Diffuse Pan Bronchiolitis Presenting with Bronchiectasis: A Case Report.

Diffuse Pan Bronchiolitis (DPB) is a peculiar airwaydisease with its pathogenesis enrooted in a complexinterplay of various genetic and environmental factors.Airway inflammation, chronic airflow limitation andsuppuratives in pulmonary infections are the distinctivefeatures of this entity. It poses a close differential toother frequently encountered pulmonary conditionslike chronic bronchitis, emphysema, bronchiectasis andconstrictive bronchiolitis. Deferment in diagnosis canculminate in irreversible airway remodeling andprogressive respiratory failure. Hence a punctualrecognition is vital. Macrolide group of drugs are primemodality of therapy and the response to therapy isbenignant. We herein describe a case of DPB withdevelopment of sequelae owing to its delayeddetection

Adenoid cystic carcinoma of the trachea.

Primary salivary gland ‑ type tumors of the lung and airways being unusual, they pose a diagnostic challenge on small biopsies and are usually consigned as non‑small cell lung carcinomas. Since the clinical behavior of these tumors is different from the conventional lung tumors, it is important to accurately diagnose them. Among this category of tumors, adenoid cystic carcinoma (ACC) of the lungs and airways is exceedingly rare. Few large studies and maximum case reports have been reported in literature on ACC of the lungs and trachea so far. We herein report a rare case of primary ACC of the trachea diagnosed on bronchoscopic biopsy.

Consensus & Evidence-based INOSA Guidelines 2014 (First edition).

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or >15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

Pulmonary fibrosis and emphysema.

A 58-year-old male presented with symptoms of progressive dyspnoea on exertion and predominantly dry cough of six months duration. He was a cigarette smoker with a smoking index of 10 pack years. He had no history of fever, exposure to dusts or drug therapy. There was no history of similar illness in the family members or any symptoms suggestive of connective tissue disease (CTD). On physical examination, clubbing was observed and there were bibasilar fine endinspiratory crackles on auscultation. Oxygen saturation by pulse oximetry showed significant exercise desaturation from 94% to 77%.