Objectives: Obesity and asthma are the common conditions that describe the distinctive nature of inflammation. The high-sensitivity C-reactive protein (hs-CRP) and fraction of exhaled nitric oxide (FENO) levels are known to influence the atopic status. This study was undertaken to compare these inflammatory markers and atopic profile between non-obese and obese asthmatic patients. Methods: Two hundred asthma patients aged between 11-58 years were enrolled for this study and divided into two groups: non-obese [body mass index (BMI) <25 kg/m2) (n=100) and obese (BMI>30 kg/m2) (n=100)]. All the subjects were assessed for the pulmonary function test (PFT), hs-CRP from blood serum, FENO and skin prick test (SPT) against the battery of 58 common aero-allergens and subjects having at least one SPT positive were labelled as atopics. Results: Of these 200 patients, 135 (67.5%) were atopics [n=80 (59.3%) non-obese; and n=55 (40.7%) obese]. The BMI for the non-obese and obese group was 22.4 and 33.9 Kg/m2, respectively. The functional residual capacity percent (FRC%) of non-obese and obese were (111.2±24.6 versus 88.54±19.99 (P<0.001) and expiratory reserve volume (ERV%) predicted was (97.750±33.571 versus 70.9±24.8; P<0.001). Both FRC% and ERV% were significantly lower in the obese group. Levels of FENO of non-obese were significantly higher than the obese (38.08±3.13 versus 30.77±3.02; P=0.0685). The hs-CRP was significantly higher in obese atopics in comparison to non-obese (15.33±23.66 versus 21.60±45.35; P<0.001).

Objective: Tuberculosis (TB) is a significant cause of mortality and morbidity worldwide. Vitamin D deficiency has been implicated to cause pulmonary TB (PTB). On the other hand, anti-TB drugs, like rifampicin and isoniazid have been hypothesised to cause vitamin D deficiency. The objective of this study was to evaluate and compare serum vitamin D status in patients with PTB before and after anti-tuberculosis therapy (ATT). Methods: A single centre, prospective, observational, double-blinded study was conducted in 50 patients with PTB on category I ATT. Vitamin D samples were collected at baseline, two months and at the end of six months. Results: The mean age of the study population was 46.7±21.2 years. The mean serum vitamin D level at baseline was 18.1±6.7 ng/mL (Normal > 30ng/mL), 17.9±7.1 ng/mL at two months and, 17.5±7.8 ng/mL at six months. The progressive decline in the mean vitamin D levels was statistically significant (P<0.001). However, it was also observed that in some patients [n=8 (16%)] vitamin D levels increased after ATT; though in majority [n=42 (84%)] vitamin D levels decreased after ATT. Conclusion: It is postulated that vitamin D supplementation in TB treatment programmes may also have an effect on outcome, thereby the need for further studies to ascertain the exact role, dose and duration of vitamin D augmentation in improving the outcomes.

Background: Interstitial lung disease (ILD) is a chronic respiratory illness with multiple co-morbidities including obstructive sleep apnoea (OSA). There are limited data available about the prevalence of OSA in ILD. The present study was designed to document the burden of OSA in patients with ILD. Methods: In this cross-sectional, observational study, 27 stable ILD patients were enrolled over a period of one year. After baseline evaluation including spirometry and six-minute walk test, all the patients were subjected to overnight complete polysomnography. Patients diagnosed to have OSA were further classified into three severity grades of OSA. Results: Twenty (74%) of the 27 patients studied had OSA with majority having mild (n=9) and moderate (n=9) severity. ILD patients with OSA were significantly older compared to those without OSA (P=0.031). There was no significant difference in the rest of the parameters in the group. Conclusion: Obstructive sleep apnoea is an under recognised but a common entity associated with ILD.

