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Introduction:Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease affecting the airways, leading to significant morbidity and mortality throughout the world. There is a need to have a holistic evaluation of COPD patients, other than just measuring the level of obstruction as performed by spirometry. High resolution computed tomography (HRCT) scan of thorax partly fulfills this requirement.Materials and Methods:Fifty patients of COPD (confirmed on spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. Complete clinical evaluation was done. The Philips computer program for lung densitometry was used with these limits (−800/−1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes.Results:There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). Mean upper lobe MLD was −839.27 HU, mean lower lobe MLD was −834.91 HU and the mean MLD was −837.08 HU. The lower lobes MLD were found to be decreasing with increasing disease severity. A mild linear correlation of pre forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of Post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. A predictive model can be derived to quantify obstruction severity (FEV1).Conclusion:HRCT may be an important additional tool in the holistic evaluation of COPD. HRCT can well be correlated with the spirometric and clinical features and the level of obstruction can be indirectly derived from it by measuring the MLD.

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BACKGROUND Although, smoking is the most common risk factor implicated in the causation of chronic obstructive pulmonary disease (COPD), biomass smoke exposure is an important risk factor, especially in women residing in rural areas of developing countries such as India. Comorbidities are prevalent in patients with COPD because of systemic inflammation. The prevalence of comorbidities among biomass smoke-induced COPD has not been widely studied. Aims and Objectives-To assess whether patients exposed to biomass fuel have similar clinical profile and prevalence of comorbidities as smoker COPD or not. MATERIALS AND METHODSThe clinical characteristics and prevalence of comorbidities were compared between 411 male patients with smoker COPD and 288 female patients with biomass smoke-induced COPD. RESULTSThe patients exposed to biomass fuel were all females, were younger, had higher body mass index (BMI) and had less severe disease (higher values of post bronchodilator (BD) forced expiratory volume in the first second (FEV1 %)). The mean age in smoker COPD was significantly higher than in biomass smoke-induced COPD (p < 0.001). The mean BMI was lower in smoker COPD as compared to that in biomass smoke-induced COPD and this difference was statistically significant (p= 0.042). Coronary artery disease (CAD) (13.86% versus 3.81%, p < 0.0001) and systemic hypertension (HTN) (15.32% versus 3.47%, p < 0.0001) were significantly more common in smoker COPD without any other significant differences. Obstructive sleep apnoea (OSA), lung cancer and anaemia were found to be more common in biomass fuel-induced COPD, although not statistically significant. CONCLUSIONCAD and systemic HTN were significantly more prevalent in smoker COPD. KEYWORDSChronic Obstructive Pulmonary Disease, Biomass, Tobacco, Comorbidity. HOW TO CITE THIS ARTICLE: Jangpangi DS, Singh A, Rawat J, et al. A comparison of clinical profile and prevalence of comorbidities among biomass and tobacco smoke-induced COPD patients at a tertiary care centre in North India.

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ObjectivesVisual snow syndrome is relatively a recently recognized neurological entity presenting primarily with positive visual disturbance. Etiology is largely speculative.MethodsAuthors report here on a child case of ADHD that developed a probable visual snow syndrome related to methylphenidate.Results and ConclusionsAlthough remaining rare, prescribers ought to be cognizant of such unusual methylphenidate-related perceptual alterations.

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