Background: A reduction in lung capacity has been reported previously among diabetics. According to WHO estimates, Pakistan is currently eighth in the prevalence of diabetes mellitus (DM) and will become fourth by the year 2025 with over 15 million individuals. This study was designed to see the impairment of lung functions on spirometry in DM patients. Objective: Our aim was to investigate the pulmonary functions tests of Pakistani patients with DM. Materials and Methods: Between January to July 2004, 128 subjects who were never-smokers and had no acute or chronic pulmonary disease were recruited. Sixty-four of these subjects had DM and 64 were healthy matched controls. All underwent screening with detailed history, anthropometry, lipid profile, and spirometric measurements at the Aga Khan University Hospital, Karachi, Pakistan. Results: The mean age of diabetics and matched control were 54.3±9 and 54.0±8 (P<0.87) years, respectively. Diabetes patients showed a significant reduction in the forced vital capacity (FVC) [mean difference (95% CI) - 0.36 (-0.64, -0.07) P<0.01], forced expiratory volume in one second (FEV ₁ ) [- 0.25(-0.50, -0.003) P<0.04], and slow vital capacity (SVC) [- 0.28(-0.54, -0.01) P<0.04], relative to nondiabetic controls. There was no significant difference noted in the forced expiratory ratio and maximum mid-expiratory flow between the groups. There was also a significant higher level of triglycerides noted among diabetics (P<0.001). Conclusion: Diabetic patients showed impaired lung function independent of smoking. This reduced lung function is likely to be a chronic complication of diabetes mellitus.

Background: Tuberculosis (TB) is said to be one of the commonest opportunistic infection in patients with HIV/AIDS. Objective: To study the clinical and laboratory profile of patients with HIV/TB coinfection. Materials and Methods: Fifty adult TB patients having confirmed HIV seropositivity were included in randomized manner. A detailed history and thorough physical examination was done. Laboratory and radiological investigations were carried out as appropriately warranted. Results: Most of the patients were farm workers (30%) followed by manual laborers (22%) and transport drivers (16%). Heterosexual route was found in 86% of patients. Cough was present in 94% while fever and weight loss in 86% and 78% of patients, respectively. Out of 50 patients, 40% had only pulmonary TB (PTB), 46% had pulmonary and extra-pulmonary TB (EPTB), 10% had only EPTB and 4% had multisystemic EPTB. Mediastinal lymphadenopathy was present in 34% while pleural effusion and extra-thoracic lymph nodes was present in 20% and 18% of patients, respectively. Positive smear for acid-fast bacilli (AFB) was found in 25.58% while positive Mantoux test was found in 32.14% of patients. Conclusion: HIV/TB coinfection is more common in sexually active age group and commonest mode of HIV infection is heterosexual transfer. Sputum smear AFB and Mantoux test positivity is low in TB patients having HIV. Disseminated TB is common in HIV. Mediastinal lymphadenopathy is common site among extra-pulmonary tuberculosis.

Objectives: This observational study was done to describe the clinical profile, and delays in diagnosing cystic fibrosis (CF) disease in Kashmir, India. Materials and Methods : A total of 6758 patients between the ages of 0 and 19 years were registered over a period of 1 year. Out of these, 150 patients suspected of having CF, on clinical grounds, were subjected to pilocarpine iontophoresis, and later on genetic evaluation. Apart from these specific tests, these patients were subjected to laboratory tests like blood counts, blood sugar, KFT, LFT, pancreatic function test, serum electrolytes, and chloride, urine, throat swab, blood culture, ABG analysis, chest and paranasal X-rays. In addition, sonographic evaluation of abdominal organs was carried out to know the status of internal organs. A polymerase chain reaction (PCR)-based test was used for the identification of CF mutation. Results: CF was diagnosed in three (0.8%) patients. Median age of presentation of CF was 78 months. Family history suggestive of CF was present in one (33.3%) and consanguinity in three (100%) patients. Common clinical manifestations at the time of presentation included recurrent pneumonia in three (100%), failure to thrive in three (100%), recurrent diarrhea in one (33.3%) patients. General physical examination showed pallor in three (100%), malnutrition in three (100%), and clubbing in two (66.7%) patients. Examination of respiratory tract revealed hyperinflation in two (66.7%), rhinitis in two (66.7%), and creptations in two (66.7%) patients. Sonography of abdominal organs revealed pancreatic cysts in one (33.3%), hyperechoeic and increased liver span in two (66.7%), and small gallbladder in one (33.3%). Staphylococcus aureus was cultured from sputum in one (33.3%), pseudomonas aeruginosa in one (33.3%) patients. Delta F508 mutation was present in one (33.3%) patient. Conclusion: CF may be more common in Kashmir and other parts of Asia, than indicated by our study; diagnosis is often considerably delayed when the disease is identified solely on clinical grounds. It would be advisable to raise the index of suspicion about CF.

