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Lung function impairment is known to occur after pulmonary TB irrespective of duration of treatment and outcome of disease. Obstructive lung disease is the predominant lung function impairment in symptomatic cases. Significant number of asymptomatic cases are also having obstructive pattern of lung function in spirometry analysis.

Allergic bronchopulmonary aspergillosis (ABPA) is underdiagnosed and underevaluated routinely because of clinical and radiological overlap with tuberculosis (TB), especially in tropical setting with high TB burden countries like India. ABPA is the best-recognized manifestation of Aspergillus-associated hypersensitivity to Aspergillus antigens in patients with long-standing atopic asthma. ABPA with varied clinical presentation has been reported to occur in 20% of asthmatic patients admitted to hospitals and in 5% of all rhinitis cases. In this case report, we documented middle age male with known asthma case for many years with constitutional symptoms such as cough, fever, and shortness of breath diagnosed as TB and received anti-TB treatment for 4 weeks. Finally, we confirmed as a case of ABPA and documented complete clinical and radiological response to medical treatment with antifungals and systemic corticosteroids.

Background: Chronic obstructive pulmonary disease (COPD) is a more prevalent chronic lung disease with a significant health burden, and the majority of these cases receive inadequate treatment. Methods: Prospective, observational, interview (questionnaire) based complete workup COPD study, screened 12,000 cases with chronic respiratory symptoms with cough, sputum production, and shortness of breath. A total of 6000 COPD cases were enrolled after the spirometry test. COPD cases were assessed as disease knowledge and methods of treatment offered by applying questionnaires to patients and treating physicians.Results: In the present study, 3% of study cases were aware of their COPD illness, 54% were not having knowledge about the disease, and 43% cases were not accepting the COPD diagnosis (p < 0.0001). A total of 58% of cases received inhalation treatment as levosalbutamol monotherapy in 31% cases, levosalbutamol plus beclometasone in 18% cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 9% of COPD cases (p < 0.0001). Total 42% cases received oral treatment as theophylline in 16% cases, salbutamol in 7% cases, oral steroids in 19% cases (p < 0.0001). Conclusion: "Doctor-patient-drug trio" discordance clubbed as "difficult doctor, difficult patient, and difficult treatment" is a very crucial issue observed during diagnosis and management of COPD in peripheral settings in India. K E Y W O R D S chronic obstructive pulmonary disease, difficult doctor, inhalation treatment, salmeterol fluticasone, spirometry Research HighlightsCOPD is an underestimated chronic lung disease and is halfheartedly treated in rural settings in India. In the present study, we observed that 43% of cases were difficult to accept COPD diagnosis, 91% of cases did not receive rational inhalation treatment, and 42% of cases were treated with oral medicines over rational inhalation treatment.

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Background: Primary myelofibrosis (PMF) is a myeloproliferative neoplasm (MPN) characterized by abnormal proliferation of megakaryocytes, bone marrow fibrosis, and extramedullary hematopoiesis. We did mutation profile of 50 patients of PMF and tried to correlate it with initial clinical presentation of these patients. Materials and Methods: All new and follow up patients who were diagnosed as PMF based on WHO 2016 definition of PMF were included. Mutation profile of these patients including JAK2 V617F, JAK2 exon 12, CALR and MPL mutations was done and all clinical, demographic and laboratory details were recorded. Results: Total 50 patients were enrolled out of which 29 were males and 21 were females. Out of these patients, 32 (64%) were JAK2 positive, 13 (26%) were CALR positive, 1 (2%) were MPL positive and 4 (8%) were triple negative. As compared to JAK2+ve patients and triple negative group, CALR positive patients were younger, had lower total leucocyte count, larger spleen size, lower dynamic international prognostic scoring system (DIPSS) score and higher grade of fibrosis of marrow. Conclusion: This study depicts that incidence of JAK2 and CALR mutations in Indian PMF patients is fairly similar to that in rest of the world. CALR positive patients have better clinical parameters at presentation and have better prognosis as compared to JAK2 positive patients.

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Hemoptysis is nonspecific respiratory symptom with variable etiological factors ranging from infections like tuberculosis, pneumonia, fungal infections to malignant lung process. Although Tuberculosis is leading cause of hemoptysis and reason for empirical treatment and delay in diagnosis, computerized tomography and fiberoptic bronchoscopy has made real change towards approach in management of these cases presented with nonspecific symptoms. In this case report, we have documented 'invasive bronchopulmonary Mucormycosis' as cause of recurrent hemoptysis and persistent pulmonary opacity on chest radiograph irrespective of best possible conventional treatment including higher antibiotics and blanket cover of anti-tuberculosis treatment for 4 months. We have documented 'Reverse halo sign' on chest CT imaging and final diagnosis established with Bronchoscopy guided lung biopsy showing 'presence of fungal infection causing extensive parenchymal necrosis, angioinvasion and cartilage destruction along with bronchiolar invasion.' Caution should be taken during biopsy of these hypervascular lesions as propensity to have post-biopsy 'catastrophic massive hemoptysis.' We have also documented near total complete resolution of airway and lung lesions to medical management including Amphotericin and Posaconazole.