Background: While methods like the 6-minute walk test, shuttle walk test, and cardiopulmonary exercise testing (CPET) are available to assess exercise limitation, they need a large space to perform/advanced lab settings which makes 1-minute sit-to-stand test (1STST) a feasible option in office practice. Data on test-retest reliability and the minimal detectable change (MDC) of 1STST is lacking in both national and international literature. Materials and methods: In this prospective observational study, our objective was to assess test-retest reliability and the MDC of the 1STST in patients with ILD and to determine the correlation of 1STST with the severity of interstitial lung disease (ILD) by spirometry and mGAP index. Results: A total of 65 ILD patients underwent 1STST during the study duration. The mean number of repetitions during the test retest 1STST and were 20 ± 6 and 21 ± 6 respectively (p = 0.029). The intraclass correlation coefficient (ICC) between a number of repetitions during 1STST and retest 1STST was 0.914 with SEM of 1.551 repetitions and a MDC of 4 repetitions. Statistically significant poor correlation was observed between test and retest 1STST repetitions with diffusion capacity of lung for carbon monoxide (DLCO) predicted z score (r = 0.428 and p = 0.006). modified gender age lung physiology index score (r = –0.195, p = 0.142), SpO₂ drop (r = –0.301; p = 0.013), BMI of patients (r = –0.287; p = 0.02), and baseline hemoglobin level (r = –0.095; p = 0.504) had a negative poor correlation with number of repetitions during 1STST. Conclusion: The 1-minute sit-to-stand test is a valuable tool for detecting exercise-induced desaturation in ILD patients, showing reliability and a MDC of approximately 4 repetitions.

Aim and background: Data on clinicians’ views and practice patterns regarding interstitial lung disease (ILD) management in India is currently lacking. The objective of this survey was to understand clinicians’ perspectives on the diagnosis and treatment of patients with ILDs. Materials and methods: This was a questionnaire-based survey conducted among clinicians attending continuing medical education programs on ILDs across India in February 2020. Data entry and statistical analysis were done for completed questionnaires and results are expressed in terms of percentages based on the number of responses obtained. Results: A total of 321 clinicians managing ILDs participated in this survey, of which 87.75% were pulmonologists. Chronic hypersensitivity pneumonitis was ranked as the most common ILD seen in clinical practice, followed by idiopathic pulmonary fibrosis (IPF), connective tissue-ILD, and sarcoidosis. In total 43% of respondents preferred a combination of clinical evaluation, high-resolution computed tomography, and serology for ILD diagnosis. In the case of a planned biopsy, transbronchial lung biopsy (50.17%) was most preferred for idiopathic interstitial pneumonia. For follow-up, spirometry (86.60%) and a 6-minute walk distance (78.19%) were the most commonly performed tests. Antifibrotics (63.42%) were the preferred treatment for IPF while steroids either alone or in combination with immunosuppressants were preferred for non-IPF ILDs. Only 50% of respondents opined that pirfenidone 1800 mg/day and above was tolerated by over 45% of their IPF patients. Conclusion: Management of ILD has improved significantly in India. Antifibrotic dosing remains suboptimal in IPF. In non-IPF ILDs, a significant number of clinicians now use alternative immunosuppressants to steroids.

Foreign body aspiration (FBA) is considered to be a consequential health concern in the childhood and adolescent phase associated with a considerable rate of morbidity and rarely mortality. Commonly two types of foreign bodies inhaled are organic and inorganic. A 20-year-old female student was referred to the Pulmonary Department for a chronic cough. High-resolution computed tomography (HRCT) chest showed localized bronchiectasis and mucus impaction in the right lower lobe. A bronchoscopy was planned and the patient continued the bronchodilator treatment. The patient expectorated one plastic tip of a pen with a bout of cough after one month of the treatment.

A 41-year-old female patient presented with a painful swelling in right breast for 6 months. Pus was aspirated and subjected to cartridge-based nucleic acid amplification test (CBNAAT) and line probe assay (LPA) which confirmed it as a case of multidrug-resistant tuberculosis. Isolates were resistant to rifampicin (R) and second-line injectables (SLI). The patient improved on bedaquiline (BDQ)-containing regimen.

Pulmonary nocardiosis (PN) is a rare disease caused by nocardia species. Earlier, commonly considered as an opportunistic infection, various case reports and case series of the disease have been reported in immunocompetent patients also, particularly among those with chronic lung diseases. Chronic obstructive pulmonary disease (COPD) is commonly found in association with PN. This disease has non-specific signs/symptoms and difficult bacteriological culture, making it difficult to diagnose and sometimes misdiagnosed as tuberculosis. We report a case of PNs in a 60-year-old female with COPD. Since the patient was never on systemic or inhaled steroid therapy and has no comorbidities causing immunosuppression, it supports that, COPD could represent an independent risk factor for PN.

