1 , S. Phadnis 1 , D. Ghorpade 1 , S. Madas 1 , S. Bhalare 1 , M. Lopez 2 , S. Nair 2 , V. Naik 2 , J. Gogtay 2 , S. Salvi 1

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Cipla Ltd, Mumbai, Maharashtra, India

Background: AIR combines inhaled corticosteroids (ICS) with fast acting bronchodilators like salbutamol or formoterol and are beneficial for reducing exacerbations and improving compliance as compared to traditional SABA relievers. However, there is limited empirical evidence from India regarding its usage and the factors influencing its adoption by healthcare professionals.

Objective: To understand doctors’ prescribing patterns and preferences for anti-inflammatory relievers and their role in asthma management.

Methods: Clinicians (pulmonologists, general physicians and paediatricians) in India were randomly selected and invited to participate in this study. Data was collected through a structured study instrument, using both self-administered questionnaires and telephonic interviews with doctors.

Results: Among the 404 doctors who participated in this study, 52.0% were pulmonologists, 35.6% were physicians and 12.4% were paediatricians. On an average, 73% of the asthma patients received a reliever medication. AIR was prescribed to an average of 72.5%, while SABA was prescribed to 27.5% asthmatic patients. 29.2% of doctors prescribed only AIR as reliever while 70.3% doctors prescribed SABA or AIR. Table 1 shows the prescribing patterns of different AIR combinations. 85.1% of doctors opined that efficacy of AIR therapy was better than SABA alone.

Conclusion: A total of 29.2% doctors prescribed only AIR as reliever therapy. Budesonide-Formoterol combination was the most commonly prescribed AIR. The concept of AIR is well-accepted in India, however, there is scope to further improve the uptake.

Acknowledgment: This study was supported by Cipla Ltd. India.

Abstract No. 02: Factors associated with respiratory symptoms in urban slums of Pune city: Findings from a cross-sectional health survey

Asmita Gaikwad 1 , M. Barne 1 , S. Madas 1 , V. Das 2 , M. Dhawale 1 , A. Shaikh 1 , P. Shinde 1 , A. Sabale 1 , S. Salvi 1

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India

Introduction: India has a population of 1·3 billion people of which 15% lives in slums as per a report by committee on slum statistics/census. India accounts for 18% of the global population but contributes to a disproportionate 30.2% of the global burden of chronic respiratory diseases. We aimed to study the prevalence and risk factors associated with respiratory symptoms in the urban slums in Pune City.

Materials and Methods: We conducted a cross-sectional, interviewer administered, questionnaire-based study among men and women >18 years of age in the urban slums of Pune City. The questionnaire included questions on respiratory symptoms and the factors that were associated with them.

Results: We screened 3862 (M: F = 39%: 61%), age > 18 yrs, 93 % from urban slums. Prevalence of current respiratory symptoms in this population is as per the Figure 1 . The factors that were associated with respiratory symptoms are depicted in Table 1 .

Conclusion: Our study shows that dhoop, agarbatti, loban, mosquito coil, use of biomass fuel, passive smoker in the house, smoker (self), family or past history of asthma or TB were associated with a high risk of respiratory symptoms. Respiratory symptoms were also significantly associated with presence of anaemia, hypertension, diabetes and obesity. We also found that presence of a separate kitchen and presence of one or more window in the house were negatively associated with respiratory symptoms.

Keywords: Poor indoor air quality, respiratory symptoms, separate kitchen

Abstract No. 03: An Observational Study on Respiratory Morbidity and Lung Function Assessment in 2450 Traffic Police Personnel in Bengaluru City - The Largest Occupational Health Screening Study of Traffic Police Personnel in India

Benin Rajesh, Hariprasad Kalpakam, Rohit Vadala, Sameer Bansal, Anmol Thorbole, Ravindra Mehta

Vaayu Chest and Sleep Specialists, Bengaluru, Karnataka, India

Background: Vehicular traffic emission is one of the largest sources of air pollution in metros. Progressive deterioration in air quality leads to significant morbidity and mortality by affecting multiple organ systems, exponentially increased in high-risk populations. Specifically, occupational exposure to vehicular pollution is a significant health risk to traffic policemen, and affects lung function and cardiovascular health.

Aim: This cross-sectional point-prevalence study aimed to screen traffic police personnel (TPP) in Bengaluru city for respiratory and general health.

Methods: A comprehensive respiratory health screening project for TPP was done in Bengaluru, from 1-12-23 to 30-8-24. Symptoms, mask usage, smoking history, prior co-morbidities, BMI, vitals, random blood sugar and spirometry were assessed.

Results: 2450 TPP were screened over 10 months, 91% males. Mean age was 38.84 years (range 26-59; SD-8.62). The participants had an average of 13.45 years of service (range 3-28; SD-7.82). Majority of them did not use masks (n = 1370, 55%) during working hours. The average air quality index (AQI) estimated during the study period was 115. There were 5% active smokers (n = 131). The average BMI was 25.8 kg/m2, and 47% were overweight (n = 891), 11% obese (n = 206). Diabetes mellitus was noted in 14% (n = 343), 50% of them with uncontrolled sugars. Hypertension was noted in 15% (n = 367), 25% uncontrolled. Cough was the most commonly reported symptom (13%). Spirometry showed early lung function impairment (Preserved Ratio with Impaired Spirometry-PRISM) in 28% (n = 513) and obstructive pattern in 1% (n = 20).

Conclusions: This is the largest occupational health screening study of TPP’s in the Indian literature, and one of the largest in global literature. Significant respiratory and general health issues were noted, and likely reflects the situation in other major metros of the country. There is an imperative need for interventions to protect the health of TPP’s in Bengaluru. Implementing protective measures such as use of face masks, regular screenings, promoting a healthier lifestyle, and comprehensive follow-up of affected individuals are major interventions required at an individual and policy level.

Acknowledgements: Shri MN Anucheth, IPS, Joint Commissioner of Police, Traffic, Bengaluru City. Mrs. Nandita Sanghani, Dr. Nanda Sanjay, Mrs. Roopa Chillamkurti and other volunteers at Vaayu who helped selflessly in the initiative.

Keywords: Lung function, occupational health, pollution, traffic police personnel

Abstract No. 04: Kartagener’s syndrome: A case series

Chittal Palaniappan , Somanath Dash, Raghavendra Rao, Madhu Harsha

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Kartagener’s syndrome is an autosomal recessive genetic disorder with triad of Situs Inversus, Chronic sinusitis & Bronchiectasis. In this syndrome, there is defective movement of cilia leading to recurrent chest, ENT infections & infertility. We hereby report five cases of this syndrome & two among them were associated with Pulmonary Tuberculosis (PTB).

Methods: All patients with Dextrocardia who came to our institute on 2024 with history of cough with sputum were included in this study. On the basis of clinical & radiological findings, Kartagener’s syndrome (KS) was diagnosed.

Results: Five cases included in this study, 3 males & 2 females. Among females, one is adult of age 48 years & another is 22 years. Among 3 males included, one is adult of age 53 years & other two are of ages 20 years & 22 years. Two cases were associated with PTB. Semen analysis done for two male patients, one was infertile & other was fertile. Whole Genome Sequencing done for one patient showing homozygous mutation in DNAI1 gene.

Conclusion: KS exists as cases of chronic recurrent sinopulmonary infections. PTB with secondary bacterial infections can be the presenting manifestation in them. Initial sputum AFB may be negative but repeat sputum examination following control of secondary infection may be rewarding in diagnosis of PTB. Diagnosis are delayed as there is no reliable non-invasive diagnostic test for KS. Genetic counselling & fertility issues should be addressed once diagnosed, though Infertility is not a universal phenomenon in KS

Keywords: Bronchiectasis, Kartageners syndrome, sinusitis, situs inversus, tuberculosis

Abstract No. 05: Unmasking small airways disease in asthma: Insights from an Indian multicenter study on the phenotypic distinctions between asthmatics with and without small airways dysfunction as identified by lung oscillometry and spirometry classifications

Disha Ghorpade 1 , S. Bardapurkar 2 , H. Vhora 3 , V. Singh 4 , P. Bhattacharyya 5 , R. Diwan 6 , S. Bardapurkar 2 , U. Singh 4 , S. Chauthmal 7 , S. Madas 7 , R. Swami 7 , A. Sable 7 , M. Lopez 8 , J. Gogtay 8 , S. Salvi 7

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Shree Nursing Home, Aurangabad, Maharashtra, India, 3 Vhora Chest Clinic, Baramati, Maharashtra, India, 4 Asthma Bhawan, Jaipur, Rajasthan, India, 5 Institute of Pulmocare and Research, Chakpachuria, West Bengal, India, 6 Jyotirling Hospital, Kolhapur, Maharashtra, India, 7 Chest Research and Training, Pune, Maharashtra, India, 8 Cipla Ltd, Mumbai, Maharashtra, India

Background: Asthma is an inflammatory disease which affects all portions of the airways, whereas COPD affects only the small airways. Small Airways Disease (SAD) asthma is emerging as an important phenotype of asthma that has distinct clinical manifestations. SAD asthma is reported in up to 50% of asthmatics, highlighting its prevalence and the importance of identifying it as a distinct phenotype. The recognition of SAD in asthma has significant implications for treatment, as it may require targeted therapy aimed specifically at the small airways to manage symptoms effectively and improve patient outcomes. Physiological tests such as spirometry FEF25-75% and more recently lung oscillometry is emerging as an important sensitive diagnostic test for SAD asthma.

Methods: Pulmonologists from 5 centers across India, who were members of the International Network for Lung Oscillometry Research (ARISE) took part in the study. Oscillometry was performed using the Antlia FOT (iCALTECH, Bangalore. India) and spirometry was performed using devices meeting ATS/ERS standards, among asthmatic patients visiting their clinics. SAD was defined using cut-off of ≥1 for R5-R20 or ≥65% for FEF25%-75%. In addition, the prevalence of PRISm (preserved ratio impaired spirometry), Obstructive Airways Disease (OAD) and Restrictive Lungs Disease was also identified using spirometry classification, amongst the SAD patients.

Results: Out of data obtained from 1969 asthmatic patients, 1334 were eligible for the final analysis, of which 1069 (80.1%) had SAD. Considering the phenotypic differences, asthma presents with more breathlessness, wheeze, and chest tightness than non-SAD asthma as shown in Table 1 . The prevalence of PRISm and OAD by spirometry amongst asthmatics has been shown in Table 2 .

Conclusion: The early detection of SAD, particularly mild cases, is better achieved with lung oscillometry. Understanding these differences is crucial for implementing appropriate therapies that address the specific needs of patients with SAD asthma.

Abstract No. 06: Clinical pattern and mutational analysis of lung cancer patients in a tertiary care hospital

Dhruv Gupta , Varuna Jethani, Shahnwaz Saifi, Ankit Batra, Rakhee Khanduri, Sushant Khanduri

Department of Respiratory Medicine, HIMS, SRHU, Jollygrant, Dehradun, India

Introduction: Lung cancer remains a leading cause of cancer-related mortality worldwide, characterized by diverse clinical presentations and genetic heterogeneity. This study aims to analyze the epidemiology, clinical patterns and mutational profiles of lung cancer patients treated at a tertiary care hospital.

Methods: The study was conducted in the Department of Respiratory Medicine at the HIMS, Dehradun after written informed consent. The approval of institutional ethics committee of Swami Rama Himalayan University was taken before starting the study. Demographic and anthropometric indices, socioeconomic status were recorded. As per radiological features patients were further subjected for diagnosis of lung cancer by bronchoscopy, Computed tomography guided Fine needle aspiration or Biopsy and thoracoscopy and further mutational analysis was done.

Results: Majority of patients were males. The most common symptom was shortness of breath. A significant majority were smokers, with history of 10-20 pack years. Upper lobe was the most frequently involved area. Adenocarcinoma was the most common pathological type. Over half of the patients had mutations, with Epidermal growth factor receptor (EGFR) being the most common. Among EGFR mutations, Exon 19 was the most prevalent.

Out of the total 71 patients, 52.11% exhibited mutations, while 47.89% did not present any mutations. In the study conducted by Kaler A. K. et al, only 38.67% of patients tested positive for any mutation. Similar findings were observed in the study by Veldore et al., where mutations were detected in 40% of cases. In our study, EGFR mutations were the most prevalent at 29.58%, followed by TP53 at 11.27%, and KRAS at 7.04%. Singh V et al. reported a higher prevalence of EGFR mutations

Conclusion: This highlights the critical intersections between lifestyle factors, genetic predisposition, and cancer development, underscoring the urgent need for integrated prevention, early detection, and tailored therapeutic strategies.

Keywords: Immunohistochemistry, lungcancer, mutational analysis

Abstract No. 07: Utilization and outcome of nebulized glycopyrronium in patients with obstructive airway disease exacerbation in hospital setting: A real world study

Divya Bhojwani , Rithik, Sagar Bhagat, Saiprasad Patil, Hanmant Barkate

Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, Maharashtra, India

Introduction: Glycopyrronium provides rapid bronchodilation within five to fifteen minutes of administration and has a good safety profile. This study evaluated the use of nebulized glycopyrronium (Neb G) in hospitalised patients and its impact on clinical outcomes.

Methods: Medical records of adult patients treated with Neb G for acute exacerbations of OAD in hospital were reviewed. The study was conducted at 400 centers in India after approval from an independent ethics committee.

Results: Out of 4,000 medical records, 2,780 were analysed. The mean patient age was 59.56 ± 9.72 years, with 2,084 males (74.96%). COPD was the primary diagnosis in 1,804 (64.89%) patients followed by asthma in 523 (18.81%). A total of 1,558 (56.04%) patients had a history of exacerbations, and 1,156 (41.58%) had previous hospitalizations. Nearly half, 1,390 (51.55%), received Neb G as monotherapy, while combination therapy with Nebulized ICS and LABA was preferred for others on first day of hospitalization. The preferred dosage was 25 mcg twice daily for an average of 13.45 days. Patients stayed in the ICU for 3.15 ± 2.93 days and in the ward for 4.96 ± 3.03 days. SABA was required in 1492 (53.66%) patients, mostly needing them on the first or second day 1390 (50%), while 714 (25.68%) required oral corticosteroids. Oxygen support, in the form mechanical ventilation or NIV, was needed in 564 (20.28%) patients. Clinical resolution and discharge occurred in 2497 patients (89.82%). Adverse events occurred in 56 patients (2.01%), with dry mouth reported in 3 (0.11%).

Conclusion: Nebulised Glycopyrronium, as monotherapy or in combination with ICS/LABA, offers an effective, reliable option for managing OAD exacerbations in hospital settings.

Keywords: Bronchodilators, exacerbation, glycopyrronium, nebulisation

Abstract No. 08: Evaluating the role of nebulized glycopyrronium in hospitalized patients with exacerbations of obstructive airway disease: Transitioning from hospital care to discharge

Divya Bhojwani , Rithik, Sagar Bhagat, Saiprasad Patil, Hanmant Barkate

Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, Maharashtra, India

Introduction: Acute exacerbations of obstructive airway diseases (OAD) require prompt medical intervention. While nebulized (Neb) short-acting bronchodilators (SABA/SAMA) are commonly used, they often necessitate multiple doses. Glycopyrronium (GLY), however, offers a rapid & longer duration of action. A questionnaire survey was conducted to evaluate its use in hospitalized patients.

Methods: A structured 10-question survey was administered to physicians managing OAD exacerbations from last 10 years. The survey was validated by a panel of four senior pulmonologists specializing in OAD management.

Results: Of the 120 physicians invited to participate in the survey, 101 physicians actively participated. For managing exacerbations, most physicians preferred Neb bronchodilators (SABA + SAMA) as the first line therapy, Neb GLY with Neb ICS/LABA being the secondary choice for severe exacerbations [ Table 1 ]. Opinions varied regarding the timing of therapy transitions, particularly in severe exacerbations [ Table 2 ]. After stabilization in Emergency Room (ER)/Intensive Care Unit (ICU) to the ward, 44% of physicians preferred Neb GLY based open triple therapy, while 26% opted for GLY-based triple therapy (pMDI/DPI). This trend continued at discharge. The majority (84%) of respondents supported using Neb GLY, either alone or Neb ICS/LABA, for hospitalized patients. Of these, 59% initiated treatment within the first two days and 48% continuing therapy until discharge, extending it for 7-15 days’ post-discharge.

Conclusion: Nebulized glycopyrronium is widely preferred for hospitalised OAD patients, particularly in ERs/ICUs and wards. Its use alongside open triple therapy is favoured throughout the hospital stay and during follow-up care. Our findings highlight the role of Neb GLY’s in managing OAD exacerbations, especially in severe cases.

Keywords: OAD exacerbation, nebulized glycopyrronium, survey

Abstract No. 09: Comparative analysis of FEV 1 and FEF 25-75 in the diagnosis of diverse lung pathologies: Insights from 200 pulmonary function tests at a tertiary care centre

Bhaumik Kamdar , Shahid Patel, Girija Nair, Lavina Mirchandani, Manas Bhanushali, Deepika Ughade

Department of Pulmonary Medicine, DY Patil School of Medicine, Mumbai, Maharashtra, India

Objective: Pulmonary function tests (PFTs) are critical in diagnosing and categorizing lung pathologies. This study aims to compare the diagnostic utility of Forced Expiratory Volume in 1 second (FEV 1 ) and Forced Expiratory Flow at 25–75% of vital capacity (FEF 25-75 ) across various lung pathologies, including obstructive, restrictive, and mixed ventilatory defects.

Methods: A prospective analysis of 200 PFTs was conducted, encompassing patients diagnosed with a spectrum of lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and mixed-pattern pathologies. Data on FEV 1 , FEF 25-75 , and other spirometric parameters were extracted. Comparative analysis was performed to evaluate the sensitivity, specificity, and overall diagnostic performance of FEF 25-75 relative to FEV 1 in characterizing airway obstruction, small-airway dysfunction, and disease progression. Statistical significance was determined using appropriate tests, and correlations between these indices and clinical diagnoses were analyzed.

Results: FEV 1 demonstrated robust sensitivity in detecting airflow limitation in obstructive and mixed-pattern diseases. However, FEF 25-75 exhibited greater sensitivity for identifying early small-airway dysfunction, particularly in asthma and early-stage COPD. FEF 25-75 showed higher variability but provided additional information to FEV 1 , particularly in cases with borderline FEV 1 /FVC ratios. In restrictive pathologies, both parameters were less discriminatory but still informative for mixed-pattern differentiation.

Conclusion: While FEV 1 remains the cornerstone of spirometric analysis, FEF 25-75 offers valuable additional insights, particularly in detecting early small-airway dysfunction and in cases with equivocal FEV 1 findings. Integrating both indices enhances diagnostic accuracy and provides a more nuanced understanding of lung pathology, particularly in diseases involving heterogeneous airway involvement.

Keywords: FEF 25-75 , FEV 1 , obstructive lung disease, PFT, restrictive lung disease, spirometry

Abstract No. 10: To study diagnostic yield and adverse effects of bedside bronchoscopy in acute respiratory failure patients with moderate to severe hypoxemia

Gaurav Mishra , Rahul Tyagi

Department of Respiratory Medicine, Armed Forces Medical College, Pune, Maharashtra, India

Background: Bronchoscopy is a valuable tool in managing critically ill patients, particularly in intensive care settings, due to its diagnostic and therapeutic potential with a low incidence of complications. However, in patients with severe hypoxemic respiratory failure, bronchoscopy especially bronchoalveolar lavage (BAL), poses risks such as hypoxemia. Despite these risks, timely diagnosis is crucial as undetermined causes of acute hypoxemia are associated with poor outcomes. This study investigates the diagnostic yield, clinical outcomes, and complication rates of bedside bronchoscopy in hypoxemic patients.

Objectives: (a) To determine the frequency of a change in the primary diagnosis following bedside bronchoscopy in patients with hypoxemic respiratory failure, (b) To assess the incidence, types, and severity of adverse effects associated with bedside bronchoscopy in patients with hypoxemic respiratory failure.

Methods: This retrospective observational study was conducted from December 2023 to December 2024 at a tertiary respiratory care center. 40 patients aged >14 years with hypoxemic respiratory failure with moderate to severe hypoxemia (FiO2 requirement >40%) underwent bedside bronchoscopy. Medical records were analyzed for changes in diagnosis, treatment modifications, and adverse events. FiO2 requirements before, during, and after the procedure were recorded. Patients were followed until discharge or death.

Results: In a cohort of 40 patients with hypoxemic respiratory failure (mean age: 51.5 years) who underwent videobronchoscopy with bronchoalveolar lavage (BAL), an etiological diagnosis was achieved in 26 patients (65% of the total cases). The BAL findings led to a change in treatment in 20 patients (50% of total cases), of whom 10 patients (50%) had a favorable outcome. In contrast, among the 14 patients where no diagnosis was established, only 4 patients (28%) had a favorable outcome. Overall, 14 patients (35%) survived, while 26 patients (65%) succumbed to their illness, highlighting the potential impact of BAL in guiding treatment decisions and improving outcomes in respiratory failure patients. BAL was crucial in diagnosing conditions like PCP pneumonia, fungal pneumonia, strongyloides, DAH and PAP, which would have been easily missed. The procedure was well-tolerated, with no significant complications other than transient increases in oxygen requirements which was effectively managed with increasing the oxygen support.

Conclusion: Bronchoalveolar lavage (BAL) in acute respiratory failure, though technically challenging, facilitates the identification of atypical diagnoses and can significantly improve patient outcomes.

Keywords: Bedside bronchoscopy, clinical outcomes, bronchoalveolar lavage, diagnostic yield, hypoxemic respiratory failure

Abstract No. 11: Study of microalbuminuria as a biomarker for management acute exacerbation of COPD with corpulmonale in hospitalised patients of tertiary care centre

M. Harshavardhana , C. Nandish, B. Vidyasagar

Department of Respiratory Medicine, Bapuji Hospital, JJM Medical College, Davanagere, Karnataka, India

Introduction: Cardiovascular disease is a major cause of mortality in COPD. Microalbuminuria (MAB) is a sensitive marker of cardiovascular risk and kidney disease. The presence of MAB is associated with arterial stiffness and worse cardiovascular outcomes. MAB has a stronger association with cardiovascular events and death than CRP. MAB is believed to reflect a state of generalised endothelial dysfunction, and therefore could be a promising biomarker to identify patients with COPD COR PULMONALE at increased cardiovascular risk, without any comorbidities.

Aim of the Study: To evaluate the association between presence of MAB and outcomes of patients hospitalised with acute exacerbation of COPD (AECOPD) IN COR-PULMONALE.

Methods: (1) Study population: This is a prospectively collected data from patients admitted for aecopd to the respiratory medicine department of bapuji hospital in J. J. M. M. C, davanagere. Patients with history of respiratory disorders other than COPD, other comorbidities, inability or unwillingness were excluded. (2) Study design: Patients demographics, clinical parameters were recorded on admission, including vital signs, level of dyspnoea (mMRC and 6MWT), and abg (pH, PaCO2, PaO2). Standard laboratory measurements (CBC, serum creatinine and CRP) collected from each patient at the time of admission prior to initiation of any treatment. Patients with GFR < 60 mL/min/1.73 m2 were excluded. Patients were classified in four COPD groups A–D as defined by GOLD criteria. Study investigator recorded the patients vital status and the numbers of new AECOPD (defined as need for antibiotics and/or oral corticosteroids, visits to the emergency department and/or hospitalisations) based on self-reporting of patients and was confirmed by hospital records. MAB was defined as a urinary albumin excretion of 30–300 mg/24 hours, when measured in a 24-hour urine collection using a standard spectrophotometric method. (3) Statistical analysis: AECOPD and hospitalisations are both reported as the proportion of patients undergoing an event as well as the mean (SD) number of events per patient per year. Categorical values were analysed using the χ 2 test or Fisher’s exact test (χ 2 ) as appropriate and were reported as n (%). Continuously measured variables were compared by Student’s t-test. Continuous parameters with normal distribution are reported as means±SD. Level of statistical significance was set at p value < 0.05. All statistical analyses were performed using SPSS for Windows software.

Results: Patients with MAB required a more prolonged hospitalisation days and had higher rates of AECOPD.

Conclusion: MAB on admission for AECOPD was associated with a higher risk of AECOPD at 1-year follow-up. Patients with MAB required more prolonged hospitalisation, were frequent exacerbators, had more severe COPD according to the GOLD classification, more severe airflow obstruction, more comorbidities, lower BMI, more severe dyspnoea, lower 6MWT, more impaired oxygenation, higher PaCO2, higher use of LTOT and NIMV prior to admission. This suggest a possible role for MAB in the identification of patients with COPD at increased risk of adverse outcomes that may need early intensive interventions and management.

Abstract No. 12: MiRNA profiling in exhaled breath condensate: A novel approach for differentiating lung cancer from COPD

Jaya Tak 1 , D. Rai 1 , P. Adwika 1 , B. Pattnaik 1 , S. Bangaru 1 , N. Bhatraju 2 , R. Guleria 1 , A. Agrawal 2 , G. Yadav 3 , R. S. Dhaliwal 3 , T. Srivastva 4 , A. Mohan 1

1 Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India, 2 CSIR-IGIB, New Delhi, India, 3 ICMR, New Delhi, India, 4 Department of Genetics, University of Delhi (South Campus), New Delhi, India

Background: Lung cancer and chronic obstructive pulmonary disease (COPD) are major health concerns with overlapping risk factors like tobacco smoke. Differential expression of microRNAs (miRNAs) in these conditions suggests their potential as biomarkers. Exhaled breath condensate (EBC) provides a non-invasive method for miRNA detection, which could aid in distinguishing between lung cancer and COPD.

Methods: We conducted a cross-sectional study with 25 healthy controls (mean age: 60.07 ± 8.3 years), 25 COPD patients (mean age: 61.6 ± 8 years), and 25 lung cancer patients (mean age: 57.6 ± 10 years). Exhaled breath condensate (EBC) was analyzed for miRNA expression using microarray and quantitative PCR (qPCR). The statistical analysis involved global mean normalization, ΔCt value calculation, and unpaired t-tests to compare miRNA levels between the groups.

Results: Among the recruited subjects, the number of current smokers was 7 in the healthy control group, 21 in the COPD group, and 18 in the lung cancer group. The average BMI was 25.9 for healthy controls, 23.6 for COPD patients, and 20.1 for lung cancer patients. We identified 36 miRNAs distinguishing COPD from healthy controls and 43 miRNAs separating lung cancer from healthy controls. Additionally, 18 miRNAs were specific to differentiating lung cancer from COPD, with 15 upregulated and 3 downregulated.

Conclusion: miRNA profiling in EBC demonstrates significant potential as a non-invasive tool for differentiating lung cancer from COPD. The promising results highlight its utility in diagnosis and disease differentiation. However, to fully establish its clinical value, additional validation and functional studies are essential.

Abstract No. 13: A study on platelet count, D-Dimer, CRP, Il-6 levels in bilateral atypical pneumonia patients testing negative for SARS CoV-2 and H1N1 on RTPCR

Razak Khan

RNT Medical College, Udaipur, Rajasthan, India

Introduction: SARS-CoV and MERS-CoV are emerging coronaviruses with mortality rates of 10% and 35% respectively. Research suggests that hematological tests may help identify need for additional diagnostics for SARS-CoV-2 infection. While many studies focus on RT-PCR for diagnosis, there is gap in research on hematological markers in patients with atypical pneumonia who test negative by RT-PCR. This study aims to explore how hematological parameters can guide diagnosis and treatment.

Methods: It was hospital based descriptive epidemiological study. Cross-sectional in design. Study was planned for 12 months from August, 2020 to July, 2021 till sample size is achieved. Study population were patients presenting in wards, ICU and OPD of RNT medical college with atypical pneumonia, testing negative for both COVID-19 on RT-PCR and H1N1.

Results: In our study of 151 patients, 127 (84.1%) had low platelets, and 5 (3.3%) had high platelets. Of 127 with low platelets, 37 (97.4%) died, and 90 (79.6%) were discharged. Elevated D-Dimer levels were seen in 97.37% of the deceased and 80.54% of the discharged. CRP levels were elevated in 94.74% of the deceased and 84.96% of the discharged. IL-6 levels were elevated in 78.95% of the deceased and 67.26% of the discharged.

Conclusion: This study provides valuable insights for future researchers and clinicians, enhancing their understanding of atypical pneumonias and enabling identification of such patients based on hematological parameters during a pandemic, even in presence of negative diagnostic test results.

Keywords: Atypical pneumonia, CRP, D-dimer, IL-6 levels, platelet count, severe acute respiratory syndrome coronavirus

Abstract No. 14: Development and evaluation of a novel sonographic scoring system for differentiating exudative and transudative pleural effusions

Rishab Rampradeep

Saveetha Medical College Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

Introduction: Accurately distinguishing exudative from transudative pleural effusions is essential for guiding treatment. While Light’s criteria remains a diagnostic standard, it is prone to misclassification, particularly in heart failure. This study explores the potential of a novel sonographic scoring system using thoracic ultrasound to determine the exudative or transudative nature of pleural effusions.

Methods: This prospective study involved 74 patients with pleural effusions, categorized based on clinical diagnosis. Thoracic ultrasound was performed to assess laterality, loculations, fluid echogenicity (anechoic or echogenic), and pleural thickening (≥3 mm). These parameters were integrated into a sonographic scoring system, where each positive finding contributed one point to a total of 4. The diagnostic performance of the scoring system was compared to Light’s criteria in terms of sensitivity and specificity.

Results: Thoracic ultrasound findings correlated significantly with exudative effusions. The sonographic scoring system achieved a sensitivity of 98.4% and specificity of 40% in distinguishing exudative from transudative effusions.

Conclusion: The proposed sonographic scoring system could serve as a simple point of care, non-invasive bed side screening tool which could aid physicians in determining the nature of the pleural effusions.

Keywords: Pleural effusion, sonographic score, thoracic ultrasound

Abstract No. 15: Identifying spirometry challenges: Insights from a multi-centric study in India

Ruby Swami 1 , Nagrajan Srinivasan 2 , K. S. Arora 3 , Deepak Shukla 4 , Indranil Haldar 5 , Joydeep Ganguly 6 , K. Madhu 7 , Rennis Davis 8 , S. K. Awasthi 9 , Sandeep Raj Bharma 10 , Vikram Jaggi 11 , Sapna Madas 1 , Sujata Chauthmal 1 , Abhishek Sabale 1 , Rushika Shah 12 , Meena Lopez 12 , Senthilnathan Mohanasundaram 12 , Jaideep Gogtay 12 , Deesha Ghorpade 1 , Sundeep Salvi 1,13

1 Chest Research and Training Pvt Ltd (CREST), Pune, Maharashtra, India, 2 Hindustan Hospital, Coimbatore, Tamil Nadu, India, 3 Kharak Singh Arora Multispeciality Hospital, Alwar, Rajasthan, India, 4 Dr. Deepak Shukla Chest and Allergy Care, Jabalpur, Madhya Pradesh, India, 5 The Lung Care Clinic, Hooghly, West Bengal, India, 6 J. Ganguly Chest Clinic, Berhampore, West Bengal, India, 7 Apollo BGS Hospital, Mysore, Karnataka, India, 8 Dr. Rennis Davis’s Clinic, Thrissur, Kerala, India, 9 Matra Chaya Chest and Allergy Centre, Kanpur, Uttar Pradesh, India, 10 Chest Medical Center, Hyderabad, Telangana, India, 11 Asthma Chest and Allergy Centres, Delhi, India, 12 Cipla Ltd, Mumbai, Maharashtra, India, 13 Pulmocare Research and Education Foundation, Pune, Maharashtra, India

Background: Spirometry is crucial for diagnosing various lung diseases and is considered the gold standard for lung function measurement. However, it remains a challenging test for many patients, requiring significant effort and cooperation.

Objective and Methods: In this cross-sectional, observational, point prevalence study, we evaluated the challenges faced by spirometry technicians and pulmonologists referring patients for spirometry, particularly those undergoing the test for the first time. The study was conducted across 10 centers (pulmonologist clinics) in India, located in Uttar Pradesh, South Delhi, Telangana, Tamil Nadu, Kerala, Karnataka, Madhya Pradesh, West Bengal (2 centers), and Rajasthan.

Results: The study included 12 experienced technicians (average experience of 6.9 years) and 316 patients [Mean age: 44.39 ± 17.23, range18-96 years; M: F = 57.9%: 42.1%]. One patient refused to perform spirometry. Of the 315 who underwent spirometry, all completed 3 blows, except one who was unable to perform due to old age. The average spirometry trials performed were 4 and the average time taken was 23 minutes (range: 6-60 mins) The primary reasons for spirometry testing were obstructive airway disease (50%), breathlessness (23%), and cough (18%). According to the pulmonologists, the use of spirometry influenced management in 27.85% and diagnosis in 25.32% of patients. The spirometry technicians reported that 29% of patients found it challenging to perform the test (74.7% due to breathing difficulties, 9.9% due to inability to follow instructions, and 15.38% due to other reasons). Furthermore, 34.9% of patients themselves reported challenges with the test, primarily breathing issues (58.2%), instructional difficulties (22.7%), and mouthpiece–related problems (12.73%). Approximately 34.81% of patients indicated a preference for a simpler alternative lung test to spirometry.

Conclusion: Despite the involvement of well-trained technicians, a significant proportion of patients (around one-third) found spirometry difficult to perform. This highlights the ongoing need for simpler, more accessible alternatives to traditional spirometry for lung function assessment.

Keywords: Alternative lung test, diagnostic tool, lung function test, obstructive airway disease, patient challenges, pulmonary function, spirometry, technician experience

Abstract No. 16: Unmasking the Culprit: A Rare Fungal Encounter in the Anterior Mediastinum

S. Shilpa , P. Thomas George

Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India

Background: The anterior mediastinum is a site of diverse pathological entities ranging from benign and malignant neoplasms to infectious and inflammatory conditions each presenting unique diagnostic and therapeutic challenges. Fungal infections of the mediastinum are rare, they can occur in the context of immunosuppression or as an unusual presentation of systemic fungal disease. These infections are often misdiagnosed due to their nonspecific clinical and radiological manifestations, leading to potential delays in appropriate treatment.

Case Study: 39 year old male presented with h/o cough of 4 months duration, followed by left sided pleuritic chest pain for 3 months, hoarseness of voice, loss of weight and loss of appetite, features of superior vena caval obstruction like dilated veins over chest and left upper limb. Past history revealed the blackish discolouration and induration of left palm for the past 4 years. CT Thorax showed non enhancing soft tissue lesion in prevascular space encasing arch of aorta, pulmonary vessels, left main bronchus and causing erosion of 2 nd and 3 rd ribs. Blood investigations including serum beta HCG, AFP, LDH within normal limits. USG guided transthoracic biopsy revealed suppurative granulomatous inflammation with giant cell reaction with fungal organisms, morphology favouring phaeohypomycosis. Patient was started on oral antifungals. After 1 month of therapy, patient showed significant improvement with no features of SVCO and xray showed significant reduction in size of lesion.

Conclusion: The case highlights the unique presentation and the importance of maintaining a broad differential diagnosis when evaluating an anterior mediastinal mass, emphasizing its rarity and clinical significance

Abstract No. 17: Functional impairment in bronchiectasis: To correlate the sputum neutrophil elastase levels with spirometry parameters

Shraddha Acharya , N. Huliraj, Deepak Kumar, Basava S. J., G. K. Shankar

Department of Respiratory Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India

Introduction: Bronchiectasis is defined as the abnormal, irreversible dilatation of the bronchi along with airway inflammation, where patient presents with cough, sputum production and recurrent respiratory tract infections. Proteolytic enzymes play a pivotal role in bronchiectatic distortion of the airway, and are therefore considered valuable prognostic markers. Bronchiectasis is also associated with impaired ventilatory function of the lungs. Hence this study highlights the relationship between the sputum neutrophil elastase ratio and the spirometry severity changes in bronchiectasis patients.

Methods: It is a cross sectional observational study conducted in group of 30 patients, over a duration of 9months at KIMS Hospital, Bangalore. The study was done on whom HRCT thorax confirmed bronchiectasis. Exclusion criteria included, patients aged below 18 years, bronchiectasis due to other causes including interstitial lung disease, old pulmonary tuberculosis and lung malignancy.

Results: The sputum neutrophil elastase (NE) readings by ELISA increased with the severity of obstruction in bronchiectasis. The value of neutrophil elastase levels were significantly lower, i. e. mean NE value of (34.2 +/- 1.27) ng/ml in mild obstruction, as compared to individuals with severe obstruction, with mean NE (82.23 +/- 22.38) ng/ml according to spirometry severity classification.

Conclusion: A significant correlation is found between higher sputum NE levels with lower FEV1 values, suggests that NE could be employed as a diagnostic and prognostic tool to assess the disease severity of bronchiectasis and monitor treatment protocol in clinical practice.

Keywords: Biomarker, bronchiectasis, neutrophil, spirometry

Abstract No. 18: An unusual presentation of chest pain: A hidden link to plasma cell disorder

Shraddha Acharya , Basava S. J., N. Huliraj, M. K. Raghavendra

Department of Respiratory Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India

Background: Multiple myeloma and plasmacytoma are disorders characterised by abnormal proliferation of plasma cells. Plasmacytoma is typically a localised tumour composed of plasma cells, whereas Multiple Myeloma is marked by the uncontrolled proliferation of plasma cells in the bone marrow, leading to widespread systemic damage affecting various organs. In our case study, we highlight this unique overlap of plasmacytoma with Multiple Myeloma.

Case Study: A 77 year old man presented with right side shoulder pain, chest pain and exertional breathlessness that had persisted for one month. High resolution computed tomography (HRCT) Thorax revealed a heterogeneous enhancing lesion in the right upper lobe. A CT-guided biopsy was performed, and histopathological examination showed CD-138 positive plasma cells, suggestive of Plasmacytoma. Serum Protein electrophoresis revealed the presence of a M spike and elevated beta-2 microglobulin levels. A bone marrow aspiration was performed, which had features consistent with Multiple Myeloma. Chemotherapy was initiated based on the working diagnosis of multiple myeloma with plasmacytoma.

Conclusion: The case report underscores the importance of early evaluation of patient with unexplained shoulder pain, as the final diagnosis may be Multiple Myeloma. Early diagnosis and prompt initiation of chemotherapy, along with supportive care can significantly improve the prognosis and quality of life for patients with Multiple Myeloma.

Abstract No. 19: HOCUS – POCUS with a focus on lung pathology: A case series

Shradha Bajan , Girija Nair, Lavina Mirchandani

Department of Pulmonary Medicine, D. Y. Patil Hospital, Navi Mumbai, Maharashtra, India

Introduction: Point-of-Care Ultrasound (POCUS) has revolutionized bedside diagnostics, offering clinicians with a rapid, non-invasive tool for evaluating and managing patients. In pulmonary medicine, POCUS has become indispensable, enabling real-time assessment of lung pathologies extremely fast with high accuracy, minimal cost, and no radiation exposure.

Case Reports: In our case series of 5 patients, POCUS provided quick and accurate diagnosis. Case 1: A patient after violent coughing becomes acutely breathless. Pneumothorax: Absence of lung sliding, “barcode sign.” on M-mode and presence of a lung point and lung pulse. Case 2: A case of SLE and hypoalbuminemia has progressive breathlessness over 2 months and decreased air entry on the right side. Pleural Effusion: Visualization of anechoic fluid collections in the pleural space with presence of the sinusoidal sign and the waving hand pattern. POCUS also helped this patient to quantify and tap the Right pleural effusion without causing a pneumothorax. Case 3: A 70 year old diabetic smoker, also a K/C/O dilated cardiomyopathy. Pulmonary Edema: Detection of B-lines and absence of A-lines indicating interstitial fluid accumulation. A plethoric poorly collapsible IVC and a poor EF 25% was also found. Case 4: 20 year female with post covid fibrosis develops fever, productive cough and acute breathlessness. Pneumonia: dynamic air bronchogram giving a Shred sign and a Starry Night sign S/O consolidation found. Case 5: A 20 year morbidly obese patient after a long travel from the US, presents to the ED in hypotension and hypoxia. DVT with Pulmonary Embolism: D sign, Mc Connells sign, Tricuspid Regurgitation, and plethoric non collapsible IVC. Thrombus noted in the Femoral vein. In emergency and critical care, POCUS enables swift diagnosis and guides interventions like thoracentesis, chest tube placement, and monitoring of disease progression. The advent of portable ultrasound devices and artificial intelligence integration has further expanded its accessibility and diagnostic capabilities.

Conclusion: POCUS has transformed pulmonary diagnostics by providing clinicians with a powerful, rapid, accurate bedside imaging modality that enhances patient diagnosis and care.

Abstract No. 20: Role of a protocolized pulmonary rehabilitation programme in improving performance status in patients with end-stage lung disease eligible for lung transplant

Shubham Agarwal 1 , Anant Mohan 1 , Vidushi Rathi Ish 1 , Karan Madan 1 , Vijay Hadda 1 , Saurabh Mittal 1 , Randeep Guleria 1 , Milind Hote 2 , Manoj Sahu 2 , Sandeep Seth 3 , Aarti Vij 4 , Maroof A. Khan 5

1 Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India, 2 Department of CTVS, All India Institute of Medical Sciences, New Delhi, India, 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India, 4 Organ Retrieval and Banking Organisation, All India Institute of Medical Sciences, New Delhi, India, 5 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

Introduction: Pulmonary rehabilitation (PR) in chronic respiratory diseases improves symptoms, quality of life, and exercise capacity. Lung Transplantation (LT) is the treatment of choice if disease progresses despite optimal management. As poor performance status (PS) has adverse peri-operative outcomes, improving PS via protocolised rehabilitation may increase chances of getting waitlisted.

Aims: Primary objective was to study effect of a protocolised PR programme on performance status using Karnofsky Performance Status (KPS) score. Secondary objectives were ECOG status, quality of life, symptom severity, sarcopenia, spirometry (PFT and DLCO), six-minute walk distance, and eligibility for LT waitlisting.

Methods: Prospective, single arm, interventional study on patients with end-stage lung disease, meeting referral criteria for LT. A protocolised 12-week hybrid hospital and home-based PR intervention was conducted, and all outcomes were assessed at baseline, and within 1 month of completion of the intervention.

Results: 75 patients were enrolled, and intervention completed by 51 patients (68%). 35 patients met LT listing criteria, 27 being “unfit” for LT at baseline, 18 of whom completed the intervention. Significant improvement seen in KPS, ECOG, SGRQ score, visual analogue scale (VAS) score for cough and dyspnoea, and sarcopenia for all 51 patients. Of the 18 patients unfit for waitlisting, 12 became fit, and 7 were waitlisted for LT.

Conclusion: Patients eligible for LT benefit from a hybrid PR programme, with improvement in KPS, quality of life and sarcopenia, and eligibility for LT waitlisting.

Abstract No. 21: A tradition meets toxins: A rare case report of mercury toxicity with pulmonary manifestations

P. Smitha , B. P. Rajesh

JJM Medical College, Davangere, Karnataka, India

Introduction: Mercury is a heavy metal known to cause harmful effects on various organ systems. It exists in 3 forms-Elemental mercury, Organic mercury, and Inorganic mercury compounds. Mercury toxicity is hazardous when inhaled, intravenously administered or ingested and can result from both occupational and non-occupational exposure. The common manifestations are fever, gastrointestinal distress, respiratory complications, neurological abnormalities, nephrotoxicity and dermatological manifestations.

Case Report: A 38 years old female came with complaints of non-productive cough for 10 days with no significant past history and comorbidities. On examination Vitals-WNL, RS-B/L rhonchi. ChestXray showed high density opacity in all over lung fields. Patient reassessed with history and gave history of taking medications for infertility from the local traditional folk practitioner two tablets twice daily with betelleaf juice and cowmilk from past 1 months. Composition of medications showed Swarna (Gold), PARADA (Mercury), Gandhaka (Sulphur) in 1:8:16 ratio. HRCTthorax showed high density opacity with classical diffraction. CBC, RFT, LFT – WNL. Blood mercury level 46mcg/L, Urine mercury level – 14mcg/L increased. A multidisciplinary approach made to rule out other systemic manifestation but no obvious findings. Patient started with Dimercaprol injection 150 mg twice daily im for 11 days and repeat blood and urine mercury level monitored showed improvement.

Conclusion: This case report demonstrates the diagnostic and therapeutic challenges in managing a patient with mercury poisoning. The patients’ recovery relied on an interdisciplinary approach and timely medical interventions, highlighting the significances of coordinated care in managing toxicological emergencies.

Abstract No. 22: A comparative study of stop bang questionnaire with oxygen desaturation index in screening of obstructive sleep apnea in India

P. Smitha , Akshay M. Hiremath, B. Vidyasagar

JJM Medical College, Davangere, Karnataka, India

Introduction: Obstructive sleep apnea syndrome (OSAS) is frequent partial (hypopnea) or complete (apnea) upper airway collapse during sleep leads to oxygen desaturation, increased respiratory effort, arousal and sleep fragmentation. OSAS is considered independent risk factor for hypertension and has association with heart failure, arrhythmias, coronary disease, metabolic syndrome and type 2 diabetes. Although due increasing prevalence of OSAS, overnight technician attended polysomnography performed in sleep laboratory remains gold standard for diagnosis, its high cost, long waiting list and limited accessibility have made it impractical in OSA screening. This study evaluated the value of Stop BANG Questionnaire (SBQ) to screen for OSA and compared it with the oxygen desaturation index (ODI) and their combination. Objectives: 1. Evaluating the effectiveness of diagnostic value of individual and the combined SBQ and ODI with AHI in diagnosing OSA. 2. Assessing the individual and combined validity of the ODI and SBQ alongside the AHI in diagnosing OSA.

Methods: One year cross sectional study conducted among 80 patients who are clinically risk for OSA based on screening SBQ in comparison to the objective assessment who underwent standard overnight attended polysomnography (PSG level-1. PHILIPS RESPIRONICS SLEEPWARE G3) in Bapuji Hospital, attached to JJM Medical college, Davangere from May 2023 to May 2024.

Results: Of 80 screened patients 53 % had OSA. All the patients reported at least one suspected OSA symptom, the most common were snoring (72%) and tiredness (57%). SBQ showed increased sensitivity than specificity to screen OSA. As severity of OSA increased, the sensitivity increased and specificity decreased for both measurements. ODI achieved an increased specificity and could correctly diagnose OSA which was better than SBQ. For all severities of OSA, ODI alone displayed a larger AUC than SBQ and similar AUC to their combination.

Conclusion: The ODI demonstrated higher specificity and AUC compared to the SBQ. Additionally, combining ODI with SBQ did not enhance diagnostic accuracy. Thus, ODI may be a more effective and user-friendly option for initial OSA screening compared to SBQ

Abstract No. 23: A study to analyse neutrophil-lymphocyte ratio in blood among copd patients as a marker of disease severity

S. G. Sowmitha

Department of Respiratory Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Introduction: Chronic obstructive pulmonary disease (COPD) is a heterogenous lung condition characterised by chronic respiratory symptoms (dyspnea, cough, sputum production and/exacerbation) due to abnormalities in airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstuction. The chronic inflammation of COPD is due to recurrent colonization or due to recurring inflammatory process as an aftermath of bacterial colonization. WBC and its subtypes are well known markers of inflammation. During periods of stress the neutrophil levels go up and the lymphocyte levels come down, this is the basis behind calculating the NLR ratio. There are other inflammatory markers which have been under scrutiny including ESR, CRP, which need to be correlated with NLR. Measurement of FEV1 is a reliable marker to assess the degree of obstruction and disease severity. But this value does not signify the level of inflammation. Moreover, pulmonary function testing and exercise related tests cannot be performed in many COPD patients who are in exacerbation, hence at these junctures, biomarkers can help in risk and severity assessment and treatment.

Aim: To analyse the Neutrophil-Lymphocyte Ratio in blood among COPD patients as a marker of disease severity. The objectives of the study included:

1. To analyse the neutrophil-lymphocyte ratio in blood among COPD patients, 2. To find out the correlation of NLR ratio with severity of obstruction, RDW and see if NLR can be used to assess disease severity comparing with BODE index.

Methods: In a cross sectional design, 80 patients were recruited. Patients with acute exacerbation of COPD admitted in the respiratory medicine ward and also stable COPD patients attending the Respiratory Medicine OPD were chosen as study subjects. Data like MMRC grade, BMI, PFT, 6MWT, ESR, CRP, RDW, Absoute Neutrophl count and absolute lymphocyte count are collected. Also a chest xray is taken to rule out other pathologies.

Results: NLR has positive correlation with MMRC, RDW and BODE index. Thus NLR can be used as a marker of disease severity in COPD. According to ROC curve analysis of NLR, with 4.1 as cut off, NLR can be used to predict an exacerbation in COPD patients. NLR and RDW are increased among the exacerbated COPD patients compared to the stable patients. Hence both these markers can be used to denote the severity of the disease and also an exacerbated state. Also RDW is positively correlated to NLR, hence both these simple, cost effective markers can be used in routine practice to grade the severity of COPD. CRP, another acute phase reactant protein is also found to have a statistically significant association with COPD and is found to be elevated more in the exacerbated COPD patients compared to the stable ones.

Conclusion: NLR is a cost effective, easy, quick marker derived from routine CBC. It can be used as a marker of disease severity among COPD patients, and also to predict an exacerbation.

Abstract No. 24: Burden and prevalence of small airways dysfunction (SAD) asthma in Indian population: A multicentre study using lung oscillometry and spirometry

Sujata Chauthmal 1 , Suhas Bardapurkar 2 , Harshvardhan Vhora 3 , Virendra Singh 4 , Parthasarathi Bhattacharya 5 , Ragini Diwan 6 , Shreehas Bardapurkar 2 , Udaiveer Singh 4 , Sapna Madas 1 , Ruby Swami 1 , Abhishek Sabale 8 , Meena Lopez 7 , Jaideep Gogtay 7 , Sundeep Salvi 1,8 , Deesha Ghorpade 1

1 Chest Research and Training, Pune, Maharashtra, India, 2 Shree Nursing Home, Aurangabad, Maharashtra, India, 3 Vhora Chest Clinic, Baramati, Maharashtra, India, 4 Asthma Bhavan, Jaipur, Rajasthan, India, 5 Institute of Pulmocare and Research, Chakpachuria, West Bengal, India, 6 Jyotirling Hospital, Kolhapur, Maharashtra, India, 7 Cipla Ltd, Mumbai, Maharashtra, India, 8 Pulmocare Research and Education Foundation, Pune, Maharashtra, India

Background: Small airways dysfunction (SAD) asthma is an emerging phenotype of asthma which is associated with more severe form of the disease, uncontrolled asthma, greater night-time awakenings, obesity and exercise-induced asthma. This phenotype of asthma has been shown to affect more than 50-60% of asthmatics globally. However, there is limited data on the prevalence of SAD in the Indian asthmatic population.

Aim: We aimed to study the prevalence of SAD among Indian asthmatics using lung oscillometry and spirometry.

Methods: Pulmonologists from five centres across India, who were members of the International Network for Lung Oscillometry Research (ARISE), were invited to participate in this study. The study involved asthmatic patients visiting their clinics, where lung oscillometry and spirometry were performed along with a questionnaire that captured data on demographics, risk factors, symptoms and co-morbid conditions. Oscillometry was conducted using the Antlia FOT device (iCALTECH, Bangalore, India), while spirometry was performed using devices that met the standards set by the American Thoracic Society (ATS) and the European Respiratory Society (ERS)-2019. SAD was defined using specific criteria: R5-R20 value of ≥1 cmH2O/l/sec or FEF25%-75% ≤ 65%.

Results:

Out of data obtained from 1969 asthmatic patients, 1334 were eligible for the final analysis. The prevalence of SAD using cut-off values of ≥ 1, > 0.9, > 0.8 and > 0.7 cmH2O/L/sec for R5-R20 were reported to be 60.6%, 65.8%, 72.2% and 77.4% respectively, whereas FEF25%-75% <65% was reported to be 61.8%. The prevalence of SAD amongst males and females was reported to be 77% and 82.4%, respectively. In SAD asthmatics, 50.7% of males and 53.5% of females were obese, while 18.8% and 15.7% were overweight, respectively. SAD was significantly more common among obese and overweight females (p = 0.002), and a similar trend was observed amongst SAD asthmatic males (p = 0.007).

Conclusion: The burden of SAD-Asthma among 1334 asthmatics visiting clinics across 5 centers in India was 60% using the cut-off of R5-R20 of ≥1 cmH2O/L/sec.

Abstract No. 25: Efficacy and safety of vilanterol/glycopyrronium pMDI compared to formoterol/glycopyrronium pMDI in COPD: A Phase-III RCT

S. V. Suman , Ravi Tejraj Mehta, Ashok Jaiswal

Medical and Regulatory Affairs, Zydus Healthcare Limited, Mumbai, Maharashtra, India

Introduction: Most of the currently available LABA/LAMA combinations are twice-daily therapies. Once-daily inhalers may provide better adherence & symptom control in COPD compared to twice-daily therapies. This study evaluated efficacy & safety of world’s first pMDI of vilanterol combined with glycopyrronium (Gly/Vt) in patients with COPD.

Methods: Prospective, randomized, double-blind, multicentre, phase III clinical trial. Patients of either gender (n = 288), 40-65 years, current/ex-smokers with moderate-severe COPD, CAT-score ≥ 10 with clinically stable COPD within 4weeks prior to screening were randomized to receive either Gly/Vt 25/12.5 mcg pMDI 2-puffs once-daily or Glycopyrronium/Formoterol (Gly/For) 9/4.8 mcg pMDI 2-puffs twice-daily for 12 weeks.

Results: Primary endpoint i. e., Change in trough FEV1 from baseline to week-12 was numerically more with Gly/Vt (LSM ± SD = 204.15 ± 21.77 ml with Gly/Vt & 178.37 ± 21.62 ml with Gly/For, mean difference 25.77 ml, p = 0.401). Trough FVC improved by 165.94 ± 385.72 ml with Gly/Vt & 154.07 ± 304.47 ml with Gly/For (p = 0.7719). Post-bronchodilator FEV1 improvement was 307.78 ± 416.22 ml & 252.46 ± 319.58 ml with Gly/Vt & Gly/For respectively, p = 0.2065. Post-bronchodilator FVC change from baseline was 180.98 ± 364.16 ml with Gly/Vt & 158.41 ± 297.92 ml with Gly/For (p = 0.5651). CAT score reduced by 11.20 ± 6.88 & 10.71 ± 7.04 in Gly/Vt & Gly/For group respectively, p = 0.5487. No significant difference in exacerbations were observed (Gly/Vt-13, Gly/For-15, p=0.7195; all exacerbations were mild). Both the treatments were well-tolerated, most common adverse events were cough & headache. No serious adverse events were reported.

Once-daily Gly/Vt improved FEV1, FVC with reduction in CAT & exacerbations similar to twice-daily Gly/For.

Conclusion: In patients with moderate-severe COPD, once-daily Vilanterol/Glycopyrronium significantly improved lung-function, symptom-control with good safety profile & was non-inferior to twice-daily Glycopyrronium/Formoterol.

Keywords: COPD, formoterol/glycopyrronium, glycopyrronium, vilanterol

Abstract No. 26: Human metapneumovirus pneumonia: Connecting symptoms to radiological insights

Taruna Rathore , Sumeet Singhania

Department of Pulmonary Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Center, Mumbai, Maharashtra, India

Introduction: Human metapneumovirus (hMPV), a single-stranded RNA virus identified in 2001, primarily impacts high-risk populations. Its clinical presentation often overlaps with other respiratory pathogens, complicating diagnosis. This study seeks to characterize hMPV’s clinical and radiological features to enhance better understanding of this viral illness.

Methods: This retrospective study analyzed patients with hMPV detected via Filmarray Biofire (January 2023–November 2024) and had lower respiratory involvement as seen on computed tomography (CT). The clinical and radiological findings were reviewed to assess disease patterns.

Results: A cohort of 10 patients (mean age 57, with a predominance of females) was included in the study. 5 patients had diabetes and 3 were immunosuppressed. The most frequent CT finding was ground-glass opacity (9/10 patients), followed by bronchopneumonia (5/10) with lower lobe predominance. 2 out of 10 patient required ventilator support and eventually succumbed to ARDS. 2 other patients developed post viral organizing pneumonia which responded well to steroids.

Conclusion: Human metapneumovirus (hMPV) diagnosis is challenging due to overlapping clinical pictures but it has certain unique features. Lower respiratory involvement is common in elderly immunosuppressed patients and is associated with significant mortality. Biofire Filmarray 3 enhances quick diagnosis and helps avoiding extensive investigation and support antibiotic stewardship leading to improved patient outcomes.

Keywords: Antibiotic resistance, biofire filmarray, diagnostic challenge, human metapneumovirus, radiological findings

Abstract No. 27: STOP BANG versus STOP BWAG versus STOP BWANG for predicting OSA in Indian population

Avirup Maiti , Arup Halder, Raja Dhar, Shyam Krishnan, Beauty Biswas

CK Birla Hospitals, CMRI, Kolkata, West Bengal, India

Introduction: The pre-test probability of obstructive sleep apnoea (OSA) is assessed by several questionnaires. However, the validity of these questionnaires hasn’t been well verified in Indian population. The present study assesses whether the predictability of STOP BANG changes with adding extra parameter like waist circumference.

Objective: To identify the optimal predictors for OSA (mild, moderate, and severe) in Indian patients undergoing evaluation for sleep disorders.

Methods: We designed a questionnaire which aimed at looking at a new scoring system which might be more valid for an Indian population. The patients were selected based on a polysomnogram that was done and the study was carried out on successive patients over a one-year period.

Results: Waist circumference showed the strongest association with OSA severity (p < 0.001). Neck size >40 cm was also significantly associated with OSA severity, (p < 0.001). BMI >35 was associated with OSA severity but less prominently compared to waist circumference and neck size (p < 0.001). Waist circumference and BMI equally predicted ODI. For predicting T <90%, waist circumference outperformed neck circumference and BMI. The STOPBANG model (Odds Ratio: 2.83, AUC: 0.849, AIC: 164.2) outperformed the STOPBAWG model (Odds Ratio: 2.577, AUC: 0.819, AIC: 167.66). Including waist circumference as a categorical predictor as STOP BWANG improved AUC to 0.88, indicating a significant enhancement in model performance. Replacing neck circumference with waist circumference led to a slight reduction in predictive performance, but the models still demonstrated strong associations with OSA severity.

Conclusion: When we used the STOP-BWANG instead of the STOP-BANG, it is truly the best tool for predicting OSA in an Indian population.

Keywords: OSA, STOP BANG, STOP BAWG, STOP BWANG

Abstract No. 28: Epidemiology and implications of post-intensive care syndrome in ICU survivors

Shubham Kumar , Raja Dhar, Amrita Bhattacharya, Shyam Krishnan, Aditya Satpati, Beauty Biswas, Arup Halder, Pradip Mondal

CK Birla Hospitals, CMRI, Kolkata, West Bengal, India

Background: Post-intensive care syndrome (PICS) is increasingly recognized among ICU survivors. This study aims to investigate the prevalence of PICS following discharge from a respiratory ICU and its relationship with ICU parameters, severity of illness, and overall health-related quality of life (HRQL).

Methods: A prospective observational study was conducted involving 122 ICU patients. Forty-four patients were excluded due to mortality or readmission within six months of discharge. The remaining 78 patients were assessed three months post-discharge using the Hospital Anxiety and Depression Scale (HABC) and the Short Form-36 (SF-36) survey. Clinical and biochemical parameters, including APACHE II scores, PaCO2 levels, and p/f ratios at admission, were analyzed in correlation with PICS indicators.

Results: The average HABC score was 7.10, with 25% of the cohort displaying moderate PICS symptoms. The functional domain of HABC was most significantly affected. A strong positive correlation (p = 0.00001) was observed between APACHE II scores (mean: 10) and HABC scores, highlighting the influence of illness severity on PICS outcomes. Admission PaCO2 and p/f ratios also demonstrated significant relationships with HABC scores. Furthermore, an inverse correlation was identified between HABC scores and SF-36 results, emphasizing the negative impact of PICS on HRQL.

Conclusion: Approximately 20% of ICU survivors in this cohort experienced moderate PICS, with functional impairments being predominant. Key ICU metrics, including APACHE II scores and admission blood gas parameters, were associated with PICS development. The inverse relationship between HABC and SF-36 highlights the detrimental impact of PICS on quality of life, underlining the need for targeted interventions and rehabilitation strategies for ICU survivors.

Keywords: APACHE II scores, HABC score, HRQL, ICU Survivors, post-intensive care syndrome

Abstract No. 29: Pulmonary rapid intraoperative diagnostic evaluation: A comparative study of frozen section and imprint cytology in interventional pulmonology

Diptendu Dey , Shyam Krishnan, Nirmalya Banerjee, Raja Dhar

CK Birla Hospitals, CMRI, Kolkata, West Bengal, India

Introduction: Rapid intraoperative diagnostic methods are essential for confirming sampling accuracy and providing quick pathological insights. Frozen section (FS), a well-established technique, involves tissue freezing and microscopic examination, requiring specialized equipment. Imprint cytology (IC) offers a simpler alternative, involving pressing tissue on the slides for immediate cytological assessment. This study compares FS and IC in pulmonary biopsies to evaluate IC as a rapid diagnostic tool.

Methods: This study analysed 119 biopsy specimens (55 endobronchial, 56 pleural, and 8 transbronchial) from May 2023 to November 2024 at a tertiary care hospital in Eastern India. Specimens were evaluated using IC, FS, and final histopathology. Sensitivity, specificity, and procedure time were calculated for each technique.

Results: FS demonstrated an overall sensitivity of 89.74% and specificity of 90.24%, compared to 58.44% sensitivity and 92.86% specificity for IC. For endobronchial specimens, FS sensitivity and specificity were 92.30% and 87.50%, respectively, while IC achieved 64.10% sensitivity and 93.75% specificity. Procedure times averaged 28.4 minutes for FS and 11.2 minutes for IC. Both methods showed comparable positive predictive values (PPV) for malignant and tubercular lesions: FS at 94.11% and 100%, and IC at 92.5% and 100%, respectively.

IC exhibited significant specificity for both endobronchial and pleural specimen. PPV of IC almost equal to FS. Procedure time is significantly shorter in IC.

Conclusion: IC offers a reliable, cost-effective and rapid diagnostic alternative.

Keywords: Endobronchial, frozen section, imprint cytology, pleural

Abstract No. 30: The impact of coal-fired power plant emissions on respiratory health in India and Bangladesh

Raja Dhar , M. Eswar Narayan, Joyanto Routh, Shyamashree Dasgupta, Sayantan Saha, Apostolos Bossios, Ujjwal Neogi

CK Birla Hospitals, CMRI, Kolkata, West Bengal, India

Introduction: Ambient air pollution, particularly PM2.5 from coal-fired thermal power plants, impacts respiratory health globally. This longitudinal, transdisciplinary study assesses seasonal, transboundary, and gender-based respiratory health impacts downwind of a Thermal Power Plant, addressing co-located exposures and populations from socioeconomically disadvantaged and geographically remote communities with limited healthcare access.

Methods: Meteorological data were derived using the Whether Research & Forecasting (WRF) model, with plume dispersion estimated via FLEXPART. The study analyzed 138 adults (66 case, 72 control) with lung physiology estimated by spirometry and FENO, focusing on smoking, biomass exposure, and power plant emission by Aerosol sampling.

Results: The study highlights abnormal lung function with PRISm related to poor socioeconomic conditions in the case site, with PRISm indicators. Biomass fuel use in women and lower income were linked to reduced FEV1, FVC, and FEF25-75%, emphasizing economic and environmental impacts on lung health. Males showed no significant spirometric differences between sites.

Conclusion: The study highlights transboundary pollution from the Farakka TPP, with higher PM2.5 exposure worsening respiratory health at the case site. Socioeconomic factors amplify risks, with biomass usage adding to vulnerabilities. Study findings reveal PRISm and small airway obstruction in local subjects, which should trigger targeted socio-economic interventions.

Keywords: Fractional exhaled nitric oxide, particulate matter, respiratory health, spirometry, thermal power plant, transboundary pollution

Abstract No. 31: Clinical correlation between sleep apnea clinical score (SACS) and Apnea-Hypopnea Index in diagnosis of obstructive sleep apnea patients

Divya Sree Kalakota , Swapnil S. Kulkarni

KEM Hospital, Pune, Maharashtra, India

Introduction: Obstructive sleep apnea is defined by presence of repetitive episodes of upper airway obstruction during sleep with an AHI of atleast 5 events/hour and with persistent complaints of snoring, excessive day time somnolence, apneic spells, unrefreshing sleep and fatigue.

Methods: This retrospective study was conducted at a tertiary hospital in Pune using SACS score. Study group consisted of 80 patients out of which 50 patients were positive and 30 patients were negative for AHI, diagnosed at our hospital on the basis of history, probability scores and polysomnography was analyzed. Inclusion criteria-more than 40 years and both the genders. Subjects were categorised into 3 groups based on their SACS score (S-snoring, A-apnea, C-neck circumference in centimeters, S-systemic hypertension).

Results: A total of 80 patients were included in study. Patients were classified as per their SACS score as follows:

SACS score less than 43–22 SACS score between 43 & 48 – 44 SACS more than 48-14

Patients were classified as per their AHI as follows:

AHI less than 5 – 30 AHI between 5 and 15 – 12 AHI between 15 and 30-22 AHI more than 30-16

Correlation in OSA patients with AHI and SACS score

Of the 30 negative AHI patients-16 (72.7%) had low, 11 had moderate and 3 had severe SACS score.

On applying chi-square test to the above Table 1 , correlation between SACS score and presence of OSA was highly significant (P value = 0.05).

Irrespective of OSA, patients with moderate to high SACS score were found to have one of the following pre-existing cardiovascular diseases (systemic hypertension, Ischemic heart disease, arrythmias).

Conclusion: SACS score is a good predictor for diagnosis of OSA which is a quick and reliable method that can be used in OPD basis and most of patients with moderate to severe SACS score have OSA. Further studies are needed for better evidence to support diagnosis of OSA.

Abstract No. 32: The effect of pulmonary rehabilitation in various chronic lung diseases in inpatients and outpatients in tertiary care centre of North India: A prospective study

Maria Florence , J. K. Mishra, Mohit Bhatia

Department of Respiratory Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India

Introduction: Respiratory diseases are leading cause of death and disability worldwide and they account for 10% DALY worldwide. There is still a gap in knowledge regarding benefits of Pulmonary rehabilitation in India.

The objective of this study was to access the impact of Pulmonary Rehabilitation (in patients exercise capacity, self efficacy and health related quality of life) in various chronic lung diseases and to find whether effects vary across different lung disease.

Methods: Patients with Interstitial lung diseases, COPD, Bronchial asthma, non severe pulmonary hypertension, Bronchiectasis were included and total of 100 patients were enrolled. All patient included in the study attended pulmonary rehabilatation sessions for 12 weeks. Patients were evaluated by treadmill, bicycle ergometry, 6m walk test, spirometry, St George’s respiratory questionnaire, Mmrc dyspnea scale and psychiatry Das assesment score and the diagnostic performance was assessed by receiver operating characteristic (ROC) curve and accuracy was calculated.

Results: We found that patient who received pulmonary rehabilitation had significant improvement in 6MWT, St George Respiratory questionnaire and MMRC. In our study COPD and Bronchial asthma patients had reduced rate of exacerbation and hospitalization.

Conclusion: Eventhough pulmonary rehabilitation has been age old therapy it is important in countries like INDIA to do proper councelling and enroll patients in PR. PR leads to improvement in MMRC, DAS assessment, St George respiratory questionnaire and reduces exacerbation significantly in COPD and Bronchial asthma patients.

Abstract No. 33: Navigating adverse drug reactions in drug-resistant tuberculosis: Insights from an ambispective cohort study

Niraj Dhakare , Radha Munje, Gyanshankar Mishra

Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Introduction: Tuberculosis (TB), particularly drug-resistant tuberculosis (DR-TB), continues to be a major global health threat, especially in India, where the emergence of drug resistance complicates treatment. Adverse drug reactions (ADRs) to TB medications further challenge treatment compliance and patient outcomes. Understanding ADR profiles is critical for optimizing treatment strategies.

Objectives: This study aimed to evaluate the incidence, causality, severity, and risk factors associated with ADRs in DR-TB patients undergoing treatment, and to assess treatment compliance in those affected by ADRs.

Methods: An ambispective cohort study was conducted at a tertiary care institute from January 2023 to September 2024. The study included 174 DR-TB patients receiving treatment under the Programmatic Management of Drug-Resistant TB (PMDT). Data were analyzed using SPSS, and associations with ADR occurrence were assessed using the Chi-square and t-test. Inclusion criteria involved DR-TB patients aged ≥18 years, registered under PMDT-NTEP.

Results: Out of 174 patients, 79% (138/174) experienced ADRs, with common reactions being skin discoloration (60.34%), peripheral neuropathy (52.87%), and joint pain (28.74%). Most ADRs were mild (52.90%) or moderate (40.58%). Causality assessment classified 92.03% of ADRs as probable. Male patients and those with pulmonary TB or co-morbidities, such as diabetes and hypertension, were more likely to develop ADRs. No significant association was found between ADRs and HIV status or addiction history. Bedaquiline was found to be relatively cardio-safe.

Conclusion: This study highlights the need for proactive ADR management, the development of less toxic drugs, and enhanced monitoring strategies to improve treatment adherence and outcomes in DR-TB patients. The findings support the expanded use of Bedaquiline in all-oral regimens and advocate for therapeutic drug monitoring (TDM) to optimize treatment.

Keywords: Adverse drug reactions, bedaquiline, drug-resistant tuberculosis, pharmacovigilance, treatment adherence

Abstract No. 34: The prevalance of syndrome Z (association of obstructive sleep apnea with metabolic syndrome) in a tertiary care center Maharashtra, India

Satyam Mahakale

N. K. P. Salve Institute of Medical Sciences, Nagpur, Maharashtra, India

Introduction: Syndrome Z is the coexistence of two chronic diseases obstructive sleep apnea (OSA) and metabolic syndrome (MS). Metabolic syndrome and OSA share a similar pathophysilogic milieu that increase the risk of cardiovascular events. Metabolic syndrome include central obesity, hypertension, insulin resistance and hyperlipidaemia. The objective is to investigate the prevalence and severity of syndrome Z at tertiary care center.

Methods: A prospective study was conducted in 30 patients in tertiary care center who met the screening criteria for OSA using STOPBANG Questionnaire and the Epworth Sleepiness Scale. All patients underwent overnight level 2 polysomnography using Alice PDx Philips machine. Parameters of MS and OSA were noted using National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) and American Academy of Sleep Medicine guidelines. We did a comparative study using metabolic syndrome parameters and AHI level in PSG in study group patients.

Results: Mean age of participants was 51.6 years, 72% were male, Mean BMI and waist circumference were 30.4kg/m2 and 110.6cm respectively. Almost 73% of participants were k/c/o DM. 83.5 % of hypertension and 62.8% of Dyslipidemia. The prevalence of OSA in the entire group was 93.0%. 10 patients who fulfilled all the criteria for diagnosis of MS had severe OSA.

Conclusion: The prevalence of Syndrome Z in study individuals was high. OSA may represent an important risk factor for development of MS. Therefore, it is essential for clinicians to systematically evaluate the presence of metabolic abnormalities in OSA patients and vice versa.

Keywords: Metabolic syndrome, obstructive sleep apnea, polysomnography, syndrome Z

Abstract No. 35: Breathless and beyond: Cardiac insights into interstitial lung diseases

Mohd Aateer Shaikh , Radha Munje, Sanjay Gour

Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Introduction: Interstitial lung diseases (ILD) represent a heterogeneous group of lung conditions characterized by dyspnoea, hypoxia, restrictive ventilatory defects, and diffuse pulmonary infiltrates on radio imaging. Cardiovascular involvement in ILDs leads to increase morbidity and mortality in these patients, thus understanding cardiac profile of ILDs is important for early diagnosis and management.

Objectives: This study aimed to evaluate the incidence, causality, severity, and risk factors for cardiovascular disorders associated with ILDs.

Methods: A cross-sectional study was conducted at a tertiary care centre from October 2022 to September 2024. The study includes 73 ILD patients attending OPD/IPD of centre. Data were analysed using SPSX and association between factors were assessed using the Chi-square and t-test. Inclusion criteria involved were newly and old diagnosed cases of ILDs using high resolution computed tomography.

Results: Out of 73 patients, 26 (35.6%) had normal ECG, 8 (10.9%) had RBBB pattern, and 6 (8.22%) had p-pulmonale. Out of 60 patients undergoing echo graphic evaluation 27 (45%) had pulmonary hypertension (PH), 12 (44.4%) mild, 10 (37.04%) moderate, and 5 (18.52%) had severe PH. 50% fibrotic ILDs, and only 11.1% non-fibrotic ILDs had PH. No significant difference in gender and different age groups. 46% of CTD-ILD, 69.2% Of IPF, 60% Of HP, and 100% of CPFE had PH.

Conclusion: The increase prevalence of PH can exacerbate symptoms of breathlessness and despite optimal disease specific treatments and management of secondary infections, patients may not experience satisfactory symptomatic improvement. Thus, this study highlights the need for proactive cardiac evaluation and their management in ILD patients.

Keywords: Cardiovascular health, interstitial lung diseases, pulmonary hypertension

Abstract No. 36: Radiological Findings in 802 Allergic Broncho Pulmonary Aspergillosis (ABPA) Patients: Insights from 23 Centers Across India

S. Madas 1 , R. Davis 2 , D. R. Kumar 3 , P. Valsalan 4 , A. Singh 5 , S. Singh 6 , A. R. Paramez 7 , N. Maturu 8 , A. Dave 9 , A. Jindal 10 , V. Gella 11 , S. Sarkar 12 , K. Saha 13 , R. Dhar 14 , A. Chaudhary 15 , R. Godra 16 , R. Dua 17 , P. Chhajed 18 , S. Kant 19 , P. Saxena 20 , R. Prasad 21 , B. Ghewade 22 , M. Agrawal 23 , S. Ananthraj 24 , S. Kulkarni 1 , S. Gadhave 1 , P. Bhalekar 1 , M. Chandolkar 1 , S. Chhowala 25 , S. Sawant 25 , J. Gogtay 25 , R. Agarwal 26 , S. Salvi 27

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Amala Institute of Medical Sciences, Kerala, India, 3 All India Institute of Medical Sciences, Phulwarisharif, Patna - Bihar, India, 4 Department of Pulmonary, Critical Care and Sleep Medicine, Aster Medcity, Kochi, Kerala, India, 5 Dayanand Medical College & Hospital, Tagore Nagar, Civil Lines. Ludhiana, Punjab, India, 6 Rajashthan Hospital, Jaipur, Rajasthan, India, 7 Lisie hospital, Kerala, India, 8 Clinical and Interventional Pulmonary Medicine, Yashoda Hospitals, Telangna, India, 9 Lung Care, Dayamadhav Hospital, Gujarat, India, 10 Jindal Clinics, Chandigarh, India, 11 Director & Senior Consultant, AIG Hospitals, Hyderabad, India, 12 Advanced Chest Clinic & Sleep Apnea Centre, G 11, Alkapuri Complex, Lalpur, Ranchi. India, 13 Medical College, Kolkata, India, 14 The Calcutta Medical Research Institute, Kolkata, India, 15 Apollo Medics Super Speciality Hospital Lucknow, India, 16 Rukmani Birla hospitals, Jaipur, Rajasthan, India, 17 Additional Professor, AIIMS, Rishikesh, Uttarakhand, India, 18 Institute of Pulmonology, Medical Research and Development, Mumbai, India, 19 King George Medical College, Shah Mina Rd, Chowk, Lucknow, Uttar Pradesh, India, 20 Army Hospital Research And Referral, Delhi, India, 21 Era’s Lucknow Medical College & Hospital, Uttar Pradesh, India, 22 Jawaharlal Nehru Medical college, Datta Meghe Institute of Medical, Sciences, Sawangi, Wardha, India, 23 Manglam Plus Medicity Hospital, Jaipur Rajasthan, India, 24 Dr Rela Institute and Medical Centre, Tamil Nadu, India, 25 Cipla Limited, Mumbai, India, 26 Postgraduate Institute of Medical Education and Research Sector-12, Chandigarh, India, 27 Pulmocare Research and Education Foundation, Pune (India

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a complex allergic disorder caused by hyper-immune reactions against the offending fungus, Aspergillus fumigatus. HRCT and Chest X-ray play crucial roles in diagnosing and monitoring ABPA. The ISHAM criteria for ABPA diagnosis involve a combination of serological markers and radiological findings. However, these criteria are not always used for diagnosing ABPA.

Aim: This study aimed to investigate the radiological findings in Allergic Broncho Pulmonary Aspergillosis (ABPA) patients across multiple centers in India.

Methods: An observational study was conducted by pulmonologists from 23 centers registered with the Respiratory Research Network (RRN). ABPA patients underwent chest X-rays and high-resolution computed tomography (HRCT). Based on the International Society for Human and Animal Mycology (ISHAM) 2013 criteria, patients were classified into three groups:

Group 1: Fully meeting ISHAM criteria. Group 2: Partially meeting ISHAM criteria (positive HRCT or serological results in two parameters). Group 3: Diagnosed by a physician but not meeting ISHAM criteria.

Results: Of the 802 patients, 37.2% (n = 299) were in Group 1, 50.2% (n = 403) in Group 2, and 12.4% (n = 100) in Group 3. HRCT was performed in 84% of the patients, and 81% of those (n = 544) showed findings consistent with ABPA. Key differences between Group 1 and Group 2 in abnormal HRCT findings included bronchiectasis (P = 0.002), high-attenuation mucus (P = 0.047), centrilobular nodules (P = 0.006), tree-in- bud appearance (P = 0.04), and mosaic attenuation (P = 0.03).

Chest X-rays were performed in 717 patients, with 64% (n = 458) displaying abnormalities [ Table 1 ]. Co-morbidities such as hypertension and diabetes were most prevalent in Group 2.

Conclusion : ABPA patients who fully met ISHAM criteria exhibited significantly distinct HRCT and chest X-ray findings compared to those not meeting the full criteria. These findings underscore the importance of ISHAM guidelines in ensuring accurate diagnosis of ABPA.

Keywords: Imaging Sciences in Pulmonology, Chest Infections

Abstract No. 37: Factors influencing adherence to inhalers among asthma and COPD patients in India

J. Yenpure 1 , S. Patil 2 , A. Singh 3 , G. Singhal 4 , S. Sarkar 5 , H. Sawhney 6 , B. Ghewade 7 , A. Dave 8 , I. Haldar 9 , J. Ram 10 , A. Mendiratta 11 , M. Sarkar 12 , A. Badam 13 , S. Karmakar 14 , S. Moitra 15 , P. Valsalan 16 , A. Jindal 14 , S. Toke 18 , H. J. Gayathri Devi 19 , A. Shah 20 , T. Kulkarni 21 , S. Balamurugan 22 , S. Phadnis 1 , D. Ghorpade 1 , S. Madas 1 , S. Bhalare 1 , M. Chandolkar 1 , A. Sabale 1 , J. Gogtay 23 , M. Lopez 23 , S. Nair 23 , V. Naik 23 , S. Salvi 1

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Venkatesh Hospital and Critical Care Centre, Latur, Maharashtra, India, 3 Dayanand Medical College and Hospital, Ludhiana, Punjab, India, 4 Neelkanth Hospital, Haldwani, Uttarakhand, India, 5 Advanced Chest Clinic and Sleep Apnea Center, Ranchi, Jharkhand, India, 6 Faith Hospital, Chandigarh, India, 7 JNMC Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, 8 Lung Care (Daya Madhav Hospital), Vadodara, Gujarat, India, 9 Lung Care and Research Institute, Hooghly, West Bengal, India, 10 SIMS Chellum Hospital, Salem, Tamil Nadu, India, 11 Krishna Clinic, Vasco da Gama, Goa, India, 12 Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, 13 Shruthi Super Specialties Hospital, Hyderabad, Telangana, India, 14 All India Institute of Medical Sciences, Patna, Bihar, 15 Allergy and Asthma Research Centre, Kolkata, West Bengal, India, 16 Aster Medcity, Kochi, Kerala, India, 17 Jindal Clinics, Chandigarh, Punjab, India, 18 Muktai Speciality Clinic, Pune, Maharashtra, India, 19 Joshy’s Medical Center, Bangalore, Karnataka, 20 SBKS MI and RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India, 21 Jupiter Hospital, Thane, Maharashtra, India, 22 Chest and Diabetes Research Institute, Chennai, Tamil Nadu, India, 23 Cipla Ltd., Mumbai, Maharashtra, India

Background: Adherence to inhaler devices play an important role in the treatment of Asthma and Chronic Obstructive Pulmonary Disease (COPD). Our recent study (Adherence to Inhalers in COPD and Asthma-AICA) showed that, 61.8% patients had poor adherence to inhalers. In this post-hoc analysis, we aimed to determine the factors influencing the adherence to inhalers among these patients.

Methodology: AICA was a multi-centric, observational study in which we collected data regarding adherence to inhalers using the Test for Adherence to Inhalers (TAI) from 390 Asthma and COPD patients across India. In this study, we analysed individual components from the TAI scale for the patients who had poor adherence (n = 241).

Results: Out of the 241 Obstructive Airway Disease (OAD) patients with poor adherence (63.1% Asthma and 36.9% COPD), 59.8% reported that they sometimes forgot to take their inhalers. A higher proportion of patients reported they stopped (42.7% sometimes and 22.8% always) using inhalers after feeling well. Patients also reported (51.9% sometimes and 14.1% always) using fewer inhalations than prescribed. 25.3% and 8.3% patients reported stopping inhalers sometimes and always due to side effects, respectively. Only 14.1% mentioned that cost was sometimes a barrier to inhaler use, whereas, 81.7% patients stated that cost was never a barrier. Subgroup analysis of individual components for asthma and COPD patients revealed better adherence among COPD patients with fewer participants reporting forgetting or stopping inhaler use after feeling well as compared to asthma patients [ Figure 1 ].

Conclusion: Factors like forgetting to take inhalers, discontinuing use when feeling better and using fewer inhalations than prescribed were the major contributors that resulted in poor adherence to inhalers. Fear of side effects was not found to be a major concern as two-third of the participants reported never stopping their inhalers due to this reason. Individual component analysis revealed that COPD patients had better adherence as compared to asthma patients, perhaps due to the severity of the condition and the need for persistent use of inhaler. These findings highlight the importance of raising awareness and providing training to OAD patients about the need for consistent adherence to inhaler therapy.

Keywords: Poor adherence, TAI, COPD, Asthma, Inhalers.

Abstract No. 38: Pulmonary rehabilitation in an era of escalating chronic respiratory disease: A large series of a unique 360 model of PR delivery in an urban metro setting

Yogita Hatmode , Sameer Bansal, T. V. Sagar, Prerana Abhisheki, Ravindra Mehta

Department of Pulmonary Rehabilitation, Vaayu Chest and Sleep Specialists, Bengaluru, Karnataka, India

Introduction: PR delivery in India has limited data, in the face of exponentially rising chronic respiratory diseases. Awareness, acceptance, adherence and economics are barriers to effective PR. The 3T’s of time/travel/traffic are a challenge in most metros. To surmount this issue, we formed a unique model of OOHH (onsite/online/hybrid and home), to enhance PR delivery. This study describes the preliminary results of this approach, focusing on relevant outcomes.

Methods: PR done with standard guidelines was carried out in VAAYU Pulmonary Rehab center, an outpatient facility with the OOHH model-we report findings of the 1 st 15 months. All patients were initially offered onsite PR, and then hybrid models were adopted for the 3T issues. Pure online rehab was done for out of town patients, and home PR was offered for patients who could not be brought to the PR center. Baseline characteristics, patients preferences and outcomes were noted and analysed.

Results: 842 patients were referred for the PR program, of which 390 patients (46%) were eventually enrolled.189/390 (48%) were males, mean age 63.6 yrs. A total of 5421 PR sessions were conducted in 15 months. PR delivery modes were onsite, online, hybrid and home-based in 71%, 16%, 9%, 4% respectively. Most common indications for PR were ILD, COPD, severe bronchial asthma, bronchiectasis, severe lung infection sequelae and others in 33%, 22%, 14%, 10%, 7%, 14% patients respectively. Overall adherence to the PR program was 77%. Improvements were seen in 6-minute walk distance in 84% patients, quality of life scores (CAT AND SGRQ) in 93.4% patients and fatigue scores in 91% patients at the end of the PR program (minimum 6 sessions).

Conclusion: This unique delivery model in a large series of patients in an urban metro setting, shows a high engagement and completion rate. High adherence (77%) and significant improvements in exercise capacity, quality of life, and fatigue were observed. This is the first study to show that the ‘OOHH model’ as an innovative PR delivery mechanism can surmount practical issues with better outcomes. A flexible PR delivery system can be a tremendous value addition to enhance accessibility, adherence and effectivity.

Keywords: Chronic obstructive pulmonary diseases, interstitial lung disease, pulmonary rehabilitation

Abstract No. 39: Awareness/knowledge about E-cigarettes/vaping among medical undergraduates and interns in a medical college hospital

Vinay C. Dharmadhikari

S. S. Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India

Introduction: Electronic cigarettes are battery powered electronic devices which aerosolize liquid that contains nicotine, humectants and flavours. E-cigarette smoking is becoming a trend among young adults and gaining wide acceptance as they are considered a less harmful and safer alternative to conventional cigarette smoking. Numerous studies have shown that E-cigarettes are not emission free and presence of nicotine increases levels of NO exhaled from consumers and hence marked airway inflammation. Increased oxidative stress, vascular endothelial damage, impaired endothelial function and changes in vascular tone have all been reported in different human studies on vaping. E-cigarettes are expanding nicotine market by attracting youth who are likely to consider vaping as a cooler alternative to conventional smoking. Most of the people still remain unaware about e-cigarettes and the harmful effects caused by them. Hence the study was conducted among medical undergraduates and interns to assess their knowledge and understanding about E-cigarettes.

Methods: A Questionnaire based study among 200 medical undergraduates and interns of a tertiary care hospital in Davanagere, regarding E-cigarettes. The questionnaire consisted of three parts-Sociodemographic details, Knowledge, Beliefs, and Attitude about E-cigarettes and comprised of 13 questions. Quantitative data was expressed as mean+/-SD. Qualitative data was expressed as numbers and percentages. Software SPSS-22 was used for statistical analysis.

Results: The mean age of study population was 20.37 years with+/-2.12 years. Majority of the study population were males (63%). Among 126 males, 15 were smokers, none of the 74 females were smokers.123 out of 200 had heard about E-cigarettes. 81 knew a little about E cigarettes, 36 had reasonable knowledge, whereas 6 had substantial knowledge about E-cigarettes.

More than 60% of medical undergraduates and interns knew about E-cigarettes, more than 50% believed that they are safer than conventional smoking, helpful in smoking cessation and opined that they have to be regulated at public and workplaces.

Conclusion: Comprehensive awareness programs may be needed in further educating undergraduates and interns about E-cigarettes hence can help in educating patients in future.

Keywords: Awareness, conventional moking, electronic cigarettes, questionnaire

Abstract No. 40: Rifampicin-induced DRESS syndrome in pulmonary tuberculosis: A rare case

Vishal Bhise , Radha Munje, Gyanshankar Mishra

Department of Respiratory Medicine, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India

Introduction: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe hypersensitivity reaction linked to various drugs, including antitubercular therapy (ATT), though rarely reported. This case highlights a rare Rifampicin-induced DRESS syndrome, emphasizing early recognition and management to prevent complications.

An 18-year-old female was diagnosed with drug-sensitive pulmonary tuberculosis and initiated on a shorter regimen under programmatic research: two months of daily Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Moxifloxacin (2HRZEM), followed by two months of Isoniazid, Rifampicin, Ethambutol, and Moxifloxacin (2HREM). After 26 days, she developed drug-induced hepatitis, necessitating temporary discontinuation of ATT. Following recovery, the regimen was restarted. Subsequently, the patient presented with fever, maculopapular rash, eosinophilia, and liver enzyme abnormalities. A diagnosis of DRESS syndrome was confirmed using RegiSCAR criteria. Rifampicin was identified as the causative drug through rechallenge protocols. To manage the adverse reaction, the ATT regimen was modified to exclude Rifampicin. The revised regimen included Streptomycin, Levofloxacin, Isoniazid, and Ethambutol during the intensive phase (2 months), followed by Levofloxacin, Isoniazid, and Ethambutol during the continuation phase (4 months). The patient tolerated the revised treatment well, with resolution of symptoms and successful completion of therapy.

Conclusion: DRESS syndrome, though rare with ATT, must be considered in patients with rash, eosinophilia, and systemic involvement. Drug rechallenge under close monitoring is critical for identifying causative agents. Early diagnosis, drug withdrawal, and therapy modification ensured a positive outcome, highlighting the importance of individualized care.

Abstract No. 41: A demographic analysis of depression severity in MDR-TB patients: Based on PHQ-9 scores

Vishwambar Shridhar Khadekar , Jairaj P. Nair, Sonal Karpe, Swapnil Thorve, Siddharth Waghmare

Department of Respiratory Medicine, Lokmanya Tilak Medical College and General Hospital, Mumbai, Maharashtra, India

Introduction: Depression is known to be more prevalent in patients with tuberculosis (TB). This issue is particularly pronounced in patients with multi-drug resistant TB (MDR-TB), where the complexity of the disease, extended treatment regimens, and increased mortality rates contribute to higher depression rates.

Methods: Fifty patients with drug-resistant TB receiving treatment were interviewed using the PHQ-9, for measuring the severity of depression this was a cross sectional point prevalence study to assess the prevalence and severity of depression among these patients.

Results: This was observed that 94% of MDR TB patients had depression. Depression was present in all age group but the levels of depression varied across the ages. In patients aged <30 years, 35% exhibited minimal depression and 25% mild depression, with no cases of severe depression. For those aged 30–60 years, 39.1% reported moderate depression, particularly males, while 34.8% had minimal depression. Among patients >60 years, minimal and mild depression were equally common (42.9% each), with moderate depression observed in 14.3%. Gender differences were also notable, as males in the 30–60 years’ group experienced higher rates of depression, whereas females in the <30 years’ group exhibited depression. Across all age groups, minimal depression was most prevalent, followed by mild depression. Moderate depression was more frequent in males aged 30–60 years, while severe depression was absent.

Conclusion: As Depression is commonly prevalent the need for integrated mental health care in MDR-TB management is necessary to improve treatment adherence and quality of life

Limitation: Etiology of depression needs to be studied with a larger sample size as the disease severity duration of treatment, pill load and drug like cycloserine in the regimen of treatment cannot be determined.

Keywords: Depression, MDR-TB, PHQ-9, Tuberculosis

Abstract No. 42: A case of discoid lupus erythematosus secondary to anti-tubercular therapy

Veeravalli Varun Teja , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Drug-induced lupus erythematosus (DLE) is a rare response that arises following drug exposure, resulting in systemic lupus erythematosus (SLE) symptoms in the absence of pre-existing lupus.

Case: A 42-year-old patient, with a diagnosis of pulmonary tuberculosis which is sputum CBNAAT detected, started on Anti-tubercular therapy (ATT), he came for a follow-up after 3 months, where he developed dark patches on his face, upper and lower extremities, and scalp, photosensitivity, scarring alopecia, and malar rash and ANA result found to be positive. The patient was found to have drug-induced Discoid Lupus Erythematosus (DLE) and was prescribed 200 mg of hydroxychloroquine tablets for treatment.

Conclusion: DLE is an idiosyncratic reaction in which drug exposure triggers SLE-like features in individuals without pre-existing lupus. Patients with DLE are believed to have a genetic predisposition, and an alternative theory suggests a link with slow acetylators of INH.

Keywords: Anti nuclear antibody, discoid lupus erythematosus, isoniazid, tuberculosis

Abstract No. 43: Haemoptysis in tuberculosis - Mysteries since centuries

Snehal Shinde , Dipika Koli, Ketaki Utpat, Unnati Desai

Department of Respiratory Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India

Introduction: Haemoptysis remains a critical and often life-threatening presentation in respiratory medicine. It is a diagnostic and therapeutic challenge, particularly in endemic regions where tuberculosis (TB) is prevalent. TB, with its potential to cause cavitary lung lesions, is a major risk factor for secondary infections like chronic pulmonary aspergillosis (CPA). CPA often develops in pre-existing lung cavities, creating a complex interplay between these conditions.

Case Report: A 28-year male presented with complaints of cough with expectoration, haemoptysis and fever for 5 days. he was evaluated with sputum studies which came MTB not detected and CTPA suggested no evidence of pulmonary thromboembolism and right upper lobe fungal ball [ Figure 1 ]. Clinico-radiologicaly weight adjusted empirical ATT and antifungal was started in view of past inadequate att. Clinically, the patient improved and discharged. Four months later, the patient presented with recurrent massive haemoptysis and hemodynamic compromise. The patient inotropic support, blood transfusions. The patient was re-evaluated with sputum was negative and CTPA suggestive of chronic pulmonary aspergillosis with fungal ball [ Figure 2 ]. Patient underwent a Bronchial artery embolization. The patient was stabilised and discharged on anti-fungal medications and referred for surgical lobectomy.

Conclusion: This case underscores the importance of a structured diagnostic approach, timely intervention, and individualized therapy in managing haemoptysis in patients with a history of TB and chronic pulmonary aspergillosis. Collaborative, multidisciplinary management remains the cornerstone of care.

Haemoptysis due to chronic pulmonary aspergillosis can be managed with medical, interventional and surgical line of management.

Abstract No. 44: Study of prevalence of MDR TB, XDR TB in all sputum positive TB patients in tertiary care hospital

Shraddha Zodpe , Ravindra Rathod

Department of Respiratory Medicine, SVNGMC, Yavatmal, Maharashtra, India

Introduction: Emergence of drug-resistant tuberculosis is of major concern to global TB control. The Estimation of Prevalence of drug resistance for TB in community will be useful for creating new policies and treatment will effective drugs to complete cure and it will avoid development of drug resistance. Our study was an observational cross-sectional study. 139 subjects were enrolled in study. Data was analyzed by Statistical software EPIINFO VERSION 7.2.

Objectives: To detect drug resistance in all sputum positive patients.

Methods: Observational cross-sectional study. Study conducted on all sputum positive TB patients aged 18yrs and above. Sample size – 139. Patient collects the early morning sputum sample in falcon tubes were processed for CBNAAT/TRUNAT testing, Patients detected MTB and rifampicin resistance were further tested for 1 st and 2 nd Line probe Assay at Intermediate Reference Laboratory.

Results: At the start of the study 139 subjects were TB positive, out of that 139 patients (100%) were MTB DETECTED on CBNAAT, out of that 10 cases (7.2%) had Rifampicin resistance and 8 cases (5.8) had Isoniazide resistance (high level) and 2 cases (14%) had Isoniazide (low level) resistance on 1 st LPA. No Resistance detected on 2 nd LPA. p value <0.05, is considered as statistically significant.

Conclusion: Results show 7.2% prevalence of MDR TB among sputum positive TB patients.

Abstract No. 45: Bilateral Breast TB in an Adolescent girl – A Rare Presentation

Shanmugapriya K. 1 , Preethi Evangeline 2

1 Department of Respiratory Medicine, SLMCH, Chennai, Tamil Nadu, India, 2 SLMCH, Chennai, Tamil Nadu, India

Introduction: Breast tuberculosis, also known as tuberculous mastitis, is a very uncommon type of tuberculosis commonly presented in young women. It accounts for <0.1% of all breast illnesses and <2% of TB cases. Even in TB-endemic nations like India, tubercular mastitis is frequently misdiagnosed as pyogenic breast abscess or breast cancer. We present a case of tuberculous mastitis, which presented as a breast abscess with no history of tuberculosis.

