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Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of morbidity and mortality globally. COPD is a systemic disease, cardiovascular and Peripheral Arterial Disease (PAD) are common entities in COPD. Asymptomatic, undiagnosed PAD can lead to impaired functional exercise capacity, increased morbidity and mortality. Aim: To find out the occurrence of PAD in COPD and relative contribution of PAD, severity of COPD, and Health Related Quality of Life (HRQL) on functional exercise capacity. Materials and Methods: The present study was a prospective, cross-sectional, analytical study carried out in the Department of Respiratory Medicine of a teaching institution in eastern India over a period of six months. All COPD patients diagnosed as per Global Initiative for Obstructive Lung Diseases (GOLD) criteria were recruited for the study after obtaining written informed consent. HRQL was assessed by Clinical COPD Questionnaire (CCQ). Exercise capacity was assessed by Six Minute Walk Test (6MWT) and PAD was evaluated by Ankle Brachial Index (ABI) on Ultrasound (USG) Doppler. Data were analysed using appropriate statistical tests. Mean, Standard Deviation (SD) and percentages were calculated for descriptive frequencies, p-value was calculated using Fischer’s-exact test or Chi-square test for categorical data and independent sample t-test and Kruskal Wallis test for parametric and non parametric data, respectively. Results: Out of 75 COPD patients, PAD was present in 18 (24%) patients. Majority of COPD patients (n=35; 46.6%) were in GOLD group D. There was no statistically significant difference in age, Body Mass Index (BMI) and smoking index between COPD with and without PAD. Most PAD patients were asymptomatic. In comparison to COPD without PAD, severe PAD cases had significantly less Six Minute Walk Distance (6MWD), more episodes of leg cramps and needed to stop more frequently during 6MWT. Apart from PAD, increasing severity in COPD was associated statistically significant changes in Forced Expiratory Volume in the first second (FEV1), CCQ score, 6MWD, post 6MWT Heart Rate (HR), Respiratory Rate (RR), Borg score, fatigue, Oxygen Saturation (SpO2). Conclusion: PAD is a frequent entity in COPD and can be diagnosed easily by measuring ABI. Increasing COPD severity affect HRQL and exercise capacity significantly. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is continuing to be a significant burden in the developing world and tubercular empyema thoracis still remains a common entity with significant morbidity and mortality. Clinical course of tubercular empyema is often accompanied by bronchopleural fistula, concomitant pulmonary tuberculosis and unfavourable outcome. Aim: A prospective study was conducted to assess the clinical presentation of tubercular empyema with special emphasis on evaluating diagnostic role of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and outcome issues. Materials and Methods: A prospective study was carried out consisting of adult cases of tubercular empyema admitted in the department of Respiratory Medicine in a teaching hospital in eastern India over a period of 18 months. Tubercular empyema cases were analysed on the basis of clinicoradiological features, diagnostic challenges with special interest on role of newer molecular diagnostic test like CBNAAT, management and outcome issues. Results: A total of 40 cases of tubercular empyema were encountered during the study period. Tubercular empyema frequently affected young population (mean age 31.5 years) with a male preponderance (72.5%). Thirty five (87.5%) patients had a duration of illness of more than one month on presentation. There was frequent accompaniment of concomitant pulmonary tuberculosis (60%) and bronchopleural fistula (42.5%). Sputum smear for acid fast bacilli (55%) and CBNAAT (57.5%) were positive in good number of cases. Pleural fluid smear for acid fast bacilli and CBNAAT yield were also very high (72.5% and 92.5% respectively). Pleural fluid CBNAAT had a sensitivity of 92.5% (95% CI: 79.61-98.43) and specificity of 100% (95% CI: 93.51-100) in diagnosis of tubercular empyema. Mean duration of Intercostal tube drainage was 45.6 days and eighteen patients needed decortication. Conclusion: Tubercular empyema is a disease affecting the young population most commonly, has a chronicity in clinical course and is commonly complicated by presence of associated pulmonary tuberculosis, bronchopleural fistula and unfavourable outcome. Pleural fluid and sputum CBNAAT have good yield in diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety and depression are important but often under-diagnosed co-morbid conditions in patients with Chronic Obstructive Pulmonary Disease (COPD) which may affect the functional capacity of the patients. Aim: To find out the proportion of depression and anxiety among stable COPD patients using a validated questionnaire suitable for use in clinic and the factors affecting their reduced functional capability as assessed by six-minute walk test. Materials and Methods: This was a descriptive cross-sectional study. Seventy five patients diagnosed with stable COPD in outpatient Department of Pulmonary Medicine in a tertiary care hospital, satisfying all inclusion criteria, were included in the study. They were examined clinically, categorized as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity assessment guideline and interviewed by designated interviewer using validated questionnaire for depression (Hamilton depression rating scale, HAM-D) and anxiety (State Trait Anxiety Inventory, STAI). The functional exercise capacity of the patient was assessed by six-minute walk test. Statistical analysis was performed using Minitab software (version16.1). Results: Among 75 stable COPD patients (68 male, 7 female), majority (32 out of 75) had both depression and anxiety, while only anxiety or depression was present in 9 each. The patients with depression had no significant difference in six-minute walk distance, change in heart rate and respiratory rate (p = 0.4186, 0.219 and 0.41 respectively) as compared to those without depression, but were found to be more dyspnoeic at the end of the test (p= 0.003). There was also no significant difference in walk distance in patients with high STAI score as compared to those with low STAI score (p= 0.276). Conclusion: Both anxiety and depression were present in majority of the stable COPD patients. The presence of these co-morbid conditions had no significant effect on the functional status of the patients in the form of reduced six-minute walk distance, though they were more symptomatic than those without these co-morbidities. [ABSTRACT FROM AUTHOR]

