Department Of Pulmonary Medicine Research Articles

Pulmonary Function Tests in Patients with Chronic Rhinosinusitis : A Comparative Study

Coexistence of upper and lower respiratory diseases has long been known. Since chronic rhinosinusitis and pulmonary diseases are closely related this study was made to observe the pulmonary function of patients with chronic rhinosinusitis. Methods: The study was conducted in the Department of ENT and Pulmonary Medicine, IGMC Shimla on 27 adult patients of chronic rhinosinusitis and 26 age matched healthy control subjects between November 2018 and November 2019. The pulmonary function tests were performed using a spirometry and included Vital Capacity (VC) , Forced vital capacity (FVC) , Forced expiratory volume in one second (FEV1) and Forced expiratory volume in one second by Forced vital capacity ratio (FEV1/FVC). Results: Following observations were made from the results of the study, among controls majority of the subjects i.e 23 (92%) had a normal PFT with only 1 patient (4%) had mild and another 1 patient (4%) had moderate restriction on PFT. Where as among the patients group 10 patients (37%) had a normal pre-operative baseline PFT. Another 10 (37%) and 7 patients (25.9%) had mild and moderate obstruction respectively.

Psychosocial Impact of Pandemic and State Imposed Lockdown on Caregivers of Patients Presenting with Respiratory Complaints Mimicking COVID-19: A Short-term Follow-up Study

Introduction: Pandemics and subsequent lockdowns affect mental health of different subgroups of populations. In Coronavirus Disease-2019 (COVID-19), caregivers of those patients who have respiratory complaints is one such subgroup which is more vulnerable to disturbances in mental health, because of the fear that their patient’s respiratory symptoms could be because of COVID-19. Aim: To assess the psychosocial impact of COVID-19 and subsequent state imposed lockdown on the caregivers of patients presenting with respiratory complaints and also to evaluate the effect of relaxation of lockdown after following-up them over a period of time. Materials and Methods: This prospective observational study was conducted in the Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India (tertiary care institute), from April 2020 to June 2020. Baseline assessment was done using socio-demographic performa, lockdown related questionnaire {3 domains, summed as total score (Lockdown)}, COVID-19 related questionnaire {Total score (COVID-19)} and General Health Questionnaire-12-Hindi version (GHQ-12). Reassessment was done twice i.e., at 11-15 days and 41-45 days after relaxation of lockdown. Quality Of Life (QOL) at first and second follow-up versus pre-lockdown times (score A and C) and first follow-up versus un-lockdown (score B) was also noted. Analysis was conducted using Statistical Package for Social Sciences (IBM, SPSS)version 22.0. Results: Mean age of the participants was 40.2±11.812 years with maximum caregivers 25 (41.7%) aged between 31- 40 years. Majority (83.3%) were men. Psychological distress was experienced in 50% of caregivers at baseline and 23.7% caregivers at first follow-up (p-value=0.001). Worry for COVID19 (p-value=0.035), Domain 1 scores (p-value <0.001), Domain 2 scores (p-value=0.003), Domain 3 scores (p-value=0.001), and Total score Lockdown (p-value <0.001) decreased significantly at first follow-up. Mean C score was significantly better than mean A score (p-value <0.001). Baseline psychological distress was significantly more in those with worry for COVID-19 (p-value=0.018), poorer scores of domains 1 (p-value=0.005), domains 2 (p-value <0.001), domains 3 (p-value <0.001), total score (Lockdown) (p-value <0.001) and total score (COVID-19) (p-value=0.010). Follow-up psychological distress was more in those with “worry for COVID-19” (p-value <0.001), negative thoughts (p-value=0.001), poorer follow-up scores of three domains, total score (Lockdown), mean A, B and C scores (p-value <0.001). Conclusion: Caregivers experienced extreme levels of psychological distress, which decreased, but persisted even after relaxation in lockdown.

Lipid Abnormalities in Tuberculosis Patients with Diabetes Mellitus: A Hospital-based Cross-sectional Study