Case Report: A 20 year-old girl presented with a lump in her right breast for two months that ruptured the day before her hospital visit, associated with discharge of pus and intermittent pain. She also noted a palpable lump in her right axilla. Investigations were all normal except for erythrocyte sedimentation rate of 100 mm/hr and positive Mantoux test of 20 x 20 mm induration with vesiculation. Chest X-ray was not suggestive of tuberculosis. Family screening of TB was negative. Breast ultrasound revealed mastitis with an abscess in the right breast and lymphadenopathy in the right axilla. Fine needle aspiration cytology (FNAC) was performed, which revealed sheets of lymphocytes mixed with aggregates of epithelioid histiocytes reflective of granulomatous inflammation, suggesting a case of tuberculous mastitis. The patient was started with empirical antituberculosis therapy (ATT). After completion of intensive phase of ATT, she reported back with a swelling in the left axilla and a lump in the left breast of one month duration. Abscess was drained. Acid-fast staining of the discharge demonstrated acid-fast bacilli (AFB). Gene-Xpert was done, which reported the presence of Mycobacterium tuberculosis and rifampicin resistance was not detected. On follow-up after 3 months, the enlarged lymph node had regressed, the abscess had resolved and the patient was asymptomatic.

Conclusion: There are very few cases of breast TB reported. Most commonly, women of reproductive age group, including multiparous and pregnant women are affected. In our case, an adolescent girl presenting with bilateral tuberculous mastitis makes the diagnosis challenging. Concomitant axillary lymphadenopathy is common in this form of mastitis. A trial of ATT combined with routine clinical evaluation is strongly recommended if there is a high clinical suspicion of TB.

Keywords: Anti-tubercular therapy, axillary lymphadenopathy, breast TB, tuberculous mastitis

Abstract No. 46: Miliary tuberculosis with pancytopenia – Fighting the prognosis

Razak Khan

RNT Medical College, Udaipur, Rajasthan, India

Introduction: Miliary tuberculosis refers to haematogenous spread of the tubercular bacilli resulting in dissemination of the disease. It might be associated with multiple atypical manifestations that result in a delayed diagnosis, often a missed diagnosis. One such manifestation is that of pancytopenia which is a rare entity in miliary tuberculosis.

Case Report: Here is a case of 30 year old female who came with complaint of generalised weakness since 3 months, low grade fever since 3 months, cough with minimal mucoid expectoration (whitish in colour) since 2 months, Patient also complaint of shortness of breath (grade-1) which worsened over 2 months to breathlessness at rest which is the time when patient presented to the OPD. CBC was done which showed pancytopenia. Chest x ray revealed multiple millet sized nodules spread over B/l lung fields, following which HRCT – THORAX was done which also revealed multiple nodules less than 3 mm in size and a diagnosis of miliary tuberculosis was made. Peripheral blood smear and bone marrow biopsy was planned. Bone marrow biopsy revealed well formed granulomas with reduced cellularity. Patient was started on anti-tubercular treatment with methylprednesolone and Filgrastim. With initiation of treatment patient started showing improvement in CBC values with clinical improvement. Patient was discharged on ATT and after 3 months patient came for follow up with normal CBC values.

Conclusion: It is imperative to start anti-tubercular therapy as early as possible in cases of Miliary Tuberculosis to ensure a better prognosis

Abstract No. 47: A rare yet leathal case of intra cranial tuberculoma

Jasmine Thippuluri , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Intra cranial tuberculomas are rare and represent a serious form of tuberculosis caused by hematogenous spread of mycobacterium tuberculosis

Case Report: A 15 yr. old male presented with complaints of fever, loss of weight since 3 months, one episode of tonic clonic seizure 4 days back, headache and left sided weakness since 1 day. Past h/o: no significant past history. Chest x-ray shows cavities at right lower lobe and left upper lobe. Ct chest shows few consolidatory patches seen involving right lower lobe and left upper lobe, multiple fibrocavitory lesions with changes in superior segment of right lower lobe and apico posterior segment of left upper lobe. MRI BRAIN: T2 hypointense focus is noted at left frontal lobe with mild perifocal edema in periphery

Conclusion: The combination of MRI findings with clinical features can enhance the overall diagnostic accuracy for intra cranial tuberculomas. Radiologically inra cranial tuberculomas classically appear isointense to gray matter with vasogenic edema on T2-weighted magnetic resonance imaging with ring enhancement after contrast administration, repeat MRI of brain demonstrated evolution of mass lesion, with increased edema. Diagnosing and treatment with anti tubercular theraphy with corticosteroids and anti epileptics are corner stones.

Keywords: Intra cranial tuberculoma, MRI, seizures

Abstract No. 48: Unmasking the unusual: A rare case of tubercular osteomyelitis of the rib presenting as a bone mass

K. S. Vishnu

B. J. Government Medical College, Pune, Maharashtra, India

Introduction: Musculoskeletal tuberculosis, although less common, is one of the prevalent form of extrapulmonary tuberculosis. In rare instances, tuberculosis can affect the chest wall, leading to rib destruction. Typically, such cases are accompanied by lesions in the pleuro-pulmonary region. Here, we present a case of tubercular osteomyelitis of the rib, resulting in its destruction, without any associated lung parenchymal involvement.

Case Report: A 15-year-old female presented to the outpatient department with a 4-month history of left-sided chest pain, weight loss over the past 3-4 months, and intermittent episodes of fever for the past month. The patient was referred from an outside hospital for a Transthoracic Needle Biopsy based on the findings from an outside CECT thorax report. On examination, the patient was vitally stable, and no palpable swelling of the chest wall was noted. CECT Thorax showed a well-defined, heterogeneously enhancing soft tissue mass located at the posterior aspect of the left second rib, with underlying bony erosion. The mass extends into the muscular plane of the left posterior chest wall and is seen abutting the first left rib superiorly. Mediastinal necrotic lymphadenopathy is also noted. These findings are indicative of a neoplastic origin, likely originating from the bone, such as Ewing’s sarcoma. A CT Guided Trans Thoracic Needle Biopsy was performed from the lesion. The histopathology report of the biopsy taken from the soft tissue lesion at the posterior aspect of the second left rib indicates chronic granulomatous inflammation, suggestive of tuberculosis, and there was no evidence of malignancy. Treatment included the Pediatric AKT regimen. After 6 months of AKT, the patient was followed up and reported significant improvement in symptoms. A repeat CT was performed to assess radiological resolution, which showed a significant reduction in the size of the lesion.

Conclusion: The findings in this case highlight the importance of maintaining a high suspicion of tuberculosis in patients presenting with destructive rib cage lesions, especially in a country like India where tuberculosis is prevalent.

Although not common, Musculoskeletal Tuberculosis should be considered in the differential diagnosis of any patient presenting with nonspecific chest pain and radiological evidence of rib cage bony erosion.

Abstract No. 49: An atypical presentation of miliary tuberculosis: A case report

Somaraju Chinta , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Background: Miliary tuberculosis is an uncommon cause of acute respiratory distress syndrome with a high mortality.

Case Report : The patient was a school-age child who had been experiencing fever since three months, shortness of breath for four days, and weight loss from two months. Comorbidities are absent, and ICTC is likewise negative. The patient had dyspnoea and tachypnoea upon evaluation. All regions had coarse crepitations and bilateral normal vesicular breath sounds upon auscultation. The ABG showed hypoxemia with respiratory alkalosis, and the pao2/fio2 ratio was less than 100. Due to the patient’s ongoing hypoxia, patient was intubated. The infectious aetiology of the HRCT impression is most likely military TB. Numerous investigations have been conducted to determine if COVID-19 RTPCR-negative, ET tube secretions are CBNAAT-positive. The patient has shown clinical improvement after the gradual initiation of anti-tubercular medication.

Conclusion: A rare cause of ARDS is Tuberculosis. In India where tuberculosis is common or in patients with ARDS of obscure aetiology, where the clinical features suggest tuberculosis as an inciting cause, antitubercular therapy should be started empirically and the diagnosis actively pursued later.

Keywords: Acute respiratory distress syndrome, antitubercular therapy, miliary tuberculosis

Abstract No. 50: Effectiveness of an educational intervention on knowledge, attitude, and behaviour regarding NTEP and TB among medical interns: An experimental study

P. Arunan , L. Muthukumaran, N. Meenakshi, R. Sridhar

Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India

Introduction: Tuberculosis (TB) remains a global health challenge, with early diagnosis and treatment ensuring a high cure rate. Medical interns, as frontline healthcare providers, play a crucial role in TB management. Enhancing their knowledge, attitude, and behaviour (KAB) is vital for improving TB control. This experimental study evaluates the impact of an educational intervention on the KAB of medical interns towards TB and the National Tuberculosis Elimination Program (NTEP).

Methods: A one-group pretest-post-test design was used to assess the effectiveness of the intervention among 110 medical interns at Chettinad Medical College. Data were collected using a WHO-based KAB questionnaire administered before and after the intervention. The intervention consisted of educational sessions focusing on TB pathophysiology, NTEP guidelines, and tools like GeneXpert and Nikshay. Paired t-tests and Wilcoxon Signed Ranks tests were used to analyse pretest and post-test differences.

Results: Knowledge - Mean scores increased from 42.85% to 81.33%, with 70% achieving adequate knowledge post-intervention (p < 0.001). Attitude - Scores improved from 43.64% to 77.73%, with adequate attitude rising from 6.4% to 43.6% (p < 0.001). Behaviour - Mean scores increased from 40.73% to 74.00%, with adequate behaviour improving from 13.6% to 58.2% (p < 0.001).

Conclusion: This study demonstrates the effectiveness of a structured educational intervention in improving the KAB of medical interns. Greater emphasis on clinical exposure is essential to translate knowledge and attitudes into practical behaviour.

Keywords: Educational intervention, experimental study, medical interns, NTEP, TB

Abstract No. 51: Predictors of extra pulmonary and pulmonary tuberculosis among diabetic patients

D. Archanaa , Shanmugapriya K .

Department of Respiratory Medicine, Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India

Background: The Dual Burden of Diabetes and Extrapulmonary Tuberculosis: A Growing Public Health Concern. The intersection of diabetes and tuberculosis is becoming an emerging public health challenge, with a notable rise in cases of extrapulmonary tuberculosis (EPTB) among diabetic patients. Diabetes, known for its role in weakening the immune system, is now recognized as an independent risk factor for tuberculosis. This bidirectional relationship between the two conditions poses significant health risks, as each condition can exacerbate the other. Given the growing prevalence of diabetes worldwide, understanding its impact on EPTB is crucial. This study aims to investigate the incidence and key predictors of extrapulmonary tuberculosis among diabetic patients. Insights from this research could inform targeted interventions and guide the development of integrated healthcare strategies to manage the dual burden of diabetes and tuberculosis.

Methods: This institutionally-based retrospective cohort study was conducted among 76 diabetic patients at Sri Lalithambigai Hospital between January 2024 and July 2024. All eligible diabetic patients who met the inclusion criteria were included in the study. Data were collected and entered using EpiData Version 4.6 and analyzed using STATA Version 17. The survival time of diabetic patients was estimated using the Kaplan-Meier survival curve, and differences in survival times across various categorical variables were assessed using the log-rank test. Both bivariable and multivariable Cox proportional hazards regression models were fitted to identify independent predictors of tuberculosis among diabetic patients.

Results: Incidence of EPTB in 76 Patients:

Observed cases: Approximately 76/500×17≈2.6. This can be rounded to 2 or 3 cases in the smaller cohort. Incidence rate: The incidence rate remains consistent at 1.5 per 100 person-years.

Person-Years of Follow-Up: To calculate the follow-up time for 76 patients: Follow-up time = 76/500 × 1101.5PY = 167.83. Thus, the total follow-up time for 76 patients is approximately 168 person-years.

Factors Associated with Increased EPTB Risk:

Age: Older diabetic patients remain at significantly increased risk (AIR: 4.8, 95% CI: 1.2–20.7, p = 0.03).

Diabetic medication: Certain medications increase the risk (AIR: 1.4, 95% CI: 1.24–16, p = 0.03). History of PTB: Having had pulmonary tuberculosis before diabetic follow-up increases risk (AIR: 1.5, 95% CI: 3.2–6.9, p = 0.01). Alcohol consumption: History of alcohol use significantly increases risk (AIR: 4.0, 95% CI: 1.2–13, p = 0.02).

Protective Factor:

Normal BMI (18.5–25): Associated with a reduced risk of developing EPTB (AIR: 0.22, 95% CI: 0.06–0.76, p = 0.02).

Implications for 76 Patients:

For a smaller cohort of 76 diabetic patients, the findings suggest:

Targeted interventions are essential for individuals with the above risk factors. Prevention strategies, such as maintaining a healthy BMI, should remain a focus to reduce the burden of EPTB in diabetic populations.

While the absolute numbers are scaled down, the significance of these findings is proportionally relevant and emphasizes the need for vigilant monitoring in smaller diabetic cohorts.

Conclusion: In this study, we found a high rate of extra-pulmonary tuberculosis among diabetic patients. Factors significantly linked with increased risk of extra-pulmonary tuberculosis included age, using insulin as a hypoglycemic medication, having a past history of PTB before diabetic follow-up initiation, and a history of alcohol consumption, while BMI was associated with a rate reduction of EPTB. Early screening and treatment for extra-pulmonary tuberculosis is highly recommended at diabetes mellitus follow-up for patients with the above risk factors.

Keywords: Diabetes mellitus, extra-pulmonary tuberculosis, predictors of extra-pulmonary tuberculosis

Abstract No. 52: Is alcoholisam a risk factor for development of tuberculosis

K. Venugopal , P. R. Sreelatha, Gopika Venugopal

Department of Respiratory Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Introduction: With availability of TRUENAT in secondary health care systems during Covid pandemics made us make early diagnosis tuberculosis also. The high sensitivity of TRUENAT helped to detect paucibacillary tuberculosis cases in patients with comorbid conditions. Here we are trying to evaluate TB incidents in such comorbid conditions and its relation with gender.

Aim: To assess any difference in TB incident among comorbid and its differential pattern on gender basis.

Methods: All the TB cases diagnosed at General Hospital Alappuzha were included in the study. Study was conducted between 01.03.2021 and 31.08.2021.

Results: Of the total 70 cases detected, 55 were male and 15 were female in a ratio of 4.6: 1, comparable to gender based incidents of TB. Among the 55 males 20 (36%) are alcoholic, 18 (32%) have smoking habits 10 (18.1%) had diabetes and 5 have COPD (3 with COPD alone). In Kerla NFHS found 20 % prevelance of alcoholism. Among 15 female, 6 (40%) had diabetes and 2 with COPD.

Conclusion: Alcoholism should be considered as a great risk factor for tuberculosis diease.

Abstract No. 53: Knowledge, attitude and adherence towards tuberculosis prevention therapy among contacts of active PTB cases in Thiruporur tuberculosis unit level

Himanya Tatineni , S. Chandrasekar, Kaleeshwari, L. Muthukumaran, R. Sridhar, N. Meenakashi

Department Respiratory Medicine, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India

Background: Tuberculosis (TB) remains a global health challenge. The WHO’s End TB Strategy aims to reduce TB incidence by 90% between 2015 and 2030. India’s National TB Elimination Programme (NTEP) provides tuberculosis preventive treatment (TPT) to household contacts (HHCs) of pulmonary TB patients aged <5 years and HHCs aged >5 years without TB infection.

Objective: To assess the knowledge and attitude of HHCs towards TPT, evaluate adherence and reasons for discontinuation, identify programmatic obstacles, and assess adverse drug reactions.

Methods: A cross-sectional study using a structured questionnaire via telephone calls was conducted with data from Nikshay, targeting HHCs of active pulmonary TB cases from 2024 in Thiruporur TU. Descriptive analysis was performed on knowledge, attitude, adherence, adverse effects, and barriers.

Results: Of 260 registered, 214 participated. 97% had positive knowledge about TPT, with 98% recognizing its preventive role and 100% informed by health workers. Attitude was positive in 86%, with 80% strongly agreeing on TB prevention benefits. Adherence was 75%, while 25% discontinued treatment. Awareness of side effects was universal, and all participants acknowledged free medication availability and clear staff communication. Barriers included difficulty visiting health centers (4%). Older individuals (>55 years) faced difficulty like missing the dose and loosing interest.

Conclusion: While knowledge and attitude towards TPT were high, adherence remains suboptimal, especially among older participants. Addressing age-related challenges and logistical barriers is essential for improving adherence and achieving NTEP goals

Abstract No. 54: Complex interplay of Evans syndrome, pulmonary tuberculosis, and chronic liver disease in a 41-year-old female

Siramsetti Manoj Sreevatsav , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Evans syndrome is a rare autoimmune disorder characterized by simultaneous or sequential autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia. Co-occurrence of pulmonary tuberculosis (PTB) in such a setting, compounded by chronic liver disease (CLD), poses significant diagnostic and therapeutic challenges. This report details the intricate interplay of these conditions in a middle-aged female, emphasizing the need for multidisciplinary management.

Case Report: A 41-year-old housewife presented with shortness of breath, chronic cough with expectoration, fever, and loss of appetite for a month. She was a known case of AIHA (ANA-positive) diagnosed two years ago and managed with transfusions. Additionally, she had diabetes (3 months) and hypothyroidism (3 years) on regular medication. Biomass fuel exposure history suggested a predisposition to chronic respiratory disease. Imaging revealed extensive pulmonary pathology: patchy consolidations, cavitations, pleural thickening, and ground-glass opacities indicative of PTB. Concurrent liver findings (hepatosplenomegaly, fatty liver, hepatic hemangiomas, portal hypertension, ascites) confirmed CLD. Laboratory investigations showed anemia, thrombocytopenia, elevated D-dimer and CRP, deranged liver function, and albuminuria. PTB diagnosis was confirmed by sputum TRUNAAT positivity. Managing TB in CLD required initial pyrazinamide cessation, later reintroduced in an adjusted regimen. On follow-up, the patient clinically improved on anti-tubercular therapy (ATT).

This case highlights the critical importance of individualized care in complex cases involving rare autoimmune disorders like Evans syndrome, TB, and CLD. Early identification and tailored treatment prevent further complications, underscoring the role of vigilant multidisciplinary approaches.

Conclusion: Evans syndrome co-existing with PTB and CLD necessitates a comprehensive evaluation and cautious therapeutic strategy to avoid drug toxicity and optimize outcomes. A coordinated team effort is essential for managing such intricate cases effectively.

Abstract No. 55: The significance of bronchoalveolar lavage in diagnosing pulmonary tuberculosis in clinically and radiologically suspected patients with negative sputum examination

Sarthak Jindal

RNT Medical College, Udaipur, Rajasthan, India

Introduction: Overall, 40–60% of cases suspected clinically and radiologically for PTB yield negative-sputum smear results for acid-fast bacilli. Research indicates that over 50% of these patients would require chemotherapy within 12 months if untreated. Fiberoptic bronchoscopy combined with bronchoalveolar lavage can be employed to diagnose smear-negative PTB. The BAL sample can undergo Ziehl–Neelsen staining, microbial cultures, and molecular analysis.

Methods: Patients admitted with clinical and radiological indications of pulmonary tuberculosis who had no prior history of receiving antitubercular treatment from any source were included in study. In these individuals, one spot and one overnight sputum sample were collected and those negative for AFB staining and CBNAAT were included. After administering appropriate pre-medications, fiberoptic bronchoscopy was performed and bronchoalveolar lavage was obtained and sent for ZN staining, CBNAAT and culture.

Results: Of the 82 bronchoalveolar lavage samples, the Ziehl-Neelsen smear, CBNAAT, and culture were positive in 48 (58.5%), 58 (70.7%), and 60 (73.1%) patients, respectively. When comparing BAL culture using BACTEC MGIT, sensitivity, specificity, positive predictive value, and Negative predictive value of BAL AFB smear are 73.3%, 81.8%, 91.6%, and 53%, respectively. In contrast, sensitivity, specificity, PPV, and NPV of BAL CBNAAT relative to BAL culture are 93.3%, 90.9%, 96.5%, and 83.3%, respectively.

Conclusion: FOB-guided BAL samples are highly effective for the rapid and definitive diagnosis of sputum-examination negative patients who have a strong clinical and radiological suspicion of pulmonary tuberculosis.

Abstract No. 56: Causes of delay in pulmonary TB diagnosis in a TB unit of South India

K. Venugopal 1 , P. R. Sreelatha 2 , Gopika Venugopal 3

1 Government General Hospital, Alappuzha, Kerala, India, 2 Department of Pediatrics, MCH, Alappuzha, Kerala, India, 3 Department of Respiratory Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Introduction: RNTCP is being implemented all over India since 1993. A high rate of high-grade sputum positive cases is noted in many districts. Reasons of late reporting (advance stage) needs to be explored.

Aim: To study various factors contributing delay in diagnosis of pulmonary TB cases in a RNTCP district.

Methods: All high grade (2+ & 3+) cases detected in Alappuzha TU were interviewed as per a pre-tested questionnaire by Principal Investigator. The study was conducted between January 2016 and June 2017 at District TB Center, which is the Head Quarters of Alappuzha TU.

Results: 42 cases qualifying the inclusion criteria were analyzed. 30 (71%) cases were 3+ and 12 were 2+, of which 38 were male. Only 18 (43%) were aware about TB disease, its symptom, mode of diagnosis and treatment. Majority are having only primary education. Nearly 57% has co-morbid condition with following distribution. Diabetes Mellitus–11 (26%), COPD–5 (12%), Cardiac Disease–7 (17%), Multiple Disease–2 (4.76%), Chikungunya–1 (2%). 17 (40%) made initial consultation with private practitioners and 25 (60%) with Govt. doctor and an average of 6 week delay was noted before referral to RNTCP and is more predominant among private practitioners. 3 (7%) reported to the microscopic center by their own initiative.

Conclusion: Late reporting of TB cases to microscopic center is of multi factorial causes. Delay in referral to RNTCP for diagnosis, Low literacy, co-morbid condition, awareness about the tuberculosis is all probably the major contributing factors. More elaborative studies in this matter are required.

Abstract No. 57: Endometrial MDR TB: A rare case report

Rakshita Jain , N. Bhaskara Rao

Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India

Introduction: TB caused by M. tb strains that are resistant to both H and R with or without resistance to other first-line anti TB drugs is called Multidrug-resistant TB (MDR-TB). Infection of the female genital tract caused by Mycobacterium Tuberculosis is known as female genital tuberculosis. Endometrium is involved in approximately 50%-60% of women with genital tuberculosis.

Case Report: A 32 year old female with complaints of menstrual irregularity and infertility presented to the clinic for evaluation of infertility and under routine evaluation, endometrial biopsy was done and sent for CBNAAT and the result showed RR-TB. Patient was then referred to pulmonology OPD and then upon evaluation patient did not have any previous history of tuberculosis and no other constitutional symptoms were present. Routine blood investigations, ECG and other investigations like chest X-ray, sputum CBNAAT, CECT chest and abdomen were done and no abnormality was detected. Hence, the patient was started on Short Oral Bedaquiline Regimen and now the patient is under follow up.

Conclusion: It has been estimated that approximately 5% of females presenting to sub-fertility clinics worldwide have genital tuberculosis which is most commonly drug sensitive but drug resistant genital tuberculosis is rare. Endometrial biopsy sample should be sent for CBNAAT, culture along with HPE other wise MDR-TB can be missed.

Abstract No. 58: A great imitator: Pulmonary tuberculosis masquerading as malignancy – A diagnostic challenge

Swaroop Godbole , Amita Athavale, Pratibha Singhal, Vijay Khatri, Bhumin Patel, Tanya Athavale, Gaurav Jain, Dhiraj Atram

Department of Pulmonary Medicine and EPRC, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India

Introduction: Pulmonary tuberculosis (TB) often mimics malignancy, posing diagnostic challenges, especially in high TB-prevalence areas. This case emphasizes the need for a high suspicion of TB, even when malignancy is suspected based on clinico-radiological basis.

Case Report: A 54-year-old male with ischemic heart disease, diabetes, hypertension, and a history of alcohol and tobacco use, presented with a 5-month history of fever, chills, shortness of breath, and weight loss. Chest X-ray showed right-sided pleural effusion (resolving) and right upper zone opacity. CECT revealed a lobulated soft tissue lesion with a cavity in the right upper lobe, associated pleural effusion and thickened pleura, raising concern for malignancy. Pleural aspiration revealed exudative lymphocytic fluid with low ADA and negative GenExpert for MTB. A WB-PETCT scan showed metabolically active lesions in the right middle lobe, pleura, and subcarinal lymph nodes, suggesting malignancy. Bronchoscopy revealed inflammation, mucosal irregularity, and thick filamentous material in the right upper lobe. GenExpert on bronchial washings was positive for MTB with Rifampicin resistance.

Conclusion: ADA levels in TB effusion can be low and thus low ADA in pleural fluid does not exclude TB. While imaging initially suggested malignancy, resolving pleural effusion on serial Chest X-rays, “tree-in-bud” nodules, and absence of bronchus cut-off sign on CT raised suspicion for TB. Bronchoscopy findings were consistent with endobronchial TB, particularly the hyperemic type.

A high index of suspicion for TB is crucial, even with atypical radiological findings, to ensure timely diagnosis and appropriate management

Abstract No. 59: Tuberculous pleural effusion mimicking malignancy

Vidit S. Shah 1 , Nilesh C. Dutt 2

1 Department of Respiratory Medicine, Sheth L. G. General Hospital, Maninagar, Ahmedabad, India, 2 Narendra Modi Medical College, LG Hospital, Ahmedabad, Gujarat, India

Introduction: Differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is difficult because the biochemical profiles are similar. However it is important to differentiate the two.

Case Report: 57/M patient admitted with chief complaints of high grade, decreased appetite, left sided chest pain and weight loss since 15 days. On examination patient was febrile with 38.3 C with generalized anasarca more on arms and legs. All routine Investigation were suggestive of hypoalbuminemia, hemoglobin was suddenly dropped from 14. to.9 g/dl in 10 days. Chest Xray was done which showed opacity obscuring whole left lung, USG chest suggestive of left moderate pleural effusion. So pleural tapping was done (reddish thick) suggestive of exudative pleural effusion with atypical cell in cytology but ADA report was high. So we put patient on AKT as clinical diagnosed TB Pleural effusion. CECT thorax suggestive of malignancy/infective etiology with moderate left pleural effusion usg guided pleural biopsy suggestive of pneumonia. We continued AKT and clinical improvement was shown.

Conclusion: Differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is difficult because the biochemical profiles are similar. but in every case tuberculous pleural effusion always should be ruled out.

Abstract No. 60: Diagnostic ability of bronchial washings CBNAAT in sputum negative tuberculosis suspects

Priyanka Kattepogu , K. Venkata Ramana

Department of Pulmonary Medicine, GHCCD, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Introduction: All suspects of pulmonary tuberculosis are subjected initially to sputum CBNAAT. CBNAAT is sensitivity in 86%. In few subjects CBNAAT can be negative, due to dry cough or improper sample collection. Fibreoptic bronchoscopy is an alternative method to obtaining sample in such cases which aids in early diagnosis and initiation of treatment thus, reducing mortality and morbidity.

Methods: Clinico-radiologically suspected subjects of pulmonary tuberculosis who are either sputum negative or not getting adequate sputum sample were identified and those fit for bronchoscopy were subjected to procedure and bronchi washings were obtained. Smear and CBNAAT examination of fluid was done. Data recorded and results statistically analysed.

Results: In this study out of total 60 cases, 36 (60%) subjects were males while 24 (40%) subject’s females. The most common lesions detected on chest imaging were consolidation (49%), bronchiectasis (28%) endobronchial spread (13%) and cavities (10%). Out of the 60 subjects, 24 subjects (40%) were BAL positive, among BAL positive 4 subjects (16.6%) Rifampicin resistant, and 8 (33.3%) subjects among BAL positive previously used ATT.

Conclusion: In subjects with strong clinical and radiological suspicion of tuberculosis and in whom sputum CBNAAT is negative, FOB could be used as a tool for further assessment to confirm tuberculosis microbiologically and also to know drug resistance patterns.

Keywords: Broncho alveolar lavage CBNAAT, bronchoscopy, pulmonary tuberculosis, sputum CBNAAT negative

Abstract No. 61: Rare case of tuberculosis of bone marrow with pancytopenia in a case of old, healed pulmonary TB

Sahu Gaurav , Nair Shreeja, Potdar Pradeep

Department of Respiratory Medicine, MGM Hospital, Kamothe, Maharashtra, India

Introduction: Tuberculosis (TB) is primarily a pulmonary disease, but it can disseminate to other organs, including the bone marrow. Bone-marrow involvement in TB is exceedingly rare and typically occurs in the context of disseminated or miliary TB. The case explores the potential mechanisms behind this rare manifestation and the implications for management. [1]

Case Report: We present a case of 55-year-old female with a history of successfully treated pulmonary TB 15 years ago presented with progressive fatigue, easy bruising, and bleeding gums. She had recently started empirical antitubercular therapy (ATT) for suspected TB reactivation, prompted by respiratory symptoms and abnormal chest X-ray findings. Her sputum and Bronchoalveolar Lavage (BAL) was negative for TB. A complete blood count revealed pancytopenia. Bone-marrow aspiration and biopsy demonstrated granulomatous inflammation with numerous AFB on Ziehl-Neelsen stain, confirming Mycobacterium tuberculosis involvement in the bone-marrow. HIV and hepatitis screen were negative. Bone-marrow involvement by TB is extremely rare and typically occurs in disseminated TB or immunocompromised patients. This case challenges the notion that TB reactivation only affects the lungs, suggesting that latent TB can later disseminate to the Bone-marrow. The pancytopenia may have resulted from both disseminated TB and hematologic side effects of ATT, known to occasionally cause Bone-marrow suppression. The patient’s ATT regimen was adjusted to address Bone-marrow involvement. She received supportive care, including blood transfusions and growth factors to manage pancytopenia. Over the following months, her blood counts gradually normalized, and she showed clinical improvement. Follow-up imaging demonstrated stabilization of pulmonary findings, and no further hematologic complications were noted. This case highlights the importance of considering Bone-marrow involvement in patients with a history of TB, particularly those starting empirical ATT. While rare, bone-marrow TB should be considered in patients presenting with unexplained pancytopenia, even years after the initial TB diagnosis.

Conclusion: Clinicians should be aware of the potential complications of ATT in patients with prior TB and monitor for hematologic abnormalities. Further research is needed to explore the pathophysiology of bone-marrow TB and to refine management strategies for these rare, complex cases.

Keywords: Acid-fast bacilli, ATT complications, bonemarrow involvement, disseminated TB, empirical antitubercular therapy, granulomatous inflammation, pancytopenia, reactivation, tuberculosis

Reference

1. Kuo PH, Yang PC, Kuo SS, Luh KT. Severe immune hemolytic anemia in disseminated tuberculosis with response to antituberculosis therapy. Chest 2001;119:1961-3.

Abstract No. 62: Persistent fever in a diagnosed case of pulmonary tuberculosis on antitubercular therapy

Niladri Palit , Soumya Bhattacharjee

Department of Respiratory Medicine, R G Kar Medical College and Hospital, Kolkata, West Bengal, India

Introduction: A 12 year old girl with fever, weight loss, diagnosed as tuberculosis, clinicoradiologicaly, started on atd but symptomps not improved, discontinued ATD by herself, visited different clinics, finally re-evaluated. This time came as microbiologically detected [bal fluid] pulmonary tuberculosis. Rifampicin sensitive. Received atd for 6 months, still worsen clinically.

Case Report: Presented at our emergency with severe hypoxia with bilateral extensive fibrocavitary lessions. After ruling out all other possibilities with present clinical scenarios, we decided to repeat bal fluid study, this time also results came as rifampicin sessitive pulmonary tuberculosis, but we also have sent serum and bal fluid galactomannan, both were raised, started on HRZE plus IV-voriconazole. Within 2 weeks hypoxia improved. MDR TB ruled out with fllpa sllpa.

Conclusion: Fungal infection of lung is one of the common causes of secondary infection, specially, when there is architectural distortion of lung parenchyma. Need to be treated with antifungals. After treating this case with atd+antifungals, patient clinicaly improved in 2 weeks, completed ATD, with microbiological conversion. Now she is attending her school regularly and engaged in her regular activities. In pulmonary tuberculosis cases, with persistent fever with worsening of symptomps, despite being on ATD, we always need to re-evaluate and rule out other secondary infections, along with other possibilities, like mdr tb, particularly when there is fibrocavitary lessions.

Abstract No. 63: A rare clinical presentation of Lemierre’s syndrome (septic thrombophlebitis of internal jugular vein) due to pulmonary and extrapulmonary TB with anemia

Mohit Kondisetti , Nikhil Sarangdhar, Deepika Ughade, Girija Nair, Shahid Patel, Tanay Sinha

Department of Pulmonary Medicine, D Y Patil University, School of Medicine, Navi Mumbai, Maharashtra, India

Introduction: Lemierre’s syndrome is a Septic Thrombophlebitis of Internal Jugular Vein, the common causes of which include Fusobacterium, Bacteroides, other anaerobes and Methicillin-resistant Staphylococcus. We describe an unusual presentation of Lemierre’s syndrome where Mycobacterium Tuberculosis was identified as the etiological agent in a young female.

Case Report: A 26-year-old lady presented with fever, left sided painful neck swelling since 3 months associated with odynophagia, pain and swelling over left cheek, productive cough, loss of weight and appetite and low grade fever since 3 months. Neck Sonography revealed bilateral cervical and axillary lymphadenopathy (L > R) of which FNAC was inconclusive. CT thorax revealed presence of a thrombus in the Left Internal Jugular Vein, consolidation of right middle lobe and mediastinal, cervical and axillary lymphadenopathy. Her USG Neck Vein Doppler revealed Bilateral Internal Jugular Venous (IJV) thrombosis with significant luminal compromise (L > R) with a conglomerated lymph node compressing the Left IJV. Deep Vein Thrombosis scan of bilateral lower limbs showed no Thrombus. Hemogram and coagulation profile were normal except for the presence of microcytic hypochromic anemia and leukocytosis. Broncho Alveolar Lavage and the CBNAAT of the BAL washings detected the presence of Mycobacterium Tuberculosis sensitive to Rifampicin. Patient was started on Anti-TB Therapy of Isoniazid, Rifampicin, Pyrazinamide, Ethambutol (HRZE) from NTEP and Low Molecular Weight Heparin for 5 days, switched to oral Rivaroxaban, to which the clinical improvement was observed in terms of reduction in cervical lymph node swelling, resolution of fever and cheek pain, increased appetite and she was discharged with advice for follow-up.

Conclusion: Tuberculosis is widely prevalent in the Indian Subcontinent and unusual and bizarre clinical presentations are often encountered at tertiary care centers as seen in this case of Disseminated Tuberculosis with Septic Thrombophlebitis of Bilateral Internal Jugular Veins with Pulmonary and Extrapulmonary Tuberculosis

Abstract No. 64: Five years retrospective analysis of TB patients at tertiary care centre (Navi Mumbai)

Sharmin Mukadam , Manas Bhanushali, Girija Nair, Deepika Ughade, Tanay Sinha, Nikhil Sarangdhar

Department of Pulmonary Medicine, DYPMCH, Pune, Maharashtra, India

Objective: To analyse the clinical profile, demographic trends, and treatment outcomes of patients diagnosed with tuberculosis (TB) at a tertiary care centre in Navi Mumbai over a five-year period, providing insights into the epidemiological changes in TB management.

Methods: A retrospective study was conducted on TB patients managed at the Department of Pulmonary Medicine, DYPMCH, from 2020 to 2024. Data were obtained from TB registers, the Medical Records Department (MRD), and the NIKSHAY portal. Both indoor and outdoor patients were included, with variables such as age, gender, type of TB (pulmonary/extrapulmonary), comorbidities, treatment regimens, and outcomes analysed.

Results: A total of [2043] patients were reviewed. The majority of cases were pulmonary TB (65%), with extrapulmonary TB accounting for 34. The male-to-female ratio was 2:1, with the most affected age group being [20-30yrs ]. Treatment success rates were observed in 95% of cases. The trends showed decrease in smear positive cases during year 2020 and 2021 due to covid-19 effect.

Conclusion: This five-year retrospective analysis highlights changing demographic and clinical trends in TB cases, emphasizing the need for early diagnosis, tailored management, and strengthened follow-up systems. The findings underscore the importance of continuous epidemiological monitoring to improve TB control strategies in tertiary care settings.

Keywords: Clinical profile, demographics, retrospective , tertiary care, treatment outcomes, tuberculosis, analysis, navi mumbai

Abstract No. 65: Lower lung field tuberculosis in immunocompetent patient

Tanisha James , B. L. Shashi Bhushan, K. U. Vivek

Department of Pulmonary Medicine, BMCRI, Bengaluru, Karnataka, India

Introduction: Lower lung field tuberculosis without concomitant upper lobe disease involvement occurs in 7% or less with active pulmonary tuberculosis, results from transbronchial perforation of hilar lymph node with spread into adjacent lung. Lower zone opacity on chest x-ray often masquerades as pneumonia, aspiration, atelectasis.

Case Report: 70 year old male, fruit vendor by occupation presented with complaints of cough with expectoration, whiteish in colour, non-foul smelling and non-blood tinged and complaints of fever since 2 weeks, low grade intermittent, not associated with evening rise of temperature. No associated history of loss of weight or appetite. Patient had no know co-morbidities. Known alcoholic and smoker. Chest Xray showed right lower zone consolidation. Sputum AFB smear and CBNAAT was negative. HIV screening was negative, CECT thorax was done which reported patchy areas of consolidation in right lower lobe with few non enhancing areas in right lower lobe likely necrotizing pneumonia. Patient was initially treated on Ceftriazone, on no clinical improvement diagnostic bronchoscopy was performed, bronchoalveolar lavage and post bronchoscopy sputum samples were sent for gene Xpert and analysis. BAL CBNNAT was negative however post bronchoscopy sputum CBNAAT was positive for PTB and patient was started on first line antitubercular drugs, Patient symptomatically showed improvement and was discharged home with ATT medication.

Conclusion: Post primary tuberculosis usually affects upper lung field, occurrence in lower lung fields is rare via transbronchial perforation of hilar lymph node. Tubercle bacilli maybe challenging to detect on smear and culture, bronchial sampling or post bronchoscopy sputum may reveal tubercle bacilli. Tuberculosis should be considered as a potential diagnosis in lower lung field pneumonia in individuals with cough, fever and evening spikes of temperature, in high TB burden countries such as India.

Abstract No. 66: A case of atypical mycobacterial infection of the parotid gland

Pawar Sumit , Shah Umang, Shah Arpan

Department of Pulmonary Medicine, Pranayam Lung and Heart Institute, Vadodara, Gujarat, India

Introduction: Tuberculosis is a necrotizing granulomatous disease with varied clinical presentations. Tuberculosis of the parotid gland is a rare clinical entity even in countries where the disease is rampant. Involvement of the parotid gland and lymph nodes may develop in two ways:

Mycobacterial infection in the oral cavity liberates the mycobacterium that ascends into the salivary gland via its duct or pass to its associated lymph nodes via lymphatic drainage The second pathway involves haematogenous or lymphatic spread from a distant primary lung focus.

Establishment of diagnosis of tuberculosis requires histological confirmation since imaging findings are not specific. In parotid lesions FNAC has a sensitivity of 81–100% and specificity of 94–100%.

Case Discussion: 3 year old female child, presented with firm to hard gland in left parotid region Pre-auricular region with a fistula Patient was started on 4 drug ATT as per weight. She took it for period of 2 months but no response in spite of medicines She presented to us at this stage. Physical examination revealed 2 by 2 cm post-auricular gland of left parotid gland 2 * 2 cm abscess. Initially started on Amoxyclav and combiflam no response. Pus from left cheek was sent for Routine Gram Stain and Culture AFB Smear and AFB Culture, Fungal Smear and culture. Mycobacteria (M. Abscessus ) was grown.

Conclusion: Our case is unique in following ways: Atypical Mycobacteria (M. Abscessus), Immunocompetent Host, Increase in NTM infections and advances in immunotherapeutic treatment regimens infections with NTM need to be considered in lesions of unclear origin at the same time considering the fact that they may at times be present as contaminants as well.

Abstract No. 67: Prevalence of tuberculosis and level of awareness of the disease among healthcare workers in a tertiary care hospital

Shreeja Nair 1 , Tanuja P. Barve 2

1 Department of Respiratory Medicine, MGM Medical College, Kamothe, Maharashtra, India, 2 MGM Medical College, Kamothe, Maharashtra, India

Introduction: Healthcare workers (HCWs) who tend to patients of active drug-sensitive and multidrug-resistant tuberculosis are more likely to become infected due to greater exposure than the public. This study was done to assess the challenges and quality of life among HCWs working in a medical college in Raigad district of Maharashtra, which houses the district TB centre. We also calculated the prevalence of TB among these HCWs. Our aim also included promotion of prevention strategies, raising awareness about national guidelines, treatment options, and to address social stigmas associated with TB.

Methods: This was a prospective, observational, cross-sectional study done over two months in a tertiary care center in Maharashtra. 250 HCWs (doctors, nurses, laboratory technicians, workers from housekeeping department, security staff, clerks) were interviewed for the study with three validated questionnaires and results were calculated with appropriate statistics methods. This study was an STS project with grant by ICMR in 2024.

Results: From the study we found a prevalence of TB among HCWs to be 6.4%, a slightly higher figure as compared to previous studies. 44% of these HCWs were doctors, 25% were housekeeping staff and 12.5% nurses. 75% cases had pulmonary TB and 19% had MDR TB. A dismal 73% of HCWs had adequate awareness of TB. 31% were smokers but none had significant comorbidities. 96% had good quality of life. None of the patients faced any stigma related to TB during treatment.

Conclusions: This study reiterates the fact that TB is highly prevalent among health care workers and we must take strict measures and implement strategies to reduce its spread in hospitals. Awareness of the disease is equally important and emphasis must be given on training HCWs on TB. We hope to make efficient changes in the infection control policies of our hospital with this study.

Keywords: Healthcare workers, prevalence, tuberculosis

Abstract No. 68: Navigating adverse drug reactions in drug-resistant tuberculosis: Insights from an ambispective cohort study

Niraj Dhakare , Radha Munje, Gyanshankar Mishra

Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Introduction: Tuberculosis (TB), particularly drug-resistant tuberculosis (DR-TB), continues to be a major global health threat, especially in India, where the emergence of drug resistance complicates treatment. Adverse drug reactions (ADRs) to TB medications further challenge treatment compliance and patient outcomes. Understanding ADR profiles is critical for optimizing treatment strategies.

Objectives: This study aimed to evaluate the incidence, causality, severity, and risk factors associated with ADRs in DR-TB patients undergoing treatment, and to assess treatment compliance in those affected by ADRs.

Methods: An ambispective cohort study was conducted at a tertiary care institute from January 2023 to September 2024. The study included 174 DR-TB patients receiving treatment under the Programmatic Management of Drug-Resistant TB (PMDT). Data were analyzed using SPSS, and associations with ADR occurrence were assessed using the Chi-square and t-test. Inclusion criteria involved DR-TB patients aged ≥18 years, registered under PMDT-NTEP.

Results: Out of 174 patients, 79% (138/174) experienced ADRs, with common reactions being skin discoloration (60.34%), peripheral neuropathy (52.87%), and joint pain (28.74%). Most ADRs were mild (52.90%) or moderate (40.58%). Causality assessment classified 92.03% of ADRs as probable. Male patients and those with pulmonary TB or co-morbidities, such as diabetes and hypertension, were more likely to develop ADRs. No significant association was found between ADRs and HIV status or addiction history. Bedaquiline was found to be relatively cardio-safe.

Conclusions: The high prevalence of ADRs in DR-TB treatment underscores the need for improved pharmacovigilance and tailored management strategies. The findings support the expanded use of Bedaquiline in all-oral regimens and advocate for therapeutic drug monitoring (TDM) to optimize treatment.

This study highlights the need for proactive ADR management, the development of less toxic drugs, and enhanced monitoring strategies to improve treatment adherence and outcomes in DR-TB patients.

Keywords: Adverse drug reactions, bedaquiline, drug-resistant tuberculosis, pharmacovigilance, treatment adherence

Abstract No. 69: Isolated primary inguinal lymph node MDRTB: A rare case report

Sowmya Mandula , Raghu Srikanti

Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India

Introduction: Inguinal lymph node MDR TB is rare.

Case Report: A 38-year-old male presented with left side groin swelling for one month not associated with pain, fever and cough with expectoration for 10 days. History of rheumatoid arthritis for 12 years and on regular treatment. No previous history of anti-tubercular treatment and other comorbidities. Chest X-Ray and CT chest are normal. FNAC from left inguinal lymph node send for CBNAAT shows MTB positive, rifampicin resistance detected and Sputum CBNAAT negative. Patient was initiated on short oral Bedaquiline regimen and is on follow up.

Conclusions: Here we reported a unique case of unilateral isolated inguinal MDR TB because of increase in prevalence of extra pulmonary MDR TB. CBNAAT is crucial for the early diagnosis of drug sensitive and resistant tuberculosis and its management in India like endemic countries.

All lymph node FNAC should be sent for CBNAAT along with histopathological examination.

Abstract No. 70: Isolated tubercular subphrenic abscess

Eesh Goyal , Vishal Chopra, Kranti Garg

Department of Pulmonary Medicine, GMC, Patiala, Punjab, India

Introduction: Subphrenic abscess is relatively common, but a tubercular subphrenic abscess in the absence of coexisting tubercular abdomen is extremely rare and often confused with pyogenic or amoebic liver abscess. A tuberculous abscess is usually associated with foci of infection either in the lung or GIT, or with an immunocompromised state.

Case Report: A 16-year-old female presented with complaints of right-sided chest pain. The dull, aching pain was located in the right infraaxillary area and radiated to the back. On systemic examination, dullness on percussion was noted in the right 6th and 7th intercostal space in the mid-axillary area, and reduced breath sounds were heard in the right infraaxillary area. On abdominal examination, tenderness was present in the right hypochondrium. The patient’s CBC was within normal limits; however, the CXR showed a raised right hemidiaphragm with angle blunting. An USG of the abdomen revealed a cystic lesion in the subdiaphragmatic region and hepatomegaly. A CECT of the whole abdomen showed a moderate-to-large-sized, thick, irregularly-walled, multiseptated, multiloculated collection within the subdiaphragmatic space, with extensive areas of necrosis. The patient was managed with drainage and antibiotics. Pus was sent for aerobic culture, sensitivity testing, CBNAAT, and liquid culture for MTB. CBNAAT showed MTB detection with no resistance to rifampicin. The patient was started on ATT. A repeat ultrasound of the abdomen showed complete resolution of the abscess.

Conclusion: Isolated tubercular subphrenic abscesses, though rare, can be confused with pyogenic and amoebic liver abscesses. Therefore, any isolated subphrenic abscess should be evaluated for a tubercular etiology, as misdiagnosis can lead to serious complications.

Keywords: Amoebic liver abscess, CBNAAT, subphrenic abscess

Abstract No. 71: Correlation of demographics and clinical features with adverse drug reaction among patients receiving anti tuberculosis treatment for drug sensitive tuberculosis

Utkarsh Singh , Medha Bragaje, Pramod Chaudhari, A. Anita, Anubhuti Singh

Department of Respiratory Medicine, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, Maharashtra, India

Inroduction: TB is one of the leading cause of mortality among infectious disease and has a enormous impact on many countries. India has highest TB burden country accounting for the 1/5 th of the total global incidences. ATT induced ADR includes hepatitis, gastritis, arthralgia, haematological disorders, skin related disorders. Adverse events due to drug-sensitive as well as resistant TB treatment are one of the most important reasons for treatment interruption and nonadherence.

Methods: A descriptive longitudinal study which was conducted over period of 8 months from May 24 to December 24 in pulmonary medicine department of Bharati hospital and research institute, Pune. 50 patient were registered under RNTCP which include both pulmonary and extra pulmonary tuberculosis. All patients above 18 years of age who are diagnosed with Drug sensitive tuberculosis and who developed ADR during the intensive phase of treatment.

Results: Our study includes 50 patients, showed that 45 patients developed ADR, which is 90%. Gastritis was the most common ADRs, occurring in 31 (18.93%) patients of the total. Hepatitis was noted in 15 (9.15%), while skin-related problems were reported in 9 (5.49%), Joint pain was experienced by 14 (8.54%) and hematological problems were observed in 5 (3.05%). Additionally, other types of ADRs were reported in 4 (2.44%) patients. Specifically 54% were females and 46% males. As per Kuppuswamy classification, most patients (52%) belonged to economic status category III, followed by 36% in category II. Occupationally, 28% were students and 28% in other roles, 20% homemakers, and 12% each IT professionals and business owners.

Conclusion: In this study of 50 TB patients, 90% developed ADRs, with gastritis being the most common. With a gender distribution showing that females constituted the majority. The majority belonged to economic status category III. Effective ADR management is essential for treatment adherence.

Abstract No. 72: Analysis of NLR and bacterial load in tuberculosis positive patients

Nirupam Rajanish , P. L. Meshram, R. R. Hegde, S. A. Agale

Department of Pulmonary Medicine, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India

Introduction: Tuberculosis (TB) is a significant global health issue, with millions of new cases annually. Managing TB involves assessing bacterial load and immune response, as these affect disease severity and treatment. The Neutrophil-to-Lymphocyte Ratio (NLR) is a notable immune marker, indicating systemic inflammation and disease progression in TB and other infections. NLR shows the balance between neutrophils, elevated during acute inflammation, and lymphocytes, key in adaptive immunity. The study involved using the Sputum GeneXpert system to explore the correlation between the Neutrophil-to-Lymphocyte Ratio (NLR) and bacterial load in tuberculosis (TB) patients.

Methods: This prospective hospital-based study, conducted over a month at a tertiary care center, involved 65 patients with pulmonary tuberculosis. Elevated NLR suggests an inflammatory response, as neutrophils are part of the acute inflammatory response, while lymphocytes are involved in the adaptive immune response, and GeneXpert provides results in about 2 hours, significantly faster than traditional methods like culture (which may take weeks). This quick turnaround is crucial for initiating early treatment and controlling TB spread.

Results: The average neutrophil-lymphocyte ratio (NLR) ranges from approximately 3.12 (low bacterial load) to 5.75 (high bacterial load). The average NLR for medium bacterial load is approximately 4.71. The average NLR for very low bacterial load is approximately 5.67. The very low bacterial load category, with an average NLR of 5.67, contradicts the typical trend that lower bacterial loads should correspond to lower NLRs. This anomaly suggests that the relationship between bacterial load and NLR is not as straightforward as the figures presented and requires more nuanced analysis to account for the multitude of variables at play.

Conclusion: This study aimed to correlate NLR with bacterial load in TB patients by leveraging the GeneXpert MTB/RIF system for bacterial detection. This study shows that NLR can vary independently of bacterial load, as it is influenced by several factors such as the patient’s immune response, underlying comorbidities, or treatment interventions. The findings could shed light on how systemic inflammation correlates with TB severity, offering a potential avenue for better patient management, especially in settings where quick and simple diagnostic tools are needed.

Keywords: Neutrophil lymphocyte ratio, sputum genxpert

Abstract No. 73: Studying the effectiveness of bedaquiline versus kanamycin-based treatment regimens of multi-drug-resistant TB in terms of occurrence of treatment failure

Srushti Bonde , P. L. Meshram, R. R. Hegde, S. A. Agale

Department of Pulmonary Medicine, Grant Government Medical College, Mumbai, Maharashtra, India

Background: The National Tuberculosis Elimination Programme (NTEP) in India regularlyupdates its guidelines for the treatment of drug-sensitive and drug-resistant tuberculosis. In 2020, a significant change was introduced with the replacement of injectable kanamycin with bedaquiline in multi-drug resistant tuberculosis (MDR-TB) treatment regimens. This study aimed to compare the treatment failure rates between these two approaches.

Methods: Data was collected from the Nikshay portal, focusing on freshly diagnosed MDR-TB patients treated with kanamycin-based regimens (2018-2019) and bedaquiline-based regimens (2020-2021). Treatment failure rates werecalculated for both groups, and the influence of various factors, includingdemographics, comorbidities, and specific treatment regimens, was analyzed.

Results: The study found no significant difference in treatment failure rates between kanamycin and bedaquiline-based treatments. Within the bedaquiline group, the shorter MDR/RR-TB regimen showed a slightly higher, though not statistically significant, failure rate compared to the longer oral regimen. Similarly, in the kanamycin group, the regimen for MDR with fluoroquinolone resistance had a slightly higher failure rate than the conventional MDR regimen. Factors such as diabetes, HIV co-infection, and previous TB treatment history did not significantly impact treatment failure rates. The comparable treatment failure rates between kanamycin and bedaquilinebased regimens suggest that the shift to bedaquiline maintains treatment efficacy while eliminating the challenges associated with injectable medications. The slightly higher failure rates observed with specific regimens within both groups warrant further investigation to optimize treatment strategies.

Conclusions: This study supports the NTEP’s transition to bedaquiline-based regimens for MDR-TB treatment. Continued monitoring and analysis of treatment outcomes are crucial to ensure the long-term success of TB control efforts.

Keywords: Bedaquiline, India, kanamycin, MDR-TB, NTEP, treatment failure, tuberculosis

Abstract No. 74: Unusual presentation of pulmonary tuberculosis: A case series

Anita Saibannavar , Harshita Mittal

Department of Pulmonary Medicine, R. C. S. M. G. M. C., Kolhapur, Maharashtra, India

Background and objectives: Pulmonary tuberculosis classically presents with cavitation which is a hallmark radiological feature. It usually manifests as single cavitary lesion mostly in the upper lobe (apical and posterior segments). This upper lobe predilection is attributed to decreased blood supply, higher oxygen tension and impaired lymphatic drainage. Later in HIV era, pulmonary TB presentation have diversified with lower lobe involvement and diffuse pulmonary disease becoming more common due to profound immunosuppression and low CD4 counts.

However, with the growing prevalence of comorbidities such as diabetes, malnutrition and alcoholism, unusual and diffuse radiological patterns are also seen in Non-HIV patients. This case series aims to highlight such unusual radiological presentations in Non-HIV patients with mild immunosuppression.

Methods: A retrospective case series was conducted on five Non-HIV patients with mild immunosuppression who were diagnosed with pulmonary TB at a tertiary care center. Clinical data, comorbidities, and radiological findings were reviewed and analyzed for deviations from classical TB presentations.

Results: All patients exhibited unusual radiological findings, notably bilateral multiple cavitary lesions. These radiological lesions resembled those seen in bronchopneumonia, septic emboli and fungal infections. None had profound immunosuppression or HIV, but all had underlying comorbidities such as diabetes, malnutrition and alcoholism.

Conclusion: Pulmonary TB can present with unusual radiological findings in Non-HIV patients with mild immunosuppression, mimicking other infectious and inflammatory pulmonary conditions. Awareness of such presentations is crucial for timely diagnosis and management, especially in the context of rising comorbidities.

Keywords: Unusual presentation, multiple cavitary lesion, comorbidities, upper lobe predilection, mild immunosuppression

Abstract No. 75: CARE: Combination of Acetylcysteine and AcebRophylline in moderate to severe asthma and COPD PatiEnts

Raja Dhar 1 , Rakesh K Chawla 2 , Moumita Rahaman 3 Aditya K Chawla 2 , Gaurav Chaudhary 2 , Ashutosh Gautam 4 , Rajat Singal 4

1 Birla Hospital, Kolkata, West Bengal, India, 2 Chawla Clinic, Rohini, New Delhi India, 3 RMO, Birla Hospital, Kolkata, West Bengal, India, 4 Mankind Pharma Ltd, Okhla Phase III, New Delhi, India

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma profoundly affect patients’ quality of life (QoL), yet traditional severity measures often fail to capture this dimension. While GOLD guidelines recommend mucolytic agents to reduce exacerbation risk and enhance QoL in COPD, data on the combined assessment of QoL and lung function changes, especially from the Indian subcontinent, remain limited.

Objective: To assess the efficacy and safety of the combination of N-acetylcysteine and Acebrophylline (Combination named Abiways), in patients with moderate to severe COPD and Asthma.

Methods: In this non-randomized, interventional, prospective, single-arm, post-marketing surveillance study, participants were administered Abiways for 90 days. The primary endpoint was Quality of Life, which was evaluated using the COPD Assessment Test (CAT) and Asthma Control Test (ACT) scores. Secondary endpoints included mean FEV1 and FVC changes and adverse event occurrence.

Results: Of 102 recruited patients with moderate to severe obstructive airway disease, 97 completed the study (76 COPD and 21 Asthma patients respectively; mean age 57.9 ± 8.1 years; 33 females, 64 males). Overall, FEV1 improved significantly from 1.287 L to 1.484 L (197 mL; p < 0.001) with similar statistical improvements in COPD (1.237L to 1.414L; p = 001) and asthma (1.477 L to 1.747 L; p = 0.004) subpopulations. COPD patients showed statistically significant improvements in CAT scores (17.18 ± 1.02 to 10.58 ± 0.9, p = 0.0001); however, such significance was not observed in the ACT scores for asthma patients. FVC remained unchanged in all subgroups [ Figure 1 ]. No severe adverse events occurred.

Conclusion: The combination of N-acetylcysteine and Acebrophylline improves CAT scores in moderate to severe COPD patients, and FEV1 in both COPD and asthma patients with a favorable safety profile. The combination appears safe and effective for obstructive airway disease management.

Keywords: ABIWAYS, acebrophylline, asthma, CAT score, COPD, FEV1, N-Acetylcysteine

Abstract No. 76: A study of serum electrolytes in COPD and its use in management of patients in a tertiary hospital

Muthirevula Archana Reddy , Adheep B. Amberker, B. Vidyasagar

Department of Respiratory Medicine, JJM Medical College, Davangere, Karnataka, India

Introduction: In COPD patients, impaired gas exchange and hypercapnia trigger various hormonal and endothelial responses that can lead to water retention and hyponatremia. This condition can cause central nervous system dysfunction, reversible cardiac conduction defects, secondary renal insufficiency, and potentially death. Hypokalemia often accompanies hyponatremia in COPD patients, either independently or together. Hypokalemia can result from respiratory acidosis, metabolic alkalosis, or prolonged steroid use, and β2 agonists may also contribute. Acute respiratory failure with hypokalemia is associated with high mortality rates, often due to cardiac arrhythmias or impaired nerve-muscle conduction.

Objectives: To evaluate the extent of electrolyte imbalance during acute COPD exacerbations and to use these imbalances as prognostic indicators for COPD management.

Methods: Primary data was collected from 130 COPD patients with acute exacerbations admitted to Bapuji Hospital, Davangere, from May 2023 to May 2024. Diagnosis was based on history, clinical examination, pulmonary function tests, and the modified medical research council dyspnea grading. Age and sex-matched healthy controls were recruited from the general population. Serum electrolyte levels were measured at admission and discharge. Data were analyzed using MS Excel and SPSS Software, with categorical values reported as numbers and percentages, and numerical values as means and standard deviations. Statistical significance was determined with ANOVA and unpaired t-tests, considering p < 0.005.

Results: The study included 130 patients (78 males, 52 females) with a mean age of 56.85 years, compared to 58.33 years for controls. Sixty percent of both cases and controls were male, and forty percent were female. Fifty-five percent of cases and sixty percent of controls were smokers. At admission, the mean SpO2 of cases was 86.14%, which was statistically significant compared to controls. The mean FEV1 for cases was 51.55% versus 81.42% for controls, and the FEV1/FVC ratio was 56.1 for cases compared to 71.24 for controls. Serum sodium levels in cases were 130.45 mEq/L versus 138.2 mEq/L in controls, while serum potassium levels were 3.24 mEq/L in cases compared to 4.4 mEq/L in controls. Hyponatremia and hypokalemia worsened with advancing age. Males had a mean sodium level of 130.4 mEq/L and potassium of 3.3 mEq/L, while females had 131.8 mEq/L and 3.4 mEq/L, respectively. Longer illness duration correlated with greater electrolyte imbalances. Eighty-five percent of cases had wheezing, forty-three percent had crepitations, and eighteen percent had SpO2 below 70%. Hyponatremia and hypokalemia were significantly associated with lower oxygen saturation. Patients with both emphysema and chronic bronchitis had a mean sodium of 128.70 mEq/L and potassium of 3.1 mEq/L. Lower sodium and potassium levels were observed in patients with reduced more severe MMRC and GOLD stages. Duration of hospital stay and frequency of exacerbations correlated with electrolyte imbalances. Patients requiring mechanical ventilation had mean sodium and potassium levels of 126 mEq/L and 3.03 mEq/L, respectively.

Conclusions: Hyponatremia and hypokalemia are common in acute COPD exacerbations, and there is a significant correlation between serum electrolytes and severity indicators such as the oxygen saturation, MMRC grading, pulmonary function tests, GOLD index. Reduced SpO2 at admission and advanced age are assoventilation severe hyponatremia and hypokalemia, often necessitating mechanical ventilation.

Abstract No. 77: Impact of budesonide/glycopyrronium/formoterol on efficacy outcomes in COPD patients based on exacerbation history: Post hoc analysis of a phase 4 clinical trial

Sanjana Shastri 1 , Meena Lopez 1 , Manish Jain 2 , Priti Meshram 3 , Akash Balki 4 , Himanshu Pophale 5 , Sharad Tikkiwal 6 , Sandesh Sawant 1 , Abhijit Vaidya 1 , M. Senthilnathan 1 , Jaideep Gogtay 1

1 Medical Department, Cipla Ltd, Mumbai, Maharashtra, India, 2 Maharaja Agrasen Superspecialty Hospital, Jaipur, Rajasthan, India, 3 Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India, 4 Shree Hospital and Critical Care Centre, Nagpur, Maharashtra, India, 5 AMAI Charitable Trust’s Ace Hospital and Research Centre, Pune, Maharashtra, India, 6 Asthma Bhawan, Jaipur, Rajasthan, India

Introduction: GOLD-2024 recommends triple therapy in frequent exacerbators. Evidence is emerging on triple therapy benefits in patients without a recent exacerbation; however, data is lacking in Indian patients. In an Indian Phase-IV trial, Budesonide/Glycopyrronium/Formoterol (BGF)(400/25/12mcg) FDC given through Dry-Powder-Inhaler (DPI) was well-tolerated and improved lung-function, symptoms and HRQoL. The aim of this post-hoc analysis was to assess impact of BGF on symptom-scores, lung-function and HRQoL in patients with and without a recent exacerbation.

Methods: The phase-IV open-label, prospective, non-comparative, 24-weeks clinical trial evaluated safety and efficacy of BGF-DPI twice-daily in moderate-severe COPD. Patients 40-75 years, current/ex-smokers, with spirometry-diagnosed COPD (GOLD-2020 guidelines), CAT>10 and able to use DPI were included. Outcomes evaluated in this post-hoc-analysis were change at 24 weeks from baseline in CAT, FEV1, SGRQ & mMRC in patients with (Group 1) and without (Group 2) documented history of exacerbation prior to 1-year from screening.

Results: Of 194 patients in Phase-IV trial, exacerbation history data was available for 106 (74-Group1; 32-Group 2). Mean CAT score improved (p < 0.001) by 24-weeks in both groups (6.639 + 4.136-Group1; 6.233 + 5.070-Group2). Trough FEV 1 improved in Group 1 (0.053 + 0.188 L, p = 0.024) at 24 weeks; improvement in Group 2 was not significant (0.044 + 0.294 L). Mean SGRQ improved (p < 0.001) by 21.819+16.471 in Group1 and 15.967 + 17.365 in Group2. Improvement (p < 0.001) of 0.417 + 0.645 units in mMRC was seen in Group 1; improvement was non-significant in Group 2 (0.167 + 0.531). In patients with and without a recent exacerbation history, at the end of 24 weeks, CAT and SGRQ scores improved significantly. Trough FEV1 and mMRC saw significant improvement in patients with a recent exacerbation history and numerical improvement in those who did not have an exacerbation in the year prior. No significant inter-group differences were seen in CAT, trough FEV1 and SGRQ measures.

Conclusion: Budesonide/Glycopyrronium/Formoterol FDC significantly improved symptoms and HRQoL in Indian COPD patients, irrespective of exacerbation history.

Keywords: Budesonide/glycopyrronium/formoterol, COPD, exacerbation, triple therapy

Abstract No. 78: Hot and cold therapy for management of patients with nonmalignant airway lesions

Siddhartha Chakraborty , Manu Chopra, Rahul Tyagi, Kislay Kishore, Aseem Yadav, M. C. Jyothis

Department of Respiratory Medicine, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India

Background: Therapeutic bronchoscopy plays a pivotal role in management of non-malignant endobronchial lesions such as carcinoid, leiomyoma and hamartoma, with minimal side effects and saving the patients from life-threatening surgeries.

Case Reports: Four patients underwent therapeutic bronchoscopy using cryotherapy with repeated freeze thaw cycles, argon plasma coagulation and electrocautery for debulking and ablation of lesion. A 34 year old male with soft tissue density mass lesion in superior segment right lower lobe was diagnosed as a case of pulmonary hamartoma on endobronchial biopsy. He underwent multiple sessions of debulking of mass using cryofreeze and thaw technique with near complete resolution of endobronchial lesion. Another 29 year old male with mass lesion in left main bronchus and proximal left upper lobar bronchus with distal near total collapse of left upper lobe was diagnosed as a case of pulmonary hamartoma using a novel procedure tunnelled endobronchial biopsy. He underwent multiple sessions of electrocautery fulguration resulting in complete resolution of lung mass. Another patient diagnosed as a case of leiomyoma, an extremely rare tumour especially in male, in the right upper lobe bronchus underwent multiple sessions of electrocautery fulguration and debulking using cryotherapy with repeated cycles of freeze thaw. There was significant resolution of the lesion, avoiding pneumonectomy. A case of carcinoid right lower lobe, diagnosed on endobronchial biopsy, underwent debulking using cryotherapy and electrocautery leading to near complete resolution.

Conclusion: Therapeutic bronchoscopy using cryotherapy, electrocautery and argon plasma coagulation led to positive outcomes and resolution of non-malignant lesions, saving the patients from critical surgeries such as pneumonectomy

Abstract No. 79: Real world evidence on safety and effectiveness of single inhaler triple-therapy (formoterol/glycopyrronium/budesonide) in Indian patients with COPD

Ravi Tejraj Mehta, Ashok Jaiswal

Medical and Regulatory Affairs, Zydus Healthcare Limited, Mumbai, Maharashtra, India

Introduction: Single inhaler triple therapies, combining LABA/LAMA/ICS are promising treatment for COPD, the second-leading cause of deaths due to non-communicable diseases in India. This study aimed to assess the effectiveness and safety of Formoterol/Glycopyrronium/Budesonide (FGB) administered as SITT in COPD patients in real-world clinical setting in India.

Methods: This is a 24-week, prospective, multicentric, real-world observational study involving adults with COPD prescribed a single inhaler triple therapy [FGB 12/25/400 mcg DPI (n = 168) or 4.8/9/160 mcg pMDI (n = 127)] at the discretion of the treating physician. Effectiveness outcomes include change in FEV1, FVC, COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ). Adverse events are also assessed. Interim analyses (n = 295) of patients who have completed 24-week follow-up are presented here.

Results: FEV1 improved from 1.16 ± 0.50 litres at baseline to 1.33 ± 0.58 litres by week 4 (mean change 0.17 ± 0.39; P < 0.0001), and 1.49 ± 0.73 litres at week 24 (mean change 0.33 ± 0.64; P < 0.0001). FVC improved from 1.90 ± 0.70 litres at baseline to 2.06 ± 0.76 litres at week 4 (mean change 0.16 ± 0.45; P < 0.0001) and 2.24 ± 0.98 litres at week 24 (mean change 0.35 ± 0.87; P < 0.0001). CAT score reduced from 21.81 ± 10.04 at baseline to 11.17 ± 6.63 at week 24 (P < 0.0001), and CCQ from 4.08 ± 3.05 at baseline to 1.90 ± 1.54 at week 24 (P < 0.0001). FGB was well-tolerated, most common adverse events being palpitations (1.7% patients) and dryness of mouth (1.4%). No serious adverse events were reported.

Conclusions: This large ongoing real-world study enrolling patients across India highlights the high symptom burden and poor lung functions of COPD patients eligible to receive triple therapy. SITT with FGB is a well-tolerated therapeutic option which effectively improves lung function early within a month leading to relief from symptoms and improvement of QoL at 6 months.

SITT with FGB significantly improves lung function and QoL in COPD patients with good safety profile.

Keywords: Budesonide, COPD, formoterol, glycopyrronium, quality of life, single inhaler triple therapy

Abstract No. 80: Effect of glycemic control on outcome of NIV therapy in patients with AECOPD with diabetes mellitus

Gareema Narwal , Vipul Kumar, Kanishka Choudhary

Department of Respiratory Medicine, Pt BD sharma, PGIMS, Rohtak, Haryana, India

Introduction: Acute exacerbation of COPD (AECOPD) is a frequent complication of COPD that may result in hospitalization requiring NIV. Patients with COPD and diabetes mellitus are more prone to infections and subsequent exacerbation of COPD. In present study we have tried to decipher the effect of glycemic control with regards to outcome of NIV therapy in AECOPD patients with T2DM.

Methods: A prospective cross sectional study was conducted in tertiary care centre from January 2023 to April2024.Patients of AECOPD with or without diabetes mellitus requiring NIV therapy were enrolled. Group A-50 patients of AECOPD without T2DM, GroupB-90 Patients of AECOPD with T2DM. Parameters such as ABG values at start of NIV therapy, subsequently at interval of 12 hrly, at discharge from hospital, length of hospital stay were used to assess the response to NIV therapy.

Results : Diabetic patients have a significantly lower pH, lower (PaO2) oxygen levels (41.6+/-12.77), higher PaCO2 (83.8+/-15.31) compared to non-diabetic patients suggesting more severe acidosis, worse oxygenation and worse hypercapnia. 37.78% of patients with diabetes had a stay of more than 6 days. Hospital stay was found to be 4.33 +/- 0.718 days in those who had mean random blood sugar (RBS) below140 mg/dl, 6.19 +/- 1.14 days in those who had RBS above 140. No association was found between hospital mortality and status of diabetes mellitus.

Conclusions: We observed that AECOPD patients with T2DM require longer duration of NIV, improvement in acidosis and oxygenation status is more gradual with NIV therapy when compared to non diabetic patients. Effective glycemic control plays a critical role in improving the outcomes of NIV therapy in patients with AECOPD and diabetes mellitus.

Abstract No. 81: Role of HFNC oxygen therapy in patients of AECOPD

Kanishka Choudhary , Vipul Kumar, Gareema Narwal

Department of Respiratory Medicine, Pt.BD Sharma, PGIMS, Rohtak, Haryana, India

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is now one of the top three causes of death worldwide and 90% of these deaths occur in low-and middle-income countries (LMICs). NIV is the standard of care for most patients with AECOPD but some patients are intolerant to NIV due to various factors. In this prospective observational study we have studied the role of HFNC in patients of AECOPD patients who are intolerant to NIV.

Methods: 80 patients who presented to emergency department with AECOPD without any other comorbidity were enrolled. All patients having respiratory acidosis(pH<7.35 and paCO2>50mmHg), an exacerbation of dyspnea with evidence of accessory respiratory muscle use and persistent hypoxemia despite oxygen therapy were included. All patients were given NIV therapy and various parameters such as arterial blood gases, improvement in paCO2 and paO2 levels for 12hrs, 24 hrs and 48 hrs and 72 hrs) were used to assess the level of improvement. Patients who couldn’t tolerate NIV were given a trial of HFNC(60 L/min) and results were assessed.

Results: Twenty patients intolerant to NIV were switched to HFNC; 4 improved, while the rest required invasive mechanical ventilation (MV). Improvement criteria included decrease in paCO2 levels, length of hospital stay, improvement in respiratory rate and paO2 levels.

Conclusion: This study highlights the role of High Flow Nasal Cannula (HFNC) oxygen therapy as a potential alternative in patients with acute exacerbation of COPD who are intolerant to Non-Invasive Ventilation (NIV). While HFNC showed limited overall effectiveness, with only 4 patients meeting the improvement criteria, it demonstrated some benefit in improving parameters such as arterial blood gases, respiratory rate, and oxygenation levels and hence helped in avoiding the MV along with complications. However larger randomized controlled trails are needed to know the exact place of HFNC in management of AECOPD.

Abstract No. 82: An ounce of prevention is worth a pound of cure

Shradha Bajan , Shahid Patel, Girija Nair, Abhay Uppe, Nikhil Sarangdhar

Department of Pulmonary Medicine, D. Y. Patil University, Navi Mumbai, Maharashtra, India

Introduction: Breast carcinoma is increasingly affecting lower age groups over the last decade giving an age adjusted rate for Indian females of 25.8/ lakh women. Breast carcinoma can metastasise to the following organs in the frequency of bones-51%, lungs-17%, brain-16%, and liver-6%. Cancers other than breast carcinoma that can metastasize to the lungs include colorectal, testicular, thyroid malignancies and osteosarcoma.

Case Report: A 40 year female, with left breast carcinoma underwent MRM. Histopathology-immunohistochemistry showed TNM stage pT2N3a with ERpositive, PRpositive and HER2positive. Treated with 8 cycles of chemotherapy - Endoxan, Doxorubicin and Steroids (no targeted therapy given), 15 cycles of 3DCRT radiotherapy and was discharged on tamoxifen. Two years later, presented with bilateral ovarian complex cysts. CA125/ROMA values negative. Underwent trans-abdominal hysterectomy, bilateral salpingo-oopherectomy and left ovarian cystectomy. Histopathology ruled out malignancy and was suggestive of inactive endometrium consistent with tamoxifen therapy with chronic papillary endocervicitis.

After seven months, presented with an acute cough, breathlessness and mild fever at D.Y.PATIL HOSPITAL. With a differential-diagnosis of fungal/bacterial LRTI, tuberculosis and metastatic lung disease, bronchoscopy performed. BAL negative for cytology, KOH mount, Gramstain and GeneExpert. Serial chestxrays showed rapid worsening, suggestive of infectious etiology. HRCT showed bilateral mild pleural effusions and consolidation. Appropriate antibiotics and antifungals administered, with little improvement. PET-CT showed lung and bone metastasis, mediastinal lymphadenopathy, bilateral pleural effusion and consolidation in the lungs indicating metastatic lung disease with concomitant lung infection. Started on targeted chemotherapy with paclitaxel and trastuzumab. Serial chest xrays showed improvement.

Conclusion: (1) Early detection by spreading awareness of self breast examination is mandatory. (2) Metastatic disease in CA breast reduces the 5 year survival rate from 96% to a horrific 21%. (3) HER2+: Targeted therapy with Monoclonal Antibodies (Trastuzumab and Pertuzumab) + IV Hyaluronic acid prevents metastasis.

“Being Proactive and Not Just Reactive” helps prevent progression and metastasis.

“To Be Fore-warned Is To Be Fore-armed”

Abstract No. 83: Bronchiectasis in case of rheumatoid arthritis – A case report

Mohd Hamza Omer , Anita Saibannavar

Department of Pulmonary Medicine, R.C.S.M. G.M.C., Kolhapur, Maharashtra, India

Background: Rheumatoid arthritis is a systemic autoimmune disorder that primarily affects the joint but can also lead to extra articular manifestation including pleuropulmonary involvement. One such complication is Bronchiectasis, a condition characterized by permanent dilation and damage to the airways and recurrent respiratory infection. This case study highlights the co-occurrence of bronchiectasis in a middle age female patient with rheumatoid arthritis.

Case Report: Here we present a case of a middle age female, case of rheumatoid arthritis presented with respiratory symptoms without any prior history of respiratory disease since childhood. Rheumatoid arthritis was confirmed by RA factor and Anti CCP antibody test. On HRCT thorax she was diagnosed as bilateral bronchiectasis. With detailed history and examination, we ruled out other causes of bronchiectasis. Her respiratory symptoms improved with antibiotics and chest physiotherapy and Rheumatoid arthritis was managed as per Rheumatologist opinion. Regular follow up was advised to monitor disease progression.

Conclusion: This case highlights the importance of recognizing pleuropulmonary complications like Interstitial lung disease or Bronchiectasis in patients of rheumatoid arthritis particularly those with persistent respiratory symptoms. Early diagnosis and multidisciplinary approach to treatment are essential for improving outcomes and to prevent further pulmonary sequelae in them.

Keywords: Bronchiectasis, lung and autoimmune disorder, rheumatoid arthritis

Abstract No. 84: Role of mini nutritional assessment tool to detect malnutrition in patients with COPD: Prospective observational study

Sanat S. Verenkar , Gajanan S. Gaude, Bhagyashri B. Patil, Jyothi Hattiholi, S. Gautam, Kirankumar Pujar

Department of Respiratory Medicine, KAHER Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition that often leads to significant weight loss and malnutrition, exacerbating disease severity and disability. Malnutrition in COPD patients is underrecognized despite its strong association with respiratory muscle dysfunction and clinical outcomes. The Mini Nutritional Assessment (MNA) is a validated tool offering a comprehensive evaluation of nutritional status, surpassing the limitations of Body Mass Index (BMI). This prospective observational study aims to assess the prevalence of malnutrition in COPD patients using MNA and to compare its efficacy with BMI.

Methods: A total of 100 COPD patients were recruited from the Respiratory Medicine OPD of KLE Dr. Prabhakar Kore Hospital, Belagavi, over one year. Assessed using MNA, anthropometric measurements, mMRC dyspnea scale, CAT score, and spirometry. Nutritional and clinical correlations were analysed.

Results: Over 50% of the participants were either malnourished or at risk of malnutrition based on MNA scores. The study found that BMI alone failed to identify many at-risk patients who were flagged by MNA. Malnutrition prevalence correlated strongly with worsening spirometric indices (FEV1), higher CAT scores, and advanced GOLD stages. Notably, even patients with normal or high BMI exhibited nutritional deficiencies detected by MNA. Furthermore, psychological factors, reduced food intake, and prolonged smoking histories were common contributors to malnutrition.

Conclusions: The findings confirm that malnutrition is prevalent among COPD patients and often goes undetected using BMI alone. MNA proved to be a more comprehensive tool, offering insights into the multifaceted aspects of nutritional status, such as dietary intake and psychological health.

Routine application of MNA for COPD patients could enhance early detection of malnutrition and facilitate timely interventions, potentially improving outcomes and reducing hospitalizations.

Keywords: BMI, COPD, malnutrition, MNA

Abstract No. 85: Evaluating the HALP score as a predictive biomarker for bronchiectasis exacerbations and its relationship between clinical parameters

Vedamurthy Basavaraja Janglera , T. Prasannakumar, D. Pragati Rao

Department of Respiratory Medicine, M S Ramaiah Medical College, Bengaluru, Karnataka, India

Introduction: Bronchiectasis is a chronic inflammatory disease. In India, bronchiectasis is a significant public health concern due to various factors, such as the high prevalence of pulmonary infections, including tuberculosis (TB) and lower respiratory tract infections. Following anatomical damage in the bronchi, exacerbations tend to increase due to the progressive deterioration of pulmonary physiology. HALP score is an indicator of nutritional status and systemic inflammation and that has been used to predict bronchiectasis exacerbation. The HALP score is a comprehensive index that measures immune health as well as nutritional status.

Methods: 86 patients with HRCT Thorax confirmed bronchiectasis were included in the study. HALP score is determined by the following formula: Hb (g/L) x albumin (g/L) x lymphocytes (/L)/platelet (/L). Spirometry was performed, FEV1 And FVC were recorded. Compared HALP scores and other metrics between the exacerbation and stable groups. Continuous data was represented as mean and standard deviation. Mann-Whitney U Test/Independent t-Test was used for Comparative analysis between groups. Spearman/Pearson correlation analysis between other variables. P-value<0.05 was considered as statistically significant.

Results: HALP scores were significantly lower during exacerbation periods compared to stable periods (p < 0.001) suggesting reduced nutritional and inflammatory resilience. Mean HALP Scores of 12.30 during Exacerbation and 18.76 during stable period. Lower lung function ratios (FEV1/FVC) and FEV1 in the exacerbation group compared to the stable group (r=0.214r). HALP scores did not differ significantly between genders (p = 0.228).

Conclusions: The study highlights the significant utility of the HALP score as a biomarker to differentiate between clinical states (exacerbation and stable) in patients with Bronchiectasis reflecting systemic inflammation and nutritional status.

The HALP score in Bronchiectasis could be a non-invasive, cost-effective tool for monitoring patient status and predicting exacerbations.

Keywords: Bronchiectasis, cost effective, exacerbation and stable period, HALP score

Abstract No. 86: Assessment of multidimensional COPD indices and it’s correlation with severity of COPD

Cheshtha Singla , Vishal Chopra, Kranti Garg

Department of Pulmonary Medicine, GMC, Patiala, Punjab, India

Introduction: Chronic obstructive pulmonary disease (COPD) remains a global public health burden. COPD is a heterogenous lung condition characterised by a persistent, often progressive airflow limitation. A physiological variable – FEV1 (% predicted) is used to grade the severity of COPD. Multidimensional scales like the BODE, ADO, DOSE index have been used to determine the prognosis of COPD. Our study aims to compare these indices with GOLD grading and determine their correlation for determining the severity of COPD.

Methods: It was a prospective cross-sectional study on 100 COPD patients. The patients enrolled in the study were classified as per their GOLD grading and ABE assessment tool. Indices like BODE index, ADO index, DOSE index were calculated for each patient at the time of enrolment. These prognostic scores were used to determine if any statistically significant correlation exists between these indices and GOLD grading.

Results:

A significant positive correlation exists between BODE index and GOLD grading (expected Pearson r > 0.6). ADO index correlates moderately with GOLD grading (expected Pearson r ~ 0.4-0.6). DOSE index shows weaker or inconsistent correlation (expected Pearson r<0.4).

Conclusions: Multidimensional indices complement GOLD grading by integrating physiological and symptom-based measures. Indices like BODE are valuable for tailoring interventions and monitoring progression.

BODE index is a stronger predictor of COPD severity compared to ADO and DOSE. DOSE index may excel in identifying symptom burden but not airflow limitation.

Keywords: ADO, BODE, COPD, DOSE, GOLD

Abstract No. 87: Analytical study of aero and food allergens sensitisation by skin prick testesting in bronchial asthma patients

Vaishnavi Handral , Lavina Mirchandani, Girija Nair, Shahid Patel, Nikhil Saranghdhar, Manas Bhanushali

Department of Pulmonary Medicine, D Y Patil University School of Medicine, Navi Mumbai, Maharashtra, India

Introduction: Bronchial Asthma is a common airway disorder with exposure to environmental allergens being a known risk factor. Skin prick test is a valuable diagnostic tool for assessing allergen sensitization and in customizing the management of Bronchial Asthma. Aims and objectives of our study are to document the various food and aero allergen sensitization with skin prick test and their correlation with exacerbation of bronchial asthma.

Methods: A prospective cross-sectional observational study was conducted among 85 patients of diagnosed bronchial asthma aged 18-60 years that are willing to undergo skin prick test. Patients aged less than 18 years and more 60 years were excluded. A diagnosis of bronchial asthma confirmed with careful history and examination along with routine investigations and with a standard spirometry criteria. With consent of patient, skin prick test was performed. A wheal more than 3mm in diameter was considered positive. Statistical tests were applied to find out correlation between patients with history of exacerbation of bronchial asthma in past year and sensitization to aero and food allergens.

Results: In our study majority of the patients were more than 50years (36.5%) and 64.7% were female. Sensitization to most common allergens among each allergen group (dust, mites, pollens, epithelia, insect, food, fungus) are described. 20 individual (23.5%) sensitized to house dust. 21 individuals (24.7%) were sensitized to mites d. pteronyssinus. 12 individuals (14.1%) sensitized to cassia siamea, 11 individual (12.9%) sensitized to pigeon feather, housefly, cockroach, rice weevil all were sensitized in 20 individuals (23.5%). 30 individuals (35.3%) tested sensitive to Aspergillus fumigatus. In the study population, 45 individuals had at least one exacerbation in the past year, of which 7 patients required ICU. Mites sensitization was statistically significant (p-0.03) in the patients that required ICU.

Conclusion: There is significant correlation with mite sensitization and exacerbation of Bronchial Asthma. Eliminating allergen exposure and Allergen Immunotherapy guides management.

Abstract No. 88: Distinguishing asthma and COPD using simple inflammatory indices: A retrospective study

Anna George , Lavina Mirchandani, Girija Nair, Shahid Patel, Manas Bhanushali

Department of Pulmonary Medicine, Dr. D. Y. Patil Medical College, Navi Mumbai, Maharashtra, India

Introduction: Asthma and COPD are distinctly different in terms of clinical presentation, radiological and spirometry findings. However, there exists considerable overlap causing diagnostic dilemma, impacting their management. Sputum cellularity is being used to differentiate obstructive airway phenotypes. In this study, we assessed certain objective inflammatory indices and correlated them with pulmonary function tests- FEV1 and FEV1/FVC ratio.

Methods: A total number of 77 patients were taken diagnosed with asthma (n = 43) and COPD (n = 34) between June 2024 to December 2024.The patient’s pulmonary function test were conducted and routine blood samples were analyzed for inflammatory indices. The levels of these indices were compared between the two groups, and their relationship with FEV1 and FEV1/FVC ratios was assessed.

Results: The majority of the participants were male (51.95%). The mean age of the study participants was 47.17 ± 17.96 years. 25.97% of the participants were smokers, and 7.7% of them had a history of tuberculosis. The mean FEV1 and mean FEV1/ FVC ratio were not significantly different between the 2 groups. Similarly, no significant difference was found in mean platelets and eosinophil count or median Eosinophil Neutrophil ratio (ENR), Eosinophil Basophil Ratio (EBR), and Eosinophil Lymphocyte Ratio between the groups. However, the median Neutrophil Lymphocyte Ration (NLR), Systemic immune -inflammation Index (SII), and Systemic Inflammation Response Index (SIRI) were significantly higher in the COPD group, while the median Lymphocyte Monocyte Ratio was higher in the asthma group (p < 0.05), with Mann-Whitney U test. The FEV1/FVC ratio correlated positively with SIRI in both groups, though this was not statistically significant using Spearman’s correlation test.

Conclusion: The results of this study show inflammatory indices can serve as biomarkers to distinguish patients with asthma and COPD. Larger multicentric trials will help to further explore their clinical relevance and predictive value.

Abstract No. 89: Clinical profile of patients with “adult onset asthma” - A hospital based cross-sectional study

Abhishek Singh , G. N. Srivastava, Vinod Kumar

Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background: When a Doctor makes a Diagnosis of Asthma in people older than age 20, it is known as adult-onset. Usually, asthma symptoms appear early in life. However, some people develop asthma symptoms for the first time in adulthood; their clinical status is called LOA, defined as: “asthma with onset of symptoms in adult life in a patient with no pre-existing, persistent respiratory symptoms,” but the definition of age has not been clarified. A better understanding of all the aspects of LOA can help clinicians make more precise guided treatment decisions using existing or new treatment approaches and to devise optimal personalized management of the disease.

Objectives: To determine clinical profile of Patients with adult onset asthma, To assess severity of disease through Spirometry, To evaluate blood & sputum Eosinophillia, To see any old infective lesions/Bronchiectasis in chest x-ray.

Methods: It is cross sectional study conducted at tertiary care hospital, All patients with age > 20 years .All patients presenting with symptoms of asthma. All Patients satisfying the diagnostic criteria according to recent GINA guidelines are included in study. Value determined by Spirometry has been taken as a measure of severity of asthma. Grading of asthma severity has been done using latest GINA guidelines.

Results: Total 25 patients were enrolled in the study 15 males & 10 females most common symptoms among patients was Breathlessness f/b chest pain f/b cough. 45 %of patients had mild impairment of lung functions, 25 % patients had severe impairment of lung functions & 30 % had moderate impairement of lung functions, with significant reversibility. Eosinophils was raised in 15 % cases & sputum eosinophils was seen in 5% cases,Chest x-ray was within normal limits in almost 72 % cases, 18% patients had bronchiectatic changes, hyperinflation was seen in 7 % cases & hilar lymphadenopathy in 3 % cases.

Conclusion: This study implies diagnostic need & early treatment of adult onset asthma as this are the patients who are mostly treated as urti hence proper inhaler therapy having Ics & LABA combination is preferred.

Limitations: Limited time, Data limitations.

Abstract No. 90: Trends and patterns in prescriptions of ICS-LABA combinations for management of Indian children with asthma: Findings from the RAINBOW survey

Swapna Nair 1 , Subhashis Roy 2 , Srinivas Jakka 3 , Vaishali Naik 1 , Meena Lopez 1 , M. Senthilnathan 1 , Jaideep Gogtay 1

1 Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India, 2 Shaishab Clinic, Kolkata, West Bengal, 3 Ankura Hospitals, Hyderabad, Telangana, India

Introduction: Guidelines recommend using a combination of inhaled corticosteroids and long acting beta 2 -agonist (ICS-LABA) for children whose asthma is not controlled with ICS alone. The usage patterns of ICS-LABA among Indian children with asthma however remain unclear. This study therefore aimed to examine the prescription trends of ICS-LABA in managing asthma in children in India.

Methods: A digital cross-sectional survey was conducted among clinicians managing pediatric asthma.

Results: 454 clinicians (55.7% respiratory physicians and 44.3% pediatricians) participated in the survey. Pediatricians reported seeing more asthma patients/month as compared to respiratory physicians (62.7% pediatricians and 24.11% respiratory clinicians saw >20 asthmatics/month,p<0.001). The usage of ICS-LABA for management of pediatric asthma was similar across specialties with 64.03% of respiratory physicians and 74.13% of pediatricians reporting that up to 50% of their patients wereprescribedthe combination. Being uncontrolled on low-dose ICS (53.96%), ICS+leukotriene inhibitors (49.78%), PRN-SABA (44.93%) or medium-dose ICS (41.85%) were cited as the most common reasons for prescribing ICS-LABA combination. Respiratory physicians cited reduction in daytime (32.41%) and night-time (27.27%) symptoms as the most important reasons for preferring ICS-LABA, whereas pediatricians cited reduction in night-time symptoms (34.33%) and emergency clinic visits (32.34%) as the most important benefits. Budesonide-formoterol was the most preferred ICS-LABA by both respiratory physicians and pediatricians (78.66% vs 61.69%, p<0.001) followed by fluticasone-salmeterol (11.86% vs 27.36%). 83% respiratory physicians vs. 63.68% pediatricians (p<0.001) preferred using the combination as maintenance and reliever therapy (MART). pMDI with spacer (80.18%) was the preferred device for managing asthma in children.

Conclusion: The findings of the survey indicate that ICS-LABA is well-accepted for the treatment of pediatric asthma in India, with budesonide-formoterol being the favored combination. ICS-LABA was reported to provide benefits such as decreased symptoms and fewer emergency clinic visits in children.

Abstract No. 91: ABPA: The hidden fungal threat in your lungs

Mahika Khandelwal

Department of Pulmonary Medicine, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India

Introduction: Allergic bronchopulmonary mycoses are complex pulmonary disorders caused by immune reactions mounted against fungi, most often Aspergillus fumigatus, which colonize the airways of patients with chronic lung disease, most commonly asthma or cystic fibrosis (CF). ABPA has a significant global burden, with an overall prevalence of 11.3% in asthmatic adults visiting tertiary care.

Case: A 33 years old male presented to chest OPD with complaints of cough since 4 years (intermittent on and off) along with hemoptysis since last 2 and half months which has increased in frequency and amount, shortness of breath for 2-3 days, chest pain (right sided since 3 days – diffuse, non-radiating). No known comorbidities, H/o ATT intake since last 8 months on clinico radiological basis for pulmonary tuberculosis. Nonsmoker/ nonalcoholic. He is a salesman by occupation. Routine blood investigations showed eosinophilia. CXR showed homogeneous opacity in the right upper lobe s/o mass. CECT thorax was done which showed well defined irregular shape heterogeneously enhancing mass causing abrupt cut-off of right upper lobe segmental bronchus with multiple enlarged mediastinal and right hilar lymph nodes. Biopsy was done from right lung mass which showed pneumocytic hyperplasia, lymphocytes, plasma cells and histiocytes s/o organising pneumonia. No evidence of malignant cells or granulomas were noted. Cbnaat gene xpert of the biopsy sample turned out to be negative. Fungal KOH of the sample turned out to be positive. Totals. Ige was which was followed by aspergillus specific igE which turned out to be highly elevated that is 7630IU/ml and 1.2kUA/L respectively s/o allergic bronchopulmonary aspergillosis. Patient was started on itraconazole 200 mg twice daily and Prednisolone according to body weight which showed resolution of symptoms as well as radiological improvement in chest radiographs in follow up. Patient is currently stable with no active hemoptysis and symptomatic relief.

Conclusions: In cases of lung mass, ABPA HAM is also to be considered as a differential diagnosis and thorough workup is required to differentiate between infectious causes and malignancy.

Abstract No. 92: The diverse clinical picture of pulmonary aspergillosis

S. Ashok Kumar , Mahavir Modi

1 Department of Pulmonary Medicine, Ruby Hall Clinic, Pune, Maharashtra, India

Background: Pulmonary aspergillosis, primarily caused by Aspergillus fumigatus, manifests in various forms, from acute infections to chronic lung diseases. Clinical presentations depends on the patient’s immune status and underlying health conditions.

Objective: To elucidate the clinical presentations of pulmonary aspergillosis, including acute invasive aspergillosis, chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Understanding these variations is crucial for accurate diagnosis, effective treatment and improving outcomes.

Case Studies: (1) A 23-year-old male with recent influenza presented with fever and dry cough. CT chest revealed bilateral ground-glass opacities. Bronchoscopy showed diffuse white plaques, and BAL culture grew Aspergillus fumigatus. He was diagnosed with acute bronchopulmonary aspergillosis and responded well to antifungal treatment. (2) A 38-year-old male with chronic sinusitis presented with fever, cough and breathlessness. CT chest showed bilateral cavitating lesions and sputum culture grew Aspergillus fumigatus, confirming chronic pulmonary aspergillosis. He improved with antifungal therapy. (3) A 55-year-old male with lung cancer and asthma presented with cough and expectoration. CT chest revealed proximal bronchiectasis and serology and sputum were positive for Aspergillus. He was diagnosed with allergic bronchopulmonary aspergillosis and managed with steroids and antifungals.

Conclusion: The diverse presentations of pulmonary aspergillosis highlight the need for heightened clinical awareness and comprehensive diagnostic strategies. Effective management requires prompt identification and a personalized approach, underscoring the need for ongoing research and vigilance.

Keywords: Aspergillus fumigatus, aspergillus lung disease, invasive aspergillosis, pulmonary fungal infection

Abstract No. 93: NTM masquerading as reactivation of PTB

K. Alekhya , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Pulmonary NTM disease is a chronic pulmonary infection caused by NTM bacteria. The incidence and prevalence of pulmonary NTM is increasing world wide.

Case Study: A 29 year old male presented with complaints of sob since 10 days cough with expectoration since 10 days, chest pain since 4 days, fever since 2 days. Patient had an history of ATT usage for 1 time over the past 2 years.

