Background: Pleural effusion involves the accumulation of fluid between the parietal and visceral pleura. When complicated by severe intrapleural inflammation, fibrous septations can form, leading to loculated effusions that are challenging to manage. Intrapleural fibrinolytic therapy, such as streptokinase (STK) instillation, has shown potential in enhancing drainage and resolving adhesions. Methods: This cross-sectional study included 35 patients with septated pleural effusions of various etiologies. All underwent ultrasound-guided intercostal chest tube insertion, followed by intrapleural administration of STK. Data were collected on daily fluid drainage, imaging findings (chest X-ray and ultrasound), and overall treatment response until discharge. Results: The mean patient age was 52.94 ± 8.9 years; 65.71% were male. The most common causes of effusion were tuberculosis (40%) and parapneumonic infection (28.57%). STK therapy significantly increased mean fluid drainage from 260.77 to 1306.86 mL ( P < 0.0001). Radiologic improvement was noted in most patients, with 22 (62.86%) cases achieving successful outcomes. Adhesion dissolution was observed in the majority, with complete resolution in 3 (8.57%) cases. There was no statistically significant association between the underlying etiology and treatment response. Conclusion: Intrapleural STK is a safe and effective treatment for loculated pleural effusions. It markedly enhances fluid drainage and may reduce the need for surgical intervention, regardless of the underlying cause.

Background: India has a significant burden of chronic respiratory diseases, many of which require long-term oxygen therapy (LTOT) for respiratory failure. Previous studies have shown poor compliance with LTOT, but data on quality of life (QOL) in patients receiving LTOT is limited. Methodology: This was a prospective observational study conducted at a tertiary care center. 56 patients with chronic respiratory failure who were prescribed LTOT were followed up for 6 months, and their QOL was assessed and compared to baseline. Results: Chronic obstructive pulmonary disease was the most common diagnosis (64%), followed by obstructive sleep apnea–obesity hypoventilation syndrome overlap (25%) and interstitial lung disease (20%). Most (77%) of the patients preferred getting an oxygen concentrator on a monthly rental basis, rather than purchasing one. LTOT compliance at 6 months was 44.4%, with reasons for discontinuation including financial constraints (31%), feeling better (28%), and doctor’s advice (24%). There was statistically significant improvement in QOL for patients who continued using oxygen at 6 months. Conclusion: LTOT improves QOL in patients with chronic respiratory diseases, irrespective of the hours of usage.

Antimicrobial resistance represents one of the most significant threats to global public health, with intensive care units (ICUs) serving as critical epicenters for the emergence and transmission of resistant pathogens. This narrative review examines current evidence on the prevalence, transmission dynamics, and clinical implications of antibiotic resistance genes (ARGs) among ICU healthcare workers (HCWs). Through analysis of recent literature, this review demonstrates that HCWs frequently act as asymptomatic carriers of ARGs, potentially facilitating the transmission of pathogens within healthcare environments. My findings indicate that colonization rates among ICU staff range from 15% to 45% for resistant organisms, with significantly higher prevalence observed in settings with limited infection control resources. Notably, I emphasize the underappreciated role of mobile genetic elements in horizontal gene transfer between commensal and pathogenic bacteria, thereby transforming HCWs into potential reservoirs and vectors of resistance determinants. Current screening protocols predominantly focus on known pathogenic organisms rather than resistance genes themselves, creating a significant surveillance gap. Based on evidence synthesis, I propose a novel surveillance framework that incorporates periodic genomic screening of HCW microbiomes to detect ARGs regardless of their bacterial hosts. Additionally, I advocate for institution-specific microbiome mapping to establish baseline resistance profiles and identify transmission networks. Limitations of current research include heterogeneity in screening methodologies, limited longitudinal data, and ethical challenges in implementing worker surveillance programs. Future research should explore novel decolonization strategies, assess economic impacts of enhanced surveillance, investigate the resistome dynamics of HCW microbiomes, and develop targeted interventions for high-risk procedures and personnel.

