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Endobronchial ultrasound (EBUS)-guided mediastinal cryobiopsy is a new modality for sampling mediastinal lymph nodes. The data regarding the diagnostic yield and utility of mediastinal cryobiopsy is still limited. Consecutive patients who were undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) were recruited in this study. We subjected the enrolled patients to EBUS-guided mediastinal cryobiopsy after obtaining their informed consent. The final diagnosis was made with a clinical-pathological-radiological assessment and clinical-radiological follow-up. A total of 101 patients were enrolled in the study. Adequacy in sampling achieved in EBUS-TBNA was 92.07%, compared to 98.01% achieved in EBUS-TBNA with mediastinal cryobiopsy. Diagnostic yields achieved in EBUS-TBNA and EBUS-TBNA with mediastinal cryobiopsy were 67.32% and 86.13%, respectively (p=0.001). EBUS patterns failed to predict the utility of mediastinal crobiopsy. No significant complications were observed. To conclude, EBUS-guided mediastinal cryobiopsy improves yield in patients undergoing EBUS-TBNA.

Background: Pulmonary rehabilitation (PR) is a well-recognized intervention in the management of individuals with chronic obstructive pulmonary disease (COPD) that is designed to improve patients’ physical and psychosocial conditions. The primary aim of the study was to determine the effect of PR on ultrasonography (USG) assessment of diaphragmatic excursion. Materials and Methods: The current study is a prospective, interventional study in COPD (Group D) patients. All subjects underwent 8 weeks of supervised PR. The baseline assessment with USG diaphragmatic excursion, quadriceps femoris (QF) thickness, biceps brachii (BB) thickness, mid-thigh circumference, mid-arm circumference, modified Medical Research Council score, 6-min walk distance, COPD assessment test score, and after 8 weeks of supervised rehabilitation same parameters observed. Results: About 25.71% of the study population was in the age group range of 45–55 years, 51.43% between 56 and 65 years and 22.86% within 66–75 years of the age group. Out of 35 patients, 15 (42.86%) were females and the rest 20 (57.14%) were males. A significant increase was found in the diaphragmatic excursion (cm) from (P < 0.0001), mid-arm circumference (cm) (P < 0.0001), BB thickness (cm) (P < 0.0001) (upper limb strength and endurance training), and mid-thigh circumference (cm) (P < 0.0001) along with QF thickness (cm) (P < 0.0001) (lower limb strength and endurance training). Conclusion: An 8-week physical and PR program in COPD patients can lead to an improved USG diaphragmatic excursion.

Host-defense peptides (HDPs) such as human beta-defensin-2 (hBD-2) and cathelicidin (LL37) are essential components of innate immune response against tuberculosis (TB) infection, which could also be assessed for diagnostic potential in spectrum of TB infection. We assessed mRNA and circulating levels of HDPs in pulmonary TB (PTB) patients and their household contacts (HHCs). hBD-2 and LL37 were found to be significantly higher in both PTB and HHCs suggestive of bacterial exposure which was further corroborated by higher levels of HDPs in mantoux positive HHCs (latent TB). Higher levels of HDPs in HHCs may suggest protective host response against infection as indicated by inverse relation of LL37 with disease severity in PTB. Both peptides demonstrated high levels of sensitivity and specificity, although hBD-2 proved to be a better HDP for distinguishing LTBI from active TB at a cutoff of 3904 pg/ml. However, follow-up studies are required to validate these findings.

Endobronchial ultrasound (EBUS) guided mediastinal cryobiopsy, and intranodal forceps biopsy are newer modalities for sampling mediastinal lymph nodes. The data regarding the diagnostic yield of both modalities is scarce. Patients were recruited retrospectively from our existing database. Patients who had undergone both an EBUS guided mediastinal cryobiopsy and an intranodal forceps biopsy were enrolled in the study. The final diagnosis was made with a clinical-pathological-radiological assessment and clinico-radiological follow-up after one month. A total of 34 patients were enrolled in the study who had undergone both EBUS guided mediastinal cryobiopsy and intranodal forceps biopsy and had complete data available, including 1-month follow-up data. The sample adequacy rate of EBUS-transbronchial needle aspiration (EBUS-TBNA), EBUS-TBNA with mediastinal cryobiopsy, and EBUS-TBNA with intranodal forceps biopsy was 94.11%, 97.05%, and 94.11%, respectively (p=0.56). The diagnostic yield achieved in EBUS-TBNA, EBUS-TBNA with mediastinal cryobiopsy, and EBUS-TBNA with intranodal forceps biopsy was 73.52%, 82.35%, and 79.41%, respectively (p=0.38). No major complications were seen in any patient. To conclude, adding EBUS guided mediastinal cryobiopsy and intranodal forceps biopsy to EBUS-TBNA may not be superior to routine EBUS-TBNA.

