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Background: COPD being a systemic inflammatory disease is accompanied by alteration of various inflammatory cytokines which affect the metabolic equilibrium of body. Some therapeutic options, mainly statins via their wide range of pharmacologic actions alter the level of proinflammatory cytokines hence, helpful in attenuating various extra-pulmonary consequences of COPD. We did a randomised case-control study to study the effect of statin supplementation on pulmonary function and inflammatory markers in patients of COPD. Methods: We included 40 stable COPD subjects & randomized them in two groups, Intervention & Non-intervention. Intervention group received 40 mg atorvastatin once daily for 3 months in addition to the conventional treatment of COPD similar to the prior one. We studied levels of IL-6 & CRP and correlated them with disease severity before and after the aforementioned intervention. Results: We observed that CRP levels decreased in both the groups after a follow up of 3 months, but neither of them was statistically significant (p=0.57 & 0.63 respectively) nor the mean of their difference (p=0.969). IL-6 levels showed a persistent decline in intervention group but, was not significant (p=0.91). In this study, we noticed statistically significant improvement in FEV1 (p=0.008) in the intervention group which was in contrast to non-intervention group. Similarly, the exercise capacity also statistically increased in the intervention group (p=0.002). There was also evident negative correlation between exercise capacity and IL-6 as well CRP levels. FEV1 also showed statistically significant negative correlation with IL-6 levels (p=0.023). Conclusion: We can improve the disease outcome and alter its natural progression by altering the levels of inflammatory markers with the aid of some additional pharmacological interventions i.e., in this study was atorvastatin.

Background: Chronic obstructive pulmonary disease (COPD) has a major impact on health status in accordance with disease severity. It is usually assessed by the various quality of life questionnaires. Objectives: The aim of this study is to assess the disease severity and health status in stable patients of COPD using COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores and to correlate with BODE index and its components. Methods: One hundred patients of stable COPD were subjected to CAT, CCQ irrespective of the stage of COPD during their visit. BODE index was also calculated. Results: COPD severity status assessed using forced expiratory volume 1% (FeV1%) predicted values correlated significantly with individual scores (CAT and FeV1%; r = −0.67; P < 0.001 and CCQ and FeV1%; r = 0.61; P < 0.001). CAT and CCQ score also correlated significantly (r = 0.84, P < 0.001) and both with the BODE index (r = 0.80; CAT and r = 0.66; CCQ, P < 0.01). Individual components of BODE index significantly correlated with CAT and CCQ scores. Conclusions: The CAT and CCQ have similar psychometric as well physical properties to assess the health status of COPD patients and can be used as a reliable scientific research tool and can be used in clinical practise to study the disease state and plan an appropriate treatment plan. The BODE index which is more objective, correlated well.

Amiodarone is an iodine-rich Class III antiarrhythmic drug, which acts via membrane ion channels. It is metabolised in the liver to produce the active metabolite desethylamiodarone. It is highly lipophilic with a large volume of distribution and accumulates in many different tissues, especially the liver. It is widely used in supraventricular and ventricular arrhythmias and given as a loading dose, either via the intravenous or oral route, followed by maintenance doses. The common adverse effects of amiodarone are nausea, vomiting, tremor, thyroid dysfunction, peripheral neuropathy, photosensitivity, bradyarrhythmia, worsening of arrhythmia and the less common ones are pneumonitis, optic neuropathy and hepatotoxicity.

Tissue hypoxia due to repeated sleep apneas leads to increased serum levels of uric acid (UA) and lactate in patients with obstructive sleep apnea syndrome (OSAS). Studies on assessment of serum level of UA in patients of OSAS are available. However, research on simultaneous evaluation of levels of serum lactate and UA is lacking.Prospective, case-control study in a tertiary care institution.Forty patients suffering from OSAS, diagnosed by night polysomnography (PSG), were included in this study. Forty age- and sex-matched subjects in whom the presence of OSAS was ruled out by night PSG were included as healthy controls. Participants underwent a procedure for the measurement of serum UA and lactate before and after sleep.Both before and after sleep UA levels of patients with OSAS were found to be significantly higher (P=.001 and .002, respectively) as compared to UA levels of controls. A statistically significant (P=.02) overnight (after sleep) rise was observed in the serum lactate level of OSAS patients. The correlation between serum UA values and %TSTs (percentage of total sleep time spent) below 95% SaO2 (arterial oxygen saturation) was statistically significant (P=.02). The correlation was positive with %TSTs below 90% SaO2, whereas it was found negative with normal basal oxygen. No significant correlation was observed between serum UA and the AHI (apnea-hypopnea index). Polysomnographic variables failed to show significant correlation with serum UA on respective multiple regression models controlling for age, body mass index, and waist-hip ratio. However, plasma lactate levels after sleep correlated with %TSTs below 95% of SaO2 and AHI with P values of .02 and .01, respectively.Both serum UA and lactate were positively correlated with the degree of hypoxia in OSAS. The plasma UA levels in patients with OSAS did not show an overnight rise. However, the plasma lactate levels were higher in the morning. The measurement of serum lactate level was a better marker of oxidative stress among patients with OSAS.

