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Background and objective: There is a need for simple functional test to assess treatment response in chronic pulmonary aspergillosis (CPA) in resource-constrained settings. The one-minute-sit-to-stand test (1-min-STS) is one such test. However, the minimal important difference (MID) for 1-min-STS in subjects with CPA remains unknown. Herein, we estimate the MID for 1-min-STS for CPA subjects. Materials and Methods: We retrospectively reviewed the clinical details of CPA subjects treated with oral azoles for 6 months. We included only subjects who completed the 1-min-STS test at baseline and 6 months. We used the change in VAS (visual analogue scale, for overall improvement) as an external anchor. We used the anchor and the distribution (standard deviation-based) methods to determine the MID estimates. We used the anchor-based method only if there was correlation of 0.3 with the 1-min-STS test. Results: One hundred-eight subjects completed the 1-min-STS test at baseline and 6 months. We did not find significant correlation between the change in VAS for overall improvement (r² = 0.024, P value = 0.809) and the 1-min-STS test. The MID for the 1-min-STS test was 2 repetitions (range, 1.5--2.8 repetitions). Conclusion: The MID for the 1-min-STS test in subjects with CPA was 2 repetitions. Future studies using a global rating of change scale as an anchor must confirm our findings. [ABSTRACT FROM AUTHOR]

The article focuses on assessing the prevalence of allergic sensitization to Aspergillus fumigatus (AS) in chronic obstructive pulmonary disease (COPD) patients, comparing smokers and non-smokers. It explores the association between AS and factors like tobacco smoking, biomass fuel exposure, and the prevalence of allergic bronchopulmonary aspergillosis (ABPA), particularly in those who smoke bidis or cigarettes.

Yes: 65No: 974 REFERENCES 1 Sehgal IS, Dhooria S, Prasad KT, Muthu V, Aggarwal AN, Agarwal R. Barrier enclosure device during patient preparation for flexible bronchoscopy. Sir, We have previously described a barrier enclosure device use to limit aerosol dispersion during high aerosol-generating procedures such as flexible bronchoscopy and endotracheal intubation to protect health-care workers.[[1]],[[2]] While using the barrier enclosure device, one may occasionally encounter difficulty in sampling lesions located either distally or in the upper lobes posterior segment. [Extracted from the article]

This document is a research letter published in the journal Lung India. It describes a very rare case of anomalous systemic arterial supply to the lung without sequestration. The patient presented with abnormal vessels extending from the celiac trunk to the inferior vena cava, supplying the lung. This condition is a congenital abnormality that is usually associated with pulmonary sequestration, but in this case, the sequestration was absent. The document provides a brief overview of bronchopulmonary sequestration and discusses the rarity of systemic arterial supply to the lung without sequestration. [Extracted from the article]

The European Respiratory Society (ERS) and the British Thoracic Society (BTS) have recently published their statements on the treatment of sarcoidosis. There are five key questions in sarcoidosis treatment that need to be addressed: when to treat, how to initiate treatment, how long to treat, when and how to change treatment, and how to treat relapses. Herein, we describe the principles and protocols to answer these questions based on the ERS and BTS statements and other expert reviews. Pulmonary or extrapulmonary sarcoidosis should be treated with anti-inflammatory therapy if it significantly impairs the quality of life (QoL), causes significant organ dysfunction, or threatens to cause organ damage, disability, or death. If treatment is initiated for improving the QoL alone, low-dose (10 mg/day) prednisone is a good initial treatment that can be tapered and stopped over 3 months. Disease that causes significant organ dysfunction needs to be treated with medium-dose glucocorticoids (initial daily dose, 20 mg of prednisone equivalent) tapered over a minimum duration of 6 months. Worsening of disease while tapering treatment indicates that longer (9-24 months) treatment may be necessary. If a daily prednisone dose of >10 mg is required for >6 months to maintain remission, it is best to use a second-line drug such as methotrexate or azathioprine. Anti-tumor necrosis factor agents, such as infliximab or adalimumab, may be used to treat inflammatory disease that persists on combination treatment with glucocorticoids and a second-line agent. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of tuberculous (TB) pleurisy remains difficult because of its paucibacillary character. Several authors have studied the usefulness of interferon gamma release assays in the early diagnosis of TB pleurisy, whereas these tests are designed for the detection of latent TB infection. Our objective is to study the performance and clinical relevance of QuantiFERON TB Gold in Tube (QFT-GIT) in the diagnosis of TB pleurisy in Algeria. Patients and methods: QFT-GIT was tested in vitro in serum and pleural fluid on a prospective recruitment of 158 immunocompetent patients with pleural effusion. Results: Of the 158 cases of pleurisy identified, 84 (53.84%) were TB, diagnosed and proven by conventional methods, and 72 (46.15%) were non-TB, of whom 67 (93%) were confirmed of neoplastic origin, five (7%) secondary to a systemic disease and two of nonspecific inflammatory origin. Our results showed a high pleural sensitivity of QFT-GIT (97.62%) compared to serum sensitivity (80.95%). In contrast, serum specificity (83.78%) was higher than pleural specificity (72.97%). When we used the optimal values from the receiver operation characteristics curve analysis, the area under the curve of interferon-gamma produced by the QFT-GIT test was significantly higher in the pleural fluid than in the blood. Area under the curve of TB antigen interferon-gamma response was 92, 18 [95% confidence interval (CI)=87.56–96.79], nil tube was 95.71% (95% CI=92.43–99), and mitogen tube was 65.34 (95% CI=57.71–72.98). Conclusion: QFT-GIT in pleural fluid appears in our study as a useful test for the diagnosis of TB pleurisy, but its diagnostic accuracy needs to be validated in further large-scale research. [ABSTRACT FROM AUTHOR]