Introduction: Tuberculosis (TB) is a chronic infectious disease that also causes lipid abnormalities. Limited studies are focusing on metabolic abnormalities in TB patients with Diabetes Mellitus (DM). While studying lipid abnormalities in pulmonary TB patients, there were no marked differences between serum levels of cholesterol, triglycerides, Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL). However, it was suggested that increased levels of lipoprotein (a) in patients with pulmonary TB may be a risk for atherosclerosis. Aim: To study the lipid abnormalities in TB patients with DM. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary Medicine at a tertiary care teaching institute {PES Institute of Medical Sciences and Research (PESIMSR} Andhra Pradesh, India, between October 2015 to March 2016 (six months). Four groups were made, Group I included 30 patients with TB and no DM, Group II included 25 patients with TB with DM, Group III had 30 patients with DM only and Group IV was control group with 30 healthy individuals. Lipid profile testing was done for all the participants and the values obtained were compared. Analysis of Variance (ANOVA) test was used to compare the means between the groups and Kruskal-Wallis test when data did not follow the normal distribution. The p-value <0.05 was considered statistically significant. Results: Total 25 patients in group II had 18 male and 7 female with mean age of 48.5±11.12 years. The total cholesterol, triglycerides, Very Low Density Lipoprotein (VLDL) was high in group III (176.33±43.35 mg/dL, 221.733±39.2 mg/dL, 34.8±17.81 mg/dL respectively). The HDL was lowest in group II (27.88±8.03 mg/dL). However, the LDL values showed no significant difference between the groups (p-value=0.162). group I had Low Body Mass Index (BMI) (18.61±3.6 kg/ m2). The atherogenic index was high in group II especially in males. Conclusion: In patients with TB and DM, screening of lipid profile can provide markers of atherogenicity which may help to predict and prevent cardiovascular events. A good nutritious diet is recommended alongside chemotherapeutics in the treatment for TB patient's management and their lipid profile status should be monitored while managing the patients.

Therapeutic efficacy of oscillating positive expiratory pressure therapy in stable chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and the lung to noxious particles or gases. Sputum production is a cardinal feature in COPD. Airway clearance techniques have been the mainstay of management. Oscillating positive expiratory pressure (OPEP) devices are handheld devices that provide a combination of positive expiratory pressure (PEP) with high frequency oscillations which involve exhaling against a resistance that is fluctuating. It encourages airflow within secretions, whereas oscillations induce vibrations within airway wall to displace secretions into airway lumen and help in expectoration. A randomized control trial was conducted at the department of pulmonary medicine, Government Medical College & Hospital, Chandigarh, in which 50 patients with stable COPD were enrolled for one- and- half years. After taking proper history, they were subjected to spirometry, six- minute walk test, and were asked to fill the St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT). These patients were randomized into group A (intervention group) and group B (control group), where group A was prescribed Aerobika OPEP device for daily use for a period of three months. After three months of use of device, the patients were again subjected to assessment parameters and inquired about any exacerbation within the three- month period. At the end of three months were compared with baseline results. The median change in FEV1, FVC, 6MWD from baseline in group A was significantly more as compared to group B (FEV1: P < 0.001; FVC: P < 0.001; 6MWD: P = 0.08), whereas SGRQ score showed a significant improvement in both the intervention and control groups (P < 0.001) and CAT score showed significant improvement in comparison to the control group (P < 0.001). The median change in 6MWD and CAT from baseline in group A was significantly more as compared to group B (SGRQ: P < 0.001; CAT: P < 0.001), whereas it was not significant in case of SGRQ (P = 0.233). There was no significant difference in the incidence of exacerbation in the two groups (P = 0.19). The device did not help in controlling the rate of exacerbation in the present study at three months. Stable COPD patients who were given OPEP therapy as an adjunct to the standard drug therapy showed improvement in the spirometry parameters, exercise capacity and symptom burden in comparison to the drug only group.

A Longitudinal Study Evaluating Indications, Section Efficacy and Complications of Bronchial Artery Embolisation

Introduction: Embolisation is defined as the therapeutic introduction of Gelfoam or Poly-Vinyl Alcohol (PVA) particles into the circulation to occlude vessels. Selective embolisation of the bronchial arteries feeding the affected areas could be more effective than surgical intervention which is more hazardous leading to prolong Intensive Care Unit (ICU) stay, air leaks, stump infection. Aim: To study various indications, success rate, complications, and recurrence after Bronchial Artery Embolisation (BAE). Materials and Methods: The present longitudinal study was conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was done on 50 patients admitted in view of moderate to massive haemoptysis. Common indications requiring BAE, success rate with gelfoam or PVA particles, and common complications of the procedure were studied. Mean age of presentation with haemoptysis, co-morbidities associated with the disease were also studied. The patients were followed-up for six months. Repeat BAE was done in patients with PVA particles before referring for surgical intervention in cases with recurrent haemoptysis. Results: The mean age of patients requiring BAE was 37.98 years, with male predominance. Most common indication was pulmonary tuberculosis followed by post-tuberculosis sequelae. The overall success rate of the procedure was 88% at six months follow-up.BAE done with PVA (10/10) particle showed a better outcome as compared to gelfoam (34/40). The most common complication related to the procedure was puncture site pain. Three patients out of six with recurrent haemoptysis required repeat BAE within three months, out of which only one required surgery. Conclusion: The most common indication for BAE in this study was pulmonary tuberculosis. There were no major complications, even with repeat BAE. Hence, BAE should be the procedure of choice for moderate to massive haemoptysis despite of previous history of BAE, before considering for surgical intervention. BAE with PVA is associated with better success rate.

