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Background: Disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) is a growing concern among the elderly in rural India, as its prevalence is higher than in urban areas. Thus, the rationale of the present study is to address different demographic, socioeconomic, behavioural, and health-related factors associated with ADL and IADL disability among the elderly in rural India. Data and methods: A total of 19,578 samples from the Longitudinal Ageing Study of India (LASI) Wave 1, 2017–2018, formed the basis of this study. A multivariable binary logistic regression model was administered to identify the risk factors associated with functional disability using Stata 16. Results: A multivariable binary logistic regression model shows that the higher odds ratio of ADL/IADL disability is found among the elderly who meet the following criteria: poor health status, age 80 years and above, female, depressed, not attending school, having chronic diseases such as heart disease, lung disease, and arthritis, smoking and drinking alcohol, poor economic status, physically inactive, and not covered by health insurance. On the contrary, the lowest odds ratio was found only among the elderly who belonged to a Scheduled Tribe (IADL disability) and had lung disease (ADL disability). Conclusion: A better understanding of these factors in the study can help to reduce functional disability by planning and implementing services specifically for rural areas. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mine workers face various health risks from occupational hazards, notably dust-related pulmonary dysfunction. This dysfunction is also attributed to diverse risk factors and health conditions. Despite the variety of underlying mechanisms, conflicting evidence persists regarding hypertension as a potential risk factor for such dysfunction. OBJECTIVE: To determine the predictors of pulmonary dysfunction vis-à-vis the hypertension status of mine workers. METHODS: We conducted a cross-sectional study among 444 mine workers from ten open-cast mines in Gujarat state (western part of India) from November 2020 to February 2022. We collected data on demographics, occupation, addiction, and comorbidities, including measurements like anthropometry, blood pressure, blood sugar, haemoglobin, and lipid levels. Hypertension was confirmed based on self-reported history and/or onsite blood pressure measurement, while pulmonary functions were assessed using a spirometer (expressed as forced expiratory volume in the first second FEV1 and forced vital capacity FVC). Multiple linear regression analysis was performed to determine the significant predictor of FEV1 or FVC vis-à-vis the hypertension status after adjusting for confounding variables. In addition, we assessed the effect of anti-hypertensive medications on pulmonary dysfunction. RESULTS: A total of 41% (95% CI: 36-45%) of mine workers were suffering from hypertension. On multiple linear regression, only being a male and work experience duration were the significant predictors of FEV1 [0.900 (0.475-1.092), p=<0.001; -0.029 (-0.034 - -0.021, p=<0.001] and FVC [1.088 (0.771-1.404), p=<0.001; -0.031 (-0.038 - -0.024, p = 0.001] respectively. While unadjusted analysis indicated hypertension led to FEV1 and FVC reduction, this effect lost significance after adjusting for confounders. Nevertheless, subgroup analysis revealed those on antihypertensive medications had reductions in FEV1 and FVC by -0.263 (95% CI: -0.449 - -0.078, p = 0.006) L and -0.271 (95% CI: -0.476 - -0.067, p = 0.009) L respectively. CONCLUSION: In our study among mine workers, alterations in lung function (FEV1 and FVC) on spirometry were predicted by gender and duration of work experience, while hypertension did not serve as a predictor. It is noteworthy that antihypertensive drugs were found to reduce lung functions on spirometry, highlighting the need for further research. [ABSTRACT FROM AUTHOR]

Background: Seed processing workers are exposed to dust particles generated during the processing of seeds, which can have adverse effects on their respiratory health. Aim: to estimate the prevalence and patterns of respiratory morbidity among seed processing workers in Hooghly district, West Bengal, India, and to explore their use of respiratory personal protective equipment (PPE). Methods: A cross sectional observational study was conducted in 5 seed processing plants from December 2022 to February 2023. A sample size of 129 workers was selected using probability proportionate to population size to select seed processing plants and simple random sampling to select workers at selected plants. Data on sociodemographic characteristics, occupational profile, substance use patterns, respiratory PPE use, and respiratory symptoms were collected through structured interviews. Spirometry was performed with a hand held tabletop spirometer (RMS Helios 401) to assess respiratory function. Results: 52.7% of participants reported at least one chronic respiratory symptom, while 17.1% had evident respiratory morbidity based on spirometry results, with most having restrictive patterns (10.1%). Multivariable regression analysis revealed that factors associated with respiratory morbidity included increasing work years of exposure [1.10 (1.02 1.18)], irregular use of respiratory PPE [4.36 (1.22 15.57)], and primary or below education level [6.09 (1.38 26.98)]. Conclusion: The study highlights the high prevalence of respiratory symptoms and morbidity among seed processing workers. It emphasizes the importance of implementing effective respiratory protection measures and raising awareness about occupational lung diseases in this industry. Further research and interventions are needed to improve the respiratory health and well being of seed processing workers. [ABSTRACT FROM AUTHOR]

Context: Children with human immunodeficiency virus (HIV) infection frequently present with opportunistic infections of the lung that may be associated with high mortality rate. There is no study, to the best of our knowledge, correlating specific radiographic patterns of chest infections with CD4 levels of immunity in HIV-infected children of Indian subcontinent (where prevalence of respiratory tuberculosis is very high). Aims: To study the radiological patterns of chest infections in HIV-infected children, and to correlate these radiological findings with CD4 cell count and final diagnosis. Methods: Forty-five HIV-infected children (1–18 years of age) with suspected chest infections were included in the study. The baseline and the most recent CD4 counts were recorded for each patient. Chest X-ray (CXR) was obtained in all the patients, and multi-detector computed tomography (MDCT) chest was done in 27 patients having clinical suspicion of infection with normal or equivocal findings on CXR. Chest radiographs and MDCT chest were analyzed for different radiological patterns of chest infections. Imaging findings were correlated with CD4 count range for disease spectrum. The final etiopathological diagnosis was achieved in combination with clinico-radiological findings, laboratory data, cytohistopathology and follow-up imaging. Results: Out of 45 children confirmed to be HIV-infected, 27 (60%) had bacterial infection, 14 (31.11%) had tuberculosis, and four (8.89%) had fungal infection. Consolidation on CXR/CT strongly suggested bacterial etiology (P < 0.05). Mediastinal/hilar lymphadenopathy (with or without necrosis) strongly suggested tubercular etiology (P value < 0.05). Diffuse GGO/haziness on CXR/CT strongly suggested fungal etiology (P value < 0.05). On correlation with CD4 count (cells/mm3), the bacterial infections occurred at early stages of HIV infection when immune status was relatively preserved, and most of the patients with tubercular infection had moderate immunosuppression. On the other hand, all patients of fungal infection showed severe immunosuppression. Conclusion: A wide spectrum of pulmonary disease encountered in HIV-infected children warrants an integrated approach of image interpretation. Familiarity with the imaging patterns, combined with relevant clinical/laboratory details, may greatly help to improve the diagnostic confidence and to reach to a more meaningful differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) virus has caused widespread Acute Respiratory Disease globally since 2020. Patients with evidence of lower respiratory illness either clinically or radiologically had moderate-to-severe illness. COVID respiratory and nonrespiratory symptoms (psychological and cognitive) noticed after 4–8 weeks of primary disease were called long COVID syndrome. Survivors of moderate-to-severe disease had a poor quality of life. The main objective of this retrospective study was to assess the role of outpatient pulmonary rehabilitation (PR) done in moderate-severe COVID-19 survivors who had symptoms after 4–8 weeks at Shaivam Lung Rehabilitation Centre, Ahmedabad. Methods: We analyzed the impact of PR on 30 patients' post-COVID-19 who were willing to participate during the ongoing pandemic. It was an outpatient 6–8 weeks of program designed to target respiratory and general muscle training, relaxation technique, nutritional counseling, occupational and psychological support. Patients were tested with of combination of self-assessment quality of life scale (adapted from short form 36 questionnaire), muscle training, dyspnea scale, and physical assessment. The standard objective assessment included oxygenation index (SpO2/FiO2 ratio), 6 min walk distance (6 MWD), Modified Medical Research Council (MMRC) score, manual muscle testing (MMT) along with pulmonary function testing. All these subjective and objective variables were tested pre- and post-PR program to assess the impact on defined parameters. Results: From December 2020 to March 2022, we studied the impact of PR on 30 out of 55 patients fitting into the inclusion criteria. Significant benefit was noted in subjective Short Form 36 (SF 36) score and objective (6 MWD, MMRC, oxygenation, MMT) quality of life post-PR program (P < 0.001). Improvement in spirometry was not statistically significant, indicating structural chronicity of COVID pulmonary fibrosis. Conclusion: PR is safe, effective, and feasible on an outpatient basis in COVID-19 survivors of illness with poor quality of life. Further research is required to prove its widespread benefit in such patients. [ABSTRACT FROM AUTHOR]