Background: Sometimes etiological diagnosis of pleural effusion is difficult despite cytological, biochemical and microbiological tests and labeled as undiagnosed exudative pleural effusions. Aim of present study was to make an etiological diagnosis of pleural effusion. Materials and Methods: Study group included patients of exudative pleural effusion where etiological diagnosis could not be yielded by conventional cytological, biochemical and microbiological investigations. Pleural tissue was obtained by Cope's pleural biopsy needle and or thoracoscopy. Pleural biopsy was subjected to histopathology, ZN staining and culture to find the mycobacterium tuberculosis. Results: Out of 25 patients, 17 (68%) and 8 (32%) were male and female, respectively. Age ranged from 15 to 65 years (mean 31.72). Mean value of serum and pleural fluid LDH was 170.56 U/L and 1080.28 U/L, respectively. Histopathology of 9 (36%) showed epitheloid granuloma with caseation necrosis. In other 9 (36%) patients, epitheloid granulomas (with or without giant cells) was reported. In 5 (20%) patients, histopathology report was of nonspecific chronic inflammation. Histopathology was reported as normal in one case; it turned out to be a case of malignancy. In two (8%) patients, pleural tissue obtained was inadequate for opinions; however, other tests revealed malignancy in one and tuberculosis in other. Ziehl-Neelsen (ZN) stain was positive for AFB in two patients and culture of pleural tissue showed presence of Mycobacterium tuberculosis in three patients. Conclusions: The role of percutaneous closed needle biopsy of pleura among patients of undiagnosed exudative pleural effusion is still accepted as a diagnostic tool, as this may lead to a specific diagnosis among 76% of cases. This is of particular importance in a developing country like India where the facilities of thoracoscopy and imaging guided cutting needle biopsies are not easily available.

Background: Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes. Aims: To assess the cardiac changes secondary to COPD by echocardiography and to find out the correlation between echocardiographic findings and severity of COPD, if there is any. Materials and Methods: A total 40 of patients of COPD were selected and staged by pulmonary function test (PFT) and evaluated by echocardiography. Results: On echocardiographic evaluation of COPD, 50% cases had normal echocardiographic parameters. Measurable tricuspid regurgitation (TR) was observed in 27/40 cases (67.5%). Pulmonary hypertension (PH), which is defined as systolic pulmonary arterial pressure (sPAP) > 30 mmHg was observed in 17/27 (63%) cases in which prevalence of mild, moderate, and severe PH were 10/17 (58.82%), 4/17 (23.53%), and 3/17 (17.65%), respectively. The frequencies of PH in mild, moderate, severe, and very severe COPD were 16.67%, 54.55%, 60.00%, and 83.33%, respectively. Right atrial pressure was 10 mmHg in 82.5% cases and 15 mmHg in 17.5% cases. Cor pulmonale was observed in 7/17 (41.17%) cases; 7.50% cases had left ventricle (LV) systolic dysfunction and 47.5% cases had evidence of LV diastolic dysfunction defined as A ≥ E (peak mitral flow velocity of the early rapid filling wave (E), peak velocity of the late filling wave caused by atrial contraction (A) on mitral valve tracing). Left ventricle hypertrophy was found in 22.5% cases. Conclusion : Prevalence of PH has a linear relationship with severity of COPD and severe PH is almost associated with cor pulmonale. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions.

