Background Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. MethodsThe Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines.

Amyloidosis is an uncommon heterogeneous and multi‐systemic disease characterized by extracellular amyloid deposition. The size of proteins varies and forms a part of local disease or systemic process. Light chain amyloidosis (AL) is the most prevalent form of systemic amyloidosis which may also be seen in localized disease. Isolated tracheobronchial amyloidosis (TBA) is rather unusual with local amyloid deposition which may pose a diagnostic dilemma with subsequent therapeutic challenge. Awareness of such a presentation is crucial in the diagnosis of this rare disease. We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated TBA, and a review of literature.

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IntroductionIdentifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India.MethodsThe EMBARC-India registry is a prospective observational study of adults with CT confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: Mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and FEV1decline.Results1018 patients with at least 12 months follow-up data were enrolled in the follow-up study. Frequent exacerbations (3 or more per year) at baseline were associated with an increased risk of mortality (hazard ratio(HR) 3.23 95%CI 1.39–7.50), severe exacerbations (HR 2.71 95%CI 1.92–3.83), future exacerbations (rate ratio(RR) 3.08 95%CI 2.36–4.01) and lung function decline. Co-existing COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all endpoints studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular co-morbidity. Infection with Gram-negative pathogens (predominantly Klebsiella pneumoniae) was independently associated with increased mortality (HR 3.13 95%CI 1.62–6.06), whilePseudomonas aeruginosainfection was associated with severe exacerbations (HR 1.41 95%CI 1.01–1.97) and overall exacerbation rate (RR 1.47 95%CI 1.13–1.91).ConclusionThis study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.FundingEU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and Asthma and Lung UK.

Summary Essential hypertension remains a major modifiable risk factor for cardiovascular diseases (CVD) despite important advances in our understanding of its pathophysiology and the availability of effective treatment strategies. Available evidences and researches favour the utility of non selective beta‐adrenergic receptor blocking agents. Propranolol belongs to this class and is indicated for treatment of hypertension. Owing to its low bioavailability (26%) and extensive hepatic metabolism, reduction in absorption and elaborative side effects in patients, it is not assumed as an ideal drug candidate for oral drug delivery. Hence, it would be beneficial if it is given through an alternate route, bypassing gastro‐ intestinal degradation, for faster therapeutic effect, enhanced bioavailability and less dosage. To address these issues, transmucosal nasal drug delivery promises as an interesting alternative. The objective of this study was to develop propranolol nanoparticles for transmucosal nasal drug delivery through ionic gelation method. The Particle size analysis, zeta potential, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) studies confirmed a nanometric size range of nanoparticles below 200 nm, with nearly spherical morphology. Moreover, rheological parameters indicated a good stability of the optimised nanoparticle formulation. In‐vitro drug release and cytotoxicity results showed sustained release of the drug till 24 hours along with less cytotoxicity.