Background: Air pollution due to road traffic is a serious health hazard and thus the persons who are continuously exposed, may be at an increased risk. Although several studies have confirmed the ill effects of air pollutants on the lung function of traffic policemen, only a few have investigated the relationship between respiratory health and duration of exposure in this category of occupationally exposed persons. Aim: The study was carried out with the aim of evaluating the extent of impairment in lung function in traffic policemen in respect to an unexposed control group having the same age group. Materials and Methods: A cross-sectional study was conducted in which the spirometric parameters of a group of 100 nonsmoking traffic policemen, aged 20-55 years, working in and around Patiala city, were compared with those obtained in an age-matched control group, consisting of 100 healthy males, serving in the Punjab Police, who have never done traffic duty and are thus not exposed to traffic pollution. Lung function was done with MEDSPIROR. The data on the overall health status of the subjects was collected using the standard Respirator Medical Evaluation Questionnaire. The statistical analysis was carried out with SPSS PC software version 13. Results: Traffic policemen recorded a significant decline in various parameters, such as forced vital capacity (FVC), forced expiratory volume in one second (FEV ₁ ), and peak expiratory flow rate (PEFR) when compared with controls, and is probably due to exposure to vehicular pollution. It was also observed that in traffic policemen with >8 years of exposure, the values of FVC (2.7 L), FEV ₁ (1.8 L), and PEFR (7.5 L/s) were significantly lower than those obtained in traffic policemen with <8 years of exposure, in whom the values were 2.9 L, 2.3 L, and 7.7 L/s for FVC, FEV ₁, and PEFR, respectively. Conclusion: The effect of pollution by vehicular exhausts may be responsible for these pulmonary function impairments.

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Inhalation therapy has been employed as the mainstay of the treatment in chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Beta-2 agonists, anticholinergic bronchodilators, inhaled corticosteroids, and sodium cromoglycate are often used alone or in combination in an inhaled form. Studies have shown that inhaled drugs used in the treatment have some adverse effects on the oral health based on their dosage, frequency, and duration of use. Several oral conditions such as xerostomia, dental caries, candidiasis, ulceration, gingivitis, periodontitis, and taste changes have been associated with inhalation therapy. Since the prevalence of chronic respiratory diseases is rising, it is important to provide optimal oral care to the individuals receiving inhalation therapy. This article will review the influence of inhaled drugs on the oral health of individuals and adequate management and prevention of the same.

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Background: Limited data is available on the clinical expression of chronic obstructive pulmonary disease (COPD) from India. The impact of gender on expression of COPD has received even less attention. Apart from tobacco smoke, indoor air pollution, especially from biomass fuel may play an important role in development of COPD in women. Materials and Methods: Seven hundred and two patients of COPD were studied regarding the etiological and risk factors leading to COPD, gender-related differences in clinical presentation, radiological expression of COPD and the co-morbidities in COPD. Results: Tobacco smoke in the form of beedi smoking was the predominant smoke exposure in males, whereas smoke from biofuel burning was the predominant exposure in females. As compared to males, females were younger, reported more dyspnea, more severe bronchial obstruction, more exacerbations, and exhibited higher prevalence of systemic features. Also, females smoked less and had lesser incidence of productive cough, lower body mass index, lesser co-morbidities and less number of hospital admissions as compared to males. Males were more likely than females to have an emphysema-predominant phenotype, while airway-predominant disease was more common among females. Conclusion: The current study shows that gender-related differences do exist in COPD patients. Understanding these differences in etiological agent and clinical picture will help early diagnosis of COPD in females.

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Background: HIV/AIDS pandemic is responsible for the resurgence of TB worldwide, resulting in increased morbidity and mortality. HIV and Mycobacterium tuberculosis have a synergistic interaction; each propagates progression of the other. Coinfection with HIV infection leads to difficulties in both the diagnosis and treatment of tuberculosis, increase risk of death, treatment failure and relapse. Objective: The aim of the present study is to study the clinical, radiological profile of pulmonary and extrapulmonary tuberculosis (EPTB) in HIV-seropositive patients and their relationship to CD4 counts. Materials and Methods: It was a prospective study conducted over a period of 1 year in the department of medicine, Indira Gandhi Medical College, Shimla. We examined 87 HIV-infected patients with associated tuberculosis recruited from the department of medicine and antiretroviral center and were subjected to thorough clinical examination, X-ray chest, tuberculin testing and sputum examination for AFB and necessary relevant investigations for EPTB. Results: Most common affected age group was 31-40 years. EPTB is the commonest form of TB in our study detected in 65 patients. Commonest EPTB was CNS tuberculosis. Disseminated tuberculosis was only found in patient with CD4 count less than 200/cmm. Majority of lymph node TB was diagnosed by fine needle aspiration cytology (FNAC) examination. All patients with AFB-positive lymph node had CD4 count below 200/cum. Conclusions: The results of this study provide information regarding the various forms of TB and their presentation in HIV-infected persons. Early diagnosis of tuberculosis and prompt institution of antitubercular treatment (ATT) reduces mortality and morbidity significantly. In resource-poor areas, the diagnosis can be established with cytological/biochemical analysis of fluid, histopathological examination and ZN staining of tissue coupled with radiological features and response to ATT. Therefore, adequate knowledge of the manifestations of tuberculosis in HIV-infected patients is absolutely necessary for optimal management and to reduce mortality and morbidity.

