Not all that Wheezes is Asthma.

We want to highlight the presentation of a 75-year-old female who was initially managed as asthma and subsequently diagnosed with concurrent excessive dynamic airway collapse (EDAC).

Assessing the potential impact of glacial lake outburst floods on individual objects using a high-performance hydrodynamic model and open-source data.

Glacial lake outburst floods (GLOFs) are one of the major natural hazards in certain populated mountainous areas, e.g., the Himalayan region, which may lead to catastrophic consequences including substantial loss of lives. Evaluating the potential socio-economic impact of GLOFs is essential for risk mitigation and enhancing community resilience. Yet in most of the cases, this is confronted with the challenges of limited availability of data and inaccessibility to most of the glacial lakes in the high-altitude areas. This study aims to exploit open data from different sources and high-performance hydrodynamic modelling to develop a new framework for GLOF exposure and impact assessment. In the new framework, different GLOF scenarios are created using a simple dam breach model. A high-performance hydrodynamic model is then adopted to simulate the resulting flood hydrodynamics. Necessary socio-economic information is collected and processed from multiple sources including OpenStreetMap, Google Earth, and global data products to support exposure analysis. Established depth-damage curves are used to assess the GLOF damage extents to different exposed objects and an existing fatality estimating procedure is adopted to assess the potential loss of lives. The evaluation framework is applied to the Tsho Rolpa glacial lake in Nepal. From the results, the worst GLOF scenario as considered can potentially inundate 1647 buildings, impact 5038 people and hit 123 key facilities including schools, hospitals, airports, hydropower plants, etc. It may substantially damage 900 buildings, 10.63 km2 of agricultural land and 50.9 km roads and may potentially lead to 45 deaths even if warning is available.

Oesophageal intramural pseudodiverticulosis presenting as non-resolving pneumonia: A sinister cause diagnosed by EUS-B-FNA.

We report a case of an oesophageal intramural pseudodiverticulosis leading to a mediastinal collection caused by Candida glabrata presenting as a non-resolving pneumonia and mimicking an oesophageal mass. The patient was a 60-year-old diabetic male who was referred from another hospital and presented with a history of low-grade fever and breathlessness. His computed tomography (CT) of the chest disclosed a mediastinal mass alongside the oesophagus with pleural collection. Endobronchial ultrasound scope was inserted through the oesophagus (EUS-B) and fine-needle aspirate was taken from the mass. The cultures of specimen from the mediastinum grew drug-resistant C. glabrata. The patient was managed with oral voriconazole along with oesophageal stenting after which he showed remarkable recovery. Repeat CT revealed a near-complete reduction of the mediastinal infection. The case highlights the need of a high degree of suspicion, right approach to diagnostic work-up and appropriate histopathological and microbiological examination of clinical specimens.

Multi-year observations of the high mountain water cycle in the Langtang catchment, Central Himalaya.

The Langtang catchment is a high mountain, third order catchment in the Gandaki basin in the Central Himalaya (28.2°N, 85.5°E), that eventually drains into the Ganges. The catchment spans an elevation range from 1400 to 7234 m a.s.l. and approximately one quarter of the area is glacierized. Numerous research projects have been conducted in the valley during the last four decades, with a strong focus on the cryospheric components of the catchment water balance. Since 2012 multiple weather stations and discharge stations provide measurements of atmospheric and hydrologic variables. Full weather stations are used to monitor at an hourly resolution all four radiation components (incoming and outgoing shortwave and longwave radiation; SWin/out and LWin/out), air temperature, humidity, wind speed and direction, and precipitation, and cover an elevational range of 3862-5330 m a.s.l. Air temperature and precipitation are monitored along elevation gradients for investigations of the spatial variability of the high mountain meteorology. Dedicated point-scale observations of snow cover, depth and water equivalent as well as ice loss have been carried out over multiple years and complement the observations of the water cycle. All data presented is openly available in a database and will be updated annually.

Alveolar Air Leak Syndrome a Potential Complication of COVID- 19-ARDS - Single Center Retrospective Analysis.

