Background: The measurement of ECO may represent a new method for the non-invasive monitoring of airway inflammation and oxidant stress in Chronic Obstructive Pulmonary Disease, asthma, bronchiectasis, cystic fibrosis patients. Quantification of lung oxidative stress in stable COPD patients by measuring ECO levels may also contribute to the understanding of the pathophysiology of COPD. Aims & Objective:To study the utility of measuring Exhaled Carbon Monoxide (ECO) level in addition to Pulmonary Function Test (Spirometry) in the monitoring of Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: COPD patients who were smokers and with a history of exposure to wood smoke (n =60) and healthy nonsmokers as control (n =40) were selected as subjects by fulfilling the exclusion criteria as per the GOLD guidelines. Clinical examinations and spirometry including reversibility test were made following the standard protocol/procedure. ECO was measured using a MICRO III Smokerlyser. Results: The difference in level of ECO between COPD cases and healthy non-smokers was highly significant (F = 23.897; df = 98; p < 0.0001). The difference in the level of ECO among different groups (mild, moderate, severe and very severe) was highly significant (F=15.995; df =2; p<0.0001). ECO level in female COPD cases who were exposed to wood smoke was elevated (4.11 ± 1.323) when compared to healthy female non-smokers (1.50 ± 0.519) and the difference was highly significant. (F =1.593; df = 30; p < 0.0001). Conclusion: ECO levels in COPD cases vary with different grades of air way obstruction. We concluded that measuring the level of ECO in COPD cases along with spirometry forms a new approach for better understanding of pathophysiology of COPD cases, with indirect assessment of airway inflammation, oxidative stress and severity of airway obstruction.

Background: Tumor necrosis factor alpha (TNF α) is the most widely studied cytokine of TNF super family. TNF α plays a significant role in many inflammatory diseases affecting the lung, such as chronic bronchitis (CB), chronic obstructive pulmonary disease (COPD), asthma, acute lung injury (ALI) and acute respiratory distress syndrome. Elevated levels of TNF-alpha are seen in COPD patients. An increased level of TNF-α has been found in induced sputum or lung biopsy of COPD patients. 14-16 This study includes correlation of level of TNF α with severity and characterization of individuals with COPD. There are only limited numbers of studies being conducted regarding this topic in the world, including India. Objectives of present study were to measure the TNF-α level in patients with chronic obstructive pulmonary disease and to correlate TNF α level with severity of chronic obstructive pulmonary disease.Methods: The study was conducted on one hundred and eight (108) patient’s COPD patients attending the Pulmonary medicine department of Sri Manakula Vinayagar Medical College and Hospital Puducherry, who are aged above forty years, with a duration of 18 months, starting from the date of getting approval from the Ethics Committee. The subjects were analysed on their TLC, DLC was done to rule out any co-existing infections. Spirometry was done to confirm the diagnosis of COPD. Blood was taken from the confirmed COPD patients after getting their approval, for the estimation of serum TNF α level.Results: The Serum TNF alpha levels increases according to the COPD severity. The mean serum TNF alpha level in patients with mild obstruction, moderate obstruction, severe and very severe obstruction were 9.91+2.9, 21.25+4.8, 32.4+8.2 and 39.2+3.1pg/dl respectively. Mean TNF alpha value was 26.7pg/dl. The values of TNF α increases with the stages of COPD which is statistically significant with p value of 0.0001.Conclusions: The present study showed that serum TNF alpha level correlates with severity of airway obstruction in spirometry among the COPD patients. It also correlates with the disease severity as per the different stages of COPD patients (GOLD COPD staging 2016). Thus, serum TNF alpha is a useful marker to monitor the disease severity in addition to spirometric parameters like FVC, FEV1 and FEV1/FVC. However, further studies are needed with larger sample size.

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Adequate cognitive functioning in chronic obstructive pulmonary disease (COPD) patients is essential to understand the nature of the disease, adherence to treatment, and for leading a better quality of life. While cognitive impairment in severe forms of COPD have been well documented, identification of subclinical cognitive impairment in stable COPD patients remains crucial for planning prevention strategies. Hence the present study aimed to study and compare the cognitive function between the COPD patients, and normal individuals. The cognitive function was assessed in 42 stable COPD patients and 42 normal individuals with Mini Mental State Examination (MMSE), and auditory P300 event related potentials. Baseline characteristics and the cognitive parameters were compared between the COPD patients and the normal individuals; a p<0.05 was considered statistically significant. The latency of the P300 waves was significantly (p<0.05) prolonged (304.27±20.73 in COPD, 291.11± 24.53 in normal individuals), and the amplitude (4.36±1.56 in COPD, 5.46±3.12 in normal individuals) was significantly reduced in the COPD patients compared to the normal individuals. MMSE scores were also significantly (p<0.001) different between the COPD patients (26.97±0.89), and the normal individuals (27.80±0.83). Cognition may be affected even at the earlier stages of the disease among the COPD patients, as evident by changes in the P300 values. Auditory P300 event related potential may be used as an adjunct to the routine MMSE examination, as it serves as an effective tool in identifying the cognitive impairment in different stages of COPD. This may help the patients to adopt prevention strategies that help to avoid adverse effects on cognition in future.

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Pulmonary hypertension is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest as assessed by right heart catheterisation. Pulmonary hypertension in pregnancy is known to be associated with significantly high morbidity and mortality rate which ranges between 30% and 56%. So during pregnancy, efforts to be made to diagnose common medical ailments that can be complicated by pulmonary hypertension. Bedside 2D Echo and thoracic ultrasound are the strongly recommended in these patients to diagnose early and prevent the devastating complications. Relevant blood investigations need to be sent to diagnose the underlying etiology and to assess the prognosis. Cardiac catheterization is the gold standard investigation of choice for pulmonary hypertension. But it is 1 performed in very few cardiac centres in developing countries. In India diagnosis largely depends on echocardiography. It should be made clear to women at the time of their PAH diagnosis that pregnancy is not recommended due to the high maternal and fetal risks. If a woman with known PHT become pregnant, counselling should be given for therapeutic abortion. If they are willing for therapeutic abortion, it should be done before 22 weeks of gestation. All women with PHT should be initiated on PAH specific therapies (prostanoids, ccbs, phosphodiesterase inhibitors) except endothelin receptor blockers as it is teratogenic. Pregnancy in PAH is difficult to manage and needs mutidisciplanary team. Pregnancy is not recommended in women with PAH and appropriate counselling to be done to the mother and their relatives.

Necrotizing pneumonia (NP) is an uncommon complication of bacterial pneumonia in children, which must be looked into if a severe pneumonia has poor response to recommended antibiotics. The present case is a toddler with NP in whom fever and cough persisted despite treatment with first-line antimicrobial therapy, computed tomography (CT) scan revealed consolidation with multiple cavities, pseudomonas aeruginosa was the pathogen isolated from bronchoalveolar lavage, which a very uncommon organism is causing NP. Community acquired necrotizing pneumonia caused by pseudomonas is not reported in paediatric population. Hence, we report this case.