Chest xray PA view was done which showed B/l fibro cavitatory lesions. Sputum CBNAAT- was negative. sputum AFB- negative. BAL NTM for Rtpcr – positive.

Conclusions: NTM pulmonary disease may simulate pulmonary tuberculosis in its clinical and radiological expression posing a diagnostic dilemma and challenge to the treating physician, especially in high TB prevalent countries. NTM is commonly acquired from the environmental sources. NTM can produce disease not only in immunocompromised population, but also in healthy individuals leading significant morbidity and mortality.

TB endemic areas, NTM can be misdiagnosed as pulmonary TB leading to repeated failed anti TB treatment and increased morbidity, emphasizing the need for improved diagnosis.

Keywords: NTM, PTB

Abstract No. 94: Nonresolving pneumonia presenting as malignancy

Prashant Ghule , Anil Sontakke

NKPSIMS and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Case Report: A 38 Year old Young Female Presenting with Non Resolving Pneumonia turned out as Adenocarcinoma. She Presented with 7 Months history of Breathlessness on exertion (MMRC-III), Progressing to Breathlessness at Rest(MMRC-IV) over the past month.She also reported a Cough with whitish Expectoration,Right sided chest pain,Loss of Appetite,Weight Loss for 1 &1/2 months, Fever for 20 Days. Previously Outside CT Chest, Bronchoscopy was done (In November 2024)which was non conclusive,Repeat CECT Chest Followed by Bronchoscopy was done which revealed Adenocarcinoma on Bronchial wash Cytology. CECT Thorax(19/12/2024)-Segmental/Subsegmental Lung collapse of Right Lower Lobe with ill defined Heterogenously enhancing area,Diffuse area of Consolidation in Right upper lobe and Middle Lobe.It is likely extending into the Middle Mediastinum from T4-T7 Vertebral level and Multiple variable sized nodules and few mass scattered in B/L Lungs,findings are s/o Neoplastic etiology. BAL Cytology (23/12/2024)-Suspicious of Adenocarcinoma.

Conclusion: Non Resolving Pneumonia is a case that does not improve despite adequate treatment with Antibiotics, this condition can leads to Adenocarcinoma.Bronchoscopy is helpful for evaluation of etiology like Malignancy, Foreign body, Resistant Infections.

Abstract No. 95: Uncommon but deadly: Fungal empyema with candida growth – A serious threat in immunocompromised patients

S. Sriram , S. Yuvarajan, R. Praveen, Cherukumalli Navya, Sagana

Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

Introduction: Candida is an opportunistic fungus which colonizes the oral cavity and can be considered as a commensal when it is seen in the sputum. Candida in pleural fluid is rare and it needs utmost attention as it is a sterile fluid. It can result from invasive candidiasis or by direct inoculation of the pleural space after thoracic or abdominal surgeries.

Case: A 75-year-old male who is a known case of diabetic, coronary artery disease and chronic kidney disease, with irregular treatment adherence presented to the hospital with one-month history of cough with expectoration and breathlessness. Investigations, including blood culture, sputum culture, acid-fast bacillus (AFB) smear, and fungal smear (KOH), were negative. CT thorax revealed left-sided empyema. Diagnostic thoracentesis was performed, the pleural fluid fungal smear revealed yeast with pseudohyphae, which was suggestive of Candida. Fungal culture confirmed the growth of Candida albicans.The patient underwent therapeutic thoracocentesis and was started on intravenous fluconazole for antifungal treatment.

Conclusions: Candida in pleural fluid is a rare but severe condition characterized by fungal growth in pleural fluid, often following pneumonia, abscesses, or esophageal rupture, and is associated with high mortality, especially in immunocompromised patients. Mortality rates in Candida empyema vary but can reach up to 30%, with factors like sepsis and diabetes contributing to poor outcomes. Despite antifungal therapy, this condition is often fatal, particularly in cases linked to surgery or esophageal rupture. Diagnosis requires isolation of the same fungus from pleural fluid and other specimens, along with signs of infection like fever and leukocytosis. Treatment typically involves thoracocentesis and antifungal therapy. Carry home message Early recognition of fungal empyema is crucial for successful management. Prompt application of diagnostic methods, including imaging and microbiological cultures, is vital for accurate diagnosis. Initiate targeted antifungal therapy without delay and maintain regular follow-up to assess treatment response and prevent potential complications.

Abstract No. 96: An unusual presentation of simple aspergilloma as sequelae of paraquat poisoning

P Jayakar Reddy, N. Bhaskara Rao

Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India

Introduction: Aspergillomas are formed when colonized fungal organisms lining innersurface of pre-existing cavity spread into the cavity itself the fungi proliferate in the form of fungal ball inside the cavity.

Case Report: A 23 year old female with allegedly consumption of paraquat poisoning 6months back immediately developed vomitings and loose stools was treated in hospital and later sent home within one month developed SOB,revisited the hospital,was treated,sent home with LTOT which she used for 1month,chest radiography shows fibrotic strands later went to hospital again for fever,chest pain,increased with cough.Multiple visits to hospital i/v/o SOB,headache,fever.Now Xray shows a cavity in left upperlobe,so started ATT clinicoradiologically.After using ATT for 15 days she developed DILI&LFT shows elevated bilirubin and enzymes,so ATT stopped.Referred to pulmonology opd i/v/o left upperlobe cavity and h/o ATT usage and with complaints of cough,sob,pleuritic chestpain,followup Xray shows soft tissue density within the cavity with fibrotic changes in left mid&lower zones.HRCT done which confirmed aspergilloma.Serum aspergillus specific IgG done was elevated and aspergilloma confirmed.Patient started on itraconazole and now is on followup Carry home message: Pulmonary cavity although very rare cannot be overlooked in case of Paraquat ingestion which is an extremely toxic herbicide, which can cause severe damage to lungs, liver, kidney, etc.,with no specific antidote.

Conclusion: This case highlights the very rare occurrence of cavity& aspergilloma within cavity as sequelae of paraquat poisoning and emphasizes need for prompt recognition and management.

Abstract No. 97: A diagnostic conundrum in a case of pulmonary hydatid disease

Elsa Rachel Abraham , Raghu Srikanti

Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India

Introduction: Hydatid disease, a worldwide zoonosis is caused by the larval stage of Echinococcus. Lung are the second most common location (20%) in Cystic echinococcosis after the liver (80%). Most pulmonary cysts are located in lower lobes and unilateral in 80% of pulmonary echinococcosis.

Case Report: 53 years old female cook by occupation presented with chief complaints of shortness of breath, cough, abdominal pain since 3 months. Her chestxray and CTchest showed right sided loculated pleural effusion for which she was started on ATT empirically.Upon detailed history taking it was revealed that patient had complaint of pain abdomen in right hypochondriac and umbilical area 20 years back and underwent surgery. She was then sent for USG abdomen which revealed cystic lesions in sub diaphragmatic region.CT Abdomen revealed small multiple hepatic,sub hepatic,sub diaphragmatic cysts.CT Chest showed multiple cysts in right lung with water lily sign which is pathognomonic of Pulmonary hydatid disease. Based on the radiological evidence and past history, she was diagnosed as Pulmonary Hydatid Disease and started Albendazole 400mg BD.Albendazole was continued beyond 6 months as her symptoms were not resolved.Chestxray done after 2 years revealed 80% resolution& patient had significant clinical improvement.

Carry Home Message: Prolonged medical management beyond 6 months has shown significant clinical improvement and improvement in the quality of life.

Conclusion: Hydatid cysts most often occur as a single unilocular cyst, with only 38% occuring as multiple unilocular cysts.The most important diagnostic tool is radiology.Good medical response and improvement in the quality of life is seen even in cases of multiple lung hydatid cysts after prolonged therapy beyond 6 months.

Abstract No. 98: Clinical and epidemiological profile of Influenza A H1N1 cases at a tertiary care centre - A descriptive study

P. R. Sreelatha , S. Niveditha

TDMCH, Alappuzha, Kerala, India

Background: Influenza is a highly contagious viral infection primarily caused by Influenza A, known for its potential to cause both epidemics and pandemics. The clinical presentation and severity can vary with each outbreak, with children being the most commonly and severely affected. Early detection and timely initiation of antiviral therapy are essential to reduce morbidity, mortality, and overall disease severity.

Aim: This study aims to examine the clinical profile of microbiologically confirmed Influenza A H1N1 cases among inpatients aged 28 days to 12 years during the period from April to September 2024.

Methods: A descriptive study was conducted in the Pediatrics Department of Government Medical College, Alappuzha, Kerala, South India. Children aged 28 days to 12 years who tested positive for Influenza A H1N1 via polymerase chain reaction (PCR) from nasopharyngeal swabs during the study period were included. Data were collected from medical records using a semi-structured proforma, with prior approval from the Institutional Research Committee, Ethics Committee, and Medical Superintendent.

Results: A total of 85 pediatric cases tested positive for Influenza A H1N1 PCR. The gender distribution was nearly equal (male to female ratio 1:1.1). Age distribution showed a predominance of cases between 1 and 10 years, with fewer cases in children younger than 1 year or older than 10 years. The peak incidence occurred in June and July, coinciding with the monsoon season. Fever was the most common symptom, followed by rhinitis and cough. Constitutional symptoms such as lethargy and anorexia were also frequent. Neurological symptoms, including seizures, delirium, and headache, were observed, with seizures being more common in children under 5 years and delirium more frequent in older children. Gastrointestinal symptoms such as vomiting, abdominal pain, and diarrhea were also reported. Blood tests revealed a leukocyte count ranging from 1,500 to 18,400, with about one-third showing leucopenia, particularly on day 5 of illness. A neutrophil-to-lymphocyte ratio of less than 2 was found in three-quarters of the cases. Platelet counts ranged from 5,6000 to 67,5000 with 23.5% of patients showing thrombocytopenia, especially between days 3 and 5 of illness. Elevated SGOT levels (51–350 IU/L) were seen in half of the patients, most commonly in those aged 6 to 10 years, with a threefold rise predominantly in girls. Liver enzyme elevation (SGOT and SGPT) was noted in 12% of cases. CSF analysis in 11 patients and EEG in 4 revealed normal results, except for one patient showing transient slowing on EEG. The length of hospital stay ranged from 2 to 12 days, with a median of 5.5 days, except for two children with severe acute malnutrition. Nineteen percent of patients required intensive care unit (ICU) admission. Eighty percent of children received oseltamivir, which was initiated between day 1 and day 8 of illness. No correlation was found between the timing of antiviral therapy initiation and the duration of hospital stay. About one-third of the patients were also treated with antibiotics.

Conclusion: This study on 85 pediatric cases of microbiologically confirmed H1N1 Influenza A during the 2024 monsoon epidemic highlights the occurrence of transient encephalopathy in older children and significant transaminasemia, particularly in girls. No correlation was found between the timing of antiviral therapy initiation and the length of hospital stay.

Keywords: Clinical profile, influenza A H1N1, pediatrics

Abstract No. 99: Pathogen trinity: The overlapping shadows of pneumonia

Medishetty Abhigna , A.Vinay Kumar

Department of Pulmonary Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, India

Background: Pertussis in older adults often presents as chronic cough, commonly misdiagnosed as other LRTI , GERD,asthma, COPD.It can also lead to severe outcomes such as pneumonia in infants and older adults, necessitating hospitalization. Pneumonia associated with pertussis in adolescents and adults often results from secondary bacterial infections. This case highlights the complex interplay of bacterial and viral pathogens contributing to severe respiratory failure in a patient with chronic respiratory disease.

Case Study: A 66-year-old male , chronic smoker presented to the emergency department with a 1 year history of an intermittent productive cough, which had worsened over the past 7 days , difficulty breathing since 3 days , history of 3 days of fever 5 days prior to admission. Routine investigations showed leukocytosis, elevated C-reactive protein (CRP), and elevated D-dimer levels. A chest X-ray revealed bilateral interstitial infiltrates and consolidations, more prominent on the right side. ABG indicated Type 1 respiratory failure. Sputum culture revealed Bordetella pertussis and further culture testing identified multidrug resistant Klebsiella pneumoniae. Nasopharyngeal tested positive for COVID-19 via RT-PCR.

Discussion: This case underscores the challenges posed by co-infections in the setting of chronic pulmonary conditions and smoking. The patient’s chronic airway inflammation likely predisposed him to secondary bacterial infections, while COVID-19 exacerbated the inflammatory and immune dysregulation. The multidrug-resistant Klebsiella pneumoniae posed therapeutic difficulties, limiting antibiotic options. Co-detection of Bordetella pertussis is rare in adults but highlights the need for vigilance in atypical respiratory infections. Additionally, COVID-19 positivity further complicated management, contributing to hypoxemia and increased risk of poor outcomes.

Conclusion: Pertussis should be considered in the differential diagnosis of persistent cough or atypical pneumonia in older adults .Co-infections with resistant bacterial pathogens and viral agents, including SARS-CoV-2, underscore the need for timely diagnostic workup and integrated management strategies.

Key words: Pertussis, klebsiella, Covid 19, respiratory failure, chronic cough

Abstract No. 100: Bronchopulmonary aspergillosis with klebsiella pneumonia in a case of Sheehan’s syndrome presenting with right upper lobe collapse an unusual clinico-radiological presentation

Archit Gupta , Deepika Ughade, Manas Bhanushali, Tanay Sinha, Girija Nair, Nikhil Sarangdhar

Department of Pulmonary Medicine, D.Y Patil University School of Medicine, Navi Mumbai, Maharashtra, India

Introduction: Sheehan’s syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. The coexistence of aspergillosis with Klebsiella in a patient of Sheehan’s is an unusual occurrence in medical literature.

Case Report: A 55 year old female came with complaints of cough, breathlessness & fever since 1 week with history of Sheehan’s syndrome with hypothyroidism, on thyroxine & low dose of oral prednisolone. Chest radiograph showed right upper lobe collapse. HRCT thorax s/o consolidation with right upper lobe collapse. Patient was admitted and broncoscopy was advised. Bronchoalveolar lavage taken from all the segments of both lungs with biopsy from posterior segment of right upper lobe. BAL c/s shows klebsiella sp. and lung tissue HPE revealed aspergillosis. Patient started on antibiotics as per drug sensitivity and on Tab Itraconazole.

Conclusion: Bronchoscopy is a very useful diagnostic as well as therapeutic tool which helps in management of such unusual cases of infection with the risk factor of immunosuppressant due to long corticosteroid therapy in the absence of pulmonary vaccination in the background of hormonal imbalance. Early clinical suspicion coupled with prompt diagnosis and multidisciplinary interdepartmental discussion often helps to resolve diagnostic and treatment dilemmas, besides offering a good standard of care and a better chance of survival.

Abstract No. 101: Dynamics of H1N1 influenza: Analysing changes in seasonal trends at a tertiary care centre in Western India - Retrospective study

Vamshi Goud 1 , Anita T. Anokar 1 , Anuradha Tolpadi 2 , Sheetal Vernekar 1 , Meera Modak 2

1 Department of Respiratory Medicine, Bharati Vidyapeeth (DTU), Pune, Maharashtra, India, 2 Department of Microbiology, Bharati Vidyapeeth (DTU), Pune, Maharashtra, India

Introduction: Influenza poses a significant public health burden in India. The re-emergence of H1N1 influenza underscores the need to understand the post -COVID dynamics of this virus so as to guide the surveillance and prevention strategies accordingly.

Methodology: A single centre retrospective study is carried out in Pune, Maharashtra, to analyse changes in seasonal trends, mortality and age distribution of H1N1 positive cases in last 2 years (January 2023 to December 2024). The demographic, clinical and outcome data was collected and analysed.

Results: In this study, total 137 H1N1 PCR positive cases were included, out of which 135 were hospitalised. Total 68 were in children <18years. The age distribution of cases indicates a higher concentration of cases in the 0-10 and 40-50 year’s age group. Males comprised a larger proportion of H1N1 cases (59.9%) compared to females (40.1%). In the year 2023, the month-wise distribution showed peak of cases in September. The number of positive cases increased throughout the year in 2024, total 110 cases with two peaks, first in late winter and second largest peak during monsoon season in August. Mortality in the admitted cases was 14.28%. The mortality rate is notably higher in the 0-5 and >50 years age groups compared to other age groups. The vaccination among the hospitalised adults with Influenza was 2.9%.

Conclusion: Rising H1N1 influenza cases with higher mortality and poor adult vaccination is a major public health concern. Considering potential shifts in seasonality and intensity is crucial for informing public health interventions, vaccination and preparedness strategies in India.

Key words: Influenza, H1N1, Vaccination

Abstract No. 102: Evaluating the improvement in oxygen desaturation index during CPAP titration using split night polysomnography in patients with obstructive sleep apnea and cardiovascular diseases

Yash Kedia

Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, New Delhi, India

Introduction: Oxygen desaturation index (ODI) has a significant correlation with the development and progression of cardiovascular diseases (CVD) in patients with obstructive sleep apnea (OSA). Continuous positive airway pressure therapy (CPAP) improves the hypoxic burden in OSA but has not been shown to reduce cardiovascular morbidity conclusively. We evaluated if optimal CPAP titration aimed at reducing the apnea hypopnea index (AHI), also optimally reduced the hypoxic burden, as assessed using ODI.

Methods: This was a retrospective observational study in 40 patients of OSA who underwent a split-night level 1 sleep study and achieved optimal CPAP titration based on the AHI index. We calculated the AHI and ODI during the diagnostic portion and at the optimal CPAP titration pressure and compared the results between patients with and without CVD.

Results: 55% of the patients had CVD, including hypertension, dyslipidemia, or coronary artery disease. During the diagnostic study, the AHI and ODI had significant positive corelation (r = 0.90, p = 0.001). During the CPAP titration study, despite achieving an AHI of < 5 events per hour in supine REM sleep, 50% of the patients had an ODI of more than 5 events per hour. At the optimal CPAP titration pressure, the mean ODI was significantly higher in patients with CVD (p=0.026).

Conclusion: Despite optimal CPAP titration, the hypoxic burden as evaluated using ODI was persistently higher in patients with CVD. This under correction of the hypoxic burden despite optimal CPAP titration might contribute to the progression of CVD in OSA.

Abstract No. 103: Prevalence and clinical correlates of rem sleep-related obstructive sleep apnoea in patients with obstructive sleep apnea: A cross-sectional analysis

Ann Elizabeth John , Bhagyashri Patil, Gajanan S. Gaude, Jyothi Hatiholli, S. Gautam, Kiran Kumar Pujar, Ningappa Karalingannavar

Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

Introduction: Rapid eye movement (REM) sleep related obstructive sleep apnoea (OSA) represents a distinct subtype of OSA characterised by apnea and hypopnea episodes predominantly occurring during REM sleep. These events result in significant hypoxemia and sleep fragmentation. The purpose of this study was to assess the prevalence of REM related OSA among patients with OSA, explore its association with the Epworth Sleepiness Scale (ESS) and analyse related demographic and polysomnographic parameters.

Aim: Determine the prevalence of REM OSA in patients with obstructive sleep apnoea. Assess the correlation of Epworth sleepiness scale with overall AHI, REM OSA.

Methods: The study included fifty-eight patients who underwent polysomnography (PSG) at K.L.E Dr.Prabhakar Kore Hospital, Belagavi. REM-related OSA was defined based on previously established broad and strict criteria (REM apnea-hypopnea index [AHI]/non REM [NREM] AHI ratio ≥2 and REM AHI >5 with NREM AHI <5, respectively) and its association with socio-demographic parameters and polysomnographic features were analysed using appropriate statistical measures.

Results: Prevalence of REM related OSA in the study was 39.66% (strict criteria) and 43.1% (broad criteria). There is no significant correlation between REM AHI and ESS (Epworth sleepiness scale) or overall AHI and ESS. Patients with REM related OSA also exhibited: (1) Higher BMI (31.28 ± 1.17 vs 30.39 ± 1.98; p=0.038), (2) Larger neck circumference (41.8 ± 1.68 vs 39.94 ±2.95, p= 0.004), (3) Poorer sleep efficiency (82.32 ± 2.41 vs 84.00 ± 2.32; p=0.009), (4) Greater oxygen desaturation (lowest spo2:77.48 ± 1.94% vs. 81.58 ± 5.04%; p<0.001), (5) Longer apnea events during REM sleep (35.96 ± 3.12 vs 31.33 ± 6.01 seconds; p<0.001) were observed.

Conclusion: REM related OSA is associated with obesity, severe oxygen desaturation and significant contribution to overall AHI. This study aims to highlight the importance in identifying patients with REM OSA and their subsequent management to mitigate its cardiovascular and neurocognitive risks.

Keywords: Epworth sleepiness scale, obstructive sleep apnea, polysomnography, rapid eye movement sleep related apnea

Abstract No. 104: Prevalence and correlates of pulmonary hypertension in patients with obstructive sleep apnea: An observational study

P. Dhinesh , Jyothi Hattiholi, Gajanan S. Gaude, Bhagyashri B. Patil, S. Gautam, Kirankumar Pujar

Department of Respiratory, Jawaharlal Nehru Medical College, KAHER University, Belgaum, Karnataka, India

Background: Sleep-disordered breathing, including obstructive sleep apnea (OSA), involves interrupted or reduced breathing during sleep, often due to airway blockage. Diagnosis is made through polysomnography. The prevalence of pulmonary hypertension (PH) in OSA varies widely (15% to 75%), with most patients having normal pulmonary artery pressure (PAP) or mild PH. Severe PH, leading to right heart issues, is more common in those with additional lung conditions like COPD or obesity.

Aim/Objective: The study aims to determine the prevalence of PH in OSA, assess the correlation between the severity of PH and OSA severity, and identify other risk factors associated with both conditions.

Method: All patients undergoing polysomnography will be included. Informed written consent will be obtained, with parental consent for those under 18. Detailed patient histories will be recorded, and polysomnography will be classified into mild, moderate, or severe categories. Pulmonary artery pressure will be evaluated using 2D echocardiography. The correlation between polysomnography severity and PAP will be analysed.

Results: The study involved 60 patients (65.4% male, 34.6% female), with 76.4% being obese. The distribution of OSA severity was 16.3% mild, 25.5% moderate, and 58.2% severe. Pulmonary artery pressure findings were 21.9% mild, 9.1% moderate, 5.4 % severe, and 63.6% normal, with an overall prevalence of PH in OSA patients at 36.4%.

Conclusion: Routine screening by 2D echocardiography for PH in OSA patients is recommended, regardless of the presence of severe comorbidities, as lung disease is not a prerequisite for PH in OSA.

Abstract No. 105: To study sleep apnea in patients with thyroid diseases using polysomnography

Simran Agarwal , Girija Nair, Nikhil Sarangdhar, Deepika Ughade, Shahid Patel

Department of Pulmonary Medicine, D Y Patil University of Medicine, Navi Mumbai, Maharashtra, India

Introduction: Thyroid disorders may directly cause sleep-related breathing disorders or act as contributing factors through metabolic syndrome. Various studies have been done to establish an association between sleep apnea and hypothyroidism or thyroid disorders; however, the relationship remains unclear. As such, recognition and management of both SDB and thyroid disorders and the effect each has on the patient are essential.

Methods: An observational study of 50 patients with deranged thyroid profile or already diagnosed with thyroid disorders, with a STOP BANG of 3 or more. Patients were evaluated for sleep-disordered breathing using level 1 polysomnography at the sleep lab in D Y Patil Hospital, Navi Mumbai.

Results: Among the 50 subjects, Obstructive Sleep Apnea (OSA) was diagnosed in 52%, with OHS in 10% and mixed sleep apnea in 4%, while 34% of patients had no sleep-related breathing disorders. The chi-square test indicated a significant association between thyroid disorders and sleep apnea diagnoses (P value = 0.013), with 73.1% of those with obstructive sleep apnea (OSA) hypothyroidism and 41.2% with subclinical hypothyroidism.

Conclusions: Our study underscores a significant link between thyroid disorders and sleep apnea, specifically OSA. In patients with thyroid disease, there was a positive correlation between AHI and weight, BMI, and STOP-BANG.

This study used polysomnography to investigate the prevalence and characteristics of sleep apnea in patients with thyroid diseases. Our findings reveal significant associations between thyroid dysfunction and sleep apnea, contributing to the growing evidence of the interplay between these conditions.

Keywords: Apnea–hypopnea index, hypothyroidism, obesity, obstructive sleep apnea, polysomnography

Abstract No. 106: Long legacy of asbestos exposure, a case of mesothelioma

Simren Faizal

Baby Memorial Hospital, Kozhikode, Kerala, India

Introduction: Mesothelioma is the most common primary malignant tumour of the pleura, with 70% of cases linked to asbestos exposure. The lifetime risk of developing mesothelioma in asbestos workers is 8-13%.

Case Report: A 76-year-old retired marine engineer with intermittent asbestos exposure and a history of diabetes, hypertension, and coronary artery disease presented with a 4-month history of progressive dyspnoea, right-sided chest pain, and dry cough. Examination revealed decreased chest wall movement, tactile fremitus, stony dullness on percussion, and diminished breath sounds on the right side. A diagnosis of moderate right-sided pleural effusion was made. Chest X-ray showed right-sided opacity with convex upper border and superior mediastinal widening. Thoracentesis revealed exudative pleural fluid with lymphocytic predominance. CT thorax showed lobulated soft tissue density involving the right pleura, extending to the mediastinal, costal, and diaphragmatic surfaces, with pleural effusion and underlying lung collapse, suggesting a malignant etiology, likely metastatic involvement or mesothelioma. Thoracoscopy revealed multiple exophytic nodules on the costal and mediastinal pleura. Cytology showed atypical cells, and pleural biopsy revealed neoplastic cells in papillae and cords within desmoplastic stroma. Immunohistochemistry showed positivity for D240 and WT-1, consistent with epithelioid mesothelioma. PET-CT staging revealed T4N2M0, indicating stage 4 disease.

Conclusions: Given the patient’s history of intermittent asbestos exposure, the diagnosis of epithelioid mesothelioma emphasizes asbestos as a significant risk factor.

This case highlights the strong link between asbestos exposure and malignant mesothelioma, underscoring the need for early diagnosis and appropriate staging for effective management and prognosis.

Abstract No. 107: Tropical pulmonary eosinophilia: A condition often misunderstood

Kaushik Bhowal

Department of TB and Respiratory Diseases, Institute of Medical Sciences, BHU, Uttar Pradesh, India

Introductions: Tropical pulmonary eosinophilia (TPE) is a clinical manifestation of a parasitic infection caused by filarial nematodes (Wuchereria bancrofti, Brugia malayi and Brugia timori) caused by immune hyper-responsiveness to microfilaria trapped in lungs. Commonly occurs in young adults and transmitted by mosquito vectors and humans being the definitive hosts. Imaging studies in TPE can be easily misdiagnosed with other differential diagnosis. Here we present a case of Tropical pulmonary eosinophilia.

Case: 27 years old male presented with complaints of dry cough for 2 months without any H/O hemoptysis, dyspnea for around 2-3 months- insidious onset, non-progressive, Fever around 2 months back which subsided after 15 days with medications. There was no history of chest pain. There was no H/O any known comorbidities. The patient had no prior H/O anti tubercular drug intake or contact with TB patient. He has no H/O smoking or alcohol intake and is a college student. The patient had no allergic history to any substance. Chest auscultation revealed wheeze in the Left suprascapular area. CXR was done which revealed a miliary pattern in B/L lung fields without any other significant finding. To confirm the finding, HRCT chest was done which confirmed it to be miliary pattern and reported as small randomly nodular lesions in B/L lung parenchyma - likely miliary Koch’s. The patient was advised with routine blood investigations along with fibre optic bronchoscopy. CBC revealed elevated TLC with marked eosinophilia (36%) with other blood parameters within normal limits. Routine examination of BAL fluid also confirmed similar findings (eosiniphilia) Later on, Total serum IgE was found to be elevated (14539 kUA/l). BAL c/s, fungal KOH and fungal c/s showed sterile reports. BAL CBNAAT was reported as MTB not detected. Serum Microfilaria antigen was sent and showed to be negative but serum antifilarial IgG was seen to be markedly elevated. A diagnosis of Tropical pulmonary eosinophilia was made and patient was started with diethylcarbamazine for 21 days, antibiotics and other supportive medications including bronchodilators. Patient showed significant improvement in symptoms and chest radiograph showed resolution in lesions. Currently, patient is asymptomatic and without any ongoing medications.

Conclusions: Imaging studies in TPE can mimic miliary tuberculosis, the presence of marked eosinophilia is an important distinguishing feature and further management is thereafter differ drastically and has a significant impact on patient overall.

Abstract No. 108: Silicoproteinosis - A rare variant of silicosis

Shivam Gurme , Siddharth Waghmare, Jairaj P. Nair, Sonal Karpe, Swapnil Thorve

Department of Respiratory Medicine, Lokmanya Tilak Medical College and General Hospital, Mumbai, Maharashtra, India

Introduction: Alveolar silicoproteinosis is a rare form of silicosis that develops rapidly following intense exposure to respirable crystalline silica. It leads to alveolar accumulation of lipoproteinaceous material, causing bilateral lung consolidation, patchy ground-glass opacities, and a characteristic “crazy-paving” appearance on imaging.

Case Report: A 27-year-old male stone cutter with five years of silica exposure presented with progressive dyspnea and intermittent cough with whitish sputum over two years. He reported diffuse bilateral chest pain, non-radiating and unrelated to palpitations or sweating. He had a history of sputum-positive pulmonary tuberculosis, treated with anti-tubercular therapy (ATT) for six months, but self-discontinued a second course initiated after symptom recurrence. On examination, SpO 2 was 98%, with bilateral crepitations. Chest X-ray showed dense bilateral opacities sparing the upper zones. CT revealed multiple consolidative masses with air bronchograms, centrilobular nodules, fibrotic changes, and mediastinal lymphadenopathy with egg-shell calcifications. Bronchoalveolar lavage (BAL) fluid was milky, negative for infectious agents, and showed PAS-positive macrophages. The diagnosis was silicoproteinosis with progressive massive fibrosis.

Conclusions: Silicoproteinosis is a pathologic variant of acute silicosis, resembling pulmonary alveolar proteinosis (PAP). It results from silica-induced macrophage dysfunction and type II pneumocyte hyperplasia, leading to proteinaceous alveolar accumulation. Imaging features include centrilobular nodules, consolidations, and lymph node calcifications. The patient’s history of tuberculosis complicated the diagnosis, underscoring the overlap between silicosis, tuberculosis, and silico-tuberculosis in occupations with high silica exposure, such as stone cutting. This case highlights the importance of early recognition and differentiation of these entities to guide appropriate management.

Abstract No. 109: Diagnostic yield of Medical thoracoscopy in undiagnosed exudative pleural effusion

V. Samskruti , Gajanan S. Gaude

Department of Respiratory Medicine, JGMMMC, Hubballi, Karnataka, India

Introduction: Medical thoracoscopy also known as pleuroscopy today remains the gold standard technique for diagnosing and managing undiagnosed exudative pleural effusions. Major indication of medical thoracoscopy is evaluation of undiagnosed, lymphocyte predominant exudative pleural effusions where tuberculosis (TB) and malignant pleural effusion are clinical possibilities and when the initial pleural fluid analysis is inconclusive.

Objectives: To detect the diagnostic yield of medical thoracoscopy in undiagnosed exudative pleural effusions.

Methods: 53 patients with undiagnosed pleural effusion who underwent semirigid thoracoscopy were included in this study. For all the patients, initial pleural fluid analysis and cytology tests were done.

Results: A total of 53 patients were included, mean age was 54.1 +/- 14.4 years, with 32 male and 21 female patients. 83.1% of the pleuroscopies were diagnostic out of which 39.6% patients had the diagnosis of Adenocarcinoma, 32.1% Tuberculosis followed by chronic pleuritis in 16.9%, Squamous cell carcinoma in 5.6%, Spindle cell carcinoma in 3.77% and Malignant mesothelioma in 1.89%. There were no major complications associated with the procedure only 3 patients had longer ICD insertion secondary to pneumothorax and subcutaneous emphysema.

Conclusion: Medical thoracoscopy is a safe procedure and simple procedure with low complication rates.

Keywords: Exudative pleural effusions, medical thoracoscopy

Abstract No. 110: Safety and efficacy of point-of-care ultrasound-guided transthoracic needle biopsy for peripheral thoracic lesions: A retrospective study

Nitesh Goyal , T. G. Ranganath, Ajoy Kumar Behera

Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, Raipur, Chhattisgarh, India

Introduction: Lung cancer, a leading cause of global cancer mortality, necessitates timely and accurate diagnostic methods. Transthoracic needle biopsy (TTNB) is pivotal for obtaining tissue from peripheral thoracic lesions for histopathology. Ultrasound-guided TTNB (USTTB) offers real-time imaging, cost-efficiency, and safety advantages over CT-guided methods, particularly for immobile or vulnerable patients. This study evaluates the diagnostic efficacy and safety of USTTB for peripheral thoracic lesions.

Methods: A retrospective study at AIIMS Raipur analysed 97 patients undergoing USTTB between October 2022 and March 2024. Data on demographics, clinical presentation, radiological findings, and histopathology were assessed. The Bard Max-Core™ biopsy instrument was utilized. Statistical analysis employed IBM SPSS Version 20.0.

Results: The study cohort had a mean age of 54.9 ± 15.9 years, with 74.23% males. Cough (77.32%) and chest pain (62.89%) were the most common symptoms, while 67.01% patients reported weight loss. Ultrasound findings revealed heterogeneous echotexture in 81.44% of lesions, with intervening pleural effusion in 9 patients. The biopsy procedure involved 4–6 passes, yielding high-quality cores for histopathological evaluation. Diagnostic yield observed was 91.75%, with lung adenocarcinoma (44.94%) and squamous cell carcinoma (17.98%) being the commonest diagnoses. Rare conditions such as pulmonary alveolar proteinosis and diffuse alveolar damage were also identified. Complications included hemoptysis (2.06%), pneumothorax (8.25%) and chest pain (21.65%), all managed conservatively without requiring invasive intervention. Histopathological assessment confirmed adequate tissue sampling in all cases, demonstrating the robustness of the biopsy technique.

Conclusions: USTTB demonstrated high diagnostic accuracy with minimal complications, consistent with prior studies. Its bedside feasibility, cost-effectiveness, and safety profile make it suitable for vulnerable patients and resource-limited settings. Limitations include the retrospective design and lack of a comparative cohort.

USTTB is a safe and effective diagnostic tool for peripheral thoracic lesions. Its integration into diagnostic workflows is recommended, particularly in settings requiring real-time, minimally invasive techniques.

Keywords: Diagnostic yield, lung cancer diagnosis, minimally invasive procedures, peripheral thoracic lesions, safety profile, transthoracic needle biopsy, ultrasound-guided biopsy

Abstract No. 111: Bronchoscopy guided techniques are “point of care test” in non-resolving pneumonia cases: A single center experience

Shital Patil 1 , Ganesh Narwade 1 , Gajanan Gondhali 2 , Deepak Patil 2

1 Department of Respiratory Medicine, Venkatesh Chest Hospital and Critical Care Center, Latur, Maharashtra, India, 2 Department of Internal Medicine, MIMSR Medical College, Latur, Maharashtra, India

Background: Non-resolving pneumonia (NRP) has significant impact on cost of care, mortality and morbidity due to incorrect diagnosis due to inadequate samplings, inappropriate and or adequate antibiotics use and impaired host defenses. Tuberculosis is the predominant etiological diagnosis in NRP cases in high burden settings. Bronchoscopy is the most appropriate invasive technique in these cases due to pathological site-oriented samplings with high yield with rapid molecular based Gene Xpert MTB/RIF test.

Methods: Prospective, observational study, included 794 non-resolving pneumonia cases (NRP) (defined as pneumonia with slow or incomplete resolution after twelve weeks in spite of adequate and appropriate antibiotic treatment during hospitalization) admitted in indoor unit during 2015 to 2023. All cases were having inconclusive etiological profile including induced sputum smear AFB and Gene Xpert MTB/RIF tests. Covariates recordings such as Age, gender, smoking history, diabetes mellitus, alcoholism and nutritional status were done. HRCT thorax imaging done in all cases for defining exact pathological site. Bronchoscopy guided BAL has been sent for bacterial, fungal and tuberculosis and malignancy workup. Tuberculosis samplings were processed for Gene Xpert MTB/RIF and Liquid (MGIT 960) culture methods. Statistical analysis by Chi-test and Anova Test.

Results: Etiological diagnosis of 794 NRP cases as TB in 398 (50.12%) cases, Lung malignancy in 156 (19.64%), Bacterial pneumonia 112 (14.10%), fungal pneumonia in 100 (12.59%) and foreign bodies in 16 (2.01%) & undiagnosed in 12 cases. Total TB diagnosis is confirmed in 398 cases, by MTB documentation in Gene Xpert MTB/RIF and or liquid culture yields mycobacterium tuberculosis. BAL Gene Xpert MTB/RIF Positive (very low cycle threshold) in 68 cases and confirmed TB by culture in 42 (61.76%) cases. BAL Gene Xpert MTB/RIF Positive (low to high cycle threshold) in 318 cases and conformed TB by culture in 316 cases. TB diagnosis by BAL cycle threshold (very low and low to high) and Liquid culture methods has showed significant association (p<0.00001). Sensitivity of BAL CBNAAT (in consideration with Culture) is 89.94% in our cases with negative initial induced sputum results. Covariates analysis has observed significant association with TB diagnosis by BAL cycle threshold (very low and low to high) and Liquid culture methods (p<0.00001).

Conclusion: Tuberculosis is the very common and underestimated cause of NRP and usually missed with conventional diagnostic techniques. Bronchoscopy is the gold standard test in workup of NRP and provides etiological diagnosis in near all cases. BAL gene Xpert MTB/RIF is sensitive and specific test to diagnose tuberculosis. Semiquantitative analysis with cycle threshold has given important clues towards to start treatment directly. We recommend for cautious workup in cases with very low MTB load in Gene Xpert MTB/RIF test and these cases should undergo liquid culture techniques to prevent overtreatment.

Abstract No. 112: Utility of HACOR score in patients with acute exacerbation of post-tuberculosis obstructive airway disease

Shivam Suresh Gurme , Siddharth Waghmare, Jairaj P. Nair, Sonal Karpe, Swapnil Thorve

Department of Respiratory Medicine, Lokmanya Tilak Medical College and General Hospital, Mumbai, Maharashtra, India

Introduction: Post-tuberculosis obstructive airway disease (post-TB-OAD) is a common sequelae associated with pulmonary TB. Acute exacerbation of post-TB-OAD is characterized by acute worsening of symptoms. Hypoxia and respiratory fatigue are indications for non-invasive ventilation in these cases.

Methods: Sixty patients of Post TB OAD who received NIV were enrolled for HACOR score. HACOR score was calculated 1 hour after NIV application. NIV success was defined as clinical improvement, correction of respiratory acidosis, and no subsequent need for intubation. The need to shift from NIV to the invasive mode of ventilation was defined as NIV failure. A cuffoff score of >5 was considered predictive of NIV failure. Using contingency tables the sensitivity, specificity, negative predictive value and the positive predictive value was calculated.

Result: 60 patients were enrolled in the study. NIV failure was seen in 18 patients. The mean HACOR score in this group was 7. The sensitivity was 77.77%, and the specificity was 28 % for a score of >5. The positive predictive value and negative predictive value were 31% and 75 %, respectively.

Conclusions: In our study, we tried to assess the effectiveness of the HACOR score in predicting NIV failure in patients with post-TB-OAD. Previous study conducted by Duan et al revealed sensitivity of 72.6% and specificity of 90.2%. Another study by Waghmare SR et al had Sensitivity 89.47% and Specificity of 87.09%. Compared to these our study showed comparable sensitivity (77.77%), however specificity was low.

We Found a score more than 5 had a higher NPV and sensitivity in predicting NIV failure.

Keywords: HACOR, NIV, post TB OAD

Abstract No. 113: Desmoplastic small round blue cell tumor complicated by pulmonary hemorrhage: Successful management using high frequency positive pressure ventilation

Sanjay Kumar , Pranjali Atrish

1 Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Introduction: Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive malignancy, predominantly affecting adolescents and young adults. It arises from serosal surfaces, with common primary sites including the abdomen, ovary, and orbit. The tumor is driven by the EWS-WT1 fusion gene, leading to oncogene upregulation. [2] Treatment typically includes chemotherapy, radiation, and cytoreductive surgery, but severe complications, such as hematologic toxicity and pulmonary complications, are common. This case highlights the successful management of a 3-year-old child with DSRCT who developed pulmonary edema and hemorrhage following chemotherapy, treated with high-frequency positive pressure ventilation (HFPPV), corticosteroids, and antifibrinolytic agents.

Case Series: A 3-year-old child with no significant past medical history presented with abdominal distension, constipation, and intermittent fever. Imaging revealed a mass in the right lumbar region, confirmed as DSRCT through biopsy. The tumor involved the perimuscular connective tissue, serosal surface, and lymph nodes. Following exploratory surgery and mass resection, the patient underwent chemotherapy (VDC-IE regimen). Ten days later, the child developed pancytopenia and febrile neutropenia, requiring blood transfusions. Respiratory distress, tachypnea, and tachycardia led to ICU admission, where pulmonary edema was diagnosed via ultrasound and chest X-ray. Despite initial treatments, including diuretics and transfusions, the patient progressed to respiratory failure and required intubation, from which he was successfully weaned and extubated in 3 days. On day 2 post extubation, the patient experienced a worsening respiratory condition, requiring reintubation due to massive pulmonary hemorrhage. High-frequency positive pressure ventilation was initiated to maintain ventilation. The ventilatory settings were adjusted to pressure control with a respiratory rate of 90/min, a pressure control of 30 cmH2O, a positive end-expiratory pressure (PEEP) of 10 cmH2O, and 100% FiO2. Tranexamic acid and Methylprednisolone (20 mg/kg/day) was initiated and slowly tapered both of which helped resolve pulmonary hemorrhage and successfully weaning the child from ventilator and ultimately being extubated.

Conclusions: This case emphasizes the challenges in managing DSRCT complicated by pulmonary edema and hemorrhage. The use of HFPPV, corticosteroids, and tranexamic acid played a key role in stabilizing the patient’s respiratory function and enabling subsequent treatment. Early intervention with this approach significantly improved the patient’s prognosis, highlighting the importance of tailored management strategies for pediatric oncology patients with severe complications.

Abstract No. 114: Evaluation of clinical outcome of mechanically ventilated patient in tertiary care hospital

Aditya Padmakar Adhikari , L. Muthukumaran, R. Sridhar, N. Meenakshi

Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India

Background: Invasive mechanical ventilation (IMV) is a life-saving intervention for critically ill ICU patients but is associated with high morbidity and mortality depending on underlying conditions. Understanding clinical outcomes in these patients aids in identifying prognostic factors and guides improvement in ICU care.

Objective: To evaluate of Clinical Outcome of Mechanically Ventilated Patient in Tertiary Care Hospital.

Methods: A retrospective study of ICU patients at Chettinad Hospital requiring IMV. Adults with inadequate respiratory drive or unresponsive to oxygen therapy were included. Patients extubated and transferred to the ward were classified as having a “good” outcome. Those who died or were discharged against medical advice without extubation were categorized as “adverse.”

Results: 110 patients were analyzed (mean age 61.01±14.32 years, 71.8% male). The mean ICU stay was 9.00±5.35 days, ventilation duration was 6.00±3.96 days, and hospital stay was 18.00±8.89 days. Respiratory issues were the leading cause of IMV (44.10%), followed by cardiac (20.20%), neurological (15.80%), non-cardiac (14.50%), and sepsis (9.40%). Of the patients, 65.40% had a good outcome, while 34.60% had adverse outcomes. ICU mortality was 20%, with 14.6% dying post-transfer. There was statistically significant difference in outcome of patients with respiratory causes as compared to other causes.(p=0.03). In multivariable regression analysis concerning medical diagnoses, multi-organ dysfunction syndrome were statistically positively correlated with mortality, with a p-value of less than 0.05.

Conclusions: Mechanical ventilation is a life-saving intervention; prompt detection of problems and appropriate treatment significantly reduce morbidity. A considerable proportion of patients admitted to the ICU necessitate breathing assistance through invasive mechanical ventilation. with mortality being highest in those suffering from multi-organ dysfunction syndrome.

Early intervention and targeted care for high-risk groups improve outcomes, highlighting the importance of continuous ICU practice evaluation to reduce mortality.

Abstract No. 115: Prolonged ventilation in respiratory patients: Outcomes, challenges and road ahead

Gaurav Mishra , Rahul Tyagi

Department of Respiratory Medicine, AFMC, Pune, Maharashtra, India

Introduction: Weaning from prolonged invasive mechanical ventilation (> 7 days of IMV) presents significant clinical challenges, particularly in patients with complex comorbidities. This case series evaluates the clinical management and outcomes of 40 patients requiring prolonged IMV, with a focus on survival, challenges encountered, and strategies employed in a tertiary respiratory centre in western Maharashtra.

Methods: A retrospective analysis of 40 patients aged 58–87 years requiring prolonged IMV was conducted. Underlying conditions included bronchiectasis-COPD overlap, severe pneumonia with ARDS, massive pulmonary embolism, and chronic structural lung diseases. Data regarding patients who underwent tracheostomy or managed with multidisciplinary interventions, including physiotherapy, nutritional support, antimicrobial therapy, and psychosocial care were recorded and analyzed with their final outcome.

Results: Of the 40 patients requiring prolonged mechanical ventilation, 12 (30%) survived and were successfully decannulated. Out of 12 patients who were successfully weaned off, 07 (17.5%) are still on OPD follow up. The average hospital stay was 48 days (range: 30–72 days), with ventilator support lasting an average of 14 days and tracheostomy duration averaging 42 days (range: 18–95 days). Key interventions included managing multidrug-resistant infections, such as MDR Klebsiella, Pseudomonas, and Burkholderia, through culture-guided antibiotic therapy, addressing electrolyte imbalances like hypokalemia/hyponatremia, and providing continuous renal replacement therapy (CRRT) for acute kidney injury. Survivors benefited from structured weaning protocols, including early transition to non-invasive ventilation, T-piece trials, physiotherapy-driven ambulation, employment of relatives for early psychological support and early oral feeding initiation, and. These strategies were critical in facilitating recovery and achieving decannulation.

Conclusions: Prolonged ventilation remains a significant clinical challenge, with a survival rate of 37.5% in this cohort. Successful weaning necessitates a multidisciplinary approach involving early identification of complications, infection control, robust rehabilitation, and psychosocial support. This series highlights the need for individualized care pathways to optimize outcomes in prolonged IMV cases.

Keywords: Multidisciplinary care, prolonged mechanical ventilation, weaning and decannulation

Abstract No. 116: Treat the cause not the symptom - A successfull Bae story in a patient of pulmonary AV malformation

Maria Florence Armstrong

Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India

Introduction: Pulmonary AV malformations are rare abnormal dilated vessels leading to abnormal connections between pulmonary arteries and veins right to left shunt. They are direct high flow, low resistance fistulous connection. Here we present a young female patient with avm with chronic hemoptysis refractory to conservative management.

Case Report: Using 6FR catheter vascular access was made and H1 catheter was used to cannulate right EIV and common iliac vein. Later right bronchial artery was superselectively embolized and cyanoacrylate was injected into AVM.

Patient was stable and she did not develop further hemoptysis after procedure on follow up.

Conclusions: BAE reduces the recurrence of hemoptysis 70-90%. In massive hemotysis, chronic hemoptysis refractory to conservative treatment prompt decision has to be made to treat with bronchial artery embolization.

BAE has to be considered as a mainstay of treatment in patient of AV malformation, refractory hemoptysis, massive hemoptysis.

Keywords: AV malformation, BAE, good success rate

Abstract No. 117: A case report of primary apla and pulmonary thromboembolism

G. Pushpa Latha , Somanath Dash

Department of Respiratory Medicine, Ganni Subbalakshmi Medical College, Rajamundry, Andhra Pradesh, India

Introduction: Antiphospholipid syndrome (APS) is an autoimmune condition that’s characterised by the presences of antiphospholipid antibodies (aPL). It has variable clinical presentations such as vascular thrombosis and obstetrical complications, pulmonary thromboembolism (PTE), pulmonary hypertension, and ARDS. The incidence and prevalence of APS is increasing worldwide.

Case Report: A 24 year old female presented with left sided chest pain since 5 days, dry cough since 1 day, shortness of breath since 1 day. Patient had history of recurrent abortions.

Chest x ray PA view was done which showed bilateral hyperinflation of lung with tubular heart.PT, APTT, INR –increased, APLA –POSITIVE.

Conclusions: Resources for the detection of antiphosholipid antibodies should be made readily available in resource limited settings.

Keywords: APLA, PT

Abstract No. 118: Unanticipated radiation-induced lung injury following transarterial radioembolization in a patient with hepatocellular carcinoma and low lung shunt fraction

Kumar Doshi 1 , Salil Bendre 1 , Kavita Mehta 1 , Anjali Kamath 1 , Sameer Shah 2 , Hardik Shah 2

1 Department of Pulmonary Medicine, Nanavati Max Superspeciality Hospital, Mumbai, Maharashtra, India, 2 Department of Gastroenterology, Nanavati Max Superspeciality Hospital, Mumbai, Maharashtra, India

Introduction: Transarterial Radioembolization (TARE) is an effective intra-arterial treatment for liver cancers, especially hepatocellular carcinoma (HCC), that employs radioactive microspheres containing yttrium-90 (90Y). However, TARE has possible side effects, such as radiation-induced lung damage, frequently observed in patients with a large hepatopulmonary shunt, higher than 20%. [2] However, cases involving lower lung shunt fractions remain rare and poorly understood.

Case Report: A 69-year-old male, case of Hepatocellular Carcinoma with portal hypertension, presented with complaints of breathlessness and dry cough for 20 days. His lung shunt fraction was 9%. The patient had undergone Transarterial Chemoembolization (TACE) with 50mg Adriamycin 30 days ago followed by TARE. His symptoms began five days after TARE. He denied fever or chest pain and was a known diabetic. Prior to treatment, the patient’s HRCT thorax showed no parenchymal lesions. However, a repeat imaging revealed ground-glass opacities in both the upper lobes, middle lobe, and lingula, along with smooth interstitial septal thickening in upper lobes. Based on clinico-radiological findings, the patient was started on intravenous steroids, initially with methylprednisolone 40mg. Despite treatment, his oxygen requirement increased. Repeat imaging showed an increase in the ground-glass opacities. With ongoing clinicoradiological deterioration, the steroid dose was escalated to 80mg/day, and a diagnostic bronchoscopy was performed which showed no growth in lavage cultures. Pulse high dose steroid therapy was initiated and patient showed significant improvement in clinical parameters.

Conclusion: This case highlights that radiation-induced lung injury from TARE can occur even with a lung shunt fraction as low as 9%, which is below the accepted threshold of 20% for significant risk. This underlines the importance of closely monitoring patients undergoing TARE, as lung toxicity may develop despite a relatively low risk profile based on traditional shunt fraction thresholds. Early recognition and timely intervention are crucial for mitigating the severity of pulmonary complications in these patients.

Abstract No. 119: Stabilizing of lung functions in a patient with pulmonary langerhans cell histiocytosis on subcutaneous cytarabine

Yash Kedia 1 , Nitesh Gupta 1 , Pranav Ish 1 , Rohit Kumar 2 , Ankur Jain 3

1 Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, New Delhi, India, 2 Department of Pulmonary Medicine, VMMC and Safdarjung Hospital, New Delhi, India, 3 Department of Hematology, VMMC and Safdarjung Hospital, New Delhi, India

Pulmonary Langerhans cell Histiocytosis (PLCH) presents as a cystic lung disease, causing bilateral bizarre shaped cysts, which often rupture and cause pneumothorax. PLCH can present with progressive lung disease leading to declining lung functions and worsening quality of life. Treatment options include smoking cessation, long term oral corticosteroids and use of chemo toxic drugs like vinblastine, cladribine and cytarabine. However, there is no consensus for the use of one drug over the other. We here present a case of a 22-year-old non-smoker male, who presented with secondary spontaneous pneumothorax and was diagnosed to have PLCH along with diabetes insipidus. He was treated with oral corticosteroids and subcutaneous cytarabine 5 days per month for one year. Follow up at one year was suggestive of preserved lung functions (on spirometry and six-minute walk test) along with regression of cysts on computed tomography scans of the thorax.

Abstract No. 120: Cavitatory pneumonia: A case of granulomatosis with polyangitis

G. Mohan Siva Sundaram , Girish Dandagi, Sandeep Dandin, Santosh Honnavar

Department of Respiratory Medicine, Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India

Introduction: Granulomatosis with polyangitis (GPA) is a rare ANCA- associated vasculitis, with a prevalence of about 3 per 100,000 individuals. It is characterized by necrotizing granulomatous inflammation usually involving respiratory tract, and necrotizing vasculitis affecting small and medium sized vessels. GPA can affect individuals of any age, frequently involving upper airways, lungs and kidneys, though it can affect any organ.

Case Report: A 19 yr old male, software employee trainee by occupation, with no co- morbidies presented with chest pain, fever and dry cough since 15 days. Investigations revealed positive C- ANCA with CXR showing multiple nodules with cavitations, HRCT shows multiple areas of lobular, subsegmental consolidation with ground glass opacities diffusely involving both lungs with multiple areas of internal cavitation and lung biopsy showing chronic inflammatory changes. He was treated with prednisolone and methotrexate, leading to clinical and radiographic improvement.

Conclusions: This case underscores considering GPA as differential diagnosis in patients with respiratory symptoms with B/L cavitatory changes. Timely diagnosis and treatment are crucial for managing GPA effectively, highlighting the need for vigilance in recognizing this rare but serious condition.

Granulomatosis with polyangitis should be considered in differential diagnosis of patients presenting with respiratory symptoms. Early diagnosis is critical, as high-dose steroids and cytotoxic agents is essential for improving patient outcomes and managing this potentially life threatening condition.

Abstract No. 121: Cavitary form of cryptogenic organising pneumonia mimicking as a lung malignancy - A rare presentation

Prasanna J Shah, R. K. Chopra, Sneha Tirpude

1 Department of Pulmonary Medicine, Ruby Hall Clinic, Pune, Maharashtra, India

Introduction: Cavitary form of cryptogenic Organizing Pneumonia (COP) is a type of idiopathic interstitial pneumonia characterized by the formation of granulation tissue within the lung’s airspaces and/or interstitium. Only 4 cases have been published so far, ours being 5 th .Thick-walled cavitary form is still rarer and which may mimic malignancy.

Case Report: A 62-year-old male, ex-smoker presented with persistent symptoms of dry cough and breathlessness of 6 months duration, denied history of fever, haemoptysis and weight loss. Chest x ray showed a thick-walled cavity in right upper zone. PET CT showed FDG avid (SUV max 20.2) heterogeneously enhancing cavity lesion in right upper lobe with wall thickness of 20 mm, likely of neoplastic pathology. CT guided biopsy was done from thick wall of the cavity. Histology was suggestive of Organizing pneumonia. Other causes of COP like GPA, sarcoidosis, RA, eosinophilic pneumonia was excluded. Our final diagnosis was cavitary form of COP.

Conclusion: Thick walled Cavitary form of COP can mimic malignancy, particularly when wall thickness is more than 5 mm. Organizing pneumonia presenting as thick wall cavity is rare. It should be considered as differential diagnosis of lung cavitary lesions.

Keywords: Cavitary form of cryptogenic organizing pneumonia, CT guided biopsy, neoplastic, wall thickness

Abstract No. 122: Beyond diagnosis: A case study of cryptogenic organising pneumonia

Vedamurthy Basavaraja Janglera , D. Pragati Rao

Department of Respiratory Medicine, M S Ramaiah Medical College, Bengaluru, Karnataka, India

Introduction: Cryptogenic Organising Pneumonia (COP) is a critical diagnosis due to its clinical and radiological similarities with infectious pneumonia, COP is often misdiagnosed. An accurate diagnosis of COP is essential because the treatment approach differs significantly from other forms of pneumonia.

Case Report: A 63year old lady known case of diabetes, hypertension and hypothyroidism presented with 20days history of low-grade intermittent fever and cough. On examination vitals were stable and left infra scapular crepitations heard. Chest x-ray and HRCT thorax showed bilateral lower lobe consolidation (L>R). In view of persistent fever spikes and non-resolving pneumonia further underwent bronchoscopy and BAL. BAL gram stain, culture, MGIT and fungal elements were negative. For further work up, patient underwent CT guided biopsy which showed many fibrotic plugs filling the alveolar sacs and ducts (Masson bodies), PAS and GMS stains were negative for fungal elements, ZN stain negative for AFB and no features of malignancy. A diagnosis of COP was made and started on Oral Corticosteroids (0.5mg/kg) and tapered on follow up. On follow up after 1 month a repeat HRCT was done showed complete radiological resolution.

Conclusion: Prompt recognition of COP is essential given its nonspecific symptoms and potential for misdiagnosis. Our patient demonstrated a favourable response to corticosteroid therapy. Long-term follow-up will be crucial to monitor for disease recurrence or complications.

Abstract No. 123: Incidental arteriovenous malformations in seizure patient: A clinical challenge

Mili Gupta , Pramod Chaudhari, Anubhuti, Makarand Sanpurkar, Tushar Aneja

Department of Respiratory Medicine, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, Maharashtra, India

Introduction: PAVMS are rare but crucial in the differential diagnosis of pulmonary issues like dyspnea, hemoptysis, hypoxemia and nodules. Complication include life- threatening conditions like stroke, brain abscess, and severe hemoptysis.

Case Report: A 58-year-old female patient was admitted with seizure, frothing at the mouth, and transient left hemiparesis. MRI identified a brain abscess and conservative treatment with cephalosporins and antiepileptics was started. Despite this, the patient had another seizure and was referred to our center. CXR revealed a well- defined opacity in the right lower lobe. Subsequent CT pulmonary angiography confirmed pulmonary arteriovenous malformations with aneurysms in the right middle and lower lobes. A 2D echocardiogram excluded valvular vegetations and atrial septal defect while bubble contrast study verified right to left shunting, confirming the presence of PAVMS. Dermatological examination found multiple asymptomatic ecchymotic lesions and past history of recurrent epistaxis was suggestive of hereditary hemorrhagic telangiectasia (HHT), also known as Osler -Weber – Rendu syndrome. The patient underwent successful embolization of three PAVMS using amplatzer vascular plugs and coil embolization using catheter, which stopped blood flow.

Conclusions: PAVM symptoms typically appear in middle aged adults. Studies show only 40% are symptomatic, primarily with dyspnea and hemoptysis. When associated with HHT, it can manifest as epistaxis and telangiectasias. They should be suspected in patients with unexplained dyspnea, hypoxemia, nodules, or a history of stroke or brain abscess.

Understanding the potential for neurological complications, including strokes and brain abscesses due to paradoxical embolization, is critical. Routine screening of all patients with brain abscess for ACM will improve outcomes in this patient population.

Abstract No. 124: Lymphocytic interstitial pneumonia in Sjogren’s syndrome: A case report

Shubham Lohade

Vedantaa Institute of Medical Sciences, Dahanu, Maharashtra, India

Introduction: Lymphocytic interstitial pneumonia (LIP) is a rare pulmonary complication of Sjogren’s syndrome (SS), characterised by diffuse infiltration of lymphocytes in the pulmonary interstitium. This case highlights a patient with SS presenting with significant respiratory symptoms, emphasising the diagnostic and therapeutic challenges.

Case Report: A 56-year-old female with a known diagnosis of Sjogren’s syndrome presented with breathlessness of MMRC grade 3 and productive cough for two weeks. She denied fever, chest pain, pedal oedema, or hemoptysis. On examination, the patient was tachypneic with oxygen saturation of 90%. Systemic examination was unremarkable, but bilateral crackles and wheeze were noted on auscultation. Routine blood work, sputum cultures, and other infectious workups were negative. High-resolution computed tomography (HRCT) revealed bilateral ground-glass opacities (GGOs), multiple thin-walled cysts, diffuse interstitial thickening, and sub-pleural consolidation. These findings, combined with the clinical presentation and absence of alternative causes, led to a diagnosis of LIP secondary to Sjogren’s syndrome. The patient was managed with a combination of antibiotics, oral corticosteroids, inhalational bronchodilators, and oxygen therapy. Clinical improvement was noted, and she was discharged in stable condition with outpatient follow-up arranged.

Conclusions: Lymphocytic interstitial pneumonia should be considered in patients with Sjogren’s syndrome presenting with unexplained respiratory symptoms. Prompt diagnosis using clinical, radiological, and laboratory findings is critical for appropriate management and improved outcomes.

This case underscores the importance of recognising LIP as a potential manifestation of Sjogren’s syndrome. HRCT is instrumental in diagnosis, and a multidisciplinary approach is crucial for optimal management. Early intervention with corticosteroids and supportive therapy can result in favourable outcomes.

Abstract No. 125: A rare case of interstitial lung disease in a 16 year old child with familial hypopigmented lesions

Ganapuram Santhi Deepika , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Childhood interstitial lung diseases (chILDs) is a rare group of paediatric lung diseases affecting the lung interstitium diffusely causing significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment.

Case Report: A 16 yr old female presented with complaints of dry cough, fever since one week, shortness of breath since 2 days. Past h/o tuberculosis twice for which she used ATT for 6 months. On examination: Multiple hypopigmented macules present all over the body, thickening of skin is seen over palms and soles. Her sibling has similar skin findings. Chest Xray shows reticular opacities in bilateral lower zones with cardiomegaly. CT chest shows: Multiple areas of tractional bronchiectasis mixed fibrobronchiectasis with right lower lobe predominance PTB sequelae, reticular opacities mixed few subpleural areas of honey combing associated with pleural thickening likely interstitial pneumonitis/ ILD-NSIP Pattern, moderate pericardial effusion.

Conclusions: Childhood interstitial lung disease (chILD) is remarkably rare with a reported prevalence from 0.13 per 100,000 children under 17 years to 16.2 per 100,000 children under 15 years of age. Considering the skin findings and similar findings in her sibling the diagnosis is pointing towards some genetic cause. So early diagnosis and prompt initiation of steroids can reduce the pulmonary fibrosis.

Keywords: Familial skin hypopigmentation, interstitial lung disease (NSIP)

Abstract No. 126: “Assessing diagnostic delays in interstitial lung disease: Duration and contributing factors” Multicentre study catering to population of rural India

Deepak Muthreja 1 , Shital Patil 2

1 Department of Respiratory Medicine, American Oncology Institute, Nagpur, Maharashtra, India, 2 Department of Respiratory Medicine, Venkatesh Chest Hospital and Critical Care Center, Latur, Maharashtra, India

Background: Interstitial lung disease (ILD) encompasses a diverse group of chronic pulmonary disorders characterized by progressive scarring of lung tissue, leading to impaired gas exchange and respiratory function. These conditions can significantly impact quality of life, often resulting in considerable morbidity and mortality. Early and accurate diagnosis is essential for initiating appropriate treatment and improving patient outcomes. However, ILD diagnosis is frequently delayed due to its nonspecific symptoms, which often overlap with more common respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD). The delay in diagnosing ILD can result in advanced disease progression at the time of diagnosis, limiting therapeutic options and contributing to poorer prognosis. Factors contributing to these delays may include patient-related issues, such as delayed healthcare- seeking behavior; healthcare system challenges, such as inadequate access to specialized diagnostic services; and clinician-related barriers, including limited familiarity with ILD and its atypical presentations.

Methods: Prospective, observational study in two tertiary care centers, American Oncology Institute, Nagpur & Venkatesh Chest Hospital and critical care center, Latur India, included 100 cases of interstitial lung diseases diagnosed by HRCT thorax cases. The protocolized medical history & covariates such as age, gender, smoking history, occupation, history of malignancy, or chemotherapeutic drug exposure and alternative diagnosis such as COPD, Asthma, Tuberculosis and pneumonia made before final diagnosis were recorded.

Results: In a cohort of 100 patients with ILD, the average time to diagnosis was observed to be 2.2 years following the onset of symptoms. Notably, the most common initial misdiagnosis were bilateral pneumonia (40%), COPD/asthma (30%), and tuberculosis (30%). These findings highlight the diagnostic challenges posed by ILD, as its early symptoms are often mistaken for more prevalent respiratory conditions.

Conclusion: Understanding the duration and causes of diagnostic delays in ILD is crucial for developing strategies to enhance early recognition and timely intervention. This study aims to further investigate the time elapsed between symptom onset and ILD diagnosis, as well as to identify key factors contributing to these delays. By addressing these gaps, the findings of this study may guide efforts to improve diagnostic pathways and ultimately optimize care for individuals with ILD.

Abstract No. 127: A case of refractory antisynthetase syndrome - Interstitial lung disease

Jigneshkumar M. Patel , Anisha Rajvanshi, Nisha Chandra, Zarir F. Udwadia

Department of Respiratory Medicine, P. D. Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India

Introduction: Antisynthetase syndrome (ASyS) is a rare autoimmune disease that commonly presents as interstitial lung disease (ILD), myositis, and arthritis. Disease progression, particularly in ILD, significantly affects morbidity and mortality, requiring timely diagnosis and personalized treatment, including novel therapies like rituximab.

Case Report: A 28-year-old female presented with a history of small and large joint pain at age 18, which resolved spontaneously. At age 22, she developed papular rashes on her forearms and nodular lesions on her fingertips, initially misdiagnosed as eczema and treated with steroids. At age 23, she reported myalgia, low-grade fever, dry cough, and joint pain. Investigations showed nonspecific interstitial pneumonia (NSIP) ILD on HRCT. Autoimmune markers were positive for ANA, anti-PL7, and anti-Ro52, with elevated inflammatory markers and CPK. She was diagnosed with ASyS and started on steroids and azathioprine, which was switched to tacrolimus due to intolerance within a few weeks. At age 24, due to worsening joint symptoms and muscle pain, methotrexate was added. At age 25, she presented to our hospital with worsening symptoms, increased GGO on HRCT, and declining FVC and DLCO, prompting the addition of mycophenolate mofetil and discontinuation of tacrolimus. At age 26, with persistent breathlessness, fibrotic NSIP on CT, and further decline in FVC and DLCO, nintedanib and rituximab were initiated. Three doses of rituximab (1 g each) were administered: the first two doses two weeks apart, and the third dose after 6 months. This led to symptom improvement, highlighting its potential in refractory ASyS-ILD.

Conclusion: Rituximab offers a promising option for patients with refractory ASyS-ILD, particularly when standard therapies fail. Its timely initiation in this case stabilized disease progression and improved symptom control, underscoring its importance in managing refractory cases.

Abstract No. 128: Poorly differentiated neuroendocrine tumour presenting as pancoast Tobias syndrome

Sweta Das , Divya Balan

Department of Respiratory Medicine, KMC, Manipal, Karnataka, India

Introduction: Pancoast Tobias Syndrome is a rare condition primarily caused by bronchogenic carcinoma which accounts for less than 5% of all bronchogenic carcinomas. Small cell carcinoma at this site is particularly rare. These tumours arise in the lung apex, invading nearby structures including brachial plexus and sympathetic nervous system. The syndrome is characterized by symptoms including ipsilateral shoulder and arm pain, muscle weakness, paraesthesia, and Horner’s syndrome.

Case Report: A 70-year-old male with smoking index of 350 with a 10-year history of gradually progressive dyspnoea and cough with new onset right upper limb pain and weakness for the past two months. Examination showed grade 2 clubbing, bilateral inspiratory rhonchi, and right-hand muscle wasting, reduced power and reduced sensation. He had right eye partial ptosis and ipsilateral miosis. CT showed right upper lobe lesion with invasion of surrounding structures including the brachial plexus, ribs, vertebrae, and subclavian vessels. Biopsy suggestive of poorly differentiated neuroendocrine tumour.

Conclusions: Pancoast tumours, though rare, should be suspected in patients with upper limb pain, weakness, and Horner’s syndrome, particularly in heavy smokers. Early diagnosis and a multidisciplinary approach are key to improving outcomes.

Pancoast tumours typically present with neck and upper limb pain due to brachial plexus involvement. Risk factors include smoking, male gender, and elderly. Diagnosis requires imaging and biopsy. Treatment includes chemoradiation and surgery, with palliative care for advanced cases.

Keywords: Bronchogenic carcinoma, neuroendocrine tumour, pancoast tumour

Abstract No. 129: Unveiling hidden pathology: Diagnosis of CA Lung in a case of drowning

Vishwambar Shridhar Khadekar , Vishwambar Khadekar, Jairaj P. Nair, Sonal Karpe, Swapnil Thorve, Siddharth Waghmare

Department of Respiratory Medicine, Lokmanya Tilak Medical College and General Hospital, Mumbai, Maharashtra, India

Introduction: Drowning is a leading cause of accidental death worldwide. However, the presence of underlying pathologies, such as lung malignancies, can complicate the clinical presentation and management of drowning This case highlights the rare but critical coexistence of lung malignancy and drowning.Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer, accounting for approximately 85% of all cases. It encompasses a range of histological subtypes, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, Diagnosis typically involves imaging studies, biopsy, and molecular testing to identify genetic mutations (such as EGFR, ALK, or ROS1) or PD-L1 expression.

Case Report: 62 yr old male transferred from pvt hospital after 7 days of A/H/O fresh water drowning under influence of alcohol with DOE grade II -III since drowning and low grade fever and cough since 3 days patient was intubated in pvt hospital for two days.k/c/o DM and HTN.patient is bidi smoker 1 bundle /day since 30 yr. sputum c/s Ecoli grew.appropriate antibiotics and NIV support given.after 10 days of treatment no resolution of consolidation on cxr so CECT chest done suggestive of B/L consolidation with thrombus in SVC. Bronchoscoy with TBLB done suggestive of Non small cell carcinoma of Lung.

Conclusion: This case report highlights the incidental discovery of lung cancer in a patient with drowning. Bronchoscoy TBLB revealed the presence of an undiagnosed lung malignancy, which was not clinically suspected during the patient’s lifetime.this emphasizes the need for increased awareness of lung cancer and it’s screening that may be asymptomatic or overlooked until advanced stages.

Abstract No. 130: Lung cancer masquerading as lung abscess

Nemi Chand Garg

RNT Medical College, Udaipur, Rajasthan, India

Introduction: Patients presenting with lung abscess may have an associated malignancy in 7-36% cases.There should always be a high index of suspicion for lung cancer whenever there is a radiographic diagnosis suggesting lung abscess especially in patients with associated risk factors(higher age,smoking,wall thickness >15 mm,irregular speculated margin) and unresponsive cases to ensure early diagnosis and initiation of treatment.

Case Report: Here is a case of 58 yr old male who came with the following complaints- right sided chest pain radiating towards back dull aching in nature since 1year, cough with mild expectoration (whitish in colour) since 9 months. Patient had multiple history of hospital admission first in October 2023 where bronchoscopy was done which revealed no endobronchial growth, following which patient was again admitted in December 2023 and a diagnosis of tubercular lung abscess (clinically diagnosed) with superadded infection with staphylococcus aureus. Patient was started on antitubercular therapy and sensitive antibiotics for staph aureus (cefepime and linezolid). Patient was reassessed and diagnosis felt more in favour of malignancy therefore a repeat FNAC was done which revealed well differentiated squamous cell carcinoma and the patient was referred to the department of radio-oncology for further management.

Discussion: Malignancy can itself lead in abscess formation in multiple ways. (1) Lung cancer can cause endobronchial obstruction which may result in post obstructive pneumonia which may progress to abscess formation. (2) Squamous cell carcinoma is well known to undergo cavitation which may be followed by abscess formation.

Conclusion: Thus physicians should have a high suspicion for lung cancer when there is a radiographic diagnosis of suspicious lung abscess. Proper diagnostic evaluation and repetitive cytology is necessary so as not to delay an underlying diagnosis of lung cancer.

Abstract No. 131: Double trouble: A rare case of nocardiosis and tuberculosis coinfection

Yadlapalli Vasmitha Chowdary , A.Vinay Kumar

Department: Pulmonary Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, India

Background: Nocardia, a genus of Gram-positive bacteria, thrives in aerobic conditions. Infection typically occurs through inhalation into the respiratory tract. Often referred to as “the great masquerader,” Nocardia has a remarkable ability to mimic tuberculosis in both clinical symptoms and imaging characteristics. The situation becomes even more complex when co-infection with Nocardia and MTB occurs, presenting a heightened challenge that demands careful attention and prompt intervention.

Case Study: A 60-year-old male presented with a cough with sputum and SOB for the past 3 months, along with a headache for the last 2 days. The patient has a history of pulmonary tuberculosis and was on ATT for 18 months. He has been using inhalers for 3 years. chest revealed bilateral fibronodular opacities. An MRI of the brain showed multiple conglomerate ring-enhancing lesions in the left occipital lobe, hippocampus, and right temporo-occipital lobe, with perilesional edema. Bronchoscopy was performed, BAL sent for modified ZN stain revealed Nocardia species and CBNAAT positive for MTB.

Discussion: Approximately two-thirds of all primary Nocardia spp. Infections affect the lungs .In our case, the patient initially presented with respiratory symptoms, followed by the onset of headache. Inhalation was likely the route of infection. CNS is the second most frequent site of infection, typically through dissemination from the primary pulmonary focus. The importance of microscopic examination cannot be overstated, as the presence of branched, unevenly colored Gram-positive bacilli is strongly indicative of Nocardia sspp. Advanced diagnostic techniques like MALDI-TOF MS and 16S rRNA gene analysis are instrumental in confirming the presence of Nocardia. Given that clinical signs are often non-specific, distinguishing pulmonary nocardiosis from tuberculosis can be challenging. A confirmed diagnosis of tuberculosis helps eliminate other potential pathogens.

Conclusion: Patients face higher morbidity and mortality following opportunistic infections caused by pulmonary pathogens like Nocardia and MTB. Consequently, the early detection of these pathogens, coupled with the prompt selection of appropriate antimicrobial therapy, can drastically improve patient outcomes and prognosis.

Keywords: Disseminated Nocardia, MTB, immunocompromised, Microbiological isolation.

Abstract No. 132: Paraskeletal plasmacytoma presenting as a chest wall mass: A rare case report

M. Anjali , Banani Jena

Department of Pulmonary Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India

To report a rare case of paraskeletal plasmacytoma manifesting as a chest wall mass and to emphasize its clinical presentation, diagnostic approach, and treatment challenges.

Methods: A case report approach was used to document the clinical history, diagnostic imaging (chest radiograph, CECT), laboratory results, and histopathological evaluation of a chest wall mass. Treatment included a triplet chemotherapy regimen (bortezomib, lenalidomide, and dexamethasone).

Case Report: A 60yr old male presented with right-sided chest pain and a localized chest wall swelling. Imaging revealed a homogenously enhancing soft tissue mass associated with rib fractures and lytic skeletal lesions [ Figures 1 and 2 ]. Histopathology confirmed plasmacytoma with immature plasma cells [ Figure 3 ]. Diagnostic studies also showed monoclonal gammopathy and extensive bone marrow involvement. Despite initiating chemotherapy, the patient succumbed to the disease after one cycle.

Conclusion: Paraskeletal plasmacytoma is a rare manifestation of multiple myeloma with poor prognosis. Differentiating paraskeletal plasmacytoma from extramedullary disease is essential for treatment planning. This case highlights the challenges of managing aggressive presentations of multiple myeloma.

Abstract No. 133: Clinical profile of diagnosed bronchogenic carcinoma with pleural efussion in special reference to pleural fluid malignant cell

Niladri Palit , Soumya Bhattacharjee

Department of Respiratory Medicine, R G Kar Medical College and Hospital, Kolkata, West Bengal, India

Introduction: In bronchogenic carcinoma with pleural effusion cases, presentation and clinical features are different [in terms of severity and grading] in case of cytologicaly positive and cytologically negative cases.There are some paramalgnant causes of pleural effusion, in a diagnosed carcinoma case, where cause of effusion is not malignancy itself, we tried to find out those causes.

Methodology: This is a descriptive observational study conducted in patients with newly diagnosed bronchogenic carcinoma with pleural efussion admitted in department of respiratory medicine, rgkar medical college in alloted time frame.

Results: In 60% cases pleural fluid malignant cell positive. Among cytologicaly positive 5% were trasudative rest exudative, 70% heamorrhagic efussion. Among cytologicaly negative, 3 cases (5%) were later diagnosed as malignancy by thoracoscopic biopsy. CYTOLOGICALY positive cases presented with relatively large efussion and more severe symptomps, than cytologically negative cases. In cytologicaly positive cases there were underlying visible mass in 65% cases and enlarged mediatinal node in 35% cases on chest radigraphy, which is relatively higher than cytologicaly negative cases, 25% and 5% respctively. In 45% of malignant cell positive efussion cases, there was distant metastasis, predominantly in liver (90%). Cytologicaly negative cases later diagnosed with tissue biopsy in 40% cases, 15% cases were diagnosed by fob guided biopsy. adenocarcinoma (40%), squamous cell carcinoma (30%) were the leading cause. In 40% of cytologicaly negative cases, cause of efussion found to be paramalignant, among which 15% were due to associated pulmonary oedema, 15% were due to liver dysfunction, 35% cases were pulmonary infections (consolidation with parapneumonic efussion), 10% were due to lymphatic bockage, 5% due to ckd, in rest of cytologicaly negative cases, causes remain undiagnosed.

Conclusion: Pleural efussion in bronchogenic carcinoma cases is not always due to malignancy itself. in this study we have seen melignant cell can only be demostrated in about half of the malignancy cases with pleural efussion. But when malignant cell is found in pleural fluid, disease is more severe. Among half of the cytolgicaly negative pleural efussion in bronchogenic carcinoma cases causes of efussion are paramalignant like, pneumonia with parapneumonic efussion> pulmonary oedema>liver dysfuntion>lymphatic obstruction>CKD.

Keywords: Bronchogenic carcinoma with pleural effusion, malignant cells, paramalignant effusion

Abstract No. 134: A rare case of pulmonary spindle cell neoplasm in a 30 year old female

N. Nagpavan , D. Pragati Rao, F. Tanisha Saleem

Department of Respiratory Medicine, M S Ramaiah Medical College, Bengaluru, Karnataka, India

Introduction: Sarcomatoid carcinoma of the lung is a rare, high-grade, poorly differentiated, non-small cell cancer. The incidence of sarcoma is 0.3% to 1.3% of all lung cancers. According to the WHO classification, there are five histological variants of sarcomatoid carcinoma, among them is spindle cell carcinoma of the lung with rare histological subtypes.

Case Report: A 30 year old female who presented with one month of breathlessness on exertion, cough and left-sided chest pain. Contrast chest CT unveiled a large, heterogeneously enhancing left lung mass with massive pleural effusion, suggestive of neoplasm. Smaller lung lesions hinted at metastasis. CT guided lung biopsy showed features are of spindle cell neoplasm. Known case of Left Lower Limb sarcoma status post radiotherapy.

Conclusions: Sarcomatoid carcinoma of the lung, though rare, should be considered in patients presenting with aggressive pulmonary symptoms and masses, particularly in those with a history of sarcoma or prior radiotherapy. Its high-grade and poorly differentiated nature underscores the importance of early recognition, accurate histological diagnosis and a multidisciplinary approach to management to improve outcomes.

Pulmonary spinal cell carcinoma is a rare and aggressive malignancy. Initial presentation may be chest pain, cough, shortness of breath or hemoptysis. Treatment involves a multidisciplinary approach, including surgery, radiation therapy and chemotherapy. Prognosis can be grim due to its propensity for metastasis and resistance to treatment. Research into targeted therapies and immunotherapy is ongoing, offering hope for improved outcomes in the future. Vigilant surveillance, early intervention and personalized treatment plans are essential in managing this challenging disease.

Abstract No. 135: Metastatic lung adenocarcinoma masquerading as tuberculosis in systemic sclerosis: A complex diagnostic challenge

Umesh Kulkarni

B. J. Medical College, Pune, Maharashtra, India

Introduction: Systemic sclerosis (Ssc) is chronic multisystem disease characterized by wide spread vascular dysfunction and progressive fibrosis of skin and internal organs. The diagnosis of SSc is based primarily upon the presence of characteristic clinical findings and supported by specific serologic abnormalities. SSc is usually associated with pulmonary manifestations like Pulmonary Hypertension, Interstitial Lung disease and less commonly malignancy.

Case Report: A 30year old female came to OPD with complaints of Fever and Hip pain for the past 15 days. Patient was diagnosed as a case of clinically diagnosed Pulmonary tuberculosis from outside hospital and received 5 months of Anti-Tubercular Therapy. Patient had history of difficulty in opening mouth, dyspnoea on exertion and dry cough with constitutional symptoms for past 7 months. On clinical examination Clubbing (Grade 2) was present, digital ulcers were present, along with Fish mouth appearance and pinched nose. PET scan revealed pleural based soft tissue mass in right lower lobe. ANA-IF had 4+ speckled pattern. CT guided biopsy of right iliac region s/o metastatic deposits of adenocarcinoma.

Conclusion: SSc is one of the common autoimmune condition that has a high predisposition for malignancy. Patients with rheumatic disease should receive age and sex appropriate screening for malignancy as well as screening appropriate to individual risk factors that are present This case highlights the importance of microbiological confirmation of Tuberculosis before treatment initiation even in high prevalence country like India.

Abstract No. 136: A rare case report of testicular germ cell tumor with lung metastasis and review of literature

Muthirevula Archana Reddy , H. Arjun

Department of Respiratory Medicine, JJM Medical College, Davangere, Karnataka, India

Introduction: Germ cell tumors are known to metastatise to the lungs. We present a case along with a review of the literature.

Case Report: A 24 year male patient presented with chief C/O cough with expectoration and streaky hemoptysis x 15 days. Associated with C/O loss of weight and loss of appetite since 1 month. c/o Painless swelling in right scrotum since 3 months. Swelling was initially small in size and gradually increased to present size. Known Smoker x 2 years, non-alcoholic No known comorbidities, On Examination: Right scrotum: swelling present, hard in consistency. Left testis normal.

CXR-PA: Multiple rounded, smoothly marginated radio-opacities in bilateral lung fields with no zonal predominance- S/O cannon ball metastases. CECT THORAX: Multiple randomly distributed heterogeneously enhancing pulmonary nodules with central non enhancing areas in bilateral lungs with few showing feeding vessel sign > s/o Pulmonary Metastasis. Serum Beta HCG: >1 lakh – Elevated.

Conclusion: (1) Germ cell tumor of testis, usually metastazie early with half of patients presenting with metastatic disease most commonly to the lung, hence thorough screening and diagnosis is important for further clinical management. (2) USG of inguino-scrotal region and CECT of abdomen and thorax are specific for detecting these lesions with additional help from serological markers like serum Beta HCG and alpha feta protein helps in staging and predicting the prognosis of disease in longer run. The presence of cannonball mets is a sign of advanced disease and indicates a poor prognosis.

Abstract No. 137: Bronchorrhea, a rare and debilitating symptom of lung carcinoma

Abhishek Singh , G. N. Srivastava, Vinod Kumar

Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background: Bronchorrhea defined as production of voluminous watery sputum greater than 100 ml per day, is a debilitating symptom mostly found in end stage lung disease, specifically in invasive mucinous adenocarcinoma.

Methods: Hospital based case study was done on 55 year old female presented with Cough with expectoration, watery and copious in amount since 6 months followed by shortness of breath progressive in nature, chest pain (on and off ), fever with chills and loss of appetite. Farmer by occupation with no addiction history. Vitals signs &blood tests including were normal. Sputum for AFB, fungal stain and malignant cell all came to be negative. Her USG W/A showed 2 hepatic cyst in right lower lobe early renal parenchymal disease. Patient was managed conservatively. Ct thorax done revealed right middle and lower lobe consolidation with B/L centrilobular nodules and GGO? Koch’s etiology?? Viral etiology, ??? Bronchoalveolar carcinoma. CT guided biopsy & pathology suggestive of Focal atypical adenomatous hyperplasia. Patient referred to Oncology centre for further management.

Result s : Bronchorrhea can be caused by both malignant and non malignant etiology. Clinical presentation vary from asymptomatic to impending respiratory failure.

Conclusion: Bronchorrhea is an extremely rare and debilitating complication of lung carcinoma associated with mucinous adeno carcinoma, although the quality of evidence is very low.

Abstract No. 138: Visualization of visceral pleura in bronchoscopy: A case of lung squamous cell carcinoma

Madamanchi Yamini Sri Varun Teja , Vishak Acharya

Department of Respiratory Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India

Introduction: Visualization of pleura on bronchoscopy often indicates severe structural compromise, thinning out erosion and destruction of lung parenchyma and bronchial walls, due to multiple etiologies varying from infections, inflammations, trauma or even malignancies. Squamous cell carcinoma (SCC) of the lung is a common histological subtype of non-small cell lung cancer (NSCLC), frequently associated with smoking. Bronchoscopic evaluation plays a vital role in diagnosing SCC, offering direct visualization of endobronchial abnormalities and facilitating tissue sampling.

Case Report: A 62-year-old male, ex-smoker and known case of chronic kidney disease, diabetes mellitus, dysthymia, and ischemic heart disease, presented with complaints of exertional breathlessness, cough with occasional hemoptysis, and intermittent fever for two weeks. A chest X-ray revealed a cavity in the right lower lobe. The patient underwent bronchoscopy, which demonstrated distorted architecture in the right lung with visualization of the visceral pleura. A biopsy from the surrounding tissue confirmed squamous cell carcinoma.

Conclusion: This case report illustrates a rare presentation of squamous cell carcinoma of the lung with a cavitary lesion and visualization of the visceral pleura on bronchoscopy. The findings emphasize the critical role of a systematic diagnostic approach, including advanced imaging, bronchoscopy, and histopathology, in managing complex lung pathologies.

Abstract No. 139: A rare convergence: Tuberculosis and malignancy unveiled by pleural effusion

Himanya Tatineni , L. Muthukumaran, S. Chandrasekar, S. Sridhar, N. Meenakshi

Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India

Background and Objectives: Tuberculosis (TB) and lung cancer pose significant global health challenges, often presenting with overlapping clinical features that complicate diagnosis. While TB is prevalent in endemic regions, lung adenocarcinoma is increasingly diagnosed in elderly populations. The coexistence of TB and lung cancer is rare but clinically significant, requiring a multidisciplinary diagnostic and therapeutic approach. This report discusses a 73-year-old female with chest pain, breathlessness, and pleural effusion, ultimately diagnosed with Stage IV lung adenocarcinoma and microbiologically confirmed pulmonary TB.

Case Study: A 73-year-old female with biomass fuel exposure, pet exposure, and tobacco snuff use presented with chest pain, breathlessness, appetite loss, and significant weight loss. Imaging revealed a heterogeneously enhancing lesion in the right lower lobe, pleural nodular thickening, and moderate effusion. Bronchoscopy showed narrowed lumen with no intraluminal obstruction and thoracoscopy findings included hemorrhagic fluid, sago-grain plaques and pleural thickening. Histopathology confirmed adenocarcinoma of lung, and Pleural tissue CBNAAT detected Mycobacterium tuberculosis. Immunohistochemistry showed TTF-1, CK7, and Napsin-A positivity. The patient was started on weight-based anti-tubercular therapy (ATT) and immune checkpoint inhibitor therapy.

Conclusion: Dual pathology of TB and lung adenocarcinoma is rare but clinically significant. A multidisciplinary approach using imaging, microbiology, and histopathology is essential for accurate diagnosis. Early ATT initiation and personalized cancer therapy are crucial for improving outcomes in such complex cases. Further research is needed to better understand the interaction between TB and lung cancer and optimize management strategies.

Abstract No. 140: From effusion to resolution: A pseudo-meigs case

Shaik Yasmin Sultana , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Pseudo-meigs syndrome is defined as pleural effusion, ascites and ovarian tumour other than fibroma.

Case Report: A 47yr old female presented with complaints of cough, breathlessness, abdominal pain and distension since 10 days. On examination decreased breath sounds on right hemithorax and xray shows right sided pleural effusion. Thoracocentesis done and pleural fluid sent for biochemical, cytological analysis.USG ABDOMEN showing solid cystic lesion suggesting malignancy and ca125 is elevated. Patient underwent laparotomy and resection of tumour and ovary has been done.Post resection pleural effusion and ascites was resolved confirming the diagnosis of pseudo-meigs syndrome.

Conclusions: The etiology of fluid accumulation remains unclear, most likely being filtration of interstitial fluid in peritoneum through tumour capsule and diffusion into pleural space through diaphragmatic lymphatic vessels and apertures.

Pseudo-meigs syndrome is rare entity. The management is symptomatic relief, exploratory laparotomy and definitive surgery.After surgery further management and prognosis depends on type of tumour.

Abstract No. 141: A case of right pneumothorax with persistent bronchopleural fistula treated by pleurodesis with autologous blood patch with contralateral post-tubercular lung disease

Shital Modak , Shahid Patel, Girija Nair, Sanket Patel, Nikhil Sarangdhar

Department of Pulmonary Medicine, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India

Introduction: Non-resolving pneumothorax with persistent bronchopleural fistula is a dreaded complication of underlying lung disease and it may not resolve by Conventional methods of treatment. We describe an unusual case of a young female, previously treated for drug-resistant pulmonary tuberculosis in childhood who developed pneumothorax with bronchopleural fistula on the contralateral side 9 years after treatment completion and was successfully treated with autologous blood patch.

Case Report: A 22-year-old female was referred with pneumothorax and ICD in situ. Physical examination was normal except for tachycardia and tachypnea. Chest Radiograph and CT revealed right sided pneumothorax with a destroyed left lung. The patient underwent fiberoptic bronchoscopy (FOB), right sided pleurodesis using autologous blood patch. Previous history was of MDR-TB in 2014 with resistance to Rifampicin and Isoniazid and susceptibility to Kanamycin, PAS, and Ofloxacin. Bronchoscopy was performed with sequential balloon occlusion of each segment of the right lung. Subsequently 2 autologous blood patch pleurodeses with 25 ml blood were performed was and the ICD was unclamped and post-procedure chest radiograph showed full expansion of right side of lung and patient was discharged. The pneumothorax resolved successfully without recurrence during follow-up.

Conclusions: Autologous blood patch pleurodesis provides an effective, cost-efficient alternative to surgical interventions for pneumothorax in patients with compromised pulmonary reserve. The fibrin seal created by autologous blood facilitates pleural adhesion and prevents further air leaks.

Abstract No. 142: A rare case of lymphangioleiomyomatosis presenting with bilateral spontaneous pneumothorax

Pallavi Jaybhaye , Radha Munje, Gyanshankar Mishra, Sanjay Gour, Kapil Mate

Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Introduction: Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease primarily affecting women of reproductive age. It occurs in two forms: tuberous sclerosis complex-associated LAM (TSC-LAM) and sporadic LAM, the latter arising due to spontaneous genetic mutations. LAM often presents with progressive dyspnea, recurrent pneumothorax, or chylous effusions, making early recognition crucial.

Case Report: A 41-year-old female farmer presented with sudden-onset breathlessness for seven days, initially Modified Medical Research Council (mMRC) Grade 2, progressing to dyspnea at rest over three days. She also reported right-sided chest pain and dry cough. There was no history of pulmonary tuberculosis, smoking, inhalational therapy, trauma, or prior hospitalization. She had undergone intercostal chest drain (ICD) insertion for a right-sided pneumothorax at a private hospital two days prior. On admission, vital signs were stable (pulse rate: 84/min, respiratory rate: 22/min, blood pressure: 104/70 mmHg, oxygen saturation [SpO 2 ]: 96% on room air, random blood sugar: 100 mg/dL). Chest radiograph revealed a left-sided pneumothorax with the right-sided ICD in situ, necessitating left-sided ICD placement. High-resolution computed tomography (HRCT) of the thorax showed gross left-sided pneumothorax, minimal right-sided pneumothorax, and multiple thin-walled cysts in both lungs, suggestive of cystic lung disease—LAM. Laboratory investigations were unremarkable except for elevated lactate dehydrogenase (LDH) (403 U/L). Histopathology from transbronchial lung biopsy (TBLB) confirmed LAM, with human melanoma black-45 (HMB-45) and smooth muscle actin (SMA) negativity. Vascular endothelial growth factor-D (VEGF-D) testing was recommended.

Conclusions: LAM should be considered in women of reproductive age presenting with spontaneous pneumothorax, especially when HRCT reveals multiple thin-walled lung cysts. Early diagnosis is crucial for appropriate management.

Abstract No. 143: Empyema in a child with suspected osteogenesis imperfecta: Unveiling a rare diagnostic interplay

Pallavi Jaybhaye , Radha Munje, Gyanshankar Mishra, Kapil Mate

Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Introduction: Empyema is a serious pediatric complication of pneumonia, often requiring early diagnosis and intervention. When associated with skeletal abnormalities, conditions like osteogenesis imperfecta (OI) should be considered, as they may predispose patients to infections and fractures. This case highlights the diagnostic challenge of empyema in a child with suspected OI.

Case Report: A 13-year-old male presented with fever for 10 days, right-sided chest pain, breathlessness, and dry cough for 7 days. His history included recurrent leg fractures, bilateral congenital clubfoot, and walking difficulties since birth. On admission, vital signs were: pulse rate (PR): 134/min, respiratory rate (RR): 40/min, blood pressure (BP): 100/70 mmHg, oxygen saturation (SpO 2 ): 99% on room air, temperature: 102°F. Clinical examination revealed acute respiratory distress, right-sided chest tenderness, and diminished breath sounds. Chest X-ray and thoracic ultrasound showed a moderate right-sided pleural effusion, and diagnostic thoracentesis revealed frank pus, confirming empyema. Laboratory findings included anemia, leukocytosis, elevated erythrocyte sedimentation rate (ESR), and high pleural fluid adenosine deaminase (ADA) and lactate dehydrogenase (LDH) levels. Pleural fluid analysis identified methicillin-resistant Staphylococcus aureus (MRSA) sensitive to linezolid, cotrimoxazole, doxycycline, and chloramphenicol. Further evaluation revealed blue sclera on ophthalmic examination, raising suspicion of OI as an underlying connective tissue disorder. The patient was treated with MRSA-sensitive antibiotics and supportive care, leading to clinical improvement.

Conclusions: Children with osteogenesis imperfecta have an increased risk of recurrent respiratory infections and pleural effusion. Early recognition of underlying skeletal disorders is crucial for timely intervention and better clinical outcomes.

Abstract No. 144: The pancreatic floodgates: A case of pancreatic pleural effusion

Kommera Akshay , A. Vinay Kumar

Department of Pulmonary Medicine, Chalmeda AnandRao Institute of Medical Sciences, Karimnagar, Telangana, India

Background: Pancreatic pleural effusion often unrecognized clinical syndrome which results from an internal pancreatic fistula and usually presents as an exudative effusion of unknown cause. The effusion frequently occurs without clinical evidence of pancreatitis, but occasionally it may be associated with a pseudocyst of the pancreas. Chronic massive pancreatic pleural effusion is usually recurrent and characterized by very high levels of amylase in the pleural fluid.

Case Report: 37 year old male patient with history of chronic alcohol usage and previous episodes of pancreatitis presented with complaints of productive cough since 1 month, Difficulty breathing since 1 month which was gradually progressing. chest Xray reviled a right gross pleural effusion thoracocentesis was done dark red colour fluid was drained & Fluid analysis showed educative picture i/v/o respiratory distress a chest tube was placed. Sr. Amylase and lipase are elevated, pleural fluid cytology was negative,Pleural fluid analysis for amylase and lipase are elevated, cect abdomen revealed chronic pancreatitis features leading to a diagnosis of pancreatic pleural effusion.