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.

INTRODUCTION: Managing and treating infected nonunion is one of the most challenging clinical scenarios despite numerous advances in the fixation methods, soft-tissue management, and antibiotic therapy. The infection of the fracture site causes internal fixation to become unstable and it slows down fracture healing. AIMS AND OBJECTIVES: To assess role of antibiotic-impregnated bone cement rod in control of bone infection and assessing its role in union in cases of infective nonunion of long bones. MATERIALS AND METHODS: This was a prospective study comprising of 30 cases of established infected nonunion of long bones carried out in a tertiary care center in Western Maharashtra. Patients of nonunion of long bone diaphysis with established clinical and laboratory evidence of infection were included in the study. RESULTS: Twenty-one cases showed complete union at 6 months or earlier. Two more cases showed significant callus formation. In three cases, there was no callus formation at fracture site till 6 months. DISCUSSION: Various authors in their studies confirmed that gentamicin and vancomycin are antibiotics which maintain activity even after being exposed to the high temperatures resulting from poly (methyl methacrylate) hardening. CONCLUSION: From our study, we confirm that the use of antibiotic-impregnated bone cement rod has a significant role in control of bone infection and also assists in union in cases of infective nonunion of long bones.

Peripartum acute renal failure is an important complication related to pregnancy leading to significant morbidity and mortality. Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma, with formation of gas within the collecting system, renal parenchyma, or perirenal tissues. EPN is common in persons with diabetes or urinary tract obstruction. Herein we report a case of bilateral emphysematous pyelonephritis in a postpartum lady who had no evidence of diabetes or urinary tract obstruction. Management of this condition has traditionally been aggressive, and surgery has been considered mandatory. Our patient was managed successfully with antibiotics and supportive measures alone.

Hemophagocytic syndrome (HPS) is a rare, fatal disorder, presenting with fever, pancytopenia, liver dysfunctions, hepatosplenomegaly, hypertriglyceridemia, and hyperferritinemia [1]. HPS may be primary related to genetic mutations or secondary to various infections, malignancies and rheumatic conditions [2]. These antigenic stimuli cause uncontrolled immune reaction with a cytokine storm and activated macrophages that can be fatal. Anecdotal reports of pregnancy-induced HPS are available [3, 4]. We report a case of pregnancy induced HPS which was almost fatal for the mother but she recovered after spontaneous abortion.

Introduction: Backache and sciatic pain are routinely seen in day-to-day practice. In all urban settings with changed lifestyle, lack of exercise, bad posture, excessive use of vehicles, and disturbed nutrition; problem of discogenic backache and sciatica is on the rise. The treatment modalities vary from conservative to surgical methods, but they predominantly provide relief to leg pain and not back pain. Nerve root block acts at these inflammatory processes, by the action of the steroid and thus decreasing the chemical irritation to the nerve roots. Furthermore, there is a decrease in sensitization of dorsal horn neurons by bupivacaine. Aims and Objectives: To evaluate diagnostic and therapeutic efficacy of root block procedure. To study relief in terms of pain alleviation, activities of daily living, and straight leg raising (SLR) restriction. Materials and Methods: Retrospective study of fifty patients of sciatic radiculopathy between the ages of 20 and 60 years were evaluated under this study at Dr. D. Y. Patil Medical College and Research Centre, Pune. All the patients of different age and sex had radicular pain with or without back pain, restricted spinal mobility, positive active and passive SLR test, and other nerve tension signs. Results: Out of fifty patients selected after thorough clinical and radiological examination, 45 (90%) had enjoyed complete pain relief and 31 (62%) of which were completely symptom-free at the end of 1 year. Conclusion: Spinal nerve root block may provide lasting therapeutic benefit, allowing the patient to participate in physical therapy and early return to routine activities saving working manpower hours.

Background: Dengue infections may present with neurological complications. Whether these are due to neuromuscular disease or electrolyte imbalance is unclear. Materials and Methods: Eighty-eight patients of dengue fever required hospitalization during epidemic in year 2010. Twelve of them presented with acute neuromuscular weakness. We enrolled them for study. Diagnosis of dengue infection based on clinical profile of patients, positive serum IgM ELISA, NS1 antigen, and sero-typing. Complete hemogram, kidney and liver functions, serum electrolytes, and creatine phosphokinase (CPK) were tested. In addition, two patients underwent nerve conduction velocity (NCV) test and electromyography. Results: Twelve patients were included in the present study. Their age was between 18 and 34 years. Fever, myalgia, and motor weakness of limbs were most common presenting symptoms. Motor weakness developed on 2 nd to 4 th day of illness in 11 of 12 patients. In one patient, it developed on 10 th day of illness. Ten of 12 showed hypokalemia. One was of Guillain-Barré syndrome and other suffered from myositis; they underwent NCV and electromyography. Serum CPK and SGOT raised in 8 out of 12 patients. CPK of patient of myositis was 5098 IU. All of 12 patients had thrombocytopenia. WBC was in normal range. Dengue virus was isolated in three patients, and it was of serotype 1. CSF was normal in all. Within 24 hours, those with hypokalemia recovered by potassium correction. Conclusions: It was concluded that the dengue virus infection led to acute neuromuscular weakness because of hypokalemia, myositis, and Guillain-Barré syndrome. It was suggested to look for presence of hypokalemia in such patients.

