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Background: Tuberculosis is one of the biggest public health concerns in India with a prevalence of 195 cases per 100000. Silica is cytotoxic to macrophage which is primary defense mechanism to tubercular bacilli and, hence, exposure to silica dust increases risk for TB. Silica exposed persons are at 2.8 to 39 times greater risk of affected by pulmonary tuberculosis in comparison to healthy subjects. Methodology: A cross-sectional epidemiological study was conducted among 935 workers in sandstone mining. Full-size posteroanterior view (PA) chest X-ray in full inspiration was evaluated and evidence of tuberculosis was noted. Fourier transform infrared spectrophotometer was used for determining the free silica in 23 dust samples. Results: 6.4% X-rays showed evidence of TB and silica dust concentration was 0.11 to 0.16 mg/m³. The TB cases significantly increased from 2% to 6% to 12.7% as the work exposure increased from <10 years to 11-20 years to >20 years respectively. 8.5% of the TB cases were seen among the workers having more than 10 years of work exposure. The odds ratio (95% CI) for work exposure more than 10 years to less than 10 years was 4.53 (1.92-10.65). Conclusion: Reduction of silica particles from work environment can significantly reduce the number of TB cases and hence wet drilling should be practiced and personal protective equipment should be regularly used. [ABSTRACT FROM AUTHOR]

Background: The leather industry stands as one of India's burgeoning sectors, boasting significant manpower. Workers in the finishing sector, particularly those involved in polishing, face heightened risks due to exposure to formaldehyde, aniline, and resins, which can lead to respiratory complications. Aims and Objectives: The aims and objectives of the study are to determine the small airway obstruction in asymptomatic finishing sector workers of a leather factory. Materials and Methods: The current study was a cross-sectional study conducted in a leather factory located in Chennai, Tamil Nadu. A random sample of 60 workers was drawn from different sectors of a leather factory. Basic demographic details, smoking history, nature of work, exposure to irritants along with duration, and respiratory symptoms were collected. All workers were subjected to spirometry as per ATS guidelines and the results were analyzed. Association between length (years) of exposure, respiratory symptoms, and spirometry impairment among the workers were analysed. Results: Out of 60 samples, 38 were exposed to irritants and 22 were not exposed to irritants. Out of 38, 25 had small airway disease, seven had large airway obstruction, one had a restrictive pattern, and five had normal spirometry. 42.1% of them were asymptomatic. Conclusion: Small airway obstruction is notably prevalent, especially among asymptomatic workers in the polishing sector. Prolonged exposure is associated with the development of large airway obstructive disease. This study underscores the importance of continuous monitoring for airway diseases in occupationally exposed workers, advocating for timely preventive and protective measures to curb disease progression. [ABSTRACT FROM AUTHOR]

Introduction: Mulligan therapy includes Sustained Natural Apophyseal Glides (SNAGs) and Mobilisation With Movement (MWM), which can be applied for spinal pain and Range of Motion (ROM). It helps to stretch the structures on the convex side of the offending movement and opens the intervertebral foramen. Pulmonary Function Test (PFT) is an important diagnostic test that helps guide decisions for management. Normal chest expansion is crucial for respiratory system function and tissue oxygenation. The contraction of external intercostal muscles moves the ribs upwards and outwards, causing the rib cage to expand, which increases the volume of the thoracic cavity. After the age of 25 years, normal pulmonary function begins to decline. Inappropriate posture leads to reduced thoracic cage mobility, thereby decreasing chest expansion. Thoracic SNAGs and MWM help stretch the structures, which will aid in chest expansion. Aim: To determine the effect of Mulligan therapy on pulmonary function and chest expansion in healthy individuals. Materials and Methods: A quasi-experimental study was conducted at Ramaiah Hospitals in Bengaluru, Karnataka, India over an 11-month period between July 2021 and June 2022. Based on the inclusion criteria, 103 participants were included, and Mulligan therapy was performed. Pre- and post-PFT and chest expansion measurements were taken and analysed using Student’s t-test. Results: The results showed a statistically significant difference in chest expansion at all three levels (p<0.001) and Forced Expiratory Volume (FEV1) in the first second/Forced Vital Capacity (FVC) (p=0.04), Peak Expiratory Flow (PEF) (p=0.03), Forced Inhibitory Volume in the first second (FIV1) (p=0.01), and FIV1/FIVC (p=0.03) values in the PFTs. Conclusion: Chest expansion and FEV1/FVC, PEF, FIV1, and FIV1/FIVC show a significant change post thoracic SNAGs, intercostal MWM, costochondral, and costovertebral MWM. However, no significant changes have been observed in the other parameters of pulmonary function. [ABSTRACT FROM AUTHOR]

