Missing the Forest for the Trees - A Rare Cause of Pleural Effusion.

Neurofibromatosis type 1 (NF-1) is a genetic disorder associated with dermatological, musculoskeletal, and neurological features. Apart from these, knowledge of other uncommon manifestations, including intrathoracic and pulmonary involvement, is crucial for early diagnosis and treatment. These patients are predisposed to various sarcomatous and non-sarcomatous malignancies. We report the case of an elderly lady with NF-1 who presented with pleural effusion related to the genetic disorder, which was missed, and elaborate on the diagnostic workup done to reach a diagnosis.

A filamentous trio.

Opportunistic infections caused by fungi and unusual bacteria are predominantly encountered in the setting of immunosuppressed host. Co-infections with multiple such organisms can pose multiple challenges even to the astute clinician from establishing the diagnosis to drug interactions during treatment of such infections. We hereby present one such case of a triple opportunistic infection in an immunocompetent host and the difficulties faced in the therapeutic decision making.

Chronic granulomatous 'Aspergillus lung mass'.

The diverse clinicopathological spectrum of pulmonary aspergillosis is a consequence of varying levels of invasiveness of this ubiquitous fungus, which largely depends on the host immune response and pre-existing lung disease. The clinical presentation of pulmonary aspergillosis spans a wide spectrum from hypersensitivity to life threatening angio-invasive and disseminated disease. We report the case of a young immunocompetent male with no underlying lung disease, who presented with an incidentally detected 'infective mass' lesion in the lung associated with minimal respiratory symptoms. The diagnostic challenges posed by the unusual clinical, radiological and histological picture as well as the therapeutic dilemmas faced are discussed in this report.

E-cigarettes: Out of the frying pan into the fire?

Electronic nicotine delivery systems were developed over a decade ago to simulate the experience of smoking, although with a lower exposure to toxins than in conventional smoking. However, they have their own unique profile of side effects, some of which can be life threatening. We report the case of a young male, who in a desperate bid to de-addict himself from smoking developed a serious adverse effect related to the e-cigarettes.

A 51-Year-Old Woman With Pellets in the Sputum.

CASE PRESENTATION: A 51-year-old woman with no comorbidities presented with a 3-month history of cough with mucopurulent expectoration and intermittent fever. Over the past 1 month, she complained of streaky hemoptysis and gave history of expectorating "whitish pellets" in the sputum on two occasions. She had developed progressive breathlessness for a week prior to presentation to our hospital. There was no history of chest pain or loss of weight or appetite. She was a nonsmoker and did not consume alcohol. She had received multiple courses of antibiotics at another center with no relief of symptoms.

Excessive sleepiness, sleep hygiene, and coping strategies among night bus drivers: A cross-sectional study.

BACKGROUND: Sleep disruption and excessive sleepiness are the known consequences of shift work. The recent spate of night-time road and air accidents, with some being directly attributed to driver sleepiness prompted us to undertake this study. AIMS: To screen for excessive sleepiness, coping practices, and post-shift sleep hygiene in night bus drivers. SETTINGS AND DESIGN: This prospective study was carried out on night bus drivers of a public transport organization in Bengaluru, Karnataka, India. MATERIALS AND METHODS: Bus drivers driving for ≥8 h at night were screened with the Epworth Sleepiness Scale (ESS) and a prevalidated shift work questionnaire. STATISTICAL ANALYSIS: Descriptive statistics were used to analyze the compiled data using Statistical Package for the Social Sciences (SPSS) version 20. RESULTS: One hundred and eighty bus drivers aged 22-63 years were screened. EXCESSIVE SLEEPINESS: Although only 2 (1.1%) drivers scored above the cutoff on ESS, 10 (5.6%) and 103 (57.2%) drivers admitted to feeling sleepy during daytime and night driving respectively. None of the drivers admitted to causing accidents related to sleepiness. The coping strategies for nocturnal sleepiness included consuming coffee/tea (16.7%), chewing tobacco (12.8%), smoking (6.1%), and walking (3.9%). POST-SHIFT SLEEP PRACTICES: Post-shift sleep duration ranged between 1 h and 10 h. Twenty-six (14.4%) and 16 (8.9%) drivers had difficulty initiating and maintaining sleep, respectively, while 9 (5%) reported frequent awakening during daytime sleep. CONCLUSION AND IMPLICATIONS: This study has demonstrated a high incidence of nocturnal sleepiness and daytime sleep disruption among night bus drivers, thus necessitating the need for education about shift work and alertness testing among shift workers in critical professions.

Endobronchial tuberculosis: two case reports and review of the literature.

Endobronchial tuberculosis commonly affects young patients and presents as acute or insidious onset cough, wheeze, low grade fever, and constitutional symptoms. Although endobronchial lesions usually result in sputum positivity for acid fast bacilli (AFB), a false negative sputum or absence of radiological lesions may result in delayed diagnosis. On the other hand, sputum positivity with presence of signs on chest radiology may lead to consideration of parenchymal TB as the primary diagnosis and the coexistence of endobronchial lesions may be missed until sequelae of the latter ensue. Besides, in elderly patients, consideration of other differentials like malignancy and pneumonia may lead to misdiagnosis. Hence, bronchoscopy is essential for confirmation of endobronchial TB. We hereby report two cases of endobronchial TB which stress the importance of bronchoscopic diagnosis for timely institution of treatment and prevention of permanent sequelae, respectively.