A 52-year-old female was diagnosed with rheumatoid arthritis and was on methotrexate and prednisolone. She developed fever, cough, hemoptysis, and cavitary lesion on chest skiagram. She was put on antitubercular therapy without any improvement, meanwhile she developed painful right foot drop. Clinicoradiology and C-ANCA study confirmed the diagnosis of granulomatosis with polyangitis (GPA). She was started on cyclophosphamide, corticosteroid, and co-trimoxazole. While her treatment was being continued she showed significant improvement of pulmonary manifestations. About 1 year later, there was reappearance of fever, cough, and radiological opacity with oropharyngeal candidiasis. She became very ill with disseminated intravascular coagulation (DIC)-like features. Immunological markers were negative but bronchoalveolar lavage fluid study showed growth of Aspergillus spp. The patient was promptly put on intravenous voriconazole but unfortunately she succumbed to her illness. [ABSTRACT FROM AUTHOR]

Context: Non-resolving pneumonia is often an area of concern for pulmonologists. Fiber optic bronchoscopy (FOB) may have a special role in etiologic evaluation of non-resolving pneumonias. There is paucity of recent studies in this field. Aims: This study aimed to assess the patients of non-resolving or slowly resolving pneumonia with special emphasis on efficacy of FOB and computed tomography (CT)-guided fine needle aspiration cytology (FNAC) in diagnosis. Settings and Design: Prospective, observational study conducted in a tertiary care institute over a period of one year. Materials and Methods: After fulfilling the definition of non-resolving pneumonia by clinical and radiological parameters, patients were evaluated by FOB with relevant microbiological, cytological, histopathological investigations and CT scan of thorax. CT-guided FNAC was done in selected cases where FOB was inconclusive. Results: Sixty patients were enrolled in the study. Mean age was 51.33 ± 1.71 years with male to female ratio 2:1. Right lung was more commonly involved (65%), and right upper lobe was the commonest site (25%). Pyogenic infection was the commonest etiology (53.3%), bronchogenic carcinoma and tuberculosis accounted for 26.7% and 16.7% cases, respectively. Both, FOB (85.7%) and CT-guided FNAC (91.67%) were very useful for etiological diagnosis of non-resolving pneumonia. Both the procedures were safe, and no major complication was observed. Conclusions: Because of the high yield of FOB, it is very useful and safe diagnostic tool for evaluation of non-resolving pneumonia. CT-guided FNAC also gives good yield when cases are properly selected. [ABSTRACT FROM AUTHOR]

Introduction: Understanding oral health and not merely dental health are becoming priorities as mouth often offers first sign and symptoms of many localised and systemic diseases. Like any other urban slums, Siliguri slum peoples were also prone for many illnesses and oral health was a different concern as because offering areca nut with betel to guests was a common practice in that particular area. Aim: To find out oral morbidity pattern among study subjects and to ascertain few behavioural determinants of oral morbidity. Materials and Methods: Community based cross-sectional study was performed in slums of Siliguri city, West Bengal, India, from January 2017 to January 2019. As Siliguri is a large city with more than 5 lac population and 154 slums, cluster sampling was adopted to choose samples from each cluster slum. Total 210 samples were studied derived from World Health Organisation (WHO) sample size formula and applying principles of 30 cluster sampling and data regarding socio-demographic profile, behaviour details and clinical history and examination was collected via self-structured, pretested schedule. Results were analysed in Statistical Package for the Social Sciences (SPSS) version 20.0 software and was presented in frequency tables, Chi-square test was applied for testing statistical significance. Results: Out of 210 study subjects, 154 of them (73.3%) had any form of oral morbidities, 136 study subjects (64.8%) had dental morbidities. Bleeding was commonest symptom for 96 study subjects (62.3%). A total of 59 study subjects (28.1%) had irregular brushing habit and 132 subjects (62.9%) did not wash their mouth after each major meal. A total of 94 subjects (44.8%) had the habit of any form addiction. Conclusion: Adult slum dwellers of Siliguri reported a huge proportion of oral morbidities, majority of which was dental morbidities, irregular brushing habit, lack of mouth wash after meal and addiction were associated with oral morbidities. [ABSTRACT FROM AUTHOR]

