Targeted metabolomics studies reported metabolic abnormalities in both treated and untreated people living with human immunodeficiency virus (HIV) (PLHIV). The present study aimed to understand the plasma metabolomic changes and predicted the risk of accelerated aging in PLHIV on long-term suppressive antiretroviral therapy (ART) in a case-control study setting and its association with the plasma proteomics biomarkers of inflammation and neurological defects. Plasma samples were obtained from PLHIV on successful long-term ART for more than five years (n = 22) and matched HIV-negative healthy individuals (n = 22, HC herein). Untargeted metabolite profiling was carried out using ultra-high-performance liquid chromatography/mass spectrometry/mass spectrometry (UHPLC/MS/MS). Plasma proteomics profiling was performed using proximity extension assay targeting 184 plasma proteins. A total of 250 metabolites differed significantly (p < 0.05, q < 0.1) between PLHIV and HC. Plasma levels of several essential amino acids except for histidine, branched-chain amino acids, and aromatic amino acids (phenylalanine, tyrosine, tryptophan) were significantly lower in PLHIV compared to HC. Machine-learning prediction of metabolite changes indicated a higher risk of inflammatory and neurological diseases in PLHIV. Metabolic abnormalities were observed in amino-acid levels, energetics, and phospholipids and complex lipids, which may reflect known differences in lipoprotein levels in PLHIV that can resemble metabolic syndrome (MetS).

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BACKGROUNDMalignant pleural effusions are a common cause of morbidity in patients with advanced cancers. Common malignancies associated with malignant pleural effusion include lung, breast and lymphomas. Diagnostic methods include cytological analysis and pleural biopsy either closed or thoracoscopic guided. This study was taken up to analyse the cancers associated with malignant pleural effusions and the diagnostic modalities employed towards the diagnosis of malignant pleural effusion. MATERIALS AND METHODSRetrospective analysis of case records of patients diagnosed as malignant pleural effusion prior to the use of thoracoscopicguided pleural biopsy during a two year period was done and the results were analysed to assess the causes of malignant pleural effusion and the diagnostic methods employed to confirm the diagnosis of malignant pleural effusion. RESULTS48 cases of malignant pleural effusion were identified during the study period. The commonest malignancies associated with malignant pleural effusion were lung and breast cancer. Most of the patients were elderly, but some of the cases were identified in younger age groups especially in breast cancer. Cytological analysis and closed pleural biopsies were the diagnostic methods employed for diagnosing malignant pleural effusion. CONCLUSIONThe study results were consistent with published data that malignant pleural effusions were commonly associated with lung and breast malignancies. Most of the malignancies were in patients aged more than 50 years, but some cases in younger age group especially associated with breast malignancy were noted. Cytology and closed pleural biopsy are adequate to diagnose malignant pleural effusion even in absence of thoracoscopy.

BACKGROUND At present, multidrug resistant (MDR-TB) is a challenge in global efforts to prevent and control tuberculosis. WHO reports estimate that 3.5% of newly diagnosed TB patients and 20.5% of previously treated patients had MDR-TB. 1,2 Known risk factors for emergence of MDR TB include age, sex, number of times exposed to ATT treatment, HIV status and alcoholism. 3,4,5 The aim of the study is to compare the predisposing factors towards the development of drug susceptible and drug resistant PTB among retreatment cases. MATERIALS AND METHODS This study was conducted among 300 retreatment pulmonary tuberculosis patients attending Government Hospital of Thoracic Medicine, Tambaram sanatorium from 2016-18. 150 patients each of drug (Rifampicin) sensitive and drug resistant (Rifampicin) TB diagnosed by CBNAAT were selected by simple random sampling. Detailed data including demographic particulars, treatment history, personal history, HIV status were collected using a standardised questionnaire and the results were statistically analysed. RESULTS Age >45 years, male sex, lower educational status, history of treatment interruption, HIV positive status, smoking and alcoholism were found to have a statistically significant correlation with the development of drug resistant TB.

BACKGROUND Spirometric measurement of post-bronchodilator FEV1 is essential for establishing the diagnosis, assessment of severity, to predict the outcome and to assess response to treatment in COPD. Measurement of the walking distance is used to assess functional capacity of patients with COPD. Six-minute walk test (6MWT) is a simple, objective, and reproducible test. The facility of spirometry is not available in many rural areas of India because of lack of infrastructure where 6MWT can be done easily. The COPD assessment test (CAT) is a validated test for evaluation of COPD impact on health status. Therefore, in this study, we aim to find relationship between Six-minute walk test, Spirometry and COPD Assessment Test (CAT) scores in chronic obstructive pulmonary disease patients. MATERIALS AND METHODSSeventy-five patients of COPD were enrolled for the study after applying inclusion and exclusion criteria. The impact of COPD on health status was assessed using CAT score. All patients underwent spirometric measurement of FEV1, FVC, and ratio of FEV1 and FVC and test repeated after bronchodilation by 200-400 μg of salbutamol. 6MWT was performed following American Thoracic Society (ATS) protocol of 6MWT and distance was measured in metres. The results were analysed using SPSS software version 19. RESULTSWe found significant linear correlation of 6MWD with post-FEV1(r=0.561, P<0.001), post-FVC (r=0.341, P=0.003), and FEV1/FVC (r = 0.476, P < 0.001). The mean CAT score was 20.49 ± 5.34 SD. There was a significant association between post-FEV1 and total CAT score (P< 0.001). The correlation between mean post-FEV1 and mean score of CAT groups 1,2, 3, and 4 was statistically significant (P<0.001). CONCLUSION6MWT can be a useful replacement of spirometry in assessment of severity of COPD. The relationship between CAT score and post-FEV1 suggests that CAT is linked to severity of airflow limitation and GOLD classification in stable COPD patients. Spirometry is not needed every time to assess the severity of COPD. However, Spirometry is necessary to diagnose COPD. CAT score can be used to assess the impact of COPD on health status and quality of life. Both 6MWT and CAT score can be used even in a rural setting where most of the COPD patients have no access to spirometry. KEYWORDSChronic Obstructive Pulmonary Disease (COPD), Spirometry, Six-minute Walk Test (6MWT), CAT Score.HOW TO CITE THIS ARTICLE: Krishnaraj VSP, Pugazhendhi A, Viswanathan VK, et al. Correlation of six-minute walk test and COPD assessment test (CAT) scores with spirometric indices in chronic obstructive pulmonary disease patients in a tertiary care hospital in Chennai.