Introduction and Background: Chronic Obstructive Pulmonary Disease (COPD) exerts significant impacts on cardiac function, encompassing the right ventricle, left ventricle, and pulmonary vasculature. Material and Methods: This study was undertaken in the Department of Cardiology and the Department of Respiratory Medicine, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India. It was an observational study. The study was conducted from August 2022 to July 2023. Results: The previous identification of COPD as a lung disease has been disproven, and the disease has instead been shown to be systemic in nature. The cardiovascular system is the most prominent organ outside of the lungs to suffer from this. It is widely established that cardiac dysfunction is the leading cause of death in persons with COPD of any severity. Modifications to the cardiovascular system have been shown in numerous investigations and are well documented in the literature for both mild and moderate COPD. Conclusion: COPD severity promotes right ventricular global dysfunction and pulmonary hypertension. All COPD patients should get an echocardiography to detect early heart problems and reduce cardiac death and morbidity. [ABSTRACT FROM AUTHOR]

IgG4-related lung disease is a diagnostic challenge as the presenting patterns can mimic other commonly seen pulmonary diseases like infections, interstitial pneumonia, malignancy, etc. The diagnosis of IgG4-related disease requires a correlation of clinical, radiological, biochemical, and histopathological features. Especially, an adequate tissue sample is necessary to diagnose this disease confidently. Conventionally surgical lung biopsy was needed for histopathology. But with the availability of the new less invasive technique-transbronchial cryo lung biopsy, adequate tissue can be obtained to clinch the diagnosis via bronchoscopy, thereby avoiding surgery. We report a case of IgG4-related interstitial lung disease diagnosed with the help of this technique in a tertiary care center in South India. Clinicoradiological features were inconclusive. Transbronchial cryo-lung biopsy helped to achieve the diagnosis. [ABSTRACT FROM AUTHOR]

Lung transplantation is gaining widespread acceptance as the preferred therapeutic option for selected cases of end-stage lung disease in India. The indications of lung transplantation are increasing, with better post-operative survival, including the COVID affected lung, if we choose our patients well. The national acceptance of expanded criteria in lung donation, streamlining of the process of lung transplantation by governmental, and non-governmental organizations and significant increase in the number of organ donations in India have strengthened the lung transplantation program within the country. Through this article, we describe a brief history, the process, and our experience of lung transplantation since we started our program in 2017 until date. [ABSTRACT FROM AUTHOR]

Background A wide variety of computed tomography (CT) findings in COVID-19 have been reported in different studies, and the CT findings differ according to the stage of the disease and disease severity and associated co-morbidities. The study aimed to determine the role of HRCT chest in the evaluation of COVID 19 patients. Methods This is a retrospective study done at K.J. SOMAIYA MEDICAL COLLEGE & HOSPITAL SION, MUMBAI. The Present Study was on 160 hospitalized patients who underwent HRCT CHEST with symptoms of COVID 19. Results Most of the patients in the fifth and sixth decade of age group with a mean age of 58.36±15.36 years. There was a male preponderance (68.13% male and 31.88% female). Out of 160 patients, 145 patients (90.6%) were symptomatic, while 15 patients (9.4%) were asymptomatic. 53.8% of patients had some or the other underlying comorbid disease in the sample population. HRCT chest of the study population showed the variety of opacity characteristics. Out of 160 patients, 61 (38.13) patients had pure Ground glass opacities (GGO) while another 82 (51.25) patients had both mixed GGO. In early phase of the CT scan, 66.67% patients had GGO while in the intermediate phase high percentage of (56.1%) of the patients had mixed GGO & consolidation. The lobe involvement was measured using the Ct severity scoring system. In this study majority (59.38%) of the patients had a CT severity score between 1-7 indicating mild disease, 35.63% patients had CT score 8-15 indicating moderate disease while only 5.00% had CT severity score 16-20 indicating severe disease. Conclusion: HRCT chest in COVID-19 patients had significant diagnostic and prognostic importance as positive CT findings more prominent in symptomatic patients and comorbid patients. CT imaging was found to be useful in predicting a patient's clinical recovery or disease progression. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax (PT) is defined as the presence of air in the pleural cavity. Primary spontaneous pneumothorax (PSP) arises in an otherwise healthy person without any underlying lung disease. PSP occurs in people aged 20 to 30 years, with a peak incidence in the early twenties. The recurrence rate in spontaneous PT patients is approximately 10%-20%. In the present study, 50 cases of spontaneous PT were undertaken with an aim to analyse aetiology, clinical profile and management outcome of PT patients. Materials and Methods: The present study was conducted for a period of 12 months, among 50 patients presenting with unilateral PT. The therapeutic interventions were indicated when there was a loss of volume of lungs of 32% or more, and this loss of volume was calculated using Collins method. The association between the side of PT, smoking status and size of PT were found using the Chi-square test, and the association between variables were considered significant if the P value was <0.05. Results: In the present study, the male patients were 92.0% and only 8.0% of patients were females. The further history-taking of patients had shown that the mode of onset of PT was sudden in 72.0% of patients. Although the success rate of Intracth procedure was lower in comparison with the intercoastal drainage (ICD) procedure, the complication rate of Intracath was lower when compared with extensive subcutaneous. Conclusion: PSP is less common than secondary spontaneous PT. Smoking is an independent risk factor for PT, and it delays its resorbtion. [ABSTRACT FROM AUTHOR]

Introduction: Autopsy history is intimately connected with that of anatomy and medicine in general and it remains key aspect of medicine today. Millions of people around the world and in India are affected by preventable pulmonary diseases. The clinical and radiological findings in most of the respiratory diseases are not very specific and thus to make correct and specific diagnosis histopathological examination serves as an important diagnostic tool. Objective: The aim of this study was to analyze the various lungs lesion histopathologically on lungs received after autopsy at Histology section of Department of Pathology, Gajra Raja Medical College, Gwalior during the period of 1.5 years. Method: It was a prospective study carried out on 100 specimens of Lungs received during 2021-22. All relevant histopathological details pertaining to gross and microscopic features were comprehensively studied. Result: Out of total received 100 cases, 43% of cases lungs were normal grossly and 8% of cases lungs were normal microscopically while 57% of cases lungs were diseased grossly and 92% of cases lungs were diseased microscopically. On gross examination, the most common lesion was Focal Greyish White lesions in (20%) of cases while majority of the cases (43%) were Unremarkable on gross. On microscopic examination, the most frequently found Pathological Lesion was Interstitial Pneumonitis (19.0%). Conclusion: Histopathological examination of the autopsy specimen provides the reliable evidence on the occurrence of various respiratory diseases in the population which may not have been otherwise become evident. With better insight into disease prevalence in the population, appropriate screening procedures and diagnostic tests could be introduced at appropriate time for early detection of various pathologies. Early detection may also lead to better prognostic outcome of disease. Methods could also be deployed for the prevention. [ABSTRACT FROM AUTHOR]

Background: Pulmonary involvement is one of the most common extra-articular manifestation of rheumatoid arthritis (RA) and the second common cause of death due to infection. Pulmonary function tests are widely used to provide objective measure of lung function for detecting and quantifying pulmonary impairments. Material & Methods: This study was hospital based cross sectional nonintervention study. About 100 patients of rheumatoid arthritis have been selected from Rheumatology Clinic (OPD) of R. G. Kar Medical College and Hospital according to the ACR/EULAR diagnostic criteria, 2010. All patients were undergone for Hb% estimation, ESR determination, estimation of serum RA-factor, C-reactive protein and ACPA. Disease Activity of RA had determined by DAS-28 calculator. All cases and controls are undergone lung function test by means of electronic spirometer in the Department of Physiology of the same institute. Results: In our study 82% cases were female and 18% cases were males. In our study we got significant changes in lung function of the RA patients. FVC, FEV1, PEFR and FEF 25-75% etc. were significantly deteriorated, (p-value<0.0001). About 44% cases showed evidence of restrictive type of pulmonary function abnormality, it was significant (p-value<0.05) whereas only 2% cases show evidence of obstructive type of abnormality, which was not significant (p-value>0.05). There was definite correlation between disease duration and disease activity with abnormal pulmonary function, (p-value<0.0001). Conclusion: Therefore from the summary of this study, we can understand that lung function parameters can be used to stratify abnormalities in a clinically useful manner and lung function tests can be used as indicator of disease activity of rheumatoid arthritis. So all patients of RA should undergo PFTs to detect abnormality and by this way we can reduce morbidity and mortality of RA patients due to subclinical or overt pulmonary dysfunction. [ABSTRACT FROM AUTHOR]