The article discusses a rare case of isolated tracheal mucormycosis in a patient with diabetes mellitus. The authors highlight the importance of bronchoscopic management in treating this condition, as nearly 30% of patients with isolated tracheobronchial mucormycosis may require therapeutic bronchoscopy. They describe a case in which a 49-year-old man with poorly controlled diabetes presented with airway obstruction due to mucormycosis and required airway stenting. The patient was successfully treated with a combination of bronchoscopic intervention and antifungal therapy. The article emphasizes the need for a high index of suspicion and appropriate management strategies for this uncommon condition. [Extracted from the article]

Flexible bronchoscopy (FB) is a frequently employed diagnostic procedure for evaluating respiratory disorders.[[1]],[[2]] Studies in the previous decades suggest a complication rate of 1% with FB.[[3]],[[4]] The complication rates in the contemporary era are unknown. We reviewed our bronchoscopy database to assess the frequency of major complications among subjects undergoing FB procedures without sedation. [Extracted from the article]

Background: Tuberculosis is one of the major burdens to developing nations. India is among the countries categorized by the World Health Organization (WHO) as experiencing a significant burden of TB, HIV-associated TB, and MDR/RR-TB within the context of low- and middle-income nations. Globally South East Asian and African region alone accounted for 82% of death (HIV negative), where India accounts for 36% of TB fatalities. Materials and Methods: The data was extracted from NIKSHAY web portal on TB notification cases in UP, India. The random effects meta-analysis was performed to estimate pooled proportion of TB cases in public and private notified during both the periods. Spatial analysis was used to display the spread of TB cases across the state, during both the periods. Results: A total 75 districts data on TB notified cases were available for current investigation. The pooled proportion of TB cases were 0.24 (0.21, 0.27) and 0.76 (0.73, 0.79) during COVID-19 period for private and public hospitals, respectively. Similarly, the pooled proportion of TB cases were 0.26 (0.23, 0.29) and 0.74 (0.71, 0.77) post-COVID-19 for private and public hospitals, respectively. Conclusion: The proportion of TB cases were more in public hospital as compared to private hospitals during COVID-19 period. Similarly, result was obtained in post-COVID-19 period. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to monitor prescription patterns, clinical outcomes, and adverse drug reactions (ADR) among patients of various interstitial lung diseases (ILDs). Materials and Methods: This prospective study was conducted in the Department of Pharmacology and Therapeutics in collaboration with the Department of Respiratory Medicine, King George’s Medical University, Lucknow, for a period of 12 months (October 2020–September 2021). A total of 77 patients were enrolled after satisfying the inclusion and exclusion criteria. The prescriptions were collected, and necessary details were noted on the case report form. After completion of the study, the data were analyzed for prescription patterns, clinical outcomes, and quality of life with the help of a validated questionnaire-King’s Brief ILD (KBILD) questionnaire. At the same time, ADRs, if any, were assessed using Hartwig’s Severity Assessment Scale and Naranjo Causality Assessment Scale. Results: The most common ILD was acute/chronic hypersensitivity pneumonitis (HP). Average number of drugs per encounter was 4.45. Crepitations were the most common clinical signs. Clubbing and rhonchi were reported maximum in idiopathic pulmonary fibrosis. It was found that psychological, breathlessness and activities, chest symptoms, and total KBILD reduced significantly after 3 months as compared to baseline with a statistically significant difference as P < 0.01. ADRs were found in 23.38% (18) of the subjects. Maximum ADR reported was gastritis (9.09%), followed by hepatitis (3.90%). Conclusion: The high proportion of patients clinically diagnosed with HP in our study highlights the importance of a detailed environmental exposure history in the diagnostic evaluation of patients with ILD to avoid inaccurate diagnoses. ADR-related hospital admissions are a significant problem in the health-care system. [ABSTRACT FROM AUTHOR]

Introduction: Lung transplant (LTx) is a potential treatment option for all patients with chronic, end‑stage respiratory disease, who are refractory to optimal medical therapy or where no medical therapy exists. In India, LTx is still in its evolving stages and published literature is sparse. The current study was carried out to study the selection criteria for lung transplant and to evaluate the clinical and socio‑economic profile of patients referred for the same at a tertiary health care facility. Methods: The study was a descriptive, prospective, observational study. All adults referred for lung transplant were evaluated for clinical and laboratory profiles. All enrolled patients were assessed for presence of referral criteria, listing criteria, contraindications, and willingness for lung transplant. These patients were followed up for 2 years for transplant‑free survival, and the Cox proportional hazards model was used to determine independent predictors of all‑cause mortality. Results: A total of 103 were included in study. The most common diagnosis was interstitial lung disease (57.2%), followed by bronchiectasis (17.5%) and COPD (13.6%). Most patients were referred for LTx at an advanced stage as 90% met listing criteria. Fifty‑four (52.4%) patients had an absolute or relative contraindication to transplant; however, the majority of those contraindications were modifiable. Patients with a lower socio‑economic status were less likely to be willing for LTx. The median survival was 757 days. A 6‑minute walk distance (6MWD) lesser than 250 m was found to be an independent predictor of mortality. Conclusion: Making patients aware about lung transplant early in their treatment may give them sufficient time to come to terms with their disease and understand the risk and benefits associated. Efforts should be focused on screening and early treatment of reversible contraindications for the eligible patients. Patients with 6MWD < 250 m are at increased risk of mortality. [ABSTRACT FROM AUTHOR]

