BACKGROUND: The incidence of lung abscess acquired in the community is unknown, but this is a common clinical problem encountered in developing countries. The incidence of lung abscess was high in the pre-antibiotic era but the advent of susceptible antibiotics it has reduced with an equal fall in mortality to 8.7%. With the emerging antibiotic resistance and change in the trends of bacteriological profile causing lung abscess, it is the need of time to reevaluate lung abscess. AIM: The study aimed to determine the clinical, radiological and bacteriological profile of lung abscess. MATERIAL AND METHOD: The study was a non-randomized prospective observational study conducted in the department of pulmonary medicine for 18 months. In the study, patients > 15 years of age with clinical features of lung abscess were recruited and were subjected to chest X-ray, routine blood test. Sputum gram stain and culture, as well as antibiotic sensitivity according to the organism, were evaluated. Reports of all investigations along with patient characteristics and risk factors were analysed statistically using SPSS 20.0. RESULTS: Forty-six cases of lung abscess were included, and the majority of patients were found to be adults with a mean age of 42.9 years with a male to female ratio of 6.6:1. The most common predisposing factor was an unhygienic oral cavity in 28% of cases with alcohol ingestion being the most important risk factor in 22% of cases. The most common organism found in lung abscess cases was Klebsiella pneumoniae, and they were sensitive to ceftazidime. CONCLUSION: Our study shows that Klebsiella pneumoniae should be considered an important pathogen in community-acquired lung abscesses.

Objectives: This study aimed to assess the variation in the levels of the neutrophil lymphocyte ratio (NLR) and platelet indices in patients with stable chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) patients and its association with GOLD stages. COPD is heterogeneous in nature. AECOPD is diagnosed clinically, which is subjective, and clinical judgement may vary from clinician to clinician. Since chronic inflammation underlies the pathogenesis of COPD, markers of inflammation have generated considerable interest in their potential to be used as biomarkers of COPD. Methods: This prospective analytical study was carried out at the Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from December 2018 to July 2020. A total of 64 subjects (32 stable COPD, 32 AECOPD) who satisfied the study criteria were included. Blood samples were taken from stable and AECOPD patients and were compared. Results: It was observed that the NLR, the platelet distribution width, the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) increased in AECOPD patients compared to stable COPD patients (P <0.001). A positive correlation was observed between the neutrophil lymphocyte ratio, the platelet distribution width, the ESR and the CRP (P <0.001). Conclusion: The NLR and platelet distribution width values increased significantly in AECOPD patients compared to stable COPD patients.

Chronic obstructive pulmonary disease (COPD) patients often experience acute exacerbations requiring hospitalization. Recently, attention has focused on Aspergillus sensitization in the airways of these COPD patients. This study aimed to assess the prevalence of chronic pulmonary aspergillosis (CPA) in COPD patients with acute exacerbations and identify associated risk factors. A cross-sectional descriptive study was conducted at the Jawaharlal Institute of Postgraduate Medical Education and Research from January 2021 to June 2022. Sixty-one COPD patients presenting with acute exacerbations were included. Demographic details, blood investigations, and sputum examinations were performed for all patients. A high-resolution computed tomography thorax was conducted for eligible patients. The prevalence of CPA among patients with an acute exacerbation of COPD was found to be 9.8%, with chronic cavitary pulmonary aspergillosis being the most common presentation (50%). Among post-tubercular COPD patients, the prevalence of CPA was significantly higher at 22.7%. Hemoptysis (p<0.001) and a previous history of tuberculosis (p=0.008) were associated with Aspergillus sensitization. This study highlights the substantial prevalence of CPA in COPD patients with acute exacerbations, particularly in those with a history of tuberculosis. Early recognition and targeted management of CPA in COPD patients may improve outcomes and reduce hospitalization rates. Further large-scale multi-center studies are needed to validate these findings and comprehensively address the impact of CPA on all COPD patients.

Prevalence of systemic sclerosis (SSc)-related organ injury is difficult to estimate as it occurs early in SSc, even though patients are often asymptomatic. As the patients with organ damage have a poor prognosis, all the patients should be carefully evaluated and followed‑up in the initial periods. This facilitates the early identification and initiation of appropriate therapy. This study emphasizes on different clinical manifestations and early predictors of lung involvement by using clinical, radiological, and pulmonary function tests in a tertiary care centre. A total of 53 SSc cases, who satisfied American College of Rheumatology (ACR) 2013 criteria, without any overlap syndromes were included in the study. All patients underwent thorough clinical examination along with Modified Rodnan Scoring (MRS) assessment, nailfold capillaroscopy (NFC), chest X-ray (CXR), HRCT thorax, 2D-echocardiography, spirometry and diffusion lung study by carbon monoxide (DLco). Out of 53 patients, four were male and 49 were female. Twenty-one patients had limited SSc (lcSSc) and 32 had diffuse SSc (dcSSc). Eighty-three per cent of subjects presented with skin manifestations and 34% with respiratory complaints. Reticulonodular opacities and ground glassing were the predominant radiological abnormalities suggestive of non-specific interstitial pneumonia (NSIP) followed by usual interstitial pneumonia (UIP). Pulmonary hypertension was predominant in patients with lcSSc. Thirty-eight patients had a restrictive pattern of spirometry. Forty-four patients showed deranged DLco, among which two patients showed an isolated decrease in DLco. Thirty-seven patients had abnormal NFC among which dropout pattern was predominant. MRS was significantly correlated with pulmonary involvement by DLco and HRCT. SSc can affect the lungs even before developing obvious clinical pulmonary manifestations. DLco and HRCT play a critical role in detecting early lung involvement and predicting the outcomes in SSc. Higher modified Rodnan’s score, which has a significant correlation with DLco and HRCT can be used to predict early visceral involvement in resource-limited settings.

Lung malignancy is known to be one of the leading causes of cancer-related mortality. Endocrine paraneoplastic syndromes in lung cancer are common. These are due to secretion of various substances and not because of direct tumour invasion or me-tastasis. These syndromes have also been associated with lung cancer prognosis. This review describes the many endocrine paraneoplastic syndromes seen in lung cancer and narrates their incidence, biology, clinical features, diagnosis, and management.

To compare clinical, radiological and haematological manifestations among newly diagnosed smear positive tuberculosis patients between Group I (Elderly >60 yrs) and Group II (Younger age between 13 and 60 years). This was a hospital-based cross-sectional study conducted at the out-patient department of pulmonary medicine, between March 2014 and December 2017. There were 61 patients in Group I (Elderly > 60 yrs) and 110 patients in Group II (Younger age between 13 and 60 years). Continuous variables were compared using student’s t-test and Mann-Whitney test. Chi square test and Fischer test was used for analysing categorical variables. All statistics were two-tailed, and a p-value of 0.05 was considered to be statistically significant. The mean age for Group I (Elderly >60 yrs) was 65 ± 2 years and for the Group II (Younger age between 13 and 60 years) was 40 ± 1 years. There was a statistically significant association of cavitation with infiltrates (p = 0.007) in younger age group. Bilateral multiple zone (48, 64.86%) involvements were commonly observed in both the age groups. There was no significant difference between two groups with regard to haematological and clinical parameters. We did not find any difference in the presentation of tuberculosis in both the groups. Radiologically, there was more of cavitating lesion in younger age group. So, they should be isolated and followed up at regular intervals.