Background: Bronchial asthma is a chronic disorder of the airways. Bronchial asthma can be broadly categorized into atopic and nonatopic based on the immunological status, which may be helpful to plan appropriate treatment. In this study, the cytokine profile of the blood was estimated to evaluate the difference between the atopic and the nonatopic asthmatics. Aim: The aim was to document the differences in cytokine (IL-6, TNF-α, and IFN-γ) imbalance in asthmatics with high serum immunoglobulin E (IgE) levels compared to those with normal serum IgE. Materials and Methods: Thirty confirmed bronchial asthmatics (17 men, 13 women) were included in this study. The serum levels of IgE, IFN-γ TNF-α, and IL-6 were measured using the enzyme-linked immunosorbent assay technique. They were divided into two groups based on serum IgE: asthmatics with normal serum IgE levels as group A (n = 7) and high IgE levels as group B (n = 23). Results : The differences in the mean values of IgE, TNF-α, and IFN-γ were statistically significant between the groups. These values were significantly higher in group B compared to group A. IL-6 was not significantly different between the groups. In group A, IL-6 was negatively correlated with IgE and IFN-γ. IgE and IFN-γ were positively correlated. In group B, IFN-γ and TNF-α showed a high correlation of +0.93. Conclusion : Two groups of asthmatics stratified according to their serum IgE levels were immunologically different showing different profiles of serum cytokine levels and the relationship between the cytokines.

To systematically review the role of corticosteroids in prevention of acute respiratory distress syndrome (ARDS) in high-risk patients, and in treatment of established ARDS. Primary articles were identified by English-language Pubmed/MEDLINE, Cochrane central register of controlled trials, and Cochrane systemic review database search (1960-June 2009) using the MeSH headings: ARDS, adult respiratory distress syndrome, ARDS, corticosteroids, and methylprednisolone (MP). The identified studies were reviewed and information regarding role of corticosteroids in prevention and treatment of ARDS was evaluated. Nine trials have evaluated the role of corticosteroid drugs in management of ARDS at various stages. Of the 9, 4 trials evaluated role of corticosteroids in prevention of ARDS, while other 5 trials were focused on treatment after variable periods of onset of ARDS. Trials with preventive corticosteroids, mostly using high doses of MP, showed negative results with patients in treatment arm, showing higher mortality and rate of ARDS development. While trials of corticosteroids in early ARDS showed variable results, somewhat, favoring use of these agents to reduce associated morbidities. In late stage of ARDS, these drugs have no benefits and are associated with adverse outcome. Use of corticosteroids in patients with early ARDS showed equivocal results in decreasing mortality; however, there is evidence that these drugs reduce organ dysfunction score, lung injury score, ventilator requirement, and intensive care unit stay. However, most of these trials are small, having a significant heterogeneity regarding study design, etiology of ARDS, and dosage of corticosteroids. Further research involving large-scale trials on relatively homogeneous cohort is necessary to establish the role of corticosteroids for this condition.

One of the key indicators used under India's TB control program is the DOTS case detection rate of new sputum smear positive TB whose estimates in India are based on incidence estimates derived from Styblo's rule. Styblo's rule was formulated in an era without well-established tuberculosis control program, effective tuberculosis drugs, and emergence of TB-HIV coinfection, so today it does not reflect the true incidence of TB. Considering various loopholes in different methods of measurement of incidence (prevalence surveys of disease/ infection, vital registration system and Styblo's rule), strengthening of existing surveillance system is the best tool to obtain correct estimates of tuberculosis incidence in India.