Non-resolving consolidation refers to the persistence of radiographic abnormalities beyond the anticipated timeframe. Conditions such as infection, malignancy, inflammatory disorders, and connective tissue diseases can all manifest as non-resolving consolidation. We share a clinicopathological case study involving a 30-year-old male who exhibits nonresolving consolidation accompanied by hepatosplenomegaly. [ABSTRACT FROM AUTHOR]

Sir, Endobronchial tuberculosis is a well-recognized clinical entity; however, it is uncommon without pulmonary parenchymal or mediastinal lymph node involvement.[[1]] Endobronchial tuberculosis is further classified as exudative, granular and ulcerative.[[2]] Herein, we report a rare presentation of tuberculosis manifesting as a solitary ulcer in the right main bronchus. The anatomic location of the ulcer (beneath which the right inferior pulmonary vein would be expected) and the depth of the ulcer should have deterred us from obtaining a biopsy. [Extracted from the article]

This document discusses a rare case of anomalous systemic arterial supply to the lung without sequestration. The case involves a 43-year-old male who was incidentally diagnosed with this congenital anomaly during a routine medical examination. The patient had a history of hemoptysis 10 years prior, which was managed conservatively. The article provides an overview of systemic arterial supply to the lung and emphasizes the rarity of this specific anomaly. [Extracted from the article]

Background: Sculpting is a common occupation in India. However, there have been no studies from India on sculpting-related silicosis. Aims: The aims of this study were to evaluate- 1. awareness of disease related to sculpting. 2. Clinical, radiological, and physiological parameters in "sculpting workers" suffering from silicosis. Settings and Design: This was a retrospective evaluation of data collected during compensation visits for silicosis in workers of the sculpting industries. Methods and Material: The data were collected between January 2021 to April 2023. A total of 114 patients were evaluated. All patients underwent clinical evaluation including awareness about the disease, chest radiography, high-resolution computed tomography (HRCT) scan of the chest, and spirometry. Results: The majority of patients (109) (95%) did not use any personal protective equipment while at work and did not have any awareness regarding preventive measures. On chest radiography, small opacities (rounded or irregular) and large opacities were seen in 84 (73.7%) and 26 (22.8%) patients, respectively. The size of large opacities was significantly proportionate with duration of job (P = 0.019). HRCT chest was more sensitive compared to chest radiographs. 94 (82.4%) patients were having abnormal spirometric findings. Conclusions: The benefits of prevention of silica dust exposure and patient education considerably outweigh the benefits of early detection and treatment of silicosis, as there was an increase in the size of lesions with increasing duration of exposure. There should be a national health program on silicosis to protect worker's health. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium w (Mw), an immunomodulator, resulted in better clinical status in severe coronavirus infectious disease 19 (COVID-19) but no survival benefit in a previous study. Herein, we investigate whether Mw could improve clinical outcomes and survival in COVID-19. Materials and Methods: In a multicentric, randomized, double-blind, parallel-group, placebo-controlled trial, we randomized hospitalized subjects with severe COVID-19 to receive either 0.3 mL/day of Mw intradermally or a matching placebo for three consecutive days. The primary outcome was 28-day mortality. The co-primary outcome was the distribution of clinical status assessed on a seven-point ordinal scale ranging from discharged (category 1) to death (category 7) on study days 14, 21, and 28. The key secondary outcomes were the change in sequential organ failure assessment (SOFA) score on days 7 and 14 compared to the baseline, treatment-emergent adverse events, and others. Results: We included 273 subjects (136 Mw, 137 placebo). The use of Mw did not improve 28-day survival (Mw vs. placebo, 18 [13.2%] vs. 12 [8.8%], P = 0.259) or the clinical status on days 14 (odds ratio [OR], 1.33; 95% confidence intervals [CI], 0.79-2.3), 21 (OR, 1.49; 95% CI, 0.83-2.7) or 28 (OR, 1.49; 95% CI, 0.79-2.8) between the two study arms. There was no difference in the delta SOFA score or other secondary outcomes between the two groups. We observed higher injection site reactions with Mw. Conclusion: Mw did not reduce 28-day mortality or improve clinical status on days 14, 21 and 28 compared to placebo in patients with severe COVID-19. [ABSTRACT FROM AUTHOR]