Conclusion: Chronic pancreatic pleural effusion is a rare and complex condition that poses significant diagnostic and therapeutic challenges. Our case highlights the importance of considering this condition in patients with recurrent or persistent pleural effusion, particularly in those with a history of pancreatic disease. The management of chronic pancreatic pleural effusion requires a multidisciplinary approach, involving gastroenterologists, pulmonologists, and surgeons. While thoracocentesis and ERCP with stenting can provide temporary relief, surgical intervention may be necessary in some cases to address the underlying pancreatic disease.

Abstract No. 145: The baffling enigma of pleural effusion

Vishak Acharya , Madhav Kamath, Saraswathi Ram Mohan, Aquilin Sara Alias

1 Department of Respiratory Medicine, Kasturba Medical College, Mangalore, Karnataka, India

Introduction: Mediastinal cysts are true congenital cysts and are commonly found in the middle mediastinum, comprising of 12-25% of the mediastinal mass.Bronchogenic cysts are the most common (40-50%) followed by esophageal duplication cysts. They are usually incidental findings on computed tomography, typically appearing as a round fluid filled lesion. Esophageal duplication cysts are present in early childhood, with an incidence rate of 1 in 8200, with twice as likely to occur in males compared to females.

Case Report: 52 year old female presented to the outpatient department of Kasturba Medical College, with complaints of on and off fever for 2 months, with chest x-ray showing gross right sided pleural effusion, which warranted further evaluation. On physical examination, there was decreased breath sounds over the right interscapular, infrascapular, mammary, infra-axillary areas. Blood tests revealed elevated total counts, Pleural fluid showed lymphocyte predominance and culture grew methicillin resistant staphylococcus aureus, with GeneXpert being negative. Imaging: USG Chest showed right sided gross pleural effusion, with cholelithiasis. MRCP was done, showed cholelithiasis, loculated collection indenting the left lobe of liver, left hepatic vein with suspicion of mediastinal cyst. PET scan -Duplication cyst in the right hemithorax with no FDG uptake he was taken up for right sided thoracotomy with excision biopsy.Histopathology showed features consistent with esophageal duplication cyst. Esophageal duplication cysts should be considered as a rare but possible differential diagnosis in patients with recurrent right sided pleural effusion.Esophageal duplication cysts are commonly seen in children. They are usually asymptomatic and are found incidentally.

Conclusions: The case underscores the importance of considering congenital anomalies like esophageal duplication cysts in the differential diagnosis for patients presenting with atypical chest symptoms. Early diagnosis is essential to prevent complications of infection, compression of adjacent structures. Surgical excision remains the definitive treatment.

Abstract No. 146: Idiopathic chylothorax with chylous pericardial effusion resolved after surgical intervention: A rare case report

Abhay H. Moon

B. J. Government Medical College, Pune, Maharashtra, India

Introduction: When Thoracic duct gets disrupted chyle drains into pleural or pericardial space causing chylothorax and chlylous pericardial effusion. Causes can be grouped into four categories; Trauma, malignancy, miscellaneous and idiopathic of which Trauma is most common cause followed by malignancy.

Case Report: A 17 year old male presented to outpatient department with complaints of left sided chest pain and breathlessness on exertion since 1 month. On Auscultation, breath sounds were reduced on left side. Chest Xray- homogenous opacity involving entire left lung field with Cp angle blunting with mediastinal shift to right. Usg thorax- left gross pleural effusion with mild to mod pericardial effusion. (1) Pleural tap was done and fluid sent for investigation, (2) Pleural fluid reports showed increased trigyceride levels (>1382 mg/dl). LDH- 96 Cytology- negative for malignancy, (3) ICD inserted due to Recurrent refilling of fluid and pericardial drain inserted as 2Decho s/o gross pericardial effusion, (4) USG neck and lymphoscintigrapy were normal, (5) Treatment: Left Posterolateral Thoracotomy, Left lung Decortication and pleurodesis and Pleuro- Percardial window, right lateral thoracotomy( muscle sparing), Thoracic duct ligation and Right pleurodesis.

Conclusion: Here we discussed the case of Chylothorax with chylous pericardial effusion where even after extensive diagnostic work up cause could not be found and recovered completely after surgical ligation of thoracic duct.

High suspicion, early diagnosis and early surgical intervention is essential to prevent malnutrition and complete recovery.

Abstract No. 147: A rare case of idiopathic chylothorax with chylous pericardial effusion

Abhay Moon

B. J. Government Medical College, Pune, Maharashtra, India

Introduction: When Thoracic duct gets disrupted chyle drains into pleural or pericardial space causing chylothorax and chlylous pericardial effusion. Causes can be grouped into four categories; Trauma, malignancy, miscellaneous and idiopathic of which Trauma is most common cause followed by malignancy.

Case Report: A 17 year old male presented to outpatient department with complaints of left sided chest pain and breathlessness on exertion since 1 month. On Auscultation, breath sounds were reduced on left side. Chest Xray- homogenous opacity involving entire left lung field with Cp angle blunting with mediastinal shift to right. Usg thorax- left gross pleural effusion with mild to mod pericardial effusion. Pleural tap was done and fluid sent for investigation. Pleural fluid reports showed increased trigyceride levels (>1382 mg/dl). Cytology- negative for malignancy. ICD inserted due to Recurrent refilling of fluid and pericardial drain inserted as 2Decho s/o gross pericardial effusion. USG neck and lymphoscintigrapy were normal. Treatment: Left Posterolateral Thoracotomy, Left lung Decortication and pleurodesis and Pleuro- Percardial window, right lateral thoracotomy( muscle sparing), Thoracic duct ligation and Right pleurodesis.

Abstract No. 148: A case of recurrent pneumothorax associated with tuberous sclerosis

Nagineni Venkata Vineela , S. Venkateswarlu, K. M. Dhanamurthy, Sahithi Karnala

Mamata Medical College, Khammam, Telangana, India

Introduction: Lymphangioleiomyomatosis (LAM) is a multisystem disorder predominantly affecting women, characterized by cystic lung lesions, abdominal angiomyolipomas and lymphatic abnormalities. It occurs in Tuberous sclerosis (Bourneville disease), an Autosomal Dominant disorder resulting from germline mutations in TSC1 and TSC2 genes.

Case Report: A 20yr old female presented with sudden onset of dyspnea and left sided pleuritic chest pain. Past H/O recurrent pneumothorax with repeated tube thoracostomy (8 times with in the past 2 years). O/E - Red papules on face involving nasolabial folds, cheek, hypopigmented macules on legs are seen. O/A - RS - Absent breath sounds over left hemithorax. Investigations: CBP - Within normal limits. CXR PA VIEW - Left sided pneumothorax present. CT CHEST & ABDOMEN - Multiple large cysts in B/L upper lobes and small cystic lesions in right middle and B/L lower lobes. Pneumothorax present on left side. Multiple lipomatous tumors in both kidneys and liver suggestive of angiomyolipomas. Treatment - ICD tube thoracostomy and Tab.Sirolimus.

Conclusion: LAM is a disease of women usually of reproductive age. LAM should be considered as differential diagnosis of cystic disease and recurrent pneumothorax.

Abstract No. 149: Unveiling recurrent spontaneous pneumothorax: An overview of the rare condition

B. Bavithra , Raghu Srikanti

Department of Pulmonary Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India

Introduction: Pneumothorax is abnormal presence of air in the pleural cavity. It can be spontaneous and traumatic. Spontaneous can be primary or secondary. Primary is without underlying lung disease. Secondary is due to airway disease, connective tissue disorder, malignancy, etc.

Case Report: A 13 year old girl brought to hospital with complaints of sudden onset breathlessness with left sided chest pain since 2 days. Patient is on Anti-tubercular treatment since 5 months under sputum basis. Previous history of right sided pneumothorax for which Intercostal drain insertion done in outside hospital 1 week back followed by resolution. On examination positive wrist / thumb sign, arachnodactyly, high arched palate, suggestive of marfanoid Habitus. Chest Xray showed Right upper lobe hyperlucency, Left sided Pneumothorax with bilateral cystic lucencies. High-resolution computed tomography chest showed Left sided pneumothorax, right upper lobe bulla, Bilateral cystic lucencies with surrounding consolidation. Patient had seizure episode suggestive of hypercoaguable state. Magnetic Resonance Imaging Brain showed cerebral venous sinus thrombosis. Clinical and radiological picture is in favour of marfans syndrome, which is responsible for Secondary spontaneous pneumothorax.

Conclusions: Recurrent spontaneous pneumothorax (RSP) is a clinically significant condition that presents unique challenges in diagnosis and management. It not only occurs due to pulmonary consequences but also due to systemic manifestations either acquired or genetic predispositions.

By early diagnosis and treatment of multisystem involvement in marfan’s syndrome increases the life expectancy by 30 years.

Abstract No. 150: Psoriatic arthritis with bronchiectasis presenting with secondary spontaneous pneumothorax

Sahu Gaurav , Nair Shreeja, Potdar Pradeep

Department of Respiratory Medicine, MGM Hospital, Kamothe, Maharashtra, India

Introduction: Psoriatic arthritis (PsA) is an inflammatory autoimmune condition that primarily affects the joints but can also involve various extra-articular manifestations, including the lungs. While pulmonary complications in PsA are less common, bronchiectasis/cystic/ bullous lung disease has been documented, and secondary spontaneous pneumothorax (SSP) may complicate pre-existing lung disease. However, the association between PsA, cystic lung disease and SSP is rarely described in the literature. We present a 19-year-old malnourished male with Pierre-Robin syndrome, PsA, bullous lung disease, and bronchiectasis.

Case Report: He presented with acute right-sided chest pain, dyspnea, and hypoxia. Imaging revealed a large right-sided pneumothorax, which was managed with thoracostomy tube placement. However, a bronchopleural fistula was slow to heal. Bronchoscopy was attempted but complicated by maxillary and mandibular hypoplasia. The fistula, located in the posterior segment of the right upper lobe, was identified using dye instillation. Broncho-alveolar lavage revealed Enterobacter and Acinetobacter species, and antibiotics were adjusted accordingly. The patient improved and was discharged after 30 days with follow-up for PsA and bronchiectasis. This case highlights the rare but important consideration of secondary spontaneous pneumothorax in asyndromic patient with psoriatic arthritis and bronchiectasis with bullae. Chronic pulmonary diseases, such as cystic lung disease and bullous lung disease, increase the risk of pneumothorax due to airway damage and lung tissue fragility. [1] Clinicians should be aware of this potential complication in patients with autoimmune diseases and chronic lung conditions, particularly when they present with acute respiratory symptoms. Pulmonologists should anticipate difficulty that may arise when attempting bronchoscopy in patients with poor mouth opening and narrowed airway for management of Bronchopulmonary fistulae.

Keywords: Autoimmune disease, bronchiectasis, chest tube, cystic lung disease, Pierre Robin’s syndrome, psoriatic arthritis, respiratory distress, secondary spontaneous pneumothorax1

Reference

1. Cooley J, Lee YC, Gupta N. Spontaneous pneumothorax in diffuse cystic lung diseases. Curr Opin Pulm Med 2017;23:323-33.

Abstract No. 151: A prospective cohort study comparing the effects of standard versus long term pulmonary rehabilitation program in patients with interstitial lung diseases

Gopika Ramesh , M. Anand, Safreena Muhamed

Government Medical College, Kozhikode, Kerala, India

Introduction: Interstitial lung disease (ILD) comprises of a heterogeneous group of diseases characterized by varying degrees of pulmonary inflammation and fibrosis. Pulmonary rehabilitation is an important component in the treatment of patients with ILD.

Methods: A prospective cohort study of 60 patients with ILD were studied at Government Medical College, Kozhikode. Patients were recruited into 2 groups. One group received PR program of 8 weeks and the other group received PR program of 20 weeks. After collecting baseline data, patients were recruited for pulmonary rehabilitation program (PR). They were followed up at 3,6,9 months and assessed pulmonary functions, 6MWD and other relevant data.

Results: Out of 60 patients with ILD, 38 were females and 22 were males. They were equally recruited into 2 groups. The long term pulmonary rehabilitation group showed a significantly greater increase in 6 Minute Walk Distance (6MWD) 380m compared to standard pulmonary rehabilitation group 260m (p value <0.001). There was no significant change in pulmonary function test (FEV1, FVC, FEV1/FVC). Long term pulmonary rehabilitation group showed substantial reduction in SGRQ scores, but not statistically significant. Dyspnea score was improved in long term pulmonary rehabilitation group, but not statistically significant. Anxiety and depression scores improved significantly in the long term pulmonary rehabilitation group compared to standard pulmonary rehabilitation group.

Conclusion: Long term pulmonary rehabilitation provides significant benefits over standard pulmonary rehabilitation program in patients with ILD, including improved exercise capacity, quality of life along with reduced rates of hospitalisations and exacerbations.

Keywords: 6MWD, interstitial lung disease, pulmonary rehabilitation

Abstract No. 152: When is the earliest benefit of pulmonary rehabilitation in a real world setting? Efficacy analysis of a 3–week milestone in an outpatient pulmonary rehabilitation program

T. V. Sagar , Yogita Hatmode, Sameer Bansal, Anmol Thorbole, Ravindra Mehta

Department of Pulmonary Rehabilitation, Vaayu Chest and Sleep Specialists, Bengaluru, Karnataka, India

Background: Guidelines recommend a minimum 6-week comprehensive Pulmonary rehabilitation (PR) program for patients with chronic respiratory diseases (CRDs), to see desired outcomes. However, acceptance, adherence, logistics and economics is a challenge in the global and Indian setting for the recommended duration. We hypothesized that a lesser duration may also meet desired outcomes, and assessed the interim efficacy/outcomes at the 3-week milestone in an outpatient PR program.

Methods: A retrospective analysis was conducted at a 3-week interim period in patients undergoing outpatient PR for various CRDs, at an outpatient PR facility in Bengaluru (VAAYU Chest and Sleep Services). 2 supervised sessions were conducted every week.

Results: 380 patients were enrolled for PR program of varying durations (3 to 12 weeks). 182/380 (48%) patients completed a 3-week program, and were assessed for standard outcomes. The mean age was 64.3 yrs. (±15). The most common diagnoses were Interstitial Lung Disease, Chronic Obstructive Pulmonary Disease, Asthma, Bronchiectasis and others in 40%, 23%, 17%, 12% and 8% patients respectively. Average 6 Minute Walk Distance (6MWD) was 252m (±103) at baseline. Mean increase after 6 sessions was 33.6 [p - 0.16]. Mean change in Fatigue severity scale (FSS) was -7.4 [p<0.01] from a baseline mean score of 38. Mean change in CAT score was -4 [p<0.01] from a baseline mean of 23, while change in SGRQs was -8.9 [p<0.01] from baseline average score of 48.6. MCID was reached for all parameters after a 3-week (6 sessions) PR program, except for 6MWD. Of note, there was a high re-enrolment rate (62%) for longer duration PR program after completion of 6 sessions.

Conclusion: The earliest significant improvement is seen at 3 weeks in an outpatient PR program, which may represent the minimal effective duration that leads to significant improvement of functional and quality of life parameters. This milestone also encourages patients to re-enrolment for longer PR programs, overcoming challenges mentioned above.

Keywords: Chronic respiratory diseases, pulmonary rehabilitation

Abstract No. 153: Coexistence of upper airway obstruction in flow-volume loops on spirometry in patients with COPD and post-infectious obstructive airway disease

Dipika Koli , Unnati Desai, Ketaki Utpat

Department of Respiratory Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India

Introduction: Spirometry is essential for diagnosing respiratory diseases like COPD and post-infectious obstructive airway disease, particularly in assessing airflow obstruction through FEV1 (Forced expiratory volume in 1 second) and FVC (Forced vital capacity) measurements. It also helps detect Upper Airway Obstruction (UAO), which can complicate these conditions. In patients with COPD and post-infective airway disease, the presence of UAO may exacerbate symptoms and alter spirometric patterns, making it essential to evaluate both lower and upper airway components. This study focuses on using spirometry to identify Upper Airway Obstruction (UAO) and assess its impact on lung function in these patients.

Methods: This is a retrospective observational study, conducted over two years at a tertiary care center, including spirometric testing of COPD and PIOAD patients. Measurements included FEV1, FVC, PEF, Empey’s index, ratio of the flow at the midpoint of the forced expiratory manoeuvre to the flow at the midpoint of the forced inspiratory manoeuvre FEF50/FIF50, and flow-volume loops (FVLs). The various spirometry indices and FVLs were analyzed to identify distinct patterns of airway obstruction, focusing on variations in peak expiratory flow and loop shape, which may reflect differences in the underlying pathology of airflow limitation.

Results: The study included 193 patients, with 80 diagnosed with COPD and 113 with PIOAD. The mean age was 56.3 years (±12.95), with 126 males and 67 females. Visual assessment of flow-volume loops (FVLs) showed 120 patients with normal loops (48 COPD, 72 PIOAD). Inspiratory loop flattening was observed in 17 patients (5 COPD, 12 PIOAD), and expiratory loop flattening in 42 patients (22 COPD, 20 PIOAD). Both inspiratory and expiratory loop flattening was seen in 5 patients (3 COPD, 2 PIOAD). Variable intrathoracic UAO was present in 53 COPD and 49 PIOAD patients, while extrathoracic UAO was seen in 3 COPD and 26 PIOAD patients. Fixed UAO occurred in 2 PIOAD patients.

Conclusion: The study found that upper airway obstruction can occur in COPD and PIOAD patients, further limiting airflow and worsening FEV1 reduction, altering flow-volume loops, and lowering the FEV1/FVC ratio. The added resistance from upper airway narrowing complicates spirometry, exacerbating the obstructive pattern and worsening lung function.

Keywords: Chronic obstructive pulmonary diseases, flow-volume loop, post-infectious obstructive airway disease, upper airway obstruction

Abstract No. 154: He role of impulse oscillometry in the early detection of airway changes in smokers and non-smokers

K. Shanmugapriya 1,2

1 Department of Respiratory Medicine, Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India, 2 Dr. M. G. R. Educational and Research Institute, Chennai, Tamil Nadu, India

Background: Spirometry is a diagnostic tool commonly used to treat chronic obstructive pulmonary disease (COPD). The impulse oscillometry system (IOS) allows for the calculation of respiratory impedance indices, showing promise for early COPD detection.

Methods: This prospective comparative study was performed at a tertiary care hospital. Consecutive sampling was employed to select the participants. We recruited participants into two groups: non-smokers and smokers (n=30 in each group). All participants underwent comprehensive evaluation, including spirometry and IOS assessments. These measurements provided important data for comparative analysis of respiratory function within the studied groups.

Results: Non-smokers were outnumbered in all categories except for the 21-30 group. The proportion of smokers was 23.3%, compared to 16.7% of non-smokers. The highest proportion of non-smokers was found in the 41-50 age group (33.3%), while the lowest was in the 21-30 group (16.7%). The highest proportion of smokers was found in the 21-30 age group (23.3%), and the lowest was in the 41-50 age group (13.3%). Smokers and non-smokers showed similar distributions in weight categories: normal weight (36.7%), overweight (53.3%), and obese (10%). No significant differences in demographic characteristics were observed. Significant differences emerged in spirometry parameters (FEV1, FVC, FEV1/FVC, and FEF) and IOS parameters (R5, R5-R20, and AX) between smokers and non-smokers. Among smokers with normal spirometry results, 53% had airway obstruction in the IOS.

Conclusion: The IOS is effective in assessing airway obstruction in patients with limited cooperation. Furthermore, it acts as a sensitive screening tool for early detection of bronchial obstruction.

Abstract No. 155: The effects of respiratory training and limb exercises on pulmonary function, sputum clearance and quality of life in patients with bronchiectasis

A. Nikhil Krishnan , E. Jyothi

Department of Pulmonary Medicine, Government Medical College, Kerala University of Health Sciences, Kozhikode, Kerala, India

Background: Effective airway clearance, anti-infective treatment, and preservation of airway patency have long been considered crucial therapeutic modalities for bronchiectasis. The role of pulmonary rehabilitation has been extensively studied in patients with chronic respiratory disorders. While most of the research associated with pulmonary rehabilitation has been done in patients with COPD, there is limited data about its efficacy in patients with bronchiectasis. This study aims to investigate the effects of respiratory rehabilitation and limb exercise training on pulmonary function, sputum clearance and quality of life in patients with bronchiectasis.

Methods: Primary observation indexes include patient’s sputum volume, 6MWD, spirometry values and St George Respiratory Questionnaire. Data will be collected on first visit after taking written informed consent and enrolled into the program. Supervised respiratory training combined with limb exercises will be given to the patient for a total period of 3 months at a frequency of 3 times a week. A typical session will be a 45 minute supervised training. It includes diaphragmatic and pursed lip breathing techniques, deep breathing with chest wall expansion, endurance training and limb exercises. Sample size – 70.

Results: After the programme, sputum volume increased from 23±5.2 to 35 ±8.8 ml/day; FEV1 increased from 1.27±0.38 to 1.46±0.18L; FVC increased from 1.53±0.26L to 1.70±0.27L; 6MWD improved from 282+/-48 to 321m+/- 55; SGRQ also showed improvement.

Conclusion: The study results suggest that pulmonary rehabilitation significantly improved the quality of life, pulmonary function and sputum clearance in patients with bronchiectasis.

Abstract No. 156: Utility of forced oscillometry technique in pediatric population

R. Usmanali , Dipika Koli, Ketaki Utpat, Unnati Desai

Department of Respiratory Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India

Introduction: Spirometry is currently the commonly performed lung function test in clinical practice for diagnosis of obstructive airway diseases. However, it requires forceful expiratory and inspiratory maneuver and good patient co–operation. Spirometry cannot be done in pediatric population who are unable to understand complex commands. Forced oscillometry technique (FOT)is a non-invasive method to assess lung function. In 1956, DUBOIS et al described the forced oscillation technique by using sinusoidal sound waves of single frequencies generated by a loud speaker and passed into the lungs during tidal breathing. The output of a measure of respiratory impedance (z), which included the respiratory resistance (R) and respiratory reactance (X) measured over a range of frequencies (usually from 3 to 35Hz). FOT has advantages being effort independent for diagnosis of multiple respiratory conditions.

Case Report: A 9-year-oldfemale child, 4 th standard student was referred to the OPD. She was symptomatic since 4 yr with complaints of episodic dyspnea and episodic cough, seasonal and diurnal variation of symptoms,allergic rhinitis on exposure to dust and cold. No family history of bronchial asthma. The clinical examination was normal. Chest X-Ray was normal. The patient did not cooperate for a PFT. Hence a FOT was performed [ Figure 1 ]. The FOT showed an increase in resistance at 5 hertz (R5), normal resistance at 19 Hertz (R19), increase in resistance of the small airways ( R5-19), The reactance was more negative (X5) and the an increased FRES. All these findings were suggestive of a small airway obstruction.

Conclusion: FOT diagnosed small airway obstruction in this pediatric patient.

FOT is a non-invasive test which can be easily done in children, elderly and disabled patients.

Abstract No. 157: Chest ultrasound in emergency settings: A versatile tool for rapid pulmonary diagnosis

Satheesh Radhakrishnan

MOSC Medical Mission Hospital, Kunnamkulam, Thrissur, Kerala, India

Introduction: Chest ultrasound (USG chest) is a non-invasive, bedside imaging tool enabling rapid evaluation of respiratory conditions in emergency settings. This study assesses its diagnostic utility by comparing clinical history, USG chest findings, and final diagnoses in pulmonary pathologies.

Methods: Design: Prospective analysis of 50 patients with respiratory distress. Protocol: Diagnoses were established based on: (1) Clinical history and symptoms, chest X ray. (2) USG chest findings using BLUE protocols. (3) Final diagnoses confirmed by clinical, radiological, and laboratory data. Conditions Studied: (1) Pulmonary oedema, (2) COPD/Asthma, (3) Lung consolidation/pleural effusion, (4) Interstitial lung diseases (ILD).

Results: Demographics: Mean age: 62 years (range: 45–80); male-to-female ratio: 2:1. Sensitivity (S), specificity (Sp) and Cases Diagnosed by Modality: (1) Pulmonary oedema. (i) History: 16 (S- 88.9%, Sp- 92%), (ii) Clinical evaluation: 15 (83.3%, Specificity-100%), (iii) Chest X ray: 9 (S- 50%, Sp-100%), (iv) USG chest-19 (S-100%, Sp-96.8%), (v) Final diagnosis- 18. (2) COPD/Asthma. (i) History: 14 (S-71.4%, Sp-90%), (ii) Clinical evaluation: 17 (S-58.8%, Sp-87.5%), (iii) Chest X ray: 15 (S-66.7%, Sp- 87.5%), (iv) USG chest: 9 (S-66.7%, Sp-85%), (v) Final diagnosis:10. (3) Consolidation/ pleural effusion. (i) History:12 (S-66.7%, Sp-100%), (ii) Clinical evaluation: 15 (S-83.3%, Sp-100%), (iii) Chest X ray: 10 (S-55.6%, Sp-100%), (iv) USG chest: 18 (S-100%, Sp-100%), (v) Final diagnosis: 18, (vi) Interstitial lung disease, (vii) History:8 (S-66.7%, Sp-90%), (viii) Clinical evaluation:2 (S-16.7%, Sp-90%), (ix) Chest X ray: 1 (S-8.3%, Sp-94%), (x) USG chest: 4 (S-100%, Sp-96.7%), (xi) Final diagnosis: 4.

(1) Pulmonary Oedema and Consolidation/Pleural Effusion: USG chest demonstrated superior accuracy compared to history, clinical evaluation, and chest X-ray, achieving 100% sensitivity and specificity for consolidation/pleural effusion. (2) COPD/Asthma: Combining USG chest with clinical history improved diagnostic accuracy. (3) ILD: USG chest showed high diagnostic precision even for less common conditions.

Conclusion: USG chest is a highly accurate, reliable, and indispensable tool for diagnosing pulmonary conditions, particularly pulmonary oedema and lung consolidation. Its bedside utility, especially in resource-limited emergency settings, significantly improves diagnostic precision and patient outcomes.

Abstract No. 158: Radiological outcomes as “residual lung abnormalities” in recovered COVID-19 pneumonia cases at 1 year follow up: The “post COVID lung study” in dedicated covid care setting

Shital Patil 1 , Ganesh Narwade 1 , Gajanan Gondhali 2 , Deepak Patil 2 , Manojkumar Bhadake 2

1 Department of Respiratory Medicine, Venkatesh Chest Hospital and Critical Care Center, Latur, Maharashtra, India, 2 Department of Internal Medicine, MIMSR Medical College, Latur, Maharashtra, India

Introduction: Radiological outcomes are initially interpreted as post covid lung fibrosis in short term follow-up of recovered COVID-19 cases in post covid care settings and during long term evaluation these abnormalities are defined as post covid sequalae’s. In present study, post covid lung abnormalities were evaluated as ‘Residual Lung abnormalities (RLAs)’ as radiological outcomes phenotypes.

Methods: Prospective, observational study, initially included 1000 COVID-19 RT-PCR confirmed cases with lung involvement documented and radiological severity phenotypes categorized on HRCT thorax as mild, moderate and severe as per lung segment involvement bilaterally at entry point. Final radiological outcomes were defined by performing radiological assessment done at one year of discharge from hospital in cases with specified inclusion criteria. Radiological final outcomes phenotypes were defined as radiological lung abnormalities (RLAs) and categorised as resolving, persistent and progressive types documented in HRCT imaging at one year of follow up. Finally, we have included 209 cases with RLAs. Covariates recordings of age, gender, comorbidity, laboratory parameters and interventions such as oxygen support and oxygen plus ventilatory support requirement during hospitalization were done. Statistical analysis is done by using Chi square test.

Results: RLAs were documented in 20.73% (209/1000) cases. Final radiological outcomes were documented as resolving 72.24% (151/209), persistent 19.61% (41/209) and progressive 8.13% (17/209). Significant association was documented between RLAs and duration of illness at entry point [p<0.00001], laboratory parameters at entry point (D-dimer, CRP, IL-6) [p<0.00001], radiological CT severity phenotypes [p<0.00001] and interventions required in indoor unit [p<0.00001]. Significant association observed between RLAs with covariates such as age, gender, diabetes mellitus, IHD, Hypertension, COPD, Obesity and lung functions assessment by spirometry at one year follow-up. [p<0.00001].

Conclusion: Radiological lung abnormalities (RLAs) are new radiological classification of post covid lung sequelae and categorized as resolving, persistent and progressive. Final outcomes phenotypic classification showed an important role in further workup and treatment plannings of these RLAs during follow up. Importantly, the proportionate number of progressive phenotypes have underlying rheumatological predisposition, and the large number of cases in resolving phenotypes doesn’t need any treatment; while, few cases in the persistent category need protocolized follow up.

Abstract No. 159: A study on ultrasonographic evaluation of diaphragmatic activity and its correlation with disease severity among cases of chronic obstructive pulmonary disease attending in a tertiary care hospital

Subhasish Chanda , Animesh Mandal

Department of Respiratory Medicine, IPGMER and SSKM Hospital, Kolkata, West Bengal, India

Introduction: Being the chief respiratory muscle, the function of diaphragm has a direct impact on the prognosis and quality of life in COPD patients. Here, we assessed the structural and functional status of diaphragm by Ultrasonography in stable COPD patients.

Methods: This is a cross-sectional observational study done in 100 stable COPD patients attended the OPD of Department of Respiratory Medicine, IPGME&R and SSKM Hospital. Basic clinical details, spirometric assessment, CAT SCORING and BODE INDEX were collected for each patient. Diaphragm structure and function were measured in terms of thickness, thickening ratio and fraction, excursion separately for both right and left hemi-diaphragms and the values are compared with progressive worsening of COPD.

Results: Out of 100 patients, 58 patients were male and 42 were female. The mean age of the patients was 62.94±6.49. The outcomes were compared with mild, moderate, severe obstructive groups. There were significant differences in diaphragmatic thickening fraction- Right side: 63.57±9.32, 60.96±10.23, 48.71±10.43 (p<0.001) and Left side: 66.29±8.63, 60.77±8.64, 53.42±7.98 (p <0.001). There were significant differences in thickening ratio- Right: 1.63±0.09, 1.60±0.10, 1.48±0.10 (p <0.001) and Left: 1.67±0.11, 1.61±0.08, 1.53±0.08 (p <0.001). There were significant differences in excursion during deep inspiration- Right: 4.20±0.40, 3.92±0.46, 3.29±0.41 (p <0.001) and Left: 4.23±0.36, 4.02±0.46, 3.37±0.40 (p <0.001). Both thickness ratio (Right: r -0.701, Left: -0.634; p <0.001) and excursion (Right: r -0.784, Left: r -0.768; p <0.001) were significantly correlated with the number of exacerbations.

Conclusion: Diaphragm ultrasound parameters can be used along with pulmonary function tests for the evaluation of severity in COPD patients.

Keywords: COPD, diaphragm excursion, diaphragm thickness

Abstract No. 160: USG guided lung biopsy in a case of pulmonary tuberculosis mimicking as lung malignancy

Geet Doshi

Doshi Chest Clinic & Hospital, Baramati, Maharashtra, India

Introduction: The diagnosis of peripheral lung lesions is challenging as the yield of Sputum cytology & flexible bronchoscopy is relatively low. For peural/peripheral lung parenchymal lesions the diagnostic accuracy of Ultra-Sonography(USG) guided biopsy is similar to that of CT guided biopsy.

Case Report: A 45/M presented with chronic dry cough,breathlessness,Left sided chest pain & constitutional symptoms since 6 months. Patient was admitted & all routine investigations were done. Chest X-Ray (CXR) was suggestive of left sided multiple well circumscribed homogenous opacities. A contrast enhanced CT Thorax was obtained to look for vascular involvement of the lesions; which suggested non-vascular lesions. The largest sub-pleural lesion was selected and USG guided lung biopsy was done with Bard’s Biopsy Gun under local anaesthesia. The lesion was located by scanning the intercostal spaces & Colour Doppler helped identify the absence of blood vessels in the path of biopsy. Biopsy with caseous material was collected in 2 containers – 1)Normal Saline-(Truenat) 2)Formalin-(Histopathology-HPE). Post procedure USG screening showed no evidence of Pneumothorax. Post procedure CXR showed no evidence of pneumothorax. Truenat reported MTB detected, Rifampicin Resistance not detected. HPE was suggestive of acute on chronic inflammatory infiltrates composed of neutrophils, eosinophils & macrophages with large areas of necrosis. Patient was started on Antitubercular drugs 4FDC 4-tablets/day (Weight 52Kg) under NTEP(National Tuberculosis Elimination Program) and was discharged.

Conclusion: USG remains underutilized as a diagnostic technique despite its high diagnostic yield, real time guidance, no radiation exposure. USG is portable, light-weight, affordable with excellent imaging, readily available & its use in interventional procedures should be encouraged.

Abstract No. 161: A curious case of cyclic chest chaos: Thoracic endometriosis syndrome

Shivam Gurme , Jairaj P. Nair, Sonal Karpe, Swapnil Thorve, Siddharth Waghmare, Anjali Kamath

Department of Respiratory Medicine, Lokmanya Tilak Medical College and General Hospital, Mumbai, Maharashtra, India

Introduction: Recurrent hemorrhagic pleural effusion is often caused by tuberculosis, malignancy, or collagen vascular diseases. However, thoracic endometriosis (TES), an extra-abdominal manifestation of endometriosis, should also be considered in women of reproductive age. Thorax is the most common site for TES, which requires a high degree of clinical suspicion for diagnosis. We present a rare case of recurrent pleural effusion due to TES in a young female with infertility.

Case Report: A 33-year-old female presented with 6 months of exertional dyspnoea (MMRC grade 2) and occasional dry cough. She was treated for tubercular cervical lymphadenopathy and had undergone three therapeutic thoracenteses. Her menstrual history was significant for menorrhagia and dyspnoea since menarche. She underwent hysteroscopy and work up for infertility was inconclusive. Clinical examination and chest xray revealed moderate right-sided pleural effusion. Thoracentesis showed hemorrhagic fluid. Pleural fluid analysis ruled out tuberculosis and malignancy. Medical thoracoscopy revealed hemorrhagic fluid and small raised erythematous area on the parietal pleura. Biopsy of this area showed endometrial stroma, confirmed by immunohistochemistry (PAX8 and CD10 positive), diagnosing pleural endometriosis. The patient underwent talc slurry pleurodesis and started on monthly subcutaneous GnRH analogue injections for 3 months. Follow-up chest X-ray after 3 months showed no recurrence of pleural effusion.

Conclusion: Awareness and early recognition of thoracic endometriosis can prevent unnecessary treatments, reduce delays in diagnosis, and improve patient outcomes through targeted, multidisciplinary management.

Abstract No. 162: The diagnostic challenge of a tumour-like lesion

Arun V. Joy , Vani Viswanath

Department of Pulmonology, MGM Muthoot Hospitals, Kozhencherry, Kerala, India

Case Report: A 73-year-old man, with history of cough with scanty hemoptysis, anorexia and weight loss for 3 months. Clinical examination demonstrated reduced breath sounds, fine crepitations on right infrascapular areas and no enlargement of the superficial lymph nodes.

Chest x ray showed heterogenous lesion right lower zone. CECT chest showed focal heterogeneously enhancing lesion right lower lobe posterobasal and medial basal segment measuring 5x5x8 cm.Post contrast enhancing lesion with hypoenhancing areas suggestive of necrotic components with segmental bronchus cut off and multiple enhancing mediastinal lymphnodes (largest-1 cm). Whole body PET showed metabolically active lesion in right lung lower lobe (moderate FDG uptake-SUV-7.2).No definite PET evidence of hypermetabolic lesion elsewhere in the body [ Figure 1 ].

He underwent relevant investigations, which found ESR of 92mm/h, C-reactive protein of 166 mg/L, LDH-386 mg/dl. Antinuclear antibody quantitative determination, ANCA profile results were all negative. Bronchoscopy and lavage taken from right lower lobe bronchus and sent for bacterial culture,cytology,cellblock, CBNAAT, AFB culture,fungal culture and all reported to be negative. CT guided biopsy of right lower lobe lung mass was performed; histology was negative for malignancy and showed severe chronic interstitial inflammation with fibrosis and old haemorrhage. IHC showed numerous positive IgG4 plasma cells (more than 40 positive cells per higher power field in both samples), which was highly suggestive of IGG4-RD.\

Lung biopsy tissue. H&E staining, original magnification ×40. The immunohistochemistry shows IgG4/IgG-positive plasma cell ratio of >40% [ Figure 2 ].

Therapy with corticosteroids has been shown to be effective in both pulmonary and extrapulmonary lesions, although there is no consensus on the regimen for steroid maintenance therapy. The guidelines of Japanese consensus for the treatment recommend ‘an initial prednisolone dosing of 0.6 mg/kg/day for 2–4 weeks, tapered every 1–2 weeks by 5 mg/day, based on biochemical markers, clinical improvement and imaging’. A maintenance dose of 2.5–5 mg is recommended, which should be discontinued after 3years of treatment, depending on improvement after increase in dosage, considering readministration in case of relapse. Following that recommendation, treatment was initiated with oral prednisone 60mg/day, with a slow tapering plan over the two following months.

Prednisone therapy relieved our patient’s symptoms and pulmonary lesions. Currently, the patient is still under corticosteroid therapy. A chest x-ray and CT chest was performed 2 months after treatment, which showed remission of the right lower lobe mass [ Figure 3 ]. Patient has been lost to follow up since he is asymptomatic. It is accepted that IgG4-RD must be followed up with serum levels of IgG4 in order to evaluate relapsing (up to 50% of patients show high levels of it before relapsing). For patients who are steroid refractory, immunosuppressants can be considered, including rituximab.

Conclusions: Our case fulfilled the diagnostic criteria for IgG4-RD, with lung involvement, therefore, the diagnosis was made. First-line treatment is based on immune-modulating drugs, namely corticosteroids, while the use of immunosuppressors should be considered only after the failure of first-line treatment. Surgery did not seem to play any role in the treatment of the disease, and it is uniquely related to diagnosis confirmation; in fact, IgG4-RD is often diagnosed only after the unexpected results of a biopsy for a suspected lung malignancy due to the rarity of the disease and the lack of specific signs or symptoms.

Abstract No. 163: Uncommon presentation of pseudocyst of pancreas presenting as right sided pseudocyst of lung

Sidhant Narang , Hafiz Deshmukh, Ashish Deshmukh, Sunil Jadhav, Shivprasad Kasat

Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India

Introduction: Pancreatic pseudocyst, a common complication of acute or chronic pancreatitis, in rare instances may also extend to the mediastinum and the pleural space. Here is an unusual presentation of a pancreatic pseudocyst communicating with the thoracic cavity via esophageal hiatus and presenting as a case of right sided pseudocyst of lung.

Case Report: A 51 year old male came with complaints of abdominal pain and abdominal fullness since 6 months along with breathlessness, cough and right sided chest pain since 1 month. Patient is an alcoholic and was admitted as a case of acute on chronic pancreatitis,6 months prior. Examination of respiratory system revealed stony dullness on percussion and diminished breath sounds on auscultation over the right hemithorax. Abdominal examination showed mild tenderness over the entire abdomen Haemogram, KFT, LFT were within normal limits. Chest radiograph revealed a homogenous opacity over the right hemithorax with contralateral shift of mediastinum. Pleural fluid showed high amylase and lipase concentration. CECT chest was suggestive of large pseudocyst in right hemithorax causing right lung collapse and contralateral mediastinal shift, communicating with the pseudocyst of lesser sac via esophageal hiatus

Conclusion: Usually pancreato-pleural effusions present as left sided effusions. We could only find 3 documented cases of right sided pancreatic pleural effusions with only 1 of them communicating via esophageal hiatus. A detailed history, lab investigations and radiological evaluation should be considered in cases of both right and left sided effusions which is crucial in identifying the primary pathology and guiding further workup.

Abstract No. 164: “Pulmonary agenesis” - A case report and review of the literature

Kailas Chakote , Ketaki Utpat, Unnati Desai

Department of Respiratory Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India

Introduction: Lung agenesis is a rare and complex congenital malformation characterized by the complete absence of one or both lungs. It is a developmental anomaly that typically results from the failure of lung formation during early embryogenesis, often leading to significant respiratory and developmental challenges. While unilateral lung agenesis is more common, bilateral lung agenesis is extremely rare and generally fatal shortly after birth due to the absence of essential respiratory function.

Case Report: A 17-year-old female presented with dyspnea. She had complaints of dyspnea, occasional chest pain since 4years. She had no significant past medical surgical or family history.

Her vitals were normal. Her general examination was normal. On respiratory system examination, she had decreased breath sounds on left hemithorax. On CVS examination apex beat was on the extreme left side of the chests, which indicated left sided mediastinal shift.

She was evaluated with sputum studies for CBNAAT, which was MTB, not detected. Her Chest X ray showed a left opaque hemi thorax with tracheal shift towards left [ Figure 1 ]. A computed tomography of chest showed there was complete mediastinal shift towards left and hyperinflation of right lung noted. Tracheal shift towards the left with left main bronchus not visualized [ Figure 2 ]. Bronchoscopy showed tracheal web with tracheal lumen severely compromised, around 2 cm distal to vocal cords, scope could not be negotiated further [ Figure 3 ].

The differential diagnosis of left opaque hemi thorax with left tracheal shift includes bronchial obstruction by a foreign body, endobronchial mass, pulmonary agenesis versus aplasia, hypoplasia, pneumonectomy.

Conclusions: Pulmonary agenesis/aplasia, while rare, should be considered in patients presenting with unexplained respiratory symptoms and radiological findings of lung absence. Early, accurate diagnosis with counseling is crucial for unnecessary workup.

Abstract No. 165: A rare case of nitrofurantoin induced interstitial lung disease

Shanmukha Venkat Sai Kiran Kona , Somanath Dash

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Drug-induced Interstitital lung disease is a large and very heterogeneous group of adverse drug reactions, ranging from mild to progressive and life threathening disease.

Case Report: A 71 yr old female presented with complaints of shortness of breath and dry cough aggrevated sine 10 days. Past h/o recurrent urinary tract infections for which she used NITROFURANTOIN for 8 yrs. Chest xray shows bilateral reticular opacities in lower regions. Ct chest shows diffuse reticular and ground glass opacities, interlobular septal thickening and few fibrotic bands noted in bilateral lung fields suggestive of INTERSTITIAL LUNG DISEASE – NSIP pattern. Nitrofurantoin was stopped, patient gradually improved clinically and radiologically.

Conclusion: The diagnosis can be particularly challenging when multiple potentially pneumotoxic drugs are used for treatment of diseases that frequent cause pulmonary complications. Acute pneumonitis generally develops within one to two weeks of nitrofurantoin use and presents with fever dyspnea and cough. In subacute and chronic disease, the most common presenting symptoms are dyspnea and cough, which develop after atleast one month of treatment. Identification and discontinuation of the culprit drug is the cornerstone of treatment.

Abstract No. 166: Kartagener syndrome: A rare condition diagnosed in a young female patient

Chittal Palaniappan

Department of Respiratory Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India

Introduction: Kartagener Syndrome (KS),a subset of Primary Ciliary Dyskinesia (PCD), rare Autosomal Recessive genetic ciliary disorder with triad of Situs Inversus (SI),chronic sinusitis,bronchiectasis.First described by Siewart in 1904.Mannes Kartageners recognized etiological correlation between elements of triad in 1933.Basic problem-defect in ciliary movement.Mutations in genes DNAI1,DNAH5 leads to ↑ susceptibility of PCD.Diagnostic criteria: clinical picture of recurrent chest infection,bronchitis, rhinitis since childhood along with ≥1: 1) SI in patient/sibling 2) Alive but immotile spermatozoa/impaired follicles movement within fallopian tubes 3) ↓or absent transbronchial mucociliary clearance 4) Electron microscopy ultrastructural defect of cilia. Screening test of PCD: 1) ↓ exhaled NO 2) Saccharin test to assess mucociliary function of nasal epithelium.Diagnostic test: 1) Ciliary beat pattern 2) Electron microscopy confirmation of ultrastructural defect in cilia from nasal mucosa or tubal mucosa biopsy.

Case Report: 20Y/F unmarried,born to non-consanguinous parents.Recurrent episodes of cold,sneezing,cough with expectoration,exertional breathlessness for 5 years.Similar episodes in childhood.Apex beat-right 5 th ICS.Bilateral wheeze,right basal crepts and heart sounds best heard in right side of chest.ECG-Dextrocardia.CXR PA view-cardiac apex and aortic arch on right side.Maxillary sinus mucosal thickening in radiography.USG abdomen pelvis-normal liver & gall bladder on left side & normal spleen on right side.HRCT chest-dextrocardia,nodular opacities in right lower lobe s/o bronchiectasis.Whole exome sequencing-homozygous variant in intron19 of DNAI1 gene.

Conclusion: Recognizing & considering rare condition like KS in differential diagnosis of chronic respiratory infections is crucial.Early identification leads to timely intervention & improved outcomes, prevents complications.In vitro data on restoring ciliary function are available,likely during next decade,major advances in treatment of PCD are to be expected.

Abstract No. 167: Swyer-James Syndrome: A rare cause of unilateral hyperlucent lung

S. Ashok Kumar 1 , Mahavir Modi 2

1 Department of Pulmonary Medicine, Ruby Hall Clinic, Pune, Maharashtra, India

Introduction: Swyer-James-MacLeod Syndrome (SJMS) is a rare, acquired pulmonary disorder characterized by unilateral hyperlucency of the lung, often diagnosed incidentally through imaging. First described in the 1950s, SJMS results from childhood bronchiolitis obliterans, leading to alveolar overdistension and reduced vascular perfusion in the affected lung. The hallmark radiologic feature is a hyperlucent lung with reduced vascular markings, typically unilateral. Clinical presentation varies, ranging from asymptomatic cases to recurrent respiratory infections, chronic cough, and exertional dyspnea. Pulmonary function tests may reveal obstructive or restrictive patterns. Diagnosis relies on chest X-ray, CT scan, and ventilation-perfusion scans, which demonstrate ventilation-perfusion mismatch. Treatment focuses on symptom management, infection control, and, in severe cases, surgical resection of the affected lung. This review discusses the pathophysiology, clinical manifestations, diagnostic approaches, and management strategies for SJMS, highlighting its relevance in differential diagnoses for hyperlucent lung syndromes.

Case Report: A 65-year-old female presented with complaints of breathlessness. Clinical examination revealed decreased breath sounds on the right side.

Investigations:

Chest X-ray (CXR): Unilateral hyperlucency on the right side Arterial Blood Gas (ABG): Type II respiratory failure 2D Echocardiography (Echo): Severe pulmonary hypertension CT Pulmonary Angiography (CTPA): No evidence of pulmonary thromboembolism (PTE), but findings consistent with Swyer-James Syndrome (SJS).

Swyer-James Syndrome presenting with severe pulmonary hypertension and Type II respiratory failure.

Conclusion: Swyer-James Syndrome (SJS) remains a rare but important diagnosis in patients presenting with unilateral hyperlucent lung and respiratory symptoms. Early recognition through imaging and clinical correlation is essential for appropriate management and to prevent recurrent infections and long-term complications. Although the condition is irreversible, symptomatic treatment, infection control, and pulmonary rehabilitation can significantly improve quality of life. Continued awareness and research are needed to enhance diagnostic accuracy and refine therapeutic approaches for this underrecognized syndrome.

Keywords: Bronchiolitis obliterans, hyperlucent lung, pulmonary disorder, rare lung disease, respiratory failure, Swyer-James-MacLeod Syndrome.

Abstract No. 168: Acute respiratory failure in an adolescent male: A genetic connection

Siddhartha Chakraborty 1 , Manu Chopra 1 , Rahul Tyagi 1 , Kislay Kishore 1 , Aseem Yadav 1 , M. C. Jyothis 1 , Ankush Gupta 2

1 Department of Respiratory Medicine, AICTS, Pune, Maharashtra, India, 2 Department of Cardiology, AICTS, Pune, Maharashtra, India

Introduction: We present a rare case report of an adolescent male, product of a consanguineous marriage, who had severe pulmonary hypertension and worsened on Anti-PAH therapy. He was diagnosed as a case of Peripheral Veno-occlusive disease based on right heart catheterization and whole genome sequencing.

Case Report: A 17 year old male presented with progressive breathlessness to a peripheral hospital. Two-dimensional echocardiography showed severe pulmonary hypertension. He was started on anti-pulmonary hypertension medications. However, his condition worsened while on medications and he reported to our center with severe hypoxemia. Computed tomography pulmonary angiogram showed multiple ground glass nodules with mediastinal lymphadenopathy. Right heart catheterization revealed pre-capillary pulmonary hypertension. Detailed history taking revealed history of consanguineous marriage amongst parents and sudden death of elder sibling few years ago. Genetic studies revealed EIF2AK4 gene mutation. He was diagnosed as a case of pulmonary veno-occlusive disease and was referred for lung transplantation. His condition rapidly progressed, sustained cardiac arrest and could not be resuscitated. This case report highlights the importance of need for awareness about this rare disease as early diagnosis and referral for lung transplantation can be lifesaving.

Conclusions:

Distinguishing PVOD from PAH is crucial for treatment as PVOD patients are at risk for life-threatening pulmonary edema with PAH therapies. This case report highlights the importance that not all patients who have pulmonary hypertension should be started on anti-PAH therapy without diagnosis of the underlying etiology A young male, with history of consanguineous marriage in parents, and pre-capillary pulmonary hypertension on right heart catheterization should raise a high clinical suspicion of PVOD. Genetic studies should be done when possible for confirmation of diagnosis Early lung transplant referral is essential due to poor treatment response This case report highlights a rare disease entity which can be diagnosed based on a high index of clinical suspicion and thorough evaluation.

Abstract No. 169: Behind the mask of an anterior mediastinal mass: A rare clinical discovery

E. Uvarajan , S. Yuvarajan, R. Praveen, Cherukumalli Navya, Sagana

Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

Introduction: Anterior mediastinal masses encompass a diverse group of neoplastic and nonneoplastic lesions located within the mediastinum, presenting a diagnostic challenge due to their varied etiologies and potential for serious complications. Tuberculosis presenting solely as an isolated mediastinal mass, as observed in our patient without parenchymal lesions, is rare.

Case Report: A 25-year-old male presented with dry cough and right sided chest pain for the past 6 months. On initial evaluation the patient had a palpable mass of 3x2 cm below the clavicle. Chest radiograph shows ill-defined heterogeneous opacity over the right middle and lower zone silhouetting the right heart border. Computed tomography showed hypo dense soft tissue density in anterior mediastinum on right side obscuring right heart border and ascending aorta. USG guided anterior chest wall biopsy showed caseous necrosis with adjacent fibrocollageous tissue showing epithelioid granuloma and gene Xpert indicated very low Mycobacterium tuberculosis detection without rifampicin resistance. He was started on Anti-tubercular therapy and currently is on follow up.

Conclusions: Anterior mediastinal mass in this case exemplifies the diverse and often enigmatic nature of thoracic pathologies, requiring comprehensive and multidisciplinary diagnostic approach. The atypical manifestation challenges conventional diagnostic paradigms, highlighting the necessity for a high degree of clinical vigilance. The integration of advanced imaging modalities, coupled with histopathological and microbiological evaluation, remains paramount in establishing accurate diagnosis. Early recognition and prompt initiation of targeted therapy are crucial in mitigating potential complications and ensuring favorable outcomes.

Abstract No. 170: Unveiling the hidden culprit: Thyroid FNAC unlocks the mystery of cystic lung disease – A case report

Dhiraj Atram 1 , Amita Athavale 2 , Vijay Khatri 2 , Tanya Athavale 2 , Gaurav Jain 2

1 Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India, 2 Department of Pulmonary Medicine and EPRC, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Introduction: Cystic lung diseases are a heterogeneous group of conditions characterized by multiple cystic lesions in the lung parenchyma. These conditions can stem from infections, genetic disorders, autoimmune processes, or neoplasms, often presenting diagnostic challenges due to overlapping clinical and radiological features. The complexity increases with systemic involvement, such as endocrine dysfunctions or extrapulmonary lesions. A thorough evaluation involving multiple disciplines is crucial to determine the underlying cause and guide effective management.

Case Report: A 31-year-old male with recurrent bilateral pneumothorax and progressive dyspnea underwent bilateral ICD placements and left-sided pleurodesis. HRCT revealed extensive bilateral cystic lung disease, predominantly in lower lobes. PET-CT showed hypermetabolic thyroid and cervical lymph nodes. FNAC confirmed Pulmonary Langerhans Cell Histiocytosis with rare thyroid involvement. Differential diagnoses like lymphangioleiomyomatosis and lymphocytic interstitial pneumonia were excluded. Systemic manifestations, including hypothalamic hypogonadism, diabetes insipidus, and hypothyroidism, supported a multisystemic LCH diagnosis. Thyroid involvement in LCH is exceedingly rare, with few cases reported, highlighting the importance of systemic evaluation and multidisciplinary collaboration in diagnosing and managing such complex cases.

Conclusions: This case highlights the diagnostic complexity of LCH with atypical lower lobe involvement and rare thyroid manifestations.

Pulmonary LCH with thyroid involvement is rare, necessitating consideration in unexplained systemic symptoms and abnormal imaging. A multidisciplinary approach and long-term follow-up are essential for disease monitoring and prevention of recurrence.

Abstract No. 171: Neutrophil-to-lymphocyte ratio as a prognostic marker in acute respiratory distress syndrome patients: A retrospective study

N. Nagpavan , T. Prasanna Kumar

Department of Respiratory Medicine, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India

Introduction: Acute respiratory distress syndrome (ARDS) is the leading cause of high mortality in intensive care units (ICUs) worldwide. An effective marker for prognosis in ARDS is particularly important given the absence of effective treatment strategies aside from small tidal volume ventilation. Previous studies identified an association between the neutrophil-to-lymphocyte ratio (NLR) and prognosis in critical patients. In this study, we explored the prognostic and predictive value of the NLR in ARDS patients.

Methods: We retrospectively included 70 ARDS patients. Clinical characteristics and experimental test data, including the NLR, were collected from medical records at 24 hours after the ARDS diagnosis. Subgroup stratification was performed according to different factors and continuous factors were divided according to median values.

Results: The NLR in survivors was significantly lower than that in non-survivors (P<0.001). We took the median NLR value as the cut-off point and further divided all patients into a high NLR group (NLR >14) and a low NLR group (NLR ≤14). We found that NLR >14 was associated with shorter overall survival (P=0.005).

Conclusion: Our study showed that a high NLR (>14) at 24 hours after an ARDS diagnosis independently predicted a poor prognosis in ARDS patients. This marker could potentially be used in clinical practice due to its convenience.

Keywords: Acute respiratory distress syndrome, biomarker, neutrophil-to-lymphocyte ratio, prognostic marker, retrospective study

Abstract No. 172: Unexpected ROS-1 rearrangement in elderly male smoker: Successful treatment with selpercatinib

Ayushi Sinha , Rajat Bajaj, Mrinal Sircar

Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India

Background: Non-small-cell lung cancer (NSCLC) is a prevalent form of lung cancer, accounting for 85% of cases. Approximately 25% of NSCLC cases harbour oncogenic alterations, offering potential targets for therapy. ROS-1 rearrangement, a less common oncogenic driver, is identified in 0.9-2.6% of NSCLC cases. These rearrangements are more frequently observed in women, non-smokers, and younger individuals. This case report presents an unusual occurrence of ROS-1 rearranged NSCLC in an elderly male smoker, who demonstrated a positive response to Selpercatinib, a highly selective RET inhibitor. At the time of treatment, Selpercatinib was considered a second-line therapy for RET+ NSCLC. However, following the LIBERTTO trial, it has received FDA approval as a first-line treatment option.

Case: A 67-year-old male with a substantial smoking history presented with RET+ adenocarcinoma of the lung. Initial imaging revealed a mass lesion in the upper mediastinum and metabolically active lesions in the right lung. Biopsy confirmed metastatic adenocarcinoma. Unexpectedly, genetic testing identified an ROS-1 rearrangement. The patient received initial chemotherapy, but later transitioned to Selpercatinib. This treatment led to significant tumor regression and improved his life span.

Conclusion: The successful treatment of this unusual case with Selpercatinib aligns with the findings of the LIBERTTO trial, which led to its FDA approval as a first-line treatment for RET+ NSCLC. This case suggests that Selpercatinib may also be effective in treating NSCLC patients with ROS-1 rearrangements, particularly those who are elderly and have a history of smoking.

Abstract No. 173: Study of factors influencing acceptance of influenza and pneumococcal vaccines in patients with chronic respiratory diseases – A cross sectional study

N. Aditya Reddy , Medha Bargaje, Pramod Chaudhari, Anubhuti Singh

Department of Respiratory Medicine, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India

Introduction: Chronic Respiratory Diseases (CRDs) is one of five NCDs that contribute to highest mortality and morbidity globally. CRDs are frequently associated with multiple comorbidities. Pneumococcal and Influenza infection cause significant increase in recurrent hospitalisations, disease burden, mechanical ventilation and mortality in CRD patients, particularly among those with multiple comorbidities. Several studies and international guidelines recommend influenza and pneumococcal vaccines. This study aims to determine factors influencing acceptance of vaccines in CRD patients.

Methods: A cross sectional study was conducted over period of 6 months from June 2024 to November 2024 in Department of Respiratory Medicine, BHRC, Pune. 54 patients were enrolled in the study. All clinically diagnosed patients of chronic respiratory diseases who are above 18 years were included in the study. All participants provided informed consent.

Results: Out of 54 patients, 58% were Male. Mean Age was 63.85. The main comorbidities were Hypertension (44%), Diabetes Mellitus (46%) and heart disease (11%). Influenza and Pneumococcal vaccine coverage was 43% and 18% respectively. Of these, 84% of influenza vaccinated group and 100% of pneumococcal vaccinated group were previously recommended by doctors to obtain vaccine. Vaccine coverage was higher in ex-smokers (66.6%), education level above high school (38%) and history of prior exacerbations, hospitalisations (56%). Vaccinated group had higher proportion of pre-existing comorbidities (72%) compared to non-vaccinated group. Majority of influenza vaccinated group had also received pneumococcal vaccine.

Conclusion: Physicians and Pulmonologists may have to communicate the benefits of vaccination more effectively to patients with chronic respiratory diseases. Pneumococcal and Influenza vaccine inclusion under national immunisation programmes may improve acceptance rates.

Keywords: Acceptance rate, chronic respiratory diseases, influenza, pneumococcal

Abstract No. 174: Uncommon presentation of a common disease

Krunal Sidapara

Department of Respiratory Medicine, Sheth L. G. General Hospital, Ahmedabad, Gujarat, India

Introduction: Endobronchial tuberculosis (EBTB) is a form of tuberculosis that affects the airways, leading to inflammation, obstruction, and symptoms such as coughing and wheezing. It can complicate pulmonary tuberculosis and may be challenging to diagnose due to its subtle presentation.

Case Report: I am presenting the case of a 14-year-old male patient admitted with complaints of fever with chills for the last 2 days, bilateral chest pain for the last 2 days, and generalized weakness for the last 2 days. Past and family histories did not reveal anything significant. A chest X-ray (PA view) of this patient suggested right middle zone consolidation. CRP was elevated, and total WBC counts were also raised, so a possible diagnosis of pneumonia was suspected. A sputum sample was tested using the TrueNAT method, and the result was negative. A sputum sample was also sent for culture and sensitivity, which showed normal flora. The patient was started on empirical antibiotic therapy but did not improve symptomatically after one week of treatment. HRCT Thorax was done, which showed consolidation with surrounding nodular opacities in the lateral segment of the right middle lobe. Bronchoscopy showed narrowing in the right middle lobe of the right bronchial tree. BAL was performed and sent for BAL CBNAAT, which tested negative for Mycobacterium tuberculosis. A biopsy was also taken and sent for HPE, which revealed moderate to dense chronic active nonspecific inflammation. Despite inconclusive results from all investigations, the patient was clinically diagnosed with endobronchial tuberculosis and started on anti-tuberculosis treatment. On follow-up after 15 days, the patient showed symptomatic improvement, and after 2 months, the patient’s chest X-ray also showed improvement.

Conclusion: Endobronchial tuberculosis is a rare yet critical manifestation of a common disease that requires heightened clinical vigilance. Its non-specific symptoms often mimic other respiratory conditions, leading to delayed diagnosis and potential complications, such as airway stenosis. Prompt diagnosis via bronchoscopy and timely treatment are essential to prevent long-term airway damage.

Abstract No. 175: A rare case of idiopathic fibrosing mediastinitis in a young male presenting as superior mediastinal mass

Aditya Reddy 1 , Pramod Chaudhari 1 , Anita Anokar 1 , Anubhuti Singh 1 , Vishal K. Seth 2 , Niraja Rath 1

1 Department of Respiratory Medicine, Bharati Vidyapeeth(DTU) Medical College and Hospital, Pune. Maharashtra. India, 2 Department of Gastroenterology, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune. Maharashtra. India

Introduction: Fibrosing Mediastinitis or sclerosing mediastinitis, is an uncommon, benign and progressive condition characterised by an invasive proliferation of fibrous tissue within the mediastinum. It affects persons aged between 13 and 65 years, with a strong predilection for young females. We report an unusual case of a 22-year-old male with fibrosing mediastinitis presenting as superior mediastinal mass causing dysphagia, cough and hoarseness of voice.

Case Report: 22 years male, presented with dry cough, dysphagia, exertional dyspnea, hoarseness of voice and weight loss since 1 year. Bronchoscopy with BAL was done, which showed no evidence of TB, but considering the clinical and radiological picture, he received empirical ATT. After completing 6 months of ATT, patient had persistent symptoms of dysphagia and hoarseness of voice. Contrast scan revealed a superior mediastinal mass. Endobronchial ultrasound was non confirmatory. PET CT showed hypermetabolic superior mediastinum soft tissue lesion extending from left thoracic inlet to left prevascular station, encasing mediastinal vessels, trachea and esophagus. Repeat EUS-TBNA and biopsy was done, which revealed broad keloidal bands of collagen with scattered fibroblasts and myofibroblasts without any granulomas or neoplastic cells. Immunohistochemistry and ZN staining was negative. Serum IgG4 was within normal limits.

Conclusions: Fibrosing Mediastinitis should be considered in the differential diagnosis when a young patient presents with symptoms of mediastinal compression.

Abstract No. 176: Toxic optic neuropathy in linezolid based MDR-TB regimen in central Karnataka: A case report and review of literature

M. Harshavardhana , Shashikanth J. U .

1 Chigateri Government District Hospital, JJMMC, Davangere, Karnataka, India

Introduction: A case of a 35-year-old male diagnosed with sputum microscopy positive pulmonary tuberculosis was started on HRZE regimen [NTEP]. 1 month later his FLLPA was suggestive of MDR-PTB [both HR] hence changed to linezolid-based regimen. Linezolid is a member of synthetic antimicrobials known as Oxalidinones, after 3 months he presented with the chief complaints of painless progressive deterioration of vision of both eyes even after post surgical correction of cataract of left eye.

Case Report: Patient was farmer by occupation and had nil comorbidities and was a nonsmoker/alcoholic. His best-corrected visual acuity (BRVA) checked was reduced to counting fingers up to 2 m in both eyes and colour vision was abnormal and Visual field analysis showed generalized constriction of the peripheral visual field in both eyes visual field analyzer revealed bilateral central scotoma, Fundoscopy examination reveals temporal pallor, bilateral symmetrical disc edema, Optical coherence tomography imaging of the optic nerve head revealed Retinal Nerve Fibre Layer (RNFL) thinning in the right eye, more in the inferior and temporal quadrants and inferior quadrants of left eye. Linezolid-induced toxic optic neuropathy was suspected after ruling out all metabolic and neurological causes. Hence patient was stopped of linezolid and started on ethionamide based regimen and followed. 3 months later patient symptoms and visual field improved and color vision became completely normal.

Conclusions: Pre treatment evaluation of tb patients is not only prevents and helps in early detection of adverse drug reactions of multiple drugs but also aids in increases diagnostic confidence in the treating physician and stops it progressing to permanent irreversible damages.

All patients starting on multidrug regimen, especially in difficult to treat patients with co-morbidities and multi drug resistance should be made to evaluate compulsorily to prevent lifelong sufferings due to irreversible and ir-repairable damages.

Abstract No. 177: Tuberculosis or malignancy: A masquerade

Dhruv Gupta , Varuna Jethani, Aarti Kotwal, Sushant Khanduri, Anuradha Kusum

Department of Respiratory Medicine, HIMS, SRHU, Dehradun, Uttarakhand, India

Introduction: Tuberculosis is a major public health issue and if untreated adequately it is associated with high morbidity and mortality with estimate 13% of global case fatality rate especially in less developed countries like India. Always to rule out tuberculosis be it a rarest site and presentation.

Case Report: There are three cases with unusual site of involvement and unusual presentation mimicking malignancy, two patients diagnosed as tuberculosis from extrapulmonary site (pancreas and sternum) and one from lung soft tissue mass like presentation.

Conclusions: Tuberculosis is well known diagnostic chameleon and can resemble malignancy, vigorous efforts should be made to obtain preoperative microbiological or/and histological diagnosis to avoid the patient unnecessary surgical procedures. A proper follow up is required to monitor the response.

Abstract No. 178: Erasmus syndrome: A rare case report

Batta Sree Dinesh Kumar , Sonali Parida

Department of Pulmonary Medicine, IMS and SUM Hospitals, Bhubaneswar, Odisha, India

Introduction: Erasmus syndrome is a rare occupational rheumatological disorder in which systemic sclerosis develops following exposure to silica, with or without silicosis.

Case Report: A 41-year-old male, stone cutter by occupation, presented with shortness of breath since 1.5 years; bowel disturbances, low grade intermittent fever since 6 months, progressive skin tightening, symmetrical polyarthritis, bluish discoloration of fingers and toes on exposure to cold & dyspepsia from 3 months. H/o weight loss-13 kgs over 6 months.

Vitals are stable.Pallor,clubbing- grade 3,pitting pedal-edema were seen.Skin thickening with areas of hyperpigmentation on the neck and upper back, microstomia were seen.

Bilateral basal fine crepitations in IAA,ISA and decreased breath sounds on the left.

Mild normocytic normochromic anemia and hypoalbuminemia, Chest X-ray revealed presence of multiple patchy non homogenous opacities in the middle and lower zones along with bilateral effusion. CT-Thorax & Abdomen showed B/L pleural effusion with pleural thickening, pericardial effusion, multiple discrete calcific foci with few random nodules, multiple mediastinal and abdominal calcified L.Ns with foci of necrosis. Pleural fluid analysis suggestive of transudative effusion. Mantoux-negative.Moderate Pericardial effusion and Mild PAH in 2D-ECHO.EUS FNAB was done from mediastinal lymph nodes biopsy of which was CBNAAT negative. HPE showed granulomas with multinucleated giant cells with a foci of necrosis surrounded by epitheloid cells, AFB stain negative.UGIE showed antral erosions with LES dilated.Malabsorption was ruled by Colonoscopy.ANA-positive (3+) Anti-Scl 70. Patient treated with ATT, oral Prednisolone, Tadalafil, diuretics, etopride.

Conclusions: Crystalline silica exposure from stone quarrying, mining, or marble workers not only causes silicosis but also autoimmune diseases like SLE,rheumatoid arthritis, systemic sclerosis,and vasculitis.

A high index of suspicion is necessary while dealing with silicotuberculosis cases regardng coexistence of other diseases because treatment is different from the cases presenting with only silicotuberculosis.

Abstract No. 179: A rare convergence: CIDP and Sjögren’s syndrome in an adolescent

Mohd Aateer Shaikh , Radha Munje, Sanjay Gour

Department of Respiratory Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Introduction: Sjögren’s syndrome, a systemic autoimmune disease, can rarely present with motor-predominant polyneuropathy mimicking Guillain–Barré syndrome (GBS). We describe a case of Sjögren’s syndrome initially manifesting as acute motor polyneuropathy resembling GBS, later progressing to chronic inflammatory demyelinating polyneuropathy (CIDP). This rare overlap highlights the need for detailed clinical evaluation and diagnostic studies, including electrophysiology and autoimmune markers, to ensure timely diagnosis and treatment. Early immunomodulatory therapy is crucial to managing these complex, overlapping conditions effectively.

Case Report: A 19-year-old female, presented with progressive limb weakness over 3 months (ascending paralysis), low-grade fever for 5 months (high-grade for 15 days), breathlessness at rest, generalized body swelling, and intermittent vomiting. She had been hospitalized 3 months earlier for similar symptoms and was diagnosed with GBS based on MRI and nerve conduction studies, treated with intravenous steroids and plasmapheresis. On admission, she had hypotension, tachycardia, hypoproteinemia, cardiomegaly with pleural effusion, and metabolic acidosis. Investigations revealed albuminocytologic dissociation in CSF, ANA positivity, and SSA/SSB antibodies. A lip biopsy confirmed Sjögren’s syndrome. Diagnosed with CIDP secondary to Sjögren’s, she was treated with steroids, diuretics, and physiotherapy, resulting in clinical improvement at discharge. This case highlights the overlap of autoimmune and immune-mediated neuropathies, requiring multidisciplinary management.

Conclusions: Early recognition of atypical neurological manifestations in autoimmune diseases like Sjögren’s syndrome is crucial. Timely diagnosis and multidisciplinary management can significantly improve outcomes in rare overlaps like CIDP.

This case illustrates the rare occurrence of CIDP in a patient with Sjögren’s syndrome, initially presenting as GBS. It emphasizes the need for a thorough clinical evaluation, including electrophysiological studies, serological testing, and tissue biopsy, to accurately diagnose overlapping autoimmune and immune-mediated conditions. Early initiation of immunomodulatory treatment, such as steroids, is essential in managing complex cases to prevent progression and improve clinical outcomes.

Abstract No. 180: An unusual presentation of chest pain: A hidden link to plasma cell disorder

Shraddha Acharya , Basava S J, N. Huliraj, M. K. Raghavendra

Department of Respiratory Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India

Background: Multiple myeloma and plasmacytoma are disorders characterised by abnormal proliferation of plasma cells.Plasmacytoma is typically a localised tumour composed of plasma cells, whereas Multiple Myeloma is marked by the uncontrolled proliferation of plasma cells in the bone marrow, leading to widespread systemic damage affecting various organs.In our case study, we highlight this unique overlap of plasmacytoma with Multiple Myeloma.

Case Report: A 77year old man presented with right side shoulder pain,chest pain and exertional breathlessness that had persisted for one month.High resolution computed tomography (HRCT) Thorax revealed a heterogeneous enhancing lesion in the right upper lobe.A CT-guided biopsy was performed, and histopathological examination showed CD-138 positive plasma cells,suggestive of Plasmacytoma.Serum Protein electrophoresis revealed the presence of a M spike and elevated beta-2 microglobulin levels.A bone marrow aspiration was performed, which had features consistent with Multiple Myeloma. Chemotherapy was initiated based on the working diagnosis of multiple myeloma with plasmacytoma.

Conclusions: Patients with plasmacytoma typically present with focalized bony pain, and backpain being one of the most common symptom associated with multiple myeloma.However, backpain was absent in this patient.Imaging studies, such as MRI and CT scans, are crucial for the diagnosis in such cases.In patients with Multiple myeloma, histopathological evaluation and bone marrow aspiration are essential for confirming the diagnosis and guiding further management.

The case report underscores the importance of early evaluation of patient with unexplained shoulder pain, as the final diagnosis may be Multiple Myeloma.Early diagnosis and prompt initiation of chemotherapy, along with supportive care can significantly improve the prognosis and quality of life for patients with Multiple Myeloma.

Abstract No. 181: A tradition meets toxins: A rare case report of mercury toxicity with pulmonary manifestations

P. Smitha , B. P. Rajesh

Department of Respiratory Medicine, JJM Medical College, Davangere, Karnataka, India

Introduction: Mercury is a heavy metal known to cause harmful effects on various organ systems. It exists in 3 forms - Elemental mercury, Organic mercury, and Inorganic mercury compounds. Mercury toxicity is hazardous when inhaled, intravenously administered or ingested and can result from both occupational and non-occupational exposure. The common manifestations are fever, gastrointestinal distress, respiratory complications, neurological abnormalities, nephrotoxicity and dermatological manifestations.

Case Report: A 38 years old female came with complaints of non-productive cough for 10 days with no significant past history and comorbidities. On examination Vitals-WNL, RS- B/L rhonchi. ChestXray showed high density opacity in all over lung fields. Patient reassessed with history and gave history of taking medications for infertility from the local traditional folk practitioner two tablets twice daily with betelleaf juice and cowmilk from past 1 months. Composition of medications showed Swarna (Gold), PARADA (Mercury), Gandhaka (Sulphur) in 1:8:16 ratio. HRCTthorax showed high density opacity with classical diffraction. CBC, RFT, LFT – WNL. Blood mercury level 46mcg/L, Urine mercury level – 14mcg/L increased. A multidisciplinary approach made to rule out other systemic manifestation but no obvious findings. Patient started with Dimercaprol injection 150 mg twice daily im for 11 days and repeat blood and urine mercury level monitored showed improvement.

Conclusions: A rare yet serious medical illness occurred with unintentional ingestion of mercury containing medications. This case study illustrates the complexities involved in diagnosing and treating rare manifestations of mercury toxicity. The presentation of symptoms depends significantly on the form of mercury, the method of exposure and the amount involved.

This case report demonstrates the diagnostic and therapeutic challenges in managing a patient with mercury poisoning. The patients’ recovery relied on an interdisciplinary approach and timely medical interventions, highlighting the significances of coordinated care in managing toxicological emergencies.

Abstract No. 182: Unmasking the culprit: A rare fungal encounter in the anterior mediastinum

S. Shilpa , P. Thomas George

Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India

Background: The anterior mediastinum is a site of diverse pathological entities ranging from benign and malignant neoplasms to infectious and inflammatory conditions each presenting unique diagnostic and therapeutic challenges. Fungal infections of the mediastinum are rare, they can occur in the context of immunosuppression or as an unusual presentation of systemic fungal disease. These infections are often misdiagnosed due to their nonspecific clinical and radiological manifestations, leading to potential delays in appropriate treatment.

Case Report: 39 year old male presented with h/o cough of 4 months duration, followed by left sided pleuritic chest pain for 3 months, hoarseness of voice, loss of weight and loss of appetite, features of superior vena caval obstruction like dilated veins over chest and left upper limb. Past history revealed the blackish discolouration and induration of left palm for the past 4 years. CT Thorax showed non enhancing soft tissue lesion in prevascular space encasing arch of aorta, pulmonary vessels, left main bronchus and causing erosion of 2 nd and 3 rd ribs. Blood investigations including serum beta HCG, AFP, LDH within normal limits. USG guided transthoracic biopsy revealed suppurative granulomatous inflammation with giant cell reaction with fungal organisms, morphology favouring phaeohypomycosis. Patient was started on oral antifungals. After 1 month of therapy, patient showed significant improvement with no features of SVCO and xray showed significant reduction in size of lesion.

Conclusion: The case highlights the unique presentation and the importance of maintaining a broad differential diagnosis when evaluating an anterior mediastinal mass, emphasizing its rarity and clinical significance.

Abstract No. 183: Predictive value of eosinopenia, neutrophil-percentage-to-albumin-ratio and neutrophil to lymphocyte ratio for clinical outcomes in patients with AE-COPD

Resham Agarwal , D. Pragati Rao

Department of Respiratory Medicine, M S Ramaiah Medical College, Bengaluru, Karnataka, India

Introduction: Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalization and mortality. Identifying early and accessible biomarkers to predict clinical outcomes like length of hospitalization (LoH), requirement for Non-Invasive Ventilation (NIV), mechanical ventilation (MV), and in-hospital mortality are essential. This study evaluates the predictive role of Eosinopenia, NAPR, NLR in AECOPD patients for early identification of high-risk patients.

Methods: 50 patients hospitalised for AECOPD were included in the study. Inflammatory biomarkers (eosinopenia, NAPR, NLR) were measured on admission. Clinical outcomes—LoH, NIV requirement, need for Mechanical Ventilation, and in-hospital mortality—were recorded. Cox regressions determined the associations between NPAR, NLR, eosinopenia with all-cause mortality and other clinical outcomes. Receiver operating characteristic (ROC) curve analysis estimated the predictive performances of these biomarkers for the clinical outcomes.

Results: Eosinopenia predicted a 30% higher risk of mortality (p = 0.02). Higher NAPR correlated with prolonged LoH and increased intubation rate (OR = 1.8, 95% CI: [1.3-2.5], p = 0.02). NLR ≥ 13.2 predicted in-hospital death with the sensitivity of 100% (95% CI 35.9-100%) and specificity of 92.6% (95% CI 88.8-95.4%).

Conclusion: NAPR, NLR and Eosinopenia are reliable tools for predicting clinical outcomes in AECOPD. They are simple, cost-effective, and will guide early interventions improving patient outcomes. This will result in the reduction of the financial burden caused by COPD exacerbations on patients and the healthcare system.

Abstract No. 184: Squamous cell esophagial carcinoma with esophageal-pleural fistula: A rare case report

Vipul Kumar , Neha Johar

Department of Respiratory Medicine, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Case Report: Esophageal cancer presents with most common symptoms like dysphagia, vomiting, epigastric pain. We report a case of 45-year old male who was known case of squamous cell carcinoma esophagus, patient was on chemotherapy since 2 years presented to emergency with complaints of left sided chest pain and cough with sputum since 2 days. On clinical evaluation and routine investigation with a chest X-Ray found to have left pleural effusion, ultrasonography thorax was suggestive of left side pleural effusion and CECT chest was suggestive of moderate left hydro pneumothorax communicating with esophageal lumen. On ICD insertion thick purulent fluid drained. Presentation of esophageal cancer directly as pyothorax without any symptoms like fever, dysphagia, septic shock is not common phenomenon.

Conclusions: This case reinforce us to think about rare presentation and progression of any disease.

Keywords: Esophageal cancer, pyothorax, squamous cell carcinoma, trachea-esophageal fistula

Abstract No. 185: Disseminated tuberculosis: A case study

Gopal Ekade , Priti Dave, Nitin Gaikwad, Sudeep Kumar

Department of General Medicine, Mimer Medical College, Pune, Maharashtra, India

Background: Tuberculosis is a chronic infectious condition still rampant in many parts of India. It has a variable clinical picture and one of the forms seen in immunocompromised patients is disseminated tuberculosis. This is characterised by involvement of two or more *non contiguous sites* resulting from lympho haematogenous dissemination of TB.

Case Report: 65 yrs. old hypertensive and Diabetic male patient came with c/o generalised weakness, decreased appetite and headache since 15 days. He also had cough with mild sputum and fever since 10 days. There was past H/o Abdomino-paracentesis and probable diagnosis of abdominal kochs was made at some outside hospital, but patient did not take any medication. Vitals on admission were Pulse- 60bpm, BP- 86/56 mm Hg, RR-22/min, SpO2- 98%. Patient was supported on inotropes for hypotension. On clinical examination there were bilateral crepitation and neck rigidity was present. Xray chest showed bilateral non homogeneous opacities. CSF revealed lymphocytosis, raised proteins and ADA. Sputum ZN stain and CBNAAT were positive for pulmonary tuberculosis. Our case was having pulmonary tuberculosis, tubercular meningitis, adrenal and gastrointestinal involvement hence a diagnosis of disseminated tuberculosis was made.

Conclusions: Still awareness is needed specially in rural population about early diagnosis and treatment of tuberculosis. Delay in treatment may cause disseminated tuberculosis with multiorgan involvement and could be catastrophic for the patient which otherwise can be treated.

Keywords: Acid fast bacilli, disseminated, tuberculosis

Abstract No. 186: Prevalence and implications of preserved ratio impaired spirometry in community health screening camps in Western India: A comprehensive assessment

Vandana Das 1 , Sapna Madas 2 , Monica Barne 2 , Monika Dhawale 2 , Ashfaque Shaikh 2 , Prasad Shinde 2 , Asmita Gaikwad 2 , Abhishek Sabale 2 , Sundeep Salvi 2

1 Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India, 2 Pulmocare Research and Education Foundation, Pune, Maharashtra, India

Background: Preserved Ratio Impaired Spirometry (PRISm) is a novel spirometry index with significant implications for diagnosing and managing respiratory conditions. It is defined by a normal FEV 1 /FVC ratio but reduced FEV 1 and/or FVC.

Objective: This study aims to evaluate the prevalence and impact of PRISm, along with associated factors, in community health screening camps in urban slums and rural areas of western India.

Methods: We organized community health screening camps under the Pollution Awareness & Wellness Assessment (PAWAN) initiative. Participants completed a paper-based questionnaire to collect demographic information, respiratory symptoms, and risk factors such as smoking and environmental exposures. Health screenings included measurements of height, weight, BMI, blood pressure, oxygen saturation, blood sugar, hemoglobin levels, and pre-bronchodilator spirometry. PRISm was identified based on FEV 1 /FVC ≥0.70 with FEV1 <80% predicted and/or FVC <80% predicted.

Results: Out of 3862 participants, 1759 (45.54%) reported respiratory symptoms or a family history of asthma/allergies. Spirometry was performed on 1230 individuals, revealing a 9% prevalence of obstructive airway disease (OAD) and a 24% prevalence of PRISm among the remaining 1114 subjects. Detailed phenotypic characteristics of PRISm, OAD, and normal lung function groups are outlined in Table 1 , which highlights differences in age, gender, smoking status, lung function, and associated health conditions. PRISm with FVC <80% predicted exhibited more severe lung function impairment. Increased prevalence of hypertension and anemia was noted in PRISm groups compared to normal and OAD groups.

Conclusion: In our screening camps, 66.6% of individuals with respiratory symptoms had normal spirometry, 24% had PRISm, and 9.4% had OAD. PRISm was linked to heightened respiratory symptoms and small airway evidence. One-third of PRISm cases had FEV 1 <80% predicted, indicating potential early or future OAD. PRISm was also associated with symptoms such as breathlessness, cough, wheezing, and health conditions like asthma, hypertension, anemia, and diabetes. These findings underscore the need for further research to understand PRISm’s implications and to develop targeted interventions for affected populations.

Abstract No. 187: Carcinoid syndrome

Sangeeta Reddy , B. L. ShashiBhushan, A. S. Deepa

Department of Pulmonary Medicine, BMCRI, Bengaluru, Karnataka, India

Introduction: Small cell carcinoma of lung contains most malignant tumours of lung and accounts for 20-25% of cases. A significant smoking history is present in vast majority of cases. Patient may present with majority of pulmonary symptoms. mediastinal extension may cause superior vena cava syndrome with recurrent laryngeal nerve paralysis.

Case Report: 32/year old male security by occupation presented with complaints of cough with expectoration since 6months, associated with hemoptysis 1-2 episodes/day, intermittent, 5-10ml/episode last episode was today morning associated with reddish sputum mucoid non foul smelling and complaints of fever since 6 months, low grade intermittent, associated with evening rise of temperature not associated with chills associated history of loss of weight or appetite over last 6months. Also complaints of breathlessness since 6 months, MMRC Grade 2, aggravates on exertion, a/w wheeze, chest pain,not on any inhalers or nebulisation not associated with seasonal/postural variation.h/o Horseness of voice, alopecia since 6 months. Patient is a k/c/o Psoriasis vulgaris since 3yreas not compliant to medication. No history of other known co-morbidities. Known alcoholic and smoker. Chest Xray showed right hilar widening. Sputum AFB smear and CBNAAT was negative. HIV screening was negative. CECT thorax was done which reported Malignant mass lesion in right infrahilar region s/o bronchogenic carcinoma with left vocal cord paresis. FOB+BAL+BIOPSY done s/o? neoplastic etiology. Histopathological examination showing poorly differentiated carcinoma s/o small cell carcinoma of lung. patient was later referred to oncology institute for further management.

Conclusions: Small cell carcinoma of the lung remains one of the most challenging cancers due to its aggressive behavior, early metastasis, and poor overall prognosis. While advances in chemotherapy and immunotherapy have improved outcomes for some patients, the disease still carries a high mortality rate. Early detection and novel treatment approaches, including targeted therapies and immunotherapy, are essential for improving survival rates in SCLC.

Abstract No. 188: Case series: All that mimics TB are not Tuberculosis

Sapana K. Bhagat 1 , K. C. Shoo 2

3 rd Year PG Resident, PG Department of Pulmonary Medicine, IMS & SUM Hospital, Bhubaneswar, India, 2 Assistant Professor, PG Department of Pulmonary Medicine, IMS & SUM Hospital, Bhubaneswar, India

Introduction: As TB is highly common in india and is a common differential diagnosis for any presentation and our ambitious target to reduce the incidence and death due to TB,their occurs a high chance of false positive dx of TB to various diseases.

Case Presentation: Case details with lab findings and radiological changes are depicted in Table 1 .

Conclusion: As the TB community looks to close the diagnostic gap through expanded screening and improved diagnostic tools, it is important to acknowledge false-positive TB diagnoses.

Keywords: Bronchoscopy, kikuchi, lymphadenopathy

Abstract No. 189: Pulmonary alveolar microlithiasis: A rare case report

Sathiya Palani , Khyati Shamaliya, Grinish Tamakuwala

Department of Respiratory Medicine, Government Medical College, Surat, Gujarat, India

Background: Pulmonary alveolar microlithiasis (PAM) is a rare hereditary disease of abnormal phosphate transport associated with accumulation of calcium phosphate crystas within the alveolar airspaces of the lung with predominance to mid and lower zone. The disease is often discovered incidentally in asymptomatic patients and tends to progress slowly, often resulting in respiratory insufficiency in middle age. Attempts to treat PAM empirically have been uniformly disappointing, and lung transplantation remains the only remedy for end- stage disease. The discovery that mutation in the Sodium phosphate co-transporter gene SLC34A2 cause PAM.

Case Study: A 27 Years old male Patient came to our tertiary hospital With C/o breathlessness on exertion for last 3 month, chest pain on & off for one month and low grade fever with fatigue for 1 month. He was a smoker. There was no known past and 1family history of respiratory disease. Patient was vitally stable and apart from RS finding (BL crepts) all the clinical examination was normal. Blood biochemistry including Calcium, phosphorus concentration, hepatic, renal and parathyroid functions was found as normal. Radiological investigation CXR shows infiltrates as fine sand like calcific micronodules also called “sandstorm lung “ diffusely involving both lungs, most marked in middle and lower zones. Chest HRCT shows soft dense calcification involving peripheral pleura along septal thickening and diffuse GGO & “Black Pleura Sign “overall all findins s/o Pulmonary Alveolar Microlithiasis. PFT showed a mild restrictive pattern. Bronchoalveolar lavage (BAL) fluid examination showed no microliths. Histopathological examination of a transbronchial lung biopsy revealed numerous concentric calcified concretions.

Conclusion: Pulmonary alveolar microlithiasis is a rare lung disease with an autosomal recessive trait with mutation of SLC34A2 gene. Characteristic chest radiography and CT finding along with lung biopsy confirms the diagnosis. There is no effective medical therapy. The long -term prognosis is poor and respiratory failure is the usual cause of death. Need of lung transplantation is warranted at some stage of progression of the disease.

Abstract No. 190: Unmasking small airways obstruction in India: Evidence from a large community study

S. Madas 1 , M. Barne 1 , V. Das 2 , M. Dhawale 1 , A. Shaikh 1 , P. Shinde 1 , A. Gaikwad 1 , A. Sabale 1 , S. Salvi 1

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India

Introduction: Small airways obstruction (SAO) is a common feature of obstructive lungdiseases. SAO is the earliest manifestation of COPD even before symptoms occur and lung function decline. In Asthma SAO is a distinct phenotype that is difficult to treat. We aimed to study the prevalence of small airways obstruction on Spirometry and study the variables associated with it in a population-based seƫng among subjects with respiratory symptoms.

Methods: As part of the Pollution Awareness and Health Assessment (PAWAN) project, community-level health camps were organized to raise pollution awareness and evaluate lung health. An interviewer administered lung health questionnaire was administered to collect demographic information and potential risk factors for lung diseases. Spirometry was performed using NDD spirometer according to ATS/ERS standards in subjects reporting respiratory symptoms or clinical examination.

Results: Among 3,862 participants, 1,396 (36.1%) reported respiratory symptoms such as cough, breathlessness, and wheezing. A family history of atopy was reported by 11.6% of participants, while 4.7% reported a past history of asthma or tuberculosis. Spirometry was conducted in 1,230 participants (33.4%) based on the presence of symptoms, medical history, or findings from clinical examinations by physicians. Among those whounderwent spirometry, 56.7% showed evidence of small airways obstruction, defined asFEF25-75 <65% predicted. The prevalence of small airways obstruction was significantlyassociated with hypertension [OR=1.8 (1.4, 2.5)], respiratory symptoms[OR=2.4 (1.9, 3.1)], afamily history of atopy [OR=2.2 (1.6, 3.0)], past H/O asthma or tuberculosis [OR=5.6 (3.2, 9.8)], multimorbidity (defined as presence of Anaemia / HTN/Diabetes / Skin or Heart condition /Kidney disease/any cancer) [OR=2.7 (2.0, 3.6)], anaemia [OR=1.4 (1.1, 1.7)], diabetes [OR=1.8 (1.3, 2.5)] and female gender [OR=1.9 (1.5, 2.4)].

Conclusion: The prevalence of small airways obstruction (SAO) is high among subjects havingrespiratory symptoms and is strongly associated with hypertension, female gender, atopy, andpast asthma or tuberculosis highlights the need for awareness, early detection, and effectivemanagement to prevent chronic respiratory disease progression.

Keywords: Allergy and airways diseases (Asthma and COPD), small airways obstruction (SAO)

Abstract No. 191: Breaking the airway: Rheumatoid nodules leading to spontaneous pneumothorax

Mayuri Upase , Parul Vadgama, Grinish Tamakuwala

Department of Respiratory Medicine, New Civil Hospital and Government Medical College, Surat, Gujarat, India

Introduction: Rheumatoid arthritis is a systemic inflammatory disorder that most commonly affects the joints, causing Progressive, symmetric, erosive destruction of cartilage and bone, which is usually associated with Autoantibody production, primarily affecting joints, but also has significant extra-articular manifestations. Pulmonary complications include Parenchymal disease-Interstitial lung disease; Pleural disease-Pleural effusion, Pneumothorax, Bronchopleural fistula, Trapped lung syndrome, Airway obstruction, Cricoarytenoid arthritis, Bronchiectasis, Follicular bronchiolitis, Obliterative (constrictive) bronchiolitis, Nodules- Rheumatoid nodules, Caplan syndrome, Vascular disease- Rheumatoid vasculitis, Pulmonary hypertension. While spontaneous pneumothorax in RA is uncommon, it may result from the rupture of subpleural rheumatoid nodules. This report describes a rare presentation of this complication in a 60-year-old female.

Case Report: A 60-year-old female with a 25-year history of seropositive RA presented to the Out patient department with Dyspnoea on exertion and right-sided pleuritic chest pain since three months. Her RA had been moderately controlled with hydroxychloroquine and leflunomide. She had no history of smoking or known pulmonary disease. On examination, she was having Respiratory rate: 20-22 breaths/min, Oxygen saturation: 95 % on room air, Decreased breath sounds and hyper resonance over the right hemithorax. Chest X-ray: Revealed a right-sided pneumothorax. High-resolution CT scan revealed: Few thick walled peripherally distributed cavitatory nodules in bilateral lower lobes with Moderate amount of pneumothorax with e/o few thin septation in right pleural cavity with underlying partial collapse of right lung parenchyma and resultant contralateral shift of mediastinum and heart towards left side due to rupture of subpleural cavitatory rheumatoid nodule. Laboratory tests: Rheumatoid factor (RF): Elevated, Anti-CCP antibodies: Positive, CRP and ESR Normal.

As patient was vitally stable, no immediate intervention was done. Watch for respiratory distress was advised. Patient’s PFT showed Obstructive pattern with Good Post Bronchodilator Reversibility and hence started on Inhaler. Patient was Continued on hydroxychloroquine and leflunomide after multidisciplinary review.

Conclusion: This case underscores the need for early imaging in RA patients presenting with respiratory symptoms. Prompt recognition and management can prevent morbidity and improve patient outcomes. Regular follow-up and imaging are crucial in patients with known pulmonary nodules.

Abstract No. 192: Pulmonary aspergiloma mimicking a lung cancer

Kartik Chaudhary , Nilesh C. Dutt

Department of Respiratory Medicine, Sheth L.G. General Hospital, Ahmedabad, Gujarat, India

Case Report: 36/F admitted with chief complain of left sided chest pain, fever, anorexia since 15 days. she was k/c/o hypertension on treatment.Chest cxr suggestive of consolidation at left lower lobe with left lower zone opacity and left cp angle was blunted. usg chest s/o mild left pleural effusion (60cc). So pleural tapping was done (reddish thick) suggestive of exudative pleural effusion. ADA was negative and cytology negative for malignancy. On further examination cect thorax suggestive of peripherally enhancing hypodense lesion in inferior lingual segment if left upper lobe possiblity of neoplastic etiology / infective etiology. Patient had history of allery so IGE was done. IGE >2500And positive for aspergillus species.Bronchoscopic guided TBNA taken from lingular segment of left upper lobe. Histopathology report suggestive of allergic mucin containing thin fungal hyphae suggestive of aspergillus.

Conclusion: An aspergilloma presenting a mass shadow on imaging may mimic a lung cancer in healthy people with intact immune response.

Abstract No. 193: Prevalence of Lung Conditions and Associated Multimorbidity in a community based cross sectional study

S. Madas 1 , M. Barne 1 , V. Das 2 , M. Dhawale 1 , A. Shaikh 1 , P. Shinde 1 , A. Gaikwad 1 , A. Sabale 1 , S. Salvi 1

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India

Introduction: The prevalence of multimorbidity in India is approximately 32% (Patel et al. BMC Geriatrics (2023) 23:53) and is steadily increasing due to rapid urbanization, population aging, and the dual burden of communicable and non-communicable diseases. Beyond additive effects, multiple coexisting conditions often interact with each other that leads to a compounded impact on patients’ health- related quality of life (HRQoL). We aimed to study the burden of multimorbidity, lung health and its association with various factors in the adult general population.

Methods: As part of the Pollution Awareness and Health Assessment (PAWAN) project, community health camps were conducted to raise awareness about pollution and assess lung health. A lung health questionnaire was administered to collect demographic information, respiratory symptoms, underlying health condition (acute / chronic), smoking and family history. Spirometry was performed according to ATS/ERS standards in participants reporting respiratory symptoms.

Results: Among the 3,862 participants (40% male, 60% female; mean age 44±15 years), 72% reported having acute or chronic health conditions [ Figure 1 ]. Among these, 44% had a single condition, while 28% experienced multimorbidity (i.e., multiple health conditions). Lung conditions, including asthma, COPD, repeated lung infections, obstructive airway disease (OAD), or severe airway obstruction (SAO), were reported in 26% of the study population. Association analysis revealed that lung conditions were significantly linked with Female gender [OR=1.43 (1.23, 1.66)], Respiratory symptoms[OR=3.30 (2.84, 3.84)], Family history of atopy [OR=2.70 (2.21, 3.13)], Past H/O asthma or tuberculosis [OR=9.89 (6.9713.93)], Multimorbidity (defined as presence of Anaemia / HTN/Diabetes / Skin or Heart condition / Kidney disease/any cancer) [OR=1.71 (1.41, 2.07)], Household air pollution [OR=1.37 (1.04, 1.83)], Smoking [OR=1.28 (1.03, 1.59)] and Older age groups; Age50+ [OR=2.56 (2.04, 3.21)], Age(31-50) [OR=2.15 (1.73, 2.67).