Thoracotomy is used to manage a variety of medical conditions, including lung cancer, pulmonary infections, and chest injuries. Decortication surgery is indicated in the case of a thickened pleural layer leading to atelectasis of the underlying lung parenchyma. It is done to prevent further restriction of the lung parenchyma. Atelectasis, pleural effusion, pneumonia, and consolidation following decortication are common complications of the surgery. Physiotherapy following decortication helps in preventing damage to the lungs and also helps in maintaining and regaining good lung function postsurgery. This is a right-sided lung decortication thoracotomy surgical procedure where physiotherapy interventions were given preoperatively and early postsurgical care was taken for adequate lung expansion and to reduce respiratory complications following it. Incentive spirometer (4 times/day) with breath hold technique (3 s.) along with conventional physiotherapy interventions such as chest mobility exercise, breathing exercises, breath control techniques, and early mobilization in the form of long sitting at the end of a bed, high sitting, chair sitting, standing, walking, and stair climbing were improved in chest expansion, functional activities, rating of perceived exertion level, and reduced pain level. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer has been the most common cancer in the world for several decades. There are estimated to be 2.38 million new cases in 2023 (12.9% of the total), 58% of which occurred in the less developed regions. The disease remains as the 3rd most common cancer in men worldwide. Cancer of the lung has not received much attention in India so far, neither has the carcinogenic potential of tobacco smoke been adequately realized by the general public.11 The prevalence of Lung Cancer is increasing in India along with increase in tobacco smoking habit particularly in rural India. Material And Methods This is a prospective study consisting of 50 Lung cancer patients examining the clinical, radiological and Histopathological Profile. The present study comprises of 50 patients who are admitted in the Department of Respiratory Medicine, Kamineni academy of medical sciences and research centre, Hyderabad from April 2022 to March 2023. All the patients having symptoms and radiological features suggestive of primary or secondary malignancy of Lung and Pleura are included in the study. Detailed demographic and clinical parameters including age, sex, occupation, and habits like smoking and alcoholism were taken. Results: Most common diagnostic modality used was FOB guided biopsy (36%), followed by CT guided trans thoracic biopsy (32%). Ultra sound guided biopsy was done in 18%. 6% of patients were diagnosed by pleural fluid analysis. 4% were diagnosed by lymph node biopsy and bronchial washings cytology. Squamous cell carcinoma was the commonest histopathological type noted accounting for 48% followed by adenocarcinoma. It was also observed that 10 patients presented with secondary lung malignancy, 3 of whom were presented with lung mass lesions and the remaining 7 patients were presented with pleural effusions. Conclusion: This study has shown smoking as the principal risk factor in the causation of lung cancer among men. Lung cancer should always be suspected in a person presenting with unexplained cough of several weeks with other symptoms such as weight loss and fever with nonresolving collapseconsolidation on chest radiograph, and further investigations should be carried out to rule out lung cancer. Majority of the cases were misdiagnosed as tuberculosis and treated, causing delay in diagnosis. This emphasized the need for more effective methods like FOB, CT for early detection of lung cancer. [ABSTRACT FROM AUTHOR]

Given the paucity of research on asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) and the high prevalence of co-morbidities and healthcare utilization associated with it, the current study looked at the prevalence of ACO and its clinico-radiological phenotype in patients with chronic airflow obstruction. The study was conducted at a tertiary care hospital in North India. Patients over 40 with COPD or asthma were screened for inclusion in the ACO, asthma, and COPD groups. The ACO and COPD groups were further investigated. The clinical characteristics, lung functions, health-related quality of life, and radiological features of both groups were investigated and compared. ACO was discovered in 16.3% of patients with chronic airflow obstruction (asthma and COPD). The most commonly observed symptoms at presentation in the evaluated ACO patients (n=77) were shortness of breath, wheezing, cough, and expectoration (mean age at presentation: 57.9; mean duration of illness: 8.62 years). Exacerbation rates in ACO patients were significantly higher than in COPD patients (p<0.001). The ACO group had a significantly greater mean change in FEV1 post-bronchodilator in millilitres (ml) and percentage (379.61 ml and 37.72%) than the COPD group (p<0.001). The proportion of patients with emphysema was lower in the ACO group than in the COPD group (p<0.001). The ACO and COPD groups did not differ significantly in major airway wall thickness (p=0.3), but the COPD group had a significantly higher proportion of patients with vascular attenuation and distortion (p<0.001). Patients with COPD had a higher degree of hyperinflation, according to high resolution computed tomography (HRCT) indices. This study found that patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. More research on the radiological features of ACO is required to identify the anatomical abnormalities involved in the disease's pathogenesis and to validate the radiological features of ACO. [ABSTRACT FROM AUTHOR]

Aim: The objective of medical legal post-mortem examination is to establish the identity of a body when not known to ascertain the time since death and the cause of death; and whether that the death was natural or unnatural, and if unnatural whether it was homicidal, suicidal, or accidentally. Material and Methods: The Present study is conducted in 200 corpses reporting for postmortem analysis over a period of one year above 18 years of age presenting to the Department of Forensic Medicine and Toxicology. The corpses are randomly selected and are assessed for the statistics regarding the epidemiology based on the autopsies performed. The Autopsy reports are anonymized with the patient code number, and sex, time of death, manner of death, pattern of death and cause of death data is documented. Results: Male predominance was observed among the sudden death cases. Sudden death is more common among the cases brought from urban residential areas, with 136 out of 200 cases (68%). Among the causes of sudden death, the most commonly involved organ system was the cardiovascular system (46%), followed by the gastrointestinal system (20%), respiratory system (18%), central nervous system (14%) and genitourinary system (2%). Conclusion: Our strongest conclusion is that male/female differences in medicolegal autopsies are highly dependent on historical time and geographic location. Increased frequency of sudden deaths among urban, married and adult male populations might be due to sedentary lifestyles in urban areas and increased stress among married individuals due to workload and family responsibilities, indicating a physical and mental disequilibrium in modern times resulting in this type of unexpected deaths. [ABSTRACT FROM AUTHOR]

Purpose: To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC). Methods: Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups. Results: Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m Conclusion: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established. Trial registry details: Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019). [ABSTRACT FROM AUTHOR]

Purpose: Food insecurity and multimoribidity (i.e., ≥ 2 chronic conditions) may be linked bidirectionally, but there are no studies on this topic from LMICs. Therefore, the aim of the present study was to examine the association between food insecurity and physical multimorbidity in a large representative sample of older adults from six LMICs. Methods: Cross-sectional, community-based data on adults aged ≥ 50 years from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa were analyzed. A total of 11 chronic physical conditions were assessed. Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the associations. Results: Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50–114 years; 47.9% males] were analyzed. After adjustment for potential confounders, in the overall sample, compared to being food secure, moderate and severe food insecurity were associated with 1.29 (95% CI 1.06–1.56) and 1.56 (95% CI 1.13–2.16) times higher odds for multimorbidity, respectively Conclusion: Food insecurity was associated with greater odds for multimorbidity in older adults from LMICs. Addressing food insecurity in the general population may reduce risk for multimorbidity, while screening for food insecurity and addressing it among those with multimorbidity may lead to better clinical outcomes, pending future longitudinal research [ABSTRACT FROM AUTHOR]