Background: Brain metastases (BM) are common in metastatic nonsmall cell lung cancer (NSCLC). However, routine neuroimaging in asymptomatic patients with metastatic NSCLC is controversial as there is no conclusive evidence of benefit from the detection and treatment of asymptomatic BM. Herein, we evaluated the prevalence of asymptomatic BM and its treatment implications in a resource-limited setting. Methods: Consecutive patients with newly diagnosed, treatment-naïve, metastatic, nonsquamous NSCLC (NS-NSCLC) were included. Subjects who already had clinical or radiological features suggestive of BM were excluded from the study. All eligible subjects underwent contrast-enhanced magnetic resonance imaging (MRI) of the brain. Management of the detected BM was at the discretion of the treating clinicians. Results: Among 809 subjects who were screened, 100 (12.4%) were included in the study and underwent MRI. BM was present in 30 (30%) of the subjects and absent in the remaining 70 subjects. A majority of BM were multiple (70%), involved the frontal lobe commonly (73.3%), and had a mean (standard deviation) size of 13.2 (7.3) mm. Detection of BM resulted in a treatment alteration in 17 (17%) of the study subjects (brain irradiation, n = 17, change in targeted therapy, n = 3) with BM. There was no difference in survival of patients who underwent treatment alteration for management of BM compared to those who did not (P = 0.132). Conclusions: About one-third of patients with metastatic NS-NSCLC had BM in MRI despite the absence of symptoms. Despite treatment of the majority of the patients with BM with brain irradiation, there was no demonstrable survival benefit. Hence, we conclude that although routine neuroimaging of asymptomatic patients with newly diagnosed metastatic NSCLC may result in treatment alteration (primarily brain irradiation) in a small proportion of patients, it may not influence outcomes in resource-constrained settings. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are the top two killers of infectious disease. We aimed to determine the association of TB coinfection with the inhospital mortality of COVID-19 patients in Indonesia as a TB-endemic country. Methods: We conducted a retrospective cohort study in a tertiary lung hospital in Indonesia. All TB-coinfected COVID-19 patients who were hospitalized between January 2020 and December 2021 were included in the study. COVID-19 patients without TB were randomly selected for the control group. Clinical characteristics and laboratory results were assessed. Survival analysis was performed to determine the estimated death rate and median survival time (MST). Multivariate Cox regression analysis was conducted to define the association of TB coinfection with the in-hospital mortality of COVID-19. Results: We included 86 (8.3%) TB coinfections among 1034 confirmed COVID-19 patients. TB coinfection patients had younger age, malnutrition, and different symptoms compared to the COVID-19 group. TB-coinfected patients had a lower estimated death rate than the COVID-19 group (6.5 vs. 18.8 per 1000 population). MST in the COVID-19 group was 38 (interquartile range 16-47) days, whereas the same observation time failed to determine the MST in the TB coinfection group. TB coinfection had a crude hazard ratio of mortality 0.37 (95% confidence interval [CI] 0.15-0.94, P = 0. 004). The final model analysis including age, sex, and lymphocyte as confounding factors resulted in an adjusted HR of mortality 0.31 (95% CI 0.1-0.9). Conclusion: This study showed TB coinfection was negatively associated with the in-hospital mortality of COVID-19. [ABSTRACT FROM AUTHOR]

This article from the medical journal Lung India explores the uncertainties and controversies surrounding idiopathic nonspecific interstitial pneumonia (NSIP). NSIP is a condition characterized by inflammation and fibrosis in the alveolar septae. The article discusses the various underlying conditions and associations of NSIP, as well as the challenges in diagnosing the condition. It also mentions a study that found 64% of NSIP cases to be idiopathic, while 36% were secondary to known causes. However, the study had limitations, and the article calls for future research to provide more comprehensive information. [Extracted from the article]

Background: Lung cancer is one of the major causes of morbidity and mortality both in developed and developing countries. Adverse drug reactions (ADRs) are inevitable, albeit unwanted aspects of cancer chemotherapeutic agents used in lung cancer. Aim and Objectives: To determine common ADRs and the severity of ADRs of different chemotherapeutic agents used in non-small cell lung cancer (NSCLC) patients. Materials and Methods: The study was conducted among purposively selected 160 patients who had undergone chemotherapy for lung carcinoma. Clinical records of NSCLC patients were reviewed and data related to the socio-demographic and clinic-therapeutic profiles of patients were collected. ADRs were graded according to the Common toxicity criteria (CTC) grading. Data analysis was done using the IBM-SPSS software and presented using the principle of descriptive statistics. Relationships between ADRs and drug regimens were determined using Chi-square tests considering a 95% confidence interval and P value ≤ 0.05 as significant. Result: Among 160 patients, 78.8% were males and 21.3% were females. The mean age was 59.15 ± 10.6 years, illness duration was 7.5 ± 10.6 months, and treatment duration was 4.4 ± 0.91 months. The overall mortality rate and systemic toxicity of the paclitaxel–carboplatin combination were the lowest. Almost an equal proportion of moderate to severe changes in parameters such as myelosuppression, anemia, thrombocytopenia, alopecia, skin changes, allergic reaction, and peripheral neuropathy, were observed with all chemotherapeutic regimens. Gemcitabine–carboplatin regimen was associated with a higher proportion of altered liver enzymes, electrolyte imbalance, diarrhea, pleural effusion, and renal toxicities. Conclusion: There was a high prevalence of ADRs with different chemotherapeutic agents. Early detection of these ADRs may help in minimizing the damage by either modifying the dose or changing the offending agent. [ABSTRACT FROM AUTHOR]

Background and Aims: Sepsis-induced immunosuppression appears to be reversible with immunomodulatory drugs. Mycobacterium indicus pranii (MIP) stimulates the Th1 type of immune response. This systematic review and meta-analysis of randomised controlled trials (RCTs) was aimed to find out if MIP is effective at improving clinical outcomes in sepsis patients. Methods: The databases (PubMed, Google Scholar, Web of Science, and Cochrane Library), along with preprint servers until June 2023, were searched. The methodology was evaluated using the 'Cochrane Collaboration risk of bias-2 tool' for RCT. The study included patients more than 18 years of age with sepsis within 48 h of first organ dysfunction. The primary outcome was 28-day mortality, and secondary outcomes were the length of stay in the intensive care unit (ICU), days on vasopressor support, ventilator-associated pneumonia (VAP), secondary infections, catheter-related bloodstream infections (CRBSI), and the delta sequential organ failure assessment (SOFA) score. Results: The meta-analysis included two studies with 252 participants. In a pooled analysis, mortality in the MIP group was 43% lower than in the control (RR: 0.57, 95%CI: 0.33–1); however, this difference was statistically not significant. We observed the days on a vasopressor day (standardised mean difference [SMD]: 0.38; 95%CI: −1.20 to 0.44), length of ICU stay (SMD: 0.46; 95%CI: −1.44 to 0.51), secondary infection (RR: 0.75; 95%CI: 0.19–3.01), VAP (RR: 0.6; 95%CI: 0.28–1.56), CRBSI (RR: 0.97, 95%CI: 0.14–6.98), delta SOFA score (SMD: 0.88, 95%CI: −1.66 to − 0.10) between the two groups. Conclusions: Our findings observed preliminary evidence in the trends for a positive association of MIP with better outcomes in sepsis patients. [ABSTRACT FROM AUTHOR]