Background: The prevalence and spectrum of interstitial lung diseases (ILDs) varies from region to region depending upon genetic and environmental factors. Methods: This was a descriptive observational study of 262 consecutive ILD patients diagnosed in the Pulmonary Medicine Department over a period of four years. Results: The mean age of the patient was 52.7±14.9 years; there were 120 males. All types of ILDs were more common in women except idiopathic pulmonary fibrosis (IPF) which was found predominantly (90.6%) in male patients. High resolution computed tomography (HRCT) showed definite usual interstitial pneumonia (UIP), possible UIP and inconsistent with UIP patterns in 50.4%, 9.5% and 40.1%, respectively. IPF was the most commonly found ILD (24.1%) followed by connective tissue disease related ILD (CTD-ILD) (22.1%), non-specific interstitial pneumonia (NSIP) (17.2%), hypersensitivity pneumonitis (HSP) (15.6%), sarcoidosis (7.6%), combined pulmonary fibrosis and emphysema (CPFE) (4.6%), cryptogenic organising pneumonia (4.2%), and occupational lung disease (2.7%), respectively. Bronchoscopic procedures were performed in 66 (25.2%) of patients which were diagnostic in 27 (44.9%); overall pathological diagnosis was possible in 10.2%. Univariate analysis showed smoking and hypothyroidism as statistically significant risk factors associated with IPF Conclusions: Idiopathic pulmonary fibrosis was found as most common ILD; UIP pattern was seen in IPF, CTD-ILDs, chronic HSP and fibrotic NSIP

Background: Current pharmacological management for patients with chronic obstructive pulmonary disease (COPD) focuses on inhaled long-acting bronchodilators, which are considered as the recommended first-line treatment option for such patients. Methods: A prospective study was conducted in 70 patients with moderate to severe COPD. Thirty-five patients (Group A) were administered daily glycopyrronium bromide (50ìg) and 35 (Group B) received tiotropium bromide (18ìg). Patients were assessed for forced expiratory volume in one second (FEV1) score, COPD assessment scale (CAT), modified Medical Research Council (mMRC) scale, body-mass index, airflow obstruction, dyspnoea and exercise (BODE) index for COPD survival for two consecutive follow-ups after every three months of drug use. Results: Group A showed a significant improvement with respect to different evaluation methods compared to group B. Significant results were observed for group A parameters were mMRC (0.0001), CAT (0.01), BODE (0.0001) and FEV1 (0.03). Conclusions: In patients with moderate to severe COPD, glycopyrronium bromide (50ìg) once daily is found to be more beneficial than tiotropium bromide (18ìg).

A 53-year-old male presented with complaints of dry cough, hoarseness and breathlessness for two months. He has been working in an electrical switch manufacturing unit for 25 years with history of exposure to Bakelite fumes and dust. Otorhinolaryngology examination revealed left-sided vocal cord palsy. Chest radiograph showed bronchiectasis. Other investigations like computed tomography of neck and chest, bronchoscopy with lung biopsy and magnetic resonance imaging of vagus nerve did not reveal any pathology for the cause of vocal cord palsy. We considered occupational exposure to Bakelite as the cause of vocal cord palsy and the patient was counselled to refrain from the occupational exposure to Bakelite. Subsequently, on regular follow-up, no further deterioration of the symptoms was observed.

Platypnoea-orthodeoxia syndrome (POS) is a rare clinical entity with very few cases reported worldwide. We report a case of a 27-year-old male with a seven-day history of fever, dry cough, and breathlessness; later on, diagnosed to have H1N1 (Swine flu) and acute respiratory distress syndrome. He was put on mechanical ventilation and weaned off in due course. However, he had persistent dyspnoea and desaturation in sitting position that relieved on lying down (platypnoea/orthodeoxia). He was again mechanically ventilated. High resolution computed tomography of chest revealed tension pneumomediastinum and pneumothorax. Computed tomography-guided pigtail drainage of mediastinal air and bilateral intercostal drainage tubes were performed. His symptoms improved immediately. He had no underlying demonstrable cardiac disease. The diagnosis of POS was made due to a high index of clinical suspicion and helped in establishing POS as a presentation of concomitant pneumomediastinum-pneumothorax in this patient. To the best of our knowledge, acute respiratory distress syndrome complicated by concomitant pneumomediastinum-pneumothorax as an extra-cardiac cause of POS has not been reported.

Exposure to electrical current can affect any organ in the body. The nature of the affected tissue; the damage depends on the type of current and the duration of exposure. Cardiac lesions are the most typical visceral lesions associated with electrical burns. Pulmonary involvement is an infrequent manifestation. We report here a case of electrical injury to the lung parenchyma, with chest wall damage in a labourer; who sustained a high voltage electrical shock while working on a construction site. Chest radiograph and contrast-enhanced computer tomography (CECT) of chest was suggestive of consolidation of bilateral lung fields with pneumomediastinum. All other possible causes of parenchymal abnormalities were ruled out. This case demonstrates that a high voltage electric current can cause isolated lung damage and timely management is the crux to salvage the life of the patient.