Anti-Synthetase Syndrome (ASS) is a rare autoimmune disorder characterized by Interstitial Lung Disease (ILD), inflammatory myositis, fever, Raynaud's phenomenon, mechanic's hand, and inflammatory polyarthritis in the setting of antibodies against amino acyl-transfer RNA synthetases, with anti-Jo-1 antibody being the most common. It can sometimes present as interstitial lung disease without any other expression of the syndrome. Clinical and radiological features can be similar to atypical pneumonia and could be a challenge to diagnose at an early stage. Prognosis is generally poor, especially when there is associated ILD and delay in diagnosis can lead to increase in morbidity due to progression of pulmonary involvement. We report a patient of ASS presenting with ILD, diagnosed early and treated successfully with immunosupression.

Background: COPD (Chronic obstructive pulmonary disease) is considered as a systemic disease due to associated systemic inflammation which can manifest as metabolic syndrome or its component illnesses. This study was undertaken to determine the proportion of metabolic syndrome in patients with COPD.Methods: 51 patients with COPD were compared with equal number of age and gender matched controls. GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria were used for diagnosing COPD. Metabolic Syndrome (MS) was diagnosed based on modified NCEP:ATP III criteria (National cholesterol education Program Adult Treatment Panel III). Subjects were evaluated for hypertension, WC, FBS, and serum triglycerides and serum HDL (High-density lipoprotein) to diagnose MS.Results: Metabolic syndrome was diagnosed in 16 (31.4%) patients with COPD and in 8 (15.7%) controls. The proportion of individual parameters of MS in cases and controls was as follows: DM in 19 (37.3%) cases and 13 (25.5%) controls, hypertension in 21(41.2%) cases and 9 (17.6%) controls, low serum HDL in 31 (60.7%) cases and 22 (43.1%) controls increased WC in 14 (27.5%) cases and 7 (13.7%) controls and elevated serum TG in 12 (23.5%) cases and an equal number of controls.Conclusions: Metabolic syndrome and its parameters are more prevalent in COPD patients. Early detection and treatment of MS in COPD patients can prevent development of complications due to the combined effects of both diseases.

BACKGROUND Bronchiectasis is defined as "abnormal and permanent dilatation of one or more bronchi due to weakening or destruction of the muscular and elastic components of the bronchial walls." HRCT has become the gold standard to diagnose bronchiectasis. Antibiotics and chest physiotherapy are main forms of management. The aim of the study is to study the outcome of treatment in acute exacerbation of bronchiectasis in adults. MATERIALS AND METHODS This study was done prospectively in the Department of Respiratory Medicine in Rajarajeswari Medical College and Hospital from November 1, 2015, to April 30, 2017. Out of 55 cases admitted during the study period, 44 cases (10 females) were eligible for participation in the study. 2 cases of Kartagener's syndrome under follow up in our department for past 3 years were included. Flexible bronchoscopy was done in 31 patients. RESULTS Cough with sputum was the commonest symptom. Breathlessness was documented in 32 patients. Arterial blood gas analysis was abnormal in 29 patients. Haemoptysis in 13 cases. History of antituberculous therapy was present in 34 patients. Digital clubbing was present in 30 patients. Pedal oedema was documented in 14 cases. Associated cultures were positive in 28 cases. CONCLUSION The most frequent form of bronchiectasis is post-tuberculous. Pseudomonas aeruginosa is the most frequently isolated bacteria. The most frequent concomitant disease in bronchiectasis is COPD. Piperacillin/tazobactum is the most effective antibiotic for initial empirical treatment of acute exacerbations of bronchiectasis.

Purpose: Anterior cruciate ligament (ACL) injury places individuals at high risk for development of premature knee osteoarthritis (OA), and studies question the ability of ACL reconstruction (ACLR) to restore normal gait mechanics, with evidence of altered knee biomechanics beginning early after surgery. Abnormal gait patterns have been suggested as a mechanism for the development of knee OA after ACL injury and reconstruction, but few studies have longitudinally looked at changes in gait over time after ACLR, with the majority of studies investigating changes at a relatively early time point after surgery. Thus the goal of this study was to investigate changes in knee kinetics from a relatively early time point following ACLR (approximately 2 years postsurgery) to longer-term follow-up (approximately 8 years post-surgery). We tested the hypothesis that there are changes in the magnitudes of the first and second peak knee extension moments (KEM1 and KEM2), peak knee flexion moment (KFM), first and second peak knee adduction moments (KAM1 and KAM2), and total knee adduction moment impulse (KAM Impulse) from baseline to follow-up. Methods: Seventeen subjects with unilateral primary ACLR surgery (12 female, age: 29.7 ± 7.3 yrs; BMI: 23.5 ± 2.7 kg/m 2 ; 8 left knees) were tested at baseline (2.2 ± 0.3 yrs post-ACLR) and returned for a follow-up test session (7.7 ± 0.7 yrs post-ACLR). At both visits, subjects were tested bilaterally during normal walking with a motion capture system and force plate to calculate joint moments. Changes in ACLR and contralateral knee kinetics were assessed using 2 Â 2 repeated measures ANOVA with time and limb as within-subject factors. Unpaired Student's t-tests were used to compare the ACLR and contralateral kinetics at baseline and follow-up to an age-, sex-, and BMI-matched control group (12 female; age: 35.4 ± 7.3 yrs; BMI: 24.5 ± 3.0 kg/m 2 ). One knee was randomly selected per control subject. An a ¼ 0.05 was used with

The term ‘refractory asthma’ includes patients with severe asthma, steroid-dependent and/or resistant asthma, difficult-to-treat asthma and irreversible asthma. In patients with to difficult to treat asthma, exclusion of other causes of persistent wheeze like vocal cord dysfunction, upper airway obstruction and allergic bronchopulmonary aspergillosis is important. Besides, the presence of anatomical abnormalities that could affect effective medication delivery could also result in sub-optimal treatment response. These factors reiterate the need for a rigorous and systematic approach to rule out alternative co-existent diseases or abnormalities in a patient with difficult-to-treat asthma. We hereby report a case of an asthmatic patient with refractory bronchospasm despite optimal treatment, wherein work-up for an additional pathophysiological process aided in successful management of his symptoms.