There is no universally acceptable protocol for the withdrawal of non-invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients presenting with acute hypercapnic respiratory failure (AHcRF). This study was carried out to evaluate immediate against stepwise reduction in NIV. Sixty COPD patients with AHcRF who were managed with NIV were randomized into two groups - immediate NIV withdrawal (Group A), and stepwise reduction of NIV duration (Group B). The rate of successful NIV withdrawal, time to recurrence of hypercapnic respiratory failure, total duration of NIV use, and hospital length of stay (LOS), were compared among the 2 groups. NIV was successfully withdrawn in 51/60 (85%) patients. NIV was successfully withdrawn in 24/30 (80%) patients in Group A and 27/30 (90%) patients in Group B (p=0.472). The total duration of NIV use was significantly lower in Group A (38.97±17 hours) as compared to Group B (64.3±7.74 hours) (p

Double network sodium alginate/chitosan hydrogels were prepared using calcium chloride (CaCl2) and glutaraldehyde as the crosslinking agents by the ionotropic interaction method for controlled metronidazole release. The effect of polymer ratios and CaCl2 amount is investigated by the developing porosity, gel fraction, and extent of swelling in simulated physiological fluids. Interaction between the polymers with the formation of crosslinked structures, good stability, phase nature, and morphology of the hydrogels is revealed by Fourier-transform infrared spectroscopy, thermogravimetric analysis, X-ray diffraction, and scanning electron microscopy. A sodium alginate/chitosan hydrogel (weight ratio of 75:25) crosslinked with two percent CaCl2 is chosen for the in-situ loading of 200 mg of metronidazole. The drug release kinetics using different models show that the best-fit Korsmeyer-Peppas model suggests metronidazole release from the matrix follows diffusion and swelling-controlled time-dependent non-Fickian transport related to hydrogel erosion. This composition displays enhanced antimicrobial activity against Staphylococcus aureus and Escherichia coli.

The sequential use of non-invasive ventilation (NIV) for weaning in hypercapnic respiratory failure patients is a recommended practice. However, the effectiveness of weaning on High flow nasal cannula (HFNC) is unclear. Chronic obstructive pulmonary disease patients with hypercapnic respiratory failure who received invasive ventilation were screened for enrolment. This study was a single-centre, prospective, randomized comparative study. The primary outcome was treatment failure within 72 hours after extubation. Patients who were screened positive for extubation were enrolled in the study and randomized into the HFNC group and NIV group using a computer-generated simple randomization chart. The treatment failure was defined as a return to invasive mechanical ventilation, or a switch in respiratory support modality (i.e., changing from HFNC to NIV or from NIV to HFNC). Of 72 patients, 62 patients were included in the study. Treatment failure occurred in 8 patients (26.67 %) in HFNC group and 8 patients in NIV group (25%) (p=0.881). The mean duration of ICU stay in HFNC group was 5.47±2.26 days and 6.56±3.39 in NIV group (p=0.376). In the current study, HFNC was non-inferior to NIV in preventing post-extubation respiratory failure in COPD patients, while HFNC had better treatment tolerance.

Massive hemoptysis can lead to respiratory failure and life-threatening hypoxia in patients with underlying post-tubercular fibrocavitary disease. In the absence of urgent surgical interventions in a resource-poor country, interventional bronchoscopy and bronchial artery embolization (BAE) can be lifesaving in critical care management of such patients. We present a young male who required mechanical ventilation, emergency bronchoscopic intervention, and BAE, and showed recovery.

Abstract-Right hypochondrium pain with air-fluid level in chest X-ray can have a long list of differential diagnosis. A meticulous evaluation of history with appropriate investigations can help make the correct diagnosis.

Even nearly two years after the first reported case, the novel coronavirus (SARS-CoV-2) continues to ebb and flow around the world. A retrospective cohort study was carried out to determine the clinico-epidemiological profile and outcome of the cases. The study analyzed secondary data from 827 patients who presented to our center with COVID-19-related illnesses between December 15, 2021, and February 15, 2022 (third wave in India). There was a significant difference in the vaccination status of patients treated at home and those admitted, with 87.9% having received two doses compared to 74% in the second group being unvaccinated. Patients who were isolated at home recovered at a rate of 99.4%, while hospitalized patients died at a rate of 26.5%. Vaccination reduces the severity of COVID-19; however, constant vigilance for new variants, precautionary measures, and increased vaccination drives are critical moving forward. *Other members of the Safdarjung Hospital COVID-19 working group: B. Lal (Medicine), Harish Sachdeva (Anaesthesiology), Santvana Kohli (Anaesthesiology), Amandeep Jaswal (Anaesthesiology), Sumitra Bachani (Obstetrics and Gynecology), Ajay Kumar (Pediatrics), Rohit Kumar (Pulmonary Medicine), Vidya Sagar Chaturvedi (Surgery), Vinod Chaitanya (Medicine).