Introduction: Upper Gastrointestinal Endoscopy is considered the best screening tool for varices among patients with chronic liver disease. However, it is an expensive and invasive procedure that is not routinely available in rural India. Abdominal ultrasonography along with colour Doppler study is an inexpensive test commonly ordered for patients with chronic liver disease. Recent literature suggests that ultrasonographic parameters can be used to predict varices. Aim: To determine if ultrasonography of the entire abdomen and spleno-portal Doppler study findings can predict oesophageal varices in patients with chronic liver disease. Materials and Methods: The present hospital-based observational, cross-sectional study was conducted in the indoor ward of the Department of General Medicine at Medical College and Hospital, Kolkata, India, over a duration of one year from February 2021 to February 2022. Total 100 patients with chronic liver disease, admitted to the hospital ward, were included in the study. Child-Turcotte-Pugh (CTP) scores were obtained for all patients. Ultrasonographic and spleno-portal Doppler indices, such as liver size, spleen size, portal vein diameter, splenic vein diameter, peak systolic velocity of the portal vein, and portal vein/splenic vein diameter ratio, were measured alongside upper gastrointestinal endoscopy to detect varices. The data were analysed using Statistical Package for Social Sciences (SPSS) version 28.0. The Chi-square test was used to test for significant differences in proportions (categorical data), and the independent t-test and Analysis of Variance (ANOVA) with Tukey's Post-hoc test were employed to test for significant differences in means (continuous data). Additionally, Receiver Operating Characteristic (ROC) curves were obtained for statistically significant parameters to predict the presence of varices. Results: The study enrolled 100 patients (63% males, 37% females) with a mean age of 49.19±14.965 years, ranging from 14 to 91 years. (median age of 52, range 14-91 years). Of these, 68 patients (68%) had oesophageal varices, while 32 (32%) did not. The study found that a mean spleen size of 13.55 cm, a mean portal vein diameter of 12.5 mm, and a mean splenic vein diameter of ≥9.05 mm were predictive of varices. Additionally, a mean portal vein/splenic vein diameter ratio of 1.6150 was also predictive of varices. However, there was no significant difference in mean liver size and peak systolic velocity between those with and without varices. Conclusion: The present study suggests that a spleen size, portal vein diameter, splenic vein diameter, and portal vein/splenic vein diameter ratio can be reliably used to predict oesophageal varices among patients with chronic liver disease. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Depression is a hidden pandemic among adolescents with multi-factorial causal risk and risk correlates. Objectives: To find the prevalence of depression and risk factors among school-going adolescents. Methods: A cross-sectional study was conducted among 838 adolescents enrolled in 6th–11th standards (age: 11–19 years) in 15 urban schools in Patna city by using the modified Patient Health Questionnaire-9 (PHQ-9); binary logistic regression was applied to find significant risk correlates. Results: Depression was noted among 51.2% adolescents of our study participants: mild 32.3%, moderate 14.3%, moderately severe 3.9%, severe depression 0.6%; among early adolescents (46.2%; boys-21.2%, girls-78.8%) and among late adolescents (55.3%, boys-34.7%, girls-65.3%). Adolescent depression was significantly associated in our study with female gender, late adolescence, higher classes (9th–11th), vegetarian diet, soft drink consumption, fast foods, screen time, domestic harassment, academic dissatisfaction, parental discord as well as mental illness. Girls had higher risk who were in higher classes, on a vegetarian diet, habitually on soft drink, more screen time (>3 h), face more family nuisance, parents brawling frequently, and suffering from known mental diseases. Conclusion: Depression was noted in more than half of the adolescents, with a higher prevalence in girls, scholastic failure, higher grades, vegetarian diet, more screen time, familial disease, and conflict. [ABSTRACT FROM AUTHOR]

