Introduction:Influenza A (H1N1) virus has caused serious respiratory illness (swine flu) and death over the years. The first confirmed case of swine flu H1N1 in India was documented in May 2009, but huge numbers of cases were reported thereafter. In 2015, swine flu outbreak in India had led to significant morbidity and mortality.Objective:to study details of swine flu patients admitted in a rural tertiary care center in western India in 2015 and to identify predictors of mortality.Methodology:Retrospective data of swine flu cases admitted at a tertiary care teaching hospital in 2015 and their outcome as either cured or expired was recorded.Result:Out of 65 confirmed cases of severe swine flu that required hospitalization, 40(61%) were male. 55 of 65 (84.61%) patients [mean (SD) age: 50(15)] were cured while 10 patients [mean (SD) age 51(15)] expired. Overall mean (SD) age was 50.23(15) years with average (SD) days of hospitalization were 6.32(3.3) days. The commonest symptoms were cough (100%) followed by throat pain (96.9%), common-cold, fever (93.8%), and breathlessness (83.1%). 40% of patients needed non invasive ventilator support while 16.9% patient required invasive ventilator. Mean temperature on presentation was (99.96’F), RR (25.89/min), SpO2 on room air was 82.06%. Average White Blood Cells were 8274/mm3 with neutrophils were 79.58%. Mean procalcitonin was 0.83 ng/ml. It was found through univariate analysis that sputum production (P = 0.013), chest pain (P = 0.04), Respiratory Rate (P = 0.013), SpO2 on presentation at room air (P = 0.001), Days of non invasive ventilator (P = 0.001), intubation and invasive ventilator (P = 0.001) were statistically significantly associated with outcome but through multivariate analysis it was revealed that only requirement of intubation (invasive ventilator) was significantly predicting mortality(Odds ratio=234) (P = 0.0001).Conclusion:Requirement of intubation was associated with poor outcome.

Pulmonary tuberculosis is commonly presented as cavitary lesion and infiltrations. It commonly involves upper lobe. Lower lobe involvement is less common. Various atypical presentations of tuberculosis on radiology are reported like mass, solitary nodule, multi lober involvement including lower lobes. Atypical presentations are more commo in patients with immunocompromised conditions like Diabetes Mellitus, anemia, renal failure, liver diseases, HIV infection, malignancy, patients on immunosuppressive therapy. Cannon ball presentation of pulmonary tuberculosis is extremely rare and not so common. Common causes of cannon ball presentation in lung are metastasis, fungal infections, Wegener's grannulomatosis, sarcoidosis, etc. We report here a case of middle year female with diabetes mellitus presented with atypical symptoms with cannon ball appearance on radiology and found to be of tuberculosis in origin. Thus any patients with immunocompromised condition can present with atypical manifestation of tuberculosis either clinically or radiologicaly in high endemic countries for tuberculosis.

Background: Flexible fiber-optic bronchoscopy (FFB) is a well-established procedure in pulmonary medicine but still underutilized in rural area of developing countries where patients are still managed without confirmation of diagnosis. It is considered as an important tool in the diagnosis and therapy of varieties of pulmonary diseases. Objective: To study the role of bronchoscopy in diagnosis of different pulmonary diseases such as tuberculosis, pneumonia, and lung cancer. Materials and Methods: All consecutive FFB were retrospectively reviewed using bronchoscopy reports and corresponding patient's charts over 2 years. Demographic data were recorded including age, gender with indication for procedure, radiographic findings, suspected diagnosis, bronchoscopy findings, and final diagnosis. Results: Infections including tuberculosis and malignancy were two main indications for performing bronchoscopy. The overall diagnostic yield with bronchoscope was 62%. Tuberculosis was diagnosed in 50% of suspected cases, whereas bacterial and fungal pneumonia were diagnosed in 60% of suspected lower respiratory tract infections (bacterial 83% and fungal 17%). Seventy-five percent of patients had community-acquired pneumonia and 25% had hospital-acquired pneumonia. Gram positive organisms were isolated in 25% cases, Gram negative in 70% of cases and in 5% cases mixed growth was present. Malignancy was confirmed in 68% of suspected cases (squamous cell 44%, adenocarcinoma 24%, small cell 4%, undifferentiated 24%, and metastatic carcinoma 4%). In other diseases, such as pulmonary eosinophilia, interstitial lung diseases, upper airway abnormality, and pseudo hemoptysis, it helped to establish the diagnosis. Conclusion: Diagnostic yield of FFB in our study is fairly comparable to other studies and its widespread use is recommended in order to achieve confirmation of diagnosis, to diagnose malignancy timely, and to prevent overenthusiastic empirical use of anti-tuberculoses drugs, which can eventually prevent resistance in rural area also.

It is not so common to aspirate foreign body in normal adults without any predisposing factors as compared to children and those with the altered neurological state. Endobronchial foreign bodies are one of the causes of obstructive pneumonia and difficult to diagnose as signs and symptoms are often nonspecific. However, once they are diagnosed, they can generally be removed, leading to rapid and drastic resolution of symptoms. Bronchoscopy is the gold standard in the identification and localization of an airway foreign body and also for better management of the ailment. However with the help of virtual bronchoscopy one can decide the location of the foreign body before any invasive intervention and being noninvasive it can be performed in follow-up easily to check the patency of airways. It is not possible to detect the exact size of foreign body with the virtual bronchoscopy. In this article, we report a case of unnoticed foreign body aspiration in a 49-year-old female patient who was initially treated for pneumonia. However, due to nonresolution of opacity contrast enhanced computed tomography thorax with virtual and flexible bronchoscopy were performed, which revealed a foreign body in the right lower lobe bronchus that was removed with biopsy forceps in piecemeal. In her follow-up visit, she underwent virtual broncoscopy that revealed clear airways. Thus, detailed history and high index of suspicion is required for nonresolving pneumonias that may occur due to unnoticed foreign body/ies in an adult.