The rapid increase in the number of CT acquisitions during the COVID-19 pandemic raised concerns about increased radiation exposure to patients and the resultant radiation-induced health risks. It prompted researchers to explore newer CT techniques like ultra-low dose CT (ULDCT), which could improve patient safety. Our aim was to study the utility of ultra-low dose CT (ULDCT) chest in the evaluation of acute COVID-19 pneumonia with standard-dose CT (SDCT) chest as a reference standard. This was a prospective study approved by the institutional review board. 60 RT-PCR positive COVID-19 patients with valid indication for CT chest underwent SDCT and ULDCT. ULDCT and SDCT were compared in terms of objective (noise and signal-to-noise ratio) and subjective (noise, sharpness, artifacts and diagnostic confidence) image quality, various imaging patterns of COVID-19, CT severity score and effective radiation dose. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of ULDCT for detecting lung lesions were calculated by taking SDCT as a reference standard. The mean age of subjects was 47.2 ± 10.7 years, with 66.67% being men. 90% of ULDCT scans showed no/minimal noise and sharp images, while 93.33% had image quality of high diagnostic confidence. The major imaging findings detected by SDCT were GGOs (90%), consolidation (76.67%), septal thickening (60%), linear opacities (33.33%), crazy-paving pattern (33.33%), nodules (30%), pleural thickening (30%), lymphadenopathy (30%) and pleural effusion (23.33%). Sensitivity, specificity and diagnostic accuracy of ULDCT for detecting most of the imaging patterns were 100% (p < 0.001); except for GGOs (sensitivity: 92.59%, specificity: 100%, diagnostic accuracy: 93.33%), consolidation (sensitivity: 100%, specificity: 71.43%, diagnostic accuracy: 93.33%) and linear opacity (sensitivity: 90.00%, specificity: 100%, diagnostic accuracy: 96.67%). CT severity score (range: 15–25) showed 100% concordance on SDCT and ULDCT, while effective radiation dose was 4.93 ± 1.11 mSv and 0.26 ± 0.024 mSv, respectively. A dose reduction of 94.38 ± 1.7% was achieved with ULDCT. Compared to SDCT, ULDCT chest yielded images of reasonable and comparable diagnostic quality with the advantage of significantly reduced radiation dose; thus, it can be a good alternative to SDCT in the evaluation of COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Background: Due to the staggering number of tobacco users in India, it is important to determine the exact mortality and morbidity rates due to tobacco use. This study aimed to estimate deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) attributable to cigarettes, bidis, and smokeless tobacco (SLT) in India. Methods: Data pooling and meta-analysis were done using case-control studies available on the three types of tobacco products. Health burden was estimated by applying the population attributable fraction (PAF) value to the total disease burden. Findings: A total of 33 studies were included. PAF was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT. Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 deaths; bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths, and SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually. Conclusion: Evidence of measurable health burden and methodology for calculation for individual states was provided in the study. The generated evidence could be utilized for policy recommendations and revision of the existing taxation norms. [ABSTRACT FROM AUTHOR]

Background: Long-term exposure to silica dust makes people prone for silicosis which raises the risk of the individual in developing pulmonary tuberculosis (PTB). Silicosis is a progressive lung disease characterize with shortness of breath, cough, fever, and bluish skin, caused due to inhalation of crystalline silica dust found in abundance in sand, rock, and quartz. Aims and Objectives: The disease is known to effect the functioning of macrophages making it unable to defend mycobacterium species, thus allowing the bacterium to invade and develop tuberculosis. Materials and Methods: A retrospective cross-sectional study is carried out to estimate the prevalence of PTB in newly diagnosed silicosis patients at Madurai Medical College, Madurai, Tamil Nadu. All the patients who got registered in Occupational Lung Diseases Registry from January 2016 to December 2021 are included in the study. Silicosis patients tested positive on sputum CBNAAT are considered as silicotubercular patients, whose prevalence is calculated. Results: Our study included a total of 54 subjects (90.8% males and 8.2% female) with mean SD age of 38±6.7 years ranging from 26 to 53 years. Of which 22 patients, 40.7% tested positive for Mycobacterium tuberculosis (MTB) on sputum CBNAAT. The prevalence of MTB in among silicosis patients was found to be 40.7%. Conclusions: Association of TB and silicosis is very strong with the prevalence of TB among silicosis patients as 40.7%. Our study also observed the male sex and elder age as elevated risk of developing silicotuberculosis. All the people getting exposed to silica dust need to be educated in the usage and usefulness of protective equipment. [ABSTRACT FROM AUTHOR]

BACKGROUND and objective: Obesity is a major health issue and there is steady trend of increasing obesity over the past several decades. Obesity can alter the respiratory function and may impair the health of an individual. Although several factors such as respiratory muscle strength, lung compliance, resistance to airflow and even obesity affect the lung functions, the nature of relationship with markers of adiposity, the role of body fat distribution has received limited attention. So the objective of this study was to correlate PEFR and WC in overweight women. Methods: 100 overweight women whose BMI was 25-29.9 kg/m2, who fulfill the inclusion and exclusion criteria, aged between 20-50 years were selected for the study. Waist circumference (WC) and Peak expiratory flow rate (PEFR) of all the subjects were measured. Results: Data were analyzed using Spearman's correlation coefficient. The result showed non-significant correlation (p=0.057) (r = -0.057) between PEFR and WC in overweight women. CONCLUSION: The study concluded that obesity, measured as WC did not significantly affect the PEFR in young overweight females in the age group of 20 to 50 years. A central pattern of fat distribution, as measured by WC alone was not associated with lower values for PEFR in young female overweight adults. [ABSTRACT FROM AUTHOR]

Introduction: Bronchoalveolar lavage (BAL) is a diagnostic procedure by which cells and other components from bronchial and alveolar spaces are obtained for various studies. One of the main advantages of BAL is that it can be done as a day care procedure. Material obtained by BAL can give a definite diagnosis in conditions such as infections and malignancies. Aim: To assess the utility of BAL as a tool to determine the diagnostic accuracy of the material obtained from BAL in various infections and neoplastic lesions and to study the limitations of BAL in certain lung disorders. Material and Methods: This study was done in a tertiary care center and teaching college in North India. Bronchoscopy was done in 120 cases and lavage fluid was obtained. Microbiological examination and cytological evaluation was done for each case. Cases selected included non-resolving pneumonias, diffuse lung infiltrates, and ventilator- associated pneumonias. It is an observational and cross-sectional study with intent to look for findings in bronchoalveolar lavage in suspected lung disease. During our study, BAL was done in 120 patients and results were analyzed by calculating percentage, proportion and mean. Analysis was done using the SPSS version 20. Descriptive statistics and diagrammatic representation were performed to describe the studied variables. Results: Bronchoalveolar lavage was done in 120 cases over a period of 1 year. Tuberculosis was diagnosed in 10 cases, fungal infections in 7 cases. Twenty-two cases of bacterial pneumonias were diagnosed; Klebsiella, Streptococcus and Pneumococcus were the most common organism. Malignancy was diagnosed in thirty-six cases. Adenocarcinoma was the most common type identified. Conclusion: Definite diagnosis can be made in tuberculosis, fungal infections, bacterial pneumonias and in malignancies. It is not only used as a useful diagnostic tool in diagnosing bacterial pneumonias, tuberculous lesions, fungal infections but also malignancies and diffuse lung diseases (DLDs).Its role is limited in diagnosing and prognosticating DLDs. The number of lesions with a definite diagnosis outnumber the lesions that cannot be diagnosed hence we opine that BAL is a useful diagnostic modality not only for routine diagnosis, butals of orancillary techniques and research purpose. [ABSTRACT FROM AUTHOR]