COVID-19 vaccination was initially started in India on 16th January 2021 after approval from national authorities. This study was carried out to assess the effect of vaccination status on the severity and clinical outcome among patients infected with COVID-19. The study included all adult COVID-19 patients admitted to our hospital from 1st April to 30th June 2021. A total of 819 patients were enrolled in the study out of which only 183 (22.3%) were vaccinated. The study documented a statistically significant reduction in the severity of illness among the vaccinated (single/double dose) (33% severe COVID-19) against the unvaccinated (43% severe COVID-19) groups; along with a reduction in mortality. On univariate and multivariate analysis, age, severity of illness and lack of COVID-19 vaccination status were associated with a statistically significant increased mortality. To conclude, this study demonstrates the role of vaccination in decreasing the severity and mortality of COVID-19 infection.

Tuberculosis is an uncommon cause of acute hypoxemic respiratory failure. We present a case of a middle-aged women with near-fatal respiratory failure due to underlying tuberculosis with favorable clinical recovery. Early diagnosis and treatment are imperative to prevent morbidity, mortality, and disease transmission.

The similarities and differences between the mortality patterns of the two waves in India remain largely unknown. This was a retrospective study of medical records conducted in the COVID data center of our hospital This study analyzed data of patients who died in the month of August, 2020 to October 2020 (one month before and after the peak of first wave i.e., 16th September, 2020) & April 2021 to June 2021 (one month before and after the peak of second wave i.e., 6th May, 2021), corresponding to an equal part of the pandemic during first (2020) and second (2021) wave. Out of 1893 patients in the study, 764 patients were admitted during the first wave and 1129 patients during the second wave of pandemic. In total, 420 patients died during the entire study period. Of those, 147 (35%) deaths occurred during the first wave and 273 (65%) during the second wave, reflecting a case fatality rate (CFR) of 19.2% during the first wave and a CFR of 24.18%. There were no significant differences in the Age Group, Gender, Presenting Complaints, Duration of Stay and Comorbidities. However, the deceased COVID-19 patients had an increase in Case Fatality Rate, average duration of symptoms from onset to Hospital Admission (DOSHA) and a major shift from MODS to ARDS being the Cause of Death during the second wave of Pandemic. This study demonstrates increased CFR, average DOSHA and a paradigm shift to ARDS as cause of mortality during the second peak of the Pandemic. It is necessary to remain vigilant of newer COVID-19 variants of concern, follow COVID-19 appropriate behaviors and keep emphasizing on care of high-risk groups including patients with comorbidities and elderly population to prevent mortality.

Dear Editor Long years of respiratory medicine practice lets one develop a clinical instinct which certainly aids in diagnostic acumen...

Present study describes the inhibition property of benzo 1,3-diazol 2-(4-{[4-Methyl-6-(1-methyl-1H-1,3-benzodiazol-2-yl)-2-propyl-1H-1,3-benzodiazol-1-yl] methyl} phenyl) benzoic acid (Telmisartan, Cresar-H) on mild steel corrosion in 1 M HCl using weight loss, electrochemical, and surface measurements. Results showed that the corrosion inhibition efficiency (η%) increases with increasing Telmisartan concentration and attained the maximum value of 97.39% at 125 mg L−1 concentration. Polarization studies revealed that Telmisartan acted as cathodic type inhibitor. Electrochemical impedance spectroscopy (EIS) studies suggested that the Telmisartan inhibits mild steel corrosion by becoming adsorbate at the metallic/electrolyte surfaces. Among the several tested isotherms, adsorption of the Telmisartan on mild steel surface obeyed the Temkin adsorption isotherm. The values of the apparent activation energy (Ea) suggested that Telmisartan inhibited metallic corrosion by creating energy barrier for corrosion process. The adsorption of corrosion inhibition was well supported by SEM/EDX and AFM studies. Keywords: Mild steel, Acid corrosion, Telmisartan, SEM/EDX/AFM, EIS/Bode/Tafel curves