Conclusion: The study highlights a high burden of acute and chronic health conditions, with 26% of participants reporting lung-related issues. The findings underscore the complex interplay between demographic, environmental, and clinical factors contributing to lung health. Targeted interventions addressing modifiable risk factors, such as reducing household air pollution and smoking cessation, along with focused screening and management for at-risk groups could help mitigate the burden of lung conditions..

Keywords: Occupational and environmental lung diseases, respiratory hazards

Abstract No. 194: Bronchial artery embolization in a post-tuberculosis bronchiectasis patient: A successful case report and review of the long-term outcome

Samarth Agarwal

Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India

Aim/Objective: The aim of this case report was to describe a case of Bronchial artery embolization for post-tuberculosis cystic bronchiectasis and to provide a review of the post embolization symptoms and the patient’s quality of life following the embolisation.

Introduction: Bronchiectasis is a well-known post tubercular (TB) complication. Post-TB lung dysfunction often occurs unrecognized, despite its relatively high prevalence. It is associated with recurrent infections leading to reduced quality of life. Post TB Bronchiectatic patients experience significantly more cough, hemoptysis and physical activity limitations than those without bronchiectasis.

Case Report: In this case report we discussed a 67yr old male presenting with complaints of massive hemoptysis for 3 yrs associated with productive cough and breathlessness. He gave history of ATT intake in 1993 for 6 months and again in 2013 for 1 yr. He was a known diabetic and hypertensive for 10 years and had a history of smoking as well. He was diagnosed as post tb bronchiectasis. He was initially kept on antifibrinolytic therapy which lead to improvement in symptoms but hemoptysis persisted. Multiple episodes of hemoptysis lead to multiple hospitalisations over the course of 3 yrs but to no avail. Then the patient was advised bronchial artery embolization. After proper counselling and evaluation he underwent bronchial artery embolization which improved his quality of life and the patient is asymptomatic since then.

Results: After Bronchial Artery Embolization, there is a significant improvement of patient’s quality of life and reduction of symptoms.

Conclusions: Bronchial Artery Embolization leads to significant improvement in patient’s quality of life.

Abstract No. 195: Role of thoracoscopy in the treatment of undiagnosed exudative pleural effusions

Ajal Shaji

Aster Medcity, Kochi, Kerala, India

Introduction: Thoracoscopy first emerged as a diagnostic tool in the early 20 th century when therapeutic pneumothorax became the surgical treatment of choice for tuberculosis. Currently, the role of medical thoracoscopy in the treatment of undiagnosed pleural effusions is increasingly being recognized.

Methods: We analyzed prospective data of 50 thoracoscopic procedures performed at our center on patients with undiagnosed exudative pleural effusions in 6 months. Patients were subjected to medical thoracoscopy based on ultrasonographic stratification and a computed tomography (CT) thorax. Medical thoracoscopy was performed after an intercostal block under conscious sedation with midazolam (2 mg) and fentanyl (50 mcg) and local anesthesia with lignocaine 2% (10–15 ml), through a semirigid thoracoscope.

Results: A total of 50 patients (28 males and 22 females) underwent medical thoracoscopy during the study period. The mean age was 56.96 ± 14.84 (range, 22–88). The final diagnosis by thoracoscopy was bacterial empyema in 8 patients, tuberculosis in 13 patients and malignancy in 19 patients. Medical thoracoscopy was successful without subsequent intervention in 48, two patients underwent a second procedure, in the form of decortication. There were no major procedure-related complications that required intervention.

Conclusion: Medical dogma teaches: “the sun should never rise nor fall on a pleural effusion.” Although this is an overly simplistic view, the basic principle that a new pleural effusion needs prompt and thorough evaluation still holds. Medical thoracoscopy is a minimally invasive and cost-effective procedure in patients with exudative pleural effusions who have been stratified carefully using radiological methods. Thoracoscopy is recommended for the patient with an undiagnosed pleural effusion in whom the diagnosis of malignancy or tuberculosis is suspected, and in whom at least one pleural fluid cytology and one pleural fluid marker for tuberculosis (adenosine deaminase or interferon) have been negative.

Keywords: Pleural effusion, thoracoscopy, tuberculosis

Abstract No. 196: A cross sectional study of linezolid resistance in cases of MDR, Pre XDR and XDR tuberculosis in diagnosed cases of drug resistant tuberculosis in a tertiary health care centre in Western India

Anoop Ponnachan

Grant Government Medical College and Sir JJ Hospital, Mumbai, Maharashtra, India

Introduction: The increasing global burden of tuberculosis (TB) and the emergence of multidrug-resistant (MDR) TB have necessitated the use of second-line anti-TB drugs. According to the WHO World TB Fact Sheet, the estimated proportion of new TB cases with MDR/RR-TB decreased from 4.1% in 2015 to 3.2% globally. Linezolid, an antituberculosis drug from the oxazolidinone class, acts as a protein synthesis inhibitor [1] and has been found to be highly effective in MDR-TB cases. Initially, resistance to Linezolid was observed in 1.9% of Mycobacterium tuberculosis strains. A 2019 study from India reported high sensitivity (97%) and low resistance (3%) to Linezolid in MDR-suspected patients. [2] However, a recent study from Mumbai indicated 6.7% resistance in MDR-TB cases. [3]

Objective: This study aims to evaluate Linezolid resistance in patients attending a tertiary care center in western India.

Methods: This cross-sectional study was conducted at a tertiary healthcare center in Mumbai, India. Data were collected from diagnosed and follow-up cases of MDR and pre-XDR TB with drug susceptibility testing (DST) reports. Patients visiting the outpatient department were included in the study.

Results: Out of 629 patients (314 males, 315 females) who underwent Linezolid DST, 72 (11.2%) were found to be resistant. Of these, 25 (34%) had a history of TB exposure, and 15 (20%) had prior exposure to anti-tuberculosis treatment (ATT). Interestingly, the majority of cases showed no prior exposure to Linezolid, suggesting primary resistance.

Conclusions: Global meta-analyses estimate Linezolid resistance at approximately 4%. [4] Previous studies from India have reported resistance rates of 3% in Gujarat (2019) [2] and 6.7% in Mumbai (2020). [3] Compared to these findings, our study reveals a significantly higher resistance rate of 11% in Mumbai during 2022–2024.

While Linezolid remains an effective drug for MDR-TB treatment, the increasing resistance observed in this study underscores the need for routine DST for all diagnosed TB cases in Mumbai, India, to ensure appropriate and effective treatment strategies.

Keywords: India, Linezolid, MDR, Mumbai, Resistance, XDR

Abstract No. 197: A study of fungal sensitization in patients of severe bronchial asthma

Samarth Agarwal , K. B. Gupta, Asna Khan, Harshita Rani

Department of Respiratory Medicine, ERA Lucknow Medical College and Hospital, ERA University, Lucknow, Uttar Pradesh, India

Background: Asthma is characterized by variable symptoms of wheeze, shortness of breath, chest tightness and cough, and by variable expiratory airflow limitation. Severe Asthma is defined as asthma that remains uncontrolled despite optimised treatment with high dose ICS –LABA, or that requires high dose ICS- LABA to prevent it from becoming uncontrolled. Severe Asthma with Fungal Sensitization (SAFS) is a severe (poorly controlled) asthma with a positive skin-prick test result for fungi (but not necessarily to Aspergillus species) with a total serum IgE concentration <1000 kU·L −1 . This study was done to estimate the prevalence of SAFS in patients of severe asthma.

Methods: All diagnosed Patients of Severe bronchial asthma as per GINA guidelines 2023 were subjected to skin prick test to all fungal antigens. SPT positive patients then underwent further investigations - total serum IgE and IgE, IgG Specific to Aspergillus fumigatus, Chest Xray and HRCT thorax. After the confirmation of diagnosis of SAFS, prevalence of SAFS and ABPA were determined.

Results: Of the 80 patients studied of severe Bronchial Asthma 36 were found to be of SAFS and 20 patients were found to be of ABPA.

Conclusion: Out of 80 patients 45% showed Fungal sensitization and 25% came out to be patients of ABPA.

Abstract No. 198: Role of bronchoscopy in cases of pulmonary atelectasis – Case series

Hassan Ali

NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India

Introduction: Atelectasis or collapsed lung is non functional lung due to airway obstruction from inside due to endobronchial growth,foreign body or mucous plug; or due to external compression by mass or enlarged lymph node or lung compression due to pneumothorax and pleural effusion.Bronchoscopy is diagnostic procedure to rule out endobronchial pathology and can be used for therapeutic purpose to relieve endobronchial obstruction by removing foreign body, mucus plus or resection of endobronchial growth.

Methods: Retrospective study was done including patients with partial or complete lung atelectasis in ICU. We report 5 cases of lung collapse secondary to different etiologies. Portable bronchoscopy was done for diagnosis and treatment of pathology. Mucus plug was dislodged with the help of NS flush and INJ N acetylcysteine. Thick plugs were Physically dislodged by bronchoscopy and aspirated. Bronchial wash was sent for bacterial culture to rule out bacterial infection.

Results: Emergency Bedside Bronchoscopy resulted in immediate clearing of endobronchial obstruction which leads to partial or complete expansion of the collapsed lung. Evidence by repeat chest x-rays after bronchoscopy.

Conclusion: Timely clinical and radiological diagnosis of lung collapse along with bronchoscopy for therapeutic management if done can prove substantial in case of lung collapse patients in ICU setting.

Keywords: Atelectasis, bronchoscopy, chest physiotherapy, lung collapse, mucolytics

Abstract No. 199: A study to analyse the in-hospital mortality in acute exacerbation of COPD: A comparison between 4 scoring systems

Sushmita Vinod

Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Introduction: Prognostic research in exacerbations requiring hospitalization has been limited, and there appears to be little common ground between predictors of mortality in stable disease and during AECOPD. The study aims to compare the prognostic value of the DECAF score, modified DECAF score, BAP 65 score and the 2008 score in predicting in-hospital mortality of patients with AECOPD.

Methods: Analytical prospective study conducted among 70 patients admitted in a state of acute exacerbation of COPD according to GOLD guidelines supported by spirometric evidence of airflow obstruction, in a tertiary care hospital.

Results: The sensitivity of 2008 score, DECAF and modified DECAF score was 100% in our study whereas the sensitivity of BAP-65 was 83.3%. The specificity of BAP-65 is highest when compared to all other scores and it was around 94.8%. Comparing the AUROC curve among the 4 studied scores, we found that the second highest AUROC curve was that of the BAP-65 score (0.948).

Conclusions: The ideal scoring system should be sensitive, specific, easy to perform and readily available on admission to facilitate the quick diagnosis and treatment. BAP 65 score satisfies all these requirements and emerges as a superior tool in predicting the mortality of AECOPD.

BAP-65 score can be used as a tool for evaluating and predicting the patient mortality based on minimum number of invasive tests and initial status of presentation of the patient. The BAP-65’s components are virtually impartial. This emphasizes that this score is consistent and reliable- qualities that are essential for any potential clinical tool. We find that compared to the BAP-65 score had a greater specificity, higher AUROC, and thus, a better predictor of in-hospital mortality in AECOPD patients.

Abstract No. 200: Cross-sectional analysis of allergen profiles in Marathwada region of Maharashtra, India: A skin prick test study

Bharat Anil Toshniwal 1 , Damkondwar Omprasad Bhagwat

Consultant Chest Physician Interventional Pulmonologist and Allergy Specialist, Toshniwal Chest Hospital and Shwas Chest Hospital, Nanded, Maharashtra, India, 2 Associate Professor, Department of Community Medicine, Parbhani Medical College, Parbhani, Maharashtra, India

Context: Allergic diseases are a growing global health concern, especially in rapidly urbanizing areas. Marathwada, a region in Maharashtra, India, presents a unique setting to examine the influence of environmental and demographic factors on allergic sensitization.

Aim: To investigate the prevalence and patterns of allergen sensitivities in the Marathwada region using skin prick testing and to examine correlations with demographic factors such as age and gender.

Settings and Design: A cross-sectional study was conducted at a centralized healthcare facility in Marathwada. Participants presenting with allergic symptoms underwent skin prick testing (SPT).

Statistical Analysis Used: Data was collected using a structured questionnaire and analyzed with Microsoft Excel 2021. Descriptive statistics were used to determine allergen prevalence and demographic correlations.

Results: Among 513 participants (54.39% female), the most represented age group was 21–30 years (32.4%). Positive SPT reactions were observed in 71.53% of participants. Mite allergens such as Dermatophagoides pteronyssinus, D. farinae, and Blomia tropicalis showed the highest positivity rates. There was a notable correlation between SPT positivity and elevated serum IgE levels across all age groups.

Conclusions: The study reveals a high prevalence of allergen sensitivity, particularly to mites, in the Marathwada region. These findings underscore the importance of region-specific allergen profiling to inform clinical management and public health strategies.

Abstract No. 201: Mechanical ventilation respiratory distress observation scale: A method to predict weaning outcome – An observational study in the medical ICU

Keerthana Gnair

Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

Introduction: Extubation timing is crucial in managing mechanically ventilated patients, often based on a spontaneous breathing trial (SBT). However, SBT failure may lead to extubation failure and prolonged ventilation. Currently, no standardized tool reliably predicts SBT outcomes. This study evaluates MV-RDOS as a predictive tool for SBT failure and compares its accuracy with the Rapid Shallow Breathing Index (RSBI). MV-RDOS, if validated, could improve ICU protocols by minimizing SBT failures and enhancing patient care.

Methods: Patients intubated for more than 48 hours were included if they met standard readiness-to-wean criteria. MV-RDOS and RSBI were assessed before the SBT and at 2, 15, and 30 minutes (end) of the trial. Sensitivity, specificity, and AUC were calculated to assess the predictive value of MV-RDOS and its comparison with RSBI.

Results: Among 62 patients (mean age 63.05 ± 15.12 years), A MV-RDOS ≥ 2.06 before SBT predicted failure with 79% sensitivity and 88% specificity (AUC 87%). At 2 minutes, a cutoff ≥ 2.22 had 79% sensitivity, 98% specificity (AUC 90.8%); at 15 minutes, a cutoff ≥ 2.19 achieved 89% sensitivity, 98% specificity (AUC 94.2%); and at 30 minutes, a cutoff ≥ 2.56 had 89% sensitivity, 100% specificity (AUC 90.2%), with all p-values <0.001. At 15 minutes, MV-RDOS predicted success in 42 of 44 normal cases and failure in 17 of 18 abnormal cases. At 30 minutes, it predicted success in 40 of 42 normal cases and failure in 17 of 20 abnormal cases. MV-RDOS showed a significant association with RSBI but demonstrated higher sensitivity, specificity, and accuracy, particularly at 15 and 30 minutes, supporting its reliability.

Conclusions: MV-RDOS outperformed RSBI in detecting early respiratory distress and predicting SBT outcomes. It offers a reliable, sensitive, and feasible approach to refine weaning protocols, reduce unnecessary weaning attempts, and improve extubation success. Multicenter validation is necessary to confirm its utility.

MV-RDOS is a valuable tool for early detection of respiratory distress and predicting SBT outcomes, compared to RSBI. It may be helpful in weaning decisions in ICUs.

Keywords: ICU care, mechanical ventilation, MV-RDOS, RSBI, SBT failure, weaning protocol

Abstract No. 202: Role of pulmonary rehabilitation in improving health status in chronic respiratory diseases

Aditi Padki , Priti Patil, Shraddha Kulkarni

Tulip Healthcare, Pune, Maharashtra, India

Introduction: ACCP and AACVPR recommends pulmonary rehabilitation as appropriate for patients disabled with respiratory symptoms due to chronic lung disease. Irrespective of the severity of the disease, Pulmonary Rehabilitation (PR) can prove beneficial in improving functional capacity and overall health of patients. Telerehabilitation can also be considered as an option to classic centre-based rehabilitation in patients with barriers like transportation, fixed schedules and financial burden.

Methods: Total no. of patients enrolled for pulmonary rehab in the year 2024 were retrospectively evaluated. A 6-minute walk test and Pulmonary function test were taken in these patients, pre and post rehabilitation. Changes in the outcome measures were assessed post PR to analyse the health condition of the patient.

Results: Out of the 21 patients enrolled for Rehabilitation with chronic lung diseases, 66.7% were female. The average age of patients was 63.33 years. The average no. of rehab sessions completed by patients was 14, with 30 being highest and 04 lowest. Diagnosis included both obstructive (61.9%) and restrictive (38.1%) lung diseases. The average difference in 6-minute walk distance pre and post rehab was 52m and the average improvement in FVC post rehab was 7%. 4 patients out of 21 were on long term oxygen therapy and 2 of them were able to stop oxygen post rehab. Out of the 21 enrolled, nearly 33% (N=07) opted for telerehabilitation.

Conclusions: This analysis reinforces the need for pulmonary rehabilitation in patients suffering from chronic lung diseases for enhancing functional capacity and exercise tolerance. Further research is warranted to investigate the long-term impact of PR on various patient outcomes, including quality of life, healthcare utilization, and disease exacerbations.

Keywords: Pulmonary rehabilitation, tele pulmonary rehabilitation, walk test

Abstract No. 203: Bilateral pneumothorax and beyond, where genetics meet pulmonology – A journey through Birt Hogg Dubè syndrome

Anubha Tiwari

Midland Healthcare and Research Centre, Lucknow, Uttar Pradesh, India

Introduction: Birt-Hogg-Dubé Syndrome (BHDS) is a rare autosomal dominant disorder caused by mutations in the (FLCN) Folliculin gene. It is characterized by pulmonary cysts, spontaneous pneumothorax, renal cysts or tumors, and cutaneous lesions such as fibrofolliculomas. Patients with BHDS are at an increased risk of developing Chromophobe renal carcinoma. Early diagnosis and management are critical to prevent complications like recurrent pneumothorax and renal malignancies.

Case Report: Presenting Complaint: 61 years old Male patient presented with dyspnea for 4 days, later diagnosed as bilateral pneumothorax with a larger left-sided pneumothorax requiring an intercostal drainage (ICD).

Imaging findings:

Chest X-ray: Bilateral pneumothorax, left side larger Chest CT: Multiple bilateral pulmonary cysts, more prominent on Left Lower lobe Renal Ultrasound: Bilateral simple cortical cysts, larger on the right kidney, without evidence of malignancy. Mutation: c.1285dup (p.His429ProfsTer27) in the FLCN gene, confirming the diagnosis of BHDS.

(1) Acute Pneumothorax Management:

Oxygen therapy, nebulization, antibiotics ICD placement for left-sided pneumothorax

Right sided - conservative management

(2) Renal Management:

Monitoring of bilateral renal cysts without immediate intervention.

Patient was advised for VATS pleurectomy i/v/o high chances of recurrence & presence of high risk factors.

Subsequent review of his pedigree discovered skin lesion suspicious of fibrofolliculoma in his both brothers.

Patient Opted for Close Follow up:

Regular imaging for pulmonary cysts and renal masses. Genetic screening for family members. Multidisciplinary follow-up with pulmonology, nephrology, and dermatology.

Conclusions: This case highlights the importance of genetic testing in diagnosing BHDS in patients presenting with bilateral pneumothorax. Long-term monitoring for renal malignancies and pulmonary complications is crucial in improving outcomes in BHDS.

Birt-Hogg-Dubé syndrome weaves a high-stakes tapestry of recurrent pneumothorax, RCC risk, vigilant care demands, and the weight of significant morbidity and mortality, thereby urging definitive intervention.

Abstract No. 204: Cardiac manifestations in COPD – A hospital based cross sectional study

Rahul Kuruvilla , G. N. Srivastava, Vinod Kumar

Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Introduction: COPD is defined as a heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. It often coexists with cardiac conditions like pulmonary hypertension, heart failure, arrhythmias, and ischemic heart disease, which worsen prognosis. Heart failure affects 20-70% of COPD patients and increases mortality, highlighting the need for early diagnosis and intervention.

Methods: A cross sectional study was conducted on patients satisfying inclusion criteria. Informed consent was obtained. Patients were evaluated in the OPD, and demographic details, history, and symptoms were recorded. Complete blood tests, chest X-ray, spirometry, and echocardiography were performed. Spirometry results were used to assess COPD severity, graded according to the latest GOLD guidelines, following which cardiac changes secondary to COPD and its association with severity of COPD is assessed by echocardiography.

Results: Total 25 patients were enrolled in this study. Echocardiographic findings were normal in 8 out of 25 subjects (32%). Abnormal echocardiographic findings included Tricuspid Regurgitation (TR) in 17 (68%), Pulmonary Hypertension (PAH) in 14 (56%), Cor Pulmonale in 6 (24%), and RA & RV dilatation in 7 (28%). The most common echocardiographic finding was TR, observed in 17 out of 25 cases (68%), among whom PAH was present in 14 cases (82.6%). The prevalence of mild, moderate, and severe PAH in these cases was 7/14 (47%), 4/14 (31%), and 3/14 (21%), respectively.

Conclusion: Our study revealed that echocardiography is a valuable tool for the early identification of cardiac comorbidities in COPD patients. It highlighted a significant prevalence of pulmonary hypertension, tricuspid regurgitation, cor pulmonale, and right atrial and ventricular dilatation, particularly in those with severe and very severe stages of COPD.

Keywords: Cardiac comorbidities, COPD, echocardiography, pulmonary hypertension, tricuspid regurgitation

Abstract No. 205: Lung mass in a patient with ANCA associated vasculitis

Rahul Kuruvilla , G. N. Srivastava, Vinod Kumar

Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Introduction: Granulomatosis with polyangiitis is a potentially lethal ANCA associated small vessel vasculitis characterised by triad of upper respiratory tract, lung and kidney involvement. Lung involvement in GPA occurs in 25 -80% of cases.The most common involvement are lung nodules and masses, very often multiple. As there are various clinical presentations the diagnosis can be challenging, and the illness is difficult to distinguish from other diseases such as infection or malignancy.

Case Report: Hospital based case study was done on 52 year old female presented with complaints of shortness of breath, fever and cough of 2 months CT biopsy showed post inflammatory changes. PET CT showed metabolically active multiple variable sized irregular nodules and mass in bilateral lungs. Metabolically active soft tissue component in right maxillary sinus and diffuse FDG avidity in mucosa of right nasal cavity was seen. CECT THORAX showed ill-defined heterogeneously enhancing lesion in bilateral upper lobe, right middle and bilateral posterior segment of right lower lobe lung parenchyma of size 64×50mm. PR3-ANCA (C-ANCA) value was 76.35 AU/ml. CT guided biopsy of lung lesion showed inflammatory cells in histopathology. Patient was managed with methotrexate pulse therapy, prednisolone and supportive measures following which patient showed significant improvement in symptoms and reduction lung mass size.

Conclusions: A lung mass in ANCA-associated vasculitis is rare and can mimic malignancy or infection. Early diagnosis through biopsy and imaging, followed by timely immunosuppressive therapy, ensures effective treatment and better outcomes.

AAV should be included in the differential diagnosis of lung masses, especially in patients with known systemic vasculitis. Prompt diagnosis and tailored immunosuppressive therapy can prevent irreversible organ damage and improve patient outcomes.

Abstract No. 206: From blockage to breath: Relieving severe hypoxemia due to endobronchial obstruction using therapeutic bronchoscopic techniques

K. T. Deviprasad , Manu Chopra, Rahul Tyagi, Kislay Kishore, Aseem Yadav, M. C. Jyothis

Department of Respiratory Medicine, AICTS, Pune, Maharashtra, India

Introduction: We present a case report of an adult male, a case of thymic neuroendocrine tumor with endobronchial lesion who presented with features of obstruction collapse with respiratory failure requiring 100% FiO2. He was managed with therapeutic bronchoscopy allowing for patient to be weaned off oxygen support and allowing to be fit for a life saving surgery.

Case Report: A 42 year old male, a known case of metastatic thymic neuroendocrine tumour (NET), diagnosed in 2017, on chemotherapy, presented with rapidly progressive breathlessness and hypoxemia. On evaluation, PET CT revealed FDG avid mass lesion with irregular margin (4.5 x 6.1 x 4 cc) in middle mediastinum and a FDG avid perihilar lesion (3 X4.2 X 3.9cc) with collapse of distal RML. Video-bronchoscopy showed a fleshy endobronchial lesion completely occluding the right main bronchus. Endobronchial biopsy of the same revealed well-defined NET, Grade I. Patient was declared unfit after assessment by onco-surgeon and anaesthesiologist in view of severe hypoxemia and high FiO2 requirement. We performed therapeutic bronchoscopy as a high risk procedure was done using electrocautery fulguration and cryo-canalisation of the endobronchial lesion. Minor complication was faced in the form of minimal bleeding which was controlled using local measures. There was signification resolution of obstructive symptoms and hypoxemia and he was weaned off oxygen support. The intervention ensured patient could be taken up for life-saving surgery and also improved his quality of life.

Conclusions: Therapeutic bronchoscopy using cryotherapy and electrocautery can be used as a life-saving intervention to relieve endobronchial obstruction in malignant lesions of airway leading to positive outcomes.

Abstract No. 207: Effect of 8 weeks hybrid (in-person and telemonitored) pulmonary rehabilitation on exercise capacity and quality of life in stable chronic obstructive pulmonary disease patients

Preetha Senthilkumar

Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality. Non-pharmacological management, such as vaccination, smoking cessation, and pulmonary rehabilitation (PR), play a crucial role in managing COPD. PR combines exercise training, education, and psychological support to improve quality of life (QOL) and reduce disability. This study assesses the effectiveness of an 8-week hybrid (in-person and telemonitored) PR program on exercise capacity and QOL in stable COPD patients.

Methodology: This prospective observational study, conducted at a tertiary care centre in Chennai, involved 62 COPD patients meeting specific inclusion criteria. Participants completed an 8-week hybrid PR program with 24 sessions (3 sessions per week): six in-person and the remaining virtual, remotely monitored. COPD Assessment Test (CAT), St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), BODE index, and spirometry were performed before and after intervention and results were compared.

Results: The 6MWD improved by 19.61 meters, from 223.58 to 243.19 meters (p<0.001). CAT and SGRQ scores decreased significantly, from 21.17 to 19.53 and 55.4 to 42.24, respectively (p<0.001). FEV1 increased from 0.96 to 1.34 liters (p<0.042). The BODE index decreased from 5.11 to 4.45 (p<0.002).

Conclusions: The improvements in 6MWD and reduction in CAT and SGRQ scores reflect enhanced exercise capacity and QOL respectively. A reduction in the BODE index suggests better disease outcomes with PR. Statistically significant improvements in 6MWD, CAT and SGRQ scores were seen in COPD GOLD grades 2 and 3, while only SGRQ scores improved in GOLD grade 4, highlighting the benefits of early PR introduction in COPD.

The 8 week hybrid PR program effectively improved exercise capacity, QOL, lung function and prognosis in COPD patients, demonstrating its potential as a valuable intervention in COPD management.

Keywords: Chronic obstructive pulmonary disease, exercise capacity, pulmonary rehabilitation, quality of life

Abstract No. 208: Impact of sources of indoor air pollution on various health conditions in urban slums of Pune city

M. Dhawale 1 , M. Barne 1 , S. Madas 1 , V. Das 2 , A. Gaikwad 1 , A. Shaikh 1 , P. Shinde 1 , A. Sabale 1 , S. Salvi 1

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India

Introduction: Air pollution, both ambient and indoor, is a major public health issue, causing 6.7 million premature deaths annually. In India, 0.98 million deaths are attributed to ambient air pollution and 0.61 million to indoor pollution. IAP accounts for 17.8% of total deaths, with unclean fuels being a major contributor. In India, there are several other sources of IAP which are usually not studied.

We aimed to understand the health impact of sources of IAP other than unclean fuels.

Methods: Through our Pollution Awareness and Wellness Assessment Initiative (PAWAN) project we conducted a questionnaire based cross sectional study in Pune City. Sources of IAP captured were burning of mosquito coils, incense sticks, dhoop, and loban at least once a day inside the house. We also checked BP, height, weight, random blood glucose and hemoglobin. 1230 participants underwent spirometry.

Results: We administered the health-related questionnaire to 3862 participants of which 1230 underwent spirometry. Average age was 44 +/- 15 years and 60% were females. 93% of the participants resided in urban slums. 41.7% used mosquito coils, 28.7% burnt dhoop batti or loban or camphor and 70.5% burnt incense sticks at least once a day. IAP was significantly associated with the health conditions as shown in Table 1 .

On Spirometry 697 (56%) out of 1230 had small airways obstruction which was also strongly associated with IAP [ Table 2 ].

Conclusion: Our study found that about 92% of slum dwellers are exposed to different sources of IAP other than unclean fuel. Among those who are exposed to IAP, odds of presence of respiratory symptoms was 61% higher, Diabetes was 55% higher and obesity/overweight was 39% higher. Additionally, in these who underwent spirometry, odds of having SAO was 46% higher if they were exposed to IAP.

Keywords: Diabetes, hypertension, indoor air pollution, obesity, respiratory symptoms, urban slums

Abstract No. 209: Drug hypersensitivity reactions caused by anti-tubercular drugs

Saroj Meena , Rohan Malakar

National Institute of Tuberculosis and Respiratory Disease, New Delhi, India

Background: Tuberculosis (TB) is a major cause of mortality and morbidity worldwide, with India accounting for 25% of the global TB burden. Anti-tubercular drugs (ATD) can cause multiple adverse reactions, including hepatitis, flu-like syndrome, and optic neuritis. Cutaneous Adverse Drug Reactions (CADRs) can range from mild itching to severe conditions like toxic epidermal necrolysis (TEN), which may require treatment discontinuation. Drug rash with eosininophilia and systemic syndrome (DRESS) is a less frequent but severe hypersensivity reaction, usually reported with anticonvulsant, allopurinol, NSAIDs, and antibiotics. The prevalence of DRESS ranges from 1 in 1000–10,000 people, with a mortality rate of 10–20%. It is characterized by fever, skin eruption, hematological abnormalities, and systemic organ involvement with a long latency period of 2–8 weeks. Around 60% of tuberculosis patients experience adverse drug reactions, with one-third being Drug Hypersensitivity Reaction (DHR). Combination treatment with four drugs increases the risk of simultaneous MDHS. Some cases of MDHS associated with anti-tuberculosis drugs have been reported, and some patients with MDHS have been included in studies. We describe an unusual case of DRESS syndrome in a young female with drug-sensitive TB. The syndrome was triggered by multiple anti TB medications, presenting challenges in formulating a treatment regimen for the patient.

Aim and Objective: To study and evaluate the adverse drug reactions caused by anti-tubercular drugs.

Methods/Case Study: We present a 32-year-old female patient from Delhi. She had complaints of fever for 3 months, productive cough for 3 months. Loss of weight and Loss of appetite for same duration. She had no history of vomiting, pain abdomen or icterus. The patient was diagnosed with PTB sensitive to Rifampicin and Isoniazid by LPA and started treatment with first-line Anti-tubercular drugs from outside hospital on April 2023. After 17 days, the patient developed fever, pruritus, deranged LFT values, leukocytosis and redness on her torso, which subsequently spread to her limbs. We present the case of a 32-year-old female patient from Delhi, who experienced severe adverse reactions to first-line ATDs. The patient reported a three-month history of fever, productive cough, weight loss, and loss of appetite. She had no history of vomiting, abdominal pain, or jaundice. In April 2023, the patient was diagnosed with pulmonary tuberculosis (PTB) sensitive to Rifampicin and Isoniazid through Line Probe Assay (LPA) and commenced treatment with first-line ATDs at an external hospital. Seventeen days into the treatment, the patient developed fever, pruritus, and elevated liver function test (LFT) values, leukocytosis, and a rash that started on her torso and spread to her limbs. She was hospitalized, and first-line ATDs were discontinued. An induction regimen was initiated, gradually introducing one drug at a time, starting with Isoniazid. After two days of Isoniazid therapy at 150mg, the patient developed an erythematous rash with pruritus. Anti-allergic medications and oral steroids were administered for five days, and Isoniazid was discontinued. Upon resolution of symptoms, Rifampicin was reintroduced incrementally. However, after one day of 150mg Rifampicin therapy, the patient developed another erythematous rash with pruritus. This was again managed with anti-allergic medications and steroids. Pyrazinamide was then introduced incrementally. The patient tolerated a 600mg dose for three days without issues, but similar reactions occurred at higher doses. Pyrazinamide was withheld, and symptoms were managed with anti-allergic drugs and a short course of steroids. Ethambutol was also reintroduced incrementally, but on the second day, the patient developed pruritus and an erythematous rash. This was managed similarly. Throughout this period, the patient’s SGOT and SGPT levels were elevated to more than three times the upper limit of normal. A modified ATT regimen, including Streptomycin, Levofloxacin, and Ethambutol, was attempted. However, the patient again developed erythematous rash and pruritus, leading to the discontinuation of the modified ATT and management with steroids and anti-allergic. DRESS syndrome or ATT-induced hypersensitivity syndrome was suspected due to presence of fever, rashes, and elevated liver enzymes and persistent lymphocytosis. Multiple attempts at sequential reintroduction of ATDs were made at different hospitals, but rashes developed each time. One year after the primary diagnosis, the patient was referred to our hospital and admitted to the department of tuberculosis and respiratory diseases. A repeat sputum LPA confirmed PTB sensitivity to Rifampicin and Isoniazid. Her ATT had been stopped for the past month when she came to us. We initiated a Bedaquiline-based all-oral longer regimen, including Bedaquiline, Levofloxacin, Linezolid, Clofazimine, and Cycloserine after a pre-treatment evaluation. Given the patient’s history of drug-induced skin rash, we decided to introduce the drugs one by one with a gap of three days between each. The patient tolerated Bedaquiline, Levofloxacin, Linezolid, and Clofazimine without issues. However, upon introduction of Cycloserine, the patient developed an erythematous skin rash on the torso and trunk, along with pruritus and fever. Cycloserine was with-held and symptoms were managed with steroid and antihistaminics. Ethionamide was added in replacement of Cycloserine. Patient developed itching and erythematous rash after 1 day of starting Ethionamide. Hence Ethionamide was stopped and inj Amikacin added. After one day patient developed rash, so it was stopped. Delaminid was added in to the regime. This time patient tolerated the drug without any skin reactions. Patient’s final regime comprises of Bedaquiline, Delamanide, Levofloxacin, Linezolid, Cycloserin. ECG and relevant blood investigations were performed on regular interval and occurrence of any skin reaction has been monitored closely. Due to long standing in-adequately treated disease process, patient developed sudden onset hypoxia and left sided chest pain. CXR revealed left sided Pyo-pneumothorax. It was managed with Intercostal Chest Drain with water seal bag. We have suspected HLA association in hypersensitivity reaction when multiple drugs are used. We have sent HLA typing for this patient, although no correlation was found in our case. Patient didn’t show any adverse reactions, improved clinically after starting the individualized treatment regime. Her total leukocyte count reduced to 10000 from 39000 and she is now in room air. Her appetite has improved and physical and mental wellbeing is restored. Her ICD is still working and pus collection is >100ml/day.

Conclusion: ATD induced drug reaction is a very common adverse reaction that may occur during the tenure of treatment of Tuberculosis. We should look for the adverse reactions more closely and meticulously.

Abstract No. 210: Exploring the challenges of managing difficult-to-treat asthma: A questionnaire based approach

Sharvary Rathod , Priti Ghadage, Alpa Dalal, Tarang Kulkarni

Jupiter Hospital, Thane, Maharashtra, India

Introduction: Difficult-to-treat asthma (DTA) remains a major clinical challenge, characterized by persistent symptoms despite optimal therapy. This study investigates the factors contributing to DTA, aiming to enhance management strategies and patient outcomes.

Methods: 78 patients aged 18-70 with poorly controlled asthma were recruited in this one-year observational study in the Pulmonary Medicine Department of Jupiter Hospital. Patient’s were subjected to a semi-structured interview and a detailed Asthma-Counselling Program. Data was collected from routine outpatient and inpatient visits. Inclusion criteria focused on patients with poor asthma control despite maximal treatment, while excluding those with other chronic respiratory diseases or cognitive impairments.

Results: The study revealed multiple factors impacting asthma control:

Comorbidities: 37 % patients had multiple comorbidities, including AR (55%), GERD (51%) OSA (17%)and nasal polyposis (3%) Triggers: 87 % patients were exposed to multiple triggers (stress, occupational exposure, household pets, indoor pollution) Adherence & Inhaler Technique: Over a third struggled with adherence; 57% patients lacked proper inhaler technique Control Status: 29% of patients had moderate and 37% poor asthma control Spirometry: 61% patients had not undergone spirometry, limiting comprehensive asthma management GINA assessment : In this cohort, 46% patients were in step 3 having moderate asthma and 32% were in step 4 and 5 requiring high dose therapies for severe asthma.

Patient education helped identify key issues of 87% patients having exposure to various environmental triggers and 45 % patients having incorrect inhaler technique. Symptom Control and better quality of life was evident after teaching environmental control measures and by just correcting their inhaler technique which helped them not progressing to Severe Asthma.

Conclusion: In conclusion, improving asthma management requires a multifaceted approach, focusing on enhancing patient education, ensuring regular monitoring of lung function, and providing personalized care based on individual inflammatory profiles and triggers. Continuous updates to patient data and regular follow-ups are essential to optimize treatment and improve asthma control.

Keywords: Adherence, asthma control, asthma, inhaler technique, patient education, spirometry, triggers

Abstract No. 211: Tuberculosis in ICU, not all is a lost case

Amol Suryawanshi , Ketaki Utpat, Unnati Desai

Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India

Introduction: Patients with tuberculosis though rare can present with respiratory emergencies in certain circumstances like massive hemoptysis, respiratory failure and pulmonary thromboembolism being few of them. Stigma associated with tuberculosis is still common in many societies contributing to delays in treatment seeking and treatment disparities.

Case Report: A 38 years old male known diabetic was admitted in Chest Medicine RICU with type 1 respiratory failure. He hailed from Rajasthan and worked in Mumbai. His co-workers gave history of acute onset of symptoms for 5-6 days with complaints of dyspnea MMRC grade III – IV, cough with expectoration associated with hemoptysis, intermittent fever. He was admitted with the provisional diagnosis of bilateral pneumonia with type 1 respiratory failure with ARDS and initiated on antibiotics, NIV and later HFNC. The radiology was atypical for ARDS and hence a detailed history was sought from the patient when he was little better. He gave history of TB therapy and DM in the past. His relatives who later were available gave history of prolonged ICU care in the past which was treated with ATT but no reports or documents were available. His coworkers were not aware of this history as the patient feared stigmatization inspite of previous complete TB therapy.

Clinical Examination:

His Vitals were

Pulse rate -104/min

Respiratory rate-34/min

SpO2-90% @ HFNC (40 L/Min flow, 40% FiO2)

RS- BSBE bilateral crepitation.

He was evaluated with sputum studies for CBNAAT which came MTB detected medium rifampicin resistance detected. His chest x-ray showed bilateral consolidatory changes [ Figure 1 ]. A computed tomography of chest with pulmonary angiography done post stabilization showed no pulmonary thromboembolism however consolidation with air bronchogram, cavitation and multiple adjacent centrilobular nodules in bilateral lung field, multiple sub centimetric pre and paratracheal, subcarinal and pre vascular lymph nodes largest measuring 1.7 x 0.8 cm, multiple enlarged lymph nodes in bilateral cervical levels II, III, IV, V and in bilateral axillary region largest measuring 3 x 2.2cm in right axilla [ Figure 2a - c ]. Sputum AFB smear came AFB seen 3+. TB-LPA First line Rifampicin and Pyrazinamide resistance detected. TB-LPA Second line came Fluroquinolones, Kanamycin, Amikacin, Capreomycin resistance not detected.

Initial ICU care as in Type I respiratory failure with antibiotics and NIV/HFNC for 4 days. The respiratory failure was better by the time the sputum diagnosis came within 4 days. He was started on all oral longer BDQ regimen (Weight based) and shifted to ward on the 5 th day of hospital stay.

-Tab. BDQ 400 mg OD for 14 days f/b Tab. BDQ 200 mg OD alternate day

-Tab. Linezolid 600 mg OD

-Tab. Levofloxacin 1000 mg OD

-Tab. Clofazimine 100 mg OD

-Tab. Cycloserine 1000 mg OD

Within three days as he was tolerating drugs and stable. He was discharged home with NTEP referral to his hometown and drugs given for a week to continue therapy as he wished to go back to his home town.

Patient showed steady improvement in clinical parameters and was discharged in stable state within 8 days of hospital admission.

Conclusions: Tuberculosis should be kept in mind as a possible etiology in respiratory failure in presence of history, radiological features like cavitation and presence of risk factors like DM. Every attempt should be made to achieve quick diagnosis with microbiological confirmation. Basic ICU care in a case of respiratory failure should be given to all presenting with the same as no patient comes with the labelled diagnosis. In pulmonary tuberculosis, super added secondary bacterial infections or complications like hemoptysis, thromboembolism or pleural complications cause respiratory failure rather than the primary lung parenchymal involvement due to TB disease. Over diagnosis should be avoided as empirical ATT can cause serious adverse events. On stabilization patients can be discharged home and rarely need prolonged institutional care in TB hospitals.

Abstract No. 212: A case of persistent rifampicin sensitive PTB which responded to BDQ based all oral regime after being declared a clinical failure

Amit Sharma

National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India

A 35-year-old lady presented with cough, expectoration and fever for last 2-3 months. Her past history was significant as she had received Anti-Tubercular Chemotherapy 2 times in the past year. Initially she was sputum positive and Line Probe Assay (LPA) showed Isoniazid (H) resistance with Rifampicin (R), Fluoroquinolone (FQ) and second-line injectables (SLI) sensitive. As per guidelines, she was started on a FQ, Levofloxacin (Lfx), R, Ethambutol (E) and Pyrazinamide (Z) which she took for 6 months. Patient improved during treatment but developed cough, expectoration and fever within 15 days of stopping treatment. She was again sputum positive for AFB with same resistance pattern as before (H mono-resistance). She was again started on LRZE for 6 months. However, at the 5 th month of treatment, patient developed fever, cough and expectoration. Sputum was again positive for AFB and LPA showed this time H and FQ resistance. R and SLI were both sensitive. Patient’s Chest X Ray had deteriorated and clinically also, she had deteriorated. After detailed analysis, patient was declared a Clinical Failure started on Bedquiline (BDQ), Linezolid (LNZ), Clofazimine (Cfz), Cycloserine (Cyc), Delamanid (Dlm). The patient improved on this regime and after 7 months of treatment now, both her smear and culture is continuously negative and patient is asymptomatic with significant radiological improvement. This case report demonstrates that clinico-radiological failure of ATT in PTB patients may not always be accompanied with microbiological evidence of failure by Drug Susceptibility testing (DST). In this case, DST only revealed H resistance before first and second course of ATT and H and FQ polyresistance at around the end of second course. Yet clinico-radiological features highly favored a treatment failure and second line drugs were initiated such as BDQ and Dlm. The patient responded very well to this regime and she became clinically, radiologically and microbiologically negative.

Conclusions: A judicious and diligent decision making in such complex cases may be life saving for the patient.

Abstract No. 213: A perception-based survey to understand the role of combination of bilastine and montelukast in the management of allergic rhinitis

Mahavir Bagrecha 1 , Vikrant Deshmukh 2 , Sanjay Sathe 2 , Mahavir Bagrecha 2 , Swapnil Kadam 2 , G. Gananathan 2 , Carlton Periera 2 , Vaishali Gupte 2 , Gurmeet Thakur 2 , Manjushree Naik Patil 2

1 Cipla Ltd., Pune, Maharashtra, India

Introduction: The present survey aimed to understand clinical perceptions and the role of a combination of bilastine and montelukast in the management of allergic rhinitis (AR).

Methods: A digital questionnaire-based survey was conducted from May to October 2024.

Results: Among 445 clinicians (ENT, Chest, Consulting Physicians), most (43.12%) were aged 31-40 years. In practice, 40% reported an AR prevalence of 21-30%, and 37.98% noted that 10-20% of AR patients had concomitant asthma. Sneezing was the most reported AR symptom (67.19%). For diagnosing patients with moderate-to-severe or persistent AR 56.40% of clinicians recommended a skin prick test. For managing mild intermittent/persistent AR, 45.39% preferred antihistamines, while 53.71% favored a combination of antihistamines and leukotriene receptor antagonists for moderate intermittent/persistent AR. Approximately 87% of clinicians preferred the bilastine-montelukast combination for AR management, citing its non-sedative properties, superior nasal congestion control, cardiac safety, and compatibility with renal or hepatic impairments. Around 61% supported its use for various AR patient profiles, including those with asthma, mild to moderate AR with any cardiac or renal dysfunction, moderate to severe AR not controlled with INCS, mild to moderate intermittent AR, and persistent AR. The ideal duration of this combination was reported to be 3-4 weeks by 44% of clinicians. Most HCPs expressed satisfaction with this combination’s efficacy (88.8%) and safety (92.3%). The most reported adverse events were gastrointestinal disturbances and fatigue (30%), followed by headache (22%). Neuropsychiatric events were noted by 7% of clinicians.

Conclusion: The survey demonstrates a combination of bilastine-montelukast was preferred by most clinicians in the management of AR across diverse patient profiles and was found to be effective and well-tolerated.

Keywords: Antihistamine, AR, bilastine montelukast combination, LTRA

Abstract No. 214: Survey of Indian respiratory physicians on burden of COPD and usage of triple therapy in routine practice

Ronak Panwala, Kundan Nivangune, Kamlesh Patel

Lupin Limited

Introduction: >7% of Indian adults are estimated to have COPD, and it is the second leading cause of deaths in India. Amongst various single/dual/triple combination inhalation therapies, Single inhaler triple therapy (SITT) is relatively new concept. This study was conducted to understand COPD burden and usage patterns of triple therapy in management of COPD by Indian respiratory physicians.

Methods: Structured Questionnaire was administered to HCPs through personal interview. Descriptive statistics were applied.

Results: 608 HCPs completed survey. Participant HCPs reported high burden of COPD patients:~50% HCPs reported >40 COPD patients/month. 37% HCPs responded proportion of newly diagnosed COPD patients to be <30%, 38% responded proportion to be 30-50%. Majority HCPs(>50%) preferred COPD treatment per GOLD COPD report, 21% preferred based on experience. 66% HCPs opined their initial pharmacotherapy was guided more as per symptom burden and exacerbation history, rather than airflow obstruction. ~20% HCPs reported Group E COPD patients to be >50% of all patients. 45% HCPs preferred SITT more, 13% preferred MITT, 40% HCPs showed no particular preference. Severe exacerbations, frequent exacerbations, EOS>300 were reported as leading factors to use triple therapy. ~10% HCPs reported concomitant Asthma also an important criterion. 50% HCPs prescribed triple therapy for 3 months, 33% & 16% HCPs prescribed triple therapy for 6 & >6 months respectively.

Conclusion: This study based on survey questionnaire amongst 608 HCPs showed high burden of COPD in Indian respiratory physicians’ practice. It demonstrated the usage of triple therapy (including SITT) in patients with severe/frequent exacerbations, patients with high EOS count. Future real-world studies should be done to investigate patient selection, time-point of initiation, outcomes during triple therapy and after step-down to dual therapy.

Keywords: COPD, GOLD, SITT, triple therapy

Abstract No. 215: Survey of Indian respiratory physicians on usage patterns of acebrophylline+ N-acetylcystiene in management of obstructive airway disease

Ronak Panwala , Kundan Nivangune, Kamlesh Patel

Lupin Limited

Introduction: Acebrophylline is an airway mucus regulator with anti-inflammatory, mild bronchodilatory, pulmonary surfactant secretory activities, and is widely used in patients with Asthma, COPD, and other respiratory disorders. N-acetylcysteine is a mucolytic agent with antioxidant properties, and also has been found to reduce the incidence of exacerbations in COPD patients. This survey-based study was conducted to identify practice patterns for combination of Acebrophylline + NAC.

Methods: Structured Questionnaire was administered to HCPs through personal interview. Descriptive statistics were applied.

Results: 248 HCPs completed the survey. 75% of participant HCPs reported mucus hypersecretion to be prevalent in 20-60% of patients suffering from asthma/COPD, despite using standard inhalation therapies. 95% HCPs believed mucus hypersecretion to be an independent risk factor for poor outcomes in chronic respiratory disease. 71% HCPs responded that mucoregulators/mucolytics should be integral part of therapy for majority of patients. 60% HCPs reported usage of Acebrophylline+NAC in 30-70% of their COPD patients. Molecular properties such as mucoregulatory (~60% HCPs), mucociliary clearance (35% HCPs), synthesis & release of pulmonary surfactant (~25% HCPs) were leading benefits perceived by HCPs while using Acebrophylline. 85% of HCPs opined that regular use of mucolytic/antioxidant such as NAC can reduce exacerbations and can improve health status. 80% HCPs believed that NAC could also improve efficacy of antibacterial drugs. 44% HCPs predominantly preferred Acebrophylline+NAC in Group B, followed by 28% & 27% HCPs in Group E and Group A COPD patients respectively. Apart from COPD, HCPs reported use of this combination in chronic bronchitis, bronchiectasis, Asthma. 75% HCPs recommended Acebrophylline+NAC two times a days whereas 25% HCPs recommended once a day. Regarding duration of treatment, 45% of HCPs usually prescribed this combination for 2-4 weeks, whereas 28% of HCPs prescribed the combination for 1-3 weeks.

The current survey suggests wide use of add-on therapies such as Acebrophylline + NAC to manage chronic mucus hypersecretion. Whereas mucolytic property can translate in early relief to patients’ symptom, use of such therapy for prevention of exacerbations need longer duration of treatment and follow-up. This study reported 2-4 weeks of duration of treatment with Acebrophylline + NAC combination. Studies can be done to investigate benefit of short (i.e. early post-exaceberbation period) and long term treatment with these agents.

Conclusion: Finding from this 248 Indian Respiratory physicians survey suggests chronic Mucus hypersecretion to be widely prevalent in patients with obstructive airway disease, and pharmacotherapeutic agents such as Acebrophylline + NAC are widely used in practice. >90% of HCPs perceived combination of Acebrophylline + NAC to be better than either agent alone. Prospective studies could be planned to identify right patient profiles, to measure magnitude of patients benefits symptomatically and for lung function, and to assess optimal duration of treatment.

Keywords: Acebrophylline, antioxidant, COPD, mucus, N-acetylcysteine

Abstract No. 216: Neuroendocrine tumor of the lung presenting as renal mass

Putta Sravya Krishna , Divya Balan

Department of Respiratory Medicine, KMC, Manipal, Karnataka, India

Introduction: Lung cancers are divided into sclc and nsclc. Sclc is a neuroendocrine tumor that accounts for 15% of all lung cancers. Sclc occurs predominantly in smokers. Some of the common sites for metastasis include bone brain liver adrenals. Renal metastases is rare.

Case Study: A 56-year-old man presented with complaints of breathing difficulty, cough and pain abdomen for 15 days. Patient had history of significant weight loss. Ultrasound abdomen and pelvis revealed a right renal mass of 16*16 mm. Fnac of mass was suggestive of metastatic deposits from neuroendocrine carcinoma. CT thorax was suggestive of a focal lesion of 14mm in the apical segment of the right upper lobe. Bronchoscopy revealed endobronchial growth in right upper lobe bronchus and biopsy of the lesion was suggestive of neuroendocrine carcinoma of lung.

Carry Home Message: This case is a rare case of neuroendocrine carcinoma of lung presenting as renal mass. Due to its unusual presentation, where the metastatic lesion is bigger than the primary lesion, it can be mistaken for a primary Renal cell carcinoma.

Conclusion: A Thorough evaluation including biopsy of primary and metastatic lesion is of importance in establishing the diagnosis as it will define the further course of treatment.

Keywords: Biopsy, lung, metastases, neuroendocrine carcinoma, renal cell carcinoma

Abstract No. 217: Correlatioin of neutrophil-to-lymphocyte ratio with the clinical severity in patients hospitalized with exacerbation of bronchiectasis

Kavitha Nair

Nizams Institute of Medical Sciences, Hyderabad, Telangana, India

Introduction: Bronchiectasis is a chronic respiratory disease marked by recurrent infections and persistent bronchial inflammation. A prominent feature is heightened neutrophil activity, leading to enzyme-mediated airway damage and accelerated lung function decline. The neutrophil-to-lymphocyte ratio (NLR), a cost-effective and accessible biomarker, offers a measure of inflammation and immune balance. This study explores the association between NLR, measured at hospital admission, and the severity of bronchiectasis exacerbations.

Methods: A prospective hospital-based study was conducted over 12 months in the Department of Pulmonary Medicine at NIMS, Hyderabad. Adult patients hospitalized for bronchiectasis exacerbation were enrolled. NLR was calculated using absolute neutrophil and lymphocyte counts from blood samples taken within 24 hours of admission. The severity of exacerbation was classified based on the type of respiratory support required, including oxygen therapy and mechanical ventilation (non-invasive or invasive).

Results: A total of 108 patients participated in the study, with a mean age of 47.9 years; 67 (62%) were male. The average BMI was 18.54 ± 4.71 kg/m², and pulmonary hypertension was the most common comorbidity (27.8%). The predominant cause of bronchiectasis was idiopathic (42.6%), followed by post-tubercular sequelae (24.1%). The mean NLR was 7.74 ± 7.48. Patients requiring mechanical ventilation had significantly higher NLR (12.21 ± 10.74) compared to those needing oxygen only (7.01 ± 5.41) or no support (4.64 ± 3.58). A statistically significant positive correlation was observed between NLR and mechanical ventilation requirement (rpb = +0.37, p < 0.01).

Conclusion: NLR correlates positively with disease severity and mechanical ventilation requirements in bronchiectasis exacerbations.

Keywords: Bronchiectasis, exacerbation, mechanical ventilation, NLR

Abstract No. 218: A clinical conundrum: Extensive thrombosis in the framework of Evan’s syndrome

Jeeva Babu

Amala Institute of Medical Sciences, Thrissur, Kerala, India

Introduction: Pulmonary embolism (PE) can present with severe respiratory distress and may be complicated by coexisting haematological disorders, such as autoimmune haemolytic anaemia (AIHA) and immune thrombocytopenia (ITP). This case highlights the diagnostic and therapeutic challenges in a young male patient with PE and concurrent AIHA and ITP.

Case Report: A 37-year-old male, previously healthy, presented with bilateral pneumonia, respiratory failure, and significant shortness of breath. Investigations revealed bilateral pleural effusions, elevated D-dimer, and severe pulmonary artery hypertension. CTPA confirmed PE. Initial treatment included anticoagulation and antibiotics, but the patient showed no improvement, developing symptomatic anaemia and thrombocytopenia. Thrombolysis was performed, and autoimmune workup indicated positive direct Coombs test, leading to the diagnosis of AIHA and ITP. Treatment was escalated with IVIG, rituximab, and steroids.

Conclusion: The case underscores the importance of a multidisciplinary approach to managing complex cases involving PE and haematological disorders. Timely diagnosis and tailored immunosuppressive therapy were crucial in improving the patient’s condition.

Keywords: Autoimmune haemolytic anaemia, immune thrombocytopenia, multidisciplinary approach, pulmonary embolism, thrombolysis

Abstract No. 219: Case series on foreign body removal using different accessories via fiberoptic bronchoscopy

Jeeva Babu

Amala Institute of Medical Sciences, Thrissur, Kerala, India

Background: Rigid bronchoscopy is traditionally preferred for the removal of foreign bodies (FB) lodged in the airways. However, flexible bronchoscopy has shown a high success rate in ideal cases with optimal modality. This study aims to evaluate the effectiveness of flexible bronchoscopy using various accessories for FB removal.

Methods: This retrospective analysis reviewed 3064 bronchoscopic procedures performed over 15 years at a tertiary hospital in central Kerala. Among these, 52 procedures were conducted for FB removal. The fiberoptic bronchoscope (Olympus BF-1T 150) and pediatric rigid bronchoscope (Karl Storz) were utilized. Accessories included toothed and cup forceps, dormia basket, tripod forceps, snare, and cryobiopsy probes.

Results: The incidence of FB aspiration was 1.7% (52/3064). Of the 52 patients, 36 had organic FBs, and 16 had inorganic FBs. Organic FBs included blood clots (47.2%), peanuts (16.7%), chicken bones (8.3%), mucus plugs (5.6%), green peas (2.8%), arecanut (2.8%), garlic (2.8%), sitaphal seeds (2.8%), and ayurveda tablets (2.8%). Inorganic FBs included hairpins (31.2%), teeth (25%), pen tips (12.5%), pen caps (12.5%), LED bulbs (6.3%), nose pins (6.3%), and whistles (6.3%). For organic FBs, toothed forceps were most commonly used (52.8%), followed by tripod forceps (38.9%), cryobiopsy forceps (5.5%), and dormia basket (2.8%). For inorganic FBs, toothed forceps were used in 68.8% of cases, followed by dormia basket (18.8%) and tripod forceps (12.4%). Seventeen patients had life-threatening blood clots requiring emergency intervention.

Conclusion: Flexible bronchoscopy with a multi-modality approach using different accessories is effective for diagnosing and removing FBs in the lower respiratory airways in adults, achieving a high success rate (90%) comparable to rigid bronchoscopy. Rigid bronchoscopy is recommended if flexible bronchoscopy fails, if the FB is centrally located, firmly embedded in scar tissue, or for removing sharp objects to minimize mucosal trauma, especially in pediatric patients. Cryobiopsy is particularly effective for organic FB retrieval. The Fogarty balloon catheter is a valuable aid in preventing distal displacement of FBs during retrieval.

Abstract No. 220: A study to evaluate the cardiovascular status in chronic obstructive pulmonary disease patients in a rural medical college, in West Bengal

Tamal Bhattacharyya

Department of Respiratory Medicine, IIMSAR and Dr. B. C. Roy Hospital, Haldia, West Bengal, India

Introduction: COPD1 & cardiovascular disease frequently coexist, leading to poor outcomes than each condition alone. Complication includes Pulmonary artery hypertension(PAH), Ischemic heart disease, Ventricular Dysfunction. ECG & Echocardiography provides rapid, non-invasive, cost effective method to detect early cardiovascular complication & management.

Methods: This hospital based cross sectional study involved 114 diagnosed COPD patients from OPD & IPD of Department of Respiratory Medicine & classified by GOLD2 A,B,E classification & mMRC3 grading. Cardiovascular complications were assessed by ECG & echocardiography.

Results: Out of 114 patients ECG findings : IHD-37.72% (p=0.002) ; P-Pulmonale-32.46% (p=0.002); Right Bundle Branch Block-28.07% (p=0.017); Left Anterior Hemiblock-13.16% (p=0.044); P-Pulmonale-32.46% (p<0.001). In Echocardiography : Tricuspid Regurgitation gradient in 35.9%, p<0.001, mean 30.16, SD=8.17; PAH in 44.7% (mild-22.81%, moderate-12.28%, severe-9.65%). ROC analysis showed PASP4 cut off 40.5(sensitivity 87.5%, p<0.011) & TAPSE/PASP5 ratio cut off 0.5(sensitivity 82.65%).

Conclusion: PAH is highly prevalent in advanced COPD significantly elevating mortality and morbidity risks. Early ECG & Echocardiography are crucial for prognosis & management. Routine cardiovascular screening for all COPD patients is recommended.

Keywords: COPD1-Chronic obstructive pulmonary disease, GOLD2-Global initiative for obstructive lung disease, mMRC3-Modified medical research council, PASP4-Pulmonary artery systolic pressure, TAPSE5-Tricuspid annular plane systolic excursion

Abstract No. 221: Tuberculosis and isoniazid acetylaytion: What a clinician needs to know

Fasmi Navas , Dipika Koli, Ketaki Utpat, Unnati Desai

Topiwala National Medical College, Mumbai, Maharashtra, India

Introduction: Tuberculosis (TB) is a common clinical condition presenting in a physicians or pulmonologist practice.While AEs are a chapter in most clinical guidelines, the drug related pharmacokinetics and metabolism are rarely elaborated upon. Isoniazid (INH) acetylating status and its variability amongst different regions and parts of the world is well known, however never elaborated much in day-to-day TB guidelines.

Case Report: There are 3 case reports: (1) A 58 year old lady, history of CA rectum presented with complaints of dyspnea,cough with expectoration and fever of 1 month duration. (2) A 63 year old lady, known case of Interstitial lung disease presented with complaints of increased dyspnea, cough with expectoration and fever of 2 weeks duration. (3) A 62 year old, known case of meningitis post multiple excisional surgery presented with complaints of dyspnea,dry cough, fever and cervical swelling.

Three of them were vitally stable. The third patient had right cervical swelling with redness over it with no pus discharge.There were no other significant clinical findings.

(1) Cxr showed bilateral consolidation [ Figure 1 ]. Sputum for CBNAAT came to be negative. (2) Cxr showed patchy acinar opacities bilaterally [ Figure 2 ]. Sputum CBNAAT detected MTB, Rifampicin resistance not detected. (3) Cxr revealed mediastinum widening [ Figure 3 ]. Sputum and cervical lymph node aspirate tested for MTB on CBNAAT came negative.

First and third patient were intervened by bronchoscopy and bronchial wash yielded MTB on CBNAAT, rifampicin resistance not detected. The three of the patients were started on drug sensitive fixed drug combination of Antitubercular therapy. Within a week,all 3 of them developed nausea,vomiting.Liver function tests were deranged,viral hepatitis panels were negative,USG abdomen came not significant. Therapeutic drug levels of ATT and NAT2 genotyping were sent.All 3 of them revealed mutations for NAT 2 indicating they are isoniazid slow acetylators.

The three patients were started on a regimen omitting isoniazid, ensuring their fluoroquinolone sensitivity.

Conclusion: The three patients of late fifties presented with cough,dyspnea,fever of 1 month duration,with cxr changes.They had microbiological confirmation for drug sensitive Tuberculosis,started on weight adjusted ATT and yet developed ATT induced hepatitis within a week.Blood investigations revealed NAT 2 mutations showing they are Isoniazid slow acetylators.They were then started on modified ATT regimen omitting isoniazid and patients symptomatically improved.

Abstract No. 222: Predictors of health-related quality of life among patients with idiopathic pulmonary fibrosis attending a tertiary care setting in Southern India

Anitha Mohanraj Barney 1 , Barney Isaac 2 , Balamugesh Thangakunam 2 , Sumita Danda 1 , Debashish Danda 3 , Venkata Raghava Mohan 4 , Christhunesa Soundararajan Christudass 5 , Devasagayam J. Christopher 2

1 Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India, 2 Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India, 3 Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India, 4 Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India, 5 Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

Background: Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive Interstitial Lung Disease (ILD) that has a significant impact on the health-related quality of life (HRQoL). There are generic and disease-specific questionnaires to assess this, but no literature from India exists.

Objective: To estimate the impact of IPF on HRQoL and determine its predictors in a cohort of patients attending a tertiary care centre in Southern India.

Methods: Consecutive consenting patients diagnosed with IPF by the ILD MDD between September 2023 and August 2024 were self-administered the St. George’s Respiratory Questionnaire (SGRQ) and the King’s Brief Interstitial Lung Disease (KBILD) questionnaire to assess the HRQoL.

Results: In all, 70 patients with IPF were recruited into the study. The median total SGRQ was 35.9 (23.9 – 57.8), and the median total KBILD was 54.5 (46.4 – 65.6). Based on SGRQ (>30), 63% (44/70) and based on KBILD (≤50), 34% (24/70) had a poor quality of life. The SGRQ was significantly lower in those not on antifibrotics across all domains, with a trend towards near significance in the activity domain. The GAP (Gender, Age, Physiology) index had a significant association with the KBILD - breathlessness and activity domain (p-value 0.01) and the total score (p-value 0.02).

Conclusion: This is the first Indian study reporting HRQoL in IPF. IPF impacts HRQoL drastically, with a predominant impact on physical wellness and a lesser effect on psychological well-being. KBILD is associated with the GAP index. A larger study is required to identify independent factors associated with HRQoL.

Acknowledgement: The research work presented in this article is part of a proposed PhD thesis of The Tamil Nadu Dr. M.G.R. Medical University, Chennai - 600 032.

Keywords: Health-related quality of life (HRQoL), Idiopathic Pulmonary Fibrosis (IPF), Interstitial Lung Disease (ILD), King’s Brief Interstitial Lung Disease (KBILD) questionnaire, St. George’s Respiratory Questionnaire (SGRQ)

Abstract No. 223: An exploratory exome sequencing analysis of idiopathic pulmonary fibrosis patients attending a tertiary care setting in the Indian subcontinent

Anitha Mohanraj Barney 1 , Barney Isaac 2 , Devasagayam J. Christopher 2 , Balamugesh Thangakunam 2 , Venkata Raghava Mohan 3 , Christhunesa Soundararajan Christudass 4 , Debashish Danda 5 , Sumita Danda 1

1 Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India, 2 Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India, 3 Department ofCommunity Health, Christian Medical College, Vellore, Tamil Nadu, India, 4 Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India, 5 Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India

Background: The etiology of IPF, the prototype idiopathic interstitial pneumonia with poor prognosis, remains poorly understood. While genetic and environmental factors have been proposed and studied, there is a dearth of data from India on the genetic predisposition of IPF. This study aims to fill this crucial gap.

Objective: We conducted an exploratory whole exome sequencing analysis to identify the genetic variants associated with IPF among Indian patients.

Methods: Consecutive consenting patients attending the pulmonary medicine outpatient service at a tertiary care hospital in southern India from February to June 2024 who met diagnostic criteria for IPF and were recruited. Their clinical, demographic, radiological, and physiological parameters were captured. A blood sample was taken for whole genome sequencing, and the results were analysed.

Results: In all, 15 IPF patients with a mean age of 63 were recruited. There was male predominance (93%). Seven patients harboured variants in TERT, TTR, MUC5B, DSP, ECT2 , and CFAP74 genes. In 2 patients whole exome sequencing identified a missense benign variant c.3004G>A (p.Val1002Met) and c.11224T>G ( p.Ser3742Ala) in the MUC5B gene. Both these variants show susceptibility to pulmonary fibrosis, and neither patient reported cough. WES picked up a frameshift variant c.4687_4688del (p.Leu1563GlufsTer63) in the DSP gene, which could cause arrhythmogenic right ventricular dysplasia – 8 in a patient in which IPF was incidentally diagnosed while being evaluated for cardiac arrhythmia.

Conclusion: This exploratory research gave insights into the underlying genetic predispositions for IPF in India. A larger Indian study is warranted.

Acknowledgement: The research work presented in this article is a part of a proposed PhD thesis of the Tamil Nadu Dr. M.G.R. Medical University.

Keywords: CFAP74, DSP, ECT2 , Idiopathic Pulmonary Fibrosis, MUC5B, TERT, TTR , Whole Exome Sequencing

Abstract No. 224: Unveiling isolated pulmonary cryptococcosis in lymphoma: A critical insight

Alina Varghese , Awnish Shubham, Alpa Dalal, Dipanjan Haldar

Jupiter Lifeline Hospital, Thane, Mumbai, Maharashtra, India

Introduction: Pulmonary cryptococcosis, caused by Cryptococcus neoformans, is a serious opportunistic infection leading to isolated or disseminated disease, particularly in immunocompromised individuals. Lymphoma is a major haematological malignancy linked to cryptococcal infections due to factors like T-cell depleting agents, glucocorticoid use, and immune dysregulation. Below unveils a case of Pulmonary cryptococcosis in a DLBCL patient:

Case: A 77 year old male known hypertensive, presented with right sided chest swelling and pleuritic chest pain associated with cough and other constitutional symptoms. Right sided pleural tapping was done and he was diagnosed with DLBCL (CD20 & Pax5 positive)- Triple hit lymphoma(c-myc,bcl-2,bcl-6 positive). He was treated with 5 cycles of dose adjusted R EPOCH along with radiation therapy. Patient did clinically well, with interval PET imaging showing significant metabolic and morphologic resolution of soft tissue mass and lymphnodes. However, a follow-up PET scan after 7 months of chemotherapy surprisingly revealed new 4-5mm nodules along with a metabolically active subpleural opacity in the left lower lung (2.6*1.6cm -SUV max -12.23) while the primary lesions showed full regression. He was evaluated further and a CT guided biopsy of left lung lesion was done which revealed - Areas of necrosis with many cryptococcal yeasts, with surrounding epitheloid cell granulomas. PAS/GMS stain & Fungal culture revealed cryptococcus neoformans. Bacterial culture and TB tests-Negative. CNS involvement of cryptococcosis was also ruled out. The patient was started on oral fluconazole therapy-400mg daily. He responded well to treatment with good radiological response.

Conclusion: Early identification and maintaining a low threshold of suspicion along with aggressive approach in immunocompromised patients is crucial for early diagnosis and management to prevent fatal outcomes.

This case highlights the importance of close monitoring for infections among immunocompromised patients through regular imaging and investigating through invasive approach.

Abstract No. 225: Purview of pulmonary fungal infections in renal transplant recipients

Mahima Jaisinghani , Sneha Tirpude, Ram Chopra

Ruby Hall Clinic, Pune, Maharashtra, India

Introduction: Fungal infections contribute to around 5% of infections in kidney transplant recipients. Gomori’s silver methenamine & mucicarmine staining on histopathology reveals Candidiasis as the most common, followed by aspergillosis and cryptococcosis. Invasive aspergillosis is especially severe with poor prognosis. We present 4 such rare cases to study the presentation along with radiology and its management [ Table 1 ].

Conclusion:

Clinical features of fungal infections vary from fever, cough, chest pain, dyspnea, hemoptysis, or just weight loss Radiological features vary from cavity to mass like lesion to nodules with or without effusion. Prompt diagnosis and early treatment result in good prognosis for fungal infections patients Three fungal infections were diagnosed by CT guided lung biopsy and one by Bronchoscopic bronchial washings In the first case, presentated as late as 13 years post transplant. He developed haemorrhagic pericardial effusion as a complication of the biopsy procedure, injury to adjacent structures. which was manageed prompltly. Other complications of a CT guided lung biopsy include pneumothorax, hemothorax, needle tract seeding,

Amphotericin related side- effects are acute toxicity -nausea, vomiting, rigors, fever, hypertension or hypotension, and hypoxia and chronic side effects of nephrotoxicity. Our case series showed well tolerance.

Abstract No. 226: Novel forms of organizing pneumonia

Mahima Jaisinghani , Sneha Tirpude, Ram Chopra

Ruby Hall Clinic, Pune, Maharashtra, India

Introduction: Organizing pneumonia (OP) has an incidence of 1.97-7/100,000 and typically presents subacutely without severe disease. It is an inflammatory, fibroproliferative lung condition with multifocal, diffuse, cavitatory, or nodular patterns.

Case Reports: This report presents four cases with varying manifestations, all diagnosed through histopathological analysis, highlighting the diverse presentations of this clinico-pathological syndrome [ Table 1 ].

Organizing pneumonia (OP) affects individuals without a specific age or sex predilection. Radiologically, the typical presentation is diffuse, patchy, peripheral consolidation surrounded by ground-glass opacities (GGO), with the Atoll sign seen in 20% of cases. However, all four cases presented here show localized, unilateral involvement, a less common form of the disease. Histopathologically, OP is characterized by organized fibrin balls in alveoli and respiratory ducts, with patchy distribution and the absence of vitreous membranes, inflammatory granulomas, eosinophilic pneumonia, and bronchiolitis with abscess formation. The first case describes secondary OP as an extraintestinal manifestation of Crohnrespiratory ducts, with patchy distribution and the absence of vitreous membranes, inflammatory granulomas, eosinophilic pneumonia, and bronchiolitis with abscess formatiThis case involved acute fibrinous organizing pneumonia. In the second case, a patient presented with a mass lesion with spiculated margins, raising suspicion of malignancy. While OP is typically bilateral, this case showed the rare single nodule presentation. Diagnosing COP requires excluding both infection and malignancy. The third case involved a recurrence of OP in a diabetic patient, eight years after initial treatment, at a new site. This recurrence required another course of corticosteroids, and delayed initial treatment, along with evidence of cholestasis, was associated with multiple relapses. The fourth case was a 62-year-old smoker who presented with a unifocal mass, another rare presentation of COP. Despite smoking being a known risk factor for many respiratory diseases, it is not considered a risk factor for Cryptogenic organizing pneumonia.

Organising pneumonia can have varied presentations and clinicians need to be wary of those.

Abstract No. 227: Challenges in bronchoscopic management of aspirated sapota seed in adults: A single-center experience of 5 cases

Pravin Taware , Arjun Srinivasan, Pattabhiraman Vallandaramam, Mahadevan Sivaramakrishnan, Arun Raja

Royal Care Superspeciality Hospital, Neelambur, Tamil Nadu, India

Introduction: Foreign body aspiration in the airway is a rare occurrence in adults, and such foreign bodies can be either organic or inorganic. We present a case series of five adult patients who aspirated sapota seeds and the challenges faced during their bronchoscopic management at a tertiary care hospital.

Objectives: The study aims to discuss and document the unusual cases of sapota seed aspiration, highlight the challenges encountered during bronchoscopic removal, and present the solutions employed for successful extraction.

Methods: We conducted a retrospective review of patient records with foreign body aspiration who underwent bronchoscopic removal at a tertiary care referral center between November 2016 and July 2023.

Results: Among 50 retrieved foreign bodies via bronchoscopy during the study period, 28 cases (56%) were in adults, and five of these adults had aspirated sapota seeds. All five patients were females with a mean age of 64.6 years. All had delayed presentations. Presenting complaints consisted of cough and dyspnea in all patients, wheezing in one (20%) with post-obstructive pneumonia in two patients (40%) and hyperinflation in two patients (40%). Granulation tissue and mucosal reactions were observed in all cases. The sapota seeds were lodged in different locations within the bronchial tree with the left side being the most common (n=3,60%). Four cases were managed with a rigid bronchoscope (80%) with one managed with flexible under local anaesthesia. A rigid bronchoscope and various accessories, such as forceps, dormia basket, Fogarty catheter, cryoprobe, electrocautery snare and knife were employed for successful retrieval. In 2 cases (40%), the seed was removed in toto along with a rigid barrel and in the remaining 3 cases(60%) seed was broken and removed in a piecemeal fashion using cryo-probe and forceps.

Conclusion: Sapota seeds are unusual foreign bodies that we occasionally encounter in adults. The size and physical structure poses unique challenges in its retrieval. A skilled team is crucial for successful extraction. Rigid bronchoscopy is a safer option for chronically impacted sapota seeds. Rigid and flexible bronchoscopes are complementary to each other. The use of various bronchoscopic accessories is essential for effective retrieval and at times breaking of the seed may be needed for successful extraction.

Abstract No. 228: Co-infection of pulmonary melioidosis and influenza a in a rice farmer with underlying bronchial asthma: A rare case report

Pravin Taware , Wasim Khot, Manali Nilekeri, Namrata Jasani, Samir Garde

Gleneagles Hospitals, Mumbai, Maharashtra, India

Introduction: Melioidosis is an infectious disease caused by a gram-negative bacterium Burkhloderia pseudomallei which is ubiquitous in rice farming areas. It is an endemic disesase in West Coastal Maharashtra, but remained under-reported.It causes significant morbidity and mortality if diagnosis and treatment is delayed. Important risk factors are diabetes, chronic kidney disease, chronic lung disease, immunosuppressive therapy etc.Influenza is usually a self-limiting disease but can cause morbidity and mortality in high risk groups. Both melioidosis and Influenza A commonly present with pneumonia. Secondary bacterial pneumonia is a known complication of Influenza A infection.However, melioidosis is not commonly reported as a cause of bacterial pneumonia complicating influenza A infection.Here we report a rare case of concurrent pulmonary melioidosis and influenza A.

Case Report: A 58 year-old male rice farmer with background history of asthma and type 2 DM presented with high grade fever, nonproductive cough, throat pain, dyspnea and severe headache. He was febrile on admission.He was evaluated with CT thorax a week before hospitalization.CT thorax was showing ground glass opacities in bilateral lower lobe of lungs suggestive of viral or atypical infection for which he received empirical antibiotic and antiviral.On admission viral RTPCR panel showed H1N1 influenza A detected. He was continued to have fever and headache.CT brain revealed no abnormality.In view of persistent fever and cough, a repeat CT thorax was done. CT chest revealed a large consolidation with cavitation along with GGO in right lower lobe with differential of TB versus fungal etiology. Sputum aerobic culture showed no growth hence decision of bronchoscopy was taken. BAL was collected from lower lobe of right lung. BAL Mycobacterial evaluation showed no MTB detected. Aerobic culture showed no growth till 3 days of incubation.MDT with ID specialist and microbiologist decided to incubate the culture for further few days. After 5 days of total incubation, culture showed cream colored colonies of B. pseudomallei. He was treated with 3 weeks of ceftazidime and 3 months of Trimethoprim/sulfamethoxazole. Patient improved symptomatically. CT thorax after 12 weeks of treatment showed only a small fibrotic band in right lower lobe.

Conclusion: Melioidosis is an emerging infection, especially among immunocompromised patients in coastal areas. The clinical picture is often similar to tuberculosis which is seen commonly in the same subset of patients. It is important to consider this uncommon infection in our differential diagnoses when faced with an appropriate clinical scenario in patients with co-infection of Influenza a infection.

Abstract No. 229: Idiopathic lymphocytic interstitial pneumonia – A rare presentation

Vipin Patel

School of Respiratory Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India

Introduction: Lymphoid interstitial pneumonia is a rare form of diffuse cystic lung disease with very less cases worldwide and is frequently associated with connective tissue disorder, infection and sometimes idiopathic. When symptomatic, the most frequent complication is dyspnoea on exertion and nonproductive cough. LIP affects women more frequently than men (M:F -1.00-2.75). Men are more likely to develop idiopathic LIP while women are more likely to develop LIP related to an autoimmune disorder. Some patients may have an indolent or even an asymptomatic course while others may have complications such as associated infections, pulmonary fibrosis and transformation into lipoma. Diagnosis is based on the history, physical examination, imaging tests and lung biopsy. The management of LIP should be focused on controlling the underlying disease process. LIP is a steroid-responsive disease with symptomatic and/or radiographic stabilization in 50-60% of the patients.

Case: A 78-year-old male presented to our Respiratory Medicine OPD with complaints of dyspnoea on exertion for 12 months and cough associated with expectoration. Patient did not have any known comorbidities and was a chronic bidi smoker for 40 years. On examination patient had fine crypts on auscultation, with no evidence of clubbing. Patient was diagnosed with COPD in a public health setup and was on bronchodilators with incomplete resolution of symptoms. HRCT chest was done which was suggestive of diffuse patchy lower lobe predominant cysts and thickened peri-broncho-vascular markings with intervening normal lung parenchyma. Patient was negative for antiretroviral disease and serology was negative for Anti SS-A and Anti SS-B. PFT was suggestive of restrictive lung disease with impaired DLCO. Bronchoscopy was done and transbronchial lung biopsy was suggestive of dense interstitial lymphoid infiltrate with type two cell hyperplasia and intraalveolar macrophages. Diagnosis of LIP was confirmed and patient was started on oral prednisolone at 1mg/kg. Patient is currently under regular follow up and has symptomatic relief.

Conclusion: LIP is a rare entity and is a benign lymphoproliferative disorder. Here we presented a case of a 78/year old male who was initially diagnosed with COPD but was later confirmed to have idiopathic LIP. Patient responded well to immunosuppressive therapy and is currently under regular follow up.

Abstract No. 230: Malignant appearance of a benign fungal pneumonia

Rithin Mogarala , Deepti Badwe, Prahlad Prabhudesai

Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India

Coccidioidomycosis is a disease endemic to the Southwestern United States and Mexico, with cases in non-endemic regions such as India primarily being imported. Establishing a history of exposure is essential for accurately diagnosing coccidioidomycosis, particularly in non-endemic locations.

Case Report: This study reports on a 76-year-old male patient from India who presented to our hospital with symptoms of chronic cough, malaise and loss of weight, revealing a mass lesion with a small cavity in the upper lobe of the right lung. Prior to his admission, he had spent four months in Tracy, California. Diagnosis of pulmonary coccidioidomycosis was established through histopathological analysis of a CT-guided lung biopsy, serological testing for Coccidioides and confirmed by growth on fungal cultures.

Conclusions: Accurate differentiation from tuberculosis, other dimorphic fungi, and malignancies is crucial for appropriate management.

Abstract No. 231: Thoracoscopic diagnosis of atypical pleural effusion – A clinical case insight

Sharadruthi Akula

MGM Insititute of Health Sciences, Navi Mumbai, Maharashtra, India

Introduction: Tuberculosis remains a major global health challenge, with pleural effusion being one of its common extrapulmonary manifestations, typically presents with constitutional symptoms such as fever, weight loss, and cough, often accompanied by unilateral fluid accumulation in the pleural cavity. While pleural fluid analysis, including adenosine deaminase levels and cytology, is a cornerstone for diagnosis, some cases exhibit atypical features, such as ambiguous imaging findings or inconclusive fluid analysis which pose significant diagnostic challenges, delaying timely intervention.

Thoracoscopy, a minimally invasive procedure, has emerged as a valuable tool for evaluating undiagnosed pleural effusions. By allowing direct visualization of pleural surfaces and enabling targeted biopsies, it provides a higher diagnostic yield compared to traditional methods.

Case Report: A 55 yrs old male presented with breathlessness, dry cough, chest congestion, weight loss since 15 days. Chest xray suggestive of right sided pleural effusion. Pleural fluid, sputum, bronchoalveolar lavage, GeneXpert and cultures were negative. Further evaluation through thoracoscopic pleural biopsy tissue MGIT confirmed the presence of mycobacterium tuberculosis

Conclusion: Atypical presentations of tubercular pleural effusion require advanced diagnostic techniques like thoracoscopy. This procedure ensures diagnosis by enabling direct visualization and biopsies, allowing for prompt initiation of anti-tubercular therapy.

In regions with a high TB burden, thoracoscopy should be considered early in evaluating unexplained pleural effusion. Its use improves clinical outcomes, reduces morbidity, and prevents complications associated with delayed treatment, making it an indispensable diagnostic tool.

Thoracoscopy is valuable for diagnosing atypical tubercular pleural effusion, ensuring timely and accurate treatment. Its early use improves outcomes, prevents delays, and is essential in high TB prevalence regions.

Abstract No. 232: Exploring the landscape of invasive pulmonary aspergillosis: Insights from a prospective observational study in a tertiary care setting

Komal Shah 1 , Bhavik Shah 2

1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, Maharashtra, India, 2 Department of Critical Care, Ashoka Medicover Hospital, Nashik, Maharashtra, India

Introduction: Invasive pulmonary aspergillosis (IPA), traditionally seen in immunocompromised individuals, is increasingly found in immunocompetent patients with atypical presentations. This prospective study aimed to examine the clinical features, diagnostic approaches, and treatment outcomes of IPA, focusing on posaconazole as an alternative to voriconazole.

Methods: Conducted over six months at Dr. Vasantrao Pawar Medical College, Nashik, the prspective observation study included 18 IPA patients diagnosed via positive bronchoalveolar lavage (BAL)/serum galactomannan, Aspergillus smear/culture, or PCR. Demographic data, immune status, risk factors, clinical presentation, radiological findings, and treatments were analyzed. Outcomes included mortality rates, treatment response, hospital stay, and complications.

Results: The study revealed diverse IPA presentations, with half of the patients (9/18) showing atypical forms, such as secondary IPA following bacterial sepsis (5 cases), endobronchial mass, unstable angina, concurrent tuberculosis, and even a case of IPA after deep cleaning in an immunocompetent individual. Common risk factors included immunocompromised states and sepsis. Main symptoms were fever, cough, and breathlessness, with 40% of patients also reporting weight loss and decreased appetite. Radiological findings primarily showed consolidations with ground-glass opacities (GGOs), while only 25% presented with cavitary lesions. Diagnosis was confirmed by BAL galactomannan (14), fungal cultures (5), histopathology (2), and PCR (1). Treatment mainly included posaconazole, with voriconazole/caspofungin used for critically ill patients. Outcomes included 5 complete resolutions, 9 partial recoveries under ongoing treatment, and 3 deaths.

Concluson: This study underscores the importance of BAL galactomannan testing and fungal cultures in non-resolving pneumonia cases, as IPA can present atypically. Early diagnosis and prompt treatment with azoles like posaconazole significantly improve outcomes, emphasizing the need to consider IPA in the differential diagnosis.

Abstract No. 233: Study of IgE Levels as biomarker in bronchial asthma patients in Madhya Pradesh population

Ashok Sudam Bansode , Balaji G. Tuppekar

LN Medical College JK Hospital, Kolar road, Bhopal, Madhya Pradesh, India

Background: Bronchial asthma incidence is rising due to urbanization and pollution. This study examines IgE levels as biomarkers in bronchial asthma patients in Madhya Pradesh.

Methods and Results: 80 patients were analyzed for IgE levels and spirometry data. Findings include classification of IgE by age, severity, and clinical manifestations.

Conclusion: IgE and spirometry are effective in diagnosing asthma severity, aiding efficient treatment.

Abstract No. 234: Tuberculosis with polyserositis in a young male: A case report

Arpit Gupta

Vedantaa Institute of Medical Sciences, Dahanu, Maharashtra, India

Introduction: Tuberculosis (TB) remains a significant health burden, particularly in developing countries, often presenting with diverse clinical manifestations. Polyserositis, characterized by the simultaneous involvement of multiple serous membranes, is a rare and severe manifestation of TB. This report discusses a unique case of TB with polyserositis in a young male with a history of chronic alcohol and tobacco abuse, highlighting its clinical challenges and diagnostic approach.

Case Report: A 24-year-old male farmer with a six-year history of chronic alcoholism and five years of tobacco abuse presented to the emergency department in February 2024. The patient complained of non-productive cough, high-grade fever with chills, dyspnoea (MMRC grade 4), pleuritic chest pain, significant weight loss (6 kg), and loss of appetite for two weeks. On examination, the patient appeared pale and sick, with a temperature of 101.4°F, pulse rate of 108/min, and blood pressure of 110/70 mmHg. Auscultation revealed decreased air entry over the left lung field and evidence of a pericardial rub. Radiological investigations, including a chest X-ray and CECT thorax, showed gross left-sided pleural effusion and pericardial effusion. Ultrasound (USG) of the thorax confirmed the findings, and USG abdomen revealed ascites with a cirrhotic liver. Laboratory findings indicated grossly deranged liver function tests (SGOT/PT: 1323/2016 IU/L), hypoalbuminemia (2.5 g/dL), and elevated PT/INR (25 sec/1.97). Analysis of pleural, pericardial, and ascitic fluid showed raised ADA levels (82/64/58 U/L) with lymphocytic predominance. Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) confirmed Mycobacterium tuberculosis with rifampicin sensitivity.

Conclusion: Tuberculosis should be considered a differential diagnosis in patients presenting with polyserositis, especially in endemic regions. Early identification and intervention are crucial to prevent severe complications. Comprehensive imaging and laboratory analyses, including ADA levels and CBNAAT, are indispensable for diagnosis.

This case highlights the complexity of TB with polyserositis, emphasizing the importance of a multidisciplinary approach to timely diagnosis and management. Early treatment can significantly improve patient outcomes in such severe TB manifestations.

Abstract No. 235: Viral pneumonitis with thrombocytopenia presenting as a case of acute respiratory distress syndrome – A case series

Ronit Kumar , Arpit Gupta, S. V. Ghorpade, Vinod Mutkule

Vedantaa Institute of Medical Sciences, Dahanu, Maharashtra, India

Introduction: Acute respiratory distress syndrome complicating viral pneumonia occasionally presents with the complications like thrombocytopenia. ARDS is defined by a PaO2/FiO2 ratio ≤300 mmHg, with severe ARDS classified as ≤100 mmHg. This case series explores the role of thrombocytopenia correction in improving prognosis in patients with ARDS and viral pneumonitis.

Methods: Three patients were included: a 60-year-old female with viral pneumonitis and severe ARDS with thrombocytopenia (PaO2/FiO2 = 90 mmHg), a 17-year-old male with severe ARDS and thrombocytopenia (PaO2/FiO2 = 85 mmHg), and a 56-year-old male with severe ARDS and thrombocytopenia (PaO2/FiO2 = 75 mmHg). All presented with fever, cough, severe shortness of breath, and bilateral reticular opacities on chest X-rays. HRCT confirmed ARDS and viral pneumonitis. Laboratory findings included thrombocytopenia, leukopenia, and normal liver and kidney function tests. Dengue NS1/IgG/IgM was negative for all the three patients. Management included intensive oxygen therapy, antivirals, corticosteroids, and platelet transfusions.

Results: The 60-year-old female and 17-year-old male showed significant clinical improvement after thrombocytopenia correction and were discharged in stable condition. In contrast, the 56-year-old male succumbed to severe ARDS due to delays in platelet correction.

Timely correction of thrombocytopenia paired with intensive care approach helped improve oxygenation (PaO2/FiO2 >150 mmHg) and clinical outcomes in two patients. Delay in platelet correction despite intensive oxygen therapy was a key factor in the poor prognosis of the third patient, underscoring the importance of early intervention.

Conclusion: Thrombocytopenia correction is a crucial therapeutic component in managing ARDS and viral pneumonitis. Early platelet transfusions can significantly improve PaO2/FiO2 ratios, clinical recovery, and survival rates.

Keywords: ARDS, PaO2/FiO2 ratio, platelet transfusion, respiratory distress, thrombocytopenia, viral pneumonitis

Abstract No. 236: Congential methemoglobinemia: A clinical perspective

Dimple Swetha

SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India

Introduction: methemoglobin is a form of hemoglobin in which iron in hb is in an oxidised form (FERRIC) instead of ferrous making it difficult to bind with oxygen, usually methhemoglobin present in small quantities in human but once methb increase beyond 3 %,it is know as methemoglobinemia, classified into hereditary and acquired. Hereditary forms are rare causes of hypoxia and cyanosis.

Case Description: A 22 yrs old female primigravida was refered to pulmonology OPD from OBG OPD for evaluation of bluish discoloration of hands she gives H/O of bluish discoloration of hands, feet, tongue, lips present since childhood and increased after pregnancy

No C/O dyspnea /cough. No H/O exposure to drugs expect iron and folate supplementation. No significant family history. O/E -central and peripheral cyanosis. SPO2 88 % at room air. In the view of low SPO2 and cyanosis, patient was admitted and was started on O2. But her SPO2 did not improve inspite of increasing O2 flow to 8-10 LIT/MIN. Laboratory test normal expect for PCV-47%, ABG –PaO2-72, CXRAY-normal. Blood drawn showed chocolate brown color. Cardiology reference was sought adviced 2d echo which was normal. The clinical picture with no cardiovascular disease or pulmonary and the discrepancy between PaO2 and SpO2 raised suspision of abnormal HB. HB electrophoresis sent-normal Meth hemoglobin -43.5 %haematologist opinion was sought adviced for ascorbic ACID 500 mg TID orally.

Conclusion: Congenital methemoglobinemia is usually missed as a cause of cyanosis especially in adult it is crucial to consider as differential diagnosis when assessing cyanotic patients mainly if they have discrepancy between PaO2 and SpO2.

Abstract No. 237: Prevalance of bedaquiline resistance in drug resistance tuberculosis in a tertiary care centre

Kriti Agarwal

Grant Medical College and JJ Group of Hospitals, Mumbai, Maharashtra, India

Introduction: Bedaquiline has become a cornerstone in the treatment of multidrug-resistant and extensively resistant tuberculosis. However, emerging reports of bedaquiline resistance raise concerns about its long-term efficacy and need for ongoing surveillance to guide treatment strategies. Understanding the prevalence and determinants of bedaquiline resistance in pulmonary tuberculosis (TB) is critical to maintaining the effectiveness of this important drug.

Methods: A cross-sectional study was conducted at a Tertiary Care Hospital, involving 1831 patients diagnosed with drug-resistant TB. Resistance to bedaquiline was assessed using molecular diagnostic methods (e.g., PCR sequencing, line probe assays) and mycobacterial culture-based drug susceptibility testing. Demographic, clinical, and microbiological data were collected to identify factors influencing resistance.

Results: Patients were enrolled in a period of 2 years, from January 2022 to December 2023. Out of total 1831 patients, only 257 were further tested for DST for bedaquiline. Out of 257 tested, 51(19.84%) patients had bedaquiline resistance in which 24(47.0%) were males and 27(52.9%) were females. Majority (80.39%) were young (less than 40 years of age) and only 10(19.6%) patients had history of Bedaquiline exposure or contact, rest were primary resistance.

Conclusion: The prevalence of bedaquiline resistance in pulmonary TB patients, especially those with MDR-TB and XDR-TB, is a growing concern and warrants intensified surveillance efforts. The findings highlight the need for more comprehensive diagnostic tools, regular resistance testing, and tailored treatment strategies to mitigate the spread of drug-resistant TB and need for further studies to assess impact.

Keywords: Bedaquiline, pulmonary tuberculosis, drug susceptibility, extensively drug-resistant tuberculosis, multidrug-resistant tuberculosis, prevalence

Abstract No. 238: Predictors of health-related quality of life among patients with idiopathic pulmonary fibrosis attending a tertiary care setting in Southern India

Anitha Mohanraj Barney 1 , Barney Isaac 2 , Balamugesh Thangakunam 2 , Sumita Danda 1 , Debashish Danda 3 , Venkata Raghava Mohan 4 , Christhunesa Soundararajan Christudass 5 , Devasagayam J. Christopher 2

1 Department of Clinical Genetics, Christian Medical College, Vellore, Tamil Nadu, India, 2 Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India, 3 Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India, 4 Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India, 5 Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

Background: Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive Interstitial Lung Disease (ILD) that has a significant impact on the health-related quality of life (HRQoL). There are generic and disease-specific questionnaires to assess this, but no literature from India exists.

Objective: To estimate the impact of IPF on HRQoL and determine its predictors in a cohort of patients attending a tertiary care centre in Southern India.

Methodology: Consecutive consenting patients diagnosed with IPF by the ILD MDD between September 2023 and August 2024 were self-administered the St. George’s Respiratory Questionnaire (SGRQ) and the King’s Brief Interstitial Lung Disease (KBILD) questionnaire to assess the HRQoL.

Results: In all, 70 patients with IPF were recruited into the study. The median total SGRQ was 35.9 (23.9 – 57.8), and the median total KBILD was 54.5 (46.4 – 65.6). Based on SGRQ (>30), 63% (44/70) and based on KBILD (≤50), 34% (24/70) had a poor quality of life. The SGRQ was significantly lower in those not on antifibrotics across all domains, with a trend towards near significance in the activity domain. The GAP (Gender, Age, Physiology) index had a significant association with the KBILD - breathlessness and activity domain (p-value 0.01) and the total score (p-value 0.02).

Conclusion: This is the first Indian study reporting HRQoL in IPF. IPF impacts HRQoL drastically, with a predominant impact on physical wellness and a lesser effect on psychological well-being. KBILD is associated with the GAP index. A larger study is required to identify independent factors associated with HRQoL.

Acknowledgement: The research work presented in this article is part of a proposed PhD thesis of The Tamil Nadu Dr. M.G.R. Medical University, Chennai - 600 032.

Keywords: Health-related quality of life (HRQoL), Idiopathic pulmonary fibrosis (IPF), Interstitial lung disease (ILD), King’s brief interstitial lung disease (KBILD) questionnaire, St. george’s respiratory questionnaire (SGRQ)

Abstract No. 239: A case report on sporadic lymphangioleiomyomatosis: An overview on clinical symptoms and management of rare disease

Anjana Manikandan

PDU Medical College, Rajkot, Gujarat, India

Introduction: Pulmonary sporadic lymphangioleiomyomatosis is a female dominant disease associated with smooth muscle cell proliferation in lung parenchyma, airway cells as well as lymphatic system. It is estimated to have an incidence of 1 in 100000 patients in US and Europe,however disease is potentially underdiagnosed.LAM may be mistaken for other pulmonary disorders due to similarities in initial presentation.LAM has two specific types .sporadic and congenital.