Mycobacterium indicus pranii (MIP), previously called Mw vaccine, is a one-of-a-kind immunomodulatory vaccine. It was indigenously developed in India for use in leprosy. MIP is heat-killed Mycobacterium w, which is a non-pathogenic atypical mycobacterium belonging to Class IV of Runyon classification. It shares epitopes with Mycobacterium leprae and Mycobacterium tuberculosis, which forms the rationale behind its use in leprosy and tuberculosis. MIP activates both innate and acquired immunity. It induces a Th1 and Th17 immune response along with downregulation of Th2 pathway and activates macrophages and dendritic cells. MIP vaccine is safe with adverse effects such as local site erythema, swelling, and rarely fever and other systemic reactions. Apart from leprosy, MIP has been used in dermatological diseases such as warts and psoriasis. Clinical trials have evaluated the efficacy of MIP in a plenitude of non-dermatological conditions such as category II tuberculosis, Gram-negative sepsis, non-small cell lung cancer, human immunodeficiency virus (HIV), muscle-invasive bladder cancer, and very recently, coronavirus 2019 (COVID-19). In vitro and animal studies have also demonstrated its utility in leishmaniasis, melanoma, and as a vaccine for the prevention of pregnancy. The PubMed database was searched using "Mycobacterium indicus pranii, MIP, Mycobacterium w" as the keyword in title. This comprehensive review provides useful information for healthcare professionals about immunotherapeutic potential of MIP vaccine, its composition, dosing schedule, administration, and side effects besides its efficacy in various indications other than leprosy. [ABSTRACT FROM AUTHOR]

This research letter discusses a study on the use of intravenous administration of heat-killed Mycobacterium w (Mw) in patients with gram-negative sepsis. Gram-negative sepsis is a major cause of mortality in intensive care units in India. Previous studies have shown that intravenous Mw administration is safe and effective, and this study aims to further evaluate its efficacy and safety. The study included 20 patients and found that Mw, along with standard care, was well tolerated and did not result in any major adverse events. However, the study had limitations and further research is needed to evaluate the efficacy of Mw in a larger trial. [Extracted from the article]

This article discusses a study on malnutrition in individuals with Allergic Bronchopulmonary Aspergillosis (ABPA) complicating asthma. The study aimed to compare the body mass index (BMI), anthropometric measurements, and body composition analysis in asthmatic subjects with and without ABPA. The results showed a higher prevalence of undernutrition in ABPA subjects compared to asthmatics, as well as reduced triceps skin-fold thickness, mid-upper arm circumference, and body fat. However, there was no significant difference in skeletal muscle mass between the two groups. The study suggests that ABPA may be associated with a higher risk of malnutrition. [Extracted from the article]

Over the past decade, endobronchial ultrasound‑guided transbronchial needle aspiration (EBUS‑TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS‑TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS‑TBNA are still not standardized. Hence, evidence‑based guidelines are needed to optimize the diagnostic yield and safety of EBUS‑TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS‑TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two‑day in‑person meeting. These guidelines provide evidence‑based recommendations encompassing indications of EBUS‑TBNA, pre‑procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS‑TBNA in special situations, and training for EBUS‑TBNA. [ABSTRACT FROM AUTHOR]

Background and Objective: India, a highly heterogeneous country, has no common reference standards for predicting spirometry values, with very few recent studies from south India. This study aimed to create reference equations for rural south Indian adults, based on a population‑based survey in Vellore, south India and compare it with other equations from India. Methods: The data from 583 non‑smoking, asymptomatic participants (30 years and older) from a spirometry‑based survey for airflow obstruction (rural Vellore, 2018), were used to develop equations for FEV1, FEV1/FVC, and FVC. The dataset was divided for development (70%) and validation (30%), by gender. Differences between observed and predicted values were assessed using the new equations and comparisons made with other equations from India. Results: Predictions with Vellore rural equations were closest to the previous south Indian equations from urban Bangalore. However, the Bangalore equations led to overestimation of FVC values in males, and of both FEV1 and FVC values in females. Using the rural Vellore equations also led to a higher percent of males being classified as having airflow obstruction, compared to the Bangalore equations which underestimated airflow obstruction in this rural population. Comparison with previously derived Indian equations from other parts of the country showed pronounced variations. Conclusions: Our study reiterates the need for representative rural and urban studies of adults from various parts of India, to obtain region specific reference equations, given the wide variations in spirometry values in “normal” individuals, due to social heterogeneities of the Indian population and resulting complexities in defining normal. [ABSTRACT FROM AUTHOR]

Transbronchial lung cryobiopsy (TBLC) is a technique used to sample the lungs for diagnosing diffuse lung diseases. A sizeable tissue is sheared off the lung parenchyma during TBLC leading to a defect in the lung, which might result in a cystic lesion on imaging. Computed tomography (CT) performed for other reasons might incidentally reveal such a cyst. We report a 75‑year‑old patient who underwent TBLC and developed significant intraprocedural bleeding. Chest CT performed for worsening breathlessness revealed an acute exacerbation (AE) of the underlying interstitial lung disease, and incidentally showed a new cyst in the biopsied lung lobe. The patient recovered clinically after the administration of high‑dose methylprednisolone. A chest CT performed nine months later showed resolution of the lung cyst. A systematic review of the literature revealed that cysts/pneumatoceles/cavities may appear in 50% of patients following TBLC. About 90% are due to biopsy trauma and mostly resolve spontaneously. Rarely, a cavity may be due to infection; antimicrobial agents should be administered in such cases. [ABSTRACT FROM AUTHOR]