A 30-year-old male, carpenter by profession, presented with a history of dry cough and progressive shortness of breath for two months along with right-sided chest pain for one and a half months. The clinico-radiological picture was suggestive of right-sided massive pleural effusion. Computed tomography (CT) scan of the thorax showed a huge mediastinal mass occupying the entire right hemithorax with very small amount of pleural effusion. CT-guided fine needle aspiration cytology and tru-cut biopsy from the mass both revealed small round-cell tumour, possibly small cell carcinoma of the lung. However, on immunohistochemistry tumour cells expressed Mic-2 and it was consistent with a diagnosis of primitive neuroectodermal tumour [ABSTRACT FROM AUTHOR]

A 28-year-old male presented with fever with right-sided chest pain for 2 weeks. Clinicoradiological picture was suggestive of right-sided pleural effusion. He had history of polytrauma following a road traffic accident and had to undergo emergency laparotomy a month ago. Microscopic and culture examination of the pleural fluid showed neutrophilia, high bilirubin content and presence of gram-negative bacilli. Ultrasound of the abdomen showed the presence of biloma in the liver and right subdiaphragmatic space with fistulous communication into the right thoracic cavity. The patient was managed successfully with complete recovery. [ABSTRACT FROM AUTHOR]

A 70-years-old male presented with blackening of both hands and face for last six months which was progressive and attended dermatology outpatients department. Dermatologist opined the skin lesions as acanthosis nigricans. He was referred to our department to evaluate for any underlying internal malignancy as he was a smoker. His chest X-ray revealed right sided hilar prominence with a mid zone cavity with fluid level. Fibreoptic bronchoscopy was done, there was one ulcerative growth in right middle lobe bronchus. Biopsy from the ulcer revealed probable squamous cell carcinoma. CT scan of thorax was also done and CT guided FNAC of Rt lung lesion yielded non small cell carcinoma. His skin lesions were also biopsied and diagnosis of acanthosis nigricans was confirmed. Here we report a case of acanthosis nigricans associated with non-small cell cancer of lung. [ABSTRACT FROM AUTHOR]

Background: Thoracic empyema is a disease of significant morbidity and mortality, especially in the developing world where tuberculosis remains a common cause. Clinical outcomes in tuberculous empyema are complicated by the presence of concomitant fibrocavitary parenchymal disease and frequent bronchopleural fistulae. We performed a prospective study over a one-and-a-half-year period with the objective of comparing the clinical profiles and outcomes of patients with tuberculous and nontuberculous empyema. Materials and Methods: A prospective study of adult cases of nonsurgical thoracic empyema admitted in a tertiary care hospital in eastern India was performed over a period of 18 months. A comparative analysis of clinical characteristics, treatment modalities, and outcomes of patients with tuberculous and nontuberculous empyema was carried out. Results: Seventy-five cases of empyema were seen during the study period, of which 46 (61.3%) were of nontuberculous etiology while tuberculosis constituted 29 (38.7%) cases. Among the nontuberculous empyema patients, Staphylococcus aureus (11, 23.93%) was the most frequent pathogen isolated, followed by Gram-negative bacilli. Tuberculous empyema was more frequent in younger population compared to nontuberculous empyema (mean age of 32.7 years vs. 46.5 years). Duration of illness and mean duration of chest tube drainage were longer (48.7 vs. 23.2 days) in patients with tuberculous empyema. Also the presence of parenchymal lesions and bronchopleural fistula often requiring surgical drainage procedures was more in tuberculous empyema patients. Conclusion: Tuberculous empyema remains a common cause of empyema thoracis in a country like India. Tuberculous empyema differs from nontuberculous empyema in the age profile, clinical presentation, management issues, and has a significantly poorer outcome. [ABSTRACT FROM AUTHOR]