Case Report: A 65 yr old female patient k/c/o bronchial asthma presented with ℅ sudden onset chest pain and breathlesness, cxr showed left sided pneumothorax, chest tube put and ventillatory support given.pt had h/o left nephrectomy 7 yrs back, biopsy of the specimen shows angiomyolipoma of the left kidney with hilar node.later patient’s hrct taken showed multiple thin walled cyst suggestive of leiomyomatosis. serum VGEF Levels >800ng/ L made definitive diagnosis of lymphangioleiomyomatosis. Patient general conditions improved and chemical pleurodesis done via chest tube to avoid further pneumothoraces.patient pulmonary function test done shows restrictive changes and hypoxemia on exercise testing. Later patient discharged with bronchodilators and tab sirolimus.

Conclusion: Lymphangiomyomatosis is a rare disease in women mostly young, presents with spontaneous pneumothorax and exertional dyspnoea. The definitive treatment for this disease requires lung transplant. If patients are not transplant candidates, can be managed pharmacologically with sirolimus. Recurrent pneumothoraces can be prevented with pleurodesis and by avoiding air travel and preventing barotruama. The goal of this case report is to improve the diagnosis of this condition by considering LAM as a differential diagnosis for female patients (esp of reproductive age group), that present with exertional dyspnoea or spontaneous pneumothoraces. Subsequently, this should lead to further research and increased treatment options for LAM patients.

Abstract No. 240: Review and analysis on clinical demographical and radiological pattern on cases of CTD ILD along with effect of antifibrotic on treatment

Anjana Manikandan

PDU Medical College, Rajkot, Gujarat, India

Introduction: Interstitial lung disease (ILD) induces overwhelming morbidity and is the leading cause of mortality in patients with connective tissue disease (CTD). There are currently no approved treatments for CTD-ILD and drug development for CTD-ILD is challenged by its variable presentation, heterogeneous disease course, devastating morbidity, and considerable mortality. There have been very few randomized controlled trials (RCTs) in CTD-ILD.

Methods: Retrospective observational study conducted in tertiary care centre with 52 subjects on in-out patient basis. ATS/ERS guideline used.

Results: (1) All CTD patients are at risk for developing ILD, Certain CTDs are more likely to be associated with ILD (e. g.(SSc), (RA)), and in 40 %, ILD may be the first or only manifestation of a CTD, (2) majority of patients studied are females and no relation observed with smoking & development of ILD, (3) PFT shows restrictive>mixed>obstructive, (4) radiology shows UIP >NSIP>undifferentiated pattern & UIP is associated with RA ILD, (5) steroids are effective in managing the patients presented with A/E of ILD, (6) patients started on Nintedanib shows decrease in frequency of hospitalisation & reduction in FeV1/FVC decline.

Conclusion: Immunosuppressive treatment along with antifibrotics is indispensable in the management of interstitial lung diseases especially those at an increased risk for progression of fibrosis. The treatment approaches should be assessed in a patient-based way. The patients under immunosuppressive treatment should be cautiously followed for infections.

Keywords: CTD ILD, nintedanib

Abstract No. 241: Pneumonia that didn’t resolve

Rituparna Sarkar

Ispat General Hospital, Rourkela, Odisha, India

Introduction: As chest physicians, we encounter pneumonia having different etiologies, and persisting opacities. Many such pneumonia racks our brains when we cannot find an etiology yet have to treat the patient properly and answer the attendants when it doesn’t resolve.

Case Report: An 80 year old female having a history of recurrent uti and chronic renal failure, came with complaints of fever with chills, cough expectoration for a week. She was being treated irrgularly with antibiotics for past 7 years. Chest xray showed non homogenous opacity in whole of the right lung with evidence of pleural effusion on the right. Patient was given empirical antibiotics, and cultures were sent before starting antibiotics. All the cultures came to be negative. Patient improved slowly, and then after 7 days of antibiotics she again had episodes of fever. Bronchoscopy was done and repeat cultures were sent, no growth was found, AFB was negative. Patient gradually imroved symptomatically. After 15 days of antibiotics, but the xray infiltration remained as it is on the day of discharge.

We decided to follow up the patient by monitoring the CT scan. After 4 weeks, ct scans showed large areas of ground glass opacities, fibrotic bands and traction bronchiectasis as a post infective in the right lung. We decided to go with a diagnosis of slow resolving pneumonia with our prime differential as cryptogenic organising pneumonia. further follow up after 3 months showed resolution of the shadows. She came to us after 1 month again with similar complaints and B/L chest shadows and history repeated itself.

Conclusion: Who do we blame? inadequate treatment or overuse of antibiotics or our incompetency in diagnosis.? that is the matter of the hour.

Abstract No. 242: To compare the efficacy of doxycycline slurry and povidone iodine as a pleural sclerosing agent in malignant pleural effusion and pneumothorax

Ancy Nisha

Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Introduction: Pleurodesis is the obliteration of the pleural space by fusion of the visceral and parietal pleurae with fibrous tissue.

Methods: The study was done as an observational study among 68 subjects. Patients above 18 years, with recurrent exudative pleural effusion, and secondary spontaneous pneumothorax were included in the study. Demographic features, historical information, pleural fluid measurements, and blood sample assessments were collected. Pleural fluid was extracted with an intercostal drainage tube or thoracoscopy procedure. Following a thorough evacuation and a drainage rate of less than 100ml per day, a chest X-ray was performed to verify that the lung had fully expanded. Group 1– 10 ml of 2% lignocaine injected intrapleurally via chest tube and followed by 10 mg/kg of powdered Doxycycline slurry tablets in 100 ml normal-saline. Group 2 – 10 ml of 2% lignocaine injected intrapleurally and followed by povidone iodine pleurodesis – 20 ml of 10 % povidone iodine diluted in 80 milli litre of normal saline. The ICD was clamped for 4 hours. Response was weighed in terms Paladine’s criteria of “complete-response (CR), partial-response (PR) and failure (F)”. The study also assessed post procedural complications.

Results: In the study the subjects with lung malignancy were 72.06%, other malignancies were 5.88% and pneumothorax accounted for 22.06%. The povidone iodine group had a complication-free rate of 55.88%, whereas the Doxycycline slurry group had a complication-free rate of 79.4%. The Povidone iodine group had 76.4% success pleurodesis compared to Doxycycline slurry group which had 79.4% success rate. The partial response rate among the povidone iodine group was 5.8% compared to 3% in Doxycycline slurry group.

Conclusion: Considering doxycycline pleurodesis is a cost-effective option with success rate non inferior or slightly better to the povidone iodine group with lesser complications.

Keywords: Doxycycline slurry, pleural effusion, pleural sclerosing agent, pneumothorax, povidone iodine

Abstract No. 243: Unraveling plastic in the lung

Shivani Acharya , Aayushi Gaudani, Bineet Ahluwalia, Sanjeev Mehta

Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India

Introduction: Plastic bronchitis is a rare and serious respiratory condition characterised by the production of thick, plastic-like bronchial casts that obstruct the airways causing difficulty breathing. It has a prevalence of fewer than 600 cases worldwide. It has been associated with congenital heart disease, viral infections, hematological malignancies.

Case: A 12-year-old female came to us with a history of acute onset cough with thick mucus and hemoptysis. CT scan of chest showed a mucus plug in the left lung lobar collapse.

Bronchoscopic evaluation revealed a mucous cast, which stained positive for Masson’s trichrome and Oil Red O and composed of fibrin and mucin on histopathology. MRI lymphangiography showed a right-sided aortic arch, an aberrant left subclavian artery coursing posterior to the esophagus and the left carotid artery coursing anterior to the trachea, suggesting the presence of a vascular sling associated with pulmonary lymphatic perfusion syndrome. The patient was diagnosed as a case of plastic bronchitis treated with antibiotics and mucolytics. She experienced similar symptoms six years later. Bronchoscopic evaluation revealed casts similar to those seen previously. Cardiac MRI and CT pulmonary angiography were performed, confirming the presence of a vascular sling causing tracheal compression with a possibility of lymphatic duct obstruction. Additionally, both the patient and her mother had associated lipedema, a condition of abnormal accumulation of fat in the lower body, exacerbated by lymphatic dysfunction. She was treated symptomatically and was asked to resume duties and follow up if required.

Conclusion: Ours is a very rare case likely caused by a vascular sling, leading to lymphatic obstruction and resulting in a mucus plug of plastic bronchitis.

Abstract No. 244: A rare case of Hermansky–Pudlak syndrome

Kiran Bhadrashetty

SDM Institute of Medical Sciences and Hospital, Dharwad, Karnataka, India

Introduction: Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder with a prevalence of 1-9 in 1,000,000. It is characterized by triad of oculocutaneous albinism, bleeding diathesis, and accumulation of ceroid-lipofuscin pigment in various organs, resulting in systemic complications in the form of pulmonary fibrosis, granulomatous colitis, immunodeficiency, corpulmonale and vision problems.

Case Report: A 39 year male, who is ex-smoker and tobacco chewer and works at paper factory came to our pulmonology OPD with complaints of cough with expectoration and dyspnea on exertion since 2 months and fever since 2 days. On examination his pulse rate was 134 beats/min, BP was 110/70 mmHg, respiratory rate was 20 cpm, spo2 of 82% on room air. Respiratory system revealed bilateral fine inspiratory crepitations. Physical examination revealed decreased pigmentation of skin and hair. Chest x-ray showed B/L opacities. CT scan of chest was s/o multifocal areas of consolidation and surrounding ground glass opacities in bilateral lung fields suggestive of bronchopneumonia and mediastinal lymphadenopathy. ABG showed type 1 respiratory failure. Bronchoscopy was performed and BAL culture and sensitivity showed growth of enterococcus species and sensitive antibiotics were given. ANA Screening was positive (2+) with nuclear speckled pattern. ANA profile was negative and complement levels were within normal limits. Patient was treated with oxygen therapy, IV antibiotics, steroids, antivirals and other symptomatic measures. With background oculocutaneous albinism with type 1 respiratory failure and CT chest findings, HPS was suspected. Whole genome sequencing was sent. Genome sequencing evaluation showed likely compound heterozygous of PVS1, PMS2 suggesting HPS-1.

Conclusion: HPS is a rare autosomal recessive disorder, characterized by multisystem involvement. Pulmonary fibrosis is highly prevalent in 3 out of 10 genetic types of HPS (HPS-1, HPS-2 and HPS-4). Thus, genotyping of individuals with HPS is clinically relevant. HPS pulmonary fibrosis shares some clinical features with idiopathic pulmonary fibrosis (IPF), including dyspnoea, cough, restrictive lung physiology and computed tomography (CT) findings of fibrosis. Pulmonary fibrosis is the most serious complication and main reason of death of patients with HPS. It usually presents in the 3 rd or 4 th decades of life and accounts for premature death in 50% of HPS patients, generally by the 5 th decade. The incidence and severity of fibrosis is greatest in patients with HPS1 and HPS4.

Abstract No. 245: Lung carcinoid: It can take you for a ride

K. Princekumar , P. Prabhudesai, Sanjay Sharma

Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India

Introduction: Lung neuroendocrine tumors (NETs) are an uncommon pulmonary neoplasm characterized by neuroendocrine differentiation & relatively indolent clinical behavior. GI tract is the most frequently involved site, while lung is the second most common. Lung NETs are the most common primary lung neoplasm in children, typically presenting in late adolescence. Due to misdiagnosis, the diagnosis of lung neuroendocrine tumor (NET) is often delayed, and patients may receive several courses of antibiotics to treat recurrent pneumonia. This report highlights a simple case of lung carcinoid in a 23 years old male, showcasing importance of early diagnosis and apt choice of intervention!

Case Report: 23 years old male presented with complaints of fever with chills on & off, hemoptysis, vomiting, abdominal pain since 1 month with repeated episodes occurring on and off since 2 years. HRCT of March, 2023 showed an intraluminal lesion (1.2x0.9cm) in left lowerlobe bronchus just distal to superior segmental branch. He took multiple courses of antibiotics and was taking symptomatic treatment. Then, since November, 2024 his symptoms aggravated. HRCT of 16th December showed well-defined, nodular lesion (2.1x 2.0cm) in left lower lobe bronchus with resultant collapse of basal segments of left lowerlobe. Bronchoscopy done on 17th December showed mass in left lower lobe bronchus and biopsy was taken. Histopathology was suggestive of well-differentiated neuroendocrine tumor G1 WHO 2017. At our hospital, Check Bronchoscopy was done to decide on Pneumonectomy VS Sleeve Resection. Sr. chromogranin A levles were normal. Ultimately, patient underwent Thoracotomy+Left upper lobe saving mobilization+left lower lobe sleeve lobectomy+perbronchial lymph node dissection on 30/12/2024. IHC showed synaptophysin and chromogranin positivity with HPE confirming our diagnosis. Patient recovered well and was discharged in stable condition.

Conclusion: This case report highlights the need of early diagnosis including imaging, intervention and histopathological analysis. It highlights importance of early diagnosis and choice of intervention to be done for appropriate management.

Abstract No. 246: Myasthenia gravis crisis presenting as type 2 respiratory failure in emergency room

Manas Chauda

L. N. Medical College and J. K. Hospital, Bhopal, Madhya Pradesh, India

Introduction: Myasthenia gravis characterized by weakness and fatigability of skeletal muscles. The underlying defect is a decrease in the number of available acetylcholine receptors (AChRs) at neuromuscular junctions due to an antibody mediated autoimmune attack. Myasthenia Gravis is generally present’s ocular & muscular involvement may progress to respiratory failure.

Case Report: A 59yr old male patient presented in ER as chief complaint of SOB (MMRC GRADE 4) since 10 days (acute/progressive/no seasonal/no diurnal variation/no positional variation), no smoking OR Biomass fuel exposure history, no history of DM, Hypertension, TubercuIosis, Thyroid disorder, kidney disorder. [VITALS = BP-132/92mmHg, oxygen Saturation-90%on 2L NP, PR-110/min, RR-28/min]. ABG done on (2L NP Oxygen) pH-7.32, pCo2-60.4, pO2-54, HCo3- 30.4 (type 2 respiratory failure), patient admitted in RICU treatment started with NIV support & symptomatic treatment started, basic investigation done. on 2nd day of admission further worsening of symptoms occured i.e., generalised muscle weakness, symptoms of ocular involvement (drooping of eyelid). HRCT chest-no lung pathology seen.

Positive, on the basis of clinical symptoms MYASTHENIA GRAVIS was suspected bed side neostigmine test was done result was positive (improvement of ocular & muscular symptoms) followed by Repeated nerve stimulation (RNS) test done -suggestive of post synaptic NMJ pathology, and sample for antiAch receptor antibody sent, later reported as positive (normal < 0.40 nmoI/L) [ 4.54 nmoliL] case confirmed as “MYASTHENIA GRAVIS CRISIS” further symptomatic treatment with NIV support and immunoglobulins were given and patient condition improved.

Conclusion: In type 2 respiratory failure, clinicans must consider myasthenia in the differential diagnosis.

Abstract No. 247: The co-occurrence of systemic lupus erythematosus and hydropneumothorax

Krupa Rani

Guntur Medical College, Guntur, Andhra Pradesh, India

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organs, including the lungs. However, hydropneumothorax is a rare and potentially life-threatening manifestation of SLE that must not be overlooked.

Case Report: A 17-year-old female presented with a 20-days history of dry cough, dyspnea, left-sided chest pain, fever, and back pain. She also had skin lesions for the past year. On examination, her vital signs were stable, and a discoid rash with scarring alopecia and diffuse erythematous scaly lesions were noted, which had appeared one year ago following her first abortion due to a molar pregnancy. Nine months later, she experienced a flare-up of alopecia and skin lesions after a second abortion. She had been married for four years and had a healthy 18-month-old daughter from a non-consanguineous marriage. Laboratory results revealed anemia (hemoglobin 7.5 g/dL), a white blood cell count of 4,900, and an elevated erythrocyte sedimentation rate (ESR) of 30. Chest X-ray showed a homogenous opacity in the left lower lung zone, obscuring the left costophrenic angle, with an air-fluid level, suggesting hydropneumothorax. The patient underwent left tube thoracostomy for treatment. Further investigations revealed a positive antinuclear antibody (ANA) profile. The patient was treated with systemic corticosteroids and symptomatic care. She showed significant improvement and is currently stable with regular follow-up.

Conclusion: Hydropneumothorax is a rare but potentially life-threatening complication of SLE, emphasizing the need for early diagnosis and treatment.

In summary, SLE patients presenting with hydropneumothorax require prompt recognition, diagnosis, and treatment to prevent morbidity and mortality.

Abstract No. 248: Interesting case of spontaneous pneumothorax

Sneha Sudhakaran , Pralhad P. Prabhudesai

Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India

Introduction: Spontaneous pneumothorax can result in many lung diseases conditions, of which lymphangioleiomyomatosis (LAM) is an unusual cause. LAM is a multi system disorder, predominant in premenopausal women. It can be inherited disease associated with tuberous sclerosis complex syndrome or sporadic. LAM is complicated by spontaneous pneumothoraces in upto 70% of patients with high rate of recurrence. mTOR inhibitors are the treatment of choice in LAM.

Case Report: 30 years old female, resident of Goa, school teacher by profession, non smoker presented with acute onset breathlessness and pneumothorax but hemodynamically stable. Patient has history of tuberous sclerosis diagnosed at the age of 10 (family h/o tuberous sclerosis in father). H/o seizures since childhood, on antieplileptics (carbamazepine 200mg twice daily), h/o skin lesions and renal angiomyolipoma-s/p partial nephrectomy in 2021. On examination vitals normal, shagreen patch, adenoma sebaceum and lingual fibroma present, chest: air entry reduced on right side. Routine blood work up was normal. On chest xray cyst in the right mid zone with pneumothorax with shift of mediastinum towards opposite side. HRCT chest showed right sided pneumothorax. Patient underwent right VATS adhesiolysis with bullectomy with pleurectomy and lung tissue sent for histopathological examination. Patient was diagnosed as a case of Lymphangioleiomyomatosis requiring thoracoscopic bullectomy with pleurectomy. On follow up patient was started on tab sirolimus 2mg/day, drug levels were monitored (patient was on carbamazepine-drug inducer). Pulmonary rehabilitation was advised.

Conclusion: This case shows an interesting presentation of spontaneous pneumothorax and highlights the importance of evaluating for LAM in young females with TSC. This case also shows the role of surgical intervention in LAM-cystic lung diseases.

Abstract No. 249: Beyond steroids: The role of infliximab in managing TB meningitis

Nisha Chandra

P. D. Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India

Introduction: Tuberculous meningitis (TBM) is a form of tuberculosis that is treated with anti-tubercular therapy and steroids. For paradoxical CNS tuberculosis unresponsive to steroids, Infliximab, a TNF-alpha inhibitor, offers a promising alternative.

Case Report: An 18-year-old female with no prior history of tuberculosis presented with fever, headache, and dizziness. Brain MRI showed leptomeningeal enhancement with multiple ring-enhancing lesions, suggestive of TBM. CSF analysis showed high protein, low glucose, normal ADA, lymphocyte predominant, TB genexpert MTB detected low and Rifampicin sensitive and was initially treated with isoniazid, rifampicin, pyrazinamide, and ethambutol along with intravenous steroids. Two months later, her culture revealed resistance to isoniazid and pyrazinamide, and her regimen was modified with addition of moxifloxacin and linezolid. Despite this, 2 months later her symptoms and MRI findings worsened, which was thought to be paradoxical worsening and hence IV steroids were reintroduced which lead to initial improvement in symptoms and deteriorated on shifting to oral steroids. Three attempts were made to switch her intravenous to oral steroids which failed, she suffered seizures with persistent headaches hence a trial of thalidomide 100mg BD was started. Meanwhile, 7 months in to treatment she developed severe hydrocephalus, underwent an initial EVD insertion followed by VP shunting 3 days later. Following unsuccessful trials with IV and high dose oral steroids, thalidomide and surgeries, we advised infliximab (5 mg/kg) 3 doses, which resulted in symptomatic improvement allowing her to transition from intravenous to oral and eventually stopping her steroid therapy.

Conclusion: Paradoxical reactions in TBM can be steroid-dependent, necessitating exploration of alternative treatment options to effectively manage these challenging scenarios.

This case highlights the challenges in managing paradoxical worsening in TB meningitis, particularly in steroid-dependent scenarios and underscores the potential role of biologics like Infliximab which allowed successful tapering and cessation of corticosteroids.

Abstract No. 250: Delayed diagnosis of cystic fibrosis in adult male: A case report

Nisha Chandra

P. D. Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India

Introduction: Cystic fibrosis (CF) is an autosomal recessive disorder with pulmonary and extrapulmonary symptoms. It affects 1 in 40,000 to 100,000 individuals in India, but remains severely underdiagnosed.

Case Report: 29 year old male with a history of seasonal cough and cold since age 2 and low BMI from birth. At age 8, he developed chronic cough with thick expectoration and was treated with inhalers. He later developed bilateral otitis media at age 15. CT thorax done during the period was suggestive of bilateral bronchiectasis. Between the ages of 19 and 23, he received three courses of empiric anti-tuberculosis treatment from local doctors, but his symptoms persisted, and was repeatedly treated for pneumonia. In 2019, he sought care at our hospital. Investigations revealed sputum culture positivity for Pseudomonas, TB, NTM cultures negative with normal serum immunoglobulin levels. Upon enquiring, the patient also reported to have fatty stools. Given his pulmonary and extrapulmonary manifestations, CF was suspected and a delF508 RTPCR test was advised which was negative. A sweat chloride test was recommended but could not be done initially due to unavailability of the test and then the COVID-19 pandemic. He continued to experience recurrent exacerbations and his condition worsened, with increasing breathlessness, cough, and fatigue. In 2024, during follow-up, stool analysis revealed multiple fat globules and low fecal elastase levels, suggesting severe pancreatic exocrine insufficiency. Given these findings and the persistence of symptoms, whole exome sequencing was performed, which confirmed a compound heterozygous mutation, ultimately establishing the diagnosis of CF.

Conclusion: Diagnosis of CF is essential as it has implications in genetic counselling, family planning and prenatal testing.

This case highlights the importance of considering CF in adults with recurrent respiratory and extrapulmonary symptoms, and the value of comprehensive diagnostic testing, including advanced genetic analysis.

Abstract No. 251: Enhancing pulmonary rehabilitation for ILD patients: The impact of telerehabilitation on PR compliance and clinical outcomes

Kumari Sulochana 1,2

1 Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India, 2 Bharati Hospital and Research Centre, Pune, Maharashtra, India

Background: Interstitial Lung Disease (ILD) is a progressive condition characterized by inflammation or fibrosis of the interstitial space, resulting in reduced exercise tolerance and diminished quality of life (QoL). Pulmonary rehabilitation (PR) is important to ILD management, improving symptoms & QoL. However, poor compliance with traditional in-person PR programs, often due to travel difficulties and time constraints, limits their effectiveness. This study evaluates the impact of telerehabilitation on compliance and dropout rates in ILD patients undergoing PR.

Methods: An RCT was conducted with 46 ILD patients divided into two groups. The intervention group (n=25) participated in a 6-week telerehabilitation program delivered via Google Meet and WhatsApp, including tailored exercise sessions, and health education. The control group (n=21) underwent a 6-week conventional institution-based PR program. Compliance rates, dropout rates, and clinical outcomes were compared to assess telerehabilitation’s effectiveness.

Results: The telerehabilitation group demonstrated significantly higher compliance rates (85% vs. 65%) and lower dropout rates (10% vs. 30%) compared to the institution-based PR group. The telerehabilitation patients showed improved accessibility to PRP and satisfaction with the program. Additionally, clinical outcomes such as exercise tolerance (6MWT) and symptom management showed comparable improvements in both groups.

Conclusion: Telerehabilitation offers a promising approach to improving ILD management by reducing barriers to PR, fostering better adherence, and enhancing patients’ QoL.

Keywords: Compliance rate, exercise tolerance, interstitial lung disease, pulmonary rehabilitation, telerehabilitation

Abstract No. 252: Evaluating the status, knowledge, and challenges of pulmonary rehabilitation in India: A nationwide survey of healthcare professionals

Kumari Sulochana 1,2

1 Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India, 2 Bharati Hospital and Research Centre, Pune, Maharashtra, India

Introduction: The burden of chronic respiratory diseases (CRDs) in India exceeds 100 million cases and shows signs of growing further. Pulmonary rehabilitation (PR) is proven to be an effective, evidence-based intervention for improving the health outcomes of patients with CRD. However, the adoption and implementation of PR programs (PRPs) in India remain limited. Despite the strong evidence supporting PR as a beneficial and cost-effective intervention, poor referral and uptake rates by suitable CRD patients are global issues. This study aims to evaluate the effectiveness, and challenges of PR programs (PRP) in India, focusing on identifying key barriers faced by the healthcare professionals in initiating and sustaining these programs.

Methods: Following validation, a cross-sectional survey was administered to healthcare professionals to evaluate their receptiveness to pulmonary rehabilitation in India. The survey comprised seven domains to evaluate HCPs’ knowledge, Attitudes, and practices and the challenges they faced in carrying out the PRPs.

Results: A total of 155 HCPs (M: F = 2:3) participated in the survey. While over 75% of respondents were familiar with PRPs, only 65.8% were actively involved in delivering at least one form of PR. Younger clinicians demonstrated higher levels of engagement, with a mean knowledge score of 4.48±1.77. Most PRPs (75.5%) are concentrated in urban areas, leaving rural regions underserved. Patient adherence remains a significant challenge, with only 10% completing ≥75% of prescribed sessions and 62.7% dropping out after 25-50%. Key barriers include inadequate infrastructure, limited availability of facilities, and the financial burden on patients.

Conclusion: The study highlights barriers such as limited awareness, inadequate infrastructure, and insufficient training. To improve patient compliance and expand PRPs, particularly in rural areas, it is crucial to enhance infrastructure, increase professional training, and reduce the financial burden on patients. Expanding PRP reach, improving adherence, and raising awareness among healthcare providers and patients are key to enhancing respiratory care quality in India.

Abstract No. 253: A rare case of paravertebral tumor mimicking a lung mass

Kusha Gupta

Institute of Respiratory Diseases, Sawai Man Singh Medical College, Jaipur, Rajasthan, India

Introduction: Paravertebral tumors can originate from the vertebrae or the paravertebral soft tissues, and can invade the epidural/intercostal spaces, mediastinum, pleura, and retroperitoneum. An MRI is needed to assess the anatomical location of paravertebral lesions, and an image-guided biopsy is required to determine the histological nature of the mass. Hence, paravertebral tumors should be considered as one of the differential diagnoses in a case of suspected lung mass.

Case Report: A 32 year old female presented with complaints of chest pain, shortness of breath for 1 month. On evaluation, routine investigations were within normal limits. Chest xray was suggestive of a well defined homogenous opacity in the right upper zone. Following which, a CECT thorax was done which revealed a pleural based soft tissue density lesion causing upliftment of the right main bronchus. Fibreoptic bronchoscopy was done which did not reveal any mass lesion. MRI chest was done which revealed a well defined encapsulated mass lesion in right paravertebral region protruding into the thoracic cavity. A CT guided biopsy was then performed which showed benign spindle cell mesenchymal neoplasm. Subsequently, immunohistochemistry was performed and a paravertebral soft tissue origin was confirmed. Hence, the patient was referred to neurosurgery department for further management.

Conclusion: Paravertebral tumors can protrude into the thoracic cavity, causing respiratory symptoms and can easily be misdiagnosed as a lung mass on a chest X-ray and sometimes even on a CECT thorax. Hence, it should be considered as a differential while dealing with a case of suspected lung mass.

Abstract No. 254: A Comprehensive Comparison Between Post-Tuberculosis Bronchiectasis and Non-Tuberculosis Bronchiectasis: Clinical, Radiological, and Microbiological Insights

Manish Yaadav

GGMC and JJ Hospital, Mumbai, Maharashtra, India

Bronchiectasis represents irreversible bronchial dilation caused by various underlying conditions, with tuberculosis (TB) being a prominent cause in endemic regions like India. Comparitive study has been done in post-tuberculosis bronchiectasis (PTBB) and non-tuberculosis bronchiectasis (NTBB) using clinical, radiological, microbiological, and disease severity dimensions. Using FACED and Bronchiectasis Severity Index (BSI) scores, analysed distinct phenotypic presentations, exacerbation patterns, and microbial colonization. These findings aim to inform specific and tailored management approach for bronchiectasis.

Introduction: Bronchiectasis, a chronic airway condition characterized by permanent bronchial dilatation, arises from various causes, including infections, immune deficiencies, and structural lung diseases. Tuberculosis, a leading respiratory disease in India, and a significant contributor to PTBB. This study aims to compare PTBB and NTBB across multidimensional parameters.

Materials and Methods

Study Design: Prospective, comparative cohort study.

Population: Patients with confirmed PTBB and NTBB, with exclusion of coexisting conditions like cystic fibrosis or severe immune compromise.

Data Collection:

Symptoms, comorbidities, exacerbation frequency. HRCT evaluation using patterns like cylindrical, varicose, or cystic bronchiectasis. Sputum cultures to identify pathogens. FACED and BSI scoring systems.

Statistical Methods: Continuous variables were analyzed using Student’s t-test, while categorical variables were compared using the chi-square test.

Results: PTBB associated with higher Hemoptysis, exacerbation rates, higher colonization by Pseudomonas and multidrug-resistant organisms, higher FACED and BSI scores and predominance of upper lobe involvement and more severe cystic changes compared to NTBB [ Table 1 ].

Conclusion: Post-tuberculosis bronchiectasis differs significantly from non-tuberculosis bronchiectasis in terms of severity, radiological features, and microbiological patterns. These differences necessitate tailored management approaches, particularly in PTBB cases, which exhibit higher severity and exacerbation risks. Early diagnosis and comprehensive severity assessment are critical for improving outcomes.

Abstract No. 255: Re expansion of pulmonary edema a rare complication of pneumothorax case report

Satej Sakurkar , V. R. Kapse

Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India

Introduction: It’s rare early complication occur fallowing insertion of ICD in pneumothorax. It’s characterised by hypoxemia and aleveolar infiltrate (edema).

Aim: Reduce risk of re expansion of pulmonary edema during ICD insertion.

Result: Use of small bore icd and gradually drainage of air (approximately 700-800cc) can prevent pulmonary edema.

Conclusion: After icd insertion x-ray suggesive of re expansion of lung and fluffy opacity give high flow O2 support give iv diuretics It will improve symptoms of patient.

Abstract No. 256: To study the relationship between asthma control, exacerbation, lung functions and biomarkers in patients with bronchial asthma

Shabina Faruqi

GGMC and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India

Introduction: Asthma is a heterogeneous lung condition characterized by chronic airway inflammation. Asthma is a clinical diagnosis; however, symptoms and spirometry do not provide accurate representation of underlying airway inflammation. Biomarkers like blood eosinophil counts (BEC) and serum immunoglobulin E (IgE) can support the diagnosis of asthma. Fractional exhaled nitric oxide (FeNO) is a simple, non-invasive test for quantifying airway inflammation.

Aim: To establish correlation between FENO, IgE, BEC, spirometry (FEV1, FEF 25-75), asthma control measured by asthma control test (ACT) and number of exacerbations in previous year.

Methods: Study design: Cross-sectional analysis conducted in a tertiary care setting on patients with clinical diagnosis of asthma, aged 18-65 years. Parameters analyzed: (1) FeNO (2) BEC (3) IgE (4) Spirometry (FEV1, FEF25-75) (5) ACT (6) Number of exacerbations in previous year. Statistical analysis: Correlations analyzed using Pearson’s method. Receiver operating characteristic (ROC) curves generated to calculate the area under the curve (AUC) and assess predictive capabilities [ Table 1 ].

Results:

A strong positive correlation was observed between FeNO and BEC (r=0.825, p<0.0001) and FeNO and serum IgE (r=0.497, p<0.0001). The findings show FeNO’s exceptional predictive capacity for BEC (AUC=0.94) and moderate capacity for IgE (AUC=0.71), suggesting its significant role in evaluating eosinophilic airway inflammation. The weak correlations with spirometric indices emphasize FeNO’s specificity for inflammatory processes, distinguishing it from measures of airflow limitation.

Conclusion: FeNO is a powerful biomarker for eosinophilic airway inflammation. Higher FeNO levels are associated with poor asthma control and increased risk of exacerbations.

Keywords: ACT, Asthma, eosinophils, FeNO

Abstract No. 257: Urinary incontinence in patients with chronic respiratory diseases

Pranay Bhad

Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.

Introduction: Urinary incontinence (UI) is one of the priority health issues recognized by WHO. Urinary incontinence (UI) is defined as a loss of bladder control and is characterized by the complaint of any involuntary urine leakage. Evidence suggests that the prevalence of UI is higher in subjects with chronic obstructive pulmonary disease (COPD) than in age-matched controls in both sexes. UI is classified as stress, urge, and mixed. However, the prevalence of UI in individuals with chronic respiratory diseases is mostly unexplored in clinical research and often underestimated in clinical practice.

Methods: This study was based among the patients in Outpatient Department of Pulmonary Medicine Department at JJ Hospital, Mumbai. 100 patients with various chronic respiratory diseases (COPD, Asthma, Cystic Bronchiectasis, ILD, Post TB OAD etc.) were evaluated for Urinary Incontinence (UI) by administration of Urinary Incontinence Questionnaire and ICIQ-UI Short Form. Whereas, cough was evaluated using Cough Severity Index (CSI) and Dyspnoea by mMRC scale.

Results: Out of 100 patients, 50 were male 50 were female. Of the 50 females 32 (64%) had UI and 21 (42%) out of 50 males showed UI. Out of which Stress incontinence was prominent in females (66.66%) while males showed nearly equal no. of stress and urge incontinence. According to ICIQ-UI SF scale, 54% patients with UI had a urine leakage several times a day and 24% once a day, whereas 2% patients with severe leakage all the day.

There was a direct relation between cough and UI. 66.66% of patients unintentionally lose urine while coughing and sneezing. Among the patients with diagnosed UI (47 out of 53) i.e. 89% had a CSI score >20 (0 to 20-10%, 20 to 30-36%, 30 to 40-54%). 11% UI patients (6 out of 53) had a CSI score >20 but with symptoms of UI. In terms of Dyspnoea, symptoms of UI were more in patients with Dyspnoea grade II (46%) and III (24%) (mMRC) scale, grade IV had 9% patients only. Non UI patients were with lesser grades of Dyspnoea (82%-Grade I and II).

Conclusions: Most patients with urinary incontinence had a mMRC score of II or III. Almost all (89%) patients with urinary incontinence had a CSI score of more than 20.

Abstract No. 258: Demographic and clinical outcomes of tuberculosis in HIV-positive patients: A retrospective study

Pranav Modi , Himanshu Pophale, Pankaj Magar, Suhas Kulkarni, Unmesha Pawar

Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India

Background: HIV and tuberculosis (TB) are interconnected global health challenges, with TB being the leading cause of death among people living with HIV, particularly in low-and middle-income countries. In 2022, TB accounted for 187,000 deaths among HIV-positive individuals. Due to weakened immune systems, HIV-positive individuals are significantly more susceptible to developing active TB.

Method: This study examines clinical and demographic data from 50 HIV-positive patients co-infected with TB, focusing on antiretroviral therapy (ART) initiation, types of TB, treatment completion rates, and CD4 counts. This retrospective study analyzed 52 patients diagnosed with Mycobacterium tuberculosis (MTB) in HIV-positive individuals across all age groups and sexes. The subjects were followed from January 2021 to June 2024 at a tertiary care hospital. MTB diagnosis was based on clinical and microbiological evidence, while HIV diagnosis was confirmed using the enzyme-linked immunosorbent assay (ELISA).

Results: The study on 52 TB-HIV co-infected patients revealed significant findings. The age range of patients was 20-50 years, with a slight male predominance (28 males, 24 females). Pulmonary TB was observed in 62% of patients, while 38% had extrapulmonary TB. ART was initiated before ATT in 48.1% of patients, while 51.9% began ART after ATT. CD4 counts ranged from 24-474 cells/mm³, with lower counts linked to poorer outcomes. Treatment outcomes showed a cure rate of 59.6 % (n-31), 17.3% (n-9) experiencing relapse, and 23.1% (n-12) succumbing to the disease.

Conclusion: These findings emphasize in assessing for HIV risk factors and to undergo HIV testing in all TB patients. Conversely, all HIV-positive cases should be screened for TB. Also the importance of initiating ART prior to ATT to improve TB treatment outcomes in HIV-positive patients. Monitoring CD4 counts and addressing immune suppression early is critical to enhancing treatment adherence and reducing mortality.

Abstract No. 259: Scoring sysytem for prediction of admissions and mortality in interstitial lung disease patients

Vaibhav Padashetti

ESI Medical College, Basaidarapur, New Delhi, India

Introduction: Interstitial lung disease (ILD) refers to heterogenous group of diseases with varying etiology. There is no score till date to predict admissions and mortality in interstitial lung disease patients, so this paper is an attempt to develop scoring system to predict the same.

Methods: This is an ambispective study. In our scoring system we had taken following parameters and scored as mentioned in the table below. Patients were followed up for minimum of 1 year duration.

Results: Our study included total of 57 ILD patients. Mean age 52.47. Mean duration of illness is 3 years. ILD score of more than or equal to 4 have 12.11 times risk of exacerbations leading to admission (p=0.0002). For mortality score of more than or equal to 4, risk for death is 3.32 (p=0.014). Score more than equal to 3 risk is 33.89 for need of LTOT (/NIV).

Our study showed that higher the score higher are the risk of exacerbation, admission, need for ltot/niv and mortality among ILD patients [ Table 1 ].

Conclusion: Hence we conclude that our score can be used to predict exacerbation, admissions and mortality in interstitial lung disease patients.

Keywords: Interstitial lung disease, mortality, scoring system

Abstract No. 260: A case report of tracheoesophageal fistula in esophageal carcinoma

Prashant Mishra

Nalanda Medical College and Hospital, Patna, Bihar, India

Introduction: A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus. Acquired TEFs may occur in individuals of any age, and elderly individuals are at increased risk. Causative factors of acquired TEFs include malignancy, trauma and various iatrogenic causes.

Case Presentation: A 46-year-old smoker male presented to us with complaints of chest pain, cough on swallowing, hemoptysis for 2 weeks and dysphagia for two months. The patient also gave a history of loss of appetite associated with loss of weight.

It has been reported that trachea esophageal fistula occur in 5–15% of esophageal cancers. In an advanced esophageal cancer complicated by a fistula, chemoradiation is the primary treatment modality.

Conclusion: TEF, together with malignant esophageal and pulmonary tumors, can be fatal apart from the carcinoma itself. This is largely due to the fact that most of these patients cannot undergo surgery owing to their poor overall condition. In these cases, stents offer an alternative to major surgery and can sometimes be a superior way to alleviate symptoms.

Abstract No. 261: Tuberculosis is not an esay disease to treat

M. Sugumar , Christopher, Balamugesh, Barney Isaac

Christian Medical College, Vellore, Tamil Nadu, India

Introduction: Adrenal crisis occurs when there is decreased secretion of steroid hormones from the adrenal glands due to various etiologies. Rifampicin may increase the metabolism of cortisol by inducing cytochrome CYP3A4 activity and precipitate an adrenal crisis.

Case: A 61-year-old gentleman presented with complaints of cough with expectoration for 9 months, Loss of appetite and weight for 1 year. Chest Xray showed left sided pleural effusion and BAL xpert confirmed diagnosis of pulmonary TB outside. He was initiated on programmatic regimen of 2HRZE, followed by 4HRE. He developed abdominal pain, loss of consciousness, hypotension, lethargy, and weakness 2 days after starting ATT. He required ICU admission and he required inotropic support with which he improved. ATT which was tentatively stopped was restarted and he had a similar episode once again after restarting ATT. On presentation he stable and examination was unremarkable. Blood counts, serum electrolytes, liver and renal parameters were normal. Chest x ray showed bilateral pleural effusion and pleural fluid analysis showed exudative lymphocytic rich with low ADA. CT thorax revealed bilateral nodular lesions, multiple mediastinal and intrabdominal lymphadenopathy, bilateral pleural effusion, bilateral adrenal enlargement. Serum cortisol (8am) was 1.2 mcg% (range: 5.27-22.45), ACTH – 485pg/ml (range: 0-46), aldosterone 21.4 pg/ml (range: 25.2-392) and direct renin 16.8 mIU/ml (4.4-46.1). CT guided biopsy from left paraaortic LN showed non necrotizing focal granulomatous inflammation, special stains for AFB and fungal were negative. He was discharged on oral prednisolone 30mg/day and fludrocortisone 25mcg/day along with ATT. He was followed after 2months and improved well. He was planned for lifelong steroid replacement therapy.

Conclusion: Current TB treatment guidelines should incorporate the diagnosis and treatment of adrenal tuberculosis regarding dose and duration of steroid replacement therapy.

Treating physicians should be cautious on initiating rifampicin containing ATT for TB in those with adrenal involvement.

Abstract No. 262: The study on different clinical phenotypes in adult patients with bronchiectasis and their severity assessment

M. Sugumar Christopher, Balamugesh T., Barney Isaac

Christian Medical College, Vellore, Tamil Nadu, India

Introduction: Bronchiectasis is a more heterogeneous and complex disease. Different clinical phenotypes and endotypes were identified previously. Single clinical variable may not be useful to assess the severity of the disease. This study aimed to identify the different clinical phenotypes and to assess their severity to implicate the knowledge to develop more personalised treatment.

Methods: It is a cross-sectional study conducted in adult patients with bronchiectasis over the period of one year. QOL was assessed by using BHQ score and disease severity was measured by FACED and BSI scores.

Results: Among 125 patients (54.4% male) five clusters were identified: Pseudomonas colonisation (16%), other organism colonisation (7%), daily sputum production (38%), intermittent sputum production (27%) and dry bronchiectasis (12%). The different aetiologies identified were post tuberculosis sequelae (44%), Idiopathic (34 %), ABPA (8%) and other causes (14%).

Our study found that most common cause of bronchiectasis is post-TB sequelae. Among the all-phenotypes average FACED and BSI scores were highest in Pseudomonas colonisation group and QOL is better in dry bronchiectasis group.

Conclusion: Cluster analysis, using clinical, microbiological, functional and radiological variables, identified five clinical phenotypes easily detected according to the presence of chronic infection with P. aeruginosa or other pathogens and sputum productivity. Patients belonging to these clinical phenotypes show differences in quality of life and mortality prediction.

Keywords: Bronchiectasis, BSI, FACED scores, phenotypes

Abstract No. 263: A rare case of rifampicine induced thrombocytopenia: A case report

Ajay Dhruw , Kamlesh G. Vithalani

Department of Respiratory Medicine, PDU Medical College, Rajkot, Gujarat, India

Introduction: Rifampicin is a crucial drug in the treatment regimens for tuberculosis. Usually it is well tolerated. Apart from minor side effects like occasional hepatotoxicity, abdominal discomfort, nausea and vomiting, very rarely it can cause life threatening acute renal failure or thrombocytopenia. Rifampicin induced thrombocytopenia was first reported in 1970. It is usually reversible if detected early and treated appropriately. The Tuberculosis Research Centre (TRC), Chennai of the Indian Council of Medical Research has been conducting controlled clinical trials for treatment of tuberculosis since 1956. Since 1974, more than 8000 patients with pulmonary and extra-pulmonary tuberculosis have been treated with rifampicin-containing treatment regimens. Here we report a case of thrombocytopenia caused by daily administration of rifampicin after interruption of the drug for two months in view of its rare occurrence.

Case Report: A case of a 60-year-old female presented to our hospital with complaints of low-grade evening rise fever, dyspnea on exertion, cough with expectoration, anorexia and weight loss since the last 2 months. CXR was suggestive of left apical Koch’s lesion. Sputum examination was positive for AFB smear. Patient was started on ATT (4FDC) as per weight band. After 1 month of ATT, patient developed bleeding per vaginum and rash on both legs. On examination, there was purpura over both legs. Blood examination revealed a Platlet count of 6000/cumm. ATT was put on hold, and patient was started on prednisolone, Patient also received platelet transfusion. After 5 days of therapy, the PC was 2.19 lac/cumm. Therefore, patient was again started on ATT. After 3 days of taking ATT, patient again developed purpuric rash over both legs. Blood reports revealed PC of 2000/cumm. ATT was put on hold, and patient received prednisolone and platelet transfusion until platelet count was normalized. ANA screening was positive for auto antibodies. It was suspected that patient was having rifampicin induced auto immune thrombocytopenia. Therefore, patient was started on ATT regimen not containing rifampicin. Patient did not develop any symptoms after stopping rifampicin.

Conclusions: Serious adverse reactions during rifampicin therapy are usually reversible if detected early and treated appropriately. The clinician must be aware of these rare complications which are life threatening, but if detected early are completely reversible. It has been recommended that rifampicin-induced thrombocytopenia is an absolute contraindication to further therapy with rifampicin. However, Bhasin and co-workers has suggested that rechallenges should be done before finally withdrawing rifampicin. In our opinion, when it is necessary to re-start rifampicin, one should always check the platelet counts frequently and this should be treated under supervision with coverage of steroids.

Abstract No. 264: Study of correlation between body mass index and peak expiratory flow rate of patients between 18 and 65 years of age in a tertiary care hospital

Aditya Gaikwad

Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India

Objective: This study aims to explore the correlation between Body Mass Index (BMI) and Peak Expiratory Flow Rate (PEFR) in patients attending a tertiary care hospital. The relationship between these two variables has significant clinical implications, particularly in understanding respiratory function in individuals with varying body weight statuses.

Methods: A cross-sectional study was conducted involving 130 adult patients, aged 18 to 65 years, who visited the hospital’s pulmonary medicine department. BMI was calculated using the standard formula, while PEFR was measured using a portable peak flow meter. Patients were grouped according to their BMI categories: underweight, normal weight, overweight, and obese. Data analysis was performed to assess the correlation between BMI and PEFR.

Results: The mean BMI of the participants was 27.5 ± 5.1, with a significant proportion categorized as overweight or obese. The overall PEFR values showed a significant inverse correlation with increasing BMI. Specifically, individuals in the obese category exhibited the lowest PEFR values, while those in the normal weight category had higher peak flow rates. Analysis revealed a moderate negative correlation between BMI and PEFR, suggesting that higher BMI is associated with reduced expiratory flow rates.

Conclusion: This study indicates a significant negative correlation between BMI and PEFR, with higher BMI leading to a decrease in respiratory function. These findings highlight the importance of weight management in improving pulmonary health. Future studies with larger sample sizes and longitudinal data are recommended to further investigate the underlying mechanisms of this association and its long-term health implications.

Abstract No. 265: Pulmonary infarct mimicking community acquired pneumonia

Roshan Katara

Shri M. P. Shah Medical College and Hospital, Jamnagar, Gujarat, India

Introduction: This case study presents a 55-year-old male patient initially suspected of having community-acquired pneumonia (CAP), but later diagnosed with pulmonary infarction (PI) resulting from pulmonary embolism (PE). The case highlights the importance of considering PI in the differential diagnosis of patients presenting with symptoms similar to CAP.

Case Report: A 55-year-old male presented with a 10-day history of right-sided localized chest pain, dry cough, and grade 2 MMRC dyspnea. He reported high-grade fever for 5 days. Initial examination showed no tachypnea or tachycardia. Laboratory tests revealed leukocytosis (TC 11k) and elevated D-dimer (1637 ng/mL). Chest X-ray showed right lower zone peripheral opacification, while ultrasound indicated right lower lung consolidation with minimal pleural effusion. ECG was normal, but troponin I was elevated (2.97 ng/ml). Initially treated for suspected CAP, further investigation with CT pulmonary angiography revealed PE with complete occlusion of the right descending artery and right lower lobe pulmonary infarct. Echocardiography showed no right atrial or ventricular dilation, apical akinesia, or pulmonary hypertension. Given the patient’s clinical stability and absence of hypoxia or hemoptysis, thrombolysis was not performed. Treatment with oral anticoagulants was initiated. Follow-up at 7 months showed resolution of chest X-ray opacities.

Conclusion: Pulmonary infarction can mimic CAP in its initial presentation. A high suspicion index and appropriate diagnostic workup are essential to differentiate between these conditions and provide optimal treatment, thereby preventing potentially devastating pulmonary complications. Pulmonary infarction, community-acquired pneumonia, pulmonary embolism, D-dimer, anticoagulation.

This case underscores the importance of considering pulmonary infarction in patients presenting with CAP-like symptoms, especially when accompanied by elevated D-dimer levels. Timely and appropriate investigations, including CT pulmonary angiography, are crucial for accurate diagnosis and management.

Abstract No. 266: Double trouble-pneumonia a/w hepatic abscess

Ayush Mali

NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Introduction: Complicated pneumonia refers to pneumonia that is associated with complications affecting the pleura or other structures. This is a case of Pneumonia complicated with Parapneumonic effusion associated with Hepatic Abscess.

Case Report: A 58-year-old male was admitted with complaints of right-side chest pain, fever and cough with expectoration. Chest X-ray was done and a diagnosis of Right-sided CAP was made. Sputum C/S was negative and BAL C/S showed Klebsiella Growth. Antibiotics were modified accordingly. The patient didn’t respond to antibiotics, counts were raised, O2 requirement increased and breath sounds were reduced on the Right side, chest X-ray was done s/o parapneumonic effusion. USG (A+P) done was s/o hepatic abscess, INJ METRO was started, Therapeutic pleural tap was done and a pigtail catheter was inserted in the abscess. The patient improved symptomatically and clinically over the course of the treatment and was maintaining saturation on room air, hence was discharged.

Conclusion: This case highlights the importance of considering secondary infections or complications in patients with pneumonia who do not respond to appropriate antibiotic therapy. As seen in this patient, the coexistence of parapneumonic effusion and hepatic abscess emphasises the need for a thorough evaluation, including imaging and culture studies, to identify and treat associated infections promptly. Early intervention with targeted therapy, drainage procedures, and supportive care can significantly improve patient outcomes and prevent further complications.

Abstract No. 267: Knowledge, attitudes, and practices of evidence-based medicine and healthcare ethics among doctors in Maharashtra, India

Mrunal N. Gaikwad 1 , Aniket M. Mathesul 2 , Nitin S. Gaikwad 3 , Ashwin Ramesh 4 , Dr. Shruti Mudale 5

1 Department of Public Health, Maharashtra University of Health Sciences, Nashik, Maharashtra, India, 2 Department of Community Medicine, MIMER Medical College, Pune, Maharashtra, India, 3 Department of Respiratory Medicine, MIMER Medical College, Pune, Maharashtra, India, 4 Department of Critical Care Medicine, Bharti Vidyapeeth, Medical College, Pune, Maharashtra, India, 5 Department of Microbiology, BJ Medical College and Sassoon General Hospital, Pune, Maharashtra, India

Introduction: Evidence-Based Medicine (EBM) and healthcare ethics are essential for ensuring high-quality, patient-centered care. However, in resource-limited settings like Maharashtra, India, challenges such as knowledge gaps, resource constraints, and insufficient training hinder their effective implementation. This study evaluates the knowledge, attitudes, and practices (KAP) of EBM and healthcare ethics among doctors in Maharashtra.

Methods: A cross-sectional survey was conducted among 195 doctors from primary, secondary, and tertiary healthcare facilities. A validated KAP questionnaire was distributed electronically to collect data on EBM knowledge, attitudes towards evidence-based practices, and ethical considerations in patient care. Data analysis included descriptive & inferential statistics to identify correlations between sociodemographic factors and KAP outcomes. Ethical approval was obtained, adhering to principles of confidentiality and informed consent.

Results: The study revealed gaps in knowledge, with only 38.4% of respondents aware of the Nuremberg Declaration, while 63.1% correctly identified “primum non nocere.” Positive attitudes towards EBM were evident, with 71.2% recognizing its role in improving patient outcomes, though 26.1% preferred experience-based medicine. Only 25.1% consistently applied EBM in clinical practice, with barriers including time constraints, limited resources, and insufficient training. Ethical dilemmas were frequently encountered, with 24.1% reporting weekly challenges and relying more on informal advice than formal ethics committees.

Conclusion: The study underscores the need for comprehensive interventions to address knowledge gaps, improve attitudes, and ensure the consistent practice of Evidence-Based Medicine and healthcare ethics. By implementing structured training programs, enhancing access to evidence-based resources, and strengthening institutional ethical frameworks, healthcare professionals can be better equipped to deliver high-quality, patient-centered care, ultimately improving clinical outcomes and fostering ethical medical practices.

Keywords: Attitudes, evidence-based medicine, healthcare ethics, knowledge, Maharashtra, practices.

Abstract No. 268: It’s not all TB, a patient with fever, lung shadows, and an uncommon diagnosis

Anisha Rajvanshi , Jigneshkumar Patel, Zarir Udwadia

PD Hinduja National Hospital and Research Centre, Mumbai, Maharashtra, India

Introduction: Histoplasmosis is often underdiagnosed and misidentified in India as tuberculosis, due to overlapping clinical features. This report highlights the difficulties in diagnosing histoplasmosis and presents the successful management of a case initially confused with tuberculosis.

Case Report: A 35-year-old female presented with persistent throat pain, unresponsive to usual antibiotic course. She had no complains of fever, cough or weight loss. In view of persistent throat pain, a biopsy of the posterior pharyngeal wall revealed inflammatory granulation tissue. Chest CT scan was advised after the biopsy which demonstrated centrilobular nodules and left upper lobe cavity, suggestive of an infectious process. She had history of pulmonary tuberculosis, treated in 2007 for 9 months. Despite negative sputum TB Gene Xpert and TB culture, she was treated empirically with anti-TB medication, but her symptom of sore throat persisted. At this point she presented to our institute and underwent a bronchoscopy. Bronchoscopy revealed irregular bronchial mucosa, and biopsy samples showed intracytoplasmic organisms consistent with Histoplasma capsulatum on GMS stain. Diagnosis of histoplasmosis was confirmed through urine antigen testing and the patient was started on IV amphotericin B. On detailed history taking patient revealed travel to endemic areas in USA few weeks before her symptoms developed. She was discharged on oral itraconazole and showed significant clinical and radiological improvement at one-month follow-up.

Conclusion: This case highlights the importance of considering histoplasmosis as a key differential diagnosis for tuberculosis.

Abstract No. 269: To study the correlation of levels of inflammatory markers with the duration of treatment in patients diagnosed with pulmonary tuberculosis - A longitudinal study

Vedant Zalke

NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Introduction: Tuberculosis (TB), particularly pulmonary TB, is a major global health challenge. This study evaluates changes in inflammatory biomarkers (CRP/HSCRP, NLR, TLC, RDW, ESR) in pulmonary TB patients at diagnosis and after the intensive phase of anti-tubercular therapy, and their correlation with radiological outcomes.

Methods: This prospective cohort study included 35 pulmonary TB patients (>18 years) diagnosed clinically, radiologically, or microbiologically. Inflammatory markers (CRP/HSCRP, ESR, NLR, RDW) and chest X-rays (by Modified Chest X-ray scoring system) were assessed at diagnosis and after the intensive therapy phase. Data were analyzed using SPSS v24 with descriptive statistics and significance tests (p<0.05).

Results: Among 35 patients (65% males, 35% females; mean age 40 years), CRP was higher in males. After 2 months, markers significantly decreased: CRP/HSCRP (25.1 ± 4.5 to 6.2 ± 2.1 mg/L), ESR (75.3 ± 12.1 to 32.8 ± 8.5 mm/hr), NLR (5.2 ± 1.4 to 2.1 ± 0.7), and RDW (16.5 ± 1.2% to 14.8 ± 0.9%) (all p<0.001). Radiological improvement occurred in 71.4% (10 severe to moderate, 8 moderate to mild, 7 complete resolution). However, 28.6% showed no improvement despite reduced markers, suggesting residual or delayed resolution.

Conclusion: Inflammatory markers (CRP/HSCRP, ESR, NLR, RDW) are effective for monitoring pulmonary TB treatment. Reductions in these markers correlated with radiological improvement, but 28.6% showed no radiological improvement despite marker decline, suggesting the need for extended follow-up and integration of inflammatory markers in routine clinical monitoring.

Keywords: Inflammatory markers, modified chest xray scoring system, pulmonary tuberculosis

Abstract No. 270: Sand storm a case of pulmonary alveolar microlithiasis

S. M. Rahul

Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India

Introduction: Pulmonary alveolar microlithiasis is a rare, progressive lung disease characterized by the widespread presence of tiny, calcium-rich deposits called microliths within the alveoli. These microliths can lead to respiratory impairment over time. PAM was first described in 1918 by the Norwegian physician Harbitz, and the condition is sometimes referred to as “Harbitz’s syndrome.

Case Description: A 35year old female who by occupation is farmer presented to casualty with insidious onset breathlessness which gradually progressed and on 15ltrs of o2 on NRBM with no relieving factors and also complaints dry cough since 10 days. All the symptoms developed following exposure to fertilizer. Following chest x ray bilateral diffuse infiltrate were noted. HRCT thorax findings were diffuse hyper dense calcification, sub pleural calcification with black pleura sign suggestive of pulmonary alveolar microlithiasis. Following bronchoscopy BAL microliths were observed. No similar family history. No other comorbidities.

It’s a rare genetic disorder seen mostly in middle aged female patients. It can be either sporadic or familial in occurrence. Can be suspected with acute history and diagnosed mainly on radiological basis. Currently the treatment recommended is sequential bilateral double lung transplant.

Conclusion: Pulmonary alveolar microlithiasis a rare inherited disease caused by mutations in the SLC34A2 gene. It requires integrated clinical, radiological, and histopathologic approach. The disease often presents with non-specific symptoms or can be asymptomatic in its early stages. As the condition progresses, it can lead to severe complications, including respiratory failure. Management varies from severity, ranging from supportive therapies to use of Disodium Etidronate (DE) to lung transplantation in advanced stages. Early diagnosis and careful monitoring are crucial to improving patient outcomes and slowing disease progression.

Abstract No. 271: Finding an alternative drug for surgery in a patient with unknown drug allergy: A case report

Ajal Shaji

Aster Medcity, Kochi, Kerala, India

Introduction: The word allergy is derived from the Greek words:”allos” meaning “other” or “different” and “ergon” meaning “work” or “action”. Allergic diseases are systemic disorders caused by an impaired immune system.

Case Report: 50 years old female, presented with complaints of swelling over epigastric region which she noticed few weeks back. She was planned for Laparoscopic epigastric hernia repair on 12/10/2024. After induction of anaesthesia, patient developed hypotension and desaturation. Possibility of anaphylactic shock was considered, surgery was deferred and she was shifted to ICU. A Pulmonology consultation was sought. From her history, we realized that she has undergone 3 prior surgeries during which she has received multiple anesthetic agents like xylocaine, propofol, scoline, atracurium, hydrocort, vecuronium, fentanyl. During this time, she was given Inj propofol, Inj Atracurium and Inj piptaz.

From history we realised that she has already received inj propofol and atracurium in the past. So the likely culprit is inj Piptaz. We were planning to proceed with an intradermal drug allergy testing next. But due to recent anaphylaxis, we first did a histamine challenge test to make sure her mast cells are active. The test came out to be positive and she was taken up for intradermal allergy testing using 26 drugs next day. The panel included commonly used anaesthetic agents and few antibiotics. She was found allergic to Piptaz, cis atracurium, ciprobid, ketamine. The test did not show positive result to antibiotic ceftum. Hence as part of finding an alternative drug which can be given to the patient peri and post operatively, we did an oral drug challenge with tab ceftum which she tolerated. We also did an IV drug challenge with cefuroxime the next day. She tolerated it as well. Hence Cefuroxime was proved to be safe in this patient by intradermal, intravenous and oral challenge. She underwent laparoscopic hernia repair and was discharged.

Conclusion: Taking a detailed clinical history is very important in drug allergy cases. 80% of patients with drug allergy in childhood outgrow them as age advances.

Patients with a history of pencillin allergy are more likely to be treated with less effective, more toxic, or more expensive antibiotics, leading to increased cost, antibiotic associated infections, longer hospital stays and increased mortality. Therefore a proactive effort should be made to delabel pencillin allergy whenever possible.

Abstract No. 272: Role of thoracoscopy in the treatment of undiagnosed exudative pleural effusions

Ajal Shaji

Aster Medcity, Kochi, Kerala, India

Introduction: Thoracoscopy first emerged as a diagnostic tool in the early 20 th century when therapeutic pneumothorax became the surgical treatment of choice for tuberculosis. Currently, the role of medical thoracoscopy in the treatment of undiagnosed pleural effusions is increasingly being recognized.

Methods: We analyzed prospective data of 50 thoracoscopic procedures performed at our center on patients with undiagnosed exudative pleural effusions in 6 months. Patients were subjected to medical thoracoscopy based on ultrasonographic stratification and a computed tomography (CT) thorax. Medical thoracoscopy was performed after an intercostal block under conscious sedation with midazolam (2 mg) and fentanyl (50 mcg) and local anesthesia with lignocaine 2% (10–15 ml), through a semirigid thoracoscope.

Results: A total of 50 patients (28 males and 22 females) underwent medical thoracoscopy during the study period. The mean age was 56.96 ± 14.84 (range, 22–88). The final diagnosis by thoracoscopy was bacterial empyema in 8 patients, tuberculosis in 13 patients and malignancy in 19 patients. Medical thoracoscopy was successful without subsequent intervention in 48, two patients underwent a second procedure, in the form of decortication. There were no major procedure-related complications that required intervention (adenosine deaminase or interferon) have been negative.

Conclusion: Medical dogma teaches: “the sun should never rise nor fall on a pleural effusion.” Although this is an overly simplistic view, the basic principle that a new pleural effusion needs prompt and thorough evaluation still holds. Medical thoracoscopy is a minimally invasive and cost-effective procedure in patients with exudative pleural effusions who have been stratified carefully using radiological methods.

Keywords: Pleural effusion, thoracoscopy, tuberculosis

Abstract No. 273: A real-world retrospective study to evaluate the effectiveness and safety of montelukast and fexofenadine fixed-dose combination in the management of patients with allergic rhinitis

Bharat Toshniwal , Dushyant Khedikar, Jafferhusein Sura, Archana Muralidharan, Lavanya M, Rahul Jaiswal, Samir Gami, Sandeep Athavale, Seemab Shaikh, Sowmya Ghosh, Sweta Lohiya, Gurmeet Thakur, Vaishali Gupte, Anand Pendakur

Toshniwal Chest Hospital Maternity and Nursing Home, Nanded, Maharashtra, India

Introduction: Allergic Rhinitis (AR) is increasing in India, significantly impacting patients’ quality of life and daily activities. Combining an antihistamine with montelukast offers a complementary effect in reducing AR symptoms. This study evaluated the effectiveness and tolerability of the fixed-dose combination of Montelukast and Fexofenadine (FDC-M/F: 10 mg + 120 mg) in real-world settings.

Methods: A retrospective, open-label, multicentre study, included patients aged >15 years, with symptoms suggesting AR (mild-intermittent/persistent, or moderate intermittent) or Total Nasal Symptom Score (TNSS) of 5 or more, provided they hadn’t used antihistamines in the past week or FDC – M/F in the last 4 weeks. Medical records were collected from the database of 12 sites across India from June 2022-June 2023. The primary variables assessed included changes in TNSS, Total Ocular Symptom Score (TOSS), Physicians Global Assessment (PGA), and Patients Global Assessment Scale (PGAS) from baseline to 4-6 weeks. All statistical analyses were conducted using R statistical software (R 4.4.0, R Core Team, 2024, Vienna Austria) with a two-tailed overall significance level set at 0.05.

Results: A total of 329 medical records met the enrolment criteria. Significant improvement in TNSS (baseline 6.66 to 0.95, p <0.001) and TOSS (baseline 1.54 to 0.23, p <0.001) were observed with FDC M/F. The mean treatment duration was 5 weeks (interquartile range: 4-6 weeks). The combination was well-tolerated, and most patients were satisfied with the treatment.

Conclusion: The combination of fexofenadine, a long-acting H1 antagonist, and montelukast, a potent LTRA, provides dual action on early-and late-phase allergic reactions in AR. This Indian multicentre study supports the effectiveness of FDC-M/F in mild intermittent/persistent AR and highlights the need for randomized trials to assess its side effect profile.

The FDC M/F may be an attractive treatment option for mild-intermittent, mild-persistent AR.

Keywords: Allergic rhinitis, FDC, fexofenadine, Montelukast, TNSS, Total Nasal Symptom Score

Abstract No. 274: Tuberculous empyema necessitans presenting as chest wall swelling: A case report

Santhosh Kandula , R. Sunil Kumar

Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Introduction: Empyema necessitans is a rare complication of empyema, defined by the extension of a thoracic empyema through surrounding soft tissues towards the chest wall, sometimes forming skin disconnections. This condition is particularly associated with Mycobacterium tuberculosis, especially in immune-compromised individuals.

Case Description: We report the case of a 42-year-old male with a history of HIV and pulmonary tuberculosis who presented with shortness of breath, fever, and progressive swelling in the right hemithorax. Examination revealed reduced breath sounds and tenderness in the affected area. Imaging studies confirmed right pleural effusion and thickened pleura with effusion extending into chest wall. Sputum cultures identified Klebsiella, while pleural fluid analysis confirmed Rifampicin-sensitive Mycobacterium tuberculosis.

Conclusion: The patient’s symptoms posed diagnostic challenges, considering the overlapping presentations of HIV, tuberculosis, and potential malignancy. The case underscores the need for a high index of suspicion for Empyema Necessitans in immunocompromised patients, particularly those with a history of tuberculosis.

Timely diagnosis and intervention are crucial in managing Empyema Necessitans to prevent complications. This case highlights the significance of adherence to anti-tuberculosis therapy in preventing the progression of extrapulmonary manifestations.

Abstract No. 275: Face to face with cutaneous tb: decoding lupus vulgaris

Niralam Kaur

Government Medical College, Patiala, Punjab, India

Introduction: Tuberculosis (TB) remains a major health concern in developing nations, with an increasing global incidence, including its extrapulmonary forms. Extrapulmonary TB constitutes 15–20% of all TB cases, while cutaneous tuberculosis is a rare manifestation, accounting for only 1.5% of these cases. Mycobacterium tuberculosis , M. bovis , and occasionally the Calmette-Guérin bacillus (BCG) can cause Cutaneous TB. Lupus vulgaris, the most common form of Cutaneous TB, presents as progressive, firm plaques with central clearing and active margins. Due to its paucibacillary nature and nonspecific clinical features, diagnosing Lupus Vulgaris is often delayed or misdiagnosed.

Case Report: A 35-year-old male presented with a persistent, reddish, firm plaque on the left malar region for four months. Systemic examination was unremarkable, with no past history of TB or contact history of TB. Chest X-ray and sputum workup were normal. Dermatology consultation ruled out other differential diagnoses. Histopathological analysis of a skin biopsy revealed mild hyperkeratosis, epidermal acanthosis, and ill-formed granulomas within dense lymphocytic infiltrates in the dermis, confirming lupus vulgaris. Anti-tubercular therapy (ATT) comprising Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol was initiated. Remarkable lesion resolution and clinical improvement were observed following treatment.

Conclusion: Cutaneous TB, though rare, is challenging to diagnose due to its nonspecific and paucibacillary presentation, often mimicking conditions like sarcoidosis, discoid lupus erythematosus, fungal infections, or basal cell carcinoma. While caseous necrosis in granulomas is diagnostic, its absence does not rule out TB. In this case, clinical and histopathological findings supported the diagnosis and guided treatment.

Diagnosing lupus vulgaris is complex and demands vigilance, especially in endemic regions like India. Prompt recognition and treatment are essential to ensure favorable outcomes and minimize complications.

Abstract No. 276: Clinico-radiological profile and functional status of post-pulmonary tuberculosis patients visiting a medical college teaching hospital in central Karnataka

Aiswarya Hari

SSIMS and RC, Davangere, Karnataka, India

Introduction: Tuberculosis is a public health problem worldwide, especially in developing countries like India. About two-thirds of patients continue to have sequelae and pulmonary impairment despite adequate microbiological cure. Our study aimed to assess the overall clinical status and lung function of treated post-pulmonary tuberculosis patients.

Methods: This was a hospital-based cross-sectional study conducted over a period of 12 months (2023-24) at Davanagere, Karnataka. All patients above 18 years with history of pulmonary tuberculosis, having completed treatment at least 12 months ago and declared cured, presenting to outpatient department of pulmonary medicine were included. They were administered structured questionnaire seeking socio-demographic data, respiratory symptomatology and subjected to chest x ray, sputum smear examination and spirometry. Patients with smear positive for acid fast bacilli, active haemoptysis, cardiac comorbidities and those not willing to give consent were excluded.

Results: Of the 70 recruited participants, males constituted 61.4% (n= 43) and 38.6% (n=27) were females. Mean age was 54.6 ±12.8 years. Mean BMI was 21.3±3.9 kg/m 2 . 77% belonged to lower socioeconomic class. Most common symptom reported was shortness of breath (74.3%), followed by cough (67%), expectoration (14.3%), wheeze (10%), chest pain (8.6%). Chest x-rays revealed 27.13% had fibrotic bands while 17.14% bronchiectasis, calcifications in 14.28%, fibro-cavitary lesions in 11.42%, pleural thickening in 7.14%, residual cavity in 5.75% and opacification of entire hemithorax in 4.28%. 12.86% had a normal chest radiograph. On spirometry, obstructive pattern seen in 51.4%, restrictive pattern 21.4%, mixed pattern 12.8% and normal finding in 14.3%.

Conclusion: Given the significant proportion of persistent respiratory symptoms, radiographic and spirometric abnormalities, post-tuberculosis patients should be carefully evaluated and followed-up regularly to control exacerbations and reduce premature mortality.

Keywords: Chest x-ray, post tubercular symptoms, spirometry, tuberculosis

Abstract No. 277: A case report of mycoplasma pneumonia with severe aortic stenosis leading to cardiogenic and septic shock requiring V-A ECMO as a bridge to valve transplant

Jigar Khanpara

Lilavati Hospital, Mumbai, Maharashtra, India

Introduction: Severe aortic stenosis (AS) is a critical cardiac condition that can be exacerbated by systemic infections, leading to life-threatening complications. Mycoplasma pneumonia, though a common cause of atypical pneumonia, rarely triggers severe cardiogenic and septic shock. This case highlights the complexities of managing such patients and the pivotal role of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) as a bridge to definitive surgical treatment.

Case Description: A 55-year-old female with severe AS presented with acute fever, dyspnoea, and hypotension. Investigations confirmed Mycoplasma pneumonia as the aetiology of severe sepsis. The patient rapidly deteriorated, developing refractory septic and cardiogenic shock despite optimal medical therapy, including antibiotics, vasopressors, steroids, and mechanical ventilation. Echocardiography revealed critically reduced cardiac output due to severe AS. Patient underwent cardiac arrest and was emergently initiated on V-A ECMO for circulatory and respiratory support [E-CPR]. After stabilization, she underwent successful aortic valve replacement. Postoperatively, ECMO was weaned off, and the patient recovered but had single organ residual dysfunction, landed on permanent haemodialysis.

Conclusion : This case demonstrates the necessity of prompt multidisciplinary management in patients with severe AS complicated by infections. V-A ECMO can provide critical support, serving as a bridge to definitive interventions such as valve replacement surgery.

Mycoplasma pneumonia in the context of severe AS can precipitate catastrophic complications. Early diagnosis, timely initiation of advanced support modalities like V-A ECMO, and coordinated surgical intervention are crucial to achieving favourable outcomes. This report emphasizes the importance of integrating ECMO in the management algorithm for critically ill patients with dual cardiac and infectious pathologies.

Abstract No. 278: Atypical presentation of adenocarcinoma in young female

V. C. Anjana

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Introduction: Adenocarcinoma is the most common type of lung cancer with distinct cellular and molecular features. Adenocarcinoma is a type of non-small cell lung cancer. Adenocarcinoma most commonly present in non-smokers. Primary lung adenocarcinoma, pneumonic type, can mimic the clinical presentation of an infectious or inflammatory lung disease which can represent a diagnostic challenge.

Case Description: A 29 year old female presented to hospital with complaints of cough with expectoration, fever since 2months, associated with loss of weight and loss of appetite, and streaky hemoptysis since 15 days. On examination SpO2-97% at room air, PR-112bpm, BP-130/80mmHg. Chest x-ray shows consolidation in right lower zone. Patient was started on emperical antibiotics, antifibrinolytics. HRCT thorax done shows patchy areas of consolidation with surrounding ground glass opacites in right lung parenchyma.

Bronchoscopy shows mucosa of right tracheobronchial tree has small nodular lesion at the right upper lobe. Narrowing of the intermediate bronchus, scope was unable to pass beyond it to intubate lower lobe segments. TBLB was taken from the mucosal lesion.

HPE features suggestive of adenocarcinoma lung.

Conclusion: Adenocarcinoma have atypical presentation like tumor discovered on bronchoscopy with no clinical suspicion. Atypical presentation of adenocarcinoma can be challenging to diagnose especially in areas with prevalent infectious diseases.

It is important for clinicians to keep adenocarcinoma in the differential diagnosis especially in patients presenting with clinical and radiological findings suggestive of pneumonia that is refractory to antimicrobial therapy.

Abstract No. 279: Exploring the causes and theraupetic challenges in recurrent secondary spontaneous pneumothorax in resource limited setting – Case series

Vinay C. Dharmadhikari

S. S. Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India

Introduction: A pneumothorax occurs when air accumulates between the visceral and parietal pleura. Classified as spontaneous, iatrogenic or traumatic. Further classified as primary or secondary, based on underlying lung parenchyma. Secondary spontaneous pneumothorax (SSPs) occur in the presence of underlying lung disease, most commonly COPD, Tuberculosis. SSP has high chance of recurrence (>50%) even in the first episode and can lead to more physiologic imbalance and can also be life-threatening.

Case: Case 1: 48 year old male, K/C/O COPD came with C/O Breathlessness on exertion, right chest pain since 8 days with H/O hospitalisation 1 month ago for similar complaints and right ICD was inserted. Chest Xray was done s/o right pneumothorax. Right ICD was done, good resolution of pneumothorax, then Chemical pleurodesis with Povidine iodine was done through ICD.

Case 2: 56 year old male with K/C/O COPD came with c/o Breathlessness on exertion and right chest pain since 2 days. Similar complaints 2 months ago, right ICD procedure was done. CXR-s/o pneumothorax with bilateral emphysematous changes. Right ICD inserted, Pleurodesis with Povidine iodine through ICD was done. Case 3: 61 year old male with H/O pulmonary TB 22 years ago. Came with c/o breathlessness on exertion since 2 days with left chest pain. H/O similar episode 20 days ago, Left ICD was inserted. CXR done-s/o post tb sequalae with pneumothorax. Left ICD inserted, pleurodesis done through ICD with povidine Iodine. In all 3 cases-1 month,6 month follow up no further recurrence of pneumothorax.

Conclusion: In a resource limited setting with no medical thoracoscopy facility pleurodesis through ICD tube with povidine iodine can be considered with probable good resolution of pneumothorax with reduced risk of recurrence.

Patients with recurrent secondary spontaneous pneumothorax should be managed promptly and an early intervention helps in better outcomes.

Abstract No. 280: Delve deeper beyond the surface findings

Anoop Ponnachan

Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India

Introduction: Tubercular pleural effusion is a common presentation in regions with high tuberculosis prevalence and is typically managed with antitubercular therapy (ATT).[ 1 , 2 ] However, the overlap of symptoms between tuberculosis and malignancies poses diagnostic challenges,[ 2 , 3 ] particularly in resource-limited settings. Here, we present a unique case initially diagnosed as tubercular pleural effusion and treated with ATT, later revealed to be renal cell carcinoma with metastasis. This case highlights the importance of thorough diagnostic evaluation and maintaining a broad differential diagnosis when treating pleural effusions, even in TB-endemic areas.

Case: 65 year old male urban Mumbai resident electronic repair agent, presented to OPD with symptoms of cough, evening rise in temperature and chest pain since last 7 days. Clinical examination revealed decreased breath sounds and stony dullness on the right hemithorax. Chest X-ray and CT thorax demonstrated a large pleural effusion with multiple pulmonary nodules. Diagnostic thoracocentesis yielded exudative fluid with high protein, lymphocytosis, and elevated adenosine deaminase (ADA) levels, and microbiological confirmation (MTB detected very low) supporting a diagnosis of tubercular pleural effusion. After multiple pleural tap around 3L pleural fluid was aspirated. Further evaluation, including abdominal imaging, revealed bilateral renal mass consistent with malignancy, confirmed by histopathology as renal cell carcinoma (RCC). [4] CT highlighted metastatic pulmonary involvement. The patient was initiated on anti-tuberculosis therapy (ATT) alongside palliative care for the malignancy.

Conclusion: The coexistence of tuberculosis and malignancy poses diagnostic challenges due to overlapping clinical and radiological features. Immunosuppression associated with malignancy and metastasis may predispose patients to opportunistic infections like tuberculosis. [5] Early and accurate differentiation is crucial for guiding treatment, as both conditions require distinct management strategies.

Coexistence of TB and immunodeficiency is very common. Workup for HIV and Malignancy should me diagnosed with a wider and more open differentials will help in managemt of other life threatening conditions.

Abstract No. 281: A life cut short: A ripple of tuberculosis in an ocean of evolving diverse clinical dilemmas

Gaikwad Naresh , C. Korday, A. Dandawate, N. Inamdar, S. Agarwal

HBT Medical College and Dr. R N Cooper Hospital, Mumbai, Maharashtra, India

Introduction: Disseminated tuberculosis remains a diagnostic dilemma in infancy due to the paucibacillary nature of the disease. A high index of suspicion, thorough family history, and extensive investigations may be the only way to reach a diagnosis.

Case: A 2-month-old full term female child with 3kg birth weight was admitted with fever, cough, poor feeding, tachypnoea, and bilateral crepitations. X-Ray chest showed bilateral lung infiltrates with lymphocytic leukocytosis on CBC suggesting viral bronchopneumonia. She was treated with HHHFNC, intravenous fluids and antibiotics. CT abdomen done for developing abdominal distension showed only mildly dilated bowel loops. Father was treated for pulmonary cavitatory TB two years ago. TB workup in the mother and child was negative. The child improved, gained adequate weight and was discharged. 3 months later, the child was readmitted with right sided divergent squint suggestive of 3 rd nerve palsy. Follow up chest X-Ray showed bilateral micronodular infiltrates suggesting miliary tuberculosis. MRI Brain revealed a ring enhancing lesion in the midbrain with vasogenic edema and eccentric scolex suspicious of neurocysticercosis/tuberculoma. MR spectroscopy was planned, however, the parents refused further hospital stay. The child was given AKT, steroids, and anti-helminthic therapy but compliance at home was questionable. During this time the father developed bronchiectasis and became hypoxic on room air. Tragically, the parents never followed up and the child succumbed three weeks later.

Conclusion: Tuberculosis presents in a diverse evolving manner even in young infants creating diagnostic dilemmas. Microbiological diagnosis is a challenge in pediatric tuberculosis. One may have to rely on the clinical and radiological route.

It is imperative to be vigilant especially in screening family contacts while managing pediatric tuberculosis. Stringent adherence to treatment and attitude change in the family is extremely important to prevent devastating consequences in our fight against tuberculosis.

Abstract No. 282: A rare finding of aspergillus niger as a cause of pyopneumothorax in immunocompromised patient

Afshan Sadaf

Deccan College of Medical Sciences, Hyderabad, Telangana, India

Introduction: Pulmonary Aspergillosis can be in the form of Invasive Aspergillosis, Aspergilloma, Allergic Bronchopulmonary Aspergillosis and chronic necrotizing Aspergillus pneumonia. Fungal entities are very rare pathogens with <1% of all pleural effusions of fungal etiology.

Case Description: A 68 year old male presented to respiratory clinic with complaints of productive cough and low grade/intermittent fever for fifteen days. Known diabetic on treatment with oral antihyperglycemic agents and a chronic smoker with a very recent cessation. Patient was initiated on an empirical trial of Antitubercular Treatment despite sputum negativity. After one month of treatment, due to no improvement in patient’s symptoms the trial was abandoned. On presentation to our hospital, a detailed blood workup/imaging was ordered. HRCT Chest revealed a right sided pyopneumothorax with pleural calcifications. An ICD was placed, the fluid was drained and sent for detailed evaluation.

Conclusion: Aerobic culture and sensitivity test to check for growth of bacteria was negative but fungal growth had been observed. Growth of fungal hyphae on cultures done on pleural fluid remains the gold standard for diagnosing an Aspergillus infection.

The diagnosis of Aspergillosis as a cause of pleural effusion is not one that is usually made unless there is a high index of suspicion based on the clinical presentation.

Abstract No. 283: Role of ultrasound guided fnac in comparison with bronchoscopy in non-resolving lung consolidation in a tertiary care center

Afshan Sadaf

Deccan College of Medical Sciences, Hyderabad, Telangana, India

Introduction: (1) Pneumonia is a common respiratory disorder, which is a leading cause of disability adjusted life years worldwide. (2) Non resolving pneumonia includes: Incomplete clearance of radiological infiltrates in 4 weeks. <50% clearance in chest infiltrates, who improved symptomatically. Non resolution of radiological infiltrates in an expected period of time with 10 days of antibiotics.

Methods: A hospital based prospective study. Sample size – 50, Investigations done after labelling patient as non-resolving pneumonia are ultrasound guided FNAC and bronchoscopy, and subjected to both the diagnostic procedures (cytology/microbiological examination). Inclusion/exclusion criteria are specified. Interpretation/Statistical analysis is performed.

Results: Out of 50 cases, distribution of consolidation is as follows. Medial – 11, Lateral-16 and Mixed – 23

Discussion: Yield obtained in medial consolidation is more by bronchoscopy whereas in lateral consolidation it is more by FNAC.

Conclusion: Sensitivity of FNAC for total cases is found as 76% which is better compared to 70% in bronchoscopy. Comparison of FNAC and bronchoscopy in medially and laterally located consolidation shows marked variation. P value using chi square test is 0.00001.

Keywords: Bronchoscopy, FNAC, non-resolving consolidation

Abstract No. 284: Gender-based variations and correlates in obstructive sleep apnea: Insights from a tertiary care cohort

Debdeep Sen , Arup Halder, Raja Dhar

CK Birla Hospitals, CMRI, Kolkata, West Bengal, India

Introduction: Obstructive sleep apnea (OSA) is a common disorder with far-reaching health implications. Understanding the influence of gender, age, BMI and comorbidities on the apnea-hypopnea index (AHI) is important for phenotyping and judging long term outcome. This study examines data from sleep studies conducted over one year to identify key correlates of OSA severity.

Methods: retrospective analysis was performed on 239 patients (149 males, 90 females) who underwent sleep studies at a tertiary care hospital. Patient demographics, body mass index (BMI), mean oxygen saturation, and AHI were analyzed. Relationships between AHI and variables such as age, gender, BMI, and comorbidities were evaluated.

Results: Males exhibited a significantly higher mean AHI (49.85) compared to females (36.87) with p<0.001. The females have a higher BMI (33.32) than males (30.35). There was no correlation between AHI and age or the number of comorbidities. However, an increase in AHI was associated with a decrease in mean oxygen saturation. Mean saturation in males and females were comparable.

Conclusion: The findings emphasize gender disparities in OSA severity, with males experiencing more severe sleep-disordered breathing. The lack of correlation between AHI and age or comorbidities suggests that other factors may influence OSA severity. The significant association between AHI and reduced oxygen saturation underscores the need for timely diagnosis and management.

This study highlights gender differences in OSA and the detrimental impact of severe OSA on oxygenation.

Keywords: Apnea-Hypopnea Index, gender differences, obstructive sleep apnea, oxygen saturation, sleep study

Abstract No. 285: A rare case of skeletal and pulmonary sarcoidosis

Srija Meddela

Mediciti Institute of Medical Sciences, Hyderabad, Telangana, India

Introduction: Sarcoidosis is a multisystemic granulomatous disease with an indetermined etiology. Sarcoidosis is caused by the human immune system reacting to unknown substances (infectious pathogens, chemicals or dust, etc.) in genetically susceptible people. The diagnosis of sarcoidosis mainly depends on the pathological manifestations of granuloma, which consist of multinucleated giant cells at the core and peripheral immunocytes. The lungs and intrathoracic lymph nodes are commonly involved, although other organs can be affected, including the skin, eyes, bone and heart. The incidence rate of extrathoracic sarcoidosis is lower & frequency of bone involvement was between 3% and 13%.

Case: A 40 yr old male with no known comorbidities presented with pain in left upperlimb and lowerlimb since 1 year. MRI LS spine showed multiple hypointense lesions in lumbar & thoracic vertebrae and concomitant CT thorax confirmed multiple peribronchovascular nodules in both lungs. FDG-PET-CT scan of wholebody showed FDG uptake in soft tissue density nodules in bilateral perihilar regions, mediastinal lymphnodes and left supraclavicular lymphnode. Routine investigations were normal. Serum ACE was raised and ionized calcium levels increased. Histopathological examination of left supraclavicular lymphnode showed granulomatous lymphadenitis without necrosis. Patient started on steroids responding well to treatment.

Conclusion: Skeletal involvement of sarcoidosis is rare. PET-CT scan & histopathological examination aids in differentiating other causes reaching the diagnosis.

This case report shows the case history of a person who visited orthopaedician multiple time because of musculoskeletal pains, on evaluation accidentally found lesions in vertebrae, PET-CT was done to rule out metastasis but to the surprise biopsy of lymphnodes showed granulomatous disease. Rare presentation of pulmonary sarcoidosis with extrapulmonary involvement of musculoskeletal system is described in this report.

Abstract No. 286: Enhanced pulmonary function outcomes with erdosteine compared to NAC

Kharak Singh Arora

Multispeciality Hospital, Alwar, Rajasthan, India

Background: While mucolytic agents are essential in managing chronic respiratory conditions, comparative data between erdosteine and N-acetylcysteine (NAC) remains limited. This study compared the effectiveness of these agents in improving pulmonary function outcomes.

Methods: This prospective, randomized, double-blind study enrolled 148 patients with chronic respiratory disease, receiving either erdosteine (300 mg twice daily) or NAC (600 mg once daily) for 12 weeks. Primary outcomes were changes in FEV1 and FVC, with secondary outcomes including 6MWD, SGRQ scores, and mMRC dyspnea scale.

Results: Of 132 study completers (erdosteine n=67, NAC n=65), the erdosteine group showed greater improvements in FEV1 (0.28 ± 0.11 L vs 0.19 ± 0.09 L, p=0.008) and FVC (0.32 ± 0.14 L vs 0.24 ± 0.12 L, p=0.015). Exercise capacity improved more with erdosteine (Δ6MWD: 42.6 ± 18.4 vs 31.2 ± 16.8 meters, p=0.024), as did quality of life (ΔSGRQ:-8.4 ± 3.2 vs-6.1 ± 2.9, p=0.018). Both treatments showed similar safety profiles and adherence rates.

Conclusion: Erdosteine demonstrated superior efficacy in improving pulmonary function, exercise capacity, and quality of life compared to NAC. These findings support erdosteine as a preferred option for patients requiring mucolytic therapy, especially when enhanced pulmonary function and exercise capacity are primary treatment goals.

Keywords: Erdosteine, exercise capacity, mucolytic therapy, N-acetylcysteine, pulmonary function, quality of life

Abstract No. 287: Mycoplasma pneumoniae in Focus: Phenotypic Predictors in a Real-World Cohort

M. Eswar Narayan , Raja Dhar, Amrita Bhattacharya, Arup Halder, Shyam Krishnan

C K Birla Group, Kolkata, West Bengal, India

Background: Mycoplasma pneumoniae is a common cause of atypical pneumonia, often presents with varied respiratory and extrapulmonary manifestations, posing diagnostic challenges. This study aims to phenotype patients presenting to the hospital with respiratory symptoms to predict Mycoplasma pneumoniae infection based on clinical features, prior illnesses, and laboratory and radiological findings.

Methods: Eight cases (all inpatients) of Mycoplasma pneumoniae confirmed via PCR testing were analysed. Patients, aged 6–46 years, included adults (37.5%) and children (62.5%), all of whom were fully immunized and belonged to a single demographic area. Clinical history, physical findings, and radiological and laboratory data were reviewed.

Results: All patients presented with fever and cough (100%), while dyspnoea (37.5%), diarrhoea (25%), ear pain (12.5%), and sore throat (12.5%) were also observed. Desaturation was noted in 25% patients. Prior illnesses included atopy (50%), bronchial asthma (25%), hypertrophied adenoids (12.5%), tuberculosis (12.5%), and tonsillitis (12.5%). Radiological findings included bilateral lung involvement (37.5%), minimal bilateral pleural effusion (12.5%), and unilateral pleural effusion (25%), which was exudative in nature. Targeted management with macrolides (azithromycin) and Broad-spectrum intravenous antibiotics resulted in clinical and radiological improvement in all cases.

Discussion and Conclusion: The clinical and radiological features of Mycoplasma pneumoniae often overlap with other forms of pneumonia. Awareness of this condition and empirical coverage with appropriate antibiotics in regions with high prevalence are crucial for effective management.

Keywords: Antibiotic management, atypical pneumonia, Mycoplasma pneumonia, PCR, phenotypic predictors, pleural effusion

Abstract No. 288: A Rare Cause of Scoliosis (Jharco-Levin Syndrome) Presenting in Adulthood with Respiratory Failure: A Case Report

Aravindan Karthikeyan

JLN Main Hospital, Bhilai, Chhattisgarh, India

Introduction: Jharco-Levin Syndrome is an exceptionally rare genetic disorder characterized by congenital skeletal anomalies, distinct craniofacial features, and developmental delays. Adult presentation with severe scoliosis leading to respiratory failure is extremely uncommon, posing diagnostic and management challenges.

Case: We report a case of a 37-year-old male who presented with progressive breathlessness and generalized weakness for one month. On examination patient had generalized oedema, scoliosis towards left side with ABG analysis suggestive of type 2 respiratory failure. Radiological imaging confirmed the presence of scoliosis of thoracic spine with spondylo-thoracic dysostosis suggestive of the diagnosis Jharco-Levin Syndrome. Patient was managed conservatively with non-invasive ventilation. Patient’s general condition improved clinically and hence discharged with the advice of domiciliary CPAP therapy.

Conclusion: This rare case of Jharco-Levin Syndrome presenting in adulthood with scoliosis and respiratory failure highlights the importance of clinical vigilance and integrated care to manage complex presentations effectively.

Keywords: Jharco-Levin syndrome, multidisciplinary management, rare genetic disorder, respiratory failure, scoliosis

Abstract No. 289: From tuberculosis to tumors: The diagnostic challenge of cardiac tamponade

Aditi Singh

Old NRH IGGMC, Nagpur, Maharashtra, India

Introduction: Cardiac tamponade as the initial manifestation of malignancy, whether primary or metastatic, is uncommon. In developing countries, tuberculosis is the leading cause of pericardial effusion, often mimicking other causes, including malignancy. This case highlights a patient initially misdiagnosed with tubercular pericardial effusion, only to be later diagnosed with disseminated malignancy.

Case: A 57-year-old female with a history of cardiac tamponade secondary to clinically diagnosed tubercular pericardial effusion, on antitubercular therapy, presented with exertional dyspnea, chest pain, and abdominal pain for 15 days. Chest radiography showed left-sided gross pleural effusion, and pleural fluid analysis indicated an exudative pattern with low ADA and negative cytology. Pleural fluid GeneXpert was negative for MTB complex. Pericardial fluid ADA was mildly elevated (46.5 IU/L), but PCR for MTB was negative. CECT revealed bilateral pleural effusion, intraabdominal lymphadenopathy, omental nodularity, and minimal ascites. Histopathology from an omental biopsy showed metastatic poorly differentiated epithelial malignancy. PET CT showed hypermetabolic lesions in the left lung, pericardium, and peritoneum, with widespread metastatic nodal involvement.

Conclusion: Consider alternative diagnoses when ADA levels are borderline. A multimodal diagnostic approach is essential. Cardiac tamponade, though rare, can be the initial presentation of undiagnosed malignancy.

This case emphasizes the importance of considering malignancy in the differential diagnosis of pericardial effusion, especially when tuberculosis is suspected but diagnostic markers are not definitive. A comprehensive diagnostic approach, including imaging and biopsy, is crucial for accurate identification. Cardiac tamponade, though uncommon, can be the first manifestation of an undiagnosed malignancy, underscoring the need for vigilance in such cases.

Abstract No. 290: Milky lungs, clear solutions: Whole lung lavage for silica-induced pulmonary alveolar proteinosis

Chakshu Chhabra

Mahatma Gandhi Medical College, Jaipur, Rajasthan, India

Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease characterized by abnormal surfactant accumulation in alveolar spaces, leading to hypoxemic respiratory failure. Secondary PAP, commonly caused by chronic silica exposure, presents unique diagnostic and therapeutic challenges. We report a case of a 40-year-old stone grinder with progressive dyspnea and cough. High-resolution computed tomography revealed bilateral ground-glass opacities with a crazy-paving pattern, and bronchoalveolar lavage fluid analysis showed PAS-positive macrophages, confirming silica-induced PAP.

The patient underwent bilateral whole lung lavage (WLL) under general anesthesia with one-lung ventilation. The procedure significantly improved oxygenation, with follow-up imaging showing resolution of opacities. This case highlights WLL as an effective treatment for secondary PAP and underscores the importance of early diagnosis and multidisciplinary management to improve outcomes.

Keywords: Bronchoalveolar lavage, crazy-paving pattern, diffuse lung disease, pulmonary alveolar proteinosis, respiratory failure, silica exposure, whole lung lavage

Abstract No. 291: A clinical study on cases of bronchiectasis with special reference to etiology, bronchiectasis severity index and faced score

Debajyoti Ghosh , Somenath Kundu

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Introduction: Bronchiectasis is a common but often inadequately treated chronic lung disease, frequently associated with recurrent exacerbation causing functional impairment and poor quality of life. This study was done to describe etiology, severity, management of bronchiectasis in patients attending tertiary care hospital.

Methods: This is a cross-sectional observational study done in 85 adult patients with non-cystic fibrosis bronchiectasis diagnosed under Respiratory Medicine department of IPGME&R from July2023 to December 2024. Details of each patient like clinical features, exacerbation history, investigations, treatment received, FACED and BSI Score for assessing prognosis and SGRQ for assessing quality of life were collected and analyzed.

Result: Out of 85 patients 43 were male (50.6%) and 42 were female (49.4%). Mean age of patients was 43.84±14.3 (SD). 27 patients had mMRC grade II (31.8%) and 37 patients (43.5%) had mMRC-III dyspnea. 41 patients had hemoptysis (48.2%), 15 had frequent exacerbations (17.7%). Post-tuberculosis, Post-infective and Idiopathic were the three common etiologies with 29 (34.1%), 16 (18.8%), 15 (17.6%) patients respectively. Radiologically 37 (40.6%) had ≥3lobes involvement and 43 (50.6%) had cystic dilatation. Frequent exacerbation phenotype were significantly associated with mMRC dyspnea grading (chi-square 17.45, p0.001), ≥3 lobes involvement (13.79, p<0.001), colonization with P. aeruginosa (8.19, p0.004) and BSI Score (r 0.385, p<0.001). Poor QoL assessed by SGRQ were significantly associated with mMRC grade (r 0.543, p<0.001), history of hospitalization (0.222, p0.04), ≥3 lobes involved (0.256. p 0.018), cystic dilatation pattern (0.214, p0.05), FEV1% (0.449, p<0.001), FACED Score (0.449, p<0.001), BSI Score (0.416, p<0.001).

