Aim: To assess the phagocytic activity of neutrophils in subjects with chronic obstructive pulmonary disease (COPD). Background/Need of Study: There is a paucity of data in relation to phagocytic function in COPD. By this multidisciplinary study, a better understanding about the etiology of lung destruction among COPD patients is being sought. Materials and Methods: The study was conducted among 28 subjects with COPD and 25 controls in a private tertiary hospital in Chennai after obtaining Institutional Ethical Clearance. Known cases of COPD as proven by clinical findings and spirometry were included in the study, and subjects with any other source of infection, recent surgery, or chronic granulomatous disease were excluded. The study subjects were divided into three groups based on the severity of COPD as determined by spirometry, and healthy volunteers were taken as Group 4. After obtaining informed consent, validated respiratory health questionnaire was administered. The phagocytic function was assessed by Candida phagocytic test and Nitroblue Tetrazolium (NBT) Reduction Test. Results: Significantly impaired phagocytic function as indicated by lower phagocytic, lytic indices and decreased NBT reduction of neutrophils was seen in COPD subjects compared to normal healthy controls (P <.001). Conclusion: This study showed that there is phagocytic dysfunction in COPD subjects when compared with normal subjects. This could be due to underlying inflammation in human airway. Understanding the role of neutrophils may lead to improved understanding of the pathogenesis of COPD, which in turn may pave way for implementing modified therapeutic intervention strategies.

Objectives: To determine the prevalence of infections, risk factors, and outcomes in a medical intensive care unit (ICU), we performed a hospital-based study. Materials and Methods: Consecutive patients were enrolled and details of risk factors and bacteriological data were obtained. Outcomes were death/transfer to palliative care or recovery. Statistical analyses were performed. Results: Four hundred and eighty-seven patients were admitted during the study period (age 55.6 ± 19 yr, men 68%). Diseases responsible were respiratory (37%), gastrointestinal/liver (22%), neurological (20%), renal (8%), and trauma (6%) related. Majority of admissions were direct (45%) or transfers from other hospitals (41%). Most important comorbidities were hypertension (41%), diabetes (31%), and chronic obstructive pulmonary disease (15%). Median APACHE-2 score was 13.0 (IQR 1–25). Antibiotics were administered in 98%. Bacteriological cultures were positive in 28% (n = 623). Respiratory infections were the most common (45.5%) followed by blood (23.3%) and urinary (16.1%). Gram-negative bacteria were common–Acinetobacter baumannii (20.9%), Klebsiella pneumoniae (19.7%), Escherichia coli (18.3%), and Pseudomonas aeruginosa (14.0%). There a high prevalence of resistance to common antibiotics. Patients with positive cultures were older, transferees (46 vs 37%, P = 0.07), with respiratory disease (48 vs. 33%, P = 0.003), with more than two comorbidities (33 vs 21%, P = 0.009), and higher APACHE-2 score (17.7 ± 8 vs. 13.3 ± 8, P = 0.07). Three hundred and fifty-two (72.3%) recovered, 68 (13.9%) died, and 67 (13.8%) were transferred to palliative care. Survival was associated with younger age, lower APACHE-2 score, negative cultures, and shorter duration in ICU (P < 0.05). Mortality was greater in patients with Acinetobacter (OR 2.36, 1.17–4.73), Klebsiella (OR 2.81, 1.33–5.92), Pseudomonas (OR 8.03, 2.83–22.76), or Enterobacter (OR 6.73, 1.29–35.12) infection. Conclusions: There is high prevalence of infections in patients in a medical ICU in India. Gram-negative bacteria are the most prevalent and resistance to antibiotics is high. Risk factors are age, hospital transfers, APACHE-2 score, and multiple comorbidities.