BACKGROUND: Alveolar air leak comprising of pneumothorax, pneumomediastinum, and subcutaneous emphysema in the ongoing COVID 19 pneumonia have been increasingly reported in literature. These air leaks were also recognized in the severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and H1N1 viral pandemics. Here we review the incidence and outcomes of alveolar air leaks over 400 patients admitted to our tertiary care institution for moderate-severe COVID-19 pneumonia. METHODS: We performed a retrospective audit of moderate to severe COVID-19 cases admitted to our hospital. Patients who were recognized as either a spontaneous pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema were identified. Their clinical features and characteristics were thoroughly documented and clinical outcomes were gathered. Each case has been presented as a brief synopsis. RESULTS: During the audit period, we reviewed over 670 patients, out of these 419 patients required intensive care for moderate to severe disease. 10 patients developed Pneumothorax, pneumomediastinum, pneumopericardium and/ or subcutaneous emphysema - referred to as Alveolar Air leak syndrome; The incidence of alveolar air leak was found to be 2.39%. 6 patients did not survive the resultant complication. CONCLUSION: Spontaneous alveolar air leaks are a rare but definite complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. ICU Clinicians must be alert about the diagnosis and treatment of this complication.

Concurrent massive hemoptysis and acute pulmonary embolism: A therapeutic dilemma.

Pulmonary Embolism and Massive hemoptysis are two very potentially fatal emergencies in Respiratory medicine practice. These two conditions are kind of antagonizing conditions requiring completely different and pharmacologically opposite nature of treatment. We hereby present the case of a 37-year old young male presented to our Hospital with massive hemoptysis, who on evaluation also had a concurrent large pulmonary embolism. The bleed was managed with bronchial artery embolization followed by anticoagulation therapy from a day later for embolism. This case report gives an insight on to how to manage a practical therapeutic challenge which is the concurrence of a massive hemoptysis and life threatening pulmonary embolism.

Necrotizing lymphadenitis: Not always tuberculosis, its Kikuchi-Fujimoto's disease.

Kikuchi-Fujimoto's disease is an uncommon self limiting, benign cause of generalised lymphadenopathy with fever. It can present as a triad of fever, night sweats and lymphadenopathy which resembles more common causes like tuberculosis and lymphoma. Being an endemic country a patient may be treated on the lines of tuberculosis often. We present case of a young female who was diagnosed as Kikuchi-Fujimoto's disease after not responding to antitubercular treatment. Pathologists and Clinicians must be aware of this condition to prevent unnecessary treatment.

Phenytoin-induced acute hypersensitivity pneumonitis.

Lungs are target organs for toxic effects of various drugs due to many reasons. Diphenylhydantoin (DPH) is reported to have many extrapulmonary side effects. We are presenting a case of acute hypersensitivity pneumonitis (HP) secondary to DPH, presenting with respiratory failure. Acute HP with respiratory failure is an uncommon drug side effect of the DPH therapy and is a diagnosis of exclusion. It requires detailed workup and exclusion of other causes along with evidence of improvement in the patient's condition after withholding DPH.

Endobronchial ultrasound: beyond nodes and masses.

Pulmonary embolism (PE) is a life-threatening condition with varied presentation and, therefore, poses clinical challenge for early diagnosis and proper management without which it carries high mortality. Previous studies on the role of endobronchial ultrasound (EBUS) in diagnosis of PE were carried out after PE was already diagnosed by computed tomography pulmonary angiography. We report a case of massive PE with shock, promptly diagnosed with bed side EBUS - Doppler study, as patient's clinical condition did not allow conventionally proposed diagnostic algorithm.

Trilogy of sequential infections in a diabetic male.

Uncontrolled diabetes is a known immunosuppressive state. It predisposes individuals to bacterial and fungal infections. The present case report demonstrates sequential infections by Klebsiella followed by tuberculosis and later development of mucormycosis in a poorly controlled diabetic patient. Timing of diagnosis is of essence because of high mortality seen with such pulmonary infections. High index of suspicion needs to be maintained as the same individual may harbor multiple infections as highlighted in this case.

Sarcoidosis as unusual cause of massive pleural effusion.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Pleural involvement is relatively rare. Development of pleural effusion in sarcoidosis needs to be evaluated for other causes, especially tuberculosis in endemic countries. Sarcoid pleural effusion responds to systemic corticosteroids. We are presenting case of 42 year old male patient of sarcoidosis who developed massive pleural effusion while on treatment with steroids, which was attributed to disease per se. Sarcoidosis as a cause of massive pleural effusion has not been mentioned before in published literature.