Conclusion: Our study shows that the etiology of bronchiectasis is multifactorial and the outcome can be predicted by multiple clinico-radiological characteristics.

Bronchiectasis is a heterogenous disorder which needs further studies to improve quality of care for the patients.

Keywords: Bronchiectsis, BSI, Exacerbation, FACED

Abstract No. 292: Retrospective study to determine prevalence of airflow obstruction in asymptomatic patients through spirometery records in tertiary care hospital of Mumbai

Richa Mittal

Department of Pulmonary Medicine, KEM Hospital, Mumbai, Maharashtra, India

Background: Chronic Obstructive Pulmonary Disease (COPD) and asymptomatic airflow obstruction (AFO) are significant public health concerns, often underdiagnosed in individuals without symptoms. This study aimed to assess the prevalence of latent airflow obstruction using spirometry in asymptomatic patients at a tertiary care hospital in Mumbai.

Methods: This retrospective study analyzed spirometry records from 100 patients who underwent Pulmonary Function Test for Pre Anaesthetic Risk assessment and presented with no respiratory complaints. The study was conducted by taking the spirometery records of three years (2021–2024), from the pulmonary medicine department, the study evaluated pulmonary function and categorized abnormalities into obstructive, restrictive, and mixed patterns. Chi-square tests were applied to assess associations with factors like allergy status, smoking, age, and BMI.

Results: Abnormal spirometry patterns were identified in 46% of the asymptomatic patients, indicating a considerable prevalence of underlying pulmonary dysfunction. Obstructive patterns were the most frequent, accounting for 31% of cases, followed by restrictive patterns at 12%, and mixed patterns at 3%. Small airway obstruction with good reversibility, potentially indicative of asthma, was observed in 10 patients. Among the 24 patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD), the majority were in the mild (47.62%) or moderate (38.10%) stages, while severe and very severe stages were less common (14.28%). Restrictive patterns were predominantly mild (80%). Significant associations were noted between airway obstruction severity and allergy status (p=0.04) and smoking (p=0.04), while no significant correlations were observed with gender, age, or BMI.

Conclusions: A substantial prevalence of latent airway obstruction in asymptomatic individuals underscores the utility of spirometry as a screening tool. The findings highlight the need for targeted interventions, particularly in high-risk groups such as smokers and individuals with allergies. Smoking cessation programs and early diagnostic efforts can improve patient outcomes and potentially mitigate disease progression.

Keywords: Allergy status, asymptomatic airflow obstruction, chronic obstructive pulmonary disease, pulmonary function tests, restrictive patterns, small airway obstruction, smoking cessation, spirometry

Abstract No. 293: Unveiling Langerhans cell histiocytosis: A rare and complex disease

Linta Sajan

Aster Medcity, Kochi, Kerala, India

Introduction: Langerhans cell histiocytosis (LCH) is characterised by proliferation of Langerhans cells. Lung involvement is called as Pulmonary LCH. Clinical features are dry cough, dyspnea, chest pain and systemic features such as fatigue, weight loss, fever. Some patients are asymptomatic or come for evaluation after incidental finding on chest imaging and spontaneous pneumothorax. It occurs exclusively in smokers.

Case Description: A 54 years old male who is a known case of diabetes mellitus presented with history of fever since 6 months. Evening rise of temperature present with night sweats. No history of loss of weight, apetite, contact with tuberculosis. He gives history of smoking of 30 pack years. He has taken multiple courses of antibiotics. Due to persistent fever he came to our centre for further evaluation. Chest Radiograph PA view showed multiple nodules in bilateral lung. A Computed tomography of Thorax showed multiple nodules of varying sizes, some showing cavitation in bilateral lung with mediastinal lymphadenopathy and emphysematous changes. He was evaluated with Sputum CBNAAT and diagnostic flexible bronchoscopy. All test results were negative. Patient underwent whole body Positron emission tomography scan which revealed metabolically active nodules in lung. He underwent VATS lung biopsy. Histopathological examination showed features of eosinophilic granuloma. Immunohistochemistry showed CD1a, S100 + langerhan cells. He was started on oral corticosteroids. On follow up repeat CT Thorax showed decrease in number of nodules.

Conclusion: Presence of CD1a, S100 + on immunohistochemistry is gold standard for diagnosis.

Pulmonary LCH should be kept in mind as a diagnosis of exclusion in patient presenting with bilateral lung nodules and cavities.

Abstract No. 294: Hemorrhagic pleural effusion in young reproductive females-thoracic endometriosis syndrome

K. V. Kavin

Christian Medical College, Vellore, Tamil Nadu, India

Introduction: Endometriosis is characterized by presence of endometrial-like glands and stroma outside uterine cavity. Endometriosis affects approximately 6%–10% of reproductive aged women. Endometriosis involving lung parenchyma, diaphragm and pleura produces range of clinical and radiological manifestations, collectively known as thoracic endometriosis syndrome (TES).

Case: 24year old married nulliparous women presented with complaints of cough, breathlessness for the past 1 year with history of recurrent right sided pleural effusion and ICD insertion with empirical ATT initiation elsewhere and no improvement. Her chest-X-ray showed right massive pleural effusion with contralateral mediastinal shift. Pleural fluid analysis showed exudative lymphocytic effusion. Medical thoracoscopy and pleural biopsy histopathology showed foci of cell aggregates positive for ER and CD10 with evidence of haemorrhage, suggestive of endometriosis. VATS decortication with pleurodesis was done in view of non-expansion of lung with histopathology suggestive of similar picture as above. Leuprolide for hormonal suppression was initiated.

36 year old married nulliparous women with history of recurrent right haemorrhagic pleural effusion and empirically ATT twice 8 years ago and bilateral hydropneumothorax 2 years ago, now presented with breathlessness, chest pain and cough for 4 days. CT thorax showed bilateral hydropneumothorax. Left ICD insertion and pleurodesis was done. CT abdomen showed cystic lesion in left ovary with features of pelvic and extra pelvic endometriosis. Hormonal therapy was initiated in concurrence with gynecology.

Conclusion: Women of reproductive age with complaints of chest pain, dyspnea, cough around the time of menstrual cycle should be evaluated for TES. A timely diagnosis may reduce the likelihood of disease progression.

Microembolization through pelvic veins and peritoneal-pleural migration of endometrial tissue through diaphragmatic defects are the most likely explanations for pathogenesis of thoracic endometriosis. Fertility preservation utilizing hormonal therapy is currently the standard of care and VATS surgery if medical management fails or is contraindicated. Postoperative hormonal suppression may further reduce recurrence of TES.

Abstract No. 295: An unusual cause of pulmonary hypertension-pulmonary tumour thrombotic microangiopathy

K. V. Kavin

Christian Medical College, Vellore, Tamil Nadu, India

Introduction: Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease process in which pulmonary hypertension (PH) develops in setting of malignancy. It is a disease process in which tumorcells embolize to the pulmonary vasculature with formation of fibrin clots and fibrocellular proliferation of intimal layer of blood vessels. Elevated pulmonary artery pressures are observed and death results from right heart failure. Patient outcomes remain poor with rapid decline in clinical condition often occurring within weeks. It is predominantly seen in gastric adenocarcinoma followed by breast and lung.

Case: 55/F, case of Invasive ductal carcinoma left breast with multiple bone metastasis underwent surgery followed by chemoradiation. PET CT done 2 years later showed disease progression with multiple bone metastasis. Presented with complaints of breathlessness. ABG showed hypoxemic Respiratory failure. CTPA showed features of PH with RV strain. ECHO showed moderate PH. RHC suggestive of Pre-capillary PH. Pulmonary capillary wedge blood samples for cytospin study were inconclusive. She was treated for OAD exacerbation as she had wheeze and therapeutic anticoagulation. She was initiated on Riociguat. Despite above treatment, her hypoxemia worsened. All other possible differentials were ruled out, she was suspected to have PTTM and was started on Imatinib. Despite the above treatment, patient succumbed to her illness.

Conclusion: In carcinoma patients presenting with respiratory symptoms and unexplained PH, clinical suspicion of PTTM should be considered. Early diagnosis of PTTM can prolong the survival of those patients.

PTTM is a rapidly progressive pulmonary disease with extremely poor prognosis. PTTM is a difficult diagnosis to establish and most cases are diagnosed post-mortem. High index of clinical suspicion, especially among patients with history of carcinoma is essential for antemortem diagnosis and treatment of PTTM. Early diagnosis may prolong the survival of PTTM patients.

Abstract No. 296: Beyond the typical: Parathyroid adenoma masquerading as chylothorax

Alekhya Dasari , M. Dhanamurthy Koppu, Basa Dhanusha

Mamata Medical College, Khammam, Telegana, India

Introduction: Chylothorax is a rare diagnosis which is characterized by the accumulation of lymphatic fluid in the pleural cavity, presenting with a multitude of diagnostic and therapeutic challenges. Our patient’s condition is further complicated by the presence of parathyroid adenoma which profoundly affects calcium homeostasis and contributes to a range of systemic issues.

Case Description: A 33year old male presented with complaints of dyspnea, cough, chest pain, pain abdomen since 2 months. Aggravated since past 3 days. O/E :vitals were stable except RR 27/min. G/E :chest movements decreased on right side, trachea deviated to left, percussion dull note on right side. O/E : breath sounds were absent on right side.

Chest X ray and USG Chest: Right moderate pleural effusion. Pleural fluid is milky white, protein-6 g/dl, sugar-120 mg/dl, lymphocytic, with triglycerides-1320 mg/dl; cholesterol : 111 mg/dl. Diagnosed as chylothorax & patient was managed with chest tube insertion. CT thorax: expansile lytic lesion involving left 6th rib on the anterolateral portion, multiple lytic lesions involving sternum. CT abdomen revealed ill defined iso dense lesions in liver. PET-CT: no FDG uptake; but a left inferior parathyroid adenoma was noted. Serum PTH and calcium levels were elevated. 99m-TC Parathyroid scintigraphy confirmed left inferior parathyroid adenoma. MR Lymphangiography revealed dilated thoracic duct throughout its course with stenosis at venous drainage site (level of T2), possibly due to compression by the parathyroid adenoma. Patient underwent left inferior parathyroidectomy and histopathology confirmed it as parathyroid adenoma.

Conclusion: As chylothorax is an uncommon cause of pleural effusion with broad differentials and significant mortality and morbidity, early recognition of underlying rare causes and multidisciplinary approach is essential for management.

This case highlights the importance of considering parathyroid adenoma in the differential diagnosis of chylothorax, particularly in patients with elevated calcium and PTH levels.

Abstract No. 297: Case report of coexistence of Churg–Strauss syndrome and Loeffler’s syndrome in a patient

Singirikonda Raghanandini , M. Dhanamurthy Koppu, Dhanusha Basa

Mamta General Hospital, Khammam, Telangana, India

Background: Churg–strauss syndrome is a systemic disorder characterized by asthma, transient pulmonary infiltrates, hyper eosinophilia and small vessel vasculitis. Loefflers syndrome is characterized by migrating lung infiltrates and by eosinophilia. Diagnosis is based on the radiographic picture and eosinophilia.

Methods/Case Study: 40yr old male patient presented to the OPD with the complaints of cough with sputum, SOB, fever since 3 months, pain abdomen since 1 month, headache since 15 days. H/o similar complaints in the past. H/o wheeze since 10 yrs but didn’t use any medication. On G/E skin lesions were seen over the back. Tenderness over maxillary sinus present. Chest x ray PA view s/o bilateral pulmonary infiltrates. CBP showed increased WBC count with eosinophilic predominance of 64%, AEC 15000, IgE were 1012 IU. Stool for ova and cyst showed large number of Strongyloides larvae, Giardia lambia larvae. Skin biopsy showed eosinophilic predominant small vessel vasculitis with granulomas. P-ANCA is elevated. Patient responded well with ivermectin and corticosteroids.

Conclusion: It is very rare to see two diseases churgstrauss syndrome and loeffler’s syndrome in the same patient

Abstract No. 298: Various etiologies diagnosed for cases of non resolving pneumonia: A retrospective study

Neha Rane

N. K. P Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Introduction: Non-resolving pneumonia refers to presumed community-acquired pneumonia (CAP) that slowly/incompletely resolve despite antibiotics. In these cases, in-depth workup including CT scan and bronchoscopy maybe warranted to aid in correct diagnosis and direct treatment accordingly.

Methods: It is a retrospective study done in department of respiratory medicine of tertiary care hospital. We reported 5 cases with right lower zone non resolving pneumonia. Patients were further evaluated with CT-thorax and flexible bronchoscopy to diagnose underlying cause.

Results: In case of non resolving pneumonia, diagnosing underlying etiology is the most important before treating the patient. Of the 5 patients diagnosed with non resolving pneumonia, 2 had vegetative foreign body impaction, 1 had endobronchial growth in right lower lobe bronchus, 1 had repeated right lower zone pneumonia and was diagnosed with tracheo-esophageal fistula in a treated case of CA larynx and 1 had newly diagnosed uncontrollable DM with worsening of pneumonia even after sensitive antibiotics treatment.

Conclusion: Timely diagnosis and treatment of non resolving pneumonia is crucial. In depth history taking and advanced diagnostic modalities helps in diagnosing and treating these cases.

Keywords: Bronchoscopy, nonresolving pneumonia

Abstract No. 299: Cross sectional study on prevalance of anemia in COPD

Prasanna Tatineni

Srinivasa Medical College Hospital, Surathkal, Mukka, Mangalore, Karnataka, India

Introduction: COPD is the third leading cause of death worldwide. Anaemia has been discovered to be a co-morbidity in copd patients, with prevelence varying from 7.5% to 33% contributing to increased number of exacerbations, hospital admissions and poor quality of life.

Methods: Type of study and source of data: A prospective, observational, cross-sectional study was conducted at a single, tertiary care hospital. Data was collected from all the patients from opd, and ipd with diagnosis of copd according to the inclusion and exclusion criteria.

Results: Total of 50 cases were included. 32 were males and 18 were female. Prevalence of anemia in the current study is 66% [ Figures 1 and 2 ]. Mean age group was 67.44. A total of 9 cases showed microcytic hypochromic, 18 normocytic normochromic and 4 cases had polycythemia [ Figure 3 ].

Conclusion: The study showed that the prevalence of anemia is high (66%) among copd patients in our tertiary care center. most common smear picture was normocytic normochomic anemia.

Keywords: Chronic obstructive pulmonary disease, anemia, normocytic normochromc anemia

Abstract No. 300: Atypical presentation of mesothelioma in a patient without asbestos exposure: A case report

Prachi Jakhar , Mahesh K. Mishra

Department of Respiratory Medicine, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India

Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive neoplasm primarily linked to asbestos exposure, with a long latency period between exposure and disease manifestation. However, cases of MPM without any known asbestos exposure have also been reported.

Case: We describe a 70-year-old male, a teacher by profession and a lifetime smoker, who presented with right-sided chest pain, shortness of breath, generalized weakness, and weight loss over two months. The patient had a history of pulmonary tuberculosis and a family history of carcinoma of the buccal mucosa. Clinical examination revealed decreased chest movement and diminished breath sounds on the right side. Imaging studies, including chest X-ray, CT, and PET-CT, indicated pleural effusion and pleural thickening.

The patient underwent medical thoracoscopy, which revealed multiple gray-white nodules on the pleura. Biopsies confirmed the diagnosis of MPM. Despite the absence of asbestos exposure, other potential risk factors such as genetic predisposition or exposure to other carcinogens were considered.

Conclusion: This case underscores the importance of considering MPM in patients presenting with pleural effusion and pleural thickening, even in the absence of known asbestos exposure. Early diagnosis through thoracoscopy and biopsy can significantly improve management and potentially enhance survival rates in MPM patients.

Keywords: Asbestos exposure, early diagnosis, malignant pleural mesothelioma, pleural effusion, thoracoscopy

Abstract No. 301: Platelet and red cell indices: A potential biomarker for predicting pulmonary hypertension in COPD patients

S. Kishore Kanna

Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic progressive condition marked by inflammation and airflow limitation. Platelets and red cells plays an important role in pathogenesis of COPD and pulmonary hypertension by mediating thrombotic, inflammatory, and immune processes in the lungs. Blood indices like platelet-to-lymphocyte ratio (PLR), platelet distribution width (PDW), Plateletocrit (PCT), Red cell Distribution Width (RDW), Mean platelet volume (MPV) and platelet count (PLT) have emerged as potential biomarkers for predicting severity of pulmonary hypertension (PH). This study compares these indices and clinical profiles between COPD and Non-COPD patients.

Methods: This cross-sectional study included 100 participants, categorized into COPD (n=75) and Non-COPD (n=25) groups. Laboratory parameters like platelet and red cell indices, and pulmonary function parameters like FEV1, FVC, DLCO were analysed. PH severity (MILD, MODERATE, SEVERE) was assessed by 2D-echo and statistical significance was determined using t-tests, chi-square tests, and one-way ANOVA.

Results: COPD patients had lower lymphocyte counts (1352.6 ± 483.9 vs. 2253.4 ± 867.6), higher PLR (253.8 ± 86.6 vs. 126.5 ± 79.4), elevated RDW (15.4 ± 0.9 vs. 11.8 ± 1.4), lower PDW (10.2 ± 1.6 vs. 11.2 ± 1.6), and higher PLT (318720.0 ± 99905.2 vs. 261500.0 ± 112661.7) when compared to Non-COPD patients. PLR (p = 0.040), RDW (p = 0.021), DLCO (p = 0.025) increased with severity of PH, while PDW, MPV, PCT, and PLT did not predict PH.

Discussion: PLR, RDW, PDW, PLT were able to differentiate between COPD and Non-COPD patients and PLR, RDW predicted the severity of PH. Hemogram is a useful investigation in a low-resource setting in COPD patients.

Conclusion: Blood markers particularly RDW, PLR are effective in predicting the severity of PH in COPD patients and can be used in early suspicion and diagnosis of pulmonary hypertension in COPD patients.

Keywords: COPD, pulmonary hypertension

Abstract No. 302: A case report of left-sided mucinous adenocarcinoma presenting as organizing pneumonia and left-sided pleural effusion

Darshna Solanki , Khyati Shamaliya, Bhoomika Patel, Parul vadgama

Department of Respiratory Medicine, Government Medical College, Surat, Gujarat, India

Introduction: Mucinous adenocarcinoma of the lung is a rare subtype of lung adenocarcinoma, often presenting with non-specific symptoms and atypical radiological findings. We report a case of left-sided mucinous adenocarcinoma initially misdiagnosed as organizing pneumonia, accompanied by pleural effusion, underscoring the importance of thorough diagnostic evaluation.

Case: A 72-year-old male patient Presented with Complaints of Progressive shortness of breath, cough with scanty whitish sputum, and left-sided chest discomfort lasting 3 months.

On physical examination:

Reduced breath sounds on the left side Dullness to percussion over the left hemithorax

Initial investigations:

Laboratory studies: Elevated inflammatory markers (CRP, ESR) Rest all investigation were within normal limits Radiological findings: Chest X-ray PA view suggestive of Homogeneous opacification of the left lower lung zone, blunting of the costophrenic angle. USG Thorax suggest of moderate pleural effusion on left side. CECT Thorax was done suggestive of Consolidation in the left lower lobe with air bronchograms and left-sided pleural effusion. Findings suggested organizing pneumonia. Pleural fluid analysis: Exudative effusion with high protein and LDH levels. Cytology: Negative for malignant cells. Diagnosis and course: The patient was treated empirically for organizing pneumonia with corticosteroids, resulting in partial radiological and symptomatic improvement. However, symptoms recurred after tapering steroids, prompting further evaluation. Repeat Investigations: CT-guided pleural biopsy taken Showed mucinous adenocarcinoma with lepidic growth pattern. Immunohistochemistry: Positive for CK 20 and CK7, confirming primary lung mucinous adenocarcinoma. Management and Outcome: Therapy Initiated: Chemotherapy started with carbaplatin and paclitaxel. ICD insertion done on left side followed by pleurodesis. Follow-up: Significant clinical and radiological improvement after 3 months of therapy.

Conclusion: Mucinous adenocarcinoma often mimics benign conditions like pneumonia or organizing pneumonia due to its imaging pattern of consolidation and air bronchograms. Pleural effusion may further obscure diagnosis. This case highlights the role of tissue biopsy in atypical cases of pneumonia non-responsive to standard treatment.

Clinicians should maintain a high index of suspicion for malignancy in cases of organizing pneumonia with atypical presentation or recurrent pleural effusion. Early diagnosis and targeted therapy can significantly improve patient outcomes.

Abstract No. 303: Comparative study of CAT (COPD Assessment Test) score and spirometry in stable COPD patients at tertiary care center

Mohan Srinivas Kunapareddy

Shri Vasantrao Naik Govt. Medical College, Yavatmal, Maharashtra, India

Introduction: Diagnosis of COPD is confirmed by Spirometry, which is defined as a Post – Bronchodilator Ratio of the forced expiratory volume in the First Second and the Forced Vital Capacity (FEV 1 /FVC) below 0.7. However, now widely accepted that FEV 1 measurement alone does not effectively represent the functional impairment and subsequent symptomatology experienced by individual patients. A hlistic patient assessment including multiple parameters is required for efficient COPD Phenotyping. CAT is good measurement of Health Status and symptoms burden in COPD Patients.

Methods: It is a cross sectional observational study done in a tertiary care hospital From January 2023 to November 2024, in population of COPD and healthy smoker attending present tertiary care center.

Results: Significantly, higher proportion of cases with the Higher (or) Very higher level of disease impact based on CAT score had higher prevalence of moderate/severe Airflow obstruction in COPD based on spirometry and vice versa. Increase in frequency of exacerbations showed significant rise in CAT Score and vice versa.

Conclusion: This study demonstrated a strong association between CAT Score and the severity of Airflow obstruction in stable COPD Patients. Patients with higher CAT Scores were more likely to have severe airflow limitation, suggesting that CAT is an effective tool for assessing the Impact of COPD on patient health.

Keywords: CAT score, COPD, spirometry

Abstract No. 304: Validation and stratification of non-malignant exudative pleural effusions based on rapid score and clinical outcomes

Kadiri Raviteja

Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

Introduction: Pleural effusions can result from increased fluid production or decreased reabsorption, categorized as transudates or exudates based on Light’s criteria. Common causes include tuberculosis, malignancy, and parapneumonic. The RAPID score, which factors in age, urea, purulence, infection source, and albumin, predicts mortality risk and helps guide management decisions.

Methods: This hospital-based prospective observational study, conducted over 18 months in the Pulmonary Medicine Department at NIMS, Telangana, lnvolved 83 participants. After obtaining informed consent, clinical data will be gathered, and relevant investigations are performed. Routine blood tests included urea, creatinine, liver function tests (LFT), and a hemogram. Pleural fluid undergone biochemical analysis (protein, glucose, ADA, LDH), microbiological analysis (AFB smear, GeneXpert, gram staining, fungal elements, and culture sensitivity), and pathological examination (cell count and cytopathology).

Results: A total of 83 participants, with a mean age of 46.1 years, were enrolled in the study. The majority were male (71.1%), and the most common pulmonary diagnosis was pleural effusion (60.2%). The remaining participants had empyema (24.1%) or hydro pneumothorax (15.7%). Most effusions were right-sided (54.2%), and dyspnea was the most common presenting symptom. Diabetes was the most prevalent comorbidity (26.5%). Diagnostic aspiration was performed in 82 participants, with 60% undergoing both diagnostic and therapeutic aspiration. Surgical interventions included pig-tail insertion, ICD, decortication, pneumonectomy, and thoracoscopy. The RAPID score identified 51.8% of participants as low risk, while the CURB-65 score categorized 74.7% as low risk. Mortality rates were higher in participants with moderate and severe RAPID scores. Significant variables included age and albumin, with comorbidities correlating with increased mortality.

The RAPID score, a validated prognostic tool, was used to predict 3-month mortality. In this study, 51.8% of patients were low risk, 32.5% moderate risk, and 15.7% high risk. Mortality rates were low across risk categories, but the small sample size and lack of statistical significance in the findings limit conclusions. Radiologically, most participants exhibited unilateral or bilateral pleural effusions, with consolidation and ground-glass opacities being common findings. Microbiological cultures were negative in 91.6% of cases, likely due to prior antibiotic treatment. Positive cultures included E. coli, Enterococcus faecalis, and Candida, highlighting challenges in pleural fluid isolation and diagnosis.

Conclusion: The RAPID score was not a reliable tool for stratifying non-malignant exudative pleural effusions. However, the CURB-65 score was effective in predicting mortality. The RAPID score did not show statistical significance for mortality prediction, whereas CURB-65 provided a useful measure for mortality risk in these patients.

Keywords: Age, albumin, CURB-65 score, diagnostic and therapeutic aspiration, diagnostic aspiration, exudative, hydro pneumothorax, microbiological analysis, RAPID score, thoracoscopy pleural effusion

Abstract No. 305: 2D echocardiographic assessment of pulmonary hypertension in eosinophilic COPD versus non eosinophilic COPD

Jadav Sravanthi

Nizams Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India

Introduction: Eosinophilic COPD patients exhibit greater left atrial dilation, mild left ventricular hypertrophy, and elevated mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR), predisposing them to pulmonary hypertension (PH) more than non-eosinophilic COPD patients. PH is a critical factor in mortality, surpassing pulmonary function measures like FEV1, and is linked to higher exacerbation rates and steroid responsiveness. Early detection and management of PH in eosinophilic COPD are essential to improve survival and reduce hospitalizations.

Materials and Methods: This one-year hospital-based cross-sectional study was conducted in the Department of Respiratory Medicine at NIMS, Hyderabad. Patients with COPD and PH, confirmed via 2D echocardiogram, were included after obtaining informed consent. Data collection included clinical History, blood tests (including absolute eosinophil count), and echocardiographic assessments to confirm PH.

Results: A total of 100 participants were studied: 53 with non-eosinophilic COPD and 47 with eosinophilic COPD.

Demographics:

Non-eosinophilic COPD: 47 males (88.7%), mean age 59.28 years Eosinophilic COPD: 39 males (83%), mean age 58.89 years.

Symptoms and Exacerbations:

Eosinophilic COPD showed higher exacerbation rates (80.9%) compared to non-eosinophilic COPD (62.3%) Severe exacerbations (>2/year) were significantly higher in eosinophilic COPD (63.8% vs. 32.1%, p < 0.05).

Pulmonary Hypertension Severity:

Eosinophilic COPD: Mild PH (48.9%), moderate (27.7%), severe (23.4%) Non-eosinophilic COPD: Mild PH (39.6%), moderate (32.1%), severe (28.3%).

Hemodynamics:

No significant differences in mPAP, RVSP, TAPSE, or TRV between groups.

Conclusion: Eosinophilic COPD is associated with higher exacerbation rates but not increased PH severity compared to non-eosinophilic COPD. Early screening for PH can reduce exacerbations and improve outcomes.

Keywords: COPD, eosinophilic, exacerbation, noneosinophilic, pulmonary hypertension

Abstract No. 306: Early identification of failing chest wall post-trauma

Shibani Chandiramani

MGM Kamothe, Navi Mumbai, Maharashtra, India

Introduction: The chest wall plays a crucial role in respiration, and traumatic injuries to the ribs or sternum can lead to significant structural and functional impairment. Sometimes these injuries are so severe or these injuries are beyond known injuries like flail chest. This can lead to physiological impairment of respiration-i. e full inspiration or full expiration can not occur and give way in between leading to respiratory failure and putting the patient on prolonged ventilation. Hence immediate recognition and Early identification is vital to reduce the risk of complications such as hypoxia, pneumonia, and prolonged respiratory insufficiency.

Aim: The aim of this review is to highlight the importance of early identification of failing chest wall following trauma. Specifically, it seeks to address the clinical signs, diagnostic strategies, and management approaches that can be employed to detect this condition in its early stages, thereby improving patient outcomes and minimizing the risk of life-threatening complications, hospital stay and financial burden.

Conclusion: Traumatic cheat wall fails to fulfill the biomechanical task required for harmonius respiratory function. Hence timely surgical restoration of bony chest wall using titanium implant result early (immediate) establishment of normal respiratory homeostasis. Early recognition of failing chest wall post-trauma is essential for effective management and prevention of respiratory complications leading to prolonged ventilatory support, if unrecognized these patient are difficult to extubate and develop Ventilator association complications lwading to death. Timely use of imaging techniques, such as chest X-rays and CT scans, alongside clinical examination, is crucial in diagnosing this condition. Interventions, including pain control, respiratory support, and, when necessary, surgical stabilization of the chest wall using titanium inplant are key to improving respiratory function and reducing morbidity. A proactive and multidisciplinary approach to management significantly enhances recovery and reduces mortality in trauma patients with chest wall failure.

Abstract No. 307: Early identification of chest trauma with flail chest

Shibani Chandiramani

MGM Kamothe, Navi Mumbai, Maharashtra, India

Introduction: Chest trauma is a significant cause of morbidity and mortality, particularly in cases of flail chest, a severe condition characterized by multiple rib fractures leading to paradoxical chest wall movement. Early identification and timely intervention are crucial for improving patient outcomes.

Objective: This abstract aims to discuss the importance of early identification of chest trauma, with a focus on flail chest, and to highlight the diagnostic tools and clinical assessment techniques that can aid in prompt diagnosis and management.

Results: Early clinical signs and symptoms, such as respiratory distress, chest pain, and paradoxical chest wall movement, are essential clues for suspecting flail chest. Physical examination findings, including decreased breath sounds, subcutaneous emphysema, and hypotension, further support the diagnosis. Chest radiography and computed tomography (CT) scans are valuable imaging modalities for confirming the diagnosis and assessing the extent of lung injury.

Conclusion: Early identification of chest trauma, particularly flail chest, is vital for initiating appropriate management strategies and improving patient outcomes. A high index of suspicion, combined with careful clinical assessment and timely diagnostic imaging, can facilitate prompt diagnosis and intervention.

Abstract No. 308: Role of CBNAAT and liquid culture in extrapulmonary tuberculosis

Rida Khan , Amita Nene

Bombay Hospital, Mumbai, Maharashtra, India

Introduction: Tuberculosis (TB) remains a significant health challenge in India, with extrapulmonary tuberculosis (EPTB) comprising 15–25% of cases. The paucibacillary nature of EPTB complicates diagnosis, often necessitating molecular tests and culture methods to identify drug resistance patterns.

Methods: This hospital-based prospective study evaluated the diagnostic accuracy of Gene Xpert (CBNAAT) and liquid culture (MGIT) in diagnosing EPTB and detecting rifampicin resistance. Over one year, 88 confirmed EPTB patients were studied using samples from pleural fluid, lymph nodes, ascitic fluid, cerebrospinal fluid (CSF), and spinal tissue.

Results: CBNAAT detected Mycobacterium tuberculosis in 47.72% of cases, identifying rifampicin resistance in 11 patients. Liquid culture yielded a higher positivity rate (65.9%). While liquid culture demonstrated superior sensitivity, CBNAAT provided faster results with higher specificity.

Conclusion: CBNAAT is invaluable for rapid diagnosis and rifampicin resistance detection, offering results within two hours—crucial for timely treatment. Liquid culture, with better sensitivity, complements CBNAAT. The combined use of both methods ensures accurate and efficient diagnosis of EPTB.

Abstract No. 309: Identification of the ‘dark bronchus’ sign on CT chest: A subtle but important imaging finding

Rida Khan , Amita Nene

Bombay Hospital, Mumbai, Maharashtra, India

Introduction: Pneumocystis pneumonia (PCP) is an opportunistic infection commonly seen in immunocompromised individuals, particularly those with HIV. While high-resolution CT (HRCT) scans typically show diffuse ground-glass opacities (GGO), subtle signs like the ‘dark bronchus’ sign can offer crucial diagnostic clues when other findings are ambiguous.

Case: A 35-year-old male with newly diagnosed HIV presented with worsening dyspnea and a persistent dry cough. Initial chest X-ray was unremarkable. HRCT imaging revealed diffuse GGO, with an unusual finding: air-filled bronchi appeared darker against the hyperdense GGO background, a feature known as the ‘dark bronchus’ sign. PCR testing of induced sputum confirmed the diagnosis of PCP. The patient was promptly treated with Co-trimoxazole and adjunctive corticosteroids, leading to significant clinical improvement. Follow-up HRCT showed resolution of GGO, aligning with the patient’s recovery.

Conclusions: The ‘dark bronchus’ sign, a subtle yet important HRCT finding, can assist in the early diagnosis of PCP, especially when conventional imaging features are nonspecific. Recognizing this sign can facilitate timely intervention, improving outcomes in immunocompromised patients.

The ‘dark bronchus’ sign is a valuable imaging marker for diagnosing PCP in HIV-positive patients. Its early recognition can guide clinicians in making an accurate diagnosis, leading to appropriate treatment and improved clinical outcomes.

Abstract No. 310: Comparison of rifampicin resistance on genexpert and MGIT-drug susceptible test in different bacterial load

N. P. Bhavyaja , K. A. Ameen, Amita Nene

Bombay Hospital, Mumbai, Maharashtra, India

Introduction: The global threat of MDR TB underscores the the prompt and rapid identification of resistant MTB strains. Benefits of rapid testing of Rifampicin resistance by molecular technique (Gene Xpert MTB/RIF) at the time of diagnosis include increased cure rates, decreased mortality, reduced development of drug resistance and a reduced likelihood of failure and relapse.

Methodology: Samples of those patients whose Gene Xpert showed ‘MTB detected’ were sent for AFB smear and AFB MGIT culture. During the study period a total of 140 patients were enrolled. All results were tabulated and Statistical analysis was done.

Results: Sensitivity and specificity for the detection of Rifampicin resistance in “very low” bacterial load was 100% & 87.5% respectively. PPV, NPV and Diagnostic accuracy for Rif resistance detection by GeneXpert with very low MTB in comparison to MGIT Culture DST were 50%, 100% and 88.89% respectively. Sensitivity, specificity, PPV, NPV and Accuracy for the detection of Rifampicin resistance in “low” bacterial load were 100%, 96.66%, 93.75%, 100% &97.78%. In all cases with Gene Xpert MTB detected medium & high, there was complete agreement with DST. The overall sensitivity, specificity, PPV, NPV and Diagnostic accuracy of Gene Xpert were 100%, 96.88%, 91.9%, 100% and 97.69% respectively.

Conclusion: GeneXpertMTB/RIF has significantly contributed to the early diagnosis and management of DR-TB because of its rapidity and high sensitivity. But it shows low specificity in detection of Rif resistance in ‘very low’ bacterial load.(should be confirmed with a “gold standard” culture-based DST to avoid in inappropriate treatment with toxic second-line anti-tuberculosis drugs).

Abstract No. 311: Cracking the code: A Journey through a challenging diagnosis

N. P. Bhavyaja , Amita Nene

Bombay Hospital, New Marine Lines, Mumbai, Maharashtra, India

Introduction: Igg4 disease is a multi system inflammatory disorder with non specific symptoms, making diagnosis challenging. Due to its rarity and overlapping features with other conditions IGG4 disease is often misdiagnosed or delayed. This case report highlights the diagnostic challenges and pitfalls encountered in a patient with IGG4 disease emphasizing the need for increased awareness and a multidisciplinary approach to accurately diagnose and manage this enigmatic disease

Case Description: A 42-year-old female with axillary lymph node tuberculosis on inadequate first line AKT for 4 months and empirical second line AKT since 7 months, presents with persistent cough and expectoration, worsening CT chest findings, dropping hemoglobin levels, elevated inflammatory markers, despite 2 nd line AKT. BAL reports and CT-guided biopsy of the right upper lobe lesion were inconclusive. MRI thigh s/o myositis. BAL and TBLB AFB smear negative, in both Gene Xpert MTB not detected. Histopathology-nonspecific inflammation. But looking into the description there were interstitial infiltrates of lymphocytes, plasma cells neutrophils, with fibrosis. IHC confirmed IGG4 disease and pt started on prednisolone 40mg. Pt improved, steroids slowly tapered and stopped.

Conclusion: It is an immune-mediated systemic inflammatory disorder that can affect almost every organ of the body. The classical features-tumor-like swelling of involved organs, an infiltrate of plasma cells, lymphocytes enriched in IgG4-positive plasma cells, and a variable degree of fibrosis.

The case reinforces the significance of considering IgG4-RD in the differential diagnosis when evaluating patients with unexplained inflammatory or fibrotic conditions. Timely diagnosis and appropriate treatment can prevent irreversible organ damage, improve quality of life, and reduce the risk of long-term complications.

Abstract No. 312: Efficacy of pneumonia biofire and conventional culture as gold standard for community acquired pneumonia

Shreyami Saha , Vishalsinh Chauhan, Amita Nene

Bombay Hospital, Mumbai, Maharashtra, India

Introduction: Globally, lower respiratory tract infections (LRTIs), mainly pneumonia cases, are one of the most reported fatal infections among intensive care unit (ICU) patients. Pneumonia Biofire is a multi-nested PCR test that has been undertaken to not only detect the organism but also their resistance pattern. Thus we have undertaken this study to evaluate the efficacy of pneumonia biofire with conventional culture as gold standard for community acquired pneumonia in tertiary care centre.

Materials and Methods: The study included 40 patients of severe community acquired pneumonia. The samples selected were sputum and BAL. This study investigated the diagnostic utility of the BioFire FilmArray Pneumonia Panel, an automated and multiplexed nucleic acid detection system that rapidly detects 26 pathogens (18 bacteria and eight viruses) and seven antimicrobial resistance markers in a single assay.

Results: Overall sensitivity for this study is 93% and specificity is 100% with PPV of 100% AND NPV OF 66.67 %. Accuracy is 94.59% for this study.

The results of our study signifies that Pneumonia Biofire is a rapid and reliable test for detection of the causative organism of pneumonia and thus warrants rapid and correct treatment. (discuss the implications of the results and their significance).

Conclusion: Overall, our results suggest that biofire is quite sensitive for the detection and identification of common bacterial causes of pneumonia.

Keywords: Antimicrobial resistance, pneumonia biofire, severe pneumonia

Abstract No. 313: Diagnostic accuracy of gene Xpert ultra/MTB RIF and AFB smear with TB MGIT culture as the gold standard for pulmonary and extra pulmonary tuberculosis in a tertiary care centre, Mumbai

Shreyami Saha , Iram Syed, Amita Nene

Bombay Hospital, Mumbai, Maharashtra, India

Introduction: Globally, an estimated 10.6 million people fell ill with Tuberculosis (TB) in 2023. India contributed 27% to the total cases with 26% of global multi-drug resistant (MDR) cases. Xpert® MTB/RIF Ultra is a next-generation assay which assay uses the same GeneXpert® platform as XpertMTB/RIF but with improved sensitivity. In 2017, WHO evaluated Xpert Ultra which is now recommended as initial test to diagnose pulmonary TB and to detect rifampicin resistance.

Methods: During the study period, November 2023 to October 2024,100 patient cases were evaluated. Pulmonary and extra-pulmonary specimens of 100 patients with growth of MTB complex on MGIT culture were retrospectively included with ZN-microscopy, GeneXpert-Ultra report.

Results: The sensitivity of GeneXpert-Ultra on smear positive samples, pulmonary as well as extrapulmonary was 100% and on smear negative TB is 86%, with a higher sensitivity of 95% in pulmonary TB as compared to 81% in extrapulmonary TB.

Thus our study shows that Genexpert Ultra is a next generation, rapid molecular test that highly sensitive to detect Rif resistance as well.

Conclusion: GeneXpert-Ultra holds promise as a rapid and highly sensitive test for tuberculosis case-detection and detection of rifampicin resistance.

Keywords: GeneXpert ultra, TB-MGIT, tuberculosis

Abstract No. 314: Silent threat: Levetiracetam-linked pulmonary complications in a TB patient

Shaibaz Sawant , Amita Nene

Bombay Hospital, New Marine Lines, Mumbai, Maharashtra, India

Introduction: Levetiracetam, a widely used anticonvulsant, is generally safe but can rarely cause pulmonary toxicity. This study highlights a pediatric case linking levetiracetam to lung injury, emphasizing diagnostic challenges and management strategies.

Case: Patient is a 9-year-old girl with disseminated TB (CNS, abdomen) taking antitubercular drugs (Rifampicin Isoniazod pyrazinamide ethambutol), anti-convulsant-levetiracetam, all medications as per weight. Her Hb: 11.2%; TLC: 7600; Eosinophil: 4%; RT-PCR: negative, Sputum CS: no growth; AFB smear: not seenSuspicion arose of drug induced lung injury, prompting a thorough review of all medications, including anti-tuberculosis therapy and anticonvulsants. Levetiraceta m was identified as the culprit, leading to a trial of discontinuation to observe any improvements. She improved following levetiracetam discontinuance and we diagnosed as drug induced lung injury.

Conclusion: Levetiracetam, though widely regarded as safe, can pose a risk of pulmonary toxicity, as highlighted in this case. Prompt recognition, discontinuation, and appropriate management can ensure favorable outcomes. Vigilance is essential.

Abstract No. 315: Decoding allergic bronchopulmonary aspergillosis without asthma: A case-based perspective

Divya Wankhede

IGGMC and MAYO Hospital, Nagpur, Maharashtra, India

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is an immune-mediated disorder caused by hypersensitivity to Aspergillus fumigatus, commonly seen in individuals with asthma or cystic fibrosis. It manifests as wheezing, mucus impaction, and pulmonary infiltrates. However, approximately 7% of ABPA cases occur in individuals without asthma, presenting diagnostic and therapeutic challenges. Diagnosis relies on clinical features, serological markers, and imaging findings. This report presents a case of ABPA in a non-asthmatic individual, emphasizing diagnostic complexities and treatment strategies.

Case Description: A 47-year-old male sanitary worker involved in chlorinating water wells presented with breathlessness, low-grade fever, and chronic cough with whitish expectoration for one month with a history of systemic hypertension, type 2 diabetes mellitus, and chronic alcoholism. Diagnostic investigations revealed significantly elevated total IgE (4280 IU/mL), Aspergillus-specific IgG (191 mgA/L), and IgE (0.40 kUA/L). Peripheral eosinophilia was mild at 520 cells/µL. Imaging studies demonstrated bilateral bronchiectasis, ground-glass opacities. These findings satisfied the revised ISHAM (International Society for the Human and Animal Mycology) criteria for ABPA.

Conclusion: This case underscores the importance of recognizing ABPA in non-asthmatic patients with persistent respiratory symptoms and occupational Aspergillus exposure. Early diagnosis and a multidisciplinary approach are essential to prevent complications. Greater awareness and research on atypical ABPA presentations are imperative to refine diagnostic and therapeutic strategies.

Abstract No. 316: Estimation of serum magnesium in asthmatic patients attending in OPD and IPD and it’s correlation with severity of asthma and spirometry in a tertiary care hospital West Bengal

Arvind Kumar Swarnkar

IIMSAR DR. B. C. Roy Hospital, Haldia, West Bengal, India

Introduction: Magnesium is an essential cation involved in cellular metabolism, cardiac function, and muscle contractility, with normal serum levels ranging between 1.5-2.3 mg/dl. This study examines the relationship between serum magnesium levels and asthma severity and control in adult patients.

Methods: A hospital-based cross-sectional study was conducted on asthmatic patients aged over 18 at the IIMSAR Haldia respiratory medicine department. Asthma control was assessed using a standardized questionnaire, and serum magnesium level were measured. Patients were categorized based on asthma symptom control (well-controlled, partly controlled, and uncontrolled) and severity (mild, moderate, and severe).

Results: Among 60 patients, 32 were in the wellcontrolled group, 23 partly controlled, and 5 uncontrolled. The mean serum magnesium levels were 2.1 1 + 0.15 mg/dl, 1.97 + 0.17 mg/dl, and 1.60 + 0.05 mg/dl for well-controlled, partly controlled, and uncontrolled groups, respectively. A decline in symptom control correlated with a significant drop in serum magnesium levels. Similarly, patients categorized by severity showed a progressive decline in serum magnesium level 2.09 + 0.15 mg/dl (mild), 1.81 + 0.12 mg/dl (moderate), and 1.59 + 0.06 mg/dl (severe). These findings confirm that magnesium levels decrease as asthma severity increases.

Conclusions: This study highlights the prevalence of hypomagnesemia in asthma patients and its association with disease control and severity. Findings align with previous studies by Yuvarajan, Saidoka, and Daliparty, which also reported a positive correlation between serum magnesium levels and asthma symptom control and severity.

Serum magnesium levels have a significant positive correlation with asthma control and severity. Low magnesium levels are particularly evident in uncontrolled and severe asthma, suggesting its potential role as a biomarker for monitoring and managing asthma.

Keywords: Asthma, magnesium, hypomagnesemia

Abstract No. 317: To study the various risk factors responsible for adverse outcome in patients with rifampicin resistant tuberculosis taking treatment under PMDT initiated at TB and Chest hospital, Udaipur, Rajasthan

Isha Sharma

TB and Chest Hospital, Udaipur, Rajasthan, India

Introduction: Multidrug-resistant tuberculosis (MDR-TB) occurs due to Mycobacterium tuberculosis resistant to isoniazid (H) and rifampicin (R), while rifampicin-resistant TB (RR-TB) involves resistance to rifampicin alone. Both present significant challenges to TB eradication. In 2023, 3.2% of new cases and 16% of previously treated TB cases were MDR/RR-TB, with only 44% of the estimated 400,000 cases treated. Treatment success for MDR/RR-TB remains low at 68%, though it has improved from 50% in 2012. Poor outcomes are linked to lengthy treatments, adverse drug reactions, and risk factors such as extensive lesions, HIV, diabetes, and delayed sputum conversion.

Methods: A prospective observational study was conducted at a tertiary care hospital in Southern Rajasthan. MDR-TB patients diagnosed, referred, or under follow-up were included. Data on demographics, clinical history, comorbidities, and radiological findings were collected. Sputum samples were tested for drug susceptibility. Patients were categorized into good outcomes (cure or treatment completed) and adverse outcomes. Treatment adherence was ensured through visits and telephonic follow-ups. Statistical analysis was conducted using SPSS software, with Pearson’s Chi-square and Fisher’s exact tests applied.

Results: Adverse outcomes were more common in males (30.48%) than females (15.24%). Other risk factors included age >45 years (23.80%), rural residence (21.90%), BMI <18.5 (30.47%), prior treatment for DSTB, high mycobacterial load, prolonged illness (>12 months), far-advanced or bilateral disease, and delayed treatment initiation.

Conclusions: The study highlights significant predictors of poor outcomes in MDR-TB treatment. Addressing these factors can optimize treatment regimens and improve adherence.

Targeted management of predictors and improved adherence strategies are essential to enhance MDR-TB treatment success.

Keywords: Adverse outcomes, MDR-TB, PMDT guidelines, predictors, Rajasthan, RR-TB, treatment outcomes, tuberculosis

Abstract No. 318: Aspergillus granuloma of the lung: A diagnostic challenge in immunocompetent hosts

Isha Sharma

TB and Chest Hospital, Udaipur, Rajasthan, India

Introduction: Aspergillus species are opportunistic fungi usually associated with infections in immunocompromised individuals. However, Aspergillus granuloma in immunocompetent hosts is rare, posing significant diagnostic challenges due to its non-specific clinical, radiological, and histopathological features. Early diagnosis is crucial to prevent treatment delays.

Case: A 66-year-old male, previously healthy, presented with a 2-month history of cough with minimal whitish expectoration, low-grade fever, exertional dyspnoea (Grade 1), and generalized weakness. He had a 10 pack-year smoking history, no prior tuberculosis (TB), and a family history of TB. Chest X-ray showed left-sided pleural effusion, leading to a suspicion of TB. However, pleural fluid analysis (ADA 28.9 U/L, protein 4.9 g/dL, sugar 95 mg/dL, lymphocyte predominance, CBNAAT negative) was inconclusive. Given his smoking history, contrast-enhanced CT revealed multiple peripheral lung nodules with central calcifications and adjacent consolidation, suggesting chronic granulomatous lesions of fungal origin. Bronchoscopy showed blackish patches in the left bronchi, and bronchoalveolar lavage (BAL) revealed septate hyphae. Fungal culture showed growth of Aspergillus Fumigatus. The patient had significant exposure to damp, fungal-infected walls at home. Aspergillus granuloma was diagnosed, and itraconazole 200 mg BD was initiated for four months. Follow-up showed marked clinical and radiological improvement, including resolution of pleural effusion.

This case highlights the diagnostic complexity of pulmonary Aspergillus granuloma in immunocompetent hosts, often mimicking tuberculosis or malignancy. A high index of suspicion, along with histopathological and microbiological confirmation, is essential to avoid misdiagnosis and complications.

Pulmonary Aspergillus granuloma should be considered in the differential diagnosis of lung lesions in immunocompetent individuals. Prompt diagnosis and antifungal therapy ensure favorable outcomes.

Key Takeaway: Broad differential diagnosis and appropriate diagnostic tools are crucial in accurately diagnosing pulmonary aspergillosis in immunocompetent patients

Abstract No. 319: Wrist joint tuberculosis – A case report

Ishani Bansal

TB Hospital, Patiala, Punjab, India

Introduction: Tuberculosis (TB), caused by Mycobacterium tuberculosis, predominantly manifests as pulmonary TB. Extrapulmonary TB often spreads hematogenously, affecting multiple systems. The skeletal system is the third most commonly involved site after pulmonary TB and lymphadenopathy, accounting for 10–35% of extrapulmonary cases. The spine is most frequently affected, followed by large joints like the hip and knee. Joint TB has an insidious course and is rarely diagnosed before arthritis develops.

Case Description: A 50-year-old male presented with a two-month history of intermittent low-grade fever (100°F) relieved by antipyretics, followed by swelling and persistent pain in the left wrist for 7–8 months. He self-medicated with analgesics. There was no history of trauma, weight loss, appetite loss, or tuberculosis in the patient or family. Examination revealed left wrist swelling, erythema, tenderness, and a discharging sinus with watery secretions. General physical examination was unremarkable.

Investigations showed a normal CBC with PBF, negative Mantoux test and normal chest x-ray. Wrist X-ray was inconclusive, while MRI revealed diffuse erosion, subluxation, synovial effusion, and thickening, suggestive of inflammatory/infective etiology. Biopsy results confirmed TB (ZN staining: AFB+, CBNAAT: MTB detected, Rifampicin-sensitive, necrotizing granulomatous synovitis). Anti-tubercular therapy (ATT) was initiated, resulting in significant improvement.

Joint TB begins as synovitis, progressing to bony erosion and joint destruction. Its nonspecific presentation mimics other pathologies, such as septic arthritis or bone tumors, often delaying diagnosis. MRI facilitates early detection, while microbiological and histopathological studies confirm TB.

Conclusion: Tuberculosis of the wrist joint is rare and frequently misdiagnosed. Early diagnosis and timely initiation of ATT are essential to prevent joint damage and reduce morbidity.

Abstract No. 320: A case of cystic bronchiectasis with familial short stature and IGF deficiency with renal cyst in a 59-year-old male: Multisystem involvement and diagnostic challenges

Sneha E. Gopal

Topiwala National Medical College, Mumbai, Maharashtra, India

Introduction: Cyst with a bronchiectasis may be present with a variety of non pulmonary manifestations. We present a case with systemic manifestations.

History: A 59-year-old male driver presented with chronic respiratory symptoms, including dyspnea on exertion (grade 2-3) and copious mucoid expectoration for the past 3-4 years. The patient reported recurrent exacerbations with multiple hospitalizations, suggesting a progressive course. His medical history included Diabetes Mellitus, and he was non-smoker. Strikingly, the patient also exhibited disproportionate short stature, noted since childhood, with similar findings in his elder sister and youngest daughter, hinting at a potential familial pattern.

Clinical examination

Disproportionate short stature (Fig 3)

Vitally stable grade 2 clubbing + and Respiratory system-B/L crepitations+

Investigations

Radiological Findings:

CT Thorax and CXR revealed classical features of cystic bronchiectasis (Fig 1, Fig2) explaining the chronic pulmonary symptoms.

Allergic Bronchopulmonary Aspergillosis (ABPA) Workup:

Elevated serum total IgE: 536 IU/mL

Aspergillus-specific IgE: Negative, ruling out ABPA despite high IgE levels.

USG Abdomen: Revealed a simple renal cyst in the left kidney, adding a renal component to the systemic involvement.

Endocrine Evaluation: Showed decreased Insulin-like Growth Factor 1 (IGF-1) with a normal sex hormone panel. The patient’s upper segment to lower segment ratio was 0.8), confirming disproportionate short stature.

The patient was managed with optimal supportive care for cystic bronchiectasis, including bronchodilators, mucolytics, and aggressive chest physiotherapy.

Referral to an endocrinologist was made for further evaluation and management of the growth hormone-related deficiency.

The renal cyst was monitored as an incidental finding without immediate intervention.

Differential Diagnosis of Cystic Lung Diseases:

Cystic Bronchiectasis (confirmed by radiology and clinical history)

Cystic Fibrosis (unlikely due to age and absence of gastrointestinal involvement)

Pulmonary Langerhans Cell Histiocytosis (less likely given no smoking history)

Lymphangioleiomyomatosis (LAM)

Short Stature:

Growth hormone deficiency (suggested by low IGF-1)

Familial short stature (supported by family history)

Skeletal dysplasia (unlikely, normal skeletal survey)

Final Outcome and Summary: This case presents a rare presentation of cystic bronchiectasis with a background of familial short stature and a renal cyst. The patient’s pulmonary symptoms were controlled with standard treatment, while his short stature raised the possibility of an underlying growth hormone deficiency, further supported by decreased IGF-1 levels. A multidisciplinary approach involving pulmonologists, endocrinologists, and radiologists was essential to provide holistic care.

Key Learning Points:

1. Systemic evaluation in pulmonary disease: Cystic bronchiectasis in the presence of familial short stature and renal cyst highlights the importance of looking beyond the lungs in cases with unusual systemic features

2. Multidisciplinary approach: Collaborative care across specialties is crucial for managing complex cases that span multiple systems

3. Chronic pulmonary management: Early recognition and intervention are vital in preventing progressive lung damage and improving patient outcomes.

Abstract No. 321: Unusual side effect of a common drug

Sanket Gadam , Avya Bansal, Amita Nene

Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially life-threatening hypersensitivity reaction to certain medications. This condition involves widespread skin rashes, fever, and systemic organ involvement, often triggered by anticonvulsants or anti-tubercular drugs.

Methods: We present a case of a 26-year-old female with pulmonary tuberculosis on first-line anti-TB therapy (HRZE) who developed generalized tonic-clonic seizures and subsequent complications, including high-grade fever, eosinophilia, and a maculopapular rash. Diagnostic evaluations included blood tests, cultures, imaging, CSF analysis, and a skin biopsy.

Results: The patient was diagnosed with disseminated TB and treated accordingly. However, despite discontinuing anti-TB therapy due to suspected drug-induced hepatitis, her symptoms persisted. A dermatology consultation and skin biopsy confirmed the diagnosis of DRESS, with inj. levetiracetam identified as the causative agent. Stopping levetiracetam led to rapid clinical improvement, including resolution of rashes, normalization of eosinophil counts, and subsidence of fever spikes.

Conclusion: This case highlights the importance of considering DRESS in patients presenting with systemic symptoms, rash, and eosinophilia, particularly when associated with anticonvulsant therapy. Early recognition and prompt discontinuation of the offending drug are critical for favorable outcomes.

Abstract No. 322: Tuberculous sacroilitis: Earlier the diagnosis better the prognosis

Anant Verma

RNT Medical College, Udaipur, Rajasthan, India

Introduction: Bone and joint tuberculosis accounts for 10%–11% of all extrapulmonary tuberculosis (EPTB) cases, representing about 1%-3% of all tuberculosis cases. The sacroiliac joint is affected in 2%-5% of cases with osteoarticular tuberculosis. The delay in diagnosis, averaging 17 months from the onset of symptoms to a confirmed diagnosis of skeletal tuberculosis, is primarily due to a lack of suspicion and limited clinical experience.

Case Study: A 20 years old boy, was referred from a private orthopaedician for evaluation and opinion on a right hip swelling which he was suspecting to be tubercular. Detailed history revealed patient had right hi pain since 2 years. With time he developed swelling on lateral aspect of right hip and constitutional symptoms of tuberculosis which ultimately lead to diagnosis.

Discussion: The diagnosis of sacroiliac joint infection is often delayed. Pain over the affected joint is the main symptom. In the early stages, the plain radiographs are normal. The CT and MRI are of great value in detecting early joint erosions, cavitation and abscess. Definitive diagnosis is obtained by fine needle aspiration or open biopsy. AFB staining, CBNAAT, culture in solid and liquid media and chronic granulomatous lesions on histopathology confirms the diagnosis.

Conclusion: The delay in diagnosis can be prevented by having a high degree of suspicion of tuberculosis in developing country like ours for non-resolving joint. Definitive investigations and timely diagnosis can save patient from major surgeries and permanent disability.

Abstract No. 323: Comparative in-vitro performance evaluation of vilanterol/fluticasone furoate (25/100 mcg) delivered via multidose discrete dry powder inhaler and unit dose dry powder inhaler

Eshita Sharma

Cipla Ltd

Introduction: Appropriate combination of drug and device is essential for determining the choice of inhaler for each patient. Vilanterol/Fluticasone-Furoate, a once-daily ICS/LABA, is currently available as unit-dose-DPI. Recently, the combination has been developed to be delivered via the Ciphaler® (multidose-discrete-DPI). Comparison of performance of the two devices is therefore warranted.

Aim: To evaluate the in-vitro performance of Voltido (Vilanterol/Fluticasone-Furoate)-Ciphaler® (Cipla-Ltd.) with Voltido-Rotacaps using Revolizer® (Cipla-Ltd).

Methods: The performance of the two devices was compared using random samples for fine particle dose (FPD), mass median aerodynamic diameter (MMAD) and geometric standard deviation (GSD). The values were measured using Next Generation Impactor (Copley-Scientific) at 76 L/min for Ciphaler® and 42 L/min for Revolizer® (flow rate at which 4 kPA pressure drop is seen). The mean of three readings taken for each parameter was calculated. The batch-to-batch consistency was also ascertained for three batches.

Results: FPD, MMAD and GSD for fluticasone furoate and vilanterol delivered with Voltido-Ciphaler and Voltido-Rotacaps® with Revolizer® were comparable.

The dose delivered with Voltido Ciphaler® was found to be consistent in all 3 batches at 76 LPM [ Table 1 ].

Discussion: As per the findings, drug delivered by both the devices were comparable, which implies that switching the patients from unit dose to multidose DPI would not affect the delivered dose. This in vitro study helps in establishing the similarity between drug delivery with Revolizer ® and Ciphaler ® and the dose consistency of newly developed Voltido Ciphaler®.

Conclusion: The FPD, MMAD and GSD of vilanterol and fluticasone delivered by both the devices were comparable at specified flow rates, suggesting similar drug delivery into the lungs under ideal conditions using correct inhaler technique.

Keywords: Drug deposition, fluticasone, Multidose DPI, vilanterol

Abstract No. 324: Beyond the ordinary: A rare case of diffuse panbronchiolitis in India

Salil Bendre , Kumar Doshi, Kavita Mehta, Anjali Kamath

Department of Pulmonary Medicine, Nanavati Max Superspeciality Hospital, Mumbai, Maharashtra, India

Introduction: Diffuse Panbronchiolitis (DPB), predominantly documented in Japan, is a rare idiopathic inflammatory condition characterized by increasing suppurative and obstructive airway illness, which, if neglected, results in bronchiectasis, respiratory failure, and mortality. [1] This disease entity has very rarely been reported from India. [2]

Case Report: A 32-year-old male with a history of childhood asthma and sinusitis presented with complaints of cough and expectoration for one week, low-grade fever, and progressively worsening breathlessness for 3 days. Examination revealed a saturation of 90% on room air, tachypnoea, and bilateral rhonchi, consistent with airway obstruction. Outpatient treatment with oseltamivir, antihistamines, and nebulised bronchodilators showed no symptomatic relief. He was given intravenous and inhaled corticosteroids, cephalosporin and macrolide antibiotics and inhaled bronchodilators. His flu panel was negative and sputum culture showed no growth. Counts were 5350 with normal differential counts. High-resolution Computed Tomography (HRCT) of the chest showed diffuse bronchial wall thickening, multiple linear branching centrilobular nodules, and patchy ground-glass opacities (GGOs), raising suspicion of diffuse pan-bronchiolitis. IV steroids and macrolides were continued, and within a week, the patient showed significant clinical response. A repeat imaging revealed significant resolution of the centrilobular nodules and ground glassing. Bronchoscopic biopsy was contemplated but deferred due to significant clinical improvement. The patient was discharged on tapering doses of oral steroids. Regular follow-up was advised to monitor symptoms and prevent recurrence.

Conclusion: This case study underscores the importance of considering DPB in the differential diagnosis for worsening airway obstruction, particularly among individuals with a history of asthma and sinusitis. Timely diagnosis and swift intervention with steroids and macrolides produced considerable clinical and radiological improvement, demonstrating the efficacy of this treatment approach. This case contributes to the limited reports of DPB in India, improving understanding of its manifestation and management in diverse populations.

Abstract No. 325: Lung malignancy: Myraids of presentation

Anjali Gangadharan

Bangalore Medical College and Research Centre, Bengaluru, Karnataka, India

Introduction: A chylothorax, also known as chylous pleural effusion, is characterized by the accumulation of bacteriostatic chyle in the pleural space.

Case Report: A 61year old male presented with complaints of breathlessness, cough since one week with unquantifiable weight loss. Examination revealed grade 2 clubbing, with palpable left supraclavicular lymph nodes and reduced intensity breath sounds on right side. Routine blood investigations were unremarkable. Chest radiograph confirmed the diagnosis of right pleural effusion. Diagnostic thoracocentesis yielded thick cream-colored pleural fluid, analysis revealed low ADA, exudative, lymphocyte predominant. Ultrasound soft tissue neck showed left cervical and supraclavicular necrotic lymphadenopathy, FNAC abandoned due to close proximity to the vasculature. Patient then underwent thoracoscopy, which suggested pus in the right pleural cavity -? Chylothorax, biochemical analysis confirmed the presence of chyle. Pleural biopsy suggested acute on chronic inflammation. CECT revealed right lobar consolidation, multiple randomly distributed nodules with nodular interlobular septal thickening in bilateral lung parenchyma, mediastinal lymphadenopathy. FOB+BAL+TBLB+TBNA suggested congested and oedematous mucosa of the right bronchus intermedius with irregularity noted, suggestive of -? Neoplastic aetiology. BAL analysis showed 100% lymphocytes, negative for malignancy, CBNAAT was negative. TBNA Smears studied were positive for malignancy, favoring metastatic carcinoma. PET CT performed suggested hypermetabolic focus in the collapsed lower lobe of right lung suspicious for primary neoplasm with metastasis to mediastinal and bilateral supraclavicular lymph nodes; hypermetabolic lung and skeletal metastasis. Histopathological examination from transbronchial lung biopsy was reported as features favoring adenocarcinoma.

Conclusions: It is imperative to note that pleural effusion, especially in elderly individuals, must be dealt with utmost care, bearing in mind the possibility of an underlying malignancy.

The presence of chylothorax necessitates further evaluation to determine the cause. Management of a chylothorax requires a multidisciplinary approach employing medical therapy and possibly surgical intervention.

Abstract No. 326: EPTB masquarding as lung malignancy

B. Neharika , Ch. R. N. Bushana Rao

Department of Pulmonary Medicine, GHCCD, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Introduction: TB can mimic lung Malignancy and can be misdiagnosed as such & vice versa. EPTB remains a difficult diagnosis to make , due to its often nonspecific & protean manifestation.

Case: A 68 yrs old female who is a house wife , nonsmoker , h/ o biomass fuel exposure came with % cough with expectoration , haemoptysis, SOB since 7 days.

H/o bleeding PR, LOA + , LOW+.

O/e: supraclavicular lymphnode present on rt. Side . Fnac showed caseating granulomatous inflammation & started on ATT.

Min . Fluid present ,sent for analysis After 2days SOB was progressed from gr:3- 4. Usg showed Anechoic area. So fluid is aspirated. Symptoms were received After 1day similar complaints with facial edema was seen .Fluid aspirated & sent for malignant cytology Report s/o +ve for malignant cells - Adeno carcinoma. So Fluid sent for IHC markers.

Conclusions:

Clinical & radiological manifestations of tb are heterogenous & include a variety of benign & malignant diseases. So, diagnostic dilemmas can delay appropriate treatment Upto 1/3rd of eptb cases can have atypical appearance.

Clinicians need to be aware of protean manifestations of tb & Malignancy& maintain high index of suspicion for simultaneous or misleading presentation. Further research is required to determine if tb infection may facilitate carcinogenesis.

Abstract No. 327: Tuberculosis in a rare entity

Basava S J , Shraddha Acharya, Deepak Kumar

Department of Respiratory Medicine, Post Graduate Kempegowda Institute of Medical Sciences and Research Institute, Bengaluru, Karnataka, India

Background: Abdominal situs inversus is a rare condition associated with abdominal organs reversal from their typical anatomical positions.Situs inversus when associated with bronchiectasis and chronic sinusitis is classified under a condition known as Kartagener’s syndrome, also known as Primary ciliary dyskinesia.We hereby present you a rare case of this entity in a tertiary health care setup in India.

Case Study: A 46 year old female, P2L2, presented with Persistent cough along with hemoptysis for a duration of 2 months. HRCT thorax showed cystic bronchiectatic changes in left upper lobe associated with abdominal situs inversus.She underwent Bronchoscopy with BAL, CBNAAT reports of which came positive for Drug sensitive Tuberculosis.PNS X-ray showed features suggestive of Pan-sinusitus.Genetic testing and ciliary function testing could not be done due to financial constraints.She was started on Antitubercular therapy, with bronchodialtors , mucolytics and pulmonary rehabilitation exercises,diagnosed as a case of Kartagener’s syndrome with Pulmonary Tuberculosis.

Conclusion: Kartagener’s syndrome though is a rare entity that should be suspected in patient’s with chronic respiratory tract infections. In Indian scenario, such patients are susceptible to infections like Tuberculosis, hence should always be evaluated in detail.Early diagnosis in this syndrome will not only aid in starting early management of patient but also will improve the quality of life.

Abstract No. 328: The role of expiratory flow limitation by oscillation technique in COPD severity assessment

Basava S J , Shraddha Acharya, Deepak Kumar

Department of Respiratory Medicine, Post Graduate Kempegowda Institute of Medical Sciences and Research Institute, Bengaluru, Karnataka, India

Background: COPD is now the top three leading causes of death across the world and 90% of these deaths occur in low and middle income nations.While Expiratory flow limitation occurs when an increase in transpulmonary pressure causes no increases in respiratory expiratory flow .It is common in patients of COPD and is a major determinant of dynamic hyperinflation and exercise limitation This study aims to evaluate the role of EFL in assessing the severity of COPD and compare the performance with spirometry.

Methods: It is a cross sectional study performed on a group of stable COPD patients.Forced oscillation technique and spirometry were performed on a group of 60 patients and EFL index was calculated by differences between inspiratory and expiratory phases of Xrs at 5Hz(ΔX5),respiratory system resistance(Rrs), X5(reactance 5Hz), AX, FEV1, FVC, FEV1/FVC, FEF (25-75).Grading of COPD patients was done based on spirometry according to GOLD 2024.Lastly, the EFL index was correlated with the spirometry values in COPD patients.

Results: On the basis of median value of ΔX5,60 stable COPD patients were classified into low EFL index and high EFL index group.A correlation was derived between the spirometry severity values with that of EFL index.ΔX5 correlate negatively with FEV1 , FVC , FEF 25-75, R5, R5-R20 and positively with AX.

Discussion: While spirometry requires forced expiration technique , FOT can be done based on Tidal volume breathing.It is a more sensitive technique in detecting early or mild airway obstruction, especially in peripheral airways.

Conclusion: EFL index is a valuable tool to assess severity in COPD patients , identify the patients at risk and can aid in treatment.

Keywords: Chronic obstructive pulmonary disease, expiratory flow limitation index, forced oscillation technique, spirometry

Abstract No. 329: Evaluvation of prevalence and predisposing factors for bronchiectasis in COPD patients – A cross sectional study

Aditya V. Patil , G. S. Gaude, Bhagyashri Patil, Jyothi Hattiholi, S. Gautam, Kiran Kumar Pujar, Guruprasad Antin, K. Ningappa

Department of Respiratory Medicine, Jawaharlal Nehru Medical College, KAHER, Belagavi, Karnataka, India

Introduction: Bronchiectasis, characterized by irreversible airway dilation and chronic respiratory symptoms, is increasingly diagnosed as a comorbidity in Chronic Obstructive Pulmonary Disease (COPD). Despite global recognition and guidelines like GOLD 2023 emphasizing its impact on COPD progression, data specific to the Indian context remain sparse. The coexistence of these conditions has significant implications, including higher morbidity and reduced quality of life, necessitating targeted research to identify prevalence and risk factors.

Aim: This study aims to evaluate the prevalence of bronchiectasis in COPD patients and analyse the associated predisposing factors.

Methods: This cross-sectional study included 135 COPD patients diagnosed per GOLD 2023 criteria. Systematic sampling was employed, and detailed clinical histories were obtained, including exacerbation frequency, prior tuberculosis treatment, and sputum analysis. Bronchiectasis was confirmed through HRCT thorax based on established radiological criteria. Risk factors such as age, gender, BMI, pulmonary function, and Pseudomonas aeruginosa colonization were assessed. Quality of life was measured using the Bronchiectasis Health Questionnaire. Statistical analysis utilized chi-square tests and multivariate logistic regression, with p < 0.05 deemed significant.

Results: Preliminary data revealed a prevalence of 24.1% bronchiectasis among COPD patients. Factors such as advanced age, male gender, and repeated exacerbations emerged as significant risks. The coexistence of these conditions correlated with worse respiratory function and diminished quality of life, emphasizing the need for early diagnosis and intervention.

Conclusion: The study highlights the considerable burden of bronchiectasis in COPD patients in the Indian population. Routine screening and targeted management strategies are essential to improve outcomes and reduce exacerbations in affected individuals.

Abstract No. 330: Unraveling a complex case: Successful management of disseminated mycobacterium abscessus in an immunocompetent adolescent

Aditya V. Patil , Ningappa Karlingannavar, G. S. Gaude, Bhagyashri Patil, Jyothi Hattiholi, S. Gautam, Kiran Kumar Pujar, Guruprasad Antin

Department of Respiratory Medicine, Jawaharlal Nehru Medical College, KAHER, Belagavi, Karnataka, India

Background: Mycobacterium abscessus is a rapidly growing non-tuberculous mycobacterium that is commonly found in the environment. It can lead to severe infections in both immunocompromised and immunocompetent individuals. This case highlights the challenges in diagnosing and managing disseminated M. abscessus infections in an otherwise healthy adolescent.

Case Study: A 17-year-old female presented with cough, breathlessness, fever, generalized weakness, loss of appetite, and weight loss over the past month. Initial investigations were inconclusive, but non-tuberculous mycobacteria (NTM) cultures eventually revealed M. abscessus. The patient was initially treated with anti-tubercular therapy (ATT) but developed hepatitis, necessitating a change in treatment. After discontinuation of ATT, she was started on a regimen including levofloxacin, amikacin, and azithromycin. Despite this, the patient developed a left-sided pneumothorax and continued to show clinical deterioration.

Sputum culture revealed Streptococcus agalactiae and M. abscessus. The M. abscessus strain was resistant to macrolides and sensitive to aminoglycosides. Consequently, treatment was adjusted to include tigecycline, amikacin, clofazimine, and linezolid, leading to significant clinical improvement.

Conclusion: This case underscores the importance of accurate diagnosis and tailored antibiotic therapy in managing M. abscessus infections, highlighting the need for vigilance in cases where conventional treatments fail.

Abstract No. 331: Unusual presentation of hydatid cystic lung disease

Aditya Kumar Tiwari

Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India

Introduction: It is rare presentation of H. cystic lung disease. It is caused by E granulosus larval migration from alimentary canal via penetrating wall of GIT by embryo or larvae & reached to Liver>Lung >Brain where they from cystic consolidation/mass.

Ingestion of contaminated water/food with E. granulosus (Tapeworm) egg handling of animal MC pet Dog Contact with infected soil.

Aspergilloma: Occurs due to colonization of aspergillus fumigatus in airway & fibro Cavitary lung & form ball like mass lesion. mc site - upper & mid zone of lung. Lung Consolidation: Caused by bacteria, viral , fungal, infection. Lung Mass: Homogenous opacity in lung? Malignancy.

Case Presentation: A31 Year old female pt. who was known case of pulmonary TB, & taken ATT 6 month back. then she has got developed hemoptysis & referred from rewa medical college two SEPM ,NSCB Medical college jabalpur for further management. then she was admitted in 3rd july 2023.Pt. was investigated as a routine lab report, chest x ray, CECT chest. in view of CXR - it was presumptively diagnosed as right upper zone consolidation,? lung mass under investigation. CECT chest report revealed that right upper to mid zone Aspergilloma? lung mass. Adv. Biopsy & HPE evaluation & correlation. Pt. was started on itraconazole + steroid & planed for bronchoscopy TBNA/ Biopsy TBNA report revealed hydatide cystic lung mass. Further pt. was investigated for serum total IgE and specific IgE for E granulosus and turned out to be positive. pt was referred to CTVS department for further management (thoracotomy & resection of H. cyst).

Note: Contact history was traced & found that pt. has got to pet dog in her home.

Conclusions: We reported a rare presentation- of 31 Year old female pt. with. Unusual/a typical presentation of hydatid cystic lung disease which was masquerading aspergilloma,? Lung mass? consolidation. This case report is prepared with Aim to increase awareness about H. cistic as Lung Disease which was mimic as another diagnostic and entity and present as a atypical/unusual presentation. Only radiological imaging cannot provide definite diagnosis, Biopsy - HPE, serum/blood marker also to be done and taken into consider to be made final definitive diagnosis.

Abstract No. 332: When rare meets rarer: Kartagener’s syndrome and systemic sclerosis with pulmonary hypertension

Ahamed Naveed , Jackin Moses, Arun Prasath, Antonious Maria Selvam, Sebin John Thaman

Department of Pulmonary Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India

Background: Kartagener’s syndrome is a rare genetic disorder characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. Systemic sclerosis is a chronic autoimmune disease that can cause fibrosis of various internal organs. The coexistence of these two conditions is extremely rare, making the case particularly interesting.

Case Study: A 26-year-old male presented with breathlessness and cough for 2 weeks. The patient had a history of infertility. On examination, the patient had an oxygen saturation of 60% on 3L O2. Auscultation revealed bilateral wheeze and inspiratory crepitation. ABG showed type I respiratory failure. CT showed dextrocardia, situs inversus with multiple cystic, traction, and varicoid bronchiectasis. 2D Echo showed severe pulmonary hypertension (TRPG-90). Autoimmune tests revealed positive ANA with a speckled pattern; ENA was significantly positive for SS-A/La and Ku antibodies.

Conclusion: This rare case highlights the complexities of managing patients with Kartagener’s syndrome and systemic sclerosis with pulmonary hypertension. Our experience emphasizes the need for early diagnosis, aggressive treatment, and close monitoring to improve patient outcomes.

Abstract No. 333: Obstruction of distal end of endotracheal tube secondary to a blood clot in a patient of bronchial asthma: A case report

Ajay Lanjewar , Pravin Satkar, Shrinidhi Datar

Department of Medicine, Mahatma Gandhi Mission Institute of Health Sciences, Sevagram, Maharashtra, India

Background: Blood clots, mucus, food particles and foreign bodies can obstruct the endotracheal tube for a mechanically ventilated patient. Immediate consequences of such an event are hypoxia, poor ventilation and if severe and sustained, hemodynamic collapse. Blood clots are seen to obstruct airways in cases of tuberculosis, cavitary respiratory lesions, mitral stenosis, trauma and malignancy ( 1 ) It is essential to diagnose and manage this condition as it can be life-threatening.

Case Description: We discuss a case of a middle-aged man who had a case of bronchial Bronchial Asthma. The patient was on bronchodilator medications. He came with a history of acute onset breathing difficulty and dry cough. On examination, he had tachypnoea, tachycardia, hypoxia and bilateral wheeze on chest auscultation. All signs and symptoms were supportive of the diagnosis of acute respiratory failure. His symptoms did not respond to Non-Invasive ventilation. Therefore, he was intubated and mechanical ventilation was initiated. We started him on intravenous methylprednisolone, salbutamol and ipratropium bromide nebulisation which resolved his bronchospasm. He was being planned for weaning off the mechanical ventilation. Pressure Support ventilation was initiated, he had spontaneous breaths and he generated good tidal volume. We observed during the hospital stay when he was defecating using a bedpan, he had episodes of respiratory distress. Chest auscultation during these episodes showed decreased respiratory sounds. Similar episodes were repeated. One day, he got self-extubated. We observed that the distal end of the endotracheal tube had a blood clot. The blood clot was surrounded by a narrow space sufficient enough to allow a suction catheter. On retrospection, the resident doctor recollected that during suctioning the Endotracheal secretions were stained with blood. In this particular case, it was difficult to predict complete Endotracheal Tube obstruction. Even in the presence of a blood clot, the suction catheter could go beyond the distal end of the ET Tube. It was also noted later that between the episodes of sudden spasm after defecation plateau pressure on the ventilator were elevated. This cause of elevation of plateau pressure on the ventilator was because of straining while defecating and positive intra-abdominal pressure.

Abstract No. 334: Pulmonary tuberculosis and lung cancer: Tackling a vital diagnostic puzzle in youth

Akshay Dalmia

RNT Medical College, Udaipur, Rajasthan, India

Background: Individuals with lung cancer are frequently mistaken for having pulmonary tuberculosis, resulting in delays in accurate diagnosis and exposure to unsuitable treatments. This issue in developing countries can be attributed to various factors, such as limited awareness, insufficient healthcare infrastructure, and socio-economic challenges.

Case Study: Here is a case of 28 year old male presented with the complaint of shortness of breath, cough with expectoration, low grade fever, decreased appetite from 2 months. Symptoms worsened despite taking Antitubercular for clinically diagnosed PTB from 2 months. A CT scan of the patient revealed a mass in the left upper lobe of the lung, which was subsequently diagnosed as squamous cell carcinoma following lung and axillary LN FNAC.

Discussion: In developing countries like India, the primary challenge in distinguishing lung cancer from pulmonary tuberculosis stems from patients’ unawareness when consulting general practitioners. This is compounded by the similar symptomatology, misinterpretation of chest radiograph results and the initiation of anti-tubercular treatment for suspicious opacities without thorough evaluation through appropriate diagnostic methods such as CT scans, sputum cytology, and bronchoscopy. Additionally, the high costs and limited availability of these diagnostic procedures may further hinder their timely use.

Conclusion: We conclude that in a patient with clinically diagnosed TB who is Efforts are required to reduce this lag period by sustaining a heightened awareness, conducting thorough and suitable investigations, and ensuring timely diagnosis and initiation of lung cancer treatment.

Abstract No. 335: Pulmonary actinomycosis: The great imitator in thoracic medicine

Akshay Dalmia

RNT Medical College, Udaipur, Rajasthan, India

Introduction: Actinomycosis is a rare, chronic bacterial infection caused by Actinomyces species, gram-positive bacilli found in the normal human flora. Pulmonary actinomycosis, accounting for 15-20% of cases, arises from aspiration of oropharyngeal or gastrointestinal material, often mimicking tuberculosis or malignancy.

Case: A 43-year-old male presented with a 6-month history of cough with blood-streaked sputum, low-grade fever, and weakness. He was a chronic smoker and alcohol user but had no weight loss or anorexia. Examination revealed decreased breath sounds over the left interscapular region. Chest X-ray showed left hilar opacity; CECT thorax revealed a left upper lobe consolidation with necrosis, cavitation, and lymphadenopathy. Bronchoscopy showed a yellowish necrotic endobronchial growth causing partial obstruction . BAL cell block and biopsy revealed filamentous organisms persistent with pulmonary actinomycosis. The patient was treated with intravenous piperacillin-tazobactam followed by oral amoxicillin-clavulanic acid, with marked clinical and radiological improvement.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for pulmonary actinomycosis in patients with persistent lung lesions. Accurate diagnosis and timely treatment can prevent complications and mismanagement, emphasizing the need for awareness among clinicians about this rare but treatable condition.

Abstract No. 336: Allergic bronchopulmonary aspergillosis: An interesting case

Alok Singh Chauhan , Swapnil Kulkarni, Kapil Iyer, Mahesh jansari

KEM Hospital, Pune, Maharashtra, India

ABPA is often underdiagnosed, resembling asthma. It’s caused by an immune response to A. fumigatus, typically presenting with transient opacities on CXR.

Introduction: ABPA is a chronic condition caused by hypersensitivity to A.fumigatus, affecting the airways and linked to respiratory diseases.

Case Report: A 22/y male came to us in Emd in drowsy state, with feeble pulse, BP of 110/60 mmHg, and spo2 82%. He had bronchial breath sounds, mainly over the right upper zone, detailed history could not be obtained due to pt condition. CXR showed a homogeneous opacity in the right upper zone and a cystic lesion in the right mid and lower zones with Rt lung volume loss and ipsilateral mediastinal shift [ Figure 1 ], led to a provisional diagnosis of right-sided fibrocystic collapse/consolidation. The patient was treated with nebulized bronchodilators, O2, iv steroids, and antibiotics, Over 1-2 days, his condition improved significantly, with SpO 2 > 92% on room air. HRCT s/o B/L central bronchiectasis [ Figure 3 ], mainly on the right. Repeat CXR s/o good resolution of opacity [ Figure 2 ]. S.IgE was 25,700 IU/ml, with specific IgE against A fumigatus is 0.8. Spirometry showed reduced lung function, confirming a diagnosis of ABPA with central bronchiectasis.

Conclusion: ABPA is a hypersensitivity reaction to Aspergillus fumigates and predisposing conditions are Asthma, cystic fibrosis, COPD, bronchiectasis, and requires early corticosteroid treatment.

Abstract No. 337: Significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in categorizing COPD patients in resource-limited settings

Althafurahiman Ali

Srinivas Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India

Introduction: COPD is the 4th leading cause of death around the world according to WHO, causing 3.5 million deaths around the globe only in 2021. COPD is more prevalent and associated with worse health outcomes in rural areas compared to urban areas, highlighting the disparities in awareness and access to facilities such as spirometry.

Methods: In this descriptive, cross-sectional study, we compared the GOLD grades of 61 COPD patients with their NLR and PLR ratios to find any association. We also compared the forced mid-expiratory flow value along with the NLR and PLR ratio.

Results: In this study, we found a positive correlation of the NLR and PLR ratio with the GOLD grades of COPD. This correlation is statistically significant in the case of the NLR ratio, with a p-value of 0.0019. In the case of forced mid-expiratory flow, we found a negative correlation with the NLR ratio. As the forced mid-expiratory flow decreases, the NLR ratio increases.

Conclusion: This study concludes that the NLR and PLR ratio has a positive correlation with GOLD grades, which is usually determined after PFT evaluation. Hence in those places where there is no access to the PFT, NLR and PLR ratios can be used to categorize the severity of the patient and fill the gap in the access to healthcare to an extent.

Keywords: COPD, GOLD grades, mid-expiratory flow, NLR ratio, PLR ratio

Abstract No. 338: Septic pulmonary embolism in Bahrain: Clinicoradiological features, microbiology and treatment outcomes

Amit Panjwani

King Hanad American Mission Hospital, Goverment Hospitals, A’ali, Bahrain

Introduction: Septic pulmonary embolism (SPE) is a type of non-thrombotic pulmonary embolism that is associated with a clinical challenge due to its rarity of occurrence, varied presentation and need for distinctive diagnostic and management options. It accounts for less than 3% of pulmonary embolisms. Despite its fatal potential, there is paucity of data on patients with SPE in Kingdom of Bahrain and is limited to case reports.

Aims: This study was undertaken to illustrate the clinical, microbiological, and radiological features of patients with SPE and to understand treatment outcomes in this rare cohort of patients from this island nation.

Methods: We retrospectively analyzed 14 patients of SPE encountered in academic tertiary care referral hospitals over a 5-year period.

Results: There was male preponderance with more than half of patients admitted in intensive care unit. Staphylococcus aureus was isolated in 57% of cases. Bilateral nodules in peripheral location were the most encountered radiological abnormality. Most of these nodules had feeding vessel sign (93%), and cavitation. Infectious vegetations of the right-side heart were detected in 36% of cases. All patients received parenteral antimicrobial therapy while drainage at extrapulmonary sites was done in 36% cases. The survival rate was 79%. None of the factors associated with increased mortality in previous studies impacted in-hospital mortality in the current study.

Conclusion: Staphylococcus aureus is the most common culprit in patients of SPE. Prompt initiation of appropriate antimicrobial therapy along with surgical intervention, where indicated, helps in achieving a favorable outcome after treatment of SPE.

Abstract No. 339: Co-existence of allergic bronchopulmonary aspergillosis and tropical pulmonary eosinophilia: A case series

Ananda Datta , Archana Malik

All India Institute of Medical Sciences, Deoghar, Jharkhand, India

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction in response to colonization of the airways with Aspergillus fumigatus that occurs almost exclusively in patients with asthma or cystic fibrosis. Tropical pulmonary eosinophilia (TPE) is caused by an immune hyper-responsiveness to microfilariae trapped in the lungs. Although both present as pulmonary infiltrates with peripheral eosinophilia, the management of these diseases is largely different. Simultaneous occurrence of ABPA and TPE is rarely reported in the literature. We here describe 3 cases with the co-existence of these two entities.

Results: The features of the cases and various modes of management are depcited in Table 1 .

Conclusions: Although infrequent, co-existence may be possible, especially in filarial endemic countries.

Understanding the overlap between TPE and ABPA is crucial for accurate diagnosis and management, as the treatments for these conditions are vastly different. Addressing both diseases can avoid suboptimal outcomes, such as the progression of individual diseases or unnecessary immunosuppressive therapy.

Abstract No. 340: Case report: Occult small cell carcinoma mimicking pulmonary embolism and respiratory infection: A diagnostic challenge

K. C. Anil Kumar , C. L. Nagaraja, B. L. Shashi Bhushan

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Introduction: Small cell carcinoma accounts for approximately 25% of bronchial carcinoma cases. It tends to grow more aggressively and often metastasizes earlier than other types of carcinoma. This case report details the unique presentation of the cancer which mimicked two illness complicating the diagnosis. The case first mimicked as Bronchopenumonia and later as pulmonary embolism. This case highlights the importance of diagnostic imaging for early diagnosis of small cell carcinoma.

Case: An 80-year-old male presented at emergency department with acute breathlessness, hemoptysis and chest pain of one-day duration. He had history of exertional breathlessness for 6 years and 30-year smoking history, with grade-3 clubbing. On Examination, the patient was afebrile and hypoxic maintaining saturation with 6L Oxygen, with reduced breath sounds in the left infra-scapular area and bilateral fine inspiratory crepitations in interscapular and infrascapular regions. The chest radiograph showed a wedge-shaped opacity in the left middle zone. Routine blood investigations were normal, and sputum culture grew Acinetobacter baumannii , prompting the initiation of antibiotic treatment. Persistent symptoms necessitated Contrast-enhanced CT, which initially suggested pulmonary thromboembolism involving the right pulmonary artery and segmental arteries. Further inspection revealed an occult mass in the apicoposterior segment of left upper lobe and superior segment of left lower lobe infiltrating segmental bronchi, descending aorta, left pulmonary and interlobar arteries indicative of bronchogenic carcinoma. Multiple malignant mediastinal lymph nodes and lesions in the adrenal gland suggested metastasis. Additional findings included extensive centriacinar emphysematous changes, cardiomegaly dilated main pulmonary artery, and calcified hydatid cysts in the liver. A CT-guided biopsy of the left upper lobe mass confirmed small cell carcinoma. The patient was referred to the Oncology department for further management.

Conclusion: This case underscores the challenges of diagnosing small cell carcinoma due to its atypical presentation and the potential for diagnostic pitfalls, such as misinterpretation of imaging findings as pulmonary embolism. A high index of suspicion and thorough evaluation, including diagnostic imaging and biopsy, are crucial for early detection and appropriate management of this aggressive malignancy.

Abstract No. 341: Impact of Apgar score on asthma control among patients with bronchial asthma

Aravind Ram

Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Introduction: Asthma is a chronic respiratory condition that significantly impacts both physical and psychological health, with poor medication adherence often complicating management. The Asthma APGAR tool was developed to improve asthma care by focusing on activities, persistent symptoms, triggers, asthma medications, and response to therapy. This study evaluates the impact of the APGAR tool on asthma control among patients with bronchial asthma in primary care settings.

Methods: A quantitative design was employed, involving 60 patients with bronchial asthma, aged 20–60 years, diagnosed for over one year, and on stable maintenance therapy for at least a month. Exclusion criteria included acute exacerbations, active tuberculosis, and those requiring systemic corticosteroid therapy. Data were collected using a three-section tool: demographic variables, clinical variables, and the Asthma APGAR assessment. The study was conducted with ethical approval from the institutional ethics committee of Sri Ramachandra Hospital, Chennai.

Results: Of the 60 patients, 44 (73%) had inadequate asthma control, while 16 (27%) demonstrated adequate control. Significant associations were observed between APGAR scores and family history of asthma, as well as asthma duration. Demographic findings showed that 38% of patients were aged 20–30 years, with 60% male, 55% having primary education, and 47% living in semi-urban areas. The clinical analysis revealed 42% had asthma for 2–5 years, 30% had hypertension, and 58% were non-smokers. The average score for medication adherence was 14.9 ± 3.45.

The study highlighted that 73% of patients had inadequate asthma control, emphasizing the need for improved patient education. The Asthma APGAR tool contributed to better documentation, adherence to treatment, and enhanced communication between patients and healthcare providers. The study supports the positive role of patient-centered approaches in asthma management, consistent with previous research showing the tool’s effectiveness in improving asthma outcomes. Future studies should assess the long-term impact of the APGAR tool on clinical outcomes and adherence.

Conclusion: The study confirmed the Asthma APGAR tool’s reliability in screening and managing asthma in the general population. It emphasized the importance of a collaborative care model, involving active patient participation in asthma management. Despite limitations, such as the lack of direct patient outcomes and the study’s homogenous participant pool, the APGAR tool showed promise in improving asthma care in primary care settings. It was well-received by both healthcare professionals and patients, providing a valuable addition to asthma management practices. Future research should explore its long-term effects and effectiveness in diverse populations.

Abstract No. 342: EBUS TBNA guided drainage of bronchogenic cyst

Aravind Ram

Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Introduction: Bronchogenic cysts are congenital anomalies that are often asymptomatic. Diagnosis with CT using characteristics of a round, well-circumscribed, unilocular mass. Resection of cysts includes through either thoracotomy or VATS procedure. Alternatively, TBNA of mediastinal cysts has been advocated in the management.

Case Description: A cohort of four patients compromising of two male and two female with prevailing symptoms featured shortness of breath, accompanied by a persistent cough in three cases and one patient had dysphagia as major compliant. Chest X-ray, followed by CT thorax done, revealing a right paratracheal lesion in three instances, subsequently confirmed as bronchogenic cysts. EBUS was used to unveil the cystic nature through the presence of an anechoic shadow in all and air-fluid level in one instance. EBUS guided aspiration of cystic lesion was executed in all cases yielding a straw-colored clear aspirate devoid of any positivity for bacterial culture or cytological examination. No post-aspiration complications were encountered, with successful discharge of two patients on the same day as the procedure. Bronchogenic cysts are diagnosed with chest X-rays irregularities, but CT or MRI affirm their cystic essence. EBUS, a minimally invasive tool, offering complete cyst drainage and preventing re-accumulation. In our four-patient cohort, post-EBUS complications were conspicuously absent, with two cases even discharged on day of procedure. No recurrence has been documented on follow up in any of our patient till date. EBUS shines over surgery, highlighting efficacy and speedy recovery rates.

Conclusion: EBUS has its advantages in the management of bronchogenic cyst. The appearance on ultrasound of an anechoic or hypoechoic structure without colour flow signal helps us to rule out nodal, vascular, or soft tissue structures. Cyst wall thickening, septations within the cyst, and hyperechoic shadows within the cyst may help to identify infection as well as complex cyst.

Abstract No. 343: The effect of obesity on spirometry tests among non-smoking adults

Aravind Ram

Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Introduction: Obesity is a growing global health concern with significant implications for respiratory health. Spirometry, a vital tool for assessing lung function, measures parameters such as forced expiratory volume (FEV) and forced vital capacity (FVC) to diagnose and monitor respiratory conditions. In non-smoking adults, obesity can influence spirometry results due to its impact on lung mechanics, including reduced chest wall compliance, altered respiratory muscle function, and increased airway resistance. Understanding the relationship between obesity and spirometry outcomes is crucial for accurately interpreting pulmonary function tests and tailoring appropriate clinical interventions.

Methods: This study evaluates the effect of obesity on spirometry test results among non-smoking adults. A cross-sectional design was employed, involving participants aged 18–65 years who were categorized into normal weight, overweight, and obese groups based on body mass index (BMI) as per WHO standards. Participants with a history of smoking, chronic respiratory diseases, or other medical conditions affecting pulmonary function were excluded. Pulmonary function tests were conducted using standardized spirometry equipment following ATS/ERS guidelines. Key spirometric parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ), and the FEV 1 /FVC ratio, were measured. Height, weight, and BMI were recorded for all participants. Data analysis was performed using statistical software to compare spirometric outcomes across BMI groups. The relationship between obesity and spirometric parameters was assessed using correlation and regression analyses, adjusting for age, sex, and other potential confounders. Ethical approval was obtained, and all participants provided informed consent.

Results: The study included 100 non-smoking adults, equally divided into obese (BMI >30 kg/m²) and normal-weight (BMI 18–25 kg/m²) groups. The mean FEV 1 /FVC ratio was slightly higher in obese participants (85.32 ± 6.27) compared to normal-weight individuals (83.08 ± 8.58), but this difference was not statistically significant (P = 0.139). Conversely, the mean FVC was significantly lower in obese patients (1.92 ± 0.92) than in normal-weight participants (2.43 ± 0.92) with a P value of 0.008, indicating a significant impact of obesity on FVC. Similarly, the mean FEV 1 was reduced in obese individuals (1.64 ± 0.79) compared to normal-weight subjects (2.01 ± 0.78), with a statistically significant P value of 0.018. However, no significant differences were observed in the mean MEF25-75 (P = 0.197) and PEF (P = 0.068) values between the two groups. These findings suggest that obesity significantly affects FVC and FEV 1 , while its impact on other spirometric parameters is less pronounced.

Conclusion: The study demonstrates that obesity significantly impacts specific pulmonary function parameters, particularly FVC and FEV 1 , which showed a statistically significant reduction in obese patients (P < 0.05). However, no significant changes were observed in the FEV 1 /FVC ratio, MEF25-75, or PEF. The findings indicate a diphasic relationship between BMI and spirometric values, with obesity playing a crucial role in reducing FVC and FEV 1 . These results highlight the need for targeted interventions to address respiratory health in obese individuals.