Giant cell tumors (GCT) of bone also referred to as osteoclastoma or myeloid sarcoma are usually benign tumors but have the potential for local recurrence and metastasis. Giant cell tumors mostly involves the long bones with the proximal tibia and distal femur sites. Giant cell tumors of the spine presenting above the level of the sacrum is relatively less common. We report a patient with GCT arising from dorsal vertebrae and presenting as a huge mediastinal mass. A 25-year-old female presented with bilateral lower limb weakness, breathlessness, and difficulty in speaking. Chest X-ray showed bilateral upper lobe mass. On further evaluation with contrast-enhanced computed tomography (CECT) of the thorax a large well defined heterogeneously enhancing posterior mediastinal lesion with necrotic areas within and bony infiltration was noted. Sequential chest X-ray was suggestive of rapid progression within 15 days. Ultrasound-guided biopsy of mass lesion revealed features of giant cell tumor with immunohistochemical markers strongly positive for CD68, negative for S100, and β-HCG. The patient was subsequently started on denosumab given unresectable pulmonary metastasis.

The initiation of anti-tubercular treatment can trigger a pathological hyper-inflammatory response to viable or dead Mycobacterium tuberculosis, known as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS). Tuberculosis immune reconstitution inflammatory syndrome has been extensively studied in HIV patients and is very rare in non-HIV patients. However, it can occur following corticosteroid withdrawal, discontinuation of anti-TNF therapy, or recovery from neutropenia in non-HIV patients. In non-HIV TB patients, TB-IRIS is particularly rare. The most common manifestation of TB-IRIS in cases of TB lymphadenitis is the development of new lymphadenopathy or the enlargement of pre-existing lymph nodes. Here, we report cases of rifampicin-resistant tubercular lymphadenitis with IRIS presenting with pleural effusion, which completely resolved following steroid therapy.

Hoarseness is a commonly encountered symptom with several underlying causes ranging from idiopathic to potentially severe diseases. Cardio-vocal syndrome/Ortner syndrome (OS) is a rare entity that presents a challenge due to its tendency to evade detection over prolonged periods. Ortner syndrome, characterized by swallowing difficulty due to extrinsic compression of the esophagus by an atherosclerotic thoracic aorta, further adds to the complexity of the diagnosis. Here we report a case of OS and dysphagia aortica in a 62-year-old male with a history of chronic smoking and cardiovascular comorbidities. This case emphasizes the significance of considering cardiovascular etiologies in unilateral vocal cord paralysis (UVCP) evaluation.

Superior vena cava syndrome (SVCS) can be associated with benign as well as malignant causes, NSCLC being the most common malignant cause and is rarely associated with adenocarcinoma of the lung. Symptoms may range from dyspnea to respiratory failure requiring urgent intervention. Endovascular stenting, radiotherapy, and treatment of underlying cancer are required to relieve symptoms. Balloon dilatation of SVC is usually done for SVC secondary to benign disease. We report a case of adenocarcinoma of the lung presenting with SVCS, which responded well to SVC dilatation and chemotherapy.

Background: Obesity is an important risk factor for the development of obstructive sleep apnea (OSA). Although clinical and epidemiological studies have shown that OSA and obesity are strongly associated, few studies have examined the associations between anthropometric obesity indices and OSA, especially in the South Indian population. This study aimed to evaluate the influence of anthropometric obesity indices on OSA in an Indian population. Materials and Methods: Anthropometric indices, such as neck circumference (NC), waist circumference (WC), and body mass index (BMI), were assessed in 50 subjects with suspected OSA. Results: Of the 50 subjects assessed, 39 (78%) were diagnosed with OSA, and 11 (22%) had no OSA. Of these, 37 (74%) were males and 13 (26%) were females. Patients with OSA had a significantly higher age, BMI, WC, and NC than patients without OSA. The mean cut-off values of NC, WC, and BMI in males were 39, 93.8, and 29.8 respectively. The mean cut-off values of NC, WC, and BMI in females were 39.3, 96.5, and 30 respectively. Conclusion: Increased anthropometric indices were significantly associated with the presence and severity of OSA in the Indian population. This study also demonstrated the mean cut-off values for increased OSA risk for body mass index, waist circumference, and neck circumference. When the means of different variables are compared with three degrees of severity of OSA it was observed that BMI and NC had a significant difference while WC had no significant difference based on severity.