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Objective: This study analyzes the research output of India in asthma during the period from 1999 till 2008. It analyzes the growth, rank and global publications share, citation impact, share of international collaborative papers, contribution of major collaborative partner countries and contribution of various subject fields. It also analyzes the characteristics of most productive institutions, authors and high-cited papers. Materials and Methods: SCOPUS database has been used to retrieve the data on publication output in asthma research. Results: India ranks 15 ^th position among the top 23 countries in asthma research, with its global publication share of 1.27% (862 papers), registering an average citation per paper of 3.43 and achieved an h-index of 33 during 1999-2008. Conclusion: Indian research output on asthma is quite low in the global context as reflected from its publication output per thousand population (0.001) and its world publication share (1.27%) during 1999-2008. Also, the impact and quality of Indian research is low compared to select developed and developing countries.

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Foreign body aspiration is an important cause of emergency hospital admissions in young children less than 3 years of age. It may manifest with acute respiratory difficulty, choking and wheeze acutely or may be asymptomatic. Surgical emphysema is an unusual presentation of bronchial foreign body aspiration in young children. We describe an infant with bronchial foreign body aspiration that manifested with subcutaneous emphysema and pneumomediastinum. Multidetector-row CT with virtual bronchoscopy helped in the diagnosis by detecting and localizing the intraluminal foreign body in the right main bronchus that was removed with rigid bronchoscopy.

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Purpose: Our objective is to scrutinize clinical, laboratory, radiological characteristics, treatment regimens, and treatment outcomes of malignant mesothelioma (MM) cases in our hospital. Materials and Methods: We investigated, retrospectively, the clinical characteristics and treatment outcomes of all 132 MM patients at Dicle University Hospital between January 2006 and April 2010. Results: A total of 82 (62.1%) patients were male, and 50 (37.9%) female. Median age was 56.0 years. Mean survival time was 9.6±6.9 months. Mean survival time of patients who had received best supportive care was 7.5 months, chemotherapy 10.4 months, and multimodality treatment regimen 12.6 months. Patients in the multimodality treatment group survived longer than did those in the other two groups (P=0.042). A total of 76 patients received chemotherapy, of whom 17 (22.3%) were administered Cisplatin/Carboplatin and Gemcitabine, 58 (76.4%) Cisplatin/Carboplatin and Pemetrexed, and one (1.3%) Cisplatin + Docetaxel. Complete and partial response to treatment in patients receiving Cisplatin/Carboplatin and Gemcitabine was found 47.1% and Cisplatin/Carboplatin and Pemetrexed was found 50.0% (P>0.05). Conclusions: MM related to asbestos exposure is seen frequently in Turkey. Patients present with the typical clinical features of dyspnea, weight loss, and chest pain. Survival analysis shows that patients receiving multimodality treatment may be better.

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Common differential diagnosis of lung and hilar opacity includes infectious pathology or a mitotic lesion. Behcet's disease (BD) is a rarely diagnosed disease in Indian subcontinent. BD is a multisystem inflammatory disorder that presents with recurrent orogenital ulceration, uveitis, and erythema nodosum. We present here the case of a patient who presented with recurrent hemoptysis with radiological picture of hilar mass, during the evaluation of which the diagnosis of BD was established.

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Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

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Multiple pulmonary artery aneurysms are seen along with venous thrombosis in Hughes-Stovin syndrome, which many investigators believe is an incomplete form of Behcet's disease. We present a case of hemoptysis with multiple pulmonary artery aneurysms, femoral vein thrombosis, and oral ulcers with emphasis on its CT features.

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We present a case of a young male who presented with complaints of fever along with cough and sputum. He was diagnosed with having right pleural effusion. He was already taking anti-tubercular therapy for one month before presentation. He was started on intravenous antibiotics and continued on anti-tubercular therapy in our hospital, based on his high leukocyte count, pleural fluid analysis, and ultrasonographic report of multiple hypoechoic areas in the liver. His symptoms continued to worsen and he subsequently developed mediastinal widening and a left lung mass. Commuted tomography (CT)-guided biopsy of the lung mass revealed a desmoplastic small-round-cell tumor. Desmoplastic small-round-cell tumor is a rare and aggressive tumor, which presents rarely as a mediastinal and lung mass. This tumor has very poor prognosis.