A 55-year-old female presented with recent exacerbation of the chronic cough, dyspnea, and copious expectoration. The symptoms worsened during the winter months. In the past, she was misdiagnosed with pulmonary tuberculosis. A computed tomography scan revealed bronchiectasis changes, high attenuated mucus, and hypereosinophilia. The diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) with subacute invasion was confirmed through bronchoscopy and fungal culture. Treatment with oral voriconazole significantly improved lung function and quality of life. This case highlights the importance of considering invasive pulmonary aspergillosis in patients with exacerbations of asthma and bronchiectasis. Early diagnosis and appropriate treatment are essential for improved outcomes in such cases. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of fungal pneumonia causing a mycotic subclavian aneurysm. The patient, a 52-year-old female farmer with asthma and recently diagnosed diabetes, presented with symptoms of cough, shortness of breath, and hemoptysis. Imaging revealed a subclavian artery aneurysm and lung abnormalities consistent with mucormycosis. Despite treatment with antifungals and planned surgical repair, the patient experienced a cardiac arrest and did not survive. The article highlights the challenges in diagnosing and managing pulmonary mucormycosis and emphasizes the importance of early empirical therapy and aggressive surgical intervention. [Extracted from the article]

In the same review, the RR of early-onset asthma associated with a maternal history of asthma was more (3.9 versus 3.3) compared to that of paternal asthma.[[153]] Children with a family history of asthma are suggested to have a more severe course.[[155]],[[156]] Although the association of adult-onset asthma with family history is weak than that of childhood-onset asthma, however, it is still a significant risk factor for adult-onset asthma. A family history of asthma is seen less frequently than those with early-onset asthma.[[111]] This phenotype of asthma is relatively steroid-resistant but highly responsive to biologic therapies targeting T2 pathways.[[112]],[[113]],[[114]],[[115]] Obesity-related asthma Obesity-related asthma is not a well-understood phenotype, and it is unclear whether it is comorbidity common in asthma that confers greater likelihood of breathing pattern disorder or it promotes a pro-inflammatory state that results in asthma.[[116]],[[117]],[[118]],[[119]] Higher body mass index (BMI) is associated with increased levels of inflammatory markers, such as, tumour necrosis factor-alpha (TNF-a), interleukin-6 (IL-6), and leptins and fewer eosinophils, fractional exhaled nitric oxide (FeNO) and corticosteroid responsiveness.[[118]],[[119]] Clinically, this phenotype comprises of a group of older non-allergic, obese females who have significant symptoms but minimal health-care utilization.[[103]],[[104]] Neutrophilic asthma Neutrophilic asthma does not have a widely accepted definition, and the consensus about the characterization of this entity is also lacking. [Extracted from the article]

Objective: The legal definitions of brain death are tantamount for legal dogmas and sometimes criminal intimidation of the treating doctors. The tests for brain death are only applicable to patients planned for organ transplantation. We intend to discuss the necessity of the "Do Not Resuscitate (DNR)" legislature in cases of brain death patients and applicability of tests for brain death irrespective of the intention for organ donation. Methods: A comprehensive review of the literature was performed till May 31, 2020 from the MEDLINE (1966 to July 2019) and Web of Science (1900 to July 2019). Search criteria included all publications with the MESH terms: "Brain Death/legislation and jurisprudence"[Mesh] OR "Brain Death/organization and administration"[Mesh] AND "India" [Mesh]. We also discuss the different opinions and implications of brain death versus brain stem death in India with the senior author (KG) who was responsible for South Asia's first multi-organ transplant after certifying brain death. Additionally, a hypothetical scenario of a DNR case is discussed in the current legal paradigm of India. Results: The systematic search yielded only five articles reporting a series of brain stem death cases with an acceptance rate of organ transplant among brain stem deaths being 34.8%. The most common solid organs transplanted were the kidney (73%) and liver (21%). A hypothetical scenario of a DNR and possible legal implications of the same under the current 'Transplantation of Human Organs Act (THOA)' of India remains unclear. A comparison of brain death laws in most Asian countries shows a similar pattern regarding the declaration of brain death and the lack of knowledge or legislature regarding DNR cases. Conclusion: After the determination of brain death, discontinuation of organ support requires the consent of the family. The lack of education and the lack of awareness have been major impediments in this medico-legal battle. There is also an urgent need to make laws for cases that do not qualify for brain death. This would help in not only realistic realization but also better triage of the health care resources while legally safeguarding the medical fraternity. [ABSTRACT FROM AUTHOR]

Introduction: Intrathoracic lymph node metastasis from extrathoracic neoplasms are rare. Primary malignancies that metastasize to mediastinal-hilar lymph nodes are head and neck, carcinoma breast, and genitourinary. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)/endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the preferred modality for mediastinal lymph node sampling. Methods: Fifty seven patients with extrathoracic malignancies with maximum standardized uptake value (SUVmax) of mediastinal-hilar lymph nodes greater than or equal to 2.5 were taken up for EBUS-TBNA. The histo-cytopathological results obtained from EBUS-TBNA were compared with SUVmax value and short-axis diameter of a lymph node as noted on EBUS. Results: Out of 74 sampled nodes, 49 (66.2%) were benign and 25 (33.8%) were malignant. The SUVmax range of benign nodes was 2.8-13 as compared to 3-18 of malignant nodes. The size range of malignant and benign nodes were 8-35 mm and 8-30 mm, respectively. The mean size of abnormal nodes (metastatic + granulomatous) was 17.5 (8-35 mm) and the mean SUVmax was 9.1 (3.4-18), and it was a statistically significant difference when compared to reactive (normal) nodes. At SUVmax cut-off 7.5, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 78.5%, 81.2%, 84.6%, and 74.2%, respectively for detecting abnormal nodes. At 13 mm size cut-off, sensitivity, specificity, PPV, NPV were 75.5%, 65%, 75%, and 72%, respectively, for detecting abnormal nodes. Conclusion: The majority of mediastinal-hilar nodes with increased metabolic activity are benign in nature. Size and SUVmax are poor predictors of metastasis in tuberculosis endemic region. There should be a restrictive attitude toward invasive diagnostic testing for mediastinal-hilar nodes in extrathoracic malignancies. [ABSTRACT FROM AUTHOR]