Radiological Patterns In Interstitial Lung Disease(ILD) And Changes In Six Minute Walk Test(6MWT)

IMPORTANCE Interstitial lung diseases comprise diffuse parenchymal diseases of varying radiological patterns and aetiology. They have varying rates of functional progression. Idiopathic pulmonary fibrosis with the Usual interstitial pneumonitis pattern is known to progress in worsening exercise capacity, spirometry and radiology. But ILDs with other radiological patterns like NSIP may also progress in function and radiology. The six-minute walk test is a good indicator of functional exercise capacity. The study assessed the longitudinal changes in the six-minute walk test in different radiological patterns. OBJECTIVES Primary objective: To assess the radiological pattern and progression of dyspnoea and six-minute walk test over a six-month interval in ILD patients in a tertiary care centre STUDY SETTING: An Observational longitudinal study in the department of Pulmonary Medicine in Kerala, south India, for one year METHODOLOGY Patients diagnosed with ILD within the study period by a multidisciplinary team comprised of pulmonologists and radiologists with more than 20 years of clinical experience based on clinical examination, PFT, and HRCT. A multidisciplinary team assessed radiological patterns. Appropriate investigations were done to identify any underlying auto-immune or connective tissue disorders. The histopathological correlation was obtained wherever possible, and a final diagnosis was obtained. Lung function was assessed by spirometry. The dyspnoea scale was assessed according to the MMRC scale, and a six-minute walk distance was determined. The patients were followed up regularly while on treatment, and the dyspnoea scale and 6MWT were repeated after six months. The association of different radiological patterns and the changes in various parameters in 6MWT was determined. RESULTS CTD ILD was the commonest, followed by hypersensitivity pneumonitis and IPF. Longitudinal worsening of the MMRC scale did not have a significant association with any radiologic pattern. The final saturation after 6MWT and 6MWD worsening &gt;25 m in the follow-up test had an association with a UIP pattern on radiology and a diagnosis of IPF. No worsening of 6MWD was observed in COP AND HSP. CONCLUSION A serial six-minute walk test is a good monitoring test to assess exercise capacity for UIP, HSP and OP patterns. The parameters 6MWD and final saturation in 6MWT show predictive associations with radiology.

Incidental Extrapulmonary Findings in Low-Dose CT of the Thorax

Purpose: The aim of the study is to evaluate the prevalence of extrapulmonary findings in low-dose computed tomography (LDCT) of the thorax. Methods: Patients who were referred to the radiology department by the department of pulmonary medicine between June 2016 and January 2018 for LDCT examination to assess either a certain or a potential pulmonary disease were identified. Images were retrospectively re-evaluated and findings were categorized according to organ system (Total of 8 groups including cardiac, vascular, mediastinal, abdominal, skeletal, thyroidal, breast and muscular-soft tissue). The LDCT was performed by using a 64-detector CT scanner with scanning parameters standardized as 120 kVp and 20 mAs with 3 mm slice thickness. Results: 102 patients (41 female, 61 male) aged between 25 and 90 years (mean age: 54.5±14.3 years) were included in the final assessment. 87 (85.3%) out of 102 patients had total 245 incidental extrapulmonary findings. Abdominal pathologies were the most common findings (62 patients (60.8%)). Overall, 26 extrapulmonary findings led to further work-up or consultation. Conclusion: Incidental extrapulmonary findings can be detected commonly in LDCT of the thorax. Radiologists should be aware of evaluating all the structures in the scanning area by following a systematic approach in the reading of such studies in order to identify possible pathologies and guide the clinician for the accurate management of patients.

Diagnostic Yield of Closed Pleural Biopsy Using Cope’s Needle in the Diagnosis of Exudative Pleural Effusion