Context: Since its outbreak, the COVID-19 pneumonia pandemic is rapidly spreading across India; although computed tomography of chest (CT chest) is not recommended as a screening tool, there is a rapid surge in the CT chest performed in suspected cases. We should be aware of the imaging features among the Indian population. Aim: To analyze the CT chest features in Indian COVID-19 patients. Settings and Design: Retrospective study. Subjects and Methods: CT chest of 31 polymerase chain reaction (PCR) verified patients of COVID-19 was assessed for ground-glass opacities (GGO), consolidations, bronchiectasis, pleural effusions, vascular enlargement, crazy paving, and reverse halo sign. Statistical Analysis Used: The data was analyzed in Microsoft Excel 2019. Results: Only one patient showed a normal scan. Multilobar involvements with parenchymal abnormalities were seen in all the patients with bilateral involvement in 74.1%. 42.5% of the lung parenchymal abnormalities were pure GGOs, while 41.6% had GGOs mixed with consolidation. Peripheral and posterior lung field involvement was seen in 70.5% and 65.5%, respectively; 56.8% had well-defined margins. Pure GGOs were seen in all six patients, who underwent CT in the first 2 days of onset of symptoms. Seventeen patients scanned between 3 and 6 days of the illness showed GGOs mixed with consolidation and pure consolidations 76%. Vascular enlargement, crazy paving, and reverse halo sign were seen in 70%, 53%, and 35% of the patients, respectively. Patients scanned after 1 week of symptoms showed traction bronchiectasis along with GGOs and or consolidations. Conclusions: COVID-19 pneumonia showed multifocal predominantly subpleural basal posteriorly located GGOs and/or consolidations which were predominantly well defined. "Crazy paving" was prevailing in the intermediate stage while early traction bronchiectasis among the patients presented later in the course of illness. [ABSTRACT FROM AUTHOR]

Background: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. Methods: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. Results: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. Conclusion: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias. [ABSTRACT FROM AUTHOR]

Background: In Indian mines, the prescribed exposure limit (PEL) for free silica dust is 0.15 mg/m3 which is much higher than those of OSHA and the ACGIH. Because of the reporting of high numbers of silicosis cases among Indian sandstone mine workers, the present study was designed to assess the dust exposure profile of the workers and to substantiate correlation of silica exposure with radiographic findings of silicosis. Methods: A cross‐sectional study of 1012 workers actively engaged in sandstone mining was conducted. Chest x‐rays were evaluated by the ILO Classification for the detection of pneumoconiosis. Representative 26 personal dust samples were collected using a personal dust sampler and free silica content estimated. Results: Radiographs compatible with silicosis were seen in 12.3% of workers, of which about 90% were ILO category 1 & 2. Prevalence of abnormal profusion increased from 2.9% to 13.1% to 22% as work exposure increased from <10 to 11 to 20 to >20 years, respectively. In dust samples, the mean silica concentration was 0.12 mg/m3 with 70% samples below the prescribed standard of 0.15 mg/m3. Conclusion: The study indicates that silica exposure below the prescribed limit in India is likely to be harmful. The PEL for crystalline silica in India of 0.15 mg/m3 is not adequately protective. Hence, there is an urgent need to reduce exposure to silica in these workplaces to prevent silicosis and to review the present standards as the government of India remains committed to the elimination of silicosis by 2030. [ABSTRACT FROM AUTHOR]