Background: Genetic variation in HLA genes influence the immune response and may thus contribute to differential development of tuberculosis (TB) in HIV-infected individuals. The study was designed to determine whether HLA polymorphisms influence the development of Mycobacterium tuberculosis infection in HIV-infected individuals. Materials and Methods: Fifty HIV-positive individuals without TB (HIV+TB−), 50 HIV patients co-infected with TB (HIV+TB+) and 50 control subjects (HIV-TB-) were analyzed for HLA Class I and II polymorphisms. Results: In HLA Class II, frequency of occurrence of DRB1*13 (OR 3.165, CI 1.176–8.518, P value 0.019), DRB5 (OR 2.253, CI 1.011–5.019, P value 0.045) and DQB1*06 (OR 2.705, CI 1.197–6.113, P value 0.016) were increased in HIV+TB+compared to HIV+TB−. HLA DQB1*02 (OR 0.436, CI 0.185–1.029, P value 0.05) on the other hand conferred a protective role. In HLA Class I, frequency of B*15 (OR 2.705, CI 1.040–7.036, P value 0.038) was increased, whereas B*51 (OR 0.148, CI 0.031–0.706, P value 0.007) was decreased in HIV+TB+group compared to HIV+TB−. These differences however were not significant when compared with healthy controls. Conclusion: HLA polymorphisms independently did not account for the susceptibility to either of the disease mostly, although they seem to play a role once the infection(s) has established in a particular individual. Further studies are needed on a larger sample size to confirm these observations.

Background: Diffuse parenchymal lung diseases (DPLD) are a group of disorders characterized by chest radiological findings of bilateral diffuse shadowing. Lung biopsy is generally required to make an etiological diagnosis of DPLD's. Transbronchial lung biopsy (TBLB) is a minimally invasive method to achieve a lung sample which has been found to be a useful diagnostic tool in patients with DPLD. As per American Thoracic Society guidelines for management of idiopathic interstitial pneumonias, TBLB is not required in patients who have findings consistent with idiopathic pulmonary fibrosis (IPF) on HRCT scan thorax. Some Indian researchers have evaluated, on a small number of subjects, the role of TBLB in patients with DPLD, but they had not excluded patients with 'IPF pattern'. This study was planned to assess TBLB in patients with DPLD after excluding patients with 'IPF pattern'. Materials and Methods: A prospective non-randomized study on 49 patients with DPLD without a characteristic 'IPF pattern' were subjected to TBLB. Results: The overall diagnostic yield of TBLB was 85.7%. Non-specific interstitial pneumonitis, tuberculosis and sarcoidosis were the most common histology patterns found (22.4, 18.4 and 16.3%, respectively). Procedure-related mortality was nil. Iatrogenic pneumothorax occurred in five patients (10.2%). Minor complications included hemorrhage and transient hypoxia. Conclusion: TBLB is a safe and effective tool in the diagnosis of DPLD.

Background and Objectives: Air pollution due to road traffic is a serious health hazard and air quality crisis in cities is mainly due to vehicular emission. Thus the persons who are continuously exposed are at an increased risk. The study was carried out to evaluate the extent of impairment in lung function in traffic police personnel compared to matched unexposed control group. Materials and Methods: A cross-sectional study was conducted to measure the spirometric parameters of 100 traffic police personnel, aged 20-55 years, working in Saurashtra region, as compared to matched control group, consisting of 100 unexposed males. Measurement of lung volumes and capacities was done with SPIROEXCEL. The statistical analysis was carried out with Graph pad instat 3. Results: Traffic police personnel had significantly declined forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), slow vital capacity (SVC) and maximum voluntary ventilation (MVV) when compared with predictive normal values, which is probably due to exposure to vehicular exhaust. Comparison of test values between groups showed significantly reduced FVC, MVV and increased FEV1/FVC ratio and insignificantly declined FEV1 and SVC in cases as compared to controls. Traffic personnel with longer duration of exposure showed significantly reduced lung functions than those with shorter duration. Smokers showed lower test values as compared to non-smokers with significance only in unexposed group. Conclusion: The effect of pollution by vehicular exhausts may be responsible for these pulmonary function impairments and traffic police personnel should be offered personal protective or preventive measures.

