Introduction Smoking is associated with the occurrence and progression of cardiovascular diseases, inflammatory disorders and malignancies. Objective To study the platelet indices, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in smokers and their correlation with smoking pack-years. Method A total of 110 smokers and 110 non-smokers were included. The smokers were grouped into three groups: mild (<5 pack-years), moderate (5−10 pack-years) and heavy (>10 pack-years). The platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) were noted. The NLR and PLR were calculated and the statistical analysis was made using the Student’s T-test, Analysis of Variance (ANOVA) and Spearman’s correlation coefficient. Results The platelet count, PCT and PDW were significantly higher with mean values: 218.56 ± 121.31 vs 203.23 ± 80.35 ( p -value = 0.038), 0.27 ± 0.10 vs 0.26 ± 0.10 ( p -value = 0.041) and 12.54 ± 1.45 vs 11.99 ± 1.70 ( p -value = 0.001) in smokers and non-smokers, respectively. The PLR differed significantly with mean values: 119.40 ± 84.81 in smokers and 181.99 ± 313.09 in non-smokers, with a p -value of 0.045. A significant positive correlation was found between pack-years of smoking and platelet count and PLR with the Pearson correlation coefficient of 0.250 and 0.198 and p -values, 0.008 and 0.037, respectively. The Platelet Count, PCT, MPV and PDW varied significantly between mild, moderate and heavy smoker groups, with p -values of 0.045, 0.010, 0.015 and 0.017, respectively. Conclusion The platelet indices and inflammatory markers NLR and PLR are derived from routine blood investigations, which are easily available and inexpensive. The monitoring of platelet indices, along with the PLR, can be used as early predictors of morbidity in smokers.

Occurrence of radiological sinusitis on CT-PNS in asthmatics without nasal symptoms and CRS in allergic rhinitis with or without asthma increases the severity of the disease and affects the QoL.

Tuberculous infection of the tracheobronchial tree, termed as endobronchial tuberculosis (EBTB), is more common in young adults and females. This clinical entity is poorly understood and the diagnosis is frequently delayed as sputum smears are often negative for acid fast bacilli and the chest radiograph can be normal, resulting in diagnostic confusion. Bronchoscopy continues to play a key role in its diagnosis. Though atelectasis is not uncommon in these patients, EBTB presenting as a middle lobe syndrome (MLS) has rarely been documented. MLS refers to chronic or recurrent collapse of the right middle lobe and has a myriad of causes. The pathogenesis of this entity too is not fully established. We report this exceptional clinical manifestation in a 19-year-old male, who presented for evaluation of respiratory symptoms for 6 months along with constitutional complaints. Imaging suggested the presence of MLS and bronchoscopy established the diagnosis of endobronchial tuberculosis. GeneXpert evaluation of bronchial aspirate detected Mycobacterium tuberculosis. Histopathology confirmed the presence of granulomatous lesions. Subsequently, the cultures of bronchial aspirate and post-bronchoscopy sputum grew M. tuberculosis. Appropriate therapy with anti-tuberculosis drugs resulted in a remarkable symptomatic and radiological improvement. EBTB presenting as a MLS is a distinct rarity.

Pulmonary tuberculosis masquerading as metastatic lung diseaseA 30-year-old, HIV-negative female, who had never smoked, was referred for evaluation of lung metastasis. She had abdominal pain, occasional fever and weight loss for 3 months. Progressive breathlessness was present for 15 days. Her physical examination was unremarkable. Chest radiography (figure 1) showed bilateral nodular opacities with indistinct margins in all the lung zones. Computed tomography (CT) of the thorax demonstrated multiple round nodules of variable sizes scattered throughout both lung fields, suggestive of metastatic lung disease. Abdominal ultrasonography revealed multiple large retroperitoneal lymph nodes, which were confirmed on CT. Several sputum samples for acid-fast bacilli (AFB) and malignant cytology were negative. Her bronchial aspirate was positive for AFB and GeneXpert (Cepheid, Sunnyvale, CA, USA) detected Mycobacterium tuberculosis without rifampicin resistance. Transbronchial biopsy revealed caseating granulomas consistent with pulmonary tuberculosis. She was then referred to DOTS (directly observed therapy, short course) centre for initiation of antituberculous therapy. Subsequently, the bronchial aspirate also cultured M. tuberculosis.The typical presentation of pulmonary tuberculosis is easily recognisable but the disease, a well-known masquerader, can be a source of diagnostic confusion radiologically when the presentation is atypical. The most common and feared cause of multiple round opacities of varying sizes in the lungs is metastasis. Pulmonary tuberculosis, as a cause of such a radiological presentation, is very rare, with only sporadic reports [1-3] documenting such an appearance. In an appropriate setting, pulmonary tuberculosis should be considered in the differential diagnosis of bilateral pulmonary nodules simulating metastasis. This could possibly prevent invasive interventions being performed to establish a diagnosis [2].

Klebsiella species infrequently cause acute community acquired pneumonia (CAP). The chronic form of the disease caused by K. pneumoniae (Friedlander's bacillus) was occasionally seen in the pre-antibiotic era. K. oxytoca is a singularly uncommon cause of CAP. The chronic form of the disease caused by K. oxytoca has been documented only once before. A 50-year-old immunocompetent male smoker presented with haemoptysis for 12 months. Imaging demonstrated a cavitary lesion in the right upper lobe with emphysematous changes. Sputum stains and cultures for Mycobacterium tuberculosis were negative. However, three sputum samples for aerobic culture as well as bronchial aspirate cultured pure growth of K. oxytoca. A diagnosis of chronic pneumonia due to K. oxytoca was established and with appropriate therapy, the patient was largely asymptomatic. The remarkable clinical and radiological similarity to pulmonary tuberculosis can result in patients with chronic Klebsiella pneumonia erroneously receiving anti-tuberculous therapy.