Background and Objective: Pulmonary dysfunction after open heart surgery is an important cause of post-operative morbidity. To evaluate effect of coronary artery bypass grafting (CABG) surgery on pulmonary functions and arterial blood gases (ABGs). Methods: A prospective study was conducted at a pulmonary unit of a tertiary care public hospital. Of the 50 patients enrolled, 42 patients completed the study. Spirometry was performed one week pre-operatively and within four to five weeks post-operatively. Arterial blood gas samples were also collected just before spirometry. The pre- and post-operative data were compared. Results: There was significant reduction in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) by 13.8% and 13.1%, respectively within five weeks of surgery. After surgery mean maximum voluntary ventilation (MVV) showed a significant decrease of 7.6%. Post-operatively, the mean pH decreased significantly by 0.1% and the mean partial pressure of oxygen (PaO2) and oxygen saturation SpO2 showed significant decrease of 10.1% and 2.4%, respectively. Conclusion: Coronary artery bypass grafting has an adverse impact on lung functions and ABGs.

Background: Fluorodeoxyglucose (FDG) positron emission tomography (PET) is emerging as an important noninvasive investigation in benign pulmonary conditions too. The aim of this study was to investigate its utility in the diagnosis and monitoring of various benign pulmonary diseases. Methods: In this prospective observational hospital-based study 50 consecutive patients (26 males) with benign lung diseases underwent computed tomography of chest followed by FDG-PET at baseline and after treatment where appropriate. The findings of FDG scan are reported in the context of clinical, histopathological, physiological and radiological findings. Results: All patients showed increased FDG uptake in the lung corresponding to CT findings. Of the 9 patients with sarcoidosis stage 1 (n=1), stage 2 (n=3) and stage 3 (n=5), additional uptake in the myocardium and thyroid was noted in two patients which resulted in a change in the modality of treatment. Repeat FDG scan post-treatment showed decreased uptake in all patients which was consistent with clinico-radiologic, microbiological or spirometry findings. Increased uptake was seen in one patient with pulmonary tuberculosis (TB) and in one patient with TB mediastinal lymphadenopathy at the end of intensive phase discordant with clinical and microbiological response. Of nine cases of idiopathic interstitial pneumonias (IIPs), additional intense FDG uptake was found in two cases which corresponded to the areas of honeycombing. Conclusions: FDG-PET scan can be used as an important adjunct non-invasive investigation in diagnosing and monitoring of various benign lung conditions. It also helps in assessing whole body disease burden which may change therapeutic decisions.

Background: Tuberculosis (TB) is one of the common infections in the world, especially in developing countries like India. Therefore, early diagnosis is important. This study was undertaken to compare the yield of sputum induction with bronchoalveolar lavage (BAL) in smear-negative suspected pulmonary TB patients in a tertiary care hospital in Agra. Methods: Fifty patients were included in the study. In all patients, induced sputum, fibreoptic bronchoscopy and BAL fluid were subjected to diagnostic testing. Results: On acid-fast smear examination, induced sputum and BAL fluid tested positive in 27/50 and 25/50 patients, respectively with a sensitivity of 83.3% and 90% respectively (p<0.0001). On comparing sputum induction versus BAL on culture, 30 patients were positive by sputum induction and 27 patients were positive on BAL fluid, with the sensitivity of 85.7% and 77.1%, respectively. The results showed that the sputum induction showed a significantly higher yield than that of BAL fluid (p=0.0013). Conclusion: Sputum induction offers an alternative approach in the diagnosis of smear-negative suspected pulmonary TB patients and would enhance sensitivity for the diagnosis of TB.

Background: Obesity is a predisposing factor for obstructive sleep apnoea (OSA). Conversely, OSA increases the risk of developing hypertension and diabetes mellitus. Whether the presence of metabolic syndrome increases the risk of sleep-disordered breathing (SDB) independent of obesity remains unclear. Methods: Consecutive 25 non-obese and 25 obese adult patients with metabolic syndrome and Epworth Sleepiness Scale (ESS) score .10 underwent full night attended polysomnography. Baseline clinical and demographic parameters were recorded for all the patients. Obesity was defined as body mass index (BMI) .25kg/m2. Occurrence of SDB (central sleep apnoea and/or OSA), sleep efficiency, and time spent in each sleep stage were noted in both the study groups. Results: The study subjects were predominantly men (n=41, 82%) with a mean age of 47.1 years. A total of 38 (76%) subjects were diagnosed to have OSA. There was no difference in the prevalence of OSA between the study groups (non-obese versus obese, 20 [80%] versus 18 [72%]; p=0.508). Patients in both the groups had low median sleep efficiency (non-obese versus obese, 47% versus 48.7%; p=0.764), and an equal number of awakenings per hour of sleep (non-obese versus obese, median interquartile range [IQR], 21 [7.5-26.5] versus 18 [13-22.5]; p=0.763). None of the patients in either group had central sleep apnoea. Conclusion: Obstructive sleep apnoea is highly prevalent in patients with metabolic syndrome and excessive daytime sleepiness (ESS .10), and the prevalence of OSA in this population is independent of BMI.

A case of pulmonary alveolar proteinosis developing in a patient with chronic dust exposure and hepatitis-C infection is reported. He was managed with modified bronchoalveolar lavage and granulocyte-monophase-colony stimulating factor.

A 79-year-old man presented with fever of unknown origin with interstitial shadows in the bilateral lung fields. A bronchoscopic examination did not indicate any malignancy or specific interstitial disease. After the bronchoscopic examination, the patient gradually developed subcutaneous and mediastinal emphysema. As the subcutaneous emphysema and mediastinal emphysema were mild, the patient was not administered any specific treatment. However, he eventually developed severe subcutaneous emphysema and mediastinal emphysema, and did not show any transient improvement. The patient underwent another bronchoscopic examination at another centre and a lacerated wound was detected. Thereafter, emergent operation was performed.

We report the case of a 28-year-old resident doctor with no past history of having taken rifampicin, who presented with thrombocytoapaenic purpura occurring after the initiation of anti-tuberculosis therapy (isoniazid, rifampicin, pyrazinamide and ethambutol) for tubercular lymphadenopathy.

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances. It can present acutely or more commonly presents as an insidious onset chronic respiratory illness. It requires a high degree of suspicion with great emphasis on history. It can mimic tuberculosis, malignancy or interstitial lung disease. We report the case of a 31-year-old male with a history of sniffing hydrogenated oil, presenting with a non-resolving pneumonia.

Urinothorax is defined as the presence of urine in the pleural cavity. Leakage from the urinary tract can cause urinoma with retroperitoneal urine collection, and secondarily, urinothorax. We report the case of a 35-year-old female who presented with dyspnoea and right-sided chest pain. Chest radiograph revealed a right-sided pleural effusion. The patient had undergone left-sided ovarian cystectomy three months ago, had sustained a left-sided ureteric injury that required ureteric stent placement. Urinothorax was suspected as a consequence of ureteric injury; pleural fluid to serum creatinine ratio was found to be greater than one, confirming the diagnosis.

Isolated pleural effusion is a rare presentation of ovarian hyperstimulation syndrome following ovulation induction therapy. We hereby report the case of a 24-year-old female who presented with unilateral moderate pleural effusion following ovulation induction therapy. Therapeutic thoracentesis was performed to relieve the breathlessness in this case.