Introduction: The present study was designed to assess peak expiratory flow rate on postnatal normal vaginal delivery women. All types of hormonal changes occur in women especially during reproductive life. To assess Peak Expiratory Flow Rate was after third day of normal delivery. These would also help to predict any existing pulmonary function test during various phases of women's life. Method: Quasi experimental, convenient sampling and sample size of 15 subjects. Subjects of 19-25 years, primipara women were included in the study. The exclusion criteria were any cardiovascular diseases, women who underwent caesarean, chest wall deformity and multiple pregnancies. The subjects were perform daily active exercises under the guidance of physiotherapist after 24 hours of delivery. After discharge from hospital they were instructed to follow the exercises in the home and noted in the chart. PEFR values are noted 3rd, 15th and 45th post operative day for data analysis. Results: There was a decrease in mean PEFR as the normal delivery women in advanced from third day and increase in PEFR in 45th day, both being statistically significant. Conclusion: The study showed significant increase in PEFR in the postnatal women compared 3rd day and 45th day. We stress the importance of regular graded active exercises in the postpartum period for the speedy recovery of these changes. [ABSTRACT FROM AUTHOR]

Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India. [ABSTRACT FROM AUTHOR]

Background: Pulmonary function testing (PFT) and monitoring plays an important role in respiratory evaluation. A complete bedside evaluation of the respiratory status is especially useful in preoperative assessment in bilateral total knee replacement patients.. Purpose: The current study aimed to observe whether the patient can maintain the vital capacity of the lungs after the surgery. To measure the post-operative bedside pulmonary function, Lung capacities and breath holding time test were done Method: An Observational, cross-sectional study with 20 subjects who have undergone bilateral total knee replacement from Shalby Multispecialty Hospital, Indore were chosen. The lung capacity (cubic centimeter/second) using incentive spirometer and breath holding time using breath holding test had collected at sampling stage one prior to bilateral total knee replacement surgery designated as baseline observations. At sampling stage two to four, the lung capacity and breath holding time had re-collected after bilateral total knee replacement surgery on day 1, 3 and 7 Conclusions: Bilateral total knee replacement surgery found with compromised total lung capacity and breath-holding time and administration of incentive spirometer after bilateral total knee replacement surgery found to be advantageous and significantly improved total lung capacity and breath-holding time to overcome post-surgery difficulties in pulmonary functioning. [ABSTRACT FROM AUTHOR]

The article presents the details of a research study to evaluate and compare the effects of Sahaja yoga meditation on pulmonary functions during aging. Details related to the materials and methods used for this research, along with the age profile of the subjects, along with the results of the study, are presented.

Background: Prediction equations for diffusing capacity of lung for carbon monoxide (DLCO), alveolar volume (VA), and DLCO/VA using the current standardization guidelines are not available for Indian population. The present study was carried out to develop equations for these parameters for North Indian adults and examine the ethnic diversity in predictions. Materials and Methods: DLCO was measured by single-breath technique and VA by single-breath helium dilution using standardized methodology in 357 (258 males, 99 females) normal nonsmoker adult North Indians and DLCO/VA was computed. The subjects were randomized into training and test datasets for development of prediction equations by multiple linear regressions and for validation, respectively. Results: For males, the following equations were developed: DLCO, -7.813 + 0.318 × ht -0.624 × age + 0.00552 × age2; VA, -8.152 + 0.087 × ht -0.019 × wt; DLCO/VA, 7.315 - 0.037 × age. For females, the equations were: DLCO, -44.15 + 0.449 × ht -0.099 × age; VA, -6.893 + 0.068 × ht. A statistically acceptable prediction equation was not obtained for DLCO/VA in females. It was therefore computed from predicted DLCO and predicted VA. All equations were internally valid. Predictions of DLCO by Indian equations were lower than most Caucasian predictions in both males and females and greater than the Chinese predictions for males. Conclusion: This study has developed validated prediction equations for DLCO, VA, and DLCO/VA in North Indians. Substantial ethnic diversity exists in predictions for DLCO and VA with Caucasian equations generally yielding higher values than the Indian or Chinese equations. However, DLCO/VA predicted by the Indian equations is slightly higher than that by other equations. [ABSTRACT FROM AUTHOR]