Introduction: The aetiology of pleural effusion may be difficult to diagnose based on the pleural fluid cytology, biochemical and microbiological study. Pleural biopsy using Cope’s needle may help in such cases where definitive diagnosis can not be achieved with the help of cytology. Aim: To make aetiological diagnosis of undiagnosed exudative cases using Closed Pleural Biopsy (CPB) and to determine the diagnostic yield of CPB taken by Cope’s needle in aetiologically confirmed exudative pleural effusion. Materials and Methods: This prospective observation study was conducted in Department of Pulmonary Medicine at Burdwan Medical College and Hospital, Burdwan, West Bengal, India, from April 2021 to March 2022 among 52 patients. Under local anaesthesia, diagnostic and therapeutic thoracocentesis were done. The pleural fluid was sent for complete biochemical, microbiological analysis, and cytology. Later, pleural biopsy was also done using Cope’s pleural biopsy needle. The variables studied were age, gender, pleural fluid cytology, pleural fluid for acid fast bacilli, Gram stain, and culture and pleural biopsy histopathology. Results: Out of 52 patients, 34 (65.4%) were males and 18 (34.6%) were females. The majority of the patients (41, 78.8%) had a right-sided pleural effusion. The mean value of lymphocytes and polymorphs count was 57.7% and 32.7%, respectively. Histopathology showed granulomatous inflammation compatible with tuberculosis in 18 (34.6%) patients, non-specific inflammation in 17 patients (32.7%), and 5 (9.6%) patients as adenocarcinoma. Squamous cell carcinoma was seen in 4 (7.7%), 2 (3.8%) showed undifferentiated carcinoma, while 6 (11.5%) samples had inadequate tissue for opinion. In 6 (11.5%) cases pleural tissue was inadequate to give any opinion. 5 (9.6%) cases showed adenocarcinomas, 2 (3.8%) cases showed squamous cell carcinoma and 4 (7.7%) cases showed undifferentiated carcinoma. The true positives were 18 and 11 for tuberculous and malignant pleural effusion, respectively. The diagnostic yield of pleural biopsy was found to be 75% in case of tubercular pleural effusion and 78.6% for malignant pleural effusion. Conclusion: This study suggests that tuberculosis and malignancy are the two common aetiologies for exudative pleural effusion. Pleural biopsy plays an additional role in histopathological confirmation of aetiologically diagnosed exudative pleural effusion.

The safety and tolerability of pirfenidone in Indian patients with idiopathic pulmonary fibrosis

Background: Idiopathic pulmonary fibrosis (IPF) is a form of progressive fibrosing interstitial lung disease with a poor prognosis. Pirfenidone is an oral antifibrotic agent used in the treatment of IPF, and it reduces the rate of decline of lung function. However, the tolerable dose and adverse effect profile appear to be different in the Indian population. Methodology: This prospective observational study was conducted in the Department of Pulmonary Medicine at a tertiary care center in India between January 2015 and June 2016. All adult patients diagnosed as IPF based on multidisciplinary discussion were enrolled. Subjects with active respiratory tract infection, other end-organ failures, and drugs interacting with Pirfenidone were excluded. Data collection was done with a predesigned questionnaire at baseline. Subsequently, they were followed up telephonically every week and in-person review at 3 and 6 months. Results: The cohort has 30 patients with a mean age of 60 years ± 4.5 (standard deviation 8.9). 80% did not tolerate the recommended total dose (40 mg/kg/day or 2400 mg/kg) and the median tolerated dose was 1800 mg/day (25–30 mg/kg). 75% reported adverse events, the most common being anorexia, and gastroesophageal reflux disease in gastrointestinal (GI) reaction, followed by a rash in dermatological reactions. All these adverse effects were mild to moderate and managed with supportive care or dose reduction. None of them were severe, causing cessation of therapy. Conclusion: Pirfenidone has a lower tolerable dose and predominantly GI adverse effects in our population, and if addressed early, it can prevent cessation of treatment and better quality of life for patients.

Assessment of pleural effusion quantity, assistance for quality, and management by clinical examination, sonography, and laboratory parameters in a super specialty hospital

Introduction: This study is the easiest and fastest; patient and observer comfort level increase with the convenience of evaluation of pleural effusion (PE) qualification, and assessment of quality and guidance for management is taken into consideration. Four plus one formula are taken for the existing literature, and the patient imaging evaluation and all the four plus one measurement are taken and calculated and kept for comparison. Later, the patient has aspirated patient PE catheter drainage done and calculated with the above four plus one measurement, and statistical analysis correlation is done. Aim: The aim of this study was to find the quantity, quality, and nature of PE in planning the management. Objectives: Primary objective - study to assess the nature of PE by clinical, sonography laboratory results. Secondary objective - To decide the mode of management and follow-up by diagnostic, therapeutic, closed pleural biopsy, pleuroscopy, video-assisted thoracoscopic surgery, and surgical decortication. Need of the Study: Because of the shape of pleural space and its anatomy, the PE volume variability in the estimation of actual quantity is complex subjectively even for an experienced clinician estimation or by computed tomography scan and sonography. Hence, instead of many available complicated clinical estimation and imaging formulae, the sonography formulae showed a wide spectrum of values in measuring the actual PE amount. This observational study was performed utilizing and comparing the available references and formulae. Sonography is modified to give the best comfort to patients and the most accessible and fastest sonographic t estimation and comparison with other groups of studies and to arrive at a consensus value for the purpose of our institutional uniformity. Study Site: Department of Radiology and Imaging Sciences and Department of Pulmonary Medicine, Apollo Hospitals, Chennai-06. Study Design: This was an observational, cross-sectional study. Study Duration: The duration of the study was March 2020–September 2021. Inclusion Criteria: patients with clinical suspicion of PE are taken up for study. Exclusion Criteria: patients with noncooperation and restless severe hydropneumothorax. The total number of patients is 181, both male and female, Equipment: High-end EPIQ-7G, PHILIPS ULTRASOUND machine with advanced feature and with broadband convex C5-1 transducer used, and all parameters are recorded systematically. If the fluid is beyond the image frame, we utilized a panoramic software view for any length of fluid, heightens the advantage in the study. Results: Balick et al. and our single measurement study were correlated, and we found in this study stresses on any axis, longest single measurement and position of the patient made easier for the estimation utilizing, highest hand equipment, having panoramic view software. Conclusion: Single-free longest axis measurement in this study is useful with the standard deviation of the single-fixed axis of measurements of other studies.