Objectives "Silicosis" is a leading cause of occupational morbidity globally. In Rajasthan, India silicosis has been recognized as an epidemic, resulting in the development of a new pneumoconiosis policy in 2019. This study was conducted to provide an overview of the policy implementation regarding the detection, prevention, and control of silicosis. Methods A qualitative study was carried out in the Jodhpur district of Western Rajasthan in which stakeholders were interviewed. Themes were identified regarding prevention, detection, diagnosis, and certification, and organized by stakeholder role. Data were retrieved from the Silicosis Grant Disbursement Portal of the Government of Rajasthan to present an overview of the existing system for detection, prevention, and control of silicosis and to determine the delays in various aspects. Results A total of 35 stakeholders were interviewed. There was low awareness regarding the prevention, detection, diagnosis, and rehabilitation of silicosis amongst multiple stakeholders. There is a need for robust enforcement in mining units regarding silicosis prevention and screening. Unregistered mining activities and migration of mineworkers are major challenges in the detection of silicosis cases. Misdiagnosis and low notification rates prevent workers from accessing resources. There are myriad reasons for delays in workers receiving diagnosis and benefits, which have systemic roots but can be uprooted through rigorous implementation of the legislative provisions. Conclusion There are several well-established pieces of legislation to protect the rights of mineworkers; however, there are gaps in the effective implementation of various provisions that require immediate attention to address the challenges faced during the prevention, detection, diagnosis, and rehabilitation of workers with silicosis. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease is currently one of the top three causes of mortality globally, with poor and middle income nations accounting for 90% of all deaths. The physiological cost index is a technique for calculating the energy cost using the measurement of heart rate. Aim: To evaluate Physiological cost index among patients with chronic obstructive pulmonary disease and to check their compliance with pulmonary rehabilitation protocol and to rate their exertion using modified Borg scale. Methodology: A total of 30 participants were included in this study. Subjects were asked to walk for 6 mins at comfortable walking speed and Physiological cost index was calculated by using the walking heart rate. The Physiological cost index were studied on two occasions, before and after performing the given exercises, included upper and lower mobility exercises along with breathing exercises. Results: Data was analyzed using statistical software R software version 4.1.2. P-value less than equal to 0.05 was statistically significant. Conclusion: This study found that the Physiological Cost Index of subjects with Chronic Obstructive Pulmonary Disease was seen to decrease after performing the prescribed exercises, suggesting a favorable reduction in energy consumption and improving their functional performance. [ABSTRACT FROM AUTHOR]

Miliary tuberculosis or disseminated tuberculosis is one of India's most typical forms of tuberculosis. It can have varied presentations, from classical pulmonary disease to affection of extra-pulmonary sites, the most common being the vertebral column. With a wide array of clinical manifestations, differentiating disseminated tuberculosis from common malignancies is no less than a herculean task for a clinician. Keeping a high index of clinical suspicion and detailed work up in the right direction can save the clinician and the patient from an exhaustive ordeal of futile investigations. Here, we present a rare case of miliary tuberculosis masquerading as a common malignancy of the elderly, reemphasizing the need for a systematic approach to such confusing presentations. [ABSTRACT FROM AUTHOR]

Introduction: Dizziness may be associated with negative health outcomes. This study aimed to determine the associations between dizziness and mental and physical health outcomes in middle-aged and older community-dwelling adults in India. Methods: Cross-sectional data from 72,262 individuals (≥ 45 years) of the Longitudinal Ageing Study in India (LASI) Wave 1 in 2017-2018 were analyzed. Dizziness was assessed with the question of having persistent or troublesome dizziness or light headedness in the past two years. Results: More than one in seven participants (13.7%) reported past 2-years dizziness. In adjusted logistic, linear and Poisson regression analyses, dizziness was associated with worse self-rated health status, lower life satisfaction, major depressive disorder, insomnia symptoms and severe fatigue. Regarding physical health, dizziness increased the odds of pain conditions, cardiovascular conditions, chronic lung disease, functional limitations, fall history, hearing loss, impaired vision and higher number of medications currently used. In addition, in the unadjusted analysis, dizziness was negatively associated with cognitive functioning. Conclusion: Dizziness was associated with six poor mental health and eight poor physical health outcomes. Findings support multidimensional management of dizziness in the general population. [ABSTRACT FROM AUTHOR]

The chest radiograph (CXR) is among the most widely used investigations in coronavirus disease 2019 (COVID-19) patients. Little is known about its predictive role on the long-term outcome. The purpose of this study was to explore its association with the short and long-term outcome in COVID-19 patients. A total of 1530 patients were assessed for the presence, radiographic pattern and distribution of lung lesions observed on baseline chest radiographs obtained at admission. The Brixia scoring system was applied for semiquantitative assessment of lesion severity. Short-term outcome was determined by clinical severity, duration of hospitalization and mortality. The 1415 survivors in this group were assessed after 5–6 months for the presence of residual symptoms. About 67% patients had an abnormal baseline CXR. Bilateral involvement with a basal preponderance was observed and ground-glass opacification was the most frequent finding. The Brixia score ranged from 0 to 16, median 2, interquartile range (IQR) [0–6]. About 36% patients were symptomatic on 5–6-month follow-up, with fatigability being the commonest symptom. A good correlation was observed between the CXR score and disease severity as well as duration of hospitalization. On multivariate analysis, the CXR score was found to be a significant independent predictor of in-patient mortality as well as presence of long-term residual symptoms in survivors. Disease severity as seen on the chest radiograph appears to play an important role in driving the short and long-term consequences of COVID-19 and could serve as a prognostic indicator, which influences short-term management and long-term follow-up. [ABSTRACT FROM AUTHOR]

Objectives: Ground-glass opacity (GGO)—a hazy, gray appearing density on computed tomography (CT) of lungs—is one of the hallmark features of SARS-CoV-2 in COVID-19 patients. This AI-driven study is focused on segmentation, morphology, and distribution patterns of GGOs. Method: We use an AI-driven unsupervised machine learning approach called PointNet++ to detect and quantify GGOs in CT scans of COVID-19 patients and to assess the severity of the disease. We have conducted our study on the "MosMedData", which contains CT lung scans of 1110 patients with or without COVID-19 infections. We quantify the morphologies of GGOs using Minkowski tensors and compute the abnormality score of individual regions of segmented lung and GGOs. Results: PointNet++ detects GGOs with the highest evaluation accuracy (98%), average class accuracy (95%), and intersection over union (92%) using only a fraction of 3D data. On average, the shapes of GGOs in the COVID-19 datasets deviate from sphericity by 15% and anisotropies in GGOs are dominated by dipole and hexapole components. These anisotropies may help to quantitatively delineate GGOs of COVID-19 from other lung diseases. Conclusion: The PointNet++ and the Minkowski tensor based morphological approach together with abnormality analysis will provide radiologists and clinicians with a valuable set of tools when interpreting CT lung scans of COVID-19 patients. Implementation would be particularly useful in countries severely devastated by COVID-19 such as India, where the number of cases has outstripped available resources creating delays or even breakdowns in patient care. This AI-driven approach synthesizes both the unique GGO distribution pattern and severity of the disease to allow for more efficient diagnosis, triaging and conservation of limited resources. [ABSTRACT FROM AUTHOR]

OBJECTIVE: There is very limited data on the usefulness of pulmonary rehabilitation in patients with coronavirus pneumonia who have survived intensive care unit care. The primary aim was to explore the feasibility of conducting a pulmonary rehabilitation program in patients with coronavirus disease-19 pneumonia surviving intensive care. The secondary aim was to study the impact of a hospital-based 6-week pulmonary rehabilitation program on exercise capacity, quality of life, and psychological parameters in these patients. This study was conducted at the Center for Pulmonary Rehabilitation, Department of Pulmonary Medicine of the institute. MATERIAL AND METHODS A total of 27 patients were enrolled. Among them, 14 patients who completed the desired 12 sessions over 6 weeks constituted the pulmonary rehabilitation group and 13 patients who either did not consent or defaulted within the first 2 weeks were considered as controls. Both groups had assessments at 0 and 6 weeks that included a 6-Minute Walk Test, Incremental Shuttle Walk Test, mMRC Dyspnea Scale, Baseline Dyspnea Index, and Transitional Dyspnea Index, Saint George's Respiratory Questionnaire score, and Depression, Anxiety, Stress Scale-21 score. RESULTS: Significant improvement in dyspnea by mMRC (P = .01) and exercise capacity as measured by 6-Minute Walk Test (P <.001) and Incremental Shuttle Walk Test (P = .025) was seen in the pulmonary rehabilitation group as compared to the control group. There was no significant improvement in quality of life and psychological parameters (Depression, Anxiety, Stress Scale 21 score) after 6 weeks of pulmonary rehabilitation program as measured in our study. CONCLUSION: Pulmonary rehabilitation is feasible and appears promising in coronavirus disease acute respiratory distress syndrome survivors. However, data from other centers and a larger number of patients are required to imbibe conclusive results. [ABSTRACT FROM AUTHOR]