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Localized solitary plasmacytoma of the bone is a rare disease and is characterized by only one or two isolated bone lesions with no evidence of disease dissemination. We report a case of solitary plasmacytoma of the rib in a 43-year-old female. The patient underwent complete en-bloc resection of the chest wall including rib, muscle, and parietal pleura. Patient is asymptomatic without any recurrence after two and half years of follow up.

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Two clinical cases of aspiration are reported in elderly ladies with differing presentations following inhalation of the same brand of calcium tablet. One of the patients distinctly recalled the choking episode, whereas the other failed to do so making the diagnosis of aspiration difficult. One of the aspirated tablets was successfully retrieved during rigid bronchoscopy after the patient reported several months of cough requiring multiple courses of antibiotics. The other aspirated tablet was coughed up by the patient after the successful treatment of a pneumonia complicated by a parapneumonic effusion.

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Bronchopleural fistulas can occur from a number of causes (infective, traumatic, or neoplastic). Combined esophageal-pleural and bronchopleural fistula is not a common entity and previously has been reported after pneumonectomy. We describe the imaging findings and procedure of endoscopic glue injection in a case of combined esophageal-pleural and bronchopleural fistula after penetrating thoracic trauma. The treatment included esophageal exclusion for esophageal-pleural fistula, followed by endoscopic injection of glue for closure of bronchopleural fistula. The fistulae were completely sealed.

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Although, smoking is considered the most important predisposing factor in development of emphysema; environmental exposures also play an important role. There have been several studies on work related respiratory symptoms and ventilatory disorders among employees of cement industry. We report a case of cement exposure related emphysema in 75 years old woman construction worker.

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A 22-year-old unmarried man presented to the chest outpatient department with a history of productive cough of two-month duration. He also complained of pain and swelling on the anterior aspect of right side of chest of one-month duration. Imaging studies of the thorax, including chest roentgenography and computerized tomography, revealed an unruptured lung abscess which had herniated into the chest wall. Culture of pus aspirated from the chest wall swelling grew Mycobacterium tuberculosis. He was diagnosed to have a tuberculous lung abscess which had extended into the chest wall, without spillage into the pleural cavity or the bronchial tree. Antituberculosis drugs were prescribed, and he responded to the treatment with complete resolution of the lesion.

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Objective: The objective of the pilot study is to obtain normal maximal inspiratory and expiratory pressures for individuals in the age group 20-70 years in the Mangalore population and to predict normal values according to age, sex, height, and weight using the regression equation. Materials and Methods: Two hundred and fifty subjects were selected through a convenient method of sampling. Fifty subjects each were enrolled in the following age groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 70. Each group had 50 subjects (males-25 and females-25). Baseline data such as height, weight, body mass index were recorded. Maximal inspiratory pressure (PI) and expiratory pressure (PE) were determined following standardized protocol. Result: With regard to PI max and PE max, the measured values were significantly lower than those recorded in previous studies for both males (30%) and females (20%). We found that age served as the best factor for the prediction of PI max and PE max in both genders. Conclusion: The results of this study can be used to predict respiratory muscle strength in healthy adult subjects, and the strategy employed in this study will serve as a useful, simple, reproducible, rapid assessment of respiratory muscle function and also aid the planning of treatment.

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There can be various causes for hemoptysis. We present here a case of hemoptysis in which the chest X-ray helped us to arrive at the diagnosis because of a classical sign. This highlights the need of identifying this finding for prompt recognition of the cause of hemoptysis.

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The burden of chronic obstructive pulmonary disease (COPD) has increased recently in developing countries. On the other hand, structured or non-structured rehabilitation services for COPD patients are not routinely available in these countries. We, therefore, planned this review to re-emphasize the emerging benefits of pulmonary rehabilitation in COPD population. Aim of this review is to stimulate pulmonary physicians in India and other resource-poor areas of the world so that they start using pulmonary rehabilitation or its components more often. The search included standard english literature PubMed citation of relevant original articles, review articles and practice guidelines. The articles and reviews were searched including standard MeSH terms - Rehabilitation (TIAB) and pulmonary disease, chronic obstructive/therapy (MAJOR) and guidelines (TIAB). Available 58 articles in English including 23 reviews from July 2001 to October 2010 were screened for evidence-based benefits regarding respiratory rehabilitation as a whole or its different components. The cross references and current citations relating to primary articles were also included for description. No attempt was done to make a systematic analysis because our purpose was not to derive evidence-based recommendations from database and because sufficient evidence is already available for benefits of selected components of pulmonary rehabilitation in COPD patients. Pulmonary rehabilitation has emerged as an important modality as an adjunct to other therapies in patients of COPD. Limited and more cost-effective protocols are to be developed and executed by healthcare providers, especially in developing countries like India.

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