Background: Aspergillosis represents a diverse group of infections caused by Aspergillus species, ranging from benign allergic reactions to severe invasive disease. While its clinical spectrum is influenced by host immunity and environmental exposure, regional epidemiology remains underexplored, particularly in Eastern India. Aims: This study aimed to characterize the clinical presentation, risk factors, and management outcomes of aspergillosis cases observed over 4 years in two tertiary care centers in Kolkata, India. Methods: A retrospective observational study was conducted, reviewing the records of 35 confirmed aspergillosis cases diagnosed using clinical, radiological, microbiological, histopathological, and immunological criteria. Diagnosis was classified according to international diagnostic definitions, including European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education, international society for human and animal mycology (ISHAM), and ECMM/ISHAM guidelines. Results: Among 35 patients, pulmonary manifestations were predominant ( n = 22), followed by sinus ( n = 10) and extrapulmonary involvement ( n = 3). Allergic fungal rhinosinusitis and allergic bronchopulmonary aspergillosis were common non-invasive manifestations, while invasive pulmonary aspergillosis, cerebral aspergillosis, and Aspergillus osteomyelitis represented severe disease. The most prevalent risk factors included asthma (20%), chronic obstructive pulmonary disease (22.8%), human immunodeficiency viruses/acquired immunodeficiency syndrome (14.3%), and post-COVID-19 status (5.7%). Voriconazole and amphotericin B were the primary antifungal therapies. Clinical outcomes varied by disease spectrum and immune status. Conclusion: Aspergillosis continues to pose significant diagnostic and therapeutic challenges in tertiary care settings. Enhanced surveillance, early diagnosis, and individualized antifungal strategies are vital for reducing morbidity and mortality, especially in immunocompromised populations.

Paediatric thoracic malignancies are always a diagnostic challenge. In this case series, we report eight cases of malignancies in the paediatric age group. Case 1: A 13-year-old female presented with an anterior mediastinal mass. Computed tomography scan (Imaging Modality)(CT)-guided tru-cut biopsy from the mass revealed T-cell lymphoblastic lymphoma. The patient was initiated on the APO (doxorubicin, vincristine, prednisone) protocol for the induction therapy. The patient received four cycles of chemotherapy and is currently in remission. Case 2: A 14-year-old boy presented with an anterior mediastinal mass. CT-guided core-needle biopsy revealed it to be T-lymphoblastic lymphoma. The patient was initiated on the APO (doxorubicin, prednisone, vincristine) protocol for the induction therapy. The patient received four cycles of chemotherapy and is currently in remission. Case 3: A 12-year-old boy presented with an anterior mediastinal mass. Ultrasonography, ultrasound guided biopsy procedure (USG)-guided core needle biopsy revealed it to be primary mediastinal large B cell lymphoma. The patient was started on R-CHOP regimen (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone). The patient achieved remission after six cycles of chemotherapy. Case 4: A 9-year-old girl presented with a mass in the anterior mediastinum. USG-guided tru-cut biopsy confirmed it as a classical variant of Hodgkin’s lymphoma. The patient was initiated on the ABVD regimen (adriamycin, bleomycin, vinblastine, dacarbazine). The patient achieved remission after four cycles of chemotherapy. Case 5: A 12-year-old boy presented with a mass occupying the entire right haemithorax. USG-guided biopsy revealed it as a mixed germ cell tumour. The patient received chemotherapy with cisplatin and etoposide. The patient died after the first cycle of chemotherapy. Case 6: An 11-year-old boy presented with a mass in the posterior mediastinum. USG-guided core needle biopsy revealed ganglioneuroblastoma. The patient underwent surgical excision of the mass followed by radiation therapy. The patient was doing well after the surgery and was scheduled for regular screening and radiation therapy if required. Case 7: A 10-year-old girl presented with bilateral rounded opacities on chest imaging. USG-guided tru-cut biopsy coupled with the history of osteosarcoma and below left thigh amputation established the diagnosis as osteosarcoma metastasis to the lungs. The patient died before any definitive treatment for the metastasis. Case 8: A 3-year-old girl presented with a mass occupying the entire left lung. USG-guided biopsy revealed a small round blue cell tumour. The patient died before any further investigations could be done.

Background Tuberculosis (TB) is a major public health concern and remains a leading cause of death from infectious diseases worldwide. Information, Education, and Communication (IEC) is an integral and important strategy of the program to create awareness among the general public. The study was conducted to assess the impact of a sensitization lecture on the clinical aspects of TB among first-year postgraduate (PG) students of a tertiary care hospital in the pre-COVID era. Materials and Methods: A questionnaire-based pilot study was conducted by using a predesigned and pretested questionnaire, distributed among 90 first-year PG students from various departments of a tertiary care hospital, and the presensitization and postsensitization responses were noted. The data obtained was compiled, and statistical analysis was done using SPSS version 23. A paired-samples t -test was conducted to analyze the impact of sensitization session on the students. Results: The mean knowledge score regarding TB presensitization was 5.84 (2.47) and postsensitization was 9.37 (2.16). The scores pre- and postsensitization regards diagnosis, treatment of drug-sensitive TB, and awareness of multidrug-resistant TB were 1.85 ± 0.775 versus 2.26 ± 0.85, 2.62 ± 1.13 versus 4.02 ± 1.34, and 1.36 ± 1.12 versus 3.13 ± 1.13, respectively. Conclusion: Knowledge about various aspects of TB significantly improved after students attended a training session. Efforts should be made toward education in terms of training and retraining regarding TB, as it is known that IEC activities can create awareness among students, thus eradicating the stigma and fear associated with it. While advanced learning methods are encouraged, trainees can learn from the old school method of a didactic lecture if other advanced teaching methods are not possible to be conducted.