Context: Accurate diagnosis may be challenging in nonneoplastic lung diseases. Newer techniques such as bronchoalveolar lavage (BAL), bronchial brushing (BB), and transbronchial needle aspiration (TBNA) have been studied mainly in lung cancers. Aim: This study assesses the efficacy of BAL, BB, and TBNA in non-neoplastic lung diseases, against a gold standard of transbronchial lung biopsy (TBLB). Settings and Design: Three-year prospective study in a tertiary care center in North India. Methodology: Adult patients (n = 137) with nonimproving respiratory complaints and clinical and radiological suspicion of having a pulmonary pathology were recruited. Patients of malignancy were excluded. Patients for whom all four samples of BAL, BB, TBNA, and TBLB were unavailable were excluded. Statistical Analysis Used: Sensitivity (SN), specificity (SP), positive predictive value, and negative predictive value for all tests were computed and represented with 95% confidence intervals. TBLB was taken to be the gold standard. Two or more tests taken in combination were also analyzed. Results: We studied the patients of tuberculosis, interstitial pneumonia, acute and chronic nonspecific inflammation, sarcoidosis, fungal infection, interstitial lung disease, eosinophilic pneumonitis, and pulmonary alveolar proteinosis in this study. TBNA had higher SN and SP (59.8% and 96.7%) than BB (57.0% and 93.3%) or BAL (54.2% and 86.7%). When combined, SN increased to 68.2% and SP decreased to 76.7%. Diagnostic yield for interstitial pneumonia and chronic inflammation was relatively high but poor for tuberculosis and sarcoidosis. Conclusions: TBNA had the highest SN and SP in diagnosing the various nonneoplastic lesions. However, BAL and BB are useful and complementary tools in the definitive diagnosis of localized and diffuse pulmonary infections. [ABSTRACT FROM AUTHOR]

Background: Many studies have been conducted on heart, liver, and endocrine abnormalities in thalassemia; however, studies on pulmonary dysfunction (PD) have been limited. Previous studies on the prevalence of restrictive lung disease (RLD) and obstructive lung disease (OLD) in β-thalassemia major patients have lacked agreement. Objective To assess the prevalence of PD in β-thalassemia major patients by systematic review of the literature and meta-analysis. Methods We searched Cochrane Library, PubMed, Web of Science, MEDLINE, Scopus, and Embase for relevant articles. Articles were selected according to the inclusion criteria and data were extracted. The primary outcome was prevalence of pulmonary dysfunction in β-thalassemia major with 95% confidence interval (95%CI). Subgroup analyses were applied to explore the prevalence in different age groups, regions, and serum ferritin levels. Sensitivity analysis and publication bias assessment were also conducted. Results: A total of 37 studies comprising 1,467 cases were included in this analysis. Pulmonary dysfunction was present in 64.7% (95%CI 57.6 to 71.1) of cases. The pooled prevalence of RLD (44.9%) was higher than that of OLD (7.6%) and diffusion impairment (DI) (35.6%). Subgroup analysis revealed that the region with the highest pooled prevalence of PD was the Americas (75.2%). The highest prevalence of RLD and DI was found in Asia (48.2% and 44.6%, respectively) and that of OLD in Europe (9.7%). Sensitivity analysis showed that the pooled results were robust. Conclusion: A high prevalence of pulmonary dysfunction, mainly RLD rather than OLD, was detected in b-thalassemia major patients. [ABSTRACT FROM AUTHOR]

Introduction: Air leak consisting of pneumothorax, pneumomediastinum, and subcutaneous emphysema has been described as one of the complications of coronavirus disease-2019 (COVID-19) infection affecting disease course and outcome. We aimed to conduct a systematic review of published literature to highlight the risk factors, types, and outcomes in COVID-19. Method: A systematic search of PubMed, Embase, Scopus, and Google Scholar was performed from November 1, 2019, to February 28, 2021. Seventy-one studies fulfilled the inclusion criteria and 136 adult patients were included in the final analysis. Results: Majority of patients were male (75.2%) with the mean age of 58 years. Hypertension was the most common comorbidity followed by diabetes mellitus. Moreover, 12.5% of patients had a history of smoking while 11.7% had preexisting lung disease. Isolated pneumothorax (48.5%) was the most common and 17.65% had developed spontaneous pneumothorax. Mean onset time was 11.6 days and 67% of patients required an intercostal drainage tube for management. Mortality was 40%, and elderly, female gender, obese and hypertensive were at higher risk. Conclusion: COVID-19-related air leaks are associated with higher mortality and longer hospital stay and can occur even without positive pressure ventilation. History of smoking and preexisting lung disease has not been shown to increase the incidence of air leak. A well-designed study is required for a better understanding of COVID-19-related air leak. [ABSTRACT FROM AUTHOR]

Background: Diffuse parenchymal lung disease (DPLD) is not an uncommon problem in clinical practice. Although the exact prevalence of DPLD in India is not known, the relative etiological distribution in DPLD in India has been reported. There has been no information as regards the seasonality of the disease. Patients and Methods: The archive of the Institute of Pulmocare and Research, Kolkata, was searched for the number of new patients registered at the outpatient department to a single consultant (practicing in the same style on appointment only) over years from 2009 to 2019. The attendance (absolute and relative) was arranged year wise and then month wise to look for the annual and seasonal trends, if any. Results: A total of 2226 patients were registered from 2009 to 2019. There has been a steady increase in both the absolute number (104 in 2009 to 204 in 2019) and the relative percentage of attendance (4.36% in 2009 to 6.9% in 2019) of new registration of DPLD patients over the years. Regarding seasonal variation, two consistent peaks in attendance have been observed as December–January and April–May over the years with dips in February and September; the first being more consistent then the latter. Conclusions: The increase in relative attendance in the DPLD patients over the years needs further investigation to establish a rising trends in incidence and prevalence of DPLD. The unequivocal trend in seasonal variation needs attention and further research. [ABSTRACT FROM AUTHOR]

Interstitial lung diseases (ILDs) are a frequently occurring pulmonary manifestation in patients of connective tissue diseases (CTD). Detailed understanding of this subset of lung diseases is vital, hence the study was conducted to analyze the clinico-radiological characteristics of CTD-ILD. The present study was conducted between March 2017 to February 2018 at a tertiary care teaching hospital from western India. A total of 100 patients having respiratory symptoms suggestive of ILD, who were either diagnosed cases of CTD or had clinical manifestations of underlying CTD, were included in the study. Twentyseven percent of patients belonged to age group 41-50 years and 78% were females. Chief respiratory complaints were dyspnea and cough. Clubbing was present in 29% patients. The most common CTDs were rheumatoid arthritis (RA) (26%), systemic sclerosis (SSC) (21%), mixed connective tissue disorder (MCTD) (19%) and Sjogren's syndrome (SS) (16%). Restrictive defect on spirometry was seen in 58% cases and was most significant among patients with RA (65%) and SS (62%). Pulmonary arterial hypertension was seen in 40% cases and was most evident in MCTD (78%) and SSC patients (58%). Chest radiograph was normal in 47% of subjects. Most common radiological pattern on high resolution computed tomography (HRCT) thorax was non-specific interstitial pneumonia (42%) followed by usual interstitial pneumonia (21%). ILD is a common manifestation of CTD. Work-up for an underlying CTD should be offered to all ILD patients and vice versa. [ABSTRACT FROM AUTHOR]

Introduction: Blastomycosis is an endemic granulomatous fungal infection involving multiple organ systems predominantly the lungs. The diverse clinical spectra of the pulmonary disease encompass a subclinical infection, an acute infection mimicking a bacterial pneumonia and a chronic variant masquerading as tuberculosis or malignancy. Case Presentation: Here we report a case of a middle-aged gentleman who was evaluated for a malignant pulmonary mass which was later identified as pulmonary blastomycosis. The diagnosis of blastomycosis was made through histopathology and was retrospectively corelated with a travel history to an endemic region. Conclusion: The endemicity of this infection contributes to the diagnostic dilemma in the non-endemic setup. This warrants a high clinical suspicion in patients with a chronic pulmonary syndrome with a travel history to an endemic area. [ABSTRACT FROM AUTHOR]

