Objective: Pulmonary manifestations are rarely a major problem in hypothyroid patients; though subtle restrictive pattern on spirometry has been reported. The effect of thyroxine replacement on spirometric indices has not been adequately studied. Methods: Patients with primary hypothyroidism (thyroid stimulating hormone [TSH] > 15 mIU/L) not having any known pulmonary or cardiac pathological (N=42) were screened for inclusion in the study. All patients underwent spirometry and following parameters were recorded: forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, mid-expiratory flow rate (FEV_25%-75%), peak expiratory flow rate (PEFR), both as absolute values and as a percentage of the predicted value. Subsequently, patients were started on levothyroxine replacement treatment and the dosage was titrated to achieve euthyroid state. Spirometry was repeated two months or more after the restoration of the euthyroid state. Results: Their mean age was 37.1±12.6 years. No significant correlation was observed between thyroxine (T4) and thyroid stimulating hormone (TSH) and any of the baseline spirometric parameters. Comparison of spirometric parameters (as percentage of predicted values) before and after treatment showed a clinically significant improvement in FVC, FEV1 and FEF_25%-75% (P< 0.05). Conclusions: Hypothyroidism was characterised by an asymptomatic; yet predominant restrictive pattern of pulmonary function abnormality. After thyroxine replacement, there was a significant improvement in the restrictive pattern.

Objective: Common factors for exacerbation of chronic obstructive pulmonary disease (COPD) are viral and bacterial infections. Presence of purulent sputum for the initiation of antibiotic therapy is non judicious because antibiotic usage in viral exacerbation may lead to the development of bacterial resistance and unnecessary economic burden on the patient. Procalcitonin (PCT) is a marker which can be used to differentiate between viral and bacterial causes as an aetiology of these exacerbations. Methods: Patients with exacerbation of COPD (increased dyspnoea, cough, increased sputum volume and/or purulence) were identified. Sputum culture was sent along with serum PCT levels. Patients were divided into two groups –Group I (COPD patients with bacterial exacerbation, confirmed by the sputum culture) and Group II (COPD patients without bacterial exacerbation). Serum PCT levels were measured in both the groups. Results: Results of the study revealed that PCT levels ranged from 0.01 to and 12.03 ng/mL with a mean value of 3.18±2.60 ng/mL in Group I and 0.23±0.39 ng/mL in Group II and median values of 2.98 ng/mL in Group I and 0.09 ng/mL in Group II. There was a statistically significant difference between the two groups (P<0.001) with Group I showing a higher mean values compared to Group II. A significant near strong correlation was observed between total leucocyte count and PCT levels (r=0.699; P<0.001). However, a weak negative and borderline significant correlation between forced expiratory volume in one second/forced vital capacity (FEV1/FVC) levels and PCT levels was observed (r=–0.199; P=0.050). Conclusion: Procalcitionin can be used to differentiate between bacterial and viral exacerbation of COPD. PCT- guided antibiotic therapy has a potential to decrease the unnecessary use of antibiotics and economic burden on the patient.

A rare case of interstitial pneumonia with autoimmune features in a 53-year-old female is presented. She was treated successfully with immunosuppressive drug regimen. This case report underscores the importance of scrutinising patients with overlapping features of connective tissue disorders with interstitial lung disease and further outlines the strategy for the diagnostic and management issues of this condition.

Pulmonary artery pseudoaneurysms are an uncommon pulmonary pathology; but associated with high mortality. Untreated lesions can enlarge, rupture or lead to exsanguination and death. Pseudoaneurysms are either idiopathic or may be caused by tuberculosis, fungal infection, penetrating trauma, blunt trauma, bacterial endocarditis, catheterisation of either pulmonary artery or right heart.

A 32-year-old male patient diagnosed with smear positive pulmonary tuberculosis presented with excessive hair fall two months after starting anti-tuberculosis treatment. In the absence of any specific metabolic or dermatological cause, drug-induced alopecia was suspected. A review of the literature revealed isoniazid as the culprit drug. Isoniazid was withdrawn and the patient started having new hair growth gradually.