25-Hydroxy Vitamin D and Calcium Levels Section in Patients of Drug Resistant Tuberculosis: A Retrospective Study from a Tertiary Care Institute of Eastern India

Introduction: Drug Resistant Tuberculosis (DR-TB) is a rapidly escalating problem. Vitamin D and calcium serum levels can be an important determinant of Multidrug-Resistant Tuberculosis (MDR-TB) infection, progression to disease.The link between the serum level of 25-hydroxy vitamin-D {25(OH) D and MDR-TB is an emerging area for conducting evidencebased research. Aim: To assess the serum 25(OH)D and calcium levels and its deficiency in all the patients with drug resistant tuberculosis. Materials and Methods: This retrospective, observational study was conducted in the Department of Pulmonary Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, from October 2019 to October 2020, in the newly detected 100 patients experiencing DR-TB. Patients sputum/body fluid samples were subjected for GeneXpert/Line Probe Assay (LPA) examinations to confirm resistance to anti-tubercular drugs. The frequency and prevalence of mean serum vitamin D and mean serum calcium levels were recorded based on age and gender. DR-TB categorised into H-Mono resistance, MDR-TB, Pre-Extensively Drug Resistant (Pre-XDR) and XDR-PTB, based on GeneXpert and LPA of sputum/body fluid. Descriptive statistics were used to determine the characteristics of all the patients. All the statistical analysis was done using the STATA software. Results: Mean age of study population was 31.12±15.49 years. Among them 63 were males and 37 were females. The mean serum vitamin D level of 10.87±8.49 ng/mL (deficient) and serum calcium level of 8.62±0.82 mg/dL (normal) was reported. Mean serum vitamin D levels were deficient in all the four types of DR-TB (p-value=0.04), while changes in mean serum calcium level was non significant (p-value=0.15). Conclusion: All patients with DR-TB have significant propensity to vitamin D deficiency. While changes in mean serum calcium level was non significant.

Utility of Serum Markers in Obstructive Sleep Apnoea Syndrome: A Case-control Study

Introduction: Obstructive Sleep Apnoea Syndrome (OSAS) consists of cessation of breathing for at least 10 seconds during sleep in spite of inspiratory efforts. The OSAS is an independent risk factor for a number of cardiovascular diseases and cerebrovascular events. The OSAS is diagnosed and assessed by polysomnography which is time consuming and expensive. C-Reactive Protein (CRP) and Creatine Phosphokinase (CPK) are markers of systemic inflammation. Inflammatory component is present in OSA. Biomarkers like CRP and CPK may serve as diagnostic tools which are simpler, cheaper and quicker alternatives. Aim: To study the role of serum markers CRP and CPK in the diagnosis of sleep disordered breathing. Materials and Methods: This was a case-control study, conducted from May 2021 to October 2021, in the Department of Pulmonary Medicine, NRI Medical College, Guntur, Andhra Pradesh, India. Total 50 patients were studied for their various symptoms suggestive of OSAS and confirmed by polysomnography were selected for the study. Total 40 age and weight matched controls were included in the study. The association of serum CRP and CPK with OSA was assessed. The Z-test of difference between two proportions was used to compare gender and smoking status of study participants of the two groups. The p-value &lt;0.05 was reported as statistically significant. Results: The mean CRP in those suffering from obstructive sleep apnoea was 12.075±7 mg/dL with 13.89 in moderate to severe OSAS group and 10.26 in mild cases. The CRP showed statistically significant association (p-value=0.00344) with OSA whereas CPK levels in OSA subjects showed no statistically significant association with OSAS. Sensitivity of CRP and CPK compared to the Apnoea Hypopnea Index (AHI) in the diagnosis of OSAS was 66% and 34%, respectively. Specificity of CRP and CPK was 87.5% for both. Positive predictive value for CRP and CPK was 86.8% and 77.2%, respectively. Conclusion: C-reactive protein, a systemic inflammatory marker has a potential role in the diagnosis of OSAS.