Introduction: The Centers for Disease Control and Prevention (CDC) has listed primary immunodeficiency disorders as being predisposed to severe coronavirus disease 2019 (COVID-19). However, patients affected with X-linked agammaglobulinemia (XLA) have shown contrary results. In this study, we present 2 boys in late adolescence from south India with XLA who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as well as a review of cases reported in the literature. Case Presentation: Two patients with XLA had been diagnosed late and were started on regular immunoglobulin prophylaxis only during adolescence. Both of them had developed bronchiectasis, an irreversible suppurative lung disease. However, both patients made an uneventful recovery without the need for artificial ventilation or convalescent plasma. Conclusion: Successful outcomes of patients with XLA and COVID-19, except for delayed recovery, from our experience and from global reports are intriguing and the role of B cell depletion is being studied as well. Further research and clinical experience are necessary to fully elucidate the reasons for these observations. [ABSTRACT FROM AUTHOR]

Background: Chronic respiratory diseases (CRDs) are major causes of mortality and morbidity worldwide with a substantial burden of the disease being borne by the low and middle income countries (LMICs). Interventions to change health behaviour which aim to improve the quality of life and reduce disease burden due to CRD require knowledge of the problem and factors influencing such behaviour. Our study sought to appreciate the lived experiences of people with CRD, their understanding of the disease and its risk factors, and usual practice of health behaviour in a rural low-literate community in southern India. Methods: Qualitative data were collected between September and December 2018 through eight focus group discussions (FGDs), five in-depth interviews and four key-informant interviews from patients and community members. Community engagement was undertaken prior to the study and all interviews and discussions were recorded with permission. Inductive coding was used to thematically analyse the results. Results: Major themes included understanding of chronic lung disease, health behaviours, lived experiences with the disease and social norms, attitudes and other factors influencing health behaviour. Discussion: Poor understanding of CRDs and their risk factors affect health seeking behaviour and/or health practices. Stigma associated with the disease and related health behaviours (e.g. inhaler use) creates emotional challenges and mental health problems, besides influencing health behaviour. However barriers can be circumvented by increasing community awareness; communication and connection with the community through community based health care providers can turn challenges into opportunities for better health care. [ABSTRACT FROM AUTHOR]

Background: Auto drivers battle several occupational health hazards due to increasing pollution and unhealthy lifestyle. Improper diet and sleeping habits coupled with smoking, tobacco and alcohol use make them prone to respiratory and cardiovascular health hazards. Objectives: To assess the health status and quality of life (QoL) among auto drivers in Bangalore city and to study the association of selected parameters with respiratory and cardiac morbidities. Methods: In this cross-sectional study, 450 auto drivers were given a questionnaire and they were distributed according to age, education, body mass index, smoking, tobacco and/or alcohol consumption. The QoL was assessed by World Health Organization Quality of Life Instrument (WHOQOL-BREF) and peak expiratory flow, blood pressure, and blood sugar levels for each participant were recorded. The association between two categorical variables was determined by Chi-square test and p≤0.05 was considered statistically significant. Results: The association of number of years of driving with prevalence of chronic morbidity (p=0.005), hypertension (p=0.008), diabetes (p<0.001), and heart disease (p=0.04) were significant. QoL for physical and environmental domain were 16.11±0.28 and 12.48±0.06, respectively. Conclusion: A proportional increase in the risk of respiratory and cardiac morbidities with increasing number of driving years was observed among auto drivers. [ABSTRACT FROM AUTHOR]

Aim: Bleomycin, etoposide, and cisplatin (BEP) regimen is the standard treatment for germ-cell tumors (GCTs). Bleomycin-induced pulmonary toxicity (BPT) is fatal and dose-limiting toxicity associated with this regimen. In this study, we aimed to identify the frequency and risk factors of BPT in South Indian GCT patients receiving BEP regimen.Patients and Methods: The study was carried out in the Department of Medical Oncology, Regional Cancer Centre at a tertiary care hospital in South India. All the patients with GCT (testicular and ovarian) who were receiving BEP regimen from December 2014 to May 2018 were included in the study. BPT was defined as the presence of radiological features and/or clinical symptoms during or post-treatment.Results: BPT was observed in 11 (27%) patients of 41 analyzed patients. Five (12%) patients developed BPT during treatment whereas six (15%) patients developed BPT post-treatment. Cumulative bleomycin dose ≥240 mg (relative risk 3.8, confidence interval: 1.2-12.2,P =0.02) was found to increase the risk of BPT. Three-year overall survival in patients with and without toxicity was 82% and 93%, respectively.Conclusions: The frequency of BPT in the study population is 27%, and cumulative bleomycin dose ≥240 mg has been found to be associated with increased risk of developing BPT. BPT does not negatively impact survival outcome in GCT patients receiving BEP regimen. [ABSTRACT FROM AUTHOR]

Health effects attributable to short-term and long-term ambient air pollution (AAP) exposure in Indian population are less understood. This study evaluates the effect of short time and long-term exposure to AAP on respiratory morbidity, mortality and premature mortality for the exposed population. A total of 59 studies are reviewed to examine the effects of short-term exposure (n = 23); long-term exposure (n = 18) and premature mortality (n = 18). Short-term exposures to ambient pollutants have strong associations between COPD, respiratory illnesses and higher rates of hospital admission or visit. The long-term effects of AAP, associated with deficit lung function, asthma, heart attack, cardiovascular mortality and premature mortality have received much attention. Particulate matter (PM2.5 and PM10) is primarily responsible for respiratory health problems. Out of 18 literature reviewed on premature mortality, most (12 of 18) studies have statistically significant associations between AAP exposure and increased premature mortality risk. [ABSTRACT FROM AUTHOR]

The pandemic of COVID-19 has emerged as a serious health crisis globally and India too has been extensively affected with 604,641 active cases reported, till date. The present study focuses on the demographic, clinical and laboratory profile of such patients from a tertiary level non-COVID respiratory care hospital. This is a retrospective observational study. Seventy-seven sick patients fulfilling COVID suspect criteria were admitted to the isolation area. Their RT-PCR test was done from the designated laboratory and 35 of them were confirmed to be COVID-19 patients. The detailed demographic, clinical and laboratory profile of these COVID-19 patients was studied. The mean age was 46±17 years with male predominance (57%). Majority of the cases (83%) were symptomatic. The most common symptom was cough (66%) followed by breathlessness and fever. Nineteen (54.3%) patients had one or the other co-morbidity and 16 (45.7%) had chronic lung diseases as one of the comorbidities. Nearly half of the patients (51%) required supplementary oxygen on presentation. Two patients were put on invasive mechanical ventilation while 4 patients required non-invasive ventilation before being shifted to the COVID hospital. Hence, it can be concluded that COVID-19 in patients of chronic respiratory diseases manifests with higher prevalence of symptoms and also higher severity of disease. Further, the symptomatology of COVID-19 closely mimics the acute exacerbation of chronic lung diseases, so cautious screening and testing should be done, especially at the pulmonary department. [ABSTRACT FROM AUTHOR]

Background: In India, the active case-finding (ACF) strategy began in 2017 under the Revised National Tuberculosis Control Programme to find its missing tuberculosis (TB) cases. Few studies have been conducted in India to assess the treatment outcome of TB patients detected by ACF. Aim: The aim of this study was to assess the treatment outcomes of patients detected through ACF campaigns during the year 2018 in Haridwar district, Uttarakhand. Study Design: This was a cross-sectional study which used the existing data and records. Materials and Methods: The ACF campaign records of 2018 were extracted from six TB units of Haridwar district. Details of sociodemographic, clinical profile, and treatment outcome of 100 diagnosed patients were obtained and analyzed. Results: Out of the total 100 TB patients detected, the site of disease was pulmonary in 98% of patients. Almost all (92%) the patients were diagnosed microbiologically and treatment was initiated by 78% of the patients. The proportion of successful treatment outcome was found in 64% of the patients. The median time interval from diagnosis to treatment was found to be 2 days. Conclusion: In spite of these efforts of ACF, a high proportion of initial loss to follow-up (22%) and unsuccessful treatment outcome (18%) among ACF patients is a major concern. Findings of ACF campaign pose a concern for active follow-up after diagnosis and close monitoring during treatment. [ABSTRACT FROM AUTHOR]