Introduction: Laryngeal tuberculosis is often misdiagnosed and is a highly contagious public health problem. The changing pattern of the clinical involvement of this disease poses a diagnostic challenge. The authors report four cases of laryngeal tuberculosis encountered in a short span of one month. Materials and Methods: All the four patients who presented to us with hoarseness had underlying active lesions in the lung. In spite of that they presented with mainly laryngeal symptoms and a multitude of findings on laryngeal examination. A diagnosis could be established owing to a high index of clinical suspicion, and due consideration given to the chest findings and positive sputum examination. The patients showed an excellent response to antituberculous therapy. Results and Conclusions: This study underlines the varied nature of laryngeal tuberculosis and the importance of addressing the hoarseness of a patient at the earliest, for the prompt diagnosis of this infectious condition.

Background: Acute exacerbations of chronic obstructive pulmonary disorder (AECOPD) are known to be associated with increased morbidity and mortality and have a significant socioeconomic impact. The factors that determine frequent hospital readmissions for AECOPD are poorly understood. The present study was done to ascertain failures rates following AECOPD and to evaluate factors associated with frequent readmissions. Materials and Methods: We conducted a prospective study among 186 patients with COPD with one or more admissions for acute exacerbations in a tertiary care hospital. Frequency of previous re-admissions for AECOPD in the past year, and clinical characteristics, including spirometry were ascertained in the stable state both before discharge and at 6-month post-discharge. Failure rates following treatment were ascertained during the follow-up period. All the patients were followed up for a period of 2 years after discharge to evaluate re-admissions for the AECOPD. Results: Of 186 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex-heavy smokers, associated co-morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.37; 95% CI: 0.10-0.86), use of Tiotropium (OR = 2.29; 95% CI: 1.12-4.69) and use of co-amoxiclav during first admission (OR = 2.41; 95% CI: 1.21-4.79) were significantly associated with higher immediate failure rates. The multivariate analysis for repeated admissions revealed that disease duration >10 years (OR = 0.50; 95% CI: 0.27-0.93), low usage of inhaled ICS + LABA (OR = 2.21; 95% CI: 1.08-4.54), and MRC dyspnea grade >3 (OR = 2.51; 95% CI: 1.08-5.82) were independently associated with frequent re-admissions for AECOPD. Conclusions: The outcomes of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing frequency of repeated COPD exacerbations were disease duration, low usage of inhaled ICS + LABA, and MRC dyspnea grade >3.

Air pollution has become the world's single biggest environmental health risk, linked to around 7 million deaths in 2012 according to a recent World Health Organisation (WHO) report. The new data further reveals a stronger link between, indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischemic heart disease, as well as between air pollution and cancer. The role of air pollution in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases, is well known. While both indoor and outdoor pollution affect health, recent statistics on the impact of household indoor pollutants (HAP) is alarming. The WHO factsheet on HAP and health states that 3.8 million premature deaths annually - including stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer are attributed to exposure to household air pollution. Use of air cleaners and filters are one of the suggested strategies to improve indoor air quality. This review discusses the impact of air pollutants with special focus on indoor air pollutants and the benefits of air filters in improving indoor air quality.

We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.

Teratoma is a rare presentation in adult, specifically in cervico-mediastinal region. We reported two adult patients with diagnosis of cervico-mediastinal teratoma and operated them. In adult patients who present with cervico-mediastinal mass, benign teratoma could be one of a differential diagnosis although it is a rare presentation.

There are limited treatment options for advanced interstitial lung disease (ILD). We describe a patient of ILD treated with mesenchymal stromal stem cell infusion. The index patient had end-stage ILD due to a combination of insults including treatment with radiotherapy and a tyrosine kinase inhibitor Erlotinib. He was oxygen-dependent and this was hampering his quality of life. He tolerated the first infusion stem cells without any problem. During the second infusion he developed anaphylactic shock, which was appropriately managed. At 6-months follow-up he had no improvement in oxygenation, pulmonary function or CT scan parameters. In view of anaphylaxis, further infusions of MSC were withheld. A longer follow-up may reveal long-term benefits or side effects, if any. However the occurrence of anaphylaxis is of concern suggesting that further trials should be conducted with intensive monitoring.

Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.

Presence of miliary shadows in chest imaging in the appropriate clinical setting is often taken as a marker of miliary tuberculosis. If sputum is negative for acid -fast bacillus, empirical anti-tubercular therapy is given without securing a histological or microbiological diagnosis. We report a young female with human immunodeficiency virus infection who had miliary infiltrates on chest radiography. She was started on empirical anti-tubercular therapy. But an alternate diagnosis was achieved later with invasive sampling and ATT was stopped. This case illustrates the need for physicians to remain alert to diseases which mimic tuberculosis in presentation.