Abstract No. 344: A neglected comorbidity in pulmonary tuberculosis

K. Aswathi

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Introduction: Even though Deep Vein thrombosis has been associated with tuberculosis, the true incidence is unknown with studies reporting values between 3%-4%. The true incidence may be higher because of non specific or asymptomatic clinical presentations of deep vein thrombosis.

Case: A 28 year old male presented to casualty with c/o cough with expectoration, dyspnea and fever since 2 months. On examination, patient’s saturation at room air was 84% and RR was 26 cpm. He was febrile and BP was 100/60 mm hg and pulse rate was 120 bpm. He had right calf pain also. Sputum CBNAAT was sent and patient was diagnosed to be sputum MTB detected, rifampicin sensitive. Patient was started on ATT under NTEP.D-Dimer was raised with value 3.96 mcg/ml., B/L DVT screening was done which showed deep vein thrombosis of right popliteal vein. Patient was started on IV anticoagulation. Emergency CTPA was done and it showed no evidence of pulmonary thromboembolism. Patient became symptomatically better and was hence discharged home on ATT and oral anticoagulants.

Conclusions: This case shows that an integrated approach is required towards a pulmonary tuberculosis patient, so that diagnosis such as deep vein thrombosis is not missed. Active history taking with leading questions should be encouraged to avoid missing DVT and if found to be DVT positive, an emergency CT pulmonary angiogram is advisable to rule out pulmonary thromboembolism.

Abstract No. 345: Lungs on alert: The mucormycosis challenge

Awnish Shubham , Alina Vargheese, Tarang kulkarni, Alpa Dalal

Jupiter Hospital, Thane, Maharashtra, India

Introduction: Pulmonary mucormycosis is a rare and aggressive fungal infection affecting immunocompromised individuals and is associated with high morbidity and mortality. We present four cases of pulmonary mucormycosis in immunocompromised patients treated at our centre.

Case 1: A 66 year old male with uncontrolled diabetes and long term corticosteroids for COVID19 infection presented with cough , fever, hoarseness of voice and weight loss. CT scan chest revealed left upper lobe consolidation with central breakdown. BAL fungal stain and endobronchial biopsy revealed mucormycosis. He was successfully treated with amphotericin B and subjected to left upper lobectomy.

Case 2: A 27 year old male kidney transplant recipient on immunosuppressant presented with cough with rusty sputum ,weight loss and pleuritic chest pain. CT scan revealed peripheral round opacity in right middle and lower lobe. CT guided biopsy showed aseptate hyphae of mucormycosis. His immunosuppression is reduced and managed successfully with amphotericin B followed by posaconazole and lobectomy.

Case 3: A 63 year male with diabetic ketoacidosis was transferred on mechanical ventilation with complaints of cough, fever and hemoptysis. HRCT thorax revealed bird’s nest sign in right upper lobe. Bronchoscopy revealed black mucosal lesions and biopsy confirmed mucormycosis. Despite starting on liposomal amphotericin B, he died of septic shock.

Case 4: A 31 year old diabetic female with diabetic ketoacidosis presented with fever , abdominal pain and cough. CT imaging suggested fungal pneumonia. BAL and biopsy confirmed mucormycosis. Liposomal amphotericin B started, but her clinical condition deteriorated and she died.

Conclusion: Pulmonary mucormycosis is diagnostic and therapeutic challenge. A multidisciplinary approach combining early detection, aggressive antifungal therapy and surgical intervention are vital for reducing mortality in high risk population.

Abstract No. 346: Migratory plEural effusion: A diagnostic challange

Bharti Kumari

Army Institute of Cardio Thoracic Sciences, Pune, Maharashtra, India

Introduction: Pulmonary paragonimiasis, caused by Paragonimus species, is a food-borne parasitic lung disease often contracted through consuming raw or undercooked freshwater crab or crayfish. Due to overlapping clinical, radiological and pleural fluid features, it can be misdiagnosed as tuberculosis leading to delayed and inappropriate management.

Case Description: We report a 56-year-old male smoker with coronary artery disease (post-PTCA, September 2023) who presented in February 2024 with left-sided pleuritic chest pain. Imaging revealed left-sided pleural effusion with segmental collapse consolidation and ground-glass opacities. Diagnostic pleurocentesis showed an exudative, neutrophil-predominant effusion with low glucose and ADA (28), treated as empyema. Bronchoscopy showed no infection, but BAL revealed raised galactomannan and 12% eosinophils, prompting antifungal therapy. In August 2024, he presented with fever and right-sided pleuritic chest pain. Imaging revealed right-sided effusion with resolution of the left-sided effusion. Pleurocentesis showed an exudative, lymphocyte-predominant effusion with high ADA (105). Thoracoscopy revealed necrotizing granulomas, but infective workup was negative. He was started on ATT but remained symptomatic. Persistent eosinophilia (AEC-2600/cmm), raised IgE, and crab consumption history raised suspicion of paragonimiasis, confirmed by serology. Treated with praziquantel, his symptoms resolved, and follow-up radiographs showed complete resolution.

Conclusion: pleuropulmonary paragonimiasis represents a rare but critical differential in patients presenting with exudative effusion with high ADA with histologic picture of tuberculosis Pulmonary paragonimiasis should be considered in patients from endemic areas with tuberculosis-like symptoms and imaging findings. A positive dietary history, negative TB cultures, and lack of response to TB therapy warrant revision of the diagnosis.

Abstract No. 347: Impact of nutritional education and excercise on lung capacity and exercise tolerance in COPD patients

Bharti Kumari

Army Institute of Cardio Thoracic Sciences, Pune, Maharashtra, India

Introduction: Chronic Obstructive Pulmonary Disease (COPD) affects millions globally, severely impacting quality of life by impairing breathing, physical activity, and daily functioning. Malnutrition, affecting 25–65% of COPD patients, is a significant yet underrecognized factor influencing disease progression. Nutritional deficiencies, particularly in protein and essential micronutrients, weaken diaphragmatic and skeletal muscle function, reducing lung capacity and exercise tolerance. This study investigates the role of nutritional education as a critical component of COPD management, emphasizing its potential to alleviate symptoms, improve clinical outcomes, and enhance patients’ overall quality of life.

Methods: This prospective observational study was conducted at a tertiary care hospital, AICTS Pune, involving pre- and post-interventional assessments. Sixty COPD patients participating in a tele-rehabilitation program were included. Lung capacity and exercise tolerance were assessed using FEV1 and the 6MWT before and after intervention. Disease severity and prognosis were evaluated using the BODE (Body mass index, Obstruction, Dyspnea, Exercise capacity) and ADO (Age, Dyspnea, Obstruction) indices. A structured nutritional education program, supplemented with advice on energy intake and muscle mass building, was implemented to assess its impact on patient outcomes.

Results: The study cohort (n=60, mean age 65.87 ± 5.40, 54% male) demonstrated statically significant improvements post-intervention. BODE scores decreased from 4.36 to 2.54 (p = 4.19×10 -4 ), and ADO scores declined (p = 0.008). Spirometry revealed an increase in FEV1% from (1.05→1.68L) 51.64% to 68.57% (p = 4×10 -4 ), while 6MWT scores improved by a mean of 50.2m (p = 0.0001).

Conclusion: Nutritional education is a pivotal non-pharmacological intervention in COPD management. Incorporating nutritional counselling into routine COPD care significantly improves lung capacity, exercise tolerance, and quality of life, reduces disease burden, and potentially slows disease progression.

Carry Home Message: A well-balanced diet and targeted nutritional therapy, combined with rehabilitation and exercise, should be promoted to enhance outcomes in COPD patients.

Abstract No. 348: Dysfunctional breathing: CPET as diagnostic tool and shared lung physiology in body plethysmography

Diptendu Dey , Arup Halder, Raja Dhar, Shyam Krishnan, Beauty Biswas, Aditya Satpati, Pradip Mondal

CMRI Hospital, Kolkata, West Bengal, India

Introduction: Unexplained exertional breathlessness in young individuals often presents a diagnostic challenge. Dysfunctional breathing (DB) is characterized by abnormal breathing patterns that can occur in the absence of significant organic disease. This study aims to emphasize the role of CPET in diagnosing DB and explore the lung physiology of these patients.

Methods: Five patients (mean age: 23.2 years, gender-all females) presented with exertional shortness of breath over 6–12 weeks, associated with mostly with 3 to 4 of the following symptoms-chest discomfort, palpitations, generalized weakness, and mood instability. Clinical examination & investigations (chest X-ray, ECG, and echocardiography) were unremarkable. Subsequently, CPET was performed to evaluate unexplained breathlessness. Body box plethysmography with DLCO was conducted to assess the lung physiology of these patients.

Results: CPET findings in 5 patients revealed oscillatory breathing patterns, sufficient ventilatory reserve, elevated VE/VCO2 slope, and the absence of oxygen desaturation. Body plethysmography revealed in all 5 patients: Elevated residual volume (162%–296% predicted), Increased RV/TLC ratio (40.39%–50.21%), Reduced VA/TLC ratio (0.70–0.74).

Conclusions: Dysfunctional breathing emerges as a key contributor to unexplained exertional breathlessness, with CPET playing a pivotal role in diagnosis especially oscillatory breathing pattern is highly indicative of this condition.

Consistent lung physiology abnormalities might indicate two possible factors:

The presence of an undiagnosed obstructive airway component by Low VA/TLC ratio An unusual breathing habit maintaining high residual lung volume (162-296%).

CPET is invaluable in diagnosing DB, with oscillatory breathing patterns serving as an important feature. The physiology for DB mandates further research to diagnose Undiagnosed airway disease and High Residual lung volume is associated with DB.

Keywords: CPET, Dysfunctional breathing, exertional breathlessness, lung physiology, oscillatory breathing

Abstract No. 349: Disseminated nocardiosis in an immunocompetent host presenting as empyema necessitans

Guna Jefferson

Christian Medical College, Vellore, Tamil Nadu, India

Introduction: Nocardia, a genus of Gram-positive bacteria, typically causes opportunistic infections in immunocompromised hosts but can also affect immunocompetent individuals.

Case: This case involves a 59-year-old female presenting with left-sided chest pain, dry cough, weight loss, and fever over several months. Initial CT revealed consolidation in the left lower lobe with minimal pleural effusion; however, pleural fluid analysis was inconclusive. After empirical antibiotic treatment, her symptoms recurred, and a repeat CT showed a hypodense collection in the left posterior costophrenic recess, extending through the 10th intercostal space into the posterior chest wall, quadratus lumborum, and paraspinal muscle. Ultrasound-guided drainage was performed, revealing pus suggestive of aerobic actinomycetes. It was likely that she had nocardiosis and as Nocardia are prone to cause brain abscesses, CNS imaging was conducted even though the patient did not exhibit neurological symptoms, leading to the discovery of an abscess in the right anterior striatocapsular region. Pus culture confirmed Nocardia asiatica. The patient was started on intravenous ceftriaxone and cotrimoxazole, with a planned total therapy duration of one year. Follow-up MRI showed a reduction in abscess size, and she reported improvement after one month.

Conclusion: Pulmonary Nocardia infections have the potential to disseminate, most often to the brain. Nocardia can also spread contiguously from the lungs to adjacent structures, causing complications such as empyema, empyema necessitans, mediastinitis, pericarditis, and superior vena cava syndrome. Therefore, the differential diagnosis for this presentation, even in immunocompetent individuals, must include less common entities such as disseminated Nocardia.

Abstract No. 350: Diffuse-alveolar septal type of pulmonary amyloidosis

Guna Jefferson

Christian Medical College, Vellore, Tamil Nadu, India

Introduction: Amyloidosis can present in the lungs in three forms: nodular pulmonary amyloidosis, diffuse alveolar-septal amyloidosis, and tracheobronchial amyloidosis. Diffuse alveolar-septal involvement is a rare form of pulmonary amyloidosis.

Case: A 65-year-old male presented with cough, breathlessness (Grade II MMRC), loss of appetite, weight loss, and frothy urine for three years. His chest X-ray showed reticular opacities in the bilateral mid and lower zones. An ECG revealed a left anterior fascicular block, and spirometry indicated a restrictive pattern. HRCT thorax demonstrated diffuse reticulations, irregular interlobular septal thickening, and ground-glass opacities predominantly in the subpleural regions of both lungs. 24-hour urine protein test was high (784 mg/24 hr). 2D echo showed thickened left and right ventricular walls, a dilated left atrium, Grade II LV diastolic dysfunction, and an apical-sparing pattern on longitudinal strain, all suggesting cardiac amyloidosis. Urinary Bence-Jones protein was positive. The HRCT thorax was discussed in a multidisciplinary team meeting, leading to the conclusion that the CT features were consistent with diffuse alveolar-septal type amyloidosis. Bone marrow aspiration and biopsy revealed diffuse interstitial plasmacytosis and lambda light chain restriction. Immune fixation electrophoresis showed only lambda light chains, with elevated kappa (38.94) and lambda light chains (683.60), resulting in a kappa/lambda ratio of 0.056. He was diagnosed with lambda light chain myeloma and started on a chemotherapy regimen of cyclophosphamide, bortezomib, and dexamethasone (CyBORD). After 28 days of follow-up, he was doing well.

Conclusion: Knowledge of pulmonary amyloidosis is crucial due to the nonspecific findings in chest CT scans. This case underscores the importance of multidisciplinary team meetings in diagnosing diffuse parenchymal lung diseases.

Abstract No. 351: An usual disease presenting unusually as persistent pleural effusion

Hari Haran

Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, India

Introduction: Immunoglobulin light chain (AL) amyloidosis is an uncommon disease. Approximately 20% of multiple myeloma patients will develop AL amyloidosis. Persistent pleural effusions occur in 1 to 2% of patients with systemic amyloidosis and are usually associated with poor prognosis.

Case Description: A 57 years old male presented with breathlessness, right sided chest pain, dysphagia for 6 months. He was diagnosed with left sided lymphocytic, exudative pleural effusion with pleural fluid xpert positive so started on antitubercular therapy elsewhere. After completing 6 months of ATT presented to our hospital with persistent pleural effusion. Initial chest xray showed bilateral pleural effusion. Diagnostic thoracocentesis done which showed lymphocytic exudative effusion, xpert negative. Thoracoscopy done which showed a pleural nodule, pleural biopsy showed submesothelial proteinaceous eosinophilic deposits with apple green birefringence in Congo Red stain, so diagnosed as amyloidosis. His ECHO showed interventricular septal speckling and relative apical sparing, grade II diastolic dysfunction suggestive of cardiac amyloidosis. Regarding dysphagia, gastroscopy done showed patchy erythematous mucosa in antrum and its biopsy showed amorphous extracellular deposits (Congo red: positive). Abdominal fat pad biopsy was also suggestive of amyloidosis and immunostaining for SAA is negative. For workup for amyloidosis, did urine Bence jones protein which was positive, serum light chains showed elevated lambda chain1131 mg/l). Bone marrow biopsy showed plasmocytosis (60%). So the final diagnosis as multiple myeloma with AL systemic amyloidosis affecting pleura, gastric mucosa, heart, started on VPD protocol with Bortezomib, Pomalidomide, Dexamethasone.

Conclusions: Even in case of pleural fluid xpert positive effusion, if not responding to antitubercular therapy should keep a high suspicion of other etiology.

Abstract No. 352: Instant orthopnea but not cause of the heart!!!!

Hariharan Sivakumar

Indira Gandhi Medical College and Research Institute, Puducherry, India

Introduction: A large medisatinal mass masquerading as instant orthopnea.

Case: A 39 yr old male presented with complaints of dyspnea for 2 months, more profound on lying in supine position within a few seconds. on examination no pedal edema, no lymphadenopathy JVP not elevated and desaturation on lying down,bilateral air entry decreased right >> left. Chest xray showed a large homogenous opacity covering the entire right lung and part of left lung with silhouetting of heart borders. Only a part of left upper and part of lower zone were visible. Contrast CT Thorax showed a heterodense well defined large solid mass covering the anterior mediastinum measiring 21.5cm* 9.5 cm* 17.9 cm (TR*AP*CC) Extends fron T1 to T9. Causing pressure effects on trachea leading to luminal narrowing, encases the aortic root and ascending thoracic aorta by 180 degrees. Moderate pericardial effusiion and bilateral pleural effusion right > left. Pleural fluid analysis exudative lymphocyte prediminant effusion, with low ADA, no malignant cells. 2d echo- moderate to severe pericardial effusion, no cardiac tamponade, EF-55% USG guided gun biopsy-thymoma B3 type. Myasthenia gravis evaluation- no ocular / limb weakness, tensilon test negative, AchR Ab- negative. Final diagnosis-thymoma stage 3 (Masaoka-Koga staging).

Conclusion: Not all orthopnea are due to disorders of the heart. We have to evaluate other causes of orthopnea and manage it accordingly to prevent worsening of the patients condition.

Abstract No. 353: Nitrofurantoin induced interstitial lung disease – Importance of medical history in diagnosis

Jerry Jose

Little Flower Hospital and Research Centre, Angamaly, Kerala, India

Introduction: Establishing cause of ILD is challenging. Obtaining proper medical history is important. Here we discuss about a 74-year-old male with worsening breathlessness of 1 month and diagnosed as Nitrofurantoin induced ILD based on history and by exclusion of other causes.

Case Report: 74-year-old male, ex-smoker with worsening breathlessness and cough of 1 month. He had a history of fall 3 years back following which he had vertebral fracture, paraparesis. He was tachypnoeic, with saturation of 76% in room air. He had bilateral fine end inspiratory crepitations throughout the lung field. With NIV he was stable and was maintaining a saturation of 95 % with 60 % FiO2. His chest X ray showed bilateral reticular shadows with ill-defined cardiac and diaphragmatic borders. ECHO showed moderate pulmonary hypertension with good systolic and diastolic function. HIS HRCT chest was suggestive of Non-specific interstitial pneumonia with no evidence of active infection. He was further evaluated with RA, ANA profile, ACE and were negative. On detailed medical history he gave history of recurrent urinary tract infection for the last 3 years as he was catheterised and he used to take oral nitrofurantoin almost every month. He was diagnosed as Nitrofurantoin induced ILD after excluding other causes. He was started on intravenous methylprednisolone and by third day weaned off from NIV support and maintained 93 % with 2L/Mi. Repeat CXR showed clearance. 2 months following discharge he was clinically improved with saturation of 97 % in room air. Proper medical history will help in diagnosis of ILD.

Conclusion: Clinical and radiographic features of drug induced ILD are often difficult to distinguish from other causes of ILD. Drug induced lung injury should always be kept in mind. Appropriate medical history will help in establishing the cause in most cases of ILD.

Abstract No. 354: Prospective study to assess the correlation of pulmonary artery acceleration time in chronic obstructive pulmonary disease with respect to CAT score and pulmonary function test

Jyothi Kini

M S Ramaiah Medical College, Bengaluru, Karnataka, India

Introduction: COPD is one of the leading causes of morbidity and mortality worldwide. COPD has considerable effects on cardiac functions. Most of the increased mortality associated with COPD is due to cardiac involvement. Spirometry is the gold standard test to diagnose COPD and to determine the severity of disease. 2D echocardiogram with PAAT is used to determine mean pulmonary artery pressure and derive pulmonary hypertension, to correlate disease severity and relation with mean pulmonary artery pressure

Primary Objective: To determine correlation of CAT score with stages of pulmonary hypertension.

Secondary Objective: To determine pulmonary hypertension with measurement of pulmonary artery acceleration time and mean pulmonary artery pressure in COPD patients.

Materials and Methods: Total 33 subjects were enrolled into study from 1/05/2023 to 30/04/2024 and were subjected to mMRC scale, CAT scoring, PFT , GOLD grading, 2D echocardiogram ,PAAT and HRCT thorax.

Results: In our study 84.8% of subjects had mild pulmonary hypertension. There was no correlation of mPAP with mMRC score, CAT score and GOLD grade. There was a strong negative correlation between PAAT and mPAP which was statistically significant. Specificity of the PAAT for mPAP assessment was 100%, sensitivity was 92.86%, Accuracy was 93.94%. PPV of 100% and NPV OF 71.43%.

Discussion: GOLD grade 1 and 2 have pulmonary hypertension: 82% and 90% respectively. Patients with low CAT score can have pulmonary hypertension.

Conclusion: All patients with a diagnosis of COPD irrespective of the stage of disease should undergo PAAT and mPAP estimation, which is cheap, noninvasive, repeatable, highly sensitive, and highly specific diagnostic test. This helps in optimizing the COPD treatment with pulmonary rehabilitation and reduce morbidity and mortality from cardiac complications. To improve correlation we need larger study group and need to include subjects with normal FEV1 and HRCT finding consistent with COPD.

Keywords: CAT score, COPD, mMRC scale, PAAT

Abstract No. 355: Evaluating the real-world effectiveness and safety of formoterol fumarate and fluticasone propionate combination in asthma: A prospective, multicentre study

Kundan Nivangune

Medical Affairs, Lupin Ltd., Mumbai, Maharashtra, India

Introduction: The burden of asthma in India is significant with high mortality and poor adherence to treatment. Also, real-world data on the effectiveness and safety of fluticasone-formoterol is limited in India. This study evaluated the effectiveness and safety of Formoterol fumarate (6 µg) and Fluticasone propionate (250 µg) administered via dry powder inhaler (DPI) or metered-dose inhaler (MDI) in Indian asthma patients.

Methods: This 24-week prospective, multicentre study (CTRI/2023/08/056250) evaluated Formoflo 250 Transcaps (DPI) and Formoflo 250 Transhaler (MDI) in adults (18–65 years). The primary endpoint was the change in trough forced expiratory volume in 1 second (FEV1) at weeks 12 and 24. Secondary endpoints included changes in trough forced vital capacity (FVC), Asthma Control Test (ACT), and Asthma Quality of Life Questionnaire (AQLQ) scores. Safety was assessed through adverse events (AEs) and asthma exacerbations, with statistical analyses performed on the modified intention-to-treat (mITT) population.

Results: A total of 503 patients were enrolled, with 495 included in the mITT analysis and all 503 in the safety analysis. Trough FEV1 improved significantly from 1993.0 ± 423.6 mL at baseline to 2305.2 ± 441.3 mL at Week 24 (P<0.0001) with mean change from baseline to end of study of 310.8 ml ± 118.4 ml (300.1 to 321.4). Similarly, trough FVC increased from 2495.6 ± 531.4 mL to 2774.9 ± 533.4 mL (P<0.0001). The mean ACT score improved from 10.3 ± 2.5 at baseline to 21.9 ± 3.2 at Week 24, with 78.4% of patients achieving excellent asthma control (ACT > 20). The mean AQLQ scores also improved significantly from 3.5 ± 1.0 to 5.9 ± 1.0 (P<0.0001). AEs were reported in 7.0% of patients, primarily mild, with no serious AEs or fatalities. These findings demonstrate consistent effectiveness and safety of Formoflo DPI and MDI formulations in the real-world settings in India.

Conclusion: The Formoterol-Fluticasone combination significantly improved lung function, asthma control, and quality of life, with comparable effectiveness and safety between DPI and MDI in Indian asthma patients.

Keywords: Asthma management, dry powder inhaler (DPI), formoterol-fluticasone combination, metered-dose inhaler (MDI)

Abstract No. 356: Value of scoring scale of obstructive sleep apnoea

G. Madhavan

Department of Respiratory Medicine, SLMCH, Chennai, Tamil Nadu, India

Objective: To evaluate the performance of existing screening questionnaires and scoring scales in identifying clinically relevant obstructive sleep apnea (OSA) patients.

Methods: This observational study was conducted at Sri Lalithambigai Medical College & Hospital over six months, involving seventy-three subjects referred to the sleep clinic. Participants completed the STOP-Bang questionnaire and the Epworth Sleepiness Scale (ESS), with OSA diagnosis confirmed through polysomnography (PSG) or home sleep apnea tests (HSAT). Data analysis included correlation, logistic regression, and sensitivity/specificity assessments using SPSS 26.0.

Results: The mean age of subjects was 52.3 years, with a majority being male (61.6%). The mean BMI was 30.1 kg/m², and the mean neck circumference was 38.5 cm. ESS and STOP-Bang scores were positively correlated with AHI (r = 0.45 and r = 0.60, respectively, p < 0.001). Higher STOP-Bang scores were significantly associated with more severe OSA. Sensitivity and specificity analyses revealed that STOP-Bang (cutoff ≥5) had higher sensitivity (90%) compared to ESS (cutoff ≥11) at 85%.

Conclusion: The STOP-Bang questionnaire demonstrated superior performance in screening for OSA compared to ESS, with higher sensitivity and stronger correlation with AHI. These findings support the use of STOP-Bang as a primary screening tool in clinical settings to identify patients at high risk for OSA, facilitating timely diagnosis and management.

Abstract No. 357: A case of aspergillus pneumonia in a chronic alcoholic patient with diabetes mellitus as the only comorbidity: A case report

Mandar Shinde

Dr. Vasantrao Pawar Medical College, hospital and research centre, Nashik, Maharashtra, India

Introduction: Aspergillus is a ubiquitous fungus, isolated from construction sites, soil, and hospital dust and is present in the surroundings almost everywhere. Repeated inhalation of its spores can either trigger immune response in sensitive individuals (e.g. ABPA) and/or can have infective presentation as aspergilloma. Aspergillus infection can occur in either immunocompetent patients with underlying lung disease or in immunocompromised hosts [critically ill individuals managed at the intensive care unit (ICU); neutropenia; chronic use of corticosteroids; immunosuppressants; cancer; COPD; HIV infection; chronic renal disease; liver disease; DM and occupational exposures], with or without underlying lung disease. In this case report, a case of 45 years old male with type 2 DM who developed aspergillus pneumonia will be presented.

Case: A 45-years-old male, farmer, presented with complaints of chronic cough (dry), fever with chills (on and off), generalized weakness, reduced appetite and weight loss since 4-5 months. He is a known case of type 2 DM for past 10 years, is non-compliant on medications & a chronic alcoholic since 25 years. His routine lab investigations were done. RBS, FBS, PPBS and HbA1c were deranged. Chest radiograph s/o left middle zone inhomogeneous opacities. HRCT thorax was s/o left middle lobe and superior segment of left lower lobe consolidation. Bronchoscopy was done. BAL fluid C/S, CBNAAT, gram stain were all negative. BAL fluid galactomannan was 1.23 and BAL fluid fungal culture was suggestive of Aspergillus spp. Patient was started on Tab. Posaconazole 300 mg OD for 8 weeks, at the end of which there was complete resolution of clinical and radiological findings.

Conclusion: Fungal infections should be suspected and investigated thoroughly in patients having risk factors causing immunocompromised state, with management of the fungal infection along with controlling/eliminating the risk factor(s) responsible for immunocompromised state.

Abstract No. 358: Emerging insights into pulmonary mucormycosis: Pathogenesis and treatment

Pooja Patil , Sanjiv Zangde

Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India

Pulmonary mucormycosis, a severe fungal infection caused by mucormycetes, has emerged as a critical concern in immunocompromised populations, particularly during the COVID-19 pandemic. This presentation aims to elucidate the latest insights into the pathogenesis of pulmonary mucormycosis, emphasizing the factors that facilitate infection, including host immunosuppression, hyperglycemia, and environmental exposure. We will explore the unique morphological and biological characteristics of mucormycetes that contribute to their virulence and the host’s inflammatory response. Additionally, we will discuss advancements in diagnostic techniques, including imaging modalities and molecular methods, that enhance early detection and improve patient outcomes. Treatment strategies will be reviewed, highlighting the role of antifungal therapies, surgical interventions, and supportive care in managing this life-threatening condition. Furthermore, we will address the challenges in treatment, such as drug resistance and the need for timely intervention. By synthesizing recent research findings and clinical experiences, this presentation aims to provide a comprehensive overview of pulmonary mucormycosis, fostering awareness and guiding future research efforts in this critical area of infectious diseases.

Abstract No. 359: Role of fiberoptic bronchoscopy in sputum negative, unable to expectorate, in radiologically suspected pulmonary tuberculosis patients: A prospective study

Pramod Chavan

Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India

Introduction: Tuberculosis is a major health problem, with an estimated eight million new cases and two million deaths occurring every year worldwide. However, 40-60% of patients with Pulmonary Tuberculosis suspected clinically or radiologically may fail to produce any sputum can be diagnosed with Fiberoptic Bronchoscopy.

Aims: To assess significance of Fiberoptic Bronchoscopy in diagnosis of radiologically suspected but sputum negative and unable to expectorate patients.

Methods: A prospective study was conducted in 80 patients at Saijyot Multispeciality Hospital Koparkhairane Navi Mumbai between 2023-2024. Among the 80 patients 44 were Sputum negative and 36 were unable to expectorate. This data was analyzed and results were given in percentage.

Results: Out of 80 patients, 45% patients were diagnosed as Bronchoalveolar lavage (BAL) positive for Pulmonary Tuberculosis, 20% were Bacterial Pneumonia, 35% were no growth on microbiological examination in Fiberoptic Bronchoscopy.

Conclusion: Fiberoptic Bronchoscopy has an important role in accurate and early diagnosis of sputum negative and unable to expectorate patients, in radiologically suspected Pulmonary Tuberculosis patients.

Keywords: BAL, fiberoptic bronchoscopy, pulmonary tuberculosis

Abstract No. 360: Retrospective study of 8 years of bronchoalveolar lavage of 2123 patients at tertiary care centre

Prarabdh Modi , Shahid Patel, Girija Nair, Manas Bhanushali, Tanay Sinha, Nikhil Sarangdhar

D Y Patil Hospiatl, Navi Mumbai, Maharashtra, India

Introduction: Retrospective analysis of the bronchoalveolar lavage in patients undergone bronchoscopy at tertiary care hospital may yield valuable insights about changing paradigms in the trends of various diseases diagnosed by interventional pulmonology techniques.

Objective: To analyse retrospective bronchoalveolar lavage reports in patients and to assess the prevalence of various lung diseases diagnosed by bronchoscopy over a period of 8 years.

Methodology: Retrospective data from 1 st January 2017 to 31 st December 2024 was collected and analysed from our bronchoscopy registers and medical records. Disease stratification into infectious (Tuberculosis, non-tubercular mycobacterial infections, Pneumonias) and non- infectious (malignancy, Interstitial lung diseases and others) causes .The trend were analysed year wise for each diagnosis.

Results: Total 2123 bronchoscopy reports were found over 8 years. Out of these 793 are positive for bacterial culture, 229 for tuberculosis (Drug Sensitive and Drug resistant),83 for NTM , 70 for malignancy and 25 were others. 923 BAL reports were normal. An interesting trend observed was a rise in Non-tubercular mycobacterial infections in 2020 and 2021 and bacterial culture and sensitivity. The prevalence of tuberculosis and malignancy remained otherwise stable. The drop in all diagnoses during the year 2020 could be attributed to the COVID-19 lockdown.

Conclusion: Bronchoscopy remains a valuable tool for diagnosis and management of a wide variety of pulmonary diseases, both acute like infections and chronic such as ILDs and others.In our study 43.4 % of bronchoalveolar lavage reports were normal showing that bronchoscopy also helps greatly to rule out certain pulmonary diseases, mainly infections and malignancy.

Abstract No. 361: A rare case of pulmonary sequestration in an adult

Nandakishore Bommeri

Department of Pulmonary Medicine, Adichunchanagiri Institute of Medical Scicences, Mandya, Karnataka, India

Introduction: Pulmonary sequestration is a rare condition where a portion of lung tissue develops abnormally and is not connected to the normal airway system. Instead, it has its own blood supply separate from the rest of the lung. [1] This condition was first identified by Pryce in 1946 and makes up a small percentage of congenital lung abnormalities i.e., about 0.15%-6.40%. [2]

Case: A 47 year old non-smoker male with no co-morbidities presented to outpatient clinic with history of recurrent cough since 20 years and 1 st episode of heamoptysis. TLC was 19520 cells/mm 3 . Sputum culture yielded Heavy growth of Pseudomonas aeroginosa. CECT Thorax showed brochiolectatic cavitatory changes with air fluid levels in bilateral lung fields and a segment of left upper lobe receiving anomalous arterial supply. The CT aortogram revealed an intralobar pulmonary sequestration in the lingular segment of the left upper lobe. The anomalous artery originates from the abdominal aorta at L1, traversing the diaphragm to supply this sequestered lung tissue [ Figures 1-4 ].

Conclusions: Pulmonary sequestration is a rare congenital anomaly characterized by a lack of connection to the airway, rendering it typically non-functional.

Diagnosis of pulmonary sequestration is uncommon during adulthood, however it warrants to keen high index of suspicion for the diagnosis of sequestration in patients with bronchiectasis with or without hemoptysis & recurrent infections. Often, intralobar sequestrations need to be resected to prevent recurrent infections and considerable shunting of blood. In the past few years, endovascular embolization and coiling have emerged as a therapeutic alternatives.

Abstract No. 362: A rare case of malignant pleural effusion resulting from squamous cell carcinoma of tongue

Prajakta Mane , Shahid Patel, Girija Nair, Lavina Mirchandani, Manas Bhanushali, Nikhil Sarangdhar

D Y Patil University, School of Medicine, Navi Mumbai, Maharashtra, India

Squamous cell carcinoma of tongue is a common malignancy within the head and neck region. Distant metastasis from carcinomas of the tongue is quite rare . In carcinoma of tongue the most common site for metastasis usually are the lymph nodes , lungs , liver. ,brain and bone , but the pleura involvement by squamous cell carcinoma is distinctly rare and the latent period between the primary and distant metastasis is usually long. Detection of these metastasis are essential for staging and management of the patient. We here by present you a case of 51 year female a case of right malignant pleural effusion arising from distant metastasis of squamous cell carcinoma of tongue.

Keywords: Carcinoma tongue, malignant pleural effusion, metastasis

Abstract No. 363: Aspergillus niger as the culprit for non-resolving pneumonia presenting as peripheral wedge-shaped opacity in an immunocompetent host - A rare case report

Priya Rajvanshi

PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India

A 20-year-old male presented to the chest clinic with fever, and pleuritic chest pain for the past six weeks. Patient had no significant past medical or surgical history. The patient had no history of recent travel, exposure to tuberculosis, or immunosuppressive therapy. Digital chest X-ray-PA view revealed a peripheral wedge-shaped opacity in the right upper lobe and that was confirmed by CECT-Thorax. 2DECHO, D-dimer, CTPA, cardiac profile ruled out thrombo-embolic condition. BAL fungal culture showed a growth of Aspergillus niger species and BAL-Galactomannan showed strongly positive-3.54 OD supporting the diagnosis of invasive aspergillosis. Tablet oral voriconazole, 200 mg twice daily was started along with other symptomatic medication. His symptoms began to improve after two weeks of anti-fungal therapy. The report highlights the diagnostic challenges and treatment approaches in such uncommon clinical presentations and emphasizes the importance of considering fungal infections as an etiology of non resolving pneumonia even in immunocompetent individuals.

Abstract No. 364: Comparing asthma control test and asthma control questionnaire with GINA guideline criteria for asthma

Priyanka Chhabaria

Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Introduction: Asthma is a heterogeneous disease characterized by airway hyperresponsiveness and chronic airway inflammation and usually presents with variability in respiratory symptoms (cough, shortness of breath, wheeze, chest tightness) over time and in intensity along with variable expiratory airflow limitation. Various tools have been developed and validated to measure symptom control- GINA symptom control tool I, Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ).

Aim: Comparison of the level of asthma control using ACT and ACQ tools with GINA asthma symptom control.

Objectives: To compare the ACT and ACQ tools with GINA criteria in detecting asthma control.

Methods: It is cross sectional study conducted at HIMS, VARANASI. All patients with age> 20 years presenting with symptoms of asthma and Diagnosed with criteria according to recent GINA guidelines are included in study. Baseline data were collected and control status was determined using the GINA symptom control tool, ACT, and ACQ.

Results: Total of 60 patients were enrolled in the study. The sample comprised of 69% males and 3 I% females. There was a moderate-strong correlation of GINA with ACT (p= 0.82, p < 0.001), and ACQ (p= 0.6; p < 0.001).

Conclusion: We conclude that the GINA symptom control tool correlates well with ACT and ACQ for classifying well controlled asthma and used as tool for asthma control.

Keywords: ACQ, ACT, Asthma, GINA

Abstract No. 365: Pill burden, income and gender as key determinants for first month default after treatment initiation among MDRTB patients in a slum population in Pune

Raghupathy Anchala

Indian Institute of Public Health, Hyderabad, Telangana, India

Introduction: Social determinants of health play a key role in adherence to treatment among patients suffering with MDRTB. The aim of the study was to explore the unknown determinants that may play a role in the first month default among MDRTB patients.

Methods: A cross-sectional study was carried out among newly registered MDRTB patients who didn’t follow up with the treatment one month later at TB Units (TU) in slums of Pune district, to identify social determinants associated with defaulting from treatment. As part of the sampling strategy, the initial defaulters identified within the study’s time frame (July- Sep 2021) and one year earlier in the selected Tuberculosis units (TUs) were included. Patient’s address were retrieved from Nikshay registers from different TUs and patients were contacted either through a phone call or interviewed in their home.

Results: Among 74 diagnosed and registered MDRTB patients in the TUs, 14 patients were reported cured, 12 patients died as a result of MDRTB, 20 patients were currently undergoing MDR TB treatment, 18 patients shifted to private hospitals for further treatment, and 10 patients were reported as missing. 64% of men (24 out of 37) reported being able to manage the amount of medication pills, whereas only 28% of women were able to cope with the pill burden (p=0.004). Patients with family income more than Rs 10,000 per month were likely to shift to private practitioners when compared to low income category after treatment initiation (p= 0.010).

Discussion: In addition to previously known social determinants such as income and gender, our study has shown that pill burden among female MDRTB patients plays an important role in initial treatment default among MDRTB patients.

Conclusion: Social determinants of health such as family income, gender, and pill burden play an important role in the first month default among MDRTB patients.

Keywords: First month defaulters, MDRTB, pill burden, social determinants

Abstract No. 366: Treatment prospects in co-existing COPD and diastolic heart failure: A comparative study

Rajeev Ranjan , Utkarsh Singh

Department of Pulmonary Medicine, Bharati Vidyapeeth, Pune, Maharashtra, India

Introduction: The effects of Chronic Obstructive Pulmonary Disease (COPD) and the impacts of Diastolic Heart Failure with Preserved Ejection Fraction (HFpEF) worsen the overall condition of a patient and complicate treatment as the two tend to occur concomitantly, this study aims to analyze how such patients respond to treatment along with the evaluation that the use of combination therapy is more effective than providing therapy.

Methods: This study adopts a one-year approach, examining 106 patients who suffer from COPD at the Chest Hospital Chapra OPD. The patients were subjected to diagnosis-controlled research in which they were divided into two groups after the diagnosis. The first group of patients was treated only for COPD under GOLD standards while the second group was treated for COPD and HFpEF. A minimum follow-up of three months was conducted to assess the effectiveness of the treatment, with a focus on clinical improvement, symptom relief, and the overall efficacy of the medical care given.

Results: Both sides of the group that received dual treatment for COPD with HFpEF had better results than those treated for only COPD. Respiration, exercise capability, and quality of life factors improved. The dual-treatment group also had a statistically significant lower number of acute exacerbation and hospital admissions during the entire follow-up. On the contrary, patients in the group that only received treatment for COPD made little advancement and continued suffering from chronic breathlessness and the events of exacerbation.

Conclusion: This study demonstrates the need for a conflict-resolving approach in the presence of the comorbidities of COPD and HFpEF. The necessity of addressing the comorbidity of pulmonary and cardiac dysfunction is substantiated when both problems are tackled together which translates into better outcomes. In the context of the management of COPD where HFpEF is also present, future recommendations need to explore the possibilities of using approaches of dual management to improve the treatment of patients and reduce the burden of these concurrent diseases.

Keywords: COPD, diastolic heart failure, GOLD standards, HFpEF

Abstract No. 367: Indoor air pollution related COPD in the developing world: An underreported epidemic

V. P. Rasheeka

Department of Pulmonary Medicine, Amrita Hospital, Faridabad, Haryana, India

Introduction: Chronic obstructive pulmonary disease (COPD) is strongly linked to tobacco smoking, with considerable epidemiological evidence focused on smokers despite recent research highlighting the effect of indoor air pollution on development of COPD. A large population in many parts of the developing world still uses coal and indigenous gas stoves which generates tremendous amount of indoor air pollution. Therefore, a growing need exists to differentiate between the various epidemiological, clinical, radiologic and prognostic characteristics of Tobacco smoke (TS) associated COPD and indoor air pollution associated COPD (AP-COPD).

Methods: 120 patients with COPD (GOLD diagnostic criteria) were studied. 60 patients had significant exposure to smoked tobacco. 60 patients were never smokers but had been exposed to significant indoor air-pollution for at least 5–10 years, mostly for domestic cooking exposure.

Results: 92.5% (37/40) in the smoking group were males. 85% (34/ 40) in the BMF group were females. The average age at presentation for TS group was 54 years and 69 years in AP-COPD group. In the TS group the average FEV1 value (% age predicted) was 54% and 62% in AP-COPD group. Both the groups had an average exacerbation of 2/year, over the 2 years of study period. AP-COPD group had a higher prevalence of associated Bronchiectasis on CT scans (53% vs 18%).

Conclusions: Majority of AP-COPD patients are females, who are unknowingly exposed to large a corpus of inhaled smoke via indigenous stoves and wood fire used for cooking. AP-COPD group had a late age of first presentation, first presentation in exacerbation and poor post discharge follow up. This special subgroup of COPD patients’ needs to be identified and treated early, for more favourable outcomes.

Abstract No. 368: A rare case of severe pulmonary cryptococcosis

Rohan Khoobchandani

Sir Ganga Ram Hospital, New Delhi, India

Introduction: Cryptococcosis is a fungal infection caused by Cryptococcus neoformans and Cryptococcus gattii , which thrive in environments with bird droppings, soil, and decaying organic matter. It primarily affects the lungs but can spread to other organs, particularly the central nervous system. While more common in immunocompromised individuals, it can also occur in immunocompetent hosts.

Aim: To describe a case of severe pulmonary cryptococcosis in an immunocompromised individual.

Methods: We report a case of a 63-year-old male, previously undiagnosed with type 2 diabetes and chronic liver disease, who presented with a 2-week history of dry cough and fever. Chest X-ray showed left lower zone homogenous opacity and CT thorax revealed a large lobulated mass lesion in the left lower lobe. Bronchoscopy and bronchoalveolar lavage confirmed cryptococcal infection with narrow-based budding yeast cells.

Results: The patient was started on antifungal therapy, including amphotericin B, 5-flucytosine, and fluconazole. Despite 2 weeks of medical treatment, he had persistent fever and no radiological improvement in repeat CT chest. Consequently, left lower lobectomy was performed. The postoperative period was uneventful, and the patient completed 4 weeks of amphotericin B and 5-flucytosine, before being discharged on oral fluconazole.

Discussion: Diagnosis of cryptococcosis involves isolating the pathogen from blood, cerebrospinal fluid (CSF), sputum, or tissue samples, as well as antigen detection and microscopic examination. In this case, underlying diabetes and liver disease may have contributed to the poor response to medical therapy, necessitating surgical intervention.

Conclusion: The induction phase of cryptococcosis treatment typically lasts 2 weeks but may extend to 4-6 weeks, depending on infection severity. Surgical intervention, such as resection of cryptococcomas, may be needed if there is no improvement with medical management.

Abstract No. 369: Squamous cell carcinoma presenting as cold abscess in pulmonary TB patient: A rare case report

Rucha Gurme

T.S. Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India

Introduction: The incidence of squamous cell carcinoma of oropharynx is increasing in developed and developing countries but its presentation as retropharyngeal cold abscess in pulmonary tb patient is rare as in our case.

Case: A 71-year-old nonsmoker male presented to our opd with complaints of dyspnea for last 1 year, difficulty in swallowing & dry cough on and off for last 1 month. He also gave h/o weight loss and loss of appetite. On presentation his Spo2 was 70% at room air, RR-28, HR- 91 bpm, BP-150/80mmhg. On general examination clubbing was present. On auscultation B/L basal crepts were present. Despite oxygen & noninvasive mechanical ventilatory support patient was unable to maintain saturation. On laryngoscopy narrowing of tracheal orifice was seen i/v/o which patient was intubated. Sputum for GeneXpert was positive for mycobacterium tuberculosis and ATT was initiated accordingly .CECT thorax revealed diffuse centrilobular nodules in b/l lung fields predominantly in b/l lower lobes with few of these nodules coalescing to form tree in bud pattern- likely suggestive of infective etiology & CECT neck suggestive of ill-defined multiloculated peripherally enhancing hypodense collection in retropharyngeal space extending superiorly from inferior end plate of C2 vertebral body and reaching into the superior end plate of D1 vertebral body inferiorly with extension -infective etiology (retropharyngeal abscess). Trial of CT guided drainage of retropharyngeal abscess was unsuccessful so, CT guided left parapharyngeal lymph node excision biopsy was done which was suggestive of -squamous cell carcinoma.

Carry Home Message: Multidisciplinary evaluation and timely interventions, including imaging and biopsy, are crucial to avoid delays in diagnosis and treatment.

Conclusion: This case highlights the importance of considering alternative diagnoses in patients with pulmonary tuberculosis who fail to respond to standard anti-tuberculosis therapy. Early recognition of coexisting malignancy can significantly impact clinical outcomes.

Abstract No. 370: A rare lung tumor: Primary pulmonary synovial sarcoma

Sabari Harish

Indira Gandhi Medical College, Puducherry, India

Pulmonary synovial sarcoma is a rare lung tumor with an incidence of 0.5% when compared to other lung malignancies. It is more common in males. Clinical diagnosis of this tumor is a challenging task. Hence to confirm the diagnosis we need histopathological examination and immunohistochemical staining. TLE1 is a specific and sensitive IHC marker for synovial sarcoma and helpful to differentiate from other tumors which are histologic mimics of synovial sarcoma. To establish the diagnosis other primary lung malignancies should be ruled out. Till now only a few cases have been documented in the literature. Considering the rarity of this tumor we report a case of a 66-year-old female with a huge right lung mass with ipsilateral pleural effusion that was diagnosed as primary pulmonary synovial sarcoma by USG guided lung biopsy.

Abstract No. 371: All cavities are not tuberculosis

Sai Vittal

SVS Medical College, Telangana, India

Introduction: A Cavity is a gas-filled space seen as a lucency or low attenuation area, within a pulmonary consolidation, mass or nodule. Acute pulmonary cavities occur due to secondary infections, chronic pulmonary cavities may be due to Tuberculosis, Primary lung cancer, Autoimmune diseases etc.

Case: A 50yr old male smoker presented with c/o productive cough & shortness of breath since 1 month with no constitutional symptoms & comorbidities , Grade 3 clubbing was present. Chest Xray shows right upper zone cavity. Sputum for Gene-Xpert was negative. Advised Flexible bronchoscopy in view of persistent symptoms, which showed Right Main Bronchus narrowing with corrugated posterior walls & Right upper lobe Bronchus directly opening into cavity with blackish pigmentation. Biopsy was taken from right main bronchus narrowed part. BAL for AFB, CBNAAT, Fungal smear & Galactomannan was negative HPE report showed Non Small cell Carcinoma suggestive of poorly differentiated Squamous carcinoma.

Conclusion: We present a case of 50yr old smoker with c/o cough, shortness of breath since 1 month, Chest xray showing Right upper lobe cavity , Sputum for Cbnaat Negative. Started on ATT drugs on radiological basis. Due to persistent symptoms Bronchoscopy was done & Biopsy was taken. BAL for AFB CBNAAT Fungal smear Galactomannan was negative , HPE report showed Non Small cell Carcinoma suggestive of poorly differentiated Squamous carcinoma concluding that NOT ALL CAVITIES CAN BE DUE TO TUBERCULOSIS.

Abstract No. 372: The misfortune of posterior mediastinal mass: A case report

Saikat Sarkar

Pulmocare Research and Education Foundation, Pune, Maharashtra, India

Introduction: Sarcomatoid mesothelioma is a rare, aggressive subtype of mesothelioma characterized by rapid progression, poor prognosis, and resistance to conventional therapy. It is underreported in India, with an estimated 2,213 cases from 2012 onwards. The disease has a long latency period of 20 to 50 years and presents with non-specific symptoms, often leading to delayed diagnosis.

Case Description: A 34-year-old male surgical assistant presented with pleuritic left-sided chest pain, loss of appetite, and unintentional weight loss. Imaging revealed a posterior mediastinal mass and liver lesions. After extensive testing and a PET scan, a radial EBUS-guided biopsy was attempted but abandoned due to bronchial hyperreactivity. A metabolic biopsy confirmed the diagnosis of sarcomatoid mesothelioma. The patient was referred for palliative therapy with permetrexed, cisplatin, and bevacizumab.

Conclusion: Sarcomatoid mesothelioma is the rarest and most aggressive subtype of mesothelioma, with a dismal prognosis. The lack of clinical data in India often leads to delayed diagnosis and poor outcomes. Despite advances in therapy, there is an urgent need for research into clinical biomarkers for early detection and screening of at-risk populations to prevent it from becoming a public health problem in developing countries.

Abstract No. 373: Amyloidosis

Sangay Chopel Bhutia 1 , Pulak Kumar Jana 2

1 PGT, NRS Medical College and Hospital, Kolkata, West Bengal, India, 2 Deparment of Respiratory Medicine, NRS Medical College and Hospital, Kolkata, West Bengal, India

Introduction: Amyloidosis is a rare heterogenous disorder caused by extracellular deposition of misfolded proteins resulting in organ dysfunction and eventually death. It predominantly affects male population (male to female ratio 3:2) and mean age being 67 years. It can be localized or systemic. Systemic amyloidosis has incidence of approximately 10 cases per million per person’s year and pulmonary involvement is seen in 50% of cases. Pulmonary amyloidosis can present as nodular, diffuse alveolar septal, Tracheobronchial and amyloid deposition in diffuse alveolar septal pattern is the least common variety seen only in 3% cases of pulmonary amyloidosis and has poor prognosis.

Case: A 72-year, female presented with the complaint of insidious onset with gradual progression of shortness of breath along with dry cough for one year and pain abdomen since past 1 month. She had past history of Anti tubercular drugs intake for 1 month and left on her own. Examination revealed pallor, Tachypnoea and tachycardia with SP02 of 94% in room air. Accessory muscle of respiration was working and auscultation of chest reveled bilateral diffuse rhonchi. Xray and CT chest revealed presence of bilateral random nodules distributed all the lobes of lung and an area of pleural thickening. CT guided Tru cut biopsy was done from the lesion but during procedure patient developed hemoptysis and bleeding from the puncture site, oxygen saturation dropped to 80% which was managed on site. The tissue sample was sent for HPE and revealed it to be Amyloid deposition. Possible secondary causes for amyloidosis were ruled out and the diagnosis of Primary amyloidosis involving Lung was made.

Conclusion: Pulmonary Amyloidosis is a rare disorder that has the potential to cause significant morbidity and mortality. It should be considered as one of the differentials along with other common diagnosis as malignancy, infections, and vasculitis when multisystem involvement is seen or when non resolving pneumonia is encountered. The diagnosis of amyloidosis should be based on tissue biopsy from easily accessible sites as abdominal fat or minor salivary glands due increased risk of hemorrhage with an organ biopsy. Knowledge about pulmonary amyloidosis is important due to nonspecific findings in CT chest and poor prognosis and treatment depend upon the pattern of involvement.

Abstract No. 374: Lung transplant recipient evaluation: Novel web based software to reduce evaluation time in busy OPD

Shemsya Shajahan

Armed Forces Medical College, Pune, Maharashtra, India

Introduction: Lung Transplantation has become a viable treatment option in patients with various advanced stage lung disease. Since the inception of first lung transplant the number of lung transplant procedures performed have rapidly increased, the current trend shows the increase in acceptable donors as well as recipient and relatively lower absolute contraindications. Lung transplantation offers the potential to prolong and improve quality of life for patients.

Description: Referring a patient for lung transplant is a multifaceted procedure. Ideally, patients should be referred before they meet criteria for wait-listing to provide an opportunity to introduce the concept of lung transplant, its requirements, and expected outcomes. The right patient selection and referral at the right time is significantly associated with positive outcomes and less complications. Lung transplant evaluation in a busy OPD can be time consuming and may deter physicians from performing a detailed evaluation for LT referral and listing at an early stage. We hypothesized that assessing the same via a web-based software can provide accurate results in less time a step-based approach. Till now in India there is no such study done despite having a huge population with advanced lung disease. We developed a web based ‘lung transplant eligibility calculator’ which can be used to do a comprehensive evaluation and assess the eligibility of patients for referral/listing according to ISHLT criterion. This will ensure early and correct assessment, thus improving outcomes. Ethical clearance was taken from Institutional Ethical committee, AFMC, Pune (IEC No: IEC/2024/516) and the study was registered with CTRI (CTRI registration no- CTRI/2024/06/068913). Patients of COPD, ILD and Bronchiectasis with end- stage lung disease attending respiratory OPD at a tertiary care centre in Maharashtra were included.

Results: We have included 23 candidates till now of which 52% patients were found to be eligible for referral and 43% patients were eligible for listing according to ISHLT criterion.

Conclusion: Referral for lung transplantation is a complex, multifactorial process that significantly impacts patient outcomes. Early identification and prompt referral of eligible patients will streamline and accelerate the process for lung transplantation. A scientific study will give statistical data on average time period required in referring and listing patients eligible for lung transplantation.

Keywords: Bronchiectasis, COPD, end stage lung disease, ILD, lung transplant eligibility calculator, lung transplantation, web based software

Abstract No. 375: Unveiling the uncommon: Endobronchial amyloidosis as a rare cause of large airways obstruction

Shubham Kumar , Raja Dhar, Beauty Biswas, Shyam Krishnan, Aditya Satpati, Arup Halder

CK Birla Hospitals, CMRI, Kolkata, West Bengal, India

Introduction: Large airway obstruction necessitates urgent intervention to ensure airway patency and prevent life-threatening complications. Endobronchial amyloidosis (EA), a rare cause of large airway obstruction due to amyloid deposits in the bronchial tree with unique diagnostic challenges.

Methods: Three cases of endobronchial amyloidosis diagnosed at a tertiary care institute in Kolkata, were retrospectively reviewed. Clinical data, imaging findings, bronchoscopy observations, and histopathology results were analyzed. Diagnosis was confirmed via endobronchial biopsy with Congo red staining for amyloid deposits on histopathology.

Results:

Case 1 : A 49-year, male presented with dry cough, exertional dyspnea, and fever. HRCT thorax revealed right upper lobe consolidation with hilar and paratracheal lymphadenopathy. Bronchoscopy showed a diffuse endobronchial mass-like growth occluding 70% of the RUL bronchial lumen at its maximum. Rigid bronchoscopy with laser debulking reduced the obstruction to 10%, restoring airway patency. Histopathology confirmed localized EA

Case 2 : A 69-year, female presented with dry cough, exertional dyspnea, stridor, and intermittent hemoptysis. HRCT showed narrowing at the left main bronchus. Rigid bronchoscopy with tumor debulking reduced the obstruction from 80% to 20%. To maintain patency, a self-expanding metallic stent was placed. Histopathology confirmed localized EA.

Case 3 : A 62-year, female with chronic dry cough, monophonic wheezing (right parasternal area), and worsening dyspnea over three months was found to have segmental atelectasis of the right middle lobe on HRCT thorax. Bronchoscopy revealed a friable vascular lesion partially occluding 60% of the right middle lobe bronchus. Multiples biopsies were taken from RML and the complete mass was removed endoscopically and bleeding was managed with argon plasma coagulation. Histopathology confirmed localized Endobronchial amyloidosis.

Conclusion: Endobronchial amyloidosis is a rare but significant cause of large airway obstruction. Early diagnosis through bronchoscopy and histopathology, combined with timely intervention to restore airway patency, is critical for managing symptomatic patients.

Abstract No. 376: Diverse presentations and innovative interventional approaches in endobronchial infections: A case series

Shubham Kumar , Raja Dhar, Shyam Krishnan, Beauty Biswas, Aditya Satpati, Arup Halder

CK Birla Hospitals, CMRI, Kolkata, West Bengal, India

Introduction: This case series highlights complex endobronchial infections, emphasizing the pivotal role of advanced interventional pulmonology techniques in diagnosis and management.

Case: A 45/male with fever and hemoptysis and a CT Thorax suggestive of a lingula and left lower lobe mass lesion with High Attenuated Mucus (HAM) underwent diagnostic bronchoscopy which revealed necrotic material in the lingula and left lower lobe. Cryoprobe debulking done and histopathology confirmed aspergillosis, suggesting that the mass lesion was actually HAM. A 58/male, initially being treated for sarcoidosis, presented with fever, altered sensorium, with right upper lobe cavitary lung and brain lesions on imaging. Radial EBUS biopsy and CSF analysis confirmed pulmonary and CNS histoplasmosis. A 39/male with past H/O Nasal Rhinosporidiosis, now presented with haemoptysis and dyspnoea. CT thorax was suggestive of right main bronchial obstruction which was diagnosed as Rhinosporidiosis on bronchoscopic biopsy. Rigid bronchoscopy with a microdebrider restored airway patency. A 34/male with severe kyphoscoliosis and respiratory failure underwent bronchoscopy revealing necrotic slough like material in right lower lobe, which was biopsied and was diagnosed as endobronchial tuberculosis. A 65/female with COPD and bronchiectasis presented with hemoptysis. Bronchoscopy showed necrotic sloughed off mucosa in RLL bronchus. BAL AFB was positive with CBNAAT negative raising suspicions of MOTT, but eventually revealed nocardiosis. A 60/male with a right upper lobe cavitary lesion and mediastinal lymphadenopathy with inflamed nodular mucosa in RUL on bronchoscopy was diagnosed with pulmonary mucormycosis using EBUS-TBNA and endobronchial biopsies. A 63/male with a suspected bronchocoele showed friable vascular tissue during bronchoscopy, which histopathology confirmed as squamous carcinoma.

Conclusion: This series underscores the critical role of interventional pulmonology in diagnosing and managing rare and complex pulmonary infections.

Abstract No. 377: Haematological manifestation of pulmonary and extra pulmonary tuberculosis in a tertiary care hospital - An observational study

Sri Aishwarya

Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India

Objective: Pulmonary tuberculosis (TB) remains a major health challenge globally, with hematological manifestations being frequently observed in TB patients. This study aims to determine the frequency of various hematological abnormalities in newly diagnosed pulmonary tuberculosis cases based on complete blood counts.

Methods: This retrospective cross-sectional study was conducted at Sri Lalithambigai Medical College, Chennai, on 230 newly diagnosed pulmonary tuberculosis patients. Data was collected from 1st September 2023 to 30th March 2024, using consecutive sampling. Detailed medical histories, physical examination findings, and complete blood counts (CBC) including erythrocyte sedimentation rate (ESR) were retrieved from the hospital’s electronic medical records system. The data was entered into SPSS version 23.0 for analysis. The results were presented as mean±SD for continuous variables and frequency and percentages for categorical variables, using tables and figures.

Results: The mean age of the patients was 34.36 ± 6.41 years, with a male to female ratio of 2.52:1. Anemia was present in 82.6% (n=190) of the patients, leukocytosis in 46.2% (n=106), and leucopenia in 20.4% (n=47) of the cases. Thrombocytosis was found in 26.2% (n=60) of the patients, and raised ESR was observed in 99% (n=228) of the patients. There was no significant association between age and gender with the hematological manifestations. However, thrombocytosis was significantly more common in male patients (p-value = 0.008).

Conclusion: Hematological abnormalities, especially anemia, leukocytosis, and raised ESR, are highly prevalent in patients with newly diagnosed pulmonary tuberculosis. Thrombocytosis was more frequent in male patients. These findings emphasize the need for thorough hematological screening in pulmonary tuberculosis cases for early detection and management.

Keywords: Anemia, erythrocyte sedimentation rate-give the result with changes of 230 samples, hematological manifestations, leukocytosis, pulmonary tuberculosis, thrombocytosis

Abstract No. 378: Unseen invaders: Understanding parasitic lung diseases and their impact on respiratory health

Sri Valli

Mediciti Institute of Medical Sciences, Hyderabad, Telangana, India

A 29-year-old female presented to the OPD with complaints of body aches, breathlessness, 3-day history of fever, left lower chest pain, breathlessness, giddiness, weakness, abdominal pain, and bloating. A chest X-ray revealed left paracardiac shadow on the left side, and she was treated with antibiotics and supportive care. Further evaluation with high-resolution computed tomography (HRCT) of the chest showed multiple bilateral lung nodules, soft tissue density with calcifications in the inferior lingula, adjacent traction bronchiectasis, and areas of ground-glass opacity, with suspicion of collapse. A PET-CT scan identified a hypermetabolic collapsed consolidation (2.8 x 2.2 x 2.7 cm) in the left inferior lingula, with FDG-avid ill-defined lesions and calcifications, raising concerns about malignancy. Minimal left pleural effusion was also noted. Above lesion biopsied under CT-guided. Histopathological examination revealed lung parenchyma with acute inflammation and lamellated calcified nodules, suggesting a reaction to dead parasites, rather than malignancy.

Conclusion: The imaging and biopsy findings, including calcified nodules and acute inflammation, were consistent with a parasitic infection, likely a granulomatous response to dead parasites. These findings indicated that the clinical presentation a parasitic etiology.

Abstract No. 379: Lung cancer with an unusual presentation as a lung abscess

Sumit Verma

NSCB Medical College, Jabalpur, Madhya Pradesh, India

Introduction: Lung cancer has various presentations and is sometimes diagnosed as a tuberculous cavity or an abscess. The link between lung abscess and lung cancer has been known, but the presence of malignancy in lung abscesses often undiagnosed. Obstruction from lung cancer can predispose to the development of a lung abscess. Here we present a case of 73-year-old male who was diagnosed with tuberculous lung abscess which was later confirm to be squamous cell carcinoma of lung.

Case Presentation: A 73 year old male manual labour by occupation came to our outpatient department with complaints of chest pain and cough associated with haemoptysis since 6 month it was also associated with hoarseness of voice and difficulty in swallowing and loss of appetite and significant weight loss of 10kg over 2months, he was clinically diagnosed with tuberculous lung abscess by a local district hospital and was already taking anti tubercular treatment since 3 month, he was a chronic smoker smoking about 30 bidis per day for 30years. There were no palpable lymph nodes and no digital clubbing. Patient was subjected to sputum examination which was negative for AFB on direct smear and showed no growth of bacteria after 5 days of incubation. Patient was subjected to CECT chest which revealed large thick cavity with air fluid level communicating with right sub segmental bronchus along with metastatic lymphadenopathy and adrenal mets. Patient was subjected to bronchoscopy which revelled irregular mucosal growth in right main bronchus less than 2cm from carina, sample were taken for brush cytology, biopsy and histopathology which was suggestive of squamous cell carcinoma. Patient was started on chemotherapy and followed up periodically.

Conclusion: We reported a rare case, a 73-year-old male patient, with the diagnosis of Carcinomatous Lung Abscess. This case report was prepared with the aim of increasing awareness of malignancy in patients with a clinical presentation of abscesses, especially in old age.

Abstract No. 380: When fibrosis meets malignancy: Unveiling the rare link between scleroderma and lung cancer

Swetha Pasupuleti

Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India

Introduction: Scleroderma, a rare autoimmune connective tissue disorder, is characterized by skin fibrosis and internal organ involvement, including the lungs, heart, and kidneys. Pulmonary complications, such as interstitial lung disease (ILD) and pulmonary hypertension, are frequently observed. However, the association between scleroderma and lung malignancies, particularly squamous cell carcinoma (SCC), remains poorly documented. This report highlights a rare case of SCC in the lungs of a patient with scleroderma.

Case Description: A 58-year-old female with a history of diffuse cutaneous scleroderma and progressive ILD presented with a persistent cough, chest pain, and dyspnea lasting seven months. Imaging, including HRCT, revealed bilateral extensive consolidation, initially suggestive of tuberculosis. Despite six months of anti-tubercular therapy, empirical antibiotics, IV steroids, and supportive care, her symptoms persisted. Sputum GeneXpert and cultures were negative. Further evaluation through bronchoalveolar lavage (BAL) cytology confirmed the presence of epithelial malignancy consistent with squamous cell carcinoma.

The co-occurrence of SCC in scleroderma raises concerns about an increased predisposition to cancer in this population. Chronic inflammation, immune dysregulation, and lung fibrosis associated with scleroderma may play a role in carcinogenesis. Additionally, ILD-related architectural lung changes may create a microenvironment conducive to malignancy. This case underscores the importance of maintaining a high index of suspicion for malignancy in scleroderma patients presenting with persistent or atypical respiratory symptoms. Early recognition and timely intervention are crucial for improving outcomes.

Conclusion: In conclusion, while lung cancer is not commonly associated with scleroderma, its possibility should not be overlooked, particularly in patients with refractory pulmonary symptoms. Clinicians must remain vigilant for malignancies, including SCC, in this unique patient subset to ensure appropriate management and better prognosis.

Abstract No. 381: A case of aspergillosis mimicking pneumocystis jirovecii pneumonia, a rare presentation in a newly diagnosed HIV patient: Case report

Yash Gholve

Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India

Introduction: Pneumocystis jirovecii pneumonia is a potentially life threatening fungal infection seen in immunocompromised individuals. In 1980s, the worldwide epidemic of HIV dramatically increased the prevalence of PCP. Because of the progress of ART and the use of routine prophylaxis against PCP, the incidence of PCP in HIV infected population was reduced in most of the industrialized countries. However , PCP still remains to be the most common opportunistic infection among patients with AIDS. A case of pulmonary fungal infection in a newly diagnosed HIV patient is reported here. Pneumocystis jirovecii pneumonia was initially suspected due to typical radiological features, but the patient was eventually diagnosed with pulmonary aspergillosis.

Case Description: 30 year old male, newly diagnosed HIV patient came to opd with complains of dry cough weight loss & loss of appetite since 2 months. Routine labs were within normal limits. CXR PA s/o bilateral perihilar infiltrates. HRCT showed bilateral perihilar ground glass opacities and cystic changes. Bronchoscopy was done. BAL cultures, CBNAAT, PCP PCR were negative. BAL galactomannan was 1.74. Pt was started on Tab Posacanazole for 8weeks. Clinical and radiological improvement were seen within 4 weeks of treatment.

Conclusions: Pulmonary aspergillosis and pneumocystis jiroveci pneumonia are life threatening opportunistic infections that occur in immunocompromised hosts. Early diagnosis and treatment of these opportunistic infections is essential to the survival of immunocompromised patients.

Radiological findings can offer valuable suggestions regarding the underlying cause of pathological condition, but there are instances where these findings lack specificity and can lead to misinterpretation.

Abstract No. 382: Rethinking management of graft-versus-host disease bronchiolitis obliterans syndrome in post hematopoietic cell transplantation patients

Rutvee Kakkad , Tarang Kulkarni, Alpa Dalal, Dipanjan Haldar

Jupiter Hospital, Thane, Maharashtra, India

Introduction: BOS is a chronic lung injury leading to narrowing and/or obliteration of bronchial lumen by granulation tissue or fibrosis giving rise to new onset fixed airflow obstruction in patients post- transplant. Development of BOS worsens lung function, contributing to increased morbidity and mortality post HCT.

Case 1: A 30-year-old patient, post Bone Marrow Transplant for Acute Lymphocytic Leukemia (ALL), with history of lichenoid GVHD, with no prior history of atopy, asthma or bronchitis, presented with increased breathlessness, cough, chest tightness and wheezing since 2 weeks. CT Chest showed mosaic attenuation and air trapping on expiratory phase. PFT demonstrated severe irreversible obstruction with significant air trapping. BOS was diagnosed based on the 2014 National Institutes of Health (NIH) consensus criteria. Patient was treated with daily inhaled Fluticasone and oral Montelukast with thrice weekly oral Azithromycin (FAM therapy) and twice daily oral Ruxolitinib. There was improvement in symptoms and serial Pulmonary Function Tests (PFT) after initiation of therapy.

Case 2: A 34-year-old Male, ALL, post HCT, with history of gastrointestinal tract GVHD, with no prior history of atopy, asthma or bronchitis, required hospitalization for fungal pneumonia. Patient was treated with oral antifungal therapy, but patient persisted to have breathlessness. Interval CT Chest revealed complete resolution of pneumonia and new pulmonary nodules with air trapping. Serial PFTs showed worsening lung functions. Patient started on FAM therapy and Ruxolitinib. Patient is clinically better, currently on follow-up.

Take-home message: Identification of high-risk patients, early diagnosis and timely management of BOS is crucial to improve clinical outcomes and quality of life post HCT.

Conclusion: There is increasing evidence on Janus Kinase inhibitors like Ruxolitinib for refractory chronic GVHD-BOS post HCT due to its immunomodulatory and steroid-sparing effect. With access to newer management strategies, prompt initiation of treatment is fundamental in improving outcomes post HCT.

Abstract No. 383: Malignant pleural mesothelioma presenting as acute empyema

Aamir Ahmed , Viswesvaran Balasubramanian, Ramya Reddy Malipeddi

Department of Pulmonary Medicine, Yashoda Hospital, Hyderabad, Telangana, India

Background: Malignant pleural mesothelioma and empyema, although distinct lung conditions, can exhibit similar symptoms, such as chest pain and cough. This case highlights mesothelioma presenting as thoracic empyema.

Case: A 50-year-old male farmer, chronic smoker, presented with dry cough and left-sided chest pain for two months. Chest X-ray revealed a left-sided homogeneous opacity. Subsequent contrast-enhanced CT Chest suggested a loculated pleural effusion. A ultrasound-guided intercostal tube drained 100 ml of pus, which was analyzed and showed elevated ADA levels (50 U/L), neutrophilic predominance, and high LDH (1636 U/L). predominance, and high LDH (1636 U/L). Histopathology from the VATS biopsy indicated moderately differentiated adenocarcinoma. Immunohistochemical markers were positive for CK WT1, CK 5/6, and calretinin, while negative for CK7, CK20, and napsin, confirming malignant mesothelioma.

Conclusion: Accurate diagnosis is crucial as thoracic empyema and malignant pleural mesothelioma can mimic each other. VATS aids in this diagnostic process, as empyema-like presentations could suggest a poorer prognosis for mesothelioma patients.

Abstract No. 384: Scrub typhus and respiratory manifestations: A review of clinical cases

Ashree Ayusya

Hitech Medical College, Bhubaneswar, Odisha, India

Background: Scrub typhus, caused by Orientia tsutsugamushi , poses a significant public health challenge in South-East Asia, contributing to 25% of acute undifferentiated febrile illness (AUFI) cases in India. The disease typically presents with fever, headaches, myalgia, and gastrointestinal symptoms but can lead to severe complications such as hepatitis, renal failure, meningoencephalitis, and acute respiratory distress syndrome (ARDS). Respiratory involvement in scrub typhus, particularly ARDS, is of special interest due to its rarity in tropical infections and its association with high morbidity and mortality. Understanding this manifestation is crucial for early diagnosis and effective management.

Aim and Objective: To study the respiratory manifestations of scrub typhus patients admitted to our tertiary care center between January and June 2024.

Method: A retrospective observational study was conducted after ethical approval. We included patients with acute febrile illness (AFI) who tested positive for scrub typhus IgM. Their clinical and demographic data, particularly respiratory symptoms, were analyzed.

Results: Among 42 patients with AFI, 14 (33.3%) had respiratory involvement. Common manifestations included cough, dyspnea, and sore throat (42.8%), pleural effusion (21.4%), ARDS (21.4%), pneumonitis (7%), and diffuse alveolar hemorrhage (7%) [ Figure 1 ]. The median hospital stay was 12 days, with one mortality due to hemorrhage. Most patients recovered with doxycycline and azithromycin therapy, with some requiring steroids.

Conclusion: Early diagnosis and appropriate antibiotic treatment can prevent severe respiratory complications in scrub typhus patients, improving outcomes.

Keywords: Chest infections, critical care, miscellaneous

Abstract No. 385: Adherence to BA-pMDI, MDI, and DPI inhalers and it’s impact on COPD assessment test and asthma control test (AICA study)

S. Phadnis 1 , S. Patil 2 , A. Singh 3 , G. Singhal 4 , S. Sarkar 5 , H. Sawhney 6 , B. Ghewade 7 , A. Dave 8 , I. Haldar 9 , J. Ram 10 , A. Mendiratta 11 , M. Sarkar 12 , A. Badam 13 , S. Karmakar 14 , S. Moitra 15 , P. Valsalan 16 , A. Jindal 17 , S. Toke 18 , h. J. Gayathri Devi 19 , A. Shah 20 , T. Kulkarni 21 , S. Balamurugan 22 , D. Ghorpade 1 , S. Madas 1 , S. Bhalare 1 , M. Chandolkar 1 , A. Sabale 1 , J. Gogtay 23 , M. Lopez 23 , S. Nair 23 , V. Naik 23 , S. Salvi 1

1 Pulmocare Research and Education Foundation, Pune, Maharashtra, India, 2 Venkatesh Hospital and Critical Care Centre, Latur, Maharashtra, India, 3 Dayanand Medical College and Hospital, Ludhiana, Punjab, India, 4 Neelkanth Hospital, Haldwani, Uttarakhand, India, 5 Advanced Chest Clinic and Sleep Apnea Center, Ranchi, Jharkhand, India, 6 Faith Hospital, Chandigarh, Punjab, India, 7 JNMC Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, 8 Lung Care (Daya Madhav Hospital), Vadodara, Gujarat, India, 9 Lung Care and Research Institute, Hooghly, West Bengal, India, 10 SIMS Chellum Hospital, Salem, Tamil Nadu, India, 11 Krishna Clinic, Vasco da Gama, Goa, India, 12 Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, 13 Shruthi Super Specialties Hospital, Hyderabad, Telangana, India, 14 All India Institute of Medical Sciences, Patna, Bihar, India, 15 Allergy and Asthma Research Centre, Kolkata, West Bengal, India, 16 Aster Medcity, Kochi, Kerala, India, 17 Jindal Clinics, Chandigarh, India, 18 Muktai Speciality Clinic, Pune, Maharashtra, India, 19 Joshy’s Medical Center, Bengaluru, Karnataka, India, 20 SBKS MI and RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India, 21 Jupiter Hospital, Thane, Maharashtra, India, 22 Chest and Diabetes Research Institute, Chennai, Tamil Nadu, India, 23 Cipla Ltd., Mumbai, Maharashtra, India

Background: The type of inhaler device is an important determinant in adherence to the treatment of Asthma and Chronic Obstructive Pulmonary Disease (COPD). Our objective was to study the adherence to BA-pMDI, MDI and DPI in Asthma and COPD patients and its impact on disease outcomes.

Methodology: In this multi-centric, observational study, we collected data from 390 Asthma and COPD patients using different inhaler devices across 23 sites in India. We measured adherence to inhaler devices using the Test of Adherence to Inhalers (TAI) and Morisky Medication Adherence Scale (MMAS-8). The impact of disease was measured using the Asthma Control Test (ACT) and COPD Assessment Test (CAT) .

Results: Out of 390 patients, 59.7% had Asthma and 40.3% had COPD. 37.7% of patients used BA-pMDI, 29.5% used MDI and 32.9% used DPI. On the TAI scale, the Good/Intermediate adherence for BA-pMDI, MDI, and DPI users was 42.9%, 42.6%, and 63.3%, respectively. However, on the MMAS-8 scale, a significantly high proportion of BA-pMDI users showed Good/Medium adherence as compared to MDI and DPI users [91.2%, 65.2%, and 76.6%, respectively (p<0.001) ]. The results for the impact of Good/Intermediate adherence according to TAI and MMAS scores on the ACT and CAT scale are shown in Table 1 . BA-pMDI users had significantly fewer exacerbations and lower hospitalizations in last 3 months than MDI and DPI users (Exacerbations: BA-pMDI: 15.9%, MDI: 28.6% and DPI: 24.7%, p<0.05) (Hospitalization: BA-pMDI: 6.3%, MDI: 12.2% and DPI: 9.9%) .

Conclusion: The study showed that irrespective of the inhaler type, patients who showed Good/Intermediate adherence were more likely to have complete control and a low impact of Asthma and COPD on their lives. BA-pMDI users reported lower exacerbations and the number of hospitalizations as compared to MDI and DPI.

Acknowledgment: This study was supported by Cipla Ltd. India.

Keywords: ACT, adherence, asthma, BA-pMDI, CAT, COPD

Abstract No. 386: Clinical and serological profiles of 802 Allergic Broncho Pulmonary Aspergillosis (ABPA) patients across 23 centers in India

S. Phadnis 1 , R. Davis 2 , D. R. Kumar 3 , P. Valsalan 4 , A. Singh 5 , S. Singh 6 , A. R. Paramez 7 , N. Maturu 8 , A. Dave 9 , A. Jindal 10 , V. Gella 11 , S. Sarkar 12 , K. Saha 13 , R. Dhar 14 , A. Chaudhary 15 , R. Godra 16 , R. Dua 17 , P. Chhajed 18 , S. Kant 19 , P. Saxena 20 , R. Prasad 21 , B. Ghewade 22 , M. Agrawal 23 , S. Ananthraj 24 , P. Bhalekar 1 , S. Gadhave 1 , M. Chandolkar 1 , S. Bhalare 1 , S. Madas 1 , A. Sabale 1 , D. Ghorpade 1 , S. Chhowala 25 , S. Sawant 25 , J. Gogtay 25 , S. Salvi 1 , R. Agarwal 26

1 Pulmocare Reserach and Education Foundation, Pune, Maharashtra, India, 2 Amala Institute of Medical Sciences, Kochi, Kerala, India, 3 All India Institute of Medical Sciences, Patna, Bihar, India, 4 Department of Pulmonary, Critical Care and Sleep Medicine, Aster Medcity, Kochi, Kerala, India, 5 Dayanand Medical College and Hospital, Ludhiana, Punjab, India, 6 Rajasthan Hospital, Jaipur, Rajasthan, India, 7 Lisie Hospital, Kochi, Kerala, India, 8 Department of Clinical and Interventional Pulmonary Medicine, Yashoda Hospitals, Hyderabad, Telangana, India, 9 Lung Care, Dayamadhav Hospital, Vadodara, Gujarat, India, 10 Jindal Clinics, Chandigarh, India, 11 AIG Hospitals, Hyderabad, Telangana, India, 12 Advanced Chest Clinic and Sleep Apnea Centre, Ranchi, Jharkhand, India, 13 Medical College, Kolkata, West Bengal, India, 14 The Calcutta Medical Research Institute, Kolkata, West Bengal, India, 15 Apollo Medics Superspeciality Hospital, Lucknow, Uttar Pradesh, India, 16 Rukmani Birla Hospitals, Jaipur, Rajasthan, India, 17 All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, 18 Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India, 19 King George Medical College, Lucknow, Uttar Pradesh, India, 20 Army Hospital Research And Referral, Delhi, India, 21 Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India, 22 Jawaharlal Nehru Medical College, Datta Meghe Institude of Medical Sciences, Wardha, Maharashtra, India, 23 Manglam Plus Medicity Hospital, Jaipur, Rajasthan, India, 24 Dr Rela Institute and Medical Centre, Chennai, Tamil Nadu, India, 25 Cipla Limited – Mumbai, Maharashtra, India, 26 Postgraduate Institute of Medical Education and Research, Chandigarh, India

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a complex allergic disorder caused by immune reactions against the offending fungus, Aspergillus fumigatus. ABPA most commonly complicates the course of patients with bronchial asthma or cystic fibrosis (CF). We aimed to evaluate the diagnostic practices of ABPA by physicians from multiple centers across India.

Methods: Pulmonologists from 23 centers within the Respiratory Research Network (RRN) participated in this observational registry study. Patients were categorized into 3 groups based on International Society for Human and Animal Mycology (ISHAM) 2013 criteria; Group 1: meeting ISHAM criteria, Group 2: meeting partial ISHAM criteria (HRCT positive or serological positive in any 2 parameters), and Group 3: physician diagnosed, not meeting ISHAM criteria.

Results: Out of 802 patients, 37.2% (299) were in group I, 50.2% (403) in group II, and 12.4% (100) in group III. 97.2% were non-smokers. A total of 742 out of 802 had a history of asthma and 73% (n= 587) were residing in urban areas.A significant difference was observed amongst the 3 ISHAM criteria groups for the serological parameters namely, Serum total IgE level (IU/mL), Serum A. fumigatus IgE levels (kUA/L), Serum A.fumigatus IgG levels converted, Total eosinophil count (per uL) (P=0.000, 0.724, 0.002, 0.004) respectively. Differences between 3 groups are presented in Table 1 .

Conclusion: There is considerable variation in the diagnostic criteria for ABPA across India and greater awareness needs to be created about ISHAM criteria.

Keywords: Asthma, diagnosis, treatments

Abstract No. 387: Pulmonary mass in middle aged adult: Phantom tumor or subpleural focus

N. S. Shruti Neurekar , Parag Khatavkar

Kem Hospital, Pune, Maharashtra, India

Introduction: A phantom/vanishing tumor represent interlobar pleural fluid collection mimicking a tumor on CXR, resolving with appropriate management. It occurs when transudation from pulmonary vessels exceeds pleural lymphatic absorption but in patients without prior heart failure, an infective cause should be considered.

Case Report: A 58-year-old male, LIC agent and Ex-smoker (~0.4pack-year) with DM, HTN, IHD (post-CABG) presented with hematemesis (2-3 episodes), cough with hemoptysis (1-2 tsp) for 4 days and fever for 2 days (upto 101°F) and 6-month H/O anorexia, mouth dryness, and dysphagia (solids>liquids). UGI scopy 2 months ago –s/o Severe erosive reflux esophagitis. 2DECHO- conc LVH LVEF-55%, mild PH (PASP 45 mmHg). Outside HRCT revealed right upper lobe mass-like cavitary consolidation (4×4 cm), bilateral septal thickening with right pleural effusion [ Figure 1 ]. Pleural fluid analysis from (150 cc aspirated) showed reddish fluid, TLC-850 cells (lymphocyte predominant), elevated proteins, negative cytology for malignancy/granulomas. Bronchoscopy had blood-admixed fluid; microbiology and cytology inconclusive. Repeat CT thorax showed lentiform collection with air-fluid levels in right minor fissure s/o blood products, without enhancement. Patient treated with piperacillin-tazobactam, tranexamic acid, ethamsylate, diuretics showed symptomatic improvement. Hence, took discharge at request.

On follow up 2 months later, repeat 2D ECHO -severe concentric LVH, LVEF 50%, mild PH. Bilateral pleural effusion present (R>L), Right pleural space thoracentesis done (~250 cc). Microbiologically inconclusive, Cytology- mesothelial hyperplasia, Blood ProBNP– 451. UGI scopy revealed columnar-lined healing epithelium with esophagitis. CT guided Thoracentesis from collection and biopsy yielded haemorrhagic fluid with negative microbiology and cytology. ANA blot- negative. The final diagnosis suggested benign/non-malignant cause.

Follow Up Imaging: 1 month apart [ Figures 2 and 3 ].

Conclusion: Subpleural focus, ruptured in minor fissure, forming organised hematoma.

For radiographic pulmonary masses, use appropriate diagnostic modalities and antibiotics to avoid unnecessary and harmful errors.

Abstract No. 388: Pulmonary aspergillosis mimicking malignancy in a non-immunocompromised patient

V. Swathy Radhakrishnan , B. L. Shashibhushan, T. J. Basavaraju

Bangalore Medical Collage, Bengaluru, Karnataka, India

Introduction: Pulmonary Aspergillosis is a mycotic disease usually caused by Aspergillus Fumigatus,a saprophytic airborne fungi.Aspergillus related lung diseases are classified into four different forms-whose occurrence depends upon immunological status of underlying lung disease -Allergic Broncho-Pulmonary aspergillosis (ABPA), Saprophytic infection (aspergilloma), Chronic necrotizing aspergillosis (semi invasive form) and Invasive aspergillosis in severely immunocompromised patients.

Case Description: A 55/F farmer by occupation presented to OPD with the complaints of breathlessness since 2 months, cough with expectoration since 2 months, History of loss of appetite present.On resentation Spo2 :96%, Pr 69 bpm, RR 22 cpm, Bp 190/100 mm hg. On examination trachea was pulled to left side,supraclavicular hollowing was present on left side and chest movements reduced over left hemithorax. On auscultation bronchial breath sounds heard in left infraclavicular, axillary, mammary areas. Chest Xray showed left lung collapse. Patient was empirically started on INJ CEFTRIAXONE. CT Thorax was done suggestive of complete collapse of left lung, with mucous plug in left main bronchus.Patient underwent FOB+BAL which showed cauliflower like growth seen in lower end of the trachea occluding tracheal lumen more in favour of neoplastic etiology and Biopsy was sent.HPE report showed fibrinous material admixed with colonies of hyphae suggestive of Pulmonary Aspergillosis.Patient was started on oral Voriconazole and became symptomatically better and discharged with a plan of outpatient followup.

Conclusions: This case emphasizes the importance of considering pulmonary aspergillosis in the differential diagnosis of lung masses, particularly in patients with pre-existing lung damage or risk factors such as smoking. Radiologic features of aspergillosis including cavitary lesions with fungal balls, can closely resemble malignancy, potentially leading to misdiagnosis.

Abstract No. 389: A tapestry of rare conditions: Unraveling a complex medical mystery

Vani Viswanath , Praveen Valsalan

Aster Medcity, Kochi, Kerala, India

Case Report: A 51-year-old male, non-smoker, who was working as an IT professional presented to us with history of attacks of chronic intermittent cough and copious sputum production over the last 7 years. It was also associated with recurrent pneumonia and hospital admissions. Had progressive dyspnea now increased to grade 3-4 mmrc dyspnoea scale. No significant history of hemoptysis, difficulty of swallowing, or chocking was reported. Systemic examination was unremarkable. He used inhalers and cough suppressants as required. He is married and is having 1 child. No other relevant family history.

Examination:

The patient was thin built and malnourished. Pan digital clubbing, bilateral pedal edema was present, Dyspneic, tachypneic, Spo2-86% room air, Bilateral midinspiratory coarse crackles noted, more in lower hemithorax areas, Other system examination were normal except for loud p2.

Chest X-ray :

Enlongated opacity along paravertebral region from c7 spine extending below diaphragm with tapering towards left near the fundus of the stomach.Small cystic changes with peribronchial thickening noted on right midzone,lower zone and left lower zone [ Figure 1 ].

Work Up:

Initial blood investigation showed increased inflammatory markers

Absolute eosinophil count, serum Ige levels, Aspergillus specific Igg, Ige were normal

Immunoglobulin profile was normal except for Igg that was high

Abg showed type 2 respiratory failure

ANA profile was negative

Spirometry-Severe obstruction with no reversibility

Renal function test was deranged.

In view of elevated Igg and acute kidney injury, serum electrophoresis was sent which showed monoclonal M band.

Hemato oncology opinion was sought and bone marrow biopsy reported as multiple myeloma-light chain deposition disaese.He was treated with CyBroD and Bortezomib of 6 doses and is on follow up.

Bronchoscopy was done in intubated state during hospital stay.Thick copious purulent secretions noted in bilateral bronchial tree and thorough bronchial toileting done.

Bal culture showed MDR pseudomonas.

Echo showed mild dilatation of RA, RV with severe PAH.

Provisional Diagnosis:

Primary achalasia with pneumoesophagus causing bilateral bronchiectasis with type 2 respiratory failure and corpulmonale. Multiple myeloma-light chain deposition disease.

CT Chest-2020 [ Figure 2 ]:

Confirmed the presence of the TEF at the level of sternoclavicular joint along with dilated esophagus. Also, there was evidence of cystic, cylindrical, and varicose bronchiectatic changes in both the right upper, middle lobes, and in the lingula Unfortunately Ct finding of trachea esophageal fistula was missed during follow up in local hospital for the last 5 years. We repeated CT chest and it showed progression of bronchiectasis and features of pulmonary hypertension with v/q mismatch.H type trachea esophageal fistula at D3 level.

CT Chest-2021 [ Figure 3 ]:

Further Investigations:

Esophageal manometry showed aperistaltic esophagus.

Upper GI endoscopy revealed the presence of smooth tracheoesophageal opening (fistula) in the upper 3rd of the anterior wall of the esophagus at 25 cm from the incisor teeth with dilated esophagus [ Figure 4 ], however, biopsy and wash aspiration from this fistula was negative for tuberculosis TB panel. Medical gastroenterology opinion was sought for possibilities of closure of tef and they suggested over the scope clip closure [ Figure 5 ]. Over-the-scope clip closure of tef and pneumatic dilatation of achalasia cardia done.

Final Diagnosis :

Primary achalasia cardia with congenital H type tef Chronic aspiration and bilateral cystic bronchiectasis with coexisting multiple myeloma.

Management:

Post procedure oral contrast study showed no evidence of leak with persisting achalasia cardia. During discharge FEES done showing no evidence of aspiration and he was started on diltiazem thrice daily for achalasia cardia

reatment of exacerbation with antibiotics, bronchodilators and mucolytics

Airway clearance and anti inflammatory treatment

Bipap and supplemental oxygenation atleast 15 hours per day

Pneumococcal and influenza vaccination

Pulmonary rehabilitation and nutrition.

Conclusion: This case highlights the importance of identifying rare congenital anomalies like H-type TEF and achalasiacardia in adults presenting with chronic respiratory symptoms. Delayed diagnosis led to severe bilateral bronchiectasis, respiratory failure, and cor pulmonale. The coexisting multiple myeloma further complicated the clinical picture. A multidisciplinary approach combining interventional, medical, and supportive therapies was key to stabilizing the patient and improving quality of life.

Abstract No. 390: Left hydatid cyst of lung mimicking as left hydropneumothorax

Sireesha Madhu , B. M. S. Patrudu

Andhra Medical Collage, Vishakhapatnam, Andhra Pradesh, India

Introduction:

Hydatid disease is endemic mainly in the mediterranean countries In India hydatid disease is common in Andhra Pradesh and Tamilnadu Liver is the most common site for hydatid disease 75% of cases followed by Lungs 15% spleen 5%.

Most commonly caused by larva of Echinococcus Granulosis.

Case Description: A 41 years male patient came with complaints of left side chest pain since 2 days ,shortness of breath since 2 days, fever since 1 day, loss of appetite present since 2 days , loss of weight present +. Clinical examination shows tracheal shift to right side, the following are seen on left side: bulging of intercostal spaces, decreased chest wall movements, hyper resonant note on percussion, decreased breath sounds. Chest xray shows left hydropneumothorax.

HRCT CHEST: left moderate pneumothorax, mild pleural effusion, underlying lung collapse, evidence of well defined cystic lesions with membranes(water lilly sign) stage CE3a. Evidence of well defined hypodense cyst of size 5.6 -7.5 cms noted in left lobe of liver – likely hydatid cyst. CECT CHEST : well defined hepatic cyst with hyper attenuation in left liver lobe. 5.6 – 10.8 cms well defined air fluid cavitatory lesion with internal crumpled membranes in left lower lobe of lung, with left mild pleural effusion.

Conclusion: Large hydatid cyst with pneumothorax and effusion is a rare presentation. So physicians should be careful enough in diagnosing and managing hydatid cyst. Surgery is the main treatment modality.

Abstract No. 391: Diagnostic Accuracy of Next-Generation Sequencing (NGS) in a Tertiary Care Intensive Care Unit (ICU)

Mihika Sawale , Rishabh Raj, Mugdha Bhide

K. J. Somaiya Institute, Mumbai, Maharashtra, India

Background: Infectious diseases remain a significant cause of mortality worldwide, particularly in ICU settings where timely identification of pathogens is critical. Traditional culture-based methods are time-consuming and often fail to detect fastidious or atypical organisms, leading to delayed treatment. Next-generation sequencing (NGS) offers a promising alternative, enabling comprehensive, rapid, and unbiased pathogen identification. This study aimed to evaluate the diagnostic accuracy of NGS compared to culture-based methods in a tertiary care ICU in India.

Methods: A retrospective analysis was conducted on 187 patients admitted to the ICU with infectious etiologies. Paired samples from blood, urine, bronchoalveolar lavage fluid (BALF), cerebrospinal fluid (CSF), and other body fluids(pleural fluid, ascitic fluid, pus, peritoneal fluid, bile, and joint aspirate were subjected to both NGS and culture-based diagnostics. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using culture as the reference standard. The concordance rate was also calculated, including the matched positive results (both tests detect the same organism) and matched negative results (both tests yield negative findings). Subgroup analyses were performed based on each sample type.

Results: NGS exhibited a sensitivity of 75%, specificity of 59.6%, PPV of 62.23%, and NPV of 72.84%. NGS detected pathogens in 56.68% of cases compared to 47.06% by culture. It identified atypical organisms in 17 cases missed by culture. The highest sensitivity for NGS was observed in CSF (100%) and BALF (87.5%) samples, while the highest specificity was noted in pleural fluid (100%) and blood (87.5%) samples. The overall concordance between NGS and culture was 57.2%.

Conclusion: NGS offers a powerful diagnostic advantage by detecting a broader range of pathogens, including atypical organisms often missed by culture-based methods. Its superior sensitivity across various sample types highlights its potential as a complementary tool in ICU settings. However, the relatively lower specificity and operational challenges such as cost and standardization limit its standalone clinical application. Integrating NGS with conventional diagnostics could enhance pathogen identification and guide targeted antimicrobial therapy. However, further studies are needed to optimize its use and assess its impact on clinical decision-making and patient outcomes.

Abstract No. 392: A clinical exploration of young’s syndrome: Navigating diagnosis and management

Aardra Prem

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Introduction: Young syndrome, also known as primary ciliary dyskinesia (PCD) with bronchiectasis, sinusitis, and azoospermia, is a rare autosomal recessive condition. This case report describes the clinical presentation, diagnostic workup, and management of a patient with Young’s Syndrome, emphasizing the importance of early recognition and multidisciplinary care.

Case: A 20 year old male, student, with no known comorbidities, presented with complaints of fever since 2 weeks, cough with expectoration since 4 years, breathlessness since 4 years and history of recurrent upper respiratory tract infection since childhood. On examination vitals were stable, Grade II clubbing was present and on auscultation bilateral inspiratory crepitations heard.

Chest X-ray showed bilateral lower zone bronchiectatic changes. HRCT Thorax showed Cystic bronchiectasis in bilateral lower lobe bronchial segments. Sputum Culture showed Enterobacter cloacae growth and CBNAAT MTB not detected.Bronchoscopy showed Ectatic segments in right middle and lower lobe. BAL gene xpert MTB not detected.ENT opinion sought for chronic upper respiratory symptoms and was adviced CT Paranasal sinuses- which revealed bilateral maxillary and ethmoidal sinusitis. Scrotal Ultrasonography done -showed prominent bilateral epididymis with tubular ectasia with no obstruction. Semen Analysis no spermatozoa seen. Serum Testosterone, LH, FSH were normal. Patient was diagnosed as a case of Youngs Syndrome based on clinicoradiological features.He was discharged with antibiotics,mucolytics ,adviced chest physiotherapy ,and instructed to Follow up in OPD .He was also explained on vaccination, Genetic Testing and anticipated fertility issues.

Conclusions: As Young’s Syndrome links respiratory and reproductive health, it is important not to miss out on its diagnosis and always be considered in differential diagnosis.

This case report underscores the need for awareness regarding this rare condition. A comprehensive diagnostic workup, multidisciplinary approach and timely intervention can alleviate symptoms, improve fertility prospects, and enhance overall well-being and quality of life.