In 1984, nearly 500,000 inhabitants of Bhopal city, India, were exposed to toxic gases that leaked from a nearby pesticide manufacturing plant. In 1985, four cohorts were established to assess the long-term health impact of exposure, namely, mild, moderate, severely exposed and unexposed groups. The self-reported morbidity data of these cohorts were collected by follow-up cross-sectional surveys at regular intervals over the last 35 years. The present study aimed to analyse the long-term trend of chronic (duration of symptoms >3 months) respiratory morbidity in the four cohorts, stratified by age groups. The design of this study is a longitudinal analysis of cross-sectional respiratory morbidity data. Chronic respiratory morbidity data within the cohorts were analysed at 5-year intervals (first recorded data from 1986). Based on age at the time of exposure, subjects were stratified into four age groups: children (aged <10 years), teenagers (aged ≥10 to <20 years), younger adults (aged ≥20 to <40 years) and older adults (aged ≥40 years). During the first decade, after exposure to the toxic gases, chronic respiratory morbidity in children and teenagers was high (up to 9.1%), which declined thereafter. Progressively increasing chronic respiratory morbidity was observed in both the younger and older adult age groups within all cohorts during the initial 5–10 years after exposure. Respiratory morbidity in both the younger and older adult age groups remained high for 15–20 years and thereafter recorded a declining trend. The highest respiratory morbidity observed during this study in the younger and older adult age groups was 38.6% and 59.5%, respectively; these values were both recorded in the severely exposed cohort. Exposure to toxic gases released during the Bhopal gas disaster has resulted in chronic respiratory morbidity of the exposed population; this morbidity has continued over decades. The age of the individuals at the time of exposure and exposure severity were crucial determinants of the long-term trend of respiratory morbidity. • Individuals, from neonates to the elderly, were exposed to toxic gases during the Bhopal gas disaster. • Exposed and unexposed cohorts were assembled to assess the health effects. • The long-term trend of chronic respiratory morbidity of the cohorts was analysed. • Chronic respiratory morbidity of exposed cohorts continued over decades. • Exposure severities and age at the time of exposure influenced the trends in respiratory morbidity. [ABSTRACT FROM AUTHOR]

Background: Ventilator-Associated Pneumonia (VAP) is a recognized nosocomial infection and a leading cause of high morbidity and mortality. Intensive Care Unit (ICU) nurses are in the best position to put the known evidence-based strategies into practice to prevent VAP. The aim of the present study is to assess the knowledge and practices of ICU nurses related to prevention of VAP in selected ICUs of a tertiary care centre in India (2013-2014) and to find out the association between knowledge and practices. Materials and Methods: A descriptive survey was conducted in the different ICUs of a tertiary care hospital in India. Purposive sampling technique was used and 108 ICU staff nurses were enrolled during the period of data collection. The tool used for data collection was a self-developed valid and reliable knowledge-based questionnaire and an observational checklist. The descriptive (frequency and percentages) and inferential (Chi-square test) statistics was used. Results Out of the 108 nurses enrolled in the study, 82 (75.93%) had average, 24 (22.22%) had good and only 2 (1.85%) of the ICU nurses had poor knowledge. Assessment of the practices revealed that 68 (94.44%) nurses had average and only 4 (5.55%) nurses had good practice. There was no association between the knowledge and practices of ICU nurses related to prevention of VAP. (χ² = 0.14, p = 0.710). Conclusions: Although the nurses were having good to average knowledge scores, their practices were not associated with knowledge scores. There is a need to find out the ways that would help the nurses to adhere to good practices. [ABSTRACT FROM AUTHOR]

Hypersensitivity pneumonitis (HP) is an interstitial lung disease, commonly occurring due to exposure to various inciting agent related to occupation. Few studies have shown that it can also occur without any occupation exposure. In this study we are presenting clinical, radiological and bronchoscopic finding of 103 HP patients. We retrospective analysis of 5½ years HP patient's data from a chest institute of India. The diagnosis of HP was considered with following criteria: i) known exposure to an inciting antigen; ii) presence of respiratory symptoms; iii) radiologic evidence of diffuse lung disease; iv) no other identifiable cause; v) lung biopsy specimen that demonstrated features of HP; and vi) bronchoalveolar lavage lymphocytosis (=30%). The mean ±SD age was 47±12.8 years; 67% were female. The common symptoms were cough (97%) and dyspnea (91%). History of exposure to inciting agent was present in 61% with pigeon exposure being the most common (56%). Majority of patients (86%) were having chronic symptoms for >6 months. On 6MWT oxygen desaturation >4% was seen in 57% patients. Centrilobular nodules (61%) and ground glass opacity (47.5%) were common finding on HRCT chest. Bronchoalveolar lavage (BAL) lymphocytosis >30% was present in 48.5% and histopathological diagnosis HP on transbronchial lung biopsy (TBLB) and/or endobronchial lung biopsy (EBLB) was in 50% patients. HP is exposure related environmental disease, as it can occur without any occupational history. Bronchoscopy with BAL and lung biopsy should do in all suspected cases to confirm diagnosis in our country as it is less invasive, day care procedure with less complication. [ABSTRACT FROM AUTHOR]

Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of disorders that cause muscle weakness and also have extramuscular manifestations involving various organ systems; namely the lung, skin, heart, and joints. Previously classified broadly as dermatomyositis (DM) and polymyositis now the spectrum of the disease has evolved into more clinical subtypes. There are now five clinicoserological subtypes recognized worldwide DM, antisynthetase syndrome (AS), overlap myositis (OM), immune mediated necrotizing myopathy (IMNM), and inclusion body myositis. Each of these subtypes has a unique phenotype and specific antibodies associated. With the evolving treatment options from the use of immunosuppressive medications to the use of targeted therapy with biologic agents, and further understanding of the pathogenesis of inflammatory myositis, we may have more effective treatment options. We discuss in this review, various myositis-associated antibodies associated with each clinicoserological subtype of IIM and their role. We also describe the evolving therapies and the evidence for the newer biologic therapies in the treatment of IIMs. [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]

A quasi experimental research design was adopted for the study. The study was conducted in tertiary hospitals of kanchipuram district. The sample of the study well COPD (who are fulfilled the inclusion criteria between the age group of 25yrs - 55yrs) the purposive sampling technique 56 samples are experimental group and 56 are considered control group. the data collection instrument was the structured interview to assess the knowledge on pulmonary rehabilitation the results revealed that in the post test of the experimental group, the overall mean 39.46 with SD: 0.738 in control group the overall mean 17.52 with SD 3.722 the impaired T-test value was t=37.808 experimental group the T=3.810 control group its depicts the + there is significant difference between the experimental and control group so that the computer based education is effective the past test of dyspnea scale in experimental group over all mean 0.58 with SD: 0.499 in control group over all mean 1.63 with SD:1.396. the impaired T test value was t=14.402 experimental group. The T=1.264 control group based education programme effective. The past test of cat scale in experimental group mean 9.21 SD=2.213, control group cat scale mean 25.88 SD=5.596 increased control group effective. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQL) is an important outcome for chronic diseases such as diabetes mellitus that is associated with complications, comorbidities, and lifelong care. Objectives: The present study aims to explore the impact of comorbidities on the different dimensions of HRQL among type 2 diabetic patients attending primary care. Methods: A total of 912 type 2 diabetic patients attending primary care centers in India were assessed using a predesigned and pretested questionnaire – Diabetes Comorbidity Evaluation Tool in Primary Care. The HRQL was measured by physical and mental health summary scores [physical component summary (PCS) and mental component summary (MCS)] of the Short Form Health Survey 12. The associations of sociodemographic variables and clinical variables with PCS and MCS were assessed, and a minimal difference of 5 in the scores (on a scale of 0–100) was kept as clinically relevant difference for this study. Mean differences in mental (MCS) and physical (PCS) scores of quality of life by number and type of comorbid conditions in type 2 diabetic patients were calculated. Result: The presence of comorbid conditions was associated with lower scores of PCS and MCS (P < 0.001). Significant reduction in HRQL was found with increase in number of comorbid conditions, and negative association was established between the number of comorbidities and the PCS (r = −0.25, P < 0.0001) and MCS scores (r = −0.21, P < 0.0001). Among comorbidities, acid peptic disease, chronic lung disease, visual impairment, depression, and stroke had significantly and clinically relevant reduced scores. Duration of diabetes, use of insulin, and obesity were also associated with poor HRQL. Conclusion: Comorbidities considerably impair the HRQL among type 2 diabetic patients. National programs designed for diabetes management should also take into account the challenges of coexisting chronic conditions and its substantial effect on HRQL. [ABSTRACT FROM AUTHOR]