Lung function measurement is one of the ways of assessing respiratory health status. Stone mine workers are prone to lung problems due to stone dust, are a great concern from public health point of view. The aim of the study was to understand the nature of age related changes in lung function traits of the Santal stone mine workers of Birbhum district, West Bengal. Cross-sectional data on lung function traits including FVC, FEV1.0, FEV1.0/FVC and PEFR have been collected from 328 (149 males, 179 females) healthy adult Santal stone mine workers of Birbhum district, West Bengal. Statistical analysis including descriptive statistics, ANOVA and linear regression analysis were done separately for males and females for each lung function trait. The value of FVC and FEV1.0 reaches its peak within 25 years of age and then gradually decreases in both sexes. Similarly, the FEV1.0/ FVC ratio decrease with the increment of age in both sexes. The peak value of PEFR reaches between 25-34 years of age in male, but in case of female the peak value of PEFR reaches between 35-44 years of age. The ANOVA result showed that significant differences (P≤0.05) exists between/among age cohorts in terms of mean values of all the lung function traits for both males and females. The result of linear regression equation for lung function traits on age were as follows: FVCmale=3.168-0.015xage, FVCfemale=2.214-0.012xage, FEV1.0male=3.119- 0.021xage, FEV1.0female=2.111-0.013xage, FEV1.0/FVCmale=1.004-0.003xage, FEV1.0/FVCfemale=0.953+0.0006xage, PEFRmale=8.649-0.064xage, PEFRfemale=4.690- 0.014xage. Therefore, it seems that lung function traits gradually decline with progression of age and the pattern is similar in both sexes. However, generalization cannot be made out of this small-scale study. [ABSTRACT FROM AUTHOR]

The article focuses on deriving the prediction formulae to find the peak expiratory flow rate (PEFR) in young healthy, nonsmoking Indian population in the age group between eighteen and twenty five years. The matched value for PEFR was found to be more in males and females as compares with previous Indian studies.

The article presents research on the impact of aerobic exercises on physical fitness index (PFI) and peak expiratory flow rate (PEFR) among females. Results of the study show the changes in parameters when compared to baseline values, increase in PEFR, and the significant difference between the two groups.

Objective: To obtain reference values for FEV1, FVC, FEV1% and PEFR among children aged 8-14 years in south Gujarat region of India.Materials and Methods: This cross-sectional study was conducted among 655 normal healthy school children (408 boys and 247 girls) of Surat city aged 8 to 14 years studying in V to VII standard during November 2007 to April 2008. Height, weight, body surface area were measured. All included children were tested in a sitting position with the head straight after taking written consent from parents. Spirometry was done using the spirometer "Spirolab II" MIR 010. Spirometer used in the study facilitates the total valuation of lung function including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume ratio in one second (FEV1%) and peak expiratory flow rate (PEFR). Results: FVC, FEV1 and PEFR were found to be statistically significant in the study groups. For FVC and FEV1, highest correlation was found with age in girls and height in boys. For FEV1%, significant negative correlation was found with age and height in both sexes, but positive correlation was found with surface area. Similarly, PEFR showed highest correlation with surface area in boys and girls. Conclusion: Variables such as FVC, FEV1 and PEFR show good positive correlation with height, age and body surface area in both sexes. There is a need to have regional values for the prediction of normal spirometric parameters in a country like India with considerable diversity. [ABSTRACT FROM AUTHOR]

Peak expiratory flow rate (PEFR) was measured with mini Wright's peak flow meter in 783 children (aged 6-17 years) from a school in urban Delhi and 523 children (aged 6-15 years) from another school in Nellore, Andhra Pradesh. In all the children, age in completed years, sex, height, weight, chest circumference at full inspiration and maximum chest expansion were recorded. Age, sex, height and weight were independent predictors of PEFR in children from Nellore. Age, sex and height, were independent predictors of PEFR in boys from Delhi while height alone was an independent predictor of PEFR in Delhi girls. Common prediction equations for predicting PEFR in boys and girls have been developed for both regions based on age and height. For the same height and age, boys had higher PEFR than girls. In the females, the PEFR seemed to have a plateaux effect after the age of 14 years; such an effect was, however, not seen in the boys in the age range studied. The PEFRs of children from both parts of the country were similar, and were lower than those reported for American white children.