Patients presenting for surgery postlobectomy with Broncho pleural fistula are prone for perioperative respiratory complications and pose a significant challenge to anesthetist. Published data to guide perioperative management of such cases especially for abdominal surgeries are scarce. We describe a 51-year-old gentleman status postlobectomy with Broncho pleural fistula posted for cholecystectomy in view of symptomatic gallstones. Laparoscopic surgery was later converted to open surgery in view of surgical difficulties. Perioperative period was uneventful and proper modes of analgesia helped in faster recovery. Proper understanding of physiological and anatomical changes and proper planning of anesthesia facilitated safe and uneventful anesthesia. [ABSTRACT FROM AUTHOR]

Even if the virus is eradicated in patients who have recovered from COVID-19, total eradication of the virus, which causes lung lesions, does not completely exclude the development of a progressive and irreversible fibrotic interstitial lung disease. [7] Epidemiological studies show that during the post-COVID-19 convalescence period many patients still have lung lesions caused by the presence of fibrotic tissue and that the complete healing process may occur slowly. [Extracted from the article]

[7] Epidemiological studies show that during the post-COVID-19 convalescence period many patients still have lung lesions caused by the presence of fibrotic tissue and that the complete healing process may occur slowly. Even if the virus is eradicated in patients who have recovered from COVID-19, total eradication of the virus, which causes lung lesions, does not completely exclude the development of a progressive and irreversible fibrotic interstitial lung disease. It can be hypothesized that using antifibrotic therapy at the beginning of the convalescence period in patients with lung lesions could prevent further damage and accelerate full recovery. [Extracted from the article]

In coronavirus disease 2019 (COVID-19) patients, dysregulated release of matrix metalloproteinases occurs during the inflammatory phase of acute respiratory distress syndrome (ARDS), resulting in epithelial and endothelial injury with excessive fibroproliferation. COVID-19 resembles idiopathic pulmonary fibrosis (IPF) in several aspects. The fibrotic response in IPF is driven primarily by an abnormally activated alveolar epithelial cells (AECs) which release cytokines to activate fibroblasts. Endoplasmic reticulum (ER) stress is postulated to be one of the early triggers in both diseases. Systemic sclerosis (SSc) is a heterogeneous autoimmune rare connective tissue characterised by fibrosis of the skin and internal organs. Interstitial lung disease (ILD) is a common complication and the leading cause of SSc-related death. Several corollaries have been discussed in this paper for new drug development based on the pathogenic events in these three disorders associated with pulmonary fibrosis. A careful consideration of the similarities and differences in the pathogenic events associated with the development of lung fibrosis in post-COVID patients, IPF patients and patients with SSc-ILD may pave the way for precision medicine. Several questions need to be answered through research, which include the potential role of antifibrotics in managing IPF, SSc-ILD and post-COVID fibrosis. Many trials that are underway will ultimately shed light on their potency and place in therapy. [ABSTRACT FROM AUTHOR]

Background: Little data exist on antifibrotic drugs for treating symptomatic patients with persistent interstitial lung abnormalities in the postacute phase of coronavirus disease 2019 (COVID-19). Herein, we describe the physician practices of prescribing pirfenidone and nintedanib for these patients and the physician-assessed response. Materials and Methods: This was a multicenter, retrospective survey study of subjects administered pirfenidone or nintedanib for post-COVID-19 interstitial lung abnormalities. Data on the demographic details, comorbidities, abnormalities on the computed tomography (CT) of the chest, treatment, antifibrotic drug use, and physician-assessed response were collected on a standard case record pro forma. We explored physician practices of prescribing antifibrotics (primary objective) and the physician-assessed response (secondary objective). Results: We included 142 subjects (mean age, 55.9 years; 16.2% women) at eight centers. The most common abnormalities on CT chest included ground glass opacities (75.7%), consolidation (49.5%), reticulation (43.9%), and parenchymal bands (16.8%). Of the 5701 patients discharged after hospitalization at six centers, 115 (2.0%) received antifibrotics. The drugs were prescribed an average of 26 days after symptom onset. One hundred and sixteen subjects were administered pirfenidone; 11 (9.5%) received the full dose (2400 mg/day). Thirty subjects were prescribed nintedanib; 23 (76.7%) received the full dose (300 mg/day). Of 76 subjects with available information, 27 (35.6%) and 26 (34.2%) had significant or partial radiologic improvement, respectively, according to the physician's assessment. Conclusions: Antifibrotic agents were administered to a minority of patients discharged after recovery from acute COVID-19 pneumonia. Larger, randomized studies on the efficacy and safety of these agents are required. [ABSTRACT FROM AUTHOR]

