According to National drug resistance survey 2017, 36.82% of previously treated patients have resistance to at least one ATT drug. This observational study was undertaken to evaluate the reasons for treatment interruption among patients presenting with history of treatment interruption at GHTM. Most patients interrupting treatment were found in the productive age group (82.5%), smokers(72%), alcoholic (82%), 12% of patients were not aware of treatment duration and 16% had other co morbidities. Most of the treatment interruption was after 2 months of ATT. This study provides and insight into reasons for treatment interruption and serves as a guidance to focus on pretreatment counseling with goal of reducing the emergence of drug resistant TB.

Introduction: Tuberculous pleural effusion is the second most common extrapulmonary tuberculosisl. Due to its paucibacillary nature, it is difficult to demonstrate tubercle bacilli in pleural fluid by a standard AFB staining and culture, thus leading to a large number of cases being undiagnosed or misdiagnosed2. According to RNTCP, the sensitivity of CBNAAT compared to a liquid culture is high in biopsy specimens3. However, the preferred specimen for diagnosing a pleural TB is a pleural tissue8. To date, the studies on evaluation of CBNAAT which are performed on pleural tissue are only few. Objective: To compare the yield of CBNAAT, AFB culture and histopathology of pleural tissue in suspected tuberculous pleural effusions undergoing pleural biopsy. Methodology: A case series comprising 20 patients with presumptive pleural TB underwent thoracoscopy guided pleural biopsy in the department of respiratory medicine. Specimens were sent for CBNAAT, AFB culture and for histopathological examinations. Comparative analysis of these reports were carried out. Results: Out of 20 cases, 11 were microbiologically diagnosed as tuberculous pleural effusion. Mycobacterium tuberculosis was detected by CBNAAT in 10 cases, culture showed AFB growth in 7 cases. Histopathological examination of pleural biopsy showed granulomatous inflammation in about 13 cases. Conclusion: CBNAAT is the most rapid, highly sensitive test compared to AFB culture and more confirmatory to diagnosis microbiologically confirmed tuberculosis compared to HPE.

Bronchial thermoplasty is a novel treatment for patients with severe asthma who continue to be symptomatic despite medical treatment.It aims at reducing smooth muscle mass in the airways by delivering controlled thermal energy to the airway walls during a series of three bronchoscopies. Randomizedtrials of bronchial thermoplasty in severe asthma have not been able to show a reduction in airway hyper responsiveness or change in FEV1 but have suggested an improvement in quality of life, as well as reduction in rate of severe exacerbation, emergency department visits and days lost from work .Strict inclusion and exclusion criteria of these trials resulted in elimination of patients with severe asthma who experienced more than three exacerbation per year. Therefore the generalizability of this treatment to the severe asthma population still needs to be determined. The short term adverse events consists primarily of airway inflammation and occasionally more severe events requiring hospitalization. Long term safety data are evolving and have shown thus far clinical and functional stability up to 5 years after bronchial thermoplasty treatment. Additional studies on bronchial thermoplasty are needed to establish accurate phenotyping of positive responders, durability of effect, long term safety.

Empyema Necessitans (EN) is a rare complication of untreated pleural infection. It burrows through the parietal pleura and extends to the extra pleural space. Tuberculosis is the most common cause of EN. It can be seen in both immunocompromised and immunocompetent patients. Diagnosis can be challenging due to long duration and indefinite symptoms. Missing the disease can have dreadful consequences on the patient’s health. Here we report two cases that presented with chest wall abscess later to be diagnosed as Empyema Necessitans.

Botryomycosis is a rare, chronic suppurative granulomatous bacterial infection of skin, soft tissue, and viscera with aggregates of nonbranching gram positive or negative bacteria. This is a very rare infection usually under diagnosed, mostly seen in immunocompromised state, so far only few case reports were reported worldwide. 59-year-old gentleman from Port Blair, with no comorbidities came with complaints of cough with expectoration for past six months who already received multiple treatments outside. On examination, he had basal crepitation’s in right infrascapular area. His chest X-ray showed right lower zone opacity. Blood investigation revealed leukocytosis with elevated ESR. HRCT Chest revealed right lower lobe consolidation. Bronchoscopy was done which showed mobile intrabronchial mass in RLL-CBS. Following removal, he improved. Histopathological examination of foreign body revealed vegetative material and showed gram negative bacteria with interspersed gram-positive bacteria surrounded by splendore-hoepplii phenomenon suggestive of botryomycosis. He was treated with antibiotics and he improved well.

Dasatinib is a potent second-generation tyrosine kinase inhibitor for the treatment of chronic myeloid leukemia. Pulmonary side effects like pleural effusion due fluid retention are common. But dasatinib, causing chylothorax is very rarely reported. Exact mechanism along with clinical manifestations is very poorly understood. Here we report 35-year-old man presenting with chylothorax following with dasatinib use.

Foreign body aspiration (FBA) is relatively rare in adults. In non life threatening aspiration, patients seldom recall the history of aspiration and the clinical presentation is mostly subtle and inconsistent. Chest Xray directly identify foreign body in only a minority of patients. CT chest has better resolution in detection but it does entail limitations. Though rigid bronchoscopy remains the gold standard for retrieval of FB especially in children, now with new dedicated instruments Flexible bronchoscopy has become the most commonly used diagnostic and therapeutic modality in majority of patients. Herein, we describe a patient with a smooth, spherical FB impacted in a segmental bronchus retrieved with substantial difficulty using cryoprobe and forceps.

Case: A 19 year old female came with complaints of haemoptysis and right side chest pain for 3 years with history of ATT intake twice and h/o VATS guided biopsy from right hilar mass which was inconclusive . Chest radiograph : Non-homogenous opacity on the right hilar region. Bronchoscopy : only two segments in right upper lobe. CT Chest Angiogram: suggestive of intralobar pulmonary sequestration which had arterial supply from internal mammary artery and venous drainage into the right pulmonary vein . Angiogram: shows multiple feeders from right internal mammary artery supplying the sequestrated segment of lung. Treatment: Embolisation of two major feeding branches from right internal mammary artery done. Patient became asymptomatic.