We report a case of Mycobacterium monacense (M. monacense) isolated from sputum of a female patient for the first time in India. The chest radiograph and symptoms were suggestive of pulmonary tuberculosis. M. monacense was isolated from the sputum specimen at the end of 11 days of incubation. The identification was confirmed by conventional biochemical tests and polymerase chain reaction (PCR) -based Restriction Fragment Length Polymorphism (RFLP) and DNA sequencing targeting Internal Transcribed Spacer (ITS) region and hsp65 gene. The patient was treated with conventional anti-tuberculous drugs.

Lupus vulgaris is chronic, postprimary, paucibacillary cutaneous tuberculosis found in individuals with moderate immunity and high degree of tuberculin sensitivity. Eighty percent of the lesions are on the head and neck. We present the case of a 38 year old lady who was admitted with complaints of worsening breathlessness and low grade fever of one month duration. Examination showed multiple, nontender skin ulcers on bilateral lumbar areas, two oozing serosanguinous discharge and others scarred in the centre. Respiratory system examination and chest X-ray revealed right sided pleural effusion. On investigation, pleural fluid was tuberculous in nature. Skin biopsy from the edge of ulcer was also suggestive of tuberculosis. Patient is doing well on antituberculous drugs . This case highlights the importance of cutaneous manifestations of systemic disease and is an example of the unusual presentation of lupus vulgaris in a case of pleural effusion.

Kerosene ingested, intentionally or accidentally, is toxic. Data is scarce on complications and outcomes of hydrocarbon poisoning following kerosene aspiration in adults and there has been no known case of bilateral hemorrhagic effusion occurring due to it in literature. We, hereby, report a case of a bilateral hemorrhagic pleural effusion secondary to hydrocarbon aspiration in a 40-year old adult.

Non-Hodgkin's lymphoma (NHL) can commonly present as chylothorax and rarely as chylopericardium. Here we are presenting a case of a 21-years-old female with bilateral chylothorax, chylopericardium and chylous ascites all together finally diagnosed to have NHL as the etiology. To the best of our knowledge, it has been reported very infrequently.

Malignant myeloma (MM) is a clonal proliferation of plasma cells with multiple osteolytic lesions. Extramedullary dissemination of multiple myeloma in lung is relatively uncommon. Hereby, we present a case of multiple myeloma with lung plasmacytoma of lung in a 45-years-old, non-smoker, female.

Pulmonary alveolar microlithiasis is a rare disease of unknown cause. We report a case in a young boy who presented with history of failure to thrive and chest X-ray finding suggestive of miliary mottling. Open lung biopsy revealed pulmonary alveolar microlithiasis.

Video Assisted Thoracoscopy (VATS) like any other minimal access surgery has the obvious advantage of less surgical insult, enabling quicker recovery with its attendant reduced hospital costs and earlier return to work. The benefit of earlier return to work is much more important in developing countries. Unfortunately minimal access surgery is yet to gain popularity in trauma surgery, especially in the developing countries due to various reasons. We describe one case report where VATS was used successfully to remove an intrapleural foreign body.

We report a case of anomalous left pulmonary artery (pulmonary artery sling) detected incidentally on computed tomography thorax. This was carried out to rule out bronchogenic carcinoma in a patient of chronic obstructive pulmonary disease who presented with streaking. He was a chronic smoker having bilateral hilar prominence on chest radiograph.

Fraudulent data and plagiarized text may corrupt scientific medical literature and ultimately harm patients. By prescribing erroneous treatment to an individual, only single patient is affected; but by presenting incorrect data or transcripts, the whole scientific medical universe is affected. Although both scenarios are highly undesirable, one can assume the magnitude of the effect of latter. Writers of scientific medical literature have been found to be involved in plagiarism and other publication misconducts from time to time irrespective of social, economic and geographic structure. The reason of such behavior is not usually obvious. Easy availability of personal computers has led to widespread dissemination of medical literature. As a result, young scientists are now publishing their research more frequently and efficiently. At the same time, this has increased the tendency to submit hurriedly prepared, poorly drafted and even illegitimate publications. Use of some amount of copy-paste followed by modifications during preparation of a manuscript seems to be common. Therefore, the researchers, especially postgraduate students, should be educated continuously about ethical medical writing.