The Löeffler syndrome is characterized by pulmonary infiltrates on a chest x-ray accompanied with peripheral eosinophilia. In this article, we have highlighted the Löeffler syndrome complicated with a eosinophilic leukemoid reaction in a previously healthy boy. The patient was treated with albendazole for five days, with a successful result. In countries where parasitic diseases are endemic, the Löeffler syndrome must always be considered in patients who present with a eosinophilic leukemoid reaction.

Primary myoepithelial carcinoma (MC) of the lung is exceedingly rare. We report here, to the best of our knowledge, the first pediatric case having primitive pulmonary MC. The originality of our case was the disappearance of the pulmonary opacity spontaneously, without any treatment. The difficulties in our case were the diagnosis of this rare entity and its subsequent treatment. In fact, given the rarity of these tumors, recommendations regarding chemotherapy or radiation, were difficult to formulate.

Lymphocytic interstitial pneumonia (LIP) is a rare form of interstitial lung disease usually associated with other systemic diseases; however, idiopathic cases are being reported. As per recent ATS/ERS 2013 guidelines, diagnostic criteria of clinical, radiological and histopathological for LIP is same as 2002 except some cystic changes on HRCT chest. Many cases diagnosed in the past as LIP now turn out to be NSIP; therefore as per new ATS/ERS classification whenever anybody report a case of LIP, NSIP should always be kept in mind as differential diagnosis. Here we present a case of LIP in an immunocompetent adult male presented with history of persistent dry cough and breathlessness on exertion, confirmed on HRCT chest and histopathologically, treated successfully with steroids.

Multiple myeloma is a malignant neoplasm of plasma cell origin that mainly affects bone marrow and skeletal system, producing large amount of light chain immunoglobulins. Pleural involvement in multiple myeloma is a rare complication which carries very poor prognosis. We report a case of multiple myeloma who presented with recurrent pleural effusion that was evaluated by means of thoracoscopy.

Endobronchial tuberculosis has a very varied presentation. Diagnosis is often very challenging as typical radiological features are absent and sputum smear for acid-fast bacilli is often negative. However, detection is essential as it may lead to long-term sequelae such as bronchial stenosis. Bronchoscopy is a very useful investigation in such cases. Our case is a rare manifestation of endobronchial tuberculosis as it mimicked malignancy.

The term "cryotherapy" comes from the Greek cryo (κρυύο) meaning cold, and therapy (θεραπειύα) meaning cure. Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. Carcinoid tumors of the lung are a fascinating but uncommon group of pulmonary neoplasms. In the past, these tumors were grouped with benign or less aggressive malignant pulmonary tumors, namely bronchial adenomas. Recent studies have revealed that carcinoid lung tumors are the most indolent form of a spectrum of bronchopulmonary neuroendocrine tumors that, at its extreme, include small cell carcinoma of the lung as its most malignant member. They commonly present as endobronchial obstructions, and if complete, can be life-threatening and require immediate intervention.^[1] Recently, we have treated a patient of carcinoid tumor of lung who was managed with cryo-recanalization with excellent response.

Isolated pulmonary cysticercosis is extremely rare manifestation of a rather common disease which is distributed worldwide. Most common sites which provide perfect nourishment for the growth of cysticercosis are muscle and brain followed by eye. Pulmonary involvement in cysticercosis is very rare and if at all present, then ill-defined nodular shadows distributed throughout the lung is the usual radiological presentation. No case of cysticercosis presenting as lung cavity with pleural effusion has been reported so far in literature. We came across a rarest presentation of cysticercosis as cavity in the lung with effusion. After nullifying all the differential diagnosis of cavitary lung lesions, a diagnosis of pulmonary cysticercosis was made by histopathological examination of the lung cavity aspirate and enzyme linked immunosorbent assay (ELISA) for cysticercosis. Case was successfully treated with albendazole (15mg/kg) with steroid cover.