Background: There is a lack of data on the prevalent practices of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in India. Aim: To study the current practices of EBUS-TBNA in India. Methods: This survey was an online questionnaire designed on the Google forms interface. The survey included various questions related to demographics, sedation, analgesia and anesthesia, technical aspects, and infection control related to the procedure of EBUS-TBNA. Results: Data from 134 respondents (mean age: 42.2 years) were analyzed. Most (97.8%) were pulmonologists or physicians, and a majority (94.8%) practicing in either a private multi-specialty setting or medical college. 40.3% had received procedure training at a formal training program. Mild/moderate sedation was the most common strategy (70.1%). Midazolam (76.7%), Fentanyl (76.0%), followed by propofol (46.5%), were the most frequent drugs, and 82.8% preferred combination sedation. 26.1% used cricothyroid lignocaine injection, and the use of 1% or 2% lignocaine for spray-as-you-go administration was similar. The oral route was preferred, while the laryngeal mask airway was the most common airway conduit under general anesthesia. Suspected granulomatous mediastinal lymphadenopathy (TB/sarcoidosis) (67.2%), followed by lung cancer (32.8%), were the most common indications of EBUS-TBNA. 81.3% performed EBUS-TBNA for lung cancer staging. 21 G needle was preferred (64.9%), and vacuum suction was common (80.6%). 55.2% routinely performed ROSE. Alcohol fixed glass slide smears were the most common method (93.1%) for cytological preparation. 49.3% also performed EUS-B-FNA. 76.9% routinely obtained endo bronchial biopsy and transbronchial lung biopsy in patients with suspected sarcoidosis. Elastography was infrequently used. Nearly three-fourths (77.6%) reused EBUS needles. Conclusion: There is practice variability in the multiple aspects related technical performance of EBUS-TBNA. Evidence-based guidelines addressing the multiple technical aspects are required to standardize the practice of EBUS-TBNA. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) in cancer remains underdiagnosed. This prospective study aimed to evaluate the feasibility of screening for VTE in lung cancer (LC) patients. We assess the incidence of VTE, its risk factors, and effects on overall survival (OS).Methods: Consecutive treatment-naive LC patients were screened for deep venous thrombosis (DVT) with compression ultrasonography and pulmonary thromboembolism (PTE) with computed tomography pulmonary angiography (CTPA) at diagnosis and after 3 months of treatment. The incidence rate of VTE (DVT and/or PTE) was calculated. Risk factors associated with VTE were assessed using logistic regression analysis. All participants were followed-up to 1 year after enrollment. OS was compared in LC subjects with and without VTE, using the Cox proportional hazard analysis.Results: Around 301 subjects with LC (stages IIIB-IV accounted for 83.1%) were enrolled, of which 16 had VTE (5.3%). The incidence rate of VTE was 90 per 1000 person-years (PY). PTE was asymptomatic in 27.3% of cases while all DVT episodes were symptomatic. The incidence rate of asymptomatic PTE identified during the screening was 17 per 1000 PY. The median duration from LC diagnosis to the VTE event was 96.5 days. Median OS was significantly less in VTE patients [161 versus 311 days; P = 0.007] and death was attributable to VTE in 50%. After adjusting for covariates, VTE (hazard ratio [HR] = 2.1), smoking (HR = 1.7), and Eastern cooperative oncology group performance status ≥2 (HR = 1.6) were independently associated with poor OS in LC.Conclusions: VTE occurs in approximately 1 in 20 newly-diagnosed patients with LC and is associated with decreased OS. Screening for PTE may be considered even in resource-limited settings. [ABSTRACT FROM AUTHOR]

Introduction: Long-term quality of life, return to work, economic consequences following Acute Respiratory Distress Syndrome (ARDS) are not well described in India. This study was aimed to address the question. Methods: A prospective cohort study of 109 ARDS survivors were followed up for a minimum of 6 months following discharge. Quality of life was assessed using the SF-36 questionnaire. Respiratory quality was assessed using the St Georges Respiratory Questionnaire. Time to return to work was documented. Costs-direct medical, as well as indirect were documented up to 6 months. Results: At 6 months, 6/109 (5.5%) had expired. Low energy/vitality and general heath were noted in the SF-36 scores at 6 months; overall a moderate quality of life. Pulmonary function tests had mostly normalized. Six-min walk distance was 77% of predicted. Respiratory quality of life was good. It took at the median of 111 days to go back Interquartile range (55–193.5) to work with 88% of previously employed going back to work. There were no significant differences in the severity of ARDS and any of these outcomes at 6 months. The average total cost from the societal perspective was ₹ 231,450 (standard deviation 146,430-, 387,300). There was a significant difference between the 3-ARDS severity groups and costs (P < 0.01). There were no independent predictors of return to work. Conclusion: ARDS survivors have low 6-month mortality. Pulmonary physiology and exercise capacity was mostly normal. Overall, quality of life is average was moderate, while respiratory quality of life was good. Return to work was excellent, while cost of care falls under a catastrophic heath expense. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has created an unprecedented crisis, affecting every sphere of human life. A major challenge for health care workers (HCWs) is to care for patients with a highly contagious airborne disease, while making sure of their own safety. Interventional pulmonology (IP) procedures, like bronchoscopy, are particularly risky due to significant aerosol generation. Guidelines by several scientific bodies were framed on the precautions to be taken while performing IP procedures. We evaluated the IP procedures performed during the COVID-19 pandemic, and whether the precautions adopted proved adequate in preventing transmission amongst the HCWs involved in these procedures. Method: We performed a retrospective analysis of all patients who underwent IP procedures between March 2020 and November 2020, at a tertiary cancer hospital. We also evaluated the proportion of HCWs, who were involved in these procedures, and were affected by COVID-19, through their health care records. Results: We performed a total of 506 IP procedures. Two of the 18 HCWs, working in that unit, suffered from COVID-19 and recovered after a mild illness. Three HCWs were isolated with suspected infection but proved to be negative. The procedures in our IP unit were uninterrupted for the entire duration of the study period. Conclusion: IP procedures can be safely performed even in the presence of a highly contagious viral pandemic with adequate precautions. [ABSTRACT FROM AUTHOR]