Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

Background:Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. Literature on its utility from developing countries is limited. We herein describe our initial experience on the utility of semi-rigid thoracoscopy from a tertiary care teaching and referral center in north India. We also perform a systematic review of studies reporting the utility of semi-rigid thoracoscopy from India.Patients and Methods:The primary objective was to evaluate the diagnostic utility of semi-rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. Semi-rigid thoracoscopy was performed under local anesthesia and conscious sedation in the bronchoscopy suite.Results:A total of 48 patients underwent semi-rigid thoracoscopy between August 2012 and December 2013 for undiagnosed pleural effusion. Mean age was 50.9 ± 14.1 years (range: 17–78 years). Pre-procedure clinico-radiological diagnoses were malignant pleural effusion [36 patients (75%)], tuberculosis (TB) [10 (20.83%) patients], and empyema [2 patients (4.17%)]. Patients with empyema underwent the procedure for pleural biopsy, optimal placement of intercostal tube and adhesiolysis. Thoracoscopic pleural biopsy diagnosed pleural malignancy in 30 (62.5%) patients and TB in 2 (4.17%) patients. Fourteen (29.17%) patients were diagnosed with non-specific pleuritis and normal pleura was diagnosed on a pleural biopsy in 2 (4.17%) patients. Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients. Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively. There was no procedure-related mortality. On performing a systematic review of literature, four studies on semi-rigid thoracoscopy from India were identified.Conclusion:Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed exudative pleural effusions.

Leptospirosis should be considered as yet another important cause of acute-on-chronic liver failure in endemic areas associated with poor outcome. Death is often due to hepatorenal dysfunction.

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Mucinous adenocarcinoma represents a rare subtype of adenocarcinoma of the lung, which is frequently invasive and has a poorer prognosis. Of its wide range of imaging appearances, air-space consolidation is the most frequent pattern while cavitary form has only rarely been reported. Despite imaging advancements, the differentiation of benign and malignant cavitary lung lesions sometimes remains imperfect. We propose “Tambourine” sign on computed tomography to raise the suspicion of mucinous adenocarcinoma in a lung cavity, under appropriate clinical settings. The sign indicates an irregular cavity with undistorted prominent thick walled bronchioles within the wall and draping along thereby resembling the musical instrument “tambourine”. Adjacent ground glass and internal septations may also be seen.

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Background: On October 15, 2006, the China information system for disease control and prevention revealed typhoid fever (TF) cases increasing greatly from October 7, comparing with the same period of the previous year, in a coastal city, P.R. China.Objective: To identify its epidemiological cause, and develop its control measures.Methods: TF case was defined as any case involving onset of fever between October 7 and December 15, 2006, plus the following: high fever (>38.5 • C), headache, malaise, intestinal hemorrhaging, myalqia, or rose-colored spots on the skin, and with the laboratory result of the decreasing Eosinophil cell or Widal test (+) in Jiaojiang district. The first 25 cases from October 7 and 100 controls randomly chosen from neighborhood of each case, age referring to +5 year old, were selected to carry out a case-control study, through questionnaire. Well water was randomly selected to detect the total bacteria, Coliform group. The chi-square test and non-conditional logistic regression analysis was used for statistical analysis. Statistical significance was assessed by the two-sided test with the test level equaling 0.05.Results: Totally 58 typhoid cases, including 29 confirmed and 29 probable cases were identified between October 7 and December 15, 2006. The cases were mainly non-residents. Through non-conditional logistic regression analysis, the result showed that mode to use well water (Odds Ratio [OR] = 5.71, 95%. Confidence interval [95% CI] = 2.23-14.59) and eat outside (OR = 8.18, 95% CI = 1.51-44.26, AR = 0.27) was the main causation of this outbreak. In addition, through chi-square test, the result also shows that Xiama market (OR = 5.46, 95% CI = 1.61-20.37, AR = 0.23), cooked food taking (OR = 4.13, 95% CI = 1.44-11.92, AR = 0.27 may also the suspected risk factors of this outbreak. The number of total bacteria and Coliform group in well water both far outnumber the national drinking water standards. Further more, through field investigation, a public toilet was found 5 meters far from a well in the Xiama market.Conclusion: This TF outbreak was mainly caused by the inappropriate manner to use contaminated well water system, probably by septic tank seepage into storage well and unhealthy food habits. The epidemic was controlled by the effective measures.

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