Correlation Between Degree of Desaturation and Severity of Obstructive Sleep Apnoea: A Cross-sectional Study

Introduction: Obstructive Sleep Apnoea (OSA) is major Non Communicable Disease (NCD) which is becoming very common worldwide. The OSA results in day time hypersomnolence, nocturnal hypoxia and snoring. Repeated desaturation events during sleep results in aerobic metabolism at tissue level changing to anaerobic metabolism, which results in cellular inflammation and insulin resistance further complicating metabolic syndrome. Aim: To study correlation between degree of desaturation and severity of obstructive sleep apnoea. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary medicine at KS Hegde Medical Academy (tertiary care hospital), Mangaluru, Karnataka, India, from March 2018 to February 2021. Total 54 patients who underwent overnight polysomnography and diagnosed to have OSA were included in the study. The minimum recorded oxygen saturation (SpO2 ) defined as maximum desaturation was noted. Relative desaturation was defined as drop in saturation by 3% or more from the pre-event baseline. Correlation between total number of relative desaturation and Apnoea Hypopnea Index (AHI) was analysed. The correlation between two variables were analysed by Pearson’s correlation and the coefficient was calculated. The p-value was calculated by regression analysis and Analysis of Variance (ANOVA). Results: Total of 54 patients was included in the study. Out of which, 22 were mild, 14 moderate and 18 severe OSA respectively. Number of relative desaturations recorded was from 0 to 636. The correlation between AHI and mean SpO2 in sleep was r-value=-0.4542 (p-value=0.001) and the correlation between AHI and minimum SpO2 was r-value=-0.45577 (p-value=0.001) respectively. Correlation between mean SpO2 and minimum SpO2 was r-value=0.747266 (p-value&lt;0.001) and the correlation between AHI and relative desaturation was r-value=0.876698 (p-value=0.001). Conclusion: As the severity of the obstructive sleep apnoea worsened, there was greater degree of desaturation in sleep and the lowest SpO2 was also observed during severe obstructive sleep apnoea.

Pathological Features of Lung in COVID-19 Disease Subjects: A Postmortem Study

Introduction: The current Coronavirus Disease-19 (COVID-19) pandemic is considered as one of the most serious public health crises which caused more than 1.62 million deaths from October 2020 to November 2020. Acute respiratory failure is leading cause of death followed by sepsis, cardiac failure and hemorrhage. Since the pathological findings are diverse in COVID-19 and majority of studies in literature were by open autopsy; the present study was done using percutaneous core needle biopsy. Postmortem lung biopsies are rather easy and quick to perform and decrease the infective risk caused by full autopsies. This could be an essential tool for diagnosis, surveillance and research. Aim: To study the pathological features of lung in COVID-19 deceased patients by postmortem. Materials and Methods: This cross-sectional study was conducted in the Department of Pulmonary Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India from October 2020 to November 2020. In present study, postmortem percutaneous core needle biopsies from lung were performed within two hours of death from eight deceased patients who died of COVID-19. Clinical history, inflammatory markers and treatment details were collected from case sheets, biopsy was done, specimen was collected and sent for pathological examination. Data was presented in the descriptive form for each variable. Results: Out of eight cases, five were men and three were women with a mean age of 54.12 years. Majority of patients presented with complaints of shortness of breath and fever. Hypertension, type 2 diabetes mellitus, obesity, hypothyroidism, history of pulmonary tuberculosis were the co-morbidities noticed. Four biopsies presented acute lung injury with hyaline membrane changes, Diffuse Alveolar Damage (DAD) with hyaline membrane was seen in two cases, squamous metaplasia was seen in two cases and acute lung injury with organising pneumonia was seen in two cases. Conclusion: Postmortem lung biopsies are safe, easy to perform and provide insights of possible undergoing pathology of the disease with regard to clinical presentation.