Objectives: To detect the site of airway obstruction in patients of emphysema by impulse oscillometry (IOS) and to compare its observatios with flow volume loop (FV loop) studies. Methods: Twenty-five patients of emphysema were subjected to both impulse os-cillometry (IOS) and conventional spirometry. The resulting impedance spectra by IOS and FV loop were utilized to identify the site of airway obstruction in each of the patients. Both methods applied were also compared for sensitivity to identify airway and specify the site of obstruction. Results: Four patients were excluded from the final analysis as their impedance spectra showed significant upper airway influence, which would have made the localization of the site of airway obstruction by IOS invalid. Both IOS and FV loop could detect airway obstruction in all 21 patients. FV loop localized the site of obstruction as combined central and peripheral airways in 15 patients (71.4%) and as peripheral in 6 (28.6%).The IOS however, revealed the presence of the predomi-nant site of obstruction peripheral in all the 21 patients, and both central and pe-ripheral obstruction in 5 patients (23.8%). Conclusions: IOS had proven to be advantageous over FV loop studies as it could identify central and peripheral airway obstruction separately and established the predominant site of obstruction.

Background: To identify the patients of bronchial asthma (suspected or proven), not responding to optimal therapy, for the presence of vocal cord dysfunction (VCD) and to compare the diagnostic ability of flow volume (FV) loop and impulse oscillometry (IOS). Materials and Methods: Fifty one patients of suspected/proven bronchial asthma not responding to optimal therapy were included for the study. Each patient was subjected to both FV loop and IOS studies. Direct visualization of the vocal cords with flexible fiberoptic bronchoscope for the presence of inspiratory vocal cord adduction during quiet respiration, with speech, and while performing provocative maneuvers was carried out. All patients were subjected to simple pulmonary function tests and recording of FV loop. IOS was performed on each patient to look for the site of obstruction and upper airway influence. The observations of both FV loop and IO studies were compared. Results: Among 51 patients participated, 12 (23.53%) had bronchoscopical evidence of VCD and were labeled as VCD-positive group and rest 39 were designated VCD negative. No statistically significant difference in pulmonary function test (prereversibility) results between the VCD-positive and VCD-negative patients was found. Reversible airway obstruction was observed in 75% of the patients of VCD-positive group and 67.65% of the patients in the VCD-negative group. Only one patient in the VCD-positive and none in VCD-negative group had inspiratory limb flattening of FV loop. Upper airway influence was evident by IOS in 58.3% of patients in the VCD-positive group and in 15.4% of patients in the VCD-negative group. This difference was statistically significant (P < 0.005). Conclusion: VCD was a common finding in patients with symptoms suggestive of asthma and frequently coexists with asthma. IOS was found to be a useful screening test for VCD and was more sensitive than FV loop.

Background: Mechanical ventilation (MV) is a life saving modality. Till no method is evolved to predict the duration of this treatment. This study is undertaken to evaluate the clinical and laboratory parameters at initiation and 48 hour of the patient being treated by mechanical ventilation; and correlate these parameters with the duration of MV required. Methods: It was prospective observational study conducted in the respiratory intensive care unit (RICU) of a tertiary referral and teaching hospital. Thirty consecutive patients suffering from various medical diseases requiring MV were the participants. Clinical, laboratory, ventilatory parameters and six severity scores viz.; GCS, APACHE-II, SAPS, OSF, ALI/ARDS and Sepsis/Septic shock criteria of each patient, both at initiation and at 48 hour of MV were recorded. Correlation between various severity scores at initiation and at 48 hour of initiation with duration of mechanical ventilation was computed. Results: Based on the duration of mechanical ventilation required, the patients were divided in two groups. Those requiring mechanical ventilation 7 days were designated Group I and Group II respectively. Three out of 6 severity scores (GCS, APACHE-II, SAPS) recorded at 48 hour of MV showed statistically significant difference between the both groups with p value of 0.010, 0.009 and 0.006 respectively. Further stepwise logistic regression analysis showed that SAPS score at 48 hour of initiation was the best predictor of duration of MV. It was found that a cut off value of 15 for SAPS score at 48 hour might predict the duration of MV i.e. 7 days. Based on linear regression analysis a simple equation was formulated by putting the SAPS value at 48 hour, the value of Y was computed. If MV required was less than 7 days, the value of Y was more than - 0.172 and if need of mechanical ventilation was more than 7 days, Y was less than -0.1720. Conclusions: For patients requiring MV the clinical, laboratory, ventilatory parameters and severity scores at 48 hour of initiation of MV were more significantly correlated to duration of MV as compared to those at initiation. So the parameters and severity score at 48 hour may help to anticipate the approximate duration of MV. Further a cut off value of 15 for SAPS score at 48 hour helped to predict the duration of mechanical ventilation. The calculation of Y from evolved equation is presumed to predict the duration of requirement of MV.