Context: Pneumothorax continues to be a major cause of morbidity and mortality among respiratory patients, but there is a paucity of data regarding etiology, clinical profile, management, and outcome of spontaneous pneumothorax (SP), from this part of the world. Aims: To assess the patients of spontaneous pneumothorax in adults with special reference to the etiology, clinical presentation, management, and outcome of SP. Settings and Design: Prospective, observational study conducted in a tertiary care institution over a period of one year. Materials and Methods: All adult patients of SP attending the department of pulmonary medicine in a tertiary hospital were studied and detailed clinical, radiological, and management data were recorded and analyzed. Results: Sixty consecutive patients, who satisfied the inclusion criteria were included in the study. Among them 10 had primary spontaneous pneumothorax (PSP) and 50 had secondary spontaneous pneumothorax (SSP). The overall male to female ratio was 4:1. The mean age of the PSP patients was 26.3 ± 2.19 years, whereas, that of the SSP patients was 53.42 ± 2.07 years (P < 0.0001). Seventy percent of the patients were smokers. The most common clinical manifestation of PSP was chest pain (80%) in contrast to dyspnea in SSP (96%). The most common cause of SSP (42%) was found to be chronic obstructive pulmonary disease (COPD) followed by pulmonary tuberculosis (30%). The cases were managed with intercostal tube drainage (85%), simple aspiration (8.33%), and observation (6.67%). Full expansion of the lung was noted in 91.67% of the cases. Conclusion: Spontaneous pneumothorax was more common in men. SSP was far more common in this study, and the predominant underlying cause of SSP was COPD, which surpassed tuberculosis as the leading cause of SSP. This is in contrast to the results from previous studies done in our country. Intercostal tube drainage was the mainstay of treatment and the response was good. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical spectrum of diffuse parenchymal lung diseases (DPLD) encountered in the Indian setting and to compare idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated DPLD (CTD-DPLD), the two commonest aetiologies. Materials and Methods: A prospective study of clinical, imaging and laboratory parameters of patients diagnosed as DPLD and followed up in the Pulmonary Medicine Department of a tertiary-care teaching institution in eastern India was conducted over a period of one year. Results: 92 patients of DPLD were diagnosed in the study period with IPF (n = 35, 38.04%), CTD-DPLD (n = 29, 31.5%), hypersensitivity pneumonitis (n = 10, 10.9%), sarcoidosis (n = 5, 5.4%) and silicosis (n = 5, 5.4%) being the common causes. The CTD-DPLD group had a lower mean age (39.5 ± 1.86 vs 56.9 ± 1.12 years), a longer duration of symptoms (3.5 ± 0.27 vs 2.5 ± 0.26 years), more extra pulmonary manifestations, significantly more base line FVC and 6-minute-walk-distance than the IPF patients. 19 patients of IPF (54%) opted for treatment. All the IPF patients had a significant fall in FVC after six months (mean change -0.203 ± 0.01 litres) compared to the CTD-DPLD group (mean change - 0.05 ± 0.04 litres.) Conclusion: CTD-DPLD patients belong to a younger age group, with longer duration of symptoms, more extrapulmonary features, better physiological parameters and better response to therapy than IPF patients. Larger prospective epidemiological studies and enrolment in clinical trials are necessary for better understanding of the spectrum of diffuse parenchymal lung disorders and their therapeutic options. [ABSTRACT FROM AUTHOR]

A response by Somenath Kundu, Subhra Mitra, Subhasis Mukherjee, and Soumya Das to a letter to the editor about the article on the shared experience with video-assisted thoracoscopic surgery (VATS) in the January 2011 issue is presented.

Hexamethyl Melamine (HMM), a derivative of triazine, possesses various pharmacological actions against breast, lungs and ovarian cancers. These derivatives bind with MAP-kinase p-38. A Quantitative Structure-Activity Relationship (QSAR) model was developed using 16 compounds and its ability was verified by a set of nine compounds. Several graph theoretical indices were computed along with quantum chemical parameters and regression equations constructed. A series of triazine derivatives has also been designed and their activity predicted. Some compounds which have high predicted activity are also suggested. [ABSTRACT FROM AUTHOR]

The article focuses on the management and treatment of patients suffering from spontaneous pneumothorax (SP). Topics discussed include pleurodesis for secondary spontaneous pneumothorax (SSP) patients; management of SSP by oxygen flow; high recurrence rate of SP due to agent installation using chest tube; removal chest tube to prevent recurrence, and chest radiography to cross check the recurrence.

A response to a letter to the editor is presented concerning the role of sputum in patients with tuberculous pleural effusion for acid-fast bacillus (AFB) smear.