Perceptions and Experience of Medical Students Regarding E-learning during COVID-19 Lockdown- A Cross-sectional Study

Introduction: Medical education has been adversely affected during COVID-19 pandemic. Imparting medical education through e-platforms exclusively was a novel experience both for students and teachers. Even though online classes have been ongoing since almost a year and half, not much data on perception and experience about e-learning among medical students is available from India. Aim: To evaluate perceptions, experiences and challenges faced by medical students regarding e-learning during lockdown period owing to COVID-19 along with their future preferences. Materials and Methods: The present study was a questionnaire based cross-sectional survey regarding use of e-learning during COVID-19 pandemic among 340 MBBS (Bachelor of Medicine and Bachelor of Surgery) and Bachelor of Science Nursing (BSc-NUR) students. Study was conducted in the Department of Pulmonary Medicine at Shri Lal Bahadur Shastri Medical College and Hospital Mandi, Himachal Pradesh, India from May-July 2021. Students perceptions’ of e-learning were assessed using the validated Technology Acceptance Model (TAM) model and responses were measured on 5-point Likert scale. Quantitative data was expressed by mean and standard deviation and significant level of differences between means were tested by Student’s t-test (unpaired). Proportions were compared by Chi-square test or Fisher’s-exact test. Results: Out of 400 students, 340 responded of which 225 were females. Of the total 340 students, 97.9% (n=333) respondents, had an idea of e-learning and more than half (n=188; 55.3%) had used any type of e-learning platform prior to onset of COVID-19. More number of MBBS students had used e-learning than BScNUR students (55% v/s 41%; p=0.033). Cell phone was the most common device (n=324; 95.3%) used. The quick sharing of material (n=258; 76%) and flexibility (n=233; 68.5%) were top rated benefits of e-learning. The key disadvantages were suboptimal practical training (n=222; 65.3%) and lack of face-to-face interactions (n=146; 43%). Majority of students voted for traditional learning (n=156; 45.9%) closely followed by blended learning (n=140; 41.2%). Conclusion: The students had an overall positive attitude towards e-learning and wanted to continue e-learning alongside traditional teaching i.e., blended learning. Exploration of merits and barriers to e-learning during pandemic can act as a guide to implement blended learning in medical curriculum for enhanced teaching/learning experience.

Adverse drug reactions reporting: Five years analysis from a teaching hospital.

Adverse drug reactions (ADRs) are important cause of morbidity and mortality. Despite its known importance, rate and quality (completeness score) of ADR reporting is not satisfactory. The objective of this study was to analyze pattern and completeness score of ADRs during past five-years. In this retrospective study, ADRs reported between 2017 to 2021 were analyzed according to year, gender, age-group, pharmacological class and department. The completeness score of ADRs was calculated. The number of sensitization programs conducted over 5 years and its impact on the completeness score was also evaluated. A total of 104 ADRs were reported among 61 (58.6%) female and 43 (41.4%) male patients. Adults (18-65 years) comprised the most affected age group, accounting for 82 (79%) patients. Out of all, 35.5% ADRs were reported in 2018, whereas 27% were reported during 2021. Except during 2017, percentage of females with ADRs was more. Department of pulmonary medicine and dermatology contributed to maximum extent in ADR reporting. Antibiotics [23 (22.11%)], antitubercular drugs (AKT) [21 (20.19%)], and vaccines [13 (12.4%)] represented the most common agents with which ADRs were reported. ADR reporting was very low in 2017 (4/104). Percentage improvement in completeness score in 2021 vs. 2018 was 11.95% (P < 0.05). Positive trend in the improvement of average completeness score with number of sensitization programs was observed. Incidence of ADRs was more common in females. AKT and antimicrobials are commonly implicated in ADRs. Increase in awareness of ADR reporting through sensitization programs can help to improve rate and quality of reporting.

SARS-CoV-2 Antibody Response in Patients with Co-morbidities in Kashmir’s Ethnic Population: An Observational Cohort Study

Introduction: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection risks in co-morbid patients are still unknown two years after the pandemic began. The prevalence of antibodies against SARS-CoV-2 infection is crucial for determining disease preventive and mitigation strategies. Obesity, type 2 diabetes, and chronic cardiovascular disease can raise the risk of Coronavirus Disease-2019 (COVID-19), which has a greater morbidity and fatality rate. Aim: To determine the seroprevalence of SARS-CoV-2 (COVID19) antibodies and their relationship to co-morbidities in Kashmir's ethnic population. Material and Methods: The present observational cohort study was done in the Department of Pulmonary Medicine at Chest Disease Hospital Srinagar, Jammu and Kashmir, India, from September 2020 to September 2021 and 1,846 co-morbid unvaccinated patients were chosen for the study. As per standard methodology, a cohort study was undertaken, a questionnaire was prepared, and demographic and associated parameters were recorded. All participants had their immune profiles tested, and the existence of Immunoglobulin G (IgG) antibodies for SARS-CoV-2 was determined using the chemiluminisence immunoassay technique. Chi-square and Fischer exact test were used for stastical analyses and p-value &lt;0.05 were taken as statistically significant. Results: As per the present study estimates, demographic and socio-economic characteristic affected test attendants. The SARS-CoV-2 IgG antibody response among co-morbid patients were found to be 54.3%. The hypertension and diabetes were most prevalent co-morbidity found in the individuals (p&lt;0.001). Conclusion: Co-morbidities including hypertension and diabetes in an individual are more likely have COVID-19 which can lead to death. COVID-appropriate conduct is required to limit infection transmission in the community, and immunisation is of paramount importance for all individuals. More research is needed to determine the risk of co-morbidities among Kashmir's ethnic community.

