Background: Tracheobronchial foreign body aspiration (TFBA) is a common clinical emergency, with symptoms including hoarseness, cough and dyspnea, more likely to appear in children and possibly associated with immature teeth and uncoordinated swallowing. ^[1] The anatomical structure of the right main bronchi makes foreign bodies more likely to be incarcerated. Right bronchus is straighter and broader than the left bronchus, facilitating the deposit of foreign body on right side. Patients with mild symptoms may delay hospital visits for longer periods of time, leading to more severe complications. Materials and methods: Present study was prospective study conducted in Department of ENT, Medical Sciences and Research, India. Case records of patients with confirmed tracheobronchial foreign body (TFB) aspiration were studied for last 2 years. Cases with history of aspiration, sudden onset of breathlessness or choking sensation in a healthy person, recurrent respiratory infections with clinical or radiological evidence, and suspicion of foreign body & later had confirmed evidence of TFB were considered for present study. Patients with bronchial asthma, acute laryngo-tracheobronchitis, COPD, bronchiectasis were not considered for present study. Result: 60 cases satisfying study criteria were studied. Majority were children below 2 years of age (38.3%), followed by 3-4 years age group (30%). Majority of cases were male (58.3%) as compared to female (41.7%). Majority of cases had symptoms or history of dry cough (61.7%), noisy breathing (50%), and respiratory distress (46.7%) and witnessed choking (30%). While among signs majority of cases had unilateral reduced air entry (53.3%), unilateral wheeze (41.7), whistling and clicking sounds (20%) and no signs (16.7%). Chest X-Ray findings were consolidation (60%), lobar collapse (53.3%), hyperinflation (50%), ipsilateral emphysema (38.3%) and normal (16.7%). CT Bronchogram was not done in 45%, while in cases underwent CT were findings of foreign body/mucus plug (30%) and foreign body (25%).  Conclusion: Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

We present an interesting case of severe dyspnea due to chronic obstructive airway disease exacerbation and upon further evaluation a diagnosis of stress cardiomyopathy was entertained. We highlight a management of this particular case and provide a brief review of stress cardiomyopathy

Hepatic hydrothorax is defined as the presence of significant pleural effusion in a cirrhotic patient without primary pulmonary or cardiac disease1. Postulated mechanisms for the development of pleural effusions in patients with hepatic cirrhosis include: hypoalbuminemia and decreased oncotic pressure leakage of the plasma from the hypertensive azygos vein, lymphatic leak from the thoracic duct, passage of ascitic fluid to the pleural space by way of lymphatic channels in the diaphragm, and transfer of peritoneal fluid directly via diaphragmatic defects2. The usual unilaterality of hepatic hydrothorax could be attributed to a congenital factor, but not to physiologic mechanisms3. The most likely explanation appears to be that ascitic fluid passes through congenital or acquired fenestrations in the diaphragm directly into the pleural space2. The description of hepatic hydrothorax in the absence of ascites is very rare1. The flow of the ascitic fluid into the pleural space equaled the rate of ascites production in patients with this entity3.

Patients with Wegner’s Granulomatosis often present with diffuse alveolar haemorrhage alongside the classical triad of haemoptysis, anaemia and progressive dyspnoea. The diagnosis is confirmed by bronchoalveolar lavage with serial aspirated aliquots of fluid revealing persistently bloody returns. Lung biopsy is very helpful if it shows granulomatous inflammation and vasculitis however it lacks sensitivity and specificity. Studies suggest that the detection of antineutrophil cytoplasmic antibodies (ANCA) along with Proteinase-3 can substitute for biopsy for the diagnosis of Wegner’s Granulomatosis in patients who present with diffuse alveolar haemorrhage.

Ectopic pregnancy is a public health issue and a life-threatening condition in Sub-Saharan Africa due to high risk of sexually transmitted infections. While surgical option of management is often advocated for cases of ruptured ectopic gestation, unruptured cases can be managed medically especially where fertility is of a major concern. The case presented is that of a 30-year-old GIP0+0 who presented at a private health facility with mild right sided lower abdominal pain and spotting per vaginal of 2days duration at a gestational age of 7weeks and 2days, she was hemodynamically stable. A pelvic Ultrasound done showed a right sided gestational sac with no cardiac activity and an empty uterus. Serum β HCG done was 913mIU/ml. She was managed as a case of unruptured ectopic gestation with intramuscular methotrexate injections and she had a complete resolution of the ectopic gestation as evidenced by the disappearance of the symptoms and biochemical assessment of the level of serum β HCG which dropped to zero.

Background: Urinary tract infection (UTI) in the elderly poses a very serious problem. The knowledge of microbiology and antibiotic susceptibility of micro-organisms causing the disease is vital for defining the empirical treatment. There are no large-scale studies on the same from India. Aim: To find out the common presenting symptomatology and risk factors associated with UTI and distribution of isolated uropathogens and their resistance pattern. Settings and design: Prospective study done in a tertiary care centre in Bangalore. Methods and material: The study included elderly patients aged 65 years and above who were admitted, or visited the outpatient departments in the hospital, and had confirmed UTI. Results and conclusions: Fever (57/194 - 29.4%) and dysuria (52/194 - 26.8%) were the most common symptoms of UTI. Diabetes Mellitus (DM) was the most common risk factor associated with UTI. Extended Spectrum Beta-Lactamase (ESBL) producing Escherichia coli (E. coli) (93/194 - 47.94%) was the most commonly isolated pathogen. Of the total, 56.2% of the uropathogens showed ESBL positivity. Overall, the highest antibiotic resistance was recorded for Fluoroquinolones (79.9%).

Whether chronic pain induces clinical depression or depression initiates psychosomatic pain (through physiological mechanisms) is difficult to prove. The burden of illness increases when patients suffer from both. Financial hardship and medical costs affect the quality of life which leads to difficulties in coping and further decreased functioning, making the treatment of both conditions more complicated. Therefore, better recognition, assessment, and treatment of comorbid pain and depression should, at least in theory, lead to better outcomes. Pain is broadly categorized into three groups: nociceptive (any painful stimulus), neuropathic (for example, diabetes), and psychogenic. Nociceptive pain occurs with direct noxious stimuli. Neuropathic pain is a result of disease or injury to the nervous system or spinal cord. Psychogenic pain has no discernible physical origin. Although the precise physiological mechanisms are not entirely understood, there are two basic categories of sensory neurons. The first type is myelinated and fast conducting; the second is unmyelinated and slow conducting.