BACKGROUND Tobacco is a public health problem globally and an important cause of preventable premature death in middle and low income countries. The government of India has taken several measures to ensure tobacco control and suggested that a systematic surveillance system is a key strategy in tobacco control. However the fact remains that people continue to smoke. This study was undertaken to understand the smoking patterns among patients attending a Pulmonology clinic and to assess their knowledge of smoking cessation methods. Data from this study can be used for planning and resource allocation of a smoking cessation clinic. The aim is to study the smoking patterns and the knowledge of cessation strategies and to analyse the willingness of the patients to quit smoking in patients attending a Pulmonology clinic. MATERIALS AND METHODS Around 489 patients visiting the Pulmonology clinic for 15 days were screened and patients with history of smoking habit were included in the study. 133 such patients were assessed with a structured questionnaire and results were analysed. RESULTS The prevalence of patients with smoking habits was 27.2%. The mean age of smoking initiation was 20.9 years of age. Percentage of beedi smokers (52.6%) was much higher than the cigarette smokers (37.6%). The average number of cigarettes or beedis smoked per day was 16.6. Only 12.8% were aware of therapeutic options for nicotine de-addiction. Most of the patients had difficulty in smoking cessation.

BACKGROUNDMalignant pleural effusions are a common cause of morbidity in patients with advanced cancer. Cancer of the lung breast and lymphomas account for approximately 75 % of malignant pleural effusions. Sarcomas and melanomas account for a small percentage of malignant pleural effusion. In about 6 % of patients the primary is unknown.The aim of the study is to evaluate the efficacy of pleurodesis using Vincristine and Cisplatin and to compare the outcomes of pleurodesis with these two sclerosing agents in malignant pleural effusions. MATERIALS AND METHODSAll patients with malignant pleural effusion were evaluated and patients with previous sclerotherapy, hepatic or renal dysfunction were excluded. Patients eligible for pleurodesis were randomized by "Randomisation by Blocking" technique into two groups. They received either Vincristine (2 mgs/m2) or Cisplatin (70 mgs/m2) intrapleurally through the intercostal tube as per BTS guidelines on management of malignant pleural effusions. Patients were evaluated for response after four weeks. Design-Prospective randomized clinical trial. RESULTS48 cases of malignant pleural effusions were evaluated. 30 cases were excluded for reasons for reasons such as rapid progression of the disease(13), non expansion of lung (15) and not willing for further treatment(2). 18 eligible patients were included for the study and randomized to receive either Vincristine or Cisplatin. Out of 10 patients who received Vincristine sclerotherapy, complete response was noted in 60 % and objective response (complete plus partial responses) in 70 %. Out of 8 patients who received Cisplatin sclerotherapy, complete and objective response was noted in 87.5 %. There was no significant differences in response rates between Vincristine and Cisplatin either in complete response (p = 0.315) or in objective response (p = 0.588). CONCLUSIONBoth Vincristine and Cisplatin are effective sclerosing agents in malignant pleural effusions, though neither agent was superior to the other in this study. Since Vincristine is cheaper, it is more cost effective agent for pleurodesis in malignant pleural effusions.

BACKGROUND With the ever increasing prevalence of diabetes, complications of diabetes are encountered across all specialities. Hence, it is imperative that all specialists should have a working knowledge of diabetes mellitus. This study was done to understand the prevalence and complications of diabetes among patients attending a pulmonologist OPD. Knowledge of diabetes and its complications will help pulmonary medicine specialists to identify and manage the complications of diabetes better. MATERIALS AND METHODS All patients attending a pulmonologist's clinic for a period of one month were enquired regarding their diabetes status and patients with known history of diabetes were questioned using a standard questionnaire and their available records examined regarding their complications pertaining to diabetes and the results analysed. RESULTS In this study, 18.7% of patients attending pulmonologist clinic had diabetes mellitus and 13.5% of patients had diabetes of more than 10 years duration. Most of the patients were in the age group of 40 to 60 years and were predominantly male. Among the diabetic patients, 71.9% had complications due to diabetes. Infections were the most commonly associated complication followed by pulmonary and cardiovascular complications. Many cases of pulmonary tuberculosis were observed among these patients. Other respiratory infections observed included pneumonias and flu. Cardiovascular complications like systemic hypertension, coronary artery disease and dyslipidaemia were observed. CONCLUSION With the rising prevalence of diabetes mellitus, such cases are frequently observed across all medical specialities. Hence, it is vital that all specialists should be trained in a management of diabetes, which is a frequent comorbidity observed by all specialists. Knowledge of diabetes, identifying diabetes early and management of complications will go a long way in reducing the morbidity and mortality due to diabetes and also help specialists to manage their case better.