Post-COVID-19 pulmonary function tests in young health care workers in South Indian population – An observational study

Background: The risk of exposure to COVID-19 pandemic was substantially higher in frontline young health care workers. Due to repeated exposure while treating patients, the viral load is exponentially higher than the other population. Lungs being the earliest organ to be affected carry more risk of long-term morbidity. Thus, pulmonary function tests (PFTs) on post-COVID young health care workers provide a better view on the impact, recovery and residual effects. Aim and Objectives: The objectives of the study are as follows: (i) To assess the PFT in study group who have recovered from COVID-19 within the past 3 months; (ii) to compare their lung function with that of health care workers who have not been infected by COVID-19; and (iii) to determine obstructive, restrictive or mixed pulmonary changes if any in health care workers after 3 months of recovery. Materials and Methods: This study involving 50 young health care workers was done in the department of pulmonary medicine for a period of 4 months between January and April 2021. The study (mild COVID-19 positive) control group involved 25 participants each. PFT and diffusing capacity of lung for carbon monoxide (DLCO) were measured using computerized spirometer and single breath method. Results were analyzed using Shapiro–Wilk test, Independent sample t test, and Chi-square test. Results: A statistically significant difference was observed among the subjects of case and control group with respect to the level of FEV1 (P &lt; 0.05), FEV1/Forced vital capacity (FVC) (P &lt; 0.01), and FEF. FVC, Peak expiratory flow (PEF), forced expiratory time, DLCO, and peak inspiratory flow (PIF) were not statistically different between the study and control group. (P &gt; 0.05).The 3-month post recovery values were high in males when compared to females, except for PIF, PEF and FEV1%. Conclusion: PFT and DLCO values were normal in young health care workers after 3 months of COVID-19 infection except for a decrease in FEF 25–75%.

Demographic and Clinicoradiological Presentation of Tuberculosis in Patients with Sickle Cell Haemoglobinopathy: A Cross-sectional Study

Introduction: Infectious disease is an important contributor to disability and death in Sickle Cell Haemoglobinopathy (SCH). India has a high burden of Tuberculosis (TB) and SCH is widespread among residents in and around Burla, Odisha. This was the first attempt to find the prevalence of SCH in active cases of TB in Indian adults. Aim: To estimate the prevalence of SCH in TB and to evaluate the demographic and clinicoradiological presentation of TB in patients with SCH in a subset of Indian population. Materials and Methods: A cross-sectional study was done from October 2010 to September 2012 in Department of Pulmonary Medicine of V.S.S.M.C, Burla, Odisha, India. The primary inclusion criterion was patients with TB and SCH. Demographic characteristics, clinical, radiological, microbiological and histopathology data were collected. Statistical analysis was done using Statistical Package of the Social Sciences (SPSS) 18.0. Association between categorical data was calculated using Chi-square test and Fischer’s exact test. A p-value of &lt;0.05 was considered to be significant. Results: Out of 1243 TB patients who were screened, 64 TB patients had SCH. The mean age of the patients was 30 (±13) years with female predominance 33 (51.56%). The prevalence of SCH in TB was 51.49/1000, Sickle Cell Anaemia (SCA) was 13.68/1000 and Sickle Cell Trait (SCT) was 37.81/1000. 47 (73.43%) patients had SCT and 17 (26.56%) patients had SCA. Majority of patients with SCA 15 (88.23%) and SCT 35 (74.46%) belonged to the age of ≤40 years. 38 (59.37%) patients had Pulmonary TB (PTB) and 26 (40.62%) had Extrapulmonary TB (EPTB). EPTB 11 (64.70%) was common in patients with SCA than PTB 6 (35.29%) and vice-versa in SCT 15 (31.91% vs 32 (68.08%) (p=0.018). Among PTB patients, cough was the most common symptom seen in 7(10.93%) patients of SCA and in 26 (40.62%) patients of SCT. The mean (±SD) haemoglobin in patients with SCA was 7.270 (±2.007) gm% and SCT was 9.021 (±1.578) gm% (p=0.002). The most common chest radiographic finding was nodules in patients with SCA 9 (52.94%), reticular opacities and pleural effusion 11 (23.40%) each in SCT. Conclusion: In the present study, 5.14% of TB patients had SCH. PTB was more common than EPTB in patients with SCH.

Preparation for the challenge of heavily mutated Omicron variant.

Preparation for the challenge of heavily mutated Omicron variant.