Background: Non-invasive ventilation (NIV) with bi-level positive airway pressure (BiPAP) is commonly used to treat patients admitted to the hospital with acute hypercapnic respiratory failure (AHRF) secondary to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Aims: Evaluation of the outcome of NIV with BiPAP in the management of hypercapnic respiratory failure (HRF) patients in AECOPD with respect to success rate and treatment failure in a tertiary care hospital. Methods: A single-centred, prospective observational study was conducted for a period from April 2021 to September 2022 in the Department of Respiratory Medicine of a tertiary care hospital to evaluate the outcome of NIV with BiPAP in the management of HRF patients in AECOPD. Fifty-three patients were included in this study. Patients were divided into two groups as follows: NIV success group (Group I) and NIV failure group (Group II). Evaluation was based on clinical parameters and arterial blood gas analysis (ABG) parameters. Clinical parameters include heart rate (HR), respiratory rate (RR), systolic blood pressure, diastolic blood pressure at the time of admission. ABG was analysed at the time of admission and after 2 hours of initiation of NIV. Results: In our study, 44 (83.0%) patients improved with NIV (Group I: NIV success group) and 7 (17%) patients failed NIV and were intubated (Group II: NIV failure group). Only three clinical parameters, i.e., level of consciousness, HR and RR at the admission time, showed statistical significance between the two groups to predict treatment outcome. pH and PaCO 2 revealed significant improvement after 2 hours in the success group. Conclusion: Only three clinical parameters at the time of admission, i.e., level of consciousness, HR, and RR, predict the success of NIV in patients with AECOPD. pH and PaCO 2 both can be used as predictors for treatment outcome.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. This study investigates the association between smoking, dietary habits, and urinary cotinine levels with COPD in a tertiary care setting in Kashmir. Methods: A prospective, hospital-based observational study was conducted at a tertiary care institute in Kashmir, from August 2022 to August 2024. A total of 250 COPD cases and 500 age- and sex-matched controls were included. Spirometry was used to diagnose COPD as per global initiative for chronic obstructive lung disease (GOLD) criteria. Smoking status; type of smoking (hookah, cigarette, mixed); dietary habits; and urinary cotinine levels were assessed. Statistical analysis was performed using SPSS v20. Results COPD was significantly associated with smoking ( P < 0.001; odds ratio = 4.48, 95% confidence interval: 3.23–6.19). Hookah smoking was predominant (62%) among cases compared to cigarette smoking (25.1%). Among females, 83% were hookah smokers. Urinary cotinine levels were highest in current smokers (60.8 ± 36.65 ng/mL), followed by ex-smokers (35.6 ± 32.22 ng/mL) and never-smokers (18.1 ± 24.07 ng/mL) ( P < 0.001). COPD patients had significantly higher fruit and vegetable intake compared to controls ( P < 0.001). The majority of cases (40.8%) belonged to GOLD stage III. Conclusion Hookah smoking is a dominant risk factor for COPD in Kashmir, particularly among females. Urinary cotinine levels correlate with smoking status and may serve as a biomarker for tobacco exposure. Public health interventions targeting smoking cessation may reduce the COPD burden in this region.

Context: Tuberculosis (TB) remains a significant global health issue, with a mortality of 23 per lakh population despite treatment efforts. Identifying factors contributing to TB-related deaths is essential for improving outcomes. Aims: This study aims to identify factors associated with TB-related mortality in patients undergoing anti-tubercular drug (ATD) treatment at a tertiary care center in West Bengal, India, from April 2024 to February 2025. Settings and design: A descriptive observational study was conducted at a tertiary care center, including 45 TB patients who died during ATD treatment. Methods and material: Data were collected from hospital records, TB treatment cards, death review forms, and minutes of TB death surveillance and review meetings. Factors like demographics, TB type, comorbidities, and treatment delays were analyzed. Statistical analysis used: Descriptive statistics and logistic regression were used to analyze associations between factors and TB-related mortality. Results: Of the 45 patients, 16 (35.56%) died from TB-related complications. Significant associations were found between prior ATD intake (odds ratio = 24.939 [95% confidence interval 1.437–432.768], P = 0.027) and age (median age 54 years vs. 36.5 years, P = 0.010) with mortality. No significant relationships were found with gender, TB type, comorbidities, or treatment delay. Conclusions: Prior ATD intake and older age were key factors in TB-related mortality, highlighting the need for targeted monitoring of high-risk patients. Further research is needed to explore additional contributing factors.